FREE PAPER

A case control study on serum lipid parameters in Drug-naive Major Depressive Disorder Patients in comparison to normal subjects

BACKGROUND: There is evidence to suggest dysfunction in many biological functions in major depressive disorder (MDD). There is a possible link between variation of different lipid parameters and depression.

AIM: The aim was to compare variation of different lipid parameters in Drug-naive major depressive disorder patients in comparison to normal subjects.

MATERIALS AND METHODS: This case control study was conducted on outpatients in Department of Psychiatry, GMC Srinagar. A total of 100 subjects which included 50 Drug-naive major depressive disorder patients and 50 normal controls, were included in this study. Data analysis was performed using SPSS 16. Continuous variables and categorical variables were summarized, respectively, as mean and standard deviation and frequency and percentage.

RESULTS: There was a significant variation in mean serum total cholesterol (TC) and mean serum low-density lipoprotein cholesterol (LDL-C) between the two groups with significantly low levels for both these lipid parameters in study group in comparison to the control group. There was a negative correlation between severity of depression and serum TC (r = −0.710; P = 0.0001), mean serum LDL-C (r = −0.608; P = 0.0001), and triglycerides (TGs) (r = −0.289; P = 0.042).

CONCLUSIONS: Drug-naive MDD Individuals had significantly low serum TC and LDL-C in comparison to control subjects. A significantly negative correlation was there between the severity of depression and TC, LDL-C, and TG.

Knowledge of Electroconvulsive Therapy and Attitudes toward it among Medical Interns and the General Public

Background: Negative view and unfavourable attitude about electroconvulsive therapy (ECT) is common not only in the general public, but also in medical professionals.

Aim: We aimed to check knowledge of ECT and attitude toward it among medical interns posted in department of psychiatry on first day of posting and in the general public. Materials and Method: In this cross-sectional study, ECT knowledge and attitude questionnaire was used to assess the desired knowledge and attitude in medical interns and general public. A total of 36 participants from each group were included in the study. Results: The primary source of information were books among the medical interns (in 75%) and media in general public (in 88.9%). Participants from both groups had more knowledge about the consent, procedure and side effects part of the questionnaire. Medical interns were significantly more knowledgeable than the general public with mean score of 16.58 ± 4.78 and 9.94 ± 4.82 respectively (t=3.74; P= 0.001). Similarly, the mean score on attitude questionnaire was significantly high for medical interns with mean score of 9.94 ± 4.82 and 0.83 ± 8.56, respectively (t=5.56; P=0.0001). There was a significant positive corelation between total score on knowledge questionnaire and total score on attitude questionnaire (rs=0.542, P < 0.001 and rs=0.446, P < 0.006) respectively, for medical interns and general public.

Conclusion: Although medical interns had more knowledge and positive attitude toward ECT than general public, lacunae still exists in them. Our findings suggest that by improving knowledge about ECT, attitude becomes more favourable.

Rare case report and brief review of literature: Marchiafava-Bignami disease.

Background: Marchiafava-Bignami disease (MBD) is a rare condition marked by demyelination and necrosis of corpus callosum mostly due to chronic use of alcohol and malnourishment.

Case presentation: In this study, we report a case of 54 years old male presenting to psychiatry OPD with chief complaints of aggressive behaviour and fluctuating orientation since one day. Patient had history of alcohol consumption since 30 years with increased quantity since 5 years. On examination, patient had deranged liver function test, low vitamin b12 with presence of upper motor lesion and impaired mental status examination. Patient scored low on Montreal cognitive assessment (MoCA) test and Mini mental status examination (MMSE) indication mild cognitive impairment. MR findings showed low signal in central area of corpus callosum with sparing of dorsal and ventral layers showing “ sandwich sign”. On the basis of clinical, laboratory and motor assessment, diagnosis of Marchiafava-Bignami disease was made. Patient was treated aggressively with thymine and multivitamins along with anti-craving agents. Complete resolution of psychomotor activities in 3 weeks and resolution of lesions in the period of 12 weeks was seen. Conclusion: MBD is a complication of chronic alcoholism with various clinical manifestations which is often misdiagnosed and mistreated. But recent advance in neuroimaging has made early diagnosis of MBD possible & helps in early initiation of treatment. Recognition of the imaging features of MBD is essential for proper diagnosis.

Keywords: Marchiafava-Bignami disease, corpus callosum, sandwich sign.

Remote technologies for mental health evaluation and treatment have been used for over 50 years in the United States (US). Initial barriers to widespread tele-mental health included cost, reimbursement, regulatory, privacy, and licensure issues; lack of infrastructure; technological limitations and illiteracy; and resistance to change. With technological advancements, increased adoption of videoconferencing occurred within the US in areas with limited in-person access (e.g., rural areas, corrections) and at large institutions/academic centers at the turn of the century. Although earlier studies indicated high levels of patient satisfaction and reliability, hesitation and concerns voiced by clinicians limited the usage of videoconferencing as a mainstream modality. In March 2020, the coronavirus disease 2019 (COVID-19) outbreak led to an accelerated adoption of videoconferencing for mental healthcare, due to strict social distancing policies enforced by the US government. The entire mental healthcare system adapted to offer psychiatric services through video platforms. Now, three years post-COVID, many of these changes have persisted and there is a gradual shift towards hybrid platforms of mental healthcare delivery, with many providers offering “virtual-only” care. Patient surveys have indicated high levels of satisfaction with care delivered through telepsychiatry and this modality has been found to increase effciency at a lower cost. In this paper, I present a review of the research on use of telepsychiatry in the United States, describe the current trends in adoption of telepsychiatry and discuss why the future of mental healthcare lies in the virtual domain.

Assessment of burden of caregivers of opioid dependence syndrome : a cross-sectional study from north-eastern India

Background: Long term opioid abuse may cause significant physical, emotional, social as well as financial distresses that, in turn, can lead to a trail of problems or adversities in lives of not only the abusers but also their caregivers, which can be termed as ‘burden’.

Aim: To study the burden of caregivers of patients with opioid dependence syndrome and find its association with socio-demographic background of caregiver and clinical profile of the patient.

Methods: Caregivers of 100 patients of opioid dependence syndrome attending Psychiatry OPD or admitted in Psychiatry ward of a tertiary care general hospital were selected by convenient sampling and interviewed using a self-designed proforma. Caregiver burden was assessed by using Modified Burden Assessment Schedule.

Results: Majority (40%) of the caregivers reported to have mild burden , followed closely by severe burden (39%). Significant association was found between burden perceived and occupation of the caregiver. Caregiver burden was also found to be significantly associated with few aspects of patient’s clinical profile, like duration and route of opioid use, presence of hepatitis and history of prior deaddiction.

Conclusion: Our study found that caregivers of opioid abusers experience substantial burden, more so if the patient is abusing since long, or uses intravenous route, or has comorbidity like hepatitis, or is a multiple treatment failure, and also if the caregiver is weak occupation-wise. These findings indicate scope of future research in this area.

SRI DEVARAJ URS MEDICAL COLLEGE, TAMAKA, KOLAR: NARRATIVE REVIEW: DEPARTMENT OF PSYCHIATRY

Are benzodiazepines “steroid like” in psychiatric practice?

Dr MOHAN REDDY M, Dr MANO RANJITHA.V

During the acute phase of certain medical conditions, healthcare professionals may prescribe the use of steroids or benzodiazepines for a brief period of time. The former is commonly used to alleviate severe inflammatory conditions, while the latter is often prescribed to help individuals experiencing acute withdrawal symptoms due to alcohol dependence syndrome. Both classes of drugs are for short-term use only. Prolonged use can lead to abuse, dependence resulting in mental and behavioural symptoms. Prolonged steroid use can result in medical complications such as high blood pressure and impaired glucose tolerance among many others.. Abrupt cessation of benzodiazepines can lead to rebound anxiety and withdrawal symptoms. Similarly steroids should be gradually tapered off over several days. In some cases, benzodiazepines are used to treat delirium tremens, while steroids are used to treat septic shock or anaphylactic reactions. Both drugs should only be used for acute conditions and carefully monitored. Benzodiazepines are best suited for acute psychiatric conditions such as panic attacks, while steroids are indicated for acute medical conditions such as septic shock or Bell’s palsy. In conclusion, it is essential to use benzodiazepines and steroids judiciously and not prescribe them for prolonged durations. Healthcare professionals must exercise vigilance in monitoring their patients for any signs of dependence. Short-term use of these drugs can provide immediate relief for acute medical conditions, but their extended use can lead to detrimental outcomes.

Introduction

The nonspecific initial presentation and variable progression often create a diagnostic dilemma. Among these, subacute sclerosing panencephalitis (SSPE) is still present in India due to forgetfulness of childhood measles infection and timely vaccination.

Aims

To emphasize that SSPE is not rare but rarely suspected hence underdiagnosed and underreported through a journey of 5 children diagnosed with SSPE. Although no definitive treatment is available, an early diagnosis can reduce the expenditure of managing undiagnosed cases.

Methods

All atypical cases with bizarre behavioral abnormality, movement disorders, myoclonic jerks, seizure, and focal neurological deficit underwent MRI, EEG, CSF examination, etc., to rule out mimics. The SSPE can be diagnosed if three out of five criteria are fulfilled.

• (1)Typical clinical presentation with progressive intellectual deterioration with signs of myoclonus
• (2)Characteristic electroencephalographic (EEG) pattern
• (3)elevated cerebrospinal fluid (CSF) globulin levels
• (4)elevated CSF measles antibody titers; and
• (5)brain biopsy suggestive of measles.

Results

All 5 patients were male with 15.40 ± 1.67 years of age and the delay in diagnosis was 2.30 ± 1.20 years. The most common initial presentation was behavioral abnormality and seizures. Patient 4 had neither myoclonus nor seizure episodes. MRI showed white matter changes except for patient 2. The EEG revealed periodic discharges except for patient 4. The IgG measles antibody in CSF was highly raised in all.

Conclusion

Detailed evaluation with imaging, CSF, EEG, etc. is a must in any child with atypical features and to strengthen vaccination policy to defeat SSPE.

A Cross-sectional Observational study of Sexual dysfunction and self-esteem in Psychiatric Patients.

Background: Sexual dysfunction is remarkably prevalent amongst psychiatric patients than general population. The commonest dysfunction among women is sexual desire dysfunction complained by around 30 % of women. The commonest dysfunctions among men are erectile dysfunction and premature ejaculation. Despite the importance and high prevalence of the problem, these patients do not inform the problem either due to feeling that they do not view it as a treatable problem.

Methods: This was a cross sectional study which was undertaken in the Psychiatry OPD of HAHC Hospital associated with Hamdard Institute of Medical Sciences and Research, New Delhi. A total of 100 patients selected by purposive sampling will be taken. The data was collected using questionnaires. A self-designed semi-structured Performa was used for socio-demographic details. The Changes in Sexual Functioning Questionnaire was used to assess sexual dysfunction and Rosenberg self-esteem scale was used for assessment of self-esteem. Data were collected and analyzed using Microsoft Excel 2010 and SPSS software Version 28 (Statistical Package for the Social Sciences, IBM Corp, USA).

Results: The study was conducted on a total of 100 patients presenting to Psychiatry OPD. The prevalence of Sexual dysfunction was found to be 75% which was higher among males (63%) than females (12%). Majority Participants with sexual dysfunction were found to be on Antidepressants (89.3%). Further analysis also revealed that significant association of sexual dysfunction was found with > 1 sexual partner (p value: 0.019), those with porn addiction (p value: 0.015), masturbation once a month (p value: 0.006). Statistically significant association was found between sexual dysfunction and low self-esteem with p value 0.001.

Conclusions: Higher prevalence of sexual dysfunction is an issue of concern in psychiatric patients and has possibly affected their mental health. Management Strategies are to be devised on a priority basis for minimizing sexual dysfunction in these patients. Prevention of sexual dysfunction will contribute to increased self-esteem and happy lives.

ASSESSMENT OF CORRELATION BETWEEN DISSOCIATION DUE TO KETAMINE AND ITS ANTI-DEPRESSANT EFFECT

BACKGROUND: Recent research has seen low-dose ketamine emerge as a novel, rapid-acting antidepressant. Ketamine, an N-methy-d-aspartate (NMDA) receptor antagonist, leads to effects on the glutamatergic system and abnormalities in this neurotransmitter system are present in depression. The literature demonstrates evidence supporting a rapid-acting antidepressant effect of low-dose intravenous ketamine in major depressive disorder, in bipolar depression and in depression with suicidal ideation.

AIM: To find correlation between dissociation and antidepressant effect of ketamine.

METHODOLGY: 41 patients diagnosed with major depressive disorder using DSM-5 criteria attending OPD and IPD department of the tertiary care centre with inadequate response to oral medications were selected for ketamine therapy and the effect of intravenous ketamine was assessed by applying Hamilton Depressive rating Scale before and after ketamine application. The dissociation was measured using Clinician Administered Dissociative Symptom Scale (CADSS).

RESULT: No particular co-relation was found between the changes in HDRS scores and the CADSS scores.

CONCLUSION: No particular association between ketamine’s anti-depressant action and it’s dissociative effect.

“The Study of Nomophobia, Self Esteem and Satisfaction of life in medical students “

Presenting Author:

Dr. Pooja sapovadia

Resident Doctor, Department of Psychiatry, Government Medical College & Sir. Takhtasinhji Hospital, Bhavnagar.

Co- Author:

1. Dr. Ashok Ukabhai Vala

Professor & Head, Department of Psychiatry, Government Medical College &Sir.Takhtasinhji Hospital, Bhavnagar.

2. Dr. Hetal dabhi

Senior Resident Doctor, Department of Psychiatry, Government Medical College & Sir. Takhtasinhji Hospital, Bhavnagar.

Address:Room 33 , pg hostel 1, sir T hospital campus, Bhavnagar -364001 Bhavnagar medical College and Sir Takhtasinhji General Hospital, Gujarat, India

Phone numbers:9033544863

E-mail address:pooja6sapovadia@gmail.com

TheStudy of Nomophobia , Self Esteem and Satisfaction of Life in medical students

Background:Nomophobia is considered to be a modern phobia which appeared in this digital era.it is the conjunctions of “non-mobile” and “phobia “,and refers to the worry,anxiety,and discomfort associated with not having a mobile device when needed.

Aims and Objective:

1. To study the prevalence of Nomophobia in medical students.

2. To study Self esteemassociated with Nomophobia among medical student.

3. To study the Satisfaction of Life associated with Nomophobia among medical students

Materials and Methods: It is a single centred, cross sectional, observational study . Total 700 students studying in MBBS,doing internship and postgraduation in government medical college Bhavnagar were assessed by proforma containing demographic detail,questionnaire of Nomophobia(NMP),Rosenberg Self-Esteem Scale(RSES) and Satisfaction with Life Scale(SWLS)

Result: We found all participants were having some degree of nomophobia.Amongst them 63.29%student were having mild nomophobia,31.29%having moderate and 5.43%students were having severe nomophobia.There is significant association between nomophobia with self esteem and also between nomophobia and satisfaction with life.

Conclusion: participants with nomophobia are more likely to experience low self esteem and poor satisfaction with life.

A Comparative study of burnout and resilience between clinical and nonclinical postgraduates

Dr. SAI PRASANTH P¹, Dr. N. ANNAPURNA²

1.Junior resident, Department of Psychiatry, Andhra Medical College, Visakhapatnam

2.Assistant Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam Corresponding address

Dr. SAI PRASANTH P,

Junior resident,

Department of Psychiatry,

Andhra Medical College, Visakhapatnam.

Contact: 9791595399

Email id : saiprasanth26@gmail.com

BACKGROUND :

• Burnout is a pervasive and debilitating state that results from an unsustainable period of overwhelming stress. Burnout in doctors can lead to reduced care of patients, increased medical errors, and poor health.

• Resilience refers to the capacity of psychophysiological systems to recover from challenging conditions and allow the organism to efficiently return to its health maintenance equilibrium

AIM :

To assess the resilience and burnout and to compare the resilience and burnout between clinical and nonclinical

postgraduates.

METHODOLOGY :

• It is a cross sectional comparative study done in 142 medical postgraduates, between 25 and 35 years of age. 99 clinical postgraduates and 43 nonclinical postgraduates participated in the study. They were given the printed hard copies of the resilience (Connor Davidson resilience scale) and burnout (Copenhagen burnout inventory) scale. The mean scores of personal, work and client related burnout and total resilience score was compared between clinical and nonclinical postgraduates.

RESULTS :

Among the 99 clinical postgraduates, the mean scores of personal, work and client related burnout are 49.28, 47.99 and 42.17 respectively. Among the 43 non clinical postgraduates, the mean scores of personal, work and client related burnout are 43.99, 35.66 and 26.66 respectively. The mean values of work and client related burnout are statistically significant while the mean values of personal burnout are not statistically significant. The mean value of resilience in clinical and non clinical postgraduates are 61.43 and 60.74 respectively which are not statistically significant. There is a weak positive correlation between working hours and burnout. There is a weak negative correlation between sleeping hours and burnout.

CONCLUSION :

Our study showed that there was a higher prevalence of work and client related burnout in clinical postgraduates compared to nonclinical postgraduates, while there is no significant difference in prevalence of personal burnout. Also, there is no significant difference in resilience between the two groups. Furthermore, prospective, controlled studies are needed to investigate the risk factors for burnout and other mental health disorders among clinical doctors, as well as the effects of treatment.

Rehabilitation: concept of comprehensive care

S.R. Adhikari¹

¹Medical Director, Beautiful Mind Institute of Psychiatry, Kharahani-11, Chitwan, Nepal

Background: Integrated treatment of patients with medical treatment / rehabilitation and possibilities of social recovery is the cornerstone of current scenario in psychiatry. Patients with psychiatric disorders encounter many hurdles in multiple domains of life which are not at all related to psychiatric symptoms and its consequences.

Aims: Medical improvement does not necessarily correlate with functional outcomes. This leads to negative impact not only on patients but also on family members and create a “toxic social environment”.

Methods: This presentation will be discussing rehabilitation concept, with reference to Nepal and world scenario. Presenters will also highlight validity of rehabilitation in currently changing world.

Results: Most of current treatment modality in psychiatry is confined to what can be labeled as “medical model” focusing less on “rehabilitation model”. Evidence based studies have shown that rehabilitation and medical models can be complemented with each other with greater treatment outcome. Medical treatment will achieve biological improvement whereas rehabilitation will increase self-esteem, decrease burnout, stigma and boast empowerment.

Conclusion: Rehabilitation leads to recovery and patients can become important member of the community, society and country. Rehabilitation should be started along with day first of medical treatment in every patient.

Key words: rehabilitation, mental illness, substance abuse, medical model, co-morbidities

Addresses of author

Shailendra Raj Adhikari

Medical Director, Beautiful Mind Institute of Psychiatry, Kharahani-11, Chitwan, Nepal adhikaryindra1971@gmail.com

‘The Healing Canvas: Art Therapy in Psychiatry’

Art therapy has emerged as a powerful and holistic approach in the field of psychiatry, offering a unique avenue for individuals to express their innermost thoughts, emotions, and struggles. This paper explores the transformative potential of art therapy as a complementary treatment modality within psychiatric care. Drawing from a comprehensive review of existing literature and clinical evidence, we examine the theoretical foundations, therapeutic mechanisms, and clinical applications of art therapy in addressing various mental health disorders.

The paper delves into the theoretical underpinnings of art therapy and the role of creativity in promoting self-expression and self-discovery. We also explore the neurobiological basis of art-making, shedding light on the emotional and psychological benefits of engaging with art.

Furthermore, the paper provides an overview of clinical applications, showcasing how art therapy can effectively complement traditional psychiatric interventions across a spectrum of disorders, including depression, anxiety, post-traumatic stress disorder, and schizophrenia. Real-world case studies and empirical evidence are presented to illustrate the practical effectiveness of art therapy in facilitating emotional regulation, enhancing self-esteem, and fostering personal growth.

In conclusion, this paper underscores the transformative potential of art therapy as a valuable addition to psychiatric treatment protocols. It emphasizes the importance of a multidisciplinary approach in mental healthcare and advocates for the integration of art therapy as an innovative and person-centred tool for healing and self-discovery. As mental health continues to be a global concern, understanding the role of art therapy in fostering psychological well-being becomes increasingly vital for clinicians, researchers, and policymakers alike.

Presenting author: Dr. Bhoomi Raval

Second year resident doctor

Mail: bhoomiraval118@gmail.com

Guide: Dr. Gopi Gajera

Assistant professor

Dept. of psychiatry

PDUMC, Rajkot.

Comparison of Sleep Quality in Remitted Bipolar Disorder Patients and Healthy Controls: A Cross-Sectional Study

Savitha S¹*, Karthik Vangal², Rajesh Krishna Bhandary P¹, Samir Kumar Praharaj¹

1: Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India

2: Institute of Psychiatry and Human Behaviour, Goa

*Presenting author

Background:

Bipolar disorder (BD) is a recurrent and chronic disorder characterized by fluctuations in mood state and energy that affects around 2.4% of the global population. Patients diagnosed with bipolar disorder often have sleep related problems, even when not in an episode.

Aim:

The objective of our study was to evaluate the sleep quality in patients with bipolar disorder, currently in remission and compare it to the control population.

Methods:

It was a cross-sectional, observational study carried out on 86 remitted bipolar disorder patients in the age group of 18 – 55 years of both genders and 86 age matched healthy controls. All the study participants had given a written informed consent. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality over the last month in both the groups. Data obtained was analyzed using SPSS Statistics 20.0. PSQI scores between the groups were compared using MANOVA, followed by univariate ANOVA.

Results:

The total PSQI score was higher for bipolar patients as compared to controls. Subjective sleep quality and sleep duration were the most affected domains in the bipolar patients. There was a statistically significant difference between the two groups in all domains of sleep quality as well as in total score.

Conclusion:

Our study found that patients with bipolar disorder have poorer sleep quality as compared to healthy controls, even when in the euthymic phase of the disorder. While all domains of sleep quality were affected, subjective sleep quality and sleep duration were affected the most.

Category: Free Paper

Presenting Author: Dr. Savitha S

Affiliation and Designation: Additional Professor & HOU, Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka

E mail: savithasoman@yahoo.com

Phone Number: 9845240653

Co-authors:

Dr. Kartik Vangal, Senior Resident, Institute of Psychiatry and Human Behaviour, Goa

Dr. Rajesh Krishna Bhandary P: Associate Professor, Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka

Dr. Samir Kumar Praharaj, Professor & Head, Department of Psychiatry, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka

BACKGROUND:

The growing presence of social media in the lives of young adults and its effect on mental health among this population has garnered negative attention. Since there is a dearth of studies in the Indian setting, this study is aimed at determining the prevalence of anxiety and depression, along with its association to severity of social media use and the relationship between resilience and psychiatric morbidity in students.

METHODS

In this study, 334 students studying in various disciplines were recruited through convenience sampling. A study proforma for collection of sociodemographic details and details about their pattern of social media use was used. Severity of social media use was assessed using the Social media disorder scale. Beck’s Depression Inventory and Beck’s Anxiety Inventory were applied to assess for Depression and Anxiety respectively. Brief Resilience Coping Scale was applied to assess the coping strategies used by the participants. Data was collected, compiled, tabulated, and analysed using appropriate statistical software.

RESULTS:

Prevalence of depression was found to be 32.6% in the study population and 71% in students with social media disorder, and that of Anxiety was 14% in the study population and 27.5% among those with social media disorder.

CONCLUSION:

The study indicated a higher prevalence of Depression and anxiety in students having social media disorder compared to normal population and a significant association was seen between resilience and psychiatric comorbidities.

Efficacy of a brief group intervention program for hazardous drinking

Dr Harpreet Singh

Introduction: Screening and Brief Intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. This study was conducted to assess the outcome of a brief intervention program delivered at workplace in a group setting for the participants identified with hazardous drinking.

Materials and Methods: Study was a pre- and post-intervention study without a control group. Following an educational lecture, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those who screened positive for hazardous alcohol use were given BI in a group setting at their workplace which consisted of two semi-structured sessions of one hour duration each. Three months later, the outcomes were assessed using a semi-structured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software.

Results: Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective.

Conclusion: The study showed that brief intervention for hazardous drinking in a group setting can be a cost and time effective method requiring less trained manpower.

Impact of Habit Reversal Therapy in Alliance with Mindfulness Based Therapy for Adolescents with Trichotillomania

Dr. Maria Madiha¹ (Presenter) & Dr. Deoshree Akhouri²

¹Research Associate, Defence Research & Development Organisation (DRDO), Delhi

²Associate Professor (Clinical Psychology) Department of Psychiatry, Jawaharlal Nehru Medical College & Hospital, Aligarh Muslim University, Aligarh, UP, India.

Background: The amount of psychological issues skyrocketed at the time of outbreak of COVID-19. Its impact is still felt across the nations. Trichotillomania, was one those many issues encountered. It is characterized by frequent hair pulling, hair loss, and severe functional impairment in the patient. Cognitive behavioural psychotherapy (habit reversal training or acceptance and commitment therapy) and medication are available as first-line treatments for trichotillomania. Over the years, numerous intervention strategies have been devised for the treatment.

Aim: The aim of the present study was to evaluate the impact of habit reversal therapy (HRT) with mindfulness-based therapy (MBT) for adolescents with trichotillomania.

Methods: Adolescents between the ages of 10-19 years were enrolled for the study. They were diagnosed either by clinical psychologist or psychiatrist. Total 45 patients of trichotillomania were randomly divided into 3 groups; HRT+MBT+Medication group, HRT+Medication group and MBT+Medication group. Socio-demographic details and clinical profile were collected. Severity of trichotillomania was assessed using NIMH Trichotillomania Symptom Severity Scale, WHO Quality of Life was used to assess patient’s quality of living and mindfulness level was assessed through Five Facet Mindfulness Questionnaire. Total 12 sessions were designed for the intervention. For statistical analysis, ANOVA was used.

Results: The results showed that when combined with habit reversal therapy, mindfulness-based therapy reduces the severity of trichotillomania. The obtained results also show the improvement of level of mindfulness among the adolescents.

Conclusion: It is easy to conclude that combination of HRT and MBT is an effective intervention strategy for improving trichotillomania.

Keywords: trichotillomania; habit reversal therapy; mindfulness-based therapy; adolescents;

A study of prevalence of depression, anxiety and individual differences in emotional reactivity and coping in Rheumatoid arthritis (RA)

BACKGROUND

RA is a chronic autoimmune disease causing inflammatory polyarthritis leading to disability and premature mortality. Physical limitations, including fatigue and pain have significant effects on mental health of these patients. Individual differences in emotional reactivity and predominant coping style may also play a role in causing anxiety or depression.

AIMS

• * To study the prevalence of depression and anxiety in the patients of RA and its correlation with disease activity of RA.

• * To study individual differences in emotional reactivity and coping in the patients of RA.

• * To study the association between depression, anxiety, emotional reactivity and coping in the patients of RA.

METHODS

100 patients diagnosed with RA attending the Rheumatology clinic in the department of medicine at a tertiary care hospital in Mumbai were enrolled. Rheumatoid Arthritis Disease Activity Index (RADAI), Hamilton Anxiety rating scale (HAM-A), Montgomery and Asberg depression rating scale (MADRS), Perth emotional reactivity scale short form (PERS-S), Brief COPE inventory were applied.

RESULTS

The prevalence of anxiety and depression in this study was 24% and 41% respectively. There was a significant association between disease activity and prevalence of anxiety and depression. Negative emotional reactivity had positive correlation with anxiety and depression. Most of the patients (40%) had approach as their predominant coping style.

CONCLUSION

Owing to high prevalence of psychiatric co-morbidities in RA patients there should be integration of medical and psychiatric care for their screening.

SIDE BIAS IN DEPRESSION : A STUDY USING DICHOTIC LISTENING MEASURE

Subodh Kumar

Department of Psychiatry, Bokaro General Hospital, Jharkhand, India

Background : Side bias, the preferential use of one of the paired organs such as hand, foot, eye, or ear while doing unilateral activities of daily life, is considered to be an important indicator of cerebral lateralization. Findings of the studies generally showed an association between anomalous (left, mixed or reduced rightward) lateral bias and depression. No Indian study has been conducted using both side bias measures and experimental dichotic listening test. Aims: To examine and compare the pattern of side bias on measures of handedness, footedness, eyedness, earedness and dichotic listening test in patients with depression, their first-degree relatives and normal controls. Methods: Thirty patients with depression, thirty first degree relatives of the patients and thirty normal controls were assessed on the Side Bias Questionnaire (for handedness , footedness, eyedness and earedness) and verbal dichotic listening test using thirty pairs of consonant- vowel (CV) syllables. Results: Patients and their first-degree relatives expressed reduced rightward bias on handedness , footedness and dichotic listening test, and mixed bias on earedness in comparison to the normal controls. The observed gradient in the magnitude of left hemispheric asymmetry (right ear advantage) exhibited by the three groups on the dichotic listening test is remarkable. Conclusion: Dichotic listening measure may be considered as a potential neuro-behavioural marker of depression and used to identify the at-risk population of depression.

Abstract for free paper: A comparative study of frontal lobe executive function in forensic psychiatric patients with history of homicide

Dr Sreeraj K V, Dr Rajin T K, Dr Shynu

Introduction

Studies suggest up to 90 % of homicide offenders suffer from some form of psychiatric illness.

Studying the neurocognitive characteristics of such individuals will help to formulate laws and treatment protocols for these patients.

This being the first Indian study will focus on frontal lobe executive function as frontal lobe dysfunction has been associated with violent behavior and homicide can be considered as a severe form of violence.

Objectives

To assess the frontal lobe executive functioning in forensic psychiatric patients with history of homicide.

Method

A case-control study with 25 cases( psychiatric patients with a history of homicide ) and 50 matched controls, matching was done by selecting subjects of same demographic characters, diagnosis and disease duration to that of cases but without history of homicide. The subjects were compared using Frontal Lobe Assessment Battery (FAB)

Result

Case performed significantly poorer than that of control group in FAB Score (p<0.001), with significant impairment in subset tasks of similarities and difference, motor-series, conflicting instructions and inhibitory control, and with no significant difference in subset tasks of lexical fluency and environmental autonomy.

Conclusion

Our study concludes that psychiatric patients with a history of homicide have significant frontal lobe executive dysfunction which poses the question of whether these individual are completely responsible for their crime or not.

Model evaluation for preliminary assessment of a Child in conflict with law at tertiary care centre

BACKGROUND

After Nirbhaya Rape case 2012, Juvenile Justice Act 2000(amendment 2015) argued that adolescents of 16-18 years who commit heinous crime should be tried as an adult or not, by the provision of a preliminary assessment [Section15(1)] on the basis of evaluation of their mental capacity, physical capacity, ability to understand the consequences of offences and the circumstances under which it was committed. However, its implementation is faced with many practical challenges, as there is no universal accepted model for preliminary assessment of a Child in conflict with law(CCL).

AIMS

To suggest a model evaluation for preliminary assessment of a CCL at tertiary care centre.

METHODS

A preliminary assessment of CCL is to be conducted through Judicial Magistrate order in the department of Psychiatry.

Age certificate, Social Investigation/Background Report and statement of witnesses are to be provided by the Probation officer.

During observation period, detailed psychiatric and psychological evaluation to be done which includes daily MSE with clinical history and relevant scales, age appropriate assessment of IQ, personality traits, cognitive abilities and drug abuse screening.

RESULT

After thorough discussion with psychologists, psychosocial workers and consultant psychiatrists, an uniform age appropriate model evaluation for preliminary assessment of CCL is made.

DISCUSSION

This is to resolve variations in the opinion regarding preliminary assessment of CCL and adopt an universal model in this regard. However, its practical application on enough study sample is an undergoing process.

Inflammatory markers in Depression and its relationship with adverse childhood experiences

Background:

Major depressive disorder (MDD) is a complex psychiatric condition with different subtypes and etiologies. Exposure to adverse childhood experiences (ACE) is an important risk factor for the development of MDD later in life. Evidence suggests that pro-inflammatory processes may convey this risk as both MDD and ACE have been related to increased levels of inflammation. In the present study, we aimed to disentangle the effects of MDD and ACE on inflammation levels.

Aim:

To study the association between Inflammatory markers in Depression and adverse childhood experiences.

Methods:

The study included 100 MDD patients who were newly diagnosed. Current depressive symptoms severity were captured by the Montgomery Asberg Depression Rating Scale (MADRS). ACE was assessed by using a Adverse Childhood Experiences International Questionnaires(ACE-IQ). After the clinical assessment, participants were divided into 2 groups: The Depression without ACE and Depression with ACE. A blood sample was collected from all participants to measure CRP levels. CRP levels were compared between the 2 groups after adjusting for sex, age, BMI, smoking, alcohol, and chronic diseases.

Results:

We observed the highest inflammation levels in MDD patients with a history of ACE. Our study revealed that MDD patients with ACE showed significantly higher CRP levels compared to MDD patients without ACE.

Conclusion:

These findings suggest that childhood adversity promotes the inflammatory signaling and it leads to a depression. Accordingly, MDD patients with ACE who not responded for Antidepressants might potentially benefit from anti-inflammatory therapies.

A cross sectional study on prevalence and severity of Depression, Anxiety and sleep quality in COPD patient attending Tertiary care center.

Background: COPD(ChronicObstructivePulmonayDisease) is one of the leading causes of morbidity and mortality in India and incidence and burden of COPD are rising owing to increasing air pollution in cities of India. The presence of anxiety and depression in COPD patients is associated with increased mortality, exacerbation rates, lengthy hospital stay, and poor compliance to medications, decreased quality of life and functional status. Very few studies have made a wholesome description of frequency and severity of depression, anxiety and sleep quality among various severity grades of COPD. In this background our study aims to describe the prevalence and severity of depression, anxiety and quality of sleep in various severity groups of COPD.

Aim: To assess the Prevalence and severity of depression, anxiety and quality of sleep in COPD patients.

Method: 50 consecutive COPD patients visiting respiratory medicine department in govt. rajaji hospital Madurai were graded into groups A,B,E based on latest global initiative for COPD(GOLD)criteria(2023). The patients were applied with Hospital anxiety and depression scale and Pittsburgh sleep quality index scale is applied to assess anxiety, depression and quality of sleep.

Result: Depression, anxiety and poor sleep quality found to be a significant psychiatric comorbidity across all grades of COPD.

Conclusion: Depression, anxiety and poor sleep quality being important comorbidity in COPD necessitating screening of all COPD patients (especially those with increased symptoms and frequent exacerbations) and prompt referral to psychiatrist for treatment are recommended.

A CROSS-SECTIONAL STUDY ON PSYCHOLOGICAL EFFECTS IN AMPUTEES WITH PHANTOM LIMB PHENOMENON

Background :

Phantom limb phenomenon (PLP) is a common entity occurring after the amputation of a limb and can be accompanied by serious suffering. Psychological factors have been shown to play an important role in acquisition and maintenance of pain symptoms. The circumstances preceding amputation and the irreversible procedure of amputation may contribute to the occurrence of symptoms of psychological distress. Depression and anxiety are common problems among patients who have suffered from amputation. Compared to other types of pain, there has been little research on the role of psychological variables in PLP.

Aim :

To evaluate the psychological effects in amputees with phantom limb phenomenon

Methods :

Cross-sectional study on patients who underwent amputation and presented with phantom limb phenomenon in Government Rajaji Hospital, Madurai. Scales used are Body Distortion Questionnaire, MINI (Mini-International Neuropsychiatric Interview)

Results:

Our results showed that patients with phantom limb phenomenon have significantly greater rates of psychiatric comorbidities, including Major depressive disorder, Generalised Anxiety Disorder, PTSD, and Suicidal ideation .

Conclusion :

Our study revealed that patients with phantom limb phenomenon exhibit significantly higher rate of psychiatric comorbidities compared to those without documented phantom limb phenomenon. Major depressive disorder, Suicidal ideation, Generalized anxiety disorder, and Post-traumatic stress disorder were especially common, and consequently a multi-disciplinary approach is essential for proper management and comprehensive care of these patients.

Olanzapine induced urinary retention in a young female with Schizophrenia: A Case Report

Introduction:

Schizophrenia is a severe mental disorder characterized by a mix of multiple symptoms: positive symptoms, negative symptoms, cognitive symptoms and so on. Olanzapine is an atypical antipsychotic with 5HT2A/D2 antagonism used in the treatment of schizophrenia. Olanzapine induced urinary retention is a rare side effect, even rarer in young reproductive age group females.

Case Presentation:

A 27 year old female brought with complaints of suspiciousness, muttering and gesturing to herself, abusive behaviour, impaired self care and decreased sleep since the last 5 years. She was admitted to the psychiatry ward. All baseline blood investigations: WNL. Patient had a past history of treatment with Tab Olanzapine and had shown improvement with it so the patient was again started on Tab Olanzapine (10mg) initially which was gradually uptitrated to 20mg. On day 10 of admission abdominal distension was noted from the umbilicus till the hypogastrium. USG Abdomen: Overdistended bladder pressing on the portocaval system. Surgery referral was done and Foley’s catheter was inserted post which the urinary output was 4 litres. Tab Olanzapine was stopped and the urinary retention resolved. Patient was then started on Tab Ziprasidone (60mg) and showed improvement in psychotic features.

Discussion:

Olanzapine induced urinary retention as a side effect has received little attention. This case shows that the physicians should be on the look out for this side effect with routine renal function monitoring of the patients on Olanzapine.

Clinical profile and treatment outcome in patients on opioid substitution treatment at an Addiction treatment facility in Goa, India

Opioids are the major drugs of potential harm and health consequences with more and more people getting involved in it especially from rural areas. The objective of this study was to assess the sociodemographic profile, pattern of opioid use, and clinical profile in patients with opioid use disorders.

Methods: This was a cross-sectional descriptive study conducted amongst patients with opioid use disorder between 18- 65 years of age, diagnosed as per the International Classification of Diseases 10, who visited the district drug de-addiction centre for treatment. A semi-structured proforma was used to record sociodemographic profile and clinical profile.

Results: A total of 60 patients were included in this study. The mean age of our patients was 33.8 years (SD + or - 9.57). Most of the patients were males (88.33%) married (50%) from nuclear families (56.66%) from rural background (70%) belonging to upper lower socioeconomic status (56.66%).

Mean age of starting opioid use was 27.2 (SD + or - 7.2) with heroin an opioid used in 100% of patients. Majority of the patients (58.33%) were using inhalational route, mean amount of opioid used 1.2 gm [SD +or – 1.09], with relapses on substitution therapy being 2 [SD + or – 3.49]. Most common coexistent use of other substance was nicotine (80%).

Conclusion: Young male from rural areas is increasingly involved in opioid use disorders.

Heroin use has increased significantly particularly through inhalational route.

A case series of harm related obsessions and summary of ERP

Dr. Susmita Sen¹, Dr. Aditi Gupta², Dr. Arka Adhvaryu³, Dr. Payel Talukdar⁴

1.Junior Resident, RG Kar MCH

2.Junior Resident, RG Kar MCH

3.Senior Resident, RG Kar MCH

4.Associate professor and HOD, RG Kar MCH

Background

Obsessive-compulsive disorder (OCD) is a heterogenous condition where patients present with broad range of obsessions and compulsions, with a prevalence of 1.6% - 2.3% in the community. SSRIs and Exposure Response Prevention (ERP) are main treatments for OCD. Harm OCD is a sub-type of OCD characterized by obsessive, intrusive thoughts of harmful acts towards oneself or others and active avoidance towards the same.

Aims

To observe treatment response to ERP and pharmacotherapy combined, in patients presenting with harm related obsessions.

Methods

5 patients taken from inpatient department and presenting with harm related obsessions. Case histories and evolution of symptoms (YBOCS & MADRS) along with management and treatment outcome discussed. Review of literature on harm OCD discussed.

Results

Out of 5 patients, 4 were females, giving female: male ratio of 4:1, with mean age of 26.4 years belonging to lower-middle SES. Mean total duration of illness is 14.4 months. All five patients presented with secondary features of anxiety and depression, two had suicidal ideation with multiple attempts of suicide. Three patients given T. Fluoxetine titrated upto 80 mg, two received T. Fluvoxamine titrated upto 200 mg. Augmentation with Tablet Risperidone(2mg) done for two patients. ERP (16 sessions) was given. >50% improvement in symptoms as well as insight after 6 months of combined therapy.

Conclusion

Response of ERP combined with pharmacotherapy was encouraging in the patients, showing efficacy of ERP in harm related obsessions. More studies needed to illustrate efficacy, safety and novelty of combined therapy in harm related obsessions.

Neuroleptic Malignant Syndrome with Atypical Antipsychotics: A Rare Case Series

Background:

Neuroleptic malignant syndrome (NMS) is rare but potentially most serious adverse response usually observed with the use of first-generation antipsychotics. NMS having an incidence rate of 0.01% to 3.2% in patients taking neuroleptic medications is characterised by hyperthermia, muscle rigidity, altered consciousness and dysautonomia. Atypical antipsychotics exhibit improved efficacy and safety when compared to conventional first-generation anti psychotics because of their pharmacologic modifications.

Aims:

To highlight the need to examine the patients on ‘atypical’ antipsychotics for fatal side effects like Neuroleptic malignant syndrome.

Methods:

In this case series we observed three cases of Schizophrenia on atypical antipsychotics with NMS. The clinical progression and treatment of the cases have been discussed.

Results:

In our case series, we evaluated three patients belonging to 20-30 years age group, two female and one male diagnosed with Schizophrenia of which one patient was on T. olanzapine(10mg/day) and other two patients on T. Aripiprazole 15mg & 20 mg/day respectively. All of these patients presented with symptoms of high fever, muscle rigidity, elevated creatine kinase and was diagnosed to be NMS within an average duration of one week of starting SGAs. Antipsychotics were immediately stopped and they were treated with tapering dose of T. Lorazepam, T. Bromocriptine 7.5mg/day and supportive therapy. The symptoms resolved within an average duration of 2 weeks.

Conclusion:

It is important to clinically suspect and stay vigilant even under therapeutic management with atypical antipsychotics for the signs and symptoms of NMS.

delusion of pregnancy

DR.JITENDRA KUMAR DR. O.P. RAICHANDANI DR.AFTAB AHMED KHAN DR. NEHA RAMSINGHANI

NETAJI SUBHASH CHANDRA BOSE MEDICAL COLLEGE JABALPUR

Background-

• A shared psychotic disorder is a system of delusions shared by two or more individuals.

• Shared psychotic disorders typically develop in pairs or groups with a close relationship who are socially isolated.

• The function and affect of those inflicted with shared psychotic disorders usually remain intact.

Aim-

• How to diagnose and manage shared psychosis.

Method-

• It is a Case report of daughter of schizophrenic mother who has shared psychotic disorder with belief of delusion of pregnancy.

Result-

• Shared psychotic disorder is seldom identified, diagnosed, and treated.

• This case describes a shared psychotic disorder incidentally discovered in a medical unit.

• Shared psychotic disorder (Folie a deux), is a rarely seen and poorly understood psychiatric disorder.

Conclusion-

• It is characterized by the transfer of delusional belief from one (primary patient) , who is already suffering from a psychotic disorder to another person, ( the secondary patient) .

• It is easily misdiagnosed and bigger challenge for management .

• The treatment for shared psychotic disorders involves separation of the individuals and pharmacotherapy with antipsychotics.

ABSTARCT FOR FREE PAPER: Dependent personality disorders complicating comorbid mental illnesses

Dr Neeraj Zambare¹, Dr Anuraag Aedma², Dr Shalin Aghera³, Brig (Dr) P S Bhat (Retd) ⁴

^1,3 Junior Resident

²Assistant Professor

⁴Professor& HOD

Presenting Author: Dr Neeraj Zambare

Junior Resident

Dept of Psychiatry

Rural Medical College, Loni, Maharashtra-413736

Contact details: Dr Neeraj Zambare

Mobile: 9987301521

Email: zambareneeraj@gmail.com

Conflict of Interest: Nil

Words: 239

Dependent personality disorders complicating comorbid mental illnesses

Dr Neeraj Zambare, Dr Anuraag Aedma, Dr Shalin Aghera, Brig (Dr) P S Bhat (Retd)

Background:

Personality disorders such as Dependent personality disorder have shown limited academic development in terms of its contribution as a condition associated with various mental illnesses. In many instances, an underlying personality disorder complicates both presentation and management of other mental illnesses in the patient.

Aim:

To discuss impact of Dependent personality disorder on comorbid longstanding adjustment disorder.

Case vignette:

A 34-year-old mother of two children from low socioeconomic status brought by relatives with history of childlike behavior of recent onset in the background of rebuke by a family elder. There was longstanding history for more than two decades in the form of multiple episodes of emotional breakdown and behavioural abnormality whenever faced with significant stressors, seeking reassurance repeatedly, not assuming responsible role functions, feeling excessively vulnerable leading to even separation from spouse. Physical examination was unremarkable. In the ward she exhibited irritability, inadequate selfcare, extreme clinging tendency, excessive tearfulness and deranged bio drives. Psychometry revealed high scores on dependent and anxiety traits. Managed with antidepressants, psychotherapy focusing on to change the negative thoughts and motivating to engage in more independent behaviours.

Conclusion:

Presence of Dependent Personality Traits or Disorder makes the individual highly vulnerable to breakdown in the face of any significant life stressors. A high index of suspicion and detailed history taking coupled with appropriate psychometry will help in understanding the individual better and helps in providing illness specific interventions.

ABSTARCT FOR FREE PAPER: Depersonalization Derealization Disorder: Report on a case study and challenges in management

Dr Aboobacker Alphy K H¹, Dr Shalin Aghera², Dr Anil Korade³, Dr (Brig)P S Bhat (Retd)⁴

^1,2Junior Resident

³Associate Professor

⁴Professor & HOD

Presenting Autor: Dr Aboobacker Alphy K H

Junior Resident

Dept of Psychiatry

Rural Medical College, Loni, Maharashtra-413736

Contact details: Dr Aboobacker Alphy K H

Mobile: 8884545918

Email: alphyaboobacker2001@gmail.com

Conflict of Interest: Nil

Words: 250

Depersonalization Derealization Disorder: Report on a case study and challenges in management

Dr Aboobacker Alphy K H, Dr Shalin Aghera, Dr Anil Korade, Dr (Brig)P S Bhat(Retd)

Background:

Depersonalisation-derealisation disorder(DP/DR) is a distressing clinical condition with a pathophysiology that is not yet well understood. It is an alteration in the perception or experience of the self and the environment. In the management of this disorder, various approaches have been tried in small studies.

Aim:

To discuss DP/DR in the context of different management strategies across the literature, challenges in the management and approach to a case of DP/DR which showed satisfactory response.

Case vignette:

A 21-year-old male initially presented with complaints of repetitive thinking, excessive analysis of trivial things resulting in anxiety of about few months duration. He had family history of major psychiatric illness, anankastic traits, high score on Y-BOCS scale and initially managed with Fluvoxamine. Initial symptoms started improving but expressed strong feelings of unrealness around him that was changing in quality, as if his reactions were not of him, had become emotionally numb and was in severe distress. His Cambridge depesonalisation score was very high. Lamotrigine was added to the regime for which he gradually responded over the weeks.

Conclusion:

In the management of DP/DR, various approaches have been tried in small studies, with mixed results. One of the few pharmacological treatments that has shown some efficacy in recent clinical studies is the combination of SSRI with the mood stabilizer lamotrigine. In our case, we managed with a combination of Fluvoxamine with Lamotrigine along with other supportive measures and achieved satisfactory response.

Intensive Care Unit stress and burnout among healthcare workers

Background

Working in an intensive care unit (ICU) environment is known to be stressful. For all ICU healthcare workers more than the physical work, it is the psychological factor of dealing with the seriously ill patients which leads to huge mental stress. This stress when persisting for quite some time can lead to burnout, which in turn can cause a decreased personal well-being, increased absenteeism, more mistakes and ultimately compromised patient care. Most studies from western countries have tried to correlate the level of stress and burnout but have not clearly elucidated the reasons for them.

Aims

To study stress and burnout among Healthcare workers in Intensive Care Unit (I.C.U.)

Methods

This will be a cross sectional study, the sample taken will include all doctors (Faculties, Senior Residents and Junior residents) and nurses working in the I.C.U. of Santosh Medical College and Hospital, Ghaziabad by using sample size 62 by using the following psychiatric scales:

1. Semi structured proforma for Socio demographic data

2. Cohen Perceived Stress Scale

3. Maslach Burnout Inventory Scale (MBI)

Results

As per the data collected, positive correlation between MBI and Cohen Scale has been established with a p value of >0.01 ( 0.036).

Conclusion

The degree of burnout among critical care providers is significantly correlated with both job satisfaction and stress levels. To avoid burnout, there should be a strong recommendation to reduce stress-causing factors and boost employee job satisfaction.

Effect of excessive mobile phone use on IQ of children: A cohort study

Apoorva Nair¹, Bageshree Seth², Revathi N², Parineeta Samant³, Indra Vijay Singh¹, Sayali Mokal¹, Vasant Bhasma¹, Maninder Singh Setia¹

¹MGM Institute of Health Sciences, Navi Mumbai, India

²Dept of Paediatrics, MGM Medical College, Navi Mumbai, India

³Dept of Biochemistry, MGM Medical College, Navi Mumbai, India

Background: Excessive use of cell phones has been linked to poor attention, memory, concentration, and cognitive functioning. It is also associated with various health issues such as headaches, poor sleeping patterns, and fatigue.

Aim: To study the association between mobile phone use and IQ in children 2-5 years of age.

Methods: We present data from 64 children; IQ was assessed using the Stanford-Binet Intelligence Scales-5 ^© (PRO-ED Inc, 2003). We assessed verbal IQ, non-verbal IQ, and full-scale IQ. The age at which children started using mobile phones and the hours of mobile use per day were recorded.

Results: The mean (SD) age of children was 53.4(6.4) months and the median hours (IQR) of mobile use was 1.5(1.0, 2.75). The median age for initiating mobile use was 18(12, 30) months. The proportion of children with below-average verbal IQ was significantly higher in those with longer hours of mobile use (13.8% vs. 0%; p=0.037). Similarly, fluid reasoning (13.8% vs. 0%; p=0.037) and quantitative reasoning (17.2% vs. 0%; p=0.016) were significantly below average in these children. There was a negative correlation between total duration of mobile use (in months) and non-verbal IQ (r=-0.19, p=0.15), verbal IQ (r=-0.10, p=0.45), and full-scale IQ (r=-0.14, p=0.28) scores.

Conclusion: This study shows that longer hours of mobile use are significantly associated with poorer verbal, fluid reasoning, and quantitative reasoning scores in children. Adequate restriction of the use of mobile phones and cognitive monitoring of children is recommended; as excessive use is likely to affect children’s mental capacity.

Association between mobile phone use and neurodevelopment in children: A cohort study

Apoorva Nair¹, Revathi N², Bageshree Seth², Parineeta Samant³, Indra Vijay Singh¹, Sayali Mokal¹, Chandrakant Ughade¹, Maninder Singh Setia¹

¹MGM Institute of Health Sciences, Navi Mumbai, India

²Dept of Paediatrics, MGM Medical College, Navi Mumbai, India

³Dept of Biochemistry, MGM Medical College, Navi Mumbai, India

Background: Exposure to radiation from cell phone towers and mobile phone use may be associated with health problems such as sleep disturbances and headaches. Excessive screen time in children is also associated with developmental delays in children.

Aim: To study the association between mobile phone use and neurodevelopmental parameters in children 2-5 years of age.

Methods: We present data from a cohort of 204 children. We assessed the level of radiation in the homes, mobile phone use, and the Specific Absorption Rate (SAR) of the mobile phone. We evaluated the development of these children using the Ages and Stages Questionnaire-3 ^© (2015 by Paul H. Brookes Publishing Co., Inc.)

Results: The mean (SD) age of children was 41.6 (10.0) months. The median (IQR) daily mobile phone use by children was 1.5 (0.5, 2.5) hours. The median (IQR) age of initiation of mobile phone use was 24 (12, 30) months. The median (IQR) SAR value was 1.16 (0.86, 1.60) W/kg. The proportion of children with communication problems was significantly higher in those with longer (>median hours) daily mobile phone use (15.6% vs. 3.6%; p=0.003). Similarly, personal-social problems were significantly higher in this group (18.5% vs. 7.2%’ p=0.015). Though gross motor (15.2% vs. 7.2%; p=0.068), fine motor (7.6% vs. 2.7%; p=0.10), problem-solving (25.0% vs. 18.9%; p=0.30), and social-emotional (17.4% vs 10.8%; p=0.18) problems were also higher, the difference was not statistically significant.

Conclusion: Strict adherence to screen time guidelines and closely monitored neurodevelopmental parameters is required for optimal cognitive and developmental outcomes.

ABSTRACT FOR PAPER PRESENTATION PREVALENCE OF DEPRESSION AND ANXIETY AMONG CANCER PATIENTS IN SOUTHERN RAJASTHAN.

1-Dr Anurag Kaur Brar, Junior resident, Department of Psychiatry, AIIMS, Udaipur.

2-Dr. ROHIT DOMINIC JAWAHAR REBELLO (MBBS, MD (RADIATION ONCOLOGY),

DM-(MEDICAL ONCOLOGY), HEAD: DEPARTMENT OF MEDICAL ONCOLOGY, AIIMS Udaipur.

3-Dr Abdul Sajid Mansoori, Associate Professor, Department of Psychiatry, AIIMS Udaipur.

BACKGROUND:

Anxiety and depression are the most common psychiatric disorders among patients with malignant cancer. Presence of depression and anxiety complicates the treatment outcomes due to poor adherence to treatment regimes.

METHODOLOGY:

A cross sectional study was conducted on cancer patients of either sex presenting to AIIMS Udaipur, psychiatry department and oncology department. The participants were given liberal verbalexplanations and description about the topic of research. After obtaining informed written consent, semi-structured proforma was used to record socio-demographic data of patients. HAM-A and HAM-D were applied by the principal investigator.

RESULTS

The questionnaires were completed by 30 patients receiving cancer outpatient care. The patients’ mean age was 52.57 years. The majority of the patients (n = 19; 63.33%) were older than 50 years. Males (n = 17; 56.67%) outnumbered the females (n = 13; 43.33%). A little under half (n = 14; 46.67%) of the patients had GAD or a depressive disorder as their primary psychiatric morbidity. In comparison to GAD (n = 11; 36.67%), depression (n = 13; 43.33%) was slightly more common. Only a small number of patients (n = 2, 6.67%) had severe depression and most patients (n = 10, 33.33%) had moderate depression. 61.5% patients met the criteria for both depressive disorders and GAD.

CONCLUSION:

Depression and anxiety can erode one’s ability to adhere to treatment plans, manage symptoms effectively, and engage in healthy lifestyle behaviors. It can exacerbate the severity of physical symptoms, increase healthcare utilization, and ultimately contribute to a lower quality of life.

Prevalence of eating disorder and its association with depression, anxiety & stress in medical and paramedical students

Background:Eating disorders cause serious, disabling, life-threatening mental health burden that significantly reduce physical health and interfere with psychosocial functioning which often go unnoticed. Eating disorders are caused by poor body image, body weight, and eating habits along with psychological attributes which play a significant role in the development and persistence of the disorder. Paradox lies in the fact that medical and paramedical students who are otherwise connected to the subject of health sciences are significantly susceptible to eating disorders.

Aims: to evaluate the nature and extent of eating disorders and its association with depression, anxiety and stress in medical and paramedical students.

Methods: This will be a cross sectional study, the samples taken will include students of both medical and paramedical fields-MBBS, PG, BOT, BPT & GNM of a medical college in Ghaziabad using sample size of 100 using the following scales:

1. Semi-structured socio demographic data Performa

2. Eating Aptitude Test- 26 (EAT-26)

3. Depression, Anxiety, Stress Scale-21 (DASS-21)

Results: Positive correlation found between EAT 26 and DASS-21 established with p value <0.01 establishing a greater association of eating disorders with depression, anxiety and stress.

Conclusion: Data found that eating disorders are prevailing among the students of Ghaziabad and have significant effect on their mental and physical health.

a rare case of multiple neurocysticercosis presenting with depressive symptoms

Introduction – neurocysticercosis, the most common type of neuroparasitosis, is a condition in which the central nervous system (CNS) is infested with the pork tapeworm Taenia solium cysticercosis larvae. A variety of psychiatric problems induced by neurocysticercosis such as delirium, perceptive sensory changes, anxiety, depression, and personality disorders, have been identified. Neurocysticercosis is a standard differential diagnosis of most neurological, but not psychiatric, conditions in the endemic regions. However, the infestation results in complex physiological, neurosurgical, and psychological syndromes.

Case details – we report a case of a 48-year-old male presented with complaints of headache, low mood, forgetfulness, one episode of seizure and was further evaluated and diagnosed with neurocysticercosis with depressive features and cognitive impairment due to underlying medical condition.

Conclusion – this case report describes finding of neurocysticercosis in a patient who presented with depressive symptoms with cognitive impairment, headache, episode of convulsion. This pleomorphism is predominantly associated with individual variations in the number and location of nervous system lesions and the magnitude of the host’s immune response to the parasite. It is important to consider NCC in differential diagnosis of patients in endemic areas presenting with psychiatric symptoms, especially those showing poor response to the standard treatment and in those with history of seizures.

Keywords – depressive symptoms, neurocysticercosis

Spectrum Of Skin Dermatoses Among Patients of Substance Use Disorder-A Hospital Based Study

Background:

Various substances of abuse are known to cause specific cutaneous manifestations. Cutaneous manifestations are associated with the use of cocaine, methamphetamine, heroin, marijuana, alcohol, anabolic steroids, and general signs of the drug abuse, including the stigmata of injection drug use, infectious complications, and vascular complications. However, the literature on the same is very limited from Indian subcontinent.

Aim:

To find out various dermatoses in psychiatric patients of substance use disorder.

Methods:

In the present study, 46 Diagnosed cases of substance use disorder as per Diagnostic and statistical manual of mental disorder-5 (DSM-5)¹ were taken. Cutaneous examination was performed accordingly. Laboratory investigations were done as per need.

Results:

Mean age was 42.21±16.64. Majority of the patients were illiterate (41.3%) and 26.1% were either graduate or post graduate and 21.7% were high school pass and 6.5% were middle school and minority had primary school education (4.3%). All patients are taking substance in one or other form. Majority of the patients had complaints of raised lesions (56.5%) and followed by redness (23.9%), pain (19.6%), burning (13%) and oozing (13%) discomfort and flaking of skin (10.9%), rash (8.7%), light spots (6.5%) and fluid filled lesions (4.3%).

Conclusion

Few substances were associated with specific dermatoses. However there is very little data on the same so this study will add upon minuscule literature on this topic.

Comparative study of delirium associated with alcohol withdrawal versus other medical illnesses: clinical profile, course of illness & outcome

Background: Delirium is a prevalent and serious condition observed in the medical intensive care unit (MICU), with various etiologies including alcohol withdrawal and other medical illnesses. However,limited research has compared the clinical profiles, course of illness, and outcomes between these different types of delirium.

Aims of study- To evaluate the symptom profiles and courses of alcohol withdrawal delirium and delirium associated with other medical illnesses, as well as to assess the correlation between cognitive status and psychotic symptoms.

Methods: This is a longitudinal follow up study, conducted at Tertiary medical college. Consecutive subjects who were diagnosed with delirium were taken. Sample consisted of 152 subjects. Symptom profiles,course of illness,and outcomes were assessed using six scales: the Brief psychiatric rating scale,Kuppuswamy socioeconomic scale,Cognitive Test for Delirium, Severity of Alcohol Dependence Questionnaire,Delirium rating scale revised 98 and the delirium etiology checklist.

Results: Findings indicate that alcohol withdrawal delirium and delirium associated with other medical illnesses exhibit distinct symptom profiles and courses of illness. Alcohol withdrawal delirium showed specific symptoms related to withdrawal state,while delirium associated with other medical illnesses displayed symptoms characteristic of the underlying medical condition.

Conclusion: This study provides valuable insights into the clinical profiles of delirium associated with alcohol withdrawal versus other medical illnesses. The findings suggest the importance of recognizing the specific features and courses of each type of delirium for appropriate management and interventions in the MICU.

“Hormonal assay in postnatal women with psychiatric morbidity-A study in tertiary care hospital”

Dr. K.Raghav*, Dr.Lakshmi Sarath Chandra**, Dr. P.Ramya Keerthi***, Dr. N.Nageswara Rao****

*Post-Graduate, Department of Psychiatry, S.V.Medical College, Tirupati. **Assistant Professor, Department of Psychiatry, Viswabharathi Medical college,Kurnool.

***Associate Professor, Department of Psychiatry, Institute of Mental Health, Kadapa.

****Professor and HOD, Department of Psychiatry, Kurnool Medical College.

Background

• Postpartum period is characterised by an increased susceptibility to psychiatric disorders.

• Childbirth causes trauma, sleep deprivation and adjustments in relationships and is a major life transition.

• A range of psychological disorders occur in women in the postpartum period including blues, depression, anxiety, psychosis, and posttraumatic stress disorders.

• There are large changes in the levels of several hormones over the peripartum period which may also contribute to changes in mood in vulnerable women.

• This study aims at identifying the relationship of serum hormonal variations with psychiatric morbidity of women in their postpartum period.

Aim Of The Study

• To study the serum hormonal levels in postnatal women with psychiatric morbidity

Methodology

• The present study is a Case-control study using purposive random sampling method and the study sample consisting of 40 Postnatal women with psychiatric morbidity and 40 Postnatal women without psychiatric morbidity diagnosed as per Mini-International Neuropsychiatric Interview (M.I.N.I.) version 7.0.2.

• Study Period is 6 months and the study was undertaken after obtaining approval from the Institutional Ethics Committee (S.V. M.C Lr No. 08/2022).

• All the subjects included in the study were attending to Outpatient and Inpatient Department of Psychiatry, Tirupati and the Outpatient and Inpatient Department of Obstetrics and Gynaecology, Tirupati.

• Semi-structured proforma was used to record socio-demographic profiles, and obstetric history.

• Blood sample was collected under aseptic precautions at 8am in the morning under fasting. Enzyme-linked immunosorbent assay (ELISA) was used to estimate the serum levels of hormones T3, T4, Thyroid Stimulating Hormone, Luteinizing Hormone, Estrogen, Progesterone and Cortisol.

Results

• 60% of cases and 12.5% of controls had a past history of psychiatric illness which showed a significant P value=0.001.

• 25% of cases and 2.5% of controls had a parity of 4 which showed a significant P value=0.031.

• The mean serum T3 levels among cases was 1.00 ± 0.30y, while among controls was 1.47 ± 0.48y. On applying chi-square test P value is 0.001, Hence it is significant.

• The mean serum TSH levels among cases was 3.34 ± 1.84y, while among controls was 2.50 ± 1.46y. On applying chi-square test P value is 0.031, Hence it is significant.

• The mean 8 AM serum cortisol values among cases was 20.81 ± 7.30y, while among controls was 15.31 ± 6.05y. On applying chi-square test P value is 0.001, Hence it is significant.

• Among the cases, 47.5% were diagnosed with major depressive episode of which 63.2% had 8 AM serum cortisol values over 22.6 microgram/dl which showed a significant P value= 0.032.

Discussion

• Serum hormones could play a major role in the onset of psychiatric disorders in the postpartum period.

• Patients with a known psychiatric illness are likely to experience a relapse during postpartum period.

• Thyroid hormones and cortisol could be used as biomarkers for postpartum psychiatric disorders.

• Cortisol looks to be a more specific marker for postpartum depression.

Leveraging RCPsych International Volunteering as Catalyst Agents for Advancing Mental Healthcare: A Case Study from Bangladesh

This presentation will delve into a compelling case study showcasing the transformative impact of collaboration between judges and psychiatrists in Bangladesh, resulting in notable improvements in forensic psychiatry practices.

As the Chair of the Volunteer Psychiatrists’ Special Interest Group (VIPSIG), I am excited to share insights from a compelling use case that spotlights the collaborative efforts of judges and psychiatrists in Bangladesh. This collaboration has led to remarkable improvements in the field of forensic psychiatry in Bangladesh, thereby making a substantial impact on the mental healthcare landscape. The focus of my presentation will extend beyond the success story itself and delve into the challenges faced and the enabling factors that have been instrumental in ensuring the success of such volunteering projects.

My talk will encompass a structured approach to sustainable volunteering, elucidating the importance of micro-volunteering, the process of piloting innovative ideas, strategies for building robust stakeholder engagement, and the essential steps for scaling up initiatives with the support of international organizations.

Furthermore, the presentation will showcase lasting solutions that have emerged from our collaborative work with Bangladesh’s judiciary training institutions and National Mental Health Institute. These solutions include but are not limited to:

1. Enhancing the language used in court orders to improve clarity.

2. Incorporating mobile phone numbers in court orders to facilitate rapid communication with patients and their relatives.

3. Providing De-stigmatizing information within legal and medical professionals.

4. Advising on contemporary treatment successes in the realm of mental disorders for legal professionals

5. Providing guidance on the process of psychiatric assessments and the requisite time frame for report preparation

6. Importance of supplying contextual information such as First Information Reports (FIRS) to assist psychiatrists in their evaluations.

7. Emphasizing the use of email communication for swift and effective responses in critical cases.

This talk will not only shed light on the accomplishments but also address the challenges and enabling factors crucial for the success of international volunteering projects. The presentation will outline a systematic approach to sustainable volunteering, emphasizing micro-volunteering, piloting innovative ideas, cultivating stakeholder engagement, and scaling up with support from international organizations. The talk will pave the way for further international collaboration within the reason replicating this model of volunteering as an agent of catalyst for change.

Impact of Dementia diagnosis on Management of inpatients at regional Mackay Base Hospital, QLD Australia

A Rana¹, S Reelh¹, S Sinha¹, QM Lee¹, A Ajit², C Tan², M Hiskens³

¹Mackay Base Hospital, ²James Cook University, ³Mackay Institute of Research and Innovation,

Background

Dementia affects our behaviour, cognition, and ability to perform everyday tasks. More than 400,000 Australians live with dementia, and this figure is expected to double by 2058. More than 28,650 people have younger onset dementia and this is expected to double within the same timeframe; however, it is recognized

Aims and Objectives

1. Assess changes in LOS of patients compared to previous 2017 audit

2. Evaluate use of pathways for patients with suspected cognitive impairment including timely diagnosis and management of patients with dementia

3. Identify developmental needs of a local geriatric service to improve outcome of care

Methodology

Ethics approval was sought to review data of 100 consecutive patients ≥65yo who attended MBH in 2022 were assessed. Assessment parameters used in the used 2017 audit were used. In addition, recommendations made previously were assess by cognitive screening tool usage. These parameters can be found as Table 1.

that many cases go undiagnosed.

From 2015, the rate of hospitalization due to dementia increased 1.6% each year. The average length of stay (LOS)in hospitals due to dementia is 5x higher than all other hospitalizations (13 days vs 2.6 days). While younger onset dementia had a greater average LOS than older people (22 days vs 13 days).

A 2017 audit done in Mackay Base Hospital (MBH) found high proportion of patients >65yo displayed cognitive impairment but weren’t screened appropriately and were missed dementia diagnoses. That resulted in increased LOS and re-admission rates. Recommendations made after were aimed at increasing screening, diagnosis and management pathways for dementia patients.

Discussion Points and Results:

• ResultsLOSfordementia patients has largely remained unchanged since 2017 (The same applies to total hospital LOS)

• The barrier to diagnosing dementia has improved relatively – where only 4% of our population did not receive a dementia diagnosis (Compared to 79% in 2017)

• ACE-III and RUDAS remains the 2 main screening tool used, these were mainly performed by Occupational Therapist and Psychologists

• Categorizing into dementia types and it’s associated severity remains suboptimal

• Readmission rates albeit low would benefit from further improvement

All 100 patients selected were put through the tool. Some population demographics can be found in Table 2. Most patients had a diagnosis of dementia, while 13% of patients had newly diagnosed dementia shown in Figure 1. Dementia types were mostly not documented, while Alzheimer’s remains the most common type of dementia as shown in Figure 2. Dementia severity was also not documented in most cases, however where documented, most cases were severe as shown in Figure 3.

The LOS comparison can be found in Figure 4, the LOS for dementia has increased as compared to 2017. While the maintenance LOS for the various categories is found in Table 3, patients who were admitted from their usual residential aged care facility (RACF) had the longest LOS at 53 days. Home was the commonest discharge location as in Figure 5. 21% of patients were readmitted within 30 days.

Recommendations

This completed audit cycle shows improvement in clinical acuity and a reduced barrier to screening and diagnosing dementia. There remains considerable work in the development of effective management of dementia and utilisation of health resources. Dementia underdiagnosis reduces the perceived importance of resourcing health services to manage cognitive impairment in older people.

Further development to help continue this improvement trajectory should be undertaken; such as continuous key stakeholder engagements, establishment of a geriatric service and to collaborate care approaches to utilize trans-disciplinary cadre of various clinicians.

References

1. Dementia Australia. dementia prevalence and incidence projections, from 2011 to 2050, for Queensland, by Federal Electoral Division (FED), State Electoral District (SED) and Health Service District (HSD). Projections of dementia prevalence and indecision in Queensland 2011 – 2050. Accessed May 20, 2023.

2. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145(10):713-726. doi:10.7326/0003-4819-145-10-200611210-00004

3. Bacsu J, Mateen FJ, Johnson S, Viger MD, Hackett P. Improving Dementia Care Among Family Physicians: From Stigma to Evidence-Informed Knowledge. Can Geriatr J. 2020;23(4):340-343. Published 2020 Dec 1. doi:10.5770/cgj.23.426

A STUDY OF SERUM LEVELS OF THIAMINE IN PATIENTS OF ALCOHOL DEPENDENCE SYNDROME

BACKGROUND:

• The harmful use of alcohol is a worldwide problem and not only a causal factor in many diseases but also a precursor to injury and violence.

• According to a recent systemic review and metanalysis done in 2022, in India, the estimated overall prevalence of Alcohol use disorders (AUDs) was 12.5%, in which harmful use was 8.6% and dependent use was 2.6%

• Severe alcohol use disorder has been associated with significant nutritional and vitamin deficiency, especially thiamine deficiency which is associated with neurological deficits.

• Some studies showed a relationship between lifetime alcohol use severity, psychiatric symptoms, and response to thiamine among alcohol dependent men.

AIM:

To study serum levels of thiamine in patients of Alcohol dependence syndrome in the department of psychiatry , SVRRGGH , Tirupati.

OBJECTIVES:

• A)To correlate serum levels of thiamine in patients of Alcohol dependence syndrome with and without psychosis
• B)To correlate serum levels of thiamine with severity of illness by using severity of alcohol dependence questionnaire

METHODOLOGY

• The present study is a Hospital based Cross sectional study using purposive random sampling method and the study sample consisted of a total of 30 subjects with alcohol dependence syndrome without and with psychosis

• Study period was 2 months from period of ethical committee clearance.

• The subjects were all patients with alcohol dependence syndrome in the department of psychiatry, SVRRGGH, who consented to participate in the study. Severity of dependence was measured using Severity of Alcohol Dependence Questionnaire (SAD-Q)

• Semi structured proforma was used to record socio-demographic profiles

• Blood samples were collected under aseptic precautions and was thiamine levels was estimated by Enzyme linked Immunosorbent Assay (ELISA).

RESULTS:

• Of the 30 subjects, 60% had moderate dependence when measured with SAD-Q and had no correlation or association with socio demographic factors assessed.

• The withdrawal psychosis did not have any association with the severity of alcohol dependence with P value of 0.361.

• There was no significant correlation between serum thiamine levels and the severity of alcohol dependence (P value of 0.692)

• There was no significant correlation between thiamine values and psychosis during alcohol withdrawal (P value of 0.163)

• The socio demographic factors also did not show any significant association to the alcohol dependence or thiamine levels

DISCUSSION:

• Thiamine deficiency in AUDs is vastly known to be associated with several neurological disorders like Wernicke’s encephalopathy and Korsakoff’s psychosis and its supplementation is known to prevent the development of these disorders

• This study showed that there was thiamine deficiency in AUDs, although there was not any significant correlations between thiamine and severity of alcohol dependence and alcohol withdrawal psychosis, the sample size was small, diet habits were not assessed and only male patients were included

• Hence, future studies are necessary to understand the above mentioned correlations and their clinical implications

A comparative study of sociodemographic factors and depression among nulliparous and multiparous pregnant women

PRESENTER: Dr Ashish Kumar Agarwal

(2^nd year Resident, Psychiatry Department, PDU Medical college Rajkot)

BACKGROUND:

Depression is a prevalent mental health issue that affects women across the lifespan. The susceptibility to depression is influenced by a complex interplay of biological, genetic, psychological, sociodemographic and environmental factors. Whether a female is nulliparous or multiparous can also be a factor, but it’s essential to understand that this is just one of many factors that can contribute to a person’s risk of depression.

AIMS:

To compare the influence of sociodemographic factors on depression in nulliparous and multiparous pregnant women.

METHODS:

Data was collected through a cross-sectional survey conducted among women aged 20 to 45 years. Sociodemographic-variables such as age, education, occupation, socioeconomic-status etc were collected. Depression was assessed using Edinburgh-postnatal-depression-scale and diagnosis was made as per DSM-5. Statistical analysis was done and chi-square test was applied to examine the relationship between sociodemographic factors and depression in both groups.

RESULTS:

Preliminary findings suggest that sociodemographic factors may exert varying degrees of influence on depression. In multiparous women, being employed and living in rental house were significantly associated with depression, while no any significant association with depression was found in nulliparous women.

CONCLUSION:

This study underscores the importance of sociodemographic factors when assessing depression in pregnant women. The findings suggest that nulliparous and multiparous women may have distinct risk profiles for depression, necessitating tailored approaches for prevention and intervention.

A study of a risk factor for Delirium tremens among patients with alcohol withdrawal

1)Dr. Varun Bansal, Junior Resident, Department of Psychiatry, J.L.N. Medical College, Ajmer

2)Dr. Mahendra Jain, Senior Professor and Head, Department of Psychiatry, J.L.N. Medical College, Ajmer

3)Dr. Parth Singh, Professor, Department of Psychiatry, J.L.N. Medical College, Ajmer

4)Dr. Charan Singh, Associate Professor, Department of Psychiatry, J.L.N. Medical College, Ajmer

1 : Presenting Author

2,3,4 : Co-authors

Background- Delirium tremens (DT), is characterized by severe consequences and a high death rate. Identifying people at higher risk of DT would have significant therapeutic and preventative ramifications. Therefore, the goal of the current study was to find clinical risk variables that could foretell the emergence of DT.

Aim- To determine the prevalence of delirium tremens among in-patients admitted with alcohol withdrawal and to compare the sociodemographic and clinical correlates between those with and without Delirium Tremens.

Methods- In this study, 300 consecutive in-patients diagnosed with alcohol withdrawal as per ICD-10 were included, out of which, 29 patients developed DT. The subjects were assessed using Semi-structured demographic profile, clinical proforma, Severity of Alcohol Dependence Questionnaire (SADQ) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) on the day of recruitment. Two groups were made and comparison of different parameters within groups was done.

Results- The mean age of patients in group without DT was 36.86 years and in group with DT was 44.59 years, which was found to be statistically significant. All subjects with DT had a high mean SADQ-C and CIWA-Ar score of 47.86 and 35.24 which was significantly higher than the score of 41.52 and 27.26 in the non-DT group respectively.

Conclusion- The risk of development of delirium tremens in patients with alcohol withdrawal should be carefully monitored by assessing the various variables which have been indicative of being a risk factor.

Study of risk factors in children with disruptive mood dysregulation disorder

Dr Sourabh Pal- Junior resident, Seth G S Medical College and KEM Hospital Dr Vinita Pawar - Ex resident, Seth G S Medical College and KEM Hospital Dr Ajita Nayak- Professor and HOD, Seth G S Medical College and KEM Hospital

BACKGROUND:

Disruptive Mood Dysregulation Disorder (DMDD) first described in DSM 5 is a condition occurring in children and characterised by severe aggression. It has been reported that the 3- month prevalence rates for DMDD ranged from 0.8% to 3.3%, with the highest rates in preschoolers. Some studies suggest that male children with a family member with a psychiatric condition are at higher risk. However Indian studies are lacking.

AIMS: To study the sociodemographic profile, associated birth complications and parental psychopathology in children suffering from DMDD.

METHODS: 80 consecutive children satisfying the DSM-5 Criteria for DMDD and living with their parents were studied. A semi-structured proforma was used to note the details.

RESULTS: Of the 80 children 74% were school aged children and 26% teens. A male preponderance was seen. No parental psychopathology was found in 95% children. 25% of children were found to have assisted deliveries at birth. 6.25% were found to be pre-term. Post birth around 31.25% of children had other complications (e.g., LBW, Jaundice, Febrile convulsions).

CONCLUSIONS:

Our study showed that DMDD occurs mainly in school aged male children. It was found to be associated predominantly with birth complications.

Comparison of Mental health literacy, Physical health literacy & Stigma among medical graduates & community: A Cross-Sectional study

Background

Mental health conditions contribute significantly to the global disease burden, with stigma and limited mental health literacy hindering early interventions and help-seeking behaviours. Mental health literacy encompasses various abilities, including recognizing disorders and fostering positive attitudes, while health literacy, in general, is essential for informed decision-making and positive health behaviours.

Aim

To assess and compare the mental health literacy, physical health literacy &stigma among medical undergraduates & community.

Method

This study conducted at tertiary hospital in Karnataka is an online cross-sectional observational study. It uses purposive sampling for medical students and snowball sampling for the community, excluding individuals with psychiatric illnesses. The study employs three instruments, including the Reported and Intended Behaviour Scale (RIBS) to assess mental health stigma, the All Aspects of Health Literacy Scale (AAHLS), and the Mental Health Literacy Questionnaire-Short Version for Adults (MHLQ-SVA).

Results

Physical health literacy was more compared to mental health literacy in both groups of medical graduates and community. Stigma was higher in the community compared to medical graduates.

Conclusion

Promoting mental and physical health literacy and reducing stigma in India necessitates a multifaceted approach grounded in scientific evidence. Empowering healthcare professionals with the expertise to identify and address mental health issues, coupled with community education on physical & mental health literacy and stigma’s detrimental effects, can substantially alleviate the disease burden and enhance population well-being.

Cross-sectional study of burnout in university exam attending students

BACKGROUND – University life is a critical phase in a student’s life mixed with intellectual growth, personal development, academic demands, and peak stress-inducing events. The experience of burnout, a state of physical and emotional exhaustion, coupled with reduced performance has become a growing concern. The current study addressed this by assessing burnout in students during university examinations.

AIMS – To assess burnout among university students during examination periods.

METHODS – The cross-sectional study recruited students of Narayana Medical College after obtaining informed consent. Online questionnaires including socio-demographic data of name, age, gender, and academic year along with the Maslach Burnout Inventory were sent to the students via social media. Data were analysed using descriptive statistics and necessary analytical measurements to identify the level of burnout in these individuals and their contributing factors.

RESULTS – Our study found a substantial prevalence of burnout symptoms among the surveyed students, with a significant score between student academic burnout and perceived stress levels. Academic workload, poor sleep quality, and excessive social media usage were identified as the most significant factors.

CONCLUSION – This cross-sectional study sheds light on the prevalence and factors associated with burnout in university exam-attending students and found a significant association between them. Interventions should encompass stress reduction programs, academic support, sleep hygiene, and adaptive coping strategies.

Relationship between internet addiction and sleep quality among Nursing students : a cross sectional study

Background: The number of people using the internet has surged in the last few years and the internet has become a fundamental part of daily life for many of us. As of July 2023, there were 5.19 billion internet users worldwide (64.6 %). Of this total, 4.88 billion (59.9 %), were social media users. Excessive use of internet among adolescents often led to later bedtimes and poor sleep quality. This study assessed the relationship between internet addiction and sleep quality among nursing students of Madurai Medical College.

Aim: To study the relationship between internet addition and sleep quality among nursing students of Madurai Medical College.

Method: This structured questionnaire based cross sectional study enrolled nursing students of Madurai Medical College . We assessed sleep quality and internet addiction using Pittsburgh Sleep Quality Index ( PSQI) and Young’s Internet Addiction Test (IAT)

Results: Our results showed that internet addiction was significantly associated with poor sleep quality. Worse quality of sleep as reflected by PSQI was noted in students with moderate and severe degrees of internet addiction compared to those with mild or no internet addiction .

Conclusion: Our study revealed that internet addiction was found to be significantly associated with poor subjective sleep quality, increased sleep latency, reduced sleep duration, use of sleep medication, and daytime dysfunction. There is a need for programmes to raise awareness towards internet addiction as well as it’s impact on sleep among students.

Subjective Happiness in medical students and correlations with Personality and Coping

Background: Students around the globe choose medicine in the hopes of leading a meaningful and happy life, but the journey is fraught with challenges. With increasing competition and academic demands, student stress levels are rising by the day. In this situation, being mentally healthy and feeling happy becomes paramount for growth and productivity. Various factors, including the student’s personality structure and coping strategies used, might play a role in determining whether he/she stays happy in the face of adversities.

Aim: To assess subjective happiness in medical students, and explore its relationships with various demographic factors, personality traits and coping strategies.

Methods

256 students from BJMC Ahmedabad were enrolled in the study. They filled a proforma with demographic details and three self-report scales: Subjective Happiness Scale for happiness, Big Five Inventory for personality traits, and Brief COPE for coping strategies.

Results

The mean happiness score was 5.06 (range: 1.75-7). Males scored higher compared to females (p=0.009). Final MBBS part1 students had the highest scores (5.4). Extraversion, agreeableness, and conscientiousness positively correlated with happiness, while neuroticism was negatively correlated (all p <0.001). Active Coping, Positive reframing and Acceptance correlated positively, while Self-blame and Substance-use were negatively related to happiness.

Conclusion

Using mean as a cutoff, slightly more students felt unhappy (51.56%) than average, while 28.5% students had happiness levels below/equal to lower limit in general populations. Males, final year students, living with families with multiple hobbies were happier. Extroverts, agreeable and conscientious students, employing adaptive coping strategies like Acceptance were happier compared to neurotic ones using maladaptive strategies like Self-blame.

CASE SERIES REPORT ON VIRTUAL AUTISM

BACKGROUND: New clinical case studies have found that many children who spend a lot of time in front of phone, computer, television or tablet screens may develop a new type of autistic spectrum disorder: virtual autism. Symptoms of autism include lack of social reciprocity, lack of visual contact, lack of language development, lack of play and especially social play, a role in which the child pretends to be something or something and stereotypical and repetitive games.[¹]

Some studies suggest that increases screen time is associated with melanopsin-expressing neurons and decreasing gamma-aminobutyric acid (GABA) neurotransmitter, and thus results aberrant behaviour, decreased cognitive, and language development.[²] Early exposure of electronic media in early life (< 2 years old) gives an impact on language, but it still inconclusive. [³]

AIMS: 1.To study the course of virtual autism over six-month follow-up after stopping screen time completely by assessing on ISSA scale.

METHODS: 14 children with symptoms of autism & with history of early screen exposure are assessed on ISSA scale on first visit ,3 months later,6 months later. Complete abstinence from screen time was promoted and ensured by parents.

These children shown normal developmental milestones prior to screen exposure.

Result: 1. Shows improvement in total score of ISSA over 3 & 6 moths follow-up.

2.IMPROVEMENT IN SOCIAL RELATIONSHIP AND RECIPROCITY

3.Emotional responsiveness score

3.SPEECH LANGUAGE AND COMMUNICATION SCORE

4.BEHAVIOURAL PATTERNS SCORE

5.SENSORY ASPECT SCORE

6.COGNITIVE ASPECT

7.RELATION OF HOURS OF SCREEN USE TO ISSA SCORE

CONCLUTION: -

1. Total abstinence of screen time improves the Autism symptoms significantly over six months.

2. Hours of screen time is directly related to severity of virtual autism.

ABSTRACT FOR PAPER PRESENTATION ASSESSMENT OF BURDEN AND QUALITY OF LIFE OF CAREGIVERS IN SCHIZOPHRENIA IN SOUTHERN RAJASTHAN

1.Dr Anurag Kaur Brar, Junior resident, Department of Psychiatry, AIIMS, Udaipur.

2.Dr Divya Modi, Senior Resident, Department of Psychiatry AIIMS Udaipur.

3.Dr Rohan Modi, Senior Resident , Department of Psychiatry PIMS Udaipur.

Background:

Schizophrenia is a severe and chronic mental disease affecting approximately 20 million people globally. A chronic disease in a family member, particularly a severe mental illness, can adversely affect the function and quality of life of the whole family.

Methodology:

A cross sectional study was conducted on 30 caregivers of schizophrenic patients of either sex presenting to AIIMS psychiatry department. The participants were given liberal verbal explanations and description about the topic of research. After obtaining informed written consent, semi-structured Performa was used to record socio-demographic data of patients, caregivers of schizophrenic patients was assessed by WHOQOL-BREF and Zarit burden interview were applied by the principal investigator.

Results:

The mean age of participants was 38±10.61 years. More participants were female (51.0%), studied up to primary school (32.0%) and perceived their income as inadequate (60.44%). . Family caregivers of patients with schizophrenia reported a high level of caregiving burden, with 36% of the caregivers perceiving severe burden relating to their role. The mean values of each domain of WHOQOL with maximum mean value of 54.65 in domain 1 least mean value in domain 4.

Conclusion:

The study highlights the impact on caregivers of schizophrenic patients in the form of burden and quality of life of caregivers. Hence, there is need to address and provide support to the caregivers of schizophrenia particularly those from lower socioeconomic status.

Prevalance of Psychiatric Morbidities in patients with Acute Coronary Artery Syndrome in a Tertiary Care Hospital

Background

The epidemic of heart disease started in India in the past two decades. Hence this study was undertaken to study the prevalence and pattern of psychiatric morbidity in patients with ACS.

AIM

To study the prevalence and patterns of psychiatric morbidity and life stressors in patients with ACS and to assess its relationship between socio demographic variables.

Methods

This is a cross sectional study done on 60 patients with acute coronary artery syndrome admitted in cardiology ward in theni medical college. Semi structured interview was done to assess the socio demographic data. The diagnosis of psychiatric disorders was made based on the MINI international neuropsychiatric interview. Modified Kuppuswamy rating scale for socio economic status ,Hospital anxiety and depression scale ,Eysenck Personality Inventory ,Presumptive stressful life events scale ,Hostility and direction of hostility was applied on the patients. Data analyzed using SPSS software version 17.0

Results

Significant number of our study subjects had higher incidence of depressive states (46.7%), anxiety states (45%) and features of neuroticism (56.6%) and higher incidence is noted with the increase in age. The difference was statistically significant. With increased frequency of neuroticism and stressful life events, there was increase in depressive and anxiety features

Conclusion

Psychiatric morbidity especially depression and anxiety along with stressfull life events is more common in patients with ACS. These results support the view that psychological stress plays a role in ACS.

perceived stress and coping in undergraduate medical students in different phases of mbbs course : a comparative study

Dr. Sunetra Adhikary¹

Dr. Kamala Deka²

1.Post Graduate Trainee. Department of Psychiatry, Jorhat Medical College and Hospital, Jorhat

2.Professor & Head of the Department, Department of Psychiatry, Jorhat Medical College and Hospital, Jorhat

Presenting Author: Dr. Sunetra Adhikary*

*PGT, Jorhat Medical College and Hospital, Jorhat Mobile no: 9163562200, Email: mbbskpc.sha@gmail.com

Background: Medical curriculum is vast and stressful. Perceived stress often exerts negative impact on medical students’ physical health, academic performance and psychological well beings. Keeping these facts into consideration, Competency Based Undergraduate Curriculum was implemented from August 2019 in India which offers more efficient and effective way to teach medical students.

Aim: To study Perceived Stress and Coping in Medical Students in different phases of undergraduate MBBS student of CBME course.

Methods: A comparative study conducted among under-graduate students of CBME course studying at a government tertiary care hospital situated in Jorhat city of Assam. Using Systematic Random sampling technique, a total of 220 out of 528 medical students, consisting 55 students from each phase [phase-I, II, III(part-1) and III(part-2)]were invited to participate in the study. A self-administered questionnaire consisting of sociodemographic details and perceived stress scale questions, General Health Questionnaire(GHQ-12), Brief COPE-28 questions were used.

Results: Perceived stress in individual phases of undergraduate medical students showed tendency to have mostly moderate stress in every individual phases though phase wise no statistically significant difference of stress level found. General (non-psychotic) mental health problems among the individual phase of medical students showed distress is maximum in Phase-I but there is no statistically significant distress level difference between different individual phases. In every phase medical students mainly adopted problem focussed coping strategy. Emotional focused coping was significantly higher in Phase I and lowest in Phase III(P-1)and avoidant type also significantly higher in Phase I and significantly lower in PhaseIII(P-1).

Conclusion: While several studies reported significant high perceived stress among undergraduate medical students earlier but we found that after CBME course implementation, majority of students faced moderate level of stress in individual phase with less general mental health problem and their coping strategies had been improved as the study year progressed in individual phases though few maladaptive coping strategies were found significantly high in phase-I.

Keywords: Perceived stress, CBME course, general mental health, coping strategy.

Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and its association with Severity of Depression and as a Biomarker for suicidal behavior.

Dr Swathi¹, Dr Niranjan Hebbar Y R², Dr Harisha Delanthabettu³, Dr Shubrata K S⁴, Dr Sai Komal⁵

¹Postgraduate Student, ^2,5Assistant Professor ,³Professor and HOD, ⁴Professor, Department of Psychiatry, Subbaiah Institute of Medical Sciences, Shimoga.

Background

Depression has a significant impact on a person’s quality of life and is a leading cause of death by suicide that is often ignored. Growing evidence points to a function for the immune and inflammatory systems in the pathophysiology of depression. Studies have shown that Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) is positively associated with depression severity and may be a peripheral biomarker of suicidal behaviour in depressed patients.

Aim

The aim of this study is to find NLR, PLR values in patients with Depression and its association with the severity of Depression and to test its validity as a biomarker for suicidality.

Methods

The study population consisted of 150 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into 3 groups according to their HAM-D score such as mild, moderate and severe depression. NLR and PLR values are estimated.

Results

Patients with higher HAM-D score had significantly higher NLR and PLR levels compared to patients with lower HAM-D score. No significant association was found in the distribution of NLR and PLR values with Gender. NLR and PLR values were substantially higher for the Suicide Attempters group than the Non-Suicide Attempters. The optimal cutoff value for NLR in predicting the risk for Suicide attempt was 1.96 with sensitivity of 75%, and specificity of 74%.

Conclusion

Our data suggest that NLR and PLR may be an easily accessible and cost-effective strategy to determine suicide risk in Depression.

ANCIPS 2024: Abstract for free paper: A cross sectional study on Psychiatric morbidity in female patients undergoing infertility treatment in a tertiary care hospital.

Dr. K.Abinaya (3rd year Post Graduate), Dr. Arun Narayan Pradeep (Associate professor), Dr. Arul Saravanan (Professor and HOD)

BACKGROUND: While psychological distress can cause infertility, patients undergoing infertility treatment can also suffer from psychiatric morbidities like depression, anxiety, eating disorders etc., Even though there’s a fairly good amount of research about psychiatric morbidity and infertility treatment, there’s a shortage of such studies in Indian population.

AIM :

• 1)To identify psychiatric morbidity in females undergoing infertility treatment by using a screening tool – MINI Psychiatric assessment scale.
• 2)To study the quality of life of patients who undergo infertility treatment by using FertiQOL scale.

METHODS : It is a cross sectional study conducted in Department of Obstetrics and Gynaecology and Department of Psychiatry for a period of 6 months from April 2023

• September 2023. Study population is female patients aged between 18 years to 45 years after getting informed written consent. A total of 150 females with infertility were enrolled for the study. Tools used are Semi structured proforma for clinical & socio demographic variables, MINI, HAM D (Hamilton scale – Depression), HAM A (Hamilton scale – Anxiety), SCOFF Questionnaire and FertiQOL (Fertility Quality of life).

RESULTS : Socio demographic factors have been seen to affect the mental health significantly. Psychiatric morbidity is more in females with treatment failures in past compared to those seeking treatment for the first time. Out of 150 females assessed 68.67% had associated psychiatric morbidity. Depression was found in 35.33% females, anxiety in 26.67%, Mixed anxiety and depression in 3.33%, OCD in 1.33% and eating disorder in 2%.

CONCLUSION : Infertile females undergoing treatment procedure report that it is a stressful and exhausting experience and thereby experiencing their willingness to pursue psychiatric intervention as a part of their infertility treatment. The result from the present study suggest that health care professionals dealing with infertile individuals should be alert to symptoms reflecting psychiatric morbidity

Background. Stigma associated with mental disorders is largely responsible for people with mental illness not receiving adequate care. Self-stigma is likely to vary with the stage of illness and the care experience. Inpatient setting offers an opportunity to assess self-stigma following acute worsening of mental health. Aim: The aim of the study was to understand the frequency and correlates of self-stigma during acute mental healthcare in inpatient setting.

Methods: Stigma was measured using Internalized Stigma of Mental Illness Inventory – 9-item (self-report) Version. It measures five themes of internalized stigma of mental illness.Higher scores on this scale indicates higher self-stigma.

Results: The sample consisted of 100 consecutive inpatients. The sample were mostly male (65%); married (61%), unemployed (56%), 83% were educated at high school level or above. Diagnostic breakdown suggested that 29% had psychotic disorders, 13% bipolar disorder, 8% depression, 10% personality disorder, 20% alcohol dependence and 20% other diagnoses. Mean stigma at admission was 16.99 ± 6.5 (n=84). 65% of patients reported minimal stigma. Higher levels of stigma were reported by 19.3% patients.

Stigma correlated with many variables studied at admission. Age, depression, anxiety, impairment in work (WSAS score) and insight had positive correlation while well-being had negative correlation with stigma.

Self stigma has not been studied in Indian population immediately following an acute worsening of mental health.

Conclusion: Self stigma reported in this population ( 19 %) is considerably less than reported in previous studies.

A descriptive study on pattern of consultation liaison psychiatry in a tertiary care centre in North Karnataka

Bennis Baby, Sumati Arikera, Chandrashekhar T R

Background:

Consultation-liaison psychiatry is a sub-specialty which includes all diagnostic, therapeutic and research activities of psychiatrists in the non psychiatric divisions of a hospital. Psychiatrists have an important role in providing holistic care to people with various physical illnesses.

Objectives:

To assess specific patterns of consultation liaison to psychiatry, psychiatric diagnosis, and interventions among inpatients and to explore demographic factors.

Methodology:

A cross-sectional study was conducted assessing inpatients fulfilling the inclusion and exclusion criteria referred to the Psychiatry Department for Consultation-liaison Psychiatry over 1 month in a tertiary care hospital. The subjects were assessed by a semi structured proforma and ICD-10.

Results

62 patients were included and assessed after referral from various departments, of which 67.7% were male; the mean age of the sample was 36.2 years. 77.4% were from rural areas. The mean days of referral were 3.6 days. The medicine department contributed to maximum referrals (53.2%).The most common psychiatric diagnosis was alcohol and nicotine dependence (22.6%). Past history of psychiatric illness was seen in 27.4%. 64.5% received both psychotherapy and pharmacotherapy. Association was found between gender, department and treatment offered with psychiatric diagnosis.

Conclusion

By addressing the psychiatric co morbidity while continuing treatment for the surgical/medical illnesses gives a holistic approach towards our patients that can influence not only the course but also the quality of life of them.

Study of prevalence and association of psoriasis with anxiety disorder- A cross sectional study in southern Rajasthan

BACKGROUND: Psoriasis is a chronic inflammatory dermatological condition characterized by skin lesions covered with white or silver scales with a strong genetic susceptibility, and complex autoimmune pathogenesis. This illness may predispose people to mental disorders such as depression and anxiety. Stress and emotional disturbances have been implicated in both triggering the onset and exacerbation of psoriasis.

AIM: The study aimed to assess the magnitude of psoriasis and anxiety disorders/anxiety symptoms association.

METHODS: After obtaining clearance from the Institutional Ethics Committee and written informed consent from individual study subject, 30 consecutive patients with confirmed diagnosis of psoriasis attending the dermatology outpatient department of a tertiary care centre were included in this cross-sectional study. Diagnosis was made using ICD-10 and a semi- structured proforma designed for this study along with Hamilton anxiety rating scale (HAMA), Psoriasis area severity index (PASI) were used to assess the prevalence of anxiety and psoriasis respectively.

RESULTS: Majority of patients were male aged 35-50 years among them most were educated upto high school, employed, married belonging to nuclear family with urban background. This study revealed mild anxiety symptoms on HAMA scale. In our study there was significant association of psoriasis severity with HAMA severity.

CONCLUSION: Patients with psoriasis have a clinically significant prevalence of anxiety. The association between depression features, anxiety with psoriasis severity is important and can influence the appropriate management of psoriasis.

Key words: Psoriasis, Anxiety, HAMA, PASI.

BDNF Val66Met Polymorphism in patients with major depression from North India.

Background: The brain derived neurotrophic factor (BDNF) plays a critical role in the neuronal growth and synaptic transmission. The Val66Met polymorphism of BDNF gene has been studied in depression, with conflicting findings.

Aim: The study assessed the BDNF gene polymorphism and its association with clinical variables in patients with major depressive disorder (MDD).

Methods: A total of 87 treatment-seeking adult patients with DSM-5 MDD were recruited from a tertiary care teaching hospital in Delhi. All cases were currently depressed, without any co-occurring psychiatric or medical illness. Cases were assessed using NIMH-Life Chart Method, 17-item HAM-D, Clinically Useful Depression Outcome Scale and Clinical Global Impression. Five ml of venous blood sample was collected. After DNA extraction, the genotyping for rs6265 was carried out using TaqMan assay.

Results: Mean age of the participants was 35.32±11.69 years (48% males, 52% females). Allelic distribution was 33% (Met), 67 % (Val) and genotypic distribution was 51% G/G (Val/Val), 32% G/A (Val/Met) and 17% A/A (Met/Met). The allelic distribution didn’t significantly differ with gender (p =0.59). No relationship was found with age of onset, family history, lifetime suicidality and severity of depression.

Conclusion: The study adds to the limited information on frequency of Val66Met polymorphism in patients with MDD from Indian settings. The Val66Met polymorphism did not have an association with illness variables.

Keywords: Val66met polymorphism, Brain derived neurotrophic factor, depression, India

Raja Babu Ramawat (presenting author), Ram Kumar, Rizwana Quraishi, Raman Deep, Raka Jain

Catatonia in a case of Borderline Intellectual Functioning: A case report

Introduction

Catatonia is defined as a marked decrease in reactivity to the environment” characterized by negativism, mutism, stupor, repeated stereotyped movements, staring, and grimacing. Individuals with neurodevelopmental disabilities (NDDs) may be at increased risk for catatonia. Current prevalence estimates of catatonia in NDDs vary widely from 6 to 20.2%.

Case Presentation

A 30 year old female presented with complaints of decreased interaction, maintaining odd postures, vacant staring spells, standing at one place for long and refusal to eat or drink since 8 days. Patient had no history of any psychotic or mood disturbances in the past.

Patient was admitted in psychiatric ward and medicine referral was sought to rule out organcity. On lorazepam challenge test patient showed improvement within 15 minutes where patient started speaking and her negative symptoms subsided. She was treated thereafter with Tab. Lorazepam 6mg.

Patient’s IQ test was done and her IQ was 72 s/o Borderline Intellectual Functioning.

DISCUSSION:

To date, there is no literature discussing older adult patients with IDs and catatonia. This is likely secondary to the under identification of catatonia as well as the complexity of treating patients with IDs. With the change in the DSM-5 diagnostic criteria, hopefully awareness of catatonia as an entity separate from psychosis will increase awareness of catatonia in adults with IDs. Better tools are needed to help monitor and treat these patients.

Care Seeking Challenges for Women with Mental Illnesses: A mixed method study

BACKGROUND: One in seven Indians suffer from varying severities of mental disorders, with a higher prevalence in females, potentially due to gender discrimination and adverse socio-cultural norms. Addressing gaps in mental healthcare delivery and providing effective prevention and treatment programs for women is thus, crucial.

AIMS: To estimate the onset of illness and the time to reach a diagnosis, assess the health care service utilization by women with mental illness, and explore the patient and caregiver perspective towards care challenges.

METHODS: A cross-sectional study was conducted at a tertiary medical college hospital in Bhubaneswar, employing a mixed-method design including questionnaires (quantitative) and subsequent interviews (qualitative) with caregivers and patients. 312 women participated, exploring their quality of life, care-seeking pathways, and healthcare expenses. 25 participants experiencing over a 6-month delay in reaching their diagnosis underwent in-depth interviews to investigate the reasons for delay and challenges faced during care-seeking.

RESULTS: Approximately 42.2% of patients reported more than a 6-month delay from symptoms onset to consulting a healthcare provider, primarily due to unawareness of their illness’s symptoms and treatments. Most of them depended on others for treatment decisions. Many initially sought advice from traditional healers and consulted multiple physicians before receiving a definitive diagnosis, incurring significant out-of-pocket expenses.

CONCLUSION: The study shows a notable delay in diagnosing mental disorders in Indian women, primarily due to misconceptions related to symptoms and treatments, resulting in multiple consultations and elevated expenses. This highlights the immediate need for enhanced awareness, easily accessible healthcare, and specific interventions for women.

Management of Tardive Dyskinesia and Tardive Dystonia with Clozapine: A Retrospective Study

Nishtha Chaurasia, Sandeep Grover

Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh

Background: Tardive Dyskinesia and Tardive Dystonia are among the most disabling side effects of antipsychotics. Limited information is available about different management strategies for Tardive Dyskinesia and Tardive Dystonia. Aim: To evaluate the effectiveness of clozapine in the management of tardive dyskinesia. Methodology: Using a retrospective study design, 54 patients with drug-induced Tardive dyskinesias and Tardive dystonias were identified who were treated with clozapine for management of Tardive Dyskinesia and Tardive Dystonia and underlying primary mental illness or used only for the management of Tardive Dyskinesia and Tardive Dystonia. Results: Clozapine was used in 54 patients (35 males, 19 females) with Tardive Dyskinesia and Tardive Dystonia. Most of the participants (n=18) developed Tardive Dyskinesia or Tardive Dystonias or both while receiving risperidone (18) followed by olanzapine (n=12), haloperidol (n=7), aripiprazole (n=2), Amisulpiride (n=1), fluphenazine (n=2), trifluoperazine (n=2), and lurasidone (n=2). Majority of these patients were diagnosed with schizophrenia (n=39), followed by schizoaffective disorder (n=1), Psychosis NOS (n=4), bipolar disorder (n=2), and depressive disorder (n=7). Majority of the patients showed significant improvement in Tardive Dyskinesia or Tardive Dystonias with clozapine, with mean dose of clozapine required for management was 170.43 (SD: 83.21). Conclusion: Clozapine is an important option for management of Tardive Dyskinesia or Tardive Dystonias.

Background

Women are faced with various social disadvantages during their lifetime which combined with the biological vulnerability poses them to a range to psychiatric conditions.

AIMS

To measure the association of perceived stress and social support with common mental disorders in women.

METHODS

• Cross sectional observational case control study.

90 Cases, 90 Controls (after putting values)

• SCHEMA

RESULTS

Cases were significantly associated with higher mean stress scores as well as lower mean social support scores with a significant difference between them(p<0.0001).

CONCLUSION

CMDs were found to be associated with higher social stress and lower social support hence focus needs to be broadened and shifted from ‘individual’ to ‘sociocultural factors’, so that the misattribution to women responsible for causing their own illness can be minimised.

Attitude of Interns towards Mental Illness and Psychiatry : A Study from Tertiary Care hospital

Background:

Prevalence of psychiatric disorders in India is rising, with cumulative rate of 14.9/1000 in rural and urban areas. However, there is severe shortage of psychiatrists, with only 0.75 psychiatrists per 1 lakh people compared to recommended 3 per 1 lakh. Worldwide, medical graduates often hesitate to pursue psychiatry due to misconceptions and stigma. In India, undergraduate medical education allocates only 1.4% of teaching time to psychiatry, while countries like Denmark and USA dedicate significantly more hours.

Aims:

This study investigates interns attitude towards psychiatric patients and illness, psychiatry branch, psychiatrists, psychiatric treatment and hospitals, psychiatric knowledge and teaching. Research aims to determine if exposure to psychiatry postings influences interns attitudes.

Methods:

This longitudinal and comparative study focuses on interns in psychiatry.After Ethical approval , the study spans 3 months. Data collection tools include a sociodemographic intake proforma, ATP 30 scale (a 30-item questionnaire evaluating attitude towards psychiatry), and Modified Kuppuswamy Scale . Inclusion criteria involve interns attending compulsory psychiatry postings, exclusion criteria pertain to interns with psychiatric family history, undergoing mental health treatment, or having relatives working as psychiatrists.

Conclusions:

This study elucidates interns attitudes towards psychiatry and examines if psychiatry postings positively influence their perspectives. Understanding these attitudes is critical for enhancing mental healthcare in India and potentially attracting more medical graduates to psychiatry. The findings may guide strategies to dispel misconceptions and reduce stigma associated with the field.

Prevalence and Risk Factors of Suicidal Ideations in patients presenting to Psychiatry Department of Tertiary Care Hospital

Dr. Kritika Sharma¹, Dr. Gurmeet Kaur Brar², Dr. Ramit Gupta³, Dr. Manpreet Singh⁴

1.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

2.Professor, Dept. of Psychiatry, AIMSR, Bathinda

3.Associate Professor, Dept. of Psychiatry, AIMSR, Bathinda

4.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

BACKGROUND: Suicide is preventable and closely tied to mental disorders. The World Health Organization highlights the importance of mental well-being. 90% of suicide deaths involve mental disorders, especially when comorbid with depression and other psychiatric conditions like anxiety or bipolar disorder. Understanding the effects of comorbidity is crucial in explaining the connection between mental disorders and suicidal behaviour.

AIM: To study the prevalence and risk factors of suicidal ideations in patients presenting to psychiatry department of tertiary care hospital.

METHODS: A cross-sectional study was conducted at Department of Psychiatry, AIMSR, Bathinda, Punjab on 40 patients of either sex of 19-60 years of age diagnosed with a psychiatric disorder according to ICD-10 DCR to study the prevalence of suicidal ideations using a semi-structured sociodemographic proforma, Beck’s Suicide Intent Scale; Depression Anxiety Stress Scale 21-(DASS-21) and Hopelessness Scale of Beck et al.

RESULTS: The overall prevalence of suicidal ideations among patients was found to be 25%. Out of these, 60% patients had depressive disorder, 20% anxiety disorder, 10% bipolar disorder and 10% substance use disorder. Suicidal ideations were commonly observed in patients with depression and other mood disorders. Suicidal ideations were prevalent in 18-30 age group, especially among students. Family problems emerged as the predominant risk factors along with lack of support systems.

CONCLUSION: Increased suicidal ideations were associated with high levels of anxiety, stress, depression and hopelessness which was most commonly observed in patients with depression amongst other psychiatric disorders.

Keywords: suicidal ideations, anxiety, depression, hopelessness

THE RELATIONSHIP BETWEEN PARENTING STYLES AND TEMPERAMENT IN CHILDREN

Dr. Anil Kumar G, Resident, Dr. Sudarshan C Y. Professor & HOD

Department of Psychiatry, J.J.M Medical Collage, Davanagere-577004, Karnataka.

BACKGROUND

Parenting style refers to pattern of child rearing arising from parent’s behavior towards their children. Parenting styles of each parent can be related. Temperament refers to relatively consistent, basic disposition inherent in a person that underlies and modulates the expression of activity, reactivity, emotionality and sociability. Child’s temperament and Parenting style influence one another.

AIM

To assess the relationship between Parenting styles of parents & Perceived parenting style by children and between Parenting styles and Temperament.

METHODS:

Sample consisted of 100 Children aged between 13 to 14 years. After obtaining Informed consent socio-demographic details were elicited. Parenting style questionnaire was used to assess parenting styles in both parents. Perceived Parenting style was administered to children. Temperament in children was assessed by Temperament measurement schedule(TMS). Relationship between parenting styles of parents & perceived parenting style by children and relationship between parenting style and temperament was assessed. IBM SPSS Version 22 for windows was used for analysing data.

RESULTS.

70% children were from nuclear family. Authoritative parenting style was most common parenting style in both parents which was corroborated by their children. There was no relationship between parenting styles of parents. Perceived authoritative parenting style by the child had significant positive correlation with authoritative parenting style of both parents. On TMS children had average score on all items. Temperament in children had no relationship with parenting style.

CONCLUSION.

Perceived parenting style and self reported parenting style are related to one another.

Temperament was not related to parenting style.

Evaluation of factors determining functional remission in patients with schizophrenia

Dr. Navanita Sarma, Dr. Prosenjit Ghosh, PRESENTER- Dr. Navanita Sarma

Mobile- 9101078245, Email- yutika.sarma555@gmail.com

BACKGROUND- Schizophrenia is a chronic psychiatric disorder which results in deterioration of functioning in daily life, interpersonal relationships and occupation. Functional remission in patients with schizophrenia is a critical goal of treatment.Several factors can determine functional remission and they are multifaceted and interconnected. Therefore, a better understanding of them is very important in developing strategies for better treatment of schizophrenia.

AIMS AND OBJECTIVES- To study the factors determining functional remission in patients with schizophrenia.

METHODOLOGY- The study was a hospital based cross-sectional study and conducted among patients fulfilling the inclusion criteria. A semi- structured interview was developed to collect the data which included the socio-demographic details and disease related characteristics and tools like GAF( global assessment of functioning), PANSS( positive and negative symptoms scale), CGI ( clinical global impression) and FROGS ( functional remission of general schizophrenia scale).

RESULTS- The majority of the population belonged to low socio-economic class. The findings showed that functional remission was positively correlated with social support, drug compliance and negatively correlated with number of hospitalizations and duration of untreated illness.

CONCLUSION- It was concluded from the study that social support, drug compliance, less number of hospitalisations and less duration of untreated illness are the factors positively impacting functional remission in schizophrenia. Treatment plan addressing these factors can play a significant role in the functional remission.

Prevalence of Psychiatric Comorbidities in Opioid Use Disorder Patients in Tertiary Care Hospital

Dr. Manpreet Singh¹, Dr. Gurmeet Kaur Brar², Dr. Ramit Gupta³, Dr. Kritika Sharma⁴

1.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

2.Professor, Dept. of Psychiatry, AIMSR, Bathinda

3.Associate Professor, Dept. of Psychiatry, AIMSR, Bathinda

4.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

BACKGROUND: A rapid rise of drug abuse is seen in India past causing a major health problem with a prevalence of 0.7% in 2003, increased to 2.1% in 2019. In Punjab, opioid use is 9.69% with dependence of 1.28%. Among chronic opioid abusers, a high prevalence of psychiatric comorbidities is being seen at an alarming scale. Occurrence of psychiatric comorbidities further lead to increase in administration of opioids.

AIMS: To study the prevalence of Psychiatric Comorbidities in Opioid Use Disorder Patients in Tertiary Care Hospital.

METHODS: A cross-sectional observational study was conducted at Department of Psychiatry, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab on 40 patients. Patients of age 19-60 years diagnosed with Opioid Use Disorder using DSM-5. Patients were assessed using semi-structured sociodemographic proforma, Hamilton Anxiety Rating Scale-(HAM-A), Hamilton Depression Rating Scale-(HDRS), Young Mania Rating Scale-(YMRS) and Positive and Negative Syndrome Scale-(PANSS).

RESULTS: The overall prevalence of psychiatric comorbidities among patients of opioid use disorder as per HAM-A, HDRS, YMRS and PANSS was found to be 27.5%. The following psychiatric comorbidities were found: Anxiety disorder- 7.5%, Depression-12.5%, Depression and Anxiety- 2.5%, Psychosis- 2.5%, Mood Disorder with Psychotic Features- 2.5%. Psychiatric comorbidities were more prevalent in 19-30 age group, unemployed and unmarried individuals.

CONCLUSION: The psychiatric comorbidities are highly prevalent among patients of opioid use disorder. These often-neglected comorbidities need to be considered in the management for preventing relapse, improving adherence to treatment and better functional outcome in patients.

opioid use disorder, psychiatric comorbidities

ABSTRACT FOR ORAL PAPER PRESENTATION

Researcher : Dr Sanjana K, Post Graduate Resident, Mandya Institute of Medical Sciences

Guide: Dr Bhagyavathi HD, Professor and HOD, Mandya Institute of Medical Sciences

The Association Between Attention Deficit Hyperactivity Disorder And Age Of Onset Of Alcohol Dependence: A Cross Sectional Study

Background:

Attention Deficit Hyperactivity Disorder(ADHD) is common but often underrecognized¹ in patients with Substance Use Disorder(SUD). Early Onset alcoholism perhaps represents a more severe and heritable subtype, which is associated with externalizing disorders such as ADHD and conduct disorder.

Aim:

To evaluate the relationship between ADHD and age at onset of Alcohol Dependence Methodology:

100 patients aged 18-65 years, presenting to the Psychiatry Department of Mandya Institute of Medical Sciences, who meet ICD-10 Diagnostic Criteria for Alcohol Dependence Syndrome (ADS) were included after informed consent, using purposive sampling method over 3 months. Subjects with co-morbid psychiatric illness or other substance dependence, except nicotine were excluded.

The patients were divided into Early Onset and Late Onset groups.

For retrospective assessment of childhood ADHD, the Wender Utah Rating Scale was used, and ASRS checklist to assess ADHD in adulthood. Data will be entered in excel sheet and descriptive analysis will be done. Chi-square tests and odds ratios were used to express the relative risk of association of ADHD with early-onset ADS.

Discussion:

With few studies done in India, there is a substantial need for evaluation of ADHD in adults with Alcohol Dependence Syndrome, especially those with an Early Onset of ADS, and more intensive management of this high-risk group in view of their poorer prognosis.

Background:

In patients receiving antipsychotics sexual dysfunction is prevalent due to multiple factors but they do not receive much medical attention. Lack of compliance to medications is one of the important risk factors for relapse in patients having Schizophrenia. Sexual dysfunction may contribute to lack of medication adherence.

Aims and Objectives:

To determine and compare the sexual dysfunction and medication adherence between patients taking Olanzapine and Risperidone.

Materials and Methods:

A comparative study on 309 patients having schizophrenia was conducted in a tertiary care center in Hyderabad. Sexual dysfunction was assessed using the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) and medication adherence using Medication Adherence Rating Scale (MARS). The data was analysed using SPSS version 26.

Results:

65% and 50% of the patients maintaining remission on Risperidone and Olanzapine respectively reported sexual dysfunction. Medication adherence was greater with Olanzapine than Risperidone.

Conclusion:

To improve medication adherence the clinician must evaluate sexual dysfunction in Schizophrenia patients as a part of their regular follow-up and provide necessary timely interventions. For a sexually active patient, possible sexual impairment must be given adequate consideration before choosing an anti-psychotic.

Pituitary microadenomas presenting with Psychiatric manifestations: Case series of 5 patients

1. Dr. Soham Palui 2. Dr. Dipanwita Biswas

1.Junior Resident, NRS Medical College and Hospital,

Kolkata, India

2.Senior Resident, NRS Medical College and Hospital, Kolkata, India

Introduction- Apart from the visual change and endocrine abnormalities, Tumours is pituitary may present with symptoms that mimic psychiatric manifestations. Microadenoma of pituitary is usually less than 10mm and macroadenoma is more than 10mm. There are case reports of psychiatric problems associated with expansive macroadenomas but very few reports on initial psychiatric presentations of microadenomas. Here we present a series of cases having pituitary microadenoma with psychiatric manifestations.

Patients and methods- Two patients presented to Endocrine outdoor with endocrine problems along with psychiatric features like irritability, headache, non-suicidal self-injurious behaviour, dissociative features like regressive child-like behaviour etc.

Other 3 cases presented to Psychiatry outdoor with symptoms of persisting headache, dissociative unresponsiveness, depressive features etc. and they were found to have Pituitary microadenoma during evaluation. The case history of them are discussed.

Results- We found psychiatric symptoms associated with pituitary microadenomas in relatively young age group with mean age of 24 years with female to male ratio of 4:1. One patient was gainfully employed, while one was student and other three were homemakers. Out of 5 patients 2 had elevated Prolactin level and only 1 patient had hypothyroidism. In 4 cases psychiatric symptoms resolved in next 2 months with treatment with gradual discontinuation of medicines in next 6 months, in 1 patient whose symptoms of anxiety and insomnia still persist for last 2 years.

Conclusion: Findings highlight need for high suspicion for organic cause and imaging in psychiatric presentations for timely diagnosis and outcome is favourable with treatment.

Neurological soft signs in non psychotic siblings of psychotic patients – a cross sectional study

Dr.T.Lavanya¹,Dr.A.Balaji²

¹MD Postgraduate ,Department of psychiatry , Kilpauk medical college and hospital, Chennai.

²Assistant professor , Department of psychiatry , Kilpauk medical college and hospital, Chennai.

Background:

Neurological soft signs (NSSs) are “objectively measured, non localizing abnormalities, not related to impairment of a specific brain region, reflecting improper cortical-subcortical and intercortical connections.” The possibility of NSS as an endophenotype in schizophrenia has been studied across the globe. In this study , we are observing the prevalence of neurological soft signs in non psychotic siblings of schizophrenic patients to understand the specific neurological abnormalities in three functional areas of interest such as sensory dysfunction , motor incoordination and impaired sequencing of complex motor acts.

Objectives :

To study the prevalence of neurological soft signs in non psychotic siblings of schizophrenic patients .

Methods :

A total of 30 Non psychotic siblings of Schizophrenia patients , attending the psychiatry department at a tertiary health care , kilpauk medical college Chennai taken into study .Diagnosis made according to ICD 10 or DSM 5 and Neurological soft signs in each group were assessed with the Neurological Evaluation Scale (NES).

Results :

In our study , to measure the severity of neurological impairment, the total score and scores for each of the four subscales were used. When 15 was considered the cut-off point, 30% of their siblings had abnormal neurological signs.

Conclusion: Our results confirm the findings of previous studies suggesting a higher prevalence of NSS in non psychotic siblings of schizophrenic patients ,which have the important implication that neurological impairment in schizophrenia may be familial and trait-like in nature. Neurological soft signs aggregate in the family members of schizophrenics and suggest common genetic and/or environmental factors in the pathogenesis of these abnormalities.

Sensory processing difficulties in children and adolescents with attention deficit hyperactivity disorder

Background -There is a significant overlap between symptoms of Attention-deficit hyperactivity disorder (ADHD), such as impulsivity, inattention, and or hyperactivity and sensory processing difficulties. Sensory processing difficulties are impairments in responding to sensory stimuli such as impairments in detection, modulation, or interpretation of stimuli. In our population, there are not many studies which have looked into various sensory processing difficulties and its correlation with ADHD.

Aim – To assess sensory processing difficulties in children and adolescents with Attention Deficit Hyperactivity Disorder, correlation between sensory processing difficulties and severity of ADHD, to assessing global functioning in these children

Method – 90 children diagnosed with ADHD as per DSM 5 were interviewed after getting consent from parents and participants were assessed using detailed proforma and Short sensory profile, to assess sensory processing difficulties; Children’s Global Assessment Scale (CGAS), to assess functioning in children; Vanderbilt scale, to assess severity of ADHD

Results – There is a significant prevalence of sensory processing difficulties in children with ADHD and there is a positive corelation between children having sensory processing difficulty and severity of ADHD, and impact on functioning correlates with sensory processing difficulties

Conclusion – Sensory processing difficulties are common in children with ADHD, understanding regarding its impact and management needs further research

“Heterotypic clinical presentation in adolescents and young adults with Bipolar Affective Disorder: A Case Series”

Background: The major contemporary classificatory systems like ICD (International Classification of Diseases) and DSM (Diagnostic and Statistical Manual) are categorical and divide psychiatric disorders into symptom-clusters. However, many psychiatric disorders may have varied clinical presentation. They may show unconventional concurrent symptoms (polymorphic) or the symptom presentation may change over time (heterotypic). Presence of certain symptoms at early age may predict a presence of different disorder at later period of time. This leads to diagnostic dilemma and treatment challenge.

Methodology: A detailed examination of prodromal symptomatology with special reference to adolescent and young patients aged 14 – 24yrs was carried out in inpatient population. Patients were assessed for symptoms at onset of illness and final presentation. Many cases of BPAD (Bipolar Affective Disorder) showed a heterotypy in their clinical presentation or sub-threshold symptoms that served as a precursor to BPAD. Five such cases showing distinctly divergent symptoms that later organized into BPAD-cluster are presented in this case series.

Discussion: This case series highlights the importance of age, concurrent symptoms and consideration of co-morbidities for a diagnosis in young patients. The concurrence of dual diagnosis may lead to volatile destabilization of the other. It unveils difficulties inherent in the concept and challenges in diagnosis and management as well as prognosis.

BACKGROUND: Diabetes Mellitus is an illness associated with a wide variety of complications. Its implications on sexual functioning, especially among women are yet to be explored adequately. Problems pertaining to sexual functioning when addressed adequately will have a direct impact on the quality of life of these women.

AIM: The objective of this study is to determine the prevalence of sexual dysfunction in females with diabetes mellitus and evaluate the risk factors associated with it.

METHODS: Participants for this cross-sectional study are recruited from the Endocrinology OPD, SRIHER, based on selection criteria after obtaining their informed consent. Details were obtained with the help of a semi-structured proforma and sexual functioning was assessed using the Female Sexual Function Index and a diagnosis of sexual dysfunction was made based on DSM-5 criteria.

RESULT: Preliminary analysis of an ongoing study on female individuals with diabetes revealed significant challenges including limited education and unemployment. Dyslipidemia and hypertension were prevalent, significant proportion reported health complexities such as ulcers, untreated illnesses, and mobility limitations, underscoring the multifaceted nature of their health issues. Although a significant proportion of participants voiced apprehensions over their sexual health, none of them indicated experiencing any psychological disturbance. This implies that although sexual difficulties are common among women with diabetes, they may not necessarily result in psychological anguish.

CONCLUSION: The results of the study show that it is crucial to prioritize the management of sexual health difficulties as part of a complete approach to diabetes care and overall holistic well-being.

Background: Diabetes mellitus (DM) is a chronic disease inducing short-term and long-term complications including sexual dysfunction (SD) which can consequently reduce patients’ quality of life. SD is an often-overlooked condition which has consequences on the psychological well-being and reproductive function.

Aim: The objective of this study is to determine the prevalence of sexual dysfunction in males with diabetes mellitus and evaluate the risk factors associated with it.

Methods: This is a cross sectional study. All male patients with type 2 diabetes mellitus attending Endocrinology OPD, SRIHER were screened based on the selection criteria. Patients were recruited after a detailed description of the study and getting informed consent and their details were noted using a semi structured performa. Sexual dysfunction was diagnosed based on DSM5 criteria and by using the International Index of Erectile Dysfunction (IIEF).

Results: In our ongoing study involving males with diabetes, initial analysis has revealed a association between diabetes and lower educational attainment, alongside the co-occurrence of high cholesterol and hypertension. There was notable variability in sexual health, with instances of satisfactory sexual outcomes despite suboptimal desire and arousal levels.

Conclusion: These early results underscore the need for further research to deepen our understanding of these observed trends and holistic healthcare, considering medical and psychosocial aspects among diabetic individuals. Further investigation is ongoing.

description of symptomatology and phenomenology of Acute and transient psychotic disorders: cross sectional study

Background: Acute and transient psychotic disorder (ATPD) is a common psychotic phenomenon occurring frequently in developing countries. Has a polymorphic picture. its symptomatology and phenomenology not seen in other disorders; it differs from schizophrenia in various aspects. Several subgroups identified by ICD -10

Aims: 1) describe the symptomatology and phenomenology in patients of ATPD

Methods: 50 patients diagnosed with ATPD presenting to IPD and OPD of tertiary care centre were recruited. Necessary required consents were taken from nominated representatives/ reliable attenders Demographic details, history taken, Mental status examination done and Brief psychiatric rating scale and Global Assessment of Functioning Scales applied. Data analysed using appropriate statistical methods

Results: patients suffering from ATPD had symptoms like lack of sleep, delusion of persecution, lack of insight, irritability, decreased appetite, catatonic symptoms in some common whereas 3^rd person auditory hallucinations, anxiety symptoms were relatively less

A cross sectional study to assess psychiatric morbidities in care givers of patients with suicidal behaviour- A need of the hour.

Dr. Abhinav Dhankar¹, Dr. Kunal Kumar², Dr. Abhinit Kumar³, Dr. Shruti Sharma⁴, Dr. Nikhil Nayar⁵, Dr. Shubhika Aggarwal⁶, Dr. Chaitanya Sheoran⁷, Dr. Sourabh Ojha⁸, Dr. Pankaj Shah⁹

1-Junior Resident, 2- Professor, 3- Professor, 4- Assistant Professor, 5- Assistant Professor, 6 & 7- Senior Resident, 8 & 9- Junior Resident

Introduction: Caregivers provide most of the care for people with suicidal behaviour. As a result of their significant social, economic, and personal contribution, caregivers experience high rates of physical and mental illness, social isolation, and financial distress. Psychiatric morbidities impair decision-making, functioning, and conflicts with family members which compromises patient treatment and support.

Aims and Objectives: The study was conducted to ascertain anxiety and self-esteem among the caregivers of patients with suicidal behaviour.

Materials and Methods: It was a cross-sectional observational study, conducted in the out-and in-patient department of psychiatry at Sharda Hospital, Uttar Pradesh among the caregivers of patients with suicidal behaviour, having no prior history of any psychiatric comorbidities using interview-based HAM-A and Rosenberg’s self-esteem scales.

Results: We included 40 caregivers having mean age of 41.83 (SD=11.18) years of which, there were 25 males and 15 females. Majority of the caregivers were graduates (45%), married (82.5%), living in an extended family (42.5%) and were living in rural areas (60%). 52.5% of caregivers were having mild to moderate anxiety, and 85% of caregivers were having low self-esteem.

Conclusion & Recommendation: Healthcare providers should offer psychological support and interventions to caregivers, recognizing their crucial role in identifying and managing their patients with suicidal tendencies. Additionally, raising awareness about mental health issues in caregivers is essential.

Keywords: Caregivers, Suicidal Behaviour, Psychological Well-being, HAM-A, Self-esteem

Exploring psychosis through photographs: A photovoice project with persons with psychosis in Chennai, India

Background: Participatory art methodologies emphasize community participation in the creative process, encouraging them to become co-creators, making the art form incomplete without their participation. Photovoice is a participatory arts-based research methodology that engages community members to capture their views on an issue through photographs they take themselves. It provides a space for creative expression and encourages upskilling. Among persons with mental illnesses, photovoice has demonstrated improvement in self-esteem, a feeling of control over their lives, reduction in anxiety & self-stigma and offers opportunity for advocacy. Evidence for photovoice in mental health in low-and-middle-income countries is scarce.

Aim: To explore psychosis through photographs made by persons with psychosis using photovoice.

Methods: Four consenting individuals between the ages 21 - 38 years, diagnosed with psychosis, with access to a mobile phone to photograph, were selected to participate in the study. Participants received training in basic mobile phone photography. One-on-one & group discussions helped to develop narratives of their experience.

Results: Emerging themes in participants’ photographs, includes pursuing dreams, family support, and personal growth, reflecting the interplay between internal experiences and the external world.

Conclusion: This pilot study shows that individuals with psychosis can actively participate in the photovoice methodology, sharing valuable insights into their lived experiences. Larger studies are needed to examine the role of photovoice to explore its role in mental health literacy, advocacy and interventions for psychopathology.

Funding: This study is funded by the National Institute of Health & Care Research as part of the Early Career Research grants in the PIECEs project.

Adverse Childhood Experiences and Adult Anxiety: A Case Control Study in Greater Noida, Uttar Pradesh

Dr Parika Kochhar¹, Dr Kunal Kumar², Dr Abhinit Kumar³, Dr Shruti Sharma⁴, Dr Nikhil Nayar⁵, Dr Shubhika Aggarwal⁶, Dr Chaitanya Sheoran⁷, Dr Siddharth Bhargava⁸

1-Junior Resident, 2-Professor & Head, 3-Professor, 4-Assistant Professor, 5-Assistant Professor, 6 & 7-Senior Resident, 8-Junior Resident

Introduction: Childhood abuse is a global issue that affects the society at large and can have both short-term and long-term consequences. Studies have linked childhood maltreatment with adult-life anxiety in its victims. However, there is a dearth of such studies in the Indian context.

Aims & Objectives: To determine the association between adverse childhood experiences (ACE) and anxiety.

Materials & Methods: This case-control study matched for age and gender was conducted in the Department of Psychiatry at Sharda Hospital, Uttar Pradesh. Patients diagnosed with anxiety were enrolled as cases while those not having anxiety were labelled as controls. The cases and controls were interviewed using ACE questionnaire for assessing adverse childhood experiences.

Results: We enrolled 17 cases and 17 controls. 94.1% of the cases diagnosed with anxiety were significantly associated with adverse childhood experiences. (p<0.001) The odds of having anxiety among the patients having adverse childhood experiences were 29.33 times the odds of having anxiety among those who did not have adverse childhood experiences. Among the patients of anxiety, mild anxiety was seen in patients with low ACE Score, but this association was not significant (p=0.622).

Conclusion: The findings reveal that individuals with a history of ACEs are at substantially higher odds of developing anxiety compared to those without such experiences, underscoring the long-term impact of childhood abuse on mental health. Involving early intervention, trauma-informed care, and counseling services can help prioritize the identification and support of individuals with a history of ACEs to mitigate the risk of anxiety disorders.

ABSTRACT FOR ORAL PAPER PRESENTATION

Dr Abdul raheman, Post Graduate Resident, Mandya Institute of Medical Sciences, Mandya

Prevalence of sexual dysfunction in patients with alcohol dependence syndrome, a cross sectional study in district hospital.

BACKGROUND

Chronic and persistent alcohol use is one of the most common significant psychiatric illnesses known to cause sexual dysfunction. Aim of the study is to determine the prevalence of sexual dysfunction among patients with Alcohol Dependence Syndrome (ADS).

METHODOLOGY

A cross-sectional study was conducted in a district hospital over a3-month period, with a sample size of 80 patients with diagnosis of ADS. Data were collected using purposive sampling method frompatients diagnosed with ADS, based on the International Classification of Mental and Behavioral Disorders, 10th Edition–Diagnostic Criteria for Research. Sociodemographic profile and clinical variables were recorded in a specific case report form prepared for the study using the severity of alcohol dependence questionnaire to assess the severity of ADS and using Arizona sexual experiences scale to assess the prevalence of sexual dysfunction among patients with ADS. Data will be entered in MS Excel sheet and descriptive analysis will be done. Categorical data will be expressed in percentages. Continuous data will be expressed as Mean, Standard Deviation. A value of p< 0.05 will be considered as significant.

CONCLUSION

The findings of this study will help in understanding the relation between alcohol use and its deleterious effect on sexual dysfunction and motivate the patients to quite alcohol use.

The impact of pre menstrual syndrome on the quality of life of nursing students- a cross sectional study in North Karnataka

Introduction:

Pre-menstrual syndrome (PMS) is defined as physical, behavioral, emotional or psychological symptoms that occur during the luteal phase of the menstrual cycle and experienced around the time of menstrual flow. Premenstrual symptoms during young age can complicate interpersonal relationships, social and educational performance in a negative way resulting in poor self-esteem and inadequacy. Nursing students are exposed to high levels of stress at an early age which can complicate the picture of premenstrual symptoms. Hence studying the impact of premenstrual syndrome on quality of life in these individuals is essential.

Material and methods:

A descriptive cross sectional study with objective to assess the effect of premenstrual syndrome among nursing students on their quality of life was conducted in nursing college, North Karnataka. Simple random sampling method was used and data was collected for the period of 1 month. Sample size of 160 was considered. Students meeting the inclusion and exclusion criteria were enrolled. Semi-structured sociodemographic proforma and Premenstrual Syndrome Scale and WHO-QOL Scale were used. Results were analysed by Chi-square and Pearson’s coefficient tests.

Result

Majority belonged to 21-22years, 37.5% belonged to class 3 socioeconomic status, 50.2% had regular cycles. 48% had moderate level of physiological symptoms, 36.8% had severe level of psychological symptoms and 56.2% had moderate level of behavioral symptoms. Significant association was found between pre menstrual symptoms and quality of life.

Living a Meaningful Life with Chronic Mental Health Issues: A qualitative study.

* Dr. Sushma Kumari

Background

Mental health issues are generally seen as having a lifetime adversity with high vulnerability for social marginalization, health hazards, and economic deprivation. In spite, of all these adversities, there are many individuals struggling with mental health issues are leading an outstanding life of courage, dignity and are contributing equally to society as other members who do not have a mental health issue. The existing scientific research has largely studied the negative outcomes associated with mental health issues and ignored those persons who are leaving a meaningful life. Considering the above, the present study attempted to shed the light upon the lived experiences about personal recovery of persons with chronic mental health issues that helped them to lead a meaningful life.

Methodology: The present study was based on exploratory qualitative research design. Patients who were maintaining well on treatment and had capabilities to recognise their functional, occupational, and social abilities for leading a meaningful life were included. They were assessed in detail by in- depth interview about their lives and personal journeys after obtaining their due consent.

Results: The main themes emerged from the study was related to their own experience related to recovery needs, maintain their functional level, securing a respectful employment, efforts to initiate independent living, retention of their gainful employment and acknowledged as a person rather than a patient. However, constant worry regarding their future were also present.

Conclusion: The findings of the present study would enhance the understanding among the health professional, policy makers and community persons to treat persons with mental health issues as a person and involved them as a partner with emphasis on shared decision making about their treatment plans. It would also help to change the prevailing attitude among general public regarding persons with mental illness, after seeing that how a person with mental illness is able to challenge the deficit associated with mental illness and excelling in specific area they engaged.

Key words: Chronic mental health issues, living a Meaningful life, Personal recovery

*Details of presenting Author:

Dr.Sushma Kumari, Assistant Professor (Social Work), Human Behaviour Department, Institute of Human Behaviour &Allied Sciences (IHBAS), Dilshad Garden, Delhi- 110095. Mobile No. 9971439297, 9868396922. Email: sushma_cip@yahoo.com

Childhood Abuse and Adult Anxiety: A Case Control Study in Greater Noida, Uttar Pradesh

Dr Parika Kochhar¹, Dr Kunal Kumar², Dr Abhinit Kumar³, Dr Shruti Sharma⁴, Dr Nikhil Nayar⁵, Dr Shubhika Aggarwal⁶, Dr Chaitanya Sheoran⁷, Dr Siddharth Bhargava⁸

1-Junior Resident, 2-Professor & Head, 3-Professor, 4-Assistant Professor, 5-Assistant Professor, 6 & 7-Senior Resident, 8-Junior Resident

Introduction: Childhood abuse is a global issue that affects the society at large and can have both short-term and long-term consequences. Studies have linked childhood maltreatment with adult-life anxiety in its victims. However, there is a dearth of such studies in the Indian context.

Aims & Objectives: To determine the association between adverse childhood experiences (ACE) and anxiety.

Materials & Methods: This case-control study matched for age and gender was conducted in the Department of Psychiatry at Sharda Hospital, Uttar Pradesh. Patients diagnosed with anxiety were enrolled as cases while those not having anxiety were labelled as controls. The cases and controls were interviewed using ACE questionnaire for assessing adverse childhood experiences.

Results: We enrolled 17 cases and 17 controls. 94.1% of the cases diagnosed with anxiety were significantly associated with adverse childhood experiences. (p<0.001) The odds of having anxiety among the patients having adverse childhood experiences were 29.33 times the odds of having anxiety among those who did not have adverse childhood experiences. Among the patients of anxiety, mild anxiety was seen in patients with low ACE Score, but this association was not significant (p=0.622).

Conclusion: The findings reveal that individuals with a history of ACEs are at substantially higher odds of developing anxiety compared to those without such experiences, underscoring the long-term impact of childhood abuse on mental health. Involving early intervention, trauma-informed care, and counseling services can help prioritize the identification and support of individuals with a history of ACEs to mitigate the risk of anxiety disorders.

A cross sectional study on Coping behaviour, Personality characteristics and Co-dependence in the wive of persons with alcohol use undergoing deaddiction treatment in a tertiary care setup in Chengalpattu

BACKGROUND : Low marital satisfaction (Pradeep R Johnson, et al, 2018), poor social support and economic burden are the other major issues among the spouses of men with alcohol dependence. The psychological distress seems to be apparent from such factors making the spouses to cope less efficiently. Hence the present study was undertaken to assess the present personality of the wives of alcoholics and the effect of their behaviour on husband’s alcoholism.

AIM: To identify the ‘Coping behaviour’, ‘Personality characteristics’ and ‘Co-dependence’ in the wives of person with alcohol use and to also identify the correlation between these factors and the severity of alcoholism in their husbands

METHODS: This is a Cross sectional study comprising of person with harmful pattern of Alcohol drinking (according to ICD 11) coming for deaddiction treatment and their wives who attend the department of psychiatry in a tertiary care hospital who consent to participate in this study. 90 participants along with their spouses were included as per prevalence value inclusion exclusion criteria and were interviewed by the principal investigator along with a fixed psychologist. The tools used for interviewing were Friel’s Codependence Assessment Inventory, Coping Questionnaire and Neo-FFI for personality characteristics for the wives and ASI (Alcohol severity Index) for their husbands, carried out by principal investigator, each interview taking 1 hour.

RESULTS: Though alcoholism is a major problem in India, the Indian studies on the behaviour of spouses on alcoholism are a few. It was found that wives majorly were submissive, timid, trustful, conventional, conservative, dependent and poised different from pathological model from the western population. co-dependency behaviour arises due to the stress of living with an alcoholic and is responsible for the personality deficits seen in the spouse. Maladaptive coping skills lead to codependence adversely affecting their social and functional roles as mothers, sisters, homemakers etc., thus having a significant impact on the family. Personality expressed by spouses show lower scores in openness,conscientiousness and higher scores in introversion.

CONCLUSION: Severe the alcohol use, severe the stress on their spouses, which results in codependence as well as poor coping behaviour which further reinforces their change in personality, becoming a vicious cycle bringing disharmony in family as well as their children’s mental well-being.

Spectrum of Dissociative experiences in Depression: A case-control study

Dr Pankaj Shah¹ , Dr Kunal Kumar², Dr Abhinit Kumar³, Dr Nikhil Nayar⁴, Dr Shruti Sharma⁵, Dr Shubhika Aggarwal⁶ ,Dr Chaitanya Sheroen⁷, Dr Abhnav Dhankar ⁸, Dr Sourabh Ojha⁹

1-Junior Resident,2-HOD and Professor,3-Professor,4 &5-Assitant Professor,6&7-Senior

Resident,8&9-Junior Reseident

Introduction: Dissociative experiences have been reported in the patients of depression that are often unacknowledged but frequently encountered and they contribute to the burden of illness. There are very limited studies in India on the topic of dissociative experiences in patients of depression.

Aims & Objectives: To evaluate the clinical spectrum of dissociative experiences in depression patients.

Material and Methods: It was a case control study conducted in the department of psychiatry at Sharda University, Uttar Pradesh. Patients above 18 years of age screening positive on HAM-D scale were enrolled as cases, while the rest were enrolled as controls. DES-2 scale was applied to evaluate the cases and controls for dissociative experiences.

Results: We enrolled 19 patients of depression against 30 patients who did not have depression. The patients of depression were of the mean age 27.37 (SD=7.06) years, mostly females (68.4%), Hindu (84.2%), married (52.6%), and living in a joint family (57.9%).

Dissociative experiences were significantly more in depressed patients (DES-2 score :31.46±16.47) as compared to controls (DES-2 score: 17.18±14.56) (p=0.003). Dissociative experiences significantly increased with the severity of depression (p=0.029). The odds of having high DES score among the patients of depression were 2.97 (95%CI: 0.86-10.17)

Conclusion: Dissociative experiences are prevalent among depressed patients, with a significant association between depression severity and dissociation. Clinicians should routinely assess dissociative experiences in depressed patients, especially those with higher

depression severity, to provide appropriate interventions.

Keywords: Dissociative experiences, Depression, Clinical spectrum, Severity, Assessment

Pattern of dysfunction in sexual activity among Indian men with alcohol dependence-a cross sectional analysis

Dr Sourabh Ojha¹, Dr Kunal Kumar², Dr Abhinit Kumar³, Dr Shruti Sharma⁴, Dr Nikhil Nayar⁵, , Dr Shubhika Aggarwal⁶, Dr Chaitanya Sheoran⁷ , Dr Abhinav Dhankar⁸, Dr Pankaj Shah⁹

1-Junior Resident, 2-Professor & Head, 3-Professor, 4-Assistant Professor,

5-Assistant Professor, 6 & 7-Senior Resident, 8 & 9-Junior Resident

Introduction: Alcohol consumption is a global health concern with India ranking second in the world, where approximately 33% of the population abuses alcohol. Chronic alcohol use exerts major effects on various organs, including sexual functions.

Aims & Objectives: This study aims to investigate the association between alcohol dependence and sexual dysfunction among males in Uttar Pradesh, India, with significant implications for awareness, addiction services, training, and further research.

Materials & Methods: A cross-sectional analytical study was conducted at the Department of Psychiatry, Sharda University. The study enrolled 22 male participants aged 18 to 50 years with no history of sexual dysfunction before initiating alcohol. Severity of alcohol dependence and sexual dysfunction were assessed using SADQ and CSF-MQ questionnaires.

Results: We enrolled 22 participants. The mean age of participants was 38.41 (SD=8.26) years, with 86.4% being married and 50% being graduates. The mean scores for SADQ and CSFQ were 29.68 (SD=9.96) and 39.27 (SD=8.04), respectively. Notably, sexual dysfunction was observed in 77.3% (n=17) males, with 64.7% (n=11) exhibiting severe alcohol dependence (p=0.001). Further analysis revealed significant associations between the severity of alcohol dependence and conditions such as premature ejaculation, erectile dysfunction, and hypoactive sexual disorder (p<0.001).

Conclusion: This study underscores a substantial link between alcohol dependence and male sexual dysfunction, particularly among those with severe alcohol dependence. To address this public health concern, it is recommended that Indian healthcare providers and policymakers prioritize interventions targeting alcohol dependence and its associated sexual dysfunction.

Keywords: Alcohol Dependence, Sexual Dysfunction, Male Population, Severity, India

PAPER PRESENTATION- ANCIPS 2024

Dr Deena Anna Jacob¹, Dr Sheena Varughese², Dr Roy A Kallivayalil³.

TOPIC: Disability and Social Support received by People with Lived Experiences of Serious Mental Illness.

AIM: To assess Disability and Social Support received by People With Lived Experiences of Serious Mental Illness.

BACKGROUND: Serious Mental illness is defined as mental illness that resulted in functional impairment which substantially interferes with or limits one or more major life activities. It mainly includes Schizophrenia spectrum disorders, Bipolar and related disorders and Depressive disorders. These mental illness are devastating chronic/ recurring condition that may present an adverse impact on the individual, family, and community. Apart from social stigma and disapproval, people with lived experience of mental illness may experience health and well-being challenges that may affect their quality of life. Disability can be defined as an interference. with activities of the whole person in relation to the immediate environment Disability associated with mental illness is a major contributor to the global burden of disease. Social support is perception and a reality that helps individuals to believe that they are cared for, loved, esteemed, valued, and belong to a network of communication and mutual obligation. Social support such as family, friends, and significant others independently predicted the quality of life of psychiatric patients and provides a sense of security and emotional assistance which may help the patients to address their mental health challenges more efficiently and improve their quality of life. There had been many measures taken in last decades to improve support for them and this study helps to know the social support received by people with lived experience in our society currently.

METHOD: Patients satisfying inclusion criteria and exclusion criteria with a diagnosis of serious mental illness such as Schizophrenia spectrum disorders, Bipolar and related disorders and Depressive disorders according to DSM 5 attending psychiatric OPD will be recruited by convenience sampling after taking consent. Semi structured Performa will be used to collect socio-demographic details, Disability and social support will be measured using WHO DAS II and Multi-dimensional Scale for Perceived Social Support (MSPSS).

RESULTS AND CONCLUSION: Patients with long symptom free period and recovery found to have less disability and good social support and there could be multiple factors associated which further need to be studied in detail.

Challenges of Rehabilitation in dealing with homebound and homeless _ABSTRACTpersonswith mental illness: An exploration with case series.

*Dr. Sampa Sinha, Psychiatric Social Worker, Department of Psychiatric Social Work, IHBAS, Delhi-95 & Dr. Manisha Jha, Assistant Professor Clinical Psychology, Department of Clinical Psychology, IHBAS, Delhi-9

Homebound or homeless persons with mental illness are usually found persisting inthe social drifting process due to several psychosocial, familial, financial and health issues.The role of the family, society and the responsibility of the state are often diluted. Also, homeless and homebound persons with mental illness (HPMI) suffer indignities due to shirking of obligations by society (Swaminath G. et al. 2019).The current study aims to discuss a series of caseswhere homeless persons with mental illnessare rehabilitated in their own community or at a government-runhalfway/long-stay home after a long-term psychosocial intervention with the objective of exploringand explaining the challenging aspects ofrehabilitation efforts carried out for these cases. Psychosocial assessment was done by interviewing the cases using a specifically designed proforma, and analysis of the same helped to drafta plan of rehabilitation. The study concluded with the understanding that constraints of resources may not be the major barrier to rehabilitation rather the attitudinal problems, prejudices, misconceptions among common people, and lack of collaboration among various stakeholders may hinder successful rehabilitation services for homebound or homeless persons with mental illness(HPMI).

Key Word: Homebound And Homeless Persons with Mental Illness(HPMI), Mental Illness, Rehabilitation, Halfway/Long-Stay Home

Presenting Author: *

Correspondence: sinhasampa25@rediffmail.com

Changing trends in demographic and clinical profile of perinatal patients receiving Emergency Psychiatry services

BACKGROUND

The perinatal period is one of the most stressful periods in the life of a mother which is associated with increased vulnerability to develop various physical, psychological, social and cognitive changes. Recent studies have shown a rise in prevalence of depression and anxiety among new mothers which can lead to negative outcomes for both mother and infant.

AIM

To compare the demographic and symptom profile of patients being referred to Psychiatry ER in the past year (2022-23) and 9 years back(2013-14).

MATERIALS AND METHODS

Chart review of perinatal patients who was referred to Psychiatry ER in the past year (2022-23) and 9 years before (2013-14)

RESULTS

There was an increase in the number of cases referred to the Psychiatry ER from 14 to 49. Majority of the cases in the period of 2013-14 showed symptoms of mania and psychosis In 2022-23 out of 49 patients 22 were antenatal and 27 were postnatal patients.13 showed anxiety symptoms,4 with psychotic symptoms,7 with mood symptoms,4 with dissociative symptoms,8 with mixed symptoms and 4 patients were referred in view of self harm attempts.

CONCLUSION

The results demonstrated the escalating burden of mental health disorders among perinatal women which points towards the need for more screening facilities and timely interventions in order to improve the mother-infant mental health.

Post stroke depression – Predictors and prevalence

Dr Shadaan Afeen, MD Psychiatry (Consultant psychiatrist), Dr Jaypal Reddy, MS, McH (Neurosurgeon) ABS Neuro hospital, Attapur Hyderabad.

BACKGROUND: Depression has been reported in post stroke individuals wide the literature. However very few studies have been reported in predicting depression in post stroke individuals. The present study intends to explore depression its predictors and varied clinical presentation with patients in stroke.

METHODOLOGY: A hospital based cross sectional study was done for a period of 1year to identify post stroke depression in patients diagnosed as cerebrovascular accident atleast 3 months prior. Sample size was taken from patients attending outpatient in their follow up. General health questionnaire was used as a screening tool and Hamilton’s rating scale for ideas of depression. Further site and size of lesion was also correlated with the severity of depression.

RESULTS: Prevalence of depression was seen as 18.3% . Predictors of depression included education status, amount of disability and associated medical condition (hypertension)The characteristics of depression were studied and we found 72% of the patients showed agitation and irritability as common symptom (p<0.01%) followed by insomnia (63.5%)..When the site of lesion was correlated lesions nearer to prefrontal cortex were having higher severity of depression where as size of the lesions were not statistically significant.

Keywords- Post stroke depression, lesion

Abstract for Paper Presentation: Awareness and Attitude of Undergraduate Medical Students to LGBT Community in Kerala, India: A Cross-Sectional Study

Background

There has been a shift in understanding of LGBT (Lesbian, bisexual, gay, and transgender) people group from a pathological model to a normal variant model of sexuality. In spite of this move, there remains a significant amount of phobia towards this community among the Indian population. LGBT community face high rates of stigma and discrimination at health care facilities, which further deteriorate the health of this community. Medical students being budding doctors, it’s important to know their awareness and attitude towards this community.

Aim

To assess the awareness and attitude of medical students towards the LGBT community in Kerala.

Methodology

This was a cross sectional study done at a medical college in Kerala. Students from first year MBBS till internship were included in the study. This study was approved by the institutional ethical committee. Informed consent was obtained from all participants after providing details of the conduct of the study, assurance of participant’s confidentiality and voluntary participation. Semi structured questionnaire and LGBT-DOCSS scale were circulated among the students.

Results

380 students participated in the study. Majority were first years (35.3%), females(69.7%). 89.2% were less clinically prepared, majority(58.4%) has low knowledge about and 89.5% had a positive attitude towards the LGBT community.

Conclusion

Our study highlights the positive attitudes of medical students but also identifies their self-reported inadequacies in LGBT patient care-related clinical skills and preparedness.

ASSESMENT OF SEASONALITY IN PATIENTS WITH MOOD DISORDER IN TERTIARY CARE HOSPITAL

Dr. Navjot¹, Dr. Gurmeet Kaur Brar²,Dr.Anil Goyal³ Dr. Ramit Gupta⁴

1.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

2.Professor and Head Dept. of Psychiatry, AIMSR, Bathinda

3.Professor, Dept. of Psychiatry, AIMSR ,Bathinda

4.Associate Professor, Dept. of Psychiatry, AIMSR, Bathinda

BACKGROUND:- Mood is a sustained, pervasive feeling or emotion that colour the person’s perception of the world. The rate to which seasonal change affect parameters of sleep length, energy, appetite, mood or wish to socialize with other people is called seasonality.

Seasonality also linked with changes in neurotransmitters like Serotonin, Melatonin, Dopamine and Norepinephrine

MATERIALS AND METHODS: A cross-sectional observational study conducted at Department of Psychiatry, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab on 20 patients. Patients of depression and mania according to ICD 10 and DSM 5 are evaluated. After obtaining the consent, semi-structured proforma, HAM-D, YMRS and SPAQ are administered.

RESULTS: The overall prevalence of seasonality among patients of mood disorder as per HAM-D, YMRS, SPAQ was found to be 1.7 peercent.

CONCLUSION: - The maximum association of seasonality was found in patients with bipolar affective disorder followed by Recurrent depressive disorder. A seasonal variation was seen in depressive patients in May-July months and Nov- Jan months whereas the bipolar patients showed seasonal variations in Feb-Apr, Nov-Jan and Aug-Oct months respectively

Keywords: Seasonality, Mood disorder

Author for correspondence- Dr.Navjot, Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

BACKGROUND: As per World Health Organization, Stigma is a major cause of discrimination and exclusion. Medical students face mental health problems and lower quality of life at a higher rate than the others of similar aged population. Their mental health deteriorates as well over the course of medical training, and they are also less likely than the general population to receive appropriate treatment despite having better access to care.

AIM: To assess the prevalence of stigma about mental health and knowledge about mental health and their association in medical college students. Also association about knowledge of mental health and help seeking behaviour.

MATERIALS AND METHODS: A cross sectional study on MBBS undergraduate students from a private medical college was conducted. And stratified random sampling was done.Three scales, MAKS (Mental Health Knowledge schedule), SSOSH (Self stigma of seeking help scale) and SSRPH (Stigma Scale for Receiving Psychological Help) will be administered to all the students who are willing for participation.

RESULTS: A total of 515 responses were received out of which 47% were male and 53% were females. Overall on the SSRPH and SSOSH scale mean score was 6.02 and SD 2.75, 29.67 and 2.69 respectively which showed that stigma was moderate among students. On the MAK scale the mean score was 44.31 and SD was 8.49 which showed good knowledge about mental illness in medical college students. Also there is a negative correlation between Stigma for receiving psychological help(SSRPH) and mental health knowledge(MAK) as suggested by pearsons coefficient -0.25.

CONCLUSION: Stigma was found to prevalent in medical college students. Increasing mental health knowledge can help reduce stigma to receive psychological help to some extent. Majority of the students disagreed that they should hide their problems about mental health.Problems with seeking psychological help like reduced self esteem, feeling inferior and changing views about oneself if addressed can help in reducing stigma.

A Cross Sectional Study on Consultation Liaison Gap in patients presenting with Deliberate Self Harm to emergency department of Tertiary Care Center

Dr Neema C¹ Dr Fakirappa B Ganiger² Dr Jitendra Mugali³ Dr Somashekhar Bijjal⁴

Background: Deliberate self-harm (DSH) is defined as an injury inflicted on self without intent of ending of life and it is an emerging silent epidemic in middle-and low-income countries.Consultation Liaison Psychiatry(CLP) involves recognizing and treating mental illness in physical illness context. Despite the benefits of CLP,referral rates for DSH from health care professionals remains low even in places where psychiatric services exist.

Aims & Objectives:

1. To assess the consultation Liaison Gap in patients presenting with Deliberate Self Harm

2. To assess the Socio-demographic profile, mode and lethality of DSH

3. To assess psychiatric co-morbidities among patients with Deliberate Self Harm

Materials and Methods:

This cross-sectional observational study was conducted in the Tertiary care center after obtaining Institutional ethical committee clearance.Patients who presented to the emergency department with DSH during the period Jan 2022 to Dec 2022 were included in the study.Written informed consent was obtained from the patients.Patients were screened using WHO-CIDI questionnaires and DSH Inventory questionnaire to screen for psychiatric co morbidities and IPDE is applied for personality assessment.

Results: 642patients presented with DSH attempt to the emergency department during the study period. Among these,64%(416) were not referred to a psychiatrist,61.5%(256) were discharged against medical advice(DAMA) and 3%(16) were succumbed to death.34%(144) were not given Psychiatric opinion from the health care professionals.Only 35.2% (226) has been referred to psychiatrist for assessment of psychiatric co morbidities which indicates the significance of consultation liaison gap.

Conclusions: Consultation Liaison Gap from the above study is huge which indicates the less awareness regarding Deliberate self harm in patients, attenders and Health care professionals which needs to be evaluated.

Impact of Chronic Cough in developing Depression in patients with COPD

Background:- Chronic Obstructive Pulmonary disease (COPD) is a prevalent respiratory condition characterized by progressive airflow limitation. Among the myriad of distressing symptoms associated with COPD, chronic cough stands out as a significant contributor to patients’ overall well-being. Patients with COPD are at a higher risk of comorbid conditions such as anxiety and/or depression, which in turn increase their symptom burden and rehospitalizations compared to the general population.

Aim:- The purpose of this study is to explore the intricate relationship between chronic cough and the development of depression in COPD patients

Materials & Methods:- This cross-sectional study was performed in 35 COPD patients diagnosed by GOLD staging of COPD and was conducted in NMCH,Nellore. Participants were assessed for the presence and severity of chronic cough using standardized criteria and depression screening with Patient Health Questionnaire-9(PHQ-9).

Results:- The study found a statistically significant association between chronic cough and higher PHQ-9 scores, indicating a higher prevalence of depression in COPD patients with chronic cough. Educational and occupational status, FEV1, respiratory symptoms, physical impairment and dyspnea were found to be potential predictors of depression in COPD patients.

Conclusion:- : Patients with severe COPD are at increased risk of developing depression. The results of this study underscore the importance of reducing symptoms and improving physical functioning in patients with COPD.

Key words:- COPD, Depression, PHQ-9, GOLD Staging.

Prevalence of sexual dysfunction in patients with alcohol dependence and its correlates: A cross-sectional study

Background: Chronic and persistent alcohol use is known to induce sexual dysfunction, which leads to marked distress and interpersonal difficulty. Dissatisfaction in sexual life is often associated with anger, increased rates of marital violence, less warmth, and unity in relationships, breakups – all of which may in turn worsen the alcohol consumption.

Aim: The aim is to estimate the prevalence of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables.

Materials and methods: The study employed a cross-sectional descriptive design and recruited 89 patients visiting tertiary care center. The evaluation was conducted using a specially designed intake proforma and tools such as Severity of Alcohol Dependence Questionnaire, Arizona Sexual Experience Scale, and International Classification of Disease, 11^th revision, diagnostic criteria for research.

Results: 42 patients out of 89 with alcohol dependence had sexual dysfunction (prevalence of 47.19%). Out of which there was decreased sex drive in 19.05% patients, difficulty in arousal in 7.14% patients, erectile dysfunction in 42.86% patients, premature ejaculation in 11.9% patients and no satisfaction from orgasm in 19.05% patients.

Sexual dysfunction was significantly associated with the duration of alcohol dependence, quantity of alcohol consumption, severity of alcohol dependence, comorbid use of tobacco, and educational background .

Conclusions:

There is a significant association between the sexual dysfunction with the sociodemographic variable like age, Duration of Marriage, Quantity of alcohol consumed, and tobacco use.

Keywords: Arizona sexual experiences scale; severity of alcohol dependence questionnaire; sexual dysfunction in alcohol dependence syndrome.

Behavioural disturbances in patients with autism spectrum disorders attending occupational therapy

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting social communication,repetitive behaviour patterns during early periods of development negatively impact social-occupational aspects.Occupational therapy(OT) modifies child’s ability to process, gross motor,attention,participation in activities,and develop organized,adaptive behaviors

Aim : to study common behavioral disturbances and assess improvement after occupational therapy in patients with ASD .

Methods : study conducted on 30 patients with ASD diagnosed as per DSM-V in a tertiary care hospital .Permission from IEC was taken for study. Assessment of behavioural disturbances was done using the Indian scale for assessment for autism,scores were calculated using statistical software ,STATA,10.1.Mean differences calculated with unpaired t tests,for paired observation, paired t test were used. Chi-square test was used to compare differences in proportions for qualitative parameters. P value < 0.05 considered significant for all comparisons.

Results : In study of 30 subjects,domain of social relationship and reciprocity has highest percent(30%).Unable to relate to others(20.93%),temper tantrums(25%),echolalic speech(16.67%),lacks fear of danger(33.33%),sensitivity to sensory stimuli(35.71%) inattention and difficulty in concentration(38.46%)were the common symtoms as per category.Common symptom overall is unable to relate to others(16.67%).Most common symptoms in females is the speech-language(83.3%)domain,males is the social reciprocity domain(88.9%).As per age(66.7%)is social reciprocity.Mean ISAA score132.93 before OT improved upto 97.1 after OT

Conclusion : most common behavioural disturbances with respect to domains in patients with ASD can be assessed,it can help early recognition of symptoms and assessment with OT reducing severity of symptoms.

Keywords : autism,behavioural disturbances,occupational therapy

Original research paper: To study the diet patterns in children with neurodevelopmental disorders: An observational study

Background:

The dietary pattern approach has gained prominence in nutritional epidemiology, rather than relying on individual nutrient determination methods.²

Neurodevelopmental disorders, often early in development, can impact personal, social, academic, or occupational functioning.⁴

ASD children often exhibit selective eating, food refusal, and nutritional deficiencies due to their tendency to consume processed foods and starches.^{5, 10}

Aims:

1. To study and analyze the different dietary patterns in children with neurodevelopmental disorders.

2. To co-relate socio-demographic and psychosocial factors with the diet patterns.

Method:

The study is an observational study on 30 children with neurodevelopmental disorders under 18 years old, analysing data through statistical tests over three months.

Results:

• Use of electronic devices is higher at an early age.

• Children take longer time to finish their meals.

• Even at a later age, children require help to finish meals.

• Excess intake of sugar is more in older male children.

Conclusion:

• The study revealed that over half of children with neurodevelopmental disorders are given electronic devices more frequently by their parents while eating food as a distraction to keep them occupied, with mobile phones and television being the most common.

• 70% of the study’s participants reported taking longer time to finish their meals.

• About 30% of children require parental or guardian assistance to eat their meals even at a later age.

• Higher intake of sugar in the form of sweets, sweetened beverages, etc is observed more in older children diagnosed with ADHD, especially male gender.

• Male children tend to be more selective and consume processed and fried foods, often eating by themselves at home and at school, but there is no significant age difference.

• History of pica is found clinically significant and is seen in 43.3% of the children in the study.

• The study found that 60% of children eat more meals daily, with older females having a higher proportion, possibly due to incomplete meals or evening snacking.

Key words: diet patterns, neurodevelopmental disorders, age up to 18 years, psychiatry OPD.

Behavioural Disturbances in patients with Autism Spectrum disorder attending Occupation Therapy

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting social communication,repetitive behavior,activities during early periods of development negatively impact social, occupational areas .

• Behaviors such as poor eye contact,echolalic speech lack of social interest.Sensory-motor problems,sensitivity to certain foods/clothes,strong attachment to in-animate objects.

• Behaviors diminish child’s functional capabilities, including his sense of purposefulness, social interactions,ultimately overall health.

• Problem behavior is not socially acceptable, may be physically dangerous,negatively impacts functioning (aggression,self-injurious behavior,tantrums, property destruction)

• Occupational therapy aims at improving motor skills, socialization, attention, behavior control, reading skills, participation in game activities,the achievement of personal goals.

• It increases the child’s ability to process and integrate sensory information,develops organized and adaptive behaviors.

Aims

To study common behavioral disturbances and assess improvement after occupational therapy in patients with ASD .

• 1)To study the common behavioral disturbances in each domain as well as overall common symptoms
• 2)To study symptoms as per sociodemographic factors (age ,sex)
• 3)To study the improvement before and after OT using Indian Assessment for Autism scale.

Methodology

• A prospective study was conducted on 30 patients between age groups 1 to 12 years with ASD diagnosed as per DSM-V in a tertiary care hospital in a period of 6 months.

• Permission from Institutional Ethics Committee was taken for study.

• Assessment of behavioural disturbances was done using the Indian scale for assessment for Autism,

• Data was coded and analysed with the statistical software, STATA , version 10.1, 2011 by StataCorp, Texas (USA)

• Comparison of mean differences in quantitative parameters in two groups was evaluated with two-independent samples (unpaired ) t-test , and for paired observations within group comparisons were performed by Paired T-test.

• Pearson’s Chi-Square test or Fisher’s exact test (for small samples) was performed for comparing differences in proportions for qualitative parameters across groups and sub-groups .

• P-value <0.05 will be considered statistically significant for all the comparisons.

Results

Table 1.

Comparison of Domains by age-groups

Domain	1-6 years	6-12 years	P*
Behaviour patterns	3 (37.5%)	5 (62.5%)	0.1441
Cognitive aspect	0 (0.0%)	2 (100.0%)	-
Emotional responsiveness	1 (50.0%)	1 (50.0%)	1.00
Sensory aspect	1 (33.3%)	2 (66.7%)	0.2196
Social relationship and reciprocity	3 (33.3%)	6 (66.7%)	0.0335
Speech-language	2 (33.3%)	4 (66.7%)	0.0826

Domains of social relationship and reciprocity between age groups 6-12 years showed highest 66.7% with P value 0.03

Table 2.

Comparison of Domains by gender

Domain	Male	Female	P*
Behaviour patterns	7 (87.5%)	1 (12.5%)	0.0001
Cognitive aspect	0 (0.0%)	2 (100.0%)	-
Emotional responsiveness	2 (100.0%)	0 (0.0%)	-
Sensory aspect	0 (0.0%)	3 (100.0%)	-
Social relationship and reciprocity	8 (88.9%)	1 (11.1%)	0.0001
Speech-language	1 (16.7%)	5 (83.3%)	0.0001

Domains of social relationship and reciprocity in male gender showed highest percent 88.9% and in females , domain of speech-language indicates highest percent values (83.3%)

Table 3.

Distribution of subjects by Domains (n=30)

Domain	Freq.	Percentage
Behaviour patterns	8	26.67
Cognitive aspect	2	6.67
Emotional responsiveness	2	6.67
Sensory aspect	3	10.00
Social relationship and reciprocity	9	30.00

Figure 3.

Distribution by Domains (n=30)

Table 4.

Distribution of subjects by Behavioural disturbances (n=30)

Behavioural disturbances	Freq.	Percentage
Acquired speech then lost it	2	6.67
Attention and concentration	2	6.67
Echolalic speech	3	10
Exhibits aggressive behaviour	2	6.67
Insistence on sameness	2	6.67
Lacks fear of danger	2	6.67
Poor eye contact	3	10
Remains aloof	1	3.33
Sensitive to sensory stimuli	3	10
Stereotyped repetitive motor mannerisms	1	3.33
Stereotyped repetitive use of language	1	3.33
Temper tantrums	3	10
Unable to relate to others/environments	5	16.67

Figure 4.

Behavioural disturbances

The most common symptom overall among all the domains is unable to relate to others/environment with 16.67% being the highest of all

Table 5.

Comparison of pre-OT and post-OT ISAA scores (n=30)

ISAA score	Pre-OT	Post-OT	Pre-post difference	P*
Mean	132.93	97.1	35.83	0.0001
SD	20.76	13.67	12.73
Median	136	96	34	0.0001
QD	14.88	6.38	9.12

*Paired t-test for difference in means; Sign test for difference in medians. The pre-occupational therapy and post occupational therapy mean ISAA scores were found to be 132.93 and 97.1 respectively

Figure 5.

Comparison of avearge pre-and post OT ISAA scores

The pre-occupational therapy and post occupational therapy mean ISAA scores were found to be 132.93 and 97.1 respectively.

Table 6.

Distribution of subjects according to demographic characteristics (n=30)

Characteristics	Frequency	Percentage
Age (years)
1-6	10	33.3
7-12	20	66.7
Gender
Male	18	40.0
Female	12	60.0

Figure 1.

Age distribution of study subjects

In this study of 30 subjects, majority showed between age groups 7-12yrs

Figure 2.

Gender distribution of study subjects

In this study of 30 subjects , male : female ratio was 60 : 40

Discussion :

• In this study, it was found the most common domain showing highest percent scores were the social relationship and reciprocity, having unable to relate to others/environment as the most common symptom among others such as remaining aloof, difficulty in maintaining peer relationships, lacking social smile, engaging in solitary play. other significant findings such as from domains of emotional responsiveness – lack of fear of danger, from speech-language domains such as acquiring speech then losing it ,use of echolalic speech and repetitive language showing highest percent, and temper tantrums , insistence on sameness, sensitivity to sensory stimuli, difficulty in attention and concentration having highest percent scores .

• Occupational performance is the ultimate outcome expected in sensory processing development and occupational therapy programs. our study results support the effectiveness of the OT in improving occupational performance of ASD children.

• In this study can help us to recognize these symptoms in early developmental stages and utilizing occupational therapy to modify the gross motor skills , reading skills , social communication using applied behaviour therapy, sensory integration therapy and speech therapy, thus improving overall outcomes.

• These improvement in symptoms after 30 sessions of occupational therapy. Isabel Yorke1 · Pippa White1 et al showed similar findings after assessment with occupational therapy

Conclusion

• As assessed by Indian scale for assessment of autism , indicating difficulty in relatedness , echolalic speech , lacking fear of danger , temper tantrums , inattention and poor concentration were the most commonly found behavioural disturbances in patients with autism.

• Early intervention with occupational therapy , speech therapy , sensory integration therapy increases the occupational performance and sensory processing abilities in ASD children and subsequently the health status of ASD children.

• By recognizing early symptoms as confirmed from our study and similar findings found, it will be beneficial for physicians as well as caregivers to reach out for early interventions and reduce the likelihood of dependence and improve overall functioning status in patients with ASD.

Limitations

Small sample size

Future implications

• Recognition of symptoms of autism spectrum disorder in early stages of development will pave way for seeking occupational therapy, speech therapy , sensory integration therapy, play and behaviour therapy , thus improving overall social and functioning outcome of children with ASD.

• Early recognition and appropriate intervention increases likelihood of routine daily life activities to be carried out with little assistance and developing an independent and more adaptive behaviour. Overall outcome serves the child to have better involvement in same peer group activities as well as academic and social opportunities.

• Conflict of interest : nil

References :

• 1)Kashefimehr B, Kayihan H, Huri M. The effect of sensory integration therapy on occupational performance in children with autism. OTJR: occupation, participation and health. 2018 Apr;38(2):75-83.
• 2)Yorke I, White P, Weston A, Rafla M, Charman T, Simonoff E. The association between emotional and behavioral problems in children with autism spectrum disorder and psychological distress in their parents: A systematic review and meta-analysis. Journal of autism and developmental disorders. 2018 Oct;48:3393-415.
• 3)Tomchek S, Koenig KP, Arbesman M, Lieberman D. Occupational therapy interventions for adolescents with autism spectrum disorder. The American Journal of Occupational Therapy. 2017 Jan 1;71(1):7101395010p1-3.
• 4)Dovey TM, Kumari V, Blissett J. Eating behaviour, behavioural problems and sensory profiles of children with avoidant/restrictive food intake disorder (ARFID), autistic spectrum disorders or picky eating: Same or different?. European Psychiatry. 2019 Sep;61:56-62.
• 5)Abelenda AJ, Rodríguez Armendariz E. Evidencia científica de integración sensorial como abordaje de terapia ocupacional en autismo. Medicina (Buenos Aires). 2020 Mar;80:41-6.
• 5)Welch CD, Polatajko HJ. Applied behavior analysis, autism, and occupational therapy: a search for understanding. The American Journal of Occupational Therapy. 2016 Jul 1;70(4):7004360020p1-5.
• 6)Smith SA, Press B, Koenig KP, Kinnealey M. Effects of sensory integration intervention on self-stimulating and self-injurious behaviors. The American Journal of Occupational Therapy. 2005 Jul 1;59(4):418-25.
• 7)Clarke E, Hull L, Loomes R, McCormick CE, Sheinkopf SJ, Mandy W. Assessing gender differences in autism spectrum disorder using the Gendered Autism Behavioral Scale (GABS): An exploratory study. Research in Autism Spectrum Disorders. 2021 Oct 1;88:101844.
• 8)Haney JL, Houser L, Cullen JA. Parental perceptions and child emotional and behavioral problems in autism. Journal of autism and developmental disorders. 2018 Jan;48:12-27
• 9)Tsiplova K, Ungar WJ, Szatmari P, Cost K, Pullenayegum E, Duku E, Volden J, Smith IM, Waddell C, Zwaigenbaum L, Bennett TA. Measuring the association between behavioural services and outcomes in young children with autism spectrum disorder. Research in Developmental Disabilities. 2023 Jan 1;132:104392.

Background: Dhat syndrome as a clinical entity has been rarely described in females. Studies suggest that females with depressive and somatic symptoms, often misattribute it to vaginal discharge, which in the majority of cases is physiological vaginal discharge.

Aims: This case series intends to provide insights into the clinical presentation, diagnostic challenges, and management approaches of female patients presenting with “female” Dhat syndrome as a comorbid condition.

Methods: A series of clinical cases involving females who presented with Dhat-like features as a comorbidity alongside other psychiatric and somatic complaints. Detailed clinical assessments, including comprehensive psychiatric, physical (including gynecological) evaluations, and laboratory investigations were conducted to establish a diagnosis and assess the comorbidity’s impact on the patient’s overall well-being.

Results: Gender-specific differences were noted. Our cases were older than their male counterparts (seen in late teens to early twenties in men). Secondly, they presented with a comorbid Axis-1 diagnosis, which is uncommon in males. Finally, there was no “guilt” driven psychopathology found in our cases (which is typical in males); it was rather “fear” driven. Management of the comorbid psychiatric illness was done as per guidelines, but the treatment of “Dhat-syndrome” was individualized based on educational level, cultural background, and nature of their comorbid psychiatric disorder. Psychoeducation regarding the differences between physiological and pathological vaginal discharge was done.

Conclusion: Female Dhat syndrome as a comorbidity is a relatively rare but clinically significant phenomenon that warrants its nosology. This case series underscores the importance of recognizing and addressing this entity in females, including those with comorbid Axis-1 psychiatric diagnoses, as its presence can impact their overall presentation and management.

A case Series of internet addiction disorder presenting as withdrawal symptoms

Background :

It is a pattern of excessive &prolonged internet gaming that results in a cluster of cognitive & behavioral symptoms

Three cases of internet addiction presenting as typical withdrawal symptoms & atypical presentation of withdrawal psychosis& Catatonia have been discussed .

case description :

A 17 yr old male presented with one year of playing free fire game ,Attempts to get him away met with complaints of insomnia ,school refusal , withdrawal symptoms of anger outburst , low mood fulfilling for depressive disorder . No history suggestive of other medical / substance / psychiatric comorbidities . Lab& neuroimaging studies found to be normal .

A 15 yr old male,was brought to the dept with continuous mobile use ,insomnia ,vague unknown fear ,hearing voices that developed two week after discontinuation of playing free fire game . On MSE his psychomotor activity increased , anxious affect with delusion of persecution , delusion of reference , auditory hallucination & diagnosed as internet addiction presenting as ATPD & started on antipsychotics .

A 15 yr old student came with the complaints of playing free fire game for two yrs , following annual exam announcement he developed reduced communication , refusal of foods , reduced sleep, Kept his hand in shooting position for long hrs, later he revealed delusion of persecution &reference , auditory hallucination

Conclusion:

Therefore, internet addiction more common in young adolescents & it can prone to cause psychosis& depression

A case of Risperidone monotherapy causing serotonin syndrome in one of the monozygotic twins.

Dr. Irene Mary Ike (Junior resident), Dr. Jayaprakashan KP (Associate Professor), Dr. Rajani Raju (Assistant Professor), Department of Psychiatry, Government Medical College, Thiruvananthapuram.

Introduction: Serotonin syndrome (SS) is a life threatening condition characterized by triad of altered mental status, neuromuscular and autonomic dysfunction. Most common culprits are SSRIs or a combination of serotonergic drugs that work by different mechanisms. Only few cases of atypical antipsychotics like risperidone when used in combination with serotonergic drugs & even rarer reports of risperidone monotherapy causing SS are reported.

Case Presentation: A 15-year old male, second born of monozygotic twin, with history of septal heart defect, and family history of Bipolar disorder in mother was diagnosed along with his twin brother as “other specified schizophrenia spectrum disorder”. Both were treated with Risperidone 4mg, that showed improvement. After 2 weeks of discharge, second twin presented with worsening of his psychotic symptoms, slowness of movements, reduced speech & hyperthermia. First twin didn’t report any such symptoms.

Examination, revealed autonomic instability, rigidity, brisk reflexes, eyelid myoclonus & ankle clonus. MSE revealed psychomotor retardation, catatonic signs, persecutory delusions & auditory hallucinations. Investigations showed raised WBC & CPK levels. Differential diagnosis of SS & neuroleptic malignant syndrome were considered. As Risperidone was considered to be a cause, it was tapered & stopped. Supportive treatment with Injection Lorazepam & Cyproheptadine were given. Since Hunter Serotonin Toxicity Criteria was satisfied & symptoms resolved rapidly on starting Cyproheptadine, moderate serotonin syndrome with Risperidone monotherapy was considered as final diagnosis.

Discussion: This case illustrates, possibility of occurrence of SS even with atypical antipsychotics like risperidone monotherapy. Awareness of the same can prevent significant morbidity & mortality.

ANCIPS 2024 Psychiatric Care: Problems, Progress and Prospects: Abstract for a free paper on original research: “Exploring diverse stakeholder perspectives for optimizing youth mental health clinic spaces in a healthcare setting”.

Helen Victory R^1*, Jagadeesan Settu^1*, Vijaya Raghavan D^2*

^*Schizophrenia Research Foundation (I), Chennai, Tamil Nadu – 600 110, India ¹Research Assistant, Department of Youth Mental Health

²Consultant Psychiatrist and Research Head, Department of Youth Mental Health

Corresponding Author

Mail ID: helenvictory@scarfindia.org

Contact: 9003094557

Background	Youth mental health services are evolving in response to the multifaceted spaces young people occupy, encompassing the real world, and the intricate emotional challenges they face. Youth mental health is a rapidly evolving specialty and there is a growing need to understand the diverse perspectives of stakeholders involved in shaping the future of youth mental health services.
Aims	To explore the various viewpoints of stakeholders on how the youth mental health space for youth should be designed and what it should encompass.
Method	A qualitative research approach was adapted to interview diverse stakeholder groups within the Youth Mental Health department. The sample was purposively selected to ensure representation and a structured interview was conducted using the guide with diverse stakeholders. Thematic analysis was used to identify common themes and patterns in the stakeholders’ viewpoints.
Results	We interviewed 7 service users, 9 mental health professionals, and 6 non-mental health professionals who expressed a variety of ideas and priorities, including accessibility, inclusivity, holistic care, early intervention, and the integration of technology to enhance the existing youth space at the healthcare institution. The theme that emerged was the youth space should be an easy-going, comforting ambiance that emphasizes a non-judgmental attitude from co-users, extremely anonymous and supportive, and highly informative to address any queries regarding youth-specific problems.
Discussion	This study highlights the importance of considering diverse stakeholder
	perspectives in shaping the future of youth mental health services.

Establishing an Advisory Board for Individuals with Early Psychosis: Qualitative Insights

Jagadeesan Settu^1*, Greeshma Mohan ^2*, Dr. Vijaya Raghavan ^3*, Priyadharshini^1*, Krishna Priya K^1*

^*Schizophrenia Research Foundation (I), Chennai, Tamil Nadu – 600 110, India ¹Research Assistant, Department of Youth Mental Health ²Project Coordinator (Research and Clinical Position)

³Consultant Psychiatrist and Research Head, Department of Youth Mental Health

Presenting Author

Mail ID: Jagadeesan@scarfindia.org

Contact: 8220077627

Background: The establishment of advisory boards has been identified as an important participatory research method to address health disparity. In mental health, most boards are led by MHPs, rather than service users. Nevertheless, some have been formed, especially in developed countries.

At SCARF, Chennai, the FEP Program is the only specialized psychosis program in the country, and much of the evidence-based data and experience on LMIC populations is derived from this centre. The establishment of an advisory board was deemed essential for advancing program goals, reducing disparities in access, and enhancing services to the extent permissible by the local mental health system’s resources. Because there is a lack of literature on this subject, the first step toward creating a local, culturally relevant, and sustainable body was to understand the process involved in doing so.

Objective: To explore qualitatively the key components of an advisory board for people utilizing early psychosis services at SCARF.

Methodology: Using expert opinion, a potential list of key stakeholders was identified, and 22 participants were interviewed. They included MHP, individuals with lived experiences, their caregivers, faith healers, professionals from academic settings, law, media etc. The focus was to identify the composition, function, and challenges involved in setting up an advisory board. The transcribed interviews underwent thematic analysis.

Results: The identified themes revolved around fostering awareness and empowerment of patients.

Conclusion: This study highlights the importance of establishing an advisory board composed of key stakeholders. Furthermore, the findings provide valuable guidance for future initiatives in LMICs to establish psychosis advisory boards.

Funding: This study is funded by the National Institute of Health & Care Research as part of the Early Career Research grants in the PIECEs project.

Atypical Presentation of Postpartum Psychosis due to Postpartum Autoimmune Thyroiditis

Dr. Sonamon Das, Dr. Swayanka Samantray, Dr. Udit Kumar Panda, Dr. Jayaprakash Russell Ravan

Department of Psychiatry, KIMS, Bhubaneswar.

Background:

Postpartum psychosis is a rare psychiatric emergency occurring in 1-2 per 1000 deliveries, with onset in the first 2 postpartum weeks. Atypical presentations may occur.

Aims:

To describe an atypical psychiatric manifestation of postpartum psychosis due to underlying autoimmune thyroiditis.

Methods:

Case report of a 22-year-old married female who 6 weeks after delivery developed emotional lability, insomnia, anxiety, disorganized thoughts, paranoid delusions and bizarre behaviour. Thyroid function tests were done.

Results:

Tests revealed elevated thyroid hormone levels and suppressed TSH, indicating thyrotoxicosis from postpartum autoimmune thyroiditis. Treatment with an antithyroid medication and beta-blocker dramatically resolved psychotic symptoms and normalized thyroid function in 2 weeks.

Conclusion:

This case demonstrates that postpartum autoimmune thyroiditis can manifest solely as psychiatric symptoms. Timely diagnosis and treatment of the thyroid dysfunction can rapidly resolve psychosis. A comprehensive medical workup should be pursued in postpartum females before assuming primary psychiatric pathology. Increased awareness among psychiatric and obstetric providers regarding atypical postpartum psychosis presentations is essential to identify reversible organic causes like postpartum thyroiditis that are critical in optimizing maternal psychiatric outcomes.

Background:

Electroconvulsive therapy (ECT) is contentious yet effective treatment for psychiatric conditions, with polarized opinions among psychiatrists, patients caregivers, and nurses. Nurses, in particular, who lack sufficient knowledge about ECT, may harbour negative attitudes, hindering their ability to support patients and address concerns. Given nurses pivotal role in ECT administration, understanding their baseline knowledge and attitudes is essential. This study focuses on nursing students with no prior exposure to ECT or psychiatry, aiming to explore how their knowledge and attitudes change with psychiatry training.

Aims:

Compare the knowledge and attitudes of nursing students toward ECT before and after undergoing psychiatry training.

Methods:

This is a longitudinal and comparative study .In participants meeting inclusion criteria and providing informed consent a questionnaire assessing attitudes and knowledge regarding ECT was administered on the first and last days of their psychiatry training.This questionnaire is adapted from a previous Indian study conducted by Sandeep Grover.

Conclusion:

This study, focusing on nursing students unexposed to ECT and psychiatry, aims to shed light on how their knowledge and attitudes evolve throughout their training. By comparing their pre- and post-training perceptions, we can gain valuable insights into the impact of education on these crucial aspects. Understanding the dynamics of knowledge and attitudes among future nursing professionals will be pivotal in addressing controversies and improving patient care in the context of ECT.

Approach to Management of Insomnia in Primary Care Settings: A Three-step Algorithm

Dr Meghal Gulati, Dr. Swayanka Samantray, Dr. Udit Kumar Panda, Dr. Jigyansa Ipsita Pattnaik, Dr. JPR Ravan

Dept. of Psychiatry, KIMS, KIIT university, Bhubaneswar

Background: Insomnia is commonly encountered in primary care settings but is often not adequately addressed. Availability of over-the-counter medications, lack of sleep-medicine professionals, and self-medication result in inappropriate sedative-hypnotic use (particularly benzodiazepines), thus leading to inadequate response and drug dependence.

Aims: With the aim to improve patient outcomes, enhance the quality of care, and streamline the management of insomnia within the primary care setting, we propose a “rational, Three-step algorithm to Insomnia Management”.

Methods: A 3-step algorithm for insomnia management in primary care is described.

Step 1 involves assessing and managing contributing acute or subacute medical conditions.

Step 2 comprises identifying and treating axis 1 psychiatric illness. Step 3 includes the treatment of primary insomnia with the prescription of good sleep hygiene techniques and reserving hypnotics for selective cases after proper evaluation.

Results: Step 1 would identify contributing medical conditions like uncontrolled asthma, infection, reflux, pain, headache, etc. By effectively treating these underlying medical issues, insomnia can be resolved in a substantial portion of patients.

Step 2 would screen for depression, anxiety, substance use and psychosis. Guideline-based management of these primary psychiatric conditions can significantly improve the biological sleep cycle.

Step 3 emphasizes non-pharmacological interventions, including sleep hygiene education, cognitive-behavioural therapy for primary or non-organic insomnia, and practices like yoga and meditation. When necessary, pharmacotherapy such as melatonin, antidepressants, and other psychotropics are considered judiciously. Referral to psychiatry is warranted if insomnia persists despite these sequential interventions. The algorithm would notably reduce the inappropriate use of sedative-hypnotics.

Conclusion: The three-step algorithm for managing insomnia in primary care offers a practical, evidence-based approach to addressing this common sleep disorder.

Background

Sexual dysfunction is a common side effect of psychotropic medications used to manage bipolar disorder, adversely affecting patients’ quality of life and medication compliance. Lithium, a primary BPAD treatment, is associated with sexual dysfunction in about one-third of patients. While anticonvulsants like valproate are used for BPAD, their impact on sexual function remains less studied. Furthermore, comparative research on sexual dysfunction between valproate and lithium as mood stabilizers in BPAD is limited. Understanding prevalence and comparative aspects of sexual dysfunction in these medications is crucial for comprehensive patient care.

Aims:

Estimate and compare the proportion of sexual dysfunction among BPAD patients receiving lithium and sodium valproate.

Methods:

Cross-sectional and comparative study will be conducted over a 3 month period. Study sample will consist of 130 BPAD patients aged 18 to 45 years who meet specific inclusion criteria. Data on sociodemographic factors, remission status (HDRS and YMRS scores), and sexual dysfunction will be collected. Sexual dysfunction will be assessed using the Arizona Sexual Experience Scale(ASEX), which evaluates dysfunction across five domains. Clinical sexual dysfunction is indicated by total ASEX score of ≥19, score of ≥5 on any one item, or score of ≥4 on any three items.

Conclusion:

Study seeks to shed light on prevalence of sexual dysfunction in BPAD patients treated with lithium and valproate. By comparing these two commonly prescribed mood stabilizers, we aim to contribute to better understanding of their impact on sexual health, ultimately facilitating more informed treatment decisions and improved patient care

Identifying Loneliness and Poor Social Network using Natural Language Processing from Electronic Health Records

Braja Gopal Patra, PhD¹, Lauren A. Lepow, MD, PhD², Prakash Adekkanattu, PhD³, and Jyotishman Pathak, PhD^1,4

¹Department of Population Health Sciences, Weill Cornell

Medicine, New York, NY, USA

²Icahn School of Medicine at Mount Sinai, New York, NY, USA

³Information Technology & Services, Weill Cornell Medicine, New

York, NY, USA

⁴Department of Psychiatry, Weill Cornell Medicine, New York,

NY, USA

Background:

“Poor social network” describes a situation in which an individual has lim-ited or no connections with others in their social environment. In contrast, “loneliness” represents a subjective emotional state characterized by distress or discomfort arising from a perceived gap between a person’s desired level of social connection and their actual level of social interaction¹. Research has shown that loneliness and insufficient social connections are associated with an increased risk of heart disease, stroke, and premature death^{2, 3}. Electronic health records (EHRs) are a valuable repository of longitudinal data of patient information and outcomes, including information related to loneliness and poor social network typically documented in clinical encounter notes. However, the extraction of

such data from narrative notes is often a time-consuming and labor-intensive process. To address this issue, we propose an automated natural language pro-cessing (NLP) approach to extract information regarding loneliness and poor social network from narrative notes.

Data: We used clinical notes and International Classification of Diseases (ICD)-based diagnosis codes from EHR system in a New York City-based academic medical center with >67M clinical notes (2006-2023) from 332,498 patients (who were prescribed an antidepressant medication or have a diagnosis of one or more mental diseases).

Methods: First, we created lexicons for both loneliness and poor social network using manual chart review and neural network techniques such as word2vec. Subsequently, we developed a regular expression-based NLP (rNLP) system that utilize these lexicons to identify clinical notes with mentions of both categories. The system was evaluated on a manually annotated gold standard clinical notes corpus (n=230). Finally, the rNLP system used to extract these concepts in the entire corpus (>67M). We also analyzed mental health outcomes for the patients with loneliness and poor social network.

Results and Discussion: When applied to gold standard, the rNLP system obtained macro-averaged F-scores of 0.98 and 0.80 for identifying loneliness and poor social network concepts, respectively. Upon processing 67.33M notes, the system identified 15,667 and 37,339 patients with mentions of loneliness poor social network, respectively. Notably, there were 6,009 patients who fell into both categories. Patients with these mentions reported higher mental health comorbidities (Table 1) and more emergency department visits.

Table 1.

Top mental health outcomes of patients with loneliness and poor social network.

Categories	Loneliness (%)	Poor social network (%)
Depression	70.7	36.7
Anxiety	61.1	36.4
Suicidal ideation	17.8	10.2
Bipolar disorder	14.7	8.3
Alcohol disorder	14.3	7.0
Psychosis	8.6	11.8

Conclusion: We developed an NLP system to extract loneliness and poor social network from clinical notes in EHR data. Future research can utilize a supervised classification approach to identify these concepts in clinical notes.

References

1. Wickramaratne PJ, Yangchen T, Lepow L, Patra BG, Glicksberg BS, Talati A, et al. Social connectedness as a determinant of mental health: A scoping review. PLOS ONE. 2022;17:1-30.

2. Murthy V. Our epidemic of loneliness and isolation: The US surgeon gen-eral’s advisory on the healing effects of social connection and community. US Department of Health and Human Services, Office of the Surgeon General; 2023.

3. Patra BG, Sharma MM, Vekaria V, Adekkanattu P, Patterson OV, Glicks-berg B, et al. Extracting social determinants of health from electronic health records using natural language processing: a systematic review. Journal of the American Medical Informatics Association. 2021;28(12):2716-27.

Words Matter: Use of Stigmatizing Language in Clinical Notes of Patients with Opioid Use Disorder

Prakash Adekkanattu, PhD¹, Braja Gopal Patra, PhD², Veer Vekaria, BS², Marianne Sharko, MD², Jyotishman Pathak PhD^2,3

¹Information Technologies & Services, ²Department of Population Health Sciences, and

³Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA

Introduction: Structural bias and stigma are highly prevalent in the US healthcare system. Patients from racial and ethnic minority backgrounds and those with obesity and substance use disorders (SUDs) have been impacted by conscious and unconscious biases among healthcare professionals. Stigma can be experienced and communicated in many ways including the language used by clinicians in encounter notes in the electronic health record (EHR). Objectives: This study aimed to investigate the use of stigmatizing language (SL) in clinical notes among patients with an opioid use disorder (OUD) diagnosis. Methods: The National Institute on Drug Abuse (NIDA) identifies a list of terms and phrases that assign negative labels, stereotypes, and judgement to individuals. Such language may discourage individuals from seeking help, and it is recommended to use people-first language (PFL) when interacting with patients and documenting encounters. We developed appropriate lexicon for each of the SL terms in the NIDA list and implemented a simple rule-based natural language processing (NLP) algorithm to extract these terms from clinical notes. We processed 980,194 notes for 2,700 patients with an OUD diagnosis between 2010 and 2023 at a major academic medical center in New York City. We analyzed the incidence rates of SL in notes and demographic characteristics of patients with SL compared to those without SL found in their encounter notes. Results: As shown in Table 1A, our NLP system identified 2,279 (84.4%) patients with one or more SL term(s) in their notes, and 421 patients with no SL. Terms such as “abuse”, “opioid abuse”, “addict”, and “substance dependence” were the most frequent ones found in clinical notes. As shown in Table 1B, we found significant differences by age, gender, race, and ethnicity across these cohorts. Patients with SL tended to be older and female. Patients who identify as Black or Hispanic had higher incidence of SL compared to those who identify as White and non-Hispanic. We also found that notes authored by female providers use SL terms more frequently than those authored by male providers. Additionally, notes authored by mental health providers have a lower incidence of SL compared to other specialties. In particular, notes authored by social workers had higher incidence of SL in their notes. Conclusions: These observations highlight the need for modeling best practices to decrease stigma and bias, and further a need for provider education on what constitutes stigmatizing language in clinical documentation practices.

Differential Changes in Outpatient Mental Health Service Utilization among Individuals with and without Severe Mental Illness since COVID-19

Rohith Kumar Thiruvalluru, MS¹, Mohit M. Sharma, MPH¹, Mark Olfson, MD, MPH², Jyotishman Pathak,

PhD¹, Yunyu Xiao, PhD¹

¹Weill Cornell Medicine, New York, NY,

²Columbia University Medical Center, New York, NY

Background: The COVID-19 pandemic has exacerbated pre-existing healthcare disparities affecting individuals with Serious Mental Illness (SMI). These patients face higher treatment discontinuation risks due to factors like anxiety, fear of virus exposure, routine disruptions, and limited access to telehealth. While the literature on SMI treatment gaps exists, in-depth studies on pandemic-related disruptions and reconnections are limited.

Objective: This study aims to clarify how the pandemic influenced outpatient mental health service utilization use among existing and recurrent SMI patients compared to those without SMI.

Methods: To delineate the differential changes in healthcare utilization, we analyzed electronic health record data from Healthix, a large public Health Information Exchange in the U.S., consisting of individuals who were tested for COVID-19, hospitalized, or treated for COVID-19. We examined differences in healthcare utilization during three distinct time frames: Pre-COVID (Jan 2019 - Dec 2019), Pre-Vaccination (Jan 2020 - Dec 2020), and Post-Vaccination (Jan 2021 - Apr 2022). These individuals were classified into three groups: individuals with new SMI, recurrent SMI, and non-SMI. Recurrent SMI patients had two SMI diagnoses in separate periods. Our primary outcome was 1) treatment discontinuation, characterized by a 90-day gap without any outpatient visits following the last registered outpatient visit, and 2) reconnection, which was marked by resuming treatment following this 90-day interval. ORs were computed using logistic regression.

Results: Out of 3,724,348 individuals in the study population, 589,389 (15.8%) were categorized as SMI patients (newly diagnosed and recurrent), and 3,134,959 (84.2%) were categorized as non-SMI Patients. More than 52% of recurrent SMI patients (n=78,280) experienced significant disruptions in outpatient mental health services, by a 90-day gap in visits (OR=1.68, p<0.001). In contrast, only 29.8% of non-SMI patients (n=933,797) experienced such disruptions (OR=1.08, p<0.05). Reconnection rates showed an 11.8% increase among non-SMI patients in the post-vaccination phase (OR=1.27, p<0.01), compared to a 6.2% increase among SMI patients (OR=1.09, p<0.05). The vulnerability was more pronounced among SMI patients aged 45-64, with a 14.2% increase in reconnection rates (OR=1.35, p<0.01). SMI individuals with comorbidities like diabetes and hypertension saw a 16% increase in reconnection rates (OR=1.39, p<0.01), indicating a higher perceived need to resume treatment.

Conclusions: Our study highlights individuals with SMI experienced significant disruptions in healthcare services and reconnection during COVID-19. These findings underscore the urgent need for targeted interventions to ensure equitable and uninterrupted access to healthcare services for this vulnerable population, particularly in individuals aged 45-64 and those with specific comorbidities.

Correlates of Physical Restraint Post Mental Health Care Act 2017: A Retrospective Study

Name of the investigators: Dr Sanat Lotlikar, Dr Colin Braganza, Dr Ashish Srivastava, Dr Shilpa Waikar

Institute of Psychiatry and Human Behaviour(IPHB)- Bambolim

Background-Patients with severe mental illnesses and substance abuse have an increased likelihood of aggression and self-harm and may pose a significant risk to themselves and others. Physical restraint is a coercive approach of reducing a patient’s physical movement to promote safety and treatment in such situations.

Section 97 of the Mental Health Care Act, 2017 regulates the use of restraint. In view of the legal regulations as well as the risk of physical injury and psychological trauma to patients, it is important to evaluate the use of coercive measures and physical restraint so as to find ways to further decrease the use of the same and to enhance the care provided to those with mental illness.

Aim-To evaluate the use of physical restraint and study the sociodemographic and clinical correlates of its use at a tertiary care psychiatric hospital in Goa.

Methods-Sociodemographic and clinical data from the Physical Restraint Monitoring and Reporting Forms and Case Records of all those who received physical restraint at IPHB, Goa over the one-year period from April2022 to March2023 was collected retrospectively and analysed.

Results-Physical restraint was administered to 266 individuals over the 1 year period. The mean age for restraint was 36.24±11.67 years and a majority(64.28%) were males. The most common diagnosis requiring restraint was Bipolar Disorder in Mania(27.44%, n=73). The mean duration of restraint was 20.53±7.59 minutes and a large majority(92.85%) also received chemical restraint.

Conclusion-Understanding the socio-demographic and clinical correlates of restraint could help guide pre-emptive measures to decrease the need for the same.

A study of anxiety, depression and quality of life in dialysis and non dialysis patients with Chronic Kidney Disease.

Background

The aim of this study was to investigate the presence of anxiety, depression and to compare quality of life between dialysis and non dialysis patients with Chronic Kidney Disease (CKD). Chronic kidney disease is a life-threatening condition that persists for an extended period of time and necessitates lifelong medical intervention and dietary restrictions. This leads to change in lifestyle and emergence of psychological stress due to restricted physical and social activities. Some patients experience Depression and Anxiety during the course of illness and leads to decrease in QOL.

Aim

• To study the prevalence of Anxiety and Depression masked in the patients with CKD.

• To compare the quality of life in Dialysis and non dialysis patients with CKD.

Methods

A Cross sectional study. A total of 50 patients with CKD (25 Non dialysis and 25 dialysis undergone) will be cross sectionally studied using scales like

• Depression and Anxiety were assessed by Hospital Anxiety and Depression scale.

• QOL was evaluated using the 36 item Short Form Health Survey questionnaire

Results And Conclusions

As study is still undergoing the results are yet to be ascertained.

The Prevalence and associaTion of dePressive disorders wiTh irriTable bowel syndrome: a comParaTive cross- secTional sTudy

Background- Irritable Bowel Syndrome (IBS) is a very common gastrointestinal dysfunction and comorbidity of IBS and psychiatry disorders is common. The prevalence of at least one psychiatry disorder has been reported as high as 80% among patients with IBS.

Aim- To explore and compare the sociodemographic profile and depressive disorders with IBS group and healthy control.

Materials and methods- After obtaining clearance from institutional ethics committee and written informed consent form individual study subject, 30 consecutive patients with confirmed diagnosis of IBS attending the Gastroenterology medicine outpatient department and 30 patients without IBS of a tertiary care center were included in this cross-sectional study. Diagnosis was made using ICD-10 and a semi -structured Performa designed for this study along with Hamilton Depression rating scale (HAM-D) to assess the prevalence of depressive symptoms

Result- Most of the patients were Male 30-45 year and 18-30 in IBS and Healthy control group respectively. There was high statically significant difference between both groups regard to education, occupation and socioeconomic status. Regarding depression moderate and severe depression reported in IBS group respectively, while 60% participants reported mild depression in healthy control group.

Conclusion- The prevalence of depression in IBS group is very high. Therefore, this research highlights the need for appropriate assessment and treatment of depressive symptoms and or/ disorder in these patient group should be implemented for improve their overall health.

Key words – IBS, DEPRESSION, HAM-D

A rare case of Partial Androgen Insensitivity Syndrome with Persistent Somatoform Pain Disorder and Sexual Paraphilias

Background: Androgen Insensitivity Syndrome (AIS) is a Disorder of Sexual Differentiation (DSD), characterized by partial or complete inability of cells to respond to androgens. It can impair the development of male genitals and male secondary sexual characteristics at puberty. Partial androgen insensitivity syndrome (PAIS) is indicated when the external genitalia are partially masculinized.

Data is lacking regarding the prevalence and forms of psychiatric illnesses among people with Disorder of Sexual Differentiation .

Methodology: A case of 58 year old unmarried male, from a lower- middle socioeconomic family in Hubli, with well adjusted premorbid personality, educated till 10^th standard.

At birth was assigned female and brought up as a girl, did not attain menarche, was evaluated and diagnosed with Disorder of Sexual Differentiation . Hormonal assays and ambiguous genitalia on physical examination reveals partial AIS. Prophylactic orchidectomy 2 years back.

History of partial AIS in his brother. History of transvestism, exihibitionism, voyeurism since age 20. Identifies self as heterosexual male.

Was brought with complaints of multiple screaming episodes secondary to persistent abdominal pain in the left lumbar region and socio-occupational dysfunction since 3 years; not relieved by multiple analgesics. Detailed and multiple investigations revealed no underlying cause.

Results: Patient was treated with duloxetine ,opipramol ,supportive psychotherapy following which symptoms improved.

Conclusions: Early detection and treatment of psychiatric illnesses among people with Disorder of Sexual Differentiation can improve functioning and quality of life.

Preserving minds, protecting data – The Intersection of Data Privacy and Mental Health – A Narrative Review

Dr Meghna Madhusudhan (Post Graduate)

Dr Milan Varghese (Senior Resident)

Dr Sachin N (Assistant Professor)

Department of Psychiatry, St John’s Medical College and Hospital, Bengaluru

Background: It is important to understand how data privacy and mental health intersect in the digital age, examining the potential negative impacts of privacy breaches on individuals with psychiatric conditions.

Aims:

1. 1.Examine data privacy’s role in mental health data.

2. 2.Assess the impact of privacy laws on mental health.

3. 3.Explore strategies for evolving mental healthcare privacy.

Methods: We conducted a PubMed search using keywords ‘data privacy’ and ‘mental health’ for relevant literature published till date. Only freely available articles were retrieved for the study. We selected 9 relevant articles and manually checked their citations for additional sources.

Results: Out of the initial 9 articles we found, one delves into the implications of linking data with Aadhaar. Two articles are qualitative studies, focusing on user perspectives regarding data sharing. Three articles explore the challenges and opportunities of mental health app usage globally while the remaining articles examine issues related to data acquisition and sharing within mental health care systems. Our review underscores the significance of safeguarding patient confidentiality through data privacy measures. We discuss the impact of data privacy regulations like General Data Protection Regulation (GDPR), Health Insurance Portability and Accountability Act (HIPAA), and Personal Data Protection Bill (PDPB) on mental health care and address ethical dilemmas arising from balancing data privacy with the advantages of data sharing in mental health research and treatment.

Conclusion: This review emphasizes data privacy’s importance and advocates collaborative efforts among policymakers, researchers, clinicians, and mental health care seekers to enhance protective frameworks.

A study on stressful life events and role of personality in patients with first episode psychotic illness

Dr. D. Dining Rongmei, Dr. Raju Sah, Dr. P. Barman.

Background: First episode psychosis refers to the initial psychotic episode. Recent stressful life events and personality traits are linked to the development of psychosis. So we looked into whether the five factor model of personality traits can predict stressful life events and whether personality traits may mediate the impact of stressful life experiences.

Aims: To determine the association of personality in first episode psychotic illness.

To determine the association of stressful life events in first episode psychotic illness.

Method: A Cross-sectional, Descriptive study was carried out in the Department of Psychiatry, Silchar Medical College and Hospital. The diagnosis was made using the ICD-10 criteria and confirmed by two psychiatrists for 50 cases with first episode psychosis. Semi-structured questionnaires were used for sociodemographic data. The Presumptive Stressful Life Events Scale (PSLES) was used to measure perceived stress, and the Five Factor Model (FFM) was used to measure personality.

Results: We found a significant positive correlation between neuroticism and psychosis in our study, but a significant negative correlation between extraversion, openness, agreeableness, and conscientiousness, and a positive correlation between stressful life events and psychosis.

Conclusion: In our study, people with neuroticism are more prone to undergo stress and psychosis. The stressful life events is relevant as a significant cause of perceived stress in the first episode psychotic group. This study emphasizes the significance of psychological intervention in the management of illness and may be a key strategy for prevention in this susceptible group.

Anxiety Disorders in persons with Locomotor Disability

Background : More than a billion people are estimated to live with some form of disability, or about 15% of the world’s population. Inability to work as a normal productive member of the society bears a huge psychological distress among disabled individuals.

Aims: The aim of the study was to find out the prevalence of psychiatric morbidities in locomotor disabled patients and their relation to their socio-demographic variables.

Methods: 100 persons who fulfilled the criteria of Loco motor disability were included in the study. Psychiatric evaluation was done as per ICD-10.The severity of morbidity was assessed using rating scales (HAM-D, HAM-D, BPRS).The severity of loco motor disability was measured as per disability guidelines of Govt. of India. Statistical analysis was done using simple statistical analysis like Chi square test, t- test , p value for significance and correlation coefficient.

Results: Out of 100 patients 76% were found to have psychiatric illness. . Depressive Episodes was the most common psychiatric illness found in 41% of patients.28% of the patients were found to have Generalized Anxiety disorder 5% had Post Traumatic

Stress Disorder. Patients with disability percentage > 70% found to have greater psychiatric morbidity than its counterpart of 40 - 70%.This observation was found to be statistically significant (P < 0.002)

Conclussion: This study again reaffirms the association of psychiatric morbidities with locomotor disability and the importance of a surveillance system to prevent/treat the psychiatric problems occurring with disability.

Psychiatric morbidities, and coping styles amongst Civil Service aspirants in Bangalore: A cross-sectional study.

Dr Roopali M - Postgraduate

Dr Archana G - Assistant Professor

BMCRI

BACKGROUND: UPSC (Union Public Service Commission) Exam is one of the most difficult examinations in the country due to the limited number of attempts and seats which builds an enormous pressure on the aspirant.

Young adulthood is characterized by the pursuit of greater educational opportunities resulting in stress that precipitates the onset or recurrence of psychiatric disorders such as depression, anxiety or Substance use disorders.

Perceived social support and problem focussed coping styles play an important role.

AIMS:

• To assess the prevalence of psychiatric morbidities in the Civil Service Aspirants.

• To assess the coping styles in the Civil Service aspirants.

METHODS: Civil service aspirants aged 21-32 years in Bangalore willing to give informed consent were recruited in the study. Sociodemographic details collected. Depression, Anxiety and Stress Scale (DASS 21), Positive and Negative Affect Scale(PANAS), Multidimensional Scale of Perceived Social Support(MSPSS) scale, WHO-ASSIST, Brief Coping Orientation to Problems Experienced Inventory applied. The data analysed.

RESULTS: Amongst 31 participants, the prevalence of Depression, Anxiety and Stress was found to be 58.1%, 51.6% and 45.2% respectively. Emotion focussed coping was most frequently used coping strategy in this population.

CONCLUSION: The prevalence of Depression, Anxiety and Stress is higher in civil service aspirants. This study is planned which helps in the early detection and effective management of the same and further policy making in the field of education.

The correlation between cognitive functions and serum uric acid levels in patients with schizophrenia

Dr Pradyumna (3rd year Postgraduate), Dr Madhusudhan S (Associate Professor), Department of Psychiatry, Bangalore Medical College and Research Institute, Bangalore.

Background

Schizophrenia(SCZ) is a disabling disease with a global burden of approximately 0.24–0.31%. Cognitive impairment affects at least 80% of patients with schizophrenia which is important in predicting patient’s treatment and functional outcome. It is found that high Uric acid(UA) level is associated with better cognitive function.

Aims

This study aims to clarify the relationship between UA and cognitive impairment and explore whether UA could be a potential biomarker of cognition in SCZ during maintenance period.

Methods

After obtaining clearance from the institutional ethics committee, 30 patients fulfilling the diagnostic criteria for SCZ according to ICD-10 were enrolled for the study after obtaining informed consent. Montreal Cognitive Assessment(MOCA) scale was applied and UA levels were checked in all patients. Association between UA level and cognitive functioning is looked for.

Results

Out of 30 patients, 16 had mild cognitive impairment, 5 had moderate cognitive impairment and remaining 9 had normal cognition. Patients with mild to moderate cognitive impairment had low UA levels as compared to normal cognition.

Conclusion

This study showed that high levels of UA in patients of schizophrenia have better cognitive functioning and vice-versa; hence the level of UA can be used as a screening tool for assessing cognitive functioning in schizophrenic patients.

A CLINICAL STUDY ON SUICIDE ATTEMPTERS : A CROSS SECTIONAL STUDY FROM NORTH INDIA

Rachit Singhania¹, Robin Victor² PriyaRanjan Avinash

¹Junior Resident, Department of Psychiatry, Himalayan Institute of medical sciences, Swami Rama Himalayan University.

²Associate Professor, Department of Psychiatry, Himalayan Institute of medical sciences, Swami Rama Himalayan University.

³Professor, Department of Psychiatry, Himalayan Institute of medical sciences, Swami Rama Himalayan University.

INTRODUCTION:- Suicide is a major problem across the world resulting from a complex interaction between psychological, biological and environmental factors. For the purpose of establishing the cause of death, suicide is legally defined as the “intentional act of self-destruction committed by someone knowing what he is doing and knowing the probable consequences of his action.” The verdict of suicide should be supported with evidence and can never be presumed. The Rate of suicide varies in various countries with the lowest rate of 0.17 per 1 lakh in the Maldives to the highest rate of 62.3 per lakh in Belarus. In descending order of rates of suicide India ranks 43rd. According to the NCRB report (National crime record bureau) the global average of suicide is 14.2 per lakh per year and the current national rate is 11 per lakh per year.

Aim: To, find out the sociodemographic and the clinical data of the subjects presenting to the tertiary care hospital with an attempt of suicide. We also assessed the psychiatric diagnosis of these cases and explored the severity of depression, hopelessness and suicidal intent and their co-relation with each other.

Methods and Materials: This hospital based cross-sectional, single interview study was conducted at Himalayan Institute of Medical Sciences, Dehradun, which is a multi-specialty teaching hospital after approval from institutional ethics committee. A total of 58 patients who attempted suicide and were admitted to the hospital irrespective of the department over a period of 3 months starting from 11th of April, 2023 to 10th of July, 2023 were selected consecutively and included in the study.

Following instruments were administered in each patient:

(i)Case sheet Proforma ,Tenth Revision of the International Classification of Disease and Related Health problems (ICD-10 criteria),(ii)The Hamilton Rating Scale for Depression (HRSD),(iii) Suicidal Intent Questionnaire – (SIQ),(iv) Hopelessness scale devised by Beck et al;.(1974)

Results:- A total of 108 patients who attempted suicide were taken serially for this hospital based cross sectional study. The study subjects were of age group 15-64 with the mean age 26.23±10.40 years. Out of the 108 patients who were included in the study, we found that majority belonged to age group of 15-24 years (59.25%) While looking across the gender it was seen that suicidal attempt was slightly more among females (54.62%) as compared to the males (45.37%). Most of the patients were Hindus (53.70%) and from a rural background (69.44%). Majority of the patients under study were from nuclear family (64.81%). Looking at marital status we found that majority of the cases were single (60.18%). It was also seen that most cases were from lower middle social economic status (36.11%).

Conclusion:-We found significant correlation between the three different entities of depression, hopelessness and suicidal intent.

THROMBOCYTOPENIA IN PATIENTS HOSPITALIZED FOR ALCOHOL WITHDRAWAL SYNDROME AND ITS ASSOCIATIONS TO CLINICAL COMPLICATIONS

Background :The aim of this study was to assess the predictive value of thrombocytopenia(TP) in alcohol withdrawal syndrome(AWS) as a marker of evolution of non complicated AWS(nAWS) to severe,complicated AWS(cAWS):delirium tremors and withdrawal seizures and to broaden knowledge about differences between nAWS and cAWS in relation to severity of thrombocytopenia.

Aim :

The main objective of the study was to assess the association of alcohol induced TP with selected parameters of AWS of severity requiring hospitalization.

Methods :

Cross-sectional study in patients were selected from the population of inpatients diagnosed as AWS according to ICD-10 diagnosis of F10.3 or F10.4 divided into nAWS and cAWS groups. Alcohol withdrawal syndrome severity measured by CIWA-Ar.Available clinical and laboratory data were analyzed

Results:

non complicated AWS and complicated AWS not differ according to age,gender,length and severity of last binge.A relationship between the occurrence of Thrombocytopenia and complicated alcohol withdrawal syndrome was found(P<0.001).The lower was the number of platelet, the more AWS incidence was observed. In CIWA-Ar,TP subjects had at least moderate AWS(P<0.001).nAWS had higher platelet values than cAWS cases.The predictive value of thrombocytopenia in cAWS was confirmed.

Conclusion :

The study demonstrates the patients with alcohol withdrawal syndrome and Thrombocytopenia are higher risk of developing complicated alcohol withdrawal

REFERRANCES

(1987) Verbal report methods in clinical research on alcoholism: response bias and its minimization. J Stud Alcohol 48:410–24.

Bakovic D, Pivac N, Eterovic D, et al. (2013) The effects of low-dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets. Clin Physiol Funct Imaging 33:30–7.

Ballard HS. (1997) The hematological complications of alcoholism. Alcohol Health Res World 21:42–52.

Berggren U, Fahlke C, Balldin J. (2000) Transient increase in platelet monamine oxidase B activity during early abstinence in alcoholics: implications for research. Alcohol Alcohol 35:377– 80.

Berggren U, Fahlke C, Berglund KJ, et al. (2009) Thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures. Alcohol Alcohol 44:382–6.

Chen S, Du C, Shen M, et al. (2018) Sympathetic stimulation facilitates

thrombopoiesis by promoting megakaryocyte adhesion, migration, and

proplatelet formation. Blood 127:1024–35.

Eyer F, Schuster T, Felgenhauer N, et al. (2011) Risk assessment of moderate to severe alcohol withdrawal – Predictors for seizures and delirium tremens in the course of withdrawal. Alcohol Alcohol 46:427–33.

Frye JL, Thompson DF. (1993) Drug-induced thrombocytosis. J Clin Pharm Ther 18:45

Role of family system in developing depression in elderly – a cross sectional study.

Background:

Depression is the most common psychiatry disorder in elderly. Urbanization promotes nucleation of family system and a decrease care in elderly people. Family system role in depression has not been studied extensively.

Aim:

To determine the relationship between depression and type of family system, also the prevalence of depression in the elderly as well as correlation of depression with other important socio demographic variables.

Method

This is a cross sectional study . questionnaire based on interviews conducting in hospital visiting elderly people using 15 item Geriatric Depression Scale.

Results and conclusions

Study is under going and results are yet to be determined.

Dissociation chronicles : diving into the abyss

Introduction:

Dissociative disorders are mind’s mysterious puzzles. They involve a fascinating and complex array of conditions where aspects of a person’s identity, memory, or reality become fragmented or separated.

Cases series of dissociative disorders with various presentations:

Case 1:Unveiling Silence: A 38Y/F who manifested speech mutism. Despite intact language skills, the patient experienced profound difficulty speaking without any apparent organic cause , diagnosed as Dissociative motor disorder.

Case 2 :Identity in flux: A 26Y/F exhibited episodes of identity alteration and apparent possession by distinct personalities. Through a comprehensive psychiatric evaluation the diagnosis of dissociative trance and possession was confirmed.

Case 3: Unveiling the Shadows: A 28Y/F experienced memory loss following a hanging incident. Despite surviving the traumatic event, the patient displayed profound memory gaps and a fragmented sense of self. Comprehensive assessment unveiled the diagnosis of Dissociative Amnesia.

Case 4: Dissociation in motion : A 26Y/F previously diagnosed with Juvenile Myoclonic Epilepsy(JME)experienced convulsions that mimicked epileptic-seizures but were psychogenic in nature, the coexistence of Dissociative Convulsions alongside JME was revealed

Case 5: A Complex Presentation: A 18Y/F who sequentially experienced dissociative abdominal pain, followed by a severe headache, and culminating in dissociative convulsions. Extensive medical evaluations ruled out organic causes, leading to the diagnosis of Dissociative disorder not otherwise specified

CONCLUSION: This case series highlights the multifaceted world of dissociation disorders with its unique challenges and knowing them can help avoid misdiagnosis and promote more early targeted effective interventions.

Safe use of Clozapine in Patients Diagnosed with Seizure Disorder

Arshia Sood, Sandeep Grover, Subho Chakrabarti

Post Graduate Institute of Medical Education and Research, Chandigarh

Background: Seizures are considered to be one of the dreaded side-effects of clozapine and due to this, use of clozapine is avoided in patients with treatment resistant schizophrenia. However, there is little information about use of clozapine among patients with seizure disorder. Aim: To present the data of 15 patients, who were diagnosed to have seizure any time in their lifetime prior to starting of clozapine and received clozapine for management of treatment resistant schizophrenia. Results: In most of the patients who received clozapine, it was used under the cover of an antiepileptic medication, with most commonly used antiepileptic medication being valproate or lamotrigine. A small proportion of patients had recurrence of seizures after starting of clozapine and required readjustment of dose of antiepileptics or clozapine. In none of the patients, clozapine had to be stopped due to continuation of seizures. Conclusion: Clozapine can be used in patients with treatment resistant schizophrenia with history of seizure anytime in the lifetime under cover of an antiepileptic medication.

Blood is affected, but the mind reacts: Psychosis masquerading Porphyria

Poulomi Ghosh, Prashnat Bhardwaj, Suprakash Chaudhury

Background: Porphyrias are a set of uncommon genetic diseases where specific enzyme abnormalities impact the heme production pathway. It can mimic a number of frequently occurring illnesses, creating a diagnostic minefield. Psychiatric symptoms are highly prevalent, and the clinical picture is often marked by cloudy awareness, paranoid traits, and schizophrenia-like behaviors.

Aim: We present three cases of Acute Intermittent Porphyria that primarily presented with florid psychiatric symptoms.

Method: Three cases were admitted to the psychiatry ward because of gross behavioral abnormalities. They had psychotic symptoms like delusions and hallucinations, spoke irrelevantly, and had a history of unprovoked violence. One case presented with certain depressive features. All three cases also complained of some gastrointestinal problems. They were evaluated thoroughly with all relevant investigations, and a detailed general, systemic, and mental status examination was carried out.

Result: Psychotic developments obscured other underlying aspects; however, the discovery of dysautonomia and a confusional state at the peak of the psychotic presentation in these individuals prompted us to begin a thorough investigation for an underlying organic illness. The passage of high-colored urine and the presence of porphobilinogen in urine in all three cases confirmed the diagnosis of acute intermittent porphyria.

Conclusion: Porphyria is vital in psychiatry as it may present with only psychiatric symptoms and may be disguised as psychosis. Thus, a high index of suspicion and appropriate investigation is a must to detect this metabolic abnormality.

Frequency, pro ile and predictors of medication use in children with Autism Spectrum Disorder : A Cross-sectional Study

Autism spectrum disorder (ASD) comprises a group of neurodevelopmental disabilities. The DSM-5 includes autism, Asperger’s disorder, and “pervasive personality disorder not otherwise speci ied” under the umbrella heading of ASD. The symptoms of ASD generally appear between the ages of 2 and 3 years. The children experience dif iculty in developing social, speech, and behavioral skills. Therefore, behavioral therapy is usually the irst-line treatment, with pharmacological therapies added to help patients function in their daily activities. Risperidone and aripripazole are some FDA approved antipsychotics, for treating irritability associated with ASD. Medications are also used in ASD are to treat comorbid seizure disorder, ADHD or sleep and gastrointestinal issues.

This study was carried out to identify frequency of medication usage, medication pro iles and clinical predictors of medication use in children with ASD.

A Total of 30 children diagnosed with ASD were recruited for the study after obtaining an informed consent from the parents, sociodemographic details were collected, assessments were done using BPI-S, ISAA and FAD General functioning scale.

The data was analysed using relevant statistical methods. 9 out of 30 children (30%) were on antipsychotics, risperidone being the most common. 9 out of 30 children (30%) were on medications for comorbid ADHD with Clonidine being the most common. The study found a strong positive correlation between ISAA scores and BPI (+0.56) and higher scores in both were associated with higher likelihood of medication use.

Indian Approach to Family Therapy

Dr.V.Sayee Kumar*

Family therapy is a form of therapy that is designed to address the problems that influence the psychological as well as mental health of family and its members. It is often used as a complementary treatment approach for many physical and mental health conditions. Indian society is collective in nature and considered to be strong, stable, close, resilient and enduring with focus on family integrity, family loyalty, and family unity at expense of individuality, freedom of choice, privacy and personal space. We can still believe that our family system forms a resource for mental health that India cannot neglect, yet utilization of family in management of mental disorders is minimal. But our clinicians face significant challenges in their attempts to practice or use techniques of family therapy that we have learned based on western theories on psychotherapy and family therapy. This paper discusses the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. An attempt is made to evaluate the scope and effectiveness of family therapy in India. Because family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders.

*Consultant – Counselling & Psychotherapy – CBT, Chennai

Email: dr.sayeekumar@gmail.com

Paper to be presented at ANCIPS 2024, 75th Annual National Conference of Indian Psychiatric Society, Organised by Indian Psychiatric Society, Kochi, Kerala | 18th - 21st January, 202: A patient of LG1 autoimmune encephalitis presenting with movement disorder

Background:

Autoimmune Encephalitis is a complex disorder that can present with various neuropsychiatric symptoms such as seizures (most commonly Faciobranchial dystonic seizures), cognitive impairments, sleep disturbances, psychiatric and behavioral disorders.

Aims:

To understand various neuropsychiatric symptoms constellation in autoimmune encephalitis and management.

Methodology:

We present a case of 40 year old married male, from a lower middle socioeconomic status family in Bijapur, with well adjusted premorbid personality, postgraduate, with family history of alcohol dependence in brother, no significant past history, was referred to psychiatry OPD with motor symptoms suspected to be of conversion disorder. On examination patient had episodes of choreoathetoid movements associated with behavioral abnormalities in the form of screaming, restlessness lasting for about 30 seconds with normalcy in between episodes and memory disturbances, decreased sleep, excessive worry. Patient was evaluated and blood investigations showed persistent hyponatremia, decreased TSH, USG abdomen showed bilateral grade I/II nephropathy for which endocrinology opinion was sought and managed accordingly and in view of abnormal choreoathetoid movements and behavioral disturbances and MRI brain showing prominent subarachnoid space around optic nerves, neurology opinion was sought for suspected autoimmune encephalitis and LG1 autoantibodies were strongly positive in serum testing.

Results:

Patient was treated with antiepileptics, thyroxine, cyclophosphamide and methylprednisolone following which there was improvement in symptoms and is currently maintaining well with treatment.

Conclusions:

Choreoathetoid movements, behavioral abnormalities, with persistent hyponatremia should be thoroughly evaluated for autoimmune encephalitis and should be managed adequately .

ABSTRACT PAPER ANCIPS 2024: THE NOVEL AGENTS UNDER TRIAL FOR MAJOR DEPRESSIVE DISORDERS

Dr. Archana Chauhan, Dr. Mohit Agrawal, Dr. Prateek Yadav

Background: There is substantial interest in the availability of new treatment options that have greater, broader or more specific efficacy, similar or enhanced tolerability and new mechanisms of action compared to already available agents. This may also help in personalization of treatment. This paper highlights the medications with innovative mechanisms of action that are undergoing phase 2 or 3 testing for the treatment of major depressive disorder, seen as having promising results in the form of superiority over placebo, magnitude of the observed effect and demonstration of safety and tolerability.

Aim: To discuss the novel drug development targets and related mechanism of action aimed at the treatment of the major psychiatric illness of Depressive disorders in adults is essential to observe, learn from and, possibly, pursue further, should specific agents under development successfully progress through their phase 2 and 3 programs and, ultimately, lead to regulatory approval.

Methods: To review the various studies conducted on the novel agents aimed at treatment of major depressive disorder.

Result: The novel antidepressants agents target directly or indirectly the cannabinoid, cholinergic, dopamine, estrogen, GABA, glutamatergic, inflammatory, immunological, ion channel, neurotrophic, noradrenaline, opioid, peroxisome proliferator activated receptor, serotonin, sigma, TAAR, and sub­stance P systems. Cariprazine, extended release formulation of Levomilnacipran, intransal Esketamine, ASX 05, Esmethadone, Rapastinal, Zuranolone are a few antidepressant under phase 2 /3 trial.

ABSTRACT FOR ORAL PAPER PRESENTATION

Dr Mohammed Irfan Sheikh, Post Graduate Resident, Mandya Institute of Medical Sciences, Mandya

Attitude among medical graduates of Mandya Institute of Medical Sciences towards Psychiatry

BACKGROUND

For providing better mental health care across the country, not only there is a dire need of increased number of Psychiatrists but also, the increased number of interested, motivated, well-informed MBBS graduates taking up Psychiatry as their specialty. Hence the aim of this study is to explore attitude towards psychiatry among medical graduates and to determine the stigma associated with Psychiatry and psychiatric patients

METHODOLOGY

A google form will be created and circulated to all the participants with the questionnaire to record socio- demographic variables and Attitude towards psychiatry-30 (ATP- 30) questionnaire to assess attitude of all three groups towards psychiatry. This questionnaire with 30 items assesses following eight dimensions of attitude using various combination of questions. It is scored in the Likert format of 5 options ranging from 1 - strongly agree to 5 - strongly disagree. Data will be entered in MS Excel sheet and descriptive analysis will be done. Categorical data will be expressed in percentages. Continuous data will be expressed as Mean, Standard Deviation. A value of p< 0.05 will be considered as significant.

CONCLUSION

The findings of this study will help in understanding inclination of MBBS graduates towards taking up Psychiatry as specialization and as a field of work

Clinical and sociodemographic profile of patients utilizing Psychiatric emergency services at a tertiary care hospital in India

Dr Swathy S^1*, Dr Ginu Moideen², Dr Jaimon P M³, Dr Lekshmy Gupthan⁴,

Dr Anilkumar T V⁵

Government Medical College, Ernakulam

E mail: swathysanthosh96@gmail.com

Background: Over the past years the use of emergency services for psychiatric treatment has dramatically increased. There is also a change in trend regarding the type of cases attending emergency psychiatric care.

Aims: This study aimed at assessing the clinical and sociodemographic characteristics of patients who are attending psychiatric emergency services of a tertiary care hospital in India.

Methods: The study was a retrospective observational study of patients attending the emergency psychiatric services of a tertiary care centre in India from 1^st June 2023 to 31^st August 2023. Data were collected from the records available at the Psychiatry Department. Data obtained were analysed using R software for Windows.

Results: A total of 145 patients attended the Psychiatric emergency services during the study period. Mean age was 37 years with standard deviation 15.5. 55.2% of population was of age group 20-39 yrs. Males were 68.3 % and females were 31.7%. Most common presentation was for substance use disorder (26.7%). Significant association was found between age groups attending casualty (p <0.001). Significant association was found between adjustment disorder and female sex p-0.001) and substance use and male sex (p <0.001).

Conclusion: This research describes the role of age and sex in presentation of various psychiatric diagnosis. Due to the limited sample size of the study and short time period of study many significant findings which were expected could not be obtained.

¹Junior Resident

²Senior Resident

³Assistant Professor

⁴Associate Professor

⁵Professor and HOD *Presenting Author

A COMPARATIVE STUDY OF EFFECTIVENSS OF ELECTROCONVULSIVE THERAPY AMONG PATIENTS WITH UNIPOLAR AND BIPOLAR DEPRESSION

Namita Sharma, Sandeep Grover, Subho Chakrabarti, Subodh BN

Post Graduate Institute of Medical Education and Research, Chandigarh

Background: There is limited data comparing the clinical profile and outcome of patients with unipolar and bipolar depression.

Aim: To compare the socio-demographic, clinical profile, indication for ECT, effectiveness, and complications among patients with unipolar and bipolar depression undergoing ECT.

Methods: Data (sociodemographic variables, clinical variables, and outcome) of 202 bipolar depression patients were compared with 1144 unipolar depression patients who received ECT from 2014 to June 2023. The data was extracted from the ECT register of the department. Results: The mean age of patients was 48.6 (SD: 15.5) for unipolar depression patients and 48.8 (SD: 15.8) years for patients with bipolar depression. The majority of the patients were Hindus (64.3%) by religion, and from the middle socioeconomic class (91.3%). Total duration of illness, baseline symptoms severity on Hamilton Depression Rating Scale were significantly greater in bipolar depression patients compared to unipolar depression patients (p<0.001). Duration of symptoms of current episode was longer in unipolar depression patients (mean: 6.9; SD: 10.7), compared to bipolar depression patients (mean: 4.8; SD: 4.4). Significantly higher proportion of patients with bipolar depression achieved >50% improvement (p<0.001) and remission (p=0.04) when compared to patients with unipolar depression. Very few patients reported immediate and late onset side effects with electroconvulsive therapy, with no significant difference in majority of the complications between the two groups.

Conclusion: Compared to unipolar depression, a significantly higher proportion of patients with bipolar depression achieved response and remission with electroconvulsive therapy.

Keywords: Bipolar depression, Electroconvulsive therapy, Depressive episode.

Varied presentations of Psychogenic Non-Epileptic Seizures (PNES): Reflections on the Diagnosis and Management

Dr Ipsita Basu, Dr Ankit Singal, Dr Vinay Singh Chauhan, Dr Surender Sharma

Background:

Nonepileptic behavioral disorders or psychogenic nonepileptic seizures (PNES) are involuntary, psychogenically induced spells that mimic many epileptic behaviors. Up to 30 percent of patients with epilepsy are also affected by nonepileptic seizures.

Aims:

To delineate the clinical differentiation in presentation of PNES in varied age groups and highlight certain essential components of management.

Methods:

Three cases of PNES are described with above aims. The first case was of a 14-year-old boy, presented with episodes of loss of consciousness and unresponsiveness lasting for 10-15 min, and difficulty falling asleep with frequent awakenings.

The second case was of a 23-year-old lady, presented with episodes lasting for 2-3 min of clenching of jaw, tongue bite, transient apparent loss of consciousness, urinary incontinence, with eyes closed, and no memory of the same after regaining consciousness, since 15 days, alongwith headache and difficulty falling asleep.

The third case was of a 28-year-old lady, known case of seizure disorder, presented with episodes of violent movements of body, lasting for 15-20 min, unlike the seizures she earlier had. Also complained of low mood, crying spells and passive death wishes.

Results:

EEG and neuroimaging revealed no abnormality in either of the above patients, all of whom responded well to psychotherapy and pharmacotherapy.

Conclusion:

PNES is important to be differentiated from epileptiform seizures. They have a good prognosis if diagnosed appropriately.

Prevalence of cognitive impairment in patients with moderate to severe depression

Vignesh Singh, Nirnay Sachdeva, Abbas Mehdi

Background: Almost all depressive disorder patients have cognitive impairments to a certain extend. Depression and cognitive dysfunction share a common neuropathological platform in cortical and sub-cortical brain areas. The current study was designed to explore the prevalence of cognitive impairment in severe depression and to examine the correlates of cognitive impairment and depression with other sociodemographic variables.

Methods: A hospital based cross-sectional study on the prevalence of cognitive impairment in moderate to severe depression. Total 100 patients were evaluated using Hamilton rating scale for depression (HAM-D), Addenbrooke’s cognitive examination (ACE-III).

Results: The mean age of study sample was 31.92 years (SD:7.62). The mean Hamilton Depression Rating Scale score for severe depression was 21.70 (SD: 1.34). Prevalence of cognitive impairment in moderate depression was 56% (33.0% women, 23% men); and in severe depression was 28%, with relation to age, literacy and severity of depression, there were significant differences observed.

Conclusion: Cognitive impairment and depression were well known in elderly population. Present study suggests that more than one fourth of young age patients having severe depression reported cognitive impairment which is more prevalent in the females than in the males. Hence, psychiatrist should pay special attention for early detection and treatment of cognitive impairment.

cognitive impairment, depression, prevalence

Cognitive impairment in patients with schizophrenia and its impact on quality of life

Umang Narayan, Rishabh Chandra, Abbas Mehdi

Background: Schizophrenia is well known to cause impaired quality of life (QoL) which is multidimensional construct. Cognitive deficits in various domains have been consistently seen in patients of schizophrenia. Therefore, present study was designed to assess the impact of cognitive impairment on quality of life in patients with schizophrenia.

Methods: A hospital based cross-sectional study on the impact of cognitive impairment on quality of life of schizophrenic patients. Total 60 patients were evaluated using Positive and Negative Syndrome Scale (PANSS), Addenbrooke’s cognitive examination (ACE-III) and World Health Organization Quality of Life Brief Version (WHOQOL-BRFE).

Results: The mean age of study sample was 28.00 years (SD:6.58). The mean of total PANSS score of major cognitive impairment group was 84.25 (SD: 23.43). the mean total ACE-III score of major cognitive impairment group was 54.25 (SD: 4.90). There was a significant increase among all neurocognitive function score was observed.

Conclusion: Present study findings depict that major cognitive impairment are seen in significant number of patients in schizophrenia. Though our study could not find any significant association between WHOQOL Score and neurocognitive functions. Hence, in schizophrenic patients priority interventions to improve QOL is utmost important.

Keywords: cognitive impairment, schizophrenia, quality of life

A CROSS- SECTIONAL STUDY TO ASSESS THE RESILIENCE AND ITS RELATIONSHIP WITH DISABILITY IN MALES WITH ALCOHOL DEPENDANT SYNDROME

DR. DASARI PAVANI, DR.G. ANUHYA GUYTON, DR. DIVYA JANAKANI

Post Graduate, Department Of Psychiatry, Andhra Medical College, Visakhapatnam Assistant Professor of Psychiatry, Andhra Medical College, Visakhapatnam

Post Graduate, Department of Psychiatry, Andhra Medical College, Visakhapatnam

BACKGROUND

Alcohol use is a major risk factor for global disease burden, and excessive use leads to disability in the individual. Dependence on Alcohol may cause serious health conditions, social and economic problems in the individual. Resilience is the capacity to bounce back after adversity. Resilience and related factors as predictors for relapse risk in alcohol use disorders. Dependence on alcohol is associated with poor functional outcomes and disability.

AIM

This study aimed to assess the resilience and its relationship with disability in males with alcohol dependence syndrome.

METHODOLOGY

A Hospital based cross-sectional study with sample size (N=60) with age between 18-60 years among treatment seekers for alcohol dependence using ICD-10 Criteria. Severity of alcohol dependence questionnaire (SAD-Q) were used to assess the dependence or severity of the disease. Connor Davidson Resilience scale (CD-RISC) And Indian disability evaluation and assessment scale (IDEAS) were used to assess the resilience and disability respectively. Statistical analysis was done. Descriptive statistics and correlation analysis was done

RESULTS

Among 60 participants recruited in the study ,72% have moderate dependence ,15% have severe dependence, & 13% have mild dependence on SAD-Q scores. In this study there is significant correlation between the SAD-Q score and the resilience score (P-value=0.002), correlation co-efficient is (-0.315) & the p-value for SAD-Q score and IDEAS- disability score (p-value=<0.0001) & the correlation co-efficient is(0.429).

CONCLUSION

In alcohol dependence patients increase in resilience will have less impact one or more domains of disability and reduces the relapse rate in the future . Resilience works as protective factor and lower level of resilience increases vulnerability for developing pathological consequences of adverse environmental events. There is some evidence that resilience is modifiable and this opens up for possible novel therapeutic interventions and prevent future relapse in alcohol use disorder & can reduce the functional disability in these patients.

MODIFIED ELECTROCONVULSIVE THERAPY AND METABOLIC SYNDROME : AN EXPLORATORY STUDY FROM NORTH INDIA

Aaliya Khanam¹, Zaid Ahmad Wani^1, Rajnish Raj¹

¹institute of Mental health and neurosciences, Kashmir.

Background: Modified Electroconvulsive therapy (mECT) is the treatment of choice in suicidality, catatonia and resistant psychiatric disorders like treatment resistant depression, bipolar disorder and schizophrenia. A handful of studies with modest sample sizes have suggested effect of mECT on metabolic parameters like glycemic control and cholesterol levels, however, not a single study has explored the association between mECT and Metabolic syndrome. Hence the present study was undertaken to find out the prevalence of metabolic syndrome in patients receiving mECT.

Methods: This was a cross-sectional exploratory study in which 75 patients receiving mECT were recruited via purposive random sampling and evaluated for metabolic syndrome by using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Results: 50.07% of patients fulfilled the modified NCEP ATP-III criteria for Metabolic syndrome. Among the individual parameters studied- elevated blood pressure (66.67%) was the most common metabolic abnormality, followed by increased waist circumference (46.67%) and increased triglycerides levels (42%). Least common metabolic abnormality was impaired fasting glucose in 25% of patients. Compared to patients without metabolic syndrome, patients with metabolic syndrome had received higher number of mECT sessions . Conclusion: Our findings revealed an increased prevalence of metabolic syndrome in patients recieving mECT, this highlights the importance of screening for metabolic syndrome at an early stage to employ timely care so as to reduce the risk of cardiovascular disease and premature death.

ECT, Metabolic syndrome, metabolic derangement, NCEP ATP III criteria.

Impact of social media on body image perception in medical students of BLDE, Vijayapura

Introduction:

The term “body image” (BI) refers to a person’s feelings, ideas, and perceptions about their physical appearance.

Social media can have an impact on a person’s BI, which can have a beneficial or negative effect depending on the user and the content they are viewing.

Social media posts can cause body disappointment, which occurs when a person believes that their body is less appealing than an ideal body.[⁸] This discontent not only causes mood changes, but it can also have major effects on behaviour, such as altering eating patterns or developing anorexia nervosa

AIM AND OBJECTIVE

To study association between, on one hand, type of content, duration of social media exposure, and on other hand, perception of body image.

METHODOLOGY:

Medical students, both undergraduate and postgraduate, of BLDE (DU) Vijayapura, between the age group of 18-30 years who gave written informed consent were enrolled in the study and completed a questionnaire assessing sociodemographic profile, anthropometric measures, social media usage (including the platform, frequency of use, average time spent on those platforms, type of content etc), Social Media Disorders Scale, Body Shape Questionnaire (BSQ-16B) for body image concerns, Rosenberg survey for self confidence and Modified SCOFF Questionnaire for screening ED.

Results:

We found an association between content watched on social media and the frequency of comparing one’s own physical appearance to that of people followed on social media and body dissatisfaction and self-confidence.

Discussion:

The widespread use of social media in teenagers and young adults could increase body dissatisfaction therefore rendering them more vulnerable to eating disorders.

A CROSS SECTIONAL STUDY ON THE PSYCHOSOCIAL FACTORS INVOLVED IN FIRST ATTEMPT SUICIDE OF YOUNG ADULTS

DR.Bhuvaneshwari (PG), Dr.Balaji (Asst Prof), Dr.Jayakrishnaveni(Assoc Prof), Department of Psychiatry, Kilpauk Medical College & Hospital.

BACKGROUND: Suicide is the conscious act of self-induced annihilation. WHO statistics indicate that suicide occurs in approximately 16.7/1Lakh persons/year. It is a complex phenomenon associated with psychological, biological and social factors. With this background, it is intended to study the psychosocial factors associated with suicide attempt.

AIMS &OBJECTIVES: To study the psychosocial factors, degree of suicide intent, personality profile involved in first attempt suicide of young adults

METHODOLOGY: This descriptive study was conducted in a secondary care centre during 3 months period. Every consecutive patient with first suicide attempt is included in the study. Sociodemographic details, psychosocial factors are studied by semi structured clinical proforma. Suicide intent was assessed by Beck’s Suicide Intent scale. IPDE was administered to assess the personality profile. Association between sociodemographic details, psychosocial factors, suicide intent, personality profile were assessed.

RESULTS: Out of 110 people, predominant first suicide attempts were in the age group between 17-24 years, Females > Males. Poisoning was found to be the most common method of suicide attempt. Most common reason was interpersonal problems with family followed by financial & job-related stressors. 2% had psychiatric diagnosis like schizophrenia, depression. There were significant association between suicide intent and personality profile of the participants.

CONCLUSION: By studying psychosocial factors it provides a measure of the mental health status in the population studied and allow recognition of specific groups or communities in greater need of mental health services.

Tactile Hallucination-A Case Series

Background:

Tactile hallucination is the false sensory perception involving the sense of touch occurring in the absence of any relevant external sensory stimulation.

Three cases (2 Paranoid Schizophrenia and 1 Delusional Parasitosis) with Tactile Hallucinations have been discussed.

Case Descriptions:

1. A 42 year old female came with the complaint of sensation of snake crawling in her mouth during most of the day and also hearing multiple unknown voices abusing her in obscene language.She claimed that her husband’s alleged mistress had put black magic on her to put her under constant torture.

2. A 70 year old female came with the complaints of being infested with worms and fishes in her ears and mouth.She was able to feel those worms and fishes entering her through ears and reach her mouth.She was able to feel them moving in her mouth and tried to remove them by chewing and eating them.While eating them,she was able to taste their blood.Despite this,she continued to have these sensations.

3. A 65 years old female started to develop the feeling of soil all over her body and the suspiciousness that unknown strangers controlling her head movement through television and cellphone.She continued to have this sensation of soil on her body despite the multiple washing.She believed that the ghosts in her house had been putting soil on her body.

Conclusion:

In all three cases,the management was resorted to pharmacotherapy and psychosocial rehabilitation,leading to improvement but not the complete remission.

Background: ICD-11, the first major revision of ICD in over 25 years, has substantial changes. Whenever diagnostic systems are changed, challenges are faced by the clinicians, researchers, and policy makers. However, few studies compared ICD-11 with other systems for substance use disorders, and no study compared the application of scales/instruments across diagnostic systems.

Aims: Study the implications of proposed changes in ICD-11 in Alcohol and Opioid Use Disorder patients. Examine the agreement between ICD-11 and other systems with regard to severity of dependence using ASI-Lite. Compare the application of AUDIT, and WHO-ASSIST in screening across systems.

Methods: Cross-sectional study among newly registered, adult male patients attending NDDTC OPD, or community clinics. N= 200 (100 each of Alcohol and Opioid users). Instruments: Semi-structured proforma, CIDI 3, ASI-lite, WHO-ASSIST, AUDIT. Items of CIDI used to make the diagnosis according to various systems. Diagnostic agreement was assessed by kappa. Scores of scales across systems were compared using Two Independent sample t-test.

Results: Highest prevalence of Dependence was found using ICD-11. Almost perfect agreement between ICD-11 and ICD-10 for all substances (kappa >0.8) except Inhalants. Similar results for ICD-11 Dependence and DSM-5 Moderate-Severe Use Disorder. Mean scores of AUDIT and ASSIST were generally lower in participants who received the diagnosis according to ICD-11 (significant difference for Cannabis Dependence). No significant difference in scores of ASI-Lite Domains across diagnostic systems.

Conclusion: There are significant implications of the changes in ICD-11, and further testing of the impact of these changes is needed.

Health-care needs of patients with First episode psychosis in Clinical Remission: An Exploratory Study

Raj Laxmi, Swapnajeet Sahoo, Ritu Nehra, Sandeep Grover

Background: Health-care needs is a measure of outcome in which subjective perceptions of patients, caregivers or care-providers are evaluated in order to determine ways of improving the outcome of illness for the patient. The numbers of studies specially focusing on the health-care needs of patients with first episode psychosis (FEP) are limited, with no study from India. Aim: To evaluate the health care needs of patients with FEP, currently in clinical remission. Methodology: One hundred three patients of FEP (duration of illness ≤5 years) in clinical remission were assessed on Camberwell Assessment of Need-Research version (CAN-R), and Supplementary Assessment of Need (SNAS) Questionnaire. Results: Mean age of the study sample was 26.87 (SD: 6.19) years. Males outnumbered females. The mean number of unmet needs of the study participants was 4.87 (2.41) on CAN-R and 3.63 (2.12) on SNAS scale. The mean number of met needs of the study participants was 2.21 (1.79) on CAN-R and 1.83 (1.54) on SNAS scale. Conclusion: The present study suggests that patients with FEP have a number of unmet health-care needs, even when they are relatively stable and recovered. Hence, all the efforts must be made to address the unmet needs of the patients with FEP, during the remission phase, to improve their overall outcome of the illness.

Keywords: First Episode Psychosis, Health care needs Mapping the prevalence of Metabolic Syndrome in patients of Bipolar I disorder-2 (MMS-2 Study)

Dr Sandesh Warudkar, Dr Amit B Jain, Dr Meera Kacha, Dr Pragna Patel, Dr Nilanj Dave, Dr Alok Chaturvedi, Intas Pharmaceuticals Ltd.

Objective:

The objective of this retrospective, multi-centre, cross sectional, observational study was to primarily evaluate the prevalence of metabolic syndrome in patients who are diagnosed with Bipolar I disorder.

Study design:

Data was collected from multiple centres across India (hospitals, clinics and health care institutes).

Retrospective data was collected by the psychiatrists/consulting physicians in MMS -2 study data capture form.

Results:

Out of total of 3044 patients with Bipolar I disorder, 1270 (41.7%) were symptomatic. 537 (42.28%) of them had depressive symptoms, 313 (24.64%) had manic symptoms and 420 (33.07%) patients had mixed symptoms. 16.32% (n=497), 12.94% (n=394), 7.32% (n=223), 6.34% (n=193) had hypertension, diabetes mellitus, cerebrovascular disease, coronary artery disease and polycystic ovarian disease respectively as commonly associated co-morbid metabolic conditions. Whereas, 55.05% (n=1676), 30.91% (n=941), 15.47%(n=471) 15.41% (n=470) and 11.69% (n=356) had anxiety, schizophrenia, personality disorder, eating disorder, substance abuse and attention deficit hyperactivity disorder respectively as most common co-morbid psychiatric conditions. Divalproex (49.86%) was the most prescribed drug in patients with bipolar 1 disorder followed by olanzapine (22.89%), lithium (18.85%), oxcarbazepine (17.34%) and aripiprazole (16.81%). 44.38% (n=1351) patients were prescribed with ≥ 2 drugs.

Conclusion:

Amongst patients with bipolar 1 disorder, hypertension and diabetes were the most common co-morbid metabolic conditions whereas anxiety and schizophrenia were the most common comorbid psychiatric conditions. Divalproex was the most commonly prescribed drug amongst Indian patients with Bipolar 1 disease.

Passivity Phenomenon- A Case Series

Background:

In Delusions of Control/ Influence/ Passivity, the patient’s thoughts, emotions, perceptions or actions are under the control of a different agent.

Three cases (2 Schizophrenia, 1 Schizoaffective disorder) have been discussed.

Case Descriptions:

• A 36 year old male, noticed that he was able to consume lesser quantities of food and water, had slurring speech ,believed that food consumed was redirected to his back(for 1 year). He attributed this to a machine placed in his throat by his manager via surgery. He would urinate in public places against his will, attributing it to a switch implanted on his penis. He felt burning sensations over the body due to sensors, operated by a laptop.

• A 29 year old female, with 4 months amenorrhoea believed that a machine was placed in her uterus by a man pursuing her. Another machine was used to strip off her skin , replace it with artificial skin to make her ugly ;was also made to laugh inappropriately against her will using the machine.

• A 28 year old male with manic features, claimed that his dead lover’s spirit sat on his left arm , moved it against his will to slap his mother . He would beat up his relatives against his will, claimed that it was due to a chip in his neck operated by his dead lover (for 2 months).

Conclusion:

Two patients attempted suicide due to the distress.All cases were managed with antipsychotics leading to partial remission.

Psychiatric comorbidity in chronic osteoarthritis and its correlation with pain severity .

Dr Moumita sing, PGT, Dept of Psychiatry, NRS Medical College and Hospital

BACKGROUND- Patients with osteoarthritis are commonly seen in general population. Psychiatric comorbidity associated with it often undiagnosed as some symptoms of depression like fatigue, pain, insomnia mimics symptoms of arthritis. As osteoarthritis results in chronic pain and difficulty in activities of daily living of patients, it causes depression, due to depression the perception of pain also gets increased.

AIMS- To estimate prevalence of anxiety and depression in patients suffering from chronic osteoarthritis and its correlation with pain severity

METHODS- a sample of patient diagnosed with osteoarthritis fulfilling the selection criteria are taken. Detailed history was taken and was diagnosed with depression and anxiety as per ICD10DCR . HAM-A and HAM-D scale administered to see the severity of the condition. Intensity of the pain is measured by Visual Analogue scale

RESULT- In this study we have found that significant correlation found between psychiatric comorbidity and the severity of pain perceived by the patients. It was found that about 30% patient presented with pain has both anxiety and depression and experienced the greatest pain severity (p<0.0001).

CONCLUSION- The added morbidity of anxiety and depression in chronic osteoarthritis is strongly associated with more severe pain

ATTITUDE OF STUDENTS TOWARDS USE OF E-CIGARETTE:- A K.A.P STUDY

AIM

To study knowledge, Attitude and Practice about E-cigarette in students of BLDE University, Vijayapura.

INTRODUCTION

Electronic cigarettes (E-cigarettes) are electronic nicotine delivery systems, also known as vaping devices and vape pens. It was developed as a habit-breaker for tobacco cigarette smokers to quit smoking. Worldwide, e-cigarette popularity and use among adolescents and children have increased alarmingly; roughly a fifth of India’s smoking population is reportedly aware and using e-cigarettes.

METHODOLOGY

Data was obtained online from both undergraduate and postgraduate students of BLDE(DU), Vijayapura, aged between 18-40years who are willing to consent and complete a questionnaire comprising socio-demographics, smoking habits, and GATS (Global Adult Tobacco Survey) to understand the Knowledge, Attitude and Practice about E-Cigarettes. Later a cross sectional study design was used to analysis the data.

RESULTS

We found that E-Cigarette use was alarming among in Undergraduate students aged 18-34 years, with prevalence of 40% in around 55% of the smoking population. Most students started using due to peer pressure (78% n=74) and social-media influence (40% n=36). While 68% (n=61) reported curiosity in trying and 61% liked it in first use.

Around 51% say they prefer it over tobacco cigarettes, and 41% believe its safe.

A low percentage of students believe it can aid in quitting smoking.

Students shows poor knowledge regarding the side effects

CONCLUSION

Students’ knowledge, attitude and practice towards e-cigarettes are seen to be inadequate and proper education and awareness need to be warranted.

Combination of Clozapine and Paliperidone LAI for treatment resistant mania: A case report

Background: The long-term course of Bipolar disorder (BD) is marked by chronic symptoms, multiple relapses and functional disability despite the use of current treatment options. Treatment resistant Mania poses significant clinical challenges with limited treatment options available.

Aims: Here we discuss a case of treatment resistant mania which eventually showed improvement on a combination of Clozapine and Paliperidone long-acting injection.

Methods: A 48-year-old male with 25 years history of Bipolar disorder presented with multiple episodes of mania in the last one year with incomplete resolution of symptoms between episodes despite use of multiple anti-psychotics and mood stabilizers. Poor social support, non-adherence to treatment and side-effects of medications further worsened the scenario. During his 3 months in patient stay at a tertiary care set up, patient was tried on a combination of antipsychotics, mood stabilizers and ECTs with inadequate response and poor tolerance. Patient was eventually started on a combination of Clozapine (100mg/day) and LAI Paliperidone (150mg/month).

Results: Patient showed improvement on standard assessment scales with this combination and was eventually discharged in a near asymptomatic state. Reduction in the need of other medications, requirement of lower doses of Clozapine leading to reduced side-effects and, ensuring treatment adherence were other benefits of this combination.

Conclusions: Combining Clozapine and Paliperidone LAI provides a novel treatment option in treatment resistant BD cases and deserves more attention in future research.

A Rare Case Report Of Obsessive Compulsive Disorder (Ocd) With Urinary Obstruction-Related Obsessions And Compulsions.

Robin Baghla¹, Prof.(Dr.)Sudhir Kumar², Prof.(Dr.) Haseeb Khan³, Dr. Astha Singh⁴, Dr Neha Nilakh¹

¹Junior Resident, ²Professor & Principal, ³Professor & Head, ⁴Associate Professor Department of Psychiatry

Hind Institute of Medical Sciences Safedabad, Barabanki, Uttar Pradesh. Presenting author – Dr. Robin Baghla Email id:drrobinbaghla4@gmail.com Mobile no: 7973059984

Background - OCD typically presents with contamination, checking & intrusive thoughts about harm or morality. However, OCD can occasionally manifest with highly specific and rare obsessions and compulsions, reflecting the diverse nature of the disorder.

Aim- To provide insight into a unique presentation centred around urinary obstruction-related obsessions and compulsions.

Case report–35yr old male presented to psychiatry OPD with complaints of intrusive persistent thoughts regarding sudden stoppage of urination, if someone was entering / leaving house or saw mosquito in toilet. In case, he sees shadow of person at toilet door while urinating, he was unable to urinate as he feels other person wants to urinate too, so he would leave toilet so that other person can urinate then he would use the loo. After micturation, anxiety would slightly alleviate, but complete satisfaction never achieved. In order to urinate more effectively, he listened to inspiring videos while turning off his phone to avoid disturbance by texts or calls. He visits toilet 20 to 25 times/day for 15 to 20 minutes each time, but never felt bladder completely empty. These symptoms have largely impacted his personal, professional & social life.

Discussion- Report highlights a rare presentation of OCD focused on urinary obstruction -related obsessions and compulsions. It emphasizes importance of recognizing and addressing symptomatology to ensure appropriate treatment.

Conclusion- OCD can manifest in diverse and unexpected ways, as demonstrated in the case. Early diagnosis, treatment & psycho education for patients and their families are essential in managing rare presentations.

Delusion of Pregnancy- A Case Report and Indian Literature Review

Abhishek Kalra¹, Prof. (Dr.) Sudhir Kumar², Prof. (Dr.) Haseeb Khan³, Dr. Anuranjan Vishwakarma⁴

¹Junior Resident, ² Professor & Principal, ³ Professor & Head, ⁴ Assistant Professor Department of Psychiatry

Hind Institute of Medical Sciences

Safedabad, Barabanki, Uttar Pradesh

PRESENTING AUTHOR

Dr. Abhishek Kalra

Junior Resident

Department of Psychiatry

Hind Institute of Medical Sciences

Safedabad, Barabanki, Uttar Pradesh

Email-abhishekkalra.ak1@gmail.com

Mob No- +91 9910003362

BACKGROUND: Although uncommon, patients with underlying psychiatric disorders like schizophrenia, bipolar disorder, psychotic depression, schizoaffective disorders, delusion disorders, affective disorders, and other physiological disorders of mental function have all been documented to experience delusions of pregnancy. A persistent belief that one is pregnant despite clear evidence to the contrary is referred to as a delusion of pregnancy. These signs have also been noted in organic problems like epilepsy, dementia, and other organic brain syndromes. Males have also been known to experience pregnancy delusions. This case report is of 54 years old female with delusion of pregnancy as a symptom with diagnosis of Paranoid schizophrenia.

AIM: To report a rare case of delusion of pregnancy in paranoid schizophrenic and review of literature in Indian population

MATERIAL AND METHODS: pregnancy,” “Pseudocyesis,” and searched from databases such as Relevant articles with keywords “Delusions of “Psychiatric disorders” in combination were PubMed, Google Scholar, Embase. Among 25 searched articles, after removing duplicity, total 11 articles from India were included for review.

RESULT: There were 14 cases with delusion of pregnancy in the Indian literature, further analysis revealed that delusion of pregnancy seen most commonly in Schizophrenia followed by Depressive disorder, Bipolar affective disorder, Organic causes.

CONCLUSION: Delusions of pregnancy can appear as a symptom of many neuropsychiatric diseases. Multifactorial etiology of these delusions renders the disorder difficult to manage. A comprehensive strategy incorporating medicine, cognitive treatments, and supportive psychotherapy is required for effective management.

A Cross Sectional Study of Psychiatric Co-morbidities in inpatients with Cardiovascular Disorders in Tertiary Health Care Center.

Background: Cardiovascular disorders are rising exponentially and are found to frequently coexist with various psychiatric disorders. They share a bidirectional relationship such that they affect the outcome of the other as evident through various studies. Thus, it is of prime importance to use screening tools in the earlier stages to assess various psychiatric co-morbidities in patients with cardiovascular disorders.

Aim: To study Psychiatric co-morbidities in inpatients with cardiovascular disorders in Tertiary Health Care Center.

Methodology: 100 medically stable patients with cardiovascular disorder admitted in wards or in intensive care units in tertiary health care center were assessed, after taking their informed consent, for Psychiatric co-morbidities using M.I.N.I International Neuropsychiatric Interview, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale.

Result & Discussion: Out of all the participants, 61% percent were found to have psychiatric comorbidities. Out of these participants,22% participants were suffering from Major Depressive episodes, 19% from Generalized Anxiety Disorder, 14% participants from substance use disorder (non-Alcohol), 5% participants from Alcohol use disorder & 1% participants from Schizophrenia.

Conclusion: According to the study, Depression was found to be the predominant psychiatric co-morbidity followed by Generalized Anxiety Disorder. Controlled interventional studies are necessary to comprehend the nature of existing co-morbidities, their pathophysiology and prognostic value which could promote the optimum course of treatment and hence survival and decreased disability in patients with cardiovascular disorders.

Key Words: Cardiovascular disorder, Psychiatric co-morbidities.

Differentiating Counselling, Psychotherapy and Case Work for Clinical Practice

Dr..Veerapillai Sayee Kumar*

Case Work, Counselling and Psychotherapy have come into the mainstream practice of mental health professionals such as Psychiatrists, Clinical Psychologists, Psychiatric Social Workers and Psychiatric Nurses. This paper mentions key definitions of counselling and psychotherapy and outlines the discussion on the relationship (in terms of differences and similarities) between them. Also, the significance of these psychosocial interventions within roles of mental health professionals is explored. This is happening in the context of years of changes such as emerging work by a number of professional bodies for the cause of counselling and psychotherapy; increasing awareness on mental health and its link with physical wellbeing, gradual shift to non-pharmacological therapies, increasing challenges to the stigma of mental health issues and promotion of mental health consultancy services, popularisation of counselling and psychotherapy in the media etc. While at one side we have more awareness and demand for professional services of case work, counselling and psychotherapy and another side we have a short and uneven supply of qualified therapists. So Patients and families find it hard to find a suitable therapist and ascertain the wanted intervention. Apart from that many of our own mental health team of professionals are not aware of the clear differences between case work, counselling and psychotherapy hence affecting the choice of intervention and referral errors. Patients and care givers now, quite rightly, demand up-to-date information not just about the types of therapy on offer, but also the form and nature of the delivery of the therapy they will receive. Since they have become informed consumers, requesting specific therapies and particular interventions it is our responsibility to serve them accordingly. This paper discusses the dilemma surrounding the differences by bringing more clarity to promote the psychosocial interventions

*Consultant: Counselling & Psychotherapy- CBT, Chennai

Paper to be presented at ANCIPS 2024, 75th Annual National Conference of Indian Psychiatric Society, Organised by Indian Psychiatric Society, Kochi, Kerala | 18th - 21st January, 2024

Depressive symptoms, self-esteem and suicidal risk in undergraduate medical students: A cross-sectional study

Background: Medical students experience greater rates of depression and suicidal ideation than their peers, stressing the need for early identification.

Aims: To assess depressive symptoms, self-esteem, and suicide risk in undergraduate medical students.

Methods: Consenting undergraduates were screened for depressive symptoms and suicidal risk through self-reporting Google forms using Patient Health Questionnaire-9 (PHQ-9) and Columbia-Suicide Severity Rating Scale screener (CSSR-S), respectively. Rosenberg Self-Esteem Scale (RSES) was used to measure self-esteem levels. For statistical analysis, SPSS Software V.26.0 was used.

Results: Out of 103 participants, 76 (73.7%) screened positive for depressive symptoms on PHQ-9 in varying severity, and 27 (26.21%) were found to have suicidal risk on CSSR-S. The Mean PHQ-9 scores and RSES were 8.73 + 5.86 and 15.93 + 5.40, respectively. High PHQ-9 scores were correlated to low self-esteem scores (spearman’s rho = -0.572, p = 0).

Conclusion: Depressive symptoms and suicidal risk were high among undergraduate medical students. Periodic mental health screening and robust strategies are the need of the hour to save the nation’s young white coats.

Clinical and Sociodemographic profile of Psychiatric Inpatients in the pre-COVID and post-COVID period: A Study Report

Dr Jasmine Fathima Said^1*, Dr Jaimon P M², Dr Lekshmy Gupthan³, Dr Anilkumar T V⁴

Government Medical College, Ernakulam, Kerala E Mail: jasmine.said2@gmail.com

Background: COVID-19 has impacted all the hospital services including the psychiatric inpatients globally.

Aims: Our study was aimed to assess the effect of COVID-19 pandemic at our Psychiatric inpatients and to compare the clinical and Sociodemographic profile of inpatients in the pre-COVID and the pre- COVID period.

Methods: We conducted a retrospective observational study of Psychiatry inpatients admitted during the one-year pre- COVID from 1^st March 2019 to 29^th February 2020 and post COVID period dating from 1^st March 2022 to 28^th February 2023 attending a tertiary care centre in India. Data obtained were analysed using R software for Windows.

Results: A total of 746 patients were admitted to psychiatric department during the study period; 56.9% (425) were in the pre-COVID period and 43.1% (321) were in the post COVID period. There was a 24.5% decline in the number of IP admissions in post- COVID period. The mean age of the patients was 37.9 years (SD-13.1) and mean days of hospital stay was 11.6 (SD-9.2). Forty-six percentage of the admissions were substance related cases. A significant increase in number of patients presenting with substance related disorder getting admitted in the post-covid period was noted (p-0.002).

Conclusion: There was reduction in number of psychiatric inpatients in the post- COVID era. A significant increase in number of inpatients with substance related disorders were noted in the post- COVID period.

Key words: COVID-19, Tertiary Care, Psychiatric inpatients

¹Junior Resident

²Assistant Professor

³Associate Professor

⁴Professor and HOD

*Presenting Author

A study of socio-demographic profile and prevalence of psychiatric disorders in paediatric suicide attempters attending a tertiary care hospital.

Dr.Latha.M.R¹ Dr.Bharathi.G² Dr.Santosh.S.V³ Dr.Punith.M⁴

1.Post graduate 2.Assistant Professor 3.Professor and Head 4.Senior Resident, Department of Psychiatry,HIMS,Hassan.

Background:

Suicide, a leading cause of death worldwide, with 703,000 cases reported annually. With worldwide rate of 6.9/1,00,000 among teenagers between 15-19 years. Understanding the interplay between such distressing acts and psychiatric-conditions in adolescents becomes indispensable.

Aims:

To study the socio-demographic profile and prevalence of Psychiatric-disorders among paediatric-suicide-attempters

Methods:

A cross-sectional analysis was performed on 75 paediatric suicide attempters, attending psychiatric OPD, aged between 10-18 years, at HIMS, Hassan. Psychiatric disorder diagnosis was done by Consultant Psychiatrist according to International-Classification-of-Diseases-10.

Results:

The average age of participants was 16±1.9 years. A notable 70.7% were females, with a significant proportion hailing from rural backgrounds (70.7%). The educational background indicated that most had completed PUC (45.3%). In terms of the final diagnosis, Adjustment-Disorder emerged as the most prominent (48.0%), trailed by those with no diagnosable psychiatric illness at 30.7%. Major-Depressive-Disorder was diagnosed in 9.3%. Other niche diagnoses, including Generalised-Anxiety-Disorder, Attention-Deficit-Hyperactivity-Disorder with Conduct Disorder, and MDD with Psychotic Features, were present in a minority at 1.3%. Most attempted suicide via poisoning (58.67%) or tablet overdose (40%). The main stressors were family conflicts (32%) and relationship issues (24%). Influences largely came from media (48%) and personal decisions (29.33%).

Conclusion:

This study accentuates the necessity of understanding the demographics and psychiatric dispositions of paediatric suicide attempters, which is pivotal for formulating targeted prevention strategies.

A COMPARATIVE STUDY ON RETINAL NERVE FIBRE LAYER THICKNESS IN SCHIZOPHRENIA PATIENT AND HEALTHY CONTROLS.

Background:

Schizophrenia is a complex psychiatric disorder characterized by disturbances in Thought, Perception, Cognition, and emotion. While its etiology remains elusive, there is growing interest in exploring potential biomarkers that could aid in early diagnosis and treatment monitoring. This study presents a comprehensive comparative analysis of Retinal Nerve Fibre Layer (RNFL) thickness between individuals diagnosed with schizophrenia and a demographically matched healthy control group.

Aim:

To assess the alterations in RNFL thickness among schizophrenia patients and compare it with healthy controls through non-invasive optical coherence tomography (OCT)

Method:

A well-defined cohort of schizophrenia patients and healthy controls underwent OCT imaging to assess RNFL thickness across various retinal quadrants. Clinical, demographic, and ophthalmologic data were collected and analyzed to account for potential confounding factors.

Result:

Findings suggest that individuals with schizophrenia exhibit subtle but discernible variations in RNFL thickness compared to their healthy counterparts. These alterations may hold diagnostic and prognostic value, possibly reflecting underlying neuroinflammatory or neurodegenerative processes associated with schizophrenia.

Conclusion:

Compared to healthy controls, Schizophrenia patient have thinning of RNFL. Further exploration of these findings could provide valuable insights into the pathophysiology of schizophrenia and offer a novel approach for early detection and monitoring of this debilitating mental disorder.

ABSTRACT FOR PAPER PRESENTATION: ASSESSMENT OF BURDEN AND QUALITY OF LIFE OF CAREGIVERS WITH OBSESSIVE COMPULSIVE DISORDER PATIENT’S IN SOUTHERN RAJASTHAN

1.Dr. Anurag Kaur Brar, Junior resident, Department of Psychiatry, AIIMS, Udaipur.

2.Dr. Krishna Kumar Carpenter, Assistant Professor, Department of Psychiatry AIIMS Udaipur.

3.Dr. Brajesh Kumar Pushp, Professor-Head of Department of Psychiatry, AIIMS Udaipur

BACKGROUND:-Obsessive-compulsive disorder (OCD) is represented by a various group of symptoms that include intrusive thoughts, preoccupations, rituals and compulsions. The obsessions or compulsions are exhausting and also interfere significantly with the person’s relationships, normal routine, occupational functioning.

Methodology:-A cross sectional study was conducted on OCD patients of either sex presenting to AIIMS psychiatry department. The participants were given liberal verbal explanations and description about the topic of research. After obtaining informed written consent, semi-structured Performa was used to record socio-demographic data of patients, OCD symptom by YBOCS whereas caregivers will be assessed by WHOQOL-BREF and Zarit burden interview were applied by the principal investigator.

Results:- 60% of OCD subjects were females and they belonged to age group (31-40) years. Majority of them were unskilled workers (50%) (22.5%) patients had mild OCD whereas (12.5%) patients had extreme OCD. Severity of OCD was assessed by using YBOCS whereas burden of caregivers was assessed by using ZBI. Severity of OCD of patient had significant association with burden. In extreme OCD majority of caregivers had severe burden. The mean values of each domain of WHOQOL with maximum mean value of 54.65 in domain 1least mean value in domain 4.

CONCLUSION:- The study highlights the impact of obsessive compulsive disorder on caregivers in the form of burden and quality of life of caregivers. Hence, there is need to address and provide support to the caregivers of obsessive compulsive disorder patients.

Factors associated with agitation in patients with delirium attending Psychiatric emergency services in a tertiary care centre in India

Dr Balamukund R^1*, Dr Jaimon P. M², Dr Lekshmy Gupthan³, Dr Anilkumar T.V⁴

Government Medical College Ernakulam, Kerala

E Mail: wizalpha42@gmail.com

Background: Delirium is a neuropsychiatric condition of varied etiology. Only few studies have explored the factors associated with agitation in delirium in an emergency setting.

Aims: Our study aimed at assessing the factors associated with agitation in patients presenting with delirium at Psychiatric emergency services in a tertiary care centre in India.

Methods: We conducted a retrospective observational study of patients with delirium attending the Psychiatric Emergency in a tertiary care centre in India between 1^st April 2022 and 31^st March 2023. The details of the patients were collected from the records maintained in Psychiatry department. The diagnosis of delirium was done using Confusion Assessment Method for the ICU (CAM-ICU). Sociodemographic details and presence of agitation were collected into a specially designed sociodemographic proforma. Data obtained were analysed using R software for Windows.

Results: A total of 417 patients needed emergency psychiatric consultation during the study period. Out of these, 62 (14.9%) patients had delirium. Mean age of the population was 47.7 years with standard deviation 16.1 years. Majority were males (91.9%). Forty-two (67.7%) patients had agitation. The proportion of migrants with delirium was 53.2%. The study found significant associations between younger age group (p=0.007), migrant status (p=0.007), cannabis use (p=0.001), past history of delirium (p=0.039) and substance withdrawal (p=0.001) and agitation in patients with delirium.

Conclusion: Younger age, Cannabis use, Substance withdrawal, migrant status and past history of delirium is associated with higher risk of agitation in patients with delirium.

Agitation, delirium, Psychiatric emergency

¹Junior Resident

²Assistant Professor

³Associate Professor

⁴Professor and HOD

*Presenting Author

Prevalence of depression, anxiety, and stress among I.T. sector professionals.

Jayesh Alwani¹, Parth Singh Meena ², Mahendra Jain^3.

1.Resident, Department of Psychiatry, JLN Medical College, Ajmer, 8560030245, jayesh.alwani@gmail.com

2.Professor, Department of Psychiatry, JLN Medical College, Ajmer,

3.Senior Professor & Head of Department, Department of Psychiatry, JLN Medical College, Ajmer,

Introduction-Information technology sector has become an important field in the past few years. The sector has its own pros and cons, on one hand it provides professionals with high salary, a good position and opportunity to work abroad, but on the other hand they have long working hours, stressful deadlines, high performance expectations. Due to these problems, they face many challenges, so there is a need to assess the often-neglected struggles of IT professionals. Thus, this study aims to find out the prevalence of depression, anxiety stress among I.T. sector professionals.

Aim-To assess the prevalence of depression, anxiety, stress, and the level of quality of life among I.T sector professionals and its association with sociodemographic profile.

Methodology- The current study employed a cross section observational study design using online google forms over 4 months. After getting approval of the study from the institutional ethical committee google forms were distributed using social media and mail ids. After applying the inclusion exclusion criteria 204 participants were included in the study. Sociodemographic profile was assessed using specially designed sociodemographic proforma and depression, anxiety and stress was assessed by DASS-21 scale. Data was analyzed using appropriate statistical tools.

Results- The overall prevalence of depression, anxiety and stress was 68.62%., 74.50%,70.58% respectively. There was significant association with gender, working hours and age distribution in these emotional states.

Conclusion- There was a high prevalence of stress, anxiety, and depression among I.T. sectors. Sociodemographic factors can influence these emotional states among the I.T. sector professionals.

Clinical Profile of Cultural Beliefs and Traditional Healing Practices among Patients of Common Mental Disorders: A cross-sectional study.

Dr. Dinesh Dutt Sharma, Prof. and Head, Department of Psychiatry, IGMC, Shimla

Dr. Ravi Sharma, Assistant Professor, Department of Psychiatry, IGMC, Shimla

Dr. Anupama Arora* Senior Resident, Department of Psychiatry, Dr. YSPGMC, Nahan.

Presenting author email id: dr.aarora07@gmail.com

Background: Cultural beliefs and traditional healing practices exert significant influence on the perception and treatment of mental illnesses.

Aims: To study the clinical profile of cultural beliefs and attitudes towards mental illness among patients.

Methods: A cross-sectional, questionnaire-based study was conducted over a period of 2 months in adult patients attending Psychiatry OPD for seeking treatment of common mental illnesses who had ever contacted faith healer.

Results: Of 139 patients, 61.87% were females and 55.4% belonged to 21-40 years of age. First line of contact was faith healer in 50.36% (n=70) patients, 64.75% were informed about the faith healer by their family, and 47.48% visited for treatment of “Ghabrahat”. Pandit was contacted in 84.89% patients, 69.78% visited faith healer 2-10 times/month, 31.65% received multiple form of faith healing and 42.45% spend no money on faith healing. No improvement in symptoms was seen in 59.71%; 63.31% discontinued treatment from faith healers for the same reason. After consulting a registered medical practitioner (RMP), 61.87% did not visit the faith healer and 58.27% did not believe in faith healing anymore.

The odds of association between improvement in symptoms and visit to faith healer after visiting RMP was 10.63 and this was statistically significant (p=0.03). The association between visit to faith healer after visiting RMP and belief in faith healer was highly significant statistically (p<0.001).

Conclusion: The study provides valuable insights into the cultural beliefs and traditional healing practices which should be integrated in mental health to improve patient-centeredness, treatment outcomes, and cultural sensitivity.

Prevalence and severity of Depression and Anxiety in Diabetic Patients in a Tertiary Care Hospital

Dr. Simerpreet Kaur1, Dr. Gurmeet Kaur Brar2, Dr. Rakendra Singh3, Dr. Sahil Jindal4

1.Junior Resident, Dept. of Psychiatry, AIMSR, Bathinda

2.Professor, Dept. of Psychiatry, AIMSR, Bathinda

3.Professor and Head, Dept. of Medicine, AIMSR, Bathinda

4.Senior Resident, Dept. of Psychiatry, AIMSR, Bathinda

BACKGROUND: Depression and anxiety, two of the most prevalent mental health disorders globally, have been found to co-occur at alarmingly high rates among individuals with chronic medical illnesses like diabetes. The relationship between chronic medical illness and mental health is complex and bidirectional, with each condition exacerbating the other in a vicious cycle.

AIM: To study the prevalence and severity of depression and anxiety in diabetic patients.

MATERIAL AND METHOD: A cross sectional study was conducted at Department of Medicine, Adesh Institute of Medical Sciences and Research, Bathinda from August 2022 to February 2023 on 40 consenting patients. Socio-demographic data was collected and depression and Anxiety were assessed using Hamilton Depression Rating scale (HAM-D) and Hamilton anxiety Rating Scale (HAM-A).

RESULTS: Prevalence of depression in patients of diabetes was found to be 55%. Out of these 36.36% showed Mild depressive symptoms, 40.9% displayed Moderate depressive symptoms, 6.66% had moderately severe depressive symptoms and 22.73% severe depression.

Anxiety symptoms were even more prevalent, present among 75% patients. 25% showed no anxiety symptoms 30% showed mild anxiety symptoms, 35% displayed moderate anxiety symptoms, 10% displayed severe anxiety symptoms.

CONCLUSION:Recognizing the high prevalence of depression in individuals with diabetes underscores the urgent need for integrated healthcare approaches that prioritize both physical and mental well-being. Screening for depression and anxiety should be a routine part of medical care for individuals with chronic conditions, enabling early identification and intervention.

Disability and Psychosis: A cross-sectional study amongst psychotic comorbidity in a tertiary care hospital.

Debasis Saha

Department of Psychiatry, Burdwan medical college.

Background: Disability can be defined as any limitation or absence of capability (arising from an impairment) that hinders an individual from performing an activity in the typical manner or within the normal range expected of a human being. It is characterized by deviations from the customary standards of activity performance and behavior, and these variations can be temporary or permanent, reversible or irreversible, and either progressive or regressive in nature. Psychotic disorders are significant contributors to the global disease burden due to the associated disabilities they cause. Worldwide, approximately 10% of the population experiences some form of mental disability, while 1% grapples with severe forms of mental disorders that result in disability. Most research regarding its association with Psychiatric disorder conducted in southern states of India. Very few of this study has been conducted in Eastern state of India.

Aims and Objectives: To examine the relationship between mental disability and non-affective psychotic disorder.

Methodology: In this cross-sectional study 50 non-affective psychotic patient with in age group of 15-60 years who visited Burdwan medical college Psychiatry OPD are selected. BPRS scale was applied to assess the severity of psychosis. IDEAS scale was applied to assess degree of disability.

Result: In this study we have found that degree of disability are more in lower socio-economical group. There is significant correlation between degree of disability with severity of psychosis (p<0.00001). And there is also significant correlation between degrees of disability with duration of illness (p<0.00001).

Conclusion: This research helps us learn more about how psychotic disorders affect people with disabilities using a comprehensive approach. This information can be useful for mental health policies that want to create strategies to reduce the burden of disability faced by people with psychotic disorders.

A study on sexual functioning and dyadic adjustments in remitted bipolar patients

Dr. Haritha S ¹, Dr Soumya P Thomas ² Dr. Roy A Kallivayalil ³

E-mail : hrthsunil@yahoo.com

Background: Bipolar disease is an episodic illness which can affect sexual functioning during affective phases. Manic episodes can have higher sexual drive whereas depressive episodes tend to be related with sexual dysfunction. Sexual dysfunction is also more commonly seen in euthymic bipolar patients than in the general population. Sexual satisfaction is one of the essential factors in dyadic adjustment, and there may be a bidirectional relationship between sexual dysfunctions and couple relations.

Aim: To assess the sexual functioning and dyadic adjustment in men and women with bipolar disorder during remission.

Method: Patients satisfying inclusion and exclusion criteria and with a diagnosis of bipolar disorder in full remission 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. Patients sexual functioning and dyadic adjustment will be assessed by Arizona sexual experience scale and Dyadic adjustment scale respectively.

Results: Appropriate statistics will be applied.

Conclusion: Sexual functioning in patients with bipolar disorder during manic and depressive episodes have been studied extensively. In this study, sexual functioning was assessed during remission. Patients with BD has a lower dyadic adjustment than healthy population and appropriate psychosocial interventions could help patients with BD to improve their dyadic adjustment.

Prevalence of Suicide in Maraimalai Nagar of Tamil Nadu from 2020-2022-A Descriptive study

BACKGROUND : Suicide is the 15th leading direct cause of death worldwide. According to the data given by National Crime Record Bureau (NCRB) , among the Indian states, the highest percentage of suicides are seen in Maharashtra (13.6%), followed by Tamil Nadu (9.7%) .

AIM: To estimate the prevalence of Suicide from January 2020 – December 2022

METHODS: This is a descriptive study on the prevalence of completed suicide in an urban area of Maraimalainagar in Tamil Nadu from 2020 to 2022. The population information for each year and census on total death rate was obtained. Death certificate data was taken from Maraimalainagar Municipality office and individuals with completed suicide were identified along with mode of suicide.

RESULTS: The prevalence of suicide during 2020 to 2022 in Maraimalainagar was 54 for 1,12,000 population. The suicide mortality rate for per 1 lakh population was 6.7 in 2020, 11.3 in 2021 and 32.1 in 2022 and M:F suicide ratio was 5.3. Hanging was found to be the most common mode of suicide.

CONCLUSION: The suicide rate observed in this study was highest for the year 2022. Further assessments through verbal autopsy can be done to assess the cause of suicide.

The Association between Serum Magnesium Levels and Depression among patients attending Psychiatric OPD

Background

Depression is the second leading cause of Disability-Adjusted Life Years (DALYs) after Ischemic Heart Disease. Studies conducted in Community, Primary care clinics and Hospitals showed prevalence as 15.1%, 21 to 40.45% and 5 to 26.7% respectively. Though drugs are available for management, more studies on biomarkers can help to formulate more individualized treatment plans. Magnesium is essential for optimal nerve transmission and formation of membrane phospholipids. Many studies conducted in western countries concluded that lower serum magnesium levels were associated with depressive symptoms, supporting the use of supplemental magnesium as therapy. Very limited studies conducted in Indian context. Because of significant socio cultural differences between India and other western countries we need separate study.

Aim

To determine the association between Serum Magnesium level with depressive symptoms among patients with Depression

Methods

Case-control study was conducted. We recruited 100 patients and 100 healthy controls. The serum levels of Magnesium was analysed by Calorimetric method. We compared mean serum magnesium level between cases and controls with independent sample t-tests and correlation between magnesium levels and depression score using Pearson’s correlation test was conducted.

Results

Serum magnesium concentrations in patients with depression was significantly decreased compared with control subjects (p < 0.05)

Conclusion

This study shows that patients with depression have decreased serum concentrations of Magnesium when compared with control subjects. There may be relation between serum magnesium levels with pathogenesis of depression. To use serum magnesium as a prognostic tool and as a treatment supplement we recommend further studies.

Evaluation of a Regional Consultation Liaison Psychiatry Service in Australia

A Rana¹, S Reelh¹, A Ajit², C Tan², M Hiskens³

¹Psychiatry, Consultation Liaison Psychiatry, Mackay Base Hospital, Mackay, Australia

²James Cook University, Townsville, Australia

³Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, Australia

Background

Mental Health Consultation Liaison Psychiatry (CLP) services started in Mackay Hospital and Health Service (MHHS) in 2016. The team provides service for a 251-bed hospital, covering mental health assessments and follow-up during working hours for patients hospitalized with various non-psychiatric pathologies. Through the years the number of referrals to the CLP service have increased approximately 4-fold. Staff satisfaction survey, being a key performance measure of CLP service, was conducted to assess the CLP service and aid further development.

Results

Response rate was 54%. Majority of respondents have worked 1 to 5 years, with clinicians as the bulk of respondents at 65%. The split of the surveys being equal amongst the departments helped limit response skewing. As seen in Figure 1, the 3 main reasons for referrals were similarly split, while other reasons were for advice on non-pharmacological interventions. Most respondents were aware of the CLP referral pathway. The CLP team responded to referrals 73% of the time within 24 hours as shown in Figure 2. The questions placed on a 5-point Likert scale showed an overall high satisfaction level. 3 items received a median rating of 4, while the satisfaction with CLP consultation received a median rating of 4.5 – shown on Figure 3.

Common positive aspects of CLP in the open-ended questions included great access, use of psychotropics and ease of approachability of the team. Areas for suggested improvement included education on the use of psychotropics and non-pharmacological management techniques, and for multi-disciplinary meetings, the possibility of conducting outpatient clinics and having a CLP psychologists.

Aims and Objectives

1. Assess awareness of healthcare professions within the MHHS regarding CL service delivery and referral pathways

2. Evaluate and utilize acquired feedback for the provision of recommendations in the development of CLP services which could be used as future standards of practice

3. Benchmark the current MHHS CLP service with comparative services for service expansion and resourcing

Methodology

A 13-question survey, in Table 1, was designed and validated to measure CLP service provision, based on a combination of the Victorian CLP service model and other Queensland based CLP services

A total of 120 surveys were circulated to hospital departments of CLP service users. Surveys were available from May to September 2022. The distribution of the surveys were equal across 6 departments and across the professions.

Conclusion & Recommendations

• CLP service have been providing adequate delivery of service in line with RANZCP’s CL service model of delivery.

• The lack of a formalized geriatric service in MHHS puts additional pressure on the CLP service.

• Overall satisfaction from CLP users’ are positive, but there remains more work to be done to further build unto this.

  • Expansion of current CLP service would be required to cater to exponentially increasing needs – such as an additional registrar and 2 multidisciplinary team members (e.g. allied health or psychologists)
  • More in-house training/teaching for nursing and medical staff involved in management of psychogeriatric patient on general wards

References

1. Nitchingham A, Caplan GA. Current Challenges in the Recognition and Management of Delirium Superimposed on Dementia. Neuropsychiatr Dis Treat. 2021;17:1341-1352. Published 2021 May 5. doi:10.2147/NDT.S247957

2. Fong, T.G., Inouye, S.K. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nat Rev Neurol 18, 579–596 (2022). https://doi.org/10.1038/s41582-022-00698-7

*The authors have no conflicts of interest to declare

A Multifaceted Assessment of impact of a Consultation Liaison Psychiatry Service in a regional district hospital in Australia

A Rana¹, S Reelh¹, A Ajit², C Tan², M Hiskens³

¹Psychiatry, Consultation Liaison Psychiatry, Mackay Base Hospital, Mackay, Australia

²James Cook University, Townsville, Australia, ³Mackay Institute of Research and Innovation, Mackay Base Hospital, Mackay, Australia

Background

Consultation- Liaison Psychiatry (CLP) is a sub -specialty of Psychiatry which integrates the provision of mental health care into the general hospital system. Since its inception in 2016, the CLP service has been catering to a regional Queensland population served by the 251 - bed Mackay Base Hospital (MBH) . The CLP service is currently fronted by one consultant, one advanced trainee and one clinical nurse consultant (CNC).

CLP provides services for mental health assessments and follow ups for patients hospitalized with non-psychiatric conditions but with psychiatric co-morbidities. Medical- psychiatric comorbidity is often known to be linked to increased use of hospital resources. Coincidentally, the demand for the local CLP services have increased 4–folds.

Aims and Objectives

1. Determine current baseline demographics of CLP patients within the service

2. Assess efficacy and sufficiency of current CLP service and resources

3. Establish standardized indicators of service for future service assessments

4. Evaluate from findings – liaison opportunities with various departments for development of in-hospital protocols

Methodology

Ethics approval was sought to acquire retrospective data of patients’ formally referred to the CLP service during the periods of May 2021 to May 2022 from the hospital’s electronic records.

The assessment tool was designed to measure key areas of service and to fulfil study objectives. Multiple consultations with various psychiatrists and service users were done to aid the design of this tool to ensure a broad evaluation. The tools’ parameters are listed in Table 1.

Results

149 patients met the inclusion criteria. Most referrers were doctors. Most referrals were from the medical ward. Some common themes seen as the reason for admission under treating team was worsening mental state, cerebrovascular accidents and attempted suicides. Diagnostic clarification made up the main referral reason.. Time taken for CLP to review patient was mostly <24h. A significant portion of these patients were males, aged 60 to 79 years old and not of rural origin.

Brief psychiatric background( are shown in Figure 3. The various diagnosis made by CLP post review are shown in Figure 4. Addition of medications made up 58% of review outcomes. The number of days of CLP consultation compared to days hospitalized is shown in Figure 5.

Discussion

This study found that the CLP service is useful in assisting the management of mental illness in the general hospital system. In keeping with the increase in prevalence for mental illnesses, a little over half of these patients have previous psychiatric diagnoses, predominantly cognitive and mood disorders. The main age range of referrals being 60 to 79 years old could explain why ‘Diagnostic Clarifications’ was the main reason for referrals, due to frequent dilemma between delirium and dementia. The major diagnosis of BPSD further supports this finding.

Conclusion & Recommendations

Despite being a team fronted by 1 part time consultant, 1 advanced trainee and 1 CNC, the MBH CLP service responds in a time effective manner. With an expected increase in demands, the CLP team requires expansion with more multidisciplinary resources to provide a safe and efficient service. The addition of geriatric services could also be key. Psychoeducation and liaison should be undertaken to medical teams about CLP service, referral and management pathways.

References

1. Nitchingham A, Caplan GA. Current Challenges in the Recognition and Management of Delirium Superimposed on Dementia. Neuropsychiatr Dis Treat. 2021;17:1341-1352. Published 2021 May 5. doi:10.2147/NDT.S247957

2. Fong, T.G., Inouye, S.K. The inter-relationship between delirium and dementia: the importance of delirium prevention. Nat Rev Neurol 18, 579–596 (2022). https://doi.org/10.1038/s41582-022-00698 -7

*The authors have no conflicts of interest to declare

Background: The COVID-19 pandemic has been associated with economic instability, social disruption, increase number of deaths and severe post covid mental and physical. This study is to assess prevalence of depressive, anxiety symptoms, and perceived stress in hospitalized covid-19 patients. Methodology: The Cross-sectional study was conducted on 103 consecutive category B Covid-19 positive patients admitted in a CFLTC in Malappuram. Hospitalized covid-19 positive patients, age group 18 to 60 years, willing to take part in study were assessed using a socio-demographic questionnaire, Montgomery and Asberg Depression Rating Scale (MADRS), Hamilton Anxiety scale (HAM A) and Perceived Stress Scale (PSS). The data collected is analyzed by chi-square test, t-test, Pearson correlation and ANOVA. Results: Out of 103 participants, 88.3% experienced mild depression and 8.7% had moderate depression. Only 2.9% had no depressive symptoms. The HAM-A scores showed that 80.6% had mild and 19.4% had moderate anxiety. The stress levels were moderate in 55.3% while mild in 44.7% of the patients. The depressive scores were also significantly associated with unemployment, (14. 98 Vs. 12.80; t=2.59, p=0.01), low socio-economic status (14.47 Vs. 12.56; t= 2.04; p=0.04) and longer hospital stay. (16.90 Vs. 13.10, t=3.67; p<0.001) The anxiety scores and stress were significantly more in the lower socio-economic status, history of psychiatric illness and self-harm. Conclusion: It has been observed that there is significant level of anxiety, depressive, symptoms, and perceived stress in hospitalized COVID 19 patients. Measures for screening and management of such patients need to be considered.

A Cross- Sectional Study of Quality of Sleep, Burnouts, Anxiety and Depression in Rotatory Shift Workers at a Hospital in Bhavnagar

Introduction: Rotatory shift work is quite prevalent in the general population. The knowledge that effect does not depend on a single cause, but rather, diseases are multifactorial in origin, resulting in widespread interest towards the preventive aspect and focussing on the causative factors that directly or indirectly influence the health and well- being of shift workers.

Materials and Methods: We analysed data from an observational, cross- sectional, single- centred, interview- based study of a total of 100 shift workers working in Sir T Hospital in Bhavnagar conducted from July 2020 to December 2021. The study was performed via face- to- face interviews using structured questionnaires. We used the Pittsburgh sleep quality index (PSQI) to evaluate sleep quality. To diagnose depression, anxiety and burnout, we used the Hamilton Depression Rating Scale (HAM- D), Hamilton Anxiety Rating Scale (HAM- A) and Copenhagen burnout inventory (CBI), respectively. Statistical data were analysed using R software version 4.0.5 (R Development Core Team, Vienna, Austria).

Results: A total of 100 participants were interviewed. The respondents are almost symmetric in terms of male and female, married and unmarried and rural and urban residence. The mean age of our sample is 36.98 ± 9.37 years. Around 15% of participants showed moderate/severe levels of depression (18%) and moderate/severe levels of anxiety (9%) using HAM- D and HAM- A, respectively. Using CBI subscales, 27% of respondents showed personal burnout, 54% showed work- related burnout and 20% showed client- related burnout. Sleep quality was poor among shift workers (45%) using the PSQI scale. Significant positive correlations are found between HAM D and personal burnout (r = 0.206, P = 0.040), work burnout with personal burnout (r = 0.243, P = 0.015) and client burnout (r = 0.246, P = 0.013). Furthermore, personal and client burnout shows a positive correlation (r = 0.271, P = 0.006). Although these correlations are still significant, they indicate low positive nature of the relationship between such variables.

Conclusion: The prevalence of depression, anxiety, burnout and poor sleep quality was high. The effect on shift work mental health is multifaceted, dealing with several aspects of personal characteristics and working and living conditions. Further research is needed to support the mental well- being of shift workers and minimise workplace- related psychiatric disorders by developing short- and long- term strategies.

Various neuropsychiatric presentations of Wilson’s disease

Dr.Sundar.S - post graduate Assistant Professor Dr.Priyadharshini.R Associate Professor Dr.M.Priyasubhashini Stanley Medical College, Chennai-01.

Introduction:

Wilson’s Disease is an autosomal recessive disorder affecting the Liver and CNS. Psychiatric disturbances can present as personality changes, affective disorders, psychosis, cognitive impairment.Here we describe 3 cases of Wilson’s disease with various neuropsychiatric presentations

Case Series :

Case 1:

A 22/F k/C/o Wilson’s disease presented with cheerfulness, increased activity, spending sprees, excessive talking, reduced sleep, lack of sexual inhibition for 1.5 months. On Examination , Increased psychomotor activity, Pressure of speech, elated mood and Flight of ideas were present.She was diagnosed as Mania without Psychotic symptoms and started on Lithium, Quetiapine . On followup, patient improved symptomatically

Case 2:

A 37 year old male with complaints of hearing voices, suspiciousness,referential ideas,sleep disturbances,irritability. On examination delusion of persecution, delusion of reference, auditory hallucination were present. Patient later diagnosed as a case of Wilson’s disease

Case 3:

A 13 years old female child presented with behavioural disturbances in the form of anger outbursts, irritability. On examination psychomotor agitation was present. Child was not able to sit on chair for long time, looked anxious. She had abnormal involuntary movements of hands. Investigations revealed it as a case of Wilson’s disease

How common is sexual dysfunction (SD) with antipsychotics? A cross sectional observation study.

Background: Antipsychotics have revolutionised treatment of psychotic disorders however they are commonly associated with sexual dysfunction (SD). This side effect affects patient’s quality of life and adversely influence patient treatment adherence. There are few Indian studies in this context and even lesser have studied SD in female psychiatric patients.

Aim: The aim of the study was to assess the prevalence of SD in patients taking antipsychotic medications. Also, various socio-demographic and clinical factors associated with SD were assessed.

Methods: This was a cross sectional observational study. 398 adult patients aged 18 - 65 years (males & females) taking antipsychotic medications for any indication were studied. 14 item Change in Sexual Functioning Questionnaire (CSFQ) was used to assess and rate the sexual dysfunction.

Results: Global SD was seen in 63.6 percent of patients. The rates of SD were higher in males (65.9 percent) compared to females (59 percent). The rates of SD were higher in older age group, those with longer duration of treatment and divorced/ separated marital status. Combination of antipsychotics was associated with higher odds of SD while Aripiprazole use was associated with lesser odds.

Conclusion: A significant proportion of patients taking antipsychotics have SD. The rates are significant for both males and females. Certain clinical and demographic factors are associated with higher odds of SD. It is important that clinicians enquire about this frequent yet often overlooked side effects of these drugs.

Background: Alcohol use disorder may be directly or indirectly related to mindfulness and distress tolerance, and these factors are often targeted in treatment. However, such evidence has yet to be established among tribal. The research aimed to investigate the levels and relationships of mindfulness, distress tolerance, and dependence severity among tribal individuals with alcohol use disorder.

Methodology:- Two hundred tribals with alcohol use disorder were recruited at three tertiary health care centres in three districts and assessed- with the sociodemographic and clinical pro forma, Cognitive and Affective Mindfulness Scale Revised (CAMSR), the Severity of Dependence Scale (SDS), and Distress Tolerance Scale (DTS).

Results: The mean score on the SDS, CAMSR, and DTS was 4.99, 23.52, and 33.44, respectively. There were no statistically significant relationships between the measure of mindfulness scores and dependence severity scores. However, the perceived capacity to endure emotional suffering and negative emotions consuming one’s focus was significantly inversely linked to the severity of dependence.

Conclusion: There are lower distress tolerance and mindfulness levels among tribals with alcohol use disorder. The severity of alcohol use has no significant link with mindfulness but has inversely linked with emotional distress tolerance and attention absorption by negative emotions.

Health-care needs of patients with First episode psychosis in Clinical Remission: An Exploratory Study

Raj Laxmi, Swapnajeet Sahoo, Ritu Nehra, Sandeep Grover

Background: Health-care needs is a measure of outcome in which subjective perceptions of patients, caregivers or care-providers are evaluated in order to determine ways of improving the outcome of illness for the patient. The numbers of studies specially focusing on the health-care needs of patients with first episode psychosis (FEP) are limited, with no study from India. Aim: To evaluate the health care needs of patients with FEP, currently in clinical remission. Methodology: One hundred three patients of FEP (duration of illness ≤5 years) in clinical remission were assessed on Camberwell Assessment of Need-Research version (CAN-R), and Supplementary Assessment of Need (SNAS) Questionnaire. Results: Mean age of the study sample was 26.87 (SD: 6.19) years. Males outnumbered females. The mean number of unmet needs of the study participants was 4.87 (2.41) on CAN-R and 3.63 (2.12) on SNAS scale. The mean number of met needs of the study participants was 2.21 (1.79) on CAN-R and 1.83 (1.54) on SNAS scale. Conclusion: The present study suggests that patients with FEP have a number of unmet health-care needs, even when they are relatively stable and recovered. Hence, all the efforts must be made to address the unmet needs of the patients with FEP, during the remission phase, to improve their overall outcome of the illness.

Keywords: First Episode Psychosis, Health care needs

Reasons of non initiation of clozapine by care givers in patients with treatment resistant schizophrenia-A cross sectional hospital based study.

Ruqaiya, Deeba Nazir, Zaid Ahmad Wani

Background

Clozapine is an atypical second-generation antipsychotic belonging to the family of diabenzodiazepines. It is being widely used for the treatment of various psychiatric disorders which include, but are not limited to treatment-resistant schizophrenia and mania, in addition to being an effective anti- suicidal agent.

Objective

The objective of this study was to explore the reasons for non initiation of clozapine by care givers in patients with treatment resistant schizophrenia.

Methods

The present study was conducted at the Institute of mental health and neurosciences, Kashmir. This was a cross -sectional,non controlled,noninterventional, hospital based study conducted among the caregivers of patients with treatment resistant schizophrenia (TRS). All the caregivers were interviewed after taking the written informed consent in their local language. Caregivers with active psychopathology, poor intellectual capacity and those who refused to participate were excluded from the study.

The 39 caregivers of patients with TRS, who were planned for initiation of clozapine, but was not initiated, were taken up for the study. A self-made validated questionnaire was made which included details of the patients and their caregivers, along with reasons for not starting clozapine in patients with TRS.

Results

The study included 39 caregivers out of which 71.7% were males and 28.2% were females with mean age of 49.47+_ 12.9 , 53.8% of whom were from rural areas and 46.1% hailed from urban areas. Majority of the caregivers belonged to nuclear families (69.2% ) of lower socioeconomic status( 64.1%) with most of them being parents (48.7%), followed by siblings (23.07%) and spouses(15.38%).

The reasons for not starting clozapine were the need for regular monitoring & follow up(43.5%), fear of blood dyscrasias(15.3%), followed by fear of other side effects(10.2%), cost of the drug(7.6%), compliance(15.3%), and poor family support(7.6%).

Conclusion

In conclusion there were a number of reasons for not initiating clozapine by care givers in patients of treatment resistant schizophrenia,the most common of which was the need for regular monitoring & follow up in our settings.

Key words

Blood dyscrasias,Second generation antipsychotic,Treatment resistant schizophrenia.

Prevalence and clinical profile of patients using tapentadol visiting drug de-addiction center in Kashmir

Background: Misuse of prescription opioids has been a hazard lately with tapentadol being a recent addition to the list. Tapentadol is a Schedule II opioid (United States Controlled Substances Act), approved for the management of moderate to severe acute and chronic pain.

Aims and Objectives: We examined the prevalence of tapentadol use among patients attending Drug De-addiction Center, Government Medical College, Srinagar, Kashmir along with their socio-demographic and clinical profile. Methodology: It was a cross sectional study. Patients who reported current tapentadol use were included in the study. Results: In a span of 4 months, a total of 104 patients using tapentadol were seen. Our study mostly consisted of young, unmarried males. More than half of our study participants had concurrent opioid dependence. In our study, no participant had ever injected tapentadol.

Conclusion: Tapentadol is becoming infamous as a cheap and ready to available drug, replacing other opioids during their non-availability. This should be a potential alarming sign for drug control authorities. As such, its sale and supply should be well regulated.

Drunkorexic behavior in patients with alcohol consumption

Dr Shaika Shamsudeen¹, Dr Rajesh M², Dr Ravichandra Karkal³

Yenepoya medical college

Background:

Drunkorexia is a behavioral disorder that is also known as alcoholic anorexia or alcoholic bulimia. Four main characteristic behaviors reported are:

• (1)Planning to limit food in order to compensate for the calorie contained in alcohol,
• (2)Vomiting or using laxatives or diuretics to reduce caloric intake,
• (3)Excessive exercise to reduce calories from alcohol consumption,
• (4)Planning to limit food intake to increase intoxication after alcohol consumption.

Aims and objectives:

• 1)To estimate incidence of Drunkorexia in patients with alcohol consumption
• 2)To assess the clinical profile of Drunkorexia in patients with alcohol consumption

Methods:

A total of 82 participants are included in this ongoing study who fulfills the inclusion criteria. This cross sectional study is carried out after obtaining clearance from institutional ethics committee. Patients coming to Psychiatry and Medicine outpatient and inpatient department of Yenepoya medical college with history of alcohol consumption and meeting inclusion criteria are assessed. A routine mental status examination is done, as only stable patients not in delirium, with insight and intact judgement are included. Drunkorexia Motives and Behavior scale is applied to assess for drunkorexic behavior.

Results:

The study is ongoing at present. Statistical analysis of data obtained will be analyzed and results will be published during conference.

Key words: Drunkorexia, alcohol dependence, drinking

UNDERSTANDING THE PRESCRIPTION PATTERN OF THE INDIAN CLINICIANS TOWARDS PHARMACOTHERAPIES FOR ALCOHOL USE DISORDER

Introduction: Alcohol Use Disorder (AUD) is a significant cause of morbidity and mortality globally. Despite their availability, uptake of AUD pharmacotherapies among clinicians has remained low. There exists a research gap regarding clinician attitudes and the diffusion of AUD pharmacotherapies among Indian clinicians. We conducted a survey to assess the same for selected medications.

Methods: An online survey was sent to clinicians nationwide from February to April, 2023. The survey collected demographic information, and assessed attitudes and practices of various AUD medications. Logistic and ordinal regression models evaluate the clinician and caseload factors determining medication diffusion & attitudes toward each pharmacotherapy.

Results: A total of 387 clinicians responded to the study resulting in a response rate of 15%. The majority were male (61.7%) and trained psychiatrists (56.3%). The diffusion for Acamprosate, Naltrexone and Disulfiram was 69.8%, 81.4%, and 58.2% respectively. Baclofen had the highest diffusion was considered the safest and most acceptable Female respondents had significantly lower perceived efficacy, acceptability, and safety for Disulfiram.. Independent practitioners were more likely than others to try all pharmacotherapies except Baclofen.

Discussion: As a group, the FDA-approved drugs had more diffusion but was far from complete. Surprisingly Baclofen had the highest diffusion, probably reflective of a combination of beneficial cost and safety profile. Despite, its perceived efficacy, safety concerns impacted the diffusion of Disulfiram. Female clinicians in particular, may benefit from specific interventions addressing their attitudes towards Disulfiram. These findings indicate that specific training for AUD pharmacotherapies is warranted for female clinicians and non-psychiatrists.

Keywords: alcohol use disorder, medication diffusion, medication attitudes

Personality profile in Alcohol Dependence Syndrome patients: A cross-sectional study in a tertiary care hospital

Bithorai Basumatary¹, V. Kandasamy²

¹Postgraduate Student, Department of Psychiatry, Tirunelveli Medical College, Tirunelveli, Tamil Nadu.

²Assistant Professor , Department of Psychiatry, Tirunelveli Medical College, Tirunelveli, Tamil Nadu

Background: Alcohol dependence syndrome is the most common substance use disorder and poses a significant public health problem all over the world. Personality factors are associated with pathogenesis, clinical course, treatment outcome and relapse in alcohol dependence syndrome (ADS). Keeping in view of scarcity of Indian data available, the study was with the aim to find Personality traits more commonly associated with ADS patients, and identify specific traits, associated with relapses of ADS.

Aims: To assess the personality traits of alcohol dependence syndrome patients.

Methods: It is cross sectional study of personality profile in alcohol dependence syndrome patients , conducted in the department of psychiatry in Tirunelveli medical college and hospital. Data were collected through working proforma (socio- demographic), alcohol use disorders identification test (AUDIT), severity of alcohol dependence questionnaire (SAD Q) and 16 personality factor (16 PF) inventory.

Results: Majority of the patients scored high on personality traits such as warmth, dominance ,sensitivity, vigilance, while they scored low on factors liveliness and perfectionism. Factors such as emotional stability and tension were found to be significantly associated with severity of ADS and relapses.

Conclusion: Personality factors play a role in the severity of alcohol use and might be associated with relapses and poor treatment outcome. Therefore it is prudent to identify personality traits and address these during management of alcohol dependence syndrome to improve the outcome.

Prevalance of Depression in women of reproductive age group with Rheumatoid Arthritis - A Cross-sectional study from a Tertiary care centre

Dr.Bagyashri Murugan[¹] , Dr.G.Ramanujam [²] , Dr.Vidya Srinivasan[³]

1Post Graduate student, 2Professor and Chief of Department of Psychiatry,3 Assistant Professor of Rheumatology, Tirunelveli Medical College, Tirunelveli, Tamil Nadu.

Background :

Rheumatoid Arthritis (RA) is associated with multiple Psychiatric comorbidities. Women in reproductive age group with RA are vulnerable for Psychiatric comorbidities like Depression and Anxiety.

Aim :

To describe the frequency of Depression in women of reproductive age with Rheumatoid Arthritis.

Methods :

Cross- sectional study on non-pregnant women of reproductive age group with Rheumatoid Arthritis attending Rheumatology OPD in Tirunelveli Medical College Hospital by employing Hamilton Depression Scale (HAM-D).

Results :

Our results showed that women of reproductive age group with RA are found to have significantly greater rates of psychiatric comorbidities like Depression.

Conclusion :

Our study revealed that high frequency of probable or possible cases of Depression were recognized in women of reproductive age with RA. Hence a multi-disciplinary approach is essential for proper management and comprehensive care of these patients.

Pituitary gland volume in help-seeking sample of adolescents with non-suicidal self-injury

Ruqaiya^* ,Shabir Ahmad Dar, Zaid Ahmad Wani

^*Presenting author

Dr. Ruqaiya

Postgraduate scholar, postgraduate department of Psychiatry ,Govt. Medical College, Srinagar

Email; ruqaiyarashid111@gmail.com

Background: Non-suicidal self-injury (NSSI) amongst young people is a rapidly growing phenomenon with as many as 45% of adolescents thought to have tried it at some point. NSSI can be distressing not only to the person who is injured but also to their family and friends. Based on studies linking NSSI with stress, alterations in hypothalamic-pituitary-adrenal (HPA) axis functioning have been suggested. This study was taken to examine pituitary gland volume (PGV) in adolescents engaging in NSSI.

Methods: This was a cross-sectional, hospital-based, observational study in which 49 consenting patients with a history of NSSI in the past week were recruited through a purposive sampling technique. 45 age and gender-matched healthy controls were also recruited for the study. All the cases and controls underwent the Magnetic Resonance Imaging of brain and PGV was obtained by manual tracing method.

Results: The mean age of cases and controls was 16.66±2.20 and 16.82±1.82 years , p = 0.68. In this study patients engaging in NSSI and healthy controls did not differ in terms of total brain volume (cases:1188.33 ± 92.60 cm3; Controls: 1192.85 ± 91.977cm3, t(60) = 0.88, p = 0.39), and total brain volume was not associated with PGV (r = − 0.06, p = 0.53). PGV increased linearly with age in healthy controls (B = 61.39, SE = 14.94, p < 0.01), and no corresponding association was found in cases (B = 16.83, SE = 12.20, p = 0.17). PGV was not related to adverse experiences during childhood (p > 0.05).

Conclusion: These results provide preliminary evidence that there is no alteration in PGV in adolescents engaging in NSSI as compared to healthy controls.

Keywords : Non-suicidal self-injury, Pituitary gland volume, Magnetic Resonance Imaging

A CROSS SECTIONAL STUDY OF SUICIDE RISK AND PERSONALITY PROFILE IN PATIENTS OF ALCOHOL USE DISORDER.

Dr.Himanshi, Dr. Rohini A. Kokkalki

BACKGROUND:

Alcohol use is widely prevalent in India and leads to multiple losses in terms of physical hazards, economic losses, social problems and mental problems. (¹) As the perceived stress increases, it might result in increased consumption of alcohol. Alcohol is one of the leading causes of death and disability accounting for 3.2% of deaths worldwide every year. (¹) Patients with Alcohol Use Disorder (AUD) generally have high neuroticism, low conscientiousness and low agreeableness. (²) Suicide is a major public health issue in those suffering from alcohol use disorder. The prevalence of suicide in patients of AUD is 15%. (³)

AIMS:

The aim of the study is to find out the relationship between AUD, perceived stress and suicide risk, how the personality traits of patients with AUD affect the suicidal risk.

METHODOLOGY:

An observational cross-sectional study was conducted among new patients diagnosed clinically by consultant Psychiatrist as Alcohol Use Disorder attending de-addiction centre.

RESULTS:

• Highly significant relationship between severity of alcohol dependence and suicidal ideation risk.

• Suicidal ideation risk was found to be highly significantly related to perceived stress.

• High extraversion and openness have been found in 52.5% and 59% of the patients respectively and low agreeableness and conscientiousness in 62% and 58% respectively.

• Neuroticism trait has been found to be highly significantly correlated with the severity of alcohol dependence, with increased suicidal risk and with perceived stress.

• At the time of interview, 33% of the patients had suicidal ideations and 23.5% of the population had attempted suicide.

CONCLUSION:

This data shows that:

• As the severity of alcohol use increases, patients have increased risk for suicidal ideations.

• Neuroticism trait has higher tendency to perceive stress and get depressed, which increases their vulnerability to develop alcohol use disorder and to develop suicidal thoughts.

• As the stress perceived by the patient increases, risk of having suicidal ideations increase and they tend to consume more alcohol to alleviate stress.

Key words: Alcohol Use Disorder, Perceived Stress, Neuroticism, Suicidal risk.

Assessing the Tolerability of Vortioxetine Versus Escitalopram in the Management of Major Depressive Disorder: A Tertiary Care Hospital Study

Background - FDA approved vortioxetine for MDD on September 30, 2013. It’s a multi-modal antidepressant acting on serotonin receptors and the transporter. Vortioxetine is 5.1 times more likely to produce a positive response than placebo. Given that the majority of existing studies have primarily focused on assessing the efficacy of vortioxetine in comparison to a placebo, this research paper aims to comprehensively analyze how it compares in terms of tolerability with other antidepressant medications.

Aim – To assess and compare the tolerability of vortioxetine and escitalopram for the management of major depressive disorder.

Method – Subjects were screened based on inclusion/exclusion criteria, assessed using the HAM-D scale and the anti depressant side effect checklist scale. Random allocation ensured double-blinded treatment. Escitalopram and vortioxetine were administered at 10 mg/day, taken nightly. Benzodiazepines for anxiety/sleep were allowed. No other medications were permitted to maintain unbiased results. Exclusions included additional drugs affecting the study due to psychiatric issues or medical conditions. Patients were followed up for 3 months.

Result - Vortioxetine Demonstrates Improved Tolerability with Fewer Notable Adverse Effects Compared to Escitalopram, Resulting in a Higher Rate of Discontinuation Among the Escitalopram-Treated Patients

Conclusion - Vortioxetine demonstrates superior tolerability compared to escitalopram in the management of major depressive disorder.

Assessment of Anxiety and Depression in Patients with Genital Dermatoses

Background

Genital dermatoses are very common. Persons suffering from genital dermatoses can have significant distress but may be reluctant to consult due to its stigma. This can worsen their condition and can also cause varying psychological distress.

Aims

This study aimed to assess the anxiety and depression in patients diagnosed with genital dermatoses.

Methods

This was a cross-sectional study conducted at a tertiary care centre in South India. The study participants were persons diagnosed with genital dermatoses. The sample size was 60. Participants gave written informed consent to participate in the study and were all >18 years of age. The sampling method was convenience sampling. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used to assess the anxiety and depressive symptoms respectively.

Results

Among the 60 participants, 35(58.3%) were females, and the rest 25 (41.7%) were males. The mean HAM-A score of all participants was 13.22(Standard deviation=6.97), indicating mild anxiety symptoms. The mean HAM-D score of all participants was 11.07 (Standard deviation=6.52), indicating mild depressive symptoms. There was no significant difference in either the mean anxiety score or the mean depression score between both genders. There was no significant correlation between HAM-A and HAM-D scores and age. However, there was a significant difference in HAMA-A and HAM-D scores between groups of various occupations.

Conclusion

Genital dermatoses can cause significant anxiety and depression. There is a need to look into the psychological symptoms of patients presenting with genital dermatoses.

Internet And Smartphone Addiction In Medical Students And Its Correlation With Quality Of Sleep

Introduction

Smartphone and internet addictions are growing global problems and lead to significant psychosocial morbidity. This is especially true for students, who already suffer from chronic sleep deprivation, which is exacerbated by smartphone and internet addiction.

Objectives

The study was conducted to assess prevalence of smartphone and internet addiction among MBBS students and correlate it with quality of sleep.

Methodology

An observational cross-sectional study was conducted among 323 undergraduate medical students of a teaching hospital of Telangana for a period of one year. To assess the prevelance the scales used were: Smartphone addiction-SAS-SV scale, Internet Addiction-IAT test, and Quality of Sleep-PSQI instrument.

Results

The mean age of participants was 22.4±1.8 years. Interns were the most numerous (37.5%). Most participants used smartphones for 3 to 5 hours daily (44.9%). 44.3% reported using smartphones 1-2 hours before bedtime. The mean SAS score was 30.7±10.1, mean IAT score was 30.1±16.4. The mean PSQI score of the was 13.9±4.2. Both smartphone addiction (r 0.633, p-value <0.001) as well as internet addiction test scores (r 0.971, p-value <0.001) were significantly positively correlated with poor quality of sleep among the participants.

Conclusions

It was seen that undergraduate medical students scored high in both smartphone and internet addiction screening tests, and had relatively poor quality of sleep. It was also seen that among them, smartphone and internet addiction was positively correlated with poor sleep quality.

Apathy in Post stroke patients in a tertiary health care centre – a cross sectional study

Dr.J.Marcel¹,Dr.A.Balaji²

¹MD Postgraduate ,Department of psychiatry , Kilpauk medical college and hospital,Chennai.

²Assistant professor , Department of psychiatry , Kilpauk medical college and hospital,Chennai.

Background:

Apathy is defined as a reduction in goal-directed activity in the cognitive, behavioral, emotional, or social domains of a patient’s life and occurs in one out of three patients after stroke. Apathy is clinically under-recognized and poorly understood.Apathy occurs frequently, and with substantial impact on quality of life, in a broad range of neurological and psychiatric conditions. Apathy is often misdiagnosed as other post-stroke conditions such as depression.Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy.

Objectives :

To study the prevalence of Apathy in post stroke patients in Tertiary health care centre

Methods: A study was conducted among patients attending Neurology OPD in tertiary care hospital. 50 consecutive chronic stroke patients were included in the study. The participants are included after obtaining informed consent. Semistructured sociodemographic proforma (Name, Age, education occupation, family income and socioeconomic status) for obtaining demographic and clinical variables was used.The patients included in the study are administered Apathy Evaluation Scale. Data collected were statistically analyzed using SPSS software.

Results : Apathy was present in 26% of stroke patients.

Conclusion:

Often difficult to diagnose apathy secondary to stroke affects about quarter of chronic stroke patients. So screening of patients for apathy is vital in stroke rehabilitation as it has a significant negative effect on quality of life stroke survivors, particularly on their mental health. Interventions for apathy could improve quality of life in chronic stroke patients.

Personality profile in Alcohol Dependence Syndrome patients: A cross-sectional study in a tertiary care hospital

Bithorai Basumatary¹, V. Kandasamy²

¹Postgraduate Student, Department of Psychiatry, Tirunelveli Medical College, Tirunelveli, Tamil Nadu.

²Assistant Professor , Department of Psychiatry, Tirunelveli Medical College, Tirunelveli, Tamil Nadu

Background: Alcohol dependence syndrome is the most common substance use disorder and poses a significant public health problem all over the world. Personality factors are associated with pathogenesis, clinical course, treatment outcome and relapse in alcohol dependence syndrome (ADS). Keeping in view of scarcity of Indian data available, the study was with the aim to find Personality traits more commonly associated with ADS patients, and identify specific traits, associated with relapses of ADS.

Aims: To assess the personality traits of alcohol dependence syndrome patients.

Methods: It is cross sectional study of personality profile in alcohol dependence syndrome patients , conducted in the department of psychiatry in Tirunelveli medical college and hospital. Data were collected through working proforma (socio- demographic), alcohol use disorders identification test (AUDIT), severity of alcohol dependence questionnaire (SAD Q) and 16 personality factor (16 PF) inventory.

Results: Majority of the patients scored high on personality traits such as warmth, dominance ,sensitivity, vigilance, while they scored low on factors liveliness and perfectionism. Factors such as emotional stability and tension were found to be significantly associated with severity of ADS and relapses.

Conclusion: Personality factors play a role in the severity of alcohol use and might be associated with relapses and poor treatment outcome. Therefore it is prudent to identify personality traits and address these during management of alcohol dependence syndrome to improve the outcome.

*Dr. Saurabh Vijay Gavhane **Dr. Arun Marwale***Dr. Amreen Sait

*2^nd Year PG Student, Department of Psychiatry, M.G.M. Medical college, Aurangabad **Professor, Department of Psychiatry, M.G.M. Medical college, Aurangabad

***1^st Year PG Student, Department of Psychiatry, M.G.M. Medical college, Aurangabad

Neuropsychiatric manifestations in a female with anti-NMDA autoimmune encephalitis: A case report

Background: Anti-NMDA autoimmune encephalitis is a rare disorder with antibodies targeting N-methyl-D-aspartate (NMDA) receptors, leading to a range of neuropsychiatric symptoms, making its diagnosis and management a complex task. Existing studies estimate its occurrence in approximately 1 to 2 individuals per million annually.

Aim: To acknowledge neuropsychiatric manifestations associated with anti-NMDA autoimmune encephalitis, emphasizing its diverse range of neuropsychiatric symptoms to improve early diagnosis and proper management.

Methods: We present the case of a 28-year-old female patient with altered behaviour and seizure episodes, which subsequently progressed to include psychosis, abnormal movements, and memory deficits. The diagnostic process included a medical history review, physical examinations, systemic evaluations, and central nervous system assessments. Imaging studies, including MRI and ultrasound, were conducted to rule out other potential causes. The presence of positive anti-NMDA receptor antibodies confirmed the diagnosis. Neurological treatment included immunosuppressants and intravenous immunoglobulins.

Results: Despite a diligent trial of psychotropic medications, the patient’s condition exhibited limited improvement, with symptoms fluctuating, as is common in this disorder. This case highlights the complexity of diagnosis and treatment and underscores the importance of considering anti-NMDA autoimmune encephalitis in patients with diverse neuropsychiatric symptoms.

Conclusion: This case underscores the complexity of diagnosis and management in individuals with Anti-NMDA Autoimmune Encephalitis and emphasizes the need to consider it in patients with various neuropsychiatric symptoms. Raising awareness of this condition among healthcare providers is crucial for early intervention and improved patient outcomes.

NEUROCOGNITIVE DEFICITS IN HIV PATIENTS A CROSS SECTIONAL STUDY

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 a diagnostic challenge to clinicians. HIV enters the brain shortly after infection and has a predilection for the subcortical regions of the brain areas. The cognitive impairment is attributed to HIV replication in the brain and the 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 patients’ activities of daily living.

Methodology:

A cross-sectional study was done on 46 HIV-infected individuals who come to Victoria hospital ART center, who fulfilled inclusion and exclusion criteria will be considered. Semi-structured proforma was used for collecting socio-demographic and clinical variables. IHDS (international HIV dementia )scale was applied to know the neurocognitive severity & patients (score less than <=10) were considered for Neuro Psychiatry battery..

Results:

67 percent of our study participants have been detected for HIV-associated neurocognitive disorder (HAND) and were classified as having an 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.

Conclusions:

More than 60% of HIV patients have HIV-associated neurocognitive disorders (HAND), and they are categorized under the asymptomatic category.

HIV, HAND, IHDS, Neuro-Psychiatry battery, HAART.

Anxiety, Depression and Stress among Medical Students during COVID-19 Pandemic and their Coping strategies.

Subahani Shaik

1 Assistant professor, department of psychiatry, ACSR govt. medical college

Background: Covid 19 has not only affected the physical, social health it also had significant impact on the mental health of the medical students. Due to lack of exposure leading to inadequate training and a sense of alienation, turmoil had invaded the medical student with physical exposure to patients and also increasing the risk of infection. This study was conducted to assess the mental health of the medical students during pandemic & to determine their coping strategies.

Methodology: A cross-sectional study was done, among all MBBS students of ACSR govt medical college, Nellore. Depression, Anxiety, and Stress Scale (DASS-21) was used to assess the mental health. Details of all the students were obtained and google form was sent to their email id, and data was collected from August 2020 and September 2020.

Results: Out of 421 responses of which 21 were invalid, so analysis was done for 400 responses. Prevalence of depression, anxiety & stress among study subjects during Covid -19 was found to be 20.2%, 13% & 51.3%. Video chat with friend 35% and watch movies online 32.2% & only 5.5% took doctor help to cope up with their mental situations. Negative impact was found on the daily routine activities of medical students. Academic year of the medical student and type of family they live in was found to be statistically significant.

Key words: Depression, Anxiety, stress, prevalence, coping strategies, medical students, Covid 19.

A case of adolescent onset bipolar disorder with comorbid dissociative identity disorder

¹Dr. Shriram S, (Junior Resident), ¹Dr. Ajithra M (Junior Resident) ¹Dr. Anjana Rani (Assistant Professor), ¹Dr. Arun B Nair (Assistant Professor),¹Dr. Indu P V, (Professor)

1.Department of psychiatry, Govt medical college, Thiruvananthapuram

Introduction: Paediatric bipolar disorder often has atypical presentation. Here we have a case of bipolar disorder in an adolescent which initially presented with dissociative identity disorder (DID)

Case Description: A 16-year-old boy presented with declining scholastic performance and difficulty concentrating since last year, appeared inattentive in the class with brief periods of vacant stares since 6 months, episodes of loss of awareness with reduced responsiveness since 3 months. Later on developed fearfulness, easy irritability, sudden involuntary switching of behaviour from his own self to that of a four year old child to that of an animal(dog), when he became aggressive which lasted for brief periods of few minutes. Episodes of aggressive behaviour worsened, showed suicidal gestures and had reduced sleep in the last 3 days which warranted in-patient care.

On examination he was conscious, oriented, psychomotor activity increased, multiple dissociative episodes were observed, mood was irritable, depressive ideas, death wishes and auditory hallucinations, semi-abstractable thinking with grade 2 insight. Brain imaging, electroencephalography, clinical psychology evaluation was done. A diagnosis of unspecified bipolar and related disorder with comorbid DID was made. He was started on Valproate and risperidone and optimised but the agitation was difficult to control in the open ward and hence transferred to Mental Health Centre where he was managed as BPAD with valproate, oxcarbazepine and quetiapine along with behavioural and cognitive therapy, by the clinical psychologist, improvement seen over 1 month.

Discussion: This case details the diagnostic challenges in identification of bipolar disorder in paediatric population, especially with dissociative symptoms and need for an interdisciplinary team approach is emphasised.

Chanakya—An unsung ‘psychoanalyst’

TG Sriram, MD

Chanakya was a scholar, statesman, and adviser to King Chandragupta of Magadha empire. He is believed to be a Brahmana, who was born in the 4th century B.C. In Takshashilā. His father was Kutala, hence his other name is Kautilya. Another view is that his father’s name was Chanaka and hence his derived name Chanakya. He received his education in Takshashilā university. He dethroned the Nanda dynasty and coronated Chandragupta to the throne of Magadha empire. His popular works include, Arthashastra, Chanakyaneeti.

Chanakya had remarkable insights about the workings of the human mind. He had an astute understanding of the effects of both heredity and environment in personality development. His verses, which will be presented, show a remarkable understanding of pathological personality conditions. He dwells on many other topics including human frailties, moral codes of conduct, desirable attributes of rulers, to name a few. His sayings are very relevant to mental health professionals.

Important references include

1. Naveen Kumar Jha: Chanakyaneetidarpanaha., J.P. Publishing House, Delhi, 2018

2. Tantrik Yogi Ramesh(Translator): Ethics of Chanakya., Sahni Publications 1995

3. Rudrapatna Shamashastri and Ashok Kumar Shukla (translators) Kautilya’s Arthashastra, Vol 1&2, Parimal Publications, Delhi 2023

Optimizing Clozapine Use in India: Insights into Therapeutic Drug Monitoring

Clozapine, a potent atypical antipsychotic, has long been recognized as a cornerstone in the treatment of treatment-resistant schizophrenia and related severe mental illnesses. However, its full potential in India is hindered by numerous challenges, primarily stemming from a lack of awareness and proper management of therapeutic drug monitoring (TDM). This presentation focuses on the critical role of TDM in optimizing clozapine use in the Indian context.

The effective use of clozapine necessitates a deep understanding of the pharmacokinetic and pharmacodynamic principles governing its action. Therapeutic Drug Monitoring, a method to measure the concentration of clozapine and its metabolites in the blood, is indispensable for tailoring the dosage to individual patient needs. The presentation delves into the technical aspects of TDM, including the ideal timing of blood sampling, the interpretation of serum levels, and the significance of steady-state concentrations in optimizing clinical outcomes.

Furthermore, the presentation addresses the pivotal role of TDM in the management of clozapine-related adverse effects. By closely monitoring serum levels, healthcare providers can enhance the drug’s efficacy and mitigate potential side effects, such as agranulocytosis, myocarditis, and seizures. This ensures the safety and well-being of patients on clozapine therapy.

The audience will gain valuable insights into the practical implementation of TDM in an Indian clinical setting, including establishing guidelines for regular patient monitoring. Additionally, the presentation emphasizes the importance of educating healthcare professionals and patients about TDM, ultimately fostering a culture of responsible clozapine use.

In conclusion, optimizing clozapine use in India is contingent upon a thorough understanding and efficient utilization of therapeutic drug monitoring. By emphasizing the significance of TDM in individualizing treatment, enhancing safety, and promoting a culture of informed clinical practice, this presentation aims to pave the way for improved outcomes and a brighter future for individuals living with treatment-resistant schizophrenia in India.

Comparison of metacognition between patients with schizophrenia and healthy controls

Promil Redhu, Ritu Nehra*, Sandeep Grover**, Aseem Mehra***

Junior Resident, *Professor of Clinical psychology, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, **Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh,

***Associate Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh

Background: Metacognition deficits person with schizophrenia contribute to the inability to form complex ideas about the others around them and themselves. However, limited information is available from India about metacognitive deficits in schizophrenia patients. Aim: To compare the metacognition of patients with schizophrenia and healthy controls. Methods: 100 patients of schizophrenia in clinical remission and 100 healthy controls were assessed on Metacognition self- assessment scale (MSAS). Results: Mean age of the study sample was 34.89 (SD: 9.33) years. Males outnumbered females. In the patient group as assessed on MSAS the mean weighted score was highest for the domain of mastery and decentration, followed by the domains of monitoring, and least for domains of integration and differentiation. When the metacognition of patients with schizophrenia and that of control group was compared, on MSAS, patients performed significantly worse than the controls on all the domains. Conclusion: Patients with schizophrenia have poor metacognition, when compared to the healthy controls.

The demographic and clinical profile of recurrent/periodic catatonia

Surabhi Gupta, Sanjana Kathiravan*, Sandeep Grover**

Junior Resident, *Former-Senior Resident, **Professor, Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh

Background: Recurrent/Periodic catatonia is a rare entity characterised by recurring episodes of catatonia. There is limited data on periodic catatonia from India.

Objective: The aim of this study was to assess the demographic and clinical profile of patients with periodic catatonia.

Methods: This retrospective study included data of 50 patients presenting with recurrent episodes of catatonia irrespective of the primary diagnosis. Demographic and clinical profile was extracted.

Results: Among patients with recurrent/periodic catatonia females (58%, n= 29) outnumbered males. Majority of the patients were married (62%, n= 31), homemakers (48%, n=24), Hindu by religion (78%, n= 39), from nuclear family (66%, n= 33) and urban background (56%, n= 28). The mean age of the study sample was 44.78 (SD: 20.66) years. Most common diagnosis was schizophrenia (n=22), followed by recurrent depressive disorder (n=12), acute and transient psychosis (n=5) and bipolar disorder with depressive polarity (n=3). Mean age of onset of illness was 30.34 (SD:14.06) years and the mean age of onset of 1^st catatonic episode was 34.82 (SD: 15.91) years. Mean number of catatonic episodes in lifetime was 4.22 (SD: 6.96), ranging from 2-47, and the mean duration of catatonic episodes ranged from 3 to 180 days. The symptom profile of catatonia did not vary between the episodes in 41 (82%) patients. In the most recent episode, lorazepam challenge test was positive in nearly half of the patients and 27 patients received Electro Convulsive Therapy for management of catatonia.

Conclusion: Recurrent/Periodic catatonia is associated with both psychotic and affective disorders.

Mental health and well-being in elderly South Asian immigrants: a scoping review

Shabbir Amanullah1

Vibha Sarathy2

Anupam Thakur3

K Shivakumar4 Maria Hussain5

1.Division Chair of Psychiatry, Queens University, Kingston, Ontario, Canada, K7L 3N6

2.Medical sciences, University of Western Ontario, London, Ontario, N6A 3K7

3.Department of Psychiatry, University of Toronto; Centre for Addiction and Mental Health, Toronto, Ontario, Canada, M5S 1A1

4.Northern Ontario School of Medicine, Sudbury, P3E 2C6

5.Consultant Psychiatrist, Queen’s University, Kingston, Ontario, Canada, K7L 3N6

Background

Rising numbers of immigrants from South Asian countries have been observed globally and although this has helped with manpower shortages it has brought with it health care delivery issues that are poorly understood.

The unique experiences of each community and challenges with their mental health and overall well-being in South Asian immigrants have been largely unexamined. Understanding the mental health needs of older South Asian immigrants is becoming increasingly important, given the potential implications for healthcare, social services, and health care and economic policies.

Aims

This scoping review aims to investigate the mental health of older South Asian immigrants with the following objectives:

• 1)Identify the types and prevalence of mental health concerns
• 2)Key Factors that affect their well-being;
• 3)Identify barriers to accessing mental health services.

Methods

This scoping review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Literature between 2013 and 2023 was obtained using two databases: Medline and Scopus. Articles were screened, and determined eligible if they were English language articles, and discussed mental health and/or well-being in South Asian immigrants above 65 years of age. From these studies, data was extracted and summarized.

Results

The findings highlight the presence of depression among South Asians (Karasz et al., 2016). Social isolation and acculturation stress are identified as key factors impacting well-being (Ali et al., 2021). Barriers cultural incompatibility, personal attitudes, and circumstantial challenges (Lai & Surood, 2013).

Conclusions

It is vital for professionals to understand the cultural differences that lead to service barriers and the determinants of well-being among older South Asian immigrants. This understanding is key for delivering culturally sensitive and effective care, reducing disparities, and enhancing overall well-being.

References

Ali, S. H., Islam, T., Pillai, S., Kalasapudi, L., Mammen, S., Inala, S., Kalasapudi, V., Islam, N. S., & Gunness, H. (2021). Loneliness and mental health outcomes among South Asian older adult immigrants in the United States: A cross-sectional study. International Journal of Geriatric Psychiatry, 36(9), 1423–1435. https://doi.org/10.1002/gps.5549

Karasz, A., Gany, F., Escobar, J., Flores, C., Prasad, L., Inman, A., Kalasapudi, V., Kosi, R., Murthy, M., Leng, J., & Diwan, S. (2016). Mental health and stress among South Asians. Journal of Immigrant and Minority Health, 21(S1), 7–14. https://doi.org/10.1007/s10903-016-0501-4

Lai, D. W., & Surood, S. (2013). Effect of service barriers on health status of aging South Asian immigrants in Calgary, Canada. Health & Social Work, 38(1), 41–50. https://doi.org/10.1093/hsw/hls065

Evaluation of the psychometric properties of Bengali version of the Yale-Brown Obsessive Compulsive severity scale

Background- The Yale-Brown Obsessive Compulsive Scale (YBOCS) is gold standard instrument for structured assessment of severity of symptoms of obsessive-compulsive disorder (OCD). A vernacular version of Y-BOCS will help to assess the severity of OCD accurately in Bengali-speaking population.

Aim- To evaluate the psychometric properties of the Bengali version of the Y-BOCS severity scale.

Methods- The original English version of Y-BOCS was translated into Bengali which involved forward and backward translation, validation by experts, pilot testing with native speakers for understandability/clarity. The translated version was then administered on 100 patients diagnosed with OCD along with National Institute of Mental Health - Global Obsessive-Compulsive Scale (NIMH-GOCS) and Patient Health Questionnaire-9 (PHQ-9) for assessing convergent and divergent validity respectively. The Bengali version of Y-BOCS was re-administered within 1 week after the initial assessment in 20 subjects (for evaluating retest reliability) and by an independent rater in an independent subset of 20 participants (for evaluating inter-rater reliability).

Results- The Bengali version of YBOCS has good internal consistency for the total Y-BOCS score (Cronbach’s Alpha 0.934), obsessions subscale (Cronbach’s Alpha = 0.866), compulsions subscale (Cronbach’s alpha = 0.894). The split-half reliability was 0.924 (Spearman Brown Coefficient). Intra class coefficient was 0.938 (0.845- 0.975) for test-retest, 0.925 (0.814-0.970) for inter-rater reliability. The Y-BOCS had a stronger correlation with NIMH-GOCS (r = 0.914) as compared to PHQ-9 (r = 0.427), supporting its validity.

Conclusion- The Bengali-translated version of YBOCS is psychometrically reliable and valid measure for assessment of the severity of OCD in the Bengali-speaking population.

Assessment of Quality Of Life in Chronic Obstructive Pulmonary Disease: An Institution Based Cross-Sectional Study

Dr. Shovan Biswas¹, 3^rd year Post-Graduate Trainee, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata Dr. Somsubhra Chatterjee², Associate Professor, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata Prof. (Dr.) Asim Kumar Mallick³, HOD, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata

Prof. (Dr.) Supriya Sarkar, HOD, Dept. of Respiratory Medicine, Sagore Dutta MCH, Kolkata

Background:

Chronic Obstructive Pulmonary Disease (COPD) is a group of lung disease that block airway and make it difficult to breath. COPD is characterized by air flow obstruction, which is generally progressive, may be accompanied by airway hyper-activity, and may be partially reversible. The global prevalence of COPD is approximately 13.1%.The prevalence of COPD in our adult population (≥45 years) was 3.6% and it increased greatly with age (1.9% in the age group 45–64, 4.8% in 65–74, 6.8% in 75–84 and 5.6% in ≥85 years). COPD appeared more common in males than in females (4.1% in males and 3.1% in females). It is highly complex in relation to its etiology and treatment is challenging, even for experts. Quality of life (QoL) has become an important subject for society and especially for health professionals. It can be defined as the individual satisfaction or happiness with life in domains that the subject considers important. Several factors may affect a subject’s well-being, such as work, occupation, housing and financial concerns. Health is also one of these factors. There is no such study in this setting comparing quality of life with severity of COPD. Early assessment in comparison to severity of COPD may improve the patient health condition, daily life activity; decrease the burden of mental illness and health care expenditure and improves quality of life of the patient.

Aim:

• [a]To determine the proportion of impairment of Quality of Life in patients with Chronic Obstructive Pulmonary Disease
• [b]Comparison of severity of Impairment of Quality of life with severity of Chronic Obstructive Pulmonary Disease

Methods:

This study was an institution based cross-sectional observational study conducted over 3 months at Respiratory Medicine Outdoor of Sagore Dutta MCH, Kolkata. 75 numbers of patients with chronic obstructive pulmonary disease (based on inclusion and exclusion criteria) attending respiratory medicine opd of my college were selected from the register book of the office of the respiratory medicine dept. by census method during my data collection period. After taking consent, socio-demographic data of the patients were recorded. GOLD criteria was used to assess the severity of Chronic Obstructive Pulmonary Disease while CCQ questionnaire was used to assess Quality of Life impairment. Statistical analysis was done using SPSS/ Excel software.

Result:

We included 75 patients with COPD (mean age 50.9±7.1 years, M: F 53:22), disease duration ranging from 6 weeks to 20 years, median 119 weeks. Almost 32% patients reported associated smoking. The median CCQ score was 1.3 (range 0.2-5.1). CCQ scoring revealed 44% (33/75) patients with impaired quality of life (QoL). CCQ scores showed a significant positive correlation with GOLD criteria (r=0.4, p <0.0001) and disease duration also showed a significant positive correlation (r= 0.6, p <0.0001).

Conclusion:

Impaired QoL is relatively common in COPD patients, affecting 1 in every 3 patients. Disease severity and duration are the most important risk-factor for impaired QoL. Such patients need multidisciplinary management involving psychiatrists to improve their disease outcome.

Assessment of Quality Of Life in Chronic Spontaneous Urticaria: An Institution Based Cross-Sectional Study

Dr. Joydip Pandit¹, 3^rd year Post-Graduate Trainee, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata Dr. Somsubhra Chatterjee², Associate Professor, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata Prof. (Dr.) Asim Kumar Mallick³, HOD, Dept. of Psychiatry, Sagore Dutta MCH, Kolkata

Dr. Indrashis Podder⁴, Assistant Professor, Dept. of Dermatology, Sagore Dutta MCH, Kolkata

Background:

Chronic spontaneous urticaria (CSU) is a debilitating skin disease, which affects 0.5 to 1% of the population. It is characterized by erythematosus, papulous, itchy lesions of a fluctuating nature that persist for over six weeks. It is highly complex in relation to its etiology and treatment is challenging, even for experts. Quality of life (QoL) has become an important subject for society and especially for health professionals. It can be defined as the individual satisfaction or happiness with life in domains that the subject considers important. Several factors may affect a subject’s well-being, such as work, housing and financial concerns. Health is but one of these factors. There is no such study in this setting comparing quality of life with severity of CSU. Early assessment in comparison to severity of CSU may improve the patient health condition, daily life activity; decrease the burden of mental illness and health care expenditure.

Aim:

• [a]To determine the proportion of impairment of Quality of Life in patients with Chronic Spontaneous Urticaria
• [b]Comparison of severity of impairment of Quality of life with severity of Chronic Spontaneous Urticaria

Methods:

This study was an institution based cross-sectional observational study conducted over 3 months at Dermatology Outdoor of Sagore Dutta MCH, Kolkata. 64 numbers of patients with chronic spontaneous urticaria (based on inclusion and exclusion criteria) attending dermatology opd of my college were selected from the register book of the office of the dermatology dept. by census method during my data collection period. After taking consent, socio-demographic data of the patients were recorded. UAS-7 scale was used to assess the severity of Chronic Spontaneous Urticaria while DLQI questionnaire was used to assess Quality of Life impairment. Statistical analysis was done using Excel software.

Result:

We included 64 patients with CSU (mean age 37.3±10.9 years, M: F 16:48), disease duration ranging from 6 weeks to 20 years, median [IQR] 19 [¹¹-⁵²] weeks. Almost 40% patients reported associated angioedema, and 45% presented with concomitant symptomatic dermatographism. The median [IQR] UAS7 score was 16.5 [⁹-²⁶] (range 2-39). DLQI scoring (median [IQR] 9 [1-18.5], range 0-29], revealed 60% (38/64) patients with impaired quality of life (QoL). In majority patients (40.6%, n=26) CSU exerted no effect on the patients quality of life, while in 32.8% and 10.9% the disease exerted very large effect and extremely large effect on patients quality of life. DLQI scores showed a significant positive correlation with UAS7 scores (r=0.8, p <0.0001), while disease duration showed a negative correlation (r= - 0.1, p=0.2).

Conclusion:

Impaired QoL is relatively common in CSU patients, affecting 3 in every 5 patients. However, the impairment is mild in most patients. Disease severity is the most important risk-factor for impaired QoL, while other risk-factors include concomitant angioedema, advancing age and long-standing disease. Such patients need multidisciplinary management involving psychiatrists to improve their disease outcome.

CROSS-SECTIONAL STUDY OF PSYCHIATRIC MORBIDITY AMONG EPILEPSY PATIENTS

Author:	Co-author:
Dr.Vinayak Krishnan	Dr. K. Pavan Kumar K
PG 2nd year	Professor & HOD CAIMS, Karimnagar
CAIMS, Karimnagar
Ph: 9447327038
E-mail: vinayak_krishnan@yahoo.com

Background

• Association between epilepsy a nd psychiatric comorbidities has been known since antiquity. I t ranges from 20 -50% reaching 80% in selected populations like individuals w ith temporal lobe epilepsy. There is also a uncerta inty a s to w hether c ertain psychiatric disorders have a greater or lesser propensity to coexist with c ertain types of epilepsies we undertook this study aiming to accomplish this.

Aims and objectives

• To assess psychiatric comorbidities a mong patients with epilepsy (PWE) attending Neurology OPD.

• To determine the correlation between spec ific seizure subtype and a psychiatric comorbidity.

• To determine the Correlation between seizure frequency, seizure duration and abnormal E EG finding in psychiatric co-morbidities among epilepsy patients.

Method

• A cross sec tional study was conducted in CAIMS hospital, Karimnagar including PWE attending neurology OPD for a period o f 1 year. Administered Semi structured proforma and MINI 7. 0.2.

Results

• 100 PWE with psychiatric comorbidities were evaluated, found that generalized anxiety disorder (59%) followed by MDD (46%) were predominant. GAD was greatly associated with Focal motor seizures with secondary generalization (FMSWG)(64.3%) seizure frequency of >5/year, seizure duration of 11-15 years, and in patients with Normal EEG. MDD was associated with FMSWG (57.1%) frequency of 2-5/year duration >15 years and in patients with normal EEG.

Conclusion

• The present study sug gests that GAD and MDD a re the psychiatric comorbidities w hich a re mostly a ssociated w ith PWE. FMSWSG is the seizure subtype g reatly associated with GAD and MDD.

ABSTRACT FOR FREE PAPER: POST STROKE MANIA: A CASE REPORT

Dr Nisha Anna George¹, Dr Shashidhar Bhat², Dr Akshay Jadhav³

,Dr Anil Korade⁴

¹Junior Resident

2Junior Resident

³Senior Resident

⁴Associate Professor

Presenting Autor: Dr Nisha Anna George

Junior Resident

Dept of Psychiatry

Rural Medical College, Loni, Maharashtra-413736

Contact details: Dr Nisha Anna George

Mobile: 7045915217

Email: drnishag12@gmail.com

Conflict of Interest: Nil

Words: 246

POST-STROKE MANIA: A CASE REPORT

Background:

In recent decades, the prevalence of lifestyle-related diseases, particularly hypertension, has surged, leading to associated complications such as stroke. While depression affects 30-40% of stroke survivors, post-stroke mania is a rare occurrence, affecting less than 1% of patients.

Case Summary:

This report details the case of a 74-year-old male diagnosed with hypertension and a cerebrovascular accident in 2017. Over the past year, the patient displayed behavioral disturbances including irritability, aggression, reduced need for sleep, heightened talkativeness, claims of divine incarnation, and belief in superhuman abilities. These symptoms intensified over the last four months, with no significant family history. On examination, he was alert, conscious and oriented with an irritable mood, increased volume of speech and grandiose delusions.

Management:

MRI revealed chronic small vessel ischemic changes in bilateral fronto-parieto-occipital lobes with microbleeds in the parietal lobe and thalamus. The patient was initiated on tablet Divalproex Sodium upto 750mg per day, and Clonazepam to 0.5mg at night. Significant behavioral improvement was noted within one month of treatment initiation, with sustained positive outcomes on the prescribed medications.

Conclusion:

A high index of suspicion of Mania stemming from a primary medical condition shall be kept in mind even in the absence of a personal or family history of mood disorder. The temporal correlation between cerebrovascular insult and the onset of psychiatric disorders underscores the need for thorough assessment and analysis. Appropriate interventions can markedly enhance quality of life and foster adherence to medical management.

Cross sectional qualitative & quantitative study of quality of life of individuals with gender dysphoria who underwent gender affirming surgery.

Background: Gender identity refers to the alignment of one’s inner sense of gender with their outward expression. Gender Dysphoria often results in discrimination and psychological challenges. Gender affirming surgery (GAS) has increased accessibility to gender transitioning by aligning one’s appearance with their gender identity.

Objectives: To evaluate the quality of life of transgender individuals with gender dysphoria one year after GAS.

Methods: A cross-sectional study included 40 individuals with gender dysphoria who underwent GAS 12 months before the study. Quality of life was quantitatively assessed using the WHOQOL-BREF scale. Depression severity was determined using the Patient Health Questionnaire (PHQ-9), and qualitative assessment was conducted through interviews.

Results: On average, individuals realised their gender identity at 11.8 years old. They lived in their perceived gender roles for about 19.7 years. About 25% had moderately severe and 5% had severe depression (PHQ-9 scores). According to the WHO Quality of Life scale, mean scores for Physical health, Psychological, Social relationships, and Environment were 66.9, 62.6, 78.8, and 62.6, respectively. Qualitative interviews revealed that peer support and self-satisfaction improved quality of life, while lack of family support and employment worsened it.

Conclusion: Among individuals with gender dysphoria who underwent GAS, there was a slightly higher quality of life score in terms of psychological health and social relationships, but not physical health. Qualitative interviews can contribute to improving the well-being of people with gender dysphoria.

“Psychiatric morbidity in children of persons with Alcohol Dependence Syndrome - A cross sectional study”

Dr. Madasu Prithvi Raj¹, Dr. Umme Ammaara², Dr. S. Sireesha³ Junior resident¹, Junior resident², Professor³

Department of Psychiatry (Institute of Mental Health), Osmania Medical College

Background:

Children between 7 and 15 years of age have to be nurtured and taken care but those having parents with alcohol dependence suffer from physical, emotional, verbal abuse, take responsibilities of family leading to stress, behaviour problems, poor scholastic performance, poor coping skills affecting their interaction with others and are at increased risk of depression, anxiety and other issues which disturbs psychosocial development of children.

Aims and Objectives:

To study and compare psychiatric morbidity among children of persons with and without alcohol dependence syndrome

Materials and Methods:

In a tertiary care center in Hyderabad, 100 children aged 8-17 years, with parental consent, were evaluated for psychiatric disorders using the Childhood Psychopathology Measurement Schedule (CPMS). The CPMS scores of these children were then compared, distinguishing between those with parents with alcohol-dependence and those without. All statistical data was meticulously analyzed using SPSS version 26.0.

Results:

Children of parents with alcohol dependence were found to have increased rates of depression, anxiety, adhd, conduct disorder and other disorders when compared to children of parents without alcohol dependence.

Conclusion:

The study underscores the critical need for comprehensive support systems for these children which includes psychological support, community and school-based programs, raising awareness about the profound impact of parental alcoholism on children’s mental health and lastly training of healthcare professionals and making policies aimed at curbing alcohol abuse so that it helps in child’s growth and development.

Association of serum uric acid levels with suicidality in psychiatric patients: A pilot study

Background: Purinergic transmission have been shown to be linked to the regulation of many aspects of behavior and mood. Uric acid is an end-product of the purine pathway. Studies on association of Uric acid levels and suicidality has been limited to a few psychiatric disorders alone. However, there have been no studies to assess the association of suicidality as a separate component with serum Uric acid in different psychiatric disorders.

Aims: This pilot study aims to compare the level of serum uric acid between psychiatric patients with, and without suicidal ideation.

Methods: After extensive search of available literature, it has been found that there is no prior studies to assess the association of suicidality as a separate component with serum Uric acid levels in different psychiatric disorders. Hence, a pilot study was conducted with 10 patients without suicidal ideation and 10 patients with suicidal ideation for the calculation of the sample size and to identify any preliminary association between the above. Patients were prospectively recruited from the in-patient unit of the Department of Psychiatry at a tertiary care hospital in Kerala.

Results: Students t-test was used to test the statistical significance of the difference in the mean level of serum uric acid between patients with and without suicidal ideation.

Conclusion: No statistically significant association have been found between the levels of serum uric acid in psychiatric patients with and without suicidal ideation.

Positive Psychology – to alleviate features of Depression as an adjunct to standard interventions

Background: An estimated 3.8% of the global population experience depression. National Mental Health Survey 2015-16 revealed that one in 20 Indians suffers from depression. 54% of adults show improvement after antidepressant medication. 66% of adults show improvement after CBT. Research has shown Positive Psychology Interventions (PPI) is equally or more effective than CBT in alleviating features of depression, however not a mainstream therapy in this regard.

Aims: To determine the effectiveness of PPI as an adjunct to standard interventions in alleviating features of depression in patients admitted or attending OPDs with Depressive Episode in a tertiary care hospital.

Methods: Quasi Experimental study in Psychiatry OPD and Ward, with 25 patients diagnosed with F32 in control and 25 in experimental group. Pre-intervention BDI assessed and co-related with selected demographic variables like age, gender, living with spouse and comorbidity, followed by 3 sessions of PPI over 9 days, BDI re-assessed after 1 week of last session.

Results – The mean pre-intervention BDI score among females is significantly higher than the males, t value=3.29073, p value=0.000939 at p<0.05. The mean pre-intervention BDI score is significantly higher than the mean post-intervention BDI score, t=2.91115, p=0.002723 at p<0.05.

Conclusion – The level of depression is supposedly higher among the women hence more attention to be given. The module of PPI has proved its mettle as an adjunct standard intervention which may bridge the treatment gap and bring about better outcomes in patients with depression.

Predicting Delirium Tremens (DT) in patients admitted for acute alcohol withdrawal.

BACKGROUND

Delirium Tremens (DT), is the most severe complication associated with alcohol dependence. Although rare, it’s linked with significant mortality in patients of acute alcohol withdrawal. It is thus important to identify patients with a higher risk of DT so it can be prevented.

AIMS

• a)To assess risk factors for increasing risk of DT in admitted patients for acute alcohol withdrawal.
• b)To predict DT in patients with acute alcohol withdrawal.

METHODS

Eligible patients seeking indoor treatment for alcohol withdrawal at NCH Surat were included during the course of the study. Risk factors for severe withdrawal were assessed at the time of admission which were correlated to the occurrence of DT during treatment. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) was used to observe withdrawal severity and Confusion Assessment Method (CAM) was used to make a diagnosis of DT. The risk factors were assessed using appropriate statistical analyses.

RESULT

72 participants were included in this study. 12 risk factors were found to have a significant correlation to the presence of DT. Out of these, 4 (time since last intake, past history of seizures, palpitations and raised ALT) had a low strength, 4 (seizure in past 48h, >24h since last drink, sweating and agitation) had a moderate strength, and 4 (withdrawal severity, poor GC, tachycardia and CIWA-Ar score >16) had a high strength of association with DT (Based on Cramer’s V).

CONCLUSION

There was a significant burden of DT in patients with alcohol withdrawal, with 34.7% of the participants developing DT. The average duration of DT after development was 31.92 hours, showing how difficult it is to treat acutely. Tobacco (90.3%) and cannabis (8.3%) with the most common comorbid substances.

KEY WORDS: Alcohol Withdrawal, Delirium Tremens, Dependence.

Developing a common framework to describe the actions of all types of psychotherapies.

Background

Psychotherapy is not one type of therapy.

There are about 400 to 600 ‘brands’ of psychotherapy – each with different theories of aetiopathology, goals of treatment, techniques, and proposed mechanisms of actions.

Each school of psychotherapy uses different terminology / vocabulary to describe all these.

Even if the same patient goes to therapists of different schools, the description of all these aspects will be different.

Aims

To develop a common framework and terminology to describe the aetiopathology, goals of treatment, techniques, and mechanisms of action – that can be used by therapists of all schools.

Jeffery Smith, Leader of the Psychotherapy Caucus of American Psychiatric Association, 2021, described how different therapies have different explanations that make sense to only disciples of that school. He emphasized need for a common infrastructure to bring all therapies under one Big Tent.

Method

In all medical specialities, even if the clinician chooses different modalities of treatment (such as medicines, surgery, or physiotherapy), the framework for describing the aetiopathology and actions of treatments remains the same.

A similar common framework for describing all aspects of psychopathology and therapies has been developed and will be presented.

Results

Each patient has specific psychopathological dysfunctions.

Different schools of psychotherapy use equivalent or synonymous terms to describe them. These are described with examples.

Conclusions

A novel framework called the ‘4-Levels, 5-Parts Framework’, can be used by therapists of all schools of psychotherapy to describe their actions.

A study on the association of sleep patterns with aggression among forensic psychiatric patients in a tertiary care hospital in Hyderabad

Introduction- Human aggression has been defined as any behaviour directed toward another individual that is carried out with the immediate intent to cause harm. Aggression, currently, is either adaptive or derived from adaptive techniques. Explanation for aggression is found in the General Aggression Model (GAM). This model focuses on various inputs, routes and outcomes of aggression. Among the inputs are various personal and situational factors. The personal factors include traits of the person, gender, beliefs, attitudes, values and long-term goals. The situational factors could be aggressive cues, provocation, frustration, pain and discomfort, drugs, incentives etc.

Lack of sleep can play a vital role in worsening these situational factors. Sleep plays a vital role in the regulation of emotions. Physiologically, emotional regulation involves a complex interplay of the prefrontal cortex and subcortical and posterior cortical regions. These regions are sensitive to sleep disturbances.

NEED FOR THE STUDY

Previous studies have primarily compared sleep and aggression in forensic psychiatric patients without considering the effects of psychopathology. There is a need for studies, especially in the Indian context, that explores this association.

Possible clinical implication: adequately addressing sleep in this population could reduce aggression.

AIM

To study the association of sleep quality with aggression in forensic psychiatry patients.

OBJECTIVES

1. To study the association of sleep quality and aggression in forensic ward inmates.

2. To evaluate the impact of improvement of sleep quality over aggression.

OPERATIONAL PROCEDURE

The study was initiated after due ethical approval was taken from the Institutional Ethics Committee of Osmania Medical College. It was conducted on the inpatients of the Forensic Psychiatric Ward of the Institute of Mental Health, Hyderabad. Patients fulfilling the inclusion criteria were selected by convenience sampling. The procedure, need to follow up were explained to them using the participant information sheet, and their written consent was taken.

Institutional ethics committee approval was taken (ECR/300/Inst/AP/2013/RR-16)

Those fulfilling the inclusion criteria were interviewed (120 patients). Written informed consent was taken. The socio-demographic and crime-related data were acquired through a semi structured intake pro-forma. BPRS, MOAS & PSQI were applied. Sleep hygiene was explained. A sleep diary was maintained, and those having sleep disturbances were addressed. After one week, BPRS, MOAS and PSQI have applied again (110 patients, ten got discharged, so they were not included in the study). 2^nd and 3^rd -week follow-up was done, and BPRS, MOAS and PSQI were applied. (32 participants couldn’t be followed up)

Results

There were poorer sleep scores at baselines and a gradual increase was seen over the four weeks in most sleep parameters. This could be due to medications given in the hospital and a reduction in psychopathology.

• Similarly, there was a reduction in the aggression components and severity of mental illness scores over the four weeks.

• When sleep was improved in forensic psychiatric patients, there was a corresponding significant reduction in aggression scores over some time.

• This correlation was significant, independent of psychopathology.

Procrastination as a marker of anxiety among graduate students

Background:

Procrastination or Task avoidance is a behavioural phenomenon and defined as a needless delay in beginning or completing tasks, in which prevents individual from reaching their goals.

AIMS:

1. To estimate the prevalence of procrastination among graduates.

2. To assess the frequency and reasons of procrastination among graduates.

3. To correlate the relationship between procrastination and anxiety among graduates.

METHODS:

A descriptive study with sample size 286 was conducted over 6 months in Sri Venkateshwara Medical College Hospital and research centre among graduate students from any discipline, who were recruited by convenient sampling method using the following instruments

• Procrastination Assessment Scale for Students

• Hamilton Anxiety Rating Scale

RESULTS & CONCLUSION:

Among 353 participants 347 completed the study and 26 did not give consent. The median total score of procrastination is 32 (31 ± 4.89) and high procrastinators were who scoring more than 32 which (n= 187) constitutes 54%. Among the participants most scored high on “keeping up with the weekly reading assignment” (6.25 ± 2.07). Least score “academic administrative tasks like filling out forms” (4.42 ± 2.04).

Among the reasons for procrastination, “worried you would get a bad grade” (n=118) was scored high.

Correlation between total procrastination score and anxiety showed weak to no correlation (spearman correlation coefficient of 0.26, with 95% C.I 0.16 – 0.36) significant with p-value of <0.00. But in-spite of the weak correlation, this study gives us some insight into the most procrastinated act and the reason for procrastination.

ANCIPS 2024: Attitudes towards Homosexuality among medical and paramedical staff in a tertiary care hospital in India. A cross sectional survey

Background

People with same sex orientation face discrimination and harassment due to negative attitudes. Amidst huge challenges in daily routine, they may suffer more disappointments if they face stigma in health-care facilities. It is essential to sensitize healthcare workers including the paramedical staff to promote a favourable approach while dealing with homosexual population.

Aim

To understand the attitude towards homosexuality among healthcare workers

Methods

This is a cross sectional hospital-based study involving medical and paramedical staff working in AIIMS Gorakhpur. Approval was taken from Institutional ethics committee. A purposive sampling technique was used and all consenting participants were included. A semi structured proforma was used to collect sociodemographic details. Homosexuality Attitude Scale (HAS) was used to assess attitude towards homosexuality. Data was analysed using freely available statistical software.

Results

83 doctors, 211 nursing officers and 56 paramedical staff participated in the study. Although, overall score across the groups indicates a positive attitude towards homosexuality, negative attitudes were seen in certain domains. Doctors had the highest mean scores (79.23 ± 15.32), followed by nursing staff (79.12 ± 10.92) and paramedical staff (74.80 ± 18.44) but the difference in scores between the three groups were not statistically significant. It was seen than younger (18 to ≤ 40 years), female, and single healthcare workers had significantly higher mean scores on the HAS scale.

Conclusion

The study results have highlighted the current prevailing attitude towards homosexuality in our tertiary care hospital. Pattern of responses obtained from HAS scale can be used to plan awareness programs and promote a positive approach towards care of people with homosexuality.

A cross sectional study on attitude towards mental illness among resident doctors in a tertiary care hospital in a metropolitan city

Background: In India, mental health is a growing concern, with a large portion of the population suffering from some form of mental illness. Despite this there is still stigma about mental illnesses and patients. Resident doctors form a part of the front line of Indian health care system and it’s important for them to have a positive attitude towards psychiatric illnesses.

Aim: To study the attitude among resident doctors working in a tertiary care hospital in a metropolitan city towards mental illness.

Methodology: 400 resident doctors were included in the study. Data on age, gender, speciality and year of residency were collected. All the study subjects filled an online self-reported questionnaire to assess residents’ attitude towards mental illness using Mental Illness: Clinician’s Attitudes Scale (MICA) v4.

Results: The mean age of the participants was 28±2 years. Majority of them belonged to non surgical clinical fields (62%) and were in the second year of residency (56%). Mean score of MICA-v4 for residents was 48 for 1st year, 51 for 2nd year and 53 for 3rd year residents. Attitude leaned more towards positive as years of residency increased. Residents from non surgical clinical specialties had higher average score than surgical clinical specialties.

Conclusion: Majority of the resident doctors had an overall positive attitude towards mental illness and the attitude improved with more years of residency.

Keywords: Attitude, mental illness, stigma, residents.

A cross-sectional study of cognitive impairment in young-onset diabetes mellitus type 2 (young-onset DM-2)

Dr Kiran R (2^nd Year Post graduate), Dr Shankar K (Associate Professor), Dr Sharon Ruth (Clinical Psychologist) BMCRI, Bangalore.

Background:

Early-onset type 2 diabetes and it’s association with cognitive dysfunction is not well known. Cognitive dysfunction is increasingly recognized as a significant comorbidity of diabetes. The spectrum of cognitive deficits ranges from mild to severe, significantly impacting quality of life. However it is important to study as young onset DM is associated with relatively higher vascular burden.

AIMS:

• To assess the frequency of cognitive deficits in young onset DM-2.

• To look for association between diabetes mellitus related variable cognitive deficits and quality of life.

Methods:

50 Patients were enrolled for the study after obtaining informed consent. study was conducted encompassing patients aged 18 to 60 with (young-onset DM-2). Cognitive assessment tools, including Digit Symbol Substitution Test, Clock Drawing Test, Digit Span Test, and Trail Making Test, were employed. Quality of life was evaluated using the WHO-QOL-BREF tool screening.

Results:

Around 30% of the sample had significant deficits along these tests. Duration of DM and number of micro vascular complications predicted cognitive deficits in DSST; TMT; CDT. Cognitive deficits measured on DSST showed significant positive correlation with social domain , TMT with emotional domain .

Conclusion:

Significant burden of cognitive deficits in young onset DM which has association with Quality of life.

This needs further study and interventions have to be planned accordingly.

A Study On The Caregiver’s Burden Of Children With Autism Spectrum Disorder ( ASD )

Dr. Anannya Roy, JR, Psychiatry

Background : Autism spectrum Disorder is a developmental disability characterised by inadequate social interaction, reduced eye contact, inadequate appreciation of social emotional cues, restrictive and repetitive stereotyped patterns of behaviour. Caring for children with Autism Spectrum Disorder can be challenging for caregivers as they are burdened with lack of social support, financial constraints, changes in daily routine, dealing with unusual patterns of behaviour. All these factors can add to the stress of caregivers and they may suffer from psychological distress.

Aim: To assess psychosocial, emotional, financial burden of caregivers of patients with ASD

Objective :

• To identify factors responsible for caregiver’s burden

• To assess correlation between severity of the diagnosis of ASD with the caregiver’s burden

• To assess psychological burden

Methodology:

Study Design : Cross-sectional study

Caregivers of 100 children between 5 years and 14 years with ASD are chosen. Children with ASD having any other serious physical and mental illness are being excluded. Study population was 80 caregivers. The children are assessed by ISAA, Autism Treatment Evaluation Checklist for treatment outcome and clinical proforma . The caregivers are assessed by Caregiver Strain Index, Caregiver Burden Inventory and HADS Scale. The data will be analysed by appropriate statistical method

Results: Average age of children with ASD in the study was 7.5 yrs,70% children were male, caregivers interviewed were mostly female ( 70 %), 60% study population were residing in urban area. The average CBI score was 65 and it had a significant positive corelation with ISAA score. ( r = 0.2, p = 0.01). Average score for HADS – A= 12.2 and HADS-D = 12.8.

Determinants of stress and psychological well-being in medical undergraduate students: A cross sectional study.

Background:

• Medical education in India is very stressful. Psychological well-being of medical undergraduate students help them to deal with this stress.

Aims and objectives:

• To estimate prevalence of stressors and psychological well-being among medical undergraduate students.

• To determine the association between various socio-demographic characteristics and socio-economic status with stress and psychological well-being.

Material and methods:

• This is a cross sectional study conducted among medical undergraduate students of Government medical College. A Google form with participants information sheet, socio-demographic information, modified Kuppuswamy’s socio-economic status scale, Medical Students Stressor Questionnaire (MSSQ) with 40 items, and 18 item version of Ryff’s psychological well-being scale were send to all 500 students. Descriptive statistics was used to describe socio- demographic characteristics, stressors and psychological well- being. Bivariate correlation analysis were used to assess determine association between socio- demographic characteristics, stressors, stress and psychological well-being.

Results:

• The overall response rate was 60.6%(303 out of 500 students). Mean age was 20.74+-1.796. 50.2% Of students were males, and 47.9% were females. 83.5% were Hindu. 47.5% were from upper middle socio-economic status. Mild, moderate, severe and very severe stress was found in 32.0, 39.6, 23.4 and 5.0% respectively. High psychological well-being was found in 97.4% students. Significant correlation of stress in students was found with socio-economic status, residence, father and mother relationship, relation with parents, dealing with daily stress, exercise time, internet time, memory and attention problems and sleep difficulties. Psychological well-being is significantly associated with intra and inter personal stressors, group activities and social related stressors but not with academic and teaching learning related stressors.

Conclusions:

• Medical undergraduate students needs social, intra and inter personal relationships skills training. Workshops and group activities need to be conducted on the large scale at college and community levels. Special arrangements need to be done for students from rural areas, with disturbed family relations and lower socio-economic status.

Efficacy of ketamine therapy in patients with somatic symptom disorder: a case series

Dr Pranjalee Bhagat, Dr Swapnil Aloney, Dr Richa Saxena

Background: Somatic symptom disorder(SSD) is characterized by a dysfunctional preoccupation with one or more physical symptoms. Patients with SSD often pursue excessive and unnecessary investigations, hospitalisations and treatments that significantly affect quality of life and drain healthcare resources. Proven pharmacological treatments include selective serotonin reuptake inhibitors or tricyclic antidepressants. Ketamine is an N-methyl-d-Aspartate receptor antagonist and has been found to have therapeutic effects for a range of psychiatric conditions.

Aim:The effect of subanesthetic dose of intravenous ketamine was assessed on somatic symptoms.

Improvement was assessed after treatment with ketamine.

Methods: Three patients presenting with somatic symptoms and having no underlying organic cause and not showing improvement with antidepressants were admitted. Assessments were made at baseline and injection ketamine hydrochloride was given at a subanesthetic dose of 0.5 mg/kg as slow intravenous infusion at the rate of 100 ml/hour. Six doses were given over 2 weeks and assessments were done prior to each dose and 1 hour after each dose. Final assessments were made after 1 month of the last dose. Results: There was a significant improvement in the somatic symptoms after 2 weeks and 1 month of the last dose of ketamine.

Conclusion: Treatment with Ketamine infusion has a significant effect on somatic symptoms.

Keywords: somatic symptoms, ketamine

A comparative study of the resilience in patients with schizophrenia and bipolar disorder.

Dr. Wothungo L Jami¹, Dr P. Swathi²

1.Junior resident, Department of Psychiatry, Andhra Medical College, Visakhapatnam.

2.Assistant Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam.

Correspondence address:

Dr. Wothungo L Jami,

Junior Resident, Department of psychiatry,

Government Hospital for Mental Care,

Visakhapatnam: Andhra Pradesh

Contact: 9525756737

Email ID: wotzjami@gmail.com

Keywords: Resilience, Bipolar, Schizophrenia.

Background:

• Resilience is the ability to adapt effectively and quickly to stressful or traumatic events, without regressing to one’s initial state. It’s a dynamic process shaped by biological, social, and environmental influences.

• Resilience emerges as a crucial defense mechanism and protective factor when humans face challenging situations or stimuli that disrupt their psychobiological balance, allowing them to safeguard themselves and adapt effectively.

• Resilience is often conceptualized as existing along a continuum of vulnerability. Individuals with low vulnerability have a high resistance to psychopathology, although they are not entirely invulnerable to the development of a psychiatric disorder.

AIM: To compare the resilience between patients diagnosed with schizophrenia and bipolar affective disorder.

Methodology:

This is a cross-sectional study and convenient sampling was used. The study was conducted in Government hospital for mental care, Visakhapatnam. A Sample of 60 participants of which 30 participants were patients with bipolar affective disorder and 30 participants with Schizophrenia were evaluated using a semi-structured proforma for sociodemographic data and Resilience scale by Dr Vijaya Lakshmi and Dr.Shruthi Narain was used to assess Resilience. Results were analysed statistically.

RESULTS:

• Out of 60 patients males : 73.3%(n=46) and females : 26.7% (n=14) with mean age 32.63.

• In total sample illiterates 15% (n=9), primary education 25% (n=15) secondary 43.3% (n=26) and intermediate 5%(n=3) and graduate were 11.7% (n=7).

• In total sample employed are 36.7% (n=22) and unemployed were 63.3%(n=38).

• Resilience scores of bipolar disorder and schizophrenia were 98.60 ± 6.821 and 75.13 ± 7.925.

• There is significant difference between resilience scores in bipolar patients and schizophrenia. P value is 0.000001 i.e <0.05 so p value is significant.

CONCLUSION:

• Resilience is an important factor to assess the patient’s wellbeing. The aim of the treatment plan should be to develop resilience in patients and the need to plan for additional health care support during crisis period when the resilience is low.

• The more we learn about resilience, the more potential there is for integrating salient concepts of resilience into relevant fields of medicine, mental health and science.

A study on Internet addiction and poor sleep quality among resident doctors from a tertiary care hospital in Kashmir. Background

The Internet has become increasingly ingrained in people’s daily lives due to its tremendous benefits. However, overindulgence of it can be problematic, leading to negative effects on people’s academic and professional outcomes as well as mental health.

Aims

The aim of the study is to assess the prevalence of Internet addiction, pattern of Internet use and its relation with quality of sleep in resident doctors working in a government institute.

Materials and methods

A cross-sectional study was carried out among medical professionals in a tertiary care hospital. The tools included sociodemographic questionnaire, Young’s Internet addiction test, Pittsburgh sleep quality index and self designed questionnaire related to Internet use.

Results

A total of 160 doctors constituted the study population. The mean age of participants was 27.9 years. Duration of internet use exceeded more than 4 hours daily in about 59.4% of the participants. On analysis through Internet Addiction Test, 44.4 % of participants had no addiction, 46.2% had mild addiction, 9.4% had moderate addiction. About 69.6% of subjects who suffer from internet addiction had poor quality of sleep and 58.4 % denied doing recommended physical activity due to internet use.

Conclusion

The current study documents a high prevalence of internet addiction among resident doctors. In the emerging era of internet, raising awareness about internet addiction may be a fruitful strategy to decrease its prevalence and negative effects.

PSYCHIATRIC MANIFESTATIONS IN DENGUE – A CASE SERIES

Mishra Soumya Ranjan, Choudhury Suprakash

Dengue fever is an aedes mosquito-borne infection that causes a severe flu-like illness with high grade fever, severe joint and muscle pain and decreased platelet with rashes & bleeding tendency. Neurological sequelae to dengue infection are not uncommon, and psychiatric manifestations are increasingly reported in the past 5-7 years. In this case series we report four cases with no prior psychiatric illness or family history of psychiatric illness who developed acute psychiatric symptoms during and immediately after an acute dengue infection. Two of the four cases had acute mania during the course of illness, one patient had acute mania 4 days after the infection and one patient had mixed anxiety depression 1 week after the infection subsided. The cases of acute mania were treated with low dose antipsychotics and the case of mixed anxiety depression was treated with low dose of SSRI.

Key words- Dengue, Psychiatric complications, Organic mania, Organic depression

BACKGROUND

Addiction is defined as a problematic behavior characterized by recurrent failure to control the behavior and continuation of the behavior despite significant negative consequences. Children’s smartphone addiction has significantly increased over time. Parents and parenting styles have been reported as a major risk factor for smartphone addiction among children. Researchers have assumed parents to have a critical influence on children’s behavioral, emotional, personality and cognitive development .

AIM-

The prevalence of smartphone addiction in children and its association with parenting style.

METHODS-

Children aged 10-14 years coming to paediatric OPD of Gandhi Medical College will be randomly selected and approached to participate in the study. Informed consent will be obtained. The children who provide consent will be given Smartphone Addiction Scale-Short Version (SAS-SV) and Parenting Styles Questionnaire in the presence of a research assistant.

RESULT-

The results showed that out of 200 respondents ,108 respondents (54.3%) experienced moderate smart phone addiction, 48 respondents (24.3%) experienced severe smart phone addiction, and 44 respondents (21.4%) experienced mild addiction. Out of 200 respondents ,100(50%) had parents with permissive parenting, 53 (26.5%) respondents had parents with authoritarian parenting style and 47 (23.5%) respondents had parents with an authoritative parenting style.

Conclusion

Based on the results of research, it can be concluded that there was a significant correlation between the parenting styles(Permissive) and smart phone addiction. To overcome the bad effects of playing smart phone, parents need to control the use of smart phones by their children.

Comparative Study of Suicidal Ideations and Attempts in Schizophrenia and Bipolar Affective Disorders

BACKGROUND

Psychiatric disorders contribute substantially to the global disease burden, often underestimated due to diagnostic challenges. Suicide, a grave consequence of mental illness, claims a staggering number of lives worldwide. Understanding suicidal tendencies in specific disorders is essential for effective prevention.

AIM:

To compare the characteristics of suicide ideations and suicide attempts between patients with schizophrenia and bipolar affective disorders and to find the association between suicidal ideation and depression

METHODS:

This study was done on 60 individuals aged 18-60 diagnosed with schizophrenia (GROUP SCZ) and bipolar affective disorder (GROUP BP) respectively. Utilizing comprehensive assessment tools such as PSLES, MSSI, BSI, BPRS, CDSS, HAM-D, and CARS-M, the research explores distinct patterns of suicidal behaviour in these groups. Statistical analysis was done using the SPSS Trial version 24.

RESULTS:

The present study reveals increased PSLES total mean score in the schizophrenia group( p value < 0.017). , higher suicidal ideations were seen earlier in the path of illness( which mainly include younger age group)in bipolar disorder ( p value < 0.014)and it was significantly associated with depression and previous suicide attempt.

CONCLUSION:

This comparative analysis underscores the nuanced nature of suicidal tendencies in schizophrenia and bipolar affective disorders within the Indian context. Presence of stressors and depression have an increased risk of suicidal ideation especially in younger age bipolar affective disorder patients. Tailored interventions targeting specific risk factors are essential for effective suicide prevention.

A Study Of Birthing Experiences In Primipara Women Who Had Induction Of Labour

Background

Birth is a multi-layered experience having long term implications on the woman’s physical and mental well-being. This experience varies with the type of delivery and plays a major role in child-care and bonding.

The number of women who deliver by induction of labor (IOL) ranges from 5% to 22%. Few studies have looked at the experience of these women, more so in the Indian context. Being aware of these will help plan interventions that aim to make this experience a positive one, thereby facilitating healthy child care and mother-child bonding.

Aims

To elicit the knowledge and psychological experiences of the process of IOL in primiparous women.

Methods

A qualitative study was conducted at the Obstetrics Department of a tertiary care centre, Bangalore. Thirty primipara women were interviewed after delivery by IOL, focusing on their knowledge and birthing experiences. Responses were recorded and transcribed, and predominant themes arrived at after qualitative analysis (Atlas.ti)

Results

Mean age of the mothers was 25 years. They were mostly educated and urban home-makers.

Majority were unaware of the induction process and about the severity of pain that it involved.

The analysis revealed themes which were divided into positive, negative and miscellaneous experiences of childbirth.

Conclusion

Pregnant women appear to have little knowledge about the modes of delivery and possible birthing experiences. Planned intervention in enhancing knowledge would help women have a better birthing experience.

I.A. (Internal Assessment) of A.I.: How accurate is A.I. in Psychiatry?

Background: “Artificial Intelligence (A.I.)” can be defined as the ability of machines to perform cognitive tasks in a manner analogous to humans. Over the last decade or two, there has been rapid progress in A.I. resulting in its influence spreading to almost all spheres of our lives. Healthcare and the disciplines constituting it are no exception.

Elements of psychiatry in specific rely heavily on human-human interaction. Diagnosis in Psychiatry is not based on grading of symptoms, biological cut-off values and visualization through naked eyes or through imaging, as in many other branches of medicine. Hence, there has always been a big question-mark on the ability of A.I. to diagnose psychiatric disorders accurately.

Through this study, we have tried to assess the accuracy of A.I. in psychiatric diagnosis.

Aim: To assess the ability of A.I. in diagnosing psychiatric disorders accurately.

Methodology: The study was designed as a cross-sectional study conducted at Psychiatric O.P.D. of Varun Arjun Medical College and Rohilkhand Hospital. Simple random sampling was employed for selecting study participants. Sample size was 100. Open AI’s Generative Pretrained Transformer-4 (GPT-4) was used as the representative AI system due to its user-friendliness. The diagnosis provided by the AI was compared against the diagnosis of trained psychiatric professionals to assess the accuracy.

Results: At the time of this submission, preliminary results point towards AI system falling short in diagnostic accuracy when compared to judgement of trained psychiatric professionals. Detailed results are being computed.

Conclusion: Based on the preliminary results it so appears that AI systems lack the level of diagnostic accuracy for psychiatric disorders which would be expected of them. However, more research is necessary to arrive at a more definitive conclusion.

Knowledge Attitude and Practices of Medical Residents Towards Patients with Substance Use Disorder in Jammu and Kashmir

Background: The epidemic of substance use disorders has assumed alarming dimensions in Jammu and Kashmir. In their day-to-day practice medical residents see an increasing number of patients with substance use disorder.

Objectives: This study was conducted to assess the knowledge, attitude and practices in medical residents working in various tertiary care hospitals of Jammu and Kashmir towards patients with substance use disorder.

Methods. This cross-sectional study was conducted through an online survey in the month of January 2021. The questionnaire had four segments to collect data regarding socio-demographic details, knowledge regarding substance use disorder, attitude and practice-based questions. The questionnaire was shared via social media to reach the target population.

Results: Among the participants who responded 106 (65.4%) were in the age group of 20-30 years, the qualification of 83(51.2%) was MD, 140(86.4%) belonged to clinical branches. Majority i.e. 150(92.6%), agreed that addiction is a mental illness also known as substance use disorder. 162(100%) participants agreed that substance use can lead to serious medical and mental health problems.112(69.2%) participants agreed that patients with substance use can recover completely.

130(83.3%) agreed that the trend has changed from the use of medicinal opioids to I/V heroin use. 82(50.6%) participants were aware of the opioid substitution therapy (OST) given in opioid use disorder. Majority i.e., 85(52.5%) disagreed that substance use is a moral problem than an illness. 72(46.2%) did not knew if OST intercepts the chances of complete abstinence. Majority i.e. 84(51.5%) agreed that they try to avoid patients with SUD and transfer their care to someone else. Majority i.e. 117(75%) agreed that they have to make a psychiatry call for managing patients with substance use disorder.145(89.5%) agreed that they need further training in the management of substance use disorder for their daily practice. Conclusions: Our study showed that the resident doctors had a good knowledge, positive attitude and sensible practices towards patients with substance use disorder except opioid substitution treatment. Limited knowledge regarding OST limits its proper use in candidate patients. However more training and educational programs are crucial for improving the current practices and promoting a patient friendly health care system.

Conflict of interest: none

Keywords: medical residents, Knowledge, Attitude, Practices, substance use

1. Dr Athiya Fahiem Khan, Senior Resident, Department of Psychiatry, GMC Srinagar.

Introduction: Opioids represent a significant threat to human health due to their harmful effects. In India, heroin is the most frequently abused opioid, and it is consumed through various methods, including intravenous injection and the “chasing the dragon” technique. Chasing is a widely practiced method, both globally and in India. Nevertheless, research comparing the clinical characteristics and outcomes of these two user groups is limited.

Materials and Methods: We conducted a retrospective chart review of patients diagnosed with primary opioid dependence. We compared fifty consecutive heroin chasers attending our institute’s de-addiction clinic with fifty injection heroin users (IHUs) in terms of socio-demographic factors, clinical characteristics, and treatment outcomes.

Results: Most individuals seeking treatment for heroin dependence fell into the 20-34 age groups (74% for IHUs and 76% for chasers, with a non-significant p-value of 0.78). The mean scores for the severity of opioid dependence were higher in injection users (42.45 ± 9.23) compared to chasers (37.56 ± 8.28), and this difference was statistically significant (P < 0.01). There was no significant difference between the two groups in terms of overall quality of life (17.32 ± 3.33 for IHUs vs. 19 ± 4.32 for chasers, with a p-value of 0.44). IHUs were 1.79 times more likely to receive Buprenorphine for withdrawal management than chasers (Confidence Interval: 1.1-4.1), and this difference was statistically significant (P < 0.01). IHUs had a lower drop-out rate during the first follow-up compared to chasers (6% vs. 34%, Odds Ratio: 0.12, Confidence Interval: 0.03-0.45, P < 0.01).

Conclusion: Our findings suggest that there were no significant differences in most socio-demographic variables between IHUs and heroin chasers. IHUs exhibited a higher severity of opioid dependence and were more likely to receive Buprenorphine as a withdrawal management option. They also had higher retention rates compared to chasers. However, there was no distinction in the overall quality of life scores between the two groups.

Buprenorphine: Enemy or Saviour

Background: Buprenorphine-naloxone is being considered as a preferred treatment for opioid dependence in Punjab for a long time now. It has become the main focus of treatment after a rise was seen in overdoses and medical emergencies related to opioids. However, the research examining experiences with long term buprenorphine plus naloxone among polysubstance has been limited.

Aim: The purpose of the study was to analyze the health-related quality of life and record experiences of buprenorphine plus naloxone use among polysubstance users entering OOAT Program in Punjab.

Methods: This study which was a cross sectional, observational study analyzed data by dividing opioid dependence patients who were using buprenorphine regularly as a part of the OOAT plan and others who were on symptomatic treatment or had come to enroll for OOAT.

Results: Out of the 200 patients, 98 percent were males. 92 percent of users said buprenorphine plus, naloxone helped them with their substance use while 18% of buprenorphine plus naloxone users reported that it either had no effect or a negative effect on their drug problems. Over 94% reported relief from withdrawal. However, over 25% reported that they use buprenorphine plus naloxone until their preferred drug could be obtained and used for its euphoriant effect. Also, it was seen that the group using buprenorphine had significant improvement in quality of life.

Clinical Profile of patients attending a psychosexual clinic – a cross sectional study at a tertiary health care center.

INTRODUCTION: In India, despite the significant influence of sexual dysfunction on health and well-being, it remains under-researched. This study delves into the clinical profiles of patients from a psychosexual clinic in a tertiary psychiatric department to bridge this research gap.

AIM: To assess the prevalence and severity of sexual disorders and sexual functioning in patients presenting to psychosexual clinic.

MATERIALS & METHODS: Patients at a psychosexual OPD underwent cross-sectional assessment using structured tools like BPRS (Brief Psychiatric Rating Scale), IIEF-15(International Index of Erectile Function-15) HISD-32 (Hulbert Index of Sexual Desire), PEDT (Premature Ejaculation Diagnostic Tool), NSSS (New Sexual Satisfaction Scale), the Male Body Image Self-Consciousness Scale, PCI (Porn Consumption Inventory), and SKAQ-II (Sexual Knowledge and Attitudes Questionnaire).

RESULTS: Key findings include a notable percentage of tobacco use (22.95% smoking; 14.21% chewing) and alcohol (3.83%). Some had co-existing DM (3.28%) and HTN (2.19%), while a smaller group had both (1.09%). Participants, on average, were aged 34.90 years, with an income of Rs.3,966.62, seeking help after 7.08 months of illness. Average scores were ED: 12.8, PEDT: 7.9, PCI: 31.28. ED severity varied, with 15.3% severe and 4.37% mild. PE prevalence stood at 23.49% with probable PE at 13.11%.

CONCLUSION: The study underscores the prevalence of tobacco and alcohol use, highlights common health issues, and reaffirms the need for early interventions addressing erectile dysfunction and premature ejaculation in this cohort.

“Integration of Perinatal Mental Health (PMH) into Routine Reproductive and Child Health (RCH) Program in Telangana by Systems Strengthening

*Raveena Akkineni, Nithin Kondapuram, Sai Naveen Singagari, Sundarnag Ganjekar, Veena Satyanarayana, Prabha S Chandra,Dr Khyati Tiwari, Dr Padmaja,Ms Resha Desai, Ms Sowjanya Medisetti

*presenting author

Background

In India, one in five women may experience stress, anxiety, and depression during pregnancy and postpartum. Lack of knowledge regarding the importance of mental well-being during pregnancy and postpartum among health professionals is a major barrier to early identification and interventions. There are other systemic challenges, such as heavy caseloads and multi-tasking by medical officers. To overcome this, a program that integrated mental health with maternal nutrition was co-designed by NIMHANS, the Government of Telangana, and UNICEF. The current study describes changes in knowledge and confidence levels about PMH among medical officers.

Methods

A standard training module on perinatal mental health was delivered through a Training of trainers(TOT) model and training was given to medical officers in Telangana. The module included 1. Importance of Mental well-being during Pregnancy and Postpartum, 2. Assessment for Anxiety and Depression, 3. Psychological Interventions, and 4. Safe use of Psychopharmacology. The one-day training on perinatal mental health was part of an integrated nutrition and mental health program. Adult learning methodologies such as brief didactics, video-based learning, case-based group exercises, and peer learning methods were incorporated into the training. Two case-based learnings on stress, anxiety, and depression during pregnancy and postpartum were used for pre and post-assessments. Mean scores on this questionnaire consisting of eleven multiple-choice questions were compared between pre-training and post-training.

Results

The training was conducted in 21 of 33 districts of Telangana, and 487 medical officers underwent training on perinatal mental health from July to October 2023. There were 21 batches of 126 hours of training conducted. There was a significant improvement in the scores after training in areas of case identification classification, and management of common mental health conditions during pregnancy and postpartum, indicating a substantial increase in the understanding of common mental disorders (CMDs) among primary healthcare (PHC) medical officers after the perinatal mental health training.

Deleted[Khyati Tiwari]: ,

Conclusion

Our one day training program in PMH was able to enhance the ability of medical officers in case identification as well as first level psychological and pharmacological management of perinatal mental health. Given the shortage of mental health professionals in the country, training in the identification and first level care of CMDs by medical officers is the way forward for supporting mothers and infants. The next essential step is to strengthen the referral pathways and secondary levels of mental health care within the District Mental Health Program by system strengthening to ensure high quality perinatal mental health care.

6-Months Outcome Of Negative Symptoms Of Schizophrenia Among Patients On Cariprazine: Early Experience From a Tertiary Care Hospital.

Dr. Devarapalli Priyanka1, Dr. Shivashanker Reddy Mukku 2, Dr. Sharath Srikanta2 ,Dr E.K. Sumanth2 Dr.Shaik Abuzar Rahiman3, Dr.J.Mayurnath Reddy4.

Postgraduate1, Assistant Professor2,Senior Resident3, Head of department4.

Department of Psychiatry, Viswabharathi Medical College and General Hospital, Dr Y.S.R University of Health Sciences, Vijayawada, Andhra Pradesh

Introduction- Negative symptoms of schizophrenia (SCZ) are disabling, persistent symptoms contributing to poor outcomes. Among the pharmacological options with little evidence, cariprazine have been recently approved for negative symptoms, however this aspect is not studied well among patients with SCZ in Indian settings

Objective -To study the effect of cariprazine on negative symptoms predominant SCZ patients and metabolic profile over 6 months period.

Material and Methods- The study is conducted at a tertiary care hospital, the sample includes patients with predominant negative symptoms of SCZ on cariprazine for 6 months or more. The patients were assessed using Positive and negative syndrome scale (PANSS)and Scale for assessment of negative symptoms (SANS) at baseline, 3-month and 6-month intervals.

Results: This study included 4 patients with a mean age of 32.2 (range: 21-41) years and both genders 3:1.The mean duration of illness was 5.25 years (range: 2-14) and mean baseline scores for negative symptoms on PANSS were 28 and mean BMI is 24.15 kg/m2.At 6 months mean negative symptoms sub-score on PANSS was 21.6 and BMI was 23.1kg/m2.

Discussion: Our study results were similar to previous case studies by Ivanova et a., 2007 and Vasiliu., 2021 which showed significant reduction of negative symptoms and PANSS mean score decreased by 23.8% and 22% respectively. In this case series Cariprazine was effective for negative symptoms.

Conclusion: Cariprazine was an effective and safer option for negative symptoms. However, need studies with larger sample and longer follow-up among Indian patients.

ASSESSMENT OF NEUTROPHIL- LYMPHOCYTE RATIO IN PSYCHIATRIC DISORDERS- A RETROSPECTIVE STUDY USING MEDICAL RECORDS

Presenting Author - Dr Sukriti Singh , Second Author- Dr Manju Bhaskar , Third Author - Dr Geetika Chopra

Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

Prsenting author Email- sukritisingh487@gmail.com

ASSESSMENT OF NEUTROPHIL- LYMPHOCYTE RATIO IN PSYCHIATRIC DISORDERS- A RETROSPECTIVE STUDY USING MEDICAL RECORDS

Introduction: Increasing evidence suggests that immunological and inflammatory dysfunctions may play an essential role on predisposition, onset, and progression of major psychiatric disorders . The neutrophil to-lymphocyte ratio (NLR), has more recently been employed to assess systemic inflammation in psychiatric patients. NLR can be calculated from a full blood count and is thus cheaper and more readily available than cytokine testing.

Aims and objectives:

AIM

To assess Neutrophil- Lymphocyte ratio in psychiatric disorders.

OBJECTIVES

To assess Neutrophil- Lymphocyte ratio in psychiatric disorders and compare with healthy controls.

Methodology:

Complete blood counts (CBCs) was obtained for each patient by retrospective screening of the hospital’s medical database. NLR was calculated for each patient, using absolute counts.

A control group was established from healthy donors age-matched with the case group who presented to the blood bank in the same hospital.

Results: We found higher neutrophil to lymphocyte ratio in bipolar, major depressive disorder and schizophrenia when compared with healthy controls.

Conclusions: In conclusion it seems that inflammatory ratio like NLR are inexpensive, suitable for routine , and reproducible markers of the systemic inflammatory response that can be useful to detect inflammatory activation in psychiatric disorders even if some area remains unclear and needs future investigation especially to better investigate association of inflammatory ratios with the severity of disorders and psychopharmalogical treatment.

Keyword: NLR , Bipolar disorder, Schizophrenia

Factors associated with Intentional self-harm among patients admitted in a tertiary care hospital in Dakshina Kannada

BACKGROUND:

Self-harm has proven to be a burden on the healthcare system as well as the social service resources of a country. It can be a consequence of multiple factors, ranging from socioeconomic status to psychiatric illness. This study was performed to identify the contribution of various factors associated with intentional self-harm in Dakshina Kannada, acknowledging the shortage of such studies in India.

AIM:

To study the sociodemographic and clinical profile of subjects with intentional self-harm referred to the Department of Psychiatry for evaluation in a tertiary care hospital.

METHODS:

Study design: Cross-sectional study

Study setting: tertiary care hospital in Dakshina Kannada

Sample collection - convenience sampling of the age of more than 18 years, both males and females, with intentional self-harm with an intent to die within the last 1 month

Sample size: 64

Data collection was done using questionnaires:

• Socio-demographic and Clinical profile of the patient o Alcohol Use Disorders Identification test scale

• Beck Suicide Intent Scale

RESULT:

Out of the 64 participants, 40 are males & 24 females. 49 reported impulsive attempts,15 planned and 30 had alcohol consumption within 12 hours of the attempt. 8 reported a history of self-harm and 9 psychiatric illness. 36 scored high on suicidal ideation on Beck’s scale. 46 had low-risk alcohol consumption whereas 9 met dependence pattern.

CONCLUSION:

Our findings suggest the need for community-based awareness about suicide, and alcohol use.

Clozapine associated weight loss: a case series

Janani Rajasekaran*, Abhiram N Purohith, Rajeshkrishna Bhandary P, PSVN Sharma

Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India – 576104

*Presenting author

Introduction: Clozapine is considered as the most effective pharmacological option for patients with treatment resistant schizophrenia. Its use is often limited by its propensity to cause metabolic adverse effects including dysregulation of body weight, glucose and lipid metabolism and fat distribution. Contrary to this, clozapine has rarely been associated with significant weight loss.

Aim: We aim to describe the clinical profile of patients who had clozapine associated weight loss.

Methodology: The details of socio-demographic profile, illness, treatment, physical examination, biochemical investigations were extracted through retrospective file review of six patients who had clozapine associated weight loss during the last ten years (2013-2023).

Results: Six patients (three male and three female) with a mean age of 39 years (SD 6.8) were identified during this time period. Four patients were diagnosed with Schizophrenia and other two with Schizoaffective disorder and Bipolar affective disorder respectively. The mean dose of clozapine was 520 mg (SD 192). The median weight loss of 10kgs (IQR 17) was noted. All these patients had poor treatment response with Clozapine.

Conclusion: The mechanism behind Clozapine associated weight loss is not clear and a complex pharmacodynamic, environmental and genetic interplay has been implicated. Extant literature reveals that a subgroup of these patients also had poor treatment response with Clozapine. A thorough physical evaluation is warranted to rule out associated medical conditions. This phenomenon warrants further research.

Keywords: Clozapine, weight loss, adverse effect.

Exploring Clinical Characteristics of Patients Attending the Geriatric Psychiatry OPD at a Tertiary Care Hospital: A Retrospective Analysis

Dr. Priyam Sharma*, Dr. Om Prakash^#, Dr. Anadrika Debbarma**, Dr. Amit Khanna***, Dr. Poulami Basu*, Dr. Druhin Grover*, Dr. Sankalp Jain* & Dr. Garima Bharti*

*Senior Resident; **Assistant Professor; *** Associate Professor; ^# Professor

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, India

Background: The geriatric population, typically defined as individuals aged 60 years or older, is experiencing a global increase in numbers due to extended lifespans and improved healthcare services. As individuals age, the prevalence of mental and behavioral disorders tends to rise, driven by the natural aging process of the brain, declining physical health, and cerebral pathologies. Diagnosing psychiatric disorders in this population poses challenges due to the presence of concurrent physical illnesses. Additionally, factors such as disability resulting from various health conditions, social isolation, limited family support, reduced personal autonomy, and financial dependency contribute to a higher incidence of mental and behavioral disorders. Stigma surrounding mental illnesses and a lack of understanding often deter many elderly individuals from seeking the necessary assistance. Older individuals also have a heightened susceptibility to cognitive disorders such as delirium and dementia, in addition to other psychiatric conditions. This study aims to examine the clinical characteristics of patients attending the geriatric outpatient department (OPD) at a psychiatric tertiary care hospital in Delhi.

Methods: We carried out a retrospective analysis by reviewing patient charts. The study included 60 individuals who made their initial visit to the geriatric outpatient department (OPD) at a tertiary healthcare institution in Delhi. Data was gathered from patient records covering the period from 2022-23, followed by subsequent statistical analysis.

Results & Conclusion : The majority of OPD visitors sought assistance for sleep disturbances. A significant portion of these patients exhibited neurotic symptoms, with the majority receiving a diagnosis of depression. The most prevalent comorbidities observed were diabetes and hypertension, while tobacco emerged as the most commonly consumed substance among this group. Need further research to substantiate research findings.

Combined Cyproheptadine and Dexamethasone dependence, a rare dependence syndrome or under-reported? - A case series

Aniket Mukherjee, Institute of Psychiatry, IPGME&R, Kolkata.

Email: ask.aniket@gmail.com

BACKGROUND: Cyproheptadine, is an anti-serotonergic, antihistaminic, orexigenic drug often used as an appetite stimulant. Dexamethasone, a corticosteroid, is also known to increase weight. There are only a few case reports on Cyproheptadine and Dexamethasone (CD) dependence in India. Here we reported 3 such similar cases.

AIM: To describe the rare CD dependence which will add more to the existing literature that may help in early intervention and awareness generation among the vulnerable.

PRESENTATION OF THE CASES: Two male patients (27- and 24 years), presented at the OPD, with irritability, low mood, tremors, abdominal pain, and reflux. One female patient (38 years) presented at the emergency with insomnia, anxiety, and agitation after stopping CD for 2 weeks. They revealed taking two types of pills, CD, for 2, 4, and 7 years respectively, starting with a dose of 4 mg and 1 mg, up to 12 mg and 4 mg / day respectively. They tried to quit but restarted again because of insomnia, decreased appetite, anxiety, and palpitation. Their gym mate (1^st and 2^nd case) and friend (3^rd case) suggested these pills for quick weight gain, look good and also for muscle gain (1^st and 2^nd case). All were treated with Clonazepam, Mirtazapine, and PPI, along with psycho-education, and felt better in 2 weeks, and remained abstinent.

CONCLUSION: Research on this topic is rare but there is potential for under-reporting. Young people are most vulnerable, especially the gym goers. Early intervention and psychoeducation are necessary with strict regulation of non-prescription drug dispensing.

Free Paper: STUDY OF IMPACT OF SMART SPEAKER USE ON THE WELL BEING OF OLDER ADULTS

Background: Ageing is an unavoidable demographic trend worldwide. Older adults face various issues, such as low socioeconomic status, health deterioration, and improper emotional ties with families or friends, which are associated with loneliness, depression, and even suicide risk. There has been considerable increase in use of digital technology. A recent study on amount of digital communication technology use seems to reduce feelings of loneliness, psychological distress via the perception of social support. Many various studies are done on loneliness and depression in older adults, but their association with smart speaker use is still not much explored. The present study is an attempt to focus on that.

Aims: To study the impact of use of smart speaker use and its association with the well-being of older adults using it.

Methodology: A cross sectional study will be done including 50 older adults in the age group of 60 or >60 years, coming in the psychiatry OPD of our institution. Tools used are UCLA LONELINESS SCALE and Hamilton Depression Rating Scale (HDRS).

Results & Conclusion: Most of the patients would be of educated urban class based on the socio demography of the associated region. Smart speakers use can reduce feeling of depression and loneliness and be especially valuable to older adults living alone. Whereas, its frequent use may alleviate depression and loneliness in older adults.

Clinical response predictors of repetitive transcranial magnetic stimulation (rTMS) in depression: A retrospective study from a tertiary care centre

Introduction:

Clinical characteristics that determine response to rTMS in depression are not consistent across studies and centres. Our prior study has found that higher the degree of treatment resistance, lesser is the likelihood of remission with rTMS.(Baliga SP et al, 2020) The current study aims to examine the consistency of this observation in an independent sample of depressed patients who received rTMS at the same centre.

Methodology:

Out of 83 patients a total of 77 who received > 10 rTMS sessions were finally analysed for response to rTMS. We included both bipolar and unipolar depression patients receiving sequential bilateral theta burst stimulation. Clinical characteristics like number of failed antidepressant trials, medical and psychiatric comorbidity, severity and type of depression, age at onset, duration of illness, gender and family history of psychiatric illness in first-degree relatives were examined as potential predictors of response to rTMS. Hamilton Depression rating scale (HDRS-17) was used to assess symptom severity at baseline and following treatment. A HAM- D Score of < 7 was considered as criteria for remission.

Results:

A total of 22 patients receiving rTMS remitted. Univariate statistics revealed that remission was significantly associated with the number of failed antidepressant trials (t=2.4, p=0.01) and the presence of family history of psychiatric illness in first degree relatives (χ² =3.93, p= 0.04). None of the other baseline predictors were associated with remission.

Conclusion:

This study replicated the previous findings that number of failed antidepressant trial is an important predictor of response to rTMS in depression. Based on these findings, we may consider augmentation with rTMS early on in patients with resistant depression.

Sociodemographic profile of patients visiting the geriatric OPD of psychiatry tertiary care hospital : A retrospective study

Dr. Poulami Basu Dr Harsha Dr Priyam Dr. OmPrakash, Dr. Deepak Kumar

Institute of Human Behaviour and Allied Sciences, New Delhi, India

Background: Globally there is an increase in geriatric population (defined as those aged 60 years or above) owing to increased longevity and better health care facilities. Due to the normal aging of the brain, deteriorating physical health and cerebral pathology, the overall prevalence of mental and behavioral disorders tends to increase with age. Disability arising due to various illnesses, loneliness, lack of family support, restricted personal autonomy, and financial dependency are other important contributing factors for higher prevalence of mental and behavioural disorders.

The aim of this study is to assess the sociodemographic profile of patients visiting the geriatric opd of psychiatric tertiary care hospital in Delhi.

Methods: A retrospective chart review was conducted. Participants who visited the geriatric opd of tertiary health care institute in Delhi for first time were included in the study. Data was collected from file records of patients who visited the hospital the hospital from the year 2022 till 2023. Statistical analysis was done.

Results and Conclusion: Majority of patient visiting the geriatric OPD were male, from age group 61-70 years, residing in rural area, not currently working and the major reason for visit was sleep disturbance. Many patients had neurotic symptoms and majority of them had depression.

Red Flag indicators of Affective Switch in Children and Adolescents-A focus on the Socio-Demographic and Clinical profile of the sample

Objective: The purpose of this study was to assess the factors associated with the risk of manic switch among children and adolescents.

Methods : A retrospective chart review of electronic medical records was carried out in a cross-sectional population who attended outpatient clinics from January 2021 to February 2021. Children and adolescents who were on any medication were included in the study. Socio -demographic and clinical profile of the sample was collected. A total of 117 children and adolescents were included in the study.

Results : The study sample constituted of 73 children and 44 children with neurodevelopmental delay. The number of males were 68 (58.1%) and females were 49(41.9%). Among the study population 69 (59%) belonged to middle socio economic status, 43 (36.8%) belonged to lower socio economic status. Among the total 117 patients, medication induced affective switch was seen in 27 patients(23.1%). A majority of population who switched were males 19(70.4%). Family history of neuropsychiatric illness was present in 17 (63%) patients who had a manic switch. Among those who switched about 55.6% switched had a poor academic performance. Among the clinical factors studied presence of psychosis (p<0.001) and melancholic symptoms (p=0.03) had a significant relation to manic switch.

Discussion: Positive family history of neuropsychiatric illness, lower and middle socio – economic status, poor academic performance were found to be associated in children and adolescent who had an affective switch. Presence of psychosis and melancholic symptoms had a significant relation to manic switch. Identification of these red flag indicators will help in early identification and treatment planning.

Neuropsychiatric Challenges In Parkinson Disease Post Deep Brain Stimulation: A Comprehensive Narrative Review

Vijay Sain

Background - Deep brain stimulation is an established surgical treatment for PD that can be complicated by adverse neuropsychiatric side effects, most commonly characterized by impulsivity and mood elevation, although depression, suicide, anxiety and apathy. Cognitive problems predominantly seen are verbal fluency, verbal memory, executive functions and processing speed

Method - A narrative review of the relevant studies focusing on Neuropsychiatric sequalae of DBS In Parkinson patient.

Discussion – The literature indicates that neuropsychiatric symptoms post – DBS are generally transient and treatable, with no significant differences between GPi-DBS and STN-DBS. However, cognitive outcomes after STN DBS are controversial, often showing mild to moderate declines in verbal fluency. Indian studies also echo this decline. Studies face challenge such as small sample sizes, distinguishing medication from DBS effects, and understanding the impact of pre operative neurobehavioral symptoms. Having a dedicated psychiatrist in the DBS center can help manage neuropsychiatric issues effectively

Conclusion – Post surgery psychiatric symptoms can vary and should be addressed given the high neuropsychiatric morbidity in advanced PD to improve patients’ quality of life.

Background: Resilience can be defined as “the absence of psychopathology despite exposure to high stress & reflects a person’s ability to cope successfully in the face of adversity, demonstrating adaptive psychological & physiological stress responses”. Culmination of spousal alcohol dependence related marital dissatisfaction & stress could progress to psychiatric morbidities. In recent years, resilience has been projected as an independent coping strategy for anxiety & depression related with spousal alcohol dependence. Strengthening of resilience has also been suggested to be an effective measure for understanding, preventing, & treating psychiatric conditions in the family members of alcohol dependent patients.

Aim: To assess resilience, anxiety & depression in the wives of alcohol dependent males.

Methods: 99 male alcohol dependent patients & their wives were enrolled & evaluated for severity of alcohol dependence in the patients (SADQ ). Resilience (BRS), anxiety (HAM-A) & depression (HAM-D) were measured in the wives.

Means along with standard deviations were used to depict the central tendencies & dispersions of data. Analysis of variance & Independent ‘t’-tests were used to compare the mean values among (more than two) & between (for two) groups. Pearson bivariate correlation coefficient was calculated as a measure of linear bivariate correlation between two continuous variables.

Results: Findings in essence showed a high prevalence of depression, anxiety & resilience loss in the wives, which was independent of sociodemographic characteristics & was mainly dependent upon the severity of alcohol dependence.

Conclusion: Findings show that wives of alcohol dependent patients go through severe stressful situations that affect their resilience & place them at a high risk for anxiety & depression.

ABSTRACT- PAPER

Dr Athulya Thankachi K

PSYCHOGENIC POLYDIPSIA INDUCED SEIZURES IN A PATIENT WITH POSTPARTUM PSYCHOSIS

BACKGROUND:

Many psychiatric patients have polydipsia and polyuria without identifiable underlying medical causes. Hyponatremia develops in some polydipsic patients and can progress to water intoxication resulting in confusion, lethargy, seizures and death.

AIMS AND OBJECTIVES:

To study a rare case of psychogenic polydipsia induced seizures in a patient with postpartum psychosis.

METHODS:

A 33 yr old female who delivered a healthy baby girl 6 weeks back was brought to ER in an unresponsive state, with history sudden onset of one episode of seizure-GTCS type lasting for 2-3 minutes at home with LOC. History of Irrelevant talk - with somatic delusion of having a oral tumor since 3 days, refusal to feed the baby since 2 days and increase in thirst since one day with an intake of 6Lrs of water in 2.5 hrs. Relevant investigations were done.

RESULTS:

Patient was managed with electrolyte correction and antipsychotics

CONCLUSION:

Psychogenic polydipsia though commonly found in patients with psychiatric illness it can be a potentially fatal condition. There have been reports of life threatening conditions such as seizure, rhabdomyolysis, aspiration pneumonia, and death associated with psychogenic polydipsia .The present case is an example which shows seizure as a complication of hyponatremia secondary to water intoxication caused by psychogenic polydipsia in a patient with diagnosed postpartum psychosis. It is a challenge to diagnose and manage the condition as patients themselves do not reveal and deny treatment.

Female Gender and Social & Clinical Factors In Admission of PMIs at a State Mental Health Institute

Dr. Sankalp Jain*, Dr. Namrata Bhardwaj*, Dr. Aparna**,Dr. Shipra Singh***, Dr. Pratibha** and Dr. Deepak Kumar^#

*Senior Resident; **Assistant Professor; ***Associate Professor; ^#Professor, Institute of Human Behaviour and Allied Sciences, New Delhi, India

Objective: This retrospective study examines female admissions in a State Mental Health Institute under the Mental Health Care Act 2017. We analyze the selection of care settings, specifically wards with open access and wards with supervised/restrictive access, for female patients over a six-month period. We investigate the influence of social and illness-related factors on care setting choice, including abscond risk, aggressive behavior, court orders, lack of family support, and livelihood loss.

Methods: Data from a State Mental Health Institute were collected in the background of the Mental Health Care Act 2017. Female admissions, care settings, and social and illness-related determinants were analysed.

Results: Preliminary data suggest variations in care setting selection for female patients. Factors such as abscond risk, aggressive behavior, court orders, family support absence, and livelihood loss significantly determined care environment.

Implications: Understanding the influence of social and illness-related factors on care setting selection is essential for the implementation of the Mental Health Care Act 2017. It highlights the need for more individualised, patient-centric mental healthcare approaches in line with the Act. By recognising these factors, mental health professionals can improve the quality of care for female patients, ultimately enhancing their well-being and overall mental health outcomes.

Conclusion: This research illuminates the impact of social and illness-related factors on care setting choices for female patients in a State Mental Health Institute governed by the Mental Health Care Act 2017. Understanding these factors is essential for tailored and effective care strategies, in alignment with the Act, and for advancing female mental healthcare.

Keywords: Female admissions, care settings, Mental Health Care Act 2017, State Mental Health Institute, social and illness-related factors, Delhi.

Red flag indicators of Affective Switch in Children and Adolescents-A focus on the medication profile

Background: The risk of affective switch with medications in children and adolescents with a Bipolar diathesis can have significant implications in the course and outcome of illness. Identifying Red flag indicators in terms of clinical and medication profile can be of use when initiating pharmacotherapy in this population.

Methodology:

A retrospective review of electronic medical records was carried out in a cross-sectional population who presented to the outpatient clinic in a tertiary care centre for a period of 1 month. Children and adolescents who were on any medication were included in the study. Data on the socio -demographic, clinical profile and medications of the sample was collected. A total of 117 children and adolescents were included in the study.

Results: Among the total 117 patients, medication induced affective switch was seen in 20(17%) patients. The number of males were 68 (58.1%) and females were 49(41.9%). A majority of population who switched were males 16(47%). Family history of neuropsychiatric illness was present in 10 patients who had a manic switch. The medication profile of switch was as follows: SSRI 12(10.2%, p-0.00), NRI 3(2.5%, p-0.012), TCAs 2(1.7%, p-0.054), SNRI 2(1.7%, p-0.054), NaSSA 1(0.8%, p-0.07).

Discussion: Caution needs to be exercised when initiating children and adolescents on medications. Identification of red flag indicators of Bipolar diathesis will aid in choice of medication while planning for treatment.

A study of Quality of Life of patients of Migraine vs Tension type headache and it’s relationship with severity

Background: In the realm of neurological disorders, migraine and tension-type headache stand as two of the most prevalent and debilitating conditions, affecting millions of individuals worldwide. These conditions not only inflict physical pain but also significantly impair the overall quality of life of the sufferers.

Aim: To study and compare the quality of life of patients with migraine and tension type headache and it’s correlation with severity of headache

Methods: The present study was conducted in Department of Psychiatry of a tertiary care hospital. 30 consecutive patients each of Migraine and tension type headache as diagnosed by International Classification of Headache Disorders Edition 3, aged 18 to 65 years fulfilling the specific criteria laid down for the study were included. A semi structured proforma, Clinical global impression scale and World Health Organization Quality of Life Assessment scale WHOQOL – BREF Hindi (version) were used.

Results: Mean age of migraine patients was 35.56 + 8.04 years and those of tension type headache was 36.34 + 7.54 years. Significant difference was found between patients of migraine and tension type headache in the domains of physical health with patients of migraine having poorer quality of life in this domain (12.52+2.05 vs 16.85+1.49). Severity of headache correlated positively with physical and psychological health domains of quality of life (p <0.05) in both the types of headache.

Conclusion: Both migraine and tension type headache impair quality of life of patients significantly. Hence, due attention is required on this aspect for holistic patient management.

A cross sectional study to evaluate cognitive functioning in schizophrenia individuals with comorbid substance dependence

Dr Sreekeerthi Kothapalli¹ , Dr Prasanna Kumar²

1)Post graduate resident 2)Professor Department of Psychiatry – Andhra Medical college, Vishakhapatnam

Introduction: Schizophrenia is characterized by disturbances in domains of mental modalities. Thinking, perception, self experience, cognition, volition, affect, behavior are major domains. Medication is one of the important modality in treatment, however majority of medication were not effective in cognitive symptoms. Alcohol and cannabis use can lead to neuropsychiatric symptoms. Persons with substance use can also have cognitive deficits secondary to substance use. Hence this study is conducted to evaluate cognitive symptoms in schizophrenia with comorbid substance use.

Aim:

To compare the cognitive functioning in schizophrenic patients with comorbid alcohol and cannabis dependence

Materials and methodology

This is a comparative study on cognitive evaluation in patients diagnosed as schizophrenia as per DSM 5 attending Out patient and inpatient wards of tertiary care hospital. Patients who are giving consent and in the age group of 18-60 years were included in the study. Study groups comprises two groups with thirty patients in each group based on random sampling. The first group consists of patients diagnosed as schizophrenia and another group schizophrenia with comorbid substance dependence of alcohol or cannabis. Socio demographic data , Brief Psychiatric Rating scale, Cognitive Assessment interview were done and their scores were evaluated

Results:

Results will be discussed during paper presentation as study is going on .

Conclusions:

Conclusions will be discussed during conference

Analyzing the profile of patients referred for ‘Fitness to stand trial’: A retrospective chart review

Dr. Druhin Grover*, Dr. Anadrika Debbarma**, Dr. Om Prakash^#, Dr. Amit Khanna***, Dr. Manoj Kumar** and Dr. Deepak Kumar^#

*Senior Resident; **Assistant Professor; *** Associate Professor; ^# Professor Institute of Human Behaviour and Allied Sciences, New Delhi, India

Background: Fitness to stand trial, a fundamental concept in jurisprudence, plays a pivotal role in the legal proceedings involving criminal defendants who may have known or suspected mental illnesses. This study seeks to evaluate the demographic, clinical, and forensic attributes of individuals referred for assessments of their fitness to stand trial.

Methods: We conducted a retrospective chart review that included individuals referred for fitness to stand trial at a tertiary healthcare institute in Delhi. Data were extracted from patient files covering the period from 2017 to 2022, and subsequent statistical analysis was performed.

Results: A total of 112 individuals were referred to assess their fitness for trial by the judiciary. The majority of those referred were males. A significant portion of the participants had limited education and were unemployed. Out of the 112 participants, 60 were determined to be fit for trial. Among the referred participants, the most prevalent diagnoses were schizophrenia and other psychotic disorders, along with intellectual disabilitY. The most frequently reported crimes involved offenses against other individuals, primarily murder, followed by offenses against children.

Conclusion: Among patients with psychiatric illnesses, a 50% rate of fitness for trial was observed. It is important to approach this data with caution and acknowledge the need for further research and interpretation.

FOLIE A DEUX IN DISSOCIATIVE DISORDER IN TWIN SISITERS

Dr. Saurabh Chaudhary (Junior resident), Dr. Shivani Gusain (Senior resident), Dr. Nishant Goyal (Professor)

Central Institute of Psychiatry, Ranchi

Background-Transmission of symptoms resulting in concurrent appearance of them among persons who are either close to each other or members of a same family living together is coined as “ Folie a deux”. This phenomena is rare in dissociative disorders. However, dissociative hyperventilation, trance and possession disorder and dissociative amnesia have been reported.

Aim-To demonstrate a case of shared dissociative phenomenon in twin sister.

Material and methodology- A 17-year adolescent presented with father and twin sister to OPD with the complaints of fearfulness, episodes of loss of responsiveness, multiple somatic complaints for 2.5 months. Previous to this, her twin sister had similar complaints for past 3.5 months and diagnosed as dissociative stupor, so index sister was exhibiting shared dissociative phenomena. There was no family history of any psychiatric disorder in other family members. Clinical interviewing and psychological assessments were done.

Result-Improvement was seen with contingency management, mainly separating the index patient from her twin sister for the time being, and relaxation techniques.

Conclusion- Negative history of any psychiatric comorbidity and dissociation in other family generations makes biologic basis for “folie dissociation” in this a remote possibility. Also psychosocial management can have major role in treatment of such patients.

A cross-sectional study on social media addiction, fear of missing out and sleep quality among college students.

Dr Surya Prabhavathi Kosuri1 Dr P Swathi2

1Post Graduate 2Assistant Professor ,Department of Psychiatry, Andhra Medical College, Visakhapatnam

Introduction:

Social media platforms have penetrated all aspects of everyone’s day to day life especially in youth. Multifunctional smart phone applications and consistent internet access has led to increased and excessive usage of social media platforms which led to negative consequences such as social media addiction ,fear of missing out and problems with sleep .So this study was undertaken to evaluate social media addiction ,fear of missing out and sleep quality among college students.

Aim:

To evaluate social media addiction, fear of missing out and sleep quality among college students

Methods:

A cross sectional design was used in the study. College students were assessed using the following materials: self administered socio-demographic profile, Smart Phone Addiction Scale-Short Version (SAS-SV) ,Fear Of Missing Out Scale(FOMO) ,Pittsburgh Sleep Quality Index(PSQI)

Result:

The results showed smart phone addiction is closely associated with fear of missing out and also had effect on sleep quality in college students

Conclusion:

Smart phone use may be pleasurable and exciting in early stage ,but excessive use can trigger greater negative effects .Upon experiencing negative consequences of social media use (social media addiction) students were likely to have fear of missing out and also experience sleep problems .These findings can be used as an evidence that there is requirement of certain measures to be taken in order to prevent smart phone addiction ,fear of missing out and improve sleep quality.

prospective study of efficacy of intravenous ketamine infusion to prevent suicidal ideation in mood disorders

Backround:

The presence of suicidal ideation with a strong suicidal intent is considered to be a clinical emergency. Conventional pharmacotherapy takes several weeks usually 3-12 weeks to improve the symptoms .There is a role of glutamate in depression, especially the NMDA receptors and serotonin receptors. There is a growing evidence which shows in subanesthetic dose , ketamine has rapid antidepressant and antisuicidal action. Single dose of ketamine has rapid action on depressive and suicidal symptoms and this persists for weeks which also suggests the role in neuroplasticity.

Aim:

To study the effect of sub anaesthetic(0.5mg/kg/body weight)administration of ketamine infusion to prevent suicidal ideation in mood disorders and effect of ketamine.

Methods:

Study design : Prospective Study

Study center: Institute of mental health ,Chennai -10.

Study period: 3 months (November 2023 to January 2024)

Study population: All patients who have symptoms of suicidal ideation and severe and treatment resistant depressive disorder in inpatient care. Above the age of 18 years below the age of 60 years.

Results : In this study paire sample test significance level is P value < .05 pre and post administration of HAMD and beck depressant indent scale and MADRAS after 90-110mins sub anaesthetic (0.5mg/kg) of ketamine significant reduction in sucidal ideation.

Conclusion: ketamine is a rapid and effective treatment for depression,ketamine has shown preliminary evidence of reduction in depressive symptoms as well as reduction in sucidal ideation.

A Study on the impact of Religious and spiritual beliefs of psychiatrists in their clinical practice

Dr.K.Bhavana Jyothi1,Dr.M.Gangadhara rao2 ,Dr.D.Vijaya Lakshmi3,Dr.K.V. Rami Reddy4

1.Second year Post graduate,Department of psychiatry,Andhra medical college

2.Assistant Professor, Department of psychiatry,Andhra Medical College

3.Professor and HOD, Department of psychiatry,Andhra Medical College

4.Professor and Superintendent,Government Hospital for mental care,Visakhapatnam

Introduction:“The relationship between Spiritual and Religious beliefs and psychiatry is complicated and is influenced by complex belief systems making it difficult to address spiritual and religious beliefs in clinical practice.

Aim:To examine the relationship between psychiatrists’ religious and spiritual beliefs and their attitudes regarding religion and spirituality in clinical practice.

Materials and methodology:A cross sectional study conducted at Government Hospital for Mental Care Visakhapatnam. The sample comprised of Psychiatrists working at Government Hospital for mental care including both faculty,senior and junior residents . Subjects were invited to collaborate with the study by answering a brief and confidential self report questionnaire which consisted of participants sociodemographic and professional characteristics, religious and spiritual characteristics and their opinions and behaviors related to religiousness/spirituality

Result: Most of the Subjects consider themselves as spiritual rather than religious, around 51%(n=18 )Subjects felt religious beliefs doesn’t effect their clinical practice, and majority 72% (n=25)they also felt that religious beliefs are to be enquired by treating psychiatrists should enquire and found that lack of training is the barrier in approaching patient’s religiosity

Conclusion: Study suggest that training might be of importance for handling Religion and spirituality in clinical practice and raising awareness about potential evaluative biases in the assessment of patient’s religiosity

key words: Psychiatrists,Religion,spirituality

Efficacy of drug refusal skills awareness programme among graduate college students of Doda, Kishtwar and Ramban districts of J&K

Background

Recent studies have shown rising prevalence of substance abuse in the state of J&K especially among its youth. Improving drug refusal skills among youth is one of the key preventive measures.

Aim

The study was conducted to assess the efficacy of a drug refusal skills awareness programme among graduate college students of Doda, Kishtwar and Ramban districts of J&K.

Method

Six graduate degree colleges from the districts of Doda, Kishtwar and Ramban districts of J&K with the largest student population were chosen. A 30 minutes long awareness programme on drug refusal skills consisting of powerpoint presentation and interactive session was conducted in each of the colleges for students after pretesting for acceptability. Drug Refusal Skills subscale of Brief Assessment of Life Skills Training with higher scores indicating better awareness was administered before and one month after the awareness programme.

Results

A total of 512 students participated with 281 girls (54.9%) with a mean age of 21.3 years. Cronbach’s alpha was 0.71 for the instrument used. Statistically significant increase was noted from pre-test mean of 3.4 to post-test mean of 8.8 (p<0.05) scores of the instrument used.

Conclusion

The brief drug refusal skills awareness programme conducted was efficacious among degree college students of Doda, Kishtwar and Ramban districts of J&K in improving drug refusal skills, and can be easily replicated in other higher educational/ training institutes of the state for prevention of substance abuse among its youth.

Pathways to Progress: Digital Training in Mental Health for Primary Healthcare Workers in Karnataka

Medikonda M, Sabbahit G.G, Nujella S, Mullerpattan G, Kulal N, Patley R, Das N,Manjunatha NKumar C.N., Math B.S

Background: In Karnataka, the prevalence of mental illnesses stands at 8%, reflecting the nationwide challenge. To address the substantial 80% treatment gap, a digital training program with task-sharing approach engaged Medical Officers (MO) and Accredited Social Health Activists (ASHA) lasting 6 and 4 weeks respectively. This study aimed to uncover the challenges and facilitators experienced by the doctors and ASHAs during the training, along with the outcomes regarding their roles in community-based mental healthcare.

Methods: Two semi-structured Focus Group Discussions (FGDs) were conducted with 8 Medical officers and 9 ASHAs chosen through purposive sampling. The resultant qualitative data was subjected to thematic analysis to derive themes and sub-themes depicting their experiences of the program.

Results: ASHA workers reported enhanced screening, patient engagement, and reduced stigma. Simultaneously, doctors benefited from their collaboration with District Mental Health Program (DMHP) services. Both groups gained confidence, with availability of Collaborative Video Consultation (CVC) and TeleMANAS. However, both groups encountered challenges with limited digital literacy and overlapping responsibilities . Moreover, MOs faced limitations in delivery with unavailability of psychiatric medications .

Discussion : These findings underscore potential of digital training program utilizing existing primary healthcare providers to strengthen the treatment continuum, from ASHA-led screening and referral to medical officers’ basic management. This approach contributes to integration of mental health within primary healthcare.

Prevalence and correlates of body image disturbance among undergraduate medical students studying in a tertiary care hospital

Sree Balaji Medical College and Hospital, Chennai

Dr. Anoop J. Alappat, Dr. E. Sivabalan

Background: Body image is the subjective picture of an individual’s own body, no matter how the body actually looks. Body image misperception is common in the general population and a component of body dysmorphic disorder, anorexia nervosa, and bulimia nervosa. Excessive smart phone usage and social media usage in certain individuals can cause these issues.

Aim: The objective of this study is to assess the frequency of body dysmorphia among teenage adolescents and young adults and its association with increasing time spent on social media.

Methods: This cross-sectional online survey was conducted in Sree Balaji Medical College, Chennai. Consenting students were asked to fill an anonymous predesigned online questionnaire encompassing BDDQ (Body Dysmorphia Disorder Questionnaire) and SAS-sv (Smartphone Addiction Scale – Short Version).

Results: Study comprising of 74 students, mean age was 22.47, among which 39.2% were males and 60.8% females. Mean SAS-Sv score was at 33.31. Checking themselves greater than 20 times was reported by 16% and 33.8% found that their body image was moderately to severely unattractive. About 25% individuals reported moderate to severe issues in social and personal life.

Conclusion: There is a rising body dysmorphia among medical students. It is important to facilitate the youth in the right direction by intervening and helping them understand the falsity in the current available body image representation.

A case of Early-onset trance and possession phenomena in an 8 year-old child

Dr. Shalini Sarangi (Junior Resident), Dr. Shivani Gusain (Senior Resident),

Dr. Nishant Goyal (Professor),Central Institute of Psychiatry.

Background: Dissociation is a psychological phenomenon characterized by a lack of integration of thoughts, emotions, identity, and/or physical sensations into consciousness. It has been linked to childhood maltreatment and trauma, parental emotional dysregulation and dissociative behaviours. Mean age of onset of trance and possession disorder is between 20-25 years and is rarely seen in children below 10 years of age.

Aims: To demonstrate a case of early-onset possession trance phenomena along with other dissociative symptoms in an 8-year-old child, with regressive behaviour as early indicator of dissociation.

Methods: Presenting complaints- headache since 5 years of age (2020), stomachache and fainting for 6 months in 2022-23, episodes of possession with aggression for 1 month in May 2023, episodes of not recognising people, speaking in infantile voice for 2 months in June-July 2023, episodes of abnormal body movements and sleep walking for last 3 months. History of abuse at 4 years of age; urinary incontinence in 2019, April 2023, August-September 2023; history of dissociative episodes and emotional dysregulation in mother. Clinical interviewing and psychological assessment done.

Results: Improvement seen with escitalopram 15 mg, clonazepam 1mg, risperidone 0.5 mg, contingency management, play therapy, life skill training.

Conclusion: Rare case of early onset possession trance demonstrated with a focus on regressive behaviour as early indicator of dissociation in child in at-risk environment.

“Executive functioning deficits in patients of alcohol dependence: A case control study”

Background - Alcohol’s effect on brain functioning is evident after acute intoxication. Chronic and heavy use affects neuropsychological functioning in a more extensive manner with consistently increased risk of developing cognitive decline. Executive functions comprise a set of abilities that balance other components of the cognitive system to synchronise thoughts and actions. They consist of several constituent functions, like planning, problem-solving, mental flexibility and working memory among others. Deficits in executive functioning can lead to impaired adaptive decision making and as a result hamper treatment.

Aim - To determine whether alcohol dependent patients perform differently than healthy controls on tests of executive functioning

Methods - 40 acutely-detoxified alcohol dependent patients and 40 healthy controls were selected based on predefined inclusion criterias from a sub-urban North Indian population. They were matched for age, gender, and years of formal education. 3 tests were applied to determine executive functioning - the TMT-A and TMT-B for flexibility and the Phonemic and Category Fluency Tests (PFT, CFT respectively) for verbal fluency. Analysis was done using SPSS.

Results - All study participants were males. The mean age for cases and controls was 38.93 and 38.20 respectively. Both the groups had comparable educational status. Patients of alcohol dependence performed worse on all the tests applied, with the difference being statistically significant (p<0.05).

Conclusions - Alcohol has a lasting effect on brain functioning, which was demonstrated in the present study with evidence of executive dysfunction even after acute detoxification.

A STUDY OF PSYCHIATRIC COMORBIDITIES IN POST HYSTERECTOMY PATIENTS.

BACKGROUND: Uterus has a deeply symbolic meaning to women. Hysterectomy being a common major gynecological surgery performed for various benign and malignant conditions can have adverse psychosocial outcomes.

AIMS & OBJECTIVE: To evaluate psychiatric comorbidities in post hysterectomy patients.

METHODOLOGY: The study was conducted in Department of Psychiatry, Government Medical College, Kota. 50 post hysterectomy women aged 18 to 45 years attending gynecology outpatient department and 50 matched healthy controls who fulfilled the specific criteria laid down for the study were included in the study. Participants were screened for anxiety by Hamilton rating scale for Anxiety (HAM-A), depression by Beck Depression Inventory scale (BDI).

RESULTS: Mean age of cases and controls was 39.30±3.30 years and 37.66±3.99 years respectively. 66% patients had abdominal hysterectomy while 34% underwent vaginal hysterectomy. It was found that 27 (54%) and 26 (52%) were suffering from depression & anxiety respectively. On further classification according to severity of depression it was found that 40%, 12% and 2% patients had mild , moderate and severe depression respectively. Similarly, 36%, 14% and 2% patients had mild, moderate and severe anxiety respectively. It was also found that Young, nulli-parous and patients living in nuclear family who underwent vaginal hysterectomy had more severe anxiety and depression.

CONCLUSIONS: High prevalence of psychiatric comorbidity in post hysterectomy women highlights the need for better awareness and timely psychological intervention and support among these patients.

A CHART REVIEW OF CLINICAL AND SOCIODEMOGRAPHIC FACTORS OF ELDERLY PERSONS WITH ALCOHOL DEPENDENCE SYNDROME

Dr.Adila VK¹, Dr. Prasanna Kumar N²

1.Postgraduate, Andhra Medical College

2.Professor of Psychiatry, Andhra Medical College

AIM

To evaluate the clinical and sociodemographic factors in elderly alcohol dependence persons.

BACKGROUND

Alcohol Use Disorder is a pervasive public health concern, and it affects worldwide. Alcohol dependence is one of the most common condition and its management is multimodal. There were many medications for preventing craving but preventing relapse is a challenge in alcohol dependence. It is also associated with multiple medical complications and mortality. Evaluation and management of elderly alcoholics is even more difficult based on their comorbid general medical conditions. Hence in this study an attempt is made to evaluate the clinical pattern and socio demographic data in elderly alcohol dependence persons.

MATERIALS AND METHODS

This is a hospital based retrospective study. Case records of patients diagnosed as alcohol dependence as per ICD 10 and age more than 60 years were included in the study. The case records were taken from the year 2018 to 2023.Socio-demographic variables were assessed by sociodemographic proforma . Clinical data was evaluated in semi structured proforma comprising of age of start of alcohol, duration of dependence, number of abstinence, medical complications, treatment aspects and number of relapses. The data was analysed based on SPSS software.

RESULTS: Since this is an ongoing study the results will be discussed in the conference.

CONCLUSIONS: This will be discussed at the time of conference.

A Comparitive study between Disulfiram and Baclofen in the management of Alcohol use disorder

Dr Velpula Praveen Rao¹, Dr N Prasanna Kumar², Dr R Krishna Naik³

1.Post graduate, department of Psychiatry, Andhra medical college, Visakhapatnam,

2.Professor of Psychiatry, Andhra Medical College, Visakhapatnam.

3.Assistant Professor, Andhra Medical College, Visakhapatnam.

BACKGROUND: Alcohol use is one of the etiological factor for many health issues. Medications like Disulfiram, Naltrexone, and Acamprosate were reported to be beneficial for controlling alcohol use. Disulfiram reduces alcohol consumption by its aversive effect. Recent studies indicated the efficacy of Baclofen, a GABA B receptor agonist, in achieving alcohol abstinence among alcohol-dependent patients. However, there were no comparative studies comparing disulfiram with baclofen. This study aims to compare Disulfiram and Baclofen in Alcohol use disorders(AUD).

AIM: To Compare the Outcomes, and Relapses in persons treated with Disulfiram and Baclofen for Alcohol Use Disorder.

Methodology: The present study is conducted in the subjects aged between 18-55years of age those who met the diagnostic criteria for alcohol dependence syndrome, agreed to abstain from alcohol and given consent for the study. Individuals having diagnosis of psychosis, alcohol induced dementia or amnestic disorder and hepatic disorders were excluded from this study. This study is done in tertiary care hospital and is a Retrospective follow up study with non-probability convenient sampling. The study group is divided into two subgroups of disulfiram and baclofen. Case records of last 3 years with diagnosis of alcohol dependence and who were started with either disulfiram or baclofen were included in the study and were assessed for sociodemographic and clinical data and recent intake of alcohol by CAGE questionnaire.

Results and conclusions: Results will be discussed in the conference as it is ongoing study.

ASSOCIATION OF NEGATIVE AND COGNITIVE SYMPTOMS WITH DISABILITY IN PATIENTS ADMITTED WITH SCHIZOPHRENIA IN A TERTIARY CARE HOSPITAL

Dr. Gemima Job¹ Dr. N Prasanna Kumar²

¹Post Graduate Resident ²Professor, Dept of Psychiatry, Andhra Medical College, Visakhapatnam

BACKGROUND:

Chronic schizophrenia patients will have impairment in every day functioning. Disability in schizophrenia can affect the patient’s every day activities and increase caregiver burden. Majority of medication works on positive symptoms compared to negative symptoms and cognitive deficits.The predictors of disability in patients receiving medication were less studied.

In this study, we will be assessing the cognitive and negative symptoms among patients requiring hospital care and assess the relation of severity of negative and cognitive symptom domains on disability with schizophrenia.

AIM:

To study the association of cognitive and negative symptoms of Schizophrenia with disability in patients receiving in patient care.

MATERIALS AND METHODOLGY:

Adult patients with Schizophrenia admitted and getting treated in Government Hospital for Mental Care Visakhapatnam, and who are able to provide consent on their own or through a nominal representative will be included in study.

Patients who are diagnosed with schizophrenia based on ICD 10 criteria will be included in the study. Sociodemographic variables of the patients will be evaluated by sociodemographic proforma. Scale for the assessment of negative symptoms (SANS) will be used to assess negative symptoms and cognitive assessment interview will be used to assess cognitive symptoms. Disability will be assessed using Indian Disability Evaluation And Assessment Scale (IDEAS) scale. The data will be compared and assessed subsequently.

RESULTS:

Results will be discussed after the completion of the study

CONCLUSION:

Conclusion will be discussed after the completion of the study

Psychiatric manifestations of anti-NMDA encephalitis- A life course perspective, through a case report

• Gayathri Rajan* ¹Senior Resident DM, Department of Child and Adolescent Psychiatry, PGIMER, Chandigarh

• Naveen Sankhyan ²Professor and HOD, Department of Pediatric Neurology, PGIMER, Chandigarh

• Renu Suthar ³Additional Professor, Department of Pediatric Neurology, PGIMER, Chandigarh

• Akhilesh Sharma⁴Additional Professor, Department of Child and Adolescent Psychiatry, PGIMER, Chandigarh

• (*Corresponding author-g3cr.89@gmail.com,9995172621, IPS-LOM/G05/22)

Background- Ninety percent of patients with anti-NMDA Encephalitis exhibit initial symptoms of psychiatric illness. These are challenging to distinguish from core mental illness.

Life course perspective is a concept from developmental psychopathology which looks at disorders from a longitudinal perspective as disorders which have roots in childhood have sequelae that persist in adult life.

Aims- To analyze a case of 18-year-old female who had first attack of anti-NMDA encephalitis at the age of 5 years using a life course perspective.

Methods- The index patients typical development prior to the first attack of anti-NMDA encephalitis, developmental regression following the attack, her genetic risks included family history of suicide in father(adverse childhood experience), environmental factors including authoritative parenting by mother(protective factor), poor social support, cognitive decline was present with social quotient on vineland social maturity scale being 54 and cultural factors, which influenced the psychopathology apart from neurological manifestations and inadequate response to immunotherapy.

Results- Though generally a good prognosis is expected the index case has poor prognostic indicators such as significant cognitive decline from baseline.

Conclusion- with respect to the index case the life course perspective is indicative of heterotypic continuity.

Thyroid volume in subjects with bipolar disorder on lithium maintenance: a case-control study

Introduction: Lithium is first-line treatment for bipolar disorder (BD), but is known to cause a spectrum of thyroid-dysfunction. Thyroid ultrasound is likely to assist in an early detection of volumetric or echogenic abnormalities.

Aim: We assess thyroid volume in chronic lithium users with BD and assess the relationship to thyroid functions and prophylactic treatment response.

Method: This was an observational, case-control study of 102 participants. Cases consisted of 52 patients with DSM-5 BD on lithium >1 year. Patients were clinically stable (HAM-D≤ 13, YMRS <8). Controls were 50 healthy individuals without psychiatric illness. Assessments included clinical-proforma, lithium-response scale and NIMH Life-chart Method. Fasting venous sample was used for thyroid-functions and serum-lithium estimation. Ultrasonographic assessment for thyroid was conducted within same week.

Results: Mean age of the cases was 39.42± 12.62 years, with 44% females. Age, gender and residence was comparable. Cases had median illness of 126 months (Q1-Q3=72-228 months) with 54 months of lithium treatment (Q1-Q3:26.75-93), with mean lithium levels 0.67±0.31 mmol/L. Total thyroid-volume was 10.67±5.46 mL for cases and 4.30±2.06 mL for controls (p<0.001). Findings remained significant (p<0.001) for left and right lobe-volume. Mean rank for serum-TSH was higher (p=0.018) in cases. Total thyroid-volume did not show significant correlation with thyroid-functions or lithium response. Conclusion: Findings are indicative of a large thyroid gland in chronic lithium users. The impact of enlarged-thyroid-gland on illness-course and treatment response remains to be assessed in prospective follow-up studies.

Association of pro-inflammatory cytokines with complex post-traumatic stress disorder in patients visiting a tertiary centre in Kathmandu

Complex Post-traumatic stress disorder (CPTSD) is a newly validated mental disorder that can occur after trauma. Although inflammatory markers such as cytokines are found altered in trauma and PTSD, there are no studies exploring biomarkers in connection to CPTSD. As a part of the Study Of Health Outcomes of Trauma (SHOT Study), we analyzed cytokines among trauma-affected patients and matched healthy controls. Fifty patients (cases) with trauma, visiting the University hospital in Kathmandu and thirty-nine healthy controls were selected, and the levels of cytokines were determined using a Luminex IS 200. Further, to remove biases, we compared the levels of the cytokines in thirty-four age and gender-matched pairs of case and control among three groups: healthy volunteers, cases diagnosed as PTSD, and cases without PTSD. Among the 34 pair-matched cases and controls, IL-1β, IL-6 and TNF-α were significantly higher in CPTSD positive cases [0.26 (0.05-0.39) pg/ml; p = 0.036], [3.57 (2.15-9.84) pg/ml; p = 0.000] and [58.87 (46.97-77.35) pg/ml; p = 0.036] respectively, than in controls [0.00 (0.00-0.115) pg/ml], [0.39 (0.00-1.45) pg/ml], and [30.15 (23.33-43.42) pg/ml] respectively for IL-1β, IL-6 and TNF-α. This shows the need to explore further for the biochemical markers of CPTSD.

Dr. Riya Gangwal1, Dr. V.S. Pal2, Dr. Pali Rastogi3, Dr. Priyash Jain4

1Junior Resident, Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh 452001, India

2Professor and Head, Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh 452001, India

3Professor, Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh 452001, India

4Senior Resident, Department of Psychiatry, MGM Medical College, Indore, Madhya Pradesh 452001, India

“Spirituality and Resilience in Depression: Exploring the Correlation and Implications for Treatment”

Introduction: In recent years, the influence of spirituality on well-being has gained recognition, particularly in psychiatric contexts. Depression, a pervasive and treatment-resistant mental health challenge in some cases, poses substantial socioeconomic burdens. This study explores the link between spirituality and resilience within depression, seeking innovative treatment implications to enhance the well-being of affected individuals.

Aim: To assess the link between spirituality and resilience in individuals with depression.

Methods and Materials:

The cross-sectional study was conducted in a Tertiary Healthcare Center in Central India after approval from the institutional ethical committee. The study included 50 patients and 50 healthy controls attending the Psychiatry Outpatient Department (OPD). They were assessed using a semi-structured proforma consisting of socio-demographic and clinical variables. Clinical rating scales, i.e., Hamilton Rating Scale for Depression (HAM-D), Spiritual Well-Being Scale (SWBS), and Connor-Davidson Resilience Scale (CD-RISC), were applied. Data obtained will be statistically analyzed using SPSS.

Results and conclusions will be discussed during the final presentation.

Neuropsychiatric aspects of Autoimmune encephalitis : A narrative review

Ojasvi Meena, Vaibhav Patil

Introduction

Autoimmune encephalitis, with an estimated annual incidence of 8 to 15 cases per 1,000,000, primarily affects females. It often starts with psychiatric complications, such as psychosis and catatonia, predominantly in young adults. Specific symptomatology for diagnosis of autoimmune encephalitis is lacking, which can complicate diagnostic process.

Methods

A narrative review of the relevant studies focusing on neuropsychiatric aspects in patients with autoimmune encephalitis was conducted

Discussion

Autoimmune encephalitis presents with diverse psychiatric symptoms, including disorientation, cognitive dysfunction, psychosis, and mood disorders. Specific autoantibodies are associated with suicidal tendencies, but no consistent antibody-symptom correlation exists, except for NMDA autoantibodies in catatonia and Ma/Ta autoantibodies in obsessive-compulsive behavior. Psychiatric symptoms vary with different autoantibodies, emphasizing the importance of comprehensive autoantibody testing. Timely diagnosis and immunotherapy are essential. Evidence for psychiatric drug treatments is limited, with better outcomes when initiated post-diagnosis and immunotherapy. Electroconvulsive therapy is an option for refractory cases, particularly catatonia. Glutamatergic receptors may play a role in psychiatric disorders, but autoantibodies in psychiatric patients need further investigation.

Conclusion

Autoimmune encephalitis presents complex clinical picture ranging from agitation, sleep disturbances to hyperactive delirium symptoms. Neuropsychiatric manifestations in autoimmune encephalitis can be primary presentation and may emerge subacutely, with severity linked to specific antibodies. Early diagnosis and treatment may fasten and improve the recovery process.

Keywords : Autoimmune encephalitis, neuropsychiatric aspects and presentation

URIC ACID AS A POTENTIAL AND EMERGING BIOMARKER OF BIPOLARITY- A COMPARISON STUDY

Aaliya Khanam1, Zaid Ahmad Wani1, Junaid Nabi1, Nigah Nazir1, Rajnish Raj1

¹Institute of Mental Health and Neurosciences, Kashmir.

Background: Data emanating from current research hints at the involvement of purinergic system in the pathophysiology of bipolar disorder. As one of the non-enzymatic antioxidant systems, uric acid may participate in the pathogenesis of bipolar disorder through oxidative stress and other mechanisms. The latest research findings suggest that serum uric acid levels demonstrate a very good-to-excellent prognostic accuracy as a biomarker for conversion to Bipolar disorder in depressed subjects, so it is crucial to explore the association between uric acid levels and bipolar disorder.

Methods: we recruited a total of 159 patients of bipolar disorder, during active mania, and depressive mood episode, patients of unipolar depression and 50 age and gender matched healthy controls in the study. Young mania rating scale (YMRS) was used to rate manic symptomatology, while as Hamilton rating scale for depression (HAM-D) was used to rate depressive symptomatology.

Results: we found significantly higher uric acid levels in patients of acute mania, as compared to unipolar depression and demographically matched control group( p -= 0.004). we also found a positive corelation between mean YMRS scores and serum uric acid level in patients of maniaO.

Conclusion:. ur results indicate a strong association between serum uric acid levels and bipolar disorder. Further studies about whether uric acid levels can be an independent and economical biomarker for bipolar disorder need to be investigated.

Bipolar disorder, biomarker, uric acid, YMRS.

Effects of Mobile Use on Subjective Sleep Quality

Presenting author-Dr.Alisha Sunil Co-author–Dr.Sushil Gawande

Background:

Sleep is a physiologically regulated state of unconsciousness. We spend close to one-third of our lives asleep. Over the past 10-20 years, there has been significant decrease in amount of sleep that people get.

Aim:

This study aimed to investigate the relationship between mobile-related sleep risk factors(MRSRF) and subjective sleep quality.

Methodology:

• The tools used were Pittsburgh sleep quality index (PSQI) and MRSRF online questionnaires.

• Sample size- 114

• Sample population- Online survey

Results:

• In participants with more than 8 hours of mobile phone usage(n=7), 71.43%(n=5) had a bad sleep quality.

• In participants who had more than 30 mins of screen time in bed after the lights were turned off(n=34), 61.76%(n=21) had bad sleep quality.

• 57 participants kept their phone near pillow during bedtime, out of which 61.4%(n=34) had bad sleep quality.

• 57.58%(n=38) participants who did not use blue light filter while using mobile phone in bed had bad sleep quality.

• 51.76%(n=44) participants who did not use airplane mode during sleep had bad sleep quality.

• Engineers(71.43%) showed higher prevalence of bad sleep quality compared to other professions such as IT professionals(50%), medical professionals(52%) and others(50%).

Conclusion:

Comparison of sleep quality in participants with various MRSRF indicated that subjects who use mobile for >8hours/day, use mobile after the lights have been turned off for atleast 30minutes (without blue light filter in mobile), who put mobile near their pillow while sleeping have statistically significant poor sleep quality respectively.

ABSTRACT FOR PAPER: A cross-sectional study assessing mobile phone addiction and its correlation with depression and sleep quality.

Dr. Kartikay chaturvedi1, Dr.V.S Pal2, Dr K R Bagul3, Dr Priyash Jainl4

1Junior Resident, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh 452001, India

2Professor and Head Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

3Professor, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

4Senior resident, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

BACKGROUND

Mobile phones have become an essential communication tool worldwide, with India having 831.54 million mobile connections, the second-highest mobile connections after China. This ubiquitous penetration of mobile phones, especially smartphones, has resulted in an increased prevalence of mobile phone addiction. Numerous studies have previously established an association between mobile phone addiction and depression, anxiety, and sleep disturbance. However, studies have been lacking in the Indian context.

AIM and OBJECTIVE

To study the prevalence of mobile phone addiction and to study its correlation with sleep quality, and depression in undergraduate medical students.

METHOD

The present study is a cross-sectional study performed on Undergraduate medical students at a tertiary care institute. The subjects who provided consent to participate in the study were required to fill mobile phone addiction scale, Pittsburgh sleep quality index, and PHQ-9. Data obtained will be analysed using an open-source statistical analysis computer program “R”.

RESULTS and CONCLUSION

Will be discussed during presentation

Presenter – Dr. Kartikay chaturvedi

Junior Resident, Department of Psychiatry,

MGM Medical college ,Indore

E-mail – kartikaychaturvedi143@gmail.com

Psychiatric Morbidity In Psoriasis Patients Attending Tertiary Care Centre – A Pilot Study.

Dr Sumedha M*, Dr B C Jahnavi**, Dr Radha Krishna Raju***

Background: Psoriasis is a deformative, recurrent and chronic dermatological condition that is linked to a number of psychological disorders that might exacerbate it. So there is a need to recognize these psychiatric co-morbidities in such patients and treat them accordingly to enhance their way of living.

Aim & Objectives: The purpose of the study was to evaluate the prevalence of psychiatric illness and associated morbidity in psoriasis patients

Methodology: MINI international psychiatric interview was utilized to screen for psychiatric morbidity in patients with psoriasis and ICD 10 criteria was utilized to confirm the diagnosis in 60 consecutive clinically diagnosed patients.

Results: According to our study 76.66% (n=46) of psoriasis patients had general psychiatric morbidities. The distribution of particular psychiatric morbidities in our current study is as follows. Depressive disorder 43.33% (30%- mild depression, 11.66%- moderate depression, 1.66% severe depression). Anxiety disorders 25% (GAD-13.33%, panic disorder- 8.33%, social phobia-3.33%). Alcohol dependence in 8.33%.

Conclusion: Psychiatric comorbidity is significantly increased in psoriasis. Most prevalent psychiatric illness associated with psoriasis is depression. Therefore for better results and management, psychiatric examination is necessary for psoriasis patients.

Key words: psoriasis, psychiatric co-morbidity, MINI, Depression, Anxiety, Alcohol dependence.

The retina as a window to the brain—from eye research to CNS disorders

Dr. Shabir Ahmad Dar

Lecturer ,Postgraduate Department of Psychiatry ,Govt. Medical College, Srinagar, J&K

Emai:shabir1055@gmail.com

Background: This study’s purpose is to determine the effects of current episode and the mood stabilizers on chorio-retinal layer thicknesses of bipolar disorder (BD) patients using spectral-domain optical coherence tomography (SD-OCT).

Methods: Sixty-seven patients were diagnosed with BD I and using lithium (Li) or valproic acid (VPA), of whom 20 were manic, 24 were depressive, and 23 were in remission, and 49 healthy individuals were included in the study. Peripapillary retinal nerve fiber layer (RNFL), ganglion cell layer, and macular thicknesses of the participants were measured automatically using SD-OCT, and their choroid layer thicknesses were measured manually using the depth imaging mode of SD-OCT. Statistical analysis of the data was performed using Statistical Package for the Social Sciences version 23.0.

Results: The patient group’s mean age was 39.78 ± 11.78, and the control group’s mean age was 42.06 ± 12.10. The mean disease duration was 13.22 ± 8.23 in the patient group, and 26 patients were using Li. While peripapillary RNFL thicknesses were lower in the patient group (P < .05), other layer measurements were similar between the groups. Moreover, the episodes experienced by BD patients did not affect chorioretinal SD-OCT measurements. The patients on VPA had significantly lower RNFL thicknesses compared to the control and the Li groups, and all chorioretinal measurements were similar between the Li and the control groups.

Conclusion: As a result of the study, it was established that neurodegenerative processes play a role in the pathophysiology of BD and the usage of Li is protective against the neurodegeneration of RNFL. Retinal changes measured with SD-OCT can be used for the diagnosis and prognosis of BD and for evaluating responses to mood stabilizers.

Keywords: Bipolar disorder, Peripapillary retinal nerve fiber layer, spectral-domain optical coherence tomography

Comparison of anxiety and depression among primary caregivers of cancer and schizophrenia patients and association with their quality of life

Dr. Arnab Deb, Senior Resident, Agartala Government Medical College

BACKGROUND:

Cancer and Schizophrenia, one physical and other mental illness, both requires long term treatment along with caregiver support. Existing study results show a marked increase in the levels of anxiety, depression and reduction in quality of life among caregivers for both cancer and schizophrenia patents.

AIMS:

To determine the level of anxiety ,depression and their association with the quality of life among the primary caregivers of cancer and schizophrenia patients.

METHODOLOGY:

120 consenting Primary caregivers (60 each for cancer and schizophrenia), were interviewed using Hamilton Anxiety Rating scale, Hamilton Depression Rating Scale and WHOQOL-BREF scale. Chi-square test was used, p-value <0.05 was considered statistically significant.

RESULTS:

Among the cancer caregivers, 46.7% had anxiety and 36.7% had depression. Among the schizophrenia caregivers, 43.3% had anxiety and 40% had depression.

The QOL was significantly low over physical and psychological domains among schizophrenia caregivers who had anxiety and over physical, psychological and environmental domains among those who had depression.

The QOL was significantly low over all 4 domains of WHOQOL-BREF among cancer caregivers who had anxiety and over physical, psychological and environmental domains among those who had depression.

CONCLUSION:

This study results indicate upmost importance for taking care of the caregiver’s need and psychiatric morbidities which will also help in treatment outcome of patients.

Treatment adherence in psychiatry. Should I take my pills?

Shivangi Mehta , Priti Arun, Harmanpreet

Background

Treatment adherence is most important determinant of management of psychiatric disorder. Limited studies have evaluated the effects of patient-specific factors on medication adherence among patients with mental disorders. Current study aimed to assess medication adherence and its associated factors among patients with severe mental illness, chronic mental illness, substance addiction, geriatric psychiatric clinic and child guidance clinic.

Methodology

Study design was cross-sectional, hospital-based study. Study recruited total of 50 subjects including 10 patients each with diagnosis of Severe Mental Illness( SMI), Common Mental Illness(CMI), Substance Abuse, Neurodevelopment Disorders( NDD), geriatric patients with psychiatric illness. The sociodemographic details were noted on structured proforma. The Medication Adherence Rating Scale was applied for assessing medication adherence by the patients or the caregiver. Data collected was analyzed using mean, continuous variables and percentages.

ANOVA was used to compare adherence amongst the groups.

Results

Total of 50 patients were included with mean MARS score was 7.24 1.87). Maximum adherence was in NDD (86%, Mean MARS Score of 8.60 1.07) as medicine was mostly given by caregiver followed by patients of SMI (7.80 0.91) and least in Substance Use patients( 6.20 1.61)with posthoc Bonferroni correction of 0.033 which was significant. ANOVA depicting intergroup differences in adherence as significant. (P-0.022, df-31)

Conclusion: Adherence to medication in psychiatric disorders is a daunting task yet with close supervision as in NDD and SMI, the adherence is less of a challenge.

Treatment adherence, mental illness, NDD, SMI.

Background : self-efficacy , a concept introduced by Albert bandura as a part of his Social Cognitive theory ,is defined as an individual’s belief in their capability to organize and execute specific courses of action to achieved desired results .it plays a pivotal role in governing human behavior ,including health behaviors. Bandura suggested that self – efficacy beliefs could govern the ability to resist substance use by influencing cognitive process , affecting emotional responses , and leading to the acquisition of problem - solving skills and coping strategies

However the role of self efficacy in substance use is multifactorious and complex . It varies by substances used , by individual characteristics , and by environmental context

Methods : a cross sectional study was conducted on patients who was had been previously admitted in IMH for detoxification and now on regular follow up for de-addiction . subjects was divided into two groups ,one group are those who consumed alcohol in the past one month after taking detoxification (Relapse) and another group those who did not consume alcohol at least in the past 3 months after treatment ( Abstinence ). All study subjects were assessed using Alcohol Abstinence Self Efiicacy scale (AASES-C ,AASES-T) and Multidimensional Scale of Perceived Social Support( MSPSS)

AIM OF THE STUDY

To study/ assess the role of self-efficacy in dealing with substance (alcohol) use

Objectives

To assess the role of self efficacy in contributing to relapse To assess the role of self efficacy in maintaining abstinence

RESULTS

CONCLUSIONS

CLINICAL PREDICTORS OF SERUM CLOZAPINE LEVELS- AN EXPLORATORY STUDY FROM NORTH INDIA, KASHMIR

Aaliya Khanam1, Zaid Ahmad Wani1, Junaid Nabi1, Nigah Nazir1

¹Institute of Mental Health and Neurosciences, Kashmir.

Background: Clozapine remains underused and is associated with many clinical challenges, including difficulties in predicting therapeutic serum levels (350-600ng/mL). we investigated the association between clozapine dose and serum level, and the clinical predictors of the clozapine serum level, in patients of treatment resistant schizophrenia.

Methods: This was a cross-sectional study in which 97 patients of resistant schizophrenia were recruited from clozapine clinic. We used a single measure of the serum clozapine level, which was collected 12h after the last oral dose of clozapine under steady-state conditions.

Results: The average clozapine dose and serum level was 400mg/day and 705ng/mL, respectively. Majority of patients had serum levels higher than 700ng/ml. Majority of patients were on polypharmacy with Amisulpride, valproate and lithium being the most common psychotropic augmenting agents. Modified electroconvulsive therapy augmentation was present in 59% of patients. We found that Clozapine dose and serum levels were positively correlated (rs [⁹⁴]=0.32, p=0.002).

On multivariate regression model, dose of clozapine, fluvoxamine and smoking status were found to predict the serum clozapine levels.

Conclusion: These findings highlight the significance of individualised therapeutic drug monitoring, which may assist clinicians while prescribing clozapine to resistant schizophrenia patients of Kashmiri population. Our exploratory study lays a roadmap for future psychopharmacological studies on this demographic population.

Keywords: clozapine, drug levels, therapeutic monitoring.

Background: Impulsivity has been recognised as a significant risk factor predisposing the initiation and continuation of excessive alcohol use. Evidence suggests that impulsivity is also a result of alcohol use disorder (AUD), for which mindfulness-based approaches have been proven to be effective. However, the specific link between mindfulness and impulsivity has been little explored with a particular dearth of Indian studies.

Aims: This study aims to investigate the association between impulsivity and mindfulness in patients with AUD in an inpatient setting in Telangana, India.

Methods: Patients in a rehabilitation centre meeting a diagnosis of AUD as per DSM-V completed self-report measures of Short UPPS-P Impulsive Behavior Scale (SUPPS-P) and Five Facets of Mindfulness Questionnaire (FFMQ-SF).

Results: The measures obtained were analysed using Statistical Package for Social Sciences (SPSS) V 26. It was found that SUPPS-P facet negative urgency inversely correlated with non-reactivity facet of FMMQ-SF scale, also facets of SUPPS-P like lack of premeditation and lack of perseverance negatively correlated with acting with awareness facet of FMMQ-SF.

Conclusion: Relationships of varying magnitudes were discovered between dispositional mindfulness and impulsivity domains in people with AUD, implying that higher mindfulness skills are associated with less impulsive traits. Our findings call for more long-term research into the ability of specific mindfulness components to reduce impulsivity in AUD inpatients, as well as the underlying mechanisms.

Challenges in striving for tobacco cessation in Psychiatric In- patients -A Qualitative Study

Dr. Jewel Johns (Junior Resident), Dr. Priya Sreedaran (Associate Professor) St. John’s Medical College and Hospital, Bangalore

Background: Prevalence of tobacco dependence in psychiatry inpatients is high. However, this population is underserved with respect to tobacco cessation. This is of concern as tobacco dependence is a modifiable cardiovascular risk factor in psychiatric in-patients who could suffer from metabolic syndrome due to psychotropics.

Aims: To describe the challenges in targeting tobacco cessation in psychiatric in-patients. We used a qualitative study design.

Materials and Methods: 10 eligible psychiatry in-patients were assessed for capacity to participate in this study. Written informed consent was then taken. These participants had received a telephonic brief intervention (TBI) for tobacco cessation. TBI comprised of inquiry into their mental health, status of tobacco use, and encouraging them to discuss tobacco cessation with their treating team. As part of this inquiry, we obtained information on the challenges faced while trying for tobacco cessation.

Results: We used thematic analysis to generate themes reflective of the challenges. These themes included difficulty in access to phones to contact health care professionals, relapses of psychiatric symptoms and decreased focus on use of Nicotine Replacement Therapy.

Conclusions: It is essential to treat tobacco dependence as a psychiatric co-morbidity and give it the necessary treatment.

ABSTRACT FOR FREE PAPER PRESENTATION

Presenting Author: Dr. Bharat M Mohan

Email id: bharatnyr@gmail.com

Contact Information:

Co-author:

Dr. Poonam M

Professor and HOD,

Department of Psychiatry,

KVG Medical College, Sullia, DK

Socio-demographic Profile And Severity Of Dependence On Alcohol In Patients Diagnosed With Alcohol Dependence Syndrome

BACKGROUND:

As per the World Health Organization, Alcohol Use Disorders (AUD) rank high among prevalent mental disorders worldwide, impacting 8.6% of men and 1.7% of women in 2016. Globally, alcohol was responsible for 5.3% of all fatalities and 5.1% of Disability-Adjusted Life Years in the same year. According to a study, in India, around 18.5% of alcohol users consumed alcohol in a dependent manner.

Social and demographic factors play a significant role in influencing patterns of alcohol use. Understanding the impact of these socio -demographic factors is crucial for designing effective prevention and intervention strategies to address alcohol-related issues.

AIMS:

The obtain a comprehensive social and demographic portrait of individuals diagnosed with Alcohol Dependence Syndrome and to explore how these factors correlate with the severity of their alcohol dependence.

METHODS:

This study was conducted in the Department of Psychiatry, KVG Medical College, between May 2023 and August 2023. Socio-demographic details were recorded using a semi-structured proforma. Alcohol use related parameters were recorded by interview method. The severity of alcohol dependence was be assessed using SAD-Q Questionnaire.

RESULTS:

The sample studied mostly composed of lower middle income, pre-university, males. Almost half the patients were diagnosed with complicated withdrawal features. The mean duration of alcohol use was ~16 years and age of initiation ~19 years. Lower incomes were observed to be linked to increased levels of alcohol consumption. The age of initiation played a role in determining their current drinking habits.

CONCLUSION:

Strategies to enhance awareness of the harmful repercussions of alcohol consumption is needed to curb alcohol abuse. It is imperative to implement family-focused interventions that specifically address the needs of unskilled individuals.

STIGMATIZATION IN HEALTHCARE WORKERS INVOLVED IN COVID-19 CARE PATHWAY; EXPERIENCES FROM AN EXPLORATORY STUDY IN NORTH INDIA

Aaliya Khanam1, Zaid Ahmad Wani1, Jagmeet singh1

¹institute of Mental health and neurosciences, Kashmir.

Background: Health care workers (HCWs) caring for COVID-19 patients are at an increased risk of being stigmatized- which might compromise their individual mental well-being and thereby affect the quality of care they deliver. We conducted the present study to assess COVID-19 stigma among HCWs. Methods: This was a cross-sectional exploratory study in which 133 HCWs were recruited through purposive and snowball sampling. We used a semi-structured socio-demographic proforma and ‘Stigma questionnaire’ to determine stigma amongst HCWs.

Results: More than half of the participants were married (57.1%) , a majority of them were Doctors (59.4%), followed by nurses (23.3%) . Majority were working in COVID-19 designated hospitals (57.9%) during the period of survey with 44.4% directly involved in the care of COVID-19 patients either in COVID ward (39.7%), quarantine or isolation room(27.4%) , COVID-19 clinic (13.7%) or triage for COVID-19 case detection(11%).

Mean overall COVID-19-related stigma score was 40.6±8.0. About 41.4% reported that people don’t want them around their children. Most participants (84.9%) thought they should stay away from their families until COVID-19 subsides (associative stigma) and felt guilty (80.5%) that they might expose their families to infection (self-stigma).

Conclusion: A considerable proportion of HCWs experienced COVID-19 related stigmatisation which highlights the need to develop specific research and targeted interventions particularly addressing COVID-19-related stigmatization among HCWs.

Keywords: COVID-19, HCW, Stigma, Stigmatization.

Free Paper: Study of consultant liaison psychiatry in a medical college with super speciality

Dr Abhishek Gupta1, Dr Nidhi Dixit2

Background: ‘Consultation-Liaison’ demonstrates the inter-relatedness of psychiatry and clinical teaching, facilitating interdepartmental cooperation and effective treatment. A proper treatment of psychiatric illness is possible if the referring doctor also has an understanding of psychiatry.

Aims: To study the cause of referral associated with other variables and follow up in such patients.

Methodology: We had conducted our study for 3 months, taking both IPD & OPD referred patients for psychiatric evaluation, resulting in data of 388 patients. The data was entered in a semi-structured proforma & analysed.

Results: Most of the cases are female, Hindu, either married or in a relationship, of 21 – 30 year age group, referred mostly by the medicine department followed by the neurology department . Most common cause of referral is alleged suicide attempt or self-harm followed by vague somatic symptoms. Most of the follow up is done by the patients (in terms of percentage) by those who have schizophrenia and psychotic disorder, followed by those who have depressive disorder.

Conclusion: Psychiatry referrals are quite low, considering the magnitude of psychiatric illness. The newly joined post graduate student should be sensitized in a manner so that they can identify the signs & symptoms of psychiatric issues associated with their respective speciality for proper referrals. An understanding should also be given to the patient & relative when they come up for the first time, so that proper follow up can be ensured.

PREVALANCE AND CLINICAL CORELATES OF METABOLIC SYNDROME IN MANIC, DEPRESSED AND MIXED BIPOLAR STATES- STUDY FROM NORTH INDIA, KASHMIR

Aaliya Khanam1, Zaid Ahmad Wani1, Nigah Nazir

¹Institute of Mental Health and Neurosciences, Kashmir.

Background: Compared to the general population, the prevalence of metabolic syndrome is reported to be 2-3 fold higher in populations with mental illness. Amongst all psychiatric disorders, bipolar disorder has more frequently been associated to unhealthy lifestyles, as (excessive caloric and cholesterol intake, sedentary life style, and excessive smoking) which contribute to increased cardiovascular risk and thereby predispose to metabolic syndrome.

Methods: The current study was undertaken to find out the prevalence and clinical corelates of metabolic syndrome in 297 patients of bipolar disorder during manic, depressive and mixed states. Metabolic syndrome was diagnosed as per NCEP ATP III criteria.

Results: we found prevalence of metabolic syndrome as 41.8% as per the modified NCEP ATP-III criteria and 38.4% as per the IDF criteria- there was concordance between the two criteria. Increased waist circumference (WC) was the most common metabolic abnormality endorsed by 172 (57.90%) patients in our study. Decreased HDL level was the second most common deranged metabolic parameter present in 157(52.9%). Elevated fasting blood sugars was the least common metabolic parameter 51(17.3%). We found a significant association between age (p=0.001), gender (<0.001) and metabolic syndrome. Higher Life time mood episodes (p<0.001), greater numbers of manic and depressive episodes, increased duration of bipolar disorder, type of mood stabilizer, dose of valproate (p<0.001), lithium (p<0.001) , and lamotrigine, type of antipsychotics (p=0.004) dose of quetiapine and treatment with electroconvulsive therapy (p=0.002) was significantly associated with metabolic syndrome.

Conclusion: Considering the high prevalence rates of metabolic syndrome in patients with bipolar disorder, routine screening for metabolic syndrome is highly indicated.

Keywords: Bipolar disorder, IDF, Metabolic syndrome, NCEP ATP III criteria.

To compare burden of care, quality of life and coping strategies among spouses of alcohol dependence patients and normal individuals

Dr. Pratishtha Singh, Dr. (Brig) Suprakash Chaudhury, Dr. (Brig) Daniel Saldanha

Background: Caregiver of alcohol dependent patient has to suffer burden which impacts their quality of life, so they adapt coping strategies to improve it.

Aim: To study burden of care, coping strategies and quality of life among spouses of alcohol dependence patients.

Method: A case control, analytical, study, where 100 spouses of diagnosed Alcohol Dependence patients were taken as cases and same number of age, sex matched spouses of normal individuals were taken as controls. AUDIT – C scale was applied to diagnose alcohol dependence in patients. M.I.N.I scale on spouses, to rule out chronic psychiatric illness. Burden Interview Schedule, EUROHIS-QOL scale and Brief COPE Scale, were used to find burden on spouses, quality of life, coping strategies.

Results: Mean burden of care score (BIS), mean scores for BIS sub-domains was significantly higher in cases (35.11±4.97) as compared to that in controls (16.56±9.98). There was no significant difference in EUROHIS-QOL between cases and controls. Mean BRIEF COPE scores were significantly lower in cases (77.39±18.10) as compared to that in controls (82.89±16.43).

Conclusion: This study revealed, spouses of alcohol-dependent patients experience high burden of care in all sub-domains. They adapted coping strategies to overcome this burden, mainly adaptive coping strategies, but their quality of life was not much affected.

Keywords: Alcohol Dependence, Burden of Care, Quality of Life, Coping Strategies.

A clinical study to assess Disability and Internalized Stigma among Treatment-Seeking Individuals with Opioid Use Disorders

Background: India being located between the Golden Crescent and the Golden Triangle is vulnerable to being both a destination and transit route for opioids, leading to significant clinical and public health burden.

Aims: This study aimed to assess the disability and internalized stigma among opioid use disorder (OUD) patients.

Materials and Methods: This was a cross-sectional, observational, descriptive study conducted in the drug de-addiction center of a tertiary care medical college and hospital in North India in patients with OUDs. Disability among patients with OUDs was measured using the Indian Disability Evaluation and Assessment scale (IDEAS), while stigma was measured using the Internalized Stigma of Mental Illness scale.

Results: Among 100 patients with OUD, maximum impairment noted was in interpersonal relationships followed by the work domain. However, the least affected was the self-care domain. The mean total score of internalized stigma was 4.31 ± 0.39. There was a statistically significant correlation between demographic variables with injection drug use and high-risk behavior (r = 0.92, P < 0.01, and 0.883, P < 0.01, respectively).

Conclusions: Disability assessment using IDEAS among patients with OUD shows a significant impairment across various domains. The highest degree of disability was found in the interpersonal relationships followed by the work domain. Targeting internalized stigma in patients with OUD can contribute toward reducing the disability associated with it.

Keywords: Indian Disability Evaluation and Assessment scale, internalized stigma, opioid use disorders

The impact of Mean platelet volume and neutrophile-lymphocyte ratio on the Diagnosis of Depression

Background: Depression is one of the most common disorders. 3.3 – 5% population in India are affected. Diminished activity of serotonin pathways plays a causal role in the pathophysiology of depression. Peripheral platelet models are used as the indicator of central serotonin (5HT) metabolism since they reflect central serotonergic function. Mean Platelet volume (MPV) is a potential indicator of platelet activity, and a significant relationship has been reported between MPV and depression. Another etiological hypothesis for depression is inflammatory mechanism. Assessment of neutrophil-lymphocyte ratio (NLR), calculated through a simple blood count is shown as a new biomarker in determining systemic inflammatory response in depression.

Aim: To assess the MPV and NLR in depression and their correlation with the severity of depression.

Method: This study included 40 patients with depression and 40 healthy controls. Severity of depression was assessed by Hamilton Depression Rating Scale (HAM-D). Sociographic details were collected and MPV and NLR values were compared.

Result: NLR (t=2.15, p=0.03)and MPV (t=3.63, p=0.0005) were high in depressive patients compared to controls and this difference is statistically significant. NLR and MPV values were higher in females when compared to men as well as in patients with suicidal ideations when compared to patients without suicidal ideations, although the values were not statistically significant. As the severity of depression increased, the MPV values also increased which is statistically significant (p=0.02). Pearson correlation showed HAM-D was negatively correlated with NLR (R=0.05, p=0.75) and positively correlated with MPV (R=0.08, p=0.62)

Conclusion: Levels of serotonin and inflammation plays an important role in depression as indicated by levels of MPV and NLR and can be used as potential value as biomarker for depression.

Aim: To compare the Executive Functions among males with Alcohol Use Disorder (AUD) and Low Risk Drinkers.

Background: Executive functions have a role in attention, working memory coordination and integration of information, set shifting and inhibition of responses. Several psychiatric conditions lead to impairment in executive functions. Substance use disorder is one among them. Studies have demonstrated that excessive consumption of alcohol for prolonged periods results in executive dysfunctions. Prominent deficits found in alcohol use disorders are impairment in abstract ability, complex visual-motor functions, attention, working memory and set-shifting.

Methods: Initial screening with AUDIT was used in the alcohol use disorder group and low-risk drinker group. In alcohol use disorder SADQ was applied to assess the severity. Both groups were rated on the alcohol urge questionnaire (AUQ) before and after giving appetitive cues with Geneva Appetitive Alcohol Pictures. Tests for executive functions (Stroop, Trail making test, Wisconsin card sorting Test) were applied to both groups.

Results: Cue-induced increase in AUQ was significantly higher (f=11.838, p=0.01) in AUD group than low risk drinker group. The correlation between AUQ and trail making test time scores were higher in AUD group (r=0.327) than low-risk drinker group (0.028). The correlation between AUQ and WCST percentage error was higher in AUD group (r=0.418) than low risk (r=.154).

Conclusion: Persons with AUD group had poorer executive function profile and their executive functions Were related to their alcohol urge to a greater extent than low risk drinkers.

Dr Parul Narwar¹, Dr Priti Arun¹, Dr Sushmita Bhattacharya¹

¹Department of Psychiatry, Government Medical College and Hospital, Chandigarh.

Hidden Struggles Behind the Battle: Unveiling Psychiatric Morbidity in Cancer Patients

Background -Cancer diagnosis and treatment constitute a life-altering experience, often resulting in a profound impact on an individual’s mental health. It is not only a physical battle but also takes a significant toll on the mental health of patients. Understanding the prevalence and nature of psychiatric morbidity, among cancer patients is crucial for comprehensive care. This study aimed to investigate the occurrence of psychiatric illnesses in a sample of cancer

Introduction- Cancer patients often face emotional distress, but the extent and specific types of psychiatric morbidity in this population are not well-documented. This study sought to fill this gap by examining the presence of psychiatric illness in cancer patients.

Method: A cross-sectional study was conducted involving 35 cancer patients undergoing treatment at a tertiary care centre. Participants completed structured clinical interviews and validated psychological assessments to diagnose psychiatric conditions. Data were analysed to determine the occurrence of psychiatric morbidity.

Result- Among 35 cancer patients surveyed, 22 (62.9%) were suffering from psychiatric illnesses. Among these, 11 (31.4%) were had depressive disorder, and an additional 11 (31.4%) were diagnosed with anxiety disorders. The co-occurrence of depressive and anxiety disorders was also noted, highlighting the complexity of emotional challenges faced by individuals dealing with cancer.

Conclusion- This study underscores the substantial burden of psychiatric morbidity in cancer patients, particularly in the form of depressive and anxiety disorders. Early identification and management of these conditions are essential to improve the overall well-being and quality of life for cancer patients.

Acute and transient psychotic disorder: An overview of symptom profile ,course and risk factors – a cross sectional study

Dr. Sathya Prabha

Background: There exists lack of clarity regarding the risk factors, onset , impact of stressors, course, symptoms profile and efficiency of antipsychotics in the short lived psychotic disorder i.e, acute and transient psychotic disorder. These conceptual lacunae result in variation of classification in diagnostic criteria in ICD 11 and DSM 5,which hinders in treatment protocol, follow up and long term treatment decisions and also research.

Aim: This study aims to throw some light over these factors contributing to the heterogeneity of symptomatology, strength of association of stressors .

Methodology:

The sociodemographic details, stressors , symptoms of the patients present with acute psychosis, to the tertiary care mental heath center is collected and analyzed based on mini 7 version. Those who have diagnosed as acute psychosis has been followed up for three months and the course of the disorder is analyzed with rating scales. The outcomes are studied and the association between the risk factors and outcome is studied.

Results:

The results to be discussed.

Non suicidal self injury and its functions among medical students: A cross sectional study.

BACKGROUND:

NSSI is defined as intentional self infliction or damage to the one’s body without any suicidal intent. The functions of the behaviour could be to obtain relief from negative feeling, to resolve an interpersonal difficulty or induce a positive feeling state.

Common examples include cutting, burning, scratching, and banging or hitting, Self-injurious behavior is increasing among college students, and is common in both psychiatric and nonclinical populations. NSSI and suicidal thoughts/behaviors (STB) in young adult populations constitute areas of significant medical and psychiatric concern.

AIMS:

To study the prevalence and understand the functions of Non suicidal self injury in medical students and association with adverse childhood experiences and to evaluate psychiatric morbidity in them.

METHOD:

Data collected through online questionnaire using tools like THE NON SUICIDAL SELF INJURY ASSESSMENT TOOL (NSSI-AT),PHQ -9,INVENTORY OF STATEMENTS ABOUT SELF-INJURY (ISAS),ADVERSE CHILDHOOD EXPERIENCE (ACE) QUESTIONNAIRE.

All undergraduate medical students at Gandhi medical college & hospital, secunderabad.

RESULTS:

Prevalence of non suicidal self injury was 24.5% among medical students with 29.5% of them in form of severe scratching/pinching,12.9% in form of engaging in fighting,12.9% in form of cut wrists. Functions of NSSI were determined using ISAS with predominant functions being Affect regulation with score of 0.73,Self punishment with score of 0.62 and Anti Dissociation with score of 0.35.

CONCLUSION:

This study highlights the higher prevalence of NSSI among medical students and importance of considering independent functions for self injurious behaviours.

Impact of Social Media over Quality of Sleep among Medical Students

Dr.Dhatri Sri Bheemavarapu1,Dr.Arpita B2,Dr.Likhita Bandi3

1.Postgraduate 2.Assistant Professor 3.Senior Resident Department of psychiatry , GSL Medical College , Rajahmundry

Background : Social media use has grown rapidly over recent years . Despite the mirage of early advantages, its negative effects are increasingly being recognized with time, especially in younger population. This behaviour has been seen to develop at the cost of healthy biological and behavioural habits, including sleep pattern. It is necessary to identify the sleep quality of social media user and how social media interrupt their sleeping behaviors

Aim: To assess impact of using social media on sleep quality among medical students

Methods: Cross-sectional study conducted in undergraduate students of a private medical college , using socio-demographic variables , social networking addiction scale , pittsburg sleep quality index

Results:There is a significant correlation between social media usage and quality of sleep among medical students

Conclusion: It will be useful to see the overuse of social media networks as a public health problem, to avoid dependency . There is a strong need for integrating sleep hygiene education and to promote correct and effective use of social networks to minimize their possible side effects among medical students

A study on quality of life and prevalence of depression in information technology(IT) professionals in South India.

Dr Visishta Praphulla Rejeti¹ , Dr B. Arpitha², Dr. Likhita Bandi³

1.Postgraduate 2.Assistant Professor 3.Senior Resident

Department of psychiatry, GSL Medical College

Background: In recent decades , the IT sector has rapidly grown in India and majorly in South India with lakhs of IT professionals involved. The employees become stressed when they are given unachievable targets and deadlines. Hence there is a need to assess their quality of life and depression among them.

Aim: To find the prevalence of quality of life and depression in IT professionals in South India.

Method:

This is a cross-sectional online study , using snowball technique of sampling and using screening questionnaires like quality of life scale and patient health questionnaire 9.This study will be conducted specifically on professionals working in an IT firm with the designation of a software engineer.

Results: The quality of life scores in IT professionals being affected by various factors and the outcome interleading to various psychiatric illnesses especially depression.

Conclusion: Poor quality of life and depression in software engineers could hinder the progress of IT development and also increases the incidence of psychiatric disorders.

An operational study on the need for Home-Based Assessments for autistic individuals in their care and intervention plan.

Harshita Shetty1, Anjali Mathew1, Suhas Chandran1

Background: Autism Spectrum Disorder (ASD) is a lifelong condition which implies that most individuals require help even in their adulthood. Teen-years, in general, have their difficulties which in-turn can be difficult for individuals diagnosed with ASD. There are no manualized interventions or assessment present for young-adults with ASD. The idea of planning home-based assessments is not popularized in India. There are a few NGOs or centers working with adults with ASD, but none of their activities are manualized or published.

Aims: Our aim is to standardize home-based assessments for young-adults with ASD which helps us to practically assess their functional-skills, social-skills and family-functioning in a setting where they’re comfortable and give us a better understanding. This will aid in providing necessary treatment-services and interventions required for the complete family.

Methods: Home-visits were conducted for thirty-five of the participants. A Home-Based Assessment Proforma was curated by our multi-disciplinary team which covers various aspects to understand in-depth about these families and the participants’ behaviors.

Results: Most of our participants were able to perform the tasks given better and their interaction with our teams was also improved, compared to their hospital-visits. It helped us build a rapport with the young-adults and their families, gave us a clear idea of their household settings and of the care-givers’ issues.

Conclusion: We could identify and assess the functional-skills, social-skills and family-functioning of our young adults in an in-depth manner. The study is the first of its kind in an Indian setting, focusing on home-based assessments.

MODIFIED ELECTROCONVULSIVE THERAPY AND METABOLIC SYNDROME : AN EXPLORATORY STUDY FROM NORTH INDIA

Aaliya Khanam¹, Zaid Ahmad Wani^1, Inam ul Haq²

¹Institute of Mental Health and Neurosciences, Kashmir.

²Government Medical College, Srinagar.

Background: Modified Electroconvulsive therapy (mECT) is the treatment of choice in suicidality, catatonia and resistant psychiatric disorders like treatment resistant depression, bipolar disorder and schizophrenia. A handful of studies with modest sample sizes have suggested some effect of mECT on metabolic parameters like glycemic control and cholesterol levels, however, not a single study has explored the association between mECT and Metabolic syndrome. Hence the present study was undertaken to find out the prevalence of metabolic syndrome and to explore its clinical corelates in patients receiving mECT. Methods: This was a cross-sectional exploratory study in which 89 patients receiving mECT were recruited via purposive random sampling and evaluated for metabolic syndrome by using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Results: The prevalence of metabolic syndrome in patients receiving modified electro-convulsive therapy was 55.06% as per modified NCEP ATP-III criteria. The most common metabolic abnormality noted was elevated blood pressure, with increased diastolic blood pressure in 71.9% of patients and elevated systolic blood pressure in 67.42% of patients, followed by increased triglycerides in 65.17% of patients. Third most common metabolic abnormality noted was increased waist circumference, present in 44.94%.. Least common metabolic derangement was elevated blood sugar noted in 23.60% of patients.

We found a significant association between age (p <0.001 and gender of patients on ECT with metabolic syndrome. (p = 0.019). Having received mECT’s in past (p <0.001) and a higher number of mECTs (p <0.001)were both significantly associated with metabolic syndrome.. On multi-variate logistic regression metabolic syndrome was significantly predicted by number of mECTs [ {(unadjusted odds ratio 1.57), (adjusted odds ratio 1.52)}(p value <0.001)}]

Conclusion: Our findings revealed an increased prevalence of metabolic syndrome in patients recieving mECT, this highlights the importance of screening for metabolic syndrome at an early stage to employ timely care so as to reduce the risk of cardiovascular disease and premature death.

Keywords: ECT, Metabolic syndrome, metabolic derangement, NCEP ATP III criteria.

A cross-sectional study to assess day time sleepiness and sleep quality in adults with smartphone addiction.

Dr Divya J, Dr M Prajwala, Dr D Pavani

Junior Resident, Assistant Professor, Junior Resident

Background: World is ever changing due to advancement in technology and science, one among such is the field of smartphones.

Smart phone is the most dominant. portal of information and communication technology Smart phone addiction is a common worldwide problem which negatively affects mental and physical wellbeing.

Aim: The study aims to assess the relationship of smartphone addiction and excessive day time sleepiness and sleep quality among adults.

Methods: A cross-sectional study was conducted on sample of 189 students. Semi-structured proforma was used to collect sociodemographic data and students were asked to complete self-administered rating scales, namely Epworth sleepiness scale (ESS), Pittsburgh sleep quality index (PSQI), Smart phone Addiction scale-short version (SAS-SV)

Results: There was found to be positive correlations between day time sleepiness scale and smartphone addiction and significant correlation between smartphone addiction and sleep quality.

Conclusion: Increasing popularity in trends of smartphone usage, significant time is being spent on smartphone has resulted in development of addictive tendencies. This study concludes adults are not only addicted but also are developing significant sleep and behaviour problems owing to excessive smartphone usage.

Resilience and well-being in patients with chronic kidney disease a cross sectional study

Dr.Mohana M¹,Dr. S.J.Daniel²^, Dr. C. Jayakrishnaveni³

¹MD Postgraduate, Department of psychiatry, Kilpauk medical college and hospital, Chennai.

²Assistant Professor, Department of psychiatry, Kilpauk medical college and hospital, Chennai.

³Associate Professor, Department of Psychiatry, Kilpauk Medical college, Chennai.

Background:

Chronic kidney disease is rapidly growing global health burden with approximately 735,000 deaths per year. Patients with chronic kidney disease undergo various stages of therapeutic adaptation which involve lifestyle modifications, physical changes, and adjustment to renal replacement therapy. This process produces adaptive stress. Individuals differ in their adaptive capacity and psychological factors play a role in management and outcome among persons with CKD. Resilience has been associated with greater adherence to treatment, better outcomes, and improved quality of life (QOL) in people with chronic health conditions.

Objectives:

To study Resilience related to perceived stress and well being in chronic kidney disease.

Methods:

The study was conducted among patients attending the Nephrology OPD in a tertiary care hospital. 50 consecutive patients with chronic kidney disease were included in the study. Informed consent was obtained. A Semi structured proforma was used for obtaining socio-demographic and clinical variables. The patients included in the study were administered CD-RISC, PSS, OHI.

Results:

Significant distress is common among patients with CKD. Resilience is a protective factor.

Conclusion:

Resilience, and well-being are correlated in patients with CKD, and resilience is an independent predictor of well-being. Therefore, clinical care providers need to access the resilience level of CKD patients as early as possible and design appropriate interventions to improve both medical and mental health outcomes.

Knowledge, Attitude and Perception towards mental illness and Psychiatry as a branch among nursing students – An analytical cross-sectional study

Dr.G.Sasidharani (Junior Resident), Dr.Bharathi.G (Assistant Professor), Dr.Santosh.S.V

(Professor and Head)

HIMS, Hassan

BACKGROUND:

Nursing staff plays a major role in reducing the stigma towards mental illness in the community by creating awareness regarding mental illness and mental health.

AIMS:

This study aims to assess the knowledge, attitude and perception (KAP) towards mental illness, psychiatry as a branch and treatment modalities used in psychiatry and to compare the same between 1^st and 4^th year nursing students.

METHODS:

A cross-sectional study was conducted among 1^st and 4^th year nursing students. 148 students participated. Data collected through self-administered questionnaires to assess KAP towards mental illness and psychiatry.

RESULTS:

Out of 148 participants, 78 students were 1^st year and 70 students were 4^th year nursing students. Majority of 4^th year students showed significant knowledge about causes of mental illness than 1^st year. There was differential negative attitude towards people with mental illness (PWMI) in both groups with no significant difference except for questions related to working or communicating with PWMI. Both groups perceived PWMI negatively with no significant differences. Significant positive attitudes found towards psychiatry as a branch and treatment modalities used in psychiatry.

CONCLUSION:

Despite the knowledge of causes of mental illness, negative attitude and perception were observed among nursing students indicating the persistence of stigma towards mental illness. Thus, there is need for measures to reduce stigma regarding mental illness in nursing students.

A clinical study of the pattern and prevalence of cannabis use among patients with schizophrenia.

Background

Schizophrenia is arguably one of the most puzzling yet disabling of all brain diseases.

Cannabis is the most abused illicit drug especially among teenagers and young adults.Cannabis may increase the risk of schizophrenia by as much as 40%,particularly in heavy users.

Aims:

1. To determine the prevalence and pattern of cannabis use in patients of schizophrenia.

2. To determine the association of cannabis use with the clinical profile of patients with schizophrenia.

Methods:

A cross-sectional study was done among 43 patients between the age of 18- 60 years diagnosed as schizophrenia with cannabis use either prior to symptom onset or after it,attending the OPD or admitted in the IPD of the department of Psychiatry of Gauhati Medical College and Hospital between 1^st October 2022-30^th September 2023.A semi-structured proforma and Positive and Negative Syndrome Scale (PANSS) was administered to the patients.Appropriate statistical methods were applied to analyze the results.

Results:Out of total 1492 schizophrenia patients,43 had cannabis use hence,prevalence-=2.88%.

Most commonly patients were of -18-26 years age, males(43), Hindus(33), nuclear families (37),rural background (30), low socio-economic status (31),educated upto school(24),unemployed (14),74.4%(32) had cannabis use before the illness onset,the main route of intake was smoking(43),main form-chillum,majority(35) smoked >50 times,predominantly clinical symptoms observed from PANSS were-delusions(P1),Conceptual disorganisation (P2),hallucinatory behaviour(P3),hostility(P7),blunted affect(N1),social withdrawal(N4),lack of judgement and insight(G12),disturbance of volition(G13),poor impulse control(G14).

Conclusion-cannabis is highly prevalent in Assam and north eastern region of India,hence keeping that in view,a study to see the pattern of its use and prevalence among patients with schizophrenia would be helpful.

1.Dr. Prayashi Kashyap, 1^st year Post Graduate Trainee, Dept of Psychiatry, Gauhati Medical College and Hospital, Guwahati , Email: prayashikashyap4@gmail.com , Ph: 9365286052

2.Dr. Suresh Chakravarty,Professor, Department of Psychiatry,Gauhati Medical College and Hospital,Guwahati.

BEHAVIOURAL AND PSYCHOLOGICAL MANIFESTATION IN PATIENTS WITH DEMENTIA AND CARE GIVER BURDEN – CROSS SECTIONAL STUDY

Dr.S.Aishwarya , Post graduate , Institute of Mental Health

Guide – Dr.Shanthi Maheshwari , Assistant Professor , Institute of Mental Health

INTRODUCTION

Dementia is a clinical syndrome due to disease of the brain usually of a chronic or progressive in nature, in which there is disturbances of multiple higher cortical functions including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Behavioural and psychological symptoms of dementia are major contributors to the burden of dementia. Impairment of cognitive functions are commonly accompanied and occasionally preceded by deterioration in emotional control, social behaviour and motivation

AIM AND OBJECTIVE

To assess the clinical profile and severity of behavioural and psychological manifestation in patients with dementia

To assess the care giver burden in dementia patients

METHODS

This study was conducted in outpatient and inpatient department from psychiatry/ Neurology OPD of MMC. Sample size -80. Study population on descriptive analysis of ICD – 10 category taken for the study. After obtaining informed written consent, severity of dementia was assessed with dementia severity rating scale

Behavioural and psychological symptoms assessed using Neuropsychiatry inventory Care giver burden assessed using Burden assessment schedule

RESULTS

In our study around 16.3 % were having mild severity, 55 % moderate severity and 28.7 % had severe dementia

Care giver burden using burden assessment schedule found to be 61.3 had minimal, 38.7 % had moderate burden

CONCLUSION

Neuropsychiatric symptoms are frequent in dementia and contribute to significant caregiver burden.

Care giver burden and BPSD manifests itself in varying degrees of severity and frequency across the different stages of dementia. The severity of burden increases during the severe stages of dementia. Psychosis occurred more frequently with declining cognition. Anxiety and depression were more common in younger individuals. Behavioural and psychological symptoms of dementia affect nearly all people with dementia. The research on BPSD can lead to issues related to prevention, early intervention and overall treatment effectiveness.

Posterior Reversible Encephalopathy Syndrome (PRES) in a post-partum patient without history of hypertension, pre-eclampsia or eclampsia - a case report.

Background:

First described by Hinchey in 1996, Posterior Reversible Encephalopathy Syndrome,PRES is a rare syndrome characterised by headache, seizures, encephalopathy and visual disorders due to reversible vasogenic edema detectable by neuroradiological investigation of the brain.It commonly seen post-partum with acute arterial hypertension, pre-eclampsia or eclampsia.

Aim: To study a post partum case presenting with behavioural abnormalities without history of hypertension,pre-eclampsia or eclampsia favouring diagnosis of PRES.

Method:

A 22 year old primi-gravida with history of emergency LSCS 11 days back due to foetal distress. Pregnancy itself was uneventful without any recorded hypertension. Patient presented with acute onset one week history of behavioural abnormalities suggestive of psychosis along with some confusional behaviour. Her BP was recorded at 170/110 mm of Hg, other vitals being within normal limits on the first day.

The patient was admitted to Psychiatry ward with a working diagnosis of Acute Transient Psychotic Disorder, post partum onset with differential diagnosis of Delirium of unclear aetiology. She was started with injectable antipsychotic, and oral antihypertensive. Brain MRI showed symmetrical t2/flair hyperintensities involving bilateral frontoparietal and occipital lobes.

Result:

Patient started showing improvement by day 2 and was symptom free by 5-th day except a dull aching headache. At follow-up after 10 days, patient was doing fine without any significant symptom.

Conclusion:

The diagnosis of PRES in this case was not immediately suspected due to negative history of any hypertension, pre-eclampsia or eclampsia. There is report that PRES may develop even without history of hypertension in post-partum patients. MRI Brain in this patient was tell-tale, and so it is important to consider PRES in post-partum patients with behavioural symptoms to reduce the complications.

1.Dr. Prayashi Kashyap, 3^rd year Post Graduate Trainee, Dept of Psychiatry, Gauhati Medical College and Hospital, Guwahati , Email: prayashikashyap4@gmail.com , Ph: 9365286052

2.Dr. Uddip Talukdar,Associate Professor, Department of Psychiatry,Nagaon Medical College and Hospital, Nagaon.

Free-Paper Presentation: Stress and eating behaviors among medical students

Dr. Kashish Singhal¹, Dr. M. Vijaya Gopal², Dr. S.V.V. Jagadeesh³, Dr. Arpitha B.⁴, Dr. Likhita Bandi⁵

¹Post-Graduate, ²Professor and Head,³Associate Professor, ⁴Assistant Professor, ⁵Senior Resident

Department of Psychiatry, GSL Medical College and General Hospital, Rajahmundry

Background: Eating Behaviors refer to actions, attitudes and patterns related to food consumption. They vary greatly depending on cultural, social, psychological and physiological factors, and decide the physical and mental health of the individuals. Pertaining to the rigorous academic requirements and clinical rotations in medical students, their eating behaviors are highly influenced and may lead to disruptive eating. This can have a significant impact on their physical, psychological and immune functioning.

Aim: To determine the prevalence of disruptive eating behavior in medical undergraduate student and to understand the impact of their socio-demographic profile and stress on the same.

Materials and Methods: This is a cross-sectional study conducted among 500 undergraduate students of a private medical college in East Godavari District, using Socio-demographic, Perceived Stress Scale (PSS-10) and Eating Behavior Questionnaire (AEBQ).

Results: 310 students (62.0%) were women, and 190 students (38.0%) were men, with an average age of 20 years (±2 years). Based on AEBQ results, 53% enjoy their food, 2% are food-responsive, 6% are satiety-responsive, 6% are emotional overeaters, and 14% are emotional undereaters. Additionally, 5% exhibit food fussiness, 4% are slow eaters, and 5% display hunger behavior.

Conclusion: The study suggests that lifestyle significantly influences emotional eating issues. People with high BMI, poor diets, little physical activity, meal underestimation, and high stress levels are more prone to emotional eating. Further research is needed to determine the generalizability of these findings.

Keywords: Eating behaviors, Medical students, Disruptive eating, Psychical, psychological and immune functioning

Prevalence of Anxiety and Depression among Young Women with PCOS

Dr. R. Rajeshwari¹, Dr. S. J. Daniel², Dr. C. Jayakrishnaveni³

¹Junior Resident, Department of Psychiatry, Kilpauk Medical College, Chennai.

²Assistant Professor, Department of Psychiatry, Kilpauk Medical College, Chennai.

³ Associate Professor, Department of Psychiatry, Kilpauk Medical College, Chennai.

Background: Polycystic ovarian syndrome (PCOS) is a common hormonal disorder among women in reproductive age group. According to the Indian Fertility Society, the prevalence of PCOS ranges from 3.7% to 22.5%. Women with PCOS experience adverse social, physical, emotional, and psychological like depression, anxiety, sadness and loneliness which have a negative impact on their health.Stress could be a mediating factor in PCOS through its impact on endocrine system.The psychological problems associated with PCOS is often overlooked and limited literature is available in this aspect.

Objectives: To study the prevalence of Anxiety and Depression among young female patients with PCOS.

Methods: A study included 50 consecutive patients with PCOS <25 years attending OG OPD in tertiary care hospital. After obtaining informed consent, Semi structured proforma was used for obtaining socio-demographic and clinical variables. The patients included in the study were administered HAM-A and HAM-D to identify anxiety or depressive symptoms.

Results: The prevalence of significant depressive and anxiety symptoms among young women with PCOS was 50 %

Conclusion: Higher prevalence of depression, anxiety was found among the PCOS patients, and associated with clinical manifestations. Thus, an appropriate approach towards psychological management should be implemented.

IMPACT OF POLYCYSTIC OVARIAN SYNDROME ON THE QUALITY OF LIFE OF WOMEN

Dr Shakeela Banu

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, affecting approximately 5%-10% women in the western world; where as in India prevalence is upto 10%.

PCOS is a stigmatizing condition that affects a woman’s identity, mental health and has negative impact on the quality of life (QOL). They also experience higher rates of depression and anxiety than women in the general population.

Aim: To assess the Psychiatric co-morbidities and QOL among outpatients diagnosed with PCOS. and to compare the same between PCOS diagnosed women and healthy controls.

Methods: Consecutive 30 patients diagnosed with PCOS and age matched 30 controls were assessed for Psychiatric co-morbidities using Mini International Neuropsychiatric Interview 7.0 (MINI 7 )and QOL using World Health Organization Quality of Life Instruments - BREF (WHOQOL- BREF) questionnaire.

Results: Mean age out of 30 patients is 25.3±5.76 years, most of them hailing from rural background. 43.33% patients were diagnosed with Depressive disorders where as 30% patients had Anxiety disorders and 26 % with nil psychiatric co-morbidities. Among controls only 10% had depressive disorders, 6% had anxiety disorders. Patients had lower QOL comparatively as well as patients and controls who had psychiatric morbidities are found to have significantly lower QOL in physical, psychological domains compared with patients and controls with no psychiatric morbidities.

CONCLUSION: Screening PCOS women for psychiatric co-morbidities helps us to aim for the holistic management of the cases.

A Study on the Impact of 104 -Suicide Prevention Helpline in a Tertiary Care Hospital in Tiruppur

Dr. Haripriya M, Dr. Sanjay Bose, and Dr. Deepak Kumar

Department of Psychiatry

Government Medical College and Hospital, Tiruppur

Background: According to the National Crime Records Bureau (NCRB) report 2021, Tamil Nadu has recorded the 2^nd highest number of suicides. The Tamil Nadu Health System Project (TNHSP) in collaboration with Tamil Nadu Accident Care and Emergency Initiative (TAEI) and GVK EMRI launched a Suicide Prevention Counselling Project in 2019, to offer counselling to those who had deliberately harmed themselves. Studies regarding the functioning of the 104 Program are sparse.

Aim and Objectives: 1) To evaluate the Sociodemographic profile of the patients participating in the program, with DSH attempts.

2) To identify the factors regarding the patient’s refusal to consent for program

Materials And Methods: After obtaining the Ethical Committee approval, a record analysis of DSH attempt patients registered at TAEI Ward during the period- September to November 2023 and those who gave consent for counselling services was done. The data was collected using a semi structured questionnaire and analysis done using standard statistical tools (Percentages, Chi-square test).

Results: Probable results affirmed by the current status of data evaluation possibly indicate a high level of refusal to participate in the program and its utilization. Since this is an ongoing study, results are to be evaluated.

Conclusion: This research contributes valuable insights to the field of suicide prevention and promotion of mental wellbeing and also the measures needed to improve the participants’enrollment in the program.

FREE PAPER ABSTRACT FOR ANCIPS-2024: Trichotillomania- an addictive disorder?

Dr. Vidushi Baveja¹, Dr Lokesh Singh Shekhawat^2, Dr Priyanka Hooda³,

¹MD Psychiatry Resident

²Professor

³Senior Resident

Department of Psychiatry, Centre of Excellence in Mental Health, ABVIMS & Dr. RML

Hospital, New Delhi

Presenter: Dr. Vidushi Baveja

Co-Authors: Dr. Priyanka Hooda priyankapikahooda69@gmail.com, Dr. Lokesh Singh Shekhawat drlokesh4@gmail.com

Background

Trichotillomania(TTM) is a disorder characterised by the inability to control pulling one’s hair from various parts of a body, resulting in noticeable hair loss, which occurs in bizarre patterns and is non-scarring. (1)

Although traditionally, TTM was classified as an Obsessive-compulsive Related disorder (OCRD), the presence of an addictive component to the disease has led to a hypothesis of an alternative model which treats TTM as an addictive disorder.

To examine whether trichotillomania should be classified as an addiction, clinical similarities between trichotillomania and substance use disorders need to be considered. For many, but not all, individuals with trichotillomania, their behaviour shares features with the core elements of addictions: (1) repetitive or compulsive engagement in the behaviour despite adverse consequences; (2) diminished control over the problematic behaviour; (3) an appetitive urge or craving state before engagement in the problematic behaviour; and (4) a hedonic quality during the performance of the problematic behaviour.

While literature regarding the addictive aspect of TTM is scarce, we present a case of TTM with features similar to addictive disorder.

Case details

A 15-year-old adolescent girl presented with diffuse bizarre nonscarring alopecia with a history of automatic hair plucking and eating, suggestive of Trichotillomania. She also gave a history of plucking and eating the hair of family members, associated with a sense of pleasure. She had a presenting score of 21 on the Massachusetts General Hospital (MGH) Hair Pulling Scale(3) on the first visit, and on treatment with medication, Motivational Enhancement Therapy (MET) and Cognitive Behavioural Therapy (CBT), she had dramatic improvement with the MGH score dropping to 9, after two months. The uniqueness of our case was the craving to consume the hair of others.

On presentation

2 month follow up

Trichoscopy: Diffuse non-scarring alopecia in large bizarre patches with perifollicular haemorrhages at some hair roots. (On presentation)

Conclusion

While a subset of patients of TTM patient have OCRD-like features, an addictive component of TTM cannot be disregarded. Our case illustrates that not only is an addictive component to TTM plausible, but it also has far-reaching therapeutic implications.

TTM is a complex disorder encompassing heterogeneous psychopathologies, and further analysis of neurobiology is required before classifying TTM. Nonetheless, a thorough clinical examination should guide the management of TTM patients and patients with components of addiction should be addressed accordingly.

References

1. Meike Bohn, Per Hove Thomsen & Judith Becker NissenUgeskr Læger 2022;184:V11210829

2. Grant JE, Odlaug BL, Potenza MN. Addicted to Hair Pulling? How an Alternate Model of Trichotillomania May Improve Treatment Outcome. Harvard Review of Psychiatry. 2007 Mar;15(2):80–5.

3. Houghton DC, Capriotti MR, De Nadai AS, Compton SN, Twohig MP, Neal-Barnett AM, et al. Defining Treatment Response in Trichotillomania: A Signal Detection Analysis. J Anxiety Disord. 2015 Dec;36:44–51.

Abstract for free paper presentation – ANCIPS 2024 Attitude and beliefs of medical students towards suicide

Dr. Abhirami Rajeev¹, Dr. Lakshmi Prasunna², Dr. Subahani Shaik³ Post Graduate, Professor and HOD , Assistant Professor. ACSR Govt. Medical College Nellore, Andhra Pradesh

Background

Suicide attempts in India are increasing at an alarming rate especially in the past couple of years and has become an issue of major public health concern. As per NCRB an increase of rates of suicide had escalated by 7.2% over the span of 1 year. However, it is preventable with timely, and often low-cost interventions. Stigma and myths about suicide and mental health is widely prevalent not just in the society but quite shockingly among the medical professionals too. Medical students are the future of the health resource of the country, their attitude toward suicide attempters is of great significance for understanding and addressing the health needs of these emerging health professionals. There are several studies from the different parts of the world, but very few conducted in India, so this study was taken up.

Aim: Assess the attitude and beliefs of medical students towards suicide attempters.

To determine the sociodemographic variables among both the genders.

Study design: cross section observational study

Study population: undergraduate students of ACSR Govt medical College Nellore AP

Tools: Sociodemographic data

Suicide Opinion Questionnaire (SOQ)

Results: Female students were found to be having better sympathy and understanding regarding suicide attempters.

Conclusion : need to create awareness among medical graduates

Abbreviation : NCRB – National crime records bureau

Key word: suicide attempt, medical students, attitude.

ABSTRACT FOR PAPER: Management of agitation in antenatal patients in a tertiary care institute

Dr. Simran Sandhu¹, Dr VS Pal², Dr Varchasvi Mudgal³, Dr Priyash Jain⁴

1Junior Resident, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh 452001, India

2Professor and Head Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

3Assistant Professor, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

4Senior Resident, Department of Psychiatry, MGM Medical college Indore, Madhya Pradesh,452001, India

BACKGROUND

In the psychiatric emergency many patients present with agitation who are at risk of injury to self and others. There are many studies addressing the pharmacological management of the agitated patient but very few studies that address the pharmacological management of agitation during pregnancy. This study was conducted in order to better understand how agitated pregnant women are managed in an emergency setting.

AIM and OBJECTIVE

To evaluate the pattern of psychotropic drugs used to manage agitation in antenatal patients in a tertiary care institute.

METHOD

The consultation liaison (CL) records of interdepartmental psychiatric referrals were assessed for a duration of one year between October 1 2022 to September 30 2023. Data was recorded and analysed using an appropriate statistical software.

RESULTS and CONCLUSION

Will be discussed later

Presenter – Dr. Simran Sandhu

Junior Resident, Department of Psychiatry,

MGM Medical college ,Indore

E-mail – simransandhu311296@gmail.com

A hospital-based study to assess prevalence of autism and factors associated with Autism – A retrospective case note review.

Background

The prevalence of ASD has increased significantly over the last few decades, creating a growing concern for healthcare providers, educators, policymakers, and families affected by ASD. There is limited research on autism prevalence in India, and we do not have a reliable and recent estimate of the prevalence at the national level.

Aims

To estimate the prevalence of autism spectrum disorder amongst children in an urban population (Health Scheme beneficiary cohort) and to assess the symptom profile of children and factors associated with age at diagnosis in children with autism.

Methodology

All the children seen by the Department of Psychiatry, BARC Hospital from January 2010 to December 2020 will form the sampling frame. The Population includes only those covered by the Contributary Health Care Scheme (CHSS). Data recorded from case note were the demographic details of the child and the parents. This includes presenting age, parental age, family details and clinical symptoms of the child. Assessment recorded includes Childhood Autism Rating Scale (CARS) and Indian Scale for Identification of Autism (ISAA).

Results and Discussion

Our study gives a prevalence estimate of 101.2 cases per 10000 children, which is comparable to the global estimate of the prevalence of 100 in 10000. And is higher than the previous estimates of prevalence in India, which could also be because of higher reporting because of universal access to health care. Our study found low birth weight and complications at birth, to be significant risk factors for autism. Each factor increased the risk of autism by approximately 2 times. The median age of diagnosis in this population was 40 months We found that higher birth order, severity of autism and maternal age above 30 were factors that lead to earlier diagnosis of autism.

A study on association of serum uric acid levels with agitation in psychiatric patients

BACKGROUND:

Adenosine is acknowledged for its ability to regulate second messenger pathways, maintain energy balance, influence dopaminergic and glutamatergic neurotransmission, thereby impacting cognitive functions, sleep patterns, and behavior. Allopurinol, an Xanthine oxidase inhibitor, has been explored as an adjunctive treatment for refractory schizophrenia and mania. However, there has been limited research supporting this hypothesis. Our study aims to evaluate the relationship between purinergic metabolism and agitation symptoms across various psychiatric disorders.

Aim:

This pilot study aims to compare serum uric acid levels between agitated and non-agitated patients.

Methods:

Upon obtaining informed consent, patients were categorized as agitated or non-agitated based on the revised OASS score. Sociodemographic information, MINI-5 and ICD-10 for diagnoses, Clinical Global Impression-Severity Scale for severity assessment, and Overt Agitation Severity Scale for measuring agitation levels were administered. Serum uric acid levels were collected for both groups upon admission and subsequently for the agitated group. Statistical significance of the mean serum uric acid level difference between the two groups was tested using the student’s t-test.

Result:.

The statistical analysis revealed no significant correlation between serum uric acid levels in psychiatric patients with and without agitation.

Conclusion:

The findings did not indicate an association between serum uric acid levels and agitation, nor did a connection with various psychiatric disorders within the agitated group.

ABSTRACT FOR ORAL PAPER PRESENTATION

Researcher : Dr Sanjana K, Post Graduate Resident, Mandya Institute of Medical Sciences

Guide: Dr Bhagyavathi HD, Professor and HOD, Mandya Institute of Medical Sciences

The Proportion Of Attention Deficit Hyperactivity Disorder In Alcohol Dependence Patients: A Cross Sectional Study

Background:

Attention Deficit Hyperactivity Disorder(ADHD) is common but often underrecognized¹ in patients with Substance Use Disorder(SUD). Comorbid ADHD in Alcohol Dependent patients has been associated with earlier onset of the dependence and higher risk of relapse².

Aim:

To study proportion of ADHD in alcohol dependent patients.

To evaluate the relationship between ADHD and age of onset of Alcohol Dependence.

Methodology:

100 patients aged 18-45 years, presenting to the Psychiatry Department of Mandya Institute of Medical Sciences, who meet ICD-10 Diagnostic Criteria for Alcohol Dependence Syndrome (ADS) were included after informed consent, using purposive sampling method over 3 months. Subjects with co-morbid psychiatric illness or other substance dependence, except nicotine were excluded.

The patients were divided into Early Onset(developed dependence before 25 years of age) and Late Onset groups.

For assessment of childhood ADHD, the Wender Utah Rating Scale was used, and ASRS checklist to assess ADHD in adulthood. Data will be entered in excel sheet and descriptive analysis will be done. Chi-square tests and odds ratios were used to express the relative risk of association of ADHD with early-onset ADS.

Discussion:

With few studies done in India, there is a substantial need for evaluation of ADHD in adults with Alcohol Dependence Syndrome, especially those with an Early Onset of ADS, and more intensive management of this high-risk group in view of their poorer prognosis.

Background: Internalised Stigma is the inner subjective experience of stigma resulting from applying negative stereotypes and stigmatizing attitudes to oneself. In severe mental illnesses, clinical remission is inadequate to achieve patient oriented outcomes and pragmatic constructs like stigma have evolved from sociological phenomena to mediators of recovery. An exploration of internalised stigma and its association with functional outcomes can drive therapeutic endeavours.

Aim: To assess and compare the influence of internalized stigma on disability among patients diagnosed and treated for bipolar disorder and Schizophrenia in a tertiary care facility.

Methods: Study design- Hospital based, cross sectional, comparative design; Study population-Patients of bipolar disorder and schizophrenia with 2-5 years illness and CGI-S <4; Sampling procedure- Consecutive sampling; Sample size- 30 patients each; Scales Used- ISMI, IDEAS and CGI-S; Patients were evaluated with IDEAS and 15 persons with and without significant disability were recruited in each group of schizophrenia and bipolar disorder.

Results: The mean ISMI Total score for persons with schizophrenia was 2.42 ± 0.27 whereas that for persons with bipolar disorder was 2.41 ± 0.23. For schizophrenia, ISMI total scores as well as all domains except Stigma resistance are significantly higher (t= 7.541, p=0.000) in individuals with benchmark disability. For bipolar disorder, ISMI total scores (t= 2.568, p=0.016) and only one domain, Stereotype Endorsement scores are significantly higher in individuals with benchmark disability.

Conclusion: When disability is factored in, internalized stigma is comparable in persons with schizophrenia and bipolar disorder. The type of disorder does not significantly affect the relationship between internalized stigma and disability. Irrespective of diagnosis, higher internalized stigma is associated with higher disability.

A cross-sectional study on body image perception & factors influencing it among the adolescents.

Background: Body image (BI) is the internal representation of one′s external appearance and encompasses self-perceptions related to the body and personal attitudes, including subjective satisfaction, affection, cognitions and behaviours. BI dissatisfaction generally implies a perceived discrepancy between the evaluation of one’s body and the ideal body. Adolescence is an important formative period for views of self, alongside undergoing bodily changes of puberty and hence holds risk of internalization of sociocultural ideals which are transmitted by society and social media.

Aim: To assess body image dissatisfaction and its association with sociodemographic and sociocultural factors and to ascertain attitudes of weight control behaviours among adolescent age group 16-18yr.

Methods: A cross-sectional study was done among 280 students attending Vydehi School of Excellence, Bangalore. A semi-structured questionnaire (BI questionnaire, SATAQ-3, SCOFF) were used to collect data on factors associated with body image and to screen for attitudes of weight control behaviours. Body mass index of the participants was calculated. Univariate and regression analysis was applied.

Results: BI dissatisfaction was majority among the girls (~77%). Factors such as higher BMI, sociocultural norms of ideal body image for physical attractiveness are majorly associated with BI dissatisfaction. The most common attitude of weight control behaviours was- belief to be fat when others say you are too thin.

Conclusions: BI dissatisfaction is an evolving major concern among adolescents. Hence, effective intervention regarding BI must address individual feelings, physical self-awareness and behaviours regarding appearance.

CHARACTERISTICS AND RISK FACTORS FOR SUICIDE ATTEMPTS IN PATIENTS WITH SCHIZOPHRENIA & DEPRESSION VISITING EMERGENCY PSYCHIATRY

INTRODUCTION:

Suicide is a major public health issue, causing one million deaths annually and 20 times more attempts, with MDD and schizophrenia being common associated illnesses.

AIMS AND OBJECTIVES:

To study the socio-demographic profile, prevalence of schizophrenia & depression and association between risk factors for both, in suicide attempters coming to emergency department at SSG Hospital

METHODS:

A 6 month, cross-sectional study on 250 patients fitting the criteria, with history of suicide attempt coming to emergency department of SSG hospital, Vadodara. Detailed history, MSE with psychiatric scales was done.

RESULTS:

Among 250 patients, 39.6% had Depression and 16.8% had Schizophrenia.

The majority of patients included were married, males 18-29, Hindu, from rural areas, nuclear families, educated upto high school/primary, unemployed, had past psychiatric illness & suicide attempt history. The act preceded by a stressor and impulsive in nature.

Depression and Schizophrenia were seen more in younger population, Hindus, males, married, unemployed, educated upto primary/high school, from lower socioeconomic status, nuclear families, with h/o substance use.

There was significant association in those with underlying depression regarding age, gender, marital status, education, family type, socioeconomic status, history of Psychiatric illness, family history of Psychiatric illness and substance use.

There was significant association in those with underlying Schizophrenia with education, occupational status, family type, socioeconomic status, substance use, history of psychiatric illness and history of medical illness with Schizophrenia.

CONCLUSION:

The study provides a comprehensive profile of suicide attempts, revealing prevalent psychiatric co-morbidities like depression and schizophrenia, aiding in identifying at-risk populations and promoting timely intervention.

Rajitha Reddy

2^nd Year Resident, Department of Psychiatry, Medical College Baroda

Rajitharsreddy21@gmailcom

Guide: Rakesh Gandhi

HOD & Professor in Department of Psychiatry, Medical College Baroda

Psychological morbidity amongst medical students and its correlation with substance use and suicidal intent.

Presenting author-Dr. MeghaMaghade,Assistant professor Co-authors-Dr.PravinVerma ,Associate professor

Dr. Priya Madavi- Assistant professor Dr.Anand Saoji - Associate professor

Dr. Abhishek Somani- Head of the department

Department of psychiatry, Indira Gandhi government medical college, Nagpur

Background: Medical education and training is considered one of the toughest carrier branch. During tenure medical students commonly experience psychological distress. Psychological Stress in medical students can prompt substance use, resulting in catastrophic consequences like impaired academic performance, impaired competency, medical errors and sometimes suicidal ideation. This study aimed to assess the psychological morbidity of students and its correlation with substance use and suicidal intent.

Materials and Methods: Cross-sectional study was conducted among 235 consenting students of a tertiary care medical college comprising of (150) undergraduates and (85) postgraduates. Responses were recorded using predesigned and pretested google form. Assessment was done with DASS 21, pretested and validated questionnaire for substance use and suicidal intent. Data was analysed statistically.

Results:

DASS-21 scores (Undergraduates 38.7 %, Postgraduates 69.5%), prevalence of substance use (overall-17.9% undergraduate 5.3% postgraduate 40%) and suicidal intent (overall- 7.23%, undergraduates 2% postgraduates 16.5%) were significantly higher among postgraduates. Harmful substance use pattern was seen in 11.5%. Use of Alcohol (36.4%) and smoking (41.4%) had significant overlap. Clinical Postgraduates had higher morbidity (82.2 %), higher substance use (62.3%) and higher scores on suicide behaviour checklist (24.4%). This difference was statistically significant compared to nonclinical postgraduates. Significant corelation was seen between DASS scores and suicidal intent (p=<0.001).

Conclusion:

More than half of medical students experience psychological stress. Substance use for coping often results in harmful use pattern. Higher suicidal intent seen in clinical branches. Robust measures for promoting positive mental health, early identification and risk mitigation to reduce stress and suicide rate, also educative measures to avoid substance use as coping mechanism are needed.

Keywords: Medical students, Suicidal intent, Substance use, Psychological morbidity

Dr Pratik Lad

Designation: Junior Resident

Department: Psychiatry

Institute: MIT MAEER’s MIMER Medical College & Dr. BSTR Hospital

Email ID: ladpratikr@gmail.com

Mobile Number: 9769863145

A STUDY OF SEXUAL HEALTH IN GERIATRIC AGE GROUP IN WESTERN PART OF MAHARASHTRA

Background: Sexual health among the ageing population continues to be a major concern for both individuals and couples. Treatment of sexual dysfunction requires an understanding of the normal ageing process and how to care for ageing men and women. This study is being conducted to illustrate the facts that are common in society and how older people feel about the behavior. It attempts to bring the healthcare system’s attention to the need to improve the sexual health of the older age group.

Methods: The survey is Qualitative Cross-Sectional Study conducted in a semi urban area involving 64 participants. Consenting persons between the ages of 60 and 90 involving both males and females were chosen at random for the survey. Participants with memory deficits, psychiatric illness and diagnosed with stroke or paralysis were excluded in the survey. Participants’ socio-demographic profiles were recorded, and they were given a semi-structured proforma to self-administer in their local language. Each question’s results were accurately recorded, and the overall prevalence was calculated as a percentage.

Results: According to the survey, 55% of respondents believed that getting older has an impact on sexual health. Participants’ sexual activity was only seen in 35% of them. Overall, 42% of participants reported experiencing stress in the previous two days, with 37% attributing it to current sexual health difficulties. The majority of participants, 76% agreed that, aside from reproduction, sexual activity is more important in life. Among participants, only 24% discussed their sexual interests with their partners. 65% of respondents anticipated that doctors would start the conversation about sexual health. Of the participants’ 60% who reported having difficulty in sexual intercourse, 25% used sexual dysfunction medication. The most frequent causes of issues with sexual health were comorbid medical conditions, trouble maintaining erection, and climaxing too soon.

Conclusion: Older persons regularly experience sexual issues, but doctors are rarely informed of these issues. The senior population anticipates that healthcare experts will bring up the topic and address their concerns. Talking about these concerns will aid in reducing the stigma and immoralism associated with sexual desires in the aging population. The ability of physicians to recognize clinically a wide range of health-related and potentially curable sexual disorders should be enhanced by their knowledge of sexuality at older ages.

Keywords: Sexual Health, Stress, Sexual Interests, Ageing

PREVALENCE OF DELIRIUM AMONG THE ELDERLY PATIENTS PRESENTING TO EMERGENCY TRAUMA SETTING: AN EXPLORATORY STUDY

Kanika Sethi, Aseem Mehra, Sandeep Grover, Sameer Aggarwal, Deepak Negi

Background: Elderly patients are at a higher risk of trauma due to accidental falls and often present to the emergency trauma setting for immediate interventions. Little is known about the prevalence of delirium in this group of patients. Aim: To evaluate the prevalence of delirium among elderly patients presenting to the Emergency trauma setting. Methodology: Using a cross-sectional study design 206 elderly (age ≥ 60 years) who presented with a traumatic injury were enrolled using a convenient sampling technique. These patients were assessed for delirium using the DSM-5 criteria and Confusional Assessment Method. Results: The prevalence of delirium as per DSM-5 criteria was 24.3 % and as per CAM the prevalence was 27.2%. Conclusion: About one-fourth of the elderly patients presenting to the emergency with trauma have delirium. Hence, it is important to screen all the elderly patients presenting to emergency with trauma for delirium.

PAPER PRESENTATION: ALCOHOL DEPENDENCE - GENERALIZED ANXIETY DISORDER, SOCIAL ANXIETY DISORDER AND DEPRESSION

Background

Anxiety disorders and depression in individuals with alcohol dependence , becomes an indicator of risk of relapse. This study is an effort to provide knowledge to clinicians on the relationship between these disorders and alcohol dependence thereby bridging the gap in the existing literature.

AIM

To estimate and compare the prevalence of generalized anxiety disorder, social anxiety disorders and depression in individuals with alcohol dependence , and to study their co relationship with socio demographic and clinical variables

Methods

This is a cross sectional descriptive study done on 150 patients with alcohol dependence syndrome attending the psychiatry OPD in theni medical college. Semi structured interview was done to assess the socio demographic data. The diagnosis of Alcohol dependence syndrome and other psychiatric disorders was made based on the ICD-10. Hamilton Anxiety Rating Scale, Leibowitz Social Anxiety Scale , Beck’s depression Inventory was applied on the patients. Data was analyzed using the SPSS software version 20

Results

The present study reveals GAD=11.3% and SAD=8.0%, people with both socialized anxiety and generalized anxiety is 18.7% while people with either anxiety or depression is 27.3% and prevalence of depression is 8.7%.

The relationship between anxiety and duration of alcohol use is statistically significant(p<0.04).

Conclusion

The co-morbidity of ALCOHOL DEPENDENCE and SAD/GAD/depression is high in the study population. The results of people with ALCOHOL DEPENDENCE with co-morbidity are significant as people with these co morbidity tend to relapse.

“A cross-sectional study of Sleep Quality in Hypertensive Patients attending a secondary care hospital in Telangana”

Dr. Boda Bhanu Sai¹, Dr.P.C.B.Gupta^{2 ,} Dr.Omesh³

Junior resident¹ , Professor and HOD² , Assistant Professor³

Department of Psychiatry, Institute of mental health, Osmania medical college, Hyderabad

Background:

Hypertension is a prevalent cardiovascular condition often associated with a range of comorbidities. Sleep quality is a critical factor in overall health and well-being, and its assessment in hypertensive individuals is essential to understanding the potential impact on their cardiovascular health.

Aims and Objectives :

To assess the quality of sleep in hypertensive patients and to find the factors associated with poor sleep quality .

Methods:

100 hypertensive patients were taken for study after written informed consent . Participants sociodemographic and clinical characteristics, including blood pressure status, medication regimens and lifestyle factors were recorded using semi-structured proforma. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Patients were screened for anxiety and depression using Hamilton anxiety and depression scales respectively. The PSQI scores were analyzed to determine the prevalence of poor sleep quality and statistical analysis was done using SPSS software V26.0 to identify the factors associated with poor sleep quality.

Results:

The overall prevalence of poor sleep quality was 74.5 %. The mean PSQI score was 7.8 ± 2.2, signifying suboptimal sleep quality. Factors such as old age, female gender, overweight, poor physical activity, substance use and comorbid anxiety or depression were associated with poor sleep quality.

Conclusion:

This study underscores the significance of evaluating sleep quality and addressing psychiatric comorbidities, such as anxiety and depression, in hypertensive individuals. Healthcare providers should routinely assess and manage sleep disturbances and consider referrals to psychiatrists for comprehensive care and treatment.

Unlocking the Secrets of Marital Satisfaction: A Comprehensive Analysis of Personality Traits and Marital Adjustment in Couples

Background: Marriage, a fundamental institution in human society, significantly influences the well-being, mental health, and societal harmony, with an individual’s personality and adaptability playing pivotal roles in shaping the overall quality of the marital relationship.

Aims and Objectives: The study was conducted with an aim of assessing marital satisfaction and thereafter, determining an association between marital adjustment and personality traits among their spouses.

Methodology: Married couples consenting to participate were enrolled in the study. International personality disorder examination (screening tool), and Marriage adjustment test were used as our data collection tools.

Results: The mean marital satisfaction score of husbands was119.7 (SD=29.69), while that of the wives was 116.70 (SD=30.23). Out of 10 couples, marital dissatisfaction was observed in 3 husbands. Most common personality traits among their spouses were Borderline (100%), Paranoid (66.7%), Schizoid (66.7%), Anxious (66.7%), Dependent (66.7%). Marital dissatisfaction was seen in 2 wives. Most common personality traits among their spouses were Paranoid (50%), Schizoid (100%), Dissocial (50%), Impulsive (50%), Borderline (50%), Anankastic (50%), Dependent (50%). No statistical significance was seen between marital adjustment and personality traits.

Conclusion: This study delves into the complex interplay between personality traits and marital satisfaction, shedding light on the intricate dynamics within marital relationships. While common personality traits were identified among spouses, the absence of statistical significance in the association between these traits and marital adjustment raises intriguing questions. Further research is needed to explore the intricate factors that contribute to marital satisfaction, offering potential insights for improving the well-being and harmony of married couples.

Study of the relationship between spiritual intelligence and perceived stress amongst postgraduate medical residents in tertiary care hospital.

Background: Spiritual intelligence is concerned with the internal life of mind and spirit of an individual and its association with one’s being in the world. It implies a capability for a deep understanding of existential questions and insight into multiple levels of consciousness. In addition to self-awareness, it implies awareness of our relationship to the transcendent, to each other, to the earth and all beings. Previous studies have shown that spiritually healthy persons can cope better with stressors. Continuous working hours with increasing workload acts as a significant stressor in the post graduate resident’s life.

Aim: To examine the level of spiritual intelligence and perceived stress in postgraduate resident doctors of tertiary care hospital and study the correlation between the two, if any

Materials and methods: This is a cross-sectional observational study. The participants were postgraduate resident doctors of the institute who were willing to participate. A semi structured questionnaire was used to collect the socio-demographic details, their views and individual practices about spirituality. The Spiritual Intelligence Self-Report Inventory and the Perceived Stress Scale were used for quantifying the observations.

Results: A negative correlation was observed between Spiritual Intelligence and Perceived stress suggesting that, higher spiritual intelligence is associated with lower perceived stress.

Conclusion: Spiritual intelligence may have a positive role in alleviating the perceived stress of postgraduate residents.

An unusual case of OCD that was long misdiagnosed as schizophrenia

BACKGROUND:

Schizophrenia is a chronic mental condition that affects about 1% of the population. The general population has 1% OCD, schizophrenia patients have 25% OCD symptoms, and 12% just have OCD. The patient with OCD, have concerns about the content of the preoccupation and will usually wonder why they are having an obsessive image; the mere presence of those makes them uncomfortable, referred to as ‘ego dystonic’ .

CASE PRESENTATION:

We report a case of 30 year old female who,on initial assessment presented with seven years history of visual percepts involving known people, living or dead alongwith rusty objects following an altercation and sleep disturbances. She seemed to move towards or away from the hallucinated object fearfully during her clear consciousness .She lacked control which lead to development of some distress .Adequate trial of second generation anti-psychotics was given, 25 % improvement was noted . On further enquiry she reported repetitive intrusive images of rust on roof of building and nearby surroundings following heavy rains .With her increasing distress ,she acted upon those by trying to harm herself. Immediately the trial of SSRI was initiated with 70 % improvement in her symptoms .

The idea behind choosing this case is to report a very rare condition with an even more atypical presentation.

CONCLUSION: Walk of fine line between this perceptual information of schizophrenia with other visual manifestation conditions, would be improved.

Gender differences in Deliberate Self Harm (DSH) in Tertiary care centre

Dr. Sheetal H. (PG), Dr. F. A. Sattar (Prof & HOD), Dr. Kiran Kumar K. (Prof), Dr. Yamini D. (AP)

Introduction: Suicide attempts, a growing public health concern, involve self-initiated actions with the intent of causing one’s own death. In India, suicide rates are high, with factors like family issues, illness, and gender playing a significant role. Women attempt suicide more often, facing greater psychosocial stressors. Understanding these factors can aid in tailored prevention strategies. [¹]

Objectives:

1. To evaluate the gender differences among the sociodemographic variables in DSH patients.

2. To evaluate the association of gender with the modes of attempts and psychosocial stressors.

Material & Methods: 80 Deliberate self harm patients presenting to emergency department in Vydehi Institute of Medical Sciences & Research Centre between the period of April 2022 to February 2023 are assessed & data collected. Data analysed using SPSS version 21.

Results: Majority of the DSH patients were female and are married. For both the genders, the most common mode of attempting suicide was by poisoning and the most common psychosocial stressors were interpersonal conflicts.

Conclusion: Differences in suicide attempts between genders could be indicative of the impact of societal, cultural, and geographical factors on suicidal behaviour.

References:

1. Gutti S, Koppisetty SS, Paladugu S, Kumar Reddy MM, Murali Krishna N, Rama Rao N. A case control study on factors influencing suicide attempts. Indian Journal of Pharmacy Practice. 2019;13(1):36–41.

A study on association of serum uric acid levels with agitation in psychiatric patients

BACKGROUND:

Adenosine is acknowledged for its ability to regulate second messenger pathways, maintain energy balance, influence dopaminergic and glutamatergic neurotransmission, thereby impacting cognitive functions, sleep patterns, and behavior. Allopurinol, an Xanthine oxidase inhibitor, has been explored as an adjunctive treatment for refractory schizophrenia and mania. However, there has been limited research supporting this hypothesis. Our study aims to evaluate the relationship between purinergic metabolism and agitation symptoms across various psychiatric disorders.

Aim:

This pilot study aims to compare serum uric acid levels between agitated and non-agitated patients.

Methods:

Upon obtaining informed consent, patients were categorized as agitated or non-agitated based on the revised OASS score. Sociodemographic information, MINI-5 and ICD-10 for diagnoses, Clinical Global Impression-Severity Scale for severity assessment, and Overt Agitation Severity Scale for measuring agitation levels were administered. Serum uric acid levels were collected for both groups upon admission and subsequently for the agitated group. Statistical significance of the mean serum uric acid level difference between the two groups was tested using the student’s t-test.

Result:.

The statistical analysis revealed no significant correlation between serum uric acid levels in psychiatric patients with and without agitation.

Conclusion:

The findings did not indicate an association between serum uric acid levels and agitation, nor did a connection with various psychiatric disorders within the agitated group.

Treatment of late-onset OCD in geriatric patient

Introduction: Obsessive-Compulsive Disorder (OCD) Is characterised by unwanted and intrusive repetitive thoughts impulses or urges that lead to increased distress and may lead to repetitive behaviour or mental acts to be done in response. OCD has a median age of onset of 19 years and onset after 30 is rare. The prevalence of OCD in older adults is estimated to be between 0.1 to 2%. The presentation of OCD symptoms after 60 years of age is a rarer finding.

Case description: A 63-year-old female presented with complaints of repetitive thoughts of contamination of dirt and repetitive acts of hand washing for the past 2 years with an insidious onset and a deteriorating course. On examination, she had dry cracking hands. MSE is characterised by anxious affect, obsessive thoughts of contamination of dirt and compulsive acts of hand washing. A diagnosis of late-onset OCD of moderate severity was considered with a YBOCS score of 21. The patient was started on Selective Serotonin Re-Uptake Inhibitor (SSRI).

Discussion: The onset of OCD symptoms in the geriatric population is a rare but not uncommon presentation. Most of the OCD geriatric patients will require a combination of both behaviour therapy and pharmacotherapy. Recent evidence demonstrates the efficaciousness of low-dose fluoxetine in OCD of elderly.

A digital solution for screening of perinatal anxiety and depression: Does it work?

Background: Pregnancy, often a joyous journey, can also bring about significant emotional and psychological challenges. Studies conducted in India have reported antenatal anxiety rates ranging from 22.6% to 55.7% and depression rates between 9.18% and 65%. In low and middle-income countries, mental health resources are unevenly distributed, and stigma often acts as a formidable barrier to treatment. Many obstacles deter mothers from seeking traditional, face-to-face treatment during this crucial period. These challenges have prompted an increasing number of women to turn to digital solutions.

Aim: This study investigates the feasibility, acceptability, and utilization of digital self-screening for perinatal anxiety and depression within urban obstetric clinics.

Method: A total of 101 pregnant women receiving antenatal care participated in the study, using digital tablets for self-assessment of anxiety and depression. Obstetricians conducted assessments and provided guidance. After 24 hours, participants shared their experiences and satisfaction with the tablet-based screening.

Results: Self-screening identified mild anxiety in 17.8% and moderate to severe anxiety in 9.9% of participants. Mild depressive symptoms were found in 30.6%, with 14.8% experiencing moderate to severe depressive symptoms. A promising discovery was that 46.7% of participants believed self-assessment through the digital application provided a non-judgmental platform for disclosing mental health concerns. Additionally, 21.1% preferred a self-assessment tool with guidance. These findings highlight the potential of digital solutions in addressing perinatal anxiety and depression.

Conclusion: Digital self-screening holds the potential for early detection and serves as a well-received referral channel. Such a digital intervention has the potential to offer tailored support and decrease the stigma associated with seeking assistance during this pivotal phase of life.

Case series of Bipolar affective disorder presenting with dissociative symptoms

Dr. P. Mohammedal Abitha[¹] Dr. B. Bhuvaneshwaran [²]

1.Post Graduate- Department of psychiatry; Tirunelveli medical college

2.Assistant professor- Department of psychiatry;Tirunelveli medical college

Introduction

Bipolar disorders are a group of disorders characterised by recurrent episodes of elevated and depressed mood associated with high levels of mortality and morbidity. Whereas dissociative symptoms are characterised by disruption in the integration of one’s consciousness, memory, identity,behaviour, perception and motor control.

The co-morbidity/ presentation of dissociative symptoms in BPAD is understudied. It is associated with treatment delay, poorer response to treatment.

Background

8 cases of which 7 female cases and 1 male case presented to psychiatry department of Tirunelveli medical college with different dissociative symptoms namely dissociative stupor, pseudoseizures, aphonia, possession attack, fugue and hemiparesis.among which 2 patients had previous history of dissociative symptoms. All the above mentioned patients are drug naive, and it is their first psychiatric consultation. Patients were admitted and treated initially as a case of dissociative disorder. They show poorer responses to lorazepam and psychotherapy and showed crying spells and mood lability on initial days Then they were started on with antidepressants. Most of the patients within a week started to show agitation, increased psychomotor activity with boastful talk; suggestive of Bipolarity and their dissociative symptoms settled. Following then antidepressants were stopped and patients were started on with mood stabilisers. All the patients are on regular follow up.

Conclusion

In southern part of India dissociative symptoms may be one of the commonest presentation of underlying bipolar disorder, careful evaluation of patients based on presentation, personality traits, family history, and initial treatment response should be done for prompt diagnosis and timely management thereby reducing morbidity.

Assessment of attitude towards learning communication skills in medical students at a Government Medical College

BACKGROUND: The general view of communication is that it is an interaction with social context. Communication usually involves a sender(source) and a receiver. Communication between patients and physicians must be based on common understanding in a caring and dynamic relationship that also involves the patient’s family. Communication plays a crucial role in the present era of medical litigations and hospital attacks. A good doctor has to be a good communicator. Studies suggest that one of the main reasons for doctor-patient conflicts is the lack of proper communication between both parties. Hence, in recent decades, substantial importance has been placed on improving communication skills training in the medical curriculum. It is essential to assess the attitude of the undergraduates towards teaching of communication skills before introducing it as part of the teaching learning process.

AIM: The present study was done to understand the attitude of medical students towards learning communication skills.

METHODS: This cross-sectional study was conducted on undergraduate medical students at a Government Medical College and Tertiary care hospital who were consenting to participate in the study. Data was collected using Semi-structured questionnaire and Communication Skill Attitude Scale, a 26-item scale with positive and negative attitude dimensions used to assess attitude towards learning communication skills.

RESULTS and CONCLUSION: As per communication via e-mail with the scientific committee, results and conclusion shall be presented at the conference.

Emotional intelligence (EI), personality traits and perceived stress in medical students: a cross-sectional study

Background: EI is a measure of emotional awareness and ability to respond to emotion in oneself and others. Higher EI in medical students contributes positively to increased empathy, positive doctor-patient relationships, teamwork and communication skills, organization commitment, leadership, stress management and good clinical skills. Many more core competencies underpinned by EI are professionalism, interpersonal and communication skills. Personality is defined as individual differences in characteristic patterns of thinking, feeling and behaving. EI has been found to be related to personality in medical students and influence the patient-physician relationship and patient care. Stress is defined as defined as the strain that accompanies a demand perceived to be either challenging (positive) and threatening (negative) and depending on its appraisal, may be either adaptive or debilitating. Medical students face academic stress and stress during their clinical practice. Students with higher EI cope better with stress.

Aims: The aim of the current study was to determine how emotional intelligence and personality traits and perceived stress are correlated.

Methods: This cross-sectional study was conducted on undergraduate medical students (MBBS) of government medical college who were willing to participate. Study measures included socio-demographic form, Quick Emotional Intelligence Self-Assessment Test, Big Five Personality Test and Perceived Stress Scale.

Results and Conclusions: As per communication via email with the scientific committee, results and conclusion shall be presented at the conference.

Free Paper: Original article: A Study Of Psychiatric disorders In patients With Tuberculosis

Dr.SHAIK FIROJ^1, Dr. N ANNAPURNA²

1.Postgraduate, Department of Psychiatry, Andhra Medical College, Visakhapatnam (Email ID: sameerferoz7@gmail.com)

2.Assistant Professor, Department of Psychiatry, Andhra Medical College, Visakhapatnam.

Background:

Tuberculosis is an infectious disease caused by the bacteria belonging to the Mycobacterium tuberculosis complex. According to the World Health Organisation, tuberculosis (TB) is a major global health problem. TB ranks alongside human immunodeficiency virus as a leading cause of death worldwide. India has the highest incidence of TB in the world. It is estimated that, in 2021, there were 2.14 million incident cases in India. Tuberculosis and psychiatric disorders have many common risk factors including homelessness, HIV positive serology and alcohol or substance abuse. Also, TB is associated with financial burden, poor quality of life and stigma, which again increase the risk of psychiatric illnesses. Presence of psychiatric illnesses like depression can affect TB outcome through poor compliance. Chronic alcohol use is associated with impaired immune functioning in the body which can predispose an individual to tuberculosis disease. Smoking can affect lung defence mechanisms, thereby increasing the risk of TB. There is significant interplay between TB and psychiatric illnesses including alcohol and substance use disorders. In this study, we have attempted to study the of psychiatric disorders in people with tuberculosis, so as to improve the understanding of the association between and psychiatric illnesses and tuberculosis and improve the outcome of tuberculosis

Aim:

To study the psychiatric disorders in patients undergoing treatment for tuberculosis.

Objectives of the study:

To assess the association between psychiatric disorders and different sociodemographic factors (age, gender, education) and tuberculosis disease related factors.

Methodology:

The present study was cross-sectional study using a convenient sampling method conducted on 110 patients from both the inpatient and outpatient at the Government Hospital for Chest and Communicable diseases hospital, UPHC s and local PHC s of Vishakhapatnam, with a clinical diagnosis of Tuberculosis. Sociodemographic and clinical variables were collected. All the subjects were assessed by using the M.I.N.I Scale.

Results:

In this study majority belongs to 45-64 years (50.90%).majority are males (67.27%),with a education status majority are illiterate (30.90%) followed by middle school(28.18%) In which major patients are unemployed (36.36%) with a BPL in which they belongs to nuclear family (59.09%) followed by Joint family(29.09%) .in our study sputum positive are 69.09%,23.63% are clinically diagnosed and extrapulmonary are 7.27%.MDR-TB is around 3.63%.presence of HIV co infection is around 4.54%.psychiatric disorders with MINI in descending order depressive disorder >Alcohol use disorder > substance use non-alcoholic >GAD>suicidality .

Conclusion:

A high prevalence of psychiatric illnesses in patients with tuberculosis (65%) has been observed in our study which is similar to previous studies. In developing countries like our India, the presence psychiatric illness in tuberculosis has increases the burden which results poor outcome of treatment. Initial evaluation and screening of psychiatric illness may have a better outcome in related to treatment and prognosis.

A high prevalence of alcohol use disorder and substance use non-alcoholic disorder has been observed in our study. Effective identification and management of alcohol and nicotine dependence can improve the outcome of tuberculosis. An effective liaison services between the physicians treating tuberculosis and psychiatric services can improve the outcome of tuberculosis and thereby improve the quality of life of people with tuberculosis.

Psychiatric illness, Tuberculosis, substance use.

Prevalence of glaucomatous changes in patient taking psychotropics drugs-cross sectional study in tertiary care centre

Dr. P. Mohammedal Abitha[¹]

Dr. A. Godson [²]

1.Post Graduate- Department of psychiatry; Tirunelveli medical college

2.Assistant professor- Department of psychiatry;Tirunelveli medical college

Introduction

Glaucoma is the second most leading cause of blindness. Various medications including psychotropic medications which have anticholinergic actions can cause change in intraocular pressure; structural changes in anterior chamber ultimately leading to fundus changes in prone individuals. Previous studies provided mixed results in establishing relationships between glaucomatous changes and psychotropics.

Aims and objectives

• To estimate the prevalence of glaucomatous changes in patients taking antipsychotics and antidepressants.

• To compare the prevalence between patients taking antipsychotics and antidepressants.

• To determine the relationship between duration of psychotropics use and glaucomatous changes.

Materials and method

Patients attending review OPD in psychiatry department who is on Antipsychotics and antidepressant respectively are sent to Opthal OPD for glaucoma evaluations

The parameters obtained will be analysed individually by standard statistical tools

Results

Positive correlation between the use of psychotropics and glaucomatous changes

Conclusion

Since Glaucoma is the “silent thief of vision” regular visual assessment should be done among patients using psychotropics and its early identification will help in preventing loss of vision

Abstract for paper: Impact of Screen Addiction on Mental Health Awareness in MBBS students at Tertiary Care Institute

Introduction: Mental health awareness is a major concern worldwide, without mental health awareness there can be no true physical health. Mental health awareness encompasses recognition ,causes ,self help ,facilitation of professional intervention and navigating the information available in public domain. Very often medical students are first contact for mental health related queries of general population. This calls for more awareness in medical students regarding mental health. At other times use of internet and internet-based tools were of great help, it allows individuals to communicate ,connect ,gather, and share information, this in turn raises the query of authenticity of information. In this era of information excess, very often information of social media is propagated mindlessly without conforming source, credibility and expertise of the information. Via this study we want to explore whether excess screen time has increased mental health awareness or increased stigma related to mental health.

Aims-Screening for Mental Health Awareness and Screen Addiction in MBBS students. To Assess correlation between Screen Addiction and Mental Health Awareness.

Materials and Methods-A cross sectional survey was conducted among MBBS students studying in a Medical College in Maharashtra. All the students were screened via Google Form. Using semi structured Questionnaires including Community Attitudes Towards Mental Illness (CAMI scale) and Internet Addiction Test. Sample were collected as per enrollment after taking ethical committee clearance.

Results- 450 medical students were enrolled in to the study after prior consent. There is weak correlation between mental health awareness and screen use, increased screen time does not necessarily mean improvement in mental health awareness.

Conclusion-Internet based social connectedness is a double edge sword, it has great potential of stigmatizing or destigmatizing mental health queries. This calls for circulation of adequate, accurate and authentic information on social media sites which is largely unscrutinized.

“Prevalence of Vitamin-D deficiency in individuals afflicted with Psychiatric Disorders”

Dr.Priyanka Devarajulu¹,Dr.T.AdiSeshamma²

1.2nd year post graduate, Department of Psychiatry, Government Medical College, Ongole..

2.Professor & HOD, Department of Psychiatry, Government Medical College,

BACKGROUND

• Vitamin-D, an essential fat-soluble-vitamin required for bone metabolism, plays a pivotal role in brain functions; exhibits neuro-protective effects by mitigating β-amyloid deposition, and by its antioxidant, anti-inflammatory properties.

• Numerous studies consistently associate Vitamin-D deficiency with mental health-conditions, including Schizophrenia, Depression, Alzheimer’s, Autism, Parkinsonism, Etc.,

• Individuals with mental-illness are more susceptible to Vitamin-D deficiency d/t various factors like inadequate dietary-intake, limited sunlight exposure, and hindrances in synthesis d/t medications, smoking/ alcohol-consumption.

AIM

• To study the prevalence of Vitamin-D deficiency & insufficiency in patients with psychiatric-illnesses

METHOD

• It is a cross-sectional comparative study set in tertiary-care-teaching-hospital, Ongole, AP

• Participants[n=100] were categorized into three-groups based on their Vitamin D levels: 1)

• Vitamin-D deficiency: <10 ng/ml; 2) Vitamin-D insufficiency: between 10–29.99 ng/ml; 3)

• Vitamin D adequacy: ≥30 ng/ml.

• Patient data, including socio-demographic factors, primary psychiatric diagnoses, and serum vitamin-D levels were collected for analysis.

• The three groups underwent comparison using chi-square tests.

• Significance was set at p < 0.05, with vitamin-D categorized as deficient or non-deficient, as dependent variable.

• Statistical analyses were performed using SPSS-software.

RESULTS

• 33% of the participants exhibited Vitamin-D deficiency, while 44% were classified as having insufficiency. 23% of patients demonstrated normal Vitamin-D levels.

CONCLUSION

• Prevalence of Vitamin-D deficiency is notably high in individuals with mental-illness; influenced by factors like age, gender, lifestyle choices including poor diet, physical inactivity, alcohol and tobacco usage. It is necessary to incorporate vitamin-D supplementation alongside the existing medication-regimen to these patients.

Is CARIPRAZINE a Mood elevator ? - A case series

Dr. S. Dhivagar1 , Dr. Arun Selvaraj2 , Dr.Souganya Devi3 Department of Psychiatry, SMVMCH, Puducherry.

1Second year PG , 2Professor & Head , 3Assistant professor

Background : CARIPRAZINE is an atypical antipsychotic medication indicated for the treatment of schizophrenia, MDD and bipolar mania. In previous studies, CARIPRAZINE has not significantly arisen alerts for treatment emergent affective switches and has suggested a dose increase of CARIPRAZINE could address the emerging manic symptoms associated with the low dose. We here describe three clinical cases admitted in our psychiatric ward who developed elevated mood and increased libido after the introduction of low dose of CARIPRAZINE and no improvement with up-titrating the dose.

Case 1 - A 31 yrs unmarried male, k/c/o Resistant Schizophrenia for past 21 yrs on CLOZAPINE presented with c/o talking to self, suspiciousness, avolition and apathy for 2 months.

Case 2 - A 26 yrs unmarried male, k/c/o Schizoaffective disorder, mixed type for past 12 yrs on CLOZAPINE presented with c/o irritability, decreased energy, suspiciousness towards mother, decreased social interaction, claiming he has divine powers for 6 months.

Case 3 - A 20 yrs unmarried female, k/c/o Chronic Bipolar Affective Disorder partial remission presented with c/o irritability, increased self esteem, over-spending and talking to self for 1 month.

Discussion : All three cases were started on CARIPRAZINE 1.5mg and up-titrated to 6mg. Despite the ongoing treatment with Mood Stabilizers, patient showed manic symptoms with predominantly increased libido on about 4-6 days of initiation of CARIPRAZINE evident by disinhibitory behaviors, increasing scores on YMRS & Naranjo adverse drug reaction probability scale. Upon withdrawing the drug, symptoms resolved by self.

Conclusion: CARIPRAZINE due to its D3-preferred properties expressed in brain regions controlling reward, emotions, and motivation probably caused elevated mood symptoms and increased libido . Based on our observation, patients and psychiatrists should receive an information regarding early identification of warning signs and monitor possible CARIPRAZINE-induced manic symptoms.

Attitude towards homosexuality in nursing students of selected colleges in Ahmedabad

1)Samyak Upadhyay, 2)Saba Anees, 3)Sasvinder Kaur, 4)Chirag Parmar, 5)Ajay Chauhan

1.Junior resident 2,3,4,5,Psychiatrists (GIMH Ahmedabad)

INTRODUCTION

Homosexual desire is the affective experience of same-sex attraction. Despite medicine and psychiatry arguing that homosexual orientation is a normal variant of human sexuality, mental health fraternity and the government in India are yet to take a clear stand on the issues to change widely prevalent prejudice in society..

RESULTS

There was a statistically significant difference in the overall scores with respect to education and medium of education.

MATERIALS & METHODS

A descriptive cross sectional study, was conducted on nursing students wfrom Aug 2020 to Sep 2021, standardised questionnaire for homosexuality attitude was used to assess the students attitude towards homosexuality, any student who consented was taken in the study, students who understood English were chosen, a total of 218 students consented, data was entered in MS excel and analysis done using SPSS version 20

AIMS & OBJECTIVES

In the current paper we are trying to assess the factors influencing the attitude towards homosexuality in nursing students of some selected colleges of Ahmedabad.

CONCLUSION

It can be inferred from the above study that attitude towards homosexuality in nursing students is complex and variable depending on the situation and understanding about the concept

REFERENCES

• Larsen, K. S., Reed, M., & Hoffman, S. (1980). Attitudes of heterosexuals toward homosexuality: A Likert- type scale and construct validity. Journal of Sex Research, 16(3), 245-257.

• Anand, P. V. (2016). Attitude towards homosexuality: A survey based study. Journal of Psychosocial Research, 11(1), 157.

CONFLICT OF INTEREST

None

Study Of Factors Affecting Compliance in Patients with Schizophrenia

Dr. Digna Trivedi^* ,Dr. Aditya Mhaskar^**, Dr. Rakesh Gandhi^***

*Second Year Resident, Department of Psychiatry, Medical College Baroda **Senior Resident, Department of Psychiatry, Medical College Baroda

***Professor and Head of Department, Department of Psychiatry, Medical College Baroda

Background: Non-compliance with the treatment is a major problem in the case of psychiatric patients. One of the ways to improve drug compliance is by knowing about the factor responsible for poor drug compliance and planning for appropriate management strategies to improve it.

Aim: To study the factors influencing treatment compliance and association between non-compliance with treatment and socio-demographic and clinical variables.

Methods: A 7-month cross-sectional study at SSG Hospital enrolled 145 Schizophrenia patients aged 18-60. Data, collected via a semi-structured proforma on demographics, illness, and treatment, assessed treatment adherence with Rosack’s criteria, and employed DSM-V criteria for diagnosis. Data were recorded in Microsoft Excel 2010 and analyzed using Epi Info 7 software.

Result: The study found a high non-compliance rate of approximately 40% within the population. This non-compliance was particularly prevalent among individuals residing in rural areas, those in nuclear families, and those with illnesses lasting over 10 years. It was also more common among patients on polydrug therapy regimens, possibly due to difficulties in medication management and the burden of taking numerous tablets each day. This could be attributed to the limited availability of community mental healthcare facilities in rural areas.

Conclusion: Non-adherence to treatment in chronic conditions such as Schizophrenia poses a challenging management issue. The findings from our study, which include socio-demographic and clinical variables, have the potential to enhance treatment compliance in Schizophrenia patients. Ultimately, this could significantly improve the overall prognosis of individuals living with Schizophrenia.

Comparing quality of life in schizophrenia patients with or without depression.

Parul Gupta¹ , Pradeep Patil² , Ragini Patil³

1.Resident, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra. Email – parulgupta10000@gmail.com mobile-8085315830.

2.Professor, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra. Email - dr.p.s.patil2012@gmail.com, mobile-8999248979.

3.Professor and Head, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra. Email – ragini.tushar@gmail.com, mobile-9096136123.

Presenting Author: Dr. Parul Gupta,

Resident, Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Sawangi Meghe, Wardha, Maharashtra.

Email – parulgupta10000@gmail.com

Mobile- 8085315830.

Background: Quality of Life reflects sense of well-being. Individuals with Schizophrenia remarkably suffer a poor standard of living compared to others in the community. Depression in Schizophrenia has been recognized as one of the essential factor influencing the Quality of Life (QOL).

Aim: To compare and contrast the quality of life in individuals with Schizophrenia with and without depression.

Method: For this study, 120 patients with a clinical diagnosis of Schizophrenia as per ICD-10 were divided into two groups (with and without depression) based on their score on the Calgary Depression Rating Scale for Schizophrenia (CDSS). After that, all patients were assessed on the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) for psychopathology, on the WHOQOL BREF scale for QOL, and PGI Social Support Questionnaire for perceived social support.

Results: Both depressed and non-depressed schizophrenia groups were found to be significantly different in general psychopathology and negative subscale symptoms of PANSS, with the depressed group scoring higher. On the WHOQOL and PGI social support questionnaire, the depressed group scored low. Amongst the total sample, the Negative subscale, General psychopathology, and CDSS score had significant negative correlations with all four domains of WHOQOL BREF. PGI Social support score showed positive correlation with all four domains of the WHOQOL BREF scale.

Conclusion: All symptom clusters of PANSS and depressive symptoms are related to poor QOL, and negative symptoms, general psychopathology, and depressive symptoms are critical predictors of QOL. This study confirms the poor quality of life in schizophrenia patients with depression.

To assess patterns of personality traits in psychiatric disorders.

Background: Personality traits reflect people‘s characteristic patterns of thoughts, feelings, and behaviours, which tend to remain relatively stable and constant. Given the limited data available on individuals with personality disorder traits (PD traits) and their association with psychiatric disorders more research is needed to explore the impact of these traits . Hence, this study aims to assess the pattern of PD traits in psychiatric patients.

Aim: To asses patterns of personality traits in psychiatric disorders

Methods: A cross sectional study

Based on the prevalence of Personality traits (56.3%) in patients with Psychiatric disorders observed in an earlier publication by Saini B, Bansal PD et al and with 20% allowable error and 95% confidence, the minimum sample size comes to 75.

Patients who fulfil the ICD-10 diagnostic criteria for various psychiatric illness and were in remission were taken up for the study through convenience sampling.

An informed consent was obtained and Personality assessment was done using the International Personality Disorder Examination.

Results: To test the statistical significance of the association of personality traits and psychiatric disorders, Chi-square test was used.Cluster wise prevalence in this study showed Cluster C>mixed>B>A. Among subtypes anankastic and mixed had highest prevalence.

Conclusion: Cluster wise prevalence in this study showed Cluster C>mixed>B>A. Among subtypes anankastic and mixed had highest prevalence.

An experience of using Clozapine in Elderly Patients with Mental Disorders

Pranshu Sharma, Sandeep Grover, Subho Chakrabarti

Department of Psychiatry, PGIMER, Chandigarh

Background: There is little information on using Clozapine in elderly patients with mental disorders from India. Aim: To evaluate sociodemographic and clinical profile of patients who were started on Clozapine after the age of 60 years. Methodology: Clozapine registry in the department was screened to identify patients who were started on Clozapine after the age of 60 years. Treatment records of these patients were reviewed to extract sociodemographic and clinical profile. Results: 30 patients were identified who were started on Clozapine after the age of 60 years. Most of these patients were males and in majority of these patients, Clozapine was started for treatment resistant clozapine. However, in few patients, Clozapine was started for management of Tardive Dyskinesia, Dystonia and Psychosis in patients with Parkinson’s Disease. In general, Clozapine was found to be effective in conditions for which it was used and it was well tolerated. Elderly patients experienced similar common side-effects as noted in adult age group. Conclusion: Clozapine can be safely used in elderly patients with mental disorders. Hence, Clozapine should not be withheld in elderly patients with mental disorders whenever indicated.

Obsessive-compulsive disorder and perceived stress among undergraduate medical students: A Cross-sectional study

Dr Sahil Arora, Dr Abhijeet Bansod, Dr Anand Chabukswar, Dr Manish Thakre

Background - Obsessive-compulsive disorder (OCD) is a condition in which an individual has repetitive, intrusive, unwanted thoughts, impulses or urges and repetitive images that cause distress or anxiety (Obsessions) and that drives him to do repetitive behaviours, rituals and mental acts that are unpleasurable and are performed in response to an obsession (Compulsions). Stress is again one of the important predisposing factors leading to OCD as its symptoms worsen during periods of stress.

Aims - This study aimed to evaluate prevalence of OCD in undergraduate medical students and its association with perceived stress.

Materials and methods - A total of 250 MBBS students were assessed using a semi structured proforma specially designed to study the Obsessive-compulsive symptoms and Perceived Stress. Tools used were Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Perceived Stress Scale (PSS).

Results - Prevalence of OCD in MBBS students was found to be 33.60% (95% CI 27.8 -39.8%). Mean Y-BOCS score was 7.88. Mean PSS score was 17.772. There was a strong, positive and significant correlation between Y-BOCS and PSS scores (P value = 0.0001).

Conclusion - Obsessive compulsive disorder and stress have a significant correlation with each other. High perceived stress in MBBS students could be a major predisposing factor in developing OCD.

Background: An estimated 3.8% of the global population experience depression. National Mental Health Survey 2015-16 revealed that one in 20 Indians suffers from depression. 54% of adults show improvement after antidepressant medication. 66% of adults show improvement after CBT. Research has shown Positive Psychology Interventions (PPI) is equally or more effective than CBT in alleviating features of depression, however not a mainstream therapy in this regard.

Aims: To determine the effectiveness of PPI as an adjunct to standard interventions in alleviating features of depression in patients admitted or attending OPDs with Depressive Episode in a tertiary care hospital.

Methods: Quasi Experimental study in Psychiatry OPD and Ward, with 25 patients diagnosed with F32 in control and 25 in experimental group. Pre-intervention BDI assessed and co-related with selected demographic variables like age, gender, living with spouse and comorbidity, followed by 3 sessions of PPI over 9 days, BDI re-assessed after 1 week of last session.

Results – The mean pre-intervention BDI score among females is significantly higher than the males, t value=3.29073, p value=0.000939 at p<0.05. The mean pre-intervention BDI score is significantly higher than the mean post-intervention BDI score, t=2.91115, p=0.002723 at p<0.05.

Conclusion – The level of depression is supposedly higher among the women hence more attention to be given. The module of PPI has proved its mettle as an adjunct standard intervention which may bridge the treatment gap and bring about better outcomes in patients with depression.

PREVALENCE OF DELIRIUM AMONG THE ELDERLY PATIENTS PRESENTING TO EMERGENCY TRAUMA SETTING: AN EXPLORATORY STUDY

Kanika Sethi, Aseem Mehra, Sandeep Grover, Sameer Aggarwal, Deepak Negi

Background: Elderly patients are at a higher risk of trauma due to accidental falls and often present to the emergency trauma setting for immediate interventions. Little is known about the prevalence of delirium in this group of patients. Aim: To evaluate the prevalence of delirium among elderly patients presenting to the Emergency trauma setting. Methodology: Using a cross-sectional study design 206 elderly (age ≥ 60 years) who presented with a traumatic injury were enrolled using a convenient sampling technique. These patients were assessed for delirium using the DSM-5 criteria and Confusional Assessment Method. Results: The prevalence of delirium as per DSM-5 criteria was 24.3 % and as per CAM the prevalence was 27.2%. Conclusion: About one-fourth of the elderly patients presenting to the emergency with trauma have delirium. Hence, it is important to screen all the elderly patients presenting to emergency with trauma for delirium.

Introduction: Internet addiction or “electronic opium” as the Chinese call it, is the most modern form of addiction. The prevalence among Indian adolescents is 27.6 %. Internet addiction prevails among students who uncontrollably immerse themselves in it as a way of escaping from their challenges and stressors which may negatively affect their health and quality of life. The impact of internet addiction is multi-faceted. Physiologically body aches, Carpal Tunnel Syndrome, insomnia, vision deficits, weight gain, psychologically Depression, Anxiety disorders, ADHD, suicidal ideations, low academic performance, isolation, anti-social behaviour and legal issues like cyber bulling are to name a few.

Aims: To assess the prevalence and severity of internet addiction among high school students in a selected school of a city and determine the correlation between internet addiction and psychiatric caseness.

Methodology: A correlational study was conducted among 100 high school students using stratified random sampling. Young’s Internet Addiction Test (IAT) and Problematic and Risky Internet Use Screening Scale (PRUISS) were used to assess prevalence and severity of internet addiction.

General Health Questionnaire 12(GHQ 12) was used to detect psychiatric caseness.

Results: On IAT, 37% mild and 21% had moderate addiction. PRUISS showed 46.5% had a risk for problematic internet use. Only 2 students were suggestive of psychiatric caseness as per GHQ. The IAT score and PRUISS score had strong (r=0.7661) and moderate (r=0.6052) positive correlation with GHQ score respectively.

Conclusion: Internet addiction is a growing problem among high school students. It is corelated with psychological ill health. Consultation liaison needed.

Prevalence of lifetime suicidal ideation and its correlates in patients with schizophrenia

Aim: To evaluate the factors associated with lifetime suicidal ideation in patients with schizophrenia. Methodology: Using a cross-sectional study design, 100 patients of schizophrenia were assessed for lifetime suicidal ideation. Those with and without suicidal ideation were compared. Results: The prevalence of lifetime suicidal ideation in the study sample was 53%. Compared to those without lifetime suicidal ideation, those with lifetime suicidal ideation were more frequently treated as inpatients, were hospitalized for higher number of times, had higher residual psychopathology, higher severity of depressive symptoms, higher level of verbal and physical aggression and higher severity of negative symptoms. Conclusion: There is a high prevalence of lifetime suicidal ideation in patients and it is associated is with higher residual psychopathology and depressive symptoms.

Keywords: Schizophrenia, Correlates, Suicidal behaviour

Relationship of Depression and Anxiety with Quality of life in patients undergoing Dialysis

BACKGROUND: Patients with chronic renal disease necessitating dialysis exhibit low quality of life (QoL) compared to the normal population. Prior studies mainly focus on the unmodifiable factors like age, sex and comorbidities. It’s crucial to identify the modifiable factors like depression, anxiety, physical activity among others, linked with lower QoL in such patients.

AIM: To study the prevalence of depression and anxiety in adult patients suffering from chronic renal disease on maintenance dialysis and their influence on their quality of life.

METHODOLOGY: A cross sectional study was conducted on adult patients of chronic renal disease (N=100) at Medical college, Tertiary care hospital, Vadodara. For all patients assessments were done by completing PHQ-9 (Patient Health Questionnaire scale), GAD (General Anxiety Disorder scale and WHOQOL-BREF scale. Depression and Anxiety prevalence was determined and its correlation with QoL was examined.

RESULTS: The prevalence of depression was found to be 89% based on the PHQ-9 scale. Anxiety measured through GAD scale was prevalent in 59% of the sample. Additionally, a significant negative correlation was observed between scores on the PHQ-9 as well as GAD-7 and WHOQOL-BREF scale domains: physical health and psychological health. This suggests that the higher level of depression and anxiety are associated with lower health-related quality of life among these patients.

CONCLUSION: Depression and Anxiety are prevalent among adult patients with chronic renal disease on maintenance dialysis, and they significantly influence their quality of life. Treating depression and anxiety effectively can improve quality of life.

Keywords:

Chronic Kidney Disease, Dialysis, Depression, Anxiety, Quality of Life

A study on treatment emergent sexual dysfunction due to antidepressants among females.

BACKGROUND: Sexual dysfunction is a well-known side effect of antidepressants which is associated with significant distress and hinders treatment compliance. There is comparatively little data on antidepressant-induced sexual dysfunction in females as compared to males.

AIMS: To assess the sexual dysfunction in females using antidepressants.

METHODS: It was a cross sectional study done at Institute of mental health and neurosciences Kashmir (IMHANS-K) over a period of one year from March 2022- March 2023. A total of 50 females receiving antidepressants for various psychiatric disorders for at least 3 months were assessed using a preformed Performa, Arizona Sexual Experience Scale (ASEX) and Brief Adherence Rating Scale (BARS) after giving consent.

RESULTS: mean age of our patients was 33.11+2.99 years. Majority of the patients were using SSRI’S (70%). As per ASEX scale 68% of patients had sexual dysfunction and the domain most affected was difficulty to reach orgasm (72%) which was followed by dysfunction in sexual drive(69.2%).In majority of the patients, sexual dysfunction did not lead to discontinuation of the antidepressant.

CONCLUSION: Antidepressants affect many domains of sexual functioning which needs to be discussed with the treating doctor specially among females and further studies are required to prove the effect of antidepressant induced sexual dysfunction on treatment adherence.

Evaluating the training of Peer Support Volunteers (PSVs) to deliver support to persons with lived experience of schizophrenia.

Background: As peer support is increasingly being recognized as important, studies have reported several benefits and challenges to implementing peer work. Training is necessary to manage these challenges, bring in formal peer supporter roles, and define core peer support competencies for accreditation of PSVs.

Aim: To evaluate the peer support training offered to persons with lived experience of schizophrenia to become PSVs.

Methods: Training was done using the Using Peer Support In Developing Empowering Mental Health Services (UPSIDES) model of peer support. UPSIDES trainers with first-hand experience, trained the researchers, who trained a group of 6 PSVs. The training for PSVs was conducted 2-3 times a week, for 7 weeks, each session lasted up to 3 hours. Training notes were maintained. Post-training the PSVs were invited for a Focused Group Discussion (FGD) that was audio-taped, transcribed, and analyzed using theme analysis along with the training notes.

Results: Several key themes emerged in the training notes and FGD such as relating to “recovery” based on personal experiences. Activities like experience sharing and role plays were useful. Challenges included finding words to fit the local language, maintaining group rules during training, and so on. Based on these findings, recommendations were made for future training programs.

Conclusion: Evaluation showed that it was possible to train PSVs.Based on feedback and themes, modifications were required in the training process.

Acknowledgments: This study is funded by the National Institute of Health & Care Research as part of the Early Career Research grants in the PIECEs project.

MODIFIED ELECTROCONVULSIVE THERAPY AND METABOLIC SYNDROME : AN EXPLORATORY STUDY FROM NORTH INDIA

Aaliya Khanam¹, Zaid Ahmad Wani^1, Rajnish Raj¹

¹institute of Mental health and neurosciences, Kashmir.

Background: Modified Electroconvulsive therapy (mECT) is the treatment of choice in suicidality, catatonia and resistant psychiatric disorders like treatment resistant depression, bipolar disorder and schizophrenia. A handful of studies with modest sample sizes have suggested effect of mECT on metabolic parameters like glycemic control and cholesterol levels, however, not a single study has explored the association between mECT and Metabolic syndrome. Hence the present study was undertaken to find out the prevalence of metabolic syndrome in patients receiving mECT.

Methods: This was a cross-sectional exploratory study in which 75 patients receiving mECT were recruited via purposive random sampling and evaluated for metabolic syndrome by using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Results: 50.07% of patients fulfilled the modified NCEP ATP-III criteria for Metabolic syndrome. Among the individual parameters studied- elevated blood pressure (66.67%) was the most common metabolic abnormality, followed by increased waist circumference (46.67%) and increased triglycerides levels (42%). Least common metabolic abnormality was impaired fasting glucose in 25% of patients. Compared to patients without metabolic syndrome, patients with metabolic syndrome had received higher number of mECT sessions . Conclusion: Our findings revealed an increased prevalence of metabolic syndrome in patients recieving mECT, this highlights the importance of screening for metabolic syndrome at an early stage to employ timely care so as to reduce the risk of cardiovascular disease and premature death.

Keywords: ECT, Metabolic syndrome, metabolic derangement, NCEP ATP III criteria.

Impact of Dementia diagnosis on Management of inpatients at regional Mackay Base Hospital, QLD Australia

A Rana¹, S Reelh¹, S Sinha¹, QM Lee¹, A Ajit², C Tan², M Hiskens³

¹Mackay Base Hospital, ²James Cook University, ³Mackay Institute of Research and Innovation,

Background

Dementia affects our behaviour, cognition, and ability to perform everyday tasks. More than 400,000 Australians live with dementia, and this figure is expected to double by 2058. More than 28,650 people have younger onset dementia and this is expected to double within the same timeframe; however, it is recognized

Aims and Objectives

1. Assess changes in LOS of patients compared to previous 2017 audit

2. Evaluate use of pathways for patients with suspected cognitive impairment including timely diagnosis and management of patients with dementia

3. Identify developmental needs of a local geriatric service to improve outcome of care

Methodology

Ethics approval was sought to review data of 100 consecutive patients ≥65yo who attended MBH in 2022 were assessed. Assessment parameters used in the used 2017 audit were used. In addition, recommendations made previously were assess by cognitive screening tool usage. These parameters can be found as Table 1.

that many cases go undiagnosed.

From 2015, the rate of hospitalization due to dementia increased 1.6% each year. The average length of stay (LOS)in hospitals due to dementia is 5x higher than all other hospitalizations (13 days vs 2.6 days). While younger onset dementia had a greater average LOS than older people (22 days vs 13 days).

A 2017 audit done in Mackay Base Hospital (MBH) found high proportion of patients >65yo displayed cognitive impairment but weren’t screened appropriately and were missed dementia diagnoses. That resulted in increased LOS and re-admission rates. Recommendations made after were aimed at increasing screening, diagnosis and management pathways for dementia patients.

Discussion Points and Results:

• ResultsLOSfordementia patients has largely remained unchanged since 2017 (The same applies to total hospital LOS)

• The barrier to diagnosing dementia has improved relatively – where only 4% of our population did not receive a dementia diagnosis (Compared to 79% in 2017)

• ACE-III and RUDAS remains the 2 main screening tool used, these were mainly performed by Occupational Therapist and Psychologists

• Categorizing into dementia types and it’s associated severity remains suboptimal

• Readmission rates albeit low would benefit from further improvement

All 100 patients selected were put through the tool. Some population demographics can be found in Table 2. Most patients had a diagnosis of dementia, while 13% of patients had newly diagnosed dementia shown in Figure 1. Dementia types were mostly not documented, while Alzheimer’s remains the most common type of dementia as shown in Figure 2. Dementia severity was also not documented in most cases, however where documented, most cases were severe as shown in Figure 3.

The LOS comparison can be found in Figure 4, the LOS for dementia has increased as compared to 2017. While the maintenance LOS for the various categories is found in Table 3, patients who were admitted from their usual residential aged care facility (RACF) had the longest LOS at 53 days. Home was the commonest discharge location as in Figure 5. 21% of patients were readmitted within 30 days.

Recommendations

This completed audit cycle shows improvement in clinical acuity and a reduced barrier to screening and diagnosing dementia. There remains considerable work in the development of effective management of dementia and utilisation of health resources. Dementia underdiagnosis reduces the perceived importance of resourcing health services to manage cognitive impairment in older people.

Further development to help continue this improvement trajectory should be undertaken; such as continuous key stakeholder engagements, establishment of a geriatric service and to collaborate care approaches to utilize trans-disciplinary cadre of various clinicians.

References

1. Dementia Australia. dementia prevalence and incidence projections, from 2011 to 2050, for Queensland, by Federal Electoral Division (FED), State Electoral District (SED) and Health Service District (HSD). Projections of dementia prevalence and indecision in Queensland 2011 – 2050. Accessed May 20, 2023.

2. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145(10):713-726. doi:10.7326/0003-4819-145-10-200611210-00004

3. Bacsu J, Mateen FJ, Johnson S, Viger MD, Hackett P. Improving Dementia Care Among Family Physicians: From Stigma to Evidence-Informed Knowledge. Can Geriatr J. 2020;23(4):340-343. Published 2020 Dec 1. doi:10.5770/cgj.23.426

An Audit on Code White Team Response

Hari Priya. M, Syed Ummar. I and G. Raghuthaman

Department of Psychiatry

PSG Institute of Medical Sciences and Research,Coimbatore

Background: Code White is a trained team response called in emergency situations when a patient exhibits aggressive or violent behaviour, posing a risk to themselves, other patients or hospital personnel. One of the goals in the management is to address this behaviour in a respectful, caring, safe manner using evidence based therapeutic methods. It is important to evaluate and enhance the overall response strategy, strengthen the team’s abilities and thus promote a safer healthcare environment

Aim To assess if Code White response was appropriate as per Department policy

Methods Audit was conducted on 17 patients admitted in Psychiatry ward for whom Code White was announced and the observations were documented using a data collection form

Results: All patients for whom Code White was initiated had definite indication- most common being aggression, danger to self or others. Pre Code White Proceedings (<95%) Protocol for availability of Code White Members (<90%) and Physical Restraint Policy were not abided as per Department policy in all patients

Conclusion: From the study it was evident that the team response has to be refined. Recommendations made were- initial training and regular refresher training, obtaining informed consent, monitoring vitals at regular intervals, reviewing and documentation of MSE at frequent intervals and debriefing to be followed by the staffs when Code White is declared

DISABILITY EVALUATION – FUTURE

BY

Dr. Arjun Balaram

DNB Psychiatry Resident

Govt Mental Health Centre

Trivandrum

In today’s context, the definition of disability and the rights for individuals with disabilities fall under the jurisdiction of the RPWD Act, which replaced the 1995 PWD Act and aligns with the UNCRPD. The legal landscape in the context of disability has evolved to embrace a more inclusive and compassionate approach, especially regarding mental disorders. However, there is a notable lag in the advancement of disability assessment methods to align with these legal changes.

Currently, the assessment of disability still relies on IDEAS (Indian Disability Evaluation and Assessment Scale). IDEAS, introduced in 2001, was designed to align with the perspective on mental disorders outlined in the PWD Act of 1995. There arises a need to critically evaluate the persisting use of IDEAS scale for disability assessment. The use of other tools, which might be more detailed and better suited for assessment in the current context, must be considered. The evolution , that came about in the conceptualisation of what comes under the umbrella term disability, has not been sufficiently reflected in the areas of its practical application vis-à-vis assessment and certification. This paper aims to address the aforementioned issue by conducting a critical evaluation of the IDEAS scale and exploring alternatives

ABSTRACT – FREE PAPER: DISABILITY EVALUATION – PRESENT

BY

Dr. Meera Mohan

DNB PSYCHIATRY RESIDENT

GOVT MENTAL HEALTH CENTRE

TRIVANDRUM

The Rights to Person With Disability act came into effect on 30th December 2016. The synergy between RPWD 2016 and psychiatry marks a quantum leap in how society addresses mental health with in the framework of disability rights.This nexus signifies a paradigm shift ,recognizing mental health conditions as disabilities deserving equal rights and opportunities.

Aligning its principles with that of UNCRPD, the RPWD act encompas several changes in comparison with the PWD Act; expanding the number of disabilities covered , a more comprehensive definition of mental illness are to name a few. The act thus act as a catalyst in destigmatizing mental health issues ,ensuring that individuals with psychiatric disabilities receive the same considerations and accomodations as those with physical disabilities. This paper seeks to present a comprehensive overview of the RPWD Act, highlighting the modifications introduced in the evaluation of different psychiatric disabilities.

ABSTRACT – FREE PAPER: DISABILITY EVALUATION – PAST

BY

Dr.Vijesh Vijayan

DNB Psychiatry Resident

Govt.Mental Health Centre

Trivandrum

Disability associated with psychiatric disorders is considered an important public health problem in developing countries like India. Psychiatric disorders cause disability in individuals and pose significant burden on their families. Disability due to psychiatric illness refers to dysfunction or inadequate performance in specific activities of daily living which are normally expected from a person according to his age, sex and societal role. India has witnessed a remarkable evolution in its approach to disability assessment, moving from traditional models of impairment classification to a holistic understanding of functioning and participation. In the pre-independence era, disability assessment in India was primarily focused on identifying and classifying individuals based on their perceived physical or mental impairments. This approach, often rooted in medical diagnoses, led to the stigmatization and segregation of individuals with disabilities, limiting their opportunities for education, employment, and social participation. The post-independence era marked a significant shift towards a more person-centred approach to disability assessment. This shift recognized that disability is not solely defined by impairments but is also influenced by an individual’s environment, social context, and personal experiences. In 1975: the National Institute for the Mentally Handicapped (NIMH) is established in Secunderabad. In 1992: The government establishes the National Trust for the Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities. Mental illness has been recognized as one of the disabilities in the Persons with Disabilities Act, 1995. In this act “Mental illness” has been defined as any mental disorder other than mental retardation. The adoption of the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) in 2001 revolutionized disability assessment practices in India. The ICF framework provided a holistic understanding of disability, encompassing physical, mental, and social factors that influence an individual’s functioning and participation in society. The ICF framework paved the way for the development and adoption of standardized assessment tools like IDEAS, provide a structured and consistent approach to assessing functioning across various domains, such as mobility, self-care, communication, and social participation. Initial development and release of IDEAS was on 2001.In this paper I try to explain the evolutionary process of assessment of psychiatric disability in Indian scenario.

New onset Gender dysphoria in Bipolar Affective Disorder- A Case Series

DR ANJALI SHARMA

Gender confusion in the context of mania is very less frequently described in the literature. The actuality of a primary psychiatric condition in gender identity complaint has significant bearing on the applicable operation and prognostic. This case series describes cases of bipolar affective complaint presenting in a manic occasion whose mania was marked by hypersexuality and the desire to be of opposite gender. Both of these symptoms resolved with treatment of the manic occasion. Case 1, a 17-year-old male presenting with an episodic illness, with current manic episode. He is currently interested in boys and has started enjoying feminine activities. Upon treatment, his symptoms showed improvement. Case 2 ,a 22-year-old gay male, with a total duration of 7 years, current episode mania. Now, he is considering himself a lesbian and feels he is mentally a modern female. After 4 months of treatment there was significant improvement in his complaints and he stopped cross-dressing as a female. Case 3, a 21 years old female, with manic episode. After one month, the patient began acting and speaking more like a boy. The patient has shown improvement while on treatment. Gender dysphoria occurring along with a psychotic episode and resolving with management of the primary psychiatric disorder are rarely recorded. Psychiatrists should be aware of this scenario so that proper treatment strategies for gender incongruence can be planned.

Keywords: Gender Dysphoria, Hypersexuality, Mood disorder, Bipolar affective disorder, Mania

MEPHENTERMINE INDUCED PSYCHOTIC DISORDER: A CASE SERIES.

Dr. Shreyash Upadhyay¹, Dr. Manish Roshan Thakur², Dr. Sajjadur Rehman³, Dr. Shiv Prasad⁴

1.Postgraduate Resident, Department of Psychiatry and Drug De-addiction Centre, Lady Hardinge Medical College, New Delhi, India-110001

2.Senior Resident, Department of Psychiatry and Drug De-addiction Centre, Lady Hardinge Medical College, New Delhi, India-110001

3.Specialist, Department of Psychiatry and Drug De-addiction Centre, Lady Hardinge Medical College, New Delhi, India-110001

4. Director Professor & Head, Department of Psychiatry and Drug De-addiction Centre, Lady Hardinge Medical College, New Delhi, India-110001

BACKGROUND: Mephentermine is an alpha-adrenergic agonist which is structurally similar to methamphetamine. Despite a relatively well established dependence potential and other psychiatric sequelae, reports of mephentermine misuse or dependence are few.

AIM: We present a case series of 4 patients who presented in a tertiary health care facility with symptoms of psychosis following long term use of mephentermine.

CASE HISTORY: Case 1 A 33 years old male with h/o mepehentermine use from 2.5 years and complaints of suspiciousness, physical aggression, auditory hallucinations, visual hallucinations from 7days. Case 2 a 19-year-old male with h/o mepehentermine use from 2 months and complaints of suspiciousness, fearfulness, verbal and physical aggression decreased sleep, increased activity, inflated self-esteem and overspending. Case 3 a 20 years old male, with h/o mephentermine use since 2weeks and complaints of suspiciousness, auditory and visual hallucinations, physical aggression and sleep disturbances from ten days. Case 4 a 39 year old male with h/o mephentermine use since 3.5 years in dependence pattern and increased irritability, verbal aggression, delusions of grandiose ability since 2years.

CONCLUSIONS: This series highlights the importance of recognizing and managing mephentermine induced psychosis to optimize treatment outcomes and patient adherence.

Clinical study of Buprenorphine based Opioid Substitution Therapy in tertiary care centre – Southern India

Dr Pavana Lalitha

Background: Opioid substitution therapy (OST) is an evidence-based intervention for opiate-dependent persons that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine and methadone. OST reduces HIV risk behaviour and harms associated with injecting opioid. OST as a HIV prevention strategy was formally integrated in NACP in 2007.

Aims: To study sociodemographic variables, HIV status, risk behaviour, comorbid substance use pattern, and required dose of buprenorphine used for treatment of injection drug users attending oral substitution therapy (OST) centre at a tertiary health care centre.

Methodology: A total of IDUs aged 18–60 years who attended OST centre during 1-year period at a government medical college are included in the study.

Results: Majority of IDUs are male with mean age of 32.8 years. The mean dose of buprenorphine was 4.6 mg/day at the start of therapy. Unemployed participants dependent on the family 12.76%. Most of the IDUs are of lower educational status and educated up to secondary school. Most common substance abused is cannabis, followed by pentazocine. 50.44% belong to nuclear and 49.55% to joint family. High-risk behaviour found among OST clients was unprotected sexual intercourse (29.78%), sharing needle (37.23%), and sexual intercourse with multiple partners (15.95%). HIV positive cases were 2 (1.67%).

Conclusion: This study helps in understanding the effectiveness of treatment strategies and further implications of future research in this field.