FREE PAPERS (ORAL)

. 2015 Jan;57(Suppl 1):S11–S112.

FREE PAPERS (ORAL)

PMCID: PMC4333351

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Epidemiology Of Relapsed Alcohol And Opioid Addicts In The Drug Stricken Belt Of Punjab

Aditi Popli^*1, Ranjive Mahajan²

¹CMC Hospital, Hisar, India, docadi2002@yahoo.co.in, ²DMC Hospital, Ludhiana, India

Keyword: Alcohol, Opioid, Addicts, Relapse, social support, stressful life events

Aims: To study the epidemiology of Alcohol and Opioid addicts who present with relapse.

Methods and Study Design: The study was conducted in 100 patients from the outpatient or inpatient who come with Alcohol or Opioid relapse. It was conducted in 100 patients. The patients were divided into two groups consisting of 50 patients each with Alcohol and Opioid addiction respectively. The patients were aged between 18- 65 years. Those who had been abstinent or had undergone detoxification for substance dependence but currently again presenting with relapse were included in the study after written informed consent. The sociodemographic and clinical variables were collected. All subjects were assessed using the following scales: 1) Presumptive Stressful Life Events Scale, 2) Relapse Precipitant Inventory, and 3) Social Support Scale.

Statistical analysis used: ANOVA scale, Multiple Logistic Analysis Equation I & II.

Results: The study showed a higher rate of relapse in persons belonging to nuclear families with ineffective support structure, and in those who were employed and had a basic education level of secondary education. Relapse was seen more in persons facing stressful life events.

Conclusions: There was no significant difference between the profiles of Alcohol and Opioid addicts. It is important to understand the factors associated with relapse in Alcohol and Opioid addicts in order to have better relapse prevention strategies.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Manic illness associated with right temporo-thalamic arteriovenous malformation: A case report

Satyakam Mohapatra, Neelmadhav Rath

Mental Health Institute, Scb Medical College, Cuttack, Odisha, India, satyakgmu@gmail.com

Keyword: Arteriovenous, malformation, mania

Background: Organic manic disorder is an infrequent psychiatric presentation. Arteriovenous malformation is a rare neurological condition associated with organic manic episode.

Aim and objectives: To present a case of manic illness in a 15-year-old girl in whom a right medial temporal lobe and thalamic arteriovenous malformation was discovered.

Methods: We are presenting a case of 15 year old female presented with complaints of irritability, over talkativeness, decreased need for sleep for last 1 month. 4 years back patient had history of weakness of left half of body. There was no history of fever, headache, head injury, seizure episode or any other neurological abnormality. This weakness of left side of body was permanent. After 2 months of Onset of this neurological problem she developed a manic episode, which resolved completely with 4 weeks of treatment. Currently on neurological examination there was atrophy and flaccidity of left upper and lower limbs, power was 2/5, superficial reflexes were diminished, deep tendon reflexes were exaggerated, plantar reflex was extensor on left side. On mental status examination affect was irritable, grandiose ideas and decreased need for Sleep were elicited. CT angiography revealed intracranial arterio-venous malformation embedded in right medial temporal lobe and thalamic regions.

Conclusion: Few cases of organic manic syndromes have been reported so far due to the clinicians’ failure to detect organic factors in mania and relative rarity of its occurrence. So organic factors must always be considered in patients with different psychiatric disorders, especially in those with atypical symptoms, who do not respond to conventional treatment, who presents beyond the usual age of onset for specific psychiatric disorder, those without any family or personal history of psychiatric disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Electroconvulsive Therapy Induced Mania in A Child with Catatonia: Case Report and Review of literature

Khairkar Praveen, Ramdas Ransing, Dipayan Sarkar

Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevgram, India, ramdas_ransing123@yahoo.co.in, dipayans@mgims.ac.in

Keyword: Catatonia, ECT, Mania, Mood Stabiliser

Introduction: Despite controversial history in paediatric population, ECT has been found to be effective treatment in psychiatric disorders including Catatonia with fewer side effects. Mania or hypomania has been reported as one of the rare side effect of ECT in adult population and discussed well. We report a case of ECT induced mania in paediatric patient.

Case Report: A 14 yrs old right handed female child presented with sudden onset of catatonic symptoms of 1 month duration. She developed manic episode after three cycles of ECT as a treatment module for Catatonia. She was treated successfully with combination of antipsychotics and mood stabiliser.

Conclusion: Clinician should consider mania as a rare but possible side effect in paediatric population while treating catatonia. Lithium may be considered as one of the treatment option for such manic switch.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of comorbid anxiety disorders and anxiety symptoms in children and adolescents with oppositional defiant disorder

Satyakam Mohapatra^*1, Vivek Agarwal²

¹Mental Health Institute, SCB Medical College, Cuttack, Odisha, India, satyakgmu@gmail.com, ²King Geogre’s Medical University, Lucknow, Uttar Pradesh, India, satyakgmu@gmail.com

Keyword: anxiety, comorbidity, oppositional, defiant, disorder

Introduction: In recent years oppositional defiant disorder has received a lot of interest because of the high level of comorbidity that it usually presents. There is a relative paucity of research examining the association between anxiety and oppositional defiant disorder, despite the fact that such comorbidity has important clinical and nosological implications.

Aim: The aim of this study was to assess the frequency and phenomenology of comorbid anxiety disorders and anxiety symptoms in children and adolescents with oppositional defiant disorder.

Methods: Patients between age group of 6 to 16 years attending child and adolescent psychiatry clinic with a diagnosis of oppositional defiant disorder were screened for anxiety disorders by Screen for child anxiety related emotional disorders (SCARED) scale. Screen positive patients for anxiety disorders were assessed for the phenomenology of anxiety disorders by using Kiddie – Schedule for Affective disorders and Schizophrenia– present and lifetime version (K-SADS-PL). Those patients having anxiety symptoms, but not fulfilling criteria for any anxiety disorder their phenomenology was assessed by SCARED scale.

Results: Out of the 45 patients with oppositional defiant disorder 4(8.88%) patients had anxiety disorders and 11(24.44%) patients had anxiety symptoms, but not fulfilling criteria for any anxiety disorder. Out of the 4 patients with anxiety disorders 2(4.44%) patients had generalized anxiety disorder, 1(2.22%) patient each with specific phobias and panic disorder. In patients with anxiety symptoms, but not fulfilling criteria for any anxiety disorder most common anxiety symptoms were feeling nervous (11.66%), headache when at school (8.75%), worrying about things that had already happened (6.2%), worry about going to school (3.45%).

Conclusion: The results of our study have several practical implications, including the association observed between oppositional defiant disorder and anxiety should be considered an important risk factor for the presence of impairment in the global functioning of the children and adolescents, and warns of the need for early identification of diagnostic conditions, risk factors.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Innovative Teaching Methods for Year 4 Medical Students in Psychiatry about Understanding Antipsychotic Induced Movement Disorder

Soman Elangovan, Sivakumar Thurairajasingam, Jeyarajah Selvadurai, Zohreh Karbassi

Monash University Malaysia, Malaysia, somanelangovan@yahoo.co.in, sivakumar.thurairajasingam@monash.edu, jeyarajah.selvadurai@monash.edu, zohreh.karbassi@monash.edu

Keyword: Movement Disorder, Drug Induced, Antipsychotic, Video clips

Background: Movement disorders associated with antipsychotic is disabling and distressing and results in behavioural disturbances in the forms of violence and aggression, non-adherence and exacerbation of psychosis. However, some of the motor sign may be misinterpreted as psychotic symptoms, Bradykinesia limb stiffness, masked fancies seen in Parkinsonism are a social and functional handicap. The restlessness and agitation associated with akathisia have similar effects. Interestingly, patients with tardive dyskinesia may not be distressed by the symptoms, but family and relatives may find them distressing (Maju et al 2005). These movements are very obvious to the observer and add to stigma of psychiatric illness it is hence very important to do a careful evaluation of these symptoms when patients are treated with antipsychotics. Moreover, it is very much important for the undergraduate medical students during their psychiatric posting to see as many cases presenting with Drug Induced Movement Disorder and to understand the complexities of theoretical and clinical identification of these conditions at an early stage. They would then be able to appreciate the concept of “risk versus benefits “when antipsychotics are used to treat acute and medium to long standing psychiatric illness. The aim of the study was to evaluate and introduce innovative teaching methods in understanding Anti-Psychotic Induced Movement Disorders using video clips.

Objectives and Methods: To evaluate students level of knowledge and skills of Anti –Psychotic Induced Movement Disorders during their psychiatric clinical postings (pre and post –delivery).

To assess the role of virtual teaching on the level of knowledge of Anti-Psychotic Induced Movement Disorders.
Based on the evaluation to make recommendation on improving routine clinical psychiatric teaching with regards to the existing curriculum and to emphasize on the importance of bedside clinical skill identification of drug induced movement disorder.

Results and Conclusions: Of this study will be presented in the conference oral presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Impact of Psychosocial Risk Factors in Health-Related Quality of Life: A Pilot Study among Breast Cancer Survivors in Johor Bahru, Malaysia

Soman Elangovan¹, Amutha Ramdas¹, Nisha Angela Dominic¹, Nevein Philip Botross¹, T Jayanthi¹, Amgard Riad², Ahmad Qureshi¹

¹Monash University Malaysia, Malaysia, somanelangovan@yahoo.co.in, Malaysia, amutha.ramdas@monash.edu, nisha.dominic@monash.edu, nevin.botross@monash.edu, t.jayanthi@monash.edu, ¹Newcastle University, Malaysia, amgadriad@hotmail.com, ahmadmqureshi@gmail.com

Keyword: Quality of life, Mental health, psychosocial

Background: Breast cancer is the most common cancer among Malaysian women and according to the National Cancer Registry of Malaysia 2006; it represents 16.5% of all registered cancer cases among women. The treatment for breast cancer has improved by leaps and bounds in recent years coupled with advances in early detection, which have led to reduced mortality rate. We are now facing the issue of younger breast cancer survivors who may have many years of morbidity ahead. Hence there is a need to improve their quality of life to improve their overall mental health. A detailed assessment is crucial as many cancer patients may not express their concerns or psychosocial needs to their healthcare providers. A comprehensive multidimensional assessment of psychosocial factors is needed to further improve breast cancer survivors’ overall level of well-being.

Objectives and Methods: The aims of this study were: (1) to determine the impact of psychosocial risk factors on health-related quality of life of breast cancer survivors with regards to aspects of socio-demography, nutrition and occupational well-being and (2) to develop an on-going support programme to improve the health-related quality of life of the survivors.

For this purpose, pilot cross-sectional survey in a sample of 100 breast cancer survivors was conducted to identify the vital psychosocial factors including medical, nutritional and occupational issues. In addition, an interactive workshop was conducted to gather further feedback from the breast cancer survivors. A long term and continuous program addressing the psychosocial factors and quality of life of breast cancer survivors will be eventually developed based on study findings.

Results and Conclusions: The interesting findings from this study will be shared during the oral presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychological Well-Being Among Medical Student In Clinical Years

Soman Elangovan, Sivakumar Thurairajasingam, Cindy Biding Ahin, Jayarajah Selvadurai, Zohreh Karbassi

Monash University Malaysia, Malaysia, somanelangovan@yahoo.co.in, sivakumar.thurairajasingam@monash.edu, cindy.biding.ahin@monash.edu, jayarajah.selvadurai@monash.edu, zohreh.karbassi@monash.edu

Keyword: medical student, well-being, psychological

Introduction: Medical school’s demanding curricula are aimed to equip graduates with adequate knowledge and skills to survive in the medical world [Dyrbye LN et al, 2006]. Overwhelming amount of materials to learn in a short period of time, unclear expectations and financial stressors could contribute to unnecessary burnout, stress, anxiety and depression [Vitaliano PP et al, 1984]. Students may experience levels of stress that are similar to physicians and the levels are often well above the normal population [Dyrbye LN et al, 2006]. These poor psychological wellbeing correlates with poorer academic performance, unprofessional behaviours, increased academic dishonesty, substance abuse and diminished empathy [Scott J et al, 2012]. At any given time, nearly half of all medical students would experience burnout [Dyrbye LN et al, 2008]. In the same study, 13.6% were found to have major depressive symptoms and 11.2% had suicidal ideation. There are limited data on the impact of poor psychological wellbeing on the performance and development of medical students and even lesser data on intervention.

Objectives:

To assess and compare levels of psychological wellbeing and its relationship to stressors, demographic, social and lifestyle patterns
Identify risk factors that impact wellbeing
Explore preventive measures and appropriate resources.

Methodology: A preliminary, cross sectional survey among 179 medical students in their clinical years utilizing the validated Medical Student Well-Being Index (MSWBI) questionnaire. Data was analyzed utilizing SPSS Version 20.

Results: Poor psychological wellbeing, as assessed by the MSWBI was significantly correlated with female students, a positive family history of financial problems, less than six hours of sleep and a lack of exercise.

Conclusions: Based on the findings, preventive measures are warranted to help students cope and maintain good psychological wellbeing to avoid disruption of academic performance and professional behaviour.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Volume Neurotransmission

Devashish Konar^*1

¹Mental Health Care Centre, Kolkata, India, devkon59@yahoo.com

Keyword: Volume Neurotransmission

Background: Traditional understanding of neuronal transmission is through synapses. But that is just part of the total story. Some neurotransmission does not need a synapse at all. Neurotransmission without a synapse is called volume neurotransmission or non-synaptic diffusion neurotransmission.

Chemical messenger in addition to sending message to specific neuron by synapse also spill over to sites distant to synapse by diffusion. The brain is thus not just mechanical collection of wires, it is like a total environment soaked in various media of neurotransmitters. So neurotransmitters will find relevant receptors in the radius that it is able to diffuse to.

Modifying volume neurotransmission may indeed be a major way in which several psychotropic drugs work in the brain.

Recent scientific evidence is leading to greater understanding of the complexities and intricacies of chemical communication in the brain. The relative importance of both fast/precise and slow/summation types of communication have yet to be fully appreciated. Advancing knowledge is gradually elucidating the roles that volume neurotransmission plays in supporting normal brain function. Also, this mode of chemical communication provides new avenues with great potentials in the understanding of psychiatric conditions where till date treatment is less than satisfactory.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Exploring the coexistence of axis-1 diagnosis. A case report

Shyamsundar Gobisankar, Yogendra Singh, Deepa Braganza

Christian Medical College, India, drsam111@gmail.com

Keyword: Mood disorder, seizure disorder.,chronic lacunar infarct, unsteady gait, headache

Background: Historically, various case reports have clearly reported the interaction between psychiatric illness and medical illness specially the ones involving the brain. The symptoms over all are mixture of both, with typical presentation being affected. As such it becomes difficult to treat the psychiatric patient as symptoms have atypical presentation and under standing them will need to look for medical illness simultaneously.

Discussion: The case shows how a psychiatric illness, here bipolar affective disorder presenting with mood symptoms that are easily controlled by mood stabilizers was accompanied by sudden changes in the behaviour which could not explained by the typical way of presentation of same. On further evaluation underlying seizure activity can very well explain the atypical presentation and drugs with anticonvulsant property has effectively helped in decreasing the symptoms.

Conclusion: whenever a psychiatric illness has atypical presentation, an underlying neurological cause may be evaluated for.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Fluid Intelligence in Executive Functions in Schizophrenia

Sudhir Kumar, Sandhyarani Mohanty, Rakesh Kumar

Institute of Mental Health and Hospital, Agra, India, imhh.agra@gmail.com, mohanty.imhh@gmail.com, jain.imhh@gmail.com

Keyword: fluid intelligence, executive functions, schizophrenia

Background: Fluid intelligence or fluid reasoning is the capacity to think logically and solve problems in novel situations, independent of acquired knowledge. Fluid reasoning includes inductive reasoning and deductive reasoning. Executive function is an umbrella term for the management (regulation, control) of cognitive processes, including working memory, reasoning, task flexibility, and problem solving as well as planning, and execution. Historically, the executive functions have been seen as regulated by the prefrontal regions of the frontal lobes. Many clinical and experimental tests are known to be sensitive to frontal impairment.. The Wisconsin Card Sorting Test (WCST) and Verbal Fluency, for example, are often used to measure frontal ‘executive’ impairment. The importance of the frontal lobe in fluid intelligence and in a diversity of specific cognitive tests raises the question of how much a loss of fluid intelligence contributes to other frontal deficits. Literature reports that fluid intelligence is a substantial contributor to many frontal deficits. The present research is specifically designed to estimate to what extent loss in fluid intelligence contributes to executive function deficits as measured by WCST in persons with schizophrenia. This is a cross-sectional study being carried out at Institute of Mental Health and Hospital, Agra. The sample will constitute 30 persons with schizophrenia. Standard Progressive Matrices (SPM) is being used as a measure of fluid intelligence and WCST as a measure of ‘executive function’. Correlation coefficient and regression analysis will be performed to estimate magnitude of executive function deficits explained by a loss in fluid intelligence. Detailed results will be presented.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Executive Function in Cognitive Insight in Persons with Schizophrenia

Sudhir Kumar, Sandhyarani Mohanty, Rakesh Kumar

Institute of Mental Health and Hospital, Agra, India, imhh.agra@gmail.com, mohanty.imhh@gmail.com, jain.imhh@gmail.com

Keyword: cognitive insight, executive function, schizophrenia

Background: The concept of cognitive insight describes the reduced capacity of persons with psychotic illness to distance themselves from their psychotic experiences, reflect upon them and responsiveness to corrective feedback. Cognitive insight includes the evaluation and correction of distorted beliefs and misinterpretations. There are two dimensions of cognitive insight (a) self-reflectiveness (b) Self-certainty. These dimensions of cognitive insight are correlated with psychotic symptoms in schizophrenia; e.g. delusions are associated with low self-reflectiveness and high self-certainty; hallucinations on the other hand were found to be associated with high self-reflectiveness and low self-certainty. It is postulated that Cognitive insight and neurocognition may have a conceptual overlap which need be empirically established. Researchers have established a positive link between cognitive insight vis-à-vis memory, verbal learning, attention and neurocognitive complaints. The neuroimaging studies reported an association of cognitive insight with hippocampal volume. The present study is designed to extend the work on neurocognition and cognitive insight by exploring the role of executive function in two dimensions of cognitive insight. This will be a cross-sectional and correlational study; which will be carried out at Institute of Mental Health and Hospital, Agra. 20 persons with schizophrenia would constitute the study sample. Beck Cognitive Insight Scale and Wisconsin Card Sorting Test will be administered on the selected patients. The data will be processed for computation of correlation co-efficents to determine the nature and extent of relationship between various aspects of the two measures. The detailed results will be presented.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Metacognition and Self-esteem in Persons with Schizophrenia

Sudhir Kumar, Sandhyarani Mohanty, Ajai Kumar Srivastava

Institute of Mental Health and Hospital, Agra, India, imhh.agra@gmail.com, mohanty.imhh@gmail.com, drajaik@gmail.com

Keyword: metacognition, self-esteem, schizophrenia

Background: Metacognitive capacity refers to the ability to think about one’s own thinking and that of others. Metacognitive capacity allows an individual to form representations of own mental state and to revise and question what is believed, felt, feared or pretended in a wide range of contexts. It includes both explicit and implicit knowledge. It allows an individual to form and then accept or reject ideas about him/herself in the moment and also to sustain more enduring ideas about the kind of person he or she is across different situations. Metacognitive capacities allow people to view disappointments and achievements in a given perspective and to see growth opportunities in pain and disappointments. Research has established metacognitive deficits in persons with schizophrenia. These deficits are also related to symptoms and functional impairment. It is suggested that deficits in Metacognitive capacities may be a risk factor for severe levels of illness and dysfunction in persons with schizophrenia. The present study was designed to explore to what extent metacognitive capacity affects the self-esteem in persons with schizophrenia. 50 persons with schizophrenia were sampled from Institute of Mental Health and Hospital, Agra. Rosenberg Self-esteem Scale and Metacognition Assessment Scale were administered. Correlation Coefficient were estimated between two measures. The detailed result will be presented.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Explanatory models and perceived dysfunction in people with medically unexplained symptoms

Vikas Menon, Siddharth Sarkar, Shijo Thomas, Jyoti Wadhwa, Ravi Philip Rajkumar

JIPMER, India, drvmenon@gmail.com, sidsarkar22@gmail.com, shijoppan@gmail.com, drjyoti48@yahoo.com, ravi.psych@gmail.com

Keyword: Explanatory models, beliefs, dysfunction, medically unexplained symptoms

Introduction: Medically unexplained symptoms are common and place a heavy burden on the health care delivery system with repeated and often unsatisfactory consultations and ineffective treatments. We assessed the explanatory models of illness among the patients presenting to our center with medically unexplained symptoms using a structured questionnaire.

Methods: Fifty three consecutive patients who had at least 2 specialist visits for ‘unexplained’ somatic symptoms and came with a written referral to Psychiatry were recruited. The Short Explanatory Model of Illness (SEMI) interview was used to assess their explanatory models.

Results: The mean age of the sample was 36.55 years (range 14-60years). 27 (50.9%) were females. The median number of symptoms reported was four. 40 (75.5%) believed that their problems were serious. 21 (39.6%) attributed their symptoms to internal causes while 20 (37.7%) ascribed it to social and interpersonal factors. Significant dysfunction in work was reported by 42 (79.3%). 13 (24.5%) had not been offered any explanation for their symptoms by previous doctors whereas 16 (30.2%) were told that they were normal and had no illness. 28 (52.9%) felt that consultations with previous doctors had not been useful.

Discussion: Majority of the sample reported minimal benefits and unsatisfactory experience with the treating doctors. Clinicians and practitioners need to pay attention to the explanatory models offered by the patient in order to harmonize the treatment approaches and derive maximum treatment gains.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Retrospective Audit of ECT Use In Children and Adolescents in A Tertiary General Hospital

Sagar Karia, Avinash Desousa, Shivanshu Shrivastava, Sushma Sonavane, Nilesh Shah

Lokmanya Tilak Municipal Medical College, India, kariabhai777@gmail.com, avinashdes888@gmail.com, shivanshu789@gmail.com, sushma_son@rediffmail.com, drnilshah@hotmail.com

Keyword: Electroconvulsive therapy, children, adolescents, audit

Background: Electro Convulsive Therapy (ECT) is used in large number of indications in adult populations, but there is lack of data for use of ECTs as a treatment modality in adolescent age group.

Objective: Given the prevalence and severity of psychiatric disorders in adolescent age group, we decided to carry out a retrospective audit of ECTs given in this age group in last one year in a tertiary hospital.

Methods: The ECT records of last one year of adolescent patients (age group of 10 - 19 years) were studied and the socio-demographic data, indications, number of ECTs given, anesthetic agents used and side effects were recorded. The data was then pooled, tabulated and subjected to statistical analysis.

Results: In our audit, we found that ECTs were given to 64 adolescents in last one year. 72% patients suffered from schizophrenia and other psychotic disorders, 14% patients had mood disorders, 7.8% patients had mental retardation. There were no side effects noted.

Conclusions: Thus ECT is a useful and safe treatment modality in adolescent age group patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Antidepressant Action of Ketamine Anaesthesia during Electroconvulsive Therapy in a case of Treatment Resistant Depression: a case report

Chetan Lokhande, Avinash Desousa, Nilesh Shah

Lokmanya Tilak Municipal Medical College, India, chetanlokhande45@gmail.com, India, avinashdes888@gmail.com, drnilshah@hotmail.com

Keyword: Electroconvulsive therapy, ketamine, depression.

Background: Ketamine has been used in treatment resistant depression either as intravenous infusion and as an anaesthetic agent for electroconvulsive therapy and patients are known to show dramatic and rapid improvement.

Objective: the aim of the case report is to describe a case of treatment resistant depression that responded to ketamine and electroconvulsive therapy over a period of 7 sessions.

Conclusions: ECT and ketamine when used together may be a useful alternative to manage cases of chronic and resistant depression

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Stem Cell Transplantation In Psychiatric Disorders: A Case Series

Amol Kelkar, Avinash Desousa, Nilesh Shah, Sushma Sonavane, Anup Bharati

Lokmanya Tilak Municipal Medical College, India, amolkelkar18@yahoo.in, avinashdes888@gmail.com, drnilshah@hotmail.com, sushma_son@rediffmail.com, dranupsb@gmail.com

Keyword: stem cell, transplantation, schizophrenia, substance abuse, autism, OCD

Background: Stem cell therapy or transplantation has been heralded as one of the latest innovations in the management of chronic and debilitating neurodegenerative and neurodevelopmental disorders. It is a therapy in its nascent stage and yet has anecdotal case reports that speak of promising results.

Objective: This paper describes a series of cases with psychiatric disorders that received stem cell therapy and showed some drastic improvements whereas routine treatments over the years had failed to produce the same in these patients.

Methods: The case series describes 3 cases one of chronic undifferentiated schizophrenia, one of chronic substance abuse and antisocial personality disorder and a child with autism. All these patients had a chronic course with multiple relapses and remissions. In all these cases it was the relatives that read about stem cell therapy and opted for the same while it was not suggested by the treating psychiatry team. The stem cell procedure was done by the department of neurosurgery and we followed up the progress of the cases.

Results: Marked improvements in various areas of psychopathology and symptoms were observed in all the cases and these are discussed. Certain mechanisms for these improvement are hypothesized and debated. It is uncertain what this benefit could be atributed to.

Conclusions: Stem cell therapy needs further research and is relevant to treatment options in chronic psychiatric disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Depression on Sexual Function in married Women

Mithlesh Khinchi, Sanjay Jain, Parth Singh Meena, I D Gupta, Rajesh Sharma, R S Matoria

MD, India, mithlesh.khinchi@gmail.com

Keyword: depression, sexual dysfunction, Arizona

Introduction: Sexual dysfunction is reported to be two to three times as likely in a depressed population as in a normal population, and depressed mood plays a role in the etiology of sexual dysfunction. Depressive illnesses are twice more common in women than men. The lifetime prevalence of depression in women averages about 20%, and the rate of sexual dysfunction in depressed women has been estimated as high as 70–80%.

Aims and Objective: To determine the effect of depression on sexual function in women

Methodology: We recruited 50 female patients suffering from depression from the Department of Psychiatry, SMS Medical College. Depression assessment done by using HAM-D Score then for assessment of Sexual dysfunction done by using the Arizona sexual experience scale (ASEX). Statistical analysis was done using SPSS.

Results and Conclusion: depression is associated with a higher rate of sexual dysfunction in women. There was a significantly positive correlation between disease severity of depression on HAM-D scores and Sexual dysfunction on Arizona sexual experience scale (ASEX).

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Pathways to care for Medically Unexplained Symptoms at a specialty Psychosomatic Clinic

Vivek Arun Kumar J K, Siddharth Sarkar, Vikas Menon, Shijo Thomas

¹JIPMER, Puducherry, India, drvivekarunkumar@gmail.com, sidsarkar22@gmail.com, drvmenon@gmail.com, drivirx@gmail.com

Keyword: Psychosomatic, somatoform, medically unexplained symtoms, somatization, panic, hypochondriasis, specialty clinic, referrals

Background: A growing body of evidence suggests that patients with medically unexplained symptoms tend to delay help seeking behaviours.

Objectives: This paper depicts the pathway to care for patients seeking treatment for unexplained medical symptoms at a specialty psychosomatic clinic.

Methods: The clinic caters to patients with unexplained somatic symptoms referred from other departments or directly seeking treatment. After detailed assessment, diagnosis is made as per ICD 10 clinical descriptions and diagnostic guidelines and management plan formulated. The pathway of care for patients registered in this clinic was assessed using a structured questionnaire.

Results: Pathway of care information was available for 49 out of the 53 patients (92.5% of the sample) registered in the first 8 months of the clinic. Median age of these 49 patients was 36 years; and 25 (51.0%) were females, 40 (81.6%) married and 32 (65.3%) belonged to nuclear family. Thirty three patients (67.3%) visited general practitioners, 13 (26.5%) had visited traditional practitioners and faith healers, 48 (98.0%) had made visits to specialists/tertiary care centres and 9 (18.4%) had consulted psychiatrists before being referred to our centre. The first point of contact was general practitioner in the majority (53.1%). Patients had waited for a median of 24 months and taken 16.5 consultations before presenting to our clinic.

Conclusion: Patients with medically unexplained somatic symptoms may undertake considerable number of consultations and wait for a long time before being referred to psychiatric treatment services. This point towards a need for training more doctors, especially general practitioners, in recognizing and managing unexplained medical symptoms.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Factors associated with Treatment Completion in Women with Opioid Dependence: Findings from a Tertiary Care Drug Dependence Treatment Centre of India

Prabhoo Dayal, Yatan Pal Singh Balhara, Ashwani Kumar Mishra

All India Institute of Medical Sciences, New Delhi-11027, India, drpd007@gmail.com, ypsbalhara@gmail.com, ashwanikm@gmail.com

Keyword: opioid dependence, female, treatment completion

Background: Objectives: To study the predictors of inpatient treatment completion among females patients with opioid use disorder in relation to their socio-demographic & clinical profile. Methods: We reviewed case records of female patients admitted with opioid use disorder at our centre between 1^st January 2008 and 31^st December 2012.

Results: Over the 5 years, 72 female patients were admitted with opioid dependence. During the study period, out of 72 patients, 44 (61.11%) were inpatient treatment completers and 28 (38.89%) were non-completers. Mean length of ward stay was 5.07+ 3.76 days and 16+ 11.78 days for inpatient treatment non-completers and completers respectively. Bivariate analyses examined relationship between socio-demographic- clinical characteristics and treatment completion status. Age at onset of opioid, education status, employment, Marital status, opioid use with husband, reason for initial use of opioid,, concomitant use of tobacco and sedative use were significantly associated with the treatment completion status. The multivariable analysis (adjusted for selected demographic characteristics as marital status, education and employment) revealed that most women taking drug for relief from pain; having history of medical morbidity; and onset of opioids at age 25 years or more had significantly greater likelihood for being completers. Those using sedatives and tobacco had significantly lesser likelihood for being completers. However, after Sidak correction for the multiple correction {((1-(1-0.05))^1/4)=0.01, four independent predictors in multivariable analysis}, only three variables remained significant as reasons for drug use, onset of opoids and sedatives use.

Conclusion: There is limited literature on opioid drug abuse among women from Asian countries including India. Such information is essential for better understanding on this issue. This will help to improve treatment services for female opioid drug abusers.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Neurocognitive Deficit In Bipolar I Disorder Patients Currently In Euthymic State Their Unaffected First Degree Relative And Healthy Control Group:- A Comparitive Study

Vikash Dixit, Payal Sharma

L.T.M.M.C. & G.H., India, drvikasdixit@gmail.com, sharmapayal0908@gmail.com

Keyword: Neurocognitive deficit, bipolar disorder, factors affecting

Background: Neurocognitive dysfunctions particularly executive functioning, attention, processing speed, verbal learning and declarative memory are key aspects of Bipolar disorder, as they occur in all the phases of the illness, across all neuropsychological domains, even during remission of symptoms.

Objectives: To compare frequency and types of neurocognitive deficits and factors influencing them in individuals with Bipolar I disorder, their first degree unaffected relatives and healthy control.

Methods: It was a cross sectional, case control, comparative, study with 50 samples in each of three groups. Diagnosis of Bipolar disorder I was made following DSM IV TR criteria and current euthymic state was established by applying YMRS and HDRS scale. Neurocognitive performance was assessed on MMSE, Frontal assessment battery, Trail making test A and B. Statistical tests used were chi square test, ANOVA and Pearson’s correlation using SPSS 20 software.

Results: Early onset, increase in age, duration of illness, total number of episodes and number of manic episodes worsen the neurocognitive performance.

Family history of Bipolar disorder and number of depressive had no significant relationship

First degree unaffected relatives of Bipolar I disorder patient had impairment in psychomotor speed and executive functioning with alternating attention suggesting, these may be valid endophenotypic traits of bipolar disorder.

Euthymic Bipolar I patients had significant frontal dysfunction and impairment in psychomotor speed, visual conceptualization and visuomotor tracking

Conclusion: Neurocognitive deficits in the euthymic Bipolar I patients and their first degree unaffected relatives may be of different nature, more global in patients while more specific in relatives

Neuropsychological deficits in remission period impair socio-ccupational functioning which lead to poor compliance and more relapses.

This highlights the need of routine assessment and early interventions even in euthymic stage.

Cognitive impairment in unaffected first degree relatives warrants periodic neurocognitive testing, psycho education and early medical intervention if required.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study of the Levels of Trust and Expectation on Psychiatrist and Its Relationship with Patients Satisfaction and Treatment Adherence

Vinay Kumar, Dushad Ram, T. S. Sathyanarayana Rao

JSS Medical College And Hospital, India, vinay.was.appi@gmail.com, dushadram@hotmail.com, tssrao19@yahoo.com

Keyword: Patient trust, Patient expectation, Patient satisfaction, Medication adherence, Mental illness

Background: Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This study reveals the levels of trust and expectation on psychiatrist and its relationship with patients’ satisfaction and treatment adherence.

Objectives: To study the levels of trust and expectation on Psychiatrist and its relationship with patients’ satisfaction and treatment adherence.

Methods: One hundred and twenty three consecutive outpatients were recruited on follow-up who satisfied the selection criteria. They were assessed with Socio-demographic and clinical Performa designed for the study. Methods used to assess were Patient Trust Scale, Patient Satisfaction Survey, Patient Expectations Questionnaire and Medication Adherence Rating Scale.

Results: There was a high mean score in Patient Trust Scale (Mean 38.9, SD 8.5) and Patient Expectations Questionnaire (Mean 13.5, SD 3.3). Significant group differences were observed for family type (df =2, F =13.8, Sig. =0 .000) and knowledge about treatment (df =3, F = 8.0, Sig. =0 .000) in the scores of Patient Trust Scale. Similar differences were also observed for treatment sought before (df =3, F = 5.2, Sig. =0 .002) and knowledge about treatment (df =3, F = 4.2, Sig. =0 .007) in the scores of Patient Expectations Questionnaire. Scores in Patient Trust Scale has a significant positive correlation with Scores in Patient Satisfaction Survey (p<01) on correlation analysis.

Conclusion: Based on this study result, it can be concluded that patients’ trust vary with family type and knowledge about treatment, while expectation varies with any previous treatment and knowledge about treatment. Patient trust is positively related to satisfaction.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Capgras Syndrome in a patient resulting from Hyponatremia caused due to dehydration.

Devesh Sharma, Ramesh Kumar, Sudhir Sharma

Indira Gandhi Medical College and Hospital, India, drjumbo0118@gmail.com

Keyword: Capgras Hyponatremia Diarrhoea

Background: We present a case of a 56 years old male developing Capgras delusion after hyponatremia caused by dehydration. He was a previously healthy male who had secondary paranoid systematization after developing misidentification syndrome. This case highlights the need for evaluating the role of organic aetiology in the causation of this syndrome that is more often encountered in Schizophrenia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Premenstrual Syndrom: Menstrual cycle characteristics Personality factors, number of stressful life events and Psychiatric Morbidity In College Going Students

Chitra Verma, Mithlesh Khinchi, Mahendra Jain, Ashok Chaudhary

MD, India, drchitra3@gmail.com, mithlesh.khinchi@gmail.com

Keyword: Premenstrual, neurocitism, morbidity

Aims & Objective: To study the menstrual cycle characteristics, personality profile, the number of stressful life events and psychiatric morbidity in the premenstrual syndrome group in comparison to the control group.

Methods & Materials: 300 college students of nursing belonging to JLN Nursing University, Ajmer were selected and screened for PMS by menstrual history form & screening questionnaire & menstrual distress questionnaire “A” form. Those students who fulfill the criteria for PMS formed the experimental groups & control group was selected from the remaining sample. Both the group were subjected to Eysencks’s personality inventory (E.P.I.), Presumptive stressful life events scale(PSLE SCALE), Beck depression inventory, Indian psychiatric interview schedule, Max Hamilton anxiety rating scale.

Result & Conclusion: The result revealed that early age of menarche, longer duration of cycle with longer duration of menstrual flow and heavy bleeding during menstrual cycle are positively correlated with PMS. PMS patients scored significantly higher on neurocitism scale, psychiatric morbidity (anxiety & depression), and number of stressful life events on respective scales.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Suicidal Behaviour In Schizophrenia & Its Relation to The Severity of Patient’s Illness

Mulchand Jiyandmal Harjani^*1, Sonia Parial², P. N. Shukla

¹Pg student, India, drmulchandharjani@gmail.com, ²PGIBAMS, India, soniaparial@gmail.com

Keyword: Suicidal behaviour, Schizophrenia, Positive Symptoms, Negative Symptoms.

Objective: Patients with schizophrenia are known to be at high risk for suicide attempts. However, little research has been conducted to determine whether the risk for suicidal behavior is elevated among patients with psychosis in general. Our aim is to see relation between suicidal behaviour in schizophrenia and in its relation to the severity of patient’s illness in Indian population.

Methods: Present study was done over 6 months on 30 patients diagnosed with schizophrenia (SCID & DSM IV criteria) between the age of 18- 55 yrs. Severity was assessed using Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), & Scale for Suicidal Ideation (SSI).

Results: Among all the domains of positive and negative symptoms of SAPS and SANS scale studied to co-relate with suicidal ideation (SSI), strongest positive correlation was found for delusions(r=0.51, p value 0.000**), positive formal thought disorder(r=0.70, p value 0.000**), and attention (r=0.419, p value 0.021*). Suicidal behaviour was also found to be in increasing rates among urban and high income population as well as in patient’s having education up to secondary, higher secondary or above.

Conclusion: Suicide risk is maximum at the first visit, at the time of admission (if the patient is getting admitted) and at the time of discharge as these are the peak times when patient is having risk of getting suicidal thoughts and finally along the course of illness. Important implication of this study is to identify the risk factors in schizophrenia which can progress to suicidal thoughts and sudden suicide in them, making psychosocial interventions for the patients and caregivers.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Life events, Social support, coping strategies in attempted suicide: A case-control study.

Pradeep Yadav, Mona Srivastava

Institute of Medical Sciences, India, drmonasrivastava@gmail.com

Keyword: Suicide; coping; social support; life events

Background: Suicide is a major concern to medical professionals because of the association of social, personal, occupational modalities and a dearth of effective interventions especially so in our set up.

Aims: The aim was to analyze and compare the type and severity of life events, coping strategies and social support of suicide attempters versus matched normal controls, and to identify the antecedents if any leading to suicide.

Materials and methods: A total of 20 consecutive suicide attempters were Compared and matched with healthy controls on the following Presumptive Stressful Life Events Scale, Social Support Questionnaire, Carver Coping Style Scale, and General Health Questionnaire.

Results: Attempters experienced significantly more stressful life events whereas the control group experienced higher desirable and impersonal life events. Social support, adaptive coping, was significantly lower in attempters. Among all risk factors desirable life events, adaptive coping, and good social support were protective against suicide.

Conclusion: Suicide attempters were compared with healthy controls. The findings of the study are preliminary, but emphasize the need of an effective coping and a good social support system especially during significant adverse life events. These steps can contribute in decreasing the morbidity of suicide significantly.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Serum ceruloplasmin level in Obsessive Complusive Disorder (OCD)

Sundar Gnanavel, Pratap Sharan, Vivekanandan Subbiah

AIIMS, India, sundar221103@yahoo.com, pratapsharan@yahoo.com, svivek_aiims@yahoo.com

Keyword: ceruloplasmin, OCD

Objectives: Recent studies implicate dopaminergic dysregulation as a possible mechanism in pathophysiology of OCD. The current study aims to evaluate the serum level of ceruloplasmin (α2-globulin hypothesised to lead to dopaminergic dysregulation)in psychotropic-naïve patients of OCD. It is hypothesised that levels of ceruloplasmin would be higher in OCD patients as compared to normal controls.

Methods: Serum concentration of ceruloplasmin was measured in 25 psychotropic-naïve patients with OCD without any other comorbid psychiatric illness (as ascertained by Mini International Neuropsychiatric Interview, M.I.N.I) and an equal number of age and gender matched healthy controls. Other exclusion criteria included tardive dyskinesia related to neuroleptics, presence of organic brain disorders, use of any antioxidant agent (i.e. vitamins E and C) and infectious diseases. Severity of OCD was recorded by administering YBOCS (Yale Brown Obsessive Compulsive Scale) and types of obsessions or compulsions documented by YBOCS-SCL (YBOCS- Symptom check list). Ceruloplasmin concentration in serum was determined by Enzyme Linked Immunosorbent Assay (Elisa) (Abcam^®)

Results: Ceruloplasmin level was elevated in patients with OCD as compared to controls (p<0.05) It was also demonstrated that duration of illness correlated with ceruloplasminlevels (r = +0.734; p<0.05) in OCD patient group. Severity of OCD correlated with ceruloplasmin levels(r=+0.872; p<0.05). However, the ceruloplasmin level did not differ according to the types of obsessions or compulsions. It also did not differ based on gender, age of onset of illness and other socio-demographic variables in the OCD patient group.

Conclusions: This study provides further evidence for possible dopaminergic dysregulation in OCD. The other possibility is serotenergic dysregulation linked to copper metabolism in patients of OCD. Studies with a larger sample size and use of patients with other psychiatric illnesses like depressive disorder as controls might shed more light on this issue.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Consultation Liaison Psychiatry at a tertiary hospital in the North-Eastern part of India

Ranita Devi Athokpam, Bhushan Bhagwan Mhetre, Lenin Singh Rajkumar

Regional Institute of Medical Sciences Imphal, India, ranitaathokpam@gmail.com, bhushanbmhetre@gmail.com, rklenin@yahoo.com

Keyword: Consultation liaison psychiatry, referral, psychiatric disorder

Objectives: To determine the pattern of psychiatric referrals from various departments, in a tertiary hospital.

Materials and methods: Ninety one patients, who received psychiatric consultation from various departments, were studied. In total 21072 patients were admitted during the study period, October 2012 to February 2013. It was a descriptive study. In this study, psychiatric consultations were assessed by demographic characteristics of patients, frequency of referral from various departments, psychiatric diagnoses made and treatment received by the patients.

Results: Of those 21072 admitted cases during the period, 91(53 men and 38 women) patients received psychiatric consultation. The frequency of referral rate was 0.43%. Majority of the referrals were from medicine department (38.5%) followed by surgery (17.6%) and orthopedics (12.1%). Patients were referred average of seven days after admission (mean =6.87, maximum =33, minimum =0). Among the referral cases substance related problem was diagnosed in 24.2%, depression in 17.6% and psychosis in 8.8%. Diagnosis of acute stress reaction was made in 6 cases (6.6%) while anxiety related illness was found in 7.7%. Delirium and post encephalitic sequeal was seen in ten cases (11%). Common reasons for referral were expert opinion (52.7%), abnormal behavior, not sleeping at night (27.5 %), psychoactive substance use (25.3 %,) and irrelevant talk (23.1 %,). Injectable psychiatric drugs were given in 35 cases (antipsychotics in 10 cases, lorazepam in 25 cases). Antidepressants were prescribed in 33 cases (36.3%). Six cases (6.6%) were transferred to psychiatric wards for better management of symptoms.

Conclusion: Considering the high prevalence of psychiatric disorders, it seems that more training programs are required for personnel and specialists to increase general awareness about psychiatric diseases and mental disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Hidden Obsessive Compulsive Symptoms in Schizophrenia and its relationship with clinical features and pharmacological treatment

Ranita Devi Athokpam, Heramani Singh Ningombam, Gojendro Singh Senjam, Bhushan Bhagwan Mhetre

Regional Institute of Medical Sciences Imphal, India, ranitaathokpam@gmail.com, drnheramani@gmail.com, drgojendro@gmail.com, bhushanbmhetre@gmail.com

Keyword: Obsessive compulsive symptoms, schizophrenia, positive symptoms, negative symptoms.

Objectives: To assess the frequency of obsessive-compulsive symptoms (OCS) in patients of schizophrenia, its relationship with clinical features of schizophrenia and pharmacological treatment.

Methods: OCS was evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) in 80 patients with schizophrenia over a one and a half year period. The patients were divided into two subgroups, depending on the Y-BOCS score: those with at least a moderate level of OCS and those with mild or absent OCS. Two subgroups were then compared using scores on the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Global Assessment of Functioning Scale (GAF).

Results: Of the 80 patients with schizophrenia, 22.5% had at least moderate OCS (Y-BOCS score ≥ 16). Principal OCS endorsed were contamination obsessions and cleaning and washing compulsions. Bizarre behaviors (SAPS) were significantly higher (p= 0.010) and GAF scores were significantly lower (p=0.040) in schizophrenia patients with significant obsessive compulsive symptoms. No correlation was found between obsessions with delusions and compulsions with bizarre behavior. Interestingly, there was no difference in the pharmacological treatment received by the OCS and non OCS schizophrenia patients.

Conclusions: As presence of OCS has the potential to affect clinical outcomes in schizophrenia, it emphasizes the need of targeting these symptoms in schizophrenia which often remains neglected.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Sertraline in Post Traumatic brain injury (TBI) Depression and Quality of Life in Traumatic Brain Injury

Akhilesh Jain^*1, Ahmed Ansari², Achal Sharma², RS Mittal², ID Gupta²

¹ESIC Model Hospioal, Jaipur, India, akhilesic@gmail.com, ²SMS Medical College, India, ahmed.ansari2@gmail.com, sharmaachal@hotmail.com, dr_mittal@hotmail.com, ishwardayal@gmail.com

Keyword: Traumatic brain injury (TBI), Quality of life (QOL), depression.

Introduction: Traumatic brain injury (TBI) is a major cause of disability. Depression is one of the major sequelae of TBI in both inpatient and outpatient populations. Depression is associated with numerous negative outcome, thus affecting Quality of life (QOL) adversely in these patients. Addressing depression in treatment regimen of TBI may improve QOL of these patients.

Objective: Present study is designed to evaluate the role of sertraline in post TBI depression and its impact on QOL.

Methodology: Eighty male patients with post TBI depression were included in study amongst the 250 male patients of mild to moderate TBI recruited for evaluation. Half of the patients were given sertraline 50 mg PO whereas other half served as control without sertraline treatment. Participants were assessed on GCS, PHQ-9 and WHOQOL at regular interval till the end of 6 months.

Result: Depression was found in 35.6% of total patients recruited. Most of the patients (63.1%)were below 35 years of age. Depression was more common in mild TBI cases than those with moderate TBI(53.7% v/s 46.25%,p=0.04). Left side brain injury (56.25%)with cerebral contusions was more commonly associated with depression(p=0.04). Patients in sertraline group responded well to treatment with significant improvement in mood symptoms(PHQ-9 score 14.88±3.603 v/s 5.33±2.98,p=0.04)). All the four domains of QOL improved significantly in sertraline group than the control Group without sertraline treatment.

Conclusion: Management of TBI should also focus on treatment of associated mood symptoms which is likely to be associated with poor QOL in these patients. Sertraline has been found to be effective in treatment of depression with significant improvement in QOL in TBI patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Semantic Incongruity As An Endophenotype In Opioid Dependence: A Family Study Using Erp N400 Wave

Vivek Chhalotre, Christoday RJ Khess, Nishant Goyal

Central Institute of Psychiatry, Ranchi, India, vchhalotre7@gmail.com, psynishant@gmail.com

Keyword: Semantic Incongruity, N400,Opioid Dependence, Endophenotype

Introduction: N400 is a negative Event Related Potential (ERP) wave used to study language comprehension, mainly semantic congruity. Studies have been conducted showing alterations in semantic congruity in individuals with opioid dependence syndrome. Data suggests that semantic incongruity might have endophenotypic value in opioid dependence, though conclusive evidence is lacking.

Aims and Objectives: Present study is aimed at assessing semantic congruity in patient with opioid dependence syndrome and their first degree relatives. The author will compare amplitude and latency of N400 in individuals with opioid dependence syndrome, their unaffected first degree relatives and healthy controls. They will also try to study the relationship between various N400 ERP wave parameters and severity of opioid dependence in the patient group.

Material and Method: It will be a cross-sectional hospital based study, conducted at centre for addiction psychiatry of a tertiary level psychiatry care facility in eastern part of India. Study population will consist of 10 right –handed individuals (as on sidedness bias schedule) with opioid dependence syndrome, their first degree relatives and 10 age, sex, handedness and education matched healthy controls. The individual with opioid dependence will be detoxified for 2 weeks and at recruitment will have COWS (Clinical Opioid Withdrawal Scale) score of less than 5. Ishihara’s chart, SDS (Severity dependence scale), HAM-D(Hamilton Rating Scale for Depression and HAM-A(Hamilton Rating Scale for Anxiety) will be applied. Following this assessment, 40 channel ERP will be recorded in patients on N400 visual paradigm. After application of Ishihara’s chart, sidedness bias schedule and General Health Questionnaire 12 in first degree relatives and normal control, 40-channel ERP will be recorded similarly.

Results and Discussion: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Ventricular Brain Ratio (VBR) and Ventricular Enlargement in Major Depressive Disorder

Adya Shanker Srivastava^*1, Deoraj Sinha², Arvind Kumar Srivastava³

¹Deptt. of Psychiatry, I.M.S.,B.H.U.,Varanasi, India, adya_shanker@yahoo.com, ²Deptt. of Psychiatry, T.N.M.College, Mumbai, India, deoraj.sinha@gmail.com, ³Deptt. of Radiodiagnosis, I.M.S.,B.H.U.,Varanasi, India, adya_shanker@yahoo.com

Keyword: Ventricular Brain Ratio(VBR),Ventricular Enlargement, Major Depressive Disorder

Background: With the introduction of neuro-imaging techniques psychiatric morbidities have got a new research dimension. Ventricular changes in Major Depressive Disorder have been reported in some studies abroad.

Objective: The main aim of the study was to find out any evidence of ventricular changes in patients of Major Depressive Disorder and compare it with control group.

Method: Thirty(30) patients of age range 21 to 40 years fulfilling DSM-IV criteria of Major Depressive Disorder, without any evidence of organicity i.e. head injury, epilepsy or physical morbidity;were included in the study. The cranial C T Scan of patients in study group was done under supervision of expert in neuro-imaging. The control group consisted of thirty (30) normal C T Scans of age and sex matched patients screened for headache. The ventricular brain ratio was estimated by measuring width of lateral ventricle most prominant in C T Slice and the maximum diameter of brain at the same level. It was expressed as percentage. The ventricular size was rated as small, normal or enlarged.

Result: The changes in ventricular brain ratio were found in different age groups and it showed an increasing trend with increase in age as compared to control group. Similarly mean VBR showed an increasing trend with increase in duration of illness. Ventricular enlargement was also observed in patients of Major Depressive Disorder as compared to control group.

Conclusion: Ventricular changes in form of change in ventricular brain ratio and ventricular enlargement have been found in patients of Major Depressive Disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Intracranial Structural Changes-Assessment of Cortical Atrophy in Major Depressive Disorder

Adya Shanker Srivastava^*1, Deoraj Sinha², Arvind Kumar Srivastava³

¹Deptt. of psychiatry, I.M.S.,B.H.U.,Varanasi, India, adya_shanker@yahoo.com, ²Deptt. of Psychiatry, T.N.M.College, Mumbai, India, deoraj.sinha@gmail.com, ³Deptt. of Radiodiagnosis, I.M.S.,B.H.U.,Varanasi, India, adya_shanker@yahoo.com

Keyword: Intracranial Structural Changes, Cortical atrophy, Major Depressive Disorder

Background: Whether Major Depressive Disorder has organic etiology with related changes in brain has been a matter of interest for researchers and clinicians.

Objective: The main aim of the study was to find out intracranial structural changes-evidence of cortical atrophy in patients of Major Depressive Disorder.

Method: Thirty(30) patients of age range 21 to 40 years fulfilling DSM-IV criteria for Major Depressive Disorder, without any evidence of organicity or physical morbidity;were taken into study. Their C T Scan (cranial) was done under supervision of expert in neuro-imaging. The control group consisted of thirty(30) normal C T Scans of age and sex matched patients screened for headache. The evaluation of cortical atrophy(sulcal widening) was done and it was scored as 0-3,4-7 and 8-11 for five cortical areas-frontal, temporal, parietal, insular and occipital.

Result: Significant cortical atrophy was observed in patients of Major Depressive Disorder as compared to control.

Conclusion: Patients of Major Depressive Disorder have intracranial structural changes and cortical atrophy is important finding in brain.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Expressed Emotion In Schizophrenia and Bipolar Disorder: A Comparative Study

Seema Parija^*1, Rakesh Kumar Jain²

¹Kalinga Institute of Medical Sciences, India, drseemaparija@gmail.com, ²Institute of Mental Health and Hospital, Agra, India, jain.imhh@gmail.com

Keyword: Expressed emotion, schizophrenia, bipolar disorder

Background: Expressed emotion is an important predictor of outcome in patients with schizophrenia. However studies assessing expressed emotion in bipolar disorder have been fewer than in schizophrenia. Especially there is lack of data in this area in Indian context.

Objective: To estimate and compare the extent of expressed emotion in schizophrenia and bipolar disorder.

Method: 40 patients with schizophrenia and 40 patients with bipolar disorder, along with their 80 caregivers were assessed for expressed emotion. Socio-demographic and clinical data was collected using semi-structured pro-forma. Patients were assessed using Family emotional involvement and criticism scale by Shield’s et al (FEICS). Family Attitude Scale (FAS) was applied on caregivers. Results were compared using appropriate statistics

Results: On FAS, expressed emotion was found to be significantly higher in schizophrenia than in bipolar disorder. On FEICS, the caregivers of patients with bipolar affective disorder were perceived as having greater over-involvement than the caregivers of schizophrenia.

Conclusion: The presence of significant expressed emotion points to the need for psychosocial intervention in families of patients with schizophrenia and bipolar disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of Psychiatric Morbidity Among Medical Inpatients in a Tertiary Care Centre

Gaurav Kulkarni, Sivaprakash B, Mohammed Hanifah, Sukanto Sarkar

Mahatma Gandhi Medical College & Research Institute, India, r_gaurav@yahoo.com, drprakashb1965@gmail.com, hanifahforu@gmail.com, sukanto_sarkar@yahoo.co.in

Keyword: Psychiatric, co-morbidity, medical inpatients

Context: Psychiatric illnesses among medical inpatients, increase health care utilisation and reduces quality of life. Co-morbidities are often under-recognized and untreated.

Objective: To study the prevalence of depression, anxiety and significant alcohol use in medical inpatients, and influence of socio-demographic & clinical variables.

Study Design: Observational cross-sectional study. Setting: Departments of Psychiatry and General Medicine in a tertiary care hospital. Subjects: All consecutive patients aged 18-64 years, admitted to the medical wards over a period of 11 months.

Procedure: A semi-structured proforma used to record socio-demographic and clinical details. PHQ-9, GAD-7 and CAGE questionnaire were used for screening of psychiatric co-morbidities & Dukes Severity of Illness Checklist used to assess the severity of the medical illness. Multivariate analysis was done.

Results: Out of 195 medical inpatients, prevalence of depression, anxiety and significant alcohol use was 83.1%, 92.30% and 29.30% respectively. In terms of severity, 31.30% had moderate depression & 60% had mild anxiety. Suicidal ideas were reported by 45.10% patients.

Associations were found between psychiatric co-morbidity and age (p=0.003), gender (p=0.0003), area of domicile, socioeconomic status (p = 0.035). A positive association was found between severity of medical illness and anxiety (p=0.039), between diabetes and severity of anxiety (p=0.003).

Conclusion: This study showed high prevalence of depression, anxiety and significant alcohol use in medical inpatients. Significant inpatients reported suicidal ideations and significant severely ill had anxiety. Males from rural background had an increased risk of psychiatric co-morbidity. This study highlights the importance of mental health screening among medical inpatients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Appetitive responses and executive function in the self control of alcohol use among individuals with alcohol dependence syndrome and social drinkers: A comparative study

Vikas Patel, Christoday R.j Khess, Sanjay Kumar Munda

Central Institute Of Psychiatry, India, vikasimp@gmail.com, drsanjaymunda@gmail.com

Keyword: Alcohol dependence syndrome, social drinker, executive function, appetitive respone

Introduction: Past studies have demonstrated the critical role of executive functioning (EF) in self-control, including the ability to maintain and update information in working memory, to inhibit selected behaviors, and to shift between sets of information or tasks. Studies have also demonstrated that the extent to which appetitive responses are associated with alcohol consumption appears to be moderated by self-control resources. Although there is some evidence to suggest that situational restraint goals may moderate the impact of Executive Functioning on alcohol responses, there is little known about how individual differences in the desire to restrain drinking may moderate the interaction between appetitive responses and Executive functioning.

Aims and objective: Present study aims to compare the executive function and appetitive responses in self control of individuals with alcohol dependence syndrome and social drinkers.

Material and method: It will be a cross sectional hospital based study, conducted at S.S.Raju Centre for Addiction Psychiatry. Study population will consist of 25 individual with alcohol dependence syndrome and 25 individual with social drinker defined according to NIAAA criteria. Both the group will initially be screened with AUDIT. Then after detoxification of alcohol dependent individual and after 12 hour of last drink of social drinker, executive function test such as WCST, Color Stroop test and Trail making test will be applied. Then they will be rated on Urge to Drink Alcohol Scale. After this, they will be exposed to alcohol [smell and sight]. Again they will be rated on Urge to Drink Scale, apart from this anticipated biphasic alcohol effect scale, Restraint subscale of Temptation and Restraint inventory will be applied on both group.

Result and discussion: Result will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

IT In Psychiatry - Emerging Trends

Murugan Manickavasagam^*1, Vennimalai Manickavasagam²

¹Zen Med Hospitals, India, mmuru100@gmail.com, ²Aavanor Systems, India, venni@aavanor.com

Keyword: IT

Background: It is now commonly accepted that I.T is part of any professional venture, be it banking, defence or medicine. However Doctors in general and Psychiatrists in particular are only now waking up to the possibilities that I.T brings to their sphere of activity.

This paper covers the WHY, the WHAT and the HOW –

Why I.T in Psychiatry?
What are the various I.T options available to Psychiatrists? and
How to implement/use I.T effectively?

I am sure that you will all agree with me when I say that practicing medicine today is not what it was even a few years ago. Our patients have become so much more knowledgeable and demanding that they just cannot be taken for granted anymore. Hence the way you run your practice in terms of efficiency and patient satisfaction assume significance. This is where IT steps in and can turn around the way the clinic functions right from the time the patient seeks an appointment to see you, to the actual consultation and his leaving your clinic with either a good or bad impression of the whole process.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depressive Symptoms in Schizophrenia: Predictors across Gender

Lokesh Kumar Singh^*1, Samir Kumar Praharaj²

¹All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, singhlokesh123@gmail.com, ²Kasturba Medical College, Manipal, Karnataka, India, samirpsyche@yahoo.co.in

Keyword: gender difference, depressive symptoms, schizophrenia

Background: Schizophrenia remains a heterogeneous disorder, more so when compared across gender. Beginning from prevalence and incidence rate up to the outcome, several studies have been done with lack of corroboration and more of contradictions. This study aims at determining various predictors of depressive symptoms in schizophrenia across the gender.

Methods: In an assessment of gender difference in symptoms profile of schizophrenia, 67 patients (44 males and 23 females) with schizophrenia were evaluated for illness history, subtypes, positive symptoms, negative symptoms, depressive symptoms, side effects with the administration of socio-demographic sheet, Positive and Negative Symptoms Scale (PANSS), Hamilton Depression Rating Scale (HDRS), UKU side effect scale. Linear regression analysis was done in both genders with HDRS total score as outcome variable.

Results: Females were diagnosed more frequently with paranoid type and male were diagnosed more frequently with undifferentiated type. Neither on global nor on separate subscales of PANSS any significant difference was found. Though, on item wise comparison grandiosity, tension and anxiety were significantly higher in female whereas impulsivity and active social avoidance were higher in male. In male patients with schizophrenia, the predictors of depressive symptoms were Lack of spontaneity, Anxiety, Depression, Poor impulse control, Lack of judgment & insight whereas for the female patients Poor Rapport, Guilt feelings, Depression, Motor retardation, Disturbance of volition and Poor attention were the main predictors. The model explains 66% of variance in the HDRS scores.

Conclusion: Depression was the common item for both the genders whereas for male patients the items which emerged as predictors were Lack of spontaneity, Anxiety, Poor impulse control, Lack of judgment & insight. In female patients Poor Rapport, Guilt feelings, Motor retardation, Disturbance of volition and Poor attention emerged as the main predictors.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Best Practice for the safe initiation of alcohol detox regimes, Re-audit against NICE Clinical Guidelines (CG100 and CG115), UK, January 2014

Bapu V Ravindranath, Joseph Malone

Mersey Care NHS Trust, United Kingdom, Bapu.Ravindranath@gmail.com, Joseh.Malone@merseycare.nhs.uk

Keyword: NICE National Institute of Clinical Excellence, CG Clinical Guideline, BrAC Breath Alcohol Concentration

Background: This re-audit has streamlined factors being appraised against NICE guidelines. We used NICE guidelines CG 100 and CG 115(guidance.nice.org.uk) and created an easier to repeat shorter assessment tool incorporating Severity of Alcohol Dependence Questionnaire (SADQ), Clinical Institute Withdrawal Assessment of Alcohol Scale – Revised (CIWA-Ar), physical and mental health parameters including features of complex withdrawal such as seizures, delirium tremens and co-morbidity.

Furthermore, patient safety is a priority. We liaised with other leading alcohol detox centres in London and Manchester regarding Breath Alcohol Concentration (BrAC) scoring, to evaluate its use on admission, highlighting any need for change in practice.

Methods: Windsor Clinic is a 16-bed inpatient alcohol detox unit tertiary centre, serving the Merseyside population of 1,356,000. Typical stay is 7-10 days. Most patients referred have failed assisted alcohol withdrawal and often have co-morbidities.

A sample of 50 consecutive admitted patients had their electronic notes reviewed. The sample period was August 2014.

BrAC of patients on admission was assessed for Alcohol level before commencing detox regimes.

Results: All NICE guidelines were met in 43(86%) of patients assessed.

46(92%) BrAC scores were done on admission. 3(6%) of the 4(8%) missed had a reason: Intoxication, emphysema, inter-hospital transfer. One was missed with no reason. The BrAC scores ranged from 0-2. 9(18%) of the BrAC scores were recorded as over 1.5 mg/l. However only 5(10%) of these were repeated to ensure levels were dropping.

Conclusions: The Windsor Clinic is maintaining good practice and following NICE guidance.

There was improvement or the maintenance of good practice across all areas assessed.

We have now begun two BrAC score values before commencing detox unless showing signs of severe withdrawal, or known risk of seizures, meriting immediate commencement of detox.

The authors will further discuss the assessment process and significance of BrAC scores.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Buprenorphine Tapering - With and Without Long Acting Antagonist

Jaswinder Singh Gandhi^*1, Deepinder Kaur²

¹Amrit foundation, India, jaswinder1968@hotmail.com, ²Sri guru ram das institute of medical colleges and research centre, India, jaswinder1968@hotmail.com

Keyword: opioid use disorders, buprenorphine, antagonist,

Background: Opioid use disorders is chronic relapsing disorder. MAT with Buprenorphine is proven to be safe and effective since its approval. This treatment once started is generally advised to be continued for indefinite period since different studies report high relapse back to illicit opioids once the treatment is discontinued. However some patients stable with Buprenorphine want to stop it after a period of time due to different reasons.

Methods: We report a series of 34 patients in which we tapered buprenorphine. After stopping buprenorphine in first group of 16 patients only comfort medicines were given and second group of 18 of Naltrexone patients were implanted with two long acting opioid antagonist naltrexone along with comfort medicines. All the patients in both the group were psycho-socially stable at-least six months before stopping buprenorphine. In all the patients a gradual detox from buprenorphine was done in 7-10 days. In all these patients weekly telephonic calls were made and urine was tested regularly either on office visit or by significant others at home for six months.

Results: In first group of 16 patients only comfort medicines were given after seven days. After three months eight patients tested negative for illicit Opioid in urine, two patients went out of country permanently, one patient was untraceable and five had relapsed back to Opioid use. After six months 4 patients tested negative to urine Opioids (25%), 3 were untraceable and 7 had relapsed back to Opioid use. In second (Naltrexone implant) group of 18 patients first implant was done after 7-10 day of detox and second implant was put after 12 weeks of first implant. After 3 months 13 patients tested negative for Opioid and were re- implanted, 2 were untraceable and 3 had relapsed. After 6 months 11 implanted patients tested negative for Opioid (61%), 2 were untraceable and 5 had relapsed.

Conclusions: We find that long acting preparation of opioid antagonists are safe and effective method to reduce the incidence of relapse after stopping buprenorphine in patients of Opioid use disorder

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Attitudes towards Psychiatry and Mental Illness among medical students in a university

Chapagai Manisha, Saraswati Dhungana, Pratikchya Tulachan

Tribhuvan University Teaching Hospital, Institute of Medicine, Nepal, manisha_chapagai@yahoo.com, iomsaras@gmail.com, prats38@gmail.com

Keyword: Attitude, Mental illness, Psychiatry, Medical student

Background: Introduction Psychiatry is viewed negatively by medical student. They tend to have negative attitudes toward psychiatry, Psychiatrist, mentally ill and mental illnesses as whole. This study was intended to assess attitudes to psychiatry and mental illness among medical students in tribhuvan University Teaching Hospital.

Methods: It was a cross sectional study done to assess attitudes to psychiatry and Mental illness among fourth year medical students in Tribhuvan University Teaching Hospital. Sociodemographic information was filled up and two likert scale ATP -30(Attitude to Psychiatry) and ATM (attitude to Mental illness) were used to assess attitude. Descriptive analysis was done and chi-square test was used to see for any statistically significant difference for the item using SPSS version 20.

Results: Total sample size was forty five and male comprised three fourth of the respondents. The mean age of participant was 22.4 with somewhat higher number of respondents from valley. Brahmins (26.6%)and Hindu (88%) constituted the majority.84.4% of the respondents belonged to nuclear family. The mean ATP -30 and ATM score obtained were 106.78 and 66.93 respectively.

Conclusion: Overall attitude to psychiatry and mental illness among fourth year students in Tribhuvan University Teaching Hospital was found to be positive. Studies with higher sample size with students from multiple universities and medical colleges and comparison of attitudes before and after psychiatry rotation are further needed.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Thyroid Function in Postpartum Psychosis

Rati Ranjan Sethy, D Ram

Central Institute of Psychiatry, India, ratisethy@gmail.com

Keyword: Postpartum, Thyroid, Ultrasonography, Psychosis

Background: Transient thyroid abnormality was seen in postpartum psychosis.

Aim: To assess thyroid profile in patients with postpartum onset psychosis and compare them with patients of psychosis without postpartum onset and subjects with normal postpartum.

Methods And Materials: forty patients who were clinically diagnosed according to ICD-10 DCR with psychotic disorder due to postpartum onset and without postpartum onset were taken up for the study. Twenty females with normal postpartum were taken. The measurement of thyroid volume was done by using ultrasonography and venous blood was taken for the measurement of free T3, free T4 and TSH. Psychosis group patients were asses with CPRS, HDRS and YMRS.

Results: The duration of illness was significantly less in psychosis with postpartum onset compare to psychosis without postpartum onset. The past history of postpartum onset psychosis was significantly more in past postpartum psychosis group compared to without postpartum psychosis group. The postpartum onset psychosis group had significantly higher score on CPRS compared to psychosis without postpartum onset group. The HDRS score was significantly higher in postpartum psychosis group compared to psychosis without postpartum onset. The volume of the right lobe and total thyroid volume were significant different among postpartum onset psychosis, psychosis without postpartum and normal postpartum group. The total thyroid volume was significantly larger in postpartum onset psychosis group compared to psychosis without postpartum onset group. The blood free T4 level was significantly different among postpartum onset psychosis, psychosis without postpartum onset and normal postpartum group. In Pearson correlation the left lobe volume was found to be significant positive correlation with number of children and TSH was shown positive correlation with the age of onset.

Conclusion: Women with postpartum psychosis are at higher risk for clinical thyroid abnormality mainly free T4 level and also increase in thyroid size.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Body Image Concerns In Patients With Schizophrenia Who Are Overweight-Cross Sectional Study

Ananya Karikala, Sreejayan K

KMC Manipal, India, klkananya@gmail.com, sreejayan.k@gmail.com

Keyword: overweight, body image concern, schizophrenia

Objectives:

To study the body image concerns in overweight patients with schizophrenia compared to overweight normal controls
To study the Physical activity in these two groups
To study the effect of body weight concerns on physical activity in both groups
To study the effect of psychopathology on body weight concerns and physical activity

Methods: Cross sectional study, includes 50 cases and 50 controls

The cases would be recruited from the outpatients and inpatients of Kasturba Hospital
Controls matched for age, gender and education would be recruited Inclusion criteria-
Patients between the ages of 18-60 years, diagnosed with Schizophrenia (under the F-20 criteria in ICD-10) by a consultant psychiatrist
Of either gender
BMI > 25 ; In remission (score ≤ 3 on eight core PANSS items (delusion, unusual thought content, hallucinatory behavior, conceptual disorganization, mannerism/posturing, blunted affect, social withdrawal, lack of spontaneity)
Who can read Kannada, English or Hindi Inclusion criteria for controls-
BMI > 25
No Psychiatric disorder when screened on MINI
Age and gender matched

Statistical Analysis: Will be done by using paired student t test by using SPSS software version 13. Non parametric tests would be used to compare the two groups

Results: Results and Conclusion will be sent as soon as possible after completion of data collection.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Antipsychotic agents may target and facilitate inhibition of occipital gamma oscillations, and therefore irrelevant neuronal signals in schizophrenia

Sayantanava Mitra, S Haque Nizamie, Nishant Goyal, Sai Krishna Tikka

Central Institute of Psychiatry, India, sayantanava@gmail.com

Keyword: EEG, Gamma, Schizophrenia, Treatment marker

Background: An abnormal increase in activity in EEG gamma frequency band (>30 Hz) has been demonstrated in schizophrenia in past. It has been proposed that this may be reflecting a deficit in the development and maturation of the basic cognitive functions of attention, working memory and sensory processing; especially of signal-filter mechanisms.

Aims and Objectives: Hypothesizing that abnormality in gamma oscillatory activity may be a potential marker for schizophrenic psychopathology, present study aimed at evaluating its response to antipsychotic treatment and further investigating its role in schizophrenia.

Method: Fourteen (M=11, F=3) drug free/naïve right-handed schizophrenia patients were recruited, compared at baseline with 14 age-sex-education-handedness matched healthy controls, and were followed up for eight weeks of antipsychotic treatment. Resting state spontaneous EEG waves were recorded using 192-channel EEG at admission, four weeks and eight weeks (Nihon-Kohden Neurofax 1100K). Psychopathology of the patients at baseline was recorded on PANSS, and also followed up at 4 and 8 weeks. Data was analysed using Matlab7.12. Spectral power was calculated using Fast Fourier Transformation, hanning window. The power was averaged region-wise over nine scalp regions (right and left frontal, parietal, temporal, occipital and central) regions in 3 frequency ranges (gamma1 = 30-50 Hz, gamma2 = 50-70 Hz, gamma3 >70 Hz).

Results: Patients and controls differed significantly at intake in terms of gamma power at all scalp sites upon intake, being greater in the patient group throughout. Consequent persistent reduction in spectral power values was seen on gamma 1& 2 bands in left occipital region with 8 weeks of antipsychotic treatment.

Conclusions: Our finding suggests that in schizophrenia, specific aspects of neuronal circuit abnormality may remain amenable to treatment. Further, antipsychotic agents may reduce occipital gamma power in a way to facilitate inhibition of irrelevant neuronal signals, thus restoring the signal-filters and improving psychopathology, in schizophrenia. Our findings therefore have widespread treatment implications.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Naloxone A New tool for Addiction Specialists for saving lives

Jaswinder Singh Gandhi^*1, Deepinder Kaur Gandhi²

¹Amrit foundation, India, jaswinder1968@hotmail.com, ²Sri Guru ram das institute of medical sciences and research center, India, drdeepindergandhi@gmail.com

Keyword: Naloxone, opioid use disorder, addiction

Background: In last few years, these has been rise in patients with Opioid Use Disorders and hence mortality associated with it. Most common cause of death in OUD is sudden respiratory failure associated with Opioid overdose. Studies show Opioid overdose is generally witnessed.

Naloxone a pure Opioid antagonist is very safe, reliable, cheap, easily available and fast acting drug. Naloxone causes reversal of sedation and respiratory depression associated with Opioid Overdose within minutes. It is only drug of coma cocktail which can be given even without any emergency setup and it has no side effect of its own even in higher doses.

Addiction is a chronic relapsing disorder where even a recovering patient can relapse anytime and die of Opioid overdose. Considering the fact that a large number of OUD patients come to addiction specialist for treatment, these physicians have a moral responsibility and they can play a major role in reducing the mortality of OUD by educating the patients and their Significant Others against Opioid overdose and prescribing Naloxone to them in addition to other addiction medicines. These patients and their attendant can keep Naloxone at a secure place and use it in case they witness an Opioid overdose and save a life.

Recently in some developed countries OEND (Overdose Education and Naloxone Dispensing) program is being practiced widely and they have been able to minimize the mortality associated with Opioid overdose. Also Good Samaritan law is being implemented at many places where even a layman can give Naloxone in case of witnessed Opioid overdose and he is protected by law of and any legal hassle.

As an addiction specialist certified by ISAM, in last two years I have been able to save six patients in emergency with Naloxone who were brought to me with Opioid overdose respiratory depression.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Randomized Sham-Controlled Study Of Transcranial Direct Current Stimulation In Depression

Syed Danish Ahmed, Vinod Kumar Sinha, Nishant Goyal

Central Institute of Psychiatry, India, dr_danish08@yahoo.com, psynishant@gmail.com

Keyword: tDCS, depression

Introduction: Studies have shown efficacy of transcranial Direct Current Stimulation (tDCS) in treatment resistant depression and were found to be effective in depression to some degree but with many limitations. Fregni et al, (2006) (n =10, tDCS at 1mA, 20min per session) observed significant reduction of depressive symptoms (60- 70%) but had limitations of small sample size and only 5 sessions.

Aims and Objectives: Present study attempts to evaluate potential use of tDCS in depression as an adjunct to conventional anti-depressant treatment; specifically aimed at assessing the efficacy of active tDCS at left dorsolateral prefrontal cortex on depressive symptomatology.

Material and Method: It will be a cross-sectional hospital based study, conducted at a tertiary level psychiatry care facility in eastern India. Study population will consist of 30 right handed patients (assessed using handedness bias schedule), with unipolar depression defined as per ICD-10. Patients will be divided into two groups of 15 each, by simple randomization. One will receive active tDCS and the other sham stimulus. Treatment-as-usual, following Institute’s protocol, will be given to both and kept unchanged during study period. Baseline assessment of patient will be done using ‘Hamilton Rating Scale for Depression’ (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A). tDCS will be administered with anode over left dorsolateral prefrontal cortex (PF3, 10/20 system), and the cathode placed over the lateral aspect of the contralateral orbit (F8, 10/20 system). Stimulation will be given at 2mA for 20 min (ramped over 30 sec). For sham stimulation, a 1mA current will be applied for 30 sec giving just an initial sensation. Total of 15 sessions will be given over a 3 week period. Symptomatology will be reassessed at 3 weeks, and efficacy of tDCS will be assessed.

Results and Discussion: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Awareness and attitude towards mental illness among a rural population

Ruth Sneha Chandrakumar, Mohan Reddy, Mona Nongmeikapam

Sri Devaraj URS Medical College, India, ruth.sneha@gmail.com, drmmrpsy@yahoo.co.in, psychiatry@sdumc.ac.in

Keyword: Public perceptions, Stigma, Discrimination

Background: There are few studies dealing with the diversity in people’s knowledge and attitude towards mental health problems.

Objectives: To assess the knowledge, attitude and practices of the general public with regard to mental illness.

Methods: This is an observational study, conducted in Sri R.L Jalappa hospital and research centre, Tamaka, Kolar. The relatives of all patients who visited the hospital served as the study population. One hundred consecutive individuals fulfilling the inclusion criteria were chosen for the study. The participants were interviewed using the public perceptions of mental illness questionnaire after obtaining a written informed consent.

Results: Majority (39%) of the participants agreed that mental illness is caused by brain disease. On the other hand, one fifth thought mental illness was God’s punishment. Regarding the knowledge they had about people with mental illness, twenty five percent thought that people with mental health problems are largely to blame for their own condition and one third felt that someone with a mental illness was usually dangerous. Our study also identified the magnitude of stigma attached to mental illness. Almost half (40%) of the participants said they would not want people to know about it if they were suffering from a mental illness and thirty five percent believed that one should avoid all contact with the mentally ill. Less than one fifth thought someone could recover from mental illness and only eleven people were aware that mental health services were available in the community.

Conclusion: The present study concludes that the understanding of the nature of mental illness, its implications for social participation and management remains poor among the general public. Hence the need for well coordinated public education, mental health awareness programs and increased accessibility of effective mental health services at primary health centers through training, support and supervision.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Factors Associated With Insight In Obsessive Compulsive Disorder

Niska Sinha, D. Ram

Central Institute of Psychiatry, India, niskasinha@yahoo.com

Keyword: Insight, Metacognitions, Symptom dimensions in ocd

Background: Obsessive-compulsive disorder is an anxiety disorder with a diverse symptom presentation. In OCD, insight in to senselessness of symptoms is treated equivalent to insight into illness and in OCD a range of insight exists in various symptom dimensions but there is conflicting data. Metacognition is process of “thinking about thinking”. Dysfunctional metacognitions might represent critical prerequisites for the phenomena to emerge and maintain the disorder.

Aims and Objectives: Present study is aimed at assessing metacognition, depression, anxiety, quality of life, disability and insight in OCD compared to patients with minor skin problems. Authors will study sociodemographic, clinical, symptom dimensions of OCD and relation of insight with metacognition, anxiety, depression, quality of life, various symptom dimension.

Material and Method: It will be a cross-sectional hospital based study, conducted at CIP, Ranchi and consist of 40 cases with primary diagnosis of OCD according to ICD-10 DCR and 40 cases of minor skin problems from skin OPD of institute matched with OCD group 18-60 years.

Socio-demographic and clinical data will be collected after written consent and then Metacognition Questionnaire, Brown Assessment of Beliefs Scale, Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, WHO Quality Of Life -BREFand Sheehan Disability Scale will be applied on both groups and Yale–Brown Obsession and Compulsion Scale and the Dimensional YBOCS on OCD group. BABS will be employed first as a composite of insight into existing OCD symptoms, and second as assessments of insight into each OCD symptom dimension separately.

Results: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Severity of tinnitus and severity of anxiety / depression: is there any correlation?

Suneet Kumar Upadhyaya

GMERS Medical College, Patan, Gujarat, India, dr_suneet12@yahoo.com

Keyword: Anxiety, Depression, Tinnitus

Background: Prevalence of depression in tinnitus varies from 3 to 20% while of anxiety is reported to be much lower than depressive disorders. There are very few studies relating tinnitus severity with severity of anxiety/depression.

Objective:

To assess prevalence of anxiety and depression in tinnitus patients
To correlate severity of tinnitus with severity of anxiety and depression

Methods: This cross sectional study will be conducted at GMERS medical college hospital, Patan, Gujarat after obtaining ethics committee approval. All consecutive tinnitus patients visiting ENT department who agree to give written informed consent will be considered for study. Those who have any mental illness or have taken any drug affecting mental status like antidepressants, anxiolytics, antipsychotics, or mood stabilizers in last 3 months will be excluded. Those who meet these criteria will be enrolled in study till reaching a sample size of 200. Tinnitus handicap inventory [THI] will be used to assess tinnitus severity. Patient health questionnaire 9 (PHQ 9) generalized anxiety disorder 7-item scale (GAD -7) and will be used as screening tool for depression and anxiety disorders respectively. Gujarati versions of PHQ-9 and GAD-7 are validated and available in public domain. Those who scored 10 or more on PHQ, and/or 8 or more on GAD-7 will be referred to dept of psychiatry. Psychiatrist will assess the severity of anxiety and depression on basis of Hamilton anxiety rating scale (HAM-A) and Hamilton depression rating scale (HDRS or HAM-D) respectively, while being blind to THI score. The data will be analyzed with appropriate statistical methods including descriptive and analytical statistics with post tests where applicable.

Result and conclusions: will be discussed in the conference

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

The Effect Of Adjunctive Theta Burst Repetitive Transcranial Magnetic Stimulation (Rtms) On Symptomatology And Sensory Gating Phenomenon In Migraine Patients: A Sham-Controlled Study

Amiya Krushna Sahu, Vinod Kumar Sinha, Nishant Goyal

Central Institute of Psychiatry, India, draksahu81@gmail.com, psynishant@gmail.com

Keyword: Migraine, rTMS, iTBS, sensory gating

Background: The treatment of migraine remains elusive to clinicians till date. To add to various aetiological hypotheses contributing to this confusion is the demonstration of increased cortical bioelectrical activity and impaired sensory gating in patients with migraine as compared with normal subjects. Past studies regarding role of rTMS in treatment of migraine are inconclusive, and there is dearth of literature about use of intermittent theta burst stimulation (iTBS) in this regard.

Aims and Objectives: The present study aims at assessing the efficacy of adjunctive iTBS in symptomatic management of migraine, and its effect on sensory gating phenomenon in this group.

Material and Method: It will be a prospective hospital based study, conducted at K.S. Mani Center for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi. Study population will consist of 10 right handed patients (5 active rTMS- ‘experimental group’ and 5 sham rTMS – ‘sham control group’) & 5 age, sex and handedness matched healthy controls. Migraine patients with/without tension type headache will be included in the study. Patients taking prophylactic medication for migraine will continue the medication during study. General Health Questionnaire-12 (GHQ-12), Handedness Preference Schedule, HAM-D (Hamilton Rating Scale for Depression) and HAM-A (Hamilton Rating Scale for Anxiety) will be applied to all study populations. P50 will be recorded in basal condition in both patient groups and controls, using 40-channel ERP.10 sessions of iTBS, twice daily will then be administered to patients on 5 consecutive days over the left dorsolateral prefrontal cortex (DLPFC) at 80 % of motor threshold. rTMS Side-Effects Checklist will be applied after each session. P50 will be recorded again after completion of 10 sessions of iTBS. Migraine disability assessment scale (MIDAS) will applied at base line and every 2 weeks for 6 weeks to assess symptom response.

Results and Discussion: The results will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Correlation Of Clinical Features And Insight In Bipolar Affective Disorder

Sonia Malhotra, Pankaj Bharat Borade, Pradeep Sharma, Gunjan Solanki

SMS Medical College Jaipur, India, docsoniamalhotra@gmail.com, pankajthephilosopher@gmail.com, pradeeprameshwar@gmail.com, drgunjanr@gmail.com

Keyword: Insight, Bipolar Disorder, Clinical Features

Background: Lack of insight is a characteristic phenomena of schizophrenia, but is also seen in a state dependent manner in bipolar affective disorder, both manic and depressive episodes. Bipolar affective disorder is a chronic disorder requiring intensive pharmacological and psychosocial support and insight in such a disorder correlates with the severity of symptoms. Level of insight is also likely to determine the patient’s treatment compliance and his ability to function in the society. Hence, this study aims to correlate the clinical features and insight in patients of bipolar affective disorder, both manic and depressive episodes.

Objective: To correlate the clinical features and insight in patients of bipolar affective disorder, mania and depression.

Methods: 25 patients each of bipolar affective disorder, Mania and Depression were recruited from Psychiatry OPD of SMS Medical College, Jaipur. Sociodemographic questionnaire, Young’s Mania Rating Scale, Hamilton rating scale for Depression, Positive and Negative Syndrome Scale and Scale to assess Unawareness of Mental Disorder were applied on these patients for assessment.

Results and Conclusions: will be discussed in detail at the time of presentation in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect Of Life Events On Psoriasis

Sreejayan Kongasseri^*1, Aman Gouri², Shweta Rai²

¹Kasturba Medical College, Manipal, India, sreejayan.k@gmail.com, ²Manipal School of Allied Health Sciences, India, gouri.s.dec@gmail.com, shwetaraisrcp@gmail.com

Keyword: Psoriasis, life events, stress,

Introduction: Psoriasis is a recurring and remitting skin disorder which has an immunological basis. Stress can alter the immunological state in the body and cause relapses. This study was done to evaluate the effect of life events on the disease. Understanding this relationship would help us in planning appropriate psychological management in these patients.

Objective: To study the influence of stressful life events on number, severity and duration of episodes in patients with psoriasis over five years.

Method: The study was conducted at Dermatology out patient department of Kasturba Medical College, Manipal. It is a cross sectional study and purposive sampling was used. 99 patients were included in the study. The information about number of episodes and severity of each episode was charted on the psoriasis life chart. The life events over last five years were assessed with Presumptive stressful life events (PSLES) scale and charted on the life chart. The severity of current episode was scored on Psoriasis Area Severity Index (PASI). The data was analysed using Statistical Package for Social Sciences (SPSS 16.0). Non-parametric tests were used to compare differences between groups. Pearson’s correlation was done to assess the association between life events and illness variables.

Results: Mean age of the sample was 43.71±11.07 years. 71% were men and 29% women. Total duration of all episodes, total severity of all episodes, and average severity of an episode correlated with total number of life events and frequency of life event per year. Severity per life event did not correlate with the above mentioned illness variables.

Conclusion: Patient with psoriasis who had more number of life events had more episodes which were more severe. However severity of life event did not have any effect on the psoriatic episodes.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Pattern Of Internet Use Among Medical Students

Nirmal R, Senthil Kumaran C

Government Stanley Medical College, India, nirmaldr20588@gmail.com, senthilchidambaram@outlook.com

Keyword: excess internet use, internet addiction

Background: The Internet is used by general population, especially adolescents.. Number of Internet users who go online regularly had surpassed 1.5 billion in 2009 â”€19% in India alone.

Objectives: study pattern of internet use, presence of depression among excessive internet users.

Materials: Semi-structured proforma, young internet addiction scale(IAT), beck depression inventory(BDI), satisfaction with life scale(SWLS), Rosenberg self esteem scale(SES)

Methods: The study was done cross-sectionally in SMC, Chennai including 751 undergraduate medical students having access to the internet from the past 6 months after institutional ethical committee approval. The semi-structured proforma along with the scales were distributed in classes necessary instructions were given. Those with significant scores in IAT were given BDI, SWLS, SES.

Results: Among 751 students, 464(62%) scored significantly in IAT. 361(48%)were average online users, 101(13%) experienced occasional problems, 2(0.2%) significant problems.31%(n=145)had habit of using internet in classrooms.17.6%(n=82)started using internet by 15yrs.54%(n=254) accessed internet through both mobile, computer even among them mobile users were frequent .53%(n=246) had habit of checking updates immediately after waking up.31%n=146 were randomly logging into websites.415 used social networks all had face book accounts 95 also used others. 84%(n=394) were continuously using social networks. BDI scores revealed mild 17%(n=80) borderline 9%(n=46) moderate 12%(n=57) severe6.25% (n=29) extreme0.6%(n=3) with p value(<0.005). 29%(n=135)had significant depression scores. 30%(n=138) had low Self esteem score(p=.297). 15%(n=70) were below average, 13%(n=62) dissatisfied in satisfaction with life scale(p=0.663). SWLS, SES scores showed positive correlation with IAT Scores.

Conclusion: Depression seems to occur in those with excessive internet usage this warrants judicious use of internet in future.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Co Morbid Sexual Disorders In Patients With Alcohol Dependence Syndrome

Apurva Reddy Chada, Sinjoni Roy

Chalmeda Anand Rao Institute of Medical Sciences, India, chadaapurvareddy@gmail.com, sinjoniroy8@gmail.com

Keyword: Alcohol dependence, sexual disorders.

Background: Alcohol is the most widely used substance in the world. The Alcohol use disorders and sexual functioning have a complex relationship. Use of alcohol has also been linked with impaired sexual performance. Hence, there is a need for studying the affect of alcohol abuse as an independent factor affecting the sexual functioning.

Aim and objectives: To assess the co morbid sexual disorders in male patients diagnosed with alcohol dependence syndrome.

To correlate the presence of sexual disorders with the severity of alcohol dependence.

Material and Method: Cross sectional study was done in consecutive 60 male in-patients who were diagnosed as alcohol dependence syndrome according to ICD 10 criteria in Chalmeda Anand Rao Institute Of Medical Sciences, Karimnagar, Telangana during the period of May 2013 to April 2014.

Patients were assessed for severity of dependence using Severity of Alcohol Dependence questionnaire (SADQ)

Assessment of sexual disorders was done using ASEX© (Arizona Sexual Experiences Scale).

Relationship between severity of alcohol dependence and presence of sexual disorder is analyzed using chi square and SPSS software

Results: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Neurological Soft signs in Obsessive-Compulsive disorder

Richa Tripathi, Alok Kumar Tyagi, Ajitabh Soni, Suresh Gupta

S.M.S.Medical College, India, drricha12@gmail.com, dralok_tyagi@yahoo.com, ajitabhsoni89@gmail.com, s123hubham@yahoo.com

Keyword: NSS-Neurological soft signs, CNI-Cambridge Neurological Inventory, OCD-Obsessive Compulsive disorder

Introduction: It is generally supposed that NSS* reflect impairments in central nervous system. NSS have been described in several psychiatric disorders.

Objective: To compare the prevalence of NSS in OCD & healthy controls using a standardized assessment, the CNI and to find out correlation between Y-BOCS total score & NSS scores and also between age of onset of OCD & NSS scores.

Participants and Methods: A cross sectional hospital based study including 70individuals (40 patients of OCD who were attending outpatient department of our psychiatric clinic & 30 healthy subjects). Instruments of the study (CNI, YBOCS and sociodemographic Proforma) were applied on both groups.

Results: No statistically significant difference was found between cases and control in total NSS scores (0.197) or subscores - motor coordination(.103),sensory integration (.634)and disinhibition test(.673). NSS were not found to be correlated with illness severity and age at onset.

Conclusion: NSS are not specific for OCD. Further studies are required to find out subtypes of OCD related specifically with NSS.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study to evaluate social stigma as a causative factor in causation of somatic symptoms in the patients of depression

Seikhoo Bishnoi^*1, Nand Kishore²

¹Maharashi Agrasen Medical College, Agroha, India, dr.sheikhoo@gmail.com, ²Santosh Medical College, Ghaziabad, India, sheikhoo003@gmail.com

Keyword: Social stigma, Depression, Somatization

Background: A lot of patients with depressive symptoms present in OPD with somatic symptoms. Social stigma prevents the patients to present to a Psychiatrist directly and instead they present first to a Physician.

Objectives: To study effect of social stigma in causation of somatic symptoms in the patients of depression.

Methods: The study was conducted at Department of Psychiatry, Santosh Medical College, Ghaziabad. It included a total of 50 patients who presented either directly to OPD or who were referred from other departments of hospital. The study was a cross-sectional study and purposive sampling was used. The assessment was used with semi-structured demographic proforma, Hamilton Rating Scale of Depression (HAM-D), Hamilton Rating Scale of Anxiety (HAM-A), Stigma score from Explanatory Model Interview Catalogue (EMIC) and Symptoms Prominence Rating Scale. The data was analyzed with appropriate statistical tests.

Results: Our study found that HAM-D scores in study were with mean of 24.64 in patients of MDD and 15.27 in the patients of Somatization Disorder. When means were compared the difference was found to be statistically significant. The mean stigma score derived from EMIC in patients of MDD was 51.25 and in patients of Somatization Disorder was 14.13. The difference was statistically significant.

Conclusions: Our study found that experience of stigma was associated with depressive disorder than somatization disorder. A positive correlation was found between severity of depression and stigma scores, more severe the depression more is social stigma

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Social anhedonia and gamma band oscillations in remitted schizophrenia patients and their first degree relatives: A high resolution EEG study

Umesh S, Shamshul Haque Nizamie, Nishant Goyal

Central Institute of Psychiatry, India, umesh.yes@hotmail.com, sh.nizamie@gmail.com, psynishant@gmail.com

Keyword: schizophrenia, gamma activity, anhedonia

Background: Social anhedonia and gamma band oscillations have been proposed as endophenotype in schizophrenia.

Objectives: To study social anhedonia and spontaneous gamma band oscillation in remitted schizophrenia patients and their first degree relatives (FDRs) to determine whether they can be used as composite endophenotype.

Methods: This cross sectional study included 20 remitted schizophrenia patients, 20 FDRs of patients and 20 healthy controls. Revised Social Anhedonia Scale (RSAS) and Temporal Experience of Pleasure Scale (TEPS) were used to assess social anhedonia and pleasure respectively. All participants underwent awake, resting 192 channel EEG recording. Gamma spectral power and intra-hemispheric spectral coherence were calculated. One-way ANOVA, Pearson’s correlation analysis and step-by-step linear discriminant functional analysis were subsequently performed.

Results: Social anhedonia was significantly higher and anticipatory pleasure was lower in schizophrenia and FDRs than healthy controls. Spectral power of gamma band was significantly lower (p<0.001) in right fronto-temporal and central regions in schizophrenia and FDR than healthy control. Social anhedonia scores were negatively correlated (p<0.01) with right frontal gamma1 power. Discriminant analysis found RSAS total score, central gamma3 power, right frontal gamma3 and right fronto-temporal intra-hemispheric gamma2 coherence to accurately classify (85%) when all four measures were considered together as composite variable.

Conclusion: We propose that social anhedonia and gamma band oscillations in central and right fronto-temporal regions as a composite endophenotype for schizophrenia. There may be an association between dysfunction of right fronto-temporal circuitry and genetic liability to schizophrenia. An altered glutamatergic signalling might also play a role in this causation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical Indicators Of Suicidal Ideation In Depression

Arunima Chatterjee, Rudra prosad Chakraborty

Manobikshan, India, rudrapc@yahoo.com

Keyword: suicidal ideation, major depression, Hamilton Rating Scale for Depression

Background: In a depressive patient sociodemographic risk factors are not fully specific for predicting suicide.

Aim: to examine whether a suicidal depressive episode clinically varies from a nonsuicidal depressive episode other than presence of suicidal ideation.

Method: Patients of both sexes, of 18-55 years age, fulfilling ICD-10 diagnostic criteria for major depressive episode (moderate to severe), either unipolar or bipolar, formed the universe. 20 such patients with associated suicidal ideation (group 1) and 20 such patients with number associated suicidal ideation (group 2) were taken consecutively into the study. Presence of suicidal ideation was examined by Beck’s Scale for Suicidal Ideation. Informed consent was taken. All participants were assessed by Hamilton Rating Scale for Depression. Results: patients with suicidal ideation had significantly more no of past suicidal attempts, middle insomnia, general symptoms, obsessions and compulsions and total HDRS score.

Conclusion: Suicidal ideation is common in depressive patients with middle insomnia, general symptoms, obsessive-compulsive symptoms and past suicidal attempts.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Association of Social anxiety disorder with depression and quality of life among medical undergraduate students

Imran Jahangirali Ratnani¹, Bharat Navinchandra Panchal¹, Deepak Sachchidanand Tiwari², Ashok Ukabhai Vala¹, Smruti S. Karambelkar¹, Milankumar G. Sojitra¹, Nidhi Nagori¹

¹Department of Psychiatry, Government Medical College and Sir Takhtasinhji General Hospital, Bhavnagar, Gujarat, India, drijratnani@gmail.com, drbnpanchal@rediffmail.com, ²Department of Psychiatry, M. P. Shah Government Medical College and Guru Gobindsingh Government Hospital, Jamnagar, Gujarat, India, dstiwari36@gmail.com, drvala1758@gmail.com, smrutikarambelkar@gmail.com, millllansojitra@gmail.com, nidhi.nagori12@gmail.com

Keyword: Social Phobia, Depression, Quality of Life

Objective: Social Anxiety Disorder (SAD, also known as Social Phobia) is characterised by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder and suicide among them.

Methods: It is an observational, cross sectional, single centred, questionnaire based study assessing frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck’s Depression Inventory (BDI II) and World Health Organisation Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression and quality of life respectively.

Results: Frequency of SAD is 11.37% and depression is 8.96%. Females are more likely to experience SAD with Female: Male ration of 1.5:1. Participants with SAD are more likely to experience depression (p<0.0001) and have poor quality of life (p=0.01). Participants with depression have higher SPIN score (p<0.0001) and poor quality of life (p<0.0001). Females are more likely to experience social fear (p=0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (p=0.01). Severity of depression is correlated with severity of social anxiety (r²= 0.1934, p<0.0001).

Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice a versa.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

The Prevalence Of Physical Comorbidities And Risk Behaviors Among Opioid Injectors Attending RIMS De-Addiction Cetre(OPD): Screening And Co-Management Model Care

Andreecia Mn Mawiong, Senjam Gojendra Singh, N Heramani Singh, Th Bihari Singh, Santa Naorem

Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India, andreeciamawiong@gmail.com

Keyword: opioid injectors, physical comorbidities, risk behaviors

Objectives: The purpose of this study is to find out the physical comorbidity and risk factors associated with injection of drugs in opiod injectors to allow planning and strengthening of healthcare for these population at rims psychiatry department.

Methods: A sample of 63 male opioid injectors (total number of opioid injectors who attended rims psychiatry opd w.e.f august 2013 to august 2014) were interviewed face to face using a semi structured pro-forma, invetsigations were sent like complete haemogram, LFT, KFT, RBS, ECG, CHEST-XRAY, HCV, HBV AND HIV. spss16 was used for analysis.

Results: results shows that among the 63 opioid injectors, the most common physical comorbidity is hyperpigmented scar along the vascular distribution due to repeated needle prick (100%), they are also infected with HCV(58.7%), HIV(42.9%) and HBV(11.1%). some suffer from anaemia (28.6%),some have deranged LFT(9.5%). Some also have ECG changes like left ventricular hypertrophy(11.1%) and short PR interval(4.8%) and some have pulmonary TB(3.2%), none of the client shows abscess,81% of them are involve in sharing of needle, and 74.6% have contact with sex workers.

Conclusion: Opioid injectors are many in Manipur though only few seek help, RIMS de-addiction center is one of the centre where opioid injectors seek help. With the outcome of this study we can now have a better planning in giving appropriate care to our client especially the opioid injectors like besides de-addiction their needs for counseling will be stressed and also stress will be given on referrals of the opioid injectors to counselors, psychologist and other specific special clinic of the institute.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity and Quality of Life in Rheumatoid Arthritis patients

Divya Sharma, Devendra Kumar Sharma, Chandra Shekhar Sushil, Devendra Kumar Vijayvergia

Government Medical College, Kota, India, divyasharma01@gmail.com, drdksharma1310@rediffmail.com, divyasharma01@gmail.com, drdevendra.android@gmail.com

Keyword: Rheumatoid arthritis, psychiatric morbidity, HADS, SF 36

Objective: The purpose of this study was to study the psychiatric morbidity of Rheumatoid Arthritis and to look for the quality of life in the Rheumatoid Arthritis Patients. Method: 35 patients were selected from Government Medical College & Hospital, Kota as per Association of Rheumatoid Arthritis (A.R.A.) revised criteria. The DAS-28, SF-36, Hospital Depression & Anxiety Scale (HADS) were administered to these patients.

Results: The results will be presented at the time of presentation.

Conclusion: Results and conclusions to be discussed during the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study of sociodemographicdeterminants and patterns of opioid use among opioid dependent patients

Sanjay Gupta, Arun Kurupath

IMS, BHU, Varanasi, India, guptavaranasi@hotmail.com, arun.kurupath@rediffmail.com

Keyword: sociodemographic determinants, patterns of opioid use, opioid dependence

Objective: To study the sociodemographic determinants and pattern of opioid use among opioid dependent patients.

Method: 50 Patients aged between 16 to 60 years visiting psychiatry opd of Banaras Hindu Hospital and also admitted patients meeting criteria for opioid dependence as per DSM 1V are included in study. Study is conducted between august 2014 to December 2014. The charts were analyzed for the socio demographic data, age at onset, past history, pattern of use, risk factors associated with intake of opioid.

Results: Will Be Discussed During Presentation

Conclusion: Will Be Discussed During Presentation

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Sociodemographic profile and Disability assessment of patients admitted for alcohol de-addiction

Divya Sharma, Devendra Kumar Sharma, Devendra Kumar Vijayvergia, Divyesh Vernwal, Chandra Shekhar Sushil

Government Medical College, Kota, India, divyasharma01@gmail.com, drdksharma1310@rediffmail.com, drdevendra.android@gmail.com, divyesh2k5@gmail.com

Keyword: sociodemographic profile, WHODAS, de-addiction

Aims And Objectivse: To study the socio-demographic and clinical variables with disability assessment in patients with alcohol dependence syndrome.

Methodology: It is a cross-sectional study on alcohol dependent individuals. Patients who were admitted in psychiatry department for purpose of deaddiction were selected as sample. Data was collected about socio-demographic profile on semi-structured proforma and severity of alcohol dependence was assessed using severity of alcohol dependence questionnaire. Instruments used to assess disability was WHODAS.

Results: Results and conclusions will be discussed in the conference

Conclusions: Conclusions will also be discussed in the conference

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Comparative Parallel Prospective Randomised Study to Assess the Efficacy of Rifaximin vs Relaxation therapy in the Management of Patients with Irritable Bowel Syndrome

Sreelakshmi V, Alka Subramanyam, Ravindra Kamath, Pravir Gambhire, Pravin Rathi

T.N.M.C and B.Y.L. Nair Hospital, India, sree.vaidyanathan@gmail.com, alka.subramanyam@gmail.com, pravir999@gmail.com

Keyword: Irritable Bowel syndrome, Rifaximin, Quality of Life, Relaxation therapy

Background: Irritable Bowel Syndrome is a chronic condition with no known cure. Clinically important benefits might be achieved in patients with Rifaximin owing to altered microbiota in this condition. Similarly, relaxation therapy has been tried owing to altered Brain Gut Axis.

Objectives:

To assess the effect of symptom severity on Quality Of Life (QOL) in patients with IBS
To assess and compare the efficacy of Rifaximin vs. Relaxation Therapy in terms of reduction in symptom severity and effect on QOL in these patients

Methods: Total 120 subjects were recruited subjects and randomised to 2 groups - Group A received Rifaximin 400mg tid for 14 days and Group B taught Jacobson’s Progressive Muscle Relaxation Technique which was practiced under supervision for 14days and instructed to perform the technique twice in a day. Thereafter, the subjects were followed up at 3 months and then at 6 months. Parameters of Generalized ill feeling, Abdominal discomfort, score for Severity and QOL were applied at baseline and at each follow up.

Statistical analysis was done using SPSS v20 software. Linear regression was used for correlating symptom severity with QOL score and analysis of quantitative variables was done with ‘One Way ANOVA test’ for comparison between the 2 groups over the 6 month period.

Results: IBS causes impairment of QOL, which shows significant improvement with treatment. The QOL is directly affected by symptom severity. Between the two treatment groups, Rifaximin showed better short term effects (at 3 months) while Relaxation took longer to show effects but had better long term benefits.

Conclusion: Both pharmacological (Rifaximin) and non – pharmacological (relaxation therapy) modalities show improvement in the symptoms and QOL of IBS patients, at varied time intervals of treatment and hence combined therapy would be more holistic and show better results.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Determinants of Depression in Principal caregivers of Patients with Cancer

Sreeja Sahadevan, Trissia Mary George, P. C Sudheeran, Sreekumar D, Vasudevan Namboodiri

Amala Institute of Medical Science, India, sreejasubin@gmail.com, trissia.nelli@gmail.com, pcsudheeran@yahoo.com, sreekumar.amala@gmail.com, vasudevan.namboodiri@gmail.com

Keyword: Depression, determinants, cancer, breast cancer, caregivers

Background: Cancer affects not only the patients, but also the key relatives involved in caring. Existing literature suggests a high rate of depression in caregivers, comparable or even higher than patients themselves. There appears no specific previous study of depression among caregivers of breast cancer from India.

Objectives: We assessed prevalence of depression and its determinants in principal caregivers of patients with breast cancer

Methods: This is a cross-sectional study of 80 patient–key relative dyads, done at a tertiary care cancer centre at Kerala. Depression was assessed using HAMD. Socio-clinical data was broadly collected under patient characteristics, caregivers’ characteristics, caregivers’ experiences and care characteristics.

Results: All statistical analysis were done using SPSS 16. Fisher’s Exact test was applied for finding the association between factors in care-giving and depression. Majority of caregivers report depressive symptoms, despite patients being in a stable phase of illness and with a low perceived financial burden. Spousal relatives, men in this study, were significantly more depressed than non-spousal relatives (P-value = 0.000). Relation of caregiver and the patient had significance (P-value= 0.004). Those living together with the patient had a significantly higher association (P- value = 0.007). Caregivers doing domestic chores, in addition to caring, were more depressed to a level of statistical significance (P-value= 0.018). Similarly, those having to fund the care were more depressed (P-value= 0.001). The logistic regression analysis found that those factors were independently associated with the presence of depressive symptoms.

Conclusion: Cancer treatment teams need to be more sensitive to the psychological and emotional needs of caregivers. This might aid development of focused interventions for this group, which may improve the outcome of the patient as well.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of Relapse precipitants, stressful life events, Coping behaviors in Alcohol relapse: An Indian Scenario

Deepti Anujankinju Abraham^*1, Devavrat Gurudas Harshe²

¹Assistant Professor, Department of Psychiatry, SS Institute of medical Sciences and Research Centre, Davangere 577005, India, drdeepabrah@gmail.com, ²Senior Registrar, Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India, devavrat.harshe@gmail.com

Keyword: Alcohol relapse, Precipitants, Coping, life events

Background: Relapse is a common, frustrating rule of alcohol use disorders rather than an exception, for patients, caregivers and psychiatrists alike. Although several models of relapse are described in the West, few Indian studies have examined coping behaviors and immediate life events in Alcohol relapse.

Aims: Study the association between alcohol relapse and life events. Determine relapse precipitants and coping behaviors used in alcohol relapses.

Design & settings: Cross sectional study for1 year conducted in tertiary care hospital and AA groups.

Methodology: 60 patients fulfilling DSM IV TR criteria for alcohol dependence, reusing alcohol recently, following abstinence for at least 6 months were selected for the study. Relapse precipitants Inventory (RPI), Coping behavior Inventory (CBI) and Presumptive stressful life event scales (PSLES) were administered. Data analysis done, using IBM SSPS V 20.0.

Results: Commonest relapse precipitant belonged to lessened cognitive vigilance (100%), while commonest life stressor belonged to undesirable events (10%). 34% of participants had no life events in the year before relapse. Subjects separated from spouses had higher (p<0.05) negative mood states precipitating relapse than married. Significant association (p<0.05) was found between lesser periods of abstinence and Euphoric mood states and Lessened cognitive vigilance as a relapse precipitant. Participants relapsing after 6-12 months had lower total CBI scores (p<0.001) compared to those relapsing after 25-36 and < 48 months. Total CBI scores were higher (p<0.05) in respondents who sought help from both resources than those who sought help from the psychiatrist, AA alone and sought no help at all.

Conclusion: If similar mechanisms of relapse & co-relates operate across several categories it could be beneficial in preventing relapses in alcohol as well as several behavioral addictions and impulse control disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study Of Factors Affecting Adherence To Treatment In Patients Of Obsessive Compulsive Disorder

Pankaj Bharat Borade, Sonia Malhotra, Alok Tyagi

SMS Medical College, Jaipur, India, pankajthephilosopher@gmail.com, docsonia@gmail.com, dralok_tyagi@yahoo.com

Keyword: Obsessive Compulsive Disorder, Adherence

Background: Non Adherence to treatment is common problem in the patients diagnosed with Obsessive Compulsive Disorder. Moreover, there has been limited research and evidence available on this topic. Adherence to the treatment has grave impact in the prognosis of OCD. Hence, this study aims to study the factors affecting the compliance to priscribed treatment in patients diagnosed with Obsessive Compulsive Disorder.

Objectives: To study adherence to prescribed treatment in the patients diagnosed with OCD.

Method: It is a cross sectional study done in 50 patients diagnosed with OCD coming to Psychiatric Centre, Jaipur out patient department. The Adherence score is assessed by using the Morisky Medication Adherence Scale (MMAS). The correlates of non adherence will be obtained and explored by using a structured questionnarie.

Results and Conclusions: will be discussed in detail at the time of presentation in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of psychopathology in Juvenile criminal offenders and its relation to the nature of crime

Bhakti Hemant Murkey, Gunjan Solanki, Pradeep Sharma, Vijay Choudhary

SMS Medical college, India, doctor.bhaktii@gmail.com

Keyword: Juvenile, crime, psychopathology

Introduction: The prevalence of antisocial and delinquent behavior in juveniles has increased dramatically over the past decades. It is posed that these change might reflect underlying psychopathology in children contributing to intentional and severe crimes as opposed to subjects without significant psychopathology. This study was conducted with an aim to study the role of social, economic, educational backgrounds and impact of psychopathology on intent and severity of committing a crime by the juveniles.

Methodology: 60 boys (between age 9 and 16 years) were chosen randomly after permission from the presiding officials, from Juvenile Home, Jaipur affiliated to the Government of Rajasthan. These children stayed on a variable probation period at the shelter. They were interviewed regarding the nature of crime committed by them, intent of crime and socio-economic and educational background. The Childhood Behavior Check-list (self report), the ADHD rating scale (self report) and Temperament Assessment Schedule were applied on them. A qualitative assessment of the data was done with the help of SPSS 20.

Results and Conclusions: Are still under processing and will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prolactin and Leptin Serum Levels and Alcohol Craving

Subodh Kumar^*1, C.R.J Khess², Jayati Simlai³

¹All India Institute of Medical Sciences, India, kumarsubodh2050@gmail.com, ²Central Institute of Psychiatry, India, jmou@rediffmail.com, ³Ranchi Institute of Neuro-Psychiatry and Allied Sciences, India, jayatisimlai@gmail.com

Keyword: Prolactin, Leptin, Alcohol Dependence, Craving

Background: Prolactin and leptin are the two biomarkers among many which are associated with craving in alcohol dependence found in various studies. Prolactin secretion is closely connected to dopaminergic transmission that is known to play a crucial role in mediating reinforcement and craving in alcoholism. Leptin serve as an endocrine signal involved in the regulation of appetite, energy expenditure and drug reward and one might speculate that alcohol craving may also be modulated by Leptin.

Aim: To study the association between serum prolactin and leptin levels and craving.

Methodology: 50 male patients of alcohol dependence syndrome according to ICD-10 DCR (WHO, 1993) were included in the study after admission for detoxification treatment. Serum for prolactin and leptin analysis were obtained on day 1. Both leptin and prolactin concentration were measured by using high sensitive ELISA kit. The extent of withdrawal and craving severity on first day was assessed by Clinical Institute Withdrawal Assessment of Alcohol and Obsessive Compulsive Drinking Scale.

Results: Mean prolactin level was within normal range and mean leptin level was below normal range for males.

Conclusion: No significant correlation was found between prolactin, leptin and craving. Significant correlation between leptin/BMI ratio with alcohol withdrawal was found and leptin was correlated with BMI.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Assessment of Suicidal behavior in Obsessive Compulsive Disorder Patients

Saritha Gaddam, Apurva Chada, Sinjoni Roy

Chalmeda Anand Rao Institute of Medical Sciences, India, drsarithav@gmail.com, chadapurvareddy@gmail.com, sinjoniroy8@gmail.com

Keyword: OCD, suicidal behavior, YBOCS, SSI

Background: Assessment of Suicidal behavior in Obsessive compulsive disorder patients

Introduction: Suicidal behavior is defined as an act through which an individual harm himself whatever may be the degree of lethal intention or recognition of genuine reason for their action. Suicidal behavior is the result of a complex interaction of biological, psychological, genetic, sociological, and environmental factors. Life threatening attempts are more common than fatalities. 15% of untreated depressed patients may commit suicide. Obsessive compulsive disorder is chronic distressing anxiety disorder associated with significant functional impairment.

Aims: To assess the suicidal behavior in obsessive compulsive disorder patients

To correlate the severity of obsessive compulsive disorder with suicidal behavior

Materials and Method: Cross sectional study was done in 50 patients diagnosed as having obsessive compulsive disorder according to ICD 10 in Chalmeda AnandRao Institute of medical scienses, Karimnagar, Telangana state, psychiatric OPD during the period of dec2013 to may 2014

Severity of obsessive compulsive disorder was assessed by using Yale-Brown obsessive compulsive scale [Y-BOCS]

Assessment of suicidal behavior in these patients using Scale for suicidal Ideation [SSI] Correlation of severity of Obsessive compulsive disorder with suicidal behavior is done by using chi square test and SPSS software

Results: Will be discussed later.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychosis In A Patient With Hypopituitarism Due To Secondary Empty Sella Syndrome Following A Snake Bite

Arjun Kartha^*1, Badr Ratnakaran¹, Varghese P Punnoose², Sathesh Vadasseril¹

¹T.D Medical college, Alappuzha, India, arjunkartha18@gmail.com, brodoc@gmail.com, ²Govt Medical college, Kottayam, India, vargheseppunnoose@yahoo.com, drvsathesh@gmail.com

Keyword: Empty Sella, hypopituitarism, psychosis, russell’s viper, snake bite

Background: Endocrinological disturbances are known to have psychiatric manifestations. But literature on psychosis in clear sensorium in hypopituitarism is limited and restricted to case reports.

Case: 42 year old married male following a visit to the Dermatology department for chronic hyperpigmentation of the skin, was referred to Psychiatry after he was noticed to be talking to himself and other hallucinatory behaviours. He gives a history of hypothyroidism and acuteadrenal insufficiency following a snake bite 13 years back. Patient then gradually developed low mood, anhedonia, persecutory ideas, increased religiosity, decreased social interaction, sleep, libido and appetite. Over the past 4 years, he would mutter to himself, gesturing as if he was conversing with someone. On mental status examination he was found to have poor eye contact with decreased psychomotor activity and talk, guarded about revealing details of his persecutory ideas and described visual hallucinations of seeing ghosts to which he would converse, impaired attention, concentration, immediate memory with Grade 3 insight. System examination showed melasma over the face, decreased body hair and bilateral pitting oedema. His investigations revealed he had hypothyroidism and low testosterone and morning serum cortisol levels. MRI scan revealed an Empty Sella and diagnosis of organic psychosis due to hypopituitarism was made

Treatment and outcome: Patient’s condition improved on treatment with only oral prednisolone and thyroid supplements

Conclusion: In patients with organic causes of psychiatric disturbances especially endocrinological, dramatic improvement can be seen upon correction of the cause without the need for psychotropic medications.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Delirium in cognitively impaired elderly: outcome of intervention with low doses of quetiapine versus haloperidol

Ashok Kumar, Sarvada Chandra Tiwari, Abdul Qadir Jilani

King George Medical University, India, forsake_river@yahoo.co.in, imjilani@gmail.com

Keyword: Delirium, cognitive impairment

Introduction: Several lines of evidence suggest that delirium may result from various neurotransmitter abnormalities, including dopamine and serotonin dysregulation. The available research shows that many of the patients with delirium recover on removal of causative factor/s. The available literature is not conclusive about efficacy and tolerability of antipsychotics in management of delirium in patients with cognitive impairment.

Aim: We aimed to compare the efficacy and tolerability of low dose of haloperidol and quetiapine in delirious patients with premorbid cognitive impairment.

Methods: Severity of delirium was evaluated at the time of presentation, from day 1 to day 7, using DRS-98 and total sleep time. The clinical global impression improvement (CGI-I) was applied daily.

Results: 20 patients were recruited for both the groups. For haloperidol group mean dose was 1.53 mg and for quetiapine it was 123mg per day. Both the groups were comparable in regard to age, gender and socioeconomic status. Severity of dementia was more in haloperidol although it was not statistically significant.

Discussion: Results indicated that the outcome with haloperidol was comparable with quetiapine group. Regarding safety more patients in quetiapine group reported sedation than haloperidol group.

Conclusion: Cognitively impaired elderly presenting with delirium have similar outcome in regard to efficacy and safety with low dose quetiapine and haloperidol.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

An Exploratory Study on Mortality in an Indian Psychiatric Hospital: A Retrospection of 23 Years.

Gargi Mondal, Arun Lata Agrawal, Sanjay Kumar Munda

Central institute of Psychiatry, India, gargi.mondal.tua@gmail.com, dralagrawal@hotmail.com, drsanjaymunda@gmail.com

Keyword: exploratory, mortality, retrospective, psychiatric inpatient.

Introduction: Research on the causes of death of psychiatric patients is a worthwhile endeavour as it has long been recognized that death rates among patients with chronic mental illnesses are higher than among the general population. The reality of increased occurrence of unexplained death in patients with severe mental disorders is indeed poorly captured in death certificates. Hence this study will provide the basis for a better patient care. To the best of our knowledge this is the first Indian study to know about the mortality in psychiatric hospitals.

Objectives: The aim of this study is to explore to the occurrence and cause of mortality in an Indian psychiatric hospital in the past 23 years (1991 to 2013).

Method: It will be a retrospective study in which the data of the deceased patients would be collected from the case record files. The study will include all the patients who were admitted in the hospital and who died during the course of their hospital stay between 1981 and 2013. Case record files of the patients will be analysed in different parameters, like socioeconomic data sheet, clinical data sheet using appropriate statistics.

Results and Conclusions: Will be discussed in details at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Efficacy of Adjunctive Neuronavigated Repetitive Trans Cranial Magnetic Stimulation(rTMS) in Localization Related Epilepsy in Children and Adolescents: A Sham-Controlled Study

Nirmalya Mukherjee, Vinod Kumar Sinha, Nishant Goyal

Central institute of Psychiatry, India, nirmalya.ik@gmail.com, vinod_sinhacip@yahoo.co.in, psynishant@gmail.com

Keyword: Neuronavigation, rTMS, Localization related epilepsy, children and adolescents, adjunctive.

Introduction: Refractory epilepsy, estimated to affect 10–20 % children with epilepsy, can have profound effect on the education, social and cognitive functioning and recreational activities of the child. Repetitive transcranial magnetic stimulation (rTMS), a safe, noninvasive and easily applied technology, can certainly be tested as an alternative to drug therapy. Low-frequency (<1 Hz) rTMS (slow rTMS) decreases the excitability of the primary motor and other cortical areas. Long-term depression, a phenomenon associated with synaptic plasticity, which can be induced by rTMS, might be part of the underlying mechanism. Low-frequency rTMS prolonged the latency of the development of pentylenetetrazol- induced seizures in rats, which provided a rationale for using low-frequency TMS to treat patients with epilepsy.

Purpose: This study is designed to evaluate the effect of adjunctive neuronavigated rTMS in localization related epilepsy in children and adolescents. To the best of our knowledge it is first of this kind of studies where neuronavigation for rTMS is being used, to maintain site specificity. Also there are very few studies in children and adolescent age group.

Methods: 6 patients, of either sex, aged between eight to eighteen years, with 4 or more paroxysms of localization related epilepsy, with or without secondary generalization, in last one month on continuous anti-epileptics, will be included in study. They will be divided randomly and equally in active group, receiving 2 daily sessions of neuronavigated rTMS (100% Motor Threshold) at 0.3 Hz on vertex for total of 10 sessions over a week, and sham group, receiving sham stimulation with same protocol. Pre and post stimulation Seizure frequency, qEEG, along with scores in depression and anxiety rating scales will be obtained and compared up to 3 months after stimulation.

Results and Conclusions: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study on Risk factors in adolescents admitted with deliberate self harm/suicide attempt in Tata Main hospital Jamshedpur

Manoj Kumar Sahoo, Harshita Biswas, Sanjay Agarwal

Tata Main Hospital, Jamshedpur, India, drmanojsahoo@gmail.com, harshi.biswas@gmail.com, sanjpsy@yahoo.co.in

Keyword: Deliberate self harm, adolescent, risk factors

Background: To understand the psychological, social and personality factors contributing to deliberate self harm/suicide attempt in patients of adolescent age group admitted to Tata Main Hospital Jamshedpur.

Methodology: The study is being carried out in the Tata Main Hospital Jamshedpur. Any act of self damage inflicted with self destructive intentions, however vague or ambiguous will be taken as suicide attempt, for the purpose of the study. Consecutive suicide attempters upto the age of 19 years referred from medical or surgical wards over a period of 6 months are taken up for study. Patients are interviewed once they gain physical stability after resuscitation and a period of observation in medical or surgical unit. Close family members of each patient are interviewed for additional information. Data is collected on socio demographic sheet and specific Performa to collect various risk factors contributing to this behavior specifically designed for this study. Data was analyzed using descriptive statistics. i.,e mean and percentage.

Results: As per preliminary results from a sample group of 31 adolescents (male=12, female=19), the mean age was found to be 17 years. In considerable number of patients (16%) the most preferred method of deliberate self harm was consumption of phenyl, harpic, overdose of medications lying at home like paracetamol, iron capsules etc followed by consumption of pesticides (10%) and hanging (6%). In the current sample group 42 % of the patient did not have any psychiatric diagnosis, But on the other hand 16 % patients had depression and 12% patients had adjustment disorders. Around 75% patients had a precipitating factor present prior to committing suicide. The most common precipitating factors for suicide among adolescents were interpersonal problems, failure in examination, break up with friend, family conflict, illness or death of family member, excessive alcohol, or drug usage by family member.

Conclusion: The risk factors associated in this study has preventive implications.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical Profile of Children with Poor School Performance

Salman Kareem, Sherry Arakkal Abdul Khader

Academy of Medical Sciences, Pariyaram, India, drsalmankareem@gmail.com, sherryarakkal@yahoo.com

Keyword: Poor school performance, children and retrospective study

Background: Poor school performance (PSP) can be defined as a school achievement below the expected for a given age, cognitive skills, and schooling. About 15% to 20% of children in their early school years have difficulty learning and, thus, a poor school performance. Poor school performance should be seen as a symptom and reflecting a larger underlying problem/problems in the child and/or the environment

Aims and Objectives

To understand the profile of children attending the speciality child and adolescent clinic with complaints of poor school performance (PSP)
To assess various causes for PSP

Methods: A retrospective chart review of all children with poor school performance who attended the child psychiatry clinic of a state medical college in Kerala from August 2012 to July 2013 was conducted and data was analysed using descriptive statistics.

Results: Sample consisted of 59 children. Majority of the sample were males (74.6%). Mean age of the sample was 10.58 ± 3.4 years. Mean age at which academic difficulties were noticed was 6.20±2.05 years. 42.4% of the children were diagnosed with psychiatric co morbidity of which ADHD (33.9%) was the predominant diagnosis. 61% of the referred children with poor school performance had below average intelligence. 50.8% of the children assessed had mixed type of specific learning disorders.

Conclusion: PSP is fast becoming a common cause for referral to mental health professional. PSP as a symptom requires detailed evaluation and assessment to understand the factor/factors leading to the problem

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A comparison between the characteristics of persons certified with disability due to Mental Retardation and that of census of persons with Mental Retardation in NCT of Delhi, India

Deepak Moyal, Sumit Kumar Gupta, Bhavuk Garg, Aninda Sidana

IHBAS, India, deepak.moyal@gmail.com, Drsumit@aol.in, bhavuk.garg@gmail.com, nandy.aninda@gmail.com

Keyword: disability, mental retardation, census report

Background and objective: The objective of this study is to analyze if there is any difference between various characteristics of persons availing disability benefits meant for persons with Mental Retardation and that of census of persons with Mental Retardation. As a direct estimate of former population may be difficult, the persons seeking disability certification have been used as a proxy indicator of persons availing disability benefits.

Materials and methods: Institute of human Behaviour and Allied Sciences was the only center authorized by Govt of NCT of Delhi for issuing disability certificates for mental retardation between 2010 to 2013. A comparison of age and sex distribution of the persons certified for disability due to mental retardation is made with census of persons with Mental Retardation (as per Census 2011) for NCT of Delhi.

Results and conclusion: There was a steep rise in total number of persons receiving disability certificate from 508 to 1387 over a four year period. There was no meaningful difference between the persons certified and census of persons with MR. Not more than one in three persons with mental retardation would have been availing disability benefits till beginning of the year 2014 in NCT of Delhi as per this estimate.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Minor Physical Anomalies in Schizophrenia- Widows Peak Sign, Whorls

Sunny Chattopadhyay¹, Raghavendra B Nayek², Om Prakash Singh¹, Nanasaheb M Patil⁴3

¹NRS Medical College, India, sunny11802001@yahoo.com, ²DIMHANS, India, ³JNMC Belgaum, India

Keyword: Minor Physical Anomalies, Schizophrenia, Widows Peak Sign, Whorls

Aim: To compare the frequency of occurrence of Widows Peak Sign, Whorls, Greying and spiky hair to other anomalies of minor physical anomalies scale.

Method: We selected patients with clear-cut diagnosis of schizophrenia and enrolled them. A standard proforma was prepared and demographic details were entered. They were scored for minor physical anomalies as well as anomalies in question. Statistical analysis was performed, T-test was used.

Result: The anomalies in question were equally common or commoner than some characters in minor physical anomalies checklist.

Conclusion: There are other characteristics other than minor physical anomalies checklist which are equally common in schizophrenia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study of Socio-Demographic Factors among the Patients of Obsessive-compulsive disorder

Gajanand Verma¹, Devendra Kumar Vijayvergia², Devendra Kumar Sharma², Chandra Shekhar Sushil²

¹Psychiatric Centre, Jaipur, India, gajanand_verma@ymail.com, ²Govt. Medical College Kota, India, drdevendra.android@gmail.com, drdksharma1310@reddifmail.com, sushilcs58@yahoo.com

Keyword: socio-demographic, obsessions, compulsions

Obsessive: Compulsive disorder (OCD) is an intriguing and disabling illness characterized by the presence of obsessions (unwanted thoughts, images or impulses) and/or compulsions (repetitive behaviors).Various Sociodemographic factors are associated with it.

Aims and Objective: To find out the various sociodemographic variables associated with patients of obsessive compulsive disorder.

Material and method: A total of 100 patients (both outpatient and inpatient), with an established diagnosis of obsessive compulsive disorder (OCD) as per ICD-10 criteria were taken and various socio-demographic factors (Age, Sex, education status, occupation, marital status, economic status, domicile, type of family, family size, birth order, Stressful life events) were studied. Appropriate Statistical tools were applied.

Result: will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Reasons for inhalant use in adolescents: An explorative study from tertiary de-addiction center of India

Roshan Bhad, Raka Jain, Manju Mehta, Anju Dhawan

All India Institute of Medical Sciences, New Delhi, India, drroshansindia@gmail.com, drroshansindia@gmail.com, drmanju.mehta@gmail.com, dranjudhawan@gmail.com

Keyword: Inhalant abuse, Adolescent substance use, Perceived effects of Inhalants

Background: Adolescent inhalant use continues to be rapidly emerging, puzzling and yet poorly understood problem in India. Since there are limited studies in the area of inhalant use, a study was conducted with the aim to explore reasons for inhalant use among treatment seeking adolescents.

Objectives:

To assess sociodemographic and clinical profile of the treatment-seeking adolescents.
To explore reasons for inhalant use among treatment seeking adolescents.

Method: A total of 23 consecutive adolescents (between age groups 13 to 18) with the history of inhalant use in past one month and seeking treatment at National Drug Dependence Treatment Centre (NDDTC), AIIMS were recruited in the study. Socio-demographic and clinical profile was assessed using semi-structured questionnaire. A checklist based on review of literature was used to know perceived effect of inhalant use among adolescents.

Results: A descriptive statistics using SPSS 20.0 was used to analyze the data. Mean age of the participants was found to be 16 (n=23). All participants were from urban area and were staying with their parents. Ninety percent (22/23) adolescents reported physical abuse by family members and 77 % (17/22) of them reported it being the reason for continuing substance use. Inhalants use was a part of the peer activity in age group (17-18 years). The common perceived effects were boldness (56%), reduced appetite (43.5%) and euphoria (26.1%).

Conclusions: Results indicate multiple reasons for use of inhalants among adolescents. The study findings are likely to give insight into the understanding of adolescent inhalant use behavior and will aid in management of the problem.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Characteristics of the patients certified for disability due to mental retardation in NCT of Delhi: a four year analysis

Aninda Sidana, Bhavuk Garg, Deepak Moyal, Sumit Kumar Gupta

IHBAS, India, nandy.aninda@gmail.com, bhavuk.garg@gmail.com, deepak.moyal@gmail.com, drsumit@aol.in

Keyword: disability, mental retardation, four year trend

Background: Disability Certificate is the essential requirement for availing various benefits entitled to persons with disability. Planning of various services for persons with disability due to Mental Retardation requires data regarding the characteristics of target population, which was not available.

Materials and methods: IHBAS was the only center authorized by Delhi Government for certification in disability due to Mental Retardation for calender years 2010 to 2013. A census of all the persons certified with disability due to mental retardation in this period is presented based on their age, sex and degree of Mental Retardation.

Results: Males constituted approximately two-thirds of the total number and this trend was secular. Also the patients with moderate degree of mental retardation were highest in number followed by mild. Persons with profound degree of mental retadation were certified at youngest age.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Correlation between Psychiatric and Physical Illnesses: A Comparative study among Indoor Psychiatric Patients in a Tertiary Care Health Institution.

Bharat Udey, Vijay Niranjan, R C Jiloha, Manushree Gupta

Maulana Azad Medical College, India, bharatudey@gmail.com, dr.vijayniranjan@gmail.com, bharatudey@gmail.com, manushree@gmail.com

Keyword: metabolic disorders, physical illnesses, psychiatric in-patients, schizophrenia, stomatognathic disorders

Aim and Objective: To find the nature and prevalence of physical illnesses among psychiatric in-patients.

Methods: One hundred eighty consecutive psychiatric in-patients fulfilling the selection criteria were taken for the study. The subjects were diagnosed for psychiatric and physical illnesses after detailed clinical history based on WHO ICD-10 criteria, physical examination and investigations. Comparative analysis between groups of psychiatric diagnosis and physical diagnosis was done using chi-square test, Fischer’s exact test, student t-test, Pearson’s correlation coefficient, univariate and multiple regression analysis.

Results: Seventy percent patients were found to have associated physical illnesses. Metabolic disorders were present among 28.9% patients followed by endocrinal (25.6%), hematological (18.3%), gastrointestinal (15%), cardiovascular (12.2%), neurological (9.4%) and stomatognathic disorders (8.3%). Association of schizophrenia spectrum disorders and mood disorders with number of physical illnesses at the time of assessment was found to be statistically significant (p values of 0.042 & 0.019 respectively).

Conclusion: Physical illnesses are prevalent among psychiatric in-patients. Most common group of physical illnesses present among psychiatric in-patients were of metabolic disorders. A significant correlation was found between schizophrenia spectrum disorders and mood disorders with number of physical illnesses at the time of assessment.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Tippling to a Frenzy in 3 cases cases of alcohol induced mania

Krithishree S S^*1, Aditya Hegde², Praveen Das¹, Priya Sreedaran¹, Ashok M V¹

¹St. John’s Medical college, Bangalore, India, krithishree.somanna@gmail.com, ²National Institute of Mental Health and Neurosciences, Bangalore, India, h.aytida@gmail.com, praveendas07@yahoo.co.in, drpriyasreedaran@gmail.com, mysoreashok@gmail.com

Keyword: Alcohol, mania, bipolar disorder, alcohol-induced mania, alcohol-induced bipolar disorder

Background: The co-occurrence of affective disorders and alcohol abuse has been well documented. Various hypotheses have been proposed to explain the phenomenon. Affective disturbances are known to precede as well as succeed changes in pattern of alcohol use. Change in the pattern of alcohol use has been reported to induce episodes of mania. In this report, we present three cases of ‘alcohol induced mania’ treated in an in-patient setting. There is a need to document such occurrences and explore alcohol-induced mania as a potential sub-type of mania.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A comparative study of Family Burden and Quality of Life of caregivers of patients with chronic Psychiatric versus chronic Medical disorders

Ashok Arora, I D Gupta, Pradeep Sharma, Kishore Dudani

SMS Medical College Jaipur, India, ashokarora010@gmail.com, ishwardayalgupta@gmail.com, pradeeprameshwar@gmail.com, dudani_kishore@yahoo.co.in

Keyword: Caregiver, Burden of care, Quality of life, chronic illness

Background: Caregivers are individuals who have the responsibility of meeting physical and psychological needs of the dependent patient. Chronically ill patients need assistance or supervision in their daily activities often placing a major burden on caregivers, placing them at a great risk of mental and physical problems and an impaired quality of life. The burden perceived by the caregivers is an important prognostic aspect which refers to daily difficulties and negative life events resulting from caring for or living with the ill member and can be said as physical, emotional and financial toll of providing care.

Objectives: This study aims to assess and compare the burden of care and quality of life (QOL) of caregivers of patients with chronic psychiatric disorders (schizophrenia and OCD) with that of chronic medical illnesses (Chronic Renal Failure CRF and Chronic Obstructive Pulmonary Disease COPD).

Methods: This is a hospital based observational analytical study conducted over 1 year period (2013-14) in Psychiatry and Medicine OPD of SMS medical college and attached hospitals, Jaipur. Healthy caregivers in blood relation and spouse, residing for atleast 2 years with patients of chronic psychiatric disorders and chronic medical illnesses willing to give written informed consent were included. 60 primary caregivers of patients of psychiatric disorders (30 each of schizophrenia and OCD)and of chronic medical illnesses (30 each of CRF and COPD) as per ICD-10 diagnosis, will be compared. The following instruments were applied in assessment: Semi-structured proforma(SSP), Family Burden Interview Schedule (FBIS) to assess burden of care, World Health Association WHO-QOL BREF for quality of life assessment. The data will be analyzed using suitable statistical tools.

Results: Exploring ways of supporting caregivers can have beneficial effects on the outcomes for both patient and the caregiver. The study is being conducted and details will be presented in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Socio-Demographic And Clinical Profile of Children and Adolescents With Dissociative Disorders Admitted In A general hospital psychiatry unit In India-

Satya Kant Trivedi¹, Avinash G.Kamath², Rishikesh V Behere²

¹PCMS, BHOPAL, India, satyakanttrivedi@gmail.com, ²Kasturba Medical College, Manipal, Manipal University, India, kamathavi@gmail.com, rvbehere@gmail.com

Keyword: Socio-demographic, Clinical, Children, Adolescents

Background & Objective: To study the socio-demographic and clinical features of children and adolescents admitted with a diagnosis of dissociative disorders (ICD-10) in last 5 years (Jan 2008 to Dec 2012) in the psychiatry unit of a general hospital in India.

Methods: The sample consisted of children and adolescents admitted with a diagnosis of dissociative disorder (ICD-10) in the department of psychiatry, Kasturba Hospital Manipal between 2008 and 2012. The medical records of these patients was reviewed and a semi-structured proforma was used to collect information about sociodemographic details and diagnosis.

Results: A total of 30 patients had been admitted with dissociative disorder over the past 5 years. Overall, there were 10 male (33.3%) and 20(67.3%) female patients. Mean age was found to be 13.7 years. All patients were from nuclear family and 23(19.7%) Most patients 23(73.7.7%) had been referred by other departments to psychiatry And 33(28.2%) patient had sought magico religious treatment before visiting a hospital. the most common diagnosis was dissociative motor disorder (35%). 37(21.6%) patients had a comorbid psychiatric diagnosis with Depressive disorder (33.3%) being the most common comorbidity. Stressor was associated with 26(86.7), with Academic stressors being the most common 13(43.7%). Combined pharmacological and psychological treatment was given in 21(70%) cases while the rest 30% required psychological therapy alone. Outcome was favourable in majority of patients 27(90%).

Conclusions: Dissociative disorders in childhood and adolescents seem to have a female predilection. Dissociative motor disorders were the most common subtype in our study. Academic stressors were most commonly present. Importantly the outcome was favourable in a large majority of cases.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity In Patients Admitted To Non Psychiatric Wards Of A General Hospital

Vikas dhingra, Sudarshan C Y, Shamshad Begum

¹JJMMC Davanagere, India, drvikasdhingra007@gmail.com

Keyword: Comorbidity, Somatic symptoms, psychiatric morbidity.

Background: Psychiatric disorders can present with psychiatric symptoms and/or physical symptoms. They are not associated with any positive finding on examination or investigations and are regarded as medically unexplained physical symptom, hypochondriacal worry or somatic preoccupation & somatic presentation of mood disorder. High prevalence of psychiatric morbidity is reported in them. Depression can present with somatic symptoms in 75% of patients leading to its non-recognition. A proportion of admissions in non-psychiatric wards of a general hospital can be regarded as “ nonspecific cases” based on absence of clinical findings, positive investigation results and treatment given. Thus inpatients in medical wards can have only medical illnesses, only psychiatric illnesses or a combination of both.

Aims and Objectives: To study the prevalence of psychiatric morbidity in patients admitted in medical wards of a general hospital.

Materials and methods: Sample included inpatients aged between 18 to 45 years of both sexes admitted to medical and orthopaedic wards of the general hospital. After eliciting socio-demographic data, those who were cases on GHQ were interviewed to elicit psychiatric history and psychopathology to arrive at diagnosis based on DSM IV criteria. Somatic symptoms and mood disturbances were assessed by using Scale for Assessment of Somatic Symptoms and HADS respectively.

Results: 45.23 % of 252 patients in medical wards did not have specific medical diagnosis. More than 3/4^th of these patients had diagnosable psychiatric syndrome, somatoform disorders accounting for 69.38% of them. Comorbidity of medical and psychiatric disorders in medical ward was 33.33% and was significantly associated with mood disturbances & somatic symptoms. Referral to psychiatrist was poor despite the presence of psychiatric syndrome.

Conclusion: Significant comorbidity and psychiatric morbidity alone in medical wards emphasizes the importance of consultation liaison psychiatry and orientation of non-psychiatric medical professionals to psychiatry.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Window of time from suicidal idea to attempt: Opportunity for intervention in a select few?

Avin Muthuramalingam, Siddharth Sarkar, Shivanand Kattimani, Nancy R Premkumar

JIPMER, India, avinniva87@gmail.com, sidsarkar22@gmail.com, drshivanand@gmail.com, nancyrpremkumar@gmail.com

Keyword: attempted suicide, prevention and control, suicidal ideation, time factors

Background and Aims: Suicide attempts are an important cause of mortality, especially among the younger age groups. Many suicide attempts are impulsive, while some are with forethought which provides a opportunity to intervene. This study aimed to find out the time for suicidal process, i.e., time between the emergence suicidal ideas to attempt and to identify characteristics of those who have longer suicidal process thereby giving opportunity for intervention (window of opportunity).

Methods: This hospital-based record review included medically stabilized suicide attempters evaluated in a crisis intervention clinic of the hospital. Information was obtained from the records about demographic data, reason and mode of attempt, other clinical characteristics along with time from emergence of suicidal idea to the current attempt. The time from emergence of suicidal idea to attempt (‘window of opportunity’) was divided into four quartiles. The last quartile (> two hours) compared with the other first three quartiles (≤ two hours).

Results: The sample comprised of 319 patients, seen over the three consecutive years (July 2010 to June 2013), with a window of opportunity being more than two hours in 75 patients (23.5% of the sample). In others, this was ≤ two hours, deemed inadequate for intervention. Those providing window of opportunity came from urban areas (p = 0.011), had significantly different reasons for attempt (p = 0.002), were less likely intoxicated at time of attempt (p = 0.005), more likely visited a health professional in the past three months (p = 0.015), more likely had a mood disorder (p = 0.028), and less frequently used problem-focused disengagement type of coping (p = 0.015).

Conclusion: Differences in characteristics of suicide attempters based on duration of the suicidal process demonstrated in this study. Resolution of the crisis and appropriate treatment of psychiatric disorders can help in the prevention of some suicide attempts. However, a large number suicide attempts seem to be impulsive and thus less scope for preventive measures.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Knowledge and Attitude Towards Alcoholism Among Nursing Students: An Interventional study

Poorav Rameshchandra Patel, Harsh Oza, Gautam Prajapati, Ganpat K Vankar

BJ Medical College, Ahmedabad, India, poorav_patel2@yahoo.com

Keyword: Knowledge, Attitude, Nursing Students, Alcoholism, Interventional Study

Background: Alcohol is one of the most common substances leading to abuse and dependence. Adequate knowledge regarding alcoholism and positive attitudes in paramedical college students towards alcoholism would make early recognition of and appropriate intervention in this disorder more likely and hence better outcome of illness.

Objectives: This study was conducted to raise knowledge and to change the attitude of nursing students towards alcoholism.

Methods: Survey method, Pre and Post-interventional session in students of Government Nursing School, Ahmedabad.

Questionnaire containing 36 questions regarding alcoholism was given before and after the interventional lecture to 100 nursing students.

Questionnaire comprising of 3 scales: The Marcus questionnaire (Marcus,1980), The Tolor-Tamerin Scale (Tolor-Tamerin,1975) and The Seaman-Mannello Scale (Seaman-Mannello,1978)

Chi square test. SPSS version 15. P value of <0.05 was considered statistically significant.

Results: After the intervention, attitude of the nursing students changed significantly. Attitude has been changed mainly regarding etiology, moral factors and nature of alcoholism. After the intervention significant number of students has accepted alcoholism as a psychiatric illness. Before intervention 40 students considered alcoholism as an illness and after intervention 67 students considered it as an illness.

Conclusion: Interventions like lecture of nursing students on alcoholism results in improvement in knowledge and positive attitude towards the illness, leading to early recognition and better treatment.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Profile of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) attending a state medical college hospital

Arun N, Arun Madhumal Palayat

Academy of medical sciences Pariyaram, India, nandanath@gmail.com, arunpalayat@gmail.com

Keyword: ADHD, children, clinical profile.

Background: ADHD is a chronic neuropsychiatric disorder with onset in early childhood. In fact it is the most common childhood psychiatric disorder precipitating the consultation with a child mental health professional.

Objectives: Assess the demographic and clinical profile of children diagnosed with ADHD attending child psychiatric services of a state medical college hospital in Kerala

To describe the interventions and medication prescription patterns offered to these children

Methods: This was a descriptive cross sectional hospital based study. Children were assessed using Socio-demographic data sheet, Vanderbilt ADHD diagnostic parent rating scale, Conner’s rating scales-parent’s evaluation.

Results: Among 52 children diagnosed with ADHD during the study period, 47 gave informed consent to participate in the study. Male to female ratio was 4.2:1. Mean age of the sample was 9.57 ±2.8 years 55.3% were Hindu, 21.3% Muslim and 23.4% were Christians. 61.7% of the sample was first in birth order. Antenatal period was uneventful in 80.9% of cases. Delivery was normal in 63.8% of cases. 53.2% sought consultation for behavioural problems and rest due to academic difficulties. 2.1% cases were referred due to speech delay. In 48.9% of children, problems noticed before 5years of age. 59.6% had behavioural problems in school. 68.1% had history of psychiatric illness in the family. 11.5% had history of developmental mental disorder. Medications were prescribed for majority of patients but 38.3%preferred only non pharmacological interventions

Combined type of ADHD was the predominant (61.7%) followed by inattention (31.9%) subtype.

Conclusion: ADHD is a common cause for help seeking among Indian children and the profile and pattern of the illness is similar to reports in western studies.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Suicide attempters with abdominal pain as the reason: Case series

Mathan K¹, Siddharth Sarkar¹, Arunkumar K², Shivanand Kattimani¹

¹Jawaharlal Institute of Postgraduate Medical Education & Research, India, drmathanmd@gmail.com, sidsarkar22@gmail.com, ²Lakeshore Hospital and Research Center, India, drarunkumark@yahoo.com, drshivanand@gmail.com

Keyword: attempted suicide, demography, coping behavior, functioning level, psychiatric diagnosis, stressful events

Objectives: Suicide attempt is a complex human behaviour. Presence of mood disorders, substance use and stress can tilt the balance. Stated reasons for suicide attempt are interpersonal issues, exam failure, unemployment etc. We found a considerable number of cases where they stated their reason for recent suicide attempt was abdominal pain. This was an attempt to characterize those with stated reason as abdominal pain from those suicide attempters whose stated reason was other than abdominal pain.

Methods: It is retrospective chart review of person records collected from the crisis intervention clinic, between the years 2009 to2013.

Results: Out of 427 persons, abdominal pain was the stated reason for the attempt in 37 (8.7% of the sample). The 37 persons were age and gender matched with suicide attempters with stated reason other than abdominal pain as controls in the ratio of 1:2. Suicide attempters whose stated reason was abdominal pains had lower education, suffered from physical illness and chronic abdominal pain prior to the attempt, lesser stressful life events and gave lesser hint of suicide prior to the attempt. Gender, age, psychiatric diagnosis, coping strategies used did not differ from other suicide attempters.

Conclusion: This shows that those with lesser education, having physical illness (mainly chronic abdominal pain) are likely to attempt suicide due to abdominal pain.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depressive symptoms in Schizophrenia: Relation to Insight and Perceived Stigma

Pooja Deepak Mehta, Aditi Chaudhari, Kaustubh Mazumdar, Shobha Nair

Bhabha Atomic Research Centre Hospital, India, pooja@slarc.in, draditi@barc.gov.in, kmazum@gmail.com, dr.shobhasnair@yahoo.co.in

Keyword: Schizophrenia, Insight, Depression, Stigma

Background: There is high prevalence of depressive symptoms in Schizophrenia. They could be an integral part of the illness or its consequence. Regardless of their cause, depressive symptoms in Schizophrenia are known to be associated with increased suffering caused by the illness, deficits in psychosocial functioning and commonly precede attempted and completed suicide. Many studies have found an association between higher level of insight into the illness and the presence of depressive symptoms. Stigmatising attitude and discriminatory behavior amongst the general population against people with severe mental illness is common in our society and this can act as a barrier to recovery. Yet little is known about the impact of stigma on depressive symptoms. The present study has been designed on this background.

Aims And Objectives:

To study the prevalence and severity of depressive symptoms in patients suffering from Schizophrenia.
To study the level of insight in these patents.
To evaluate the degree of stigma perceieved by the patients.
To study any association between the presence of depressive symptoms, level of insight and perceived stigma.

Materials And Methods:- 30 patients suffering from Schizophrenia between ages 18 to 60 years to be included. They will be assessed for depression using The Calgary Depression Scale. Their level of insight will be assessed using the Schedule for Assessment of Insight and the perceived stigma will be assessed using The Stigma Scale. Any corelation between these variables will be studied using the appropriate statistical methods.

Results And Discussions: With respect to the available literature.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Negative emotional states and coping strategies in patients with End Stage Renal Disease (ESRD) undergoing chronic haemodialysis

Abhijeet Subhash Patil, Ravichandra Karkal, Mohan Chandran, Santosh Pai

Yenepoya Medical College Hospital, India, dr.abhijeet.s.patil@gmail.com, minddocravi@gmail.com, mohanchandran660@yahoo.com, psyc@yenepoya.edu.in

Keyword: End Stage Renal Disease (ESRD), Haemodialysis (HD), Depression, Negative emotional states, Coping Strategies, Brief-COPE.

Objectives: Patients with End Stage Renal Disease (ESRD) on haemodialysis (HD) undergo significant stress due to loss of support networks and relationships, unemployment, financial and time constraints, mood fluctuations, functional limitations and fear of death. We set out to examine negative emotional states and coping strategies in patients undergoing haemodialysis.

Methods: Hospital based cross-sectional study based on single assessment of 25 patients aged >18 years with ESRD undergoing HD for >3 months. Two self-report measures-42 item Depression Anxiety Stress Scale (DASS) to assess negative emotional states and 28 item Brief COPE for coping styles were applied to patients giving informed consent. Descriptive statistics were applied to assess socio-demographic and clinical variables. Pearson bivariate correlation was done to examine association between negative emotional states, coping styles and socio-demographic variables.

Results: Systemic hypertension was the cause of ESRD in 56% of patients. Mean age years was 48.44 (±14.53) with 80% being unemployed and 56% had at least 1 comorbidity. Mean duration of HD was 16.32 (±15) months. 68% of subjects reported of depressive symptoms of which 40% had severe symptoms. 48% reported anxiety symptoms and 52% reported of feeling stressed. Mean Depression score- 17.96(±10.69); Anxiety score- 7.28(±4.41) and Stress score- 14.8(±9.21). Depression, anxiety and stress scores positively correlated with each other. There was significant positive correlation between self-distraction subscale and all negative emotional states; and between venting and stress scores. There was significant negative correlation between depression severity and acceptance.

Conclusions: Chronic haemodialysis leads to significant emotional distress characterized by depression, anxiety and stress. Self-distraction which is an emotion-based coping strategy was associated with significant emotional distress; venting was associated with significant stress and acceptance reduced with increase in depression severity. There is an urgent need for holistic interventions for depression in ESRD with focus on adaptive coping strategies.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study on Efficacy and Adverse effects of Clozapine in Treatment Resistant Schizophrenia.

Aamani M

Alluri Sitharamaraju Academy Of Medical Sciences, India, aamanimurari@yahoo.com

Keyword: Treatment Resistant Schizophrenia, Agranulocytosis, Clozapine

Background: A Study on Efficacy and Adverse effects of Clozapine in Treatment Resistant Schizophrenia. Dr. Aamani. M, Dr. Raga Deepthi, Dr. Prabhu Kiran, Dr. Somasundar Babu. R, Dr.Nanda kumar.V. K. Dept of Psychiatry, Alluri Sita Rama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh.

Introduction: Treatment Resistant Schizophrenia is the Schizophrenia, not responding to two antipsychotics (one of which is atleast atypical), belonging to two separate classes, each drug given for four to six weeks, with a minimum dose of 1000mg of Chlorpromazine or its equivalent. Clozapine is a dibenzodiazepine and an antagonist of 5-HT 2A, D1, D3, D4 and I± receptors used to treat both positive and negative symptoms of Schizophrenia.

Aim: To study the efficacy and adverse effects of Clozapine in Treatment Resistant Schizophrenia.

Materials and Methodology: The present study is a short term, non comparative, prospective study lasting for 8 weeks duration. 25 patients with Treatment Resistant schizophrenia, diagnosed by two consultants individually, were selected among schizophrenia patients, diagnosed using ICD -10 criteria. Preliminary investigations along with written consent from patient and spouse were taken. Base level Clinical assessment was done by applying Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Symptom Scale (PANSS) separately. Selected patients were given 25mg/day of Clozapine and increased by 25mg every day to an average dose of 300mg/day in two divided doses. Weekly clinical and haematological monitoring was done for detection of adverse effects. Improvement was assessed by applying weekly BPRS and PANSS.

Results: Will be discussed during the time of presentation.

Conclusion: Our study concluded that Clozapine definitely has got an important role in the management of treatment resistant schizophrenia. Though Agranulocytosis is a limiting factor for the liberal usage of CLOZAPINE worldwide, it was reported to be lesser in occurrence in Indian population, when compared to western studies. The reasons could be many folds, genetical, racial, HLA, etc., In our study, Clozapine has shown neither extra pyramidal side effects nor agranulocytosis. Hence, in Indian setup, CLOZAPINE is the ideal drug for the Resistant Schizophrenics, provided, the precautions against agranulocytosis to be taken.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparative study of clinical and socio demographic correlates between Schizophrenia patients having higher and lower initial seizure threshold (IST).

Siddeswara BL, Kangkan Pathak

LGBRIMH, India, blsiddeswara@gmail.com, drkpathak@gmail.com

Keyword: Electroconvulsive Therapy, Seizure threshold, Schizophrenia.

Background: Lot of challenge is in deciding the amount of charge to be used initially in Electroconvulsive Therapy. This study attempts to identify Factors that may contribute to the initial seizure threshold.

Objective: To compare the clinical and socio demographic correlates among Schizophrenia patients who have higher initial seizure threshold (HIST) with lower initial seizure threshold (LIST) for modified Electroconvulsive Therapy.

Methods: Crossectional, comparative, in-patient Study of 30 HIST (≥210 Mc) Schizophrenia patients versus 30 Schizophrenia patients having LIST(≤60 Mc) sampled purposively. PANSS (positive and negative symptom scale), BPRS- E (Brief psychiatric rating scale) and socio demographic questionnaire was applied to find the factors that differed between two groups. Additional data regarding current medications use, routine lab reports, number of admissions, duration of in patient stay was collected.

Chi square test was used to find and any significant difference existed between the two groups with respect to nominal and ordinal variables like age, sex etc. Continuous variables like the score of scales (PANSS, BPRS or factorial score) were analysed by independent t test using SPSS v 20.

Results: Out of two groups studied factors that significantly differed were age (1, N = 60) = 21.991, P < 0.01, Days of inpatient care (1, N = 60) = 6.239, p = 0.012, duration of illness (2, N=60) = 12.698, p = 0.02. Rest of the results will be presented in conference.

Conclusions: Efforts to determine the factors responsible for variation in seizure threshold has been met with no significant results. Even though study does have certain limitations, it hints towards further research in assessing the influence of schizophrenia symptoms on seizure threshold and help in effective use of Electroconvulsive Therapy.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effectiveness of Integrated Audio Visual Aided Interactive Relapse Prevention (IAVARP) in Alcohol Dependence in Central and State Government Settings

Prasanthi Nattala^*1, Pratima Murthy²

¹NIMHANS, India, paidi89@gmail.com, ²NIMHANS, India, pratimamurthy@gmail.com

Keyword: Alcohol dependence, audio visual aids, relapse prevention, post-discharge drinking outcomes

Background: A major concern with teaching relapse prevention is that alcohol use triggers operate in real life, and are difficult to demonstrate within the treatment center. The critical issue is to bring those high-risk real world situations to the treatment setting, and then teach patients how to avoid relapse in such situations.

Aim: The present study aims to achieve the above by making use of a structured, intensive Integrated Audio Visual Aided Interactive Relapse Prevention (IAVARP) for patients with Alcohol Dependence, and testing its effectiveness at a Central Government, and a State Government setting.

Methods: The IAVARP comprises of live action videos employing human characters to portray various relapse prevention strategies, designed to simulate real life situations. The relapse prevention strategies demonstrated include: 1) Craving Management, 2) Drink Refusal Skills, 3) Dealing with Faulty Cognitions, 4) Dealing with Fatigue as a Relapse Trigger, 5) Dealing with Boredom, 6) Stress Management, 7) Anger Management, 8) Managing Lapse/Relapse.

The effectiveness of the IAVARP is presently being tested at a tertiary mental health center (NIMHANS; N=60), and a State Government mental health center (DIMHANS, Dharwar; N=60). Six-month follow-up assessments are scheduled following discharge of the patients, to assess effectiveness of the IAVARP on 3 outcomes: (1) Quantity-Frequency of Alcohol Consumption, (2) Number of Drinking Days, (3) Mean Time for Lapse/Relapse.

Results: Since the 6-month follow up assessments have just begun, complete results at both the settings will be available by October/November 2014.

Future plan: Following completion of the present study, it is planned to dub the IAVARP into Hindi, and South Indian languages, for wider utility.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect Of Rajayogi Lifestyle On De Addiction In India

Avdesh Sharma

Mind’s Vision, India, India, avdeshsharma@rahat.org

Keyword: Rajyogi life style, Brahmakumaris, de-addiction

Background: In an independent retrospective study (through structured one-on-one interviews by trained persons) by Dr. Avdesh Sharma, Consultant Psychiatrist and Dr. Sachin Parab, Physician 1021 persons, who have now given up addiction/abuse of substances were studied. They were mostly males from various backgrounds; urban and rural, representing entire India (25 States and 2 Union Territories). They were illiterate to highly educated professionals; mostly employed/self employed, abusing/addicted to mainly Tobacco/Smoking and Alcohol but also Marijuana, Opiates, Tranquilizers and Pain Killers (many having multiple addictions). They were studied for “Effect of Raja Yogi Life Style as taught by the Brahma Kumaris”. It was found that two thirds (65%) of the study subjects gave up substance of abuse successfully within one month of starting the comprehensive practices of Raja Yogi Life Style and a total of 85% within one year. An extremely low number (3%) relapsed subsequently with almost nil withdrawals (less than 1%). The components of Raja Yogi Life Style – meditation and knowledge classes, practice of control of thoughts at prefixed timings, satwik diet and soul consciousness state were very useful in helping the person give up and stay off abuse/addiction with positive results co-relating with better adherence to Raja Yogi Lifestyle.

In India, about 8-10% persons are addicted to substances of abuse and much higher numbers are abusing them. The devastating health, economic, vocational and legal consequences are tremendous. An effective, no cost program (Raja Yogi Life Style is taught free of cost) can be adopted. It is already being done by the existing centres of Brahma Kumaris – about 8500 centres in about 137 countries. These principles can be followed in health set ups and at a policy level, including for prevention of abuse of substances and for reduction of human, health and economic cost in the community.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychogenic Flatulence: A case report

Satya Kant Trivedi^*1, Siddhartha Sinha², Samir Kumar Praharaj³

¹PCMS & RC, BHOPAL(Madhya Pradesh), India, satyakanttrivedi@gmail.com, ²Ranchi Institute Of Neuropsychiatry and Allied Sciences Ranchi, India, sidsin69@gmail.com, ³Kasturba Medical College, Manipal, Karnataka, India, samirpsyche@yahoo.co.in

Keyword: Somatoform, psychogenic, flatulence, sexual

Background: Functional gastrointestinal disorders are common presentations of somatoform disorders. However, psychogenic flatulence is very infrequently described.

Objective: To study a 24-year old male with recent onset psychogenic flatulence following marriage and was related to underlying sexual dysfunction.

Results: There was gradual improvement in flatulence following treatment with dapoxetine and benzodiazepines along with psychotherapeutic interventions.

Conclusion: Psychogenic flatulence is a rare variant of functional gastrointestinal disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Substance Abuse Patterns And Their Predictors In An Alcohol Prohibited District From Central India

Kshirod Mishra, Praveen H Khairkar, Aditi Jain

Mahatma Gandhi Institute Of Medical Sciences, Sevagram, India, drkkmishra2003@yahoo.co.uk, pravinkhairkar@mgims.ac.in, nishajainprays@gmail.com

Keyword: Substance Abuse, Central India, Patterns, Predictors

Background: Some of the major factors towards substance abuse have been attributed to easy availability and accessibility. Prohibition has been planned as one of the major strategy towards risk reduction for substance abuse. Here we intend to discuss the patterns of various substance abuse(s) in a dry district of Central India where there is prohibition on sales and consumption of alcohol since independence.

Aim and Objectives: We aimed at studying the socio-demographic profile, pattern and predictors of substance abuse of all the new cases admitted to the psychiatry ward at our rural medical college of central India situated in a dry district of central India.

Methodology: Study design: Retrospective evaluation of all the new cases of substance dependence syndrome.

Study duration: Over last six years (2007-2012)

Using semi-structured clinical evaluation sheet.

Results: During the study period, a total of 821 new cases of various substance uses were admitted in psychiatric inpatient services out of which 91.8% were alcohol dependent, 6.2% were opioid dependent, 1.8% were using cannabinoids. 24.8% were having polysubstance use dependence. The maximum percentages of cases were admitted during the months of January/February every year. 98.8% were males out of which 68% belonged to the age group of 26-45 years; most of them (78.8%) were married and 55.5% were educated more than matriculation, 42.4% were farmers. Only 1.1% had revealed history of having unprotected sex with sex worker.

Conclusions: The present study exemplify patterns and predictors about how and to what extent the various substance dependence were seeking inpatient psychiatric treatment despite legal access being prohibited to them in this part of India.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Domestic Violence and Marital Satisfaction in Wives of Alcohol Dependent Males

Neha Dua, Soumitra Ghosh

Assam Medical College Hospital, India, duaneha24@yahoo.co.in, drsghosh640@yahoo.co.in

Keyword: Wives of alcoholics, Domestic violence, Marital satisfaction

Background: Researchers in wide array of settings have encountered family disruption, domestic violence, marital distress among wives of alcoholics.

Objectives: To assess domestic violence and Marital satisfaction in wives of men with alcohol dependence and explore the association.

Methods: 115 wives of men with alcohol dependence were evaluated as study group. 115 age matched wives from normal population, having same sociocultural background, with husband not dependent on alcohol were assessed as control group. Domestic violence and Marital satisfaction was assessed usingHITS (Hurt – Insult – Threaten - Scream) scale and Marital Adjustment Test respectively. Severity of alcohol dependence in the husbands was assessed using Severity of Alcohol Dependence Questionnaire. For statistics students t-test, ANOVA, Pearson’s Correlation, Chi-square and regression tests were used.

Results: 71.30% of wives screened positive for domestic violence in study group as compared to 31.30% in control group (Odds Ratio-5.45). 86.09% wives in study group had distressed marital relationship as compared to 31.30 % in control group. Majority of wives in study group had marital satisfaction scores at the lower end of the scale. In the study group domestic violence, marital dissatisfaction in wives and severity of alcohol dependence in husbands, were found to be significantly correlated with each other and their association was robust.

Conclusion: Domestic violence is high and marital satisfaction is low in wives of alcohol dependent men. Addressing such issues in spouses will improve the treatment outcome for alcoholics. This study emphasizes the point that wives of alcoholics also merit therapeutic intervention, and calls for incorporating more focused couple based interventions into standard alcohol de-addiction programs.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Correlations of cannabis use with human cognition and bipolar disorder

Ajay Halder, Avijit Chakraborty, Supreem Bose

institute of psychiatry, kolkata, India, halder.ajay@gmail.com, drabhijit2013@rediffmail.com, halder_ajay@yahoo.in

Keyword: cannabis, cognitive function, bipolar disorder

Background: Subjects with bipolar disorder frequently struggle with substance abuse and dependence. Typically, cannabis is the most commonly abused substance in individuals with bipolar disorder. There are very few studies about the impact of cannabis on cognitive function and features of bipolar disorder and the results are still inconclusive and to some extent contradictory.

Objectives: To compare the cognitive function of patients having dual diagnosis of bipolar affective disorder and cannabis dependence with those having either diagnosis alone and with healthy controls.

Methods: Study subjects were selected from patients attending psychiatry OPD in presence of two senior consultant psychiatrists. Among the pool of the patients, only those who meet the inclusion and exclusion criteria were selected for the study. Then the selected patients were administered the Semi structured socio-demographic data sheet, Young mania rating scale(YMRS),Hamilton depression rating scale(HAM-D), General Health Questionnaire-12 (GHQ-12),Trail Making test Part A & Part B, Verbal fluency tests, Stroop Neuropsychological Screening test (SNST), Clock drawing test. Statistical analysis was done by using appropriate statistical methods.

Results: The results of our study showed there was significant impairment of cognitive function of the patients of bipolar with cannabis dependence than the patients of bipolar disorder or cannabis dependence alone. It had been also found that with increase in age of onset of bipolar disorder, there was decrease in number of episodes, decrease current duration and inter-episodic recovery was better.

Conclusion: The significant cognitive function impairment exists in bipolar with cannabis dependence and the severity of bipolar outcome correlates with the extent of cannabis use also. In spite of certain limitations like absence of Indian Version of Neuropsychological tests and referral bias inherent in hospital based studies; present study provides valuable empirical insight into complex relationship between cannabis dependence, bipolar disorder and cognitive dysfunction.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Juvenile onset Bipolar disorder: a rare entity

Bhakti Hemant Murkey, Pradeep Sharma, Kishore Dudani, Gunjan Solanki, Vijay Choudhary

SMS Medical college, India, doctor.bhaktii@gmail.com

Keyword: juvenile, bipolar

Background: The usual onset of Bipolar disorder is between 15 – 25 years of age. Concept of Bipolar disorder in children (< 12 years) has recently grown acceptance due to its increasing prevalence. An abundance of co-morbidity in children with Bipolar disorder and its atypical presentation makes it more challenging for proper diagnosis and management.

The following is to report such early (juvenile) onset of Bipolar disorder. Master Anil, 6 years old male child, belonging to middle socio-economic family of rural background is first born child of a non-consanguinous marriage. He presented with acute onset 2 months history of excessive running around, decreased hours of sleep, irritability, singing, dancing, demanding behavior, excessive and fast talk and at times, big talk. There is no contributory family/perinatal/developmental history and no history suggestive of inattention. The child was known to be cheerful, obedient and made friends easily. He started schooling a year back and adjusted well. There were no complaints from school.

On MSE the child had normal psycho-motor activity, distractibility, spontaneous speech, frowning and laughing in between, cheerful affect and increased self esteem but reported low mood.

General and systemic examination revealed normal findings. The results of investigations for routine blood profile, Thyroid profile, EEG and brain imaging to rule out medical causes/co-morbidities are awaited.

A provisional diagnosis of Bipolar affective disorder was made and the child was initiated on Sodium Valproate syrup titrated up to 400 mg/day. Discussion on co-morbidities and response to treatment will be done at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Internet Addiction among Medical Students: Extent & Effect

Vipin Kumar, Vishal Sinha, Abhishek Bharti, Ashwini Kumar Mishra, Zeeshan Anwar, Mahboobul Hasan Ansari

S N Medical College, India, vipinnarwal@gmail.com, drvisnh2000@yahoo.com, abhishek_bharti55@rediffmail.com, drashwani2010@gmail.com, zeeshan.anwar.mbbs@gmail.com, mha.snmc@gmail.com

Keyword: Internet, Internet Addiction, Medical Students

Background:

Objectives: The technology is boon as well as curse depending on how we use it. Internet has become integral part of all domains of our life. Medical students are one such segment of professionals which is exposed to this technology in the search of knowledge, risking them to the deleterious effect of it. The deleterious effect of this addicting technology has attracted attention of researchers but still much is needed before we can define it on solid evidence. So, the present study has been planned to evaluate the impact of internet addiction among medical students.

Methods: A cross sectional study was conducted in all under graduate and post graduate the medical students at the S. N. Medical College, Agra. The subjects were assessed using predetermined semi-structured socio-demographic proforma and Internet Addiction Test questionnaire, General Health Questionnaire -30, WHO Quality Of Life Index –BREF.

Results: Among all the students 62.41% were average online users & 18.9% experiences occasional or frequent problem due to internet. Most of the students were using the internet for social networking sites “under two hour” per day. The internet addiction levels of males, undergraduate students were significantly higher than those of females & post graduate students respectively.

Conclusion: To keep pace with the recent advancement in learning, use of internet has become a kind of compulsion which somehow prone to make students internet addicts. So, it’s time to probe insight into internet addiction and its parameters to curb the spread of this problem.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparison of Clinical Features and Duration of Illness in Patients of Schizophrenia with and without Abnormal CSP

Naveen K Srivastava, Sourav Khanra, Vivek Chail, C R J Khess

¹Central Institute of Psychiatry, Ranchi, India, navnsrivastava02@gmail.com, esouravkhanra@gmail.com, vchail@gmail.com, jmou@rediffmail.com

Keyword: Abnormal CSP, Duration of illness, Antipsychotics

Background: Though prevalence of abnormal cavum septum pellucidum (CSP) in patients of schizophrenia remains controversial, its role in clinical outcome, duration of illness and effect on treatment remains less understood.

Objective: We tried to look the difference in clinical features and duration of illness in two groups of patients i.e., with and without presence of CSP.

Methods: We took 139 patients of schizophrenia during the year of 2012-2013 who had undergone CT scanning. We compared these patients of schizophrenia based on the presence and absence of abnormal CSP. We found 16 patients with abnormal CSP and compared them with those without abnormal CSP for socio-demographic variables, type of prominent symptoms, diagnosis, age at onset of illness and duration of illness. We also correlated these clinical variables with dimension of CSP.

Results: We found significantly increased duration and chronic course (p=.009) in patients with abnormal CSP. Though correlation between clinical variables and dimension of CSP remained insignificant, but most patients with abnormal CSP required combination of typical and atypical antipsychotics for treatment.

Conclusion: Prevalence of abnormal CSP in patients of schizophrenia may be a common finding, but it can be said that abnormal CSP may give rise to a longer and resistant course.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Profile and pattern of opioid use among the treatment seekers attending a tertiary hospital, Imphal, Manipur

Rakesh Mohanty, Heramani Ningombam, Gojendra Senjam, Lenin Rajkumar

Regional Institute of Medical Sciences, Imphal, India, rmohanty.dr@gmail.com, nheramani@yahoo.co.in, drgojendra@gmail.com, leninrk@yahoo.com

Keyword: opioid use, demographic profile, pattern of use, psychoactive substance

Background: Opioid abuse is widely prevalent in the north-eastern (NE) region of India especially in Manipur. Illegal production and drug trafficking from Myanmar has made the opioid abuse a big problem for all the NE states. Global trend among those dependent on drugs is towards the use of multiple psychoactive substances, with people moving from one substance to another, and using drugs in various combinations. The patterns of opioid use change over time, and it is important to document such changes.

Objectives: To know the demographic profile and pattern of opioid use in treatment seekers attending psychiatry OPD in Regional Institute of Medical Sciences (RIMS), Manipur from 2012-2014.

Methods: A semi structured proforma was used to collect information on demographic and various pattern of use among the opioid abusers. Information from 80 opioid users was collected and data were analysed using suitable statistics.

Results: In our study, all the cases were males. Majority (55%) of them were Hindus. The mean age of opioid abusers were 32.05 years and mean age of initiation of opioid abuse was 22.93 years. Around 57.5% were married and majority of our study population (81.25%) are from urban background. Around 53% opioid abusers were mixing up other psychoactive substances besides the opioid being the primary substance of abuse. 13.7% of them were infected by hepatitis C infection and 7% were also infected by Human immune deficiency virus.

Conclusion: Majority of opioid users were using more than one psychoactive substance along with the primary substance of abuse i.e. opioid. So treatment approach for these patients will be different from those users who use only opioids.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of Cycloserine induced psychiatric morbidity in patients with MDR-TB

Siddhika Kalyan Ayyer, Bindoo Jadhav, Bharat Shah

¹K. J. Somaiya Hospital, India, sids.ayyer@gmail.com, blmaru@gmail.com, brshah25@gmail.com

Keyword: Cycloserine, MDR-TB, psychiatric morbidity.

Background: Psychiatric complications in MDR-TB occur due to both psychosocial factors and anti-tuberculosis drugs. Significant psychiatric symptomatology has been most commonly associated with cycloserine, isoniazid, ethambutol and fluoroquinolones. Cycloserine is a second line anti-tuberculosis medication which is being used increasingly due to emergence of multi-drug resistance. Severe psychiatric manifestations including hallucinations, anxiety, depression, euphoria, behavioral disorders, and suicidal ideation/attempts have been reported to occur in 9.7%–50% of individuals on cycloserine. Psychiatric morbidity has been postulated to occur due to the drug’s partial agonist action at NMDA receptor and hyperdopaminergic state which occurs at doses above100 mg. Medication side effects and psychiatric comorbidities adversely affect treatment adherence and have to be managed effectively without compromising anti-tuberculosis treatment.

Aims and objectives:

To study the prevalence of psychiatric morbidity among patients using Cycloserine.
To study the nature of psychiatric morbidity among these patients.

Materials and Methods: A prospective study of 50 patients with MDR-TB started on cycloserine will be conducted. Ethics committee approval and informed consent will be taken. Patients with pre-existing psychiatric illnesses and/or on psychiatric medication will be excluded from the study. Socio demographic data of patients will be collected as per semi-structured proforma designed for the study. The patients will be evaluated for psychiatric morbidity using criteria as defined in DSM-5 on starting the drug, after 10 days and after 1 month. Hospital anxiety and depression scale (HADS), Young mania rating scale(YMRS) and brief psychiatric rating scale(BPRS) will then be administered as required.

Results: Data collected will be subjected to appropriate statistical analysis and discussed in view of the available review of literature.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Salient features of chronic schizophrenia: mental hospital based case study

Jai singh Yadav^*1, Samiksha Kaur²

¹All India Institute of medical sciences New Delhi, India, jsypsy@bhu.ac.in, ²SRLN Hospital varanasi, India, samikshakaur@rediffmail.com

Keyword: salient feature, chronic schizophrenia

Background: There are many features in chronic schizophrenia that are affected by external and internal milieu. Therefore many of those are hardly explained on the basis of existing literatures.

Case A: 40 year old male chronic schizophrenia patient left taking medicines and foods and when he was persuaded for taking medicine and food he used to say” One day I will die then why I should take food?”. Initially cognitive and insight oriented psychotherapies were given but he did not improve then medical assistance of Ryle’ s tube feeding and parenteral antipsychotics were given but he was not improved, finally died with renal failure.

Case B: 37 year old male chronic schizophrenic patient left taking all food except gular, he used to collect it and put excess for reserve. Although it was difficult to arrange this fruit during off season, he continued to take what he had previously collected.

Objective: Find out rare symptoms of chronic schizophrenia.

Method: In both the cases three month follow up was done prior to their death. During the study period baseline investigations, PANSS, HDRS applied at monthly interval and weekly cognitive psychotherapy were given.

Result: Base line investigative finding in case A was normal but in case B Koch’s lung was positive. There were minor changes on both scales one month before death of both cases.

Discussion: Changes of psychopathology in chronic schizophrenia may lead to develop new features in patients, sometimes those symptoms resistant to drug treatment and psychotherapeutic intervention.

Conclusion: Atypical symptoms related to refusal or selective food intake can be found in chronic schizophrenia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect Of Zinc Supplementation On Antidepressant Therapy And Serum Zinc Level In Unipolar Depression: A Randomized Double Blind Controlled Study

Dileep Kumar Verma, Basudeb Das

Central Institute of Psychiatry, India, dr.dileep09@gmail.com, basudeb71@gmail.com

Keyword: unipolar depression, zinc supplementation, antidepressant therapy

Introduction: WHO has predicted that depression will be 2^nd most important cause of human disability adjusted life years by 2020. Efficacy of new antidepressants is still unsatisfactory. There is need to search for newer more effective and safer therapies. In recent, studies shown the important role of zinc in pathology and therapy of depression but till date there is no clinical trial of zinc in unipolar depression carried out in India. Mechanism of zinc deficiency in depression is still controversial. Lower serum zinc level in depression may be due to lower level of serum albumin (zinc transporter) and sequestration of zinc by metallothionein in liver which is related to mediators of inflammation e.g. IL-6&c-rp.

Aims and Objectives: To assess:

efficacy of zinc in reducing severity of depression,
difference in zinc levels before and after treatment
Correlation of zinc level with albumin and c-rp.

Material and Methods: Study will be a prospective comparative inpatient hospital based, conducted at CIP, Ranchi. Subjects will be recruited into two groups by simple random sampling technique using computer generated randomization table. Sample size will consist of 50 drug naive (or drug free for min.2wks) cases of depressive episode or recurrent depressive disorder. After informed consent and Socio-demographic data a physical examination will be done. HAM-D, BDI, BPRS, BSSI, SES, HAM-A, CGI, UKU will be applied. Blood samples will be drawn to assess complete hemogram, LFT, RFT, TFT, FBS, lipid profile, serum zinc and c -rp. For patients selected for zinc supplementation, 20mg of elemental zinc daily would be given along with antidepressants and other group will be treated with antidepressants only, rater would be kept blind. Blood tests and assessment will be repeat after 2, 4 & 8 wks.

Results and Discussion: Results will be presented and discussed at time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of Socio-demographic and clinical profile of patients attending Child and Adolescent Psychiatry (CAP) clinic in a tertiary care Psychiatric hospital: A Preliminary Report

Kishore Dudani, Pradeep Sharma, Ashok Arora

SMS Medical College, India, dudani_kishore@yahoo.co.in, pradeeprameshwar@gmail.com, ashokarora010@gmail.com

Keyword: Child and Adolescent Psychiatry, socio-demography, clinical profile

Background: Child and Adolescent Psychiatry is a specialty within Psychiatry working with people up to the age of 18, and their families. Working in Child and Adolescent Psychiatry is both varied and rewarding. There are many approaches to treatment, ranging from cognitive behavior therapy and pharmacotherapy to family therapy. Child and Adolescent Psychiatry combines the rigor and science of medicine, with the art and creativity of therapy. The department of Psychiatry at SMS medical college Jaipur has started a Child and Adolescent Psychiatry (CAP) clinic from June 2014 onwards. This is the first of its kind in state of Rajasthan. The clinic caters to mental health needs of children upto 18 years attending outpatient services of the hospital. Initially, a diagnostic evaluation is performed to assess a child’s condition with attention to its psychological, biological, social and environmental components. The next step is to develop a comprehensive treatment plan for the child and family, often integrating ongoing care with health, educational and social service providers in the community.

Aims and Objectives: To study the socio-demographic and clinical profile of patients attending CAP clinic of the hospital over 6 month period starting from June 2014 onwards.

Methods: The socio-demographic and clinical details including nature and duration of the psychiatric illness and co-morbid medical condition as per ICD-10 diagnosis, birth and developmental history, family account, and management being given will be recorded in a semi-structured proforma (SSP) especially designed for the study.

Results & Conclusion: The study is in process and details will be presented in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Minor physical anomalies in patients of schizophrenia comparative study with first degree relative and normal population

Rakesh Kumar^*1, Ajeya Singh²

¹IGIMS Patna, India, drrk2k1@gmail.com, ²PMCH Patna, India, annu.ajeya@gmail.com

Keyword: Minor Physical anomaly, Schizophrenia, prevalence.

Background: Minor physical anomalies (MPAs) in patients with schizophrenia suggests an early disturbance in the development of the neuroectoderm. There are studies regarding minor physical anomalies in schizophrenia. But comparative studies with first degree relative and general population are few.

Objectives: To find the prevalence and type of minor physical anomalies in patients of schizophrenia and to compare it with first degree relative and general population in OPD and inpatients.

Methods: 50 patients of schizophrenia diagnosed as per ICD-10 DCR criteria along with 50 unaffected first degree relative and 50 normal control from same ethnic background. Only drug naive or drug free patients were chosen. Patients from extreme of age have been excluded. Sociodemographic data sheet filled for all subjects. GHQ-12 (General health questionnaire -12) applied on FDR and general population. PANSS applied on all schizophrenia patients. Modified Waldrob scale will be applied on all subjects.

Results: The mean values of minor physical anomalies total score in patient, FDR & normal population were 5.8, 2.82, and 1.22 respectively. High incidence of MPA (Total score) in patient group compared to FDR & normal population group (0.0001). When the total minor physical anomalies were compared between different subtypes of schizophrenia in patient group like paranoid & undifferentiated; it was found that MPA total is more statistically significant (p value 0.0007) in undifferentiated schizophrenia than paranoid.

Conclusion: This study confirms the stability and reproducibility of higher number of MPAs as disease markers in schizophrenia. Results of this study secured the endophenotypic nature of MPAs in schizophrenia as MPA scores of first degree relatives were in between the scores of patients and healthy controls.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity, Attitude Towards Appearance And Coping Strategies Among Patients With Psoriasis And Acne:a Comparative Study

Nidhi Jain, C. R. J. Khess, S.K Munda

Central Institute of Psychiatry, Kanke, Ranchi, India

Keyword: psychiatric morbidity, attitude towards appearence, coping strategy

Introduction: Chronic and severe dermatological disorders are often associated with psychiatric comorbidity. Although previous researches indicate that there is a strong connection between psychosocial distress experienced By the patient and skin disorders but there are very few studies investigating attitude towards appearance, coping strategies in India. The psychosocial milieu of the developing countries being different from that of the developed countries and only a limited amount of psychosocial researches on psoriasis and acne are available from India.

Aims and Objectives: The aim of this study was to compare the occurrence of psychiatric morbidity, attitude towards appearance and coping strategy in psoriasis and acne patients and also to study the relationship of severity of disease with psychiatric morbidity along with attitude towards appearance among patients with psoriasis and acne.

Method: 30 Psoriasis and 30 acne patients matched for age, sex and education were taken for the study. For assessing the severity of the disorder, psoriasis area severity index and global acne severity scale were applied on the respective group. Then Ghq-60 was applied on both the groups. After that mini international neuropsychiatric interview, hamilton rating scale for anxiety(Ham-A), hamilton rating scale for depression(Ham-D), beck depression inventory(Bdi) were applied on both the groups patients with positive score (>_12) in Ghq-60 and attitude towards appearance, brief cope scale were applied on both the groups patients irrespective of Ghq-60 score.

Results: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Neurocognitive Deficits In Adolescents At Risk For Susbtance Abuse

Uma Rao

University of Tennessee at Knoxville, United States, urao@utk.edu

Keyword: adolescence, cognitive deficits, executive function, high-risk, premorbid, substance abuse.

Background: There is evidence that substance use disorders (SUD) are associated with discernable cognitive impairments. Executive function (higher-order) cognitive deficits are frequent and contribute to poor treatment outcomes. The current study was undertaken to determine the extent of premorbid cognitive deficits in at-risk youth that would ultimately determine which subset of youth would develop SUD.

Neurocognitive tests were performed in four adolescent groups: (1) normal controls with personal or family history of a psychiatric disorder (n = 47), (2) healthy adolescents at high risk for SUD based on parental SUD (n = 23), (3) high-risk youth who developed SUD at follow-up (n = 35), and (4) adolescents with nicotine dependence (n = 23). The tests covered areas of general cognition, working memory, and executive function.

After controlling for general cognitive ability, youth at high risk for SUD, particularly those who later developed SUD, had lower scores on executive function on objective tests as well as self-report measures than normal controls. Performance on many measures in the high-risk group was similar to that of youth with nicotine dependence, including working memory, mental flexibility, mental control in selecting and applying solutions to problems, and sustained attention and processing speed.

These results suggest that premorbid cognitive deficits in executive function are evident in at-risk youth and increase vulnerability to SUD. Adolescence represents a pivotal stage of dynamic growth and remodeling of the prefrontal cortex with parallel increases in the development of higher-order cognition. Onset of SUD during this critical period can disrupt the development of more mature cognitive processes, particularly in those whose cognitive abilities are already compromised. Cognitive remediation programs can exploit the neuroplasticity associated with prefrontal maturation and improve the clinical course and prognosis of early-onset SUD.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Reproductive health and contraception in severe mental illness: a hospital based survey

Akshada Suresh Sabnis^*1

¹Institute of Psychiatry And Human Behaviour, Goa, India, akshadasabnis@gmail.com

Keyword: contraception, severe mental illness

Background: Reproductive behaviours of patients with severe mental illness is a largely unresearched area. The reproductive health as well as awareness of contraception is an important area as it not only affects the quality of life but also has direct bearing their psychiatric condition

Aim: The aim of this study is to assess family planning needs and contraceptive use in female psychiatric inpatients.

Objectives

1)
To study the awareness of contraception in patients with severe mental illness.
2)
To study the use of methods of contraception in these females.

Method: Study Population: Female patients with severe mental illness admitted at a tertiary care psychiatry hospital, comprising disorders like schizoaffective disorders, delusional disorders, mood disorders, schizophrenia.

Type of Study: Cross sectional survey.

Sampling: Serial admissions between November 2013 and April2014.

Data collection: All consecutive female admissions were recruited and a structured questionnaire was used to obtain reproductive history and awareness of contraceptive techniques in them.

The data is currently being analysed and the findings will be presented at the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Chronic Disease And Mental Disorder

Jai Singh Yadav¹, Samiksha Kaur^*2

¹AIIMS New delhi, India, jsypsy@ipsf.in, ²SRLM hospital Varanasi, India, samikshakaur@rediffmail.com

Keyword: Chronic disease, mental disorder

Background: Severity of disease and loss of psychological resources appear to heighten psychological distress among chronically ill. A number of studies suggest that people with a chronic disease are at riskof psychological distress. The odds for a specific mental disorder (mostly depression) are increased for patients with cancer (Bodurka-Bevers et al., 2000; Carroll, Kathol, Noyes, Wald, & Clamon, 1993

On the other hand, Hayward’s (1995) review reports only weak evidence supporting an association between psychiatric illness and cardiovascular disease. Similarly, Cassileth et al. (1984) found no differences in mental health between those with chronic medical illnesses (arthritis, diabetes, cancer, kidney disease, and dermatological diseases) and people with no chronic illness, while both groups differed markedly from depressed patients (Cassileth et al., 1984

Objective: The aim of the study was to achieve a relationship between chronic medical illness and mental disorder.

Method and Procedure: 100 chronic (20 cancer, 20HIV, 20TB, 20heart attak, 20 diabetic) patients taken for the study from various centre at Varanasi. First scrutinized the medical ill patients then the demographic data was collected and Scales; Mini Mental State Examination, Back Depression Scale and Hamilton Anxiety Scale were applied for each patient. All patients were male and age was 25-58 years and belongs to middle class status.

Results: it was found in the study that 98% cancers, 90% HIV, patients have high anxiety, depression. On MMSE cancers patients and HIV score respectively 65% and 50%. Whereas heart attack patients have 60% anxiety and depression was 40%. TB patients have less anxiety, depression then all groups. About the diabetic patients anxiety was 70% and depression was only 40%.

Conclusion: It was found in our study that chronic medical illness/non curable like HIV and Cancers have a relationship of poor psychological illness

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Gender Difference In Clinical Presentation And Sociodemographic Variables Of Patients With Bpad

Mohd Abrar Ahmad Guroo, Rahul Lalit Khemani, Anand Kumar S, Arun Kumar N, Ramakrishnan K

Athma Institute of Mental Health and Social Sciences, India, abrarguroo@hotmail.com, rkhemani2@gmail.com, anandanash83@gmail.com, drkullans@yahoo.com, athma07@gmail.com

Keyword: BPAD, clinical presentation, Gender differences, sociodemographic variables

Background: Bipolar affective disorder is one of the potentially disabling illnesses, significantly affecting person’s ability to function in work and social situations. Clinically it is clearly evident that key socio-demographic variables have a complex interplay with bipolar disorder. This clearly pertains to gender also. As literature shows that women are more prone to develop depressive/mixed episodes, vulnerable during pregnancy/post partum period, prone to rapid cycling and men tend to have more substance use during episodes and even uni-polar mania. Other than gender, age, family h/o, duration & frequency of episodes, compliance, type of medication used, type of earlier episodes, substance use could also contribute to the outcome of BPAD

Aims & objectives: To compare the differences in clinical presentation and influence of key variables of patients with bipolar affective disorder in regard to gender

Methods: All the patients visiting the O.P.D. of Psychiatry in Athma Hospital during May 2014 to November 2014 will be screened for Bipolar affective disorder. The patients diagnosed with BPAD will be thoroughly evaluated through a semi-structured interview.

A proforma especially designed for the study was used on these patients to get details of key variables
The data was fed into the latest version of SPSS for statistical analysis

Results: Will be discussed in the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

10 Year Outcome of Acute and Transient Psychotic Disorder: A retrospective chart review

Rahul Lalit Khemani, Mohd Abrar Ahmad Guroo, Anand Kumar S, Arun Kumar N, Ramakrishnan K

Athma Institute of Mental Health and Social Sciences, India, rkhemani2@gmail.com, India, abrarguroo@hotmail.com, India, anandanash83@gmail.com, India, drkullans@yahoo.com, India, athma07@gmail.com

Keyword: Acute and transient psychotic disorder, First episode, 10 year course and outcome

Background: Acute and transient psychotic disorder (ATPD; F23) was added to the WHO international classification of diseases (ICD-10) as a separate sub classification under psychotic disorders in 1992. ATPD is a disorder characterized by acute onset and rapid resolution of symptoms. There are relatively few epidemiological studies that employ standardized assessment methods to investigate this disorder. ATPD presents with or without stressor and the prognosis is usually good in early intervention. The previous studies show a diagnostic change in half of the patients (48%), most often to schizophrenia (15%) and affective disorder (28%). From index admission to follow-up, patients with an unchanged diagnosis of ATPD manage fairly well with regard to psychosocial functioning, and no deteriorating development is observed. We lack sufficient information on the long term diagnostic stability of ATPD, epidemiological and clinical characteristics, the association with stress and on its relationship with schizophrenia. Our study aims to look for the course of a patient who presented with acute and transient psychotic disorder.

Objectives: To study the 10 year course and outcome of first episode acute and transient psychotic disorder.To compare the influence of key socio-demographic variables on the course and outcome of first episode acute and transient psychotic disorder.

Methods: Patient records with diagnosis of 1^st episode ATPD during the year 2003 and 2004 were taken as part of the inpatient criteria. The course, diagnostic stability, outcome (including drop-outs) of these patients over the next decade were determined. The study is retrospective longitudinal case review The statistical data was fed into the latest version of SPSS

Results: Will be discussed in the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Serum Electrolytes And Hepatic Enzymes Level In Patients Of Alcohol Withdrawal With And Without Delirium Tremens: A Comparative Study

Ankur Jyoti Borah, Kamala Deka, Kailash Bhattaracharya

Assam Medical College, India, bhbhai42@gmail.com, drkamala_99@yahoo.co.in, drkailash52@gmail.com

Keyword: delirium tremens, alcohol withdrawal without delirium tremens, hepatic enzymes, serum ions

Introduction: DeliriumTremens (DTs) the most severe alcohol withdrawal symptom, is an emergency situation with high mortality rate, Despite appropriate treatments, the current mortality for patients with DTs ranges from 5-15 %. Mortality was as high as 35 % prior to the era intensive care and advanced pharmacotherapy. The most common conditions leading to death in patients with DTs are respiratory failure and cardiac arrhythmias.

Aims And Objectives-,

To estimate the Level of serum Na⁺, k⁺,Mg²⁺,Cl- and liver enzymes ALT, AST, GGT in alcohol withdrawal patients with and without delirium tremens.
To compare the level of serum electrolytes and liver enzymes between both the study groups
To study the correlation of serum Na⁺,k⁺,Mg²⁺,Cl^- and AST, ALT, GGT in alcohol withdrawl with and without delirium tremens.

Methods: A prospective cross sectional study was conducted for a period of one year from July 2013 to July 2014 at Assam medical College Hospital. A total of 50cases of alcohol withdrawal with Delirium tremens (F 10.4) and 50 cases without DT (10.3) were studied in that psychiatry department. Diagnosis of alcoholwithdrawal and DT were confirmed both clinically, using ICD-10 and patients were evaluated using CIWA-Ar,. Clinical and investigation details were studied with the help of advanced clinical biochemistry Laboratory, AMCH

Results

Significant difference of serum K+ and Mg++ is found in DT group(F 10.4)
Hepatic enzymes AST and GGTP is also changed significantly in DT group than the alcohol withdrawal (F 10.3) group.
No significant difference of Na+,Cl- noted in F 10.4 group than F10.3
In the DT group, serum K+ maintains a positive correlation with ALT. Other serum ions has no correlation with hepatic enzymes both in F 10.4 and F 10.3 group.

Conclusion: Hypokalemia, hypomagnesemia and elevated level of hepatic enzyme AST and GGTP is a predictor for occurence of Delirium tremens in alcohol withdrawal patient.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of sub clinical hypothyroidism and cardiovascular risk in the post menopausal women

Ram Kumar Solanki^*1, Aditi Ranawat²

¹Dr. S. N. Medical College Jodhpur, India, solanki_ramk@yahoo.co.in, ²Mahatma Gandhi Medical College Jaipur, India, aditiranawat@yahoo.co.in

Keyword: post menopausal, sub clinical hypothyroidism, cardiovascular risk

Background: As we know that mild thyroid failure can have a number of clinical effects such as depression, memory loss, cognitive impairment and a variety of neuromuscular complaints. Myocardial functions has been found to be subtly impaired. The main purpose of this study is to find out correlation if any of subclinical hypothyroidism to cardiovascular risk.

To fulfill the above aim the present study was planned. Sixty four depressed post menopausal women were recruited for the study who were meeting the inclusion and exclusion criteria and willing to participate in the study.

The study sample is divided in two groups on the basis of TSH level ie subclinical hypothyroidism (34) and euthyroid (30). The lipid profile of both the groups were compared.

Results: In our study the hypothyroidic group have increased serum total cholesterol, low density lipoprotein & decreased levels of high density lipoprotein fraction.

All these levels are indicative of increased cardiovascular risk.

Conclusion: On the basis of results there is high association of subclinical hypothyroid, depression and cardiovascular risk among post menopausal women.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Pharmacotherapy for the Treatment of Smokeless Tobacco users

Abbas Mehdi, Sanjay Gupta

Institute Of Medical Sciences BHU, India, abbas_georgian@yahoo.co.in, guptavaranasi@hotmail.com

Keyword: Smokeless tobacco, Bupropion SR, pharmacotherapy

Background: Pharmacotherapies have been shown to increase tobacco abstinence rates among smokeless tobacco (ST) users. Bupropion SR has demonstrated potential efficacy for ST users in pilot studies. We conducted a randomized, clinical trial to assess the efficacy and safety of bupropion SR for tobacco abstinence among ST users.

Methods: Adult ST users were randomized to bupropion SR titrated to 150 mg twice daily (N= 32) for 12 weeks. The primary endpoint was the 7-day point-prevalence tobacco abstinence rate at 6 week. Secondary outcomes included prolonged and continuous tobacco abstinence rates, craving and nicotine withdrawal, at week 8 and week 12.

Results: The 7-day point-prevalence tobacco abstinence rates with bupropion SR at week 6 (28.1%), week 8 (28.1%) and week 12 (28.1%); p = 0.0003). The prolonged and continuous tobacco abstinence rates did not differ at weeks 6, 8, and 12. The treatment response was observed over time with FTND-ST scale. At 12 weeks, the mean (±SD) FTND-ST score change from baseline among abstinent subjects was a decrease of 2.66 (±1.52) for the bupropion SR group.

Conclusions: Bupropion SR did significantly increase tobacco abstinence rates among ST users, as well as it significantly decreased craving over the treatment period.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Body Image And Its Relationship With Eating Attitudes, Influence Of Media And Self-Esteem Among College Students

Aditya Soni, Nimesh Parikh, Hitendra Gandhi, Girish Banwari

Sheth V.S Hospital, India, adityaricha8@gmail.com

Keyword: Body image, body mass index, media, self-esteem

Background: A cross-sectional study looked to focus body image satisfaction, heretofore under investigated arena in our setting. This study additionally examined the relationship of body mass index, influence of media and self-esteem. Our second objective was to assess whether there was any relationship between body image dissatisfaction and gender.

Methods: A cross-sectional study using body image satisfaction described in words was undertaken, which also explored relationship with body mass index (BMI), influence of media, self-esteem and other selected co-variables such as socio-demographic details, overall satisfaction in life, and particularly in academic/professional life, current health status using 5-item based Likert scale. Convenience sampling was used to select participants of both genders aged from 17 to 32 on a sample size of 303 participants.

Results: The body image satisfaction had significant relationship with Body mass index (P<0.001), eating attitude (P<0.001), influence of media (P<0.001) and self-esteem (P<0.001). Students with low weight had a significantly higher prevalence of body image satisfaction while overweight students had a significantly higher prevalence of dissatisfaction (P<0.001). Females showed more concern about body image as compared to males.

Conclusions: Generally, this study reveals that the eating attitude, influence of the media and self-esteem is significantly related to the body image. On an empowering note, this level needs to be saved for overall mental and sound advancement of people. Proactive preventive measures could be started in foundations on identity improvement, acknowledgement of self and individual contrasts while keeping up ideal weight and dynamic life style.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Negative body image and abnormal eating behaviours among medical students in Sikkim

Prabhleen Singh Jaggi, Geeta Soohinda, Bhanu Pratap Singh

Sikkim Manipal Institute of Medical Sciences, India, z.prabhleen@gmail.com, gsoohinda@gmail.com, bhansinghjodhpur@yahoo.in

Keyword: body image perception, abnormal eating behaviors, young adults

Background: Body image relates to a person’s perceptions, feelings and thoughts about his or her body and is usually conceptualized as incorporating body size estimation, evaluation of attractiveness and emotions associated with body shape and size.

Body image dissatisfaction is considered to be an “essential precursor” to eating disorders. It has been linked with the full range of unhealthy eating behaviours, including binge eating, restrictive dieting and self-induced vomiting.

There is scarcity of Indian research in this area.

Objective: This study aims to find negative body image perception and abnormal eating behaviours in medical students in Sikkim.

Methods: A sample of 100 female students and 100 male MBBS students of Sikkim Manipal Institute of Medical Sciences, 5^th Mile, Tadong will be selected randomly. All the consenting subjects with a BODY MASS INDEX of less than 25 will be administered the following questionnaires:-

Body Shape Questionnaire which is a self-report measure of the body shape preoccupations typical of bulimia nervosa and anorexia nervosa.
Eating Disorder Examination Questionnaire or EDE-Q 6.0 which is a self-report version of the Eating Disorder Examination Questionnaire

Exclusion Criteria: Students who do not give a written consent for their participation.

Students who have BMI more than 25.

Students suffering from or have suffered from any major systemic illness in the last one month.

Appropriate statistical methods will be used to ascertain whether any association exists between negative body image and abnormal eating behaviours. Also, whether age, ethnicity or year of study has any impact on eating behaviours will be studied.

Results and Conclusion: Results and conclusion will be discussed at the time of presentation

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Delusional Disorder: A Descriptive Study at a Tertiary Psychiatric Institute in North-East India

Diptadhi Mukherjee, Priyaranjan Avinash, Dhrubajyoti Chetia

LGBRIMH, Tezpur, India, diptadhimukherjee@gmail.com, drpriyaranjan.avinash@gmail.com, dchetia234@gmail.com

Keyword: Delusional Disorder, Parasitosis, Demographic profile, Educational Status, Stability

Background: Often considered rare, delusional disorder has not received the due attention from clinicians. Moreover the clinical nihilism towards it has undermined the need to generate research in this field. Hence we did this pioneer study in the north-east India to fill the massive gap of knowledge.

Aims and Objectives: To study prevalence, socio-demographic profile, Clinical parameters including subtypes, stability of the diagnosis, family history, treatment and follow up rates of delusional disorder.

Methods: The records of all patients attending outpatient department of LGBRIMH, Tezpur with the diagnosis of delusional disorder (F22) during a period of 5 years (2009-2013) were reviewed. Eighty –two subjects fulfilling the inclusion criteria were enrolled. Finally appropriate statistical analysis was done using SPSS version 20.

Results: Hospital prevalence of delusional disorder was 0.16 %. Almost equally distributed among sex, region and religion, the mean age of onset of all delusional disorder was around 4o years. The most common subtype was delusional parasitosis(30.5%) followed by delusional jealousy (29.3%)and persecutory delusion(18.3%). Delusional jealousy is twice as common in men as in women. Delusional parasitosis was more prevalent among uneducated samples. Family history of psychiatric illness was seen 10 times more frequently in persecutory delusion than in delusional parasitosis. Majority of delusional parasitosis have consulted physicians or dermatologists before. The course of delusional disorder was mostly stable, delusional parasitosis was the most stable. Only 20% of the total samples were given typical antipsychotics, while around 40 % of delusional parasitosis was given typical antipsychotics. More than 2/3^rd of the samples diagnosed as delusional parasitosis followed up while less than half of the samples of delusional jealousy followed up.

Conclusion: Delusional parasitosis is the commonest type. Follow up in general is poor, however follow up and treatment outcome are positively correlated.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Personality, Sensation seeking and Impulsivity in patients of Remitted Bipolar disorder and Remitted Schizophrenia with Cannabis dependence. A comparative study

Chandan Singh, Christoday Raja Jayant Khess, Tathagata Mahintamani

¹Central Institute of Psychiatry, India, drchandansingh02@gmail.com, mahintamani@gmail.com

Keyword: personality, impulsivity, remitted bipolar, remitted schizophrenia, cannabinoid dependence.

Background & Need for Study: Cannabis use disorders are common co morbidity in psychiatric illness & their presence is independently associated with greater disability associated with Bipolarity as well as schizophrenia. Personality profile in schizophrenia may influence symptom expression and social functioning. In terms of phenomenological characteristics, impulse control disorders and bipolar disorders have some common features like risk taking, sensation seeking, and seeking of pleasurable activities. Various studies have found a significant correlation between impulsivity & aggressiveness. No study, as per the best of our knowledge has compared personality, sensation seeking &, impulsivity between remitted bipolar and remitted schizophrenia with cannabis dependence.

Aims & Objectives: The present study aimed to compare, personality, sensation seeking and impulsivity in patients of remitted bipolar disorder with cannabis dependence and remitted schizophrenia with cannabis dependence.

Materials & Methods: After one month of the admission 20 bipolar patients (50% reduction in the YMRS scores) & 20 schizophrenia patients (with 50% reduction in PANSS scores) with cannabis dependence were recruited for study. Normal controls (with GHQ score <3) were taken from general population, all three groups were assessed on Barratts Impulsivity Scale and Temperament and Character Inventory (TCI).

Statistical Analysis: Data were analysed using SPSS version 20.

Results: This study found significantly increased impulsivity & Novelty seeking in bipolar group with respect to both schizophrenia & normal controls. Harm avoidance and Self directedness were significantly lower in both bipolar, & schizophrenia groups with respect to normal control. Significant positive correlation was found between duration of illness and novelty seeking, as well as Persistence and severity of manic Symptoms. Harm avoidance was significantly inversely correlated with both psychopathology score and impulsivity.

Conclusions: This study showed that with co morbid cannabis dependence remitted bipolar patients had significantly higher Impulsivity & novelty seeking than remitted schizophrenia patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Thyroid Profile and its Relationship with Response to Treatment with Lithium in Bipolar Mood Disorder Patients

Priyaranjan Avinash^*1

¹LGBRIMH, Tezpur, India, drpriyaranjan.avinash@gmail.com

Keyword: Bipolar Mood Disorder, Thyroid, Lithium, Response

Background: There is substantial evidence that even minor perturbation of thyroid function plays a significant role in clinical course and treatment outcome. Keeping this premise in our mind we did this study to check the relationship of pre-treatment thyroid profile and response to treatment by lithium in patients of Bipolar Mood Disorder.

Aims and Objectives: we did this study to understand the relationship between thyroid profile and Bipolar disorder subtypes and to study the relationship between pre-treatment thyroid profile and response to treatment with Lithium along with other predictors of response to treatment with Lithium in cases of Bipolar Mood Disorder.

Methods: This study was conducted in the indoor facilities of LGBRIMH, Tezpur in the year of 2012, after clearance from scientific and review committee and Ethics committee of the institute.45 consecutive indoor patients diagnosed with Bipolar Mood Disorder using DSM IV TR criteria were selected after applying the Inclusion and exclusion criteria. On day 1 Blood was collected for thyroid profile and BPRS 24 item scale version 4.0 was applied. They were all started on Lithium monotherapy, and only Lorazepam was used on S.O.S basis. On day 30 the BPRS was applied again to check the response to treatment. Finally appropriate statistical analysis was done using SPSS version 16.

Results: The response to treatment was good with the mean % fall of the BPRS score being 40%, with the maximum fall in the subscale of grandiosity and minimum for depression. Age, Illness duration, substance use, family history 2nd or later episodes were negatively correlated with treatment response. Pretreatment T4 level was positively correlated while pre-treatment TSH level was negatively correlated with the treatment response.

Conclusion: Lithium monotherapy proved to be a good agent for 1st episode of Bipolar Mood disorder patients with manic symptoms, and pretreatment T4 and TSH level were predictors of treatment response.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depression and Anxiety in patients attending Rheumatology Clinic, RIMS, Imphal.

Robindro Khangembam Singh, Lenin Rajkumar Singh, Heramani Nigombam Singh

Regional Institute of Medical Sciences, India, robindrodr@gmail.com, leninrk@yahoo.com, nheramani@yahoo.co.in

Keyword: Rheumatic disorders, anxiety, depression, mental health, liaison

Background: Rheumatoid arthritis (RA) is a lifelong disease of unknown cause where no cures are available. The diagnosis of RA may cause stress and uncertainty in patients and their relatives. It can influence all aspects of one’s life, like social, interpersonal and work relationships, family life, and psychological well-being in addition to physical symptoms. Psychiatric disorders are highly common in RA cases. The main psychiatric disorders reported in RA cases are depression, anxiety, and both.

Objective: To find out the frequency of anxiety and depression among patients with rheumatic disorders.

Methods: Cross-sectional, analytical study with sample size of 55. Patients attending the Rheumatology Outpatient Clinic, RIMS, Imphal with more than 1 year duration of rheumatic disorder were screened during the period from February to August 2014. A physician made the assessment regarding the rheumatological disorder. Manipuri version of Hospital Anxiety and Depression Scale (HADS) was used to assess anxiety and depression. Clinical assessment was done according to International Classification of Diseases-10 (ICD-10).

Results: Out of 55 patients, majority were female (81.9%), and mainly house wife (38.1%), mean age 42.90 years, Hindus were outnumbered (98%), married (78.1%), above matriculate (44%). Anxiety was found to be 48.8% and depression was found to be 51.1% among the cases collected.

Conclusion: Depression and Anxiety were high in patients being treated for chronic rheumatological disorders. A close liaison between rheumatologist and mental health professionals could prove beneficial for these patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity Among Smokeless Tobacco Users: A Case Control Study

Babool Raja, Anupama M

JJM Medical College, Davangere, India, dr_babool@yahoo.com,

Keyword: Smokeless Tobacco, Psychiatric morbidity, Nicotine dependence

Background: Tobacco use is highly prevalent in Indian population. Despite the higher rates, studies are done mainly on Cigarette smoking and there is no specific study examining the psychiatric morbidity among Smokeless Tobacco users.

Aims And Objectives: To study the prevalence of psychiatric morbidity among smokeless tobacco users.

Materials And Methods: Data included adults attending the out-patient department of the tertiary care dental treatment center were recruited after obtaining informed consent. The patients were screened for nicotine dependence and psychiatric morbidity using Fagerstrom Test for Nicotine Dependence and GHQ-12. Measures included DSM-IV TR diagnoses by MINI PLUS, Hamilton Anxiety Rating Scale (HARS) & Hamilton Rating Scale for Depression (HRSD) for severity assessment. Controls were compared for psychiatric disorders.

Results: A total of 100 subjects were included in the study. Cases and Controls were matching for socio-demographic data. The mean age of the study sample was 40.7 ± 11.74 years. About half of the cases (48%) who had met the criteria for nicotine dependence were moderate nicotine dependent. 68% of cases had a specific psychiatric diagnosis on MINI Plus as compared to controls 10%(χ² =35.35 df=1, P<0.000) and most common diagnosis was Major Depressive Disorder(30%). The Mean severity scores on HARS (t=4.49, df=98, P<0.000) & HDRS (t=5.22,df=98, P<0.000) were also statistically significant.

Conclusion: This study is the first to examine psychiatric morbidity among smokeless tobacco use in Indian population. Understanding shared mechanisms between all forms of tobacco use with anxiety and depressive disorders remains an important area for investigation and the intention to stop tobacco chewing should be proactively supported among these comorbid patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence And Sociodemographic Determinants Of Depressive Disorders Among Elderly Residing In Rural And Semi urban Areas Of Varanasi

Sanjay Gupta, Ajay Kumar Singh, Arun Kurupath

IMS, BHU, Varanasi, India, guptavaranasi@hotmail.com, arun.kurupath@rediffmail.com

Keyword: Prevalence, Sociodemographic Determinants, Elderly

Study Objectives:

To assess the prevalence of depression among the elderly.
To determine the epidemiological factors which are associated with depression

Design: A cross-sectional, observational, community based study.

Period: January 2011 to July 2012

Setting: The study was conducted in rural and suburban areas of Varanasi.

Subjects: The individuals who were aged 55 years and above were interviewed and examined.

Method: By random sampling, the villages were selected. This study was conducted through house-to-house visits in the selected villages. Clinical examinations, observations and interviews were carried out by using a pre-designed, pre-tested proforma in the local language.

Size: Two hundred subjects. The data was analysed by using SPSS (Statistical Package for Social Sciences), version17.

Results: The prevalence of depression was 27.5%. The prevalence of depressive disorders was higher in female sex (31%) as compared to male (24%). The highest prevalence was 27.8% in elderly males as compared to elderly females (21.1%). There were high proportions of women in age group >80 yrs (100%) having depressive disorders as compared to males of same age group (66.7%). Depressive disorder was more in individuals who had physical problems (37.1%) as compared who do not had physical problems (5%). Widow individuals had highest prevalence rate of depressive disorders (71.4%) compared to married group (13.4%). Depressive disorder was more prevalent in illiterate (53.8%) and individuals with education up to high school (28.6%). The prevalence of depressive disorder was higher in lower (lower and upper lower) socioeconomic class (63.4%) than middle socioeconomic class (28%) and upper socioeconomic class (20%).

Conclusion: The prevalence of depression was found to be positively associated with increasing age, the female sex, illiteracy, a low socio-economic status, those who were living alone, those who were economically partially dependent and those who were totally dependent for the activities of daily living

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A cross sectional study of serum folate and vitamin b12 levels in psychiatric in patients

Rashmi Prakash, Ram Chandra Jiloha, R K Saran

G B Pant Hospital, India, drrashmisagar@gmail.com

Keyword: folate, vitamin B12,psychiatric in patients

Aims and Objectives: To study the pattern of serum folate and vitamin B₁₂ levels in psychiatric in-patients compared to non-psychiatric control.

Methods: This cross-sectional study was conducted on Psychiatry in-patients, from 1/1/11 to 31/12/11, with the aim to see the pattern of Serum folate and vitamin B12 levels in patients with psychiatric illness. Patients of ages 12 and serum folate levels were measured in all the subjects and their caregivers who were sharing the same kitchen as that of patient. Serum homocysteine was also measured in subjects and their caregivers.

Results: The result of this study showed vitamin B₁₂ deficiency in 25 % patients with psychiatric illness which was compared with the control group with 5 % population having low vitamin B₁₂ and folate deficiency was about 2% of patients with psychiatric illness while none of the controls had low serum folate levels. In addition to that we found 35 % of the patients with raised serum homocysteine levels while in control group only 13 % had raised homocysteine levels. Rest of the results will be discussed.

Conclusion: Significant proportion of psychiatric patients was found to be vitamin B12 deficient. In-depth studies are required to establish the cause effect relationship between vitamin B12 deficiency and psychiatric illness, and the effect of vitamin B12 replacement.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparative Study of Depressive disorders in Elderly from Rural and Semi urban Areas of Varanasi

Sanjay Gupta, Ajay Kumar Singh, Arun Kurupath

IMS, BHU, Varanasi, India, guptavaranasi@hotmail.com, arun.kurupath@rediffmail.com

Keyword: Comparative Study, Depressive disorders, Elderly

Background:

Study Objectives:

To assess the prevalence of depression among the elderly from rural and semi urban areas of Varanasi.
To determine the epidemiological factors which are associated with depression.

Design: A cross-sectional, observational, community based study.

Period: January 2011 to July 2012

Setting: The study was conducted in rural and suburban areas of Varanasi.

Subjects: The individuals who were aged 55 years and above were interviewed and examined.

Method: By random sampling, the villages were selected. This study was conducted through house-to-house visits in the selected villages. Clinical examinations, observations and interviews were carried out by using a pre-designed, pre-tested Performa in the local language.

Size: Two hundred and twelve subjects. The data was analyzed by using SPSS (Statistical Package for Social Sciences), version17.

Results:. Our study figures had higher rate of depressive disorder in rural (31%) population than sub urban (24%). Trend that is seen is prevalence is more in elderly aged 55-80 years. It is more till 80 years in rural. This rural semi urban difference ceases above 80 years beyond which semi urban slightly overtakes it. Further there is two fold increase from 55-60 group compared to 65-70 years group.

A bigleap is seen in going from sixties to seventies almost witnessing two and half times increase in prevalence. This increase is also seen in semiurban but with an even greater rise(more than 3 times).

Conclusion: Mild depression was more prevalent (73.3%) in oldest old (>80) age as compared to other age groups. Rural population had higher rate of depressive disorder than suburban population

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Recovery from Homelessness for Homeless Mentally Ill: A myth or a Reality

Arnab Mukherjee, Arun R, Anna Tharyan

Christian Medical College, Vellore, India, arnabmukh11@gmail.com, arunrdr@gmail.com, anna.vellore@gmail.com

Keyword: homelessness, homeless mentally ill, psychosocial, rehabilitation, destitute mentally ill, community psychiatry

Background: Homelessness secondary to mental illness is not uncommon. However, care of homeless mentally ill that includes rescuing them from streets, recovering them from psychiatric illness and reuniting them with their families are limited in India. Udhavum Ullangal, a non-government organisation (NGO) in Tamil Nadu, aims at rehabilitation of homeless mentally ill. The NGO has incorporated above principles in its functioning.

Objectives: The outcome of psychosocial rehabilitation by Udhavum Ullangal in terms of family reunion of homeless mentally ill is discussed.

Methods: Home for Psycho-social Rehabilitation of Mentally Ill Persons run by Udhavum Ullangal Tirupattur Tamil Nadu is registered under Dept of Social Welfare Government of Tamil Nadu. It started functioning in April 2006. The intake strength is 50. Regular psychiatric care is provided by Dept of Psychiatry, Christian Medical College, Vellore, and Tamil Nadu. Data on inmates were collected from the source, were entered into SPSS 16.0 and analysed using descriptive statistics.

Results: During the period 2006-2013, 112 inmates were admitted (men: 79, women: 33). Psychiatric assessment revealed most were suffering from ICD-10 diagnosis of Psychosis-unspecified. In addition, a few were intellectually disabled too. At the time of admission, only 7 percent (N=8) could provide accurate personal address whereas 65 percent (N=72) could not provide any address details. Consequent to psychiatric and psychosocial care, families of 64 percent (N=71) were traced. Of these, thirty four men and fourteen women could be reunited with their families. In spite of tracing the family, twenty four inmates continue to stay in the home for various reasons.

Conclusion: Psychosocial rehabilitation (PSR) can help address homelessness in mentally ill. However, attitude towards mentally ill still remains an obstacle to PSR. Similar models of rehabilitation of homeless mentally ill should be replicated. (Further analysis and conclusion will be presented during the conference).

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Trends of Psychiatric Follow-up of Patients with ADHD- A Retrospective Analysis

Tejas Jagannath Gholap, Shakeel Ahmed, Kaustubh Mazumdar, Shobha Nair, Aditi Chaudhari, Divya Ramdas, Anita Patel

Bhabha Atomic Research Centre Hospital, India, gholap.drtejas@gmail.com, dr.shakeel26@gmail.com, kmazum@gmail.com, dr.shobhasnair@yahoo.co.in, draditi@barc.gov.in, divya_alikkal@yahoo.co.in, admin@slarc.in

Keyword: Adhd: Attention Deficit Hyperactivity Disorer, Iq: Intelligence Quotient, Chss: Central Health Services Scheme

Background: ADHD is one of the most common behaviour disorder encountered in children. It makes up for nearly 50% of the attendance in Child Psychiatry Clinics. ADHD has been described as a developmental disorder characterised by varying degrees of inattention, hyperactivity and impulsivity arising in childhood. If not treated in chldhood then such children are at risk of academic failure and peer rejection. While the adolescent with ADHD who remain untreated face other risks such as increased proneness to automobile accidents, substance use and abuse and trouble with the law. Though effective drug therapy is available for treatment of ADHD the parents are resistant to medicate their children because of their concerns regarding side effects, stigma, other social factors, etc. Resultantly there is high dropout rate from treatment as has been seen in clinical trials of methylphenidate versus placebo. This study will help us understand the follow up trends of patients with ADHD especially in a setting where the treatment is provided free of cost (to all CHSS beneficiaries) and hence the effect of factors like availability and cost of health care is neutralized

Aim & Objectives:

1)
To study the duration of follow up of patients with ADHD.
2)
To correlate duration of follow up with age at onset, gender, birth order.
3)
To correlate duration of follow up with educational and occupational status of parents.
4)
To correlate duration of follow up with co-morbidities (especially with specific learning disability), and level of intelligence.

Material and Methods: Data will be retrieved from all the available case records of patients diagnosed with ADHD during the period of 2007 to 2013. Data will include socio-demographic details, illness profile, associated co-morbidity, Intelligence Quotient and details about follow up.

Results and Discussion: Data will be analyzed and discussed in accordance with available literature.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Jung, Mid-life crisis and Indian Philosophies

Padma Shilpa Velkuru, Ramakrishna Podaralla, Ramakanth P

Deccan College of Medical Sciences, India, shilpa2011r@gmail.com

Keyword: Carl Jung, Indian psychotherapy, Vedas, Upanishads, Bhagavad Gita, Indian philosophers.

Background: “I often had to cling to the table, so as not to fall apart.” Carl Jung

Carl Gustav Jung, a Swiss psychiatrist and psychotherapist, suffered mental breakdown / acute crisis at midlife, which prompted him to come to the conclusion the midlife passage is symbolic of the path of individuation,-a spiritual journey for a new and deeper meaning, value and purpose in life. Jung was also the first psychiatrist to introduce Eastern spiritual disciplines to the west, and this was important at the time, because he was a well known psychiatrist. Dr.Vahia, Dr.Neki etc. have recognized the importance of indianization of psychotherapy, using Indian spiritual / philosophical concepts in psychotherapy.

Objectives: This paper will explore how ancient indian philosophical systems like Vedas, upanishads, Bhagavad Gita and selected contemporary philosophies, can be used in a step-wise healing through mid-life crisis, (highlighting relevant studies.)

Methodology: Researching Indian philosophies citing relevant sources.

Discussions:

Chanting Vedic mantras can stabilize the mind

Upanishads can help in challenging the cognitive/spiritual distortions by a Qand A session between client and therapist

Bhagavad Gita (the four yogas) can be practically applied in daily life to maintain the recovery.

Selected contemporary Indian philosophies can help in self-reflection.

It is important that the therapist be there as the guru (Guru-Chela relationship - Neki) through the entire process, guiding the client.

Conclusion: Indian philosophical systems are as deep as the ocean, and there is an infinite treasury of gems to be discovered - the therapist can offer the client many options from which he/she can pick and choose. By considering Mid-life crisis as a spiritual crisis, Indian philosophies can be used in Jung’s words “from treatment of the mentally ill to a means for spiritual development of the personality.”

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Rehabilitation of Homeless Mentally Ill: Outcomes and Lessons for Mental Health Care in India

Arun R, Arnab Mukherjee, Anna Tharyan

Christian Medical College, Vellore, India, arunrdr@gmail.com, arnabmukh11@gmail.com, anna.vellore@gmail.com

Keyword: Rehabilitation, Psychosocial rehabilitation, Rehabilitation homes, Homeless mentally ill, Destitute mentally ill, Community psychiatry,

Background: Chronic mental illness has many adverse social outcomes, one being homelessness. Homeless mentally ill (HMI) are marginalised; provisions for caring HMI are limited. In this background Home for Psycho-social Rehabilitation of Mentally Ill Persons at Tirupattur Vellore District Tamil Nadu gains attention. Run by non-government organization Udhavum Ullangal, the home rescues HMI from streets and provide shelter, assistance in activities of daily living (ADL), vocational rehabilitation and, psychiatric care are provided by Department of Psychiatry, Christian Medical College, Vellore.

Objectives: To assess course and outcome of rehabilitated homeless mentally ill inmates in domains of psychopathology, selfcare, communication, social skill and vocation.

Methods: Data from 2006 to 2013 were analysed. From admission (baseline), the inmates’ progress is rated periodically on Periodic Psychiatric Assessment Chart (PPAC). using SPSS 16.0, descriptive statistics and paired t test were done.

Results: There were 112 inmates of which 30 percent were women. Common psychiatric diagnosis was Psychosis–unspecified. All were on supervised psychotropics. PPAC scores at baseline, at 1 month, at 3 month, at 6 month, at 1 year, at 2 year and at 5 year were analysed. In PPAC, those with ‘Stable’ mental status were 1%, 3.2%, 5.7%, 17.9%, 36%, 61.9% and 61.5% at observation points. Similar trends were evident in communication, social skills and occupation. Within 6 months, half of inmates became independent in self-care. Paired t test revealed statistically significant change in total PPAC score from baseline to various observation points.

Conclusion: Lessons from this model highlight the role of rehabilitation facilities for HMI. Rehabilitation facilities can help HMI in improving psychopathology, ADL and vocation. In spite of such provisions, a proportion is in need of continued supervised care. (Further analysis and conclusion will be presented during the conference).

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study on correlation of Addiction severity with Cognitive Functions in Alcoholism.

Muktesh Kakasaheb Daund, Dhrubajyoti Chetia, Sailendrakumar Deuri

LGB Regional Institute Of Mental Health, Tezpur, Assam, India, dr.mukteshdaund@gmail.com, drdhrubajyotichetia@gmail.com, skdeuri@sify.com

Keyword: Alcohol, Planning, Decision Making, Tower of London, IOWA gambling task

Background: Alcohol dependence is a major problem in India. The available evidence suggests that alcohol abuse produces a decrease in specific cognitive abilities particularly those associated with executive functions, which leads to frequent relapse.

Objectives: The aim of the study is to assess and correlate the addiction severity with decision making and planning functioning in persons with alcohol related disorders.

Methods: Cross sectional study, done in LGBRIMH. Sample size 60 (Case 30, Control 30). After purposive sampling, the tools applied were sociodemographic proforma, MINI plus, addiction severity index, IOWA gambling task and Tower of London. The findings were analysed with t-test, chi-square and Pearson’s correlation test.

Results: Findings from the composite score of addiction severity index shows the mean value to be 0.6557±0.7181.

Decision making analysed using the IOWA gambling task shows impaired decision making in 93.4 % amongst the cases while 40 % amongst the control. X² =19.2, p < 0.01

Planning was analysed using the Tower of London. Findings shows the mean value of a total number of moves as 78.1±17.353 in a case group, and in control as 57.4±3.125, t = 6.43, p <0.01.

The assessment of correlation between the case and control group in decision making shows the r = -0.170, p = 0.369. The planning correlation value was found to be r= 0.03, p = 0.871. Findings suggest, there was no significant correlation between addiction severity and decision making and planning abilities in a case group.

Conclusion: We can say that alcohol consumption has an impact upon the decision making and planning abilities of the individuals. But however, the study failed to show a significant correlation between addiction severity and decision making and planning abilities in the case group. But impaired decision making & planning abilities are inherent traits in alcoholics, in other words impaired planning & decision making are vulnerability factors for alcoholics.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Internet Addiction and Psychological Morbidity among Undergraduate Medical Students

Nymisha Dangeti, Samir Kumar Praharaj

Katurba Medical College, India, drnysh@gmail.com, samirpsyche@yahoo.co.in

Keyword: Internet addiction, Psychological morbidity, Medical students

Background: There is a growing recognition of internet addiction among internet users, specifically in younger population. Also, internet addiction has been associated with existing psychopathology

Objective: To study the prevalence of internet addiction among undergraduate medical students and its correlation with psychiatric morbidity.

Methods: This is a cross-sectional study in which 250 undergraduate medical students will be assessed on Internet Addiction Test (IAT) and Self Reporting Questionnaire (SRQ).

Results: Will be presented later.

Conclusion: Will be presented later

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study to assess disability among patients of bipolar affective disorders & obsessive compulsive disorder

Prodipto Dhar

Burdwan Medical College and Hospital, India, pdhar2011@gmail.com

Keyword: Disability, IDEAS

Introduction: Major psychiatric disorders are associated with significant functional and social impairments which lead to disability to the patients. Obsessive Compulsive Disorder and Bipolar Affective Disorder are diseases that are known to affect various aspects of a person’s social, personal & occupational life. Indian Disability Evaluation and Assessment scale (IDEAS) is a tool for measuring and quantifying disability in mental disorders developed by the Rehabilitation Committee of Indian Psychiatric Society (December 2000).

AIMS: 1. To assess the disability among the patients with Bipolar Affective Disorders (BPAD) and Obsessive Compulsive Disorder (OCD) using IDEAS.

and 2. To compare the domains of IDEAS between these two groups.

Materials And Methods: In this cross sectional study patients (N=100) with OCD and BPAD (N=50 each), aged 18-60 years, illness duration two to five years, from both sexes, and with at least one reliable informant would be assessed for disease severity using Yale Brown Obsessive Compulsive Scale and Young Mania Rating scale/Hamilton Rating scale for depression for OCD and BPAD, respectively. Disability would be assessed with IDEAS. The two groups would be compared on various domains of IDEAS and the relation between disease severity and certain disease parameters would also be explored in each group. Statistical analysis will be done using appropriate statistical measures.

Results And Discussion: As it is an ongoing study results will be shared at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Socio-Demographic Profile and Drug Seeking Situation in Alcohol Dependent Patients: A Cross Sectional Study

Arun Kumar V, Murali M, Gopalakrishnan G

Sowmanasya Hospital & Institute of Psychiatry, India, arun_0398@yahoo.co.in, muralipsychiatrist@gmail.com, sowmanasya@gmail.com

Keyword: Alcohol dependence, drug seeking situation, IDTS, relapse prevention

Objectives: Alcohol dependence is associated with enormous health complications both psychological and physical. It is important to understand the factors leading to its dependence which will help to plan strategies to reduce its intake. Hence we decided to study the socio-demographic profile and drug seeking situations in alcohol dependent patients.

Materials & Methods: It was a cross sectional, analytical, hospital based study of 75 alcohol dependence syndrome patients. A predesigned proforma was used for collecting socio-demographic data and Inventory of Drug-Taking Situation scale (IDTS) was used to assess various drug seeking conditions in alcohol dependent patients.

Results: Mean age of the study sample was 42.37 years and mean duration of alcohol use was 16.81 years. Majority of subjects were male, belonging to Hindu religion, were literate and skilled workers. Most were married, living in nuclear family, with family income of Rs 10000 or above and were living in suburban areas. Majority had a family history of alcohol dependence and the commonest medical diagnosis was hypertension. The common drug seeking behaviour assessed using Inventory of Drug-Taking Situation was pleasant times with others (positive situations) followed by social pressure (temptation situations).

Conclusion: Most of the patients in the study were long term alcohol users with initiation in the young adult age. Identifying these high risk situations and forming alternate coping strategies for dealing with these particular high risk situations will help in reducing the severity of alcohol consumption and relapse prevention.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity Profiles Of Child & Adolescent Patients Attending The Regional Institute Of Medical Sciences, Imphal.

Md Munnawar Sameer Hussain^*1, Ching Gou Maan², Ningombam Heramani Singh², Raj Kumar Lenin Singh²

¹Vydehi Institute of Medical Sciences & Research Centre, Whitefield, Bangalore, India, Munnawar1986@gmail.com, ²Regional Institute Of Medical Scinces, Imphal, India, mcaroline920@gmail.com, India, N.heramnai@yahoo.co.in, India, leninrk@yahoo.com

Keyword: Child & adolescent, psychiatric morbidity, socio-demographic, dissociative disorder, retrospective study

Background: Child and adolescent mental problems are increasing in frequency, though variable in type among the South Asian and Western population. A variety of psychiatric manifestations can be seen in children and adoloscence below the age of 19 years.

Objective: This study aims to examine the socio-demographic, morbidity profiles, & clinical correlates of child & adolescent patients attending the psychiatry out-patient department of Regional Institute of Medical Sciences over a 1year period.

Methods: It is a retrospective case record analysis of all child & adolescent patients attending the psychiatry out-patient department between Jan-Dec 2011 in RIMS, Imphal, Manipur, India. Eight hundred and seventy six cases attending the Out patient department were analyzed. Results: Females comprise 508(58%) & males comprise 368(42%) and the mean age of the patients was (15.68±3.73 years). Age range is (4-19 years). Most of the patients (67.0%) were from 16-19 years group. Cases from urban areas (655 or 74.8% out of 876) predominate and majority (587 or 67.0% out of 876) were Hindu. Psychiatric diagnosis was found to be maximum in Dissociative disorder (212 or 24.1%) followed by depression (103 or 11.7% respectively). Majority of the females had a diagnosis of dissociative disorder (170 or 33.4%) followed by depression (69 or 10.03% respectively) whereas among males most (57 or 15.4%) had a diagnosis of mental retardation followed by depression (52 or 14.1% respectively).

Conclusion: This study highlights a high prevalence of mental health disorders in children & adolescents in a tertiary care centre and the need for providing mental health services to this vulnerable group.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence Of Anxiety And Depression Among Diabetic Patients - A Hospital Based Study

Nimeesha Nekkanti, Nukala Srikrishna, Vijayagopal Mopineni, Sravani Behara

GSL Medical College, India, nimeesha.nekkanti@gmail.com, srikrishnanukalas@gmail.com, vijayagopal123@gmail.com, sravani.behara2006@gmail.com

Keyword: Anxiety, Depression, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease which affects every organ in the human body. India has the largest diabetic population in the world and it is expected to be 69.9 million by 2025. DEPRESSION and ANXIETY are common among people with diabetes. Patients with depression and anxiety in diabetes have been shown to have poorer self-management and poorer adherence to ant-diabetic treatment.

Aims And Objectives:

To assess the prevalence of anxiety and depression among diabetic patients using standardized rating scales for depression and anxiety.

Materials And Methods:

Study Sample And Setting: Patients diagnosed with diabetes attended GSL general hospital, diabetic clinic between april 2014 - august 2014 who were assessed after taking their informed consent using Hamilton depression and Hamilton anxiety rating scale and they were also assessed for socio-demographic profile, duration of illness and type of treatment. The data obtained was analyzed on various samples.

Total number of samples – 100

Males- 45, Females - 58

Study Design:

Cross-sectional study.

Inclusion Criterion:

Patients above the age of 20 years.
Patients with diagnosis of diabetes mellitus.

Exclusion Criterion:

Presence of any serious organic illness.
Any past history of psychiatric disorders.
Patients with severe cognitive impairment.

Conclusion: Depression has an important bearing on the course of diabetes, leading to worsening of the disease and increased diabetic Effective treatment facilitates adherence to diet and exercise and results in improved glycemic control.

Results: 46% of the patients had depressive disorders in which males constituted 39.1% and females 60.86% Anxiety was noted in 56% of the sample in which males being 39.2% and females 60.7%

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence Of Psychiatric Morbidity In Stroke Patients: A Hospital Based Study

Swetha Garikimukku, Nukala Srikrishna, Vijayagopal Mopineni, Sravani Behara

GSL Medical College, India, swetha.amc84@gmail.com, srikrishnanukalas@gmail.com, vijayagopal1234@gmail.com, sravani.behara2006@gmail.com

Keyword: Stroke, Psychiatric morbidity, MINI Plus, Depression, Anxiety

Background: WHO defined stroke as “rapidly developing clinical signs of focal (or global)disturbance of cerebral function, with symptoms lasting 24 hrs or longer, leading to death with no apparent cause other than of vascular origin. Strokes produce wide range of mental and emotional disorders.

Neuropyshiatric disturbances have an overall effect on quality of life, social functioning and recovery of stroke.

Aims And Objectives: To Determine The prevalence of psychiatric morbidity among stroke patients by MINI PLUS [mini international neuropsychiatric interview]

Materials And Methods:

Total study sample: 50 patients

Study setting:Neurology department at GSL general hospital

Study period:4 months from April 2014-July 2014

Study design: Cross sectional study

Study Tools: MINI PLUS[mini international neuropsychiatric interview]

Inclusion Criteria:

Patients above age of 18 years

Patients diagnosed with stroke

Exclusion Criteria:

Presence of any other serious organic illness

Any past history psychiatric disorder

Patients with severe cognitive impairment

Results:

Overall prevalence of psychiatric morbidity -44%(22/50)

Depression- 26%

GAD-18%

Substance use disorders-18%

Conclusion: Psychiatric co-morbidity among stroke patients will lead to poor motivation for rehabilitation and are also associated with poor outcomes.

Thus the importance of identifying psychiatric co-morbidity among stroke patients should be stressed.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Insomnia, Depression and Suicidal Behavior: A Comparative study between Male and Female Inmates of Guwahati Central Jail

Bhaktishree Raha, Swapanjit Sarma

Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, India, bhaktishree_raha@yahoo.co.in, raak84@gmail.com

Keyword: prison, suicide, insomnia, depression,

Background: Prisoners are widely reported to suffer more from insomnia, affective disturbances and higher suicide rates than general population. Studies are scarce to investigate crime related variables in regard to prevalence of these morbid conditions across gender.

Objective: To compare the prevalence of insomnia, depression and suicidality between male and female inmates and to probe possible association of the nature of crime, duration of stay, penal status, socio-demographic and clinical variables with these morbid conditions.

Method: 40 male and 40 female prisoners of Guwahati Central Jail, Assam were subjected to Socio-demographic proforma, BDI, Pittsburgh Insomnia Rating Scale and Columbia Suicide Severity Rating Scale after obtaining written approval from Inspector General of Prisons, Assam and Institutional Ethics Committee, Guwahati Medical College. Appropriate statistical tests for categorical and continuous variables were performed with significance defined as p<0.05.

Results: Prevalence of depression was 62.5% in males and 85% in females (p=0.04), insomnia in males was 65% and females reported 72.5% insomnia (p=0.0073), and suicidal ideation in male and female prisoners were 10% and 30% (p=0.04) respectively. The relative risk of suicide was 0.33. Depression and suicidality were significantly associated with increasing duration of stay only in female prisoners (p=0.029 and p=0.032 respectively), also being convicted of crimes associated with more insomnia (p=0.026), depression (p=0.045) and suicidality (p=0.032) than UTPs only in females. Significant association was found for age, marital status, occupation, having or not having children and physical illness with depression, insomnia and suicidality mainly in female prisoners.

Conclusions: Although limited in its inability to attribute causality, our study conclusively demonstrated increased prevalence of depression, insomnia and suicidality in female prisoners. Penal status, duration of stay and many other socio-demographic factors negatively influence the fairer sex in custody.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Occurrence of Life Events in Obsessive Compulsive Disorder and its Impact on Disease Severity

Sandip Kumar Hazra, Sikha Mukhopadhyay, Sujit Sarkhel

Institute of Psychiatry, Kolkata, India, sandiphazra@rocketmail.com, sikhamukho54@gmail.com, sujitsarkhel@gmail.com

Keyword: Life Events, Obsessive Compulsive Disorder (OCD), occurrence, impact

Background: Existing research into the onset of obsessive-compulsive disorder (OCD) suggests the occurrence of potential life events as triggering factors; however studies are very few in number having methodological limitations and contradictory findings.

Objectives

1)
To find out the frequency of life events in patients with OCD in comparison to their matched controls.
2)
To find out the impact of life events on the severity OCD.

Methods: Sixty patients, between ages 18 to 60 years, belonging to either sex, meeting the DSM-IV TR diagnostic criteria for OCD were selected for the study. Cases were rated with Yale Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A). Life events were evaluated using Presumptive Stressful Life Events Scale (PSLES) both for lifetime and past 1 year. A group of 60 normal controls were also rated on PSLES. Finally, both groups were compared in terms of life events.

Results: The frequency of life events, one year (t=5.31, p=<.001) and lifetime (t=11.53, p<.001), were significantly higher in patient group in comparison to controls. PSLES scores at both lifetime and one year showed significant correlation with YBOCS total scores. There was correlation between HAM-D and HAM-A scores with 1 year PSLES scores and between HAM-A and lifetime PSLES scores.

Conclusion: Life events were significantly more frequent in OCD patients both one year and lifetime, as compared to healthy controls. The severity of OC symptoms was directly proportional to the number of life events experienced in the last one year and lifetime.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Problems In Mothers Of Children With Cleft Lip And Palate(Clp) Using Standarized Interviews

Hemanth Madhav Gajarao, Ramakrishna Podaralla

Deccan College of Medical Sciences, India, hemanth.madhav99@gmail.com, dr_p_ramakrishna@yahoo.com

Keyword: Mothers, Cleft Lip and Palate Children, Quality of Life, Anxiety, Depression

Background and Aims: The present study was conducted with an aim to determine the Psychological status of mothers of Cleft lip and palate children and to study the change in Quality of Life across different sociodemographic variables using standardized interviews. The subjects were randomly assigned and after initial interview, sociodemographic data, education of mothers, employment status, living situations, social support, sex and age of the child, order of the child, type of pregnancy and Family Hisory of CLP were collected using an intake proforma.

Settings and Design: Plastic Surgery OPD in Owaisi Hospital and Research Centre affliated to Deccan College of Medical Sciences, Kanchanbagh, Hyderabad.

Materials and Methods: In total 60 subjects were included and interviewed using intake proforma and structured questionnaires (GHQ, HAM-A, HAM-D and WHOQOL Brief). The data was analysed and following conclusions were drawn.

Results and Conclusions: 55% of the mothers in the study sample have SEVERE Anxiety and 35% have MODERATE Anxiety and 10%(n=6) were having MILD Anxiety. 36.7%(n=22) of mothers in the study have VERY SEVERE Depression, 18.3% (n=11) of mothers have SEVERE Depression and 30% (n=18) of them have MODERATE Depression and 15%(n=9) have MILD Depression. Depression was higher among the mothers those who are unemployed when compared to that of the employed mothers. Order of the child has a significant impact on the Psychological status of mothers. Higher Anxiety and Depression was found in the 1^st order children when compared to that of the 2^nd and further order children. Anxiety and depression was higher in mothers if the CLP child is a female when compared to that of the male CLP child. Depression and Anxiety was higher in mothers if the child’s age is less than 3months when compared to older children

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Lessons from the Community Care of Street Children

Asif Iqbal Ahmed^*1, Bhavna Barmi²

¹PsyCare, India, psych_asif@yahoo.com, ²Mind Track, India, bhavs2001@yahoo.com

Keyword: Inhalant, Street children, Psychiatric morbidity, Intervention

Background: There are millions of children around the world living or working on the streets. Their struggle to survive is made even harder by high levels of drug use. a “hidden epidemic” of drug use has been described that “poses serious health threats.” (Braitstein P, 2013)

Children and adolescents, even young children are seen walking around the streets with glue bottles essentially stuck to their noses which are essentially inhalants. Inhalants are cheap, are not regulated or illegal and easy to get. Street children also use alcohol, tobacco and marijuana. Street children abusing drugs can also have a much harder time re-entering society. Once a child is addicted to something like glue, it makes it very difficult for them to go to school – have a normal family life. They are more likely to make their livelihood by illegal means (Unicef, 1984).

Street children have been a focus of attention for aid agencies and governments for sometime. Issues need to be identified and strategies developed for street children. Over the years there was little research specifically done on street kid drug abuse. That prompted this work and the resultant study

Objectives

To study the intervention strategies of the Center and make suitable recommendations
To study the sociodemographic patterns and NeuroPsychiatric morbidity of the street children with drug abuse.

Methodology: 40 children were surveyed and data collected on street children’s familial, socio-economic, migrational and educational backgrounds. It further explored their health status, MSE and psychometry. The nature of work of this kind made data collection an essentially emergent process, yielding reliable qualitative information from extensive interview and case study material. Interviewee location was the NGO Center.

Results: The major concern of the NGO being the constant state of intoxication due to substance abuse the center had the policy of getting substances deposited before the children begin the day, it is challenging to control their use. Current strategy of intervention or tackling the children involved one on one negotiation with the child. Of most benefit was the attachment bond created between the centre care giver and the child, However it was observed that the same was being taken advantage of by the children for secondary gains. Of advantage was also the some of the regular routine events such as morning bath, clean clothes, afternoon lunch, music, tv, dance and other entertainment activities as well as education being provided which were independently or as a whole a source of extrinsic motivation for the children to return to the centre.

Sociodemography and Neuro Psych morbidity- The subjects were all boys in the age group of 9-18 years. Most common drug of abuse was Tyre adhesive (Glue), cannabis and alcohol being ithers. The most common reasons were essentially peer pressure, the need to survive. One child was also using Smack. Conduct disorder, Drug induced mood disorder and drug induced psychotic disorder were found in a proportion of the subjects. One case of Bells Palsy was also detected.

Conclusions: Neuropsych morbidity was quite high and behaviour management was difficult with frequent breakouts of fights and conflict amongst the children. In order to create an environment of fair treatment for all as well as to manage difficult behaviour, contingency management, such as the system of token economy, Contingency Management, Psychotherapy, Behavioural and Emotional Management, and Constructive Scheduling of the Day were recommended. Those children assessed with severe Substance Abuse and and those diasgnosed with Substance Induced Mood Disorders were refered for formal rehabilitative management at specialised instituite.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Social Anxiety in Institution Care of Substance Abuse Patients

Tanmoy Mitra, Kedar Ranjan Banerjee, Debbani Bhattacharjee, Jayita Saha, Madhumita Das

National Institute of Behavioural Sciences, India, tmitra.nibs@gmail.com

Keyword: Substance abuse, Rehabilitation, Social anxiety, Social skill training.

Background: Experience from dealing with institutional drug rehabilitation patients often indicated that social anxiety and substance use problems frequently coexist and this comorbidity often influence the drop-out rate of stay at rehab. As social interaction is encouraged and practiced in most rehab centres, some of these addicted individuals felt defensive and withdrawn while being there. Thus higher social anxiety can be a determinative factor for entering in rehab treatment as well as completing rehabilitation. Present study focuses on role of social anxiety in patients with substance abuse and whether treatment for that affects the entry and stay in institutional rehab.

Method: Two groups, each comprising 30 institutionalized subjects with substance related disorder were recruited for the study. The average age was 26 and average using time was 8 months. At the time of entry detailed psychometric assessment was performed for baseline and subjects with at least one symptom of social anxiety and one avoidance of one social situation on Liebowitz Social Anxiety Scale were selected. A structured social skill training was used. Subjects were followed at the completion of the program and at three months following entry into residential rehabilitation (or six months post-baseline for participants who do not enter treatment).

Results: Differences between the intervention and control groups were analysed using Analysis of Variance, and differences between the intervention and control groups in psychological outcomes over time indicated significant difference (p<0.01). Additionally, chi-square analysis had been done for differences (social anxiety vs no social anxiety) between the intervention and control groups.

Conclusion: Present study indicates that social anxiety can play a potential role in entry and retention of residential drug treatment. Screening and developing of better coping skill for social anxiety are needful for institution treatment of drug addiction.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of psychiatric morbidity in Sri Lankan refugees settled in Kottapattu Sri Lankan refugee camp, Trichy district, Tamilnadu

Suma Tudupa, Sunitha M, Priya Nataraj, Arun Kumar K, Ramakrishnan K

Athma Institute of Mental Health and Social Sciences, India, udupa.suma@rediffmail.com

Keyword: Refugees, psychiatric morbidity, prevalence

Background: It is estimated that 1% of world’s population has been displaced either from their home or from their home country. According to UNHCR currently there are 16.7 million refugees across the world. UNHCR’s most recent statistics, show that at the end of 2010 there were some 140,000 Sri Lankan refugees in 65 countries, with a majority – almost 70,000 in 112 refugee camps and another 32,000 living outside camps in Tamil Nadu. Refugee families often encounter a number of acculturative and resettlement stressors as they make lives for themselves in host countries. These difficulties may be compounded by past trauma and violence exposure, posing increased risk for mental health problems.

Objective: To determine the prevalence of various psychiatric disorders in Sri Lankan refugees settled in Kottapattu Sri Lankan refugee camp in Trichy district in Tamil Nadu.

Method: 100 families residing in this camp were taken up for study. Psychopathology was measured using Mini International Neuropsychiatry Interview Schedule (MINI).

Results and conclusions: These will be presented at the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Adolescent Romantic Relationships related problem and Some Psychological Factors

Tanmoy Mitra, Kedar Ranjan Banerjee, Jayita Saha, Debbani Bhattacharjee, Madhumita Das

National Institute of Behavioural Sciences, India, tmitra.nibs@gmail.com

Keyword: Adolescent, Romantic relation, Aggression, Peer relation, Psychosocial function

Objectives: An increase of adolescent romantic relationship related tribulations are evident now-a-days in urban clinical practice in cities like Kolkata. Various dimensions as aggression, externalizing construct, peer relationship and psychosocial functioning which have been linked with such relationship needed careful evaluation to deal with the problem. Present study investigated the relations between romantic relation and effect of negative peer pressure, aggression, locus of control and other constructs affecting psychosocial functioning.

Methods: Total 96 adolescent students have been screened for the study who reported having romantic relation for at least six months. The measures used were as Relational aggression questionnaire, LOC questionnaire, Beck Depression Inventory, Fear of Negative Evaluation etc. The assessments were done at baseline, after therapeutic intervention (at 8^th week) and at follow-up (at 12^th week).

Results: Results indicated strong relationship between relational aggression and negative peer pressure. Locus of control is found to be related and fear of negative evaluation is proportional to relational aggression. Higher hostility related to more aggressive behaviour as expected.

Conclusion: Adolescents who are found to be exposed to high negative peer pressure were more aggressive in romantic relation. This type of aggression leads to depressive symptoms and poor impulse control which can show improvement with therapeutic intervention. It may be important for parents, schools, and therapists all have the potential to create opportunities for individuals during childhood and early adolescence to help equip teens with the tools necessary to deal with negative peer pressure.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Sleep abnormalities and association with epileptiform activity in children with autism

Shankar Kumar, Prasad Bs, Archana NB, Amrtavarshini Radhakrishna, Chandrashekar Hongally

Bangalore Medical College and Research Institute, India, shankarkjs@gmail.com, prasadbsbmc@gmail.com, iamamrta@gmail.com, chanag61@gmail.com

Keyword: autism, sleep, behaviour

Background: Sleep problems are common in children with autism though they are not part of the diagnostic criteria for autism. Multiple sleep problems have been reported in these children which include problems related to sleep onset and maintenance than typically developing children, including greater difficulties with irregular sleep–wake patterns, long sleep latencies (how long it takes to go to sleep), problems with sleep onset, generally poor sleep, early and night waking, and poor sleep

Routines: There is literature on association of sleep problems and epileptiform activity in these children, which is sparse.

Objectives: To study the prevalence and patterns of sleep abnormalities in children with autism and their correlation with autistic symptomatology and epileptiform activity.

Methodology: This study is part of an ongoing larger study which aims to study the prevalence of autism spectrum disorders among those referred for disability assessment due to Mental retardation. 35 children with a diagnosis of Autism made by the clinician and rated on Indian scale for assessment of autism were recruited and children s sleep habits questionnaire were administered to study patterns of sleep behaviours. EEG was done for all these children and comparisons were made between children with and without sleep problems with respect to epileptiform activity, autistic symptomatology and disability using t-test and chi-square test appropriately.

Results and conclusion: The prevalence of sleep abnormalities in our sample of autistic children were 20%. Epileptiform activity was significantly more in those children with sleep abnormalities(p=0.03) and these children had significantly more behavioral problems(p=0.04). These sleep problems need further evaluation for their clinical applicability.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Domestic Violence and Role of Some Related Factors in Indian Urban Young Adults

Debbani Bhattacharjee, Kedar Ranjan Banerjee, Tanmoy Mitra

National Institute of Behavioural Sciences, India, tmitra.nibs@gmail.com

Keyword: Domestic Violence and Role of Some Related Factors in Indian Urban Young Adults

Objective: Domestic violence in form of physical aggression, emotional abuse, and sexual violence are becoming a serious problem in Indian urban life. In addition to physical injury, victims report greater psychological distress, suicidal thoughts, substance use and even indulgence in sexual promiscuous behaviour. This study examined several risk and protective factors for the domestic violence victimization among adolescents and young adults.

Methods: The subjects who visited the clinic at Kolkata during the period of 2010 to 2013. The resulting sample of participants (N = 180) included 142 women (78.89%) and 38 men (21.11%) with a mean age of 22.6 years (range 18–26 years). Questionnaires used for the purpose were serious violation, violence prevalence, Locus of Control, number of siblings level of education and religiousness.

Results: Serious violation behaviors remained statistically significant in the multivariate model. Participants with an inner Locus of control were also significantly more likely to report those behaviours. Participants who have no sibs were more likely to report. Education level was not statistically significant. More religious people reported lesser violence. Greater serious violation were done by men statistically.

Conclusion: Violence is a significant public health issue associated with serious issues for victims, families, and children witnessing family violence. The present study identified several risk factors associated with violence among a high-risk sample of young adults as serious violence-related behaviors, inner Locus of Control, use of intoxicating substance, and having less/no sibs emerged as significant predictors of violence. Collectively, these results suggest that interventions might focus on parental teaching about changing gender roles, causes of violence, anger, and stress reduction as one means to prevent domestic violence. Some possibilities include providing skills training for coping with stress, anger, and anxiety.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of The Extent And Nature Of Coverage Of Mental Health Issues In Newspapers

Deepali Gul^*1, Gulbahar Singh Sidhu²

¹Punjab Institute of Medical Sciences, India, deepaligul@rediffmail.com, ²DOABA Hospital, India, gulbaharsidhu@rediffmail.com

Keyword: Mental health, coverage, newspapers

Background: Topic:others (Media And Psychiatry)

Title: An assessment of the extent and coverage of mental health problems in newspapers

Aims and Objectives: The aim is to assess the extent (in terms of space and prominance) and nature (in terms of the type of mental health problems covered) in national, local and vernacular newspapers as well as leading hindi and over a two month period.

Methodology: One english language national daily, one local hindi daily, one newspaper in vernacular language (Punjabi) will be screened for any newsitem and/or article relating to mental health by a psychiatrist.

This screening will be carried out over a two month period starting from september1, 2014.

The coverage will be recorded in terms of space occupied, and prominance accorded to the news-item.

The nature of mental health problems (in terms of the topics covered) will also be recorded.

Results and Conclusions: The results and conclusions will be discussed at the conference as the study is currently underway.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depression And Anxiety In Patients With Epilepsy

Sanyam Gupta, Shantanu Bharti, Ajay Singh, Charanpreet Singh, Ajay Kohli, Anju Agarwal

Department of Psychiatry, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India, sanyam2k7@gmail.com, drshantanubharti@gmail.com, ajaysingh1811@hotmail.com, drrajveersingh.chd@gmail.com, drajaykohli@gmail.com, dranjubadhan@gmail.com

Keyword: epilepsy, depression, anxiety, comorbidity

Background: The relationship between epilepsy and psychiatric illness is under the focus of clinicians for centuries. Several studies have assessed the prevalence of psychiatric disorders in epilepsy. They are characterized by considerable heterogeneity, because of differences in the population setting and type of study. In an attempt to clarify these issues, our group decided to conduct further investigation into the relationship between depression/anxiety and epilepsy.

Objective: To assess the prevalence of depression and anxiety among epileptic patients using standardized rating scales for depression and anxiety.

Methods: One hundred diagnosed patients of epilepsy were screened using inclusion and exclusion criteria and subsequently assessed, after taking their informed consent, using the Hamilton rating scale for depression (HDRS) and the Hamilton rating scale for anxiety (HARS). They were assessed on sociodemographic profile, duration of illness, and type of treatment, and the data were analyzed on different domains.

Results: Anxiety (mild to moderate) was seen in majority of the patients, with occurrence more in females than males. Comorbidity (anxiety and depression) was higher in middle age group and in patients belonging to semi urban/urban background.

Conclusion: Present study shows that individuals with epilepsy are more prone to comorbid disorders like anxiety and depression. Early identification of these comorbidities and appropriate intervention will help to improve overall quality of life in these patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of Problem Internet Use (PIU): Findings from a study among undergraduate medical students

Yatan Pal Singh Balhara, Rishab Gupta, Rakesh Lal

AIIMS, New Delhi, India, ypsbalhara@gmail.com

Keyword: Problematic internet use, Internet addiction, medical under-graduates

Objectives: Ever increasing penetrance of the internet in the countries across the world has its own unique problems despite multitude of benefits. Impact of behavioral addictions like internet remains under-studied in India. Medical under-graduates are known to depend upon internet for studies, clinics, research and leisure activities but not much attention has been paid to them with respect to their unhealthy use of internet. The present study aimed to assess the prevalence of problematic internet use (PIU) among medical undergraduates of a medical school in India.

Methods: This cross-sectional study was conducted among the MBBS undergraduates across all professional years studying in a medical school in India. Subjects were classified as having PIU based on the scores obtained on Young Internet Addiction Test (YIAT). Logistic regression was used to find out the predictors of problematic internet use.

Results: A total of 270 subjects were evaluated. Majority of the subjects were males (71.8%). Mean number of years of internet use was 5.8 and mean hours of daily internet use were 2.45. 60.4% of the subjects were found to have PIU. 15.5% of the subjects were found to have moderate to severe PIU. Subjects with PIU were exposed to internet for significantly greater number of years and spent higher time on daily internet use. Significantly greater number of subjects with PIU indulged in browsing, chatting, social networking, shopping and watching pornographic material using internet as compared to subjects without PIU.

Conclusion: Medical undergraduate with problematic use tend to have greater exposure to internet since early age and greater numbers among them pursue hedonistic activities on internet.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Social Support And Bipolar Affective Disorder

Charanpreet Singh¹, Parampreet Kaur², Ajay Kohli¹, Anju Agarwal¹, Shantanu Bharti¹, Sanyam Gupta¹, Ajay Singh¹

¹Era’s Lucknow Medical College and Hospital, India, drrajveersingh.chd@gmail.com, ²Guru Nanak Dev University, India, paramkaur138@yahoo.in, drajaykohli@gmail.com, dranjubadhan@gmail.com, drshantanubharti@gmail.com, sanyam2k7@gmail.com, ajaysingh1811@hotmail.com

Keyword: bipolar disorder, social support, sociodemography

Background: Bipolar Disorder is a highly recurring and impairing illness having high rates of disability, comorbidity and poor outcomes despite the gains from pharmacological approaches. The profound psychological difficulties involved in adjusting to this disorder, with its unpredictable symptom fluctuations and difficulties in social functioning, accentuate the need for social support as it appears to influence the broad range of biological and psychological processes.

Objective: To assess the socio-demographic variables and examine variations in symptom severity in the patients with bipolar affective disorder in respect to social support.

Methods: A cross-sectional observational study was conducted in Psychiatry OPD in a hospital setting involving 50 patients above the age of 18 years coming as a followup case of Bipolar Affective Disorder fulfilling inclusion and exclusion criteria with a reliable informant and further assessed using Interpersonal Support Evaluation List (ISEL), Hamilton’s rating scale for depression (HAM-D), young mania rating scale (YMRS). The statistical analysis was done using pearson’s correlation method and ANBUA

Results and Conclusion: Of the current patient sample, 53% were men. 60% belonged to Muslim religion and 70% were married. Using pearson’s correlation method, it was found that the depression and social support are negatively correlated (r = -.329) especially among belongingness and self esteem sub variables of social support and significant differences were found in the values of depression in people having low and high scores on social support scale (t=15.15). In relation to mania, using t test, significant difference was found in the groups with high and low social support (t = 32.11). we could not find any significant effect of social support on mania using ANOVA ie. the F values were insignificant.

Conclusion: Low social support contributed to depression among patients of bipolar affective disorder with social support being a key factor in the severity of symptoms of both mania and depression

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Help seeking behavior among patients of dissociative disorder

Ajay Singh, Kunwar Vaibhav, Ajay Kohli, Anju Agarwal, Shantanu Bharti, Charanpreet Singh, Sanyam Gupta

Era’s Lucknow Medical College and Hospital, India, ajaysingh1811@hotmail.com, kunwarfzd@yahoo.com, drajaykohli@gmail.com, dranjubadhan@gmail.com, drshantanubharti@gmail.com, drrajveersingh.chd@gmail.com, sanyam2k7@gmail.com

Keyword: Dissociation, help seeking behaviour, care

Background: Dissociative disorders are among the oldest known mental disorders, yet the study of dissociation is a neglected and marginalized area of mental health, as in the Indian society myths and misconceptions about mental illness contribute to the stigma surrounding it and leads many people to be ashamed, thus preventing them from seeking help. There is also paucity of such study in this region, which necessitates the need for such a study.

Help seeking behaviour is characterized by sequence of contacts with individuals and organizations which are initiated by distressed person and those of his or her significant others, to seek appropriate help. These are structured multi disciplinary plans which detail the essential steps in the care of patients with specific clinical problems.

Objectives: To assess the help seeking behavior among patients of dissociative disorders

Methods: A cross sectional outpatient based study was carried out in the psychiatric OPD in a hospital setting, upon patients diagnosed with dissociative disorder. Inclusion and exclusion criteria were applied and a sample size of 66 patients who were above the age of 18 years and were accompanied with a reliable informant was selected and these patients were then subjected to evaluation and help seeking behavior was assessed using a semi structured inventory of questions and appropriate statistical methods were applied.

Results and Conclusions: 25 (37.9%) patients utilized services of LMP’s followed by 18 (27.3%) patients each who used the services of faith healers & GMPs & 5 (7.6%) patients had not taken any previous treatment. 44 (66.7%) patients had contacted more than one care provider before reaching the study centre. None of the patients had visited a psychiatrist as a first order service provider.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Valproate Induced Isolated Hyperammonemia

Achyut Kumar Pandey, Ramakant Rawat

UPRIMS & R Saifai Etawah UP, India, achyutpandey575@yahoo.com

Keyword: valproate, hyperammonemia, behaviour

Background: Introduction: Valproate induced hyperammonemia is a rare but severe drug related adverse effect which occurs as monotherapy as well as combination with other drugs. It may be observed under normal plasma valproate level as well as increased plasma valproate level.

Case Report and Discussion: A 30 Years old male, known case of seizure disorder maintained on sodium valproate (VPA) 1000 mg/d, phenytoin 300mg/d and clobazam 20 mg/d was referred to psychiatry for evaluation of abnormal behaviour- irritability, lethargy, yawning and forgetfulness. Physical examination was within normal limits. Mental state examination revealed slowness, episodic twisting of body and face without alteration in consciousness, anxiety, irritability and cognitive deterioration, ill sustained concentration and impaired memory and intelligence. Differential diagnosis of seizure disorder with pseudo seizures/adverse effect of AED/depressive disorder were kept. His investigations revealed decreased serum folic acid was .57ng/ml (N > 5.38) and markedly raised serum ammonia level (274 micro mol / l N 10-47 micro mol/l). Valproate was tapered off and Levitracetam was added and escalated to 1500 mg/d to control breakthrough seizures. Tab Escitalopram 10 mg/d was added for managing depression and anxiety. Folate was added to recover its deficiency. Dietary restriction was advised. Counseling of the patient was tried. Details of improvement and follow ups will be discussed in case presentation.

Conclusion: Because of the wide spectrum of symptoms associated with valproate induced hyperammonemia, physicians should consider hyperammonemia in the differential diagnosis of any patient taking VPA who shows changes in behaviour, cognition or orientation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Attenuated Psychosis a reality ?

Ambrish Sanjay Dharmadhikari, Vihang Vahia

Dr. R. N. Cooper Hospital, India, ambrish30@gmail.com, vvahia@hotmail.com

Keyword: Schizophrenia prodrome Attenuated psychosis

Backgroud: Approximately 80% of patients with schizophrenia recall their prodromal phase. Though traditionally viewed as an inherently retrospective construct, attempts to prospectively identify potentially prodromal adolescents and young adults have begun in recent years. In doing so, the prodrome is conceptualized prospectively as an “at-risk mental state,” indicating that an affected person is at that time more likely to develop psychosis in the near future than someone without such symptoms.

Objective: To characterise prodromal period of schizophrenia.

To calculate mean duration of prodrome of schizophrenia

To estimate prevalence of various sign and symptoms of prodrome of schizophrenia

Methods: Purposive sampling will be used to collect the study sample. Sample of 50 outpatients and inpatients, diagnosed as First episode Schizophrenia (ICD 10/DSM 5) from the OPD of Dr. R. N. Cooper hospital that fulfill other inclusion and exclusion criteria will be taken up for the study. After written informed consent, relevant data will be obtained from patient and its primary care giver.

Socio-demographic and clinical data will be documented on the predesigned data sheet designed for this study. Symptom onset will be assessed as specified in the schizophrenia symptom onset inventory (Perkins et al, 1999). Severity of the symptoms will be then be rated on Positive and negative syndrome scale (PANSS). Impact of the symptoms on functioning and symptoms related disability will be rated on the WHO Disability assessment schedule (WHODAS) 2.0

The control group of 50 respective First degree relative (FDR), who comply with inclusion and exclusion criteria will be evaluated after a written informed consent. Details of control group will be documented on the socio-demographic and clinical data sheet. Each case will be evaluated on the Schizophrenia symptom inventory (Perkins et al, 1999) and the WHO Disability assessment schedule (WHODAS) 2.0.

Result & Conclusion: Will be presented at conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of psychiatric morbidity and quality of life in patient with type 2 diabetes mellitus treated with insulin versus with those treated on hypoglycemic agents

Swati Mittal, Shubhangi Dere, Shaunak Ajinkya, Rakesh Ghildiyal

Mahatma Gandhi Medical College And Hospital, India, docswati5@gmail.com, shubhangi.dere@gmail.com, shaunaka@hotmail.com, rakghil@gmail.com

Keyword: DM TYPE 2,Psychiatric morbidity, QOL

Introduction: diabetes is a common major health problems with many complications and disability. Studies show that in addition to physical discomfort of disease symptom, patients also has to endure mental, social, financial, personal and occupational distress. Hence there is a higher risk of psychopathology like depression, anxiety and sexual dysfuncion resulting in poor QOL. There are several studies concerning the influences of type of therapy on psychiatric morbidity and QOL of patients thus we decided to study psychiatric morbidity and QOL in diabetic patients with different treatment modalities, i.e. insulin versus OHA

Methodology: Hundred adult patients diagnosed with type2 DM and on treatment for the same, shall be included in study and assigned to two groups (group A-50 patientson insulin;group B -patients on OHA) after obtaining ethics committee approval and informed consent. Socio demographic data will be coolected using self design questionnaire and psychiatric morbidity studied using DSM 1V TR. Quality of life will be assessed using WHO QOL-BREF scale.Data will be pooled and analysed using SPSS version 17

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Impact of Obsessive Compulsive Disorder a case control study in a subset of Indian Population

Radhika Muddireddipalli Sangam, Prasad Rao Gundugurti, Nandini Biswas

Asha institute of medical psychology, counselling & psychotherapy, India, radhika.sangam@dr.com, prasad40@gmail.com, ³University of Calcutta, India, biswas.nandini@gmail.com

Keyword: OCD, Impact, QOL, Disability

Background: Extent of Disability and perceptions of Quality of Life (QOL) were assessed in a sample of 31 patients suffering from Obsessive Compulsive Disorder (OCD) with or without comorbid depression. A second objective of the study was to compare the QOL outcomes measured by two widely used evaluation tools: the 36-item Short-Form Health Survey (SF-36) and the World Health Organization Quality of Life Assessment. In comparison with a matched group of normal healthy controls (N=31), OCD patients fared poorly in all aspects of Disability and QOL. Severity of obsessions but not compulsions predicted Disability and QOL. Compared with non-depressed OCD patients, depressed OCD patients showed markedly greater impairment in discharging home responsibility, although no such difference was found in work and social life domains. Patients of depressed subgroup also reported experiencing more bodily pain and poorer overall physical health. In addition, comorbid depression significantly interfered with QOL in the Environment domain. Among the symptoms of OCD, religious obsession was the strongest predictor of Disability and Quality of Life. Overall OCD symptoms caused significant impairment in the patients’ work domain but had no effect on their social life and responsibility towards home. Age of onset of illness predicted suicidal ideas or attempts. Scores on Quality of Life domains on the two WHOQOL versions were highly correlated. However, subscale scores on the SF-36 and WHOQOL-100 showed weak correlation, indicating that the tools may measure different constructs. Practical impact of the findings on treatment planning, management and rehabilitation of patients are discussed.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of type of anemia in patients admitted in psychiatry ward

Abhijeet Bansod, Abhijeet Faye, Sushil Gawande, Rahul Tadke, Sudhir Bhave, Vivek Kirpekar

NKPSIMS & LMH Nagpur, India, abhijit.horizon@gmail.com, dr.abhifaye@yahoo.co.in, sushil.gawande@rediffmail.com, rahultadke@vsnl.net, shbhave@gmail.com, vivek.kirpekar@gmail.com

Keyword: Psychiatry, Anemia, Hemoglobin

Background: Anaemia is a global public health problem affecting both developing and developed countries with major consequences for human health. According to National Family Health Survey-3, cut off levels of haemoglobin for anaemia for males and females were 12.9 g/dl and 11.9 g/dl respectively. Patients with psychiatric illnesses are prone to suffer from various nutritional deficiencies because of their negligence about personal health and due to the lack of attention given by their caregivers. With this background in mind, the present study was carried out.

Aims and Objectives:-

1)
To study the type of anemia in patients admitted in psychiatry ward.
2)
To study its correlation with various socio-demographic, clinical, nutritional factors as well as haemogram.

Materials and Methods: After taking permission of the institutional ethics committee 30 patients admitted in the psychiatry ward satisfying the inclusion & exclusion criteria were interviewed individually with semi structured proforma prepared for the study. Diagnosis of anemia was made by history, physical examination & blood investigations whereas psychiatric diagnosis was made according to the DSM-V criteria for psychiatric illnesses. Data was collected and statistical analysis was done.

Results: Mean age of the patients was 35 years, with 60% males having mean haemoglobin level of 12.6 and 40% females with mean haemoglobin level of 11.4. Most common psychiatric diagnosis was schizophrenia. 43% of patients admitted in psychiatric ward had low levels of haemoglobin and types of peripheral smears seen in these patients were normocytic hypochromic, microcytic hypochromic, megaloblastic normochromic and megaloblastic hypochromic.

Conclusion: Upto half of the patients admitted in psychiatry ward had presence of anemia and thus evaluation for anemia should be a part of routine psychiatric workup.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect of Belief in Jinnie (Ghost, Bhoot) and Black Magic on Psychiatric Illness.

Aziz Ahmed Quadri, Shahid Haseeb Farooqui

Mental Health Center, India, merajquadri@hotmail.com, drhaseebphy@rediffmail.com

Keyword: Effect of Belief in Jinnie (Ghost, Bhoot) and Black Magic on Psychiatric Illness.

Background:

1)
Study the concept of Jinnie (Ghost, Bhoot) and Black Magic in psychiatric patients.
2)
To observe the impact of belief on Jinnie (Ghost, Bhoot) and Black Magic on treatment and prognosis of psychiatric illness.
3)
To study the different methods used by faith healers (to treat psychiatric disorders).
4)
Compare different diagnostic categories of faith healers & ICD-10.
5)
To study differences in concept of Jinnie (Ghost, Bhoot) and Black Magic in major religions like Hinduism, Christianity and Islam.

Sample size: 100 Psychiatric Patients and their relatives attending psychiatric nursing.

Method: Structured interview focusing on

1)
Beliefs on Jinnie (Ghost, Bhoot) and Black Magic in the light of different Religious teachings.
2)
Awareness about psychiatric illnesses.
3)
Methods used by faith healers to treat psychiatric patients.
4)
Beliefs on faith healers.
5)
Treatment outcome in patients treated by faith healers.

Conclusions & Result:

1)
In our sample 100% relatives of Psychiatric patients believe that the patient is suffering from black magic or possessed by Jinnie.
2)
This idea is reinforced by faith healers and culture, as their family believes that it is a religious concept, they resist treatment.
3)
Most of the methods used by faith healers did not have any religious basis (especially in Islam).
4)
The concept of Jinnie and Black Magic is not advocated by religion in causation of these illnesses.
5)
There is a huge need of awareness about mental illness and education about misconceptions worldwide along with proper religious teachings.
6)
There is a need to work with religious leaders for making them aware about mental illness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A case-control study to assess prevalence of metabolic syndrome among patients with alcohol dependence syndrome: Preliminary findings

Pooja Patnaik Kuppili, Rishi Gupta, Raka Jain, Yatan Pal Singh Balhara

AIIMS, India, poojapatnaik.aiims@gmail.com, mailrishigupta@gmail.com, rakajain2009@gmail.com, ypsbalhara@gmail.com

Keyword: Metabolic Syndrome, Alcohol Dependence Syndrome

Background: Alcohol has been identified as a risk factor for development of Metabolic Syndrome (MS). There is limited literature that has explored prevalence of MS among Alcohol Dependence Syndrome in Indian setting.

Objectives: The current study aimed at assessment of prevalence of metabolic syndrome among patients with alcohol dependence syndrome seeking treatment at a tertiary care substance use disorder treatment centre using a case-control design.

Materials and Methods: The study was conducted at a tertiary care substance use disorder treatment centre. Cases included individuals diagnosed with Alcohol Dependence Syndrome as per DSM-IV. Controls included age, sex, diet and tobacco use matched healthy subjects. The study used a case-control design.

Instruments: Semi-structured proforma was used for socio-demographic profile; DSM IV was used to establish diagnosis; Anthropometric measurements- height, weight, waist circumference; Urine Thin Layer Chromatography to confirm drug of abuse; Biochemical investigations for Fasting blood sugar, serum triglyceride (TG) and High Density Lipoprotein (HDL). The criteria for diagnosing MS was Modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III).

Ethical approval: was obtained from IEC.

Analysis: Data were analysed using SPSS ver 17.0. Descriptive statistics, independent sample t test (for continuous variables), chi square test (with Fischer’s exact test) (for categorical variables) were used. Spearman’s correlation coefficient was used to assess level of correlation between study variables. Level of statistical significance was kept at p< .05.

Results: Cases and controls were comparable on various socio-demographic variables. MS was identified among 60% and 40% of cases and controls using NCEP-ATP III definition, respectively. However, the difference was not statistically significant as compared to the control group (chi square- .80, df-1, p= .65). BMI was also comparable between cases and controls ((t- 1.27, p= .21).

Conclusions: The prevalence rate of MS among patients with Alcohol Dependence Syndrome is comparable to control group

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Event Related Potential correlates of Attention Impairment in Dissociative Disorder: A prospective study

Jitendra Kumar, Daya Ram Kumar

Central Institute Of Psychiatry, India, jnikumarjitendra24@gmail.com

Keyword: P300, P50, Dissociative Disorder

Background: Various studies found that patients with dissociative disorder showed increased startle reflexes and delayed habituation. These findings suggest that dissociative disorders are not associated with increased physiological reactivity. In fact, dissociative disorders seem to be associated with reduced physiological reactivity. One possible mechanism that could explain reduced physiological reactivity in dissociative disorders is reduced attention to external stimuli. Though it has been suggested that amplitudes of P300 might be a state-dependent biological marker of dissociative disorders, there has only been limited exploration on this aspect. It is possible that an attenuated P300 might decrease the amount of information flow, reducing allocation of attention resources, and updating of working memory to avoid both excessive long-term memory system activity and resurgence of affect-laden memories.

Aims and Objectives: Sensory gating abnormalities have not been studied in patients with dissociative disorders. Present study, therefore, attempts to investigate on these lines, and study the electrophysiological correlates of attention in dissociative disorder using event related potential and subsequent changes in these properties with treatment.

Methods: This will be a Hospital based Prospective controlled study. Sample size will include 5 patients with Dissociative Disorder (ICD-10-DCR) and 5 age, sex, education & handedness matched healthy controls. Sociodemographic and clinical data of the subjects will be collected. Baseline ERP will be done using TAT card stimulus and Auditory-oddball paradigm, and data related to P300 and P50 will be collected from patients. It will be matched with data from controls, collected on similar task. The dissociative subjects will then be treated as per institute’s standard protocol. After one month’s follow up, ERP will be re-recorded and data related to P300 and P50 will again be collected. Appropriate statistical methods will be used for analysis.

Results and Discussion: Results will be discussed during the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Renal Transplantation and Psychiatry: Connecting and Missing Links

Amlan Kusum Jana^*1, Neelanjana Paul², Sujit Sarkhel³, Samir Kumar Praharaj⁴, Debasish Sanyal⁵

¹KPC Medical College, Kolkata, India, amlankj@yahoo.com, ²ICARE Institute of Medical Sciences & Research, Haldia, India, neelanjana.paul@gmail.com, ³Institute of Psychiatry, Kolkata, India, sujitsarkhel@gmail.com, ⁴Kasturba Medical College, Manipal, India, samirpsyche@yahoo.co.in, ⁵KPC Medical College, Kolkata, India, dsanyal99@hotmail.com

Keyword: Renal transplantation, psychiatric comorbidity, legal issues

Introduction: Renal transplantation (RT) is an accepted mode of treatment of end stage renal disease (ESRD), providing a favorable outcome both in renal function as well as quality of life. There is a bidirectional interaction between Psychiatry and RT. ESRD itself may cause various behavioral disturbances. Transplantation is a potential source of stress, in the donor due to organ loss, who is also a relative of patient, in most cases. There are psychosocial issues like restrictions in lifestyle after transplantation, cost, and vocational changes. Moreover, use of steroids and other immunosuppresants after RT may directly cause psychiatric comorbidity.

Psychiatric comorbidities have been described in other modes of transplantation as well. However, the sheer volume of patients in RT is higher, making it more relevant than others for studies on comorbidities.

Psychiatric co-morbidities in renal transplantation in RT can arise out of stress of the procedure, change of lifestyle, introduction of new medications, or from their combinations. Depression and anxiety are the commonest, though psychosis is not rare. Symptoms are often precipitated or worsened by complications of illness e.g. rejection, rehospitalization or infection. Quality of life generally improve from pre RT level but worsens with onset of psychiatric illnesses.

Treatment of psychiatric disorders in transplantation recipients is a therapeutic challenge. Many psychotropic drugs are unsuitable for use in renal impairment. Changes in pharmacokinetics, with reduced capacity of patients to excrete drugs and their metabolites, has to be considered along with possible interactions of psychotropics with other drugs that he may be receiving. It is also interesting to discuss as to what extent treatment of psychiatric disorders can alter outcome of transplantation.

Legal issues: There is controversy in RT about legality of related and unrelated donors, with most states in India disallowing unrelated donors, except West Bengal. Another pertinent issue is cadaveric transplantation, which is being conducted nowadays though not very commonly.

Research status and future directions: There is lack of research in psychiatry in this population. There are methodological difficulties in assessing psychiatric co-morbidities, though qualitative and quantitative research is being undertaken in some multi-disciplinary, tertiary hospitals in our country.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A rare case report of Hyperosmolar Nonketotic Diabetes mellitus with Choreo-athetosis

Dipti Reddy Nallu-Indla

SVS Medical College and General Hospital, India, diptin1910@gmail.com

Keyword: chorea-athetosis, hyperosmolarity, non-ketotic diabetes

Objectives:

1)
To describe a rare case report of a hyperosmolar nonketotic hyperglycemia causing choreo-athetosis.
2)
To describe the findings of CT brain imaging.
3)
To determine the prognostic importance of early diagnosis and controlling blood sugar levels to treat the choreo-athetosis.

Methods: This is a case report of a 56 year old female with no previous history of diabetes, who was brought to emergency department at SVS medical and general hospital, Mahabubnagar, Andhrapradesh, in November 2013 with bilateral choreo-athetosis involving upper and lower limbs, perioral area of one day duration. The movements were absent during sleep. The patient was referred to psychiatry department suspecting a conversion disorder.

Results:

1)
RBS 425mg/dl, FBS 201mg/dl, PPBS 396mg/dl, HbA1C 13.2%
2)
Urine glucose ++, urine for ketone bodies negative
3)
Serum osmolality 310mOsm/kg
4)
CT Brain: hyper densities noted in bilateral lentiform nucleus and caudate nucleus.
5)
The choreo-athetosis subsided after controlling the blood sugar levels with insulin therapy within 3 days.

Conclusions: A 56 year old female was brought to emergency department with acute onset of continuous choreo-athetosis of 1 day duration. On investigations, blood sugar and glycated Hb levels were elevated, urine for ketone bodies were negative and CT Brain showed hyperdensities in bilateral basal ganglia. A diagnosis of diabetes mellitus with hyperosmolar non-ketotic hyperglycemia causing choreo-athetosis was made. The movements subsided as soon as blood sugar levels were brought under control with insulin therapy.

It can be concluded that acute onset of choreo-athetosis associated with hyperosmolar non-ketotic diabetes mellitus is reversible if blood sugar levels are controlled and clinicians may avoid expensive and time consuming diagnostic evaluations. Also early diagnosis and prompt treatment will decrease the morbidity.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence and Severity of Postnatal Depression in relation to the percieved Social support, Nature of Delivery and Gender of the baby

Dipti Reddy Nallu-Indla

SVS Medical college and general hospital, India, diptin1910@gmail.com

Keyword: postnatal, depression, prevalence, severity

Background:

Objectives:

To know the prevalence of depression in postnatal women in relation to their socio-demographic profile
To assess the severity of depression in them according to the percieved social support
To assess the severity of depression in relation to nature of the delivery
To know how the severity of depression varies with the gender of the baby

Materials And Methods: This is an on going study planned for a duration of five months, that is from July ^1st to November 30^th of 2014. The expected total sample size is one hundred post natal women who delivered at SVS medical college and general hospital, Mahabubnagar, Andhra Pradesh. The sample selection is consecutive.

Tools used:

1)
Socio-demographic and clinical data sheet to record the demographic details of the post natal women
2)
Edinburgh postnatal depression scale (EPDS)-to screen for the presence of depression
3)
ICD-10 RDC-to confirm the diagnosis of depressive episode.
4)
Multi dimensional scale of percieved social support assessment-to assess the percieved social support from family and friends
5)
Hamilton depression rating scale (HAM-D)-to know the severity of depression

Results And Conclusions: Will be discussed in the conference

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Metabolic Syndrome and their association with drug naïve Schizophrenia and Mood Disorders-A comparative study

Bishnu Bashyal, Hiranya Kumar Goswami

AMCH, India, nubish4u@gmail.com

Keyword: metabolic syndrome, drug naive schizophrenia and mood disorders

Background: It has been found that mental disorders are often associated with metabolic abnormalities, both as an independent co-morbidity and as a consequence of psychopharmacological agents. It has been seen that patient suffering from mental illness demonstrate a higher prevalence of metabolic syndrome (MS) or its component as compared to the general population. According to NHANES III (National Health And Nutrition Examination Survey), USA, the prevalence of MS is 25% (approx) in the adult population in USA. By contrast prevalence of metabolic syndrome in patient with schizophrenia ranges from 37% to 50% and 50% of women and 66% of man with bipolar disorder are overweight.

International Diabetes Federation (IDF) criteria (2005)

Central obesity (defined as waist circumference but can be assumed if BMI > 30 kg/m²) with ethnicity-specific values,* plus two of the following:

Triglycerides 150 mg/dl or greater.
HDL-cholesterol < 40 mg/dl in men and < 50 mg/dl in women.
BP 130/85 mmHg or greater.
Fasting glucose 100 mg/dl or greater.
To meet the criteria, waist circumference must be: for Europeans, > 94 cm in men and > 80 cm in women; and for South Asians, Chinese, and Japanese, > 90 cm in men and > 80 cm in women. For ethnic South and Central Americans, South Asian data are used, and for sub-Saharan Africans and Eastern Mediterranean and Middle East (Arab) populations, European data are used.

Aims and objectives:

To assess the alteration in waist circumference, serum HDL Cholesterol, serum Triglycerides (TGs), Fasting Blood Glucose and Blood Pressure(BP) in newly diagnosed cases of treatment naive schizophrenia and mood disorders.
To compare the waist circumference, serum HDL cholesterols levels, serum triglycerides levels, fasting blood glucose levels and blood pressure between schizophrenia and mood disorders.

Methods: A prospective cross sectional study was conducted for a period of one year from July 2013 to July 2014 at Assam Medical College & Hospital(AMCH). A total of 50 cases each of drug naive Schizophrenia and Mood Disorders were studied. Diagnosis of Schizophrenia and Mood Disorders were done clinically, using ICD-10 and patients of Schizophrenia were also evaluated using PANSS. Clinical and investigation details were studied with the help of Advanced Clinical Biochemistry Laboratory, AMCH.

The ‘treatment naive’ cases of Schizophrenia and Mood Disorders will constitute the study group, wherein treatment naive = 1. Newly diagnosed drug – free cases of Schizophrenia & Mood Disorders. 2. Previously treated known cases of Schizophrenia & Mood Disorders, currently drug – free for ≥ 6 months.

Results: The level of serum HDL Cholesterol was found to be significantly lower in drug naïve Mood Disorders as compared to Schizophrenia (p<0.05). Also the level of serum triglycerides (TGs) was found to be significantly higher (p<0.05) in Schizophrenia patients who scored more in negative symptoms than positive symptoms (i.e, N>P) in PANSS scale.

Conclusion: Amongst the parameters of MS, serum HDL cholesterol is lower in Mood Disorders as compared to Schizophrenia. Serum TGs is higher in Schizophrenia with predominant negative symptoms.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Profile of Depressive symptoms in Late life based on Montgomery Asberg Depression Rating Scale.

Anisha Nakulan¹, Sebind K², Sumesh T P², Shaji K S²

¹Amala Institute of Medical Sciences, India, anisha_nakulan@rediffmail.com, ²Government Medical College, Thrissur, India, sebind@gmail.com, drsumeshtp@gmail.com, drshajiks@gmail.com

Keyword: Late life Depression, MADRS

Aims and Objectives: To study the profile of depressive symptoms among community resident older people.

Methodology: Two hundred and seventy five people (sixty five years or older), from three wards were invited to participate in the study. Clinicians made assessments during camps or home visits organized for this purpose. Diagnoses were made as per ICD-10 Research Diagnostic Criteria. Profile of depressive symptoms was assessed using Montgomery Asberg Depression Rating Scale (MADRS).

Results: 220 consenting subjects were assessed. Point prevalence of depression was 39.1% (95 % C.I: 32.6 - 45.9).Of the 86 depressed elderly, 52.3% (95% C.I: 41.3-63.2) had a sleep disturbance of moderate severity characterized by fragmented sleep or total sleep time reduced by 2 hrs. 64% (95% C.I:52.9-74) of the depressed had reported sadness of moderate severity. Mild concentration difficulties were reported by 59.3% (95% C.I:48.2-69.8). 54.7% (95% C.I:43.5-63.4) reported mild level of pessimistic thoughts regarding their self. Weariness of life and fleeting suicidal thoughts were reported by 37.2% (95% C.I: 14.8-33.6) of the depressed elderly.

Discussion: Late life depression remains largely undiagnosed and inadequately managed. More than half of the depressed in our study reported that they felt sad most of the time. Significant depressive symptoms like feeling sad always, sleep disturbances, concentration difficulties and pessimistic thoughts are usually disregarded by the non-specialist health care providers as characteristics of normal ageing. Screening for depression in the elderly who report these symptoms, by all health care providers, may help in better detection and management of late life depression.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Relationship between spirituality, religiousness and coping skills in patients with schizophrenia during remission

Soumitra Das, Sathesh Vadasseril, Varghese P. Punnoose

Department of Psychiatry, Govt. T. D. Medical College, Alappuzha, Kerala, India, soumitratdmc@gmail.com, drvsathesh@gmail.com, vargheseppunnoose@yahoo.com

Keyword: Sprituality, Religiousness, Coping, Schizophrenia, Remission.

Background: Schizophrenia is often a chronic and disabling condition associated with impairments in multiple domains of functioning characterized by disruption in cognition, perception and emotion. Patients rely more on maladaptive coping during the illness. Religiousness and spirituality seems to offer valuable benefits to patients living with and recovering from Schizophrenia. Patients suffering from Schizophrenia often report that religion is source of strength and resilience in their life even though the role of religion in mental illness remains understudied.

Objective: To evaluate the relationship between spirituality, religiousness and coping skills during remission in Schizophrenia patients.

Methodology: Hospital based cross sectional study in the Department of psychiatry, Govt. T. D. Medical College, Alappuzha.

Duration: 1 year.

Tools for assessment:

Positive and Negative Syndrome Scale [PANSS]
Personal and Social Performance Scale (PSP)
Ways of coping questionnaire - Revised (WAYS)
WHO Quality of Life-Spirituality, Religiousness and Personal Belief scale [WHOQOL-SRPB]

Procedure: Clinically diagnosed patients with schizophrenia obtained by consecutive sampling were screened with PANSS and PSP to collect cases in remission. Then cases were examined with WHOQOL-SRPB followed by WAYS. All the scales were applied in a single setting after taking written consent from the patient as well as care giver.

Statistical analysis: Results are analyzed using SPSS software. Following tests are used:

Independent T test, Mann Whitney U test, Kruskal Wallis H test, Chi-square test, Pearson’s product moment correlation test.

Results: There is significant relationship (P<0.05) between domain score and the scales of WAYS except confrontive coping and escape avoidance. It signifies the importance of spirituality and religiousness in adaptive coping mechanism during remission of Schizophrenia.

Conclusion: A sound religious and spiritual system positively affects the coping skills. Understanding and assessing the spirituality and religiousness of subjects with schizophrenia can help in better management of the disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Delirious mania as an uncommon presentation: response to electroconvulsive therapy

Smitha L. Rasquinha, Ashok M. V., Priya Sreedaran

St. John’s Medical College, India, smithaljr@gmail.com

Keyword: delirious mania, acute onset, electroconvulsive therapy (ECT)

Background: Delirious mania refers to a syndrome that includes altered consciousness, disorientation as well as manic symptoms. A subtype of catatonia characterized by excessive motor activity, delirious mania is an uncommon presentation. However, this condition can be fatal without timely recognition and treatment (Lee et al., 2012).

Here, we describe a patient with delirious mania who presented to the emergency room, and the role of electroconvulsive therapy (ECT) in treatment.

Methods: Ms. P, a 19 year old student from the suburbs presented to our emergency room with restlessness and agitated behavior of acute onset, accompanied by confusion and disorientation that had been persisting since over a week. She was found mumbling to herself, holding abnormal postures for long periods, refusing food and unable to sleep at night.

Results: Patient was transferred to psychiatry after all relevant investigations were found to be normal. In the ward, she was found to be delirious, with double incontinence. She was initially maintained on lorazepam and no improvement was noted. Hence, it was decided to administer ECT: a total of 5 sessions were administered. Improvement was noted in the form of orientation to surroundings, as well as bowel and bladder control. After the 5^th ECT, delirium completely resolved; however, manic symptoms emerged. Ms. P was started on sodium valproate optimized to 750mg, to which response was noted, and patient was subsequently discharged within a week.

Conclusion: Delirious mania is a subtype of catatonia, unlike hyperactive delirium; therefore, antipsychotics must be used with extreme caution. Initiation of ECTs as the modality of treatment was seen to lead to the rapid resolution of manic delirium.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect Of Vitamin D Supplementation In Treatment Of First Episode Psychosis: A Randomized Double Blind, Placebo Controlled Study

Satyam Kishore, Basudeb Das, Kshitiz Kumar Kshitiz

Central Institute of Psychiatry, Ranchi, Jharkhand, India, sksrivastava1986@gmail.com, basudeb71@gmail.com, drkshitiz08@yahoo.co.in

Keyword: First episode psychosis, Vitamin D, 2000IU/day, Placebo.

Objectives: This study is designed to evaluate the effect of Vitamin D supplementation in patients with First episode psychosis. Vitamin D deficiency is seen in large number of patients with established psychotic disorders, but it is not known if this is present at the onset of illness and what effect would supplementation of Vitamin D would have in the prognosis of the illness. To the best of our knowledge, there are no clinical trials in India linking the role of Vitamin D in first episode psychosis patients and its efficacy in treatment.

Method: The study will be a randomised double blind, placebo controlled hospital based study. The subjects will be recruited for the study by simple random sampling technique. Sample size will consist of 10 diagnosed drug naïve (or drug free for minimum 4 weeks for oral psychotropic medications & 8 weeks for depot preparations) cases of first episode psychosis according to ICD-10 DCR (WHO, 1993). Recruited sample for the study would be divided into two groups using computer generated randomization table. For those patients selected for Vit.D supplementation 2,000IU/day of Vit.D daily would be given along with medication and the other group will be treated with medications and placebo (procured from the same source as Vit.D). Blood sample examination for various parameters assessed at baseline and clinical assessment using the scales will be done at time of admission and again after 4 weeks.

Results and Discussion: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric in-Patients Perception of impact of Yoga on their Health

Sailaxmi Gandhi^*1

¹National Institute of Mental Health & Neurosciences (Institute of National Importance), India, sailaxmi63@yahoo.com

Keyword: Yoga, complementary therapy, health perception, mental illness, psychological health, physical health, social health

Objectives: This study was undertaken to explore psychiatric in-patients’ perception of the impact of yoga on their health as well as the association of socio-demographic variables with this perception.

Methods: Fifteen male and fifteen female psychiatric in-patients attending yoga sessions, and in the age group 20-50 yrs. were invited to participate in this study following informed consent and ethical clearance using purposive sampling and a post-factor without control group research design. A structured interview schedule consisting of 30 items within the five domains of physical health, psychological health, social health and mental health was administered. Analysis was done using descriptive statistics, t-test and one-way ANOVA.

Results: While 46.7% of the subjects felt active and more flexible, 43.4% expressed improved digestion and bowel movements & 30% felt relief of aches and pains. 60% felt happier, 46.7% found life more interesting and 36.7% noted that they were more calm and could control anger. More positive thoughts were reported by 46.7%, a feeling of being more relaxed by 53.3%, improved concentration by 43.3% and better sleep by 33.3%. Better interpersonal relationships, higher self-esteem and increased ability to deal with difficult situations were highlighted by 33.3%. Urban residents reported higher perception of better health (t = -2.337, p=0.032). Patients admitted several times reported better perception of social health following yoga (t=-2.481, p=0019).

Conclusion: Visceglia et al., (2011), reported significantly better quality of life following yoga in patients with schizophrenia. This research too supports yoga as a complementary therapy for persons with mental illness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Evaluating Seizure disorder as a predictors of Delirium Tremens (DT) in the course of moderate to severe alcohol withdrawal Case Control study

Shailesh Jha^*1, Amit Garg², Pallavi Sinha³, Pankaj Kumar⁴

¹IHBAS, India, dr.shaileshk.jha@gmail.com, ²IHBAS, India, drgargamit@yahoo.com, ³IHBAS, India, pallavisinha0102@gmail.com, ⁴IHBAS, India, drpankajkumar13@yahoo.co.in

Keyword: Alcohol Withdrawal Syndrome, Delirium Tremens, Seizure disorder

Background: The alcohol dependence is not uncommon in patients with independent diagnosis of seizure disorder. The dilemma faced at the time of differentiating withdrawal seizures from those of independent seizure disorder. Delirium tremens (DT) in course of alcohol withdrawal carries significant risk of mortality. Early risk identification and initiation of treatment can help in preventing DT. Studies have suggested that a recent epileptic seizure is found to herald the development of DT. Therefore this prediction can become the cornerstone in avoiding DT especially in patients with past independent epilepsy.

Objectives: To study seizure disorder as a predictor of Delirium Tremens (DT) in the course of moderate to severe alcohol withdrawal.

Methods: A retrospective cohort of 61 patients consecutively admitted in the de-addiction unit of a neuropsychiatric tertiary care hospital within a span of 18 months with DT was evaluated. The diagnosis of independent past seizure disorder made, based on clinical description and medical records. Two groups were made and compared: group I i.e. DT with seizure disorder and group II as control i.e. DT without seizure disorder. The data also included sociodemographic details, pattern of drinking, clinical variables and baseline investigations.

Results: Parametric statistics were applied on the data. 16.94% of total admissions were diagnosed as alcohol withdrawal delirium. The mean age of patients with DTs was 35.66 years while mean age at which criterion for alcohol dependence were met was 25.34 years. The mean duration of abstinence was 3.52 days. The complete data will be presented at the time of presentation.

Conclusion: DT is a potentially life threatening state with previously established clinical variables which indicate towards the development of DT. Assessment for easily detectable risk factors can enable the clinician to make an accurate prediction of developing alcohol withdrawal delirium.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A comparison of sexual dysfunctions in Obsessive Compulsive Disorder and Healthy Controls

Pankaj Bharat Borade, Sonia Malhotra, Alok Tyagi

SMS Medical College, Jaipur, India, pankajthephilosopher@gmail.com, docsoniamalhotra@gmail.com, dralok_tyagi@yahoo.com

Keyword: sexual dysfunctions, Obsessive Compulsive Disorder

Background: Sexual dysfunction is a common problem in the patients diagnosed with obsessive disorders and other neurotic disorders. Sexual dysfunction has a debilitating impact on patient’s social functioning. Moreover, past studies do indicate sexual dysfunctions as secondary to many of anti neurotic medications. Therefore, a study of comparing rates in patients with OCD and healthy contros warrants high importance.

Objectives: To compare the sexual dysfunctions rate between OCD and Healthy Controls.

Method: A Cross sectional comparative study of 100 patients, 50 each of patients diagnosed with OCD and as Healthy controls, in patients coming to OPD of psychiatric centre Jaipur. Yale Brown Obsessive Compulsive Disorder Scale (YBOCS) is used to access the severity in OCD. Arizona Sexual Experiences Scale (ASEX) is used to asses sexual dysfunctions. The Patients are diagnosed as OCD according to ICD criteria.

Results and Conclusion: It will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Stress in school teachers of a school in west bengal, India

Sumanta Dawn, Om Prakash Singh

Nilratan Sircar Medical College and Hospital, India, dawncnmc@gmail.com

Keyword: stress, schools, teachers, social psychiatry

Background: Teaching in school is a highly stressful occupation.The study is a significant addition to the teacher stress and burnout literature.

Stress is defined as “An excess of demand made upon the adaptive capabilities of the mind and body” and is seen in the form of a physical demand, a mental demand or both.

The globalization and privatization of the education system in different countries and in India forced the higher education to be more competent so as to produce the stakeholders with better knowledge, accommodativeness, skills and competencies which are essential for survival inthe world market. In tune with this, the Indian education system had undergone rapid changes in terms of expansion, privatization, marketization, curricular reforms and pedagogical innovations. With those rising demands of modern educational system, teachers are being more stressed day by day.

The findings will help to implement effective primary and secondary level prevention programmes against occupational stress taking into account how males and females and younger and older teachers perceive stress at work.

Objectives: To measure the magnitude of stress among school teachers

To find out the relation between different socio demographic variables and stress

Method: All the teachers of the school meeting the inclusion and exclusion criteria who gave valid consent are studied using

a socio-demographic questionnaire
work tension scale
SPSS latest version is used for statistical analysis

Result-: 60% of the study population(n=61) were either moderately or severely stressed. There is more stress in female teachers than their male counterpart(0.175,p<0.05)using work tension scale. Travel time of more than 2 hours from residence is associated with increased stress(0.134,p<0.05). Para-teachers with income of less than 10000/month are more stressed than their regular counterparts(0.217,p<0.05).

Conclusion: Most of the teachers are stressed with significant relation to their stress with female gender, distance from school and less remuneration.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence and correlates of attention deficit disorder among young adults with risky sexual behaviour

Shankar Kumar, Varun Huilgol, Amrtavarshini Radhakrishna, Chandrashekar Hongally

Bangalore Medical College and Research Institute, India, shankarkjs@gmail.com, varungh@gmail.com, iamamrta@gmail.com, chanag61@gmail.com

Keyword: attention deficit disorder, sexual behaviour,

Background: The prevalence of attention deficit disorder (ADD) in adults is 4-8% as per literature. This can manifest itself with unstable interpersonal relationships, multiple dismissals from employment, risky driving and also risky sexual behavior due to the symptom domain of impulsivity in ADD. Research on prevalence and correlates of risky sexual behavior in ADD is lacking.

Thus, this study aims to study the prevalence of ADD in young adults (<25yrs) with risky sexual behaviors and also its correlates with other personality traits and psychopathology.

Methodology: 50 young adult volunteers, recruited through snowballing technique who had risky sexual behavior as assessed by HIV risk behavior scale were recruited into the study. MINI Plus was used to screen for Axis-1 psychiatric disorder. They were then administered Adult ADD screening rating scale (ASRS) and Wender Utah rating scale to screen for ADHD, Barretts impulsivity scale abbreviated and Stimulating and instrumental risk questionnaire to measure personality traits of impulsivity, sensation seeking, risk taking. SPSS v 17 was used for analysis of data.

Results and conclusion: The prevalence of ADD in our sample of those with risky sexual behavior was 15%. This population also had significantly high prevalence of Impulsivity and sensation seeking traits than those without ADHD(p=0.03). Further results will be discussed..

Thus, ADD could probably contribute to risky sexual behavior which needs further evaluation as this could be a potentially treatable factor.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study on Depression and Coping Mechanisms used by Multiple Sclerosis Patients

Namita Singh, Subhashini Prabhakar

Apollo Hospitals, Hyderabad, Telangana, India, namsingh31@yahoo.com, subhashiniprabhakar@yahoo.co.in

Keyword: Multiple Sclerosis, Depression, Coping Mechanisms

Background: Aim- To assess the level of depression and coping mechanisms used by multiple sclerosis (MS) patients.

Methodology: It is well known that the diagnosis of MS has a deep emotional and physical impact on the quality of life of the patient. In a preliminary study twenty MS patients in age range 33-62 years with different stages and types of the disease were examined in the MS clinic of Apollo hospital, Hyderabad. The patients and caregivers were interviewed on types of resources used by them as their coping mechanisms. Beck’s depression Inventory-II (BDI-II) was used to assess the level of depression. The patients were evaluated by a neurologist for level of illness using Expanded Disability Status scale (EDSS). Qualitative content analysis was done for the responses given by the patient, to study the in-group comparisons of age at onset of the disease, stage and coping mechanisms used.

Results: The scores indicate minimal to severe levels of depression in the patients depending on the onset age and type of MS as Relapsing-Remitting Multiple Sclerosis (RRMS) or Secondary Progressive (SP). The patients with severe levels of depression also had a high ranking on EDSS. These coping mechanisms consisted of psychosocial, physical and medicinal support categories. Few of the variables studied are age, education, marital status, financial status, physical workout, mode of recreation and type of treatment –Interferons, Immunomodulatory drugs.

Conclusions: It is important to develop formal programs for the patients and their care-givers to sustain improved quality of life at emotional, physical and social levels. This will be used as a protocol for treatment. We would further like to explore how common is depression in people with MS? Is there a correlation between fatigue and low moods in MS? What psychosocial factors increase the risk of the anxiety and depression in MS patients?

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

An Item Response Theory based analysis of the Hamilton Depression Rating Scale-An Indian Perspective

Debasish Sanyal^*1, Bhaskar Mukherjee²

¹KPC Medical College, India, dsanyal99@hotmail.com, ²Maldah Medical College, India, dr.bhaskar.mukherjee78@gmail.com

Keyword: Item Response Theory, Hamilton Depression Rating Scale, psychometry, depression

Background: First published more than 40 years ago Hamilton Depression Rating Scale (HAMD) remains the most widely used outcome measure. Many consider the scale to have many defects. Psychometric properties of the individual HAMD items using Item Response Theory(IRT) perspective needs to be done in Indian context.

Aims: To use IRT analysis to identify HDRS items which are problematic in terms of IRT parameters, thus suggest changes to the scale.

Methods and Material,: Settings and Design-subjects from a Out Patient Department of a mental hospital. Observational cross-sectional study was done Patients attending psychiatric OPD meeting DSM-5 criteria for unipolar depression were selected for the study. Patients were between 18-65 years of age, had no major medical problems and were not on any medicines at present. 17 item HDRS was administered using the anchors developed by William Guy as part of the ECDEU NIMH Collaborative Study. All HAMD administrations in the studies were done by trained, experienced raters using a structured interview guide. To determine the relationship between scores on the individual HAMD items and overall depressive severity in an outpatient population. Option Characteristic Curve (OCC) which is a graphical representation of the probability of endorsing the different options for a given item across the range of depressive severity) and Item Characteristic Curve (ICC) which is a graphical representation of the mean item score (expected value) and confidence interval as a function of depressive severity was used.

Results: Results showed that Items Depressed Mood, Work and Activities show good relationship between item responses and overall depressive severity. Items Hypochondriasis, somatic symptoms general and retardation appeared to be more problematic with regard to their ability to discriminate over the full range of depression severity.

Conclusions: Further studies are needed to critically review one of the most commonly used scale for one of the commonest malady of humans

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Safety Pins in Peritoneum: A Case of Pica with Intestinal Perforation and Peritonitis

Rajeev Ranjan, Shobhit Jain, Rajesh Sagar, Abhinav Pandey

AIIMS, New Delhi, India, rajeevranjan5@yahoo.co.in, jainshobhitji@gmail.com, rajeshsagar@rediffmail.com, drabhinavpandey0103@gmail.com

Keyword: PICA, Safety pins, Surgical complications, Adult Onset

Background: Pica is a type of eating disorder in which individual generally have craving for substances not fit as food or of no nutritional value. Pica is commonly seen in pregnancy, small children with developmental disability and mental retardation. Although geophagia (earth eating) has been documented in many areas of the world, the specific preference for consuming sharp objects like pins, nails are less well known. Also, there have been frequents reports of pica in children but occurrence in adults with surgical complications other than pregnant women has rarely been reported.

Methods: The case presented here reports a 32 year old female patient who had craving for ingestion of safety pins since the age of 20 years after marriage. She introduced the practice of ingestion of safety pins, iron nails to herself as she had a significant amount of stress in her personal life since marriage. Presently, even though the patient is relieved of stress she is psychologically unable to stop the habit. The presentation in this patient was abdominal pains, with the radiographs showing radio opaque opacities suggestive of bunch of safety pins nearby colon in peritoneum. These opacities were of varying sizes, and of varying densities and changed in position with time, when patient was admitted second time after having exploratory laparotomy and removal of pins in first admission. Patient also developed pyoperitoneum, right tubo ovarian abcess which was drained in first admission.

Results: The patient described showed reluctance to reveal her craving for pins and only after a thorough detailed questioning, she admitted her craving history. Relevant clinical issues, pertaining to pica in adulthood and surgical complications of pins are reviewed and discussed in the report.

Conclusion: The case report adds to the limited literature on adult onset pica with consumption of safety pins and their surgical complications.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Tobacco use characteristics amongst women in an urban community.

Sonali Jhanjee, Rakesh Lal, Ashwani Mishra, Deepak Yadav

¹All India Institute of Medical Sciences, India, sonali_arj@hotmail.com, rakeshlall@rediffmail.com, ashwanikm@yahoo.com, ydeepakaiims@gmail.com

Keyword: smokeless tobacco; women; dependence

Background: The South-East Asia Region is one of the fastest growing markets for tobacco consumption particularly among women. It is important to study their tobacco use characteristics to plan intervention.

Aims: The aim of this study was to study tobacco use characteristics among women in an urban resettlement colony in Delhi.

Methodology: A representative sample of women were screened by ASSIST (The Alcohol, Smoking and Substance Involvement Screening Test), assessed on tobacco use characteristics on a semistructured proforma, and administered Fagerstrom’s test for nicotine dependence(FTND) and Fagerstrom’s test for nicotine dependence-smokeless tobacco(FTND-ST) to assess the severity of dependence on smoking and smokeless tobacco use respectively.

Results: A total of 95 female tobacco users with a mean age of 44 ± 12 years were included in the study and majority of them were married (78%). Most females were illiterate (62%). Majority were housewives (68%) and 58% came from nuclear families. Most females were smokeless tobacco users and pan with tobacco (92.6%) was the commonest form of smokeless tobacco use in these women. Mean ASSIST score was 20.95 ± 5.3 indicating moderate risk users and the mean scores of FTND-ST of 4.0± + 2.5 indicating low level of dependence on smokeless tobacco.

Conclusions: The moderate ASSIST scores and low levels of dependence on tobacco indicate that low cost psychological interventions like brief intervention can be provided to women in this setting to help them to quit tobacco.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Rare case of Dysembryoblastic Neuroepithelial Tumour presented as Psychosis

Jeyaprakash Jeganathan, Kumar Namakkal Santhanam, Venkatesh Madhan Kumar, Mohammed Ilyas Rahmadullah, Asokan T V

Government Stanley Medical College & Hospital, Chennai, India, drjjeyaprakash@rediffmail.com, nskumar92@gmail.com, drjjeyaprakash@rediffmail.com, drjjeyaprakash@rediffmail.com, tvasokan@gmail.com

Keyword: Dysembryoblastic neuroepithelial tumour, atypical psychosis, surgically treatable psychosis, vocal tics

Introduction: Dysembryoplastic neuroepithelial tumors are benign, rare, neuronal and mixed neuronal glial tumors with supratentorial cortical location and the extra cortical areas. Usually occurs in children and young adults. We present a case of DNET presenting atypically with vocal tics and psychiatric manifestations without epilepsy.

Case Report: A 35Y/Male, c/o anger outbursts, using obscene language, frequently making high-pitched abnormal sounds like ‘aei’, seeing female images, hearing voices- past 8years. Chronic and slowly progressive. Ideas of persecution & ideas of control present. Visual& auditory hallucinations present. MRIbrain scan was carried out, to r/o the possibility of any SOL. Surprisingly, MRIbrain showed well defined, bubbly, cystic and multiseptated lesion in the left putamen, posterior limb of internal capsule& anterior aspect of corona radiate s/o DNET. Neurologist ruled out possibility of seizures(TLE). Normal EEG. Neurosurgeon suggested surgical intervention.

Discussion: These slow-growing tumors usually show an indolent course and stable for many years with a favorable prognosis. So the recognition and correct diagnosis is important and complete resection is the treatment of choice. To date, there is only one case report of the association of DNET and psychiatric features. In this patient, the tumour at the region of basal ganglia produce vocal tics and psychiatric manifestations and after surgical resection of the tumour, complete remission occurred.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Performance of MiniCog test in rural elderly from Southern India

Siddharth Sarkar, Shivanand Kattimani, Sonali Sarkar, Gautam Roy, K C Premarajan

Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, sidsarkar22@gmail.com, drshivanand@gmail.com, sonali.s@jipmer.edu.in, gautam.r@jipmer.edu.in, premarajan.kc@jipmer.edu.in

Keyword: MiniCog, cognitive impairment, elderly, community, screening

Background: Though MiniCog has been well established as a screening instrument for cognitive impairment in the Western elderly population, its applicability to the Indian elderly still needs to be evaluated.

Objectives: The present study aimed to assess the performance of rural elderly population on MiniCog screening test.

Methods: The cross-sectional study involved 256 consenting elderly (age 60 and above) from a village in rural Puducherry. MiniCog was used as a screening instrument for assessment of cognitive impairment and compared with standard screening tool, mini-mental status examination developed for Indian rural population, popularly known as Hindi adaptation of MMSE (HMMSE).

Results: The mean age of the sample was 68.8 (±7.7) years, with 62.5% of the sample being females, and 60.5% had no formal education. Out of the 256 participants, only 142 (55.5%) of the tests on MiniCog were eligible for evaluation. A considerable proportion of participants (44.5%) could not be rated on MiniCog due to refusal or inability to draw the clock. Most of these had not seen the clock. Scores below cut-off qualifying for presence of cognitive impairment was present in 26.1% of the participants on MiniCog. Increased age independently predicted poor performance on MiniCog. The sensitivity and specificity of MiniCog with respect to HMMSE was 100% and 78.4% respectively.

Conclusion: MiniCog may not be a good measure for assessment of cognitive impairment in Indian rural elderly. A significant proportion of the elderly population had no concept of clock or was reluctant to hold pencil to draw the clock.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of Sociodemographic and Clinical Predictors of Compliance with Pscychotropic medications

Bhanu Pratap Singh, Harshavardhan Sampath, Geeta Gurung

Sikkim Manipal Institute of Medical Sciences, India, Bhansinghjodhpur@yahoo.in, drharsha79@yahoo.co.in, geetacintury@yahoo.com

Keyword: Compliance Psychotropic medication

Background: Compliance is defined as the extent to which a patient’s behaviour coincides with medical or prescribed health advice. It has become a focus of increasing concern as the reported rates of non compliance for psychiatric illness ranges from 24-90%. Compliance is a multi factorial problem that involves the patient, treating clinician, number of medications prescribed, the nature of illness and complex socio- cultural issues. It is a challenging matter in psychiatry as it negatively impacts on prognosis, disability, quality of life and economic burden of the illness.

There is paucity of Indian research on compliance among psychiatric patients that can guide good clinical practice and policy making.

The aim of the study is to assess the socio-demographic and clinical correlates of compliance among patients attending the outpatient services of the department of postgraduate Psychiatry at Sikkim Manipal Institute of Medical Sciences.

Consecutive samplings of all consenting patients attending the OPD for a period of 3 months are included in this study. Socio-demographic variables like age, gender, marital status, education level, economic status, and place of residence are recorded.

Non compliance was operationally defined as missing medication for 3 consecutive times, or 2 days in a week, or 5 days in a month or changing the dose of medication without advice of physician. Non compliant patients were administered the Reasons for Noncompliance questionnaire. This is a 19 item questionnaire that was developed after extensive literature analysis and review to assess the various factors that contribute to non compliance.

The incidence of noncompliance and the socio-demographic and clinical correlates are analysed using appropriate statistical tools.

The results will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Mental Health of “Doctors-to be”: A cross sectional study

Vinod Akkasali, Narayan Mutalik, Sreeraj V S, Bhaskar Mara, Sucheta Waghamare

S N Medical College, India, avnode28@gmail.com

Keyword: Medical students, Mental health, GHQ-28

Background: Medical education has been identified as one of the most exhaustive courses with rigorous training period, which might contribute to the development of psychiatric morbidity.

Method: This cross sectional study was designed to assess the status of mental health of 301 medical students from Sri Nijalingappa Medical College, Bagalkot using the General Health Questionnaire-28.

Results: The psychological problems stood at 52.1%; highest among first year students (61.9%) followed by 3rd year part-1 students (75.6%). Least was during internship (17.5%) followed by final year students (50%). Female students showed a higher prevalence of psychiatric morbidity compared to males.

Conclusion: There was a high prevalence of psychological problems indicating higher psychiatric morbidity among medical students. Similar findings in literature across medical institutions of our country, calls for an immediate attention and effective management. Prevalence of problems decreases with training years, the causes of which, the factors leading to the psychological distress, the coping methods used as well as the actual prevalence of psychiatric disorders needs to be evaluated.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Clinical Study Of Disruptive Mood Dysregulation Disorder Among Children And Adolescents Attending Psychiatry OPD

Rashmi Tiwari, Vivek Agarwal, Amit Arya, Pawan Kumar Gupta, Pooja Mahour

Department of Psychiatry KGMU Lucknow, India, drrashmikgmu06@gmail.com, drvivekagarwal06@gmail.com, amitarya.11kgmu@gmail.com, gpawan2008@gmail.com, poojapsy@gmail.com

Keyword: Disruptive Mood Dysregulation Disorder, Chronic irritability, DSM 5, paediatric mood disorder

Background: Recent reports suggest that there is a dramatic increase in the rate of diagnosis of paediatric bipolar disorder in last two decades. Often children presenting with chronic irritability, were misdiagnosed as bipolar disorder. DSM-5 included new category of Disruptive Mood Dysregulation Disorder (DMDD) under mood disorders to diagnose chronic irritability.

Aims: The aims of our study were to assess phenomenology, co-morbidities and global functioning in children & adolescents with Disruptive Mood Dysregulation Disorder.

Methods: Children and adolescents in the age range of 6 to 16 years presenting with irritability for more than one year were screened for selection criteria and those who fulfills the criteria were studied further. After detailed assessment on K-SADS-PL, DSM 5 diagnostic guideline was used to make a diagnosis of DMDD and comorbidities were diagnosed on DSM IV TR. Severity of irritability was assessed using Affective Reactivity Index. Phenomenological assessment was done on Conners Parent Symptom Questionnaire. Impairment in functioning was assessed on CGAS.

Results: 21 (30%) out of 70 screened patients were diagnosed with DMDD. Majority of the DMDD patient (71.4%) were in the age group 6-12 years (mean age11.14 years) and were male (76.2%).Most common presenting complaint were, being angry or getting irritable frequently (100%), not paying attention to studies (95.2%). Most of the patients (85.71%) had moderate to severe irritability as per the parent version of ARI. 62% of DMDD subjects had comorbidities of which common were ODD (30.8%), ADHD (23.1%), and dissociative disorder (23.1%). Mean CGAS score was 46.14(6.95).

Conclusion: DMDD was diagnosed in about one third of patients presenting with chronic irritability in hospital set up. Most of the patients showed moderate to severe irritability. Psychiatric comorbidities are commonly associated with DMDD. Patients had significant impairment in functioning.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Short term outcome of psychiatric co-morbidity in children and adolescents with intellectual disability admitted to a tertiary care centre

Sugnyani Devi Patil^*1, Satish Chandra Girimaji²

¹DIMHANS, India, sugnyani.devi63@gmail.com, ²NIMHANS, India

Keywords: intellectual disability, psychiatric co-morbidity, outcome

Abstract: Children and adolescents with Intellectual Disability (ID) are at increased risk of psychiatric disorders when compared with their non ID peers. Psychiatric co-morbidity can have a significant impact on a child’s functioning, coping skills and adaptation to community life.

Objectives: We aimed to examine the outcome of psychiatric and behavioral co-morbidity in children and adolescents with intellectual disability.

Methods: We evaluated 30 children and adolescents admitted in child and adolescent psychiatry ward NIMHANS, Bangalore with ICD-10 diagnosis of mental retardation (Intellectual disability) and psychiatric co-morbidity using Mini International Neuropsychiatric Interview for children and adolescents (MINI-KID),Vineland Social Maturity Scale, Developmental behaviour Check list - parent version (DBC-P), Clinical Global Impression, Children’s Global Assessment Scale (C-GAS), Family interview for stress and coping in mental retardation (FISC-MR). Participants were assessed at admission, discharge and one month following discharge. Descriptive statistics, correlation coefficient and repeated measures of ANOVA were used for analysis.

Results: 18.8% of children with ID had multiple psychiatric co-morbidities. Attention deficit hyperactive disorder (n=20, 62.5 %) and pervasive developmental disorder (n=20, 62.5 %) were most prevalent co-morbidity. Baseline scores of DBC, C-GAS, FISC-MR significantly reduced at discharge and at follow up with treatment as usual at child and adolescent psychiatry unit, NIMHANS, Bangalore (p<0.01). There was significant reduction in perceived stress in the family at discharge and which maintained at follow up.

Conclusion: Above findings highlight the importance of assessing psychiatric and behavioral problem in children with ID. Appropriate management of psychiatric co-morbidities in children with ID had better short term outcome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Linking Cognitive Function and Perception of Facial Expression: A comparative study in schizophrenic and bipolar patients

Kaberi Bhattacharya, Gargi Dasgupta

Medical College and Hospital, Kolkata, India, bkaberi.acharyya@gmail.com, gdasguptain@gmail.com

Keywords: emotion perception cognitive function schizophrenia bipolar

Background: Perception of emotional expression in others is an important social skill which is impaired in schizophrenia and contributes to poor social adjustment. Similarly many of the symptoms experienced by patients with bipolar disorder, including irritability, distractibility, and emotional lability would appear to be associated with abnormalities in emotion processing. Moreover it is well established that both group suffer from cognitive dysfunction.

Objective: Our assumption in the context of present study was that emotional and cognitive functions are inter related and affect each other. Thus, difficulty in cognitive domains may influence emotional perception. We examined the relationship between expressions of emotions in both group of patients and compared them with other neurocognitive functions.

Methods: 30 chronic and stable schizophrenic patients and 28 euthymic bipolar patients were given Wechsler Adult Performance Intelligence Scale (WAPIS) which contains picture completion, picture arrangement, object assembly, block design and digit symbol test. They were also given PGIBBD verbal intelligence scale which assess 4 areas e.g. digit span (attention), comprehension, calculation and information. To assess their ability to perceive emotion Bengali version of” Reading the mind in eyes” test was given. Their sociodemographic profile was noted. 25 healthy age sex education matched controls were given the same set of tests.

Results: Relation of emotion perception with different domains of cognitive function was assessed statistically. Significant differences were noted in the result. Conclusion: Emotion perception and cognition are interrelated.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Emotional Recognition: Validation of Reading the Mind in the Eyes test in Bengali

Gargi Dasgupta, Kaberi Bhattacharya

Medical College and Hospital, Kolkata, India, gdasguptain@gmail.com, bkaberi.acharyya@gmail.com

Keywords: validation, emotional recognition, reading the mind in eyes, Bengali

Background: The ‘‘Reading the Mind in the Eyes’’ test is a simple but advanced Theory of Mind test, and it is widely used across different cultures. Originally developed by Simon Baron Cohen in 1997, and later revised in 2001, is a test of adult ‘mentalising. It contains 36 different facial expressions expressing different emotions and for each picture participants have to choose one of four emotional states which he finds appropriate to the picture.

Objective: To validate the scale in Bengali.

Methods: All the 4 options describing emotions in “Reading the Mind in the Eyes” scale were translated in Bengali by translation-retranslation method. This was done by 4 bilingual people who comprised of a psychologist, psychiatrist and two non-medical persons. A pilot study was conducted among 50 healthy volunteers with no family history of mental illness and on the basis of the results few changes in translation of terms were done. A group of 176 volunteers were invited to fill in the Bengali version of the Eyes test. Among them 70 were reassessed after one month for test –retest reliability. A group of chronic stable schizophrenic patients (in whom theory of mind is impaired) were given the test to assess criterion validity. Construct validity was measured by comparing the score with that of Picture arrangement of Wechsler Adult Performance Intelligence test which assess social cognition.

Results: Results indicated internal consistency to be satisfactory. Test-retest validity was found to be adequate, criterion validity and construct validity was found be reasonable. Few items were omitted from the original scale. The validated scale can be used among Bengali speaking population to assess emotional recognition.

Conclusion: The validated version can be used in Bengali population.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Differences in the pattern of co-morbid mental illnesses in patients using alcohol or cannabis in a dependent pattern: a retrospective chart review

Rishi Gupta, Najef Moideen, Yatan Pal Singh Balhara, Rakesh Lal

All India Institute Of Medical Sciences, India, mailrishigupta@gmail.com, drnaju123@gmail.com, ypsbalhara@gmail.com, drrakeshlall@gmail.com

Keywords: Dual Diagnosis, co-morbid substance use, epidemiology

Background: Substance use disorders are chronic relapsing illnesses, and have been shown to be frequently associated with other psychiatric morbidities, leading to a dual diagnosis for the patient. This study aims to review the records of the dual diagnosis clinic at our center, and analyze the pattern of distribution of mental illnesses amongst patients of substance use disorders, using either alcohol or cannabis.

Method: A retrospective chart review of the records of the patients attending the dual diagnosis clinic at NDDTC, Ghaziabad was conducted. The diagnoses were screened, and only those who used either alcohol, or cannabis in a dependent pattern were included in the review. Statistical analysis was performed to check whether the pattern of distribution of other mental illnesses was significantly different amongst the two groups.

Results: Dual diagnosis clinic case records from the year 2012-2014 were screened and a total of 61 records were found which were relevant to the study and met the inclusion criteria. Out of these, 33 (54.1%) cases used alcohol, and 28 (45.9%) used cannabis in a dependent pattern. All patients were male, and the two groups did not differ significantly in their age distributions (t=0.846, p=0.401). The two groups differed significantly in the pattern of distribution of mental illnesses (χ²=12.66, p=0.005), with mood disorders being the most common in alcohol users (58.3%), and psychotic disorders being the most common in cannabis users (65.4%).

Conclusion: It was seen that the two groups of substance users differed significantly in the pattern of distribution of other mental illnesses. Further analysis is needed to elucidate in greater detail how the substance of use correlates with the co-morbid mental disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Gender differences in Body Image & Self esteem in Schizophrenia using B-WISE

Vidhya Mohandoss, Hema Tharoor

Schizophrenia Research Foundation, Chennai, India, vidhya_mohandoss@yahoo.in, hematharoor@scarfindia.org

Keywords: BWISE, gender, Schizophrenia

Background/Objectives: Weight gain is an important problem in patients with schizophrenia. An instrument to evaluate body image and self-esteem related to antipsychotic induced weight gain has recently been developed called the B-WISE(Body weight, image and self esteem questionnaire). The objective was to evaluate whether the tamil version of the 12 item B-WISE could detect any gender differences in weight gain related psychosocial adjustment due to antipsychotic medication.

Methods: In a case –control comparative study, tamil version of the B-WISE has been tested on a large sample of patients with schizophrenia (N=82) and healthy controls (N=42).

Results: The mean age of the sample is (29.2±10.1yrs). Total B-wise scores ranged from 13.3 to 33.1. Cases and controls showed good psychosocial adjustments. Patients were found to be less aware that excess weight is not good for their general health.

Conclusion: B-WISE could be a useful instrument to evaluate the subjective psychosocial consequences associated with current weight and weight gain in patients with schizophrenia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

C- reactive protein & severity of psychopathology in Schizophrenia

Sindhu Maran, Hema Tharoor

Schizophrenia Research Foundation, Chennai, India, sindhudr21@gmail.com, hematharoor@scarfindia.org

Keywords: CRP, psychopathology, Schizophrenia

Background/Objectives: The present study examined the hypothesis that elevated serum levels of C-reactive protein (CRP) would be associated with more severe clinical symptoms in patients with schizophrenia.

Methods: In a pilot exploratory study (June-Dec2014) thirty patients with schizophrenia or schizoaffective disorder will be recruited by the end of the study. Serum levels of CRP measured for each patient will be assessed with the Positive and Negative Syndrome Scale (PANSS).

Results: Preliminary results on eleven subjects indicate elevated CRP in one and normal levels in the remaining ten. Subjects with CRP levels above the normal range (CRP>5 µg/dl, elevated CRP group, N=1) scored significantly higher than those with CRP levels in the normal range (CRP< 5µg/dl, normal CRP group, N=10) on the PANSS total score, negative symptom subscale score and general psychopathology subscale score. Difference between the two groups on the PANSS subscale scores will be discussed after completing the recruitment.

Conclusion: CRP as a putative inflammatory marker may be postulated based on the findings.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Add on Raloxifene treatment in Schizophrenia

Aparna Goyal, Hema Tharoor

¹Schizophrenia Research Foundation, Chennai, India, piku0908@gmail.com, hematharoor@scarfindia.org

Keywords: SERM, Raloxifene, post menopausal women, Schizophrenia

Background/objectives: Hypoestrogenism and use of selective estrogen receptor modulator (SERM) like Raloxifene are novel strategies in treatment of Schizophrenia especially in postmenopausal women. A pilot exploratory study was undertaken at SCARF to test the efficacy of adjuvant treatment with raloxifene.

Methodology: Preliminary findings with a recruited patient are given below. Ten Consenting postmenopausal treatment resistant women with Schizophrenia (ICD-10) will be started on Raloxifene (60-120mg/day). Positive and negative syndrome scale (PANSS) will be used to assess the severity of symptoms at 0, 4 and 8 weeks.

Results: 53 year old highly symptomatic post menopausal woman diagnosed with treatment resistant Paranoid Schizophrenia was recruited. Add on with Raloxifene 120 mg/day indicated a 29% improvement in PANSS scores at 4 weeks. Further findings with the remaining recruited patients will be discussed to validate the utility of Raloxifene as a potential add on agent in Schizophrenia.

Conclusion: Adjunctive use of Raloxifene appears to be efficacious in the treatment of postmenopausal woman with Schizophrenia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Schizotypy assessment using ESQUIZO-Q in siblings of first episode psychosis

Vidya Mohan, Aparna Goyal, Hema Tharoor

Schizophrenia Research Foundation, India, 08.vidya@gmail.com, piku0908@gmail.com, hematharoor@scarfindia.org

Keywords: ESQUIZO-Q, Schizoptypy, Psychosis, First Episode Psychosis, Early Intervention

Background/Objectives: Schizotypy could be considered as an putative risk marker for schizophrenia or a behavioral expression of liability for psychosis. Keeping this in mind, the current study was designed to assess risk of psychosis in adolescent siblings of the First Episode Psychosis cohort attending SCARF using ESQUIZO-Q (Oviedo Schizotypy Assessment Questionnaire).

Methodology: All consenting unaffected adolescent siblings (N=30) of the FEP cohort attending SCARF services from June- December 2014 will be screened using the GHQ -12. 51 item translated Tamil version of the ESQUIZO-Q (Oviedo Schizotypy Assessment Questionnaire) will be administered.

Results: Preliminary results of seven patients are enclosed. Females showed a higher degree of severity in referential thinking, magical thinking, paranoid ideation, odd behavior and social anxiety subscales. 57% of recruited participants were found to be in high risk of psychosis. The findings of the remaining patients will be discussed.

Conclusion: ESQUIZO-Q findings indicate that construct of Schizotypy is a possible valid entity to be considered during screening of ultra high risk group for risk of psychosis.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Coping Strategies In Wives Of Alcohol Dependent Patients

Praveen Kumar Vodala

SVS Medical College, India, praveen.vodala@gmail.com

Keywords: Coping strategies, wives, mean coping scores, socio-demographic variables, independent t test and ANOVA.

Background: 1. To assess the ways of coping among wives of alcohol dependent patients. 2. To determine the association between the coping strategies and socio-demographic variables.

Methods: 1. Sample size - 100 consecutive subjects i.e. wives of alcohol dependent patients who were admitted for de-addiction in psychiatry ward of SVS Medical college and Hospital, Mahabubnagar, A.P.

2. To assess the ways of coping using the Ways of Coping Questionnaire.

3. To assess the association between coping strategies and socio-demographic variables – Independent‘t’ test and ANOVA test.

Results:

1. Study showed that all the eight ways of coping were used by the subjects.

2. Majority of them used – self controlling (83%), accepting responsibility (81%), positive reappraisal (76%), whereas distancing (38%), seeking social support (45%), planful problem solving (49%) were used to a lesser extent.

3. Significant association was found between Mean coping score and

A. Wives education, employment status, religion.

B. Husbands education,

C. Total family income and

D. Husbands age at marriage.

Conclusions: Majority of the wives use coping strategies while dealing with stress due to behavior of alcohol dependent husbands.

The findings will help Psychiatric and other health personnel to

Identify various coping strategies. Reinforce the Healthy ones and rectify the maladaptive strategies. Change the perception of stressful situations from threatening to manageable and challenging.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of Problematic Internet Use and Sleepiness amongst students of medical college in Sikkim

Bhanu Pratap Singh, Sanjiba Dutta, Prabhleen Singh Jaggi

Sikkim Manipal Institute of Medical Sciences, India, Bhansinghjodhpur@yahoo.in, sanjibadutta@rediffmail.com, z.prabhleen@gmail.com

Keywords: Problematic Internet Use Sleepiness Sleep Loneliness

Background: Problematic Internet Use (PIU) is broadly conceptualized as an inability to control one’s use of the Internet which leads to negative consequences in daily life. It is rapidly escalating as a social issue of global proportions. Growing number of people have access to high speed internet to surf exciting online-based contents such as games, gambling, shopping, social networking site, and pornography. Negative consequences of pathological internet use include- family, academic and occupational problems.

The source of internet access has evolved over time from large desktops to mobile devices that can be used anytime and anywhere leading to indiscriminate use. One of the consequences of this has been loss of sleep as people who spent more time on the internet tended to sleep later and have increased fatigue and tiredness during the day.

Aims and objectives – To determine the prevalence of Problematic Internet Use in medical college students. To assess the proportion of students with PIU who have sleep problems. To assess the impact of PIU on social relationships.

The study was done in a medical college in Sikkim. Consenting students participated in this cross sectional observational study. Socio demographic data was collected using a semi structured proforma. PIU was assessed with Internet Addiction Test (IAT) devised by Young et al. Day time fatigue and sleepiness was assessed using Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index was used to determine sleep problems. The impact on social relationships was assessed using Differential Loneliness Scale.

Appropriate statistical tools will be used for analysis of the results which will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study on women substance abusers seeking treatment in de-addiction centre in east Sikkim

Geeta Gurung, Sanjiba Dutta, Bhanu Pratap Singh

Sikkim Manipal Institute of Medical Sciences, India, geetacintury@yahoo.com, sanjibadutta@rediffmail.com, Bhansinghjodhpur@yahoo.in

Keywords: Substance Use Women De-Addiction

Background: Although the number of women seeking de-addiction services has increased over the recent decades, the reported data is very limited from India.

NMHS-3(2005-2006), Government of India, has highlighted a significant prevalence of alcohol use in Sikkim-45.4% & 19.1% among above 15-49 years of age in males & females, respectively. It has the third-highest per capita alcoholism rate amongst all Indian states, behind Punjab and Haryana. Moreover, after its annexure to Indian states in 1975 which led to migration of people from other states, there has been introduction of other substance abuse practices in the community, including abuse of opioids.

Studying the profile of substance abusers of women seeking treatment in the de-addiction centre can be an effective tool to have an idea about the nature of substance abuse in the community among females, to create a baseline data about substance abuse in east Sikkim and nearby areas and can also help in planning the management of such patients.

Aim& Objective- To study the socio-demographic and drug use profile of women substance abusers seeking treatment at a de-addiction centre in East Sikkim.

Design & Methodology: This study is a retrospective structured chart review of women substance abusers seeking treatment at a de- addiction centre in East Sikkim from 2004-2014.

The information collected includes socio-demographic profile, substance use pattern, physical and psychiatric co-morbidities as diagnosed by the attending physician, impairment in different areas of functioning, reasons for seeking treatment and the treatment outcome. Records which were incomplete were excluded from the study.

Analysis of data: It will be done using appropriate statistical methods.

Results and Conclusion: It will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Internalizing and Externalizing Factors Affecting Internet Addiction and Substance Use Disorders in Adolescents Cross Sectional Analytical Study

Zoheb Raj, Sajeev Kumar

Kannur Medical College, India, zoheb39@yahoo.co.in, snehithansaji@gmail.com

Keywords: Externalizing Internalizing internet addiction substance use adolescents

Background: Pathological internet usage has been included as an entity in the addictive behaviours in DSM 5. Alcohol and substance addiction have been linked to externalising symptoms, while behaviour addiction has co morbid occurrence with anxiety and other internalising symptoms. Although there is a clear overlap between various addictive behaviours the symptoms profile in addiction needs to be chalked out.

The current study was conducted to determine the prevalence of externalizing and internalizing symptoms among school going adolescents and their relationship with addictive behaviour.

Objectives:

1)
To estimate the prevalence of Internet addiction and substance Use Disorder
2)
To Estimate prevalence of externalizing and internalizing symptoms among the same population
3)
To establish a relationship between symptom profile and addictive behaviour

Methodology: 1000 School going adolescents in Kannur in multiple schools were screened using questionnaires to assess internet usage, substance addiction and the prevalence of internalizing and externalizing behaviour and subjects can remain anonymous. The data collected will be analysed using SPSS.

Results: Overall prevalence of substance use and internet addiction among school going adolescents was low. Further analysis of the data is underway and would be explored at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of Psychiatric Morbidity in Gynaecological patients attending Rural hospital

Umesh Gunasekaran, Srinivasa Gopalan

Meenakshi Medical College Hospital & Research Institute, India, umedc14@gmail.com, India, umedc14@gmail.com

Keywords: psychiatric morbidity, gynaecology, general health questionaire, SCID

Background: Psychiatric morbidity in gynaecological patients is relatively less studied.

Objectives And Aim: This study was undertaken to determine the prevalence of Psychiatric Mobidity in Gynaecological patients attending Meenakshi medical college hospital and research institute.

Methods: Participants were eighty consecutive women attending department of gynaecology interviewed using general health questionaire (GHQ 30) and also SCID = structured clinical interview for dsm orders (OR) MINI = mini-international neuropsychiatric interview will be used in a semistructured proforma.

Results: The results will be assessed with appropriate statistical method and will be discussed in the conference.

Conclusion: Will be discussed in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of hyperprolactinemia and osteoporosis in patients on long term Risperidone: A cross sectional study

Jayaprakash Russell Ravan^*1, Deepa Brajanza², Naveen Thomas³

¹Kalinga Institute of Medical Sciences, India, jpr_219@yahoo.co.in, ²CMC Vellore, India, deepa@cmcvellore.ac.in, ³Melbourne Health, Australia, naveenlinda2002@yahoo.co.in

Keyword: Risperidone, Osteoporosis and bone mineral density (BMD), hyperprolactinaemia, Erectile Dysfunction(ED), Menstrual Dysfunction(MD)

Background: Risperidone is a widely used antipsychotic, known to cause secondary hyperprolactinaemia. Related problems include bone mineral density (BMD) and vitamin D deficiency. However, there is insufficient information about the extent, severity and association between these side effects, particularly in the Asian population.

Objectives: To estimate the prevalence of osteoporosis, and vitamin D deficiency in patients taking Risperidone for more than 1 year. Also, to investigate whether erectile dysfunction (ED) or menstrual dysfunction (MD) can be used as a proxy indicator of BMD loss in such patients, replacing dual energy X-ray absorptiometry (DEXA) scan.

Method: Sixty-five patients (mean age 29.6) receiving Risperidone as the only prolactin raising medication for minimum period of one year were selected taking into consideration the socio demographic and clinical variables. History of ED/MD, DEXA measurement of their lumbar and hip bone and endocrine variables were recorded.

Results: I. The prevalence of hyperprolactemia in female was found to be 84.4% and in males 78.8%, females being 1.4 times more at risk than males. Abnormal BMD was found in 40% of the subjects. Furthermore, 30% had Vitamin D deficiency and 60.8% had vitamin D insufficiency.

II. A statistically significant association was observed between ED/MD and BMD (OR 3.71; CI 1.23-11.24) but this varied according to the gender.

Conclusion: These results suggest that patients on long term Risperidone are at high risk of developing hyperprolactinaemia, reduced BMD and Vitamin D although multiple contributory factors or mechanisms can be suggested. Clinically, ED was more significantly associated with changes in BMD.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Impact of Hematopoietic Stem Cell Transplantation on Psychiatric Morbidity in Haematological Malignancies

Deeksha Elwadhi¹, Sudhir Kumar Khandelwal², Pratap Sharan², Atul Sharma², Lalit Kumar²

¹GB Pant Hospital, New Delhi, India, elwadhideeksha@gmail.com, ²All India Institute of Medical Sciences, New Delhi, India, sudhir_aiims@yahoo.co.uk, pratapsharan@gmail.com, atul1@hotmail.com, lalitaiims@yahoo.com

Keywords: HSCT, Psychiatric morbidity, Haematological malignancies

Background: Hematopoietic stem cell transplantation (HSCT) has gained widespread popularity as a treatment modality for various life threatening haematological malignancies. Elevated rates of both physical morbidity (infection & GVHD) and psychosocial sequelae (depression, anxiety, memory and concentration difficulties) have been seen in patients receiving HSCT. Cancer in itself has been associated with high levels of anxiety and depression which might impede patient’s long term outcome & recovery.

Aim: To assess the impact of HSCT on psychiatric morbidity in haematological malignancies in adults.

Methodology: A longitudinal prospective study on a purposive sample of 30 patients with haematological malignancies recruited from a tertiary care cancer research centre was conducted. HMSE & CPRS were applied along with detailed psychiatric assessment 1 week before and, 3weeks & 3 months after HSCT. A descriptive analysis of the socio-demographic parameters was done and comparison of the change over three assessment points was evaluated using ANOVA

Results: The mean age of the sample was 42.3 years with 24 males and 6 females. 70% were diagnosed with multiple myeloma. Mean HMSE scores at all assessment points were within normal range. The maximum mean CPRS scores were found 3 weeks after transplantation, with mean scores at the last assessment lower than the baseline. Most patients reported anxiety and depressive symptoms but none was suffering from a diagnosable psychiatric disorder.

Discussion & Conclusions: Psychosocial sequelae of HSCT are important with respect to patient’s recovery and deserve consideration. Transplant recipients in our study had a good psychological functioning. HSCT itself did not come out as a procedure that increases the psychiatric symptoms, and in the long run lead to a decrease in these symptoms. Recent surge in the long term survivors of the procedure calls for further research in this direction so as to aid the overall improvement

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical implications of Anxiety disorder co-morbidity in Children and adolescents with bipolar disorder

Sudipta Ghosh, Pradeep Kumar Saha, Sujit Sarkhel

Institute of Psychiatry, IPGME & R, Kolkata, India, sudipta_dr@yahoo.co.in, pradeepnimhan@gmail.com, sujitsarkhel@gmail.com

Keywords: Children and adolescents with bipolar disorder, pediatric quality of life, Children global assessment scale, Anxiety disorder co morbidity.

Background and Aim: Bipolar disorder among children and adolescent is a rare entity with limited data available in Indian literature. Here we sought to assess Anxiety disorder co-morbidity among them and its clinical implications on severity of illness and quality of life.

Materials and method: We evaluated and followed up consecutive 50 children and adolescents below 16 years with ICD-10 DCR diagnosed bipolar disorder from their first diagnosis to remission. Assessment of functioning and quality of life was done by Children’s Global Assessment Scale(CGAS) and Pediatric Quality of Life inventory(PQLI) respectively. After remission, Anxiety co morbidity current and lifetime was screened and evaluated using Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL). Numbers of episodes, percentage of time spent in illness, suicidal ideation, presence of psychotic symptoms, time to recovery, school dropout were assessed as severity indicators.

Results and Discussion: Among children and adolescents with bipolar disorder, presence of anxiety co morbidity is associated with more severe course along with poorer quality of life and global functioning. Anxiety co morbidity is an early indicator and should thereby be recognized early and effective management strategy has to be developed, as conventional (SSRIs) medications have been shown to destabilize the symptoms of Bipolar Disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Alcohol and Memory Impairment

Hemika Agrawal, Aman Goyal, Amit Garg

Institute of Human Behaviour and Allied Sciences, India, hemikaagrawal1@gmail.com, amangenesis@gmail.com, drgargamit@yahoo.co.in

Keywords: memory, alcohol

Background: memory impairment is one of the most common problems associated with alcohol related brain impairment (ARBI). People with ARBI can experience problems with learning new information, focusing on a topic of conversation, retrieving information from the past stored in their memory.

Case Report: Mr A, 33 years old male, Hindu, unmarried, presented to psychiatric unit of a tertiary care hospital, Institute of Human Behaviour and Allied Sciences, with no past or family history of psychiatric illness, and with 10 yrs history suggestive of alcohol dependence syndrome, with history of binge pattern of intake, and withdrawal seizures, with 6 months history of subacute onset, of memory disturbances. Pt had MRI report showing right fronto temporal and right peri callosal gliosis. No history of head trauma was present. Patient was kept inpatient, and was thoroughly examined. Higher mental functions, MMSEs and neuropsychological assessment was done. Impairment in short term memory were evident, with low MMSE scores. Impairments in frontal and temporal lobe functions were found. In ward behavior, pt was also found to be withdrawn, and although syndromal depression could not be established, affect and ward behavior pointed towards a depressive episode. Serum levels of Vitamin B12, Serum folate levels, Thyroid function tests were within normal limits, and viral markers were negative. Pt was admitted for 2 months, in which fluoxetine 20 mg was added, along with B complex, thiamine and multivitamins supplements. Pt was given neurocognitive enhancer, nootropil. Occupational therapy and cognitive retraining were done. Pt showed improvement in all, recent memory, affect, interaction and ward behavior and MMSE scores.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cost effective model of tele-psychiatry in a limited resource setting in India

Sydney Moirangthem^*1, Sabina Rao², Suresh Badamath³, Naveen Kumar C⁴, Mathew Varghese⁵

¹National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, Bangalore, India, sydmoir2006@yahoo.com, sabinarao@yahoo.com, nimhans@gmail.com, cnkumar1974@gmail.com, mat.varg@yahoo.com

Keywords: tele-psychiatry, low cost model, secondary consult.

Background: Tele-medicine is an effective method to deliver health services in distant places. This portal is well accepted by various medical specialties & is a cost effective tool. The usage of tele-psychiatry as a model for cost effective health care delivery in India is minimal.

Objectives: To present a model of tele-psychiatry consultation which is effective in a limited resource setting.

Methods: The end user of our tele-psychiatry model is Nirashritra Parihara Kendra (NPK) for the beggars in Bangalore, Karnataka. The facility houses about 700 inmates of which 350 suffer from mental illness of very long duration. The facility has only a doctor & two nurses at any point of time to attend the inmates. The facility was served by the community psychiatry team of NIMHANS as an out-reach clinic twice a month. With increasing number of admissions, it was felt that routine visit & consultation will not be enough for the patients (with some needing more attention-special population on clozapine). The treating team of NPK, both the medical & nursing were trained in using tele-medicine & about the clinical features of a relapsing or a worsening patient. All the patients were assessed in details initially in person by the psychiatry team & tele-psychiatry is a secondary consult of follow-up patients. No patient is assessed the first time by this portal. About 20-25 patients are attended by this portal every week.

Results: The model is well accepted by the ‘treating team’ & ‘patients’ of NPK. The clinical outcomes so far have been good. About 15-20% of patients have been placed back into their homes.

Conclusion: Tele-psychiatry is a cost effective model to deliver health care services in limited resource settings.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence and correlates of Delirium Tremens in Alcohol related disorders

Nithin A Shetty, Abhay Matkar, Girish Babu N

SDM Medical College and Hospital, India, shetty_doctor@yahoo.com, drabhaymatkar@hotmail.com, girisha1980@gmail.com

Keywords: Prevalence, Delirium Tremens, Alcohol related disorder

Background: Alcohol use leads to multiple problems such as physical, psychological and social problems.

Aims and Objectives: To determine the rate of occurrence of delirium tremens in patients with alcohol related disorders, in a general hospital setup and to compare the clinical and biochemical correlates of patients with delirium tremens with uncomplicated withdrawal states

Methods-a prospective Cross Sectional Study was conducted for a period of one year at SDM College of Medical Sciences and Hospital. A total of 160 cases were assessed from January 2011 to January 2012 and 153 cases were included for the final analysis. Cases were selected according to inclusion and exclusion criteria i.e., Adult patients with more than 18yrs of age who had attended or referred to the Department of Psychiatry for alcohol related problems as per DSM IV- TR were included. Clinical evidence of other significant primary psychiatric illness such as dementia due to any cause, schizophrenia, bipolar affective disorders and major depressive disorders, other substance use disorders excluded

Results: Out of 153 patients 33(21.56%) developed DT, 15(9.8%) withdrawal seizures. All 33 cases had predominantly autonomic hyperactivity. Majority of the cases of DT resolved by four days of admission and detoxification while 3 cases had prolonged delirium over one month duration. High amount of alcohol use, high score of SADQ-C, high total CIWA-Ar score on Day 1, past history of seizure, past history of Delirium, Delirium tremens, blood parameters such as increased neutrophil count, decreased lymphocyte count, increased AST, ALT etc. were significantly associated with DT

Conclusion: The prevalence of DT in cases with alcohol dependence syndrome was 21% in the patients admitted in a general hospital setup for alcohol de-addiction. It was associated with frequent occurrence of withdrawal seizures and was seen in patients with higher score on CIWA-Ar rating scale.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Eating behaviours and its correlates among young adults with ADD

Shankar Kumar, Amrtavarshini Radhakrishna, Chandrashekar H

Bangalore Medical College & Research Institute, India, shankarkjs@gmail.com, iamamrta@gmail.com, iamamrta@gmail.com

Keywords: attention deficit disorder, eating behaviour

Background: The prevalence of attention deficit disorder (ADD) in adults is 4-8% as per literature. This can manifest itself with unstable interpersonal relationships, multiple dismissals from employment, risky driving, risky sexual behavior and also binge eating due to the symptom domain of impulsivity in ADD. The eating behaviour may predispose to obesity which could be preventable.

Thus, this study aims to study the eating behaviors in young adults (<25yrs) with ADD and also its correlates with other personality traits and psychopathology.

Methodology: 50 young adult volunteers, recruited through snowballing technique who had risky sexual behavior as assessed by HIV risk behavior scale were recruited into the study. MINI Plus was used to screen for Axis-1 psychiatric disorder. They were then administered Adult ADD screening rating scale (ASRS) and Wender Utah rating scale to screen for ADHD, Barrett s impulsivity scale abbreviated and Stimulating and instrumental risk questionnaire to measure personality traits of impulsivity, sensation seeking, risk taking. Eating behaviour patterns questionnaire was administered to assess eating behaviours. SPSS v 17 was used for analysis of data.

Results and conclusion: The prevalence of ADD in our sample of those with risky sexual behavior was 15%. This population also had significantly high prevalence of Impulsivity and binge eating than those without ADD(p=0.03). Further results will be discussed. Thus, ADD could probably contribute to binge eating and obesity which needs further evaluation as this could be a potentially treatable factor.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

To Study Psychiatric And Cognitive Manifestations Of HIV AIDS And Its Comparison With Other STD Patients

Ankit Parmanand Panchmatia, Girish Banwari, Nimesh Parikh, Hitendra Gandhi

Vadilal Sarabhai General Hospital, India, ankit_panchmatia@yahoo.com

Keywords: psychiatric and cognitive manifestations, HIV and other STD patients, comparative study

Background: Objectives: To study psychiatric and cognitive manifestations of HIV AIDS and its comparison with other STD patients.

Purpose of study: HIV infection and psychiatric disorders have a complex relationship. Being HIV infected could result in psychiatric disorders as a psychological consequence of the infection or because of the effect of HIV virus on brain. Disorders may be varied as depression, post traumatic stress disorders, AIDS phobias, grief and other cognitive distortions. In addition, several psychiatric conditions may predispose individuals to acquiring HIV infection as a consequence of their influence on behavior. There is also strong evidence of the relationship of substance use disorders and severe mental illnesses with HIV infection. Majority of the work in India has focused on substance use and HIV, and to a lesser extent on the psychiatric and cognitive effects of HIV infection. Given the magnitude of the problem in the country and multiple physical and psychological stressors that persons with HIV face in India, more research is needed.

Methods: study is going to be conducted by taking 50 patients of HIV AIDS and 50 of other STDs and in them applying scales:- SAMISS(substance abuse and mental illness symptoms screener),DASS(depression anxiety stress scale),MOCA(montreal cognitive assessment). And after that, comparative study will be done between those 2 groups. Participants: Patients visiting ART centre of Sheth Vadilal Sarabhai Hospital, Ahmedabad.

Results and Conclusion: This article provides an overview of the epidemiology and clinical manifestations of HIV associated cognitive and psychiatric manifestations and its comparisons with other STD patients. As the study is going on, results and conclusion will be discussed in the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Impulsivity, Affective Intensity and Functional Impairment in Bipolar Disorder: Implications of Lithium Therapy

Sandeep Motichand, Vinod Kumar Sinha

Central Institute of Psychiatry, India, psycsandy@gmail.com, vinod_sinhacip@yahoo.co.in

Keywords: Impulsivity, Affective Intensity, Bipolar Disorder, Lithium

Background: Currently there is a growing consensus that Bipolar Disorder(BD) leads to a substantial functional impairment. Studies investigating correlates of functional impairment in this group of patients have identified impulsivity and affective intensity as a leading cause. Research into role of therapeutic interventions in order to prevent functional impairment in BD is lacking.

Objective: To study the difference in the role of trait markers such as impulsivity and affective intensity in socio-occupational functioning in euthymic bipolar patients on treatment with lithium and antiepileptic mood stabilisers.

Methods: 20 patients, aged 18-60 years fulfilling ICD-10 criteria for BD currently in remission, who are on prophylactic lithium from at-least 6 months with scores of less than 8 and 7 on Young Mania Rating Scale and Hamilton Rating Scale for Depression respectively, will be rated on Barrett’s impulsivity scale, Affect intensity measurement, Functioning assessment short test. The scores obtained on these measures shall then be compared with 20 age and sex matched patients with BPAD in remission on anti-epileptic mood stabilisers.

Results: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Profile of patients with dual diagnosis: An experience from an integrated Dual Diagnosis clinic

Abhishek Ghosh, Debasish Basu, Subodh BN, Surendra Kumar Mattoo

Post Graduate Institute of Medical Education and Research, India, ghoshabhishek12@gmail.com, db_sm2002@yahoo.com, drsubodhbn2002@gmail.com, skmattoo@ymail.com

Keywords: Dual diagnosis, integrated treatment, substance use

Background: Co-morbid substance use and mental illness is prevalent and often results in serious consequences. A specialized integrated clinic for managing this group of patients has been found to be more effective than a parallel or sequential treatment facility.

Objective: This study was designed to find out the profile of dual diagnosis patients attending an integrated dual diagnosis clinic, started in August, 2011.

Methods: The study was a retrospective chart-based review of consecutive patients attending an addiction treatment center in a tertiary-care hospital in north India from August, 2011 to December 2013. Provisional diagnoses were made by clinical interview and were confirmed by consultant psychiatrists following a thorough examination and critical discussion. Patients found to have comorbid non substance psychiatric disorders were registered in the Dual diagnosis clinic. All data on demographics, substance use disorder and psychiatric diagnoses, treatment, and short-term outcomes were obtained from the records.

Results: Out of 1929 patients registered over a span of 28 months, 1907 (98.8%) records were traceable. Amongst these, 287(15%) had a comorbid non-substance psychiatric disorder. Mood disorders were the commonest (141, 49.1%) amongst all dual diagnoses. Psychotic disorders (65, 22.6%) were the second most prevalent diagnosis followed by anxiety and stress related disorders (58, 20.2%), organic disorders (6, 2%) and other mental disorders (22, 7.7%). Alcohol was the primary substance of use in both psychotic (30.8%) and non-psychotic (47.3%) co-occurring disorder. However, cannabis use is relatively more prevalent (23%) in the psychosis group. Mean duration of outpatient follow up was 2.6 months. A significant proportion (45.7%) of patients was improved.

Conclusion: Co-occurring substance use and mental disorders are common in addiction psychiatry clinics. This group of patients has a high attrition rate and relatively poor prognosis.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychological problems in survivors of Uttarakhand

Varun Mehta, Sandeep Jaiswal, Abhishek Pandey, Daya Ram

Central Institute of Psychiatry, India, vs_mehta@yahoo.co.in, sandeep_jaiswal@gmail.com, abhishek_pandey@gmail.com, dram_cip@rediffmail.com

Keywords: Disaster, depression, post traumatic stress disorder

Background: In recent times, we have seen both natural and manmade disasters that have taken toll of the physical and psychological health in humans. The psychological impact of disaster depends upon the duration and intensity of the disaster coupled with the resources available to cope with it. After the basic needs of survival are met, the mental health needs of the affected victims are brought to attention. Anxiety, depression, somatic complaints and substance abuse appear to be the most common reported mental health problems with factors such as availability of social support, ongoing disruptions, psychological resources and socioeconomic status that have been found to influence recovery from these problems.

Methods: A team of 3 individuals consisting of a psychiatrist, psychologist and psychiatric social work was sent to the Pithoragarh district of Uttarakhand a month after the disaster by the institute to assess the psychosocial needs of victims affected by the disaster. The individuals spoke to 110 victims who had been shifted in various disaster relief camps. The information was collected using a disaster mental health intake form in which their socio-demographic details, presenting condition and type of intervention required were recorded. A screening questionnaire for disaster mental health was used to assess the symptoms of depression and post-traumatic stress disorder. The General Health Questionnaire 12 (GHQ 12) was also applied to gauge their quality of life.

Results & Conclusion: They will be shared at the time of presentation

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Identification of Bipolar Spectrum Disorder in individuals with Unipolar Depression

Abhishek Samal, M.S. Reddy

Asha Hospital, India, abhibhaimbbs@gmail.com, drmsreddy@gmail.com

Keywords: Bipolar Spectrum Disorder; Temperament; Unipolar Depression; SCI-MOODS; TEMPS-A

Background: Considerable interest is being renewed in the Krapelinian concept of the occurrence of a continuum of affective states coloured with individual temperaments to constitute the Bipolar Spectrum as evidenced in the works from Akiskal to Ghaemi. Research into unipolar depression has found missed bipolarity in many individuals. Identification of such individuals would have therapeutic and prognostic implications.

Aims and Objectives: This study intends to identify Bipolar Spectrum Disorder, as defined by Ghaemi’s criteria, in individuals diagnosed with Unipolar Depression, along with an assessment of their temperament.

Methods and Materials: 50 patients of Unipolar depression were selected on purposive sampling in a cross-sectional study, and their socio-demographic details, family history and past clinical history taken. They were interviewed using the Structured Clinical Interview for Mood Spectrum (SCI-MOODS), their temperament evaluated using TEMPS–A, and severity of depression rated on Montgomery-Åsberg Depression Rating Scale.

Results and Conclusion: To be discussed at the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Eye Movement Desensitization Reprocessing (EMDR) in Treatment of Depression: A case series

Anju Gupta, Satnam Goyal

Dr. Baba Saheb Ambedkar Hospital, Rohini, New Delhi, India, anjusimran_2003@yahoo.co.in, satnam.goyal@yahoo.com

Keywords: EMDR, Depression, Trauma

Background: Active behaviour in response to traumatic memories plays a role in Depression. Being able to stop or control the behaviour, secondary to recall of distressful memories, is the reason why Eye Movement Desensitization and Reprocessing (EMDR) has been recommended in patients with depression. However, patients show varying benefits after EMDR.

Objective: This case series describes EMDR therapy in four patients with Major Depressive Disorder

Methods: Four patients with diagnosis of Major Depressive Disorder (according to DSM-IV) and history of significant traumatic events in the past were taken. EMDR therapy was done by a psychiatrist trained in EMDR. The effectiveness in these patients was evaluated in terms of reduction of symptoms on Hamilton Depression Rating Scale (HAM-D).

Results: All four patients, after EMDR, reported being less troubled by traumatic memories and showed reduction in HAM-D scores. The doses of antidepressants were also reduced with no need to initiate pharmacotherapy in one of the patients.

Conclusion: EMDR may be a beneficial modality of treatment and may be used to augment the on-going treatment in patients with history of traumatic stressors.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of Thyroid Dysfunction in Psychiatric Inpatients

Rajeev Ranjan Raj, Arunlata Agrawal, K.K. Kshitiz

Central Institute of Psychiatry, India, rajeevrsam@gmail.com, dralagrawal@hotmail.com, rajeevrsam@gmail.com

Keywords: prevalence, thyroid function, psychiatric in-patients.

Background: Introduction: Thyroid hormones play important roles in brain development and function. Thyroid hormones also play an important role in the functioning of the mature brain. Mental symptoms, notably cognitive dysfunction and depression, are common expression of thyroid disorders. Moreover, abundant evidence suggests that abnormalities in the metabolism of thyroid hormones and in thyroid system immunity are important in mental disorders, especially in mood disorders.

Purpose: Our study will be carried out to examine and compare the level of thyroid dysfunction among different psychiatric disorder in a hospital-based inpatient sample. This study aims at studying the prevalence of thyroid dysfunction in psychiatric in-patients which will help us in guiding and formulating a better management plan for such patients. Also it will guide us for future whether routine thyroid function assessment for psychiatric patients is necessary or not.

Method: This will be a cross-sectional, prevalence study. Patients of either sex, aged between 18 to 60 years, with a first episode psychiatric disorder, diagnosed as per ICD-10 DCR, and drug naive or drug free for last 4 weeks will be recruited by purposive sampling method from a pool of patient who will be admitted in any ward of Central Institute of Psychiatry, Ranchi over a period of 3 months. Thyroid function tests will be done routinely for all patients during the first admission. TSH will be done first for all patients; T3, T4will be done when TSH level is abnormal. Blood samples will be drawn from all patients between 8 and 9 a.m. after 12 hour overnight fast. Further if any patient present with obvious neck swelling along with abnormal TSH, T3 &T4 values, USG neck will be done.

Results and Conclusions: Will be discussed in details during presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Erectile Dysfunction: An underestimated presentation in Patients with diabetes mellitus

Abhishek Bharti, Vishal Sinha, Vipin Kumar, Ashwani Kumar Mishra, Zeeshan Anwar

S. N. Medical College, Agra, India, abhishek_bharti55@rediffmail.com, drvsinh2000@yahoo.com, vipinnarwal@gmail.com, drashwani2010@gmail.com, zeeshan.anwar.mbbs@gmail.com

Keywords: sexual disorder, erectile dysfunction, diabetes mellitus

Background: Erectile dysfunction (ED) is a common complication in diabetics. The present study is to assess the association between ED and diabetes (type 1&2) and to determine its effects on quality of life.

Methodology: This will be a cross sectional study. All consecutive patients >18 years of age with at least 1 year duration of diabetes attending the medicine and psychiatry O.P.D. in S.N. medical college from April 2014 to December 2014 will be recruited in it. They will be assessed using pre- structured socio demographic parameters, detailed history and general examination, mental state examination including HAM-D, GHQ-30 (General Health Questionnaire-30), IIEF (International Index of Erectile Function) & QOLID (Quality Of Life In Diabetics) and sex myth check list.

Result: Results will be discussed at the time of presentation.

Conclusion: An insight into the much neglected area of sexual dysfunction can help to formulate early and prompt management of diabetes related sexual dysfunction and can improve the quality of life as well as the zeal of life.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of Sleep Disturbances In patients Depressive Disorders: A Cross Sectional Study

Mallikarjun Rao Sagi

Deva Institute of Healthcare & Research Pvt. Ltd, Varanasi, India, mas.dihr@gmail.com

Keywords: MDD, Insomnia, OSA, BMI.

Background: The co-morbidity of sleep disorders with various psychiatric conditions, such as depressive disorders has been repeatedly shown in previous studies, although research investigating these disorders together is scarce. The aim of the present study was to explore relation between sleep disturbances like Insomnia; Sleep disordered breathing (OSA) and Major Depressive Disorders.

Methods: A cross-sectional hospital based observational study was designed. Outpatients and Inpatients over eighteen years old and below 65 years old were taken. Major Depressive Disorders by DSM-IV TR, Hamilton Rating Scale for Depression (17-items), HAMD-17 and Montgomery-Asberg Depression Scale (MADRS), Insomnia by the Insomnia Severity Index, and OSA by Berlin questionnaire assessed. Analysis done by SPSS-16.

Results: 100 subjects of MDD were enrolled in study. Prevalence of Insomnia & OSA high in severely depressed, also in BMI >30. Co-morbidity of MDD is more in sleep disorder patients.

Conclusion: Bidirectional association of Depressive disorders and Insomnia, OSA is significant. This signifies priorities and modes of management of co-morbid conditions in MDD and Sleep disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Patients’ expectations from Psychiatrists: A cross sectional study in a tertiary care centre

Sakshi Gupta, Dinesh Kataria

Lady Hardinge Medical College, India, dr.sakshi.lh06@gmail.com, drdineshkataria@gmail.com

Keywords: Psychiatrists, psychotic disorder, psychoeducation

Background: Objectives: Patients perspective regarding mental health professionals have largely been undermined. Moreover there is paucity of data in the Indian context. The aim of this study is to identify the issues important to patients consulting psychiatric outpatient clinic.

Methods: The cross sectional study was carried out on 50 adult patients attending Psychiatry OPD in a tertiary care centre diagnosed with psychiatric disorders by ICD-10. Patients suffering from schizophrenia and other psychotic disorders were excluded. 12 item questionnaire was used to collect data. The responses were graded over 4 point likert scale and statistical analysis was done.

Results: Talking to doctor about illness and provision of symptomatic relief were of utmost importance for 90% of the patients. Information about the cause and duration of illness, with treatment options, the best being decided by the doctor were significant by more than 80% of patients. However only 10% wanted to decide themselves about their treatment after discussion.28% considered important to be part of support group. There is no co-relation between duration of illness and patients’ expectations.

Conclusion: Psychoeducation about the illness and treatment is an indispensible facet of patient care. Future research may investigate the relation between expectations of patients and their clinical outcomes.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effects of add-on trans cranial Direct Current Stimulation (tDCS) on insight facilitation in schizophrenia patients with auditory hallucinations: A sham controlled study

Astik Bibhishan Mane, Basudev Das

Central institute of Psychiatry, India, kitsaenam@gmail.com

Keywords: tDCS, schizophrenia, poor insight, auditory hallucination

Background: Introduction: The IPSS study suggest that internationally, more than 70 percent of people with schizophrenia have auditory hallucinations. On the other hand lack of insight was the most common symptom of schizophrenia in the IPSS. Poor insight is associated with decreased compliance, worse overall function, increased levels of psychopathology, recurrent illness, and poor outcomes. It seems obvious that attempts should be made to improve insight, and that improved medication adherence and improved outcomes should follow. Considering the recent observations in the context of reported relationship between prefrontal deficits and poor insight in schizophrenia, the anodal stimulation of left DLPFC may lead to insight improvement in schizophrenia patients.

Aim: To examine insight facilitation effects of add-on tDCS in schizophrenia patients with auditory hallucinations and compare with sham control.

Method: 10 Patients, aged 18-45 years, of either sex, with diagnosis of Schizophrenia as per ICD 10 DCR, with at least 2 years of illness, drug free for 4 weeks, will be included in study. They will be randomly divided into active and sham group. For the active group, the anode will be placed with the middle of the electrode over a point midway between F3 and FP1 (left DLPFC) and the cathode located over a point midway between T3 and P3 (left temporo-parietal junction [TPJ]). The stimulation level will be set at 2-mA for 20 min. The sessions are to be conducted twice a day (separated by at least 3-hours) for 5 consecutive days. For sham group sham stimulation will be given with same procedure. They will be assessed and compared in different scales, SUMD, PANSS, PSYRATS auditory hallucination sub-scale and WHO QOL BREF, on day 0 and day 5.

Results and Conclusions: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Gender and Age Differences in the Phenomenology of Depression

Navoneela Bardhan, Dipesh Bhagabati

Gauhati Medical College and Hospital, India, navo11610@gmail.com, dbhagabati@gmail.com

Keywords: Depression, Symptomatology, Age, Sex

Background: The prevalence of depression varies across various age groups, with differences in prevalence with respect to gender (M: F = 1:2). The severity of depression shows a U-shaped curve when correlated with age. Females have an earlier age of onset, more somatic symptoms, exhibit more crying and irritability. In Asia, the frequency of somatic complaints are more when compared to western countries.

Objective: This study aimed at comparing the severity and the phenomenology of depression with respect to gender and different age groups.

Method: A total of 70 patients (35 males and 35 females) with depression diagnosed according to the ICD-10 criteria were included. Beck Depression Inventory (BDI) was administered and factor analysis was chosen to describe various subcomponents. The scores were correlated with gender and different age groups.

Results: The BDI scores increase with age, the difference being significant when comparing patients belonging to young adulthood with those defined as being in late adulthood. This finding was seen when the males were compared but the difference was not significant in females. Somatic complaints increased significantly with age. In males, there is increase in suicidality with age, decreased sexual desire in mid-life. Females had significantly greater crying. Psychotic symptoms were present in 7 patients (3 males, 4 females). They had higher mean BDI scores. Nihilistic delusions were present in 5 patients and persecutory delusion in 2 of them. Auditory hallucination was present in 1 patient.

Conclusion: The phenomenology of depression varies with age and gender across adulthood.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effectiveness Of A Training Program For Mental Health Professionals On Disability Welfare Schemes

Syjo Davis, Preenu Mathew, Preeti Rajendran, Anandhalakshmi K, Sujit John, Thara Rangaswamy

Schizophrenia Research Foundation (India), Chennai, India, syjodavis@gmail.com, preenumathew1@gmail.com, preegen@gmail.com, anandhakaliappan@gmail.com, sujitjohn@scarfindia.org, thara@scarfindia.org

Keywords: Mental disability, awareness of MHPs, Govt. Welfare Schemes

Background: Aim & Objective: To evaluate the effectiveness of a training program for Mental Health Professionals (MHPs) on disability welfare schemes at SCARF.

Objectives: To assess the level of awareness about the Government welfare schemes among MHPs and knowledge about the procedures involved for availing them

To evaluate the effectiveness of the awareness training programs in increasing knowledge about disability benefits and procedures involved.

Methodology: All the 36 MHPs working at SCARF were recruited for the study over a two week period. A specifically designed semi structured questionnaire that elicited information on socio demographic variables, years of experience in the field of mental health, awareness of the various schemes, the procedures involved, etc were collected. The baseline knowledge was then estimated.

Following which the information about the list of benefits available for people with mental illness, the eligibility criteria, documents required, processes involved and office/officer to be contacted, etc was communicated to the MHPs in a 1 hour training program, apart from this a manual was also provided to the MHPs and specifically designed posters and pamphlets were distributed.

Results: At baseline 19% (7) of the MHPs were not aware of a single scheme. The maximum number of schemes known by any MHP was six (by 1 MHP). Out of the 5 steps/procedures needed to avail the government benefits, only one procedure was known to 53% (n=19) of the MHPs and only 1 MHP was aware of all the procedures involved. Only 56% (n=20) of MHPs referred patients for disability certification. The post intervention results are presented and discussed.

Conclusion: Mental Health Professionals have low knowledge about process and procedures involved in getting disability benefits and structured training programs are effective in improving knowledge.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Repeated Self-Immolation In Tuberous Sclerosis With Borderline Personality Disorder: Challenges In Management

VINI Vivek, Shabna Mohammed, Tisha Jacob, Arun Ayyappan, Christina George, ARUN Kumar

Department of Psychiatry, SMCSI Medical College, India, viniarunrajan@gmail.com, shabna.mhd@gmail.com, viniarunrajan@gmail.com,

Keywords: Tuberous sclerosis, Borderline personality disorder, Depression

Background: Objective: To report a case of TSC presenting with a history of repeated self-immolation with Borderline personality disorder, seizures, severe depression and Post burns contractures.

Method: A 34 year old married female, with average intelligence, diagnosed to have TSC, presented with a history of repeated self-immolation attempts and disabling post burn contractures. There was family history of TSC in a 1^st degree relatives(her mother & child). The patient had neurocutaneous markers, CNS tumors and seizures. She had chronic feelings of abandonment, extreme sensitivity to the vicissitudes of interpersonal relationships, emotional dysregulation, recurrent suicidal ideas, high levels of impulsivity with repeated self injurious behavior and severe impairment of functioning with comorbid severe depression since 4 years.

Results: She was admitted and management involved pharmacotherapy with Antiepiletics, antidepressants and antipsychotics for severe mood disorder with Lithium for deliberate self-harm. She continued to be emotionally unstable and disruptive in the ward. She required high levels of physical supervision (at times 24 hour bedside monitoring), emotional support and behavioral strategies. This often caused a strain to resources within the treating team. The subject was treated in liaison with the Neurologist (optimization of seizure management), Plastic surgeon (Post burn contracture release-neck with skin grafting), Anaesthetist (high risk anaesthesia). Her husband, who often decompensated, required specific strategies for emotional support and to control expressed emotion. She was better on psychiatric, neurogical and surgical outcomes at discharge after an admission of 3months.

Conclusion: A preliminary search reveals that there is a dearth of case reports on TSC with Borderline personality disorder. A diagnosis of Degenerative disorders as well as Borderline Personality Disorder engenders skepticism, therapeutic nihilism and feelings of frustration among clinicians. It was often difficult to take decisions to invest into the management of these difficult to treat patients with complex needs.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Anti-N-methyl-D-aspartate Receptor Encephalitis Presenting with Psychiatric Symptoms: A Case Report

Sameer Belvi Mangalwedhe, Aditya Anand Pandurangi

Dharwad Institute of Mental Health and Neurosciences, India, sameerbelvi@gmail.com, pandurangi.aditya@gmail.com

Keywords: Anti-NMDA-Receptor encephalitis, Catatonia, Psychosis.

Background: Anti- N-methyl-D-aspartate (NMDA) Receptor encephalitis is a form of autoimmune encephalitis that has been recently identified. It presents with atypical neuropsychiatric manifestations. Patients with anti-N-methyl-D-aspartate receptor encephalitis develop a progressive illness from psychosis into a state of unresponsiveness with catatonic features, often associated with abnormal movements and autonomic instability. Here, we describe the case of a 35 years old lady presenting with psychosis. Positive diagnosis of anti-NMDA receptor encephalitis suggested specific treatment.

Introduction: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis belongs to the autoimmune and paraneoplastic encephalitides.^[1] Once conceptualized as a condition primarily affecting adult women and frequently associated with tumors, anti- NMDA receptor encephalitis is increasingly recognized in males, in children, and in the absence of tumors. Most patients exhibit psychosis, memory loss, seizures, and language disintegration, and may develop unresponsiveness with catatonic features or periods characterized by abnormal movements, including autonomic and breathing instability.^[2] The presence of a tumor (usually an ovarian teratoma) is dependent on age, gender, and ethnicity, and is associated with a better prognosis after tumor resection and immunotherapy (corticosteroids, intravenous immunoglobulin, plasma exchange) than in patients who do not have tumors. More than 75% of all patients recover in association with declining antibody titers but relapses are frequent and a close follow-up is necessary, at least for two years, after initial diagnosis.^[2]

We present a case report of a 35 year old lady presenting with psychiatric symptoms due to anti-NMDA-Receptor encephalitis. Following detection of an ovarian teratoma, it was operated upon. After surgical resection of her tumor, patient improved progressively.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Opioid Dependence with Somatisation Disorder

Pooja Patnaik Kuppili, Roshan Bhad, Ravindra Rao, Prabhu Dayal, Atul Ambekar

AIIMS, India, poojapatnaik.aiims@gmail.com, drroshansindia@gmail.com, drrvrao@gmail.com, drpd@rediffmail.com, atul.ambekar@gmail.com

Keywords: Pentazocine, Somatisation Disorder

Background: Physical pain is one of the cardinal symptoms of somatoform disorders. Pain relieving medications are often prescribed and used by patients, which can produce dependence. High prevalence of substance use disorders, largely restricted to alcohol and benzodiazepines, in somatisation disorder has been documented. Literature on opioid misuse/dependence in somatization disorder is scant. We present a case of somatization disorder with comorbid pentazocine dependence in a female patient.

Case Description: A 43 year old widow, with history of alcohol and opioid dependence in first-degree relatives, presented with multiple, recurrent, frequently changing somatic complaints (pain [in head, back, and abdomen], dysuria, dysmenorrhoea, nausea, vomiting, amenorrhoea and dysphagia) and pentazocine injecting for 19 years. The patient sought multiple consultations with doctors; investigations revealed no physical abnormalities. Intravenous pentazocine was prescribed by local doctors for pain-relief, which the patient started using daily and developed craving and withdrawals in the absence of injections within one month. She started injecting in absence of pain, with gradual increase in the quantity of injections and soon developed socio occupational dysfunction. Non-healing ulcers on both arms developed due to non-sterile practices of injections, resulting in further dysfunction. The patient visited our centre for injection use treatment. A diagnosis of opioid dependence syndrome with somatisation disorder was made.

Discussion: The case has several unique features – female, unwarranted opioids prescription by registered medical practitioners and ‘blind dating’ (intramuscular use of pentazocine) leading to ulceration. Management challenges include (a) overlap between somatization symptoms and opioid withdrawal, (b) pain hypersensitivity due to long-term opioid use causing somatisation symptoms worsening and (c) physical comorbidity in the form of ulcers.

Conclusion: While use of opioid analgesics is justified in certain pain conditions, patients with somatisation disorder must be carefully evaluated for risk of substance use disorder. Mental health professionals dealing with iatrogenic opioid dependence should look for co-morbidities

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Caregivers Burnout Assessment In Dementia & Approach To Reduce It In Changing Social Milieu.

Ranjan Bhattacharyya¹, Supriya Kumar Mondal^*2, Nitu Mallik³, Sumita Bhattacharyya⁴

^1,2Murshidabad Medical College & Hospital, India, rankholders06@yahoo.co.in, supriyakumarm@gmail.com, ³Medical College, Kolkata, India, drrbcal@gmail.com, ⁴Institute of Post Graduate Medical education & Research, India, ima_ber_bengal@hotmail.com

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical correlates of suicide in psychiatric patients with high suicidal risk

Hemendra Singh^*1, V. Senthil Kumar Reddi², Prabha S Chandra³

¹M.S. Ramaiah Medical College, Bangalore, India, India, hemendradoc2010@gmail.com, ^2,3National Institute of Mental Health and Neuro Sciences (NIMHANS), India, senthilreddi@yahoo.com, prabhasch@gmail.com

Keywords: Clinical correlates of suicide in psychiatric patients with high suicidal risk

Background: Introduction: According to the WHO, more than 2.58 lakh people committed suicide in India during 2012. Psychiatric illness is a major contributing factor for suicide. The lack of clinical data is a major barrier for effective management of suicide.

Aim: To study the clinical correlates of suicide in psychiatric patients with high suicidal risk.

Methodology: This study was conducted at the Emergency Psychiatry ward of the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore during 2011-12. 120 consecutive patients with high suicidal risk, aged between 17-60 years, were systematically evaluated for depression severity, hopelessness, suicide ideations and intent, past attempts, and presence of auditory hallucinations by using BDI, BHS, SSI, SIS, SBQ, and PSYRATS. The diagnostic breakup was: schizophrenic spectrum disorders (SSD) – 35 (29%); affective disorders (AD) – 78 (65%); and others 7 (5.8%). A comparison of the variables between these groups was done by using an independent sample t-test.

Results: Lifetime history of suicide attempts and NSSI (Non-Suicidal Self Injury) was 92.5% (111/120), and 36.7% (44/120) respectively. The frequency of NSSI was positively correlated with the number of suicide attempts (r = 0.317, p < 0.01). The reasons given for their suicide attempts by patients with SSD were significantly different from those given by patients with AD.

Conclusions: Factors associated with high suicidal risk among psychiatric patients are: age below thirty years; female sex; being married; urban background; past suicide and non-suicidal self injury; presence of psychotic symptoms; family and personal stressors. Hence, early detection of these factors may be helpful in preventing suicide.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Role of Integrative Medicine in Mental Illness Recovery & Social Inclusion - 100 Cases of Schizophrenia

Vinod Kumar Goyal

Parth hospital, India, drvgo999@gmail.com

Keywords: integrative medicine, premorbid personality, schizophrenia, integrative medicine, dietary supplement, psychotherapy, rTMS therapy

Background: Schizophrenia a disease where complete recovery is a myth & more so returning to the premorbid personality is rare. Currently pharmacotherapy is the main stay with variable compliance which makes complete recovery impossible. In India, team work or total approach or integrative medicine, like addition of Psychotherapy, rTMS therapy, & dietary supplement therapy is practiced in very few clinics, because of time consuming, & awareness, & cost to the patient. In this study, known 100 schizophrenic patient were taken, with 2-4 years duration of treatment with history of good background, but unable to return to the premorbid personality and job and family. To see the impact of addition of dietary supplements specific group, with rTMStherapy & family councelling, MSE was assessed before & after treatment. It was observed that 80 % of the patient returned to the premobid personality level with satisfactorily started job and continued the job with good income with steadiness. Misconception about dietary supplements and cost factor of rTMS therapy in the absence of mediclaim desist them from completing treatment.

Summary: addition of dietary supplement & rTMS along with short psychotherapy to the family if added can help in reducing the mental illness & enhance recovery with social inclusion there by reducing the stigma of mental illness in India.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Regional Cerebral Glucose Metabolism and Its Association With Phenotype And Cognitive Functioning In Patients With Autism

Anil Kumar BN^*1

¹Shridevi Institute of Medical Sciences and Research Hospital, Tumkur, India, anilkbn23@gmail.com

Keywords: Autism, PET, Neurocognition

Background: Autism is a neurodevelopmental disorder for which neither a coherent anatomical or pathophysiological theory nor a biologic diagnostic test has yet been developed. Over the last 3 decades many neuroimaging studies using different techniques like MRI, PET, SPECT and fMRI have been conducted to understand the neurobiology of autism, but still there is lack of consistency in results across various studies.

Objectives: To study the regional cerebral glucose metabolism (rCGM) in patients with Autism using PET scan and to study its association with the phenotype and cognitive functioning. Design: Case control study.

Materials and Methodology: Ten subjects (aged 8-19 years) meeting the criteria for Autism according to DSM-IV were taken up for the study. They were evaluated on Childhood autism rating scale (CARS) for severity, neuropsychological battery (Trail making test A and B, Wisconsin Card Sorting Test and Tests for Intelligence Quotient) and Positron Emission Tomography (PET) Scan. The PET findings of the Autistic subjects were compared with 15 age and gender matched control subjects without any brain pathology or neurological disorder. Results: Out of 10 autistic patients, 6 had normal PET scan and 4 patients had abnormal PET scan. In contrast none of the patient in the control group had abnormal PET scan. Of the 4 patients who had abnormal PET scan, 2 patients had findings suggestive of hypometabolism in cerebellum bilaterally and one patient showed bilateral hypometabolism in anterior temporal cortices and cerebellum and another patient had hypermetabolism in the bilateral frontal cortices and medial occipital cortices. Autistic subjects performed poorly on neuropsychological testing. Patients with abnormal PET scan findings had significantly higher scores on the ‘body use’ domain indicating more stereotypy. No correlation has been found between abnormal PET scan findings and neuropsychological performance.

Conclusion: Subjects with autism have altered brain hypometabolism in the cerebellum and this finding is related to the higher severity of abnormal body use.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Profile of risk factors related to attempted suicide in Sikkim

Chabi Lall Pradhan^*1

¹S.T.N.M. Hospital, SMIMS, India, drclpradhan@gmail.com

Keywords: Attempted suicide, Co morbidity, Life events.

Background: Suicide is a complex multidimensional phenomenon that has been studied from philosophical, sociological and clinical perspective. There are 10 – 20 times as many suicide attempts as suicide deaths. Attempted suicide is a common clinical problem in a general hospital setting which has a serious clinical, socioeconomic impact. The present study was undertaken in the department of psychiatry, STNM Hospital, Gangtok from June 2013 to June 2014. The study was conducted to identify the risk factors associated with attempted suicide. Variables related to socio-demographic, suicide characteristics, family background, psychiatric morbidity and co morbidity and life events were analyzed. Patients were recruited from Psychiatry OPD, indoor admission and casualty of STNM Hospital presenting with suicidal attempts. All the consecutive cases of suicidal attempts (n=100) treated in a general hospital were studied to know the clinical profile.

Subjects were diagnosed on ICD – 10 and PSLE scales were incorporated to access life events score and HAM-D scale were used to assess depression. Results showed adult age, rural background, nuclear family, self employed, matriculation education from middle socio economic group with a high prevalence of psychiatric morbidity and comorbidity with a significant life events have elevated risk of serious suicide attempts. Early identification and treatment of these disorders would have prevented the mortality associated with this. A proper psychiatric referral system should be built up to reduce the incidence of suicidal death.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Polycystic Ovarian Syndrome in Borderline Personality Disorder

Shobhit Jain, Rajeev Ranjan, Saurabh Kumar, Rajesh Sagar

AIIMS, New Delhi, India, jainshobhitji@gmail.com, rajeevranjan5@yahoo.co.in, saurabhksingh.singh@gmail.com, rajeshsagar@rediffmail.com

Keywords: Borderline Personality Disorder, Polycystic Ovarian Syndrome, Tourette syndrome

Background: Polycystic Ovarian Syndrome (PCOS) is a complex disorder characterized by infertility, hirsutism, obesity, metabolic syndrome and various menstrual disturbances due to elevated androgen levels. Borderline Personality Disorder patients are also known to have higher comorbid obesity, metabolic syndrome and disturbed androgen metabolism. To our knowledge, only one case control study has found association between Polycystic Ovarian Syndrome and Borderline Personality Disorder. So, there is intense need to report such association to have better understanding of etiopathogenesis of Borderline Personality Disorder. We report a case of Borderline Personality Disorder with a comorbid diagnosis of Polycystic Ovarian Syndrome and Tourette syndrome.

Methods: A 30 year old married female with history of menstrual irregularity at onset of puberty and subsequently diagnosed as PCOS at age 12. Later, she developed simple motor tics at 19 years of age and progressed to multiple motor tics and vocal tic by age of 24 years. She developed a pervasive pattern of instability of interpersonal relationships, self-image distortion, affect dysregulation and marked impulsivity by 22 years of age. She had recurrent gestures, threats, self-mutilating behavior, difficulty in controlling anger and transient anxiety spells. The patient was on regular OCP for PCOD. She was maintained on low dose of Aripiprazole and Fluoxetine for Tics and Anxiety spells. She was evaluated by MCMI3 and found to have higher scores for Borderline Personality Disorder. She responded well to regular behavior therapy. Her socio-occupational functioning markedly improved with the treatment in subsequent follow up.

Results: Elevated androgens in women with polycystic ovaries might have an impact on psychopathology leading to Borderline Personality Disorder. Relevant literature pertaining to association between Borderline Personality Disorder and Polycystic Ovarian Syndrome are reviewed and discussed in the report.

Conclusion: The present case report supports the clinical evidence of association between Borderline Personality Disorder and Polycystic Ovarian Syndrome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Priming rTMS for Obsessive Compulsive Disorder: A Randomized Controlled Study

Vidya K L^*1, G Prasad Rao², Nishant Goyal³

^1,2Asha Hospital, Hyderabad, India, dr.vidyakl@gmail.com, ²prasad40@gmail.com, ³Central Institute of Psychiatry, Ranchi, India, psynishant@gmail.com

Keywords: rTMS, OCD, Priming

Background: Obsessive compulsive disorder (OCD) is a chronic disabling psychiatric disorder characterized by obsessions and/or compulsions. rTMS is being considered for treatment of obsessive compulsive disorder, in clinical settings, usually if conventional pharmacotherapy yields partial of poor results. Studies on effectiveness of rTMS in OCD give inconclusive results. Priming rTMS is a novel stimulation method which has been studied in few other conditions like stroke, auditory verbal hallucinations and depression giving positive results but experiments utilizing this paradigm in OCD are still lacking. This study is carried out to assess the effect of priming on 1 Hz rTMS over Supplementary Motor Area in patients with OCD who remain partial/poor responders to conventional pharmacotherapy

Material and Methodology: This study is a prospective, hospital-based, double blind, randomized, sham-controlled study conducted at Asha Hospital, Hyderabad in which 10 patients of treatment resistant OCD as per ICD-10, DCR are recruited as per inclusion and exclusion criteria. All patients are assessed for handedness, severity of OC symptoms using Yale-Brown Obsessive Compulsive Scale, Hamilton rating scale for depression (HAM-D), Hamilton Rating scale for anxiety (HAM-A), clinical global improvement and rTMS side effect checklist at the point of entry and are randomized for active and sham priming using Magpro rTMS stimulator. Stimulation is provided for two weeks for 10 sessions and assessment is repeated after 2 weeks and 4 weeks respectively.

Results and Discussion: Results would be shared at the time of presentation and would be discussed accordingly.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Determining Prevalence of Epilepsy Cases and their associated psychiatric co-morbidities in the Outpatient Department of a Tertiary Level Psychiatric Hospital

Tathagata Mahintamani, Shuvabrata Poddar, Nishant Goyal, Vinod Kumar Pal, Ishita Chatterjee, Sufia Nusrat, Vinod Kumar Sinha, S Haque Nizamie

Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India, mahintamani@gmail.com, shuvabrata.poddar@gmail.com, psynishant@gmail.com

Keywords: epilepsy, focal seizure, co morbidity, anti epileptics.

Background: Epilepsy is a disorder of brain characterised by an ongoing liability to recurrent seizure attacks. There is a close and often intertwined relationship between epilepsy, and psychiatric disorders. Many psychiatric conditions are more commonly associated with co-morbid epilepsy. On the other hand, psychiatric illness, like dissociative disorders may mimic epilepsy and epilepsy as well as post epileptic conditions may present as psychiatric disorder. Beside this the concept of alternating psychosis, and forced normalization indicate the inverse relationship of epilepsy and psychosis, where heightening of psychosis normalizes the EEG abnormality and reduces seizure, and vice versa. So it is necessary to find out the prevalence of epileptic cases in a psychiatric set up.

Aims & Objectives of the Study: This study aims to find out the prevalence of epilepsy among the outpatient population in a tertiary level psychiatric care centre. The objective is to find out the prevalence, age distribution, socio-demographic variables associated with epilepsy, co-morbid psychiatric conditions, type of seizure, as well as treatment disbursed on the first visit.

Materials & Methods: This study was carried out in Central Institute of Psychiatry, Kanke, Ranchi. We followed an archival research design for the study. All the patients attending for the first time in the weekly epilepsy clinic from 2010- 2014 were included in this study. Patients’ socio-demographic data, as well as diagnosis, psychiatric co-morbidity, clinical localization (on the basis of history); and medication received on first visit were recorded systematically.

Statistical Analysis: SPSS version 20 was used for data analysis, using appropriate statistical tests as per nature of the data.

Discussions Results & Conclusion: will be shared during presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Morbidity and Quality of Life in Patients of Psoriasis, Vitiligo and Alopecia Areata: A Comparative Study

Sagar Bipin Karia, Nilesh B Shah

LT.M.M.C. & G.H., India, karia777@yahoo.com

Keywords: psoriasis, vitiligo, alopecia, psychiatric comorbidity, quality of life

Background: In view of reports of high psychiatric morbidity in skin disorders and its effect on quality of life, importance of its identification and management and dearth of Indian literature on this subject, it was decided to study the psychiatric morbidity and quality of life in patients having skin disorders.

Aims: To determine the psychiatric morbidity and the Quality of Life (QOL) in patients suffering from alopecia areata (AA), psoriasis and vitiligo and to determine the factors related with psychiatric morbidity and those affecting the QOL in these patients.

Design: It was a cross sectional, analytical and comparative undertaken in the outpatient department of Dermatology of a tertiary municipal teaching hospital.

Materials and method: 50 patients each of psoriasis, vitiligo and alopecia and 50 control were selected as per inclusion and exclusion criterias. Their demographic profile, phenomenology of skin and psychiatric illness were collected and following scales were used- BSA, PASI, SALT Score, HAM-A, HAM-D, WHO-QOL, GHQ-28. The data was analyzed using SPSS Version 20.

Results and Conclusion: Psychiatric morbidities were found more in patients suffering from skin condition with maximum in psoriasis patients. Also their quality of life was much poorer than control group and the severity of skin condition had impact on QOL. Thus early diagnosis and treatment of psychiatric comorbidity can help in improving the Quality of Life of patients having skin disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Mental Retardation, Comorbidities And Single Parenting

Vaniprabha Gandasi Visweswara, Madhusudhan Shivappa

Bangalore Medical College and Research Institute, India, drvanimads@gmail.com, drmadhunimhans@gmail.com

Keywords: Single parenting, Moderate mental retardation, Mothers.

Authors: Vaniprabha G.V, Dr. Madhusudhan .S, Dr H. Chandrashekar, and Dr. N.R. Prashanth

Background: Mental retardation (MR) has a varied prevalence in different parts of the world. While studying MR, the care giver burden issues are equally relevant. A study to investigate the prevalence of MR and co morbidities and the prevalence of single parenting was done in the Department of Psychiatry, Victoria hospital, in Bangalore.

Objectives: Is to study the degree of retardation in mentally retarded children and co morbidities among them, and prevalence of single parenting and causes related to it.

Study Design: A cross sectional study.

Materials and Methods: A total of 300 consecutive patients diagnosed as MR using appropriate intellectual functioning tests were done and included in the study. Data related to single parenting and co morbidity was collected in a special proforma along with socio economic background.

Results: The mean age of the sample was 10.6 years, mean age at diagnosis of MR was 5.5 years and their mean IQ was 47. Of the total 300 patients, 127 were moderate MR category, 87 were mild MR, 50 severe MR and 36 profound MR. 92% of the patients had significant co morbidities. Seizure, ADHD, Autism, CHD, Microcephaly, Down’s were seen. The prevalence of single parenting was 85% and mostly by mothers. The major causes were found out.

Conclusions: Prevalence of single parenting by mothers of mentally retarded children seems to be much greater. Co morbidity is higher among Moderate MR than compared to other degrees.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Rights Of The Differently Abled: Right To Disability Benefits Of Psychiatric Patients

Madhusudhan Shivappa, Vaniprabha Gandasi Visweswara

Bangalore Medical College and Research Institute, India, drmadhunimhans@gmail.com, drvanimads@gmail.com

Keywords: Mental Retardation, Mental Illness, Disability Benefits, Differently Abled, Psychiatric Patients

Background: Persons with disabilities include those who have long term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.

Design: Cross sectional retrospective study

Hypothesis: Higher the degree of Mental Retardation and Mental Illness higher the extent of benefits availed by them.

Methodology: 200 patients with disability, both mental retardation and mental illness were assessed and what disability benefits were availed by them at Victoria Hospital, Bengaluru.

Results: The 200 patients diagnosed, 181 were mentally retarded and 19 were having Mental illness. In the mental illness category, of the 19 cases, 17 belonged to moderate disability category ranging from 52 to 65% and 2 belonging to 78% and 80%.

Benefits of the disability certificate shall be discussed: Of these benefits the monthly pension scheme both for MR and MI people with 75% and above will receive a monthly pension of Rs. 1,200/- and people with disability of less than 75% will receive a monthly pension of Rs. 500/-. 74% of the 200 patients Of the 2 patients with > 75% of MI both were getting Rs. 1,200/- and of the 17 others only 9 were getting Rs. 500/-

However, Railway pass facility was availed by 76% belonging to all categories of these people and income tax benefits by 12% and other benefits could not be traced and patients who reported these benefits denied having used any other services.

Conclusion: Higher the degree of Mental Retardation and Mental Illness higher the extent of benefits.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Kleine Levine Syndrome with comorbid Schizophrenia

Pawan Sharma, Vijay Krishnan, Mamta Sood

All India Institute of Medical Sciences, India, pawan60@gmail.com, vijayk1984@gmail.com, soodmamta@gmail.com

Keywords: Kleine-Levine syndrome, Schizophrenia, Lithium

Background: Kleine-Levin syndrome (KLS) is a rare disorder. It is seen commonly in adolescent males and is characterized by recurrent episodes of hypersomnia. It is usually accompanied by hyperphagia, cognitive and mood disturbances, hypersexuality and signs of dysautonomia. The psychiatric comorbidities are common with this syndrome. However, schizophrenia comorbid with Kleine-Levine syndrome is a rare phenomenon. We present a case of KLS with paranoid schizophrenia.

Case Report: A 29 years old unmarried male from Hindu nuclear family middle socio-economic status with easy going temperament with family history of psychiatric illness of bipolar affective disorder and suicide in father, presented with acute onset episodic illness which started at the age of 10 years. It was precipitated by viral encephalitis. There was complete inter-episodic remission. Each episode was characterized by increased sleep, increased appetite, hyper sexuality, behavioral changes lasting for 1-1.5 months. Lithium was started in 2000 and gradually frequency and duration of these episodes decreased. 5 years back, he also started having auditory hallucinations of 2^nd person voices commanding and commenting type, referential ideas, somatic passivity, delusion of control, decreased sleep and appetite with significant socio-occupational dysfunction. He was hospitalized and was diagnosed as a case of KLS and paranoid schizophrenia. On admission, brief psychiatric rating scale (BPRS) score was 41. Baseline investigations, MRI brain and EEG were within normal limits. He was started on olanzapine and lithium which were gradually increased to 20mg and 900mg respectively. His psychotic symptoms improved and at the time of discharge after one month, his BPRS score was 25. On follow-up, duration of symptoms of KLS had reduced to 10-15 days though frequency remained the same. His biological, personal and social functioning had improved.

Conclusion: This case highlights the importance of recognizing psychiatric comorbidities in patients with Kleine-Levine syndrome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cognitive deficits and medication adherence in remission cases of schizophrenia a cross sectional study

V V Jagadeesh Settem, Samir Kumar Praharaj, Haridas Karnadi, P S V N Sharma

KMC MANIPAL, India, svvjagadeesh@gmail.com, samirpsyche@yahoo.co.in, haridask2001@yahoo.co.uk, psvn.sharma@manipal.edu

Keyword: Cognitive deficits, medication adherence, years in remission, schizophrenia

Background: Cognitive impairment is one of the cardinal features of schizophrenia with affected patients typically performing 0.8–1.5 SDs below the level of healthy controls across many cognitive domains. Cognitive impairments in attention, memory, and information processing may be related to patients’ difficulty in managing medications. Over the last decades, numerous studies have investigated the characteristics of the patient, the patient’s environment, or the treatment as determinants of nonadherence among which cognition and insight are important features.

Aim: To study the relationship between cognitive deficits and medication compliance in remitted cases of schizophrenia.

Materials and Methods: This is a cross-sectional, observational study, conducted at the Department of Psychiatry, Kasturba Hospital, Manipal, Karnataka. Fifty-four consecutive patients, aged 18 to 60 years, diagnosed as Schizophrenia according to ICD 10 DCR and meeting the Andreasen criteria of remission were recruited in the study. All the patients were assessed on Schizophrenia Cognition Rating Scale (SCORS) and Medication Adherence Rating Scale (MARS), Becks Cognitive Insight Scale (BCIS) and Calagary Depression Rating Scale for Schizophrenia (CDSS).

Results: Significant negative correlation was found between cognitive deficits and medication non adherence (r = -0.36, p = .01), specifically in the attention/vigilance, reasoning and problem solving and social cognition domains (p < .05). Also significant negative correlation was found between total depression score with the medication non adherence (r = -0.50, p < .001). Total years in remission was positively correlated with the medication non adherence (r = 0.29, p = .04).

Conclusion: Our study findings suggest that medication adherence is associated with years in remission and cognitive deficits and may indirectly affect the functional outcome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Relationship Between Work-Family Conflict And Occupational Stress In Police Personnel

Ramya Keerthi Paradesi, Narasimha Reddi Kamuju

Maharajah’s Institute of Medical Sciences, India, pramyakeerthi@gmail.com, reddi_kamuju@yahoo.com

Keywords: Work-Family conflict; Family Work conflict; Organisational stress; Occupational Stress; Police Personnel

Background & Objectives: Both work and family are central to one’s life but these roles do not always readily reconcile, in particular when workers are faced with major stressors in the work place such as in police service. Balancing work and family life has become an increasing challenge. Work-family conflict can have effects on employees occupational stress. The objective is to study the Work – Family conflict, organizational (ORG) and operational (OP) stress in Police personnel of Visakhapatnam region and the relationship between them.

Methods: This cross-sectional study was conducted among 141 police personnel of the rank of constable and sub-inspectors of Visakhapatnam region, Andhra Pradesh. The socio-demographic data was individually collected from them.. A scale developed by Netemeyer et al (1996) was applied to measure work-family conflict (WFC) and family-work conflict (FWC). The Police Stress Questionnaire(McCreary & Thompson,2006) was used for assessing psychological stress. Pearson’s correlation analysis was used to study the data.

Results: From the SPSS output, Correlation matrix examined the relationship between occupational stress and work-family conflict

For Constables For male officers there is a significant correlation with ORG-Stress and WFC r=.499,p=<0.01 and OP-Stress and WFC r=0.430,p=<0.01 which also significantly correlated with the OP-Stress and FWC r=.391,p=<0.01. For Female Officers there is a significant correlation with ORG-Stress and WFC r=.548,p=<0.05 and OP-Stress and FWC r=0.555,p=<0.01.

For Sub Inspectors For male and female officers there is a significant correlation with ORG-Stress and FWC r=.526,p=<0.01 and OP-Stress and FWC r=0.541,p=<0.01 which also significantly correlated with the ORG-Stress and WFC r=.350,p=<0.05. OP-Stress and WFC r=.410,p=0.05.

Conclusion: The amount of conflict experienced between the role requirements of work and family is influenced by occupational stress.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Is secondary prevention of schizophrenia the aim of Today’s psychiatrist?

Madhao Gajananrao Raje^*1, Praveen Khairkar²

¹Mahakali Hospital, India, anumanraje@yahoo.com, ²MGIMS, Sevagram, Wardha, India, pravinkhairkar@mgims.ac.in

Keywords: secondary prevention, schizophrenia, Prodrom, psychosocial intervention, family therapy, supportive psychotherapy

Background: Aim & Objectives: (I) To arrest prodromal symptoms of schizophrenia. (ii) Relapse prevention of full-blown & resistant schizophrenia.

Introduction:

Is secondary prevention of schizophrenia an imagination in 2015? Because primary goal of treating schizophrenia is prevention of relapse, i.e. secondary prevention, which is not usually aimed by clinicians Has debate of multivariate etiology of schizophrenia has died down? Multivariate etiology suggests possibility of secondary prevention. Answers could be dubious.

Can one find ray-of-hope in case studies, where psychotherapy prevents schizophrenia?

Should there be medium-large scale studies to find & substantiate answer?

To assess glimpse of answers following studies are presented.

Material & Method: case study.

(i) Young engineer of 25, suffering from prodromal symptoms of schizophrenia treated with only psychotherapy.

Supportive Psychotherapy: Method – weekly session of 1 hour. Therapeutic alliance, solution focused, psycho education, employed. Remission obtained within 9-10 months, retained.

(ii) Young engineer of 30, from upper middle class, well educated family, suffering from resistant schizophrenia since more than 5 years. P/H/o treatment. Recurrences. H/O non-compliance ruled out.

Family therapy: Method- Systemic approach. Weekly sessions focused on communication, family-belief. Therapeutic intervention sought. Family therapy sessions continued for 2 ½ months, followed by supportive psychotherapy sessions either to patient/to family.

Remission achieved within 6 months, maintained for more than 1 year.

Results & Conclusion: Remission achieved determined effectiveness of psychotherapy either alone/jointly with pharmacotherapy.

Medium-large scale studies should be initiated to ascertain rule of generalization, i.e. all schizophrenics need family therapy/psychotherapy to become fully-functioning schizophrenic.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

1 year Retrospective Review of out-patient treatment with Baclofen in alcohol dependence syndrome in an Addiction Medicine facility in a Tertiary Psychiatry Centre

Tulika Shukla, Spandana Bokka

National Institute of Mental Health and Neurosciences, India, tulikas@rediffmail.com, India, spandanabokka@gmail.com

Keywords: Baclofen, alcohol, outpatient, tertiary centre,

Background: Aims & Objectives: Baclofen has been used as an anti-craving treatment for alcohol dependence. Our aim was to study the factors related with treatment response to baclofen.

Methodology: A 1 year (March2013-March 2014) retrospective chart review of patients diagnosed with Alcohol dependence and prescribed Baclofen as long term treatment was done. Appropriate statistical analysis was done using SPSS (version21)

Results: Factors associated with abstinence and regular follow up while on Baclofen will be described. Correlation of substance use with age of onset, quantity and frequency of alcohol use, dose of baclofen and family history is described.

Conclusions: The use of Baclofen for long term maintenance treatment of ADS needs further study to elucidate predictors of treatment response.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Caregiver Burden In Mental Illness: Prevalence And Correlates- A Cross Sectional Study

Shabna Mohammed, Arun Ayyappan, Vini Vivek, Christina George

Dr. Somervell Memorial CSI Medical College, Karakonam, India, shabna.mhd@gmail.com, ayyappan.arun@yahoo.com, viniarunrajan@gmail.com, mukkath@yahoo.com

Keywords: caregiver, burden, whodas

Background: The ratio of mental health professionals to patients in india is very low. The responsibility for day-to-day care of patients usually rests with family.

Caregiver burden is defined as “the emotional, physical, financial demands and responsibilities of an individual’s illness that are placed on the family members, friends or other individuals involved with the individual outside the health care system”.

Studies show that caregivers of persons with mental illness experience moderately high levels of burden, and often receive inadequate assistance from mental health professionals.

Objectives:

To assess the prevalence of caregiver burden within a community outreach programme
To determine the socio-demographic correlates of caregivers’ burden

Materials And Methods:

Study Design:

Cross sectional community based study

Study population:

Caregivers of randomly selected patients with mental illness from the Mental Health community program at DR.S.M.C.S.I.Medical College.

Inclusion criteria:

Caregivers of patients with any ICD 10 diagnosis of mental disorder.

Caregivers who give written consent

Instruments:

Semi-structured socio demographic questionnaire
WHO DAS
The Burden Assessment Schedule

Results: 46 caregivers were assessed. Their mean age was 43.5(+/- 15.9) years. Only 10(21.7%) had obtained a matric level of education. The most frequent diagnosis was schizophrenia-(n=12; 26.08 %),with a mean duration of illness 15.6(+/- 9.9) years. The mother was commonly the primary caregiver(n=16; 34.8 %). Mean WHODAS score of the patients was 26.48 +/- 7.48. The mean for impact on well being was 7.28 +/- 2.664, impact on marital relations was 8.10 +/- 3.071, appreciation for caregiving was 6.09 +/-1.884, impact on relations with others was 6.67 +/- 2.423and perceived severity of disease was 7.26 +/-2.516.

Conclusion: Caregiver burden is a significant clinical issue even within community programmes. Community outreach programmes maybe suitable settings in which to deliver appropriate interventions.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Managing depression in people with diabetes

Srinivas Suribhatla^*1

¹Leicestershire Partnership NHS Trust, United Kingdom, srinivas.suribhatla@leicspart.nhs.uk

Keywords: Depression diabetes

Background: Diabetes is a global problem and over the last 50 years the prevalence has increased and is predicted to continue to rise. Diabetes is associated with a 2-fold increase in the prevalence of depression. Though precise nature of the relationship is not fully understood but the association is bi-directional, at least for type 2 diabetes. Co-morbid diabetes and depression has significant adverse consequences for the patient and for society rapidly across the world on all continents.

Objectives and Methods: The talk will begin by reviewing literature on the epidemiology of diabetes and depression and considering who is at risk of depression.

Results and Conclusions: We will examine putative mechanisms linking the two conditions, why this is a clinical problem that significantly affects people’s lives and clinical management, prompt screening and treatment to achieve the best for diabetic patients. We will consider newer pharmacological treatments and why complications of diabetes should be a factor in determining the type of antidepressant. These will be placed within the context of current NICE guidance and other world wide systems.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cognitive issues in Psychiatry - US perspective and update

Ranga Ram^*1, Vani Rao², Uma Rao³, Rajiv Tandon⁴, Atul Mahableshwa⁵

¹Indo American Psychiatric Association, United States, rrammd@gmail.com, ²Johns Hopkins University, United States, vani.rao@jhmi.edu, ³University to Tennessee, United States, Urao@utk.edu, ⁴Indo American Psychiatric Association, United States, rrammd@gmail.com, ⁵Takeda, United States, rrammd@gmail.com

Keywords: Recovery, cognitive issues, Traumatic brain injury, Childhood antecedents, substance abuse, schizophrenia, Depression

Background: Cognitive issues are being recognized in schizophrenia depression and in children.

The major influence of the two gulf wars has been the recognition of Traumatic Brain injury. Sports injuries have also led to an increasing understanding of TBI.

Objectives: This Symposium will summarize the current literature on cognitive issues in schizophrenia, depression and in childrens as well as in Traumatic Brain Injury.

Methods: Four presentors in the Symposium will be involved in covering the various topics.

Result: Traumatic brain injury is associated with a myriad of cognitive, emotional, and behavioral disturbances. In both the acute and chronic periods, cognitive disturbances are responsible for significant functional impairment and disability. Oftentimes, cognitive disturbances do not occur in isolation but are associated and maintained by emotional problems such as depression, anxiety and apathy. This presentation will include a discussion of the various types of cognitive deficits, evaluation, and management In addition, the importance of non-cognitive contributors to cognitive problems will also be discussed. The areas of discussion will include schizophrenia, depression, childhood antecedents of substance abuse as well.

Conclusion: Cognitive issues in different diagnostic categories are becoming an increasing focus of treatment.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Use Of Behavioral Intervention For Children With Autism

Pattam Srinivasulu, Kanakalatha Abbagani, Usha Naik

Sankalp Centre for Autism and Related Disorders, India, sripattam@gmail.com, kanakabbagani@yahoo.com, naikusha@gmail.com

Keywords: autism, behavioral intervention, DTT

Background: Autism is a developmental disorder that appears during the first three years of life.Autism is characterized by social impairments, communication difficulties, restricted, repetitive and stereotyped patterns of behaviors and sensory processing difficulties. There are several intervention programs currently practiced, for e.g. ABA/VB, TEACCH, PECS, etc.

ABA is the process of systematically applying interventions based upon the principles of learning theory to improve socially significant behaviors. Discrete trial teaching (DTT) is a technique within behavioral interventions for children with autism. It includes discriminative stimuli, structured prompting schedules, and stimulus control that enhance instruction for learners with autism.

While occurrences of the target behavior result in immediate reinforcement, such as praise, snacks, or toys, the incorrect responses result in extinction or error correction.

Objectives: The purpose of the present study is to use Discrete trail teaching(DTT)in teaching skills for children with autism and assess the post intervention gains.

Methods: The study was conducted at the autism therapy center in Hyderabad. Five children who fulfilled the DSM V criteria for Autism Spectrum Disorders, aged 3-6 years were selected for the study. They also followed biomedical treatments. Children were given intervention two hours per week for 4 months. The Assessment of Basic Language Learning Skills(ABLLS) was used to assess the skills in the following areas:Visual performance, Receptive language, Imitation, Social interaction, Generalized responding, Academic skills. Post assessment of ABLLS was conducted after 6weeks & 12weeks to see the intervention gains. Statistical analysis used for the study is Celeration Line and Wilcox son’s signed Rank test.

Results and Conclusions: The children after intervention, showed improvements in the above mentioned areas in varying degrees. The results are being analyzed and will be discussed during the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

An Intervention for Sensory Processing Difficulties in Children with Autism

Bhuwan Chandra Bhatt, Kanaklatha Abbagani, Usha Naik

“Sankalp” Center for Autism and Related Disorder, India, bhuwnbhattot87@gmail.com, kanakabbagani@yahoo.com, naikusha@gmail.com

Keywords: autism, sensory integration, ADL

Background: Autism is a developmental disability, marked by impairments of communication and social/emotional functioning that is often accompanied by significant behavior problems, restricted patterns of interest and sensory processing difficulties. Autism typically appears in the first three years of life.

Children and young people with ASD demonstrate a variety of behaviors which affect their ability to participate in their daily occupations. Occupational therapy (OT) which includes Sensory Integration (SI) is one of the interventions which enable children and young people with ASD to participate in everyday life and for families to better manage their children’s needs.

Objectives: The purpose of the study is to provide Occupational therapy intervention to five children with autism and assess the therapy gains after 12 weeks.

Methods: The study was conducted at the autism therapy center in Hyderabad. Five children who fulfilled the DSM V criteria for ASD, aged 3-6 years were selected for the study. They also followed biomedical treatments. The assessment was done using the Sensory Profile by Winnie Dunn, which includes the sub scales which assess the following: Tactile, Auditory, Vestibular, Visual, Oral sensory processing, multisensory processing, sensory processing related to endurance/tone, modulation related to body position and movement, modulation of movement affecting activity level. The children attended occupational therapy sessions two hours per week for 3 months. The assessment was done once at the beginning of therapy and after 6 weeks and 12 weeks of intervention to observe the intervention gains. The statistical analyses used is celeration line approach and wilcoxson’s signed rank test.

Results and Conclusions: The children following intervention, showed improvements in the above mentioned areas in varying degrees. The results are being analyzed and will be discussed during the presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Repetitive Transcranial magnetic stimulation (rTMS) over the supplementary motor area in the treatment of late onset OCD with Tourette’s syndrome (TS)

Saurabh Kumar, Rajeev Ranjan, Nand Kumar

AIIMS, New Delhi, India, saurabhksingh.singh@gmail.com, rajeevranjan5@yahoo.co.in, nandkm2001@gmail.com

Keywords: Repetitive transcranial magnetic stimulation (rTMS), Late onset Obsessive compulsive disorder, Tourette’s syndrome (TS)

Background: Age-of-onset for Obsessive Compulsive disorderis not a unimodal phenomena. There are two distinguishable groups; early and late onset. Repetitive transcranial magnetic stimulation (rTMS) targeting the supplementary motor area seems to be efficacious for treating OCD, however little information is available about difference in efficacy in these two groups. Treatment of late onset OCD with Low-frequency rTMS has rarely been reported.

Methods: Here we report a case of 44 years old male with OC symptoms since last 4 years. The patient was treated with anti obsessional drugs in last 2 years with partial improvement but developed prominent side effects as constipation and postural hypotension which were tried to be managed but patient became non compliant to medication. From last year patient developed motor tics and phonic tic. The patient was tried on low dose antipsychotics with no improvement in either OC symptoms or Tics and had developed sedation as side effect. Secondary causes of OCD and Tic disorder was ruled out. It was decided to give a trial of rTMS. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was 28/40 and Yale Global Tic Severity Score (YGTSS) was 42/100. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over supplementary motor area.

Results: The patient reported improvement in both OC symptoms and decrease in TICS within a week of therapy and by the end of 20 sessions, YBOCS score was 14/40 and YGTSS score was 16/100. The patient was further followed up for another 3 months in which he maintained the improvement with addition of Fluoxetine. Low frequency rTMS normalize overactive motor cortical regions and thereby improve symptoms.

Conclusion: Low-frequency rTMS over the SMA appears to be effective treatment modality in late onset Obsessive compulsive disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Creatine Phosphokinase Levels In Patients With Psychiatric Disorder: Comparative Study Among DrugNaive / DrugFree Patients, Patients On Psychotropic Drugs And Normal Population

Vilas Dattatraya Chavan, Arunlata Agarwal

Central Institute of Psychiatry, India, docvilas@gmail.com

Keywords: creatine phosphokinase (CPK), Psychotropic, drug naive/drug free, Schizophrenia, Affect disorder

Background: Creatine Phospokinase (CPK) is an important enzyme in the energy metabolism of many cell types, especially those of muscle and brain. It is a potential marker of brain injury. Increased serum CPK level is found in the majority of hospitalized acutely disturbed patients with schizophrenia and patients with affective disorders. It has been proposed that neural mechanisms mediated by hypothalamic dopaminergic and serotonergic transmissions and by autonomic nervous system may be contributing to this elevation of serum CPK. Further, significantly higher CPK levels have been found in patients receiving atypical antipsychotics compared to patients treated by conventional antipsychotics in past studies.

Aims and Objectives: Present study aimed to compare CPK levels between drug–naive/drug–free psychiatric patients and those on psychotropic drugs and with healthy normal population.

Methods: Sample size will be 60, divided into 3 groups each of 20, drug-naïve/drug-free patients, patient on psychotropic drugs and healthy controls (GHQ-12 score <3). A detailed physical examination will be done to rule out major medical or neurological illness. After that clinical assessment will be done on Brief Psychiatric Rating Scale. Total serum CPK will be measured by Enzyme Immuno-inhibition Test on OLYMPUS analyzer. Appropriate statistical tests will be applied on the collected data to study inter-group differences and relationships between the variables.

Results: The results will be presented and discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Home Based Cognitive Training In Patients Of Schizophrenia

Vikas Moun, Adarsh Tripathi, P.K. Dalal, P.K. Sinha

King George Medical University, India, dr.vikasmoun@yahoo.in, dradarshtripathi@gmail.com, docpkdalal@gmail.com, mounvikas@yahoo.co.in

Keywords: Home-based Cognitive training, schizophrenia, cognition, psychopathology, disability, quality of life.

Background: Schizophrenia has been known to cause cognitive deficits. Studies carried out over the last decade have demonstrated good results of cognitive training in patients of schizophrenia.

Objective: We studied the effects of a 2-month-long home-based cognitive training program along with treatment as usual (TAU; psychoeducation and regular treatment from OPD) on cognitive functions, psychopathology, disability and quality of life in patients of schizophrenia.

Materials and Methods: Seventy four patients of schizophrenia were randomized to either treatment group receiving home-based cognitive training along with TAU (n=36) or to control group receiving TAU alone (n=38). Patients and caregivers received basic psychoeducation and counseling. Patients were assessed for the above parameters at baseline, post-therapy (2 months) and at 4-months follow-up assessment.

Results: Of the 74 patients recruited, 28 in the treatment group and 29 in the control group completed post-therapy

and follow-up assessments. Addition of home-based cognitive training along with TAU led to statistically significant improvement

in cognitive functions of attention, verbal memory, working memory, motor speed, processing speed, verbal fluency, reasoning and problem solving. Effect sizes were moderate, although the sample size was small.

Conclusions: Home-based cognitive training program has shown promise. However, further studies with a longer follow-up are required to study the effectiveness of the program on a larger sample with an active attention comparator involving independent raters.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study Of Psychiatric Comorbidity And Psychosocial Stress Factors In Patients Attempting Suicide

Soumya Chatterjee, Maithili Kadam

Grant Govt. Medical College, India, drs.chatmedico01@gmail.com, maithilikadam@yahoo.com

Keywords: suicide, DSM-IV TR, Beck’s, Adjustment disorder, depression, personality disorder, suicide intent, parasuicide,

Background: There is increasing prevalance of attempted suicide in every day life.Some due to underlying psychopathology and sometimes it is purely a situational reaction.

Objectives:

To study prevalence of psychiatric comorbidity in patients attempting suicide.
To assess psychosocial stress factors in those patients.

Methods: 100 consecutive patients with alleged history of attempting suicide being referred in the Psychiatric Department of a tertiary care Hospital were selected during March –December 2013. Critically ill patients and patients without any reliable relatives were exempted from the study. Assessment was based on a semi-structured Proforma including DSM IV –TR, Beck’s suicide intent scale and presumptive stressful life events’ scale.

Results and Discussion: Majority were found female 66%, single mostly from upper lower socio economic class. According to the DSM IV Criteria- 32% were diagnosed with substance consumption followed by adjustment disorder (17%), depression (16%), personality disorder (16%) and schizophrenia (7%). Mean value of total suicide intent was 20.75. Commonly used methods of self-harm were self-poisoning followed by self-cutting. Mean value of stressful life events in last 1 yr was 2.02 and 6.39 in life time.

Conclusion: Parasuicide was found among low age group population (below 30 yrs) with low suicide intent where substance dependence and personality disorder prevails compare to medium to high suicide intent with more severe psychiatric comorbidity in elder subjects.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depression in Medically ill Geriatric population- A study of predictive factors

Harshitha Rao, P S Murthy

Santhiram medical college, Nandyal, India, drharshitha.r@gmail.com

Keywords: Depression, Geriatric, Elderly, Medically ill, prevalence

Background: Depression in old age is an important public health problem responsible for considerable morbidity and disability worldwide and most often causes for depression are multi-factorial and often preventable. A major factor in the context of evaluating depression in the elderly is the role of medical problems, where the under recognition and under treatment of depression is especially common.

Objectives: To study the prevalence and the possible predictive factors associated with depression in medically ill elderly population.

Methodology: A cross sectional study was done among 100 elderly with medical illness attending the tertiary care hospital in Nandyal for a period of 1year September 2012 to September 2013.

Method of collection of data: A semi structured proforma for various sociodemographic factors was administered by interview method and depression was assessed by GDS- Short version. Other scales used were Katz index for ADL, MMSE, and Presumptive stress scale.

Statistical analysis: Descriptive statistics, Chi square, Fisher’s exact test, Multiple Logistic regression by SPSS 14.

Results: The prevalence of depression in the current study has been found to be 45%. Geriatric depression was higher more among those from nuclear families [p=0.028] and lower socioeconomic class V &IV [35.5% & 28.8% respectively]; [p=0.024]. It was also observed that as the number of co-morbid medical illnesses increase, the depression morbidity increases.[p=0.047]. Diabetes Mellitus type-2 and Cerebrovascular disorders too were significantly associated with depression.[p=0.022 & p=0.009 respectively]. Certain life events and ADL [p=0.015] were observed to be significant predictive factors for depression.

Conclusions: The results reaffirm that there is a high prevalence of depression among the geriatric population and adequate measures to detect and control this psychiatric disorder in elderly by specialized geropsychiatric services are needed.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Faith Healing Practices Among Patients With Psychiatric Illness

Pavan Sharma, Sushil Kherada, Suresh Gocher, Nitin Aggarwal

R.N.T. Medical College, Udaipur, India, drpavanshrm@gmail.com, nitin88805@gmail.com, sureshgocher81@gmail.com, nitin88805@gmail.com

Keywords: faith healer, first carer, psychotic, neurotic

Background: OBJECTIVE: To find out severity/type of psychiatric illness & its correlation with the faith healing practices.

Methods: 100 consecutive patients coming on monday, wednesday, friday coming to psychiatric OPD, MBGH, Udaipur were recruited in two groups

First Group: relatives of patients with psychiatric illness

Second Group: relatives of patients with neurotic illness

Statistical analysis: with statistical software SPSS ver. 15.0

Measures for assessment:

Socio-demographic Profile Sheet

Pathway Interview Schedule

Performa for information regarding faith healing practices

Consent form

Results: It was seen that faith-healers were first carer in majority, 54% of patients in Psychotic group, 39% patients came directly to psychiatry department MBGH, & 7% consulted general practitioners

In Neurotic group 54% patients came directly to psychiatry department MBGH, 30% to general practitioners, & 14% have gone to faith healers.

Conclusion: Faith healers are a major player in the contemporary mental health scenario in this region of Rajasthan (tribal belt) and they cannot be ignored.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Motivation to quit and emotion regulation among alcohol dependents in treatment

Prakat Karki^*1

¹Christ University, India, prakatkarki@gmail.com

Keywords: Alcohol dependence, Motivation to quit, Emotional Regulation, Alcohol Treatment

Background: Alcohol abuse is responsible for more than three million deaths worldwide each year and is also widely implicated in numerous economic, social and health problems. Long term and excessive alcohol consumption has been associated with impairment in cognitive functions whereas moderate alcohol use leads to better cognition and protection from cognitive decline. Age, years of alcohol abuse and severity of alcohol dependence (Severity of Alcohol Dependence Scale- SADQ-C) were taken as a composite in delineating levels of cognitive function in alcohol dependence among a sample of alcohol dependents in treatment. Two variables implicated widely in treatment outcomes; motivation and emotional regulation were measured using the Alcohol Use Self-regulation Questionnaire and Difficulties in Emotional Regulation Scale (DERS) among different groups of alcohol dependents. It was hypothesized that motivation to quit alcohol and nature of emotional regulation will vary among different levels of alcohol dependents based on cognitive functioning. Such a difference would implicate a need for changes in approaches to alcohol treatment based on the patient’s age, years of alcohol use and severity of dependence. Independent samplers t-test (t) was performed to test for differences between the groups and correlation coefficient (r) between motivation and emotional regulation was also calculated. The data collection has been scheduled for October, 2014 in various psychosocial rehabilitation centres and hospitals across Bangalore, India and Kathmandu, Nepal.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Delusion Of Pregnancy And Response To Modified Electroconvulsive Therapy

Khyati Wadhwa^*1, Rishikesh V Behere²

¹Index Medical College Hospital And Research Center, Indore, India, khyatiwadhwa@gmail.com, ²Kasturba Medical College, Manipal, India, rvbehere@gmail.com

Keywords: ECT, Delusion of Pregnancy, Delusional Disorder

Background: Delusion of pregnancy is a special form of hypochondriacal / somatic delusion. High potency antipsychotics such as pimozide are indicated in the treatment of delusional disorder. However use of Modified Electroconvulsive Therapy (MECT) in delusional disorders has been reported infrequently.

Objectives: To study the response of Delusional Disorder to Modified Electroconvulsive Therapy (MECT) by serial evaluation of psychopathology during the course of treatment.

Methods: A case of PDD was treated in KMC, Manipal. In view of agitation and aggressive behaviour a course of MECT was started. Serial evaluation of patient’s psychopathology on Brief psychiatric Rating Scale (BPRS) and Delusion Rating Scale (DRS) was done during treatment and significant response was seen.

Results: The patient showed significant response after the initial 6 MECTs and thereafter response showed a gradual plateau. Apart from decrease in agitation, delusional belief was also successfully encapsulated. At the end of 11^th ECT there was a substantial reduction in patient’s BPRS and DRS ratings and she did not spontaneously report the delusion.

Conclusion: The response in this case of delusional pregnancy within 6 MECTs shows that MECT can prove to be therapeutically very effective in treatment of mono-symptomatic delusion of pregnancy and possibly other delusional disorders without a need to re-course to a prolonged treatment.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparative study of alexithymia, illness behavior and symptoms of depression in patients with somatoform disorders and chronic physical illness

Arizwaseem Shahajahan Inamdar, Sailendra Kumar Deuri, Kamal Narayan Kalita

LGBRIMH, India, drariz0335@gmail.com

Keywords: alexithymia, illness behaviour, somatoform disorders, depression

Background: It has been found that patients with somatoform disorders commonly have difficulties in recognising and expressing their emotions, which plays important role in maintenance of disease and treatment outcome. Considering these fact, we compared alexithymia, illness behavior and symptoms of depression in patients with somatoform disorders and chronic physical illness.

Objectives: To assess and to compare alexithymia, illness behavior and comorbid depression in patients with somatoform disorders and chronic physical illness and to analyse relationship between somatoform disorder and selected variables of illness behavior.

Methods: This cross sectional observation study was conducted in OPD of LGBRIMH and Civil Hospital, Tezpur in the year 2013. 30 patients diagnosed as somatoform disorder using ICD-10 were selected as study group after applying inclusion and exclusion criteria. 30 patients with chronic physical illness were selected as control group after matching with study group. Toronto Alexithymia Scale(26 items), Illness Behaviour Assessment Schedule(19 items) and Hamilton Depression Rating Scale(17 items) were applied on them. And finally appropriate statistical analysis was done using SPSS version 20.

Results: Prevalence of alexithymia was found to be very high in patients with somatoform disorder(64%) as compared to chronic physical illness(36%). Patients with somatoform disorder have relatively better association with few variables of illness behavior like preoccupation with somatic symptoms, inhibition in communication of affect, denial of life stressors and displacement of life stresses onto somatic illness. Symptoms of depression were seen in significant number of patients with somatoform disorder as compared to chronic physical illness.

Conclusion: The study showed that alexithymia can be regarded as vulnerability factor to develop somatoform disorders. Assessment of alexithymia in patients of somatoform disorder would help us to understand and plan optimum management strategies as alexithymics do much better with cognitive and behavioral approaches.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

How effective is Naltrexone in preventing alcohol relapses?

Satish Ramaiah^*1

¹People Tree Mind Care, India, findsatish@hotmail.com

Keywords: Naltrexone, opioid antagonist, alcohol, alcohol disorder / dependence, relapse prevention and treatment

Background: Objectives: To determine the effectiveness and tolerability profile of Naltrexone in alcohol relapse-prevention compared to placebo or other control

Methods: A literature search was carried out for double blind randomised controlled trials in adult population with alcohol dependence, comparing Naltrexone and placebo or other control. 16 studies were included after application of inclusion and exclusion criteria. Studies had adequate numbers and follow up duration. Methodologies of these studies seemed robust with some limitations reducing the generalisability of the study.

Results: Primary and secondary outcomes were analysed including adherence, drinking outcomes, effect of psychological therapies, biological markers and tolerability profiles. Studies generally favoured Naltrexone. Results suggested reduction in rates of relapse to heavy drinking and craving, including better safety profile for Naltrexone. Couple of studies demonstrated unfavourable outcomes in Naltrexone group. Several new themes like role of ‘as required’ use of Naltrexone and detoxification not being a pre-requisite for treatment were also explored.

Conclusions: The review demonstrates and further strengthens the available evidence for Naltrexone in preventing alcohol relapses both in terms of its clinical efficacy and tolerability. However, external validity and translation into clinical practice is limited due to some methodological issues. Further research with quantitative summation and economic analysis would further influence the confidence in clinical applicability of Naltrexone for relapse prevention.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Impact of National Mental Health Programme on the status of psychiatric illnesses in India.

Ravi Kumar Rana^*1

¹LLRM Medical College, Meerut, U.P., India, drravirana@gmail.com

Keywords: Disability Adjusted Life Year (DALY), neuro-psychiatric, prevention

Abstract: Psychiatric symptoms are common in general population. Psychiatric symptoms like worry, tiredness, and sleepless nights affect more than half of the adults at some time. While as many as one person in seven experiences some form of diagnosable neurotic disorder. The World Bank report (1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuro-psychiatric disorders is much higher than diarrhoea, malaria, worm infestations and tuberculosis if taken individually. According to the estimates DALYs loss due to mental disorders are expected to represent 15% of the global burden of diseases by 2020. Studies have shown that the prevalence of major psychiatric disorders is 18 to 207 per 1000 with the median of 65.4 per 1000. About 2-3 % of the population, suffer from seriously incapacitating mental disorders. Most of these patients live in rural areas, remote from any modern mental health facilities. A large number of adult pts (10.4 - 53%) coming to the general OPD are diagnosed mentally ill. These patients are usually missed by medical officer/G.P at the primary health care unit. Due to the under-diagnosis of these patients, unnecessary investigations and treatments are offered which heavily cost to the health providers. The Government of India has launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it. The aims of NMHP are prevention and treatment of mental and neurological disorders and their associated disabilities, Use of mental health technology to improve general health services and application of mental health principles in total national development to improve quality of life. The objectives of NMHP are to ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of population, to encourage application of mental health knowledge in general health in social development and to promote community participation in the mental health services development and to stimulate efforts towards self-help in the community. The strategies of the programme are to integrate mental health with primary health care through the NMHP; Provision of tertiary care institutions for treatment of mental disorders; Eradicating stigmatisation of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority, and State Mental health Authority. During the 11th Five Year Plan an allocation of Rs. 1000 crore has been made for the National Mental Health Programme. A sum of 70 crore has been provided in 2008-09 for implementation of NMHP. It has been proposed to decentralize the Programme and synchronize with National Rural Health Mission for optimizing the results. To establish Centers of Excellence in Mental Health by upgrading and strengthening of identified existing mental hospitals for addressing acute manpower shortage. To provide impetus for development of Manpower in Mental Health, in other training centers (Govt. Medical Colleges/General Hospitals etc.). Training centers would also be supported for starting PG courses in Mental Health or increasing intake capacity. Spill over of 10th Plan schemes for modernization of state run mental hospitals and up gradation of psychiatric wings of medical colleges/general hospitals.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Help Seeking Behaviour, Coping Responses Of The caregivers Of Bipolar Disorder

Ashvini Dagdusing Rajput^*1, Arunlata Agarwal¹

¹Central Institute Of Psychiatry, India, ashwini.rajput7@gmail.com

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Personality Dimensions And Their Association With Treatment Outcome In Alcohol Dependent Patients

Soundarya Soundararajan^*1, Gitanjali Narayanan², Arpana Agrawal³, Dorairaj Prabhakaran⁴, Pratima Murthy⁵

¹PhD scholar, Department of Clinical Neurosciences, National Institute of Mental Health and Neurosciences(NIMHANS), India, soundarya24@gmail.com, ²Mental Health Consultatnt, Center for Chronic Disease Control, New Delhi, India, gitanjali_n@yahoo.com, ³Associate Professor, Department of Psychiatry, Washington University School of Medicine, United States, agrawala@psychiatry.wustl.edu, ⁴Professor, Epidemiology, Director, Center for Chronic Disease Control, New Delhi, India, India, dprabhakaran@ccdcindia.org, ⁵Professor of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences (NIMHANS), India, pratimamurthy@gmail.com

Keywords: alcohol, relapse, personality, extraversion, treatment outcome

Background: Personality profiling allows researchers to generate important hypotheses regarding risk factors and correlates of alcohol use/misuse. Studies examining the association between personality traits and relapse are limited.

Objectives: To study the relationship between personality dimensions and treatment outcome in alcohol dependent patients.

Methods: Adult participants with alcohol dependence were recruited from the inpatient and outpatient wards of a tertiary care deaddiction facility in India using a prospective design, and followed up after three months. Questionnaires administered were NEO-PI-R (Revised NEO Personality Inventory), Satisfaction with life (SWL) and AWARE (Advanced Warning of Alcohol Relapse).

Results: Out of 99 recruited participants (92% males) with mean age 37(±8.42) years, follow-up information was available for 82 patients (82.8%) at 3 months, of whom 34.3% maintained abstinence.

E4 (activity) facet of the extraversion domain in the NEO-PI-R significantly correlated with the AWARE scores (p=0.043). There was a significant negative correlation between the E2 (gregariousness) facet and satisfaction with life scores (p=0.036). Age of first drink had significant negative correlation with the AWARE scores (p=0.014).

Conclusion: Our study suggests that factors related to extraversion, specifically, excitement seeking might be associated with a higher risk for relapse. More sociable people are less satisfied with their lives and might tend to cope up with substance use. Earlier the age of first drink, higher the risk for relapse. Predicting alcohol relapse by studying the personality traits would help clinicians in improving treatment outcomes.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Assessment of psychiatric co-morbidities in patients presenting with chest pain to the cardiology outpatient services in a tertiary care hospital

Ruben Parayil John, Abhishek M L, Avinash G Kamath, Rishikesh V Behere, Ranjan Shetty

Kasturba Medical College, Manipal, India, drrubenjohn@hotmail.com, mlabhi0003@gmail.com, kamathavi@gmail.com, rvbehere@gmail.com, capriscoe@hotmail.com

Keywords: psychiatric comorbidities, chest pain, cardiac, atypical

Background: Acute central chest pain is a common symptom presentation, yet less than half the patients are given a diagnosis of acute myocardial infarction. In the remaining patients the diagnosis remains elusive in 49– 60% patients. A large number of patients with chest pain are investigated for CAD extensively irrespective of having typical or atypical chest pain resulting in burden on resources. Our Literature review has shows only 10-15 citable studies that are related to co morbidities of chest pain. Recent studies have shown the relation between depression and cardiac disorders. (SADHART study, Glassman et al, 2002)

Objectives: • (Primary) To explore the prevalence of psychiatric comorbidity in patients presenting with chest pain

• (Secondary)To compare the prevalence of psychiatric comorbidity in those who are diagnosed with cardiac and non cardiac cause for chest pain.

Methodology

·Cross-sectional, Descriptive study
· Ethical clearance and informed written consent
· Patients presenting to cardiac OPD with history of chest pain are the study population.
· Enrolled based on inclusion and exclusion criteria

Questionaires:

· Semi-structured Socio-demographic Parforma
· MINI 5.0,
· HADS,
· WHO-Somatoform disorder symptom checklist
· Visual analog scale.
·Patients meeting criteria on interview will be referred to the Dept of Psychiatry for further evaluation.

Results: The preliminary findings show that there are psychiatric co-morbidities in the population under study. Statistical analysis at the end of the study is awaited to understand if the results are significant.

Conclusions: Will be presented at the conference as the study is currently on-going.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

An analysis on patients undergoing Modified Electro Convulsive Therapy at a tertiary care neuropsychiatric center

Aninda Sidana, Deepak Moyal, Vishal Dhiman, Deepak Kumar⁴

IHBAS, India, nandy.aninda@gmail.com, deepak.moyal@gmail.com, vishaldhiman102@gmail.com, srivastav.deep@gmail.com

Keywords: Modified Electro Convulsive Therapy, characterstics, agents

Background: Aim- To study the socio demographic profile, primary psychiatric diagnosis and comorbidity in patients undergoing Modified Electro Convulsive Therapy at a tertiary care neuropsychiatric center.

Materials and Methods: Study was carried out in 60 consecutive patients undergoing Modified Electro Convulsive Therapy at a tertiary care neuropsychiatric center of National Capital territory of Delhi. 60 patients who had been receiving MECTs were randomly selected from an electronic database over a period of one year were included. A retrospective chart study was conducted and all records pertaining to such patients were studied. The case records were reviewed and the socio demographic data was tabulated and analyzed.

Results & Conclusion: To be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Evaluation Of Stigma And Discrimination Among Psychiatric Outpatients In A Medical College Hospital In Karnataka

Shashwath Sathyanath, Anil Kakunje, Mohan Chandran

Yenepoya medical college and Hospital, India, shashsm@yahoo.co.in, anilpsychiatry@yahoo.co.in, mohanchandran660@yahoo.com

Keywords: Stigma, Discrimination, Psychiatric Out-patient Department, DISC-12 questionnaire

Background: Stigma was originally defined by Erving Goffman (1963) as a mark or attribute that reduces an individual “from a whole and usual person to a tainted, discounted one”. One of the identified reasons for low support for mental health is the Stigma attached to mentally ill individuals. Stigma and discrimination faced by psychiatric patients are the most important barriers in accessing care and can result in long treatment delays. Stigma is universal, but the nature, source and the impact varies across cultures and regions. Thus intervention needs to be specific. This study is to assess the perceptions of the patients with psychiatric illness regarding the stigma and discrimination they face in their lives. The main determinants and sources of stigma, as well as the nature and forms of stigma were of interest.

Objectives: Patients with Psychiatric illness are always prone to stigma and discrimination leading to delayed treatment outcomes and poor follow ups. The plan is to evaluate the factors affecting stigma and discrimination among psychiatric patients.

Methodology::It was a cross-sectional survey. The present study was carried out at YENEPOYA MEDICAL COLLEGE HOSPITAL after obtaining the Ethical committee clearance of the hospital. 100 Consecutive patients seen in OPD/camps having a psychiatric ICD-10 diagnosis made by the treating consultant were approached for consent. DISC 12 validated stigma questionnaire was administered in patient’s own language which would take around 15 to 20 minutes. Data was entered in Microsoft excel and further analysis done using SPSS version 17. Both quantitative and qualitative analysis was done. Association was determined using Chi-square test or Mann Whitney U test depending upon the distribution of data.

Results And Conclusions: of the study will be revealed later.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Suicide trend among general and hospitalized patient how does the progression differ: An analysis

Gautam Anand^*1

¹Ruxmani Ben Deepchand Gardi Medical College, Ujjain, MP, INDIA, India, drganandgwl@gmail.com

Keywords: suicide, suicide ideation, suicide planners, deliberate self harm

Background: Suicide trend is common among farmers, youths and old. It became fashion among the Indian farmers resulting faulty copying of stress and opted a national culture of use of pesticide in current social practice. other methods vary from time to time. Attributable and relative risk are quantifying the trend among general population contribute to its progression. Similarly hospitalized patient suffering from chronic and debilitating illness of poor prognosis has its own course of progression.

Aim: To establish path of progression of suicide and steps sharing among general and hospitalized population

Method: study based on previous research papers of author and simultaneously working on such issue to compile data obtained from general hospital and data available on internet based quality screened and analyzed. After analysis by logic showed significant outcome

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Correlates of burden and medication adherence in women with mental illness in remission

Arun Kumar V, Dushad Ram, Rajesh Raman, Sudharani P Naik

JSS Medical College, India, arunkumar.vinayak@gmail.com, dushadram@hotmail.com, drrajesh_2u@yahoo.co.in, drsudhanaikjss@gmail.com

Keywords: Correlates of burden and medication adherence in women with mental illness in remission.

Background: Aim and objective: To study the level of burden & adherence and its socio-demographic correlates in female patients with mental illness in remission.

Methodology: Fifty one consecutive females were assessed using Socio-demographic proforma designed for this study, The Zarit Burden Interview and Medication adherence scale.

Result: 75% of the patients experienced different levels of burden while 25 % had poor medication adherence. Scores on Morisky medication adherence scale revealed a mean score of 8.3(SD ± 1.7) and a significantly correlates with age at onset(p<05) & knowledge of treatment (p<01). Mean value for total score on Zarit burden interview was 33.6 (SD±17.0), while for personal strain domain it was 15.1(SD±8.5) and for role strain domain it was 13.5(SD±7.0). Occupation has a significant correlation to personal strain domain (p<01) and role strain domain (p<01) while marital status has a statistically significant correlation with personal strain domain(p<05). No statistically significant correlation observed between domain of burden scale and medication adherence.

Conclusion: Burden and poor compliance are highly prevalent and may be related to some socio-demographic variables

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Socio-demographic correlates of effective consumer behaviour in women with mental illness in remission

Sudharani P Naik, Dushad Ram, Rajesh Raman, Arun Kumar V

JSS Medical College, India, drsudhanaikjss@gmail.com, dushadram@hotmail.com, drrajesh_2u@yahoo.co.in, arunkumar.vinayak@gmail.com

Keyword: Socio-demographic correlates of effective consumer behaviour in women with mental illness in remission

Background: Aim and objective: To know the level of effective consumer behaviour and its socio-demographic correlates in female patients with mental illness in remission.

Methodology: Fifty one consecutive females who are living in the community after acute episode of mental illness were recruited in the outpatient department of psychiatry if they satisfy the selection criteria and assessed using Socio-demographic proforma designed for this study, The Effective Consumer Scale and Indian Disability Assessment Scale.

Result: Mean score of the study sample on Effective Consumer Scale was 31.9(SD±11.2). Socio-economic status has a statistically significant correlation with domain communications (p<05),negotiation (p<01) and decision - taking action (p<05). Other statistically significant correlation found were between family type and negotiation (p<05), diagnosis and uses of health information (p<05) & priorities (p<05). Marital status has a negative correlation with communications (p<05).

Conclusion: Effective consumer behaviour may vary with socio-demographic variables

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study of clinical profile and cognitive insight in patients of treatment resistant schizophrenia

Kundan Sandipan Kamble^*1, Ajita Sunil Nayak¹

¹Seth G.S.M.C and KEMH Mumbai, India, kundan0339@gmail.com, ajitanayak@rediffmail.com

Keywords: Treatment resistant schizophrenia, illness variables, Becks cognitive insight scale, cognitive insight.

Background: Objectives: It has been estimated that 20-50% schizophrenia can develop treatment resistance. Treatment resistance is associated with increase morbidity in these patients. It also increases the burden of care for the caretakers. Very few Indian studies have tried to establish the factors associated with resistance in schizophrenia. Hence this study was conducted to identify the socio-demographic profile, illness variables, co-morbidities, treatment received and cognitive insight in patients with resistant schizophrenia.

Methodology: The study was conducted after permission from Institutional Review Board. 50 consecutive patients of treatment resistant schizophrenia(treated with 2 antipsychotics from different classes with adequate doses for 6 weeks each and currently satisfying the DSM IV TR criteria for schizophrenia) were included in the study. Patients were administered a semi-structured questionnaire to obtain details about socio-demographic status, age of onset, family history, no. of episodes and treatment received. DSM-IV-TR was used to identify psychiatric co-morbidities. Becks cognitive insight scale was used to assess cognitive insight.

Results: The mean age of patients in the study with Treatment Resistant Schizophrenia (TRS) was found to be 33.5yrs with M: F ratio of 1.77:1. It was found that 34% of patients had an onset before 20 yrs of age. Positive family history of mental illness was present in 48% of the TRS patients. Multiple episodes (≥ 5) were present in 36% of patients. TRS was characterised by absence of affective symptoms in 90% of patients. On applying Beck’s cognitive insight scale patients of TRS were found to have higher Self Certainty Score as compared to Self Reflection on BCIS indicating poor awareness into their illness and treatment

Conclusions: It is important to identify Schizophrenia patients with early age of onset, family history, absence of affective features and poor cognitive insight to improve the long term course of Schizophrenia

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparative study among the positive and negative subtypes of patients with treatment resistant schizophrenia.

Kundan Sandipan Kamble^*1, Ajita Sunil Nayak¹

¹Seth G.S.M.C and KEMH Mumbai, India, kundan0339@gmail.com, ajitanayak@rediffmail.com

Keywords: comparative study, clinical subtypes of resistant schizophrenia, PANSS, Becks cognitive insight scale, cognitive insight

Objectives: Long term studies of patients with Schizophrenia have found variable outcomes based on the positive and negative clinical subtypes. Hence we studied patients with Resistant Schizophrenia to find out the prevalence of these subtypes and compare them on various risk factors.

Methodology: The study was conducted after permission from Institutional Review Board. 50 consecutive patients of treatment resistant schizophrenia(treated with 2 antipsychotics from different classes with adequate doses for 6 weeks each and currently satisfying the DSM IV TR criteria for schizophrenia) were included in the study. The sample was divided into 2 groups using PANSS. Group 1 consisted of patients with positive subtype while group 2 consisted of negative subtype of Schizophrenia. The 2 groups were compared on socio-demographic profile, illness variables, treatment received, co-morbidity and cognitive insight into illness and treatment. DSM-IV-TR was used to diagnose schizophrenia and to identify psychiatric co-morbidities. The Becks cognitive insight scale was used to assess cognitive insight.

Results: On applying the PANSS to the 50 patients with resistant Schizophrenia, 46% were found to have positive subtype of schizophrenia, 32 % had negative and 22% had mixed subtype. On comparing the 2 groups (positive and negative) suicidal ideations were significantly higher in positive subtype of resistant schizophrenia as compared to negative. No significant differences were found on age of onset, number of episodes or treatment received. Cognitive insight was found to be significantly poorer in the patient with positive subtype of resistant Schizophrenia.

Conclusions: Treatment resistance is found to be associated with both positive and negative subtype of Schizophrenia. Targetted interventions like treatment of suicidal ideations and cognitive behaviour therapy in patients with positive Schizophrenia is important to improve prognosis.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychosis and Meditation

Pawan Sharma, Rishab Gupta, Rajesh Sagar

All India Institute of Medical Sciences, India, pawan60@gmail.com, rishabaiims@gmail.com, rsagar29@gmail.com

Keywords: Meditation, Psychosis, Schizophrenia, Spirituality

Background: Objectives: Meditation is believed to have many health benefits apart from enhancing spiritual health. However, there is some evidence that it may lead to certain psychiatric disorders too. Some researchers have reported that meditation may even lead to psychosis or worsen it in some cases. On the other hand, it has also been proposed to alleviate even severe psychiatric symptoms among psychotic patients. Hence, there is a need to review the existing literature to clarify on this controversy of whether meditation is overall harmful or beneficial in patients with psychosis.

Methodology: We performed a systematic review of all the existing studies using PubMed and Google Scholar using following search terms: ‘Psychosis’, ‘Schizophrenia’, ‘Meditation’ & ‘Spirituality’. We gathered all the studies since inception of the databases and total of 163 articles. Studies available in non-English language were excluded. Two of the authors did the literature review independently to ensure that no relevant article is missed.

Results: There is scarcity of data in this field. Of all the available studies, there was a majority of case series and case reports describing association of psychosis with meditation. Various types of meditative techniques were mentioned in the studies, viz. Mindfulness based meditation, Transcendental Meditation, Bikram Yoga etc. Mindfulness based meditation studies were found to be beneficial to patients with psychosis. There were some evidences to point the precipitation or worsening of psychotic symptoms in patients already at risk of developing psychosis.

Conclusion: Overall, there is inconclusive evidence for or against benefit of meditation in patients with psychosis. Most of the subjects who developed psychosis with meditation were already at the increased risk. Some of the factors proposed are dehydration, sleep deprivation, sensory deprivation and hypoglycemia. Future studies using longitudinal follow up design should be able to throw more light on this issue.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Is Cognitive Dysfunction The Reason Why Schizophrenia Patients Wear Multilayered Clothes?

Tathagata Mahintamani, Daya Ram, Sayantamanava Mitra, Shuvabrata Poddar

CIP Ranchi, India, mahintamani@gmail.com, mahintamani@gmail.com, sayantanava@gmail.com

Keywords: Schizophrenia, redundant clothing, cognitive function, SCoRS, MMSE

Background: Redundant clothing or multilayered clothing is considered as a readily observable marker for schizophrenia. Cognitive dysfunctions are among the various proposed causes behind the enigmatic behaviour. Cognitive deterioration in schizophrenia involves various domains like memory, learning, attention, working memory, problem solving, processing/motor speed, social cognition, and language.

Aims: The present study aimed at comparing the different spheres of cognitive function, between patients of schizophrenia with and without redundant clothing

Materials & methods:25 schizophrenia patients with redundant clothing (at least 3 episodes of wearing multiple layers of same clothing without obvious relationship with change in environment requiring active intervention of guardians or caregiver) were compared with 25 age & sex matched controls with a diagnosis of schizophrenia but without redundant clothing. The socio-demographic and clinical data were gathered. The cognitive function was assessed by schizophrenia cognition rating scale (SCoRS) which is a gold standard scale measuring all domains, which are affected in schizophrenia, and mini mental state examination (MMSE). The data were analysed by SPSS version 20.

Result & Conclusion – will be shared during presentation at the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Cross Sectional Comparative Study Of The Personality Profile Of Bipolar Affective Disorder Patients With That Of Recurrent Depressive Disorder Patients

Krishnakumar K N, Deepak Kuriakose Pala

MES Medical College, Kerala, India, dr.knkrishnakumar@gmail.com, deepakkuriakose@gmail.com

Keywords: Bipolar affective disorder, Recurrent depressive disorder, Personality profile, NEO FFI

Background: Studies comparing the personality characteristics of various affective disorder is feww from India. There are studies from other nations most of which showed significant differences.

Objective: To compare the personality profile of Bipolar affective disorder patients with that of Recurrent depressive disorder patients in terms of the Mc Crae and Costa Five Factors – Neuroticism, Extroversion, Openness to experience, agreeableness and conscientiousness and to test if there is any significant difference

Methods: 50 patients each suffering from bipolar affective disorder and recurrent depressive disorder were selected when they come for follow up to a tertiary hospital in Kerala if they were euthymic and assessed using SCID for allotment into the 2 groups. Their personality profile is assessed using NEO FFI which is a self report personality inventory to assess the personality in terms of Neuroticism, Extroversion, Openness to experience, Agreeableness and Conscientiousness. The scores were assessed using independent t test, Chi square test and ANOVA.

Result: The 2 groups – Bipolar affective disorder group and Recurrent disorder group differ significantly in terms of all the Five factors ie Neuroticism, Extroversion, Openness to experience, Agreeableness and Conscientiousness

Conclusion: This implies that the the different personality profile could be a phenotype which would differentiate patients suffering from either of the disorders. Longitudinal prospective studies were needed to determine whether the personality differences could be taken as phenotypic marker for the disorders and the predominance of a particular factor is a risk factor for a particular disorder

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of the psychological and physiological symptoms during acute inhalant intoxication

Uzma Hashim Mulla^*1, Shekhar P Seshadri²

¹INHS Asvini, India, uzmamulla@gmail.com, ²National Institute of Mental Health and Neurosciences, India, shekhar@nimhans.kar.nic.in

Keywords: Volatile substances, inhalants, acute intoxication

Background: There are few studies reporting volatile substance abuse from India.

Objectives: To study the psychological and physiological effects experienced during acute intoxication of inhalant use.

Methods: An explorative-descriptive research design was adopted and consecutive treatment seeking volatile substance abusers as well volatile substance abusing street children staying at an NGO shelter were interviewed using a semi-structured interview schedule(n=30).

Results: The most commonly used inhalants were typewriter correction fluid(60%), adhesives(37%) and petrol(3%). Huffing from a cloth(90%) was the most common method of inhalation. 93% of the respondents reported regular use(defined here as using inhalants at least once a month). The mean duration of use was 3 yrs. The most common psychological symptoms reported during acute intoxication initially were “gives me a high(80%),makes me forget pain(70%), increases my happiness(63%) and puts me to sleep (60%)”. The most common psychological symptoms reported currently were “gives me a high(90%), makes me forget problems(80%), decreases my sadness(77%) and makes me forget boredom(67%)”. Compared to the 60% respondents who reported falling asleep during initial use, only 37% reported this currently. This could probably be attributed to the physiological tolerance that the respondents were developing. The most common physiological effects reported were blurred vision (90%), slurred speech (87%), redness of eyes(77%) and auditory hallucinations(67%). Though inhalants are known for their seizurogenic and arrhythmogenic potential, none of the respondents in the current sample reported seizures or palpitations. Inhalants are well known irritants and though conjuncitval congestion was reported by 77%, lacrimation was reported only by 40%. 57% reported an urge to hurt themselves during acute intoxication, while 50% of them had suicidal ideas. Accidental and deliberate self harm was reported by 53% and 37% respectively.

Conclusion: Though most of the reported psychological and phyiological symptoms during acute inhalant intoxication matched available literature, none of the respondents reported significant effects like seizures or palpitations.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Treatment efficacy and cost affectivity of selection of treatment plan in headache in depression of bidirectional relationship

Gautam Anand^*1

¹Ruxmani Ben Deepchand Gardi Medical College, Ujjain, MP, India, drganandgwl@gmail.com

Keywords: headache, depression, bidirectional, migraine, y/n format

Background: In continuation of previous study of type pattern and distribution of headache showed bidirectional relationship and emergence of depressive and somatic neurological symptoms has significant value. The characteristic location over scalp is bilateral temporal followed by unilateral temporal, vertex and others. Throbbing character is most predominant phenomenon than band in clinical setting present at the time to report. Sufficient time has given to pay attention or to be converted into migraine or vice versa. Treatment relies on which came first expected answer will sort the problem and cut the cost of treatment.

Aim: To understand the presence and significance of headache in depression. To design and formulate treatment plan as cost effective and minimize the overuse of drug by rational approach to the patients.

Method: subject to study were based on previous research in continuum over selected out patients having headache screened for depression as over > 9 score of HAMD Scale. They were put on three plans find the result after comparing initial baseline score over y/n headache format and calculate the cost and compare among the group

Results: The treatment plan were selected on their response had been equally effective. The cost of treatment of randomly selected group and those who failed to answer which has high cost of treatment than answered question with firmity. The treatment cost in unanswered or randomly selected had 1.5 to 2 times higher than selected answered questions who went treatment with mono therapy has understood bidirectional relationship.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Needs of parents of persons with Intellectual Development Disability

Srinivasa R Murthy^*1

¹The Association for the Mentally Challenged, India, smurthy030@gmail.com

Keywords: Intellectual Development Disability; Parents; Needs assessment

Background: To understand the ‘lived-in’ experiences and needs of the families with a person with IDD, 60 family narratives were collected using semi-structured interviews. The following seven common themes emerged: Poor awareness in the families with and intellectual developmental delayed(IDD) child: (i)There is poor awareness resulting in delay in introduction of the interventions like early stimulation and special education and ‘shopping for cure’. (ii) Families are not given the details of the permanent nature of the condition and what can be expected from interventions. Schools are not sensitive to the needs of IDD and equipped to meet their needs: In almost all families, children with IDD were admitted to regular schools but there they were either not continued or they attended for years without any progress. (iii)Parents are not given the skills needed to care for the IDD.(iv) There is lack of continuous care and support: Almost all parents have visited many many facilities looking for a ‘cure’ or care. (v) Parents require a committed, continuous, compassionated and coordinated care, but what they get is a disorganised care, which is almost no care for the IDD and the family.(vi) Government benefits are valuable However, accessing the services is paved with many problems and corruption is the order of the process. (vii) Society is largely unsympathetic to the IDD and family: Each of the parents narrate a variety of deprivations, isolation and stigma experiences at various stages of their life journey. Implications are: there is need for the range of services to be enhanced, better coordinated. One of the most easily doable measure is to build the support around the mobile phones which are available with almost all the families. In addition, AMC need to facilitate the IDD and parents to access the government facilities.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Consultation-Liaison Services in a Tertiary Hospital of Pondicherry

Sukanto Sarkar, Sivaprakash Balasundaram, Abu Backer

Mahatma Gandhi Medical College & Research Institute, Pondicherry, India, sukanto_sarkar@yahoo.com, drprakashb@gmail.com, hifromabu@gmail.com

Keywords: Consultation-liaison psychiatry, retrospective chart review, referral rates

Background: Consultation-Liaison Psychiatry (CLP) deals with clinical, teaching and research activities of mental health professionals in collaboration with health professionals of other specialities. There has been a wide difference in the pattern of its utilization across various Indian studies. Objectives: In view of the above variations, a retrospective chart review was done to evaluate the utilization of CLP services in a tertiary hospital in Pondicherry. Methods: Retrospective chart review was done from the departmental computerised database of last seven months. All cases referred to psychiatry department from other departments including Emergency, ICU and Master Health Check-up was included. The data was reviewed to collect sociodemographic and other study parameters viz. referral rates, diagnosis, referring departments, reason for referral, number of cases transferred and adherence rates. Also, current suicidal attempts and patient waiting time was analysed. SPSS 16.0 was used for analysis. Results: Referred cases constitute 25% of the total cases. Most cases were males in the middle age group. Medicine (25%) and Surgery (12%) are the most common referring departments. 12% cases were referred from Master Health Check-up. 10% of in-patient referral cases were transferred in. Alcohol related problems were the commonest reason for referral followed by depressive symptoms. Psychiatric diagnosis was found in 90% of cases out of which 16% cases had multiple psychiatric diagnosis. History of recent suicidal attempt was found in 10% of cases. Adherence rates were 17% for outpatient referrals in comparison to 30% of direct psychiatry cases. 35% of the inpatient referrals had one or more follow-ups during their stay in the ward. Average waiting time was 15 minutes for emergency and 45 minutes for other referrals. Conclusion: CLP services forms the backbone of General Hospital Psychiatry Unit and thus the need to incorporate it as a vital component of every tertiary care facility.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparative Study Of Stressful Life Events In Patients Of Bioplar Disorder And Schizophrenia

Aparna Das, R C Jiloha, Manushree Gupta

Maulana Azad Medical College & GB Pant Hospital, India, ad.mamc.1510@gmail.com, rcjiloha@hotmail.com, manushree@gmail.com

Keywords: Stressful life events(SLEs), Bipolar Disorder, Schizophrenia

Background: Aims and Objectives: The study was a comparative study done to evaluate the frequency and pattern of Stressful life events (SLEs) in indoor patients of bipolar disorder and schizophrenia

Methodology: The study was carried out in a tertiary care hospital psychiatric unit. 50 in-patients of Bipolar Disorder and 35 in-patients of schizophrenia were recruited after obtaining informed consent. The subjects were evaluated for socio-demographic characteristics, history, physical examination, mental status examination using semi-structured proforma. Diagnosis was made using WHO ICD-10 criteria and life events were measured using Presumptive Stressful Life Events Scale (PSLES). In addition BPRS scale was applied for schizophrenia patients and YMRS and HAM-D applied for patients of Bipolar Disorder. The data was analysed using SPSS and statistical tests like chi-square and t-tests were applied.

Results: Mean number of SLEs experienced one year prior to onset of currrent episode in patients of Bipolar was 4.309 (SD ± 3.671) and in Schizophrenia was 2.483 (SD ± 2.278). On comparing Bipolar Disorder and Schizophrenia there was a statistically significant difference (p=0.017) implying that patients with bipolar disorder experience more SLEs 1 year prior to onset of episode in comparison to patients of Schizophrenia.

Conclusion: To conclude patients with Bipolar Disorder had more (SLEs) 1 year prior to onset of episode in comparison to patients of schizophrenia. More research to establish a causal relationship between the SLEs and illness to widen the possibilities of and help guide clinical interventions that could improve patient outcome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

“Cognitive dysfunction in depression: A Clinical study”

Karnik Kishore, Deepanjali Medhi

Guwahati Medical College and Hospital, India, imkarnik@yahoo.co.in, deepanjali.medhi@yahoo.com

Keywords: Depression, cognition, frontal lobe function.

Background: Research in the last decades have shown that depression is associated with a significant disturbance in cognitive functioning. Cognitive symptoms appear to represent one of the core features of depressive disorders with an impact on many functional outcomes.

Objective: This study aimed at assessing the prevalence and severity of cognitive deficits in patients suffering from depression and to study the cognitive domains affected.

Method: A Total of 40 patients with Depression diagnosed according to ICD – 10 Criteria and 40 healthy controls were included. PGI Battery of Brain Dysfunction (PGI – BBD), Frontal Assessement Battery and Hamilton Depression Rating scale (HAM – D) was adminstered and analysis was done using Chi – square test, Unpaired t test and Pearson’s correlation.

Results: The study revealed significant differences in the Dysfunction scores between the study and control population. In the study group more than 80% of patients had cognitive dysfunction and a positive correlation was found between dysfunction and HAM – D scores. Similarly a negative correlation was found between HAM – D Scores and FAB Scores.

Conclusion: Depression is associated with significant disturbance in cognitive functioning and the cognitive dysfunction increases with increase in the severity of depression.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Use of Child Behavior Checklist (CBCL) in Hospitals

Mayuri Ramnarayan Mohanty, Jyoti Shetty, Nilesh Naphade

Bharati Hospital, India, drgyrus@gmail.com, shettyjyoti19@gmail.com, drnileshnaphade@gmail.com

Keywords: CBCL, Document, adaptive functioning, competency

Background: Child Behavior Checklist was developed by Thomas Achenbach for assessing emotional & behavioral competency, adaptive functioning & various problems like mood disorders or conduct problems, etc. Child Behavior Checklist is scored on the basis of information obtained from multiple informants – parents, teachers (Teacher report form) & self (youth self-report)

Objective: To Review Achenbach Behavior Assessment System (Child Behavior Checklist) for use.

Method: Review of Case Files, Various literature and research material on Child Behavior Checklist.

Discussion/Results: Based on various studies/case reports done with Child Behavior Checklist.

Utility: 1) CBCL can guide clinic interviews. 2) It can be re-administered 6 to 12 months later to determine course. 3) To document presenting problems to justify services, protect against litigation, etc. 4) assessment of children’s adjustment in various settings can be deduced.

Criticisms: 1) Wide variation in rating by multiple informants, which reflects as unreliability in the data and information bias. 2) limited sensitivity to identify mild adjustment problems. 3) Children with Chronic illnesses like asthma will score more on total scores & Children with physical handicap will score less on competency part of scale. 4) The items measure accomplishments rather than capacity, and participation in activities rather than facility or competence in social interactions. 5) CBCL, TRF, and YSR are in fact three different instruments which differ on various items on the checklist.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Problematic Internet Use among Indian adolescents: Finding from a sample of undergraduate students

Aneesh Shankarnarayana Bhat^*1, Anish V Cherian², Christopher Thomas³, Chriss Thomas⁴, Praveen jain⁵, Shrinivasa Bhat⁶, Kimberly S Young⁷, Suresh Bada Math⁸

¹K. S. Hegde Medical Academy, India, bhataneesh@gmail.com, ²K.S. Hegde Medical Academy, Mangalore, India, anishvcherian@gmail.com, ³Sapthagiri Institute of Medical Science and Research Center, Bangalore, India, India, christytomchristy@gmail.com, ⁴Jubilee Mission Medical College and Research Cener, Trissure, India, India, christytomchristy@gmail.com, ⁵K. S. Hegde Medical Academy, Mangalore, India, India, pravi.abv@gmail.com, ⁶K. S. Hegde Medical Academy, Mangalore, India, India, shrinivasabhat@yahoo.co.in, ⁷St. Bonaventure University, New York, USA, United States, kyoung@sbu.edu, ⁸National Institute of Mental Health and Neurosciences, Bangalore, India, India, nimhans@gmail.com

Keywords: Problematic internet use, adolescents

Background: There is paucity of data related to excessive or problematic internet use among young adults in India.

Method: The sample consisted of 2039 undergraduate students of various faculties across the city of Mangalore, Karnataka. The study was approved by Nitte University Institutional Ethics Committee and permission was sought from the concerned colleges. Students were cross sectionally assessed with a specially constructed semi-structured proforma and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions. Subjects were classified into Mild users, moderate users, and addicts for comparison.

Results: Of the 2039 participants who took part in the study, 1610 (79%) were female and 429 (29%) were males. The mean age of participants was 19.25 ± 1.5 years. About 42.3% of total participants were using internet for more than 4 years. As per the Young’s original criteria, about 36.7% were Mild-moderate problematic user and 0.2% was found to addicts. However, 27.7% of participants felts that they are addicted to internet and 1.4% of them sought professional psychiatric help for the same.

Conclusion: Our result shows that problematic internet user among young adults is prevalent and this population might be at risk of addiction. It indicates that there higher need to designing an intervention and treatments for this susceptible group.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Identifying Conceptual Differences between Psychiatric Disorders and Neurological Disorders even though both are Disorders of Brain

Shrirang Sadashiv Bakhle^*1

¹Dr. Bakhle Clinic, India, ss.bakhle@gmail.com

Keywords: DSM-5, Mental, Mind, Mind-brain, neuroanatomy, neurophysiology, Neurological Disorders, Psychiatric Disorders

Objective: With increasing understanding of neurobiological basis of Psychiatric Disorders, the line between Psychiatric Disorders and Neurological Disorders is getting blurred. But if the neurobiological basis is understood, should the Psychiatric Disorders be called Neurological Disorders and be treated by Neurologists? This paper explores the fundamental conceptual differences between Psychiatric and Neurological Disorders to describe the precise differentiating features.

Method: The paper explores the inclusion and exclusion criteria that can be used to distinguish between Psychiatric and Neurological disorders – especially whether these two groups can be separated on the basis of neuroanatomy (parts of brain) or neurophysiology (systems such as Dopaminergic system). Since DSM-5 is a comprehensive compendium of Psychiatric disorders, the inclusion and exclusion criteria for a disorder to be included in DSM-5 or be excluded from it are discussed.

Result: It is impossible to distinguish between Psychiatric and Neurological Disorders on the basis of neuroanatomy or neurophysiology. The only inclusion criterion that can be used to qualify a disorder as a Psychiatric Disorder is presence of ‘mental’ dysfunction i.e. dysfunction in the mind. The only exclusion criterion that can be applied to exclude a disorder from being called a Psychiatric Disorder is absence of dysfunction in the mind. The paper gives a precise definition of mind and mind-brain relationship.

Conclusion: The paper shows how Psychiatric Disorders are basically ‘Mental’ Disorders. The only criterion that distinguishes Psychiatric Disorders from Neurological Disorders is that Psychiatric Disorders are disorders of the mind. This statement is compatible with the facts that Psychiatric Disorders happen in the brain or that Neurological Disorders can be defined as disorders of the brain. The paper shows how calling Mental Disorders as disorders of brain is an imprecise definition.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Depressive Symptoms in Patients with Vitiligo

Omprakash Lolam^*1, Satish Singishetty¹

¹Prathima Medical College, India, omprakash.caims@gmail.com, coolheadcoolhead@gmail.com

Keywords: Depressive Symptoms in Patients with Vitiligo Omprakash

Background and aim: Vitiligo presents an opportunity to focus on the effect of impaired appearance on the lives of the persons with this disease. The aim is to measure depressive symptoms in these patients.

Methods: A cross sectional comparative study with Twenty Patients suffering from vitiligo and twenty healthy persons at ages between eighteen and sixty, of either sex underwent psychological tests of examination with special regard to verification of their depressive symptoms. The results were compared for both groups.

Results: The results revealed that depressive symptomatology in patients with vitiligo were significantly higher than in the control group (respectively, 55%, 10%).

Conclusion: we conclude that the cosmetic disfigurement may be of great importance in the lives of persons with this condition(vitiligo).

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study Of Compliance And Factors Responsible For Non-Compliance In Psychiatric Patients

Neena Sawant, Akanksha Sharma, Abhishek Dubey, Anshul Yadav

GSMC KEM Hospital, India, drneenas@yahoo.com, sharmaakanksha824@yahoo.com

Keywords: Compliance of psychiatric patients

Background: In psychiatry, most of the patients are on medication for a very long time, sometimes lifelong. Failure to follow up and non-adherence to medication is a major barrier for effective treatment. Many a times, patients are unaware of their psychiatric ailment and are not properly educated by their treating physician about the importance of compliance. We undertook this study in order to understand compliance in psychiatric patients, the reasons for noncompliance and the awareness among patients and relatives about the same.

Method: After IRB approval and informed consent all the willing patients and their relatives attending the psychiatric OPD of general municipal hospital were included in the study. A specially prepared semi structured case record form was used to document the compliance to medication, reasons for irregular follow up and awareness of patients and relatives about the disease.

Results: Out of total 726 patients, 523 (72.9%) patients were regular and 197(27.1%) patients were irregular in their follow up over last 6 months. Out of those 197,the reasons for noncompliance were cited as 61 (30.96%) patients felt better, 23 (11.68%) patients didn’t have relative to accompany to the hospital, 17 (8.63%) patients developed side-effects,12 (6.09%) patients said there was non-availability of medicines in hospital, 18 (9.14%) patients didn’t have money to buy medicines and 14(7.11%) didn’t get leave from workplace. 277(38.2%) patients & 256(35.3%) relatives did not know about the ailment whereas 200(27.5%) patients & 193(26.6%) relatives did not know about the treatment guidelines and 87(12.0%) patients & 74(10.2%) relatives did not know about the compliance and its importance as they were unaware of the same.

Conclusion: Patients along with their relatives should be properly educated about their ailments and importance of compliance, which may lead to proper attitude towards treatment and better socio-occupational functioning.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Attitude towards mentally ill patients among doctors in Non- Psychiatry Specialties- A Cross-sectional observational study.

Abhinav Chichra, Aiswarya R. Nair, Arun Rachana

¹Christian Medical College, Vellore, India, chichra@gmail.com, aishwarya86nair@gmail.com, arunrdr@gmail.com

Keywords: attitude, stigma, barriers, mental health, doctors, self-administered questionnaire

Background: Objectives: To assess attitude of doctors in non- psychiatry specialities towards mentally ill patients.

Background: Stigma and prejudice are important barriers towards health seeking for mental illness. The same factors may play a role in the quality of medical attention the mentally ill receive from medical professionals. Studies done elsewhere have shown a trend towards greater acceptance of the mentally ill, whether this is seen in India as well is not clear.

Methods: A modified version of validated self-administered questionnaire used by the NHS in Britain was used to assess attitude towards mentally ill. The attitude questionnaire had ten questions. Each question was scored on 5-point Likert scale (strongly agree to strongly disagree). Certain questions were reverse scored to compute total attitude score. Total score for attitude questionnaire ranged from 10 to 50. A score of 30 denoted average neutral attitude. Interns, casualty medical officers and postgraduate registrars from Christian Medical College, Vellore, Tamil Nadu constituted the sample frame. Data was collected using semi structured questionnaire and was entered in EpiData. Statistical analysis including descriptive and bivariate analysis was done using SPSS version 16.

Results: Fifty non-psychiatry doctors participated in the study of which 47 percent were men and 53 percent were women. There were 9 (18 percent) interns and the rest were either postgraduates or casualty medical officers. The mean age of study participants was 25.9 years. The mean attitude total score was 37.68 (standard deviation: 4.19). Shapiro-Wilk Test had significant score of 0.298, showing normal distribution of attitude total score. ANOVA showed no statistically significant association between weeks of exposure to psychiatry with attitude towards mentally ill. There was no significant relation between attitude and history of mental illness in self or in family.

Conclusion: Overall, attitude of the study participants towards mentally ill was positive.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Utilization and Interventions in Psychiatry Consultation Service in a General Hospital in New Delhi, India

Harsh Garekar, Ankit Goel

Lady Hardinge Medical College, India, kapoorchand138@gmail.com, hgarekar@gmail.com

Keywords: Referral and Consultation, Mental Health Services, Consultation-Liaison psychiatry

Objective: To investigate the population of patients who required psychiatric consultation and the treatment offered in a general hospital in India.

Method: This cross sectional descriptive study investigated over a six month period, the sections of the hospital that requested psychiatric consultations, the primary cause for consultation and the intervention (pharmacotherapy) offered by the consultant psychiatrist. Diagnosis of psychiatric disorders was ascertained via ICD-10.

Results: A total of 183 patients required psychiatric consultation during the study period. The most common reason for referral was acute and abnormal behavioural changes (35%), followed by substance related problems (30%) and somatic complaints with suspected depressive disorder (21%). There were 21 consultations for actual suicidal attempt. A psychiatric diagnosis could be established in nearly 80% of the subjects. The commonest diagnoses were substance related and addictive disorders (33%), delirium (26%) and depressive disorder (10%). Benzodiazepines were the most commonly administered drugs for pharmacologic intervention. Majority of the referrals were from the general medicine service (46%), followed by the surgery (18%) and the Obstetrics and Gynaecology (17%) service.

Conclusion: Despite the global advances and the emerging role of Consultation-Liaison Psychiatry (C-L Psychiatry) in providing improved care, the subspecialty remains in a nascent stage in India. Our study shows that psychiatric consultations are not frequently requested for serious psychiatric disorders but often for acute crisis management of behavioural emergencies and for medical conditions arising directly as a result of substance use. Hence, development of liaison services will not only lead to improved diagnosis and treatment but also timely intervention and prevention of psychiatric disorders in this patient population.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Assessment of knowledge and factors concerning management of emergency and common psychiatric scenarios among non psychiatry doctors; a cross sectional observational study

Topic Name: Emergency Psychiatry

Aiswarya R. Nair, Abhinav Chichra, Arun Rachana

¹Christian Medical College, Vellore, India, aishwarya86nair@gmail.com, chichra@gmail.com, arunrdr@gmail.com

Keywords: knowledge, emergency psychiatry, Delphi method, non psychiatry doctors, India

Background: Objective: To assess non- psychiatric professionals’ knowledge of common psychiatric emergencies and management issues and factors affecting the same.

Background: There are few studies with updated questionnaires to assess knowledge of relevant psychiatric emergencies in non-psychiatry professionals in India, where they are often the first, and sometimes, the only point of contact for the mentally ill.

Method: The study adopted a cross-sectional study design. Fifty medical graduates, postgraduates and trainees from Christian Medical College, Vellore, Tamil Nadu participated in the study. Using principles of Delphi method, a knowledge questionnaire on common psychiatric emergencies and psychiatric management issues was developed. The questionnaire had eleven questions. Each question had three options viz. ‘true’, ‘false’ and ‘I don’t know’. Each correct response fetched one point and each incorrect response and/or “I don’t know” response was scored zero. The total score ranged from 0 to 11. A semi structure questionnaire was also used to collect related data on participants. Data was collected and entered into EpiData. Descriptive and bivariate analysis was done using SPSS version 16.

Results: There were 9 house-surgeons (male:1, female:8), 16 casualty medical officers (male:7, female:9) and 23 other non-psychiatric postgraduates (male:14, female:9). The mean age of study participants was 25.9 years (standard deviation: 2.6 years). The total score ranged from 1 to 10 with mean score of 6.78 (standard deviation: 2). Test of normality using Kolmogorov-Smirnov test revealed that the score was not normally distributed. Gender and number of weeks of exposure to psychiatry after completing MBBS were not associated with a better total score.

Conclusion: It is encouraging to observe that there is good knowledge of common psychiatric emergencies and psychiatric management issues among study participants. The reasons for one-forth of non-psychiatric professionals scoring less than fifty percent score are a concern and worth probing into.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Aggression in mental retardation: an unmet need in society

Mina Chandra, Srikant Sharma, Smita N Deshpande

Department of Psychiatry, PGIMER & Dr RML Hospital, New Delhi, India, minasaxena@gmail.com, prachillb@gmail.com, smitadeshp@gmail.com

Keywords: Mental retardation, aggression, disability

Background: Aggression is common in Mental Retardation (MR) (Rojhan 1993, Charlot 1997) and may occur due to concomitant behavioural problems, psychosis or seizures (Gardner 2000). Beliefs like aggression as an intrinsic part of MR, social stigma, lack of awareness about treatment modalities and services contributes to delay in seeking help despite options for effective pharmacological (Ryan 2000) and non pharmacological treatment (Alavi 2013, Brown 2013). Hence aggression in MR is a significant unmet need.

We present data of aggression and its predictors in subjects with MR who presented only for disability certification at a tertiary care hospital

Objective: To study the prevalence and predictors of aggression in subjects with MR presenting for disability certification at a tertiary care hospital.

Methods: A chart review of all subjects with MR presenting for disability certification over a period of 4 years at the Psychiatry department at a tertiary care hospital was done. Data regarding sociodemographic profile, severity of mental retardation, presence of aggression and neuropsychiatric comorbidity was subjected to Descriptive and Multinomial regression analysis.

Results: Of 305 subjects [age 21.54 + 10.96 years; M:F = 67.5: 32.5%; mild: moderate: severe: profound MR= 28.2: 36.7: 24.3: 10.8 %] 104 (34.93%) subjects had history of aggression. The predictors for aggression were severity of MR (sig=0.009), age (sig= 0.009), gender (sig= 0.024) and neuropsychiatric comorbidity like Seizure Disorder and Psychosis (sig = 0.035).

Conclusion: Aggression was demonstrated by more than one third of subjects with MR who presented only for disability certification at a tertiary care hospital with age, severity of MR, gender and neuropsychiatric comorbidities as significant predictors. Yet their caregivers had not specifically sought any treatment for aggression indicating an important unmet need. Hence we recommend that all subjects with mental retardation should be evaluated for aggression and appropriate interventions for the same should be offered.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Study Of Psychiatry Patients Admitted in Emergency Settings

Ajita S Nayak, Shubhangi R Parkar, Deepak R Awachat, Swanit H Deshpande

Seth GS Medical College KEM Hospital Mumbai, India, ajitanayak@rediffmail.com, pshubhangi@gmail.com, drdeepakawchat@gmail.com, swanitdesh@gmail.com

Keywords: Emergency Psychiatry Suicide Violence

Background: Since the 1960s, with deinstitutionalization, the demand for psychiatric emergency services (PES) has increased in India and all over the world. Hence, it becomes essential to understand the characteristics of the population admitted in emergency settings, in order to optimize care and treatment flow.

Objectives: To study the socio-demographic data of patients admitted as psychiatric emergencies and the reasons for admission, diagnosis, co-morbidity and emergency management in these patients.

Methods: The study was conducted after obtaining institutional ethics committee approval. 50 consecutive patients admitted to psychiatric settings in emergency were identified. The records of these patients were obtained from the medical records section and indoor papers were examined for the data recording using case record form. Frequency distribution test were used for analysis.

Results: The study of sociodemographic characteristics of the sample revealed a M:F ratio of 3.5:1 and 50% were found to be unemployed.48% were diagnosed as Schizophrenia and related disorder and 32% had Substance related disorder. The most common reason for admission was suicidal ideations (30%). Of these 60% were diagnosed to have Schizophrenia and related disorders and 26.6% as Depression. The second most common reason was violence (28%) who received a diagnosis of Schizophrenia and related disorder (78.5%) and Substance related disorder (21.42%).

Conclusions: Suicidal ideations and violence are the most common reasons for emergency admissions. Adequate safety measures and medications should be available in PES to treat them.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Variable Presentations of Catatonia in Child Psychiatric Practice.

Sushma Gunturu, Neera Ghaziuddin

University Of Michigan, Ann Arbor, United States, sushig@gmail.com, neerag@med.umich.edu

Keywords: Catatonia

Objectives: To describe the variability in clinical presentation of catatonia in youth [<18yrs].

Background: Catatonia is a neuropsychiatric syndrome, which may be present in 10 to 15% of youth with psychiatric disorders. Missed or misdiagnosis may result in negative outcomes including chronic morbidity, impaired functioning, malignant catatonia (MC) and mortality due to multi-organ failure. Methods: We describe two cases. The first case was a young female with normal past development and good intellectual functioning, who developed depression, anxiety and auditory hallucinations. She was treated with an SSRI, resulting in increased motor activity, stereotyped behaviors and movements, mutism and finally stupor. The second case was a male with known diagnosis of autism and MR who had experienced functional decline and psychotic symptoms which had failed to respond to 3 trials of antipsychotic agents. The diagnosis of catatonia was based on motor changes (psychomotor retardation, posturing, sudden cessation of all motor activity), reduced intake and elevated creatinine phospho kinase (CPK). The first case was treated successfully with lorazepam and decreasing dosage of the antidepressant, which was eventually discontinued. The second case was treated by discontinuing the antipsychotic agent, the addition of lorazepam, and finally with ECT due to inadequate response to medication.

Results: Return to baseline was noted in both.

Conclusions: Catatonia may present in youth with normal development and in those with developmental disorders. Motor symptoms are an essential feature which may be accompanied by a variety of psychiatric symptoms including affective changes and psychotic symptoms (case 1) or psychotic symptoms accompanied by a functional decline (case 2). Accurate diagnosis and treatment are associated with a positive outcome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Portrayal of Mental Health in Malayalam Cinema

Badr Ratnakaran^*1

¹Dr. Kunhalu’s Nursing Home, India, brodoc@gmail.com

Keywords: Malayalam cinema, Mental health, Movie club

Background: Malayalam cinema has been produced since 1920’s and releases more than fifty films in a year. Malayalam cinema is known for portraying social, cultural, political issues and this also includes issues in mental health.

Objectives: To review the portrayal of mental health in Malayalam cinema

Methods: Films were identified after discussion with various experts in person, telephone and email correspondence. Web databases were also checked to identify the films. A literature search was also done for any reviews on Malayalam cinema and mental health

Results: More than 40 films from the 1960’s to 2014, portraying balanced and unbalanced version of issues in mental health have been identified. One review article on mental health and Malayalam Cinema has also been identified. The themes of the movies are based on psychotic disorders to dissociative disorders and from stigma to homosexuality

Conclusion: It can be concluded that Malayalam Cinema has a rich source of portrayal of mental health. Such a resource could be used to for movie clubs as a part of teaching curriculum during Post Graduate training. They can be an excellent medium to understand cultural issues and stereotypical views on mental health issues by the community

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Low frequency Repetitive Transcranial magnetic stimulation (rTMS) in the treatment of Tic disorder: A case report and brief review

Saurabh Kumar, Rajeev Ranjan, Nand Kumar

AIIMS, New Delhi, India, saurabhksingh.singh@gmail.com, rajeevranjan5@yahoo.co.in, nandkm2001@gmail.com

Keywords: Repetitive transcranial magnetic stimulation (rTMS), Tic disorder, Supplementary motor area

Background: Low frequency (1 Hz) rTMS has been shown to inhibit cortical excitability and has been investigated as a potential therapeutic tool in tic disorders. Mixed results have been obtained in different studies with some studies showing promising results, whereas other studies have found no therapeutic effect. Here we report a young female who failed to have any beneficial effect.

Methods: A 12 year old female has developed motor tics since last two years. On evaluation her Yale Global Tic Severity Scale (YGTSS) score came out to be (46/100) and patient had received adequate trials of risperidone and pimozide and haloperidol. She was found to be also suffering from anxiety disorder. There was family H/O tic disorder in father and sister and OCD in cousin brother who was receiving treatment. All secondary causes of Tic disorders were ruled out. It was decided to be given a trial of low frequency rTMS after discussing all the treatment options with parents and after taking informed consent. The protocol designed was 1Hz, 110%MT, 900 pulses/session, total 20 sessions over 4 weeks to be given B/L over supplementary motor area. Assessment was done using YGTSS after 5 and 20 sessions. Side effects are routinely monitored with a check list as a treatment protocol.

Results: There was no significant improvement in the symptoms, the scores on YGTSS showed slight decline, with the final score being 40 without any significant side effect. Relevant clinical issues, related to our case and its failure to show therapeutic effect with low frequency rTMS are reviewed and discussed in the report.

Conclusion: rTMS is a non invasive brain stimulation technique which has shown some promise in treating patients with tic disorder but in our patient’s we failed to have any beneficial effect.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study of experiences of stigma and discrimination in Schizophrenia and Bipolar Mood Disorder patients

Smruti Surajprasad Karambelkar, Bharat N. Panchal, Ashok U. Vala, Archana Surajprasad Kantak

Department of Psychiatry, Govt. Medical College, India, smrutikarambelkar@gmail.com, drbnpanchal@rediffmail.com, drvala175@gmail.com, archana.kantak@yahoo.in

Keywords: Stigma, Discrimination, Bipolar Mood disorder, Schizophrenia, qualitative analysis, India

Background: Stigma in mental illness is a worldwide phenomenon. Many studies were conducted to analyse the stigma experienced by caregivers of patients with psychiatric illness but fewer on patients themselves. Amongst patients themselves, comparatively many have been conducted in schizophrenia patients and few in bipolar patients especially in India.

Objectives: To study the experiences of stigma and discrimination in schizophrenia and bipolar mood disorder patients

Methods: Single centre, cross sectional, qualitative as well as quantitative study. 50 patients from psychiatry OPD of a tertiary care hospital were chosen with diagnosis of Schizophrenia and Bipolar Mood disorder and been under remission for atleast 3 months. A semistructured interview scale developed in NIMHANS was used. Sociodemographic data of patients were analysed by Chi square test. The narratives of the patients obtained on interview were analysed qualitatively using framework method.

Results: Eighty six percent (86%) patients experienced stigma. Schizophrenia and Bipolar Mood disorder patients did not differ in their experiences of stigma proving that the tag of mental illness was stigmatising enough and had no relation to the duration or intensity of illness. The outcome of the qualitative analysis showed that most of the patients experienced stigma with family members which included shame and ridicule, belittlement of opinion, separation from family.

At work place inability to hide illness lead to change of job or been considered inept to carry out reponsibility. Spousal support was good for most of the patients. Sixty percent (60%) believed that stigma could not be eradicated. To combat stigma, most patients believed that adequate rehabilitation and an assertive attitude on the part of patients was most likely to work.

Conclusions: Despite having longer remissions and a milder course than schizophrenia, Bipolar Mood disorder patients experienced same stigma as schizophrenia patients. It affected patients in all spheres of their life- family and workplace.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A cross sectional study of prevalence of psychiatric disorders, cognitive impairment and disability in systemic lupus erythematous patients in a tertiary care hospital in Mumbai

Milind Thanki, Jahnavi Kedare, Anjali Rajadhyaksha, Heena Merchant, Nilam Behere, Ajita Nayak, Shubhangi Parkar

Seth G S Medical College & KEM Hospital, India, milind_thanki@yahoo.com, jskedare@gmail.com, anjalirajadhyaksha@kem.edu, heenathedoc@gmail.com, neelamsb7@gmail.com, ajitanayak@rediffmail.com, shubhangiparkar@yahoo.com

Keywords: SLE, neuropsychiatry, depression, anxiety, psychosis cognitive impairment, disability

Background: Neuropsychiatric symptoms are very common in SLE patients. Cognitive impairment is among the commonest manifestation. Psychiatry disorders like acute confusional state, anxiety disorders, depression and psychosis are also commonly seen. Recognising pattern of these manifestations can improve care, management and rehabilitation of these patients.

Objectives: This study was planned with an objective to study the prevalence of 1) psychiatric disorders, 2) cognitive impairment and 3) disability in systemic lupus erythematous patients.

Methods:50 SLE patients attending rheumatology OPD in a tertiary care centre in Mumbai were interviewed cross-sectionally over a period of 3 months. A semistructured proforma was administered to collect sociodemographic profile. The severity of SLE and treatment details were obtained from treating physician and recorded in the proforma. Psychiatric disorders were diagnosed using DSM-5 diagnostic criteria. HAM-D and HAM-A scales were used to quantify depression and anxiety respectively. MMSE and clock drawing test were used to assess cognitive impairment. WHODAS 2.0 36 item version was used to assess disability. Chi square test, student t test and Spearman’s co-efficient of correlation were calculated with the help of SPSS version 16.

Results and Conclusions will be presented.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

National and Regional Technical Training Centres: A Unique Capacity Building Mechanism under the National AIDS Control Programme and Lessons for Delivery of Quality Mental Health Services in Public Health Settings

Alok Agrawal^*1, Atul Ambekar¹, Ravindra Venkat Rao¹, Sudhir Kumar Khandelwal¹, Neeraj Dhingra²

¹National Drug Dependence Treatment Centre, AIIMS, New Delhi, India, dralok.nddtc.aiims@gmail.com, atul.ambekar@gmail.com, drrvrao@gmail.com, sudhir_aiims@yahoo.co.uk, ²National AIDS Control Organization, India, dhingradr@hotmail.com

Keywords: Capacity building, community mental health, OST, harm reduction

Background: India has a high burden of mental health problems which often remain unrecognized and untreated due to limited availability of specialized manpower required for delivery of mental-health care. Other options for delivery of mental health care through primary and secondary health care have been explored with some success but issues such as limited reach and unsatisfactory quality of services remain a challenge.

Under the National AIDS Control Programme, Opioid Substitution Therapy (OST) is being provided to Injecting Drug Users as a means to prevent HIV infection. Under NACP, OST centres are being established in primary and secondary level government health facilities where services are delivered through non-specialist staff (doctor, ANM, etc.). To ensure minimum standards of care, several measures have been instituted: a standardized training module, standard operating procedures, clinical practice guidelines, quality assurance protocol, etc. Additionally, seven leading medical education institutions (RIMS, Imphal; NEIGRIMS, Shillong; NIMHANS, Bengaluru; KGMU, Lucknow; KEMH, Mumbai; CIP, Ranchi; AMC, Dibrugarh) are recognized as Regional Technical Training Centres. These centres work with NDDTC, AIIMS as the Nodal Technical Training Centre and are tasked with development of resource material, trainings of staff, hand-holding OST centres and conducting clinical research. Faculty members from these centres are trained as OST mentors and visit each OST centre periodically to ensure quality of services and on-site capacity building. This structured system of capacity building and quality assurance ensures delivery of a specialized psychiatric intervention through general medical staff with minimum supervision and with acceptable standards of care. The service uptake, treatment retention and adherence observed at these centres are comparable or better than western settings but at a significantly lower cost. The model has potential to serve as a template for scale-up of other mental health services in general health system without need for specialized manpower.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Comprehensive Study on the Relation between Stress (Work and Personal) and Employee Engagement in Organizations

Sumitava Talukdar^*1

¹United world School of Business, India, sumitavatalukdar@gmail.com

Keywords: stress, employee engagement, employee productivity

Background: To examine the relation between stress (work and personal) and employee engagement in organizations (mostly in IT and ITes sector) in Sector – V, which is the IT Hub of Salt Lake, Kolkata, West Bengal

Method: Survey was conducted to collect and collate primary data through questionnaire. It involved a total of 343 respondents (208 male and 135 female), from technical and non-technical domains, in the age bracket of 23 to 55, working in Sector – V (Kolkata) and based out of areas in and around Kolkata (272 respondents) and outstations (71 respondents). The respondents were grouped as managers (41 respondents and non-managers (302 respondents). Two models (the job-strain model and the effort-reward imbalance model) were used to find the relation between the parameters under study.

Results: High effort-reward imbalanced individuals were more likely to be un-engaged or disengaged at work. A higher imbalance level (higher strain, low control and rewards) was associated with disengagement at the workplace. Stress moved bi-directionally (home to work and vice-versa) and some symptoms could not be directly attributed to clear reasons.

Conclusion: The study shows a significant negative correlation between stress and engagement at work. It also suggests the fact that managers (and employers) can benefit by identifying stressful features at the workplace and modifying them accordingly to boost employee productivity.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study of Burden and Quality of Life in Caregivers of Patients with Schizophrenia

Abha Thakurdesai, Austin Fernandes, Heena Merchant, Ajita Nayak, Shubhangi Parkar

Seth GS Medical College and KEM Hospital, India, abha209@rediffmail.com, ausbren@gmail.com, heenathedoc@gmail.com, ajitanayak@rediffmail.com, pshubhangi@gmail.com

Keywords: schizophrenia, caregiver burden, quality of life

Background: Schizophrenia is a severe and chronic psychiatric disorder occurring in 1% of the population. With deinstitutionalization, the responsibility of caring for the affected patients has shifted onto the family members. Caring for patients of schizophrenia has increased the stress amongst family members who may find it overwhelming.

Objectives: The objective of this study is to assess the burden of care on these caregivers of patients with schizophrenia and to assess their quality of life.

Methods: Caregivers of 50 consecutive patients diagnosed with schizophrenia using DSM-V attending the Psychiatry OPD of a tertiary care hospital were included in the study. A caregiver was defined as a family member staying with the patient for at least 6 months. Caregivers with any history of psychiatric illness were excluded from the study. The Family Burden Interview Schedule was used to assess the caregiver burden and the WHO Quality of Life-BREF was used to assess the quality of life. The data collected was analysed using frequency distribution, chi square test and Pearson’s correlation coefficient.

Results: The results of the study will be discussed in the paper.

Conclusions: The conclusions of the study will be discussed in the paper.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

To Study The Neurobehavioural Deficits in Children Of Patients Diagnosed As Schizophrenia

Sampada Uday Raikar, Kranti S Kadam, Vinita Gurjar, Shubhangi R Parkar

Seth G.S. Medical College and KEM Hospital, India, sampadaraikar@yahoo.co.in, drkrantisk@yahoo.com, drvinita.gurjar@gmail.com, pshubhangi@gmail.com

Keywords: Neurobehavioural, schizophrenia, children, cognition, psychopathology

Background: Neurobehavioral deficits in children have been hypothesized as indicators of development of schizophrenia in children at genetic risk. Cognitive deficits occur in first-degree relatives of schizophrenic probands, even in the absence of psychotic symptoms. Poor attention, disordered thoughts and lower intelligence were also observed to be more in the children of the schizophrenic parent. Neurobehavioral deficits in children have been hypothesized as indicators of development of schizophrenia in children at genetic risk. Literature on children at risk from India is limited.

Objectives: To study in children (age group-6 to 15years) of patients diagnosed as schizophrenia:

a)
Psychopathology
b)
Cognitive disturbances

Method: Study participants are the children of patients diagnosed as schizophrenia, in the age group 6 to15 years.Those who satisfy the inclusion and exclusion criteria will be enrolled for the study after taking informed consent and assent from respective subjects.50 participants will be studied. A semi-structured proforma will be designed to collect information on the socio-demographics.

Child behaviour checklist will be administered to study psychopathology and appropriate neurocognitive battery will be administered to assess working memory, executive function and attention. Appropriate statistics will be applied. The mean measurement structures will be generated and the findings will be analyzed using SPSS.

Results And Discussion: Results will be discussed in paper.

Conclusion: The conclusion will be discussed in the paper.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

The effect of cognitive rehabilitation on frontal lobe functions of patients with schizophrenia

Debabani Bhattacharya^*1, C.R.J Khess²

¹Natonal Institute of Behavioural Sciences, India, bani2008.bhattacharya@gmail.com, ²Central Institute of Psychiatry, India, cipranchi@hotmail.com

Keywords: schizophrenia, Cognitive Rehabilitation, Cognitive Flexibility, Attention, Response Inhibition

Background: One of the biggest enigma to mental health professionals has been “Schizophrenia”. Cognitive impairment has been one of the significant features of schizophrenia. In the past few decades, Cognitive rehabilitation has been used successfully in this domain however the efficiency of cognitive rehabilitation in this domain has met with conflicting results. For this purpose, the current research aimed at assessing the role of cognitive rehabilitation on frontal lobe functioning of the patients with schiozophrenia. For this reason, 20 patients were selected from both out patient and in-patient clinical population of Central Institute of Psychiatry (CIP), diagnosed as having schizophrenia as per ICD-DCR and other inclusion criterion such as age, education etc were selected for the study through purposive sampling. Those with co-morbid psychiatric disorder, substance abuse or dependence (Except nicotine or caffeine), history of major medical or neurological disorders or history of electroconvulsive therapy in the past 6 months were excluded from the study. To examine the effect of cognitive rehabilitation, those patients were divided into two groups with the help of random sampling, each group having ten patients respectively. One of the group was recipient of cognitive rehabilitation in addition to standard medical care (experimental group) whereas the other group was given only standard care (control group). Both the group was matched on the basis of age, sex and year of illness. only patient’s education upto 5th standard were included in the sample. both group were assessed twice, once at the beginning of the therapy for obtaining baseline assessmnet and after the completion of the therapy using Wisconsin Card sorting test, Trail making test, Stroop test, Positive and negative symptoms of schizophrenia scale. The results showed improvement in terms of attention, response inhibition, visual scanning, working memory, executive functioning.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Reaching the Unreached- challenges and opportunities for psychiatrists

Srinivasa R Murthy^*1

¹The Association for the Mentally Challenged, India, smurthy030@gmail.com

Keywords: Community Psychiatry, psychiatrists role, Opportunities

Background: It was in 1977, nearly 40 years back, I wrote an article with the title ‘Reaching Unreached’ for World Health. The current attempt is to reflect on the progress and focus on the current mental health needs in the country and identify the opportunities for Indian psychiatrists.

In India, accessibility of services, acceptability of mental health interventions, and affordability of care are three challenges. Past efforts have been (i)to integrate mental health with general health care; (ii) to develop community based alternative mental health care facilities (mainly by voluntary organisations); (iii) utilise the community resources for mental health care, like volunteers, family members, teachers etc for essential mental health care; (iv) extend the mental health care to school and college students, survivors of disasters, suicide attemptors etc.; (v) promotion of mental health utilising the culturally acceptable interventions like yoga, meditation; (vi) changing the legislation towards human rights of the ill persons.

With over half the population below 35 years, rapid urbanisation, changes in the family and community life, there are new challenges for the mental health of the population. However, the demographic advantage of consumer market has challenges of meeting the demands. Consumer economists are looking at ‘if we have the best consumer market in the world, let us manufacture for it and reap the benefits’.

The opportunities for psychiatrists are to (i) organise services in an accessible, acceptable and affordable way; (ii) to enhance the value of mental health in the population by personalised tools for mental health monitoring; (iii) develop mechanisms for providing continuous, life long care; (iv) empower the ill persons, families and communities by sharing mental health skills; (v) collaborate with other professionals and people working at the community level; (vi) link mental health to development programmes and (vii) be community leaders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Attitude towards mentally ill among nursing professionals: Evidence from a tertiary care general hospital

Biswadip Chatterjee, Piyali Mandal, Rajesh Sagar, Nand Kumar

AIIMS, New Delhi, India, biswadip.c@gmail.com, piyum2008@gmail.com, rsagar29@gmail.com, nandkm2001@gmail.com

Keywords: attitude, stereotype, mental illness, nursing professional

Objectives: The objective of the study was to assess the attitude of the nursing professional towards mentally ill and various treatment setting and modality for mentally ill and associated factors. Methods: Total of 75 nursing professionals who are neither currently working nor have ever worked in the psychiatric unit of a tertiary care general hospital were enrolled in the study. Detailed socio-demographic and professional profile, opinion regarding various treatment setting and modality for mentally ill was recorded in a semi-structured proforma, after taking an informed consent The stereotyped attitude towards mentally ill was assessed using ‘Community Attitudes Towards the Mentally lll’ scale. Various stereotypes were assessed using 9 item ‘Attribution Questionnaire (AQ-9). Descriptive, comparative, correlation statistics were used. Result: None of the socio-demographic variables other than age found to have significant correlation with different domains of community attitude and attribution pattern. Forty percent participants favoured restrictive settings of treatment for mentally ill. Majority were against using pharmacological treatment. Significant group difference in various domains of community attitude was found between those who approved the need for treatment and those who did not (p<0.05). Similar difference was also observed among those who approved coercive and restrictive setting and those who did not (p<0.05). Stereotype score did not have bearing on community attitude. Results will be discussed further in detail during the presentation. Conclusion: This study provides insight into the attitude of healthcare professionals towards mentally ill and their approval for restrictive treatment setting and disproval for pharmacological treatment. This holds significance as these professionals are entrusted with the responsibility to care for patients. It highlights the need periodic sensitization regarding mental illness and current treatment methods.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

7 year Retrospective Review of in-patients with Benzodiazepine use in an Addiction Medicine facility in a Tertiary Psychiatry Centre

Spandana Bokka, Tulika Shukla

National Institute of Mental Health and Neurosciences, India, spandanabokka@gmail.com, a, tulikas@rediffmail.com

Keywords: Benzodiazepine, substance use disorders, tertiary center, retrospective, sedative hypnotic

Background: Aims & Objectives: Benzodiazepine use is a growing problem. Our aim was to study the patterns of use among those admitted to a tertiary addiction medicine centre in the past 7 years.

Methodology: A 7 year (January 2007-January 2014) retrospective chart review of patients admitted to the Centre for Addiction Medicine, NIMHANS who had a history of Benzodiazepine use was done. Appropriate statistical analysis was done using SPSS (version21)

Results: The patterns of Benzodiazepine use in terms of gender distribution, types of Benzodiazepine used, age of initiation, reasons for initiation, age of dependence and approximate amounts will be described. Co-morbid drug use, psychiatric disorders, medical disorders, pharmacological treatments used as well as follow-up data (in terms of number of follow-ups, whether still in follow-up, compliance and current use patterns) will also be described.

Conclusions: The use of opioids in the Indian context requires more study in terms of long-term outcomes.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Basics in Biostatistics - A useful aid for postgraduate residents in their research work and dissertation

Devavrat Gurudas Harshe, Sagar Karia

Lokmanya Tilak Medical College and Municipal General Hospital, India, devavrat.harshe@gmail.com, karia777@yahoo.com

Keywords: statistics, chi square, odds ratio, ANOVA, correlation

Background: Clinical research is being encouraged in India across all faculties. The encouragement consists 1) Various research grants from government as well as private regulatory bodies, 2) Various awards for the most promising and innovative research, 3) Best dissertation awards given by certain faculties.

However, one of the most dislike aspect of the clinical research by the residents is biostatistics. The causes for the dislike are multifactorial, 1)Biostatistics is taught in PSM usually in 2^nd MBBS; when there is minimal/absent clinical orientation, 2)Biostatistics is taught in a classroom setting with minimum field experience.

Thus, after a gap of three and a half years, when any MBBS student enters a residency programme, the terms “P value”, “Chi-square”, “ANOVA”, “Correlation”, “Positve and Negative Predictive Value” seem alien and many times confusing. This also causes hindrance in project at hand, as well as creates difficulty while reading and understanding research work published by others as well!

The workshop will include discussing the basic concepts in biostatistics. It will also consist of demonstration of 1) Effective ways of data entry, 2) Basic statistical analyses using a computer based statistical software. The aim being helping residents to overcome the difficulty in statistics in research work.

The speakers will cover - 1) Variables, Normal distribution, 3) Comparison of means, 4) Predictive values, 5) Odds ratio, 6) Correlation with demonstration.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Attitude Towards Mental Illness In Undergraduate Nursing Students

Yoseph Bhagwant Kale, Ashish Srivastava

Institue of Psychiatry and Human Behaviour, India, dryosephkale@yahoo.co.in, ashishsri1977@rediffmail.com

Keywords: attitude, stigma

Background: Introduction: The negative attitude towards mental illness is due to the stigma, fear of illness and lack of knowledge about the disease. Stigma can be public stigma or self stigma.

There are few studies to measure the attitude towards mental illness in the general population. The same applies even to special population groups like the students of the paramedical courses. So the aim of our study is to measure the attitude towards mental illness in the students of B.Sc. nursing in Goa. Type of study: cross-sectional, questionnaire based study.

Methodology: It is cross sectional study where-in all the students pursuing B.Sc. nursing course from the INE (Institute of Nursing Education), Goa, will be included. The students will be randomized into two equal groups and both the groups will be shown a video clip based on mental illness in a patient. One group will be informed that the person has a mental illness and other will be unaware of the same. All participants will then be administered the following questionnaires:

1)
Attitude towards mental illness questionnaire.
2)
Perceived stigma questionnaire.
3)
Job candidate evaluation form.
4)
Semi-structured socio-demographic data sheet.

The data will be collected and results would be analyzed using SPSS and presented at the conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Male Genital Self Mutilation

Vinay Singh Chauhan^*1

¹Base Hospital Delhi Cantt, India, vinaychauhan2@gmail.com

Keywords: male genital self mutilation

Background: Male genital self-mutilation (GSM) is a rare, but serious phenomenon. Some of the risk factors for this act are: presence of religious delusions, command hallucinations, low self-esteem and feelings of guilt associated with sexual offences.

Data section: Two male GSM cases are presented: Case 1 is diagnosed with schizophrenia, Case 2 with Alcohol dependence syndrome with delirium tremens

Case 1 - 38 yr old male manifested with insidious onset and gradually progressive delusions of persecution, reference and third person auditory hallucinations. He would hear voices of many people warning him “aage kat kar, aage kat kar, tu bach zayega, family bach zayega”. On above background, he went to the bathroom, latched the door and sliced off his penis from the base with a shaving blade and threw the shaft into the toilet.

Case 2 - 42 yr old male who would consume around 180-240ml of spirits almost daily since past 04 yrs on a dependence pattern manifested on abrupt cessation of alcohol use with disorientation, auditory hallucinations (hearing voices of his alleged persecutors threatening to cut his genitalia), altered sleep-wake cycle. He on above background thought that he will not allow his persecutors to succeed and himself brutally mutilated his genitalia (scrotum, testes & penis) with a blade.

Discussion: Proposed factors for GSM are absence of a competent male figure for identification during the early developmental period, over-controlling mothers who encouraged their sons’ masochistic behaviors, Pathological feminine behavior of the male child, repudiation of body image (esp the penis),unresolved sexual conflicts.

Conclusion: Psychotropic medication must be the first line intervention in both treating the active psychotic episode and in preventing recurrences. An important contributing and motivating factor for male GSM appears to be sexual dysfunction, so clinicians may prefer medications causing fewer sexual side effects.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study on prevalence of depressive symptoms among young adults in a semi urban city of India

Shrinivasa Undaru Bhat^*1, Anish V Cherian¹, Christofer Thomas², Chriss Thomas³, Aneesh Bhat¹, Shishir Kumar¹, Praveen Arahantabailu¹, Suresh Bada Math⁴

¹K. S. Hegde Medical Academy, India, shrinivasabhat@yahoo.co.in, anishvcherian@gmail.com, ²Sapthagiri Institute of Medical Science and Research Center, Bangalore, India, India, christytomchristy@gmail.com, ³Jubilee Mission Medical College and Research Center, Trissure, India, India, chrissmanojaa@gmail.com, bhataneesh@gmail.com, shishiramin@yahoo.com, pravi.abv@gmail.com, ⁴National Institute of Mental Health and Neurosciences, Bangalore, India, India, nimhans@gmail.com

Keywords: depressive symptoms, young adults, self rating questionnaire

Background: Depression among young adults has been recognized as a major public health burden. However, there is scarcity of data on depression among young adults from low-middle income setting.

Method: The sample consisted of 2039 undergraduate students of various faculties across the city of Mangalore, Karnataka. The study was approved by Institutional Ethics Committee. Students were cross-sectionally assessed with a specially constructed semi-structured proforma and Self Rating Questionnaire (SRQ) which was self -administered by the students after giving those brief instructions. A score of 6 and above on the SRQ – 20, which indicated a moderate to severe degree of depressive symptoms.

Results: Of the 2039 participants who took part in the study, 1610 (79%) were female and 429 (29%) were males. The mean age of participants was 19.25 ± 1.5 years. About 34.2% had a score of at least 6 or above on SRQ. There was no significant gender difference with regard to symptoms (31.9%, male Vs 34.8%, female, p =0.227).

Conclusion: The prevalence of depressive symptoms was significantly high among young adults. It indicates the essentiality of developing a psycho-social intervention for this vulnerable group.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Cross-sectional study of Prevalence and Pattern of substance use among the patients attending Psychiatry Outpatient department.

Ram Gulam Razdan, Aman Kishore, Roshni Jain, Rajpal Singh Pamar

Department of Psychiatry, M.G.M. Medical College, Indore, India, ram_ghulam@yahoo.co.in, amankishore@rediffmail.com, rani.jain27@gmail.com, amankishore@rediffmail.com

Keywords: Substance use disorders in psychiatric disorders

Background: Substance Abuse is a complex problem having medical and social ramifications which impacts all social strata. It affects not only the user and their families but all sections of the society. Data on substance use is required from different regions in the country as the likelihood of regional disparity in substance use is high.

Aims: To study the prevalence and pattern of substance use among the Patient attending Psychiatric OPD.

Objectives: 1. To study the socio-demographic profile of studied sample

2. To study the prevalence of substance use in studied sample.

3. To study substance use profile of the studied sample.

Methodology: Study Design: Cross-sectional study

Studied Population: Patient attending Mental hospital, Indore OPD registered between 2013 and 2014.

Study duration: Jan 2014 – Dec 2014

Procedure: After taking consent from patient data will be entered in semi-structured data entry performa which has questionnaire of the socio-demographic and substance use profile data.

Appropriate statistical analysis will be done using SPSS v16

Results and discussion: Will be discussed at the time presentation in conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Changing trends in mental health services at mental hospital Indore

Ram Gulam Razdan, Kapildev Arya, Aman Kishore

Department of Psychiatry, M.G.M. Medical College, Indore, India, ram_ghulam@yahoo.co.in, ram_ghulam@yahoo.co.in, amankishore@rediffmail.com

Keywords: Changing trends in Mental Hospital Indore

Background: Mental Hospital Indore is central or tertiary referral center and address a large bulk of patient s with psychiatric illnesses and a major point from where patients avail services in terms of medicine, hospitalization and rehabilitation at the same time. This institute have the history from closed inmate patients to a open setup of treatment and rehab facilities.

Aims: To discuss available mental health services and ongoing trends of psychiatric illnesses at Mental Hospital Indore.

Discussion: We have working at a major centre for mental health services and as similar to many other psychiatric hospitals spread over the country and in historical perspect we have significant changes in services, providers attitude and community participation.

Conclusion: We now came across a long journey in terms of patients treatment and rehabilitation services. We can still in midway with various plans and themes like half way home and day care centre. We are just in the process of becoming role model for others in same journey.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence of Psychiatric Co-morbidities in Oncology Patients

Topic Name: Consultation Liaison Psychiatry

Prashanth Peethala, Namrata Potula, Mahima Acharya

Kasturba Medical College and Hospital, Manipal, India, dr.prashanth.peethala@gmail.com, potulanamrata@gmail.com, mahimaacharya@hotmail.com

Keywords: psycho-oncology, cancer, psychiatric co-morbidities

Background: This study aims to find the prevalence of psychiatric comorbidities in oncology patients.

Methods: This will be a cross-sectional descriptive study. All patients admitted under oncology will be assessed using mini or mini plus to generate psychiatric diagnoses. Presumptive stressful life events scale (PSLES) will be used. HAM-A scale and BPRS will be used for the assessment of primary outcome. All patient treatment details will be noted, like chemotherapy, radiotherapy etc. The data will beanalyzed using the statistical package for social sciences version 16.0 software. The analysis involved descriptive analysis of the data.

Results and conclusion: Will be presented after the completion of the study.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparison of Prevalence of CSP in Patients of Alcohol Dependence and Normal Controls

Sachchidanand Singh, Naveen Kumar Srivastava, Vivek Chail, C R J Khess

Central Institute of Psychiatry, Ranchi, India, sachchi4u@gmail.com, navnsrivastava02@gmail.com, vchail@gmail.com, jmou@rediffmail.com

Keywords: Prevalence of CSP, Abnormal CSP, Alcohol Dependence

Background: Role of CSP in alcohol dependent patients has been seen in some studies where it was found abnormally enlarged. In this study, we have compared the prevalence of CSP in patients of alcohol dependence and normal controls. We took out all the CT Scans from our Radiology department for the year 2012 -2013 and selected only those in which diagnosis of alcohol dependence was made as per ICD-10 and CT was done to rule out organicity. Similarly, we took out all CT Scans done during the same period of staff persons as control group. We selected the CT Scans of subjects between 18-60 years and dropped out those in which there was any history of neurological illness, significant head injury, systemic illness with potential cognitive sequele and history of other substance dependence except alcohol and nicotine. We took two criteria for defining normal and abnormal CSP; first was based on Grades (0-4, Grade 0, 1 and 2 were considered as normal and Grade 3 and 4 as abnormal) and second was based on length (less than 6 mm was taken as normal and equal or more than 6 mm was taken as abnormal).

Results and Discussion will be discussed during presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical Profile of Dhat Syndrome- A Hospital Based Study

Venugopal V P, Kiran Kumar K, Shashank B, Malini Govindan, Danish Hussain Pampori

Vydehi Institute of Medical Sciences & Research Centre, India, venugopal.v.p.0@gmail.com, drkiran.psychiatry@gmail.com, shashankballur@gmail.com, nannasuri@yahoo.co.in, danish0318@hotmail.com

Keywords: Dhat Syndrome, psychiatric comorbidities, source of belief, conceived routes of semen loss.

Background: Dhat syndrome is considered as an “exotic neurosis of Orient” and is a culture bound syndrome specific to Indian Subcontinent, caused by ‘undue concern about the debilitating effects of the passage of semen’. This study includes variables like the source of belief/recent reinforcement and conceived routes of semen loss which have not been extensively studied. A knowledge of these factors will shed light on the clinical diagnosis of unusual presentations and further facilitate primary prevention strategies.

Objectives: To study the socio-demographic and clinical characteristics of patients with Dhat Syndrome

To study the psychiatric comorbidities among patients with Dhat Syndrome

Methodology: Hospital based descriptive study, Sample size: 32, Method of sampling: Simple Random Sampling

Method of collection of data: Patients attending to the Marital and Psychosexual Clinic of Vydehi Institute of Medical Sciences & Research Centre-Bangalore, from September 2012 to September 2014 are interviewed & the socio-demographic details were collected using a semi-structured proforma used in the department. All the patients with a diagnosis of Dhat syndrome as per ICD-10 diagnostic criteria are included in the study after obtaining a written informed consent. Data was analyzed using descriptive statistics.

Results: A majority of the cases were from rural domicile, Hindu by religion (75%), unmarried, educated till 3th standard or above and belonging to class III or IV of modified BG Prasad’s Classification. Analysis of data revealed an adolescent or early adulthood onset, with mean duration of the illness 4.8 years, commonly reported source of belief/recent reinforcement is peers (75%) and four patients reported conceived route of semen loss as through both penis and anus (12.5%). Most common co-morbid problem were premature ejaculation (40.6%), failure of genital response (18.75%), substance abuse and depression.

Conclusion: Will be discussed at the time of conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Retrospective Study Of Illness Variables Among Patients Who Attended Child And Adolescent Psychiatry Outpatient Department In A Tertiary Care Hospital

V. Vivian Kapil, C.J. Maikandaan Bose

¹Meenakshi Medical College Hospital and Research Institute, India, viviankapil@yahoo.com, dr_maikandaan@yahoo.co.in

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparison Between Sociodemographic Profile, Psychopathology And Personality Traits In Patients Of Alcohol Use Disorder And Other Substance Use Disorder

Swati Shankarrao Chavhan, Shilpa Adarkar, Shubhangi Parkar

¹KEM Hospital, India, chavhan.swati@yahoo.com, shilmit@gmail.com, chavhan.swati@yahoo.com

Keywords: Psychopathology, Personality, Alcohol, Substance Use

Background: Substance use disorder is a known worldwide problem. The consistent findings on the association of personality disorders and psychopathology with persistent substance use in patient indicates their importance in understanding the course of substance use disorder (SUD). Little is known about the role of a broad range of personality disorders in the course of SUD and whether these differ by substance. So we decided to study and compare based on socio-demographic profile, psychopathology and personality traits in patients of alcohol use disorder and other substance use disorder. This will help in early identification of substance use disorder and related problem and potential applications of these findings can be used to plan treatment development. It will also help in improving quality of life of patients.

Objectives: To compare between patients of alcohol use disorder and other substance use disorder based on-

1]
Socio-demographic profile
2]
Personality trait and disorder
3]
Psychopathology

Methods: Patients coming to de-addiction OPD in tertiary care hospital diagnosed with alcohol use disorder and with other substance use disorder were screened in 3 months. Out of them, 30 of alcohol use disorder and 30 of other substance use disorder satisfying the criteria were enrolled for the study after informed consent & ethics approval. A semi-structured proforma was designed to collect information on the socio- demographics, psychopathology was assessed by SCL 90 and personality assessed by the personality inventory for DSM 5 brief form adult. Appropriate statistical tests were applied.

Results And Conclusion: would be discussed during the paper.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

How To Make A WRAP

Zia Nadeem, Fatima Waliulla Nadeem, Rajni Gupta

Oxygen Institute of Psychiatry & Rehabilitation Centre, India, nadeez@gmail.com

Keywords: Rehabilitation, Recovery, Wellness, SEMI

Background: Recovery in Severe & Enduring Mental Illnesses is a concept that encompasses a wide range of treatment modalities that helps one to recover his/her life from the clutches of the SEMI and helps to lead a near normal life despite the illness. WRAP or Wellness Recovery Action Plan is one such tool that has been developed by several people with severe mental illnesses in various stages of recovery, assisted by Dr May Ellen Copeland. It is a personalized recovery tool based on the principle of self-determination and self-actualisation. When appropriately developed, it helps chronically ill patients to decrease and prevent intrusive or troubling feelings and behaviours, increase personal empowerment, improve quality of life and achieve their own life goals and dreams. It also helps patients to self monitor distressing feelings and behaviours.

Healthcare professionals need to learn and utilise this important tool to promote recovery in their patients. This workshop will aim to cover broad aspects of the theory of WRAP and guidelines to help people develop their individual WRAPs.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric morbidity in postpartum women in a tertiary care hospital

Mathumathi Shanmugasundaram, Sailaja Choudhury

Meenakshi Medical College and Research Institute, India, ssmathu@yahoo.com

Keywords: postpartum psychiatric morbidity

Aim: to estimate psychiatric morbidity in postpartum women attending a tertiarty care hospital.

Background: Psychiatric morbidity is common during postpartum and its diagnosis is often missed. It can manifest as postpartum depression or psychosis. The effects of psychiatric postpartum morbidity can go beyond the mother in that it also affects the partner and the child. severe postpartum depression can lead to infanticide as well as maternal death often by suicide. several studies indicate that an episode of postpartum depression increases the risk of lifetime episode of major depression.

Method: 100 women who are attending the OG op in Meenakshi Medical College during their postpartum period have been assesed using Edinburgh postnatal depression scale, MINI, Marital satisfaction scale by Brinda Amirthraj, social network index. Appropriate statistical methods will be applied.

Results: It will be discussed in the forthcoming conference.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A study on Sleep Quality in Alcoholics under medication: A Comparative Study

Venkateswaran Arunachalam, Shanmugiah Arumugam, Archana Ravichandran, Kiruthika Dhanabalan, Ilamurugu Murugesan

Natchiyar Medical Centre, India, eswarvenkat2001@yahoo.com, natchiyarmedicalcentre@gmail.com

Keywords: Alcohol, Alcohol dependent, PSQI, DASS, Sleep Quality, Stress, Anxiety, Depression, Anger

Background: Sleep is a physiological function that plays a major role in relaxation and rejuvenation of an individual. It is one of the natural biological functions that aids in the process of recovery, in a patient. On the other hand the ‘Sleep quality’ is deeply affected in a patient with alcohol dependence. During the abstinence and early detoxification phase, a frequent complaint by a patient is observed as: either decrease in sleep or decrease in sleep quality. This is a probable risk factor for frequent anger outbursts, medication noncompliance and/or relapse. In the present study, the aim is to assess and evaluate sleep quality in patients, at different stages of treatment, along with the relationship to the level of depression, anxiety and stress. The study follows both qualitative and quantitative research methods. The research sampling technique adopted in the present study is convenient sampling technique. The sample size includes 30 patients (males) belonging to the age group of 20-50 years, who are alcohol dependent or have patterns of harmful use of alcohol. The tools used in the present study are: Pittsburg Sleep Quality Index (PSQI) and Depression, Anxiety, Stress Scale (DASS). The data gathered is used for a comparative study, between the patients taken in for treatment (both new and those on follow up). Thus the overall focus and discussions of the present study will be analyzed in order to stress the importance of educating the patient about recovery pattern and alternative methods of rejuvenation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical study of adult attention deficit hyperactivity disorder in patients of bipolar affective disorder

Nitin Omprakash Pattanashetty, Nanasaheb M Patil

Jawaharlal Nehru Medical College, India, nitinpattanashetty49@gmail.com, nmpatil@hotmail.com

Keywords: Adult ADHD, bpad, hyperactivity

Background and Objectives: Adult attention deficit hyperactivity disorder [ADHD] is not a common entity in India, with very few studies and very minimal information available in patients of bipolar affective disorder[bpad], therefore this study was done to diagnose adult ADHD in patients suffering from bpad and also to study the clinical profile of these patients.

Methods: A total of 50patients who were already diagnosed as bpad currently in remission as per ICD-10 were screened using adult ADHD self reporting scale v1.1[ASRSV1.1] screened positives were evaluated on ASRSV1.1 symptom check list and ICD -10 criteria was used to study clinical profile.

Results: A total of 7 were diagnosed as adult ADHD and among them most common symptoms of ADHD were poor concentration, easy distractibility, poor academic performance and all of the positive subjects had multiple psychiatric co-morbidities like substance abuse/dependence, anxiety disorders.phobias etc.

Intepretation and Conclusion: patients of BPAD had high incidence of pre existing Adult ADHD and diagnosis of it necessary as management differs and this study also noted that patients of adult ADHD had high incidence of other psychiatric co morbidities.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Personality characteristics and sexual dysfunction in females

Shwetha M S, T S Sathyanarayana Rao

JSS Medical College, India, shwetha21259@yahoo.com, tssrao19@yahoo.com

Keywords: Personality characteristics, sexual dysfunction

Background: Our sexual behavior expresses not only our psychosexual makeup but also the entirety of our personality. Sex is the one realm of conduct which involves the full gamut of emotions, cognitions, socialization, traits, heredity, and learned and acquired behaviors. By observing one’s sexual predilections and acts, we can learn a lot about the patient. Costa et al.. (1992) found neuroticism to be correlated with lower sexual satisfaction and extroversion with sexual drive. It is also reported that obsessive compulsive personality traits also leads to sexual dysfunction (Black et al.. 1997; Shapira et al.. 2000).

Aim of the Study: To assess the personality characteristics of the patients presenting with sexual dysfunction.

Materials and Methods: A total of 100 women attenders(not first degree relatives) coming along with the patients to psychiatry out patient department JSS Hospital, Mysore were taken. Subjects were taken based on inclusion and exclusion criteria. Informed consent was taken from the subjects. Socio-demographic data sheet and clinical variables sheet was filled up, after successful screening through General Health Questionnaire (GHQ 12). Sexual Functioning Questionnaire (SFQ 28) was administered to assess sexual dysfunction and Cattel’ s 16 PF Questionnaire was administered to assess their personality traits. Ethical committee clearance was obtained from JSS University.

Results: The results will be presented in the conference during presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Adolescent Males manifest Higher Dissociation than Adults - A Comparative Study

Oral

NV Saisudha Gorthi, Anand Bogaraju

Institute of Mental Health, Osmania Medical College, Hyderabad, India, nvsaisudhagorthi@gmail.com, anand6121957@gmail.com

Keywords: Dissociative experiences, adult, adolescent male

Background: Dissociative experiences are common in adolescence. These are considered as mediators of psychopathology. There are very few Indian studies on dissociative experiences.

Objectives:

To study gender influences on dissociative experiences between adolescents and adults

To study correlation between

Age and dissociation
Total dissociative experience scores and their pathological taxons

Methods: Dissociative experiences scale (DES) (Bernstein etal, 1986) is a 28 item self-report questionnaire for adults. Adolescent dissociative experiences scale (ADES) (Armstrong etal, 1997) is a 30 item self-report measure. It has excellent convergent validity with the DES adult version. Both these have a subscale with 8 items constituting pathological taxon (DES-T, ADES-T)

Adolescent group constituting 100 high school students and adult group constituting 61 adults were administered ADES and DES respectively. Socio-demographic variables were expressed in tables and bar diagrams. Student t-test was used to study gender differences. Pearson product moment correlation was used to study association between 1.Age and DES/ADES scores, 2.Total scores (ADES/DES) and pathological taxon (ADES-T/DES-T). They are represented in a scatter plot.

Results: Adolescent males had significantly higher scores in ADES and ADES-T when compared with females (p-values 0.02, 0.0005) while this difference was not present in adult population (p-values 0.86, 0.44). Findings suggest negative correlation(r=-0.7) between age and ADES/DES and positive correlation(r=0.9) between total scores (DES/ADES) and their pathological taxons (DES-T/ADES-T).

Conclusion: Significant pathological dissociation in adolescent males compared to females implies higher abnormal dissociative experiences in males. These are a risk factor for psychosis and a component of prodromal phase as dissociation is considered a mediator between trauma and psychosis. Such gender difference was not noticed in adult group.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Co-morbid depression among patients of Alcohol dependence syndrome: A prospective study

Aman Kishore^*1, G. Gopalkrishnan Gopalkrishnan²

¹Department of Psychiatry, M.G.M. Medical College, Indore, MP, India, amankishore@rediffmail.com, ²Sowmanasya Hospital and Institute of Psychiatry, Trichy, TN, India, sowmanasya@gmail.com

Keywords: Depression among patients with Alcohol dependence

Background: Despite of high prevalence of depression in alcohol dependent individual, the nature of relationship between depression and alcohol dependence has been difficult to define.

Aims and Objectives: Present study investigates the relationship between socio demographic and alcohol related variables with the diagnosis of depression and assessed the changes in the severity of depression following period of abstinence in an inpatient alcohol dependent sample.

Methodology: It is a prospective descriptive study with a sample of 50 individuals diagnosed to have alcohol dependence syndrome that consented and fulfilled inclusion and exclusion criteria.

Procedure: MINI-6 was administered for dividing the sample into depressed (n=11, 22%) and non depressed (n=39, 78%) groups. Severity of alcohol dependence was evaluated on SAD-Q scale, HAM-D scale was used to assess severity of depression in the depressed individual at baseline, 2 weeks and 4 weeks.

Result and discussion: There were only few differences among the two groups on socio-demographic and alcohol related variables. More than 50% reduction in severity of depression was noticed after 2 weeks of de-addiction treatment.

Conclusion: From the current study it can be suggested that depression is largely associated with episode of drinking which lead to admission in the patients who are dependent on alcohol and may be due to chronic intoxication. Socio-demographic and alcohol related characteristics appear to bear little relation to the presence of depression.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Predictors Of Mixed Episode In Bipolar Patients: A Hospital Based Study

Joyita Sinha, Daya Ram

Central institute of Psychiatry, India, joyitasinha1502@gmail.com, joyitasinha1502@gmail.com

Keywords: Mixed state, Predictors, life events, suicidal ideations, global functioning

Background: Concept of mixed states assume significance because of scanty scientific data available, in comparison to manic and depressive episodes

Objectives: To study the estimate of mixed episode in bipolar patients, temperament, life events, current functioning, social support and premorbid adjustment of patients of mixed state compared to manic and depressive episodes and the relationship of temperament, life events, social support, current functioning and premorbid adjustment with severity of mixed episode

Method: One hundred and fifty bipolar patients were divided into manic, depressive and mixed group by The Affective Self Rating Scale for diagnosis of mixed state and assessed by Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-questionnaire, Young Mania Rating Scale, Hamilton Scale for Depression, Brief Psychiatry Rating Scale, Presumptive Stressful Life Event scale, Scale for suicidal ideation, Social Support Questionnaire, Premorbid adjustment scale and Global Assessment of functioning Scale

Results: The prevalence of patients having mixed episode was 17.34%. The number of past mixed episodes, suicide attempts and cannabis use was significantly higher in the mixed group. They also showed significantly poorer inter episodic recovery and experienced significantly higher number of life events in past 1 year and lifetime, more psychotic symptoms, suicidal ideations and perceived significantly less social support and had poor pre morbid adjustment and poor current global functioning as compared to mania and depression group. Mixed group had more dysthymic and cyclothymic temperament compared to mania and depression group.

Multiple regression analysis revealed that overall recent life events, severity of suicidal ideations and poor global functioning emerged as significant predictors of severity of mixed states in bipolar disorder.

Conclusion: In our study overall recent life events, severity of suicidal ideations and poor global functioning emerged as significant predictors of severity of mixed states

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cognitive impairment in alcohol related disorders

Ajay Yadav, Nilesh Naphade

BVDUMC, India, ajay.yadav198703@yahoo.in, drnileshnaphade@gmail.com

Keywords: Alcohol, abstinence, cognition, Addenbrookes scale.

Background: Cognitive Impairement In Alcohol Related Disorders

Objectives: This study aims at determining the effects of alcohol on cognitive function of individual and to study if abstinence from alcohol leads to improvement in cognitive function.

Methods: Study was carried out in a Tertiary Psychiatry Hospital .60 patients were included in study aged more than 18 years.3 groups were made as follows,20 patients in each group-

Group A-Alcohol dependent

Group B-Alcohol dependent with sustained full remission

Group C-Non Alcohol dependent controls

Patients who had major Psychiatric illness or who were diagnosed with Dementia, Delirium tremens, amnestic disorders or any other neurological condition were excluded from study

Cognitive function was assessed using Addenbrook’s cognitive examination scale which assesses 5 cognitive domains namely attention, orientation, memory, verbal fluency, language and visio spatial abilities. Total score is 100. Higher score indicates better cognitive functioning.

Results: Initial results suggest normal cognitive function in non Alcohol Dependents where as cognitive impairment in Alcohol Dependents. Also, improvement in cognition was noticed after an abstinence of minimum period of 9 months.

Conclusion: Non alcohol dependents have poor cognition as compared to alcoholics and cognition improves as patient observes abstinence from alcohol.

1^st Author- Dr.Ajay Yadav (MD 2^nd Year)

Correspondance---ajay.yadav198703@yahoo.in

Mobile no.9873586848,9764919069

2^nd Author-Dr.Nilesh Naphade (Prof.),drnileshnaphadegmail.com

3^rd Author- Dr.Jyoti Shetty (Prof.& HOD),shettyjyoti19@gmail.com

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Indian Instrument For Cognitive Examination (IICE) Obtaining Normative Data For Geriatric Population

Topic Name: Dementia

Akshith Shetty^*1, Rishikesh V. Behere¹, Bhargavi Nagendra¹, Shweta Rai², Haridas K.¹

¹Kasturba Medical College, Manipal, India, akshithshettyb@gmail.com, rvbehere@gmail.com, bhargavi.nagendra@manipal.edu, ²School of Allied Health Sciences, Manipal, India, shwetaraisrcp@gmail.com, haridask2001@yahoo.co.uk

Keywords: Indian geriatric population, Cognitive assessment, IICE, Normative data, Validation

Background: Introduction: With an increasingly large population of elderly in India, there is a felt need for screening tools that aid in the diagnosis of dementia as early as possible. Clinical cognitive assessment tools include the MMSE, ACE-R, RUDAS, ADAS-COG. For the Indian population, the Kannada and Malayalam translations of ACE; the HMSE and VSID has been described. However, these may be limited in their utility, as no single scale assesses all domains of cognitive functions, western scales lack age, and education adjusted norms for Indian population. Hence, there is a felt need for a brief cognitive assessment tool applicable to the Indian setting. AIMS AND.

Objestives: To obtain normative data and validate Indian Instrument for Cognitive Examination (IICE) for use in geriatric population.

Methodology: The Indian Instrument for cognitive examination (IICE) is a brief instrument comprehensively assessing all domains of cognitive functioning useful for bedside cognitive assessment. 60 healthy individuals above the age of 60 years (HMSE score >24) with no known neurological disorders were administered the IICE, HMSE, PGI-MS and Color trails test. Subjects were divided into 3 groups based on educational status (10 years of education). Performance on IICE was compared with standard cognitive assessment tasks to establish its validity. Normative data defined as 2 standard deviation below the mean was derived for various domains of cognitive assessment on the IICE.

Results and Conclusion: The derived normative data would be presented. The study demonstrated IICE to be a clinical useful, valid scale for cognitive assessment in geriatric population in India.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Behavioral and Psychological Symptoms of Dementia among patients with dementia of Alzheimers Type Attending to a Tertiary Hospital, Manipur

Robindro Khangembam Singh^*1, Lenin Rajkumar Singh¹, Heramani Ningombam Singh¹, Gojendra Senjam Singh¹, Roshan Lourembam Singh²

¹Department of Psychiatry, Regional Institute of Medical Sciences, IMPHAL, India, robindrodr@gmail.com, leninrk@yahoo.com, nheramani@yahoo.co.in, drgojendra@gmail.com, ²Department of Clinical Psychology, Regional Institute of Medical Sciences, Imphal, India, roshandela@rediff.com

Keywords: Alzheimers dementia, longevity, cognitive decline, caregivers, burden, depression

Background: Behavioral and psychological symptoms of dementia (BPSD) include noncognitive symptoms and behaviors that commonly occur in patients with dementia. BPSD can result in suffering, premature institutionalization, increased cost of care, and significant loss of quality-of-life for the patient and his or her family and caregivers.² The development of BPSD is a major risk factor for caregiver burden and depression. For patients, BPSD is associated with worse quality of life, greater impairment in activities of daily living, and more rapid cognitive decline.³

To evaluate the behavior and psychological symptoms among patients with dementia of the Alzheimer’s type and also to study the demographic profiles in relation to BPSD. Cross-sectional, analytical study with sample size of 40. Patients attending the Outpatient Department of Psychiatry, RIMS, Imphal fulfilling the diagnostic criteria of dementia of the Alzheimer’s type according to DSM-IV-TR were evaluated for BPSD by the application of BEHAVE-AD scale. MMSE was applied to measure the level of cognitive impairment and the Global Deterioration Scale (GDS) was applied to measure the stages of dementia.

Out of the 40 cases 80% of the study samples were having symptoms of activity disturbances. Delusion and paranoid ideation were present in 75% of the sample studied and 42.5% had hallucination which was the lowest among the symptoms. The other symptoms such as aggressiveness, diurnal rhythm disturbances, affective disturbances and phobia were present in 67.5%, 65%, 55% and 52.5% respectively. Socio demographic factors such as age (p-value = 0.677), gender (p-value = 0.372), religion (p-value = 0.980), educational level (p-value = 0.290), marital status (p-value = 0.226), monthly income (p-value = 0.167), employment status (p-value = 0.968) and family type (p-value = 0.078) are all found to be statistically insignificant relationship with the behavioural and psychological symptoms.

BPSD is common in patients with dementia of the Alzheimer’s type.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical Features, Cognition And Outcome In Geriatric Bipolar Disorder: A Follow Up Study

Neha Singh^*1, Pradeep Kumar Saha², Malay ghoshal³

¹Central Institute of Psychiatry, India, ²Institute of Psychiatry, Kolkata, India, ³Calcutta Medical College, Kolkata, India, mail.singhneha@gmail.com

Keywords: Geriatric, bipolar disorder, cognition, functional impairment, outcome

Background: The knowledge about geriatric bipolar disorder (BD) and the effect of age at onset on their presentation is limited.

Objective: To compare late onset (LO) and adult onset (AO) BD on clinical profile, burden of medical co-morbidities, cognitive functions, functional impairment and outcome over 3 months.

Method: This was an observational follow up study of 3 months duration, recruiting consecutive outpatients of BD of age ≥50 years, presenting with mania. Patients with moderate to severe dementia and aphasia were excluded from study. Patients divided into two groups on the basis of age at onset: adult onset, with onset 18-50 yrs and late onset, >50 yrs. Each group consisted of 25 patients. The two groups were compared regarding clinical symptoms, cognitive functions, functional impairment and outcome at 3 months. The cognitive functions were also compared with age and education matched control group.

Results: In comparison to LO-BD, AO-BD patients have significantly higher burden of medical co-morbidity, significantly worse cognitive functions at baseline and follow up and significantly worse functional and symptomatic recovery over follow up of 3 months.

Conclusion: In geriatric BD, distinction between AO-BD and LO-BD has important implications for treatment selection, treatment response, symptom recovery and functional outcome.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Socio-demographic and Clinical Correlates of Intentional Self Harm: A Hospital Based Study

Malini Govindan, Venugopal V P, Danish Hussain Pampori, Shashank B

Vydehi Institute of Medical Sciences & Research Centre, India, drmalinig@gmail.com, venugopal.v.p.0@gmail.com, danish0318@hotmail.com, shashankballur@gmail.com

Keywords: Intentional Self Harm, ISH attempters, Psychiatric comorbidity

Background: Intentional Self Harm rates in South Asia are one of the highest in the world. WHO estimates that about 1,70,000 deaths by Intentional Self Harm(ISH) occur in India every year. The fact that 71% of ISH in India are persons below the age of 44 years imposes a huge social, emotional and economic burden on society. It is estimated that for every completed suicide, nearly 8 to 10 attempt to end their life. Reports suggest that one in 60 persons are affected by suicide including both, those who have attempted suicide and those who have been affected by the suicide of family members or friends, thereby making ISH a major public health challenge. There is a need for research on the various aspects of ISH attempters so that further strategies can be planned to aid this group.

Aim: To determine the socio-demographic and clinical correlates of ISH attempters admitted in the Medical/Psychiatric wards of Vydehi Institute of Medical Sciences and Research Centre.

Methodology: The study population consisted of 50 consecutive suicide attempters who gave informed consent for the study during the study period (from Jan 2014 to September 2014). The data was collected using a semi structured proforma which included socio-demographic factors and clinical factors. Data was analyzed by descriptive statistical techniques.

Results: Among the ISH attempters 56% were female, 54% belonged to the age group of 18 to 28yrs and 56% were from the urban area.14% of attempters had a psychiatric diagnosis the most common being depression. 30% had high intentionality and lethality. The most common method adopted was organophosphorous poisoning followed by drug overdose.

Conclusion: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Socio-Demographic Characteristics And Phenomenology Of Acute And Transient Psychotic Disorder

Devendra Kumar Sharma, Chandra Shekhar Sushil, Devendra Kumar Vijayvergia, Ramchandra Lamba

¹Govt. Medical College, India, drdksharma1310@rediffmail.com, ramchandra_lamba@yahoo.co.in, drdevendra.android@gmail.com

Keywords: ATPD, phenomenology, stressful life event

Background: 1. Aims and objectives - To study the socio-demographic characteristics, stressful life events, phenomenology of patients with Acute and Transient Psychotic Disorder (ATPD).

2. Methodology: 50 consecutive patients diagnosed as suffering from ATPD by consultant Psychiatrist attending Psychiatry OPD and those admitted in the Psychiatry ward, New Medical College Hospital, Kota will be taken up for study. All these patients will be evaluated on the specially designed proforma to obtain Socio-demographic data, details of present illness, past illness, family history & personal history. These patient were assessed on Presumptive Stressful Life Events Scale (P.S.L.E.S.) and Brief Psychiatric Rating Scale (BPRS)

3. Results: will be discussed at the time of presentation.

Conclusion: will be discussed at the time of presentation

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Caught in a virtual web: A case report

Snehil Gupta, Vijay Krishnan, Pratap Sharan

All India Institute of Medical Sciences, India, snehil2161@gmail.com, vijayk1984@gmail.com, pratapsharan@gmail.com

Keywords: Internet, gaming disorder, CBT,

Introduction: Internet gaming disorder has recently been included in DSM-5 as a condition warranting further study, and is conceptualized as a behavioral addiction sharing characteristics with substance use disorders. This case presenting at the Out-patient department of a tertiary care hospital in India typifies some of the diagnostic and management issues relating to this condition.

Case report: The patient is an 18 year old male belonging to a Sikh nuclear family, who presented with increasing time spent on multi-user online games and progressive neglect of other interests and activities including his personal, family and social obligations, over the past 2 years. During this time he would remain preoccupied with online games, increased his use up to a maximum of 20 hours per day and had to drop out of class XII. He continued to use it despite having physical symptoms and remorse after playing and would not be able to control his use despite repeated attempts to restrict the time he spent on these games. When forcibly restricted, he would experience decreased sleep, sadness and irritation. A diagnosis of Internet Gaming Disorder was made, and the patient showed significant improvement with SSRIs and psychotherapeutic intervention.

Discussion: Although similar to other addictive states, patients with internet addiction also show some significant differences in their presentation. This report highlights the potential for dysfunction, the typical course, and the characteristics of both player and game that are found in such patients. The management of the case requires awareness of this condition, and a holistic management plan which must take neurobiological, individual, game-related and cultural factors into account. As internet penetrance increases, it is likely that this, and other similar conditions, will become more common in India, and this case report is particularly relevant in that context.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Frontal Lobe Meningioma presenting as Mania

Mithun S, Divya Hegde, Priya Sreedaran

St. John’s Medical College, India, mdmitsmj@gmail.com, divyahegde19@gmail.com, drpriyasreedaran@gmail.com

Keywords: Meningioma, Mania, Visual Hallucinations.

Background: Brain tumours can present as varied psychiatric manifestations.1 Here we describe a patient with Right Frontal Lobe Meningioma presenting with manic symptoms and persistent visual hallucinations.

Methods: Mrs.A, 55 yrs old elderly lady from rural background presented with a 8 months duration of irritability, grandiosity, over-religiosity, overfamiliarity, wandering behaviour and lability of mood.

Similar presentation was there 4 years back for about 10 days.

Results: On enquiring patient also had 4 yrs history of persistent Frontal Headache, Progressive Right Eye Visual Disturbances, Visual Hallucinations and 1 seizure episode 8 months back. Her physical examination including the neurological system was unremarkable. Ophthalmology opined Right eye Anisocoria with decreased Visual acuity. MRI Brain revealed Right Frontal Parasagittal Meningioma. Her behavioural symptoms were controlled with Valproate and Risperidone until transferred tto Neurosurgery for surgical management.

Conclusion: This is a case of Right Frontal Parasagittal Meningioma presenting with psychiatric manifestations. The late onset of symptoms with seizure, headache and anisocoria suggested a structural lesion. Unique in this case is the presentation of only psychiatric manifestations in the absence of neurological deficits. This case also highlights that a psychiatrist may be the first point of contact for a patient with a brain lesion. Hence in an elderly patient with atypical changes on mental status Organicity needs to be ruled out.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Executive Dysfunction in Obsessive Compulsive Disorder.

Bikramaditya Jaiswal^*1, Pradeep Kumar Saha², Sujit Sarkhel²

¹Central Institute of Psychiatry, India, ²Institute of Psychiatry, Kolkata, India, dr.bikramaditya@gmail.com

Keywords: Obsessive-compulsive disorder, Executive functions, Depression, Working memory.

Background: Several studies in Obsessive–Compulsive disorder (OCD) patients suggest impairment of Executive functions (EF) but the results are inconsistent so far, with several studies showing that OCD patients did not differ from controls on tests of EF or the impairment are shown to be partially due to co-morbid depression.

Objectives: 1. To find out whether EF in OCD patients is impaired in comparison to the matched controls. If so, which domains of EF are affected?

2. To find out the impact of severity of the disease and the impact of severity of depression on EF.

Methodology: 50 OCD patients and 50 matched controls between 18-50 years age were recruited. Tests for EF like Trail making test A and B, Stroop neuropsychological test, clock drawing test, N-back test and frontal assessment battery were applied on both groups and were compared with appropriate statistical methods.

Result: Statistically significant differences between both groups were found in almost every measure of executive functions, with OCD patients performing considerably worse than the control group. No significant correlation was found between BDI scores and EF.

Conclusion: Patients with OCD showed specific cognitive deficits on tasks of executive and working memory function which further supports frontal subcortical circuit involvement in this disorder. This is also consistent with their poor functional outcome. No correlation was found between EF and Beck’s Depression Inventory (BDI) scores which suggest that these neuropsychological deficits may be primarily attributed to OCD.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect of Injectable valproate loading in addition to Oral valprote in acute mania among patient attending Mental hospital Inpatient department & emergency department: A Randomized Control study

Topic Name: Psychopharmacology

Dheerendra Kumar Mishra, Ujjawal Kumar Sardesai

MGM Medical College Indore, India, mdheerendra.ssmc@gmail.com

Keywords: injectable valproate loading in addition to oral valproate

Background: Title: Effect of Injectable valproate loading in addition to Oral valprote in acute mania among patient attending Mental hospital Inpatient department & emergency department: A Randomized Control study

Introduction: Valproate has emerged as a drug of primary choice for the treatment of acute mania. It can be administered in high doses as an oral loading therapy (Grunze H et al 1999) but to achive its therapeutic level in blood need many days. So Injectable valproate loading in addition to Oral valprote in acute mania helpful to early archive therapeutic dose in blood and some studies say that injectable valproate is more efficacious and better tolerated than oral valproate as it reduces manic symptoms more rapidly than oral valproate(Solanki et al 2006)

As there is scarcity of research work in this area in our setting, this study is planned to asses the efficacv of injectable valproate over its adverse effect in the comparison of oral valproate and lithium carbonate

Aim: To study the use of Injectable valproate loading in addition to Oral valprote and lithium carbonate in acute mania patient.

Objective:

To study the Demographic profile of studied sample
To study the Clinical profile of studied sample
To study the adverse effect profile of Injectable valproate loading vs Oral valprote and lihium in acute mania patient

Methodology: (a)Study Design: Randomized double blind controlled study. (RCT)

(b)Study population: Manic patients attending IPD & Emergency in mental hospital Indore. (c)Duration of study: 1,Oct 2014 – 30 Dec 2014

(d)Tools:

Semi-structured data entry proforma
For diagnostic Criteria: ICD-10
For severity assessment: YMRS, BPRS, Clinical global impression scale.

Result and Discussion: As the study is ongoing, the analysis will be done using SPSS v16 by appropriate statistical analysis; results and discussion will be shown at the time of free paper presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Ethical Challenges in Psychiatric Research

Pooja Patnaik, Shobhit Jain, Rajeev Ranjan, Rajesh Sagar

AIIMS, New Delhi, India, coolpatnaik10789@gmail.com, jainshobhitji@gmail.com, rajeevranjan5@yahoo.co.in, rajeshsagar@rediffmail.com

Keywords: Ethics, Psychiatry, Research

Background: Psychiatric illness is highly distressing and stigmatizing. There are several gaps in current understanding of psychiatric illness which is a stumbling block in treatment of these illnesses. Ongoing researches have increased over past decade to help in understanding current trends and better treatment of illness. On other hand, there are high rates of retraction of published researches in past decades. Ethical guidelines are required to increase the overall quality and morality of research. Ethical issues and available guidelines pertaining to psychiatric researches are reviewed with specific note of concern related to Indian context.

Methods: A search was conducted on Pubmed and Google Scholar for search terms (eg. “Ethics” “Psychiatry” “Research”). Relevant studies were selected for the review.

Results: Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges and other issues. Specific guidelines are lacking pertaining to psychiatric researches.

Conclusion: Ethical Guidelines are very important tool of research which safeguards participants in keeping with interest of researcher. It safeguards participant interest who participates for interest of mankind. Due to dearth of such guidelines, psychiatric research is facing many of discussed ethical challenges. Such guidelines are urgently needed for psychiatric researches in India.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Reasons For Relapse In Alcohol Dependence Syndrome

Sri Ramya Ivatury, D Phani Bhushan

NRI General Hospital, India, kundetisriramya@gmail.com

Keywords: Alcohol, Relapse, Reasons.

Background: Alcohol consumption is known to be one of the most prevalent forms of substance use across the world. It occurs along a continuum, with considerable variability in drinking patterns among individuals. There is no sharp demarcation between “social” or “moderate” drinking and ‘problem’ or ‘harmful’ drinking. Several attempts have been made to classify patterns of alcohol use into distinct categories or subtypes based upon drinking patterns, personality factors and multi dimensional approaches in order to understand the complex interaction of biological and psycho social factors and their role in management of alcohol related disorder.

Aims and objectives:

(1)
To assess the influence of socio demographic factors in ADS.
(2)
The relationship between the severity of Alcohol dependence and the relapse.
(3)
To find out the various subjective reasons for relapse in ADS.

Methodology: 60 Admitted patients (minimum second time) with ADS as per ICD-10 during 6 months period are assessed for Socio demographic factors, Severity of Alcohol Dependence and subjective reasons for their relapse.

Tools:

(1)
Admitted patients with ADS as per ICD-10.
(2)
Socio demographic factors assessment.
(3)
Severity of ADS – Measured by SOADQ

Results will be discussed at the time of conference

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Factors Related To Non Compliance Among Patients With Psychosis

Manjeera Chintapalli^*1

¹Sowmanasya Hospital and Institute of Psychiatry, India, manjeera86@gmail.com

Keywords: noncompliance, psychosis, quality of life, side effects, attitude, functioning.

Background: The primary objective in evaluating non-compliance is to discover the factors that contribute to it, and evaluating the level of compliance accurately.

Aim And Objectives: Present study investigates the socio demographic profile, percentage of adherence to medication and relationship between the variables like psychotic symptoms, side effects, functioning, quality of life and attitude towards medication that contribute to non compliance.

Methodology: It is a descriptive cross sectional study with a sample of 100 individuals diagnosed to have Psychosis (Schizophrenia, Schizoaffective and Psychosis NOS) who gave consent and fulfilled inclusion and exclusion criteria. Sample was interviewed with socio demographic proforma and socio demographic variables have been studied. BARS was administered and percentage of non compliance has been assessed. BPRS, LUNERS, GAF, WHOQOL and DAI-10 were administered to evaluate psychotic symptoms, side effects, functioning, quality of life and attitude towards drug respectively.

Results:79% of the total samples are only 0-25% compliant to medication. Mean values of psychotic symptoms, side effects, functioning, quality of life and attitude has been evaluated. There was statistically significant relationship between the variables.

Conclusion: From the current study it can be suggested that non compliance is a complex phenomenon influenced by various factors. Psychotic symptoms, side effects, functioning, quality of life and attitude has statistically significant correlation and may influence the outcome compliance. More clinical and research emphasis should be put on finding better solutions for the identification and management of treatment non compliance, particularly in patients with psychotic disorders.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Association of hypotestosteronemia with negative symptoms in patients with Schizophrenia

Mamta Singh¹, R.K. Solanki^*2, M.K. swami³

¹Mahatma Gandhi Medical College, Sitapura, Jaipur, Rajasthan, India, mamta.garhwal1980@gmail.com, ²S.N. Medical College, Jodhpur, Rajasthan, India, Solanki_ramk@yahoo.co.in, ³BPS Goverment Medical College, Sonepat, Haryana, India, mukesh.swami@gmail.com

Keywords: Schizophrenia, hypotestosteronemia, negative symptoms

Background: Association of hypotestosteronemia with negative symptoms in patients with Schizophrenia.

Background: Gender differences have been reported in patients with schizophrenia and involve various aspects of the disease. The existence of gender differences in these areas may be related to the action of gonadal sex hormones in these patients.

Aims and Objectives: 1. To assess and compare the serum level of testosterone in schizophrenia patients with normal healthy subjects

2. To ascertain correlation of serum testosterone with Positive and Negative Syndrome Subscale Scores.

3. To seek association between testosterone level and onset of illness and disease duration in patients with schizophrenia.

Methodology: This cross-sectional comparative study was conducted at Department of Psychiatry, S.M.S. Medical College, Jaipur. One hundred male schizophrenic inpatients (20-56 years) with predominant negative symptoms, diagnosed on the bases of ICD-10 and fulfilling the exclusion and inclusion criterias were recruited. Fifty age matched healthy subjects without a history of psychiatric disorders or endocrine illness were used as control for comparison.

The socio-demographic characteristics, data’s regarding onset of illness, disease duration and medication histories were recorded in self designed semi-structured proforma after consent. Morning fasting blood samples were collected between 8.30 to 9.30 am from all subjects. The severity of illness was assessed by using the Positive and Negative Syndrome Scale (PANSS) on the same day. Serum level of testosterone was measured by Chemiluminescence Immunoassay (CLIA). The data collected on above tools, were analyzed by using z test and Pearson Correlation Coefficient.

Results: Serum testosterone level was significantly low in schizophrenia patients with predominant negative symptoms (p<0.001) as compared to healthy comparison subjects A significant inverse correlation was also observed between negative subscale scores of PANSS and serum testosterone level (r=-0.25; p<0.01).

Conclusions: In our study hypotestosteronemia is more common (36%) in schizophrenic patients with predominant negative symptoms. Therefore, testosterone level should be routinely examined in these patients and treated accordingly.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparison of family burden among patients of schizophrenia and depression: a cross sectional study

Naresh Solanki, Pali Rastogi, Ramghulam Razdan, Aman Kishore

M.G.M. Medical College Indore, India, solankinaresh90@yahoo.com, dr.deeptirastogi@gmail.com, ram_ghulam@yahoo.com, amankishore@rediffmail.com

Keywords: Caregiver burden comparison among schizophrenia and depression patients.

Background: Study Title: Comparison of family burden among patients of schizophrenia and depression: a cross sectional study

Presenting Author: Dr. Naresh Solanki

Co-Authors: Dr. Pali Rastogi, Dr. R.G.Rajdan, Dr. Aman Kishore

Institute: Department of psychiatry, M. G. M. Medical College, Indore.

Introduction: Caregiving has been identified as a basic component of human nature and a primary element of close relationship. Caring may have serious consequences for family caregivers, with a great impact on the quality of family life. Schizophrenia and Depression are disabling illnesses which also place considerable degree of burden on the caregivers. Many studies from India have tried to measure the burden of care in schizophrenia and some studies have made an attempt to measure the burden experienced by the caregivers of depression. Few studies have compared the two disorders.

Aims And Objectives: This study aims to examine family care burden in families of schizophrenia patient and compare them with patients having depressive disorders, attending the general psychiatric O.P.D. of M.Y. hospital, Indore.

Material And Method: Family caregivers of patient with schizophrenia and family caregivers of patient with depressive disorders were recruited for the study. Patients of age 18 years and above will be taken for both groups. It will be a cross sectional study. The patients will be diagnosed as having schizophrenia (all types) and depressive disorders using International Classification of Disease-10, Classification of Mental and Behavioural Disorders, Diagnostic Criteria for Research ICD-10 DCR criteria. The burden among the caregivers will be assessed using Burden Assessment Schedule. Appropriate statistical analysis will be done by using SPSS 16.

Result and discussion: will be discussed at the time of paper presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Retrospective Follow-up Study on Diagnostic Stability of Acute and Transient Psychotic Disorder in a Tertiary Mental Health Institute of North-East India

Diptadhi Mukherjee, Priyaranjan Avinash, Dhrubajyoti Chetia, Sajjadur Rehman

LGBRIMH, Tezpur, India, diptadhimukherjee@gmail.com, drpriyaranjan.avinash@gmail.com, dchetia234@gmail.com, sajjadur25@gmail.com

Keywords: ATPD, F 23, Stability, Polymorphic, Diagnostic shift

Background: Objectives: To study prevalence, socio-demographic profile, clinical characteristics including onset, presence or absence of stress, past history, family history, associated substance use, subtypes, stability of the diagnosis, and diagnostic shift of acute and transient psychotic disorder (ATPD).

Methods: 350 randomized samples from the patients attending outpatient department of LGBRIMH, Tezpur with the diagnosis of ATPD (ICD-10 diagnosis - F23) during the period of 5 years (2007-2011) allowing for a minimum of 3 years follow up, were reviewed. A total of 298 samples were taken for analysis after discarding the rest due to inadequate data. Finally appropriate statistical analysis was done using SPSS version 20.

Results: The hospital prevalence of ATPD was 6.3% and 15 % of which needed admission. The mean age of onset was 29 years, and was almost equally distributed in both male (49%) and female (51%). Acute and abrupt onset was almost equal. Majority (70 %) did not have any stressful life event. Around 1/4^th had positive past and family history. Substance use was present in very few cases (15 %). 32.2% of the samples were diagnosed as polymorphic subtype followed by schizophrenia like subtype (26.8%). Mean number of follow up was 8. More than half had stable diagnosis (51 %). 22% were re-diagnosed as schizophrenia and 12.3% as Bipolar disorder. ATPD diagnosis was more stable among those with stress, however it was not significant (p=0.18). Diagnosis of ATPD was significantly more stable among married people (p = 0.038), cases with abrupt onset (p=0.02), and the cases with polymorphic subtype (p=0.04). People with schizophrenic symptoms were significantly (p=0.01) more likely to be re-diagnosed as schizophrenia than those with polymorphic symptoms.

Conclusion: Our findings suggest that ATPD is a relatively stable diagnosis. However where diagnostic shift occurs, the majority are re-diagnosed as schizophrenia followed by bipolar disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychosocial Interventions in Tobacco use and Dependance: A Review

Sachin Kumar, Gaurishanker Kaloiya

All India Institute of Medical Sciences, India, dr.sachinmangla@gmail.com, gkaloiya@gmail.com

Keywords: Psychosocial intervention, Tobacco dependence,

Background: Tobacco is a leading cause of disease and premature death. India has 275 million adult tobacco users and tobacco use is estimated to contribute to more than a million deaths in the country each year. There is an urgent need to develop and evaluate affordable, practicable and scalable interventions to promote cessation of tobacco use

Objectives: To explore various psychosocial modalities for tobacco use and dependance cessation and to assess their effectiveness.

Methodology: A search was conducted on PubMed and Google Scholar for search term “ Psychosocial intervention” “ Tobacco dependance”. Relevant studies were selected for the review

Results: Tobacco use and dependence treatment interventions can be carried out at 3 levels (Level 1: ABC approach, Level 2: 5A approach, Level 3: intensive behavioural support) depending on time and competency level of the health professional. Various studies found that individual counseling was more effective than minimal behavioural intervention like self-help materials, brief advice etc. Similar effect of intensive counselling and brief counselling in one session. Group therapy was equally effective to a similar intensity individual counselling. Limited evidence of extra benefit by adding group therapy to other form of treatment. Proactive telephone counselling helps tobacco use to quit. Motivational Interviewing is good for tobacco user’s not willing to make quit attempt

Conclusion: Both behavioural and pharmacological interventions are effective for tobacco use and dependance. Combination of both results in higher abstinence rates. Behavioural intervention can be provided by variety of clinician depending on time and competency. Telephone and Web based technology should be incorporated in treatment of tobacco users. Complementary and Alternative therapies are new intervention to help tobacco users to quit

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cultural influences in the development of delusional parasitosis: a case Series

Karthick MS, Vikas Prabhav

Sri Ramachandra Medical College and RI, India, drkarthikms2008@gmail.com, viqi_v@yahoo.co.in

Keywords: Delusional disorder, Cultural factors, Delusional parasitosis.

Background: Abstract: Delusional parasitosis is an uncommon psychiatric condition which is characterized by a false and fixed belief of being infested by parasites. It is a delusional disorder of the somatic type, wherein the central theme involves bodily functions or sensations. It is the most common form of a monosymptomatic hypochondrical delusional disorder. The delusion here is usually considered to be primary; however it is sometimes described as an elaboration of a primary hallucinatory experience, paraesthesia or pruritus. Although several cases of delusional parasitosis have been reported, the role of cultural belief systems and native treatments in transforming an idea into a delusion has not been reported frequently. This paper reports a series of eight cases in which cultural factors which included belief in native treatments played a major role in the development of delusional parasitosis.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A population based study on prevalence of stress and depression among school teachers

Veda Neelakanth Shetageri, G Gopala Krishnan

MVJ MC & RH, India, drveda_24@rediffmail.com, sowmanasya@gmail.com

Keywords: Stress, Depression, School teachers

Background: Teaching is among one of the most respected, noble and preferred professions. Teaching is also often considered to be one of the very stressful professions. Even though there are multiple studies on stress experienced by teachers, only a few studies have been done so far to explore the stress and depressive symptoms among teachers associated with their profession. Anxiety, depression and somatoform (pain) are common mental disorders that are widely prevalent in India among the working population. Review of literature has found that approximately 1 out of 10 individuals working in the education sector will have depression over the course of a year. Our study aims (A) to find out the prevalence and severity of depression among school teachers (B) to study work related stress and its severity among teachers and (C) to study the relationship between the socio demographic and occupational profile of the teachers with stress and depression. Socio demographic and occupational details were collected using a semi structured questionnaire designed for the study. This study is a population based study which included 100 teachers of either sex working in English medium schools situated around Hoskote town in Bangalore, Karnataka, India. Informed consent was obtained from all the teachers who were included in the study. Out of 100 teachers included in this study, 30 taught in nursery, 35 taught in primary schools and 35 taught in high schools. Beck’s depression inventory (BDI)–II and Teachers stress inventory (TSI) were used in assessment. The analysis of data and results after analysis shall be provided and described at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Outcomes on buprenorphine-naloxone at a tertiary care substance use facility: a retrospective chart review

Vijay Krishnan, Atul Ambekar, Piyali Mandal, Ravindra Rao, Ashwani Kumar Mishra

All India Institute of Medical Sciences, India, vijayk1984@gmail.com, atul.abekar@gmail.com, piyum2008@gmail.com, drrvrao@gmail.com, ashwanikm@yahoo.com

Keywords: opiate substitution treatment, buprenorphine-naloxone, retention, chart review

Background: Opioid substitution treatment (OST) is an important strategy in the treatment of opioid dependent subjects, and treatment with buprenorphine-naloxone has been established world-wide as an effective option. Most studies in India have reported outcomes for daily dispensed buprenorphine, very few studies have systematically reported outcomes of clients on take-home buprenorphine-naloxone treatment, which was the aims and objectives of the study.

Methodology and Analysis: A structured pro-forma was used to review data from the records of all clients considered fit for take-home buprenorphine-naloxone tablets, and were initiated treatment between January 2007 and December 2012. Pre-treatment initiation data included socio-demographic and clinical profile of clients, drug use and high-risk behaviours, past treatment attempts was collected. Data on buprenorphine-naloxone outcomes was collected quarter-wise from initiation till June 2013, which included information on improvement in various domains, drug use, results of urine screening, dosing pattern and treatment compliance.

Results and Discussion: Complete treatment records were available for 84 Clients. The treatment duration was for less than 3 months to more than 6 years. Patients were predominantly males (96%); 69% had used heroin, mostly by chasing (54%); 50% had injected ‘ever’. About 64% had at least one past abstinence attempts. Eighteen months after the treatment initiation (when data for all patients is available) with buprenorphine-naloxone, 64% patients continued to be on the treatment, either weekly (80%) or twice-weekly (20%) dispensing schedule. About 90% patients who underwent urine screening were detected positive for buprenorphine. A retention rate of 64.3% was obtained for a period of 1.5 years, which is similar to the rates found in community-based studies in India for the same period.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

To Study the objective burden in Mothers of children diagnosed as Attention Deficit Hyperactive Disorder(ADHD)

Shubhangi R Parkar, Sampada Uday Raikar, Natasha Kate, Bhumi Pabari

Seth G.S.Medical College and KEM Hospital, India, pshubhangi@gmail.com, sampadaraikar@yahoo.co.in, natashakate@gmail.com, pabaribhumi@gmail.com

Keywords: mother, burden, attention deficit hyperactive disorder,

Background: Attention-deficit hyperactivity disorder (ADHD) is a neurobehavioral disorder of childhood onset characterized by severe, developmentally inappropriate motor hyperactivity, inattention and impulsiveness that result in impairment in more than one setting. ADHD decreases parents’ productivity and places a psychological and emotional burden on the family especially on the mother.

Objectives: To study the burden experienced by the mothers of children diagnosed as ADHD.

Method: Study participants are the mothers of children diagnosed as ADHD.Those who satisfy the inclusion and exclusion criteria have been enrolled for the study after taking informed consent. A semi-structured proforma has been designed to collect information on the socio-demographics.

Family burden scale has been administered to assess the burden in a sample of 40 subjects. Appropriate statistics will be applied. The mean measurement structures will be generated and the findings will be analyzed using SPSS.

Results and Discussion: Results will be discussed in paper.

Conclusion: The conclusion will be discussed in the paper

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Protein Powder Supplement With Steroids Induced Mania With Psychosis

Srinivasa Sivaram Kishore, Dheeraj Kattula, Deepa Braganza

CMC Vellore, India, dssrkishore@gmail.com, askdheeraj@gmail.com, deepa@cmcvellore.ac.in

Keywords: Steroids, Mania With Psychotic Symptoms, Restricted Delusional Theme

Background: Introduction: It is well known that patients with medical conditions on steroid therapy may develop steroid induced mood and psychotic disorders.

Case Report: Mr. J is a 22 year old single male from a middle socioeconomic status family from an urban South Indian background.

Premorbidly well adjusted, and described to have no deviant traits, he has no significant past or family history of neuropsychiatric morbidity.

He is a fitness enthusiast. He began using a locally produced, labelled nutritional supplement, recommended by his fellow body builders five days prior to presentation. Instructed to take two spoons daily, he took four to five spoons a day. Three days later he developed abnormal behavior.

He was brought to this centre with a three day history of reduced need for sleep, flight of ideas, pressure of speech, aggressive and assaultive behavior, and delusion of persecution with a delusional theme confined to that supplement where people would poison his food with that supplement and kill him

Admitted in the acute care facility, as he was physically aggressive, he required both chemical and physical restraint. Within 24 hours he developed significant EPS with just 4 mg of Risperidone. However, symptom reduction was rapid and remission was seen within 48 hours.

The temporal link of the onset of symptoms with the use of the supplement was striking. Unusual features included marked sensitivity to the side effects of antipsychotic, and rapid resolution of florid symptoms, that has maintained on follow up after 2 months.

There are allegations that the supplements are opened, and resealed after addition of banned substances like anabolic steroids, and distributed to athletes via word of mouth. Nutritional supplements are available over the counter and doctors may be largely ignorant of their composition or safe limits of usage.

The challenges of diagnosis, evaluation and management of a case with this presentation are discussed

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Study Of Pathway Of Care In Patients With Dhat Syndrome

Topic Name: Sexual disorders

Amit Singh, Vivek Agarwal, Bandna Gupta, Adarsh Tripathi

King George’s Medical University, India, amitsingh0612@gmail.com, drvivekagarwal06@gmail.com, drbandna@yahoo.co.in, dradarshtripathi@gmail.com

Keywords: Culture bound syndrome, Pathway of care, Semen

Background: Dhat syndrome is characterized by excessive concern about debilitating effects of loss of semen. By the time, patients with Dhat syndrome consult a psychiatrist they have often already consulted several indigenous healers, vaids, hakims, sex specialists and practitioners of modern medicine for relief.

Aims: The aim of this current study was to study the pathway of care in patients with ‘Dhat syndrome’.

Patients And Methods: A single point cross-sectional study was conducted to understand the pathway of care adopted by patients with Dhat syndrome and its relationship with the socio-demographic determinants in the study population. Total of 55 patients of Dhat syndrome attending psychiatric outpatient were assessed using a, semi-structured interview schedule.

Results: The majority of patients were unmarried, young adult and adolescent males with mean age about 25 years, belonging to rural background. Mean duration of Dhat syndrome was about 6.5 years. The mean time of delay between seeking help from first care provider and the study centre was about 4.6 years. Most of the patients (49.1%) first contacted unqualified practitioners. Most of the patients consulting first care-provider (58.2%) as well as the study centre (40%) were self-referred. A large number of patients (36.4%) contacted more than 3 care providers during pathway of care. Mean number of consultations per patient with different care-providers was 3.46 (±2.82). More than two thirds of patients consulted unqualified practitioners (71.1%) and allopathic medical practitioners (67.3%) during the pathway of care.

Conclusion: The patients with Dhat Syndrome first seek the help of various sources prior to attending a psychiatric health facility. As an enormous time gets wasted in finding the appropriate care provider for the problem, there is a need for incorporating an efficient and effective referral mechanism to speed up access to psychiatric care in Dhat patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Mental health consequences of wars and terrorism in Iraq: a preliminary report

Jawad Kadhim Al-Diwan, Jawad Kadhim Al-Diwan

College of Medicine, Baghdad University, Iraq, jawadkadhim.aldiwan876@gmail.com

Keywords: War, Terrorism, PTSD, SUD, Poor academic achievement, Iraq

Background: Background: Iraq has been at wars several times in its history, and at last the civil war and terrorism after 2003. There were few studies on the effect of war, civil war and terrorism on mental health in Iraq.

Objective: The work was carried out to report on mental health consequences of wars and conflicts on youth and children in Iraq.

Methods: A total of 210 university students resident in Baghdad (their age 18 - 24 years with male to female ratio of 0.8:1) selected randomly and 230 school children from Al-Sader city, Baghdad, selected by multistage random sample (their age was 9 - 20 years with male to female ratio 1:1.2). A questionnaire was filled for each participant. Requested data were demographic information, data on school achievement and Harvard Trauma questionnaire (exposure to war trauma, posttraumatic stress disorder and substance use disorder). Variables were dichotomized (PTSD vs non PTSD; academic achievement (poor vs good).

Results: Out of the total, 209 (99.5%) and 151 (71.9%) of university children and school children, respectively, were exposed to trauma. Of the exposed there were 39 (18.7%) and 65 (43%), respectively, with PTSD; 22 (10.5%) and 19 (12.6%), respectively, with substance used disorder; and 53 (25.4%) and 49 (32.4%) had poor academic achievement. High rates of PTSD, substance use disorder and poor academic achievement were significantly associated with exposure to accumulated trauma events, among university students and school children.

Conclusion: High exposure rates to trauma events and high prevalence of PTSD, SUD and poor academic achievement were observed. Accumulated exposure to trauma events was significantly associated with high rates of PTSD, SUD and poor academic achievement.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Qualitative Assessment of Knowledge, Attitude and Skills in Psychiatry among Interns

Akanksha Rathi, Shubhangi Parkar, Nandita Tarasingh Hazari

KEM Hospital, India, akanksha131089@yahoo.com, pshubhangi@gmail.com, h.nandita@gmail.com

Keywords: knowledge, attitude, skill, psychiatry, doctors, interns

Background: Recent years have revealed that medical education in psychiatry in developing countries is not yet at par with that in developed countries. The situation is possibly due to the fact that psychiatry is a short subject during the undergraduate curriculum and examinations, and there is insufficient sensitisation of students to mental illnesses. Additionally, there is restricted period of two weeks for psychiatry during the internship period. As a result, the knowledge, skills and attitude of a basic doctor or intern towards psychiatry, remain largely insufficient to deal with a large chunk of patients with mental illness.

It is a known fact that the proportion of psychiatric disorders amongst patients coming to a primary care physician is on the rise in recent times. Also, India has an unfavorably skewed ratio of psychiatrists to patient population. Knowing these facts, The need to develop doctors with a reasonable efficiency in identifying and managing psychiatric patients in the community becomes imminent.

Objectives: This study was undertaken with a view to evaluate the quality of knowledge, skills and attitudes of interns pertaining to common psychiatric disorders.

Methodology: The study was done in the setting of a medical college in Mumbai. The subjects for the study were 100 interns from the same college, having completed their internship post in the department of psychiatry. Feedback assessment forms consisting of MCQs were developed. Qualitative data was recorded, compiled and analysed.

Results and Conclusions: Will be discussed at the time of presentation.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Can a five-day training programme on Opioid Substitution Therapy (OST) improve scores on knowledge and skills of different cadre of service providers? Analysis of routine programme data

Ravindra Rao, Aditya Kumar Singh Pawar, Alok Agrawal, Atul Ambekar, Sudhir K Khandelwal

All India Institute of Medical Sciences, India, drrvrao@gmail.com, adityapawar@gmail.com, dralok.nddtc.aiims@gmail.com, atul.ambekar@gmail.com, sudhir_aiims@yahoo.co.uk

Keywords: opioid-substitution-therapy; training programme

Objectives: To study the impact of a five-day training programme on Opioid Substitution Therapy (OST) on different cadre of service providers by analysis of data routinely collected, pre- and post-training.

Methodology: Training programmes are held regularly to provide knowledge and skills on OST to service providers employed for running OST services supported under the National AIDS Control Programme. Each programme is for five-day duration, and has participants from medical and non-medical field. Every participant is administered a questionnaire of 20 questions (MCQs and true/false questions, possible score range: 0–20) on harm reduction, basics of drugs and OST, before and after training. The trainings are conducted by experienced trainers using standard training module. We analyzed data collected routinely and compared pre- and post-training scores using paired-t test analysis with SPSS software.

Results: A total of nine trainings were held in the 13-month period, in which 267 OST staff members (average 30 participants per training) from various states of North and South region were trained, using standardized training module. A total of six trainers were involved in imparting the training. The mean age of participants was 32.5±9.5 years. The proportion of different cadre was: Doctors: 17.7%, Nurses: 20%, Counsellors: 19%, Outreach workers: 28.2%, and programme managerial staff: 14.7%. The mean pre-test and post-test score was 9.3±2.6 and 13.4± 2.9 respectively. Comparison of mean scores using paired t-test analysis showed significant difference between the two scores (p<0.001).

Conclusion: The five-day training programme improves knowledge and skills of OST staff. It is feasible to train different cadre of staff in single training programme to initiate OST services.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect of Oxytocin on resting state brain functional connectivity: A functional magnetic resonance imaging study

Arpitha A Jacob^*1, Naren P Rao¹, Shivarama Varambally², Ganesan Venkatasubramanian², Gangadhar N Bangalore³

¹Centre for Neuroscience, Indian Institute of Science, India, arpitha.jacob@gmail.com, docnaren@gmail.com, ²Department of Psychiatry, National Institute of Mental Health and Neurosciences, India, drvarambally@gmail.com, venkat.nimhans@gmail.com, kalyanybg@yahoo.com

Keywords: Oxytocin, Functional Connectivity, Resting State fMRI, Social cognition

Background: Objective: Intranasal oxytocin has been examined as a potential therapeutic agent for social cognitive deficits in psychiatric disorders like schizophrenia and autism. However, the effect of oxytocin on brain regions involved in self referential processing is not known. Hence this pilot study investigated the effect of intranasal oxytocin on resting state brain functional connectivity in healthy volunteers using functional magnetic resonance imaging (fMRI).

Method: Resting state fMRI scans of four healthy male volunteers were acquired using 3 Tesla MRI scanner (TR=2500ms, TE=30ms, flip angle=78°, FOV=210mm). During the scan participants were instructed to relax with their eyes open, fixating on a cross hair displayed on screen. Each participant underwent three scans: baseline, following intranasal oxytocin (24IU) and placebo. Structural MRI images (TE=2.45ms, TR=2200ms, flip angle=8°, FOV=256mm) were acquired for co-registration. Using CONN functional connectivity toolbox, we examined functional connectivity analysis among default mode network seeds.

Results: Comparison of connectivity maps for oxytocin Vs placebo conditions revealed reduced connectivity (p_uncorrected = 0.0007) between medial prefrontal cortex (0, 54, -8) and precuneus (0, -56, 28) with oxytocin condition than placebo.

Conclusion: Findings of this pilot study indicate modulation of functional connectivity between default mode network regions following oxytocin administration. Preliminary evidence from previous EEG studies suggest that oxytocin modulates frontal cortical activity during self referential processing, supporting our findings. These findings if replicated in larger samples would provide further evidence for modulatory effect of oxytocin on self referential processing.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Problematic Mobile Use in Patients with Mental Illness-An exploratory study

Vathsala Javagal Krishnamurthy^*1, Hema Tharoor²

¹Schizophrenia Research Foundation (SCARF), Chennai, India, dr.vathsala.javagal@gmail.com, hematharoor@scarfindia.org

Keywords: Problematic mobile phone use, Mental illness, Mobile Addiction

Background: Problematic Mobile Use has become a growing concern in the last decade leading to addiction. The prevalence and ill-effects related to excessive mobile use remains unexplored in patients with mental illness.

Methods: In a prospective study design, consenting patients (>18yrs) attending the outpatient services at Schizophrenia Research Foundation (SCARF) were screened. During the study period (Sept- Dec 2014) patients were administered the 30 item The Problematic Mobile Phone Use Questionnaire (PMPUQ). The data collected was analyzed using the SPSS 16.0.

Results: Preliminary results of the 60 participants recruited so far indicate a mean age of 31.67(±)8.33 years. There is a near equal representation of the genders in the sample. Early findings indicate a diagnosis of Schizophrenia predominantly and majority of the participants were found to have mild financial problems (64.5%), mild Prohibity use (77.4%) and mild dangerous use (64.5%) of the mobile phone, while only 16.1% of them had severe dependence use of mobile phone.

Conclusion: Mobile dependence may soon be recognized as a dual diagnosis and warrant intervention in patients with severe mental illness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Burnout Syndrome among Medical Interns: Prevalence and Gender differences

Vijay Niranjan, Sandeep Sekhon, R C JIloha

Maulana Azad Medical College, India, dr.vijayniranjan@gmail.com, jyot_angel8@yahoo.co.in, dr.vijayniranjan@gmail.com

Keywords: Burnout, Interns, Psychological morbidity, Gender differences

Background: Burnout is a psychological syndrome characterised as state of emotional exhaustion, negative attitude towards the recipient of care (depersonalisation) and a feeling of low accomplishments in human service professionals. However, there is very limited literature about Burnout syndrome among medical interns from India.

Aim: To study the prevalence of burnout syndrome among medical interns and to find any gender differences Among them.

Methods: The study was a cross sectional study conducted at a medical college in Delhi. A convenient sample of 100 interns was taken. Subjects filled a pretested semi-structured questionnaire, which consisted of demographic data and measures of assessment. Burnout was assessed by application of Masalach Burnout Inventory, General Health Questionnaire 12 items version (GHQ-12) was applied for assessing Psychological morbidity. Definition of burnout was taken as high score (>27 points) on Emotional exhaustion subscale, along with high scores (>10 points) on depersonalization subscale and Low score (<33 points) on personal accomplishment subscale.

Results: Mean age of the sample was 23.9 years. 52 % were males and 48 % were females. Burnout syndrome was found to be present in 22% subjects. 34 % scored High on Emotional exhaustion subscale, while 46 % scored High on depersonalization subscale and 77 % scored Low on personal accomplishment subscale. 38 % of the sample was found to be psychologically distressed as per GHQ-12 scores. Burnout status and subscales scores did not vary significantly with gender, however psychological morbidity was found to be significantly more distributed among female interns(p=0.03).

Conclusion: Considering the higher ratings on various domains of Burnout and psychological morbidity among medical interns there is a need for targeted action and further research for a healthy workforce development in field of Medical care.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

A Cross Sectional Study on Prevalence of Mild Cognitive Impairment (MCI) among Elderly Caregivers of Psychiatric Patients in Tertiary Care Hospital

Sunitha M, Suma T Udupa

Athma Institute Of Mental Health And Social Sciencs, India, sunitha.mm@gmail.com, udupa.drsuma@gmail.com

Key words: Elderly, mild cognitive impairment

Background: Rapid demographic aging is a growing public health issue in many low and middle income countries. Mild cognitive impairment is a construct frequently used to define groups of people who may be at a risk of developing dementia crucial for targeting preventive intervention. However only few studies have investigated the prevalence of Mild Cognitive Impairment in India

Objective: The study aims to know the prevalence of Mild Cognitive Impairment among elderly caregivers of psychiatric patients in tertiary care hospital

Materials and methods: A cross sectional study was done in elderly caregivers of psychiatric patients. 60 years and above who gave informed consent, were included in the study. Caregiver’s with a primary psychiatric diagnosis were excluded. They were assessed on socio-demographic profile and screening for cognitive function was done using Addenbrooke’s Cognitive Examination-III (ACE-III) Tamil version which is a brief cognitive test that assesses five cognitive domains: attention, memory, verbal fluency, language and visuospatial abilities. The total score is 100 with higher scores indicating better cognitive functioning, cut of scores of 88 and below are considered for suspicion of dementia.

Results: Results would be discussed during the presentation

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Prevalence Of Anxiety And Depressive Symptoms In Cases Of Haematological Malignancies: A Cross-Sectional Indian Study

Shashikumar Ramadugu^*1, Pankaj Sharma²

¹AFMC, India, sribuj@rediff.com, ²inhs sanjeevani, India, pankajks02@rediffmail.com

Keywords: Haematological malignancies, anxiety, depressive symptoms

Background: Objective: The primary objective of this study was to assess the prevalence of anxiety and depressive symptoms in cases of haematological malignancies.

Methods: This study was carried out at a tertiary care centre .132 patients of haematological malignancy above the age of 15 years with no past history of psychiatric illness were include in the study. It was a cross-sectional study; patients admitted to the oncology unit between Jan 2012 to Jun 2013 participated in the study. Validated Hospital Anxiety and depression scale (HADS) self report questionnaire was used to assess the prevalence of anxiety and depressive symptoms. Data collected was analysed using Statistical package for social sciences (SPSS) program version 17.0.

Results: Significant numbers of patients were found to have anxiety and depressive symptoms. 21.21% patients had a score of more than 11 on anxiety scale indicating moderate to severe anxiety. 18.93% patients had a score of more than 11 on depression scales indicating mild to moderate depression. In our study, patients with multiple myeloma reported higher anxiety symptoms while patients with Hodgkin’s lymphoma reported higher depressive symptoms. The above findings and other outcomes of the study will be discussed.

Conclusion: Significant numbers of haematological patients suffer from anxiety and depressive symptoms which need to be addressed.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Successful use of olfactory hallucinations as early warning sign in a patient with bipolar disorder

Praveen Tripathi, Abhishek Pratap Singh, Priyanka Goyal

IHBAS, India, tripathipraveenucms@yahoo.co.in, dr.aps1983@gmail.com, priyankagoyal.1710@gmail.com

Keywords: Bipolar disorder, Early warning signs

Background: Recognising early warning signs that herald the onset of a manic or depressive episode has become an important component of succesful management of patients with bipolar diorder. The common early warning signs include sleep disturbances, increased activity levels, increased self worth etc. We report a case with an usual prodromal symptom in form of olfactory hallucinations which were succesfully used for the management of an impending episode. A 28 years old male, presented with 3 weeks history of overtalkativeness, increased spending, decreased need for sleep, grandiose ideas and perceiving a pleasant smell not perceived by others. There was no history of any seizure, any automatism or urinary/fecal incontinenece assocaiated. The MSE was consistent with a manic episode.. The MRI and EEG of brain were also normal. The patient showed significant improvement on medications. While he was euthymic, patient was psychoeducated about the illness and the need to identify early warning signs of a new episode. Patient reported that his episodes start with perception of a pleasant smell which would initially be perceived episodically; however, in a span of a week, would be present throughout the day. On the basis of this information, patient was explained the possibility of using olfactory hallucinations as early warning sign for manic episodes. After maintaining well for around one year patient came to outpatient with symptoms suggestive of olfactory hallucinations and detail history from family revealed that he had started to work excessively and was sleeping less. The above mentioned case exemplifies that olfactory hallucinations can also be the prodromal symptom in a patient with bipolar disorder and hence can be used as an early warning sign for an episode. Studies have found that early identification of prodromal symptoms and prompt treatment can succesfully delay the relapse of bipolar disorder, as was also seen in the index case.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Twin burden of mental illness and intimate partner violence (IPV) in female subjects: Results from a randomized controlled trial from India

Akriti Kamran, Manushree Gupta, R.C. Jiloha

Maulana Azad Medical College, India, akritikamran@gmail.com, manushree@gmail.com, rcjiloha@hotmail.com

Keywords: Intimate partner violence, psychiatric disorders, marital relationship

Objectives: Intimate partner violence (IPV) is an international public health problem that affects the lives of thousands of people across the globe. Domestic or intimate partner violence is related to significant physical and mental health consequences. The present study aims to test whether females with mental illness have a higher prevalence of intimate partner violence as compared to those with physical disorders. The study also aims to assess the sociodemographic and clinical variables related with the occurrence of intimate partner violence.

Methods: 75 female subjects visiting psychiatry OPD and 50 female subjects visiting other outpatient departments of GB Pant Hospital, New Delhi and fulfilling the selection criteria were recruited after informed consent. The subjects were diagnosed according to ICD-10 clinical guidelines. Semi-structured proforma detailing sociodemographic and clinical characteristics of the groups and WHO domestic violence study questionnaire were used as assessment tools. The results from the two groups were compared using statistical methods like Chi-Square test, Fischer’s exact test, Student’s t-test, Pearson’s correlation coefficient, univariate & multiple regression analysis

Results: Intimate partner violence (IPV) was found to be significantly higher (p<0.05) in subjects with psychiatric disorders (27%) as compared to those with physical disorders (13.1%). Dissociative (50%) and Somatoform disorders (12.5%) were the most common psychiatric disorders in patients with IPV. Marriage duration of less than 3 years, mean years of education less than 10 years and unskilled occupation of the husband were significantly associated with IPV. Physical and economic violence were the most common forms of domestic violence.

Conclusion: Our study draws an important conclusion that females with mental disorders carry the added burden of domestic abuse, which is significantly more than those with physical disorders. Until this hidden factor is addressed in females with mental illness, their condition will not improve.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Psychiatric Service Development: Market Forces and problems of quality

Dinesh Sinha^*1

¹NHS, United Kingdom, sdanes@gmail.com

Keywords: cost quality commissioning competition ethics

Background: The paper aims to discuss the challenges of developing and delivering psychiatric services in an environment of resource challenges and shifiting priorities.

The paper will use suitable examples to compare and contrast differences between a commissioning led versus a predominanlty market led delivery of psychiatric services. In the UK, commissioning services has traditionally offered the opportunity to develop a system wide idea of need and make attempts to balance the spread of resources. This traditional view is challenged by the entry of market led economics in the UK, which have arguably been present in India for a much longer time. Using appropriate references, the paper will discuss constraints and challenges to practice imposed by the frame of delivery services for ethical issuesarising out of competition.

The author will seek to present vignettes and examples based on experiences of working in both the UK and India with connections to various other health economies.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

PANDAS presenting in a young boy: A Case Report

Aakanksha Singh^*1, Santhosh Kumar T², Susanta Kumar Padhy³

¹PGIMER, Chandigarh, India, aakankshapgi@gmail.com, susanta.pgi30@yahoo.in

Keywords: PANDAS, OCD, ADHD

Background: PANDAS (Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is characterised by presence of multiple neuropsychiatric disorders like OCD, ADHD, tic disorders, learning difficulty and hoarding. The aetiology is autoimmune mediated following infections with group - A beta-haemolytic streptococci. This condition is rarely reported in the literature.

Objective: To present the case of 8 years old boy with PANDAS presenting with multiple neuropsychiatric symptoms and discuss its management.

Methodology (Case description): A 9 year-old boy studying in 3^rd standard, belonging to a Sikh family of upper socio economic status and urban background presented with symptoms of acute onset from last one year. The symptoms comprised of hyperactivity, deterioration of handwriting, learning disability, hoarding and compulsive behaviour. He also had fluctuating motor tics including eye blinking and shoulder shrugging and vocal tics included throat clearing. Exploration of history revealed that he had multiple upper respiratory tract infections one year back and these were temporally related with onset of symptoms. Throat swab was positive for beta haemolytic streptococci. Serum antibodies were positive for CaM Kinase II activity, Dopamine receptor D1 and beta tubulin. Based on these findings he was diagnosed with PANDAS. Management involved treatment with Fluoxetine, Risperidone and Methylphenidate in required doses and behaviour therapy for learning disability. There was improvement in tics and hoarding but insignificant improvement in other domains. Response to I.V. Immunoglobulin administration is awaited.

Conclusion: The PANDAS subgroup has a distinct clinical presentation and an identifiable course of symptoms with a clear relationship between streptococcal infections and neuropsychiatric symptom onset and exacerbations. Some cases may need IV Ig or plasmapharesis for improvement. Additional studies are required to determine the role of immunomodulatory therapies and antibiotics prophylaxis for this group of patients.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

To Study The Correlation of Depression and Perceived Stress to Glycemic Control of Recent Onset Type II DM

Preeti Pansari^*1, S M Manohari²

¹NIMHANS, India, preeti_pansari@yahoo.com, ²St Johns Medical College, India, smmanohari@yahoo.com

Keywords: Depression, Recent Onset Type II Diabetes, Perceived Stress, HbA1c, Obesity

Background: A bidirectional relationship between depression and diabetes is well established. It is a well appreciated fact that stress worsens the course of chronic illnesses and chronic illnesses by themselves are known to cause stress. A good glycemic control (HbA1c) in Type 2 DM can alter the outcome of illness. Any factors which alter the glycemic control needs to be targeted to promote health in diabetes.

Objectives: To assess the correlation between depression and glycemic control and to understand the relation of perceived stress to the glycemic control.

Methodology: A cross sectional study was conducted in the outpatient department of an urban tertiary hospital. 94 patients with established Type 2 DM of more than 1 year and less than 13 years duration and without complications of diabetes were evaluated for depressive symptoms, anxiety symptoms and perceived stress on objective questionnaires.

Results: A higher level of perceived stress was seen in 67% of the sample. Perceived stress was significantly associated with depressive and anxiety symptoms. No significant correlation was found between HbA1c and perceived stress (p=0.3928); depressive symptoms (p=0.2518) and anxiety symptoms (p=0.9953). Obesity (n=77) was the commonest comorbidity in this study. Exercise was significantly correlated with HbA1c (p=0.03).

Conclusion: In this study though the occurrence of anxiety symptoms and depressive symptoms was 43% and 33% respectively, HbA1c did not show any correlation with the presence of depressive or anxiety symptoms in recent onset diabetes. This is in contrast to earlier studies which clearly established the worsening of HbA1c in the presence of depression in type 2 DM. Exercise was significantly correlated to HbA1c in this study as is well established in literature. Incidentally, obesity was considerably high in this population and the BMI was found to be significantly correlated with perceived stress.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Interplay of schizophrenia and complex partial seizures

Manish Borasi, Hemika Agrawal, Shailesh Jha, Rajesh Kumar

IHBAS, India, manishborasi0407@gmail.com, hemikaagrawal1@gmail.com, drshaileshkjha@gmail.com, manishborasi0407@rediffmail.com

Keywords: Schizophrenia, Complex Partial Seizures, Treatment Resistant

Background: Seizure disorder is one of the common neurological disorder found in daily clinical practice and it is not uncommon to find having presentation with comorbid psychosis. Psychosis with certain seizure type i.e. complex partial seizures, is often a diagnostic dilemma and reflects treatment resistant which requires careful approach to a case and if found independent then follows specific pharmacological treatment. Considering the propensity of antipsychotics (AP) to provoke seizure and risk of pharmacokinetic interaction with antiepileptic drugs (AEDs), it becomes of immense need to understand above said issues.

Here, we describe through case series of six patients, way to approach diagnosis and management of a patient with schizophrenia with later comorbid complex partial seizures.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Stress vulnerability and coping pattern in patients of dissociative disorder

Supriya Kumar Mondal^*1, Kamala Deka², Soumitra Ghosh³, Ranjan Bhattacharyya⁴

¹Murshidabad medical college, India, drsupriyakumarm@gmail.com, ²Assam medical college, India, supriya007007@yahoo.co.in, ³Assam medical college, India, drsupriyakumarm@rediffmail.com, ⁴Murshidabad Medical College, India, drrbcal@mail.com

Keywords: Stress dissociative disorder

Introduction: Somatoform disorder is a chronic and disabling illness with distressing symptoms. The role of stress in the causation of somatoform disorder has been studied earlier and in some recent literatures. But studies are scanty in the field of coping strategies adopted by this group of patients in national and international literatures.

Objective: The purpose of the study is to asses’ role of perceived stress on symptom severity and to predict impact of coping on stress perception in patients with somatoform disorder.

Methodology: The study was conducted in Department of Psychiatry, Assam Medical College & Hospital, Dibrugarh, Assam, within a period of 8 month. The study was done in a case control model and systemic random sampling used for drawing the study sample from outpatient and indoor patient’s pool and demographically matched control populations collected from the same sociocultural background. Life events, perceived stress, physical symptoms and coping strategy were assessed through PSS (perceived stress scale-14),PHQ-15(patient health questionnaire-15) and WOCQ (ways of coping questionnaire) for both case and control groups. The obtained results were compared between groups.

Result: Somatoform disorder patients scored significantly higher physical symptom, and perceived stress in comparison to control groups. The two groups differ significantly regarding adoption of coping strategy in stressful situation. The study group scored high in distancing and avoidant type of coping whereas the control group scored high on plan full problem solving and positive reappraisal. Physical symptoms have linear correlation with perceived stress score. In study group perceived stress is inversely related to coping with positive reappraisal.

Discussion: Somatoform disorder group experienced more perceived stress than healthy population. Their somatic symptoms are positively correlated with stress perception. These patient groups tend to experience more stress in similar situation. Somatoform disorder group adopted more unhealthy type of coping namely distancing and avoidant coping compared to positive reappraisal and plan full problem solving in healthy populations. Unhealthy coping style is probably the cause for their higher stress perception and that might be one of the etiological factors for the chronic and disabling symptom of this disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Cross Sectional Study Of Relationship Between Subtance Use Disorder, Mental Health Problems And Family Assesment

Prerna Kukreti, Amit Garg, Pravesh Gautam

Institute of Human Behaviour and Allied Sciences, India, dearfrien@gmail.com, dr.amitg80@gmail.com, drpravesh03@gmail.com

Keywords: drug problem, alcohol problem, interpersonal relationship

Objective: The study aimed to study relationship between family history of mental illness, substance use disorders & alcohol use disorder, severity and interpersonal relationship in clients with dual diagnosis.

Methodology: Cross sectional study was conducted over a period of 2 months. Family history subsection of Addiction Severity Index (ASI) was administered on all patients (N=30) admitted in dual diagnosis ward. Participants were categorized into family history risk groups for each ‘problem domain’ based on the number of first & second degree relatives with alcohol, drug or psychiatric problems. Socio demographic variables were analysed using descriptive statistics, logistic regression was used for assessing association.

Result: High rates of mental health problems, alcohol and drug problems were found across all the family members’ categories; being highest for siblings. Of the entire high risk group, 30% were in the ‘psychiatric problem’ domain, 70% in the ‘alcohol problem’ domain and 55% in the ‘drug problem’ domain. Across problem domains, relationship problems encountered with parents/siblings was more in the high-risk group. Also, the siblings/parents too reported increased rates of lifetime emotional and physical problems as compared to low or moderate-risk group. Higher rate of poor interpersonal familial relationship was associated with Family history of psychiatric problems, drug and alcohol problem.

Conclusion: Holistic assessment of not just the index client but also the family members for these parameters can help in planning integrative therapy and better relapse prevention strategies.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Pathway analysis of suicidal self directed violence in late life

Akanksha Sonal, P.P Kannan

¹Institute of Mental Health, Chennai, India, dr.akanksha.sonal@gmail.com

Keywords: suicidal self-directed violence, depression, late life, path analysis.

Background: Suicide in late life is one of the most rapidly emerging healthcare issues, not just in developed countries but also in developing countries like India. With more of just failed attempt than other age groups.

Aims and Objectives: The objective of this study was to identify the risk factors associated with suicidal self directed violence in the population age 55 years and above.

Methods: The study recruited 85 subjects older than 55 years (males = 53, females = 3), registered to Rajiv Gandhi Government Hospital, with history of suicidal self directed violence. After getting informed and written consent participants were interviewed. The subjects’ were asked about socio-demographic data, physical and mental health, alcohol problems, social relationships, psychological well-being.

The scales used in the study were, CDC self directed voilence survillance manual to collect information on socio demographic and event related details. Physical Illness burden using Cumulative Illness Rating Scale, Burden of illness using WHO DAS2, Depression using Geriatric Depression Scale, Impulsivity Rating Scale, Loneliness Scale, perceived social support, alcohol use, level of expressed emotion. Suicide intensity assessed in this study using Risk Score.

Statistics used: Correlation and hierarchical multiple regression analyses were performed to identify the factors associated with the suicidal risk scores. The study results were tested using a path analysis.

Results and discussion: Depression, impulsivity, physical illness and burden associated, alcohol use and related problem, with lack of perceived social support, criticism severity was positively correlated with suicide risk. Depression severity had the largest direct impact, and economic status and social relationships had no significant impacts on suicide ideation. Psychological well-being exerted both direct and indirect influences.

Effective suicide prevention strategies requires multimodal approach, involving primary health, mental health and social connectedness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Health profile of homeless mentally ill women: Review from national capital state psychiatric hospital

Prerna Kukreti, Om Prakash, Amit Garg

Institute Of Human Behaviour And Allied Sciences, India, dearfrien@gmail.com, op.ihbas@gmail.com, dr.amitg80@gmail.com

Keywords: homeless mentally ill women, rehabilitation

Objectives: Homelessness and mental illness together confer significant morbidity, women amongst them further is a more vulnerable section. As per Ministry of Health and Family Welfare, 6–7% of Indian population suffers from a mental disorder and about 25% of mentally ill are homeless. But systematic studies in this area are scarce. This study was conducted with the aim to evaluate socio-demographic, socio-cultural and health profile (physical and mental health) of Homeless mentally ill (HMI) women, and to study reasons of homelessness and outcome related variables in these patients.

Methods: A retrospective chart review was conducted on the patients admitted in one of the female forensic psychiatry ward of a tertiary care neuropsychiatry centre of Delhi over a period of 18 months from August 2012 to January 2014. Socio demographic and clinical variables were analyzed using descriptive statistics.

Result: Of 75 homeless women admitted, 75% had psychiatric illness and 20% had only intellectual disabilities. Majority were illiterate, from low socioeconomic and rural backgrounds. 65% belonged to Hindi speaking area, for rest a specialized interpreter services were required making assessment and management further more difficult. HMI had considerably high rates of co-morbid intellectual disabilities (38.6%) and physical problems (75.4%) most commonly seizure disorder Most common mental illness were non affective psychosis 70%, followed by affective psychosis 20 %. Most (84.3%) were mentally ill before leaving home, 30 % were having past history of homelessness due to mental illness and 20 % had history of >1 hospitalization due to same. 70% responded well to treatment and 65 % could be reintegrated with family. Rest, 32.4% were sent to a government run facility for homeless women and 2.6 % to a NGO. But even the capital of nation is not having any specific government run rehabilitation facilities for homeless mentally ill. Untreated/inadequately treated mental illness was the most common reason for homelessness.

Conclusions: Homelessness and mental illness is a vicious cycle. But the machinery available is yet unprepared to handle it. A assessment surveys and building specialized services is strong felt need.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

An Unusual Case Of Secondary Mania Following Hypoxia In A Suicide Attempt Following Hanging

Prerna Kukreti, Pravesh Gautam, Amit Garg

Institute Of Human Behaviour And Allied Sciences, India, dearfrien@gmail.com, drpravesh80@gmail.com, dr.amitg80@gmail.com

Keywords: Secondary mania, hypoxia, suicide

Objective: Mania has very rarely been described as one of the clinical manifestation of delayed anoxic encephalopathy (DAE). Prior case reports of precipitating mania in clients with a previous history of mood disorder after hypoxia have been described. But, here, we report a young male with no past history of neurological or psychiatric illness developing mania as a symptom of DAE after suicide attempt of hanging.

Method: We present a case of a young adult male of 25 years age group with past 8 years history suggestive of prescription opioid dependence, who impulsively attempted suicide by hanging self on not being provided money to procure substance. Patient was saved by the family members and brought to the psychiatry hospital in view of altered sensorium. On examination, patient was conscious, had ill sustained attention and was disoriented to time and place. Patient had horizontal ligature mark on neck, mild pupillary constriction, spontaneous breathing, spO2 98% on air and stable vitals, with no tracheal shift or tardieu spots on skin or mucosa. Patient was admitted in ICU, NCCT neck revealed no soft tissue, bony or vascular injury. MRI Brain showed few ischemic hyperintensities in frontal lobe. Patient was managed symptomatically and over two days delirium improved on conservative management. But on clearing of sensorium, patient developed transient manic symptoms including euphoria, increased sociability, overtalkativeness, physical aggression and increase psychomotor activity. On Haloperidol 15 mg, he improved over next two weeks and continues to maintain well in follow up.

Result & Conclusion: A clear mechanism for development of mania due to hypoxia is unknown. Developed possible hypothesis will be discussed at the time of presentation. Clinicians should be vigilant for the development of affective states, not just a reactive depression but possible mania too in the patients recovering from hanging.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Restless Leg Syndrome: A Multicentre Study of Impact on Common Medical Comorbidities(RLSIM Study)

Gaurav Rajender^*1, Akash Rajender²

¹SMS Medical College, India, drgr27@gmail.com, ²Mahatma Gandhi Medical College, India, drakash5@gmail.com

Keywords: Restless Leg Syndrome, comorbidity

Objectives: Restless legs syndrome (RLS) is a sensorimotor, neurological sleep disorder, found in 7.2% population, which may be associated with several medical comorbities, affecting quality of life. The objective of the study was to evaluate the prevalence rate of RLS in a sample of elderly patients with different comorbidities, risk factors& medication at tertiary care centres.

Methodology: Four hundred patients with various comorbidities ≥ 65 years, presenting at OPD’s of Department of General Medicine, Psychiatry at M.G.Medical College & Hospital, Jaipur and Department of Psychiatry SMS Medical College, Jaipur (Rajasthan) were included in the study from June 2013 to July 2014. Data including RLS diagnosis, SESP, comorbidities with their selected risk factor & medication were evaluated. RLS was defined as the presence of all 5 International RLS Study Group (IRLSSG) revised 2012 criteria. Statistical analyses was performed using SPSS 12.0

Results: Based on IRLSSG criteria, 51/400 participants (12.75%) had RLS, 34(66.67%) being females. Multivariate analyses demonstrated that estrogen use (OR= 2.3), CVD (OR=2.02), hypertension and self-reported COPD (OR = 2.6) were independent risk factors predicting RLS. RLS was associated with higher prevalence of insomnia (27.45% vs. 7.45%, p = 0.001), increased sleepiness(39.22% vs. 21.49%, p = 0.033); and higher sleeping pill use(25.49% vs. 10.03%, p = 0.015).

Conclusion: The history of hypertension, COPD&use of estrogen was associated with a significantly higher incidence of RLS. RLS, in turn, was associated with insomnia and increased sleepiness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Case Of Sertraline Induced Delayed Hyponatremia And SIADH

Khushboo Bairwa, Prerna Kukreti, Om Prakash, Hemika Aggarwal

Institute Of Human Behaviour And Allied Sciences, India, dearfrien@gmail.com, drdsabat@gmail.com, drdsabat@rediffmail.com

Keyword: Sertraline, SIADH, hyponatremia

Introduction: Selective serotonin reuptake inhibitors (SSRI) are the preferred first line agents for depression. Hyponatremia is a rare complication of SSRI therapy, seen usually 5 to 120 days after initiation or dose change. We report a unique case of sertraline induced delayed manifestation of hyponatremia & SIADH.

Method: A 46 year elderly female known case of depression & asthma presented to OPD with one week history of generalized weakness & an episode of presyncope. She had been on stable medications since past three years including sertraline 100 mg daily and albuterol inhaler. Physical examination revealed stable vital signs, no edema or focal neurological deficits. Her laboratory data revealed 120meq/L sodium, 27mg/dl blood urea, 0.6 mg/dl serum creatinine & urine sodium of 126 meq/L. Her serum osmolality was 240 meq/kg & urine osmolality was 434 meq/Kg. Her serum sodium was 132 meq/L two months ago. This was suggestive of SIADH, hence, sertraline was discontinued. After medicine consultation, she was placed on water restriction with resulting improvement in serum sodium in next three days. She was started on bupropion & her subsequent clinical followup showed no recurrence of hyponatremia.

Risk factors for the development of SSRI induced hyponatremia include advanced age, female gender, concomitant use of diuretics and low baseline serum sodium concentration (<138 mEq/L). Mechanism of hyponatremia with sertraline is multifactorial but the most studied one is increased release of ADH through serotonin receptors. Sertraline induced SIADH often improves with fluid restriction & discontinuation of the agent but symptomatic severe hyponatremia might need aggressive treatment

Result & Conclusion: Physicians prescribing Sertraline should be aware of the possibility of delayed development of hyponatremia. Routine monitoring of electrolytes might benefit those who have additional risk factors but all patients should be educated about the signs and symptoms of hyponatremia.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Behavioural Profiles of Children of Alcoholics in Two Villages in South India

Preeti Pansari, Preethi Shetty, Rakesh Sharma, A. Mohammed, Ramkrishna Goud, M V Ashok

St Johns Medical College, India, preeti_pansari@yahoo.com, mysoreashok@gmail.com

Keywords: Behavioural profiles, children of alcoholics, south India, village, ADHD, COA’s

Introduction: Prevalence rate of childhood behavioral disorders is significantly high in children of alcoholics (CoAs) compared to offspring of non-alcoholic subjects. Studies have indicated that children of alcoholics need increased mental health inputs and may also be at risk for adult psychiatric morbidity. Literature on CoAs from the Indian context is scanty. An earlier study looking at social correlates of childhood behavioral problems in Mugalur village had suggested that certain behavior profiles may be more related to parental alcoholism. We wish to explore this further with a cross sectional study in the same population, through independent ascertainment of the two variables –namely parental alcoholism and childhood behavioral problems.

Objectives: To study childhood behavioural disorders among COA’s

Methodology: .Presence or absence of FIGS determined parental alcoholism was established in households with a total of 250 children in the age group of 4-16 years in Mugalur and Bovipalya. Child behavior Checklist and Strength and Difficulties questionnaire based childhood behavioral problems were determined in these 250 children by investigators blind to parental alcoholism status.

Results: The results suggest an excess of behavioral and emotional problems in CoAs, compared to those without parental alcoholism. The need for both primary and secondary preventive interventions for this group and other potential implications are discussed and the need to follow up in these children is emphasized.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Qualitative Study Of Belief, Attitude And Behavior Regarding Nicotine Smoking And Smoking Cessation Amongst Smokers With Dual Diagnosis

Prerna Kukreti, Amit Garg, Pankaj Kumar

Institute Of Human Behaviour And Allied Sciences, India, dearfrien@gmail.com, dr.amitg80@gmail.com

Keywords: Smoking nicotine, belief, attitude, behaviour

Background: Nicotine dependence is common in severe mental illnesses (SMI), making management more complex as nicotine use increases morbidity but SMI hinders effective participation in the smoking cessation interventions. The study was aimed at exploring attitudes & behaviors regarding smoking and smoking cessation amongst dual diagnosis patients.

Methods: A qualitative study was conducted on thirty five patients of dual diagnosis ward of tertiary care psychiatry centre of Delhi. All the clients were divided into small focused groups of five patients each and were inquired regarding first person perspective of daily smoking patterns, reasons of smoking, perceived benefits of smoking, quit attempt, sources of quit information & reasons/motivation to quit information.

Results: All participants reported various personal life events involved in smoking initiation and maintenance. It was reported as reinforcement for work, source of pleasure & a coping strategy. Majority did not regard it as a mental health problem as compared to other substances. Though awareness regarding health hazards of smoking nicotine was much more than other substances but the abstinence pattern was just opposite. Majority expressed willingness and need to quit other substance more than nicotine. Majority expressed need of being prescribed an anticraving agent but reported having minimal trust on medicines for relapse prevention. Details of other findings will be discussed during presentation.

Conclusions: Planning tobacco cessation in the dual diagnosis clients with SMI requires a flagship initiative to include not just pharmacological therapies but therapies addressing their core belief and attitude influencing the behavior.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effects of Traumatic Brain Injury

Saldanha D, Ambarish G, Madhav G, Sameer G, Kushagra V

Department of Psychiatry Dr DY Patil Medical College, Pimpri, Pune, India. d_saldanha@rediffmail.com

Background: Traumatic Brain Injury is a leading cause of morbidity and mortality worldwide and particularly in India due to the demographic changes of modernization in recent times. It is difficult to estimate the loss in economy. Current estimates put the rate of brain injured 1.5-2 million deaths in India per year. Those who survive are left with severe Psychiatric Sequele.

Aim: To evaluate the effects of Traumatic Brain Injury

Material and Methods: 50 Patients in the age-group 18-60 years with head injury admitted at tertiary care hospital excluding previous psychiatric problems, repeat head injury, history of epilepsy hypertension & Diabetes Mellitus, were studied with Glasgow Coma Scale to ascertain the severity and cognitive impairment with MMSE, GHQ, BDI, BCRS and followed up at 6 months and 1year.

Results: Out of 50 consecutive patients in age range of 18 - 60 years admitted, 8 expired 10 were lost to follow up. 32 completed the study protocol. Mean age was 34.82 with a SD of 13.30. 62% were below the age of 35 years.74% were males. Out of 82% educated lot 28% were graduates 12% were students, 60% employed, 28% unemployed. 60% were married.78% earned less than $250(Rs 15,000/) a month. 7.14% with severe traumatic brain injury became dependent on the family. Cognitive deterioration was seen in 38.10% in the first instance, 34.4% at 6 months and 37.10% at one year. HAM-A showed mild anxiety in 64.3% and moderate to severe anxiety in 35.7%. Depression assessed with BDI rose from initial 7.14% to 25% at 6 months and 37.05% at one year. Development of psychosis following TBI was not seen.

Conclusion: Traumatic Brain injury is a major problem which involves significant high cost of rehabilitation services

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Effect Of Cognitive Behavior Therapy For Problematic Internet Usage

Dr. G. S Ajay Krishna, Dr. Madhavi Kodali, Dr. Krishnamohan. P, Dr. P Sai Kiran

Dr. Pinnmaneni Siddartha Institute of Medical Sciences and Research Foundation

Background: Excessive and potential misuse of the internet among students is observed to have an adverse affect on their psychological wellbeing. Limited data is available on the efficacy of cognitive behaviour therapy as treatment for internet addiction.

Objectives: The aim of the present study was to evaluate the therapeutic effectiveness of cognitive behavioural therapy (CBT) for problematic internet usage.

Methods: A total of 60 college students, who met criteria for internet problem users based on Internet Addiction Test (IAT) were recruited for the study. The sample was divided randomly into an active treatment group (n= 30) and a clinical control group (n= 30). The cognitive behavioural therapy combines individual and group interventions with a total duration of 4 months. Internet use, time management, co-morbid mental symptoms were assessed for both groups at baseline and immediately after the intervention.

Results: 60 students with Internet problem addiction were identified and SDQ was applied to assess behavioral problems and it was observed that in case group of 30 individuals 6 individuals are having borderline socre on emotional symptom scale, 3 individuals are having borderline scores on conduct problem scale, 7 individuals are having abnormal scores and 2 individuals have borderline scores in hyperactivity scale, 6 indivduals were found to have borderline scores in peer problem scale, 1 individual has abnormal score and 4 individuals are having borderline scores on pro social scale.

In control group 9 individuals were found to have borderline scores on emotional symptom scale, 3 individuals have abnormal scores, 3 have borderline scores on conduct problems scale, 4 individuals were found to have abnormal scores and 6 individuals have borderline scores in hyperactivity scale, 1 individual had abnormal scores and 6 individuals were found to have borderline scores in peer problems scale, 1 individual had abnormal scores and 7 individuals have borderline scores on pro social scale.

It was observed that individuals who underwent CBT, improved in symptoms of internet addiction such as motivation to quit, time management, relationship function and engage in offline activites.

Conclusion: Basing on the above results it is clear that CBT is effective, in reducing as well as improving the daily life of people with internet addiction.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Clinical Patterns And Psychiatric Comorbidity Of Headache: A Study From Tertiary Care Hospital

Dr. Saikiran P, Dr. Madhavi Kodali, Dr. Ajay Krishna, Dr. Krishnamohan. P.

Department of Psychiatry

Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation

Background: Headache is the most common medical disorder with a lifetime prevalence of over 90%. Headache is commonly associated with psychiatric syndromes where psychiatrists are often consulted for the evaluation and treatment of people suffering from it.

Objectives: To study the clinical patterns and psychiatric co-morbidity of the patients suffering from headache attending to department of psychiatry in a general hospital.

Methodology: After prior consent, Socio-demographic details and the clinical details of the headache were collected and the diagnosis of the headache was coded using ICHD. Psychiatric diagnosis was made using ICD-10 with the help of consultant.

Results: Mean age of the individuals is 36.5 years. Out of the total sample, Primary headache constitutes 69.1 % and secondary headache constitutes 30.9%. Among the individuals with primary headache Tension headache, Migraine and primary headache associated with sexual activity constitutes 49.1 %, 18.2 % and 1.8 % respectively. Among the individuals with secondary headache, headache attributed to psychiatric disorder, headache attributed to a substance or its withdrawal, headache attributed to cranial or cervical vascular disorder and headache attributed to head and/or neck trauma constitutes 18.2 %,9.1 %,1.8 %,1.8 % respectively.

Among the total sample (n= 110), forty four individuals have depression, ten individuals have ADS, ten individuals have GAD, six individuals have panic disorder, five individuals have conversion disorder and two individuals have somatoform disorder, two individuals have delusional disorder and one individual has OCD.

Conclusion: Headache is commonly co-morbid with psychiatric disorders. Early identification of psychiatric disorders helps in proper management and treatment of the individuals with headache.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Comparison Of Anti-Craving Efficacy Of Right And Left Repetitive Transcranial Magnetic Stimulation In Alcohol Dependence: A Randomized Double-Blind Study

Biswa Ranjan Mishra*¹, Samir Kumar Praharaj², Sukanto Sarkar³, Mohammad Zia Ul Haq Katshu⁴, S. Haque Nizamie⁵,

Assistant Professor, Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India; E-mail: brm1678@rediffmail.com

Associate Professor, Department of Psychiatry, Kasturba Medical College, Manipal, Karnataka, India; E-mail: samirpsyche@yahoo.co.in

Assistant Professor, Department of Psychiatry, Mahatma Gandhi Medical College and Research Institute, Pudduchery, India

PhD Student, School of Psychology, Brigantia Building, Bangor University, Bangor, Wales LL57 2AS, UK

Director and Head of Center for Cognitive Neurosciences, Central Institute of Psychiatry, Kanke, Ranchi, Jharkhand, India – 834006; E-mail: sh.nizamie@gmail.com

Keywords: Alcoholism; Craving; Transcranial magnetic stimulation (TMS); Dorsolateral prefrontal cortex (DLPFC); Randomized controlled trial (RCT)

Objective: To compare the anti-craving efficacy of high frequency repetitive transcranial magnetic stimulation (rTMS) of the right versus left DLPFC in patients with alcohol dependence.

Methods: We performed a prospective, double-blind study involving 20 patients with alcohol dependence syndrome according to ICD-10 DCR, with CIWA-Ar scores ≤10. Patients were randomly allocated to receive either right or left rTMS over DLPFC in a 1:1 ratio (10 sessions at 10 Hz frequency; 20 trains per session; 4.9 seconds per train and inter-train interval 30 seconds). Alcohol craving questionnaire (ACQ-NOW) was administered to measure the alcohol craving at baseline and after the last rTMS session.

Results: Two way repeated measures ANOVA for ACQ-NOW total score showed no main effect of group (F[1,18] = .0001, p=.993) but significant main effect of time (F[1,18] = 185.91, p<.0001, η² = .912). The interaction effect between group and time was not significant (F[1,18] = .03, p=.864). For ACQ-NOW factor scores, repeated measures ANOVA showed no main effect of group, but significant main effect of time (p<.0001). The interaction effect between group and time was not significant.

Conclusions: There was significant reduction in craving scores in patients receiving either right or left rTMS with large effect size. However, there was no difference in anti-craving efficacy between the two groups. The results highlight the potential of rTMS which if combined with other anti-craving drugs can act as an effective strategy in reducing craving and subsequent relapse in alcohol dependence.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

“Expressed Emotion and Relapse of Alcohol Use Disorder”

Dr. Shobhana Mittal, Dr. Charan Teja Koganti, Dr. Aruna Yadiyal, Dr. Chandini, Dr. Pavithra Rao

Institution: Father Muller Medical College, Mangalore / Rajiv Gandhi University of Health Sciences, Bangalore

Introduction: The family’s expressed emotion has shown to be predictive of outcome of mental and physical illnesses in a variety of cultural settings. Expressed emotion (EE) is a significant characteristic of the family milieu that has been found to predict symptom relapse in a wide range of mental disorders. The empirical data shows that EE is amongst the major psychosocial stressors and has a direct association with recurrence of illness. In particular, attitude of caregivers towards the patient and their understanding of the nature of illness are important. Family can play an important role in helping in the recovery of a person with substance use disorders. A considerable amount of data suggests that expressed emotion can lead to relapse in vulnerable individuals, even when they are on medication.

Objectives: To study the relationship between expressed emotion and relapse of alcohol use

To study the relationship between expressed emotion and maintenance of abstinence from alcohol use

To evaluate the role of expressed emotion in relapse of alcohol use disorder

Methods: An observational, cross sectional, case control study was conducted in Mangalore, Karnataka. 30 participants admitted in Father Muller Medical College for de-addiction for Alcohol Use Disorder, with relapse of alcohol use within 12 months of previous attempt at abstinence from alcohol, constituted the case population. 30 participants who were maintaining abstinence from alcohol use for a period greater than 12 months, after having previously met the clinical diagnostic criteria for Alcohol Use Disorder, constituted the control population. Participants were selected using information oriented sampling. Informed written consent was taken from the participants & confidentiality was assured. Data was collected using a semi-structured Performa for assessment of socio-demographic information and alcohol use pattern. Family Emotional Involvement & Criticism Scale was used to measure expressed emotion. Statistical analysis was carried out using t-test and chi-square test.

Results: Expressed emotion was found to be significantly associated with relapse of alcohol use in Alcohol Use Disorder. Criticism and Emotional Involvement both were found to be high in the family environment of participants, who restarted alcohol use within 3 to 12 months of de-addiction, as compared to those who were able to maintain abstinence from alcohol for a longer period of time.

Discussion: Expressed emotion has been used as a construct in understanding the interaction between patients and their caregivers. The interaction between expressed emotion and patient outcome is complex. Researchers have highlighted the importance of EE in the understanding and prevention of relapse in a broad range of psychopathological conditions. Expressed emotion appears to be a stronger predictor of relapse in patients with more longstanding illnesses. In this study, a strong correlation was found between high expressed emotion and relapse of alcohol use in persons with alcohol use disorder. This highlights the need for psychosocial assessment of expressed emotion and intervention at the level of family as a unit, in order to help prevent relapse of alcohol use.

Conclusion: Expressed Emotion is modifiable risk factors for relapse of alcohol use. An understanding of the role of expressed emotions in alcohol use disorders can help target expressed emotion during recovery and help in relapse prevention.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S11–S112.

Factors Associated With Poor Treatment Compliance In Schizophrenic Patients

Ghimire SR¹, Vyas JN¹

¹Department of psychiatry, National Medical College, Birgunj, Nepal. drsrghimire@gmail.com

Keywords: Non-adherence, Non-compliance, Poor compliance, Schizophrenia

Background: Patient’s compliance is an important factor influencing the successful maintenance of treatment and the prevention of relapse. Poor treatment compliance is a serious condition that interferes with a person’s capacity to function in the world and is a major preventable cause of psychiatric morbidity and mortality. The objective of study was to identify patients with poor treatment compliance and factors associated to it among schizophrenic patients.

Method: This study explored factors associated with poor treatment compliance in 200 schizophrenic patients attending OPD at National Medical College, department of Psychiatry. The study was descriptive type and purposive sampling, a type of non random sampling technique was utilized for study. The patients and their informants who were considered for inclusion criteria in screening were explained the nature of the study and their informed consent was taken prior to study. After giving proper direction, questionnaire was given to patients and their family members.

Results: Out of 100 respondents, majority were male (61%) and females(39%) in the ratio of 1.56:1. One third (32%)of them were illiterate, more than half(59%) have income less than 5000. Approximately 50% of respondents and family members have lack of knowledge and awareness of illness. Poor compliance among patients were found due to numerous direct or indirect reasons, important being patient and illness related factors like suspiciousness(2%), hallucination(2%), poor insight(2%), unaffordability (68%), non availability(8%), unwanted side effects(92%), co-morbid illness(14%), substance use(19%). Similarly doctors related factors contribute to poor compliance were less awareness given, <10 minutes given in appointment(87%), unfriendly attitude(7%), and inaccessibility (11%) and prescription of more or equal to 4tablets(35%). The socio-cultural, familial and environmental factors associated with poor compliance were poor knowledge of illness(38%), drug therapy, lack of knowledge about family role(29%), negative contribution by people(77%), lack of access of mental health service (87%), and socio-cultural belief.

Conclusion: The study explored factors that directly or indirectly contribute for poor treatment compliance which were multi-factorial. No isolated single or definite factor was responsible for the illness. Detection and prevention of certain condition at proper time could prevent individual vulnerable to non-compliance. Moreover exploration of contributing factors also helps in early detection of poor compliance and treatment of illness.

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