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Indian Journal of Psychiatry logoLink to Indian Journal of Psychiatry
. 2015 Jan;57(Suppl 1):S3–S10.

AWARD PAPERS

PMCID: PMC4333354
Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

DR. D.L.N. MURTI RAO ORATION: Suicide in India — Changing trends and challenges ahead.

R. Ponnudurai

E-mail: ponnudurai.dr@gmail.com

Introduction: Suicide in ancient India have largely been influenced by the sacrificial motives, for the sake of honour causes, religious and socio-cultural beliefs, apart from the psychiatric and other causes. However, over the centuries changes in several domains that have contributed to suicide have been witnessed.

Recent Drift in the Socio-Demographic Profile of Suicides in India: India is labelled as “Suicide capital of South-east Asia” as it has recorded the highest number of suicides in South-east Asia in 2012, according to a WHO report. Are we going to dismiss this report as ill-founded?

Barring a few fluctuations there has been a gradual shift of the 1967 suicide rate of 7.8 to the rate of 11.0 in 2013 in India. In the previous few decades major proportion of suicides was by the youth, but, recently middle aged persons also form sizeable proportion. The percentage distribution of student suicide has risen from 5.5 in the year 2010 to 6.2 in 2013. Another disturbing trend is noted in farmers’ suicide as the number of victims in 2010 has reached a peak of 15964 as against 11096 in 2009. Although there is a decline in 2013, the figure is still higher than in the earlier years.

Factors Gaining Momentum in Influencing Suicides in India: Indian research on suicide have pointed out the role of alcohol and drug abuse on suicidal behaviour, even much earlier than the official reports of Government of India. What is more disturbing is the emergence of some recent reports that have pointed out much higher prevalence of suicide among substance abusers than the previous reports.

Family problems such as conflicts with parents in law and spouses have also more recently contributed for the escalation of suicides.

Deviations in the Methods Adopted: Notwithstanding the traditional modes of suicide, recent reports have also brought to light cases of cut injuries and stabbing. The traditional method of hanging which usually ends fatally has been the choice over other methods for many of the successful suicides.

Challenges Ahead: Systematic reviews of research have established that media reporting of suicide triggers imitation suicides. Hence, on one hand, unlimited press freedom and lack of mechanisms to restrain the depiction of suicide behaviour in visual media, serve as suicide promotion agencies. Psycho-social complications arising due to growing internet addictions and communication networks, particularly among the youth, might become a major concern in future.

More research on biological aspects of Indian Suicides need to be advocated as suicide prevention strategies are indicated.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

TILAK VENKOBA RAO ORATION: Clinical and therapeutic particularities of depression in old age

Om Prakash

Associate Professor of Psychiatry, Institute of Human Behaviour & allied Sciences (IHBAS), New Delhi, INDIA. E-mail: drjhirwalop@yahoo.co.in

The increasing number of elderly living upto an advanced age appear more prone to depressive disorders. Research in geriatric depression has always remained challenging particularly in methods used to characterize depression in medically ill. Understanding diagnosis, psychiatric and medical comorbidities, and genetics continues to be a goal of research workers throughout world. This review updates the recent progress in the characterization of geriatric depression. Depression in the elderly remains underdetected and underdiagnosed, particularly in medical clinics. Studies of the impact of psychiatric comorbidities and of the negative outcomes of depression in older adults demonstrate that geriatric depression is a serious medical condition which needs sertious attention. Clinicians should become more aware of the advances in detection of depression and the effect of psychiatric comorbidities associated with late-life depression and its early management.

Key words: Geriatric depression; identification; screening

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

MARFATIA AWARD: 1. Serum cytokine levels in drug naïve first episode depressive patients in comparison to healthy controls and changes following treatment with antidepressants

K K Mishra, AA Pawar, VSSR Ryalli, PS Alhuwalia, J Rathod

Department of psychiatry, MGIMS, Sevagram. E-mail: drkkmishra2003@yahoo.co.uk

Background: Depression is associated with acute phase response and increase in production of cytokines, primarily pro inflammatory types.

Aim: The study was aimed at finding the levels of cytokines in patients of first episode depression in comparison to healthy controls and to compare levels after treatment with conventional antidepressants.

Patients and Methods: Based on purposive sampling of 50 consecutive cases of first episode depression of different severity, diagnosed on ICD-10 diagnostic criteria were included in the study. They were compared with equal number of age and sex matched healthy controls. Subjects were evaluated clinically. They were administered Beck’s Depression Inventory and Beck’s scale for suicide Inventory(BSI). Five ml of blood sample was collected from patients prior to starting the antidepressants and from the controls at entry. The psychometric tests were repeated for the patients at 4-6 weeks and 6 months after the treatment. At this point blood samples were also collected. Levels of IL-1, IL-6 and TNF-a were estimated by ELISA technique using human cytokines kits. The values obtained were statistically analysed using SPSS version 10.0. The levels were compared for patients and controls at entry and for the patients pre and post treatment values after treatment with conventional antidepressants.

Results: Analysis of data showed significant higher values of cytokines mainly for IL-6 and TNF-a in depressed patient in comparison to healthy control. The difference was significantly at P < 0.05 and P < 0.001. there was significant reduction in the levels of following treatment.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

2. A study of psychiatric co-morbidity in patients with thyroid disorders

G.Vanishree, G.S.Chandraleka, T.V. Asokan, R. Jeyaprakash

Department of psychiatry, institute of mental health, kilpauk, Chennai. E-mail: vanishreeprithvi@gmail.com

Background: Psychiatric symptoms and syndromes are common among patients with thyroid disorders and other medical disorders. To what extent the psychiatric symptoms remit with treatment of the medical disorder remains a point of debate.

Objectives: To study the prevalence, course of psychiatric disorders, to identify its correlates in thyroid patients and compare the same with psychiatric morbidity in general medical patients.

Methods: 147 thyroid patients(cases) and 147 general medical patients(controls), satisfying the required criteria were matched for age and gender. They were recruited in the study, after getting informed consent. All participants were evaluated using the ICD10 for psychiatric disorders. Thyroid patients and other medical patients were then managed with appropriate medications. In each participant with a psychiatric diagnosis, the degree of psychiatric morbidity was measured using standardized instruments initially, at every subsequent visit, as well as at the end of six months. The results were statistically analysed.

Results: Psychiatric morbidity is twice as prevalent in thyroid disorders, than other general medical disorders. Following appropriate management of the medical condition, at the end of six months, the number of patients continuing to have a psychiatric morbidity was significantly higher in the thyroid illness group than the other medical illness group. Psychiatric morbidity was more severe in patients with overt thyroid abnormalities than sub clinical thyroid abnormalities.

Conclusion: In thyroid disorders, psychiatric morbidity is more frequent, more severe, more persistent and less amenable to medical management.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

3. Validity and reliability of diagnostic module of telepsychiatry software applications used by non-specialists

Savita Malhotra, Subho Chakrabarti, Ruchita Shah, Minali Sharma, Kanupriya Sharma, Akanksha Malhotra, Suneet K Upadhyaya K, Mushtaq A Margoob, Maqbool Dar, Gopal D Jassal

Department of Psychiatry, PGIMER, Chandigarh, India. E-mail: savita.pgi@gmail.com

Context: With the broader aims of codifying medical knowledge, an internet-based logically linked decision support system for diagnosis and treatment of psychiatric disorders has been developed as part of the telepsychiatry project and validated at the nodal centre. The Application is being used by non-psychiatrist doctors and para-professionals who underwent a brief training in its use through video-conferencing, for diagnosis and management of people with mental illness.

Aims: We aimed to evaluate the accuracy and reliability of the diagnoses generated by the Application at the remote sites when used by non-specialist interviewers.

Settings and Design: The study was conducted at the telepsychiatry centres of PGIMER, Chandigarh as the nodal centre and of the three remote sites as peripheral centres after approval from the IRB.

Methods and Material: The diagnostic tool comprises of initial screening followed by detailed criteria-wise diagnostic modules for 18 psychiatric disorders that open selectively based on screening. The study included 100 consecutive consenting adult outpatients attending directly or referred to the Telepsychiatry centres at the remote sites. To assess inter-rater reliability, the patients were interviewed face-to-face by non-specialists at the remote site using the Application (active interviewer) and assessed on the online Application simultaneously via video-conferencing by a passive assessor at the nodal centre. Simultaneously, another interviewer at the nodal centre rated the patient using MINI for diagnostic validation.

Results: The screening sub-module had high sensitivity (0.8 to 1), low positive predictive values (0.10 to 0.71), but high negative predictive values (0.97 to 1) for most disorders. For the diagnostic sub-modules, Cohen’ kappa values were >0.4 for all disorders, with kappa of 0.7 to 1.0 for most disorders. Sensitivity of diagnoses range and positive predictive values were high for most disorders. Negative predictive values were consistently high. Inter-rater agreement analysis revealed kappa >0.6 for all disorders. Thus, the diagnostic tool has acceptable validity and reliability when used by non-specialists at remote sites. In conclusion, the diagnostic tool of the application has the potential to empower non-specialist doctors and paramedics to diagnose psychiatric disorders accurately and reliably in remote sites.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

4. An Indian experience of neurocognitive & endophenotypic makers in unaffected first degree relatives of schizophrenia

Ram Kumar Solanki, Ashok Kumar, Yogesh Kumar Sajita, Suresh Gupta, Paramjeet Singh

S.N. Medical College, jodhpur, India. E-mail: Solanki_ramk@yahoo.com

Multiple susceptible genes interact with environmental adversities to yield a range of phenotypes in the schizophrenia spectrum. Endophenotypes can help characterize the impact of risk genes by providing genetically relevant traits that are more tractable than the behavioral symptoms that classify mental illness.

We aimed to adjudicate neurocognitive endophenotypes for schizophrenia.

Study Design: A cross sectional study was carried out sample was drawn from first degree relatives of patients who had diagnosis of schizophrenia. Fourty unaffected relatives of schizophrenia and similar number of controls were subjected to extensive diagnostic interviews and neurocognitive evaluations. After assessment, first degree relatives were compared with controls on measures of attention, verbal working memory, auditory verbal memory on indices of immediate recall and recognition, visuospatial working memory, visual attention and executive functions.

Discussion: Results indicate that, first degree relatives of patients with schizophrenia score poorly on measures of neurocognition and then controls. On conducting comparison over of composite neurocognitive score (we found that cognitive index with combitnation better dicscriminate between the first degree relatives and control groups).

Conclusion: Neurocognition on measures of attention, verbal visual and episodic memory, auditory verbal working memory, visuospatial memory and executive functions signigficantly differentiates first degree relatives of patients with schizophrenia from controls and can be used as endophenotypic markers of schizophrenia in non caucasians populations.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

BHAGWAT AWARD: 1. Early motor resonance differentiates schizophrenia patients from healthy subjects and predicts social cognition performance

Urvakhsh Meherwan Mehta, Hulegar Ashok Abhishekh

Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore. E-mail: urvakhsh@gmail.com

Context: Mirror neuron system (MNS) is deficient in schizophrenia. How MNS- activity changes with repeated stimuli (time-course) has not been explored.

Aims: To compare the time-course of MNS-activity between schizophrenia patients and healthy subjects, and examine its association with social cognition (SC) performance.

Settings and Design: Case-control design employing transcranial magnetic stimulation (TMS) to examine motor facilitation during action observation– a putative marker of MNS-activity.

Method: Fifty-four schizophrenia patients and 45 healthy subjects underwent 10- recordings (T1-T10) of cortical reactivity, using two single- and two paired-pulse paradigms, while they observed a goal-directed action and a static image. They also underwent comprehensive SC assessments.

Statistical Analysis: Time-course of MNS-activity was compared between the two groups using RMANOVA. Correlation analysis was used to examine the association between SC and phases of MNS-activity.

Results: Single-pulse measurements (spMNS-activity) showed initial fall and later rise in both patients and controls (quadratic occasion effect: F = 12.21; P = 0.001). It was not so for paired-pulse measurements (ppMNS-activity). Group X occasion interaction effects were not significant in both measurements. We categorized MNS- activity as early (T1-T3), middle (T4-T7) and late (T8-T10). Early spMNS-activity was reduced in patients compared to healthy subjects (t = 2.23, P = 0.029). SC score had significant correlations with early spMNS (r = 0.34, P = 0.01) and early ppMNS-activity (r = 0.314, P = 0.02) in patients.

Conclusions: MNS-activity time-courses did not vary across groups. The magnitude of early MNS-activity was reduced in schizophrenia compared to healthy subjects. This tardy mirror response was associated with their SC deficits.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

2. Predictors of retention in treatment in a tertiary care de-addiction centre

Siddharth Sarkar, Pradipta Majumder, Rishab Gupta, Bichitra Nanda Patra, Yatan Pal Singh Balhara

Department of Psychiatry, Sree Balaji Medical College and Hospital, Chromepet, Chennai. E-mail: Sidsarkar22@gmail.com

Background and Aims: Retention in treatment can improve the outcomes of patients with substance use disorders. The present study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders.

Methods: This record based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in northern India. Patients were classified as being retained in treatment or drop-outs based upon follow-up records. Logistic regression was used to find out the predictors of retention in treatment.

Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10th grade, employed, belonged to nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body and loss of social respect were the commonest substance-related complications experienced Out of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socio-economic status and having a family member with substance use was associated with higher chances of treatment retention.

Conclusion: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

3. A study of medical and psychosocial problems including disabilities, attitudes towards life and health-care seeking behavior of aged persons in urban Meerut

Ravi Rana, Ratandeep Lamba, Rakesh Kumar Pashwan,

LLRM Medical College, Meerut, UP. E-mail: drravirana@gmail.com

Background: We will all grow old one day – if we have the privilege. Let us therefore look at older persons not as people separate from ourselves, but as our future selves and let us recognize that older people are all individuals with individual needs and strengths, not groups that are all the same because of their age.

Aim: The study was planned to study the medical and psychosocial problems including disabilities, attitude towards life and health care seeking behavior or aged persons.

Methodology: Present study was conducted in Meerut city of Meerut district. The study was conducted on persons aged 60 years and above in the selected area. The technique was multi-stage simple random sampling. After obtaining verbal informed consent, the selected aged persons in 3 urban and 3 slum areas were interviewed and the information was recorded on schedules having following parts: Socio-demographic information, medical health status, mental health status was assessed using self-made questionnaire, MSE & MINI. Social Adjustment Scale for Aged (SASA) was also used for obtaining information on adjustment of aged persons in the society.

Results and Conclusions: Most common morbidity among geriatric came out to be of musculoskeletal system (58.8%), followed by cardiovascular system (50%) and visual system (44.6%). Morbidity was highest among housewives (91.2%) and unskilled worker (86.4%). Among aged who were completely dependent on others, 93.7% were found to be suffering from diseases. It was found that 70.2% aged had moderate social adjustment while only 2% were in high social adjustment, all being from urban areas. Regarding satisfaction with life, more than half were satisfied (55.4%), being more in urban area (78.8%) than slum area (32.9%). Majority (65.8%) of the respondents preferred to go to private health facility for their treatment during illness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

4. Regional posterior cerebellar volumetric deficits in medication naive obsessive compulsive disorder

Janardhanan C Narayanaswamy, Dania Jose, Sunil V. Kalmady, Mahavir Agarwal

National Institute of Mental Health and Neurosciences, Bangalore

Background: Even though conventional neurobiological models of obsessive compulsive disorder (OCD) commonly demonstrate abnormalities involving fronto-striatal circuits, there is emerging evidence regarding the role of posterior brain structures such as cerebellum.

Aim: In this study we examined the cerebellar regional volume in a large sample of medication naïve OCD patients compared to matched healthy controls (HC).

Methods and Material: In 49 medication naïve right handed OCD patients and 39 matched HC, sub-region wise volume of cerebellum was extracted from the T1 weighted images using Spatially Unbiased Infra tentorial Template (SUIT) toolbox and compared using hypothesis driven, region of interest approach after clinical assessment with standard scales.

Results: After controlling for age, sex and ICV, the subjects with OCD had significantly smaller cerebellum compared to HC (P = 0.003), especially in the posterior lobe (P = 0.002). Sub-regions confined to the posterior lobe which demonstrated volume reduction were lobule VI and left crus 1 (P < 0.05-false discovery rate corrected).

Conclusions: This study gives preliminary evidence for region specific cerebellar volumetric deficits in OCD, thus providing novel insights in to the neurobiology of this disorder. Regional cerebellar volume deficits conform to the abnormal connectivity of cerebellum to specific cortical regions and it is indicative of involvement of regions outside the conventional fronto-striatal circuitry.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

COL KIRPAL SINGH AWARD: The study of primary psychotic disorders with concurrent substance abuse in terms of their diagnostic stability in service setting

Maj Ankit Singhal, Col PS Bhat, K Srivastava, Lt Col Jyoti Prakash

AFMC Pune. E-mail: ankit.aashu@gmail.com

Background: Co-morbid substance use is common among individuals presenting with symptoms of psychosis. There is paucity of research in this area especially in service setting.

Aim: To study the longitudinal follow up of patients in service setting over one year of first episode psychosis with concurrent substance use in terms of their diagnostic stability.

Methods: 50 patients having at least one symptom of psychosis at first admission at a tertiary care hospital along with concurrent substance abuse were included and followed up for one year. ICD 10 diagnostic criteria was used for diagnosis. Semistructured socio-demographic performa to assess sociodemographic profile BPRS & Audit as rating scales were used for assessment at 06 & 12 months.

Results: Of 50 patients, 31 patients had a diagnosis of primary psychosis who retained their diagnosis at follow up. The mean age of cases in substance induced psychosis group was 37.47years which was significantly higher than in primary psychosis group at 31.52 years. However 07 patients of the substance induced psychosis group required a change in diagnosis to primary psychosis group. Primary psychosis group patients were significantly younger, less educated, had less family support, had greater family mental illness, had more severe symptoms & less hallucinations.

Conclusion: Present study is a forerunner in this area in service setting. Salient differences indicated in the study can help in differentiating the diagnosis and in management of cases. This is particularly relevant in service setting for disposal and long term intervention purpose.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

YOUNG PSYCHIATRIST AWARD: 1. A case-control study to assess the prevalence of metabolic syndrome among patients with opioid dependence syndrome seeking treatment at a tertiary care substance use disorder treatment centre

Yatan Pal Singh Balhara

Department of Psychiatry, AIIMS, New Delhi. E-mail: ypsbalhara@yahoo.com

Background: There is an ongoing debate on the most appropriate definition of MS. The study exploring prevalence of MS among individuals with Opioid Dependence Syndrome reported rates of 9.6%.2 However, this study failed to include a control group and utilised only one definition of MS.

Objectives: The current study aimed at assessment of prevalence of metabolic syndrome among patients with opioid dependence syndrome seeking treatment at a tertiary care substance use disorder treatment centre using a case-control design. The two different criteria for diagnosing MS included Modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) criteria adapted for Indian setting.

Materials and Methods: Subjects: Cases- Individuals diagnosed with Opioid Dependence Syndrome as per DSM-IV. Controls- Age, sex, diet and tobacco use matched healthy subjects. Sample size- Based on prevalence rate reported in the earlier study a 10% precision value yielded a sample size of 34 for a 95% confidence interval. Cases and controls were included in a ratio of 1:1. Study design: Case-control study. 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). Ethical approval- 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 8.3% and 12.5% of cases using NCEP-ATP III and IDF definition, respectively. However, the difference was not statistically significant as compared to the control group (chi square- 3.26, df-1, P = .15 for NCEP-ATP III; chi square- 2.64, df-1, P = .13 for IDF). BMI was significantly higher among controls as compared to cases (t- 2.11, P = .04). There was a significant positive correlation between age of onset of opioid use MS diagnosed with NCEP- ATP III criteria (r- .48, P = .01).

Conclusions: The prevalence rate of MS among patients with Opioid Dependence Syndrome tends to vary based on diagnostic criteria. There is a correlation between age of onset of opioid use and MS.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

2. Neurocognitive endophenotypes in first degree relatives of bipolar affective disorder: An Indian experience

Ashok Kumar

King George Medical University, Lucknow, UP. E-mail: drashok2k@gmail.com

Introduction: The term endophenotype was first used by Gottesman to describe a trait that may be intermediate on the chain of causality from genes to diseases. An endophenotype may be neuropathological, neurocognitive, emotional, neurophysiological or neurobiological in nature.

Aim: We aimed to evaluate neurocognitive endopheotype markers of bipolar affective disorder.

Study Design: A cross sectional study was carried out. Sample was drawn from first degree relatives (FDR) of bipolar affective disorder (BPAD) patients and controls. After assessment of neurocognitive function first degree relatives of BPAD were compared with controls on measures of aattention, verbal working memory, auditory verbal memory, visuospatial working memory visual attention and executive functions. We also calculated the composite neurocognitive score of both subjects and controls and compared them with each other.

Discussion: Results indicated that, first degree relatives of BPAD patients scored poorly on measures of various neurocognitive domains than controls. On conducting comparison over composite neurocognitive score, we found that cognitive index in combination better discriminate the first degree relatives of BPAD from controls.

Conclusion: Neurocognition on measures of attention, verbal episodic memory, auditory and verbal working memory, visuospatial working memory and executive functions significantly differentiated first degree relatives of BPAD patients and controls.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

3. Structural abnormalities in cerebral cortical thickness in Bipolar I disorder

Rashmin Achalia

Government Medical College, Aurangabad. E-mail: rashminachalia@gmail.com

Background: Abnormalities in brain regions are known to be important in identifying the emotional significance of stimuli and in producing affective states are proposed as the underlying neurobiology of bipolar disorder. However, as human cerebral cortex has many folds and nearly two-thirds is buried within the cortical sulci previous neuroimaging methods are suboptimal to study cortical thickness. Importantly, to the best of our knowledge till date no study from India has examined cortical thickness abnormalities in bipolar disorder. Hence we aimed to study cortical thickness abnormalities in Indian bipolar disorder-I patients.

Methods: Brain magnetic resonance images (MRI) of 28 bipolar disorder-I patients (17 males) and 28 age and sex matched healthy volunteers using 1.5 tesla scanner. Was taken the brain images were processed using surface based processing stream of Freesurfer package to calculate the cortical thickness. The cortical thickness differences between groups were compared using independent t- test. The study was approved by the ethics committee of Government Medical College, Aurangabad.

Results: Bipolar disorder-I patients had significantly decreased cortical thickness in the following cortical regions (P < 0.05) in comparison to healthy controls; right cingulate, left middle frontal, right supramarginal, right superior parietal, right inferior temporal, right cuneus, left superior temporal, left insula, left precuneus, left lingual and bilateral lateral occipital cortices.

Discussion: Results of this first time study in Indian patients suggests cortical thickness abnormalities in bipolar disorder I. Cortical thinning in various brain regions involved in affective states and emotional processing suggests their disruption as a potential neuroanatomical model for bipolar disorder.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

4. Clinical correlates of suicide in psychiatric patients with high suicidal risk

Hemendra Singh, V Senthil Kumar Reddy, Prabha S Chandra

M.S. Ramaiah Medical College, Bangalore. Email: hemendradoc2010@gmail.com

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. Lack of clinical data is a major barrier for effective management of suicide.

Aim: To study the clinical correlates of suicidein psychiatric patients with high suicidal risk.

Methodology: This study was conducted at the Emergency Psychiatry Ward of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore during 2011-12. 120 consecutive patients with high suicidal risk, aged between 17 ad 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 PSYRADS. The diagnostic break up was: Schizophrenic spectrum disorder (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 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 the 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 <30 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):S3–S10.

KC DUBE POSTER AWARD: 1. Clozapine induced seizure disorder: A brief report involving 222 patients receiving Clozapine

Sandeep Grover, Nandita Hazari, Subho Chakrabarti, Ajit Avasthi

Department of Psychiatry, PGIMER, Chandigarh. E-mail: drsandeepg2002@yahoo.com

Aim: To study the prevalence and incidence of seizures in patients receiving clozapine.

Methodology: A retrospective chart review of treatment records of 222 patients started on clozapine was done to evaluate the prevalence of seizures in patients prior to being prescribed clozapine and to study the incidence of after starting clozapine.

Results: Majority of the patients who were started on clozapine were male, (65.3%), single (65.3%) and unemployed (56.8%). The mean dose of clozapine received by the patients was 277.9(SD – 102.5) mg/day. Six patients had prior history of seizure and they were treated with clozapine under the cover of antiepileptic medications. Only one (of these six) had recurrence of seizure on clozapine, due to poor compliance to ongoing antiepileptic medication. The incidence rate of new onset seizure with clozapine was seen in 5.55% (12/216) patients. Majority of the patients, who developed seizures were male, aged between 25-41 years of age and had a long duration of illness (>10 years). The risk of seizure was associated with the dose of clozpine used. The risk of seizure with respect to the dose of clozapine was 3.1% (5 out of 159) with clozapine dose up to 300 mg/day, 8.2% (4 out of 40) in those receiving clozapine in the dose range of 325-500 mg/day had seizures and 37.5% (3 out of 8) in those receiving clozapine more than 500 mg/day. In more than half of the patients (7/12) who developed seizures while receiving clozapine were managed with reduction in the dose of clozapine. In one third of the cases (4/12) an antiepileptic medication was added and in one case clozapine was stopped. All patients continued on clozapine remained seizure free at follow up of a duration ranging from 6 months to 4 years.

Conclusion: The incidence rate of seizure with clozapine is 5.55% and the risk of seizures increases with higher doses.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

2. Neuropsychology of First Episode Schizophrenia: Characterization and Clinical Correlates

Vimal Doshi. V

Institute of child health, madras medical college, Chennai. E-mail: veeshi45@gmail.com

Aim and Objective: Cognitive deficit represent the core deficit in determining occupational and social functioning in schizophrenia. This study focuses on neuropsychological performance in first episode schizhophrenia and its correlation with social functioning and symptom profile.

Method: 12 neuropsychological tests were given to 34 patients with 1st episode schizophrenia and to a comparison group of 30 normal controls. Patterns of cognitive deficit and their relationship to sociodemographic characteristics were assessed. Correlations of cognitive deficit with symptom dimensions and social functioning were also studied.

Results: Study group showed poor performance in all cognitive measures when compared to controls. Marked differences between two groups noted in speed of processing, mental flexibility, verbal working memory, sustained attention and new learning ability. Study showed significant correlations between vigilance, sequencing, set shifting, abstract reasoning and verbal memory with social functioning. Negative symptom domain correlated highly with lexical fluency, speed of processing, sustained attention and verbal working memory.

Conclusion: Study documents global (pan)Neuropsychological deficit in patient with 1st episode schizophrenia when compared to healthy controls. Specific pattern of cognitive deficit are correlated highly with social functioning and negative symptoms.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

M. MURUGAPPAN POSTER AWARD: 1. Regional Cerebral glucose Metabolism and its Association with Phenotype and Cognitive Functioning in Patients with Autism

Anil Kumar B.N.

Shridevi Institute of Medical Sciences and Research, Tumkur

Background: Autism is a neurodevelopmental disorder for which neither a coherent anatomical nor 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 Methods: Ten subjects(aged 8-19) 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 tesr 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 disorders.

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 spatients 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 hypometablism in the cerebellum and this findings is related to the higher severity of abnotmal body use.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

2. Life events, Social Support, coping strategies in attempted suicide: A case control study

Pradeep Yadev

Institute of medical sciences, Varnasi

Keywords: Suicide, coping, social support, life events

Background: Sucide 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 setup.

Aim: The aim was to analyze and compare the type and severity of life events, coping stratergies 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 consequtive suicide attempters were compare with matched controls 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 groups 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 suicde significantly.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

3. A study of soft neurological signs in patients with first episode psychosis

G. Vanishree

Institute of Mental Health, Chennai

Keywords: Neurological soft signs (NSS), first episode psychosis (FEP), Schizophrenia

Background: Soft neurological signs are minor, non localizing, objective abnormalities, thought to reflect a damage in connections in between intra cortical and subcortical structures or between cortical structures.

Objectives: The study aims to find the prevalence of soft neurological signs in drug naïve patients with first episode psychosis. The study also examines the correlation between the presence of soft neurological signs and patient characteristics as well as illness characteristics.

Methods: 30 patients with first episode psychosis, meeting the required selection criteria, were age and gender matched with 30 controls (medical patients with no past or present mental illness). Informed consent was obtained. patients with psychotic symptoms were evaluated and diagnosed on the basis of ICD10. Neurological evaluation was done in all the psychiatric disorder was rated using standardized instruments. Results were statistically analyzed.

Results: Soft neurological signs are four times more prevalent in patients with first episode psychosis than in patients with medical illness. Among the cases, there were specific soft neurological signs which were significantly more prevalent in patients diagnosed of schizophrenia. The presence of soft neurological signs correlated significantly with the severity fo psychosis.

Conclusion: In patients with first episode schizophrenia, the presence of soft neurological signs had a diagnostic significance, correlating with severity of the illness. In patients with other categories of first episode psychosis soft neurological signs may have a prognosic implication.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

BPSS AWARD: Central zone: Attitude towards mental illness in paramedics

Vishal Sinha, Abhishek Bharti, Vipin Kumar, Ashwani Kumar Mishra, Zeeshan Anwar

SN Medical College, Agra. E-mail: drvsinh2000@yahoo.com

Keywords: Attitude, knowledge, stigma, mental illness

Background: The lack of knowledge about mental illness is conducive to emergence of stereotypes and discrimination against the mentally ill people. The negative attitude of stigmatization towards mental illness is hindrance in providing good services to a mentally ill.

Method: The subjects chosen were students of nursing and pharmacy. This is a cross sectional study carried out with 115 paramedical staff selected as study population. The socio-demographic profile and a pre-designed, pre-tested questionnaire containing information on various variables were used to assess attitude, knowledge and perception regarding mental illness. Data was analysed and interpreted using inferential statistics.

Result: Among 115 students, there were 80 nursing students and 35 B. pharmacy students. The mean age of study group was 22.37 years (SD = 2.7986) with 68.7% female & 31.3 % male. 83 % of the subjects were from middle class socioeconomic status. There were significant differences regarding separatism, stereotyping, pessimistic prediction and stigmatization domains of attitude scale for mental illness between the two groups of professional paramedical students.

Conclusion: Apart from laymen the attitude towards mental illness among paramedics has a great impact in the quality of care and help offered to people suffering from mental illness.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

South Zone: Resolution of cognitive adverse effects of electroconvulsive therapy in persons with schizophrenia: A prospective study

Naveen Kumar C, Vivek H Phutane, Jagadisha Thirthalli, Naveen Jayaram, Muralidharan Kesavan, Urvakhsh M Mehta, Vidhi Tyagi, Bangalore N Gangadhar

NIMHANS, Bangalore. E-mails: cnkumar1974@gmail.com; naveen.nimhans@gmail.com

Background: Cognitive effects are among the most important adverse effects of electroconvulsive therapy (ECT). Little is known about the course of cognitive effects in schizophrenia patients who receive ECT.

Methods: We examined the persistence of cognitive impairments in a sub-sample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing bi-frontal (BFECT; n = 23) and bi- temporal (BTECT; n = 26) electrode placements. Performance on Hindi Mental State Examination and tests for processing speed, sustained attention, working memory and verbal fluency was assessed at two points: At the end of ECT course and at follow-up after a mean (SD) of 98.7 (38.3) days. The course of cognitive impairments was assessed in BFECT and BTECT patients using Repeated measures ANOVA (RMANOVA). Proportion of patients scoring below respective norms for the cognitive tests at the two assessment points was compared using Mc-Nemar test.

Results: Performance on all cognitive tests showed significant improvement at follow-up for all patients (n = 49; time effect on RMANOVA: P < 0.01 for all tests). Time X Group interaction effect was significant (RMANOVA: Interaction effect P < 0.05) for HMSE and spatial span tests, suggesting that BTECT patients’ cognitive performance improved to catch up with that of BFECT patients. In the entire sample, there was a significant decline in the proportion of patients scoring below the norm in most of the tests (Mc-Nemar test; P < 0.01 for all tests except verbal fluency).

Conclusions: In patients with schizophrenia, cognitive performance improves substantially by the end of three months post-ECT. Improvement occurs irrespective of the electrode placements in bilateral ECT.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

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

Srikumar Mukherjee, S Haque Nizamie, Nishant Goyal

CIP Ranchi. E-mail: umesh.yes@hotmail.com

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 gamma 3 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):S3–S10.

West Zone: Study of facial emotion recognition, cognitive impairment and psychopathology in patients of schizophrenia

Sneha Gore

Background: Schizophrenia is known for cognitive deficits and impaired social cognition, which causes poor functional outcome. Facial emotion recognition is an important component of social cognition, which is impaired in schizophrenia.

Aims: To study and correlate cognitive defecits, facial emotion recognition pattern and psychopathology in patients of schizophrenia.

Methods and Material: 33 patients of schizophrenia were studied and compared with 33 normal subjects for facial recognition. The patient group was also assessed for psychopathology by using PANSS. Various cognitive tests were administered to assess functioning in domains of executive function, attention, working memory. Data was pooled and subjected to statistical tests.

Statistical analysis uses: IBM SPSS v 20.0.

Results: The performance of patient group was significantly poor as compared to control group on facial emotion recognition task. Schizophrenia group showed impairment in cognitive function, which had significant correlation with errors in recognition of fear and neutral faces. No correlation was found between psychopathology and facial emotion recognition.

Conclusion: Impairment in facial emotion recognition correlated significanty with impairment in neurocognitive tasks.

Indian J Psychiatry. 2015 Jan;57(Suppl 1):S3–S10.

North Zone: A voxel based DTI study showing white matter abnormalities in first episode, treatment naive patients of depressive disorder

Srivastava S, Bhatia MS, Chandra S

University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi. E-mail: srivastava_shruti@hotmail.com

Keywords: Voxel based Analysis, Diffusion Tensor Imaging, Depressive disorder, anisotropy, recent progress in the characterization of geriatric depression

Objectives: White matter abnormalities in the fronto- subcortical circuits have been shown in Major Depressive Disorder (MDD) using diffusion tensor imaging (DTI) of the brain. Recently, some investigators have employed voxel based analysis, an automated whole- brain magnetic resonance imaging technique. We explored white matter abnormalities in 15 first-episode, treatment naive patients of major depressive disorder versus 15 healthy subjects using diffusion tensor imaging.

Methods: A voxel based analysis was used to analyze the DTI scans on 3 Tesla Magnetic Resonance Scanner of 15 patients of major depressive disorder and 15 healthy subjects. We measured Fractional anisotropy (FA) values in both the groups, compared the differences and examined the correlation of FA values in patients with disease severity scores.

Results: Our results showed significantly lower fractional anisotropy values in left superior longitudinal fasciculus, left prefrontal cortex and left parietal white matter in patients compared to healthy subjects. We found no correlation between DTI parameters and severity of depressive symptoms.

Conclusions: Our preliminary findings suggest that white matter abnormalities presenting early in the course of MDD may contribute to the disruption of neural circuits thereby contributing to its patho-physiology.

Articles from Indian Journal of Psychiatry are provided here courtesy of Wolters Kluwer -- Medknow Publications

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