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. 2019 Jan;61(Suppl 3):S364–S378.

KC DUBE AWARDS

PMCID: PMC6366275
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: TO STUDY SELF-ESTEEM, PERCEIVED SOCIAL SUPPORT AND THE QUALITY OF LIFE IN POST BURN PATIENTS.

Aditya Anvekar 1, Rahul Bagal 2, Kranti Kadam 3, Shubhangi Parkar 4,✉

Being burned is a traumatic life event which affects the individual not only physically but also psychologically and also has long lasting effect on life. Studies have indicated that the outcome following burn is interplay between physical sequelae and psychological make up of the individual.

Since years burn care has been focused more on medical issues rather than psychosocial problems and quality of life. With advanced medical care leading to increased survival rate, psychological problems related to burn have become the subject of interest over last few decades.

AIMS & OBJECTIVES:

To study in post-burn patients-

  1. Self-esteem and

  2. Perceived social support.

  3. Quality of life.

METHODOLOGY: Patients who suffered burns for more than one month and seeking treatment in the Department of Plastic Surgery were enrolled for the study. Their self-esteem was assessed using Rosenberg’s self-esteem scale and their perceived social support was measured by applying Multidimensional scale of perceived social support. Quality of life was assessed by applying WHOQOL-BREF scale.

RESULTS: As per Rosenberg’s self-esteem scale, a total of 33/100 cases were having a low self-esteem.

As per Multidimensional scale of perceived social support, it indicates a good perceived social support overall. Relatively the average score seems to be lower on sub-scale for FRIENDS as compared to others. While average score on FAMILY and SIGNIFICANT OTHERS sub-scales are comparable. Also, on comparing sub-scales the average score of each sub-scale (22.71, 16.79, and 20.59) is more than 50% of total score of each sub-scale (i.e. 28).

On comparing all the domains of WHOQOL-BREF, psychological domain(11.68) had least mean score while the environmental domain(16.64) had the highest score in burn patients.

On comparing QOL Score on WHOQOL-BREF with SELF-ESTEEM, P-value was found to be very significant.(P<0.0001)

A positive co-relation was seen between quality of life and perceived social support.(r = 0.56)

DISCUSSION: It was a cross-sectional study, where we studied the quality of life, self-esteem and perceived social support in post burn patients.

ON MDSPSS, the mean perceived social support score was found to be 60.19 indicating a good overall perceived social support. Also on comparing individual domain of MDSPSS, the domain score concerned with friends as support was less as compared to those of family and significant others.

On WHOQOL-BREF, majority of burn patients had an overall good quality of life score which was in concordance with the previous studies, which can be explained by good perceived support by family & significant others. On comparing the mean score for the four domains, patients had least score in psychological domain (11.68) followed by physical domain (13.65) while environmental domain had highest score (i.e. 16.64). Similar finding was noted by previous studies. All the domains showed a positive co-relation with the overall quality of life with but more strongly with the psychological domain.

On comparing the raw scores of quality of life between males and females, no significant difference was observed while on comparing the domain scores for males and females, only physical domain ha significant difference between both of them. This finding may suggest that females are more sensitive towards their physical appearance as found in previous studies.

On comparing raw scores between those patients having low self-esteem with that having high self-esteem, significant difference was found between these groups with p-value being very significant. Hence, patients with low self-esteem are more prone to have a poorer quality of life.

Further on finding co-relation between raw scores of quality of life with social support scores for individually, a positive co-relation was seen between both of them thus this may imply that perceived social support and quality of life may be associated with each other and any variation in one of them may affect the other and vice a versa.

CONCLUSION: Post burn patients not only suffer from physical disfigurements but also suffer a lot due to psychological trauma which most of the times gets neglected. Hence this study can be used as a screening tool and early intervention can be done in those having low scores which ultimately improve their quality of life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

TITLE – WHO WILL GUARD THE GUARDIANS? A STUDY ON PSYCHIATRIC MORBIDITY IN CAREGIVERS OF CHILDREN SUFFERING FROM THALASSEMIA MAJOR

Amey Y Angane 1,✉, Kranti S Kadam 2

TITLE- Who will Guard the Guardians? A study on psychiatric morbidity in caregivers of children suffering from Thalassemia major.

ABSTRACT-

Introduction

Thalassemia major results in frequent hospitalization of patients due to lifelong regular blood transfusions. Caregivers are more affected than the patient themselves because of better appreciation of magnitude of illness and its treatment resulting in increased risks for anxiety and mood disorders. With such little attention given to the caregivers of thalassemia major patients, it is necessary that this vulnerable population should be studied for psychiatric morbidity.

Aims and Objectives

The purpose of this study was to find the type and prevalence of psychiatric morbidity amongst the caregivers of thalassemia major patients. The study also assessed the quality of life, various coping strategies and the association of the same with the socio-demographic variables.

Methodology

A cross-sectional study with 100 consecutive caregivers of thalassemia major patients attending thalassemia day care centre in a tertiary care hospital were taken. Subjects were administered GHQ-12, WHO-QOL BREF and CISS 21. Those scoring more than 3 on GHQ-12 were further interviewed and were diagnosed according to the ICD-10 diagnosis.

Results and Discussion

The prevalence of psychiatric morbidity was 35% amongst the caregivers with Depression (22%) being the maximum. Psychiatric morbidity had significant association with both the frequency (p = 0.037) and total number of blood transfusions (p = 0.020). Coping also had a strong association with psychiatric morbidity (p = 0.001) and psychological QOL (p = 0.029) stating that faulty coping techniques paves way for psychological distress and psychiatric morbidity eventually.

Conclusion

Caregivers of thalassemia children face psychological, social and financial burden. A significant amount suffered from depression or anxiety for which treatment was not sought. Caregivers need psychological training on how to handle the disease and use healthy coping strategies to avoid further psychological distress. It is only the improved psychological health of the parents that will guarantee and ensure a better care of the ill child and better adherence to the treatment.

Abstract for Poster presentation at ANCIPS 2019 for Professor K.C. Dube Poster Session I award

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: Faith healing among psychiatric inpatients hospitalized to a tertiary care centre of north India

Anamika Das *1, Sujit Kumar Kar 2

Introduction: Faith healing is a common therapy practice across the globe specifically in resource poor countries, which can affect the course and outcome of the mental illness. In spite of its widespread use there is lack of studies about the profile of psychiatric patients using faith healing practices.

Objective: To study and compare between the sociodemographic and clinical profile of patients using faith healing or not using it.

Method: This is a cross-sectional, observational study on in-patients of a particular psychiatric unit of Department of psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh. Retrospective chart review of in-patients in a particular psychiatric unit, over August 2013 to July 2018 was done and data was extracted in a semi-structured proforma. Data was analysed using appropriate statistical tests.

Results: The study sample consisted of 303 patients. 35.6% (108) of them used faith healing. Faith healing was significantly higher in the younger age group-highest in age group< 20 years(47.8%) and lowest in >60 years(20%)[p=0.013], lower educational group-highest in primary educated patients(47.0%) and lowest in post graduates (19%)[p=0.023], persons with severe mental disorder (46.8%)[p<0.001] and having a primary diagnosis of psychotic disorder-F20-29 as per ICD 10 (44.4%) [p=0.018]. It was seen that patients with alcohol use disorder (17.9% vs 38.3 % who do not use alcohol [p=0.013]) and opioid use disorder (0% vs 37.2 % who do not use opioid [p=0.006]) had lower faith healing practices.

Conclusion: Faith healing is a highly prevalent practice in psychiatric patients of Northern India. Young, less educated patients and patients with severe mental disorder are the most prevalent part of the faith healing seeking population. Patients with disorders which can have a medical model like organic disorders, psychiatric problems in old age, alcohol or opioid use disorder has less prevalence of its use.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: Illness perception and depression and their determinants in carcinoma patients in a tertiary care hospital of eastern India

ANIRBAN RAY 1,✉, ALOK GHOSH DASTIDAR 2

Place of Work/ Institution: Institute of Post Graduate Education and Research, Kolkata, West Bengal

INTRODUCTION: Carcinoma is a dreaded disease. It has been associated with significant depressed feeling. People perceive their illnesses differently. That, in turn, leads to different coping strategies & different psychological consequences. It needed to understand the determinants of illness perception and depression along with the relation between them, if any. MATERIALS & METHODS: Beck’s Depression Inventory (BDI) and Brief Illness Perception Questionnaire (B-IPQ) was translated in the Bengali language. 198 diagnosed carcinoma patients were randomly recruited from radiotherapy OPD for the study (approached 225, consented 200, completed questionnaire 198). Measured illness perception is analyzed for dependence on different demographic & disease parameters. RESULTS: Translated B-IPQ (α = 0.82) and BDI (α = 0.794) had good internal consistency. TNM stage of the disease (p = 0.004) or education of the patient (p = 0.008), marital status (p= 0.015) and psycho-education status (p = 0.001) predict the illness perception. Depressed feeling is also significantly influenced by psycho-education (p = 0.000), marital (p = 0.000), overall educational status (p = 0.001) of the patient and also stage (p = 0.036) of the disease. Age though not correlated with illness perception score (r = 0.110, p = 0.123), significantly correlated with depression (r = 0.217, p = 0.002). Total illness perception and depression scores were strongly correlated entities (r = 0.822, p = 0.000). 38.4% patients had clinically significant depression. DISCUSSION & CONCLUSION: Less educated & widowed or divorced persons perceive the disease more threatening and had more depressed feeling. Proper Knowledge of the disease has a role in allaying fear about the disease also to prevent psychiatric morbidity. Psycho-education along with supportive therapy can be very effective in this patient group. Further interventional study of the effectiveness of such modules can be undertaken in future.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: Adherence with psychiatry outpatient appointments: An Exploratory Study

Aseem Mehra 1, Subho Chakrabarti 2, Sandeep Grover 2, Sridhar M 3

Abstract:

Background: Adherence to psychiatric clinic is measure concern and also the topic of considerable interest. Poor treatment adherence is associated with higher level social, psychological as well as financial burden. Data from the western countries suggest that treatment non-adherence is influenced by patient related factors and clinician related factors. However, there is lack of data from India.

Aim of the study: This study aimed to examine the extent, pattern and correlates of adherence with outpatient appointments among patients with various psychiatric illnesses attending a tertiary care centre for the first time.

Materials and Methods: 1309 consecutive new adult patients (aged 18-65 years) attending the walk in clinic were assessed at the baseline, 3 months and at the 6 months.

Results: Slightly more than half of the patients were diagnosed with non-psychotic/non-affective disorders (54%), one third of the patients had a mood (affective) disorder (31%) and rest were diagnosed with psychotic disorders (15%). Nearly half of the patients were moderately ill (49%) and slightly less than a-third of the patients (28%) were markedly or severely ill and about one-fifth (19%) were mildly ill at the baseline evaluation. According to treatment adherence pattern, 19% were categorised as completers, 40% as partial attendees and 41% were dropouts at 6 months. A significantly higher proportion (85%) of patients had missed appointments. Patients who dropped out of treatment were more often from nuclear families, urban background, residing at a distance of > 80 kilometres away from the hospital, had a later age of onset with continuous course of illness, had a shorter duration of illness, were less likely to have a past or family history of psychiatric illness, co-morbid physical illnesses when compared to completers. Dropouts had poorer self-reported medication adherence, had less severe illness with a better level of functioning, were on lesser number of medications and were less satisfied with their first visit to the outpatient clinic when compared to completers.

Conclusion: About two-fifth of the new patients attending the psychiatric outpatient services dropout of treatment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of article: A study to assess impact of teaching proper case history taking of the most common psychiatric disorder- Major Depressive Disorder (MDD) in Interns

Bhaveshkumar M Lakdawala 1,✉, Parlin M Dadhaniya 2, Tanvi G Kacha 3

Title: A Study to Assess Impact of Teaching Proper Case History Taking of the Most Common Psychiatric Disorder - Major Depressive Disorder (MDD) in Interns

Introduction:

Psychiatry lectures & clinical posting are the only learning experience of psychiatry for Medical Graduates. Only interns attend their compulsory psychiatry posting.

Aims and Objectives:

To make Interns competent to elicit & write proper history of MDD and able to describe different components of history taking, diagnostic criteria, to demonstrate communication skills

Materials and Methodology:

It was a Prospective Interventional Study done in 45 Interns posted consecutively in Psychiatry. On Day1, Interns were asked to take and write history of MDD patient and evaluated on Checklist for history taking (10 components), SMCQ (15) and Mini-CEX. Then Interns were taught about MDD by CBL, SGL and Role Play. On Day 7, they were again evaluated on Mini-CEX. On term ending, they were again evaluated as per Day1. Feedback of Interns and faculties were taken. Appropriate Statistical Tests were used using SPSS Version 16.

Results:

On Checklist for history taking of MDD apart from Negative History and Mental Status Examination, Interns’ skills improved significantly. Mean score on SMCQ got doubled from 6±0.83 to 12±0.83. On Mini-CEX, apart from clinical judgement, counseling skills and overall clinical competence, Interns improved from unsatisfactory to superior level. Feedback was positive on most of the components of study but few were satisfied completely with their history writing & communication skills and diagnosing ability. Faculties’ perceptions were very encouraging.

Conclusion:

Teaching of MDD case history taking was well taken & perceived by interns. Knowledge about MDD & competency to take history and identifying patients of MDD improved satisfactorily.

Key Words: Interns, History taking, MDD, Psychiatry, Mini-CEX

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of the poster “To end or not to end, is the question!”: Content analysis of suicide-notes and thematic analysis of interviews, a Qualitative study in suicide survivors

Debanjan Banerjee 1,✉, Santosh Loganathan 2,✉

Title: A Pilot study of Self Reported Hypersexual Behaviours in India.

Authors:

  1. Mehak Nagpal, Senior Resident, Dept of Psychiatry, ESIC Hospital, New Delhi

    IPS Number: LOM/M03/17

  2. Keya Das, Assisstant Professor, Dept of Psychiatry, PESIMSR, Kuppam, Andhra Pradesh

    IPS Number: LOM KC/KA/02

  3. T.S. Sathyanarayan Rao, Professor, Dept of Psychiatry, JSS Medical College, Mysore, Karnataka

    IPS Number: 1900162000 (19016)

Objectives: To screen for sexual compulsion and psychiatric comorbidity in persons presenting with self reported concerns of excessive sexual behaviours.

Materials & Methods : A cross-sectional, pilot study carried out in 100 sexually active men and women presenting with self/partner reported hypersexual concerns to the Psycho-sexual Clinic, Dept. of Psychiatry, ESIC Hospital New Delhi. Approval was taken from the Institutional Ethics Committee, written informed consent obtained from all participants aged 18–45 years who were sexually active since past 1year. 86 men and 14 women were studied over a period of 2 years using semi-structured demographic proforma and clinical history (including details of time and money spent on pursuing sexual behaviours). Sexual Compulsivity Scale (SCS) and MINI were used by the psychiatrist. Appropriate statistical analysis done using SPSS 21.

Results: Pornography use was the most frequently reported specifier in men (n=81), followed by phone sex (n=70) and visiting massage parlours for sexual favours (n=60) Partnered sexual activity was more common amongst women as compared to men. However, the most common hypersexual behaviour in women was also masturbation (n=12) and porn watching (n=9). 55% (n = 55) of the entire sample (49 men and 7 women) met the criteria for sexual addiction according to SCS; out of which 47% had cybersex addiction. Significant association was seen between distress related to sexual behaviours and scoring above the cutoff on SCS (p=0.01). Gender was significantly related to the mean score (p=0.03). Women also reported clinical depression, anxiety more than men (p<.05) but not substance use disorders which was higher among men.

Conclusion: The SCS can be used clinically as a screening tool for problematic sexual behaviours which is a neglected area in the changing Indian social milieu.

Keywords: sexual behaviour, sexual compulsion, gender

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

TITLE- AN ONLINE SURVEY OF PSYCHIATRY RESIDENTS’ PERSPECTIVE ABOUT MHCA, 2017

Hussain Iftikar *, Kalita KN **, Iftikar Hussain ‡,✉

ABSTRACT

Mental Health Care (MHC) Act 2017 came with the aim of strengthening the medical care as well as rights of persons with mental illness. Concepts such as advance directive and nominated representative, have been introduced. Despite our search for a study which explores the issues related to this act among the psychiatric residents, we could not find any. So the present study will attempt to know the view of psychiatry residents on MHC act 2017.

AIM AND OBJECTIVES

  1. To assess the attitude and opinion of MHCA, 2017 among the residents.

  2. To correlate these finding with their personal profile if any

METHODOLOGY

This is a cross sectional study between 01. 04.18 to 09.09.18.

Inclusion criteria

The P.G. trainee of psychiatry of Assam who have given consent for the study

TOOLS:

Personal profile

Self- designed questionnaire.

graphic file with name IJPsy-61-364-g001.jpg

RESULT & ANALYSIS - 80% respondents feel that there is a need for a separate act for mental illnesses. More than 2/3 of the residents have expressed disagreement regarding the definitions provided in the act. Majority believe that advance directive may be an obstacle for treatment, also the act is more patient centric at the cost of over regulation of psychiatric practise. Decriminalisation of suicide has been considered as a positive step by most of the respondents.

graphic file with name IJPsy-61-364-g002.jpg

CONCLUSION:

This study has shed light about the opinions and views of future psychiatrists regarding advancements into our health setup.

REFERENCES:

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title:Tofisopam as an alternative intervention in organic catatonia: An open label study.

JP Russell Ravan 1, Jigyansa Ipsita Pattnaik 2, Susanta Kumar Padhy 3, Soumya Swaroop Sahoo 4

Introduction:

The treatment of organic catatonia includes benzodiazepines, ECT and treatment of the primary condition. Lorazepam in such patients produces sedation, hypotension and respiratory depression3. Tofisopam, a non-sedative benzodiazepine, (approved for IBS4) was safe and effective which can be a treatment alternative.

Objective :

To study the efficacy and adverse effects of Tofisopam in organic catatonia.

Methodology :

This study included 30 patients irrespective of age and gender with diagnosis of organic catatonia (F061, ICD-10). Patients with delirium, history of psychiatric illness and substance use disorder were excluded. Busch Francis Catatonia Rating Scale was used to assess the catatonia.

Scores were obtained at baseline and at 48 to 72 hours. Changes in BP, RR, spO2 and GCS were noted.

Tofisopam 50-100mg/day was administered in divided doses.

Statistics: Paired T test, Chi square test, Pearson’s correlation and SPSS 17 was used.

Results :

The mean age was 54.27 ± 16.5 years (range 18–82 years) with 23 males and 7 females. The mean baseline score of Catatonia in BFCRS was 11.73+-1.31. Out of 30 patients, 22 (71%) had response. Response was defined as reduction of catatonic signs to 1 or none on 14 item BFCRS5.

Response occurred in CKD without multi organ involvement, Parkinsonism, Severe anemia, Hypertensive encephalopathy, Coronary Artery Disease- post CABG and post GI surgery patients.

No improvement in catatonic symptoms occurred in Septicemia, CKD with Multi-organ Failure. The domains with significant improvement were Stupor, Mutism, Staring, Posturing, Rigidity, Negativism and Withdrawal. No significant adverse effects noted.

Discussion:

Tofisopam (mixed dopamine agonist-antagonist)6 probably modulates the hypo-dopaminergic state in catatonia. Its non sedative, non hypotensive7 property can explain the added advantage over lorazepam. Efficacy in GI pathology could be due to organ-specific action.

Conclusion:

Tofisopam can be a safe and effective alternative treatment in organic catatonia.

References:

  • 1.Dash S S, Anshuman, Kumar S, Pany S K, Ravan J R. Novel Role Of Tofisopam In Organic Catatonia: Hypothesis Generated From A Case Series In A Tertiary Medical College And Hospital Setting. Indian J Psychiatry. 2017 Jan;59(Suppl 2):S167–S219. [Google Scholar]
  • 2.Leventer SM1, Raudibaugh K, Frissora CL, Kassem N, Keogh JC, Phillips J, Mangel AW. Clinical trial: dextofisopam in the treatment of patients with diarrhoea-predominant or alternating irritable bowel syndrome. Aliment Pharmacol Ther. 2008;27(2):197–206. doi: 10.1111/j.1365-2036.2007.03566.x. [DOI] [PubMed] [Google Scholar]
  • 2.Payee H, Chandrasekaran R, Raju GV. Catatonic Syndrome: treatment response to lorazepam. Indian J Psychiatry. 1999;41(1):49–53. [PMC free article] [PubMed] [Google Scholar]
  • 2.Petócz L. Pharmacologic effects of tofizopam (Grandaxin) Acta Pharm Hung. 1993;63(2):79–82. [PubMed] [Google Scholar]
  • 2.Bond A, Lader M. A comparison of the psychotropic profiles of tofisopam and diazepam. Eur J Clin Pharmacol. 1982;22(2):137–42. doi: 10.1007/BF00542458. [DOI] [PubMed] [Google Scholar]
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

EEG FINDING AND IMPLICATION OF CLINICAL SEIZURE’S ABSENCE OR PRESENCE IN ATTENTION DEFICIT HYPERACTIVITY DISORDER

Jita Baruah 1,✉, Hemendra Ram Phookun 2

BACKGROUND : Epilepsy and attention deficit hyperactivity disorder (ADHD) are often seen to be comorbid conditions and have significant effects on the social and behavioural development of children. Many of the ADHD children have abnormal electroencephalograph (EEG) results, compared to that of healthy children

AIMS. To correlate the EEG findings in established cases of ADHD.

and to find the association of clinically absent seizure and abnormal EEG finding.

MATERIALS AND METHODS : Patients(50 sample) already diagnosed as ADHD attending a tertiary care hospital,age 5 to 18 were enrolled for the study. Detailed history from parents taken. Epilepsy already diagnosed by neurologists.IQ test done on all the patients.EEG was advised to all the patients. Data analysis was done using SPSS 21.0 Software version.

RESULTS AND DISCUSSION :. In our study 11 patients i.e. (22%) had epilepsy, similarly another study has mentioned a bidirectional relationship of ADHD and epilepsy in two cohort studies. Also a study done in 2018 have mentioned has mentioned that individuals with epilepsy had a statistically significant increased risk of ADHD. Out of the 50 patients, 11 of them had clinical seizure.(22%). 52% of the patients of ADHD had abnormal EEG irrespective of clinical presence of seizures. Similarly in a study done in 2014 has revealed that about half (48.3%) of the children with ADHD had abnormal EEG findings It was seen that out of the 50 patients, 39(78%) patients had no clinical seizure but 16(41%) patients out of them had an abnormal EEG (p<.003).. Similar to our study a study done in north east India in 2016 out of 113 patients having various psychiatric diagnosis in children(including ADHD) 26.54% had abnormal EEG and had significant correlation.

CONCLUSION: From the present study it is reflected that ADHD is not a disease of single entity,multiple comorbid conditions including epilepsy and abnormal EEG finding.

Keywords: EEG,epilepsy,gtcs,complex partial seizure

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

TITLE- To understand the role of language in patients with and without hearing impairment, who were experiencing Auditory Verbal Hallucinations while suffering from Severe Mental Illness.

Kamaldeep Sadh 1,✉, Urvakhsh Mehta 2, Muralidharan K 3, N Shiva Shankar 4, Sanjeev Jain 5

INSTITUTE- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India

AIM - To understand the role of language in patients with and without hearing impairment, who were experiencing Auditory Verbal Hallucinations while suffering from Severe Mental Illness.

METHODOLOGY- We compared the experience of Auditory Verbal Hallucinations in patients experiencing psychotic symptoms with hearing impairment (HI,N=20)and with normal hearing (HN,N=20).

RESULTS- Most of the patients in both the groups reported hearing voices mainly in the first language that they have learnt or heard,despite of knowing multiple languages (17/20; 85% in HN and (16/16; 100% HI). The HI patients described the hallucinations in simple sentences as compared to elaborate details in hearing normal group.A significant proportion in HI group (7 patients (7/20 i.e. 35%) reported using a hearing aid; and 5 patients (5/7 i.e. 71%) reported that the intensity of the hallucinations decreased after using them.

DISCUSSION -

It is seen that a proper organization of semantics and syntax is required for a communicative language, and internal speech processing. Those with hearing impairment perhaps do not get this feedback and report hearing simple sentences, and lack of depth (physical and emotional) in the experience of hallucinations.

Many subjects heard voices in more than one language. Multilingualism is known to have protective effect in dementia and other conditions. The impact of this on nature and outcome of psychosis needs to be studied.

The experience of auditory hallucinations are thought to be arise from dysfunction in frontotemporal connectivity. The obvious impairment in sensory inputs(in hearing impaired patients)and change in quality and nature of experienced hallucinations in these individuals can help us dissect the role of cortical areas in production of psychotic experiences.

CONCLUSION-

The effect of bilingualism/polyglotism, which is common in south Asian context, provides a unique opportunity to study the interface between language, brain and psychopathology in psychoses. Improving the peripheral outputs and decreasing the intensity and frequency of auditory hallucinations is emphasized

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Study of Relation between Self-reflection, Insight, Attitude towards Life and Self-stigma associated with Help Seeking Behaviour amongst Resident Doctors in a Tertiary Care Centre

Krishna Patel *,*

AIMS:

To study the self-stigma associated with psychological help seeking behavior and its relationship with self-reflection capacity, insight and attitude towards life amongst resident doctors

METHODOLOGY:

Ethically data collected using Self-Stigma of Seeking Help Scale, Self-Reflection and Insight Scale and Life Attitude Scale, from resident doctors of C. U. Shah Medical College and Hospital was analyzed by SPSS version 16.

RESULTS:

Self-stigma in 81 resident doctors was at medium(60.5%) and low(39.5%) level, which had a strong negative association with both global scores – 1) Life Attitude (χ2=4.364,γ=-0.449,P</=0.05) and 2) Self-reflection and Insight (χ2=12.656,γ=-0.692,P</=0.05).

DISCUSSION:

Stigma associated with mental illness affects the medical fraternity also. The decrease in stigma level is in accordance with the recent studies. This study is a step towards establishing scientific evidence for association of level of stigma with self reflection capacity and attitude towards life of a person. Being future of health sector, resident doctors are at a level in their life where these qualities are developing at a very fast rate and have a possibility to reach its peak, which are required not only for themselves but also for their patients whom they will be guiding to take correct decisions for their health including mental health. Their own level of internalized stigma can definitely affect the convincing power. Lower levels of stigma indicates more openness, which can motivate an individual to guide the patients in seeking psychological help.

CONCLUSION:

Measures that help in developing more positive attitude towards life and which increases the self reflection capacity and develop insight in an individual can lower the levels of self stigma associated with seeking psychological help.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Study of Relation between Self-reflection, Insight, Attitude towards Life and Self-stigma associated with Help Seeking Behaviour amongst Resident Doctors in a Tertiary Care Centre

Patel Krishna *,*

AIMS:

To study the self-stigma associated with psychological help seeking behavior and its relationship with self-reflection capacity, insight and attitude towards life amongst resident doctors

METHODOLOGY:

Ethically data collected using Self-Stigma of Seeking Help Scale, Self-Reflection and Insight Scale and Life Attitude Scale, from resident doctors of C. U. Shah Medical College and Hospital was analyzed by SPSS version 16.

RESULTS:

Self-stigma in 81 resident doctors was at medium(60.5%) and low(39.5%) level, which had a strong negative association with both global scores – 1) Life Attitude (χ2=4.364,γ=-0.449,P</=0.05) and 2) Self-reflection and Insight (χ2=12.656,γ=-0.692,P</=0.05).

DISCUSSION:

Stigma associated with mental illness affects the medical fraternity also. The decrease in stigma level is in accordance with the recent studies. This study is a step towards establishing scientific evidence for association of level of stigma with self reflection capacity and attitude towards life of a person. Being future of health sector, resident doctors are at a level in their life where these qualities are developing at a very fast rate and have a possibility to reach its peak, which are required not only for themselves but also for their patients whom they will be guiding to take correct decisions for their health including mental health. Their own level of internalized stigma can definitely affect the convincing power. Lower levels of stigma indicates more openness, which can motivate an individual to guide the patients in seeking psychological help.

CONCLUSION:

Measures that help in developing more positive attitude towards life and which increases the self reflection capacity and develop insight in an individual can lower the levels of self stigma associated with seeking psychological help.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of the study: A Study of Burden in Primary Caregiver of Alcohol Use Disorder Patients

Manan R Thakrar *,✉, Falguni Patel †, Bhaveshkumar Lakdawala ‡

Name of Institution:

AMC MET Medical College and Sheth L.G. General Hospital, Maninagar, Ahmedabad: 380008, Gujarat

Total no. of pages: 23

Background: Alcohol Use Disorder is well recognized as a complex bio-psycho-social phenomenon;

it is a major social and personal threat and is considered as “family disease”. Alcohol dependent

person in the family affects every aspect of family life which negatively affects family members.

Aims: To assess the level of Burden in Primary Caregiver of Alcohol Use Disorder (AUD) patient,

to find the prevalence of Psychiatric morbidity in Primary Caregiver, to study the correlation

between severity of alcohol dependence and psychiatric morbidity with level of caregiver burden.

Materials and Methods: It is Cross-sectional Observational study in which convenient sample of 100

Patients with AUD and their primary caregivers were taken according to inclusion and exclusion

criteria. Patients were screened for AUD by AUDIT and Severity by SADQ. Caregiver burden and

distress were assessed by Family Burden Interview Schedule (FBIS) and Psychiatric morbidity in

caregiver was assessed by M.I.N.I. Statistical analysis was done by SPSS version 16. Chi-square test

and Pearson’s correlation coefficient was used for further analysis. P<0.05 was considered statistically

significant.

Results and Discussion: The result demonstrates that primary caregivers of AUD experienced severe

burden in all the domains of FBIS. 50% of the caregivers were having psychiatric illness of which

major depressive episode, dysthymia & anxiety disorders were most common. Severity of caregiver

burden in domains of routine family activities disruption, financial burden & disruption of family

leisure had strong positive correlation with alcohol dependence severity. Significant correlation

between Objective & Subjective burden and psychiatric morbidity in caregivers was also found.

Conclusion: The study has illustrated that significant amount of burden has been experienced by all

the primary caregivers of alcohol use disorder patients. It also found that the burden of care was

positively correlated with severity of alcohol dependence in the patients and psychiatric morbidity in

primary caregivers.

Key words: Alcohol use disorder, Primary caregiver, burden, psychiatric morbidity

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Use of Clozapine in patients with schizophrenia with comorbid diabetes mellitus

Meha Verma 1, Sandeep Grover 1,✉, Subho Chakrabarti 1

Background: Use of clozapine and other atypical antipsychotics is often associated with significant metabolic side effects like deranged blood glucose levels, deranged lipid profile and raised blood pressure. Among various atypical antipsychotics, clozapine is reported to possibly have highest risk of developing diabetes mellitus. Due to this many a time’s psychiatrists avoid use of clozapine in patients with schizophrenia and comorbid diabetes mellitus, despite patients having treatment resistant schizophrenia. However, in some circumstances the clinicians are left with no other option but to use clozapine.

Aim: To evaluate the outcome of diabetes mellitus among patients of schizophrenia, who had diabetes mellitus prior to starting of clozapine.

Methodology: Clozapine data of the department was screened to detect the patients who had diabetes mellitus prior to starting of clozapine. Those who had diabetes mellitus prior to starting of clozapine were taken up for the study.

Results: Out of the 428 records screened, 24 (5.6%) patients had diabetes mellitus prior to starting of clozapine. Among the 24 patients, there was equal distribution of subjects of either gender. In three-fourth (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-two patients had type-2 diabetes mellitus and 2 patients had type-1 diabetes mellitus at the time of starting of clozapine. Majority of the patients also had deranged blood glucose levels at the time of starting of clozapine and required close monitoring of blood glucose levels and also starting/continuation of anti-diabetes medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the time of compilation of the data majority of the patients were in regular follow-up for more than one year and their blood glucose levels were maintained close to the normal range. Majority of these patients showed good response to clozapine.

Conclusion: Present study suggests that presence of diabetes mellitus should not scare the clinicians to use clozapine among patients with schizophrenia with comorbid diabetes mellitus.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of the study: A study towards a newer approach for classification in child psychiatry

Nilofar Rahman *,✉, Shyamanta Das **, Soumitra Ghosh ***

INTRODUCTION: Many studies reported that half of all lifetime mental disorders start by the mid-teens and three-fourths by the mid-20s. Later onsets are mostly found as secondary conditions. Additional research and good empirical data is needed for extending adult diagnostic criteria and their classification for application on appropriate treatment for early incipient cases and on long-term evaluation of the effects of early intervention.

AIMS AND OBJECTIVES: To study the childhood and adolescent psychiatric disorders in order to arrive at a newer classification system which will be more acceptable at community level.

METHODOLOGY: Sample consisted of children and adolescents up to 18 years of age. Study period was from August 2016 to September 2018. Diagnoses were made according to the ICD 10 ‘clinical descriptions and diagnostic guidelines’ (WHO 1992).

graphic file with name IJPsy-61-364-g003.jpg

RESULTS: Total sample size was 240. Eleven were excluded from the study due to discharge prior to a diagnosis was made. Three were diagnosed with seizure disorder Mean age was 14.51 years. 124 were girls. We found 119 children and adolescents with emotional disorders, 35 with disruptive disorders, 21 with developmental disorders and 95 with dysfunctional disorders. Comorbidity was more within across groups in our study.

DISCUSSION AND CONCLUSIONS: Enormous advancements in classification of childhood and adolescent psychiatric conditions in the recent years provide stronger empirical basis to support early intervention with prodromal or incipient mental disorders.

KEYWORDS: Emotional, disruptive, developmental, dysfunctional, classification

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

TITLE: Internalized stigma among elderly opium users

Prashant Gupta 1, Udit Kumar Panda 2, Arpit Parmar 3, Roshan Bhad 4

IPS membership number: 1802672017

Background: Opium use is widely prevalent in India with socio-cultural acceptability, but it has been criminalized under India law. Preliminary studies among older adults who use opium report minimal complications. Stigma is an important determinant of lack of treatment seeking and poor outcomes among substance users. But no study so far has assessed stigma in elderly opium users.

Objectives: To assess internalized stigma among elderly opium users seeking treatment at a tertiary care substance use treatment centre in North India.

Methods: A purposive sample of persons aged ≥60 years attending the outpatient clinic at the above mentioned centre, for treatment of opium use, was recruited after due consent. Socio-demographic and clinical details were recorded and stigma was assessed using Internalized Stigma of Mental Illness (ISMI) scale – Hindi version.

Results: 26 participants were recruited. All were males, with a mean age of 62.9±23.98 years. Majority were married (n=21; 80.8%), farmers by occupation (n=13; 50.0%); and were from a rural background (n=22; 84.6%). All participants reported using poppy husk (doda/bhukki), while 16 (61.5%) also used opium resin (afeem). The mean duration of use was 33.38±7.43 years and 29.67±10.2 years respectively. Use of other opioids and psychoactive substances other than opioids was reported only by few. Only few had medical problems, and most wanted to quit because of unavailability and unaffordability. Majority of participants reported minimal to mild internalized stigma, with the mean scores ranging from 2.19 to 2.59 in different sub-domains of ISMI.

Conclusions: Opium use in elderly was associated with minimal complications, low levels of internalized stigma and good social integration. In some, the onset of opium use preceded the NDPS act, 1985 which criminalized it. Interventions need to be specifically tailored for this population to address their issues.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Association between childhood abuse and intimate partner violence among women with severe mental illness: a comparison with healthy women

Preethi V Reddy 1, Kavita Jangam 2, Ms Tansa K A 2, Kesavan Muralidharan 1

Aim: To study the association between childhood abuse and intimate partner violence (IPV) among women with severe mental illness (SMI) in comparison to healthy women (HW).

Methodology: The data for the study conducted at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, came from a larger study on childhood abuse in women with SMI (n=514) compared to HW (n=100). For this analysis those who were in a marital or live in relation present or past were included SMI (n=487) HW (n=72) International Child Abuse Screening Tool Retrospective–ICAST-R and Composite abuse scale were used to assess childhood abuse and IPV. Statistical analyses were done using chi square, independent sample t test, bivariate correlation and logistic regression.

Results: The two groups were comparable in age, education and marital status (all p>0.09). Incidence of childhood abuse (p<0.05) and all types of IPV (severe combined abuse, physical abuse, emotional abuse and harassment) (p<0.05) was significantly higher in the SMI group. Bivariate correlation showed significant correlation between childhood abuse with all forms of IPV (all p<0.01), among the SMI group compared to HW. Logistic regression showed that childhood sexual abuse and childhood physical abuse predict severe combined abuse (p=0.032) emotional abuse (p=0.029; p=0.012) and harassment (p=0.028; p=0.010) later in adulthood.

Discussion : Both of Childhood abuse and IPV could have an additive effect in causing some of the epigenetic changes leading to expression of the illness. Childhood abuse especially childhood sexual abuse and physical abuse appear to predict IPV later in life which needs further exploration.

Conclusions : IPV and mental health have a reciprocal relationship, particularly in women. Identifying factors associated with or predicting IPV become important in planning holistic interventions in this vulnerable population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title Page: Title: Clinical correlates, Psychiatric co-morbidity, Disability and Quality of Life in patients with Migraine at a tertiary care Centre.

Premprakash 1, Shri Gopal Goyal 2,*2, Rishab Gupta 3, Rajesh Sagar 4, KK Verma 5

Background- Headache is among the most common presenting complaints of patients attending primary care clinic. Moreover, headache as a syndrome is also associated with many physical and mental ailments, and other co-existing health related conditions. These pose an additional burden on all domains of patients’ life, their caregivers and the close associates and hence make it an even more relevant issue for health and social policies.

Aims and objectives- To study Psychiatric Co-morbidity, Disability and Quality of Life in Patients with Migraine.

Material and methods- A cross-sectional observational study was conducted among the patients attending psychiatric clinic with the primary complaint of headache for 2 years, in age group of 18-50 years and satisfying International Headache Society-II criteria for Migraine. Migraine analysis was done using a semi-structured proforma. For the assessment of psychiatric comorbidity, we used MINI version 6, for assessment of quality of life, WHOQOL-BREF, and Headache Impact Test Version-6 to assess disability.

Results- Majority of the participants were female (79.5%). Eighty four percent of the participants reported their headache as severe, mainly ‘localized’ (50%) followed by ‘holocranial’ (11.4%) and ‘hemicranial’ (6.8%). Majority of participants reported throbbing/pulsating type of pain (79.5%) followed by burning (9.1%), and constricting (6.8%). Psychiatric co-morbidity was present in 56.8% of patients. Majority of participants reported no family history of headache and psychiatric illness (88.6%). Physical health, Psychological health and Social Relation domains on WHOQOL-BREF were positively correlated with Environmental domain of WHOQOL-BREF and negatively correlated with Headache Impact Test.

Conclusion- Participants presenting with the chief complaint of headache have high probability of psychiatric co-morbidity that worsens outcome and impairs quality of life. Therefore, it is better to perform a detailed psychiatric interview of the patients with headache and treat them efficiently keeping in view their psychiatric symptoms.

Key words: Headache; Psychiatric Comorbidities; Disability; Symptoms; Quality of Life

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

“QUANTITATIVE CORRELATES OF EMPATHY IN EUTHYMIC BIPOLAR PATIENTS – A qEEG ENDOPHENOTYPE STUDY”.

Rajeev Ranjan Sahoo *,✉, Nishant Goyal *, Daya Ram *, Rajeev Ranjan Sahoo †, Daya Ram ‡

Introduction: Higher order emotional competencies, e.g. empathy, are important prerequisites for successful social interaction. In bipolar disorder, disruptions of social functioning have been consistently reported. These deficient social competencies may result from a dysfunctional ability to understand and react to emotional expressions of other people.

AIMS and Objectives: The study aims to measure the electrophysiological correlates of empathy in euthymic patients and compare them with first degree relatives and healthy controls.

Materials and Methods: 20 euthymic bipolar patients, their first degree relatives and 20 matched controls were recruited for the study. EEG recording was done using a 256 channel high resolution EEG while the subjects were viewing a virtual avatar social cognition task in which the avatar would relate a neutral, happy, angry and a sad incident.EEG recording was anaylsed using MATLAB 8 while statistical anaylsis was done using SPSS 24.

Results: The study suggests that euthymic bipolar patients had significant difference in EEG correlates of empathy as compared to healthy control and first degree relative. There was no significant correlation of measures of empathy and EEG correlates of empathy in the patient group. There was also greater mu wave suppression in male patients in comparison to female patient during angry emotion task.

Discussion and Conclusion: Considering the Facial Emotion Recognition (FER) as an biomarker for bipolar disorder and FER being one of the domains of empathy, the current study predicts that the neural correlates of empathy can also be regarded as a endophenotype marker of bipolar disorder and this knowledge could ultimately aid in efforts aimed at identifying risk-related genes for the illness, as well as in prevention and early intervention.

Keywords : Euthymic Bipolar, Empathy, Theory of mind, Endophenotype

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Antidepressant effects of Ketamine and ECT: A Pilot Comparison

Ravi K Sharma a*, Gajanan Kulkarni a, Naveen Kumar C a, Shyam Sundar A a, V Sudhir b, Urvakhsh M Mehta a, Sayantanava Mitra c, Milind Vijay Thanki a, Jagadisha Thirthalli a

Objective: To compare the acute antidepressant effects and cognitive dysfunction between intravenous ketamine infusion and electro-convulsive therapy (ECT) in patients with severe depression.

Methodology: Twenty-six consenting subjects with severe bipolar/unipolar depression were randomized to receive either ECT (n=13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min, diluted in normal saline) (n=12) for six alternate-day sessions. Blinded assessments were done using Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI) and B4ECTReCoDe (for cognitive functions) at baseline and after twenty-four hours of each session of intervention.

Results: Intent-to-treat analysis showed that patients in the ECT group had greater reduction in HAM-D scores as compared to the ketamine group (time*group ineraction F1,21= 5.85, p= 0.025). 8/12 patients in the ketamine group and 13/13 in ECT group (p-.039) satisfied the criteria for response (≥50% decrease in HAM-D score), while 6/12 in ketamine group and in 12/13 in ECT group (p-.030) achieved remission (HDRS score <8). Patients in the ECT group achieved response (log tank= 9.09, p= 0.003) and remission (log rank= 7.72, p= 0.005) faster compared to the ketamine group. Patients on ketamine had significant improvement in B4ECTReCoDe scores compared to baseline (p- 0.028), while no significant difference was observed in the ECT group (p- 0.285).

Discussion: While both ECT and ketamine were found to be helpful in decreasing depressive symptoms, patients in the ECT group responded faster and had increased responder/remission rates. However, there was some evidence to suggest that low-dose ketamine may have cognitive benefits.

Conclusion: ECT was superior to low dose ketamine infusion for acute treatment of depression. Nevertheless, ketamine was also helpful in majority of patients treated. The results have to be corroborated in studies with large sample size.

Keywords : Ketamine, Electro-convulsive therapy, Depressive disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

A STUDY OF DEPRESSION, STRESS, ANXIETY AND QUALITY OF LIFE IN PATIENTS ATTENDING A TERTIARY CARE ONCOLOGY INSTITUTE IN AN URBAN SETTING

RUCHA SULE 1, DEVAVRAT HARSHE 2, SNEHA HARSHE 3, SHIRISH SULE 4, GURUDAS HARSHE 5

Aims & Objectives: Cancer is a leading cause of morbidity and mortality worldwide. It affects physical and psychological health and affects quality of life. This study brings to fore psychological and psychiatric problems in cancer patients and it’s association with the quality of life.

Methodology : 227 consecutive patients diagnosed with cancer and seeking treatment for at least six months were recruited and assessed cross sectionally with NCCN distress thermometer for perceived distress and concerns, DASS scales for anxiety,stress,depression and FACT-G scale for quality of life (QoL). Data were analysed using descriptive statistics and multivariate stepwise regression.

Results : 62% subjects scored above the cut-off for anxiety and 48% did for depression. Farmers showed significantly higher scores on DASS and lower scores on FACT-G, whereas retired individuals had significantly lower scores on DASS and higher scores on FACT-G. Age (ß=-0.175, t = -3.090, P = 0.002), DASS-D score (ß=-0.278, t = - 2.685, P = 0.008), DASS-S score (ß=-0.199, t = -1.899, P = 0.059) and number of emotional concerns (ß =-0.195, t = -3.312, P = 0.001) predicted FACT-G score.

Discussion : Studies have shown that, patients with cancer have similar concerns across culture and QoL shows significant improvement when these concerns are addressed. Multiple reasons have been hypothesized to play a role in causing the depressive symptomatology in cancers, viz. the disease process, various chemotherapeutic agents and secondary effects of the malignancies, such as paraneoplastic syndromes, metastases and hormonal & nutritional deficiencies..

Conclusions : Psychological factors and emotional concerns play a significant role in QoL in cancer patients from this region. Farmers have significantly poor QoL and psychological health. These findings highlight the need of psycho-oncology services in cancer hospitals and better, inclusive healthcare policies to address this issue.

Keywords : cancer, healthcare, access, depression, psychology, mental health

References

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Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: Are Female Sex Workers (FSWs) rescued under Prevention of Immoral Trafficking Act (PITA) more prone for psychological morbidities?

Santosh Chavan *, Chaitanya Lata Singh †, Manjeet Santre ‡, Krishna Kadam LF §, Gayatri Saraf , Nishant Das #

Background- Human trafficking is the exploitation of human beings in ways that include sexual exploitation, other forms of forced labour, through the threat or use of force, abduction, abuse of position of power. Majority of the trafficked victims are forced into sexual exploitation. Sex work carries severe occupational risk, hazards that many authors have conceptualised as traumatic. Given the public health importance, actions almost exclusively focus on risks associated with infections like HIV, rather than on health problems in general, or mental health consequences in particular.

We carried out this study focusing on overall psychological morbidities among FSWs rescued under PITA, who were in the protected environment of a Pune-based NGO, Rescue Foundation.

Methodology- This was a cross-sectional, observational, interview based study.100 FSWs participated in the study. After obtaining necessary permissions from the NGO, written informed consent was taken from subjects and socio-demographic data was collected. Patients were clinically interviewed and diagnosis were given using DSM-V and ICD-10 wherever necessary. Structured instruments such as MINI, HAM-D, HAM-A, PTSD Check List-5 (PCL-5) were applied. Results were tabulated and statistical analysis was done using SPSS 23.

Results –Most of the FSWs were non-Indian. Results suggested that the prevalence of psychiatric morbidity in FSWs were 47%. The commonest diagnosis was substance use (16%), followed by depression (9%) and anxiety disorders (6%). Significant association was seen with substance use, suicidality and psychological morbidities (p value< 0.005).

Conclusion - Female sex workers are more prone for substance use disorders and other adverse mental health effects and morbidities. Therefore screening of these morbidities and timely management will help this population in rehabilitation process and better quality of life.

Key words - Female sex worker, psychological morbidity, human trafficking

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title: The trend and trajectory of clinical profile of alcohol dependent patients with and without dual diagnosis: A 10 year retrospective comparative study from a tertiary care deaddiction centre in South India.

Sreeja Sahadevan 1, Indu S 2, Kalesh M Karun 3, Joseph Varghese P 4

Aim/Objectives: To study and compare the trend and associated factors of clinical profile of alcohol dependents with and without dual diagnosis

Methodology: This is a retrospective chart review conducted in a tertiary care deaddiction centre in South India. We reviewed data of 2105 patients admitted by the Psychiatrist with a diagnosis of alcohol dependence syndrome over 10 years from April 2007 to March 2017. Socio-demographic data, alcohol drinking pattern, clinical profile and dual diagnosis were extracted from the patient intake proforma and case file. Statistical analysis was done using R software. Trend of clinical profile was visualized by line diagram as dependent variable (y), years of study as independent variable (x) and analysis was done using linear regression. Chi square and fisher exact tests were applied as univariate analysis and logical regression for multivariate analysis.

Results: Out of 2105 patients, all were males, with mean age36 years (SD=9). Among them 1566(74%) had a dual diagnosis of Bipolar disorder [974(62%)], depression [323(20%)], psychotic disorders [162(10%)], antisocial personality disorder [107(7%)] and others [16(1%)]. Trend analysis revealed that the proportion and pattern of dual diagnosis and socio-demographic and clinical profile remained the same over years. In univariate analysis factors like binge drinking (p=0.002), domestic violence (p=0.04), occupational dysfunction (p=0.038) and debts (p=0.029) had significance in patients with dual diagnosis. However multivariate analysis did not support the same.

Discussion: Comparing the existing literature, proportion of dual diagnosis is higher in our study, mood disorders being the commonest. Though there are changes in social conditions over the decade the profile of patients seeking deaddiction remained almost same. The social complications of alcohol were more pronounced in the dual diagnosis group.

Conclusion: Dual diagnosis is not only a diagnostic challenge, but it should alert the treatment team regarding the pharmacological and psychosocial management as well.

Key words : alcohol, trend, dual diagnosis, deaddiction

References

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Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of the Poster: RETINAL NERVE FIBRE LAYER THICKNESS IN PATIENTS WITH SCHIZOPHRENIA AND THEIR FIRST DEGREE RELATIVES: AN OPTICAL COHERENCE TOMOGRAPHIC STUDY

Sukanto Sarkar 1,✉, AR Rajalakshmi 2, Eswaran Subramanium 3

IPS MEMBERSHIP: LIFE ORDINARY MEMBER (LOM/S07/10)

NO IPS MEMBERSHIP

IPS MEMBERSHIP: LIFE FELLOW IPS 05004 (90/857)

INSTITUTE: MAHATMA GANDHI MEDICAL COLLEGE & RESEARCH INSTITUTE, PONDICHERRY

Background: Optical Coherence Tomography (OCT) is a non-invasive method of imaging the retina. Retinal nerve fibre layer (RFNL) thickness, a marker of neurodegeneration is found to be reduced in patients with schizophrenia in comparison to controls. Our study aims to investigate RNFL thickness of schizophrenia patients and compare it with their first degree relative (FDR) and normal controls.

Method: Cross-sectional study done in department of Psychiatry & Ophthalmology after obtaining ethical committee clearance. Twenty patients, aged 18 to 40 years, diagnosed with schizophrenia (DSM-5) & their twenty sex matched disease free FDR (siblings) was included in the study. Twenty healthy controls matched in terms of age and sex with FDRs was included. Written informed consent was taken from all participants. All three groups underwent detailed ophthalmic evaluation. OCT images of retina were obtained using Spectral laser ophthalmoscope ((OPTOS SD-SLO). Statistical analysis was done using SPSS (16.0). The groups were compared using independent sample‘t’ test and ANOVA. P value less than 0.05 was considered to be significant.

Results: Mean RNFL thickness of patients was 101.26 µm whereas that of FDRs was 101.87 µm. Mean RNFL thicknesses in normal controls was 113.66 µm, which is higher than the other two groups. There was no significant group difference between patients and FDRs, but significant group difference (p<0.04) was present between FDR and Normal Controls (post hoc test) in terms of RNFL thickness. Severe psychotic symptoms was negatively correlated with RNFL thickness (p<0.01).

Discussion: In view of published literature stating significant difference in RNFL thickness between schizophrenia and controls, significant difference between FDR and controls in our study shows that FDRs have a similar neurodegeneration process as patient.

Conclusion: Reduced RNFL thickness can be considered an endophenotype of schizophrenia, and a simple ophthalmological examination at outpatient will be useful to detect FDRs at risk.

Key words: Schizophrenia, First degree relative, Retinal Nerve Fibre Layer, Endophenotype

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

TITLE: Internalized stigma among elderly opium users

Prashant Gupta 1, Udit Kumar Panda 2, Arpit Parmar 3, Roshan Bhad 4

Background: Opium use is widely prevalent in India with socio-cultural acceptability, but it has been criminalized under India law. Preliminary studies among older adults who use opium report minimal complications. Stigma is an important determinant of lack of treatment seeking and poor outcomes among substance users. But no study so far has assessed stigma in elderly opium users.

Objectives: To assess internalized stigma among elderly opium users seeking treatment at a tertiary care substance use treatment centre in North India.

Methods: A purposive sample of persons aged ≥60 years attending the outpatient clinic at the above mentioned centre, for treatment of opium use, was recruited after due consent. Socio-demographic and clinical details were recorded and stigma was assessed using Internalized Stigma of Mental Illness (ISMI) scale – Hindi version.

Results: 26 participants were recruited. All were males, with a mean age of 62.9±23.98 years. Majority were married (n=21; 80.8%), farmers by occupation (n=13; 50.0%); and were from a rural background (n=22; 84.6%). All participants reported using poppy husk (doda/bhukki), while 16 (61.5%) also used opium resin (afeem). The mean duration of use was 33.38±7.43 years and 29.67±10.2 years respectively. Use of other opioids and psychoactive substances other than opioids was reported only by few. Only few had medical problems, and most wanted to quit because of unavailability and unaffordability. Majority of participants reported minimal to mild internalized stigma, with the mean scores ranging from 2.19 to 2.59 in different sub-domains of ISMI.

Conclusions: Opium use in elderly was associated with minimal complications, low levels of internalized stigma and good social integration. In some, the onset of opium use preceded the NDPS act, 1985 which criminalized it. Interventions need to be specifically tailored for this population to address their issues.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

EEG FINDING AND IMPLICATION OF CLINICAL SEIZURE’S ABSENCE OR PRESENCE IN ATTENTION DEFICIT HYPERACTIVITY DISORDER

Jita Baruah 1,✉, Hemendra Ram Phookun 2

BACKGROUND : Epilepsy and attention deficit hyperactivity disorder (ADHD) are often seen to be comorbid conditions and have significant effects on the social and behavioural development of children. Many of the ADHD children have abnormal electroencephalograph (EEG) results, compared to that of healthy children

AIMS. To correlate the EEG findings in established cases of ADHD.

and to find the association of clinically absent seizure and abnormal EEG finding.

MATERIALS AND METHODS : Patients(50 sample) already diagnosed as ADHD attending a tertiary care hospital,age 5 to 18 were enrolled for the study. Detailed history from parents taken. Epilepsy already diagnosed by neurologists.IQ test done on all the patients.EEG was advised to all the patients. Data analysis was done using SPSS 21.0 Software version.

RESULTS AND DISCUSSION :. In our study 11 patients i.e. (22%) had epilepsy, similarly another study has mentioned a bidirectional relationship of ADHD and epilepsy in two cohort studies. Also a study done in 2018 have mentioned has mentioned that individuals with epilepsy had a statistically significant increased risk of ADHD. Out of the 50 patients, 11 of them had clinical seizure.(22%). 52% of the patients of ADHD had abnormal EEG irrespective of clinical presence of seizures. Similarly in a study done in 2014 has revealed that about half (48.3%) of the children with ADHD had abnormal EEG findings It was seen that out of the 50 patients, 39(78%) patients had no clinical seizure but 16(41%) patients out of them had an abnormal EEG (p<.003).. Similar to our study a study done in north east India in 2016 out of 113 patients having various psychiatric diagnosis in children(including ADHD) 26.54% had abnormal EEG and had significant correlation.

CONCLUSION: From the present study it is reflected that ADHD is not a disease of single entity,multiple comorbid conditions including epilepsy and abnormal EEG finding.

Keywords: EEG,epilepsy,gtcs,complex partial seizure

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Use of Clozapine in patients with schizophrenia with comorbid diabetes mellitus

Meha Verma 1, Sandeep Grover 1, Subho Chakrabarti 1

Background: Use of clozapine and other atypical antipsychotics is often associated with significant metabolic side effects like deranged blood glucose levels, deranged lipid profile and raised blood pressure. Among various atypical antipsychotics, clozapine is reported to possibly have highest risk of developing diabetes mellitus. Due to this many a time’s psychiatrists avoid use of clozapine in patients with schizophrenia and comorbid diabetes mellitus, despite patients having treatment resistant schizophrenia. However, in some circumstances the clinicians are left with no other option but to use clozapine.

Aim: To evaluate the outcome of diabetes mellitus among patients of schizophrenia, who had diabetes mellitus prior to starting of clozapine.

Methodology: Clozapine data of the department was screened to detect the patients who had diabetes mellitus prior to starting of clozapine. Those who had diabetes mellitus prior to starting of clozapine were taken up for the study.

Results: Out of the 428 records screened, 24 (5.6%) patients had diabetes mellitus prior to starting of clozapine. Among the 24 patients, there was equal distribution of subjects of either gender. In three-fourth (75%) of the patients, clozapine was started while these patients were admitted to the inpatient unit. Twenty-two patients had type-2 diabetes mellitus and 2 patients had type-1 diabetes mellitus at the time of starting of clozapine. Majority of the patients also had deranged blood glucose levels at the time of starting of clozapine and required close monitoring of blood glucose levels and also starting/continuation of anti-diabetes medications. None of the patients developed diabetic ketoacidosis during the initial part of the treatment. At the time of compilation of the data majority of the patients were in regular follow-up for more than one year and their blood glucose levels were maintained close to the normal range. Majority of these patients showed good response to clozapine.

Conclusion: Present study suggests that presence of diabetes mellitus should not scare the clinicians to use clozapine among patients with schizophrenia with comorbid diabetes mellitus.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Association between childhood abuse and intimate partner violence among women with severe mental illness: a comparison with healthy women

Preethi V Reddy 1, Kavita Jangam 2, Ms Tansa K A 2, Kesavan Muralidharan 1

Aim: To study the association between childhood abuse and intimate partner violence (IPV) among women with severe mental illness (SMI) in comparison to healthy women (HW).

Methodology: The data for the study conducted at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, came from a larger study on childhood abuse in women with SMI (n=514) compared to HW (n=100). For this analysis those who were in a marital or live in relation present or past were included SMI (n=487) HW (n=72) International Child Abuse Screening Tool Retrospective–ICAST-R and Composite abuse scale were used to assess childhood abuse and IPV. Statistical analyses were done using chi square, independent sample t test, bivariate correlation and logistic regression.

Results: The two groups were comparable in age, education and marital status (all p>0.09). Incidence of childhood abuse (p<0.05) and all types of IPV (severe combined abuse, physical abuse, emotional abuse and harassment) (p<0.05) was significantly higher in the SMI group. Bivariate correlation showed significant correlation between childhood abuse with all forms of IPV (all p<0.01), among the SMI group compared to HW. Logistic regression showed that childhood sexual abuse and childhood physical abuse predict severe combined abuse (p=0.032) emotional abuse (p=0.029; p=0.012) and harassment (p=0.028; p=0.010) later in adulthood.

Discussion : Both of Childhood abuse and IPV could have an additive effect in causing some of the epigenetic changes leading to expression of the illness. Childhood abuse especially childhood sexual abuse and physical abuse appear to predict IPV later in life which needs further exploration.

Conclusions : IPV and mental health have a reciprocal relationship, particularly in women. Identifying factors associated with or predicting IPV become important in planning holistic interventions in this vulnerable population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Antidepressant effects of Ketamine and ECT: A Pilot Comparison

Ravi K Sharma a*,✉, Gajanan Kulkarni a,✉, Naveen Kumar C a,✉, Shyam Sundar A a,✉, V Sudhir b,✉, Urvakhsh M Mehta a,✉, Sayantanava Mitra c,✉, Milind Vijay Thanki a,✉, Jagadisha Thirthalli a,✉

Objective: To compare the acute antidepressant effects and cognitive dysfunction between intravenous ketamine infusion and electro-convulsive therapy (ECT) in patients with severe depression.

Methodology: Twenty-six consenting subjects with severe bipolar/unipolar depression were randomized to receive either ECT (n=13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min, diluted in normal saline) (n=12) for six alternate-day sessions. Blinded assessments were done using Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI) and B4ECTReCoDe (for cognitive functions) at baseline and after twenty-four hours of each session of intervention.

Results: Intent-to-treat analysis showed that patients in the ECT group had greater reduction in HAM-D scores as compared to the ketamine group (time*group ineraction F1,21= 5.85, p= 0.025). 8/12 patients in the ketamine group and 13/13 in ECT group (p-.039) satisfied the criteria for response (≥50% decrease in HAM-D score), while 6/12 in ketamine group and in 12/13 in ECT group (p-.030) achieved remission (HDRS score <8). Patients in the ECT group achieved response (log tank= 9.09, p= 0.003) and remission (log rank= 7.72, p= 0.005) faster compared to the ketamine group. Patients on ketamine had significant improvement in B4ECTReCoDe scores compared to baseline (p- 0.028), while no significant difference was observed in the ECT group (p- 0.285).

Discussion: While both ECT and ketamine were found to be helpful in decreasing depressive symptoms, patients in the ECT group responded faster and had increased responder/remission rates. However, there was some evidence to suggest that low-dose ketamine may have cognitive benefits.

Conclusion: ECT was superior to low dose ketamine infusion for acute treatment of depression. Nevertheless, ketamine was also helpful in majority of patients treated. The results have to be corroborated in studies with large sample size.

Keywords : Ketamine, Electro-convulsive therapy, Depressive disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S364–S378.

Title of the Poster: RETINAL NERVE FIBRE LAYER THICKNESS IN PATIENTS WITH SCHIZOPHRENIA AND THEIR FIRST DEGREE RELATIVES: AN OPTICAL COHERENCE TOMOGRAPHIC STUDY

Sukanto Sarkar 1,✉, AR Rajalakshmi 2, Eswaran Subramanium 3

INSTITUTE: MAHATMA GANDHI MEDICAL COLLEGE & RESEARCH INSTITUTE, PONDICHERRY

TITLE : RETINAL NERVE FIBRE LAYER THICKNESS IN PATIENTS WITH SCHIZOPHRENIA AND THEIR FIRST DEGREE RELATIVES: AN OPTICAL COHERENCE TOMOGRAPHIC STUDY

Background: Optical Coherence Tomography (OCT) is a non-invasive method of imaging the retina. Retinal nerve fibre layer (RFNL) thickness, a marker of neurodegeneration is found to be reduced in patients with schizophrenia in comparison to controls. Our study aims to investigate RNFL thickness of schizophrenia patients and compare it with their first degree relative (FDR) and normal controls.

Method: Cross-sectional study done in department of Psychiatry & Ophthalmology after obtaining ethical committee clearance. Twenty patients, aged 18 to 40 years, diagnosed with schizophrenia (DSM-5) & their twenty sex matched disease free FDR (siblings) was included in the study. Twenty healthy controls matched in terms of age and sex with FDRs was included. Written informed consent was taken from all participants. All three groups underwent detailed ophthalmic evaluation. OCT images of retina were obtained using Spectral laser ophthalmoscope ((OPTOS SD-SLO). Statistical analysis was done using SPSS (16.0). The groups were compared using independent sample‘t’ test and ANOVA. P value less than 0.05 was considered to be significant.

Results: Mean RNFL thickness of patients was 101.26 µm whereas that of FDRs was 101.87 µm. Mean RNFL thicknesses in normal controls was 113.66 µm, which is higher than the other two groups. There was no significant group difference between patients and FDRs, but significant group difference (p<0.04) was present between FDR and Normal Controls (post hoc test) in terms of RNFL thickness. Severe psychotic symptoms was negatively correlated with RNFL thickness (p<0.01).

Discussion: In view of published literature stating significant difference in RNFL thickness between schizophrenia and controls, significant difference between FDR and controls in our study shows that FDRs have a similar neurodegeneration process as patient.

Conclusion: Reduced RNFL thickness can be considered an endophenotype of schizophrenia, and a simple ophthalmological examination at outpatient will be useful to detect FDRs at risk.

Key words: Schizophrenia, First degree relative, Retinal Nerve Fibre Layer, Endophenotype

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