E-POSTER

. 2019 Jan;61(Suppl 3):S521–S631.

E-POSTER

PMCID: PMC6366281

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

1. Adapting Cognitive Bias Modification for Interpretation Biases to demonstrate Inverse Reasoning in India

The purpose of this study was to investigate the presence of the Inference Based Approach to OCD in a student population in India. It also sought to explore the therapeutic applications of the Cognitive Bias Modification under the model. The relation between OC traits and working memory was also explored through the dual n-back task. A sample of 50 students were taken as part of this study and they were a mix of reported Obsessive Compulsive traits and participants who did not report those traits. Convenience sampling was used for the same. Statistical analysis used were correlation, regression and descriptive statistics like Mean. The findings support the IBA model due to the significant positive correlation of inverse reasoning along with scores on the Dimensional Obsessive Compulsive Scale (DOCS). The effectiveness of the CBM training module could not be ascertained in this study. However, there was a preference for a particular dimension on the dual N-back task. The implications of the results, along with limitations and future scope.

Keywords: Inference-Based Approach, inverse reasoning, obsessive-compulsive disorder, cognitive bias modification, n-back.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

3. A case series on late onset Obsessive compulsive disorder and its review of literature

Varsha B G ¹, Sharanabasappa Algoodkar ²

Obsessive compulsive disorder is a common psychiatric disorder and is a potentially disabling disorder usually having the onset in the second and third decade. Onset after the age of 50 is rare.1

Onset after age 50 is relatively rare and may be more likely to have an organic etiology. Here we are presenting two patients who presented to our OPD who presented with symptoms of obsessions and compulsions where the onset was after 50 years. Assessments showed that significant scores in YBOCS. On neuroimaging there was no organic pathology found. The primary diagnosis of Obsessive compulsive disorder was made and treatment was started. There was significant improvement in the symptoms in the due course of time.

Details of the cases will be discussed in the poster

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

5. Title- Experience of Caregiving in Caregivers of Obsessive Compulsive Disorder. Are there any positive aspects???

Erika Pahuja, Anil Nischal ¹

Background

Experience of Caregiving represents both positive and negative appraisals of caregiving whereas burden of care represents only negative connotation. Caregiving experience may depend on various patient and caregiver related factors including caregiver’s personality and coping strategies used by them. It is well known that severe mental disorders like Obsessive Compulsive Disorder have a significant level of burden on caregivers. But are there any positive aspects of caregiving of a patient with OCD still remains unfolded. Experience of Caregiving has been studied in SMDs like Schizophrenia, Anorexia Nervosa, however we did not come across any study on Experience of caregiving in OCD. Hence we planned our study on the same.

Aims

To study the experience of caregiving in caregivers of OCD.

Method

Sixty seven caregivers of patients of OCD were assessed on Experience of Caregiving Inventory. Association of experience of caregiving with socio-demographic variables of caregivers and patients; clinical variables of patients and coping strategies used by caregivers was studied.

Result and Conclusions

Positive aspects of caregiving of a patient of OCD were present. ‘Good Aspects of Relationship’ scored more than ‘Positive Personal Experience’ in positive appraisal of caregiving. Positive aspects were related to various sociodemographic variables and coping strategies used by caregivers. Male caregivers had high positive appraisal of caregiving. Progressive Reinterpretation and Growth, Active Coping and Planning influenced positive appraisal of caregiving. On the other hand, negative appraisal was higher in female, rural, illiterate caregivers and in caregivers of severe and extreme OCD. Instrumental social support and Emotional social support were found to influence negative appraisal of caregiving and

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

6. Title: A case report of very early onset Obsessive compulsive disorder

Pragati Bhatnagar ¹, Suresh Gupta ¹, Kuldeep Singh Yadav ¹, RK Solanki ¹

Obsessive compulsive disorder is a common psychiatric disorder with chronic and fluctuating course. It is a distressing and disabling disorder which severely affect the life of patient and his family members. Obsessive Compulsive Disorder is not common in very young children and only few cases are reported worldwide.

This case report depicts OCD in child of age 3 year 7 month attending S.M.S Medical College, Jaipur with insidious onset and gradually progressive course. His compulsions began at age of 3 year and 2 months. There was no history of perinatal complications, developmental delay, medical, surgical and psychiatric illness. Fever was not present during beginning of symptoms neither any abnormal body movement nor vocal utterance was present. Child presented with love for symmetry, tendency to arrange things, repeating words and sentences till he pronounce them correctly and need for multiple reassurance. He had a tendency to maintain particular postures and get irritable and cried if interrupted, his irritability represent distress felt by him. There is strong family history of anankastic personality traits in his grandmother and maternal grandfather. Diagnosis of Obsessive compulsion disorder made on the basis of diagnostic criteria Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Selective serotonin reuptake inhibitors was started in low dose along with instructions given to his parents. After 2 weeks of treatment he improved clinically.

This case report signifies that OCD can began in preschoolers and early diagnosis and effective management is critical as they can benefit the prognosis of patient.

Keywords: Psychiatry, Obsessive compulsive disorder, OCD, very early

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

7. Atypical Presentation of a case of Obsessive Compulsive Disorder during Pregnancy : a Case Report

Sk Kamal Hassan ¹

Pregnancy is a well-recognized risk factor in precipitating obsessive- compulsive disorder. I present a case of obsessive-compulsive disorder with atypical presentation during pregnancy. During teen-age years the patient had a fear of becoming transgender (Hizra) and also obsession of contamination but that did not amount to be diagnosed as obsessive -compulsive disorder. Gradually, as she grew older, these symptoms disappeared. After marriage, at fifth month of her second pregnancy, the fearful thoughts of becoming transgender (Hizra) reappeared and increased in severity. She could not get rid of the thought, though she knew that this fear was irrational. She had obsessive imagery of dancing transgender people around her. She developed compulsive dancing like transgender people. This behaviour, though supported the thoughts of becoming transgender, had an anxiety relieving property, as stated by the patient. She was treated with psychotherapy & SSRI and had some improvement of symptoms. She continued medication till delivery, but stopped taking medicines following childbirth. Nevertheless, those symptoms completely disappeared after one month of delivery without any medication. Future research is needed to understand the mechanism involved in etiology of obsessive-compulsive disorder in pregnancy.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

8. Trichotillomania misdiagnosed as Alopecia Areata

Debjani Das ¹

Introduction

A psychodermatologic disorder characterised by repetitive hair pulling leading to variable hair loss with a prevalence 0.6% - 3.4% and with a female : male of 10 : 1 it may be associated with anxiety disorders, depressive disorders and eating disorders.

Presenting complaints

An 11 yr old male patient reported with patchy hair loss in the scalp and eyebrows for the last 3 years with exacerbation since past 1 year after he recovered from malaria.

His hair pulling began at the age of 8 years when he began to pulling the hairs from the frontal area of the scalp, gradually progressing to eyebrows after 1 year.

He would pull hair repetitively in response to intense anxiety at home or even at school and leading to immediate gratification.

The course has been fluctuating with exacerbation during viral illnesses and examinations.

Since 1 year he has started pulling hair from his grandfather’s forearms, legs when sitting beside him.

There has been progressive decline in his academic performance in the last 2 years.

He has been treated with Ayurvedic, Homeopathic medications on and off since last 3 years.

Initially diagnosed as alopecia by a skin specialist and treated with ketoconazole and zinc pyrithione lotion for local application for almost a year but showed no signs of improvement and finally referred to psychiatry department.

Local examination revealed diffuse thinning and shortening of hairs, scalps and eyebrows.

Patient was prescribe fluoxetine 20mg per day with psychotherapy and habit reversal exercises.

Patient reported modest improvement in two months.

Conclusion

Trichotillomania is often misdiagnosed as alopecia areata delaying the treatment process.

Meticulous history, evaluation, psychotherapy and pharmacotherapy play a prominent role in the management.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

9. Obsessive compulsive disorder in a case of primary nocturnal enuresis: a case report

Md Wahedur Rahman ¹, Saswati Nath, Dilip Kumer Mondal, Asharul Hossain, Sk Kamal Hassan

Abstract :Obsessive-compulsive disorder (OCD) is a chronic disabling illness characterized by repetitive, ritualistic behaviors over which the patients have little or no control.

Enuresis is repetitive voiding of urine at inappropriate places at least twice a week for at least 3 consecutive months in a child who is at least 5 years of age. Diurnal enuresis is daytime wetting and nocturnal enuresis is nighttime wetting. Here I report a case of OCDin a patient(miss A,16 year) suffering from primary nocturnal enuresis. This is an uncommon case finding. Treatment of this patient starts at 9 years of age with imipramine. After that her symptoms improved and she continued treatment for nextfew months. In last 4-5 years she was on irregular medication with imipramine. Her symptoms persisted. Her TSH level was elevated(7.1)and she took tab thyroxin(25mg) for 3 months and then stopped on her own. Her friends told her that she would never have a child because of ongoing medication(thyroxin). She became tensed,frightened and developed repeated hand washing along with ordering and checking behavior which interfered her social or individual functioning. Her symptoms of enuresis also increased. After one year of having these symptoms she came for treatment in our opd. She was treated with Fluoxetine (40 mg), Imipramine (10mg) and cognitive behaviour therapy. Her symptoms improved.

More subsequent research is needed keeping the background in mind to establish positive correlation between OCD and nocturnal enuresis.

Keywords:Obsessive compulsive disorder,nocturnal enuresis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

10. Obsessive compulsive disorder presenting as bowel obsessions with comorbid Dhat syndrome: A case report

Yesh Chandra Singh ¹, Sudhir Kumar, Dinesh Singh Rathor, Sandhya Mohanty

Introduction

Bowel obsession syndrome (BOS) is a rarely diagnosed condition not included in the Rome criteria for functional gastrointestinal disorders or in psychiatric nosography. Although most often described as a subtype of OCD or as an ‘OCD-like’ disorder, bowel obsessions do not fit well into the established subtypes of OCD. Bowel obsessions have also not always responded to pharmacological interventions in ways consistent with OCD.

Case Report

A 19 old male reported to the outpatient clinic with complaints of repetitive acts, poor self care and disturbed bowel habits. The patient had had OCD since age 15 years; his main symptoms consisted of repetitive hand washing, spending excessive time in bathing, urinating and defecating. He recognized these thoughts as his own and had difficulty in resisting them. Since the last 3 years he noted that white secretions passing from his penis, he attributed this loss of Dhat as the cause of his distress. 6 months later his repetitive acts decreased and he started to pass urine and stools once every 2 days. This was associated with decreased food intake and spending excessive time in the washroom. Patient was admitted and showed improvement in Y-BOCS score after cognitive behavior therapy (CBT), Fluoxetine 40mg/day and Risperidone 2mg/day.

Discussion

BOS is a good example of a psychosomatic disorder. From the gastroenterologist point of view, altered bowel habits result from patient’s maladaptive ideational focus and related compulsive behaviors. From the psychopathological perspective, BOS includes anxiety-like symptoms related to the consequences of disordered bowel habits that might be a clinical manifestation of a motility or inflammatory illness.

Keywords : Bowel Obsession Syndrome, Obsessive compulsive disorder, Dhat

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

11. Real-world tolerability and effectiveness of short-term Clobazam therapy in patients with anxiety in India; ANXISTAT Study

Guruprasad P ^a, Srivatsa A ^b, Vijay T ^c, Chirag T ^d

Background

Anxiety disorders (AD) are very common psychiatric disorderscharacterized by persistent worrying, anxiety symptoms, and tension. Anxiolytics like Benzodiazepines (BZDs)are one of the main stay of treatment. Clobazam is different from other BZDs and has distinct advantages in terms of minimal impairment of cognitive functions, less sedation and dependence. Data on the usage of Clobazam in anxiety in Indian patients is verylimited. This study was conducted to study the safetyand effectiveness of Clobazam in anxiety in a real world setting.

Methods

Open label, multi-centric, non-randomised, non-comparative observationalstudyconducted across four representative zones (East, West, North, and South) in India. Data of patients presenting to primary care physicians with psychological or physical symptoms of anxiety and who have been prescribed Clobazamwas included.

Results

Safety was analysed for all 716 patients enrolled in the study. 28 (3.9%) patients encountered at least one adverse event (AE); somnolence wasthe most commonAE (1.4%). Majority of the AEs were of mild intensity and none of them were severe. 508 patients meeting all protocol requirements were included for efficacy analysis. As per Clinical Global Impression (CGI) Efficacy index, 281(55.3%) patients showed marked improvement and 117(23%) patients showed moderate improvement with no side effects. The global improvement was evaluated as very-much improved in 158(31.1%) patients, much improved in 282 (55.5%) patient. The mean dosage of Clobazam was 8 mg and mean duration was 2.2 weeks.

Conclusion:

Clobazam was found to have an acceptable safety and effectiveness profile for the treatment of ADs in Indian patients. Further controlled studies will be required to ascertain whether it is the best option for treatment of all disorders in the ADs family or only for specific conditions.

Funding:

This study was sponsored by Sanofi (India).

Declaration of interests

Dr. Guruprasad P has been invited speakers in meetings by Sanofi. Dr. Srivastava A declares no conflict of interest. Vijay T and Chirag T are employees of Sanofi India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

12. Neuro-hemodynamics of panic disorder using fNIRS

Pavithra J ¹, Sreeraj, Venkat subramanian G, Manjunatha N

Introduction:

Functional near- infrared spectroscopy(fNIRS) measures the hemodynamic response in the brain using light in the near- infrared wavelength range (700-900 nm).fNIRS has high temporal resolution, safety profile, tolerance to motion artifactsrelative to fMRI.our study aims to understand the neurobiology of panic disorder utilizing these advantages. We will present the protocol of the study evaluating the changes in bi-frontal hemodynamic activity during n-Back test with symptom provocation by hyperventilation between patients with panic disorder and healthy controls.

Aim: To explore the neuro-hemodynamics of cortical activity in panic disorder using fNIRS.

Methodology:

This is a hospital based cross-sectional study planning to recruit 20 patients with panic disorder with/without agoraphobia, aged 18-45 years without any major psychiatric & medical conditions. Twenty healthy controls withmatchedage, sex and education will be recruited. A detailed clinical assessment will be done using semi-structured proforma, mini international neuropsychiatric interview, panic disorder severity scale, agoraphobia scale and Edinburgh handedness inventory.

fNIRS data will be acquired from bilateral prefrontal cortex with 8*8 montage. Data will be acquired during audio-instructed hyperventilation (5-10min)along with pre- and post- hyperventilation data with 10 minutes resting state and n-back test. Data will be processed using fNIRS toolbox for Statistical Parametric Mapping and group level analysis will be done using R software.

Discussion:

Functional imaging (fMRI) studies have implicated certain areas of the brain including prefrontal cortex in the pathophysiology of the panic disorder. Measurement of prefrontal hemodynamic changes with fNIRS may give better information about pathophysiological abnormality of prefrontal cortex in panic disorder which is limited with fMRI

This first of its kind study will help us explore the prefrontal activity during a hyperventilation state as a symptom provocation experiment. It also would reveal the influence of hyperventilation on the hemodynamic activity during executive tasks.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

13. A Case Report of Obsessive Compulsive Disorder and Catatonic Features: Successful Treatment by Exposure and Response Prevention Therapy and Habit Reversal Training

Ajay Yadav ¹, Neelesh Tiwari, Anisha Batra

Abstract: Catatonia occurs in a wide spectrum of neuropsychiatric disorders; however, occurrence of catatonia has rarely been reported in obsessive-compulsive disorder

In this study, we present the case of a 27-year-old man who experienced severe obsessive symptoms for over seven years presenting with prominent catatonic features viz., negativism and posturing. For the rarity of this entity and its obvious implications for the management and conceptual issue, we report this case of catatonia in OCD.

Case Summary:

A 27-year-old female was brought to our outpatient clinic with a history of episodes of repetitive behavior causing impairment in social and occupational life. According to the family members, she had been having fear of dirt and contamination, excessive concern over cleanliness and washing and bathing rituals over the last seven years. Whenever her rituals were prevented, she used to feel sad and made suicidal attempts when she could not tolerate anxiety associated with the intense fear of dirt and contamination and during one such event she became extremely aggressive and tried to kill herself. In addition, a year later, she also started getting transient episodes of muttering to self, crying spells, decreased sleep and appetite Later, in the last six months, she developed episodes of negativism, maintaining sitting postures with both hands kept in between her thighs and unresponsiveness.

During subsequent interviews, she was noted to have depressed affect, obsessions of dirt and contamination, obsessional doubts that whether she could do an act or not, washing compulsion, magical thinking, ambitendency. She explained that she had experienced a great distr ess and anxiety, felt confused and lost awareness when her obsessional doubts that whether she could do an act or not became intolerable. Furthermore, the episodes of ambitendency, negativism, posturing and dissociative symptoms were correlated with intense psychic anxiety that emerged consequent to obsessions. She was diagnosed with OCD with unspecified psychosis (catatonia)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

14. Use of low frequency rTMS over supplement motor area in patients with OCD: A case series

ARTI YADAV ¹, Sudhir Kumar, Ajay Kumar

Background : obsessive compulsive disorder (OCD) chronic illness with treatment challenges. Use of repetitive transcranial magnetic stimulation (rTMS) have been studied in last one decade but its efficacy as an adjunctive modality is still not clear.

Objectives: to assess the efficacy of adjunctive low frequency repetitive transcranial magnetic stimulation (rTMS) administered over the supplement motor area in the patients with obsessive compulsive disorder (OCD)

Methodology: six patients selected from the outpatient department of Institute of mental health and hospital, Agra who were diagnosed with the OCD as per International classification of disease version 10 (ICD 10). OCD patients on medications, with or without associative depressive symptoms were included. Patient’s symptoms severity assessed on Y-BOC and HAM-D and CGI before starting rTMS and on 2^nd, 3^rdand 4^th week of treatment. rTMS administered 5 days in a week and no change pharmacological treatment done during this period.

Results: 5out of 6 patients found to report around 25% (give the average score)reduction of Y-BOC and all the 6 patient (give % reduction of HAMD) (CGI score) depressions responded robustly

Conclusion: Adjunctive low frequency rTMS over supplementary motor area is effective in treatment of OCD

Keywords: OCD, rTMS, supplementary motor area, Y-BOC, HAM-D, CGI

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

15. Title: Feasibility and Outcome (Short and long term) of Behaviour Therapy of patients with Obsessive Compulsive Disorder

Himani Adarsh ¹, Sandeep Grover ^2,^✉, Subho Chakrabarti ², Ajit Avasthi ², Ruchita Shah ²

Background: Obsessive Compulsive Disorder (OCD) is a very disabling condition. Among the various modes of treatment, behaviour therapy (BT) is considered to be one of the most important treatments for management of OCD. However, BT is often difficult to carryout in Indian setting due to various patients, co-therapist and the therapist related variables. Little is known about the outcome of BT in Indian Setting.

Aim: To evaluate the short-term outcome of BT done for patients with OCD in the inpatient setting. Additional aim of the study was to evaluate the long term outcome of BT among patients who were treated with BT as inpatients and to evaluate the patients, co-therapist and the therapist related variables which influence the outcome of BT.

Methodology: This was a retrospective study, in which treatment records of all the patients with diagnosis of OCD, who were admitted to psychiatry inpatient unit during the year 2015 to 2017, were extracted. Data of patients who were started on BT were evaluated in terms of outcome at the time of discharge was evaluated. Follow-up data was also evaluated in terms of regularity of follow-up and level of improvement maintained.

Results: During the study period of 3 years, 56 patients with OCD (with or without comorbid psychotic and affective disorders) were admitted to the inpatient unit, out of whom 30 received BT, besides pharmacotherapy. BT was feasible in terms of exposure and response prevention in majority of these patients and majority of the patients were discharged after 8-12 weeks in improved clinical state (>30% improvement in Yale Brown Obsessive Compulsive Symptom Scale score). However, a significant proportion of patients did not follow-up regularly and do not practice behaviour therapy at home and do not come for booster sessions and experience worsening of symptoms.

Conclusion: BT is feasible and associated with good outcome in short term, but long term improved is maintained only a small proportion of patients.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

16. OBSESSIVE-COMPULSIVE DISORDER IN GERIATRIC POPULATION: A CASE WITH MANY ATYPICALITIES

Debasmita Dey ¹, Basudeb Das

Introduction

Obsessive Compulsive Disorder is characterized by a diverse group of symptoms that include repetitive thoughts, images or rituals. The mean age of onset of the disorder is 20 years with less than 15% cases having onset after 35 years. The adult patient usually has insight into the senselessness of the repetitive thoughts or images and the cases seldom pose a diagnostic problem. However, we present a case that is atypical in many respects.

Case presentation

The patient, a 70 years old lady, a homemaker educated till the 4^th standard, on Antihypertensives for 5 years, complainedthat after she met someone, that person repeatedly walked all over her body. The problem had started after she was widowed 4 years back and the distress associated with it caused her to become completely housebound in order to avoid meeting people. On Mental Status Examination,she was co-operative, anxious and gave account of repetitive images involving people walking all over her body without associated perceptual abnormalities but she lacked insight into her illness.

Results

She has responded to treatment with oral Fluvoxamine hiked to 200 mg with Risperidone 2 mg.

Discussion

To be done during presentation.

Keywords

OCD, atypical, geriatric, absent insight

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

17. NEUROPLASTICITY AND BRAIN STIMULATION IN OCD : A TMS-FMRI BASED NOVEL PARADIGM.

CHANDRAMOULI ROY ¹, D RAM, NISHANT GOYAL

INTRODUCTION - Neuropsychological studies have reported cognitive dysfunction in OCD. Several forms of non-invasive brain stimulation have been examined to change brain function and promote neuroplasticity, most important being Transcranial magnetic stimulation (TMS). Functional-MRI (f-MRI) studies have explored the alterations in brain metabolism in the brain regions of patients with OCD using various tasks such as Stroop task etc. Here we present a novel paradigm where a multimodal approach using TMS and fMRI has been used to study the effects of experimentally induced frontal neuroplasticity on activation of cognitive network.

AIM - To study neuroplasticity measured by fMRI activation of Dorsolateral Prefrontal Cortex usingTranscranial Magnetic Stimulation in Obsessive Compulsive Disorder.

METHODOLOGY - It’s a hospital based observational study where 20 patients of OCD and 10 healthy controls will be taken. In first step resting state fMRI along with DTI will be taken. Next patient will undergo Stroop task with simultaneous fMRI recording. In the 3^rd step TMS will be given along with performance of Stroop taskand simultaneous recording of fMRI. In the 4^th step Stroop task will be performed again along with fMRI. A brief resting state fMRI taken to end the process.

fMRI – Images will be acquired via 3T MRI scanner with standard head coil and EPI images taken using fixed parameters.

TMS protocol- Biphasic TMS. 100 trains each consisting of 10 pulses at 10Hz frequency will be given with intertrain interval of 100ms. Total duration is 300 seconds. Area of application of TMS is Left DorsolateralPrefrontal Cortex.

Stroop test will be used as cognitive activation task.

The data thus acquired in DICOM format will be used for analysisfollowing the ROI FORMAT and further analysed using CONN/SPM under MATLAB.

KEYWORDS - FMRI, TMS, OCD, STROOP

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

18. Title: To study psychopathology, insight and functioning in patients of obsessive compulsive disorder.

Chandan Prasad ^*, Bandna Gupta ^***, Anil Nischal ^**, Manu Agarwal ^***, Shweta singh ^***

Background:

Insight in OCD ranges from complete awareness of the irrationality of symptoms to a complete lack of that awareness,with good or fair insight,The individual recognizes that obsessive-compulsive disorder beliefs are definitely or probably not true,with poor insight the individual thinkshis beliefs are probably true.with absent insight/delusional beliefs: The individual is completely convinced that obsessive-compulsive disorder beliefs are true.(DSM-5)

Aims:

To study psychopathology, insight and functioning in patients of obsessive compulsive disorder.

To study association among above variables in these patients.

Methodology: Patients taken from Adult Psychiatry OPD,A written informed consent will be taken. Information will be collected on semi structured proforma ICD-10. Any relevant medical history, and general physical examination will be done.YBOCS will be applied to assess severity of illness,YBOCS DIMENSIONAL SCALE will be applied for assessing multiple aspects of OCD symptom severity,BABS will be applied to Assess degree of insight and SOFAS will be applied for social and occupational functioning, Data obtained will be analyzed statistically on computer using statistics software.

Results:

The relationship between OCD symptoms dimensions and insight in a large clinical cohort of patients with OCD was seen.824 OCD Patient was assessed on Y-BOCS, the Dimensional (D-YBOCS), the Brown Assessment of Beliefs Scale (BABS),Results shows Poor insight was also correlated with increased OCD symptom severity.

Conclusion. - In OCD,Treatment response vary with level of insightwhich improves with treatment,, Degree of insight varies with different sympotoms dimension of OCD,This study intends to study psychopathology,insight and functioning in patients of obsessive compulsive disorder and association among these variable in the same population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

19. SHARED OBSESSIVE-COMPULSIVE DISORDER IN TWIN SISTERS: A CASE REPORT

Jaiswal S Kumar ¹, P Praveen ¹

INTRODUCTION: Shared obsessions and compulsions are a very rare disorder known to be represented by very few case reports in the literature. Knowledge about clinical features, treatments and prognosis in shared obsessive-compulsive disorder is limited to a few cases. New cases need to be reported in order to provide new information and experience about the shared disorder.

MATERIALS AND METHOD: We present a case report of two twin sisters of 28 year-old with similar obsessions, compulsions. Illness started first in one sister followed by in twin sister after 2 year with complaints having excess concern with dirt and contamination and repetitive rituals with water like excess washing and bathing. Y-BOCS was applied to assess severity of symptoms. Both improved with pharmacological treatment with selective serotonin reuptake inhibitor and behavioral intervention.

DISCUSSION: We highlight the uncommon phenomenon of shared or induced Obsessive-Compulsive Disorder. We raise the question of broadening the concept of shareddisorder so as to include shared OCD and perhaps other shared psychiatricsyndromes. In the current psychiatric diagnostic nomenclature, (DSM V and ICD10), there is no category for a shared OCD. Greater awareness about this entity among mental health professionals is needed

CONCLUSIONS: More controlled studies are required in order to better understandthe psychopathology and mechanisms of shared or induced OCD and other non-psychotic shareddisorders in psychiatry. We also believe there are important treatment implications ofsuch an understanding.

KEY WORDS: Obsessive compulsive disorder, shared obsessive compulsive disorder, Induced obsessive compulsive disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

20. Impulsivity, Alexithymia and Serum Lipids among Drug Naïve Patients with Obsessive Compulsive Disorder

Purvi Vats ¹, Basudeb Das, Sourav Khanra

BACKGROUND -Impulsivity has potential implications in Obsessive Compulsive Disorder (OCD). Higher attentional/cognitive impulsivity sub-construct is a demonstrated risk factor for suicide and other self-harming behaviors. Some studies suggest serum cholesterol to be a surrogate marker for impulsivity and demonstrated a correlation. According to few studies, the most important lipid fraction is HDL,whereas otherspropose total cholesterol (TC) or the LDL fraction to be important. Alexithymia, another important construct, is present in30 to 40% of patients with OCD. It has been postulated as a determinant of aggression too. Alexithymic patients had altered serum lipid levels in comparison with non-alexithymics and healthy controls. This study aims1) to examine serum lipids among drug naïve patients of OCD and compare it with age and sex matched healthy controlsand 2) to examine association between serum lipids,alexithymia and impulsivity among drug naïve patients with OCD.

METHOD - It was a hospital based cross-sectional study. Forty drug naïve or drug free patients of OCD were recruited by purposive sampling. They were rated on Y-BOCS(Yale-Brown Obsessive-Compulsive Scale), TAS-20(Toronto Alexithymic Scale- Revised), BIS -11(Barratt’s impulsiveness scale-11), HAM-Dand HAM-A. A sample of 5 ml of venous blood was collected after ensuring the subjects have fasted for 12 hours. The blood was analysed on the same day, within 2 hours of collection. TC, HDL, LDL, VLDL and Serum TG estimation was done by enzymatic method (using cholesterol esterase, cholesterol oxidase and peroxidase). Apolipoproteins (Apo) A1 and B fractions were measured using immunoturbidometry. After assessing with GHQ 12 (General Health Questionnaire 12) 40 age and sex matched healthy controls were recruited. Serum lipids were measured in both groups following above mentioned protocol. Data analysis was done with Statistical Package of Social Science Version 25 (SPSS) for Windows.

RESULTS and CONCLUSION- It will be discussed at the time of presentation.

KEY WORDS - Impulsivity, Alexithymia, Serum Lipids, Obsessive Compulsive Disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

21. Management of a Case of Obsessive Compulsive Disorder by using Exposure based on Virtual Reality Headset

Gopika Jagota ¹, Devakshi Dua ¹, Sandeep Grover ¹

Background: One of the important treatment strategies for management of Obsessive Compulsive Disorder involves Behaviour therapy in the form of Exposure and Response Therapy. However, many a times, it is not possible to expose the patients to real stimulus. In such situation, exposure is done by using imaginal exposure. However, in this age of technology, imaginal exposure can be replaced by using virtual exposure.

Aim: To present a 27 year old male, with obsessive images, managed with ERP by using virtual reality.

Methodology (Case Description): Patient was suffering from Obsessive compulsive disorder since the age of 19 years, which was characterized by having obsessive images of known people. Whenever patient would have these obsessive images, it would lead to patient repeating the acts at hand, such as crossing the doors, washing hands etc, multiple times till these images subside or till he was able to replace these images by desirable images. All these symptoms were associated with marked socio-occupational dysfunction to the extent that he was not able to carry on with his business and suffered losses. After behaviour analysis and psychoeducation about OCD and behaviour therapy, he was exposed to the images of persons, which were distressing by using virtual reality. For the same, initially pictures of the various anxiety provoking persons were collected and a hierarchy was made. Then these pictures were used to create a video having both audio and visual components to expose the patient. During the exposure, he was exposed to the video by mounting the mobile on the virtual reality headset. While being exposed he was made to carry out the tasks, without indulging in compulsive rituals. Gradually, he went through the whole sequence of images and videos, which was clubbed with response prevention. The experience of the patient was very satisfying; as this kind of exposure was more close to his experience of obsessive images and according to him, this helped in getting better with behaviour therapy.

Conclusion: This case shows that clinicians carrying out behaviour therapy can use technology such as virtual reality headset to improve the exposure to the stimulus associated with obsessive compulsive symptoms.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

22. Alexithymia, Affective Style and Obsessional Beliefs in Persons with Obsessive-Compulsive Disorder

S Kumar ¹, S Mohanty, Anil Sisodia, R Kumar

Background : Recent researches are suggesting presence of alexithymia in persons with OCD. The researchers have studied the relationship of alexithymia and OCD symptom dimensions. The knowledge of affective styles and obsessional beliefs in relation to alexithymia might be useful to address alexithymia deficits in psychotherapeutic interventions.

Aim : The present study aimed at exploring the relationship of alexithymia, affective style and obsessional beliefs in persons with OCD.

Method : 40 patients with OCD were selected from OPD of Institute of Mental Health and Hospital, Agra. Following tools were administered on each participant: (i) Toronto Alexithymia Scale [TAS-20] (ii) Affective Style Questionnaire [ASQ] and (iii) Obsessive Beliefs Questionnaire-44 [OBQ-44]

Results : The results will be presented.

Key Words: Alexithymia, affective style in OCD, Obsessional-Beliefs

srinivasbalachander@gmail.com

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

23. Immediate and Long-term Outcomes of Intensive Inpatient Care for Poor Insight Obsessive-Compulsive Disorder.

Srinivas Balachander ¹, Janardhanan C Narayanaswamy ¹, Jaisooriya TS ¹, Shyam Sunder Arumugham ¹, Janardhan Reddy YC ¹

Background/Introduction:

A significant proportion of patients with OCD (around 15-36%)are known to have poor or absent insight. These patients are particularly challenging to treat, as they have greater OCD symptom severity, more comorbidities, greater functional impairment and are known to show less favorable response to pharmacotherapy and cognitive behavioural therapy. There is paucity of data on treatment outcomes inpoor insight OCD. Intensive, inpatient-based approaches are known to be useful in patients with severe obsessive-compulsive disorder, and provide an opportunity to engage more closely and frequently for therapy. The OCD Clinic at the NIMHANS has been offering in-patient program with daily CBT/ERP involving family or caregivers, frequently enlisting them as co-therapists. The aim of this study was to look at the outcomes the subset of patients who had poor insight OCD who received in-patient care.

Methodology:

We reviewed clinical charts of all DSM-IV OCD patients admitted between January 2011 to December 2017. All patients were evaluated using the Mini International Neuropsychiatric Interview (MINI), the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression (CGI) scale. Of 420 patients from whom data was available, 69 (16.4%) had poor insight or absent insight, as assessed by YBOCS Insight Score (Item-11). They received daily CBT by psychiatry residents, clinical psychologists or psychiatric social workers under the supervision of a clinical team experienced in offering treatment for OCD. The treatment was individualized to include CBT, addressing family accommodation and expressed emotions, proxy compulsions, etc. Setting and monitoring of exposure tasks (self & assisted) were done collaboratively by therapists and caregivers. All patients also received intensive pharmacotherapy as per the existing standards, but the treatment was not controlled for. The main outcome measure was a reduction in YBOCS-Total, YBOCS-11 (Insight) and CGI scores. Naturalistic follow-up data was available until 3 months (52/69) and 6 months (38/69).

Results:

The mean Y-BOCS severity score at admission was 31.29 ± 5.02, mean illness duration of 9.49 ± 7.4 years. 47/69(68.1%) had failed adequate trials of 2 SSRIs and 51/69 (73.9%) had failed antipsychotic augmentation. Mean duration of inpatient stay was 42.88 ± 26.89 days.

At discharge, 18/69 (26.1%) were responders (35% reduction in YBOCS and CGI-S 1 or 2) and an additional 14/69 (20.3%) were partial responders (25% reduction in YBOCS CGI-S >3). 55/69 (79.9%) were rated as “Good Insight” at the time of discharge. The proportion of responders increased to 19/52 (36.5%) at 3 months follow-up and 18/38 (47.4%) at 6 months.

Conclusions:

Short term, intensive, in-patient based care involving CBT and pharmacotherapy may be an effective option for patients with poor insight OCD.

Keywords:

Conflict of Interests: nil

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

24. Trichobezoar with OCD –A Case Report

Jonathan L ^*, Priya Nayak ^**, Christina M Chandy ^***

Background: Trichobezoars are rarely described in the absence of trichotillomania. In this report we present a case of trichobezoar and OCD in the absence of trichotillomania.

Case Description:

A 10-year-old girl presented with abdominal pain and decreased appetite. Detailed work-up revealed a trichobezoar which completely filled the stomach reaching up to the duodenum. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like compulsive hand washing. Her trichobezoar was removed surgically, and she had anuneventful post-operative recovery. She is being maintained on fluoxetine and is doingwell.

Conclusion:

This case showcases the presence of trichobezoar and OCD in the absence of trichotillomania and the need to evaluate for psychiatric disorders among patients with trichobezoar.

Key Words: trichobezoar, obsessive compulsive disorder, trichotillomania

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

25. Impact of early adversity on cortisol reactivity and externalizing behavior in children of alcoholics

Anurag Timothy ¹, VivekBenegal, Priyamvada Sharma

Keywords – early adversity, cortisol reactivity, externalizing behavior, ADHD

Background: Children of alcoholics face high early adversity with vulnerability to psychiatric disorders in later life. The pathway to psychiatric disorders may lead through behavioural dyregulation. These children have been shown to have HPA axis impairment. Externalizing behavior and ADHD have also been shown to be independently associated both with hypercortisolism and hypocortisolism. We studied the association of early adversity with cortisol reactivity and externalizing behavior in a sample of COAs and age matched controls.

Methods: We examined children of alcoholics (N=50) and age and ethnicity matched healthy controls (N=50) for exposure to early adversity (both prenatal and postnatal) measured using the WHO Adverse Childhood Experiences Scale and Prenatal Psychosocial profile in a South Indian population. Cortisol reactivitywas tested using Trier Social stress test for children (TSST-C) and measured by ELISA for free salivary cortisol (samples taken at baseline prestressand 6 samples over 1 hr post stress). Externalizing and internalizing behavior were assessed using Strengths and Difficulties Questionnaire with screening for parent reported ADHD Inattentive (ADHD-I) and combined types ADHD-C) with or wthoutODD/CD (on MINI KID plus 6.0).

Results: COA had significantly higher levels of early adversity. Cortisol reactivity was reduced in COA, and negatively correlated with early adversity. Both early adversity and cortisol reactivity correlated with externalizing behavior. Children with ADHD had higher levels of adversityand lower cortisol reactivity compared to those without ADHD. ADHD-I and ADHD-C did not differ in terms of cortisol reactivity. ADHD with or without comorbid ODD/CD did not differ in terms of cortisol reactivity or externalizing behavior.

Conclusion: Our study provides further evidence that early adversity is associated with blunted cortisol reactivity and high externalizing behavior including ADHD. Cortisol reactivity may be the mediating factor between early adversity and behavioural dysregulation and may its effects may stem from genetic or epigenetic changes.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

26. Title: Early initiation of Lithium prophylaxis in early-onset Bipolar disorder

Selvarajan Sandhiya ¹, Adithan Surendiran ¹, Harshini Manohar ^2,^✉, Saibal Das ¹, Priyanka Sakkarabani ¹, Preeti Kandasamy ^*

Introduction:

The peak age of onset of Bipolar disorder is between mid to late adolescence and early-onset Bipolar Disorder (EOBD) has a malignant course with poor functional outcome. 50-80% of them experience one or more recurrences in the first 5 years; recurrence risk being high in the first 2 years. There is recent evidence that early initiation of Lithium increases the probability of response. This ongoing study attempts to assess the role of clinical parameters and genomic biomarkers in predicting prophylactic response (CTRI/2017/09/009836). The clinical profile of EOBD and the need for early prophylaxis with Lithium is discussed in the current paper.

Methods: Data regarding sociodemographic and clinical profile, episode characteristics and treatment details were collected using a semi-structured interview schedule and from case records.

Results:

The mean age of the patients at recruitment is 22.84 (6.5) years. Mean age at onset of bipolar disorder was 16.2 (1.3) years, with a median duration of illness of 4 years. 25% had only one episode, while 38.6% had two episodes and 36.4% had more than two episodes. In 93.2% patients, index episode polarity was mania.

Mean age at initiation of treatment for bipolar disorder was 17.9 (3.13) years, while lithium was initiated at an average age of 20.14 (3.83) years. Lithium was initiated during the index episode in 38.6% patients. Among them, 52.9% did not have recurrences in the first year of follow up. While among patients in whom lithium was started later during the course of illness, only 7.4% did not have recurrences.

Discussion:

There is a need for earlier initiation of lithium prophylaxis during the index episodeto increase the probability of response and reduce recurrences. This would translate into improving functioning and quality of life.

Funding agency: Science and Engineering Research Board(SERB), DST, Government of India (FileNo.ECR/2016/001849).

Keywords: Early-onset, bipolar, lithium, response, recurrence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

28. HYPOTHYROIDISM PRESENTING AS ACUTE MANIA – RARE CASE REPORT.

K Snigdha Reddy ^*,^*, GPrasad Rao ^**

In patients presenting with acute mania & psychosis, it is important to rule out organic cause of their symptoms. Neuropsychiatric problems include affective disorders, disturbances in cognition and psychosis. Mania is commonly associated with hyperthyroidism, But Hypothyroidism is a medical condition commonly encountered in a variety of the clinical settings. Patients with severe hypothyroidism may present with psychosis and less commonly with symptoms of mania. We report a case of 37 year old male presenting with acute mania & psychosis, in context of severe hypothyroidism.

KEY WORDS:

Hypothyroidism, Mania, Psychosis, Bipolar disorder, Levothyroxine.

INTRODUCTION:

Thyroid dysfunction is known to have a significant impact on mental health. [1] Hypothyroidism, in particular, has been linked to mood disorders and acute psychosis. Though most commonly associated with depression, hypothyroidism has been linked to psychosis since the late 1800s, in reports of delusions and hallucinations in patients with myxedema [2]. More recent literature highlights the incidence and coexistence of hypothyroidism and psychiatric disorders, describing possible mechanisms contributing to the pathophysiology of these disorders [1,3]. The link between hypothyroidism and mania, however, is less clear, with few reports in the literature 4. We present a case report of a 37 year old male presenting with acute onset mania with psychosis and previously undiagnosed severe hypothyroidism.

CASE REPORT:

AB is a 37 year old male, married, Telugu speaking, of rural dwelling, presented to psychiatric OPD with his family members. The attendants of patient complains of patient having inappropriate talk, bizarre behaviour, hyperactivity, sleeplessness, decreased appetite, suspiciousness on others that they are trying to cheat him and symptoms suggestive of acute psychosis of 10 days duration. He had no previous history of psychiatric aliments. AB had stress about his business & property &after that he started to behave abnormally. On enquiring with the family members they reported that he was found screaming in his apartment & had grandiose delusion of the god having entered him. He was restless & became aggressive towards family members. He has spent sleepless nights prior to these symptoms for a few weeks, according to family members. AB began fasting by not eating or drinking to prove he could become a ‘spiritual advisor’. Ab claims that his neighbours & family members are trying to cheat him, he claims that they are trying to plot against him because he has 45 acres of land though in fact he doesn’t have any land. On examination, he was conscious but restless, agitated and inattentive. All these symptoms were for the past 15 days.

Blood work indicated thyroid-stimulating hormone (TSH) > 100 mIU/L (reference value 0.38 to 5.33 mIU/L), Free tri iodothyronine (T3) 0.66ng/mL (reference value 0.70 – 2.04 ng/mL) and free Thyroxin (T4) 3.03 mg/dL(reference value 6.09 – 12.23 mg/dL). Blood investigations indicated elevated level of TSH and decreased free tri iodothyronine (T3).

AB denied previous diagnosis of hypothyroidism or ever having thyroid hormone levels checked. His mother had hypothyroidism managed with levothyroxine. Physical symptoms of hypothyroidism were not apparent and he denied physical symptoms in the past.

His social history included alcohol use and also tobacco use. AB used to consume small amount of alcohol occasionally (30ml once in a blue moon)& 3-4 cigarettes per day. 3 days prior to admission he stopped smoking cigarettes& his last social drink was one month back.

On admission AB was diagnosed with acute mania according to ICD-10 and was started with Tab. Diazepam 5mg HS and Levothyroxine 100 mcg once daily. Once the treatment was started he became more goal directed & less grandiose. He continued, however, to have mild restlessness. We persisted with the same treatment for a few more days.. The endocrinology team increased Levothyroxine to 300 mcg once daily. On this combination, his restlessness stabilized. Psychosis & mania resolved after 2 weeks in hospital without any antipsychotic or mood stabilizer and TSH trended down (83.10 mIU/L) and free T3 (0.70 ng/mL) and free T4 (5.03 mg/dL) trended upward. He was discharged on Levothyroxine 300 mcg daily with no residual psychotic or manic symptoms& diazepam was stopped after a few days.

Discussion:

In the above case rare effect of hypothyroidism was observed. The coexistence of hypothyroidism with depression, bipolar disorder and psychosis has been reported, dating back to the late 1800s. In 1949, Asher reported 14 cases of psychosis with hypothyroidism, 9 of which recovered with thyroid hormone treatment alone [2]. Numerous cases have since linked psychosis to hypothyroidism [2,5]6]. The majority of these cases were managed with a combination of antipsychotic medication and thyroid replacement, however in some cases maintenance therapy included thyroid replacement alone. There was no correlation between the degree of hypothyroidism and the severity of psychiatric symptoms [2]. Psychosis usually remits after 1 week of thyroid replacement, with earlier resolution with the addition of antipsychotic medications [2]. Although psychosis is less commonly associated with hypothyroidism than depression, it is a possible manifestation of the disorder.

Hypothyroidism is a common co-morbidity in bipolar disorder [3]. The association between hypothyroidism and mania is less clear. Mania with concomitant hypothyroidism has been reported in patients previously undiagnosed with psychiatric illness [7,8]. Patients presenting with acute manic episodes and hypothyroidism have improved clinically with a combination of psychotropic medications and thyroid hormone [4]. But in this case patient’s manic condition improved with Levothyroxine alone.

Delineating aetiology of psychiatric symptoms in our patient is a not difficult. AB’s description of manic & psychotic symptoms with no past or family history of bipolar illness would suggest the diagnosis of Acute mania. It is possible that hypothyroidism aggravated an underlying psychiatric illness or induced a manic episode with psychotic features. Treatment with levothyroxine & diazepam was considered for this patient to see whether the patient improves with Levothyroxine alone &to prove mania is secondary to hypothyroidism. It is possible that levothyroxine contributed to improvement of ABs psychotic and manic symptoms. It is surmised psychotic symptoms completely resolved when the TSH,T3, T4 levels returned to normalcy.

CONCLUSION:

Thyroid function should be investigated in all patients presenting with mania or psychotic symptoms. Without an underlying psychiatric illness, thyroid hormone replacement may suffice in the treatment of acute onset psychosis in the context of severe hypothyroidism. However, during an acute manic episode, treatment with thyroid hormone therapy alone may not suffice in some cases, and likely requires concomitant therapy with an antipsychotic or mood stabilizer.

REFERENCE:

1.Gold MS, Pottash AL, Extein I. Hypothyroidism and depression: Evidence from complete thyroid function evaluation. JAMA. 1981;245:1919–1922. doi: 10.1001/jama.245.19.1919. [DOI] [PubMed] [Google Scholar]
2.Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry. 2003;5:260–266. doi: 10.4088/pcc.v05n0603. [DOI] [PMC free article] [PubMed] [Google Scholar]
3.Chakrabarti S. Thyroid functions and bipolar affective disorder. J Thyroid Res. 2011:306367. doi: 10.4061/2011/306367. [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Khemka D, Ali JA, Koch CA. Primary hypothyroidism associated with acute mania: Case series and literature review. ExpClin Endocrinol Diabetes. 2011;119:513–517. doi: 10.1055/s-0031-1277137. [DOI] [PubMed] [Google Scholar]
5.Bhatara V, Alshari MG, Warhol P, McMillin JM, Bhatara A. Coexistent hypothyroidism, psychosis, and severe obsessions in an adolescent: A 10 year follow-up. J Child AdolescPsychopharmacol. 2004;14:315–323. doi: 10.1089/1044546041649048. [DOI] [PubMed] [Google Scholar]
6.Ueno S, Tsuboi S, Fujimaki M, Eguchi H, Machida Y. Acute psychosis as an initial manifestation of hypothyroidism: A case report. J Med Case Rep. 2015;9:264. doi: 10.1186/s13256-015-0744-z. [DOI] [PMC free article] [PubMed] [Google Scholar]
7.Lin CL, Yang SN, Shiah IS. Acute mania in a patient with hypothyroidism resulting from Hashimoto’s Thyroiditis. Gen Hosp Psychiatry. 2013;35:683. doi: 10.1016/j.genhosppsych.2013.06.013. [DOI] [PubMed] [Google Scholar]
8.Sathya A, Radhika R, Mahadevan S, Sriram U. Mania as a presentation of primary hypothyroidism. Singapore Med J. 2009;50:e65–7. [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

29. TITLE: Antidepressant induced hypomanic/manic switch: its magnitude, sociodemographic and clinical profile, a study from a tertiary care hospital of eastern India.

Soumik Barai ¹, Asim Kumar Mallick

BACKGROUND: Occurrence of mood switch in association with antidepressant (AD) treatment has been recognized since the earliest use of ADs. Presence of this clinical event often significantly influences the long term course and prognosis of the cases with mood disorder, especially in selection of psychopharmacological agents. There is dearth of study on the clinico-demographic data of these cases.

AIM AND OBJECTIVES: To enumerate the prevalence of antidepressant induced hypomanic/manic switch in patients attending in a tertiary care hospital and their sociodemographic and clinical profile.

MATERIALS AND METHODS: All consented patients attending OPD with symptoms of mania/hypomania (as per ICD-10) who had history of intake of antidepressant (within 2 weeks of starting manic/hypomanic symptoms for at least 2 weeks) will be recruited in the current cross sectional study. Patients with significant use of substances, co-morbid medical/organic illnesses and recent use of ECT were excluded from the study sample. Rest of the patients was assessed in semi structured socio-demographic, clinical profile proforma and Young’s mania rating scale. The data collected will be analyzed using appropriate statistical method.

RESULTS: The study is ongoing with results pending.

Key words: antidepressant, switch, socio-demographic, clinical

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

30. Abstract - A COMPARATIVE STUDY OF NEUROLOGICAL SOFT SIGNS IN EUTHYMIC BIPOLAR AFFECTIVE DISORDER PATIENTS, FIRST DEGREE RELATIVES AND HEA

Vikash Chandra Mishra ¹, GUNJAN SOLANKI

Background:- Among the various endophenotypes, Neurological soft signs (NSS) have received considerable attention as potential endophenotypic markers for bipolar disorder (BD) as these are seen in patients (during the euthymic phase) and in the first degree relatives.

Objective - A COMPARATIVE STUDY OF NEUROLOGICAL SOFT SIGNS IN EUTHYMIC BIPOLAR AFFECTIVE DISORDER PATIENTS, FIRST DEGREE RELATIVES AND HEALTHY CONTROLS.

Methodology - Sixty cases each of Bipolar Disorder patients in euthymic phase and their First degree relatives along with sixty age and sex matched healthy controls. These three groups were subjected to the Cambridge neurological inventory for assessing neurological soft signs.

Result Intergroup comparison shows that there was significant difference between First degree relatives (FDRs) and Bipolar patients in terms of Sensory integration and motor coordination (p<0.05). However, the two groups did not differ on subscores of disinhibition (p=0.09). Significant difference was found between FDRs of Bipolar patients and Healthy controls on measures of Sensory integration and Motor coordination, whereas on measures of disinhibition there was no statistical difference (p=0.09). On comparing measures on motor coordination, sensory integration and disinhibition subscores, statistical difference was found between the bipolar patients and healthy controls.

Conclusion:- there is significant difference in neurological soft sign scores between the bipolar disorder patients, first degree relatives and controls.

Key Words – euthymic patients; bipolar disorder; neurological soft signs.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

31. CHRONIC MANIA:DIAGNOSTIC ENIGMA AND TREATMENT CHALLENGE

Bhupendra Khobragade ¹, Shipra Singh ²

INTRODUCTION

Chronic mania, described as manic symptoms persisting for more than 2 years, is aknown but underexplored entity. Inspite of distinct symptomatology, course and outcome, itlacks nosological status. Here, we putforth a case of chronic mania, challenges in treatment and review of literature.

CASE REPORT

A 19-year-old male presented with continuous illness of 2 years, characterised by dysphoric mood, aggressive behaviour, overtalkativeness, overfamiliarity and sleep disturbance. Olanzapine (20mg) was given, with no improvement. Thereafter, Lithium was initiated (1200mg), and he developed extrapyramidal symptoms (EPS). Divalproate (1250mg) and Trihexyphenidyl(8mg) were added with no benefit in affective symptoms or EPS, and was referred to our centre.

On examination, severe rigidity, hypersalivation, slurring of speech and bradykinesia was noticed. Simpson-Angus scale score was 23. Investigations revealed Serum lithium level: 0.6 mEq/l; valproate level: 67.22μg/ml; low platelet count; high TSH; MRI: no abnormality. Thyroxine supplementation was done. Olanzapine was gradually tapered and stopped, with no improvement in EPS. It improved after discontinuation of lithium but affective symptoms flared up (probably masked by EPS). Adequate trials of divalproate and aripiprazole failed;mild improvement on Quetiapine (700 mg) but developed prolonged QTc interval. Subsequently, oxcarbazapine (1200 mg) and Haloperidol (15 mg) showed response and surprisingly, less EPS than on earlier medications. Patient has followed up 4 times and is manageable, has occassional irritability and mild EPS.

DISCUSSION AND CONCLUSION:

Among bipolar disorder, incidence of chronic mania is 6-15%. Diagnosis is often a challenge due to overlap of affective and psychotic disorder and when temperament contributes to illness; and treatment response is usually poor. In addition, index case had increased susceptibility to side-effects of psychotropics. It, therefore seems essential to understand biological correlates of chronic mania. EPS with lithium-olanzapine combination has also been reported earlier, but requires better understanding; along with the role of hypothyroidism in illness and treatment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

32. A NARRATIVE REVIEW OF CREATIVITY AND MOOD DISORDERS

Jaswant ¹, Tulika Shukla2, Gagan Hans3

BACKGROUND: The relation between mood disorders and creativity is a controversial one and researchers have tried to explore it using different methodologies. The belief that there is a link between creativity and mental illness has been mentioned time and again in literature, philosophy, media and psychiatry. Most studies have used ‘person’ and ‘process’ approach tests of creativity. The “person” approach studies have used being in a creative occupation as a marker of creativity but the definition of a “creative occupation” is quite arbitrary. Most common test using ‘process’ approach was the TTCT. In isolation, it has poor predictive validity. Biographical studies have been criticized for having possible recall bias, interviewer bias, selection bias and a cultural sampling bias. Population studies show an overrepresentation of creative occupations in bipolar disorder patients, depressive disorder patients and their relatives.

METHODOLOGY:

Literature review of was done from 1987 to 2018 using “PUBMED” “MEDLINE” and “PsycINFO” with research terms being “creativity” “mood disorders” “mania” “bipolar” and “depression”.

RESULTS:

Mood disorders are one of the commonest mental illness associated with creativity. Some studies suggest that there is increased creativity seen in hypomanic states and in cyclothymia and at the same time decreased in severe mania and severe depression. However, people prone to mood disorders do score more on creativity scales consistently. There is an over representation of creative professions in patients with mood disorders and their relatives. This lends support to the shared vulnerability model.

CONCLUSION:

Combining different assessments from different domains can be useful. Instead of developing new tools or using crude criteria, using available and standardized tools will give better results and allow comparison. Blinding of evaluator is essential. Further research is needed to look at the neurobiological and psychosocial reasons of this association.

Keywords Creativity, mood disorder, mania, bipolar, depression, methodology.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

33. ‘’OVERLAP SYNDROME SIMULATING AS ORGANIC BIPOLAR AFFECTIVE DISORDER ‘’

Manisha Sharma ¹, Fakirappa BG ¹, Karthika J ¹, Sanop JM ¹, Preethi Rebello ¹, Pavithra P Rao ¹, Aruna Yadiyal ¹

BACKGROUND: The occurrence of Affective Disorders secondary to an Autoimmune Connective tissue disease (CTD) is a rare clinical entity, while its significant link to Schizophrenia has been well reported. Occurrence of more than or equal to two CTDs is termed as Overlap Syndrome which might manifest as stroke due to immune mediated focal cerebrovascular / ischaemic changes, or might masquerade as core psychiatric symptoms of psychosis or affective disorders. Such atypical presentations in the form of psychiatric symptoms especially when occurring in a young patient like in our case, might be overlooked at times.

CASE DESCRIPTION:

We present the occurrence of Bipolar disorder secondary to right frontal subcortical and left parieto-occipital ischemic lesions as a manifestation of Polymyositis-Scleroderma (PM-Scl) Overlap Syndrome, in a 27 year old male patient without any contributory past or family history, who experienced depressive and manic episodes after 1 week and 5 months respectively, of the cerebro-vascular events manifested as stroke.

CONCLUSION:

The above described case presented with psychiatric symptoms but on evaluation was found to have a primary organic disorder i.e. PM-Scl Overlap syndrome causing cerebral vasculitis. This emphasizes the need for detailed physical examination and laboratory investigations for medical co-morbidities in patients presenting with psychiatric manifestations.

KEY WORDS:

Organic Bipolar Affective Disorder, PM-Scl overlap syndrome,

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

34. Bipolar Disorder and Immune Dysfunction : a poster presentation

Author Pawel Singh ¹

Bipolar disorder is a severe and persistent mental illness associated with significant morbidity and mortality. While numerous hypotheses have been proposed to explain the underlying patho-etiology of Bipolar Disorder, the mechanisms sub-serving disease onset and progression remain largely unknown. More recently, immune dysfunction has been implicated in the patho-etiology of BD. The hypothesis that immune dysfunction may be a mediator of disease progression in Bipolar Disorder was first proposed by Horrobin&Lieb (1981) who hypothesized that the relapsing-remitting nature of Bipolar Disorder may be driven by the immune system, as seen in other relapsing-remitting inflammatory disorders, such as multiple sclerosis (MS).

We present a male patient of young age, who came to psychiatric OPD. Patient was suffering from Vitiligo, Hyperthyroidism and came with complaints of irritable and agitated behavior, big talks, anger outbursts, wandering behavior, overtalkativeness, overfamiliarity, raised self esteem with prior history of depressive episode and similar complaints. Patient was treated with anti-psychotics and mood stabilizers and with Neomercazole for hyperthyroidism, and patient improved significantly.

Here I am documenting a rare case of Bipolar Disorder with Auto-immune dysfunction.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

35 Title: Young onset BPAD complicated by Parkinsons disease in an elderly man: A case report

Abhishek Khatri ^a, Om Prakash ^b

BACKGROUND- Literature survey indicates that bipolar disorder is linked with or influences Parkinson’s disease and vice versa. Underlying mechanisms are poorly understood, and, more importantly, no treatment options are established in such double diagnoses. Drugs for treating manic episodes might worsen parkinson and vice a versa.

Methodolgy- An elderly married male presented with TDI of 40 years, episodic course, and acute onset with complaints of elevated mood, psychomotor excitation, delusion of grandiosity. He also had recent onset parkinsonism characterized by bradykinesia, rigidity and tremors.

His PD worsened on initial treatment of manic episode with the pharmacological agents. The diagnostic workup and management will be discussed at the time of presentation. Patient was co-managed with the help of neurology team.

Results- Patient was managed on dual mood-stabiliser agents and a second generation antipsychotics. He was also put on pharmacological treatment for parkinsons

Conclusion- Current literature suggests use of valproate as the preferred mood stabilizer agent and quetiapine/aripiprazole as the preferred antipsychotics for the treatment of mania with comorbid PD.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

36. Social cognition in siblings of patients with bipolar disorder: A comparison with patients and healthy control

Swati Choudhary ^1,^✉

Background: Social cognition deficits are widely studied in patients with schizophrenia and their first degree relatives but there is scarcity of research among patients with bipolar disorder and their relatives.

Aim of the study : To evaluate the social cognitive deficits and its correlates among siblings of patients with bipolar disorder.

Material and methods : 32 Patients with bipolar disorder and equal number of their siblings and 38 healthy controls matched for age, gender and education were evaluated on social cognition rating tools in Indian setting (SOCRATIS). Siblings and healthy controls were additionally assessed on Bipolar spectrum diagnostic scale (BSDS). Neurocognitive battery was applied to all three groups.

Results: Patients with bipolar disorder performed the worst and the healthy controls performed the best on tests of social cognition, with siblings falling intermediate between the patients and healthy controls on all the subtests of social cognition except for faux pas composite index and externalizing bias. Total score of BSDS correlated negatively with second order ToM.

Conclusion: Social cognitive deficits can be considered as an important endophenotype for estimating the risk of bipolar disorder in at risk siblings. Hence, it must be considered as an important target for intervention to improve the outcome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

37. Chemotherapy induced mania in CNS Lymphoma : A case report and narrative review

Shagun Chahal ¹, Jawahar Singh, Koushik Sinha Deb, Rakesh Chadda

INTRODUCTION- Pharmacological agents used in the treatment of malignancies are associated with neuropsychiatric complications. It is important to differentiate these symptoms from complications resulting from progression of CNS malignancy. The following case report shows the onset of affective disorder in a patient who was recently diagnosed with CNS lymphoma while undergoing treatment.

CASE REPORT:

A 45 yr old married male with CNS Lymphoma post right temporal lobectomy presented with symptoms of over-talkativeness and decreased need for sleep for past three months with subacute onset and deteriorating course after surgery and first cyclechemotherapy. Withsubsequent cycles of chemotherapy and he developed increased psychomotor activity, physical and verbal aggression, increased libido, increased appetite, over religiosity, over generosity, over familiarity, authoritativeness, delusions of grandiosity, delusion of persecution and ideas of infidelity leading to marked socio-occupational dysfunction. Patient was started on antipsychotics for initial management and mood stabiliser later on. Patient responded in 1 month and became euthymic and was subsequently discharged. He then received Radiotherapy and maintained well.

DISCUSSION: Although neuropsychiatric complications are usually encountered with steroids, they can occur with chemotherapeutic agents like vincristine, procarbazine and 5-FU. Treatment emergent neuropsychiatric manifestations add to the morbidity and have significant impact on quality of life of cancer patients. Early detection of these symptoms and prompt management is essential to prevent the adverse impact on outcome.

CONCLUSION: This case presents an interesting scenario where the development of psychiatric illness happened shortly after surgery and chemotherapy. It emphasises the role of early evaluation of psychiatric manifestations in CNS malignancies and the importance of multi-speciality care for such patients.

Keywords: Chemotherapy, Mania, Psychosis, Steroids, Lymphoma

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

38. Lamotrigine induced switch: is there a dose threshold?

Anindya Das ¹

Lamotrigine, an antiepileptic mood stbilizer, has been recommended for prophylaxis in bipolar episodes. It has been reported to have caused a number of different types of alteration of mental state (or psychiatric side effects) including induced psychosis; hallucinations and hypersexuality in patients with epilepsy, and aggressive behaviour in intellectually challenged patients with epilepsy (though the opposite effect has also been noted). Lamotrigine induced affective switch is yet another undesirable effect especially encountered in patients with mood disorders though the rates have been comparatively low. We report a case of bipolar disorder who developed lamotrigine induced switch at 175 mg/d. On reducing dose to 50 mg/d he redeveloped depressive symptoms over a period of seven days. On increasing lamotrigine to 100 mg/d over six weeks, patient’s depressive symptoms abated, but had recurrence of manic symptoms in another two weeks. Lamotrigine was then decreased to 75 mg/d and the patient was asked to follow-up again at two weeks’ interval. On the fourth week patient reported of anxiety symptoms, low mood, fatigue, and headaches. Lamotrigine was again titrated upwards now in steps of 12.5 mg to 87.5mg/d. On subsequent fortnightly follow-up the patient remained euthymic for the next six months and later one year (with monthly follow-up). We discuss this case in light of extant literature.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

39. Socio-demographic correlates of patients of Bipolar Disorder with cannabis use

Mohammad Talha Shamim, Shantanu Bharti, Ajay Kohli, Anju Agarwal, Abdul Qadir Jilani, Nitin Sharma

Background/Introduction: Substance use disorder is common among bipolar disorder patients, particularly cannabis. However, scarce data is available regarding cannabis use in patients with bipolar disorder. Therefore, we aimed to examine the socio-demographic difference in bipolar disorder patients with and without cannabis use.

Methodology/ Materials and Methods: In this case control observational study, we had included equal number (n-25) of bipolar patients with cannabis use (CASES) and without cannabis use (CONTROLS) attending the Psychiatry department at Era’s Lucknow Medical College. Socio-demographic details were assessed. Cannabis use severity was assessed using Severity of Dependence Scale (SDS). Further, Young’s Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HAM-D) were used to evaluate severity of mania and depression respectively. Group difference for categorical variables will be calculated using Chi Square or Fisher’s test and other appropriate statistical test will be applied. P value <0.05 will be considered to be significant.

Results: Majority of patients using cannabis were males, unmarried (66%), unemployed (57.8%) and belonging to rural background (69.3%). Mean score on SDS scale for cannabis use was found to be 10.59±3.69, having predominantly substantial to severe dependant patients. Upon comparing socio-demographic profile of the patients with or without cannabis use, significant association was found in males (p- <0.001), those who were unemployed (p-0.001) and belonged to rural background (p-0.006). Also, patients from the nuclear family had significant (p-0.005) cannabis use. In addition to this, those using cannabis required significant frequent past hospitalization (p-0.002) and had longer duration of current illness (p-0.02).

Conclusion: Patients with bipolar disorder particularly young males, unemployed, belonging to rural background having longer duration of current illness and frequent past hospitalizations should raise an alarm

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

40. Stop and Go: Curious case of early onset bipolar disorder presenting as recurrent catatonic symptoms

Kashypi Garg, Kabir Garg, S Nagendran

Introduction: recurrent catatonic symptoms have been identified since long in literature. While the maximum number of such cases is diagnosed as schizophrenia, about a fifth of such cases are eventually found to be suffering from bipolar disorder. The condition warrants continued management of the underlying disorder rather than catatonic/ depressive symptoms alone Case: 17-year-old girl was presented to the OPD with a history of onset at 13 years of age. Her illness was characterised by recurrent episodes of acute onset depressive symptoms including depressive cognition, crying spells and would progress to significant psychomotor retardation and posturing within a few days. Each time, the episode would last 2-4 weeks and would resolve well on anti-depressant medications. However, her asymptotic period lasted usually only for a few months before onset of the other episode. The family members also reported that while her symptoms improved, she would gain her baseline completely and would stay withdrawn and would not be able to resume her studies. The patient had nil significant family, past and personal history. She had been treated at multiple centres and had history of treatment with combinations of anti-depressants and low dose anti-psychotics. Further evaluation of history revealed that the patient would have brief episodes of increased activity, irritability, reduced sleep and increased talkativeness preceding each of her depressive episodes, that would last 2-3 days and she would then almost immediately switch over to the index symptoms. Based on history, a diagnosis of Bipolar affective disorder (BPADII) was made and patient was started on Lithium along with her antidepressant after discussion with patient and family members.

Discussion: Bipolar II disorder frequently present with recurrent depressive episodes and hypomanic symptoms may be missed. A high index of suspicion is needed for diagnosis and effective management of the condition

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

42. Trichotillomania in children- a case series from tertiary care center from north India

Jyoti Singh ¹, Ruchita Shah ², Akhilesh Sharma ², Sandeep Grover ², Venkatesh Raju V ²

Background: Trichotillomania is an impulse control disorder, which is less often reported in children and adolescents from India.

Aim: To present 3 cases of Trichotillomania with onset before 3 years of age and presented before 10 years of age.

Methodology: All the three children were developmentally normal, had average intelligence and had one or more comorbidities. Out of the three children, only one child had awareness of the irresistible urges in which HRT could be applied. All the three perceived significant improvement with combination of SSRI and non pharmacological management.

Conclusion: Trichotillomania is a rare disorder in children, which can start very early. Management of Trichotillomania with combination of pharmacotherapy and behaviour therapy in children and adolescents can lead to good outcome.

Key words: Trichotillomania, HRT, SSRI, Nonpharmacological

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

43. To study the Phenomenology of Autism Spectrum Disorder in Children and Adolescents using DBCL

Amar Deep Patel ¹, Vivek Agarwal ², Amit Arya ³, Manu Agarwal ⁴, Pawan K Gupta ⁵

Background : Autism Spectrum Disorder is a neurodevelopmental disorder which is increasing across the globe that consists of group of disorder with onset in the developmental period. It includes social impairments, communication difficulties, and repetitive behaviors. ADI- R is a diagnostic tool and DBCL is screening tool used for ASD. Aim of this study were to study the Phenomenology of ASD in Children and Adolescents using DBCL.

Methodology : This is the cross sectional study to see the pattern of different sign and symptoms (Phenomenology) of Autism Spectrum Disorder using the tool DBCL (Brereton AV, et al., 2000). All old and new patients with Autism Spectrum Disorders in the age group of 4 to 16 year attending Child And Adolescent psychiatry OPD, Department of Psychiatry have been screened and included in the study.

Result : A total of 40 children were included and assessed. The most common symptom being in decreasing order were restricted interest, poor eye to eye contact communication difficulties and repetitive behavior.

Conclusion : Restricted interest, poor eye to eye contact, communication difficulties and repetitive behavior were the common symptoms as assessed on DBCL in children and adolescents with ASD.

KEYWORDS: ASD, DBCL

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

44. “A STUDY OF SLEEP PROBLEMS IN CHILDREN AND ADOLESCENTS WITH EPILEPSY IN A GENERAL HOSPITAL SET UP”

Sharanya B Shetty ¹, Girish Babu N ², Abhay Matkar ³

Background: Epilepsy is a common neurological illness of childhood. We did a study to look at the prevalence of sleep related problems in children with epilepsy and to correlate sleep problems with clinical and epilepsy related variables.

Methodology: The study was a cross-sectional study conducted in SDMCMSH, Dharwad with a sample of 100 children with epilepsy between the age group of 6 to 17 years. All were screened for sleep related problems using Children’s Sleep Health Questionnaire- abbreviated version (CSHQ).

Results: Out of a sample size of 100, 63 were male and 37 were females, with generalized tonic-clonic seizures to be the most common type of seizure type in the sample. Our study showed that the mean score onChildren’s Sleep Health Questionnaire was 48.8 and it was found that 92% had sleep related problems.

Discussion and Conclusion: The frequency of sleep related problems has been found to be high in children with epilepsy. Identification and treatment of sleep related problems should be a part of treatment plan for epilepsy.

Keywords: Epilepsy, Sleep problems, CSHQ

Author for correspondence : Dr Sharanya B Shetty, Department of Psychiatry, SDM College of Medical Sciences and Hospital, sharanyabshetty@gmail.com, Ph.no. 8762117306

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

45. Asperger’s syndrome: A rare presentation of Pervasive Development Disorder

Dennis L Khawlhring ¹

Introduction : Asperger Syndrome (AS) is a developmental disorder. It is an autism spectrum disorder (ASD), characterized by a greater or lesser degree of impairment in language and communication skills, as well as repetitive or restrictive patterns of thought and behaviour. The most distinguishing symptoms of AS is a child’s obsessive interest in a single object or topic to the exclusion of any other, they want to know everything about the topic of interest and their conversation with others will be about little else. Other characteristics include repetitive routine and rituals, peculiarities in speech and language, socially and emotionally inappropriate behaviours and the inability to interact successfully with peers, problems with nonverbal communication, and clumsy and uncoordinated motor movements. They are often isolated because of their poor social skills and narrow interest.

Case report : A 16 year old male referred from Neurology department with history of chronic headache for 3 years. On psychiatric evaluation, he was found to be an introvert, had poor eye contact, irritable, history from mother revealed that he had normal developmental milestones, had difficulty in making eye contact and social interaction since childhood, obsessed with cameras, despite having good scholastic skills he seldom formed relationships with peers because of his eccentric talk and behaviour. He was often bullied, felt embarrassed, and started to feel that people are not on par with his knowledge so he couldn’t converse with them, he started developing headache. Ophthalmic examination revealed normal visual acuity, neurologistdiagnosed him to have tension type headache which didn’t settle with medications and hence he was referred to psychiatry for evaluation. On psychological evaluation, IQ was 112 on Bhatia’s Battery of Performance Test indicating above average intelligence, score of 24 on ASSQ indicating definite signs and symptoms of Autism Spectrum Disorder, and a score of 145 on Sohn Grayson Scale indicating mild to moderate high functioning PDD (pervasive developmental disorder). Currently patient is on Tab Amitriptyline along with Cognitive Behavioural Therapy sessions.

Keywords : Autism Spectrum Disorder, Pervasive Developmental Disorder, Cognitive Behavioural Therapy, Asperger’s syndrome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

46. Behavioral phenotype of Fragile X Syndrome

Manoj Kumar ¹, Ruchita Shah ^2,^✉, Venkatesh Raju ³

OBJECTIVE: To demonstrate behavioral phenotype of fragile X syndrome in a pair of male siblings and discuss regarding the same.

CASE SUMMARY Sibling 1: A 17-year old boy presented with deficits in intellectual, emotional andbehavioralfunctioning. History and mental status examination revealed excessive shyness, constantly anxious, separation anxiety, excessive fear to noises, social phobia, gaze aversion, pervasive ignoring, inappropriate laughing, tactile defensiveness, difficulty in social interaction, clinging behaviour, lack of curiosity about the environment and irritability typically provoked by environmental stressors. Physical examination revealed large forehead with frontal bossing, large and anteverted ears, intraoral ogival palate, dental hypo mineralization, crowded teeth, joint hyperlaxity, hypotonia and unilateral macro orchidism.

Sibling 2: 8-year old boy presented with similar history. History and mental status examination was suggestive of no spontaneous initiation of speech and communication, monotonous speech, use language phrase inappropriately, difficulty in conveying simple things, minimal verbal communication, fearful, agoraphobia, inattentive, frequent temper tantrums, repetitive and stereotypic behaviour and inappropriate laughing and crying. Physical examination revealed large forehead with frontal bossing, large and anteverted ears, crowded teeth, high arched palate, smooth skin and joint hyperlaxity.

Family history: Mother has borderline intellectual functioning and two maternal uncles have similar behavioral and physical phenotype as the index patients.

Investigations: Sibling 2 has full mutation; >200 repeats CGG at FMR1 locus.

DISCUSSION: Psychiatric symptoms present as a mixed clinical picture not fitting established diagnostic categories. However there may be a wide range of anxiety symptoms, overlapping attention deficit and hyperactivity, autism spectrum disorder and affective symptoms. In our cases also, males presented with more severe anxiety, affective and behavioral phenotype besides intellectual disability.

CONCLUSIONS: In fragile X syndrome, wide range of psychiatric manifestations are a challengefor assessment and management.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

52. Title - A STUDY OF AFFILIATE STIGMA AND QUALITY OF LIFE AMONG PRIMARY CAREGIVERS OF CHILDREN AND ADOLESCENTS WITH INTELLECTUAL DISABILITY”

Ram Anuj Verma ^*, Amit Arya ^***, Vivek Agarwal ^****, Pawan Kumar Gupta ^**, Pooja Mahour ^***

Background: As compared to parents of typically developing children, ‘caregiver’s internalized stigma’ and ‘quality of life’ are most common predictor for morbidity of mental health problems in parents of individuals with intellectual disabilities,. As these children aged and become adults, new sets of care-giving challenges are likely to appear. It is thus necessary to understand the parents’ quality of life and possible barrier like internalized stigma to their care-giving experiences. There is need to advance knowledge and to develop focused interventions to reduce stigma related negative impact.

Aims: To study Affiliate Stigma, and Quality of life in primary care-givers of children & adolescents with intellectual disability.

Methodology: New patients of I.D. attending child and Adolescent Psychiatry OPD, KGMU, Lucknow will be screened for the selection criteria. IQ assessment of children and adolescents will be done by clinical psychologist. Assessment on K-SADS-PL will be done for co-morbid conditions. Diagnosis will be made as per DSM 5 criteria. All the subjects enrolled in the study had given informed consent prior to inclusion in the study. Assessment of Stigma will be done using Affiliate Stigma Scale on caregivers of children and adolescent with ID. Quality Of Life of caregivers will be evaluated on WHOQOL–BREF. Data was analysed using computerized software.

Results: In this cross sectional study 100 parents having Intellectual disability children was interviewed Result shows severity of ID significantly related to self stigma,QOL in caregivers of children with intellectual disability 80 parents was accessed using WHOQOL-BREF questionnaire reported impairment in all the four domains of QOL.

Conclusion:. The study concluded that,intellectual disability can equally affect family caregivers. Causing them to suffer from high level of stigma,and affect their quality of life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

47. Abstract Paediatric Onset Bipolar Disorder: A Case Study

Aana Shah ¹, Minakshi N Parikh

Previously thought as rare in pre-adolescents, paediatric bipolar disorder is now increasingly diagnosed in children, although in recent years intense controversies have sprung up about the exact diagnostic criteria and prevalence of this disorder. Diagnosing it is still a challenge due to the variability of clinical presentations and overlapping other common psychiatric conditions. Here we report a case of a 8 year old patient with bipolar affective disorder presenting with first episode mania. We discuss the symptomatology that led the diagnosis of bipolar affective disorder, the challenges associated with differentiating the diagnosis from other childhood mood disorders, and the treatment possibilities.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

48. SCHOOL REFUSAL – Brief Intervention IN A SERIES OF 22 CASES

BK Waraich ¹, Moushumi Purkayastha, Parul Sharma, Ruchi Gupta

OBJECTIVES:

Children who present with the chief complaint of school refusal have a multitude of symptoms stemming from multifarious diagnosis. Many a time the reason a child is brought for evaluation is the School refusal though symptoms may have been there for some time. The aim of the study is to study the sociodemographic profile, diagnosis, any family psychiatric illness and discuss management.

METHODS-Children 5 to 16 years of age who presented with School Refusal were studied and their sociodemographic details, History elicited and Diagnosis formulated.

RESULTS- A total number of 22 patients were seen. Brief Intervention in the form of sessions of Relaxation exercises, Parent training, Cognitive Behaviour therapy, were done. Seven children had 1 session, 16 had 5-10 sessions. Diagnoses are discussed.

Key Words- School refusal, Brief Intervention,

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

49. Title: Are Doctor Parents open-minded to understand stress vulnerability model in their offspring’s mental health?

Susanta Kumar Padhy ¹, Anita Thakur, Nidhi chauhan

Research has demonstrated the importance of both genetic and psychosocial factors, and their interaction for the development of Childhood Psychiatric Illness. Studies consistently show that offspring of parents with mood disorders and substance use disorders are at higher risk for developing mood, anxiety, and externalizing disorders when compared to offspring of control parents.

We describe a 12 yearsold female 8^thclass student, with good academic performance and a family history of substance abuse & Bipolar disorder in father. Patient and her elder brother witnessed several altercations since childhood. Patient would try to protect mother on multiple occasions and started voicing that mother should divorce father, owing to domestic violence. This has resulted in negative interaction pattern, role reversal and disturbed family dynamics. She Presented with multiple somatic symptoms, school refusal, vomiting, fainting. “Doctor parents” including the child were unwilling to accept psychological cause for physical symptoms till she presented to our emergency after a suicidal attempt. Though she was diagnosed as moderate depressive episode and started on SSRI, mainstay of treatment was intensive family therapy, individual psychotherapy with parents, coping strategy enhancement and cognitive restructuring of child, to which she responded well. Multi-pronged approach was used. The family dynamics were studied and boundaries analyzed. Parents were educated regarding illness, over involvement, expressed emotions, handling their relationship effectively. Family time was charted, certain games or tasks were given to father to increase his involvement. She is maintaining well with improved academic performance and stable family.

This case highlights the stress vulnerability model and labor-intensive multi-pronged approach to management of a very difficult-to-treat child and family, it emphasizes the relevance of family therapy in management of difficult-to-treat children.

Keywords - Doctor, Parents, School refusal, Depression, Suicidality

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

50. A Rare Atypical Presentation of Kluverbucy syndrome in a Young Male child

Susanta Kumar Padhy ¹, V Venkatesh raju, Aakanksha Singh

Kluver bucy syndrome is a rare neurobehavioral syndrome seen following bilateral temporal lobe injury. It has been reported across various ages with varied presentation. Various etiologies have been implicated in association with many neurological disorders involving bilateral temporal lobes. The syndrome is characterised by: (1) visual agnosia i.e. psychic blindness with inability to recognise familiar objects without loss of gross visual discrimination; (2) hyperorality i.e. strong urge to examine all objects by mouth; (3) hypermetamorphosis i.e. excessive inattention to visual stimuli with tendency to take notice of and touch every such stimuli; (4) altered sexual behaviour manifesting mainly as prominent and indiscriminate hypersexuality; (5) placidity with loss of normal fear and anger; and (6) changes in dietary habits. Symptoms like aphasia, amnesia, seizures, emotional abnormalities (apathy, excessive cheerfulness and irritability) and hyperkinetic behaviour are also included. Hyperorality is the chief manifestation of KBS and cases are classified as complete or incomplete based on this. Incomplete form is more common in humans unlike complete from in animals as lesions are not as extensive and localized as in animal experiments We aim to present a case of kluver bucy syndrome in a ten year old boy, presenting abruptly following single exposure to cannabis and a single incident of alleged sexual abuse on the same day. The case highlights the atypical presentation of KBS, where an underlying unknown brain insult got suddenly unmasked after the cannabis exposure and sexual abuse.

Though most cases of Kluverbucy syndrome will have the etiology for bilateral temporal lobe involvement, at times it is difficult to find the cause of CNS insult. As know from literature, cannabis can unmask an organic insult to present with a clinical picture. This case highlights one such rare case of KBS being unmasked by cannabis exposure

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

51. Title: Profile of subjects attending Children and Adolescents Psychiatry (CAP) clinic at AIIMS, Bhubaneswar

Suravi Patra, Sanjyoti Aggarwal, Susanta Kumar Padhy

In our country, systematic and structured Child and Adolescents Psychiatry (CAP) clinic at tertiary care hospitals are handful in number. Only two Institutions namely NIMHANS, Bangalore and PGIMER, Chandigarh provide super-specialty DM course in Child and Adolescent Psychiatry, since last 5 years. The reasons for abysmally low number are many. Some of them include: lack of awareness about the importance of child mental health as a discipline unlike in west, labor-intensive and time-consuming nature of service delivery against backdrop of scant availability of mental health professionals and paraprofessionals, and lack of team work. All India Institute of Medical Sciences (AIIMS), Bhubaneswar, one of the Institutions of National Importance (INIs), amongst six new AIIMS(es), established by an Act of Parliament by Ministry of Health & Family Welfare, Government of India, started in 2013, began its Children and Adolescents Psychiatry (CAP) clinic in 2015.

In this paper, we discuss the pitfalls and potential, of starting and building upthe Children and Adolescents Psychiatry (CAP) clinic at AIIMS, Bhubaneswar. We will present the characteristics of subjects and care-givers attending this clinic over last 5 years. We discuss the implications of this data for understanding the scope of the problem and to tailor-made the possible solutions to the need of local population from a public mental health perspective.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

52. Title: Media exposure shaping psychopathology in a Child contributing to diagnostic dilemma

Susanta Kumar Padhy ¹, Aakanksha Singh, Nidhi chauhan

Background:

Media is primarily aimed at communication and entertainment. However, unrestricted media exposure in vulnerable children exposes them to unwarranted information and can present as diagnostic dilemma in a psychiatric setting.

Methodology (Case description): Ms VG, 8 years old presented with the complaints of repeatedly seeing “bad images”, self-stimulatory behaviour with academic decline for last one year. She was diagnosed as having Obsessive compulsive disorder and was taking Sertraline 50 mg/d from last 6months. Despite good compliance, worsening of symptoms from last one month prompted parents to seek a second opinion at our centre. At 7 years of age child was exposed to pornographic content on the internet by an older neighbourhood girl, and watch television programs with “similar twist”, and focus on “sexualised aspects” of the programm. Subsequently child began to see videos of similar content on her parents’ phone. She would indulge in masturbation and tried to visualize images of videos whenever she was free at home or class. Images were not intrusive or anxiety provoking. Gradually she felt guilty of content of her thoughts and shared with her mother that some images were bothering her. Rapport building with the child and multiple exploratory sessions clarified the psychopathology, and the link with inappropriate use of media. Her medications were stopped. She improved with: restricted/optimised media use, distraction techniques, a daily schedule and behaviour therapy for self stimulatory behaviour. Academic performance improved Conclusion: Media plays an important role in shaping thoughts of all including the children. However, while eliciting psychopathology in children, it may be difficult unless various aspects of child’s development including media exposure are considered.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

53. TITLE: Comparison of stigma between bipolar and schizophrenia patients.

Author Tulika Shukla ¹, Adarsh Tripathi ², Sujit A Kar ³

BACKGROUND

Bipolar disorder has been found in studies to be less stigmatising than schizophrenia. Some studies also mention that stigma perceived in bipolar disorder is mild.

AIM:

To compare stigma perceived by patients and caregivers of bipolar disorder vs schizophrenia

METHODOLOGY

Clinically stable patients with diagnosis of bipolar disorder (YMRS<12 and HDRS<7) (N=53) and schizophrenia (PANSS<70) (N=52) as per DSM-IV TR criteria were taken from a tertiary hospital in North India. Alongwith sociodemographic and clinical information patients were assessed on Internalised Stigma of Mental Illness Scale (ISMIS) and Participation Scale (P-Scale). Caregivers were assessed on CPMI (Caregiver of People with Mental Illness scale) and GHQ-12.

RESULT

Overall stigma perceived by both groups was high. ISMI total scores as well as scores on individual domains on ISMI were not found to be significantly different between bipolar and schizophrenia patients. Participation scale scores were also not significantly different. CPMI scores were not significantly different between caregivers of bipolar and schizophrenia patients.

CONCLUSION

In our study, we found that bipolar disorder can be as stigmatizing as schizophrenia for both the patient and the caregiver.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

54. TOPIC: Biopsychosocial model of care for psychiatric inpatients

Aditya Unni ¹, Shivananda Jena ¹

INTRODUCTION: The biopsychosocial (BPS) model is both philosophy of clinical care and a practical clinical guide. It is a way of understanding how suffering, disease and illness are affected by multiple levels of organisation, from patient’s subjective experience as an essential contributor to accurate diagnoses, health outcomes and humane care. METHODOLGY: OBJECTIVE: To provide BPS Model of care for psychiatric inpatients and find the outcome DESIGN: Descriptive and prospective SETTINGS AND PATIENTS: Patients admitted to the Psychiatry Ward at GIPMER, Delhi in the last three months. RESULTS: Biological, psychological and social outcome of illness CONCLUSION: Advantages and disadvantages of BPS model of care will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

55. TO STUDY THE DIFFERENT PSYCHIATRIC PROBLEMS AMONG POLICE PERSONNEL

Nikhil Nayar ¹, MK Deshpande ²

INTRODUCTION/ BACKGROUND Law enforcement is an occupation with some peculiar characteristics that can cause work stress, and policing job is one of the most stressful. Policepersonnel are one of the few professionals where people are expected to face physical dangers and, if necessary, to risk their lives as well as face significant stress in many other aspects. Stress among policemen may present in the forms of fatigability, depression, difficulty to concentrate, irritability, impulsive behavior, substance intake, addiction etc. Till date few studies have been conducted on occupational stress, depression and anxiety in police officers both in India as well as outside India. Few studies have also been conducted outside India in relation to substance abuse among police officers, the same in India are lacking. However no study till date has combined all these domains or has studied the impact of occupational stress on the quality of life, substance abuse, depression and anxiety in police personnel.

AIMS AND OBJECTIVES

To assess the level of stress among police personnel and to find theassociation of various factors with the level of stress among policepersonnel.
To assess the quality of life and job satisfaction among policepersonnel.
To assess depression, anxiety and substance intake pattern amongpolice personnel.
To study the relationship between occupational stress and overallquality of life and psychiatric comorbidities mainly focusing ondepression, anxiety and substance intake.

TOOLS USED

PSQ-OP, PSQ-OG, WHOQOL, DASS, ASSIST

RESULTS

Results will be discussed at the time of presentation

KEYWORDS

Depression, Stress, Anxiety, Substance abuse, Police personnel

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

56. ABSTRACT- Reasons For Seeking admission in psychiatric indoor: (Psychosocial aspects)- A Cross Sectional Study.

Mayank Jain ¹, Sakshi Bhardwaj ^2,^✉, Hitesh Khurana ³

Introduction -Psychiatric illness is multifaceted and had impacts on to personal, social, occupational and other domains of life. Additionally, mental illness often invites stigma from the society. These factors many times leadto avoidance of psychiatric treatment as well as admission when it is required. Psychiatric admission is considered more stigmatizing than any other medical illness. Hence we preferred to take this study.

Objective- To explore reasons of admission and their association with psychosocial factors

Methods: Patient seeking admission in psychiatry indoor servicesin the Department of Psychiatry, PGIMS Rohtak from July to September 2018 were assessed using a self designed inventory for exploring various reasons for hospitalisation. The study is a cross-sectional study.

Results: Preliminary analysis suggests that most of the patients get admitted in the psychiatric indoor for medical reasons such as poor compliance to medication, inadequate response, worsening of pre-existing symptoms or development of side effects due to medication etc. A small proportion of the patients were admitted because of risk to self and others. Most of relatives of admitted patients did not feel stigma because of hospitalisation.

Conclusion: Though psychiatric illness and treatment is reported to be stigmatising in most of the literature, the findings of this study suggest improving mental health literacy in the community.

Keywords- Mental Illness, Stigma, Psychiatric Hospitalisation, Retrospective Cross Sectional Study

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

57. Overcoming The Barriers In North Borneo: Mental Health Promotion Using The KINABALU Module

Chua Sze Hung ^a,^✉, Nurul NadiahMuhammad ^b, Sarah Marilyn Amin ^a, Jessica Kaur Moti A/P Amarjet Singh ^a, Lew SheauVoon ^b, Loo Jiann Lin ^c, Nurul Nadiah Muhammad

Background: Malaysia National Health Morbidity Survey in 2015revealed that Sabah (North Borneo)recorded the highest (42.9%) prevalence rate of mental health problems with indigenous populationrecording the highest percentage (41.1%). Mental health literacy is low across the population especially among the rural indigenous and other vulnerable groups. The challenges of providing mental health promotion in the second most populous (3.87 million) and second largest state (73904 km²) in Malaysia with the psychiatrist to population ratio close to 1:300000are real, hence the need for an evidence-based, innovative and comprehensive approachin overcoming this difficulty.

Objective :Usinga locally developed module, we engaged in long term collaborative projects with multiple agencies aiming at delivering mental health promotion and improvinggeneral population and vulnerable groups mental health literacy.

Methodology : The authors would like to share a simple yet practical strategy (module) in achieving the aims.

Results : In order to improve mental health literacy across all segment of population, we developed a long-term collaborative module involving all relevant stake holders to provide comprehensive mental health promotion coverage across all segments of population, in particular the vulnerable groups. The KINABALU Module is a locally developed module targeting both the general population and vulnerable groups. KINABALU module takes into consideration of resource limitations, geographical challenges and lingo-cultural diversity. Five concurrent programs targeting different groups, using different strategies, modalities and partnerships were planned and executed. 1) Collaboration with Ministry of Education targeting school children and adolescent. 2) Collaboration with KadazandusunCultural Association targeting traditional healers, village elder and indigenous chiefs (Bobohizan Project). 3) Production and screening of mental health promotional videos in native language. 4) Collaboration with rural villages associations and volunteers targeting rural and indigenous population (KOSPEN Project). 5) Collaboration with social media celebrities targeting social media users (Bintang Mentari Project).

Conclusions : Mental health promotion as part of service development needs to take into consideration local needs, cultural appropriateness and resources availability. Innovative locally developed module will result in a more comprehensive and culturally appropriate approach. Utilizing multi prong strategies and collaborative efforts, KINABALU Module is a first effort of its kind in Malaysia Borneo at the time of writing to deliver mental health promotion, increase mental health literacy,improve access to mental health care services and ultimately better outcomein one of the most challenging yet unique states in Malaysia

Keywords: cultural psychiatry, mental health promotion, mental health literacy, rural psychiatry in developing country.

*kadazandusun is the largest indigenous group in North Borneo *Bobohizan is a traditional healer in kadazandusun community

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

58. TITLE: IMPACT OF URBANIZATION ON CHILD MENTAL HEALTH: A REVIEW

Namita Gautam ¹, Faisal Siddique, Abhijit Rojatkar

Background – According to the Indian 2011 Census, the level of urbanization in the country as a whole increased from 27.7% in 2001 to 31.1% in 2011. By 2025, 6 of 10 children will live in cities. The link between degree of urbanization and a number of mental disorders is well established across all age groups, however impacts of urbanization affect more to the vulnerable section: elderly, children and women. The purpose of this poster is to review the literature available regarding impact of urbanization on child mental health.

Method : A Pubmed and Google scholar based literature review was done using appropriate search terms. It was supplemented with cross references.

Results : Urbanization in developing countries creates multitude of interrelated problems such as unemployment, poverty, malnutrition, drug abuse and breakdown of the protective influences of the family. The vast majority of the world’s children is exposed to these and is at an increased risk of mental health problems. In studies schizophrenia, psychosis and depression have been found to occur more frequently in urban areas in all age groups. Increase in behavioural problems and eating disorders have also been found to increase in children who migrated from a rural to urban area and living in nuclear families. Homeless children in cities are subjected to economic and sexual exploitation; they have limited opportunities for intellectual development. Studies have shown that women in urban settings suffer more socioeconomic distress and violence than men, which in turn compromise mental health of women and children both.

Conclusion : Urbanization is vital for any countries economic growth. There is further need to assess influence of urbanization on health particularly mental health of children and to create awareness in the society. This will facilitate better care for child mental health along with balanced approach to development of countries.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

59. Title: CATATONIA IN PATIENT WITH FRONTAL LOBE ENCEPHALOMALACIA FOLLOWING TRAUMATIC BRAIN INJURY: DIFFICULTIES IN IDENTIFICATION AND TREATMENT

Vinutha Ramesh ^1,^✉, Aditya Somani ², Ashish Sharma ³

Department and Institution: Department of Psychiatry, Adesh Medical College & Hospital, NH-1, Mohri, Shahbad (M), Kurukshetra, Haryana, India, Pin code: 136135

Introduction: Catatonia following head injury has been sparsely studied. Diagnosing catatonia is especially challenging due to overlap of an array of neurological findings. Several case reports have been published and there is a varied range of presentation, posing difficulty in diagnosing the same.

Case Presentation: 31-year-old man with history of severe head injury a year ago presented with 20 days history of behavioural change. He refused food and water intake, and would hold the food in his mouth for long periods of time. He would keep his arm raised for several hours every day, and interacted minimally with family. He would keep his eyes closed and would not respond to call or touch. A differential diagnosis of meningoencephalitis and organic catatonia was made and he was evaluated for the same. Metabolic, haematological, endocrinology work-up and CSF analysis was normal to rule out meningoencephalitis. MRI brain revealed frontal lobe encephalomalacia. A diagnosis of catatonia was confirmed and he was given a trial of lorazepam but with minimal improvement. Electro-convulsive therapy was started with which he showed marked improvement in catatonic symptoms though cognitive deficits which developed following head injury persisted.

Discussion: The possible implication of this case is the need to identify catatonia at the earliest in order to reduce morbidity and mortality with appropriate treatment. However, it is important to note that organic catatonia often has a poor prognosis as compared to catatonia due to psychiatric illness.

Keywords: Head injury; Catatonia; ECT

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

60. A case report: Premature mortality in lithium use patient.

Desiree Saimbi ¹, Rupali P Shivalkar, Kumar Atmesh

Introduction:

Lithium salts are considered a gold standard treatment for mood disorders. Ithas a narrow therapeutic window and toxic levels can lead to a variety of systemic symptoms which confer significant morbidity. We present a case of bipolar disorder who wason maintenance therapy for many years with 600mglithium, developed multiple metabolic derangements and died of septic encephalopathy.

Case :

A 50 yr old obese, married lady. Addicted to smoking nicotine. Was brought to emergency with one monthhistory of anxiety, low mood and reduced sleep that exacerbated over last two days with marked restlessness and inconsolable crying episodes. Anamnesis revealed serum levels of lithium were not examined regularly. On examination she had no signs of lithium toxicity. A thoroughorganic workup was conducted,attempts were made to calm her using sedatives however she turned increasingly uncooperative and delirious. She was shifted to ICU under medicine,all psychiatric medicines were stopped. Reports revealed deranged kidney function, anemia, raised total leukocyte counts in blood and urine, hyperammonemia, serum lithium levels of 1.65mmol/L. All attempts to manage sepsis were made, blood cultures were positive for E.coli, pseudomonas. In due course of her treatment she developedcrepts and myocloinic jerks with poor urine output. Haemodialysiswas started however she turned hypotensive, developed high grade fever and had a seizure, later she suffered a sudden cardiac arrest and died.

Conclusion: There are various studies showing long term side effects of lithium salts on kidneys. In our patient unmonitored lithium levels could have possibly resulted in kidney dysfunction, however the causative linkage between two is difficult to establish as she had a rapidly deteriorating course. With sepsis she developed neurological complications, among the many complications of which septic encephalopathy (SE) is considered the most frequent and is an essential determinant of mortality. With this case we attempt to highlight routinely lithium levels monitoring could possibly prevent long term morbidity in our psychiatric patients.

Keywords : lithium intoxication, sepsis, encephalopathy, chronic kidney disease.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

61. Title-Anemia in patients suffering from mental health problems- A Cross Sectional study

Dahuja M ¹, Agarwal S ²

Background- Psychiatric patients are prone to develop anemia and other hematological changes because of neglect and poor nutrition. Routine blood investigations including Complete Blood Count (CBC) can throw light on the underlying hematological status of the psychiatric patients.

Objectives- To study prevalence of anemia and other hematological parameters in patients suffering from various psychiatric disorders.

Materials and Method- All In-Patients and Out Patients in Psychiatric Department who fulfilled the inclusion and exclusion criteria were included in this cross-sectional study by consecutive sampling technique. After obtaining consent and providing them with the complete information regarding the study; socio-demographic details of 100 patients were included in the study.

Results- In our study, 72% suffered from psychiatric illness from past 0-5 years and 28% suffered from psychiatric illness from 6-15 years. 78% of the patients were on continuous treatment. Out of which, 9% were taking treatment from past 6 months, 55% were seeking treatment from past 1-5 years and 14 % were taking treatment from past 6-10 years. 18% of them were substance abusers, 18% of them had a diagnosis of Schizophrenia, 34% of them had depressive illness, 6% suffered from Bipolar Affective Disorder (BPAD) and 24% of them suffered from Anxiety-Spectrum Disorders. Schizophrenics had more rates of anemia than substance abusers, and this finding was statistically just significant. Also in our study, patients of longer duration of illness had more anemic rates and these findings were statistically significant as well.

Conclusion- Anemia is a common physical comorbidity in patients suffering from psychiatric disorders.

Keywords- Hemogram, Anemia, Psychiatric Disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

62. A Cross-sectional study of Depression and Quality of life in Chronic Kidney Disease patients undergoing haemodialysis

Shijo John Joseph ¹, Samrat Singh Bhandari ², Sanjiba Dutta ², Dheeraj Khatri ²

BACKGROUND :Patients with Chronic Kidney Disease (CKD) who receive hemodialysis are vulnerable to emotional problems. Depression has been found to be a significant contributor to poor Quality of Life (QoL). There is a scarcity of literature with this regard in our country, which would be essential for better assessment and management of such patients.

AIMS AND OBJECTIVES : To assess depression and QoL in CKD patients undergoing haemodialysis and the impact of depression on their QoL.

METHODS : Patients were assessed from two dialysis centres in Sikkim. Patient Health Questionnaire-9 (PHQ-9), World Health Organization Quality of Life-BREF (WHOQOL-BREF) and Charlson Comorbidity Index (CCI) scales were used. Sociodemographic and clinical variables were described using mean and SD for continuous variables, while categorical variables using percentages. Non- parametric tests were used for inferential analysis due to skewed distribution.c² test was used to analyze the categorical data. Kruskal-Wallis and Man Whitney U test were used to find the association between categorical and quantitative variables. Spearman’s rho test was used to find the correlation between quantitative variables.

RESULTS : The mean age of the participants was 49.21 (SD=13.371). The number of males was higher (58.6%) than females (41.4%).A sizable number of participants (45.9%) were unemployed individuals. The duration of dialysis had a mean of 16.00 (SD=12.781) (in months).

The prevalence of depression was found to be 36.04%. QoL had mean scores of 11.1609 (SD=2.61954) for physical health, 13.3682 (SD=2.54318) for psychological health, 16.0360 (SD=2.77192) for social relationships and 14.3919 (SD=1.65887) for environment. Depression was found to significantly impact all domains of QoL negatively. (p-value=0.000, with all domains of QoL) CONCLUSION : This study concluded that depression is prevalent in CKD patients undergoing haemodialysis and it adversely impacts QoL in all domains.

Keywords: Dialysis, Depressive disorder, WHOQOL, Sikkim

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

63. Phenytoin Induced Psychosis –A Case Report

Juhi Gupta

Introduction

Phenytoin is one of the most commonly used low cost antiepileptic drug used in children in India. Although the drug has wide range of pharmacokinetic variability it has a narrow therapeutic index that can lead to toxicity. Drug overdose or toxicity can lead to varieties of psychiatric or cognitive disorders. Case reports are coming on encephalopathy, cerebellar atrophy, cognitive impairment particularly in children. Psychosis induced by phenytoin toxicity is not so common. Here we report a rare case of phenytoin induced psychosis.

Case Report A 15 years old girl was admitted with alleged history of accidental ingestion of 15 tablets of phenytoin tablet 100mg. She had history of epilepsy for 5 years and she was well maintained on oral Phenytoin 100mg BD. At the time of admission she was semi-conscious and she was treated as a case of drug toxicity/overdose. Investigations including LFT, electrolytes, EEG were within normal limits. After 3 days she was restless and aggressive, talked irrelevantly, fearful and suspicious. She was physically restrained. On MSE, psychomotor activity was increased, irrelevant talk present, shouting spells and persecutory ideas were there. Olanzapine 5mg BD, Folic acid 5mg BD, Methylcobalamine injection 1500 mg per day with Lorazepam 2mg at bedtime was given along with other supportive treatment. Patient gradually improved in next 5-7 days and was discharged on Olanzapine 5mg BD and folic acid 5mg BD after 20days of hospitalisation after complete recovery.

Discussion Phenytoin toxicity can be seen in patients with earlier folic acid deficiency but high dose of phenytoin (>5-6 times of normal dose) can lead to behavioural and cognitive problem even without folic acid deficiency state. These psychiatric symptoms are short lasting. Antipsychotics and higher dose of folic acid have prime role.

Keyword Phenytoin, Adolescent growing brain, Drug toxicity, Folic acid deficiency.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

64. Profile of donors referred for psychiatric assessment before living kidney transplantation in a tertiary care setting

Ragul Ganesh ¹, Tamonud Modak, Saurabh Kumar Singh, Koushik Sinha Deb

Background: Renal transplantation is a successful medical intervention for the treatment for end-stage renal failure. It increases the quality of life of the recipients. More than 90% of the transplants come from living donors. The donors are at slightly higher risk of end-stage renal disease and cardiovascular diseases that impair the quality of life. Screening of the living kidney donors for any medical and psychiatric conditions is essential before transplantation.

Objective: This study aimed to assess the profile of the living kidney donors to understand the factors associated with living kidney donation.

Methods: Sixty-five living kidney donors referred for screening to psychiatric outpatient clinic were recruited into the study.

Results: Out of the 65 living donors, 27 were males and 38 were females. The mean age of donors was 48.42 (+ 8.56) years. Most of the donors were married (n=45) and 21% of the donors (n=14) had lost their partners (p <0.001). Majority of the living kidney donors had formal education (n=36; p <0.001) and the mean years of education of the donors was 9.48 (+ 5.38). The mean duration of relationship between the donor and the recipient was 22.25 (+ 6.83) years. Though the total members in the family were 5 (+ 1.35), only 1.29 (+ 0.49) volunteered for living kidney donation. Majority of the living donors were housewives (n= 24; p <0.001) and non-earning members of the family (n=42; p =0.018).

Conclusion: The study assessed the profile of living kidney donors referred for psychiatric consultation before transplantation. it showed that most of the donors belong to age groups between 41-50 years which was comparable to national population. Housewives and being a non-earning member of the family were strongly associated living kidney donation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

65. A case report of Acute onset Organic delusional parasitosis

E Gokulan ¹, V Mythili, V Venkatesh Mathan kumar

Case report:

Introduction :

Delusional parasitosis is an infrequent psychotic illness characterised by an unshaken belief of having been infested by a parasite when one is not. It can be primary, secondary, or organic. Though delusional parasitosis have beenreported previously. Delusional parasitosis in the background of organic aetiology with acute course is rarely reported.

Case history : A 50 year old female, presented with complaints of persistent belief that insects crawls over her body and frequently trying to take insects from body and crushing it along with sleep disturbance for 2 months with H/o depressive episode 2 years back improved with drug treatment and h/o ventricular tachycardia on cardiac drugs for past 5 years and recently diagnosed diabetic on drugs. MSE revealed she was frequently picking up from her axilla, arms and head and keeping it on the table and claims it as insect which was not visualised, delusion of infestation. CT scans and MRI scans were found to be normal.she was given Haloperidol,Trihexiphenydyl and lorazepam.

Discussion : we considered the possibility of delusional parasitosis being primary, drug induced or organic aetiology. Psychometric assessment was done, neurologists and cardiologist opinion obtained.

Conclusion : Delusional parasitosisbeing relatively rare and have been reported before,the cause of this syndrome is not fully understoodand the difficult part is convincing the patient of the absence of parasites.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

66. Thyrotoxicosis precipitating core symptoms of paranoid schizophrenia: a case report.

Rupesh Senapati ¹, S Pareeja ²

Cuttack

Introduction- Thyrotoxicosis is defined as excessive production of thyroid hormones. The symptoms being anxiety,heat intolerance, opthalmic signs, sweating, palpitations, tremor, anxiety, panic attacks and emotional lability.psychosis and paranoia are common in thyroid storm.

OBJECTIVE- To follow and review a case of Thyrotoxicosis with predominant neuropsychiatric manifestations.

METHODOLOGY AND RESULTS- A 30 yr old male presented with symptoms of irritability, fearfulness, visual hallucinations, paranoid, hostility, aggressiveness,and combative × 3days and odd behaviors× 2 months. He was admitted with a prov/D of ATPD WITH SCHIZOPHRENIA LIKE SYMPTOMS. MSE and GE revealed tachycardia, fever, hypertension, increased RR, tremor, sweating, exophthalmos,lid lag, restlessness, irritability, weight loss, THYROMEGALLY, increased pma, fearfulness, dysphoria, paranoid delusions, visual and auditory hallucinations of ppl. F/H - Father- a k/c/o schizophrenia. The endocrinologist gave a prov/d of Thyrotoxic crisis with Neuropsychiatry manifestation d/t highT3 and T4 low TSH, and usg finding. He was started on propranolol 20 mg TDS, methimazole 20 mg TDS. In 2 weeks the symptoms of Thyrotoxicosis remitted dramatically but the Psychiatric symptoms persisted albeit in a low intensity with olanzepine 15 mg hs and promethazine 25 mg hs. TFT after 1 month showed euthyroid status but he was having symptoms of paranoia and elementary hallucinations and irritability but was functioning well. He is in follow up in psy. opd for last 5 months with improvement with olanzepine 15 hs. antithyroid medications are being tapered off. Looking at the longitudinal course of the disease the diagnosis has been changed to paranoid schizophrenia

CONCLUSION- Thyrotoxic crisis can act as an neuroendocrinological equivalent of stresser and precipitate the symptoms of schizophrenia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

67.. TITLE: LINEZOLID INDUCED SEROTONIN SYNDROME: A CASE REPORT

Rajeet Kumar ¹, Anish Shouan ², Sandeep Grover ²

Background: There is limited information on serotonin syndrome occurring in patients receiving Linezolid.

Aim: To present a case of Serotonin syndrome associated with use of Injection Linezolid.

Methodology (Case Description): A 70 year female presented with acute onset and progressive illness of 2 days duration characterized by sudden loss of consciousness followed by hemiparesis of the right side of body. On evaluation was found to have hypertension and diabetes mellitus for the first time. Her Magnetic Resonance Imaging revealed evidence of intracranial haemorrhage (Left Basal Ganglia Bleed). During the course of her illness she developed pneumonia, which was resistant to Vancomycin. In view of this, about 2 weeks after the onset of the symptoms, she was started on Injection Linezoid 600mg twice a day. After about 6-7 hours of starting of Injection Linezolid she developed additional symptoms of shivering, diaphoresis, fluctuations in blood pressure, tachycardia, fever and altered sensorium. Her neurological examination revealed evidence of hyperreflexia, clonus and muscle rigidity. On investigations she was found to have raised creatinine kinase (7914 U/L) levels along with leukocytosis (total leucocyte count: 16000). Initially she was started on Tab. Bromocriptine 5mg tds by the primary treating team, but no improvement was noted. At this time, she was seen for the first time by the Psychiatry Consultation Liaison team. In view of temporal correlation between starting of symptoms with use of Injection Linezolid, a diagnosis of Linezolid Induced Serotonin syndrome was considered and Injection Linezolid stopped immediately and patient was started on Tab. Cyproheptadine 1mg qid. Over next 48 hours, all her symptoms of serotonin syndrome resolved and her creatinine kinase levels normalized.

Conclusion: This report suggests that serotonin syndrome can develop with medications other than psychotropics, especially with antibiotics like Linezolid and ritonavir. Precautions should be taken while starting of antibiotics especially known to cause such side effect. High index of suspicion is required.

Key words: Linezolid, Serotonin Syndrome 1. Boyer EW, Shannon M. The serotonin syndrome. New England Journal of Medicine. 2005;352:1112–20.

2. Quinn DK, Stern TA. Linezolid and Serotonin Syndrome: (Rounds in the General Hospital). The Primary Care Companion to The Journal of Clinical Psychiatry. 2009 Dec 15;11:353–6.

3. Gupta V, Karnik ND, Deshpande R, Patil MA. Case Report: Linezolid-induced serotonin syndrome. BMJ case reports. 2013;2013

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

68. TITLE: Injection Zuclopenthixol depot induced Neuroleptic Malignant Syndrome: A CASE REPORT

Ankit Kumar Sinha ¹, Anish Shouan ², Sandeep Grover ²

Aim: To present a case of 35 year male who developed Neuroleptic Malignant Syndrome after starting the Injection Zuclopenthixol depot.

Methodology (Case Description): A 35year old, male, married, 10^th pass, hailing from rural background, with no family history of mental illness presented with abnormal change in behavior since 7 days. Exploration of the history revealed that, following an acute onset symptoms of delirium, 7 days back, he was given Injection Zuclopenthixol depot 200mg thrice on the same day. Within 24 hours of receiving Zuclopenthixol patient started having fever, stiffness of limbs, profuse sweating and agitation. On examination, his heart rate was 130/ min, temperature was 102⁰F and blood pressure was 80/50 mmHg. His serum CK-NAC level (839.9U/L) were found to be raised. A diagnosis of Neuroleptic Malignant Syndrome was considered. Patient was started on Tab. Bromocriptine 5mg TDS with other conservative management. With this management he showed significant improvement in the above said symptoms over the period of next 3 days.

Conclusion: Zuclopenthixol can also lead to Neuroleptic malignant syndrome (NMS).

Keywords: Neuroleptic malignant syndrome (NMS); Zuclopenthixol

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

69. Title: Catatonia associated with seizures due to parietal lobe cavernoma

Aditya Somani ^a,^✉, Ashish Sharma ^b, Nitin Goyal ^b, Manish Gulia ^b

Department and Institution: Departments of ^aPsychiatry and ^bRadiology, Adesh Medical College & Hospital, NH-1, Village Mohri, Tehsil Shahbad (M), District Kurukshetra, Haryana, India, Pin code: 136135

Abstract: Catatonia has been found to be associated commonly with psychiatric disorders and less commonly with organic disorders. In this report, we present case of a 35 years old male who was admitted to the hospital in view of multiple seizure episodes. He developed catatonia on second day of admission which improved with lorazepam. Neuroimaging revealed that he has a bleeding cavernoma in right parietal lobe. He continued to remain well only on sodium valproate, even when lorazepam was tapered off. Review of literature revealed that there are cases of patients developing catatonic features before, during, after or in-between seizures or in association with other lesions of parietal lobe. There is no reported case of catatonia in association with seizures due to cavernoma.

Keywords: Catatonia; epilepsy; seizures; parietal lobe cavernoma

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

70. Utilization rates of consultation-liaison psychiatry in north Indian tertiary teaching hospital in Uttarakhand

Arghya Pal ^1*, Rohit Gondwal ¹, Priyaranjan Avinash ¹

Introduction-

Consultation-liaison psychiatry (CLP) is a sub-specialty of psychiatry that involves clinical, research and teaching activities of psychiatry in the non-psychiatric departments. The services of CLP has resulted in growth of both psychiatry and other related branches and resulted in better care of patients with mental health symptoms. Limited recent data is available regarding the utilization rates of CLP from Uttarakhand. The current study will aim to bridge that gap.

Methods-

Data of referral to CLP from other departments will be collected over the period of January 2018 to December 2018. Data regarding the primary diagnosis and the psychiatric diagnosis (if any) will be collected. Appropriate descriptive statistics will be administered.

Results-

Trends of utilization across departments and months will be observed.

Conclusion-

The current study will enable us to understand the trends of utilization and also help in planning the services of CLP. Comparison of our data with existing literature will provide us information regarding the unique trends of our center. Review will be conducted with the aim of indentifying scope of improvement in our services.

Keywords-

Consultation liaison psychiatry, Epidemiology, India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

71. TITLE: An adolescent with Wilson’s disease presenting as neuropsychiatric disorder: A case report

MANISH KUMAR GOYAL ¹, GUNJAN SOLANKI, DHARAMDEEP SINGH, ALOK TYAGI, YOGESH SATIJA, PRADEEP SHARMA

Abstract: Wilson’s disease is a genetic disorder of copper metabolism with a prevalence of 1 in 30,000. Sometime it presents with Neuropsychiatric symptoms along with hepatic symptoms. If untreated it may lead to severe disability and death. Patients presenting with non-specific behavioural changes along with subtle neurological symptoms needs meticulous investigation to rule out disorders like Wilson’s disease.

A 13-year-old Hindu boy presented with one year illness of acute onset and continuous course with complaints of decreased sleep, wandering tendency, nonsensible talk and aggressive, abusive behaviour since one year. Later, he developed episodes of rigidity of limb and body, crying, rolling on floor, bowel & bladder incontinence followed by forgetfulness about these episodes. No history of head injury, loss of consciousness, substance use, past and family history of psychosis were reported. They had multiple consultations and eventually child was diagnosed as psychosis NOS and seizure disorder and was treated for the same. But no improvement was seen on any symptom domains except for sleep. He was admitted in psychiatric centre, Jaipur on 27/11/2017. On examination he was conscious and uncooperative with incoherent speech. Poor response to psychotropic & antiepileptic drugs & raised SGOT/SGPT/ Serum alkaline phosphatase with this presentation led to suspicion of WD which was affirmed by presence of Kayser-Fleischer ring in slit lamp examination, and low ceruloplasmin level. MRI brain showed empty Sella but normal serum cortisol. When diagnosed early in liaison with neurologist, ophthalmologist and hepatologist, WD can be effectively treated and hence should be suspected in such presentations.

Key words: Wilson Disease WD, Psychosis, Empty Sella, Adolescent

Presenting Author’s contact details: DR MANISH KUMAR GOYAL

Email address – mangoyal7@gmail.com Full postal address -64, Indira colony, Alwar, Rajasthan-301001 Mobile number -91-9024049697, 91-9351590911

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

72. TITLE : DELUSIONAL PARASITOSIS IN A ELDERLY WOMAN WITH DEMENTIA - A CASE REPORT

Swati Singh ¹

As a decline in cognitive performance and progressive deficits in social competence are the results of neurodegeneration, behavioural disturbances are common and often the initial presenting features of dementia. A 72 year old married women, hailing from deep south is a Tamil speaking Hindu. She is uneducated and used to work as a farmer. She was brought by her family to the psychiatric OPD with complaints of claiming that insects are crawling in & about her head, Preoccupation, Sleeplessness, Decline in food intake, Decreased interaction & self-care for the past 2 years. It was insidious in onset and progressive, increasing over the past 3 months. Over these 3 months, the patient was becoming increasingly agitated, hitting those around her with outbursts of unprovoked anger. She was admitted and treated under psychiatry with frequent consultations from Dermatology. On neuropsychological testing, she tested positive for decline in attention and concentration as well as an impairment in immediate memory which indicates an ongoing neurodegenerative disease. This poster is done to emphasise the importance of coordination of treatment from both psychiatry and dermatology, not only for better treatment outcome but also to improve the quality of life of the patient.

Keywords : Dementia, Neuro-degeneration, Delusion of parasitosis, Behavioural disturbances

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

73. Title: Psychiatric illness in pregnancy and consultation liaison psychiatry aspects.

APOORVA YADAV ¹, Vivek Kumar, Supriya Agarwal, Gurisha Singh

Background: Consultation liaison psychiatry is undoubtedly a very important subdivision of psychiatry. And yet, is often undervalued. Pregnancy in female psychiatric patients is known to exacerbate underlying psychotic symptoms, sometimes presenting with medical complications like anaemia due to poor nutrition and poor self-care. Thus managing such cases falls under the domain of a multi-disciplinary team, consisting of a psychiatrist, an obstetrician and a physician. Cases like these would have been extremely difficult to manage individually for either of the departments involved.

Objective: The aim of this paper is firstly, to report a case of a 34 year old woman (gravida 3 para 2 living 2) in the eighth month of her pregnancy, along with severe anaemia, fever and a psychotic exacerbation, and secondly to discuss consultation liaison psychiatric aspects in relation to it.

Method: A case report and review of literature of a 34 year old woman with schizophrenia with an exacerbation, with severe anemia, fever and a third trimester pregnancy is presented.

Results: The psychotic symptoms started resolving within 2 weeks and 3 units of blood were transfused to the patient. The oversight of the medicine and the obstetrics departments throughout the length of the stay of the patient in the psychiatry ward resulted in a quick and positive recovery for our patient.

Conclusions: Consultation liaison psychiatry is an oft ignored subset of psychiatry that is just as important as the speciality itself especially in the setting of a multispeciality hospital. Patients admitted in the psychiatry ward can present with medical/surgical co-morbidities which should be dealt in consultation with these respective departments.

Keywords: Schizophrenia, Pregnancy, Severe Anemia, Consultation Liaison Psychiatry, C-L Psychiatry

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

74. Excoriation (skin picking) behaviour in a case with Intellectual disability

Ivan Netto ¹, Anurag Borade ², Krishna Kadam ³, Niteen Abhivant ⁴

Background:

Although skin picking has been documented in the medical literature since the 19th century, only now is it receiving serious consideration in DSM5 as a psychiatric disorder. Its prevalence ranges from 1.4% to 5.4%. Skin picking disorder is not diagnosed if there is an associated psychiatric disorder. We describe a case of a patient with Intellectual disability with skin picking behaviour and the management.

Case report:

A 25 year old unmarried female a known case of intellectual disability, was brought for skin picking behaviour. She had in the past skin lesions infected, crusted and non-crusted lesions on the ventral aspects of her forearms. She also has healed skin lesions with erosions and scars with angulated borders on both her forearms. On mental status she is untidy but kept clean. She has increased psychomotor activity with skin picking behaviour. She is unco-operative. She has no delusions or hallucinations. Her insight and judgment is lacking. Her IQ was in the range of 20-35. She was treated with Tablet Olanzapine 10 mg at bed time and tablet Valproate 750 mg at bedtime. She was treated for her skin lesions by a dermatologist.

Conclusion:

Evaluation of patients of intellectual disability with skin picking entails a detailed physical and psychiatric examination, encouraging an interdisciplinary approach to evaluation and treatment. Cognitive-behavioral therapy including habit reversal or acceptance-enhanced behavior therapy and medication such as serotonin reuptake inhibitors used for skin picking disorder is not effective with patients with Intellectual disability. She responded to treatment mainly for her primary psychiatric condition and for her dermatological condition.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

75. A Case of Hyperthyroidism presenting as acute psychosis: case report

Karnik Kishore ¹, Shymanta Das, Dipesh Bhagbati

Introduction-

The common behavioural symptoms of hyperthyroidism include fatigue, irritability, emotional lability, and excitation. Severe and disabling anxiety is also found The psychiatric presentation varies widely; patients may be delirious, there may be alternate periods of hyperexcitability and exhaustion (Kamlana & Holms, 1986).

With this background in mind, we present a case of behavioural disturbance in association with hyperthyroidism.

Case History A 21 years old female was brought to the psychiatry outpatient department (OPD), it was found during evaluation that she was very anxious and irritable, and her psychomotor activity was increased. She also had visual and auditory hallucinations. She was admitted with a provisional diagnosis of acute and transient psychotic disorder..

. During inpatient treatment, she also complained of palpitations, tremors with heat intolerance, and increase in stool frequency over the last six months. Physical examination revealed bilateral proptosis and lid lag. Her thyroid gland was visibly and palpably enlarged, and non tender.

Laboratory examinations revealed decreased levels of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH), but increase in the levels of anti-thyroid peroxidase (TPO) antibody. She was diagnosed to be a case of thyroid grade II goitre

Discussion Although a primary psychiatric illness should be considered in the differential diagnosis, patients presenting with abrupt onset of psychotic symptoms or features such as irritability, nervousness, exictability, and pressure of speech should be screened for thyroid or other endocrine abnormalities. The presence of psychotic symptoms along with manifestations such as palpitation, weight loss, heat intolerance, and gastrointestinal symptoms such as loose stools and vomiting should give rise to the possibilty of hyperthyroidism (Mahmood et al., 2005).

Our case throws light in this area of consultation-liaison psychiatry.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

76. TITLE: Ketamine therapy and its efficacy in treatment of depression

Suprio Mandal ¹, Vinod Kumar Sinha ², Nishant Goyal ³, Nirmalya Mukherjee ⁴

Background: Major depressive disorder is one of the most debilitating condition prevalent worldwide. Ketamine is NMDA receptor antagonist having rapid action on depressive symptoms.

Objectives: Ketamine at subanesthetic doses have effect on different symptoms in depressive disorders. Here we will examine the effects of subanesthetic dose of ketamine on various psychopathology variables in terms of depressive symptoms, anxiety symptoms, and illness severity comprehensively in terms of immediate effect and delayed effect after repeated doses of injection on male patients of severe depression.

Methodology : A open label study of 20 patients (19 completed the study) of male sex, with a diagnosis severe depression, having no previous history of psychotic disorder, head injury, organic disorder, substance use and drug free for 4 weeks, having no cardiological problem were admitted in patient, assessments were done at baseline then injection ketamine hydrochloride was given at dose of 0.5mg/kg intravenous bolus, assessments were done at 1 hour of first dose, total 6 doses were given in similar pattern over two weeks. After two weeks final assessment was done.

Results : There is significant lowering of HAM-D, HAM-A and CGI-severity of illness from baseline to two weeks. Whereas change in scores at first hour is significant for HAM-D and HAM-A. Adverse effects seen are mild and transient and subsided within one hour of ketamine injection.

Conclusion: Ketamine has robust and rapid effect on depressive and anxiety symptoms as well as this improvement is sustained with repeated dosing after two weeks and there is overall decrease in illness severity with repeated dosing and it is also well tolerated in dose of 0.5mg/kg given intravenous bolus.

Key words: Ketamine hydrochloride, depression, NMDA

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

77. Title: Coping styles in patients with current depressive episode

Sheetal Tripathi ¹, Nitin Sharma, Shantanu Bharti, Ajay Kohli, Anju Agarwal, Abdul Qadir Jilani

Background: Stresses are most common triggers of depression. Coping styles can affect human stress response. The data on coping styles in depression is scarce especially in our Indian settings. Therefore we aimed to examine the coping styles among the patients with depression.

Methodology: In a cross sectional observational study, we included 103 participants with current depression episode as per ICD 10 criteria. MINI neuropsychiatric interview was applied to rule out other psychiatric illnesses. Hamilton Depression rating scale (HAM-D) was used to assess the severity of depression. Mechanism of coping (MOC) scale was used to examine ways of coping among participants. Proportions were compared using chi-square () test. A two-sided (α = 2) p <0.05 was considered statistically significant. Software’s MS-Excel and SPSS version 18 were used for analysis.

Results: Mean age of the participants was 34.36±9.82, with 34% presented from age group of 31-40 years, particularly female (65%) and married patients (81.6%). Almost 85% of the participants comprised of severe and moderate depression with almost equal distribution and only 15 % had mild depression. Fatalism was the most dominant coping strategy with mean raw scores of 12.18±3.44 and weighted average of 1.74 whereas escapism was the least common coping strategy with mean raw scores of 3.39±2.38 and weighted average of 0.68. No significant association between depression severity and mean scores for different dimensions of coping strategy could be seen.

Conclusion: This study shows that patients with depression have maladaptive coping styles such as fatalism. Therefore in management it is important to redirect the coping styles from passive coping to active coping, so that patients of depression could deal with it in a better way and ease one’s consciousness.

Keywords: Depression, Coping Styles, Fatalism

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

78. Prevalence of depression and anxiety among patients attending Cardiology OPD : A hospital based study in south India.

R Vadivambal ¹, R Gandhibabu ², M Asok Kumar ², S Periasamy ²

Introduction:

Cardiovascular disease (CVD) and depression are considered to be one of the leading causes of disability in the world. This relationship is found to be bidirectional. Depression is considered to be an independent risk factor like diabetes, smoking, hypertension etc., for developing CVD and this not only hampers the recovery but also increases the further risk. Depression is under diagnosed in a medical setting. Co morbidity poses a treatment challenge for Cardiology and Psychiatry. Early assessment and treating of co morbidity is found to enhance the quality of life in cardiac patients. The intention of this study is to gain appropriate knowledge about the prevalence of depression and anxiety among patients attending cardiology outpatient clinic. In the present study a hundred patients were selected consecutively from cardiology outpatient department and were evaluated for the presence of depression.

Keywords: Cardiac outpatients, Psychiatric morbidity, HAM-D, HAM-A

Materials and methods: The study was conducted at Cardiology OPD, Rajah Muthiah Medical College and Hospital, Annamalai University, Chidambaram.

Study period was from June 2017 to December 2017. A sample of 100 patients attending Cardiology OPD were consecutively chosen for the study. It is an Observational study - Descriptive type. The collected data was entered in Microsoft excel and analyzed using SPSS version 21. Quantitative data was analyzed using descriptive analysis.

Results: There was a high prevalence of depression and anxiety among cardiac patients. Sociodemogrphic factors had significant correlation.

Conclusion: As per the study we can’t ignore the high prevalence of depression and anxiety. Early identification and treatment of these will enhance the quality of life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

79. Intravenous ketamine in refractive depression: a poster presentation

SHIVANG ¹

It is widely accepted that at least 20% of all depressed patients do not respond adequately to several antidepressant drugs. Intravenous ketamine has shown rapid antidepressant effects in early trials, making it a potentially attractive candidate for depressed patients at imminent risk of suicide.

We present a male patient of middle class family. Who came to psychiatric OPD. Patient was working in orchestra had depression since past 6 months patient had decreased interest into day to day activity, low mood, sleep disturbance, ideas of helplessness and hopelessness. patient was on desvenlafaxine 37.5mg BD. We gave him ketamine infusion therapy 0.5mg/min/kg slowly. We gave him 6 cycle of ketamine infusion with concomitant desvenlafaxine and patient improved.

The importance and difficulty of ketamine infusion therapy in treatment of refractive depression will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

80. BRANCHED CHAIN AMINO ACIDS AS POTENTIAL BIOMARKERS IN DEPRESSION- A CROSS SECTIONAL STUDY

Surabhi Pandit ¹, Basudeb Das, Alok Pratap Singh

BACKGROUND - Recent research provides emerging theories on the pathophysiology of depression and possible mechanisms of action of antidepressants involving neurobiological processes underlying synaptic plasticity. Branched-chain amino acids (BCAAs) leucine, isoleucine and valine activate the mTor(mammalian target of rapamycin) pathway. mTor is dysregulated during depressive episodes, and ketamine-induced activation of mTor is associated with a short-term decrease of depressive symptoms. BCAAs might play an unrecognised vital role in the development of depressive symptomatology through their activation of the mTor pathway. This research is to evaluate whether BCAAs are altered in patients with depression and might thus be appropriate biomarkers. The study aims 1) To see the difference in levels of branched chain amino acids in patients with depressive episode and healthy controls. 2)To see the correlation between levels of branched chain amino acids and symptom severity including suicidality in depression.

MATERIALS AND METHODS - 30 cases diagnosed with mild, moderate or severe depressive episode without psychotic symptoms or recurrent depressive disorder, according to ICD-10,DCR were recruited in the study. They were rated on HAM D, Beck’s Depression Inventory, Beck’s scale for suicidal ideation. Blood samples (5ml) were collected using appropriate safety measures. The normal controls were picked out by matching age and sex with the patients after they have fulfilled the inclusion criteria. Their blood samples (5ml) were assessed under similar conditions to the patients. The level of branched chain amino acids Valine, Leucine and Isoleucine was measured using Branched chain amino acids ELISA kit. Statistical analysis was done using IBM SPSS version 25.0 for Windows.

RESULTS and CONCLUSIONS - They will be discussed at the time of presentation.

KEYWORDS - BCAAs, mTor pathway, Biomarkers, Depression.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

81. A RARE CASE OF DELUSION OF PREGNANCY: A CASE REPORT

Jwalant Samir Chag ¹

Delusion of pregnancy is a false, fixed belief of being pregnant; the belief is unshakable & is held despite all evidence to the contrary.

About one-fourth of the patients had developed delusion of pregnancy after the age of 50 years. The duration of the delusion was variable, with about one-tenth of them having the delusion over 10 years, and one case was even documented to have the delusion over 20 years.

I present to you a 57 years old Muslim female patient who came to Psychiatric OPD with complaints of sadness of mood, vague abdominal discomfort, belief that she is carrying a child within her, feeling that the child is dying inside and emanating foul smell from within, disturbed sleep and decreased appetite. She was diagnosed as Severe Depressive Episode with Psychotic symptoms and was treated with Antipsychotics, SSRI and ECTs. Currently the delusion has resolved and the patient is convinced that there is no dead foetus within her.

The purpose of presenting the case was to highlight the differences between two rare entities, Delusion of pregnancy & Pseudocyesis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

82. A CASE REPORT ON PATIENT WHO PRESENTED WITH DELUSION OF POVERTY

PARMAR SURBHI MADHUSUDAN ¹, NIMESH C PARIKH, NILIMA D SHAH, VINOD M DARJI

KEYWORDS: Delusion of poverty, depression

BACKGROUND:

Delusion of poverty depicts that person strongly believes to be financially incapacitated. This type of delusion is less common. Literature review shows that delusion of poverty is seen in setting of monosymptomatic delusional disorder and psychotic depression.

CASE HISTORY:

A 37-year-old Hindu unmarried female patient was brought to psychiatry outpatient clinic of a tertiary care hospital, with catatonic features and fix, firm belief that she is poor and her family doesn’t have any money, since last 15 years, in spite of being financially competent and having high educational degrees like Masters in Commerce (M. Com) and Bachelor of Law (LL.B). She strongly believed that she and her parents do not have enough money for even basic amenities like food and clothes and they soon would be roaming on the streets like beggars, despite being provided repeated evidences of adequate income like her possessions, jewellery and showing copy of bank balance. This was initially precipitated by an actual event of financial loss of her father 15 years back. Due to this, she also reported depressed mood, decreased interaction, two suicidal attempts and frequent death wishes in last 15 years. Patient was admitted and diagnosed as Major Depressive disorder with Mood Congruent Psychotic features as per DSM-V. The patient was started on Escitalopram 20 mg/day and Desvenlafaxine 50 mg/day as antidepressant, Clozapine 200 mg/day as antipsychotic and also Electroconvulsive therapy and the delusion of poverty decreased in intensity on these interventions along with improvement in depressive symptoms. Currently patient is better on regular treatment.

CONCLUSION:

Thus, here is a case report of a patient with delusion of poverty to highlight intricacies of the phenomenology. Here, delusion of poverty is found to be a part of depressive theme of illness.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

83. Title of the article: Revisiting Omega and Veraguth’s sign

Anantprakash S Saraf ¹, Santanu Nath

Abstract:

Omega sign and Veraguth’s fold are classically associated with melancholic depression. These result from prolonged contraction of corrugator and procerus muscles in the glabellar region. Having historical origins dating back to Darwin, there is now a renewed interest in these signs and their neurobiology; considering implications from both therapeutic and diagnostic point of view. Botulinum toxin in the glabellar area is now been increasingly used to treat depression, based on the “facial feedback hypothesis”. New advancements in facial recognition algorithms are exploring these facial signs for digital diagnosis and other purposes. The current report tries to relook into these historically important signs of depression for a different perspective, focussing on their nomenclature to their neurobiological underpinnings and their role in the overall management of this mood disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

85. Severe EPS caused by sub-therapeutic dose of SSRI

Ajay Yadav ¹, Neelesh Tiwari, Anisha Batra, Ridhi Arora, Priyanka

Discussion:

As per the guidelines standard dose of escitalopram 40mg – 60mg 1 x od as in max whose age was 24 years old with lean built weighing 68kg. Mr. x was given just 5 mg of escitalopram in morning that too gradually increased.

Symptoms of EPS started within 72 hours and after adding anti-cholinergic

symtoms were resolved within 8-10 hours of addiction. Though we give SSRIs so casually folloeing the guildlines but this can highlights the significance of propensity to cause EPS by Escitalopram and warns us.

To keep a close eye and observation while starting SSRI in a new patient.

Important : MRI and KFT, LFT reports were wnl.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

86. Empathy, Gender and Psychiatry as a Career Option among Medical Undergraduates

Samir Kumar Praharaj ¹, Santosh Salagre ², PSVN Sharma ¹

Background: Empathy is an essential attribute among healthcare professionals and is necessary for good doctor-patient relationship. In person-oriented specialty such as psychiatry, empathy is very relevant. Most studies have found higher empathy scores among females. The objective was to study whether female medical undergraduates and those with higher empathy scores may choose psychiatry as a career option.

Methods: This was secondary analysis of baseline data from a study examining effectiveness of Stigma, Empathy and Attitude (SEA) Module for medical undergraduates. 156 medical undergraduates from fifth semester (females, n=89) participated in the study. They were evaluated on Jefferson Scale for Empathy (JSE) - Medical Student version (S – version 2.3). All students were asked whether, given an option, they will choose psychiatry as a postgraduate career.

Results: Mean JSE scores were lower among females (85.7, SD 6.8, 95% CI 84.3 to 87.2) as compared to males (88.6, SD 7.9, 95% CI 86.7 to 90.5); the difference was significant (p=.016), but of small effect (Hedges’ g=0.389). Higher proportion of females (59.8%) agreed that they may choose psychiatry as a career given an option compared to males (50.8%); the difference was not significant (p=.274, φ=0.089). Linear regression analysis with JSE score as outcome showed significant relationship with female gender (B=-3.09, 95% CI -5.45 to -0.73), and no significant relationship with age (B=-1.28, 95% CI -2.59 to 0.03) and psychiatry as career option (B=0.44, 95% CI -1.90 to 2.78).

Conclusions: In contrast to previous studies, females had lower empathy scores compared to males, but the difference was small. Female gender and higher empathy scores were not associated with choosing psychiatry as a career option.

Key words : Empathy; Psychiatry; Gender; Career; Medical Undergraduate

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

87. “SAILING OUT FROM THE BLUE WHALE TRAP”

Niska Sinha ^1,^✉, Rajesh Kumar Singh ², Krishna Kumar Singh ³, Shweta Roy ⁴

INTRODUCTION: The Blue Whale Challenge is a suicide game9 which has been claimed to take the life of more than 300 children and adolescents around the world and has become a serious matter of concern not only for the parents but also across nations worldwide. India has been no exception. Awareness about the challenge is the only way out for the parents to save the life of their children. The game which is attracting basically teenagers has 50 stages and the final stage of the game makes the player to commit suicide. Without completing the final stage the player cannot rid of the game. As the teenager’s have a mindset to trust everyone hence the curators of the game take benefit of this to brain wash the children. UNICEF has instructed various countries to issue guidelines to help to protect from this suicide game10. The warning signs observed can be staying aloof, decreased interaction with family and friends as this life taking game makes the mentality of the player to hate the people in and around the surrounding and it is because of this game only that the victim stops interacting, talking about death, a change in eating and sleeping habits11,12.

CASE REPORT: In this case report we wish to report an interesting case of a 21 year old unmarried male, an IT professional working out of his state Bihar, all alone spending long duty hours on internet who just managed to get out during the initial stages of the game itself but developed significant amount of anxiety subsequently, of such an extent that almost had left his job and was all lost and fearful, did not even share this to his family members till he came in contact with our department. He on thoroughly being probed got better with the help of counselling sessions and support of medications. He has joined back his work and is regularly coming for follow ups. The details of the case would be shared at the time of presentation.

DISCUSSION: “Blue Whale Game” though has been a sensationalised hoax, it is believed that it is likely that this has led to instances of imitative self-harming and copycat groups, leaving vulnerable children at risk of suicide13. Internet safety organisations across the world have reacted by giving general advice to parents and educators on suicide prevention, mental health awareness, and online safety in advance of the next incarnation of suicide games and cyberbullying.

Experts opine that two types of adolescents fall prey to such games- either those who are adventure-prone and dare to do anything, or the shy ones, the back-benchers, who tend to play these games and get a sense of vindication and performing the tasks give them a sense of achievement. Such challenges ruthlessly play with the emotions of the participants14. According to recent reports IN newspapers “children nowadays are increasingly keeping up with trends in social media and ‘the blue whale challenge’ is another such example. The government needs to have a strict cyber security system and ban sites that perpetrate such gory deeds. Parents should monitor the digital footprints of their children and only give limited access to social media websites to adolescents.” CONCLUSION: In this era of internet and social media15, there are new emerging problems to be intelligently dealt with in order to safeguard our future generation, the younger lots of today as the seeds of mental illness begin at this vulnerable period. Timely action and support can save lives more so with this years mental health day theme of “Young people and mental health in a changing world”

REFERENCES:

1.Sousa DF, Filho JDQ, Bezerra Cavalcanti RCP, Santos ABD, Rolim Neto ML. The impact of the ‘Blue Whale’ game in the rates of suicide: Short psychological analysis of the phenomenon. Int J Soc Psychiatry. 2017 Dec;63(8):796–797. doi: 10.1177/0020764017732595. [DOI] [PubMed] [Google Scholar]
2.Beware! This Blue Whale online suicide challenge is scaring parents world over | The Indian Express [Internet] [[cited 2017 Sep 10]]. Available from: http://indianexpress.com/article/lifestyle/life-style/beware-blue-whale-online-game-life-threat-for-kids-with-its-suicide-challenge-4637463 .
3.The Blue Whale Challenge is Real, Sad, & Frightening | World of Psychology [Internet] [[cited 2017 Sep 10]]. Available from: https://psychcentral.com/blog/archives/2017/07/13/the-blue-whale-challenge-is-real-sad-frightening .
4.What makes online games like Blue Whale so addictive? - Livemint [Internet] [[cited 2017 Sep 10]]. Available from: http://www.livemint.com/Technology/Vl7hs1wPEqlicnoNEGsD2I/What-makes-online-games-like-Blue-Whale-so-addictive.html .
5.Do Not Try to Play It: The Gory World of the Blue Whale Challenge - The Quint [Internet] [[cited 2017 Sep 10]]; Available from: https://www.thequint.com/news/world/blue-whale-suicide-game-challenge . [Google Scholar]
6.“I Have Come Back”: Engineering Student Saved From Blue Whale Suicide Game [Internet] [[cited 2017 Sep 10]]; Available from: http://www.ndtv.com/india-news/i-have-come-back-engineering-student-saved-from-blue-whale-suicide-game-1743126 . [Google Scholar]
7.American Psychiatric Association. 5th ed. Washington, D.C: American Psychiatric Association; 2013. DSM-5 Task Force. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

88. Title of the article: A study of suicidal attempts among the elderly in a rural area

Uzma Hashim ¹

Preference: Oral Free paper presentation

Background and Aims: The elderly may be vulnerable to psycho-social dynamics that are different from those affecting the middle aged and economically productive population. The aim and objectives are to study the social variables, mode of suicidal attempt and immediate precipitant cause among the elderly.

Methodology: Retrospective, medico-legal case register based, explorative analysis of individuals (aged more than 50 yrs) presenting after a suicidal attempt to the emergency services of a rural tertiary care hospital in south India. Out of 829 individuals who had presented during the study period, only 63 individuals were aged more than 50 years. Data pertaining to the objectives of the study was collected from their files and analyzed using SPSS 16.

Results: Of the 63, 40 (%) were male and 23 (%) were female. 49 (77.8%) were married, 13 (20.8%) were widowed and only 1 was single. 46 (73%) were into farming and 15 (23%) were homemakers. 40 (63.5%) and 23 (36.5%) were from the lower and middle socio-economic strata respectively. 9 (14.3%) and 4 (6.3%) had past and family history of suicidal behaviour respectively. 19 (30.2%) had consumed alcohol at the time of the attempt. Organophosphorous compounds were the most commmon mode of attempt (33,52.4%) and relationship issues were the most common immediate precipitant (34, 54%).

Conclusion: While western data reports being unemployed and single to be risk factors for suicidal behaviour, most of the elderly in our study were gainfully employed as farmers and were married. Further studies are required to know more about suicidal behaviour in this select population.

Keywords: Elderly, Suicidal attempt, rural Ind

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

89. A case report: Olanzapine induced neuroleptic malignant syndrome

Niyati Sheokand, Nimmi A Jose, Pooja Yadav, Abhishek Kapoor, Vedpal Mahla

Introduction

Neuroleptic Malignant Syndrome (NMS) is a rare, severe, potentially life threatening consequence due to typical antipsychotics. Cases of NMS related to atypical antipsychotics, such as olanzapine, are less common in spite of increasing cases reported in literature. A 30 year old male patient with schizophrenia was on treatment with tablet olanzapine, later was diagnosed with NMS and was successfully treated symptomatically and discharged in stable condition in 7 days.

Objective To discuss a case of Olanzapine induced Neuroleptic Malignant Syndrome.

Case Report A 30 years old male, known case of Schizophrenia was on olanzapine 10mg for 3 weeks presented with fever (101°f) along with muscle rigidity, altered mental status, raised blood pressure and had raised CPK-MM level (365IU/l). The patient was diagnosed with NMS and offending drug was withheld. He was shifted to ICU and treated symptomatically. The symptoms of NMS got resolved in next 5-7 days but symptoms like muttering to self and suspiciousness reappeared, hence patient was started on different atypical antipsychotic and was discharged once stable.

Conclusion This case shows that NMS can occur with atypical antipsychotics such as olanzapine. Several factors such as agitation, physical exhaustion, dehydration, and pre-existingneurological deficits have been correlated with the incidence of NMS. In literature, it is stated that 90% of NMS cases occur within 30 days of initiating or increasing the dosage of the offending agent. In this case NMS was reported in 21 days of starting the olanzapine. Hence in the presence of above mentioned risk factors or rapid dose escalation, NMS can occur with atypical antipsychotics like olanzapine. By putting more efforts in understanding this syndrome, early diagnosis and appropriate management can be done which will help in reducing the fatalities.

Keywords Neuroleptic malignant syndrome, olanzapine, schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

90. Title - A Study Suicidal Of Intent And Temporal Variation In Subjects With Suicide Attempt

Prashant choudhary ^*, Bandna Gupta ^*, Anil Nischal ^**, Adarsh Tripathi ^***, Manu Agarwal ^***

Background: Suicide attempt is self-inflicted potentially injurious behavior with a nonfatal outcome for which there is evidence of intent to die (Silverman et al., 2007). Temporal variation in suicide risk has been explored in multiple studies. A better understanding of the underlying risk factors is important to improve risk assessment and intervention Strategies for addressing the suicidal behavior

Aims: To study suicidal intent and temporal variation in subjects with the suicide attempt.

Methodology: The study was a cross-sectional, non-interventional study conducted in the department of Psychiatry, King George’s Medical University, Lucknow. Patients were taken from Adult OPD and Emergency Services. A written informed consent was taken. Patients were assessed on semi-structured proforma, MINI 6.0.0, ICD-10 DCR, Beck’s Suicide Intent scale (SIS). Data was analysed using computerized software.

Results: A total of 102 patients were enrolled in the study. Statistically significant difference in suicide intent score of males (p=0.001), Age group 31-45 years(p=0.043), Earning group(p=0.008), family income<10000 per month (p=0.028), family history of suicide attempt(p=0.028), past suicide attempt(p<0.001) and psychiatric illness (p<0.001) which means suicide intent is higher in these groups. Most of the subjects attempted suicide in time period between 6:00 PM-11:59PM(55.90%), on saturdays(19.60%) and extreme of weathers ie. in December, January(approx 21%) and June, July(approx 20%).

Conclusion: Most of the subjects included in the study were aged 31-45 years, Hindus,belonged to joint family,married having family income less than Rupees 10000 per month and majority were housewives. Almost equal number of sample from urban and rural background. Our study suggests that male gender in age group 31-45, earning and family income less than 10000 per month had higher suicide intent. Subjects had positive family history of suicide and history of prior suicide attempt had significantly higher suicide intent.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

91. Gender differences in attempted suicide: a record-based study from a general hospital in south India.

Kathleen Anne Mathew ¹, Priya Sreedaran, Jayasudha N, Johnson Pradeep

Introduction A prior suicide attempt is one of the strongest predictors of death due to suicide. The socio-demographic and clinical factors associated with gender in individuals with a suicide attempt have been found to be different in Asian countries as compared to Western countries. This study was undertaken to describe the gender differences in attempted suicide in a general hospital setting in Bangalore, where a deliberate self-harm service- Assertive Management of Attempted Suicide (AMAS) has been functioning since January 2016.

Methodology The case records of 284 individuals (120 males and 164 females) who were assessed as part of AMAS services in 2016 was obtained. The socio-demographic and clinical factors, suicidality levels and psychiatric diagnosis of suicide attempters which was recorded using a semi-structured questionnaire was extracted from these records.

Results Women were more likely to be married (65.9%) compared to men (50.8%). The most common mode of attempt was overdosing on prescription medications (53%) in women and consumption of common chemicals (51%) in men. Women were more likely to be diagnosed with depression, and men with substance use disorders. Women had significantly greater suicidality as compared to men. In both genders, there was an association between high suicidality and the presence of a psychiatric diagnosis. (p=0.017 in men, p=0.008 in women).

Conclusion The results from the AMAS service differ from Western as well as other regional Indian studies in various aspects. Among suicide attempters, significant gender differences were noted with respect to marital status, mode of attempt, psychiatric diagnosis and suicidality. It is important that suicide prevention services in each setting analyse the local gender related factors and accordingly plan their interventions.

Key words: Gender; suicide; attempted suicide, psychiatric diagnosis; suicidality.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

92. Mayer-Rokitansky-Kuster-Hauser(MRKH) Syndrome Presented With Acute Psychosis

Bhatra Bhatra ^*, Krishna Kadam ^***, Sneh Babhulkar ^**, Alka Pawar ^****, Krishna Kadam1

The psychiatric co-morbidities in female population are usually not given much attention for psychiatric treatment. Especially when cases of mullerian agenesis are encountered, an inability to bear children is frequently seen. Such females are socially ostracized and there are high chances of development of psychopathology in the future. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital abnormality with absence of uterus, cervix and vagina, but normal secondary sexual characteristics and external genitalia and occurs in every 1 out of 4000-10,000 females. There is also limited literature on the probable common chromosomal aetiology for both psychosis and MRKH patients. We, present here a case of MRKH syndrome, whose initially presentation was amenorrhoea, followed by development of psychopathology in the form of depressive features initially and psychotic features later on with perceptual and behavioral disturbances. In this respect, we also highlight the much neglected need of appropriate screening of psychiatric illness and provision of psychiatric care in this population.

Keywords: Congenital anomaly, Mullerian agenesis, Primary amenorrhoea, Psychosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

93. Title: Socio-demographic and Clinical Profile of Patients Attending Geriatric Clinic in a Tertiary hospital setting.

Dileep Kumar Verma ¹, Ankit Chaudhary2, Sourav Khanra3, Avinash4 Sharma

Background: According to Population Census 2011 there are nearly 104 million elderly in India. The elderly constitute a rapidly growing proportion of our population. From 5.6% in 1961 the proportion has increased to 8.6% in 2011. The health care needs of elderly population are different, due to a higher prevalence of various illnesses including neuropsychiatric disorders as compared to the adult population.

Objectives: To assess the clinical and socio-demographic profile of patients attending Geriatric Clinic in a tertiary hospital setting and to study the correlation of socio-demographic and clinical variables with psychiatric diagnoses in this population.

Materials and Methods: A retrospective chart review of patients with age ≥60 years, who attended the new set-up of the Geriatric Clinic of a tertiary hospital at Central Institute of Psychiatry, Ranchi over a period of 6 month, has been done. Comorbid physical illnesses were also recorded for review. Information about Socio demographic profiles such as age, gender, religion, educational status, occupational status, socioeconomic status, type of family, and social support were collected. Information of other clinical profiles such as past history of physical illnesses, mental illnesses, and substance use disorders; and family history of mental illness were collected as well. The analysis will be done using IBM SPSS Statistics Version 25. Mean, standard deviation (SD), proportions and 95% confidence interval (95% CI) of the outcome, clinical and socio demographic variables will be assessed as per requirement. Spearman’s correlation coefficient will be done to assess the correlation of other variables with psychiatric diagnoses.

Results: Result will be discussed after analysis at the time of presentation.

Key words: Geriatric clinic, Socio-demographic profile, Clinical profile

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

94. TITLE: CASE REPORT - PSYCHOTIC SYMPTOMS DUE TO ENDOCRINOPATHIES

ANURAG KHAPRI ¹, PDMMC AMRAVATI

BACKGROUND:

Alterations in endocrine function have been associated with changes in mood, behavior and cognitive function. Psychiatric symptoms in thyroid dysfunctions have been associated more frequently with hypothyroidism. On rare occasions hyperthyroidism has also been suspected as a probable cause for precipitation of altered behavior, memory impairment or hysteric symptoms. We share one such case of sudden onset altered behaviour with hyperthyroid and cushingoid state.

METHOD:

Presentation of a case having sudden onset altered behavior with forgetfulness, irritability, suspiciousness & delusions with cushingoid features with raised serum TSH levels on investigation.

RESULTS:

An 55 yr old female presented to the OPD of a medical college with complaints of irrelevant talk, not identifying family members, suspiciousness and irritable behavior with a background history of multiple episodes of generalized edema. Her blood reports indicated raised thyroid and triglyceride levels. Her symptoms were effectively managed with antipsychotics with complete recovery of pre-morbid mental state.

CONCLUSION:

Hyperthyroidism has been linked with various psychiatric symptoms such as emotional lability, restlessness, anxiety and rarely even frank psychosis. The psychotic symptoms in the context of hyperthyroidism have typically been reported to present as affective psychosis. The exact mechanism of this finding is yet to be fully understood. A large number of thyroid receptors are present in the limbic system. Also, neurotransmitters such as catecholamines & dopamine have a common origin with thyroid hormone in the form of amino acid tyrosine. It is therefore suspected that changes in thyroid function may contribute to psychotic behaviors. Antipsychotic treatment should be chosen based on co-morbidities and side effect profile

KEYWORDS: Antipsychotics, Altered behavior, Endocrinopathies.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

95. Title: Comparison of Profiles of Subjects with Mild Cognitive Impairment from Community & Hospital Based Sample.

Gaurav Maggu ^*1,^✉, Sanjay Gupta ²

Background/Aims : Mild cognitive impairment (MCI) is regarded as a transitional disorder between age associated memory impairment and dementia. It affects the elderly population and because of the potential for conversion to dementia, is of increasing concern in today’s society. Our aim was to characterise cognitive & socio-demographic profile of hospital visiting & community dwelling subjects of multiple domain MCI patients & to compare cognitive profile of both the groups.

Methods: Study subjects were divided in to two groups; Group H comprised of hospital based subjects & subjects were recruited from OPD & IPD of department of Neurology & Psychiatry while Group C comprised of community dwelling subjects & were recruited from various surveys. Both groups were screened on Hindi Mental Status examination (HMSE), Clinical Dementia rating scale (CDR) & subsequently Cognitive test were applied for Verbal fluency, Immediate & Delayed Memory recall, Calculation ability, Visuo-Constructional ability & Object naming. Simultaneously, subjects were also rated on Every Day Ability scale for India, WHOQOL-BREF.

Results: Both groups were equally matched on baseline characteristics such as age (p=0.319), gender (p=1.00), mean years of schooling (p= 0.236), socio-economic status (p=0.169), marital status (p=1.00). Most of the patients belonged to rural background. On cognitive testing both study groups performed low; significant difference was found in mean scores of Verbal Fluency test(p=0.018), Calculation ability(p=0.001), Immediate Memory recall test(p=0.000)& Psychological Domain of WHO Quality of Life-BREF(WHOQOL-BREF)(p=0.024) while mean difference in Object Naming (p=0.711), Delayed Memory recall, Visuo-Constructional ability(p=0.806), Every Day Ability (p=0.183), Physical (p=0.318), Social(p= 0.113) & environmental domain of WHOQOL-BREF(p=0.634)were in-significant.

Conclusions: In this first study comparing two different population of a multiple domain MCI, cognitive performance was low in both the study groups & comparable to previous studies. More studies with large sample size are required to establish these findings.

Keywords: Multiple Domain Mild Cognitive impairment, Everyday ability scale for India, Verbal Fluency test, Calculation ability, Immediate Memory recall test & Psychological Domain of WHOQOL-BREF.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

96. FOOD COMING FROM THE HAIR - A CASE STUDY

SHARMA M ^*, PRAKASH O ^**

AIM / OBJECTIVE:

Aim of the presentation is to discuss about an unusual presentation of Monosymptomatic Delusional Disorder in an elderly person.

METHODOLOGY:

A 72-year-old female of rural background presented with clinical profile suggestive of depressive episode for 8 months. An edentulous lady moving her mouth repeatedly having decreased facial expression, decreased interaction with family members, not doing household work sitting alone with pulling her hair and rolling thumb over fingers. She was diagnosed to have Depressive disorder with possibility of Parkinson’s disease.

Accordingly tried on various antidepressants over 6 months but no response seen. A neurology opinion taken along with blood profile and radio imaging to rule out Parkinson’s disease.

Later patient reported about her belief of food coming out from her scalp hair, mouth and ear. The diagnosis was reviewed as Monosymptomatic Delusion disorder. The antidepressants were tapered and stopped

RESULTS:

Patient responded well and is maintain well for past 4 months with antipsychotics- Olanzapine with Trifluoperazine augmentation; response being rated on Brown Assessment of Belief Scale (BABS).

DISCUSSION:

An unusual presentation of Delusional (monosymptomatic) disorder; where patient presented as depressive episode and early features of Parkinson’s disease that later responded well to antipsychotics. A very few cases reported from India, which were majorly about parasitosis and nihilism type.

CONCLUSION:

Elderly is a population where atypicality is a usual presentation. A wider perspective to assess and manage a case is key to treat them

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

97. Title: Prevalence of Metabolic syndrome in Elderly with Depression

Mahendra Prakash Sharma ¹, Sandeep Grover ^1,^✉, Subho Chakrabarti ¹, Ajit Avasthi ¹

Background: Elderly patients with depression have significantly higher prevalence of physical comorbidities, when compared to depression in young patients. However little is known about prevalence of Metabolic syndrome (MetS) in elderly with depression.

Aim of the Study: To evaluate the prevalence of MetS among the consecutive elderly patients admitted to the inpatient unit of a tertiary level centre.

Materials and Methods: For this study, treatment records of all elderly (aged ≥ 60 years), admitted to the psychiatry inpatient unit during the time period of 2009 to Mid-2018 with diagnosis of unipolar depression were screened and data for the MetS was extracted. MetS was defined by using consensus criteria. Patients, who were admitted for more than once, were included only once into the study, i.e., their most recent admission was considered.

Results: During the study period, 106 patients with unipolar depression were admitted, out of which complete data was available for 96 patients. Out of the 96 patients, 7 patients were admitted more than once, hence the final study sample included 89 patients. Out of 89 patients, 57.3% were male and 42.7% were females (n=44). More than half (53.9%) of patients were already diagnosed with hypertension and 29.2% percentage were diagnosed with diabetes mellitus. Out of these 89 patients, 60.7% had abnormal waist circumference, 76.4% had abnormal blood pressure, 64% had abnormal blood glucose levels, 38.2% had abnormal high density lipoprotein levels and 29.2% had abnormal triglyceride levels. The prevalence of MetS was 52.8% in the study sample.

Conclusion: Prevalence of MetS is high among elderly with depression.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

98. Psychiatric Morbidity and Cognitive Impairment among older community members with self-report use of marijuana

Samrat Singh Bhandari ¹, Catherine W Striley ², Linda B Cottler ²

Background, objectives and Aims There is a growing incidence of psychiatric morbidity and cognitive impairment (CI) among older adults. Additionally, there is increasing prevalence of marijuana use among them. We evaluated the association between self-reported lifetime marijuana use with current psychiatric morbidity and CI based on the Montreal Cognitive Assessment (MoCA) score among community members who are ≥50 years recruited by Community Health Workers (CHW) in North Central Florida.

Method: CHWs invites community members to join the HealthStreet Registry which requires a health assessment which includes recording drug history, physical and psychiatric conditions. MoCA was administered to assess the cognitive function of the registered members who are ≥50 years of age. A score<26 was used to determine CI. The participants were divided into groups based on MoCA score and self-report of lifetime cannabis use - MoCA score<26 and lifetime use of marijuana (N=40), MoCA score <26 and no cannabis use (N=67), MoCA score ≥26 with life time use of cannabis (N=51) and MoCA score≥26 with no cannabis use(N=58). Chi Square tested the association between the sociodemographic, health characteristics and each group.

Results: The sample of 216 HealthStreet members was predominantly female (62.5%). Those with CI but no marijuana use compared to those in other groups were older. Those with CI who used marijuana were more likely to be male, African American and Separated, widowed or divorced. Those who used marijuana with or without cognitive impairment were most likely to report depression. There were no differences in the history of anxiety by marijuana use or CI.

Keywords: Cognition, Marijuana, Depression

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

99. Socio-demographic profile of the patients with psychiatric illness admitted in Regional Geriatric Centre, Gauhati Medical College & Hospital, Guwahati

HR Phookun, S Mazumdar

Introduction- The elderly population is vulnerable for various psychological and sociological changes. It is associated with different life stressors, life events for which the mind is not totally capable of handling those issues. There is a definite association of simultaneous deterioration of physical and mental health. However psychiatric morbidity in elderly either singly or comorbidity with other medical illness is one of the less focussed area in our country and much of this co-morbidity remains undetected, and therefore, remains untreated. This further prolongs the duration of suffering and the outcome of the illness as well as the management of the medical illnesses also.

Aims- To assess the socio-demographic profile of the geriatric patients with psychiatric illness.

Methodology- The present study was carried out in 85 patients at the Regional Geriatric Centre, Gauhati Medical College and Hospital from August 2016 to July 2017. Psychiatric diagnosis was made using ICD-10 classification of mental and behavioural disorders and a semi-structured interview was done to assess the socio-demographic variables.

Results- The study results showed the prevalence of psychiatric morbidity in 40 patients (47.05%) out of 85. Among the group of patients with psychiatric illness, depression was the most common followed by dementia and substance use disorder. Among these patients, male, age group 60-69 years, Hindu, married, unemployed, from rural background and those from joint families were found to be most vulnerable group for having psychiatric morbidity.

Conclusion -The study results establish the fact that psychiatric morbidity is seen among the geriatric patients and different socio-demographic variable play a definite role in psychiatric illness of elderly age group.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

100. Title: Section 377 Revoked! and socially??

Vrinda Pareek, Kishan Patel, Dhruv Chaudhary, Harman Singh Bhatia

Background: The continued importance of parents in the lives of youth is indisputable: beginning at birth, extending through adolescence, and even into emerging adulthood, affecting all relationships beyond those with the parents, and determining the individual’s own sense of self-worth. Actual or anticipated family acceptance or rejection of LGBT youth is important in understanding the youth’s experience of minority stress, how the youth is likely to cope with the stress and consequently, the impact of minority stress on the youth’s health.

Case : Here we present the case of a 47 year old female presenting with complaints of multiple suicide attempts, increased alcohol consumption, physical as well as verbal aggression, decreased sleep and decreased appetite for last 3 years. Patient was a known case of some psychiatric illness, but was a treatment defaulter. Patient was diagnosed with Recurrent Depressive Disorder (incomplete remission) with alcohol dependence. On further exploration, multiple stressors were associated with her present mental condition. But the prime stressor was her son who was a transgender and had recently joined the transgender community (i.e. 3 years back). Thereafter the symptoms aggravated. Looking at the history of multiple attempts and violent behavior, we admitted the patient. Along with routine investigations, we prescribed her Tablet Sertraline 75 mg and Tablet Lorazepam 2 mg and multivitamin supplements. After thorough examination we came up with three goals. First owing to her personality traits, we had to work on her coping skills intensively. Secondly, we convinced patient to under treatment for alcohol addiction as well. Finally, we called her son during the psychotherapy sessions to work upon their relationship as well. Finally after 15 days of admission patient was discharged. Presently, patient is regular for follow up, takes medications regularly, is maintaining abstinence and her relationship with her son has improved significantly.

Conclusion: This case brings into notice that only legal liberation will not reverse the social stigma associated with LGBT community. Health care providers working with LGBT youth should address issues of family acceptance and rejection during clinical visits to ensure that youth develop a healthy sense of self in terms of their sexual orientation and gender identity.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

101. Title: Psychological impact of Chronic Kidney Disease (CKD) among patients undergoing Hemodialysis

Himanshu Singla ^1*, Ajit Avasthi ¹, Sandeep Grover ¹, KL Gupta ²

Introduction: Chronic Kidney Disease (CKD) is a life threatening illness, management of which often involves dialysis and renal transplantation. Considering the chronic nature of the illness, it is associated with several adverse psychological effects. However, the data on psychological impact of CKD, poorly understood as most of the studies are based on use of one or two screening questionnaires to evaluate depression and anxiety disorders in these patients. There is lack of data based on prevalence of psychiatric disorders, based on the structured assessment by a psychiatrist.

Aim of the study: To assess the prevalence of various psychiatric disorders among patients with CKD on dialysis by using MINI-PLUS.

Methodology: 110 patients of CKD were assessed on MINI-PLUS for the presence of psychiatric co-morbidity.

Results: The mean age of the study sample was 33.5 years. Majority of the participants were males (87.3%), Hindu (77.3%) and educated less than the graduate level (64.5%). The mean age of onset of symptoms of CKD was 31.2years and mean duration of symptoms at the time of assessment was 24.7 months. About two-third (67.3%) of the study sample fulfilled at least one lifetime psychiatric diagnosis, with half (50%) of the study participants fulfilling a current psychiatric diagnosis. Among various diagnosis, depressive disorders were the most common (45.5%) and this was followed by generalized anxiety disorder (28.2%) and substance use disorder (23.7%) and few patients having other anxiety disorders (5.4%). Presence of current psychiatric diagnosis was associated with urban locality, less expenditure on dialysis, longer duration of dialysis, lower hemoglobin levels and lower serum albumin levels.

Conclusion: Present study suggest that CKD is associated with significantly high level of psychiatric morbidity. This finding suggests that there is a need for close liaison between Nephrologists, Transplant Surgeons and Psychiatrists.

*presenting author, email id: hmsingla31@gmail.com

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

102. Case of schizoaffective disorder with co-morbid OCD complicated with substance use- A therapeutic challenge.

abhinav tewari ¹, anuj mittal, suchika siotia, chirag patel, prashant Mishra

The concept of co morbidity certainly is not unique to psychiatry. When distinct symptoms co-occur, whether they indicate the presence of two distinct clinical entities or whether they are two components of a single disorder is mostly a matter of speculation, as we know little about the aetiology and pathophysiology interrelationship of mental illnesses. Presence of such co-morbidity affects the emergence, treatment, and prognosis, and there is a very little evidence to guide clinicians in how to prioritize multiple co-occurring diagnoses. We present a case of OCD comorbid with schizoaffective disorder along with presence of substance use, leading to complications in clinical management. However, improvement was seen in clinical course on follow up.

Keywords: OCD, Schizoaffective disorder, Substance use, clinical management

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

103. TITLE: BORDERLINE PERSONALITY DISORDER AND RECURRENT DEPRESSIVE DISORDER : A DANGEROUS COMBO-A CASE REPORT

Bapini Patra ¹, Seema Parija ¹, Sarada Prasanna Swain ¹

INTRODUTION: Borderline Personality Disorder (BPD) is a serious mental illness characterized by disregulation of emotion and impulses, an unstable sense of self, and difficulties in inter-personal relationship, often accompanied by suicidal and self harming behavior. As Major Depressive Disorder (MDD) commonly co-occurs with BPD, hence patients with BPD often present with depressive symptom. Accurate diagnosis is essential as each disorder require treatment in its own rights.

AIMS AND OBJECTIVES :

To report a case of 20 year old lady presenting with features of borderline personality disorder with recurrent depressive disorder as elicited by a detail longitudinal history of 7 years and present mental status examination.

METHODOLOGY AND RESULT:

Miss M presented to us with a duration of illness of 3 months with MDD. Taking note of her suicidal urges, she was admitted and was started with therapeutic doses of lithium and sertraline. After a detailed interview, we could elicit her earlier repeated suicidal attempts, poor temper control, impulsivity, unstable interpersonal relationship with her friends and family members, all beginning by age of 13 years besides 2 earlier episodes, suggestive of MDD. Psychotherapy in multiple sessions along with pharmacotherapy was given after administration of 16 PF and Rorschach test. She was discharged better and followed up, and maintained with lithium, mirtazapine and low dose olanzapine.

CONCLUSION: MDD co-occurring with BPD does not response as well to antidepressant medication as MDD in the absence of BPD. BPD is a significant predictor of outcome for MDD but reverse is not true. Treatment with specific psychotherapies tends to result in remission of co-occurring MDD.

Keywords: BPD, suicidal, MDD, lithium

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

104. A case of Systemic Lupus Erythematosus induced Psychosis

Vibha Tomar, Shipra Singh, Ananya Mahapatra

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder affecting multiple organ systems with diverse clinical manifestations. Neuropsychiatric manifestations occur in 60% patients of SLE seen as cognitive deficits, lupus headache, seizures and psychoses. Psychoses (12%) is relatively uncommon amongst them. These manifestations may occur due to primary disease process or secondary to central nervous system sequelae e.g. seizures, infection or adverse effects of steroids or other drugs.

Case report: We present a case of a 13 year old girl a known case of systemic erythematosus with grade 1 lupus nephritis since January’ 2018. She had pain in her wrist and knee joints, photosensitive skin rash on her cheeks and nose, multiple oral ulcers, low grade fever, 4 episodes of seizures with malena. Immunological investigations were positive for ANA (antinuclear antibody) and anti-ds deoxyribonucleic acid antibody. She was on treatment tablet prednisolone 20 mg/day, levetiracetam 800mg/day as maintenance. Last episode of seizure was in January’18. Patient discontinued medications on her own in June’18. 2 months after this she developed suspiciousness, persecutory ideas, occasional sudden anger outbursts, irritability, social withdrawal and poor self care. On general physical examination she had pallor and low grade fever. She had rashes with dark pigmented patches on face, ulcers on buccal and labial mucosa with thin scalp hair. Mental status examination revealed poorly kempt, irritable, irrelevant speech, ideas of persecution, impaired judgement and absence of insight.

Discussion and Conclusion: Psychoses in this patient should be differentiated from functional psychoses, steroid induced psychoses or other drug induced psychoses (Levetiracetam). Steroid induced psychosis is dose dependent side effect mainly seen when dose of prednisolone is >40mg/day. Levetiracetam has behavioral symptoms more common as side effect than psychosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

105. TRICHOTILLOMANIA & TRICHOPHAGIA WITH TRICHOBEZOAR

Dhayasudhan G ^1*,^*, Sivabalan E ², Thirunavukarasu M ³, Rajkumar R ⁴, Arul Saravanan ⁵, Sai Balasubramanian ⁶, Arun Narayan Pradeep ⁷

INTRODUCTION : Trichotillomania is defined as the irresistible urge to pull out the hair, accompanied by a sense of relief after the hair has been plucked. It is associated with complications like trichophagia, trichobezoar.

Case report: A 22yr old female patient presented to general surgery department with complaints of abdominal pain. On evaluation patient was diagnosed to have trichobezoar in stomach and ileum and was then operated. She was referred to psychiatry department for further management. On examination, patient reported that she had a habit of plucking and eating her hair since she was 18yrs of age. She would pluck her hair as she would have intense urge to do it and felt pleasurable after that and would eat her hair. She was diagnosed with trichotillomania. She was started on fluoxetine 10mg and is on follow-up.

Results: Patient has been on regular follow up and reports improvement. Impulsive hair plucking behaviour has decreased.

Conclusion: Trichotillomania with trichophagia cases are under reported. These patients seek consultation to dermatologist, surgeons. As the primary problem underlying is psychiatric condition, early consultation would help in preventing complications.

Keywords : trichotillomania, trichophagia, trichobezoar

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

106. Exploring the factor structure of Dissociative Experience Scale in an Indian sample of female college students Post graduate

Divya MP ¹, Anindya Das, Sai Krishna Tikka

Background: One of the most extensively used scale to quantify the frequency and severity of dissociative experience is the Dissociative Experience Scale (DES). It consists of 28 items assessing a range of dissociative experiences along a continuous scale in the respondent’s daily life. Though initially developed as a screening tool for dissociative disorders, it has been used in nonclinical samples for research on non-pathological dissociation. Literature exists in Western sample that have derived either a 2 factor or 3 factor models for DES both in clinical and nonclinical samples, though some inconsistencies do exist were some have argued for a single global factor. At the same time it is known that certain variation exist in the experience of dissociation among cultures.

Aim: The aim of the present study was to do an exploratory factor analysis and compare with extant literature of the factor structure of DES in a nonclinical sample of young adult females in Northern India.

Methods: All female nursing students enrolled at the time of the research (300) were self-administered the DES. To allow a better understanding of the items, preliminary definition and clarification was given before administration of the tool. Each question was explained to students and time was given to answer each questions.

Results: The results of the study will be presented and discussed in the conference.

Keywords: dissociation, Indian students, factor analysis, Dissociative Experience Scale

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

107. Psychiatric manifestations of autoimmune encephalitis: A case report and discussion

Ravivarma Jangam, Srilakshmi pingali

INTRODUCTION: Auto immune encephalitis refers to group of conditions that occur when body’s immune system mistakenly attacks healthy brain cells, leading to inflammation of brain.

The clinical syndrome comprises a complex of encephalopathy, cognitive disturbances, mood/personality changes, seizures and movement disorders Each of these can be the presenting manifestation, opening up a wide array of differential diagnosis, often delaying the diagnosis and therapy.

Case report : A 17 years male presented with an acute onset illness of 2days duration characterized by disinhibited behavior, overfamiliarity, decreased sleep and aggressiveness with no significant past or family history of psychiatric illness. This was associated with one week of fever, low grade.

A provisional diagnosis of mania was made. However during stay in the hospital he had an e episode suggestive of a seizure, characterized by up rolling of eye balls, followed by yawning and confusion. He also had episodes of not recognizing family members and irrelevant talk for short periods of time.

EEG revealed right temporal lobe epileptic form discharge with secondary generalization, ANA profile was border line positive, and other parameters including viral PCR for HSV, Malaria,etc were negative.

He was put on Tab. Quetiapine 25mg for sleep and treated with IV IMMUNOGLOBULINS, Doxycyclin, ceftriaxone and Mannitol He showed complete resolution of symptoms within a week.

Discussion : Encephalitis, often viral in origin presents with a cinical syndrome very closely resembling a psychiatric illness. A patient presenting for the first time often with associated neurological signs should be further investigated in this direction.

Conclusion : Autoimmune encephalitis is one of the differentials to be kept in mind while considering the differential diagnosis of a suspected organic cause of a psychiatric illness.

Key words: autoimmune encephalitis, psychiatric illness

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

108. SEXUAL ABUSE AND PSYCHIATRY: THE CONVENIENT ‘BLIND SPOT’

Gourav K ^*, Khanna A ^**

AIM/OBJECTIVE:

To discuss the relationship between ‘sexual abuse’ and ‘mental illness’ along with social, clinical, legal and ethical issues.

METHODOLOGY:

I had many questions for myself like:

are sexually abused victims more predisposed to develop psychiatric problem
are the psychiatric patients subjected to more sexual abuse than normal population
what are the types of mental illness common in victims of sexual abuse
Is there any neurobiological basis to the symptoms in such patient
What are the social/psychological factors into the play
What is my role as a clinician when i come across such a case
What are the legal framework in India for such cases
How can we best help our patients

I did extensive research and review of literature. Unsurprisingly, there were only few studies in India looking into the issue. My presentation is synthesis of my understanding from my research and from my clinical exposure.

RESULT:

Psychiatric patients are subjected to various form of sexual abuse in community as well as in hospital/long stay homes.
Sexual abuse in itself is a risk factor to develop mental illness.

DISCUSSION:

Two biggest taboo in the society are sexual abuse and mental illness. Whatever is being reported is just the tip of iceberg. Mentally ill patients are at the risk of being ‘abused’ as well as being ‘abuser’. We as clinician got to be aware of our rights, duties and responsibilities, in the light of law and society, while handling such cases.

CONCLUSION: Sexual abuse and mental illness is a two-way street where in both predisposes to each other

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

109. Study of prevalence and psychopathology of Internet Addiction midst Undergraduate students in varied streams.

Srishti Detha ^1,^✉, Manju Bhaskar ²

Introduction - The turn of the century was marked by the development of the World Wide Web. The internet, while proving itself as an unparalleled tool of information exchange, has also invaded the lives of millions as an addictive menace. Affecting socio-demographic strata ranging from the urban to the rural, there is no denying that internet addiction has evolved into a serious threat. The youngsters who are the prime users of the internet are its major victim. India having the highest number of youth population is more prone for such disorder.

Material and methods - Cross-sectional study including 1000 students from different streams and colleges.

Tools - Duke’s General Health Questionnaire, Young’s Internet Addiction Test and a semi structured proforma.

Results- In our study, out of 1000, 981 completed all the questionnaires, 499 were males (50.8%) and 482 were females (49.1%). The data analyzed by Young’s internet addiction test distributed respondents in 4 groups with 40.4% being average users,31.4% mild addicts, 27.01% as moderate addicts and 1.1% as true addicts with male preponderance coming statistically significant (P value < 0.0001).

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

110. A Rare Case of Panhypopituitarism Masquerading As Psychosis

P P Shimra ¹

Introduction: Panhypopituitarism refers to complete or partial failure of secretion of anterior and/or posterior pituitary hormones. It may arise as a result of congenital defects or acquired disease of the pituitary or hypothalamus or from infundibular lesions. The multiple aspects of normal pituitary function serve to predict the wide range of clinical manifestations of hypopituitarism which are determined by the severity, extent and duration of the condition. Psychosis is one of many possible psychiatric disturbances associated with endocrinological abnormalities and is rarely reported in males. Hypopituitarism has an estimated incidence of 4.2 cases per 100,000 per year and a prevalence of 45.5 cases per 100,000.

Case Report: A 32 year old married male presents to psychiatric OPD with acute onset fearfulness, talking to self, transient ideas of persecution, withdrawn behavior with disturbed sleep for 1 week. There was a similar episode in the past, 2 months ago lasted for 4 days. His antenatal, Natal and post natal history was normal. He had viral meningitis at 6 months following which he developed delayed motor milestones, poor scholastic performance and delayed puberty. He was married for 3 years but no children. Examination revealed pallor, short stature, fused earlobes, poor secondary sexual characters, truncal obesity, Gynecomastia. Blood investigations revealed anemia, hypothyroidism, hypocortisolism, hypogonadism, GH deficiency with no electrolyte abnormalities. CT and MRI were normal. Expert endocrinologist opinion was sought. He was treated with hormone replacement therapy, T. Risperidone 2mg OD, T. Lorazepam 2mg HS. Following which his symptoms abated and is being regularly followed up.

Keywords: Panhypopituitarim, fearfulness, short stature, hypogonadism, hypothyroidism

Conclusions- This is a public health issue which still hasn’t caught the attention of our society, including family and policy making bodies, health institutions and the education sector. It is very important to develop strategies to bring internet usage and dependence under check.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

111. Internet addiction disorder -case report

Atul Bhardwaj

Background Internet Gaming Disorder (IGD) has gained much importance of late. The increased use of cell phones in day to day life has made cell phone dependence a critical social issue. Gaming disorder has been included in the 11th International Classification of Diseases (ICD-11), defined as a pattern of gaming behaviour (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.

Case Summary We present a case of a 15-year-old teenager who exhibited IGD and problems associated with Internet gaming usage. He presented with symptoms which were suggestive of psychosis along-with episodes of unconsciousness on initial presentation but the detailed history led to the diagnosis of IGD. The patient was managed using pharmacotherapy which included risperidone in a dose of 4mg/d and naltrexone 50mg/day and CBT. There was reduction in the number of episodes of unresponsiveness and anger outbursts on the treatment. The poster also reviews the possible mechanisms of behavioural addiction, as well as the status of IGD as a potential subcategory of behavioural addiction.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

112. Pathological gambling

Devesh kumar Vyas ¹, Devesh kumar Vyas ¹

Keywords: Internet Gaming disorder(IGD), behavioural addiction, cell phone dependence, pharmacotherapy and CBT

Background: Gambling disorder (GD) is the persistence and recurrence of problematic gambling behavior, leading to clinically significant impairment or distress. The prevalence of GD is estimated to be around 0.4–1.0%

Case Description: We report a 50-year-old man who started investing in the stock market after being fired from his job. His gambling behaviour escalated with time leading to debts that exceeded his paying capacity and nonfulfillment of his duties at home and at work. Care management focused on individual cognitive-behavioral therapy and pharmacotherapy which included Fluoxetine in the doses of 40 mg/ day and Naltrexone in the doses of 100mg/day. Patient reported reported improvement in his behaviour and in the hours spent in gambling.

keywords: Gambling Disorder, Behavioural Addiction

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

113. STUDY TO SCREEN THE SYMPTOMS OF ADULT-ADHD IN MBBS STUDENTS AND INTERNS

JEET G Nadpara ¹

Background: ADHD is known to have impact on psychosocial health of an individual. Adult ADHD among students hampers the overall academic performance. By adult life, most will no longer meet full criteria for ADHD, most will retain some functional impairment related to hyperactivity. The present study was carried out to screen symptoms of adult ADHD in medical students and interns and to assess their likelihood of having adult ADHD.

Methodology : It was a cross sectional single interview study. 125 Random selected students from each batch of MBBS and Interns were selected, each was given a semi structured proforma which included socio demographic profile, Adult ADHD self-report scale symptom checklist.

Result and Discussion: The mean age was 21.7 years (S.D. 2.12), 45% were males and 55% were females, 25% from each batch were taken, majority of them staying in hostel. Mean total score of part A (Inattention scale) was 13.48. Many of them had complaints of difficulty keeping attention while doing boring work. Mean total score of part B (hyperactivity/impulsivity) was 13.8. Few of them had felt restless and fidgety more often active and compelled to do things. On comparing age with inattention scale age group 21-25 were more likely to have inattention problems, and in part B, age group less than 20 were having major problem. On comparing gender females were having more impairment in attention, male and females were equally having hyperactivity. On comparing year of education, 3^rdyear students and interns were found to have more inattention, hyperactivity was significant in 2^ndyear and 1^styear students. No significant correlation was found on paired t-test and on ANOVA.

Conclusion: Adolescents and early adulthood population should be routinely screened for adult-ADHD. Early diagnosis will help in timely intervention which would further help in improving the quality of life of the student.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

114 Title: The ‘‘post Jio effect” - Internet Addiction: a case report

Gokul Raj ¹, Shiny John ², Sreekumar D ³

Keywords: Internet addiction, Smartphone addiction, Bupropion.

Introduction :

The recent years witnessed an exponential increase in internet use across the India. Studies¹ found that immoderate use of internet affects both the physical and mental health of an individual. The following case report demonstrates internet addiction in a young girl.

Case Description:

A 21 year female B. Tech student with no past or family history of psychiatric illness was brought by her parents with complaints of recent onset academic decline, excessive mobile phone use, online shopping, intrigued telephonic relationships, frequent watching of pornography and unnecessary arguments with her parents. Her physical examination was normal and the repeated urge to check mobile phone was evident. In Young’s Internet Addiction Scale she scored 83/100 which was indicative of severe dependence.

We started her on T. Bupropion SR (150 mg, hiked to 300mg after 1^st week) and Cognitive Behavioural Therapy² was initiated. Concurrently she was asked to keep a diary to record her online activity, as well as Ubhind application was installed to monitor her mobile use. Patient was encouraged to reduce and structuralize the time spent online³ and to eliminate the temptations like favourite apps or websites. Interpersonal issues with her parents were addressed during family sessions. Eight CBT² sessions over a period of four months were given and by the end she showed significant improvement.

Discussion: The recent launch of cheap and fast internet in the country has accounted for the hike in internet addiction. Hence, in this technology-centric generation, the need for public awareness about internet addiction is of utmost importance. CBT-IA² combined with Bupropion gave good response in our case.

References:

1.Kuss DJ, Griffiths MD, Karila L, Billieux J. Internet addiction: a systematic review of epidemiological research for the last decade. Curr Pharm Des. 2014 doi: 10.2174/13816128113199990617. [DOI] [PubMed] [Google Scholar]
1.Young KS. CBT-IA: The First Treatment Model for Internet Addiction. J Cogn Psychother. 2011 [Google Scholar]
1.Przepiorka AM, Blachnio A, Miziak B, Czuczwar SJ. Clinical approaches to treatment of Internet addiction. Pharmacol Reports. 2014 doi: 10.1016/j.pharep.2013.10.001. [DOI] [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

115. AMIODARONE INDUCED DELIRIUM

Maj Rachit Sharma ^*, Lt Col Ranveer Singh

71 year old female housewife of rural agrarian background with no family or past history of any psychiatric or medical illness, admitted in Command Hospital Pune on 12/05/2018 with complaints of:

Heaviness of breath for past 1 year
Cough with liquid expectoration of 7 days duration.

Evaluation revealed Decompensated dilated cardiomyopathy with atrial fibrillation. Rhythm control achieved initially with Injection diltiazem from 12 May to 13 May 2018 changed to loading dosages of Injection amiodarone on 14/05/18. On 15th of May 18 she manifested with acute confusional state characterized by agitation, aggression, abusive behaviour, irrelevant talk, disorientation and Insomnia for which psychiatric consultation was requested. Psychiatric evaluation revealed an uncooperative, aggressive, irrelevantly talking disoriented patient who required physical and chemical restraints. In view of absence of any other offending agent or infectious etiology and available literature suggestive of evidence of amiodarone leading to acute confusional state, diagnosis of drug induced delirium was given and she was managed with injection haloperidol 2.5 MG IV slow 12 hourly for next 2 days followed by continuation to oral haloperidol 2.5 mg BD with which her symptoms reduced however there were episodes of intermittent aggression and agitation, as she was on Tab Amiodarone 200 mg OD by medical specialist. Her amiodarone was stopped and she was finally discharged on 25/05/2018 with advice to continue tablet haloperidol 2.5 MG BD in view of long half life of Amiodarone and its metabolites (60 days). During OPD review after 2 weeks her symptoms resolved completely. Her antipsychotic was gradually tapered off over next 1 month.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

116. Psychiatric Co-morbidity in patients with irritable bowel Syndrome ; A study at tertiary care centre

Ajeet Kumar, J S Yadav, Shobhit Jain, Gaurav Maggu

Background/Aims :Irritable bowel syndrome (IBS) is a chronic psycho-physiological disorder. It is considered to be the most common functional gastrointestinal disorder, and about 50-90% of IBS patients have associated psychiatric co-morbidity. We aimed to study psychiatric co-morbidities in patients with IBS visiting Psychiatric department, Institute of medical sciences BHU, Varanasi.

Methods: This was a cross-sectional case-control study conducted over a duration of one year from June 2017 to May 2018. Patients were selected from the out-patient department of gastroenterology. About 50 patients with IBS who fulfilled the inclusion criteria and who gave written informed consent were selected as study cases. The healthy attendants of cases were selected as controls. A total of 50 controls were selected. Rome-IV criteria were used to diagnose IBS. For diagnosing psychiatric disorders, we used the Mini International Neuropsychiatric Interview Schedule Plus.

Results: Mean age of our cases and controls was 30.30±10.570 and 27.28±8.887 years, respectively. Males outnumbered females in our cases as well as their controls. Psychiatric disorders were seen in 86% of IBS patients as compared to 20% in controls. Major psychiatric disorders seen in our patients were major depressive episode (26.0%), mixed anxiety depression (22.0%) and generalized anxiety disorder (20.0%).

Conclusions: The majority of patients with IBS who present to a tertiary care center have co-morbid psychiatric disorders. We need to screen these patients for such co-morbidities and develop a holistic approach for better outcome in such cases.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

117. Executive function in unaffected first degree relatives of patients of Schizophrenia and Bipolar Affective Disorder- A Comparative Study

Rohit Kothari ¹

Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India. Objective : To compare the performance of first degree relatives (FDR) of schizophrenia, bipolar affective disorder (BPAD) patients and control subjects on the Wisconsin Card Sorting Test (WCST) and to observe for any significant differences in executive function if any on WCST.

Design and Setting : Prospective cross-sectional, hospital based study in which subjects included using the purposive sampling technique.

Participants : 20 FDR each of schizophrenia and BPAD patient diagnosed according to ICD-10 criteria, and 20 control subjects, matched to patients according to age and gender.

Intervention : The WCST was administered on subjects after an explanation of the test.

Results : It showed deficit on WCST parameters by FDR of schizophrenia patients and FDR of BPAD patients in comparison to normal controls. FDR of both Schizophrenia and BPAD performed poorly on most of the variables of Wisconsin card sorting test. When both the FDR of Schizophrenia and BPAD were compared to each other they didn’t show any significant differences between them on WCST.

Conclusion : Consistent with a hypothesis of executive dysfunction in schizophrenia and BPAD endophenotype, FDR of schizophrenia patients and FDR of BPAD tend to show executive function deficit as elicited by deficits in all the variables of WCST. However, the usefulness of this indicator may be limited by its association with age, which is worthy of being studied in finer detail.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

118. TITLE: Prevalence of Psychotic-like experiences and their association with depression, anxiety, stress and self-injurious behaviour among undergraduate medical students: A cross sectional study.

Narayan R Mutalik ¹, Krupa, S B Choudhari

INTRODUCTION:

Psychological distress such as stress, anxiety and depression are frequent among medical students which can affect their academic performance, physical health and psychosocial well-being. The evidence indicates reasonably high prevalence of psychotic like experiences in general population. Few studies have examined the association between negative affect and the individual subcomponents of hallucination predisposition. As with suicidal thoughts and behaviours, adolescence appears to be a period of increased risk for Self-injurious behaviour. The alarmingly high rate at which adolescent self-injurious behaviours occur, coupled with the psychopathology and dysfunction often associated with such behaviours, underscores the need for a better understanding of how to effectively assess and treat these behaviours. Taking all these entities into consideration and as no study has been conducted in this part of the region assessing the PLEs and linking that with psychopathology, the study is primarily being conducted in order to fill the research gaps in the earlier conducted studies and it is the first of its kind associating PLEs with self injurious behaviours.

OBJECTIVES OF THE STUDY: To study prevalence of Psychotic like experiences, depression, anxiety, stress and self-injurious behaviour among medical students in general.

METHODOLOGY: A cross-sectional study was conducted among undergraduate students of private medical college at Bagalkot. We included all the first and second year MBBS students who gave written informed consent after obtaining the Institutional Ethical Committee clearance. All the recruits were given standardized self-answering questionnaires like semi-structured socio-demographic data sheet, Peter’s delusional inventory, Launay-Slade Hallucination Scale-Revised, Depression, Anxiety and Stress Scale and Inventory of Statements about Self-injury. Data was collected and tabulated using Microsoft excel. SPSS 20 version was used to process the data. Frequency and percentages were calculated for all quantitative measures. Mean and standard deviation were calculated for qualitative measures. Chi- square test was used to analyse categorical values. P value of < 0.05 is considered as statistically significant.

RESULTS: Total 288 students participated in the study with mean age being 19.7 and 44.4% were males and 55.6% were females. The prevalence of depression, anxiety and stress were 9.6%, 12.5% and 2% respectively. Prevalence of non-suicidal self-harm found out to be 7.6% with common types being banging, biting and cutting. 10.1% of the participants do self-harm while alone and 6.6% of subjects experience physical pain while self-harm. With respect to psychotic-like experiences, total 6.8% of the participants reported of being troubled by hearing voices in their head and 6.4% reported that in the past they have heard the voice of God speaking to them and 2,2% said they have heard the voice of the Devil

CONCLUSION: Emotional disturbances in the form of depression, anxiety and stress are existing in high rate among undergraduate medical students. Early interventions in the form of early detection and management of the psychotic-like experiences and the after-effects might lead to improved quality of life among the medical students and reduce the stress among students.

Key words : first degree relatives, schizophrenia, bipolar affective disorder, Wisconsin Card Sorting Test, executive function

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

119. PATTERN AND SEVERITY OF INTERNET USE AMONG MEDICAL STUDENTS- A STUDY FROM NORTHEAST INDIA.

Rakesh Mohanty, N Heramani Singh ¹

INTRODUCTION: Internet was originally devised for information exchange and research purpose, but today it is an essential need of human life for social communication, education, research, health seeking, banking, business, shopping, administration, and entertainment. Internet addiction or pathological use of the Internet usually refers to the phenomenon that an individual is unable to control his or her use of the Internet which eventually causes one’s marked distress and functional impairment in daily life. Students are particularly at risk because of their unique personal, social, academic and future needs.

AIMS AND OBJECTIVES: To see the pattern of internet use and the level of internet addiction among medical students in Imphal

METHODOLGY: A cross sectional study was conducted in Regional Institute of Medical sciences, Imphal. We assessed 207 medical students with the help of semi structured self-reported questionnaire consisting of questions related to pattern of internet use. We also applied Young’s internet addiction test Scale. Data was analysed using spss version 21.

RESULTS: We found that all of the participants were using internet more or less. Among the users, 2.9% were experiencing significant problem in their life and 20.8% of students were facing occasional or frequent problems because of internet use. Most of the participants were male, undergraduate students, unmarried and time of preference for internet use was night time between 9pm to 12 midnight.

CONCLUSION: Most of the medical students use internet frequently. Efforts should always be taken for awareness about internet addiction and its consequences. We all know that the field of internet addiction research is in its infancy but that should not distract us or prevent us from taking what is an emerging problem seriously.

KEY WORDS: Internet, Medical students, addiction.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

120. Bugs in the Belly : A Case Report of Delusional Zoopathy

Manan Desai ¹, Krishna Patel, Kamlesh Patel

211

Delusional Zoopathy, also known as Delusional Infestation, Ekbom syndrome and Delusional Parasitosis, is an uncommon but not rare clinical disorder in which affected individuals have the firm, fixed, false belief that they are infected with parasites or other living organisms without any medical or microbiological evidence. It is classified as a delusional disorder, somatic type in the DSM-5. Diagnosis of delusional infestation requires persistence of the delusion for at least one month and may be further classified into either primary or secondary. In primary delusional infestation a patient will have no underlying or prior psychiatric disorder and the delusion is not related to an medical cause or substance abuse.

Present case describes a 35 year old, illiterate, married woman, working as a labourer, was referred from surgery department with a 2 year history of feeling of 20-25 cm long an insect/worm crawling inside the gut, eating food and water from intestine, biting abdominal elements like muscle, organs, anal orifice and moving like fetus in whole GI tract from esophagus to anus. Patient had attributed the origin of infestation as her childhood habit of consuming excessive sweets. These symptoms had caused fatigability, sleep disturbance and impairment in social, occupational and inter-personal functioning. General, Systemic and Mental Status Examination did not reveal any other abnormality. All relevant laboratory and radiological investigations were normal. Clinically diagnosis of Delusional Parasitosis was considered. Ideally, pimozide is the drug of choice, but due to non availability the patient was started on tablet risperidone 2 mg increased to 4 mg over 6 months with amelioration of symptoms.

Further efforts are needed to define the scope of the problem, optimize diagnostic, pharmacologic and other therapeutic intervention and create awareness among medical professionals by consultation liaison.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

121. Tittle:-Severe Hypothyroidism playing a major cause of Psychiatric Illness.

GUREESHA SINGH ¹, Sandeep Choudhary, Supriya Agarwal, Apoorv Yadav

Background :-Hypothyroidism is a common condition found in clinical settings. It can lead to multiple somatic complaint, cognitive dysfunction, affective disorders and psychosis. Thus, in patients with mania or psychosis, it is important to rule out any organic causes. We have a case report of a female 30 year old patient who presented with suddent onset of psychotic symptoms round one year back, in the context of severe hypothyroidism.

Case presentation :- A 30 year old female presented to the psychiatry OPD with the complaints of self-muttering, self-smiling, poor self-care, wandering behaviour, decreased sleep and appetite along with drastic weight loss. Her these complaints started almost an year ago. On physical examination, her built was poor and pallor was present. BP was 90/70 mmHg. There was no abnormality on examination of cardiovascular, whole abdomen, respiratory and central nervous system. She was started on Tab Olanzapine 2.5 mg BD, Cap Dexorange 1 BD, Cap Sompraz-D 1 OD. Fluids RL and NS were started due to her low blood pressure. Her Hb was 8.1, haematocrit=26.8, MCV=76, MCH=23.2, MCHC=30.4. Her thyroid stimulating hormone came out to be >60.0 and thyroid hormone level were low (T4=2 pmol/L, T3 1.9=pmol/L) which pointed towards Severe Hypothyroidism. Then an endocrinologist referral was done after which she was started on Levothyroxine. Her psychotic symptoms resoled after three weeks of the treatment and her TSH value went down to 40.2 mIU/L and T3 and T4 came out to be 3pmol and 7 pmol respectively.

Conclusion:- In patients presenting with severe hypothyroidism and psychosis, treatment should include thyroid hormone replacement in addition to psychotropic medications.

Keywords : Psychosis, Psychiatric Illness, Hypothyroidism, Thyroid disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

123. An unusual case: Adult onset tics or conversion?

Smit Parmar ¹, Prakash Mehta

Introduction-

Tic disorders are generally considered to be of paediatric onset. Its presentation during adulthood has infrequently been described in the medical literature. Most reports depict adult onset secondary tic disorders caused by trauma, encephalitis, and other acquired conditions. Only rare reports describe idiopathic adult onset tic disorders.

Case history-

A 27-year-old female patient visited our OPD with chief complaints of involuntary sudden jerk like movement of the upper trunk, for 5 years, increased for 3 years. Initially it was limited to head and neck, in to and fro direction and currently occurs in upper trunk. It is sudden, rapid, recurrent, occurring multiple times throughout the day. The frequency of this movement increases when she is tensed about something. Movements don’t interfere with her daily routine, rather frequency decreases when at work and doesn’t occur in sleep. She can voluntarily suppress those movements, up-to some extent. Occasionally she makes an unusual sound while the movement occurs. Two neurologists in past had considered her condition to be functional, and was given escitalopram and clonazepam, but in a month her condition deteriorated. Was treated by a psychiatrist for 6 months, was given paroxetine, clonazepam, olanzapine and lacosamide, and she had partial improvement with it. Her MRI brain and EEG (done twice), were normal. The patient is currently on tetrabenazine.

Conclusion-

We know little about adult-onset tic disorders without a secondary association or cause. They are not common, and from the limited data available, appear to share some but not all features with childhood tics. This case could be used for further research, which will be important in gaining a better understanding of the epidemiology and clinical manifestations of this disorder.

Keywords- tics, adult onset, conversion disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

124. ART & PSYCHIATRY

Shivi Kataria ¹, Seema Singh, Prerana Gupta

Art stimulates mind and mind creates art.

Art gives mind an opportunity to express itself. The Ancient Greeks believed that creativity came from God & so did madness. This further prompted the ideology that mental illness is source for creativity & creative-intelligent people carry some degree of madness in them. Studies have shown the probable scientific connection between creativity & mental illness. Art is now-a-days used as a medium especially in non-communicable clients having schizophrenia, to express their fears, etc.& the same was used as therapy. Many people living with bipolar disorder have demonstrated themselves to be highly creative including famous artists, actors, and musicians e.g., writer Virginia Woolf, singer Demi Lovato. Not all people with bipolar disorder are creative, and not all creative people have bipolar disorder. However, there does appear to be a connection between the genes that lead to bipolar disorder and a person’s creativity. It was found that creative artists have difficulty in suppressing Precuneus (part of parietal lobe), which has highest levels of activation at rest. Its suppression avoids the unnecessary cognitive activity & an inability to suppress it may help artists to associate 2 different idea simultaneously. Some young autistic children may struggle with their fine motor skills. Honing their motor skills, making drawings allows autistic children to communicate thoughts and feelings they may otherwise struggle to express. Art gives them a degree of control over their learning experience. Also high performance autistic children are often creative having artistic capabilities. To be creative is to think differently and when someone is different, there is a tendency to be labelled strange, crazy, or even insane. Question remains, why more of psychiatric patients are attracted towards artistic occupation? Maybe because of comfort or not being judged.

Keywords: Art, Creativity, Schizophrenia, Bipolar, Autism

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

125. Co-morbidity of sexual dysfunction in female patients with Major Depressive Disorder – A cross sectional prevalence study

Trivedi K ^1,^✉, Kataria L ¹, Patel D ¹

Introduction: Depressive disorder is characterized by depressed mood, decreased energy and loss of interest in previously pleasurable activities. Worldwide studies have shown depression to be twice more common in women than men. The prevalence of female sexual dysfunction in western countries is reported to be between 17% and 55%. The high variability of the prevalence rates may be due to the different methods used in the studies. Hence, the prevalence of sexual dysfunction in women with depression is not really known.

Materials &Methods: The study had a cross-sectional design. A total of 50 female patients were taken as sample of study. Patients were assessed for Major depressive disorder with Hamilton Depression Rating Scale (HAM-D) and sexual dysfunction was assessed using Female Sexual Function Index (FSFI) scale.

Results: Out of 50 female patients assessed by HAM-D, having score >7 were diagnosed of Major depressive disorder, amongst which 95% patients had FSFI score less than 26.55 and were considered to have sexual dysfunction. It was found that 90% had decreased desire, 60% had decreased arousal, 40% had decreased orgasm, 70% had decreased lubrication, 40% had decreased orgasm, 70% had decreased satisfaction and 60% had pain during sexual activity.

Conclusions: Result from our study indicate a positive correlation between Major depressive disorder and Sexual dysfunction among female patients.

Key Words: Major depressive disorder, sexual dysfunction, female patients

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

126. Title - Viral encephalitis presenting as Brief psychotic disorder - A Case Report

Trivedi K ^1,^✉, Kataria L ¹, Patel D ¹

Introduction: Patients with encephalitis are known to present with psychiatric symptoms in the initial stages. However. the presence of clouding of consciousness and positive neurological findings help in differentiating them from cases of acute functional psychosis. Occasionally such patients manifest only with abnormal behavior without evidence of impairment of consciousness and without physical signs, producing diagnostic dilemma.

Case Report: A 25-year-old female patient was brought to casualty with complain of altered sensorium, irrelevant talk, muttering to self, Inappropriate behavior, restlessness, Episodes of anger outbursts, sleep disturbance from last 2-3 days. After detailed history and routine investigations (with CBC, RBS, LFT, RFT, ELECTROLYTES and URINE being within normal limits and no p/h/o fever), treatment with antipsychotic (oral olanzapine 20mg daily) was initiated suspecting acute/transient psychosis. As the patient failed to improve even after augmentation following 1 week, MRI brain and CSF study was done to rule out organicity, which suggested Autoimmune viral encephalitis. Patient was then started with Acyclovir (500mg i.v TDS) and corticosteroids (Methylprednisolone 100mg i.v OD), patient improved thereafter.

Conclusion: A multidisciplinary approach towards patient’s management ensures accurate diagnosis and timely intervention.

Keywords: Acute functional psychosis, altered sensorium, autoimmune viral encephalitis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

127. Title:Revisiting a case of Folie à deux. A Middle Aged Woman With a Wasp Inside Her Stomach - A Case Report

Mehraaj Sandhu ¹, Supriya, Sandeep Choudhary ¹, V K Singh

Introduction:.. Delusional parasitosis in 5-15% cases is associated with a shared psychotic disorder based on a meta analysis done by Wolfgang Trabert. This disorder can be described as a transfer of delusional beliefs from one person, the primary patient, to another, the secondary patient. ?We present here a case of a young female who felt that she had a wasp inside her abdomen flying around making a nest in between her organs. Here the patient was the primary care giver of her mother who was afflicted with a similar condition for the past 10 years, where she believed post her elective hysterctomy a wasp had entered her abdomen during the surgery and was laying eggs and causing her a a multitude of gastric problems was the principle partner. The patients age underlying cause of her delusion, content and the manner in which it resolved spontaneously on minimalistic treatment prompted us to report the case.

Case Report: A 22 year old female from a low socio economic background with no primary education presented with a chief complaint of abdominal discomfort for the past 4 months because of a wasp inside her abdomen flying around making a nest in between her organs wreaking havoc. This was the first episode, onset was gradual and course of illness was progressive. The predisposing factor was the patient’s family history, her mother had been suffering from a similar conditon for the past 10 years. Her symptoms were accompanied by sleep disturbances, anxiety and palpitations and a decrease in overall productivity as patient was finding it increasingly difficult to complete household chores responsibilites. Detailed description of the case shall be done at the time of presentation Discussion\Conclusion:? To be discussed at the time of presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

128. TITLE:-A RARE CASE REPORT ON CHRONIC SUBDURAL HEMATOMA COMPLICATING ALZHEIMER'S DEMENTIA.

SUJA THOMAS ¹, CHRISTINA GEORGE ², SANTOSH RAMDURG ³

BACKGROUND :-

The prevalence of Alzheimer’s disease, is high in elderly. Starting at age 65, the risk of developing disease doubles every 5 years. By age 85 years and older, between 25 % and 50 % of people will exhibit signs of Alzheimer’s disease. A meta-analysis (Prince et.al.,2013) found global prevalence of prevalence of dementia from all causesto be between 5% and 7% of adults age 60+. Elderly people with Alzheimer's dementia tend to fall due to decreased reflex mechanism. Herewe are reporting a rare case report of Subdural hematoma complicating Alzheimer's dementia. The reported annual incidence of chronic subdural hematoma is approximately 0.001% to 0.002%.

CASE DESCRIPTION:- 75 year old female, with no history of any medical co-morbidities, presented with forgetfulness of 3^1/2 year duration. Initial assessment of MMSE was recorded as 9/30. Initial investigations including CT Scan Brain was done, which showed age-related changes. Diagnosis of Alzheimer’s Dementia was made. She was started on Donepezil 5mg. After 6 months, follow up CT Scan Brain was repeated as there was abrupt deterioration in her cognitive functions. Repeat CT Brain showed Left frontotemperoparietal Chronic Subdural hematoma with midline shift towards left with pressure effects. This was following a fall, which complicated the dementia. NeuroSurgery Opinion was sought and she underwent Frontal burr hole evacuation. Post-surgically, there was no further deterioration of her cognitive functions. Clinically, she improved.

METHOD :-

Prospective out-patient follow-up including clinical assessment, laboratory and radiological investigations.

RESULTS :-

The investigations included complete blood count, RBS, LFT, RFT, TFT, Vit.B12 assay and CT Scan Brain, which were noted to be unremarkable. The initial MMSE was 9/30. Repeat CT Scan Brain showed Left frontotemperoparietal Chronic Subdural hematoma with midline shift towards left with pressure effects and parietal burr hole evacuation was done. Post-operatively, her cognitive functions improved and she was continued on anti-dementia medications.

CONCLUSION :-

From the above discussion, we can come to a conclusion that this is a rare case report where Alzheimer's dementia got complicated by Chronic Subdural hematoma. The patient suffering from Alzheimer's dementia requires cognitive monitoring. Clinicians should be aware of this entity when they are treating Alzheimer's dementia. We need a larger perspective of studies on these issues.

The cognitive impairment and confusion signs mostly appear at the beginning of dementia. Chronic Subdural hematoma is an important differential diagnosis for neurodegenerative disease, but also an important reversible cause of dementia in the elderly. If dementia is suspected in the elderly, we need to perform early neuroimaging evaluation,that may allow for timely treatment of this condition to avoid a poor outcome.

REFERENCES:

1.Prince M, et al. World Alzheimer's Report 2015, The Global Impact of Dementia : An analysis of prevalence, incidence, cost and trends. Alzheimer's Disease International. 2015 [Google Scholar]
2.Hyun Hee Ye, et al. Cognitive Impairment in the Elderly with ChronicSubdural Hematoma. Korea J KorNeurotraumatolSoc. 2008;4:66–69. [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

129. LEUKOENCEPHALOPATHY PRESENTING AS PSYCHOSIS:

D Sireesha ¹, P Krishna Mohan ¹, K Madhavi ¹, L Srikanth ¹, B Sarath ¹, R Satya Krishna Kumar ¹

BACKGROUND : Leukodystrophy is a group of demyelinating neurodegenerative diseases of brain with varied presentation and multiple aetiologies. Misdiagnosis and wrong treatment are common in this group of rare neurological disorders, especially when it presents with psychiatric symptoms.

CASE REPORT: A 31-year-old man, presented with low mood, fearfulness, suspiciousness that people are trying to harm him, inappropriate smile, decreased self care, decreased appetite and disturbed sleep for the last 3 years. Initially it was treated as depressive disorder for 2 years and as Psychosis NOS for another 3 months. No significant improvement in symptoms was observed. So, the dose of antipsychotic medication was increased. Within 4days, Extrapyramidal symptoms including drooling of saliva, rigidity, staring look occurred. With these symptoms he was brought to our hospital. Family history revealed paranoid schizophrenia, seizures, hemiparesis in his sister, who died of status epilepticus at the age of 36years. Mental status examination was attempted but could not be completed. Ongoing medication was stopped and started on Tab. Trihexphenydyl 4mg/day and Inj. Promethazine 1amp stat was given. EPS resolved within 3 days of using this medication. Thyroid profile and Fundus examination revealed normal results. MRI brain showed extensive leukoencephalopathy involving frontoparietal white matter and deep grey matter nuclei. In view of inappropriate smile and delusions of persecution, he is started on Olanzapine 2.5mg and maintained on Olanzapine 5mg hs. Fearfulness subsided completely, inappropriate smile decreased and functionality improved and was discharged on this medication.

CONCLUSION: In this case, importance of neurological and radiological evaluation and need for high diagnostic suspicion in treatment resistant psychiatric disorders is highlighted.

Keywords: leukoencephalopathy, treatment-resistant, psychosis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

130. A CASE OF NPH PRESENTING AS MANIA

R Anbazhagan ¹

Case history : A 57 years old married male presents with symptoms suggestive of first episode mania, with nil significant psychiatric history in past. Due to his atypicality in presentation, as a rule of thumb complete neurological evaluation was done to rule out any organicity. Also, he had an additional symptom of swaying on and off which the patients claim to be distressing. On evaluation, his MRI report suggestive of hydrocephalus. On work up, he was diagnosed to have normal pressure hydrocephalus(NPH) which presented as mania. He was symptomatically managed for his manic symptoms to relieve his distress associated with it. This case explains to hold the caution to rule out organicity before labelling it a psychiatric disorder and atypicality is always a clue.

Keywords : Normal pressure hydrocephalus(NPH), Mania, Atypicality

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

131. CONVEXITY MENINGIOMA ASSOCIATED WITH DEPRESSION: A CASE REPORT

D Bhuvaneswaran ¹, R Gandhi Babu ², M Asok Kumar ², M Avin ², M S P Saravanan ²

INTRODUCTION

Brain tumours such as Meningioma, that externally compress the frontal lobes may not produce any symptoms other than progressive changes in personality and intellect until they have enlarged significantly, leading to its renowned designation as a “ silent tumour “. Meningioma is the most common benign tumour accounting for 13% to 26% of intracranial tumours, most of them are slow growing and many are found incidentally. We report a case with symptoms of depression and changes in personality, which on further investigation, showed space- occupying lesions suggests Frontal Meningioma.

CASE REPORT

A 55 year old female referred to a psychiatric OPD for attempted suicide. She initially had symptoms of sad feelings, anhedonia, lack of sleep, fatigue and suicidal ideas for past 6 months. She was on regular treatment for past 4 months. Depression failed to respond to drug treatment and there was no improvement. One month before admission to hospital, she had frequent episodes of headache and she was treated symptomatically. Then her depressive symptoms got worsened and she attempted hanging. She was treated in ICU, her blood investigation were normal. CT Brain showed extra- axial hyperdense lesion with calcification along right frontal convexity indenting adjacent cerebral parenchyma, suggestive of Meningioma. EEG showed scattered bursts of sharp waves from both cerebral hemispheres. Got Neurologist opinion for headache, started on antiepileptics.

CONCLUSION

Our case illustrates the need for prompt and detailed assessment including brain imaging studies when patients present with atypical psychiatric symptoms with late onset (>50 years old) of first depressive episode or fast changes of the mental state, to decrease the suffering of patients and family.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

132. Psychiatric Presentation of Akinetic Rigid Syndrome- A Case Report

Vivek Srivastava ¹, Purushottam Jangid ², Priti Singh ³, Rajiv Gupta ⁴

Akinetic Rigid Syndrome has been reported to be caused by a diversity of etiologies which include inter alia idiopathic Parkinsonism, anoxia, trauma, Wilson’s disease, Huntington’s disease, and may involve the basal ganglia. The entity is known to be characterized by akinesia and rigidity- lead pipe or cogwheel type, accompanied by slowness of movement (bradykinesia) and thought (bradyphrenia), diminishing amplitude of repetitive alternating movements with or without tremor at rest and postural instability. However, an evocative history, symptomatology and neurological findings signifying that of catatonia, along with lack of significant findings on radiological assessment and lack of suspicion may land up the patient in a psychiatric setting, and further to be misdiagnosed and hence mistreated. This is a case report of a 16 year old male presented with decreased speech output, difficulty in initiation and slowness of movement, inability to maintain posture and sleep disturbance of acute onset with past history of suicidal attempt by hanging and other significant findings suggestive of a diagnosis of Akinetic Rigid Syndrome. Diagnostic implications and management of ths unique presentation are discussed in the presentation.

Keywords: Basal ganglia, akinesia, anoxia, catatonia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

133. A case of Organic personality disorder following near drowning

Apala Singh ¹, Surabhi Hiwale ², Ravneet Kaur ²

Introduction : Drowning is a major cause of morbidity and mortality especially in children. Near-drowning is defined as survival following asphyxia due to submersion. It has been found to have poor neurocognitive outcomes. Hypoxic ischemic injuries are common, the most affected areas being the hippocampus, insular cortex, basal ganglia and the vascular watershed areas, and global neocortical damage in severe cases. Hippocampal sclerosis/atrophy is associated with temporal lobe epilepsy and aggressive behaviour along with changes in other aspects of personality.

Case report : We present a case of a 15year old boy with easy premorbid temperament, with no developmental delay, no past or family history of epilepsy, with history of near drowning followed by development of focal dyscognitive seizures, ictal and interictal aggression, easy irritability, impulsivity, social withdrawal, sleep disturbances and academic decline. Repeat EEG showed generalised seizure discharges and MRI epilepsy protocol was suggestive of left hippocampal atrophy suggestive of left mesial temporal sclerosis. Patient was managed with antiepileptics for epilepsy and aggression along with psychoeducation and behavioural modification.

Discussion : The patient presented in psychiatry primarily for the aggressive outbursts which could be later explained by the structural changes on MRI. Left sided changes are associated more commonly with aggression and personality changes as reported in previous literature.. In our case near drowning can be proposed as the probable cause of these structural changes.

Conclusion: Differentiating such presentation from similar illness like conduct disorder, manic episodes, agitated depression, Intermittent explosive disorder, Disruptive mood dysregulation disorder can pose a diagnostic challenge to the psychiatrists. Early intervention, both pharmacological and non-pharmacological is necessary to improve the quality of life of these patients and reduce the burden on care givers.

Key words : Drowning, epilepsy, aggression, medial temporal lobe, personality change

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

134. A RARE CASE OF ARNOLD CHIARI MALFORMATION IN A PATIENT OF PSYCHOSIS PRESENTING WITH CEREBELLAR SIGNS AFTER PARTIAL HANGING

Anurag Borade ¹, Ananya Dhar ¹, Sneh Babhulkar ¹

Introduction :- This is a very rare case of patient having Arnold Chiari malformation presenting with symptoms of psychosis. Only 3 such cases have been reported yet. Arnold Chiari malformation is herniation of parts of hindbrain structures through the foramen magnum into the vertebral column causing specific neurological manifestations.

Case Summary :- A 30 years old unmarried male from rural background was brought with history of fearfulness, withdrawn behaviour, hearing of unreal voices and deliberate self harm attempt with unsteady gait. He is a known case of psychosis since 9 months, well maintained on medications till 20 days back when he had a drug drop out and subsequent relapse with complaints of suspiciousness and second person auditory hallucinations commanding him to kill himself to which he acted out by hanging, and suspended transiently above ground, but the rope broke leading to his fall. It was followed by a period of unconsciousness and soon swaying on left side while walking. On examination, his cerebellar functions were impaired on the left side predominantly, which persisted for 7 days following admission. His mental status examination revealed bizarre delusions and delusion of persecution. His psychotic features reduced on Tab. Risperidone 3mg/day. MRI brain (plain) revealed mildly dilated supratentorial ventricular system, crowding of foramen magnum, inferior displacement of cerebellar tonsils below foramen magnum for 5mm. Patient was referred to neurosurgery department for further management.

Conclusion :- Patients of Arnold Chiari Malformation are susceptible to herniation of cerebellum into foramen magnum after any activity increasing intracranial pressure such as partial hanging, hence it is important keep this diagnosis in mind while approaching such cases.

Keywords :- Arnold Chiari Malformation, psychosis, hanging

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

135. Tuberculous Meningitis: A bete noir in Psychiatry

VS Chauhan ¹, Madhubrata Ray ¹

Introduction: Tuberculous Meningitis is a subacute meningitis, is known for its various form of manifestations. It is one of the most severe form of Extra Pulmonary Tuberculosis. With discovery of new age medications, the fall in mortality is gratifying, but what are the effects upon those who survive? Long term sequalae including neuropsychiatric complications occurs in about 50% of patients. The most common neuropsychiatric complications reported are cognitive decline and behavioral changes in the form of irritability, emotional lability. Psychosis is a rare long term sequalae of Tuberculous Meningitis.

Case Series: We report 5 cases of Tuberculous meningitis who later developed psychotic features (predominantly delusions). All the cases manifested psychosis within 2 years of diagnosis of Tuberculous meningitis and after completion of Anti Tubercular Therapy. 2 cases presented with delusion of infidelity, 2 cases had delusions of grandiosity with unusual cheerful mood and one case manifested with hypochondriacal delusions that he was being contracted with HIV. Three cases out 5 had hydrocephalous in neuroimaging and rest had normal neuroimaging.

Conclusion: This report intended to increase clinician’s awareness of late and atypical sequalae of Tuberculous Meningitis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

136. Title: Psychiatric co-morbidities and quality of life in migraine patients attending psychiatry outpatient department.

Aarti Karahda ¹, Shobhit Kumar Prasad ¹, Ankit Kainth ²

This research has not been published nor is under consideration for publication

Background: Presence of psychiatric co morbidity like anxiety or depression, complicates migraine headache management and portends a poor prognosis for its treatment. HRQoL is significantly reduced in Indian migraine patient. There are few studies in India which determine the associated psychiatric co-morbidities with its impact on the quality of life in the patients with migraine.

Objectives: To assess the psychiatric co-morbidities with associated clinical profile and quantify the quality of life in cases with newly diagnosed migraine attending the psychiatry out-patient services.

Methodology: 50 patients recently diagnosed with migraine were included in study. A semi-structured questionnaire was devised to evaluate the symptom profile of migraine. Migraine Disability Assessment Score (MIDAS) was administered to assess the degree of migraine related disability. Neuroimaging (CT/MRI) of brain was done wherever indicated. Along with patients were evaluated for psychiatric co-morbidity using MINI scale at time of interview. Quality of life was determined using the WHO-QoL BREF scale. Analysis done using descriptive statistics.

Results: To be discussed in the light of above-mentioned factors.

Conclusion: To be discussed in the light of above-mentioned factors.

key-words: migraine, psychiatric co-morbidity

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

137. Title: EARLY PRESENTATION OF NEUROPSYCHIATRIC SYMPTOMS IN A YOUNG FEMALE WITH HIV/AIDS – A CASE REPORT.

Evelyn John ¹, Anisha Nakulan ²

Introduction The most common neurologic manifestation in AIDS is minor cognitive and motor disorders (MCMD) and HIV associated dementia. Psychosis is a recognized but uncommon psychiatric manifestation of AIDS. Psychosis was found more frequently in patients with AIDS related neurocognitive impairment. Even less commonly, antiretroviral therapy may precipitate psychosis.

Case description 22 year old lady presented with complaints of emotional liability, delusion of persecution, disorganized behavior, visual hallucinations, multiple deliberate self harm attempts, poor social functioning and decreased personal hygiene which progressed over past 3 years and became severe for past 8 months. Patient was diagnosed with HIV/AIDS at the age of 19 years when she initially presented with progressive bilateral motor weakness of lower limbs, urinary incontinence, progressive cognitive deficits along with emotional lability and odd behaviours. MRI brain revealed multifocal leucoencephalopathy and progressive atrophy of brain. At present patient is on antiretroviral therapy, Tab. Dolutegravir 50gm and Tab Tenofovir 300 mg once daily. Patient was started on Tab. Olanzapine and Tab. Escitalopram to control her neuropsychiatric symptoms. Patient responded well to treatment.

Discussion The reported prevalence of new-onset psychosis in patients with HIV infection has varied from 0.23 to 15.2%¹. Persecutory, grandiose, and somatic delusions were the most common symptoms, followed by hallucinations and affective disturbances². Results from published reports and anecdotal evidence suggest that new-onset psychosis is thought to generally occur in the later stages of HIV disease³. In this case the patient had an earlier presentation of neuropsychiatric symptoms than what has been reported.

References:

1.Swell DD. Schizophrenia and HIV. Schizophrenia Bull. 1996;22:465–473. doi: 10.1093/schbul/22.3.465. [DOI] [PubMed] [Google Scholar]
1.Dolder CR, Patterson TL, Jeste DV. HIV, psychosis and aging: past, present and future. Aids. 2004 Jan 1;18:35–42. [PubMed] [Google Scholar]
1.Sewell DD, Jeste DV, Atkinson JH, Heaton RK, Hesselink JR, Wiley C, et al. HIV-associated psychosis: a study of 20 cases. Am J Psychiatry. 1994;151:237–24. doi: 10.1176/ajp.151.2.237. [DOI] [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

138. Title: Acute Hypercalcemia, Hypoparathyroidism And Hyperuricemia – Unusual Complication in Extrapulmonary Tuberculosis.

Ravi Parkash ^1,^✉, Neharika Saini ², Surekha Dabla ³

This research has not been published nor is under consideration for publication

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

139. Organic Catatonia with Neurocysticerosis and Hyperparathyroidism- A rare presentation

Subathra Brammanathan ¹, Najef Moideen ², Gagan ², Pratap ²

INTRODUCTION:

Neurocysticercosis (NCC) is the most common parasitic infection of CNS. Psychiatric comorbidity is found in two-thirds of patients of epilepsy and NCC with psychosis being reported in about one-sixth of these patients. The following case demonstrates catatonia due to neuropsychiatric NCC and comorbid conditions (hyperparathyroidism; vitamin D deficiency) can be difficult to treat.

CASE REPORT:

A 31-year old lady with seizure disorder, who was on anti-epileptics, presented with a 4-month history of referential and persecutory delusions, hallucinations, irritability, sleeplessness, and poor self-care. She was started on antipsychotics, but had minimal improvement. In the following two weeks, patient developed mutism, stupor, posturing, rigidity, and social withdrawal that necessitated inpatient treatment. Initial Bush Francis Catatonia Rating Scale (BFCRS) score was 13. Lorazepam (as required) was started and anti-psychotics were tapered. Investigations revealed hyperparathyroidism, Vitamin D deficiency and active neurocysticerosis on magnetic resonance imaging (MRI). Albendazole with Prednisolone (upto 50mg) was initiated for neurocysticerosis along with calcium and vitamin D supplementation. Repeat MRI a month later, did not show any reduction in the number of lesions but showed decreased peri-lesional inflammations. After 2 months of treatment, the patient had recovered with BFCRS score of zero.

DISCUSSION:

Psychosis with catatonia is an uncommon presentation of NCC with seizures, hence a high index of suspicion is required for its identification and management. A comprehensive approach and evaluation of other causes proved fruitful as hyperparathyroidism was detected which is associated with psychosis.

CONCLUSION:

The case emphasizes the need for thorough evaluation and consideration of organic mental disorder due to NCC as a differential diagnosis in patients presenting with seizure and catatonic psychosis not responding to standard treatment.

KEYWORDS: Catatonia, Neurocysticercosis, Hyperparathyroidism, Organicity

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

140. Depression and Anxiety in Patients with Epilepsy

Deepali Negi ¹, Sanyam Gupta ², Savinder Singh ³, Ishat Kalra ⁴

Introduction: Prevalence of psychiatric disorders are higher in patients with seizure disorders as compared with general population. Depression and anxiety appear to be interictal complications in these patients. There is scanty published data assessing extent and severity of these comorbidities in this part of country.

Aim: To assess the prevalence and severity of depression and anxiety among patients with epilepsy using standardized rating scales for depression and anxiety.

Materials & Methods: The cross-sectional study was conducted in the OPD of IMH Amritsar. 100 patients aged between 16-60 years, diagnosed with epilepsy (as per ILAE, 2006 classification); having at least one seizure in last 1 year (not in last 72 hours) and consenting for inclusion in the study were purposively sampled. Patients with independent depression, anxiety or any other psychiatric illness, substance use disorder, and those taking proconvulsant medications were excluded. Selected patients were assessed using socio-demographic and clinical data sheet; HAM-A and HAM-D scales for assessment of anxiety and depression.

Data were analysed using SPSS 20 software.

Results: Anxiety was more prevalent than depression among patients with epilepsy. Both extent and severity of comorbid anxiety and depression were higher among women. These co-morbidities were more common among residents of urban and semi-urban population and those having partial seizure including temporal lobe epilepsy.

Keywords: Epilepsy, Anxiety, Depression, Prevalence

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

141. DONEPEZIL AND NEUROCOGNITIVE REHABILITATION FOR ORGANIC AMNESIC SYNDROME AND NOMINAL APHASIA AFTER HEAD INJURY IN A PATIENT OF ALCOHOL DEPENDENCE

ARNAB DATTA ¹, KRITIKA ZUTSHI ², SUPRIO MANDAL ³

INTRODUCTION: Alcoholism leads to numerous neuropsychiatric manifestations. It is also a risk factor for falls, which is the most common cause of traumatic brain injury (TBI). Higher alcohol levels during falls lead to more severe injuries. Amnesia and aphasia are common post TBI sequelae, yet evidence for management is limited in literature.

CASE PRESENTATION: 37 year old male presenting with alcohol intake of 15 years, fits for 2 years and significant head injury 1 year back. Patient had impaired recent and remote memory, impaired new learning, anomic aphasia, paralexical errors in reading and impaired constructional ability; and showed gliosis in left temporo-parietal region in CT Scan and MRI Brain. 4 weeks of donepezil 10 mg and neurocognitive rehabilitation targeting memory and naming showed significant improvements.

DISCUSSION: Differentiating chronic alcoholism related dementia from post injury organic amnesic syndrome is important due to varying outcomes. Both serotonergic and cholinergic neurotransmission has been implicated. There is inadequate evidence regarding treatment methods. Pharmacological and neuropsychological rehabilitation can collaborate to provide better results.

CONCLUSION: Co-administered Donepezil 10 mg and neurocognitive rehabilitation showed significant benefits in new learning and naming ability in patient of organic amnesic syndrome with nominal aphasia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

142. Atypical presentation of myoclonic seizures

Akhil Kesan ¹

Introduction

Myoclonus is a brief contraction of a muscle, muscle group or several muscle groups. It can be single or repetitive, varying in severity from an almost imperceptible twitch to a severe jerking, resulting, for instance, in a sudden fall or the propulsion of hand-held objects (the flying saucer syndrome). Recovery is immediate and the patient often maintains that consciousness was not lost.

Case Presentation

The patient, a 46 years old lady, a homemaker educated till the 10th standard, came with complaints of attacks of fits from last 35 years, semiology is loss of awareness followed by sudden contraction of right hand occurs mostly 4-5 minutes prior to attack followed by regaining of awareness followed by loss of consciousness followed by fall on the ground followed by contraction of both upper and lower limbs associated with up rolling of eyeballs and frothing from mouth followed by post-ictal headache and dullness. She was maintaining well with Tab Carbamazepine 600mg/day from the last 25 years but from last 6 months there are seizure attacks once in a month. Tab Carbamazepine was increased to 800mg/day with good response. Subsequently EEG revealed intermittently occurring focal spike-slow wave complexes originating from left frontal region, getting generalized along with independently occurring generalized spike-slow waves and polyspike slow wave complexes, suggestive of myoclonic seizures.

Discussion

To be done during presentation.

Keywords

Myoclonic seizure, carbamazepine, loss of consciousness, atypical

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

143. Case report of a female with probable autoimmune encephalitis- clinical presentation and difficulties in management.

Shiji Abraham ¹, Kathleen Anne Mathew, Shalini Perugu, Akshith Shetty, Suhas Chandran, Salazar Luke Joshua, Manohari SM

Introduction

Autoimmune encephalitis usually presents as a neuropsychiatric syndrome, of which psychosis is a common presenting symptom. This observation generated interest while evaluating the case of a woman who presented with such symptoms.

Case description

A 61 year old lady presented with two months history of sleep disturbance, fluctuations in sensorium, slurring of speech, impairment of recent and remote memory, impaired comprehension and judgement, periods of hypo and hyper activity with agitation. On mental status examinations, she appeared irritable with varying levels of attention and psychomotor activity. During the course in the hospital, she reported auditory hallucinations and appeared cheerful and talkative. She is a known case of Type 2 Diabetes mellitus, hypertension and obstructive sleep apnea. There was no previously recognized cognitive or mental health disturbances. Patient had hypokalaemia, hypomagnesaemia and UTI which were treated. MRI brain showed sub-acute lacunar infarct along parietal region, involving right caudate nucleus. A diagnosis of autoimmune encephalitis was considered, however autoimmune antibody panel was negative. Prior to admission she had received a trial of Dexamethasone on which the symptoms worsened. A working diagnosis of delirium was made and symptomatic treatment given. Following improvement in her medical condition, progress was noted in cognitive functions. Further details of the treatment and diagnostic dilemma encountered will be discussed in the presentation.

Discussion

This case report describes the challenges in the management of delirium in elderly with multiple co-morbidities. Autoimmune pathology is a less studied cause, which has received more clinical attention in the recent times. However, whether autoimmune panel needs to be a part of routine evaluation warrants attention, which will be described in the presentation.

Key words: Delirium; elderly; autoimmune encephalitis; psychosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

144. Use of riluzole in GAD with MND: A case report

Ajay Kumar ¹

Background: Motor neuron disease (MND) is associated with an array of neuropsychiatric symptoms (1–3). There is scarcity of literature addressing the duration of onset of anxiety symptoms and its management.

Aim and Objective: To present a case of 54 year old widow with GAD and MND.

Case report: 54 year old widow presented with Anxiety associated with day to day matters since 9 years. There was no pervasive sadness and her biofunctions was normal. In late 2013, she started difficulty in speaking, difficulty in swallowing solid food and in sleep initiation. Family members noticed her to be stubborn, irritable and disinterested in routine activity unlike her previous self.

Patient was diagnosed with generalized anxiety disorder (GAD) as per international classification of disease version tenth (ICD-10) and treated with Sertraline 200 mg, by the end of 3 months anxiety symptoms reduced by 20-30% but behavioral and speech difficulty remained as it. Detailed neurological evaluation and computed tomography indicated frontal lobe pathology; the diagnosis of MND (Bulbar onset) confirmed by neurologist and Riluzole 50 mg orally once a day was started following witch patient reported marked improvement in anxiety as well as psycho-behavioral symptoms.

Conclusion: Anxiety can antedate years before the motor symptoms of MND and respond robustly to riluzole.

Key words: GAD, MND, Riluzole

Mitchell JD, Borasio GD. Amyotrophic lateral sclerosis. Lancet [Internet]. 2007;369(9578):2031–41. Available from: http://www.sciencedirect.com/science/article/pii/S0140673607609441
Lillo P, Mioshi E, Zoing MC, Kiernan MC, Hodges JR. How common are behavioural changes in amyotrophic lateral sclerosis? Amyotroph Lateral Scler [Internet]. 2011;12(1):45–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20849323
Kurt A, Nijboer F, Matuz T, Kübler A. Depression and anxiety in individuals with amyotrophic lateral sclerosis: Epidemiology and management. CNS Drugs. 2007. p. 279–91.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

145 Elderly lady with movement disorder and depression

Vikram Singh Rawat ¹, Harshit Hemant Salian

69 year old retired English teacher Presented with progressive unsteadiness in walking, slowing of speech for past 18 years with episodes of depression.

Further evaluation and management will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

146. Neuropsychological and psychosocial outcome following mild and moderate Traumatic Brain Injury: a prospective study

MANJU MOHANTY ¹, Debarshi Chatterjee ¹, Manoj K Tewari ¹, Vivek Gupta ¹

Introduction:

Traumatic Brain Injury (TBI) is the leading cause of death and disability, with an overall mortality rate of 25 per 100,000. The patients often have impairments in neuropsychological and psychosocial functioning. As these have a significant impact on the quality of life, hence needs to be explored.

Aim:

To assess the neuropsychological and psychosocial functioning at 3 months following mild and moderate TBI.

Methodology:

After ethical clearance from Institute Ethics Committee, 62 patients above 18 years with TBI were recruited. The patients having severe TBI, past history of neurological, neurosurgical, psychiatric disorders and history of substance abuse were excluded. Written informed consent was obtained from patients. The sociodemographic and clinical details were obtained. Mini Mental State Examination, Trail Making Test, Digit Symbol Substitution Test, Controlled Oral Word Association Test, Animal Names test, Digit Span Test, Rey’s Auditory Verbal Learning Test and Hospital Anxiety and Depression Scale were administered.

Results:

The majority were males (90.3%). The mean age was 34.76 (12.61) and mean years of education was 9.37 (3.75). The commonest mode of injury was road traffic accidents. Thirty four (54.8%) patients underwent surgical intervention. The global cognitive impairment (MMSE) was observed in 27.4%. The frequency of impairment in specific domains ranged from 21.0% to 58.1 %. The most frequent impairments were observed in the domain of information processing (58.1%) and verbal fluency (58.1%). Anxiety and depression were present in 24.2% and 25.8 % respectively. There was no significant difference between mild and moderate TBI on age, education and gender. Significant differences emerged only measures of Rey’s Auditory Verbal Learning Test and Digit span test.

Conclusions:

A significant number of patients had neuropsychological and psychosocial impairment. Patients with moderate TBI had greater impairment in attention.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

147. Title: A rare case report: A Case of Viral Encephalitis Presented with Manic Symptoms

Fenil A Shah ¹, Sheth LG ², Manan R Thakrar ³, Vihang B Patel ⁴, Bhaveshkumar M Lakdawala ⁵, Bhaveshkumar M ⁶

Introduction

The most common etiology for Viral Encephalitis is herpes viruses (Herpes Simplex Virus, Varicella Zoster Virus, Epstein - Barr virus). The Characteristic Features being Headache, Fever, Aches in muscles or joints, Fatigue or weakness, agitation, confusion, altered level of consciousness from lethargy to coma rarely Frank psychotic state. Focal findings may be aphasia, ataxia, tremors, myoclonic jerks, Upper Motor Neuron or Lower Motor Neuron weakness.

Case Presentation

The Case here is a 20 Year old male presented with fever, uncooperative behaviour, agitation, irritable mood, decreased need for sleep, grandiose ideas, anger outburst and hyper religious behaviour. Patient was admitted in medicine department for fever for 2 days and referred to Psychiatry department at that time for behavioural complains and started on Risperidone 1 mg and Lorazepam 2 mg. He was discharged from Medicine department of hospital after CBC, LFT, RFT, Electrolytes, CXR, ECG were found within normal range but did not improve with treatment. Then patient was admitted to Psychiatry department and started with Valproate 900 mg along with same dose of Risperidone and Lorazepam. Neurologist opinion was taken. MRI was found to be normal, but CSF was found to be having low protein (10mg/dl) and high sugar (93 mg/dl). Based on CSF findings, acute onset altered behaviour preceded by fever, confused and uncooperative demeanour; Viral Encephalitis was diagnosed and patient was started on Thiamine I.V. thrice a day, Acyclovir 500mg I.V. thrice daily and Prednisolone 1 gm I.V. once a day. Patient had marked improvement within a week and discharged. Now he is back to his normal routine life with no behavioural complains.

Conclusion

A patient presenting with acute onset altered behaviour with history of fever should be thoroughly investigated before being diagnosed as having a psychiatric disorder.

Key words: viral encephalitis, grandiosity, decreased need for sleep, valproate, acyclovir, prednisolone

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

148. PSYCHIATRIC MENIFESTATIONS OF MOYA MOYA DISEASE: A CASE REPORT

Vrunda A Patel ¹, Minakshi N Parikh ²

Moya Moya disease is a rare progressive occlusive disease of cerebral vasculature leading to formation of collateral circulation at the base of brain. Moya moya disease has bimodal age presentation with first peak occurring in childhood as stroke, recurrent attacks of TIAs followed by paralysis or muscular weakness and seizures. Adult presentation is of intracranial hemorrhages and seizures. Neuropsychiatric menifestations are cognitive impairment, learning disability, attention deficits while psychiatric menifestations can be schizophrenia, acute transient psychosis and mania.

We present a case of 25 year of female who was diagnosed with seizure and TIA followed by muscular weakness of one side of her body at 1 year of age. At 24 years of age patient presented with seizure and bilateral IVH and SAH were seen on imaging and was later diagnosed with moya moya disease. A year following this episode patient developed visual hallucianations and persecutory delusions. Patient was given T. Sodium Valproate 600 mg in divided doses and T. Amisulpride 100 mg in divided dosed with improvement in psychotic symptoms within 15 days. Though there is vast literature on neurologic and cognitive menifestations of moya moya disease Very few case reports have been done so far that enlightens the psychiatric menifestations of moya moya disease.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

149. Title: Case report of HIV Associated Neurocognitive Disorder

Anvitha K ¹, Shankar, Yamini, Sneha, Chandrashekar H

Background / Introduction: In the recent years, opportunistic infections associated with immunodeficiency has come down but there is shift towards neurological sequelae of disease. HIV Associated Neurocognitive Disorder (HAND) is most commonly seen in advanced stages of HIV/ AIDS but can also occur in asymptomatic HIV infection. HAND is divided into three groups based on severity of cognitive impairment as Asymptomatic Neurocognitive Impairment (ANI), Mild Neurocognitive Disorder (MND), HIV Associated Dementia (HAD). Neurocognitive deficits occur due to subcortical pathological changes that result when infected macrophages or microgial cells infiltrate into the deep gray matter (i.e., basal ganglia, thalamus) and white matter. HAART has significantly impacted on severe forms of HAND but not on milder form. Though neuropsychological test is gold standard for diagnosis there is no standard protocol for it.

Methodology/ Materials and methods : 21 year old female patient, with family history of Retro Viral Disease in parents, nil significant past history, diagnosed as Retro Viral Disease six months back and on HAART TLE (tenofovir, lamivudine, efavirenz) regimen presented with over elaborative speech, cheerfulness, impulsivity, demoralization due to illness and suicidal attempt due the same.

On examination: Psychomotor activity – increased, Speech – tone / tempo/ volume increased, Mood – elated, Brisk reflexes, Plantar bilateral extensor, International HIV Dementia Scale -10, MOCA- 20, Neuropsychological assessment done Results: Animal fluency- impaired, Abstraction/ executive function- impaired, Speed of information processing- impaired, Attention/ working memory- impaired, Learning and registration- impaired, Recall- impaired

Conclusion: Results correlate with previous studies. As milder forms of HAND is common HIV patients should be screened for it. There is need for development of standard protocol for assessment of HAND and its management.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

150. Post Japanese Encephalitis sequelae in a patient of Bipolar Affective Disorder

Praveen Pandey ^*, Sujita Kumar Kar ^**, Amardeep Patel ^***, Divya Sharma ^****, Apoorva Upadhyay ^*****

An adult male, known case of bipolar affective disorder for past twenty five years maintained on medication presented with complaints of sudden onset high grade fever, headache, vomiting followed by left sided weakness, difficulty in speech for five months. The patient had been hospitalised in department of Neurology, KGMU and diagnosed as a case of Japanese Encephalitis and given treatment following which patient’s fever and vomiting episodes improved, left sided weakness improved partially and patient developed choreo-athetoid movements and hypophonia after discharge from hospital. On evaluation patient had deficits on lobar function tests and memory deficits. Patient was diagnosed as a case of BPAD currently in remission with Post Encephalitic Syndrome. Patient was given mood stabilisers, anti-epileptics, and benzodiazepines. Patient was further prescribed Tetrabenazine on which his abnormal body movements improved partially and was started on low dose Haloperidol on which abnormal body movements improved, Tetrabenazine was stopped gradually after three months. Patient attended further follow ups and his symptoms are showing.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

151. Use of Quetiapine in the management of Tardive Dyskinesia

Sukriti Kaushik, R C Sharma, Dinesh Dutt Sharma, Anirban Chakraborty

Background:

Tardive Dyskinesia (TD) is a fairly common and potentially irreversible side-effect of antipsychotic medication. TD is managed by discontinuation or dose reduction of anti-psychotics, switching to another agent or use of adjunctive agents such as Vitamin B6, tetrabenazine, donepezil etc. We share a case of TD showing significant improvement with Quetiapine.

Method:

A case report of Tardive Dyskinesia (TD) managed with switching to Quetiapine along with a brief literature review of similar case reports and new medications approved by FDA for management of TD.

Results:

A 43 yr old female with a history of suffering from Schizophrenia since 30 yrs on treatment with anti-psychotics, developed side-effect in the form of repeated involuntary movement of lips. Her blood reports and EEG did not suggest any causality for her symptoms. Gradual tapering of her anti-psychotic medication and a trial of Quetiapine showed significant improvement in her symptoms.

Conclusion:

TD has been reported in a large number of patients on long term anti-psychotic treatment. Exact mechanism remains largely uncertain. Hypersensitivity of D2 receptor secondary to long term neuroleptic usage is the commonly accepted hypothesis. Preliminary data suggests that second-generation antipsychotics have a reduced risk for TD, compared to first-generation antipsychotics. Elderly patients and co-morbidities such as diabetes mellitus have an increased risk of developing TD.

Clozapine has a favourable profile in the management of TD. However, it’s use is limited due to the unfavorable side effect profile. Quetiapine has been reported as a preferred agent in the management of TD mainly due to its suitable side effect profile and safer alternative in elderly patients.

FDA has recently approved two drugs – Valbenazine and Deutetrabenazine for the management of TD. At present both drugs are not available in India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

152. Temporal lobe epilepsy with behavioral abnormality: A case report

Anirban Chakraborty ¹, Shrikant B Deshmukh

Background:

Temporal lobe epilepsy (TLE) is one of the most common forms of refractory focal epilepsy. Cognitive alterations such as memory & language deficits and impairment in executive functions has been reported as a long term comorbidity of TLE. We present a case of TLE with behavioral abnormality.

Method:

Presentation of a case of TLE with behavioral abnormality.

Results:

A 21 yr old female patient was admitted in the medicine department for management of frequent TLE with secondary generalized tonic-clonic seizures. She was transferred to Psychiatry department for the management of behavioral symptoms in the form of irritability, agitation towards family members and wandering away. Her antiepileptic medication was switched to Carbamazepine in view of irritable behavior along with a low dose of Risperidone. Clobazam was added later on as an adjunct for anti-epileptic efficacy. Adequate seizure control was achieved along with significant decrease in irritability.

Conclusion:

Temporal lobe epilepsy is described in two main types: mesial temporal lobe epilepsy anf leteral temporal lobe epilepsy. The former type is more common. MRI studies have commonly reported structural abnormalities in Hippocampal and Amygdala. Various studies have reported associated deficits in form of memory impairment, language deficits, and impairment in cognitive functioning. Patients such as the one discussed in this report may have behavioral symptoms not related with TLE. It is important to plan a personalized rehabilitative program for individual patients with such unique presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

153. Effectiveness of YOGA on Quality of Life, Self Esteem & Psychopathology among patient with Lower Limb Amputation admitted at Surgical Unit of level I Trauma Center, AIIMS: A Pilot Study

Sushma Sagar ¹, Masood Maqbool ², Ujjwala Sharma ³, Nida Mir ⁴, Subodh Kumar ¹, Rajesh Sagar ⁵

Background: Amputation is the removal of one or more body parts and is followed by adjustments in one’s life that can be difficult many times depending upon many prevailing factors. YOGA has been found to have role in improving Quality of life and mood (Raghavendra M R, 2008) but there is scarcity of research among patients with amputation. Current study is an attempt to mark efficacy of YOGA intervention on Quality of Life, Self Esteem and Psychopathology among patients with Lower Limb Amputation.

Methodology : Sample consisted of ten patients in experimental group and ten patients in control group who underwent lower limb amputation, admitted to surgery unit of JPNATC, AIIMS. Sampling was done by random sampling method, and experimental group received bed sided and follow up session so YOGA till six weeks and no yoga therapy was given to control group, though both the groups received medical treatment as usual along with necessary physiotherapy sessions. Baseline assessment was done after the procedure of amputation and second assessment was done at six weeks of amputation by using WHOQOL, Rosenberg’s Self Esteem Scale, Depression Anxiety Stress Scale, and Mini international neuropsychiatric interview and the performances of both the groups will be compared.

Results: Appropriate statistical analysis will be done and results will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

154. Personality Traits and Burnout in Female nurses in Government Sector

KJ Divinakumar, PS Bhat

KEYWORDS: Burnout, Female Nurses, Personality, Government Sector

BACKGROUND: Few Indian Studies have deliberated on the role of Personality traits in Burnout among Female Nurses employed in the Government Sector.

METHODOLOGY: A Cross sectional Questionnaire based survey was conducted among 603 Female Nurses employed in thirty Government Hospitals of Central India. 298 valid questionnaires received with demographic data, NEO Five Factor Inventory Scores, and Copenhagen Burnout Inventory scores were analysed using Linear regression analysis.

RESULTS: Trait Neuroticism scores had modest positive correlation for Personal Burnout (R² :0.32, F: 138.68), work related burnout (R² :0.22, F: 84.09) and overall Burnout scores (R² :0.30, F: 128.09).

Extraversion Scores had low negative correlation with Personal Burnout (R² :0.08, F: 27.22, p < 0.00), Work related Burnout (R² :0.09, F: 28.81) and Overall Burnout Scores (R² :0.10, F: 31.68).

Scores on Agreeableness Trait had weak negative correlation with Personal Burnout (R² :0.10, F: 32.98), Work related Burnout (R² :0.07, F: 20.96), Patient related Burnout (R² :0.07, F: 21.27) and overall Burnout scores (R² :0.10, F: 33.43).

Openness to experience had no significant correlation to personal, work related, Patient related or Overall Burnout scores.

Conscientiousness Scores had low negative correlation with the scores on personal Burnout (R² :0.12, F: 41.96), Work related Burnout (R² :0.09, F: 27.88), and overall Burnout scores (R² :0.10, F: 31.80).

CONCLUSIONS: Trait Neuroticism increased the vulnerability to Burnout and Traits of Extraversion, Conscientiousness and Agreeableness were protective against Burnout in the sample of Female Nurses surveyed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

155. MANAGEMENT OF A CASE OF STEVEN JOHNSON SYNDROME : IMPLICATIONS OF NEURO-PSYCHOPHARMACOLOGICAL AGENT USE

Akshay Lele SR ^*, A K Mittal ^*, Arjita Arora ^*

Steven Johnson Syndrome (SJS) an acute life threatening condition, characterized by epidermal erythema and maculo-papular skin rash progressing rapidly to exfoliative dermatitis. Macules gradually spread & coalesce to cause blistering, necrosis & sloughing. The actual mechanism of this reaction is not established but postulation about it being a T cell mediated Hypersensivity reaction is the most appropriate at present. The first step in management is immediate ICU admission and intensive supportive care is necessary to avoid increased morbidity. Mortality rates are very high even with the best of the ICU care.

Amongst neuropsychiatric agents, Lamotrigine, Carbamazepine and Sodium valproate have an incidence of 10 cases per 10,000 new cases. A 33 year old male with alcohol dependence since 10 years, brought for aggressive behaviour, irrelevant talking, hostile attitude, psychomotor agitation, paranoid delusions, auditory hallucination and impaired judgement.

He was treated with parenteral haloperidol 5mg and promethazine 50 mg, 6 hourly for the first day, reducing 8 hourly second and 12 hourly third day & shifted to Tab. Sodium valproate 500 mg TDS (after his LFT were within limit), Tab. Olanzapine 5mg BD & Tab. Topiramate 50mg BD on which his symptoms subsided in 15 days and was discharged. Five days later, he presented at Emergency department as he had developed multiple skin lesions over chest which progressed to involve trunk, face, limbs, oral mucosa, palms and soles & was diagnosed by Dermatologists as SJS.

Patient was admitted in Dermatology ward & treated with Oral steroids, Cetrizine & Hydroxyzine. His behavioural symptoms recurred & was shifted to Psychiatry ward where he was treated with Tab. Trifluoperazine 10mg & Tab. Quetiapine 600mg. In addition benzodiazepines like Chlordiazepoxide and Thioendodiazepine like etizolam were used to control agitation and excitement.

Keywords – Steven Johnson Syndrome, Polypharmacy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

156. DONEPEZIL INDUCED NEUROLEPTIC MALIGNANT SYNDROME

Angshuman Kalita ¹, Anil Kumar ²

Abstract: The purpose of the paper is to report a case of development of neuroleptic malignant syndrome (NMS), in a 55year old male patient receiving low dose oral haloperidol 2.5mg/day and trihexyphenidyl 4mg /day in divided doses which he was tolerating well until after the addition of oral Donepezil 5mg /day following which he developed NMS. Antipsychotics and cholinesterase inhibitor have direct propensity to induce neuroleptic malignant syndrome but it is a very rare event, when given in together they undergo complex interaction to induce NMS and therefore should be chosen very carefully.

Key word: Haloperidol, Donepezil, Alzheimer’s disease, neuroleptic malignant syndrome

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

157. CLOZAPINE INDUCE LEFT BUNDLE BRANCH BLOCK

lavkush kumar ¹, parul Prasad ¹, pritha roy ¹

Rates of cardiovascular morbidity and mortality in psychiatric patients are higher than in the general population: it is estimated that those who suffer from schizophrenia have a life expectancy approximately 20 % shorter than those who do not, and this difference is not fully accounted for by suicide or accidental death. Cardiovascular adverse effects of psychotropic drugs are common, and potentially harmful. Less severe cardiac adverse drug reactions are extremely common. The most serious cardiovascular consequences of psychotropic drugs are arrhythmias and sudden death, which principally result from torsades de pointes following progressive QT intervall prolongation. A 60 year male suffering from schizophrenia since last 10 year two different antipsychotics’ haloperidol and olanzapine was tried in adequate dose for more than 6 months periods but symptoms not improved adequately. After proper pre clozapine workup (TLC,DLC, ECG) clozapine started and dose 300 mg reached through gradual titration. Symptomps improved but after 1 year he again presented to department with worsening of symptom since last 3-4 months. On assessment it was found that compliance of drug in last 6 month not adequate. After admission dose again titrated up 300mg. patient report chest pain and his ECG was performed it reveals left bundle branch block (W and M pattern).

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

158. Olanzapine induced discoloration of teeth – a unique case report

Kishan Patel ¹, Rajat Oswal ²

Introduction:

Olanzapine is an atypical antipsychotic which is used commonly in psychiatric practice. Common side effects of this drug can be easily managed. Drugs like Tetracycline are known to cause discoloration of tooth but it is unusual with Olanzapine. Here we are presenting a case of Olanzapine induced discoloration of teeth.

Case History:

Here is a case of 20 years old unmarried male patient who presented to us with a complaint of muttering to self, irritability with using abusive language, inappropriate smiling and crying, withdrawn behavior, decreased communication, restlessness, sleep disturbance and reduced appetite for 7 months. Patient was diagnosed as Schizophrenia as per DSM 5 criteria. He failed in 10^th board exam in 2 subjects and stopped studying after which these symptoms started. He was being treated with tablet olanzapine 10 mg daily. The patient was not on any other medication. His parents noticed discoloration of teeth after around 1 month of therapy.

Examination by dentist revealed generalized extrinsic stains on teeth. He was nonalcoholic and nonsmoker and there was no history either of excessive coffee/tea intake or drug abuse. He was not suffering from any other disease except schizophrenia. His complete blood count, biochemical, and serological tests were normal. Scrape cytology of lesion did not reveal fungal elements.

DISCUSSION AND CONCLUSION His condition was diagnosed as discoloration of teeth due to drug and Olanzapine was discontinued. Follow-up was done every 10 days. Discoloration of teeth decreased at the first follow-up (after 10 days). It disappeared completely on second follow-up (after 20 days) and remained so at the third and fourth follow-ups. The exact mechanism is not known but It has been suggested that anticholinergic property of olanzapine has some role. On Naranjo Adverse Drug Reaction Probability Scale, the score was five which revealed a probable ADR.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

159. A CASE REPORT ON RISPERIDONE INDUCED SEXUAL DYSFUNCTION REVERTED WITH ARIPIPRAZOLE

SHREYASEE BHOWMICK, NIMESH C PARIKH, NILIMA D SHAH, VINOD M DARJI

KEYWORDS: Risperidone; Aripiprazole; Sexual dysfunction; hyperprolactinemia

BACKGROUND:

High potency antipsychotics are effective in schizophrenia, but also have potential for inducing side effects. Among them, sexual dysfunction due to hyperprolactinemia is a common and yet bothersome side effect of antipsychotics, resulting in negative effect on treatment compliance. Haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics. But literature review shows that sexual dysfunction can be reverted by use of dopaminergic partial agonists like aripiprazole even after co-administering it with the high potency agents.

CASE HISTORY:

A 42-year-old Hindu married male patient suffered from auditory hallucinations and persecutory delusions since last 10 years. After diagnostic confirmation of schizophrenia as per DSM-5, patient was started on risperidone, 3 mg/day. The patient was improved in terms of symptomatology. After 3 months of treatment, the patient complained of decreased sexual desire and difficulty in erection. Organic co-morbid conditions were ruled out with help of routine laboratory investigations. After this, special investigations like serum Testosterone and serum Prolactin levels were done. Serum testosterone levels were normal, but serum Prolactin levels were twice higher (44.79 ng/ml) than normal levels (3.46-19.40 ng/ml), thus pointing towards possibility of risperidone induced sexual dysfunction. Further management of this patient was done by tapering risperidone from 3 mg/day to 2 mg/day and aripiprazole 10 mg/day was added.

RESULTS:

After risperidone was reduced and aripiprazole added, patient started improving significantly in terms of sexual side effects within 1-2 months. Serum prolactin levels repeated after 2 months had dropped to normal limits (8.2 ng/ml).

CONCLUSION:

Though high potency antipsychotics (e.g. risperidone) are highly effective in treatment of schizophrenia, it equally has risk of adverse effects like sexual dysfunction, which can be minimised by reducing dose of such antipsychotics along with adding aripiprazole.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

160. RESTLESS LEG SYNDROME (RLS) CAUSED BY MIRTAZAPINE, IMPROVED WITH PRAMIPEXOLE

Yatri Patel, Nimesh C Parikh, Vinod M Darji, Nilima D Shah

KEYWORDS: Mirtazapine; Restless Leg Syndrome; Pramipexole

BACKGROUND:

Restless leg syndrome (RLS), also known as Willis-Ekbom disease is a common condition of the nervous system that causes an overwhelming irresistible urge to move the legs. Antidepressants have long been known to exacerbate RLS and there are few literature studies which report Mirtazapine as a causative factor for RLS.

CASE HISTORY:

A 62-year-old Male patient, diagnosed as Major Depressive Disorder, Mild according to DSM V was stabilized on 15mg Mirtazapine after a trial of various Antidepressants. Within 3 and half months of starting Mirtazapine, patient started developing stretching and crawling pain in calves which would be present only during night hours after going to bed. To get rid of it, patient would have to exercise for as long as 1 hour or take a walk near his place followed by which the pain would subside but recur within 2-3 hours of sleep, thus hampering the maintenance of sleep causing marked distress. Patients Routine Investigations were done including Hb, Blood indices, RBS, Vit B12 which were within normal range.

RESULT:

Ruling out other possibilities and Considering clinically as RLS, he was initiated on 0.125 mg Pramipexole on which patient improved within few days.

CONCLUSION:

RLS often remains misdiagnosed due to complexity of somatic symptoms comorbid with Depression. Although Antidepressants are proved to be a boon for Major Depression, it should be used cautiously and its rarest side effects should be monitored and treated. The Pathophysiology of antidepressant-induced worsening of RLS remains unclear, but dopaminergic hypofunction with serotonergic and noradrenergic hyperfunction has been proposed as a possible cause. Elderly patients may be more vulnerable because of involved monoamine dysfunction. This can be reverted by Pramipexole which can also be beneficial for Depression due to its dopaminergic action.

KEYWORDS: Mirtazapine; Restless Leg Syndrome; Pramipexole

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

161. A rare case report on the deterimental effects of Topiramate on cognition in Alcohol dependence syndrome.

Sreejith Cheruvilakam ¹, Christina George ², Santhosh Ramdurg ³

Background: Topiramate has been used as an anti-craving agent in the maintenance phase of treatment of alcohol dependence. Topiramate has a dual action on the two aspects of addiction by decreasing dopamine in nucleus accumbens leading to a reduction in its rewarding potential and minimizing withdrawal symptoms by moderating the effect on neural system excitability. This helps in reducing the chances of relapse. However there are limited reports and studies about the tolerability of Topiramate.

Case description: 38 years old male with alcohol dependence syndrome was treated with detoxification and deaddiction treatment following which maintenance therapy with Topiramate was initiated after discussing various treatment options. Topiramate was initiated at a dose of 50mg/day and gradually increased to 100mg/day. One month after the initiation of the therapy the individual presented with cognitive deficits in the form of difficulty in attention and concentration along with short term memory problems during his routine work activities. The investigations including complete blood count, urea & electrolytes, liver function test, thyroid function test, Vitamin B12 assay and MRI brain scan were noted to be unremarkable. Initial psychological assessment was done using Bender gestalt test and Weschler memory scales, which reported the memory quotient as 72. He was appreciated to have normal range of visuo-motor function. His score for general information and orientation were intact. There was marked impairment in the verbal and non-verbal memory due to very poor score on visual orientation, logical memory and paired association tests. This deterioration was postulated as probably caused by Topiramate, which was stopped. A follow-up psychological assessment was done over 2 months to evaluate for further progress of the cognitive deficit demonstrated improvement in cognition and the memory quotient was reported as 90.

Conclusion: This rare case report demonstrated the deleterious effect of Topiramate on cognitive function. It could be a good practice to perform psychological assessments before, during and after the maintenance therapy with Topiramate. Further large scale studies are required to quantify the risk benefit ratio of Topiramate use.

References: · Paparrigopoulos T, Tzavellas E, Karaiskos D, Kourlaba G, Liappas I. Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study. BMC psychiatry. 2011 Dec;11(1):41.

· Mula M. Topiramate and cognitive impairment: evidence and clinical implications. Therapeutic advances in drug safety. 2012 Dec;3(6):279-89.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

162. Bupropion(SR) Induced Psychosis in a case of Nicotine Dependence Syndrome: A Rare Case Report

Monica Shringirishi ¹

Bupropion is an antidepressant, which has recently been promoted for the treatment of nicotine dependence syndrome. However due to its dopamine enhancing effect, it has been reported to induce psychotic symptoms. The bupropion induced psychosis has been linked to risk factors like old age, past history of psychosis, bipolar disorder, rapid increase in dose, large total dose, disturbed liver function tests and concurrent use of other dopaminergic medications. Most of the literature, which is available in relation to development of psychosis while receiving bupropion, has been with the use of immediate release formulation. There are a very few case reports which have reported development of psychosis with the sustained release Bupropion preparation. We present a case of 23 year old male in which use of bupropion for nicotine dependence syndrome led to development of hallucinations, delusion which responded with the use of low dose of antipsychotic medication and by stopping the bupropion. However, when antipsychotics were stopped, psychosis did not recurred.

Keywords: Bupropion, Nicotine, Psychosis, Dopamin

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

163. Decreased Leukocyte Count Related to Haloperidol

Gaurav Pawar, Sarika Dakshikar, Hrishikesh Nachne, Tejaswini Miskin

Background: Leukopenia is a significant and potentially severe side effect of antipsychotic drugs. Leukocytopenia associated with Clozapine, olanzapine, and chlorpromazine are well known. It usually resolves once the medications are stopped and patients are switched over to another antipsychotic. Haloperidol-induced leukopenia is occasionally reported and the exact mechanism is question under trial. Though few studies attribute it to direct toxic effects of the typical antipsychotics or hypersensitivity reactions associated with them. Research are limited to explore hematologic side effects related to the combined use of olanzapine and haloperidol.

Case Report: Presenting a case of 33-year-old male patient who is a case of untreated schizophrenia for 15 years. Initially started on tablet Olanzapine and titrated to full dose. Later on tablet haloperidol was added as minimal improvement was observed with Olanzapine. After the introduction of haloperidol his white blood cell count decreased, though the differentials did not get alter. Although the improvement was seen with the combinations of both the antipsychotics, due to leukopenia haloperidol was withheld and sequential blood counts were monitored. A rapid increase in leukocyte counts were observed after discontinuing haloperidol. Role of haloperidol was further confirmed by challenging the patient again to haloperidol.

Conclusion: This case alarms us to pay attention to the leukocytopenic effect of the use of haloperidol or combined antipsychotic drugs which can be life threatening in some instances. Encountering a patient with a suspected antipsychotics-induced hematologic problem, clinicians need to consider those frequently mentioned offending agents, and to observe its relation with other antipsychotic drugs. It would help fathom the problem and generate data which would add to the present knowledge, that would enable us to provide a better patient care.

Key words: l eukopenia, differential leukocyte count, haloperidol, olanzapine

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

164. A case report of Olanzapine induced Supersensitivity Psychosis in a child without past history of any psychotic illness

Abhishek Pratap singh ¹

Introduction: long-term administration of antipsychotics can upregulate D2 receptors and produce receptor supersensitivity manifested by behavioral supersensitivity to dopamine stimulation in animals, and movement disorders and supersensitivity psychosis (SP) in patients. Supersensitivity psychosis is used to discuss the spontaneous occurrence of psychotic episodes and/or the appearance of tardive dykinesia in the wake of anti-psychotic medication withdrawal.

Such spontaneous episodes have occurred even in patients who never had psychotic episodes before beginning the medication.

Case report : A 6 year old male child with intellectual disability, ADHD and seizure disorder was referred to psychiatry opd by a private practitioner neurologist. At time of presentation in psychiatry OPD, he was already on sodium valproate 900 mg, oxcarbazepine 900 mg, clobazam 10 mg, olanzapine 5 mg for last more than one year. Parents of child were very much concerned of severe hyperactivity of child. Tab atomoxetine was initiated and gradually optimised to 28 mg over period of 6weeks. In view of minimal response and severe hyperactivity clonidine was also added nand optimised to 0.2 mg. Child showed good response in hyperactivity symptom. Since child started developing execessive sleepiness after adding clonidine, tab olazpine was reduced to 2.5 mg n after one week 1.25 mg. After 1 week child started having self muttering, gesticulating as if responding to someone invisible, sleep disturbance, self smiling. As per parents, child had never these symptoms or any other psychotic symptom in past.

On examination child was conscious, oriented to time, place, person, hallucinatory behaviour was noted. no involuntary movement seen. Olanzapine was restarted and all new emergent symptoms subsided in 3-4 days.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

165. Use of Aripiprazole in child and adolescents - a review

Nimmy Chandran ¹, Sajal Sathiadevan ¹, Smitha Ramadas ²

Introduction

Aripiprazole is an antipsychotic which Lacks or has only minimal M1 muscarinic cholinergic and H1 histaminic antagonistic properties causing less sedation, weight gain, and dyslipidemia thus making it appropriate for use in children. FDA has approved the use of aripiprazole for use in children with manic or mixed episodes, irritability with autism and adolescents with schizophrenia. We would like to review the use of aripiprazole in children and adolescents.

Method

A Pubmed based literature search was done using appropriate search term which generated 210 publications and was supplemented with cross-references and google scholar.

Results

Efficacy and extrapyramidal symptoms are comparable to other second- generation antipsychotics in children. Weight gain and sleep disturbances more in children (unlike in adults). Aripiprazole cause only less hyperprolactinemia.

Conclusion

Aripiprazole can be used in children for indicated conditions. Substantial care needs to be taken for patient selection and side effects need to monitored carefully.

More multicenter large-scale head to head randomized controlled trials of different antipsychotics and comparison among different dosages of Aripiprazole is needed. More longitudinal follow up studies are also needed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

166. A CASE REPORT OF SEROTONIN SYNDROME

Laxmidevi M Patil ¹, Alok N Ghanate ²

INTRODUCTION- Serotonin Syndrome(SS) is a potentially life threatening adverse drug reaction. It is predictable consequence of excess serotonergic agonism of CNS & peripheral serotonergic receptors. The exact incidence is unknown as it has varied manifestations, lack of awareness & sensitive diagnostic criteria. The number of reported cases of SS has increased, probably secondary to the widespread use of serotonergic drugs.

Here in we describe one case presenting with serotonin syndrome

METHODOLOGY- A case report

CASE REPORT- A 45 years married female k/c/o BPAD since 20 years maintained on Divolproex sodium 500mg, Escitalopram 20mg, Olanzapine 10mg. Since past 15 days she was having somatic complaints with depressive features, for which she consulted local physician who prescribed Fluoxiteine 20mg & Escitalopram 5mg which she took along with previous medications. She presented with tachycardia, tremors, myoclonus, shivering, diaphoresis, apathy within 3-4 hours after addition of new medications. She was given supportive treatment in the form of monitoring of vitals, fluid balance along with discontinuation of SSRI. Patient improved and was discharged on Divolproex sodium 500mg, Clonazepam 0.25mg.

CONCLUSION- Our case highlights the fact that SS can have initial episodes of milder intensity. It follows a “cause-effect” relationship. In the era of increasing consumerism and doctor shopping, clinicians should take a proper history of medication intake by the subjects before prescribing newer agents. Since the clinical symptoms vary and no pathognomonic laboratory findings are found in SS, the diagnosis relies on strong clinical suspicion and exclusion of the other medical/psychiatric disorders. Prompt recognition, identification, removal of the offending drugs and supportive care are crucial in the management of SS.

Key words- Serotonin Syndrome(SS), SSRI, Serotonergic drugs

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

167. A CASE REPORT ON CHLORPROMAZINE INDUCED CATARACT

Abdul Rafe Muqtadeer Baig ¹

INTRODUCTION: Chlorpromazine a first generation antipsychotic, due to its low cost is one of the commonly used antipsychotic, especially in developing countries like India. It is associated with side effects like neuroleptic induced deficit syndrome, extrapyramidal symptoms, dizziness, sedation etc along with this side effects few cases of chlorpromazine related lenticular and corneal abnormalities were reported earlier.

we report a patient who developed cataract possibly due to chlorpromazine.

METHODOLOGY: A Case Report.

CASE REPORT : A 42 year married female k/c/o schizophrenia since 10 years with history suggestive of delusions of persecution, reference and auditory hallucinations maintaining well on chlorpromazine 600mg/day, risperidone 3mg, trihexyphenidyl 2mg since 2 years. she had stopped taking medications since one month, on questioning she reported blurring of vision since two months. Ophthalmological evaluation using slit lamp examination showed stellate central cataract of both the eyes suggestive of drug induced cataract.

CONCLUSION : Patient developed cataract following treatment with chlorpromazine. she did not have any risk factors for cataract formation like smoking, ocular trauma, previous eye surgery and older age. Chlorpromazine possibly alters the respiratory mechanisms of lens by producing a metabolic block at a site preceding succinate, which may result in cataract. The cataract may represent a foci of denatured protein resulting from the interaction of light with a drug due to photosensitization. As there is resurgence in use of typical antipsychotics, it is important for clinician to be aware of this side effect especially in developing countries and screen regularly for lenticular opacities.

Key Words : Chlorpromazine, cataract, schizophrenia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

168. AMISULPRIDE INDUCED EPS: A CASE SERIES

TONY LAZAR THOMAS ¹, NARASIMHA GVL, PRATHIMA MURTHY

Introduction

Amisulpride, a substituted benzamide derivative, is a second-generation (atypical) anti-psychotic. At low doses, it enhances dopaminergic neurotransmission by preferentially blocking presynaptic dopamine D(2)/D(3) auto receptors. At higher doses, amisulpride antagonizes postsynaptic D(2) and D(3) receptors, preferentially in the limbic system rather than the striatum, thereby reducing dopaminergic transmission. Amisulpride is an effective and well tolerated option for the first-line treatment of patients with acute schizophrenia as well as for those requiring long-term maintenance therapy. Very few cases of EPS were reported in literature, especially in the Indian context(1)(2)(3)(4)(5) (Jhanjee and Gupta, 2009; Nebhinani and Suthar, 2017; Mandal et al., 2014; Mendhekar et al., 2010; Gowda et al., 2017) and little information is available on acute dystonic reaction associated with amisulpride. Here we present a case series involving 2 patients with amisulpride induced EPS.

Case Report 1

A 21 year old male studied upto BCA had symptoms of schizophrenia (ICD-10) since the past 6 months. Patient had h/o cannabis use for past 3 years, with dependence pattern for 1 year,and is currently abstinent since last 2 months. No significant family history or past history present and he had good premorbid functioning. No evidence of prenatal/perinatal/postnatal injury present. General physical examination was within normal limits. Mental status examination showed thought broadcasting,thought insertion,delusion of control, made act, somatic passivity, delusion of reference, persecutory ideas, 2 nd person auditory hallucinations. Patient was antipsychotic naive, and Tab Amisulpride was considered as it has less risk for extrapyramidal symotoms compared to many other antipsychotics. He was started on Tab Amisulpride 100mg and it was increased to 200 mg on the second day, and further to 300 mg on 3^rd day an 400 mg on 4th day. Patient was continued on 400mg for another 4 days and then it was increased to 600 mg/day after that. On 600 mg of Amisulpride he developed sudden severe tightening and twisting contraction of neck towards left side and had painful nuchal dystonia which was relieved immediately by Inj Promethazine 25 mg intramuscular stat dose. The entire dystonic reaction lasted for around 30 minutes and otherwise his medical and neurological examination was unremarkable. There was no further episodes of dystonia and Tab Amisulpride was continued in the dose of 600 mg/day along with Tab Trihexyphenidyl 2mg /day

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

169. EFFECT OF LITHIUM IN CLOZAPINE INDUCED NEUTROPENIA: A CASE REPORT

Gaurav Aggarwal ¹, Ashwani Saini ¹, P K Pardal ¹

Clozapine is an atypical antipsychotic agent, used primarily for refractory schizophrenia. Its side effects including leucopenia, neutropenia and agranulocytosis can be life threatening and are estimated in around 1% of all patients exposed. Lithium has been used successfully to raise the WBC during cancer chemotherapy and in patients treated with carbamazepine. Literature on the use of lithium in treating clozapine induced neutropenia is scarce. We present here a case of clozapine induced neutropenia successfully treated with lithium.
Key words – clozapine, lithium, neutropenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

170. HCN CHANNELS -A NOVEL TARGET IN PSYCHIATRY

Sunny Dua ¹, Subramaiah Nagendran ², Muskaan Makkar ³

Hyperpolarization-activated, cyclic nucleotide-gated channels (HCN channels) are expressed widely in the brain and involved in various neuronal activities, including the control of neuronal rhythmic activity, setting the resting membrane potential, as well as dendritic integration.

Hyperpolarization-activated cyclic nucleotide-gated channels are concentrated in cortical and hippocampal pyramidal cell dendrites, where they play an important role in determining synaptic integration and plasticity phenomena.

Hyperpolarization-activated cyclic nucleotide-gated channels are widely distributed in both excitable (and non-excitable) cells of the nervous system and the heart. Their expression patterns in different tissue and cells are affected by different pathological conditions. These channels transmit electrical signals in excitable cells such as neurons; for instance, they control heart rate and also inhibit pain These channels have been suggested to be involved in physiological processes such as cognition as well as pathophysiological states such as epilepsy, pain, Parkinson’s disease (PD) and Alzheimer’s disease, depression and many other psychiatric illnesses.

Clozapine is the most efficacious treatment for treatment-resistant schizophrenia; however, its use can be limited by intolerability. Sinus tachycardia is a common adverse event associated with clozapine use, which may lead to the premature discontinuation of clozapine. Novel heart rate controlling agent ivabradine can be effectively and safely used to control the heart rate and to allow for continued treatment with clozapine.

KEYWORDS : Hyperpolarization-activated cyclic nucleotide-gated channels, clozapine, ivabradine, tachycardia, treatment-resistant schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

171. ‘Psychogenic purpura’ in context of Dissociative disorder: A Case series and brief literature review

Mayank Rai ¹, Debanjan Banerjee

Psychogenic purpura or ‘auto-erythrocyte sensitisation syndrome’ has been a rare but often misdiagnosed entity in the field of psycho-dermatology. It mostly stays associated with mental or physical stress and is characterised by recurrent crops of ecchymoses over the trunk, limbs and face with or without multiple other systemic complaints. There are no standard laboratory markers for this condition and clinical suspicion is the best way to diagnose it early. A myriad of serious disorders need to be evaluated and excluded before this rare condition can be thought of.

In this paper we present three cases of psychogenic purpura with comorbid dissociative disorder who presented to our tertiary care centre and improved on treatment with anti-anxiety drugs. The psychological stressors were evident in all of them which were addressed with psychotherapy and there was no recurrence of skin lesions on follow-up. All of them had financially exhaustive pathways to health-care with multiple investigations and had difficulty in accepting the psychiatric diagnosis. This shows the significance of a careful psychiatric history and exclusion of other medical causes to prevent misdiagnosis of this rare but treatable condition. A brief review of this disorder is also outlined.

Keywords: psychogenic, purpura, dissociation

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

172. Title: Mirtazapine and lorazepam for psychogenic vomiting: a case report

Aditya Somani ^a,^✉, Vinutha Ramesh ^a

Introduction: Psychogenic vomiting is a poorly studied condition and there are no clear protocols for approach and treatment of the same. Treatment is largely empirical. Relief in overt psychiatric symptoms generally leads to relief in symptoms of nausea and voimting.

Case Report: A 37-year-old lady was admitted to the hospital in view of persistent nausea and multiple episodes of voimiting daily, for last two months. All routine investigations and upper gastro-intestinal endoscopy were normal and treating physician/gastroenerologist referred her to Psychiatry OPD. She was admitted in psychiatry ward and treated with lorazepam and mirtazapine. No clear psychiatric symptoms other than mild obsessive-compulsive symptoms and some anxiety were found. She gradually improved over a week and was discharged from hospital. Lorazepam was tapered off over two weeks’ time after discharge and mirtazapine was continued. She is doing well and attending follow-up regularly for last four months.

Discussion: There are only few case reports or case series on treatment of psychogenic vomiting. Most of them deal with antidepressants like escitalopram or amitiptyline and psychotherapeutic approaches. There is no case report of tretament of psychogenic vomiting with mirtazapine and lorazepam.

Keywords: Lorazepam; mirtazapine; psychogenic vomiting

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

173. Effectiveness of Metacognitive Therapy for the management of An adult male with Obsessive Compulsive Disorder and Schizotypal personality disorder: A Case Report

Divisha Rastogi ^*, Shweta Singh ^**

Background : Schizotypal personality disorder (SPD) is characterized as odd and eccentric behavior by someone who has great difficulty in establishing close relationships. Recurrent obsessional thoughts and compulsive acts are the essential features of Obsessive Compulsive Disorder (OCD). The comorbidity between these two in an individual is a rare condition. However such condition is challenging to manage in a clinical setting. The present paper discusses about the management of a 32 year old male, diagnosed with SPD and OCD using Metacognitive Therapy.

Method: The psychotherapeutic sessions were planned for the management of OCD symptoms, benzodiazepine dependence, sleep difficulties and adjustment problems. 13 psychotherapy sessions were taken using Metacognitive Therapy (MCT) including Brain Lock technique and Behavioural Experiments.

Results:. The patient has shown significant improvement in terms his obsessive thoughts, benzodiazepine dependence, sleep difficulties and problem solving skills wherein he is able to devise various solutions to deal with the problem.

Conclusion: The case study presentation will provide us an insight into the effective management of an individual with OCD and SPD. Keywords: Schizotypal Personality Disorder (SPD), Obsessive Compulsive Disorder (OCD), Metacognitive Therapy (MCT)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

174. Title: The psychosocial rehabilitation needs of residents of halfway home for mental health care in Bangalore

Vidushi ¹, G Gopalakrishnan ²

Background: Half-way homes were established to provide intermediary care between hospital and community living for mental health care. It allows people with physical, mental, and emotional disabilities, to learn (or relearn) the necessary skills to re-integrate into society, better support and care for themselves. They are termed “halfway houses” due to their being halfway between complete independence and relying for care round the clock.

Aim: To identify the psychosocial rehabilitation needs of the residents of the halfway home, by using a questionnaire based on ADLS Materials and methods: It is an observational study done over a month. Convenience sampling was used. The residents of the halfway home, in respect of psychosocial rehabilitation were taken up for the study, after permission. A total of 21 patients (13 males; 8 females) were inducted. They were interviewed after taking informed consent. Using a semi structured questionnaire based on ADLS, the socio demographic profile, and the following dimensions were explored - skills for daily living, management of the illness, symptom control as well as sources of social support, vocational and housing aspects. These were analyzed manually by noting similarities and differences in each of the themes.

Results: In terms personal hygiene all residents commented that constant attention was given to this aspect. All residents were involved in cooking and only few said that they will have difficulty cooking independently. Most of the residents expressed their difficulty in managing their own medications and expressed the need of assistance by the staff. Half of the residents said that they needed more time with their friends and families.

Conclusion: The program encouraging independent living and increasing social skills to cope with the challenges of living in the community, after stay in halfway home; should be the goal of psychosocial rehabilitation.

Keywords - Psychosocial rehabilitation, halfway home, Mental health care

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

175. Disability Level in patients with Schizophrenia

Suma T Udupa ¹, Selvamani Dinakaran, Arun Kumar, K Ramakrishnan

Introduction: Schizophrenia is a clinical syndrome of variable, but profoundly disruptive psychopathology that involves cognition, emotion, perception, and other aspects of behavior. According to the World Health Organization, a disability is “any restriction or lack (resulting from any impairment) of ability to perform an activity in the manner or within the range considered normal for a human being”. Schizophrenia is ranked among the top ten leading causes of disease related disability in the world.

Objective: To assess the level of disability in patients with schizophrenia.

Methodology: This was a hospital-based cross-sectional study. Hundred consecutive patients diagnosed to have schizophrenia who presented to our hospital were included in the study. Brief socio demographic details was collected and disability was assessed using WHO DAS 2.0. The data obtained was analysed using SPSS version 16.0 for windows. Descriptive statistics, including mean and standard deviation (SD), and frequency (n) and percentage (%) was used to summarize continuous and categorical data, respectively.

Results: The mean age was found to be 36 (SD 9.05) years with 8 (SD 5.30) years of average duration of illness. There was almost equal distribution of gender (49% male vs 51% female). Majority of the patients (80%) were found to have mild disability. Maximum disability in our study population was seen in the area of getting along with people and life activities which included the work area; least disability was found in the area of self-care.

Conclusion: Our finding was in keeping with most of the Indian studies. It is important to assess the disability level along with the symptom profile in the clinical setting and suggest appropriate remediation measures to improve the disability.

Key Words: Schizophrenia, disability

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

176. Title: An Overview of Barriers for Vocational Rehabilitation

Ravindra Munoli ^*, Mahima Acharya ^†, N R Acharya ^‡

Keywords: Rehabilitation, Barriers, Vocational rehabilitation

Introduction: The unemployment rate for individuals with psychiatric disabilities is high. Often treating team addresses vocational issue of patients with respect to workplace adjustments, coping, etc. However, the issues of assessing/enhancing vocational skills, assisting in choosing vocation, feedback from workplace, modifying work environment, are not addressed due to the various limitations and barriers.

Methodology: Literature review of barriers for vocational rehabilitation in patients with chronic mental illness.

Discussion: The unemployment rate for individuals with psychiatric disabilities is 85% to 92%, compared to individuals with other types of disabilities whose unemployment rate is around 67%. People with psychiatric disorders face many barriers and disincentives when returning to work. Demands of the labor market, work restrictions caused by illness, complications associated with disability benefits, limited availability of evidence-based programs, all contribute. Main barriers: Illness related factors, Social Competence, Environment/Work place demands- physical and emotional, Attitude of society towards person with mental illness. In addition, various minor barriers surface when the person is at workplace. Not all factors will be modifiable; so some compromises at various levels have to be done which need not be always at the client’s level.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

177. A Confirmatory Factor Analysis of the Indian (Hindi) version of the Health and Safety Executive’s Management Standards Indicator Tool.

Laxmitej Wundavalli, Sidhartha Satpathy, D K Sharma

Introduction: In the UK, The Health and Safety Executive (HSE) Management Standards Indicator Tool has been used by organisations to monitor working conditions that can lead to stress. The tool has been translated into several languages. However, the psychometric analysis of the translated versions of the tool is not available. The purpose of this study was to do a Confirmatory Factor Analysis (CFA) of the Hindi version of the HSE’s Management Standards Indicator Tool.

Methods: The study was conducted at All India Institute of Medical Sciences, which is a premier tertiary care public sector medical institute in New Delhi, India. The filled copy of the Hindi version of the tool was collected from 530 individuals working in the hospital. A first order CFA was done on the 35 item seven factor measurement scale.

Results: The results showed an acceptable fit to the data for the instrument. The Chi square goodness of fit statistic was 1488.164 (df=529, p<0.001) and the relative value was 2.813. The GFI and the AGFI were 0.865 and 0.839 respectively. The NFI was 0.705 and the CFI was 0.785. The SRMR was 0.0656. RMSEA was 0.059 (90% CI=0.055-0.062). The Cronbach’s alpha was 0.822.

Conclusion: The results indicate that that the Hindi version of the tool has good psychometric properties for usage in evaluating stress among employees.

Key words: Stress, HSE Management Standards Indicator Tool, Confirmatory Factor Analysis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

178. Seizure and Psychosis: Forced Normalization - A Case Report and Narrative Review

Srinivas Rajkumar ¹, Shyamanand Roy ², Rohit Verma ³, Nand Kumar ⁴

INTRODUCTION: The relation between seizure and psychosis is as old as these entities. Individuals with seizure disorder have higher incidence of psychosis (9%). Artificial induction of seizure (ECT) improves symptoms of psychosis and control of seizure in a patient with psychosis may make him more prone to develop symptoms. The later phenomena is referred to as forced normalization.

Forced normalization is a complex phenomenon which is less understood and involves complex diagnostic and management challenges. The case report and review aims to demonstrate the challenges and possible evidence based treatment options.

CASE REPORT: A middle aged male with a history of seizure disorder and psychosis was admitted in ward as he had recent worsening of symptoms of psychosis (delusion of persecution, irrelevant talk and impaired self-care). A thorough review of history revealed onset of psychosis prior to seizure disorder which was untreated. The episodes of seizure occurred at the height of worsening of psychosis and was followed by disappearance of symptoms for a brief period. After one such visit to neurologist following seizure, he was prescribed anti-epileptics following which he remained seizure free but developed psychotic symptoms requiring anti-psychotics. Patient remained free of seizure and psychotic symptoms and discontinued medication after a year. He had recurrence of psychotic symptoms and after 3-4 weeks of symptoms, he had a seizure episode after which symptoms of psychosis improved, adding credence to the concept of forced normalization.

DISCUSSION: Literature as old as 1950s show psychotic episodes following seizure remission in epilepsy patients. Several possible mechanisms and criteria to categories the phenomenon have been reviewed.

CONCLUSION The case and review illustrates the importance of forced normalization, its identification and management.

KEYWORDS: Psychosis, Seizure, Forced Normalization, Neurobiology, Kindling

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

179. Association of various demographic factors and cognitive performance in patients of schizophrenia (currently in remission).

Vijay Kumar Saini, KK Verma, Girish Baniya, Santosh Kesharwani

Background

Schizophrenia is one of most common of serious mental disorder. Cognitive deficits represent a core feature in schizophrenia and have substantial influence on course of illness, on noncompliance and on psychosocial functioning. Some of the patients may not be aware about cognitive difficulties. Impairement in neurocognition is somewhat associated with many of the sociodemographic variables but the results are controversial regarding these factors.

Methodology

It was a cross sectional study. Patients of schizophrenia (currently in remission) and controls were recruited from outpatient department. Various neurocognitive domains like attention and concentration, psychomotor speed processing, cognitive flexibility and auditory verbal memory (PAL) were assessed with help of Digit Span test, Trail making test A, Trail making test B and Paired associate learning test respectively. Chi-square test and Student t test was used for comparison of two groups. Correlation was used to see association of various demographic variables with cognitive performance in patients. Difference was considered statistically significant when p value was < 0.05

Result

Both patient and control group were matched socio-demographically. Most of the participants in patient group were married(53.3%), male(83.3%), hindu(73.3%), residing in nuclear families(66.7%), hailed from rural areas(73.3%) and educated up to middle school(40%). Patient group performed significantly poor in all domains of neurocognition in comparison to control. Regarding association of various socio-demographic variables with cognitive performance, we found that more duration of illness and higher age were associated with poor cognitive performance. Higher educated patients had good performance. Gender, Residence/domicile, marital status and occupation significantly did not affect cognitive performance.

Conclusion

Patients with schizophrenia performed poorly on various test of neurocognition. Cognitive impairment was influenced by various socio-demographic variables.

Keywords

Schizophrenia, Neurocognition, Socio-demographic

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

180. “Health benefits of supported employment in PATIENTS WITH CHRONIC SCHIZOPHRENIA “

Sangeeta Kashyap*, Rupali Shivalkar, Kavita Nagpal, Manish Kansal, Garima Kapoor, Akashdeep Ghoshal

Key words: Schizophrenia, work, vocational Rehabilitation, recovery

BACK GROUND

Work brings clear health benefits for persons with Schizophrenia (Bevan 2013). Better coordinated support, increased understanding of the condition and importance of work for recovery help significant number of persons with chronic schizophrenia gain access to and remain in gainful employment (Cook and Razzano 2000; McGruk et al 2009).

Objective:

The study tried to explore health benefits of paid employment in patients diagnosed with chronic schizophrenia admitted in intensive psychosocial rehabilitation program.

Method

The study included 30 patients with chronic Schizophrenia admitted for intensive psychosocial rehabilitation program. All the patients had duration of illness > 5 years with disability as assessed on IDEAS > 40%. The health benefits of gainful employment were assessed over a period of six months using IDEAS, GAF and PANSS rating scales. Assessments were carried out at three intervals- at the time of enrollment into Rehabilitation program (baseline assessment), just before entering the employment (Pre employment) and six months of continued employment (Post employment). Perceived improvement by patients was assessed using in-depth interview technique.

Result

The finding showed significant functional improvement in pre and post employment scores as assessed on IDEAS and GAF. Also the PANSS scores showed significant reduction suggesting overall clinical improvement pre and post employment status. Subjectively patients reported enhanced self esteem, better focus, better communication ability and interpersonal adjustment.

Conclusion

The study reiterates the health benefits of gainful employment among persons with chronic schizophrenia. More research is warranted to understand the differential impact of work on various aspects of recovery.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

181. Dissimilated Neurocysticercosis may manifest schizophrenia like symptoms – A Case repost

R K Abay

A 22 years old Hindu female multipara has three children educated house maker had complaints of headache all over the scalp radiating to neck and back over the spine. She has abnormal perception and behaviour from 15 to 20 days admitted in psychiatry inpatient department. She also experienced one episode of Trans and possession one year ago during. Since then she continued and took treatment but not relieved. Her physical examination did not reveal any significant abnormality and any soft neurological signs. On Mental status examinations she showed significant changes in perception and thoughts which were assessed on SANS and SAPS Abolition & apathy, affect flattening, attention and concentration, Inappropriate affect, has questionable on scoring SAPS has formal thought disturbances marked on delusion and auditory hallucination has quality of voice of calling as hypnopompic and hypnogogic in nature but visual hallucination has again a questionable of misinterpretation in quality score. Lab investigation revealed increased total count of 10500/cc with increase in neutrophil and decrease in leukocytes MRI brain study showed disseminated neurocysticercosis all over the cerebrum and cerebellum along with perilesional edema, orbital and tongue were also involvement Musculoskeletal survey doesnot evolve any change where as ultrasonographic study of whole abdomen showed discrete calcified lesion in GB and kidney.

Provisional diagnosis was given as acute and transient psychotic disorder schizophrenia type due to physical illness.

Patient was treated with anti edema drugs manitol 100 ml bd for three days under coverage of anti epileptic drugs divalproate sodium 500 mg bd in addition to it levoteracetam 500mg bd initially for three days AND Prednisolone 10mg thrice in a day for three day. Later all were continued except manitol. After third day albendazole were administered 400 mg bd for 14 days Further evalulation on third day and fourteenth day showed symptomatic remission in headache complains at third day but there were no improvement in perceptual and thought disturbance. At the end of fourteenth day it revealed slight remission which favours the need of antipsychotic applied to her as aripiprazole 2.5 mg /day Impression – Presence of perceptual and thought disturbances favour the manifestation of schizophrenia in neurocysticercosis Key words –neurocysticercosis, schizophrenia, hynopompic, hypnogogic hallucination, SANS and SAPS

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

182. EFFECTS OF CLOZAPINE IN SYMPTOM REDUCTION, IMPROVEMENT IN QUALITY OF LIFE IN SCHIZOPHRENIC PATIENTS – A FOLLOW UP STUDY.

Prabavarani M ¹, Venkatesh Madhan Kumar ¹

INTRODUCTION

The study examined the correlations between reduction in positive and negative symptoms and improvement in quality of life in schizophrenic patients treated with clozapine and its side effects.

METHODOLOGY

The clinical responses of 80 Schizophrenic patients were examined. After all previous antipsychotic medications had been withdrawn, the patients were treated with clozapine according to a standardized titration and dosage schedule. Patients were evaluated for reduction in positive symptoms and negative symptoms, improvement in quality of life and side effects after 4, 8, 12 and 24 weeks. BPRS, PANSS, AIMS, CGI, Quality of life scale, Targeted inventory on problems in Schizophrenia (TIP-Sz) and Functional Assessment for Comprehensive Treatment of Schizophrenia (FACT-Sz), semi structured proforma including sociodemographic details and side effects would be used. Data will be analysed using appropriate statistical analysis.

RESULTS AND CONCLUSION

As this is an ongoing study results and conclusion will be published during presentation of paper.

Keywords. Positive symptoms, Negative symptoms, Quality of life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

183. A study of Glucose intolerance, Insulin resistance and metabolic syndrome in the patients of Schizophrenia

Vaibhav Dubey

Background: Schizophrenia itself or antipsychotic medications are primarily responsible for the observed increased metabolism disturbances are not clear.

Aims and Objectives: To find out presence of glucose intolerance, insulin resistance and Metabolic syndrome in the patients with schizophrenia

Materials and Methods: We conducted 3 different studies in our Department. To study glucose intolerance we did OGTT in 30 drug naïve patients of schizophrenia, 30 siblings of schizophrenic patients and 30 healthy controls. To study insulin level and insulin resistance in drug naïve patients with schizophrenia, 31 drugs naive patients suffering from first episode of schizophrenia and 40 age and sex matched healthy controls were studied. To study metabolic syndrome in patients of schizophrenia a total of 150 patients of schizophrenia were evaluated for the presence of metabolic syndrome using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria.

Result:

In the study of glucose tolerance among drug naïve patients of schizophrenia we found the significant difference in glucose tolerance testing between cases and healthy controls at 0 hour, 1 hour and 2 hour Triglyceride levels were significantly higher among the cases as well as siblings.

In the study of insulin resistance amongst drug naïve patients of schizophrenia fasting glucose, fasting insulin level, insulin resistance, VLDL, triglycerides were significantly higher in Drug naïve schizophrenia patients.

In the study of metabolic syndrome in patients of schizophrenia, 36% (54 out of 150) patients fulfilled modified NCEP ATP-III criteria of metabolic syndrome. All these abnormalities were seen in more than half (52-61%) of the patients.

Conclusion: the present study suggests that patients with schizophrenia are predisposed for developing insulin resistance and glucose intolerance and metabolic syndrome.

Key words: Glucose intolerance, insulin resistance, metabolic syndrome.

Sathish Sankar PR

A 36 yr old male, unemployed, unmarried belonging to LSES from Chennai was brought with complaints of sleep disturbances, suspiciousness, hearing voices, talking to self, multiple suicide attempst, reduced self care and food intake, dull and withdrawn for the past six years, increased for the past two years on continuous treatment and good drug adherence with history of six cycles of ECT, and on multiple antipsychotic drugs with persisting symptoms. On MSE, patient had normal psycho motor activity with relevant and coherent speech, sad, reactive and appropriate affect without lability with thought – delusion of control, delusion of persecution, delusion of reference, delusional memory with suicidal ideation, with auditory hallucinations diagnosed as a case of paranoid schizophrenia not responding to any treatment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

184. Atypical neuroleptic malignant syndrome

Favaz V, Vikas Menon, Balaji Bharadwaj, Kuppuli Pooja

Neuroleptic malignant syndrome (NMS) is a potentially fatal adverse effect of antipsychotics (AP). Atypical presentation of NMS with drugs which are not potential D2 blockers raises question for an alternative hypothesis for NMS. The current case is reported to highlight the atypical presentation as well as nosological challenges in patient developing NMS with atypical AP.

A 30 year old male presented with irritability, assaultive behavior, persecutory delusion and auditory hallucination for three days. Past history of three episodes of similar complaints which were treated with Olanzapine and Risperidone. Patient had high susceptibility to extra-pyramidal symptoms. After admission patient was started on Risperidone along with THP when he had fever, tremors, altered sensorium and rigidity at 3mg dose. After stopping Risperidone fever and rigidity improved with worsening of psychotic symptoms. Following this Olanzapine was started and very gradually uptitrated to 7.5mg when patient had recurrence of fever and perplexity with disorientation with minimal rigidity but no tremors.

Both the instances fever work up including CPK levels were normal except for thrombocytopenia and leucopenia. Provisional impression of NMS was made in both instances. After stopping Olanzapine fever subsided with improvement of blood counts. Following this patient had catatonic symptoms for which patient received 9 sessions of ECT.

In atypical presentations of NMS, hyperthermia and muscle rigidity may be absent. The first symptoms were fever and disorientation in both the instances, posing diagnostic dilemma. So there is a need for broadening the diagnostic criteria for NMS. Even though there was clear temporal relationship with up-titration and stopping of AP, a diagnosis of NMS could not be made using DSM IV-TR criteria. In our case NMS was diagnosed using Levenson criteria. Hence diagnosis of NMS must be considered with a high index of suspicion.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

185. An unusual presentation of bracelet stuck on arm causing necrosis - in a patient suffering from Schizophrenia.

Dhruv Chaudhary ¹, Rajat Oswal ²

Introduction: Schizophrenia is a chronic psychiatric disorder often first diagnosed after referral from other specialties due to physical illness. It may be the underlying cause for the physical condition due to neglect and lack of care both by patient and care takers, which may lead to severe and complicated consequences due to delay in healthcare seeking behavior.

Case Description: A 33 years old male was brought to surgical emergency by his mother with a metallic bracelet “kada” stuck on his arm along with necrosis and foul smelling discharge from the local site. Patient was referred to Psychiatry for evaluation of abnormal behavior in form of self-talking, laughter outburst and incoherent speech. On evaluation Patient was diagnosed with Schizophrenia since last 3 years. The interview with patient and his mother revealed patient having auditory hallucinations of female voice commanding and abusing him, staying aloof, poor hygiene and disorganized behavior in form of eating from left overs on the streets, wandering in neighbourhood. One month back he bought a bracelet at a fair and wore it on his hand all the way up to his arm where it got stuck, he never bothered to remove it, when it got infected and foul smelling discharge started coming out, patient’s mother took notice and brought him to hospital. He was started on atypical antipsychotic Risperidone 2mg BD along with benzodiazepine.

Discussion: Here, this type of unusual presentation emphasizes the need for awareness regarding mental illness and its treatment in the community especially the relatives of the psychiatric patient so that serious unforeseen consequences concerning health of psychiatric patients can be prevented.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

187-Abstract Title: Treatment resistant schziophrenia

Sathish Sankar PR ¹

A 36 yr old male, unemployed, unmarried belonging to LSES from Chennai was brought with complaints of sleep disturbances, suspiciousness, hearing voices, talking to self, multiple suicide attempst, reduced self care and food intake, dull and withdrawn for the past six years, increased for the past two years on continuous treatment and good drug adherence with history of six cycles of ECT, and on multiple antipsychotic drugs with persisting symptoms. On MSE, patient had normal psycho motor activity with relevant and coherent speech, sad, reactive and appropriate affect without lability with thought – delusion of control, delusion of persecution, delusion of reference, delusional memory with suicidal ideation, with auditory hallucinations diagnosed as a case of paranoid schizophrenia not responding to any treatment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

188. MAINTANANCE ECT FOR A CASE OF RECURRENT CATATONIA

Pavan Kumar, Aniji V R, Indu V Nair

Background

Catatonia was first described by Kahlbaum as a disorder of movement and speech. Kraeplin grouped catatonia along other sub types of schizophrenia. In ICD-10 catatonia is mentioned as sub type of schizophrenia. DSM-5 gives independent status to catatonia. Catatonia may be caused by many medical conditions but in psychiatry it is associated more with mood disorders and schizophrenia. There are certain conditions with recurrent catatonia like the Periodic catatonia.

Case presentation

We present a case of 35 year od south indian woman who has recurrent catatonia for the past 15 years. She was diagnosed with catatonic schizophrenia initially, treated with adequate trials of different antipsychotics, mood stabilisers and benzodiazepines with poor response. For the past several years she is being given maintainance ECT to which she is showing good response.

Conclusion

Electroconvusive therapy is effective in the treatment of recurrent catatonia and can be maintatined. But there are issues like increased tolerance to ECT in due course.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

189. DELUSION OF PREGNANCY IN SCHIZOPHRENIA

Mamatha bellamkonda ¹

INTRODUCTION:

Pseudocyesis and Schizophrenia with Delusion of pregnancy (DP) are the two closely related conditions mimicking each other,demarcation between the two is very difficult to make. Both conditions are said to be rare diseases and are more rarely reported.

Pseudocyesis is a medical condition in which the patient will have most of the signs and symptoms of pregnancy except the presence of fetus. Patient may have amenorrhoea, morning sickness, breast changes, abdominal distension, weight gain etc.

Pseudocyesis in Schizophrenia is a rare symptom and rarely reported in developing countries. Patient may have few symptoms of pregnancy. It can present more commonly as polythematic delusions or less commonly as monothematic delusion.

Pseudocyesis is considered to be a symptom of psychotic illness whereas Pseudocyesis is considered as psychosomatic symptom.

KEY WORDS: Delusion, Schizophrenia, Pseudocyesis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

190. Childhood-onset Schizophrenia

Thacker RM ¹, Chandrani KV ², Takwani TJ ³

Introduction

Despite the fact that most cases of Schizophrenia have their onset in late adolescence or early adulthood, cases of “Schizophrenia” have been identified in children throughout at least the past century. The onset of Schizophrenia in childhood is frequently insidious and it’s difficult to assess and determine whether nonspecific behavioral disturbances represent an incipient psychosis or are signs of Autism or Pervasive Developmental Disorder.

Case Report

A 14 year old boy presented with symptoms of suicidal attempt and gesture, not eating food, swaying his body to and fro constantly, markedly decreased interaction with family members and running away since 4-5 days. On detailed evaluation after admission, it was found that 2-2.5 years back symptoms started with suspiciousness that some lady would come and kill him, self harming behavior, eating soil with small pebbles and other disorganized behaviors. His birth and developmental history were normal. Family history of psychiatric illness was negative. Differential diagnosis of Autism Spectrum Disorder and Major depression with psychotic features was considered. Even with regular treatment of T. Trifluoparazine 15mg, T. Aripiprazole 15mg, and Cap. Fluoxetine 20mg for considerable period of time, he showed no improvement and had to be given Electroconvulsive Therapy for acute management of suicidality along with T. Clozapine which was gradually up titrated to 300mg with which he showed significant improvement with some residual negative symptoms.

Discussion and Conclusion

Schizophrenia can be diagnosed reliably in children using the same criteria as for adults. However, there are important differences with respect to early onset i.e. having chronic course, social and cognitive consequences and increased negative symptoms compared to adult-onset Schizophrenia. The treatment and outcome is influenced by other common differential diagnosis at that age. The treatment requires multimodal approach pharmacological and psychosocial intervention and early identification of symptoms may help in prevention.

Key Words

Schizophrenia, Childhood-onset, Clozapine

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

191. A STUDY OF ECONOMICAL BURDEN INCURRED BY FAMILY MEMBERS OF PATIENTS SUFFERING FROM SCHIZOPHRENIA.

Chetan Lokhande

Background: Schizophrenia is a devastating disorder with high economic burden for families. The caregivers experience significant human and economic burden. The purpose of this study is to estimate expenses incurred by family members thereby to derive some strategies like providing medicines at concessional rates or decreasing visit to hospital in order to optimize or reduce the costs.

AIM: To determine actual and estimated cost of psychiatric consultations, medicines, cost of traveling and miscellaneous expenses. To determine loss of patient’s and family income due to illness. To find correlation between severity of illness and cost of medicines.

Methodology: A prospective longitudinal three months follow up study was conducted in 100 patients attending psychiatric OPD in tertiary general hospital for a period of 1 year. Patients studied were diagnosed with schizophrenia and they were interviewed along with caregiver during first 3 months follow up.

Result: The mean estimated cost of consultation and medicines was much higher than actual cost of consultation. There was high mean loss of income and damage due to illness of patients during visit.

Conclusion: Early diagnosis and better treatment adherence, family centred and community-based programmes, incorporating clinical case management and improving treatment and rehabilitations are expected to lower the overall cost while improving the quality of life and social functioning of patients.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

192. ATTENUATED PSYCHOSIS SYNDROME –NEW NAME FOR KNOWN ENTITY- NARRATIVE REVIEW

Abdul Faheem1, Srinivas Rajkumar2

BACKGROUND :

A prodrome to schizophrenia has been known and documented for over a century from the time of Kraeplin. Psychotic features were present in milder forms several years before patients were admitted to asylums. Currently research has been shifted to focus in preventive psychiatry. It has led to inclusion of new entity Attenuated Psychosis Syndrome in DSM-5 under “conditions for further study”(section III) and ICD-11 under “Mental health states requiring further study”. These people are at risk of developing psychotic illnesses, bipolar affective disorder in later years.

METHODOLOGY :

Literature review of past five years was done using “PUBMED” “MEDLINE” and “PsycINFO” with research terms being “attenuated psychosis syndrome” “At Risk Mental States” and “Ultra High Risk for Psychosis”.

RESULTS:

Among these people less than 40 % develop psychosis. Of these nearly 70% of people develop Schizophrenia spectrum disorders. Transition of psychosis was found to be 36% after 3 years of follow up in these patients. Antipsychotics are not recommended. Close monitoring of them is recommended treatment.

CONCLUSION:

Adding this diagnosis in DSM 5 is criticised as it may cause stigma to the diagnosed individuals in their young age as only few develop psychosis and also the concern about more false positive cases. Intervening at earlier stage helps in reducing the duration of untreated psychosis in these individuals which will have great impact on the functioning and prognosis of these patients. They are also prone to develop mood disorders in later life suggesting pluripotent nature of entity. This entity by itself causes distress requiring clinical attention. Future research should be in the lines of discovering the course of the disease in these people. This entity would find its diagnostic place as it has its own advantage of being considered as a disorder.

KEY WORDS:

Attenuated Psychosis Syndrome, Prodrome, At risk mental states.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

193. Topic - Psychiatric morbidity among caregivers of schizophrenia patients in a rural population of Bihar

Raginee Singh, Balaram Patra, Pranav prakash Chaudhary

Background: Schizophrenia being a debilitating illness leads to deterioration in occupational, interpersonal and self-supporting abilities. This can pose numerous psychosocial difficulties for patients as well as family members who care for their loved ones resulting in a burden of care. Due to the chronic stress of caring for these patients many caregivers develop psychiatric symptoms.

Objective: To determine psychiatric comorbidity among caregivers of patients of schizophrenia in the rural population

Study design: a cross-sectional descriptive study

Place and duration: The study was carried out at the department of psychiatric Katihar medical college, from August 2017 -August 2018

Methodology: A semi-structured Questionnaire and General Health Questionnaire-28 (GHQ-28) were applied to the caregivers of schizophrenia patients who fulfilled the inclusion criteria. Among the respondents whose GHO-28 score 4 or above was administered to screen for the presence and absence of psychiatric morbidity. HAM-D (Hamilton rating scale for depression) and HAM-A (Hamilton anxiety rating scale) were used to assess frequencies of depression and anxiety. All the data collected in the study were analyzed using the statistical package for social studies (SPSS) version 23.

Results: Out of 150 respondents most of them were female 126 (84%), housewife 92 (73.01%). Out GHQ positive, 34 (36.95%) caregivers were found to have depression while 19 (20.65%) caregivers had anxiety.

Conclusion: Significant proportions of the caregiver of schizophrenic patients were suffering from psychiatric disorders that did not get any psychiatric treatment. Therefore, routine screening of caregivers will aid early diagnosis of psychiatric disorders and appropriate psychological intervention.

Keywords: psychiatric morbidity, rural population, caregivers, schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

194. Title: Impact of schizophrenia on parenting

Anju Moni Rabha ¹, Susanta Padhy ¹, Sandeep Grover ¹

Background: Schizophrenia is a severe mental disorder which is associated with difficulty in functioning arising as a result of clinical symptoms, psychological and social deficits^. Dysfunction in personal, social and occupational spheres can interfere in role functioning, especially parenting.

Aim of the study: To evaluate the parenting skills of patients with schizophrenia as perceived by themselves and their children.

Material and methods: 51 patients with schizophrenia and their 51 children were evaluated on Alabama parenting scale.

Results: The mean age of parents with schizophrenia was 45.23 years and two-third were educated beyond 10^th. More than half of the parents with schizophrenia were males-56.9%. The mean age of onset of schizophrenia was 22.5 years and mean duration of illness at the time of assessment was 22.5 years. High proportion of patients with schizophrenia reported deficits in the domains of positive parenting, indulging in corporal punishment and domain of poor monitoring. High proportion of children reported receiving corporal punishment. About one-fourth of children also reported lack of positive involvement of parent with schizophrenia. Children of patients with schizophrenia also reported lack of positive parenting.

Conclusion: Present study suggest that patients with schizophrenia have deficits in positive parenting and more frequently indulge in corporal punishment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

195 Title - Study of Cognitive Insight in First Episode Psychosis

Raj Rana ^*, Anil Nischal ^**, Bandna Gupta ^***, Adarsh Tripathi ^***, Manu Agarwal ^***

Background: Lack of insight is an eminent feature of a psychotic illness. Better insight has been linked to a better overall outcome of the illness. Beck et al. in 2004 suggested that patients with psychosis have an impaired ability to scrutinize their own beliefs and experiences and question them and defined these capabilities as cognitive insight. They also proposed a scale to assess cognitive insight namely The Beck Cognitive Insight Scale.

Aims: To study Cognitive insight over a period of eight weeks in patients with First Episode Non-affective Psychosis.

Methodology: This is a follow-up case study of patients taken from Adult Psychiatry OPD, designated criteria according to the ICD-10 DCR. All the subjects enrolled in the study had given informed consent prior to inclusion in the study. Baseline assessment was done on the same day. The patients were followed on a 2week interval on each of which patients were re-assessed. Data was analysed using computerized software.

Results: 88 patients completed the study and the data for these was analysed. Significant improvement in cognitive insight was seen at every evaluation point and the values improved from -3.82 (SD±3.53) to 10.71 (SD±3.52). A significant change was seen at each successive evaluation.

Conclusion: Female patients had significantly more improvement in the cognitive insight than males. More improvement was seen in patients with a diagnosis of acute and transient psychotic disorder, when illness was of lesser duration at baseline and when a precipitating factor was present.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

196. Title - A STUDY OF ASSESSMENT OF BLOOD BIOMARKERS IN ACUTE TRANSIENT PSYCHOTIC DISORDERS

Jaya Prakash ^*, PK Dalal ^**, Sujita kumar kar ^***, Wahid Ali ^***

Background- Drug naive patients with acute transient psychotic disorders have decreased level of Serum Prolactin and increased level of inflammatory markers[C- Reactive Protein (CRP)&S. Cortisol] which normalizes with antipsychotic treatment.

Aims:

To study Serum Prolactin and inflammatory markers(SERUM CORTISOL,CRP, ESR, TLC & DLC) in pre (drug naïve) and post-treatment (after 3months) patients with ACUTE TRANSIENT PSYCHOTIC DISORDERS

To study the relationship of clinical response with blood biomarkers in patients with Acute Transient Psychotic Disorders

Methodology:

Patient should be selected from Adult psychiatry OPD, KGMU on specified days of every week.

They will be assessed on selection criteria.
Those meeting selection criteria will be included in the study.
They will be assessed in a semi-structured proforma
Study tools will be applied
Blood sample will be taken for the estimation of blood biomarkers (Ser. Prolactin, Serum cortisol, CRP, DLC, TLC, ESR).
Patient will be regularly followed (fortnight to monthly intervals) for 3 months.
At the end of 3 months patient will be assessed and study tools and blood sample taken for estimation of blood biomarkers.

Results:

Prolactin levels in untreated patients in schizophrenia and other psychotic disorders is seen to be on the higher side. Individuals with a predilection to develop psychosis had increased prolactin levels (Aston et al., 2010 and Garcia-Rizo et al., 2012). Studies have found no difference among patients of drug naïve schizophrenia and control groups, although a higher lever of prolactin was reported in a subgroup of schizophrenic patients who had significant disorganization (Segal et al., 2007).

Chronic inflammatory states lead to an increase in c-reactive protein which affects the circulation in the microvasculature thereby leading to decreased blood perfusion (Hanson and Gottesman et al., 2005). This diminished blood flow mainly to the frontal cortex is linked to negative symptoms and impairments in cognition (Rothermundt et al., 2001).

C-reactive protein may be a substitute for IL-6 and various other inflammatory cytokines (Fernandez et al., 2016; Khandaker and Dantzer., 2016). Increased CRP disrupts the blood brain barrier, affecting the central nervous system leading to development of negative symptoms. To infer, a complicated interplay is seen between chronic inflammatory state and development of psychosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

197. Sturge-Weber syndrome presented with psychotic symptoms : A case report

Nikhil S Mankar ¹, Bhushan Mhetre ², Sharmishtha S Deshpande ³

Introduction: A thirty two year female patient presented with acute onset psychotic symptoms. Very few cases of Sturge-Weber syndrome manifesting as psychotic symptoms has been described in the literature. Sturge-Weber syndrome is a rare neurocutaneous syndrome manifesting with vascular malformations involving brain, skin and eye and mainly mood symptoms.

Case description : This is a case report of a thirty two-year-old female hospitalized in our psychiatric hospital for acute onset irrelevant talks, smiling & muttering to self, decreased self care, irritability, occasional anger outburst, sleep disturbances and staying aloof since 3 months without any apparent psychosocial stressor, with a progressive and deteriorating course. She had a port wine stain on right side of face, mild mental retardation and history of multiple seizures. Last seizure was 3 years back. She was on follow up with physician but no psychiatric consultation was done prior. A detailed history, physical and mental status examination and elaborate neuropsychological, neuroimaging and laboratory assessment was done. Referred to neurologist who diagnosed the case clinically as Sturge-Weber syndrome. Dermatology reference was done for portwine stain, pediculosis capitis with xerosis. Patient was managed in joint consultation of Neurology, Dermatology and Psychiatry. Patient remitted with Risperidone 2 mg/day, Valproate 600mg/day, Phenobarbitone 120mg/day, Ivermectin 12mg and Permethrin 1% Lotion, without any side effects.

Discussion: This report underlines the importance of holistic diagnosis and interdisciplinary treatment with psychiatrist, physician and dermatologist to devise appropriate drug treatment in such cases with atypical presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

198. Cervical dystonia with Second Generation Antipsychotics- a case report

Ivan Netto ¹, Santosh Chavan ², Manjeet Santre ³

Backround:

A rare case report of a patient of Paranoid Schizophrenia who developed cervical dystonia on the long term use of SGAs. He never received FGAs

Case report:

A 30 year old unmarried male a known case of Paranoid Schizophrenia for the last fifteen years was treated only with second generation antipsychotics. Thirteen years later there was painful retraction of his neck, more on the left side. He also started having continuous side to side movements of his neck.. He started using his left hand to eat and brush his teeth. The neck movements were continuous, disabling and painful and he had to spend most of the day time lying down or sitting with a neck support.

His complete blood, absolute neutrophil, absolute eosinophil counts were within normal limits. His Intraocular pressure, Slit lamp examination for KF ring and MRI were normal.

He was treated with Tab Clozapine 25mg per week which was gradually increased to 100mg once at bedtime. He was also given Tab Baclofen 20 mg was given once a, Tab Trihexyphenydyl 2 mg given twice a day and Tab Tetrabenazine 2 mg twice a day. He was also given Botulinum Toxin injections for the cervical dystonia totally 100 units in his neck muscles. Within two weeks time there was a good improvement in posture with reduced retraction of the neck and no pain.

Conclusion: Patients on long term antipsychotic treatment may develop Tardive dyskinesia with cervical dystonia. Switching to Clozapine is useful. Tab. Trihexyphenydyl and Tab Baclofen treatment was also useful. He had a good response to Botulinium toxin injection treatment for cervical dystonia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

199. Psychiatric Disability in Chronic Schizophrenia and Affective Disorder : A comparative study

Sangeeta Gotewal ^1,^✉

Introduction: Psychiatric disability has emerged to be an increasingly important area of the research. Persons with chronic illness, including long term psychiatric illness do face lot of difficulties, hardship, and rehabilitation issues, especially while planning intervention programmers for chronically mentally ill.

Aim: To assess the Psychiatric Disability in Chronic Schizophrenic patients and Affective Disorder patients.

Methodology : A total number of 60 patients were taken for the study, under which 20 persons with Schizophrenia (10 males and 10 females), 20 persons with Mania (10 male and 10 females), and 20 persons with Depression (10 male and 10 females). These patients were selected using the purposive random sampling technique. Samples were taken from Central Institute of Psychiatry, Kanke, Ranchi. Socio demographic data sheet was used to elicit information related to age, sex, education, duration of illness, diagnosis, family history and psychiatric history. Psychiatric Disability Assessment Schedule (W.H.O.) was administered to assess the social functioning of the patient with mental disorder. Statistical Analysis: To find out the psychiatric disability in chronic schizophrenic and affective patients, percentages were calculated.

Result : Persons with schizophrenia had shown maximum dysfunctions as compared to persons with depression and mania. In some areas persons with mania shown maximum dysfunctions followed by persons with schizophrenia and depression. Persons with depression had shown maximum dysfunctions in the area of conversation, social withdrawal, leisure interest as compared to persons with schizophrenia and mania. Detail results will be discussed during presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

200. A Rare Case of Schizophrenia with mouth bleeding-A Case Report

Smita Srivastava ¹

Introduction

Antipsychotic drugs have been proved to be effective in treating various mental disorders including Schizophrenia and bipolar disorders in children as well as adults. A benzisoxazole derivative, Risperidone is a Second generation antipsychotic drug widely used for the treatment of schizophrenia, bipolar mania, and irritability associated with autistic disorder. But, its long term use has been documented to be associated with some atypical side effects like mouth bleeding. By means of this case report, it is intended to document a rare and atypical case of mouth bleeding in an adult patient suffering from Schizophrenia associated with long term use of Risperidone.

Background

55 year old male patient suffering from Schizophrenia reported to the OPD with a chief complaint of bleeding from the mouth since January 2018. According to the patient, bleeding was accompanied with saliva and was evident on sleeping and spitting. He also complained of loss of sleep, decreased appetite, irritability, tiredness, constipation, experienced foul smells like someone has done something and hears voices from frontal region of head since 3 days. Medical history revealed that the patient was undergoing Psychiatric treatment at Nur Manzil Hospital, Lucknow since 1993. He reports that he experienced an attack of fearfulness on 6 December 1992 and was kept closed in a room for 2 days during which he says that his office mates had put a chip in his brain and all of his personal life was being monitored. After that incident patient was diagnosed with Schizophrenia and was undergoing Risperidone therapy. But from last 2 weeks patient was not taking any medication and since past 3 days he complains of insomnia, low appetite and irritation along with hearing voices.

Investigations: CBC, CT Scan (Head), MRI, RBS, T3T4TSH, ENT Consultation revealed no abnormal findings.

Diagnosis: Schizophrenia patient having mouth bleeding as a side effect with long term Risperidone therapy.

Management:

Tablet Olanzapine -5 mg, Tab. Etizolam 0.25 1BD, Tab. Zolpidem-5mg for 10 days.

Follow up visit after 10 days showed decreased bleeding from mouth and patient does not experience any foul smell and had fewer hallucinations. Thus, same medication was continued with higher dosage.

Discussion:

Risperidone is an antipsychotic agent with a benzoxazole chemical structure that has potent dopamine-2 (D2), serotonin-2A (5HT2A), and alpha-1 receptor antagonism (Gardner et al 2005). Risperidone is classified as a second generation or “atypical” antipsychotic agent due to its relatively lower propensity to induce extrapyramidal side effects at lower doses as compared with first generation counterparts like haloperidol. It is a major substrate of cytochrome-P450 (CYP450) 2D6 and a minor substrate of CYP3A4, with major and mild inhibition of those two metabolic enzyme systems, respectively. The half life of risperidone is approximately 20–30 hours, with the half-life of the active 9-OH-risperidone metabolite being 21–30 hours. The antipsychotic and antimanic effects of risperidone are postulated to result from potent dopamine-2 and serotonin-2A antagonism in the mesolimbic dopamine pathway and cerebral cortex, respectively. Risperidone has been shown to be effective in the acute and maintenance treatment of schizophrenia and bipolar disorders. Risperidone or similar SGAs, either alone or in combination with the mood stabilizers lithium, valproic acid carbamazepine, serve as first line treatment options for persons with schizophrenia (Miller et al 2004).

It is reported to cause some side effects including weight gain, dizziness, sleep disturbance, excessive thirst & appetite, somnolence, decreased libido, akathisia, gastrointestinal disturbance, fatigue, seizure, increased prolactin levels, menstrual irregularities and increased frequency of micturition. Several pharmacological mechanisms might explain this adverse reaction. Thrombocytopenia is a recognized adverse effect of atypical antipsychotic medicines and has been reported with risperidone. Oral ulceration, defined by the presence diagnoses of stomatitis and mucositis, aphthous-like ulceration and oral burns are also some side effects.

In the present case report, an adult male patient suffering from Schizophrenia undergoing Risperidone therapy reported with a rare symptom of bleeding from the mouth. It can be supposed that bleeding from the mouth can be attributed to, firstly, hematological side effects of Risperidone resulting in thrombocytopenia causing bleeding from oral mucosa. Secondly, long term therapy can cause stomatitis, mucositis and oral burns resulting oral bleeding. Thirdly, such patients are under mental stress which could lead to aphthous ulcers in the oral cavity, rupture and irritation of which can cause bleeding from injured area. Lastly, patients suffering from mental illnesses tend to neglect oral hygiene leading gingivitis and periodontitis causing bleeding from the periodontium of the oral cavity. Although such cases are rare, more scientific research is required on the effect of Risperidone resulting in mouth bleeding and the exact cause of it.

Conclusion:

Long term Risperidone Therapy can cause bleeding from the mouth due to thrombocytopenia, oral ulcerations due to stomatitis, mucositis, aphthous ulcers and gingivitis/periodontitis due to poor oral hygiene.
Using Olanzapine as an altering drug for such patients can decrease chances of mouth bleeding due to long term use of Risperidone and also effectively control the symptoms of Schizophrenia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

201. Resting state oscillatory power and functional connectivity in schizophrenia: A high-resolution EEG study

Sai Krishna Tikka ^*1#, Jose Cortes-Briones ^2#, S Haque Nizamie ³, Vinod Kumar Sinha ³, Deepak Cyril D’Souza ²

# Co-first authors

Study venue: Data was collected at Central Institute of Psychiatry, Ranchi, India and data was processed at Yale University School of Medicine, New Haven, USA

Background:

Brain function depends critically on oscillations. Studying oscillatory activity within brain-networks is a major emphasis in understanding neuroscience of schizophrenia.

Objectives:

To determine whether the oscillatory properties of the brain are abnormal in schizophrenia patients.

Material and Methods:

Resting EEG was collected under eyes closed condition (5 minutes) from 40 symptomatic schizophrenia subjects (SCZs) and 15 healthy controls (HCs) using a 256-channel Geodesic EEG System. EEG data was pre-processed to remove artifacts and sLORETA source analysis was performed. Average delta-band power was obtained for the reconstructed EEG sources (15000 vertices) using a fast Fourier transform. To estimate connectivity between regions of interest (ROIs – Brodmann areas), global signal (principal component explaining most of the variability) of each ROI was obtained and delta-band inter-ROI time-delayed (to reduce volume conduction effects) phase-locking value (dPLV) was obtained. Psychopathology was assessed using PANSS.

Power at sources (vertices) and inter-ROI PLVs were compared between SCZs and HCs and t-maps were obtained. Permutation tests using the t-max statistic were used to determine multiple comparison-corrected sources and inter-ROI PLVs. Subsequently, regression analysis was conducted to characterize correlations with any specific psychopathology scores.

Results:

The analyses showed a widespread increase in delta-band power and inter-ROI connectivity in SZC patients compared to HCs (see figures 1 and 2). Neither delta-band power nor inter-ROI connectivity was significantly correlated to psychopathology scores.

Conclusions:

We find that EEG delta oscillations in schizophrenia patients show well-replicated abnormalities. Increased power and connectivity of resting delta oscillations during symptomatic phase of the illness may infer a direct causal relationship with overall disease process.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

202. Social Cognition in clinical and familial ‘at-risk’ for psychosis in Indian population

Deyashini Lahiri ^*, Amool Ranjan Singh ², Sai Krishna Tikka ³

Impairment in specific domains of social cognition have been suggested as possible clinical markers for accurate identification of ‘at-risk’ (AR) states. Aim of the present study was to find out whether performance on social cognition tasks will distinguish ‘clinical at-risk (CAR)’ and ‘familial at-risk (FAR)’ individuals from remitted first episode schizophrenia (FES) patients and healthy controls. Fifty in each of these four groups were included for analysis. A total of 554 individuals were screened on PRIME Screen- Revised (PS-R) to identify individuals in the CAR group. The schizophrenia psychopathology in the FES group was assessed using the Positive and Negative Syndrome Scale (PANSS). Theory of mind (ToM; first and second order (SOT and FOT), and faux pas comprehension (FPC)), attributional bias (AB) and social perception (SP) were assessed using the Social Cognition Rating Tool in Indian Setting (SOCRATIS). The Facial recognition task was used to assess emotional expression recognition (ER). Significant differences in ToM, SP and ER between the four groups were noted even after controlling for performance on various neurocognitive tasks. SOT, FPC, SP and ER indices were identified as significant predictors of group membership. Compositely, these predictor social cognitive measures were able discriminate the four groups with high specificity and sensitivity. Specifically, SP index was able to more correctly classify CAR and FAR individuals. We conclude that social cognitive measures may be used as valid endophenotype markers for schizophrenia and its sub-domains like SP may be used to distinguish AR individuals from patients and healthy.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

203. The existence of Autoscopic hallucination?. A case report and review of the literature

Aseem Mehra ¹, Manoj kumar ²

Abstract: Autoscopic hallucination has been the subject of interest in the literature since the past many years. The existence of the autoscopic hallucination in clinical practice has not been reported much. An autoscopic hallucination is a purely visual impression of seeing one’s own body or its different parts as if being reflected in a mirror. Usually, this mirror image of oneself is naturally coloured. The image can be either motionless, or it imitates gestures or facial expressions. Autoscopic hallucinations are often of very short duration and are occasionally preceded by elementary visual hallucinations. We represent a case of 27 years old female presented with the symptom of her naked image appeared at a distance of 1 to 2 feet in front of her. She could identify herself, i.e. the whole body. The image would last for about 5-10 minutes. At times would also see another naked male persona and would rape her “naked image”. She would feel threatened and kept on crying. She also had symptoms like the delusion of persecution, the delusion of reference, auditory hallucination, muttering and smiling to self. She was diagnosed as a case of Schizophrenia. She was managed with the tab Risperidone. A review of the current literature has been reported. The case highlights the uniqueness of the phenomenology in the case of schizophrenia.

Keywords: Autoscopic hallucination, literature, visual hallucination, naked image

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

204 A RARE CASE OF CHILD WITH COMPLEX REGIONAL PAIN SYNDROME (CRPS) AND MENTAL ILLNESS

Keshava Pai K, Sajjan Shenoy, Rohith Pai

ABSTRACT: The diagnosis of CRPS is always by exclusion and there are no markers, or any laboratory tests. Usually there is no association of mental illness prior to the disease and there are not many reports of childhood CRPS with significant anxiety and somatoform pain disorder. Understanding the disease and its management needs a detailed psychological assessment and therapy to improve the quality of life in the sufferers. With the increased knowledge and experience about CRPS both physicians and mental health professionals can manage the cases effectively.

Keywords: Complex regional pain syndrome, somatoform disorder, anxiety, depression and therapy

Introduction

CRPS is sometimes difficult to diagnose and a childhood case of such one is a rare presentation.

In this case of CRPS there was significant psychiatric comorbidity which is an unusual presentation.

A diagnosis of exclusion

CRPS is usually diagnosed after a trauma, surgery or medical procedure. It is usually not associated with any mental illness prior to the onset.

Laboratory tests: MRI brain report is normal. No neurocognitive deficits by clinical examination.

Discussion: After detailed evaluation of this boy who has received medical attention to his pain complaints patient was found to have clinical features of mixed anxiety and depression with dissociative motor movements of right upper extremity extending up to right half of neck, shoulder and head region. Patient was taken up for supportive psychotherapy sessions and was started on low dose of benzodiazepines. Patient got completely better and was able to attend classes.

Implications: Understanding the psychological perspectives of CRPS patients will help them to recover and improve the quality of life with timely intervention. More research is required to understand the bidirectional relationship between the disease and mental illness.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

205. DEPERSONALISATION – DEREALIZATION SYNDROME: A CASE REPORT

Aarthi Anand K ¹, Thirunavukarasu ², Rajkumar ³, Sivabalan ⁴, Arul Saravanan ⁵, Sai Baalasubramanium ⁶, Arun Narayan Pradeep ⁷

INTRODUCTION:

Depersonalisation and Derealisation are psychiatric symptoms characterized by altered perception of the self and the environment respectively with intact reality testing and insight into the falsity of the perception. It is commonly reported in association with psychiatric disorders like depression, substance abuse and neurological disorders rather than as a primary psychiatric illness. The following report illustrates a case of Depersonalisation – Derealization Syndrome in a healthy adult following changes in sleep wake pattern.

DESCRIPTION:

A 27 year old unmarried male who is a software engineer with no abnormality in birth and early developmental history presented with acute onset of a feeling that ‘as if’ everything around him has changed for a duration of 4 months after working night shifts for 3 years continuously.

He had tremendous fear that he was going to forget everything due to this as if feeling. He feared that everything around him had no connection to him, and even his mother at times looked like someone he did not know. He refused to look at himself in the mirror as he could not recognize himself. In his office he could not do any work as he felt he was watching himself work from outside his body. His appetite reduced as he felt nauseous all the time. He could not sleep adequately as he was bothered by the thought of something unexplainable happening around him.

Psychological assessments were done and he was investigated further with EEG and MRI Brain showing no abnormality.

He was diagnosed Depersonalisation – Derealization Syndrome. He was treated with Antipsychotics, Antidepressants and advised to change his sleep wake cycle with which he seemed to improve well.

CONCLUSION:

This case report illustrates a rare case of Depersonalisation – Derealization Syndrome in an otherwise healthy individual who seemed to improve well with medications and with sleep hygiene. This underscores the need to identify stressors causing alteration of circadian rhythm in certain population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

206 Cognitive Emotion Regulation in Schizophrenics with Cannabis Dependence

S Kumar ¹, Anil Sisodia ¹, S Mohanty ¹

Research provides evidence that persons with schizophrenia have emotion regulation abnormalities, especially for negative emotions. The present study aims at comparing cognitive emotion regulation of negative and positive affects in schizophrenics with co-morbid cannabis dependence, with the patients of schizophrenia without co-morbid dependence. Method. At least 40 patients with schizophrenia in following two groups will be sampled from in-patients at Institute of Mental Health and Hospital, Agra. (i) schizophrenics without cannabis dependence [n=20] (ii) schizophrenics with with cannabis dependence [n=20]. Following tools will be administered (a) Cognitive Emotion Regulation Questionnaire (b) Positive and Negative Affect Scale (c) Calgary Depression Scale (d) Severity of Dependence Scale. The results will be presented.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

207. Abstract Title: A CASE SERIES ON PHARMACOLOGICAL INTERVENTION (ANTIPSYCHOTICS) IN ULTRA HIGH RISK PSYCHOSIS IN CHILD AND ADOLESCENT POPULATION

Niharika Tushar Shah ¹, Shubhangi R Parkar, Bijal Sangoi, Akanksha Rathi

INTRODUCTION: The concept of a clinical ultra high-risk state for psychosis has evolved to capture the prepsychotic phase, describing people presenting with potentially prodromal symptoms making it possible to detect and treat individuals prior to the development of full psychosis. Various studies have reported that specific pharmacotherapy and psychotherapy reduces the risk of early transition to psychosis in young people at ultrahigh risk.

MATERIAL AND METHODS: A case series of 10 children and adolescents aged 9-18 years with equal gender distribution(5 males and 5 females) identified with Ultra high risk(UHR) factors for psychosis were evaluated. The age of onset of symptoms for UHR of psychosis for 3 out of 10 cases was less than 10 years and the rest 7 cases was more than 10 years with duration of symptoms being more than 1 year in all 10 patients. The various previous diagnosis made in these patients were OCD(1/10), ADHD(1/10), Depression (1/10), conduct disorder (1/10), Mixed anxiety disorder(1/10) on treatment for their respective diagnosis and the other 5 out of 10 had no previous diagnosis. The common ultra high risk factors identified in these patients were irritability, aggressive behaviour, perseveration, academic decline and fleeting ideas of reference and persecution. Family history of psychosis was present in 8 out of 10 patients. Due to their odd and incomprehensible behaviour, not improving on previous treatment, they were started on antipsychotics.

RESULTS: Significant improvement in symptoms with antipsychotics was seen in 9 out of 10 patients on their first follow up after a week.

CONCLUSION: The results therefore suggest that an assessment of the ultra high risk factors of psychosis can help in early intervention and better prognosis.

KEYWORDS: ultra high risk, psychosis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

208. PETROL INGESTION TO COMBAT HALLUCINATIONS- A UNIQUE PRESENTATION IN A PATIENT WITH SCHIZOPHRENIA

Devashish Palkar ¹, Pradhyuman Chaudhary, Ritambhara Mehta

Introduction -

There are a myriad ways in which patients of Schizophrenia present to a psychiatry unit. While in some cases, the phenomenology is very conspicuous, sometimes the delusions and hallucinations are so distressing that patients can resort to bizarre ways to combat them which may often risk such acts being misinterpreted as a part of a different illness or a separate entity altogether unless a psychiatrist evaluates the underlying pathology behind it. There are reports of petrol sniffing as a part of addiction and ingestion of it as a form of suicide but here we present a unique case of patient with Schizophrenia who would ingest petrol and diesel to combat his auditory hallucinations.

Discussion -

A 49 year old, married male patient with Schizophrenia, fisherman by occupation, was brought by wife to psychiatry OPD and admitted with complaints of hearing voices of 3 known females who would threaten him to rape them. Upon consumption of petrol and diesel, the patient reported in his verbatim that the hallucinations subsided and thus he was saved from a sinful act for which police would have arrested him. He had been using this to combat the distressing auditory hallucinations since last 12 years.

Conclusion-

Ingestion of inedible and potentially life threatening substances like nails, blades, paper, dirt, etc by patients with Schizophrenia have been reported in literature but the author found no such report where patient himself admitted to using petrol and diesel as a means to combat the hallucinations. If the underlying reason behind such acts is not diagnosed early, it can lead to many medical and surgical complications in future.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

209. Socio-Demographic And Clinical Profile Of Patients Visiting Sexual Counselling Clinic In A Tertiary Care Hospital Of Mumbai

Mahadik Saili Purushottam ¹, Nilam S Behere, Shubhangi R Parkar

Introduction: Disorders of sexual functioning are common among men and women of all ages, ethnicities, and cultural backgrounds. There is dearth of data related to sexual dysfunction on general population which may be due to underrepresentation, cultural taboos and complex dynamic interplay with various other psychiatric and mental illnesses. Hence, we plan to do a systematic audit of patients with sexual dysfunction visiting our clinic.

Materials and Methods: The study is done in a specialized sexual counselling clinic of a tertiary care hospital in Mumbai. Patients are referred from the psychiatry OPD. An audit of the case record forms of 55 patients was done to determine the presenting sexual complaints and prevalence of psychiatric and medical comorbidities.

Results: Amongst the 55 patients, 96.36% were male, while 3.64% were female. 65.45% patients were married. Maximum patients presented with premature ejaculation (43.6%), followed by erectile dysfunction (32.7%) and hypoactive sexual desire (25.45%). 23.6% of people had culture bound misconceptions related to Dhat syndrome and related somatic complaints. 52.8% of patients had psychiatric/medical co morbidities, most common amongst which was depression (14.5%) followed by alcohol use disorder (11%). Relationship issues with their partners were seen in 27.3% of the patients, occupational stressors with 12.7% and financial stressors with 11% of our sample.

Conclusion: Men seemed to be visiting the sexual counselling clinic more than women, similar to common cultural consensus. Premature ejaculation followed by erectile dysfunction, were most common presenting feature seen. Depression was the most common co-morbidity noted. This audit implies that a more systematised study is warranted to understand the pattern of sexual dysfunction in our cultural context.

Conflict of Interest: Nil Keywords: Sexual; Premature Ejaculation; Erectile Dysfunction;

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

210. Abstract Title:A cross sectional study to assess sexual functioning and its related factors among breast cancer survivors attending general surgery

Karobi Das ¹, Anuradha Rani, Sukhpal Kaur, Gurpreet Singh

Introduction : Early diagnosis and advancements in treatment modalities of breast cancer has resulted in increase in the number and life span of breast cancer survivors. Surgical management of the breast cancer may negatively impact their body image. Chemotherapy induced premature menopause may be the predictor of poor sexual functioning.

Objectives : To assess sexual functioning and its associated factors among breast cancer survivors.

Material and Methods : The design of the study was cross sectional. One hundred twenty three breast cancer survivors attending General Surgery OPDF were interviewed during July- August 2016. Socio-demographic proforma, Female Sexual functioning Index, Beck Depression Inventory, Fatigue scale, Body Image Questionnaire and material Adjustment Test were used to collect data.3

Results : Descriptive and Inferential statistics were used to analyse data. Mean age of subjects was 47.62+- 7.54. Only 30% reported normal sexual functioning. 70% reported sexual dysfunction. Majority had problems specifically in dyspareunia (48.8%) and orgasm domain (47.2%). 50% felt that their body was out of shape. Sexual Dysfunction was more prevalent in age group 50-60 yrs (p=0.005). 63% survivors with sexual dysfunction had ≤ 2 children (p=0.02). Poor sexual functioning was reported by those who had attained menopause whether naturally or chemotherapy induces ((p=009). There was no statistical significant association of sexual dysfunction with body image, depression and fatigue. Mean marital satisfaction score were lower in survivors with sexual dysfunction.

Conclusion : Most women feel shy to discuss the issue of sexual functioning. Every Breast cancer survivor should be asked about her current sexual functioning by the health care team. Brief sexual counseling should be scheduled for these women.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

211.TITLE- RESEARCH IN ERECTILE DYSFUNCTION : FROM AN INDIAN PERSPECTIVE

Dheerendra Kumar ^*, Adarsh Tripathi ^**,^✉, Sujita Kumar Kar ^***

BACKGROUND: Erectile dysfunction (ED) has been defined as the consistent inability to achieve/ maintain penile erection which leads to unsatisfactory sexual intercourse. ED is one of the most common forms of sexual dysfunction in men. Global prevalence of ED has been projected to increase significantly to over 320 million by the year 2025. India has been dubbed as the impotence capital of the world due to the high incidence of the life style diseases and probably the largest population of males in the world. Multiple risk factors alone or in combination are associated with sexual dysfunction such as general health status of the individual, chronic illnesses particularly diabetes, psychiatric disorders, drugs and socio-demographic conditions.

AIM : To review Indian studies on ED in recent years and to find research gap.

MATERIAL AND METHODS: A web search has been used using keywords “Erectile Dysfunction” in PubMed. 3024 results were screened for the last 10 years. An overview of Indian studies was taken.

RESULTS: After web search in PubMed, it was found that extensive studies have been conducted on prevalence, mechanism and treatment of ED alongwith co-morbidities. Newer research has focussed on novel treatments and treatment of co-morbidities together with ED. Indian studies have also been done but as compared to the world scenario they seem insufficient considering the magnitude of problem in the country.

CONCLUSION: Future research should focus on robust data for non-pharmacological management of ED and effect of ED in co-morbidities.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

212. Narcolepsy: A case of Narcolepsy with Genetic Predisposition

Felex Maree Angelo ¹

Introduction: Narcolepsy is a disorder of REM sleep characterised by the tetrad of excessive sleepiness, cataplexy, sleep paralysis and hypnagogic hallucinations. Its prevalence is 25-50 per 100000 while incidence is. 74 per 100000-person years. Cataplexy refers to the sudden loss of muscle tone while partial or full consciousness is retained. It can be triggered by strong emotions. Sleep paralysis and hypnagogic hallucinations are nonspecific and can occur in conjuncture with any sleep disorders. Narcolepsy is further classified according to DSM 5 as 1. Narcolepsy without cataplexy but with hypocretin deficiency 2. Narcolepsy with cataplexy without hypocretin deficiency 3. AD Cerebellar Ataxia and Narcolepsy 4. Narcolepsy secondary to another medical condition.

Case Report: A 32-year male was referred from medicine department with history of fever with rigors for 5 days following which he developed 10 episodes of sudden loss of posture in 3 months. These episodes lasted for 2-5 minutes. During such episodes he was able to blink with difficulty and was aware of what was happening around him. Following such episodes, he would feel tired and sleep for a variable duration. On psychiatric evaluation he was found to be sociable, productive, energetic and responsible. Following such episodes, he was admitted and evaluated. His CT brain, MRI with MRA and MRV, ECG and serum electrolytes were normal. Polysomnography was normal. However, the patient was positive for both HLA DR2 and HLADQB1*06:02. So, the patient is currently on Modafinil 200mg/day and fluoxetine 20mg/ day and has been advised for follow up.

Keywords: Narcolepsy, Cataplexy, HLA DQB1*06:02.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

213 EFFECT OF LATE NIGHT MOBILE PHONE USE ON SLEEP

SP Baral ¹, K Bagul ²

OBJECTIVE: The study aims to assess the relationship between late night mobile-use and sleep duration, quality.

METHOD: Study population consists of 250 individuals, aged 18-60 years all over India. Assessment was done using online survey via google forms. All socio-demographic details were recorded and email-id was made mandatory to avoid repetition of responses. PQSI (Pittsburgh Sleep Quality Index Questionnaire) was used for sleep assessment. To see dysfunctional mobile use, PMPUS (Problematic Mobile Phone Use Scale) was used.

RESULTS: Most patients were in the age group of 18-25 yrs. 57 % were male and 43 % were female. 88.8 % belonged to urban area, 55.1 % were graduate 60.7 % were students. As per PMPUS scale, 40% participants experienced sleep problems due to excess mobile use. 150 participants reported mobile phone use after 11 pm. As per PQSI scale, most (70 %) late night mobile phone users reported decreased sleep duration, 50% reported decreased sleep efficiency, 40 % reported increased sleep latency, 30 % reported sleep disturbances and day-time dysfunctions variables. Wake-up time was 9-11 am among late-night mobile phone users and 6-10 am among non-users. Adjusted binary and multinomial logistic regression model showed late night mobile users were 1.59 times more likely to have poor sleep quality (PQSI score <5) than non-users (p< 0.001).

CONCLUSION

Late night mobile phone use by individuals was associated with poorer sleep quality. As a part of healthy life style recommendations, avoidance of late night mobile use should be encouraged.

KEYWORDS: sleep, mobile-phone, online survey

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

214. Abstract Title: A case of somnambulism and somniloquy in Noonan syndrome

K Raju, K Raju

Somnambulism is an arousal parasomnia consisting of a series of complex behaviours that result in large movements in bed or walking during sleep. Somniloquy or sleep talking is a parasomnia that refers to talking while asleep. It varies in its content and presentation, ranging from mumbling, gibberish words to full, complicated, coherent narratives.

We present a 12 year old boy, studying in 7th std, belonging to a middle socio-economic class, is a known case of noonan syndrome. who was referred to psychiatry OPD from the pediatrics department. This patient has started sleep walking after going to bed between 12am and 3am perform a variety of activities such as walking out of the room and wander in the home, He would walk with his eyes open, but he did not respond to the calling out of his name. Patient also started talking while asleep. patient would just mumble words which were barely audible, but most of the times, patient would speak coherent, meaningful sentences. The diagnosis of somnambulism F 51.3 as per ICD-10 criteria was made, and he was put on clonazepam 0.25mg at bed time, he was advised to follow consistent sleep schedule and supportive psychotherapy and regular counseling sessions were conducted. In the end patients normal sleep cycle was reestablished.

The importance and difficulty of close pediatric/psychiatric liaison in diagnosis and treatment will be discussed.

ABSTRACT

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

215. The Curious Catatonias: Experience with a score

Amit Chail ^*, Ranveer Singh ^#

Background / Introduction : The term “Catatonia” was coined by Karl Kahlbaum, who described it as a distinct disease entity. This viewpoint was reformulated by Emil Kraepelin who subsumed Catatonia as a subtype of dementia praecox. The etio-pathogenesis of Catatonia remains elusive and treatment modalities keep evolving. Though parenteral Lorazepam and ECT have been recommended as effective treatment modalities but few studies focused on outcomes based on combination of these two interventions.

Study Design: A Retrospective study to determine the outcome of Catatonia patients who presented to a tertiary care center in Pune from 01 Jan 2015 - 15 May 2018.

Methodology: Retrospective observational study. 20 Cases (OPD and IPD) were included on the basis of ICD-10 criteria irrespective of etiology. Most of the patients were initially managed with parenteral Lorazepam (8-16 mg/d) and subsequently ECT (4-6 sessions) was given to 14 patients after taking informed consent. The outcome of these patients was evaluated using BFCRS at baseline, 07, 14 and 28 days.

Results : Out of these, 12 were diagnosed as Psychotic illnesses including Schizophrenia, 05 as Affective Disorders, 02 Organic and 01 Dissociative Disorder. Mean BFCRS score for patients receiving combination therapy were 20.25 (baseline) and 0.83 (D-28) while for patients who received Lorazepam monotherapy mean scores were 21.5 (baseline) and 5.25 (D-28).

Observation : Response of combination therapy (ECT + IV Lorazepam) was superior to Lorazepam monotherapy.

Limitation : Small sample size may restrict generalizability of results.

Keywords : Catatonia, ECT, Lorazepam monotherapy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

216. Title: Knowledge and Attitude regarding Electroconvulsive therapy(ECT) among consultants and postgraduate residents.

Saloni ¹, Nitin Sharma ¹, Shantanu Bharti ¹, A Q Jilani ¹, Ajay Kohli ¹, Anju Agarwal ¹, Tanuj verma

Background: Electroconvulsive therapy (ECT) is a technique used to treat mental illnesses, however, since introduction, ECT has been held by many to be a controversial mode of treatment. Most literature have investigated knowledge and attitude towards ECT among medical students. Therefore, we aimed to determine knowledge and attitude towards ECT among non-psychiatric medical consultants and postgraduate residents and compare their responses.

Method :This cross-sectional study includes 74 doctors from all medical and surgical specialities except psychiatry who were consultants including(professors, associate professors and assistant professors) and 76 postgraduate residents at Era’s Lucknow Medical College, Lucknow. The knowledge and attitude regarding ECT were observed using a questionnaire composed from previous studies. Proportions were compared using chi-square () test. A two-sided (α = 2) p <0.05 was considered statistically significant. Software’s MS-Excel and Statistical package for the social sciences version 18 were used for analysis.

Result: Internet (52.6%) and movies (32.8%) was the principle source of knowledge among postgraduates residents, however, consultants gather their major part of information from textbooks (56.75%) and published articles (33.78%) while ‘psychiatrist colleagues’ was the least common in both groups. The most predominant notion among both groups was that ECT causes pain to the patient. A relatively high percentage of the sample from post graduate student (76%) also believed that ECT is an outdated therapy (57%), causes permanent brain damage (24.7%) and cause memory loss (57.9%) in contrast to consultants who considered it safer and had notion regarding ECT indication and procedure. Significant (p-0.001*) number of participants denied use of ECT as treatment modality for themselves if they had severe depression.

Conclusion: consultants and postgraduates residents from other specialities other than psychiatry had some knowledge about ECT,however they still harbour some misconceptions and negative attitudes about the treatment. It would be imperative to educate them as they play a pivotal role in society and their opinion may play a crucial role in correcting public misconstrued perspective about ECT.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

217. Title Incomplete remission of recurrent depression due to possible lithium induced hypothyroidism

Ashish Sharma ^1,^✉, Vinutha Ramesh ², Aditya Somani ³

Department and Institution: Department of Psychiatry, Adesh Medical College & Hospital, NH-1, Mohri, Shahbad (M), Kurukshetra, Haryana, Pin-136135 India

Introduction: Thyroid axis plays an important role in pathophysiology, treatment and management of depression. Thyroid axis disorders could lead to ineffectiveness of anti-depressants in treatment and prevention of relapse of depression. Thyroid hormone supplementation has been proven to be an effective augmentation strategy in management of resistant depression. Lithium, used as an augmenting agent in treatment of depression with/without suicidality could itself cause hypothyroidism and worsen depression in rare instances.

Case Presentation: We report case of a 30-year-old female patient with recurrent depressive disorder with incomplete remission of symptoms with anti-depressant therapy. The patient at the time of presentation was on adequate doses of paroxetine and lithium and was treated with six electro-convulsive therapy (ECT) in view of suicidality. However, she relapsed within three weeks of stopping ECT despite taking medicines regularly. Investigations revealed elevated TSH, low T3/T4 levels and negative anti-TPO antibodies. Lithium was stopped in view of possible lithium induced hypothyroidism leading to relapse of depression. She was eventually treated with ECTs and thyroid supplementation. 25 mcg levothyroxine was started in addition to anti-depressants following which she is doing well at 1-month follow-up.

Discussion: This case report gives us a rare example of patient with incomplete remission and relapse of depression possibly due to lithium induced hypothyroidism who responded well to thyroid hormone supplementation. This case emphasizes the importance of evaluation for co-morbid medical disorders and adverse drug reactions in patients for appropriate management.

Keywords: Depression, Hypothyroidism, Lithium

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

218. Title: Use of transcranial magnetic stimulation in psychiatric patients: Experience from a tertiary care center of North India

Jai Singh ^*1, Sujit Kumar Kar ², P K Dalal ³, Vivek Agarwal ³, Anil Nischal ³

Introduction: Transcranial magnetic stimulation (TMS) is an emerging treatment modality for various neuropsychiatric disorders. Its usefulness has been commonly seen with psychiatric disorders like- schizophrenia, depression and obsessive-compulsive disorder (OCD). High frequency of TMS has stimulatory effect, whereas low frequency TMS has inhibitory effect. The neuro-modulatory effect of TMS makes it an important investigational as well as interventional modality in various neuro-psychiatric disorders.

Objective: To study the clinical profile of patients, who received TMS treatment for their psychiatric disorders in department of psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh.

Method: This is a cross-sectional, observational study conducted on psychiatric patients of a tertiary care hospital in North India. Retrospective chart review of patients who received TMS for treatment between July 2014 to August 2018 was done. Data was extracted in a semi-structured proforma.

Results: The study sample consisted of 62 psychiatric patients, of which 8 patients had received high frequency TMS and 54 received low frequency TMS. Commonly used high and low frequency were 10Hz and 1Hz respectively. Patients were received TMS for Depression, OCD, Schizophrenia, stroke, anorexia nervosa, primary insomnia, cervical dystonia and post-encephalitic cognitive decline. Mean age of the patients was 36.79±11.31 years and most of the patients (67.7%) were males. Average pulses per session=1300.31±517.22. Average of total pulses delivered to each patient= 20228.31±14071.40. Average number of sessions per patient=14.91±6.84.

Conclusion: In tertiary care settings, TMS is used commonly for treatment resistant cases of Depression and OCD. Most patients receive an approximate number of 15 sessions with total pulses of 20000.

*Presenting author

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

219. Unique Presentation of Factitious Disorder: A Case Report

Vatsala Sharma ¹, Vijender Singh, Anukriti

Factitious disorder (FD) is a condition in which sufferers intentionally fabricate physical or psychological symptoms to assume the role of a patient, in absence of any obvious gain. Since FD leads to huge burden of unnecessary investigations, treatments and hospital admissions on healthcare system, its early detection is very important. A 28 years old married female presented with aggressive behavior, suspiciousness, delusions, hallucinations and deranged biological functions since 4 years. During the course of admission, symptomatology changed from psychotic to dissociative in nature and discrepancies were detected between history provided by family members as well as the patient. Her husband admitted that she had changed multiple psychiatrists and showed no improvement even on regular treatment. Her pre-morbid personality was suggestive of emotionally unstable personality (borderline type) which was confirmed by International Personality Disorder Evaluation (IPDE, WHO). Non pharmacological management was carried out which improved the symptoms and patient was discharged with the plan of continuation of psychotherapy on follow ups. However, patient revisited hospital after 2 weeks of discharge having Deliberate Self Harm, with irregular subsequent follow-ups and no evidence psychosis over next three months. The cases of FD can present with the most baffling symptomatology, the diagnosis of which has to be confirmed after continuous monitoring and careful exclusion of other conditions. Emotionally Unstable Personality Disorder (Borderline type) is a common co morbidity of patients with Factitious Disorder. Therefore, patients suffering from FD should be routinely screened for Borderline Personality Disorder.

Keywords: Factitious Disorder, Borderline Personality Disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

220 Dissociative Stupor – A Diagnostic Chameleon

Divya Sekhar, Suja Kurian

Although dissociative disorders are common in practice, dissociative stupor remains a dilemma with its capricious presentation and poorly delineated semiology; warranting individualized management and care. Dissociative stupor is defined loosely as the absence of voluntary movements and unresponsiveness to external stimuli primarily caused by stress or traumatic events. However with the inherent overlap with neurological and higher cognitive functions and heterogeneity in its symptomatology; it often goes unrecognized as a functional disorder particularly in special populations like children and adolescents. Difficulty in describing internal experiences lead to manifestations of intra-psychic distress getting misinterpreted and thereby poorly linked to presenting symptoms of stupor. Poor delineation of functional origin of stupor can lead to mismanagement. We report a case of dissociative stupor in an adolescent boy with borderline intellectual functioning who presented to outpatient facility of a tertiary care hospital with acute onset stupor. We seek to highlight the need for early pattern recognition as prompt diagnosis can avert unmerited health expenditure and hasten both clinical and functional recovery.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

221. DISSOCIATIVE IDENTITY DISORDER- A CASE REPORT

Suja Anukriti ^*, Chauhan AS ^**, Singh V ^***

AIM/OBJECTIVE:

Aim of the presentation is to discuss about dissociative identity disorder as it is a rare case.

METHODOLOGY:

A 22 year old female of urban background presented with clinical profile of altered identity in which patient developed three different identities each lasted for 2-7 days, not recognizing family members as well as one identity would not recognize the other identity, multiple attempts of self harm and voicing frequent death wishes from past 4 months. The precipitating factor being that she had been kidnapped with her cousin and was kept captive for 9 days. She and her cousin somehow managed to escape, were found by police and united with their family members. A day later she started showing these symptoms. She was diagnosed with dissociative identity disorder.

RESULT

She was subjected to both pharmacological and non pharmacological interventions. Crises intervention and supportive psychotherapy was done and benzodiazepines cover was given to decrease her anxiety symptoms.

DISCUSSION

Cases of dissociative identity disorder/ multiple personality disorder(ICD), where patient presented with 3 or more identities each lasting for 2-7 days in which one identity would not recognize the other identity and when patient regained her original identity she would not remember any of the incidences like changing identities or attempts of multiple self harm. Dissociative identity disorder is a very rare clinical picture and very few cases have been reported in India.

CONCLUSION

Generally there is significant stressor preceding the symptoms hence in such cases management depends more on the exploration of stressor and supportive therapy.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

222. Title: Life stressors associated with dissociative disorders

Abhinav Shekhar, Nitin Sharma, Shantanu Bharti, Ajay Kohli, Anju Agarwal, Abdul Qadir Jilani

Background: Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type and temporal relation of the stressors leading to dissociation. Knowledge about the association of life stressors with type of dissociative disorder will help in better management of dissociative disorder.

Method: In a cross-sectional observational study, we had recruited 60 patients with dissociative disorder. MINI international neuropsychiatric interview was applied to rule out other psychiatric disorders. Patients were then assessed using Presumptive stressful life events scales (PSLES) for evaluation of life stressors. Correlation was examined using chi-square () test. A two-sided (α = 2) p <0.05 was considered statistically significant. Software’s MS-Excel and SPSS latest version were used for analysis.

Results: More than half of the study participants were from the 15-29 years age group, with females more affected. Every second participant (58.3%) presented with stupor episodes. Marital conflict (57.9%), broken engagement or love affair (44%) and property or crops damage (37%) were prominent stressors present in study population. However, upon assessing stressful life events with types of dissociation, significant association was observed among extra marital relations of spouse (p-0.043), broken engagement or love affair (p-0.027*), marital conflict (p-0.040*) associated with dissociative stupor and death of close family member (p-0.003*)was significantly associated with trance and possession disorder.

Conclusion: Stupor was the prominent type of dissociation, especially in females. Conflicts originating from marriage or love affairs and property damage were the common stressors. An understanding of the precipitating psychosocial stressors that overcome the patient’s coping abilities would have implications for treatment and enable the clinician to devise strategies for intervention and prevention.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

223. Dissociative Myoclonus: the mystery of jerks

KAUSTAV KUNDU, anita sharma, ravi gupta

We present a case of a 28 years old married female from Haryana with emotionally unstable personality traits, had past history suggestive of 1-2 depressive episodes every year, for past 10 years, with intermittent random jerks of different parts of the body for last 6 years, and episodes of stiffening of limbs and inability to move associated with B/L headache during sexual activity since her marriage 6 years ago. Currently, she presented with symptoms of moderate depressive episode for last 2-3 months, and similar episodes of jerks and those related to sexual activity. Family history is suggestive of Recurrent Depressive Disorder in elder sister. Provisional diagnosis of RDD, current episode moderate depressive, without somatic syndrome, with orgasmic epilepsy and myoclonic jerks was considered. Her depressive symptoms improved significantly with mirtazapine 30 mg though jerks and sexual activity related episodes did not respond to anticonvulsant Valproate 1000mg, which was prescribed at another tertiary health care facility. Further clarification of history and investigations, coupled with no response to anticonvulsants pointed towards revised diagnosis of RDD with Dissociative seizures, thus implying that overuse of medications is a burden to such dissociative symptoms.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

224. Title – Comparison of Neuro-cognition in Adolescents with Conversion Disorders and Healthy Controls

Arunita Singh ^*, Vivek Agarwal ^**, Shweta Singh ^***, Pawan Kumar Gupta ^****

Background: As per DSM-5 “Conversion Disorder” is the presence of symptoms of altered motor or sensory function that (as evidenced by clinical findings) are incompatible with any recognized neurological or medical condition and not better explained by another medical or mental disorder.

Neuro-cognition in a broad term means information processing. Its various important aspects are – attention, learning, memory, executive functioning and language.

Executive functions mediate goal directed behaviour. These include planning, mental flexibility, impulse control, working memory.

Aims: To review studies on Neuro-cognition in Adolescents with Conversion Disorder.

Methodology: A web search in PubMed has been done using keywords “Neuro-cognition”, “Conversion Disorder”, “Adolescents” in PubMed. All studies on Neuro-cognition in adolescents with conversion disorder were screened.

Results: Two studies were found. In an Australian comparative study comprising of 57 children and adolescents with conversion disorder matched with 57 controls various domains were assessed, namely - intelligence, orientation, attention, executive functions. Patients showed poorer performance on tests for memory, attention and executive function. An Indian study was found which studied the relationship of cognitive functions and adjustment difficulties in 50 newly diagnosed conversion disorder children and adolescents. Impairment was observed in visuo-constructive and visual organization abilities suggesting impairment in ability for analysis, synthesis, perception and reasoning ability.

Conclusion: Present studies have shown differences on tests of neuro-cognition in adolescents with conversion disorder and healthy controls but the data is limited and more extensive and elaborate studies are required in this field.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

225. Foreign body in scalp of a patient with Migraine, OCD with dissociative amnesia

Praveen Pandey ^*, S K Kar ^**, Jai Singh ^***, Divya Sharma ^****

An adult female presented in Neuropsychiatry OPD with complaints of headache for past six months, recurrent intrusive thoughts and acts for past three months, episodes of abnormal body movement and unresponsiveness, low mood and disturbed sleep for past two months. The patient had previously hospitalised for the above mentioned complaints where she complained of pricking sensation in back of head, which on inspection was found to be due to sharp metallic objects. A CT head was done which revealed opacities which resembled safety pins. The patient was further evaluated in Department of Neurosurgery and the patient was operated for foreign body which were revealed to be paper pins and safety pins. The patient apparently had no memory of as to when these might have been acquired. On evaluation,the patient was diagnosed as a case of Migraine with Obsessive Compulsive Disorder, mixed obsessional thoughts and acts with Mixed Dissociative Disorder and was prescribed medications for the same and psychotherapy was done for dissociative symptoms. After a two week follow up, the patient’s symptoms had shown only a mild improvement and she had started complaining of pricking sensations in back of head. On evaluation she had multiple pins inserted in her skull and had apparently no memory of the event.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

226. ECG CHANGES AMONG OPIOID INJECTORS ATTENDING TERTIARY HOSPITAL IN IMPHAL

Andreecia Mn Mawiong ¹, N Heramani Singh ¹, S Gojendra Singh ¹

BACKGROUND: Unsafe injecting of illicit opioid are known to attribute physical problems worldwide. ECG changes are also linked with injecting drug use and are important public health concerns in India and in many other countries world- wide.

METHODOLOGY: The purpose of this study is to find the prevalence of ecg changes among opioid injectors. This is a cross-sectional study, all the consecutive opioid injectors who attended De-addiction Center were screened using the ecg machine to find out the presence of any ECG changes, Reports were collected and data was analysed statistically using spss21.

RESULTS: 105 patients were screened and 11.4% were found having left ventricular hypertrophy, 11.4% were found having short PR interval.

CONCLUSION: From this study we conclude that people who inject opioid in a dependent manner are susceptible to cardiac problem which may reflect in the changes of ECG.

KEYWORDS: opioid, dependent, ECG changes.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

227. Clinical correlates of Cavum Septum Pellucidum and its prevalence in patients of Alcohol dependence: A prospective comparative CT study

karnik Kishore, crj khess

BACKGROUND - Some neuroimaging studies have reported a range of functional and structural abnormalities of the limbic system in substance-dependent subjects like reduced amygdala volume immature prefrontal cortex. The role of Septum pellucidum is described as an important relay between limbic structures (hippocampus, amygdaloid complex), hypothalamic autonomic system and brain stem reticular formation. Larger CSP should be considered a developmental anomaly, contributing to neurological and psychiatric disorders.

AIMS & OBJECTIVES - To compare prevalence of CSP (normal and abnormal) between patients of alcohol dependence and matched healthy controls.

In this study we will try to explore the correlation of dimensions of CSP with the duration of alcohol dependence and prevalence of normal (length <6 mm) and abnormal CSP (length >6 mm), as defined by Kwon et al. (1998), Nopoulos et al (1998), Dickey et al (2007) and Choi et al (2008), in comparison to matched healthy controls using CT scan in prospective manner.

METHODOLOGY Venue : SS Raju Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi.

Study Design : Prospective comparative hospital based study.

Sampling technique: purposive sampling technique.

Sample size : 60 diagnosed cases of mental and behavioral disorder due to use of alcohol, dependence syndrome, active dependence according to ICD-10, DCR (WHO, 1993) and 60 healthy matched controls.

RESULTS AND CONCLUSION.

In this study 10 out of 60 patients had CSP but none of the controls had CSP. All the cases who had CSP the dimensions of CSP were < 6mm. This study thus concludes that the prevalence of CSP is higher in patients of alcohol dependence but it is not associated with abnormal dimensions.

Key words – CSP, Dimensions of CSP, Alcohol dependence, CT Scan.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

228. TOPIC : STUDY OF COGNITIVE IMPAIRMENT IN PATIENTS OF ALCOHOL USE DISORDER

SURESHRAO GHOGARE ¹

INTRODUCTION:

Alcohol use disorder (AUD) combines alcohol abuse and alcohol dependence. Besides various social, economic and physical consequences, alcoholism is also associated with deleterious effects on central nervous system functions. Severe and chronic alcoholism is consistently associated with neuropsychological impairments with respect to cognitive flexibility, problem solving, decision making, risky behaviour and further aspects of cognitive function. AUD in India is especially important to watch out for because of consumption of country liquor and high rates of alcohol use in rural population.

MATERIALS AND METHODS:

It is an observational cross-sectional study conducted in a Medical College over a period of 18 months with sample size of 100 patients. The participants were assessed by pro-forma containing socio-demographic details, questionnaires like MMSE (Mini Mental State Examination), BCRS (Brief Cognitive Rating Scale), GDS

(Global Deterioration Scale) and BG-2 (Bender Gestalt – Edition 2). Categorical data was presented as frequency and percentages and was tested for statistical significance by chi square test. Continuous data was presented as mean and standard deviation was tested for statistical significance using student t test for two groups comparison and with one-way ANOVA using post-hoc of Bonferroni for three groups comparison. P value < 0.05 was considered statistically significant.

RESULTS:

AUD (Alcohol Use Disorder) was associated with cognitive impairment in 62 out of 100 patients. 30 patients had mild cognitive impairment, 20 had moderate cognitive impairment and 12 had severe cognitive impairment.

CONCLUSION:

AUD is significantly associated with Cognitive Impairment.

KEYWORDS:

Alcohol Use Disorder, Cognitive Impairment, Cross-sectional study

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

229. Title of the article: Catatonia as a presenting feature in a case of alcohol withdrawal: where is the causative link?

Santanu Nath, Anantprakash S Saraf

BACKGROUND

Catatonia is a neuropsychiatric condition featured by alterations in motor behaviour, thought, affect and vigilance. The concept was formulated by Kahlbaum in the nineteenth century and is found to occur in a variety of psychiatric and medical conditions. Among substance of abuse, benzodiazepine and alcohol withdrawal has been reported to present rarely with catatonic picture both in rodents and humans. We report a case of catatonia that occurred as a part of complicated alcohol withdrawal symptoms while discussing the possible etiological link between them.

METHODOLOGY:

A 35 year old male with alcohol dependence came to the OPD with catatonic symptoms (echopraxia, mutism) which occurred after he cut down his alcohol intake for few days. He was also found to be disoriented to time, place and person suggesting delirium (probably delirium tremens).

RESULTS:

He was found to have a delirium tremens picture which also showed prominent catatonia picture where the most conspicuous presentation was echopraxia. He imitated each and every motoric activity of others which persisted despite instructing him not to do so.

CONCLUSION:

The case depicted here highlights that withdrawal from substance of abuse can also present with catatonia. The possible neurobiological underpinnings for such is discussed.

KEYWORDS: alcohol dependence, catatonia, echopraxia, delirium tremens.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

230. DECISION MAKING AS MEASURED BY EVENT RELATED POTENTIALS (P300) CANNABIS INDUCED PSYCHOSIS: A COMPARATIVE STUDY

Shraddha Chaudhary, CRJ Khess, Nishant Goyal

Background : Cannabis use may have a causal association with schizophrenia resulting in information processing impairments. The literature studying effects of cannabinoids on the event related potential P300 have produced inconsistent results. Our study aims to study P300 in cannabis induced psychosis ‘schizophrenia like’ (SCZ CDS) and cannabis dependent subjects without psychosis (CDS) as there is paucity of studies demonstrating the same.

Materials and Methods: The study was a hospital based cross sectional study. Twenty subjects of SCZ CDS, 20 CDS subjects and 20 education and handedness matched normal controls were recruited. Patients were rated on PANSS, BPRS, and Severity of Dependence Scale. The 40 channel ERP recording was done while doing Colour Stroop Test and P300 waves were generated. Chi-square tests, t-test, One way ANOVA and Pearson‘s bivariate correlation were applied for analyzing the data.

Results: P300 latency in majority of the electrodes was significantly delayed in subjects with SCZ CDS and CDS as compared to healthy controls. Significant difference was found in P300 latency & amplitude in parieto-occipital and frontocentral areas between SCZ CDS and CDS. There was significant correlation between P300 latency and age of patient, age of onset, PANSS positive score & severity of dependence.

Conclusions: It can be concluded that development of schizophrenia following cannabis intake added to the cognitive deficits seen in chronic cannabis users. Age, age of onset of cannabis intake & severity of dependence had significant effect on p300 latency which can have clinical implications. Hence, p300 may be used as a biomarker in cannabis induced schizophrenia.

Keywords: Event Related Potentials, P300, Cannabis induced psychosis, Schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

231. INHALANT USE DISORDERS: A REVIEW OF RECENT RESEARCH

Kamini Verma ¹, Aishwariya Brigit George ¹, Biswadip Chatterjee ¹

Objective: Inhalant use disorders are associated with significant morbidity especially among young and vulnerable sections of the population but receive less focus in research. This review attempts to identify and summarize the available research on aspects of inhalant use disorders, with a focus on recent studies and the Indian context.

Methods and Results: Search was undertaken using relevant terms and revealed that studies pertaining to the topic contributed less than 7% to the total volume of research on substance use disorders. Interest in this topic has not shown an increase from 2008 to present. Regarding modes of abuse, case reports pointed to novel means and dangerous combinations with other substances such as alcohol. There is a notable absence of epidemiological data in the Indian context, however, international annual population-based surveys such and longitudinal studies reveal that these disorders are most prevalent in the adolescent age group and prevalence decreases with age. Prevalence studies in India are from specific settings such as treatment centers and street children. From the gateway perspective, inhalants precede and are associated with a greater risk of illicit and injecting drug use. Research on risk factors have identified use by peers and siblings as increasing risk and familism, drug refusal and parental respect as protective factors. Neuro-imaging studies in chronic use substantiate damage to the white-matter regions. Adverse effects on endocrinological and growth parameters have been seen in animals. VSM is associated with psychiatric comorbidity. Mortality data show a decreasing trend from the 1990s till present. Psycho-social interventions remain the mainstay of treatment. Pharmacological agent used are buspirone, baclofen, aripiprazole, lamotrigine and vigabatrin with insufficient evidence to recommend the routine use of any.

Conclusion: VSM results in significant morbidity at a developmentally crucial stage. There are lacunae in research on all related aspects, especially in the Indian context.

Key words: inhalant, volatile substance mis-use.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

232. Unusual case of lizard use and its possible role in perpetuating or precipitating psychosis

Deeksha Kalra, Sanchari Mukhopadhyay, Nitin B Raut

Introduction:

Alcohol, cannabis, opioids, hallucinogens, stimulants, tobacco, caffeine are evidenced as substances of abuse. However, use of reptiles has been reported across literature in a limited and scattered manner. There is no clearcut document detailing symptomatology of reptile abuse, intoxication or withdrawal. Furthermore, any association between abuse of reptile and other substances is also not clear.

Case description:

A twenty year old man with premorbid temperament suggestive of a difficult child with dissocial personality traits, presented with an insidious onset continuous illness of 4 years characterised by use of tobacco, alcohol, cannabis for 4 years and dried lizard (powdered and filled in cigarette) for 1 year in chaotic pattern. The patient reported of feeling of heightened excitement and wakefulness when lizard was mixed with cannabis. Patient had two episodes of psychosis- 2 years back and 1.5 years back, with each episode responding to out patient treatment with olanzapine 10 mg and 1 month of abstinence with complete inter episodic recovery. In the current 3rd episode, the symptoms were similar to those of the past but of a greater severity with unamanageability, with a duration of 15 days prior to admission in our hospital, precipitated after increased use of dried lizard for approximately 4-5 days prior to onset of the episode. Patient was initially started on olanzapine in-patient, on which the response was inadequate. Patient responded after addition of Sodium Valproate, reaching complete remission of symptoms in 4 months.

Clinical implications:

This case highlights the use of unusual substances, the possibility of lizard use potentiating psychosis in already existing multiple substance dependence. Further research is required to study the prevalence, pattern, effects, of lizard abuse and also, possible predilection for unusual substance use in certain personality traits.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

233. Burden of care and coping skills in spouses of individuals with substance use disorders: A cross-sectional study.

Poornima Khadanga, Aparna Ramakrishnan, Vinayak Pandurang Kale

INTRODUCTION:

Substance use disorder stands as a major problem in the country today. It not only causes significant socio-occupational impairment at an individual level but also affects the quality of life of the family members living with him especially the spouses, given the intimate nature of their relationship. Addressing the burgeoning problem of substance dependence and the burden and distress among the spouses of substance dependent individuals would constitute a holistic approach towards treatment of substance dependence.

AIMS AND OBJECTIVES:

To study the level of burden borne by spouses of individuals with substance dependence and the coping strategies used by them.

MATERIALS AND METHODS :

60 spouses of individuals with substance use disorder (as per DSM-5 criteria) attending psychiatry OPD at a tertiary health care centre in Mumbai were evaluated in this cross sectional study. Burden Assessment Schedule was used to assess the pattern of burden borne by the spouse and the coping strategies were assessed by Brief COPE inventory. Data will be statistically analysed.

RESULTS AND CONCLUSION :

This is an ongoing study. The results and conclusion will be elaborated at the time of presentation.

Keywords : Family burden-subjective and objective burden-coping skills-substance dependence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

234. QULALITY OF LIFE OF PATIENTS ON TRAMADOL BUPRENORPHINE & METHADONE THERAPY AND BURDEN ON THEIR CARE GIVERS; A COMPARATIVE STUDY”

1B S Shekhawat, 2D K Vijayvergia, 3Vimal Meena*, 4Manoj Dudi, 5Rajesh Swami, 6Neeraj Sharma, 6Suresh Parihar

Abstract: Opium Use disorder has been showing a rising trend all over the world including India. Tramadol, Buprenorphine, and Methadone are mainly use for treatment of opioid dependence. The opium use disorder not only impacts the patients, but also affect their care givers. The present study was undertaken to compare quality of life of patients treated by tramadol, buprenorphine, and methadone and burden on their caregivers.

Key words: Opioid dependence, quality of life, caregiver burden.

MATERIALS AND METHODS:

The study was conducted in Drug De-addiction Centre, Department of Psychiatry, Govt. medical college Kota. After approval from ethical committee, 120 opiate dependent patients aged between 18-65 years who fulfilled ICD-10 criteria for Opioid Dependence and taking treatment for at least one month with their caregivers aged between 18-65 years, who were living with the patients for at least one year, and directly involved in the care of patients were included in this study. They were divided in to three groups (40 patients with their care givers in each group) according to type of treatment ( Tramadol buprenorphine and methadone therapy).

TOOLS OF STUDY:

A Semi structured specially designed proforma that includes socio demographic details and clinical profile of patients.
WHOQOL– BREF, WHO, Hindi (version).
Burden Assessment Schedule.

RESULTS AND DISCUSSION Data thus collected were analysed by using SPSS software (version 22) and results will be discussed at the time of presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

235. Meow-Meow for Sex: A case of Mephedrone abuse

Lt Col (Dr) Virendra Vikram Singh, amit singh

Chemsex is a term vaguely used to describe the use of substance for or during sex. It has been reported from several parts of the world during the last decade and is mostly used in relation to men who have sex with men (MSM). The drugs frequently described under this terminology are crystal methamphetamine, mephedrone and gamma hydroxy butyrate (GHB). Other drugs included in this list are MDMA, cocaine & ketamine. This phenomenon is increasingly being noticed in Europe, USA and Australia and is regarded as a cause of concern due to associated high risk sexual activities, risk of HIV, HCV and STIs. Increasing use of Mephedrone in India too has been suggested by several media reports. However scientific literature with regard to chemsex is lacking from India. We present a case of mephedrone use in context of sexual pleasure in a person from MSM community. We discuss about mephedrone, its effects and side effects, phenomenon of chemsex and hypothesis around it. This case prompts us to look into substance abuse among MSM community, the risks involved, and scope for further research.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

236. Alcohol Drinking Behaviour and Locus of Control in Urban and Non-urban Areas in West Bengal.

Tanmoy Mitra, Kedar Ranjan Banerjee, Jayita Saha, Madhumita Das

Background : Various trials have been made to ascertain whether alcoholics differ from non-alcoholics in their perceived locus of control. But very few attempts have been made to find out if there is any difference between alcoholics of urban and non-urban areas in regard to locus of control. The present study examined the responses of alcoholics in urban and non-urban areas on Levenson’s Multidimensional Locus of Control Scale. It is imperative to assess that if place of dwelling affects the concept of control on behavior of alcoholism.

Methodology : Subjects were 80 urban males and 40 non-urban males from southern parts of West Bengal. Matching of demographical aspects was done as much as practicable except the place of living. Results indicate significant differences between the urban male alcoholic and the non-urban group. Urban male alcoholics reported significantly lower internal control scores than did non-urban alcoholics. Within the sample, alcohol use and other psychological constructs showed a significant interaction with locus of control.

Conclusion : These findings suggest that locus of control may be a potentially useful clinical construct in the development of treatment plans for alcohol disorder for both urban and non-urban patients with alcohol related disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

237 Association of socio-demographic factors and clinical features with severity of alcohol dependence.

SUMIT MUKHERJEE, SAYANTI GHOSH

Introduction: Alcoholism is a major problem of the modern world and leading preventable cause of death. Increased consumption of alcohol specially in developing countries is mainly due to changes in socio-cultural and economic environment. Alcohol consumption and development of dependence is associated with several factors like age of onset of drinking, family history of drinking, presence of stressful life events and also socio-cultural back ground. Evidence suggests early intake of alcohol is associated with aggression, social role maladaptation, loss of behavioural control. All these determinants should be studied in detail for prevention of alcohol dependence.

Methodology: It is a hospital based cross sectional observational study. Purposive sampling was done and 100 cases have been selected who were having history of alcohol intake and among the cases 35 cases have been excluded from the study as they are not qualifying either in AUDIT scale or having some comorbid substance abuse excluding the tobacco. A pretested and predesigned semi-structured proforma containing questionnaire for socio-demographic profile and Alcohol Dependence Scale (ADS) was used. For statistical analysis data were entered into excel spreadsheet and then analyzed by SPSS 20.0.1 and appropriate statistical test like chi- squared test is being used.

Results: Age of onset of first drinking, marital status, occupation, family history is significantly associated with severity of alcohol dependence (p-value ≤ 0.05). Black out, delirium tremens, occupational difficulty, physical comorbidity, legal problems all are significantly associated with the severity of alcohol dependence (p-value ≤ 0.05).

Conclusion: Role of family, school and society is pivotal in eliminating alcohol dependence. Robust research in community is required to identify the exact role of sociocultural and economic aspects regarding harmful alcohol use. Appropriate policy should be implemented by the both union and state governments to prevent promotion of alcohol use and also awareness generation at community level.

Keywords: Alcoholism, Socio-cultural, AUDIT, ADS, Onset, Lega

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

238. COMMERCIAL BUTANE DEPENDENCE: A CASE REPORT

Riswana Fathima ¹, Veeramuthu ¹, Venkatesh Mathan Kumar ¹

Butane, is widely used as a propellant in aerosols and as a fuel for LPG appliances and cigarette lighters. It is a colourless, flammable gas with a boiling point of –0.5°C. Butane is commercially available in various forms including air freshener, lighter fluid, a gas heater, a gas element, and butane canisters for camp stoves. Butane is relatively highly volatile with rapid evaporation from compressed liquid which permits high dose rates and has highly lipid solubility and thus potency. Abuse of volatile substances is associated with significant psychiatric comorbidity and is also common in developing countries like India. Although exact prevalence rates are unavailable, reports suggest that the problem is of considerable magnitude. Commercial butane dependence is rarely reported in India.

Here we report the Case of a 22 year old male with inhalant (butane) use for 8 years in dependence pattern currently presenting with withdrawal features and mood symptoms. Initially he has used Air fresheners and switched over to canisters used for camp stoves. Under intoxication, he has a sense of euphoria, visual and auditory hallucinations and a heightened sense of perception. He developed palpitations, and cyanosis following one episode of overdose of substance 3 months back. ECG shows sinus tachycardia. Echocardiogram is normal. EEG shows a normal record.

Keywords: Substance use, inhalants, butane, dependence

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

239 GASOLINE ABUSE IN A 12 YEAR OLD CHILD WITH SEVERE MENTAL RETARDATION AND SEIZURE DISORDER: A CASE REPORT

N Tejaswini ¹, SVV Jagadeesh ², M Vijaya Gopal ³

Introduction/Background: The abuse of inhalants is of growing interest in the recent years. The age of onset is typically during adolescence. Gasoline inhalant use is rarely reported in adolescents with intellectual deficit. Gasoline is the generic name for petroleum fuel mainly used for internal combustion engines. It is complex, volatile and highly inflammable. We report a case of petrol dependence in a 12 year old with severe mental retardation and seizure disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

240. Prevalence of sexual dysfunction in male patients with alcohol dependence: A cross sectional study

Prashant Kumar

BACKGROUND

Sexual activity and alcohol consumption are an inter-related phenomenon. Studies suggest intake of small quantities of alcohol improve sexual performance however chronic alcohol consumption leads to decrease in sexual activity and sexual dysfunction in the form of pre mature ejaculation and erectile dysfunction. Patients of chronic alcohol consumption report of decrease in sexual activity both due to psychological and physical dysfunction leading to further increase in alcohol consumption.

AIM

We attempted to assess the prevalence and severity of sexual dysfunction in a clinical sample of subjects with alcohol dependence

MATERIAL AND METHODS

50 male patients diagnosed with alcohol dependence according to ICD -10 criteria were included in our study. SADQ for severity of alcohol dependence and ASEX for severity and subtype of sexual dysfunction scales were applied on them after informed consent and acquiring sociodemographic details.

RESULTS

Out of total 50 subjects of alcohol dependence 46% patients reported of sexual dysfunction. It was observed that patients with severe alcohol dependence on SADQ reported of maximum sexual dysfunction (76.2%) followed by moderate (33.3%) and mild sexual dysfunction was noted only in (9.1%) and most common sub type was found to be P.M.E(22%).

CONCLUSION

Sexual dysfunction appears to be a common entity among patients of alcohol dependence. This dysfunction not only leads to further increment in alcohol intake but also deteriorates the overall well being of the individual. The aim of our study was not only to prove that such a connection exists but also to use this knowledge in further management of such patients.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

241. A CASE OF PATHOLOGICAL GAMBLING PRESENTING AS DEPRESSION

SRI HARI PRAKASH C

INTRODUCTION:

ICD- 10 describes Pathological gambling as consisting of frequent, repeated episodes of gambling which dominate the individual’s life to the detriment of social, occupational, material, family values and commitments.

CASE REPORT:

A 30 year old married male working in Singapore for the past 2 years as a Foreman initially presented to the Psychiatry Out Patient Department with complaints of irritability, sad mood, difficulty initiating sleep, bleak views about future, reduced appetite and loss of interest due to disharmony at workplace and at home. On further evaluation, he revealed he went to Singapore to clear his debts where he was introduced to the State lottery by a co-worker. Initially, he had won around 50000 INR following which he developed an intense urge to gamble, which was difficult to control and spent more time at the casino, putting his job at risk. After spending all of his earnings, he later acquired huge debts from co-workers for gambling, resulting in disputes at workplace. He evaded payment of debts and returned to India without informing his superiors and co-workers. Having spent all of his earnings abroad and returning home empty handed, his relationship with his spouse had deteriorated. Patient was started on C. Fluoxetine 20mg and is on follow up.

RESULTS:

Patient reports a decreased urge to indulge in gambling on follow up.

KEY WORDS: Pathological gambling, depression, evading payment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

242. I Am a Disease; Not a Habit!! Guess Who Am I?

Sumera khan ¹, Vaibhav Dubey ¹

Background:

AUD is etiologically complex and multifactorial discarding the archaic belief of alcohol addiction being a habit. Disability suffered by people with AUD has not received much attention in research so far.

Aim:

This study aims to assess the disability and its correlates among individuals with alcohol use disorder in Indian settings.

Methodology:

A cross sectional study was conducted with a total sample of 100 patients diagnosed with Alcohol Use Disorder. Assessment of the severity of alcohol consumption was done using AUDIT questionnaire. Drinkers Inventory of Consequences questionnaire was then applied to measure adverse consequences of alcohol use. After which both World Health Organization Disability Assessment Schedule (WHODAS) version 2.0 as well as Indian Disability Evaluation and Assessment Scale(IDEAS) were used to assess disability.

Results:

AUDIT scores among all the subjects indicates hazardous level consumption, dependence and alcohol related problems with the average total score of 30.17± 2.56. Drinkers inventory of consequences suggest high level of adverse consequences both in lifetime scores (mean decile range 7.07± 1.26) as well as in recent scores (mean decile range 7.95± 1.60). Maximum subjects scored high on physical domain (81%) followed by interpersonal domain (54%) of adverse consequences during their lifetime. While the recent adverse consequences showed equal involvement of both physical (100%) as well as social domains (100%) followed by interpersonal domain (80%). IDEAS revealed severe disability in among 87% and moderate in rest 37% subjects. WHODAS 2.0 revealed a total of 83% subjects to have moderate disability and 16% with severe disability.

Conclusion: Disability assessment using IDEAS and WHODAS 2.0 shows significant impairment in patients with AUD.

Keywords: Alcohol Use Disorder, Disability, AUDIT, Drinkers Inventory of consequences, IDEAS, WHODAS.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

243 From cannabis onto inhalants- the impact of a State Election on an adolescent’s substance use pattern

TONY LAZAR THOMAS

Introduction

Social stress is an important risk factor for mental illness(1) and poverty,unemployment socioeconomic deprivation contribute to substance use disorders(2). Elections appear to be one such event which may have a mental health impact in a small group of individuals(3). The recent U.S presidential inauguration, resulted in first episode psychosis in a lady who otherwise had an unremarkable past(4). We present an interesting case report on how the recent elections in the Indian state of Karnataka influenced the substance use pattern of a young boy.

Case Report

Master X,16-year-old boy, studies in the 8^thstandard and is from a lower socio-economic status background,living in urban Bangalore. Following the death of his mother when he was only 3 years old, his father remarried. He has since been under the care of his grandmother. Since the last year,he started using tobacco in the form of cigarettes along with his friends, and within 15 days he increased his use to 5 cigarettes daily,with craving and withdrawal symptoms upon discontinuation. Two months following the initiation of smoking, he started using Cannabis in the form of joints. He felt a greater high from cannabis compared to the effect of cigarettes. He reports craving and withdrawal symptoms when not using cannabis since the past 8 months. He generally procured cannabis from a local slum, and his dealer in turn procured it from another source, located 60 kilometres from the city.

During the elections in May 2018, as part of the strict enforcement by the Election Commission, primarily focused on alcohol, there is strict vigilance for any illegal transportation of cash and alcohol. This also affects the easy transportation of other drugs including cannabis, which is illegal in India. During the elections, X could not buy his usual supply of cannabis and had withdrawal symptoms. This was so stressful for him, that he turned tousing an inhalant (Whitener/Toluene), which was being used by his peers, as a substitute for cannabis. He bought the whitener fluid which was easily available in stationery shops. Although the Ministry of Health has issued a directive against the stocking of such whitener bottles, it is still sold in some retail stores. Whenever he ‘huffed’ (a form of inhalation) the whitener, he reports a sense of high that was very different from that of cannabis. He started seeing some images moving around him and coming out of the wall. He was unaware of what happened for the next few hours. He liked this experience and continued using inhalants on a day to day basis. On one occasion, he used double the amount and was found disoriented by his family, who brought him to the emergency department. Physical examination findings were unremarkable. However, on mental status examination he was found to be disoriented, and reported visual hallucinations as described earlier. His laboratory investigations such as hemogram,liver function test, renal function test,thyroid function test, vitamin B12 and folate levels were normal. He was managed with Tab Clonazepam 0.5 mg for initial few days along with iron and folic acid supplementation. Tab Baclofen was started as an anticraving agent and dose was increased upto 30 mg/day.

Discussion

In this case report, we describe how a young boy, who was using cannabis in a dependent pattern, suddenly turned to using inhalants in a harmful pattern due to the sudden unavailability of cannabis in the context of elections, which in turn led to significant withdrawal and craving. Availability and regulatory status of mind altering substances are well known determinants of their use in society. (5). Public policy, including prohibitions during Elections, although transitory in nature, can also lead to impact on behaviours like substance use(6). For example, during elections, there can be increased seizures of alcohol, as well as bootlegging. It is worth studying in detail the impact of sudden bans, restrictions or abrupt non-availability of substances on the patterns of substance use in any community.

References

1.Mizrahi R. Social Stress and Psychosis Risk: Common Neurochemical Substrates? Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2016 Feb;41(3):666–74. doi: 10.1038/npp.2015.274. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.WHO | Substance use problems in developing countries. WHO. 2011 [Google Scholar]
3.Shy BD. Immigrants, the Emergency Physician and the Election Day. West J Emerg Med. 2017 Feb;18(2):329–30. doi: 10.5811/westjem.2017.1.33506. [DOI] [PMC free article] [PubMed] [Google Scholar]
4.Aimua FA. Impact of Political Rhetoric on Mental Health: A Case Report of First-Episode Psychosis After the 2017 US Presidential Inauguration. Prim Care Companion CNS Disord. 2018. Mar;22(20(2)):0–0. doi: 10.4088/PCC.17l02155. [DOI] [PubMed] [Google Scholar]
5.Murthy P, Manjunatha N, Subodh BN, Chand PK, Benegal V. Substance use and addiction research in India. Indian J Psychiatry. 2010 Jan;52(Suppl 1):S189–99. doi: 10.4103/0019-5545.69232. [DOI] [PMC free article] [PubMed] [Google Scholar]
6.Grossman M, Chaloupka FJ, Shim K. Illegal Drug Use And Public Policy. doi: 10.1377/hlthaff.21.2.134. [DOI] [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

244. Title: Lizard tail as unconventional addiction: Case Report

Shobhit Kumar Prasad ^1,^✉, Piyush Verma ¹, Priti Singh ²

This research has not been published nor is under consideration for publication

INTRODUCTION

The scientific literature regarding use of reptiles for purpose getting high are sparse, and mainly from developing countries. During conditions like non-availability of drugs or other substances of abuse, there can be propensity for using alternative forms of substances like reptiles or insects, which is determined by a milieu of factors, like personality profiles, socio-cultural milieus, availability and accessibility of substance and co-morbid psychopathology. We present a case of alcohol and cannabinoid dependence syndrome with dissocial traits admitted in a state drug-deaddiction center, PGIMS Rohtak describing the use of tail of Indian lizard to get high when there was non-availability of cannabis and alcohol in jail.

key-words: lizard, addiction, substance abuse, dissocial traits

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

245. “Getting High” on Highly Inflammable

Takwani TJ ¹, Patel MK ¹, Jani AM ¹

INTRODUCTION

Inhalant abuse is of increasing problem in India. Inhalants are volatile chemical vapours, which when inhaled induce mind-altering effect which is immediate with an excitatory stage followed by prolonged CNS depression. The various methods of abuse are sniffing, bagging or huffing.

CASE REPORT

A 14-year-old adolescent male studying in 9^th grade and belonging to low socioeconomic status; was presented with intense signs of separation anxiety to the outpatient department by his parents along with complaints of irritability, restlessness, refusing to eat, threats to kill himself and sleep disturbance for 1 month. On further probing, parents reported that the child was sniffing kerosene from a container since last 4 years. The child was managed by behaviour therapy in which he was allowed to meet parents only if he sat quietly at least for five minutes. Brief interventions in the form of planned recreational activities to help the child for a behavioural change were made and periodic rewards for abstaining from kerosene were offered to the child and punishments for lapses to previous behaviours were given.

DISCUSSION AND CONCLUSION

Adolescents are always curious about experiencing new things. In this case the child started using it in exploration and became dependent. Various adverse effects of chronic inhalant abuse on body organs is known. A typical inhalant abuser is a young adolescent either with scholastic decline or as a school dropout, comes from low to middle socioeconomic status family, and abuses inhalants because of their easy accessibility, cheap price, faster onset of action, and the regular “high”. Management is generally behavioural along with health education and family support.

KEYWORDS

Inhalants, Kerosene dependence, Separation anxiety, Behaviour therapy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

246. Psychiatric comorbidities among alcohol dependent patients

PRAVEEN P JOSE

BACKGROUND: Alcohol dependence syndrome often coexist with other psychiatric disorders.

OBJECTIVES: To study the relation of psychiatric comorbidity in patients with alcohol dependence.

METHODS: All patients aged 18 years and above admitted in a tertiary care centre who satisfy the ICD 10 diagnostic criteria for alcohol dependence syndrome were included in the study. A total of 400 patients were included after meeting inclusion criteria. Mini International Neuropsychiatric Interview was administered to find out different psychiatric disorders in patients. Data analysis done using SPSS version 18(free trial), Descriptive statistics and Chi square test were used.

RESULTS: 54% of the sample had psychiatric comorbidities. Among them 36% patients had major depressive disorder, followed by schizophrenia in 27.3%, adjustment disorder in 11.5%, bipolar affective disorder in 9.8%, delusional disorder in 8.3%, and dissocial personality disorder in 7.3%.

CONCLUSION: Psychiatric comorbidities are highly prevalent in alcohol dependent patients.

KEY WORDS: Alcohol dependence, Psychiatric comorbidity, ICD 10, MINI

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

247. Diffusion Tensor Imaging Studies in Auditory Hallucinations: A review

Nishtha Chawla ¹

Introduction: Auditory hallucinations (AH) are one of the common psychiatric symptoms occurring across a range of disorders, including schizophrenia. They constitute one of the most distressing symptoms in psychiatry. Several neurobiological studies have been done providing insights into specific disorders, but relatively lesser research is available on biological underpinnings of individual psychopathological symptoms, such as AH.

Methodology: PubMed was searched using search terms “Schizophrenia” AND “Hallucinations” AND “Diffusion Tensor Imaging”. Additional search was done using google scholar. Selection criteria included studies done on patients of schizophrenia which primarily or in post-hoc analysed white matter changes in association with auditory hallucinations. Psychiatric illnesses other than schizophrenia, and psychopathologies other than auditory hallucinations were not included in the review. Neuroimaging studies other than DTI were also excluded.

Results: After applying the selection criteria, 22 studies were included in the review. Ten studies out of the total selected had analysed associations with auditory hallucinations in post-hoc analysis and not as their primary aim. Majority of the studies were done assessing the DTI parameters in limited number of white matter tracts, most common being arcuate fasciculus (13). Changes were noted mainly in arcuate fasciculus, cingulum bundle, superior longitudinal fasciculus, corpus callosum, with few studies on other tracts. The duration of illness varied from as low as five months to as high as fifteen years. Defining the status of hallucinations (current/lifetime) was highly variable between the studies. Medication intake was not controlled in any study.

Conclusions/Discussion: Till date, only a few DTI studies have investigated the brain white matter in AH. Positive findings have been obtained in limited number of tracts (most commonly arcuate fasciculus). In available studies, the study population has been heterogeneous, in terms of age, duration of illness, substance use, status of hallucinations, which further limits the generalizability of the results obtained.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

248. Buprenorphine induced skin eruptions: A case Report

Anuranjan Vishwakarma, Nishtha Chawla, Siddharth Sarkar

Background: Buprenorphine is rarely known to cause skin eruptions and there are very few reports of the same. Such pharmacological adverse reactions are known to decrease drug compliance and is also a reason for treatment dropout. We present a case of opioid dependence who developed cutaneous eruptions after being started on Buprenorphine maintenance therapy.

Description: A 26 years old male diagnosed with opioid dependence syndrome characterised by craving, tolerance, withdrawal, preoccupation with the use of substance, and neglect of other pleasurable activities, presented to the community outreach clinic of national level drug dependence treatment centre. He was started on agonist long term management with Buprenorphine daily dispensing. Within a week of start of Buprenorphine administration, he started to have pustulo-erythematous skin eruptions. Relevant investigations were done and found to be normal and on suspecting drug-induced rash as the aetiology, buprenorphine was stopped after which his skin eruptions started improving. He was re-challenged with the Buprenorphine within ten days of stopping buprenorphine after which similar skin eruptions appeared again.

Conclusion: It has, thus, been emphasised that clinician should be aware of the potential cutaneous eruptions associated with Buprenorphine. Early detection of the same would lead to timely management and hence better compliance with the treatment.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

249. Mephentermine induced psychosis: A case report

Anuranjan Vishwakarma, Nishtha Chawla, Atul Ambekar

Background : Mephentermine is a sympathomimetic agent, often used to treat hypotension, which frequently accompanies spinal anaesthesia. The onset of action is prompt (within 5 to 15 minutes), which lasts up to 4 hours after intramuscular injection. It has euphorigenic and relaxing effects by it’s secondary action. There is scanty of literature regarding mephentermine use with induced psychosis. We are presenting a case of 32 years male diagnosed with use of Mephentermine in dependent pattern with induced psychosis.

Description : A 32 years old male aspiring to get selected in Indian army started administering injecting mephentermine to improve performance in physical examination. He gradually increased it to 10 times the starting dose within one year, and developed dependence over it. Around the same time, patient started to have psychotic symptoms in the form of third person auditory hallucinations. His psychotic symptoms were fluctuating with dose of Mephentermine use. Within 3 months of total abstinence, from Mephentermine, he stopped reporting of the auditory hallucinations. The psychotic symptoms reappeared as soon as he started using mephentermine again. Though after restating of mephentermine he was using it intermittently (once in 2-3 weeks) and reported auditory hallucinations to be 60% of original. Patient was admitted for further evaluation, cardiology consultation was taken along with ECG and Echocardiography, which came out to be within normal limits. A provisional diagnosis of Mephentermine dependence with Mephentermine induces psychosis was kept with a differential of paranoid schizophrenia with mephentermine dependence. In the view of short admission (logistics), he was started with low dose of risperidone (1mg) and planned for monitoring of symptoms in subsequent follow up.

Conclusions : Mephentermine dependence has been described in literature only in the form of few case reports. Mephentermine induced psychosis too is a rare clinical entity. Early detection of the same can lead to early management of the patient.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

250. Title -A study of social cognition and craving in relapsed patient of alcohol use disorder

Zaryab Alam ^*, P K Dalal ^**, Sujita Kumar Kar ^***

Background: Alcohol use disorder is a major health problem globally and is responsible for high morbidity and mortality. Alcohol use disorder is a chronic, relapsing brain disease which is characterized by irresistible drug seeking in spite of adverse consequences. Craving is most important cause of relapse. Alcohol use disorder has been clearly associated with decline in social cognition including face and prosody perception problems, deficit in theory of mind and humor processing difficulties.

Aims: To study social cognition and craving in relapsed patient with alcohol use disorder.

Methodology: The study was a cross-sectional, non-interventional study conducted in the department of Psychiatry, King George’s Medical University, Lucknow. Patients were taken from de-addiction clinic and Adult Psychiatry OPD. A written informed consent was taken. Patients were assessed on semi-structured proforma, MINI 7.0, Relapse Precipitant Inventory, SOCRATIS and Obsessive Compulsive Drinking Scale. Data was analysed using computerized software.

Results: A total of 46 patients were enrolled in the study. Total score of Relapse Precipitant Inventory shows statistically significant positive correlation with - Obsessive scale (r = 0.402, p=0.006), compulsive scale (r =0.372, p = 0.011) and total score (r =0.396, p = 0.006). The “negative mood state” domain of Relapse Precipitant Inventory (RPI) has inverse correlation with second order theory of mind task and externalizing attributional bias task of SOCRATIS. All the domain scores of craving has statistically significant negative correlation with attributional bias task of SOCRATIS Scale.

Conclusion: Craving is a significant factor in relation to relapse The more is the craving higher is the chances of relapse. Negative mood state limits the attribution to external persons. Similarly, with lessened cognitive vigilance, the chances of more external attribution increases.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

251 A late presentation of Benzodiazepine withdrawal seizures : A rare case

HEMAVATHI H ¹

Benzodiazepines are used for various purposes like alcohol deaddiction, anxiolytic, and hypnotic or muscle relaxant. Over the counter use of benzodiazepine is also very common. But prolonged use of benzodiazepines leads to dependency. Sudden stoppage of benzodiazepine can lead to many withdrawal symptom, one of symptom being withdrawal seizure. Generally seizure occurs within the first week of the withdrawal period, maximum by the end of the 2 week of the last dose of the drug. Here we are presenting a case of alcohol dependent syndrome, who was treated as in patient care adequately detoxified with chlordiazepoxide and associated mood symptoms were treated and started on escitalopram and discharged from hospital to review next week. Patient visited hospital for 2 week on regular follow-up and then lost follow-up. Patient was off alcohol but continuously took chlordiazepoxide over the counter, despite it was stopped when he discharged from hospital. Patient developed dependence and tolerance. After 2 months of continuous use patient suddenly stopped drug. On 16th day of last drug intake patient developed GTCS type of seizure and total had 5 episode in span of 6 to 7 hour. Patient was off alcohol since 3 months, no other cause for seizure was found.CT scan brain was normal and EEG on second day after seizure and three months after the seizure was normal. Here we have discussed the duration of usage of benzodiazepine,appearance of seizure after the risk period crossed, other possible causes for seizure and careful management of such patient.

Conclusion Benzodiazepine dependence is common. Withdrawal seizure are commonly seen after prolonged duration of dependence and immediately after withdrawing the drug but clinician should be ready to face any atypical presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

252. Demonstrate feedforward cycle of anxiety and alcohol use.

Akshayee Kale ¹, Raghav Shah ¹, Abhishek Ghosh ¹

AIM : To demonstrate the feed forward cycle of anxiety and alcohol use in a person with maladaptive personality traits.

CASE SUMMARY : Patient is a 33 year old male with a history of alcohol use since past 10 years and a dependent pattern of use since 7 years. He has been managed in medically monitored inpatient setting 7 times in last 2 years. A maximum of 2 months abstinence was sustained following any of the discharge. In his recent admission at the deaddiction centre of our institute, we discovered generalized anxiety disorder in the background of an anankastic personality disorder.

Patient experienced relief in anxiety symptoms with first use of alcohol itself and regular use ensued soon. But as dependence on alcohol set in the ‘dark side of addiction’, withdrawal symptoms, with prominent anxiety, came in to picture. Independent anxiety symptoms and anxiety due to alcohol withdrawal reinforced each other and lead to a progressive increase in alcohol use. The severity of alcohol dependence spiraled and patient started using ‘eye opener’ drinks to calm the disabling withdrawal symptoms in the morning itself. Alcohol withdrawal seizures and autonomic instability with tremors have complicated the withdrawals since last 2 years which have necessitated multiple inpatient withdrawal management.

An integrated management plan including pharmacological and psychosocial interventions for both alcohol use and comorbid anxiety and personality 7 has been formulated.

Conclusion: Psychiatric comorbidity in patients of substance dependence need to be addressed thoroughly to prevent relapse.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

253. Schizo-obsessive disorder and use of ECT: A case report

Yesh Chandra Singh

Background – Schizo-obsessive disorder reported to have poorer prognosis and pose treatment challenges. There is dearth of literature on use of electroconvulsive therapy (ECT) in such cases.

Case Report – Mrs. D a 19 year old female, presented with history of marked irritability and suspiciousness since 4 years followed by repeated, intrusive thought of being contaminated since 3.5 years. She would waste lots of water in repeated washing and bathing spending 4 hours a day; she would recognize these thoughts as irrational and was unable to resist them.

Since 3 years she also developed excessive disgust and avoidance towards lizard. She had responded partially to the trial of oral Fluoxetine 60 mg, Fluvoxamine 150 mg and Olanzapine 5 mg/day given for 6 months by a psychiatrist. Patient discontinued the treatment as she was not satisfied by the response of medications.

Since 2 months patient developed excessive violence, aggressiveness, wondering, poor personal care, suspiciousness, and irrelevant talks and brought to our institute.

On mental state examination she was irritable with labile affect, there was loosening of association and derailment, had obsessions of contamination and compulsion of washing, delusion of reference and persecution.

She had been started on oral Olanzapine titrated up to 20 mg/day and the response assessed on PANSS and Y-BOC but only marginal response was noted after two weeks. In view of poor oral intake and excessive aggressive behavior modified electroconvulsive therapy (MECT) was administered. Patient responded robustly after the 3^rd MECT.

Conclusion : ECT is effective in the treatment of schizo-obsessive disorder Keywords – Schizo-obsessive disorder, Obsessive compulsive disorder, Electroconvulsive therapy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

254. Screening of substance use among treatment seekers at De addiction unit of Advance center for Ayurveda in mental health and neuroscience (ACAMH&NS), CCRAS NIMHANS, implication for evolving intervention and toxicology facility

Hemant Kumar Gupta

Background:

Substance use is contributing towards disease burden in India. Recent years have seen an increase in treatment seekers for substance use treatment in Ayurveda setting. The present study is going to explore the profile of substance use treatment seeker in De addiction unit of ACAMH&NS setting as well as professional perspective for their management.

Methods: Subjects (inpatient & outpatient) will be sequentially selected using desired number of positive subjects (100) by adopting inverse Binomial sampling as well as 30 professionals working at Ayurveda setting will be interviewed for their perspective for management as well as for screening substance use. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) will be administered for screening substance use.

Results :The finding will give insight about substance use, reason for using, professional perspective for its management.

Conclusions: It will have implication for evolving treatment strategy (pharmacological as well as non-pharmacological) and screening (toxicology) in De addiction unit of advance centre for Ayurveda in mental health and neuroscience, CCRAS NIMHANS,Banglore In some developed countries Naloxone Dispensing program is being practiced widely and they have been able to minimize the mortality associated with Opioid overdose. Also there is Good Samaritan law being implemented in these countries where even a layman can give Naloxone in case of witnessed Opioid overdose. Unfortunately in certain parts of world including India there is yet no hold of OEND even in tertiary health care centres As an addiction specialist certified by ISAM, in last four years I have been able to save 14 patients in emergency with Naloxone who were brought to me with Opioid overdose respiratory depression

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

255. Title - Clinical profile and psychosocial functioning in patients of non-injecting opioid use disorders

Richa Shukla ^*, PK Dalal ^**, Amit Arya ^***, Sujita Kumar Kar ^***

Background: Opioid use disorder is being identified as having a longstanding recurring course which seems akin to that of non-transmissible diseases such as asthma, diabetes and hypertension. So there is a need for long term treatment. Patients who have been treated with short term treatment measures like DETOXIFICATION (i.e. treatment of acute withdrawal symptoms) only demonstrate increased recurrence rates which can be accounted for, by different factors like difficulty in managing prolonged withdrawal states, persistence of a desire to take substance, persistently disturbed social and occupational functioning and familial dysfunction with detoxification. These determinants are best targeted with the use of a long term opioid agonist therapy. This is referred to as ‘AGONIST MAINTENANCE TREATMENT’. Commonly used agonist maintenance treatment: Buprenorphine & Methadone

Aims: 1) To study quality of life, socio-occupational functioning, client satisfaction in non-injecting opioid users on methadone maintenance therapy versus treatment as usual

2) To study the association of various socio-demographic and clinical variables with above mentioned outcome variables in non-injecting opioid users on methadone maintenance therapy versus treatment as usual.

Methodology: Patients attending de-addiction OPD, adult psychiatry OPD and drug treatment centre (DTC) of Department of Psychiatry, King George’s Medical University, Lucknow and having a diagnosis of opioid use disorder as per DSM-5, using non-injectable opioids and on Methadone Maintenance Therapy as well as treatment as usual will be taken up for study. A written informed consent will be taken from the patient. Baseline assessment of the patient will be done on COWS, M.I.N.I. 7.0.0, WHO ASSIST, SOFAS, CSQ-8, WHOQOL BREF. Socio-demographic variables and Clinical variables of the patient will be analysed with respect to the outcome variables (Quality of Life, Socio-occupational Functioning and Client Satisfaction) in both the group.

Research Gap: Methadone maintenance therapy has recently been introduced in India and is slowly expanding across the nation. However, it has not been systematically studied in India. 88 patients completed the study and the data for these was analysed. There are 8 articles available on PubMed (by 5^th Aug 2018) out of which five are review articles, one study is not relevant, one is feasibility study (India-Nepal) and one study is related to HIV seroconversion in i.v. drug users on MMT (China-India).

Benefits: During the procedure of study the patient would be assessed thoroughly and precisely. This study will facilitate more knowledge about the clinical profile and psychosocial functioning in patients of non-injecting opioid use disorder on methadone maintenance therapy versus treatment as usual. In the future, knowledge attained from this study will be advantageous for other patients, who will suffer from these problems.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

256. Title- Alcohol Problems in Patients Presenting in General Outpatient Clinic, BPKIHS

Shakya DR ^1,^✉, A Goswami ², A Prakash ², S Maskara ²

Background- Many people with problem drinking visit other departments of General hospital including General OPD for some physical complaints.

Objectives- We intended to see alcohol problems in patients presenting in General Outpatient Clinic of BPKIHS.

Methods- This is a hospital based study carried out among the patients presenting in General Outpatient Clinic of BPKIHS, based on convenient sampling. This included the responses of 103 subjects giving written informed consent. The ‘semi-structured proforma’ and the ‘CAGE’ questionnaire were used to collect their responses. The CAGE questionnaire consists of 4 questions and those with ³ 2 ‘yes’ responses were taken as with alcohol problem.

Results- Pains/ aches in various sites and of various natures were the most common presenting complaint of the patients in the General Outpatient Department of BPKIHS. Others common symptoms were Fever, Cough and Swelling. Forty seven out of 103 had had alcohol in their lifetime. Out of them 24 were male and 23 were female. Out of the people ever having alcohol, 30% scored ≥ 2 by the CAGE criteria which indicated the possibility of alcohol problems. Four fifth of the cases fulfilling the CAGE criteria were male here.

Conclusion- The clients visiting GOPD should regularly be screened for alcohol problem though their presenting complaints might not include alcohol directly.

Key words- Alcohol problem, GOPD, Presenting complaints, Nepal Mode of Presentation: Poster

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

257. Follow up study of effects of breathing technique and relaxation program on male patients of Alcohol Dependence Syndrome

Prateek Yadav

Background

Alcohol abuse is important public health problem. Course of Alcohol dependence syndrome(ADS) is known for its relapsing nature and additional measures with empirical evidence are worth administration. Breathing techniques are regularly recommended for relaxation and stress management, and have been shown to positively affect autonomic nervous system imbalances and psychological or stress-related disorder.

Aim

To assess the effect of 4 day course of breathing techniques and relaxation program, on relapse rates in patients of Alcohol Dependence Syndrome(ADS)

Method

Total of 80 in-patients diagnosed as ADS were included after obtaining informed consent,in this prospective follow-up study and were randomized into two groups alternately and as per consent. They were administered AUDIT both at admission and 6-months after discharge. Group-I(n=40) underwent 4-day course of breathing-relaxation training apart from the standard therapy. ‘WHO(five)Well Being Index’ was administered to them before and after the course. The patients in Group-II underwent only the standard therapy for ADS. A follow-up of each patient on monthly basis and finally at 6-month interval was done to assess in terms of alcohol consumption status.

Results

Both the groups were comparable. Statistically significant Increase was noted in the ‘WHO(five)Well Being Index’ in Group-I (p<0.001). There was significant decrease in AUDIT scores after 6 months in both groups [(Group-I 18.35 ± 3.19 at admission, 11.20 ± 2.81 after 6 months; p< 0.001), (Group-II 19.25 ± 3.61 at admission, 15.30 ± 4.05 after 6 months; p<0.001)]. AUDIT scores were significantly lower in Group-I(11.20 ± 2.81) than the other(15.30 ± 4.05) after 6 months(p< 0.001). Group-I also reported fewer days of drinking (p=0.004) and reduced overall drinking in the intervening period(p<0.001) as compared to the Group-II.

Conclusion

The addition of breathing-relaxation training in management of ADS gives additional therapeutic benefits in the form of fewer days of drinking and reduced overall drinking.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

258. To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events

VINAY SINGH CHAUHAN, Shubra Nautiyal, Rajat Garg

Background and Objectives: Relapse is a complex and dynamic phenomenon that appears to be determined by biological, psychological, and social factors and an interaction among these. This study examined the association between demographic variables, clinical parameters, and psychosocial factors that predict the vulnerability to relapse in cases of alcohol dependence syndrome.

Materials and Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, life events, and dysfunction were carried out among patients with alcohol dependence syndrome (n = 100) who had relapsed and compared with those (n = 100) who had managed to remain abstinent.

Results: Patients who had relapsed were found to have significantly more positive family history of substance use, past history of alcohol related comorbidity, experienced a higher number of undesirable life events, and higher negative mood states and social anxiety and dysfunction in social, vocational, personal, family, and cognitive spheres compared to patients who had remained abstinent.

Conclusions: Relapse in alcohol dependents is an interaction of many factors, and multiple layers of assessment may be required to predict relapse. This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It provides the basis for investigating the correlates of relapse in a wide range of behavioral and substance use problems.

Keywords: Alcohol dependence syndrome, life events, relapse

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

259.A rare case of marchiafava bignami syndrome with complete recovery

madhusudhan s

Background:

Marchiafava-bignami disease is a rare complication of alcoholism, characterised by corpus callosum demyelination and necrosis. It is difficult to diagnose, which may be confirmed by MRI findings only.

Case description:

50 years married male, from low socioeconomic status, driver by occupation, rural background had history of alcohol use in dependence paern since >25 years. There was recent change in pattern by frequent usage of local arrack. He presented with sudden onset confusion, difficulty in recognising person/place, lowerlimb weakness. On examination also had right left disorientation, impaired comprehension.routine investigations were normal. MRI brain showed T2 hyperintensities -acute odematous changes and sandwich sign in posterior corpus callosum. Patient was treated for 2 months with detoxification, symptomatic treatment and vitamin supplementation. After 8 weeks repeat MRI revealed absence of oedematous changes in posterior corpus callosum. Clinically patient improved with orientation, right left coordination, walking without support.

Conclusion :

early recognition and management of marchiafava bignami can reverse changes anf prevent disability.

Chairpersons :

Surg Commodore Kaushik Chatterjee, Consultant Psychiatry INHS Asvini, Mumb

Dr (Mrs) Kalpana Srivastava, Scientist G, Clinical PSychologist, AFMC, Pune

Speaker 1 : Col Harpreet Singh, Senior Adviser (Psychiatry) CH SC

Topic : Military Psychiatry and Law : Journey down the ages

Speaker 2 : Col V S Chauhan, Associate Prof (Psychiatry) AFMC

Topic : Involuntary Hospitalization under MHA 2017 : Implications for Armed Forces

Speaker 3 : Lt Col Prateek Yadav, Classified Specialist (Psychiatry) 151 BH C/0 99 APO : Topic : Ethics in Military Psychiatry : On whose side should be the military psychiatrists ?

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

260 Hallucinatory Experiences of Schizophrenia Patients with Persistent Auditory Hallucinations

Nishtha Chawla ¹

Aim: To assess the hallucinatory experiences and beliefs regarding ‘voices’ in patients of chronic schizophrenia with auditory hallucinations and explore their relationship with severity of overall psychosis.

Methodology: We studied thirty adult patients of DSM 5 diagnosed schizophrenia (≥2 years duration) with significant lifetime as well as current auditory hallucinations (operationally defined as ≥50% of the days in current month). MINI 7.0.0 was used for excluding those with other major psychiatric comorbidities. The sample was assessed for severity of hallucinations [Psychotic Symptom Rating Scale (PSYRATS)], beliefs regarding the hallucinatory voices [Beliefs About Voices Questionnaire-Revised (BAVQ-R)] and severity of psychosis [Scale for Assessment of Positive Symptoms(SAPS), Scale for Assessment of Negative Symptoms (SANS) and Clinical Global Impression for schizophrenia (CGI-SCH)].

Results: Mean age was 32.9+9.3 years. Mean age of onset and duration of illness was 23.2+8.3 and 9.6+7.3 years respectively. On BAVQ-R, relatively higher scores were obtained for malevolence(11.1+4.7), omnipotence(12.7+3.3), emotional resistance(7.2 + 3.2), and behavioral resistance(9.0 + 4.3), when compared to benevolence(2.4 + 3.5), emotional engagement(1.9 + 3.2), and behavioral engagement(1.8 + 2.5). The hallucinations severity score (PSYRATS-H) correlated significantly with omnipotence and resistance (both emotional and behavioral) subscales of BAVQ-R. The severity of the overall psychosis did not correlate with BAVQ-R.

Conclusion: This sample of chronic schizophrenia patients believed the ‘voices’ to be more malicious than loving, and resisted them, engaging only minimally. The beliefs correlated with severity of hallucinations. The clinicians must pay attention to the patient’s personal experiences regarding hallucinations which may help to guide the interventions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

261.BED OCCUPANCY BY SUBSTANCE USE DISORDER PATIENTS IN A TERTIARY CARE HOSPITAL

Shyamanta Das ¹, Arundhati Bhagabati ²

Introduction : Bed occupancy by substance abusers in the psychiatric unit of a general medical hospital is significantly rising by the day. But owing to presence of limited number of beds there remains lapses in the treatment of patients diagnosed with other psychiatric illnesses. It would thus be helpful if we can assess the percentage of beds occupied by substance abusers in a year so that a proper plan could be formulated for the better management of the substance use disorder patients as well as the patients with other psychiatric disorders.

Aim : To estimate the total number of substance use disorder patients admitted in a year, to evaluate which type of substance use predominates among the admitted patients and to estimate the duration of hospital stay of such patients.

Methods : Sample collection was done from the indoor register of the department of psychiatry for a period of one year from June 2017 to May 2018. The study design was a retrospective study.

Results : the total number of patients admitted was 345, of which the majority(33%) were in the age group of 31-40 years. 77.7% of the patients were alcohol abusers, followed by opioid abusers. 16.5% of the patients also had a psychiatric comorbidity.

Conclusion : bed use by substance use disorder patients is very high and alcohol dependence is a leading cause of hospital admission.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

262.TITLE: Cannabis Withdrawal: A New Entity in DSM-5!

Angshuman Kalita ¹, Anil Kumar ²

Abstract: A withdrawal state in cannabis dependence was not recognized till very late. DSM-5 has recently included ‘Cannabis withdrawal’ associated with heavy and prolonged use of cannabis, characterised by certain physical and psychological symptoms. This paper discusses about the symptoms of a 20 year old male in context with a new clinical diagnostic entity in DSM-5 i.e. ‘Cannabis withdrawal’.

Key word: Cannabis dependence, Cannabis withdrawal, DSM-5

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

263. Title: Prevalence of Tobacco use in urban female students attending women college

Abhinav Tewari ^*, Sonali Jhanjee ^*, Anju Dhawan ^*, Rachana Bhargava ^*, Neelam Kalia ^**

Background/Introduction: Early age of tobacco initiation due to experimentation is associated with increased complications. Studies indicate that the consumption of tobacco in college population is growing. The national data shows increasing prevalence rates of tobacco use in women above 15 years age. This study aims to add to the sparse evidence on prevalence on tobacco use in college going female students.

Methodology/Materials and Methods: This cross-sectional study was carried out among female undergraduate students of an urban women college using stratified cluster random sampling. Sample size was calculated based on current prevalence of tobacco use among females of age group 16-24 years based on nationally representative GATS data. WHO student drug use questionnaire was used to survey for tobacco use. Descriptive statistics was done to calculate prevalence of tobacco use.

Results: A total of 586 students across 1^st, 2^nd and 3^rd years of undergraduate courses participated in the study. Ever use, Past 12-month use and last 30-days use of tobacco was reported by 23.5%, 18.9% and 8.7% of participants respectively. Use among 3^rd year students were highest across all patterns of use.

Conclusion: Our study reported higher prevalence of tobacco use compared to the nationally representative data for 15-24 years’ age groups, indicating that tobacco use among females is on the rise. Higher use among 3^rd year students indicate that further efforts are needed to understand the factors leading to initiation and continuation of tobacco use among college going female students.

Keywords: Tobacco, college students, female

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

264. Opioid use disorder in a 5 year old child: a case report from western Rajasthan

PRIYANKA SHARMA

Background : Doda or Poppy Straw, is the husk left after the opium is extracted from the pods. Regular use of Doda (opium husk) addicts the user. Opium husk is being used as a part of tradition in wedding, after death, as home remedy for treatment of diarrhea, cough, fever, teething babies and as a general tonic for well-being by parents inadvertently in rural Rajasthan. This can lead to drug intoxication, overdose and addiction unintentionally. We present a case of a 5 year old child who presented with Doda withdrawal given for general well-being.

Case presentation : Mr. X, a 5 year old child, presented to us with complaints of decreased sleep, decreased appetite, weight loss, abdominal cramping, muscle aches and running nose. There is no any history of fever, vomiting and abnormal jerky movements. He had history of consumption of Doda since last 3.5years. Initially at the age of 1.5 years his parents started giving him 1µg of Doda per day to increase his appetite and sleep both and continued it regularly thereafter. Earlier also, he used to develop similar complaints after missing dose even for a day. The last intake was 2 days before he presented to us. He had a positive family history of opioid use in his grandfather. He was successfully treated with pharmacological and non-pharmacological methods and recovered completely.

Conclusion : Opioid use disorders are rarely reported in a 5 year old child. During this age, child acquires academic, cognitive, social and life skills. Any substance abuse at this stage interferes with the normal child development and has a lasting impact on future life also. There is an immense need for awareness, education, Prevention programs, specialized clinics and rehabilitation for such children.

Keywords : Doda, child, opioid use disorder, withdrawal, Rajasthan

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

265.SUBSTANCE USE AND ROAD TRAFFIC ACCIDENTS: A REVIEW OF CRITICAL ASPECTS

AISHWARIYA BRIGIT GEORGE ¹, BISWADIP CHATTERJEE ¹

Introduction: The role of substance use in the morbidity and mortality resulting from accidents is an undeniable aspect of the burden due to substance use disorders. There are several facets to this relation such as the attributable mortality and morbidity, the reliability of commonly used estimates, the effect of changing trends of use, the population groups at high risk and associated reasons and evaluating and formulating road safety measures and policies for mitigating adverse consequences. This review attempts to address these questions.

Methods and Results: A literature search was conducted to identify relevant studies using the search terms of “substance use” and “road traffic accidents/injuries/road safety”. The relevance of this topic was highlighted by the finding that in 2016 alcohol alone accounted for 7% of deaths and DALYs globally, with road-injuries being the second most common cause of death. Trends of substances being associated with accidents are expected to change with the changing status of cannabis world-wide. There is objective evidence of different classes of both licit and illicit substances affecting driving skills. Studies have also examined the severity of accidents with respect to type and number of substances used. People identified as being at risk of high risk driving and sections that escape scrutiny such as professional drivers and long distance truckers, especially in the Indian context, need to be identified for effective prevention. Another aspect is rearrests for driving under influence, which is associated with being younger, male and having higher BAC at first arrest and amphetamine use. Culpability, responsibility and regulations in the scenario of prescription drug use needs consideration. The effectiveness of policies and programs in the light of this research needs further study.

Conclusion: Several critical stages of the link between substance use and accidents provide an avenue for intervention by health professionals, especially psychiatrists and addiction specialists, hence an in-depth understanding of these is essential.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

266. A lady with injectable opioid dependence and anasarca / oliguria

Harshit Hemant Salian ¹

presented with 4 year history of injectable pentazocine use (iatrogenic initiation for pain) along with promethazine use, also noted to be HCV positive, continued to use during pregnancy, currently for past 6 months noted to have swelling of entire body, reduced urine output, injection site necrosis further evaluation revealed low cortisol, exertional breathlessness

Physical exam - anasarca, injection site gangrene and extensive ulcers on lower limbs and upper limbs

MSE - conscious, oriented, craving, depressed affect, depressive cognitions

Further investigations and management will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

267. BIRTH OUTCOMES FOLLOWING ANTENATAL ANXIETY AND DEPRESSION

sarmistha priyadarshani ¹

INTRODUCTION: Anxiety and depression during pregnancy have been reported to cause negative pregnancy outcomes such as preterm delivery and low birth weight of infants. Present study was conducted to examine the relationship between anxiety, depression and pregnancy outcomes(gestational age, infant birth weight and apgar scores.).

AIMS AND OBJECTIVES: It was hypothesized that (i)anxiety and depression would be negatively related to gestational age and (ii)anxiety and depression would be negatively related to birth weight (iii) anxiety and depression would be negatively related to apgar scores of 1 and 5 mins.

METHODOLOGY: The study was conducted on a sample of one hundred pregnant women (aged 20 to 30 yrs) in III trimester of their pregnancy who were recruited in department of obstretics and gynecology of MKCG. Medical college. The assessment of gestational age was based on last menstrual date. Depression and anxiety were assessed using self administered questionnaire i.e. Radloffs epidemiological studies scale (CES-D) and state, trait and free floating anxiety inventory by Rastogi and tripathi respectively. Along with these questionnaires the personal data bank was also used for obtaining the information regarding delivery and health status of baby from the hospital record. The data was analysed with correlation and hierarchial regression.

RESULTS AND CONCLUSIONS: The results indicated that women experiencing high level of anxiety and depression were more likely to deliver an infant with less gestational age and low birth weight.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

268.POSTPARTUM DEPRESSION - ITS PREVALENCE AND CORRELATION WITH FAMILY DYNAMICS, AT A TERTIARY CARE HOSPITAL

MEGHAMALAS TAVARAGI

Affective disorders occur commonly in postpartum period, ranging in severity from mild and transient ‘‘baby blues to postpartum depression(PPD) to postpartum psychosis. Women afflicted with PPD are at high risk for recurrent depression. Despite its serious consequences and amenity to treatment, PPD often remains unrecognized and end up with severe psychiatric disorders.

OBJECTIVES:

To study the prevalence of Postpartum Depression among the patients who had delivered at KIMS, HUBLI.
To find the association between Postpartum Depression and selected family dynamic variables.

METHODS AND METHODOLOGY:

250 Women between 18 to 35 years, who delivered at KIMS Hospital, Hubli from January 1^st 2017 to June 31^st 2017, willing to participate in the study were taken as sample

v Postpartum depression was assessed by using Edinburgh Postnatal Depression Scale(EPDS).

v Severity of depression assessed by using Hamilton Depression Rating Scale (HAM-D)

v EPDS AND HAM-D scales were applied on 3^rd day of delivery and again on 6^th week postpartum period.

RESULT

Among 250 women 10.8% (27) women had postpartum depression. Among 27 PPD women 5 had mild depression, 13 moderate depression, 7 severe depression and 2 had very severe depression. Among 27 PPD women, 15 had delivered female babies, 5 male babies. There is significant association between PPD and family dynamics which includes, husbands alcohol use(p-0.002*), relation difficulties with in-laws(p<0.001*) and family support(p<0.001*) and psychiatric illness in family(p<0.001*).

CONCLUSION:

Postpartum depression is important health problem having significant impact on mother, mother-infant interaction and on the long term emotional and cognitive development of the baby. Hence early screening and follow up of the women along with proper maintence of family dynamics, by giving good family support may reduce the adverse outcomes among both mother and child.

KEY WORDS: POSTPARTUM, DEPRESSION, EPDS, HAM-D, FAMILY.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

269.PSYCHOLOGICAL EFFECTS ON LIFE OF SPOUSES – OF ALCOHOL DEPENDENCE SYNDROME PATIENTS

RAGHAVENDRA PATIL, MEGHAMALAS TAVARAGI

INTRODUCTION:

Alcohol dependence not only effects the patient himself but also has maximum impact on spouses health and general well being, leading to varying severity of depression. It also exerts negative impact on marital life and thus impacts on marital satisfaction of spouses of alcohol dependent patients. Spouses play an important role in treatment of Alcohol dependence patients.

METHODS AND METHODOLOGY:

50 Spouses of alcohol dependence syndrome patients admitted in psychiatry department, DIMHANS, Dharwad were assessed for depression and its severity using HAM-D, and marital satisfaction using Marital Satisfaction Scale and general well being assessed by General Well Being Scale.

OBJECTIVES :

To evaluate severity of depression using HAM-D Scale in spouses of male alcohol dependent patients admitted in DIMHANS, Dharwad.
To assess quality of marital life in spouses of male alcohol dependent patients using Marital Satisfaction scale
To assess general well being in spouses of male alcohol dependent patients using General Well Being scale

RESULTS: In 50 Spouses of male alcohol dependent patients, around 46%(23) had depression on HAM-D scale and 80%(40) of the spouses showed below low positive level of well being on general well being scale and around 74%(37) showed poor satisfaction level on marital satisfaction scale.

CONCLUSION: Spouses of alcohol dependent patients are found to be suffering from various degrees of depression, ranging from mild to very severe on HAM-D scale. Spouses have poor marital satisfaction and hence general well being is affected too. Hence there is a need to study about spouses who are the main caretakers of alcohol dependent patients and helps in treatment of ADS husbands as well as maintence of family health.

KEYWORDS: SPOUSES, DEPRESSION, MARITAL SATISFACTION, ADS.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

270 TITLE :- A CASE REPORT OF LORAZEAPM INDUCED DELLIRIUM

Nidhi Jain ^1,², Madhukar Shukla ³

BACKGROUND :- Delirium is defined as an acute decline in the level of awareness and cognition with particular impairment in attention. This condition is more prevalent in elderly population and those requiring intensive care.

A 56 year old male presented to us in acute agitation with delusion of grandiosity, auditory hallucination with chronic alcohol use since 35 years. He was managed on antipsychotics (Haloperidol) and mood stabilisers(Sodium Valproate). He was given lorazepam in oral or injectable form for sedation and control of agitation. It was a observed that after lorazepam administration he showed symptoms like confusion, disorientation and searching behaviour which was fluctuating in nature and these complaints subsided after stoppage of lorazepam indicating that this is a case of lorazepam induced Delirium.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

271 TITLE :- AN EXPLORATORY STUDY OF PSYCHIATRIC REFERRALS IN PATIENTS REQUIRING INTENSIVE CARE IN A TERTIARY CARE HOSPITAL.

Madhukar Shukla ¹, Nidhi Jain ²

BACKGROUND :- Liaison Psychiatry specialises in the interface between general medicine and psychiatry in a medical setup. Data from previous studies indicates that 30% of patients at any given number of time in a hospital have psychiatric disturbance. It has been observed from the previous studies that the referral rate is very low as considered to the higher prevalence of psychiatric comorbidities. The possible reason behind the lower rate of referrals could be lack of awareness and stigma associated with mental illness among physicians/surgeons. This study is an initiative to assess the referral status in our hospital to incorporate liaisoning for holistic care of the patient.

KEYWORDS:- Liaison Psychiatry, ICU, Referral, Psychiatric comorbidities.

AIM :- 1. To assess the number and various reasons for referral and evaluation of psychiatric co- morbidities among them 2. To evaluate the presence of psychiatric comorbidities in ICU patients and there comparison with the patients referred METHOD :- A cross sectional study in a tertiary care hospital conducted over two months including patients from various specialty ICU’s along with the other patients admitted in the ICU to find the actual rate of psychiatric comorbidities which require liaisoning. The diagnosis would be made according to DSM V guidelines and data obtained will undergo descriptive statistical analysis.

CONCLUSION: - The study has shown a very low referral rate among various specialties. Out of all the specialities maximum referral has been made from medical ICU. The various reasons for which the referral has been made were behaviour disturbance, mood changes, substance use etc. On evaluating the admitted patients in various ICU’s the presence of psychiatric comorbidities was much higher as compared to the referrals made.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

272.RESILIENCE IN WIVES OF PERSONS WITH ALCOHOL DEPENDENCE & THEIR MARITAL QUALITY – A CROSS SECTIONAL STUDY

Arushma M K ¹, Derrick Johnson ¹, Sheena Varughese ¹, Roy Abraham Kallivayalil ¹

BACKGROUND: Alcoholism is a major health problem. It not only affects consumers but also their family members especially wife. The wives are known to have significant problems especially marital satisfaction. Their resilience helps them with good outcome despite risk experiences. However there are limited studies looking into resilience and marital satisfaction.

AIMS & OBJECTIVES: To assess resilience in the wives of persons with alcohol dependence and to find its association with marital quality.

STUDY PERIOD: Three months (July 1^st to September 30^th 2018)

STUDY SETTING: Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Thiruvalla

STUDY DESIGN: A cross sectional study

STUDY POPULATION: Those attending inpatient, outpatient and consultation liaison psychiatry clinic, satisfying inclusion criteria and provided informed consent for the study.

SAMPLE SIZE: 50

SAMPLING PROCEDURE: Consecutive sampling

TOOLS FOR ASSESSMENT: Structured Questionnaire, Modified Kuppuswamy Socioeconomic scale 2018, MINI 7.0.2, Severity of Alcohol Dependence Questionnaire, Connor Davidson Resilience Scale 25, The Marital Quality Scale (Female).

ANALYSIS & RESULTS: Data entered in MS Excel and analysed using SPSS 21.0. The resilience of wives among alcoholic patients deferred significantly. There is a difference between the average scores of high and low resilience women. But there is no statistically significant association between resilience and their marital quality.

CONCLUSION: Factors associated with resilience need to be addressed during treatment to improve the outcome. The reasons for marital quality are modifiable factors which affects treatment outcome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

273 Mental Contamination, Feelings of Disgust and Thought-Action Fusion in Persons with Contamination OCD

S Kumar, S Mohanty, Anil Sisodia, R Kumar

Background : In mental contamination, the persons with contamination OCD, report feelings and thoughts of contamination without any physical contact with perceived contaminated objects. Mental contamination can be equally distressing to these patients as physical contamination.

Aim : In the present study we explored the relationship of mental contamination, feelings of disgust and thought-action fusion in persons with contamination OCD.

Method : 30 patients with contamination OCD were selected from OPD of Institute of Mental Health and Hospital, Agra. Following tools were administered on each participant: (i) VOCI Mental Contamination Scale (Rachman et al. 2015), (ii) Contamination Thought-Action Fusion [TAF Scale (Rachman, 2006), and (iii) Disgust Scale-Revised (Haidt, McCauley & Rozin, 1994).

Results : The results will be presented.

Key Words: Contamination OCD, Disgust in OCD, Thought-Action Fusion

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

274 Trait Impulsivity and Risk-Taking Behaviour in Bipolar Disorder and Epilepsy

Objectives

Current study evaluates and compares parameters of impulsivity and risk-taking behaviour among euthymic subjects with bipolar disorder, epilepsy and controls and to identify predictors of association between impulsivity, violence and risk-taking behaviour among bipolar remitted and epileptic patients.

Method

Cross-sectional study was done at two tertiary care centres of North India. It included three groups of bipolar disorder (n=32), epilepsy (n=30) and healthy controls (n=32). Subjects were assessed for socio-demographic-clinical information, impulsivity and risk-taking behaviour on semi-structured performa, Barratt Impulsivity Scale (BIS-11) and Balloon Analogue Risk Task (BART).

Results

Bipolar group subjects had higher mean score of adjusted average pump count (aAPC) than epilepsy and controls (p=0.01 and p=0.02 respectively). Epilepsy group had lower scores than controls for aAPC but only for last 10 balloons (p=0.01) and had higher total score of BIS-11 (p=0.04). History of violence was positively correlated to cognitive complexity subscale of BIS-11 (r=0.38; p<0.05). A positive correlation between history of self-harm and impulsivity was observed.

Conclusion

Compared to other two groups, bipolar subjects scored more on behavioural risk-taking task while epilepsy subjects had higher scores on behavioural measures of impulsivity. Trait impulsivity was significantly higher in both bipolar and epilepsy subjects than controls.

Keywords: Impulsivity, risk, bipolar, epilepsy, violence

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

275 Title AN INTERESTING CASE OF PSEUDOCYESIS AS PRESENTING MANIFESTATION OF PATIENT WITH SCHIZOPHRENIA

Ayushi Devendra Singh ¹, G Gopalakrishnan ¹, Veda N Shetageri ¹

ABSTRACT

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

276 Emotion Regulation in Schizophrenics having Experience of Severe Childhood Trauma

S Kumar, Anil Sisodia, S Mohanty

Severe Childhood trauma has been linked to the development of schizophrenia in later life. The nature of trauma is found to be associated with specific psychopathology. In addition to this, the persons with schizophrenia also have abnormalities in regulation of emotions. In the present study, our aim is to explore the magnitude of negative affects in persons with schizophrenia who experienced childhood trauma and to compare regulation of positive and negative affects in these patients with the patients who did not have experience of severe trauma in childhood. Method: At least 40 patients with schizophrenia in following two groups will be sampled from in-patients at Institute of Mental Health and Hospital, Agra. (i) schizophrenics without severe childhood trauma [n=20] (ii) schizophrenics with experience of severe childhood trauma [n=20]. Following tools will be administered (a) Emotion Regulation Questionnaire (ERQ) (b) Positive and Negative Affect Scale (c) Childhood Trauma Questionnaire-Short Form. The results will be presented.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

277 TITLE: Cannabis use as a predictor of earlier age at onset of Bipolar Affective Disorder

Manisha Sharma ¹, Supriya Hegde ²

CANNABIS USE AS A PREDICTOR OF EARLIER AGE AT ONSET OF BIPOLAR AFFECTIVE DISORDER

ABSTRACT

Background: Age at onset (AAO) in affective disorders is of significant prognostic value. Substances like alcohol, cannabis may affect the onset, course and outcome of Bipolar Affective Disorder (BPAD). Cannabis, already has an established role as a risk factor for psychosis, specifically Schizophrenia. However, there is scarcity of research all over the world to assess its association with onset of BPAD, and none has been performed in India yet, which calls for the need of study in this regard.

Aim: To compare the AAO of BPAD among subjects with prior history of cannabis use and those without cannabis use.

Methodology: 80 patients presenting to the Psychiatry in- and outpatient department were administered a proforma with details pertaining to socio-demographic data, family and past history of psychiatric disorders, AAO of cannabis use and first episode of mood disorder, frequency of cannabis use. Written informed consents were taken.

Results: Will be discussed.

Keywords: Age at Onset (AAO), Cannabis use, Bipolar Affective Disorder (BPAD)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

278 ANCIPS 2019 - FREE PAPER PRESENTATION: CATREGORY - CONSULTATION LIAISON PSYCHIATRY

SWATI SINGH ¹

TITLE - CAN CORTICOSTEROIDS UNLOCK HIDDEN POTENTIAL FOR PSYCHOSIS OR ARE STEROID INDUCED PSYCHIATRIC SYMPTOMS A TEMPORARY REACTION?

There is a huge body of evidence that shows a wide variety of hormones that can influence, both mood and behaviour. A 49 year old widowed female is a Telegu-Hindu from South India. She was brought to the Psychiatry OPD by her eldest son with complaints of Altered behaviour, Decreased sleep, Unable to do her work as before, Muttering to self and Unprovoked anger outbursts for the past 3 months. This was her first psychiatric consultation. There is a past history of seizures for which she was treated. She is a known case of hypothyroidism on T. Eltroxin 100 mcg. There is a strong history suggestive of Addison’s disease for which she was on high dose steroids for at least 1 year. Psychiatric symptoms can precede or present concurrently with the more typical physical symptoms of endocrine disease. These secondary disorders can be difficult to distinguish from primary psychiatric disorders. When psychiatric symptoms are secondary to the endocrine disease, as in this case, the primary treatment focus remains correcting the endocrine disorder. This paper is done to emphasise the importance of the role of the Hypothalamic-pitutary-adrenal axis and various organ systems with psychiatry.

Keywords : endocrinology, HPA Axis, steroid-induced psychosis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

279 “EFFECT OF ADJUNCTIVE SODIUM VALPROATE IN PATIENTS OF ACUTE SCHIZOPHRENIA”

GAURAV AGGARWAL ¹, ASHWANI SAINI, P K PARDAL

Background: Sodium valproate is wildly used as a mood stabilizer and as an adjunctive agent in treatment of depression and psychosis. There are controversies regarding sodium valproate efficacy in schizophrenia. Although some studies have reported that it is effective in the management of positive symptoms in acute schizophrenia, others have not found such an association.

Aims: To assess the effect of adjunctive sodium valproate in acute stage of schizophrenia.

Methods: A total of 60 schizophrenic patients (age 18-45) were taken. They were randomly allocated into two groups, A & B. Patients in group A received atypical antipsychotic with placebo and in group B atypical antipsychotic with adjunctive sodium valproate. Olanzapine was taken as atypical antipsychotic in both groups.

A diagnosis of schizophrenia was established based on ICD-10 DCR criteria. All patients were assessed by PANSS and CGI-S on day 1^st and 42^nd. The collected data were analyzed by Student Paired t-test through SPSS.

Results: Comparison of mean PANSS and CGI-S scores showed statistically significant improvement in group B patients as compared to group A after 6 weeks.

Conclusion: Our study shows that if used as an adjunctive to antipsychotic in the management of acute schizophrenia, sodium valproate will speed up the recovery of positive symptoms.

Key words: Schizophrenia, olanzapine, sodium valproate

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

280 Title: A STUDY OF ASSOCIATION OF DEPRESSION AND ANXIETY DISORDERS WITH QUALITY OF LIFE, SOCIAL SUPPORT AND STRESS IN GERIATRIC PEOPLE LIVING IN OLD AGE HOME”

Kinjal Chauhan ¹, Aayushi Shah, Bharat Panchal, Ashok Vala, Sneha Vadher, Imran Ratnani, Hiren Mor

· Introduction: Poor support and higher stress increase the risk of depression and anxiety disorders and affects the quality of life in geriatric people living in old age home.

· Objective : We assessed the frequency of depression and anxiety disorders, association of depression and anxiety disorders with quality of life, support and stress and correlation of severity of depression and anxiety disorders with support and stress in geriatric people living in old age home.

· Method : This is an observational, cross sectional, interview based study of 196 participants living in Old age home, Bhavnagar. Every participant was assessed by proforma containing demographic details, questionnaires of MMSE(Mini mental Status Examination),GDS(Geriatric Depression Scale), GAS(Geriatric Anxiety Scale),WHOQOL BREF(World Health Organization Quality Of Life)and DUSOCS(Duke Social Support and Stress Scale)to assess Cognitive status, Depression and Anxiety disorders, Quality of Life and Social Support and Stress respectively. Statistical analysis was done with graph pad in stat version 3.06 using Chi–square test, Mann-Whitney test and Spearman Correlation.

Results: We found frequency of depression is 33.16% and frequency of anxiety disorders is 18.88% among participants. Participants with depression found to have poor QOL in all domains (p value for physical, psychological, social and environmental domain <0.0001), poor social support (0.04) and higher social stress (0.0001). Participants with anxiety disorders found to have poor QOL in all domains (p value for physical, psychological, social and environmental domain were 0.0002, <0.001, <0.0001 and <0.0001 respectively) and higher social stress (0.005).

Conclusion: Participants with depression and anxiety disorders found to have poor quality of life, poor social support and higher social stress.

Keywords : Depression, Anxiety Disorders, Quality Of Life, Social Support and Stress.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

281 Title – An Observational-Cross sectional study to determine the prevalence of Anxiety and Depression among the caregivers of the patients suffering from Schizophrenia.

Gureesha Singh ¹, Sandeep Choudhary ¹, Supriya Agarwal ¹

Background :-

Care for chronically ill patients may lead to stress and subsequently mental health problems. In India, more than 90% patients of mental health problems live with their families. Family caregivers play multiple roles like helping in daily routines, checking medications, hospital visits and their financial requirements. These caregivers have to deal with emotional and behavioral disturbances in patients.

Aims and Objectives :-

Our aim to the present study was to determine the prevalence of Anxiety and Depression among the caregivers of the patients (age 18-65 years) suffering from Schizophrenia.

It is an Observational-Cross sectional study with continuous sampling.

Materials and Methods:-

Our methodology consisted of diagnosing patients with Schizophrenia in accordance with ICD 10 attending the outpatient facility of the tertiary care hospital in Meerut. The caregivers were also screened for the symptoms of anxiety and depression through Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D).

Results:-

Majority of the caregivers of the patients suffering from Schizophrenia were found to be suffering from depressive and anxiety symptoms. Around 23.3% caregivers of Schizophrenia were found to have Depressive symptoms. Around 43.3% caregivers of were found to have Anxiety symptoms.

Conclusion:-

Mental health problems have been found to affect caregivers in complex ways. Severity of symptoms as well as disability of patients have been found to affect the caregivers. These factors have been identified as predictors for consequences of caregivers.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

282 Title: Pattern of Cases Under Juvenile Justice Act attending a Tertiary-Care Facility of Haryana- A Retrospective Cross- Sectional Study.

Vivek Srivastava ^1,^✉, Sakshi Bhardwaj ², Purushottam ³, Priti Singh ⁴, Rajiv Gupta ⁵

Introduction - The Juvenile Justice Act, 2000 seeks to achieve the objectives of the United Nations Convention on the Rights of Children as contracted by India in 1992 convention. The Nirbahya Case of 2015 had lead to the demand for more pungent action against juveniles convicted in heinous crimes, who were till that time let off after a comparatively lighter sentence. Purposefully, the act in its Amendment of 2015, is provided with stringent provisions pertaining to heinous offences committed by children above the age of sixteen years. As such one of the most important functions required by the Juvenile Justice Act from a tertiary care center, is under section 15 of chapter IV i.e., to conduct a preliminary assessment of children in the 16-18 years age group, who are under trial for committing heinous offences. It indicates the mental status of the juvenile and establishes his/her fitness to be tried, convicted and punished as an adult in the court of law.

Aim - To study the pattern of referral of juvenile cases under Juvenile Justice Act, 2015 for mental status assessment, attending a tertiary care center of Haryana.

Materials and Methods - The study is a retrospective cross-sectional study conducted at Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak. It included all the juvenile cases referred to the study facility for mental status assessment by the Judiciary during a period of one year (August, 2017 to July, 2018). The court order for referral and the final report submitted by the Medical Board in each case was reviewed and data was collected.

Result - it reflects that majority of children of this age group don not suffer from any active psychopathology and were well in contact with the reality and aware of the crime committed and its consequences. However, a proportion of juveniles did show compromised intellectual functioning in the assessment.

Conclusion - The results of the study indicates that since most of the juveniles of age group of 16-18 years, under trial of heinous crimes do not have any active psychopathology, should be treated as an adult during the trial and the age criteria should not be let to deter the conviction to a lighter sentence.

Key Words- juvenile, heinous crimes, medical board.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

283 Title: “A Study of Association of Anxiety, Depression and Quality of life with Burden of Care in Caregivers of patients having Schizophrenia and Alcohol Use Disorder”

Jinesh Shamjibhai Parmar ¹, SNEHA VADHER, Bharat Panchal, Ashok Vala

Background : Caregivers play a major role in providing care to mentally ill persons. Increase in caregiver’s burden increases negative health and psychological outcomes experienced by caregivers. We assessed association of anxiety, depression and severity of caregiver’s burden and quality of life among caregivers of Schizophrenia and Alcohol Use Disorder(AUD).

Methods: This was an observational, cross sectional, single-centered, interview based study of 50 consecutive caregivers of patients having Schizophrenia and AUD each, were recruited from the Psychiatry outpatient department of a tertiary care hospital between January to June 2017. The caregivers were further assessed for demographic details, HADS (Hospital Anxiety Depression Scale for Depression and Anxiety), ZBI (Zarit Burden Interview for caregiver’s burden) and WHOQOL-BREF(World Health Organization quality of life assessment scale for quality of life). Statistical data was analyzed by GraphPad InStat version 3.06(California).

Results: Burden of care experienced by Caregivers of patients having AUD is as high as that of Caregivers of patients of Schizophrenia (p=0.46). Caregivers experiencing high burden are likely to have symptoms of anxiety (p<0.0001), depression (p<0.0001) and poor quality of life (p<0.0001). Unemployment (p=0.03) and women (p=0.006) caregivers are likely to experience high caregiver’s burden.

Conclusion: Our study suggests that caregivers of patients with AUD experience burden of care as high as that of caregivers of patients having Schizophrenia. Caregivers are more likely to have depression, anxiety and poor quality of life.

Key words: Caregiver’s burden, Schizophrenia, Alcohol use disorder, Quality of life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

284 Sociodemographic correlates, stressful life events and hopelessness among impulsive suicide attempters

Varada P ¹, Yesudas K F ², Sumesh Balachandran ²

BACKGROUND : Impulsive suicide attempters have undesirable stressful events, low level of hopelessness and suicide intent.

OBJECTIVES : To assess the sociodemographic profile, level of hopelessness, level of suicide intent and stressful life events in impulsive suicide attempters and to study the correlation of hopelessness, suicidal intent and stressful life event with impulsivity among them.

METHODS : Those admitted in a tertiary care center with any mode of deliberate self-harm were included in the study. A total of 150 patients were included after meeting inclusion criteria. Beck’s Hopelessness Scale and Beck’s Suicide Intent Scale were administered to assess hopelessness and suicide intent. Presumptive Stressful Life Events Scale was used to assess life events. Based on the score of 4 items in suicide intent scale, impulsivity score was calculated and those who scored <6 were considered as impulsive attempters. Statistical analysis was carried out using SPSS version 24.

RESULTS : 61.3% (N=92) of the sample were impulsive attempters. Among them 63% were females (N =58) and 37% males (N =34). Most common psychiatric diagnosis was adjustment disorder (27.2%) followed by personality disorder (22.9%) and alcohol dependence syndrome (17.4%). Age, history of substance use and diagnosis of personality disorder were significantly associated with impulsive suicide attempts. Impulsivity was found to be positively correlated with suicide intent score and hopelessness score. The correlation of impulsivity score with undesirable life events was weak.

CONCLUSION : Impulsivity of the suicide attempt seem to correlate with hopelessness and suicide intent. Undesirable life events do not correlate strongly with the impulsivity.

KEY WORDS : Attempted suicide, Impulsive attempts, Hopelessness, Suicide Intent, Stressful life events

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

285 Identification of stress amongst 1^st year MBBS students of a medical college

Manan Desai ¹, Krishna Patel, Kamlesh Patel

INTRODUCTION:

Stress is defined as any uncomfortable emotional experience accompanied by predictable biochemical, physiological and behavioral changes. The factors those leads to stress are called stressors. Stress in medical students can’t be ignored as mild to moderate stress leads to frustration and severe stress can lead to suicidal tendency. Although certain amount of stress is desirable as it makes them alert, stimulated and motivated.

AIMS:

To identify the prevalence of stress and associated factors amongst 1^st year MBBS students

METHODOLOGY:

Study was carried out on the students who were in their first year of MBBS in C.U. Shah medical college, Surendranagar in a single session. Students were explained about the procedure, consent was taken and then they were subjected to socio-demographic proforma and The Undergraduate Stress Questionnaire (USQ). The data was analyzed by statistical methods using SPSS (Version 16.0). The study was conducted after obtaining prior approval from Ethics Committee of the institution.

RESULTS:

Among the 97 respondents, 52 (53.60%) were males. The mean age of participant was 18 year. Out of 97 students, 35.05% having mild stress, 61.85% having moderate stress and 3.09% having severe stress. Male students were having more stress than female students. Poor academic performance, noise while studying, had no sex for a while, change in the environment, erratic schedule were major sources of stress found in the study.

CONCLUSION:

In our study, we had found that 1^st year MBBS students were having stress during their initial period of joining the college and it needs to be addressed. Factors found to be associated with stress needs to be considered while developing coping skills and interventional strategies. Student mentoring system should be strengthened by college authorities.

KEY WORDS:

Stress, 1^st year students, Medical college

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

286 Title: TO STUDY KNOWLEDGE AND OPINION REGARDING POST- PARTUM DEPRESSION BEFORE AND AFTER A STRUCTURED TEACHING PROGRAM INTERVENTION AMONG REGISTERED STAFF NURSES.

Jagdish Varotariya ¹, Shubhangi Dere ¹, Rakesh Ghildiyal ¹, Shushil Kumar ¹

Background & Aim:

During the postpartum period, about 10-15% of mothers experience a disabling and persistent form of mood disturbance diagnosed as postpartum depression (PPD).¹ Untreated post partum depression can result in poor care of the infant, poor mother-infant bonding, poor emotional development of the child and increased chances of chronic, recurring mood disorder in future. Despite its far reaching consequences, it still remains under-diagnosed. Nurses can play an important role in its early detection and facilitating management of PPD. Current study aimed to check the effect of structured teaching program upon baseline knowledge and opinion regarding epidemiology, clinical features, screening, management and the role of nurses in screening and management of PPD.

Materials and method:

It was an experimental study using pre and post-test design without control group, conducted at tertiary teaching hospital. The sample comprised of 31 qualified, registered staff nurses working in obstetric setting. Ethics committee approval and informed consent obtained. Structured knowledge and opinion questionnaires was developed comprising of 40 items focusing on epidemiology & etiology, clinical features, management & prognosis, barriers to screen PPD & role of nurses. Lecture cum discussion method was selected as an appropriate method of teaching staff Nurses. The knowledge & opinion about PPD was collected pre and post teaching intervention.

Results: The mean age of the nurses was 29.23 (± 8.90) years. Majority of them were females (96.8%), diploma nursing studied (70.97%), Hindu (83.9%), married (64.5%) with mean experience of 7.25 (± 7.99) years. Mean knowledge score on epidemiology & aetiology domain and clinical features domain significantly improved post test. Majority of nurses perceived barriers of lack of manpower, privacy at work place, and lack of time while screening for PPD. All nurses agreed that they can initiate a vital role in identifying the early signs & symptoms of PPD as they are the first line of contact with patients.

Conclusion: This study revealed that nurses’ knowledge and opinion regarding PPD can be effectively improved with teaching interventions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

287 A STUDY OF PATHWAYS TO SEX REASSIGNMENT, PSYCHIATRIC COMORBIDITIES, DISCRIMINATION AND QUALITY OF LIFE AMONG TRANSSEXUALS

Madhumitha N S ¹

Background:

Transsexual is the state of one’s gender identity which does not match with ones assigned sex. Recent estimates suggest that there are at least 490,000 transsexuals in India. Depression and anxiety disorders are quite high in prevalence among this population. Apart from poor sexual health, this patient cohort experiences perceived and internalized stigma, isolation, discrimination, and victimization that predisposes them to mental health issues.

Materials and methods : This hospital based study assessed transsexuals, sample size being 30. Participants were assessed for relevant demographic and clinical information. Quality of life was assessed with WHO QOL BREF scale. Discrimination and Stigma Scale (DISC-12) was used to estimate discrimination faced in various areas of life. MINI plus scale was applied to identify any psychiatric comorbidity.

Results : All participants fulfilled criteria for transsexualism according to ICD 10. Majority of the study population were poorly educated, belonged to low socioeconomic strata. They resorted to begging and sex work for their livelihood. Majority of them had faced discrimination in areas of housing, public transport, social life and employment. QOL domain score for physical health(64), psychological(73), social relationships(83) and environment(71) and mean of all domains was 73. Substance use disorders were high among them and had a higher prevalence of psychiatric comorbidities depression and anxiety.

Conclusion : There was a predictable pattern of development of gender identity disturbances and how they ended up with sex reassignment. Transsexuals face lot of difficulties both pre and post-surgery states. They suffer from higher rates of depression, suicide, anxiety and substance use disorders compared to general population.

Keywords : transsexuals, discrimination, sex reassignment

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

288 Title : A STUDY OF A STUDY CATATONIA IN 39 PATIENTS WITH BIPOLAR AFFECTIVE DISORDER: CLINICAL FEATURES AND RESPONSE TO MODIFIED ELECTROCONVULSIVE THERAPY.

Nirad Yadav ¹, Sanjai Jain ², Lal Chand Bairwa ³

Key Words :- Catatonia, bipolar affective disorder, modified electroconvulsive therapy

Objective :- The description of the clinical characteristics and short-term outcomes of a sample of admitted patients with bipolar disorder with severe catatonic features resistant to pharmacological treatment.

Methods :- This study involved 39 catatonic patients, which are resistant to a trial of benzodiazepines, and then treated with modified electroconvulsive therapy (MECT). All patients were evaluated prior to and one week following the MECT course using the Bush–Francis Catatonia Rating Scale (BFCRS) and the Clinical Global Impression (CGI).

Results : - In our sample, the mean (± standard deviation) age was 44.5 ±12.5 years, the mean age at onset of disease was 23.1± 12.8 years, and also the mean number of previous mood episodes was 4.5 ± 2.5. The mean duration of severe catatonic symptoms was 16.7 ± 11.8 (range: 3–50) weeks, and personal history of previous catatonic episodes was present in 15 patients (38.5%). Stupor, negativism, rigidity, withdrawal, and Mutism were observed in > 90% of patients. At the end of the MECT course 34 patients (87.1%) were classified as responders. The BFCRS showed improvement, with an 82% reduction of the initial score. The number of previous mood episodes was significantly lower and the use of ant cholinergic and dopamine-agonist medications was significantly more frequent in non-responders than in responders.

Conclusions :- The patients with bipolar affective disorder had predominantly retarded catatonia, frequent previous catatonic episodes, indicating a recurrent course. However, MECT was a very much effective treatment for catatonia in this patient that was resistant to benzodiazepines.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

290 Impact of maternal depression on child

Apoorv Yadav ¹, Sandeep Choudhary ¹, Vivek Kumar ¹, Supriya Agarwal ¹, Gureesha Singh ¹

Abstract Title: Impact of maternal depression on a child’s psychopathology

Background : Depression is among the most common psychiatric disorders worldwide, with much higher prevalence reported among women. Depression among Indian females is not an uncommon occurrence. Mental health of the mother is extremely important for the physical, mental as well as social health of the child. Studies have found that children of depressed mothers are at least two to three times more likely to develop adjustment problems, including mood disorders.

Aims and objectives : To find out the prevalence of suspected psychiatric conditions in children and adolescents between the ages of 4 and 14 whose mothers are suffering from depression.

Type of Study - Observational Cross Sectional

Type of Sampling - Continuous sampling

Methodology : Women with children between the ages of 4 and 14 attending the outpatient facility of a tertiary care hospital in Meerut, U.P., who have an established diagnosis of depression as per ICD-10 criteria, after taking written consent, were included in the study. The Montgomery Asberg Depression Rating Scale was applied to classify them as mild, moderate or severe symptomatology. Their children were screened on the Childhood Psychopathology Measurement Schedule for checking the symptoms of any major psychiatric disorder.

Results : A majority of children of depressed mothers were found to be at an increased risk of developing behavioural problems (10.5%), conduct disorder (13.1%), anxiety (28.9%), depression (11.6%), psychotic symptoms (2.6%), OCD like symptoms (5.2%) and somatization (7.8%).

Conclusion : Depressed mothers are more likely to be inconsistent, lax, withdrawn or intrusive, and ineffective in their parenting and child discipline behaviour. Inadequate parenting and lower quality lopment of symptoms of psychiatric disorders iparent-child relationships are related to increased risk for maladjustment among children, which could be the cause of an increased risk of deven these children.

Keywords : Depression, Maternal Depression, Child Psychiatry

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

291 PSYCHOSOCIAL ASPECTS OF TOBACCO USE AND NICOTINE DEPENDANCE AMONG MENTALLY ILL PATIENTS

Sagar Mudgal ¹, Nikhil Nayar

INTRODUCTION

In the only published study that provides data on tobacco use among psychiatric patients in India, Srinivasan and Thara (2002). This study was done as there are very less number of Indian studies and all data we know is based on western studies & statistics.

METHODOLOGY STUDY CENTRE I.M.C.H.R.C.

DURATION OF STUDY Jan 17 to June 18

MATERIAL AND METHODS I will be sitting in psychiatry O.P.D. of I.M.C.H.R.C., Indore.

1)
I will be shortlisting patients who fall under the diagnostic criterions of mental illnesses according to I.C.D. 10.
2)
Patients will be explained about the study and informed consent will be taken for the same.
3)
The sociodemographic profile will be collected.
4)
F.T.N.D. be applied upon them.
5)
Statistical significance will be calculated for mental illnesses.

RESULTS-

Most participants were in the age group of 31-40, married, males and from rural background. Most had studied till higher secondary. Majority were in the salary group of >70,000.

1)
Tobacco intake M>F,age group of 18-30 years, married population.
2)
Increased duration of consumption of chewed tobacco in unskilled workers while an increased consumption of smoked tobacco in the skilled.
3)
Increased duration of consumption of chewed tobacco in the illiterate and the literate preferred smoking.
4)
Increased FTND Scores in chewed forms of tobacco with increasing age.
5)
For smokeless forms of tobacco increased scores were found for the less skilled people while the opposite was seen for smoking.
6)
Maximum severity was found in patients of depression.

CONCLUSION

It was found that there prevalence of smoked & smokeless tobacco M>F.

Intake of smoking was found more in those who are more skilled, highly educated & earning more.

Intake of smokeless tobacco was found to be higher in those with lower income, lesser educated & those who are earning less.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

292 GENDER DIFFERENCES IN DEPRESSION AND ANXIETY AMONG PATIENTS WITH EPILEPSY

NITIN SHARMA, Shantanu Bharti, Ajay Kohli, Anju Agarwal, Tanuj Verma, Abdul Qadir Jilani, Prashant Kumar, Shiraz Ul Hasan

Background: Higher prevalence of depression and anxiety have been observed in patients with epilepsy. However, this association have been complicated by demographic, medicinal and other variables. Surprisingly less attention have been given to association and impact of gender difference on depression and anxiety among patients with epilepsy.

Method: In this cross sectional out-patient hospital-based study, we have included 100 participants diagnosed with epilepsy. Each subject was assessed for depressive and anxiety symptomatology using Hamilton rating scale for depression (HDRS) and Hamilton rating scale for anxiety (HARS). Proportions were compared using chi-square () test. A two-sided (α = 2) p <0.05 was considered statistically significant. Software’s MS-Excel and SPSS v 18 were used for analysis.

Results: Females composed of 47% of the study group and stated high level of both anxiety (30.23%) and depression (25.58%) in comparison with males. Neither anxiety (p-0.527) nor depression (p-0.329) was significantly correlated. However, female patients had significantly higher psychic anxiety symptoms (p-0.041*) and general somatic symptoms (p-0.049*) in contrast to males on HDRS scale.

Conclusion: Females patients with epilepsy in particular have higher levels of both anxiety and depression and should be assessed specially for psychic anxiety and general somatic symptoms. Hence, screening for anxiety and depression among patients with epilepsy will improve treatment outcome and quality of life.

Keywords: Epilepsy, anxiety, depression, gender difference, socio-demographic variables

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

293 Study of gaming characteristics and personality traits in gaming addiction among the intern doctors of Medical College, Jamnagar

Niranjanbhai Patel ¹, Hitarth H Raja, Vishal K Patel, Deepak S Tiwari, Dhruv S Patel, Nirav B Chanpa, Mayur Patel

Background: Video game addiction is more common with certain personality traits. This study aimed to examine the gaming characteristics and personality traits in gaming addiction.

Material and Methods: This was a cross sectional, observational study of 170 intern doctors of Department of psychiatry over period of twelve months. Gaming Addiction Scale- short version (GAS) was used to detect addiction in game users. Diagnostic and statistical manual of mental disorder-5 (DSM-5) research diagnostic criteria for Internet gaming disorder was used to confirm the gaming addiction. Neuroticism and extroversion of Eysenck Personality Questionnaire (EPQ-R), Arnett Inventory of Sensation Seeking (AISS), Buss Perry aggression questionnaire (BPAQ), and state self-esteem scale were used for assessment of personality factors. Descriptive statistics, independent t-test, Chi-square test and multiple linear regressions were used for analysis of data.

Result: Prevalence of gaming addiction among game users and total intern doctors was 20.72% and 13.52% respectively. Significant numbers of addicted interns (47.8%) spent money, playing games both online and offline (56.5%), used more gadgets (60.86%), played all time of day (26.1%), played for more than 2 hours in week end and week days, and played since more than 5 years (52.17%) compare to non addicted intern doctors. Neuroticism and Extroversion were positively associated with gaming addiction. Self esteem was negatively associated with gaming addiction.

Conclusion: Gaming addiction is prevalent among intern doctors those who spent more money and time, played since 5 years or more, and used multiple gadgets. Neuroticism, Extroversion, and low self esteem are more common among gaming addict. Key words: gaming addiction, prevalence, personality

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

294 Efficacy and safety of escitalopram in patients with first episode of MDD.

Bhavin Kadavala ¹, Mayur Patel, Vishal patel, Deepak Tiwari, Dhruv patel, Hitarth Raja, Nirav Chanpa

Context: Major Depressive Disorder (MDD) is the most prevalent psychiatric illness. Escitalopram is the most commonly used selective serotonin reuptake inhibitors (SSRI) to treat MDD.

Aims: To study efficacy and safety of escitalopram in patients with first episode of MDD.

Settings and Design: This was a prospective, open label, eight weeks follow-up study of patients with first episode of MDD attending Out Patient Department (OPD) of Psychiatry, M. P. Shah Govt. Medical College and G.G. Govt. Hospital, Jamnagar.

Methods and Material: Eighty four patients with first episode of MDD were selected using simple convenient sampling. Depression was diagnosed using DSM-5 diagnostic criteria for MDD. Montgomery-Asberg Depression Rating Scale (MADRS) was used to assess the severity of depression. Clinical Global Impression Severity (CGI-S) and Clinical Global Impression Improvement (CGI-I) were used to measure illness severity and global improvement. The Antidepressant Side-Effect Checklist (ASEC) was used to measure adverse reactions to antidepressants.

Statistical analysis: Descriptive statistics, t- test, Chi-Square test and p-value were used.

Results: The Mean of MADRS total score at baseline was 32.08 which was decrease in subsequent follow up and at 8 week score was 11.24. 77% of patients responded (≥50% or more reduction of MADRS total score) and 64.9% remitted (≤12 score of MADRS) at 8 weeks. 22.9% of patients reported side effects during the 8 week treatment. 94.2% of patients got significant improvement with 10 mg dose of escitalopram. The common side effects were constipation (5.4%), nausea (5.4%), dry mouth (4.1%) and yawning (4.15%).

Conclusions: Escitalopram treatment was efficacious and well tolerated in patients with first episode of MDD. Nearly two third patients achieved remission at the end of eight week.

Keywords: Escitalopram, depression, response, remission.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

295 TITLE OF THE STUDY: “A STUDY ON SOCIO-DEMOGRAPHIC AND CLINICAL FACTORS INFLUENCING ADVANCE DIRECTIVE AMONG PSYCHIATRIC IN-PATIENTS AND THEIR CAREGIVERS IN A GENERAL HOSPITAL PSYCHIATRIC UNIT (GHPU)”

REKHA HG ¹, Shivanand B Hiremath ²

BACKGROUND: Mental Health Care Act enforced on July7 2018 described about psychiatric advance directives (PADs), which allows individuals to decide about their treatment preferences and authorize legal proxy on behalf of them during crisis situations. There are significant problems associated with feasibility and acceptability of this legal document. So, there is need to study about the perspective of general population regarding advance directives and sociodemographic as well as clinical factors influencing it.

MATERIALS AND METHOD: A Cross Sectional study was conducted on 48 Inpatients and their caregivers in a GHPU. Information regarding sociodemographic data and clinical factors of both Inpatients and their caregivers was collected using Semi Structured Questionnaire. Perspective about advance directives was assessed using Bangalore Advance Directive Interview.

RESULTS: 80% of respondents were Men with a Mean age of 39.06 yrs. Majority of them were from a Poor, Nuclear family and are from Rural background. 50% of them had Substance use disorder, 33.3% had Psychotic disorders. 93.75% had either complete or Partial insight with a mean Insight Grade of 4.02. Most of married people wished to be cared by their spouse (83.87%), and unmarried individuals by their parents or their siblings. Majority of them (93.75%) expressed their wish to take treatment in GHPU. Less than half of people (47.92%) refused to take ECT in their crisis situations.

CONCLUSION: So, there is a great need to create awareness regarding rights of patient with mental illness and their perspective regarding advanced directives. This study shows some light on this matter.

KEY WORDS: Psychiatric Advance directive, Socio-demographic, Clinical factors.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

296 A CROSS SECTIONAL STUDY ON SEXUAL DYSFUNCTION IN FEMALES WITH DEPRESSION

Rashi Jha, Anju Agarwal

BACKGROUND Depression is known to hamper sexual relationships with the partner. Sexual dysfunction is known to have a major impact on personal relationships, physical health and quality of life. Reliable estimates of incidence and severity of sexual dysfunctions in depressed females are difficult to obtain, as patients are often unwilling to raise or discuss the issue of sexual health.

AIM To assess the prevalence and severity of sexual dysfunction in females with depression

MATERIALS AND METHODOLOGY

65 female patients attending the adult psychiatry OPD at Era Lucknow Medical College and Hospital were included in the study after acquiring informed consent. Patients fulfilling inclusion criteria were taken up and sociodemographic details were obtained. HAM D scale for severity of depression and FSFI scale for sexual dysfunction were applied.

RESULTS

Out of total 65 patients diagnosed with depression 54% reported of sexual dysfunction. The most common sexual dysfunction on FSFI was low lubrication (48%) and orgasmic dysfunction (48%) followed by pain during intercourse (44%). There was significant association between sexual dysfunction and depression.

CONCLUSION

Female sexual dysfunction (FSD) in depression although common is strikingly understudied. The condition, if addressed properly, can be readily cured, improving the quality of life of the patient

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

297 Temperament and emotional resilience of children with mental illness presenting to Psychiatry OPD of a tertiary care hospital

Aditi Singhal ¹, Hrishikesh Nachane ², VP Kale ²

Introduction:

Temperament and resilience are dynamic factors which are known to evolve with age and form important aspects of normal functioning. They have also been shown to have a role in etiopathogenesis of various psychiatric disorders. Children who develop mental illness at a young age frequently demonstrate different temperament traits and different level of emotional resilience as compared to normal children of their age. This may impact their further quality of life, functioning and personality. Previous studies done in this regard have focused on single disorders and there is a dearth of literature regarding their inter disorder variability. Hence, the present study was undertaken to better understand the interplay between temperament and emotional resilience in various childhood disorders and to evaluate their variation over such disorders. This will help in recognising disease specific traits in children and hence better adaptive techniques can be initiated for effective treatment.

Objectives:

The present study assessed temperament and emotional resilience in children with various psychiatric disorders. This was compared with age matched normal controls. We also assessed correlation between temperament and emotional resilience in children with psychiatric disorders

Design: Cross sectional observational study.

Methodology:

30 children between the ages of 4 to 14 meeting criteria of a childhood psychiatric disorder as per DSM-5 were recruited from the outpatient department. 30 age matched controls were recruited from normal population. After collecting sociodemographic and disease specific variables, the Temperament Measuring Schedule (TMS) and the Child and Youth Resilience Measurement - child version (CYRM-12) was applied to assess temperament and emotional resilience respectively. Comparison between various psychiatric disorders was done using one way ANOVA. Correlation studies were done using Pearson’s correlation test.

Results and Conclusion: will be discussed at the time of presentation.

Keywords: temperament, emotional resilience, childhood psychiatric disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

298 Title: Assessment of Economic Burden upon Family Members of Patients with Common Mental Disorders.

Piyush Verma ^1,^✉, Vivek Srivastava ¹, Hitesh Khurana ², Sujata Sethi ³

Introduction- Common mental disorders are known to pose significant economic burden at individual as well as family levels. Loss of productivity at individual level is associated with the cost of care for the patient and of sustenance of the care-givers in the process, which takes heavy toll upon the total family earning.

Aim & Objective- To elucidate the economic impact associated with common mental disorders at the family level, for the patients attending a tertiary care center of Haryana.

Methodology- The study is a cross-sectional study conducted at Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak. The diagnosed cases of common mental disorders, continuously on treatment for past 2 months, were selected by purposive sampling. After taking consent, a validated set of questions was used to assess the economic impact of common mental disorders.

Result- Results are discussed in the light of Indian economic scenario and cost effectiveness of treatment.

Conclusion- To be discussed in light of above factors.

Key Words- mental disorders, economic impact, cost-effectiveness.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

299 Study of phenomenological difference in psychotic disorder patients with and without cannabis use.

Mohammad Talha Shamim ¹, Shantanu Bharti ², Ajay Kohli ², Anju Agarwal ², Abdul Qadir Jilani ², Nitin Sharma ²

Background/Introduction: - In India, cannabis use is the second most common psychoactive substance used by general population. It has also been increasingly used by patients with mental disorders. Contradictory data is available on influence of cannabis use on the severity of existing psychotic symptoms. Therefore we aimed to examine the phenomenological difference among psychotic patients with and without cannabis use.

Methodology/ Materials and Methods: - This case control observational study included 25 psychotic patients with cannabis use (case) & 25 psychotic patients without cannabis use (controls) attending the psychiatry Inpatient department/outpatient department at Eras Lucknow medical college. Phenomenological differences were assessed using demographic sheet and Brief psychotic rating scale (BPRS). Results were analyzed using Statistical Package for the Social Sciences (SPSS) latest version.

Results: Cannabis users (n = 25) were significantly younger and more frequently males than nonuser patients. Patients with co-morbidity had more prominent psychotic symptoms (on BPRS scale) than the nonusers. The difference was statistically significant (p-0.001) for hallucination, excitement, grandiosity and hostility. In contrast, patients with cannabis use had lower score especially for depression, anxiety, somatic concern, guilt feelings, tension and motor retardation.

Conclusion: Patient with psychosis with comorbid cannabis use caused more morbidity in terms of more psychotic symptoms, predominantly positive symptoms. Therefore, psychotic patients with primarily positive symptoms should be evaluated for associated cannabis use as this can lead to poor quality of life.

Keywords- Phenomenology, Difference, psychosis, cannabis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

300 TITLE – Patterns of references in the Psychiatry department from different specialties in a tertiary care hospital.

Keerat Kaur ^1,^✉, Srishti Detha ¹, Prerak Kumar ², Manju Bhaskar ³

INTRODUCTION- Physical health is invariably linked to the mental health. Without addressing one’s mental health we cannot achieve complete well-being of patients. The recognition of mental health symptoms by physician has increased from previous times. This has led to the forthcoming of consultation liaison psychiatry. The study emphasizes at analyzing referral patterns and to understand the lacuna in the proper management for complete remission.

MATERIALS AND METHODS -A descriptive cross-sectional study conducted in tertiary care hospital for a period of 6 months in which the patients referred from various other specialties were assessed. Diagnosis was made by psychiatrists based on ICD-10 guidelines. Data was analyzed using statistical techniques.

RESULTS- 380 patients were referred to our department. Majority of them were females (56%) lying in mean age of 42.6 years. Medicine department sent the highest number of references. Anxiety was the most common diagnosis made by psychiatrists. There was only 18% concordance in physicians and psychiatrists diagnosis.

CONCLUSIONS- Despite having high prevalence of psychiatric illnesses in patients there is very low referral rates. This is mainly because of the lack of awareness about the psychiatric symptoms and negligence of other specialties for these disorders. In a tertiary care hospital there should be comprehensive team-based approach for treating the patient for complete remission of the illness.

KEYWORDS - Consultation liaison psychiatry, Psychiatric referral, Mental Health

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

301.RELATIONSHIP BETWEEN PERCEIVED SOCIAL SUPPORT AND SEVERITY OF SYMPTOMS IN PERSONS WITH SOMATIZATION DISORDER

Saswati Das ¹, Asharul Hossain, Saswati Nath, Arnab Pathak

INTRODUCTION:

Somatisation is a common problem in primary health care leading to disproportionately heavy demands on health services. Patients with somatisation account for about 20% of the work load in general practice. In somatisation disorder multiple or unexplained physical symptoms cause substantial disability in patients, excess use of medical services and frustration for physicians. While their psychiatric distress remains unrecognised and untreated, patients with somatisation undergo long and costly investigations. Studies have shown that Perceived social support improves the well-being of a person and also affects the outcome of treatment in somatization disorder. Our study aimed at investigating relationship of perceived social support and severity of somatic symptoms in people with somatization disorder.

MATERIALS AND METHODS:

This study is a cross-sectional single interview study in a tertiary care centre with a sample size of 60. All consecutive patients aged between 18 to 45 years attending psychiatry OPD of R. G. Kar Medical College and Hospital, Kolkata were interviewed and were clinically examined. Then cases diagnosed as somatisation disorder with ICD-10 criteria were taken. Patient Health Questionnaire-15 (PHQ-15) and Multidimensional scale of perceived social support assessment were used to assess severity of somatic symptoms and perceived social support respectively of the cases. Data was then analysed using standard statistical methods.

RESULTS:

Our study revealed that women reported more somatic symptoms than men. There was highly significant correlation between social support and severity of somatic symptoms i.e. patients who perceived high acuity of social support were reported to have less severity of somatic symptoms.

CONCLUSION:

Poor social support might be a stress response with regard to increased distress severity and psychosocial stressors rather than a cultural response to express psychological problems in somatic terms.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

302 A SHORT TERM OBSERVATIONAL STUDY ON CORELLATION BETWEEN HYPOTHYROIDISM AND MAJOR DEPRESSIVE DISORDER AMONG FEMALE PATIENTS AT A TERTIARY CARE HOSPITAL IN KOLKATA

Asharul Hossain ¹, Saswati Nath, Saswati Das, Nandalal Mal, Dilip Kumer Mondal

INTRODUCTION:- Major Depressive Disorder has the highest prevalence among any major psychiatric disorders. In October 2016, the National Institute of Mental Health and. In October 2016, the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru released a mental health survey that said that the incidence of depression is roughly one in every 20 Indians or 5% of the population. According to WHO depression will be the second largest killer of after heart diseases and second largest cause of Disability Adjusted Life Years (DALYS). A two fold higher prevalence is reported among women. Thyroid disorder in its various forms (overt or subclinical) affecting some 5% of population, predominantly female. Studies have shown that hypothyroid patients have higher than normal life-time prevalence of developing depression and conversely patients with depression have demonstrated a high prevalence of hypothyroidism. Our study was planned to establish correlation between major depressive disorder and hypothyroidism in female patients. METHODOLOGY:- The study conducted on forty female patients attending Psychiatry OPD, R G Kar Medical College and Hospital, Kolkata ; fulfilling the criteria of Major Depressive Disorder according to DSM 5 and forty female patient attending Medicine OPD of this Hospital with abnormal thyroid function test. All patients were undergone thyroid function test and evaluation of MDD with DSM-5. Data then analysed with appropriate statistical methods.

RESULTS:- this study revealed prevalence of hypothyroidism in MDD was 20.0% and prevalence of MDD in Hypothyroid was 30.0%. among MDD patients subclinical hypothyroidism was more prevalent(12.50%) than clinical hypothyroidism(7.50%) and highly significant correlation was found between MDD and Hypothyroidism(P value- 0.000)

CONCLUSION:- our study revealed that MDD has been associated with significant changes in hypothalamic-pituitary-thyroid axis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

304 Title: to study the factors affecting adherence to psychotropic medication among patients of schizophrenia adults versus elderly age groups.

Sangeeta Hatila ^1,^✉, Nirad Yadav ², Gunjan Solanki ³, Yogesh Satija ⁴

Background: Medication adherence is crucial factor in treatment of chronic illness like schizophrenia. Adherence is directly related to prognosis of schizophrenia. Non adherence is a serious problem and effects on overall treatment. Among many factors age is also sociodamographic variable which affect the adherence. Factors affecting adherence to psychotropics are different in adults and elderly.

Objectives: The present study compares the factors affecting adherence among the patients of schizophrenia in two different age groups.

Methods: study was conducted on outdoor patients of psychiatric centre, SMS hospital. After excluding the patients whose MMSE Scores<24 the two age groups were made,<60 and >60 years with the 30 patients in each group. Glasgow antipsychotic side effect scale (GASS), The Medication Adherence Questionnaire(Clinician Rating Scale),VAGUS CR insight scale and Semi Structured Performa were filled in two groups and evaluated.

Results: In elderly age group poor family support, impaired memory, increased side effects, inconvenience due to polypharmacy and in adults absent insight and distance from hospital, poor socio economic status in both were found to be main factors behind poor drug adherence.

Conclusion: Adherence is important in delivering the maximum therapeutic benefits to patients. To improve the adherence the factors affecting it, should always keep in mind. Psychiatrists should be individualized for age groups to overcome poor adherence to medication.

Key words: adherence, psychotropics, schizophrenia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

305 CORRELATIONS BETWEEN SEXUAL DYSFUNCTION, DEPRESSION AND ANXIETY AMONG FEMALE PATIENTS WITH MAJOR DEPRESSIVE DISORDER IN A TERTIARY CARE CENTER, KOLKATA.

Md Haque Sabir Hannan ¹, Arnab Pathak ², Sumit Mukherjee ³, Asharul Hossain ⁴, Taniya Kundu ⁵

Depressive disorders significantly impair functioning in a number of areas, including work functioning, social functioning, and health. Epidemiological and clinical studies show that depression and anxiety is associated with impairments of sexual function and satisfaction in both men and women. There are very few studies available which aims to evaluate sexual dysfunction among the female subjects.

OBJECTIVES :

To investigate the correlation between sexual dysfunctions depression and anxiety among drug naïve female Major Depressive Disorder patients.

METHODS AND MATERIAL

This study is a cross-sectional, single interview study in a tertiary care centre with a sample size of 52. Consecutive patients selected randomly aged between 18yrs to 45yrs, who were sexually active females attending Psychiatry OPD of a Tertiary care hospital, diagnosed as MDD with MINI 6.0 with no previous or current other axis I or II psychiatric illness, no h/o sexual dysfunction prior to depressive episode, no other significant medical or surgical illness and giving informed consent were included in this study. All the subjects diagnosed with depression were rated with BDI and BAI. Sexual experience are assessed by Arizona Sexual Experience Scale (ASEX).

RESULTS AND CONCLUSION

The result shows positive correlation between BDI and BAI (correlation coefficient 0.542). It shows significant correlation between BDI score and ASEX score (Spearman’s rho 0.542, p value 0.03). The severity of sexual dysfunction was most correlated with severity of depressive dimension.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

306 Title: Attitude towards Suicide Prevention Among College Students

Udayan Bhaumik ¹, Hemendra Singh, Adarsh B, Murali Tyloth ¹

Background:

Suicide is a global public health issue. Preventing suicide requires empathy and ability tomake judgments about suicide risk status. Till date,most studies have focussed on health professionals’attitude towards suicide itself rather than attitude towards suicide prevention.

A positive attitude towards suicide prevention among people at various levels can have a favourable outcome in suicide rates. Hence, we aimed to assess the attitude towards suicide prevention among college students from various institutions.

Methodology:

An awareness programme on suicide prevention was conducted on “World Suicide Prevention Day” at Ramaiah Medical College and attitude towards preventing suicide was assessed using The Attitudes to Suicide Prevention Scale (Herron et al.2001) among 550 college students of various institutions under Gokula Education Foundation of Ramaiah.

Results:

Over one third (140) students who attended the programme were compared with 410 controls (who did not attend programme). The mean age of the sample was 21.49 years with 267 males with 283 females. There was significant difference (P<-0.01) in mean of attitudinal responses of participants exposed vs non-exposed to awareness programme in terms of whether participants found suicide prevention work rewarding, resentful, believing suicide attempters are attention-seeking, believing suicide is unpreventable, unpredictable, feeling uncomfortable about assessing suicide and considering suicide prevention to be drain on financial resources.

Conclusions:

Our study found that those who attended the programme had positive attitude towards suicide prevention. Hence there is need for future sensitizing programmes on suicide prevention with shift of prevention from clinics to college classrooms.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

307 Title: Formulation of Stress Mapping in students with Dissociative disorders through specialized tool (SSDQ).

Vinod Verma ^*1,^✉, Malvika Pandey ², Sanjay Gupta ³

Background: Dissociative Disorder is often preceded by stressful life events or psychological trauma or strained family relationship, childhood physical or sexual abuse, the stress of examination or failure, interpersonal conflicts, and difficulties of daily life are predominant precipitating factors in this illness. As such, identification of the stress factors in each subject are of paramount importance in forming a management plan for each case.

Objectives: This study compares Semi-structured Clinical Psychiatric Interview (SCPI), (routinely used in most Departments of Psychiatry) with the specialized instrument (SSDQ) for assessing stress in students presenting with dissociation.

Method: Study subjects consisted of 30 students of Dissociative Disorder (ICD-10 Diagnostic criteria) in the age group 14- 30 years, presenting to Psychiatry O.P.D. of I.M.S, B.H.U. & Stress Management & Counseling Centre, B.H.U. The subjects were first administered SCPI to identify stress loading and subsequently the specialized SSDQ for the same.

Results : The results showed the SCPI to be ineffective in detecting stress factors linked to students presenting with dissociative disorders but the study proves SSDQ to be a highly efficient tool in identifying Stress Loading in students presenting with dissociation.

Discussion: The SSDQ proves to be the key to formulating specific intervention strategies for individual cases of Dissociative Disorders. Stress Loading, Stress Mapping and other relevant findings will be presented and their implications in the management of these disorders discussed in detail.

Keywords: SSDQ, SCPI, Stress Loading, ICD-10

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

308 A STUDY ON THE RELATION OF SERUM CORTISOL LEVELS WITH SOCIO-DEMOGRAPHIC VARIABLES, CLINICAL VARIABLES,AND CHARACTERISTICS OF SUICIDE ATTEMPTS IN DIFFERENT PSYCHIATRIC DISORDERS

Jyotismita Choudhury ¹, Deepanjali Medhi ²

INTRODUCTION- Suicide attempt as per American Psychiatric Association guidelines (2003) is a self-injurious behaviour with a non-fatal outcome accompanied by evidence that the person intended to die. Presence of mental disorders is one of the strongest risk factors for suicide attempts and suicidal deaths.

AIM- To assess the relation of serum cortisol levels with socio-demographic variables, clinical variables, and characteristics of suicide attempts.

METHODOLOGY- 60 patients with suicide attempts admitted/attended in the Department of Psychiatry, Otorhinolaryngology and Medicine at the Gauhati Medical College and Hospital from July 2017 to July 2018 were included. Psychiatric diagnosis was made using ICD-10 and a semi-structured interview was carried out to assess the socio-demographic variables, clinical variables, and characteristics of suicide attempts. Morning (8 am) serum cortisol levels were assessed using the Chemical Electroluminescence method done at the Department of Endocrinology, Gauhati Medical College and Hospital. The software IBM SPSS 21.0 version has been used for all statistical analysis.

RESULTS- The study shows that suicide attempters with presence of a stress factor, using methods of low lethality, impulsive nature of suicide attempt had normal morning serum cortisol levels; those with history of sexual abuse had high morning serum cortisol levels. These results were statistically significant.

CONCLUSION - A significant number of suicide attempters suffer from mental disorders and serum cortisol comes out as an important biological parameter of risk to suicide attempts in relation to the socio-demographic variables, clinical variables and the characteristics of the suicide attempts.

Key words: Suicide attempts, serum cortisol levels, psychiatric disorders

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

309 A Study of Burden in Primary Caregiver of Alcohol Use Disorder Patients

Manan R Thakrar ¹, Falguni B Patel ², Bhaveshkumar M Lakdawala ³

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 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):S521–S631.

310 Legal entanglement among opioid dependent patients

Rahul Mathur ¹, Siddharth Sarkar ¹, Yatan Pal Singh Balhara ¹

Background and aims : Patients with opioid dependence have high rates of legal problems, often as a consequence of associated deviant behaviour and to fund the habit of substance use. This analysis presents the data of legal entanglement among patients with opioid dependence seeking treatment at a tertiary care centre.

Methods : Patients with opioid dependence seeking treatment at a tertiary care centre were assessed (n = 173). Legal entanglement was defined as either being detained by the police, being incarcerated or having a case pending. Relationship of legal entanglement with demographic and clinical variables were assessed.

Results : Legal entanglement was reported by 41 patients (23.7% of the sample) with 39 being detained, 23 having a history of incarceration and 8 having cases pending against them. Duration of opioid use disorder (p = 0.268). Having a history of injecting drug use was associated with having history of legal entanglement (p = 0.014). Legal entanglement was higher in those with higher per-capita income (p = 0.13), and those with greater number of significant abstinent attempts (p = 0.025).

Conclusion : Legal issues could be an important concern in patients with opioid dependence. Many issues may be contributory to the legal challenges faced by them. Yet, treatment providers need to be cognisant of legal issues being a potential impediment to the treatment process.

Key words: opioid dependence, legal entanglement, incarcerated

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

311 TITLE: A study of Severity of Depression: Accentuation with Anemia in women of reproductive age group.

Chitra Singh ¹, Himanshu Sharma ², RK Solanki ³

* Presenting author.

TITLE: A study of Severity of Depression: Accentuation with Anemia in women of reproductive age group.

INTRODUCTION - Anemia is a common nutritional deficiency which has symptoms as lethargy, easy fatigability, decrease interest in work etc. A patient of anemia show signs and symptoms of behavioural and mood disorders like depression. Anemia is more common in reproductive age group female.

METHODOLOGY- In this study, 100 female patients at Psychiatric centre, S.M.S medical college and Hospitals, Jaipur, were diagnosed with major depression in accordance with ICD-10 criteria and confirmed by a senior psychiatrist. In all patients Standard Beck Depression Inventory (BDI) was used to evaluate depression severity. Blood samples were taken for Complete Blood count difference analysis, Haemoglobin (Hb), serum ferritin, and total iron binding capacity (TIBC), vitamin B12, and serum folate were checked to evaluate nutrient deficiency. The results were compared with B.D.I scores before and after treating for specific deficiencies.

RESULT & CONCLUSIONS- In our study, negative co-relation was observed between Hb levels, Vitamin B12 and folate levels and BDI scores. It demonstrates the effect of Hb, Vitamin B12 and folate deficiencies anemia occurrence on depression severity. So all the female patients diagnosed for Depression should be investigated for anemia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

312Title: Frequency and characteristics of Thyroid dysfunction in Depressive Disorders

Fakirappa B Ganiger ¹, Safeekh AT ²

Background

WHO has ranked depression fourth in the list of health problems worldwide and estimated to become second leading cause of mortality and DALY by 2020. The average life time prevalence of depressive disorders (DD) is 12%, however presence of thyroid dysfunction increases this rate to 30-40%. There is a strong possibility that, etiology and treatment outcomes of depression can be related to the condition of thyroid. Study by Chawanun involving 140 patients with DD, found 31 patients had thyroid dysfunction accounting for 22%. Dayan et al in his review study concluded, despite the large number of studies, the relationship between thyroid function and Depression remains poorly defined. However there is limited research on frequency of Thyroid dysfunction in DD

Objective

To examine the frequency and characteristics of thyroid dysfunction in patients with DD.

Methodology

It is a cross sectional study involving 82 subjects diagnosed with DD including Depressive episode, RDD and Dysthymia consenting for the study. Diagnosis of DD was made according to ICD-10 and HAM-D was used to assess the severity of episode. Subjects who were diagnosed to have thyroid dysfunction and medical illness before the onset of DD were excluded. Also subjects diagnosed with BPAD, substance induced mood disorder and who were undergoing treatment with Lithium were excluded. Thyroid Dysfunction was diagnosed based on the levels of T3, T4 and TSH levels. Data analysis was done using frequency, percentage, Mean, Standard Deviation and chi-square test.

Results

82 subjects consisting of 43 female (52.4%) and 39 male (47.6%) evaluated, of which 12 (15%) had thyroid dysfunction. Among the 8 females who had thyroid dysfunction, 6 subjects found to have subclinical hypothyroidism and 2 hypothyroidism. 4 male subjects had thyroid dysfunction among which 1 had hyperthyroidism and 3 had subclinical hypothyroidism.

Conclusion:- Will be discussed once all results are ready.

Key words

Dperessive disorders, Throid dysfunction, Recurrent Depressive Disorder, HAM-D Hamilton scale for depression.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

313 STUDY TO ESTIMATE STRESS AND COPING SKILLS IN 1^ST YEAR MEDICAL STUDENTS

ARNAB PATHAK ¹, DILIP KUMAR MONDAL ², DR SASWATI NATH ³

INTRODUCTION

Stress is particularly common in medical students adversely affecting their physical and cognitive capacities. As found in various studies, medical education is inherently stressful. Medical student is subjected to various stressors like academic performance, homesickness, financial problems, relationship problems, peer pressure. Students often suffer from impaired concentration, poor memory, anxiety, depression, insomnia, suicidal tendencies. Hence the present study is undertaken to find out magnitude of stress, various stressors, effect of stress on mental, physical & academic life of students, various coping techniques used by the pre-clinical medical students.

OBJECTIVE

To study the level of stress, level of resilience, type of coping strategies and and to find out various stressors among them.

METHODOLOGY

First year students of RGKMCH will be included in the study by total enumeration. They will be explained about the purpose of the study. Students giving a written consent will be included. A semi structured questionnaire including sociodemographic information and Student’s Stressful Event Checklist, Perceived Stress Questionnaire, Coping Scale, Brief Resilience Scale (BRS), General Health Questionnaire (GHQ)scales will be applied to them within the class under researchers’ observation and will be collected from them after specified time period maintaining privacy

RESULTS AND CONCLUSION

Initial computation of data shows a significant number of students are dealing with stress which has lead to poor academic performance and depression in few. Students who had good coping skills and resilience score had less perceived stress. Further statistical analysis and detailed result would be given in during paper presentation.

Key words: Medical students, stress, coping

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

314 A STUDY OF PSYCHIATRIC MORBIDITIES IN JUVENILE DELINQUENTS IN GOVERNMENT OBSERVATION HOMES

Mohammed Mubeen Fathima ¹, VG Prabhu kiran ², K Pavan kumar ³, YSR Shanti Navyatha ⁴

KEYWORDS : Juvenile delinquents, mental health problems.

BACKGROUND : Mental health problems are prominent among juveniles in correctional facilities. Recent studies have found that 65-85% of them having major psychiatric problems. Research in this area is sparse in India so the present study is undertaken to evaluate psychiatric morbidities in juvenile delinquent boys in observation homes in Eluru and Vijayawada cities of Andhra Pradesh, India.

OBJECTIVES:

To assess the prevalence of mental health problems/disorders of juvenile delinquents in observational homes.
To raise association with socio demographic variables and correlate wherever possible with tests of significance.

METHODOLOGY:

Study setting : Government children homes for boys –Eluru.

Government observation homes for boys- Vijayawada.

Study period : 3months duration(15^th September 2018- 15^th November 2018).

Study design : Analytical – Cross sectional study.

Study tool : Mini international neuropsychiatric interview for children and adolescents [MINI KID].

Subjects : Total no.-25, Age group -6-18years, who were residents of home.

Informed consent was taken from concerned authority prior to study.

NOTE- Since the study is in process the Results, discussion and conclusion will be discussed during the time of final presentation of the paper.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

315 RELATION BETWEEN FACEBOOK ADDICTION AND PERSONALITY TRAITS AMONG MEDICAL STUDENTS- A CLINICAL STUDY.

M Haritha Devi* ¹, V G Prabhu Kiran ², K Pavan Kumar ³

BACKGROUND: Facebook is one of the most popular social networking site being used daily by most of the people in-order to maintain and establish relationships. There may be some unique factors among the internet users that lead them to increased Facebook use and its widespread acceptance. There are some studies that looked into Facebook addiction in adolescents and youth but there are only few studies reported from India.

AIM: To deepen the understanding of the relationship between personality traits, life satisfaction and Facebook addiction.

MATERIALS AND METHODOLOGY: The study is a cross sectional study with a study population consisting of 100 medical students of ASRAM medical college and hospital and the students will be assessed using the Bergen Facebook Addiction Scale(BFAS), the Big Five Inventory (BFI-10) and Satisfaction with Life Scale.

NOTE: Since the study is in process the results, discussions, and conclusion will be discussed during the time of final presentation of the paper.

KEYWORDS: Facebook addiction, Personality traits, Satisfaction with life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

316 A clinical study of the prevalence of psychiatric comorbidity among male patients of sexual dysfunction and Dhat syndrome attending psychiatry OPD of a tertiary care general hospital.

Rajvardhan Narayan, H R Phookun

Introduction: Sexuality is an important aspect of health which can impact the overall well-being of men and women. In spite of the high prevalence of sexual dysfunction it has received little attention from researches in India. Vast majority of cases of sexual dysfunction in men and women are associated with psychiatric comorbidity; diagnosis and treatment of which is critical to a better outcome in these conditions.

Aims & objectives: To assess the socio-demographic variables and the prevalence of psychiatric comorbidity among male patients of sexual dysfunction and Dhat syndrome attending psychiatry OPD of a tertiary care general hospital.

Methodology: prevalence of psychiatric comorbidity was assessed in 50 out patients of sexual dysfunction and Dhat syndrome with the help of instrument M.I.N.I.

Results: 70% of patients with sexual dysfunction and Dhat syndrome have associated psychiatric comorbidity. Most prevalent psychiatric comorbidity found in these patients are major depressive episode (46%) followed by generalised anxiety disorder (20%). Other psychiatric comorbidities found are dysthymia (8%), suicidality (8%), social anxiety disorder (8%), alcohol abuse (6%), psychotic disorders (4%), OCD (2%), panic disorder (2%), and substance abuse non-alcohol (2%). Most common psychosexual disorders found in patients are Dhat syndrome (56%) followed by ED (36%) and PE (26%). Erectile dysfunction group has the highest prevalence of psychiatric comorbidity (83.33%), followed by premature ejaculation group (61.53%) and Dhat syndrome group (57.14%).

Conclusion: From the present study it can be concluded that psychosexual disorders are commonly associated with comorbid psychiatric disorders. Detection and treatment of these comorbidities at the earliest is essential for better treatment outcome and a better quality of life for the patients.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

317 Title: Prevalence and correlates of neurological soft signs in treatment naïve first episode psychosis

Sahana N ¹, N Heramani Singh ¹

Background: Neurological soft signs (NSS) refer to non-localizing neurological abnormalities that are not part of a well-defined neurological syndrome. Their incidence has been documented to be higher in schizophrenia than other psychiatric disorders. NSS may indicate either a genetic liability for psychosis or the severity of the underlying disease process. NSS may also act as a potential predictor of the outcome in psychosis. This study aimed to find the prevalence and correlates of NSS in first episode psychosis prior to initiation of neuroleptics.

Materials and methods: This was a cross-sectional study conducted in the Department of Psychiatry, RIMS, Imphal. A total of 96 patients with treatment naïve first episode psychosis were diagnosed according to ICD-10, severity of symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS) and soft signs were assessed by the Neurological Evaluation Scale (NES). Statistical analysis was done using IBM-SPSS version-21.

Results: The prevalence of at least one NSS in treatment naïve first episode psychosis was 81.3%. Patients with schizophrenia had higher total NES scale scores than other psychosis. There was no correlation between NSS and age, gender or education. There was a strong positive correlation between NSS and duration of illness, total PANSS score, negative and general psychopathology scales.

Conclusion: Abundance of NSS in early stages of psychosis indicates that the aberrant neurological functioning is a part of the psychotic disorder rather than an effect of medications. NSS might also be an intrinsic part of disease activity with prognostic significance. NSS should be evaluated in all patients with psychosis, especially in the early stages of illness as a clinical guide to early intervention and better management of patients.

Keywords:

neurological soft signs, first episode psychosis, prevalence, correlates, treatment naive

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

318 Title: “Pathway to psychiatric care in patients with alcohol dependence syndrome (POCADS) - An explorative study at GHPU KIMS Hubballi”

Sagar S Garag ¹, Sameer Belvi Mangalwedhe ², Arunkumar C ³, Mahesh Desai ⁴

# Department of Psychiatry KIMS, Hubli

Background : Knowledge about the help-seeking behavior and pathways to care of patients is pivotal in providing effective planning and early interventions. There is limited scientific literature regarding the pathway of care (POC) among individuals with substance use disorders. This necessitates a scientific study to understand the health seeking behaviour in our region.

Aims and Objectives: To know the pathway to psychiatric care in patient with alcohol dependence syndrome(ADS).

Methodology: A cross-sectional, observational study on 40 male subjects diagnosed with ADS as per ICD-10 was carried out. Pathways to care were assessed using the WHO encounter form. Data was analyzed in EPI INFO-7 and appropriate statistical tests were applied.

Results: The mean age of patients was 38.1yr (SD=7.5)75% were married. Majority of patients were from urban area(60%). 25.64%were illiterate and only 5.13% were graduates. 50% were unemployed. Mean age at first drink was 20.5yr (SD=5). Median age at onset of dependence was 25 years. 57.5% of patients had severe dependence at the time of first consultation. 55%of patients had their first consultation at general hospital services, and only 20% had psychiatric consultation at first contact. In 77.5%of the cases first consultation was decided by the family members. 80%of patents approached for psychiatric services for second consultation. Distance from residence, education, employment and levels of consultations were not statistically significant.

Conclusion: Lack of awareness about treatment and medical model of alcohol use disorder contributes significantly delay in Psychiatric consultation for Alcohol related problems. Creating awareness amongst general public and also medical practitioners regarding the alcohol use disorder is essential.

Keywords: Help seeking, pathway to care, Alcohol, general hospital psychiatry unit

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

319A COMPARATIVE CROSS-SECTIONAL STUDY TO ASSESS THE CORRELATION OF IMPULSIVITY AND THE AGE OF ONSET OF ALCOHOL DEPENDENCE

ARVIND RENGARAJAN ARG ¹, DEVI ¹, POORNA CHANDRIKA ¹

BACKGROUND

Alcoholism is one of the most threatening health problems in most of the countries, which poses enormous burden on the economy and health care facilities of the country. One of the primary personality dimensions that has consistently been linked to substance abuse is impulsivity. Early age of onset of alcohol dependence has been associated with a high severity of dependence. This study was aimed to find a correlation between impulsivity and age of onset of alcohol dependence, in view as to use impulsivity trait as a predictor for high risk of early age dependence.

MATERIALS AND METHODS

This is a Comparative Cross-sectional study, with purposive sampling done to take 100 patients with alcohol dependence, diagnosed according to ICD-10 criteria, who are admitted in the deaddiction ward. After obtaining informed consent, the patients will be assessed with Semi Structured Sociodemographic proforma, Barratt Impulsiveness Scale -11 (BIS-11), and Severity of Alcohol Dependence Questionnaire (SADQ). The impulsivity scores would then be compared with the age of onset and would be analysed through appropriate statistical methods.

RESULTS & CONCLUSION

As the study is underway, initial evaluation of the raw data collected show earlier age of onset of alcohol dependence in patients with high impulsivity scores. Further analysis regarding the association of 2^nd order factors of impulsivity of BIS-11 and the age of onset of dependence needs to be done and the results need to be refined. As per initial evaluations, presence of impulsivity can be determined as a risk factor for developing early age of onset alcohol dependence.

KEY WORDS

Alcohol Dependence, Age of onset, Impulsivity

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

320 Topic- Prevalence of Depression And Its Impact On Perceived Social Support In Elderly Hospitalized Patients: A Cross-sectional Hospital-based study.

Himanshu Gupta ¹

Background: Depression is the silent killer of modern era. In India there is sharp increase in elderly population. Substantial number of elderly likely to have physical and mental co-morbidity. Deficit in perceived support can be an important determining factor not only therapeutically but also prognostically.

Aims: To evaluate the prevalence of depression in Elderly Hospitalized Patients and to study its Impact On Perceived Social Support in these patients.

Methods: A hospital based cross-sectional study conducted in various Departments of Assam Medical College and Hospital with sample size of 109. Newly admitted patients with age more than 60 year were selected through simple random sampling technique and screened for depression through Prime-MD screening tool, then positive cases were confirmed and classified with ICD-10 and Ham-D respectively. Perceived support was assessed by Multidimensional Scale by Zimet, SPSS version 21.0 was used for statistical analysis of obtained data through tests like chi-square, unpaired t-test and ANOVA.

Results: The prevalence of depression was found to be 31.19%. It was more in in patients who were female, widow/widower, literate and with longer duration of physical illness. Perceived support was significantly poor in depressed patients and an association was found between severity of depression and decreased perceived support.

Conclusion: Depression is very common in elderly hospitalized patients and it is associated with poor perceived support. As conceptually perceived support can be both cause and effect of depression, so need of hour is to break this vicious cycle as early as possible and to help the elderly in living as good life as possible despite their illnesses and decreasing capacities.

Keywords: Depression, Perceived Social Support, Elderly, Hospitalized

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

321. Title-Clonidine in pre-school ADHD- 12 week naturalistic follow-up study on safety and tolerability.

Sivapriya Vaidyanathan ¹, Preeti K, C Venkatesh

Introduction: Study objective is to report on safety and tolerability of clonidine in pre-school children with ADHD in child guidance clinic in South India.

Methodology: Study was done in child guidance clinic at JIPMER, tertiary teaching hospital. It’s a 12 week prospective follow-up study to assess outcomes, safety and tolerability of pharmacotherapy in preschool ADHD children. Children aged 2.5-6 years were screened and after confirmation of diagnosis, ADHD symptom profile assessment was done at baseline and follow-up using Conner’s abbreviated rating scale and Clinical global impression –severity scale. Children with autism and social quotient less than 50 were excluded.

Results: Mean age was 4 years. Of 50 children participating in the study, 26% (N=13) were on behavioural intervention and 74% (N=37) were on combination of pharmacotherapy with behavioural interventions. 51% (N=19) of those on medications were on Clonidine, N=7 on risperidone, N=6 were on atomoxetine, N=2 on methylphenidate and N=3 were on combination mediations. The setting being government institution, choice of medication was determined by affordability, availability, growth parameters and comorbidity profile. Cardiac clearance was obtained when child’s age was less than 4 years. At end of 3 months, 1 child on clonidine had excess sedation for which clonidine was changed to atomoxetine. No other side-effects were noted. Mean dose of clonidine was 50 microgram. Pre-schoolers with ADHD on clonidine for 12 weeks showed improvement in attention deficits and aggressiveness.

Conclusions: The study adds to limited literature and improves our understanding of safety of clonidine in pre-schoolers with ADHD. Given the lack of anti-ADHD medication in current NMH program, including clonidine can address over-prescription of antipsychotics in children. Further study with larger sample is indicated.

Keywords -Clonidine, pre-school, ADHD, treatment

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

322 PREVALENCE AND CLINICAL PRESENTATION OF THE CATASTROPHIC REACTION AMONG DEMENTIA PATIENTS AT INSTITUTE OF MENTAL HEALTH

SANJAY B ¹, Venkatesh Mathan Kumar, Poornachandrika

BACKGROUND

Catastrophic reactions was defined by GOLDSTEIN as short lasting emotional outburst characterized by anxiety, tears, aggressive behaviour, swearing, displacement, refusal, renouncement and compensatory boasting. Empirical studies on the prevalence and correlates of this phenomenon is limited. For the present study we assessed a consecutive series of dementia patients using catastrophic reaction scale (CRS), semi structured psychiatric evaluation and comprehensive neuropsychological assessment.

MATERIALS AND METHODS

A consecutive series of 75 patients attending the dementia clinic of our institute who met the ICD criteria were included in our study. Appropriate psychiatric examination and neuropsychological assessment was done. Symptomatic presentation of the patients has been assessed using appropriate rating scales and severity has been noted.

Scales used- CATASTROPHIC REACTION SCALE, MMSE, DEMENTIA SEVERITY RATING SCALES, HAM-D, HAM-A.

RESULTS-

Since this is ongoing study, results need to be evaluated. probable results affirmed with current status of data evaluation has been possibly states high level of anxiety symptoms, depression symptoms, and aggressiveness among the presented individuals of dementia with catastrophic reactions on comparing with dementia patients with no catastrophic reactions.

CONCLUSION

From this study catastrophic reaction among 75 dementia patients has been evaluated, nearly 33% of patients assessed were found to be have catastrophic reactions and the symptomatic presentation is highly associated with predominant anxiety and depressive symptoms.

KEYWORDS- CATASTROPHIC REACTION, DEMENTIA, SYMPTOMATIC PRESENTATION

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

325 Title: Assessment of Suicidal Tendency in patients of Schizophrenia

Malvika Pandey ¹, Adya Shanker Srivastava ¹

Assessment of Suicidal tendency in patients of Schizophrenia

Background – Individuals with Schizophrenia commonly develop suicidal tendencies and if not managed properly may end up committing suicide. Previous literature suggests a lifetime risk of 5% of rate of suicide in patients suffering with Schizophrenia. However, most of the earlier studies have been done on the western population and Indian literature is lacking. The study aims to assess the suicidal tendency in patients suffering with Schizophrenia.

Material and Methods – The study subjects included 50 patients attending the Psychiatry O.P.D of I.M.S B.H.U, diagnosed as Schizophrenia according to ICD-10 diagnostic criteria. The subjects were in the age group 18- 60 years and were free from any other psychiatric or physical co-morbidities. They were rated on Beck’s Scale for Suicidal Ideation (SSI), Brief Psychiatric Rating Scale, (BPRS), Hamilton Rating scales for Anxiety and Depression (HAM-A, HAM-D). The results were analysed with SPSS software.

Results – The results highlight the potential risk of suicide in patients suffering with Schizophrenia and will be discussed in detail during presentation.

Conclusion – The findings of the study highlight the potential risk of patients suffering with Schizophrenia prone to commit suicide during their lifetime. It is important to know the risk involved for their effective management and prevention of any harms they may bring to themselves during the course of treatment. Further suicide prevention programmes need to address the problem to prevent suicide among patients suffering with Schizophrenia.

Keywords – Suicide, Schizophrenia, risk

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

326 NEUROPSYCHIATRIC MANIFESTATIONS OF DENGUE FEVER: 2 CASE REPORTS

Sonalika Mondal ¹, Sayanti Ghosh ², Ashish Mukhpadhyay ², Piyali Ghosh ²

INTRODUCTION

Dengue is a vector borne tropical disease caused by dengue virus that gives rise to flu like illness. In the recent times there have been epidemic outbreaks of dengue in India. During the last few years, there has been increasing reports of dengue fever with unusual manifestations,primarily neurological symptoms. Psychiatric morbidity during acute dengue infection has been rarely reported
Here we present 2 cases of bipolar mania and psychosis following dengue fever

CASE REPORTS

CASE 1:A 24yr.old male developed increased talktiveness,religiosity,elevated self-esteem, anger outburst and decreased need of sleep after 4 days of diagnosed dengue fever, with no past psychiatric history, family history of mental illness and substance abuse. He improved within 2 weeks with Tablets olanzapine20mg,sodium valproate1000mg, injectable benzodiazepene SOS.ICD10 diagnosis was organic manic disorder F06.30
CASE 2: 21yr.old male developed irrelevant talks,hearing of unseen voices,suspiciousness,fearfulness, talking to self,severe restlessness,decreased sleep and poor self – hygiene after 5 days of onset of dengue fever. There was no previous history of similar kind of illness,no family history of any mental disorder or history of any substance abuse. He improved on tablets olanzapine10mg andclonazepam1mg. His symptoms subsided within 15days and the patient is doing well in follow up after 4 weeks.ICD10 diagnosis was organic delusional(schizophrenia like)disorderF06.2

DISCUSSION

These cases states a temporal relationship between the onset of dengue fever and the emergence of psychiatric symptoms. The patient had no past and family history of mood/psychiatric disorder or comorbid substance abuse. These facts state the possibility of organic etiology(dengue infection). The history,vital signs and investigations were not suggestive of delirium

CONCLUSION

We need further systematic study to find out the prevalence of psychiatric sequelae following dengue infection as dengue become a major public health hazards in our country in recent days.

KEYWORDS: bipolar mania,psychosis,dengue fever

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

327 Utility of SSDQ, a specialized tool for assessment of Stress Loading, in Dissociative Disorders

Malvika Pandey ^*1,^✉, Vinod Verma ², Sanjay Gupta ³

Background – Dissociative Disorder usually develops in the background of stressful life, psychological trauma, strained family relationship, physical or sexual abuse, the stress of examination or failure or interpersonal conflicts. Stressful situations can worsen symptoms. Estimates show that 2% of people experience dissociative disorders, with women being more likely than men. In the management of Dissociative disorders, identification of stress factors are vital for proper and efficient management of Dissociative disorder. Formulating an effective treatment plan can be difficult, because of the lack of an efficient tool to find out stress factors leading to dissociation The study establishes how Students’ Stress Dimension Questionnaire (SSDQ) fares in detecting stress in the different domains of a person’s life.

Objective – Detecting Stress factors in Dissociative Disorder patients: Comparison of Semi-structured Psychiatric Interview (SSPI) versus specialized tool (SSDQ)

Material and methods – Study subjects comprised 30 patients, age group 20- 35 years, presenting to Psychiatry O.P.D. of I.M.S BHU as Dissociative disorder (ICD 10 diagnostic criteria). They were subjected to Tool 1, i.e. Semi-structured Psychiatric Interview (SSPI) and thereafter to Tool 2, i.e. S.S.D.Q.

Results – The results showed SSPI to be highly unsatisfactory in detecting stress factors, whereas SSDQ effectively identified various stress factors across ten domains of a person’s life.

Conclusion – The study proved SSDQ to be a highly efficient tool in the management of Dissociative disorders as it effectively identified Stress factors in the patient on which the management plan could be tailored. The statistical analysis of the results will be presented and implications discussed with reference to management issues.

Keywords: Dissociation, Stress, SSPI, SSDQ

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

328 CLINICAL CORRELATES OF ELECTROCONVULSIVE THERAPY IN PATIENTS SUFFERING FROM SCHIZOPHRENIA FOR TEN OR MORE YEARS

Krishna Prakash ¹, Tejas Gholap ², Shobha Nair ², Aditi Chaudhari ², Kaustubh Mazumdar ²

Background: Electroconvulsive therapy (ECT) is used for patients with schizophrenia for various indications. However there are very few studies which have addressed the clinical correlates of use of electroconvulsive therapy in patients suffering from schizophrenia for ten or more years.

Aims and Objectives: In patients who have suffered from schizophrenia for ten or more years, to determine i) The percentage of patients who had required ECTs ii) The association between past use of ECT and current clinical profile of the patient

Materials and Methods: 50 patients who had been suffering from schizophrenia for ten or more years were evaluated for their current symptomatology, disability and quality of life. Their socio-demographic and illness related variables were noted. Patients who had and had not received ECTs over their course of illness of more than ten years were compared on these variables.

Results: 62% patients received ECTs at some time during the course of the illness. Patients who had received ECTs had a higher number of hospitalizations and a higher current score on positive symptoms as compared to the patients who did not receive ECTs. The use of ECTs did not show any significant association with age of onset of illness, duration of untreated psychosis, number of relapses, severity of negative symptoms, general psychopathology, disability and quality of life.

Conclusion: Schizophrenia patients who had required ECTs did not have a poorer quality of life or higher disability as compared to patients who did not require ECTs.

Keywords: Schizophrenia, ECTs, Quality of life, Disability.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

329 CORRELATION BETWEEN INFLAMMATORY MARKERS (SERUM INTERLEUKIN 6) AND POSITIVE AND NEGATIVE SYMPTOMS OF SCHIZOPHRENIA PATIENTS

Piyali Ghosh ¹, Sayanti Ghosh ¹, Asish Mukhopadhayay ², Sonalika Mondal ², Piyali Ghosh ³

INTRODUCTION : Schizophrenia is a chronic form of psychotic illness that affects approximately 1% of the population worldwide. Symptoms of schizophrenia can be divided into following domains namely positive symptom, negative symptom and cognitive symptom. A large body of evidence further implicates a spectrum of immunological abnormalities in this disorder. Indeed, the idea that altered immune functions may play an important role in schizophrenia. We know that inflammatory cytokines levels are related to manifestations of schizophrenia, but much research has not been done regarding association of different domain of schizophrenia and inflammatory markers in India.

AIM AND OBJECTIVE : Association between inflammatory markers and positive and negative symptoms.

METHODOLOGY: Study area:- Psychiatry OPD, NRS Medical College & Hospital, Kolkata.

Study type:- cross sectional, hospital based Study population:- 90 patients of schizophrenia who are able to follow instruction without any other psychiatric morbidity.

All cases with diagnosis of Schizophrenia according to ICD 10 have been assessed by PANSS (positive and negative symptoms scale in schizophrenia) and serum Interleukin 6 level measured by ELISA.

Statistical Analysis done by using SPSS 24.0 (Chi-square test and Independent sample T test)

RESULTS: PANSS mean positive symptom score is 20.72 and negative symptom score is 20.16 and both has statistically significant association with Serum Interleukin 6 (5-15pg/ml).

DISCUSSION : This significant association may be helpful in treatment as the efficacy of currently available antipsychotic drugs to ameliorate negative and cognitive symptoms is limited. The further exploration of inflammatory mechanisms and anti-inflammatory strategies may open fruitful avenues for a better treatment of symptoms undermining affective, emotional, social and cognitive functions relevant for schizophrenic disease.

KEYWORDS: inflammation, schizophrenia, IL-6.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

330Title: Risk factors and experience of non-fatal opioid overdose among people who inject drugs (PWID): a cross-sectional, community-based study

Romil Saini ¹, Ravindra Rao ², Arpit Parmar ³, Ashwani Kumar Mishra ⁴, Atul Ambekar ⁵, Alok Agarwal ⁶

Background: PWID experience non-fatal opioid overdose (NFOO) at high rates, which is predictive of future fatal overdose, an important cause of mortality among PWID. Studies on NFOO and associated risk factors are lacking from developing countries, including India.

Aims: To assess the rates of NFOO and NFOO-related risk factors among PWID in India.

Methods: Cross-sectional, observational study design. A total of 104 male PWID aged 18 years and above, receiving HIV prevention services were selected by simple random technique after their consent. The participants were then interviewed in a single session using a semi-structured questionnaire, WHO-ASSIST (for substance use pattern), Leeds Dependence Questionnaire, LDQ (for opioid dependence severity) and MINI 7.0 (for co-morbid psychiatric illnesses).

Results: Participants’ mean age was 27.98 (8.38) years. The rates of NFOO were: 45.2% (n=47) ever, 25% (n=26) in last one year and 21.2% (n=22) in last three months. Those reporting NFOO in last 3 months had significantly higher illiteracy rates (p=0.02); illicit buprenorphine, tramadol and codeine use (each p<0.05); higher rates of mixing opioids with anti-histamines (p=0.01); severe opioid dependence (p=0.02), and less treatment seeking in past (p=0.01) compared to those without NFOO. PWID with NFOO in last one year had significantly higher suicidality rates (p=0.03).

Conclusion: PWID from India have high rates of NFOO, with several risk factors. Interventions to prevent and manage NFOO should focus on mitigating these high risk factors.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

331A cross-sectional study to assess the severity of Obsessive–compulsive disorder (OCD) and its sociodemographic determinants among the patients with OCD attending psychiatry OPD in KIMS,Hubli.

Nishmita TJ ¹, Sameer Belvi Mangalwedhe ², Arunkumar C ³, Mahesh Desai ⁴

Background:

Obsessive–compulsive disorder is a chronic condition characterized by obsessions or compulsions that cause distress or interfere with functioning. It is associated with many factors contributing directly or indirectly leading to a great deal of morbidity in patients.

Objectives:

To assess the severity of OCD and its sociodemographic determinants and the symptom dimensions in patients with OCD.

Methodology:

A cross-sectional study was conducted among the patients(≥18years) attending psychiatry OPD KIMS,Hubli. Study period 6 months with sample size 26. Assessment of severity was done using YBOCS. Sociodemographic profile, severity and symptom dimensional data collected and analysed using SPSS version 21.0. Chi-square and fisher exact tests were used as the tests of significance. p value <0.05 considered as statistically significant.

Results:

Mean age of patients was 33.15(±10.65). Majority were males(85.7%),married(65.4%),from urban area(76.9%). 15.4% were illiterate and 46.2% unemployed. Mean total severity

score of OCD was 21.08(±7.216). Of which 19.2% had mild,46.2% moderate, 23.1% severe and 11.5% extreme OCD. As per symptom dimensions 61.5% had aggressive obsessions,

84.6% contamination, 30.8% sexual,38.5% religious,46.2% symmetry,50% somatic obsession. Among compulsions 61.5% had cleaning,57.7% checking,30.8% repeating rituals,34.6% counting,46.2% arranging,7.7% hoarding. Source of income was found to be inversely associated with OCD total score(p value<0.05) and other factors were found to be not statistically significant. The locality (p value<0.039), marital status (p value <0.006) and education (p value <0.003) were significantly associated with the severity of OCD.

Conclusion:

Majority of patients had moderate OCD, most of them had contamination obsession. Source of income and literacy contribute to consultation for illness. Hence improving education and income of the patients will improve their approach towards illness.

Keywords: Obsessive–compulsive disorder, YBOCS, symptom dimensions

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

332 OBJECTIVES:-

Madhurima Khasnobis ¹, Kamal Nath, Madhurima Khasnobis, Monu Doley

1. Comparative assessment of sociodemographic variables and diagnostic spectrums of the patients attending the Psychiatric Out Patient Department of a Tertiary Care Centre and a Private Psychiatric Clinic located in the same area.

2. To see the distribution of the psychiatric illnesses according to sociodemographic variables of those patients in both the setups.

BACKGROUND- Both Private Psychiatric Clinic and Out Patient Department of Tertiary Care Centre provide psychiatric services for the bulk of our population. But there are not much studies comparing the above two in terms of sociodemographic profiles of the patients as well as the array of diagnostic spectrums that they present with in both these set-ups.

MATERIALS AND METHOD- Design of this study was prospective cross sectional. Total of 400 consecutive patients,200 from Psychiatric Out Patient Department of a Tertiary Care Centre and 200 from the chamber of a consultant psychiatrist in the same locality. They were diagnosed using ICD-10 criteria. The data obtained was analysed using SPSS Version 21.

RESULTS- We have found that most of the patients belong to the age group of 21-40years (59%vs47.5%),were males(61.5%vs57%),hindus(52.5%vs60%) mostly illiterate(40%vs30%) in both set-ups. However, in Tertiary Care Centre patients came mostly from lower class (48.5%) while in Private Psychiatric Clinic patient came mostly from upper middle and upper class (78.5%). Regarding diagnostic spectrum,a significant difference was observed only in the category of F40-F48(11.5%vs23.5%).

Few significant differences were observed between the two setups particulary in relation to age and socioeconomic status.

In F30-F39 group, we found, higher number of cases in Tertiary Care Centre than Private Psychiatric Clinic in the age group of 21-40yrs(29 vs 15) whereas,reverse in the age group of 41-60yrs(7vs27).

Patients from upper middle class belonging to category of F20-F29 and F30-F39 preferred private psychiatric clinic more than tertiary centre..

KEYWORDS - Clinical variables,Psychiatry OPD,Private Psychiatric

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

333 Opioid Substitution Therapy: An understanding from a tertiary care center in North India

Praveen Rikhari ¹, Vishal Sinha ², Ashutosh Kumar ³, Narveer Yadav ⁴, Rohit Singhal ⁵, Urvashi Kumar ⁶, Arvind Kumar Singh ⁷, Akhilesh Kumar ⁸

INTRODUCTION

Injectable Opioids use is one of the most widely used and problematic illicit substance used. Opioid substitution therapy (OST) is a tested, effective and evidence-based intervention for opiate-dependent persons that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine and methadone. In India, the All India Institute of Medical Sciences started Buprenorphine for opioid dependence as “long-term maintenance” in 1989. The drugs used are costly as such, but in government aided OST centres these drugs are being provided free of cost to relieve the financial burden on these patients. Substantial improvement in physical and mental health and general wellbeing of IDUs on substitution therapy is noted in various studies. What has been achieved till date needs introspection.

AIM

To study the sociodemographic variables, HIV status, comorbid substance use pattern and required dose, follow up pattern, level of satisfaction, improvement in quality of life and challenges with buprenorphine dosing used for treatment of injection drug users (IDUs) in patients attending oral substitution therapy (OST) centre at a tertiary health care centre.

METHODOLOGY

The study is a retrospective cohort study with purposive sampling.

IDUs aged 18–60 years enrolled and attending the OST centre of a government medical college and teaching hospital in north India in the last four years in the study.

RESULTS AND DISCUSSION

To be presented during conference.

KEY WORDS OST, IDUs, Buprenorphine, HIV

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

334 Consultation Liaison Psychiatry: An experience from a tertiary care government hospital of North India

Urvashi Kumar ¹, Vishal Sinha ², Ashutosh Kumar ³, Narveer Yadav ⁴, Rohit Singhal ⁵, Praveen Rikhari ⁶, Akhilesh Kumar ⁷

INTRODUCTION

Psychiatric symptoms may be a direct expression of an organic disorder, an indirect effect of the burden of severe illness (e.g. in the form of affective or anxiety disorders), or totally independent of the somatic reason for the hospital stay. Consultation-liaison psychiatry provides professional psychiatric care to hospital patients of other medical disciplines who are primarily admitted for somatic reasons and in whom comorbid psychiatric symptoms become evident at admission or during the course of their hospital stay. Consultation Liaison Psychiatry is one of the important subspecialties of Psychiatry which is under emphasised at undergraduate as well as post graduate level.

AIM

To recognize the scope and role of consultation liaison psychiatry in a tertiary care government hospital of North India.

OBJECTIVES

To look for the most frequent reason for referrals
The timeline delay before seeking psychiatric consultation
To explore the most common medical comorbidity associated with psychiatric illness
To find out most common psychiatric diagnosis and the most frequent management

METHODOLOGY

This will be an observational study

All the in- patients whose written referrals would be received from various departments of SNMC,Agra during April 2018 – March 2019 will be included in the study

RESULTS AND DISCUSSION To be presented during conference

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

335 ABSTRACT Reasons for choosing alternative treatment methods among patients attending Psychiatry Out-patient Department of a tertiary care private hospital.

Gokul Raj ¹, Shiny John ²

Background

Complementary and alternative medicine (CAM) encompasses modern or rejuvenated ancient practices that are claimed to have preventive or curative medical effects. From shamanic rituals to meditation and retreats CAM has gained a parallel course with mainstream psychiatric treatments. Recent evidences testimonialize the significantly increased worldwide use of CAM.¹ This pilot study aims to comprehend the reasons for the preference of CAM among the patients attending the psychiatry OPD of a tertiary care private hospital.

Materials and Methods

This was a hospital-based cross sectional study in which data from 340 patients who visited psychiatry OPD over a period of two months was collected. Reasons for CAM use were studied using a structured questionnaire ² with 20 questions; each being rated on a five-point scale from 1 (not at all important) to 5 (extremely important).

Results

Out of the 340 subjects 67.9 % had history of CAM use for psychiatric disorder. Majority (71%) had the history of use of more than one type of CAM. Ayurveda and Folk remedies were the popular choices among CAM users. The findings of our study suggested that most common reasons for choosing CAM were side effects of conventional medicines, dissatisfaction with conventional practitioners, misconception that CAM are safer compared to conventional therapy and the holistic approach of alternative treatment methods which gave patients a sense of autonomy.

Conclusion

This study alarms us regarding the reasons for patients being overtly enchanted by CAM for treating psychiatric illnesses. Modern medical practitioners should be aware about this possible dependence on the polypharmacy among their patients. The entangled religious and cultural traditions behind CAM, which is pronounce in many cases, make it a socially sensitive topic and calls for more diplomatic skills in planning the treatment.

Key Words

Complementary Therapies; Alternative Medicines in Psychiatry; Social Psychiatry

Reference:

1.Rudra S, Kalra A, Kumar A, Joe W. Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014. doi: 10.1371/journal.pone.0176916. [DOI] [PMC free article] [PubMed] [Google Scholar]
1.Vincent C, Furnham A. Why do patients turn to complementary medicine? An empirical study. Br J Clin Psychol. 1996 doi: 10.1111/j.2044-8260.1996.tb01160.x. [DOI] [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

336 TITLE- DIFFERENCE IN CLINICAL CHARACTERISTICS IN BIPOLAR AFFECTIVE DISORDER WITH PSYCHOTIC SYMPTOMS AND BIPOLAR AFFECTIVE DISORDER WITHOUT PSYCHOTIC SYMPTOMS.

PRIYANK JAIN ^1,^✉, PARAMJEET SINGH, LALIT BATRA, PYARE LAL BHALOTHIA, MANISH KUMAR GOYAL

INTRODUCTION - It is believed that bipolar disorder with psychotic symptoms have a serious course than bipolar without psychotic symptoms, but there is limited literature which compare phenomenological difference in both group.

OBJECTIVE - To compare phenomenological difference between bipolar disorder with psychotic symptoms and bipolar disorder without psychotic symptoms.

METHOD - Patients admitted in psychiatric centre Jaipur between 1^st September 2017 to 31^st august 2018 with the diagnosis of bipolar disorder was included. Diagnosis was made according to ICD 10 and confirmed by 2 psychiatrist of the centre.

RESULTS- Total 129 patient was taken. Bipolar mania with psychotic symptoms patients was 65 (37 male, 28 female) in which delusion of grandiosity, paranoid delusion were mainly present. Bipolar depression with psychotic symptoms was 37 (24 male and 13 female) and delusion of guilt, paranoid delusion, hypochondriasis and poor insight were mainly present. In bipolar disorder with psychotic symptoms group early onset of disease, bipolar I diagnosis, frequent hospitalization and suicide attempts were more common compared to bipolar without psychotic symptoms group.

CONCLUSION- The study concluded that bipolar affective disorder with psychotic symptoms has more various clinical characteristics than bipolar without psychotic symptoms.

KEY WORDS- Bipolar disorder, Clinical characteristics, Psychotic symptoms.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

337 Title: Assessment of neurocognitive profile in patients of Obsessive Compulsive Disorder, Depression (currently in remission phase) and Healthy Controls

RIPU DAMAN SINGH ¹, KK VERMA, RAKESH GARHWAL, GIRISH CHANDRA

Abstract: Background: Obsessive-compulsive disorder (OCD) and Depression are often disabling conditions, causing significant distress to the affected person. Brain imaging studies have suggested a putative fronto-striatial biological basis for the neuropsychological deficit in OCD. Despite inconsistencies, there are substantial empirical evidence for impairment in the cognitive functioning of patients with obsessive-compulsive disorder (OCD). Similarly Depression is also known to effect the cognition. Very few studies were conducted on neuro-cognitive functions in patients of OCD and Depression (currently in remission) in our geographical area.

Objectives: To assess and compare the neuro cognitive functions in patients of Obsessive-compulsive disorder (OCD), Depression (both currently in remission) and healthy controls.

Material and methods: This was a cross sectional study, carried out in the outpatient unit of department of psychiatry at tertiary care centre of western Rajasthan. Total 30(N) patients of OCD(n=15) and Depression(n=15) currently in remission phase were selected after applying inclusion and exclusion criteria and 15 subjects were included in control group, were assessed on Semi structured socio-demographic profile sheet, Semi structured clinical Proforma and Neurocognitive tests (Digit span test, Trail Making Test, Test for verbal retention, Visuo-spatial working memory matrix).

Result: All groups were comparable in sociodemographic variables (p>0.5). On neurocognitive test, patients with OCD and depression did not show impairments comparable to healthy controls. Similarly an attempt to correlate the test findings with the duration of illness and type of obsession with the cognitive impairment was made and it was found that there was no correlation between these two.

Conclusions: Hence the present study does not provide any evidence for neurocognitive deficit in patients of OCD and Depression currently in remission phase in comparison to healthy controls.

Key-words:

OCD, Depression, Neurocognition

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

338 STUDY ABSTRACT Title: A comparative study on emotional intelligence and personality traits among male alcoholics and non-alcoholic males

Shruthi K ¹, C Kavitha, P Poorna Chandrika

BACKGROUND

Emotional intelligence in general is the ability to perceive, control and evaluate emotions of a person and his surroundings. Researches on mental wellbeing and adequate emotional intelligence are being constantly conducted. Moreover, it is a known fact that the personality traits influence almost everything. Considering that alcoholism remains a major public health problem in our society, the current study has been planned with an aim to compare the level of emotional intelligence and personality traits among male alcoholics and non alcoholic males.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted for a period of 2 months with the study participants of 40 alcohol dependent males of age 20-45 years attending the OPD or admitted in the wards of Institute of Mental Health diagnosed as alcoholics according to ICD10. The comparison group included 40 non-alcoholic males matched as per age, education and socio-demographic status. The universal sampling method was employed and all male patients and normal males satisfying the inclusion & exclusion criteria were enrolled. All study participants were interviewed face-to-face using a semi-structured schedule for their socio-demographic attributes. In addition, Singh’s Emotional Intelligence Scale and Eysenck Personality Questionnaire, AUDIT and CIWAR-Ar were used to compare the emotional intelligence and personality traits between the 2 groups.

RESULTS

So far the study shows low emotional intelligence and deviant personality traits in alcoholics compared to non-alcoholics. Results are yet to be refined.

CONCLUSION

The systematic assessment of personality and emotional intelligence is expected to aid in minimizing the rates of relapse among alcoholics.

KEYWORDS: Emotional intelligence, Personality, Alcoholics

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

339 Schizophrenia and Eating disorders: A case report and critical analysis

Priyanka Hooda ¹, Lokesh Shekhawat ²

INTRODUCTION:

Schizophrenia is a major mental illness with a lifetime prevalence rate of 1.4%. A variety of symptoms are known to occur during the course of Schizophrenia which are not related to core symptoms of psychosis. In this context, it is important to note that symptoms of anorexia are observed in 1-4% of patients with diagnosis of schizophrenia. Psychosis has been estimated to occur in 0-13% of patients with primary eating disorders.

The following case report illustrates a case with the challenges in diagnosis and management.

CASE REPORT:

An 18 year old female presented with a ten month history of delusion of control (made volitional acts, made feelings), delusion of persecution, delusion of reference, auditory hallucination (3^rd person) with decline in socio-occupational functioning fulfilling the diagnosis of schizophrenia.

On evaluation after admission, history revealed a 6 kg loss in weight in the year preceding the onset of illness associated with body image distortion and change in diet and physical activity to get rid of perceived excess fat even though she was underweight. Patient developed Oligomenorrhoea progressing on to amenorrhea. Patient was screened using Eating disorder diagnostic scale(EDDS) – DSM-5 and then subjected to thorough psychological evaluation. Patient improved on pharmacological and psychological interventions targeting both schizophrenia and eating disorder.

DISCUSSION:

Eating disorders are known to occur during prodrome and also comorbid with Schizophrenia. While the former may require the usual treatment, the later requires targeted intervention as is the case here.

CONCLUSION:

The case illustrates the importance of recognition of eating disorder as an independent entity and providing targeted intervention rather than dismissing it as a part of psychosis.

KEYWORDS: Schizophrenia, Prodrome, Anorexia, Eating Disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

340 Title: Nomophobia prevalence, its determinants and relationship with internet addiction - A study among Indian medical students.

Pragati Bhatnagar ¹, Kuldeep Singh Yadav ², RK Solanki ²

Background: Techno culture has become an integral part of our life. But, it comes with its own demerits. Internet addiction and nomophobia are alarming problems associated with use of gadgets.

Objective: 1) To determine the prevalence of internet addiction and nomophobia in medical students.

2) To determine physical health issues caused by excessive use of smartphone.

3) To establish determinates of nomophobia and its relation with Internet addiction.

Methodology: A cross sectional study conducted on 200 internship students in Department of Psychiatry, SMS Medical College. A self-developed semistructred questionnaire was used for the interview after taking written consent from the students. Later internet addiction test (IAT) and nomophobia questionnaire (NMP-Q) was applied on the students and appropriate data analysis was done.

Results: The prevalence of internet addiction and nomophobia in medical students was 95% and 100% respectively. Most of the students belong to moderate nomophobia (62.5%) and moderate internet addiction (72.5%) group.. Nomophobia was statistically significantly higher in females, hostelites and students spending more time on smartphone. It also had statistically significant lower values in students indulged in physical activities and having adequate sleep duration. Nomophobia was also strongly correlated with internet addiction. Moreover Excessive smartphone use also leads to textneck, ringixiety eyestrain etc.

Conclusion: Nomophobia is an emerging new problem which had greatly affected medical students. Nomophobia is more common in students exhibiting internet addiction. Many of the factors affecting nomophobia can be modified.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

341 Title: Biological Rhythm in remitted Bipolar Disorder patients in comparison with normal controls

Kartik V K ¹, Savitha Soman, Rajesh Krishna Bhandary

Introduction: From earliest times, psychiatrists have described biological rhythm disturbances as characteristic of mood disorders and it appears to affect the course and prognosis of the disorder negatively. The main aim of the current study was to assess the biological rhythms in remitted Bipolar disorder patients and compare them with normal controls. Any association between clinical variables and biological rhythms in remitted bipolar disorder patients was also explored.

Materials and Methods: This was a cross-sectional, hospital-based study. 86 patients with Bipolar disorder and 86 normal controls who met the inclusion and exclusion criteria were enrolled for the study. Remission was ascertained via DSM-5 criteria and using YMRS (scores below 6) and HDRS (scores below 7) scales. Socio-demographic and clinical details were recorded. The Biological rhythms interview for assessment in neuropsychiatry (BRIAN) was used to assess the biological rhythm disturbance.

Results: Bipolar patients showed greater biological rhythms alteration compared to normal controls (BRIAN total scores 35.28 ± 5.37 vs. 29.85 ± 4.96, p<0.001). In particular, patients were more impaired than controls in the domains of sleep (8.44 ± 2.22 vs. 6.49 ± 1.41, p<0.001) and social rhythms (7.51 ± 1.49 vs. 4.76 ± 0.90). Residual depressive symptoms were also found to have a significant correlation with biological rhythms (r= 0.525, p<0.001) Conclusion: These findings suggest a potential link between biological rhythms and the pathophysiology of bipolar disorder. It also underscores the significance of novel instruments such as the BRIAN, which allow us to investigate biological rhythms disturbance in psychiatry. Rhythm disturbances appear to persist even after patients attain remission. Interpersonal Social rhythm therapy has a good adjunctive effect in reducing residual symptoms by reducing social rhythm irregularity.

Key words: Bipolar Disorder, Biological Rhythm, BRIAN, Circadian Rhythm

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

342 TITLE: Depression and Deficiency of Vitamins and Minerals: coexistence and response to treatment.

Chitra Singh ¹, Himanshu Sharma ², RK Solanki ³

TITLE- Depression and Deficiency of Vitamins and Minerals: coexistence and response to treatment.

BACKGROUND

The common but important yet ignored nutrient deficiencies like vitamin B12, folic acid, iodine and calcium leads to symptoms similar to depression and even accentuates some behavioural and mood disorders.

The female in reproductive age group with the paediatric and geriatric populations share more than 70% of the burden and tends to be the population susceptible to disorders as common as depression.

Methodology

The study had a sample size of 200 o.p.d patients at psychiatry centre, SMS medical college and Hospitals, Jaipur, diagnosed with depression, in accordance with I.C.D.10 criteria, confirmed by a senior psychiatrist and severity of Depression evaluated by standard Beck depression inventory(B.D.I) scale. Blood samples for Vitamin B12, Serum Folate, SerumT3, SerumT4, SerumTSH, Serum Calcium and Serum Phosphorus were taken, evaluated and compared to B.D.I scores. They were treated for their respective deficiencies, evaluated again and compared to previous scores.

RESULTS & CONCLUSION

We found a significant and negative correlation with levels of Vit B12 and folate levels compared with B.D.I scores.

There was a positive significant correlation between Thyroid levels and calcium levels compared with B.D.I scores.

The patients were treated for their respective deficiencies and evaluated again; there was a significant improvement in their B.D.I scores and symptoms pertaining to depression and mood disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

343 Title- Study of Emotional intelligence and Perceived stress among medical undergraduates Students.

Somesh Anand Pattan ^1,^✉, Sudarshan CY ², Anupama M ²

Background and Aim : Emotional intelligence is essential in doctors for optimum patient care. Medical profession is considered as one of the most stressful profession. Good emotional intelligence enables a person to reduce his stress levels. Emotional intelligence skills can be enhanced through awareness and practice. Present study evaluates emotional intelligence & stress levels and relation between them in Indian medical students.

Methodology: After obtaining informed consent and eliciting sociodemographic data, Quick emotional intelligence self assessment scale and Perceived Stress Scale were administered to 2^nd year undergraduate medical students. Statistical analysis was done using SPSS - Version 22.

Results - 61.2% of sample was aged less than 20 yrs and 54.4% were females. The mean scores on all the domains of emotional intelligence were in the range of effective functioning and needing strengthening. Gender difference were observed with respect to emotional intelligence. 69% of samples had moderate stress. There was no gender difference with respect to levels of stress. Levels of stress was not related to emotional intelligence

Discussion and conclusion – Medical undergraduate students had good emotional intelligence and moderate levels of stress. Levels of stress were not related to emotional intelligence. Longitudinal assessments are essential to detect changes over time to institute appropriate enhancement and intervention strategies.

Keywords- Emotional intelligence, Perceived Stress

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

344 Phenomenology of the subtypes of delirium: A study from central India.

Aditi Patel ¹, GK Vankar ², Srikanth Reddy ³

Background: To assess the psycho-pathological features among the patients of delirium being referred to the psychiatry department and to explore the possible etiological factors.

Methods: Hundred cases of delirium as diagnosed by DSM-V criteria were assessed on Delirium Rating Scale-Revised 98 (DRS-R-98), amended Delirium Motor Symptom Scale (DMSS) and delirium etiology checklist. Different motoric subtypes of delirium were compared with each other for symptoms of delirium as assessed by DRS-R-98.

Results: 72% of the patients were categorized as hyperactive delirium, this was followed by the mixed subtype (18%) and lastly the hypoactive subtype (10%). Among the various symptoms present, most patients had disturbances in sleep-wake cycle, affect liability, thought process, motor agitation, orientation, and attention. The least common symptoms were motor retardation and delusions. The most common etiologies associated with delirium were metabolic and endocrine disturbances followed by systemic infection, organ insufficiency, other systemic causes and drug withdrawal.

Conclusion: Hyperactive delirium was the most common subtype of delirium seen in the referral population. Delirium is most commonly associated with metabolic and endocrinal disturbances. The symptom profile of delirium is mostly similar across different age-groups.

Keywords: delirium, motor subtypes, etiology.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

345 Title- Coping skills and Emotional states in School teachers

Vanishree BN ^*,^✉, Sudarshan CY ^**, Shamshad Begum ^***

Background - Psychological health of teachers is essential to contribute for all round development of children. Psychological health is related to coping skills. Adaptive Coping skills reduce psychological distress, enhance psychological well being and personality development. The present study assesses the relationship between Coping skills and emotional states in teachers.

Methodology- In 103 school teachers after obtaining informed consent and recording socio demographic data, Coping skills were assessed using Brief Cope scale(28 items). Emotional states (Depression, Anxiety and Stress) was assessed using DASS-21 scale. Coping skills were correlated with emotional states. Statistical analysis was done using SPSS- Version 22.

Results- 47.6% of the sample were aged between 30-39 years, 88.3% were females. Planning, active coping and acceptance were the most common adaptive coping skills used. Maladaptive coping skills like denial, self blame and behavioural disengagement were used infrequently. There was significant positive correlation of frequent use of maladaptive coping skills like denial, behavioural disengagement, venting & self blame with depression and self blame & denial with stress. There was significant positive correlation of frequent use of adaptive coping skills like emotional support & instrumental support with depression, humor & emotional support with anxiety and Instrumental support, positive reframing & humor with stress.

Conclusion- Disturbed emotional states were significantly correlated with both adaptive and maladaptive coping skills. Adaptive coping skills have to be enhanced and maladaptive coping skills have to be minimized.

Keywords-Coping skills, DASS-21, Brief Cope Scale.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

346 TITLE: Prevalence of excessive internet use and its correlation with associated psychopathology in students of XI and XII standard

Nitin Kumar ¹, Arvind Kumar ², Manish Kandpal ³

Background - In recent years, there has been an explosive growth of internet use. Despite its uses, internet is liable to be abused and have potential adverse effects on users. Excessive internet use is associated with various psychiatric comorbidities (ADHD, depressive symptoms, low self-esteem, suicidal ideas and anxiety disorder) as reported in literature. We did a community-based study to assess the prevalence of excessive internet use in high school students. To study the extent of internet use in students of XI and XII standard and the psychopathology if any associated with excessive internet use.

Method- We conducted a cross sectional study of 426 students of class XI and XII from Kendriya Vidyalaya, New Delhi fulfilling the inclusion criteria and assessed by Young’s Internet Addiction test (IAT) and Strength and Difficulties Questionnaire (SDQ). Appropriate analysis by comparison and correlations were performed.

Result- Participants ages lied in the range of 16-18years. Among 426 students, the mean internet addiction total score was 36.63 ± 20.78 which indicated mild level of internet addiction. And 1.41 % (n=6) was diagnosed as excessive internet users, while 30.28% and 23.94% were classified as moderate and mild internet users respectively. Prevalence of excessive internet use was significantly higher among males as compared to females (p<0.001). Both positive (pro social) and negative impact (hyperactivity, emotional, conduct and peer problem) of Internet use were reported by students in this study. Further, excessive use of internet had negative impact on student lives as compared to positive impact, which was statistically significant (p<0.001).

Conclusion: Internet use is common among school children. Our Results showed that the prevalence may vary based on gender and academic stream of students. Its impact on mental health and academic performance may be negative, further studies in this area are warranted.

Keyword : Excessive internet use, prevalence, psychopathology.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

347 Title: Burnout and Stress Level among medical postgraduates in a medical college

Galina Lisa D’Souza ¹, Safeekh AT ², Siddharth Shetty ³

Category: Free paper

Background

Stress and burnout among postgraduates have implications for patient care and the health and well-being of the professional community. Sources of such stress in resident training can be divided into three components: situational (workload, sleep deprivation, and poor learning environment);personal (family, isolation, and financial); professional (overwhelming patient responsibility and information). Stress resulting from the discrepancy between the individual’s ideals or expectations and the reality of occupational life is a source of burnout.

Burnout is a “syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment”

higher levels of burnout among residents are associated with perceived suboptimal patient care and decreased effectiveness

Objective

· To understand the domains most affected with burnout and stress

· To compare stress levels among postgraduates of various years and specialties

Methodology

It is a cross sectional study involving 178 medical postgraduates consenting for the study were. Self administered questionnaires will be applied -perceived stress scale and Copenhagen burnout inventory Inclusion Criteria include Medical Postgraduates from clinical,paraclinical and preclinical branches. Undergraduates and allied health postgraduates and those with a prior/current history of psychiatric illness were excluded

Results:- Will be discussed shortly

Conclusion:- Will be discussed shortly

Key words

perceived stress scale, copenhagen burnout inventory,stress,burnout

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

348 Dissociative convulsion as an atypical phenotype of Fungal Meningitis: A case report

Parth Pratim Datta ¹, Kislaya Mishra, Shobhit Garg, Sumit Khatri

Introduction: Dissociative phenomenon are not uncommon in neurological disorders such as Migraine, epilepsy (as comorbid Psychogenic nonepileptic Seizure (PNES), vestibular disorder and part of presyncope. We report a rare case report of dissociative phenomenon (convulsions) as a prodromal phenotypic expression of subsequent diagnosed case of fungal meningitis.

Case: We present a case of young adult unmarried male who presented to hospital emergency with complaints of sudden onset headache followed by transient altered behavior with impaired reality testing lasting for few hours. Patient subsequently complained of generalised headache with fluctuating intensity and no nausea or vomiting and transient response to NSAIDs. Transient fever was present during initial few hours of admission. Patient would start to throw periods of unresponsiveness with stiffening of body, clenching of teeth and wrists, thrashing movements and agitation frequently associated with vomiting. Episodes lasted for few minutes and relieved immediately on giving placebo injections. Interictal EEG was normal study. No evidence of injury or incontinence was seen.

Due to undulating headache transient response to headache, neurology opinion was sought and was ordered for lumbar puncture despite initial neuroimaging being normal study and was found positive for cryptococcal meningitis and subsequent HIV screening.

Discussion: Dissociative processes are traditionally expressed via detachment processes induced by variety of organic processes affecting cerebral function. It can be explained by the process of ‘compartmentalization’ – a process whereby the mind fragments into separate compartments in response to extreme stress, occasionally attributed to underlying organic pathology.

This case would emphasizes the need to rule out all possible organic etiologies prior to making a purely dissociative diagnosis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

349 Comorbidity of Smartphone and Internet addiction in Generalized Anxiety Disorder and Major Depressive Disorder

L Chingkheileima ¹

Background: Smartphone device and Internet has become an essential commodity at present but with a price of negative consequences in various aspects of life starting from one’s academic and working performance to family life, social relationships and most importantly their physical health and psychological well-being.

Methodology: A cross-sectional study was conducted in Department of Psychiatry, RIMS Imphal. The study included two populations: Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD) patients, with a sample size of 73 each. Consecutive sampling method was used and data collected using semi-structured questionnaire for the socio-demographic profile and standard questionnaires: HAM-A and HAM-D for assessing the severity of anxiety and depression; short version of Smartphone addiction scale for smartphone addiction and Modified Young’s Internet Addiction Scale for Internet Addiction assessment. The data were analysed in SPSS version 21. Descriptive statistics, Chi-square test, Fisher’s Exact Test and Pearson correlation were used for the analysis. P-value < 0.05 was taken as significant.

Result: The study shows higher prevalence of Smartphone and Internet addiction in GAD group (48% and 27.4% respectively) as compared to MDD group (35.6% and 23.3% respectively). Smartphone addiction was found to be more in females whereas internet addiction more in males in both the study population. HAM-D score was found to have significant negative correlation with Smartphone Addiction scale scores (-.301 p .010). HAM-A score has significant negative correlation with smartphone addiction (-.329, p .001) and internet addiction (-336, p .004).

Conclusion: The present finding confer significant clinical implications in appreciating that the comorbidity of Smartphone and Internet Addiction with anxiety and depression.

Keywords: Smartphone addiction, Internet Addiction, Generalized Anxiety Disorder, Major Depressive Disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

350 TITLE - Behavioural disturbance of stroke syndrome

Amrendra Kumar Singh ¹, PRADEEP KUMAR ²

INTRODUCTION –

Stroke is one of the most common causes of mortality and morbidity in the world. Change of lifestyle, overwhelming stress and strains in all spheres of life, dietary habits and over competitiveness with a sustained struggle for existence have significantly increased the risk of hypertension and eventually cerebro-vascular accidents.

Since long behavioral disorders have been noticed by various clinicians and investigators as one of the most relevant disabilities of stroke syndrome. Such behavioral manifestation was merely considered a reaction to a devastating morbidity. In view of psychological reaction to any stress, disease or disability, much emphasis was give to this aspect.

However, with the advent of recent advances of technology, various non-invasive techniques like computerized tomography, MRI, PET, autoradiography of brain, various radio isotopic methods for evaluation of regional cerebral blood flow etc. Have given us a better understanding of Neuro-physiology and Neuro-psycho-pharmacology, electrophysiology, regional cerebral blood flow and overall picture of central synaptic transmission. Concentrated efforts using aforesaid technique provided us with ample evidence in favor of biological substratum of psychiatric manifestations following a stroke syndrome. As a result, there has been a resurgence of interest in proper identification of various organic psychiatric disorders, their underlying mechanism, anatomical and clinical correlations and overall management using various pharmacological agents.

It’s a general consensus that psychiatric symptoms play a pivotal role in symptoms formation and the overall disability of stroke syndrome. Very often due to superimpose of psychiatric disorders, the overall disability due to stroke syndrome per-se get exaggerated than the real magnitude of illness. It is therefore imperative to identify associated psychiatric disorders following cerebro-vascular accident more effectively and a holistic bio-psychosocial approach should be directed to achieve better result.

Keeping all these in view the present study was envisaged with the following aims and objectives.

AIM – to study post stroke psychiatric manifestations.

OBJECTIVE –

To study the clinical picture and etiological factors of stroke syndrome.
To evaluate the magnitude of various psychiatric disorders following stroke
To study the clinical profile of psychiatric disorders following stroke syndrome.
To correlate clinical phenomenology of psychiatric disorders with various clinical variables including nature & site of lesion.

METHDOLOGY -

Study design – case control study
Study site- Department of psychiatry SSMC REWA
Study duration- 18 months
Study sample- 90

Inclusion criteria

Patent of stroke syndrome coming in psychiatric OPD, IPD, geriatric OPD with or without aberrant manifestation.
Patient of strokes in acute phage as well as within 6 month of stroke will be included in the study.
No age bar.
Either sex
Patient giving written informed consent

Exclusion criteria

severe medical emergencies
Unconsciousness and cognitive decline.
Past h/o neuropsychiatric disorders.
Mental retardation.
Lack of consent.

Tools

Psychiatric rating scales (MBPRS, HAM-D, HAM-ANXIETY, Yale’s mania rating scales), for psychosis, depression anxiety and mania respectively.
Those patients fulfilling specific diagnostic categorisation on the basis of ICD-10 DCR will be subjected to quantification of the disorders using authentic rating scale.
WHO- SCALE (Quality of life).
NIH STROKE SCALE.

PROCEDURE –

The study will commence following the approval from department of scientific committee and institutional ethical and scientific committee.

The patients will be hospitalized whenever indicated.

All the patients will be evaluated using semi structural proforma for socio-demographic and clinical variables.
Detailed general and systemic examinations will be recorded and special emphasis will be given to higher functions consisting neurological and mental status examinations.
Psychiatric diagnosis will be based on recent diagnostic criteria of ICD-10(DCR).
INVESTIGATION: Routine baseline as well as specific investigation as given in proforma (LFT, KFT, Blood sugar, s. cholesterol)as and when indicated.
NEUROIMAGING: CT/MRI will be done in each patient to determine the site of lesion and nature of stoke.
Fundus will be examined in all patients.
ECHO will be done whenever required.

The sample of the study will be comprising of 90 patients of stroke syndrome

Attending psychiatric OPD, IPD and geriatric OPD fulfilling selection criteria.

The final psychiatric evaluation and their respective diagnosis will be made only after a period of 3 weeks to avoid the confounding variable of acute emotional turmoil.

Assessment of pre and post stroke psychosocial variables will be done.

The opinion of medical consultation will be done whenever needed.

Statistical analysis The results will be subjected to statistical analysis using student’s t-test (continuous variables) and chi-squared test (categorical variables) to achieve significant of various clinical variable(p=<0.05)

Result and discussion: As study is going the analysis will be done using SPSS v21by appropriate statistical analysis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

351 Gender difference in the progression of Alzheimer’s disease in patients attending a tertiary care hospital in northern India treated with donepezil

Faisal Shaan ^*, Rakesh Kumar Gaur ^**, Shahnawaz Mushtaq ^***

Background : Alzheimer’s disease (AD) disproportionately affects women in both prevalence and severity; however research on gender in the progression of Alzheimer’s disease treated with donepezil in India is very limited.

Method : We investigated changes in cognitive function by gender using data from geriatric psychiatry OPD from Jawaharlal Nehru Medical College, Aligarh Muslim University, treated with Donepezil. Method: Data of the first eight months of patients treated with donepezil were taken for the study. In the present study, patients diagnosed with Alzheimer’s disease using DSM 5 criteria and a functional assessment staging score of 4 or 5 were recruited. Cognitive functions were evaluated using Mini mental status examination (MMSE) and Clinical dementia rating scale (CDR) at baseline, two, six and eight months respectively. In our analysis, patients who had not been treated with donepezil were drawn, and their mean changes in the MMSE and CDR at each evaluation point were compared by gender.

Result and Discussion : The result of MMSE and CDR suggests a possible gender effect in the progression of AD in patients treated with donepezil.

Key words: Alzheimer’s disease, Gender, Donepezil

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

352 Attitude towards mental health among non-psychiatrist clinicians

Adesh Kumar Agrawal ¹, Soumitra Das ², BC Malathesh ³, Seshadri Sekhar Chatterjee ⁴, Sydney Moirangthem ⁵

Introduction : As mental health issues are being exceedingly incorporated among general basic medical care, attitude of non-psychiatrists is a pertinent topic for research. Firstly the literatures are fewer in India. Secondly, more replicative studies are needed to elucidate the current trends and updates. So, we did a survey to elicit attitudes of non-specialists and non-psychiatry specialists, towards mental illnesses and tried to look into the reasons behind it.

Methodology: After taking authors permission a google form link of a semi-structured porforma and Clinicians’ Attitudes Scale (MICA - 4) questionnaire was sent using Google form to non-psychiatry doctors. The scale consists of 16 questions (α=0.72) and is a validated and reliable tool. Links were sent to **** individuals of which, 112 responded.

Results: The study found mixed results with few positive attitudes with 89.3% clinicians attend on an average 1-10 patients with psychiatric comorbidity in a week, 80% clinicians preferred referring their patient to a psychiatrist. Negative attitude was characterized by aversion to screen their patient for having mental health problems (50%), & discomfort during talking to a mentally ill patient (47%). More than 3/4^th (86.00%) agreed that working in the mental health field is just as respectable as other fields of health and social care.

Conclusion : The interesting finding of the study was the change in the attitude towards psychiatry as a subject as compare to previous studies. However, stigma about mental illnesses and the mentally ill patient still persists among clinicians, which was evident through their discomfort in speaking to patients with mental illness and in screening patients for mental health issues. This also points that though the referral and accepting mental illness is improving the stigma, the subjective attitude of psychiatric illness is deep rooted and to be worked with differently. This points to the need for psychiatry as a separate subject during under graduate medical education and this will be the way forward for improve understanding of mental health disorders and attitudes towards mental health and mental health professionals.

References

1.V. Pande, R. Saini, S. Chaudhury. Attitude toward mental illness amongst urban nonpsychiatric health professionals. Industrial psychiatry journal. 2011;20(1) doi: 10.4103/0972-6748.98409. 17. [DOI] [PMC free article] [PubMed] [Google Scholar]
1.J. Gabbidon, S. Clement, A. van Nieuwenhuizen, A. Kassam, E. Brohan, I. Norman, G. Thornicroft. Mental Illness: Clinicians’ Attitudes (MICA) Scale—Psychometric properties of a version for healthcare students and professionals. Psychiatry research. 2013;206(1):81–87. doi: 10.1016/j.psychres.2012.09.028. [DOI] [PubMed] [Google Scholar]
1.Chandramouleeswaran S, Rajaleelan W, Edwin N. C, Koshy I. Stigma and attitudes toward patients with psychiatric illness among postgraduate Indian physicians. Indian journal of psychological medicine. 2017;39(6):746. doi: 10.4103/IJPSYM.IJPSYM_84_17. [DOI] [PMC free article] [PubMed] [Google Scholar]
1.Challapallisri V, Dempster L. V. Attitude of doctors towards mentally ill in Hyderabad, India: results of a prospective survey. Indian journal of psychiatry. 2015;57(2):190. doi: 10.4103/0019-5545.158190. [DOI] [PMC free article] [PubMed] [Google Scholar]
1.Hassan T. M., Asmer M. S, Mazhar N, Munshi T., Tran T., Groll D. L. Canadian physicians’ attitudes towards accessing mental health resources. Psychiatry journal. 2016:2016. doi: 10.1155/2016/9850473. [DOI] [PMC free article] [PubMed] [Google Scholar]
1.Wang J, Wang Q, Wimalaratne I, Menkes D. B., Wang X. Chinese non-psychiatric hospital doctors’ attitudes toward management of psychological/psychiatric problems. BMC health services research. 2017;17(1):576. doi: 10.1186/s12913-017-2521-8. [DOI] [PMC free article] [PubMed] [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

353 Title: Most common causes of relapse among alcoholics.

Mehraaj Sandhu ¹, Sandeep Choudhary ¹

Context: In the catchment area of our hospital Alcohol is the most common substance abused, and relapse prevention is a major challenge. Some of the most cited studies have reported an extremely high likelihood of at least one relapse in the lifetime of patients with alcohol dependence. Hence it is important to determine the most common causes of relapse and to tackle each cause individually for better long-lasting results. This is the inspiration behind the genesis of this study.

Aims and objectives : Study to Assess Factors Affecting Relapse in Alcohol Dependence patients.

Type of Study - Observational Cross Sectional

Type of Sampling -

Continuous sampling

Methodology : the present study was conducted on both outpatients and inpatients in a tertiary care hospital in Meerut, U.P., who have an established diagnosis of Alcohol dependence as per ICD-10 criteria, after taking written consent. The study sample was collected from 30 in-patients and outpatients with Alcohol Dependence using a semi-structured interview containing socio demographic variables and the reasons for relapse.

Results : Craving was found to be the most common reason for relapse (46.7%) followed by poor motivation (33.3%), family problems (23.3%), peer pressure (16.6%) and other reasons (10%). Among other reasons most common reason appeared to be boredom.

Conclusion : There are a multitude of reasons for relapse in Alcohol dependent patients. The conclusive implications will be discussed at the time of presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

354 Title: Emotional Intelligence: A comparative study between Medical, Engineering and Commerce undergraduates and their coping styles.

Abhinav Singh Meena, Manjeet Santre

Background: Emotional Intelligence (EI) is one of the essential parameters which helps to identify and manage one’s own and someone else’s emotions. It is seen that higher EI is correlated positively with, better social relationships, higher academic achievement and enhanced psychological well-being.

Aims and objective : This study aims to assess the level of EI in Medical, Engineering and Commerce Undergraduate students. The socio-demographic profile and coping strategy was assessed and correlated with the level of EI.

Materials and Method : It was a single interview cross sectional study. Study sample included 50 students each from three different colleges, i.e. a Medical College, an Engineering College and a Commerce College respectively. Ethics committee approval was obtained and only those students who fulfilled the inclusion criteria were included in the study. Students belonging to the second professional year of education who were willing to give consent were included. Students who were not willing to participate for the study along with students with severe mental and behavioural disorders were excluded. Socio-Demographic profile questionnaire, Modified kuppuswamy scale (year 2018), Schutte Self-report Emotional Intelligence Test and Brief COPE Inventory were administered. Results were tabulated and Statistical analysis was done.

Results: Mean EI was more for students belonging to commerce stream (124.48) followed by engineering (122.4) and then medical (120.86), however the findings were not statistically significant. Also, students with higher EI had positive coping strategies as compared to those with lower EI.

Conclusion: The lower levels of EI in medical students in comparison with students of other streams highlights its importance in the curriculum. It emphasizes the need to inculcate awareness regarding EI among medical fraternity and to include EI development programs.

Key words: Emotional Intelligence, Coping Styles, Undergraduate Students

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

354 Metabolic Syndrome (MS) and its relationship with clinical variables in psychiatric in-patients of a tertiary hospital in north

Ashish Narvariya ¹, Dinesh Sharma ¹, Ravi C Sharma ¹

Introduction: Patients with severe mental illness are at increased risk of developing metabolic disorders due to various factors like lack of exercise, use of psychotropic medications and inadequate medical care. Therefore this study has been undertaken to assess Metabolic Syndrome (MS) and its relationship with clinical variables in psychiatric in-patients of a tertiary hospital in north India.

Material and Methods: It was an observational cross sectional study. We recruited 146 participants aged 18-70 years with psychiatric illness admitted in the Psychiatry ward at IGMC, Shimla during the period of 1^stAugust, 2017 to 31^stJuly, 2018. Baseline anthropometric and clinical parameters were measured. International Diabetes Federation (IDF) criterion for diagnosis of MS was used. Statistical analysis was done using SPSS 20.

Results: The overall prevalence of MS was 33.6%. The prevalence was higher in females (54.7%) than males (25%) (p<0.05). Among the diagnostic subgroups, the prevalence was highest among patients with unipolar depression (62.5%), while it was lesser in patients with psychotic disorders (35.78%) and bipolar disorders (20%). Among the patients of Psychotic disorders prevalence was highest in Schizophrenia (41.53%) while it was lesser in Schizoaffective disorder (16.67%). MS was associated with long duration of illness and was present almost in every patient who had >30 years of illness. Although prevalence was slightly higher with 2^nd generation than 1^st generation antipsychotics treatment, however it was statistically insignificant.

Conclusion: Study shows that MS is highly prevalent among psychiatric in-patients and the results provide sufficient evidence to support the need for intervention studies and reinforce the requirement to conduct regular physical health checks for all patients with severe mental illness.

Key words: Metabolic syndrome, Psychiatric illness, Psychiatric inpatients.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

355 Difficult to treat schizophrenia: Is it time to update the definition?

Chandrima Naskar ¹, Sandeep Grover ^1,^✉

Background: The concept of Difficult to treat Schizophrenia (DTTS), as described 20 years back, is slightly different from the concept of treatment resistant schizophrenia (TRS). Many patients may not fulfill the criteria of TRS, but still have features which make them DTTS. The definition of DTTS considers features of inadequate response to conventional antipsychotics, problems of adverse drug effects, compliance, comorbid conditions and treatment failure (relapse on adequate drug dosage). However, this definition does not take into account features like inadequate response to atypical antipsychotics, which are now the most commonly prescribed agents. Similarly, the metabolic side effects although are seen with antipsychotics, conventionally only neurological side effects are considered while trying to categorise the patients as having DTTS.

Aim: To evaluate various clinical features among patients of TRS, which make them DTTS.

Methodology: For this study, 101 patients of TRS were evaluated for various clinical features, which possibly also indicated that these patients were additionally also having DTTS.

Results: About 67.3% of the patients had poor response to conventional antipsychotics, whereas 98% had inadequate response to atypical antipsychotics. Adverse effects with conventional antipsychotics were reported by 56.4% of patients, whereas adverse effects due to atypical antipsychotics were noted in 76.2%. About 74.3% of patients had problem with long term compliance in their lifetime. Medical comorbidity in terms of chronic physical illnesses was seen in 21.8% and psychiatric comorbidity was noted in 33.7% of the patients. Treatment failure in the form of relapse on regular antipsychotics was seen in 80.2% of patients in their lifetime. Additionally, these patients often had history of long duration of untreated psychosis.

Conclusions: In view of more frequent prescription of atypical antipsychotics, there is a need to have a broader definition of DTTS and possibly a need to have definite criteria to define the same.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

356 A Comparative study assessing diagnostic pattern of psychiatric disorders in Geriatric inpatients and outpatients across 6 month: Chart review from tertiary care hospital in Western Rajasthan.

PRIYANKA SHARMA ¹, Navratan Suthar, Ashok Kumar, GD Koolwal, Vinod Kumar, Sanjay Gehlot

Introduction: Geriatric patients attending psychiatric clinics have increased in the last decade, which is really a matter of concern. Most of the Indian states lack data about the pattern of psychiatric services use in geriatric population thus making it difficult to plan accordingly.

Aim: To comparatively study the patterns of psychiatric disorders and associated physical comorbidities in geriatric outpatients and inpatients in a tertiary care hospital.

Methods: Retrospectively 6 months data of all geriatric (age 60 years and above) patients who visited from 1 January 2018 to 30 June 2018 in a tertiary care hospital in western Rajasthan were extracted manually from the patient files. Data was analyzed by Statistical Package for Social Sciences(SPSS) version 20.

Results- Total 15004 patient’s data were analyzed out of which 2120 constituted geriatric patients. Ratio of geriatric inpatients department (IPD) and outpatients department (OPD) was 1:2. In IPD males were 5.73% and females were 1.65% while in OPD males were 9.31% and females were 4.81%. The commonest diagnoses in IPD males was Mood (affective) disorders (48.68%) and in IPD female patients was Schizophrenia (9.21%). While In OPD, both male and female patients most common diagnoses found was Mood (affective) disorders constituting 35.59% and 18.44% respectively. Hypertension and Diabetes Mellitus were the most common physical disorder found in both IPD and OPD geriatric patients.

Conclusion: Mood disorders, unspecified non organic psychoses and Organic including symptomatic mental disorders form a large group of mental disorders in both genders of geriatric outpatients and inpatients. Integrated mental health approach is required in India for geriatric well being Keywords: Geriatric, Psychiatric disorders, Inpatients, Outpatients, Mood Disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

358 Comparison of symptom profile of Catatonia in patients with Psychotic and Affective Disorders

Rahul Kumar Chakravarty ¹, Swapnajeet Sahoo, Sandeep Grover, Subho Chakrabarti, Ajit Avasthi

Aim: To compare the signs and symptoms of catatonia by using a broader list of signs and symptoms in patients with psychotic and affective disorders.

Methodology: By using cross-sectional study design, all patients presenting with catatonic signs and symptoms were assessed on a 46 items scale prepared by combining items from Bush Francis Catatonia Rating Scale (BFCRS), Northoff catatonia rating scale (NCS) and Catatonia rating scale(CRS).

Results: This study included 40 patients with psychotic illness and 32 patients with affective disorders who presented with catatonia. The most common catatonic symptoms were mutism (93.1%), autism (86.1%), staring (83.3%), loss of initiative (80.6%), flat affect (75%), posturing (72.2%), negativism (70.8%) and gagenhalten (55.6%). Comparison of psychotic and affective disorders group reveal lack of significant difference in the prevalence of various signs and symptoms except for the items of waxy flexibility (p=0.034) and jerky movements (p=0.045).

Conclusions: There are very few differences in the prevalence of various catatonic signs and symptoms between patients with psychotic and affective disorders.

Key words: Catatonia, Affective disorders, Psychotic Disorders

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

359 Schizophrenia and Eating disorders: A case report and critical analysis

Priyanka Hooda ¹, Lokesh Shekhawat ²

INTRODUCTION: Schizophrenia is a major mental illness with a lifetime prevalence rate of 1.4%. A variety of symptoms are known to occur during the course of Schizophrenia which are not related to core symptoms of psychosis. In this context, it is important to note that symptoms of anorexia are observed in 1-4% of patients with diagnosis of schizophrenia. Psychosis has been estimated to occur in 0-13% of patients with primary eating disorders.

The following case report illustrates a case with the challenges in diagnosis and management.

CASE REPORT: An 18 year old female presented with a ten month history of delusion of control (made volitional acts, made feelings), delusion of persecution, delusion of reference, auditory hallucination (3^rd person) with decline in socio-occupational functioning fulfilling the diagnosis of schizophrenia.

On evaluation after admission, history revealed a 6 kg loss in weight in the year preceding the onset of illness associated with body image distortion and change in diet and physical activity to get rid of perceived excess fat even though she was underweight. Patient developed Oligomenorrhoea progressing on to amenorrhea. Patient was screened using Eating disorder diagnostic scale(EDDS) – DSM-5 and then subjected to thorough psychological evaluation. Patient improved on pharmacological and psychological interventions targeting both schizophrenia and eating disorder.

DISCUSSION: Eating disorders are known to occur during prodrome and also comorbid with Schizophrenia. While the former may require the usual treatment, the later requires targeted intervention as is the case here.

CONCLUSION: The case illustrates the importance of recognition of eating disorder as an independent entity and providing targeted intervention rather than dismissing it as a part of psychosis.

KEYWORDS: Schizophrenia, Prodrome, Anorexia, Eating Disorder

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

360 SEXUAL DYSFUNCTION IN WOMEN WITH DEPRESSIVE DISORDER: A PROSPECTIVE STUDY

Swaleha Mujawar ¹, Suprakash Chaudhury, (BRIG)Daniel Saldanha

Sexual Dysfunction is not uncommon in women suffering from depression, but is less studied in India. Hence a necessity is felt to explore the attributes of female sexual dysfunctions and its relation to underlying depression and response to treatment. This will lead to effective treatment and enhancement of quality of life.

MATERIAL AND METHODS : This prospective longitudinal study was carried out at a Tertiary Care Hospital. Ethics Committee permission was acquired. The sample consisted of 53 consecutive females having recurrent depressive disorder as per ICD-10 DCR meeting the inclusion and exclusion criteria, which formed the study group. Equal number of age matched females without any past/ family history of psychiatric disorder formed the control group. The socio-demographic data, The Hamilton Rating Scale for Depression, Arizona sexual experience scale and Female sexual functioning index was recorded from both groups. All the patients were started on conventional lines of treatment and were re-administered the above 3 scales at the end of 6 weeks of treatment. The data entered in excel sheet and Statistical analysis done using the SPSS software package for windows, version 20.0.

RESULTS: There was an association between depression and sexual dysfunctions. A significant improvement in depression and sexual functioning was seen at the end of 6 weeks of antidepressant therapy. However, the individual domains of sexual functions were not comparable to the normal subjects at the end of 6 weeks suggesting a need for a longer treatment.

CONCLUSION: This study emphasizes the need for awareness, education for early detection and treatment of sexual dysfunction in depressed females. Since the patient may not come up with this problem on her own it is important to ask about sexual problems in depressed females and treat it so that the patient improves maximally.

KEY WORDS: depression, sexual dysfunction, females, women

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

361 A Cross-sectional study on level of satisfaction among patients and primary caregivers attending Psychiatry Department in a TCC

MONU DOLEY ¹, MONU DOLEY, KAMAL NATH, MADHURIMA KHASNOBIS

Background:- Level of satisfaction among patients and caregivers is the utmost important parameter of quality of healthcare services. As with other disciplines,the psychiatry department also lies at the core of community effort to care for individuals with major mental illness. Increase level of satisfaction leads to increase integration between general medical care and psychiatry and positive outcome.

Objectives:- To assess the level of satisfaction among patients/ care givers attending psychiatry department in this Tertiary Care Centre.

Materials and Methods:- The present study is a cross-sectional study,carried out at department of psychiatry in a TCC, situated at North-eastern part of India. A 210 consecutive patients / primary care givers >15years attending psychiatry department(180 OPD visit patient and 30 Inpatients admitted in Psychiatry Dept.)were taken as study subjects. A self-designed structured questionnaire to asses level of satisfaction was administered and responses were noted in term of excellent,good,fair and poor.

Results:- 210 study subjects were assessed. Most study subjects were of age group of 15-29years (49.5%). Majority(61.5%)were male. 33.5% educated upto high school,mostly from rural background (55.5%), daily wage earner(29.5%), married(51%) and 47 % belongs to upper lower class SES. Most patient(27.5%)visited psychiatry deptt. being reffered. It was found that,in OPD subjects 85% were satisfied with the cleanliness of the OPD. 22.5% feel excellent interacting with OPD doctors,with overall satisfaction of about 65%. However 76.6% study subjects reveals they feel more satisfied interacting with doctors in indoor ward. Inpatient care among study subjects it was found that 73.3% were satisfied with the different admission procedures explained by hospital staff. Most of the indoor study subjects(53.3%) feel comfortable of discussing private things to doctors in indoor ward.

Conculsion:- Highest satisfaction was in OPD was cleanliness(85%),subjects were least satisfied interacting doctors in OPD(35%),while feel more comfortable to interact in indoor(76.6%).

Keywords:- Patient,primary caregivers, satisfaction,OPD,Inpatients,Psychiatry Department,TCC.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

362 Cross-sectional comparative study on impact of Faith Healing Practices on Psychotic and Neurotic Patients attending Psychiatric

Sandeep Sharma ¹, K K Verma, Anant kumar Rathi, Girish Chandra Baniya

Background- Majority of population in our area still believe that the abnormality in the behavior of a psychiatric patients are actually caused by some kind of evil spirit, black magic or is a result of anger of god towards them. Result of such belief is that the patient is brought to the medical facility after visiting several religious places and faith healers thus jeopardising the welfare of such patients.

Aims and objective-

To examine the faith healing practices and impact of it on psychiatric patients.
To examine the socio-demographic profile of people approaching faith healers.

Material and methodology - It is a cross-sectional comparative study and total 200 close relatives of psychotic and neurotic patients were chosen on the basis of inclusion and exclusion criteria, from OPD of psychiatry department of tertiary care level hospital. Interview was done using detailed proforma and data was analyzed on SPSS ver.21.

Results - In this study the average age in the psychotic group was 34.80 and that in the Neurotic group is 36.58. Most common first carer for psychotic group was faith healer (54%) and second common was psychiatry department (39%). In sthe neurotic group most common first carer was psychiatric department (54%) and second common was the general practitioner group. Average expenditure was maximum when first carer was faith healer in psychotic group and minimum when the patient directly consulted the psychiatry department. In the neurotic group, expenditure was maximum when first carer was general practitioner group followed closely by general OPD of and faith healers.

Conclusion- A large number of patients doesn’t present themselves directly to mental health professionals. It was observed that significant number of patient come to psychiatric department of this hospital after consulting faith healers and religious places. it was observed that a significant number reached faith healer even when they have consulted Psychiatric OPD and have got relief from here. Thus it emerges that faith healers are a major player in the contemporary mental health scenario in this region of Rajasthan and they cannot be ignored.

KEYWORDS- Faith healing, Caregiver, Psychosis, Neurosis

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

363 TITLE: FACILITATORS AND BARRIERS TO MENTAL HEALTH SCREENING AMONG PREGNANT WOMEN: A CROSS SECTIONAL STUDY FROM A TERTIARY CARE HOSPITAL IN INDIA

Jagdish Varotariya ¹, Shubhangi Dere, Prabha Chandra, Rakesh Ghildiyal

Background & Aim: Mental health problems during the peripartum period can result in adverse effects on pregnancy outcomes, wellbeing of mother and infant. Efforts to improve screening protocols for timely intervention and effective management are warranted. However, in India we do not as yet have a formal screening program in the perinatal period. Before initiating psychosocial and mental health assessments it is important to understand women’ s perceptions about the same.

Aims- To understand pregnant women’s about routine mental health and psychosocial assessments in the perinatal period and study facilitators and barriers.

Methodology: This was a cross sectional study among 153 pregnant women attending the obstetrics out-patient department. Pre-validated and translated version of the Facilitator and Barrier (FAB) scale Kingston et al 2015 was administered to study attitudes towards getting screened for mental health as part of routine antenatal care. Data was collected and analyzed using descriptive statistics.

Result: On the FAB scale, majority subjects endorsed facilitator items like ‘their mental health during pregnancy can affect baby’s health in the future’, ‘need to be reassured about other women having emotional problems during pregnancy or postpartum’ & ‘need to know that there are many options for help, apart from medication’ (97.5%, 97.5% & 95% respectively). However, women also had several barriers- beliefs that ‘they would rather discuss their feelings with their partner, family or friends than with doctor’, ‘they would not want to be labeled or seen as depressed or anxious’, and ‘their partner, family and friends have told that the emotional swings are ‘’normal’’ and not to worry’ (67%, 65% & 65% respectively) were identified as commonest barriers towards screening for mental illnesses and psychosocial issues.

Conclusion: There was high acceptability of perinatal mental health screening among the pregnant women and women appeared to support routine screening during pregnancy and postpartum periods. Psycho-education regarding various mental health issues during perinatal period amongst not only patient but also the close relatives can be integral part of screening for mental illness.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

365 Relationship between Online Cognition And Personality Traits: A cross sectional study of medical students.

Nishant Ohri ¹, Srikanth Reddy, Puneet Tyagi, G K Vankar

Aims and Objectives

To assess the characteristics of online cognition in our subjects using Online Cognition Scale(OCS)
Compare OCS scores in context of demographic variables.
To assess personality using Eyesenck Personality Questionnaire, and analyse its relationship with online cognition domains.

Methodology A total of 163 subjects responded to the above mentioned questionnaires. Relationships between hours of internet use, OCS and personality were analysed using different statistical methods.

Results Mean age of the subjects was 20.03 years and the avreage years of use was 5.61 years. Subjects who felt that internet interfered with work/study had signifcantly higher number of hours of use. (z=2.31;p=0.02), and significanlty higher OCS scores (t=6.78;p=0.0001).

Mean OCS scores was 131.87(+/-30.09). Out of 163, 31.9% had ‘possible internet addiction’ and 19.6% had ‘internet addiction’.

Hierarchical regression revealed that Lie and Neuroticism contributed 21.8%(14.1%+7.8%) of variance in the OCS scores. Neuroticism was especially higher in subjects who scored high on impulsiveness and Loneliness/Depression subscales of the OCS.

Conclusion We observed significantly higher mean OCS scores in men, in people who thought that the internet interfered with their lives and in those who felt the need to cut down their use. A moderate positive and significant correlation was observed between weekly duration of internet use and OCS scores.

Also, Significant positive correlation was observed between Neuroticism trait and OCS, impulsivity, and loneliness/depression scores. Significant negative correlations were observed between the Lie trait and OCS scores (mainly in impulse control and distraction domains).

Neuroticism and Lie together contributed to 21.8% of variance in OCS scores.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

366 Assessment and variability of cognitive and emotional empathy with motivation in patients with alcohol use disorder.

Gomati V Nadadgalli ¹, Hrishikesh Nachane ¹, Maithili Umate ¹

Introduction: Empathy is described as being able to understand and relate to the emotions of others. Emotional empathy is an unconscious automatic drive to respond appropriately to another’s emotions whereas cognitive empathy is the largely conscious drive to recognise and understand another’s emotional state. Alcohol dependence is one of the common mental disorders which impacts patient’s social, economic and biological functioning. Previous researchers have highlighted the impact of alcohol on patient’s feelings of empathy and understanding of irony. Chronic alcohol use may affect regions of brain involved in deciphering emotions and processing humour. Motivation on the other hand plays an important role in influencing the treatment and successful long term change in patients of alcohol use disorder. There is a dearth of literature looking into variability of empathy with various stages of motivation. Hence the present study was undertaken to better understand the interplay between empathy and motivation in alcohol dependent patients. This will help in recognising the motivated patients in different stages and to what extent their empathy can change which may lead us to build better management protocols.

Objectives: The present study assessed cognitive and emotional empathy in alcohol dependent patients and age matched controls. We also assessed correlation between empathy and motivation at different stages in alcohol dependent adults.

Design: Cross sectional observational study.

Methodology: 25 alcohol dependent adults between the ages of 18-65 meeting criteria as per DSM-5 were recruited from the outpatient department. 25 age matched controls were recruited from normal population. Cognitive and Emotional Empathy was assessed using the BES-A (Basic Empathy Scale for Adults) and motivation was assessed using URICA (University of Rhode Island Change Assessment) scales.

Results and Conclusion: The study is still ongoing, the results and conclusion will be elaborated at the time of presentation.

Keywords: Alcohol, Empathy, Motivation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

367 Depression and its Association with Quality of Life in Female Patients at Different Hormonal Phases of Life - A Cross Sectional Study in Western U.P

Sujit Kumar ¹, Sandeep Choudhary ², Supriya Agarwal ³

INTRODUCTION - Gender is undoubtedly one of the major determinants of mental health. One school of thought believes that hormonal influences related to the reproductive cycle of women may play a role increased/differential vulnerability to mental problems. Unipolar Depression, which is predicted to be the second leading cause of global disability burden by 2020, is twice as common in women. Moreover, onset of menarche, maternity, and childbirth per se are stressful events in the life of a female. The purpose of this study was to analyze depression in female patients at different hormonal phases (5 phases, as predefined for this study) and its association with the quality of life in these patients.

METHODOLOGY - This cross section observational study involved 60 female patients in the department of psychiatry at a tertiary care teaching hospital in western U.P. Data was collected using self structured Socio-demographic and Clinical data sheets. Hamilton Rating Scale for Depression (HAM-D) and WHO Quality of Life (WHOQol-BREF) were used as psychometric tools. The test values of continuous variables were expressed as mean ± SD (standard deviation). The Pearson product-moment correlation was used to determine the strength and direction of a linear relationship.

RESULT AND CONCLUSION - Depression was found in all the hormonal phases with highest (35%) in late perimenopausal and Severe Depression was found to be highest (60%) in early perimenopausal group. All the cases of Post Partum Depression were of Moderate type. Pregnant patients presented in all Mild, Moderate and Severe Depressive Episodes. A significant (P<0.001) inverse correlation was found between HAM-D scores and the overall quality of life (total WHOQOL-BREF Score). Pearson’s correlation coefficient, r= -0.596. Depression scores also correlated significantly with all four domains of WHO quality of life. Depression has shown to significantly influence the quality of life in these subjects.

KEY WORDS – Women, Depression, Hormonal Phases

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

368 STUDY OF RELATIONSHIP OF SOCIAL FUNCTIONING AND INTERNALIZED STIGMA WITH INSIGHT IN PATIENTS OF SCHIZOPHRENIA AND BPAD

Komal Kohat ¹, Dinesh Kataria, Sumit Rana, Ankit Goel

The internalized stigmatization is commonly seen in persons with mental illness, leading to a range of negative consequences. Social functioning is significantly impaired in chronic mental illness, which can be further intensified by internalised stigma. Insight has been found to act as a moderator between internalisation of stigma and social functioning.

Aim- Study of relationship of social functioning and internalized stigma with insight in patients of schizophrenia and bipolar affective disorder.

Methodology- This is a cross sectional descriptive study, conducted in the Department of Psychiatry & Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi. Systemized random sampling was used and 100 patients, 50 patients with schizophrenia and 50 with bipolar disorder were selected. The scales used were,Positive and Negative Syndrome Scale,(PANSS), Hamilton Rating Scale For Depression-17 (HAM-D 17), Young Mania Rating Scale (YMRS), Scarf Social Functioning Index (SSFI), Internalized Stigma Of Mental Illness Scale (ISMI), Babs-Brown Assessment Of Beliefs Scale (BABS) were applied in appropriate patients to assess social functioning, internalized stigma and insight. Obtained data was processed using statistical Package for the Social Sciences (SPSS) and relevant test were applied.

Results- will be discussed at the time of presentation.

Conclusion- The obtained result may be useful for better intervention by health care provider, improving the bio-psycho-social dynamics, and hence helping to improve management and social integration of patients.

Keywords-social functioning, internalized stigma, insight, schizophrenia, bipolar affective disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

369 Intermittent theta burst stimulation (iTBS) for managing treatment resistant depression

Ankita Chattopadhyay ^1,^✉, Mahendra Singh Uikey ¹, Rohit Verma, Nand Kumar ¹

Background – Repetitive transcranial magnetic stimulation (rTMS) is being used worldwide for treatment of depressive disorder. With the advent of recent FDA approved theta burst stimulation (TBS) protocol, the time to treat a patient can be considerably reduced. The current case highlights the use of TBS as an addendum to pharmacological therapy in management of depressive illness.

Aim and objectives – We are reporting the safety and effectiveness of adjunctive TBS in a case of treatment resistant severe depressive episode with suicidal ideation.

Methods: Mr. T, a 64-year-old unmarried male presented with episodic illness of 20 years characterised by 4 episodes of depressed mood, anhedonia, lethargy, disturbed biological functions, reduced attention and concentration, with current episode of 4 months and having added complaints of low self-esteem, ideas of worthlessness, hopelessness and suicidal ideations for 2 weeks leading to significant socio-occupational dysfunction. With history of failure of adequate trial of Escitalopram and Venlafaxine, he was started on Imipramine. A trial of intermittent theta burst stimulation (iTBS) was simultaneously given for 15 sessions, with burst and pulse frequencies of 5Hz and 50 Hz respectively. Total 600 pulses were given per session without any side effects. Over 3 weeks, his HAMD-17 scores improved from 18 to 5 and the patient was maintaining euthymic 4 weeks after completion of sessions.

Conclusion: The use of TBS protocol in this case of treatment resistant depression took about 5 mins as compared to over half-an-hour of conventional high frequency rTMS. The case also displays the effectiveness of adjunctive iTBS in improving depression as well as suicidal ideation. This case puts forth the need for robust trials to establish the efficacy and safety profile of TBS in Indian population.

Keywords: rTMS, TBS, depression, neuromodulation, brain stimulation

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

370 Title: Reassessing the utility of electroconvulsive therapy in light of MHCA 2017 : a retrospective data based study in a tertiary care hospital.

Saurabh ¹

Introduction: Electro-Convulsive Therapy (ECT) refers to the electrical stimulation of the brain to produce seizures for therapeutic purpose. ECT has been indicated in numerous psychiatric illnesses and has proved to be beneficial for the patients in clinical practice to a large extent. ECT is an old modality, in use for psychiatric illnesses for decades, with proven efficacy. However, in the light of MHCA 2017 this therapeutic modality and its effectiveness needs re-visiting.

In this study we have examined details of 70 patients who received mECT for various psychiatric indications and their treatment outcome.

The aims is to reflect the benefits of ECT in clinical practice and the need to reassess the aversions that prevails in our society against ECT.

Methods: The given study is a retrospective data based study carried out in a tertiary care hospital in Delhi. The data was collected from ECT record book and the details of patients who received ECT in the span of one year from august 2017 to august 2018 were documented. These included patient demographic details, diagnosis, indication for ECT, parameters of ECT administered and treatment outcomes following ECT as reduction in symptom-specific scales. Descriptive statistics will be used to analyse the data using appropriate software.

Results: The data is large and the results along with conclusion will be part of final presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

371 Abnormal Paroxysmal Events In Sleep: Seizures Or Parasomnias?

Akash Kumar JR ¹, Mrinal Jha, Ravi Gupta, Bhavika Rai

Introduction: Abnormal paroxysmal events in sleep often pose a diagnostic dilemma to the clinician. On one hand they could be seizures, especially those arising from the frontal lobe. On the other, they could be parasomnias, such as somnambulism or sleep terror. While the two conditions are distinguished on the basis of timing of event during sleep, number of episodes per night, frequency of events and age of onset, they often present with overlapping clinical features.

Methodology: Here we report a 28 year old male patient who presented with paroxysmal events during sleep characterised by eye opening, sitting up in bed, vocalising and complex motor phenomenon.

Results: The use of FLEP (Frontal Lobe Epilepsy and Parasomnia) Scale and Video EEG helped make a diagnosis of Frontal Lobe Epilepsy while ruling out Parasomnias Conclusion: As the management of Frontal Lobe epilepsy is completely different from Parasomnias, it is necessary to distinguish the two conditions for appropriate treatment of the patient.

Keywords: Seizures, Frontal Lobe Epilepsy, Parasomnia, Somnabulism, Diagnostic Dilemma.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

372 Prevalence of psychiatric co-morbidities in patients with epilepsy: a cross sectional study.

Tamalika Deb Ray ¹, Savinder Singh ², Tathagata Mahintamani ³

Background: Psychiatric disorders are highly prevalent in patients with seizure disorder especially in those with refractory epilepsy. Some antiepileptics also exert psychotropic effects, which further complicates the scenario. In these patients, anxiety, depression and psychosis are some common co-morbidities. However, such co-morbidities frequently go unrecognized and untreated. This study will help in assessing and formulating both short and long term management plan for psychiatric comorbidities with primary epilepsy.

Aim: To measure prevalence and socio demographic correlates of psychiatric co-morbidities in patients with epilepsy attending psychiatric outpatient department.

Materials & methods: 100 adult patients diagnosed with epilepsy (according to ILAE, 2017 classification) and taking regular treatment for more than 1 year in psychiatric OPD were purposively sampled. Informed consent was obtained before inclusion in the study. Patients with primary diagnosis of active neurological disorder (other than epilepsy), substance use disorder and systemic illness were excluded. Patients were assessed using socio-demographic and clinical data sheet. Psychiatric co-morbidities were assessed using MINI international neuropsychiatric interview for ICD 10.

Data were statistically analysed using SPSS, 20 software.

Result & Conclusion: To be discussed at the time of presentation

Keywords: Epilepsy, prevalence, psychiatric co-morbidities

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

373 Internet addiction among college students: a cross-sectional study.

Gurleen Kaur ¹, Vikrant Bajaj ², Tathagata Mahintamani ³

Introduction: Internet has become the most important academic and recreational tool for adolescents and adults. Excessive use of internet is becoming a grave concern as problematic behavior. The extent of problematic internet use is increasing with the easier access of internet in smartphones and laptops. There is dearth of recently published data regarding Internet addiction among young adults in this part of country. This study will help in understanding the current prevalence as well as time trend of this problematic behaviour.

Aim: To assess the prevalence of Internet Addiction (IA) among college students and socio-demographic factors associated with IA.

Methods: The cross-sectional study was conducted over a period of 6 months (May 2018 to Oct 2018) in 977 consecutive college students (aged 18 years or more) studying in Khalsa College, Amritsar. Students of B.A., B. Com., B. Ed. and B. Tech. were included in the study. Informed consent was taken prior to inclusion. Students were assessed using semi structured socio-demographic data sheet and young’s internet addiction test.

Results & Conclusion: to be discussed at the time of presentation.

Keywords: Internet Addiction, Prevalence, College students.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

374 Correlation between patients’ beliefs about the causes of schizophrenia and psychopathology

Ishat Kalra ¹, Vikrant Bajaj ², Tathagata Mahintamani ³, Sanyam Gupta ⁴, Devasheesh Rattan Sharma ⁵

Aim:

Religious and cultural beliefs are particularly important in psychiatric disorders and more so in our country especially in relation to disorders like schizophrenia, which involve a complex and unclear etiology. Although there have been many studies regarding the beliefs with respect to causes of schizophrenia in India, but none of them compared the symptom severity among different belief systems. Therefore a need was felt to compare the belief systems and their impact on the psychopathology and thus, counsel the patients and caregivers regarding the faulty perspectives. This would help improve the compliance among the patients.

MATERIAL AND METHODS

Study Area : Out-patient and Inpatient units of Institute of Mental Health, Amritsar

Study population: Patients attending the outpatient and inpatient departments of IMH, Amritsar

Sample size: 100 patients diagnosed with schizophrenia according to ICD-10- DCR criteria and their first degree relatives were assessed.

RESULTS :

· Worse attitude towards drugs in patients with magico-religious beliefs and better attitude if caregivers had biological beliefs

· Lower overall PANSS scores in patients with biological beliefs

· Higher overall PANSS scores in patients with psychosocial as well as magico-religious beliefs, and also in patients whose caregivers’ had more religious beliefs.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

375 DEPRESSION, ANXIETY AND SMARTPHONE ADDICTION IN MEDICAL STUDENTS - A CROSS SECTIONAL STUDY

BUKYA KALYANI ^1,^✉, K Narasimha Reddi ², A Prasanth ²

INTRODUCTION:

A Smartphone, is a term for distinguishing mobile phones with advanced features from basic feature phones. The term “Smartphone” first appeared in 1997. This term was basically introduced in the market for a new class of mobile phones that provide integrated services from communication, computing and mobile sectors such as voice communication, messaging, personal information, management applications and wireless communication capability. Smartphone overuse or addiction may lead to negative health consequences like neck pain, accidents, depression, anxiety and sleep disturbances.

METHODS:

This is a cross sectional study done on undergraduate medical students of medical college. The aim of the present study is to know the prevalence of smart phone addiction among the undergraduate medical students and to assess its impact on the mental health

TOOLS USED:

Semi-structured proforma containing smartphone usage characteristics of participants
The Smartphone Addiction Scale (SAS-SV) (Kwon, Kim, et al., 2013).
DASS 21 questionnaire.

The purpose of this research was explained to the participants and the informed consent was obtained. Data was collected using above mentioned instruments maintaining confidentiality.

RESULTS:

Majority of participants in the study were females(60.4%). Prevalence of smart phone addiction among participants was 29.6%, among them 37.3% males and 24.5% females. Anxiety and depression was observed to be higher in males where as effect of stress was higher in female participants.

CONCLUSION:

With increasing levels of smart phone addiction students are developing significant problems of anxiety, depression and increased levels of stress.

KEYWORDS: Smart phone addiction, depression, anxiety, stress, Medical students

ANCIPS REGISTRATION ID - 1650 PHONE NUMBER - 9492086148 MEDICAL REGISTRATION NUMBER - 85563 15. Emergency in Psychiatry And Suicide

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

376 Attitude of Health Professional student towards Suicide

Deepak Tiwari ^*, GK Vankar ^*, Vishal Patel ^*, Niranjan Patel ^**

Attitude of health professional students have implications for own health as well as for the care of patients who are suicidal or has attempted suicide.

Methodology: As part of observing International Suicide Prevention Day, a series of Suicide awareness programs were conducted on campus of M.P. Shah Medical College,Jamnagar. At time of program, we evaluated the participant attitude towards suicide using Youth Attitude towards suicide. Youth Attitude to Suicide is 21 item instrument to be rated on five-point 0-4 scale(0=strongly disagree to 4=strongly agree) Results: 315 students participated, 15 responses were discarded as they contained inadequate data, leaving 300 responses for evaluation. Large majority were Hindus(97.7%) and women(92.3%), with mean age 20.86 years. Among all, 124(41.3%) were physiotherapy students, 104(34.7%)were nursing students and 72(24%) were medical/ dental students.

254(84.6%) students opined that suicide can be prevented, 144(% believed that suicide occurs without any signs, 120(40%) believed that those who talk about suicide do not kill themselves.255(85%) disagreed that If someone wants to commit suicide, it is their business and we should not interfere. Prevalent stigma related to suicide in the family was reflected in 193(64.3%) students agreeing that they would feel ashamed if a family member committed suicide.

Conclusion: Health Profession students had many negative attitudes which should be addressed in educational interventions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

377 To determine stress and substance abuse habits in M.B.B.S students

Shivam Sunil ¹, S Chaudhary, D Saldanha

Background/Introduction :

Attending medical school is presumed to be easy or stress-free. Bachelor of Medicine and Bachelor of Surgery (MBBS) being one of the toughest courses at any graduation level stress is not uncommon and is process orientated. Stress is experienced among the best and brightest medical students during classroom training, hospital rotations, residency requirements, and pre postgraduate examination preparations. It has also been linked to substances use and drug addiction.

AIM: To determine stress and substance abuse habits in M.B.B.S students

OBJECTIVES: To measure distribution and magnitude of the stress levels in the first-year MBBS students. To measure the substance abuse in the MBBS students. To find the co-relates of stress and substance abuse in MBBS students

MATERIAL AND METHODS: Type of study: Observational Cross-sectional Study. Period of study: September 2017 to September 2018. Sample size: A sample size of 200 M.B.B.S students.A written informed consent was obtained for participation in the study from all subjects recruited after explaining the purpose and design of the study.

Following tools were used for the study

A)Perceived stress scale. The Perceived Stress Scale (PSS) is the most widely used psychological instrument for measuring the perception of stress. (B) The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item screening tool developed by the World Health Organization (WHO) to assess alcohol consumption, drinking behaviors, and alcohol-related problems. The (C) Fagerström Test for Nicotine Dependence, It is standard instrument for assessing the intensity of physical addiction to nicotine.

Results : Overall mean perceived stress was 30.84 (SD = 7.01) and was significantly higher among female students. Prevalence of alcohol and tobacco use among UG students was 16.6%, 95% CI and 8.0%, 95% [6.4, 9.6]. result will be explained in detail at time of presentation

Key words: STRESS, MEDICAL STUDENT, ALCOHOL

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

378 Effect of adjuvant ECT on variation in serum tryptophan level in patients of de Nupur

Priya Sinha ¹

Basudeb Daspression

Introduction - Disturbance in tryptophan-kyneurenine (TRP-KYN) metabolism has been related to pathophysiology of depression. Tryptophan levels in blood are directly related to availability of tryptophan in this pathway. There have been no studies comparing impact of electro convulsive therapy (ECT) and antidepressants on TRYP-KYN metabolic pathway. We aim to study whether ECT has an independent effect on this pathway and whether it is similar or different from that of antidepressants.

Methodology - It’s a longitudinal observational study implicating patients of severe depression with psychosis. 18 cases and 16 controls were chosen by purposive sampling. Cases were those getting adjuvant ECT with pharmacotherapy, and controls were the ones treated with pharmacotherapy only. Serum tryptophan levels were measured at baseline and then every two weeks, simultaneously rating for symptom severity and monitoring for side effects. Obtained data was analysed using SPSS Version21.

Result- It was observed that there is no significant difference in base line serum tryptophan levels and its variation after treatment in patients treated with adjuvant ECT compared to those treated with pharmacotherapy only. However serum tryptophan level had shown strong correlation with symptom severity in both groups.

Conclusion - ECT not hols an independent effect on TRP-KYN pathway as compared with pharmacotherapy. Serum tryptophan levels can be used as prognostic marker in patients with depressive disorder.

Key words : ECT, Depression, Tryptophan

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

379 CROSS-SECTIONAL STUDY OF STIGMATIZING ATTITUDE OF NURSING STUDENTS TOWARDS PSYCHIATRIC ILLNESS

Deepali Negi ¹, Savinder Singh ², Gurleen Kaur ³, Ishat Kalra ⁴

Introduction: Attitudes towards psychiatric illness is decisive in supporting a mentally ill patient. Attitudes expressed negatively may result in exclusion and discrimination. In India with its low doctor-patient ratio, nursing staff play a major role in influencing the attitude of general population. Negative attitudes toward mental illness have been consistently reported in nursing students.

Aim: To study the perception and attitude of nursing students towards seven common psychiatric illness in relation to socio demographic variables.

Materials & Methods: The cross-sectional study is being conducted in Dr. Vidyasagar Institute of Mental Health, Amritsar, Punjab, India. 300 nursing students who had completed 18 years at the time of data collection and not older than 25 years of age and consenting for inclusion in the study were purposively sampled. Selected students were assessed using socio-demographic data sheet & interviewed using Omnibus questionnaire derived from the work of Hayward & Bright, 1997.

Data were analyzed using SPSS 23 software.

Results: result and data to be discussed at time of presentation Keywords: psychiatric illness, nursing, attitude, stigma

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

380 STRESS LEVELS IN DIFFERENT HEALTH PROFFESSIONS AND ITS CO-RELATION WITH COPING STRATEGIES USED

Shalini Bijali ¹, Ranjit Kumar ², Vikalp Wasnik ³

BACKGROUND: It has been seen that the professions involving rapid decision-making skills and decisions that affect the lives of other persons are amongst the most stressful once. The present study deals with one of such professions i.e. healthcare professionals and their daily stressful life. Stress may be a cumulative factor for physical or psychological reaction or in extreme cases a psychosomatic disease. These stress levels also depends on the various coping strategies used during acute stress.

AIM: To evaluate the level of stress in healthcare professionals and correlate it with the coping strategies used by them to overcome stressful situations or events in a tertiary care Indian hospital.

METHORD: 20 volunteers each consisting of nursing staff, residents and consultants were taken after explaining the purpose of the study and taking proper written consent. They were evaluated for the level of stress by using Perceived stress score test(PSS10). Coping strategies used by them during stressful situation retrospectively were assessed by Coping Strategies for Stressful Events (CSSE). Participants were asked to fill the questionnaire honestly and fully. Confidentiality of their responses was ensured.

RESULTS: To be discussed at the time of presentation.

Key words- Perceived stress, Coping Strategies.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

381 Assessing prevalence of depression among patients attending Community Psychiatry OPD of Rural Health Training Centre

SABAHUDDIN AMMAR ¹, MAHBOOBUL HASAN ANSARI, SHRAVAN KUMAR, RAIES AHMAD, S A AZMI

Context: Community health approach is need of time to provide adequate treatment to each individual especially those living in rural areas. In our country, population living in rural areas do not get adequate treatment of the patient suffering from mental illness due to lack of resources and trained mental health professionals. In rural areas, mental health is not given much emphasis as other organic illness. Depression affects both the mind and body and is a leading cause of social and occupational impairment. RHTC run by JNMCH provides mental health services once a week other than providing primary care. The study reports on prevalence of depression among patient attending psychiatry OPD at RHTC.

Aims: The aim of this study is to describe prevalence of depression among patients attending Psychiatry OPD of Rural Health Training Centre.

Settings and Design: This was a cross sectional record review.

Subjects and Methods: Community services are provided in the areas adjoining Aligarh covering 6 villages(Jawan,Chota Jawan,Garhia Bhojpur,Tejpur,Sumera,Jawan Sikandarpur) with a total population of 17190 having 3537 families.

Statistical Analysis Used:Appropriate statistical test was used.

Results of the study to be discussed at the time of presentation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

382 Title: Pattern and prevalence of mental and behavioural disorder due to Opioid use : A hospital based study.

Gyanendra Raghuvanshi ¹, Pradeep Kumar ²

Introduction: In Recent changing world the prevalence of substance use sharply increasing and with time this pattern of substance use is also changing. Different psychoactive substance has different medical and social consequences for subjects. Recent National household survey (NHS) data reveals that alcohol (21.4%) was the primary substance used (apart from tobacco) followed by cannabis (3.0%) and Opioids (0.7%). Prevalence of Opioid use is two times higher than prevalence in Asia and within country the pocket of high Opioid use was found especially in Indo-Pak and Indo –Nepal border States. The eastern part of Madhya Pradesh is landlocked and far away from international borders still more number of patients availing the services of hospital for Opioid de-addiction and related consequences. This study intended to study the clinical variables and pattern of Opioid use among patients attending de-addiction services in the hospital.

Aims & Objectives:

To study the hospital based prevalence of mental and behavioral disorder due to Opioid use.
To study socio-demographic and clinical variables associated with substance use disorder.

Methodology: Data collected from out patients & in patients sections of department of neuropsychiatry & mental health GMH & SGMH, Rewa. Purposive sampling methods used, all the subjects attending department for de-addiction services recruited from Jan 2018 to Dec 2018 for the study and clinical and socio-demographic details entered in semi structured data after informed consent from patients. Statistical analysis: The results will be subjected to statistical analysis using appropriate tests to achieve significance of clinical variables (p=<0.05)

Result and discussion: The data analysis will be done by using SPSS v21 with appropriate statistical analysis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

383 ROLE OF ANGIOTENSIN CONVERTING ENZYME GENE POLYMORPHISM IN COGNITIVE DETERIORATION IN PATIENTS WITH CEREBRAL SMALL VESSEL DISEASE.

Thomas Gregor Issac ¹, PT Sivakumar ², SR Chandra ³, Rita Christopher ⁴, Mariamma Philip ⁵, Jamuna Rajeswaran ⁶, Chandrajit Prasad ⁷

Cerebral small vessel disease (SVD) is the major contributor to vascular dementia SVD is characterized by periventricular white matter hyperintensities, Lacunes and microbleeds in imaging and is a common finding in asymptomatic elderly with only a third progressing to VaD. The mechanisms for the same is yet unknown though heritability has been documented in few studies. Unlike other degenerative dementias this condition is potentially treatable and preventable making it more important to determine the factors responsible for conversion to VaD.

Patients and Methods

202 patients having radiological features of SVD were selected over a period 3 years after informed consent for genetic studies and neuropsychological assessment. Neuropsychological assessment specifically designed for assessing executive dysfunction in SVD was carried out and follow up done after 1 year.

Results

There was significant difference (p<0.001) across neuropsychological scores between various neuropsychological tests between the first and second follow ups. The Neuropsychological scores with regard to ACE I/D polymorphism had a detrimental effect on cognition being associated more with ACE D/D polymorphism whereas the odds for ACE I/I polymorphism to protect from conversion to VaD was significantly high.

Discussion and Conclusions

The study corroborates the role of hypertension as a major risk factor for cerebral small vessel disease. The ACE d/d polymorphism was found to be detrimental with reference to cognitive function. SVD resembles degenerative dementia and is not similar to the presentation of dementia due to large vessel disease.

Key words Vascular dementia, Small vessel disease, Angiotensin converting enzyme, Single Nuclear Polymorphisms, Neuropsychology.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

384 STRESS LEVELS IN DIFFERENT HEALTH PROFFESSIONS AND ITS CO-RELATION WITH COPING STRATEGIES USED

Shalini Bijali ³, Ranjit Kumar ¹, Vikalp Wasnik ²

BACKGROUND: It has been seen that the professions involving rapid decision-making skills and decisions that affect the lives of other persons are amongst the most stressful once. The present study deals with one of such professions i.e. healthcare professionals and their daily stressful life. Stress may be a cumulative factor for physical or psychological reaction or in extreme cases a psychosomatic disease. These stress levels also depends on the various coping strategies used during acute stress.

AIM: To evaluate the level of stress in healthcare professionals and correlate it with the coping strategies used by them to overcome stressful situations or events in a tertiary care Indian hospital.

METHORD: 20 volunteers each consisting of nursing staff, residents and consultants were taken after explaining the purpose of the study and taking proper written consent. They were evaluated for the level of stress by using Perceived stress score test(PSS10). Coping strategies used by them during stressful situation retrospectively were assessed by Coping Strategies for Stressful Events (CSSE). Participants were asked to fill the questionnaire honestly and fully. Confidentiality of their responses was ensured.

RESULTS: To be discussed at the time of presentation.

Key words- Perceived stress, Coping Strategies.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

385 Title: “Pattern of Alcohol use and Help seeking behaviour in patients of alcohol dependence at Tertiary care center.”

Dewanand Kharolia ¹, KK Verma ², Girish Chandra Baniya ^3,^*, Harful Singh Bishnoi ⁴

Aim& Objectives: To assess pattern and help seeking behavior in patients of alcohol dependence because alcohol dependence is rising in India, due to newer and greater stresses related to rapid changes in life-style. Method: All the patients of alcohol dependence attending de-addiction clinic in OPD and IPD were screened. Those fulfilling the selection criteria were included in this study.The patients excluded who were in alcohol related withdrawal or intoxication. Diagnosis of alcohol dependence was made according to ICD 10 criteria. This was a cross-sectional study. Data was collected from 30 consecutive inpatients & outpatients with ADS using Socio-demographic performa and Semi-structured clinical performa. Statistics applied by using SPSS software (Version 20).

Results: Most of the patient take 2-4 quarter/day, both country made liquor and Indian made foreign liquor, taking regularly, no specific timing for drinking. Mostly starting drinking in age group of 20-30 years and mean duration of drinking was 18.27 years. Most common cause of taking treatment was family quarrel and second most common cause was medical illness.Conclusion: A proper address of social and familiar functioning, coping skills issue is important for management, better outcome, relapse prevention and policy making in patients of alcohol use disorders.

Limitation :Limited number of sample may limit the generalizability of the study.Key words: Alcohol dependence,Help seeking Behavior, Pattern of alcohol use.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

386 WISC-IV PROFILE OF CHILDREN WITH AND WITHOUT ADHD

PRATHEEK SHARMA ¹, VIJAYA RAMAN, S M MANOHARI

BACKGROUND AND OBJECTIVES:

Studies have shown that children with ADHD have 7-12 IQ (Intelligence Quotient) points lower than their normal controls. The primary aim of the study was to study the association between severity of Attention Deficit Hyperactivity Disorder (ADHD) and IQ scores in children with ADHD.

The secondary aim was to study the Wechsler Intelligence Scale for Children –IV (WISC-IV) profile of children with and without ADHD.

METHODOLOGY:

The study is a descriptive, cross sectional study. 55 children between 6 and 16 years of age who met criteria for ADHD according to ICD 10 were recruited. 20 children without ADHD of the same age group were recruited as the comparison group. Severity of ADHD was assessed using Conner’s Parent rating scale short version. Mini International Neuropsychiatric Interview-KID was used to exclude children with comorbid psychiatric illness. Intelligence was assessed using WISC-IV.

RESULTS:

Correlation between severity of ADHD and IQ scores showed that children with more severe ADHD had lower IQ scores (p<0.001). There was no significant difference in the mean IQ scores between the two groups (p = 0.834). There was no significant difference in the subdomain scores of Verbal Comprehension, Perceptual reasoning, Working memory and Processing speed between the two groups.

CONCLUSIONS:

The mean IQ of children with ADHD was in the normal range. However, children with more severe ADHD were found to have lower IQ scores and it was statistically significant. There was no significant difference in the sub-domain scores of WISC-IV between the two groups which is contrary to the available literature. The reasons for these findings will be discussed in the presentation.

KEYWORDS:

Attention deficit hyperactivity disorder (ADHD), Intelligence, IQ

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

387 Title: Prevalence of Psychiatric Morbidity in the convicted population of inmates of Central Jail of Amritsar.

Priyadeep Zamindar ^1*, Ishat Kalra ^2*, Savinder Singh ^3*

Introduction: A person in prison is in one of the most vulnerable positions, physically, mentally and emotionally in our current civilised society. This creates an environment that requires intense coping and adjustment from the inmates, and when unsuccessful, intense distress.

Prison environment is highly stressful and often predisposes the prisoners to develop mental disorders. People with preexisting mental disorder are more likely to indulge in activities that would result in their incarceration. Substance abuse, APD, often leads to increased risk of violent behavior.

As a result, there is a much higher chance of a jail inmate at any point of time to have a mental disorder than a regular person. There is need for further exploration into the mental health needs of Indians in jail.

Aims:

1> To gather socio-demographic information about the convicted inmates of the Central Jail of Amritsar

2> To screen for various psychiatric morbidities in this population

3> To confirm such diagnosis subsequently

MATERIAL AND METHODS:

The cross-sectional study is being conducted in the Central Jail of Amritsar, Punjab, India. 300 convicted inmates who had completed 18 years at the time of data collection and not older than 70 years of age and consenting for inclusion in study are sampled. Selected inmates are assessed using socio-demographic and clinical data sheet and MINI scale.

Results: Results and data to be discussed at the time of presentation.

Keywords: psychiatric illness, prison inmates, prevalence study.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

388 Transcranial direct current stimulation as an augmenting intervention for depression

Amit Kumar Meena ¹, Gautam Sharma, Sunil Kumar Meena, Smita N Deshpande

Aim : We assess the early response of transcranial Direct Current Stimulation in the treatment of persons with Depression while continuing with treatment as usual.

Methods : Consenting persons with depression (n=35) fulfilling ICD-10 diagnostic criteria were assessed on MADRS scale. On active tDCS, persons received total 20 sessions, twice daily with in over 2 weeks. Anode localised on the right dorsolateral prefrontal cortex (DLPFC) area and cathode placed on the left dorsolateral prefrontal cortex area (DLPFC). The tDCS device delivered a direct current of 2mA during 20 minutes. Re- interviewed participants with MADRS scale.

Results: The Age of onset of illness ranged from 17- 59 year, with mean age of onset for (32.79 ± 11.1) in males & (31.56 ± 7.1) in females The overall scores were analysed on MADRS grades and comparison of pre and post treatment scores were done using paired t-test analysis which suggests that there is a significant difference in scores (M= 21.8, SD = 6.42) and p value < 0.001.

Conclusion: Application of novel brain stimulation techniques to treat depression is a rapid growing field. Studies have reported that there has been significant improvement. The results of the present study are in unison with other published studies. The present study revealed that augmenting tDCS along with pharmacological treatment have additional benefits in persons with Depression. In our study, there were significant differences pre and post treatment after 20 sessions of tDCS.

Key words: Major depressive disorder, non-invasive brain stimulation, dorso lateral prefrontal cortex, MADRS, transcranial direct current stimulation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

389 Depression and Anxiety in Adult Patients of Systemic Lupus Erythematosus and it’s Association with Quality of Life– A Cross Sectional Case Control Study in Meerut and Western U.P.

Abhinav Dhami ¹, Sandeep Choudhary ², Vivek Kumar ³, Sundeep Grover ⁴

INTRODUCTION

Systemic Lupus Erythematosus (SLE) is a well-known chronic inflammatory and auto-immune disorder mediated by immune complex and it is characterised by its clinical manifestation and multisystemic involvement. Various studies have shown 14-75% prevalence of neuropsychiatric disorders in SLE, with depression and anxiety being the commonest. The purpose of this study was to analyze depression and anxiety in adult patients of SLE, and its association with quality of life.

METHODOLOGY

This cross sectional case control study involved 30 adult patients with diagnosed SLE and 30 healthy controls, at a tertiary teaching hospital in western U.P. Data was collected using self-structured Socio-demographic and Clinical data sheets. Hamilton Rating Scale for Depression (HAM-D), Hamilton Anxiety rating scale (HAM-A), Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and WHO Quality of Life (WHOQol-BREF) were used as psychometric tools. The test values of continuous variables were expressed as mean ± SD (standard deviation). The Pearson product-moment correlation was used to determine the strength and direction of a linear relationship.

RESULTS AND CONCLUSION

Depressive symptoms were found in 43.3% of the cases. Whereas no depressive symptoms were found in controls. Mild to moderate anxiety symptoms were found 90% of the cases. Amongst controls, only 10% had mild anxiety. There was a significant difference between all the domains of WHO-QOL except for domain 3, suggesting the high prevalence of impact of SLE on physical (p =0.006) and psychological health (p = 0.001) of cases. On Pearson’s correlation analysis, we found significant correlation between quality of life (QoL) and depression, anxiety and SLE disease activity.

Depression, Anxiety, SLE disease activity has shown to significantly influence the quality of life of patients with SLE.

KEYWORDS – SLE, Depression, Anxiety SLE disease activity

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

390 Prevalence of psychiatric comorbidity and its association with quality of life in Bipolar Disorders

Gunja Sengupta ¹, S Jena

Introduction/Background: Increasing prevalence of Bipolar Disorders (BD), and its association with significant deterioration of quality of life (QoL), is causing it to be recognised as an emerging major public health problem. Comorbidity in BD has been seen to be associated with poorer course specifiers of the disease in terms of onset, outcome and QoL. The study aimed at the estimation of prevalence of Axis I psychiatric comorbidity in such patients and to evaluate the association of the presence of such a comorbidity with QoL.

Materials and methods: This cross-sectional study was done in a tertiary care general hospital psychiatric unit in New Delhi on 100 Patients diagnosed with Bipolar Disorders in partial or complete remission (as per the DSM-IV-TR criteria). Patients were assessed using a semi-structured proforma, Mini International Neuropsychiatric Interview (MINI) 6.0 and World Health Organization Quality of Life instrument, short form (WHOQOL-BREF)-Hindi version and data was expressed as frequencies/percentages and compared between groups using Chi-square/Fisher’s Exact Test.

Results: 61% of patients had at least 1 comorbidity, 24% had 2 or more comorbidity and 10% had 3 or more comorbidity. The most common category was that of substance dependence/abuse among which the commonest substance used was tobacco (29%) which was also the commonest sub-category of comorbidity. Patients with comorbidity had significantly worse total score in WHO-QOL-BREF (p=0.006) and also had significantly poorer scores in 3 domains of QoL: Physical health (p=0.046), Psychological (p=0.004) and Environment (p=0.008).

Conclusion: A significant proportion of patients with BD have psychiatric comorbidity. The pattern of proportion of comorbidity is different from western populations. The presence of a psychiatric comorbidity negatively affects the QoL of such patients and thus needs further research as well as priority during assessment and management of patients of Bipolar Disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

391 Title: Mirtazapine associated urinary retention in an elderly female – A Case Report

Shilpi ¹, Lohit ², Sharanya ³, Sridatta ⁴, Abhay Matkar ⁵

Abstract: Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA) is a preferred molecule for treating depression in elderly patients due to minimal side effects. It is preferably used in elderly patients: with parkinsonian symptoms, with risk of developing hyponatremia, in males with risk of urinary retention and with concomitant decreased sleep and appetite.

This is a case report of 65 years old female patient, presenting to hospital with Delirium secondary to hyponatremia and diagnosed to have Dysthymia and Moderate depressive episode with somatic syndrome. Patient during hospitalisation developed urinary retention on Mirtazapine. This is the first case report of Mirtazapine induced urinary retention in a female patient. Keywords: Elderly; Depression; Mirtazapine; Urinary Retention

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

392 PREVALENCE OF DEPRESSION AND ANXIETY AMONG CORONARY HEART DISEASE PATIENTS- A STUDY IN A TERTIARY HOSPITAL

M Haritha Devi ^*, Prabhu Kiran ^†, R Somasundara babu ^‡

BACKGROUND: Depression and anxiety could reduce the quality of life, and exacerbate physical symptoms and even mortality amongst patients with coronary heart disease. According to an estimate by the World Health Organization (WHO), by the year 2020, both coronary heart disease and depression will be the two major causes of disability- adjusted life years.

AIM: To find the prevalence of depression and anxiety among Coronary heart disease patients.

MATERIALS AND METHODOLOGY: Study population consists of 30 Coronary heart disease patients admitted in department of Cardiology, ASRAM college and hospital, the study is a cross sectional study and the patients will be assessed using Hospital Anxiety and Depression Scale(HADS).

NOTE: Since the study is in process the results, discussions, and conclusion will be discussed during the time of final presentation of the paper.

KEYWORDS: Depression, Anxiety, Coronary heart disease.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

393 TITLE – Patterns of references in the Psychiatry department from different specialties in a tertiary care hospital.

Keerat Kaur ^1,^✉, Srishti Detha ¹, Prerak Kumar ², Manju Bhaskar ³

INTRODUCTION- Physical health is invariably linked to the mental health. Without addressing one’s mental health we cannot achieve complete well-being of patients. The recognition of mental health symptoms by physician has increased from previous times. This has led to the forthcoming of consultation liaison psychiatry. The study emphasizes at analysing referral patterns and to understand the lacuna in the proper management for complete remission.

MATERIALS AND METHODS -A descriptive cross-sectional study conducted in tertiary care hospital for a period of 6 months in which the patients referred from various other specialties were assessed. Diagnosis was made by psychiatrists based on ICD-10 guidelines. Data was analyzed using statistical techniques.

RESULTS- 380 patients were referred to our department. Majority of them were females (56%) lying in mean age of 42.6 years. Medicine department sent the highest number of references. Anxiety was the most common diagnosis made by psychiatrists. There was only 18% concordance in physicians and psychiatrists diagnosis.

CONCLUSIONS- Despite having high prevalence of psychiatric illnesses in patients there is very low referral rates. This is mainly because of the lack of awareness about the psychiatric symptoms and negligence of other specialties for these disorders. In a tertiary care hospital there should be comprehensive team-based approach for treating the patient for complete remission of the illness.

KEYWORDS - Consultation liaison psychiatry, Psychiatric referral, Mental Health.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

394 STUDY TO ESTIMATE STRESS AND COPING SKILLS IN 1^ST YEAR MEDICAL STUDENTS

Arnab Pathak ¹, Dilip Kumar Mondal ², Saswati Nath ³

INTRODUCTION

Stress is particularly common in medical students adversely affecting their physical and cognitive capacities. As found in various studies, medical education is inherently stressful. Medical student is subjected to various stressors like academic performance, homesickness, financial problems, relationship problems, peer pressure. Students often suffer from impaired concentration, poor memory, anxiety, depression, insomnia, suicidal tendencies. Hence the present study is undertaken to find out magnitude of stress, various stressors, and effect of stress on mental, physical & academic life of students, various coping techniques used by the pre-clinical medical students.

OBJECTIVE

To study the level of stress, level of resilience, type of coping strategies and and to find out various stressors among them.

METHODOLOGY

First year students of RGKMCH will be included in the study by total enumeration. They will be explained about the purpose of the study. Students giving a written consent will be included. A semi structured questionnaire including sociodemographic information and Student’s Stressful Event Checklist, Perceived Stress Questionnaire, Coping Scale, Brief Resilience Scale (BRS), General Health Questionnaire (GHQ) scales will be applied to them within the class under researchers’ observation and will be collected from them after specified time period maintaining privacy

RESULTS AND CONCLUSION

Initial computation of data shows a significant number of students are dealing with stress which has led to poor academic performance and depression in few. Students who had good coping skills and resilience score had less perceived stress. Further statistical analysis and detailed result would be given in during paper presentation.

Key words: Medical students, stress, coping

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S521–S631.

395. RISK MANAGEMENT OF MEDICATION STATUS IN MENTAL ILLNESS ON CLINICAL AND LEGAL MEDICINE

Babul Bandyopadhyay ¹

Mental health is the common issue that is often cared in the psychiatric treatments at clinical practices and the mental disorder spectrum follows various boundaries and clusters that involve series of molecules for chemical and biochemical interactions as enlisted remedial generic antipsychotics. But the risk management of illnesses have not yet been truly characterized update. This communication analyzed the risks and episodes of acute and chronic mental distresses in clinical and legal-medicine. A sample population was screened at hospital-clinic who underwent treatment (n=22) with quetiapine, olanzapine, risperidone, sertraline, haloperidol, zuclopenthixol decanoate etc. at varying degrees and doses for maintenance. In a separate set of experiment, the evaluation of forensic-pathological and chemical analysis also detected (p<0.01) medicines from the viscera/entrails of individuals (n=15) suffering from mental-illnesses with or without having history of clinical treatments. The mental state assessment observed that the treatment of cognitive distortion (Ψ^d) may transform into an un-resolving fourth state of cognitive emulsion (Ψ*). This study presumed that the optimum level of medicine use may be beneficial on “regular monitoring basis” irrespective of any “Drug market pull” in the clinical-care system and “Class treatment bias” on social events each of which may switch the foundation of future of psychiatric social work and forensic welfare research in preventive and resolving aspects.

[ref1] 1.Gold MS, Pottash AL, Extein I. Hypothyroidism and depression: Evidence from complete thyroid function evaluation. JAMA. 1981;245:1919–1922. doi: 10.1001/jama.245.19.1919. [DOI] [PubMed] [Google Scholar]

[ref2] 2.Heinrich TW, Grahm G. Hypothyroidism presenting as psychosis: Myxedema madness revisited. Prim Care Companion J Clin Psychiatry. 2003;5:260–266. doi: 10.4088/pcc.v05n0603. [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref3] 3.Chakrabarti S. Thyroid functions and bipolar affective disorder. J Thyroid Res. 2011:306367. doi: 10.4061/2011/306367. [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref4] 4.Khemka D, Ali JA, Koch CA. Primary hypothyroidism associated with acute mania: Case series and literature review. ExpClin Endocrinol Diabetes. 2011;119:513–517. doi: 10.1055/s-0031-1277137. [DOI] [PubMed] [Google Scholar]

[ref5] 5.Bhatara V, Alshari MG, Warhol P, McMillin JM, Bhatara A. Coexistent hypothyroidism, psychosis, and severe obsessions in an adolescent: A 10 year follow-up. J Child AdolescPsychopharmacol. 2004;14:315–323. doi: 10.1089/1044546041649048. [DOI] [PubMed] [Google Scholar]

[ref6] 6.Ueno S, Tsuboi S, Fujimaki M, Eguchi H, Machida Y. Acute psychosis as an initial manifestation of hypothyroidism: A case report. J Med Case Rep. 2015;9:264. doi: 10.1186/s13256-015-0744-z. [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref7] 7.Lin CL, Yang SN, Shiah IS. Acute mania in a patient with hypothyroidism resulting from Hashimoto’s Thyroiditis. Gen Hosp Psychiatry. 2013;35:683. doi: 10.1016/j.genhosppsych.2013.06.013. [DOI] [PubMed] [Google Scholar]

[ref8] 8.Sathya A, Radhika R, Mahadevan S, Sriram U. Mania as a presentation of primary hypothyroidism. Singapore Med J. 2009;50:e65–7. [PubMed] [Google Scholar]

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