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Indian Journal of Psychiatry logoLink to Indian Journal of Psychiatry
. 2019 Jan;61(Suppl 3):S379–S389.

DR MURUGAPPAN AWARDS

PMCID: PMC6366282
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: A comparative study of psychiatric comorbidities, severity of addiction and cognition in patients of early and late onset alcohol dependence

Anamika Das *1, PK Dalal 2, Sujit Kumar Kar 3, PK Gupta 4

Introduction: Alcohol Use Disorder (AUD) is a serious health problem over the globe. Consumption of alcohol is the world’s third largest risk factor for disease and disability. Classification of alcohol dependence has been attempted long back and one of the typologies is ‘age of onset’ with early onset being taken as onset before 25 years. Early onset AUD has more severity of illness, higher comorbidity and association of antisocial behaviours, poorer cognitive performance.

Objective: To study and compare the psychiatric comorbidity, severity of addiction and cognitive performance in patients of early and late onset alcohol dependence.

Method: The study was a cross-sectional observational study. SSAGA (semi structured assessment for the genetics of alcoholism) IV was applied to find the age of onset and the population was divided into early and late onset (on the basis of 25 years). Comorbidity was assessed through SSAGA and Composite International Diagnostic Interview (CIDI). Addiction Severity Index (ASI) was applied and Wisconsin Card Sorting Test (WCST) and Continuous Performance Test (CPT) was applied.

Results: A total of 57 patients were recruited on the study out of which 26 were early onset and 31 were late onset. The family history was higher in early onset group(p=0.006) and had more severity of addiction in most of the domains (p<0.001). The early onset group had higher current (p=0.015) and lifetime(p=0.031) psychiatric comorbidity. The early onset group had higher externalising psychopathology(p<0.001) and a poorer performance in WCST and CPT.

Conclusion: Early onset alcohol dependence represents a sub group with more severity of illness in various domains.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Development of a Hindi instrument for self-assessment of ‘recovery’ in opioid dependence: A mixed methodology study at a tertiary level drug de-addiction centre in north India

Aniruddha Basu 1, SK Mattoo 2, D Basu 3, BN Subodh 4, SK Sharma 5

Background:

Long term studies have shown that prolonged abstinence is possible and ‘recovery’ is a reality in some patients with opioid dependence (OD).

Objective:

To develop and apply an instrument for self-assessment of ‘recovery’ in OD.

Methodology:

This is a cross-sectional, descriptive study with both qualitative and quantitative arms. In the qualitative arm consenting males with OD using illicit or prescription opioids were recruited through ‘purposive’ sampling. Initially in-depth interviews were conducted among patients, care-givers and treatment providers. By ‘open coding’ of the transcripts, 70 items were derived and a 5-point likert-type self-rated Hindi Assessment of Recovery Instrument (HARI) was developed. In the quantitative arm - HARI, Addiction Severity Index (ASI), Hindi Addiction Recovery Capital (ARC), WHO-Quality of Life – BREF Questionnaire (Hindi) were applied on 30 active OD, 30 abstinent OD users and another 30 OD abstinent on buprenorphine substitution (OST). The items of HARI were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA).

Results:

EFA (varimax rotation) yielded a 40-item 5-point instrument. Six constructs - ‘holistic individual change’, ‘family and life functioning’, ‘future orientation’, ‘self-regulation’, ‘behavioural aspects of drug use’ and ‘psychological aspects of drug use’ were extracted. Expert opinion and similarity of these constructs with a qualitatively derived understanding of ‘recovery’ established the content and construct validity respectively. Internal consistency (mostly Cronbach’s alpha>0.7), test-retest reliability (rho>0.5, p<0.01) and concurrent validity were acceptable. Convergent and divergent validity were established by comparing HARI with standardised instruments (positive correlation with ARC and WHOQoL BREF at p<0.01, negative correlation with ASI at p<0.01). CFA yielded a reasonable model fit [CMIN/DF=1.78(<2)]. HARI differentiated between OST and the ‘abstinent’ subjects (p<0.01).

Discussion and conclusion :

Preliminary psychometric properties of HARI have been evaluated and clinical usefulness established. This instrument will be useful for monitoring and developing ‘recovery oriented’ services.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Awareness and utilization of disability benefits among patients attending Psychiatry Out-patient Department of a tertiary care private hospital – a pilot study.

Ashaparvathy VM 1, Anisha Nakulan 2, Sreekumar D 3

Introduction: Disability associated with mental illness is a major contributor to the global burden of disease. There is increasing emphasis on the rights and needs of people with disabilities. The Persons with Disability (PWD) Act of 1995, introduced by the Government of India, provides benefits if a person has 40% disability on Indian Disability Evaluation and Assessment Scale (IDEAS) as certified by a government medical authority.1 The awareness and utilization of these benefits among the deserving remains poorly understood.2

Aims and Objectives: This pilot study aims to understand the awareness and pattern of utilization of mental health disability benefits among patients with major psychiatric disorders attending the psychiatry OPD of a tertiary care private hospital and to plan future research based on the findings.

Materials and Methods: Seventy-five consecutive patients with their caretakers who attended the psychiatry OPD of a private-sector hospital with a diagnosis of bipolar affective disorder, schizophrenia, major depressive disorder, obsessive compulsive disorder and dementia were evaluated after informed consent. Socio-demographic parameters and details of mental illness were collected. IDEAS was administered to assess level of disability. Awareness of the disability benefits among all the patients and the pattern of utilization of these benefits were analyzed.

Results : 89.3% of the patients and their caretakers were not aware of the government disability benefits for the mentally ill. Of the total 75 patients who were assessed using IDEAS, 34 were having disability more than 40%. Only five of them were aware of mental health disability benefits and only two of these patients were utilizing it.

Discussion: Lack of awareness among people with disabilities regarding the various benefits is one of the major reasons for the poor utilization of these services.

Conclusion : Measures to increase the awareness regarding disability benefits available to the mentally ill must be taken with immediate effect.

References

  • 1.Amendments to PWD Act for Mentally Ill. [Last accessed on 2009 May 28]. Available from: www.acmiindia.or.
  • 2.Kashyap K, Thunga R, Rao A. K, Balamurali N. P. Trends of utilization of government disability benefits among chronic mentally ill. Indian Journal of Psychiatry. 2012;54(1):54–58. doi: 10.4103/0019-5545.94648. [DOI] [PMC free article] [PubMed] [Google Scholar]
Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title “WHEN I CANNOT SLEEP…”: LIVED EXPERIENCES OF PEOPLE SUFFERING FROM CHRONIC INSOMNIA – A QUALITATIVE PERSPECTIVE

Debanjan Banerjee 1, Anirudhha Basu 2

Background:

Insomnia, being an age-old problem can be multi-factorial, tends to be chronic and debilitating to the lives of the affected. Being highly subjective in its nature, understanding the experience of ‘suffering from insomnia’ can be vital in planning interventions for them.

Objective:

To understand the perceived needs and lived experiences of people suffering from chronic insomnia

Methods:

The study used qualitative design with constructivist paradigm. Participants were selected from patients who presented to our institute and were referred to various sleep centres/general hospitals and were diagnosed to have chronic insomnia there, through both clinical and objective measures. A purposive sampling of 20 patients was obtained. Data was collected using one-to-one in-depth semi-structured interviews and then thematic analysis done. Super-saturation and respondent validation done to increase reliability.

Results:

The overarching theme for ‘lived experiences’ came out to be ‘chronically depressed mood’ with sub-themes of ‘chronic worries and apprehension about sleep’, ‘monotonous lifestyle’ and ‘perceived treatment gap’. On the other hand, the main theme for ‘perceived needs’ was ‘need to be looked at like genuine patients’ with subthemes of ‘need for a new schedule’, ‘need for talking out their problem’ and ‘need for multiple medications’. Over-medication by treating physicians and pre-occupation with ‘sleep’ were concerning problems.

Conclusion:

The above results clearly lay out the unpleasant experiences in the daily lives of patients with chronic insomnia, which affects functioning. In routine clinical practice, these complaints are often ignored or which creates barriers for treatment. Patient-tailored interventions are thus highly needed to reduce this common source of distress.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: What makes Eluid Kipchoge click?

Devika Patil 1, Alka Subramanyam 2

Background: Endurance running is continuous running over 8 kms while ultra endurance is running over 42.19 kms. Running can be affected by psychological factors like motivation, defense mechanisms and attentional focus, all of which could affect performance.

Aim: To study motivation, attentional focus and defense mechanisms in healthy controls, endurance runners and ultra endurance runners and compare the same across the groups.

Methodology: A comparative, cross sectional analysis was done. Each group had 30 participants. They were assessed using Sports Motivation Scale-6, Defense Style Questionnaire-40 and Attentional Focus Rating Scale. Basic demographic details were recorded. Descriptive analysis was done. Intergroup comparison was made using One way ANOVA test. Correlation between factors was assessed using Pearson’s coefficient. P Value of <0.05 was taken as significant.

Result: For controls, endurance runners, ultra endurance runners mean age was 30yrs, 38yrs and 37.5yrs, while the longest distance run was 3.6kms, 35.7kms and 118kms. Intergroup comparison showed difference between amotivation, intrinsic motivation and external motivation factors. Motivation was more in male gender, running group participants and those with runners in family while amotivational factors reduced with increasing age. Internal attentional focus and external attentional focus were significantly different between the groups. Internal and external attentional focus was more in male gender and running group participants while only external attentional focus was found to increase with longest distance run. There was significant difference between immature and neurotic defense mechanisms between the groups. Neurotic and immature defense mechanisms were found to be less with increasing age, more no. of ultra endurance events and with participation in running group.

Conclusion: Intrinsic and extrinsic motivational factors, lesser use of immature and neurotic defense mechanisms and better attentional focus(both intrinsic and extrinsic) correlated with an ability to sustain endurance and ultra endurance running.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: EEG Spectral Power as a Response Marker for add-on Memantine in treatment of Alcohol Withdrawal Syndrome: A randomized, placebo controlled, double-blind trial

Dhruv Gupta *1, Shobit Garg 1, Sai Krishna Tikka 2, Sumit Khattri 1

Background:

NMDA receptor antagonists have been found to be effective in treating alcohol withdrawal syndrome, in preclinical studies. However, only a few studies on the efficacy of NMDA receptor antagonists in humans have been reported. As NMDA receptor function has a vital role in the assembly of EEG oscillations, they might be used as response bio-markers.

Objectives:

· To investigate the effects of memantine in alcohol withdrawal syndrome.

· To investigate the effects of memantine on depression and craving in alcohol withdrawal syndrome; also to study EEG spectral power as a response marker.

Material and Methods:

The study was a prospective, randomized, placebo controlled, double-blind trial. Out of 30 patients, 15 each were randomized to receive memantine or placebo add-on, alongwith benzodiazepines. Following scales were applied: Revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-AR), Penn Alcohol Craving Scale (PACS), Montgomery–Asberg Depression Rating Scale (MADRS) and Clinical Global Impression (CGI) Scale. CIWA-AR was applied on days 1,3,7 and 14 of alcohol withdrawal. PACS was applied on days 1,7 and 14. MADRS and CGI were applied on days 1 and 14. A resting state EEG was recorded at days 1 and 14. Spectral power in five frequency bands- delta, theta, alpha, beta and gamma was measured across 8 brain regions.

Repeated measures ANOVA was used to analyse the primary and secondary outcome variables.

Results:

We found no significant difference between memantine and placebo groups on the change of scores on withdrawal, craving, depression and overall clinical improvement over the course of 2 weeks. No differences were noted on EEG spectral power measures, as well.

Conclusions:

This study fails to demonstrate whether or not add-on memantine is significantly superior in alleviating alcohol withdrawal compared to placebo. We also fail to provide evidence for whether this protocol has any effect on EEG oscillations.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

ATYPICAL KLEINE-LEVIN SYNDROME

Sail D B 1, Saraf G 1,✉, Kadam K 1, Abhivant N 1

Background: Kleine-Levin syndrome, sometimes referred to as Rip van Winkle disease, is a rare sleep disorder mainly affecting teenage boys in which the main features are intermittent hyper somnolence, behavioral and cognitive disturbances, hyperphagia and in some cases hyper sexuality. Each episode lasts for one or two weeks, and affected people are entirely asymptomatic between episodes.

Case: Mr.ABC, 21 year old unmarried male presented with hypersomnia, decreased appetite, behavioural disturbances since 10 years. On detailed evaluation, he reported having episodes of hypersomnia (18-20 hrs/ day), decreased appetite during these episodes, and behavioural disturbances in form of withdrawn behaviour and irritability. Each episode used to last for 20-25 days and patient used to remit spontaneously& entirely asymptomatic between episodes. The patient had no known history of substance abuse or prior psychiatric disorder. The neurological examination was normal. The CT Brain and TFTs were within normal limits. A diagnosis of Kleine-Levin syndrome wasmade and he was started on T. Lithium 600mg in divided doses. The patient showed significant improvement on above treatment.

Conclusion: Kleine-Levin syndrome, can present with behavioural disturbances with episodic hypersomnia. Hence, this syndrome must be ruled out in adolescent males presenting to a psychiatrist with such symptoms.

Key Words: Kleine-Levin syndrome, hypersomnia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title of the article: HUNGRY AND STRESSED? TAKE A MOUTHFUL OF THIS AWFUL DELICACY…

Sail D B 1, Babhulkar S 1,✉, Kadam K 1

Background: Trichobezoars often occurs in young patients suffering from trichotillomania and trichophagy. The majority of these cases presented between 13 and 20 years of age. Emotional problems are frequently encountered in such cases.

Case: A 13 years old female child referred to psychiatry from surgery in view oftrichobezoar. On detailed evaluation, anxiety & depressive features were noted. In response to her anxiety she started plucking her hair & used to eat them to relieve it. Additionally a diagnosis of trichotillomania was made & patient was started on Tab. Sertraline 25mg which was up titrated to 37.5 mg & she is maintained well on same. Radiological investigations were done S/O Rapunzel syndrome & was operated for the same.

Conclusion: In young girls presenting with Rapunzel syndrome, psychiatric co morbidities should be considered to prevent relapse.

Key Words: Childhood depression, trichotillomania, trichobezor, Rapunzel syndrome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Social-cognitions, neuro-cognitions and social outcomes in patients with first episode psychosis in remission: a cross-sectional study

Mahadev Singh Sen 1, Ritu Nehra 2

Background: A significant number of patients with first episode of psychosis(FEP) have deficits which prevent their reintegration into the society. Among the various factors known to impede the reintegration of the patients with FEP include deficits in neurocognitive(NC) and social-cognitive(SC) domains. Social-cognition is affected by the sociocultural factors and data from one country cannot be generalized to the other. There is no information on social-cognitive deficits among patients with FEP from India.

Aim of the study: To evaluate the social and neurocognitive deficits among patients with FEP and to assess their relationship with outcome variable.

Methods: 30 patients with FEP, currently in clinical remission and 26 healthy controls matched for age, gender, level of education and intelligence quotient were assessed for social-cognition (domains of Theory of mind(ToM), social-perception and attributional bias), neurocognition (domain of executive functioning, attention/concentration, verbal memory, and phonemic/verbal fluency) and social outcomes (domains of Quality of life, stigma and disability).

Results: Compared to healthy controls, patients with FEP has higher level of deficits in the domains of second order ToM (t=4.447, p<0.001) and Faux Pas composite index (t=2.824, p=0.007). No significant differences were seen in other domains of social-cognition. Poor performances were noted for Hopkin’s verbal learning test and Colour Trail Test in patients with FEP. Longer duration of untreated psychosis was associated with significantly higher deficits in the first order ToM (t=0.38, p=0.04) and externalizing bias index (t=0.49, p=0.006). General psychopathology (t=0.42, p=0.022) and total PANSS (t=0.38, p=0.037) score correlated significantly with externalizing bias, higher level of psychopathology being associated with higher deficits in this domain. Poor social-cognition was associated with poor functioning and higher disability.

Discussion/Conclusion: Present study suggests that social-cognitive deficits in patients with FEP are associated with poor functioning and higher level of disability. Hence, there is a need to design intervention programs to improve the social-cognition of patients with FEP to improve their outcome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

TITLE : “Can Smartphones be a useful coping tool for medicos? A pilot study”

Neena Vijayvargiya 1,✉, AlkaA Subramanyam 1, Ravindra Kamath 1

Background:

Postgraduate students are under constant stress due to heavy academic and clinical patient workload, hectic schedule, exposure to infections, difficult workplace, deprived sleep etc. Coping from stress is an important aspect in postgraduate student life and insight into their coping styles can be effective for addressing stress.

Use of social media and smartphones has seen a rapid increase in past few years. Facebook, WhatsApp, Twitter, Myspace, Instagram, YouTube, shopping and exercising apps etc. have today become a part of routine life. Research has shown these platforms to benefit this generation, by increasing communication, retail, and possibly help to decrease stress levels.

Aims:

1. To assess coping strategies. 2. To assess social media use. 3. To correlate the above two

--in medical post-graduate students.

Methodology: We conducted a cross-sectional, observational study involving 100 postgraduate students from various departments of a tertiary care centre of Mumbai. After obtaining permission from the Institutional Ethics Committee, and with due consent, a semi structured questionnarie and Mechanism of Coping Scale by Parikh et al.was applied to them. Frequencies were calculated and correlations were done using Pearson ‘s correlation.

Results: Postgraduate students who used problem solving as a coping strategy, spent more time on the phone for work and this was significantly corelated(p=0.041). Similarly those used problem solving, had a good feeling while using the smartphones(p= 0.000). Those who used expressive action as a coping strategy, were found to use social media apps related to exercise, yoga and lifestyle organisation, and these corelated significantly(p=0.047 and 0.014). On the other hand, those who used escape avoidance were the ones who used smartphone for leisure(p=0.004).

Discussion and conclusion : The knowledge of use of various coping strategies may help us design specific apps in the future, which may help reduce stress in medical post graduate students.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

ASSOCIATION OF DEPRESSION WITH CARDIAC ARRHYTHMIA IN POST MYOCARDIAL INFARCTION PATIENTS

Nimmy Chandran 1, Koushik Sinha Deb 2, Rajiv Narang 3, Rakesh K Chadda 4

Objectives: This study was conducted to look at the effect of depression on cardiac arrhythmias in patients with recent myocardial infarction.

Method: A total of 104 patients with a recent myocardial infarction, who were attending the cardiology outpatient department in All India Institute of Medical Sciences, New Delhi were assessed for depression using Hamilton Rating Scale for Depression (HAM-D). Within 1 week of psychiatric assessment, a 24 hour Holter monitoring was done to look for cardiac arrhythmias.

Results: Among all the 104 patients, significant depressive symptoms were present in 39.42% patients. As per HAM-D, 41 patients had significant depressive symptoms and among them, 19 patients had mild depression, 7 patients had moderate depression and 15 patients had severe depression. Out of 87 patients for whom the Holter reports were available, significant arrhythmias were present in 28.75% patients. Among all the arrhythmias, ventricular arrhythmias were present in 21.84% of patients and supraventricular arrhythmias were present in 16.1% of patients. This study could not find any significant association of depressive symptoms with cardiac arrhythmias.

Discussion: Previous studies which have looked into the depressive symptoms of patients with coronary artery disease found values as low as 13.6% and as high as 86%. Few studies reported rates between 25% and 40% which is similar to our result. Investigators have looked into the association of depression with cardiac arrhythmia by studying the post- Myocardial Infarction patients and have found mixed results. Our study couldn’t find any significant association between depression and cardiac arrhythmia.

Conclusion: Significant rate of depressive symptoms were present in patients with recent myocardial infarction. This finding necessitate that cardiologists should screen for the depressive symptoms of patients with recent myocardial infarction and management of depression should be given priority.

Title of article A study of borderline personality disorder in patients with para-suicide attempt
Contributors Dr.Parlin M Dadhaniya ( Principal Author)
Dr.Bhaveshkumar M Lakdawala (Co-author)
Affiliation of authors Dr.Parlin M Dadhaniya 3rd year post graduate student, Psychiatry Dept., AMC MET Medical college and Sheth L. G. Hospital, Ahmedabad
Dr.Bhaveshkumar M Lakdawala Professor and Head, Psychiatry Dept., AMC MET Medical college and Sheth L. G. Hospital, Ahmedabad
Name of department and institute where work had been carried out Psychiatry Dept., AMC MET Medical college and Sheth L. G. Hospital, Ahmedabad
Correspondence address Dr.Parlin M Dadhaniya 3rd year post graduate student, Psychiatry Dept., AMC MET Medical college and ShethL. G. Hospital, Ahmedabad parlin30dadhania@yahoo.in Mobile no. 9427371747
Conflict of interest None
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BACKGROUND:

Para-suicide attempts can be present in variety of psychiatric illnesses. Borderline personality disorder (BPD) is one of them. Para-suicidal behaviour can predict future completed suicide and results in disruption of daily living of a person.

AIMS AND OBJECTIVES:

· To know the prevalence of BPD in patients with para-suicide attempt.

· To assess relation of borderline status with socio-demographic variables, suicidal intent factors and motives for para-suicide factors.

· To assess relation of severity of borderline symptoms with suicidal intent factors and motives for para-suicide factors.

· To compare methods of para-suicide attempt in people with BPD and Others and to know Co-occurrence of BPD with other psychiatric illnesses.

METHODS AND MATERIALS:

Total 104 inpatients with para-suicide attempt referred to psychiatry were included in study. After obtaining Socio-demographic details, they were subjected to MINI international neuropsychiatric interview for assessment of co-morbidities, McLean screening instrument for BPD(MSI-BPD) for diagnosis, Zanarini rating scale for BPD(ZAN-BPD) for measurement of severity, Short version of Beck’s suicidal intent scale (SIS), Motives for para-suicide questionnaire (MPQ). Data was analyzed by appropriate statistical methods using SPSS (version 16) and p-value of <0.05 is considered statistically significant.

RESULTS:

Prevalence of BPD was 34.6% in this study. No association found between borderline status and socio-demographics. Affective and impulsive symptoms were more severe and severity of interpersonal problems was more with serious suicidal intent in borderline patients. No association found between suicidal intent factors, motives for para-suicide attempt and severity of borderline symptoms. However, borderline patients reported high suicidal intent. Ingestion of insecticide was most common method used for para-suicide attempt. Major depressive disorder, substance abuse and dysthymia were most common co-morbidities.

CONCLUSIONS:

BPD is prevalent in para-suicidal population, which can predict future suicidality, and multidimensional approaches needed for management of both borderline state and suicidality.

KEYWORDS: borderline personality disorder, para-suicide, co-morbidity, motives, suicidal intent

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

A COMPARITIVE STUDY OF FACTORS ASSOCIATED WITH NON-ADHERENCE AMONG PATIENTS WITH CHRONIC PSYCHIATRIC ILLNESS AND CHRONIC MEDICAL ILLNESS

Preethi V Reddy 1, Raghavendra Kumar K 1, Sunil Patil 2, G Gopalakrishnan 2

Objectives: Adherence is the extent to which the patient’s behaviour coincides with medical or health advice. This study looks at the rates of non-adherence and multidimensional factors associated with it among medical and psychiatric illnesses in both inpatients & outpatients in a medical college hospital.

Methods: A descriptive study, among diabetes (n=60), schizophrenia (n=60) and OCD (n=60) patients with consecutive sampling. Medication adherence rating scale (MARS) used to assess adherence among schizophrenia patients and Morisky Medication Adherence Scale (MMAS) for diabetes and OCD patients. Attitude and beliefs towards medications assessed from specific questions in the adherence rating scales. Multidimensional factors responsible for non-adherence were assessed using a semi structured questionnaire which was prepared by the investigators based on the WHO multidimensional adherence factors. Descriptive statistics and Chi square test used for statistical analysis.

Results: Non adherence rates in our study among the three groups were: diabetes (41.7%), schizophrenia (56.7%) & OCD (53.3%), no significant difference (p>0.05). Socio-demographic factors like unemployment and comorbid substance use were associated with Non adherence. Most common factors or reasons associated with non-adherence were forgetfulness, longer duration of treatment, drug side effects and financial problems among all three groups. In the psychiatric group drug side effects, number of medications, dysfunction and lack of family support (p<0.01) were significantly higher when compared to medical group.

Conclusion: Non-adherence is a major public health problem that is likely to continue despite treatment advances. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs. It is also important to know differences in factors responsible for non-adherence specific to disorders and the individual, in order to plan interventions and develop more effective strategies to improve adherence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Quality of sibling relations and its association with illness severity, comorbidity pattern and treatment adherence in children with attention deficit hyperactivity disorder

Nayak Ajita S 1, Parkar Shubhangi R 2*, Keshari Prerna 3,✉, Nachane Hrishikesh B 4, Kumar Hemant 5, Arora Manan 6

Institute: KEM Hospital and Seth GS Medical College, Mumbai

Background: Children with ADHD have been shown to have an increased risk for poor sibling relations. Siblings may not only lack warmth and affection, but there may be a power struggle for achievement and parental preference. No study has established a relation between sibling relationship with disease outcome and comorbidity pattern in ADHD. Adherence to medications in ADHD is of concern and the impact sibling relations may have on it is not yet understood.

Objectives: The study hypothesizes that there exists a difference in sibling relations between children with ADHD and normal children. We also hypothesize that this has an impact on severity of illness, comorbidity pattern and treatment adherence.

Methodology: 45 subjects suffering from ADHD and 15 age-matched controls between the ages of 5-12, were recruited. Quality of sibling relations was assessed using Sibling Relationship Questionnaire (SRQ). Severity of illness and comorbidities were assessed using the Vanderbilt ADHD rating scale and the Clinician Rating Scale (CRS) was used for assessing treatment adherence.

Statistics: Sibling relations were compared using unpaired t-test. Correlation statistics were performed with Pearson’s correlation test.

Results: Our analysis showed that sibling pairs with ADHD expressed significantly lower affection (t = 3.69, p = 0.005) and companionship (t = 2.28, p = 0.026). They also showed lesser competition with their siblings as compared to normal children (t = 3.215, p = 0.002). Sibling pairs expressing lesser warmth and affection and more power struggle were associated with greater severity of illness (p < 0.05). Comorbid diagnosis and non-compliance were more common in the sibling pairs with less warmth and more inter-sibling conflict (p < 0.05).

Conclusions: Our study concludes that ADHD siblings express less affection and companionship as compared to normal controls. This has a significant impact on their disease outcome, comorbidity patterns and treatment adherence.

KEY WORDS: ADHD, sibling relations, comorbidity, treatment adherence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: PSEUDOCYESIS IN MAN: A CASE REPORT

Priyam Sharma 1, Shyamanta Das 2

Place of study:

Department of Psychiatry, Gauhati Medical College and Hospital.

PSEUDOCYESIS IN MAN: A CASE REPORT

INTRODUCTION

Pseudocyesis or delusion of pregnancy is common in women but is rare in men. Psychotic disorders, diseases causing abdominal distension, neuroendocrinological and neuropsychological abnormalities, misinterpretations of society, blockade and discontinuity of thoughts, sexual abuse in childhood etc. are among the various causes that can lead to pseudocyesis in both men and women.

CASE REPORT

A 25 years old Hindu man from Lanka of Nagaon district of Assam came to our OPD on 25th of May 2018 with the chief complaints of abdominal discomfort, passage of semen in urine, suspiciousness, low mood, repeated asking for different investigations, not eating adequately, decreased interest in daily activities. He had the firm belief that he was pregnant. He was sexually assaulted by his uncle in July 2015, following which the symptoms gradually started. He was on regular follow up from a private psychiatrist till February 2018. On treatment his symptoms subsided to some extent but he never attained premorbid level. This time he came to our OPD to get the advice for possible investigations to confirm his belief that he is pregnant. In the second visit to our OPD after taking medications for 14 days his delusion was found to be in idea level.

DISCUSSION

According to the DSM-5 pseudocyesis is a form of somatoform disorder. Most of the somatoform disorders also have an associated anxiety disorder. A lot of social pressure can cause depression, anxiety or emotional stress leading to a decrease in levels of dopamine and nor epinephrine activity. Another study suggested that somatic factors may stimulate pregnancy wishes which set up a psychophysiological interactions leading to clinical syndrome of pseudocyesis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

102 Not Out – Smartphone use in elderly

Reeta Chavan 1,✉, Alka Subramanyam 2, Aditi Udeshi 3

IPS Membership: Applied. IPS Membership: 01194

Aims/ Objectives : The aim of the study was to explore smartphone use and its relationship to cognition, depressive symptoms and quality of life in elderly population. Objectives were (1) To assess the validity of Smartphone Addiction Scale in elderly population. To study relationship between: (2) Symptoms of smartphone addiction and socio-demographic profile. (3) Symptoms of smartphone addiction and depressive features. (4) Symptoms of smartphone addiction and cognition (5) Symptoms of smartphone addiction and quality of life.

Methodology : 100 elderly participants (>60 years) were assessed using The Smartphone Addiction Scale (SAS), Geriatric Depression Scale (GDS), Montreal Cognitive Assessment scale (MoCA) and the abbreviated version of World Health Organization Quality of Life scale (WHOQOL-BREF). The SAS has not been assessed previously for this population.

Results and Discussion: Mean age of the participants was 72.20(±8) years. As per self-report, the main use of smartphone was as a ‘phone’ (50%). The median SAS score was 33 (33-132). 19% participants qualified as having ‘high smartphone use’ using the cutoff score of 72. There was no effect of age, gender or current working status on smartphone addiction scores. Those having high smartphone use had better cognition - especially in attention and language domains, higher depression scores and better quality of life with respect to social relationships as compared to those with low smartphone use. Also, lower smartphone addiction scores correlated with worse cognition - especially attention and worse quality of life with respect to social relationships.

Conclusions : The SAS is a good scale to use even in the elderly population. Our study shows that elderly population also exhibit symptoms of smartphone addiction. Those with higher smartphone use have better cognition and social relationships, however higher depression too. It is thus important to enquire about smartphone use as it gives good insight about depression and cognition.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Study on Effectiveness of Cranial Electrotherapy Stimulation on Patients Suffering from Somatic Symptom Disorder

Shorouq Motwani 1, Sagar Karia 1

Background: Cranial electrotherapy stimulation (CES) uses medical devices about the size of a cell phone that send a pulsed, weak electrical current (<4 mA) to the brain via electrodes placed on the ear lobes, maxilla-occipital junction, mastoid processes, or temples.

CES was first cleared for interstate marketing and export by the US Food and Drug

Administration for the treatment of anxiety, depression, and insomnia in 1979 and its use in clinical practice has steadily increased over time. The primary treatments used today for anxiety, depression, and insomnia are pharmaceuticals and psychotherapy. Stress-induced anxiety causes the cells of the human body to produce waveforms in differentfrequencies than normal. No studies have been undertaken for its effectiveness in patients suffering from somatic symptom disorders.

Aims and Objectives: The purpose of this study was to evaluate the efficacy of CES in alleviating the symptoms of somatic symptom disorder

Methodology: Diagnosed cases of somatic symptom disorder with minimal improvement on medications for the past three months were recruited for the study. Patients were started on CES sessions with one session of 15 minutes and a total of 14 sessions per patient.

Results: A significant improvement in symptoms has been noted however final results are awaited as this is an ongoing study.

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Conclusion: While this is a small circumscribed study, further large scale studies to evaluate the effect of Cranial Electrotherapy Stimulation on somatic symptoms is warranted.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: The extent and pattern of internet gaming disorder among medical college students: An exploratory study from India

Swarndeep Singh 1, Yatan Pal Singh Balhara 1

Aims: The present study aimed at providing an estimate for the prevalence of internet gaming disorder (IGD) in a sample of medical college students from India and explore its association with the socio-demographic, psychological (depressive symptoms), and internet gaming characteristics of gamers.

Methodology: This internet-based cross-sectional study conducted as online survey among 306 medical students at a tertiary care teaching college in India. The severity of problematic gaming behaviour and depressive symptoms were assessed using the Internet Gaming Disorder Scale-Short Form (IGDS9-SF) and Patient Health Questionnaire-9 (PHQ-9). A semi- structured questionnaire was used to collect information regarding socio-demographic and internet gaming characteristics of the participants. Statistical analysis was done using SPSS version 23.0, with two-tailed p-value<0.05 taken as a significant result.

Results: We identified 173 (55.6%) current gamers, with 11 (3.6%) IGD gamers based on DSM-5 criteria in the current study sample. In order to reduce the number of potential covariates with low explanatory power, bivariate analyses were carried-out prior to multiple linear regression analysis, and only statistically significant variables were entered in the multivariate model. A preference for multiplayer online gaming pattern (β=0.17, p= 0.005**), spending greater amount of time in playing digital games (β= 0.53, p< 0.01**), and higher PHQ-9 scores (β= 0.25, p< 0.01**) representing greater depressive symptom severity were associated with significantly greater scores on IGDS9-SF, indicative of a higher risk for having IGD.

Discussion and conclusion: To the best of our knowledge, this is the first systematic study assessing the prevalence and correlates of IGD among medical students in India. This study strongly suggests IGD among medical students in India as an important emerging mental health condition, with an urgent need to create awareness about it among students and concerned authorities, and to develop effective screening and treatment strategies suited for our population.

Keywords: Medical Students; Internet Gaming Disorder; Depression; Multiplayer Online Games; Diagnostic and Statistical Manual for Mental Disorders (DSM-5)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

A cross sectional study of symptoms of inattention and hyperactivity/impulsivity, deficient emotional self-regulation & perceived stress in parents of children with Attention Deficit Hyperactivity disorder

Utkarsh Mankar 1, Henal Shah 2

Aims and Objectives : Aim: To study inattentive and hyperactive/impulsive symptoms, deficient emotional self-regulation & Perceived Stress in parents of children with Attention Deficit Hyperactivity disorder. Objectives: To evaluate inattention & hyperactivity/impulsivity features, to evaluate for deficient emotional self-regulation, to evaluate for Perceived Stress, to study the correlation between inattention & hyperactivity/impulsivity features, deficient emotional self-regulation & Perceived Stress.

Methods : 100 parents of children with a DSM-5 diagnosis of ADHD were assessed using the Adult ADHD Self-report Screening Scale for DSM-5 (ASRS-5), Difficulties in Emotion Regulation Scale (DERS) and the Perceived Stress Scale (PSS-10).

Results : 24% parents screened positive for Adult ADHD. Mann Whitney U test indicated that this group had significantly higher DERS Total scores (Mdn=124) than those who screened negative (Mdn = 59), U = 132, p = 0.000. Those who screened positive also had significantly higher PSS-10 scores. (U= 123.5, p = 0.000) Pearson’s correlation showed a significant positive correlation between ASRS-5 and DERS Total scores (r =0.879, p=0.000), ASRS-5 and PSS scores (r = 0.778, p= 0.000) as well as between DERS and PSS scores (r = 0.841, p= 0.000).

Discussion : Those parents who screened positive for ADHD had significantly higher perceived stress & deficient emotional self-regulation compared to those who did not. It is possible that deficient emotional self-regulation a poorer affective response to stressful life events resulting in a higher perceived stress.

Conclusions : Adult ADHD remains an under-diagnosed condition and a significant number of parents of children with ADHD themselves suffer from inattentive and hyperactive/impulsive symptoms. Therefore, parents of children with ADHD should be routinely screened for ADHD and deficient emotional self-regulation as these correlate with higher perceived stress. Diagnosing and treating ADHD will help in improving their emotion regulation and possibly reduce perceived stress. Further research with interventional studies is necessary.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: To assess suicidality in patients with idiopathic epilepsy

Yogender Malik 1*, SK Mattoo *, Parampreet Singh **

Background: Epilepsy is a chronic medical condition which is associated with significant negative psychosocial outcomes like psychiatric morbidity, stigma, quality of life, suicidality, cognitive deficits etc. Although few studies have evaluated the suicidality among patients with epilepsy, little is known about its association with psychiatric morbidity among patients with epilepsy.

Aim: To assess suicidality in patients with idiopathic epilepsy.

Method: A cross sectional study design was followed in which 120 patients with idiopathic epilepsy were assessed for psychiatric morbidity by using MINI PLUS and Columbia Suicide Severity Rating Scale (C-SSRS), which is comprehensive standardised scale for assessment of Suicidality.

Results: Present study showed that prevalence of current and lifetime and psychiatric diagnosis as per MINI-PLUS among people with epilepsy is 68.3% and 75% respectively. On MINI plus, 24.2%of the study sample had some suicidal risk; the risk was low in 12.5%, moderate in 6.7% and severe in 5 % patients. All the patients with Suicidality had at least one current psychiatric diagnosis.

As per Columbia Suicide Severity Rating Scale (C-SSRS), about one fourth of the patients were found to have suicidal behaviour with most of the patients having low suicide risk and about one fourth of the patients had a wish to be dead, had non-specific suicidal ideations and active ideation without intent. Active ideas with some intent without plan were also seen in one-fourth of the patients. A small proportion of patients (6.7%) had history of previous suicidal attempt. Few patients also had history of non-suicidal self-harming behaviour (2.5%), interrupted attempts (4.2%) and aborted attempts. None of the patients without lifetime psychiatric diagnosis had suicidality as assessed by MINI-PLUS and C-SSRS.

Conclusion: These findings suggest that there is a need for close liaison between the psychiatrist and the Neurologist to address suicidality issues among patients with epilepsy.

Keywords: idiopathic epilepsy, Psychiatric disorders, Suicidality

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

A study of borderline personality disorder in patients with para-suicide attempt

BACKGROUND:

Para-suicide attempts can be present in variety of psychiatric illnesses. Borderline personality disorder (BPD) is one of them. Para-suicidal behaviour can predict future completed suicide and results in disruption of daily living of a person.

AIMS AND OBJECTIVES:

  • To know the prevalence of BPD in patients with para-suicide attempt.

  • To assess relation of borderline status with socio-demographic variables, suicidal intent factors and motives for para-suicide factors.

  • To assess relation of severity of borderline symptoms with suicidal intent factors and motives for para-suicide factors.

  • To compare methods of para-suicide attempt in people with BPD and Others and to know Co-occurrence of BPD with other psychiatric illnesses.

METHODS AND MATERIALS:

Total 104 inpatients with para-suicide attempt referred to psychiatry were included in study. After obtaining Socio-demographic details, they were subjected to MINI international neuropsychiatric interview for assessment of co-morbidities, McLean screening instrument for BPD(MSI-BPD) for diagnosis, Zanarini rating scale for BPD(ZAN-BPD) for measurement of severity, Short version of Beck’s suicidal intent scale (SIS), Motives for para-suicide questionnaire (MPQ). Data was analyzed by appropriate statistical methods using SPSS (version 16) and p-value of <0.05 is considered statistically significant.

RESULTS:

Prevalence of BPD was 34.6% in this study. No association found between borderline status and socio-demographics. Affective and impulsive symptoms were more severe and severity of interpersonal problems was more with serious suicidal intent in borderline patients. No association found between suicidal intent factors, motives for para-suicide attempt and severity of borderline symptoms. However, borderline patients reported high suicidal intent. Ingestion of insecticide was most common method used for para-suicide attempt. Major depressive disorder, substance abuse and dysthymia were most common co-morbidities.

CONCLUSIONS:

BPD is prevalent in para-suicidal population, which can predict future suicidality, and multidimensional approaches needed for management of both borderline state and suicidality.

KEYWORDS: borderline personality disorder, para-suicide, co-morbidity, motives, suicidal intent

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Development of a Hindi instrument for self-assessment of ‘recovery’ in opioid dependence: A mixed methodology study at a tertiary level drug de-addiction centre in north India

Background:

Long term studies have shown that prolonged abstinence is possible and ‘recovery’ is a reality in some patients with opioid dependence (OD).

Objective:

To develop and apply an instrument for self-assessment of ‘recovery’ in OD.

Methodology:

This is a cross-sectional, descriptive study with both qualitative and quantitative arms. In the qualitative arm consenting males with OD using illicit or prescription opioids were recruited through ‘purposive’ sampling. Initially in-depth interviews were conducted among patients, care-givers and treatment providers. By ‘open coding’ of the transcripts, 70 items were derived and a 5-point likert-type self-rated Hindi Assessment of Recovery Instrument (HARI) was developed. In the quantitative arm - HARI, Addiction Severity Index (ASI), Hindi Addiction Recovery Capital (ARC), WHO-Quality of Life – BREF Questionnaire (Hindi) were applied on 30 active OD, 30 abstinent OD users and another 30 OD abstinent on buprenorphine substitution (OST). The items of HARI were subjected to exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA).

Results:

EFA (varimax rotation) yielded a 40-item 5-point instrument. Six constructs - ‘holistic individual change’, ‘family and life functioning’, ‘future orientation’, ‘self-regulation’, ‘behavioural aspects of drug use’ and ‘psychological aspects of drug use’ were extracted. Expert opinion and similarity of these constructs with a qualitatively derived understanding of ‘recovery’ established the content and construct validity respectively. Internal consistency (mostly Cronbach’s alpha>0.7), test-retest reliability (rho>0.5, p<0.01) and concurrent validity were acceptable. Convergent and divergent validity were established by comparing HARI with standardised instruments (positive correlation with ARC and WHOQoL BREF at p<0.01, negative correlation with ASI at p<0.01). CFA yielded a reasonable model fit [CMIN/DF=1.78(<2)]. HARI differentiated between OST and the ‘abstinent’ subjects (p<0.01).

Discussion and conclusion :

Preliminary psychometric properties of HARI have been evaluated and clinical usefulness established. This instrument will be useful for monitoring and developing ‘recovery oriented’ services.

Conflict of Interest: nil

Ethical Permission: Institute Ethics Committee

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Title: Social-cognitions, neuro-cognitions and social outcomes in patients with first episode psychosis in remission: a cross-sectional study

Mahadev Singh Sen 1, Ritu Nehra 2, Sandeep Grover 2

Background: A significant number of patients with first episode of psychosis(FEP) have deficits which prevent their reintegration into the society. Among the various factors known to impede the reintegration of the patients with FEP include deficits in neurocognitive(NC) and social-cognitive(SC) domains. Social-cognition is affected by the sociocultural factors and data from one country cannot be generalized to the other. There is no information on social-cognitive deficits among patients with FEP from India.

Aim of the study: To evaluate the social and neurocognitive deficits among patients with FEP and to assess their relationship with outcome variable.

Methods: 30 patients with FEP, currently in clinical remission and 26 healthy controls matched for age, gender, level of education and intelligence quotient were assessed for social-cognition (domains of Theory of mind(ToM), social-perception and attributional bias), neurocognition (domain of executive functioning, attention/concentration, verbal memory, and phonemic/verbal fluency) and social outcomes (domains of Quality of life, stigma and disability).

Results: Compared to healthy controls, patients with FEP has higher level of deficits in the domains of second order ToM (t=4.447, p<0.001) and Faux Pas composite index (t=2.824, p=0.007). No significant differences were seen in other domains of social-cognition. Poor performances were noted for Hopkin’s verbal learning test and Colour Trail Test in patients with FEP. Longer duration of untreated psychosis was associated with significantly higher deficits in the first order ToM (t=0.38, p=0.04) and externalizing bias index (t=0.49, p=0.006). General psychopathology (t=0.42, p=0.022) and total PANSS (t=0.38, p=0.037) score correlated significantly with externalizing bias, higher level of psychopathology being associated with higher deficits in this domain. Poor social-cognition was associated with poor functioning and higher disability.

Discussion/Conclusion: Present study suggests that socialcognitive deficits in patients with FEP are associated with poor functioning and higher level of disability. Hence, there is a need to design intervention programs to improve the socialcognition of patients with FEP to improve their outcome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

A COMPARITIVE STUDY OF FACTORS ASSOCIATED WITH NON-ADHERENCE AMONG PATIENTS WITH CHRONIC PSYCHIATRIC ILLNESS AND CHRONIC MEDICAL ILLNESS

Preethi V Reddy 1, Raghavendra Kumar K 1, Sunil Patil 2, G Gopalakrishnan 2

Objectives: Adherence is the extent to which the patient’s behaviour coincides with medical or health advice. This study looks at the rates of non-adherence and multidimensional factors associated with it among medical and psychiatric illnesses in both inpatients & outpatients in a medical college hospital.

Methods: A descriptive study, among diabetes (n=60), schizophrenia (n=60) and OCD (n=60) patients with consecutive sampling. Medication adherence rating scale (MARS) used to assess adherence among schizophrenia patients and Morisky Medication Adherence Scale (MMAS) for diabetes and OCD patients. Attitude and beliefs towards medications assessed from specific questions in the adherence rating scales. Multidimensional factors responsible for non-adherence were assessed using a semi structured questionnaire which was prepared by the investigators based on the WHO multidimensional adherence factors. Descriptive statistics and Chi square test used for statistical analysis.

Results: Non adherence rates in our study among the three groups were: diabetes (41.7%), schizophrenia (56.7%) & OCD (53.3%), no significant difference (p>0.05). Socio-demographic factors like unemployment and comorbid substance use were associated with Non adherence. Most common factors or reasons associated with non-adherence were forgetfulness, longer duration of treatment, drug side effects and financial problems among all three groups. In the psychiatric group drug side effects, number of medications, dysfunction and lack of family support (p<0.01) were significantly higher when compared to medical group.

Conclusion: Non-adherence is a major public health problem that is likely to continue despite treatment advances. The consequences of poor adherence to long-term therapies are poor health outcomes and increased health care costs. It is also important to know differences in factors responsible for non-adherence specific to disorders and the individual, in order to plan interventions and develop more effective strategies to improve adherence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S379–S389.

Study on Effectiveness of Cranial Electrotherapy Stimulation on Patients Suffering from Somatic Symptom Disorder

Shorouq Motwani 1, Sagar Karia 2

Background: Cranial electrotherapy stimulation (CES) uses medical devices about the size of a cell phone that send a pulsed, weak electrical current (<4 mA) to the brain via electrodes placed on the ear lobes, maxilla-occipital junction, mastoid processes, or temples.

CES was first cleared for interstate marketing and export by the US Food and Drug

Administration for the treatment of anxiety, depression, and insomnia in 1979 and its use in clinical practice has steadily increased over time. The primary treatments used today for anxiety, depression, and insomnia are pharmaceuticals and psychotherapy. Stress-induced anxiety causes the cells of the human body to produce waveforms in differentfrequencies than normal. No studies have been undertaken for its effectiveness in patients suffering from somatic symptom disorders.

Aims and Objectives: The purpose of this study was to evaluate the efficacy of CES in alleviating the symptoms of somatic symptom disorder

Methodology: Diagnosed cases of somatic symptom disorder with minimal improvement on medications for the past three months were recruited for the study. Patients were started on CES sessions with one session of 15 minutes and a total of 14 sessions per patient.

Results: A significant improvement in symptoms has been noted however final results are awaited as this is an ongoing study.

Conclusion: While this is a small circumscribed study, further large scale studies to evaluate the effect of Cranial Electrotherapy Stimulation on somatic symptoms is warranted.

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