SYMPOSIUM

. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM

PMCID: PMC6366286

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 1.Challenges for Indian “Teachers of Psychiatry” (iTOP)

Since 2013 there have been efforts to bring together teachers of psychiatry from various medical colleges across the country. During every ANCIPS since then, various issues and challenges of both undergraduate and postgraduate training have been presented and discussed by the authors. The initiatives led to the starting / inauguration of a forum of “Indian Teachers of Psychiatry” (IToP) in 2016 with the active participation of Indian Psychiatry Society, the Medical Education Department of a medical college namely St John’s Medical College, Bangalore which runs a Medical Council of India Regional Training Centre for medical teachers and the Rajiv Gandhi University of Health Sciences, Karnataka. The program was attended by heads of various departments of psychiatry including NIMHANS. This was also followed by a one day training workshop on Teaching Psychiatry to Undergraduates. Indian Teachers of Psychiatry (IToP) forum since 2013 has continued active online and offline activities. The Initiative bagged the 2018 International Neuropsychiatry Association T S Srinivasan Award in the segment of public health. The prize money has been donated to Trust and an annual “IToP Minds United Award “ for the best work in undergraduate psychiatry initiated from 2018. The Indian Teachers of Psychiatry (IToP) initiative firmly backs the National Mental Health Policy and the National Mental Health Programme that envisages improved mental health care at the general health services, delivered by mental health informed and sensitized general doctors, supported by psychiatrists. This can be achieved only if the undergraduate teaching of psychiatry is uniformly improved and strengthened in all medical colleges in the country and the quality and standards of postgraduate training in psychiatry is maintained / enhanced at all centres.

The three presentations in this symposium will critically discuss the journey of iToP so far & comment on the challenges ahead.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 2. PSYCHIATRIC ADVANCE DIRECTIVES: CHALLENGES AND POSSIBLE SOLUTIONS

NM Patil ¹, Sameeran Chate ¹, Bheemsain Tekkalaki ¹

Psychiatric Advance directives (PAD) have been introduced into the Mental Health Care Act 2017.

The discussions over the feasibilities and the usefulness of PAD in Indian set up are on. the initial small scale researches have demonstrated that Indian patients have welcome this new provision of PAD. The content analysis of hypothetical PAD has also revealed that the majority of the patients would refuse hospitalization and ECTs. The impact of such decisions on the treatment and outcome of the illness is a matter of concern. In this symposium, the symposium, the speakers will discuss the practical, administrative and the legal hurdles in the way of effective implementation of PADs and their possible solutions. They also share the findings of a feasibility study of on the PAD and the difficulties cam across during this research. They also discuss e the competency assessment and its challenges, as the competency assessment is a compulsory pre-requisite to ascertain if “somebody is fit to make PAD”

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 3. Title: Impact of Residential Mobility on Borderline Personality Traits

Thwisha Bajpai ¹, Anuradha Sathiyaseelan

Co-Author Name 2:

Residential Mobility or intra-urban migration is defined as the frequent change of households within different urban areas. It has been seen as a major contributory factor to psychological well-being. This pattern of frequent relocation of residence is not alien for military families. This study aimed at establishing a relationship between high residential mobility and prevalence of borderline personality traits among young adults belonging to military families. As the immediate environment of home is the only stable factor, role of parents was also explored as a protective factor. The study was conducted following an explanatory sequential design. There were 80 participants (M=40, F=40) ranging from the age of 18-25years, belonging to a military background who participated in the study by completing two questionnaires: Parent Attachment Questionnaire and McLean Borderline Personality Disorder Screener. A semi-structured interview was conducted for the high scorers on borderline personality and analyzed using thematic analysis. The results indicated that there was no significant relation between residential mobility and borderline personality traits. However, there was a negative correlation between affective quality of relationship with parents and borderline personality. The interviews highlighted the impact of mobility on self-identity, personality development, interpersonal relationships and sense of belongingness. It also explored the relationship between these factors and their influence on borderline personality traits.

Keywords: military, residential mobility, borderline personality traits, parent attachment

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 4. Title: New Psychoactive Substance: Diagnostic Dilemma and Challenges in Management

Nitin Raut ¹, Sajjadur Rehman, Sumit Rana

Co-Author Name 3:

Recently there has been an increase in the sale and recreational use of new psychoactive substances (NPS). NPS are substances of abuse, either in a pure form or a preparation, that are not controlled by legal services but may pose a public health threat(Patil et al 2018). Most of these compounds belongs to synthetic cannabinoids, cathinones, and phen-ylethylamines. As per the World Drug Report 2017, 0.6 % suffers from drug use disorders globally. However, data about the extent and use of NPS in general population is lacking.

They show rapid washout from body and difficult to detect by usual drug screening assays. Thus easily dodge the existing legal regulations and provide the effect like other recreational drugs. Adverse health/ neuropsychiatric effects are also in rise due to NPS like seizures, severe agitation, myocarditis, and chest pain, psychosis, panic/anxiety, and seizures. Recently, few deaths associated with intoxication with NPS intake have also been reported. Drugs like GHB and Rohypnol are also implicated in criminal activities such as daterape and robbery.

Diagnosing NPS use is challenging due to lack of standardized tests, unavailability of data on signs and symptoms and constant change in chemical structure to avoid detection and legal complications. Management also is challenging due to lack of specific antidotes and rests mostly on supportive care and clearing the substance from the body. Things become even more difficult when an unknown substance or a cocktail of drugs is taken.

Thus NPS are an emerging health and legal hazard which is rapidly rising and poses a great challenge to already overburdened health and especially the de-addiction services in our country. To review the available evidence on NPS, their classification, diagnosis and management we have planned a symposium titled “New psychoactive substance: Diagnostic dilemma and challenges in management”.

New psychoactive substance: Introduction and overview: Dr. Nitin Raut, Specialist (Psychiatry), Department of Psychiatry and drug de-addiction centre, Lady Hardinge Medical College, New Delhi.

New psychoactive substance: Diagnostic dilemmas: Dr. Sajjadur Rehman, Specialist (Psychiatry), Department of Psychiatry and drug de-addiction centre, Lady Hardinge Medical College, New Delhi.

New psychoactive substance: Challenges in management: Dr Sumit Rana, Assistant Professor, Department of Psychiatry and drug de-addiction centre, Lady Hardinge Medical College, New Delhi.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 5. Attention deficit hyperactivity symptoms and Internet Addiction

Lavkush kumar ¹, pritha roy ¹, Anamika das ², jai singh ²

The objective of this study was to evaluate the relationship between attention deficit-hyperactivity/ impulsivity symptoms and Internet addiction. In total, 41 children and adolescent were recruited as case group and 40 chlidren were selected as control group. After obtaining inform consent they were assessed on semi structure proforma for socio demographic profile. Both parents were assessed separately through proper interview. Children and adolescent were screened on KSADS-PL and Diagnosis of ADHD was made as per DSM-IV TR. The presence or severity of Internet addiction was assessed by the Young’s Internet Addiction test and categorised in mild, moderate, severe and very severe use. Time of internet exposure in ADHD childen was also assessed and children were devided in to two group i.e. problematic internet use and non problematic internet use. Type of activity on internet was also assessed. Behavioural problems were assessed on Child Behavior Checklists. Among internet using children, significantly greater number of children in case group[20(55.6%)], than control[2(9.6%)] were using internet for more than 20 hr per week.(P=0.0001) and significantly higher no of ADHD(25.5%) children found to be internet addiction than the non-ADHD group (3.2%;P <0.01). Among internet addicted children pathological T score (T>60) in CBCL subdomains were found for aggrieve behavior (T=68.41), social problems(T=66.72), rule breaking(T=70.64) and Attention problem(T=60.41). Among internet addicted children a positive correlation was found between the internet addiction scale score and aggrieve behavior(r=0.77), social problems(r=0.80), rule breaking(r=0.96) and Attention problem(r=0.68) domains of CBCL.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 6. Title: Behavioral Economics and mental health, what can all mental health professionals learn?: Working title: Behavioural Economics and Mental Health

Ambrish Sanjay Dharmadhikari ¹, Avinash Shukla ², Ambrish Sanjay Dharmadhikari ³

Background

Economics is defined as how we apply limited resources to the aspirational fulfilment of unlimited wants hence it encompasses judicious allocation of resources. Economics intricately involves and to a great extent is wrapped around in human behaviour. That is why economics is considered, rightfully, a behavioural (or social) science. Occasionally, the conceptual substance of economics even integrates with that of the other recognized behavioural sciences, for example, psychology, sociology, anthropology, and political science.

The formal definition of behavioural economics, among leading scholars of the science, is economic activity infected by ‘human limitations and complications. The field of behavioural economics differs from neoclassical economics in that it focuses on the ways in which rationality may be limited or bounded, and influenced by factors such as impulsiveness, limited willpower, social norms, and the context in which choices are made. Governments worldwide are increasingly incorporating the behavioural economics approach into policymaking.

Behavioural Economics & Public Health Policy

Several studies have found that simply prompting (nudging) individuals to make a plan increases the probability of the subject eventually engaging in the prompted health behaviour, such as immunizations, healthy eating, and cancer screening.

Behavioural Economics & Mental Health

More than half of people with mental disorders do not receive treatment, even though long-standing barriers to mental health care such as stigma and financial factors appear to be receding. Many people have unhealthy diets and engage in little physical activity, for example, even when financial and attitudinal factors are not necessarily barriers to healthy behaviour. Present-orientation and procrastination have been highlighted by behavioural economists and other social scientists as potentially important explanations for these unhealthy behaviours.

Mental health could affect the general rate at which people discount future utility, and it could also affect the degree to which people value the present versus all future periods, which could in turn lead to indefinite delay (procrastination) of help-seeking.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 7. Resilience from Concept to Practice

Nisha Mani Pandey ¹, Akanksha Sonal ²

Resilience has been conceptualized across a range of disciplines including Physics, Engineering and Psychology. In terms of Mental Health, it has been defined as a dynamic psychosocial process through which individuals exposed to sustained adversity or potentially traumatic events experience positive psychological adaptation over time. This positive adaptation happens across various levels, including factors such as supportive family and relationships, effective coping skills, culture and neurobiology. These levels are complimentary rather than being mutually exclusive.

Over the past century, research on resilience has evolved through several stages, from developmental psychology of childhood to positive psychology of adult life and eventually to the concept of cognitive reserve in late life. Paralleling this evolution, the focus on determinants of resilience have moved from inherent character of the individual to the factors originating outside the individual (extra-individual) i.e., at family, community and cultural level. Following the dissatisfaction with ‘deficit’ models of illness and psychopathology, International research on resilience has increased substantially over the past two decades. Resilience is now also receiving increasing interest from the perspective of policy making and clinical practice, on account of its potential influence on health, well-being, quality of life and people’s response to the various challenges of the ageing process. Various approaches to, measuring resilience defined across literature has lead to inconsistencies and heterogeneity relating to the nature of potential risk factors and protective processes, and in estimates of prevalence. With this background here in this symposia we will be discussing about:

Resilience as an evolving concept and its significance for healthy aging
Resilience and its measures in clinical practice with special reference to late life stages (review of different scales used to measure resilience and factors associated with it).

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 8. A study of distribution of psychiatric morbidity in male prisoners

Dharmdeep Singh ¹, Kishore Dudani, Gunjan Solanki

Background: Prevalence of mental health disorders in prison is more than its prevalence in community. Not only pre-existing mental health conditions which are known to be increasing participation of affected individuals in criminal activities but also the post jail entry environmental factors, play a significant role in the development or further deterioration of his mental health condition.

AIM AND OBJECTIVES:

To assess the distribution of various psychiatric disorders amongst male prisoners (both convicted and under trial).

Materials & Method:

Data of those male inmates (both under trials & convicts) undergoing treatment for psychiatric disorders was assessed to Know the distribution of psychiatric morbidity in them & the nature of crimes committed by them.

Results:

Upon thorough assessment of available data it was found that most patients amongst those being treated for psychiatric disorders (including Substance use disorders) were of SUDs (mostly Opiod dependence/Abuse at the time of incarceration). Excluding SUDs most commonly diagnoses amongst them were on Psychotic spectrum followed by Depressive disorders, Bipolar Affective Disorders, Anxiety spectrum disorders, Obsessive- Compulsive Disorder & Dhat syndromes in the similar descending order. Most common crimes committed by those with Psychotic spectrum disorder were murder followed by illegal handling/possession of arms whereas those with Anxiety-Depression spectrum were mostly accused of robbery followed by rapes.

Conclusion:

There has been found a strong relationship between psychiatric disorders and nature of crimes committed. On the basis of available data we can say that an early diagnosis and management could have probably helped reducing the crimes in those suffering from psychiatric disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 9. Recent advances in Management of Neuropsychiatric Symptoms in Parkinson’s Disease

parul Prasad ¹, lavkush kumar ¹, pritha roy ¹

Neuropsychiatric symptoms are highly prevalent in Parkinson’s disease and associated with decreased quality of life and adverse health outcomes. Validated assessment scales are now available for the majority of common neuropsychiatric symptoms are like: depression, anxiety, psychosis, cognitive impairment, dementia and apathy.

Balancing dopaminergic therapy plays an important role in their management as increasing doses of dopaminergic agents might address depression and anxiety related to ‘off’ phases, non-motor fluctuations and apathy, while dose reduction might alleviate psychotic symptoms. More targeted treatment is possible through medications utilising different pathways. Although efficacy profiles of individual agents are not completely explored and require further exploration, antidepressants as a drug class have shown utility in depression and anxiety in patients suffering Parkinson’s disease. Psychological therapies are also very effective in treatment of depression and anxiety symptoms in patients with Parkinson disease, especially cognitive behavioural approaches. After starting dopaminergic therapy in Parkinson disease patient, psychotic symptom may appear as side effect or worsening of ongoing psychotic symptoms may observe after starting dopaminergic therapy. Pimavanserin allows the treatment of psychosis in Parkinson’s disease without directly affecting the dopaminergic and cholinergic system. The cholinergic system is currently the only target in Parkinson’s disease dementia, and antagonists of this system, as are many psychotropic drugs, need to be used with caution. Management of apathy largely relies on non-pharmacological strategies adapted from dementia care, with antidepressants being ineffective and the role of stimulant therapy needing further evaluation.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 10. Chronic Fatigue Syndrome: Indian Perspectives

Mahadev Singh Sen ¹, Swapnajeet Sahoo ², Shubh Mohan Singh ³

Chronic Fatigue Syndrome (CFS) is a syndrome of interest to patients, clinicians, and researchers. There have been several shifts in the conceptual evolution and nomenclature of the illness and most recently it has been renamed and redefined with the name of systemic exercise intolerance disease (SEID). Though the research on CFS has been mostly from the West, it is not unknown in developing countries. Fatigue is a commonly encountered symptom in developing countries. The disease characterized primarily by chronic, disabling fatigue without adequate explanation is quite challenging to treat and hence it has been the area of interest for several medical professional lobbies in addition to mental health professionals. There has been a paradigm shift with regards to patient care over the years. There are few studies which have evaluated this construct. In our country, fatigue has often been attributed to anemia and nutritional deficiencies which are then treated with nutritional supplements presumptively. Such preparations account for the largest category of drugs dispensed in South Asia. These studies have reported the strongest associations of CFS with psychosocial factors and gender disadvantage (in women) and being an indicator of poor mental health. In the Symposium we would like to discuss the research on this symptom/disease so far with special relevance to the Indian context and it’s implication to the medical/psychiatric professionals.

Presenters:

Mahadev Singh Sen: Chronic Fatigue Syndrome – concept and evolution
Swapnajeet Sahoo: Fatigue as a symptom
Shubh Mohan Singh: Chronic Fatigue Syndrome – Indian Perspective

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 11. SYMPOSIUM ON MIND-BODY MEDICINE

Sanjay S Phadke, Arun Marwale, Nischol Raval, Vani Kulhalli

Popularized by Harvard Medical School in recent times Mind-Body Medicine traces its roots in a century of Stress research starting with physiologist Walter Canon’s description of “fight or flight response” followed by endocrinologist Hans Selye’s description of “general adaptation syndrome”, psychologist Robert Ader’s formulation of “Psycho-Neuro-Immunology” and characterization of “Relaxation Response” by cardiologist Herbert Benson.

Subsequent developments include

(a) deeper understanding of neurobiology of stress at molecular and systems level, and stress adaptation including concept of allostasis

(b) role of stress either in causation or in progression/worsening of not only psychiatric disorders but host of medical conditions, most notably highly prevalent lifestyle disorders (obesity, diabetes, hypertension, heart disease, pain syndromes, functional bowel disease etc)

(c) research has generated impressive evidence to support the ability of Mind-Body approaches (like Yoga, Meditation, cognitive skills and positive psychology) to improve treatment outcomes and quality of life.

Considering that most of the Mind-Body approaches have their origin in India and healthcare is in the midst of transition everywhere it is our opportunity to conceptualize and usher in new integrative medicine that integrates Mind-Body methods with standard medical treatments for achieving superior cost-effective results.

Mental health professionals are best suited to be the practitioners and leaders of integrative Mind-Body Medicine in India, who can make the intervention available to the psychologically distressed as well as stressed medically ill. Mind-Body Medicine can also be viewed as a useful vehicle to popularize ‘mind’ interventions and thereby reduction of stigma associated with mind issues.

The symposium endeavors to present comprehensive review and discussion on state of the art on this topic and also approach to its training and implementation in the Indian context.

Key words: Mind-Body Medicine, Stress, Integrative medicine

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 12. CAPACITY EVALUATION IN THE CONTEXT OF MHCA 2017

INDU V NAIR ¹, Anil Prabhakaran ², Pavan Kumar ³, Jithin Joseph ⁴

Co-Author Name 5:

Decision making capacity is of clinical and legal importance not just in psychiatry but in the medical settings in general. With the new mental health care act this becomes important in several specific points.

In MHCA 2017, the capacity to make mental health care and treatment decisions (section 4) has a meagre mention about this complex assessment. The person is deemed to have the ability often and the assessment in its multifaceted dimension has scant reference in the draft central rules also. And it is the presence or absence of such capacity which decides on several situations like, asking for independent admission, making advance directive, taking treatment decisions, asking for voluntary discharge, for personal assistance, consenting to research etc. Hence capacity evaluation assumes great importance in the implementation of MHCA 2017.

This Symposium tries to draw clarity regarding mental capacity, its assessment, scales used, available evidence and the problems in practical application.

Key words- decision making capacity, MHCA 2017, practical applications

Abstract - ANCIPS 2019, Lucknow

Symposium

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 13. Title: Patriarchy – Epigenetic effect on the phenotype

Syeda Ruksheda ¹, Amrit Pattojoshi ², Supriya Agarwal ³

Outline:

Gender specific risk factors for common mental disorders that disproportionately affect women include gender based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank and unremitting responsibility for the care of others – WHO
Without an analysis of discrimination and patriarchy it is impossible to comprehend mental health issues impacting women, men and other genders.
It is a matter of debate and discussion, how, predominantly patriarchal mind-sets and societal influences in turn, directly or indirectly influence neurobiological framework of the brain; and how neurobiological framework of the brain in turn, governs the patriarchal mind-set. At the system level, recent studies show that dominance perception is represented in brain regions which include the amygdala, hippocampus, striatum, and various cortical networks such as the prefrontal, and parietal cortices (1). At the neurotransmitter and hormonal level, dopamine (1), serotonin (1) and testosterone (2) are mainly involved.
The most virulent effect of growing up as a male in patriarchal society is the form of the masculine ethic known as machismo. This concept has been written about from the perspectives of many different disciplines and has variously been called “compulsive masculinity” and “macho” in the literature. Studies have been shown to be associated with men’s perpetration of physical/sexual violence against women and poor health outcomes for women in terms of physical and mental health outcomes. When males feel that they are becoming powerless, violence or the threat of violence often results. He is more likely to claim authority on the strength of sex rank alone because he is usually forced to share more economic power with women. These factors are reflected in higher rates of homicide and violence. Males and their increased acceptance and respect for extreme machismo. Misogynistic attitudes are linked to poor health outcomes for men also. Substance use behaviours (alcohol, marijuana, heroin, methamphetamines, cocaine) and poor mental health (depression, self-esteem) have been found to be more in such individuals. (3,4)
Gender determines the differential power and control that men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility, and exposure to specific mental health risks (5). The expectation about what constitutes illness is gender biased. For example, the somatic complaints that form the most prominent presentation of common mental disorders may not be taken into account by the care providers. A gender bias more often than not ensures that the symptoms are taken less seriously than they are for men (5).
Education, training, and interventions targeting the social and physical environment are crucial for addressing women’s mental health (5).
This symposium aims to take a fresh look at patriarchy and its harmful affects, and discuss measures to bring about change in mental health professionals and society at large. This deliberation of the symposium purports to shed some light on the neurobiological threads of patriarchal systems in society, to simplify it for the ease of comprehension and assimilation.

Sub-topics

1)
Neurobiological Aspects of Patriarchy
2)
Impact of misogyny on attitudes and behaviour of all genders
3)
Changing the narrative

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 14. Explanations to the Medically Unexplained Symptoms (MUS): Are we looking deep enough?

Jyothi Arayambath ¹, Rajeev Kumar, Manoj Kumar

Co-Author Name 3:

Background

Psychiatric practice requires a holistic approach and medicine remains an integral part of it.

The advances in the field of medicine is not appropriately translated in to the practice of psychiatry and the discipline has now become fragmented. It is important to revisit the medically unexplained symptoms in the context of advances in medicine, as in contrary to the popular belief, majority of the medically unexplained symptoms seemed to have organic basis.

Aim

To pose questions which should hopefully highlight and encourage new research on MUS from the clinicians who observe a link between the symptoms, investigations, diagnosis and treatment. Further, to identify, explore, and apply those observations using a biological research paradigm.

Evidence

Robust evidence depends on a variety of factors including findings from new research and deeper understanding of MUS. Attempts should be made to translate such new knowledge into the clinical practice.

Discussion

Careful consideration of alternative and uncommon explanations of the rare associations as well as a detailed enquiry into recurrent common themes should help our understanding of medicine and psychiatry. For example, Vitamin D deficiency is found to have an association with a large number of difficult to diagnose cases, including depression, anxiety, fibromyalgia, ME, connective tissue disorders, IBS, allergies, asthma, immuno-deficiencies, endocrine abnormalities, Alzheimer’s dementia, Autism, ADHD, Multiple Sclerosis, Sphincter dysfunction, overactive bladder etc; apart from the more known causes. In addition to that epilepsy - particularly autonomic seizures, movement disorders, medication side effects, Paradoxical Emboli (seen in post mortem studies) remain some of the most common causes of those diagnosed with MUS.

Conclusion

There is an urgent need for better causative models of MUS. Currently, in the absence of such models, a collaborative approach is required in medical practices and hopefully with the proposed newer causative links as above will offer newer treatments rather than operating with existing consensus models populated by the outdated classification systems.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 15. TOPIC: GENDER DYSPHORIA IN CULTURAL CONTEXT

Kshirod K Mishra ¹, Surjeet Sahoo ², Sally John ³, Samrat Kar ⁴

Abstract: Gender dysphoria is experience of distress felt due to physical sex and sense of gender orientation of an individual. The condition is commoner among children but majority of children outgrow out of it by early adulthood. In adolescent and early adulthood it can culminate in gender reassignment surgery leading to change in familial and social role. It not only impacts the individual psyche, but also affects the family members, their standing in the society, and associated stigma.

We intend to discuss the merits and demerits from socio-cultural view point.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 16. PIONEERS’ OF Indian PSYCHIATRY

R Srinivasa Murthy ¹

Against the background of the conference theme it would be appropriate to have a Symposium on ‘PIONEERS’ OF Indian PSYCHIATRY.

This Symposium of Two hours would bring to the larger audience, especially the younger psychiatrists, to recognise the important contributions of senior psychiatrists from different parts of India, who are no more, as well as pay tribute to their efforts in Making Mental Health a National Priority.

Each presenter will make an 8 minute presentation, highlighting the biographical details, major contributions to Indian psychiatry and conclude with the lessons learnt from the individuals life.

The Suggested leaders to be included and speakers are as follows:

Coordinator of Symposium: Prof.R. Srinivasa Murthy

Introduction: 4 minutes

M.V. Govinda Swamy- Sanjeev Jain
N S Vahia- Vihang Vahia
R.L. Kapur- Ajit bhide
J.S. Neki- Sudhir Khandelwal
D.N. Nandi- Gautam Saha
B.B. Sethi- Santosh Tandon
N.N. Wig- R.S. Murthy
Shantha Kumar- Praveen Lal.
Rose Chacko- Russell
Ramachandran- Nambi S
Ajitha Chakraborthy- Om Prakash Singh
A Venkoba Rao- Roy, K.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 17. IAPA Symposium: Depression and Addictions: A complex comorbidity

Ashwin A Patkar ¹

Individuals with substance use disorders frequently suffer from depression, and co-occurring disorders (COD) are associated with increased morbidity and mortality along with poorer treatment outcomes. Moreover, depression is a frequently cited precipitant of relapse among individuals with substance use disorders. While some depressive symptoms are syndromes related to intoxication or withdrawal from substances which resolve with abstinence, epidemiologic studies indicate that, in many instances, depressive and substance use disorders are independent co-occurring disorders. Current treatment guidelines recommend that individuals with COD receive treatment for both disorders. However, rates of unmet need are high and only a small fraction of patient receive care for both mental health and substance use.

This presentation discusses the growing linkage between neuroscience and clinical therapeutics in the field of substance abuse and depression and reviews treatment approaches that have been developed to treat individuals who suffer from substance use disorders and depression. Integrating the newer pharmacological approaches with practical behavioral treatments have the potential to improve clinical treatments for co-occurring depression and substance use disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 18. SYMPOSIUM PROPOSAL: Tracking Deviations in Neurodevelopmental Trajectories to Predict Adult Psychopathology

Vivek Benegal ¹, Eesha Sharma ², Bharath Holla ³

Findings from the Consortium on Vulnerability to Externalizing Disorders and Addictions

Presentation 1: Description of the cVEDA cohort : Nilakshi Vaidya. Project Coordinator, cVEDA.

Presentation 2: Deviations in neuropsychological trajectories – determinants of psychopathology?

Presentation 3: Adolescent brain development of cortical and white matter structure in the cVEDA sample: Role of gender, childhood adversity, family history of alcoholism, and alcohol drinking

The Consortium on Vulnerability to Externalizing Disorders and Addiction (cVEDA), is an ICMR-MRC, UK funded collaborative, multi-centric study across 7 centres in India. The primary aim to investigate the transactional impact of developmental exposure to environmental stressors, and genomic/ epi-genetic influences, on neurodevelopment and consequent acquisition of cognitive, emotional and behavioral capacities, which regulate vulnerability/ resilience to future psychopathological states. The cVEDA is the largest-ever longitudinal-study in India, on an epidemiological scale, to understand the determinants of psychopathology using a population neuroscience framework. Starting in 2016, the study has, till date, collected data on genotype, temperament, psychopathology, family-risk, environmental exposures, and neuropsychological performance, on around 7000 individuals aged 6-23 years; and neuroimaging data on around 1000 individuals. This symposium will focus on early and novel insights, about the underpinnings of psychopathological states, emerging from the cVEDA dataset.

The first presentation will highlight the rich regional and environmental diversity characterizing this cohort, and present the methodology of this accelerated longitudinal cohort, the socio-demographic profile and description of the cVEDA databank.

Structural (neuroimaging) and functional (neuroimaging and neuropsychological performance) brain variations have been described for psychiatric disorders, suggesting that these may be intermediate phenotypes in the expression of psychopathological states. cVEDA, with population-based neuroimaging and neuropsychological data, makes it possible to study structural and functional brain development trajectories. The next two presentations examine cross-sectional developmental trajectories from neuroimaging and neuropsychological data, and explore how deviations in these trajectories could predict psychopathological states. They will also discuss the developmental influences of gender, childhood adversity, family history of psychiatric illness, and alcohol drinking on adolescent brain maturation and development of psychopathological states. Understanding such varied influences on developmental processes would ultimately make way for the early identification of and, possibly, pre-emptive interventions for psychopathology.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 19. Title: Transforming Geriatric Psychiatry for the Next Decade- Developing Training, Services and Research

AQ Jilani ¹, Dhananjay Chavan ¹, PT Sivakumar ¹, Mathew Varghese ^1,^✉

Background and Aims: There is a rapid increase in the number of elderly persons in India. As recorded in the Census of India there are many more persons in the 80+ and 90+ age groups. Most elderly have over 3 diseases including a mental disorder; the commonest of these being depression and cognitive disorders. The services, treatment settings, manpower, and programs available for the elderly are at present not adequate to deal with this impending public health problem. Hence, we need to transform the current Geriatric Psychiatry scenario in India by augmenting our current clinical services, training and programs and to prioritise our focus on dealing with this looming health priority. In this symposium we would discuss a strategic plan in developing Geriatric Psychiatry that is required for the next decade.

1. Training in Geriatric Psychiatry: Dr AQ Jilani

Training in geriatric psychiatry should start at the postgraduate level in all disciplines and specifically in the psychiatry residency programs. There is a need to further augment this training for consultants in psychiatry, neurology and other medical specialists through the conduct of regular CME programs. Training of other health personnel like psychologists, social workers, nurses and health workers is necessary to complete the broad spectrum of geriatric care. In addition, we need to develop support and training programs for family caregivers of the elderly. For these programs to be optimally utilised we would need to develop programs for public awareness and education regarding elderly problems.

2. Developing Geriatric Psychiatry Services: Dr Dhananjay Chavan

Most elders with health problems would be cared for in the community. Hence, we need to develop services at the community level through support programs in the family, day-care centers and respite care centers at the taluk level. Outpatient treatment services in the form of elder health clinics or memory clinics should be developed at the taluk level. Provision for inpatient care should be available at all district hospitals for short hospitalisation to deal with acute geriatric problems. Tertiary care centers like long term care homes should also be planned for the more serious problems that may not be handled in the community when family members are no longer able to care for the elderly person.

3. Formulating Geriatric Treatment Plans, Programs and Policy: Dr PT Sivakumar

Treatment plan and guidelines need to be developed for most of the common psychiatric disorders. Attempts may be made to adapt the WHO mhGAP guidelines for use in most primary and secondary treatment facilities. The National Program for Health Care of Elderly (NPHCE) should be operationalised so that it may be implemented at all levels in the community. There is a need to redraft the National Policy for Older Persons (NPOP) after consultations with all stake holders so that each of the States could be transformed into Elder Friendly Communities.

4. Priorities for Research in Geriatric Psychiatry: Dr Mathew Varghese

There should be a wider consultation among stakeholders to decide on the priority areas for research. Epidemiological studies should be planned in the population to study the prevalence and magnitude of the common geriatric psychiatry disorders and their causative or risk factors. Service utilisation research would be required to study the impact of service delivery and to function as clinical audits of the plans and programs that are rolled out. There should be a concerted effort to devise studies that focus on the primary prevention of these disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 20. CULTURAL ISSUES CONTRIBUTING TO THE CHANGING practice of psychotherapy in India

The influence of culture and acculturation on the practice of psychotherapy: RA Kallivayalil

How essential is ‘family’ for effective delivery of psychotherapy? Nitin Gupta How creativity contributes to the process of Psychotherapy: Vinay Kumar

The practice of psychotherapy in various countries has been influenced by social and cultural factors. In India, it has been observed and argued that psychotherapy, as practiced in the West, might be suitable only for those living in cosmopolitan cities of India and not for majority of the population.

Psychotherapy and Psychotherapists in the Indian context continue to face various dilemmas due to the ever changing cultural and moral values due to influence of the western culture on the ‘traditional culture. Nevertheless, there is a case for being able to adapt the ‘western’ model for traditional society like India too. Certain individual socio-psychological variables like creativity and acculturation seem to play a key role in the process of delivery and effectiveness of psychotherapy. Also, the family has traditionally been viewed as being effective in management of mental illnesses. But how effective it is in delivery of psychotherapy? This symposium aims to address such issues, and highlight the changing practice of psychotherapy and its delivery in the Indian setting.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 21. Symposium on Sample Size Estimation in Mental Health Research

B Das, Hariom Pachori, Avinash Sharma, Varun S Mehta, Roshan V Khanande

Sample size estimation plays pivotal role in mental health research. In this symposium we would discuss the basicSample size estimation techniques commonly used in mental health research. We would try to answer all the below mentioned questionsthrough examples in the symposium.

Why sample size estimation is important in mental health research?
What is ideal sample size to conduct any study?
How to estimate sample size in cross-sectional studies?
How to estimate sample size in case-controlstudies?
How to estimate sample size in cohortstudies?
How to tackle design effect?
What are software packages used for sample size estimation?

Keywords: Mental Health Research, Sample Size Estimation

Titles of presentation:

Overview of Sample Size Estimation in Mental Health Research: Prof. Basudeb Das
Sample Size Estimation (cross-sectional studies)in Mental Health Research: Dr. Roshan V. Khanande
Sample Size Estimation (case-controlstudies) in Mental Health Research: Dr. Avinash Sharma
Sample Size Estimation (Cohortstudies) in Mental Health Research: Dr. Varun S. Mehta
Basic Sample Size Estimation and Software packagesused for Sample Size Estimation: HariomPachori

Details of speakers:

Prof. Basudeb Das, Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006.
Hariom Pachori, Statistician, Central Institute of Psychiatry, Kanke, Ranchi-834006.
Dr. Avinash Sharma, Assistant Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006.
Dr. Varun S. Mehta, Assistant Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006
Dr. Roshan V. Khanande, Assistant Professor of Psychiatry, Central Institute of Psychiatry, Kanke, Ranchi-834006

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 22. Symposium: Advances in Neurobiochemistry of sex and its implications in sexual medicine practice.

TS Sathyanarayana Rao ¹, Mrugesh Vaishnav ¹, Darpan Kaur ¹

Sex is a bio-psycho-social phenomenon. The research has sufficiently advanced concerning brain and its mechanisms to explain various nuances of sex and relationship. Infact, brain is considered as the biggest sex organ. Apart from neuroanatomy and neurophysiological explanations, the neurobiochemistry is essential in understanding psycho-pathophysiology of sex. Also hormones and neurotransmitters play a major role in human sexual life. They determine who we love, when we love, how we love and how often we love. They mediate desire, arousal, and orgasm stages of sexual response. There are significant differences between males and females which can be interpreted and understood taking into consideration all the aspects from biology to psychology and sociology. A sexual relationship is fulfilling when there is synergy of many hormones and chemicals that are released at different phases of the love relationship. Many psychopharmacological agents have both direct and indirect, cause and effect upon sex, hence a thorough understanding and sensitivity is needed in psychopharmacology practice. The presentation looks at all the above aspects from the perspectives of sexual health, sexual disorders and its correlation to management and in particular psychopharmacology of sex in health and disease.

Speakers:

Neurobiochemistry of desire – Dr. Darpan Kaur, Mumbai.

Neurobiochemistry of erection and ejaculation – Dr. Mrugesh Vaishnav, Ahmedabad

Neurobiochemistry of Orgasm – Dr. T S S Rao, Mysore

Key words: Brain and its mechanisms, Hormones, Neurotransmitters, Neurobiochemistry of sexual function, Psychopharmacology of sex.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 23. Symposium on “Spirituality and Mental Health”

BN Gangadhar ¹, RK Mahendru ², Philip John ³, P Kishan ⁴

In every human being there seems to be a spiritual dimension, a quality that goes beyond religious affiliation that strives for inspiration, reverence, awe, meaning and purpose even in those who do not believe in God. The spiritual dimension tries to be in harmony with the universe, strives for answers about the infinite and comes essentially in focus in times of emotional stress, physical and mental illness, loss, bereavement and death. Despite empirical evidence of a relationship between religiosity/spirituality (R/S) and mental health, application of this knowledge in the clinic remains a challenge. The current state of the evidence provides evidence-based guidelines for spiritual assessment and for integration of R/S into mental health treatment. Spiritual and religious beliefs are common worldwide. According to recent surveys, at least 90% of the world population is currently involved in some form of religious or spiritual practice. There is consistent evidence that religiosity and spirituality (R/S) play a role in several aspects of life, especially mental health. Three systematic reviews of the academic literature have identified more than 3000 empirical studies on spirituality and health. In general, individuals who have more R/S have less depression, anxiety, suicide attempts, and substance use/abuse, and experience better quality of life faster remission of depressive symptoms, and better psychiatric outcomes. In view of this evidence, many professional organizations, such as the American College of Physicians, the American Medical Association, the American Nurses Association, Joint Commission on Accreditation of Healthcare Organizatins recognize that spiritual care is an important component of health care and that health care professionals should integrate it into clinical practice.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 24. SYMPOSIUM ON INTERNET ADDICTION

Anil Kakunje ¹, Alok N Ghanate ², Deepak R S ³, Abhinav Tandon ⁴

Topic: Prevention and future directions

The use of Internet has now become indispensable, and the technology has revolutionized the education and practice worldwide. Students have the opportunity to keep updated with the exponential growth knowledge to become a lifelong learner. The internet is used by some to facilitate research, to seek information and for interpersonal communication. On the other hand, it can be used by some to indulge in pornography, excessive gaming, chatting for long hours, and even gambling. Excessive internet use which is also called uncontrolled use of internet, pathological internet use, or internet addiction causes problems in work and social life.¹

Excessive Internet use is considered as addiction since symptoms of Internet addiction (IA) are comparable to the symptoms of addiction to nicotine, alcohol, or drugs.² The term IA is defined as “a psychological dependence on the Internet, regardless of the activity once logged on”.³ Furthermore, IA is described as “characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding computer use and Internet access that lead to impairment or distress”.⁴ The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) identifies Internet Gaming Disorder in Section III as a condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.⁵ The latest beta draft version of ICD-11 which was released in October 2016, included the definition of a new disorder, “gaming disorder”. According to the definition Gaming disorder is characterized by a) impaired control over gaming. b) Increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and activities, and c) continuation of gaming despite the occurrence of negative consequences. This diagnosis is included under disorders due to addictive behaviours (6C51).⁶

Thus, IA is documented as a psychiatric ailment with precise diagnostic and management principles. The US psychiatrist Jerald Block thought that IA was a “compulsive– impulsive spectrum disorder” and that the definition should include “online or offline computer usage, with recognition of at least three subtypes. The subtypes are as follows: excessive gaming, sexual preoccupations, and email/text messaging”.⁷

Even young people without mental health problems report addiction to internet and may develop mental health problems as a result of spending hours on porn sites, online shopping sites, luck and computer games, hobby sites and chat rooms. Internet addiction has been reported to be associated with anxiety disorders⁸, introversion, personality disorders and mental health problems such as pathological gambling, game playing, bipolar disorder, social phobia and depression in young people.⁹

In view of this background we would like to present a symposium on Internet Addiction and Gaming Disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 25. New Psychoactive Substances: An Emerging Challenge in Addiction Psychiatry

Rakesh Chadda ¹, Rakesh Lal ¹, Raka Jain ¹, Ravindra Rao ¹

All India Institute of Medical Sciences, New Delhi 110029

The recent years have seen an increase in the sale and recreational use of New Psychoactive Substances (NPS). The term “new” does not necessarily refer to new inventions, but “new” denotes those substances that have recently emerged in the drug market and which have not been scheduled under the International Conventions. NPS are known by various terms such as “designer drugs”, or “legal highs”. While there are many types of NPS, some commonly used NPS include synthetic cannabinioids, synthetic cathinones, and phencyclidine-like substances. Data about extent and use of NPS in general population is lacking and currently limited data collected in few countries with respect to specific substances and sub-populations is available. These newer substances are sold mainly through ‘head shops’ as research chemicals, food supplement or as medicine. Sale through internet is also rapidly increasing in today’s digital world. Though there are encouraging reports on possibility of use of NPS for medical purpose, the harmful effects of NPS are highlighted on most instances. Currently available urine or serum toxicology screens are unable to detect all newer drugs that have been synthesized and standardized drug testing for NPS are not yet available in most laboratories. The increasing number of NPS also poses challenge to traditional methods used to diagnose these substances. The heterogeneity in designer drug product contents, concentration, and chemical constituents have further increased challenges in detection. Indian data on use of NPS and use related health hazards is limited. Indirect indicators of use such as seizure data have also raised concern over growing use of NPS in India. India is also reported to be a major producer of NPS along with China. All of these makes control of NPS a challenge to existing legal and policy measures adopted by the countries worldwide.

Key words: NPS; Designer drugs; Synthetic cannabinioids; Ketamine

Presenters:

Rakesh Chadda: Introduction to New Psychoactive Substances (NPS)

Rakesh Lal: Epidemiology and typology of NPS

Raka Jain: Laboratory aspects of NPS detection

Ravindra Rao: Issues and challenges in NPS

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 26. Title: Violence and Mental Health: Various Perspectives

Bhaveshkumar M Lakdawala ¹, Rajendrakumar A Thakrar ², Manan R Thakrar ³

Objectives: Violence in any form is a topic of grave concern all throughout the world. Some forms of violence are consistent throughout the globe, whereas some forms of violence are specific to a particular culture or community. Several studies have shown a strong correlation between violence and mental health issues in victims, offenders and community at large. And there is a dire need to scientifically analyze violence issue in victims, offenders and community from a mental health perspective. At the same time, it is also very essential to discuss all the possible interventions and rehabilitation methods for the same. To address this issue and to show recent researches in these areas we have planned a symposium on this neglected and untouched subject.

Description : Violence is defined by the World Health Organization as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, which either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development, or deprivation”, although the W.H.O. acknowledges that the inclusion of “the use of power” in its definition expands on the conventional understanding of the word. Under this broad definition, it becomes extremely important to analyse and discuss violence from various points of view. To make the topic palatable and cover as many sub topics as possible, the subject of “Violence and mental health” has been divided into 3 main perspectives on which the speakers shall speak and discuss. These are as follows:

Violence and Mental Health: Victim’s Perspective
Violence and Mental Health: Offender’s Perspective
Violence and Mental Health: Community Perspective

Key Words: Violence, Mental Health, Victims, Offender, Community

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

27. TITLE: ETHICAL AND LEGAL ISSUES IN THE PROCESS AND DROP-OUTS OF MARITAL AND FAMILY THERAPY IN INDIA

Praveen Khairkar ¹, Sona Kakkar ², Suresh Bada Math ³, Mrugesh Vaishnav ⁴

Any living entity must adapt and change in order to survive and prevail. Family therapist plays major role in the state of difficult transtions/conflict ladden relationships in couples. Little is known about legal issues that surprises family therapist if he/she fails in their endeavour to re-unite the couple on the verge of impending divorce.

We would like to share and discuss a virtual life example of fundamental misconceptions prevailing with family therapy processes and its efficacy rebound untoward implications.

We intend to enlight the evidence based mediating goals, models of choice, boundaries & precautions to be taken up by therapist. Seeking out in house opinion for dilemmas and legal mandate in case of specific situations of accusations by clients would also be an objective of the present symposium.

This symposium would further like to address and calls for action after due experts opinion for forming clear guidelines for treating psychiatrists/family therapist and for medical boards as well as legal system in the country for caring the wheel run of sudden change of fortunes in the process and drop-outs of marital and family therapy in india.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

28. TITLE: ETHICAL AND LEGAL ISSUES IN THE PROCESS AND DROP-OUTS OF MARITAL AND FAMILY THERAPY IN INDIA

Praveen Khairkar ¹, Sona Kakkar ², Suresh BADA Math ³, Mrugesh Vaishnav ⁴

CONSTRUCT OF SYMPOSIUM

Any living entity must adapt and change in order to survive and prevail. Family therapist plays major role in the state of difficult transtions/conflict ladden relationships in couples. Little is known about legal issues that surprises family therapist if he/she fails in their endeavour to re-unite the couple on the verge of impending divorce.

We would like to share and discuss a virtual life example of fundamental misconceptions prevailing with family therapy processes and its efficacy rebound untoward implications.

We intend to enlight the evidence based mediating goals, models of choice, boundaries & precautions to be taken up by therapist. Seeking out in house opinion for dilemmas and legal mandate in case of specific situations of accusations by clients would also be an objective of the present symposium.

This symposium would further like to address and calls for action after due experts opinion for forming clear guidelines for treating psychiatrists/family therapist and for medical boards as well as legal system in the country for caring the wheel run of sudden change of fortunes in the process and drop-outs of marital and family therapy in india.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

29. Dealing with Obsessive compulsive disorder: New methods of pharmacology and psychotherapy

Suvendu Narayan Mishra ¹, Debadatta Mohapatra ², Sayali Mishra ³

Dealing with Obsessive compulsive disorder: New methods of pharmacology and psychotherapy

Outline of the Proposed Symposium:

Obsessive Compulsive Disorder: History and Current status of Obsessive Compulsive Disorder:

Obsessive Compulsive disorder is a common chronic and disabling disorder marked by obsession and/or compulsion that are ego dystonic (unwanted behaviour) and causes significant distress to the patient & their families. There are many other disorders which share some features with obsessive compulsive disorder. Obsessive-Compulsive and related disorders include OCD, Body Dysmorphic disorder, trichotilomania, hoarding disorder, excoriation disorder.

Recent advances in the pharmacological management of Obsessive Compulsive Disorder:

OCD is the fourth-most common psychiatric illness and a leading cause of disability. Meta-analyses of RCTs show that selective-serotonin reuptake inhibitors (SSRIs) are significantly more effective than placebo in the treatment of OCD. Higher prevalence of non responders requires many augmenting strategies. Obsessive compulsive and related disorders needs to be addressed since the management of which is essential for better prognosis.

The newer psychological therapies for Obsessive Compulsive Disorder:

The traditional approaches to treat OCD include mainly behavior or cognitive behavioural therapies which emphasis on techniques like habituation, exposure and response prevention or thought stop. In order to deal with pure obsessions (without compulsions), psychologists have also developed cognitive techniques which are derived from the cognitive theories of OCD. They deal with underlying cognitive processes of thought-action fusion, magical thinking, patient’s sense of inflated responsibility etc.

The new methods of treating OCD have come up with the inclusion of third wave psychotherapeutic methods such as cognitive drill therapy, acceptance and commitment therapy and mindfulness based cognitive behavioural interventions which are helpful to deal with more complex OCD symptoms through advanced, focused methods.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 30. Study on Gap Analysis in Mental Health Care Services in Child Care Institutions (CCI) of Delhi State

Rajesh Sagar ¹, Bichitra n Patra, Prashant Gupta, Mohit Kumar

Children and adolescents in low and middle income countries (LAMIC) like India constitutes 35–50% of the population. In India, the total number of children in the age group 0-6 years as per the population totals of Census, 2011, is 158.8 million. An estimated 200,000 children in the India are in about 5,000 Observation and Children’s Homes (Child care institution), and the numbers are growing. According to Juvenile Justice Rule, 2011, minimum facilities of mental health needs of children in Child care institution (CCI) should be there. This study funded by the National Commission of Protection of Child Rights (NCPCR) examined the current existing mental health facilities in the CCIs and found the gap in mental health care services in them and came up with valuable recommendations. In this study, the research team visited 20 CCIs (17 children homes and 3 observation homes) in Delhi. The research team comprising of psychiatrist and psychologist examined the physical and mental health, applied structured psychological scales/instruments to measure the mental health of the children of the CCIs after obtaining due Ethical clearance.

The CCIs do not have any provision to address the mental health needs of the caregivers. The caregivers reported exhaustion and burn out. The common behavioral problems found are hyperkinesis, conduct problems, learning difficulties, emotional problems, self-injurious behaviors, adjustment problems and substance use (commonly tobacco).

Based on these finding, the research team in its report made several recommendations like all children needs to have regular check up by mental health professionals, to be watched for substance use and proper record keeping of the same. The report also recommends addressing the caregiver burden and burn out. Other recommendations are addressing abuse, life skill training, sex education, career and guidance counseling and providing other medical facilities including immunization and HIV awareness.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

31. NAME OF THE TOPIC---TRYING TO UNDERSTAND CONSCIOUSNESS FROM DIFFERENT PERSPECTIVES

Debasish Sanyal ¹, Syed Naiyer Ali ², Tathagata Chatterjee ³

Developing understanding about human consciousness is possibly one of the most complex challenges facing mankind. While great hopes were repeatedly raised with advent of imaging, electrophysiological and neuropsychological assessments, consciousness still remains mostly unexplained. With advent of computers and information technology, hope of modeling human minds and concept of artificial intelligence gained ground. Computers were able to defeat human players in the game of chess which for longtime has been regarded as a game involving high level of intelligence. However, proper understanding of consciousness remained elusive.

Gradually, it has become apparent that any attempt to understand consciousness involves need to involve multiple perspective.

First speaker will overview of complex issues in consciousness-discuss definition, functions phenomenological perspectives, concept of qualia, free will, forms and kinds and various ways of studying consciousness, continuum of consciousness, artificial intelligence, computational neuroscience, issue of noncomputability in consciousness, interface with quantum physics

Second speaker will cover Neurobiological perspective of consciousness including Neural corelates of consciousness, finding from imaging and electrophysiological studies, cognitive neuroscience of consciousness.

Third speaker will touch upon both Western philosophical perspectives (Rene Descartes - John Locke,G.W Leibniz, Immnueal Kant) along with Eastern viewpoints (Vedantic and Buddhist concept of consciousness, viewpoints of Sankaracharya,Ramanuja).

In our symposium, we will try to explore possibility using these to develop some basic understanding of consciousness in a holistic manner.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 32. ALZHEIMER’S DISEASE-THE KASHMIR SCENARIO

Arshad Hussain, Insha Rauf, Kamraan Nissar, Sabreena Qadri

INTRODUCTION

Alzheimer’s disease, the leading cause of dementia affects about 10% of those aged above 65 and about 30% of people aged above 80. WHO projections suggest that by 2040, if growth in the older population continues, with no preventive measures in place 71% of the global burden (81 million cases) of dementia will be in the developing world^[77]. It is therefore imperative for researchers to focus on the risk factors of dementia so that primordial and preventive prevention measures can be put into place.

LONELINESS, SOCIAL NETWORK, SOCIAL SUPPORT, TRAUMATIC LIFE EVENTS AND ALZHEIMER’S DEMENTIA –IS THERE A LINK?

100 patients with DSM IV diagnosis of Alzheimer’s dementia (AD) with score <23 on MMSE(Kashmiri version) and 50 age matched controls were assessed for loneliness, social support, social network and traumatic life events (TLE) using De Jong Gierveld loneliness scale, Lubben Social Network Scale and Traumatic life events checklist. Loneliness was associated with an increased risk of developing AD (OR 1.19, {1.04-1.36} CI, p=0.011). Social network and social support were not associated with an increased risk of developing AD. The mean number of TLE was not associated with an increased risk of developing AD, however specific events such as death of a child were associated with an increased risk of developing AD.

EVALUATION OF ACE POLYMORPHISM sAND ALZHEIMER’S RISK IN KASHMIRI POPULATION

59 clinically confirmed cases of Alzheimer’s disease and 52 age and gender matched controls from the Kashmiri population were assessed for polymorphisms of the Angiotensin-converting enzyme (ACE) gene polymorphism. Our data revealed a statistically significant association of I/D heterozygous genotype of ACE with the Alzheimer’s disease susceptibility in Kashmiri population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 33. NAME OF THE TOPIC---application of neuroeconomics in psychiatry

Debasish Sanyal ⁴, Amlan Kusum Jana ¹, Syed Naiyer Ali ², Tathagata Chatterjee ³

Economics, psychology and neuroscience are converging into a new, unified discipline referred to as neuroeconomics. Neuroeconomics attempts to explain human behavior by understanding the processes that connect sensation and action, thus revealing the neurobiological substrate of decision-making This theory can be used as a framework to study various psychological, social and neural systems including learning, movement, social cooperation, brain reward pathways and neurotransmitter systems.

Concept of utility function in economic decision theory can be used to explain depressive symptoms with regard to lack of interest in money. Second, differences in attitudes toward uncertainty and risk suggest that avolition and anhedonia can be expected to reduce the influence of uncertainty on decision making. Third, some parametrically varied values of delay discounting show the relation of discounted value to risk of addiction. Finally, economic game theory can provide a model including social factors to address psychiatric conditions; thus, it provides a useful framework for the current diagnostic classification systems for consideration of interpersonal factors.

Neuroeconomics gains extra strength from three features that may help it reach beyond its beginnings: 1) its capacity to connect decision-making variables to details of neural circuits including details extracted from model animal systems; 2) its natural connection to computational theory with the best example being reinforcement learning and 3) its connection to game theory.

This symposium will review recent evidence from neuroeconomics and psychiatry in support of applying economic concepts such as risk/uncertainty preference, time preference and social preference to psychiatric research to improve diagnostic classification, prevention and therapy

First speaker will overview neuroeconomics-discuss definition, theories, mathematical overview

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 34. Novel approaches to enhance the efficacy and utility of transcranial magnetic stimulation in psychiatric disorders

YC Janardhan Reddy ¹, Samir Kumar Praharaj ²

Presenters:

TMS in mood disorders: Recent advances and investigative applications Muralidharan Kesavan, Professor of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru
Innovations in TMS in schizophrenia research and treatment Urvakhsh Meherwan Mehta, Associate Professor of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru
Studying state-dependent plasticity with TMS and its applications in obsessive-compulsive disorder

Shyam Sundar Arumugham, Additional Professor of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru

The ability of repetitive transcranial magnetic stimulation (rTMS) to produce targeted neuroplasticity in cortical regions has been employed to study the physiology of normal as well as the pathological brain. Its potential to produce sustained plasticity after multiple sessions has been exploited for clinical applications, especially in psychiatric disorders. While rTMS has emerged as a standard treatment for treatment-resistant major depressive disorder (MDD), factors such as duration of treatment and limited accessibility of deeper structures with standard coils limit its clinical application. In this symposium, we discuss recent research in TMS conducted at NIMHANS and elsewhere which show promise in improving the efficacy and clinical utility of TMS. Dr. Kesavan Muralidharan would discuss the recent advances in TMS technology such as theta burst stimulation, accelerated TMS and deep TMS which have shown promising results in decreasing the duration as well as improving the efficacy of treatment. Further, he would discuss recent research on motor cortical excitability, studied with TMS, in MDD as well as bipolar disorder, which have helped understand the role of GABA-ergic/glutamatergic system in mood disorders. Despite early promise, rTMS has shown inconsistent results for the treatment of schizophrenia. Dr. Urvakhsh Meherwan Mehta would discuss the possible reasons for such inconsistencies and recent research findings utilizing TMS in schizophrenia such as the study of mirror neuron activity, which has exciting clinical applications. Further novel targets such as cerebellum and combining rTMS with other interventions such as cognitive remediation may be the way forward. In contrast with the above disorders, the symptoms of obsessive-compulsive disorder (OCD) are usually triggered by external stimuli. Hence the neurophysiology in OCD patients may be state-dependent. Dr. Shyam Sundar Arumugham would discuss how the temporal specificity of TMS can be utilized to produce state-dependent plasticity and its applications in the understanding the pathophysiology as well as treatment of OCD. Further, recent advances in TMS technologies show promise in targeting deeper cortical regions such as anterior cingulate cortex which are implicated in the pathophysiology of OCD.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 35. Title: Effect of high-frequency repetitive Transcranial Magnetic Stimulation (rTMS) in Cognitive function and predominantly Negative symptoms in person suffering from Schizophrenia in a randomized sham controlled double blind trial.

Nand Kumar ¹, Rohit Verma ², Shubh Mohan Singh ³

Introduction:

Schizophrenia is one of most debilitating psychiatric illnesses manifested by positive and Negative symptoms. The negative symptoms include affective flattening, alogia, anhedonia, and avolition. Antipsychotic agents have been shown to be most effective in reducing the positive symptoms of schizophrenia, but unsatisfactory in reducing negative symptoms. Therefore, developing a more effective therapy for negative symptoms is critical for improving schizophrenia treatment. Transcranial Magnetic Stimulation (TMS) is being explored for treatment of Negative symptoms in schizophrenia. In this symposium, we intend to present the role of rTMS in person suffering from schizophrenia with predominant Negative symptoms.

Methodology:

Total 504 patients were screened as per inclusion exclusion criteria and 100 subjects who met the inclusion criteria were included in the study.

The enrolled patients were randomly assigned to the active and sham groups using a randomization software. The active group (N = 50) and the sham group (N = 50) respectively received 20 sessions either active (real) rTMS (20Hz) or the placebo-controlled sham rTMS with sham coil. The subjects were blinded regarding the treatment being given, also the rater was blinded for the allocation. The subjects were assessed and followed up at baseline then after 1 months and 3 months with PANSS, SANS,CDRS and CGI.

Outcome:

Out of total 504 subjects enrolled for the study 310 did not meet the criteria, 65 patients refused for the rTMS intervention. The 10 patients dropped out for various reasons. The final outcome as per the assessment and follow up data will be discussed during the presentation.

Key word: rTMS, Schizophrenia, Negative symptoms

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 36. Addiction Psychiatry: Newer Developments

Debasish Basu ¹, Atul Ambekar ², Pratima Murthy ³

(Symposium from the Addictive Disorder Specialty Section of Indian Psychiatric Society)

Topics and Speakers:

1. Technological advances in the management of addictions

2. Changing legal and policy environment for Substance Use: implications for psychiatrists

The field of Addiction Psychiatry is rapidly advancing. Newer challenges are being faced by the professionals and simultaneously, novel options are being explored to overcome these challenges.

A major clinical challenge in the management of substance use disorders is ensuring adherence in treatment. Due to fluctuating levels of motivation, patients – even after entering treatment and initiating pharmacotherapies – often tend to display inadequate compliance which leads to poor outcomes. In addition, treatment professionals remain concerned about the potential for diversion and misuse of many of the medications used for pharmacotherapy. A number of technological advances have been introduced to address these challenges. Newer formulations of naltrexone, such as depot preparations or implants, have been developed which promise better compliance and thus improved outcomes. For buprenorphine, besides the fixed dose combination with naloxone, newer formulations like sublingual films and patches may serve to minimize the diversion. Using novel technologies, research on developing vaccines for a variety of substances is ongoing, aimed at prevention of onset or escalation of substance use disorders. Finally, in this digital era, e-technology has the potential to transform addiction management in many ways.

It is increasingly being understood that besides harms caused by psychoactive substances, the policies aimed at governing the availability of these substances have resulted in substantial collateral damage to the health and welfare of humankind. For the narcotic and psychotropic substances, there is increasing recognition of the futility of supply-control based approach and instead the global community is exploring options like harm-reduction, de-criminalization of personal consumption and even regulated availability for recreational use. Recognizing the health harms of legal and socially acceptable substances like alcohol and tobacco on the other hand, they are increasingly being subjected to more stringent control. At the same time options for harm-reduction in the context of these substances are also being explored.

While addiction psychiatry is increasingly being recognized as a super-specialty, there is simultaneous recognition of need to enhance the wider availability of low-cost treatment services, involving general health care settings. Building the capacities at all the required levels – from general physicians to psychiatrists to addiction psychiatrist – remains a challenge, particularly for a human-resource-constrained country like India. There is a need to modify the existing medical curricula to enable even general physicians to cater to the huge unmet demand of treatment. This needs to be supplemented with short term training courses for which technological advances like NIMHANS Digital Academy are very promising. Finally, the very enthusiastic response to recently started DM Addiction Psychiatry courses at three premier Indian institutes indicates a bright future for addiction psychiatry.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 37. Prospective memory in patients with established and first-episode psychosis

P Sulakshana Rao ^1,², Madhavi Rangaswamy ¹, Jonathan Evans ^1,³, Anirban Dutt ^1,^2,⁴

Introduction

Individuals suffering from serious and enduring mental health problems such as psychotic disorders often have deficits in neuro-cognitive functions, including deficits in Prospective Memory (PM), which is the ability to carry out intentions after a delay. PM is important for activities of daily living, social and occupational functioning, yet relatively few studies have attempted to examine this problem in the South Asian setting, particularly in India.

Objectives & Methods

70 healthy controls and 40 patients with first episode psychosis and established schizophrenia were assessed in Kolkata, a socio-economically diverse, multi-ethnic and multi-cultural city. A set of neuropsychological tests including Digit Span, Auditory Verbal Learning Test, Brixton Spatial Anticipation Test, and the Cambridge Prospective Memory Test (CAMPROMT) were administered. In addition, PM questionnaires, the Prospective and Retrospective Memory Questionnaire (PRMQ) and Comprehensive Assessment for Prospective Memory (CAPM) were administered. Group differences were assessed using Mann-Whitney U Tests.

Results

There were no group differences for age (p=.416), gender (p=0.26) and education (p=.569) between patients and controls. However, the patients had significantly greater difficulties in cognitive functions including attention (p<0.005), learning (p<0.001), memory (p<0.001) and planning (p<0.001). Patients performed significantly poorer on the both the time based

(p<0.001) and event (p<0.001) based subtest of CAMPROMPT in comparison to controls. Patients also reported significantly more problems with PM in everyday life on the PRMQ (p<0.005) and CAPM (p<0.005)

Conclusions

Cognitive deficits in domains such as attention, memory and planning for individuals with FEP/schizophrenia were evident. Difficulties were also evident in both time based and event based tasks of prospective memory. Even in the early stages of psychosis, PM deficits were prominent. Although promising, these findings would need to be replicated on a larger sample, accounting for other potential confounders, for generalisation of findings in the Indian population. Further data collection is being carried out in order to acquire more conclusive evidence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 38. An Exploration of the Role of Non-profit International Mental Health Networks: A Case Study of NNDC-IF

Sameen Hosseini ^3,⁴, Hina Sharma ⁴, Anita Rao ^2,³, Murali Rao ^1,^3,⁴

More than 5.7 crore Indians, or 4.5% of India’s population, suffer from depression.¹ The World Health Organization ranks depression as the single largest contributor to global disability. For example, it is estimated that by 2020 its burden may increase to 5.7% of the total burden of disease.² Additionally, depression is the major contributor to suicide deaths. These deaths number about 800,000 per year, 133,625 of which were individuals from India. In general, individuals suffering from depression are 1.52 times more likely to die.¹

Approximately 15 crore people in India require mental health care. However, 70-92% of those individuals, depending on the state, did not receive treatment.³ Mental health NGOs in India are working to address this treatment gap in addition to other factors that may inadvertently affect treatment including stigma, mental health literacy, and lack of mental health providers. Of these cohort of NGOs, a select few have partnered with international NGOs in order to form a collaborative network. We will explore two of these in particular, along with the novel NGO, The National Network of Depression Centers- India Foundation.

NNDC-IF was modeled on its American counterpart, the National Network of Depression Centers (NNDC), which was established in 2008 in collaboration with 25 leading clinical and academic institutes in the US. NNDC-IF shares the intent of NNDC to advance research, eradicate stigma, and connect its members. However, it reprioritizes these goals to most focus on mental health literacy and stigma. Similarly, NNDC-IF ensures sustainability by tapping into the country’s mental health leaders when establishing the organization. NNDCI-IF takes this unique approach in order to instill cultural relevancy in every one of its organization’s international branches. These three elements, namely reprioritization, sustainability, and cultural relevance, highlight the measures that need to be taken to adopt NGO models in different international settings.

Keywords: Depression, Mental Health, NGOs, Stigma, Education

References

1.Depression in India- Let’s Talk (Rep.) World Health Organization. 2017 doi:http://www.searo.who.int/india/depression_in_india.pdf. [Google Scholar]
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1.National Mental Health Survey of India, 2015-16: Prevalence, Pattern and Outcomes (Rep.) National Institute of Mental Health and Neuro Sciences. 2016 doi:http://www.nimhans.ac.in/sites/default/files/u197/NMHS Report (Prevalence patterns and outcomes) 1.pdf. [Google Scholar]

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 39. THE SCIENCE AND ART OF EMOTIONS- “I FEEL THEREFORE I THINK”

ADNAN KADIANI ¹, Spandana Devabhaktuni, Shivang Agarwal, Raju Kolagani

A patient comes complaining of ‘not feeling good’, but what does that not feeling good mean? Is he feeling sad or fearful? namely is he more anxious or predominantly depressed. If it is the later than he could be feeling guilty or shameful or despair or maybe abandoned. He could be feeling shame for not being a good enough person or guilty for not being able to stop his impulsive behaviour. He could be feeling abandoned due to the belief that his loved ones are now against him and are trying to harm him, or despair because he is powerless in controlling his addictive behaviour. Emotional phenomena bring out, more urgently than other phenomena, the complex interplay of impersonal-biological and personal features of mental illness to be able to understand the meaning of the different types of emotions and to be able to pin point the exact one is clearly of diagnostic, therapeutic and prognostic importance.

The workshop will start with a talk on how the study of emotions evolved over the years the different theories used to explain emotions-cognitive theories and feeling theories. The next topic covered would be the neurological basis of emotions including the concept of mirror neurons. The Talk will then move on to cover the nuances and shades of the different emotions and the meaning of each one of them, clips from movies will be used to do so. Lastly modern techniques which used to catch visual and tonal patterns of different moods will be talked about.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 40. “Gut-Brain-Microbiota axis in Psychiatry”

E Mohandas ¹, Rajesh Nagpal ², Venugopal Jhanwar ³, Darpan Kaur ⁴

The gut microbiome comprises the collective genome of roughly 100 trillion microorganisms residing in the gastrointestinal tract constituting a biomass of 1.5 kg. The gene repertoire of our gut bacteria contains 150 times more unique genes than the human genome. The fetal gastrointestinal tract is sterile prior to birth with microbial colonization first occurring at delivery. However, the type of delivery and breast feeding alter the microbial status of the gut. Other factors influencing gut microbes include life Style, nutritional habit and antibiotic use.

There is a bidirectional influence between brain and gut microbiota. The central nervous system, autonomic nervous system and enteric nervous system are involved in the gut-brain-microbiota axis. Direct activation of the vagus nerve from the enteric nervous system to central nervous system on the one hand and signals from the central nervous system and neuroendocrine system directed to gut on the other will determine the biological effects of gut-brain-microbiota.

Gut microbiota levels have a strong effect on brain function in terms of anxiety, cognitive dysfunction, depression, emotions, motivation, memory formation, affective behaviors, decision making and emotional arousal. The current evidence on the role of gut microbes in psychiatric disorders and probable treatment strategies will be discussed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 41. PCOS : A PSYCHIATRIC DISORDER

Arshad Hussain ¹, Rajesh Chandel ², Insha Rauf ³

Polycystic ovary syndrome (PCOS), one of the most common endocrine disorder of women, is a heterogeneous disorder of unclear etiology, simply defined as the presence of hyperandrogenism and/or chronic anovulation in the absence of specific adrenal and/or pituitary disease. Preliminary studies suggest a complex relationship between psychiatric and endocrine disorders,both influencing each other.

Prevalence of psychiatric disorders in patients with a diagnosis of polycystic ovary syndrome in Kashmir

110 patients of PCOS (diagnosed by NIH criteria) were evaluated for presence/absence of psychiatric disorders using DSM-IV criteria by means of MINI plus. About 23% of cases had major depressive disorder(7.5% in controls), 1.8% had dysthymia, 15.45% had panic disorder(5% in controls), 6.36% had obsessive compulsive disorder(2.5% in controls),8% cases had suicidality, 2.72% of cases were bipolar affective disorder and 15.45% had generalized anxiety disorder (GAD).

Polycystic Ovary Syndrome in Bipolar Affective Disorder-A hospital based study

200 female patients with DSM-IV diagnosis of bipolar affective disorder were evaluated to assess the comorbidity of PCOS and to study risk factors associated with this comorbidity. PCOS was diagnosed by NIH criteria. Out of 200 patients with BPAD, 46(23%) were diagnosed as having polycystic ovarian syndrome(PCOS). 45% reported menstrual disturbances while 27% had polycystic ovaries on ultrasonography. 19.2% of the patients diagnosed as PCOS had a history of valproate intake.

Mood-Anxiety Complex of PCOS (MAPCOS)

After backgound research on PCOS, we propose a new disorder “Mood- Anxiety Complex of PCOS (MAPCOS)”. All patients of PCOS who were screened or treated had pananxiety symptoms, predominantly obsessive. They also had mood changes, severe enough to cause socio- occupational dysfunction but threshold probably below bipolarity or borderline personality disorder. We also propose same etiopathogenetic mechanisms (lifestyle changes) as common pathways for endocrinological and psychiatric manifestations.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 43. Symposia: Juvenile De addiction Rebuilding Childhood

Mayuri Buragohain, Varsha Mahadik, Jateen Ukrani

Drug use amongst children is rapidly increasing in Delhi and parts of Northern India. Studies have shown that as many as 70% children have smoked a cigarette or consumed inhalants by the tender age of 13. While the problem continues to rise, there is limited knowledge in this field. Treating children with substance abuse poses unique challenges but with the right management and treatment, these children may have a bright future. This symposium aims to discuss the extent of problem; the challenges faced in treatment, work done in this area so far and review the various treatment options available for these children.

Key Words:- Delhi and NCR, Juvenile

Substance Abuse,

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 44. Recent Good Practices & Emergence of School Mental Health in India

Prabhat Sitholey ¹, Rushi ², Jitendra Nagpal ³, Vivek Agarwal ⁴

The Way Ahead… For Behavior & Emotional Safety in Schools

CHILDHOOD AND ADOLESCENCE is a time in life span when maximum changes take place in terms of career choices, relationships, attitudes, roles etc. and have its bearings on the overall functioning of the individual. The development of children is the first priority in India’s development Agenda because they are our supreme assets and also the future human resource of our country”. A Mental Health Promoting School is a setting where education and health programmes create a Wellbeing Environment that in turn helps in promoting enriched learning. In the context of changing times, it is imperative that an appraisal be made of the psychosocial needs and influences on the child and adolescent of the nineties who is leading the baton of human chain into the 21^st century. The symposium envisages to discuss in detail the macro and micro elements of psychosocial wellbeing as a paradigm of the new policy of education (2018) and the inclusivity of mental health support for holistic development of school going young minds across the country. The proposed rural and urban model is a combined pioneering and pathbreaking approach to revolutionize the community-based child and adolescent mental health transformation in India. The legal aspects and the new PWD Act including the POCSO Act and allied areas shall be a crucial focus of this symposium.

WHO (2016) report on mental health estimates that nearly 20% of children and adolescents suffer from a disabling mental illness worldwide. India has one of the highest suicide rates worldwide, 2^nd leading cause of death of young people in India (Aaron et al., 2004). About 90% of diagnosable psychiatric illness usually depression is strongest predictor of suicide (Ang & Huan, 2006; APA, 2004,: Manjula et al., 2015)..

THE INDIAN SCENARIO

10-13 % of < 18 yrs suffer from mental health and behavioral disorders. (ICMR)
WHO – Serious Emotional Disturbances in young people – 15%
10-15% of those aged 16 and below suffer from a diagnosable psychiatric disorder
Depression can lead to suicide, now the second leading cause of death amongst 15-29-year olds
Suicide accounts 25% of deaths in boys and 50-75% of deaths in girls aged 10-19 years.

AIMS

The symposium aims to:

Highlight the importance of A Mental Health Promoting School where education and Mental health programmes create a “health promoting” environment that in turn “promotes learning”.
Increase audience awareness of types of mental health programmes in schools, setting up of such a programme and its benefits.
Highlighting the active involvement of teachers in mental health programs by enabling an understanding on the ways in which learning occurs and the importance of creating plausible situations conducive to learning so that the interventions can reach a larger population
Appreciate the need to revisit the School Counselors profile and understand the urgency for clarifying and enhancing their role and responsibility.
Enrich the role of Clinical and Counseling Psychology for supporting School Mental Health Programs in India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 45. Title: Digital assistive technology (DAT) for persons with developmental disabilities

Sharad Philip ¹, SUBHASHINI K R, BHASWATI KALITA

Outline: The symposium will focus on the following areas with regards to DAT.

Introduction to AT.
Terminology, origin and current working definitions
Legislative mandate for assistive technology in various countries.
What is digital and non-digital assistive technology?
A brief overview of developmental disabilities.
Purported benefits of DAT in developmental disabilities.
DAT for children with developmental disability (DD) – available options and review of evidence, elaborating on educational vs non-educational DAT, DAT for children with Intellectual Disability, Autism Spectrum Disorder, Speech and communication difficulties, Attention Deficit Disorders.
Differences in utility and design of DAT between children, adolescents and adults.
DAT for adolescents and adults with developmental disability (DD) – options and review of evidence.
Synthesis of current options and evidence - based recommendations for DAT use in DD.
Legislative provisions, availability under Government schemes and potential ways of procuring DAT.
Summary and Take-home message.
Useful links and references.

Conflict of interest: None

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 46. Creativity as prescription! Creativity and mental health therapeutics

Vinay Kumar ¹, Vishal Sinha ², KS Pavitra ³, Debasis Bhattacharya ⁴

The process of making art — whether be it writing, painting, singing, dancing, or anything in between — is good for us. There are both physical and mental benefits of art and creativity, which is essentially expressing yourself in a tangible way, and sharing something with the world. There is a growing body of evidence which shows that different creative art forms being prescribed have a positive impact on a variety of health conditions. There has been strong evidence emerging that prescribing specific arts activities for mental illnesses can have some unique benefits. Take singing, for example. Research has demonstrated that it can have a positive impact on mental health and wellbeing. In fact, several studies undertaken with older people have found that community singing appears to have a significant effect on their quality of life – helping ameliorate the effects of anxiety and depression. The creative activities can create social connections and might be hugely beneficial in mental illnesses where the social isolation is one of the prominent barriers for recovery. But these findings need to be put in to practice by the Clinicians.

The symposium will discuss therapeutic effects of music, movement and visual art forms and the current evidence for the use of these creative forms in the treatment of mental illnesses.

20 min for each speaker, 10 min for discussion

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 47. NEURODEGENERATION: Devashish Konar, Consultant Psychiatrist, Mental Health Care Centre, Burdwan

Debjani Bandhopadhyay ¹, Om Prakash Singh ²

With all major psychiatric illnesses there are evidences of neurodegeneration, neuroanatomically, neurochemically, and neurophysiologically. With psychological and medical intervention neuroregeneration is possible and with modern technology you have evidence for that. Brain undergoes different stresses all the time. Managing them adequately in right time provides less toxic internal environment for the brain. Preservation of neuronal structure and function is known as neuroprotection.

Neurodegeneration:

We are still in the process of understanding the mechanisms of neurodegeneration which is responsible for the major psychiatric illnesses. The basic understanding of it may be crucial for further advancement of treatment.

Neuroregeneration:

Neuroregeneration is the focus of new age treatment for diseases that involve neurodegeneration. Neuroregenerative science is in its infancy with huge potential of being used in treatment at more basic and physiological level, where therapy induces the body to heal from within.

Neuroprotection:

Neuroprotection tries to limit excitotoxicity and oxidative stress which are significantly associated with basic mechanisms of neurodegeneration. Neuroprotection is the mechanism for maintaining homeostasis and functional integrity against any neurodegenerative or neurotoxic insults. Scientists of this generation are focusing on neuroprotection to find more physiological solution to prevent and ameliorate many of the important psychiatric illnesses.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 48. Various methods of inpatient opioid detoxification:Ultra rapid vs Slow;Agonist vs Antagonist-An Indian perspective

Sarabjit Singh ¹, Ashmeet Singh, V Subbalakshmi kota, Poornima Mahindru

Background: Globally, a rampant increase in opioid use has been witnessed. According to a survey conducted in the state of Punjab, India among the 18-35 years age group, about 4 in 100 are opioid dependent and about 15 in 100 could be opioid users. There is a growing concern of medical/prescription opioid being abused. A vast majority of cases go untreated because of various reasons like lack of motivation to quit, lack of awareness, inadequate support, co morbid medical or psychiatric illness and social factors.

Pharmacological strategies currently available for opioid dependence include outpatient opioid substitution therapy and the less popular inpatient detoxification methods. There is abundance of research supporting outpatient based opioid substitution therapy and harm reduction strategies.

Material and methods: Our current study compares the various inpatient management strategies for opioid dependence. In our centre we offer ultra rapid detoxification as well as slow detoxification. Need for comparison arises as the principle, method and duration of both the strategies differs.

Results: Past 2years inpatient data showed a total of 345 patients underwent detoxification of which 125 patients opted for ultra rapid detoxification. The advantages of the ultra rapid group included a shorter duration of withdrawal symptoms as well as a shorter duration of stay; early and easy initiation of antagonist; no risk of agonist abuse/prescription opioid abuse. There was a significant difference in pain score reduction in cases of ultra rapid detoxification. Contrary to the literature available no significant complications were encountered during the procedure.

Conclusion: With proper pre anesthetic assessment, adequate precautions and financial affordability ultra rapid detoxification can emerge as an alternative treatment strategy for opioid dependence. Further studies are necessary to know the relapse rates and for the cost benefit analysis.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 49. Different facets of providing mental health care for different disadvantaged communities

Pallab K Maulik, Sudha Kallakuri, Siddhardha Devarapalli, Amanpreet Kaur, Mercian Daniel

Mental disorders and self-harm are currently estimated to account for almost 8.5% of all disability adjusted life-years worldwide. Recent National Mental Health Survey in India estimated lifetime prevalence of any mental disorder among adults is about 15%, with nearly 150 million in need of treatment. The treatment gap for mental disorders in India is huge and is particularly pronounced among disadvantaged groups. The symposia will bring together five speakers who will present on facets of mental health care for different disadvantaged communities using data from quantitative and qualitative research conducted by them:

(1)
The Systematic Medical Appraisal, Referral and Treatment (SMART), mental health programme among rural populations in Andhra Pradesh;
(2)
Addressing mental health issues among adolescents living in urban slums of Hyderabad and New Delhi;
(3)
Mental health systems and the mental health seeking behaviour of the people in the remote Scheduled Tribe areas in Andhra Pradesh;
(4)
Meeting the treatment and care needs of terminally ill patients and addressing issues that confront palliative care providers – results from Bengaluru; and
(5)
Rehabilitative (both public and private) health services for patients with severe mental disorders and their families – report from a study in Delhi NCR.

Keywords – mental health services, public health, disadvantaged populations, tribal mental health, palliative care, adolescent mental health, severe mental disorders

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 50. Progressing dialogues in Psychiatric Prevention: Beyond text and in the Field

Kabir Garg ¹, Seema Singh ², Roy Abraham Kallivayalil ³, Rakesh Chadda ⁴, T V Asokan ⁵, U C Garg ⁶

While traditionally Psychiatric prevention and mental health promotion have been underrepresented in literature and research, now it is increasingly being given importance by clinicians, policy makers and service users alike. It has been repeatedly demonstrated that preventive strategies and promoting health are cost effective in terms of reducing the eventual morbidity and need for intensive interventions while also are desirable for clinicians and clients as they reduce the chances of personal suffering. With more and more innovations in the field and legislations around the world emphasizing its importance, Preventive psychiatry has now percolated theoretical concepts in literature to everyday practice with suitable steps for all levels of resources. Frequent discussions and discourses at forums are necessary to facilitate this percolation, to educate clinicians and influencers around the world so that increasing number of service users can benefit from the efforts.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 51. The Psychological Impact of the Partition of India: A discussion on conflict, trauma and psychological impact

Alok Sarin, Sanjeev Jain, Pratima Murthy

The partitioning of the Indian sub-continent was accompanied by a large transmigration of populations. This migration was punctuated by a hitherto unseen level of trauma in the form of arson, looting and violence across the newly formed nation states. This has been the subject matter of exploration in literature, film, sociology and psychology. Interestingly, mainstream psychiatry has been intriguingly silent on the nature of psychological impact of either the migration or the violence.

In a recently published book, The Psychological Impact of the Partition of India, the authors explore this area using a interdisciplinary approach.

In this session, the authors bring together a panel of mental health professionals to further extend that exploration.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 52. Modern Crimes & Psychiatry

Jateen Ukrani, Indla Ramasubba Reddy, VIMHANS Vijayawada

Psychiatry and law have been associated with each other since Mc Naughtens rule came into force. While forensic psychiatry is taught to all post graduates it is also a branch of criminology. It includes explanations of criminal behaviour and criminality, including the role of mental disorder in crime, and discusses how psychiatry contributes to helping investigate the crime and catching the perpetrators Though the Association between law and Psychiatry is old, In recent times some new psychological phenomenon are becoming prevalent which are posing unique challenges to psychiatrists from around the country and baffling police. This talk aims to discuss these new age psychological phenomenon like blue whale game, burari suicides, cyberbullying and cybercrimes, child abuse, etc which have warranted a police investigation amid media outrage. The talk also focusses on new techniques like psychological autopsy which are being used for solving such crimes and how the scenario may change for Psychiatrists in the Modern age.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 53. Abstract: MENTAL HEALTH – NATION’S WEALTH : PERSPECTIVES FROM PRIVATE PRACTITIONERS

Swaminath G ¹, Nanasaheb Patil, Abhay Matkar

Private practitioners have an important role in mental health services delivery, and patients have relatively good experiences with services. Patients in private practice have generally better experiences than patients in public outpatient treatment, whether it is in treatment outcome, consultation time with clinician, clinicians’ comprehension of patient’s concerns, appropriateness of treatment, execution of follow-up plan, and influence on treatment.

The role of private practitioners is often not restricted to their responsibility as therapists in their clinics. Few of them embrace an add-on obligation towards community too, which in addition fulfils their inner strivings.

This symposia is conducted by three speakers with experience both in academia as well as private practice. The challenges which have been managed by them outside of the consulting room include working with the tribal population, homeless persons with mental illness, provision of free psychotropic medication to the needy, promotion of mental health in vulnerable populations such as school and college students, prevention of addiction and suicide, and use of media to promote mental health. These experiments have been arduous but satisfying, however, there have been many missed opportunities in the process, and many lessons learnt. The symposium highlights the journey of the three speakers in these trials and the issues in surmounting them to benefit the populace, improve their health and thereby improving nation’s wealth.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 54. IPS (Indian Psychiatric Society)-IMA (Indian Medical Association)-RCPsych (Royal College of Psychiatrists, UK: South Asia Division) Joint symposium on helping Doctors and Medical students with emotional and mental health problems

Nilima Kadambi ¹, Sandip Deshpande ², Ashlesha Bagadia ³

Background: India seriously lacks adequate mental and emotional health services for its large workforce in the healthcare space – namely doctors and medical students. There is a great need for a support service for Doctors and medical students in India.

The IMA in association with IPS and RCPsych-South Asian Division aims to launch a series of initiatives including a dedicated helpline for doctors and medical students in India. The primary objective of the helpline will be to provide first line support for doctors and medical students who need assistance in emotional and mental health emergencies. The helpline will provide a confidential service which offers information, support, guidance and referral for individuals who may be affected in any way by matters concerning emotional or mental well-being.

To help tackle the issue of stigma, the helpline will be an anonymous service. It will provide wide coverage using modern technology which will also aid ease of access to services.

Symposium outline:

Presentations in this symposium will focus on:

Providing an overview about psychological problems that healthcare providers face
Sensitize the delegates to the services that are available to Doctors across the globe especially in developing countries
Present the findings of focus groups conducted by this action group across different groups of doctors and medical students
Provide details of the activities that have been undertaken by IMA and the proposed helpline for Doctors
Invite feedback from the members of IPS about their involvement and ideas towards improving emotional health and wellbeing of the medical fraternity in India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 55. Sexual Dysfunction with SSRIs and management strategies

Ashish Srivastava ^**, Saumitra Nemlekar ^*, Anil Rane ^**, Wenona Fernandes ^*

Sexual dysfunction is a known adverse effect to selective serotonin reuptake inhibitors (SSRIs).. Sexual dysfunction can have significant impact on the person’s quality of life, quality of relationships, self-esteem, and recovery. It has also been noted in nearly 40-61% of patients. This may increase the risk for discontinuation and non - adherence to antidepressant pharmacotherapy

Some clinical scenarios that arise out of the same includes managing noncompliance; shifting from the SSRI to other classes and alter the pharmacological profile with add on medications for the problems. Patient education on the sexual side-effect profiles of SSRIs is critical to medication adherence, resolution of depressive symptoms, and improving quality of life. Delaying this discussion may result in confusion and distrust of pharmacotherapies and health care providers, making it more difficult to adjust and recommend medications later on. Given the prevalence of sexual dysfunction in subjects with depression, it is necessary for health care providers to give a full assessment and explanation of potential side effects of antidepressant pharmacotherapy. Use of Scales such as International Index of Erectile Function scale (IIEF) can be used to quantify the dysfunction. Current literature supports use of SSRIs at lowest dose, alternate medications to SSRIs, augmentation with PDE-5 inhibitors

The focus of this session shall be to explore the incidence, pathophysiology, and treatment of antidepressant-associated sexual dysfunction

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 56. Child Psychiatry Training

Anupam Bhardwaj ¹

Dear Sirs

I am proposing to do a presentation on Child Psychiatry Training in the UK and what we can learn in terms of developing training and curriculum to develop the DM Child psychiatry programme in India. I am currently the Lead for organising the teaching programme for higher trainees in Child Psychiatry for the Eastern Region, and have experience of developing and organising a teaching programme and curriculum development in my previous role as Honorary Senior Lecturer at UCL. I am also the Regional Representative for the Royal College of Psychiatrist.

I will give an overview of the curriculum and Child Psychiatry Training in the UK and insights into curriculum development

I was intending to link in with the departments that currently offer DM in Child Psychiatry and see how the two curricula compare and take development points.

Thank you

Anupam Bhardwaj

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 57. Management of Violent Psychiatry Patients.

Prasanna Prabhakar Khatawkar ¹, Shrikant Vishnu Patankar

Managing violent patients is always a challenging task for all psychiatrists. It is often a difficulty in specialized psychiatry setups and also in general hospital setups. An aggressive patient is a major risk for himself, the care-givers, treating team and the property in which he is treated.

Studies done worldwide have suggested that 20% of patients brought to emergency room of psychiatry hospital and 10% patients brought to general hospital need some sort of method to restrict their physical agitation and violence.

In India too studies have demonstrated the need to use restrictive methods in care of violent patients and these methods can’t be completely avoided.

Protocols for management of these violent patients are essential. Also there is a need for more standardized, cost effective, easy to use methods and equipments for this purpose.

The newer legislations make it mandatory to use more humane methods for care of violent patients.

Proper evaluation, talking down, chemical (pharmacological) methods, and physical (mechanical) methods need to be used judiciously as per the necessity of the situation with proper documentation.

Various rating scales and checklist are available for evaluation and for predication of violence. They may help the treating team for proper documentation and justification for use of the method used for purpose of management of violent patients.

Anticipation of a difficult situation, standardized protocol for management, proper documentation, good staff training, realistic communication with caregivers and all activities done as per the directions in the current legislations holds key to effective management of these violent and aggressive patients.

This symposium aims to discuss all these issues in current medical and legal perspectives.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 58. Somatoform Disorder Management: The Challenge

Alakananda Dutt, Deepak Godhmode, Dipanwita Sil

Somatoform disorder (SD), characterized by distress and dysfunction due to medically unexplained somatic symptoms has existed from the ancient times and despite the progress of modern medicine, controversies regarding the name, diagnostic criteria, aetiology and treatment continue to prevail. The presenters of the symposium will attempt to highlight the most effective means of assessment and treatment of patients with SD.

The diagnosis of SD lacks consensus across medical specialties as well as within Psychiatry which is reflected in the scarcity of epidemiological data. Disagreement prevails whether functional somatic syndromes like fibromyalgia, Hyperventilation Syndrome, Irritable Bowel Syndrome are “specialty specific” names of SD or different categories of illness. In Psychiatry too, DSM 5 and the upcoming ICD 11 have given different names for SD, viz. Somatic Symptom Disorder (SSD) and Bodily Distress Syndrome (BDS) respectively. Instruments for diagnosis, screening, assessment of severity and associated symptoms will also be enumerated.

Discussion of various aetiological models will be done with respect to their implications in treatment of SD. The effectiveness and efficacy studies on treatment despite their limitations reveal that exercise, psychological treatment, information and structured care may be more effective than medicines in SD.

The management of SD using Cognitive Behaviour therapy techniques based on the Specialised Treatment for Severe Bodily Distress Syndromes (STreSS) manual by Rehfeld et al, 2009 will be illustrated through case vignettes to highlight its applicability in the Indian outpatient setting.

From the above discussion we may conclude that the “mind body dualism” prevalent in medical science needs to end for ensuring better diagnosis and treatment to patients with SD.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 59. SUBJECT: Permission Regarding Retrospective Descriptive Study of Clinical Profile of Patients Referred for Consultation Liaison Psychiatry during a Period from 2008 to 2012 at a tertiary care centre in India

Rajni Chatterji ¹, Aruna Yadiyal ¹, Radhika Reddy ¹

BACKGROUND

Although the rate of psychiatric morbidity is very high in patients attending various other departments of a tertiary care hospital, referral rates are very low in India. Untreated psychiatric illnesses lead to significant morbidity and poor outcome in other physical illnesses too and also to frustration among treating doctors. Consultation liaison psychiatry contributes significantly to adherence to treatment, quality of life and increased patient and provider satisfaction. It also reduces stigma that follows mental illnesses not only in general public but also within the medical professionals. Studying the pattern of psychiatric referrals and clinical profile may pave the way for interventions to improve the current scenario.

STUDY DESIGN

A retrospective, descriptive study of clinical profile of patients referred to consultation liaison Psychiatry.

OBJECTIVES:

To study the patterns of referrals from other departments (IPD only) of BMHRC, a tertiary care and super specialty hospital over a period of five years.
To study clinical profile of patients referred to consultation liaison psychiatry.

METHODS AND MEASURES

Data for 540 patients were retrieved and analyzed. This data was collected from various departments functioning at BMHRC a tertiary care referral centre, Bhopal from 2008 and 2012. Patients were examined by clinical psychiatrist and psychiatric diagnosis was made according to WHO ICD-10.

RESULTS

Of all referrals from other departments majority of patients were referred from neurosurgery (84%), surgical gastroenterology (82%), pulmonary medicine (66%) and cardiology (60%). Most common psychiatric diagnosis made were anxiety disorder (13.8%), dissociative/conversion disorders (19.2%), Schizophrenia (12.7%) and mood disorders (8.5%).

CONCLUSIONS

There is an urgent need to encourage multi-disciplinary interaction for early identification of psychiatric patients for better outcome not only in psychiatric morbidity but also in other co-morbid physical illnesses. Further studies in this area are needed and should focus on interventions that can improve referral rates through early recognition of the common psychiatric conditions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 60. Discovering the biology of neuropsychiatric syndromes

Vanteemar S Sreeraj ¹, Bharath Holla ², Biju Viswanath ³

Generating potentials from the Accelerator program for discovery in brain disorders using stem cells (ADBS)

Presentation1: Clinical assessment of the ADBS cohort: Modelling etiopathogenesis in multiple affected families.

Presentation 2: Neuro-endophenotype assessments: Understanding brain and behavior

Presentation 3: Brain in the petridish: What is stem cell offering Psychiatry?

Presentation 4: New generation sequencing and familial mental illness: Approaching phenotypes through genes.

Prof. Sanjeev Jain, Professor, Department of Psychiatry, NIMHANS

The Accelerator program for discovery in brain disorders using stem cells (ADBS) is a DBT & Pratiksha trust sponsored collaborative project under the joint stewardship of three Bangalore based institutions NIMHANS, NCBS and InSTEM. The primary aim is to accelerate research in discovering the shared and unique biological underpinnings of major psychiatric disorders. In the background of shared genetic, environmental and developmental risks, families with multiple affected members with any of the five major psychiatric disorders (schizophrenia, bipolar disorder, obsessive compulsive disorder, Alzheimer’s dementia and substance use disorders) are being assessed. Links between the clinical phenotype, neuroendophenotype and cellular phenotypes are explored from the longitudinal assessments of the patients, their unaffected family members and healthy controls. This symposium will focus on the methodology of the ADBS project with some preliminary findings elucidating the potentials of the project to tap into the clinically driven translational models.

The first presentation will highlight the overall principles on conceptualizing ADBS and describes the conglomerated clinical diversity of the recruited loaded families. The clinical assessments evaluating the heritable traits, pathological states and environmental moderators would be presented. The second presentation explicate the rigorous and sophisticated neuro-endophenotype measures which includes neuropsychological assessment, functional and structural neuroimaging using magnetic resonance imaging (MRI) & near-infrared spectroscopy (NIRS), electrophysiology with electroencephalogram/event related potential (EEG/ERP) and eye movement tracking. The preliminary findings will throw light on the emerging patterns and potential explorations with imaging-genomics.

The third presentation illuminates the state-of-art technology in stem-cell techniques. It will also describe the encouraging leads obtained utilizing these techniques in this project. The fourth presentation will explicate the utility of familial studies on a platform of advancing genetic technologies like new generation sequencing in elucidating genetic architecture of severe mental illnesses. NGS approaches in a family based study design are useful to identify novel and rare variants in genes for complex disorders like SMI. The talk further provides findings from an independent validation that rare variants in Mendelian genes segregate with severe mental illness like BPAD and SCZ indicating phenotype overlap at the disease level and pleiotropy at the gene level.

This multipronged approach in envisioning the biological basis of neuropsychiatric syndromes would be the way forward for biological psychiatrists.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 61. Symposium Theme: New Frontiers in Depression

AK Agrawal, Rudra Prakash, Madhukar Trivedi ¹, Ananda Pandurangi ², Ashwin Patkar ³, Madhukar Trivedi ⁴

Sponsor: Indo-American Psychiatric Association

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 62. Title: Emergencies in Psychiatry: Challenges, approach and management principles

Praveen SR ¹, Vishwas Yadawad ², Sudheendra Huddar ³, Abhiram PN ^4,^✉

Title: Emergencies in Psychiatry: Challenges, approach and management principles

A Psychiatric emergency is an acute alteration in the behavior, mood or thought of the patient which if untreated results in harm to self or others. They constitute around one-third of all the cases that are encountered in the emergency department. This includes an acute presentation of new-onset psychiatric disorders, acute worsening of a long-standing illness or as a masquerade of acute medical/neurological illnesses. Emergency psychiatric services should meet many challenges in providing comprehensive care for such patients which includes immediate evaluation, investigations, timely management, liaison services and prompt referrals. This requires flexibility, practical approach, and broad range of knowledge. In our country with a shortage of human resources and dedicated facilities, rational approach and broad knowledge base are very essential. This symposium aims at discussing the following issues:

Epidemiology and various presentations
A Broad approach to the cases
Initial evaluation and investigations
Comprehensive management
Special situations (Unknown patient, special population, foreign nationals)
Case vignettes and discussion.

Key words: Psychiatric emergencies, Aggression, Suicide, Legal issues.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 63. Polypharmacy in psychiatry: Relevance to clinical practice in India

Satyakam Mohapatra ¹, Seema Parija ¹, Anil Kumar BN ²

Keywords- Polypharmacy, Psychiatry, Treatment, India

Polypharmacy is common in clinical practice for many psychiatric conditions and for many reasons. Polypharmacy is increasingly common and debatable contemporary practice in clinical psychiatry. Concerns with polypharmacy include harmful drug drug interactions, adverse drug reactions, complicated drug regimens leading to noncompliance, economic burden over the patient, lack of evidence-based strategies and therapeutic duplication etc. Polypharmacy in psychiatric treatment is helpful to treat co-morbid illnesses, when monotherapy provides insufficient improvement, to augment the efficacy of the primary treatment, to treat side effects associated with high dose monotherapy etc.

In order to address the issue of polypharmacy in psychiatry, the treating psychiatrists need to keep certain issues in mind including potential adverse effects and drug drug interactions and the specific indications for drugs. Sticking to certain guidelines, polypharmacy may actually give a better symptom relief and disease management with minimal or no side effects. The most important is to understand merits verses demerits of polypharmacy. Certain psychiatric drug combinations are considered irrational and recently banned by government of India.

The goal is not to simply avoid polypharmacy, but to practice rational instead of indiscriminate polypharmacy. There is need for more systematic research and the drawing up of guidelines for polypharmacy practice.

We will discuss in details about reasons for polypharmacy in current psychiatry practice, merits and demits about polypharmacy, how to avoid irrational polypharmacy in practice and about future directions in polypharmacy psychiatry practice.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 64. FALLACIES OF CLASSIFICATION IN CHILD AND ADOLESCENT PSYCHIATRY: PAST, PRESENT & WAY FORWARD

Savita Malhotra, Devashish Konar, Nishant Goyal, Anweshak Das

Diagnosis is a key part of how we communicate with patients and professionals. Diagnosis also involves understanding of what is wrong and why; and to guide logical decisions about which intervention is better and what lies next! Psychiatric diagnosis has been primarily phenomenological as the underlying pathogenetic causes, mechanisms and processes are still not fully understood. Current nosology is inadequate to capture the breadth and heterogeneity of mental disorders. The major official classification systems in use (DSM-5 and ICD 10) are categorical in nature, even though there has been major debate on whether they should be dimensional.

Of late, researchers have found that combining dimensions and categories is beneficial in understanding psychiatric disorders especially in young population. But a question always creeps up, whether a child with developmental and/or psychosocial issues be given a diagnostic tag or not, is in itself, a huge issue. Professionals need always to think twice whenever they feel tempted to give a diagnosis. Many are of the opinion that making a good formulation which speaks of child’s problem and gives a good treatment plan is what you need most in case of children. However, for communication, research, insurance and for use by other agencies we need to classify diseases.

Many changes are witnessed in DSM 5 in the field of child and adolescent psychiatry, like, greater emphasis of dimensional perspective, regrouping of diagnostic rubrics on the basis of said aetiology, being more developmentally oriented, going back from multiaxial to uniaxial approach, redefining diagnostic criteria for several disorders and then creating new diagnosis like disruptive mood dysregulation disorder and hoarding disorder. DSM 5 invited lot of criticism. Critics are sceptical about its over inclusiveness. They feel that many normal children and adolescents may be brought in inadvertently into the ambit of psychiatry and given a diagnosis. Normal childhood may get pathologized as a result.

It has to be reiterated that ICD-11 diagnoses in the field of child and adolescent psychiatry must be a step forward, taking lessons from the difficulties in implementing DSM 5 rather than perpetuating the same. Keeping in mind that it is going to be the most widely used system for diagnosis and management worldwide, ICD-11 must aim for a higher standard of scientific quality before changes are determined. ICD-11 should address both cultural and developmental aspects of disorders and focus also upon a manual for primary care.

The term used in classification for diagnosis has to be medically useful and yet not socially stigmatising. While trying to classify conditions we cannot afford to forget that society has great concern in regard to inappropriate labelling of children. At the end, it would be interesting to understand how the three systems’ approaches (DSM-5, ICD-11 and RDoC) to key issues of diagnosis correspond or diverge as a result of their different histories, purposes, and areas of implementation. Although the systems have varying degrees of overlap and distinguishing features, they should share the common goal of reducing the burden of suffering due to mental disorder.

Keywords: DSM 5, ICD 11, RDoC, Child and Adolescent Psychiatry

Scheme of Presentation (60 minutes)

Classification still has scope for improvement? :Prof. Savita Malhotra (15 minutes)
Changes brought in DSM 5: Dr Devashish Konar (15 minutes)
Changes expected in ICD 11: Dr Nishant Goyal (15 minutes)
Newer Vistas in Psychiatric Classification: Dr. Anweshak Das (15 minutes)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 65. International Young Psychiatrists Award Fellows Track Symposium: Fellowship opportunities, Perspectives sharing, networking, col

Speakers and topics: Dr Darpan Kaur shall talk about Fellowship opportunities and perspectives of WPA Berlin Fellowship, JSPN Fellowship, WPA RANZCP Fellowship, Adopt a Delegate IACAPAP Fellowship and Ramamoorthy NIMHANS SAARC Fellowship

Dr Adarsh Tripathi shall talk about Networking and Collaboration and International AINSHAMs Fellowship, WASP fellowship and Global Mentor Mentee Network Coordinator

Dr Shubrata Kalmane shall talk about application process and share experience about DJ Cohen fellowship at IACAPAP and WPA RANZCP fellowship

Dr Supriya Agarwal shall speak on Letter of Recommendation and Motivation Letter writing and perspectives about the WPA Berlin Fellowship, AFPA and WASP Fellowships.

Dr Ramdas shall talk about abstract writing and Marce Society Travel Award Fellowship and WPA RANZCP fellowship

Dr Tanay Maiti shall talk on CV Enhancement and WPA Mexico fellowship and Ramamoorthy SAARC NIMHANS Fellowship

Conclusion: The Symposium shall conclude on future opportunities for early career psychiatrists and role of collaboration and networking. Background:

There are various international fellowships in Psychiatry available from international organizations such as WPA, IACAPAP, WASP, RANZCP, JSPN, MARCE, AFPA, AINSHAMS, Global Mentor-Mentee Network, SAARC Ramamoorthy NIMHANS. There is a perceived need by the international young psychiatrist award fellows from India to conduct a joint symposium for information about fellowship opportunities, perspective sharing, networking and collaboration for skill enhancements of Early Career Psychiatrists.

Aims and objectives:

To conduct a symposium to create awareness and share experiences regarding international fellowships in psychiatry for young psychiatrists
To provide a platform for mentoring and guidance for encouragement of positive collaboration for academic and research activities for young psychiatrists.

Methodology:

This symposium shall attempt to generate awareness on various fellowships, information and perspective sharing, etc. The symposium shall highlight application process for the fellowships, CV enhancement, writing a motivational letter, writing a research abstract, collaborative work for academics and research.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 66. Negative Symptoms of Schizophrenia: A brief Overview

Dushad Ram ¹, Prasenjit Ray ¹, Rajarshi Chakravarty ¹

Abstract: Negative symptoms of schizophrenia represent an impairment of normal emotional responses, thought processes and behaviors, and include blunting or flattening of affect, alogia/aprosody, avolition/apathy, anhedonia, and asociality. Prevalence has been estimated to be around 25-50%. Negative symptoms respond poorly to treatment and affects the quality of life profoundly.

Dopamine dysregulation, hypofunction of NMDA receptor transmission, alongwith functional alterations in the prefrontal cortex, striato-ventrotegmental loops, and thalamocortical projections have been implicated in genesis of negative symptoms.

Conventional treatments targeting negative symptoms with second generation antipsychotics and antidepressants have not yielded much hope. Novel agents include a number of possible pharmacological approaches like enhancing NMDA receptor function with agents that bind directly to the glycine ligand site or with glycine reuptake inhibitors; influencing the metabotropic glutamate receptor (mGluR2/3) with positive allosteric modulators; and stimulating nicotinic acetylcholine receptors.

Other biological modalities of treatment, like rTMS, have been explored to treat negative symptoms these days. Yet, psychosocial intervention plays a large role in dealing with negative symptoms.

In the current symposium the speakers will start with the construct of negative symptoms and their biological underpinnings, then proceeding to the pharmacological and psychosocial approaches to deal with these.

Keywords: negative symptoms of schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 67. Title: Influence of parenting style on behavioural patterns in children.

Sally John ¹, Samrat Kar ², Kanika Kumar ³, K K Mishra ⁴

Introduction

Parents, as primary caregivers, exert a significant influence on the development of their child’s emotional health, personality, social and cognitive development, and academic performance. The influences of parenting style on child outcomes are numerous, but a wealth of literature indicates parenting practices play an important part in the behaviour patterns of children. Through this symposium we want to discuss the types of parenting styles and the influence they have on children. We would like to discuss our experience in this area as part of our short endeavour in school mental health program.

Parenting style and behavioural patterns

There exists an overwhelmingly wide range of parenting behaviors and an equally wide range of child behavioral outcomes. There has been extensive research on the implications parenting styles have on behavioural outcomes in children. Parenting styles are organized into four distinct types: authoritarian, permissive, uninvolved, and authoritative. Authoritative parenting was associated with more desirable child behaviour in previous research.

Conclusion

More extensive research is critical to enhance the current understanding of the role parenting styles play in child behavioural outcomes. An increased understanding of the parenting practices, may enable to address the environmental factors more effectively and guide the development of appropriate prevention and intervention programs to foster adaptive behavioural development in children.

Key Words: School Mental Health, Parenting Styles, authoritative, behavioural problems

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 69. Title: Role of Vitamin D supplementation in Depression: Where are we standing?

Naresh Nebhinani ^*1,^✉, Vikas Menon ², Sujit Kar ³

Depression is a major public health problem and at present, it is the second common cause of disability, and projected to become the leading cause of disease burden and morbidity worldwide by 2030. Vitamin D is involved in numerous brain processes including neuroimmunomodulation, neuroprotection, neuroplasticity, regulation of neurotrophic factors, and making it biologically plausible to be associated with depression.

High prevalence of depression as well as Vitamin D deficiency in general population, wider acceptability, negligible side effects and cost effective approach make Vitamin D supplementation a viable alternative for treating depression. It signifies the importance of assessing vitamin D status and treating hypovitaminosis D for effective management of depression, to avoid delay in response, and incomplete remission. But available data is inconclusive as few studies have supported this association and importance of vitamin D supplementation, while other studies have found no association. Available literature has several lacunae in study design, sample characteristics, issues with supplementation, assessment and interpretation.

This symposium will highlight on following areas:

Is there any association between Vitamin D and depression? - Dr Sujit Kar
Our clinical and research experience of vitamin D supplementation in depression- Dr Naresh Nebhinani
Gaps in available literature and priority areas for future research- Dr Vikas Menon

Keywords: Depression, hypovitaminosis D, time to remission, clinical response, Vitamin D

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 70. Title: Psychiatry training in undergraduate medical students: Time to delve, deliberate and deliver.

Maheshwar Nath Tripathi ¹, Subhash Das ², Shyamanta Das ³

Abstract: Mental morbidity is increasing in India. The recently concluded National Mental Health Survey 2015-16 mentions that the life-time prevalence of mental illness is 13.67% and the treatment gap is 83% which is very high. This could be due to several factors and to bring down this treatment gap is quite a challenge. This is almost a herculean task considering the fact that the number of mental health professionals (MHP; psychiatrists, clinical psychologists, psychiatric social workers, psychiatric nurses) are very less; World Mental Health Atlas (2014) mentions that India has just about 0.03 psychiatrists per lakh populations and other MHPs are even less. To tackle the mental health problem in India one needs to increase the number of MHPs, including that of Psychiatrists. In recent times there has been an increase in the number of Post-Graduate Psychiatry seats, however even this is not enough. One way to tackle this problem is to train Medical Officers and other health staffs in PHCs/CHCs through the District Mental Health Program. However this has its limitation like for example the government Medical Officers and health staffs have to perform a myriad of other official duties as a result of which management of mental health problems in the primary care level is likely to take a back seat. In this context, it would be fruitful if Psychiatry is recognized as compulsory subject in the MBBS curriculum so that we have well trained doctors who can recognize and treat at least the common mental disorders. However this is not the case as of now. Moreover there is also a negative attitude towards Psychiatry among medical graduates which somehow acts as a barrier in promoting interest in this subject among them. Thus it goes without saying that there is a need to increase focus on Psychiatry training among the undergraduate students in India.

Through this symposium the speakers want to explore and deliberate on:

Psychiatry training in medical students : the developed vs developing nations. (Speaker: Dr Maheshwar Nath Tripathi)
Attitude towards Psychiatry among the medical students in India and how to bring about a positive change. (Speaker: Dr Subhash Das)
Challenges in making Psychiatry a compulsory subject in exit examination of MBBS.(Dr Shyamanta Das)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 71. SUICIDE IN ADOLESCENTS: CHALLENGES IN ASSESSMENT & MANAGEMENT

Sonia Parial, Deepak Ghormode, Pramod Gupta, Mithun Dutta

Suicide defined as a fatal, intentional and self-inflected action with the intent to end one’s life, is one of the leading causes of death in adolescents worldwide. It is often seen as occurring on a continuum of severity from passive death wishes to suicidal ideas, plans, and attempts; past history of act of self harm being an important risk factor for future suicide attempts. Most of the attempts of self harm in adolescents are not reported hence the risk for future such attempts leading to death remains inadequately estimated and the rates of suicide thus may not be representative for this dreadful but preventable phenomenon. Hence the suicide in adolescents needs special attention in identifying risk factors, evaluation, management and prevention.

The presenters will try to highlight the issues of causative and risk factors in suicide in adolescents. At times it appears a difficult task for mental health professionals dealing with adolescents to inquire about the suicidal ideations in certain group of patients. The assessment of suicidal behaviours will also be discussed with the help of interview based situations in handling such patients’ initial resistance and autonomy. Management of suicidal behaviours in adolescents using principles of Dialectical behaviour therapy that includes individual treatment for affect regulation and distress tolerance, behavioral chain analyses to address self-harming behaviors, skill building, family work, and consultation will be discussed in detail with the help of case vignettes, and crisis intervention strategies will also be discussed. The presenters will also try to focus on the important preventive strategies of suicide prevention.

From the above discussion we can highlight important domains and ensure better assessment and management of adolescents with suicidal behaviour.

Keywords: suicide, adolescents

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 72. Psychiatric morbidity in migrant population- Experience from South Asia.

Abdul Majid, Dr K K Mishra, Harish Chandra Ghambeera, Nirmal Lamachanne, Helal u din Ahmed, Brig MVSK Raju

Migration is a universal phenomenon, which existed with the subsistence of the human beings on earth. South Asia is no different in this context as people in this subcontinent also migrate from one place to another for several reasons like improving their living conditions, to escape from debts and poverty, to avoid hostile & stressful environment due to conflicts, which pose threat to their life and property. People move as individuals alone, as families or en masse as communities or sects. Being a social phenomenon, in addition to mortality and fertility, migration is the third basic components of population growth of any particular region.

It is estimated that 1% of world’s population has been displaced either from their home or from their home country.[1] A report of the United States committee of refugees published in the year 2002 estimates that there are 14.9 million refugees and 22 million internally displaced persons in the world.[2]

Migration is a process which involves certain phases for individual to go through and thus one may experience lack of preparedness, face difficulties in adjusting to the new environment, the complexity of the local system, language difficulties, cultural disparities and adverse experiences would result in distress to the migrating population. This will subsequently lead to negative impact on mental health. The clinical and research literature shows a significant degree of psychological stress among refugees with relatively high levels of physical and psychological dysfunction during the first two years of resettlement. After a period of three years, there was some improvement and increased adaptability, but their serious and pervasive adjustment problems, such as high levels of somatization, Generalised Anxiety Disorder, depression and post traumatic stress disorder (PTSD), continued to affect some sectors of the refugee population. These symptoms have even been noted many years after resettlement.[3,4,5]

This symposium is aimed at understanding the impact on the mental health of the migrants based on the studies conducted around neighbouring countries in south Asia.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 73. Title: Addressing the inequity of Mental Health service delivery using Telepsychiatry

Deepak Kumar ¹, Savita Malhotra ², Rahul Gupta ³

Current status of telepsychiatry –An Overview

This symposium consists of 3 presentations which talks about the overview of Telepsychiatry set-up, different Telepsychiatry models and experience in Indian context and comparison with Australian context. Similarities and differences will be highlighted ending up with some directions for future and learnings for services wishing to set up their own Telepsychiatry Service.

Despite the high prevalence of psychiatric disorders, it is well-known that there is inequity of mental health (MH) care provision as most specialized MH services are concentrated in urban areas. This is true not only in a developing country like India but also in developed countries like Australia, US and Canada where small regional towns are separated by vast distances.

Telepsychiatry is increasingly been used to bridge the gap in MH Service delivery. However, the uptake is variable with some centres doing better than others both nationally and overseas.

In keeping with the above objectives, few projects involving development and implementation of telepsychiatry application for providing mental health care in areas where specialist mental health services are not readily available, have been started in India including one at Postgraduate Institute of Medical Education and Research, Chandigarh. Similarly in Australia, telepsychiatry services have been established to provide mental health services to rural and remote towns.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 74. Symposium Title: “CATATONIA” in clinical settings.”

Vivek Kirpekar ¹, Sudhir Bhave ¹, Rahul Tadke ¹, Sushil Gawande ¹, Abhijeet Faye ¹

Title: “CATATONIA” in clinical settings.”

Sr. No.	Subtopic	Name of Presenter	Position	IPS Membership No	Contact number & email
1	Introduction & Concept	Dr. Sushil Gawande	Associate Professor	LF-19464	09322013915
1	Introduction & Concept	Dr. Sushil Gawande	Associate Professor	LF-19464	sushil.gawande@rediffmail.com
2	Clinical Assessment	Dr. Vivek Kirpekar	Professor & Head	LF-11066	09822200689
2	Clinical Assessment	Dr. Vivek Kirpekar	Professor & Head	LF-11066	vivek.kirpekar@gmail.com
3	Investigations & Neuroimaging	Dr. Abhijeet Faye	Assistant Professor	LF-01295	09765266166
3	Investigations & Neuroimaging	Dr. Abhijeet Faye	Assistant Professor	LF-01295	abhijeetfaye12@gmail.com
4	Management	Dr. Rahul Tadke	Associate Professor	LF-18151	09823027370
4	Management	Dr. Rahul Tadke	Associate Professor	LF-18151	rahultadke@vsnl.net
5	Dos and don’ts	Dr. Sudhir Bhave	Professor	LF-02046	09822695890
5	Dos and don’ts	Dr. Sudhir Bhave	Professor	LF-02046	shbhave@gmail.com

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Catatonia is a neuropsychiatric syndrome characterized by particular motor and behavioral signs and symptoms which can manifest as a consequence of many neurologic, psychiatric (including schizophrenia), and/or general medical conditions. Catatonic signs may be frequent in patients diagnosed with brain hypoxia and traumatic brain injury. Diagnosis of catatonia is challenging because it requires physical examination and clinical suspicion. Catatonia is known to be often reversible when detected promptly and treated adequately but its under-recognition and subsequent lack of treatment might lead to further medical complications. Thus, awareness about catatonia for all clinicians is relevant to improve patient care.

The present symposium aims at discussing various aspects of catatonia & its present diagnostic status. Detail clinical evaluation and assessment with highlight on the clinical pointers which lead towards required right investigation. At what point or at which clinical suspicion should one think of catatonia? This will also be explained with help of a clinical case vignettes. The findings of ongoing research related to this will be discussed. The role of structural Neuroimagings, functional Neuroimaging and other investigations will be explained in detail. Then the authors will speak on the management & monitoring of the patients in follow up or maintenance phase and share the updates available in the medical literature including recent guidelines. In the end there will be guidance on dos and don’ts related to catatonia in clinical settings.

At the end of the symposium the participating delegates will get idea about various clinically relevant aspects of catatonia, recent updates, the knowledge and expertise one should have about it and its management in acute as well as in maintenance phase in clinical practice.

Subtopics: - 1. Introduction & Concept, 2. Clinical Assessment, 3. Investigations & Neuroimaging, 4. Management and 5. Dos and don’ts.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 75. Symposium: “Do I think about thinking?”: Recent trends in metacognition.

Shweta Singh ¹, Vibha Sharma ², GS Kaloiya ³, Swati Baghchandani ⁴, Nabanita Barua ⁵, mariyam Miraz ⁶

Humans possess wonderful cognitive ability to reflect upon one’s own thought processes. Simply defined as “thinking about thinking”, metacognition refers to beliefs or attitudes that individuals holds about their thoughts and internal states, which also directly influence plans and tendencies for action” (Cartwright-Hatton &Wells,1997; Wells & Matthews, 1996).

The multidimensional nature of the concept has brought about a distinction between three basic aspects of metacognition as metacognitive knowledge, metacognitive experience, and metacognitive regulation.

Flavell (1979) was a pioneer in the area of metacognition and proposed first formal model of metacognition. Wells (1997) expanded it and more recent work is carried out by Rees And Farewell (2013).

Metacognition plays a role across age ranges whether children, adolescents adults or elderly. In fact, awareness of the metacognitive strategies and tasks is thought to appear in childhood and could be related to the onset of the concrete operational stages that appears approximately by age 6 years (Piaget, 1970).

Healthy individuals use metacognitive strategies in day-to-day functions like language, speech, memory and complex process of social interaction, self-regulation, and personality development. Recently, the concept of ‘metacognition’ has gained increasing interest in the conceptualization and management many clinical conditions like anxiety disorders, depression, OCD, psychosis and PTSD.

Purpose of symposium:

The present symposium throws light upon the concept of meta cognition, its assessment and therapies based on it.

These processes in children adults and elderly are being discussed.

Moreover role of metacognition in various clinical conditions is also presented

Symposium Convener : Dr Shweta Singh, KGMU

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 76. Aadhaar, Voter card & government welfare benefits for long stay inpatients in state mental hospitals: NIMHANS experience

Sivakumar T ¹, Hareesh A ¹, James JW ²

Long stay inpatients in state mental hospitals are a disadvantaged population. There are > 3000 such inpatients in 43 state mental hospitals across the country.

Longstay inpatients get access to shelter, clothing, food & medicines within safe confines of the hospital. Most of them don’t get access to various government benefits and schemes for want of an identity and address proof.

Recently, the supreme court has upheld the constitutional validity of Aadhaar, recognized it as a tool for inclusion and allowed Aadhaar linkage for availing subsidies and benefits provided by the government.

According to Representation of the People Act (1951), Indian citizen can vote unless the person is declared to be of unsound mind by competent court. According to ‘United Nations Convention on Rights of Persons with Disabilities’ (UNCRPD), persons with mental illness cannot be denied right and opportunity to vote. A significant proportion of long stay inpatients have the ability to vote.

While longstay inpatients are eligible for disability pension and other benefits, there are several barriers in ensuring access for the same.

At NIMHANS Bangalore, aadhaar cards have been provided for 20 long stay inpatients with mental health issues. Recently, 3 of them also applied for a voter card and exercised their constitutional right to vote.

In this symposium, we shall describe the importance of the exercise, process followed at NIMHANS, challenges faced, practical experience and implications for long stay inpatients in state mental hospitals/ institutions in India.

The speakers and structure of the symposium are as following:

Aadhaar card for long stay inpatients: Need, securing official permission & lessons learnt: Dr T Sivakumar (20 minutes)
Enrolling long stay inpatients in electoral list & voting day experience: Mr James (20 minutes)
Access to Government welfare and disability benefits for long stay inpatients: opportunities & challenges: Dr Hareesh Angothu (20 minutes)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 77. ABSTRACT FOR SYMPOSIUM THE OVERLOOKED NUANCES OF THE PROBLEM OF ADDICTION

Himanshu Sareen ¹, Deepali Gul ², Gulbahar Singh Sidhu ³

The problem of addiction confronts the world as never before. Some 31 million persons worldwide have drug use disorders as per the latest figures released by the World Health Organization. Almost 11 million people inject drugs, of which 1.3 million are living with HIV, 5.5 million with hepatitis C, and 1 million with both HIV and hepatitis C. Globally, it is estimated that around 318,000 deaths in 2016 were the direct result of a substance use disorder. Currently, a drugs epidemic is sweeping the state of Punjab with figures suggesting that more than 860,000 young men in the state, between the ages of 15-35, take some form of drugs. These figures are alarming, to say the least.

However, there are many nuances of the problem of substance abuse and dependence which require a closer look. This includes the history of addiction, the current trends, and the changing face of laws relating to substance use disorders, the law and order problems related to substance use among others.

The first speaker would trace the history of addiction worldwide, at the national level and in the state of Punjab.

The second speaker would discuss the laws relating to Substance use disorders, the guidelines given by the Indian Psychiatric Society and those given by the World Psychiatric Association.

The third speaker would deliberate on the law and order problems related to Substance Use Disorders, the risks faced by psychiatrists in the state of Punjab, the fight against drugs being waged by Punjab and the success story of the Punjab Institute of Medical Sciences at Jalandhar (Punjab) leading to the recognition at the national level by the honorable President of India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 78. Title of Proposed Symposium: PRESCRIPTION DRUG MISUSE

K Narasimha Reddi ¹, A Prasanth ², K Ramananda Kishore ³

Introduction: Prescription drug misuse is defined as any use of a prescription medication that is outside of the manner and intent for which it was prescribed. This includes overuse, use to get high, diversion (sharing or selling to others), having multiple prescribers or non prescribed sources of the medication, and concurrent use of alcohol, illicit substances, or non prescribed controlled medications. Misuse is a necessary but not sufficient criterion for a substance use disorder. Prescription drug use can be diagnosed as a substance use disorder, if misuse of a prescription drug meets DSM-5 criteria, which can be specified as mild, moderate, or severe. In fact, the National Institute on Drug Abuse states that 25% of prescription drug abusers who began abusing earlier than age 13 ended up meeting clinical criteria for addiction and prescription drug abuse treatment. In the US alone, more than 15 million people abuse prescription drugs. According to results from the 2014 National Survey, the rate of current nonmedical use of prescription psychotherapeutic drugs was 2.6% in men and 2.3% in women. Management: Establishing a treatment plan, limiting dose and early refills, performing intermittent pill counts, lowest effective dose, and prescription monitoring programs. Preparing Doctors to Manage Pain & Addiction plays a major role. Drugs of dependence are the ones most likely to be abused. They are intended for short-term use (eg two to four weeks). If commenced following an acute hospital admission, a weaning off protocol should be provided or sought from the hospital staff or treating doctor. If drugs of dependence are required for longer term treatment, be clear of the diagnosis and monitor ongoing risks and benefits. The 4As of monitoring are analgesia, activities of daily living, adverse reactions and aberrant behaviors. Better enforcement of laws in India and implementing comprehensive drug monitoring system can help in preventing the misuse.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 79. Changing trends in Substance use in Kashmir.

Yasir Hassan Rather ¹, Haamid ismail ², Sanjeet kaur ³, Ubaid Rasool ⁴

Substance abuse is a broader term which implies the use of harmful or hazardous psychoactive substances including alcohol, inhalants, tobacco and other illicit drugs like opioids, heroin, amphetamines, cannabis and many more.

“Phenomenology of Inhalant Users Seeking Treatment at Drug De-Addiction Centre of Govt. Medical College, Srinagar”

A total of 92 patients were included in our study. Two third of our study group were in the age group 10-19 years. Fevicol SR was the most predominant inhalant used. Phenomenology of inhalant intoxication was categorized in hedonic and aversive group of symptoms. Under hedonic experiences, all subjects reported feeling of relaxation (100%), whereas under aversive experiences nausea was the most common experience. Under the phenomenology of inhalant withdrawal, all subjects (100%) reported high levels of craving.

“First Oral substitution therapy centre in Kashmir”

The data from registers maintained since the inception of the centre (November 2012) was obtained and analysed till date (September 2018). The total number of IDUs registered for OST has increased more than three times from 2012 to 2018. Nearly 91% of the total enrolled regularly attend OST clinic. The centre has a dropout rate of 4-8%. Majority of the IDUs were males falling within 16-47yrs age (mostly below 35yrs).

“Changing pattern of opioid use in kashmir: a review”

Kashmir has seen a rise in the burden of opioid use over the last two decades. In this context, a review of studies conducted over the past two decades was done which revealed a rise in the use of intravenous opioids.

Key words: Inhalant use disorder, Intravenous drug use, Oral substitution therapy

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 80. Symposium: Perinatal Mental Health: Developing integrative care model of Perinatal Psychiatry in India.

The symposium has four components

Perinatal Mental Health: beyond postpartum psychosis (Dr. Shubhagi Dare)
Perinatal Mental Health: current challenges in implementation of mental health services during perinatal period (Dr. Sonia Parial)
Perinatal Mental Health: Implementation in the state of Kerala: Lessons for other state to learn (Dr. Anil Kumar T V)
Perinatal Mental Health: How do we train fellow professionals (Dr. Kishor M).
Perinatal Mental Health: Integrating Perinatal Mental Health Units at General Hospital set-up (Dr. Sundarnag Ganjekar).

The perinatal period is a time of major transition in woman’s life and is associated with a significantly increased risk for onset and / or relapse of mental health conditions. Postpartum psychiatric disorders range from rare postpartum psychosis (prevalence of 0.1 to 0.2%) to more common postpartum depression and anxiety. In India depression during pregnancy affects 1 in 5 mothers and if undiagnosed carry risk of postnatal depression and adverse maternal and fetal outcomes.

The first presentation from Dr. Shubhangi Dare focuses on common mental disorders during pregnancy and postpartum. It has been proved beyond doubt that mental health problems during perinatal period has deleterious effect on the mother as well as the infant. Worldwide women get in touch with the health professionals during her pregnancy and postpartum and it is ideal time for assessment of mental health.

The second presentation by Dr. Sonia Parial focuses on the current challenges in the implementation of mental health services during perinatal period. Being working closely with District Mental Health Program.

The third presentation by Dr. Anil Kumar T V focuses on the lessons for other part of India to implement Perinatal Mental Health through his experience by implementing it in to the state of Kerala.

The fourth presentation by Dr. Kishor M focuses on training the professionals especially obstetrician. He has been instrumental in bringing Manual on Mental Health training for obstetrician.

Finally Dr. Sundarnag Ganjekar will present on integrating perinatal mental health units in resource scarce general hospitals in India a way forward for integrating Maternal Mental Health in to Reproductive and Child Health Program.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 81. Title- Innovative interventions in Consultation Liaison Psychiatry

Divya Hegde ¹, Priya Sreedaran, Dhanya Raveendranan, Salazar Luke, MV Ashok, Johnson Pradeep

Background

A Consultation-Liaison Psychiatrist is the ambassador for mental health in the general hospital. Lifetime prevalence of mental disorders in patients with chronic medical conditions is 42%. However, the current mental health gap in India prevents a large number of medically ill patients from accessing essential psychiatric care. Ignoring the mental health issues of medically ill patients prolongs their suffering, reduces their quality of life and affects outcome of primary medical illness. In this background we present a symposium describing innovative intervention models to deliver mental health services in liaison psychiatry.

Materials and Methods

We describe models of care using trained nurses to identify mental health issues as well as provide psychosocial interventions in a tertiary general hospital setting. In Gastro-enterology, patients with alcohol liver disease were given brief interventions to improve their abstinence. In endocrinology, nephrology and immunology; a trained nurse actively identifies patients with mental health issues and ensures their treatment. As part of suicide prevention in high risk populations, a non specialist nurse assertively identifies patients with suicide attempts treated for resulting medical complications and delivers mental health care to them.

Results

These strategies have led to an increase in patients receiving mental health care. They have also improved follow up rates and relationship with other consultants.

Conclusion

These models allow for better collaboration between psychiatrists and other specialists and thus benefit patients with medical and mental health issues. These models can aid in bridging mental health gap in India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 82. SCHIZO-OBSESSIVE DISORDER: AN UPDATE

Seema Parija ¹, Satyakam Mohapatra, Anil Kumar BN

Obsessive-compulsive (OC) features are common in patients with schizophrenia. The term schizo-obsessive disorder has been proposed to delineate the patients with schizophrenia who also have obsessive-compulsive symptoms (OCS) and/or obsessive-compulsive disorder (OCD) in addition to positive, negative and disorganized psychotic symptoms.

Three different groups of schizo-obsessive disorder patients have been described, those diagnosed with OCD before the development of schizophrenia, those who begin to exhibit OCS around the onset of schizophrenia or at any time during the course of the illness, and finally, those who show transient OCS at different stages of their disease, or after the use of antipsychotic medication. Identification of schizo-obsessive patients is complex due to difficulties in recognizing obsessions and compulsions as OCS may resemble psychotic symptoms. It can be hard to distinguish obsessions with poor insight from delusions, compulsions from mannerisms, and obsessional slowness from thought blocking. These issues will be clarified in our discussion.

Current genetic, neurobiological, clinical-descriptive and pharmacological data about OCS and/or OCD in schizophrenia hypothesize that schizophrenia combined with OCD is more than a mere comorbidity. A dimensional approach, based on the identification of a dysfunctional area, should replace categorical approach. A dimensional definition of schizo-obsessive disorder has a prognostic value in terms of severity of psychotic symptoms and it captures the complexity of both schizophrenia and OCD.

We will discuss the various dimensions in the schizo-obsessive spectrum, such as insight, compulsivity and disorganization. We will discuss in details about the epidemiology, neurobiology and clinical features of schizo-obsessive disorder. These patients have been shown to have poorer social functioning and quality of life than those with schizophrenia. Evidence based psychopharmacological and psychological treatment and future direction to improve the prognosis of these patients will be discussed in detail.

Keywords: schizo-obsessive disorder, OCD, schizophrenia

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 83. Assessment and Management of School Refusal Behaviour among Children and Adolescents

Smitha CA ¹, Aswathy G ², Indu Nair ³

Keywords: School refusal, Parenting, Child and adolescent, Management.

Background: School refusal is a very common cause of referral to child guidance clinics and has a 5% prevalence among school going children. School refusal is associated with a number of externalising and internalising symptoms and an array of mental health disorders accompany this. Presentation and underlying factors vary with the age, temperament and the environmental factors of the child.

Objective: To discuss the extent and significance of the problem, contributory environmental factors, accompanying mental health disorders and the management of the school refusal behaviour.

Overview: We will discuss the relevance of the of identifying the problem, various patterns of presentation, precipitating and perpetuating factors, associated psychiatric disorders, assessment and management of school refusal.

Speakers and Subtopics:

Aswathy G will discuss the prevalence and various types of presentations, role of the child’s temperament and different parenting styles. How the parenting styles and familial relationship subtypes are influential in the school refusal behaviour will be detailed. An algorithm for the initial assessment of the school refusal behaviour will also be discussed..

Smitha CA will review the school refusal behaviour among children, detail the age specific assessment methods, discuss the child psychiatric disorders associated with school refusal and various approaches in the management. Role of the teachers and parents in the management would be discussing in detail.

Indu Nair will address the school refusal behaviour among adolescents and approaches in the management of contributory and underlying problems. Scenarios relevant to adolescent age groups including body image, gender identity and relationship issues will also be discussed in the context of school refusal.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 84. BORDERLINE INTELLECTUAL FUNCTIONING: WHAT WE KNOW BUT DON’T SEE!!

Priti Arun ¹, Rachna Bhargava ², Nidhi Chauhan ³

Borderline intellectual functioning (BIF) is a difficult concept, getting recognised in DSM- I as ‘mental deficiency’ to a V- code in DSM- 5. It mostly refers to the group of individuals having IQ between 71 and 85 with varying levels of cognitive deficits. There is enormous literature highlighting the difficulties faced by individuals with BIF in all areas of ordinary life- from problems in adaptive functioning to increased risk of physical problems, difficulties in daily living, no access to specialised services, thus, affecting their quality of life and employability. Despite great difficulties in their daily lives, this group of individuals go unnoticed by the society at large and by policy makers in particular. Caring for individuals with BIF requires inter-sectoral coordination amongst health, education, social, employment and legal services. However, there also remains a fact that not all individuals with BIF have limitations in activities and participation restrictions. Thus, one plan for all will not meet the needs of all individuals in this group and new innovative ways needs to be explored for this group of people.

1) Concept and evolution of ‘Borderline intellectual functioning’.

2) Psychosocial impact of Borderline intellectual functioning on individuals and their families.

3) What more needs to be done for individuals with Borderline intellectual functioning and how?

Symposium -Under the aegis of IPS Geriatric Psychiatry Specialty Section and IAGMH

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 85. Positivity, resilience and spirituality- the core themes for healthy ageing

SC Tiwari, G Prasad Rao, Avdesh Sharma, Nisha Mani Pandey

Health is considered as the ability to adapt and manage oneself in the face of social, mental and physical challenges of life; and this definition emphasises on the potential of the individual which is either to be or to become healthy, even in adversity and/or diseased status. Moreover, a healthy person remains capable of using his/her potential for personal growth and development throughout their life and lead a purposeful life.

A recent review reveals 3 dimensions of healthy aging i) biological– which emphasized the need to adopt habits and behaviours inherent to lifestyle to age in a healthy way; ii) psychological-in which optimism and happiness were considered as important factors and iii) social-which revealed social relationships with family, friends and partners as the core features. It can be thus put forward that positive outlook in various domains of life with resilient worldview and spiritual characteristics (developing self by understanding one’s own abilities in terms of self-actualization and self- realization) contributes to a healthy life. If these characteristics could be introduced to aging individuals, achieving healthy aging would not be a dream. In view of this, present symposium has been planned and developed.

In this symposium the presenters will be elucidating on i) concepts and scientific understanding of positivity, resilience and spirituality; ii) resilience as a protective factor for healthy aging; iii) Spirituality-the inner strength to promote healthy aging and iv) promoting healthy aging through a resilient world-view.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 86. NEURODEVELOPMENTAL DISORDER: THE CURRENT DEBATE

Pradeep Kumar Saha ¹

Co-Author Name 1: Dr. Partha Sarathi Kundu ; Asst. Professor

Co-Author Name 2: Dr. Manish Kumar ; Asst. Professor

Co-Author Name 3: Dr. Anirban Roy ; Associate Professor

Neuro developmental disorder is a new concept in DSM V. It includes disorders that are evident from childhood, slowly improves with age, but never gets alleviated. It is more of a trait than a state. It includes ASD,IDD, ADHD, SLD, motor coordination disorder etc. Rehabilitation is the key to intervention. Till date there is no medication to address the core disorder. Such disorders are frequently associated with behavioural or achievement oriented manifestations. Those manifestations can be controlled with a few selected psychotropics. Worldwide it is a recognised entity under behavioural disorder group. But recently, Govt. of India, more precisely the Ministry of Social Justice and Empowerment for the purpose of certification of such behavioural disorders has included paediatricians as the diagnosing and certifying authority. And surprisingly, for certifying more precise subgroup of S.L.D., under this entity, they have removed psychiatrists from the certifying board. Truly speaking psychiatrists are the only professionals having hands on experience and exposure in diagnosing and managing such conditions. Some state governments going a step further have removed psychiatrists from the certifying board of entire neuro developmental diasorders. There is a need for awareness of this debate amongst fraternity need for amendment of this faulty amendment inviting debate and unified dissent on this issue.

Key words: Neuro developmental disorder, ASD, IDD, ADHD, SLD, motor coordination disorder, disability certification

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 87. Title: Screen addiction among young children and adolescents

Surjit Prasad ^*, Bhoomika Sachchacher ^†, Preeti Gupta ^‡, Neha Sayeed ^*,^✉

Screen addiction: A new entity- Dr. Surjit Prasad

Screen addiction doesn’t appear in the latest classification system, Diagnostic and Statistical Manual, the DSM-V, published in 2013. However, a closest term called “Internet Gaming Disorder” is listed as a condition demanding further study though not as an official diagnosis. Pointers to screen addiction as a health concern will be discussed in details. however, some have been identified as failure to regulate the initiate and inhibit behavior (failure to put electronic device away on first request), sleep disturbances due to activation of physiological adrenal excitement, not controlling the electronic device use even after experiencing a negative consequence and irritability.

Psychosocial correlates and consequences of screen addiction- Dr. Bhoomika Sachchacher

Parenting styles, temperament and surroundings have immense roles in the development of dependence on screen. Engaging with peers on social networks such as Facebook, Instagram, or Snapchat, or playing immersive roles in games with friends and people from around the world, are ways in which youth may feel socially connected. In an environment where people are frequently using and checking devices, research has pointed to various health problems and conflicts that arise within families when people are distracted by media and technology use as well as to major public health concerns. This will be discussed further in detail.

Preventive and treatment approach- Dr. Preeti Gupta

To identify the psychosocial and medical issues behind the problem behaviour should be the first step to look forward for the management and treatment. There is a need to recognize the importance of face-to-face communication in addition to online communication and supporting rich social relationships. Additionally, parents and other caring adults can help youth to manage media. A balanced approach is required at an individual level as well as at public level.

Problem in seeking treatment- Dr. Neha Sayeed

To identify the symptoms and coming up for treatment is a difficulty for the people who are not aware about mental illness related to screen addiction. There are various barriers to treatment and how to manage this issue will be the focus of discussion.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 88. Title: Parenting: Can it be a Cornerstone of Preventive Psychiatry?

Sumit Rana ¹

Parenting: Psychological Ramifications: Dr GS Kaloiya, Assoc. Prof. of Clinical Psychology, National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), New Delhi.

Parenting: Social Ramifications: Dr. Naveen Grover, Asst. Prof of Clinical Psychology, IHBAS, Delhi.

Estimated prevalence of psychiatric disorders in India is 65/1000 population i.e. 8.6 Crore Person with Mental Illness! Of this, around 4 Crore are suffering from Common Mental Disorders and around 1 crore are suffering from substance dependence. With increasing population and dramatic changes in the society in recent times, the number of PMI is expected to rise dramatically. It is compounded by the fact that we have just 0.2 psychiatrists per lakh population and those too are concentrated in the Cities. The shortage of other mental health professionals is even more acute with only minority of Major Institutes having Clinical Psychologists and Psychiatric Social Workers. The demand supply gap is almost impossible to fill. Further, prognosis of Mental Illnesses, though improving, is still not satisfactory. Preventive Psychiatry has the potential of dramatically reducing the prevalence.

Parenting is the process of assisting and encouraging the physical, emotional, social and mental growth of a child from birth to adulthood. Parenting is an intricate process that involves much more than a mother or father providing food, safety and support to the child. It is an intricate activity, encompassing various explicit attitudes and behaviors, which work independently and collectively in child outcomes (Darling & Steinberg, 1993; Darling, 1999).

Parenting is a universal phenomenon. Barring few unlucky ones, everyone receives parenting from their parents. Can we use this in preventing mental illnesses? Does it really have a potential of becoming the cornerstone of Preventive Psychiatry?

To deliberate on this, we have planned a symposium titled “Parenting: Can it be a Cornerstone of Preventive Psychiatry?”

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 89. Mental Health Care Services for the Marginalized Population: Reaching the ‘Unreached’

Shivangi Mehta ¹, NidhiMalhotra ², Aarzoo Gupta ³

The Department of Psychiatry, Government Medical College & Hospital-32, Chandigarh has been working diligently in the field of Community Mental Health for more than twenty years; with one of the aims of catering to the Mental Health needs of marginalized and unreached population including homeless women and children, abandoned elderly, children in conflict with law, children/adults withintellectual disability etc. During the process of developing services for the aforementioned population; we have been tirelessly liaising with multiple stake-holders like Department of Social welfare, Police personnel, Judiciary etc. and have successfully delivered Mental Health Services to various rehabilitation homes/ residential facilities covered under the UT of Chandigarh namely Ashreya, Juvenile Justice Home, NariNiketan,Snehalya, Samarth and Senior Citizen home. The presenters will highlight theservices being delivered to children and adults with intellectual disability, homeless/abandoned women and children in conflict with law in Ashreya, NariNiketan and Juvenile Justice Home respectively.

Topics:

Mental Health Services for homeless/abandoned women residing in NariNiketan(NidhiMalhotra)
Mental Health Services for children in Conflict with Law(Aarzoo Gupta)
Mental Health Services for children and adults with Intellectual Disability in a residential setting(Shivangi Mehta)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 90. THE ROAD LESS TRAVELLED: LIAISON IN CONSULTATION PSYCHIATRY

Topics

Psychiatric Consultation Notes – A Tower of Babel for Non – Psychiatrists: Dr Varghese Punnoose, Professor and Head, Dept of Psychiatry -15 minutes
“Could you please take over this patient?” – Liaison Psychiatry in Acute Care settings- Dr. Sandeep Alex /Dr Sebind Kumar, Assistant Professor–20 minutes
The somatising patient with functional overlay- The symptoms in search of explanations: Dr. Varun Rajan, Senior Resident -20 minutes

“Dignity, Understanding, Communication- Together We Work(DUCT)”-A Model of CLP in General Hospital Settings: Dr Varghese Punnoose-15 minutes

C-L Psychiatry has contributed immensely to the main streaming of Psychiatry and brought it closer to its sister specialties in modern medicine. In India, Psychiatry residency training is predominantly done in General Hospital setting, which probably explain why the current generation of residents are unaware of the historical moorings and birth pangs of this subspecialty.

This symposium aims to share our experience at the Department of Psychiatry, Govt TD Medical College, Alappuzha a tertiary care teaching hospital in an urban setting in Kerala. We will delve into patient profile, psychiatric diagnosis, comorbidities, general medical condition, expectations of patients and referring department, especially the bidirectional communication and continuation of liaison after the initial consultation.

The C-L services sought by the department of Neurology, General Medicine, Pediatrics and Nephrology will be analyzed and presented with suggestions for improvement in C-L service delivery, rooted in the newer developments in the field of Psychosomatic Medicine.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 91. Ketamine use in treatment resistant depression

Pratap Sharan ¹, Koushik Sinha Deb ², Gagan Hans ²

Presentations:

Ethical considerations and development of policy framework: Pratap Sharan

Ketamine promise, mechanisms of action and clinical effects: Koushik Sinha Deb

Evidence base of Ketamine use in treatment resistant depression: Gagan Hans

It is widely accepted that at least 30% of all depressed patients do not respond adequately to several antidepressant drugs. Treatment-resistant depression or treatment-refractory depression is very challenging to be diagnosed in routine clinical practice. It may also have a broad definition: it can usually be presented as a failure to respond to one antidepressant or two trials with antidepressants from different pharmacological classes in adequate courses, to two antidepressants in combination, or to electroconvulsive therapy (ECT) or can also be presented when there is intolerance to treatment or there is a relapse after initial response to treatment. Ketamine infusion is known to be effective treatment in treatment resistant depressed patients in sub-anesthetic dose as shown by multiple studies. Ketamine seems to have a high potential in the treatment of refractory depression. Repeated ketamine infusion can be one of new alternative treatment to electroconvulsive therapy for treatment resistant depression and patient with suicidal ideation.

Ethical considerations and development of policy framework of Ketamine use

Reports of ketamine’s unique antidepressant effects, combined with frequent media coverage promulgating the potential benefits of ketamine treatment, have generated substantial interest and optimism among patients, families, patient advocacy groups, and clinicians alike. This interest has led to a rapidly escalating demand for clinical access to ketamine treatment and an increasing number of clinicians willing to provide it. The impressive antidepressant effects of ketamine have spurred a great deal of research interest, with growing clinical use of ketamine for the treatment of depression. At present, clinical use is off label; no pharmaceutical company yet has a marketing authorisation. Additionally, there is considerable recreational use of ketamine in some countries which has led to repeated calls for tighter regulatory controls on ketamine. The key information that is needed to enhance the ethical use of ketamine for a selective disorders is structured, long-term, naturalistic data on the safety of repeated dosing, including incidence of misuse.

Ketamine promise: mechanism of action and clinical effects

While most investigations have revealed that mono-aminergic system dysregulation contributes to depression the recent studies have shown an involvement of the glutamatergic system. Consequently, it has been suggested that by directly targeting the NMDA receptor, it might be possible to modulate glutamate and GABA systems, thus creating a target for novel antidepressants. The exact mechanisms through which NMDA receptor antagonists exert their rapid antidepressant effects are not clear, however there is some speculation that directly targeting the NMDA receptors might eliminate long neurotrophic signaling cascades, which could be the reason for the delayed effects of traditional antidepressants. Ketamine, a potent selective N-methyl-d-aspartate (NMDA) receptor antagonist has emerged as a promising agent in the treatment of patients with depression. The blockade of N-methyl-D-aspartate receptors (NMDA) by ketamine may contribute to anti-depressive effects by different mechanisms. Briefly, ketamine might rapidly increase synaptic glutamate release, which may contribute to rapidly increase synaptic connections in the prefrontal cortex. Furthermore, by blocking extra-synaptic NMDA receptors, ketamine could enable the regrowth of dendritic spines by relieving inhibition of BDNF synthesis.

Evidence base of Ketamine use in treatment resistant depression

The results of various studies which have tried to evaluate the results of Ketamine in treatment resistant depression have been promising although there have been some limitations of these studies like small sample size and variable doses of ketamine used. Zarate et al in 2006 found 71% response rate and 29% remission rate in 18 patients, treated with 2 doses of ketamine (0.5mg/kg). An another study conducted by Paulo R. Shiroma et al in 2014 found response rate and remission rate slightly higher at 92% and 67% respectively. Segmiller et al in 2013 found 50% response rate and 33.3% remission rate in a sample of six patients. Similar finding were obtained by Rasmussen et al. in 2013 and Murrough et al. in 2013 who had shown a response rate of 80% and 70.8 % respectively. The results although are promising but need to be interpreted cautiously as these are just preliminary findings and a lot of work needs to be undertaken before establishing ketamine as standard treatment for resistant depression.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 92. Assessment and Management of Aggression in Inpatient Psychiatric Settings: Learnings from the GMCH Experience

Nitasha Sharma ¹, Virtu Chngtham ², Nitin Gupta ³, BS Chavan ⁴

In general, events of violence & aggression are common and one of the most challenging phenomena encountered in acute inpatient settings. With estimated rates between 8% -44%, aggression and violence has various negative trajectories; being associated with injuries, fear, low staff morale, loss of staff working days, and negative therapeutic climate coloured by distrust, anger and power struggles. Hence, an evidence-based framework is essential for the same. In this context, the Department of Psychiatry, GMCH-32, Chandigarh has been carrying out work for the last 5 years now.

Aim: The aim of the symposium is to discuss the theoretical framework and the pragmatic aspects along with guideline development for managing risk arising out of inpatient violence.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 93. Attempted Suicides and Suicide Prevention: Indian Perspective

VK Radhakrishnan ¹, Hemendra Singh ², Sathesh Vadasseril ³, Mona Nongmeikapam ⁴

The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr Radhakrishnan will be talking about hidden epidemiology of suicide in India. More than one lakh persons (1,33,623) in the country lost their lives by committing suicide during the year 2016. Hence there is an urgent need in suicide prevention strategies. Prevention strategies can be looked at an individual,community and universal levels. India is still deficient in having an effective relevant and appropriate national suicide prevention plan. Dr. Hemendra Singh will discuss about the clinical correlates of suicide attempt in psychiatric patients. It throws light on factors associated with high suicide risk in psychiatric patients and the early detection of these factors can prevent suicide. Dr. Sathesh Vadasseril discusses the gender – based comparison of psycho-socio- demographic and clinical profile of 1300 suicide attempters. The study helps in the selection of appropriate suicide preventive strategies. As history of suicide attempt is a risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide and also to rehabilitate them psychosocially. And lastly, Dr. Mona Nongmeikapam will present the huge lacunae in the parental awareness and discuss the need for a change of parental attitudes, highlighting the findings of a study conducted on adolescent self-harm attempters and their families. Early identification of such behaviour or impulses is imperative for the prevention of this leading, largely preventable cause of mortality in this age group.

Key Words: Suicide attempts, Psychiatric patients, Suicide Prevention

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 94. Missing incidents in Dementia : Antecedents and Neuroanatomical underpinnings

Shankar Kumar ¹, Yamini Devendran ²

Background: Behavioral symptoms of dementia in the form of getting lost behaviour (GLB) present the greatest challenge for informal caregivers. A missing incident in a person with dementia (PWD) is defined as an instance in which the PWD’s whereabouts are unknown to the caregiver and the individual is not in an expected location. These incidents are dissimilar to the previously accepted definition of “wandering” in dementia. GLB in the elderly is believed to involve poor top-down modulation of visuospatial processing, by impaired executive functions. Spatial Navigation is distinctly impaired across different dementias.

Methods: A retrospective design was used to trace cases of missing elderly (>65 years) persons from newspaper reports and police records of the past 1 year in Bangalore urban. Contextual and situational antecedents and outcomes were elicited in all cases. In those who were eventually found, neurocognitive antecedents were assessed by history and using neuropsychological testing at the hospital.

Results: The primary contextual antecedent to a missing incident was becoming lost while conducting a normal and permitted activity alone. The most frequent situational antecedent limited supervision and a lapse with the expectation that the PWD would remain in a safe location. The key characteristics of a missing incident were: unpredictable, non-repetitive, temporally appropriate but spatially-disordered, and while using multiple means of movement (walking, car, public transportation). In terms of Spatial Navigation, DLB patients were the worst navigators on ego and mixed ego-allocentric task, while FTLD are least impaired. Place learning (for way finding) and response learning (for route learning) strategies in preclinical and early-stage symptomatic AD were deficient.

Conclusion: There is a conceptual difference between wandering and missing. The anatomical substrates of GLB may be disease specific. The therapeutic practices must focus to target both working memory and visuospatial deficits.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 95. LATE LIFE DEPRESSION: CURRENT CONCEPTS AND CHANGING PARADIGMS

Somsubhro Chattopadhyay ¹, Rajarashi Guha Thakurta ², Sharmila Sarkar ³

LATE LIFE DEPRESSION: CURRENT CONCEPTS AND CHALLENGES

INTRODUCTION, OVERVIEW AND BURDEN OF LATE LIFE DEPRESSION

:- Change in the demographic trend has increased the geriatric population in significant numbers in our country and will increase more in the coming days. Changing family types, busy life schedules, economic redistribution, industrialization etc has rendered its effects on the lives of elderly people. Depression in this age group has increased in substantial amount. Chronic illnesses trigger or predispose late life depression. Despite availability of efficacious treatment options depression in late life remains significantly under diagnosed and untreated. Complexities of symptomatology’s, overlying comorbidities, lack of social support and stigma to illness have been recognized as factors for failure of treatment. The past decade has witnessed an acceleration of the understanding often neurobiology of late-life mood disorders. According to World Health Organization, depression in late life is among the top 10 diseases which increase disabilities in activities of daily life impacting health cost and nations economy.

CLINICAL CORRELATES, NEUROBIOLOGY AND ASSESSMENT: Geriatric depression typically occurs in the context of medical disorders. Geriatric depression is viewed as a heterogeneous entity. The similarity of depressive manifestations with symptoms and signs of dementing disorders, for example, loss of interest, decreased energy, agitation or psychomotor retardation, poor concentration, and apathy often poses diagnostic problems. Patients with psychotic depression have delusions, whereas hallucinations are less frequent. Older adults are at significant risk of death by suicide relative to younger adults. Older adults are at significant risk of death by suicide relative to younger adults. The inflammation hypothesis postulates that aging related immune processes promote changes in the emotional and cognitive neural networks predisposing to geriatric depression and/or triggering metabolic brain changes mediating the depressive syndrome in late life. An early hypothesis of late-life depression postulated that major depression with the onset of first episode in late life includes a large subgroup of patients in whom neurological brain abnormalities contribute to the development of the depressive syndrome

MANAGEMENT AND FUTURE DIRECTIONS:- The objectives of management of late life depression in are remission of symptoms, decrease the risk of relapse, limitation of disabilities, improvement of functional status and coping skills. Psychotherapy and pharmacotherapy are effective in management. Identifying the risk factors, treating comorbidities, minimizing the side effects of medication, involving the family members in treatment, psycho education to the family are important in successful treatment. Appropriate rehabilitative measures improve long term outcomes. Current recommendation is combination of both psychotherapy and pharmacotherapy. CBT, Problem solving therapy, problem adaptation therapy, Interpersonal therapy, problem solving therapy are of use. Elderly clients benefit from pharmacological agents as do young adults. SSRIs, SNRIs are first line treatment as in younger age group. Depression in this age group tends to respond slowly to treatment than younger individuals. Considering body metabolism, renal function doses should be monitored. A number of natural supplements have some evidence of efficacy in geriatric people.. Advances in neurobiological understanding will help us in more better management of depression in late life.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 96. Title: Current Status of Neuroimaging in Dementias

Jilani AQ ¹, Shrikant Srivastava ², Shantanu Bharti ³, Dhananjay B Chavan ⁴

Dementias are common neuropsychiatric disorders among elderly. In view of rapidly increasing proportion of elderly population worldwide, especially in developing nations, it is expected that the rise in the prevalence of dementia will be exponential taking a form of epidemic.

Since, dementias have progressive and irreversible course, earlier diagnosis is essential for the initiation of appropriate treatment.

The standard diagnostic guidelines including ICD-10 and DSM-V emphasize the presence of minimal set of clinical signs/symptoms for making the diagnosis. But National Institute of Ageing – Alzheimer’s Association (NIA-AA) in 2018 have proposed that, at least for research work, the diagnosis of dementia should be made based on biomarkers and or post-mortem findings, and should be equally valid for cohort studies and interventional clinical trials (Jack et al 2018). It is well known that the neuropathological changes, which are responsible for clinical manifestations, appear even a decade before onset of clinically detectable disease and this could be detected by various Neuroimaging procedures for early intervention.

In this regard, we will discuss early detection of dementias under following headings.

A: Introduction: Epidemiology, staging and clinical manifestation of various types of dementia: Dr. Shrikant Srivastava, MD, MSc, FRCPsych

B: Neuropathological basis of Neuroimaging: Dr. Jilani AQ, MD, DNB, DM

C: Neuroimaging techniques and specific finding in various dementias: Dr. Shantanu Bharti, MD

D: Special emphases on PET scan in neurodegenerative dementias: Dr. Dhananjay B. Chavan, MD

……………………………………………………………………………………….

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 97. Human rights, legal provision and challenges in research, admission, treatment, rehabilitation of a person with homeless mentally ill in India.

Guru S Gowda ^1,^✉, Vinay Basavaraju ², Barikar C Malathesh ³, Gaurav Singh ⁴, Guru S Gowda ¹, Vinay Basavaraju ¹, Barikar C Malathesh ¹, Gaurav Singh ²

The Homeless Mentally Ill (HMI) represents a unique problem in developing countries like India in the context of legal issues, human rights, humanitarian considerations, and admission, treatment and rehabilitation issues. In India, service and provisions remain limited and most of the HMI person does not have satisfactory access to mental health facilities. The HMI patients have received small attention from Non-Government Organizations (NGOs) in India in the last one decade. Moreover, services provided by NGOs may be difficult to sustain over time and on larger scales. To address the problem of homeless mental illness, National Mental Health Policy – 2014 of India is kept as one of the objectives as increase access to mental health services for vulnerable groups like homeless persons. The New Mental Health Care Act of India, 2017 has provisions for the high supported admission, treatment, and rehabilitation of homeless mentally ill patients and also involves police and legal services to provide service. Effective provisions and separate national policy are required to care for the HMI patients whose plight is borne out of a combination of health, socioeconomic and human right issues. Recent research from a different part of India on the homeless mentally ill person, thrown lights on the sociodemographic profile, clinical outcome, practical challenges of HMI person and No clear estimate about the prevalence of HMI in India, as per 2016, National Mental Health Survey of India. However, there is a need for a precise definition of homeless mentally ill person and identification of the target population; it will help in a proper understanding of its size and association with psychiatric disorders, as well as factors such as homeless people’s access to care, adherence to treatment, and follow-up. This help in national planning, innovations in the mental health service system for HMI.

Key Words –

Homeless Mentally Ill;

Human Rights;

Legal Rights;

Mental Health Care Act of 2017; India.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 98. The Rights and Laws related to persons with Mental Illness : International & Indian Scenario

Susanta Kumar Padhy ¹, Subodh BN ², Swapnajeet Sahoo ³

This symposium is intended to highlight the issues related to human rights and laws pertaining to Mental illness. It will be discussed under the following subtopics:

Persons with mental illness have been subjected to severe basic human rights violation since time immemorial. However, with the advent of human rights activists and stigma discrimination campaigns across the World, most of the countries have framed several laws to safeguard the rights of persons with mental illness. In India, the recent Mental Health Care Act, 2017 has revolutionized with the description of new rights for persons with mental illness. Persons with addictive disorders also fall under the purview of mental illness. But there are laws to punish the persons with addictive disorders with a view to curb the problem of drug menace all over the World. The Government of India has also framed few laws so as to fight with drug addiction. However, many a times, persons with addictive disorders are debarred from exercising basic human rights and privacy benefits. Hence, recently new laws have been framed so as to safeguard the basic interests of persons with addictive disorders too. Most of the mental health professionals are unaware of the common issues related to privacy, rights and laws related to persons with mental illness (including addictive disorders).

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 99. CUCKOOS OF BOLLYWOOD – IMPLICATIONS FOR SOCIETY

Sub-topics for discussion

Analysis of films between 1936 – 1970
Analysis of films between 1971 – 2017
Summary and future vision

Faculties

Dr Tophan Pati
Dr Pranab Mahapatra
Dr Sanghamitra Pati

Cinemas in India and the Indian society have been inextricably linked. Movies reflected different social issues across time and leave a strong impression on the mind of viewers. This in turn influences subsequent action by individuals as well as the society as a whole. Hindi Cinema, popularly known as Bollywood has the highest reach and coverage among the Indian population.

Since inception, medical issues have remained one of the favourite themes of Bollywood films. Mental illness and mental health care is one of such issues. The way in which mental illnesses, reel psychiatrists and mental health care settings are presented and portrayed on screen, have modulated people’s attitudes and perceptions towards the illness.

Mainstream cinema, released between 1935 and 2018, with mental illness as a plot-driving theme or an affected character as collated from Desk Review, Bollywood related books, internet sources etc reveal portrayal of diverse presentation of mental morbidity as perceived by the film maker.

The art of cinematic storytelling has changed, backed up by technological advances, thus transforming a grainy black and white film adding sound, colour and special-effects, to create a vivid lifelike experience. Simultaneously, the connotation of mental illness, treatment and rehabilitation modalities and the social attitude have undergone a great advancement.

Although there are movies which present the mental health concerns with a positive social message, yet, there are a plenty of movies which do not serve the purpose. Across the decades, movies show the embeddedness of the problem within contemporaneous socio-cultural milieu and an evolving psychiatric care.

The symposium intends to deliberate on and discuss these issues. It is hoped that changing society and progressively better mental healthcare should influence and guide depiction of afflictions of the mind in movies.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 100. ARE WE PATHOLOGIZING COMMON BEHAVIOURS: A DEBATE ON BEHAVIOURAL ADDICTION

Umesh S ¹, Samir K Praharaj ², Ravindra Munoli ³

Following the changes to the diagnostic category for addictive disorders in Diagnostic and Statistical Manual- 5^th Version (DSM-5), an expanding body of research has increasingly classified engagement in a wide range of common behaviors and leisure activities as possible behavioral addiction. Some disorders although have serious consequences, for example gambling disorder and gaming disorder, others in the list seems no more than a sheer ‘behavioural excess’. There is now a growing body of evidence that views a number of behaviours as potentially addictive, including excessive internet use, sex, exercise, using smartphones, taking photographs of self and so on. Are we pathologizing common behaviours or is there something that may require an attention. The symposium shall be designed in a way that will have an essence of a debate. It will include an overview of behavioural addiction. Then the speakers will be focusing on expressions of behavioural addiction i.e. impact on subjective distress, nature and severity of harms, functional impairment and whether all disorders classified under the rubric of behavioural addictions satisfy them. Next, there will be a discussion on the boundary between healthy engagement and disorder, taking into account normative aspects of a given behavior. There will also be a debate on whether we are right in pathologizing and treating such behaviours, if required, how and with what?

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 101. Title: Yoga and Mental Health: Indian Perspective

SK Tandon ¹, Manish Borasi ², Manish Meel ³, Rajesh Rathi ⁴

Yoga is derived from the Sanskrit verb Yuj meaning integration or unity, It indicates an integration between the individual self and the transcendental self. Bhagavad Gita and the Svetashvatara & Maitri Upanishads provide earliest references regarding existence of the role of yoga in maintaining positive mental health.

Although yoga in modern society has been often thought of as a form of physical exercise, traditionally, yoga practice has been a multidimensional discipline involving different postures and physical exercises, breath regulation techniques and the control of attention and enhancement of mindful awareness through the practice of meditation. These practices are often accompanied by a distinct psychological and physiological changes in the practice of a “yoga life-style.” Historically, the practice of yoga was a spiritual discipline whose goal was spiritual advancement and these component practices were intended to create an ideal state of psycho-physiological health and optimal functioning of body and mind in support of contemplative states of consciousness. However, in modern society, these yoga practices have often been used in a more limited application in order to maintain physical fitness and psychological well-being and also as a therapeutic intervention for psychological and medical disorders, or so called “yoga therapy,” both of which have become highly popular in the general public internationally. Documented evidence for the systematic use of yoga as therapy appears in the early 20^th century in India, and the popularity of yoga therapy has grown steadily both in India and internationally. Yoga practices have a place in the healthcare system as a treatment for a variety of psychiatric conditions, at least as an adjunctive if not as a primary therapy.

Introduction of Yoga: Dr.S.K. Tandon
Physiological and Psychological correlates of Yoga: Dr. Manish Borasi
Implications of Yoga therapies in different psychiatric disorders: Dr. Manish Meel
Recent Research- Indian Context : Dr. Rajesh Rathi

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 102. Artificial intelligence in behavioral prediction: Opportunity and challenges.

Dheerendra Mishra ¹, Naresh Solanki ², Vijay Niranjan ^3*

Objective

The goal of this workshop is to understand andto know about this new technology “artificial intelligence (AI)” and its clinical implication in behavioral sciences in current scenario or in upcoming future. AI works based on previous stored data and can better predict future responses. This technique is helpful in predicting the deviance in neuroanatomical maturity which is associated with future psychosis, suicide predictions and many more future behavioral, developmental and response of pharmacological or non-pharmacological can be predicted in a better way. This technology has promising role in better understanding of pathophysiology and treatment outcome of psychiatric illness.

Brief Description:

AI is a domain of computer science which focuses on the creation of intelligent machines working and reacting like human beings. The algorithms of AI can learn from data. The core concept of artificial intelligence include programming computers for certain traits such as: knowledge, reasoning, problem solving, perception, learning, planning, ability to manipulate and move objects. For AI programming, languages like Python, R.T.,LISP,PROLOG, JAVA etc.are used to create neuronal network. There are numerous applications of artificial intelligence in behavior science apart from consumer and business spaces.

Keywords: Artificial intelligence, Neuronal network, Deep learning, Deep mind.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 103. Title: Epilepsy and it’s management in relation to Psychiatry: An update

Ranjan Das ¹, Sumit Mukherjee ², Sk Ashik Uzzaman ³

A) Introduction and clinical presentations.

B) Association of different psychiatric illness with epilepsy

C) Management & future directions

Relationship between epilepsy and psychiatry have been attracting attention in medical literature continuously. Epilepsy is a chronic disorder characterized by recurrent seizures, or a seizure of a paroxysmal brain dysfunction due to excessive neuronal discharge. Association between psychological symptoms and epilepsy can be related to several factors such as the possibility of shared etiology, stigma and psychosocial factors related to epilepsy, and the adverse psychiatric reactions of antiepileptic drugs. Some psychotropic medications are epileptogenic; and this should also be remembered when prescribing a psychotropic medication. Psychiatric disorders in epilepsy can be classified, based on their relationship to seizures, like: pre-ictal symptoms, inter-ictal psychiatric disorders occurring between seizures; ictal psychiatric symptoms occurring during the seizure events; and post-ictal psychiatric symptoms following seizures. Sometime, an altered mental state can be the only sign of non-convulsive status epilepticus such as that of complex partial or absence types of seizures. Psychiatric conditions that are commonly associated with epilepsy are depressive disorder, anxiety disorder, attention-deficit hyperactivity disorder and psychoses. Data from the California Health Interview Survey conducted in 2005, including data from adult participants with history of epilepsy, showed that 27% had psychological distress associated with epilepsy, and 84% of them needed mental health care, and 57% have been seen by a mental health professional. Behavioral aspects of epilepsy were well-studied in temporal lobe and mesial temporal lobe epilepsy compared with other types of epilepsy. It may be due to that temporal lobe epilepsy represents the majority of cases with focal epilepsy, has well-defined underlying pathology (hippocampal sclerosis), has early onset of symptoms, and has prominent neuropsychiatric manifestations and memory impairment. This symposium focuses on the various psychiatric presentations commonly associated with epilepsy and psychiatric symptoms that emerge as side effects of antiepileptic medications, like possible risk of depression and suicide etc.

Key words: Epilepsy, Psychosis, Mood disorders, Psychotropic, Antiepileptic

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 104. Psychotropic induced Hematological Disorders

Sujit Sarkhel ¹, Subir Bhattacharjee ², Nikhiles Mandal ³

Hematological disorders are rare but extremely serious, adverse effects of psychotropic drugs. Almost all classes of psychiatric drugs (typical and atypical antipsychotics, antidepressants, mood stabilizers, benzodiazepines) have been reported to cause hematological toxicity. It includes: aplastic anaemia, haemolytic anaemia, leukopenia, agranulocytosis, leukocytosis, eosinophilia, thrombocytosis, thrombocytopenia, disordered platelet function and impaired coagulation.¹ Possible mechanisms behind those blood dyscrasias are decreased blood cell production due to bone marrow toxicity, immune complex formation, hapten formation, autoantibody production and in those with glucose-6-phosphate dehydrogenase (G6PD) deficiency, oxidative red cell damage.² Psychiatrists are often unaware of the potential hematologic complications of the psychotropics they prescribe. Knowledge and early recognition is crucial in dealing with effects of these serious and sometimes fatal adverse effects.

Topic 1: Psychotropic and disorder of leukocytes

Agranulocytosis is characterized by profound reductions in granulocytes and a neutrophil count of less than 5x 10⁹ per liter. Drug-induced agranulocytosis can be caused by direct marrow toxicity or due to immune reaction. Atypical antipsychotic clozapine is well known to cause agranulocytosis, carrying an incidence rate of 2-3 per cent of neutropenia ³ and continuous treatment needs strict and scheduled blood monitoring of leukocyte count. ⁴ Chlorpromazine is also reported for a delayed-onset agranulocytosis, with severe cases occurring in 0.1 per cent of patients taking standard doses.³ Mood stabilizer valproate and carbamazepine were also associated with ‘severe neutropenias’.

Topic 2: Psychotropic and disorder of red blood cell and thrombocyte

Aplastic anemia is a rare failure of haemopoietic stem-cell and characterized by pancytopenia and bone marrow aplasia.⁵ Mood stabilizer valproic acid, carbamazepine and lamotrigine were reported to cause aplastic anemia, having odds ratio of 9.5 (95% CI 3.0-39.7) compared with non user. ⁵

Thrombocytopenia is indicated when there are severe reductions in platelet count to less than 150x10⁹ per liter and symptoms may vary from less severe petechiae and purpura to more severe intestinal and cerebral haemorrhage. It may be due to direct effects on the bone marrow, or through an autoimmune mechanism. Perazine, carbamazepine, clomipramine, diazepam and sodium valproate had significant report of thrombocytopenia.⁶

Topic 3: Management of drug induced hematological disorder

The primary treatment of drug induced hematological disorder include discontinuation of the offending drug and symptomatic support to the patient with the goal to improve peripheral blood counts, limit the requirement for transfusions, and minimize the risk for infections. Patients must receive transfusion support with erythrocytes and platelets, as well as appropriate antimicrobial prophylaxis or treatment during neutropenic periods. ⁷ Routine use of growth factors such as recombinant human erythropoietin and granulocyte colony-stimulating factor (G-CSF) has not been recommended except there are life threatening infections. Rechallenging a patient with a suspected agent in an attempt to confirm a diagnosis is not recommended.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 105. CYBER PORN

Sai kiran Pasupula ¹, Kota Suresh Kumar ¹

Pornography addiction is an addiction model of compulsive sexual activity with concurrent use of pornographic material, despite negative consequences to one’s physical, mental, social, or financial well-being. One school of thought which views cyber porn positively is that Sex Addicts often turn to the internet as a new and safe sexual outlet to fulfill their compulsions without the expense of costly 900-lines, porn magazines, the fear of being seen at an adult bookstore, or the fear of infections in commercial sex. But the other school of thought is that viewing Cyber Porn and porn sites may promote sexual desire which leads to sexual offences. Recently few minor children who committed sexual offence on a minor girl said that viewing porn sites made them to commit the sexual offence. Another disadvantage is youth who viewed edited cyber porn videos feels that they can’t do such prolonged sex which gives rise to doubts about their sexual capacity which ultimately causes performance anxiety. More over people’s thinking and fanaticizing capacity has reduced following repeated viewing of cyber porn.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 106. Title: Role of Transcranial Direct Current Stimulation in Substance Use Disorders

Chetan Dilip Vispute ¹, Deepika Singh ², Milind Thanki ³

Outline of the proposed symposium:

Substance Use Disorders are associated with the dysfunctionalities in the Pre Frontal Cortex (PFC), which plays a significant role in the mechanisms associated with the craving. The desire to consume drugs is enhanced due to the PFC activation on exposure to drug related cues.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique which increases or decreases cortical excitability by inducing changes in resting membrane potential. Effectiveness of tDCS has been already demonstrated in the Depression, OCD and treatment resistant hallucinations in Schizophrenia.

This usefulness of this novel modality of treatment has been tested in the Substance use disorders including alcohol, Nicotine, Cocaine etc recently. The presenting authors wish to highlight and explore the potential benefits of tDCS in reducing craving, cognitive improvement & improvement in executive functioning in substance use disorders through this symposium at ANCIPS 2019 Lucknow.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 107. Title: Movement disorders: from a psychiatrist’s perspective

Kaustav Chakraborty ¹, Ranjan Bhattacharyya ^2,^✉, Rajarshi Neogi ³

Keywords: Psychogenic movement disorder, Dystonia, tremors, ataxia, consultation liaison, interface neurology and psychiatry.

Abstract:

Movement disorders represent an interface between psychiatry and neurology. The brain circuitry involved in movement disorders are also involved in regulating mood and emotions. Co-existence both the conditions are also not uncommon where it poses a challenge to clinicians.

Psychogenic movement disorders (PMD) can mimic dystonias, dyskinesias or an epileptic attack. Patients with PMD often have preceding psychosocial stressors. The episodes are usually longer, recovery uneventful and doesn’t follow the usual deficits that found in neurological disorders. Non epileptic attacks (NEA) are most difficult to diagnose which often warrant video EEG and advanced neuroimaging techniques. The most important is to rule out Non convulsive status epilepticus in such patients. Rapport building and long term psychotherapeutic engagement is the most helpful in such patients. Pentothal abreaction has also been tried successfully.

Psychotropic drugs often produce movement disorders both in short and long term. First generation antipsychotics (FGAs), both oral and depot preparations, produce parkinsonian like symptoms (tremor, cog wheel rigidity etc), acute dystonia in the short term and the tardive dyskinesia (TD) in the long term. Mood stabilizers like sodium valproate, lithium and oxcarbazepine can produce tremor and gait ataxia. SSRIs and SNRIs are also known to produce appendicular tremors. Benzodiazepines (BZDs) may produce gait ataxias, tremors etc. Psychoactive substance withdrawal states can also be associated with movement disorders like delirium tremens (DT). The appendicular tremors may be a part of psychiatric disorders per se e.g major depressive disorders (MDD), anxiety disorders etc.

Moreover a modern day psychiatrists have to face the challenges of treating patients with neurological disorders such as Idiopathic Parkinson’s disease (IPD), Huntington’s disease (HD), Wilson’s disease, Stroke, epilepsy etc which often has psychiatric comorbidities. Therefore psychiatrists need to be well versed with the neurological pathways involved and emerging new modalities in the treatment disorders.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 108. Title: Harm Reduction for Opioid Use Disorder:

Alok Agrawal ¹, Roshan Bhad ², Amit Singh ³, Ravindra Rao ⁴

Abstract: Opioid use disorder is a major public health issue with adverse consequences to lives of the affected individuals, their families and the society as a whole. Injecting drug use further add to the complications in the form of risk of HIV and other blood-borne infections as well as overdose deaths. To tackle the problem a harm reduction approach that aims primarily to reduce the adverse health, social and economic consequences of the drug use without necessarily reducing its consumption has successfully been employed. Various interventions including needle and syringe programmes (NSP), opioid substitution therapy (OST), naloxone distribution and patient outreach and education services are form of harm reduction services with shown effectiveness in reducing the spread of infections, decreasing social and legal complications and preventing overdose deaths. Despite being pragmatic and evidence-based, global implementation of the harm reduction services including OST and NSP has been highly variable; being governed by the differing policies of individual countries. Various national and international organizations including WHO, UNAIDS, UNODC are working towards developing a consensus for better utilization of these evidence-based interventions. The need to uniformly expand and scale-up the harm reduction services cannot be overemphasized. Moreover, the barriers that exist to its implementation at regional level and globally need to be understood. This symposium will try to advance the understanding on the harm reduction approach in relation to opioid use disorder. Keywords: Harm reduction, Opioid substitution therapy, Needle and syringe programme Conflict of interest –None

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 109. Conquering the ‘double trouble’ - revolution in the management of hepatitis C with co-morbid substance use disorders

Abhishek Ghosh, Madhumita Premkumar, Aniruddha Basu

Although the global prevalence of hepatitis C (HCV) ranges from 0.5% to 2.3%, among individuals with injection drug use the prevalence of HCV is between 40%-80%. The lifetime prevalence of substance use disorders in individuals with HCV is nearly 50%-80%. We wish to call psychiatrists’ attention to the unique co-occurrence of HCV and substance use disorders (SUD).

Speaker 1 (Abhishek Ghosh): Epidemiology of HCV and its link with substance use

An estimated 71 million people have chronic hepatitis, globally. A substantial minority of those develop cirrhosis of the liver. Nearly 0.4 million people die each year. Despite this considerable burden, merely 20% of patients were aware of their diagnosis, and 7% would receive treatment. People with substance use disorders have poorer rates of treatment seeking and completion. Moreover, alcohol use worsens the prognosis of chronic hepatitis. Unknown and untreated HCV in patients with SUD is a public health threat.

Speaker 2 (Madhumita Premkumar): Screening and treatment of HCV in patients with SUD

WHO recommends offering universal screening for HCV in patients with SUDs. With the advent of the directly acting antivirals (DAA) the cure rate of HCV is nearly 95%. Introduction of the generic versions has reduced their cost. Nevertheless, there is a controversy regarding the use of DAAs in patients who are actively using drugs or alcohol.

Speaker 3 (Aniruddha Basu): Treatment of substance use in patients with hepatitis C

All patients with HCV must be screened for the presence of substance use disorders. Brief intervention has been found to be effective for heavy alcohol use with co-morbid HCV. Opioid substitution therapy (OST) reduces the acquisition and transmission of HCV. It improves the rates of sustained virologic response too. Research support for other harm reduction strategies like the needle-syringe exchange is equivocal.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 110. PERINATAL PSYCHIATRY-PREGNANCY, POST-PARTUM AND BEYOND

Priya Nayak K ¹, Supriya Hegde Aroor ², Preethi ³

Introduction:

Perinatal mental illness is a significant complication of pregnancy and postpartum period. These include depression, anxiety disorders and postpartum psychosis and bipolar illness. Approximately 10-20% of women suffer these illnesses during pregnancy and first year postpartum.

The theme of this year is ‘Mental Health- Nation’s Wealth’. Statistically speaking, women represent half of this nation. It becomes very important to cater to the mental health of women who contribute in the true sense to our nation’s wealth by not only being a part of the work force but also by nurturing the other half. Pregnancy and postpartum are very challenging periods in a woman’s life. They are psychologically taxing as well. Psychiatric illnesses can impair both functioning and quality of life. It is important to understand and treat psychiatric illnesses during this period to salvage this important work force. By helping them we are not only safeguarding their health but also protecting the new life they nurture and the family they serve. In fact, the wellness during perinatal period may determine the psychological wellness and wealth of the entire family and in the broader sense, the entire nation.

Objectives:

To provide those attending the concept of perinatal psychiatry and its evolution into an entity of importance.
The epidemiology will be reviewed.
Recent classification and diagnostic criteria will be discussed.
Treatment guidelines will be elucidated with special emphasis on teratogenicity and safety during breast feeding.

Preventive strategies, importance of antenatal screening and risk in future pregnancy will be presented. Course and prognosis will be explained.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 111. Title: Perinatal psychiatry: Emerging psychiatric subspecialty

Ashok Kumar ¹, Hitesh Khurana ², Rajendra Acharya ¹

Perinatal mental health received increased attention over the last few decades as studies from the developed world demonstrated significant maternal morbidity and mortality due to mental health problems. Perinatal mental health also affects birth outcomes and offspring development in significant manner. The purpose of this symposium is to present the importance of perinatal psychiatry so it gets better attention and can be recognized as important subspecialty of psychiatry.

The subsections of symposium are as follows

1. Post Partum Psychosis (PP)- Postpartum psychosis is psychiatric emergency, which often strikes during first four weeks of childbirth. The etiological determinants include hormonal, genetic and immunological factors. Environmental factors such as sleep deprivation, obstetric complications and stress increase the risk for PP. Personal history and family history of PP is the most important predictor of PP. The PP often presents with odd affect, withdrawal from surroundings, confusion, agitated, and distraction by auditory hallucinations, mood lability and increased activity. The most worrisome consequences include suicide and homicide. The prognosis is better than psychosis occurring at other time, as 80% of PP remains symptoms free after a single episode.

Postpartum depression (PD)- Postpartum depression is most common psychiatric disorder experienced by women after childbirth. PD episodes are often characterized by violent intrusive thoughts, sadness, ideas to harm self or baby, overwhelming anxiety, feeling of burden, somatic complaints and psychotic symptoms. Women with interpersonal difficulties, past history of depression, childhood sexual abuse and trauma face increased risk for PD.

Treatment of PD and PP- The center for disease control (CDC) draws attention to the fact that “treating for two” approach is more important while treating perianal psychiatric disorders. Moderate to severe perinatal psychiatric disorder require comprehensive approach with use of medications and psychotherapy.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 112. Comorbidities in obsessive-compulsive disorder – A Clinician’s Perspective

YC Janardhan Reddy ¹, Shyam Sundar Arumugham ², Eesha Sharma ³, Jaisoorya TS ³

Obsessive-compulsive disorder (OCD) is a common and disabling neuropsychiatric condition afflicting 2% of the general population. As in other psychiatric disorders, comorbidity is often the rule. Studying comorbid conditions has enhanced the understanding of pathophysiology of the condition and thrown challenges in management. In this symposium, we discuss current understandings regarding common comorbidities in patients with OCD from a clinician’s perspective. All the faculty presenting the symposium are attached to the specialty OCD Clinic, NIMHANS which has recently commemorated two decades since inception. Professor Y. C. Janardhan Reddy, Head OCD Clinic, NIMHANS will chair and control the proceedings. Dr. Shyam Sundar Arumugham will discuss comorbid schizophrenia and bipolar disorder in patients with OCD. The prevalence of these conditions is higher in OCD patients as compared to the general population. The presence of these comorbidities is associated with marked dysfunction and has important treatment implications. Childhood-onset OCD has been recognized to have distinctive features such as increased prevalence of symmetry/ordering symptoms, comorbid neurodevelopmental disorders such as tic disorders and attention deficit hyperactivity disorder, etc. Studying these comorbidities has helped improve the understanding of phenomenology (e.g. sensory phenomena) as well as management (e.g. antipsychotic augmentation) of OCD. Dr. Eesha Sharma will address the challenges in managing these complex comorbidities in childhood OCD. The recent reclassification of OC Spectrum disorders in DSM-5 is likely to increase awareness and presentation to clinical practice. Dr. Jaisoorya TS will outline the principles of evidence-based management of common spectrum disorders including body dysmorphic disorder, trichotillomania and hoarding disorder.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 113. Treatment resistance schizophrenia: A recent update

Aseem Mehra ¹, Subodh BN ^2,^✉, Sandeep Grover ³

About one-third of patients with schizophrenia do not respond to sequential antipsychotic trials and qualify for treatment resistant schizophrenia (TRS). This symposium aims to discuss the conceptual issues related to defining TRS and management of TRS.

Concept of TRS: TRS is defined as failure to respond to 2 adequate antipsychotic trials, i.e., antipsychotics given in adequate doses and for adequate duration.

Management of TRS: Clozapine is considered to a drug of choice for management of schizophrenia. However, clinicians are often reluctant to use clozapine because of need of monitoring and its side effect profile. About one-third of patients with TRS also do not respond to clozapine. However, studies have also evaluated alternative strategies in the management of TRS

Post-clozapine strategies: About one-third of patients with TRS do not respond to clozapine. In such a scenario, augmentation with second antipsychotics, antidepressant, mood stabilizer, other novel agents and electroconvulsive therapy has been used. Among these ECT has been shown to be most effective.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 114. ARTIFICIAL INTELLIGENCE IN MENTAL HEALTH SERVICES: PRESENT AND FUTURE

Krishna Patel ¹, Vijay Nagecha, Manan Desai

AIM OF THE SYMPOSIUM:

Introducing and sensitizing the mental health professionals towards the use of artificial intelligence in the field of Psychiatry

CORE CONTENT:

Artificial Intelligence (AI) has started penetrating almost to the core of our very existence. It is used to build machines that are capable of performing tasks that require human intelligence (reasoning, learning, planning, problem-solving and perception). It’s time to carry forward AI from our routine life to our mental health clinical practice. Each clinical branch except psychiatry deals more with gross bodily changes and signs rather than abstract symptoms for assessment, diagnosis and complete management. Owing to this, application of AI is much easily utilized by our parallel clinicians much earlier. But progressive sophistications of the available softwares, we are ready to use them in the subtle branch of psychiatry.

We would try to cover specifications of various mobile apps to specific softwares being used in a psychiatry clinic and its clinical implications.

Uses of AI:

1)
Consultation
2)
Pinpointing clinical symptoms
3)
Recording signs
4)
Gathering reports of various investigations
5)
Inference of a particular diagnosis
6)
Making clinical decisions
7)
Making clinical plan of work
8)
Implementing various modes of treatment
9)
Providing education to the clients
10)
Robot assisted task completion
11)
Conducting psychotherapies
12)
Data gathering and research

CONCLUSION:

This symposium will be of use to mental health practitioners interested in learning about, or incorporating AI into their clinical practice and then using the data to carry out research to make evidence based decisions and create further more advanced strategies for management of patients suffering from mental illness. Discussion shall include practical issues that are encountered during clinical practice, ethical issues and limitation of use.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 115. THE NEUROSCIECNCE AND PSYCHIATRIC ASPECTS OF PENEOLOGY.

(Brig) M S V K Raju ¹, Shivaji Marella ², Jwalant Chag ³, Shivam Sunil ⁴

The WHO acknowledges an association between poor mental health and the experience of poverty and deprivation. A wealth of research exists in support of the social causation. This is a complex interaction and the best evidence indicates a cyclical interaction between the experience of poverty inequality and mental illness. Schizophrenia and its relationship to urbanization along with poor economic outcomes is a prototype. Mental health should be included in the policy decision making process for all government economic and social policies. This is lent impetus by the evidence of microfinance and community health services simultaneously reducing both – poverty and mental illness. Around the world new attention is being paid to the idea of a Universal Basic income especially given the coming problem of replacement of humans in jobs by AI and automation.

There are more children living in poverty today than at any time in history. Disorders such as conduct and oppositional disorder in children are found in greater proportions in children experiencing deprivation. Persistent food insecurity causes more internalizing and externalizing problems and is a risk factor independent of the fact of poverty.

New neurobiological research has shown a lower economic status changes methylation of the serotonin transporter which in turn induces greater amygdala reactivity. This in turn mediates anxiety and depression. Poverty also causes brain surface changes in the language, executive, reading and spatial skills areas in children. This is a matter of concern for the long term. There is evidence that shows differences in the way poor children handle rewards and the ability to postpone gratification which changes with change in economic status but does not entirely disappear.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 116. Title: Mental Health at Workplace: Are we practicing enough in India?

Susanta Kumar Padhy ¹

Healthy workplace means healthy Society. Work life balance that support their wellbeing at work is a priority for many employees in in today’s changing workplace dynamics and workforce. Traditional ways of looking at the workforce may not hold for too long. World Health Organization (WHO) Report released in 2017 states that 10% of the employed population take time off work for depression; an average of 36 workdays are lost per depression episode; 50% of people with depression are untreated; Cognitive symptoms of depression, such as for instance difficulties in concentrating, making decisions and remembering, are present up to 94% of the time during an episode of depression causing significant impairment in work function and productivity.

Speaker 2, Dr Nidhi Chauhan, will talk about what does a mental health-friendly workplace look like?. The Characteristics of a “good work-place” like welcoming attitude of the employer, valuing diversity, atmosphere that treats mental illnesses at par with physical illnesses, has programs and practices in situ, periodic training for managers, safeguarding confidentiality of employee health information and many others, will be discussed

Third Speaker, Dr Manoj Sahoo speaker will talk about the actions every employee, employer, policy makers should take, including “tips for colleagues, family members, boss. He will also elude how to address, assess, handle and manage such issues including administrative and legal issues at work place.

The symposium will conclude with a discussion on to what extent are we practicing in India?

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 117. Title: Sexual Education Among Children and Adolescents

Adya Shanker Srivastava ¹, Jai Singh Yadav ¹, Shobhit Jain ¹, Raghunath Prasad Verma ¹, Ajeet Kumar ¹

Sexual Education Among Children and Adolescent: Sexual education deals with human sexuality, including intimate relationships, human sexual anatomy, sexual reproduction, sexually transmitted infections, sexual activity, sexual orientation, gender identity, abstinence, contraception, and reproductive rights and responsibilities. Lack of sexual education may lead to early risky sexual behaviors, and poses several health, social, and legal problems. Developmentally appropriate sexual education is important to help children and adolescents make informed, positive, and safe choices about healthy relationships, responsible sexual activity, and their reproductive health. Further, it helps to reduce the risks of adolescent pregnancy, HIV, sexually transmitted infections, and sexual violence.

Introduction to sexual education – Prof. Adya Shanker Srivastava

Need for sexual education among children and adolescents – Dr. Jai Singh Yadav

Global Scenario – Dr. Raghunath Prasad Verma

Indian Perspective – Dr. Ajeet Kumar

Delivery of services – Dr. Shobhit Jain

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 118. Community Psychiatry Services By General Hospital Psychiatry Unit (GHPU), KIMS, HUBBALLI.

Sagar S Garag ¹, Nishmita TJ ², Sameer Belvi Mangalwedhe ³, Arunkumar C ⁴, Mahesh Desai ⁵

Background: Community mental health services are a scarcity in our country. Rural areas persistently face a shortage of mental health specialists. There is a dire need of Psychiatrists/mental health professionals inorder to address mental health issues. Outreach programmes and Tele-psychiatric services will help bridge this gap.

Objectives: To study the clinical profile of patients and assess the utilization of mental health care services provided by Department of Psychiatry, KIMS, Hubballi as part of community Psychiatric services.

Methodology: Retrospective chart review of 3 community activities for last year. Data from mental health camps every Tuesday at a PHC, monthly mental health camp at a nearby village Hebballi and 24 hours Telephone Helpline service were analysed.

Results: Total of 902 patients utilised the services. Majority of the patients attending the camps were males67.5%. Majority of the patients were diagnosed with depression(51.61%), Anxiety disorders18.01%, Epilepsy11.44%, Psychosis10.12%, substance use disorders7.47% and Childhood disorders in1.32%.

A total of 155 calls received. Majority of the callers were males(72.9%), from urban areas(78%), between 20 to 40 years of age, had contacted mental health services for themselves(68.3%) and for the first time. Calls were for issues related to work, academics and family, by persons asking for deaddiction treatment, information regarding sexual problems.

Conclusion: This improves the reach and effectiveness of mental health care in rural areas, thus reducing disease burden of the country. Many such activities should be initiated inorder to address mental health issues at grass root level.

Keywords: : Mental health, Rural areas, Psychiatric services, Helpline

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 119. Disasters And Mental Health – Lessons Learned The From Kerala Floods (Symposium)

Varghese Punnoose ¹, Sebind Kumar ², Varun Rajan ³, Varghese Punnoose ⁴

During the last two decades, studies across the world have increasingly highlighted the mental health aspects related to natural disasters. That governments are also waking up to this was exemplified in the aftermath of the recent flood situation in Kerala. As the tertiary care medical centre located in one of the worst flood affected parts of Kerala, the psychiatry department of Government TD Medical College was able to witness and be a part of the relief measures which included mental health interventions. The department also has the experience of dealing with another natural disaster: the tsunami that struck Kerala in 2004. A seamless coordination could be made between various departments in the medical college as well as government and non-governmental organisations. Problems in distributing psychiatric medications in relief camps were noted. Increase in relapses following discontinuation of medications were seen. Another problem area in related substance abuse. The symptoms of substance abuse and related disorders in the healthy male groups usually are not given the emphasis it requires due to multiple reasons including the stigma to contact medical professionals by these groups post disaster and the lack of awareness among subjects and health workers. These and other aspects related to mental health and disasters and lessons learned would be dealt in detail in the symposium

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 120. Mental Health aspects of ‘#MeToo’ movement: challenges and opportunities’

R Srinivasa Murthy ¹, Mamta Sood ², Savita Malhotra ³, Pramod Singh ⁴, Ajit Bhide ⁵

The whole world and India in particular is in the grip of the ‘#MeToo movement’ to address the issues of patriarchy, gender violence and related issues.

The headlines like the following:

“Not a single woman who does not have a #MeToo story”

“Naming and shaming these culprits on social media is the only option”“

“Men are trembling”

“The everyday hazards of being in the field”

‘#MeToo will change the narrative forever’

To a large extent the whole discourse is one of confrontation and not cooperation to address the issue of gender relations. There is a mental health aspect to the current gender relationships- both the pluses and minuses.

Gender-equation has been an issue in every age, which every culture and society has addressed in their own unique way and the life has gone on. It will be difficult to define what is ideal but every thing is apparently not right in modern times.

This issue needs to be deliberated upon on continuous basis by the society for the sake of a healthy society. Reporting of a few cases of me-too is neither the best occasion nor the best provocation. We have seen the reaction of society in the case of Nirbhaya episode. Nothing seems to have changed since, unfortunately it seems to have worsened. Similar cases have probably increased. We probably are not asking the right questions nor acting at the right level or on right targets.

#MeToo and similar cases have been happening all along and people in society have known it. Legal remedy is just one of the remedies, which may not be the best one or the most effective one. However, there should be systematic engagement of the society to prevent or protect against such and similar unfortunate situations. Sometimes, the converse may also be happening.

There is a need to deliberate upon this complex topic and develop an Indian Psychiatric Society/Indian psychiatrists, long-term plan of action.

This is the expected outcome of the Symposium to be organised by

Prof.P.K. Singh, Professor of Psychiatry, Patna and Prof. R. Srinivasa Murthy, Professor of Psychiatry(retd), Bangalore.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 121. Cancer and Emotional Health- Professional/Personal Observations

R Srinivasa Murthy ¹, Prakash Behere ², Sudhir Khandelwal ³, AK Agarwaal ⁴, Shubangi Parker ⁵, Lakshmi Vijayakumar ⁶, R Srinivasa Murthy ⁷

Cancer always disrupts the lives of those diagnosed with cancer and their families.

There is evidence of more than double the prevalence rate of emotional health problems in those diagnosed with cancer. There is strong evidence that providing emotional support not only decreases distress, improves quality of life and better survival.

Many of mental health professionals have the experience of living with cancer or being a caregiver.

What are the lessons of these experiences both for the organisation of mental health are for persons diagnosed with cancer and their caregivers as well as advance of mental health aspects cancer.

The presentations will cover the following aspects of cancer and emotional health:

Personal experiences as a caner survivor;
Experience of providing emotional health care as a caregiver for a family member;
Implications of cancer care for mental health and destigmatisation of mental health care.

EXPECTED OUTCOME:

Findings ways to make emotional health care an integral part of cancer care can have benefits to persons living with a diagnosis of cancer, their families and for the advancement of acceptance of mental health in the community.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 122. Revisiting Treatment Resistant Depression

Krishna Patel ¹, Vijay Nagecha

AIM OF THE SYMPOSIUM:

Make the mental health professionals aware about the new developments in the management of the treatment resistant depression.

CORE CONTENT:

There seems to be no single common definition being followed for treatment resistant depression encountered very commonly around the globe. It is a serious condition that needs immediate attention for depression is one of the leading causes of disability, affecting 300 million people worldwide as per WHO report 2018. 20 – 40% of these fail to respond to first line treatment of antidepressant drugs and up to 15% to multiple antidepressant drugs.

Today we practice evidence based medicine with more and more database being generated with the ongoing researches around the world. This helps us to reach to newer conclusions to face this age old problem of resistance to treatment in the most common mental disorder encountered in our clinical practice. These data are now being systematically reviewed and continuous efforts are being made to come to a common algorithm that can be followed to achieve a maximum result i.e. to lessen the ultimate number of patients suffering from treatment resistant depression.

Currently six staging methods are being employed to manage the case of treatment resistant depression:

1)
Thase and Rush Model (TRM) (Most widely accepted)
2)
Massachusetts General Hospital staging method (MGH-S)
3)
European Method of Staging
4)
Staging model based on depression subtypes on a dimension of severity (psychotic, melancholic and non-melancholic)
5)
Maudsley staging method (MSM)
6)
The Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD)

CONCLUSION:

This symposium shall open up vision to look at treatment resistant depression with totally a novel aspect and integrate all the possible perspectives to come to a final decision on case to case basis for our patients suffering from depression chronically though being treated in our day to day clinical practice

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 123. TREATMENT RESISTANT DEPRESSION

Madhukar H Trivedi

There is increasing evidence that resistance to current antidepressant treatments is very common and is also a major cause of morbidity and mortality in depression. And yet there is no consensus as to its definition, classification or clinical trial methodology. Historically, treatment resistant depression was defined as failure to respond to multiple treatments used as monotherapy as well as augmentations and combinations. However, recent emphasis on remission as the desired outcome coupled with results from large scale pragmatic clinical trials like the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) and STEP-BD suggest that treatment resistance is best defined on a continuum. Remission rates following the first treatment step are only about 30% followed by an additional remission rate of only about 25% following a second treatment step. Approximately, 25-30% of patients remain symptomatic despite multiple treatment steps. Furthermore, evidence shows that achieving sustained remission is more difficult with high rates of relapse even in those who have remission in the acute phase.

Several factors contribute to the lack of clarity and ill-suited clinical trial methodologies including high placebo response rates, lack of novel pharmacological interventions, heavy dependence on symptomatic volunteers as opposed to “real world” research participants, lack of reliable and replicable clinical and biological markers as well as insufficient emphasis on clear definition of phenotypes.

Five major lines of evidence can guide future trial methodologies: 1) careful recruitment procedures with emphasis on routine clinical populations; 2) precision of diagnoses; 3) minimize placebo response; 4) development of clinical and biomarker based clinical trials and 5) Development of novel treatment approaches like the NMDS Receptor modulators- ketamine, esketamine etc as well as magnetic stimulation.

This presentation will provide a discussion on the definition and prevalence of drug resistance in depression as well recommendations for clinical trials methodology. The presentation will also provide a discussion of practical approaches to assessing treatment resistance.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 124. Biomarkers and Treatment Selection for Depression - A Precision Medicine Approach

Madhukar H Trivedi

Currently, there are no valid clinical or biological markers to inform treatment selection for depressed patients. Recent evidence suggests that there are several potential biomarkers that may personalize selection amongst antidepressant medications with different mechanisms of action. Recent large studies have used blood-based markers, neuroimaging, and EEG to examine predictors and moderators to treatments for depression. The Combining Medications to Enhance Depression Outcomes (CO-MED) trial included adults with major depressive disorder (MDD) who provided plasma samples and were treated with either escitalopram-plus-placebo, bupropion-plus-escitalopram, or venlafaxine-pus-mirtazapine. Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial included 296 participants with MDD who were randomized to sertraline (SERT) or placebo (PBO) for 8 weeks, and provided blood, MRI, and EEG data. This presentation will review the recent biomarker results from the Combining Medications to Enhance Depression Outcomes (CO-MED) trial and the Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care (EMBARC) trial. The presentation will also provide a road map to consider for advancing precision medicine for depression.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 125. Antipsychotic drugs in the management of Depressions

A Q Jilani ^*, Anshuman Tiwari ^**, Kunwar Vaibhav ^***

Major depressive disorder is most common type of serious mental illness with high recurrence rate and morbidity. Further, the response rate to first antidepressantoccurs in about two third of patients only. Thus, the complete resolution of all the symptoms may require the use of multiple medications that have different mechanisms of action. The management strategy involves use of single antidepressants to combination of antidepressants along with augmentation and potentiation by other pharmacological agents.

Some authors also believe that concurrent treatment with antidepressants and antipsychotic. This may be due to receptor profiles for atypical antipsychotics which also involve regulation of Monoamine, Glutamate, Gamma-Aminobutyricacid (GABA), Cortisol, and Neurotrophicfactors. Hence, many of the atypical antipsychotics are recommended either as monotherapy e.g. Quetiapine,Lurasidone; and others as an adjunctive treatment therapy.

Antipsychotics are also indicated as primary therapeutic agent depending upon clinical profile and course of illness e.g. in the management of treatment resistant depression, depression with psychotic symptoms, bipolar depression, suicidal patients etc. Further, the late onset depression, where melancholic and psychotic symptoms are important phenomenology, often needs atypical antipsychotics as part of management strategy.

In this regard, the presenters will discuss the recent increment in use of antipsychotics in the management of depression under following headings:

Pharmacological profile and mechanism of action: Dr. A. Q. Jilani
Indications and clinical uses: Dr. Anshuman Tiwari
Special cases and open discussion: Dr. Kunwar Vaibhav

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 126. Challenge and approach in treating somatic versus psychological symptoms in depression in the working population in India.

Arvind Barad ^*, Sumit Upadhyaya ^†

Worldwide depression is the leading cause of year live with disability. It can affect many aspect of life including social, interpersonal and work also.

In fact, the impact of depression on job performance has been estimated to be greater than chronic conditions such as diabetes mellitus, hypertension, arthritis and back problem.

Although the disability is associated with depression make it difficult to find and keep a job, many people who have had a depressive episode are in the workforces. In 2012 majority of(71%) 25-64 year of age who had major depressive episode in the previous 12 months were employed and they were potentially dealing with interference of depressive symptoms on their ability to do their job. These depression has been associated with both absenteeism and decrease productivity(presenteeism).

Gilbert allan, 1996 has been found that there submissive behavior associated with number of interpersonal problems especially depression proneness. He has been found the retrospective analysis of depression that the phenomenon of submissive behavior, defeat, shame and entrapment has been associated with depression and this lead to depression and subsequent psychopathology in working population.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 127. ADVANCES IN INFORMATION TECHNOLOGIES AND ITS EMERGING UTILITY IN PSYCHIATRY AND NEUROSCIENCE

K Ashok Reddy ¹, C Radhakanth ², Praveen Khairkar ³

CONSTRUCT OF SYMPOSIUM

INFORMATION TECHNOLOGY HAS BECOME THE STRONGEST TOOL FOR CHANGING THE WAY WE THINK AND LIVE. TECHNOLOGICAL ADVANCES IN LAST 3 DECADES HELPED TREMENDOUSLY TO GLIMSE INTO SEEKING TRUTH, DEVELOPING SCIENTIFIC METHODS FOR REPLICABLE STUDIES AND MADE PSYCHIATRY INTO AN ACCEPTABLE & PROUD NEUROSCIENTIFIC DISCIPLINE. ARTIFICIAL & AMBIENT INTELLIGENCE, ROBOTICS, AFFECTIVE COMPUTING, HUMAN MACHINE SYMBIOSIS, BIOELECTRONICS, COMPUTER-BRAIN-INTERACTIONS AND QUANTUM COMPUTING ARE PHENOMENAL SHIFTS IN COGNITIVE MODELS OF NEUROSCIENCE. FURTHER, EMPIRICAL EVIDENCE REFLECTS THE EMERGING UTILITIES OF TECHNOLOGICAL EXPLOSION IN DIAGNOSTIC MARKERS AND TREATMENT MODALITIES IN MANY PSYCHIATRIC DISORDERS WHICH HAS THE POWER TO CHANGE TOMORROW.

THIS SYMPOSIUM IS ABOUT GENUINE PROGRESS OF SCIENTIFIC TECHNOLOGY THAT IS ALL SET TO MAKE PARADIGMAL SHIFT IN THE WAY PSYCHIATRY IS PERCEIVED AND PRACTICED GLOBALLY. THREE SPEAKERS HAVE CHOSEN THE FOLLOWING TITLES TO SUBMIT TO ANYTHING ELSE BUT TO TECHNOLOGICAL COMPLEX EXISTENCE IN THE PRESENT & FUTURE OF PSYCHIATRY TO PRODUCE RICH TAPISTRY & UNITARY PERSPECTIVE.

TITLE OF EACH SPEAKER

INFORMATION & TECHNOLOGY IN PSYCHIATRY: PAST, PRESENT AND FUTURE

BY:-DR. K. ASHOK REDDY, MD
ARTIFICIAL INTELLIGENCE Vs HUMAN INTELLIGENCE- A BIO-ELECTRO-MECHANICAL MODEL OF DEPRESSION Vs BIO-PSYCHO-SOCIAL MODEL

BY:-DR. C. RADHAKANTH, MD
EMPIRICAL EXISTENCE OF TECHNOLOGICAL ADVANCES EMERGING AS BIOMARKERS IN PSYCHIATRY & NEUROSCIENCE: THE LAST MARBLE OUT OF JAR

BY:-DR. PRAVEEN KHAIRKAR, MD

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 128. Undergraduate psychiatry education in India-Current challenges and the ways forward

Suhas Chandran ¹, Johnson Pradeep ², Priya Sreedaran ²

Background

Training undergraduates in the field of psychiatry can be considered as one of the most significant pathways to improve mental health services in our country. India has a large deficit of psychiatrists with just 0.3 for 100,000 populations, as mentioned in world mental health atlas 2014. To address this challenge, we may have to look for solutions that enable us to attract medical students to the subject of psychiatry as well as improvise on existing curricular methods to build psychiatric knowledge and skills in these students. We present a tripartite model to accomplish this.

Methods

1. Training the teachers of psychiatry- The practice of psychiatry has evolved expeditiously in the last 20-30 years and the teaching of clinical skills has had to adapt to several changes. It used to be assumed that good clinicians and good researchers would automatically be good teachers, but such hypothesis no longer hold true and doctors are increasingly being called on to train as teachers. The teaching of psychiatric skills to medical students is a skill in itself and avenues to advance these competencies will be discussed.

2. Facilitating curricular changes- Psychiatry is currently at its crossroads and there is an immediate need to implement & augment existing MCI recommended curricula for undergraduate psychiatry. At the same time it needs to be ensured that each teaching institute has the basic teaching infrastructure in psychiatry and utilizes assessment methods that are become focused, objective, and reliable. The need and methods to integrate postgraduates into undergraduate training, use of OSCE’S, Modified objective structured long examination review’s, micro seminars and flipped class room models among others will be elaborated.

3. Using entertainment and media to innovate undergraduate psychiatry- Our current generation of medical undergraduates can be regarded as ‘Digital natives’ i.e individuals who have grown up with digital entertainment and we should channelize this disposition to pique the undergraduate student’s interest in psychiatry. If the long term goal is to develop psychiatry as a compulsory subject for undergraduates, innovative and unconventional tools will have to be made use of to effectively achieve this. Some of these methods include use of gamification, movies, Role play, Film making, Storytelling, Simulation based learning, Art drama, photography, music etc.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 129. Stigma: A Major barrier to access mental health services

Ashok Kumar ¹, Asma J A Batcha ², Navratan Suthar ³

Subsections

Introduction- Dr Ashok Kumar

Stigma toward mental illness- Dr Asma J A Batcha

The way forward- Dr Navratan Suthar

Mental health problems are leading cause of morbidity across the world. According to World Health Organization (WHO) estimates about 450 Million individuals suffer with one or another psychiatric illness. 80% of these mental health sufferers fail to receive any help even after one year of illness. The major treatment gap is attributed to stigma and bias toward mental illness. Simple ignorance and lack of knowledge is most important contributor to failure to access mental health services. Lack of knowledge among policy makers and politicians contributes in form of lack of available services. Studies suggest that by simply educating the public can bring out dramatic change in accessibility and availability of mental health services.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 130. Abstract for symposium-‘Suicide among medical professionals – Are We Doing Enough To Save Our Colleagues ’

Kishor M, Dushad Ram, Suhas Chandran

The medical profession has one of the highest risks of death by suicide among all other professions. Incidence of suicide among medical professionals including students as well as doctors is showing an alarming upward trend. Literature suggests that nearly 12% of males and 19.5% of females in the medical profession suffer from depression, and it is even more common among medical students. About 15-30% of students and residents screen positive for depression. Studies also show that 1 in 16 trainees report suicidal ideation. Male physicians have a 70 per cent higher suicide rate than males in other professions; and female physicians have a 400 per cent higher rate than females in other professions.

The most common psychiatric diagnoses among physicians with completed suicides are alleged to be depression, bipolar disease and substance abuse. Long working hours, taxing medical training, violence against doctors, and stress of saving lives, are some major factors that are pushing doctors to the breaking point. More profession-specific factors are likely to provide an explanation for the elevated suicide rate, especially the knowledge and availability of the means of suicide. Certain issues may render suicide prevention in doctors even more of a challenge than in others.

Helpseeking is still a taboo among doctors. There is need for equipping medical professionals with skills of stress management and mitigate stigma associated with mental disorders so that at the time of the need, the professionals can seek help. Given the current climate of healthcare and the seemingly unending stressors in the practice of medicine, we doctors must be mindful of ourselves and our colleagues. In this symposium, we will present with a focus on epidemiology, aetiology, preventive and management strategies in suicide among doctors.

Keywords: Suicide, Mental Health Issues Among Doctors, Medical Profession

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 131. Law, Ethics and Military Psychiatry

Surg Commodore Kaushik Chatterjee ¹, Kalpana Srivastava ², Col Harpreet Singh ³, Col V S Chauhan ⁴, Lt Col Prateek Yadav ⁵

Law refers to systematic set of universally accepted rules and regulation created by an appropriate authority such as government, which may be regional, national or international. It assists in governing actions and behaviour of the members of a particular region or community for whom laws can be binding. Ethics on the other hand are the moral principles that help in deciding between right and wrong. Medical profession is strictly governed by both laws and ethics and is binding on medical professionals for discharging their duties. Armed Forces across the globe devise their own rules in order to ensure iscipline and to maintain military ethos and values. Generally they are tougher and often impinge on personal liberties and rights. Mentally sick patients occasionally experience violation of their rights owing to their lack of legal competence and in Armed Forces it can even be a matter of losing their profession. Therefore, Military psychiatry offers a unique blend of civil and military laws besides medical ethics. Military mental health providers occasionally find themselves in a bind when rights and roles of uniformed personnel get compromised on account of their mental illness. Persons with Disability Act 1995 and Mental Health Act 2017 have significantly impacted practice of military psychiatry in the recent past and many areas still need scientific deliberations. Military Psychiatry Symposium will offer a healthy discussion on the subject matter and proceedings will provide valuable inputs to the fraternity as a whole. Symposium will be in the form of 3 lectures followed by a panel discussion

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 132. Title:Passive euthanasia in India and challenges ahead for a psychiatrist

Ajay Kumar ^a,^✉, Aseem Mehra ^b, Aditya Somani ^c

Title:Passive euthanasia in India and challenges ahead for a psychiatrist

Introduction: Currently euthanasia is legally permitted in Netherlands, Luxembourg, Switzerland, Belgium and some other countries including some states of USA. Canada has introduced a federal law allowing medical aid in dying. Victoria has become the first state in Australia to legalise voluntary euthanasia from mid-2019. Though Recently, India also joined the league by legalization of passive euthanasia after landmark decision of Supreme Court.

Current Position: Passive euthanasia is legalized in India under the preview of fundamental rights. On this Medical Council of India (MCI) also has clear-cut guideline on this subject in regulation 6.7 of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002, which explicitly prohibits doctors from practicing euthanasia top of it our socio-cultural and religious believes are different from western countries which pose new challenges to the psychiatrist.

Challenges Ahead: After the ligalisation of passive euthanasia, the psychiatrist need to be more active, sensitive, understanding of culutre with more responsibility of a psychiatrist has increased.

Keywords: euthanasia, passive euthanasia, psychiatry

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 133. Title: Foretelling dementia: from biomarkers to clinical implications.

Migita M D’Cruz ¹, Praveen SR ², Abhiram PN ^3,^✉, Ankitha M Shenoy ⁴

Title: Foretelling dementia: From biomarkers to clinical implications.

In a country with a projected percentage of the elderly population of 20% by 2050, dementia seems an inevitable risk factor of aging, which calls for early detection and management. Imaging, Neuro-psychological profile, Cerebrospinal fluid, and blood-based biomarkers have the potential to improve the diagnostic accuracy. Biomarkers are being incorporated into diagnostic criteria. Not only do they enhance insights into the pathophysiology, but also aid in further research which in-turn translates into clinical management. This is an area of evolving interest with numerous biomarkers at various stages of research. This symposium aims at discussing the following aspects:

Introduction to various biomarkers in dementia
Imaging biomarkers
CSF and blood-based biomarkers
Neuropsychological markers
Clinical implications.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 134. Title: Health Insurance for Mental Disorders in India: Current Position and Challenges Ahead

Akhilesh Sharma ^a, Aditya Somani ^b,^✉, Ajay Kumar ^c, Puneet Khanduja ^d

Introduction: Traditionally, health insurance/mediclaim policies in India did not use to pay for cost of treatment towards psychiatric/psychosomatic disorders. However, as Mental Healthcare Act 2017 has come into force, Insurance Regulatory and Development Authority of India (IRDAI), apex regulator and licensing authority for insurance companies in India has made it mandatory for all insurance companies to make provision for treatment of mental illnesses on same basis as is available for physical illnesses.

Current Position: Currently, common health insurance/mediclaim policies cover only for in-patient care, along with related outpatient expenses for the same illness. The duration of outpatient cover may vary from 15-30 days of pre-hospitalization and 30-60 days of post-hospitalization period. A minimum 24-hours’ stay in hospital is mandatory to avail benefit of mediclaim except for few named day-care procedures. Additionally, there is a waiting period ranging from 1-5 years for certain illnesses before they ae payable, and there are certain set of illnesses like congenital disorders, sexually transitted disease, substance use, etc. which are not payable ever. Although the above mentioed order of IRDAI was issued on 16^th Aug 2018, none of the public/ private sector insurance companies have made approriate changes in their policy wordings to include cover for psychiatric disorders.

Challenges Ahead: Mental health professionals need to keep a strict vigilance on rules/regulations/inclusions/exclusions/sub-limits etc. likely to be drawn by insurance companies for mental illnesses. As majority of psychiatric disorders that need hospitalization are severe, often chronic/lifelong & disabling conditions, our patients would need more comprehensive long term outpatient cover and facility for psychotherapy & rehabilitative services. We need to keep a check that all deseving patients, including patients of substance use disorders are included, there is no unfair loading on premiums and adequate/compehensive cover for all-inclusive care of psychiatric disorders is provided.

Keywords: Heath insurance; Mediclaim; Mental disorders; Psychiatric Disorders

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 135. Building LGBTQ sensitivity among Psychiatrists: The role of IPC sec.377 decriminalization and a transgender policy.

Sheena G Soman ¹, Jayaprakash P, Archana N U, Jithin T Joseph, Jayaprakashan K P

The homosexual and transgender community comprising gays, lesbians, bisexuals, transgenders and queers known as LGBTQ had a land mark judgement in their favour when IPC sec.377 on unnatural offences was decriminalised. History and sociocultural religious evolution shows varied responses in time when addressing the minorities among sexual orientation and gender identity conditions. Any deviation in sexual and gender expressions which did not go the ‘natural’ way were deemed an abomination,as an act of criminality and later as a pathology. Though Homosexuality was no longer a disorder in classification systems from 1970s India held on to conservative and punitive stands till the drop of IPC sec.377 on Sep 6,2018. Only Kerala and Tamil Nadu have an existing Transgender Policy. The current medical curriculum addresses the LGBT issues scarcely and the training of psychiatry residents is limited to few hours. Clinical settings which are LGBT sensitive are scarce. The heteronormative attitude and lack of affirmative clinical practices render help seeking of this community minimal. In this wake,psychiatrists should not limit oneself as a gatekeeper,but assume multiple therapeutic roles to influence the coming out process,preserve mental health and provide therapeutic holding environments for conflict resolution. Objective:Enhancing sensitivity and advocate affirmative practices while addressing LGBT. Methods: Symposium on Historical and scientific evolution of sexual orientation and gender identity(SOGI) constructs. Taxonomical and nosologic classification of SOGI.LGBT affirmative practices and role of sexual orientation conversion efforts(SOCE). The role of societal changes and policy development in LGBTQ horizon. Conclusions: Post graduateTraining is required to reduce antiLGBT attitudes. Establish Sexual orientation and Gender clinic and restrict reparative practices in clinical settings. Need for LGBT sensitive policies and longitudinal studies.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 136. Title: Mental Health Literacy in India: Concept, Various Perspectives and Way Forward

Bhaveshkumar M Lakdawala ¹, Syeda Ruksheda ², Parlin Dadhaniya ³, Naresh Nebhinani ⁴

This symposium will be divided into the followings 3 subsections

Objectives: The term “Mental Health Literacy” (MHL) refers to knowledge and beliefs about mental disorders which aid their recognition, management or prevention. The objectives of this symposium are to address what is MHL and Indian research and Contribution; MHL for school teachers & parents; for persons having Substance Use Disorder (SUD); research & work on MHL in Suicide and how we can improve MHL so that society at large will be benefited.

Description: Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.

Many studies have shown that poor knowledge and negative & stigmatized attitudes towards mental illness and mentally ill are widespread. It is even more seen in school teachers & parents, for persons suffering from SUD and Suicide related issues. Many studies report that stigma is universal and doesn’t spare even various health professionals including our own colleagues of other branches, nursing personnel and health workers. Stigma and discrimination result in the underuse of mental health services. The main strategies for addressing psychiatric stigma focus on protest, contact and education.

Key Words: Mental Health Literacy, School, SUD, Suicide, India

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 137. The history of psychiatry, the mental hospitals and the city of Lucknow.

Alok Sarin ¹, Sanjeev Jain, Pratima Murthy

Every generation, in every society, across millennia, has struggled with defining the limits of reason and behavior, and the boundaries of insanity. We will attempt trace this ebb and flow of ideas and opinions in the care of the mentally ill in India, over the past 200 years. We will draw on archives, hospital records, and biographies to trace the development of institutional care, pharmacology, social psychiatry and neurobiology in the recent past. Of special interest here may be some early developments in psycho-pharmacology that happened in the city of Lucknow. This will allow us to have a better understanding of the nature of the progress that seems to have been made, and also shine a light on the persisting concerns about providing comprehensive care for the mentally ill.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 138. Title: PHYSICIANS WELLNESS

PK Dalal ¹

ABSTRACT: Physicians wellness is one of the most neglected areas of medicine. Lack of wellness has varied manifestations – impairment, burn out, addictions, boundary violations, other ethical and legal troubles, and outright debilitating psychiatric illnesses, including suicide. The speakers highlight scarcity of treatment resources and other barriers in accessing therapeutic services across life span of physicians in India. A center of excellence for research and treatment of physicians is proposed.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 139. TITLE- HOMOSEXUALITY EVOLUTION OF CONCEPT AND CURRENT STATUS

Jai Singh ¹, Anamika Das ², Pritha Roy ³, Lavkush Kumar ⁴, Erika Pahuja ⁵

Sexuality is not all about physical sex or gaining pleasure from opposite sex gender. It can be defined in many dimensions including gender identity, sexual identity, sexual orientation and sexual behavior. Sexual behavior has been classified according to emotional and romantic attachments. It can be among same gender people -homosexual, opposite gender -hetero-sexual or both genders - bisexual. Before 1973 homosexuality was classified as psychiatric illness according to DSM when American Psychiatric Association removed it. It was subsequently removed from ICD-10(1992). The legal framework also considered it as a punishable offence. With modernization of the society, there was a change of perspective and a huge uproar among homosexuals regarding its decriminalisation. According to section 377 IPC, which was introduced by Lord Macaulay in 1860 in British India, homosexuality used to come under unnatural sexual offences till recent times. Gradually there were changes globally in law books and homosexuality was being decriminalized all over. There were hues and cry in the Indian homosexual population to follow the same. Finally, in September 2018, after a long wait, homosexuality has been decriminalized. Though it does not belong to any psychiatric nosology presently, there is a high prevalence of psychiatric comorbidity in this population. This needs to be addressed adequately. There still remains a huge debate on this entity which requires discussion.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 140. TITLE: Medically unexplained symptoms (MUS): Pathways of care and Challenges of the enigma

Debanjan Banerjee ¹, Vishwas Yadawad ², Vishukumar HS ³, Sachin N ⁴

OUTLINE:

The mind body dualism has been debated for centuries across various cultures by artists, philosophers, spiritual aspirants etc. However, the dynamic interplay of the mind and the body in health and disease has been recognized in psychiatry. Patients suffering from medially unexplained symptoms have been seen as somatizers, malingerers, persons with abnormal illness behaviour and weak ego strength etc. However medical fraternity continues to struggle in providing adequate cure for these individuals. On the other hand, wanted or not: this population would mostly visit the psychiatrist’s chamber.

Keeping this in the background, this symposium attempts to critically evaluate the validity of the construct called ‘medically unexplained symptoms’ and take the vantage points of both; the mental health professional and a general/primary care physician as the professionals who can best manage medically unexplained symptoms. It also aims to de-mystify the construct of MUS and provide consensus on practice guidelines for the same.

The tentative topics are as follows:

1. “I am sick more than my doctors think”: The construct, nosology and prevailing practices in the management of MUS.

2. “Care over the elusive cure”: Why MUS is best managed by a Mental Health Professional.

3. “Seek and ye shall find”: Why MUS is best managed by a non-psychiatrist physician.

4. “Decoding the enigma”: Summarizing the evidence and future directions.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 141. Title: Metabolic syndrome, Circadian disruption, and Obstructive sleep apnea in patients with Schizophrenia

Naresh Nebhinani ¹, Navendu Gaur ², Ravi Gupta ³

People with schizophrenia have high mortality rate and shortened life expectancy for 10-20 years than the general population. Its major cause is physical comorbidities, predominantly cardiovascular disorders. Metabolic syndrome (MetS) may partly mediate the association, as the subjects with MetS are three times more likely to develop myocardial infarction or stroke. Compared to the healthy population Patients with schizophrenia suffer from more metabolic (MetS prevalence up to 68%) or sleep problems (around 45%). Illness variables, lifestyle factors (diet, activity and substance abuse etc.) and antipsychotics contribute to obesity of patients, which influences their sleep quality. Sleep-wake disturbance, resulting in chronic sleep loss has been associated with increased risk for weight gain, obesity, MetS, OSA and cardiac disorders. Metabolic abnormalities and sleep disturbances in schizophrenia are interrelated and further affecting their drug compliance, quality of life, illness course, outcome and prognosis.

Outline of symposium:

Metabolic syndrome in Schizophrenia (Naresh Nebhinani)
Circadian disruption in Schizophrenia (Navendu Gaur)
OSA in Schizophrenia & its association with metabolic syndrome (Ravi Gupta)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 142. Sexual Dysfunction with SSRIs and management strategies

Ashish Srivastava ^**, Saumitra Nemlekar ^*, Anil Rane ^**, Wenona Fernandes ^**

Sexual dysfunction is a known adverse effect to selective serotonin reuptake inhibitors (SSRIs).. Sexual dysfunction can have significant impact on the person’s quality of life, quality of relationships, self-esteem, and recovery. It has also been noted in nearly 40-61% of patients. This may increase the risk for discontinuation and non - adherence to antidepressant pharmacotherapy

Some clinical scenarios that arise out of the same includes managing noncompliance; shifting from the SSRI to other classes and alter the pharmacological profile with add on medications for the problems. Patient education on the sexual side-effect profiles of SSRIs is critical to medication adherence, resolution of depressive symptoms, and improving quality of life. Delaying this discussion may result in confusion and distrust of pharmacotherapies and health care providers, making it more difficult to adjust and recommend medications later on. Given the prevalence of sexual dysfunction in subjects with depression, it is necessary for health care providers to give a full assessment and explanation of potential side effects of antidepressant pharmacotherapy. Use of Scales such as International Index of Erectile Function scale (IIEF) can be used to quantify the dysfunction.. Current literature supports use of SSRIs at lowest dose, alternate medications to SSRIs, augmentation with PDE-5 inhibitors

The focus of this session shall be to explore the incidence, pathophysiology, and treatment of antidepressant-associated sexual dysfunction

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 143. Co-Morbidity of Personality Disorders in Patients with Substance Use Disorder and Therapeutic Pessimism: Clinical Folklore or Clinical Reality?

Prabhoo Dayal ¹, Om Sai Ramesh V ², Shiv Prasad ³, G S Kaloiya ⁴

Substance Use Disorder is a chronic relapsing illness. Mental health professionals struggle to manage due to its chronic and relapsing nature. Co-morbidity of personality disorders further worsen the situation and one of the reasons of non treatment seeking behaviour hence, results in poor prognosis. Persons with substance use disorders have a high prevalence of co-morbid personality disorders. The symposium shall present the overview of co-morbid personality disorders among patients with substance use disorders. Additionally, it shall focus on the issues related to diagnosis and management of co-morbidity of personality disorders among persons with substance use disorders.

Presentation-1: Overview: This presentation shall focus on the overview of co-morbid personality disorders among patients with substance use disorders. It shall also present epidemiology, implications, especially clinical of this co-morbidity. -Dr Prabhoo Dayal

Presentation-2: Relationship & Diagnostic issues between Substance use disorders and personality disorders: This presentation will highlight the relationship between SUD and Personality Disorders. How this relationship make this illness more complicated in terms of its understanding, symptomatology and treatment. Diagnostic issues & Clinical implications will also be discussed. -Dr Om Sai Ramesh V

Presentation-3: Assessment & Evidence based Pharmacotherapy: This presentation shall discuss about assessment of personality disorders and pharmacotherapy in substance use disorders. The presentation shall present a framework of evidence based pharmacological management of the co-morbid personality disorders and role of pharmacotherapy in the same. Recent evidence on this theme shall be discussed. -Dr. Shiv Prasad

Presentation-4: Barriers & Evidence based Psychosocial Interventions: This presentation shall highlight different barriers to comprehensive treatment of co-morbidity in SUD. The presentation shall present an overview of the evidence based psychosocial interventions for management of the same. -Dr G S Kaloiya

The presentations will be summarized by Dr Prabhoo Dayal

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 144. Legalization of cannabis: Where do we stand and where to go from here?

Aniruddha Basu, Abhishek Ghosh, Siddharth Arya

With an overwhelming figure of 192 million users, cannabis is certainly the most commonly misused illicit drug globally. Moreover, this number is showing an increasing trend. Although the UN conventions call for the member states to criminalize cannabis use, several countries have questioned the effectiveness of this expensive policy. These countries have tried out a range of cannabis policies, from complete decriminalization to quasi-legalization (either or recreational and medicinal use).

Speaker 1 (Aniruddha Basu): Cannabis the herb: boon or bane?

National Academies of Sciences, Engineering, and Medicine has found substantial and conclusive evidence for the role of medicinal cannabis to alleviate chronic pain, chemotherapy-associated nausea-vomiting, and spasticity due to multiple sclerosis. However, the quality of evidence has been questioned. Research so far has established the harmful effects of cannabis with reasonable degree of certainty. The link between cannabis and schizophrenia spectrum disorder is well validated through various longitudinal studies. Chronic cannabis use is associated with cognitive impairment, overall intellectual decline, poor educational attainment, and unemployment.

Speaker 2 (Abhishek Ghosh): The current scene of cannabis legalization: chaos or coherence

Several countries and nearly thirty states in the US have legalized the medicinal use of cannabis. Spain, Uruguay, Canada, and the nine states of the US and the District of Columbia have legalized recreational cannabis use. All these are reflective of a dynamic and diverse landscape of cannabis policy, We will discuss the legal stand of India in light of its ambivalent past.

Speaker 3 (Siddharth Arya): Cannabis policy: peeking into the professionals’ mind

The medical professionals seem to have divided opinion regarding recreational and medical use of cannabis. The opinion differs across the countries. We will present the results of our survey conducted among the early career psychiatrists of India and compare our findings with the existing literature from elsewhere.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 145. SUBSTANCE ABUSE: A GLOBAL APPROACH WHILE ADDRESSING DISASTER MANAGEMENT

H K Goswami ¹, Dhrubajyoti Bhuyan ², Sabita Dihingia ³, Prosenjit Ghosh ⁴, Shyamanta Das ⁵

Disasters are unpredictable events that inevitably punctuates the human existence and challenges the fundamental assumptions of individual and community safety. In addition to causing direct emotional distress through death, destruction of property and damages to infrastructure it also produces long lasting disruptions.

Psychiatric disorders may be precipitated or aggravated following a disaster. Among the behavioral disorders, increase in health risk behaviors such as increased smoking and alcohol consumptions are commonly noted post disaster. Apart from worsening of such high-risk behaviors, people who are already dependent and in harmful pattern of abuse may have difficulty accessing the substance availability following a disaster which may result in withdrawal symptoms. The government and other agencies may also resort to banning addictive substances sales after a disaster considering the social factors and its consequences.

Though overt withdrawal symptoms get medical attention, minor symptoms particularly agitations and sleep disturbances usually are disregarded from medical care. Clubbing with an already anxious state following disaster this can often result in chaotic situations and conflicts in the rehabilitation camps and during the rescue works which in turn affects the efficacy of such works.

Disaster management teams usually focuses on the high-risk groups like the children, women and geriatric age groups who may suffer from psychiatric symptoms following a disaster. However, the symptoms of substance abuse and related disorders in the healthy male groups usually are not given the emphasis it requires due to multiple reasons including the stigma to contact medical professionals by these groups post disaster and the lack of awareness among subjects and health workers.

There are very less studies examining such factors following a disaster. Psychiatric management although focusing more on behavioral symptoms related to disaster aftermath should also be focusing on the major group of less risk groups usually disregarded during a disaster for their substances, patterns of use, availability and control of withdrawal symptoms. Psychiatric team may also work in concordance with government officials in working out a strategic management plan in such situations.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 146. Title: Nicotine and psychopathology: ‘gateway’ to ‘hardening’

Dhrubajyoti Bhuyan ¹, Sabita Dihingia ², Prosenjit Ghosh ³, Shyamanta Das ⁴

Nicotine is a natural ingredient derived from tobacco leaves (Nicotiana tabacum) acting as a botanical insecticide and is the principal tobacco alkaloid. It is one of the common substances of abuse and has been in use since time immemorial. It is used for various reasons and have varied psychological and physical effects as demonstrated in numerous studies. With time we now know more about tobacco- and nicotine-containing products. Not only much is known about their modes of delivery but also the knowledge about corresponding harm potential has increased tremendously. Its use among psychiatric patients is a major area of concern for clinicians, researchers and health promoters. The rates of tobacco addiction in individuals with psychiatric disorders (mental illness and addiction) continue to remain alarmingly high despite substantial decreases in smoking in the general population More than 60% of schizophrenic patients are current smokers, while 35.5% smoke 20 cigarettes or more per day. Smoking stimulates dopaminergic activity in the brain at least by two distinct mechanisms. First, central nicotinic cholinergic receptors are stimulated by nicotine, resulting in release of dopamine and serotonin. Second, cigarette smoke decreases monoamine oxidase (MAO) activity, thus further increasing brain dopamine concentration, which in turn could contribute to its antidepressant effects. Therefore, smoking increases dopamine concentration by inducing its release and inhibiting its degradation. This symposium focuses on various issues such as nicotine and its relationship with various psychopathologies and impact on effect of psychotropic.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 147. Topic: Accessibility and affordability of existing treatment services for Addiction Management

BS Chavan ^*, Subhash Das ^**, Ajeet Sidana ^**

Brief outline of existing services

Barriers in accessing existing facilities

Strategies to improve accessibility and affordability

Symposium will be discussed under following subthemes:

Substance abuse is a major public health problem in most parts of India. National Mental health Survey (2016) reported that approximately 5 percent of Indian population (excluding nicotine) is suffering from substance use disorders (SUDs). The survey further reported that more than 80 % persons abusing drugs and alcohol had never sought treatment in the past. In addition to patient related factors (poor motivation, stigma, lack of awareness), the shortage of services for substance abuse treatment is another contributor to treatment gap. The treatment facilities for substance use disorder (SUD) are not only inadequate, but these have also been separated from mainstream general health care facilities. The isolation of SUD treatment from the mainstream medical care also denies the delivery of integrated care. There is good research evidence that mild to moderate type of SUD cases can be managed at the outdoor in general health care settings by medical officers and only severe cases might require specialized addiction treatment services. Separation of SUD treatment leads to missed opportunity for early detection, brief timely intervention and early referral. Large proportion of SUD has high co-morbidity of medical problems which might go unrecognized and untreated in specialized care. In addition to limited treatment facilities for SUD, the facilities provided by unorganized and unlicensed sector are not only unethical, but also unaffordable. Gross human right violation inside these facilities discourage large number of patients from seeking treatment even from government run facilities. Thus, there is an urgent need to look at the barriers to seek treatment and to devise innovative method to improve accessibility and affordability.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 148. Title: Substance Use Disorders in Women – Assessment and Management Issues

Atul Ambekar ¹, Piyali Mandal ², Ashish Pakhre ³, Richa Tripathi ³

Gender differences in prevalence of substance use disorders has been observed in general population. Although female sex is considered to be a protective factor for substance use but recent evidence indicates rise in substance use among women. The type, pattern and reason of initiation of substance use is quite different among women than their male counterparts. In women, there is an accelerated progression from staring of substance use to dependence. The rates of internalizing disorders, post-traumatic stress disorder and infectious diseases is also higher in females. Comprehensive knowledge about extent of substance use disorder and its negative influence on other areas of their life is crucial for diagnosis, appropriate management plan and successful outcome. It is important to understand the various psychosocial factors related to substance use as it may affect management process. Pregnancy in women with substance use disorders requires special consideration. Women are also less likely to seek treatment for their substance use disorder due to stigma. Knowledge about various psychosocial factors that affect retention in treatment, compliance, completion of treatment and outcome is needed. Better psychological functioning, good social support and absence of co-occurring disorders favors good outcome. It is also important to address the relationship and responsibility of women with substance use disorder towards their children and family members. The treatment needs of female substance users is also different from male substance users. There is a need to focus and emphasis on gender specific treatment models for women for good outcome.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 149. Leave no one behind: Indian Perspective into the cause, incidence and the preventive measures for violence against women

Mona Nongmeikapam ¹, Pavana S ², Shilpa Shri ³

Violence against women and girls is one of the most widespread and devastatingly persistent human rights violations and discrimination in today’s world. The staggering numbers is reflected by the need to commemorate 25 November annually as the International Day for the Elimination of Violence against Women by the United Nations. Dr. Mona Nongmeikapam will be presenting an overview of gender violence against women, a world-wide picture and the scenario closer home. 35% of women world-wide have reported having experienced some form of physical or sexual violence. The Indian statistics in 2011reveals: Cruelty by husband and their relatives - 43.4%; molestation - 18.8%; rape - 10.6%; kidnapping and abduction - 15.6%; sexual harassment - 3.7%; dowry death - 3.8%; Immoral Traffic Act - 1.1%; Dowry Prohibition Act - 2.9%; and others - 0.2%,making India one of the most dangerous country in the world after Afghanistan, Congo, and Pakistan. Dr. Pavana will shed some light on the exisiting preventive measures for Protection of Women against violence under the District Mental Health Programme. The Legislative Provisions as well as the various Organisational infrastructures for gender equality and sensitisation will be discussed at length. Dr. Shilpashri will compare the statistical data of gender violence against women in the Kolar District over the past 3 years and shed light on the current delivery of Psychiatric care. Research shows that achieving gender equality helps in preventing conflict, and high rates of violence against women correlates with outbreaks of conflict, which cannot be reflective of a progressive or developing society. As the UNiTE Campaign stresses, it is imperative that we leave no one behind and work towards a brighter future without violence.

Key Words: Gender violence, sexual harassment, discrimination

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 150. SYMPOSIUM- WOMEN MENTAL HEALTH- Different hormonal phases and psychiatric disorders in women- latest research and review

Agarwal S ¹, Dahuja M ², Saxena K ³, Koolwal A ⁴, Husain K ⁵

Kewords- Hormonal phases, psychiatric disorders, women.

Background- Women’s mental health has recently evolved into a very important aspect of psychiatry. Objectives and Methods- We aim to highlight the knowledge pertaining to recent research and review in this area in India. We will cover it under the following topics- Neurobiology and neuroendocrinological basis of psychiatric disorders, Pharmacological challenges while treating them, Substance Abuse in Women, Female Sexual Interest/Arousal Disorder and Domestic Violence. Women have an added endocrinological involvement in the neurobiology of psychiatric disorders as compared to men. They also suffer from disorders related to hormonal phases and different life cycles (menarche, menstrual cycle, pregnancy, lactation, and menopause). Role of aldosterone and deoxycorticosterone in Pre-menstrual dysphoric disorder ¹ and increased androgen levels in post-menopausal syndrome² are few such examples. Hence, treatment is also obviously slightly different. Antidepressants like sertraline and fluoxetine and antipsychotics like olanzapine and quetiapine are safer in pregnancy and lactation.³Coming to specific psychiatric disorders, there is limited data on substance abuse among women in India. Although, differences in pattern of use, its effects & complications are known.⁴Only Female Sexual Interest/Arousal Disorder among all psychosexual disorders will be discussed here(female Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder in DSM-5). Low sexual interest is one of the most common sexual complaints in the females(26 -43%)⁵. Sexual partners usually have discrepancy in their preferences for frequency, type and timing of sexual activities⁶. Hence, unique management principles are applied in such disorders for the couple. Women also experience Domestic Violence in majority (33% worldwide⁷ and 33.5% in India⁸). Conclusion-In this symposium, emphasis on all the above topics will be deliberated upon to get a better insight into women’s mental health, assisting in better comprehension and deeper understanding.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 151. PSYCHONEUROENDOCRINOLOGY IN WOMEN DURING MENOPAUSE

Krishna Patel ¹, Vijay Nagecah

AIM OF THE SYMPOSIUM:

Sensitizing mental health professionals towards psychological, hormonal and other systemic changes in women in perimenopausal and postmenopausal period

CORE CONTENT:

Fluctuating hormonal levels is very common in critical periods of a women’s life. Menopause is one of the critical periods. Transition to menopause is long process during which these varied hormonal levels at different times influence various systems of the body including neurological regulations of cognitive and emotional functions

Depressive symptoms like irritability, anxiety, tearfulness, labile mood, tearfulness are common but the distress does not amount to impairment in functioning. Thus most of them do not receive the diagnosis of major depressive disorder. Yet it is important to treat those symptoms.

Most of the females respond to hormone replacement therapy along with antidepressants like selective-serotonin reuptake inhibitors and venlafaxine.

Hormone replacement therapy being crucial to treating vasomotor and psychological symptoms, it indicates some different underlying neuroendocrinological mechanisms leading to these distinct symptoms.

It is very important to understand the difference in circardian rhythm, mood, emotional appetite and sexual functioning during this particular period.

CONCLUSION:

Through this symposium we as psychiatrists expect to develop a vision to view the psychological symptoms during menopause with distinct specific perspective that fits precisely to women during perimenopausal women. It is a baby step forward towards achieving an exclusive approach for women during menopause entering a psychiatric consultation room for help.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 152. Irritability and mood dysregulation in children – a dynamic construct CHANGING CONCEPTS

Anirban Ray ¹, Sarmishtha Chakraborty ², Khyati Mehtalia ³

Irritability and mood dysregulations are common clinical presentations in children, those poses significant challenge for the psychiatrists to manage. Anger outbursts is trans-diagnostic symptom. Those can be secondary to different diagnostic categories. ADHD, ODD, CD, Bipolarity, OCD, Depression. This categories are quite dynamic. DSM 5 developed a category DMDD, which is a part of depressive spectrum. But though in ICD 11 there was an attempt to unify two nosological schools, they differed with DSM 5 in this regard. It done away with DMDD and proposed two subtypes of ODD with or without chronic anger and irritability. (SPEAKER 1)

MANAGEMENT:

PHARMACOLOGICAL: Acute management may be symptomatic by injection or mouth dissolving tablets. Pharmacological management is symptomatic on one aspect through risperidone, aripiprazole. On the other hand, it depends on the underlying diagnosis. ADHD children is given methylphenidate, atomoxetine, and clonidine. Lithium & valproate are beneficial for bipolar equivalents. Though DMDD conceptualized as depressive equivalents, beneficial role of SSRI in aggression is not proven beyond doubts. One reason may be significant occurrence of activation syndrome or mood switch potential of SSRI especially in youth. (SPEAKER 2)

NON-PHARMACOLOGICAL: Non-Pharmacological management is still the gold standard in mood dysregulation and especially disruptive behaviours. Acute management by ‘de-escalation’ or talking down, to ignoring, autonomic soothers like splash of water, cool air etc. Regular management by quality time and differential reinforcement which are the basics of parental management techniques. Other family based and school based techniques were also useful. Adolescents do well with skills training, cognitive therapy. Multisystemic therapy is still the therapy of choice in conduct disorders. (SPEAKER 3)

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 153. Challenges of Mental Hospitals in India and development of Role model for futuristic needs

D Ram ^*, Prasnna Prabhakar Khatawker ^**, Ram Ghulam Razdan ^***

Topics and speakers are as following-

· Current Status of mental hospitals in India and their challenges –

In India the mental asylums were entirely of British conception,. There is a reference of some asylums in the period of Mohammad Khilji (1436-1469) during the fifteenth century. There is evidence of the presence of a mental hospital at Dhar near Mandu, Madhya Pradesh where the physician was Maulana Fazulur Hakim. There is also evidence that modern medicine and hospitals were first brought to India by Portuguese during the 17th century in Goa. However, the segregation of lunatics in mental asylum and their supervision were entirely of British origin.

Infect, the early mental institutions in the Indian sub-continent were greatly influenced by the ideas and concepts as prevalent in England and Europe during those days. Primarily the mental asylums were built to protect the community and not the insane. As such, such asylums were constructed away from cities with high enclosures in either dilapidated buildings like barracks left by the military. It appears that lunatic asylums in India were first started to treat European soldiers employed with the East India Company. To understand the development of mental hospitals, it is relevant to know the political developments in India during that time.

There are evidencesthat first lunatic asylum in India was established in Bombay (Mumbai) in the year 1745, followed by Calcutta (Kolkata) in 1784. Subsequently number of such asylums increased significantly and by the year 1947, there were 31 mental hospitals in India. After independence mental hospitals were opened in various states. A recent survey revealed that there are 59 mental hospitals in the country.

There is no uniform development of these hospital. The way they are developing under National Health program and with help of state governments.

This symposium is aimed to develop a module for future role of these Hospitals in delivery of mental health services based on our needs.

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Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 154. Health Promotion for Ageing Population- the Indian and Western Perspectives

SC Tiwari, A Ramakrishnan, Rakesh K Tripathi, Nisha Mani Pandey

Health promotion is the term commonly used to describe not only the learned health behaviours and social and cultural influences but also physiological, psychological, and environmental elements. Health promotion is aimed at preventing illness, maintaining wellbeing and enhancing quality of life of the individual and therefore, is an important aspect to understand to fully appreciate its significance at all stages of life, especially the ageing population. It is reported that millions of older Americans are aging well, functioning independently both physically and mentally for decades after 65 and that indicates that this stage of life can be as full of dignity, independence, creativity, health and vitality as any other stage. One can remain well and maintain health in later stages of life if healthy behavioural patterns and lifestyle could be adopted in view and with accordance of our accepted cultural norms. For health promotion, priority areas of action have to be emphasized by going beyond the biomedical model, focussing on the concepts of health and wellbeing, identifying and eliminating cultural obliterations and defining collaborative goals, paving pathways for preventing illnesses/maintaining health, developing strategies for sustainable interventions and maintaining the same.

Under the aegis of Indian Psychiatric Society’s Geriatric Psychiatry Specialty Section, Indian Association for Geriatric Mental Health and Mental Health Foundation Lucknow the presenters will be presenting on the Concept of Health Promotion from Indian and Western perspective, setting into context health promotional activities for elderly as per the most widely accepted Indian cultural framework, paving pathways for preventing and maintaining health-strategies interventions. The following is the format of the presentation:

Topic	Speaker	Total time 90 minutes
Overview on health promotional activities in elderly	Dr. SC Tiwari	18 minutes each and 18 minutes for discussion
Concept & ways of health promotional activities for elderlies in Western countries	Dr. A. N. Ramakrishnan
Concept & ways of health promotional activities for elderlies in India	Dr. Rakesh K Tripathi
Carry home message as per Indian and Western perspectives summating health promotional activities for elderlies	Dr. Nisha M Pandey

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Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 155. INTERNET ADDICTION AND YOUTH (IA): A NEW FRONTIER

Saxena S, Chaudhari D, Shanker G

There has been rapid increase in internet use in India with current users pegged at 462 million (approx) in 2017 (11). With rising number of users its indiscriminate and injudicious use has also increased which has lead to behavioral problems and impairment in over-indulged individuals. Beard (2) recommended excessive preoccupation with internet, unsuccessful efforts to cut down, emotional distress when trying to cut down use, need to use it for longer duration along with impairment as the criteria for Internet addiction (IA). Excessive gaming, pornography, social media/ e-mail, shopping and browsing are major sub-types of this addiction. Adolescents and young adults are most commonly affected by this disorder (7). Its prevalence has ranged from 0.8 to 26.7% in general population (9). In India prevalence of internet addiction has been suggested as 19.85 % with moderate and severe addiction being 19.5% and 0.35% respectively (7). IA has been linked with depression, anxiety, ADHD (1) and even suicide (5) in dependent adolescents and youths. China and South Korea have identified IA as significant public health problem (4). Laws/programs are being mooted to manage IA in India too.

Davis (6) postulated theoretical cognitive behavioral model for explaining internet addiction where as Robinson (10) proposed conditioning as a psychological reason behind inability to cut down internet use by addicts. Anonymity, convenience and escape model and Winkler’s model of development and maintenance of IA which takes into account socio-cultural aspects too are other psychological models explaining IA. A dysfunction in prefrontal cortex, especially dorsolateral prefrontal cortex and executive functions is involved in internet addiction. Han et al (8) found that desire to play was positively correlated with right para hippocampal gyrus and right medio-lateral frontal cortex on fMRI. Brand (3) reviewed that over-activity in cingulated gyrus is involved in poor cognitive control and conflict management in these patients. Dopaminergic reward system loop has been implicated in IA for craving and reinforcement.

Internet addiction test (IAT), compulsive internet use scale(CIUS) and problematic internet internet use scale (PIUS) are scales used to assess this disorder (4). Motivational interviewing and three phase Cognitive behavior therapy for internet addiction has been successfully used in IA(13). Reality therapy, group therapy, solution focused brief therapy (SFBT) and acceptance and commitment therapies (12) are other psychological interventions which have been useful. Selective serotonin re-uptake inhibitors (SSRIs) have been used treat co-morbid anxiety-depression symptoms in these patients. Bupropion has been found to be useful in reducing compulsive impulsive gaming in one study. Mood stablisers and naltrexone have been reported in case-reports with some benefit.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 156. Mental Healthcare Act, 2017 – Challenges and Opportunities

Resources Person:

1) Dr Naveen C Kumar	Introduction to MHCA 2017
Additional Professor of Psychiatry, NIMHANS
2) Dr Manjunatha N	Challenges to MHCA 2017
Associate Professor of Psychiatry, NIMHANS
3) Dr Mahesh Gowda	Case Vignettes Presentation
Director, Spandana Nursing Home and Rehab Left
4) Dr Suresh Bada Math	Case Vignettes Discussions
Prof of Psychiatry, NIMHANS

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Mental Health Care (MHC) Act 2017 is a reality and rights based mental healthcare legislation for protecting, promoting and preventing human rights violation during health service delivery. This legislation revolves around ‘individual rights’ & ‘liberty’ and brought various revolutionary changes such as advance directive, nominated representative, capacity to consent for treatment & admission and articulating rights of persons with mental illness. Further, independent Mental health review boards and responsibilities of government are clearly emphasized. The major importance of human rights-based approach in MHCA 2017 will eventually bring in changes by making States responsible and accountable for providing care. This new legislation bring in new hopes, new challenges and new opportunities.

The objective of this workshop is to give an overview of MHC act 2017 and its upcoming issues while implementing it. The workshop brings together all mental health practitioners and legal experts, who are interested and working in the field of mental healthcare service delivery to discuss the processes underlying the legal reasoning and helping the practitioners in making clinical decision making under the legal framework.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 157.WPA Section on Rural Mental Health Symposia: ‘Rural Mental Health, Challenges and Solutions’.

Satish Malik, Vimal Sharma ¹, Mohammed Abou-Saleh ², Paul Kingston ³, Prakash Behere ⁴, Anshuman Pant ⁵

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 158- Psychiatry as a career in UK

Manoj Rajagopal ¹, Mukul Sharma ¹, Richard Morgan ¹, Imran Chati ¹

UK has always been seen as a place for doctors from all over the world to come and work. Work experience in NHS and quality of life in UK has always been an attraction. In Lancashire Care Foundation Trust as part of the recruitment, we always welcome and support doctors from overseas. Lancashire care Trust is the major provider of community, well-being and mental health services in this area. Its size and scale mean that there are numerous opportunities available in a range of specialisms that are not available in many other Trusts. Doctors will be supported by a well-established group of peers to fulfil the potential and current aspirations and ensure that the doctor achieve the work life balance to pursue their interests outside of work.

The Trust has a range of services provided for consultants and other doctors with a range of specialisms to practise including Child and Adolescent services, Early intervention services, Forensic services, and from 2018 will also provide Liaison psychiatry and Perinatal services with a new mother and baby unit. Also there is choice of working in in- patient or community services. The Trust proactively supports consultants to get involved in developing their personal areas of interest beyond their formal role. The Trust has strong links with Lancaster, Liverpool and Manchester University and is an advocate of continuous professional development offering bespoke training packages to its doctors to support career progression. We have students joining from major north-west universities and there is a dedicated training development programme providing excellent teaching opportunities for doctors

The Trust supports all new doctors especially overseas doctors and has been providing various relocation packages. Lancashire care supports doctors to acclimatise to UK as well as the NHS system by providing induction to get used to the British NHS system as well as to the trust. All doctors join a well-established group of medics where you can be sure of peer support at your appropriate level. We offer buddies scheme for the new doctors. Doctors are also offered mentors as well as supervisors for new doctors who join the trust. We also have CESR trainers to support the new doctors to get them as consultants at the earliest possible we also provide facilities for new doctors especially overseas doctors when they come to the country by getting them accommodation, bank account, and other facilities needed to start their life in UK we also have a dedicated team do you support these overseas doctors at the initial time. We have recently acquired state of the art new accommodation exclusively for the new doctors.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 159- WPA Section on Rural Mental Health Symposia: ‘Rural Mental Health, Challenges and Solutions’

Mohammed Abou-Saleh ¹, Paul Kingston ², Prakash Behere ³, Anshuman Pant ⁴, Vimal Sharma ⁵

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 160- BRIEF REAPPRAISAL OF DREAMS IN PSYCHIATRY

Dipika Singh ^*, Manjit Santre ^*, M S V K Raju ^*

Dreams reflect the workings of the mind when we are not fully aware of the environment nor ourselves. Analysis and interpretation of dreams formed part of clinical and therapeutic workof psychiatrists at the turn of last century after the landmark publication of Freud’s “ The Interpretation of Dreams”. With the emphasis on descriptions, categorisation and medicalisation in psychiatry. interest in dreams waned. There was a reawakening of interest after the discovery of REM sleep. Advances in neuroscience in recent times have created a resurgence of interest in dreams. It is now known dreams can not only be interpreted in various ways integrated into the comprehensive therapeutic process but also can be subjected to non-dynamic quantitative study to derive insights into person’s personality. The purpose and meaning of dreaming can be understood now with much more clarity than before. Mental disorders have different patterns of dreams. Psychotropic drugs affect dreams. It is increasingly realised now that there are dimensions to dreams that need to be studied, investigated and utilised for the benefit of patients and also for the psychiatrists. The symposium will highlight the fact that as products of mind, which happens to be the area in which psychiatrists operate, dreams have a place in psychiatry.

Indian J Psychiatry. 2019 Jan;61(Suppl 3):S390–S439.

SYMPOSIUM 161- Title: The way forward in de stigmatisation in mental health

Monali Deshpande, Vikrant Patankar

Subtitle:The ground reality

Author:Dr. Vikrant Patankar

The 21 st century has achieved many milestones in many areas of human life. The development in all aspects is mind boggling. As everything comes with price, so it’s the era of stress. All of us are exposed to a different world,which puts a lot of unrealistic demands on us. Mental health of every individual is at stake with the distress and expectations put on him or her.

India is a developing country and we are moving towards being the next powerful nations in the world. The government is bringing in new laws for the rights of patients and their betterment. But as far as mental health is concerned we still are far way behind. The national programmes to come in reality will need Human Resources, infrastructure,policies which will help us implement the current mental health care act.

But we as professionals are only 6000 pan India and the mental health disorder load is far more. There is a dearth of professionals in our field and moreover the stigma and misconceptions regarding mental illness is India is the main hinderance towards achieving the required treatment plans.

2. The way ahead

Author:Dr. Monali Deshpande

To achieve the required positive results in mental health in society

We as mental health professionals need to get together for achieving it.

PANKH a ngo for psychological well-being was formed in Aurangabad, Maharashtra for the same. It comprises of Psychiatrists,psychologists,special educators,mental health social workers. As the stigma stops people from taking timely help,we designed various programmes to reach the community.

The programme conducted on 7th oct 2018 was a milestone achieved towards it.

5 people who are survivors of mental illness came together to share their life stories under PANKH.

The stories were real life time experiences of illness and its recovery. As patients themselves came up in open about their illnesses and spoke of their journey,it inspired and clarified many of the programme attendees ideas about mental illness.A lot of knowledge sharing,clarity on misconceptions about mental illness,hopes regarding recovery were put forth.

The programme helped change the way society looks at mentally ill.

The results were seen in media coverage and the registration of few patients for similar programme. The confidence to come to a psychiatrist and seek timely help is seen by all of us post this programme.

3. Lessons learned

This is module which can be replicated in all cities and towns pan India.we have to reach the community to be heard. Recovered patients are our brand ambassadors.when they share their own recovery stories the impact is far more than expected.

An all inclusive model which gives due respect to mentally ill and treats them as any other sick person,psychoeducating the society and de stigmatising the illness is the way forward.

We would like to share our and our patients success stories. The module shared will help psychiatrist generate positivity towards our profession in society and will help us reach all.

The timely help people will seek after understanding will save many lives.

The symposium aims to take a step forward towards de stigmatisation of mental illness through sharing our PANKH module.

[ref1] 1.Depression in India- Let’s Talk (Rep.) World Health Organization. 2017 doi:http://www.searo.who.int/india/depression_in_india.pdf. [Google Scholar]

[ref2] 1.Grover S, Dutt A, Avasthi A. An overview of Indian research in depression. Indian Journal of Psychiatry. 2010;52(Suppl1):S178–S188. doi: 10.4103/0019-5545.69231. http://doi.org/10.4103/0019-5545.69231. [DOI] [PMC free article] [PubMed] [Google Scholar]

[ref3] 1.National Mental Health Survey of India, 2015-16: Prevalence, Pattern and Outcomes (Rep.) National Institute of Mental Health and Neuro Sciences. 2016 doi:http://www.nimhans.ac.in/sites/default/files/u197/NMHS Report (Prevalence patterns and outcomes) 1.pdf. [Google Scholar]

PERMALINK

SYMPOSIUM

SYMPOSIUM 1.Challenges for Indian “Teachers of Psychiatry” (iTOP)

Mohan Isaac

M V Ashok

M Kishor

SYMPOSIUM 2. PSYCHIATRIC ADVANCE DIRECTIVES: CHALLENGES AND POSSIBLE SOLUTIONS

NM Patil, Dr

Sameeran Chate, Dr

Bheemsain Tekkalaki, Dr

SYMPOSIUM 3. Title: Impact of Residential Mobility on Borderline Personality Traits

Thwisha Bajpai

Anuradha Sathiyaseelan

SYMPOSIUM 4. Title: New Psychoactive Substance: Diagnostic Dilemma and Challenges in Management

Nitin Raut, Dr

Sajjadur Rehman, Dr

Sumit Rana, Dr

SYMPOSIUM 5. Attention deficit hyperactivity symptoms and Internet Addiction

Lavkush kumar, Dr

pritha roy, Dr

Anamika das, Dr

jai singh, Dr

SYMPOSIUM 6. Title: Behavioral Economics and mental health, what can all mental health professionals learn?: Working title: Behavioural Economics and Mental Health

Ambrish Sanjay Dharmadhikari, Dr

Avinash Shukla, Dr

Ambrish Sanjay Dharmadhikari, Dr

SYMPOSIUM 7. Resilience from Concept to Practice

Nisha Mani Pandey

Akanksha Sonal, Dr

SYMPOSIUM 8. A study of distribution of psychiatric morbidity in male prisoners

Dharmdeep Singh

Kishore Dudani

Gunjan Solanki

SYMPOSIUM 9. Recent advances in Management of Neuropsychiatric Symptoms in Parkinson’s Disease

parul Prasad, Dr

lavkush kumar, Dr

pritha roy, Dr

SYMPOSIUM 10. Chronic Fatigue Syndrome: Indian Perspectives

Mahadev Singh Sen

Swapnajeet Sahoo

Shubh Mohan Singh

SYMPOSIUM 11. SYMPOSIUM ON MIND-BODY MEDICINE

Sanjay S Phadke

Arun Marwale

Nischol Raval

Vani Kulhalli

SYMPOSIUM 12. CAPACITY EVALUATION IN THE CONTEXT OF MHCA 2017

INDU V NAIR, dr

Anil Prabhakaran, dr

Pavan Kumar, dr

Jithin Joseph, dr

SYMPOSIUM 13. Title: Patriarchy – Epigenetic effect on the phenotype

Syeda Ruksheda, Dr

Amrit Pattojoshi, Dr

Supriya Agarwal, Dr

SYMPOSIUM 14. Explanations to the Medically Unexplained Symptoms (MUS): Are we looking deep enough?

Jyothi Arayambath, Dr

Rajeev Kumar, Dr

Manoj Kumar, Dr

SYMPOSIUM 15. TOPIC: GENDER DYSPHORIA IN CULTURAL CONTEXT

Kshirod K Mishra, Dr (Surg Cdr)

Surjeet Sahoo, Dr

Sally John, Dr

Samrat Kar, Dr

SYMPOSIUM 16. PIONEERS’ OF Indian PSYCHIATRY

R Srinivasa Murthy

SYMPOSIUM 17. IAPA Symposium: Depression and Addictions: A complex comorbidity

Ashwin A Patkar, MD

SYMPOSIUM 18. SYMPOSIUM PROPOSAL: Tracking Deviations in Neurodevelopmental Trajectories to Predict Adult Psychopathology

Vivek Benegal, Dr

Eesha Sharma, Dr

Bharath Holla, Dr

SYMPOSIUM 19. Title: Transforming Geriatric Psychiatry for the Next Decade- Developing Training, Services and Research

AQ Jilani

Dhananjay Chavan

PT Sivakumar

Mathew Varghese

SYMPOSIUM 20. CULTURAL ISSUES CONTRIBUTING TO THE CHANGING practice of psychotherapy in India

SYMPOSIUM 21. Symposium on Sample Size Estimation in Mental Health Research

B Das