ABSTRACTS FOR ANCIPS 2020

. 2020 Jan;62(Suppl 1):S30–S73.

ABSTRACTS FOR ANCIPS 2020

PMCID: PMC6991107

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F01: Pattern of mobile phone usage and psychological morbidity among Physiotherapy students studying in rural district of Karnataka

Background: Although mobile phones and the Internet are used as communication tools, excessive use of these technologies causes individuals to become addicted.

Aims: To study the pattern of mobile usage among physiotherapy students and to assess the psychological morbidity and quality of life of these students Methods: This descriptive cross sectional study was carried out among the physiotherapy students at Sri Devaraj Urs Medical College, Tamaka, Kolar. Data was collected using the Problematic Mobile phone usage questionnaire (PMPUQ) for pattern of mobile phone use, MINI Plus for psychological morbidity and the WHO QOL BREF to assess the quality of life of the students.

Results: Mean scores for the PMPUQ subscales were 8.61 for dangerous use, 9.21 for prohibited use, 17.66 for dependence and 24.21 for financial problems. Prohibited use and dependence had similar predictors suggesting a significant overlap between dependence and prohibited mobile phone use.14(23.32%) students had Major depressive disorder. 4(6.66%) of them had Mixed anxiety depressive disorder. 88.9% reported spending more than 30 min per day on the phone. The participants with excessive use of mobile phones had lower scores on the quality of life scale (p<0.001).Female students had better quality of life compared to the males.

Conclusion: Mobile phone dependence is an emerging public health problem with major psychological consequences. Hence promotion of healthy mobile phone use and appropriate therapy for dependence are of utmost importance.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F02: Role of Repetitive transcranial magnetic stimulation (rTMS) in management of Alcohol use disorders (AUD)

Dr P Patra ¹, Rajiv Saini ¹, SA Khan ¹

Background Alcohol use disorders are notoriously difficult to treat and have myriad social, psychological, and physical complications. Repetitive transcranial magnetic stimulation(rTMS) is a non invasive brain stimulation technique and is a relatively novel approach which has promising potential in treating addiction .

Aims To evaluate the efficacy of rTMS therapy in management of Alcohol dependence syndrome .

Methods The severity of dependence was assessed by Severity of alcohol dependence questionnaire ( SADQ) . Craving was assessed by OCDS: obsessive compulsive drinking scale. Comorbid mental illness were screened by GHQ 12. Patients included were those with long standing history of alcoholism, numerous relapses and absence of comorbid mental illness. 50 patients were exposed to high frequency rTMS of the right DLPFC in a single-blind, sham-controlled study. Participants were assigned to one of the two groups in which they received either real or sham rTMS .

Results There was a significant reduction in the post-rTMS craving score in the group allocated to active rTMS compared to the group allocated to sham stimulation Conclusion 10 daily sessions of high-frequency rTMS over right DLPFC had significant anticraving effects in Alcohol use disorder

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F04: Opioid Withdrawl Delirium-A Case Study

Binita Talukdar

Opioid is a psychoactive substance which have been used for analgesic and other medicinal purposes. Continued use of opioid can cause syndromes of abuse and dependence and withdrwal symptoms. Opioid withdrawl symptoms includes muscle cramps, bodyache, rhinorrhea, watering of eye, decrease sleep,Yawing, fever, diarrhea. Opioid withdrawl delirium is rare condition though it is more common in alcohol. Here we are presenting a case of “opioid withdrawl delirium”.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F05: Perceptions of Partner Drinking Problems, Regulation Strategies and Relationship Outcomes

Vivek Kumar R, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu

Introduction: Alcohol use can have negative effects on the relationships, especially if the partner's drinking is perceived to be problematic. Interpersonal perceptions and associations between partners’ perceptions of one another have important implications for individuals comprising a relationship.

Aims & Objectives: The objective of this study was to assess Perceptions of Partner Drinking Problems, Regulation Strategies and Relationship Outcomes.

Materials and Methods: This cross-sectional study consisted a sample size of 100 participants who are admitted for alcohol de-addiction in Mamata General Hospital, Khammam, Telangana. The samples were drawn using convenience sampling method. Thinking about your Partner's Drinking (TPD) questionnaire and Partner Management Strategies (PMS) questionnaire were the tools used to collect data for this study.

Results: The results will be discussed at the conference.

Conclusions: The conclusions will be discussed at the conference

Key words: Alcohol; Relationships; Partner management strategies.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F06: Risk Factors For Relapse Among Heroin Dependent Subjects: A Prospective Study

Mahajan P, Garg PD

Introduction- Heroin dependent subjects after detoxification can relapse and there can be multiple risk factors associated to it.

Aim- To study the socio-demographic profile & the risk factors for relapse in heroin dependent patients admitted in de-addiction centre.

Materials and Method- Present study was a descriptive, longitudinal, tertiary care-hospital based study including 200 consecutive heroin dependent subjects admitted in de-addiction centre followed over one year. A diagnosis of substance dependence was made based on ICD-10 criteria. The subjects were administered socio-demographic proforma and after discharge semi-structured proforma for risk factor assessment was applied to the relapsed patients at follow-up.

Results- All patients were male, most were married, educated up to higher secondary, farmers & from rural background, mean age of first heroin use was 28.67±9.43 years. Mean monthly family income was Rs.22584.5/month & mean monthly expenses of the patients with heroin dependence was Rs.18571.50. Possessing Per capita income more thanRs.20000/month & indulgence in those peer groups who were heroin dependent were most commonly observed risk factors for relapse present in (62.8%) & (61.5%) patients respectively. Association of duration of heroin use, Status of intravenous drug use, number of previous detoxifications & education status had a statistically significant association with status of Relapse (p<0.05).

Conclusion- Relapse following addiction treatment is very common. So there is an urgent need to cover all schools, colleges and universities with awareness programmes.

Keywords: Risk Factors, Relapse, Heroin.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F07: Perceived stigma and Affiliate stigma among family members of opioid dependent men and women: A cross sectional comparative study

Verma Kamini, Mandal Piyali, Mongia Monica, Ambekar Atul

Background: Stigma associated with substance use poses considerable burden on the family members. Experience of the same prejudice and discrimination as the stigmatised individual leads to psychological distress and diminished quality of life of caregivers which may further hinder treatment seeking.

Aim: To compare Perceived stigma and Affiliate -stigma among spouses of men and women seeking treatment for opioid use disorder.

Methods: This is a cross sectional, comparative, observational study. Sample consisted of 40 (20 in each group) spouses of male and female opioid dependent patients seeking treatment at a tertiary addiction treatment centre (as per ICD10). After applying exclusion and inclusion criteria participants were assessed using a semi-structured questionnaire (Socio-demographic), perceived stigma of substance abuse scale (PSAS) Affiliate stigma scale (ASS).

Results: The spouse husband group was older than spouse wife (39.30± 6.7; 39.30± 6.7 respectively). 55% of husbands were skilled workers and all the wives were house makers. The perceived stigma group (3.762±0.28, 3.543±0.29 respectively; p=0.02) and affiliate stigma in spouse husband was significantly higher than the spouse wife group (3.31±0.40; 2.78±0.56 respectively; p=0.02). No significant correlation was observed between any of socio-demographic variables (age, years of schooling) and the perceived stigma or affiliate stigma for any of the groups (p>0.05)

Conclusion: These findings clearly reflect towards the more stigmatizing attitude towards female substance use by the society and relatively acceptable attitude towards male substance use. The findings also partially explain delay in treatment seeking by female substance users.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F08: Internet addiction and quality of sleep in the under-graduate students of a university in southern India.

Manoj Shettar

Objectives: To study internet use and its association with sleep.

Background and Aim: Internet usage has become an integral part of everyday life. Excessive internet use can cause of functional impairments like marital or family strife, decreased job productivity, and legal difficulties. Research has shown that excessive use of Internet can result in addictive behaviour in some individuals. Our aim was to assess internet use in the students of Yenepoya University and evaluate its effects on quality of sleep.

Methodology/ Materials and Methods: A cross-sectional study evaluated 158 students of Yenepoya University using Internet Addiction Test (IAT) and Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics were applied. Pearson's bivariate correlation was done to see relationship between severity of Internet addiction and the sleep quality.

Results: Among 158 participants 76 (48.1%) were males, 82(51.9%) were females. Mean age of participants was 22.92 years. 68 (43.0%) had no internet addiction, 61 (38.6%) had mild addiction, 27 (17.1%) had moderate addiction, 2 (1.3%) had severe addition of internet. Among the participants 40 (25.3%) reported of poor sleep quality. A positive correlation was seen between IAT scores and PSQI scores (r: 0.185, p<0.005). A Pearson correlation coefficient of 0.185 indicates a small to moderate effect size.

Conclusion: Research exploring internet addiction and its impact on psychological parameters are in infant stage. Internet usage can result in addictive behaviours in certain individuals. Sleep is one of the factors that are influenced by the addiction to internet. Internet addiction is associated with poor sleep quality.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F09: A study to assess cognitive functioning in patients of Alcohol Dependence Syndrome

D Bhattacharyya, Mohd Ishaque Qureshi

Alcohol dependence is seen as a major health problem worldwide and in India. It is associated with Cognitive impairments in various domains with attention, memory and executive functioning. These impairments vary in their severities and have not been studied much in indian population. Our study used PGI memory scale of PGI Battery of Brain Dysfunction for assessment of Memory, Digital Trail making test B for Processing speed and Wisconsin Card Sorting Test CV4 (WCST) for evaluation of Executive functions after atleast 3 weeks of abstinence from alcohol. It was done on 50 patients of 20-50 yrs age group and matched controls over a period of 10 months at psychiatric centre of a tertiary care hospital. Results were compared with statistical tools and revealed significant association of cognitive impairment in all above said domains in patients of Alcohol dependence syndrome.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F10: “Udta Punjab” – An insight into the reasons behind the opioid epidemic in Punjab

Kanika Kumar

Background : Drug abuse is a phenomenon extending all over the globe. India too is caught in the same and Punjab has acquired the bane of drug abuse as an epidemic in the past few years.

Aim: This study was conducted with an aim to identify the causes behind opioid abuse so that effective strategies can be suggested to tackle the same .

Methods : 200 patients coming to the psychiatry opd at a civil hospital in Ludhiana district of Punjab for the treatment of opioid dependence were included in the study. A semi structured Performa was used to collect information about the socio demographic information. RFU scale was used which helps to identify antecedents for substance use to assess the reasons behind starting opioids

Results :It was seen that the most common reason of using opioids was as someone had offered them while the second most common cause was to avoid the withdrawal and overcome pain among the other reasons.

Conclusion: The study explains that the main reasons behind this opioid menace is cultural acceptance and as a method of self medication for conditions like chronic pain and substance withdrawal.

Key words : Opioid addiction , Punjab , dependence

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F11: Substance use patterns and personality profiles in individuals with substance use disorders attending a tertiary care centre

Prosenjit Ghosh, Anshuman Gogoi, Monu Doley, Bedawatee Bora Kabir

Background: Widespread prevalence of substance is detrimental to physical and psychological health of an individual in addition to inflicting economic and social burdens. Sociodemographic markers, personality profile and pattern of use play determinant roles in causation, continuation and outcomes of substance use.

Aims: Our aims included the study of sociodemographic variables, substance use patterns and personality profiles of individuals with substance use disorders.

Materials & methods: A hospital based observational study that included 70 subjects with substance use disorders diagnosed according to ICD-10, selected by purposive sampling conducted in SMCH, Silchar, Assam. Study subjects were divided into three groups based on type of substance used, namely alcohol, opioids, and others. Data regarding sociodemographic variables and substance use patterns were gathered using a semi-structured proforma and a questionnaire respectively. For assessment of personality, 16PF questionnaire was administered.

Results: Among the 70 participants, 38.6% were using alcohol, 40% opioids and 21.4% others (cannabis, tobacco chewing, benzodiazepine etc). Opioid users were significantly younger than the other two groups, tended to be unemployed with urban backgrounds. Alcohol users had a comparatively longer duration of intake. Stress relief (82.8%), easy availability (78.6%) were the commonest reasons cited to use substances. Personality analysis showed high score for all groups in factor O (apprehensive) (7.2), Q4 (tense) (7.1) and L (suspicious) (6.4), while low scores for C (lower ego strength) (4.0).

Conclusion: Substance use has to be dealt with pharmacological as well as non-pharmacological approaches focussed on the individual personality.

Keywords: substance use, substance use pattern, personality

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F12: Digital Gaming Addiction among Students

JGrahita, KSai Madhulika, CRadhakanth

Background: Digital gaming has become a most popular leisure activity in many parts of the world, which appears to develop problems most commonly among students. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational areas of functioning. Present study shows the prevalence of addiction to video and internet games among students.

Aim: The purpose of this study was to determine the Status of Gaming Addiction among Students.

Methods: A cross sectional study is conducted in NRI Institute of Medical Sciences and Anil Neerukonda Institute of Technology and Sciences among 150 students. The data been collected using Game Addiction Scale (GAS) which consists of 7 item questionnaire and Barratt's Impulsiveness Scale (BIS-11) comprising 30 item questionnaire to rule out level of impulsiveness.

Results: The detailed results will be represented through figures , charts and tables while presenting the paper.

Conclusions: Gaming disorders are on a rise, which can lead students to mood disorders, sleep disturbances, weight gain, head ache, and impairment in education. Outdoor games should rather be encouraged among students.

Keywords: Digital gaming, Addiction, psychological health , Students.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F13: Assessment of differences among treatment seeking substance dependent subjects across different age groups.

Pradeep Kumar, Mona Srivastava

Background-There are several bio-psychological & social factors contributing to substance abuse. These factors could differ in different age groups. This study provides important information regarding different Psychosocial factors in different age groups contributing to substance abuse which would help in planning better psychosocial intervention fitting to specific age groups.

Objective-This was cross-sectional study comparing sociodemographic characters among treatment seeking substance abuse patients to find out any corelates between substance abuse and sociodemographic factors across different age groups.

Method- All patients with SUD and without any comorbid physical or mental illness were included in the study. Patients were divided into three groups based on age group, each group consist of 30 participants and were applied DAST, SDS, CPC, SDS &AUDIT and applying using SPSS software.

Results- In Young adult prevalence of Tobacco-93.3%, Alcohol-56.6%, cannabis-20%,Opioid-20%, Benzodiazepine-6.6%, Polysubstance-83.3% in Middle age- prevalence of Tobacco-96%, Alcohol-76.6%,cannabis-16.6%,Opioid-16.6%, Benzodiazepine-10%, Polysubstance-96.6%. in Elderly age- prevalence of Tobacco-96%, Alcohol-23.6%, Benzodiazepine-6.6%, Polysubstance-23.3%.

Discussion- Our study showed tobacco is most commonly used substance followed by alcohol followed by cannabis and other substances. Prevalence of alcohol and illicit drugs use decrease with increasing of age.

Key word-SUD, DAST, SDS, AUDIT, Sociodemographic characters.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F14: Severe psychotic aggression in a youth with cannabis use - should we search for something else?

S Choudhury, A Basu, R Gupta

Background: A 21-year-old male presented to the emergency with severe aggressive psychosis. Preliminary exploration suggested presence of cannabis dependence.

Aim: To discuss the need for considering other possibilities in a case of severe aggressive psychosis with self-injurious behaviour in a youth with cannabis use.

Method: Case report

Result: The patient is a 21-year-old male from upper middle socioeconomic status, with premorbid temperamental traits of high novelty seeking, impulsivity, high intensity of reaction, low frustration tolerance, low threshold of responsiveness with history of marked oppositionality, disregard for rules. He presented with a 5-day history of acute onset severe aggression, unprovoked, self-injurious behaviour, referential and persecutory delusions. Initial exploration suggested cannabis use in dependent pattern. However the marked intensity of aggression among other unusual features prompted a consideration of other substance use. Urine screen was positive for amphetamines and THC. Acute psychotic symptoms treated with antipsychotics, injectable and later oral. Following resolution of acute symptoms, the patient reported using MDMA since the past 6-7 months in a dependent pattern along with tobacco and cannabis dependence, occasional alcohol use and past history of anabolic steroid injection use

Conclusion: Severe aggressive psychosis, in a youth with even a known substance use (eg. cannabis) should encourage exploration of other possible substances also reportedly associated with a similar but more violent, disorganised psychosis, such as in this case, MDMA.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F15: Smart phone addiction in medical students,a cross sectional study

K Sai Madhulika, J Grahita, C Radhakanth

Background: Usage of mobile phones has increased dramatically owing to their more affordability and availability all over the world among students. Although these are convenient and useful, students are becoming more and more dependent on them.

Aim: The purpose of this study was to determine the level of mobile addiction and the impact on the medical students.

Methods: A cross sectional study was conducted on a total of 200 medical students at NRI Institute of Medical Sciences, Sangivalasa, Visakhapatnam, aged between 18 and 21 years who were using mobile phone for at least 1 year. They were asked to fill up the 10 item questionnaire (Smart Phone Addiction Scale) that consists details of pattern of their usage of mobile phone and their effects.

Results: The detailed results will be presented through charts and tables.

Conclusion: Besides the positive role of mobile phones in our daily lives, its overuse presents negative impact on psychological health.

Key words: Smart phone, behavioral addiction , psychological health

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F16: Cognitive Deficit In Patients With Alcohol Dependence Syndrome And Its Course After Initial Treatment: 24 Weeks Follow-Up Study At A Ghpu In India.

D Bhattacharyya, Aijaz Ahmad, Arun Kumar Dwivedi, Rajiv Saini

Introduction: Alcohol dependence is a common worldwide problem and is a major cause of morbidity, disability and mortality in India. Habitual and excessive abuse of alcohol is known to induce cognitive deficits in multiple domains and is considered as a hindrance in successful management of these patients. The nature of these cognitive deficits has been studied and reported from studies in the western countries. Similar research from India has been scarce and course of these deficits is largely unknown. There is a dichotomy in the scientific literature regarding persistence of cognitive deficits after treatment. Our study aimed to find out the nature and extent of cognitive deficits using a Neuropsychological tool validated in the Indian population. We have assessed the patients for cognitive deficits at 2 weeks (as baseline to avoid possible cognitive impairment related to detoxification treatment), 6 weeks and 24 weeks to find out if there was a change in the deficits.

Materials and methods: The study was carried out at a GHPU (General hospital psychiatry unit) of a tertiary health care Centre in India. Eighty freshly diagnosed cases of alcohol dependence syndrome and 80 healthy controls were recruited for the study. PGI-BBD (Post graduate Institute – Battery of Brain Dysfunction) was administered on all patients at 2 weeks (along with socio-demographically matched controls), and subsequently patients were re-assessed at 6 weeks and 24 weeks.

Results: Compared to controls, cases had significant dysfunctions in all domains of PGI BBD (mean total dysfunction score among cases 20 and in controls 11.01, p=0.001). No significant difference was noted on dysfunction in the performance measures (Visuomotor tests). Significant dysfunction was noted in all subscales of Memory. Among cases, maximum dysfunction was noted in Immediate recall (63.3%), Attention & Concentration (59.5%), and Mental Balance (53.2%). Notably, significant number of cases were found to have severe dysfunction (Dysfunction rating score of 3) in all subscales, compared to none amongst control. These deficits improved significantly at 6 weeks compared to baseline. Thereafter, improvement was comparatively slow and noted to be present at 24 weeks with very little improvement.

Conclusion: There are significant cognitive deficits in patients with alcohol dependence syndrome and these deficits improve with abstinence and treatment during initial 6 weeks period. Subsequently no significant improvement in residual cognitive deficit noted at 24 weeks, implying a need for cognitive assessment and necessary targeted cognitive remediation during follow-up stage after initial de-addiction treatment.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F17: Prevalence and correlates of Smartphone Addiction among Medical students: A cross-cultural perspective.

Manik Inder Singh, A Mayor, Himanshu Sareen, SK Chturvedi, Manoj Kumar Sharma

Background: Smartphone addiction is a hot topic of debate in the psychiatry circle. The present study was conducted with the objectives of comparing the correlates of smartphone use and assessing addiction among medical students in India and United States.

Materials and Methods: A cross-sectional study was conducted among undergraduate medical students aged ≥18 years studying in a medical college in Punjab, India and Florida, USA from February 2017 to May 2017. A pretested self-administered questionnaire was used for data collection. Smartphone addiction was assessed using SAS-SV(Smartphone addiction Scale) Data were analyzed using IBM SPSS Version 24.

Results: The study comprised of 160 Indian and 75 American medical students with a mean age of 20.48 years. Self-reporting of smartphone addiction was higher among the American students 36% in comparison to 28% Indians. 69% American students in comparison to 33% of Indian students reported to use the phone > 12 hours in a day. Smartphone Addiction Scores were similar for both the groups and showed no statistically significant difference.

Conclusion: Although the use of smartphone varies according to nationality among the same population, the prevalence of smartphone addiction among this population is similar and alarming, if not managed will evolve as a global public health problem.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F18: Smart gadget addiction and its disadvantages among Under Graduate Students

Krishna Naik, T V Pavan Kumar, D Phanibhushan

Background: The modern smart gadget addiction and technology have become important determinants of socioeconomic status across all generations. Model smart gadget addiction is a critical area of interest in present era. Addiction to modern smart gadgets are causing significant loss of productivity and problems in interpersonal relations. Gadget addiction can be a manifestation of variety of anxiety, depression or impulse control disorder. Everybody should aware of potential danger of modern smart gadget addiction and technology. Smart gadget addiction damages social infrastructure in near future.

Methods: After approval from institutional ethics committee predesigned questionnaire is used in this cross sectional study among 60 Under Graduate Students. 5-Point Likert Scale is used for smart gadget dependency. Data collected was analysed by descriptive statistics and chi-square test.

Results: Most of the students had their first gadget experience between 15-21 years of age. More than 90% are using smart gadgets as their regular part of life. Half of the students are using smart gadgets more than 6 hrs/day and had difficulty in day to day activities.

Conclusions: Smart gadget addiction is high among under graduate students. Advantages and disadvantages of smart gadget addiction have to be clearly explained to prevent future complications.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F19: Study of knowledge, perceptions and attitude of nursing students about alcohol use and alcoholics

Sanchita Gour, Madhur Rathi, S Sireesha

Introduction: Alcohol is one of the most widely used drug substances in the world. Alcohol use and binge drinking among our nation's youth is a major problem. Most of the problems can be minimized, by making the public aware of the complications related to alcoholism. Nurses in mental health practice are an under- utilized resource for the detection and management of alcoholic patients but little is known about the knowledge, perceptions and attitudes of nursing students towards alcohol use and alcoholics and what is the change in their perception after they have gone through psychiatry posting.

Materials and Methods: Study design- Follow up and comparative study

Procedure: Written permission from the administrators will be acquired before conducting the study. 50 Nursing students who will be attending psychiatry postings and are willing to give written informed consent will participate in the study. Their socio-demographic details will be entered in the intake proforma. 'Seaman Manello Nurses Attittudes Towards Alcoholism Scale’ will be administered to nursing students to know about their knowledge, attitude and perceptions about alcoholics and alcohol use on their first day of posting. The same scale will be applied on the last day of their posting. Analysis of the study variables will be carried out using SPSS v2.0

Results: Will be discussed at the conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F20: Stressful life events and its relationship with risk of relapse in alcohol use

Shruti Agnihotri ¹, Madhur Rathi ¹, SSireesha ¹

INTRODUCTION: Alcohol is one of the most common encountered substance in the population. Unfavorable psychosocial factors, which can produce further stress, are isolation, monotony, low pay, the pressure to increase output, and lack of career opportunities which may contribute to poor morale and psychological disturbances. This in turn may lead to alcohol use, as employers as well as employees attempt to compensate for tensions. Stressful life events and chronic stressors have been correlated with excessive alcohol consumption and alcohol dependence.

AIMS: To study the stressful life events among cases of alcohol dependence syndrome and its association with the risk of relapse.

MATERIALS AND METHODS: A cross-sectional study will be done at institute of mental health, Erragadda, Hyderabad after approval of institutional ethics committee. A self administered proforma containing informed consent and socio-demographic profile of study subjects will be applied, followed by administering Presumptive stressful life events scale and Alcohol relapse risk scale.

SAMPLING: convenient sampling

INCLUSION CRITERIA: Participants include those who are willing to give informed consent, having reliable informant and diagnosed cases of alcohol dependence syndrome by International classification of diseases-10

A descriptive, analytical and inferential analysis of the study variables will be done by using SPSS v22.0

RESULTS: Will be discussed at conference

CONCLUSION: Will be discussed at conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F21: Prevalence of psychiatric morbidity and coping pattern among spouses of alcohol dependent males in the southern districts of Assam

Prakash Barman, HA Choudhury, Jayanta Kurmi

Background: The spouses are the main caretaker of the alcohol dependent males. They undergo tremendous stress which leads to various psychiatric morbidity and hence adapt different coping patterns influenced by their cultural and social background.

Aim: To assess the prevalence of psychiatric morbidity and coping pattern among spouses of alcohol dependent males presenting to a tertiary care hospital in the southern districts of assam.

Materials and Method: Cross sectional study conducted in a tertiary care centre, in department of psychiatry, SMCH, Silchar,in the southern region of Assam, . Data was collected by using semi structured proforma for sociodemographic details, SAD-Q (Severity of Alcohol Dependence Questionnaire) to assess severity of alcohol dependence and BRIEF COPE Inventory for the coping strategy. Psychiatric morbidity was assessed by structured clinical interview according to ICD10.

Results: Most of the spouses had psychiatric morbidity (53.57%) of which major depressive disorder(32.3%) was most common followed by anxiety disorders(11%) and persistent mood disorder (7.7%). The predominant coping strategy among the wives were found to be religious coping, acceptance and use of emotional social support.

Conclusion: Early identification and appropriate intervention will help to decrease the burden of psychiatric morbidity and will have a significant role in the treatment of ADS

Keywords: Psychiatric Morbidity, Spouses, Coping pattern, Alcohol dependent syndrome.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F22: Misuse of prescription opioids in chronic non-cancer pain with somatoform disorder

Opioids are prescribed in 4-17% of chronic non-cancer pain (CNCP) patients. Effective pain management requires initially a comprehensive assessment to establish a diagnosis and risks and benefits of prescribing opioids. There is limited research that characterises opioid use behaviours in such patients.

CASE DESCRIPTION: A 31-year-old married female presented with chronic pain of 5 years duration with prescription opioid misuse in the form of tramadol/paracetamol/ dicyclomine capsules for a cumulative period of 2.5 years. Pain initially abdominal, later generalised –to pain all over the body. She had received buprenorphine upto 2.4mg twice each for a period of 6 months with partial relief in pain and deterioration in functioning. Physical examination revealed slight edema in right knee joint with 11 tender points, carious teeth, loss of teeth and alopecia. Mental status examination revealed irritable affect and intense preoccupation with pain and prominent, frequent pain behaviours. After multi-departmental evaluation, a diagnosis of Sjogren's syndrome with SLE and Persistent somatoform pain disorder was made. A rheumatology consultation was taken for SLE and Sjogren's. Buprenorphine was tapered slowly and discontinued and Amitriptyline 50mg with Cognitive behavioural therapy for somatisation was initiated.

Follow-up over 3 months showed maintenance of improvement in psychosocial functioning.

CONCLUSION: The concerns in the management of CNCP with opioids in a case with co-morbid psychiatric disorder are: development of opioid dependence, dosage and duration of treatment, side effects and achieving expected outcomes. This requires a multi-disciplinary and comprehensive approach.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F23: Correlates of Opioid Abstinence in Patients Maintained on naltrexone as compared to buprenorphine.

Vikas Singla

Aim: To Compare Maintenance Rates and Correlates of Patients abstinent from opioid on naltrexone versus buprenorphine.

Background: Currently in India, Naltrexone and buprenorphine are the two main lines of treatment available for long term maintenance of patients of opioid dependence. But Still, we seem to have very high relapse rates on both of these treatments. Also, we don’t have much knowledge that what are the profiles of the patients who should get one of the these. So, in current study we have compared these two treatment options and have seen which profile of patient will do better on which type of treatment.

Method: It is a Prospective Study in which patients attending OPD and IPD of psychiatric department in Shri Guru Ram Rai medical college and Indiresh hospital were enrolled in study after taking written consent form. 40 patients on each of these treatments were enrolled and were assessed for other substance intake, socio demographic profile was seen and were followed for opioid abstinence and maintenance on treatment for 4 months.

Result: Patients who are literate and belonging to higher socioeconomic status and taking buprenorphine were able to maintain abstinence for opioids. Tobacco was the first drug used by most of the patients.

Conclusion: In our study we have found that Buprenorphine is better drug as compared to Naltrexone for maintenance of abstinence of opioids.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F24: Sexual Dysfunction In Males Of Alcohol Dependence Syndrome

Background: Alcohol abuse is the leading cause of impotence and other disturbances in sexual dysfunction. There is a myth that alcohol acts as aphrodisiacs , but evidence says chronic alcohol abuse causes sexual dysfunction . Sexual dysfunction may lead to marked personal distress and marital disharmony among couples . Not many studies done in our country.

Aim :To study prevalence & correlates of sexual dysfunction in ADS patients &to study association between Sexual Dysfunction & alcohol related variables.

Inclusion criteria: 1) Aged 20-50yrs ,

2)Having regular sexual partner .

Exclusion criteria: History of primary sex dysfunction ,comorbid psychiatric illness, dementia ,delirium ,Mental Retardation, Schizophrenia, Depression ,bipolar affective disorder, anxiety disorders ,medications affecting sexual functions like antipsychotics ,antihypertensives , steroids., medical problems like liver cirrhosis, diabetes mellitus, hypertension ,endocrine problems ,neurological and spinal lesions & genitourinary problems.

Materials and Methods:A male patients admitted with alcohol related problems in to tertiary care hospital were taken for study .Data was entered on semistructured intake proforma , ICD 10 for diagnosis of Alcohol Dependence Syndrome, SADQ for assessment of severity of ADS ,Arizona Sexual Experiences Scale for assessment of SD were used.

Results: Details of the patients including sociodemographic data , outcome will be tabulated , analyzed and discussed. Statistical package for the social sciences software will be used to compute.

Conclusion: Results so obtained will be discussed and conclusions will be drawn.

Key words :Arizona sexual experiences scale, Severity of Alcohol Dependence Questionnaire, Sexual Dysfunction

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F25: Cannabis and Catatonia – A Case Report

Ilambaridhi B, Ragul Ganesh, Siddharth Sarkar

Introduction: Catatonia is a severe motor syndrome that can occur in context of several psychiatric disorders including neurodevelopmental, psychotic, bipolar and other medical conditions. Association between cannabis use and psychosis is consistently reported, though catatonia has been infrequently described. We hereby report a unique case of cannabis induced psychosis presenting with catatonia.

Case Presentation: A 26 years old male, reported to have daily smoking of 6-8 joints of cannabis (ganja) since last 5 years. He had a past history of 2 episodes of psychosis during heavy cannabis use lasting for 1-2 months characterized by suspiciousness, delusion of persecution, reference and 3^rd person auditory hallucinations in the last 3 years which remitted with pharmacotherapy. With a recurrence of similar symptoms since last 3 weeks, at admission, he presented with mutism, negativism, posturing and passive withdrawal since 4 days with Bush Francis Catatonia Rating Scale (BFCRS) being 6. After treatment with Lorazepam his BFCRS score reduced to 0. BPRS (Brief Psychiatric Rating Scale) score for assessment of psychotic symptoms was 25. With olanzapine upto 15 mg, he showed marked improvement in interaction and other psychotic symptoms subsided.

Discussion: The clinical presentation of psychosis in cannabis users can be atypical and highly unpredictable from mild psychotic symptoms to severe substance intoxication delirium, and in this case catatonia. Pharmacotherapeutic interventions include prompt, adequate use of benzodiazepines and second-generation antipsychotic. Further research in the pharmacotherapy of cannabis-induced psychosis is required.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F26: Drinking-Related Locus Of Control And Its Relationship With Drinking Pattern : A Study In Telangana.

Divya R, Vijay Kumar M, PhanikanthK, UmaShankar M

Introduction: Substance abuse causes acute and chronic physical, psychological and social effects in varying amounts along with serious social problems in the form of crime, unemployment, family dysfunction and disproportionate use of medical care. Locus of control (LOC) refers to a person's perceived responsibility of one's behaviour.

Aim: To study the relationship between Locus of control and its relationship with the onset, abstinence, relapse and severity of Alcohol use disorder

Methodology: A cross sectional study conducted at tertiary care hospital at Hyderabad. Subjects who fulfill the inclusion and exclusion criteria will be taken after an oral informed consent.

Inclusion Criteria:

1) Who gave consent for the study.
2) 18-65 years.
3) Who are diagnosed with alcohol dependence syndrome according to DSM 5.

Exclusion Criteria:

1) With other co-morbid medical disorders.
2) With other comorbid substance abuse except tobacco.

Tools Used:

1) A semi-structured intake proforma.
2) DSM 5
3) Severity of Alcohol Dependence Questionnaire (SADQ-C).
4) Drinking-Related Internal-External Locus of Control Scale (DRIE).

Sampling Technique: Convenience sampling, 50 subjects

Statistical Analysis: SPSS software

Results And Conclusion: The DRIE scores were significantly correlated with the number of attempts at abstinence. Therefore, it is important to assess the locus of control in order to predict the relapse in such patients

Keywords: Alcohol Use Disorder, Relapse, SADQ-C, DRIE.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F27

Background and objective: People with alcohol use may present either with its medical or psychosocial impacts. Studies have raised the possibility that there may be differences in clinical and laboratory based aspects of these two groups. Our study aims to address this by comparing the clinical and laboratory variables between the two sets of subjects mentioned before.

Methodology: A cross sectional, hospital based comparative study was done including 90 patients each from two groups- people who got admitted to psychiatry ward due to psychiatric/ psychosocial issues and for alcohol de addiction purpose constituted the first group and people who got admitted to the gastroenterology ward due to alcohol related medical problems constituted the second group. Multiple clinical factors including age of onset of alcohol use, onset of dependence, family history of alcohol dependence and psychiatric disorders, salience of alcohol, withdrawal features, presence of minor psychiatric symptoms like anxiety and depression and level of functioning between the two groups were compared. The liver function test values were also compared between the two groups.

Results and Conclusion: The study has shown that there are similarities as well as significant differences between the two groups. Though these profiles are similar in certain characteristics like age of onset of alcohol use, family history of dependence, maximum period of abstinence and frequency of use they are different in certain key aspects like level of functioning, family history of psychiatric illnesses or suicide, average amount of alcohol use, salience, withdrawal symptoms and presence of depression. They are different in terms of values of Liver function tests except AST and GGT. With similar duration of heavy use, some subjects tend to develop medical complications from alcohol consumption as opposed to others who develop psycho-social problems from its use. The factors which lead to the development of such different profiles is less understood. The biological, genetic and environmental factors associated with these needs to be studied.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F28: A Cross Sectional Study Of Perception Of Aggression In Psychiatric Inpatients Among Mental Health Nurses in Hyderabad

Sanjeevani G, Phanikanth K, Madhur Rathi

Background: Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice.The way they perceive aggression plays an important role in treatment outcome. This study was undertaken to gain an insight into this situation. It aims to study the perception of nursing staff about the aggressive patients and the socio-demographic and psychosocial determinants associated with it.

Aim: To study on Perception of aggression in psychiatric inpatients among mental health nurses .

Materials and Methods: A cross-sectional study was done in 50 mental health nurses working in IMH, Hyderabad after the approval of institutional ethics committee . Sample was collected after they meet inclusion criteria and informed consent was taken. The intake proforma containing socio-demographic profile of the study subjects was completed followed by a questionnaire, Staff Observation Aggression Scale which assesses the perceptions of nurses towards aggressive patients.

After obtaining prior permission from the concerned authority participants were selected by convenient sampling technique.

A statistical analysis was carried out using SPSS v22.0 Results: Will be discussed at conference.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F29: A comparative study of academic stress, coping strategies and mental health among adolescents of government and private intermediate colleges in Hyderabad, Telangana.

Raga Sumedhu

Background : stress is an integral part of human's life.Anything that challenges or threatens one's comfort is a stress.In the current scenario,Academic stress among students has considerably increased owing to multitude of factors.

Aims : Current study aims at assessing and comparing academic stress among intermediate students of government and private colleges of Hyderabad,Telangana.

Current study also aims at exploring the relationship between academic stress, coping strategies and mental health of students .

Methods: A cross sectional comparative study is conducted on 100 students of private and 100 students of government intermediate college.

Educational stress scale for adolescents (ESSA) for measuring academic stress, Brief cope questionnaire for assessing coping strategies and positive mental health scale for assessing mental health were administered. The data obtained was analysed using SPSS software.

Results: Students from private college experienced higher academic stress than that of government college students . It was also found that academic stress had significant relationship with mental health of students.

Conclusion: Students with severe academic stress need to be identified as early as possible and awareness has to be raised among students , parents and teachers to create a healthy environment.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F30: A Study of Health Anxiety and its correlation with Depression in Medical Students (Interns and Residents) at a Tertiary Care Hospital

Sanket V Bhailume, Parth Mantri, Sharmishtha Deshpande

Background- Excessive health anxiety often affects Medical Students and has been long documented in various studies across countries, giving this condition its popular name: the Medical Student Disease.

This condition has not been adequately addressed and leads to hesitancy in help seeking behavior in this population. This has adverse consequences on the mental health of these professionals, leading to frequent burnouts, prolonged absenteeism and overall decreased productivity at work.

Our study aims at determining the presence of this condition and screening for depression in Medical students at a tertiary care hospital.

Objective- Assessment of health anxiety and its correlation with depression in Medical Interns and PG Residents

Material and method- 30 interns and 30 post graduate students will be administered the following 3 scales

1. Health Anxiety Inventory (HAI)
2. Semi-structured questionnaire specially designed for the study
3. Patient Health Questionnaire (PHQ)

Permission from the ethical approval committee has been obtained.

Analysis and Results Assessment of correlation between depression and health anxiety in interns and post graduate students will be done and results tabulated using appropriate statistical analysis. Results will be discussed at the time of presentation

Conclusion-To be discussed at the time of paper presentation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F31: Analysis of Clock Drawing Test in Alzheimer's disease, Vascular Dementia and Fronto-temporal Dementia

Dr Sanjukta Mukherjee

Background: Analyses of clock drawings have met wide clinical use as a cognitive screening tool.This test is very quick to apply, as well as acceptable to patients. It is easy to score and independent of culture, language and education. We will also try to establish the Clock Drawing Test (CDT) as a simple and ecological way to assess visuo-perceptual functions related to Dementia.

Materials and Methodology: After taking informed consent and fulfilling the inclusion and exclusion criteria the total 50 cases with various types of dementia (Alzheimer's disease, Vascular Dementia and Fronto-temporal Dementia) has been included in the study. The patients were evaluated by BMSE (Bengal Mental Status Examination) Scale. Then, Clock Drawing Test (CDT) scoring was performed based on standard procedure.

Result: It was observed that in Alzheimer's disease problem in semantic memory was observed and CDT scoring indicates the degree of severity of dementia. Vascular dementia presents with visuo-spatial defects whereas FTD presents gross planning problem and perseveration.

Conclusion: Simple and quick clinical diagnosis procedure and differentiate between various types of dementia (Alzheimer's disease, Vascular Dementia and Fronto-temporal Dementia) by applying a clinical test without performing costly imaging can be done.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F32: Post-stroke depression and lesion location: A cross-sectional study in a tertiary care center in South India

Lekshmi G I, Sivin P Sam, Reji Thomas, Roy Abraham Kallivayalil

Depression is a common neuropsychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD. A semi-structured proforma will be used and PSD diagnosed using MINI Plus interview. Hamilton depression Rating Scale was used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment Neuro-imaging provided information on site and side of lesion.

Results: will be presented later

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F33: Cross cultural variation in Kleine–Levin syndrome (East Vs West) from phenomenology to intervention

Background: Kleine–Levin syndrome (KLS) is a rare self remitting disorder usually affecting adolescent males,characterized by episodes lasting from 1 to several weeks.It comprises neurological (hypersomnia, confusion, slowness, amnesia) and neuropsychiatric symptoms (derealization and apathy,megaphagia, hypersexuality, anxiety, depressed mood, hallucinations, delusions) arising during episodes while patients are normal between episodes.

Aim: To study the phenomenological characteristics and differences in management techniques of KLS in our Eastern ethnic populations of India .

Case Description: we report 5 cases observed at Kalinga institute of medical sciences and AIIMS Bhubaneswar. The diagnosis was clinical and the patients remained normal inter-episodically. We compared the clinical characteristics of these 5 patients who had sudden onset,recurrent hypersomnia to those in other published cohorts.

Discussion: All five patients presented with hypersomnolence and hyperphagia without hypersexuality in contrast to western findings where hypersexuality is predominant.Patients tend to eat compulsively,in large amounts with predilection for sweet food,burgers etc.Keeping in line with our cultural background,our patients reported to eat larger amounts of local snack items ,puffed rice(Moodi), maggi, mixture etc.In contrast to abnormal EEG in KLS,our patients had normal EEG recoding with normal prolactin levels.Even though Lithium is the preferred drug for treatment as well as prophylaxis our patients had good clinical response with Lamotrigine which is not one of the routinely advocated treatments.

Conclusion: Patients with KLS treated in our setup exhibited differences in clinical characteristics over a wide cultural background.The phenomenology, investigations and newer treatment modalities should be given consideration while diagnosing and treating these patients for a favourable outcome.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F34: A Case Report Of Huntington's Disease With Psychotic Features

M Sasikala ¹, Venkatesh Madhan Kumar ¹

Case Summary : A 34 yrs female brought by husband with c/o sleep disturbance, suspiciousness, irritability , assaultive behaviour , multiple suicidal attempt , involuntary movements of shoulder & neck , Difficulty to walking , Talking to self , overfamiliarity for past 6yrs ,Insidious onset , gradually progressive and continuous in nature

Hopi : She was apparently normal before 6yrs . She was a housewife 6yrs back, she developed sleep disturbance, suspiciousness towards her husband for which her husband assaulted her and she fell down and sustained head injury . After few days her suspiciousness increased and she underwent multiple suicidal attempts . She developed involuntary movements of shoulder and neck muscles , difficulty in speech and walking for which she was evaluated and was diagnosed as Huntingtons disease and was started on T. Haloperidol and Benzodiazepines . For past 8 months she had quarrelsome behaviour with neighbours, wandering, claiming that she is wife of god, and found talking to self , saying that she heard voices of dead people calling her

Past History : NIL

Physical Examination: Conscious, oriented, moderately built , no pallo/icterus/cyanosis/clubbing/pedal edema/lymphadenopathy. She was normotensive. On CNS ,Choreo athetoid movements of both upper and lower limbs ,jerky dancing gait. Tone and reflex-normal .No cranial nerve palsy

Mental Status Examination : Alert , ambulant ,walks with husband support, partially co-operative,partially kempt,adequately dressed, gaze contact made, ill sustained ,rapport established with difficulty. PMA- Increased ,speech-relavant replies,slurring of speech ,Mood- Euthymic , Affect – restricted , Thought – Delusion of infidelity towards husband . Perception-No perceptual disturbance .MMSE – 7/30,Severe cognitive impairment

Diagnosis:Huntington's Disease With Psychotic Features

INVESTIGATIONS- CBC,RFT,LFT, ECG, ECHO, TFT, USG ABDOMEN – CYSTITIS ,EEG, MRI BRAIN- Cerebral atrophy with dilated lateral ventricles, GENETIC TESTING- POSITIVE

Management

T. HALOPERIDOL 5MG BD

T.SODIUM VALPROATE 500MG TDS

T.TRIHEXYPHENIDYL 2MG BD

T.DIAZEPAM 5MG HS

T.TETRABENAZINE 250 MG 2OD

Discussion: Huntington's disease is an autosomal dominant neurogenerative disorder which is presented with cognitive , motor ,and also psychotic features It is seen 1/10000 in population.Occurs at any age but especially in third or fourth decades. The molecular origin of this disease is CAG tri nucleotide increase in the Huntington gene which is located in forth chromosomes of short arm . Our patient presented with psychotic features initially and thereafter motor and cognitive impairment. Patient improved with antipsychotics, and tetra benazine . Associated neuropsychological disorders should be treated and genetic counselling should be given .

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F35: Impact of general versus regional anesthesia on cognitive function

Bhushankumar Bhagwan Kinge, Shobhit Jain, Sharad Kumar Mathur, Mona Srivastava

Background: Cognitive function often affected after surgery. Several etiopathological hypothesis have been suggested. Role of anesthetic agent in causing cognitive dysfunction is still controversial. The present study will compare the effects of general and regional anesthesia on cognitive functions among patients undergoing lower limb orthopedics surgery.

Methods: A total of 80 patients aged 20-60y, belonging to either sex, scheduled for lower limb orthopaedic surgery <120 minutes duration, with good physical status, and with ±20% ideal weight were included. Patients unwilling for consent, past anesthetic use, cognitive impairment, sub-normal intelligence, substance use disorder, psychiatric disorder, and chronic medical condition were excluded. Patients were randomized to receive either general anesthesia(n=40) or regional anesthesia(n=40) during surgery. After routine pre-anesthetic examination and laboratory investigations, Hindi version of mini-mental status examination scale was applied prior to surgery and at 24h, 2weeks, and 6weeks postoperatively.

Results: The prevalence of POCD at 24h, 2weeks, and 6weeks after the surgery was higher among general anesthesia group (80%, 52.5%, and 27.5% respectively) compared with regional anesthesia group (57.5%, 27.5%, and 15% respectively). When compared with regional anesthesia group, the cognitive domains related to orientation to time, place, registration, recall, and copying at 24h and recall at 2weeks postoperatively were significantly affected in general anesthesia group.

Conclusion: Although POCD has multifactorial etiopathogenesis, the role of general anesthesia cannot be completely refuted. Besides preoperative and intraoperative precautions, postoperative cognitive remediation techniques may be recommended. Further studies investigating effect of individual anesthetic agent in causing POCD is required.

Keywords: Anesthesia, Postoperative Complications, Cognitive Dysfunction

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F36: Socio-demographic and clinical correlates of patients with delirium in general hospital psychiatry

Subashree ¹, Poornachandrika ¹

Background: Delirium is one of the common preventable causes of morbidity and mortality in patients admitted to a tertiary care centre. Preventive measures and early identification for at risk patients may help in lowering the prevalence and faster recovery.

Aims: This study focusses on compilation of all possible correlates with delirium in a liason or general hospital. This study focusses on the description of factors, relationship between various correlates associated with delirium.

Methods: Patients presenting with delirium over 60- day period in a general hospital are taken into the study. Descriptive and Inferential statistics are used.

Results and conclusion: The result focusses on description and analysis of socio-demographic details, type of delirium, causative & risk factors, recovery time and management.

Keywords: delirium; liason psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F37: A study for comparison of caregiver burden and Behavioral and psychotic symptoms in Frontotemporal dementia and Alzheimer's dementia.”

Background: - Dementia is a syndrome that results in the progressive deterioration of cortical functioning including comprehension, memory and thinking. Alzheimer's disease (AD) is the most common cause of dementia accounting for 50-75% and Frontotemporal dementia (FTD) around 5-10% of dementia cases. Behavioral and psychological symptoms (BPSD) form a major part of the presentation of the dementia patients at psychiatric clinic and plays a crucial role in caregiver distress which in turn is a major determinant of welfare of dementia patients in society.

Aim: - The aim of this study is to compare care giver burden and BPSD in patients with FTD and AD.

Method: - We compared 15 FTD and 20 AD patients with respect to the Neuropsychiatric Inventory (NPI), Hindi Mini Mental State Examination (HMSE) and Zarit Burden Inventory (ZBI).

Results: - FTD patients obtained a significantly higher NPI behavioral score than AD patients (mean, 47.40±4.72 vs. 39.85±7.75; p = 0.000). The ZBI was higher in FTD than in AD patients (mean, 68.80±5.29 vs. 51.50±9.57; p = 0.000), and mean value of HMSE is higher in FTD than AD (19.13±2.92, vs. 9.50±4.75). Significant positive correlation between NPI and ZBI is observed in both groups. Non significant negative correlation between HMSE and ZBI is found in AD, while interestingly in FTD significant positive correlation obtained.

Conclusion: - More behavioral problem in FTD makes it difficult for patient's caregiver to manage patients at home this leads to rapid institutionalization, although severity of dementia is less.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F38: Comparison of Quality of Life and Disability between patients of Migraine with and without Depression

Background: Migraine is both commonly occurring and severely debilitating. Global Burden of Diseases, Injuries, and Risk Factors Study continues to identify migraine as a leading cause of disability worldwide. Depression is 2.2- to 4.0 times more common in patients with migraine compared to the general population, amongst other psychiatric comorbidities.

Aims and objectives: To compare Quality of life and disability in Migraine patients with and without Depression.

Materials and Methods: 30 study subjects included patients attending outpatient clinic or inpatient of Department of Psychiatry or Neurology of All India Institute of Medical Sciences (AIIMS), Rishikesh and fulfilling ICHD-3 criteria for migraine. Patients were assessed on Mini International Neuropsychiatric Interview (MINI), Inventory of Depressive symptomatology - Clinician rated (IDS-C), World Health Organization Quality of Life- BREF (WHOQOL-BREF) and Migraine Disability Assessment Test (MIDAS). Patients were divided into two groups of 15 each, migraine patients with and without depression. Both the groups were compared for statistical significance on various scales.

Results and Conclusion: Would be discussed in the presentation as the data collection is ongoing.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F39: A study of electrolytes and other metabolic parameters in patients with delirium.

Maj Sunil Kumar, D Bhattacharyya

Behavioral management of delirium patients is one of the important aspect of consultation-liaison psychiatry in hospital settings. Studies have indicated frequent disturbance in lab parameters in delirium patients but published data is predominantly from western cohort. Such studies and published data are scarce in Indian scenario. Hence, we have planned an observational study to be conducted over 12 months to study the electrolyte imbalance and other metabolic parameters in patients with delirium and compare the same with matched non-delirium controls. This study is an effort to trim down the gap in knowledge which is critical, given the differences in the hospital setting between the western world and India. This study is likely to help the treating physicians in their approach in diagnosing and managing in hospitalized patients and later on in treatment plan also. Awareness about lab variables is also likely to modulate physician's threshold sensitivity in overall management of patients with delirium.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F40: Anxiety And Depression In Caregivers Of Adult Patients With Epilepsy

M Sai Gaayathri, K Ramananda Kishore Kavi, K Narasimha Reddi, A Prasanth

INTRODUCTION & OBJECTIVES: Epilepsy is the most common neurological disorder after stroke. The chronic and repetitive nature of seizures can lead to many serious physical and psychological problems including social stigma, marital problems. Caregivers of these patients experience lot of anxiety and depression that itself will have negative impact on patient's quality of life. The Objective is to assess anxiety and depression in caregivers of adult patients with epilepsy.

METHODOLOGY:99 patients with epilepsy and their care givers who attended the department of Neurology, KGH hospital, Visakhapatnam over period of 2 months were enrolled. This is a cross sectional study. After taking informed consent, a semi-structured interview was conducted for patients and their caregivers. Anxiety and depression were assessed using HAM-A and HAM-D respectively for caregivers.

RESULTS:Among 99 patients, 45 are male and 54 are females. Among the caregivers, spouses are 47 and parents 52. The mean HAM-A score among caregivers is 15.11 (standard deviation: 4.5) with 46% having mild anxiety, 50% having moderate anxiety and 1% having severe anxiety. The mean HAM-D score is 15.44 (standard deviation: 7.8) with 12% having mild depression, 2% having moderate depression and 55% having severe depression.

CONCLUSION:Caregivers of patients with epilepsy are seen with an increased risk of anxiety and depression. This affects the care of the patients with epilepsy. Hence identifying the anxiety and depression in care givers and appropriately managing them is important to improve the quality of life in patients with epilepsy.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F41: Efficacy Of Adjunctive Extended Continuous Theta Burst Stimulation Over The Left Superior Temporal Cortex On Auditory Hallucinations In Schizophrenia: A Pilot Study

Pranav Charkhe, Nishant Goyal, Mahesh Kumar

Introduction: The auditory verbal hallucinations in schizophrenia has been associated with anatomic and functional anomalies. Functionally, neuro-imaging studies reported increased brain activity in verbal perception and production regions in the left hemisphere such as the superior temporal gyrus. Potential of repetitive transcranial magnetic stimulation (rTMS) as a tool to induce neuroplastic changes in humans has been recently demonstrated through the development of the new theta burst stimulation (TBS). So we intended to assess the efficacy of adjunctive extended continuous theta burst repetitive transcranial magnetic stimulation on superior temporal cortex, in patients with schizophrenia having auditory verbal hallucinations.

Materials and methods: 30 patients with schizophrenia having auditory verbal hallucinations were recruited for the study. Baseline symptoms of the patients were rated on Positive and Negative Syndrome Scale (PANSS), Auditory Hallucination subscale of the Psychotic Symptom Rating Scales (PSYRATS), Clinical Global Impression scale (CGI). Patients were randomly distributed into active and sham treatment group by double blind sampling method. Left superior temporal cortex was visualized and localized by neuronavigational system then extended continuous theta burst repetitive transcranial magnetic stimulation or sham stimulation was given on left superior temporal cortex 5 times a week (maximum 30 sessions) for 3 weeks. All patients were reassessed on PANSS, PSYRATS, CGI at the end of 1^st, 3^rd and 6^thweek. Changes in the scores were analyzed.

Results and Discussion: Would be presented at the time of presentation.

Keywords: Schizophrenia, Auditory Verbal Hallucinations, Continuous Theta Burst Repetitive Transcranial Magnetic Stimulation, Left Superior Cortex

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F42: Neurocognitive disorders in HIV/AIDS patients attending to ART Centre Victoria hospital Bangalore: A Prospective cross sectional study.

Amit kumar A Kalagi

Background: Hiv infected individuals on national AIDS control organisation NACO india based HAART regimen often continue experiencing neurological complications reffered to as hiv associated neurocognitive disorder HAND.

Changes in memory, mood, attention, and motor skills are common in hiv infected patients and present in diagnostic challenge to the clinicians. Hiv enters the brain shortly after infection and has predilection for the subcortical region brain areas. The cognitive impairment is attributed to hiv replications in the brain and liberation of inflammatory neurotoxins leading to neuronal dysfunction.

Aim: To evaluate the neuro cognitive disorder in patients with hiv on HAART .

Methodology: It is a cross-sectional study done in BMCRI and attached hospitals, Bangalore. Five patients diagnosed as hiv belonging to the age group 21-50 years, with education status of 10th standard passed and who give informed consent were included. International HIV dementia scale applied. Then MINI Screening for Psychiatric diagnosis was applied. Neuropsychological test battery that provide both quantative and qualitative measures for a range of cognitive abilities. All the data obtained was entered into SPSS 24th version and then analyzed.

Result: HIV associated mild neurocognitive impairment has more prevalence than HIV associated dementia in our study. Affecting domain of memory, attention concentration, psychomotor speed, praxis and language and orientation. Mild neurocognitive impairment showed in two domains by one standard deviation and hiv associated dementia showed impairment in two cognitive domain and two standard deviation by neuropsychological test.

Discussion and conclusion: Timely detection of cognitive dysfunction in hiv patients is crucial as HAND could affect patients daily living as medication adherence employment, driving and so on . We therefore conducted this study to find out neurocognitive disorders in hiv/aids patients on HAART .

Keywords: HIV associated neurocognitive disorder, on HAART, IHDS,MINI PLUS, NEUROPSYCHOLOGICAL TEST BATTERY

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F43: A case of Tuberous sclerosis with intellectual disability

Shweta Morwal, Disha Parikh, Krishna Kadam, Nishikant Thorat, Vanshree patil

Introduction: Intellectual disability is a generalized neurodevelopemental disorder characterized by significantly impaired intellectual and adaptive functioning. It also has genetic etiology. Tuberous sclerosis is one of such syndromes which is a rare multisystem autosomal dominant genetic disease that causes non cancerous tumors and characterized by seizures, intellectual disability, developmental delay, behavioural problems, skin abnormalities, lung disease, and kidney disease.

Case Details : A 14 years old unknown male was brought to tertiary care hospital, after he was found in a public transport bus having behavioural disturbances in form of easily irritable, assaultative behaviour, and shouting spells. On admission for control of agitation we started him on Tab. Sodium valproate (600mg), Tab risperidone (6mg).Since he had multiple skin lesions dermatology reference was done and diagnosed with adenoma sebaceum . Medicine reference was done as he had an episode of convulsion in ward in the form of uprolling of eyeballs, tonic clonic movements of hands and legs, frothing from mouth followed by confusion. On further evaluation he was diagnosed of having tuberous sclerosis. With the help of psychiatric social worker, we were able to locate his caregiver. On further evaluation his father had adenoma sebaceum and mild intellectual disability.

Conclusion: Present case suggest intellectual disability often runs in families and caregiving in such situation can be challenging task and may lead to improper care, abandonment and destitution leading to exacerbation of symptoms. Hence when such cases present to tertiary care setup, a holistic management plan to ensure optimum illness management and good quality of life is required.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F44: A study on Stress, Anxiety and Depression among Caregivers of the patients with Dementia in a Tertiary Care Hospital in Eastern India.

Sk Kamal Hassan ¹

Background: Dementia is the leading cause of disability in aged people and has a major impact by reducing the capacity to live independently. This condition of dependency involves all members of the family, particularly those who take direct care of patients. The changes that take place in caregivers’ lives may alter their health and have an effect on the care of the sick.

Aims: To determine the presence of stress, anxiety and depression in caregivers of Dementia patients.

Methods: A descriptive cross-sectional study was performed in 60 principal caregivers of Dementia patients from the cognitive Clinic of Dept.of Psychiatry, R.G.Kar MCH, Kolkata,W.B. Caregivers were evaluated for intensity of Stress with the Kingston Caregiver Stress scale and for both depression and anxiety using the respective Hamilton scales. Suitable statistical test were used.

Results: 80% of caregivers were female, and 53% were older than 50 years. Majority (80%) of caregiver exhibited high level of stress; 17% high anxiety symptoms; and 66% had moderate to severe depressive symptoms. A significant association was found in the Chi-squared test between intensity of stress in caregiver and depression.

Conclusion: Caregiver stress was associated with depression. It is important for health professionals to include caregiver assessments in the treatment protocols of dementia.

Key words: dementia, caregiver stress, anxiety, depression.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F45: A study of association of depression and anxiety disorders with quality of life, social support and stress among geriatric people living in an old age home”

Background: Geriatric Population is challenged by many psychiatric problems. People living in an old age home are likely to have poor social support and they are likely to experience higher stress compared to general population. Prevalence of depression and anxiety disorders are more among them which leads to poor quality of life.

Method: This was an observational, cross sectional, single- centered, interview based study of total 196 participants of both gender above 60 years of age living in old age home of tier three city of Western India from June 2018 to November 2018. Interview was taken for diagnosis of Depression and Anxiety disorders using DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) Criteria. Every participant was assessed by proforma containing demographic details, questionnaires of MMSE (Mini mental Status Examination), GDS (Geriatric Depression Scale), GAS (Geriatric Anxiety Scale), WHOQOL BREF (World Health Organization Quality of Life) and DUSOCS (Duke Social Support and Stress Scale) for assessment of cognitive status, depression and anxiety disorders, quality of life, social support and stress respectively. Statistical analysis was done with graph pad instate (version 3.06) using Chi-square test, Mann-Whitney test and Spearman Correlation. A P value of < 0.05 was considered statistically significant.

Results: Frequency of depression and anxiety disorders among, participants was 33.16% and 18.88% respectively, Depression and anxiety disorders had positive correlation with social stress (Spearman r = 0.3443, p = <0.0001 and Spearman r = 0.3073, p = <0.0001). We found negative correlation between Depression and social support (Spearman r = _0.1567, p = 0.02). Participants with depression and anxiety disorders have poor quality of life (for depression P < 0.0001; for anxiety disorders p = 0.0002, < 0.0001, <0.0001), poor social support (p=0.04) and higher social stress (p = 0.0001; 0.005).

Conclusion: Participants with depression and anxiety disorders had poor quality of life, poor social support and higher social stress.

Keywords: Depression, Anxiety Disorders, Quality of life, Social Support and Stress.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F46: A study of socio-demographic profile, phenomenology, psychological stressor and life events in dissociative and conversion disorder patients.

BACKGROUND: Conversion disorder described as loss or alternation in sensory or voluntary function, that cannot be fully explained by known pathophysiological mechanism. Conversion symptoms are thought to be the result of an unconscious conflict, which is converted into symbolic symptoms that relieves anxiety, protect the ego from stressful situation.

AIM: To Study socio-demographic profile, phenomenology, preceding psychological stressor, life event in dissociative patients and their possible difference between male and female dissociative patients .

METHOD: This cross-sectional study was conducted at a tertiary care centre. The study sample comprised of 66 patients who were diagnosed as dissociative and conversion disorder as per ICD10. Tools used in this study were semi-structured socio-demographic profile Performa Presumptive Stressful Life Events Scale (PSLES) and Life Events Scale for Indian Children (LESIC).

RESULT: In the study sample, dissociation was more prevalent among 15 to 19 years (40.91%) age group. Half of females and three-fourth of males were married, gender difference with respect to occupational status of dissociative patients was statistically significant (p = 0.004), no significant difference observed between genders for the type of presentation. In our study we found approximately 4 life events in our patients.

CONCLUSION: Psychosocial stressors are correlated with the development of conversion disorder. Both genders tend to develop symptoms of conversion disorder after stressful events. Detection of exact nature of correlates seems to have immense potential for therapeutic as well as preventive field.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F47: Psychogenic Dysarthria: A case Report

Chintan Savani, Chirag Barot

Introduction: Functional Neurological Symptom disorder or Conversion disorder is a condition in which there are somatic symptoms or deficits present in the absence of definable organic cause. The most common presentations are Pseudosensory symptoms, Pseudoseizures, Pseudoparalysis & Psychogenic movement disorders. Psychogenic speech disorder is a rare presentation.

Case History: Here we present a case of 64 years old, Muslim, married, illiterate female patient. Patient came to Psychiatry OPD with slurring of speech, childish speech, headache, sleep disturbance since 3 months. Patient was referred to Physician and was advised MRI BRAIN which suggested no brain pathology except changes due to chronic hypertension and due to age. On detailed evaluation it was found that patient was having these symptoms when she has to do household work more and symptoms tend to improve on taking rest or by sleep. Cognitive examination showed no significant abnormality. Patient was also admitted for unilateral pseudoptosis in 2017 and improved on psychotropic medication and was diagnosed with Functional Neurological Symptom Disorder. Patient was put on Tab.DULOXETINE20mg,Tab.PREGABALIN75mg+NORTRIPTYLINE10mg+METHYLCOBALAMIN 1500mcg. Patient showed improvement on follow-up with significant reduction in childish & slurred speech.

Discussion: Existing literature on conversion disorders of speech is limited, therefore this case aims to complete the knowledge of various forms of conversion disorder or Functional Neurological Symptom disorder. It is difficult to understand and accept the psychogenic background of the symptoms produced in conversion disorder and suggest that it requires long term psychotherapy.

Key words:

Functional Neurological Symptom Disorder, Slurring of speech.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F48: Mass Psychogenic Illness: a report & short review

Anantprakash S Saraf, Sharad Manore, G K Vankar

Mass psychogenic illness also known as mass hysteria is defined as the epidemic occurrence of a series of physical symptoms in the absence of organic disorder. In current diagnostic classificatory system, it is subsumed under somatoform disorder, specifically conversion disorder. Episodes are characterised by transient and benign symptoms; rapid onset and recovery; occurrence in a segregated group; extraordinary anxiety; spread via line-of-sight, sound, or oral communication; typically down the age-scale beginning in older or higher status persons; with preponderance of female participants, adolescents and pre adolescents; rapidly dissipating once the threat is perceived to have passed; often escalated after increased attention confirming suspicions that there was a serious health threat, loose language by media, exclamatory, exaggerated descriptions.

We present here a case where a group of 21 adolescent school going children from same class hailing from an underdeveloped tribal village, admitted to our hospital with vague complaints of feeling uneasiness in abdomen followed by sudden loss of consciousness and fall, which recovers completely after few minutes to half an hour. Similar to previous reports published elsewhere, this incident also started with an index case, typically belonging to influential higher status family with stressful family environment. The children were examined by the paediatrician and all necessary investigations were done, revealing no physical illness in any of them.

All the children and their parents were reassured and counselled regarding the nature of illness and how to handle the situation. We also held a group discussion with the children, their parents, teachers, authorities and media persons to explain the illness behaviours and the phenomenon of mass psychogenic illness. All of them were discharged after 2 days with no further recurrence reported. Here we emphasise the importance of prompt identification of the episode as mass psychogenic illness, firm reassurances and proper psychoeducation of the patients, their family and caregivers for early recovery and avoiding unnecessary sensationalization by authorities and media.

Keywords: mass psychogenic illness, mass hysteria, epidemic hysteria

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F49: Stress, Burnout And Quality Of Life Among Obstetric And Gynaecology Residents – A Cross Sectional Study

Ilavarasi Kulandaivelu

Introduction:It is known that doctors suffer from high levels of psychological disturbance . Unfortunately, many myths about medical profession abound, such as that doctors are not at risk from stress ,but doctors at all levels are human ,therefore are bound to all limitations and frailities as their patients.

Post graduate doctors are found to be more stressed and burned out especially the residents of obstetrics and gynaecology with a more gruelling field to work .Medical profession however fails to discuss stress with colleagues, while peers prefer to ignore obvious symptoms of stress of their fellow medical practitioners. Few Indian and a handful of western studies have been found to throw light on this hence , the need for the study.

Aim of the study is to gain further insight into the prevalence of stress and burnout and the quality of life among residents in obstetrics and gynaecology

· To determine the prevalence of stress and burn out in obstetrics and gynaecology residents

· To determine the quality of life among the residents of obstetrics and gynaecology

· To determine the factors predisposing to the stress and the burnout.

Methods: It is a Cross - sectional study. All Postgraduates willing to participate in the study were enrolled. Socio demographic details like age, marital status, whether living with children were recorded. Privacy maintained by allotting code numbers. Scales like General health questionnaire (GHQ),Quality of life (QOL), Perceived stress scale and Mashlach burnout inventory,social support questionnaire were used. Data analysis done using SPSS -16 software.

Results : will be revealed at the time of presentation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F50: Correlation of sleep with stress in postgraduate residents of private medical college ( SAIMS)

Neet Raj Gaur

Introduction:-Postgraduate medical field is a transitional stressful period of medical students life. During this period students acquire both academic & professional skills in short duration. To compound the issue personal factors and relationship issues, increases the perception of stress. Sustained stress may increase rate of anxiety, depression, & even sucidal tendencies. Many studies done to evaluate stress in undergraduate & postgraduate residents but very few studies have correlated stress to quality of sleep.

Aim:-To evaluate & compare stress & sleep among post graduate residents of private medical college in Indore (M.P.).

Materials & Methods:-This was a cross sectional observational study group of 150 post graduate residents were evaluated on self administered Perceived stress scale and Pittsburg sleep quality index (PSQI).

Result : Under Analysis

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F51: A case of pediatric onset trichotillomania with Trichophagia and trichobezoar.

Vibha Tomar, Ananya Mahapatra

Introduction- Trichotillomania (TTM) is an impulse control disorder with chronic hair-pulling, distress and impairment¹. TTM is estimated by smaller studies to affect 1–3.5% of late adolescents and young adults, rates among younger children remains unknown². People experience medical complications such as skin irritations at the pulling site, infections and the subset of individuals with TTM who ingest the hairs after pulling are at risk of gastrointestinal complications stemming from trichobezoars, which have been documented in children as young as 4 years of age².

Case history- We present a case of 14year old female, referred to psychiatric OPD for consultation admitted in surgery department with trichobezoar. On history she had illness with onset at 4 years of age, gradual progressive course characterized by pulling of scalp hair initially, once hair grew she started to pull them as well as to put them in mouth or chew the strands. This increased in frequency with progression of illness, by 7-8 years of age she also started to play with curling strands before she ate them. She would not throw away broken strands after combing her hair and do the same with them. Her mother tried to braid her hair to stop her, but she always opened them even during the school and try to often sneak into toilet or lonely place so she could not be caught. She was often mocked by other children at school or home and she had difficulty in making friends. She presented to RML hospital in April 2019, due to complaint of abdominal pain for 3 months with vomiting and decreased appetite. Routine investigations Hb-7.9. CECT abdomen- matted density in lumen of stomach and proximal duodenum, Gastrodudenoscopy- trichobezoar. Postop she was started on fluoxetine 20 mg, followed on monthly basis. Currently she is maintaining well with improvement in her habit of pulling or chewing or eating her scalp hair.

Discusssion- TTM has common pediatric onset and significant morbidity in adults. We have little knowledge about the phenomenology, prevalence and management of young onset TTM. It could be explained due to obstacles posed by developmental factors like child's own awareness about the urge/distress, difficulty in expressing themselves, discrepancy among the informants and child, lack of standard tools/measures for pediatric population.

Keywords-Trichotillomania; pediatric; hair-pulling; impulse control disorder.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F52: Obsessive compulsive disorder (OCD)

Rajmal Meena

Background;- Obsessive compulsive disorder (OCD) is characterized by the presence of obsessions (intrusive and unwanted repetitive thoughts, urges, or impulses that often lead to a marked increase in anxiety or distress) and/ or compulsions (repeated behaviours or mental acts that are done in response to obsessions). OCD patients report general impairment in their functioning and family burden. They also suffer from disability in several areas of daily life.

Methods;- This study has a cross-sectional design, and we included total 200 consecutive selected OCD patients diagnosed according to International Classification of Disease (ICD)-10.

Results ;- We found that most of respondent included in our study were married male (74%), belonged to Hindu religion and urban background (68%) with mean age of 33 year (SD=9.91), 88% subjects were found to be employed in our study, educated middle standard and above. In our study, maximum disability was noted in domains of work (mean score 1.10) and communication & understanding (mean score 0.70), the impairment in interpersonal activity was lesser (mean score 0.34). The domain in which the maximum burden was found among family members is disruption of routine/ family activities overall (52%).

Conclusion;- The study aimed at assessing the burden in families and disability in subjects having OCD. Subjects were of either sex having age 16 and above. All subjects were assessed using following structured clinical instruments, Yale-brown symptom check list, Yale-brown obsessive-compulsive symptom severity scale, family burden interview, and Indian Disability Evaluation & Assessment Scale.

Key words;- OCD, Disability, Family burden, Sociodemographic Profile

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F53: Comparative Study of Stress in Depressed and non Depressed Undergraduate Medical Students

Abhinav Pandey, Amit Singh, AKPandey, Pankaj Sureka

Background and Aims: Stress is common among Medical students. Depression is also commonly seen among medical students. Differentiating Stress and Depression is important as both may require different management approaches. In this study, we tried to see the level of Stress and compare its severity among Students with and without Depression.

Methodology: A cross sectional study was done from January 2018 to January 2019 on 50 undergraduate medical students each from 1^st, 2^nd and 3^rd professional Years of IMS, BHU, and Varanasi. Students Stress Dimension Questionnaire was used to asses for Stress levels and categorise various domains affected. Also, Hamilton Depression Rating Scales was used to measure the Depressive symptoms.

Results & Discussion: Overall prevalence of Stress in Medical Students was found to be 66.7%. 66.67% students of who had significant stress were also found to be having Depression.

Conclusions: Depression and Stress are two different aspects of Psychological Morbidity. Differentiating them might provide better insight for targeted interventions.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F54: A Study on stress and coping among mothers of children with mental retardation (MR) attending General Hospital Psychiatric Unit (GHPU)

Rekha HG ¹, Arun Kumar C ¹, Sameer Belvi Mangalwedhe ¹

Background: Worldwide, the prevalence of Mental retardation is as high as 2.3%. Caregivers of children with intellectual disability have greater responsibilities and stressful life as intellectual disability involve impairment in areas of communication, academic and social skills which make them dependent on caregivers compared to other normal children. Majority of the times mothers are the primary caregivers and they go through stressful situations while taking care of the child.

Aims: To study stress, coping in mothers of children with Mental Retardation.

Materials And Method: A Cross- sectional study was conducted on 133 mothers of mentally challenged children in a GHPU. Information regarding socio demographic data was collected using semi structed study proforma. FISC-MR (Family interview for stress and coping in mental retardation), a tool developed by NIMHANS, Bangalore was used to assess stress and coping styles in mothers of intellectually disabled children.

Results: Statistical analysis found that there is a negative correlation between the amount of stress and degree of coping which was not significant. In subgroup analysis significant correlation was found between family emotions and financial stress(P<0.05).

Conclusions: Thus, there is a greater need to identify the stressful areas among mothers of such intellectually disabled children by health professionals and plan appropriate interventions in the form of developing coping strategies to prevent psychiatric morbidity and improve quality of life among them.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F55: Managing Dissociative Disorder in students through Stress Domain Mapping

Dr Vinod Verma ¹, Prof Sanjay Gupta ¹

Background: Dissociative Disorder is often preceded by stressful life events or psychological trauma. We hypothesize that apart from major life stressors common daily stressor across multiple life domains are involved in, or lead to, the development of Dissociative Disorders and effectively identifying these provides effective specific targeted intervention.

Objectives:

1. Mapping stressors in students presenting with Dissociative Disorder through PSLE & SSDQ.

2. Analysing the Stress Domain Mapping (SDM) over time as an outcome measure of response.

Method: 100 students of Dissociative Disorder (convulsion type)(ICD-10 DCR) of age group 14- 30 years, presenting to Psychiatry O.P.D. of I.M.S, B.H.U. were randomly allocated to either of the two study groups i.e. Stress Domain Mapping with PSLE (SDM-ps) or Stress Domain Mapping with SSDQ (SDM-ss). They were assessed at baseline and followed up at 1week, 2weeks, 4weeks and 6weeks. Psychotherapeutic Intervention was based according to the Domain specific mapping elicited through PSLE & SSDQ respectively.

Results: We found mean number of stressor to be 4.76 in SDM-ss group and 0.820 in SDM-ps group (P< 0.05). Reduction of stress load correlated with clinical response showing the growing impact of common daily stressor in disease production and maintenance.

Discussion: Our study establishes the utility of the SSDQ in Dissociative Disorder as an effective tool detecting stress holistically over different dimensions important for planning further individualized targeted intervention.

Keywords: SSDQ, PSLE, SDM, ICD-10

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F56: A Study On Association Of Pregnancy Specific Anxiety And Adverse Labour Outcomes

JishnuVJ, MruthyunjayaN, Shashidhara H L, Vinod G Kulkarni

Background: Maternal prenatal anxiety and stress have been positively associated to adverse labour outcomes and physical health problems in offspring. There are few studies regarding pregnancy-specific anxiety (PSA).

Aims: To explore and understand the experiences of pregnant women (18-35 yrs.) regarding the components of PSA and to estimate its correlation with adverse labour outcomes.

Method: The study was undertaken at SSIMS & RC, Davanagere, from October 2018 to March 2019. The participants who met the inclusion criteria were screened with PSA-I (Pregnancy Specific Anxiety Inventory) and followed up till delivery.

Results: The number of LSCS deliveries increased consistently with increase in pregnancy specific anxiety, as 62.5% and 39.09% of ladies with severe and moderate PSA had undergone LSCS, as compared to 28% and 25% of ladies with mild or nil PSA. Occurrence of emergency LSCS as compared to planned ones also followed similar trend. Furthermore, the association of PSA with Low birth weight and pre term delivery yielded almost identical results with 62.5% and 37.5% of ladies having severe and moderate PSA respectively delivering LBW babies, and 25% and 21% delivering at a preterm date.

Conclusion: The findings suggest that pregnancy specific anxiety is a core predictor of adverse labour outcomes. A routine screening of pregnancy anxiety needs to be integrated into antenatal care. Specific interventions to minimize adverse labour outcomes could be a future research area.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F57: Impact of stress assessment and management in Irritable bowel Syndrome

Nitesh Kumar Singh, Professor Sanjay Gupta

Background- Irritable bowel syndrome (IBS) is a functional bowel disorder that commonly presents with array of symptoms including abdominal discomfort and altered bowel habit. Psychological stress is an important factor for the development of irritable bowel syndrome (IBS). More and more clinical and experimental evidences are showing that IBS is a combination of irritable bowel and irritable brain. Life stresses not only contributes to symptom onset but also in exacerbation in the majority of patients with irritable bowel syndrome (IBS).

Aim & objective- Our study aims at finding the correlation between stress and IBS severity and impact of domain specific stress management on IBS over time.

Methodology- This is a hospital based longitudinal study. Sample size consists of 60 patients of age group 18-50 years fulfilling the Rome IV criteria for Irritable bowel syndrome. Stress was assessed using Student Stress Dimension Questionnaire (SSDQ) at the baseline. IBS severity was assessed using IBS Severity Scoring System (IBS-SSS). Correlation was assessed between Cumulative Stress Loading (CSL) and IBS-SSS scores. Stress domain specific Interventions were given to the patients to reduce CSL and patients were reassessed for IBS severity over 2, 4 & 6 weeks.

Results- The results showed significant correlation between cumulative stress loading and IBS severity. Intervention targeted toward reducing stress in impaired domain resulted in significant reduction in IBS severity overtime.

Conclusion- Our study highlights the importance of stress assessment and management in IBS patients. IBS is a stress sensitive disorder; therefore, the treatment of IBS should focus on managing stress and stress-induced responses.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F58: Intersecting psychosocial issues in Somatic Symptom and related disorders.

Akshat Varma, Swayam prava Baral, Dheerendra Mishra

Introduction: Somatic symptom and related disorder is a new category in DSM V including diagnoses of somatic symptom disorder, anxiety illness disorder, conversion disorder, psychological factors affecting other medical conditions, factitious disorder and other specified and unspecified somatic symptom and related disorders. A number of factors contribute to this disorder including genetic , biological and psycho-social vulnerabilities. Variations in symptom presentation are likely the results of the interaction of multiple factors within cultural contexts that affect how individuals identify and classify bodily sensations, perceive illness and seek medical attention for them.

Objective: This study aims to identify various psychosocial issues related to Somatic Symptom and related disorders.

Methodology: 50 individuals attending Psychiatry OPD in SSMC, Rewa were interviewed, Somatic Symptom scale and Life Event Scale were applied to delineate the required data for the study. Inclusion Criteria- Individuals between 15-60 years and criteria as per DSM V for Somatic Symptom and related disorders. Exclusion - Any other psychiatric or physical illness. Required interventions were given in the form of psychotherapy and pharmacotherapy.

Result: Disturbed family environment, death of spouse, failed marital relations and financial issues were found to be prominent causes.

Conclusion: This study is in conformation with bio-psycho-social model of somatic symptom disorder and gives a direction to psychological interventions in somatic symptom disorder.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

A descriptive study of pattern, clinical and demographical profile of inpatient psychiatry referrals in a tertiary care teaching hospital

Varchasvi Mudgal

Background: Consultation-liaison psychiatry is an area of clinical psychiatry that encompasses clinical understanding, teaching, research activities of psychiatrists and allied mental health professionals in the non-psychiatric divisions of a general hospital. There exist numerous inpatients in a tertiary care hospital having a psychiatric disorder along with medical axis. The research in India in field of Consultation liaison is strikingly low.

Objective: to investigate the socio demographic profile, psychiatric subtypes and physical subtypes of illness in patients admitted in other departments who were referred to psychiatry.

Methodology: The samples comprised all consecutive inpatients who were referred for psychiatric consultation from other departments of a Multispecialty Tertiary care hospital over a period of three months. In a semi-structured proforma, socio-demographic profile of patients, referring departments, reason of referral, urgency of opinion, psychiatric diagnosis, and physical illness diagnosis were recorded and analysed using descriptive statistics.

Results: Overall 172 patients were assessed after referral from various departments, of which 56.4% were males. Mean age was 34 years with majority of patients in age group of 21-30 years. Maximum referrals were from department of Medicine with the most common reason of referral being abnormal behaviour (26.2%) followed by alleged suicidal attempt or self-harm (24.4%), anxiety (10.5%) & substance use (10%). Most common psychiatric disorder among the patients were depressive disorder (24.4%), followed by substance use disorder (19.7%), schizophrenia and psychotic disorder (9.3%).

Conclusion: There is a dire need for interdepartmental information dissemination, basic understanding of psychiatry, early symptom recognition, swift referral and ensuring follow-up.

Keyword: consultation-liaison; psychiatry; referrals; tertiary care hospital

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F59: Extended continuous Theta Burst rTMS (cTBS) for Obsessive Compulsive Disorder: A Sham Controlled Study

Pramod Kumar Kumre, Nishant Goyal, Aniruddha Mukherjee

Introduction: The management of Obsessive-Compulsive Disorder is not yet fully optimized, however over the last few decades the studies provides substantial evidence of brain alterations in OCD symptoms after application of repetitive Transcranial Magnetic Stimulation. As functional Imaging studies have shown hyperactivity of Supplementary Motor Area (SMA) in OCD patients (activation was almost twice in OCD patients as compared to general population) but the findings in few studies have been robust for SMA. The previous randomized, sham controlled trials studies that looked into efficacy of rTMS over Supplementary Motor area were very limited. Hence, we intended to assess the efficacy of adjunctive extended continuous theta burst repetitive transcranial magnetic stimulation on supplementary motor area in patients with obsessive-compulsive disorder using Magstim Rapid Square Plus optimized with robotized Neuronavigation system.

Materials and methods: 10 patients with Obsessive-Compulsive Disorder (Active and Sham) were recruited for the study. Baseline symptoms of the patients were rated on Yale Brown Obsessive Compulsive Rating Scale (YBOCS), Hamilton Depression Rating scale (HAM-D), Hamilton Rating Scale for Anxiety (HAM-A), Clinical Global Impression scale (CGI). Patients were randomly distributed into active and sham treatment group by double blind sampling method. Supplementary Motor Area was visualized and localized by neuronavigational system then extended continuous theta burst repetitive transcranial magnetic stimulation or sham stimulation was given on Supplementary Motor Area 10 times a week (maximum 30 sessions) for 3 weeks. All patients were reassessed on YBOCS, HAM-D, HAM-A, CGI at the end of 3^rd and 8^thweek. Changes in the scores were analyzed.

Results and Discussion: Results would be presented at the time of presentation.

Keywords: Obsessive-Compulsive Disorder, Continuous Theta Burst Repetitive Transcranial Magnetic Stimulation, Supplementary Motor Area

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F60: A study of Executive function in obsessive compulsive disorder and its association with clinical and sociodemographic variables.

Harita Mathur

Introduction: Obsessive compulsive disorder is a chronic disabling condition characterised by obsessions and / or compulsions. Several recent studies have shown significant impairment in cognitive functions such as non-verbal memory, information processing, executive function and visuospatial function in patients of obsessive-compulsive disorder. Executive functions are involved in instrumental activities of daily living such as managing finances, medications and basic household responsibilities, therefore, it is imperative to study executive function in OCD patients and to explore how its dysfunction (if any) varies with clinical and sociodemographic variables. The findings can help us plan and address executive dysfunction in the management of OCD thereby limiting the disability of such patients and improving their standard of living

Methods: 49 patients of obsessive compulsive disorder, fulfilling the inclusion and exclusion criteria of the study as well as meeting the DSM 5 criteria for OCD, were interviewed. Semi structured performa was used to gather social demographic details and Yale brown obsessive compulsive scale(YBOCS) was applied to determine the types and severity of obsessions and compulsions and other clinical variables. Koh's Block design test and Alexander pass-along test (subsets of PGI battery of Brain dysfunction) were used to assess executive function.

Results: Average age of the study participants was 31.2 years, majority were single and male. The average duration of illness in most subjects was 4 to 8 years and a majority of the participants fell under the moderate category. Executive function was found to have significant negative correlation with severity of illness, progressive course of OCD, time spent in obsessions and interference from obsessions (more than compulsions) and pathological slowness.

Conclusion: Executive dysfunction increases with increasing severity as well as progressive course of OCD and is more strongly correlated with obsessions as compared with compulsions.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F61: A Cross Sectional Hospital Based Study On Clinical Correlates Of Insight In Obsessive Compulsive Disorder.

Bidyut Gayen

Background: OCDpatient is classically considered to have a good level of insight about their symptoms. Recently the DSM-V included two specifiers for OCD diagnosis: the presence of tics and precisely the level of insight which may be classified as ‘’good or fair” insight, ‘’poor insight”, ‘’absent” insight/delusional beliefs. In this study we tried to find out the correlation between severity of symptoms with poor insight in obsessive compulsive disorder, so that it may be considered ‘’OCD with poor insight” could be a distinct sub-type.

Aim: To find out the correlation of insight level with different symptoms dimension in obsessive compulsive disorder.

Methods: A hospital based cross sectional study, carried out in out patient department(OPD) and in patient department(IPD), Department of Psychiatry, at Medical college and Hospital Kolkata . A sample of 60 subjects were interviewed. Yale- Brown Obsessive Compulsion scale(Y-BOCS) , Brown Assesment of Belief Scale, Montgomery- Asberg Depression scale(MADRS) and appropriate statistical methods applied.

Results: Out of 60 patients 14(23.33%) patients were found to have poor insight. Poor insight associated with family history of OCD, long duration of illness, aggressive obsession and repeating compulsion is observed in this study.

Conclusion: it can be said that OCD with poor insight is a distinct subtype of obsessive

compulsive disorder and many clinical characteristics are unique to this subgroup presence of which in clinical situation should point towards the possible presence of poor insight.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F62: Adult ADHD as a Spectrum disorder: A dimensional explanation of the ‘Fifty shades of Gray’

Saibal Guha

Background & Objectives: The new incidences of diagnosis of ADHD in adults are increasing, due to environmental challenges these people face in life. The most frequent comorbidities include mood and anxiety disorders, substance use disorders, and personality disorders. There is evidence of strong familial links and neurobiological similarities between ADHD and various associated psychiatric comorbidities, thus highlighting the need to find a spectrum correlation if this exists. The overlapping symptoms between ADHD and comorbid psychopathologies represent challenges for diagnosis and treatment. Neurobiological and genetic concepts have indicated many commonalities between ADHD and psychiatric disorders. Given the considerable overlap between these disorders, the conceptualization of ADHD as a 'spectrum’ using a dimensional rather than a categorical approach to diagnosis and treatment, has been proposed and discussed in this presentation as an alternative hypothesis. An important aspect of this paradigm shift towards a dimensional approach to ADHD research is the effort ‘to better understand basic dimensions of functioning underlying the full range of human behavior from normal to abnormal’.

Methods & Results: Literature in regards to ADHD and its’ dimensional aspects are extensively scoped to form a concept of an ‘ADHD Spectrum Disorder’, which is noted to be more prevalent for adults. The validity of the concept, research and clinical implications, are discussed, along with the authors’ experience in this field spanning over a decade of dedicated work with clients with Adult ADHD in a metropolitan practice in Australia.

Conclusion: The main aim of this presentation is to review available evidence on the prevalence, burden, and neurobiology of Adult ADHD, to describe how a practical, dimensional approach can assist clinicians to identify ADHD in patients with complex presentations, and to inform appropriate management decisions in order to improve patient outcomes in this under treated population.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F63: Efficacy of Cognitive Behaviour Therapy on Defence Mechanism & Emotional Intelligence of Delinquent and Non-Delinquent Adolescents

Deoshree Akhouri, Maria Madiha, R K Gaur

Recently, Juvenile delinquency has been on a rise in developing countries, especially in India. Intensive researches has been undertaken to explore the reason behind these delinquent activities. However, there is a lack of studies in Indian context for these juvenile delinquents. Hence, this research work aims to see the effect of cognitive-behaviour therapy (CBT) on delinquent and non-delinquent adolescents. To assess and compare the effect of CBT on defence mechanism and emotional intelligence of delinquent and non-delinquent adolescents. To see the effect of CBT on delinquent and non-delinquents adolescents.

Approval from Institutional Ethics Committee and Juvenile Observation Home, Aligarh was availed. Through purposive sampling, total 25 juvenile delinquents were taken from District Child Protection Unit and 25 non-delinquent adolescents were taken from general adolescent population under the age range of 13-17 years of age, both genders, literate and illiterate belonging from rural and urban population were included for the study. After explaining the purpose of the study, consent from guardians was attained and assessment was done using different psychological tools. The pre-post research design was used. CBT was used for the management of adolescents. Follow-up was done after 3 months of termination of therapy.

Results of the present study indicate that CBT is an efficient management technique for delinquents serving in observation homes as well as for those adolescents who show deviant behaviour. Follow-up also indicates that CBT would help in prevention of delinquent acts in future.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F64: Art as a modality for psychoeducation in child psychiatric practice

Lakshmi Sravanti

BACKGROUND: Psychoeducation is a process and families often require ongoing support in the form of psychoeducation at various stages of the illness management.

AIMS & OBJECTIVES: Evaluate the role of art and present psychoeducation models for common child psychiatric conditions viz. Attention-Deficit Hyperactivity Disorder, Autism Spectrum Disorder, Dissociative Disorder and Depression.

RESULTS: Commonly used metaphors and analogies in the form of visual representations in regular clinical practice (in the abovementioned conditions) will be presented.

DISCUSSION & CONCLUSIONS: This highlights the need for culturally- and developmentally-sensitive material that can be used for psychoeducation in the management of common child psychiatric conditions.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F65: Demonstration of multiple psychiatric comorbidities in a patient of Neurofibromatosis Type 1

Apinderjit Kaur, Ragul Ganesh, Mahadev Singh Sen, Bichitra Nanda Patra, Rajesh Sagar

Background: Neurofibromatosis is a neuroectodermal autosomal dominant condition with psychiatric co morbidities of cognitive and learning impairments, Attention Deficit Hyperkinetic Disorder , Depressive and Anxiety Disorders. The current case highlights the presentation of multiple psychiatric comorbidities with NF1, difficulties in differentiating between pure compulsions and tics and the role of Habit Reversal Therapy (HRT).

Aim and Objectives: To demonstrate the presentation of Neurofibromatosis Type 1 with multiple psychiatric comorbidities.

Methods: A 22 years unmarried male known to be suffering from NF1 presenting with illness of 16 years duration was admitted and detailed evaluation and investigations were done.

Results: History revealed features suggestive of hyperactivity, impulsivity, impaired attention and concentration with complex motor and vocal tics; with obsessive thoughts and compulsive acts , self injurious behavior; with low mood, anhedonia, ideas of helplessness, worthlessness leading to socio occupational dysfunction. MRI showed hyperintense lesions in anteromedial temporal lobe. The patient's doses of Sertraline, Clomipramine, Valproate and Risperidone were optimized. There were overlapping compulsive acts and tics for which the patient was not able to give any premonitory urge. HRT sessions were taken on which the patient improved significantly.

Conclusion: This case shows the difficulty in differentiating between pure compulsions and tics when the patient is unable to give an account of the premonitory urge or any obsessive thoughts for the acts performed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F66: Prospective Study of psychosocial factors affecting short term Outcome of Oppositional Defiant Disorder

Raghu Nandan Mani

Introduction: Oppositional Defiant Disorder (ODD) is known to be linked to many biological and social factors which could have important implication in disease severity and clinical manifestations and experiences of caregiving.

Aim: The aim of the study was to examine various psychosocial factors including comorbidity in children and adolescent with ODD over a period of 12 weeks, who received treatment as usual from out and in-patient services of a tertiary care centre.

Methodology: 50 children were studied, who were diagnosed to have ODD as per DSM-IV-TR diagnostic criteria. Assessments, at baseline and follow up, were done using Mini-KID, Clinical Global Assessment Scale (CGAS), Strengths and difficulty Questionnaire (SDQ), Alabama parenting questionnaire, KIDCope- coping scale and Early Adolescent Temperament Questionnaire (EATQ).

Results: At baseline majority of children had one or more co-morbidity of which about 84% had ADHD and 12% had internalizing disorders and suicidal ideas. Those with severe ODD had less prosocial behavior, presence of problems with peer and had parents with negative parenting style with ‘poor monitoring and supervision’. Having ADHD, SLD, depression didn’t affect the course of illness and the children improved overall. Over the period of 12 weeks all the children had improved to some degree, while those in remission had on an average higher number of psychotherapy sessions.

Discussion: Profiling of children and psychosocial variables is an important caveat in treatment goal of managing children with ODD. Encouraging positive parenting practices, skill building of coping strategies could be helpful in mitigating the ‘felt burden’ which could have a positive cascade effect in further improving the outcome in children with ODD.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F67

Sumegha Mittal, Ragul Ganesh, Mahadev Singh, Bichitra Nanda Patra, Rajesh Sagar

Background: NMS is a rare idiosyncratic reaction mostly seen with Typical Anti-Psychotics. Increased awareness has resulted in earlier diagnosis and decrease in lethal cases of NMS.

Aim: To demonstrate a case in which patient presented with NMS like features with Atypical Anti Psychotics and difficulty in management.

Methods: An Adolescent male with a history of ATPD was admitted with symptoms c/b (hallucinatory behavior, irrelevant talk, aggression and impaired self-care, fluctuating course) of 10 days duration. Patient was started on Olanzapine 5 mg and on investigation Serum CPK was increased (400 U/L). Patient was unmanageable even on high dose of Benzodiazepines and with further increase in dose of Olanzapine, Serum CPK further increased to 2000 U/L.

Results: After stopping the drug i/v/o possibility of NMS, Serum CPK decreased. After re-challenge with low dose Olanzapine 2.5 mg. Serum CPK started increasing. Meanwhile patient started showing symptoms s/o Mania (Physical Aggression, decreased need for sleep, Delusion of Grandiosity, over-familiarity,) and CMRS-P score was 50. Patient was not manageable and MECT was started after consent by Parents and Independent opinion of another Psychiatrist. After 3 mECTs CMRS- P decreased to 2 and it was sustained for next 3 mECTs and after 6 mECTs was stopped.

Conclusion: The case and discussion illustrates the importance of early identification of NMS and role of mECT in adolescent with psychiatric illness with NMS like features.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F68: Paediatric factitious bleeding disorder: A case series

Ankita Chattopadhyay, Ragul Ganesh, Rajesh Sagar

Background: Factitious disorder has been reported in children in the past few decades, mostly induced by proxy. There are very few reports of factitious disorder induced by self, in children and adolescents.

Aims: We hereby aim to demonstrate the unusual presentation of factitious mucosal bleeding in children.

Methods: Two children of 12 and 9years age, who presented with history of bleeding from mucosal surfaces, were evaluated. Detailed clinical history taking and examination were done to reveal any psychopathology.

Results: In both the patients, the bleeding started after alleged history of being scolded by teacher. The bleeding would occur from nose or ear or mouth and would not be witnessed by anyone at the onset. The episodes would be precipitated during or in anticipation of meeting the same teacher or after being scolded by anyone. Detailed history did not reveal any prominent mood or anxiety symptoms with absence of any family history of psychiatric illness or bleeding disorder. Secondary gains were prominent in the form of leave from school and tuitions. Paediatric and haematology consultation were sought with testing of blood coagulation parameters, auto immune markers as well as endoscopic examination. But no significant findings were noted except fresh nail marks on external auditory meatus in the first patient. However, significant conflicts with teachers were found in both patients and both of them are currently undergoing supportive psychotherapy sessions on OPD basis.

Conclusion: The above case series therefore demonstrate that factitious disorder can be common in paediatric population. It also highlights the need to identify such paediatric patients who usually present to non-psychiatric settings and the need for effective consultation-liaison services for management of such patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F69: Factors affecting poor academic performance in child and adolescents

Yadav J S, Brijbhan, Jain Madhu

Introduction

Academic performance of student defined as competence and ability of students to demonstrate their study skill and behaviours. There are many factors like teacher, home environment, student peer groups and psychological factors can affect schooling performance. There are limited studies in this area specially among students, we conducted this study at child and adolescent centre, IMS,BHU, which focused on these issues.

Objectives

Find out relations of academic performance and socio-demographic profiles of students.
Find out the predisposing factors affecting schooling performance in child and adolescent.

Method: Study design was cross-sectional, total 1473 students enrolled between March 2018 to march 2019 at centre for excellence child and adolescent health clinic for their health related complaints, out of those 530 students had academic problems. Ethical permission, taken from IMS, BHU and for collections of data trained male and female counsellors were instructed to apply semi structured pro forma and scales. Those data were tabulated and evaluation done on applying SPSS 17.0

Result: Out of 530 students % 52.64% were male and 47.36% were females, on further analysis we found that maximum percentages of students were regular in their class study, but 6.23% students dropped out due to poor socioeconomic status, family issues, peer presser or their own problems. There are many other factors affected their poor schooling performance were depresion2.64%, anxiety16.23% and stressors 23.96%.

Summary: The major factors like poor family support, personal psychological issue, peer groups and school environments were leading causes of poor schooling performance.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F70: Poor Academic Performance - Clinical Correlates and Characteristics

Karthiga Sanhary S A, Veerappan VD, Shanthi B, Rema CM

Poor academic performance is one of the commonest presentations in a Child Psychiatry Clinic and has numerous causes and co-morbidities. It needs to be assessed carefully for appropriate early intervention.

Aim: To assess the risk factors, co-morbidities - medical and neurological and psychiatric co-morbidities of poor academic performance and specific learning disorder among children 6-18 years of age.

A cross-sectional observational study is done including all the cases registered in a tertiary care Child Psychiatry Department in a Post Graduate teaching centre over a period of time. Risk factors, socio-demographic factors, co-morbidities, and other factors is assessed for each child presenting with poor academic performance. Children presenting with other symptoms but had poor academic performance in their history is taken into a separate group for analysis. IQ assessment, NIMHANS SLD Battery and other relevant psychometric assessment were included from the case records of these children. Descriptive correlation statistics is performed based on the data's distribution. Comparison statistics is performed between the subgroups.

Results show there was a greater number of children with intellectual disability. Other co-morbidities and environmental factors also impacted academic performance.

It can be concluded that numerous causes and co-morbidities impact academic performance and needs to be carefully assessed for early intervention and effective management.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F71: Executive Dysfunction in Indian ADHD probands influenced more by inattention than I.Q. as revealed by dopaminergic gene analysis.

Background: Organizational inefficiency and inattention are speculated to be the reason for executive deficit (ED) of ADHD probands. Even with average IQ, probands often perform poorly due to higher inattention. Pharmacotherapy, cognitive behavioural therapy, and counselling provide only symptomatic relief. Several candidate genes showed involvement with ADHD; the most consistent are dopamine receptor 4 (DRD4) and solute carrier family 6 member 3 (SLC6A3).

Objective: We analyzed the association of rarely investigated DRD4 and SLC6A3 variants with ADHD core traits in Indo-Caucasoid probands.

Methods: ED, inattention, organizational efficiency, and IQ were measured by Barkley Deficit in Executive Functioning-Child & Adolescent scale, DSM-IV-TR, Conners’ Parent Rating Scale-revised, and WISC respectively. Target sites were analyzed by PCR, RFLP, and/or Sanger sequencing of genomic DNA.

Results: DRD4 variants mostly affected inattention while SLC6A3 variants showed association with IQ. Few DRD4 and SLC6A3 variants showed dichotomous association with IQ and inattention. DRD4 Exon3 VNTR >4R showed negative impact on all traits excepting IQ. Inattention showed correlation with attention span, organizational efficiency, and ED, while IQ failed to do so.

Conclusion: We infer that IQ and attention could be differentially regulated by dopaminergic gene variants affecting functional efficiency in ADHD and the two traits should be considered together for providing better rehabilitation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F72: Promotion of adolescent mental health trough life skills training by teachers

Chaitra VHM, Shivanand B Hiremath, Guru S Gowda

Background: Adolescence is a rapid transition phase from childhood to adulthood. Various health policies exist in India for holistic development of children and adolescents. But there is no special focus on mental health in those policies. Life skills training are essential to promote mental wellbeing and to identify and seek the help during various psychosocial adversities. Awareness about adolescent mental health lacks in our society. So we tried to assess and improve awareness about adolescent mental health issues among teachers by training them to conduct workshops on life skills for adolescents. We also used web based messaging service to exchange information among the teachers.

Aims: To create awareness about adolescent mental health among teachers through life skills training for adolescents. To utilize web based messaging service to monitor the workshops and exchange information

Methodology: School teachers of 15 high schools in rural and semi urban areas of northern part of Karnataka were trained to conduct life skills training for 8th, 9th and 10^th standard students as per the NIMHANS manual on life skills for adolescents. The contents of the sessions were focused on gender differences, health promotional life skills, sexual harassment, relationship and peer pressure, preparing for exams and career choices.

In addition,15 interested teachers were chosen, who could focus on mental health issues and were willing to become student counsellors in their respective schools. All the 15 teachers were sensitized about school mental health issues through a brief interactive session and were provided with a basic mental health material on school refusal, disobedience, academic difficulties, anxiety disorder and substance use problems.

We formed a group on internet-based messaging service (WhatsApp) which included these interested teachers and regularly shared vignettes and informative articles on child and adolescent mental health issues. We encouraged them to approach for more information about how to address the mental health issues at the school level and when to seek professional help.

Results: In a period of 1 year, we are able to provide life skills training to 2692 students through 30 trained teachers of 15 schools. 143 adolescents brought by the teachers and parents for consultation were assessed. Out of 143, 59 had academic

difficulties, 40 had academic failure, 21 had school refusal. Among adolescents,

59 of them had Substance Use Disorder. 77 of adolescent males had a significant diagnosable psychiatric illness compared to 11 adolescent females.

Conclusion: Through life skills training and with the help of modern means of communication school mental health promotion can be achieved.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F73: A study of the sociodemographic factors, psychosocial stress factors and family history of psychiatric illnesses in children with depressive disorders.

Background- Depression is an extremely common illness and is affecting people of all ages. Depression in children and adolescents is more commonly associated with environmental than genetic risk factors.

Aims- To study the socio-demographic profile of children with depressive disorders and to study the psychosocial stress factors and the family history of psychiatric illnesses in children with depressive disorders.

Methods- Study design- Cross sectional study

Sample size- 50

Study period- June 2018 - May 2019

Tools used were DSM-5, socio-demographic and clinical data proforma, Modified Kuppuswamy socioeconomic scale, 2018.

Statistical analysis- Descriptive statistics.

Results- 56% of the patients were females, 66% were Hindus, 42% belonged to rural area and 24% and 37% to semi-urban and urban area respectively. Most of the subjects were from nuclear families (72%). 50% of the patients had associated psychosocial stress factors. Stress factors found were academics related stress, bully, sexual abuse, death of a family member, altercation with family members or friend. 54% of the subjects had family history of psychiatric illness and among them 37% had depression in family and 22.22% had substance use disorder in father.

Conclusion- This study reflects that depression in children is associated significant psychosocial stress factors most of which can be avoided by appropriate measures. Heredity and family environment also has significant roles in development of depression in children.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F74: A Cross sectional study on relationship between skin colour satisfaction and self esteem among late adolescents

KowsalyaA, KanimozhiS

Background: Light skin colour have traditionally been associated with attractiveness, beauty and superiority (Bond & cash 1992) Coard,Breland and Raskin & Gullickson concluded that women of lighter hues are being more esteemed. In India like country which has mixed skin color population, perception towards it and its effect over self esteem are understudied and needs more research.

Aim: To evaluate perception and satisfaction towards one's own skin color and its effect on self-esteem

Method: Study done in individuals of late adolescent age group(18-21years) of both sex excluding individuals with established psychotic disorders & debilitating physical illness, with semi-structured questionnaire addressing sociodemographic profile and history regarding physical illness and psychiatric illness and evaluate skin color satisfaction and self esteem with the help of appropriate scales and analyse them statistically

Result & Conclusion: will be presented at the time of presentation at conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F75: A study on feeding patterns in infancy and their effects on temperament in toddlers

Yashwanth G, M Hrishikesh G P

Background: Feeding pattern has major implication on the temperament of children in turn in the development of higher cognitive and social aspects of personality. Exclusive breast feeding till 6 months of life has been shown to have better mental health outcome. Bottle feeding has been linked with childhood behavior abnormality. Socio demographic factors of the family are also found to play a significant role in temperament of toddlers.

Aim: The aim of this study is to study feeding pattern in infancy, sociodemographic factors and their effects on temperament in toddlers.

Setting & Design: Cross sectional, retrospective study was conducted at a Niloufer hospital for women and children, Hyderabad. After consent, 75 parents of toddlers were enquired about temperament, feeding pattern and sociodemographic factors.

Material & Methods: convenience sampling for 75 parents of toddlers between 18-36 months were selected. Temperament of toddler was assessed using early childhood behavior questionnaire (ECBQ) very short form. Feeding pattern details was collected and socio demographic profile was collected.

Results: Will be discussed at conference

Conclusions: Will be discussed at conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F76: Assessment of Need And Impact Of Life Skills Training For School Students

Saudhamini Bhat, Sameer Belvi Mangalwedhe

Introduction: To grow into well-functioning adults, it is critical that youth learn key life skills Life skills help people make responsible and informed choices and can promote healthy lifestyles as well as career skills. According to WHO, life skills may be defined as “abilities for adaptive and positive behaviour, that enable individuals to deal effectively with the demands and challenges of everyday life. Every school should enable children and adolescents at all levels to learn critical health and life skills”

Aims and Objectives: To conduct workshop on life skill development for students of 10^th standard and assess its need, usefulness and impact on students

Methodology: A 6-hour workshop was conducted to 120 students of 10^th standard at Govt Composite P. U. college of Northern part of Karnataka in the month of July 2019. Sessions on Time management, Goal setting, concentration & memory techniques, Positive mental attitude and Managing exam stress were delivered. The usefulness, impact and need for such program was assessed after 3 months period using self-report questionnaire with 5-point Likert rating scale.

Results: 80% of the students felt the necessity of such life skill training and nearly 60% of them are said to be positively affected by the training sessions.

Conclusion: This study highlights the necessity and positive impact of such program conducted for school. This demands for more such life skill training activities to be included in academic curriculum for the empowerment of youth.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F77: Cross Sectional Comparative Study of Parents Attitude between Children Diagnosed With Attention Deficit Hyperactivity Disorder and Unaffected Siblings.

Smrity Shailly

Background:-ADHD is a chronic neurodevelopmental disorder affecting approximately 3-7 % of children. It affects all areas of child's life, Children with ADHD may cause high stress in parents due to their behavioral problems and so parents report low quality of life, health problems, poor family and social support, low parenting satisfaction. These problems and cognitive errors may affect their attitude and interfere with their responsibility towards the child.

Prashant Maravi – To study comparison of parent's attitude between children diagnosed with Attention deficit hyperactivity disorder and their unaffected sibling.

Methods- This cross sectional comparative study was conducted in school mental health clinic of our hospital. Comprises 0f 30 pairs of children, 30 children diagnosed with ADHD as per DSM 5 criteria, 30 were unaffected siblings. Index of parental attitude (IPA) was filled by parents of all children along with semi structured proforma with demographic details and questionnaire regarding their children diagnosed with ADHD and the unaffected sibling.

Results- There is a difference in the attitude of parents towards children with ADHD as compared to their siblings.

Conclusion- Parents attitude was found to be unfavorable towards children with ADHD as compared to their unaffected siblings. So Health care systems and professionals should provide support and understanding to these families.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F78: Long Acting Injectable Antipsychotic use in Children and Adolescents: A Chart Review.

Siddhesh Shere, Preeti Jacob, Shobha Srinath

Introduction: Benefits of the use of long acting injectable antipsychotics in adults are well established, including a higher quality of life, functionality, lower risk of relapse, and improved adherence. There is limited data regarding this modality of treatment in the children and adolescents who have severe psychological problems.

Objectives: To study the profile and pattern of long acting injectable (LAI) antipsychotic use in children and adolescents less than 18 years of age from a tertiary care centre.

Methods: This is a retrospective chart based review from an exclusive tertiary care child and adolescent psychiatry centre between 2013-2018 in subjects less than 18 years. Data related to their sociodemographic details, primary psychiatric diagnosis, medical comorbidity, type of long acting injectable antipsychotic used along with its frequency of use and any side effects were noted.

Results: The mean age of subjects on LAI antipsychotic was 15.07 (range10-18) and with 35 (61%) boys. The most common diagnosis was Schizophrenia spectrum and other psychotic disorders 28 (49%), followed by Bipolar disorder 22 (38.5%). Commonly used LAI were Fluphenazine in 26 cases (45.6%), Flupenthixol in 21 cases (36.8%) and Zuclopenthixol in 16 cases (28%). The most common side effect mentioned was extrapyramidal symptoms such as rigidity and tremors.

Conclusions: Long acting injectable (LAI) antipsychotics are used in child and adolescent population albeit infrequently. Well- designed long-term prospective studies are needed to understand their long term safety profile and efficacy.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F79: A Study Of Religious Attitude And Its Association With Depression, Anxiety Disorder And Quality Of Life Among Undergraduate Medical Students”

Chirag Ambaliya

Introduction: There has been increasing interest in effect of religious belief and activity on mental health, particularly in regard to depression Aims and Objective: We studied association of religious attitude with severity of depression, anxiety disorders and quality of life.

Methods: This was an observational, single centered, cross sectional, questionnaire based study of 115 undergraduate medical students. Every participant assessed for demographic details, Duke University Religion Index (DUREL), Religious/Spiritual Coping Scale (RCOPE), Hospital Anxiety Depression Scale(HADS), The World Health Organization Quality Of Life (WHOQOL-BREF) for religious activity, positive and negative coping, anxiety and depression and Quality of Life assessment respectively.

Results: We found a significant association for depression with money spent on religious activity(p=0.0031) and negative religious coping(0.040). Participants having anxiety and depression have poor quality of life in all domain of WHOQOL-BREF(p<0.001). Sores of negative religious coping is correlated with severity of anxiety(r=0.0125, p=0.0317) and depression(r=0.250, p=0.007)

Conclusion: Spending money on religious activity and having negative coping are associated with depression. Anxiety and depression are associated with poor quality of life

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F80: A Study Of Psychiatric Morbidity Profile Of Children Attending Child Guidance Clinic Of Department Of Psychiatry, R.G Kar Medical College And Hospital, Kolkata

Pallavi Priyam, Saswati Nath

Background: Child guidance clinic in the Psychiatry department of R.G Kar Medical College and hospital, Kolkata is running since 1994. Children mostly from North 24 parganas of West Bengal attend this clinic. The clinic runs once a week.

Aims and objectives: This study aims to assess the socio-demographic profile, referral pattern and psychiatric morbidity profile in children attending this clinic.

Methods: A retrospective case record analysis of all children who attended this clinic in last 10 years, from July,2009 to June, 2019 was done from digital database maintained in this clinic.

Results: Total number of children was 1498 of whom 1075 (71.8%) were boys and 423 (28.2%) were girls. Majority (71.1%) were Hindus. 60% came from urban area and 40% from rural area. Most children came from social class III, IV and V. Educational levels of parents were mostly upto secondary level. Occupation of most fathers were almost equally distributed among all spheres, like service, business, skilled and unskilled work etc. Mothers were mostly homemakers. Referrals came mostly from department of Paediatrics of the same hospital (41.8%), from other hospitals in Kolkata (5.2%), from nearby schools (4%). Most common psychiatric diagnosis was Intellectual disability - 277 (18.56%). Second most common was Attention deficit hyperactivity disorder (14%). Autism spectrum disorder was found in 4.9% children and Childhood depression in 72(4.82%).

Conclusion: Children of middle and low socioeconomic status mostly attended the clinic. Referrals came mostly from school and paediatric OPD. Most common diagnosis was Intellectual disability.

Key Words: Children, psychiatric morbidity, sociodemographic profile

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F81: Prevalence and Severity of Childhood depression in School going adolescents in an Urban Indian School

Harpreet Singh, Dhiraj Raja

Background: Understanding the prevalence of a psychiatric disorder among children is essential for formulating a sound public health policy. The study aimed to estimate the prevalence of depression in school going adolescents (12-16 years) and measure the severity of depression.

Method: 500 participants in the age group 12-16 years, from a working class community, studying in an urban school were selected for the study. The children with a score greater than or equal to 19 on Children's Depressive inventory (CDI) scale, were taken for the second phase and diagnosis of depression was confirmed by a psychiatric consultant through a clinical interview. Clinical Rating Score for Depression Severity (CRSDS) was administered to estimate severity. In clinically diagnosed cases all help was rendered including follow up.

Results: The prevalence of clinical depression among school going children of age group 12 to 16 years was 8.4%. There was no significant gender difference in prevalence of clinical depression. Depressive symptoms as per CDI were more as the age increased from 12 to 16 years. Depressive symptoms were more among child with first birth order. More than 90% cases were of mild to moderate severity

Conclusions: These results highlight the need for screening school age children for depression and identifying students in need of clinical intervention or counseling.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F82: Case Series: Eating Disorder and its Psychiatric Comorbidities

Ajay Kurien, Suhas Chandran, SMManohari

Background: Anorexia nervosa (AN) is the third most common chronic illness of adolescence, .It is known that both AN and BN are often accompanied by other psychiatric conditions– either during the acute state or in the long-term course. The most frequent disorders are depression, anxiety disorders, obsessive-compulsive disorder, substance abuse, and personality disorders. Several of these disorders are substantially affected by starvation and abnormal eating patterns.

Aim: Food-related obsessive-compulsive features are noted in these patients. Anorectic individuals are also often characterized by certain traits such as rigidity, perfectionism, and scrupulosity which are evident both during acute illness and after long-term recovery.

Method: Presenting a series of four cases( two males,two females) of eating disorder admitted from the child psychiatry dept and the comorbidities in each one of them. Rigidity and perfectionism were noted in all the four patients along with a comorbid diagnosis of OCD. Anorexia with OCD is most commonly reported among females.Case series includes a male adolescent with anorexia and OCD with family history of perfectionist personality traits. The evaluation of temperament/personality was also attempted in the children.

Conclusion: Eating disorders are associated with comorbid psychiatric conditions and hence the need to evaluate for the same is crucial to the holistic management of the patient and improves prognosis.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F83: A Study To Assess Caregiver's Knowledge About Developmental Milestones In Children.

Shilpa Akkineni, Phanikanth

Background: One of the most important factors in the outcome of most child psychiatric condition is the time of presentation and early intervention. Caregivers knowledge of the child's development is crucial to assess the child's behavior and bring to the notice of the clinician to improve the overall prognosis.

Aim: The aim of this study is to assess the caregiver's knowledge about developmental milestones in children and to study the association between the caregiver's level of knowledge and sociodemographic parameters.

Setting & Design: Cross sectional study.

100 caregivers of children attending the child psychiatry outpatient department at Nilofer hospital, Hyderabad were selected for this study.

Material & Methods: Institutional ethics committee approval was obtained for conducting the study. Participants who fulfill the assessment criteria will be taken up for the study and explained about the procedure and written informed consent will be obtained. Intake proforma will be administered to record the socio demographic details. Socioeconomic status will be recorded using the OP AGARRWAL scale.Caregiver knowledge of child development inventory will be administered to all participants to assess the knowledge about developmental milestones. The obtained data was analysed using the SPSS software version 23 and appropriate tables and graphs will be used to explain the association between the variables.

Results: Will be discussed at conference

Conclusions: Will be discussed at conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F84: Comparison of perception of parenting by adolescent children of patients with severe mental illness with healthy controls

Pranshu Singh, Subodh BN, Sandeep Grover, Ritu Nehra

Aim of study: To compare the perception of parenting of adolescent children of patients with severe mental illness and healthy control.

Methodology: Biological offsprings living with their parents with severe mental disorder were assessed on Alabama Parenting Scale.

Results: Study sample comprised of two groups, i.e., Group-I comprising of 70 adolescent offsprings, one of whose biological parent was diagnosed with a severe mental illness and Group-II of 40 adolescent children, whose both biological parents never suffered from a mental illness (healthy controls).

Results: Compared to healthy controls, adolescent children of parents with mental illness rated the positive involvement and positive parenting of their mentally ill parent, significantly inferior.

Conclusion: Findings of the present study suggests that patients with severe mental disorder have various deficits in their parenting skills. Hence, clinicians should evaluate their parenting skills and should address the same.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F85: How we perceive the redness of red – the nature of our Consciousness

Swapanjit Sarma

Consciousness research is multifaceted. It is a vast area of philosophical, biological and epistemological enquiry since antiquity. Only very recently, it has bee able to capture the attention of mainstream psychology and neurology research. The term ‘Consciousness’ itself implies such varied meanings as the different states of brain activity manifesting as a contiouus graded phenomenon as alertness, relaxed awareness, attentiveness, sleep, clouding of consciousness, delirium, obtundation upto downright coma. Another meaning is the more deeper, the ‘Hard problem’ of consciousness – Qualia, the ‘redness’ of the colour red or the ‘painfulness’ of the experience of pain.

Different approaches are deployed by different scientific fields of enquiry. Philosophy and phenomenology are more concerned about the Qualia and devising ways to bring this inexorably subjecitve experience into the objective testing fields of scientific enquiry. Neurobiology paves the most enchanting and elaborate ways of demonstrating the different molecular and structural connections, circuits and biochemical alterations that seems to define different states of consciousness. Even down to the cellular or neuronal levels of circuitry elaborations has led to theorizations as varied as Default mode Network hypothesis, Global Workspace hypothesis and the micro-neuronal, single neuronal connections level theories like the ‘attractor state’ and the ‘re-entrant’ circuit hypotheses. Although, neurobiological forays into the consciousness studies seems promising, it is far from comprehensively elaborating upon the genesis or maintenance of the different clinically evident states of consciousness, let alone shining some dim light upon the hard problem of Qualia.

In this review, we have tried to provide an overview of the neurobiological approaches so far undertaken to understand the different objective states of consciousness as well as the submicroscopic neuronal level theories and the nature of Qualia, to further refine the microarchitecture of consciousness.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F86: Biochemical Assessment In Patients With Major Depressive Disorder

Alka Puria, Ekram Goyal, Sude Kumar Singh, Saldanha D

Background: Major depressive disorder (MDD), also known as, depression is a serious medical illness which can decrease the person's ability to work.

Aim: To study biochemical parameters in major depressive disorder (MDD) patients.

Materials and methods: 42 consecutive patients of Major depressive disorder (MDD) were included in the study with their consent. Institute Ethics Committee clearance was obtained before start of study. After informed written consent, Serum 25-OH Vitamin D, Insulin, Vitamin B12, Thyroid – stimulating hormone (TSH) and Ferritin levels were determined by using enzyme-linked immunosorbent assay (ELISA). The rate of severity of depression in MDD patients was measured using Hamilton Depression Rating Scale (HAM-D).

Results: A total of 42 MDD patients were studied with gender distribution of 22 males and 20 females, age ranging from 18-55years with majority.

The levels of thyroid stimulating hormone (TSH), ferritin and insulin are in normal reference range while the Vitamin B and Vitamin D 25OH levels are observed to be lower in patients.

Conclusion : Depressed people are more likely (1.5 times) to die than general population due to untreated problem, which is expected to increase over twenty years.

Therefore, there is a need for the awareness to the population about these common biomarkers

Key Words: Major depressive disorder (MDD), Vitamin B and Vitamin D 25OH

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F87: A study on LDL cholesterol relates to depression and depression severity.

Shruti Gupta

Introduction:- Depression is a common mental disorder. Prevalence of treatment resistant depression is as high as 30%. Further knowledge of the pathophysiological mechanisms underlying depression, and predictive biomarkers are needed to improve treatment options.

Objective:-To find correlation between serum lipid levels, depression and depression severity.

Methodology:-This is an observational descriptive study with cross sectional design of sample size 110. Serum lipid levels were compared between drug naive patients with a current depressive episode (n=55) (diagnosed as per ICD 10) and healthy control subjects (n=55), and associated with the severity of the episode using 17-item Hamilton Depression Rating Scale [HAMD] scores. Inclusion criteria were written informed consent and age 18–75 years. Exclusion criteria were severe physical illness, autoimmune disorders, and pregnancy.

Result: Results are pending as it is an on-going study. Expected result is higher levels of LDL and LDL/HDL ratio in patients with a current depressive episode as compared to healthy control subjects, and higher HAMD scores will also correlate with higher values of triglycerides, total cholesterol, LDL cholesterol, and LDL/HDL ratio.

Conclusion: The expected conclusion is that serum lipid levels are associated with depression per se, and depression severity. These observations will build the basis for future investigations on individualized lipid metabolism related treatment strategies in depressed patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F88: The Role of Ghrelin & Leptin on Feeding Behaviour & Metabolic profile of Schizophrenia patients receiving Olanzapine (OLZ) Therapy

Rupika Dhurjati

Background: Increased risk of weight gain and subsequent metabolic disorders on Atypical antipsychotics, hampers the compliance to medication and further prognosis of illness. Leptin and ghrelin operate inversely to optimally regulate satiety and food intake. Mechanisms leading to weight gain and metabolic derangements in patients receiving OLZ are still not well understood.

Aim: To study the effect of OLZ on serum ghrelin, leptin, change in feeding behaviour, metabolic parameters, Insulin, BMI in comparison with risperidone and the relationship of these parameters, in the OLZ group of drug-free/naive patients with schizophrenia.

Method: 15 inpatients were kept on OLZ for 4 weeks. Control group (matched) consisted of 15 inpatients on Tab Risperidone. Severity of illness was assessed using PANSS at baseline and 4 weeks. Baseline serum leptin, ghrelin, insulin, FBS and lipid profile, were measured after 12-hour overnight fast, then 12 hours after starting Olanzapine/Risperidone and later at 4 weeks of treatment. BMI was calculated at baseline and 4 weeks. Eating Questionnaire was applied and meal size calculated, to assess the appetite change, at baseline and 4 weeks.

Results: Significant increase in VLDL and TG was noted at 12 hours and 4 weeks, in OLZ group. Significant increase in insulin levels and meal size was noted at 4 weeks in OLZ group. Change in leptin level was correlated positively with change in FBS and change in insulin levels, in the OLZ group, at 4 weeks. Change in serum ghrelin levels correlated negatively with baseline ghrelin and BMI values.

Conclusion: OLZ caused significant elevation in Insulin levels and deleterious effect on lipid profile. Further, positive correlation of change in Leptin levels with FBS and Insulin, implies a role of leptin in glucose homeostasis. Also, ghrelin levels correlated negatively with baseline ghrelin and BMI values thus reinforcing the role of ghrelin as a self-regulatory feedback hormone, elevation of which causes meal-initiation and falls on attaining satiety.

Keywords: Feeding behaviour, leptin, ghrelin, metabolic profile, olanzapine.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F89: A profile of coping skills among patients with Polycystic Ovarian Syndrome

Himanshu Phulwari, Pradeep Sharma, Yogesh Satija, Gunjan Solanki

Introduction: Coping skills adopted by patients suffering from chronic diseases such as Polycystic Ovarian Syndrome (PCOS) can impact the psychological well-being and health outcome. This however has not been adequately studied.

Aims and Objectives: 1. To study the type of coping skills used by the patients of PCOS. 2. To evaluate any difference in coping skills between patients with and without psychiatric co-morbidity. 3. To study any correlation with the coping skills and body-mass index.

Materials and Methods: 70 females in the reproductive age group (18-45 years) diagnosed with PCOS as per Rotterdams Criteria without any pre-existing psychiatric illness were clinically interviewed for presence of anxiety and depression. Their coping skills were assessed using Brief Cope Scale. The scores were compared using paired and unpaired t test and ANOVA and Spearman's correlation coefficient test was used for correlations.

Results: The patients used both adaptive as well as maladaptive coping skills but the mean scores of the adaptive coping skills were higher than those of maladaptive coping. (t = 16.73 df = 69 p = 0.000). Problem focused coping was significantly higher than both emotional coping and dysfunctional coping. Homemakers had significantly lower scores on adaptive coping as compared to working women. Coping did not show any association with age, education marital status or fertility. There was no significant difference in the coping skills in patients with and without psychiatric morbidity. There was no significant correlation between coping and body-mass index.

Conclusion: Coping skills did not have a significant impact on the psychiatric morbidity or body-mass index among patient with PCOS.

Key words: PCOS, Coping skills, psychiatric morbidity, body-mass index.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F90: Study of serum lipid profile levels in the suicide attempters

Sameer Belvi Mangalwedhe, Sagar Garag, Ananth Miskin

Background:Suicides are a major concern of public health.Peripheral biomarkers to identify high risk people is very valuable for clinical practice. Disturbances in various components of serum lipid levels have been observed as a trait marker for impulsivity and suicidality.

Aim:1) To compare fasting serum lipid levels (total cholesterol, TG, HDL, LDL) in suicide attempters and controls.2)To find out association between total cholesterol, TG, HDL, LDL and suicidality.

Methods:A matched case control study design was conducted. Sample consisted a total of 122 participants that included 61 suicide attempt survivors and 61 healthy controls.Consecutive sampling method was employed.All the study participants were enrolled after obtaining written informed consent and fulfilling the inclusion criteria.Cases and controls were matched for age, gender and BMI. Fasting serum lipid levels were assessed.Appropriate Statistical analysis was performed. Level of significance was set at p-value less than .05.

Results:

The study consisted of 122participants,54%males.Mean of the participants was27.07±6.5 years.Total Cholesterol among the cases was136.9±31.79mg/dL and among the controls was 158.67±29.57mg/dL, this difference was statistically significant. (p<0.001).ROC analysis with the suicide attempt as the outcome showed that the area under the curve for the total cholesterol was 0.695,it was statistically significant (p<0.001).The Youden Index for total Cholesterol was 0.32.The cut off value of less than or equal to 136mg/dL (≤136) gives a sensitivity of 57.38% and specificity of 75.4% for suicide attempts.

Conclusion: Suicidal patients have significantly lower total cholesterol.Serum cholesterol can be considered as a biological state marker for the assessment of suicidal risk.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F91: Effect of modified electroconvulsive therapy on blood glucose and lipid profile and its prediction on response in psychotic mania.

Budhayan Roy

Background: ECT being a stress reaction, invokes changes in blood sugar & lipid profile. So, there is need to measure changes of blood sugar and lipid profile with modified ECT.

Aim: To assess blood glucose and lipid profile level change in patients with psychotic mania after a course of modified ECT and correlation of the change with symptom improvement.

Methodology: This study, conducted on 30 male cases, with diagnosis of (F30.2) or (F31.2) & 30 male healthy control. Blood samples measured just before, 20 minutes and 24 hours after 1^st ECT, for blood sugar and lipid profile. The subjects were rated on the YMRS, BPRS, MOAS & CGI scales at baseline and on every alternate day after each session of ECT till 50% improvement in YMRS. Same blood parameters were measured for controls.

Result: There is significant increase in blood sugar 20 minutes after 1^st ECT, but no significant increase after 24 hours of ECT. Lipid profile parameters have no significant difference between baseline, 20 minutes & 24 hours after ECT. There is also no significant correlation between, increase in fasting blood sugar & number of ECT needed for 50% reduction in YMRS scales.

Conclusion: There is future scope for study in this area regarding other blood parameters affected by ECT.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F92: A case control observational study on serum uric acid (SUA) levels in bipolar mania attending psychiatry department at Karnataka instituite of medical sciences, Hubli.

Mahesh Desai, Nishmita TJ, Sameer Belvi Mangalwedhe

Background

Bipolar affective disorder(BPAD) is a disabling, recurrent psychiatric condition of variable severity.Recent studies suggest purinergic system dysfunction play an important role in pathophysiology of BPAD.There is need for better understanding of role in changes in UA levels in BPAD.

Aims: To study the serum uric acid levels in acute and remission phases of mania

To compare with acute and remission phases of mania and with that of healthy controls.

Methods: A case control study of 70 Cases and 35 age and sex matched controls selected from patients presenting to tertiary care general hospital with acute and remission phase of mania, both OPD and IPD, fulfilling the study criteria.The diagnosis made using DSM–5 and severity assessed using Young Mania Rating Scale(YMRS).SUA estimated in mg/dl.

Results : Mean age of cases 32.45 years and controls 31.2 years..Majority of cases were men 54.3% and controls 51.4%,majority were married 68.6%. 60% of the cases had a positive family history.The mean SUA in mania group is 5.3, remission 3.5 and controls 3.5,found to be statistically significant( p value <0.001).The mean SUA in cases is 4.4 when compared to controls which is 3.5( p value <0.001).Moderately positive correlation exists between SUA levels and YMRS scores with correlation coefficient of 0.4 and significance level of 0.02.

Conclusion: SUA levels are found to be higher in mania.SUA has a pathogenic role in mania,a higher SUA level would mean a more severe pathology and thus a more protracted improvement.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F93: Serum Growth Derived Neurotrophic Factor (GDNF) As A Predictor Of Response To HD-TDCS In Bipolar Affective Disorder

Veenakumari M, Nishant Goyal, Mahesh Kumar, K K Kshitiz

Background: Neurotrophic factors regulate the survival and growth of neurons and influence synaptic efficiency and plasticity. Preclinical studies suggest that changes in neurotrophic growth factor might be involved in the pathophysiology of mood disorder including bipolar disorder. The glial cell line derived neurotrophic factor is a part of the TGF-beta superfamily and is abundantly expressed in the central nervous system. Changes in GDNF homeostasis have been reported in patients with bipolar affective disorders. The neurobiological basis of bipolar disorder has received increased attention and several brain regions and brain circuits have been correlated with clinical symptoms. These brain regions and circuits may represent target for neuromodulation techniques such as HDtDCS which results in more focal stimulation of selected brain regions Aim/objectives: This study aimed to determine whether GDNF in serum was abnormal in bipolar affective disorder and how it responded to drug treatment with brain stimulation techniques like HDtDCS.

Materials/method: The study sample consist of twenty (15) inpatient with bipolar affective disorder who were receiving treatment as usual (TAU) in Central institute of Psychiatry. They were randomly assigned to receive (real)active (n=7) or sham (n=8) brain stimulation by anodal HDtDCS of right dorsolateral prefrontal cortex twice a day for five days. YMRS, BPRS scale were applied at baseline, before and after receiving HDtDCS to assess severity of psychopathology scores i.e mania with/without psychotic symptoms. Serum GDNF concentration were assessed at various mood state of mania i.e, at baseline, before and after receiving HDtDCS.

Results & Discussion: The details would be shared at the time of presentation.

Keywords: GDNF, HDtDCS, Mania, Psychosis

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F94: The Fronto-Parietal Variant Of Adrenoleukodystrophy: A Stone In A Brick Wall

Aratrika Sen, Tamoghna Bandyopadhyay, Ranjan Bhattacharyya

X-Linked Adrenoleukodystrophy is the most common cause of adrenal insufficiency in children below 7 years of age and is also the most common peroxisomal disorder. Adrenoleukodystrophy spectrum in men can be broadly classified as Adrenoleukodystrophy (with primary brain involvement), Adrenomyeloneuropathy (with primary spinal cord involvement) and Addison's disease only (isolated adrenal insufficiency). The prognosis of each group is quite different (with and without treatment). Here, we describe such a case of diagnostic dilemma in the adolescent age group presented with over-talkativeness, over familiarity, disinhibited behaviour, wandering away from home, increased appetite, decreased academic performance and disturbed sleep which overlap with Adolescent BPAD.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F95: Insight In Bipolar 1 Disorder: A Cohort Study.

Prabavarani M, Vanishree, Poorna Chandrika

Background: There have been multiple studies examining insight in psychotic disorders. Most of the studies were in patients with schizophrenia. In the present study we attempted to assess the levels of insight in Bipolar I disorder.

Aims & Objectives: The aim of this study was to explore the levels of insight in patients with Bipolar I Disorder. We examined the relationship between the clinical correlates- including number of previous episodes, illness severity, presence of comorbidity, and level of insight. We also attempted to correlate the demographic variables – including socio economic status and education status with level of insight in Bipolar 1 disorder.

Methodology: 40 patients who were diagnosed of Bipolar I disorder with current manic episode, as per DSM 5 criteria were screened and enrolled in the study after getting informed consent. Semi structured proforma for sociodemographic details were obtained from each subject. All patients were administered Young mania rating scale, Insight and treatment attitude Questionnaire, Schedule for the assessment of Insight expanded version (SAI-E), on the day of presentation and at one-week intervals for two weeks. The results were analysed.

Results & Conclusion: As the statistical analysis is yet to be completed, the results and conclusions will be presented during the paper session.

Key words: Insight, Bipolar I disorder.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F96: A case report of an Epilepsy Patient in Bangladesh

Case History

Mr. A, 50 years old, graduate, unemployed, middle aged person hailing from a low socio-economic family of rural area from a northern District of Bangladesh.
He complained of convulsion two to three times per week for about one & half year

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F97: Psychiatric manifestations as the presenting complaint in underlying connective tissue disorders: A case series

Sucheta Chatterjee, Akhila G, Anupam M, Pratheek PVR, RC Das, Ravan JPR, Prasanta Padhan

Background: Immune system interactions with CNS is essential in maintaining homeostasis and development of neuropsychiatric manifestations. Hence, CNS can influence both immune system and the HPA axis causing various physical and psychiatric symptoms.

Aim and objectives: To identify clinical signs and appropriate screening tests for possible underlying connective tissue disorder in psychiatric practice.

Methodology: We have considered 15 cases presenting with syndromal depression not responding to adequate doses of antidepressants. When screened for co-morbid medical conditions, 3 cases were found to have primary connective tissue disorder.

Results and Discussion: It was noted that the 3 female patients who presented with depression and/or anxiety symptoms with generalized weakness as the chief complaint to psychiatric OPD were treated with anti-depressants for an average period of 3 months, however showing poor response to anti-depressants. Over a period of time, blood investigations revealed abnormality as follows: 1st patient had ANA and ds DNA positive (suggesting SLE), 2nd patient had Scl-70 and antitopoisomerase positive (suggesting scleroderma) and the 3rd patient had anti-Ro/La positive (suggesting Sjogren's syndrome). In all these cases the patients were started on immunosuppressant and steroids following which they had marked improvement.

Psychiatrists need to have high level of clinical suspicion with knowledge about particular screening and diagnostic tests for connective tissue disorders such as SLE, Scleroderma, and Sjogren's syndrome.

Conclusion: Connective tissue disorders should be considered while dealing with female patients who have depression, generalized weakness and responding poorly to antidepressants. These disorders should be dealt along with the supervision of immunologist, to achieve better outcomes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F98: Managing psychiatric multimorbidity: a qualitative exploration into challenges of patients and care givers.

Pranab Mahapatra, Sanghamitra Pati

Background: Multimorbidity- the concurrent presence of two or more chronic conditions, is frequently encountered in psychiatric patients. Evidence from western countries suggests that patients and their caregivers undergo multiple challenges while managing multiple coexisting conditions than those who have single psychiatric morbidity. Little research has investigated this in Indian psychiatric patients.

Aims: we aimed to garner an in-depth understanding of the challenges perceived by psychiatric multimorbidity patients and their caregivers in managing multimorbidity.

Methods: adopting a maximum variation sampling, we undertook in-depth interviews with 22 patients and three focus group discussions with their care givers. The interviews were transcribed verbatim and translated. The data was analyzed using the thematic framework approach.

Results: The major themes that emerged from patients’ accounts entailed: ruptured routine, fractured treatment trajectory, which caused greater difficulty with health care management and daily functioning. The themes from the caregivers’ accounts were fragmented care as well as barriers to engaging in care (e.g., money, transportation, and stigma) and concerns on prioritization of illness. On triangulation, we found that psychiatric multimorbidity has a significant impact on the treatment seeking pathway, continuity of care, and puts elevated stress on the care givers.

Conclusion: Psychiatric multimorbidity with its often competing and conflicting clinical and care demands imposes a disproportionate stress both on patients and their care givers. The care goals were found to be disrupted, thus mutually aggravating each constituent illness. Given the predominance of single-disease protocol, it is imperative that clinical guidelines for commonly occurring psychiatric multimorbidity clusters should be designed.

Key words: multimorbidity, psychiatric, physical-mental, qualitative, patient perspective, care challenges.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F99: Physical health issues among long-term psychiatric inpatients in a tertiary care facility: A descriptive case file audit study

Narmadha S V

Objectives: Maintaining general physical health in the presence of severe mental illness remains a daunting challenge internationally.

· To determine the demographic and clinical profile of long-term psychiatric inpatients

· To determine the anthropometric measurements among long-term psychiatric patients

· To determine the prevalence of comorbid physical illness among long-term psychiatric inpatients

Methods: Study setting

Institute of Mental Health, Madras Medical College, Chennai is a specialist psychiatric hospitals

Study design

The study will be a quantitative, descriptive audit combining clinical file data as well as regular nursing and other statistics relating to the physical health of the long-term inpatients in Institute of Mental Health.

Subjects

The study subjects will include all long-term psychiatric inpatients in Institute of Mental Health between 1 January and 30 June 2019.

Inclusion criteria

Persons with mental illness in the psychiatric inpatient facility
Both gender
Duration of stay of the inpatients more than 5 years

Exclusion criteria

Patients duration of stay less than 5 years of stay in the facility
Patients with criminal status

Study questionnaire

Semi-structured pre-forma: A semi-structured Performa will be developed to capture the relevant pertaining to the demographic, clinical, anthropometric and physical health issues variables.

Conclusion: Aims of this study are to identify the most pressing physical-health problems faced by long-term in-patients at the local specialist psychiatric hospital, and to identify specific vulnerable subgroups. It was hoped that the findings would aid the clinical management of long-term in-patients and inform institutional decisions about the services offered at tertiary care facility.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F100: Neighborhood socio economic disadvantage and type 2 diabetes comorbidity in serious mental illness

Ramya Walson

Objectives.

The primary aim of this study was to describe the association between neighborhood socioeconomic disadvantage and serious mental illness (SMI) - type 2 diabetes(T2D) comorbidity in an Australian community using routinely collected clinical data. The secondary objective was to determine how much of the between neighborhood variations in SMI-T2D comorbidity was attributable to neighborhood socioeconomic disadvantage.

Methods

This cross-sectional study considered 3816 individuals with an SMI diagnosis in Illawarra and Shoalhaven regions of NSW, Australia between 2010 to 2017. Data were analyzed using multilevel logistic random intercept modelling that controlled for individual age, gender and country of birth.

Results

SMI individuals residing in the most disadvantaged neighborhoods had 3.2 times increased odds of reporting SMI-T2D comorbidity compared with the SMI individuals residing in the least disadvantaged neighborhoods (OR 3.20, 95% CI 1.42-7.20 for Q1 vs Q5). Significant neighborhood level variations in SMI-T2D comorbidity were also observed in our sample (Median Odds Ratio =1.35) and neighborhood socio economic disadvantage accounted for approximately 17.3% of these variations.

Conclusions

The findings from this study highlight a potentially important role for geographically targeted public health prevention strategies in order to reduce the public health burden imposed by SMI-T2D comorbidity.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F101: Psychiatric morbidity in patients with vertigo attending a tertiary care hospital

Vijay C

Background

Vertigo is one the commonest symptom presented to doctors which has a lifetime prevalence of 30%. In approximately 50% of these patients, the complaint cannot be explained by an organic illness, rather it is related to a psychiatric disorder. This study is to determine the extent of psychiatric morbidity in a targeted sample population of vertiginous patients. Therefore, emphasizing the significance of early identification and treatment of the co-existing psychiatric illness.

Aim

To determine the extent of psychiatric morbidity among patients with vertigo attending a tertiary care teaching hospital.

Method

Descriptive, cross-sectional study conducted in 100 participants above 18 years of age diagnosed with vertigo at Out-patient and In-patient setting at Tertiary care hospital in south India. After obtaining written informed consent and evaluating the eligibility criteria. The participants were evaluated clinically and screened for any psychiatric morbidity by applying “M.I.N.I. Plus 5.0.0” psychiatric scale. Based on number, percentage and 95% confidence interval, chi square test was applied to assess the association between the study variables. A “p” value of 0.05 was considered statistically significant.

Results

84 % of the participants had organic vertigo rest were non-organic. Major cause was BPPV followed by migraine. Out of the 100 participants in the study, 40 had psychiatric morbidity and majority of disorders were in depressive (40.0%) and anxiety spectrum (22.5%).

Conclusion

There is significant psychiatric overlay in patients with vertigo, especially in non-organic vertigo. Hence, it may be inferred that psychiatric evaluation and management will enhance the treatment of these patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F102: Pattern and prevalence of medical co-morbidities in post partum psychosis

Prashant Maravi, Nimisha Mishra, Sunil K Ahuja, Dheerendra K Mishra

Postpartum psychosis is psychiatric emergency in obstetrics ward. Prevalence of medical comorbidies like thyroid dysfunction, hypertension, fever, anemia, gestation diabetes is quite common.

Introduction: Postpartum psychosis is an episodic mental illness whose symptoms occur as early as the first 48 to 72 hours postpartum to first 3 weeks after delivery. Associated medical comorbidies are often missed resulting in patient deaths.

Aims and objectives:

To study the magnitude and prevalence of the medical illnesses.
To evaluate the various clinical and biochemical variables found deranged.
To study and compare the pre-existing vs. existing medical comorbidies.

Methodology:

Study site: Department of Psychiatry and Dept Of Obstetrics and Gynecology, SSMC, Rewa (MP)

Study Design: Hospital based Cross sectional study

Study Duration: 12 months

Selection Criteria

Inclusion

Diagnosed patient according to ICD 10 DCR
Patient between age group 15 to 40 yrs
Multiparous patient
Give written informed consent from legally accepted relatives

Exclusion

Patient requiring ICU Care

Assessment:

General, systemic & mental status examination.

Scales: BPRS, YMRS, Bush Francis Catatonia rating scale, PANSS

Investigations:

CBC, LFT, RFT, Thyroid profile, RBS, serum uric acid, Urine routine microscopy, ECG, Lipid profile, HIV, HCV, HBsAg, USG abdomen, Neuro imaging.

Results: Result will be subjected to statistical analysis and will be presented directly.

Conclusion:

This study enables us to focus on medical co-morbidities and to establish temporal co-relationship between emergence of psychiatric symptoms with medical illness, their prevalence and pattern.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F103: Impact of Stressful Life Events in Mood Disorders

B Ooha Susmita ¹, Rayapureddy Satya ¹, Krishna Kumar P ¹, Krishna Mohan ¹

Background: Life events are defined as discrete experiences that disrupt an individual's usual activities, causing a substantial change and readjustment, such as marriage, physical illness or death in the family. A temporal relationship has been established between such stressful life events and the onset and severity of psychiatric illness in many studies.

Aims: To assess the impact of stressful life events in patients with mood disorders.

Methods: 40 patients with an established diagnosis of an affective disorder according to ICD-10 were sampled via consecutive sampling. Sociodemographic proforma and HAM-D or YMRS were applied as relevant to rate the severity of illness. Presumptive stressful life events scale (PSLES) was applied to assess for the number and score of stressful life events during the patient's lifetime and the past one year.

Results: Significant correlation was seen between severity of illness and stress scores from PSLES with events occurring over lifetime appearing to have more impact (p=0.005) than events occurring in the year just prior to onset of illness/episode (p=0.009).

Conclusion: Life events can behave as acute and ongoing stressors during the course of an illness. Establishing their impact and addressing coping mechanisms should be done to make for a comprehensive management of any patient diagnosed with a mood disorder.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F104: A Study of Factors Affecting Help-Seeking Behavior In Major Depressive Disorder

Srinivasa Kartik Valipay

Background: Major Depressive Disorder (MDD) is amongst the most common mental disorders. Depression has been found to contribute to a high degree of impairment in functioning, and yet, research shows a large treatment gap, leading to several detrimental consequences for individuals and society, and demonstrable benefits on addressing this treatment gap. Hence, it becomes important to study the factors affecting help-seeking behaviours in patients with MDD.

Materials and Method: Our study was a cross-sectional study conducted on 100 consecutive consenting patients of Major Depressive Disorder. The patients were divided into 2 groups of early and late help-seekers, and association of help-seeking behaviour with socio-demographic factors, illness factors (severity of illness, comorbid physical or psychiatric illness, psychological distress, reason for help seeking), and patient-related factors (stigma, personality traits) was assessed.

Result: In our study, we found socio-demographic factors like higher family income, joint family type and rural locality and patient-related factor of higher levels of perceived stigma to be statistically significantly associated with late help-seeking.

Conclusions: Factors like family type, stigma and living in a rural area were significantly associated with late help-seeking. Psychoeducation of family members and increased awareness and access to mental healthcare professionals may help address these issues. Studying factors affecting help-seeking on a larger scale may help with policy formulation in the future.

Keyword: Depression, treatment gap, help-seeking behavior, socio-demographic factors, stigma

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F105: A meta-analysis on predicting qEEG as biomarker for treatment response in depression.

Soumyajit Sanyal, Anamika Srivastava, Seema Jaiswal, Shrikant Srivastava

Background: Quantitative electroencephalogram qEEG analysis has a different pattern at various treatment stages in depression.

Rationale: Biomarkers to predict clinical outcomes early during the treatment of depressive disorders may reduce the duration of the episode, and possibly improve patient outcomes.

Purpose: To systematically review the evidence of qEEG as a biomarker in predicting treatment response in depression.

Data sources: Electronic databases including PubMed Central, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, WHO International Clinical Trials Registry Platform (ICTRP), Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effects (DARE) were searched from January 1990 to June 2019. The bibliography of the articles which were selected for full text review and of reviews on the qEEG and depression for the same time period (January 1990 to July 2019) were manually searched for relevant studies which may have not been figured in the database search by researcher SJ.

Study selection: Two investigators (AS and SJS) independently selected and reviewed the studies. All the discrepancies among the authors were resolved by discussion with the anchor author (SS)

Data extraction: Framework by Cochrane Collaboration tools for ascertaining the risk of bias in randomised and non randomised studies namely, Risk of Bias in Randomized Study Version 2 (ROB-2) and Risk of Bias in Non-randomized Study Version 1 (ROBINS-1) respectively.Data extraction form was devised in order to explore the independent characteristics of all studies.

Data synthesis: The findings are reported following the PRISMA guidelines retrieved from official website http://prisma-statement.org/PRISMAStatement/Checklist.aspx

Strengths and Limitations: The study may provide novel and useful information for patients, healthcare providers, stakeholders and policy makers.

Conclusion: This systematic review and meta-analysis evaluates the existing literature on qEEG analysis and treatment response among persons with depression. Our study will describe an overall estimate of odds, qEEG profile, heterogeneity using a random-effects model for analysis and treatment response on depression among persons by calculating overall effect size. To evaluate the cause of significant heterogeneity, subgroup analyses were carried out on the basis of quality of study including description of clinical variables and the treatment related variables. The results will be discussed in the present

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F106: A Study of Association of Association of CD4 Count, Depression And Quality of Life In Patient Living With HIV/AIDS

Disha Nitinbhai Patel

Background: Among people living with HIV/AIDS, depression increases the likelihood of HIV transmission, is associated with poor adherence to antiretroviral therapy leading to virology failure and may independently increase HIV progression and decreased quality of life.

Aims and Objective: To study frequency of depression, association of depression, CD4 count and quality of life.

Materials and Methods: It is a single centered, cross sectional, observational, interview based study. Participants were interviewed by DSM 5 for diagnosis of depression and assessed for severity of Major depression (HAM-D), quality of life (HR SF-36). Blood samples were drawn to assess CD4 Count.

Result: Frequency of Major depression is 19.32%. Participant having major depressive disorder have low CD4 count (p Value =0.016), poor health related quality of life (p value <0.0001). Participants with low CD4 count have more depressive symptoms (p value=0.015) and poor score in physical (p value =0.041) and social functioning (p value =0.03) domain of SF-36. Severity of depression is significantly correlated with low CD4 Count (r2 0.2142, p value = 0.001).

Conclusion: Frequency of depression among people living with HIV/AIDS is 19.32%. Participants with depression have low CD4 count and poor quality of life and vice a versa.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F107: Prevalence of mixed features in patients with affective disorders

Himani Adarsh, Sandeep Grover, Subho Chakrabarti

Background: Prior to DSM-5, mixed episodes were considered to be an indicator of bipolarity and was typically associated with mania. However, DSM-5 redefined mixed episodes as “mixed features”, and rather than considering it as a type of episode, considers it as a specifier and the concept has been extended to bipolar depression and unipolar depression, besides applying the same to bipolar mania. To qualify for mixed state a person is required to fulfil the diagnosis of one polarity (i.e., mania or depression) and have at least 3 symptoms of other polarity during most of the days of current or most recent episode. There is lack of data on prevalence of “mixed features” among patients with unipolar and bipolar depression.

Aim: To evaluate the prevalence of “mixed features” in patients with unipolar and bipolar depression.

Methodology: For this 100 patients (51 diagnosed with current episode unipolar depression and 49 diagnosed with current episode bipolar depression) were evaluated on Clinically Useful Depression Outcome Scale (CUDOS) items, Koukopoulos Mixed Depression Rating Scale (KMDRS), Hamilton depression rating scale (HDRS), Young mania rating scale (YMRS) and DSM-5 criteria for mixed specifier for depression.

Results: According to DSM-5, 53 out of the 100 patients fulfilled at least 3 out of the 7 criteria for the mixed specifier for depression, with prevalence of 51% (25 out of 49) for bipolar depression and 54% for unipolar depression (28 out of 51). The mean scores on the various scales were as follows: HDRS- 17.85 (SD-6.49); YMRS- 2.24 (SD-3.44), KMDRS-12.59 (SD-5.58) and CUDOS was 46.26 (SD-25.1). There was no significant difference in the mean scores on any of the scales between patients with unipolar depression and bipolar depression. In terms of association, there were significant positive association between HDRS total score and CUDOS-M score; KMDRS total score and YMRS score and CUDOS score and KMDRS scores.

Conclusion: Mixed features are highly prevalent in patients with unipolar and bipolar depression. Accordingly, all patients with depression, irrespective of the longitudinal course must be evaluated for mixed features and same must be taken into account, while considering different treatment strategies for management of acute episode.

Key words: Mixed, affective disorders, depression

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F108: Correlation of severity of Depression and cognitive dysfunction in Megaloblastic anemia in women with major depressive disorder.

Chitra Singh

Introduction - Anemia is a common nutritional problem lead to many unintended consequences such as decrease energy,easy fatigue ability, decrease interest, immune system problems, and neurological dysfunction. A patient anemia show signs and symptoms of behavioural and mood disorders like depression.

Methodology-In this study, 120 female patients with diagnosed major depression by ICD-10 and conform by senior psychiatrist were studied after taking consent. In all patients standard Beck depression inventory (BDI) was used to evaluate depression severity. Blood samples were taken for complete blood count difference analysis(CBC) and evaluating anemia and in those with haemoglobin (Hb) < 12 mg/dl, vitamin B12, and serum folate were checked to evaluate anemia. cognitive dysfunction was evaluated by Hindi mental state examination(HMSE) scale.

Result & Conclusion- 24 female out of 120 patients of depression had megaloblastic anemia. The negative relation was observed between Hb levels, Vitamin B12 and folate and BDI score. The positive relation was observed between Hb levels, Vitamin B12 and folate with HMSE score.It demonstrates the effect of Hb, Vitamin B12 and folate decrease and anemia occurrence on depression severity and cognitive dysfunction. So all the female patients with depression should be investigated for anemia.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F109: Study of White Matter Abnormalities in Elderly Patients with Major Depressive Disorder”

Shravan Kumar

Background: Major depressive disorder (MDD) is a common psychiatric illness which is often characterized by a chronic debilitating course especially in the elderly population. The exact pathogenesis of MDD is not yet clear but structural changes in white matter of brain have been hypothesized as an important pathogenic mechanism.

Objective: To detect the presence of white matter abnormalities in elderly patients with MDD and correlate their extent with the severity of depressive symptoms in these patients.

Methods: This study was conducted in the Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh on elderly patients above 60 years of age diagnosed as having major depressive disorder as per the DSM-5 criteria. An appropriately matched control group of healthy population was chosen for comparison. All patients underwent MRI FLAIR scan in which the presence and extent of white matter abnormalities was compared between the study and control groups. The extent of these white matter abnormalities was also correlated with the severity of depressive symptoms and cognitive function in the study group as estimated by HAM-D and HMSE respectively.

Results and Conclusion: It was observed that patients with greater white matter abnormalities, most commonly seen in periventricular region had a significant higher HAM-D score and a lower HMSE score. This resulted in a more severe longitudinal course of depression. Therefore, white matter abnormalities should be evaluated as a prognostic factor for an appropriate treatment decision making.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F110: Prevalence of depression among 50 cancer patients treated in a tertiary cancer hospital in Tamilnadu.

Ashweeja N

Introduction: Depression was found to be one of the most frequentpsychiatric co-morbidity among cancer patients.

Aim of the study: To find the prevalence of depression among 50 cancer patients of a tertiary cancer hospital in Tamil Nadu.

Methodology: Hamilton - depression scale was applied on all cases diagnosed with cancers in a tertiary care cancer hospital after obtaining consent. Data collected was statistically analyzed.

Result and conclusion: A significant number of patients were diagnosed with depression. Hence, early screening for depression in patients with cancer becomes vital for the diagnosis and timely treatment of depression to help the prognosis in patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F111: Prevalance of Depression among Type2 Diabetes Mellitus Patients of a Tertiary Care Hospital

Prashanth, Ardhanaari

Aim: To find the prevalence of depression among Type 2 diabetes patients attending a tertiary care hospital in a sub urban population

Inclusion Criteria– All diabetic patients attending the general medicine OPD.

Exclusion Criteria – Non diabetic patients and the ones who do not consent to participate.

Methodology – All patients diagnosed with T2DM attending the OPD were screened for depression using “Hamilton-D scale”.

SPSS 22 was used for statistical analysis

Result - Will be discussed in the conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F112: Sociodemographic profile and association of perceived stress with severity of depression in the psychiatry OPD of a tertiary care hospital

B Sushma

Background: Major depressive disorder is a serious mental disorder that profoundly affects an individual's quality of life. The sociodemographic factors of age, gender, marital status, education, and income have consistently been identified as important factors in explaining the variability in the prevalence of depression. Although there are many underlying aetiologies, an increasing attention has been focused on the influence imposed by psychological stress over depression.

Materials and methods: All the patients are enrolled from tertiary care hospital. The patients who are above 18 years and meeting the criteria of major depressive disorder according to DSM-5 criteria are included.

Clinical and sociodemographic data are assessed using self-reported questionnaire and severity of depression is assessed using DSM-5 criteria.

Results and Conclusion: Will be discussed in detail during the presentation as the data has to be analyzed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F113: Psychiatric Aspect of Myocardial infarction: An Indian Experience

Arvind Barad, Shankar Lal

Background: Myocardial infarction is subsequent stage of IHD & which affect by many psychosocial stressors an well as risk factors like - Sedentary life style, family history of Hypertension, Cigarette smoking & serum dyspedimia etc. Afterwards patient's behavior changes & negative emotions (Anxiety & Depression) are significantly impaired individual's social, occupational & important area of functioning. In present study we find its association.

Aims: Study was find out Psychiatric morbidity in patients of myocardial infarction with relationship of various social demography factor, role of personality pattern & association with stress full life event and also turnout post MI Psychiatric morbidity.

Design: Tertiary hospital, institutional setting the study was retrospective design.

Material & Method: 50 Patients of MI taken from cardiology department of SMS Hospital, Jaipur and equals control were patient's relative or attendance with fulfillment of omission & inclusion criteria and compare with semi structure Performa, PSLE, New personality inventory, Beck's depression inventory, Max Hamilton anxiety rating scale.

Suitable & static's are used.

Result: No significant difference of siso-demography & significant associate with risk factor Tobacco Intake, Cigarette smoking, family history of cardiac illness and stressful live event (at least 2 or more). Anxiety & depression find significant determinate. Diagnosis was made by ICD-10 criteria -

Mild depression - 8%, Moderate depression - 14%,

Major depression - 10%, Mix anxiety & depression - 12%

Conclusion: People should sensitized & made aware of their risk factor & determinant.

Keyword: Anxiety, Depression, Subtype & Outcome.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F114: Bipolar Disorder

Megha Kumari

Introduction: The mechanism of action in stabilizing mood has not been fully elucidated, but alterations in N-Acetylaspartate (NAA), Myo-Inositol (mI) and Choline (Cho) have been implicated. Modern neuroimaging techniques, such as proton magnetic resonance spectroscopy (1H-MRS), allow in vivo measurement of three non-glutamatergic brain metabolites, N-acetylaspartate (NAA) (a neuronal marker), Myoinositol (mI) (a glia cell marker) and Choline (Cho) (a membrane cell marker), implicated in both the neurobiology of BD and lithium's mechanisms of action. Most of the previous literature have either studied the levels of NAA, mI and Cho euthymic state or in the acute state and compared it with healthy controls. The studies which were conducted to compare the levels of these neurometabolites in various mood states (euthymia vs depression vs mania) were insufficient to reach a consistent conclusion. Hence our study would be an attempt to explore the response of lithium on the levels of these neurometabolites via 1HMRS in the ACC in various phases of a manic episode.

Materials and Methods: 15 Patients with manic episode receiving Lithium as mood stabilizer, 15 patients with manic episode receiving only antipsychotic and 15 matched healthy controls were to be recruited for the study. 30 patients with purposive sampling followed by block randomization into two groups. Both the groups would to be taken for the baseline measurement of NAA, mI, Cho via 1HMRS and thereafter again after 4 weeks of hospital stay. Similarly the subjects in the healthy control group were to be taken for measurement of NAA, mI, Cho via 1HMRS.

Results: To be discussed during the presentation.

Conclusion: To be discussed during the presentation.

Keywords: Bipolar Disorder, N-Acetyl Aspartate, Choline, Myoinisitol

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F115: Assessment of factors related to aggression among patients with bipolar affective disorder

Pritam Chandak

Background: Aggression is assumed to be integral part of psychiatric illness. Aggression could present as verbal, physical aggression, irritability and suicidality. Aggressive impulses may end as violence, assaultive behavior, self harm and suicide. Aggressive behavior is frequently observed in patients diagnosed with bipolar disorder. There are few studies which have assessed aggressive behavior during episode. But it is not clear whether bipolar patients have high aggressive during interepisodic period. We hypothesized that aggression would be higher among bipolar patients than normal controls.

Objectives: 1) To compare aggression among bipolar patients in remission with age, sex, related with normal control.

2) To asses risk factors for aggression among bipolar patients

Methods: 30 Consecutive consenting bipolar patients who were in euthymia for minimum of two months were interviewed after applying inclusion and exclusion criteria. 30 consenting age sex matched normal controls were chosen among relatives of medically ill patients after applying the inclusion and exclusion criteria. Both groups were administered MINI Plus to confirm their psychiatric status. They were asked about their aggressive behaviors using Overt aggression scale-modified OAS-M Scale. Their socio-demographic and clinical data were collected using a semi-structured proforma.

Results: Most of patients did not have aggressive behavior.37.7% of patients demonstrated aggressive behavior and this was comparable to normal healthy controls. aggressive behavior was of mild type and aggression was more common than irritability and suicidality. None of the socio-demographic and clinical characteristics were found to be the risk factors for aggressive behavior since there was no statistically significant relationship to p value. Joint family background had significant association with aggressive behavior in patients. Controls had significantly higher suicidality than patients.

Conclusion

1. The prevalence of aggression among bipolar patients in remission is (37.7%)and comparable to prevalence among age-sex matched normal controls.

2. Clinical and socio-demographic variables do not have any association with aggression among bipolar patients. Joint family is significantly associated with aggression among bipolar patients.

Keyword: Aggression, BPAD, OAS-M, Euthymic, OPD.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F116: Topic: A Naturalistic study of assessment of executive functioning and functional capacity in depressive disorders

Divija Bunga, Rajshekhar Bipeta

Introduction: Neurocognitive deficits are demonstrated most likely in mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD) and contribute to the functional impairment experienced by affected individuals. Cognitive impairment is associated with poor overall functional outcome and is therefore an important feature of illness to optimize for patients occupational and academic outcomes. Studies have shown neuropsychological performance is impaired in patients with MDD, even from the first episode.

Aims and Objectives

1. To study the executive functioning and functional capacity of patients with depressive disorder.

2. To study the changes in executive function and functional capacity with treatment of depression.

Methodology

50 subjects fulfilling the criteria for depressive episode according to ICD-10/DSM-5 criteria in OPD/IPD. A semi structured proforma will be given to patients to collect socio demographic details. Later, DSST, Upsa-B and CGI scales will be administered to subjects. Data will be compiled and analysed using SPSS-24.

Inclusion Criteria

1. 18-60 years, Males and females.
2. Patients diagnosed to have depressive episode according to DSM 5/ICD-10

Exclusion Criteria

1. Intellectual disability
2. Confusional states and Dementia
3. Dependence on substances such as alcohol/cannabis/BDZs

Tools

1.Semi structured intake Proforma
2. DSST (Digit Symbol Substitution Test)
3. CGI-S (Clinical Global Impression – Severity)
4. MADRS (Montgomery Asberg Depression Rating Scale)
5. UCSD Performance-Based Skills Assessment-Brief (Upsa-B)

Results and conclusion -Will be discussed at the time of presentation.

Keywords - Executive functioning, Functional capacity, Depressive disorders.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F117: Topic: Validity of Diagnostic and Self-Screening Smartphone Applications for Major Depressive Disorders

Satya Revanth Karri, Praveen Khairkar, Vishwak Reddy V

Background:

In the era of Internet and smartphones, where information is easily accessible for everyone, many mental health smartphone applications were created for several objectives such as Information retrieval, self-diagnosis, self-help guides, consultation, etc with limited validity. The purpose of this study is to determine their validity in a professional working setup to elucidate their diagnostic accuracy and capability.

Aim: To assess the sensitivity, specificity, face validity, content validity and construct validity of 15 diagnostic and self-screening smartphone applications for major depressive disorder.

Methodology: A qualitative hospital based, short-term prospective cohort study with sample of 50 patients diagnosed with Major Depressive disorder using DSM-5 and ICD-10 DCR (severity quantified using HDRS and MADRS scales) and their symptom profile have been entered into 15 Android and Apple diagnostic smartphone applications and have been assessed accordingly and compared for sensitivity, specificity and validity (content, face and construct).

Results: The data will be analyzed using SPSS software and appropriate statistical tests to determine their sensitivity, specificity and validity.

Conclusion: Diagnostic smartphone applications are easily available to the public. The available applications so far seem to lack specific validation from a psychiatric point of view. Hence these applications should be created with the collaboration of a Psychiatrist and validated before placing it into the marketplace.

Keywords: Diagnostic validity, Smartphone vs clinical validity, Major Depressive Disorder, Nosology.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F118: Title: Cognition in Late life Depression

Saloni, Jilani A, Agrawal, Gupta SB, Sinha R

Introduction:

Cognitive impairment may be part of aging as an independent phenomenon or as a subset of depressive phenomenology in late life depression. These symptoms vary from deficits in executive function (problem solving, decision making, and judgment), memory and attention to activities of daily livings. It has been seen that these deficits can occur before, during, or after a depressive episode and may serve in older adults as a precipitating factor to subsequent depression. Realizing the importance of associated cognitive deficits, the present study is aimed to explore the cognitive aspects of late life depression, as there is dearth of information regarding same from our country.

Method and methods:

This is a cross-sectional, single point assessment study, including 30 patients aged >45 years, visiting outdoor of Era's Lucknow Medical College, Lucknow. The cases were having their first episode of depression after the age of 45 years of either gender (Male and Female) as per DSM-V criteria, and who were not taking treatment for their index episode. Exclusion criteria were subjects with bipolar depression, Minor/major Neurocognitive disorders and other comorbid psychiatric and substance use disorders. HAM-D and HMSE were applied to assess the severity of depression and cognitive impairment. MINI was applied to rule out other comorbid psychiatric disorders.

Result: Majority of the patients (n=16) were male, suffering from severe depressive episode (n=23). 13 patients were illiterate and rest were having some years of schooling up to graduation. The average HMSE score of the sample was 21.93+2.41;20.57+3.89 being for patients with mild-moderate depression (n=7) and 21.13+ 3.41 for severe depression (n=23). The most impaired affected domains of HMSE in depression were of orientation, attention and concentration and recall.

Conclusion: Irrespective of the severity of depression, there is impaired cognition (decreased HMSE score) below cut off range (<24-30) of general cognitively healthy population.

Key words: Cognition, Depression, Severity

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F119: Biochemical and Hormonal correlate of irritatability in adolescent with disruptive mood Dysregulation Disorder: An Exploratory Study

Guru Vamsee Krishna A, Nishant Goyal, Kshitish K Kshitiz, Anjanik Kumar Rajan

Introduction: The main and constantly present features of DMDD are chronic, non-episodic and persistent irritability, and temper tantrums disproportionate with the trigger. DMDD is characterized by high rates of comorbidity with other psychiatric disorders as well as social and scholastic impairment. It is still not clear whether leptin and ghrelin levels are affected by mood disorder. Two of the hormones that seem to play an important role in the regulation of food intake, energy metabolism, and body weight are leptin and ghrelin. Leptin is a mediator of long-term regulation of energy balance, suppressing food intake and thereby inducing weight loss. Ghrelin on the other hand is a fast-acting hormone, seemingly playing a role in meal initiation. In this present study it is aimed to compare biochemical and hormonal level of ghrelin and leptin level in DMDD and healthy controls. Therefore, the present study was carried out to investigate a part of anorexigenic and orexigenic activity in mood disorder of Disruptive mood dysregulation disorder and their siblings. There is necessity to assess the ghrelin and leptin levels along with lipid level in adolescent with chronic irritability in Disruptive mood dysregulation disorder adolescents whether they play any role in above mentioned diagnosis till now it is not clear. There is necessity to compare the above-mentioned hormones and biochemical levels with age, sex matched healthy individuals

Material and Methods: 20 patients who fulfilled the criteria of disruptive mood dysregulation disorder and 20 healthy same age, sex-controlled group without any comorbidities were included in the study. Ghrelin and leptin levels measured by enzyme-immunoassay. Modified overt aggression scale (MOAS), Affective Reactivity Index, MINI KID (Mini International Neuropsychiatric Interview for Children and Adolescents) scales were applied. A fasting blood sample was collected to assess serum lipid level with biochemical analysis.

Results and Discussion: Results and discussion would be presented at the time of paper presentation.

Keywords: Chronic irritability; Disruptive Mood Dysregulation Disorder; Temper tantrums, ghrelin, leptin

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F120: A Study To Assess Cognitive Functions In Patients Of Unipolar Depression

Rakesh C, K J Divinakumar, S A Khan

Depression is associated with high morbidity and dysfunction. Cognitive impairments have been detected in depression with attention, memory, executive function and processing speed prominently affected. In present scenario, symptomatic remission is an insufficient goal of treatment for MDD and a return to premorbid functioning should be targeted. This study aims to compare cognitive functions of drug naive patients of unipolar depression with healthy matched controls in the select domains mentioned above and to study the correlation between the severities of depression assessed with BDI and the cognitive impairments. 50 cases each of unipolar depression and Age and sex matched healthy controls chosen (between ages 18 to 50) were subjected to psychometric testing with BDI, CPFQ questionnaire Wisconsin Card Sorting test, Digit span, verbal memory, Visual retention subtests of PGI BBD, Trail Making tests and differences in scores were noted. Data compiled analyzed for statistical significance for Association of cognitive impairment in cases of unipolar depression and association of severity of cognitive impairment with severity of depression. Results showed significant differences between both the groups for different cognitive tests and also suggested that cognitive impairment is directly associated with severity of depression.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F121: Topic : DY SHAMED OR BEING ASHAMED – A CROSS-SECTIONAL STUDY AMONG MEDICAL STUDENTS

D Ambuja, Rufus Ephraim Y, K Ashok Reddy

Background - Body shaming is the practice of making critical, potentially humiliating comments about a person's size, colour, shape and appearance. It is faced by most of the population because of the increasing trend of social media and easy accessibility to comment upon. This has lead to development of inferiority complex and a significant effect on one's emotional state and self confidence.

Aims –To evaluate the

· Effect of body shaming on self esteem and low mood · Correlation between self esteem and low mood.

Settings & design – Medical students were addressed as study population and relative screening methods were implemented.

Methods – Rosenberg's Self esteem scale, Becks Depression Inventory.

Results – The data was analyzed using SPSS software & appropriate statistical tests and a significant relationship between self esteem and depression has been seen.

Conclusion – Body shaming causes significant impact on the self esteem, mood and thus on social relations of an individual.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F122: Perceived Factors Affecting Toddy Consumption Among Rural Women of Telangana Region

Balvanth ReddyC, HariharC, Soma Sundar Babu, Lokesh Kumar

Background: Toddy (naturally obtained alcoholic sap of palm tree, used as a beverage) consumption is more common in rural areas. It could be due to various reasons like being part of local culture, as a hypnotic, or due to peer pressure. Toddy consumption with its evil effects is frequently found in the psychiatric practice in this part of the country.

Aim of the study: To study the factors influencing consumption of toddy among women in rural area of Telangana state.

Material and Methods:It is a cross sectional study. The study is conducted in Mekaguda village, Kothur Mandal, Mahabubnagar district, Telangana. Consent of the concerned village authorities was taken. A total number of 50 individuals were recruited for the study after informed consent is taken from them. They were assessed based on the following questionnaires,

1. CAGE Questionnaire
2. Checklist of perceived factors influencing toddy consumption.

Inclusion criteria: Females aged above 18 years.

Exclusion criteria: Individuals not giving consent.

Results: In this most of the study population are illiterate(58%) and 36% had primary education. The most common factors for toddy consumption among women are sleep disturbance(92%) and fatigue due to physical work and sleep(32%). On CAGE scale which is used for screening study population, 70% people scored 2, 8% scored 3 and 22% scored 4.

Conclusion: With this study it has been concluded that among rural women above 18yrs the most common reason for consumption of toddy is sleep disturbance.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F123: Behavioral abnormalities presenting to emergenc Mahboobul Hasan Ansari, Rakesh Kumar Gaur, Suhail Ahmed Azmi, Ved Prakash Gupta

Background: We explored the pattern and clinical profile of patients attending psychiatric emergencies at a tertiary healthcare centre in district Aligarh, India.

Aim: The present cross sectional study was aimed to identify the common psychiatric presentation in emergency department and their diagnosis.

Methods: All the patients attending to emergency department of JN Medical College AMU Aligarh were asked to participate in the study. The present study included patients from 1^st January 2019 to 31^st August 2019. Out of 318 patients only 291 subjects had given informed consent to participate in the study. Socio-demographic details were collected on semi-structured proforma. Diagnosis was made according to DSM-5.

RESULTS: Mean age of the patients was 29.68±4.58. The most common clinical presentation of the patients was anxiety followed by unresponsiveness, violent and aggressive behavior, breathlessness and disturbed sleep. Conversion and dissociative disorder was the commonest diagnosis followed by delirium due to other medical condition, panic disorder, major depressive disorder and brief psychotic disorder.

Conclusion: At the extremes of age peoples are more vulnerable to acute illness of mental disorder. In students dissociative and conversion disorder are very prevalent in India in contrast to western world.

Key words: Emergency, Dissociative Disorder, Conversion Disorder, Extremes of Age

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F124: To Study to look in to social and psychiatric aspect of suicide attempt in farmer and non farmer.

Dharmendra prajapati, Ramghulam Razdan, Vijay Niranjan

Introduction: Attempted suicide or deliberate self harm are just the tip of iceberg of number of suicides occurring in a community. Attempted suicides occur 8-20 times more frequently than completed suicides. Suicide among community is now a universal phenomenon. Several factors like financial constraints, altercation with any family member, Easy availability of pesticides have been attributed as the common reasons for suicide attempt among the rural population.

Material and methods: On this background we evaluated all the cases of attempted suicide admitted to tertiary care hospital in last 1 year and referred to psychiatric OPD. Details of sociodemographic profile, mode of attempt, and reason for the attempt were evaluated. Factors among farmer and non-farmer group were analyzed using suitable statistical methods.

Results: Out of total 100 cases of attempted suicide, only 20 % of the cases were farmers. Majority of them were males and were married. Main mode of attempt was poisoning. The common psychiatric diagnosis was adjustment disorder followed by depressive disorder.

Conclusion : There are multiple socioeconomic and psychological risk factor for suicide by farmers which can be targets of prevention policy.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F125: A study on subjective sense of loneliness among suicide attempters

Francis Monica Santhanaraj

Background:

Suicide is a significant problem worldwide. Feeling lonely has been identified as a factor related to thoughts of and attempts to commit suicide. Subjective Sense of Loneliness (SSL) is defined as an aversive state experienced when discrepancy exists between interpersonal relationship one wishes to have and those that one perceives they currently have, which is different from objective social isolation. Limited research to date has found SSL to be associated with increased suicidal and para-suicidal acts.

Aim:

To test the association of Subjective Sense of Loneliness and suicidal ideation among suicidal attempters and to correlate it with severity of suicidal attempt.

Methods:

Cross sectional study for 2 months on 64 patients between 18-45 years who attempted suicide and attended Suicide prevention council clinic at psychiatry OPD, Government Rajaji Hospital, Madurai with educational status of at least 8^th std were included. Patients with comorbid medical, neurological, psychiatric illness were excluded. Socio demographic proforma, Beck suicide intent scale, University of California Los Angeles loneliness scale version 3 which is Tamil standardized (Internal consistency 0.75) were administered.

Results:

Data analysis done using Statistical packages for social sciences version no 20.Our study highlights males of 31–45 years who were unemployed, unmarried to have more subjective sense of loneliness. SSL has positive correlation with severity of suicidal attempt.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F126: A Study On Socio-Demographic And Clinical Profile Of Suicide Attempters

Ved Praksh Gupta

BACKGROUND: Suicide attempt is self-injurious behaviour with intention of self killing but non-fatal outcome. World Health Organization (WHO) reported that approximately one million people die from suicide every year and 10-20 times more attempted suicide.

INTRODUCTION: Though studies have been conducted in India to find out psychiatric comorbidity in suicide attempters but only few studies have considered the impact of suicide committed by celebrity influence the society.

AIMS & OBJECTIVES:

1. Study of socio-demographic profile of suicide attempters.

2. To determine the psychiatric disorders in suicide attempters.

3. Estimation of suicide risk.

4. To find out impact of suicide or suicide attempt reporting of others by print media on subjects of the study (suicide attempters).

MATERIALS AND METHODS:

This is the cross sectional study which included all the patients attending our hospital from 1^st November 2018 to31^st August 2019 having history of suicide attempts fulfilling inclusion and exclusion criteria. All the data are collected using self-administered semi-structured proforma after obtaining written informed consent from the participants. Beck Suicide Intent Scale, Revised Kuppuswamy Scale , Presumptive Stressful Life Event Scale are being applied on all the patients. Appropriate statistical analyses were done using SPSS software.

RESULTS: A total of 56 individuals were assessed, among them 30 (53.5%) were males. The mean age of subjects was 23.8 ±5.8 years. The majority of the study participants were aged below 25 years. Ingesting pesticide poisons was the commonest mode of suicide followed by hanging. Only 8 participants were found to be depressed.

CONCLUSION: A large number of subjects were found to be free from any psychiatric illness. In majority of attempters immediate stressful events were the precipitating factors.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F127: Food, Looks and Me: A Pilot study on Correlations between Eating Attitudes, Body Image Perception and Self-Esteem in medical students of Mumbai

Shah P, Somaiya M, Subramanyam A

INTRODUCTION: Adolescents and young adults place significant value to appearance. Medical students are likely to be vulnerable to dissatisfaction with appearance and maladaptive eating attitudes.

AIMS & OBJECTIVES: This study was designed to study the eating attitudes, body image perception and self- esteem in MBBS students and their correlations with each other and with Body Mass Index (BMI), so as to identify students at risk and possibly plan measures for intervention.

METHODOLOGY: A pilot study was conducted on 55 medical students (interns); they were provided with questionnaires on electronic forms investigating their Socio-demographic Data, Eating Attitudes, Body Image Perception and Self-Esteem. Using the chi square tests and t tests, the parameters were studied and correlations using Spearman's rank correlation were established.

RESULTS AND DISCUSSION: Students with a higher BMI were at a greater risk of eating disorder and higher concerns with body perception. Those with a higher risk of eating disorders were associated with body dissatisfaction and lower self-esteem. There were no significant differences found in either gender or without an illness. Linear regression analysis showed, that BMI was the only statistically significant predictor of a high score in BSQ 8c, hence a higher BMI predicted a greater chance of body dissatisfaction in students.

CONCLUSION: Eating disorder risk is associated with body dissatisfaction and lower self – esteem in medical students. Future studies are required to establish this relation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F128: Topic: REVALENCE AND CLINICAL CORRELATES OF PATIENTS ADMITTED IN PSYCHIATRIC INTENSIVE CARE UNIT

Munivel k, Riswana Fathima k, Aravindan S

Aim and Objective:

To find out prevalence of seclusion in a psychiatric in-patient hospital
To study about the socio-demographic and clinical profile of patients admitted to PICU
To study the Determinants of transfer to PICU
To identify and describe the sociodemographic and clinical profile of patients and factors associated with seclusion admitted to a Psychiatric Intensive Care Unit (PICU)

MATERIALS & METHODS:

Method-Descriptive study

Inclusion criteria

· All patients transferred from acute and general ward to PICU ward between January 2014 to December 2018.

DATA COLLECTION:

Details of patients admitted or transferred to PICU to be obtained from PICU nominal register.
Their case records to be analyzed in the Medical Record Department after getting permission from Director.
Demographic details i.e Name, Age, Sex, Address, Religion, Marital status, Socioeconomic status to be collected. Clinical profile like Diagnosis, Type of admission, Reason for transferred to PICU, and others factors during their course of stay in PICU and discharge from PICU to be studied.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F129: Topic: How well is telepsychiatric service used in India

Shashidhara N Harihara, Vinay Basavaraju, N Manjunatha, Naveen kumar Channaveerachari, Suresh Badamath

Background: The prevalence of psychiatric disorders in India, as revealed by several studies varies anywhere between 9.5 and 370 per 1000 population (Math SB, 2007). As per the Global Health Observatory (GHO) data in 2014, 45% of the world's population lived in a country where there was less than one psychiatrist to serve 100,000 people and India is one such country. In this scenario there is a need for exploring the means of effective utilization of the available resources and delivering quality health care to the people and telepsychiatry is one such means, which is defined as “the use of electronic communication and information technologies to provide or support clinical psychiatric care at a distance” (Tracy J, 2004). The telepsychiatry service started globally in 1950s and is one of the fastest developing fields of telemedicine (Chakrabarthi S, 2015). However the telepsychiatry is not effectively used in India and there is no systematic review of the data about utility of telepsychiatry services in India. In this background we like to review the published data on telepsychiatry services in India.

Aims and objectives: Systematic review of the telepsychiatric services done in India.

Methodology:This review is being done by searching the published data on telepsychiatry from various sources like PUBMED, MEDLINE, Neuromed, Cochrane database and Google using the key words: “telepsychiatry”, “telemedicine”, “telehealth”, “tele mental health”, “e-health”, “video conferencing”, “telephonic consultaion”, “online consultation” AND “psychiatry”, “mental health”, and “mental illness”. The articles so extracted will be grouped into original research article, case reports and series, reviews and guidelines and they will be critically analyzed and reviewed.

Results and discussion will be presented at the time of presentation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F130: Title: State-trait anxiety and subsyndromal anxiety symptoms in patients with remitted bipolar disorder

Mamidipalli Sai Spoorthy

Background

Anxiety symptoms are often common during manic or depressive episodes of bipolar disorder (BD) and considered an integral part of the clinical presentation. In contrast to the numerous studies examining comorbidity of anxiety disorders in BD few studies have examined the prevalence of anxiety symptoms in remitted BD.

Aims

The aim of the current study was to examine the prevalence of anxiety symptoms, trait/state anxiety in patients with BD and non-affective psychosis (NAP). And to look for the demographic and clinical correlates of anxiety in patients with remitted bipolar disorder.

Methods

100 patients with a clinical diagnosis of BD and 50 patients with NAP were evaluated. Both the groups were assessed on State trait anxiety (STAI) scale-state and trait version, Hamilton anxiety rating scale (HAM-A), PGI Neuroticism scale (PGI N2).

Results

The BD group had significantly higher anxiety scores on the HAM-A and the STAI-State, STAI-trait scales than the NAP group. Patients with BD with higher HAM-A scores were significantly more likely to have a rapid cycling course, a higher lifetime suicidal attempts and a negative association with the duration of remission in BD. Higher STAI-state scores had a significant association with the mean duration of depressive episodes. Patients with higher PGI N2 scores were significantly more likely to have higher lifetime history of suicidal attempts.

Conclusion:

Patients with BD have higher co-morbid anxiety symptoms and traits and presence of these adversely effects the course of BD with regard to the suicidality and complete remission.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F131: Can High Levels of Fluoride in Body Tissues of Adolescents Impair Clinical, Psychological, Neurocognitive and Developmental Domains? A Qualitative, Analytical Study from Highly Fluoride Endemic District from South India.

Suresh A, Praveen Khairkar, Srujana

ABSTRACT

Background :Many researchers have discretely documented the psychological impact of high fluoride on children and adolescents particularly the slower mental functioning. In the current qualitative study, the investigators intended to find a plausible relationship between spectral levels of fluoride in drinking water and/or body tissues to qualitatively analyze psychological, clinical, neurocognitive and developmental domains in 3 different children groups exposed to varied fluoride levels.

Methodology:3 different regions in the state of Telangana in and around Nalgonda district were identified based on concentrations of water fluoride levels ranging from very low to very high. Structured and standardized clinical evaluations for children aged 11 to 15 years from native schools were performed.ICD-DCR-10,CPRS, Wisconsin Card Sorting Test, Raven's Progressive Matrices and Dean's Index for teeth fluoride induced dysfunction were used and analyzed.

Result: A total of 150 students, 50 each from 3 different populations based on water fluoride were evaluated.We identified specific learning disorders, conduct disorders and motor incoordination disorder more common as well as neurocognitive deficits in executive functions and verbal memory in children using high fluoride levels (p<0.05)

Conclusion: To our knowledge, this is the first comprehensive and integrated evaluation of impact of spectral levels of fluoride in 4 domains in its inherent nature for progressive understanding in neuropsychiatry.

Keywords: Spectral Fluoride levels, Neurocognitive dysfunction, Child Psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F132: The prevalence and correlates of social phobia among undergraduate medical students

Kandula Somabala Charishma, Raghuram Macharapu, Pramod KR Mallepalli, Ravulapati Sateesh Babu

ABSTRACT

Introduction: Social phobia is the fear of social situations that involve interaction with others. It is highly prevalent among high school, college and university students. The impact of social phobia among students leads to decreased educational performance, dependence to take alcohol, avoidance of oral presentations, weak performance at clinical examinations, and development of depressive symptoms.

Aims & Objectives: The aim of this study is to assess social phobia and associated factors among undergraduate medical students to contribute towards their optimal care.

Materials and Methods: This cross-sectional study consisted a total of 500 medical undergraduate students. Data was collected using the Oslo 3-item social support scale and Social phobia inventory (SPI) scale.

Results: The results will be discussed at the conference.

Conclusions: The conclusions will be discussed at the conference

Key words: Social phobia; Prevalence; Undergraduate

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F133: Neurological soft sign associated to short chronic illness of schizophrenia: A case report

Gurtej Gill, Gautam Anand

Abstract -Patient Anita is 38 years old female has history of psychosis feature of perceive voices, inappropriate behaviour, suspiciousness, abnormal gait, slurred and decreased speech from 1.5 years. She took treatment on and off during this period advised by psychiatrist but symptoms were not controlled and were progressively increased. She was brought psychiatry OPD for further treatment. She was admitted and evaluated for the same. She was having positive symptom like hallucination of 2nd and 3rd person along with this she has formal thought disturbance like delusion of persecution measured on SANS SAPS AH–4 , VH- 0, Delusion (persecutory) 3, Inappropriate Effect- 3 .Simultaneously she also had Alogia-3 , Attention Impairement-4 , Affect Flat-1 , Evaluation apathy- 4. Neurological examination revealed Ataxic gait with loss of movement on one arm (left side), speech disarticulated and difficulty on pronunciation, Exaggerated reflex noted in left upper limb . MRI BRAIN: showed B/L dilatation in ventricles with cortical atrophic changes

Conclusion - Correlation in presence of Positive as well as negative symptom of schizophrenia from 1.5 year along with association of neurological soft sign like abnormal gait with loss of movement in left upper arm, slurred speech , increased reflexes in left upper limb with radiological findings as ventricular dilatation and cortical atrophy changes

Keywords—Schizophrenia, SANS SAPS, Alogia, Neurological Soft sign

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

F134: A Study Of Attitude Towards Psychiatry Among Private Medical College Undergraduates

Abdul Rahman Baothman, ChalluriPrashanth, Pramod KR Mallepalli, Ravulapati Sateesh Babu

ABSTRACT

Introduction: The attitude of medical students towards psychiatry has been studied extensively in this developed world. The inability to attract medical students to specialize in psychiatry has always been a serious challenge to psychiatric recruitment in developing countries like India.

Aims & Objectives: To study the attitude of undergraduate medical students toward psychiatry.

Materials and Methods: This is a cross sectional study with sample size of 200 participants who are undergraduate medical students of Mamata Medical College, Khammam, Telangana. The samples were drawn using convenience sampling method. Attitude towards Psychiatry scale (ATP) was the tool used to collect data for this study.

Results: The results will be discussed at the conference.

Conclusions: The conclusions will be discussed at the conference

Key words: Medical College; Undergraduate; Attitude Towards Psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 1: Self-help groups in drug addiction: Approach towards sustainable recovery

Sanjay Kumar Munda ¹

1. Titles of the sub-topics:
- 1.1 Evolution of Self-help movement in the addiction field & its development in the modern era
- 1.2 Addiction related Self-help groups: International and national scenario
- 1.3 Self- help group participation and addiction related outcome
2. Names of presenters of sub-topics
- 2.1 Dr. Sanjay Kumar Munda, Assistant Professor of Psychiatry, Central Institute of Psychiatry (CIP), Ranchi – Evolution of self-help movement in the addiction field
- 2.2 Dr. Sourav Khanra, Assistant Professor of Psychiatry, Central Institute of Psychiatry (CIP), Ranchi – Addiction related self-help groups: Functioning
- 2.3 Dr. Ajay Bakhla, Associate Professor of Psychiatry & HOD, Department of Psychiatry, Rajendra Institute of Medical Sciences (RIMS), Ranchi - Self-help groups and addiction related outcomes
3. Learning objectives
- 3.1 To understand the origin and development of self-help groups in the context of drug addiction
- 3.2 To understand various addiction related self-help groups in international and national perspectives
- 3.3 To understand self-help group participation and its addiction related outcome and to present a different perspective of change by moving beyond treatment outcome perspective

Abstract

In spite of the fact that substance addiction is a chronic disorder associated with frequent relapses over lifetime, this is not reflected in the interventions being made. Most of the treatment protocol consist of management of intoxication or withdrawal followed by management of dependence through anti-craving agents and various psychosocial interventions including motivation enhancement therapy and relapse prevention therapy. Most of these treatment take the form of an emergency, intermittent and temporary effort in a start stop fashion. The forms of treatment with longer duration that exist are merely longer versions of the same protocol, with an emphasis on access to treatment, stabilisation, repair and discharge, where the patients may participate in a follow-up scheme for a short period. The basic idea appears to be that substance addiction can only be cured if we are able to determine the correct therapeutic methods and the appropriate length and intensity of the cure. To achieve continuity in the treatment of addiction disorders, there is a need to adopt a long-term perspective, where there is adequate overlap between the ongoing and the continuous efforts. In recent years, there has been a re-emergence of interest in recovery in the addictions world. This has been accompanied by a shift in how treatment and care are delivered, with recovery support services emerging as a key intervention to help people maintain recovery. However, treatment for those with addiction is not a “one-shot” intervention. Self-help groups involved in the treatment of addiction provide in a non-judgmental, caring, and supportive approach with easy access to anyone who desires to be part of the membership. The self-help groups represent a long-term and easily accessible option for individuals with addiction disorders – not only as a kind of follow-up after other forms of treatment, but also as a relevant intervention during the period the patient spends waiting for treatment. The modern self-help group movement comprises many addiction-related organizations operating in different parts of the world with distinctive history of origin, philosophy and membership requirement. Self-help organizations are quite diverse, but this does not prevent characterization of certain essential features which are universal characteristics of all self-help organizations. Self-help groups produce the same sorts of benefits one hopes for from professional addiction treatment programs, i.e., reduced substance use and lower associated psychiatric, social, and medical problems. But evaluating self-help groups as analogous to professional healthcare interventions is essential to know their effectiveness that would lead to particular choices about independent and dependent variables in outcome research, as well as to particular methods and conceptualizations. Several controversies and possible explanations can be found for why self-help groups are not used more frequently in our country, such as lack of knowledge of the methods used by these groups and their effectiveness.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 2: Resilience and Armed Forces

Charles Darwin and Leon Megginson showed that the species that is best able to adapt and adjust to a changing environment is the species that will prevail, not the strongest nor most intellectual. The same principle can be applied to War fighters, as possessing a high level of physical fitness and cognitive ability is simply not enough to succeed and to maintain overmatch superiority against adversaries. Military resilience can be defined as the capacity to overcome the negative effects of setbacks and associated stress on military performance and combat effectiveness. Military operational stress can come in many forms via the singular or combined effects of physical exertion, cognitive overload, sleep restriction, energy insufficiency, variations in the operational environments, and emotional and psychological stress. Modern warfare operations often occur in volatile, uncertain, complex, and ambiguous (VUCA) environments accompanied by physical exertion, cognitive overload, sleep restriction and caloric deprivation. The increasingly fast- paced nature of these operations requires military personnel to demonstrate readiness and resiliency in the face of stressful environments to maintain optimal cognitive and physical performance necessary for success. Resiliency is a complex process involving not only an individual's physiology and psychology, but the influence of factors such as sex, environment, and training.

Employment standards for soldiers primarily evaluate physiological resilience. If you consider a sniper's success to hit the target, the ability to handle stress has a huge impact on the performance. However, this factor, which might be trained, is always a secondary consideration after the sniper's physical performance, which is crucial for success in military operation. In other words, psychological resilience flows from the more fundamental physiological resilience. Natures versus nurture trade-offs are completely dependent on the needs of the military. Though some aspects surrounding resilience are solely grounded in nature, such as biological sex, genetic predisposition, and environmental conditions, resilience has the potential to be nurtured through physical and psychological training combined with the use of specialized equipment for extreme conditions. The military can optimize performance in soldiers that are both mentally and physically resilient and equipped with behavioral adaptations to overcome the forces of nature, including physiological predispositions and extreme environmental conditions. The future concern should also be provided for team resilience as military operations are generally executed in small and large units.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 3: Autism Spectrum Disorders (ASD) - a puzzle waiting to be solved!

TOPIC 1:

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition with lifelong impacts. Genetic and environmental factors contribute to ASD etiology, which remains incompletely understood. Research on ASD epidemiology has made significant advances in the past decade. Current prevalence is estimated to be at least 1.5% in developed countries, with recent increases primarily among those without comorbid intellectual disability.

TOPIC 2:

Genetic studies have identified a number of rare de novo mutations and gained footing in the areas of polygenic risk, epigenetics, and gene-by-environment interaction. Epidemiologic investigations focused on nongenetic factors have established advanced parental age and preterm birth as ASD risk factors, indicated that prenatal exposure to air pollution and short interpregnancy interval are potential risk factors, and suggested the need for further exploration of certain prenatal nutrients, metabolic conditions, and exposure to endocrine-disrupting chemicals.

TOPIC 3:

Approach to treatment involves a multisensory, multidisciplinary approach. Early intervention should be the aim to yield the best outcome and results. Treatments include a range of behavioral, psychosocial, educational, medical, and complementary approaches. The options vary by age and developmental status. The acronym SCERTS refers to the focus on social communication (SC), emotional regulation (ER) and transactional support (TS). TEACHH – Treatment and education of Autistic and related Communicationhandicapped Children involves an array of teaching or treatment principles and strategies based on the learning characteristics of individuals with ASD, including strengths in visual information processing, and difficulties with social communication, attention, and executive function. Occupational therapists use sensory integration therapy to help a child with autism play like other children. Pharmacological options include - antipsychotics (conventional and atypical), stimulants, antidepressants, alpha 2 agonists, anticonvulsants and mood stabilizers, antianxiety and benzodiazepines.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 7: Young Onset Dementia, A Challenge

K K Mishra

Young Onset dementia has got multifaceted problems. Intellectual decline ,loss of competence, abnormality of conduct and psychosocial suffering. The challenges of young onset dementia are ,there is a different need, concern and access to recourses than old individuals Individual with young onset dementia are likely to be healthier less likely have co morbid illness making them good candidate for therapeutic intervention. They have different challenges on all the domains of cognitive functions, from memory language and behavioral issues. They have got a high genetic loading with strong heritability.

We intended to target those challenge areas through this symposia.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 8: Management of Violence and aggression- Update

Neeraj Berry

Northumberland Tyne and Wear NHS Foundation Trust is a large mental health and disability provider in Northeast of UK. It is rated outstanding by the UK regulator. The organisation has developed a strategical approach to reduce violence, aggression, self- harm incidents on our inpatient wards across children's, adult, old age and forensic wards. This approach has several strands to it. In the present symposia we would want to present and discuss the following

- Using Dynamic risk assessment tools to predict violence- experience from Psychiatric intensive care unit
- Structured risk assessment tools- place in Clinical practice
- Novel pharmacological methods to reduce violence and aggression
- Non- pharmacological methods to reduce violence and aggression
- Rapid Tranquilisation
- The role of environment in managing violence and aggression- use of seclusion, de-escalation areas and chill out rooms.
- Violence towards the psychiatrist

The speakers would be clinicians with experience of managing specialised areas where violence is particular risk. The speakers have been involved in developing these approaches, policies, analysing evidence base and evaluating the impact of these approaches. The speakers are special expertise in teaching and learning. They would use a mix of teaching and learning methods to conduct the symposia such as oral and power point presentation, interactive methods of panel discussion, questions and answers and workshops.

The intention of the symposia is to enhance knowledge, skills and competencies of audience in the repertoire of techniques, methods and strategical approach to manage violence and aggression in their clinical areas and lead service developments in this area.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 9: Yoga Psychotherapy for Anxiety, Depression, Stress Management & Suicide Prevention Dr. Pandit Devjyoti Sharma

The word Yoga is derived from the Sanskrit root Yuj, meaning of Yuj is “to join” or “to unite” or to yoke. Yoga is a spiritual discipline leading to the union of individual consciousness with that of the universal consciousness maintaining a perfect harmony between the mind and body, Man and Nature Psychotherapy is a talk therapy, which treats psychological problems through communication and faithful professional relationship between an individual (client) and a trained mental health professional. Yoga was practiced under the direct guidance of spiritual teacher known as Guru, where spirituality was taught as a part of upasana(prayers) and shadhana (yogasana, pranayama, dhayna) etc.

The word psychotherapy comes from the Greek word psyche, which means “Soul, spirit or breath” and therpeuein, which means “to take care of or to serve”. In other words, psychotherapy is the care of the soul.

Yoga psychotherapy is a combination of two words. The first word Yoga is in Sanskrit and the second word psychotherapy is in Greek language. Yoga psychotherapy is a holistic approach for the development of the physical, mental, social and spiritual health of a person who are suffering from mood swing, sadness, low self esteem, anger, fear, psychological problems, anxiety, depression etc.

Yoga is based on immediate experience, therefore psychology of Yoga can be considered empirical. The principles of psychology of Indian Yoga have been tested pragmatically by generation after generation and experienced the similar results and effects which were experiences since long from different practioners or Gurus, then the knowledge which came from careful and systemic exploration of thousands of years by the countless Gurus could be said to have validated empirically through the experiences of thousands of years.

if we compare ancient Yoga to the recently developed modern psychology of about 140 years old, we will find that modern psychological processes known as transference, identification, projection etc have been already mentioned thousand years ago in Yoga texts. We can also see that both the modern western psychotherapy and ancient eastern Yoga psychology prefer self awareness, self acceptance, self understanding, introspection and relationship

Both the modern psychotherapy of west and ancient Yoga Psychology of east have the same aims of transforming self through cognitive, behavioral and emotional change for the purposeful goal oriented happy and peaceful life

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 10: Molecular Psychiatry, Genotype To Phenotype Through Omics, Cells, Circuits And Drugs

Sanjeev Jain ¹, Sydney Moirangthem ², Malay Dave ³, Bhaskar Mukherjee ⁴

There is tremendous improvement in the field of molecular genetics and biology and the effects are seen in every medical field. In psychiatry too the molecular biology approaches are unlocking the previously unknown areas and giving new avenues of understanding in different psychiatric disorders. The biggest problem of psychiatry is the vagueness of it's pathophysiology. How some specific genetic mutations can give rise to the some specific behavioural symptoms is still obscure. Also longitudinal stability of so called psychiatric disorders. The drugs are another enigma. How some so called neurotransmitter modulating drugs changes gene expression that's still unknown.

To understand all these we have to understand the full pathway from genotype to phenotype in psychiatric disorders along with molecular pharmacology of our drugs.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 11: Suicide: Current scenario and future directions

Prakash B Behere, Nikhil Chougule, Kaveri Chougule, Shabiullah Syyed

The main theme of World Mental Health Day observed by the World Federation for Mental Health (WFMH) for the year 2019 was suicide prevention. WHO reports that every year worldwide around 8 lakh people commit suicide. This means that 1 suicide is committed every 40 seconds and that is quite disturbing. The ‘40 seconds of action’ catch phrase was chosen in order to make the world aware of the magnitude of suicide and to work together for the prevention of suicide.

According to WHO's report, India ranks 1^st in terms of suicide rate in the entire South Asian region. The current suicide rate in India is 16.5 per 1 Lakh people. India also ranks 3^rd in terms of female suicide rate (14.7). One student commits suicide every hour in India. Deaths due to suicide account for more number of deaths than by breast cancer, malaria, war and homicide.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 12: Suicide and Substance Use Disorders

Nilam Behere, Shubhangi Parkar, Rupali Shivalkar, Sujit Sarkhel

Suicide is identified as a significant reason of death and disability all over the world. As per WHO report, largest number of suicide deaths in absolute numbers occur in low- and middle-income countries, maximum in South-east Asia region.

Amongst important modifiable risk factors for suicide, pertaining to young people, is substance use, viz. alcohol and other substances. WHO Member States have committed to the global target of reducing suicide rates by 10% by 2020. Achieving the target requires countries to take several actions including reducing risk factors like substance use. More than 90% of people who commit suicide are recognized to suffer from depression; a majority also have a substance abuse disorder, or both. The risk of suicide is more with comorbid Substance Use Disorder (SUD) and depression (major depressive disorder) or other mental disorders such as Post Traumatic Stress Disorder (PTSD), Anxiety Disorder, Bipolar Disorder, Schizophrenia and some personality disorders. Suicides also occur as a physiological or psychological consequence of chronic substance use and associated consequences. There is a shared vulnerability and reciprocal association of Substance Problems and psychological distress/ symptoms. 20-60% of all individuals who commit suicide have substance use disorders, mostly alcohol use disorders. Rates of alcohol use prior to a suicidal act are high among those with alcohol use disorders, ranging from 8 to 20%. Individuals with a substance abuse disorder are almost six times as likely to attempt suicide at some point in their life.

A regular clinical screening of suicidal risk factors in patients seeking treatment for addiction problems is necessary. Drug treatment clinics and centres should develop treatment strategies to prevent suicides. We will discuss about understanding association of Suicide and alcohol dependence, opioid dependence and its prevention and management.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 13: “Sexual crimes against women – from cradle to grave”

Submitted by: IPS Speciality Section on Women's Mental Health

Presenter:

1) Dr Rajni Chatterji (9826424725)
2) Dr Sarmishtha Chakrabarti (9831270034)
3) Dr Ruksheda Syeda (9820033095)

Sexual violence occurs throughout the world. Available data suggest that in some countries nearly one in four women may experience sexual violence by an intimate partner, and up to one-third of adolescent girls report their first sexual experience as being forced.

Sexual violence is a serious public health and human rights problem with both short- and long-term consequences on women's physical, mental, and sexual and reproductive health. Whether sexual violence occurs in the context of an intimate partnership, within the larger family or community structure, or during times of conflict, it is a deeply violating and painful experience for the survivor (WHO)

Approximately 15 million girls aged 15 to 19 years have experienced forced sexual acts. Based on data, only one per cent ever sought professional help (UNICEF2017). School related gender violence is a major obstacle to universal schooling and right to education for girls (UNESCO 2018).

40 – 60% women face street based harassment (UN Women 2017), and work place sexual misconduct towards women is common place. Cyber harassment (unwanted, offensive sexually explicit emails or SMS messages, or offensive, inappropriate advances on social networking sites) and bullying is highest in young women between 18 to 29 years of age.

Sexual crimes against older adult women population has seen an escalation in the last decade.

This symposium will shed light on this low researched area of sexual crimes against women in India, with special focus on psychiatric consequences to the individual and society at large. Case evaluations, interventions, medico legal aspects, and liaison work with other teams will be touched upon. Possible role of the Indian Psychiatrists and Psychiatric Institutions in combatting with this crisis will be explored.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 14: C.I.P DIGITAL ACADEMY: WHAT WE ACHIEVED IN THE PAST ONE YEAR”

Nishant Goyal ¹, Rajeev Ranjan Sahoo ², Ankit Choudhary ³

In a developing country like India, where there are 50 million people suffering from mental illness , there is just 1 Psychiatrist per 2 lac population in comparison to the ideal ratio of 1:8000-10000.There is a urgent need to bridge this gap and to buffer this scarcity. The main objective to start such a digital course was to define that “Cost and geographical distance should not be barrier to deliver mental health services”. There is also a hindrance in providing mental health services at a community level aptly due to lack of proper training in terms of psychiatry during the MBBS training. Hence with the help of a digital course like ours, people can always learn about mental health at their fingertips and at their own convenience.

The entire curriculum consist of 5 modules covering history taking , mental status examination, common mental disorders ,substance use disorders and severe mental disorder which needs to be completed in a span of 3 months. The course is entirely digital accessed through Google Classroom. The materials and assessments are shared through the application. It also consist of a Live Interactive Session ,which is being held every fortnight through ZOOM Cloud. At the end of the course the participant gets a certificate of “Diploma in Community Mental Health” accredited by Ministry of Health and Family Welfare.

There were around 200 registration for the course from entire India and after a pre assessment they were enrolled for the course. Till now ,we have completed 4 batches and each of the batch consisted of around 30 students.

Keywords: Community Psychaitry,Digital,

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 15: Smartphone Apps for Mental Health: Overview, challenges and recommendations for the next generation psychiatrist

Sujit Sarkhel ¹, Vikas Menon ², Koushik Sinha Deb ³

There are two major challenges involved in mental health care service delivery today in our country: firstly, many people with mental health disorders are unable to access professional help leading to a large treatment gap and; secondly, majority of the assessments and treatments of mental disorders happen in clinical settings outside of the naturalistic setting of the patient. Both these can be tackled effectively by utilizing Smartphone apps which offer portability for access anytime/anywhere, are inexpensive versus traditional desktop computers, and have additional features (e.g., context-aware interventions and sensors with real-time feedback). Apps also have a wider reach and appeal to people. Apps have been shown to be effective in promoting behavioral change in a specific time and context opening new opportunities for empowering people in their real life. Based on these premises, numerous commercial smartphone apps have been introduced for mental health in the last decade. However, many of these apps lack scientific basis or validation. This symposium will be divided into three parts. In the first part, we will provide an overview of apps that are relevant for mental health. Here, we shall look at clinician-oriented apps that support assessment, diagnosis and treatment as well as patient-oriented apps that support education and self-management. Next, their evidence base will be examined and recommendations for designing high efficacy apps will be given based on findings from the extant literature regarding what works and what doesn’t. Finally, we will look at the unique opportunities and challenges that mental health apps can pose with a discussion of possible solutions. The symposium will end by examining how practising psychiatrists can surmount barriers to use of this technology at an individual, organizational and national level.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 16: Art with impact! Indian Cinema and mental health literacy –where are we?!

Pavitra KS, Vinay Kumar, Vijayakumar Harabishettar, Smitha CA, Shivanand Hiremath

Cinema as an important means of mass media is highly influential and powerful.

The impact of cinema can be long lasting. Stigma and misunderstanding still exist around mental health and mental ill health, not only among the general public but also among health professionals

This can lead to negative experiences for those living with mental health problems – as well as for their families and carers, who can feel ignored, isolated, criticised or blamed. At the same time Stigma is reduced when the general public experience positive portrayals of people who have mental health problems.

There are only a scant 4,000 psychiatrists to tend to India's giant population of 1.2 billion (compared to America's psychiatrist headcount of 50,000), and in 2012, suicide was the second leading cause of death for Indians aged 15 to 29.

Pretty grim, for sure, and indicative of the stigma surrounding mental illness that seems to be routinely reflected in the Indian film The digital media has further made these movies easily accessible anywhere ,anytime and has also led to selective watching. There's no shortage of examples of the misleading and harmful mental illness-themed plotlines in Cinema hits of the past decade, all of which seem more intent on delivering mental illness as a punch line or device rather than an opportunity for activism or awareness.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 17: Understanding Schizophrenia beyond Neurotransmitters

Debadatta Mohapatra, Amrit Pattojoshi, Suvendu Mishra

Schizophrenia has been primarily associated with dopamine dysfunction, and treatments have been developed that target the dopamine pathway in the central nervous system. However, accumulating evidence has shown that the core pathophysiology of schizophrenia might involve dysfunction in dopaminergic, glutamatergic, serotonergic, and gamma-aminobutyric acid (GABA) signaling, which may lead to aberrant functioning of interneurons that manifest as cognitive, behavioral, and social dysfunction through altered functioning of a broad range of macro- and microcircuits.

Until a decade ago it was primarily thought that schizophrenia is the end result of dysfunction in Neurotransmitters. Research on genetics, biomarkers, microbiomes, neuroprotection and neuromodulation opened path the road to journey of pathphysiology of schizophrenia. The inefficiency of antipsychotics for management various dimensions including positive symptoms also raises suspicion that we might be missing some other link.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 18: IPS Geriatric Psychiatry Speciality Symposium

Legal Protections for Elderly in India

In view of increasing proportion of Population of India, the protection and rights of elderly (aged ≥60 years) beside the basic necessity of healthcare services are needed in future. The proportion of elderly population has been increased from 5.6% in 1961 to 8.6% in year 2011. In recent years, due to better health and improved life styles, It has been projected that there will be exponential increment reaching up to 20% of total population by year 2050. Furthermore, 71% of elderly population resides in rural areas while 29 % is in urban areas. How much proportion of elderly are aware and utilizing the provided fundamental and legal rights, protective laws and acts is matter of concern. When elderly will be aware about these measures, they will be able to protect them from their exploitation, abuses and will definitely raise their voice for help etc. These issues along with the constitutional provisions and legal acts will be presented under following sub-topic.

· Introduction and Rights of Elderly: Dr. Anshuman Tiwari

· Mental Health Care Act and Constitutional Provisions for Elderly: Dr. Kunwar Vaibhav

· Legal Acts regarding Elderly: Dr. A. Q. Jilani

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 19: Sexual side effects of Psychotropic drugs & it's management”

Ranjan Das ¹, Sk Ashik Uzzaman ², Arnab Pathak ³

Sexual dysfunction (SD) can be defined as any reduction in desire or libido, diminished arousal, a decline in the frequency of intercourse, or an undesirable delay in or inability to achieve orgasm. It has been well known for a long time that psychotropic drugs contribute to the development of SD. There were limited research effort has been invested to try to understand the mechanisms that govern these interactions. Several studies outlined that SD is rated as one of the most distressing side effects of psychotropic's and a major cause of a poor quality of life and that it is associated with a negative attitude toward therapy and noncompliance to treatment. Psychotropic-induced sexual dysfunction is a common and bothersome side effects. The majority of information available on the subject primarily pertains to antidepressants, but antipsychotics, antiepileptics (mood-stabilizers), anxiolytics sedatives hypnotics can also cause significant sexual dysfunction.

Benzodiazepines, lithium, monoamine oxidase

inhibitors, neuroleptics, and tricyclic antidepressants are reported to cause sexual dysfunctions like anorgasmia (Ghadirian et al., 1992), unsatisfying or painful intercourse.The mechanisms behind these adverse events are thought to be primarily due to antidepressants’ effects on serotonin and to antipsychotics’ anti-dopaminergic activity. Orgasm (Aizenberg et al., 1991), altered libido, erectile failure, priapism (Ziegler and Behar, 1992), menstrual irregularities, delayed or retrograde ejaculation (Segraves, 1992), and altered sexual sensation and sensitivity (Lieberman, 1988).It affects both sexes.

Keeping it in mind we have planned to present a symposium and enlighten recent updates regarding incidence prevalence of different offending drugs, neurobiology and management on the topic.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 20: Tips and Traps for a Budding Psychiatrist!

Shubrata Kalmane, Virupaksha HS, Narayan Mutalik, Mahesh Gowda

The best-seasoned post graduates start out young, green, naïve, and with little clinical experience. When they choose to join a medical college or go into private practice, they realize how much they do not know. Once they are practicing on their own, they are responsible for knowing what they know & being humble enough to acknowledge what they do not know in order to achieve a standard of care.

What makes a good teacher in a Medical College?

Teaching is a complex skill & art which requires eagerness, self-discipline, hard work, practice & feedback to make sure that you are on the right track because a teacher can never truly teach, unless he is still learning himself. Dr Narayan R Mutalik, Associate Professor, recipient of Academic Excellence Award in S.N.Medical College from Bagalkot, who aspires to be a Lifelong Learner will enlighten you on the above topic.

Facing Googlies & Bouncers!

No doctor likes to be blamed for medical negligence or get sued.
Good clinicians struggle with the litigation process.
Even when their care has been absolutely appropriate, many doctors experience great anxiety when they are accused of having been negligent in their management.
Because they have trained so hard to gain their expertise, many of doctors have found that a lawsuit strikes at them personally as well as professionally.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 21: Recent advances in Diagnosis and Management of Erectile Dysfunction – A Psychiatric perspective

Nitu Mallik, Saikat Baidya, Rudra Prasad Acharya

By definition, erectile dysfunction (ED) is the “consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual satisfaction.” This condition is projected to affect more than 320 million men worldwide by 2025.

Erectile dysfunction is one of the most common sexual dysfunction presenting to a psychiatrist.It can present as a primary complaint per se, can be associated with Psychiatric disorders or may emerge after certain psychopharmacological treatment. Generally affecting middle aged and older adults, it is noted for its high incidence of association with physical comorbidities notably diabetes and cardiovascular, limiting the pharmacological treatment options.

In the past, organic ED (ie, due to vascular, neurologic, anatomic, or endocrinologic factors) and nonorganic ED (ie, due exclusively or predominantly to psychological or interpersonal factors) were distinguished from one another. Nonorganic ED (also called idiopathic or psychological ED) was frequently assumed to be the cause of ED in men aged <40 years. They are generally referred to psychiatrists without much medical investigation. As the study of ED has evolved, it is now more appropriate to view ED as a symptom or marker of another disease (eg, metabolic, neurologic, or a combination) vs a primary condition, suggesting that a variety of evaluations may be necessary to secure an accurate diagnosis.

As more and more medical investigations have been invented, the psychiatrist should have sufficient medical knowledge about them to correctly evaluate patients. Treatment options have also changed and many a times collaboration with urologist is necessary. We are going to discuss about the recent update on investigations and management that will help in building our clinical skill for treating erectile dysfunction.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 22: Neuropsychiatry: Past, Present & Future

Anantprakash S Saraf ¹, Diptadhi Mukherjee ², Santanu Nath ³

With the rise of cognitive neuroscience in last few decades, the field of neuropsychiatry has resurrected out of a long hibernation. It lies at the interface between neurology and psychiatry; and touted as an approach to overcome the arbitrary and unhelpful divide between the two sister specialities. It's expected to serve as a bridge between the brain and the mind, finally allowing brain science to come out of the shadows of Cartesian dualism.

Neuropsychiatry traces its beginnings to the 19^th century Germany and France, where pioneers of both psychiatry and neurology were hoping to unravel the basis of brain diseases through histo-pathological methods. This agenda of the uncovering biological basis of psychiatric disorders suffered a major setback with the rise of Freudian Psychoanalysis and psychodynamic psychiatry; effectively detaching psychiatry from medicine in general and neurology in particular. After World War II, this divorce became explicit with the splitting of Archives of Neurology and Psychiatry into two separate journals.

During the 2^nd half of twentieth century especially in 1980s, with the fall of psychodynamic psychiatry, voices for re-alliance began to emerge. Eventually, organizations dedicated to the cause of neuropsychiatry were formed like British NeuroPsychiatry Association and American Neuropsychiatric Association.

There are various approaches to conceptualise the field of neuropsychiatry. Some consider it as study and treatment of conditions, which lie at the borderline or have overlap between neurology and psychiatry, including psychiatric manifestations of neurological conditions and neurological aspects of psychiatric disorders. Others like to conceptualise it in a broad way including full range of central nervous system disorders under a single umbrella. Few have suggested that this attempt to merge the two specialities will dilute the skills and expertise of both. Also, it will be practically impossible for everyone to keep up with the vast amount of knowledge, arguably the largest among any known medical speciality. Apart from these proposals, developing neuropsychiatry as a separate discipline incorporating principles from both the branches for the benefit of patients is also being discussed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 23: Supports needed for adults with intellectual disability

Jovanjeet Singh

Intellectual Disability is a condition that creates special needs and require supports for both the individual and the carers across the life span. These needs may range from independent mobility, physical care, communication needs, modified curricula, aids and appliances, occupational vocational opportunities, and. At times there may be comorbid physical and mental health conditions that would require medication if there are treatable, comorbid medical conditions.

There is a direct relationship between intensity of support needed and extent of disabled persons limitations. The relevance of such support needs in the person with disability, it becomes especially relevant since the disability legislation recognizes persons with High support need as a subset of persons with specialized disability requiring special attention¹. High support need assessment goals are different from other disabilities. The mechanism to evaluate and quantify the degree of such high support needs, requires a threshold of 60 out of 100 has been notified². our symposium will highlight on this evaluation mechanism. Its advantages anticipated and pitfalls and also report on its feasibility when applied to substrate of our clients with IDD. Our study will highlight the pertaining to the scoring of High support needs assessment scale. Our symposium will also inform of Supports Intensity Scale which is a well-known validated and widely used scale to assess such supports. This tool is used currently across various states and jurisdictions (USA, Canada, Australia). There has till date been no research conducted in India to determine qualitatively and quantitatively the various support needs of persons with intellectual disability. The previous research has mainly focused on expressed needs of patients but not on other unexpressed needs. In this background present study is planned to comprehensively assess support needs in patients having intellectual disability.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 24: Recovery in Addiction Psychiatry: concept and interventions

Biswadip Chatterjee, Dheeraj Kattula, Gayatri Bhatia, Saumya Mishra

· Concept of recovery in substance use disorder

There are many definitions of recovery in addiction psychiatry. The concept is complex and is evolving. SAMHSA simply defines recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

It is recognized that recovery occurs in different domains like in health where it is about overcoming or managing one's disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being, home where it is about having a stable and safe place to live, purpose of life meaning conducting daily activities and having the independence, income, and resources to participate in society and community which is related to having relationships and social networks that provide support, friendship, love, and hope. The conceptual boundaries would be discussed in the session.

· Role of psychiatrist in extra treatment needs

Traditionally the role of psychiatrist has been in the clinical care of the patient, in making proper diagnosis, identify comorbidity, assess risks and treat the patient appropriately including addressing the proximal factors that affect the care. However, today the role of psychiatrist is larger. It includes engagement with family and friends, liaison with other medical, mental health professionals and social services and address distal factors like employment, society and culture. It includes the role as an advocate for the patient and fight stigma and discrimination. The session would highlight the role of psychiatrist in meeting these needs in patients using substances.

· Night hospitalization

It is a special arrangement in a hospital setting providing treatment and lodging at night for patients within a hospital setting providing treatment and lodging at night for patients able to work in the community during the day. This is in contrast to day care where patients come to the hospital to work in the day time and learn skills and go back to their own homes in the night. Night hospitalization is useful for people who have work skills and can work in the community. The stay at hospital helps in early recovery period to discuss work related stress and is a graded approach to settlement in the community. The session would discuss practical aspects of night hospitalization, the challenges and the benefits.

· Interventions in community

The interventions in clinic and in community can be quite different despite being geared to aid the patient on path to recovery. This is due to patient, illness, treatment and community characteristics. The interventions in community not only focus on the individual but also develop a milieu for the patient to fit in. This implies working with NGOs, family members, community leaders, recovered substance users to help the recovering patients. The session would discuss practical steps in practice of addiction psychiatry in community

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 25: The Culture Of Capitalism : IS IT A BREEDING GOUND FOR STRESS AND MENTAL ILLNESSES IT IS DEFINITELY INCREASING COMFORT BUT IS IT REDUCING OR INCREASING HAPPINESS

Dheerendra Mishra ¹, Swayam P Baral ²

We are living through an age of transition. The new co-exists with the old. We can identify political, economic and cultural elements of this change, but we do not yet have a way of describing the kind of society we are living in. The great explanatory frameworks of political economy and sociology inherited from the industrial modernity of the nineteenth century leave too much unsaid. Theories of the moment tend to skip from one modern phenomenon to another. They are like stones skimming across the surface of water. We lack a story of these times.

In the last three decades indian economies have been experiencing a new type of capitalism. Class and the social relations of production are being re-organised by new regimes of capital accumulation. These changes raise a number of questions. How are new technologies and the new modes of production and consumption transforming the cultures and social relations of class? In what ways are individuals as social beings changing in these new conditions? How is capitalism influencing the stress resilience in people and predisposing them to various mental illness.

Contradictions abound across the old and the new, the national and the global. We need an analysis of contemporary capitalism, its culture of unrest and its forms of capital accumulation. There are no clear signposts to follow. But, as Rebecca Solnit says, getting lost is like the beginning of finding your way.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 26: How to Manage Side effects of Clozapine

Sandeep Grover, Aseem Mehra, Swapnajeet Sahoo

Clozapine is a recommended treatment strategy for a treatment-resistant schizophrenia. However, one of the major reasons for its infrequent prescription is its side effects. In fact, some of the clinicians prefer not to prescribe it because of fear of haematological side effects. Studies suggest that adverse effects lead to approximately 17% of patients on clozapine eventually discontinuing the medication. Hence, it is important to understand the various side effects of clozapine and their management. The side effects of clozapine can be categorized as haematological side effects, life threatening side effects requiring emergency care and common side effects, which can be disabling too. The hematological side effects of clozapine include neutropenia, thrombocytopenia, thrombocytosis and eosinophilia. Occasional patients go on to develop, late onset neutropenia. The life threatening side effects of clozapine requiring emergency care include myocarditis, seizures and intestinal obstruction. The common side effects of clozapine include sedation, postural hypotension, constipation, weight gain, sialorrhea, obsessive-compulsive symptoms and metabolic side effects. This symposium will focus on the assessment and management of various side effects of clozapine

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 27: Undergraduate Psychiatry Education in India: Long Road Ahead

Ashok MV ¹, Anil Nischal ², Kishor Rao ³, Mohan Issac ⁴, Henal Shah ⁵, Ravi Gupta ⁶

Undergraduate medical education of Psychiatry in India is presently limited to a small section in General Medicine. This happens despite the fact that a large body of scientific evidences shows that in general practice and specialty clinics nearly ¼ patients suffer from with pure psychiatric disorders or comorbid psychiatric disorders. Thus, an undergraduate is ill prepared to deal with a large chunk of patients that he is going to cater in his practice. One way of solving the problem is making Psychiatry a major subject. However, this will increase burden on MBBS students who are already studying other sixteen subjects. Medical Council of India has recently proposed a curriculum that is competency based. This curriculum defines the competencies and topics to be covered. However, this is too general and the time allotted to Psychiatry teaching is far shorter that expected competencies to be achieved by an undergraduate.

In view of new scientific evidences, it is important that we teach psychiatry in correct perspective, i.e., as any other medical disorder. Emphasis on social aspect should be must but limited as not only psychiatric disorders but other medical disorders have social aspects. Lastly, it is important that certain specific areas and competencies are identified to be included in UG curriculum and these should be realistic and achievable.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 28: Depression in Adolescents: Global Health Priority

Dhrubajyoti Bhuyan ¹, Sabita Dihingia ², Kavery Bora ³, Bitupan Kalita ⁴

Depression in adolescents is often under reported and remains undiagnosed. Various studies have reported serious adverse consequences of depression in this age group including poor scholastic performance, poor social relatedness, substance abuse and suicide. Adolescence has been considered as a period of heightened stress (Spear, 2000) due to many changes experienced concomitantly including physical maturation, drive for independence, increased salience of social and peer relations and brain development giving rise to intense psychological and physical intensification of emotional experience which makes them vulnerable for depression. Various Clinical and epidemiological studies have demonstrated a higher risk for development of depression in three groups namely, adolescents with subclinical depression, adolescents with past history of depression and adolescents with family history of depression. There have been several risk factors for depression such as such as emotional abuse, problems in setting boundaries in relationships, adverse childhood experiences. The clinical presentation often differs from that of adult depression. The behavioral disturbances are often ignored and equated with adolescents’ unruly behavior rather than a manifestation of depression. This leads to poor service utilization and more dysfunction in terms of academic performance and psychological disturbances and social integration. Therefore, proper understanding of the problem is of utmost importance in order to plan for proper timely management and formulating the preventive strategies

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 29: Conundrum of Classification of Psychosexual Disorders: Current Status & Future Directions

Introduction & Historical developments – Dr. G. Prasad Rao, Hyderabad

2. ICD -10 & 11 – Dr. Shivananda Manohar. J, Mysore

3. DSM – IV & 5 – Dr. Suman S Rao, Mysore

4. WPA Classification & Future Direction – Dr. T.S.S. Rao, Mysore

The Classification of Sexual Disorders has always been in disarray for varied reasons, most important being lack of understanding concerning biology, psychology and sociological issues related to sex and sexuality. The significant impetus came to classification with the work of Masters and Johnson and even today it is still been evolving. ICD system has gone through major haul, particularly sexual problems being dealt under a separate section removed from psychiatric disorders. DSM system, particularly has brought in many changes, in particular dealing with female sexuality, removing certain categories and renaming certain other categories. paraphilia's and gender identity disorders renamed gender dysphoria are two other areas which have seen the major changes. However, the WPA system of classification Edited by Mezzich and Ruben Hernandez, 2006 appears to be the best one encompassing bio-psychosocial paradigms of sex and sexuality. The symposium looks at historical aspects, International classifications, WPA system and looks forward to the progress to be made regarding the ideal system.

Key words: Classification of Sexual Disorders, ICD, DSM 5, WPA Classification of Sexual disorders.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 30: Overview & Recent Advances in CONSULTATION LIAISON PSYCHIATRY: Indian Context

Kunal Kumar, Pankaj Verma, Abhinit Kumar, Nikhil Nayar

Consultation–liaison psychiatry is a relatively young but vibrant and upcoming subspecialty of psychiatry. The term CLP is often used interchangeably with “psychosomatic medicine,” which is understood as a discipline which deals with the understanding of the interplay of biological and psychosocial factors in the development, course, and outcome of all disease. GHPUs have facilitated the mental health care, by being accessible and have also possibly helped in reducing the stigma associated with mental illnesses. CLP has also helped in establishing psychiatry as a medical discipline in the mainstream of medicine. CLP practice, training, and research have highlighted the role of mental health professionals in various disciplines of medicine and surgery, and over the years, there is evolution of terms such as psychooncology, transplant psychiatry, psychonephrology, and cardiac psychiatry. It is the need of the hour for the psychiatrists to have good knowledge about physical aspects of mentally ill patients and also have better understanding about managing psychiatric disorders in patients with concomitant physical illnesses.

In India, mental health services were limited to the confines of mental hospitals up till the1930s. However, a survey of postgraduate training centers in India done in the mid-80s reported that 75% of the postgraduate training centers were in the GHPUs setting. In general, it is evident that CLP services across various centers follow the consultation model for both inpatients and outpatients, in which on the request of the physician/surgeon, the psychiatrist evaluates the patient and provides psychiatric inputs. Over the last few decades, a significant growth has been seen in the subspecialty of CLP in India. However, there is a long way to go further. Efforts to enhance C-L Psychiatry services so as to improve clinical services, training and research at the GHPUs can enhance the quality of care to large extent. The symposium is an attempt to present an overview of the consultation liaison psychiatry in india, recent advances that has taken in CLP and what can be done for its progress.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 31: Cognitive Deficits in Schizophrenia

Sunny C ¹

Introduction:

The term schizophrenia was coined by Eugene Bleuler. Symptoms of schizophrenia are grouped intodomains. The domains of dysfunctions are positive symptoms, negative symptoms, cognitive impairments, mood and suicidity and aggression.

Context: Cognition is the sum total of mental processes that makes us acquire knowledge and keeps us aware of our surroundings and thus enables us to arrive at appropriate judgments. Cognitive deficits are enduring and persistent features in schizophrenia and can be neuro-cognitive or relating to social cognition. Neurocognitive deficits include deficits in speed of processing, attention / vigilance, working memory, verbal memory, visual memory, reasoning and problem solving, social cognition.

Methods of assessment: Cognitive function can be accessed by various methods like experimental approach, neuropsychological tests, psychometric tests and ecologic approach. Cognitive deficits when present at onset of illness producing substantial impairment. Unlike psychotic symptoms which remit with treatment functional impairments produced by cognitive impairment remain stable over time.

Significance: Detail understanding of such symptoms will help in disability limitation. Various cognitive remediation programmes are available. Multiple articles were studied to make an attempt of understanding the topic and gaining an idea of work done so far. Pubmed search with made and articles sought. The information was structured and organized.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 32: Metabolic clinic: An integrated and multidisciplinary approach in the management of metabolic syndrome

There is an unmet need for addressing Metabolic syndrome (MS) in patients with severe mental illness (SMI) as MS is frequently associated with SMI and both of them independently can cause significant morbidity. The patients with SMI have poor health seeking behavior as well as limited poor access to medical care. There is vital need to address the barriers of poor awareness, access, help-seeking etc. for effective prevention and treatment of MS. There has been upsurge in literature on role of multidisciplinary and integrated management of MS in SMI.

With this background, we aim to discuss on

1. Existing literature on role of multidisciplinary and integrated management of MS in SMI- Dr Pooja Patnaik Kuppili
2. Establishment of Metabolic clinics- Dr Naresh Nebhinani
3. Discuss opportunities and roadblocks associated with it in Indian setting- Dr Mukesh Swami

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 33: Symposium - Alcohol Craving & Relapse: How to Curb Alcohol Cravings?

Prabhoo Dayal ¹, Om Sai Ramesh ¹, Gauri Shanker ¹, Shiv Prasad ¹

Alcohol use disorder is a chronic relapsing disorder associated with a variety of psychological, social and physical problems. It is a leading preventable cause of morbidity and mortality and a major cause of health care cost. A recent nationally representative survey on magnitude of substance use in India reports that the prevalence of alcohol dependence and harmful use in India is 2.7% and 2.5% respectively. It means, about more than 5.7 crore individuals have been affected by alcohol dependence or harmful use.

Relapse prevention is a major challenge in the treatment of alcohol use disorder. Various outcome studies have documented that more than 75% of patients relapsed within one year of treatment. Relapse is a multi-factorial process and it result from a combination of various factors including the individual factors, the substance and the environmental related factors. Craving has been identified as an important risk factor for relapse in patients with alcohol dependence and high craving is associated with relapse. Literature reports that higher Obsessive Compulsive Drinking Scale (OCDS) total scores at the end of the treatment may predict the alcohol relapse during follow up.

Although pharmacologic treatments with Naltrexone, Topiramate and Acamprosate for alcohol dependence in combination with psychosocial therapies are available, these have often only modest effect and not fully addressed alcohol cravings and relapse so far. The cravings to drink are short-lived, predictable, and controllable. Therefore psychological approach commonly used cognitive behavioural therapy, may help people to change unhelpful thinking patterns and reactions. Both pharmacological and psychological treatments are accepted approaches to the management of alcohol cravings and relapse. Therefore the relapse prevention strategies should be focused on the integration of evidence-based psychosocial interventions into existing pharmacological treatment.

Keywords : Alcohol Craving, Relapse ,Naltrexone ,Acamprosate

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 34: Government Policies and Suicide Prevention in India

Sujit Sarkhel

According to available evidence, there are a few definitive steps which have been found to be effective for suicide prevention at the level of policy implementation. Developing guidelines of suicide reporting for the media is one such step. Dr Lakshmi Vijayakumar shall be talking about various efforts that have been taken in this direction, the response of the government, the press, the Press Council of India and the way forward. Substance abuse, especially alcohol, has a strong association with suicide. Dr Subhangi Parkar shall be highlighting the link between between substance abuse and suicide and whether alcohol prohibition or related policies may have a role in suicideprevention. Finally, Dr Sujit Sarkhel shall be outlining the changes in laws related to suicide following implementation of the Mental Healthcare Act, 2017 and its impact on reporting and treatment of survivors of attempted suicide.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 35: Assessment and management of depression in medically-ill

Sandeep Grover, Devakshi Dua, Subodh BN

Compared to the general population, the prevalence of depression is reported to be significantly higher in the medically-ill. The epidemiological data suggests that the prevalence of depression increases with increase in severity of the medical illness and severity of disability. The prevalence rates have been influenced by the assessment scales used and the study setting. In general, the prevalence rates are lower when these are reported on the basis of structured diagnostic interviews carried out by mental health professionals as compared to screening questionnaires. Diagnosing depression in the medically ill is often challenging due to the overlap of symptoms of depression with the physical illness and the various psychological reactions emerging due to physical illness. There are different approaches to diagnose depression in medically ill, viz. Inclusive, exclusive, substitutive and etiological. Some of the depressive equivalents in the medically ill people include demoralization, grief reaction, adjustment disorder, sub-syndromal depression, loneliness and social isolation. Most of the drug trials do not include medically ill patients. Hence, it is very difficult to apply the efficacy/effectiveness data to medically ill people. Selection of antidepressant in medically ill should take into account the type of medical illness, the severity of medical illness, the on-going pharmacotherapy for the medical illness, drug interactions and the side-effects of antidepressants. Special focus should be kept on evaluating the liver & renal functions tests, and serum electrolytes. In terms of drug interactions, both pharmacokinetic and pharmacodynamics drug interactions need to be taken into account while choosing the antidepressant. This symposium will focus on the above three aspects.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 36: Translating Research In Neurodevelopment Into Treatment For Addictive Disorders

1. Learning from Neurodevelopmental Science

Dr. Vivek Benegal, Professor of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore [Life Fellow: 02070]

Addictive disorders, like other psychiatric disorders of young onset, are increasingly understood as outcomes due to differences in psychological abilities to cope with environmental challenges, related to altered neurodevelopmental trajectories of underlying functional and structural brain connectivities. This in turn appears to be the resultant of developmental interactions between inherited genomic variation and exposure to a spectrum of environmental stressors. These insights are opening up possibilities of intervening at both individual vulnerability (personalized medicine) and broader public health interventions to pre-empt some of the early onset psychiatric disorders. We will present data from the Indian neurodevelopmental cohort study – the Consortium on Vulnerability to Externalizing Disorders and Addictions [cVEDA] to illustrate some of these learnings.

2. A Neurodevelopmental Approach To Assessment And Planning Treatments

Presenter: Dr. Deepak Jayrajan, Assistant Professor of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore

The neurodevelopmental approach to understanding addictive behaviors, serves to reframe the problem behaviors as a compensatory response to underlying neurodevelopmental vulnerabilities – incorporating trans-diagnostic psychological deficits, commonly underlying externalizing and broad autism spectrum behaviors, depression-anxiety and mood disorders. This serves to focus attention on the drivers of these behaviors and away from the traditional and stigmatising focus on the problem use, increase engagement of the patient and the care-giver and reduce therapeutic nihilism. Above all, it provides a theoretical rationale to test trans-diagnostic therapies. We will discuss the elements of the neurodevelopmental approach in assessment and treatment planning as practiced at the Centre for Addiction Medicine, NIMHANS.

3. Neurodevelopmental Approaches To Treatment: Moving From Palliative To Pre-Emptive Strategies

Presenter: Dr. Arun Kandasamy, Additional Professor of Psychiatry, Centre for Addiction Medicine, National Institute of Mental Health and Neurosciences, Bangalore [Life Fellow: 01222]

The growing understanding that addictive disorders may be the outcome of neuroplastic changes in response to early repeated exposure to abused substances and processes, especially in relatively vulnerable populations, due to epigenetic alterations in neurodevelopment, have also opened up many new avenues of engagement. We will discuss the evidence for currently used pharmacological and non-pharmacological interventions aimed at the addicted brain and the vulnerability states, as well as promising, early stage public health interventions.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 37: Practical Issues in the Management of Children and Adults with Neurodevelopmental Disorders: A Model from Eastern India

Minu Budhia ¹, Prathama Guha Chaudhuri ², Megha Rathi ³

Neurodevelopmental disorders are conditions that produce deficits in cognitive and behavioural functioning which begin during the developmental period but continue to affect an individual's entire life span. They are leading mental health related causes of the global burden of disease. Interventions to manage and reduce the symptoms are primarily based on rehabilitation and special education services. Despite the high prevalence and significant associated burden, there is an enormous gap in the provision of treatment for neurodevelopmental disorders in India. The existing service systems also tend to overlook the needs of adults with neurodevelopmental disorders.

The current symposium aims to address the treatment gap for neurodevelopmental disorders by synthesizing three bodies of evidence: a) the global evidence base on the treatment of these priority disorders

b) the barriers to implementation of this knowledge and

c) the innovative approaches taken to address these barriers and improve access to care in an Indian perspective.

The symposium would also focus on discussing a comprehensive vocational and rehabilitation model to provide individualized and need based services to children and adults with Neuro-developmental disorders. This model is being run successfully for the past five years at a centre in Eastern India.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 38: Anti NMDA Encephalitis- Meeting point of Neurologist and Psychiatrist

Praveen Kumar, Nitu Mallik, Raman Krishnan

Initially described in adult females with ovarian teratomas, autoimmune encephalitis has subsequently been reported in men, women, and children with and without teratomas and in all age groups (youngest, 8 months old). Approximately 40% of cases present under the age of 18 years.

In teenagers and adults, symptoms typically evolve in stages. A prodromal viral-like syndrome with fever and headache often occur first, followed by psychiatric symptoms that evolve over days to weeks. Psychiatric symptoms and behavioural changes can be quite striking, including visual and auditory hallucinations, paranoia, anxiety, erratic or combative behaviour, disinhibition, hyper sexuality, catatonia, and severe insomnia. These often lead to a misdiagnosis of a primary psychiatric disorder, such as schizophrenia or bipolar affective illness. Patients may later develop seizures, movement disorders (orolinguofacial dyskinesia's, choreoathetoid movements, dystonic postures, muscle rigidity, or increased tone), impaired level of consciousness, autonomic instability, or hypoventilation.

The only specific diagnostic test of anti-NMDAR encephalitis is the demonstration of IgG antibodies against the GluN1 subunit of the receptor in patient's CSF.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 39: How to design seminars and workshops for psychiatrists and others

Ruksheda Syeda

As psychiatrists we may have varied interests like academic teachings, public awareness, school and college mental health, team building, corporate and industrial psychology, public health, personal commercial ventures etc. Our training prepares us for clinical work but it seldom teaches us other aspects that may be important tools to achieve career goals.

Methodology will include talks, creative activities and tasks to guide the group to design frame works for seminars and workshops including, selection of candidates, place and other logistics, goal setting, tangible outcomes, planning sections, setting up brainstorming sessions, making slides, post session evaluation etc. A mini workshop will be conducted as a demonstration after the instructional session.

This workshop is an exercise which will equip the participants with skills to design and conduct successful seminars and workshops for various groups from psychiatrists to other stake holders, to lay people.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 40: Adverse Effects Of Psychotropic Drugs: It's Time To Take These Seriously

The proposed symposium will discuss common adverse effects of frequently used psychotropic drugs such as lithium, clozapine and psychotropics.

1. Lithium and renal adverse effects – 12 minutes (Dr Udyan Khastgir, Consultant Psychiatrist, Darlington, United Kingdom). Lithium is commonly associated with impaired urinary concentration (polyuria and polydipsia) and chronic kidney disease, though renal failure is not a common outcome. The presenter will discuss monitoring of renal function, risk assessment and management of the above adverse effects.
2. Common adverse effects of clozapine- 12 minutes (Dr Sumeet Gupta, Consultant Psychiatrist, Leeds, United Kingdom)- Hypersalivation and constipation are common adverse effects of clozapine. Hypersalivation is very distressing adverse effects. On the other hand, constipation can be a serious and rarely can lead to fatal outcome. The presenter will discuss the active monitoring and management of these adverse effects.
3. Antipsychotic induced hypoprolactinaemia – 12 minutes (Dr Santanu Goswami, Consultant Psychiatrist, Kolkata, India)- Most typical antipsychotic drug and few atypical antipsychotic drugs cause raised prolactin levels and associated symptoms such as menstrual irregularities ,sexual problems and osteoporosis. The presenter will discuss the need for monitoring and active management of hypoprolactinaemia.
4. Psychotropics and QTc Prolongation- 12 minutes (Dr Nitin Gupta, Professor of Psychiatry, GMCH-32, Chandigarh, India)- QTc prolongation is associated with psychotropics, especially antipsychotics, and can lead onto fatality due to ‘torsades de pointes’. This becomes all the more important in the background of metabolic syndrome developing commonly with atypical antipsychotics. Hence, ECG monitoring is relevant in patients on long term psychotropics and those who are at risk. The presenter will discuss these issues with illustration through a case vignette.
5. Overall Discussion – 12 minutes

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 41: Behaviour science informed evolution of law- Indian scenario-past present and furture

Indu Nair

The business of law is to influence human behaviour. Hence behavioural should proactively influence the evolution of law. The past few years have seen many new mental health legislations and amendments of the existing ones in India, like the MHCA 2017,POCSO 2012, JJA 2015,RPWD act2016, NDPSA amendments, the repeal of section 377IPC to name a few.

The MHCA2017 was a quantum leap in mental health care, with the tremendous importance given to the rights of the mentally ill, including their right to vote and many others. The emphasis given to the decriminalisation of suicide may have an important impact. The others like POCSO and JJA have incorporated the importance of behaviour sciences, but there is further scope for improvement.

The symposium will be critically appraising how far behaviour sciences have been incorporated in the framing of these new legislations, comparing the past and then considering the future scope of the same.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 42: Advanced Communication Skills Workshop

Rajashree Ray ¹, Sarmistha Chakrabarti ², Sabyasachi Mitra ³, Saugata Bandyopadhyay ⁴

Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship. A doctor's communication and interpersonal skills encompass the ability to gather information, to facilitate accurate diagnosis, counsel appropriately, give therapeutic instructions and establish caring relationships with patients.

Evidence shows that Good doctor-patient communication has the potential to help regulate patients’ emotions, facilitate comprehension of medical information, allow for better identification of patients’ needs, perceptions, and expectations.

This interactive workshop, with Role Plays will be divided into three parts.

The first part looks at how to begin a consultation, build rapport with patients, address the patient's key concern, and think ahead about what problems might arise, in managing uncertainty, annoyance and anger.

The second part looks at conducting the middle of a consultation using a basic five step communication model to help deal with the most challenging patients and scenarios, identifying their key health issues and agreeing a treatment plan together.

The final party focuses on successfully concluding a consultation, dealing with unrealistic demands, conveying further concerns, about serious possibilities, managing time and ending and lingering consultations.

Participants will be encouraged to share their experiences of managing difficult situations and by the end of the workshop , will achieve the learning objectives of good communication with their patients, improve patient satisfaction, share pertinent information for accurate diagnosis of the problems, encourage patients to follow advice, and adhere to the prescribed treatment with the aim of assisting recovery.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 43: Physician burnout is a global phenomenon

Vishesh Agarwal

Introduction - Physician burnout is a global phenomenon. It has been discussed extensively in literature over the past 45 years. Although the prevalence may vary with several demographic factors, burnout has significant negative consequences for physician health and emotional wellness while also impacting patient care.

Methods - We searched standard databases for peer-reviewed literature discussing physician wellness and cross references. Data on physician surveys was abstracted and systematically reviewed.

Results - There were several published studies from developed nations, while only limited data was available from developing countries including India. Survey results suggested burnout rates as high as 80%, with more than 30% qualifying for a formal mental health diagnosis. Additionally, increasing violence towards physicians was found to be a major contributor in worsening burnout rates.

Discussion - A shared commitment between physicians and hospital systems will need to exist. Academic and clinical excellence, use of mindfulness based approaches to self care and destress can be helpful. In more severe cases, formal evaluation and medication could be considered. Identifying and addressing burnout among physicians is key to a fulfilling career in medicine. Information Technology can be used as an ally in some of these processes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 44: Gut Brain Axis & Its Relevance for Psychiatry

Vijay Niranjan, Koustubh Rajgopal Bagul, Rahul Mathur

Gut – Brain axis is a bidirectional communication pathway between the Gut (Enteric Nervous System) and Brain (Central Nervous System). Recently This pathway has got a lot of attention from researchers and clinicians dealing with somatic and psychiatric disorders. The pathogenesis of psychiatric disorders is not clearly understood and usually a multifactorial Bio-Psycho-Social Model is considered regarding causality. Also thus, there is an ever going research about newer factors affecting the disorder's pathogenesis, clinical presentation and management.

Lifestyle factors like Diet and Nutrition modulate gut bacteria, inflammatory circuits and immune system known to be involved in pathogenesis of psychiatric disorders. It is also postulated that Healthy Bacteria in gut modulate anti stress response through HPA axis signaling. Also in animal models intestinal microbes shown role in the metabolism of Neurotransmitters like Serotonin. While in dysbiosis (microbial imbalance or maladaptation) the stress regulation response through gut brain axis gets altered and also there occurs increased permeability of mucosa and increased cytokine production as an immune and inflammatory response. This can result in interference in Neurotransmitters synthesis and their metabolism. Previous research has also shown some efficacy of Probiotics in disorders like Depression, Anxiety, Post-traumatic stress disorders etc.

Thus through this symposium we aim to discuss about Gut brain axis and its relevance in the field of psychiatry, so that the knowledge can be translated and integrated in the holistic management of psychiatric disorders.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 45: CHILDREN AND ADOLESCENTS IN VIRTUAL WORLD: FROM E-HEALTH TO ILL HEALTH

Surjit Prasad, Anamika Sahu, Preeti Gupta, Abhay Singh Tomar

Virtual world: augmented reality to virtual reality

Digital technology and internet are affecting almost every aspect of life of millions of children around the world offering unlimited opportunity for communication and commerce, learning and free expression. Virtual worlds, an extension of such technology are three dimensional computer-based simulated environments in which users can interact with others and create objects as part of that interaction. Now, from virtual reality games the further focus is on exploring and utilizing the immersive augmented (AR) and virtual reality (VR) techniques for clinical purposes that would be discussed in this heading.

Virtual reality and internet together towards e-health

Technological advancements in healthcare are rapidly increasing the options. E-health, the integration of tele-health technologies with the internet is the next logical step in this process. Mobile applications and many start ups are working on Immersive Rehabilitation, a combination of neuro and physical rehabilitation in a virtual 3D world where patients interact with virtual objects in cases where this is not possible in the physical world, allowing the person to exercise their motor functions. This section will describe the internet and Virtual Reality based e-health applications and other psychotherapeutic approaches that are and can contribute to the management of different physical and psychiatric conditions.

Immersive VR: a psychic retreat or psychic pit towards ill health

Digital technology can also make children more susceptible to harm both online and off. Engaging with peers on social networks or playing immersive role -playing games with friends and people from around the world, are ways in which youth may feel socially connected. Already vulnerable children may be at greater risk of harm. This section will debate about reasons as well as the less obvious harms children may suffer from life in the virtual world – from digital dependencies to the possible impact of VR technology on brain development and cognition. And it outlines a set of practical recommendations that can help guide more effective and responsible use of virtual world.

Recent trends in research

The extent of benefits from VR on our brain are unclear as the technology is still relatively new, and evidence of the benefits of AR and VR remains anecdotal. These days, however, VR seems more likely to help our gray matter. A new wave of psychological research is pioneering VR to diagnose and treat medical conditions from social anxiety to chronic pain to Alzheimer's disease. The related new emerging concepts and researches will be discussed under this section

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S30–S73.

SYM 46: Prospective memory in patients with first-episode psychosis

PSulakshana Rao ¹, Madhavi Rangaswamy ¹, Jonathan Evans ^1,³, AnirbanDutt ^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 or established schizophrenia were assessed in Kolkata, a socio-economically diverse, multi-ethnic and multi-cultural city. A set of neuropsychological tests including Addenbrooke's cognitive examination – Bengali, Hospital Anxiety and Depression scale 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.

PERMALINK

ABSTRACTS FOR ANCIPS 2020

F01: Pattern of mobile phone usage and psychological morbidity among Physiotherapy students studying in rural district of Karnataka

Ruth Sneha Chandrakumar

F02: Role of Repetitive transcranial magnetic stimulation (rTMS) in management of Alcohol use disorders (AUD)

Dr P Patra

Rajiv Saini

SA Khan

F04: Opioid Withdrawl Delirium-A Case Study

Binita Talukdar

F05: Perceptions of Partner Drinking Problems, Regulation Strategies and Relationship Outcomes

Vivek Kumar R

Raghuram Macharapu

Pramod KR Mallepalli

Ravulapati Sateesh Babu

F06: Risk Factors For Relapse Among Heroin Dependent Subjects: A Prospective Study

Mahajan P

Garg PD

F07: Perceived stigma and Affiliate stigma among family members of opioid dependent men and women: A cross sectional comparative study

Verma Kamini

Mandal Piyali

Mongia Monica

Ambekar Atul

F08: Internet addiction and quality of sleep in the under-graduate students of a university in southern India.

Manoj Shettar

F09: A study to assess cognitive functioning in patients of Alcohol Dependence Syndrome

D Bhattacharyya

Mohd Ishaque Qureshi

F10: “Udta Punjab” – An insight into the reasons behind the opioid epidemic in Punjab

Kanika Kumar

F11: Substance use patterns and personality profiles in individuals with substance use disorders attending a tertiary care centre

Prosenjit Ghosh

Anshuman Gogoi

Monu Doley

Bedawatee Bora Kabir

F12: Digital Gaming Addiction among Students

JGrahita

KSai Madhulika

CRadhakanth

F13: Assessment of differences among treatment seeking substance dependent subjects across different age groups.

Pradeep Kumar

Mona Srivastava

F14: Severe psychotic aggression in a youth with cannabis use - should we search for something else?

S Choudhury

A Basu

R Gupta

F15: Smart phone addiction in medical students,a cross sectional study

K Sai Madhulika

J Grahita

C Radhakanth

F16: Cognitive Deficit In Patients With Alcohol Dependence Syndrome And Its Course After Initial Treatment: 24 Weeks Follow-Up Study At A Ghpu In India.

D Bhattacharyya

Aijaz Ahmad

Arun Kumar Dwivedi

Rajiv Saini

F17: Prevalence and correlates of Smartphone Addiction among Medical students: A cross-cultural perspective.

Manik Inder Singh

A Mayor

Himanshu Sareen

SK Chturvedi

Manoj Kumar Sharma

F18: Smart gadget addiction and its disadvantages among Under Graduate Students

Krishna Naik

T V Pavan Kumar

D Phanibhushan

F19: Study of knowledge, perceptions and attitude of nursing students about alcohol use and alcoholics

Sanchita Gour

Madhur Rathi

S Sireesha

F20: Stressful life events and its relationship with risk of relapse in alcohol use

Shruti Agnihotri

Madhur Rathi

SSireesha

F21: Prevalence of psychiatric morbidity and coping pattern among spouses of alcohol dependent males in the southern districts of Assam

Prakash Barman

HA Choudhury

Jayanta Kurmi

F22: Misuse of prescription opioids in chronic non-cancer pain with somatoform disorder

F23: Correlates of Opioid Abstinence in Patients Maintained on naltrexone as compared to buprenorphine.

Vikas Singla