ABSTRACTS FOR ANCIPS 2020

. 2020 Jan;62(Suppl 1):S74–S122.

ABSTRACTS FOR ANCIPS 2020

PMCID: PMC6991111

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 47: Conclusive Study about the effect of Mirtazapine on Metabolism and Energy substrate partitioning in Healthy persons

Background: During the course of treatment with Antidepressants the issue of weight gain & metabolic changes have emerged as an important concern and specifically in long-term therapy. Though it's an ongoing debate whether weight gain and metabolic perturbations with antidepressants use are the consequences of increased appetite and weight gain, respectively, or represents direct pharmacological effects of the drug in metabolism.

Methods : We therefore conducted a proof-of-concept, open-label clinical trial, hypothesizing that in exceptionally healthy men no change if metabolic parameters would occur under Mirtazapine , when environmental factors --- nutrition, sleep and physical exercise etc were controlled and kept constant. Over a 4 week preparation phase , 15 healthy young men were attuned to a Standardized diet adjusted to their individual calorie need, to a regular sleep/ wake cycle and moderate exercise. Continuing this protocol , we administered 15 mg of mirtazapine daily for 10 days.

Results: While no significant weight gain or changes in resting energy expenditure were observed under these conditions, hunger and appetite for sweets increased with Mirtazapine , accompanied by a shift in energy substrate partitioning towards carbohydrate substrate preference. It is assessed by Indirect Calorimetry . Furthermore with Mirtazapine, there is increasing release of insulin &C-peptide in response to a Standardized Meal.

Conclusions : Our findings provide important insights into weight-independent metabolic changes associated with Mirtazapine and allow a better understanding of the long term metabolic effects observed in patients treated with antidepressant drugs.

Keywords : mirtazapine, antidepressants, metabolic changes, weight gain, environmental factors, carbohydrates, insulin, C peptide

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 48: Evidence Based Interventions for Autism Spectrum Disorder.

Dhrubajyoti Bhuyan

Autism has till date always been viewed as an illness from the medical model, and hunt for a ‘cure’ has been the norm. With increase in awareness and available therapies, the focus shifted to disability and inclusion. Autism is a polygenetic developmental neurobiologic disorder with multiorgan system involvement, though it predominantly involves central nervous system dysfunction. The evidence supports autism as a disorder of the association cortex, both its neurons and their projections. In particular, it is a disorder of connectivity, which appears, from current evidence, to primarily involve intrahemispheric connectivity.

Structural magnetic resonance imaging studies confirmed the increase in total brain volume in autism, which had been inferred from the increased head circumference. The increase in total brain volume was documented beginning at 2 to 4 years of age, the earliest age of clinical recognition, and persisted into childhood but not adolescence.

A second consistent finding of cross-sectional imaging studies in autism has been a reduction in the size of the corpus callosum.

Tools for Assessment of Autism Spectrum Disorder – Dr Shyamanta Das

Autism being a complex disorder, the assessment should as far as possible be done by multidisciplinary team who besides the psychiatrist should include a psychologist, a special educator, an occupational therapist, and an audiologist and speech therapist. Rule-out other conditions (e.g., hearing impairment), evaluate for co-morbid conditions (e.g., seizures), and search for underlying etiology (e.g., genetic syndrome). The Ministry of Social Justice and Empowerment (Department of Empowerment of Disabilities) released the INCLEN Tool for the assessment of ASD on April 25, 2016, to be uniformly followed for the assessment of autism in India. The American Association for Child and Adolescent Psychiatry recommends ASD surveillance at all developmental and psychiatric assessments of children, ASD-specific screening Modified Checklist for Autism in Toddlers (e.g., M-CHAT) at 18 and 24 months visits or when surveillance raises concern.

Effective Interventions – Dr Prosenjit Ghosh

Early intervention should be the aim to yield the best outcome and results. Despite advances in early diagnosis and intervention, efficacious reversal of core autistic symptoms is still not accomplished, to date. Treatments include a range of behavioral, psychosocial, educational, medical, and complementary approaches. The options vary by age and developmental status.

Applied behavioral analysis (ABA) – ABA is probably the most widely used intervention for children as well as adults with autism. It focuses on improving specific behaviors initially using discrete trials to teach simple skills, then progressing to more complex skills and complex behaviors.

Early-stage Denver model – This aims to accelerate children's development in all domains; intervention targets derived from the assessment of developmental skills.

Social Communication - Use of communication modalities such as sign language, communication boards, visual supports, picture exchange communication system (PECS), use of social stories, and social skills training. The latter three are more commonly used strategies, with some degree of effectiveness.

Educational - TEACHH – Treatment and education of Autistic and related Communication-handicapped Children. It involves an array of teaching or treatment principles and strategies based on the learning characteristics of individuals with ASD.

Caregiver Training - Parents of children with ASD experience higher levels of stress when compared to parents of typically developing children. Increased parent skills allow child to learn in a range of different situations and environments, and parent training is now considered an important component of successful intervention programs. Parent training is defined as an effort that aims to enhance or facilitate parent behaviors that will influence positive developmental outcomes in their children. Differs from psychoeducation. Parent training program was superior to parent education in reducing disruptive behaviors.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F135: Identification of Suicidal Ideation Through Analysis of Clinical Notes in Electronic Health Records

Prakash Adekkanattu, Marika Cusick, Thomas R Campion, Poonam Awatramani, Dimitry Francois, George Alexopoulos, Jyotishman Pathak

Introduction: We adopted a linear text classifier called fastText, previously developed at Facebook Research for efficient word representation in text classification problems ^[1], and applied to identify patients for suicidal ideation (SI).

Objectives: This study aims to evaluate the performance of a linear text classifier to identify patients for suicidal ideation via analysis of unstructured clinical text in EHR data.

Methods: Train/test sets were established using 633 patients (184,137 notes) diagnosed with suicidal ideations (positive label) and 69,905 patients (300,000 notes) with no SI diagnosis (negative label). In a second set of experiments, 5,445 notes (1,557 patients) were labelled through manual review assisted by a rule-based NLP system (to be published) for training and test sets.

Results: Table 1 shows the performance of the classifier on a patient level and document level for models trained using diagnosis codes and on a document level for model trained using NLP assisted manual process in identifying SI.

Table 1.

Classifier performance

Models	Precision (%)	Recall (%)	F1-score
Diagnosis code: patient level	78	95	86
Diagnosis code: document level	83	86	85
NLP + manual: document level	100	76	86

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Conclusions: This study demonstrated that it is possible to detect patients with suicidal ideation through analysis of clinical notes in EHR with high accuracy.

References

1.Armand Joulin, A, Grave E, Bojanowski P, Mikolov T. Bag of Tricks for Efficient Text Classification, Proceedings of the 15th Conference of the European Chapter of the Association for Computational Linguistics. 2016;2:427–431. [Google Scholar]

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F136: Title: Suicidality and its socio-clinical association in elderly depressed patients.

Ananta Manna, Amitava Dan, Srijit Ghosh

Background: Suicidality in older adults is a major public health issue globally. Specific health conditions (e.g. depression, cognitive dysfunction) and stress factors (social disconnectedness) unfold the complexity of the phenomena. Very few studies had addressed this masked phenomena.

Aim: To enumerate the magnitude and pattern of suicidality and associated socio-clinical factors in elderly depressed individual.

Methods: A cross-sectional study was conducted among 65 elderly (>60 years) patients with depression (F32 & F33 as per ICD-10). Suicidality, depressive symptoms, social connectedness, cognitive functions were evaluated by Columbia Suicide Severity Rating Scale (C-SSRS), Geriatric Depression Scale (GDS-30), Revised Social Connectedness Scale (SCS), Montreal Cognitive Assessment (MOCA) respectively.

Results: Among the participants, 28% showed suicidal intent out of which 17% have active suicidal ideation with a specific plan. The interrupted attempt and aborted attempt found 20% & 28% successively along with 5% have suicidal behaviour at the time of assessment. Among the demographic and clinical variables age, age of onset, education of patient, income of family & total duration of illness, presence of physical comorbidities were found strongly associated with suicidality. Active suicidal ideation was found associated with depression severity. Non-suicidal self-injurious behaviour and aborted attempts of suicidality were found associated with MOCA scores whereas, SCS score was not associated with any construct of suicidality.

Conclusion: Pattern of suicidality in elderly depressed individual was quite different than that of other population. The several socio-clinical factors (e.g. ageing, duration of illness, income of the family, depression severity, cognitive functioning) should be addressed at the time of intervening a depressed elderly person, to prevent suicide.

Key words: Suicidality, elderly, depression, cognitive functions

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F137: Title: Suicide Risk Prediction by Machine Learning of TAT Protocols - A Pilot Study

Neville Misquitta

Background :India has the highest suicide mortality rate in South East Asia. The limits of present suicide prediction methods appear to be profound. Machine learning methods are effective in classifying text and may help in suicide prediction.

Aim: To study the feasibility and application of text mining of Thematic Apperception Test (TAT) protocols for predicting suicide risk.

Material & Method : 128 TAT protocols at a private mental health clinic were categorised as suicidal (n=32, 25%) or non-suicidal (n=96, 75%) from Quick Inventory of Depressive Symptomatology (Self Report) scores. Text processing and analysis was done in Python using Natural Language Toolkit (NLTK), SciPy, and scikit-learn. Multiple classification algorithms were fitted with default settings, and the best was studied with 6-fold cross-validation.

Results: Text analysis revealed significant differences between suicidal and non-suicidal groups on word length (t=-2.418050,

p=0.017035). Character, digit, symbol, word, unique word counts and sentence counts, and lexical diversity, and sentence length were not significantly different. Highest coefficient non-suicidal words were ‘torture’ (0.294977) and ‘billy’ (0.247146), and highest suicidal were ‘00’ (0.306805) and 'sighs’ (0.238002). Nearest Centroid (Rocchio) classifier gave the best predictions with mean AUC=0.56 (+0.20), accuracy=0.6015625 (p=0.9603960396039604), specificity=0.846, sensitivity=0.500.

Conclusion: The present study indicates machine learning models can be applied on TAT protocols. Further work on a larger sample with more selective parameters is needed to improve prediction quality.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F138: Title: Delirium Research in India: A Bibliometric Study

Sanjana K ¹, Devakshi Dua ¹, Sandeep Grover ¹

Background: Delirium is fairly common diagnosis seen in medically ill patients, in all the treatment set-ups, with relatively higher incidence and prevalence in intensive care units. Considering the fact that, delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis.

Objectives: To assess the research output involving patients of delirium from India.

Materials & Methods: A comprehensive search was undertaken using Medline (PubMed) as database. Search words included were “delirium” AND “India”. No filters were used. Inclusion criteria were studies conducted or reported from India, with delirium as the research subject or a reported outcome.

Results: A total of 264 articles were identified out of which 222 met the eligibility criteria. The available data suggests that most of the published papers are in the form of case reports and have reported delirium as an adverse event of certain medications or interventions. There are limited number of original research papers, and most of this research has been carried out by the psychiatrists. Some of these original studies have included specialists from more than one specialty. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with some of the studies evaluating the efficacy/effectiveness of various pharmacological interventions. Most of the centres across the country have not produced any research on delirium. There are no multi-centric studies involving multiple centres from India.

Conclusion: There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of non-pharmacological interventions, and strategies evaluating the prevention of delirium.

It is the need of the hour to carry out more studies to further our understanding of delirium in Indian context.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F139: To study the prevalence of depression in patient suffering from headache in psychiatry opd in a tertiary care institute

Prasad S, Paliwal A, Razdan R

Background: Primary headache and psychiatric disorders are quite often comorbid, previous studies have reported that depression have bidirectional relationship with headache. The research in India in this field strikingly scarce.

Aims: To investigate the socio demographic profile, subtypes of headache and correlation with Depression in patients who comes in psychiatry OPD.

Methodology: Our study is a descriptive cross sectional study with 200 sample size. Patients with Headache in Headache Clinic of department of Psychiatry, MGMMC, Indore. Patient aged between 18-65 years, either sex. Diagnosis of headache was done clinically in accordance with International Classification of Headache disorders, while depression was diagnosed as per ICD-10. Semi-structured headache questionnaire, Comparative Pain scale, Hamilton Depression Rating Scale, were used for assessment of samples. Results: Among 200 patients, there were 73(36.5%) males and 127 (63.5%) females. The mean age was 33.35 ± 10.7 years. Tension type headache was 73.5%, Migraine was 22%, Mixed headache was 4.5%. Depression in headache was 68%. Depression was more in females (59.5%) than males(40.5%). It was also more in urban (60.2%) than semi urban areas (26.4%) & rural areas (13.2%). Tension-type headache (73.5%) was the most predominate type of headache. Conclusion: Patients with headache had higher comorbid depressive disorder. Screening patients with headache for depression and timely psychiatric intervention can go a long way in improving the quality of life of headache patients with comorbid depressive disorder.

Keywords: Primary Headache, Depression, Prevalence

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F140: Title: Comparative study of patients seen under DMHP versus patients seen under GHPU in Davanagere district, Karnataka

Dayananda Sagar L, RajaniP, G Sidda Reddy, NagarajH, Muralidhara PD, H Chandrashekar

Background: Mental health services as an integral part of primary health care has been a major development in the country. Psychiatric services at General Hospital Psychiatry Units (GHPU)have been initiated as early as 1970s and District Mental Health Programme(DMHP) as a model was experiment in Bellary during 90s . DMHP in Davanagere has been functioning since 2016. Under DMHP, mental health skills are provided to health service professionals through which patients are treated, whereas GHPUs provide mental health services directly. There is need to know the type of population covered by these psychiatry teams, profile of patients seen in GHPUs and DMHP could be different.

Aims and objectives: To study and compare the case profiles seen under DMHP and GHPUs.

Methodology: The study was conducted in the department of Psychiatry BMCRI and DMHP davangere district. The case reports of patients having attended the OPD under DMHP and GHPUs from April 2018 to March2019 formed the study material. Demographic profile and the clinical diagnosis was tabulated and statistically analysed and conclusions were drawn.

Results: A total of 9367 patients under DMHP and 32883 under GHPUs were analysed. Females were more (48.7%) among the patients attending GHPUs. Common mental disorders, substance use disorders accounted for 50% and 20% of total patients seen under DMHP compared to 44.5% and 5.6% at general hospitals respectively.

Conclusions: DMHP team in Davanagere district is functioning within the community with good reach in terms of magnitude of patients. Substance dependence probably needs to be further addressed at the community level.

Keywords: District mental health programme, community psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F141: ETHICS IN MEDIAL PRACTICE

Rakesh Lal

Introduction: Ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on.

Responsibility

to patients first and foremost
to society.
to other health professionals
to self.

These are not laws, but standards of conduct which define the essentials of honorable behavior for the physician

Autonomy: Patient has freedom of thought, intention and action when making decisions regarding health care procedures

For a patient to make a fully informed decision, she/he must understand all risks and benefits of the procedure and the likelihood of success.
Decisions must be respected even if they are not in the best interest of the patient.

Beneficence:

The practitioner should act in “the best interest” of the patient
the procedure undertaken should be with the intent of doing good to the patient

Acknowledge:

Technical help
Writing assistance
A department chairperson who generally supported
Assistance with study design, data collection, data analysis, or manuscript preparation
Financial and material support

Keywords: Autonomy, Beneficence, Non-maleficience, Justice, Social Responsibility, Confidentiality, Veracity

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F142: Study of Nature of Admissions, Course of stay and Discharge status of female patients admitted on Involuntary basis” at Institute of Mental Health ,Chennai.

Arivalagan C, Devi D, Poorna Chandrika P

Background: Involuntary admissions of patients to psychiatric hospital for the purpose of observation and treatment of Mental disorders has become a major issue of public interest and debate. The Goal of detention is to increase patient's ability to evaluate their own condition and restore their ability to make autonomous choices.

Aim: To analyse the socio-demographic profile and the course of stay in hospital of patients admitted on involuntary basis from 2010 to 2014 and to analyse the challenges in the discharge of patients following their recovery and approval for discharge.

Methodology: to review the case sheets of the patients selected and obtain the necessary information as discussed in the objectives and the data collected has to be analysed statistically.

Results: One-third of the patients whose discharges have been approved by the visitors committee are still staying as in-patients and they are being rehabilitated.

Conclusion: Women with severe mental illnesses often have to cope with more than just their inner turmoil of confused thinking, turbulent moods, hallucinations and delusions. They will have to deal with harsh reality of helpless and hopeless poverty stricken families, some families simply unwilling to bear the burden of care and abandonment, being the only or rather preferred choice.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F143: Development of mental health awareness tool for Armed Forces : AFMC Mental Health Awareness Questionnaire

Col Rajiv Saini, Col V S Chauhan, Kalpana Srivastava

Stress management among troops is a topic of discussion in recent years and programs are going on at various levels. However, such efforts lack objectivity and suffer from absence of measurable outcome measures. It is hypothesized that a psychometric and methodologically robust scale-based measuring awareness about stress and its related management issues will not only help in measuring baseline awareness but also indicate areas requiring focused approach to conduct such programs. This study developed a new scale-based measure of mental health awareness among troops. Construction of the AFMC mental health awareness scale was done over three key stages, including measure development, pilot testing and assessment of psychometrics and methodological quality. The resulting measure is a 15 item, univariate scale that is easily administered and scored. The mental health awareness tool demonstrated good internal and test-retest reliability. Evaluation of the methodological quality of this scale indicated that it has substantial potential for improving efficacy of stress management training among Armed Forces.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F144: Psychiatric symptoms in peri-menopausal rural women and role of duloxetine in their treatment

Background: Peri-menopausal symptoms both physical, somatic and mental, are quite prevalent in women aged 42-49 and form an important cause of morbidity in this population and burden to rural economy.

Aim: To assess different physical, somatic, neurotic and psychotic symptoms in peri-menopausal women and role of duloxetine in their treatment.

Methodology: A 100 rural female patients of age group 42-49 attending a private neuro-psychiatry/pain clinic who has attained menopause within a year or were assessed for various physical symptoms using a checklist, beck's depression inventory II, Hamilton Anxiety scale, Brief psychiatric rating scale, Clinical global improvement scale, and assessed in 1^st week, 4^th week, 12^th week. 72 individuals completed all follow ups who were put on duloxetine 60-120/mg per day with no other antidepressants or hormonal replacements from day of 1^st assessment.

Result: Depression (90.27%), anxiety (31.94%), paresthesia (81.94%), vaso-motor symptoms (66.66) were most prevalent symptoms in the population. 4^th week and 12^th week assessment revealed 86.15% and 93.84% improvement in depressive symptoms; 65.21% and 82.60% relief in anxiety symptoms, 81.35% and 94.91% improvement in paresthesia, 58.33% and 64.58% improvement in self report of vasomotor symptoms. Global improvement was evidenced by 73.61% at 4^th week and 88.88% at 12^th week.

Conclusion: It is evident from above rural based study that duloxetine acts as single most cheap option for management of peri-menopausal psychiatric as well as some of somatic symptoms in peri-menopausal age group.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F145: Psychiatric Morbidity and Associated Psycho-Social Factors Among the Inmates of a state Run Home For Women

Saudhamini Bhat ¹, Mahesh Desai ¹, Shivanand B Hiremath ¹

Background: Gender is a critical determinant of mental health and mental illness. Poor family support, separation, emotional stress, financial dependence, domestic violence, sexual abuse, trafficking, lack of awareness makes women more vulnerable for various mental health issues. Destitute and homeless women exhibit disproportionately high rates of major and other mental illness.

Aims and objectives: To assess the prevalence of psychiatric morbidity and its association with the psycho-social factors among the inmates of the state home for women.

Methodology: Inmates of State home for women, in northern part of Karnataka, satisfying the inclusion and exclusion criteria were recruited after obtaining informed consent from the participant and from the parent guardian in case of participants who cannot give a valid consent. Permission to conduct the study was obtained from the Project Deputy Director, Department of Women and Child Development. Inmates were assessed using a semi-structured proforma for psycho-social factors. MINI-PLUS version 5.0 was used to screen the inmates for psychiatric morbidity and the diagnosis confirmed using ICD 10. Quality of life was assessed using WHOQOL-BREF scale.

Results: Majority of them (82%) were diagnosed to have some psychiatric morbidity. Most common psychiatric morbidity being Psychosis (36.2%), next being affective disorders (33%), somatization disorders (22.8%) and anxiety disorder (8%). Psycho-social factors like poor family support, stressful events in past, lack of supportive environment had significant influence on the outcome of psychiatric disease and quality of life.

Conclusion: This study highlights various psychiatric morbidity, overall clinical profile and the influence of different psycho-social factors on the mental health among these vulnerable population and also help in improving the quality of life by helping in better policy making, timely psychiatric interventions and rehabilitation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F146: Impact of Mindfulness-Based Therapy on Psychological Characteristics of Juvenile in Conflict with Law

Deoshree Akhouri, Maria Madiha, S A Azmi

According to National Crime Records Bureau; India, there has been a significant increase in criminal activities among juvenile over the past 3 years, especially in Uttar Pradesh in comparison to other Northern States. Various management strategies have been undertaken for such juveniles. However, there is a lack of management strategies in Indian context. Therefore, this research work aims to see the effect of mindfulness-based therapy (MBT) on psychological factors of juvenile in conflict with law. The objective of this study is to assess and compare the impact of MBT on temperament, aggression, emotional intelligence and social intelligence of juvenile in conflict with law and also to see the effect of MBT on their level of mindfulness. After availing approval from Ethics Committee and Juvenile Observation Home, 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 and attaining the consent from guardians, assessment was done using different psychological tools. MBT was used for the management. The pre-post research design was used. Follow-up was done after 6 months of termination of therapy.

Results obtained in this study are suggestive of that MBT is a fruitful management technique for juveniles in observation homes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F147: Certification of Medico Legal Cases in Tertiary Care Hospital: Challenges and Way Ahead

Bornali Das, Mythili Hazarika, Shyamanta Das

This is a case series study of samples from a tertiary care hospital over a period of three years. This study comprised of medico legal cases (MLC). Their prevalence, awareness, and practices of filing system in digital era will be highlighted and the focus will be on the need for change and management of MLC amongst the healthcare professionals. Study outcome will create an environment of having better medico legal documentation which will directly or indirectly improve quality of patients’ care as well as their rights. In training of mental health professionals [PG (MD), M-Phil (Clinical psychologist and Psychiatric social workers)], medico legal aspects are not adequately incorporated for which these areas show paucity in application in the field. Professionals facing such situation in private hospitals and peripheral centres do have medico legal phobias compared to professionals in Government hospitals and tertiary centres. All professionals need to develop a genuine interest and bness in handling medico legal cases.

Key Word: Medico Legal Cases, Patient's Right to Life, Mental health professional trainings.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F148: Mental capacity and advanced directives of patients with mental illness: a study from a tertiary care psychiatric hospital

Rajshekhar Bipeta, Madhur M Rathi, Umashankar Molanguri

Introduction: Mental Capacity (MC) is the capacity of the person with mental illness to understand, make a decision regarding his treatment, and communicate the same. Advance Directive (AD) means a directive made by a person under section 5 of The Mental Health Care Act (MHCA) 2017. With the advent of MHCA 2017, MC and AD of play an important role in the management of patients with mental illness. The current study was conducted to assess MC of patients with mental illness and explore whether their ADs are feasible in the Indian context.

Materials and Methods: This cross-sectional study was conducted on 100 patients with mental illness visiting the Institute of Mental Health, Hyderabad, which is a tertiary care psychiatric hospital in Telangana. The sociodemographic and clinical details were captured on the intake Proforma. Instruments to assess insight, MC and AD were then administered.

Results: Will be presented during the conference.

Keywords: Mental illness; Mental Health Care Act 2017; Insight; Mental capacity, Advanced directives.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F149: Psychiatric Morbidity Among Prison Inmates

Agarwal Pranshu, Kohli Ajay, Kumar Jitendra

Background: There is a considerable lack of scientific estimate of psychiatric morbidity among Indian prisoners.

Objective: The objective of the study is to study the prevalence of psychiatric morbidity among convicted prisoners.

Settings and design: A cross-sectional study at District Jail, Sitapur.

Materials and Methods: A total of 287 convicted prisoners both male and female who were inmates during the period of mid-June to mid-September 2019 participated in the study. Socio-demographic data, clinical history and criminological history were collected from each individual. Psychiatric morbidity was assessed using MINI-Plus.

Results: A total of 198 (69.2%) had a current mental illness.70.3% of subjects were from rural population. Mood disorders were found in about 58.1%, Substance use disorders were found in 5.2%, antisocial personality disorders were found in 2.7%, Psychotic disorders were found in 4.5%, Adjustment disorders were found in 1.7%. Nearly 5% of prisoners among those with psychiatric disorders reported of suicidal ideations.

Conclusion: Mental health problems among prisoners were quite high. Prisoners are at high risk of acquiring mental health problems. Government and policy makers should look after whether prisoners suffering from mental illness be given different treatment from other prisoners.

Key words: Psychiatric morbidity, prisoners, sociodemographic profile

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F150: Referral Pattern to Consultation-Liaison Psychiatry: A Cross-Sectional Study from a tertiary care Center of Southern India.

Aravind, Sivin P Sam, Roy Abraham Kallivayalil

Background: There are few studies which evaluate the psychiatric morbidity and reasons for referral to consultation-liaison (CL) psychiatry.

Aim: The study evaluated the psychiatric morbidity, reasons for referral among the patients referred to consultation liaison psychiatry

Materials and Methods: The study employed a cross-sectional descriptive design and recruited 543 patients in a tertiary care Center. The evaluation was conducted using a specially designed intake Proforma and International Classification of Disease, 10th revision, diagnostic criteria for research.

Results: will be presented later

Keywords: Consultation Liaison Psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F151: Prevalence of Borderline Personality Organisation in Medical College Students

Introduction: Borderline Personality Disorder affects about 1–2% of the general population. It has high mortality rate due to suicide, around 10%. It is more common in women than in men (about 70% and 30%, respectively). The prevalence of borderline personality disorder was 11% at age 9–19 years and 7·8% at 11–21 years.

Evidence of significant psychiatric disturbance has been found in 10% of medical students. Some studies suggest that the medical profession has a high rate of alcoholism, drug abuse, marital discord and suicide. There is paucity of studies in this area involving medical students.

Aim: To study the Prevalence of Borderline Personality organization, self-harm and substance use in Medical undergraduates and postgraduates.

Methodology: A prospective, analytical and cross sectional study was performed in the duration of July 2019 to December 2019 in a Tertiary Care Hospital and Research Centre in a suburban area.

By Purposive Sampling, a group of 200 undergraduate and postgraduate medical students were included in the study with their informed consent. They were asked to fill up the sociodemographic proforma and Borderline Personality Inventory (Taiwan version) Scale.

Results:

BPD among medical students was 11%
Male to female ratio was 3:7
The incidence of self-harm and substance abuse among BPD students was 41% & 36.3% respectively.

Conclusion:

The prevalence of BPD among medical students found in the study correlates with those found in other studies.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F152: Study of anxiety disorders and clinical correlates in geriatric patients.

Kunal Desai, Minakshi Parikh

Background

Anxiety disorders occur in about 4% to 10% of community samples of older adults, and anxiety symptoms that do not meet criteria for a disorder affect 15% to 20%. Generalized anxiety disorder, is the most common of the pervasive anxiety disorders in later life.

Physical health, social support, socio-demographic, and recent stressful life events are additional domains relevant to the anxiety state of older adults.

Aims

1) Estimate the prevalence of anxiety spectrum disorders among geriatric population visiting

Civil Hospital Ahmedabad.
2) Identify correlates of late-life anxiety within the domains of associated mental health

Disorders (Depression and Alcohol Use Disorder)
3) Identify correlates of late-life anxiety within the domains of associated physical health

Disorders (Diabetes and Hypertension)
4) Identify correlates of late-life anxiety within the domains of associated socio-demographic characteristics.

Methods

Study type: Cross Sectional

Study site: OPD (Medicine Department, Civil Hospital Ahmedabad)

Study duration: 18 months

Sample Size: 100

Inclusion criteria: Age >60 years

Exclusion criteria:

1. Denial for consent
2. Inability to comprehend questionnaire

Scales

1. Geriatric anxiety scale- 10 item version (GAS-10)
2. DSM-V
3. Kuppuswamy Classification

Results

The prevalence of anxiety spectrum disorders was correlated within the domains of associated mental health disorders, associated physical health disorders and within the domains of associated socio-demographic characteristics.

Conclusion

There should be a high index of suspicion for anxiety disorders particularly in the clinical setting with greater correlates of physical and socio economically compromised geriatric patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F153: Worms of the Mind - retrospective review from South India

Shiva Shanker Reddy Mukku, Krishna Prasad Muliyala, PT Sivakumar, Mathew Varghese

Background: Delusional Parasitosis is a type of psycho-cutaneous disorder with predilection for middle and older age group. Among these only a minority with higher severity are known to seek psychiatrist help for treatment. Literature from India is limited.

Objectives: To study the profile of patients diagnosed with delusional Parasitosis.

Methodology: Case records of patients with psychopathology of delusional Parasitosis and seeking treatment at Psychiatry department, NIMHANS from July, 2000 to June, 2019 were reviewed. Details pertaining to sociodemography, comorbid psychiatric illness, management and follow-up details were reviewed and analysed.

Results: 20 patients were diagnosed to have delusional Parasitosis in the last 18 years. This constitutes a small proportion (2.4%) among those with persistent delusional disorder during the same period. In our sample females were predominant (M: F-2:3), majority of them were married (60%) hailing from rural background (65%). The age of onset of delusional parasitosis was 42.85 years (SD-17.2). The duration of illness prior to the consultation was 47.9 months (SD-61.68). In our sample 3 had comorbid depression, 2 had substance use, 1 had obsessive compulsive disorder. Perceptual experiences (tactile hallucinations-10, Auditory hallucinations-2, both-2). In our sample, patients who continued psychotropics, 12 had shown response. Risperidone, Pimozide, Olanzapine and Aripiprazole were the psychotropics in responders.

Discussion and Conclusion: The prevalence of delusional parasitosis ranges from 6 to 20 per 1000. Earlier studies on delusional parasitosis reported of its rarity, presentation to dermatologists, chronicity of condition and psychiatric comorbidity. Our study is similar to previous studies in term of gender difference, age of onset and duration of illness. Pheneomologically many patients has tactile experiences of the delusion which was also reported in earlier studies. In our study we found patients who were adherent to antipsychotics and amenable to psychological explanation found to have good outcome.

Keywords: Delusional parasitosis; delusional disorder; psycho-cutaneous disorder.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F154: Role of Behavioural Abnormalities In Impairment of Daily Activities In Patients With Demetia

Arun Kumar V

Background: Impairment in activities of daily living (ADL) is one of the defining features of Dementia. Data on contribution of neuropsychiatric manifestations (NP) in dementia to impairment of ADL is sparse.

Aim: To study the correlation between ADL and NP manifestations in patients with Dementia.

Methods: This was a prospective cross sectional study. The patients included were those availing dementia care service from 3 different tertiary care centers during a period of 6 years from 2010 to 2016. 183 patients were diagnosed as having dementia using the existing criteria. Cambridge behavioral inventory was used to assess the NP symptoms and ADL scale adapted to the local population was used. In addition, patients underwent other neuro-psychologic tests including ACE, Digit forward test, Trail A and Trail B, RAVLT, HADS and IQCODE.

Results: Mean age was 72.18(SD 8.23) and education 8.8 yrs(SD4.29). Mean ACE score was 46.28(SD 23.48), mean CBI score 67.37(SD33.33) and ADL 15.57 (10.64). Positive co relation was seen between CBI and ADL with and without correction for the effect of cognitive impairment (Partial correlation p=0.021, Pearsons correlation p<0.0001). Going to shop and travel were 2 items of ADL significantly associated with CBI score(p=0.002, 0.11).

Conclusion: In this cohort of dementia patients, good correlation was seen between CBI and ADL scores even after correction for effect of cognition. However, many of the items of ADL were not affected by CBI score thereby indicating that the major contribution to impairment of daily living comes from cognitive impairment than neuropsychiatric symptoms.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F155: Stress, Depression, Coping strategies and Spirituality among inmates of old age home in urban areas of north Karnataka.

Shivanand B Hiremath

Background: In coming few decades the old age population will be on rise in India. Because of urbanization, changing family structure, inclination towards modern way of life elderly people are facing a difficult challenge. There is high prevalence of depression, anxiety, stress among the inmates of old age home. Spirituality helps them to cope up with the stressful situation. In this background we plan to conduct this study in our geographical area.

Aims: 1. To assess depression, anxiety, stress among inmates of old age home

2. Coping strategies used to cope up with stress

3. Spirituality as a way of coping

Methods:

108 inmates of eight old age homes in and around Hubli- Dharwad, twin cities with about 10L population in the northern part of Karnataka were the subjects. Over the age of 60 years, who did not have debilitating medical conditions, cognitive decline MMSE >24, aphasia and psychotic symptoms were included in the study. Depression, Anxiety and Stress was measured using DASS-42, coping skills were measured by Coping inventory for stressful situations (CISS) and Spirituality was measured using Spiritual attitude inventory (SAI).

Results:

Depression was observed in around 45% , anxiety in 18% and about 70 experienced stress. Depressed and anxious individuals used more of emotional coping than task related and avoidance coping. Same result was observed with individuals who experienced high stress. Spirituality was less on all the domains, that is, religiosity, essential well-being, multiple health locus of control, in depressed and stressful individuals. Severity of depression correlated negatively with all the domains of spirituality.

Conclusion:

There is high prevalence of depression, anxiety and stress among inmates of old age homes. Spirituality and healthy coping strategies help them to over come stress.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F156: Validation of Everyday Abilities Scale for India-Malayalam version as a screening tool for major neurocognitive disorder

Indu PV, Saboora Beegum, KA Kumar

Background: In conditions with severe cognitive impairment like major neurocognitive disorders (MNCD) there is functional decline in activities of daily living (ADL). A scale to assess impairment in ADL can be used as a screening tool for MNCD. Everyday Abilities Scale for India (EASI) has not been validated in Malayalam.

Aim: To validate the Malayalam version of EASI (EASI-M) as a screening tool for MNCD

Method: As the part of a case-control study, 304 subjects aged 60 years or above, attending Psychiatry and Neurology OPDs and Geriatric Clinic of Medicine department of a tertiary care teaching centre, were evaluated using EASI-M and assessed using Addenbrooke's Cognitive Examination-Malyalam version (ACE-M) as the gold standard for diagnosing MNCD, after obtaining informed consent from the patient and informant. Information was obtained from a reliable informant for EASI.

Results: The mean age of the sample was 70.04 years (Standard deviation [SD] - 7.33). Majority of them were males (58.6%), educated up to primary school (53.9%) and belonged to below poverty line socio-economic status (59.2%). According to ACE-M scores, there were 162 cases of dementia and 142 were not demented. At a cutoff of 4.5, EASI showed a sensitivity of 77.2 and specificity of 76.1%. Area under the curve was 0.852. Positive predictive value was 78.6% and negative predictive value was 74.5%.

Conclusion: EASI-M has good sensitivity and specificity at a cut-off of 4.5. The questionnaire shows good psychometric properties as a screening tool for dementia.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F157: Transformation of Psychiatry in the last 60 years - An Eyewitness Account

ONSrivastava

Psychiatry has undergone phenomenal changes in the latter half of the 20th century. It may therefore be difficult for the younger generation to visualize what the situation was some 50 or 60 years ago and how psychiatry has transformed itself to where it is today.

I have had the opportunity to be a participant observer of this transformation from the time of my starting medical study in the early 50s to the present time. It is for this reason that I have chosen to call this ‘an eyewitness account’. Since it is an eyewitness account of my experiences, it has its obvious limitations. The picture portrayed is sure to be colored by my limited exposure to countries and hospitals where I have worked. This account may therefore not be generalizable to other countries or other settings even within the same country. Despite these limitations, I hope that the general description given here will give a vignette of what psychiatry was like in the 50s and how it has transformed to the present.

My experience is based on four countries viz. India, Canada, United Kingdom and the Netherlands. In this paper, I’ll try to give a general picture of the structure of psychiatry and the prevailing ethos, the modalities of treatment available at the time, the system of classification of psychiatric disorders current at the time, the state of psychiatric training in the medical curriculum, the state and the content of training as a psychiatrist and the level of acceptance of psychiatry in the society and within the medical discipline.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F158: Predictors of readmission in a psychiatric hospital: A study from a tertiary care centre of Eastern India.

Debshankar Mukhopadhyay, Abhijit Chakraborty, Srijit Ghosh

Background: Mental illnesses are mostly of chronic relapsing type. A significant number of patients are readmitted after discharge. Subsequent admissions posses a burden to the healthcare cost.

Objectives: To assess the predictors of readmissions in a psychiatric hospital.

Methodology: The sample consists of 86 patients admitted in a psychiatric hospital between Aug 2018 to July 2019. Detailed assessment was made based on various variables which included socio-demographic profile, duration of previous hospital stay, number of readmissions, diagnosis and severity of symptoms.

Result: Among all the admitted patients majority were unmarried, belonged to lower socioeconomic status, having a diagnosis of Schizophrenia. 24 patients (27.9%) were found to be readmitted. Readmitted patients did not differ significantly from the patients admitted for first time with regards to age, sex, socioeconomic status, diagnosis. Among the readmitted patients most were suffering from Bipolar Disorder followed by Schizophrenia.

Conclusion: Among all parameters taken into consideration, duration of previous hospital stay, adherence to medication, absence of parents was found to be important predictors of readmission.

Key words: psychiatric hospital, readmission

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F159: Level of Users Satisfaction with an OPD Based Psychosocial Intervention Clinic

Background: Psychosocial interventions (PSI) are an essential component of management of mental and substance abuse disorders. We follow the multidisciplinary team approach in the Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Psychiatric Social Work (PSW) is an integral part of the care, treatment and rehabilitation of persons with mental illness along with other disciplines. With this perspective, an OPD based Psychosocial Intervention Clinic is functioning since 2016 along with various others PSI programmes.

Aim: The aim of the study was to assess the satisfaction levels of the service users and to see whether their psychosocial needs were met with the intervention provided.

Methods: Data of 50 cases; completed with all respect were analyzed as preliminarily as a part of a bigger evaluation study using the “service evaluation framework,” the patients and caregivers who attended the PSI over a period of 1 year were evaluated using tools Screening Tool for Assessment of Psychosocial Problems (STAPP) and Patient Satisfaction Scale (PAT-SAT). In addition, socio-demographic and clinical profile data of the service users were compiled and correlated.

Results & Conclusions: Preliminarily findings demonstrate that the newly started PSI clinic is beneficial for the users and is being able to deliver PSI. Overall service users shown satisfaction and their psychosocial needs were met significantly. Through, some area and components need to strengthen for more effective and efficient service delivery which will be able to provide greater satisfaction to the service users.

Keywords: Psychosocial intervention, evaluation framework, outpatient

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F160: Title: Barriers to utilization of mental health care services among patients of Neurology

Background: Neurological disorders are frequently complicated by co-occurring psychiatric problems. Their addressal significantly improves the treatment outcome, overall health status and rehabilitation. However, in majority of cases these are neither recognized and in some cases not treated even when recognized. There is paucity of data especially in Indian settings.

Objectives:

To identify barriers to mental health care utilization for people with various neurological disorders.
Prevalence of Anxiety and Depression among patients of Neurology and to assess the relationship between socio-demographic and clinical variables with barriers to mental health care utilization

Methods: 100 consecutive patients admitted as in-patients at the Department of Neurology, CMC Vellore were recruited with informed consent over a period of 12 months. Socio-demographic and clinical details of patients were recorded.

The Hospital Anxiety and Depression Scale (HADS) was utilized to to assess the prevalence of Anxiety and Depression. All subjects were administered questionnaire to assess their barriers to utilization of mental health care services. Data analysis was performed using SPSS version 16.0

Results: This study provides with the information on the influence of disease, socio-demographic factors, attitude and service delivery on mental health care utilization.

Conclusion: This paper concludes that there is significant psychiatric comorbidity among patients being admitted under Neurology. The barriers to mental health care utilization have to be identified and addressed for a holistic treatment approach.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F161: A descriptive study of pattern, clinical and demographical profile of inpatient psychiatry referrals in a tertiary care teaching hospital

Mudgal V, Rastogi P, Niranjan V, Razdan R

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.

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

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F162: A Study to assess the help-seeking behavior of patients with mental health problems visiting a tertiary care center in Hyderabad

ArchanaR, KPhanikanth

Background: Patients suffering from mental health problems seek help from numerous sources such as family physicians, traditional faith healers, religious heads, RMP's, PMP's or practitioners of alternate medicine. Psychiatrists are usually the last resort and are least preferred due to stigma. The present study reports the various treatment options used by mentally ill patients before visiting a mental hospital.

Aim: The aim of this study is to assess the help-seeking behavior among psychiatric patients visiting a mental hospital.

Study Setting & Design: Cross sectional study. 100 new patients visiting the psychiatric outpatient service at a tertiary care hospital in Hyderabad were interviewed on a semi-structured questionnaire for the various services utilized by them for their mental health problems.

Material & Methods: Institutional ethics committee approval was obtained for conducting this study. Sample was collected from those who met the inclusion criteria and consented for the study. Intake proforma was administered to record the socio demographic details. Socioeconomic status was recorded using the Modified Kuppuswamy scale. The obtained data was analyzed using the SPSS software version 22 and appropriate tables and graphs will be used to explain the association between the variables.

Results: Will be discussed at the conference

Conclusions: Will be discussed at the conference

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F163: The Future of the Mind in Digital Era: A very short introduction

A A Mamun Hussain

Background: Digital technologies, today, have become ubiquitous and part of everyday life. It is the new normal, which has changed the face of a society: the way we think, the way we act and interact as individuals, as a community, and as a culture. Today, the web has reached the background condition of everyday life.

So, the debate is coming up in the interface of brain-machine science, illustrating the issues of consciousness, thoughts and mind in the era of our digital transformation.

Aim: This review delves into the human-machine partnership, with a peep into the future of the mind.

Method: Necessary data and information were collected after meticulous search in PubMed, Google and Google Scholar, using the keywords, viz. digital era, mind and brain-machine science.

Results: Along with the optimistic prophecies, a multiple discourse are evident explaining the grey area of digital era.

Conclusion: The transformative potential of technology, although is widely recognized but often the wellbeing of mind is ignored. With this presentation, we want to highlight the complex ways in which digital technologies manifest in society and influence future. As such, we need to explore, what we should embrace and accept, what we should unequivocally reject and what aspects of digital era we should now be debating, considering the total wellbeing of the future mind.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F164: Study of pattern of internet use and internet related behaviour among undergraduate medical students.

Shakir Farooqui, Mustafa Gandhi, Bhushan Mhetre

Background- Today's ‘INTERNET AGE’ has the largest impact on everyday human life. Inspite of the fact that the benefits of Internet have made notable improvements some users are becoming preoccupied with the Internet and are jeopardizing their professional work and personal relationships. As access to Internet technologies has increased so too have behavioral disorders related to its use. While the academic use of the internet is primarily for research and communication, the internet has also become an important part of student life. Internet Addiction can lead to dysfunction in social, academic and work domains and people affected by it usually share a comorbid psychiatric disorder.

Objectives- To evaluate the patterns of internet use amongst medical students and delve into their thoughts and opinions about the use of the internet to see what kind of an impact it has made on their lives socially and professionally.

Materials and methods- After approval from the institutional ethics committee, study was carried out among 60 undergraduate medical students. The instrument for this survey is a questionnaire which has been adapted from the Internet Behaviour Questionnaire.

Analysis and Result: Assessment of internet use and its related behaviours was done and results tabulated using appropriate statistical analysis. Results will be discussed at the time of presentation.

Conclusion: Will be discussed at the time of paper presentation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F165: Lessons from an ‘urban-based school’ survey on the “Blue Whale Challenge Game” in Chandigarh

Nitin Gupta, Sandeep Chhatwal, Harneet Kaur

Introduction: Social media and online games are a rampant method of teenage expression now-a-days. The Blue Whale Challenge (BWC) is a recognized viral game which has led to multiple suicides since its introduction. India has been mentioned as one of the prominent countries where adolescents and teens play this game and indulge in self harm and suicide despite banned links and resources. However, there is no data that has assessed the knowledge, vulnerability and awareness of these teens in India regarding the game.

Methodology: A cross-sectional survey was conducted in an all-boys, convent school in urban Chandigarh in October 2017. A specially designed questionnaire assessing for depressive features, internet usage, personality traits and knowledge about BWC was administered to boys of 4 classes (8^th, 9^th, 10^th, 11^th). Confidentiality was fully ensured.

Results: The total sample comprised 454 students; all males. There were 132, 144, 99 and 79 students from Classes 8^th, 9^th, 10^th, 11^th respectively. Overall, the total sample didn’t have any clinical depressive symptoms. Across the four sub-groups, 0.9-1% teens were over involved in the internet and online gaming; 0.7-2.6% had Cluster A personality traits and were vulnerable for landing up in depression; 0.1- 29.1% were aware about the details of the BWC, but had various myths regarding the same.

Conclusion: As a large proportion of children had awareness mixed with myths for BWC, this requires increased awareness and targeted counselling by teachers and parents in order to ensure that such online games do not lead onto hazardous consequences.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F166: Association of depression, anxiety and stress with smartphone addiction in pre- university students

Priyanka D'Souza, Aruna G

Background: Smartphone use has been linked to sleep disturbances, stress, anxiety, decreased academic performance, and decreased physical activity. Although, evidence-based research was not sufficient for smartphone addiction to be included in DSM-5, many studies have confirmed that constant smartphone use is associated with symptoms analogous to substance use disorder including inability to control its use, tolerance, impairment in socio occupational functioning, preoccupation and withdrawal.

Aims:

Prevalence of smartphone addiction in pre university students
Association of depression, anxiety and stress with smartphone addiction

Method: The ethical committee clearance was obtained. The design and nature of the study was explained to the institution/pre-university and the students. Informed consent from the institution and assent from the students obtained. A random sample of 250 pre university students completed a survey composed of

a) Questionnaire about socio-demographics, academics, lifestyle behaviours, personality type, and smartphone use-related variables
b) 26 item Smartphone Addiction Inventory (SPAI) Scale
c) Depression Anxiety Stress Scale (DASS) 21

Results: Prevalence rates of smartphone addiction were substantial. Results showed smartphone addiction risk was positively related to perceived stress and anxiety.

Conclusion: Smartphone addiction & its impact is underestimated and under researched. Strategies to promote healthy smartphone use could positively impact the psychological well-being.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F167: Title: - Increasing the ease of access to Mental Healthcare and reducing the treatment gap in India on an Artificial Intelligence powered healthcare platform.

Neeraj Raj B

Background: - Mental illnesses are a major public health problem around the world. Access to quality mental healthcare services is a major problem in India. This has been attributed to various causes like stigma, discrimination, and various other logistic reasons. Shortage of mental health professionals is also a stated reason. Thus, in order to reduce this Mental healthcare gap and to improve the ease of access to care in India, on demand healthcare with the use of mhealth is studied.

Methods: -Psychiatric morbidity in patients seeking help for mental health on an Artificial intelligence-powered healthcare platform was studied across 8 months. More than 700 patients had sought help and this data was analysed.

Results: -Most common psychiatric morbidity on digital platform included adjustment disorder, anxiety disorders, depression, sexual related concerns etc.

Conclusion: -Instant access to high-quality and reliable healthcare, especially for non-emergency conditions and the ability to connect with a doctor online in less than 60 seconds – anytime, anywhere with just a tap from the mobile phone saving both money and time was acknowledged by most of the patients. Patients were managed with pharmacological and non-pharmacological methods. Instant chat/audio or video consultation with a specialist, Follow-ups, and Valid Prescription have left an impression of a working model with great future implications.

Keywords: Artificial Intelligence, mhealth, digital platform.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F168: A Structured Training Module in Mass Communication for Mental Health Professionals-Preliminary Findings

Madhuporna Dasgupta, Pravitha MR, Sharmitha Krishnamurthy, Meena KS, Latha K, Santosh K Chaturvedi

Background- Mental Health Education is emerging as an important discipline which attempts to disseminate information related to mental health. Mental Health Professionals today, are not just restricted to clinical work, but are also contributing adequately to educate the general public with proper information thereby facilitating de-stigmatisation of mental health. With this responsibility, comes the need to be skilled in mass communication so that information reaches the target audience adequately. This paper explains the powerful impact of mass communication training for mental health professionals.

Aim- To empower the mental health experts with basic knowledge of mass communication, for effective information dissemination.

Methods- Mental Health Education Department, NIMHANS offers a number of training programs for budding mental health professionals to educate public. A major component includes a module on Mass Communication on Health Education. This follows a blended learning methodology comprising of an online coursework following a face-to-face interaction, covering the basic concepts of mass communication in three major themes: Understanding the Media, Use of Mass Communication Campaign to Change Health Behaviour and Way Forward: E-Health Communication.

Results: As an outcome of the module, the trained mental health professionals (n=11) were able to effectively plan and implement campaigns for the general public to increase awareness related to mental health both in print and also in digital media (Facebook, Instagram).

Conclusion: This paper shows the effectiveness of training in mass communication among mental health experts. This is an added benefit which can be used to educate the public and destigmatise mental health.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F169: Cyberchondria: An emerging form of health anxiety

Sujana Devi Gandla

Background: It is common among medical students to incorrectly believe that they have contracted certain diseases they have recently studied. This can also be seen in the form of health anxiety and investigating health-related information via the internet. Cyberchondria denotes repeated online searches for health-related information that are associated with increasing levels of health anxiety.

Objectives: To study the prevalence of severity of cyberchondria among medical students and its correlation with the socio-demographic data.

Methods: A cross sectional study was conducted using online Google forms. It included demographic data like age, gender and cyberchondria severity scale-15(CSS-15) questionnaire among 400 medical students and the responses were recorded. The data was analyzed using Microsoft office and SPSS trial version 25. The mean, frequencies, correlations, k means clustering and significance were assessed.

Results: The mean age of the participants was 19.28yrs. 55.5% of the participants were females. 24.8% of students reported to have previously diagnosed (medical/surgical/psychiatric) illness. The mean score of cyberchondria severity scale was 30.85. Three clusters with 31.75%, 60.25%, and 8%, of students with the CSS cluster center scores of 20.09, 34.28, and 48.28 respectively were formed. There was significant negative correlation between total score and previously diagnosed illness and age.

Conclusion: Cyberchondria is a fascinating example of how the digital technology may play an important, though not an exclusive role, in causing psychopathological phenomena. Measures need to be adopted to evaluate, prevent, and treat it at the primary level.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F170: Psychiatric Morbidity in College Students with Internet Addiction

Sanyam Gupta, Gurleen Kaur, Savinder Singh

Introduction: Internet has become one of the most important academic and recreational tool for adolescents and adults. There is grave concern about excessive use of internet as an emergent problematic behaviour. The extent of problematic internet use is increasing with the easier access of internet in smartphones and laptops. College students are a particularly vulnerable group on account of the time they spend on the internet. Despite the ubiquitous nature and importance of this topic, to our knowledge, not enough Indian studies exist which examine the pattern of Internet Usage and associated Psychiatric morbidity in this population.

Aims and Objectives: To assess the prevalence of Internet Addiction (IA) among college students and psychiatric morbidity associated with IA.

Materials and Methods: The cross-sectional study was conducted over a period of 15 months (January 2018 to March 2019) in 1500 consecutive college students (aged 18-25 years) studying in Khalsa College, Amritsar. Informed consent was taken prior to inclusion. Students were assessed using semi structured socio-demographic scale and Young's Internet Addiction Test to know the level of addictive usage of the internet. Those who came out as internet addicted were interviewed for psychiatric morbidity.

Results: Prevalence of internet addiction was found to be 13.6%. There is more occurrence of psychiatric disorders in students with internet addiction. Females were found to be more likely to be addicted than males. In this study, it was found that students with internet addiction have a high degree of anxiety and depressive disorders.

Conclusion: We believe that the results of this study will help generate awareness about the negative consequences of harmful usage of the internet and social media. Although the internet has a variety of uses, excessive usage can have adverse outcomes with consequent psychological distress.

Keywords: Internet addiction, prevalence, psychiatric morbidity, college students.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F171: Prevalence of Online Gaming Addiction in Undergraduate Medical Students in a Medical College in Assam

Prosenjit Ghosh, Anweshan Ghosh, Madhurima Khasnabis

Background- Most young adults report past-year gaming usage across a range of devices, including personal computers, laptops, consoles, and, increasingly as the technology has become more sophisticated, smartphones. Excessive gaming behavior may have significant negative consequences, particularly when sustained over a long period of time (e.g., more than 12 months), including school dropout, family conflict, poor mental health, and social isolation. Recognizing these phenomena and the need to classify health risks to develop public health responses, the World Health Organization (WHO) has included “Hazardous gaming” (QE22) and ‘’Gaming disorder’’ (6C51) in its latest revision of the International Classification of Diseases (ICD-11).

Objectives: -

To compare the important socio-demographic variables of the postgraduate medical students
To assess the prevalence of gaming disorders, internet addiction and smartphone addiction in the postgraduate medical students

Materials and Method: -This study was cross-sectional non-interventional study. 50 postgraduate students The data was collected using the 7-item gaming addiction scale, the Internet addiction test and the Smartphone Addiction Scale – Short Version. The data obtained was analysed using SPSS Version 21.

Result and Conclusion: - Results and conclusion will be discussed at the time of presentation.

Keywords: - gaming, smartphone, internet, addiction, icd-11, postgraduate, students

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F172: Mobile psychiatric unit: can this address mental health care issues effectively?

Mohan Reddy

Mental health is an important component in the overall well-being of an individual. This is reflected in the definition statement of health by WHO. Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 year, therapeutic revolutions in psychiatry have not yet been able to reduce the stigma.

The Government of India launched National Mental Health Programme in 1995 with the objective of addressing mentally ill patients.The District Mental Health Programme (DMHP) was launched under NMHP in the year 1996 (in IX five year plan).

After the initial implementation of NMHP it was observed that although there were some developments, the financial constraints and shortage of man power limited success.

As an alternative model we introduce the concept of MOBILE PSYCHIATRIC UNIT (MPU) to combat mental illness among public. In other words, with this mode we intend to offer mental health care services at the doorsteps of the people.

In this proposed model, Mobile psychiatric unit (MPU) van will visit particular center which covers around 4-5 villages on a scheduled date. On the day of visit these people with suspected mental illness will be brought to the MPU care van and given the necessary treatment.

The MPU vehicle moves to the next center on the following day.

We conclude that by implementing this MPU model we can address mental health issues more effectively in the community.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F173: Mental health is an important component in the overall well-being of an individual. This is reflected in the definition statement of health by WHO. Although the quality and effectiveness of mental health treatments and services have improved greatly over the past 50 year, therapeutic revolutions in psychiatry have not yet been able to reduce the stigma.

The Government of India launched National Mental Health Programme in 1995 with the objective of addressing mentally ill patients.The District Mental Health Programme (DMHP) was launched under NMHP in the year 1996 (in IX five year plan).

After the initial implementation of NMHP it was observed that although there were some developments, the financial constraints and shortage of man power limited success.

As an alternative model we introduce the concept of MOBILE PSYCHIATRIC UNIT (MPU) to combat mental illness among public. In other words, with this mode we intend to offer mental health care services at the doorsteps of the people.

In this proposed model, Mobile psychiatric unit (MPU) van will visit particular center which covers around 4-5 villages on a scheduled date. On the day of visit these people with suspected mental illness will be brought to the MPU care van and given the necessary treatment.

The MPU vehicle moves to the next center on the following day.

We conclude that by implementing this MPU model we can address mental health issues more effectively in the community.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F174: The association between Bullying, Self-esteem, Social phobia, Depression and Body Mass Index in a Tertiary care hospital and Medical college:

Susila SharmiliK

Background: Bullying is defined as the use of force or threat to abuse, dominate or intimidate a person. Bullying is a rising problem in children and young adults and its lifelong impact over the mental health is of rising concern.

Aims:

The study was conducted

To assess the link between bullying to self-esteem, social phobia, depression
To assess the impact of BMI on bullying

Methods: A cross sectional study was done with 250 medical college students, aged between 18 to 25 years from a tertiary care medical college after obtaining an informed consent. The students were interviewed individually and screened by Retrospective Bullying Questionnaire, Rosenberg Self Esteem Scale, Liebowitz social anxiety scale, Hamilton Depression Rating Scale. BMI was calculated.

Results: More boys were found to be bullied than girls. Being bullied was positively associated with the severities of depression and social phobia and negatively associated with the level of self-esteem. Overweight or obese individuals were found to be bullied more

Conclusion: Being involved in bullying in childhood or adolescence is associated with low self-esteem and higher incidences of social phobia and depression in the future. This study stresses on the importance of identifying bullying as early as possible and taking measures at home, schools and colleges to reduce the chances of bullying for a psychological wellbeing in the future.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F175: A Study Of Attitude Towards Mental Illness Among Female Undergraduate College Students

Background: Public attitude towards mental illness (ATMI) plays a major role in seeking treatment, recovery, relapse prevention & social inclusion of people with mental illness. Negative ATMI have been consistently reported in male students. Our study aims to investigate the current attitude among female students, as women are the key to sustainable development in family & community.

Aim: To assess ATMI among female undergraduate Arts & Science students in Madurai, Tamil Nadu in relation to sociodemographic factors, cultural beliefs & previous contact with mentally ill.

Method: Cross sectional descriptive design was adopted. The study was undertaken at Sri Meenakshi Arts College for Women, Madurai. 200 female students in the age group of 18-25yrs participated to whom Reported & Intended Behaviour Scale (RIBS) & Community Attitude Towards Mental Illness (CAMI) questionnaire standardised to local language were administered. Data analysis was done using statistical package for social sciences, version no.20.

Results: This study revealed that majority of students were from urban background, scored high in attitude categories (benevolence & community heath ideology), indicating positive ATMI. More than 1/3^rd ranked brain abnormality as foremost cause of mental illness & were willing to engage with mentally ill.

Conclusion: This study demonstrates positive shift in attitude, among students towards mental illness, which can be further reinforced with educational / mental health awareness programmes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F176: Fear of Happiness Among Medical Students,Role of Gender, Childhood Trauma--comparative study

K Surekha, Rufus Ephraim Yelamanchi, KAshok reddy

Introduction: Fear of happiness is belief that feeling happy may have negative consequences implying that it would be avoided. Emotions are perceived as terrifying experiences because happiness may be considered to be transient, which may end up as something bad. Childhood psychological trauma has major impact on fear of experiencing happiness.

Aim: This study aimed to evaluate the fear of happiness among medical college students & its relationship to gender, childhood trauma.

Settings & Design: Medical students were addressed as study population& relative screening methods were implemented.

Materials & Methods: Childhood trauma questionnaire (CTQ), Fear of happiness scale (FHS) were administered to all the participants.

Results: The data will be analysed using (SPSS software & appropriate statistical tests).

Keywords: Childhood psychological trauma, Fear of happiness, Abuse.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F177: Association of postpartum depression with early breast feeding and other factors

Manish Kumar Goyal, Kuldeep Singh Yadav, R K Solanki

Background-Post-Partum depression (PPD) is common among Indian mothers with prevalence of 22%. Its association with breast feeding (BF) is so far unclear. Decreased BF rates increase the risk of PPD, and similarly PPD may lead to reduces breast feeding. Initiation of breast feeding in first week of delivery is crucial not only to child health but also to maternal mental health. So the early diagnosis and treatment of PPD may help to prevent bad outcome.

Aim and Objective -To check the association of BF with PPD and role of other cofactors.

Methodology-This cross-sectional study was conducted in a tertiary care centre. Pregnant women were screened by Brief Symptom Rating Scale (BSRS-5) at the time of admission. After fulfilling inclusion and exclusion criteria, total 100 subjects were recruited. The Edinburgh Postnatal Depression Scale (EPDS) was completed within 1 week before discharge to predict the depression in postpartum women and was used to divide patients into two groups for further analysis: non-depression and depression.

Result-Prevalence of PPD was observed in 23% of mothers. It was noticed that high EPDS score was associated with significantly high BSRS-5 score (p=.001), high rate of caesarean section (C/S) (p=.009) and low BF rate (p=.014). Lower rate of BF is associated with Female gender of baby (p=.024) and C/S (p=.013).

Conclusion-Vaginal delivery and BF presented a lower risk of PPD in the first week postpartum. Therefore, the government and medical providers should provide prompt guidance and BF support.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F178: Development and Validation of a Postpartum Depression Risk Prediction Model using Machine Learning

Shuojia Wang, Alison Hermann, Rochelle Joly, Jyotishman Pathak, Yiye Zhang

Background: Postpartum depression (PPD) poses serious health concerns to mothers, children, and the family. However, there remains a knowledge gap on accurate and preemptive PPD risk identification.

Objective: We developed a machine learning (ML) algorithm to identify women at high risk of developing PPD using longitudinal electronic health record (EHR) data and validated using an independent set.

Methods: A retrospective study was conducted using EHRs from Weill Cornell Medicine and NewYork-Presbyterian Hospital from January 2015 to June 2018. EHR data from multiple academic medical centers derived from the New York City Clinical Data Research Network data (NYC-CDRN) between August 2004 to October 2017 was used for validation. The study outcome is defined as having a PPD diagnosis within 12 months after childbirth. Multiple ML algorithms were used to train models using data extracted at 12-week, 18-week, 24-week, and 30-week pregnancy and at childbirth.

Results: Mental health history and active symptoms, marital status, race, use of beta-blockers and antihistamines, and the number of ED visits are among the most predictive features. A total of 15,197 deliveries in WCM and 53,972 deliveries in NYC-CDRN were included. The highest area under the curve (AUC) was 0.937 with a sensitivity of 0.83 and specificity of 0.96. The AUC computed using NYC-CDRN data was 0.853, with the sensitivity and specificity at 0.84 and 0.77.

Conclusion: Sociodemographic and clinical information in the EHR before and during pregnancy were found to be predictive of PPD. Ongoing work includes validation using EHRs and patient self-report data.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F179: Attitude to Mental Illness among Medical Interns and the Role of Psychiatry Posting

Soumen Karmakar, Sharmila Sarkar

Attitudes of doctors towards mental illnesses play a very important role in care of the patients, and also destigmatize these illnesses. Training of young doctors about psychiatric illnesses is crucial in this regard. In our study we have tried to assess the role of compulsory internship posting of medical undergraduates in psychiatry department in changing their attitude about mental illnesses towards a more positive side. Sixty-two (62) MBBS interns were included in our 6-month study, and were assessed using the Attitude to Mental Illness Questionnaire (AMIQ) before and after their psychiatry posting. The AMIQ is a self-reported questionnaire which has 7 case vignettes, out of which 4 are related to mental health. Each vignette has 5 questions; the responses are framed in a 5-point Likert scale format, from -2 (negative attitude) to +2 (positive attitude). Thus, each vignette can be scored from -10 to +10. Out of 62 interns, thirty-seven were males, 25 females, and the mean age was 23.39 ± 2.34 years. Results showed initial negative attitude towards injection heroin user (-0.45 ± 2.60), and poor attitude towards schizophrenia (0.82 ± 3.03) prior to psychiatry posting. However, following psychiatry posting, their attitudes changed towards a more positive side, and these changes were statistically significant in cases of injection heroin user (1.97 ± 2.21), depression & suicide (5.08 ± 1.70) as well as schizophrenia (3.11 ± 2.50). Thus, compulsory internship posting in psychiatry department plays a very crucial role in changing attitude towards mental illnesses among young doctors.

Keywords: -Attitude, Interns, AMIQ, Mental Illness, Psychiatric Illness

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F180: A study of awareness of decriminalization of attempted suicides in India

Azmeera ramnaik, Sireesha, Sree Shanthi Donthi, MUmashankar

Introduction: Attempted suicide is a self-injury with the desire to end one's life that does not result in death. It is associated with further increase risk for recurrence of suicide. Suicide attempts occur in background of stress but section 309 IPC suicide attempt was considered as offence. But section 115 of MHCA 2017 suicide was decriminalized.

Aim: To study the awareness of de-criminalization of attempted suicides in India

Methodology: Consecutive patients were interviewed, once they are stabilized, those who gave consent were entered on a semi-structured intake pro-forma. Study subjects were informed about section 115 of MHCA 2017 and asked about their awareness and attitude. They were also enquired about section 309 IPC, abetment of suicide. Whether they would like to take psychiatrist opinion next time when they get suicidal thoughts.

Results: Most commonly used method by the attempters for suicide is by poison consumption (48.33%). 78.33% were not aware of section 309 IPC. No one was aware of sec 115 of MHCA 2017.100% of the patients felt that suicide attempters should not be punished.

Conclusion: Efforts should be undertaken at different levels and stages with media, hospital based programs. Public health policy makers should plan awareness programs regarding section 115 of MHCA 2017, with only such measures ignorance can be removed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F181: Comparison of attitudes towards psychiatry among undergraduate and postgraduate medical students

Prosenjit Ghosh, Monu Doley, Nibedita Dutta, Ankur Bhattacharya, Nibedita Dutta

Background: -Psychiatry, a discipline of Medicine has been emerging in the recent years. A stigma towards mental illness is still prevalent in society. There is a conflicting interest in taking up Psychiatry as a career choice by the medical students. There is a variation in attitudes and opinions in Psychiatry among the medical professionals.

Aims and objectives: - To access and compare the attitude of undergraduate and postgraduate medical students towards psychiatry and to co-relate the selected socio-demographic variables with their attitude towards mental illness.

Materials and Methods: -Cross-sectional study conducted in department of Psychiatry, Silchar Medical College and Hospital, Silchar.100 participants (50 undergraduate students and 50 postgraduate students) are selected.

Tools used: -Self-structured socio-demographic Performa and ATP-30 scale used for assessing attitude towards psychiatry.

Statistical Analysis used: -Students t-test, chi square test and SPSS version 21.

Results: -Nearly 24% of undergraduate medical students and 54% of postgraduate medical students have positive attitude towards psychiatry. Only 18% of undergraduate students indicated to choose Psychiatry as a career choice.

Conclusion: PG medical students had more positive attitude towards psychiatry than UG medical students. Increased negative attitude among the U.G students may be due to lack of regular classes on psychiatry or not attending psychiatric training by them, poor knowledge about psychiatric illness and stigma towards mental illness.

Keyword – Attitude, psychiatry, undergraduate medical student, post graduate medical student, mental illness.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

Introduction: Violence against psychiatric trainees (VAPT) by their patients in the workplace is of great concern and might have severe consequences. The European Federation of Psychiatric Trainees (EFPT) – Research Working Group has conducted a survey to assess violence (verbal, physical and sexual) against psychiatric trainees in different Asian countries.

Aim: To estimate the frequency, circumstances and consequences of workplace violence experienced by psychiatric trainees in India.

Method: An anonymous online questionnaire consisting of 15 questions was spread among psychiatric trainees in India.

Results: Ninety trainees completed the survey. Two-thirds has been exposed to workplace violence. Of those that have been assaulted, majority experienced assault 2-5 times. Four-fifths experienced verbal assault while over half of them reported physical violence. Inpatient ward was the most common site of the incident. Half of them reported feelings of anxiety/rage and fear while one third report no impact after experiencing an assault. Three-fifths of them did not reported to any authority as they felt it would be unnecessary or useless. Only two fifths responded that there is training for staff regarding violence and less than one fifth had established protocol in their workplace.

Conclusion: There seem to be minimal training and protocol to manage and prevent VAPT despite high proportion of trainees experiencing it. VAPT remains one of the challenges that needs to be addressed at a national level.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F183: Assessment of Determinants of Pathways to Care in Mental Illnesses

Gargee Sharma, Sanyam Gupta, Savinder Singh

Aims and Objectives: - To assess the determinants of pathways to care in various mental illnesses and to study the factors affecting the delay in pathway to care.

Materials and Methods: About 501 patients and their caregivers first time attending the out-patient Department of Institute of Mental health, Amritsar meeting the inclusion criteria were recruited in the present study. Complete socio-demographic detail was taken and clinical assessment was done using the structured proforma. Diagnosis was made by using Mini-International Neuropsychiatric Interview (M.I.N.I.) 5.0.0. Pathway interview schedule was used to access the pathways to care till the patient reaches the institute. The results were tabulated and statistically analysed using Pearson's association Chi Square test.

Results: The patients were predominantly young adults, male, from rural, agrarian but educated background and a majority of them presented with psychotic illnesses. It was seen that there were six major gateways to care of the mentally ill in the region, Faith healers being the most popular portal of care. The median duration of untreated illness (DUI) was 18.99 months and subjects had already visited 2.67 carers before visiting any mental health professional. Duration of untreated illness was longest for substance disorder. Patients of psychotic disorder traversed through maximum number of carers before reaching the institute. Patients who used psychiatric services as first portal of care had different socio-demographic variables as compared to clients who used other services.

Conclusion: This pathway to psychiatric care study in Amritsar, India demonstrated that referral pathway heavily relies on the indigenous faith healers. The study outlines the possible areas and need for the importance of raising awareness campaigns to facilitate early recognition of psychiatric disorders.

Keywords: pathway to care, help- seeking behaviour, Duration of untreated illness, Treatment Delay

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F184: A cross sectional study to assess mental health literacy among nursing students at tertiary mental health care facility.

Sneha Kulkarni, Sanket Katakdhond, SSireesha

Introduction: Mental health literacy aims to increase the knowledge and awareness regarding the psychiatric disorders among people and thus improve their attitudes and early treatment seeking behaviour. It also aims to reduce the stigma associated with mental illness. Nurses being integral part of heath care system need to be mental health literate.

Objectives: The primary objective of our study was to assess the knowledge of nursing students regarding mental health disorders. The secondary objective was to assess their attitudes towards recognition, management, prevention and help seeking behaviour for psychiatric disorders.

Methods: This is a prospective survey-based study. The mental health literacy scale was used to capture the various variables. SPSS version 22 was used for statistical analysis.

Results: The mental health literacy among the study participants was found to be less than the adequate. The levels of recognition of mental health disorders was found to be low. However, the treatment and help seeking behaviour among those who could recognise the disorders were better.

Conclusion: To ensure good mental health for all, the need for improvement of mental health literacy is prime. Empowering nursing students can prove as an effective measure in bettering the mental health care system. This can be achieved through professional training, community campaigns, workshops, peer support, field training, and shared working practices.

Key words: Mental health literacy, Nursing students.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F185: Caregiver burden and quality of life among the caregivers of Psychiatric illnesses and Chronic Medical illnesses: A Cross-sectional Comparative Study

Sathish Dande, Divija Bunga, K Phanikanth

Background: Psychiatric disorders like Schizophrenia, bipolar affective disorder, chronic medical conditions (refractory tuberculosis, chronic bronchial asthma, rheumatoid arthritis patients) need assistance or supervision in their daily activities and this often places a major burden on their caregivers, thereby placing the caregiver at a great risk of mental and physical health problems. India being a country of traditions and family values, the care-giver is usually a family member. These care-givers, being untrained in this job undergo tremendous stress. The quality of life (QOL) of these caregivers is directly related to the subjective and objective burden of the illness.

Aims and Objectives- - To study and compare the level of caregiver burden and QOL between caregivers of psychiatric disorders and chronic medical conditions like refractory tuberculosis, chronic bronchial asthma, Diabetes mellitus, HTN, Rheumatoid arthritis.

Materials and Methods: The study included 2 groups of caregivers, each of 50 members. Group A consisted of caregivers of psychiatric patients and group 2 consisted of caregivers of chronic medical illness patients. The Zarit burden interview was used to assess the caregiver burden and WHO-QOL used to assess the quality of life and data is analysed using SPSS Version-24

Inclusion Criteria

1) Males and females
2) 18 -60 years
3) Caregivers duration >1year who gave written consent

Exclusion Criteria

1) Serious medical illnesses and major disabling conditions
2) Deaf and dumb

Tools

1) A semi-structured intake proforma.
2) ICD-10.
3) Zarit burden interview
4) WHO-QOL BREF scale

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

Keywords - Caregiver burden, QOL

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F186: Knowledge of Nurses in management of aggressive patients in various psychiatric Hospitals of Lucknow, UP.

Deblina Roy, Sonam Charan, Pritha Roy

Management of aggressive patients have always been a challenge in psychiatric setups. Nurses play a very important part in the in patient management. Aggressive patients pose a threat to themselves as well as to other admitted patients and to the health care team members. The knowledge and attitude of nurses play a very important part in the management of aggressive patients in the emergency and wards. This was the reason to assess the knowledge of nurses working in psychiatric setups regarding management of psychiatric patients. The main objectives of the study were - To assess the knowledge of aggressive behaviour of patient among staff nurses. The study was conducted by using survey research design with a structured questionnaire. Non probability purposive sampling technique was used to select 40 staff nurses from various psychiatric settings of Lucknow. Employing descriptive and inferential statistics the analysis of the data was done. Majority of the participants were between 25-30 years old, had passed GNM without any specialized training in psychiatry had 3 years of experience. The findings of the study reveal that the knowledge score in pre-test were low. Knowledge was inadequate for 73.3% of the respondents and moderately adequate for 26.67% of the respondents. So this leads to the finding that there is a grave need to create short term training programs for nurses in management of psychiatric patient specific needs. Utilization of training programs like Post Basic Diploma in Psychiatric Nursing (1 year course) can help the system equip the nurses for psychiatry specific nursing actions.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F187: Title of the research project:: “Measurement of empathy levels in undergraduate medical students - A Cross-sectional study.

Objectives: The main objective of this study is to assess empathy levels in undergraduate medical students according to the year of education. This is used to measure empathy among medical students of various years with an objective to compare the empathy levels among medical students in relation to age, gender, choice of specialty.

Background: Empathy is essentially a desirable quality among clinicians and can be developed during medical education. Studies from outside India have shown that higher empathy is related to better competency and choice of specialty may be related to empathy levels in them. Change in empathy levels among undergraduate medical students with progressive training has been often ascribed to reasons such as curriculum content, timing of clinical rotations. Gender differences in empathy levels also vary among different countries. Since many of such factors differ in India there is a need therefore to understand empathy and its correlates among medical students in India

Methodology: This is a cross sectional study to be conducted in prathama medical college Karimnagar, Telangana ,India. We are planning to conduct the study among undergraduate medical students first year, second, third, fourth year and internship students, to measure the empathy levels by using Jefferson empathy scale –student version.

Results: Female students had significantly higher empathy levels than male students across all semesters. The variance in empathy scores according specialty chosen is not statistically significant.

Conclusion: The progressive decline in empathy levels with years in medical college here is seen much later than in western studies. Female students are more empathetic than male students. The relation of mean empathy scores and choice of specialty is inconclusive and at variance from other studies

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F188: A study on nomophobia, quality of sleep and associated behavioural problems in engineering students”

Alok N Ghanate, Abdul Rafe MuqtadeerBaig

Background: Growing smartphone usage among students globally has resulted in considerable issues of NOMOPHOBIA which is defined as a psychological condition when people have a fear of being detached from mobile phone connectivity. The use of smartphone among younger population raises concern for its addiction and its relationship with quality of sleep and mental health problems.

Aim: To study the prevalence of nomophobia, quality of sleep and associated behavioural problems among engineering students.

Methods: A cross- sectional study was conducted and data was collected from 1400 engineering students using a pretested self reported questionnaire. Scales used were Nomophobia questionnaire (NMP Q), Depression, Anxiety and Stress sub scores (DASS-21) and Pittsburgh sleep quality inventory (PSQI).

Results: Majority of the students 65.3% belonged to 18 – 20 years age group. About 19.9% were having mild, 60.4% having moderate and 18.5% having severe nomophobia. Among associated behavioural problems Depression accounted for 54.8%, anxiety 65.8%, stress 36.7%. On PSQI Scale poor quality of sleep was found out to be 39.5%.

Conclusion: Increasing prevalence of Nomophobia among younger individuals with significant behavioural and sleep problems owing to excessive smartphone use is seen in our study.

Keywords: Nomophobia Questionnaire (NMPQ) , Pittsburgh sleep quality inventory (PSQI), Mobile user (MU)

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

F189: Study of Quality of life in alcohol use disorder patients

Veji Odedara, Urvika Parekh, Rakesh Gandhi

Introduction: Harmful alcohol use is a worldwide problem that results in millions of instances of death, disease, injury, and violence. The significant interpersonal, psychological, and medical problems that arise due to alcohol misuse have an impact on different quality of life (QoL) domains. The construct of QoL encompasses the central notion that health is not restricted to the absence of disease; it also includes a state of social, mental, and physical well-being that is consistent with the definition of health proposed by the World Health Organization.

QoL is also an important factor for establishing treatment outcomes of alcohol misuse.

Aim: To assess quality of life in patient with alcohol use disorder.

Materials and Methods:A Cross-sectional study conducted on individuals attending psychiatry OPD for treatment of alcohol related problems. DSM-5 was used for diagnosis of alcohol use disorders. Participants were assessed for demographic data using structured questionnaire. QoL was measured by WHO-QoL scale (WHOQOL-BREF).

Results: This study found low quality-of-life scores on all four domains of WHOQOL-BREF among patients. Mean for WHO-QL System's physical domain 11.32, psychological domain 10.17, social domain 9.45, environmental domain 11.34. Scores were lowest for social domain followed by psychological, physical, and environmental domains.

Conclusion: The study confirms poor QoL in patients of alcohol use disorder before intervention. The regular follow up with the family members in outpatient setting enables the patient achieve complete abstinence, thereby improving their quality of life.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 49: Exercise and Mental Health: What is the relationship?

Mohan Raj

In medical folklore, it is believed that exercise had positive physical and psychological

pconsequences and has been advised by medical practitioners for many years. But, systematic evaluation of this association began only by the Mid1980s.

Since then, many studies have demonstrated the positive correlation between exercise and Self-perception, Mood, Mental health and other health variables.

WHO recommended guidelines for Physical activity (PA) are Performing PA ≥3 days/week to accumulate 150 min/week of moderate-intensity PA, corresponding to 3.0-5.9 metabolic equivalents [METs], where 1 MET is the resting metabolic rate or ≥75 min/wk of vigorous-intensity PA [≥6 METs] or a combination of the above.

Indian studies regarding exercise have been predominantly about yoga and its effects. Not many studies were done about physical activity.

In a major ICMR collaborative study on physical activity and inactivity in India,

Anjana etal(2014) showed that 54.4% of those studied (n=7737) were inactive while 31.9% (n=4537)were active and 13.7% (n=1953) were highly active. Subjects were more inactive in urban, compared to rural, areas (65.0% vs. 50.0%; p<0.001). Subjects spent more active minutes at work than in the commuting and recreation domains.

This presentation will evaluate the studies examining the connection between Exercise and Mental health, their methodological strength and their limitation. Recommendations for newer research in this area will also be discussed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 50: Sudhir Bhave, Vivek Kirpekar, Sushil Gawande, Aarti Bang

Tribal mental health is a much neglected field in our country, with regard to both epidemiological research and service provision. We are providing our services in such a “backward”, naxal-affected tribal area in Gadchiroli district of Maharashtra. In the symposium, we wish to discuss issues related to tribal mental health in general, our service model in the said tribal district, and practical suggestions for improving such services all over the country and challenges therein.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 51: Significance of Consultation-Liaison Psychiatry in general hospital: An Update

Consultation-liaison Psychiatry is the study, practice and teaching of the relation between the medical and psychiatric disorders. Lipowski defined CLP as a subspecialty of psychiatry that involves providing clinical service, teaching and carrying out research at the borderland of psychiatry and medicine. The term CLP is often used interchangeably with “psychosomatic medicine”. CLP is considered to have contributed significantly in moving psychiatry from the bounds of mental asylums to general hospital setting. Various models of CL services have been developed. According to focus of consultation, the models which are described include patient-oriented approach, crisis-oriented approach, consultee-oriented approach etc. Based on the function, the models of CLP include consultation model, liaison model, etc. As per the focus of work, the various models include critical care model, biological model etc. Emphasis on CLP can also help in bridging the mental health gap in terms of improving the mental health care at the primary care setting. CL psychiatrists can be considered as appropriate person for tele-psychiatry services. Although in the last 50 years, psychiatry training has shifted to the GHPUs, CLP has not been the major focus of training. Published data from most of the centers are silent on the functioning of the CLP services.

The focus of psychiatry training should move from the primary psychiatric disorders to providing holistic and personalized care.

Psychiatrists should play an important role in pre and post-organ transplant evaluation, pain management, prevention, diagnosis and treatment of delirium in the ICUs, gender reassignment surgeries, cosmetic surgeries, in palliative care, etc.

This symposium focuses on the basic concept and necessity of Consultation Psychiatry in modern day practice.

Keywords: Consultation-liaison Psychiatry, Psychosomatic medicine, Consultation model, Liaison model.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 52: Gaming Disorder ;Opening the Pandoras Box

Rajarshi Guha Thakurta, Asish Debnath, Arabinda Brahma

ABSTRACT:

Significant variability in the classification and assessment of internet gaming disorder (IGD) has resulted in inconsistent evidence relating to its phenomenology, prevalence, cross-cultural application, course, biomarkers and treatment . Petry and colleagues have made an important contribution to research and practice by standardizing the diagnostic criteria for this disorder, which is included as a condition for further study in the DSM-5.^[1] Internet gaming is one of the most popular online leisure activities. These activities, particularly massively multiplaye ronlinerole-playinggames,deliverpleasure,a senseof achievement, social interaction, and an immersive experience to online gamers. However, excessive online gaming may have negative consequences by limiting real-life experiences. ^[2].

Video games are now one of the most popular media for connecting people throughout the world. However, loss of control over video games played online has revealed a series of negative consequences. Because of its major mental health impact, the loss of control over online gaming was termed ‘internet gaming disorder’ (IGD) and included in section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition . Extensive studies have provided new perspectives of IGD . Among Internet-based games, massively multiplayer online role-playing games (MMORPGs) are the most complex and require the most intensive social interaction . Currently, MMORPGs are a very popular and enjoyable leisure activity. However, MMORPG players reveal a high (27.5 %) rate of IGD,andplayingMMORPGsis themostfrequentlycited activity in studies of Internet addiction^[3]. Studies indicate thatoptimal experiences motivate people to continue playing online games. Examples of optimal experiences include effective interaction with the system and pleasant social interactions with other gamers . New Internet technologies that enable real-time interaction and a smooth visual field have resulted in gaming experiences comparable to those in the real world and have led to the development of effective delivery systems that provide high user satisfaction. Further, because most popular MMORPGs have extensive and well designed virtual worlds, players can express themselves in ways that would cause them discomfort in real life . Review suggests the following indicators of excessive online gaming activity: (1) excessive use, often associatedwith loss of a sense of time or neglect of basic drives; (2)withdrawal, including feelings of anger, tension, and/or depression, when the computer is inaccessible; (3) tolerance, including the need for better computer equipment, more software, or more hours of use; and (4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue.^[4] study of subjects with IGD showed impaired decisionmaking ability in a dice game task . Further,Internet gaming addiction (IGA) presents cognitive biases toward information related to Internet gaming. These biases,as well as poor executive functioning skills (lower mental flexibility and response inhibition), might contribute to IGD.[5]. It remains difficult to make definitive statements on the effectiveness of psychological and pharmacological treatments for Internet gaming disorder.The majority of studies have employed psychological interventions with a focus on cognitive-behavioral therapy (CBT), but the content of CBT sessions is often described ambiguously. Nevertheless, there appears to be a stronger consensus on the benefits of CBT as compared to other approaches, and particularly in contrast to pharmacologicaltreatment. There are unresolved questions which needs to be answered.^[6]

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 53: Scripture Based Psychotherapies

P K Singh, Vinay Kumar, Rajashree Ray

Every society and culture has a set of scriptures. Scriptures generally are the epitome of collective ancient wisdom. They are considered sacred and are much revered by the masses. This reverence is the source of their power over the minds of people. This power must be channeled systematically towards the welfare of the people, more specifically for the maintenance and restoration of their mental health. However, scripture are also considered by many as a thing of the past, specially by those who get blinded by the glitter and glamour of modern science. But old is sometimes truly gold. The pearls of wisdom have to be fished out of the ocean of ancient scriptures and ways and means have to be devised to fit them into the modern therapeutic paradigms and formats to maximally optimise the mental health related matters of every individual. All scriptures of the world have something to offer. In fact many of them have so many commonalities. Scriptures generally have inbuilt mechanism for maintenance of mental health. They also provide rich resource to boost up resilience as well as provide seeds of remedies which work primarily on the mental plane. Therefore, it is very important to explore this dormant treasure. This Symposium endeavours to voyage into this area.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 54: The history of psychiatry within the Asian sub-continent is quite diverse

Alok Sarin, Anup Dhar, Sanjeev Jain, Pratima Murthy, OP Singh

The history of psychiatry within the Asian sub-continent is quite diverse. Asylums and medical colleges were established at different times in each region, and their penetration and interface with local traditions and services also varied. We will focus on the development of psychiatric services in the eastern part of India. We review the development of asylums in Dhaka, Kolkata, Tezpur and Ranchi, the personalities involved, vignettes of administrative records and case notes from these institutions; as also larger changes in social discourse. These included the introduction of mesmerism, psycho-analysis, dream-analysis by the early 20^th century; and towards the middle of the twentieth century, ideas about social psychotherapy. These ideas, ranging from biological innovations (the discovery of the first anti-psychotic in the world), to ideas of self and society, have had a significant impact of the practice of psychiatry in the region.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 55: Overview of paraphilic disorders

Sona Kakar, TSS Rao, Vijay Mahendru, Ganesh Shankar

Paraphilic Disorders have continued to arouse interest since years and constitute one of the most complex conditions to understand and manage. Changing perceptions and changes in our understanding are reflected in dynamic shifts which continue to occur in defining it. The DSM-I included sexual deviation as a personality disorder of sociopathic subtype. DSM-II continued to use the term sexual deviations, but no longer ascribed them under personality disorders, but rather alongside them in a broad category titled “personality disorders and certain other nonpsychotic mental disorders”The (DSM-IV-TR), states that a paraphilia is not diagnosable as a psychiatric disorder unless it causes distress to the individual or harm to others. Most recently, DSM-5 made a distinction between paraphilias and paraphilic disorders.

In this symposium we will review the recent advancements related to psychosocial issues, etiology, legal considerations as well as management of Paraphilic Disorders.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

WS 56: “Making most of EEG in Psychiatry”

Nishant Goyal, Umesh S, Vidya KL, Sudip Kumar Sinha

ABSTRACT:

Electroencephalography (EEG) is an age-old investigative technique used both in neurology as well as psychiatry day in and out. It is a tool which stands test of the time even in ever-advancing era of functional imaging. Being a cost effective device, it gives valuable insights into baffling cases. Though EEG is part of the curriculum of psychiatry residency in India, the training one gets is minimal and is majorly confined to the central institutions. So, establishing an EEG lab, recording good EEG data and reporting of EEG, all seem like a giant task, for many. Effectively translating and utilizing the reports of EEG for benefit of patients demands knowledge of basics of sensitivity, time constant, montage and various filters involved in an electroencephalograph. Precise understanding of the artifacts, sleep related changes and how not to mistake normal variants for probable abnormality, goes long way in helping the patient population. Furthermore, now advanced high resolution EEG research is throwing light on various manifestations of normal and abnormal states of mind. So this workshop intends to explore from setting up of EEG lab, basic parameters of EEG, use of EEG in psychiatric services to high resolution EEG in psychiatric research, using virtual graphs and illustrations. The team proposes to focus on setting the parameters for clinical EEG record, reading of various normal and abnormal EEGs, which are of importance to psychiatrists.

Divisions:

Introduction and setting up of EEG lab
Basic tenets of Electroencephalography
Use of EEG in psychiatric practice
EEG in psychiatry research

Key words: EEG, Psychiatry, training

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

WS 57: IPS Young Psychiatrists Subcommittee Workshop EMDR

Manaswi Gautam, Shivaji Marella, Jwalant Chag, Arshia Patil

Eye Movement Desensitization and Reprocessing (EMDR) is a psychotherapy treatment that was originally designed to alleviate the distress associated with traumatic memories. EMDR therapy facilitates the accessing and processing of traumatic memories and other adverse life experience to bring these to an adaptive resolution. After successful treatment with EMDR therapy, affective distress is relieved, negative beliefs are reformulated, and physiological arousal is reduced. During EMDR therapy the client attends to emotionally disturbing material in brief sequential doses while simultaneously focusing on an external stimulus. The therapist will move his or her fingers back and forth in front of your face and ask you to follow these hand motions with your eyes. At the same time, the EMDR therapist will have you recall a disturbing event. This will include the emotions and body sensations that go along with it. Gradually, the therapist will guide you to shift your thoughts to more pleasant ones. Therapist directed lateral eye movements are the most commonly used external stimulus but a variety of other stimuli including hand-tapping and audio stimulation are often used. The new associations are thought to result in complete information processing, new learning, elimination of emotional distress, and development of cognitive insights. EMDR therapy uses a three pronged protocol:

(1) The past events that have laid the groundwork for dysfunction are processed, forging new associative links with adaptive information;
(2) The current circumstances that elicit distress are targeted, and internal and external triggers are desensitized;
(3) Imaginal templates of future events are incorporated, to assist the client in acquiring the skills needed for adaptive functioning.

More than 30 positive controlled outcome studies have been done on EMDR therapy. Some of the studies show that 84%-90% of single-trauma victims no longer have post-traumatic stress disorder after only three 90-minute sessions. Another study, funded by the HMO Kaiser Permanente, found that 100% of the single-trauma victims and 77% of multiple trauma victims no longer were diagnosed with PTSD after only six 50-minute sessions.

Conclusion

As the global burden of psychological trauma continues unabated, the need for more research and investigation into treatment interventions that are both effective and efficient is essential. EMDR therapy is an effective treatment to improve diagnosis of PTSD, and reduce symptoms of PTSD, and other trauma-related symptoms.

The workshop under the aegis of the IPS young Psychiatrists Sub-Committee and under the Guidance of Brig (Dr) MSVK Raju will provide interactive training in this promising therapy along with a brief insight into the theoretical underpinnings.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

WS 58: Clinical approach to the differential diagnosis of dementias: A Practical Workshop

Aparna Dutt, Anirban Dutt

Nearly 4 million Indians suffer from dementia today and the numbers are expected to double in the next 20 years. Another important observation emerging from the clinics in India is that increasingly dementia will be among patients < 65 years of age. However, dementia often remains underdiagnosed or is delayed. This is partly attributable to the lack of adequate training in cognitive assessment of dementia in psychiatrists, neurologists and psychologists in India.

With the aim of accurate and early detection and improving dementia care, the proposed workshop will

provide an understanding of the neuropsychology of mild cognitive impairment and different dementias in relation to the underlying neuroanatomy and neuropathology
help to determine the key questions which need to be addressed during history taking
provide knowledge about the commonly used cognitive screening tools
help to determine whether cognitive screening tools are good for the detection of early cognitive impairment and whether they should be used for diagnosing dementias
provide an understanding of the essentials of bedside cognitive testing in the differential diagnosis of dementia
provide an understanding of the different issues which need to be considered for interpreting a cognitive profile including a good clinical history, the individual's premorbid cognitive functioning, educational, cultural and language background.
provide an understanding of the role of formal neuropsychological assessment in the differential diagnosis of dementias

The workshop will be interactive with case studies.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 58: ‘Chicken and egg’ paradox: alcohol and opioid use disorder and sleep problems revisited

Ravi Gupta, Vijay Krishanan, Aniruddha Basu

Overview: Insomnia is a defining symptoms of alcohol and opioid withdrawal – but all patients do not develop such problems. For example, studies have shown that upto 70 % patients with alcohol use disorder have insomnia at admission and 50% have sleeplessness even after detoxification. Roughly one-third patients complain of sleep problems in the long term. The subjective sleep problems have been assessed with respect to Pittsburg sleep quality index. Polysomnography have revealed the common findings during withdrawal like increased sleep onset latency, increased wakefulness and N1 sleep, decreased SWS and delta EEG power and increased REM sleep. Findings like REM sleep latency is an important predictor of relapse. For opioids the findings have been that r estless legs syndrome during opioid withdrawal as supported by neurobiological underpinnings. Sleep research though to a smaller extent has been done with cannabis, stimulants and other substances. Hence with this background we would like to explore some of the relationship between substances and sleep.

1^st speaker: General introduction to sleep

2^nd speaker: Relationship between sleep and substance use with special focus on alcohol and opioids and presentation of original research in this area

3^rd speaker: Sleep and substance use disorder in the presence of medical and psychiatric co-morbidity.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 59: Mental Health Literacy in India: Concept, Various Perspectives and Way Forward

Bhaveshkumar M Lakdawal, Asim Kumar Mallick, Ashish Srivastava, Naresh Valdlamani, Dhruv J Parmar; Outline of Symposia

Objectives: The term “Mental Health Literacy” (MHL) refers to knowledge and beliefs about mental disorders which aid their recognition, management or prevention. The objectives of this symposium are to address what is MHL and Indian research and Contribution; MHL for school teachers & parents; for persons having Substance Use Disorder (SUD); research & work on MHL in Suicide and how we can improve MHL so that society at large will be benefited.

Description: Mental health literacy includes the ability to recognize specific disorders; knowing how to seek mental health information; knowledge of risk factors and causes, of self-treatments, and of professional help available; and attitudes that promote recognition and appropriate help-seeking.

Many studies have shown that poor knowledge and negative & stigmatized attitudes towards mental illness and mentally ill are widespread. It is even more seen in school teachers & parents, for persons suffering from SUD and Suicide related issues. Many studies report that stigma is universal and doesn’t spare even various health professionals including our own colleagues of other branches, nursing personnel and health workers. Stigma and discrimination result in the underuse of mental health services. The main strategies for addressing psychiatric stigma focus on protest, contact and education.

This symposium will be divided into the various subsections like to understand what is MHL and Indian Contribution, School Mental Health, MHL in Substance Use Disorders, Research and work on MHL in SUD & Suicide and way forward

Key Words: Mental Health Literacy, School, SUD, Suicide, India

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 60: Sexual Violence & Digital media

Global Burden of sexual Violence and digital media – Ms. Deblina Roy
Domains of Sexual violence in digital age – Dr. Pritha Roy
Technology-facilitated sexual violence and the consequences – Dr. Anamika Das

Abstract: Sexual violence is one of the leading public health problems world-wide, majorly unreported due to a great amount of stigma attached to it. It has been found that the effects of such violence have pervasive and long term ill-effects on the health of the victims. Digitization has eased the access to the perpetrators and given them various means to carry out these activities on the digital platform. It has become virtually impossible to remove information which often falls into the hands of perpetrators and lead to criminal activities. Victims’ sufferings remain deep-rooted and can heighten the risk factors for serious mental health issues and behavioural changes. Sexual violence can occur to people at any time throughout their life span, resulting to development of serious mental health issues as a result of substance use, high risk behaviours, HIV and AIDS, anxiety, PTSD etc. India has been witness to many incidents of heinous sexual violence in the recent days, many of which were propagated and perpetuated by the use of digital media. On one hand, widespread digitalization of workplaces and public platforms has brought about a massive change in our economy; while simultaneously, cyber security, identity security has become burning issues. Legislation and awareness programs regarding proper conduct at work place and digital platforms are the need of the hour.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 61: Movement for Global Mental Health: Towards Bigger Picture

Why we really need a movement for Global Mental Health? -Dr Gautam Saha

History of Movement for Global Mental Health-Dr Devashish Konar

Global Mental Health in context of low- and middle-income countries- Dr Debjani Bandopadhyay

Future course of Movement for Global Mental Health-Dr Om Prakash Singh

Though the concept of Global Mental Health has been building for nearly three decades, it is only after the seminal series of Lancet on Global Mental Health in 2007, that the idea started crystallising and a real movement for Global Mental Health started. As we observe, the mental health had a very obviously marginalised position so much so that there was no mention of it in the Millennial Developmental Goals in 2000. In contrast, in Sustainable Developmental Goals of 2015 the importance of mental health is recognised and is focussed on. The aim of this movement is to reduce the global burden of mental disorders. World Economic Forum too is gearing up for the task and feels, that it is time to act.

Low- and middle-income countries constitute the focus of the movement for Global Mental Health. Whereas challenges are of vast dimension, the scope and possibilities are also immense. There is serious need that all of us get involved in the movement to increase its forcefulness.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 62: Treatment-Resistant depression (TRD)

Shubhangi Parkar, Nilam Behere, Deepak Awachat

Treatment-resistant depression (TRD) is a multifaceted concept influenced by variety in depressive subtypes, psychiatric co morbidity, and coexisting medical illnesses. Though it is a common clinical presentation to psychiatrist, it remains challenging. TRD is a term that initially emerged in the literature in the 1970s and has since replaced trendy term refractory depression as the typical explanation for ‘non-response to treatment. Some researchers define TRD as a case of depression that doesn’t respond to two different antidepressants from different classes. Other experts say that a person needs to try at least four different treatments before depression can be truly considered treatment-resistant. However, by definition, as successive novel treatments fail to make an impression, TRD persists, as a chronic, unremitting illness that manifests as residual depressive symptoms and eventuates in high levels of disability and mortality. Even though TRD episodes are most frequently related to Major Depressive Disorder(MDD), they are as well seen in the depressed phase of bipolar disorder. There is no universally accepted operational definition of TRD. Finally, despite the substantial morbidity associated with TRD, the relative scarcity of use of patient-oriented outcomes including functional impairment and quality-of-life, attention to the benefits of TRD treatment is a recent development. Additionally, in few clinical cases, TRD is actually ‘refractory’ and that some kinds of depression may in fact lie beyond our reach in terms of offering satisfactory treatment. In this symposium we are focussing on understanding TRD, factors associated with TRD and approaches to management.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 63: Forensic Psychiatry and Law subspeciality committee of the IPS (2019-2020)

Harassment ,Violence and Mental Health, Netto, Rajesh Kumar, Jyoti Shetty

Mental health issues arising as a consequence of harassment and violence is known.In the context of social media,virtual interactions in cyberspace, harassment can take a different form and one that is more difficult to address and get redressal.Sexual harassment can very often be normalised leading to long term mental health consequences.In this context,we present a symposium outlining the various laws addressing harassment and violence in India.In view of the repeal of Article 377 ,Transgender persons (Protection of rights)Bill 2019,discussion will also involve the need to expand the scope of certain acts like the POSH Act (Sexual harassment of women at the workplace,Prevention,Prohibition & Redressal Act 2013).

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

WS 64: Second Brain in Psychiatry

Rajnish Raj ¹, D Saldanha ², Rohit Garg ³

Objective -The goal of this workshop is to give a detailed review of the science of the gut to aid in the understanding and treatment of mental disorders.

Objective -The goal of this workshop is to give a detailed review of the science of the gut to aid in the understanding and treatment of mental disorders.

Sr no	Topic	Speaker
1	Historical Background	Dr. Ekram Goyal
2.	Why gut is called the Second Brain ?	Dr. Ramanpreet Kaur
3.	Role of second brain in Psychiatry	Dr. Rahul Singh

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The gut is called the second brain. It is regulated by a large collection of neurons called the enteric nervous system. No peripheral organ has such a highly developed neural apparatus as the enteric nervous system.

Enteric nervous system contains more neurons than the spinal cord and produces 95% of serotonin and 50% dopamine found in the body.

Serotonin is responsible for GI secretion, gut motility and maintainance of mood and cognition , alteration in the serotonin transmission underlie pathological symptoms.

It is called second brain as it arises from same tissues as our central nervous system (CNS) during fetal development.

It has many structural and chemical parallels to the brain.

The Gut- Microbiota – Brain Axis build a complex ecosystem which has an important effect on brain function and its composition is aberrant in many disorders.

Irritation in the gastrointestinal system may send signals to the central nervous sytem that trigger mood changes.

Chronic stress lead to alteration in intestinal permeability associated with a low grade inflammation as a result of which gut microbiota produce neuroactive substance that influence core symptoms of neuropsychiatric disorders including schizophrenia , autism , anxiety and depression.

Also Neurodevelopmental disorders including autism spectrum disorders and attention deficit hyperactivity disorder possess abnormal gut microbiota.

Habitual diet and rapid changes in diet can influence microbial composition and microbial metabolites.

This workshop will illuminate the audience on these issues.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 65: Non Suicidal Self Injury, Suicidal Behaviour and Suicide Prevention: Indian Perspective

Hemendra Singh, Anita Gautam, ManaswiGutam, Sathesh Vadasseril

The major risk factor for suicide is mostly an untreated and frequently undiagnosed mental disorder. Dr Anitha Gautam will be talking about hidden epidemiology of suicide in India. More than one lakh persons (1,33,623) in the country lost their lives by committing suicide during the year 2015. Hence there is need for developing a cost effective module which can address individual specific psychological stressors which are prevailing in Indian context. These psychological aspects can be delivered by non-specialist trained person. Dr. Hemendra Singh will discuss about the clinical correlates of suicide attempt in psychiatric patients. It throws light on association of Non Suicidal Self-Injury and suicidal behaviour among psychiatric patients and need for developing a brief suicide prevention module. Dr.Sathesh Vadasseril discusses the gender – based comparison of psycho-socio- demographic and clinical profile of 1300 suicide attempters. The study helps in the selection of appropriate suicide preventive strategies. Dr Manaswi Gutam discusses various strategies for suicide prevention. As history of suicide attempt is a risk factor for future suicide, it is high time that the various factors associated with suicide attempt are to be identified to prevent future suicide and also to rehabilitate them psychosocially.

Key Words: Non –Suicidal Self Injury, Suicide attempts, Psychiatric patients, Suicide Prevention

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 66: Symposium on Research Designs in Mental Health

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

Research designs plays pivotal role in mental health. In this symposium we will discuss the basic research designs commonly used in mental health. We will try to answer all the below mentioned questions through examples in the symposium.

Why research designs is important in mental health?
How to conduct any study?
How to conduct cross-sectional studies?
How to conduct case-control Studies?
How to conduct cohort Studies?
How to conduct RCT?

Keywords: Research designs, Mental Health

Titles of presentation:

Overview of research designs in Mental Health: Prof. Basudeb Das
Case Report, Case Series in Mental Health: Dr. Roshan V. Khanande
Cross-sectional, Case-control studies in Mental Health: Hariom Pachori
Cohort studies, RCT in Mental Health: Dr. Avinash Sharma
Systematic Reviews, Meta-Analysis in Mental Health: Dr. Varun S. Mehta

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 67: Suicide in India: the changing scenario

Kaberi Bhattacharya, Arnab Sarkar, Rajarshi Guha Thakurta, Somraj Mukherjee

Overview: Suicide is the third leading cause of death among youths worldwide and for last two decades the rate is increasing alarmingly.

High risk population and assessment of risk: 90% of subjects who complete suicide present to their primary caregiver within weeks or months. So assessing and managing suicidal ideation and psychiatric comorbidity is very important.

Prevention: Suicide is often the permanent solution of a temporary problem. WHO's multisite suicide prevention study has revealed that it is possible to reduce suicide mortality through brief, low cost intervention in developing countries A short cross-sectional descriptive study on suicide attempt survivors: About 50 suicide attempt survivors and 15 healthy controls of same socioeconomic background were assessed for impulsivity, perceived stress and personality inventory. Results were analysed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 68: Tobacco use in vulnerable populations in India: A review

Sonali Jhanjee, Piyali Mandal, Biswadeep Chatterjee

Background: Tobacco use disproportionately affects the poor, less educated, disadvantaged youth and women in India

Methods: Literature search was performed using MedLine, PubMed, PsycINFO and Embase for relevant English language articles published upto June 2019

Results: According to Global Adult Tobacco Survey, 2016 , the prevalence of current tobacco was 14.2% in women. India has a huge problem of widespread smokeless tobacco use, particularly among disadvantaged women. Women tobacco users not only share the same health risks as men, but are also faced with health consequences that are unique to women, including those connected to pregnancy and cervical cancer. In NFHS-3, 9% women reported antenatal tobacco use with poor awareness of its adverse health impact. Illiteracy is associated with higher rates of tobacco use, lower quit attempts and less likelihood of observing health warnings. The vicious cycle of tobacco and poverty and exacerbation of poverty due to tobacco-related diseases is also well-documented. Further, India is currently home to the world's largest youth population. The Global Youth Tobacco Survey, 2009 showed that as many as 14.6% of students currently use any form of tobacco but there is clear predominance (12.5%) of smokeless tobacco users. .

Conclusion: Tobacco control can reduce the disproportionate burden of tobacco use on the poor and decrease the wide disparities in health outcomes. Lack of awareness of the risks associated with tobacco, especially of smokeless tobacco and the industry tactics to target the vulnerable population, the women and the youth, needs effective countermeasures.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 69: Efficacy of Pharmacotherapy versus Combined Therapy in Tobacco Cessation: A Prospective Comparative Study

Abbas Mehdi ¹, Sanjay Gupta ¹, Balram Pandit ¹

Abstract Background: In view of skyrocketing number of cases leading to increased prevalence of tobacco use, especially in developing countries the interventions for smoking cessation have become an urgent need of the hour. The aim of the present study is, therefore, to know the effect of pharmacotherapy alone and pharmacotherapy with psychotherapy on tobacco cessation.

Methods: It is a prospective cohort study conducted in 75 subjects (Pharmacotherapy alone group, n= 38; pharmacotherapy with psychotherapy group n= 37). Subjects were randomly allocated into two groups. Medication was given to all the subjects with bupropion (300 mg) based on the severity of tobacco addiction while psychotherapies were individually tailored and delivered only in one group.

Results: Tobacco abstinence rates in both the groups differ markedly. The mean age of patients in the pharmacotherapy alone group and the combined group was 31.59±13.75 and 34.14±11.71 years, respectively. The mean age of starting tobacco use was 22.41±8.34 and 22.71±8.21 years in the pharmacotherapy alone group and the combined group, respectively. Overall, 22.7% (n=17) of the subjects were smoker while majority of them belonged to smokeless group (77.3%, n=58). The overall rates of continuous abstinence at 6, 8 and 12 weeks were 26.3%, 28.9% and 28.9% respectively in pharmacotherapy group, while in combined therapy group it was 47.3, 54.1, and 54.1 respectively. In Smokeless group it was 28.1% at week 6, 8 and 12 in pharmacotherapy group and 50%, 53.8% and 53.8% respectively in combined therapy group while in smokers abstinence rate at 6, 8 and 12 weeks was 16.7%, 33.3% and 33.3% respectively in pharmacotherapy group and 45.5%, 54.5% and 54.5% in combined therapy group (p<0.05).

Conclusions: Combined therapy was found to be significantly more effective than pharmacotherapy alone in both smoker as well as smokeless tobacco user group. Key words: Tobacco cessation, Bupropion, Combined therapy.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 70: Sensory processing difficulties and its impact in children with ADHD.

Piyali Ghosh, Sayanti Ghosh, Subhendu Moulick

Introduction – ADHD is one of the common behavioral disorders in children. Sensory processing difficulties that affect interpretation of sensory information can be present in children with ADHD and increase their difficulties in dealing with environmental sensory stimulation. Children with ADHD, have problems interacting effectively in the everyday environment due to sensory problem. Altered sensory information may cause poor motor coordination, incessant movement, inattention and impulsive behavior which leads to overall functional impairment in family life, academics, peer groups, social activities and in other activities of regular life.

Aim- In this discussion an attempt has been taken to understand the impact of sensory processing difficulties on functional behavior in children with ADHD and discussing the outcome of occupational therapy as one of the treatment choice alongside the conventional treatment of ADHD.

Methodology- Discussion will be divided into 3 parts.

Part 1> introduction and overview of sensory processing difficulties.

Part 2> impact of sensory processing difficulties in attention deficit hyperactivity disorder in children.

Part 3> effect of occupational therapy

Conclusion- Occupational therapy can improve the overall functioning of the children with ADHD who have associated sensory difficulties especially in the area of self-organization, self-regulation, sensory arousal and physical coordination.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP1: Iintermittent explosive disorder:: A Case report on management

Surabhi Vishnoi ¹, Anmol Singh ², Ananya Mahapatra ³

Background

Intermittent explosive disorder (IED) involves impulsive or anger-based aggressive outbursts that begin rapidly and have very little build-up. The aggressive episodes are generally impulsive and/or based in anger rather than premeditated. Aggressiveness must be “grossly out of proportion” to the provocation and accompanying psychosocial stressors.

Aims

There is a lack of evidence regarding management of IED. We present a case which was effectively managed with combination of antipsychotic and mood stabilizer.

Methods 23-year-old male educated upto B.A. presented with illness duration of 3 year characterized by sudden outbursts of extreme violence involving destruction of property and physical injury against individuals. These acts would occur 3-4 times in a month lasting for approximately five minutes and was followed by remorse. The episodes were recurrent, unpredictable, and not directed to anything particular.

Depression, anxiety, substance use disorders, antisocial personality disorder, borderline personality disorder and intellectual disability were ruled out. Systemic examination, including neurological examination was normal. Serum ceruloplasmin levels, serum copper, ultrasound whole abdomen and EEG were normal. Patient was managed on T. Divalproex sodium 1 gm and Cap. Fluoxetine 60mg. Behavioral therapy was initiated but patient did not follow up regularly.

Results

Patient had complete remission with no episode of aggression after 12 weeks of treatment. Improvement was maintained for 2 months till last follow up.

Conclusions

Combination of SSRI (Fluoxetine) and mood stabilizer (Sodium valproate) are effective options for management of IED, especially in cases when psychological interventions have failed or are not available. Further studies are warranted to confirm the finding.

Keywords: Intermittent explosive disorder, SSRI, Mood stabilizer.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP2: MHCA 2017-PRACTICAL RELEVANCE?

Rupendra kumar sharma ¹, Charan singh jilowa ¹, Parth singh meena ¹, Mahendra jain ¹

INTRODUCTION

came into force from May 29, 2018

hailed as a great step in legalizing the rights of PMI.

there is a lot of reservations regarding it's implementation.

AIMS

To discuss practicality of MHCA 2017.

METHODS

A Web search MHCA 17,MHCA 17 Practical limitations,loopholes etc was done,and practicality was assessed and apprehensions discussed.

RESULTS

Definition of mental illness in act and ICD 1O differ.

Clear distinction between Mental health establishments and other health establishments has been made while diseases are/can be a combination of two.

No proper budgetary sanctions.

Advance directives for mental illnesses only not for other illnesses, also literacy and economic status may also hinder it's applicability.

Concept of Nominated representative is also confusing.

The Indian Psychiatric Society has highlighted that AD and NR are not patient friendly.

Human rights implementation needs big budget.

Professional bodies of psychiatrists not included in CMHA and SMHA.

Accessibility and composition of MHRB.

Psychiatric social worker and mental health are included in MHP with power to admit patients.

Blanket ban on unmodified ECT.

CONCLUSION-Though intensions are not in doubt high level of skepticism is there regarding its implementation and a relook is probably warranted.

Bibliography-1Mental Health Care Act (MHCA 2017)- Is a Relook Necessary for Effective Implementation? Om Prakash Singh.

Mental health care act 2017: Review and upcoming issues rasanna kumar neredumilli. V.Padma.S.Radharani

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP3: Title:: A CASE REPORT ON PSYCHOSIS FOLLOWING CP ANGLE TUMOUR SURGERY (SCHWANNOMA)

SASANKA KUMAR KAKATI ¹

PLACE OF STUDY:

Department of Psychiatry, GAUHATI MEDICAL COLLEGE & HOSPITAL

A case report on psychosis following CP angle tumour surgery (schwannoma)

ABSTRACT

INTRODUCTION

Cerebellopontine angle tumours are the most common neoplasms in the posterior fossa, accounting for around 5-10% of intracranial tumours. In the past, there are reports that hypothesize that psychiatric symptoms could be major symptoms of cerebellopontine-angle lesions.

CASE REPORT

A 54-year-old, married Hindu female from Nagaon, educated up to class9, presented in the outpatient department of Psychiatry, GMCH on 4/5/19 with chief complaints of disturbed sleep, irrelevant talk, muttering, irritable mood, seeing and hearing things that others do not, along with increased fearfulness leading to decreased communication and she also kept her eyes closed. The symptoms appeared 6 months ago and gradually worsened in last 2 months. The onset was insidious and course was gradually progressive. The attendant (son) gave history of patient undergoing a surgery around 1 year back for a Right sided cerebellopontine angle tumour (schwannoma) in the department of neurosurgery, GMCH.

There is no past history of any known psychiatric illness. There is past history of hypertension and is currently on medication. There is also history of head injury few years back although not major.

DISCUSSION

Psychotic symptoms such as hallucinations and delusions in the absence of neurological sensory and motor signs are suggestive of functional psychosis. In the literature, disturbances in the temporal lobe region such as temporoparietal region and limbic region have been reported to be responsible for psychotic symptoms. This can also be explained by the theory of Constantin Von Monakow who coined the term “Diachisis”.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP4: Munchausen Syndrome by Proxy: Unraveling the Mystery

Munchausen syndrome by proxy (MSBP) is classified in DSM-5 and ICD-11 as “Factitious Disorder Imposed on Another” and is defined as feigning, falsifying, or inducing, medical, psychological, or behavioral signs and symptoms or injury in another person, most commonly a child dependent, associated with identified deception.

The caregiver with MSBP may either lie about the individual's symptoms, change the test results to make the individual seem ill or physically harm the individual to produce symptoms. It was shown in studies that there is a confusion regarding overall knowledge among professionals.

In this case series, we try to find any commonalities in symptom presentation or psychological factors in cases of MSBP in a tertiary care center and also discuss on how to investigate them so as to identify these cases early and prevent unnecessary medical investigations, invasive or otherwise.

We will be presenting 5 cases that were referred to the department of psychiatry and department of clinical psychology at JSS hospital, Mysore with suspected MSBP. A detailed psychiatric interview and psychological assessment was done with the child and caretaker.

We found that if a child was brought with some of these common features, not only symptomatically but also with respect to psychosocial issues, it should give rise to the suspicion of presence of MSBP.

The challenges faced in managing these cases are highlighted in the paper along with the need for a comprehensive interdisciplinary approach which can prevent the child from going through repeated physical or psychological trauma.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP5: Title: A study on the sociodemographic and clinical profile of patients leaving against medical advice

Chayanika Choudhury ^1,^✉, Shyamanta Das ^2,^✉

Place of Study:

Gauhati Medical College and Hospital

TITLE:

A study on the sociodemographic and clinical profile of patients leaving against medical advice

INTRODUCTION:

Leaving against medical advice (LAMA) is admitted patients choosing to leave the hospital before his/her treatment is complete or before the physician recommends. It requires evaluation to avoid a new revolving door phenomenon.

AIMS & OBJECTIVES:

To study the sociodemographic and clinical profile of patients opting for LAMA.

METHODOLOGY:

Data was collected by a semi structured proforma from inpatients of Psychiatry department, GMCH from a period of April to September 2019. ICD-10 was used for diagnoses. Descriptive statistics was applied.

RESULTS:

Out of the 523 patients admitted, 11.47% (60 patients) chose to leave against medical advice.

The frequency of LAMA was observed to be more in ages 21-30 years (43.33%), in males (78%) and in those with urban background (53%). 36.6% had passed high school and 26% were uneducated. 55% left within 1-4 days of admission.

The diagnosis distribution was- 33.3% in F10-F19, 30% in F20-F29, 20% in F30-F39 and 8% in F40-49. The patients leaving within 1-4 days of admission had diagnosis between F20-F29.

Reasons cited for LAMA were - 28% were ‘Dissatisfied with the treatment’, 15% cited ‘Can’t Specify’, 12% had ‘Family Issues’, 12% had ‘Financial Problems’, 13% felt ‘Improved’ and 8% wanted to go to ‘Higher centre’, 5% to a ‘Faith Healer’ and 7% had ‘Personal Reasons’.

F23 was the most common diagnosis for the shortest duration of stay with the cited reason ‘Can’t specify’.

DISCUSSION:

Ashrafi E et al. 2017 reported ‘personal problems’ as the highest ranked amongst all reasons. Ghosh & Kurmi (2018) noted that most hailed from rural background and were females and had diagnosis between F40-F49.

CONCLUSION:

The revolving door of LAMA and re hospitalization can be intervened by prior information about the diagnosis, nature of illness, management and treatment protocol which are corner stones of dealing with this problem.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP6

Men and Mental Health- Masculinity and alexithymia as predictors of men's attitudes towards seeking professional psychological help.

BACKGROUND- Research has demonstrated that many people with psychological problems are reluctant to seek help from mental health professionals with men being the least likely to seek help. Men's reluctance to access health care services is believed to be a major contributory factor to poorer health outcomes for men. A number of studies included that male gender roles and emotioal expressiveness influence help seeking behaviour. This area has been under-researched in India.

OBJECTIVES- To look for association between masculinity norms, alexithymia and attitudes towards seeking professional psychological help.

METHODS- Cross sectional online survey was used to administer self-report measures in 100 male participants.

Male role attitude scale, Attitude towards seeking professional psychological help-SF, self made questionnaire of Alexithymia were used to test the hypothesis.

RESULTS- Majority of participants belonged to the age group 26-35 (55%), Post-graduates (53%), Urban background (74%), Employed (60%), and Doctors (31%). Traditional masculine ideology (-.457**, p value= .000) and Normative alexithymia (-.273**, p value=.006) was found to be negatively correlated with professional psychological help seeking.

CONCLUSION- It was noted that men with high masculine ideologies and alexithymia were less likely to seek professional psychological help.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP7: A STUDY OF PATHWAY OF CARE AMONG PSYCHIATRIC PATIENTS ATTENDING A TERTIARY MENTAL HEALTH ESTABLISHMENT AT HYDERABAD.

Divya Meghana Sreevaram ¹, Navyaja ², S Sireesha ³

ABSTRACT:

Background:

Before attending mental health establishment many patients with mental illness seek help from faith healers, dargahs, leading to delay in proper management and reach when condition worsens.Very limited number of patients attend mental health facility as an initial step.

Materials and methods:

Study is being done at a tertiary care hospital, Institute of mental health,Hyderabad. All patients with mental illness who made their first contact with our hospital are taken into the study.

Study period:

September 2019 – November 2019

Sampling technique:

Convenient sampling

Inclusion criteria:

Who gave informed consent.

Who made their first contact with the hospital.

Exclusion criteria:

Old cases

Procedure:

Informants were asked and verified about the information given by patient.Sociodemographic details of consented patient are entered into semi structured intake proforma and diagnoses will be given as per ICD-10 criteria. Data will be analysed using SPSS version -17.

Results:

Currently study is still going on, sample collection is being done. Hence results, discussion will be presented at the time of conference.

CORRESPONDENCE:

Dr Divya Meghana Sreevaram,

1^st year post graduate, MD Psychiatry, Institute of Mental Health, Hyderabad Flat no. 403, Vasundhara grand apartment Gandhi nagar, Hyderabad, Telangana 500080

Email: drdivyameghana@gmail.com

Contact no. 9490268472

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP8: TITLE: Substance use among medical interns in tertiary health care centre of north India: A Crossectional study

PRAGATI BHATNAGAR ¹, KULDEEP SINGH YADAV ¹, RK SOLANKI ¹

• Background: Substance use among students are common nowadays and medical students are also not spared by the boom of substances. Medical students are future doctors and use of substance by them had detrimental effect on their conduct and effectiveness.

Aims:

1) To study the prevalence of substance use in medical interns
2) To determine the type and the pattern of substance use in medical interns.

Methodology:

A cross sectional study was conducted on 236 internship students in Department of Psychiatry, SMS Medical College. A self-developed semistructred questionnaire was used for the interview after taking written consent from the students. Subsequently analysis of data was done using proportion and chi square test as statistical test

Results:

The lifetime prevalence of substance use was 74 %. Males had significantly higher lifetime and past month prevalence than females. Alcohol was most commonly used substance followed by tobacco. Alcohol and tobacco were consumed daily

Conclusion:

High prevalence of substance use in medical students required an urgent need for change. Awareness and counselling sessions should be planned regularly to identify students needing help.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP9: Comparison of metabolic parameters among patients of schizophrenia on treatment with Olanzapine and Risperidone

Archana Singh, Abhay Singh Tomar, CRJ Khess, Sanjay Munda, Aleem Siddiqui, Shivani

Background: A significant challenge posed to the clinicians and specialists is the metabolic dysregulation in patients of schizophrenia on pharmacotherapy which includes weight gain, hypertension, hyperglycaemia, and dyslipidemia. These derangements are grouped together under the expression “metabolic disorder (MS)”, which has been accounted for in about 43% of people with incessant schizophrenia in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study.
MS presents increased cardiovascular risk and leads to early mortality; however it remains most of the time untreated to a large extent in patients with schizophrenia.
Methodology: This is a hospital based prospective study with purposive sampling. The study population consisted of 30 patients of schizophrenia. Only those patients were selected who fulfilled exclusion and inclusion criteria laid down for study. Clinical and Laboratory parameters were measured at the start of treatment and after 4 weeks and 8 weeks of treatment. Data was analysed using SPSS.
Result: No significant difference was found in any metabolic parameter among Olanzapine and Risperidone group. Mean values of BMI, waist circumference, triglyceride and blood glucose were higher at 8^th week of assessment than at 4^th week and baseline.
Conclusion: Metabolic Parameters were significantly different among group of patients on treatment with Olanzapine and Resperidone.
Keywords: Metabolic syndrome, Schizophrenia, Olanzapine, Resperidone

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP10: Olfactory Reference Syndrome

Background: Olfactory Reference Syndrome is characterised by persistent preoccupation with the belief that one emits a foul or offensive body odour, which is not perceived by others.
It is associated with substantial distress. Odours are often believed to originate from the mouth, genitals, rectum, or skin.
Common concerns include halitosis, genital odour, flatulence or anal odour, or sweat.
This belief is often accompanied by ideas or delusions of reference. Many patients perform repetitive behaviours, such as smelling themselves, showering excessively, and attempting to mask the odour.

Case Report

A 20 years old, Hindu, male, a known case of moderate intellectual disability who presented to Psychiatry OPD with complaints of belief that foul smell is emitted from his mouth, distress and irritability.

Patient believed that he had an oral infection, due to which his mouth was emitting foul smell, even though the smell was not perceived by others.
He was so distressed due to smell, that he would spit frequently and brush his teeth several times as he believed that his saliva was contaminated.
Patient was diagnosed as Delusional disorder and was treated with Antipsychotics. Later, the delusion resolved and the patient was convinced that there was no foul smell emitted from his mouth.
Our case highlights the probability of patients presenting to a physician, dentists, dermatologists having olfactory reference syndrome, which might be overlooked by them. Detection of such cases, timely psychiatric referral and treatment can lead to better prognosis.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP11: A Unique Case of Trichotillomania

VaibhaviPS ^1,^✉, MruthyunjayaN ¹, Shashidhara H L ¹, Vinod G Kulkarni ¹

BACKGROUND: Trichotillomania (hair-pulling disorder) is an often debilitating psychiatric condition characterized by recurrent pulling of one's own hair, leading to hair loss and marked functional impairment often associated with mood disorders like depression and anxiety.
CASE HISTORY: A 14yr old female referred by Dermatology department with h/o focussed hair pulling since 1 year d/t increased white hairs on scalp since 3 yrs which has resulted in increased hair loss since 15 days & patch of alopecia on the frontal scalp area. Patient reported that she would perceive sense of tension d/t repeated urges to pluck hair which would be relieved after plucking them, however pt denies eating them. Pt reported h/o low mood, frequent crying spells associated with death wishes, decreased sleep & appetite along with decreased interest in school activities and decreased academic performance since 1 month.
AIM: To estimate the response to SSRI with the help of CYBOCS & NIMH-TSS scale on follow up.
METHOD: Patient was screened with CYBOCS, CES-DC & NIMH-TSS and clinical diagnosis was made by ICD 10. Patient was started on SSRI i.e Fluoxetine and was followed up after 15 days (FU-1) and 45 days (FU-2) respectively.
RESULT: Patient was symptomatically better, with reduced low mood and urges to pluck hair. Her academic performance improved. Prior to treatment patient had a score of 22 in CYBOCS suggestive of moderate OCD which subsequently decreased to 10 on FU-I suggestive of mild OCD & 01 on FU-2.
CONCLUSION: SSRI's has shown definitive improvement in the treatment of trichotillomania along with improvement in mood symptoms.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP12: Nymphomania associated with childhood sexual abuse: A case report

Background

Nymphomania includes an insatiable impulse to engage in an abnormal number of sexual contacts with an abnormal number of partners without a deep emotional involvement. The sexual drive is constant, impulsive, and uncontrolled. Women who may have the criteria for this disorder have difficulty receiving treatment.

Case report

A 23-year-old female, educated up to 6^th class, resident of Nepal, married since 4 years, having two children was brought by her husband with chief complains of increased sexual desire since the past 8years. Patient was apparently all right about 8years back when her cousin forced her to have sex and continued to force her for some time. She was first married at 16 years of age for 6 months but marriage ended due to her husband discovering her extramarital relationship. After her separation she continued to have sex with her cousin and few of his friends. She was married again at the age of 18 years. No past history of any mental or physical disorder. No history suggestive of intellectual disabilities. On the PATHOS questionnaire for sexual addiction her score was 4 which was higher than the cut off score of 3. Patient was started on cognitive behaviour therapy and fluoxetine 20 mg daily.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP13: Intracranial Space occupying lesion masked by Alcohol Dependence Syndrome : A Case Report

Abstract

A lot of comorbidities exist in patients with dependence on alcohol, psychoactive or other substances. Dependence which is a cluster of physiological, behavioral, and cognitive phenomena in which the use of substance takes on a much higher priority for a given individual than other behaviors that once had greater value. Many a times, their comorbidities go undiagnosed or neglected due to the stigma prevalent with dependence.

Case Report

A 22-year-old male who was referred to the psychiatry department from medical OPD with history of daily alcohol consumption since 2 years along with an eye opener. He started experiencing episodes of convulsions around 5 months back while he was not abstinent from alcohol. Over the past 5 months he had nearly 7-8 episodes of seizures. Last episode happened one day before admission.

Upon CNS examination he was found to have altered parietal lobe tests. Upon radiological imaging he was diagnosed to have a space occupying lesion in the left parietal lobe. The excision craniotomy was done along with management of alcohol withdrawal and upon histopathological investigation, the lesion was reported to be tuberculoma.

The case highlights the high probability of a patient presenting with alcohol dependence syndrome to have some other co-morbidity which may go undiagnosed due to neglect in examining for comorbidities in patients with substance abuse.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP14: Trichotillomania in children

SUPRIYA DAVIS

Trichotillomania is a condition characterized by persistent hair pulling behavior, resulting in noticeable hair loss. Patients report feeling anxious before pulling their hair out and pleasure, satisfaction or relived after doing it. Clinical studies suggest that the prevalence of TTM varies from 0.6% to 3% and is more common in females. Differential diagnoses include more common alopecias such as alopecia aerate.

Case 1: 14 year old female who presented with complaints of plucking out her own hair since one year leading to large patches of baldness affecting her looks. It was associated with itching sensation on scalp and an irresistible desire to pluck out hair. Otherwise she would feel restless. She was treated with Fluoxetine 80mg, Buspirone 20mg and augmentation with Pimozide 2mg was done. In addition, cognitive behaviour therapy was also started for her with improvement in her condition.
Case 2: A 10 year old male, illiterate, patient presented with aggressive and abusive behaviour, roaming around aimlessly along with disturbed sleep and appetite of five years duration. Since past one year he has also started pulling out his hair and eating it at times. Patient had always been slow in learning things since childhood. He had an IQ of 27. He was treated with Fluoxetine 10 mg but was lost to follow up.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP15: Role of rTMS as an Adjunctive Treatment in Treatment Resistant OCD : A Randomised Double Blind and Sham Control Trial

Kartikeya R Singh ¹, Ravi Mohan Sharma ², D Bhattacharyya ³

Background: There are only few treatment options currently available for treatment of refractory obsessive compulsive disorder (OCD).Novel treatment strategies like repetitive trans cranial magnetic stimulation have been proposed for OCD refractory to standard treatment.

Aim: To assess the efficacy of rTMS (repetitive trans cranial magnetic stimulation) as an adjunctive treatment modality in patients of treatment resistant OCD.

Method: 28 diagnosed cases of treatment resistant OCD were included and randomized into two groups. They were assessed by administered Y-BOCS (Yale brown obsessive compulsive scale) score at initiation of therapy and thereafter at 2wks,.Group-I (n=14) underwent active rtms sessions 5 days /week for two consecutive weeks. Group-II underwent the similar treatment protocol but with sham coil..

Results: Both the groups were comparable. Statistically significant reduction in YBOCS scores were noted in Group-I (p<0.001).There was significant decrease in Y-BOCS scores after 2 weeks of treatment in both groups. Y-BOCS scores were significantly lower in Group-I than the other after 2 weeks (p< 0.001).

Conclusion: The augmentation of rtms in treatment of resistant OCD by active coil led to improvement in the Y-BOCS score in comparison to sham coil,giving additional therapeutic benefits in the management of resistant OCD.

Obsessive compulsive disorder is a chronic and a highly debilitating neuropsychiatric disorder that results in significant morbidity and social burden. Despite treatment a high percentage (30%-60%) have a partial treatment response or are unable to tolerate the side effects of medications. This has led to development of several augmenting strategies including trans cranial magnetic stimulation.

Recent studies have shown that rtms has been effective at the SMA (Supplementary motor area) leading to improvement in symptoms.

The aim of the study was to assess the efficacy of rtms as an adjunctive treatment in treatment resistant OCD.

Treatment resistant OCD was defined as cases who have failed to respond to two different classes of pharmacological treatment (two SSRI's and clomipramine) for at least 6 weeks.
Sample size N(28): Age (18-60) yrs
Patients with epilepsy other neurological disorders, head injury, cardiac pacemaker, recent h/o ECT or antipsychotics in past 6 months were excluded.
Trial was approved by the ethical committee
Follow-up: Y-BOCS at the interval 2 wks interval.
A reduction of 25% or more from baseline Y-BOCS score will be considered as positive treatment response.
During the study period, pharmacological and psychosocial treatment as usual was continued.
Descriptive and inferential Statistic was done by using SPSS 20.0.

The stimulation of SMA over Rt DLPFC, as low frequency was found to be effective which was in consonance with the imaging evidence reflecting hyper activating SMA in patients suffering from OCD. In our study majority of the cases tolerated rTMS well with no serious side effects such as seizure or syncope with only 2 dropouts during the full course of study.

We observed clinically and statistically significant improvement in Y-BOCS score after treatment with rTMS in comparison to the control groups receiving sham therapy.

There has been few studies of rtms intervention in OCD, results were promising but inconclusive due to lack of uniformity related to site, stimulation parameters and treatment duration.

Mantovani et al. ^[1],[2] targeted the SMA in the first randomized sham controlled trial targeting SMA with a larger sample size and observed that almost two-thirds patients in the real group responded to the interventions and difference was significant from the sham group.

Another study by Gomes et al. and N Kumar et al. ^[3],[4] targeted the SMA in twenty two treatment resistant OCD patients using similar stimulation parameters and found that almost 40% of the patients responded to r-TMS.

The strength of our study was that it was done in real clinical settings and following limitations were observed in our study which require further scope of improvement in future studies is increase in the sample size, crossover application of the rTMS to sham group and correlation between clinical and neurobiological parameters

Hence, we need more clinical and research data to draw some conclusion about the site of stimulation for rTMS treatment in persons suffering from OCD.

This clinical data reflects that low-frequency rTMS over SMA appears to be useful for persons suffering from treatment-resistant OCD. All subjects tolerated rTMS intervention without any marked side effects. Approximately 50% persons with resistant OCD showed statistically significant decrease of the Y-BOCS scores after the rTMS intervention. The report supports further investigation into the potential therapeutic applications of rTMS in resistant OCD.

Mantovani A, Lisanby SH, Pieraccini F Et al. Repetitive transcranial magnetic stimulation (r-TMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). International Journal of Neuropsychopharmacology. 2006;9:95-100.
Mantovani A, Simpson HB, Fallon BA et al. Randomized sham-controlled trial of repetitive transcranial magnetic stimulation in treatment resistant obsessive-compulsive disorder. International Journal of Neuropsychopharmacology. 2010;13: 217-227.
Gomes PVO, Brasil-Neto JP, Allam N Et al. Randomized, double-blind trial of repetitive transcranial magnetic stimulation in obsessive-compulsive disorder with three-month follow-up. J Neuropsychiatry Clin Neuroscience. 2012; 22: 437-443.
Kumar N, Chadda RK. Augmentation effect of repetitive transcranial magnetic stimulation over the supplementary motor cortex in treatment refractory patients with obsessive compulsive disorder; Indian Journal of Psychiatry. 2011;53(4):340-342.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP16: Subject- Submission of Research article abstract titled “Assessment of Serum Calcium, Cholecalciferol (Vit D3) and Methylcobalamine (Vit B12) in post-menopausal depressed women” for Free poster presentation.

Respected Sir,

On behalf of all the authors, I am submitting an abstract of research article titled “Assessment of Serum Calcium, Cholecalciferol (Vit D3) and Methylcobalamine (Vit B12) in post-menopausal depressed women.” This paper represents original work and has neither been published nor presented before. There is no copyright infringement in the content of the paper.

Thanking you

Dr. Manish Kumar Goyal,

Dept. of Psychiatry, SMS Medical College, Jaipur.

Mob. No.: 91-9024049697,

Mail Id: mangoyal7@gmail.com

Place of work- SMS Medical College, Jaipur.

Authors:

Dr.Aditi Ranawat Sr. Demonstrator Biochemistry, (Mob.) 9413954839 email- aditiranawat@yahoo.com
Dr. R. K. Solanki, Senior professor and Head of department, Dept. of Psychiatry, SMS Medical College, Jaipur. Mob- 9829063421. Mail id: solanki_ramk@yahoo.co.in
Dr. Kuldeep Singh Yadav, Senior Resident, Dept. of Psychiatry, SMS Medical College, Jaipur. Mob- 9610650698. Mail id: dr.kuldeepyadav29@gmail.com.
Dr. Rishika Agrawal, Senior Resident, Dept. of Psychiatry, SMS Medical College, Jaipur. Mob- 9024565999. Mail id: rishika-agrawal@live.in
Dr. Manish Kumar Goyal*, 3rd year PG student, Dept. of Psychiatry, SMS Medical College, Jaipur. Mob. No.: 91-9024049697, Mail Id: mangoyal7@gmail.com

* Presenting and Corresponding author

Title - Assessment of Serum Calcium, Cholecalciferol (Vit D3) and Methylcobalamine (Vit B12) in post-menopausal depressed women.
Aims and objectives:
To measure the levels of serum calcium, B¹² and D³ in post-menopausal depressed women.
To compare and ascertain correlation of serum calcium, B¹² and D³ among depressed and non depressed post menopausal women.
Methodology: A prospective cross sectional comparative study conducted at the department of psychiatry, SMS Medical College, Jaipur. Forty depressed post menopausal women diagnosed on the basis of ICD-10 and fulfilling the inclusion and exclusion criteria & willing to participate in the study were recruited. Thirty non depressed post menopausal women were also recruited for comparison.
The socio demographic characteristics, illness details were recorded in structured Performa after proper consent. The Hindi version of Beck's depression self rating scale administered to all the subjects for assessment of severity of depression.
The fasting blood samples of all the subjects were taken on next morning between 9 to 9:30 am and all the tests done at central lab, SMS Medical College, Jaipur. All the finding recorded and suitable statistical analysis done and results discussed.
Methodology: A prospective cross sectional comparative study conducted at the department of psychiatry, SMS Medical College, Jaipur. Forty depressed post menopausal women diagnosed on the basis of ICD-10 and fulfilling the inclusion and exclusion criteria & willing to participate in the study were recruited. Thirty non depressed post menopausal women were also recruited for comparison.
The socio demographic characteristics, illness details were recorded in structured Performa after proper consent. The Hindi version of Beck's depression self rating scale administered to all the subjects for assessment of severity of depression.
The fasting blood samples of all the subjects were taken on next morning between 9 to 9:30 am and all the tests done at central lab, SMS Medical College, Jaipur. All the finding recorded and suitable statistical analysis done and results discussed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP17: Treatment of refractory auditory hallucinations in Schizophrenia with rTMS: A case series

Alok Vinod Kulkarni ¹

Introduction:

Persistent, distressing and disruptive auditory hallucinations are experienced in psychotic disorders frequently.
Low-frequency (1Hz) repetitive transcranial magnetic stimulation on the left temporoparietal cortex has been used to successfully treat refractory auditory hallucinations.
We report a case series concerning successful treatment of refractory auditory hallucinations with low-frequency rTMS on the left temporoparietal cortex.

METHODOLOGY

The sample size consisted of three participants who had treatment-refractory auditory hallucinations.
All participants had failed trials of two non-clozapine anti-psychotics.
Low-frequency (1Hz) rTMS using the figure-of-eight air-cooled coil from the Medistim Horizon machine was applied over the left temporoparietal cortex for 5 sessions per week (1600 pulses per session) for 2 weeks.
The Hallucnations Change Scale (HCS) was used as an instrument for examining the outcome of rTMS treatment in the authors’ institution.

Results

On day 14 of rTMS, participants 1, 2 and 3 had an HCS score of 5, 2 and 10 respectively as compared to a baseline score of 10 in each of the participants on day 1 of rTMS.

DISCUSSION AND CONCLUSION

All participants reported here were adult men aged between 23 and 5 years with a primary diagnosis of treatment-refractory schizophrenia and were on clozapine at the time of the study.
Two out of the three participants reported significant reduction in the degree of auditory hallucinations following low-frequency rTMS.
These changes were evident after a minimum of 12 sessions.
This case series confirms previous findings of targeting left temporoparietal cortex in abolishing auditory hallucinations.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP18: Genetics of Alcohol Liver Cirrhosis: preliminary findings

Bhagyalakshmi Shankarappa ¹, Pratima Murthy ², Meera Purushottam ², Sanjeev Jain ², Harshad C Devarbhavi ¹, Ashok Mysore V ¹

Introduction:

Alcohol Dependence (AD) and Liver cirrhosis (ALC) are key outcomes of increased alcohol use. Genetic determination in the development of these outcomes is increasingly documented. While 80-90% of heavy users show evidence of fatty liver, only 10-20 % of such users progress to hepatitis, a precursor of cirrhosis. It is unclear as to why some individuals do not have cirrhosis despite heavy use, while they show features of dependence. We are exploring possible genetic and epigenetic mechanisms in this context.

Methods:

Study included men with ALC (N=100) and AD without liver cirrhosis (N=100) based on ICD 10 criteria, drawn from the clinical services of SJMCH (Gastroenterology and Psychiatry). Fibroscan and/or sonographic findings were used to rule out fibrosis (Liver Stiffness Measurement, LSM <7kPa). Standard laboratory measures were included. Genotyping and DNA methylation for LINE-1, ALDH2 and MTHFR loci were done by PCR-RFLP and Pyrosequencing methods respectively.

Results and Discussion:

Biochemical parameters significantly differentiated the groups. There was a trend for higher LINE1 methylation levels in the ALC group. ALDH2 methylation levels were significantly lower in ALC group (P=0.0001). MTHFR also showed decreased methylation in ALC group (P=0.0001). At present, we have not found any group difference in allele frequencies of ADH1C, ALDH2, TNFα and MTHFR .

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP19: Title: Obsessive Compulsive Disorder Following Acoustic Neuroma Excision- A Case Report

Porimita Chutia ¹

INTRODUCTION

Obsessive compulsive disorder (OCD) is a chronic mental illness. OCD secondary to cerebral lesions including traumatic brain injury, tumours, haemorrhages and infarcts in certain brain areas like temporal lobe, frontal lobes, basal ganglia and brainstem or pons is reported earlier.

CASE REPORT

A 37years old married Hindu male from Guwahati presented to psychiatry outpatient clinic of GMCH on 27^th of March 2019 with a 4 days history of repetitive distressing thought of killing his daughter, palpitation, restlessness, increased worry and disturbed sleep. He tried to stop the thought but on failing to do so became very anxious and fearful that he may actually harm his daughter. Out of fear he collected all the sharp and blunt weapon available in his home and threw it to a trash and also started living alone in a room. On reviewing the history patient revealed that he had undergone a surgery four and half months back on (2.11.2018) for right sided grade 1 Acoustic Neuroma. The patient was diagnosed with OCD according to DSM-V criteria. He was treated with medications and he responded well to the treatment.

DISCUSSION

The model of diachisis can be applied in our case, as the tumour site is cerebello pontine angle, excision of this tumour may cause injury of the blood vessel leading to infarction and subsequently the involvement of remote areas. Several prior studies already reported the association secondary OCD symptoms with abnormalities in the temporal lobes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP20: Allergic Contact Dermatitis with Nicotine Patch: A Case report

Ravindra Munoli ¹, Linda Susan Thomas ¹, Suma Udupa ¹, Samir Kumar Praharaj ¹

Case Summary: A premorbidly well-adjusted 42years old married gentleman was admitted with h/o alcohol and tobacco use of 25 years’ duration in dependence pattern. He was started on Nicotine patch 21 mg, one patch per day along with other management. He had no past h/o any dermatological disorder. After 5 days, he developed itchy, erythematous rashes (as in pics) at the site of patch and all patch applied sites showed similar pattern of rashes, though initially they did not show.

Diagnosis and Management: He was diagnosed with allergic contact dermatitis with nicotine patch. He was evaluated by dermatologist and was treated with Flutivate Cream (Fluticasone Propionate 0.05% w/w) for local application twice daily for first 10 days, then once daily for 10 days, then to stop. In addition, tablet Levocetrizine was given for 10 days for symptomatic relief of itching. Patch was discontinued and nicotine chewing gums were started. He was evaluated after two weeks. His erythematous skin lesions had remitted and he did not report of itching.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

Neuropsychiatric and vestibular manifestations in space occupying lesion - A case report

Daisy Rure ¹, Nimisha Mishra ¹, Sunil K Ahuja ¹

Introduction: Intracranial space occupying lesion account for about 5-10 per 100,000 in India and 4-5% globally. They may present with unspecific physical symptoms like headache, nausea, vomiting, dizziness, vertigo; neurological symptoms as seizures, focal neurological deficit; and behavioural changes. ENT and Psychiatric symptoms is less reported in literature making the subsequent case rare.

Case: A 45yr old female presented with complaints of vertigo, dizziness, tinnitus, hearing difficulties, recurrent fall, and low mood over 3 months. Focal neurological examination revealed, B/L Babinski sign positive, exaggerated knee reflex. Her GCS,MMSE and HAM-D were 15, 15and 14 respectively. MSE revealed Speech:low pitch,increased reaction time, depressed affect with restricted range, impaired attention/concentration, abstract ability &memory; thought content shows Bradyphrenia, worries, death wishes; Judgment is impaired and Grade III insight. Suspecting the falls to be of vestibular/cochlear origin, patient referred to ENT department, where found WNL. CT-Scan divulged large SOL involving left cerebellar hemisphere compressing 4^th ventricle. Patient was transferred to department of Neurosurgery for surgery. Post surgery, her MMSE was 15 and 18 respectively on 7^th and 21^th day.

Discussion: ICSOL have polymorphic presentation. Prevalence of vestibular(<10%) symptoms are least common which are well documented. This case is unique because the above symptom suggests vestibulo-psychiatric manifestation in ICSOL. The cerebellar symptoms were less prominent in this patient as compared to the size of the lesion.

Discussion: On Naranjo scale of probability of adverse drug reactions, score was 7 indicating probable nicotine patch induced dermatitis. Literature mentions appearance of allergic reactions immediately and as late as after 4 weeks also. Present case focuses on need to look for adverse skin reactions with nicotine patch during follow up.

Conclusion: Being commonly used agent in NRT, dermatological reactions of patch need to be monitored regularly.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP21: Neuropsychiatric and vestibular manifestations in space occupying lesion - A case report

Daisy Rure ¹, Nimisha Mishra ¹, Sunil K Ahuja ¹

Introduction: Intracranial space occupying lesion account for about 5-10 per 100,000 in India and 4-5% globally. They may present with unspecific physical symptoms like headache, nausea, vomiting, dizziness, vertigo; neurological symptoms as seizures, focal neurological deficit; and behavioral changes. ENT and Psychiatric symptoms is less reported in literature making the subsequent case rare.

Case: A 45yr old female presented with complaints of vertigo, dizziness, tinnitus, hearing difficulties, recurrent fall, and low mood over 3 months. Focal neurological examination revealed, B/L Babinski sign positive, exaggerated knee reflex. Her GCS, MMSE and HAM-D were 15, 15and 14 respectively. MSE revealed Speech: low pitch, increased reaction time, depressed affect with restricted range, impaired attention/concentration, abstract ability &memory; thought content shows Bradyphrenia, worries, death wishes; Judgment is impaired and Grade III insight. Suspecting the falls to be of vestibular/cochlear origin, patient referred to ENT department, where found WNL. CT-Scan divulged large SOL involving left cerebellar hemisphere compressing 4^th ventricle. Patient was transferred to department of Neurosurgery for surgery. Post-surgery, her MMSE was 15 and 18 respectively on 7^th and 21^th day.

Discussion: ICSOL have polymorphic presentation. Prevalence of vestibular (<10%) symptoms are least common which are well documented. This case is unique because the above symptom suggests vestibule-psychiatric manifestation in ICSOL. The cerebellar symptoms were less prominent in this patient as compared to the size of the lesion.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP22: A case of Pyromania

Introduction

Pyromania or pathological fire setting, is a very rare disorder characterized in DSM-5 by repetitive and deliberate fire-setting that is unrelated to external reward and not explained by another diagnosis or behaviour. Although fire-setting is a common behaviour and many people are fascinated by fire and the individual develops a feeling of satisfaction once the fire is set. They experience a rush and fascination when watching a fire. Pyromania is a disorder associated with loss of control over the behaviour and often legal consequences.

Case report A 22-year-old male, from a middle socioeconomic status presented to the OPD with symptoms of repeatedly burning plastic and garbage. There was no apparent motive for the burning of the plastic but only feeling relieved after fire setting. Mental status examination showed no features of anxiety, depression or psychosis. Eyesenck's series of digit span test was administered to assess the attention and concentration of the patient.
Digit forward was 5 and digit backwards was 3 which suggests attention was aroused and sustained for a considerable period of time. Rorschach psychodiagnostic test showed average productivity, quick speed of mental processing, adequate reality contact, emotional immaturity, feelings of inferiority, anxiety and lack of conformity to the social norms. He was treated with sodium valproate and CBT with decrease in fire setting episodes.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP23: A Cross-sectional study between relation of Problematic Internet Use, Sleep Disturbances & Self Esteem in Health Professional Students

BACKGROUND: Digital media comes with pros and cons and is increasingly being used. Occasionally this usage reaches a stage where it is a problem to the person and those around him. It affects physical & psychological parameters including Sleep and Social life. Low Self-esteem, a modifiable factor, is often associated with the problematic use of internet. Sleep and self-esteem are critical factors for any health professional.

AIM: Aim of this study was to discern association of PIU, Sleep & Self Esteem.

METHOD: A cross-sectional study was performed including Health Professional Students of a Tertiary Hospital using Problematic & Risky Internet Use Screening Scale (PRIUSS) for Problematic Internet Use Screening, Athens Insomnia Scale (AIS) for Sleep Assessment & Rosenberg Self-Esteem Scale for measuring Self-Esteem.

RESULT: The findings suggest that problematic internet use does occur and has a bearing on sleep and self-esteem.

CONCLUSION: PIU is an emerging mental health entity and must be addressed along with addressing the associated factors.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP24: Non-Paraphilic hyperactive sexual behavior and psychiatric consequences: A case report from north India

Background:

Nymphomania can be defined in terms of three distinct elements: marked increase in sexual drive; extremely frequent multiple partner sexual behaviour; promiscuity.

Aim: To discuss the psychiatric consequences of a rare case of nymphomania.

Methodology: A case-report- 25years young woman, married, Hindu, lower socio-economic status presented with excessive sexual desire, excessive sexual fantasies, masturbation, low mood, irritability, suicidal thoughts and attempts from one and half years. On Mental status examination she had depressed mood, uncontrollable sexual desires, guilt, hopelessness, helplessness, and suicidal ideations. Patient has been assessed on Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Arizona Sexual Experiences Scale, Yale-Brown Obsessive Compulsive Scale, Female Sexual Functioning Index and diagnosed with hyperactive sexual desire disorder with severe depressive episode without psychotic symptoms. In view of her depressive symptoms, oral Fluoxetine 80mg/day was started, which was further augmented by tablet Aripiprazole 10mg/day, and Modified Electroconvulsive Therapy applied in view of active suicidal ideation.

There was marked reduction in depressive symptoms (HAM-D 31 to 23, HAM-A 41 to 23).

Result: Hyperactive sexual desire disorder robustly associated with depression in female in context of conservative Indian sociocultural background.

Key words: Nymphomania, Modified electroconvulsive therapy, Depression.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP25: Organised scribbling of Disorganized Schizophrenia - A Case Report

Tejas joshi ¹

Introduction:

Schizophrenia is an intriguing disorder that can present with a wide array of symptomatology.

Patients of Schizophrenia have been known to create thought provoking art as an expression of their deeply complex inner world. Here, we present a case, whose notes were very interesting organised articulation of his disorder and improved with treatment.

Methodology:

A Single case report based on observations and reviewing his paper-pen notes made by patient of Schizophrenia during ward stay and on follow up after discharge to assess psychopathology and improvement.

Case report:

A 28-year-old male, Mr G was brought to Psychiatry OPD by parents with complaints of not sleeping at night, suspiciousness that people were trying to harm him, poor social interaction, self-muttering, inappropriate laughing, and anger outbursts without provocation. On ward stay, it was discovered that his bag was full of scribbled notes written by him describing the exact time, number plate or name of vehicle or details on hoardings seen on road side and on some notes the exact time when he ended noting these details, all very repetitively. Patient reported writing such notes since 6 years. He gradually worsened over time and so did the notes. The patient had been taken to multiple faith healers before coming to psychiatry facility.

On MSE, patient revealed that he thought this admission was done by PM of India and PM of Dubai. On their instructions, patient was noting all these details so that he could give them to American agency after which they would call him up to work for them. Patient was diagnosed as Schizophrenia and was treated. These symptoms improved with Antipsychotic medication and ECTS.

Discussion and conclusion:

Art by patients of schizophrenia certainly has a rich history from Louis Wain's Kaleidoscopic Cats to Vincent Van Gogh's Starry Sky, but it is not utilized enough in modern day psychiatry. Some patients may express their thoughts in writing too. As this case points out, sometimes, writing can be a very accurate marker of patient's status of improvement or deterioration in schizophrenia. It can be very helpful to give paper and pencil to patients of Schizophrenia.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP26: Neuropsychiatric Manifestations of Wilson Disease: A Case Report

Background: Psychiatric symptoms may occur before, simultaneously or after the diagnosis and treatment of Wilson's Disease(WD).

Aim: To discuss the management issues of a rare case with neuropsychiatric manifestations in Wilson's disease.

Methodology: A case report-20years/female, unmarried, lower-middle socio-economic status of rural background and overweight body mass index (28.84 kg/m²) presented with c/o stubbornness, agitation, irritability, weakness and dizziness for last 3 years, tremors in limbs, excessive salivation, smiling inappropriately and muttering to self for last 2 years. Patient had h/o delayed developmental milestones and was a slow learner since early childhood. H/O schizophrenia like psychiatric illness in 03 2^nd degree relatives. CNS examination revealed cogwheel rigidity in upper limbs, abnormal cerebellar tests. Kayser–Fleischer(KF) rings were seen bilaterally on ophthalmologic evaluation. Serum copper =50mcg/dl (N=70-140mcg/dl), serum ceruloplasmin =21mg/dl, 24-hour urinary copper excretion =21mcg/day. On mental status examination she had 2^nd person auditory hallucinations. Was on antipsychotics since May 2018 and response was poor, then started on treatment for WD in Dec 2018 after MRI brain demonstrated the “face of the giant panda” in the midbrain with high signal in tegmentum and normal red nuclei. Symptoms severity assessed on PANSS and AIMS. Treated with oral Aripiprazole 15mg/day, Trihexyphenidyl 4mg/day, Zinc acetate 150mg/day and Pyridoxine 20mg/day. Her PANSS improved (from 48 to 41) and AIMS (16 To 11) in 2 weeks’ duration.

Result: Neuropsychiatric manifestations of WD is often misdiagnosed and causes delay in definitive diagnosis.

Key-words: Wilson's Disease, Neuropsychiatric manifestations, KF ring

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP27: Use of slow repetitive Transcranial Magnetic Stimulation(rTMS) in Treatment refractory auditory hallucinations:A case report

Background: Schizophrenia is a chronic debilitating psychiatric disorder. Few treatment options are available if standard antipsychotics fail. Recent researches have shown efficacy in the management of positive symptoms of schizophrenia especially auditory hallucinations by repetitive Transcranial Magnetic Stimulation(rTMS).

Aim: To evaluate the effect of low frequency rTMS on auditory hallucinations.

Methodology: A case report-38years old, married woman from rural background, premorbidly well adjusted, presented with suspiciousness, anger outburst and hearing of voices for last 7 years. On mental status examination: delusion of reference, delusion of persecution, 2^nd and 3^rd person auditory hallucinations were found. She was diagnosed with paranoid schizophrenia as per ICD-10 and treated with oral olanzapine upto 20mg/day. Symptoms severity assessed on PANSS, PSYRATS and patient showed improvement in all symptoms except auditory hallucinations. Oral Haloperidol was added, given upto 10mg/day could not be increased due to side effects but no significant improvement was noticed even after 6 weeks. Patient was considered for rTMS after TMS Safety-Screening Questionnaire(TASS) and written informed consent (rTMS of 1Hz, with 80% Motor threshold, over left dorsolateral prefrontal cortex was administered). Her PANSS and PSYRATS scores decreased from 102 to 40 and 23 to 0 respectively after 6 sessions, indicating significant improvement.

Result: Slow rTMS appears to be a fairly effective treatment in refractory auditory hallucinations in schizophrenia.

Key words: rTMS, treatment refractory auditory hallucination, schizophrenia.

Abbreviation: PANSS -Positive and Negative Syndrome Scale, PSYRATS -The Psychotic Symptom Rating Scale

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP28: Neurological Manifestations of Inhalant Use Disorder in a street dwelling child- A case report

Dr Darshan Chudasama ¹

INTRODUCTION

Glue sniffing refers to deliberate inhalation of volatile solvents commonly found in adhesives, for purpose of intoxication. The increasing prevalence of inhalant use suggests that many physicians will encounter glue sniffing patient at some point during their practice. An increasing number of street dwelling children are indulging in this form of substance use due to its less cost, easy availability. This case report is intended to aid clinicians in the recognition, diagnosis and management of glue sniffing patients, especially in absence of reliable history.

METHOD

Single case report of a 14-year-old boy diagnosed with inhalant use disorder presented to paediatric emergency and then transferred to psychiatry ward.

CASE REPORT

A 14-year-old street dwelling child with no close relative was brought by child welfare workers to emergency with complains of drowsiness, disorientation, confusion and unsteady gait. He was admitted in paediatric ward. Over 2 days they got done routine blood investigation, blood culture, EEG and MRI, with all turning out to be normal and without much improvement in child's condition. The child mentioned once or twice that he is taking 'SOLUTION’ which the paediatric resident could not understand. On discussion with a psychiatry colleague it was understood that the child is abusing inhalants such as ‘Fevicol’ adhesive. Hence the child was transferred to psychiatric ward. He revealed inhalant use of 1 year with current pattern of 1 can of adhesive/day by sniffing after putting it on a cloth. He was started T. Clonazepam 2mg in divided doses with other supportive management with fluid and NSAIDS. He had dramatic improvement in 3 days.

CONCLUSION

Glue sniffing among street dwelling children as a phenomenon is quite prevalent, but identification is low among people as well as Health professionals. The recognition of neurological manifestations of inhalant use both acute and chronic is of important in management. The overcoming and containment of this problem demands organized societal effort and understanding the behaviour of the children and more awareness in clinicians about the manifestations of symptoms in inhalant use disorders.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP29: Setraline induced cutaneous rash: a case report

Introduction

As a class, SSRIs have been the most widely used psychopharmacological agents for depression worldwide for nearly three decades. The prevalence of dermatologic reactions with antidepressants is 2–4%. However, cutaneous reactions have seldom been reported with SSRIs. We present the case of a 28 years old female who was administered sertraline for the management of depression who developed drug induced rash.

Case report

A 28 years old female patient, k/c/o cervical spondylosis with nil significant family history presented with an illness of 8 years of duration, acute onset, episodic in nature with past history of similar episodes in 2011 and 2016 lasting for 6 months and 7 months respectively for which psychotherapy was sought, with current episode being third which fulfilled the ICD-10 criteria for major depressive disorder. The patient was diagnosed with recurrent depressive disorder and prescribed sertraline 50 mg/day which was titrated up to 100 mg/day after 5 days. Following the intake of 100 mg of sertraline the patient developed erythematous macula-popular rash over her body which subsided following cessation of sertraline. A score of 5 was obtained on Naranjo Scale implying probable ADR to sertraline.

Discussion

To make a diagnosis of drug induced rash a temporal relationship has to be established between the onset of rash, dose and duration of drug, also there is a higher likelihood of dose dependence. SSRI induced skin reactions are uncommon and only few case reports are available. Hence early detection and management will help to ensure compliance.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP30: TITLE: PSYCHIATRIC MORBIDITIES ASSOCIATED WITH ANABOLIC STEROID ABUSE

Sagar Verma, Rahul Yadav, Tathagato Singh Bhandari

INTRODUCTION

Anabolic-androgenic steroids (AAS) are a class of drugs that include the male sex hormone testosterone and its synthetic derivatives. Misuse of AAS by athletes and other individuals who participate in strength training has been reported in the literature for decades; however, it was not until the 1980s that case reports began describing individuals displaying an apparent dependence on AAS.

AIM

To assess the nature and extent of psychiatric morbidities associated with anabolic steroid abuse in people visiting health clubs

MATERIALS & METHODOLOGY

This cross-sectional study was conducted in the first half of 2019 among body building athletes referring to gyms in NCR. Five gyms were selected randomly and 125 athletes completed a self-administered proforma including a semi structured questionnaire for steroid use pattern, zung self-rating depression scale, zung self-rating anxiety scale and drug abuse and screening test -10 .

RESULTS & CONCLUSION

This study evaluated 125 men going to health clubs (28 AAS-dependent and 97 AAS-nondependent users), resulting in an estimated AAS dependence rate of 22.4%..Our study observed that 17.8% AAS-dependent users were found to have anxiety disorders (P<0.05) relative to 8.2% AAS-nondependent persons and also observed that 14.2% AAS-dependent users were found to have depression (P<0.05) relative to 7.2% AAS-nondependent persons. Despite the adverse effects and concerns, the majority of AAS-dependent users planned to continue AAS use in the future.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP31: CORELATIONSHIP OF AGE WITH QUALITY OF LIFE DOMAINS AMONG SUBSTANCE USERS.

SOURISH KARMAKAR ¹, SAMIK SINHA ², DEBASISH SANYAL ³

ABSTRACT

INTRODUCTION- substance use disorder is characterized as “maladaptive patterns of substance use leading to clinically severe impairment or distress” potentially affecting physical or psychological functioning, personal safety, social relations, roles and obligations; work and other areas. (American Psychiatric Association 1994).

BACKGROUND- many literatures show poor quality of life among patients using substance especially heroin and alcohol, as well as poor quality of life affecting the care givers. In this study, we will be showing how individual's age affects the quality of life among substance users. A portion of a study done on “predictors of quality of life among substance users” will be depicted through this poster.

METHODS AND MATERIALS- it is an observational hospital-based study conducted at KPC medical college and hospital, department of psychiatry. Study was done on total 57 Patients with substance use, attending both OPD and IPD were selected at random. Inclusion and exclusion criteria applied. The subjects were examined using semi-structured socio demographic profile proforma. Quality of life was assessed using WHOQOL-BREF. Analysis was done by using IBM@SPSS 25 software.

RESULTS AND CONCLUSION- age of an individual has significant relationship with quality of life domains, there was negative co relationship of age with quality of life domains.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP32: TITLE: LONGITUDINAL STUDY ON SHORT TERM COURSE AND OUTCOME OF FIRST EPISODE ACUTE AND TRANSIENT PSYCHOTIC DISORDER

Tathagato Singh Bhandari, Sagar Verma, Rahul Yadav

INTRODUCTION

ATPD, which was earlier termed as Delirious Mania is defined by ICD-10 as psychotic condition with onset within 2 weeks and full remission within 1 to 3 months. The most common specific disorder in this group is polymorphic psychotic disorder without symptoms of schizophrenia, followed in frequency by polymorphic psychotic disorder with symptoms of schizophrenia.

AIM

To determine the Course and outcome of patients with ATPD at 6 months and one year, to determine the diagnostic stability of ATPD at the end of one year

MATERIALS & METHODOLOGY

The current study was a hospital based prospective longitudinal study. A semi structured socio demographic Performa, BPRS and PSLES were used to collect data from the patients. 62 acute and transient psychotic disorder patients who satisfied ICD-10 criteria were chosen from OP/IP department. These patients were interviewed again at the end of six months and end of one year.

RESULTS & CONCLUSION

Majority of the patient's subjects were either lost for follow up or reached remission. It was only a minority of the sample which turned out to be schizophrenia/affective disorders. Diagnostic stability at the end of one year was around one third (29.02%). Patients with Acute polymorphic psychotic disorder with symptoms of schizophrenia at baseline turned out to have the most number of chronic illnesses including schizophrenia and mood disorder at end of one year.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP33: TOPIC: ATTITUDE OF MEDICAL UNDERGRADUATE AND POSTGRADUATE STUDENTS TOWARDS PSYCHIATRY

Rahul Yadav, Sagar Verma, Tathagato Singh Bhandari

INTRODUCTION

The lifetime prevalence of psychiatric illness is 12.2-48.6% among adults. The stigma attached to psychiatric illness is universal. Stigmatized attitudes among health professionals can result in compromised patient care.

AIM

To find out and compare the attitude of medical undergraduate and postgraduate students towards psychiatric illness and psychiatry as a subject.

MATERIALS & METHODS

415 medical Undergraduate & Postgraduate students were included in the study. Two validated likert type scales called “ATTITUDE TOWARDS PSYCHIATRY-30 (ATP-30)” & “ATTITUDE TO MENTAL ILLNESS (AMI)” were used. According to the scores attitude was compared. Anonymity and confidentiality maintained.

RESULTS

Majority of medical Undergraduate & Postgraduate students had a positive attitude towards psychiatric illness (84.10%) and psychiatry as a subject (55.18%). Females had significantly (p<0.05) more positive attitude than males. Participants belonging to urban backgroundhad significantly (p<0.05) more positive attitude than in with rural background. Similarly, students belonging to upper socioeconomic status had significantly (p<0.0001) more positive attitude than with upper middle class. Interns had a significantly (p<0.05) more negative attitude towards psychiatry as a subject as compared to undergraduates.

CONCLUSION

There is need to create awareness among undergraduates especially interns and non-psychiatric postgraduate students and mental health awareness in rural areas.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP34: Title: Internalized stigma, coping strategies and functioning in remitted bipolar disorder(BD).

SeshanKumar, ShantanuBharti, AnjuAgarwal, AQJilani, ReemaSinha

ABSTRACT:

Background: Stigma played a detrimental role in undermining self-esteem and self-efficacy. In patient with BD functional loses may be observed even during remission of the disease due to stigmatization. A diagnosis of BD can darken patient's positive behaviour and lead to social withdrawal, goal restriction and reduced quality of life. Various coping strategies are opted by patients such as secrecy, withdrawal, acceptance and education who feel stigmatized.

AIM:To determine the internalized stigma ,coping strategies and functioning in remitted bipolar disorder.

Methods: A random sample of remitted BD in a Era medical college, Psychiatry Opd was examined using a cross-sectional design(n=50). Self-stigma was measured using the Internalized Stigma of Mental Illness Inventory (ISMI). Functioning was assessed using the Functional Assessment Short Test(FAST). Stigma coping was evaluated using the Stigma Coping Orientation Scale(SCOS).

Results: Analysis revealed that uneducated, unemployed and single had faced more stigma. Stigma coping with secrecy(p=0.004) and withdrawal(p=0.0001) associated with high internalized stigma. Total fast score is related to high internalized stigma.

Conclusion: Results suggest that internalized stigma is prevalent and troublesome among individuals with BD. Stigma hinders the psychosocial functioning of patients. Psychoeducation, cognitive behavioural therapy, social skill training and incorporation of coping strategies can enhance the functioning.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP35: A Study of Psychiatric Rehabilitation Homes and Its Inhabitants in Kollam District, Kerala.

Ramkumar G S ¹, Jaimon P ¹, Anvar Sadath ¹

Background: A significant percentage of the mentally ill, especially those with enduring morbidity and disability and those who lack adequate familial support will require rehabilitative services like housing support, rehabilitation homes and day care. A mixed economy of rehabilitation services exists to address this need; majority of services run by the NGO sector. Though survey of such facilities has been done in western countries, reliable data from india is not available.

Objectives:

1. To study the nature and type of services in psychiatric rehabilitation homes in kollam district of Kerala, India.

2. To study the sociodemographic and clinical profile of the inmate patients in these rehabilitation homes.

Methods & materials: All homes that provided long term residential care for mentally ill in kollam district were included in the study. Specially designed data sheet to capture descriptive data on rehabilitative homes. Sociodemographic and illness related data sheet to collect patient information. Global assessment of functioning was assessed using a standard scale.

Results: 9 rehabilitative homes and ~ 450 mentally ill patients were included. Two of the homes were in the government sector and seven were run by the NGO sector. Patient data are being analyzed with appropriate statistical methods. Preliminary assessment reveals that a significant percentage of the patients were found wandering and they were brought into the homes through the efforts of the police. Many treatment files did not have a documented diagnosis though they were receiving psychotropics. In some places excellent treatment records were well maintained. Further quantitative analysis of data will lead to some directions in improving the treatment and rehabilitation aspects of this subset of psychiatrically ill.

Key words rehabilitative services, psychiatric rehabilitation homes, patients’ status, kerala

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP36: CASE REPORT: PSYCHIATRIC MANIFESTATIONS IN WILSON DISEASE

Raga Sumedha K ¹, Anitha Rayirala ², Rajshekhar Bipeta ³

ABSTRACT:

Background: Wilson Disease is an uncommon genetic disorder, in which abnormal copper accumulation occurs in various parts of the body.Approximately 30% of patients debut with neuropsychiatric symptoms posing a diagnostic challenge in the initial phase.

Case description: In this report, we present a case of middle aged woman with Wilson Disease who developed psychotic symptoms.

Discussion: We discuss the unique features of our case and although most patients of Wilson's develop psychiatric symptoms at some stage of the disease, currently there are no treatment guidelines for the management of the same.

Conclusion: We conclude that organic etiology should always be kept in mind while treating first atypical psychiatric episode.

Key words: Wilson's disease; Psychiatric manifestations; Penicillamine

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP37: Incubus phenomenon in patient with schizophrenia with homosexual orientation : A case report from North India

Parul Saxena ^*, Anjani Gopal ^*, Ajay Kumar ^**, Sudhir Kumar ^***

Background: The Incubus syndrome (Incubus:demonic lover) is a term used to describe patients suffering from the fixed belief that they are sexually approached at night by an unseen lover. The phenomena is described in context ofschizophrenia and considered as a variant of erotomania.

Aim: To discuss incubus phenomenon in patient with homosexual orientation and schizophrenia

Methodology:

A 25yr old unmarried girl presented with poor personal care, hearing of voices, feeling of being raped by an evil male spirit at night, sexual attraction towards other females.

On detailed exploration,patient was found to have homosexual orientation(The Sell Assessment of Sexual Orientation scale was applied), delusion of reference and persecution and second person auditory hallucination for the past 6 years followed by feelings of being raped by an unseen man at night for about 4-5 days per week in fully conscious state since one year. Her routine blood investigations and neuroimaging were within normal limits. Patient preferred to wear jeans and shirts,keep short hair like men and even had masculine body language. Her psychometric assessment confirmed homosexual orientation and presence of psychotic features. She was diagnosed with Paranoid schizophrenia by the treating consultant and started on oral olanzapine 20 mg per day and oral Amisulpride 400 mg per day. Her symptoms improved (PANSS decreased from 102 to 40 ) in 3 months.

Conclusion: Phenomena of incubus can occur in schizophrenia with homosexual orientation.

Key words: Incubus syndrome, schizophrenia, homosexuality

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP38: CASE REPORT: DYKE-DAVIDOFF-MASSON SYNDROME, A RARE ENTITY

Shikha Singh ^*, Ajay Kumar ^**, Sudhir Kumar ^***

BACKGROUND:

Dyke Davidoff Masson Syndrome is a condition characterized by hemi cerebral atrophy/hypoplasia secondary to brain insult in fetal or early childhood and accompanied by ipsilateral compensatory osseous hypertrophy and contralateral hemiparesis.

AIM:

Management of a case of Dyke Davidoff Masson Syndrome with behavioral problems

METHODOLOGY:

A 13-year-old girl presented to OPD with complaints of irritability, stubbornness, increased talkativeness, anger outbursts, delayed developmental milestone, seizure episodes, low intelligence, weakness in right side of the body and self-biting tendency. Her father reported about her mother's history of hypertension while she was in her womb. Physical Examination revealed- Microcephaly (<3^rd centile), facial asymmetry, head turned on one side (Right side), squint in right eye. Neurological examination revealed right sided spastic hemiparesis with brisk tendon reflexes and extensor plantar response. Other systemic examination being normal. Vision and hearing were normal and cranial nerves were intact. NCCT head showed- Atrophy of left cerebral hemisphere with frontal-parieto-temporal cystic encephalomalacia and ex-vacuo dilatation of left lateral ventricle. EEG showed- Abnormal interictal tracing. Patient is currently on Tab-Aripiprazole (10 mg), Tab Clonazepam (1 mg), Tab Sodium Valproate (500 mg), Tab THP (2 mg). Patient gradually improved over 3 months and is currently seizure free and maintaining well on above medications.

CONCLUSION:

DDMS is uncommon clinical entity, refractory seizure remaining the usual concern in early childhood. Hemispherectomy remains the treatment of choice along with physiotherapy, speech therapy and occupational therapy.

KEYWORDS:

Cerebral Hemiatrophy, Brain insult, Hemiparesis, Seizures.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP39: Title: Psychosis as atypical presentation of Rasmussen's encephalitis: A case report

Suneel Singh Kushwah ¹, Nimisha Mishra ¹, Dheerendra Mishra ¹

Introduction-

Rasmussen's encephalitis(RE) is a rare, chronic inflammatory neurological disease presented with focal epilepsy and progressive loss of neurological functions. Clinical sign symptoms, EEG and MRI imaging is helpful to established the diagnosis. Psychosis and abnormal behavior are less recognized in literature; we present a case of RE with psychotic symptoms.

Case-

A 23-year-old female presented with tonic jerky movement of left upper limb followed by generalized tonic clonic jerky movement, loss of consciousness since eight years, with symptoms of singing songs, aggressive behaviour, wandering aimlessly, sudden weeping and laughing spells, and disturbed sleep since 7 days. Childhood history showed delayed motor milestone and physical examination revealed weakness in left upper and lower limb. MSE revealed patient was alert a rousable with ill sustained concentration, increased psychomotor activity, spontaneous speech. Affect labile. Thought revealed acceleration and increased volubility; persecutory ideas. Judgment impaired and insight- Grade 1. MRI study suggestive of late stage RE.

Discussion

Rasmussen's encephalitis is probably driven by a T-cell response to one or more antigenic epitopes, with potential contribution by autoantibodies. In literature seizure focal neurological sign of cerebral cortex involvement was well recognized. Pathophysiology of behavioural symptoms in RE was not well understood. Behavioural abnormality in RE was less recognized symptoms and reported in this case report.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP40: Title: Perspectives on mental health status and experience of sex life among patients suffering from premature ejaculation.

Background : Premature ejaculation (PE) is a common male sexual dysfunction that may adversely affect 20% to 30% of the male population. Broadly speaking, premature ejaculation refers to persistent or recurrent ejaculation occurring before, at, or shortly after penetration and causing distress to the patient and his partner. Men with PE complain about decreased sexual self-confidence and psychological comorbidities. Thus, it seriously impair mental health and couples sexual relationships.

Some cases of premature ejaculation have a medical cause, but most appear to be related to unknown physiologic or psychological factors. Individual psychological factors such as depression, stress, anxiety, and negative cognitive processing are strongly associated with the onset and maintenance of male sexual difficulties, specially for premature ejaculation.

The objective of this study was to assess the association between premature ejaculation with psychological factors particularly anxiety,depression and the impact of this illness on patients’ overall quality of sex life.

Aims :

To find out the mental health status and quality of sex life among patients suffering from premature ejaculation.

Methods:

A cross-sectional study was conducted on 120 patients diagnosed with premature ejaculation. Subjects were recruited from outpatient section of Department of Psychiatry, Medical College & Hospital, Kolkata.

On every patient these below mentioned scales were applied:

1) PEDT (Premature Ejaculation Diagnostic Tool (PEDT) Questionnaire) scale for assessing premature ejaculation
2) HAM-D scale for depression
3) HAM-A scale for anxiety
4) SQLI (sexual quality of life questionnaire-male) scale for male for overall sexual life status in male
5) ASEX (Arizona sexual experience) scale for overall sexual experience assessment

Scores of HAM-D, HAM-A, SQLI, ASEX scales were correlated with PEDT scale scores using correlation statistics.

Result:

Anxiety and depression were significantly associated with premature ejaculation.Scores of PEDT positively correlated and statistically significant with HAM-A and HAM-D scales.

Experience of sex life declined for patients with premature ejaculation. Scores on ASEX scale and SQLI scale are negatively correlated with PEDT scale score.

Conclusion:

Our results are consistent with existing literature that shows a significant association between anxiety, depression and premature ejaculation, particularly the acquired subtype. Anxiety and depression may play a causal or perpetuating role in these patients in bi-directional way. Experience of sex life also declined for these people. Prevention and treatment of depression, anxiety may substantially decrease the risk of premature ejaculation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP41: A Rare Case of Aichmophobia and Dystychiphobia in a young male with Obsessive compulsive disorder.

Siva Anoop Yella ¹, Pravallika M ², PCB Gupta ³, Siva Anoop Yella ¹

Case summary

Specific phobias are persistent fear of specific situations, objects or persons. Aichmophobia is the fear of sharp objects like knives, needles, pins, paper clips, umbrella points etc. Dystychiphobia is the fear of having an accident. Here we present a case of 24 year old unmarried male, with anxious avoidant pre-morbid personality traits, who came to Psychiatry OPD with complaints of repeated hand washing, repeated checking of locking doors since 2 years, fear of accidents and fear of sharp objects since 1 year. History revealed that patient has repeated thoughts of contamination followed by compulsive acts of repeated hand washing and also repetitive thoughts of doubt whether he has locked the door or not which is followed by checking behavior, which gets relieved after performing the compulsive acts. Patient then started developing fear of accidents following the hearing of news that his friend has met with an accident at a distant place 1 year back, though he hasn’t seen the accident. Patient started developing fear of going out of the house because of that and even if he does, he fears that moving vehicles might hit him and therefore avoids doing the act.

Diagnosis and Management

Patient was diagnosed with Obsessive compulsive disorder with Specific phobias-Aichmophobia and Dystychiphobia. He was treated with SSRIs-Tab. Fluoxetine 20mg increased up to 60mg per day. Patient is under remission of symptoms and is on regular follow-ups.

Discussion

This is an interesting and rare case report where the patient has fear of both accidents as well as sharp objects with co-morbid obsessive compulsive disorder (OCD) and the fears are not part of OCD. They usually arise in childhood or early adulthood and can persist for many years if untreated. It is often seen in persons who have been in a serious or fatal accident or have seen such an accident.

Conclusion

Correct diagnosis of the condition is of utmost importance and proper management of such phobias is necessary to avoid further impairment.

Key words: Aichmophobia, Dystychiphobia, Specific phobias, OCD.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP42: CASE REPORT: OCD & TRICHOTILLOMANIA IN 5-YEAR-OLD BOY

Srivastava TP ¹, Chandrani KV ¹, Singh P ¹

INTRODUCTION

OCD is mostly found in late 2^ndor early 3^rd decade of life. However, symptoms can appear in 1^st decade earliest at 2 years. Estimated prevalence very young children is 0.01% which is lower than in general pediatric patients (0.5-4.0%)

Trichotillomania is an underdiagnosed condition and little is known about its prevalence in childhood. The median age of onset was found to be 13 years.

CASE REPORT

A 5 year old boy studying in 1^st standard with recent history of migration was presented to outpatient department by his parents with complaint of patch of baldness on scalp since 3-4 months. On exploration, he revealed about pulling his hair off whenever scolded by his mother or if he couldn’t change his wet clothes. Parents also reported that patient would remain preoccupied with wetness and compulsive behavior against wetness since 3years of age. Family history was suggestive of OC traits in mother, maternal grandmother and aunt.

The child was managed initially by behaviour therapy (ERP) and later was supported with Tab. Fluoxetine 10 mg.

DISCUSSION AND CONCLUSION

OCD and associated trichotillomania is quite known but in very young children is rare. Here, genetic pre-disposition and stressors like migration triggered his OCD and trichotillomania. Early detection and treatment can improve overall prognosis.

KEYWORDS

OCD, Trichotillomania, Young age, Family history, Migration.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP43: Title: Myasthenia gravis with schizophrenia a rare combination with long- term treatment challenges, A case report with Review.

Chandani Lewis ¹, Rusheeth Reddy Thummalapally ¹, Barbara Funk ²

Case Report:

Myasthenia gravis with schizophrenia a rare combination with long- term treatment challenges.

Introduction:

Myasthenia gravis (MG) is a rare autoimmune disorder caused by autoantibodies targeting the neuromuscular junction. The prevalence of MG is less than 10 per 100,000 persons per year and the mean lifetime prevalence of schizophrenia is around 1%. Only 10 cases of this rare combination is reported in the in the literature so far.

We present a case of a 45-year old African American male with a current diagnosis of schizophrenia with myasthenia gravis, who has been followed up in our clinic for more than two decades. He was diagnosed with Myasthenia gravis when he was very young and was treated with pyridostigmine. His mother and grandmother were diagnosed with MG. His first psychiatric hospitalization was at the age of 8. Over the course of his treatment, he was treated with various antipsychotic medications. When he was younger he did fairly well on oral risperidone but later he was maintained on haldol decanoate for few years. Other psychotropic medications used over time included fluphenazine, aripiprazole, and sertraline. He was treated with both oral and long acting injections. His clinical course fluctuated due to non-adherence to antipsychotics as well as pyridostigmine. We present long-term treatment challenges encountered in treating a patient with MG with schizophrenia for over 20 years.

Even though this combination is rare it is still necessary for a psychiatrist to recognize and address this disorder. It is difficult to recognize symptoms of MG in a patient with schizophrenia as the clinical symptoms of MG can be mistaken as adverse drug effects of antipsychotic medications. Antipsychotic medication treatment can potentially worsen myasthenia gravis in these patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP44: CUSTODIAL DEATH OF MENTALLY ILL PATIENT IN PSYCHIATRIC: HOSPITAL AND THE CHALLENGES IN CLINICAL AND LEGAL MEDICINE

Babul Bandyopadhyay ¹

The cases of custodial death have become an important issue in terms of the investigations made by the human rights commission in the present days. The NHRC followed up the cases of the custodial deaths and directly summoned the Magistrates. The present communication delineates the unnatural death cases of patients (n=9) having mental disorder under care and custody of psychiatric hospital and the concerned forensic analysis in medico legal aspects, as accounted. At one event, one patient died on fighting with another patient in presence of hospital staffs, while both were under treatment at the same Psychiatry hospital in Kolkata following court observation. One adolescent vagabond who underwent treatment in one secondary health care center was referred to the tertiary health care center for recovery of his mental retardation, where the accused person was also admitted in the same hospital in Court order. The autopsy reports revealed that the causes of deaths were due to the effect of injuries as noted ante mortem in nature, confirmed by the circumstantial evidences in three cases; four patients were found dead in hanging condition and in other two cases causes of death remained unknown. The forensic analysis of the viscera examined in sets ruled out the possibilities of any poisoning (p<0.01). The medication status of both the accused and deceased were significantly found important both in clinical and medico-legal aspects. The State took all necessary steps to prevent deaths in custody, ensuring protection by law, and success in preventing will lead to the well being of the society.

KEYWORDS: risk, mental disorder, safety, evidence management, custodial death, NHRC

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP45: ‘Koro and Migration’: Observational study of an outbreak of Koro in a migrant: population working in South India

Introduction

Koro is a culture-bound syndrome, common in India, characterized by the belief that one's genitals are shrinking followed by fear of impending death. Significant social stressors can precipitate this syndrome in vulnerable populations. One such factor is migration which is associated with increased vulnerability to neurosis and poor coping. It has been a less studied factor in the genesis of Koro and the same has been explored in the present study.

Method

There was an outbreak of Koro (13 cases: M:8, F:5) among a population (n=52) from east and middle India who had migrated to the south for manual work. These cases presented in clusters to our Psychiatry out-patient department within a span of two weeks. We did an observational study to explore the socio-demographic and clinical correlates of these patients. Their perceptions and attributions to the illness were also studied.

Results

Most patients were married men with lower socio-economic status and no formal education. More females were however affected than earlier reported data. Most patients knew about the illness and believed that it was contagious. Death anxiety, loss of libido and insomnia were common associated complaints. Males feared loss of impotence whereas females feared of ‘loss of child-bearing’ abilities. The major attributing factors to the illness were migration, the stigma of working near a ‘mental hospital’ and sharing shelter with the affected. Pharmacotherapy and single-session cognitive behavioural therapy were used for treatment.

Conclusions

Our study revealed unique clinical correlates and belief-systems of patients affected with Koro. It is time we stop seeing it just as ‘culture-bound syndrome’ but also a social disorder caused by distortion of body-related beliefs. Migration being a significant environmental factor can often precipitate such culture-bound syndromes. Further mixed-method studies are warranted.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP46: Atypical presentation of Adult Onset Subacute Sclerosing Panencephalitis(SSPE)

Introduction

Subacute sclerosing pan encephalitis (SSPE) is a rare chronic, progressive encephalitis, associated with a slowly evolving, persistent infection of the central nervous system (CNS) by a mutant measles virus (MV) with defective replication after the initial natural infection, affecting primarily children and young adults.

Case Presentation

The patient, a 38 years old male, graduate, came with complaints of attacks of fits from last 15 years, deterioration in physical strength and intelligence being bed ridden from the last 1 year, disinhibited behaviour from last 3 days. Seizure frequency of 1 attack in 2-3 months with last attack occurring 4 days back. Semiology is masticatory movements followed by tonic contraction in right hand with twisting of neck towards right followed by tonic contraction of whole body followed by generalized jerky movements in whole body lasting for 1 minute. There is also another seizure that follow suddenly with fear without any reason. There was poor response on Tab Sodium Valproate 1500mg. CT Scans have shown deterioration and shrinkage of white matter of brain. Increased IgG against measles virus is seen in serum.

Results

Significant improvement with combination of Tab Oxcarbazepine 900mg, Tab Sodium Valproate 1500mg and Tab Risperidone 2mg.

Discussion

To be done during presentation.

Keywords

subacute sclerosing panencephalitis, sodium valproate, deterioration, measles virus

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP47: Title – Excess internet use and psychosis

Sharayu Balwaik ¹, Panjabrao Memorial ¹, Ashish Saboo ¹

Internet Addiction Disorder is an emerging cause of psychiatric morbidity. The easy accessibility and availability of internet has led to excess internet usage.

The excess use of Massive Multiplayer Online Roleplaying Games (MMORPG's) has slowly revealed its psychopathological implications and development of psychotic experiences in vulnerable subjects.

Here we are presenting 2 case reports with first episode of acute psychotic manifestations following problematic online gaming usage. Presence of frank psychosis and depressive symptoms (confirmed by psychometric testings) were seen in both cases, hence a possible link can be made between problematic online usage and it's psychopathology considering the negative impact internet has on mental functions.

Despite our two isolated case reports, our data cannot be generalised, yet can be considered as an indication for further investigation as more cases will be reported in the future.

Keywords – Internet addiction, psychosis, MMORPG.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP 48: A clinical study to assess Memory dysfunction and pattern of memory deficits in patients of Depressive Disorder

Karnik kishore, Deepanjali medhi

Background– Research in the last decades have shown that depression is associated with a significant disturbance in cognitive functioning. Memory dysfunction appear to represent one of the core features of cognitive dysfunction in depressive disorders with an impact on many functional outcomes.

Objective– This study aimed at assessing the memory deficits in patients suffering from depression and to study the corelation between memory dysfunction and severity of depression.

Method– A Total of 40 patients with Depression diagnosed according to ICD – 10 Criteria and 40 healthy controls were included. PGI Memory scale and Hamilton Depression Rating scale (HAM – D) was adminstered and analysis was done using Chi – square test and Pearson's correlation.

Results–The study revealed significant differences in the Dysfunction scores between the study and control population. In the study group majority of patients(80%) had memory dysfunction and a positive correlation was found between memory dysfunction and HAM – D scores.

Conclusion– Depression is associated with significant disturbance in memory and the memory dysfunction increses with increase in the severity of depression.

key words: Depression, Memory, Memory dysfunction.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP49: E-Poster for ANCIPS2020

Intellectual Disability in two siblings of Xeroderma Pigmentosum---a case series, Manish Kumar Mahato ¹, Srijit Ghosh ²

ABSTRACT

Xeroderma Pigmentosum is a rare autosomal recessive disorder with defect in the DNA repair genes.

It presents with various dermatological, neuropsychiatric & ophthalmological manifestations & potential risk for cancers. This paper reports two rare cases of Xeroderma Pigmentosum in 2 siblings aged 12 years & 10 years born of consanguineous marriage. Both the siblings presented with intellectual disability with delayed developmental milestones, poor social, communication & academic skills. There was erythematous rash, freckles progressively spreading all over the faces in both the cases. Ophthalmological examination in both the cases revealed mild conjunctival congestion with clear cornea & healthy macula. Diagnosis of Xeroderma Pigmentosa was done clinically.

We are presenting these two siblings as very few cases have been reported in literature from a same family.

KEY WORDS----Xeroderma Pigmentosum, Intellectual Disability.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP50: Abstract: Poster presentation: Title: Socio-demographic profile of patients with Pulmonary Tuberculosis associated with psychiatric co-morbidities.

INTRODUCTION: Tuberculosis (TB) is an infectious disease caused by Mycobacterium Tuberculosis and is one of the leading cause of mortality worldwide. Presence of various psychiatric co-morbidities can have impact on treatment of tuberculosis and Identifying and treating them can increase cure rates of tuberculosis.

AIM AND OBJECTIVES- The aim of the study is to assess the psychiatric co-morbidities and their relationship with socio-demographic variables in patients of pulmonary tuberculosis.

MATERIAL AND METHODS- A total of 120 patients diagnosed with pulmonary tuberculosis from the department of respiratory medicine were assessed for the presence of psychiatric co-morbidity using Mini International Neuropsychiatry Inventory (MINI).

RESULT- Overall psychiatric co-morbidities were found in 54 (45%) patients out of 120. The frequency of co-occurrence of different types of psychiatric disorders was as following: depression 22.5%, social phobia 9.2%, panic disorder 7.5%, obsessive compulsive disorder 5.8%, generalized anxiety disorder 4.2%, alcohol dependence 2.5%, suicidality 1.7%. Among socio-demographic parameters, marital status and educational level were associated with psychiatric co-morbidities in pulmonary tuberculosis patients. psychiatric co-morbidities were found to be more in singles and patients with lower educational level.

CONCLUSION- Psychiatric comorbidities were found to be a common problem with pulmonary tuberculosis. The Results of this study are in line with many different research works both in India and abroad. A proper address of this issue is important for the management, better outcome and policy making in patients with pulmonary tuberculosis.

Presenting author: Kumar Utkarsh ¹

Co-authors: Rishi Rana ², Rakesh Yaduvanshi ³, Abhinav Kuchhal ⁴

Designation and institute: 1. Junior Resident 2. Junior Resident (Pulmonary Medicine) 3. Associate Professor 4. Assistant professor. Department of psychiatry Rohilkhand medical college and hospital Bareilly up.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP51: THE STATUS OF CLINICAL AND FORENSIC PSYCHIATRY ON: PROSECUTION WITNESS EVIDENCE MANAGEMENT IN INDIAN JUDICIARY

Babul Bandyopadhyay ¹

The medical treatment schedule of patients having mental disorder in the clinic/ hospital are always followed up by the practicing psychiatrists and psychologists, as guided by the principles of clinical and mental health acts and laws. However, sometimes the situations of conflicts arose when the patient refused the treatment and filed civil and/or criminal suits at the court in the matters. The mental health professionals are summoned at the Court in both civil and criminal cases of disputes when accused of breach of contract, negligent acts and behavior, and violation of the rights of the patients, as and when needed. This study accounted the treatment schedule of mental illnesses (n=14) that required determining the exact status of clinical and forensic mental health of the patients, for which the concerned prosecution witness evidences were necessary in the Court of law to defend the treatment for the interest and welfare of the patient, community and the system. But quiet unexpectedly, in some cases (n=6), the psychiatrists and psychologists outright refused to receive the subpoenas to avoid personal appearance before the Court willfully disregarding the legal system. Consequently, the Apex Court and trial Courts also failed to present the subjects of mental disorder even in the conclusive judgment orders (n=18). It absolutely violated the rights of the patient and accused involved in the conflicts and also by disobeying the psychiatry law system. These indicated and reflected the exact status and scenario of liabilities and ethical responsibilities of the physicians and maintenance of the mental health Act, clinical laws and acts and on the inactive system management as an unwelcome event at the Judiciary in The Welfare State of India.

Key words: mental illness, conflict, evidence management, forensics, Court, Judgment

* Address for Correspondence:

Dr. Babul Bandyopadhyay

M.Sc(Chem)(CU). MSW(RBU), Ph.D.Sc.(CU), FIC(IICI), Chartered Chemist(IICI),

DFAS (YCTC WB.Govt), DDP(YCTC WB.Govt), DITA(YCTC WB.Govt),

PGDC (CU & LASWB), PGD G &P C(RBU), PGDCFT(JU)

PGDSW(RBU),PG DHR(NUJS),

Medical Forensic Scientist Forensic Science Laboratory, West Bengal 47 Arabinda Pally P.O. Behala Kolkata 700034

email< bblb88@hotmail.com > M= +919830376862

www.forensicbabul.com IPS Membership LAM/B01/18

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP52: TITLE: Alcohol dependent syndrome as a consequence of non-motor symptoms of Parkinson's Disease

Nikhita Kulkarni ¹, K V Rami Reddy ²

BACKGROUND: Non-motor symptoms of Parkinson's disease like anxiety, sleep disorders, and cognitive disturbances are common and can be present before diagnosis.

AIM: This case report is being presented to highlight the maladaptive coping mechanism of non-motor features of Parkinson's disease (depressive and anxiety symptoms)

CASE SUMMARY: A 53-year-old man presented with a history of alcohol consumption from the past three years, citing stress and depressive symptoms, sleep disturbances. From the past one year, he had developed of craving, loss of control, tolerance, and use despite harm along with bio-socio-occupational dysfunction. His family members reported frequent anger outbursts, argumentative behavior, mood swings over the last six months. History of rest and action tremor for three years. He was brought to the OPD with a one-week history of ideas of persecution, second person auditory hallucinations and, tremulousness. Physical examination revealed tachycardia, diaphoresis, and a coarse bilateral resting and postural tremor.

Neurological examination revealed hypophonia, rigidity in both upper limbs, bradykinesia, mask-like facial expression. Cognitive functions revealed no abnormalities, MRI revealed age-related cerebral atrophy. He was diagnosed to have Parkinson's disease.

Even after detoxification with benzodiazepines, tremor, rigidity, and bradykinesia persisted.

CONCLUSION:

The above case highlights that the patient probably developed alcohol dependence as a maladaptive coping mechanism to deal with non-motor symptoms (anxiety and depression) of Parkinsonism.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP53: Abstract for poster presentation Title: Complicated alcohol withdrawal presenting with self-mutilation – A Case Report

Amit Kumar A Kalagi ^1,^✉, Yamini D MBBS ², HChandrashekhar ³

Introduction

Self-mutilation is understood as self-injury to body without an intent to end one's life. Several studies have reported association between substance abuse and self-mutilation. The prevalence of self-mutilation has been reported as 33% to 34% among those who are substance dependent. Alcoholic hallucinosis is a type of complicated withdrawal state characterized usually by third person auditory hallucinations, often derogatory or commanding or fragments of conversation or music and occasional secondary delusions, occurring in clear consciousness. The sufferer engages in dangerous acts during this experience.

Case description

Mr. M, a 30-year-old male from a rural low socioeconomic status, premorbidly with low frustration tolerance, with past history of three episodes of seizures during alcohol withdrawal.

He presented with alcohol drinking since 17 years, dependence pattern of drinking since 8 years, and abstinence since 3 days with self-injury to left little finger and superficial breach over ventral aspect of penis, auditory hallucinations commanding type since 2 days with clear consciousness and disturbed bio-socio-occupational function.

Treated with lorazepam and haloperidol injection and tab risperidone for 7 days and wound care. Patient symptoms improved and discharged.

Unique aspects of the case: clear consciousness self-mutilation.

Keywords; alcohol dependence syndrome, commanding hallucinations, self-injury over little finger and penis.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP54: Musical Hallucination: auditory variant of Charles Bonnet Syndrome

(case report)

Musical hallucination is a type of complex hallucination when music is perceived without external source. This is very rare in general hospital setting and with heterogenous origin. Possible etiologies are deafness, psychiatric disorders such as schizophrenia, major depression, use of medication and stress, besides neurologic diseases including epilepsy, stroke and cancer. Uncommon etiologies encompass infectious diseases, metabolic disorders. The case being reported here, a 60 year old unmarried lady started to experience musical hallucination after she developed bilateral sensorineural hearing loss following a road traffic accident. After many unsuccessful trial with many psychotropics, she was advised to reconsider for change of her hearing aid and that improved her condition and she is now undergoing treatment. The possible physiopathology of musical hallucinosis in this case might be the disinhibition of auditory memory circuits due to sensory deprivation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP55: Effect of repetitive transcranial magnetic stimulation on cognition in major depressive disorder: a retrospective chart analysis

BACKGROUND

RTMS is an FDA approved treatment for depression, with studies indicating positive effects on cognition.

AIMS

To retrospectively assess the change in cognitive functioning and depressive symptoms in patients who receive high frequency-rTMS over left DLPFC as prescribed for their depressive episode.

METHODS

This retrospective study included 16 people aged 18-45 years who were referred by their primary psychiatrists affiliated with VIMHANS-NEW DELHI a tertiary care psychiatric centre, these individuals underwent 10 sessions of high-frequency rTMS over their left DLPFC given over 2-week period as an augmentation treatment for their depressive episode along with pharmacotherapy. BDI-2 was applied pre and post rTMS sessions to monitor changes in depressive symptoms, to evaluate cognitive changes selected tests from NIMHANS neuropsychological battery were applied. Statistical significance for analysis was set as p<0.5. Study was done after approval from institutional ethics committee.

RESULTS

Paired sample t – test was used for analysis, overall the mean BDI-2 scores fell from 25.93 to 21.56(statistically significant(SS)) with four patients achieving partial treatment response, on Rey's auditory verbal learning test the long term percent retention scores increased by a mean of 1.36%(statistically not significant), the mean time taken in digit symbol substitution test improved from 283.62 seconds to 277.75 seconds(SS), the mean number of words on language fluency test marginally improved from 11.92 to 12.70(SS), in trail making test the mean time taken fell from 134.56 to 124.87 seconds(not significant) and on digit span test the average scores improved from 8.6 to 9.3(SS)

CONCLUSIONS

Although reflected in a retrospective study with small sample size, these results suggest that patients receiving rTMS as a treatment for major depressive disorder show improvement in cognitive functioning in early phase of treatment, hence large scale prospective trials evaluating the benefits of incorporating cognitive battery tests as routine evaluation for patients receiving rTMS for depressive episode to serve as an early predictor for antidepressant response is needed.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

EP56: Psychogenic Dysarthria: A case Report

Chintan Savani ¹, Chirag Barot ²

Abstract:

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):S74–S122.

EP57: Shared belief or Pseudocyesis or Delusion of Pregnancy: A Dilemma

Shivani Kanani ¹, Ritambhara Mehta ²

INTRODUCTION:

Shared belief, Pseudocyesis or Delusion of pregnancy are rare syndromes with blurred line of demarcation. In Pseudocyesis the patient has symptoms of pregnancy without confirmation. Delusion of pregnancy mostly occurs in females with schizophrenia, usually on anti-psychotics with related high prolactin levels, amenorrhea and galactorrhea as apparent manifestations giving somatic experience of pregnancy. Few cases, most from developing countries are reported.

CASE REPORT:

A 30-year-old married female was brought by husband with complaints of bodyache, headache, weakness, excessive menstrual bleeding. 8 months back she had amenorrhea, vomiting in early morning, giddiness, craving for sour food, weight gain, feeling of foetal movement, used to measure abdominal girth and felt that she was pregnant. She presented repeatedly to Obstetrics OPD, but her repeated UPT and USG abdomen were negative, was told the same repeatedly and lastly was referred to Psychiatry. Despite knowing these negative results, she was fully convinced that she was pregnant. She even felt increasing abdominal girth and fetal movements. After 5 months she had her menstruation and she started thinking she had aborted.

Her family, herself included, desperately wanted another male child as has only 8-year-old daughter. She is spiritual, superstitious, visiting healers and priests, believing in their predictions of her pregnancy. Her detailed Psychodynamics will be discussed.

DISCUSSION and CONCLUSION:

Mostly pseudocyesis occurs in infertile female living in a pronatalist society with social contexts and cultural beliefs contributing in the context of simultaneous wish and fear of pregnancy, emotional conflict, stress and ambivalence. In this case strong emotions and desire for a baby, her family environment, social belief were significant.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM1: Challenges in Bipolar Disorders (BD): Diagnostic and Therapeutic

BD is a unique disorder, one and only, in the vast arena of Medical Sciences!
Practicing clinician encounters enormous challenges in dealing with patients with BD!
On one side it is so simple and benign – 1. if any examiner dares to keep a spotter

in the clinical examination of PG Psychiatry, it will be Mania – typical John Cade's Mania with Grandiosity;

three sentences are enough to conclude a definite diagnosis of Mania, and with it the diagnosis of BD.

2. And Recovery is a rule in every episode of BD……

On the flip side it is so complicated – 1. Diagnostic dilemmas, in younger age group,

more often the Differential Diagnosis with Personality Disorders (OCPD, Borderline…), not other psychoses.

I, myself, would not have believed this a decade ago!

2. Therapeutic Challenges which are too many, at every stage of BD – Mania, Bipolar Depression, and Prophylaxis!

The clinical question is – Are we doing it right in our patients with BD? We as clinicians owe a responsibility to get our BD patient functionally reintegrated!

This symposium is about sharing a decade long clinical experience at Asha Bipolar Clinic (ABC)

Dr M S Reddy

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM2: Infant Mental Health workshop

Journey through the infant's world

Infant Mental Health deals with the social and emotional wellbeing of infants, toddlers and their families or those who share responsibility for their care and nurturing. It is one of the most important and rapidly developing areas, yet there are not many services in India who cater to this need. The current workshop throws light on the important aspects of Infant Mental Health.

It covers the following areas – Brief overview of Infant Mental Health, definition, scope and importance. Later we discuss about the Core Concepts in Infant Mental Health, common problems in infancy, diagnostic classifications, assessments in infants, and therapeutic interventions with a special focus on Attachment in infants and toddlers.

Who should attend?

The workshop would benefit Paediatricians, Child and Adolescent Psychiatrist with interest in infants and toddlers, Neonatologist, psychologist, and social workers.

Dr.Satya Raj MD, DPM, DNB, FRANZCP

Consultant, Child and Adolescent Psychiatry Unit, Christian Medical college, Vellore. Recently started the first Infant mental health clinic – in CMC – Infant Mother Nurture clinic.

Was working as Infant Mental Health Consultant in Queensland, Australia. Trained in attachment-based interventions and Circle of security. Has more than 14 papers in various National and International journals. Conducts workshop for Paediatricians, psychiatrists, psychologist and school teachers. Has a keen interest on School Mental Health, attachment and childhood trauma. Recently conducted a 1 day workshop in Infant Mental Health in NIMHANS.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM3: IPS SPECIALITY SECTION: SEXUALITY EDUCATION

TSS Rao ¹, Suparna Telang ², Sumesh Khanna ³

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYMPOSIUM TITLE: DEVELOPMENT AND TRENDS IN SEX EDUCATION

TS Sathyanarayana Rao ¹

Secretary, Psychiatry and Human Sexuality Section, WPA

Editor, Journal of Psychosexual Health

Email: tssrao19@gmail.com

Sub Topics:

1. Principles of Comprehensive Sexuality Education – Dr. Sumesh Khanna

2. School Education and its Relevance to India – Dr. Suparna Telang / Dr. Suman S Rao

3. Sex Education for Patients and Public – Dr. T.S.S Rao

ABSTRACT

The goal of sexuality education is comprehensive, multifaceted and are based on broad considerations of acquiring knowledge, motivation and personal insight to acquire skills to maintain and enhance sexual health and to avoid sexual problems. SEICUS (2011) defines that “Human Sexuality encompasses the sexual knowledge, beliefs, attitudes, values and behaviours of individuals. Its various dimensions involve the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles and personality; and thoughts, feelings and relationships. Sexuality is influenced by ethical, spiritual, cultural and moral concerns. All persons are sexual beings in the broadest sense of the word”. Even today the understanding of sexuality is mired with taboos and controversies. Historically learning of sexuality to a great extent based on behaviour and thinking of people time to time and it was fragmented, inconsistent and limited in its focus. Today it is very much broadened with emphasis on total person and the decision making. There are many approaches like Comprehensive Sexuality Education, Abstinence-based Education, Abstinence-only education, Abstinence-only-until-marriage-education and Fear-based education. There are issues, implications and controversies regarding each of them. Even in clinical practice and many studies indicate that sexual misinformation and myths are still common. Sex education is dealing accurately with topical areas and concerns. Sexuality education is not the same as sexual counselling, but both may be related. The symposium looks at principles of comprehensive sexuality education in general and school education and its relevance to India in particular. It is also attempts how to utilize the same in our day-to-day practice both concerning patients, clients and the public.

Keywords: Comprehensive Sexuality Education, Sex Education, Sex Education in schools, Myths and misconceptions, Sex education in therapy.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM4: Title:: Working in teams: Addressing the growing need of patients with neuro-psychological disabilities

Aparna Dutt ¹, Anirban Dutt ^2,³, Sanjay Garg ⁴, Farzana Mulla ⁵, Soumitra Datta ^7,7

Abstract:

India is facing a ‘hidden epidemic’ of neuropsychological disability resulting from cerebrovascular accidents, dementia, traumatic brain injury, and also post brain tumour/post encephalitis sequalae. However, clinical management of neuro-cognitive disabilities is seldom multi-disciplinary, often restricted to purely medical management largely in the absence of goal-directed neuropsychological treatment plans. The impact of the disability on the patient and family is not always addressed. Even when referrals are made to neuropsychology services, they are mostly for neuropsychological assessment of patients and not with the expectation of a neuro-rehabilitation plans. Collaboration between psychiatrists, neurologists and neurosurgeons is thus an urgent need of the hour.

The present symposium aims at generating collaboration between psychiatrists, neurologists and neuropsychologists in the management of the patients and its implications. It will inform participants ways to formulate a problem from a neuropsychological formulation and how to foster and build a team of professionals to work together with patients with neuropsychological disabilities and their family members. The symposium will be interactive with case studies and help participants learn about team working.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM5: Recent advances in neurosurgical interventions for obsessive-compulsive disorder

Presenters:

1. Neurobiology of OCD: relevance for surgical and neuromodulatory targeting

Shyam Sundar Arumugham, Additional Professor of Psychiatry, Consultant OCD Clinic, National Institute of Mental Health and Neuro Sciences, Bangalore

2. Deep brain stimulation and ablative surgeries for OCD: Evidence and techniques

Dwarakanath Srinivas, Professor of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Bangalore

3. Neurosurgical interventions for OCD: pragmatic aspects related to patient selection and management

YC Janardhan Reddy, Professor of Psychiatry, Consultant OCD Clinic, National Institute of Mental Health and Neuro Sciences, Bangalore

Around 10-20% of patients with obsessive-compulsive disorder (OCD) are refractory to standard pharmacological and psychological interventions. Neurosurgical interventions, including ablative surgeries and deep brain stimulation (DBS) are helpful in a subset of these patients with chronic, severe and treatment refractory illness. Recent advances in neurobiology and neurosurgical techniques have improved the targeting and safety of these procedures. Further, surgical procedures such as DBS provide unique opportunity to study subcortical structures and their role in pathophysiology of OCD. Towards this end, the presenters of the symposium have initiated a research project to identify biomarkers that predict response to deep brain stimulation (DBS) over subthalamic nucleus (STN) for OCD. In this symposium, Dr. Shyam Sundar Arumugham would discuss the current understanding neural circuitry and electrophysiology of OCD, with relevance to neurosurgical targeting and understanding the mechanism behind these interventions. Recent imaging findings suggest involvement of the partially segregated cortico-striato-thalamo-cortical circtuits in OCD, with various neuromodulatory interventions acting at different levels along these circuits. Dr. Dwarakanath Srinivas would discuss the current evidence for ablative surgeries and DBS in OCD, focusing on recent advances, such as magnetic resonance guided focused ultrasound and closed loop stimulation. Dr. YC Janardhan Reddy would discuss the pragmatic aspects of surgical interventions such as patient selection, consenting process, ethical/legal aspects and long term clinical management of these patients.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM6: IPS Technology and Psychiatry Task Force National Workshop on “Digitalization and Psychiatry: iClinic to i-Practice”

Parmod Kumar ¹, Vikas Thanvi ², Darpan Kaur ³

Background: Technology shall have huge implications in psychiatry in the near future. Literature highlights that research has been undertaken for studying role of technology in improving diagnosis in psychiatric disorders, development of new tools, imaging modalities, novel precision medicine, i-based psychotherapy as well as preventive approaches in mental health. Digital health related interventions are positioned to play a vital role in future based on accessibility and user engagement and needs rigorous evaluation for its effectiveness.

Aims and Objectives: To create awareness and enhance knowledge and skills of psychiatrists towards technology and its application to day to day psychiatry clinical practice.

Methodology: The workshop shall focus on skill building in domains of digitalization and psychiatry practice. Skills related to setting a digital iClinic and running a digital ipractice shall be emphasized. The intended target audience for the workshop shall be psychiatrists who wish to upgrade themselves with technological advances and learn techniques for digital electronic record keeping, Electronic Communication, E prescription and i-Therapy. The participants of the workshop maybe encouraged to bring their own smart phones, ipads, laptops so they can have hands on training experience. The faculty shall conduct live demonstrations on digital history taking, record keeping, prescription writing and digital therapies.

Conclusion: The workshop shall conclude towards discussions and Q and A on relevant medicolegal aspects of digitalization, technology and psychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM7: SUICIDE

1. NEUROBIOLOGY OF SUICIDE: Suicide is a complex phenomenon involving various neural networks in the brain – Dr. LAXMI Naresh Vadlamani 2. PSYCHIATRIC DISORDERS AND SUICIDE: The pathway to Suicides includes several psychiatric disorders. Morbidity and prevalence are discussed – Dr. Virinchi Sharma 3. EVIDENCE BASED PREVENTION STRATEGIES: Prevention of Suicides is possible and various evidence based strategies are discussed – Dr. Daljeet Kaur

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM8: Magnitude of drug use in India and the existing policy and program framework for response: A road map for evidence-informed drug supply control and demand reduction

Atul Ambekar ¹, Ravindra Rao ², Alok Agrawal ³, Ashwani Mishra ⁴

Introduction: Recently available data on alcohol and drug use in India provides important leads for reforms in the laws and policies aimed at controlling the availability as well reducing the demand. This applies to legal as well as illicit products.

Methods: In collaboration with other institutions and agencies, we conducted a National Survey (all the states and UTs) using Household Survey and Respondent Driven Sampling (with multiplier). Data from the survey was analyzed to generate estimates of people using substances and people affected by substance use disorders. We also examined this epidemiological data in the light of relevant policies and laws.

Results: For all the psychoactive substances prevalence tends to be higher among adult males. There are considerable inter-state variations in the prevalence. For Alcohol there are large variations in state policies. Data indicates that even in prohibition states a substantial number of people consume alcohol which is the legally produced (in other states) and illegally marketed. In general, the trend is towards higher taxation of low-alcohol beverages (like beer and wine) as opposed to distilled spirits, reflecting in the higher consumption of spirits as opposed to beer. Among Illicit Drugs Cannabis and Opioids have the highest prevalence. Among cannabis products, prevalence of cannabis use disorders is higher for Charas / Ganja as compared to Bhang. Among opioids prevalence of use as well as use disorders is highest for heroin. Pharmaceutical products are also used by a large number of Indians but the prevalence of use disorders is low for this category. Inhalants is the only category for which prevalence is higher among children than adults.

Discussion: India has enacted the stringent NDPS Act which criminalizes drug consumption and has subjected all narcotics and psychotropic drugs to equal degree of control. Legal and policy reforms are required so that the socio-culturally sanctioned low-potency substances (like cannabis and opium) are regulated differently as compared to the high-potency, more addictive substances (like heroin). There is an urgent need to put in place a graded and calibrated supply-control response according to the propensity of the drugs to cause public health harms. Bhang is a legal product in India with government-regulated market in many states. This markets needs to be expanded since data shows higher prevalence of high-potency, illegal cannabis use, as compared to low-potency bhang, in the states with no legal, regulated bhang market. India had a thriving system of regulated supply of opium and poppy husk to registered users till few years back, which has been discontinued. It need to be revived to prevent escalation of the heroin market. Stringent controls over pharmaceutical products makes access difficult for the patients who need them for medical purposes. The alcohol tax policies need to be reformed to discourage consumption of high-potency beverages as compared to beer and wine. Overall there is a need to move from a criminal-justice led response to health and welfare led response to address drug problems. Decriminalization of drug use needs to be a priority agenda. Enhancing the availability of treatment and harm-reduction services are the need of the hour.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM9: Cyberporn

Sex is everywhere these days--in books, magazines, films, television, music videos Commercial ads and internet. The availability of widespread public access to the World Wide Web in late 1990s led to the growth of Internet pornography. Cybersex is a virtual sex encounter in which two or more people connected remotely via computer network send each other sexually explicit messages. Statistics of cyber porn is alarming as ten crores of online users out of which two crores visit Porn websites , two lakhs sexual sites present in the web , around 500 sexual websites added each day and One out of four who browse porn view child porn websites.

Spurred by the proliferation of the Internet in the past two decades, access to sexually explicit material and the potential impact of pornography use have become increasingly significant issues in public discourse and policy debates. Anti-pornography campaigns, which equate pornography to a highly addictive drug, have gained traction and even been given a platform in public schools. The effects of pornography—and whether it is addictive—are also being debated within academia and by mental health professionals. Increasing numbers of professionals are purporting to specialize in pornography addiction treatment. Men and women perceive online sexual activity as threatening to a marriage as offline infidelity. Regarding the indirect impact on children of living in a home where a parent uses pornography, there is evidence that it increases the child's risk of exposure to sexually explicit content and/or behaviour. Pornography addiction is a reliable correlate of sexually aggressive behaviour. Meta-analyses of experimental studies have found effects on aggressive behaviour and attitudes. That pornography addiction correlates with aggressive attitudes in naturalistic studies has also been found.

Speakers:

Dr.Kota suresh Kumar M.D Psychiatry – Professor and HOD, katuri medical college , Guntur.

Dr.Saikiran Pasupula M.D Psychiatry – Assistant Professor, Katuri medical college , Guntur.

Dr.Meesala Sravanthi D.P.M - senior resident, katuri medical college, Guntur.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM10: Symposium title: Psycho-oncology: Mind and body in cancer

Soumitra Shankar Datta ¹, Kamalika Roy ²

Introduction:

Routine psycho-social care is warranted for all cancer patients. This has become increasingly relevant in the context of cancer patients surviving longer. However, in the current decade, as much as having a good quality of life, having a ‘good death’ has been held to be important. The present symposium will help audience to learn about newer developments in psycho-oncology.

The suggested talks are:

Establishing a psycho-oncology service: by Dr Arnab Mukherjee (Consultant Psychiatrist at Tata Medical Center, Kolkata)

Psycho-oncology is a relatively new sub-specialty of consultation liaison psychiatry that deals with the interplay of biological and psychosocial factors in the development and outcome of psychological and behavioural symptoms in cancer. Pre-existing psychiatric illness, fear associated with receiving cancer diagnosis, need for undergoing painful interventions, loss of autonomy and functionality, financial concerns, central nervous system involvement, chemotherapeutic agents and many other factors individually and jointly increase the risk of psychological morbidities in cancer patients. In this symposium, we would evaluate the need and steps of establishing psycho-oncology services in secondary and tertiary care hospitals.

Managing suicide risk in oncology: by Prof Sujit Sorkhel (Associate Professor of Psychiatry at IPGMER, Kolkata)

This talk will talk about specifically managing suicide risk in oncology patients. The last government data showed that 1% of all patients who died due to completed suicide were diagnosed to have cancer. ‘Adequate pain control’, 'sensitization and engaging of patients, family members and staff of cancer hospitals’ and other strategies help in managing suicide risk in cancer patients. Participants will be able to engage in a discussion about how to manage these patients in a pragmatic way in an oncology setting.

Physician-assisted death in cancer patients: by Prof Kamalika Roy (Assistant Professor of Psychiatry at Department of Psychiatry, Oregon Health and Science University, United States)

Physician-assisted death (PAD) refers to the legal use of prescription and or administration of a life-ending medication in response to a voluntary request from a patient with intact capacity, with an irrecoverable terminal illness where palliative options were tried, or knowingly not used by the patient. Several terminologies refer to a similarly legislated process in many countries and jurisdictions including Switzerland, Belgium, Netherlands, Luxemburg, Colombia, Victoria (Australia), Canada, and many states in the United States of America (Oregon, California, Washington, Hawaii, Montana, Vermont, Washington D.C., and Colorado). The terms “physician-assisted suicide” (PAS), “Voluntary Aid in Dying” (VAD), “Medical Assistance in Dying” (MAID) are synonymous, though the use of the term “suicide” has been criticized by many.

Data from several countries showed the most common reason for such requests were existential and psychological suffering and perceived loss of control and dignity. The most common underlying medical condition was cancer. Most countries do not require a mandatory psychiatric evaluation for such requests though it has been a matter of debate in some cases. Although a mandatory psychiatric evaluation might be burdensome and unnecessary in most of these cases, there might be an important role of psycho-oncologists due to the nuanced expression of mood and anxiety disorders and their effect on decisional capacity in terminally ill patients. We will highlight some data from different countries on legal PAD and discuss their potential implications in the psychiatric practice in India, with an interactive audience voting system.

Psycho-social care in familial cancer syndrome: Dr. Soumitra Shankar Datta (Consultant Psychiatrist at Tata Medical Center, Kolkata)

Psycho-social care of familial cancer syndromes especially in hereditary breast and ovarian cancer (HBOS) cancers require specialist expertise. Experience of cancer in near relatives, past bereavement experiences, dealing with survivor guilt, having an anticipation of the possibility of developing cancer and guilt associated with ‘passing on’ the gene to off-springs are common causes of emotional turmoil in patients with HBOS. This part of the symposium will help the participants to become familiar with this upcoming area of psycho-oncology.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM11: Title: ICD-11: Comprehensive assessment of existing diagnostic criteria and new diagnostic entities.

Jayapaprakash Russell Ravan ^1,^✉, Jigyansa Ipsita ², Pratheek PVR ¹

Topics:

Topic 1: ICD -11: Introduction, Conceptual differences from ICD-10 in Psychiatric Diagnoses

by Dr. Pratheek PVR

Topic 2: Newer diagnostic entities in ICD-11 related to psychiatry

by Dr. Jigyansa Ipsita

Topic 3: Coding and possible impact of ICD-11 at various levels – Social, Research, Day to Day practice by Dr. Jayaprakash Rusell Ravan

Learning objectives: The advance preview and understanding of ICD-11 will allow in future planning and clinical utility of the new version. Our symposium will help the participants to have insight into the process of development of ICD 11, conceptual changes of future oncological system as compared to ICD10. Other important learning objective would be to find out new diagnostic entities in the field of mental health and psychiatric illnesses. The proposed symposium would also throw light upon the possible coding system and its future implication in area of research and clinics, which might revolutionise the understanding of psychiatric disorders.

Main abstract:

Substantial advancements in Medicine and Biological Sciences have occurred over the last few decades. In current scenario ICD-10 is gradually perceived as outdated, both clinically and from a classification point of view.

The ICD is the foundation for identifying health trends and statistics worldwide, and contains around 55,000 unique codes for injuries, diseases and causes of death. It provides a common language that allows health professionals to share health information across the globe.

The development of the ICD-11 over the past decade is based on the principles of clinical utility and global applicability. ICD-11 will be one of the broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders.

There is a felt need in the area of mental illness for crucial structural and conceptual changes. These changes are proposed and adopted through a rigorous process in psychiatric diagnosis such as neurodevelopmental disorders, neurocognitive disorders, Obsessive compulsive related disorders, PTSD.

This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.

Abstract for each presentation

Topic 1: ICD -11: Introduction, Conceptual differences from ICD-10 in Psychiatric Diagnoses

Changes in the ICD-11 include the provision of consistent and systematically characterized information, lifespan approach, and culture-related approach for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence. Here we describe major conceptual changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, Such as in the area of neurocognitive disorders, neurodevelopmental disorders, Anxiety/fear related disorders, OC related disorders, etc.

Topic 2: Newer diagnostic entities in ICD-11 related to psychiatry

To demonstrate set of new categories those have been added to the ICD-11 and present the rationale for their inclusion. Based on scientific validity, consideration of clinical utility and global applicability, a number of new disorders have been added to the ICD-11. Description of these new diagnostic entities at various levels such as Bipolar II disorder, Internet Gaming disorder, prolonged grief disorder, complex PTSD, AFRID, bodily distress disorder, etc.

Topic 3: Coding and possible impact of ICD-11 at various levels – Social, Research, Day to Day practice

To bring the uniformity in the registry of mental illnesses appropriate coding is essential across counties and regions of the world. Coding pattern of various psychiatric disorders under ICD-11 is being changed. The digital version of coding tool - ICD-11 Coding Tool, Mortality and Morbidity Statistics (MMS), April 2019 will be demonstrated. The psychiatric disorders are coded from 6A00-6Z99. Some disorders such as sleep related and sexual related health problems are coded elsewhere. This new version of ICD-11 can have significant impact at various levels such as epidemiological prevalence of disorders, research on newer diagnostic entities, changes in day to day clinical practice.

Key words: ICD 11, ICD 10, Conceptual changes, new psychiatric diagnosis, Coding.

References

1.Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. Geoffrey M. Reed, Michael B. First et al. World Psychiatry. 2019 Feb;18(1):3–19. doi: 10.1002/wps.20611. Published online 2019 Jan 2. doi: 10.1002/wps.20611. [DOI] [PMC free article] [PubMed] [Google Scholar]
2.ICD-11, Classification of diseases by WHO. https://www.who.int/classifications/icd/en/
3.ICD-11 Coding tool, Mortality and Morbidity statistics. https://icd.who.int/ct11/icd11_mms/en/release .

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM12: Workshop

Sona Kakar ¹, Ajit Bhide ², Ashlesha Bagadia ³

The borderline personality offers a huge challenge to mental health professionals. It is challenging to be able to diagnose it due to a host of comorbidities but the often the greater challenge comes up in management. Other than psychiatric treatment a sustained long- term psychological therapy has now become the mainstay of treatment. Building a strong working relationship with this category of patients becomes the foremost task. However, ambivalence and emotional dysregulation as well as acting out tendencies threaten to disrupt any work with this group.

In this workshop we will be discussing the challenges in identification and working with BPD patients and various evolving evidence based ,psychological therapies for this group. In particular we will share our experience of using Mentalization and Intensive short- term psychodynamic psychotherapy treatments with this group of patients. We will discuss both the theory behind the treatments as well as demonstrate practical work through role play and audio- visual methods.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM13: Skills Development for Psychiatric Nurses in West Bengal. The UKIERI project.

David Keen ¹, Krishnangshu Ray ¹

Introduction

Providing quality care to people with mental health conditions presents a major challenge in both the UK and West Bengal. People with mental health conditions can face stigma from healthcare professionals, their families and the general public. In the UK at least one in four people experience a mental health problem at some point in their lives. The wider economic costs of mental illness in England are estimated at between $86-126 billion (₹6 – 8.6 lakh crore) each year. In India between 6-7% of the population are thought to suffer from mental or behavioural condition, accounting for 12% of the disease burden. Among non-communicable diseases (NCDs), mental health is the largest contributor to economic loss in India. It is estimated that mental health will account for 20% of economic loss from NCDs by 2030, which is estimated at $6.2 trillion (₹6.2 lakh crore).

Given the common prevalence of mental disorders in both UK and India, as well as the long history of both countries collaborating in health education and research, a joint approach in training presents an ideal opportunity to tackle some of the aspects of treatment of individuals with serious mental health disorders.

The Institute of Health and Family Welfare (IHFW) in West Bengal and Health Education England (HEE), UK, have been awarded a grant from the UK India Education and Research Initiative (UKIERI) to support a 2 year programme of work which aims to empower and enable nurses in West Bengal to develop an integrated and systematic approach to provide quality care to patients with mental health conditions.

Aim

The programme of work has focused on upskilling nurses in psychiatric hospitals to better deal with patients who are exhibiting challenging behaviour – a key issue which was identified by nurses working in inpatient mental health settings in West Bengal during a scoping visit. The expectation is that, by association, psychiatric trainees and other health professionals will also be engaged in this exercise, providing additional benefits within the services engaged in this exercise.

’Behaviour can be described as challenging when it is of such an intensity, frequency, or duration as to threaten the quality of life and/or the physical safety of the individual or others and it is likely to lead to responses that are restrictive, aversive or result in exclusion.’³

Outputs

The UKIERI project is expected to nearing completion early in 2020 and the project team will have the following outputs to report on at the ANCIPS conference:

Fifty nurses would have attended a train-the-trainer workshop which will upskill them into ‘Transformational Educators’.
The creation of an online ‘community-of-practice’ for the transformational educators which will support the exchange of knowledge, peer co-operation and it will link trainers to UK and Indian experts.
The Transformational Educators will have begun to roll out the training to psychiatric nurses who are working in the pilot hospitals with data collected on the behavioural change which has been observed.
A review of patient information leaflets identifying good practice from across both countries will result in more upto date information being available to patients, in multiple languages.
Dissemination of information about the UKIERI project will encourage institutions both regionally and nationally within India, and in the UK, to co-develop, co-produce and share good practice, thus promoting the principles of evidence-based learning.

UKIERI project team:

¹West Bengal team:

Prof Krishnangshu Ray, Director, IHFW & Lead Partner; Ms. Mutiny Bandyopadhyay, Joint Secretary, Dept. of Health & Family Welfare, GoWB & Project Coordinator; Prof. Malay Ghosal, Professor of Psychiatry, Medical College; Dr. Aditi Chowdury, Assistant Professor of Community Medicine, IHFW; Dr. Jayita Pal, Consultant (Medical), IHFW.

²UK team:

David Keen RN, UKIERI Lead Project manager; Christopher Dzikiti RMN; Dr Lucie Byrne-Davis PhD, Health Psychologist & Senior Lecturer; Prof Jo Hart PhD, Health Psychologist; Rebecca Lingard, RMN; Prof JS Bamrah CBE, FRCPsych, Consultant Psychiatrist.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM14: TITLE OF WORKSHOP: Qualitative Research Methods for Psychiatry: A Hands-on Primer

Importance: Qualitative method is a broad umbrella term for research methodologies that describe and explain individuals’ experiences, behaviours, interactions, and social contexts. Researchers measure the frequency of occurring events using quantitative methods; however, qualitative methods provide a broader understanding and a more thorough reasoning behind the event. Hence, it is considered to be of special importance in psychiatry. Besides hypothesis generation in earlier phases of the research, qualitative methods can be employed in questionnaire design, diagnostic criteria establishment, feasibility studies, as well as studies of attitude and beliefs.

However, in India, the adoption of qualitative approach in psychiatric research is yet to reach its full potential. With this view, our workshop is proposed to introduce qualitative research as a potent method for undertaking psychiatric research across all its domains, from symptomatology to epidemiology.

The proposed workshop aims on participants gaining their first insight into doing qualitative research and equip them with analytical tools in order to design and carry out qualitative studies. In addition, it will familiarise them with some of the qualitative methods of inquiry commonly used in psychiatry such as in-depth interview, focus groups, and participant observation. The faculties will provide examples from their own extensive research to illustrate the application of qualitative research in the mental health field.

Learning Objectives: The participants would gain a basic understanding of:

§ Qualitative research and its principles

§ The difference between Qualitative vs. Quantitative research

§ Relevance of using Qualitative methods in psychiatric research

§ Formulating qualitative research study objectives

§ Identifying the appropriate study design

§ Designing the data collection methods

§ The process of qualitative data analysis and writing the results

§ The potential ethical aspects of qualitative research

Sub-topics for discussion

§ Introduction to Qualitative research and its principles

§ Relevance and Application Qualitative Research for Psychiatry

§ Designs and Approaches to Qualitative Research in Psychiatry

§ Data collection methods and Data Analysis

§ Writing the results

§ Hands on demonstration

§ Questions and Answers

§ Way forward and wrapping up

Faculties

1. Dr Tophan Pati

2. Dr Pranab Mahapatra

3. Dr Sanghamitra Pati

(The faculties are psychiatrists and public health researcher with considerable experience in qualitative research).

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM15: Symposium abstract for ANCIPS 2020

The main title of the symposium: Mental Healthcare Management Systems (MHMS) – The Integration of mental healthcare, information technology and Law

Name of Proposer: Dr D. Dinakaran, Assistant Professor (MHMS Project) Psychiatry, NIMHANS Bengaluru dina.nimhans@gmail.com

Brief bio-data of the proposer:

Dr Dinakaran is working as Assistant Professor in the mental healthcare management systems (MHMS) project, a Government of Karnataka Initiative in collaboration with the Dept of Psychiatry, NIMHANS Bengaluru and International Institute of Information Technology, Bengaluru (IIIT-B) . He is been working in the development of online portal to integrate mental healthcare services to comply with the mental healthcare act 2017 (MHCA-2017)

Titles of Sub-topics & Names of presenters of sub-topics

Titles of Sub-topics & Names of presenters of sub-topics

No	Sub-topic	Presenter
1	Introduction: Mental healthcare management systems (MHMS) – Need of the hour Co-author: Dr Suresh Bada Math	Dr D. Dinakaran Assistant Professor of Psychiatry (MHMS Project) NIMHANS Bengaluru dina.nimhans@gmail.com
2	Implications and Progress - MHMS Co-author: Dr C Naveen Kumar	Dr Alekhya Senior Resident, (MHMS Project) NIMHANS, Bengaluru dr.alekhya29@gmail.com
3	Challenges and Future directions - MHMS Co-author: Dr N Manjunatha	Dr. Sachin Nagendrappa Senior Resident NIMHANS, Bengaluru nsachin40@gmail.com

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Two learning objectives per symposium (up to 50 words)

1. To understand the need for technologically driven initiatives in integrating mental healthcare services to comply with MHCA 2017

2. To present the ongoing progress of the MHMS project, implications, challenges and future direction

Brief description and consolidated abstract of the symposium (max. 250 words)

Mental Healthcare Management Systems (MHMS) is an internet based Karnataka state-wide registry of Mental Health Establishments (MHEs), Mental Health Professionals (MHPs), People with Mental Illnesses (PwMIs) and their treatment records (including Advance Directives –AD & Nominated Representatives –NR). This platform helps establishments and professionals ensure compliance with Mental Health Care Act (MHCA 2017). MHCA 2017 mandates registration for all MHEs (public or private) operating under the jurisdiction of the respective State Mental Health Authority (SMHA). Centrally run MHEs are mandated to be registered with Central Mental Health Authority (CMHA). It is the duty of concerned authorities to register MHEs and maintain an online registry on the same. Mental Health Professionals (Psychiatrists from various medical streams, psychiatric social workers, clinical psychologists, psychiatric nurses) will also be registered with such authorities. Basic in-patient and out-patient medical records of PwMIs along with documents related to AD/NR could be registered and maintained online. Grievances arising during the care of PwMIs in accordance with the MHCA – 2017 could be effectively handled with the availability of an online portal. Standard procedures to redress the grievances would be possible by linking it with respective Mental Health Review Board (MHRB). To facilitate this online portal, a cloud based application called MHE and MHP registration portal has to be developed. This has scope to be further elaborated to include PwMI treatment details, Grievances and Redressals. According to recent National Mental Health Survey (NMHS 2015-16), current mental illness morbidity is 10.6% with treatment gap ranging from 70-92%. In a resource constraint nation like us with the health expenditure less than 4% of the gross domestic product, it is indeed essential to effectively utilise the available resources. Mental healthcare management system is the first step in integrating information technology and the mental health system. This integration is the need of the hour as directed by the MHCA 2017. This will ensure the use of existing resources to avail the greatest possible benefits. This will provide seamless services to the people in need and assist the right based approach as directed by the law. This will also provide the reintegration of people with mental disorders into all aspects of community life, thus improving the overall quality of life.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM16: Symposium Abstract: ANCIPS 2020: Neuroimaging in Psychiatry: Past, present and Future

Gagan Hans ¹, Vaibhav Patil ¹, Ragul Ganesh ¹

Abstract

A number of imaging studies using various modalities like MRS, PET, SPECT etc. have demonstrated that there are regional and illness specific brain changes at the onset of psychiatric disorders and in individuals who are at risk of developing psychiatric conditions¹ Similarly, many studies have demonstrated that there are specific measurable changes in the brain anatomy and function following the psychiatric medications which are directly related to clinical outcomes. As a result, a new field of radiology, termed psycho-radiology, seems primed to play a major clinical role in guiding diagnostic and treatment planning decisions in patients with psychiatric disorders.¹ The advances in the field of neuro-radiology in the past 25 years have provided one of the most powerful tools for advancing human systems-level brain science and psychiatry. The capacity to quantitatively assay human brain structure, function, and chemistry in vivo has revolutionized research. And yet, it is clear that progress along these lines remains in infancy and that cost-effective clinical relevance is the ultimate goal of translation of any discovery having profound impact on lives of patients and their families still lie ahead.

Keywords

Neuroimaging, depression, schizophrenia

1. Neuroimaging in Psychiatry: Past, present and future

Gagan Hans, Assistant Professor; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

Psychiatric conditions produce disruptions of perception, cognition, emotion, and behaviour that affect distinctly human mental life and behaviour. The advances in the field of neuro-radiology in the past 25 years have provided one of the most powerful tools for advancing human systems-level brain science and psychiatry. The capacity to quantitatively assay human brain structure, function, and chemistry in vivo has revolutionized research. And yet, it is clear that progress along these lines remains in infancy and that cost-effective clinical relevance is the ultimate goal of translation of any discovery having profound impact on lives of patients and their families still lie ahead.

2. Neuroimaging: Current Advances in neurobiology of Depression

Vaibhav Patil, Assistant Professor; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

Neuroimaging studies have established various anatomic and functional deficits in multiple brain regions in patients with MDD, especially prefrontal limbic circuits. There is evidence of significant grey matter decreases in prefrontal and limbic regions, mainly including the bilateral superior frontal gyrus, lateral middle temporal and inferior frontal gyri, and bilateral para hippocampal gyrus and hippocampus.³ Smaller hippocampal volumes have been of special interest in various studies which appears to be moderated by the age of onset and to be greater in patients with recurrent episodes. ⁴

3. Neuroimaging: Current Advances in neurobiology of Schizophrenia

Ragul Ganesh, Senior Resident; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi

Neuroimaging research has contributed significantly to the understanding of neurostructural and neurofunctional aberrations in schizophrenia. Neuroimaging studies have in schizophrenia have tried to link structural and functional abnormalities to symptoms and progressive structural changes to clinical course, treatment, and functional outcome. Some of these changes appear to relate to clinical manifestations. For example, patients with prominent negative symptoms, such as affective flattening, abolition, and apathy, have been reported to show greater reductions of grey matter volume in the temporal lobe.⁵ Regions which have been of significant research in these studies include medial prefrontal cortex, striatum, and thalamus.

References

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Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 17: NAME OF THE TOPIC: Psychological Phenomenon enveloped in the Cinemas of the Bengal Trio - Ray, Ghatak and Sen

DEBASISH SANYAL ¹, Rajashree Ray ², Sonali Choudhury ³, Suddhendu Chakraborty ⁴

ABSTRACT

Cinema is a powerful medium with a strong and emotional narrative which can allow people to be informed about any issue. Besides being a popular mode of entertainment, movies are the visions of a particular culture, place, community and psyche. Emotional and behavioural issues and the contemporary social issues have been powerfully depicted through cinema. Cinema is pre-eminently the medium that engages people in a virtual dialogue with their own and their culture's unconscious, more deeply than is commonly taken for granted. The movie theatre shares symbolic features with both the church and the therapy room: all are sacred spaces where people can encounter the archetypal and ease personal suffering, in the case of the cinema whether through laughter or tears, without inhibition or fear.

Satyajit Ray, Mrinal Sen Ritwik Ghatak created art house films, many of which revolve around the complexities of relationships, gendered desires, the intricacies of emotion and the often silent struggles that are inherent in everyday lived reality.

1) DEBASISH SANYAL---Brief overview of the issues involved e and give a broad perspective of the interface of films and psychological issues.

2) Rajashree Ray-Perspective of a Psychiatrist

3) Sonali Choudhury-Psychological and Psychoanalytic issues

4) Suddhendu Chakraborty,-perspective of literature and socicultural context

We all undertake to personally present our topic at the conference, if our symposia is selected

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM18: Abstract: Symposium: Title: Violence and Mental Health

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

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

1. Violence and Mental Health: Victim's Perspective

2. Violence and Mental Health: Offender's Perspective

3. Violence and Mental Health: Community Perspective

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

Dr. Bhaveshkumar M. Lakdawala, Professor and Head, Dept. of Psychiatry, AMC-M.E.T. Medical College and Sheth L.G. General Hospital, Ahmedabad, Gujarat, India E mail: dr_bmlakdawala@yahoo.co.in M: +919687284967 IPS: 02154

Dr. Rajendrakumar A. Thakrar, Professor and Head, Dept. of Psychiatry, S.M.S. Multi speciality Hospital and Shri M.K. Shah Medical College, Ahmedabad, Gujarat, India E mail: drrajoothakrar@gmail.com M: +919426268200

Dr. Rajvinder Singh Sambhi, Consultant Psychiatrist, Heddfan Psychiatric Unit, Wrexham, North Wales, UK.

E mail: raj.sambhi@gmail.com M: +447886815931

Dr. Prosenjit Ghosh, Assistant Professor, Dept. of Psychiatry, Silchar Medical College, Assam, India

E mail: p_ghosh72@yahoo.com M: 9435072563 IPS: 16161

Dr.Shobit Garg, Associate Professor, Dept. of Psychiatry, SGRRIMHS, Dehradun

E mail: shobit.garg@gmail.com M: 8958534261 IPS: 1906502018

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM19: Topic: Telepsychiatry in modern era - A comparison between global and Indian Telepsychiatry programmes.

A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centres of excellence. This symposium intends to perform a review on the various aspects of telepsychiatry. The various models of telepsychiatry-both asynchronous and synchronous models in practice will be elaborated upon with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt will be made to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario. The legal and ethical issues, along with a few words of caution and contemplation, will be briefly touched upon. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.

Speakers:

Dr. Subrata Naskar – Consultant Psychiatrist, Institute of Neurosciences Kolkata - Telepsychiatry – A brief history and its various international models.
Dr. Bhaktishree Raha - Consultant Psychiatrist, Institute of Neurosciences Kolkata - Uses, Effectiveness, Feasibility, acceptability and attitude towards telepsychiatry.
Dr. Sk Altaf Hossien - Consultant Psychiatrist, Institute of Neurosciences Kolkata – Telepsychiatry in India.
Dr. Rajashree Ray – Consultant Psychiatrist, Institute of Neurosciences Kolkata - Legal and ethical issues in Telepsychiatry.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM20: Need for symposium

Mobile phones were introduced in few markets in the1980s, and their use spread only in the mid1990s. Subscribers increased from 12.4 million in 1990 to 500 million in 2000 to 3.3 billion in 2008 and 5.3 billion at the end of 2010¹. In 2018, 2.53 billion smartphones have been in use worldwide, and the number is increasing day by day.²According to the Telecom Regulatory Authority of India, 1186.8 million (Total Indian population is 1339.2 million) subscribers use mobile phone in June 2017.³Estimations show that the prevalence of mobile use will be increased to 95% and further more in the coming years. The use of mobile phones is now so extensive that in some countries the number of phone subscriptions outnumbers the population. Indian market is one of the largest in the world for mobile phones.

According to the DSM, a specific phobia is an anxiety disorder that represents unreasonable and irrational fear prompted by a specific stimulus (an object or a situation). Initially termed as “simple phobia” in DSM-III and DSM-III-TR, the name was later changed to “specific phobia,” beginning with the DSM-IV version, and at that time, five types of specific phobia were included: blood/injection/injury (B-I-I), animal, natural environment, situational, and other. Currently these diagnostic criteria are under review, and new recommendations to ameliorate the definition have been put forward by the DSM-V Anxiety Work Group.⁴

Moreover, new phobias are emerging, related to contemporary society and the new challenges continuously faced in the daily routine, such as the so-called technophobias,⁵ which represent a sense of discomfort toward technologies, especially the emerging and advanced ones, cyberphobia, and computerphobia.⁶ Since its first introduction in 1983, the mobile phone has seen an incredible world-wide diffusion, representing today a mainstream and pervasive technology and an important part of our technoculture⁷,⁸

Nomophobia is considered to be a disorder of the modern world, derived from the technological developments and advances that have been produced by virtual communication. The word “nomophobia” originated in England and is derived from the phrase “No Mobile Phobia”, that is, the phobia of being without a mobile phone. It is defined as the fear of being out of mobile phone contact and is considered a modern age phobia that has been introduced to our lives as a product of the inter-action between people and mobile information and communication technologies⁹. Although nomophobia has been regarded as a controversial term, it is referred to as dependence on mobile phones¹⁰ or an addiction to mobile phones¹¹. Nomophobia is a term that refers to a collection of behaviours or symptoms related to Mobile Phone use. Therefore, in the case of nomophobia, people with nomophobia or nomophobes would have an irrational fear of being out of mobile phone contact or being unable to use it, and thus they attempt to eliminate the chances of not being able to use their mobile phone. In the case of being unable to use their mobile phone, they experience intense feelings of anxiety and distress¹².

In view of this background we would like to present a symposium on Nomophobia.

Presenters and topic:

Dr. Anil Kakunje Professor and HOD department of Psychiatry medical college, Managalore Karnataka
Topic: Introduction, Diagnostic tools, Signs & Symptoms
Dr Alok N Ghanate Professor and HOD department of Psychiatry Mahadevappa Rampure Medical College Kalaburagi Karnataka.
Topic: Research evidence & our experience.
Dr Deepak R S Assistant Professor department of psychiatry Basaveshwar Medical College Chitradurga Karnataka

Topic: Prevention and Treatment.

REFERENCES

1.Mobithinking Global Mobile Statistics. All quality mobile marketing research, mobile Web stats, subscribers, ad revenue, usage, trends. 2011. Available from: http://mobithinking.com/mobile-marketing-tools/latest-mobile-stats last accessed on January 22th 2014 .
2.Number of smartphone users worldwide 2014-2020 | Statista [Internet] [Last cited on 2018 Oct 19]. Available from: https://www.statista.com/statistics/330695/number-of-smartphone-users-worldwide/
3.Press Release on Indian Telecom Services Performance Indicator Report for the Quarter ending June, 2017. Telecom Regulatory Authority of India. [Internet] New Delhi, India: 2017. [Last cited on 2018 Oct 19]. Availablefrom: https://www.trai.gov.in/sites/default/files/Performance_Indicator_Reports_28Sep2017.pdf . [Google Scholar]
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Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM21: SYMPOSIUM: RELATIONSHIPS AND MENTAL HEALTH IN DIGITAL ERA

Swayam P Baral ¹, Dheerendra Mishra ¹, Sunil k Ahuja ¹

The Mental Health Foundation defines relationships as ‘the way in which two or more people are connected, or the state of being connected’. Relationships are one of the most important aspects of our lives, yet we can often forget just how crucial our connections with other people are for our physical and mental health and wellbeing. Extensive evidence shows that having good-quality relationships can help us to live longer and happier lives with fewer mental health problems. Having close, positive relationships can give us a purpose and sense of belonging.

Loneliness and isolation remain the key predictors for poor psychological and physical health. Having a lack of good relationships and long-term feelings of loneliness have been shown by a range of studies to be associated with higher rates of mortality, poor physical health outcomes and lower life satisfaction. It's not just the number of friends you have, and it's not whether or not you’re in a committed relationship, but it's the quality of your close relationships that matters. Living in conflict or within a toxic relationship is more damaging than being alone.

DIGITALIZATION HAS CHANGED THE WAY PEOPLE PERCEIVE RELATIONSHIPS.

In the era of smart phones , face book , Instagram , twitter etc relationship status has become more of an area of competition. People are flooded with pictures of accomplished relationship goals and happy couples at exotic location . These constant streaming of pictures send subliminal messages to the people who are yet to find a suitable partner. They remain under stress of matching with their friends in terms of relationship goals, which is at times not possible because of difference in economic status and cultural backgrouds. Many people land up in depressive and other somatic symptom disorders due to relationship status and other relationship issues.

Individuals who are more mentally healthy are more likely to select into relationships, but relationships are also demonstrably associated with mental health. The type of relationship matters — evidence suggests that more established, committed relationships, such as marriage, are associated with greater benefits than less committed unions such as cohabitation. The association between relationships and mental health is clearly bidirectional, however, stronger effects are observed when mental health is the outcome and relationships are the predictor, suggesting that the causal arrow flows more strongly from relationships to mental health than vice versa. Moreover, improving relationships improves mental health, but improving mental health does not reliably improve relationships. Relationships are a keystone component of human functioning that have the potential to influence a broad array of mental health outcomes (Scott and Julliane, 2017)

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM22: Mind-Body Medicine and Health Promotion

Sanjay S Phadke ¹, Arun Marwale ¹, Nischol Raval ¹, Kalpana Raval ¹

Abstract

Mind-Body Medicine (MBM) is an evidence-based self-care approach that combines the power of traditional knowledge of Yoga & Meditation with modern psychology & medicine. MBM has applicability across the health cycle from prevention to rehabilitation for improving outcomes and quality of life, and has great potential to evolve as affordable scalable foundation of healthcare truly reflective of the spirit of health promotion i.e. enabling people to increase control over, and to improve, their health.

Mental health professionals are best suited to be the leaders and practitioners of MBM in the Indian context and MBM can be viewed as a useful vehicle to popularize ‘mind’ interventions and thereby reduction of stigma associated with mind issues.

While managing highly prevalent stress and psychiatric co-morbidity associated with NCDs/lifestyle disorders remains major unmet need, latest international research has unveiled increasing vulnerability of children and young adults to experience adverse health consequences, especially adverse mental health. The Mind-Body approach is an attractive candidate to build resilience and offset ill effects of adversities/stress and address the co-morbidity in all such populations. An alliance of mental health professionals with other stakeholders is envisaged for its implementation.

Formation of Task Force on MBM by IPS is an important step in this direction and the symposium endeavors to present comprehensive review and approach to implementation of MBM in clinical practice.

Key words: Mind-Body Medicine, Health Promotion, Stress, Resilience

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM23: Abstract for symposium at ANCIPS-2020, Kolkata: Title: Cyberchondria: When the web makes you sick: Overview, assessment, challenges and management

Rapid and wide spread digitalization in the world made information related to health easily available and accessible in an affordable price. Information related to health and illness are within the reach of poor to rich. Web provides answers to all the queries. In developing countries like India, there is gross scarcity of human resources in health sector as a result of which people can not access information from an expert through direct consultation and obtain information from web. Information available in web vary in their authenticity, which are influencing the consumers thinking and behaviour.

Cyberchondria is an emerging mental health issue of the digital world. Cyberchondria refer to an entity, where an individual experiences distress and undue concern related to his or her health after viewing information related to it online. It is also known as “compucondria”. There is increasing reporting of anxiety and worries related to health after cyber-surfing throughout the world. Such cases are reported general care physicians as well as to mental health professionals. Initially, it was a problem of developed countries or metro-cities, but now it has spread its roots to everywhere, where there is accessibility to internet. This symposium will sensitize mental health professionals about this emerging global challenge.

Sub-topics and Speakers

Cyberchondria: An emerging mental health issue: Dr.Adarsh Tripathi, KGMU, Lucknow
Assessment of cyberchondria: Dr.Naresh Nebhinani, AIIMS, Jodhpur
Challenges and management of cyberchondria: Dr.Vikas Menon, JIPMER, Pudduchery
Cyberchondria: Preventive approach: Dr.S. K. Kar, KGMU, Lucknow

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM24: Mindfulness in anger and experiential meditation”

ABSTRACT

Background:

The beneficial clinical effects of mindfulness meditation is a topic of great interest nowadays. Research has demonstrated its efficacy in a wide range of psychological conditions characterized by emotion dysregulation specifically in anger management. Mindfulness meditation has its origin in the Buddhist psychology tradition, more specifically in the texts known as Satipatthana Sutra the Abhidharma, a cycle of teachings concerns about how the mind, including emotions and consciousness. The “mindfulness” means the capacity to retain an object in the mind, but in a broad sense also implies being aware of and attentive to the present moment. It is described as a “non-elaborative, non-judgmental awareness” of present-moment experience that emerges as a result of intentionally paying attention to present experience.

Methodology:

This workshop will give a detailed account of mindfulness in aggression. It will highlight the importance of meditation in anger management. It will present how one can apply mindfulness in our day to day life and how one can change the life in a better way by choosing the right response. The workshop will include role plays and ten minutes of live demonstration of powerful meditation experience specific to control anger.

Conclusion:

This practice of mindfulness meditation has been shown to be effective in reducing impulsiveness and increasing tolerance for common day to day stressors. The workshop is intended to facilitate the participants to help in recognising their own potentials in experiencing the calmness and handle triggers associated with aggression.

Keywords: Mindfulness, anger management, meditation

Presenters:

Dr. Kuldip Kumar, Professor & HOD, Department of Psychiatry, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi-110029. Email: kuldipkumar2000@gmail.com
Dr. Kapil Bansal, PG Resident, Department of Psychiatry, VMMC & Safdarjung Hospital, New Delhi-110029. Email: kapilb2@gmail.com

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 25: Category: Workshop; Area of Topic: Child and Adolescent Psychiatry: Title: Clinical approach to evaluation of mental and behavioural disorders in Children and Adolescents.

Key words: clinical, interview, challenges, child, psychiatry

Level: Intermediate

Objectives:

To provide an overview of the profile of psychiatric problems in children and Adolescents.
To learn the clinical approach in children to assess, diagnose and plan management.
To discuss common challenging situations in clinics when encountering younger children as well as adolescents.

Speakers:

Dr Siddeswara MD (Psy), PDF, DM (CAP). Assistant Professor, Child and Adolescent Psychiatry Services, Department of Psychiatry, LGBRIMH, Tezpur.
Dr (Lt Col) Bikram Dutta MD (Psy), Senior Resident, Department of Child and Adolescent Psychiatry, NIMHANS, Bangalore.

Rationale of workshop: children with behavioural and mental problems needs modification from routine adult oriented approach. Mental health professional need to have basic orientation to such issues and need to learn necessary skill set to help children with psychiatric issues.

Brief description of the workshop

Workshop is intended for mental health professionals who are encountering children and adolescents with mental and behavioural problems in their practice. This work shop will include didactic as well as use of worksheets, videos and group activity with role plays. All spectrum of child and adolescent psychiatric disorder such as Neurodevelopmental disorders, internalizing, externalizing, serious psychiatric disorder and others will be briefly covered. Focus will be on trans-diagnostic symptom based approach rather than diagnostic. Finally, a feedback forms will be collected from all participants for further improvisation.

Number of participants: Not more than 15.

Content of workshop

Introduction of speakers and participants (5min)
Sharing of agenda and rationale (1-2min)
Brief didactic session on profile of child and adolescent psychiatric disorders (15 min)
Developmental sensitive interview and evaluation including group activity/role play and video session (15 min)
Landing on diagnosis (5 min)
Formulating child psychiatric case and Planning management (15 min)
Discussion on case vignette and challenging situations in your practice (20 min)

” Time for the presentation: approx. 60 minutes Requirement: VLC or Windows media player installed in the computer

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM26: Workshop Proposal : Art of Training Psychiatry Postgraduates in Bedside Clinic and Beyond

Mohan Isaac ^a, Ashok MV ^b, Kishor M ^c, Ajay Kumar ^d, Suhas Chandran ^e

Introduction: Psychiatry training in India has undergone major transformations in last one decade. India has more than 200 postgraduate training institutes and annually more than 800 psychiatry postgraduates start their training. The numbers of psychiatry teachers who guide and train postgraduate trainees is estimated to be more than 1500. At present for India, there is need for enhancement of training standards at postgraduate level. Few special interest groups like Indian teaches of psychiatry (IToP) have come forward to discuss & assists in enhancing the standards of training at postgraduate level. In training, competency-based curriculum looks at skills of postgraduates in different domains of learning. Teaching & evaluation by teachers in such domain is crucial for ensuring best standards. This workshop provides glimpse into various aspects psychiatry postgraduates training.

Key words: Psychiatry Education, Postgraduates Training, Competency Based Curriculum, Teachers of Psychiatry.

The Workshop is intended for: Psychiatry Faculty & Postgraduates.

Time :90 Minutes

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 27: Role of nurses in combating depression: A module based workshop for nurses

Depression is a significant contributor to global morbidity and mortality. Further, depression is associated with significant economic burden too amounting to billions of dollars. Hence, there is an unwarranted need to prevent as well as treat depression. Sadly, there is a disproportionate shortage of mental health resources.

In this context, the World Health Organisation highlighted the role of nurses in mental health care through project ATLAS. Project ATLAS with the help of International Council of Nurses demonstrated that there is lack of proper training in mental health for nurses and recommended that training in mental health must be incorporated in nursing curriculum

In this background, the current workshop aims to aid nurses in combating depression by providing the following modules for building up skills for the appropriate roles.

Module 1 [Moderated by Dr.Pooja Patnaik Kuppili]

Screening for depression and history taking

Module 2 [Moderated by Dr.Naresh Nebhinani]

Assessing suicidal risk and intervention

Module 3 [Moderated by Mrs. Mamta]

Treatment including Psychoeducation, Medication adherence, Behavioral activation, Modified Electroconvulsive therapy procedure

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM28: Future of Psychiatry

Shradha Shejekar ¹, Saumitra Nemlekar ¹, Ashish Srivastava

World Health Organization estimates that globally around 300 million people are affected by depression; 60 million people by bipolar disorder; approximately 50 million people are affected by dementia; 23 million by schizophrenia; 1 person commits suicide every 40 seconds and an average of 1 in 160 children is affected by autism spectrum disorder. Around 2,443 DALYs per 1,00,000 populations are lost in India due to mental health problems. Advanced psychiatry is thus the need of the hour.

Ø Future of psychiatric assessment:

Will address biological, informational and “energetic” causes.
QEEG will become widely used to assess neural function and predict treatment response.
Genomics, Metabolomics, Proteomics in assessment of depression
Genetic, serologic and urinary assays will be increasingly used e.g. Veripsych biomarker.
BRAIN and CONNECTOME projects.
Subtle energy assessment: pulse diagnosis; analysis of the Vascular Autonomic Signal; ultra-weak bio-photons.
Autism Spectrum Disorders: Eye trackers, Movement trackers, Electro dermal activity monitors: icalm; Touch sensing: KASPAR robot, Prosody and speech detection: LENA recorder; Video Monitoring, Ballistocardiography
Apps, web based and Wearable technology.

Ø Future of psychiatric treatment:

a. Pharmacotherapy:

Immunologic therapy.
Anti-inflammatory drugs.
N-acetylcysteine.
Hormones
Glutamatergic and nicotinergic compounds.
Nutraceuticals.
Cannabidiol.
Sodium benzoate, sodium nitroprusside, memantine, minocycline, vitamins B,C,E,D, Bexarotene, Sertindole.
Ketamine and Allergan.
Scopolamine, Psilocybin, Ayahuasca.

b. Psychotherapy:

Nidotherapy
Competitive Memory Training(COMET).
Compassionate Mind Training(CMT).
Avatar Therapy.
Bio-psycho-social model of treatment.
Individualised modular health care model.
Cupboard Therapy
Mantram repetition.
Telemedicine and computer delivered CBT.
Adaptive Disclosure
Narrative Exposure Therapy
Imagery Modification

c. Brain Stimulation:

Electroencephalogram biofeedback(EBF)
Repetitive Transcranial magnetic stimulation(rTMS)
Vagal Nerve Stimulation.

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 29: OCD Beyond SSRI

Anshuman Tiwari, Priyanka Sharma

Obsessive-compulsive disorder (OCD) is a common Psychiatric illness with a lifetime prevalence in the general population of approximately 2-3%. Serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT) in the form of exposure and response prevention (ERP) both represent first-line treatments for OCD. However, unsatisfactory response to these treatments is very common and the evaluation of next-step treatment strategies is highly relevant.

Antipsychotic addition to SRIs and CBT augmentation of drug treatment both are supported by a number of double-blind studies. The switch to IV administration of clomipramine may be clinically useful in some cases, although the return to oral formulation is often associated with a relapse. Switching to other first-line agents or to other compounds (such as venlafaxine) is supported by open-label studies or by double-blind studies without a placebo arm.

In our symposia we will talk about the neurobiological aspect and treatment options of the OCD beyond SSRI's. The symposia will be discussed under following headings-

Introduction and neurobiological consideration: Dr. Priyanka Sharma
Management Strategies in treatment resistance: Dr. Anshuman Tiwari

*Dr. Anshuman Tiwari, Assistant Professor, Department of Psychiatry, SMMH Medical College, Saharanpur, UP, India; Email: anshuman2808@gmail.com

,** Dr. Priyanka Sharma,Assistant Professor, Department of Psychiatry,GR Medical College,Gwalior,MP,India;Email:ppriya16n@gmail.com

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM30: How sane are we in this insane world? The role of wellness programs in the identification and management of Impaired Physician

Sheena G Soman ¹, Jayaprakash P ¹, Jithin T Joseph ¹

Medical Professionals are at risk of impairment in mental, physical and social health. Morbidity is reportedly high. Physician impairment can compromise patient care as a result of burnout from stress, mental illness, or chemical dependency including alcoholism.

Definition, epidemiology and psychosocial attributes of impaired physician.
Management of impaired physician and medical families.
Evolution of current public policies and prevention models.
Components of a model physician wellness program-How to incorporate in Indian scenarios?

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM 31: ADHD and Pharmacotherapy: A global perspective

Sk Altaf Hossien ¹, Utkarsh Karki ², Bikram Dutta ²

Attention deficit hyperactivity disorder (ADHD) is a common childhood-onset neurodevelopmental disorder. The estimated prevalence of ADHD worldwide ranges between 5.29% and 7.1%. In the Indian scenario, the prevalence of ADHD falls in the range of 2% to 17%.

ADHD is the only neurodevelopmental disorder in which pharmacotherapy has a major role. Acceptance to the medication has been increased and stigma got reduced, but still there remain preconceptions in public as well as most health professionals because often their views are ill-informed and inaccurate, and based on poor reporting by the lay media. However, the role of behavioural interventions cannot be ignored. Understanding of the neurobiology in terms of brain structure, brain function, and brain chemistry certainly supports the use of medications in ADHD.

Stimulant medications have been used to treat symptoms of ADHD for over 80 years, longer than the use of antibiotics to treat an infection. Stimulants and nonstimulants are approved by FDA, AACAP and NICE guidelines. NICE guideline 2018 recommends focused group parent-training program of children under 5 years with ADHD as first-line treatment and medications for children above 5 years only after poor response to behaviour therapy. In India, considering affordability, availability, distance to travel and access to care, the pattern of ADHD medication use may not be in line with the standard guidelines.

Medication choice may differ for people with comorbidities like anxiety disorder, psychosis, autism spectrum disorder, and intellectual disabilities. Based on the family's preference, each patient's treatment must be individualized.

Close monitoring of adverse effects and tolerability is an essential component of medication management in ADHD, hence regular follow up and monitoring is imperative. Finally, many studies have found short term benefit of ADHD medications but the long-term benefit remains uncertain.

Learning Objectives: The participant delegates will be able to learn the following:

Neurobiological underpinnings for pharmacotherapy
Medications for ADHD – past, present, and future
Guidelines and practice parameters across the world vs Indian scenario

Indian J Psychiatry. 2020 Jan;62(Suppl 1):S74–S122.

SYM31: Evolution of symptoms across the age spectrum and transitional service delivery models

Soumya Basu, Shabbir Amanullah, K S Shivakumar

Child and adolescent psychiatry has to deal with the disorders that manifest in childhood and also the emergence of adult psychiatric disorders. A prototype child psychiatry disorder is ADHD. The diagnosis, clinical manifestation, comorbidity, family dynamics, interactional dynamics at school and with peers and its co-occurrence with other neurodevelopmental disorders, internalizing and externalizing disorders makes ADHD an interesting construct. The clinical manifestation of ADHD, its journey across childhood to adolescence, the controversy about over diagnosis and underdiagnoses, would be covered in the first part of the talk.

> Some of the psychotic illnesses may start manifesting in childhood and adolescents. Early intervention is seen as a key to prevent long term negative consequence of psychosis. The importance, the complex challenges, the controversies around the construct of early psychosis, the experience of an early- psychosis teams dealing with the under 18 population will be covered in the second part of the talk.

> Dr Soumya Basu, is a child and adolescent psychiatrist working in community child psychiatry in Melbourne, Australia. He would be covering the first section of the topic.

> Dr KS Shivakumar - will cover areas on the transition ages 18-25

Dr Shabbir Amanullah -will cover the transition models currently in vogue with a global perspective

[ref1] 1.Armand Joulin, A, Grave E, Bojanowski P, Mikolov T. Bag of Tricks for Efficient Text Classification, Proceedings of the 15th Conference of the European Chapter of the Association for Computational Linguistics. 2016;2:427–431. [Google Scholar]

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ABSTRACTS FOR ANCIPS 2020

SYM 47: Conclusive Study about the effect of Mirtazapine on Metabolism and Energy substrate partitioning in Healthy persons

Jishnu Bhattacharya

Sagarika Ray

SYM 48: Evidence Based Interventions for Autism Spectrum Disorder.

Dhrubajyoti Bhuyan

F135: Identification of Suicidal Ideation Through Analysis of Clinical Notes in Electronic Health Records

Prakash Adekkanattu, PhD

Marika Cusick, MS

Thomas R Campion, Jr. PhD

Poonam Awatramani, MD

Dimitry Francois, MD

George Alexopoulos, MD

Jyotishman Pathak, PhD

Table 1.

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F137: Title: Suicide Risk Prediction by Machine Learning of TAT Protocols - A Pilot Study

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F138: Title: Delirium Research in India: A Bibliometric Study

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F139: To study the prevalence of depression in patient suffering from headache in psychiatry opd in a tertiary care institute

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F141: ETHICS IN MEDIAL PRACTICE

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F142: Study of Nature of Admissions, Course of stay and Discharge status of female patients admitted on Involuntary basis” at Institute of Mental Health ,Chennai.

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F143: Development of mental health awareness tool for Armed Forces : AFMC Mental Health Awareness Questionnaire

Col Rajiv Saini

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F144: Psychiatric symptoms in peri-menopausal rural women and role of duloxetine in their treatment

F145: Psychiatric Morbidity and Associated Psycho-Social Factors Among the Inmates of a state Run Home For Women

Saudhamini Bhat

Mahesh Desai

Shivanand B Hiremath

F146: Impact of Mindfulness-Based Therapy on Psychological Characteristics of Juvenile in Conflict with Law

Deoshree Akhouri

Maria Madiha

S A Azmi

F147: Certification of Medico Legal Cases in Tertiary Care Hospital: Challenges and Way Ahead

Bornali Das

Mythili Hazarika

Shyamanta Das

F148: Mental capacity and advanced directives of patients with mental illness: a study from a tertiary care psychiatric hospital

Rajshekhar Bipeta

Madhur M Rathi

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F149: Psychiatric Morbidity Among Prison Inmates

Agarwal Pranshu

Kohli Ajay

Kumar Jitendra

F150: Referral Pattern to Consultation-Liaison Psychiatry: A Cross-Sectional Study from a tertiary care Center of Southern India.

Aravind

Sivin P Sam

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F151: Prevalence of Borderline Personality Organisation in Medical College Students

F152: Study of anxiety disorders and clinical correlates in geriatric patients.

Kunal Desai

Minakshi Parikh

F153: Worms of the Mind - retrospective review from South India

Shiva Shanker Reddy Mukku

Krishna Prasad Muliyala