Indian Journal of Psychological Medicine
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ARTICLES
Trends- A tool for recognition of emotions in neuropsychiatric disorders
Rishikesh V Behere, VNGP Raghunandan, Ganesan Venkatasubramanian, DK Subbakrishna, PN Jayakumar, BN Gangadhar
January-June 2008, 30(1):32-38
DOI:10.4103/0253-7176.43132  
Defects in social cognition which includes Facial Emotion Recognition Deficits [FERD] have been consistently demonstrated in most neuropsychiatric disorders. Influences of culture, age & sex on emotional expression and perception necessitates that a tool standardized in the Indian population be developed to study these deficits in Indian patients. Four experienced and trained actors (one young male, one young female, one older male and one older female) emoted six basic emotions, namely happy, sad, fear, anger, surprise and disgust at two different intensities [i.e. high and low] along with neutral facial expressions. 52 still images and 28 video clips were obtained. These images were then validated by 51 students from various mental health disciplines and five qualified psychiatrists. On statistical analysis the tool was found to have good inter­rater agreement and internal consistency. TRENDS is a tool validated for use in the Indian population, which captures the full range and nature of emotional expressions akin to real life situations and can be utilized for future behavioral and functional imaging studies in Indian patients. Such research can give useful insights into the neurobiological basis of neuropsychiatric disorders and has important implications for improving socio-occupational functioning.
  14 4,617 381
EDITORIAL
Depression: The disorder and the burden
MS Reddy
January-June 2010, 32(1):1-2
DOI:10.4103/0253-7176.70510  PMID:21799550
  9 6,922 469
ORIGINAL ARTICLES
Psychosocial stressors and patterns of coping in adolescent suicide attempters
Anju Mathew, Subha Nanoo
January-March 2013, 35(1):39-46
DOI:10.4103/0253-7176.112200  PMID:23833341
Context: Different risk factors associated with adolescent suicide attempts have been identified including those of socio-demographic and clinical variables. Relatively, little research has been done in the area of their stressors and coping patterns. Aims: To study the recent psychosocial stressors and patterns of coping associated with adolescent suicide attempts. Settings and Design: Tertiary care hospital, case-control study. Materials and Methods: One hundred consecutive cases of adolescent attempted suicide admitted to the hospital and an equal number of controls, matched individually for age and sex, from the relatives and friends of other patients in the ward, were studied. Assessment included details regarding socio-demographic data, psychiatric and physical morbidity, their recent stressors, and patterns of coping. Stressors were assessed using Presumptive Stressful Life Event Scale and coping strategies by Ways of Coping Questionnaire (revised). Statistical Analysis: Chi-square test and multivariate logistic regression analysis. Results: The number of stressful life events and mean stress scores in the preceding 1 month and certain coping strategies such as confronting, distancing, and escape-avoidance were found to be significant risk factors associated with adolescent suicide attempts. Strategies such as self-control, seeking social support, accepting responsibilities, problem solving, and positive appraisal act as protective factors. Conclusions: Recent stressors and strategies such as confronting, distancing, and escape-avoidance are significant risk factors associated with adolescent suicide attempts, whereas certain coping strategies act as protective factors. Teaching adolescents these protective coping patterns may be a promising strategy for prevention of adolescent suicide attempts.
  9 3,310 191
Rapid response with ketamine on suicidal cognition in resistant depression
Rajarshi Guha Thakurta, Ranjan Das, Amit Kumar Bhattacharya, Debasish Saha, Sreyashi Sen, Om Prakash Singh, Bikash Bisui
April-June 2012, 34(2):170-175
DOI:10.4103/0253-7176.101793  PMID:23162195
Context: Suicidal ideation in depressed patients is a serious and emergent condition that requires urgent intervention. Intravenous ketamine, an N-methyl-D-aspartate (NMDA) antagonist, has shown rapid antidepressant effects, making it a potentially attractive candidate for depressed patients with suicidal risk. Aims: In India few studies have corroborated such findings; the present study aimed to assess the effectiveness and sustainability of antisuicidal effects of ketamine in subjects with resistant depression. Settings and Design: Single-center, prospective, 4 weeks, open-label, single-arm pilot study. Materials and Methods: Twenty-seven subjects with DSM-IV major depression (treatment resistant) were recruited. The subjects were assessed on Scale for Suicidal Ideation (SSI), 17-item Hamilton Depression Rating Scale (HDRS). After a 2-week drug-free period, subjects were given a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg) and were rated at baseline and at 40, 80, 120, and 230 minutes and 1 and 2 days postinfusion. Results: The ketamine infusion was effective in reducing the SSI and HDRS scores, the change remained significant from minute 40 to 230 at each time point. Conclusions: The real strength of this study rests in documenting the rapid albeit short-lasting effect of ketamine on suicidal ideation in depressed patients.
  7 3,035 85
Socio-demographic factors of geriatric depression
Ankur Barua, MK Ghosh, N Kar, MA Basilio
July-December 2010, 32(2):87-92
DOI:10.4103/0253-7176.78503  PMID:21716860
Background: Depression is a common mental health problem in geriatric population and the overall prevalence rate of depression in this age group varies between 10 and 20%. Objective: To study the socio-demographic factors associated with depression in geriatric population. Materials and Methods: A systematic review was done on 74 community-based mental health surveys on depression in geriatric population, which were conducted in the continents of Asia, Europe, Australia, North America, and South America. All the studies were conducted between 1955 and 2005. The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of geriatric population in the world, who were selected by simple random sampling technique. A qualitative analysis was conducted to study the socio-demographic factors of depression. Results and Conclusion: The two non-modifiable risk factors found to be significantly associated with depression in geriatric population were "older age group" and "female gender". However, the potentially modifiable risk factors for depression in the geriatric population were identified as low socioeconomic status, loss of spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL).
  6 4,581 274
Internet addiction and modeling its risk factors in medical students, Iran
Farhad Ghamari, Abolfazl Mohammadbeigi, Narges Mohammadsalehi, Amir Almasi Hashiani
July-December 2011, 33(2):158-162
DOI:10.4103/0253-7176.92068  PMID:22345841
Background : Today's internet is a usual and common method for identifying and fulfilling unknown practices. Internet network has been prepared rapid and comfortable access to information. Internet addiction is a new and attractive subject that has been regarded as behavior-based addiction recently. Purpose : To estimate the prevalence of internet addiction and some of the related factors among medical students, Iran. Materials and Methods : An analytical cross-sectional study was conducted on 426 students selected through two-stage sampling method. Yang standard internet addiction questionnaire was used for data collection. After data entry, χ 2 , t-test, and Pearson coefficient statistical tests were applied. 0.05 was considered as the significance level. Results : The overall prevalence of internet addiction was 10.8%, with moderate and severe internet addiction equal to 8% and 2.8%, respectively. Mean and standard deviation of Yang internet addiction score was calculated as 32.74±14.52. Internet addiction was associated with sex, marital status, father's job, rate of knowledge about computer and internet, and educational level (P<0.05). But it was not associated with the parents' education, residential area, field of study and level, and school of education (P>0.05). Conclusion : Because internet addiction leads to wasting of the students' leisure time and also useful time, it affects the educational situation inversely. Some measures should be taken to plan and improve the use of internet.
  6 3,615 171
Translation and validation of the insomnia severity index in hindi language
Vivekananda Lahan, Ravi Gupta
July-December 2011, 33(2):172-176
DOI:10.4103/0253-7176.92060  PMID:22345845
Aims and Objectives: Translation of the Insomnia Severity Index from English to Hindi and Validation of the Hindi version. Materials and Methods: The translation process of the Insomnia Severity Index was initiated after obtaining due permission from the author of the original version of the same. Translation was carried out by using standard translation procedures, such as combined translation, decentering, and pretest method. The final version of the Insomnia Severity Index in Hindi was finally validated. A randomly selected sample size of 65 subjects was enrolled for the purpose of validation and testing the reliability of Hindi version of the Insomnia Severity Index. Insomnia was present in 45 subjects and they constituted the insomnia group. The rest 20 subjects did not have insomnia and were included in the control group. The Hindi version of the Insomnia Severity Index was applied to both the groups. Results: The total sample constituted of 50.8% males and 49.2% females. The mean age in the control group was 30.8±8.3 years and that in the insomnia group was 40.3±4 years (t=3.04; P=0.001). The translated version of the Insomnia Severity Index showed a reliability of 0.91 (Cronbach's α=0.91). This was not just simple translation, but many of the words were changed to adapt it for the local population. Conclusion: The Hindi version of the Insomnia Severity Index is a valid and reliable tool that can be administered for the assessment of severity of insomnia.
  6 3,341 131
REVIEW ARTICLES
Metabolic syndrome in bipolar disorders
Sandeep Grover, Nidhi Malhotra, Subho Chakrabarti, Parmanand Kulhara
April-June 2012, 34(2):110-118
DOI:10.4103/0253-7176.101767  PMID:23162184
To review the data with respect to prevalence and risk factors of metabolic syndrome (MetS) in bipolar disorder patients. Electronic searches were done in PUBMED, Google Scholar and Science direct. From 2004 to June 2011, 34 articles were found which reported on the prevalence of MetS. The sample size of these studies varied from 15 to 822 patients, and the rates of MetS vary widely from 16.7% to 67% across different studies. None of the sociodemographic variable has emerged as a consistent risk factor for MetS. Among the clinical variables longer duration of illness, bipolar disorder- I, with greater number of lifetime depressive and manic episodes, and with more severe and difficult-to-treat index affective episode, with depression at onset and during acute episodes, lower in severity of mania during the index episode, later age of onset at first manic episode, later age at first treatment for the first treatment for both phases, less healthy diet as rated by patients themselves, absence of physical activity and family history of diabetes mellitus have been reported as clinical risk factors of MetS. Data suggests that metabolic syndrome is fairly prevalent in bipolar disorder patients.
  6 3,025 142
CASE REPORTS
Genital self mutilation in alcohol withdrawal state complicated with delirium
Sri Hari Charan, C. M. Pavan Kumar Reddy
July-December 2011, 33(2):188-190
DOI:10.4103/0253-7176.92045  PMID:22345848
Genital self mutilation is a rare and a severe form of self-injurious behavior usually described in psychotic disorders, with delusions and hallucinations. It has been ascribed to sexual conflicts, Body image distortions, Internalized aggression, and suicidal intent. This phenomenon has been described in schizophrenia, affective psychosis, alcohol intoxication, and personality disorders. The present case genital self mutilation in a case of alcohol withdrawal state complicated by delirium is reported.
  5 1,943 75
ORIGINAL ARTICLES
Functional neuro-imaging and post-traumatic olfactory impairment
Richard J Roberts, William Sheehan, Steven Thurber, Mary Ann Roberts
July-December 2010, 32(2):93-98
DOI:10.4103/0253-7176.78504  PMID:21716782
Objective: To evaluate via a research literature survey the anterior neurological significance of decreased olfactory functioning following traumatic brain injuries. Materials and Methods: A computer literature review was performed to locate all functional neuro-imaging studies on patients with post-traumatic anosmia and other olfactory deficits. Results: A convergence of findings from nine functional neuro-imaging studies indicating evidence for reduced metabolic activity at rest or relative hypo-perfusion during olfactory activations. Hypo-activation of the prefrontal regions was apparent in all nine post-traumatic samples, with three samples yielding evidence of reduced activity in the temporal regions as well. Conclusions: The practical ramifications include the reasonable hypothesis that a total anosmic head trauma patient likely has frontal lobe involvement.
  5 3,237 35
Insomnia associated with depressive disorder: Primary, secondary, or mixed?
Ravi Gupta, Vivekananda Lahan
July-December 2011, 33(2):123-128
DOI:10.4103/0253-7176.92056  PMID:22345834
Background: Insomnia is a common problem that is known to occur during depression. However, literature still debates whether insomnia is part of depression or a separate entity. Materials and Methods: Subjects presenting with depressive disorder according to DSM-IV-Text Revision criteria were recruited after seeking informed consent. Clinical interview was performed with the help of Mini International Neuropsychiatric Interview Plus. Their demographic data and depression related history were recorded. Depression severity was assessed by using Hamilton Rating Scale for Depression. Diagnosis of insomnia was made with the help of International Classification of Sleep Disorders-2 criteria. Type of insomnia, its duration, and its relationship with depressive illness were specifically asked. If any subject fulfilled criteria for more than one type of insomnia, both were recorded. Statistical analysis was done with the help of statistical package for social sciences (SPSS) version 17.0. χ2 test, independent sample t test, and Pearson's correlation were performed. Results: A total of 54 subjects were enrolled in this study. Primary insomnia was seen in 40.7% cases and secondary insomnia in 58.8% cases; 27.3% subjects did not experience insomnia along with depressive disorder. In the primary insomnia category, adjustment insomnia was most prevalent (63.6%), and in secondary insomnia group, insomnia due to depressive disorder was most frequent (59.3%). Interestingly, primary insomnia often followed an onset of depressive illness (P=0.04), while secondary insomnia preceded it (c2 =11.1; P=0.004). The presence of either type of insomnias was not influenced by duration of depressive illness, number of depressive episodes, and duration of current depressive episode. On the other hand, duration of insomnia was positively correlated with total duration of depressive illness (P=0.003), number of episodes (P=0.04), and duration of current depressive episode (P<0.001). Conclusion: Primary insomnia is common in subjects with depression, and it usually follows depressive illness. On the other hand, secondary insomnia often precedes the onset of depressive illness. Duration of insomnia positively correlates with duration and frequency of depressive episodes.
  5 3,312 124
REVIEW ARTICLE
Pain catastrophizing: An updated review
Lawrence Leung
July-September 2012, 34(3):204-217
DOI:10.4103/0253-7176.106012  PMID:23441031
Pain catastrophizing has been described for more than half a century which adversely affects the pain coping behavior and overall prognosis in susceptible individuals when challenged by painful conditions. It is a distinct phenomenon which is characterized by feelings of helplessness, active rumination and excessive magnification of cognitions and feelings toward the painful situation. Susceptible subjects may have certain demographic or psychological predisposition. Various models of pain catastrophizing have been proposed which include attention-bias, schema-activation, communal-coping and appraisal models. Nevertheless, consensus is still lacking as to the true nature and mechanisms for pain catastrophizing. Recent advances in population genomics and noninvasive neuroimaging have helped elucidate the known determinants and neurophysiological correlates behind this potentially disabling behavior.
  5 4,998 70
REVIEW ARTICLES
Reviewing Two Types of Addiction - Pathological Gambling and Substance Use
Seyed Amir Jazaeri, Mohammad Hussain Bin Habil
January-March 2012, 34(1):5-11
DOI:10.4103/0253-7176.96147  
Gambling, including pathological gambling and problem gambling, has received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. Gambling disorders affect 0.2-5.3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favorably evaluated, such as cognitive behavioral and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and substance use disorders, and a further understanding is needed of both the causes and treatment implications of this disorder. This article reviews definition, causes and associated features with substance abuse, screening and diagnosis, and treatment approaches.
  5 5,924 99
EDITORIAL
Suicide incidence and epidemiology
MS Reddy
July-December 2010, 32(2):77-82
DOI:10.4103/0253-7176.78501  PMID:21716862
  4 4,177 273
NEW HORIZON
Utility of repetitive transcranial stimulation as an augmenting treatment method in treatment-resistant depression
Venu Gopal Jhanwar, RJ Bishnoi, MR Jhanwar
January-June 2011, 33(1):92-96
DOI:10.4103/0253-7176.85406  PMID:22021964
About 30 to 46% of patients with major depressive disorder (MDD) fail to fully respond to initial antidepressants. Treatment-resistant depression (TRD) is a severely disabling disorder with no proven treatment options; novel treatment methods like rTMS can be used as augmentation to ongoing pharmacotherapy or as a solitary method of treatment. To evaluate the utility of repetitive transcranial magnetic stimulation as an augmenting method in TRD. In an open-label study, 21 patients with DSM-IV MDD without psychotic features who had failed to respond to an adequate trial of at least 2 antidepressants were given rTMS therapy for 4 weeks, keeping the dose of pre-existing antidepressants unchanged. High-frequency (10 Hz) stimulations were delivered over left dorsolateral prefrontal cortex at intensity of 110% of patient's motor threshold. Treatment response was defined as a reduction in score on the Hamilton Rating Scale for Depression (HAM-D) from baseline to end of treatment. Secondary efficacy measures included scores on the Clinical Global Impressions-Change and -Severity scales. At the end of 4 weeks, 19 patients completed the 4-week study and were assessed. In ITT analysis, the mean HAM-D17 scores were reduced from 30.80±5.00 to 19.00±6.37 (t=8.27, P<0.001). Only four patients reported headache, but there was no discontinuation due to adverse effects. The study indicates the potential utility of rTMS as an augmenting agent in TRD. Adequately powered, randomized controlled trials are necessary to evaluate the role of rTMS in TRD.
  4 1,918 52
ORIGINAL ARTICLES
A Study of Association of Depressive Symptoms Among the Type 2 Diabetic Outpatients Presenting to a Tertiary Care Hospital
KG Guruprasad, MR Niranjan, S Ashwin
January-March 2012, 34(1):30-33
DOI:10.4103/0253-7176.96153  
Background: The prevalence of diabetes mellitus is increasing among Indian population over time. There are varying reports about the association of depression among type 2 diabetic individuals. However, there is limited data about this in India. Aims: To study the association of depression, demographic and socio-medical factors in type 2 diabetes patients. Settings and Design: Cross-sectional, epidemiological study. Materials and Methods: All the consenting type 2 diabetes mellitus patients attending to Medical OPD (n=210) were screened for symptoms of depression using beck depression inventory. All the participants were physically examined and a detailed psychiatric assessment were done. The relevant investigations were advised to identify comorbid conditions. Statistical Analysis: Chi-square test with odd's ratio. Results: One-fourth of the screened diabetic patients were found to be having depression. Females and overweight individuals were found to have features of depression. Patients with long duration of diabetes and on combination of antidiabetic drugs were significantly associated with depression. Among depressed diabetics 25.9% were having Ischemic heart disease as a comorbid medical illness. Conclusions: This study shows there is increased rate of depression among type 2 diabetic individuals. The interesting association of depression with several demographic and sociomedical factors have an important implication in type 2 diabetics.
  4 1,997 144
Attention-deficit/Hyperactivity Disorder in Children: Clinical Profile and Co-morbidity
C Venkatesh, T Ravikumar, A Andal, BS Virudhagirinathan
January-March 2012, 34(1):34-38
DOI:10.4103/0253-7176.96155  
Background: To study the clinical profile and co-morbidity in Indian children with attention-deficit/hyperactivity disorder (ADHD). Materials and Methods: A prospective analytical study of 2 years duration at the Child Guidance Clinic of a pediatric tertiary care hospital in a south Indian city using Diagnostic and statistical manual of Mental Disorders-1V based questionnaires. Results: Of the 251 referrals, 51 (20.3%) children met the inclusion criteria for the diagnosis of ADHD. M:F ratio was 6.3:1. The mean age was 5.7 years. A majority of the children belonged to middle and lower socio-economic class and were first-born children. Most children were brought up in nuclear families. History of delayed speech and language development was commonly seen in these children. Combined type of ADHD was the most common type. At least one co-morbid diagnosis was seen in 86.3% of children, and learning disability was the most common co-morbid diagnosis. The mean IQ was 90 (SD±12). Conclusion: Early markers of cognitive dysfunction like delayed speech, language and social and adaptive development may be a pointer towards the diagnosis of ADHD in children. Knowledge about their sociodemographic profile and other co-morbid conditions that are associated with ADHD is necessary to fully understand the magnitude of the problem and to plan effective therapy for them.
  4 4,538 218
Schizophrenia - Insight, Depression: A Correlation Study
Prasanth Ampalam, Raga Deepthi, Padma Vadaparty
January-March 2012, 34(1):44-48
DOI:10.4103/0253-7176.96158  
Background: Schizophrenia is one of the severe forms of mental illness which demands enormous personal and economical costs. Recent years have attracted considerable interest in the dual problem of depression in schizophrenia and its relation to insight. Most clinicians believe that poor insight in patients with schizophrenia, though problematic for treatment adherence, may be protective with respect to suicide. The assumption is that patients who do not believe that they are ill are less likely to be suicidal. Alternatively, those patients with schizophrenia who recognize and acknowledge the illness will be more of a suicidal nature. Aim of the Study: The aim of the study is to find out the correlation between insight and depression in schizophrenic population. Materials and Methods: This study is a cross-sectional, single-centred, correlation study done in a total of 60 subjects. Inclusion Criteria - Subjects between 20-60 years, who were diagnosed to have schizophrenia as per International clasification of diseases-10 and who have given written consent to participate in the study. Exclusion Criteria - Subjects who have other diagnosis such as mood disorder, schizoaffective disorder, mental retardation, epilepsy or detectable organic disease and co morbid substance abuse are excluded from the study. Schizophrenics who have acute exacerbation are also excluded. Instruments - For insight assessment, schedule for assessment of insight, a three item rating scale, is used. For depressive symptoms assessment a nine item rating scale, Calgary depression rating scale, is administrated. Results: Insight and depression are strongly correlated in schizophrenic population with a Pearson correlation coefficient of 0.758. The correlation between insight and depression is high in subjects with less duration of illness. Conclusion: Better insight was significantly correlated with lower mood. In addition, it suggests that poor insight may protect against depression in the early stages of recovery from schizophrenia.The correlation between insight and depression is high in subjects with less duration of illness.
  4 2,479 90
Disability in a Group of Long-stay Patients with Schizophrenia: Experience from a Mental Hospital
Kalita Kamal Narayan, Deuri Sailendra Kumar
January-March 2012, 34(1):70-75
DOI:10.4103/0253-7176.96164  
Background: Recovery from schizophrenia is a complex concept. Remission of symptoms of psychotic illnesses is not necessarily linked to better functioning. Among various causes of disability, mental illnesses account for 12.3% of the global burden of diseases. Long-term hospitalization has been recognized as counterproductive and a contributory factor of disability associated with schizophrenia. Under various circumstances, many persons with mental illness are brought to mental hospitals but the measures taken for their rehabilitation and follow-up care is insufficient. Aim: In the present study we tried to find out the level of psychopathology and the associated disability in a group of patients with schizophrenia who have been staying in a mental health institution for more than 5 years due to lack of proper caregivers in the society or in their home. Materials and Methods: The study is conducted in a mental hospital of northeast India. Of the 40 patients staying for more than 5 years in the hospital, 28 fulfilled the criteria for inclusion. The Brief Psychiatric Rating Scale and World Health Organization Disability Assessment Schedule II (WHO DASII) were used for those patients. Analytical statistical methods were used subsequently. Results: Male patients were significantly older and had prolonged duration of stay. But the level of psychopathology did not differ significantly between male and female patients. Under WHODASII, understanding and communication problems are more prominent in both the groups. Of late, there are very few cases that required prolonged stay in the hospital. Many patients are fairly functional and are considered suitable for care outside hospital premises. Conclusion: Prolonged hospital stay is associated with more disability. Shorter hospital stays with proper family support is an ideal way to counteract this issue. However, due to the inadequate mandate in the Mental Health Act (MHA) 1987 and lack of other supportive facilities, patientsoften tend to languish in the hospital for longer duration, causing harm to the patients and draining scarce state resources. It is therefore necessary to revisit the MHA 1987 and provide adequate rehabilitative measures for the needy patients.
  4 2,029 76
Immunological role of hardiness on depression
Vinita Sinha, RN Singh
January-June 2009, 31(1):39-44
DOI:10.4103/0253-7176.53314  PMID:21938090
The present study holds hardiness as the independent variable and depression as the dependent variable. The immunological role of hardiness was ascertained on depression. Sample constituted of 320 people aging 21­­ to 65. Subjects were administered hardiness scale and depression scale. Based on the scores obtained on hardiness scale, subjects were categorized specifically into three hardy groups: high, moderate, and low to see their differential effects on depressive feelings. The differences between the means of three hardy groups were found to be significant and the immunological role of hardiness on depression is thoroughly highlighted.
  4 3,730 269
Acute antidepressant effects of intramuscular versus intravenous ketamine
Harihar Chilukuri, Narasimha Pothula Reddy, Ram Mohan Pathapati, Arkalgud Nagesha Manu, Sharada Jollu, Ahammed Basha Shaik
January-March 2014, 36(1):71-76
DOI:10.4103/0253-7176.127258  PMID:24701015
Objective: Conventional antidepressants take two weeks before their therapeutic action begins. Recent studies have reported on the rapid antidepressant effect of ketamine when given as an intravenous (I.V.) infusion. Little is known about its intramuscular (I.M.) use in depression. Hence this study was conducted to compare the safety, tolerability and efficacy of I.M. versus. I.V. ketamine in Major Depression (ICD-10). Materials and Methods: It was a randomized open label parallel group study in a tertiary care teaching hospital. Study sample consisted of 27 subjects having major depression divided randomly into three groups of nine subjects each. Ketamine administered to each group in the dose of 0.5 mg/kg as an I.V. infusion, as 0.5 mg/kg I.M. or 0.25 mg/kg I.M. respectively. Depression rated on the Hamilton Depression Rating Scale (HAM-D) before the injection, two hours later, the next day, and after three days. Data analyzed using the Statistical Package for Social Sciences (SPSS). Results: Mean age of the sample was 36.81 years (SD 11.815). Two hours after the injection, HAM-D fell by 58.86%, 60.29% & 57.36% in each group respectively. The improvement was sustained for next three days. Adverse effects noticed were rare, of mild nature and transient, lasting less than an hour. Conclusions: Intramuscular ketamine in the dose of 0.25 mg/kg is as effective and safe as 0.5 mg/kg given either I.M. or I.V., substantially alleviating depressive symptoms within a few hours and sustained for 3 days.
  4 3,319 128
REVIEW ARTICLE
Metabolic syndrome in schizophrenia
Nidhi Malhotra, Sandeep Grover, Subho Chakrabarti, Parmanand Kulhara
July-September 2013, 35(3):227-240
DOI:10.4103/0253-7176.119471  PMID:24249923
To review the data with respect to prevalence of metabolic syndrome (MetS) and its correlates in schizophrenia. For this review, electronic search engines PUBMED, Sciencedirect, and Google Scholar were used. Available data suggests that most of the studies have been of cross-sectional design. Prevalence rates of MetS have varied from 11% to 69% in medicated patients, and 4-26% in drug naive patients in cross-sectional evaluations. Longitudinal studies have shown the prevalence rates to range from 0% to 14% at the baseline in drug naive patients, which increase to as high as 52.4% by 3 months of antipsychotic medication treatment. The prevalence rates of MetS in patients with schizophrenia are much higher than that seen in general population or healthy controls. Though there is no causal association with any demographic or clinical variables, the risk increases with increase in age. Among antipsychotics, there seems to be an association between MetS and atypical antipsychotics like clozapine and olanzapine. Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage, however, these is some evidence to suggest an association of MetS with adiponectin levels, hematological indices, methylenetetrahydrofolate reductase (MTHFR) and Alpha-1A adrenergic receptor (ADRA1A) gene. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.
  4 3,812 193
ARTICLES
Study of effects of modafinil add-on therapy on excessive day time drowsiness and weight gain in patients on atypical antipsychotics
TP Sudhakar, G Prasada Rao, P Lakshmi Prasuna, K John Vijay Sagar
January-June 2008, 30(1):24-31
DOI:10.4103/0253-7176.43131  
  3 4,120 183
ORIGINAL ARTICLES
An open-label trial of risperidone and fluoxetine in children with autistic disorder
Avinash Desousa
January-June 2010, 32(1):17-21
DOI:10.4103/0253-7176.70522  PMID:21799554
Objective: Various studies have shown the effectiveness of risperidone and fluoxetine in the management of behavioral problems in autism. Aim: The purpose of this study was to compare these two drugs in the management of behavioral problems in autism. Materials and Methods: Forty children with autism were divided into 2 groups in a 16-week open trial that compared these two drugs. Parents rated the children using the Aberrant Behavior Checklist (ABC) and the Conners' Parent Rating Scale - Revised (CPRS-R). The author rated the children using the Children's Psychiatric Rating Scale and Clinical Global Impression (CGI) Scale. Results: The risperidone group showed significant improvement in areas like irritability and hyperactivity, while the fluoxetine group showed significant improvement in speech deviance, social withdrawal and stereotypy. When the two drugs were compared, fluoxetine showed greater improvement in stereotypy, while both drugs showed improvement on the general autism scale; and on anger, hyperactivity and irritability scales. Conclusions : In this open trial, both drugs were well tolerated and appeared to be beneficial in the treatment of common behavioral problems in children with autism. Further controlled and double-blind studies in larger samples are warranted.
  3 3,270 87
Psychiatric curriculum and its impact on the attitude of Indian undergraduate medical students and interns
Anand Lingeswaran
July-December 2010, 32(2):119-127
DOI:10.4103/0253-7176.78509  PMID:21716779
Context: Psychiatry is given very less importance in the Indian undergraduate medical curriculum and this affects the attitudes of students toward psychiatry and mentally ill patients. Aim: To study the attitude of undergraduate medical students and interns toward psychiatry and mentally ill patients. Materials and Methods: Undergraduate medical students and interns of a private medical college and research institute in South India consented to form our sample. We studied the General Health Questionnaire, overall level of satisfaction in ongoing Medical course using Visual Analog Scale, attitudes toward psychiatry scale and the attitudes toward mentally ill patient's scale of the students, with their informed consent. SPSS version 18 was used for analysis of data. Results: Participation rate was 96%. Mean age of entire sample was 20.56 years. The total mean score on the General Health Questionnaire was 13.52 in first year but became worse toward internship (18.2). The level of satisfaction in the medical course dipped from 86% at baseline to 20% during internship. Equally high scores were noted in the attitude toward mentally ill scale. On the attitude toward psychiatry scale, there were more views on psychiatry as being an unscientific specialty, psychiatrists being considered poor role models, and psychiatric teaching was of low quality and psychiatry was the least preferred career choice. Conclusions: The undergraduate medical students have a very unfavorable attitude toward psychiatry and mentally ill patients.
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* Source: CrossRef
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