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   2014| July-September  | Volume 36 | Issue 3  
    Online since June 26, 2014

 
 
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ORIGINAL ARTICLES
Co-morbidity in bipolar disorder: A retrospective study
Ravindra Neelakanthappa Munoli, Samir Kumar Praharaj, Podila Satya Venkata Narasimha Sharma
July-September 2014, 36(3):270-275
DOI:10.4103/0253-7176.135377  PMID:25035550
Background: Bipolar disorder is a relatively common, long-term, and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality, and an increased risk of suicide. Psychiatric co-morbidity in bipolar disorder ranges from 57.3% to 74.3%, whereas medical co-morbidity varies from 2.7-70%. Indian scenario in this aspect is not clear. Materials and Methods: The objective was to ascertain the prevalence of physical and psychiatric co-morbidities in patients attending a tertiary care center over a period of 1 year and its relationship with socio-demographic and clinical variables. One hundred and twenty-five case record files were included in the review. OPCRIT software was used for re-establishing the diagnosis of bipolar disorder, which yielded 120 cases. A semi-structured pro-forma, specifically designed for the study, was used to collect the socio-demographic and clinical details. Results: Co-morbid psychiatric disorders were found in 52 (43.3%) of the sample, whereas co-morbid physical illness was present in 77 (64.2%) patients. The most common psychiatric disorder associated was substance use disorder (27.5%), whereas co-morbid cardiovascular disorder was the most frequent physical diagnosis in the sample (20%). Discussion: The prevalence of co-morbid psychiatric disorders in bipolar patients was lower than that reported in western literature. It could be related to retrospective nature of study or reflect true lower prevalence rates. Also, certain disorders such as eating disorders were absent in our sample, and migraine diagnosis was very infrequent.
  2 1,812 146
A study on first intake assessments of in-patient referrals to psychiatric rehabilitation services
Geetha Desai, Aniruddha Narasimha, Shashidhara N Harihara, M Srikanth Dashrath, Poornima Bhola, P Nirmala Berigai, Sailaxmi Gandhi, Santhosh K Chaturvedi
July-September 2014, 36(3):236-238
DOI:10.4103/0253-7176.135369  PMID:25035544
Background: Psychiatric rehabilitation is an important component in mental health services. The rehabilitation needs of patients with mental illness have been highlighted in various studies. The studies on in-patient referrals to rehabilitation services however are sparse. This study describes the clinical and demographic details and the reasons for referrals to rehabilitation services during the in-patients stay. Materials and Methods: A semi-structured pro forma was used for the assessment of in-patients referred for the psychiatric rehabilitation services. The pro forma included socio-demographic details such as background, family resources, illness related details such as symptom status, risk assessment, medication details. The total number of referrals for a period of 5 months was collected and coded. Results: The total number of referrals for a period of 5 months was 216 and there were 197 forms available for the study. The mean age of the sample was 31.48 ± 10.46 years. Vocational rehabilitation was the commonest reason for referral to the in-patient services. Severe mental disorders were the most common diagnosis of patients refereed to the services. Conclusions: Patients with severe mental illness were most often referred to the in-patient services. This indicates that we need include to rehabilitation in the management plan at the earliest. Vocational rehabilitation is the most common reason for referrals and there is a need to develop services to cater to these needs.
  2 1,220 103
EDITORIAL
Schizophrenia and other psychotic disorders in diagnostic and statistical manual of mental disorders (DSM)-5: Clinical implications of revisions from DSM-IV
Rajiv Tandon
July-September 2014, 36(3):223-225
DOI:10.4103/0253-7176.135365  PMID:25035542
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ORIGINAL ARTICLES
Mu-wave activity in schizophrenia: Evidence of a dysfunctional mirror neuron system from an Indian study
Sayantanava Mitra, S Haque Nizamie, Nishant Goyal, Sai Krishna Tikka
July-September 2014, 36(3):276-281
DOI:10.4103/0253-7176.135380  PMID:25035551
Background: The 'mirror-neuron system' is thought to play an important role in automatic decoding of biological motions and interpretation of socially adaptive environmental stimuli. Accordingly, a dysfunction in this system in schizophrenia has been hypothesised to mediate the psychotic manifestations. Materials and Methods: As a part of an ongoing study, we evaluated the mirror neuron system using 'EEG mu-wave (8-13 Hz) suppression' paradigm in 15 drug naïve/drug free patients and compared the working to 15 age, sex and education matched controls. We also correlated the psychopathology scores on PANSS with the mu wave suppression in the schizophrenia patients, at baseline. We used high (192-channel) resolution EEG to record the mu rhythm while the subjects watched alternating sequences of a socially-relevant biological motion and white visual-noise on a custom made video-clip. Results: We found a significant difference in the degree of mu wave suppression between the two groups. We also found that the degree of mu suppression over right sensorimotor cortex at presentation correlated significantly and negatively with thought disorder in the patient group, and had a strong linear relationship. Conclusion: This study replicates past findings regarding a dysfunctional mirror neuron system in schizophrenia patients, and also emphasizes the role of rMNS in schizophrenic thought disorders.
  1 1,249 69
BRIEF COMMUNICATION
Serum lithium levels: Ideal time for sample collection! Are we doing it right?
Damegunta Swetha Reddy, MS Reddy
July-September 2014, 36(3):346-347
DOI:10.4103/0253-7176.135399  PMID:25035570
Lithium has been the gold standard drug for bipolar disorders. The efficacy of lithium is dose-dependent and reliably correlates with that of serum lithium levels (trough levels). Trough levels are best measured when tested just before the next dose. In clinical practice, when lithium was administered in divided doses, trough levels were measured at 12 h after the last dose. Does this practice of 12 h lithium estimation apply to once a day (OD) administration of lithium also? This study was undertaken to test this hypothesis. Serum lithium levels were measured at 12 and 24 h post the last dose in 48 patients taking an OD dosing of sustained preparations of lithium. The mean and (standard deviation) of serum lithium levels at 12 h (0.82 [0.29]) and at 24 h (0.60 [0.20]) were calculated. The serum lithium level at 12 h was 1.3 times higher than that of the 24 h levels (actual trough levels). Thus, it seems appropriate to estimate the serum lithium levels (trough levels) at 24 h post the last dose in patients taking lithium as an OD dosage, which may prevent patient maintained on a lower than required dose of lithium.
  - 1,935 86
CASE REPORTS
Brief dynamic psychotherapy in a case of obsessive compulsive disorder
S Vyjayanthi
July-September 2014, 36(3):317-320
DOI:10.4103/0253-7176.135389  PMID:25035560
A 57 years old married , retired official of Indian Railway service presented with two months complaints of recurrent fears of circulation of a duplicate CD of one of his presentations in an international conference , recurrent thoughts that the years of winning medals during his tenure in Indian Railways service were misrepresented in the records as early years. He recognized these fears as irrational, intrusive causing irritability and extreme anxiety, as he felt an urge to go and check the records, and feared it would cause humiliation. A diagnosis of obsessive compulsive disorder predominantly obsessions were made. Patient refused medication and a keen interest to receive insight. Patient had strong ego functions, stable heterosexual partnership, was open to interpretations and therapeutic contract of ten sessions of David Malan's school of brief dynamic therapy was initiated. Unconscious therapeutic alliance dominated over resistance. Displacement, isolation of affect and undoing were the neurotic defenses interpreted by the therapist. Therapeutic focus was relief of obsessions occurred by 9 th session and therapy was successfully terminated.
  - 1,320 79
Dream work in grief therapy
Konrad Joseph Noronha
July-September 2014, 36(3):321-323
DOI:10.4103/0253-7176.135390  PMID:25035561
Working with dreams is useful with grief and loss clients who present with dreams. Adlerian dream analysis is one-way of exploring dreams. It incorporates the life-style of the client. This case report demonstrates how Adlerian dream analysis was used with a client. Progress was noted in improved life-style once the client began to talk about her dream.
  - 1,155 51
Secondary enuresis associated with chorea in a Nigerian girl
Ibrahim Aliyu
July-September 2014, 36(3):324-325
DOI:10.4103/0253-7176.135391  PMID:25035562
Enuresis is a distressing psycho-social disorder. It is often a neglected disorder, and its effect on the psychosocial development of a child is often overlooked, especially in those of low socio-economic status. Its exact pathophysiology is not completely understood, but it has been related to the effect of dopamine in the basal ganglia. However, its association with pediatric autoimmune neuropsychiatric disorder associated with streptococci infection is well-established. But, the case of an 11-year-old Nigerian girl diagnosed with Sydenham's chorea and had secondary enuresis is reported.
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Doing psychiatry right: A case of severe avoidant personality disorder with obsessive-compulsive personality disorder, obsessive compulsive disorder, intermittent explosive disorder and sexual paraphilias
Sudhir Hebbar
July-September 2014, 36(3):326-328
DOI:10.4103/0253-7176.135392  PMID:25035563
Over dependence on pharmacotherapy in psychiatry, known as biological imperialism, is a world-wide phenomenon. Some authors have opined that the inadequate and ineffective utilization of psychotherapeutic interventions and only dependence on pharmacotherapy amounts to institutional malpractice. Here is an example of such a case. A young male mainly received multiple psychotropic medicines, including clozapine (and also a failed psychotherapy) over a period of 4 years, without any benefit. His global assessment of function score remained at 30. However, with proper diagnosis and effectively conducted psychotherapy a significant improvement in Global assessment of functioning score of 70 was achieved, over a period of 1½ years.
  - 2,363 64
Situational psychogenic anejaculation: A case study
Rajesh Gopalakrishnan, Packirisamy Thangadurai, Anju Kuruvilla, Kuruthukulangara Sebastian Jacob
July-September 2014, 36(3):329-331
DOI:10.4103/0253-7176.135393  PMID:25035564
Anejaculation is an uncommon clinical entity that may result from a variety of causes, both organic and psychological. Psychogenic anejaculation is influenced by relationship, behavioral, and psychological factors. We present a clinical case of situational anejaculation, which was managed with a combination of techniques that addressed these factors including changes in masturbatory technique, improved marital communication and quality, and reduction of anxiety using cognitive behavioral techniques. It is suggested that the standard techniques of sex therapy be modified and tailored to manage the specific problems of the individual patient.
  - 1,253 58
Functional convergence spasm
Abhishek Ghosh, Susanta K Padhy, Gourav Gupta, Manoj K Goyal
July-September 2014, 36(3):332-334
DOI:10.4103/0253-7176.135394  PMID:25035565
Convergence spasm (CS) means intermittent episodes of convergence, miosis and accommodation with disconjugate gaze mimicking abducens palsy. The organic causes range from metabolic to host of neurological and ophthalmic diseases that we describe. It was first described as a presentation of psychogenic disorders by von Graefe as early as in 1856. Nonetheless, patients exhibiting this sign are often subjected to plethora of unnecessary, sophisticated and invasive diagnostic procedures. Such functional cases were treated with either cycloplegic/placebo eye drop or amytal abreaction. Though epidemiological studies suggest that conversion disorder is equally prevalent in industrialized nations and developing countries, a few cases of functional CS are reported from West including Asia, that to, decade(s) before and none from India, to the best of our knowledge. We illustrate a case of functional CS with photograph after consent from patient and its successful treatment.
  - 1,262 49
Ketamine dependence in an anesthesiologist: An occupational hazard?
Shrigopal Goyal, Atul Ambekar, Rajat Ray
July-September 2014, 36(3):335-337
DOI:10.4103/0253-7176.135395  PMID:25035566
Substance abuse among medical professionals is a cause for concern. Certain psychotropic substances such as ketamine are at easy dispense to anesthesiologists increasing the likelihood of misuse and dependence and raise several issues including safety of patients. We discuss a case demonstrating ketamine dependence in an anesthesiologist from India. The reported psychotropic effects of ketamine ranged from dissociation and depersonalization to psychotic experiences. There was also development of significant tolerance to ketamine without prominent physical withdrawal symptoms and cyclical use of very high doses was observed. Issues related to management of health professionals are also discussed.
  - 966 58
Cerebellar stroke-manifesting as mania
Venkatesan Jagadesan, Kannapiran R Thiruvengadam, Rengarajalu Muralidharan
July-September 2014, 36(3):338-340
DOI:10.4103/0253-7176.135396  PMID:25035567
Secondary mania resulting from cerebral Cortex are described commonly. But secondary mania produced by cerebellar lesions are relatively uncommon. This case report describes a patient who developed cerebellar stoke and manic features simultaneously. 28 years old male developed giddiness and projectile vomiting. Then he would lie down for about an hour only to find that he could not walk. He became quarrelsome. His Psycho motor activities and speech were increased. He was euphoric and was expressing grandiose ideas. Bender Gestalt Test showed signs of organicity. Score in Young mania relating scale was 32; productivity was low in Rorschach. Neurological examination revealed left cerebellar signs like ataxia and slurring of speech. Computed tomography of brain showed left cerebellar infarct. Relationship between Psychiatric manifestations and cerebellar lesion are discussed.
  - 1,009 46
Persistent hiccups (singultus) as the presenting symptom of lateral medullary syndrome
V Sampath, Mahesh R Gowda, HR Vinay, S Preethi
July-September 2014, 36(3):341-343
DOI:10.4103/0253-7176.135397  PMID:25035568
Lateral medullary syndrome (LMS) is a constellation of varied neurologic manifestations seen in cerebrovascular accidents. The posterolateral part of the medulla oblongata of the brain stem and cerebellum receiving arterial blood supply from the posterior inferior cerebellar artery are the areas commonly affected. We present a case of a middle aged gentleman referred to our hospital for persistent intractable hiccups as presenting symptom of LMS. He presented to our emergency room with persistent hiccups and left sided cerebellar signs. The patient had significant past history of alcohol and tobacco (smoking) dependence since 30 years apart from being a hypertensive.
  - 2,055 48
Unilateral galactorrhea associated with low-dose escitalopram
P Bangalore Ravi, KG Guruprasad, Chittaranjan Andrade
July-September 2014, 36(3):344-345
DOI:10.4103/0253-7176.135398  PMID:25035569
Galactorrhea is a rare adverse effect of selective serotonin reuptake inhibitor treatment. We report a 27-year-old woman who developed unilateral breast engorgement with galactorrhea 18 days after initiation of escitalopram (10 mg/day). The symptom remitted 7 days after withdrawal of escitalopram and did not subsequently recur during maintenance therapy with agomelatine (25 mg/day).
  - 1,011 46
LETTERS TO EDITOR
Evaluation of clinical guidelines in psychiatry
Sundar Gnanavel
July-September 2014, 36(3):348-348
DOI:10.4103/0253-7176.135400  PMID:25035571
  - 587 42
Lomotil dependence
Beuy Joob, Viroj Wiwanitkit
July-September 2014, 36(3):348-349
DOI:10.4103/0253-7176.135401  PMID:25035572
  - 543 39
Time matters!: When is the right time to estimate serum valproic acid levels?
Swetha Reddy Damegunta
July-September 2014, 36(3):349-350
DOI:10.4103/0253-7176.135402  PMID:25035573
  - 1,584 56
ORIGINAL ARTICLES
Perfectionism, emotion regulation and their relationship to negative affect in patients with social phobia
Systla Rukmini, Paulomi M Sudhir, Suresh Bada Math
July-September 2014, 36(3):239-245
DOI:10.4103/0253-7176.135370  PMID:25035545
Context: Research on the perfectionism and emotion regulation strategies in anxiety disorders has gained increased attention. These have an important implication for formulation of therapies. Aims: We examined perfectionism, emotion regulation were examined in 30 patients with social phobia (SP) and 30 community participants. Settings and Design: A cross-sectional design using a clinical and a community control sample was adopted in this exploratory study. Materials and Methods: Participants were assessed on The Mini-International Neuropsychiatric Interview, Frost's-Multidimensional Perfectionism Scale, Ruminative Response Scale of the response style questionnaire, cognitive emotion regulation questionnaire, Social Interaction Anxiety Scale and the Beck's Depression Inventory. Statistical Analysis: Data was analyzed using independents samples t-test and Pearson's Product moment correlations and step-wise linear regression. Results: Individuals with SP had higher perfectionism (mean = 100.30, SD = ±17.73, t = 7.29, P < 0.001), rumination (mean = 61.47, SD = ±11.96, t = 6.71, P < 0.001) and lower levels of positive reappraisal (mean = 11.53, SD = ±3.85, t = 4.90, P < 0.001). Perfectionism was correlated with social anxiety (r = 0.44, P < 0.05) and rumination (r = 0.43, P < 0.05), but not with depression. Rumination was positively correlated with both social anxiety (r = 0.513, P < 0.01) and depression (r = 0.485, P < 0.01).Positive reappraisal was negatively correlated with depression (r = 0.396, P < 0.05) and anxiety (r = 0.335, P < 0.05). Acceptance was found to be significantly correlated only to the reflective pondering subscale of rumination. Parental criticism was a significant predictor of social anxiety (F = 11.11, P < 0.01) and brooding predicted depression (F = 10.49, P < 0.01). Conclusions: This study highlights the role of perfectionism as a maintaining factor in SP and the importance of adaptive forms of emotion regulation that need to be addressed in psychological interventions.
  - 1,957 115
Depression and stigma in medical students at a private medical college
Jagdish R Vankar, Anusha Prabhakaran, Himanshu Sharma
July-September 2014, 36(3):246-254
DOI:10.4103/0253-7176.135372  PMID:25035546
Objectives: This study aimed to assess prevalence rate of depression and perceptions regarding stigma associated with depression amongst medical students. Materials and Methods: A cross-sectional survey was conducted amongst 331 undergraduate medical students at a private medical college in Gujarat. Data was collected, which comprised of socio-demographic details, Patient Health Questionnaire (PHQ-9), and a 22-item semi-structured questionnaire to assess personal, perceived, and help-seeking stigma. Univariate analysis and chi-square tests were used to test for association between variables. Results: Overall prevalence of depression was found to be 64%. Highest level of depression was seen in first year. Moderate to severe depression was found in 26.6% students. 73.3% students felt that having depression would negatively affect their education, and 52.3% saw depression as a sign of personal weakness. Females more strongly believed that students would not want to work with a depressed student (50.9% v/s 36.2%) and that if depressed, they would be unable to complete medical college responsibilities (61.9% v/s 44.1%). With increasing academic year, there was increase in stigma about disclosing depression to friends (P = 0.0082) and increase in stigma about working with a depressed student (P = 0.0067). Depressed students felt more strongly than non-depressed students on 10 items of the stigma questionnaire. Conclusions: High stigma exists among students about the causation of depression, and there exists an environment in which students discriminate fellow colleagues based on the presence of depression. This raises need for increasing awareness and support from peers and faculty.
  - 2,844 213
Cognitive deficits in HIV infected children
OS Ravindran, Mrudula P Rani, G Priya
July-September 2014, 36(3):255-259
DOI:10.4103/0253-7176.135373  PMID:25035547
Background and Objectives: Children infected with HIV are at risk for significant neurological and neuropsychological problems. This study is aimed at identifying cognitive deficits in HIV-infected children and to compare them with equal number of normal controls. Materials and Methods: Twenty children with HIV infection who are currently on antiretroviral therapy were recruited. They were assessed for their intelligence using Malin's Intelligence Scale for Indian Children and also evaluated for their cognitive abilities with a comprehensive neuropsychological battery. They were matched with equal number of normal controls. Results: HIV-infected children have shown substantial impairments in the domains of attention, language, verbal learning and memory, visuomotor functions, fine motor performance, and executive functions. Conclusion: HIV-infected children have average intelligence, but they performed poorly on several neuropsychological measures.
  - 1,210 94
Social networking sites: An adjunctive treatment modality for psychological problems
Indu S Menon, Manoj Kumar Sharma, Prabha S Chandra, K Thennarasu
July-September 2014, 36(3):260-263
DOI:10.4103/0253-7176.135374  PMID:25035548
Background: Social networking is seen as a way to enhance social support and feeling of well-being. The present work explores the potentials of social networking sites as an adjunctive treatment modality for initiating treatment contact as well as for managing psychological problems. Materials and Methods: Interview schedule, Facebook intensity questionnaire were administered on 28 subjects with a combination of 18 males and 10 females. They were taken from the in-patient and out-patient psychiatry setting of the hospital. Results: Facebook was the most popular sites and used to seek emotional support on the basis of the frequent updates of emotional content that users put in their profile; reconciliations, escape from the problems or to manage the loneliness; getting information about illness and its treatment and interaction with experts and also manifested as problematic use. Conclusions: It has implications for developing social networking based adjunctive treatment modality for psychological problems.
  - 1,627 96
Knowledge and attitude of patients with psychiatric disorders and their relatives toward electroconvulsive therapy
Amitava Dan, Sandeep Grover, Subho Chakrabarti
July-September 2014, 36(3):264-269
DOI:10.4103/0253-7176.135376  PMID:25035549
Objective: Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives. Results: Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73). Conclusions: Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.
  - 1,694 123
Changes in distressing behavior perceived by family of persons with schizophrenia at home - 25 years later
Santosh K Chaturvedi, Ameer Hamza, Mahendra P Sharma
July-September 2014, 36(3):282-287
DOI:10.4103/0253-7176.135381  PMID:25035552
Background: Schizophrenia disorders as well as their symptoms cause distress to the family members or caregivers, which may cause poor quality of life. However, there have been advances in management, which could possibly alter this family distress. Aims: To determine if there was any change in the perception of distressful symptoms of schizophrenia, by the family members, now, 25 years after the initial studies in the same centre. Materials and Methods: Fifty-six consecutive and consenting new cases diagnosed as schizophrenia were administered the Scale for Assessment of Family Distress to identify the amount of distress caused by each of the symptoms reported. These findings were then compared with those reported by 50 patients, 25 years earlier. Results: Symptoms like does not do work and earn, does not sleep, and does not do household tasks were reported as the commonest distressing symptoms in both the samples, however, in the 1988 sample, negative symptoms like, slow in doing things, social withdrawal and has few leisure interests, were the commonest, in the present sample behavioral symptoms like beats and assaults others, threatens, is abusive and talks nonsense were the commonest distressing symptoms. Conclusions: The relatives of patients with schizophrenia suffer from considerable amount of distress and burden. There are some changes in the type of behaviours considered distressful in the current period. Assessing family distress is helpful in providing support to caregivers of persons with schizophrenia
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Attitudes towards antipsychotics among patients with schizophrenia on first- or second-generation medications
MS Karthik, Nisha Warikoo, Subho Chakrabarti, Sandeep Grover, Parmanand Kulhara
July-September 2014, 36(3):288-293
DOI:10.4103/0253-7176.135382  PMID:25035553
Background: Given the paucity of research in this area, this study attempted to assess attitudes toward antipsychotic medications and its correlates among patients with schizophrenia, either on first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs) medications. Materials and Methods: Structured assessments of attitudes to antipsychotics, psychopathology, insight and side-effects were carried out in 120 patients with DSM-IV schizophrenia; 89 of these were on SGAs and 31 on FGAs. Results: Patients had predominantly positive attitudes toward antipsychotics. Severity of side-effects was the principal correlate of attitudes, explaining 19.5% of the variance, followed by greater insight (4.2% of the variance). Other factors such as younger age, male gender, employment, higher family income, urban residence and lower symptom-severity explained only a negligible proportion of the variance (0.2%) in attitudes. Patients on SGAs had more positive views of their medications than those on FGAs. They felt more normal on their medications, believed that their thoughts were clearer on medications, felt that good things about their medications outweighed the bad and believed that their medications helped them from falling ill again. In addition, they did not feel as tired and sluggish on their medications and did not believe that medications were unnatural or controlled their bodies. Conclusions: Positive attitudes toward antipsychotics were common among patients with schizophrenia. Attitudes were principally determined by severity of side-effects and insight levels. Patients on SGAs had better attitudes, possibly because of less severe side-effects and greater insight among them. The importance of exploring patients' attitudes toward their antipsychotics is highlighted by this study.
  - 1,169 68
Attitudes toward medication and reasons for non-compliance in patients with schizophrenia
Ivatury Sarath Chandra, Kalasapati Lokesh Kumar, Mallepalli Pramod Reddy, Chada Muni Pavan Kumar Reddy
July-September 2014, 36(3):294-298
DOI:10.4103/0253-7176.135383  PMID:25035554
Background: Non-compliance for the medication is an important area of concern in schizophrenia as it contributes to relapse and re-hospitalization of the patients. One of the ways to improve the drug compliance is to know crucial factors responsible for poor drug compliance and hence that proper strategies may be planned to improve patient's drug compliance. Aim: The aim of the following study is to find out the attitudes of patients toward medication and reasons for drug non-compliance in schizophrenia and its association with clinical and socio-demographic variables. Materials and Methods: The study was conducted on follow-up patients with schizophrenia for the duration of 5 months. Their socio-demographic details were noted and illness related variables were evaluated using Positive and Negative Syndrome scale (PANSS). Patient's attitudes toward medication and the reasons for treatment non-compliance were assessed using the standardized tools, which consist of Drug Attitude Inventory-10 scale and Rating of Medication Influences scale respectively. Results: Nearly 41.9% of our study sample were non-compliant to medication. A significant association has been found between non-compliance and younger age group, unemployment, early age of onset, high positive PANSS score and poorer insight into the illness. The significant reasons for non-compliance in our study were Denial of illness, financial burden, less access to treatment facilities, Side-effects of the medication, Feeling that the medication was unnecessary and Substance abuse. Conclusions: Findings suggest that there is a need to provide adequate information about mental illness and medications prescribed, to enhance medication compliance and to develop community mental health care facilities.
  - 3,579 174
Asynchronous telepsychiatry in Maharashtra, India: Study of feasibility and referral pattern
Vanshree Patil Balasinorwala, Nilesh B Shah, Soumya D Chatterjee, Vinayak P Kale, Yusuf A Matcheswalla
July-September 2014, 36(3):299-301
DOI:10.4103/0253-7176.135384  PMID:25035555
Context: There is a paucity of published telepsychiatry results in India. Aims: This study was conducted to assess the feasibility of asynchronous telepsychiatry and to study the referral patterns. Settings and Design: This study was conducted in the telemedicine unit of a tertiary care center and design was retrospective analysis of 94 cases, which were diagnosed and treated by telepsychiatry. Materials and Methods: All 94 patients who were referred between January 2007 and August 2013 for telepsychiatry consultations were retrospectively analyzed to assess the referral pattern and feasibility. Statistical Analysis Used: Comparisons between demographic parameters and psychiatric diagnosis was done using Chi-square test. Results: In 89 out of 94 (95%) patients it was possible to make a definitive diagnosis and recommend appropriate treatment only on the basis of data received from the primary care physician by telepsychiatry. This indicates the feasibility of telepsychiatry. The most common problems for which referrals were made included schizophrenia and other psychotic disorders, mood disorders and substance related disorders. Conclusions: This study demonstrates the feasibility of Asynchronous telepsychiatry. Additional Indian studies should be conducted to build the evidence base for the best use of asynchronous telepsychiatry.
  - 1,029 80
Psychiatric morbidity and quality of life in vitiligo patients
Podaralla Ramakrishna, Tenali Rajni
July-September 2014, 36(3):302-303
DOI:10.4103/0253-7176.135385  PMID:25035556
Background: Vitiligo has underlying mental illness but mostly not diagnosed and never used psychiatric medication. Hence, the problem persists affecting mostly the individual's quality of life. Aim: Assessing the quality of life, level of depression, and self-esteem of patients with vitiligo and give psychiatric medication for underlying mental illness. Materials and Methods: The study conducted at Owaisi Hospital Research Centre, Hyderabad. The patients registered for dermatologist consultation were also registered for consultation with psychiatrist to rule out any mental illness after detailed evaluation using standardized scales. Results: Patients suffering with vitiligo had depression and low self-esteem; their quality of life was disturbed. Conclusion: The findings provide the role of Mental Health Professionals involved in the field of dermatology for the patients suffering with vitiligo.
  - 1,426 133
The relationships between self-efficacy, internet addiction and shame
Giuseppe Craparo, Roberta Messina, Sergio Severino, Silvia Fasciano, Vincenza Cannella, Alessio Gori, Marco Cacioppo, Roberto Baiocco
July-September 2014, 36(3):304-307
DOI:10.4103/0253-7176.135386  PMID:25035557
Background: Internet addiction (IAD) is one of the most diffuse mental disorders among adolescents. Aims: The aim of our study was to evaluate the relationships between shame, self-efficacy and Internet addiction. Materials and Methods: We recruited a total of 670 college students (males = 164, 24.5%; females = 506, 75.5%). The subjects were aged between 18 and 36 years (M = 20.93, SD = 2.52; males: M = 21.43, SD = 2.95; females: M = 20.76, SD = 2.35). We administered the following instruments: Experience of Shame Scale; Perceived Social Self-Efficacy Scale - Adult Version; Perceived Self-Efficacy in Handling Negative Emotions Scales; Internet Addiction Test. Statistics Analysis: We applied multivariate analyses of variance (MANOVA), Pearson's correlation indices and linear regression analysis. Results and Conclusion: We found a significant inter-relation between Internet addiction and shame. Shame could be a good predictor of Internet addiction.
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Job stress, satisfaction, and coping strategies among medical interns in a South Indian tertiary hospital
Susmita Chandramouleeswaran, Natasha C Edwin, Deepa Braganza
July-September 2014, 36(3):308-311
DOI:10.4103/0253-7176.135387  PMID:25035558
Background: It has previously been demonstrated that there is a significant drop in all domains of quality of life among interns during internship. Aims: A modified version of the health consultant's job stress and satisfaction questionnaire (HCJSSQ) was used to assess and quantify aspects of internship that were perceived as stressful and satisfying. Methods used to cope with work place stress were explored. Settings and Design: A prospective cohort study was undertaken among 93 medical interns doing a rotating internship at the Christian Medical College and Hospital, a tertiary-care hospital in southern India. Materials and Methods: After completion of 6 months of internship, the modified version of the HCJSSQ was administered to all participants. Statistical Analysis: The data were entered into Statistical Package for the Social Sciences (SPSS) Version 9 by double data entry technique. Percentages of interns reporting high levels of stress, satisfaction were calculated. Results: While 63.4% of interns reported high levels of satisfaction, 45.2% of the interns experienced high levels of stress, 17.6% coped with work stress by using alcohol and nicotine, and 37% coped through unhealthy eating habits. Conclusion: More people found internship satisfying than stressful. However, a high proportion found it stressful, and many reported unhealthy coping mechanisms.
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Role of psychosocial care on ICU trauma
Usha Chivukula, Meena Hariharan, Suvashisa Rana, Marlyn Thomas, Sunayana Swain
July-September 2014, 36(3):312-316
DOI:10.4103/0253-7176.135388  PMID:25035559
Context: Patients treated in intensive care units (ICU) though receive the best medical attention are found to suffer from trauma typically attributed to the ICU environment. Biopsychosocial approach in ICUs is found to minimize ICU trauma. Aims: This study investigates the role of psychosocial care on patients in ICU after coronary artery bypass graft (CABG). Settings and Design: The study included 250 post-operative CABG patients from five corporate hospitals. The combination of between subject and correlation design was used. Materials and Methods: The ICU psychosocial care scale (ICUPCS) and ICU trauma scale (ICUTS) were used to measure the psychosocial care and trauma. Statistical Analysis: ANOVA and simple and multiple regression were applied. Results: Hospitals significantly differed in psychosocial care provided in ICUs. Higher the psychosocial care in ICU, lower was the ICU trauma experienced and vice versa. Psychosocial care was a significant major predictor of ICU trauma. Conclusions: The study suggests emphasis on psychosocial aspects in ICU care for optimizing prognosis.
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REVIEW ARTICLE
A review of web based interventions for managing tobacco use
Yatan Pal Singh Balhara, Rohit Verma
July-September 2014, 36(3):226-235
DOI:10.4103/0253-7176.135367  PMID:25035543
Web based interventions (WBIs) have been developed for various health conditions. These include interventions for various psychoactive substance use disorders including tobacco and alcohol. Tobacco use has remained the single largest preventable cause of global mortality and morbidity for many years. It is responsible for around 6 million deaths annually world-wide. Ironically, most of the tobacco users reside in resource poor low and middle-income countries. The article reviews the existing literature on WBIs for management of tobacco use. The literature search was performed using MedLine, PubMed, PsycINFO, Embase and Cochrane Review for relevant English language articles published from 1998 up to 2013. There is limited support for effectiveness of WBIs for managing tobacco use among adolescents. Although most of the trials among adults found WBIs to be more effective at short term follow-up (a few days to weeks), the benefits failed to extend beyond 3 months in most of the studies. All but one interventions studied in a randomized controlled trial is for smoking forms.
  - 1,462 111
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