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   2014| October-December  | Volume 36 | Issue 4  
    Online since September 15, 2014

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Delusional disorder: An unusual presentation
Joseph Noel, Ranjit Krishnadas, Rajesh Gopalakrishnan, Anju Kuruvilla
October-December 2014, 36(4):444-446
DOI:10.4103/0253-7176.140757  PMID:25336783
Delusions with a sexual theme are rare, but when present are usually seen in patients with schizophrenia or other chronic psychotic disorders. We report a case of delusional disorder, with a single belief of a sexual theme. This report focuses on the management issues, wherein a combination of pharmacological and nonpharmacological interventions proved helpful.
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Quadruple pact suicide attempt involving a man and three adolescents
Siddharth Sarkar, Balachander Srinivas, Sandeep Grover
October-December 2014, 36(4):422-424
DOI:10.4103/0253-7176.140736  PMID:25336777
Pact suicides involving families have been reported in the scientific literature, but reports have been few from India. We report the case of a family, in which the father and three children had entered into a suicidal pact and executed it due to social reasons. A 41-year-old man, with no past psychiatric or substance use history, had reportedly come to know that his wife had been involved in an extra-marital affair. As expressed by him in a suicide note, he could not bear the humiliation due to this and also did not want his children to face disrespect from the society. He along with his daughter and 2 sons, aged 14, 12 and 11 years respectively, thus entered into a suicide pact to end their lives and wrote a suicide note. Man and two of his children consumed aluminum phosphide. However, the youngest son did not consume the poison and raised alarm, following which they were rushed for medical care. The father died, but the three children recovered completely. The case highlights the rare phenomenon of suicide pacts involving an adult and children.
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Late onset clozapine induced agranulocytosis
Rajmohan Velayudhan, Sushil Kakkan
October-December 2014, 36(4):425-427
DOI:10.4103/0253-7176.140738  PMID:25336778
Agranulocytosis is defined as an absolute neutrophil count less than 100/mm 3 in association with infectious disease. The risk of agranulocytosis is 0.38% of all clozapine treated cases and there is a relatively lesser incidence in Indian population. The risk of clozapine-induced agranulocytosis and neutropenia is highest in the first 6 months and higher in the initial 18 months after the onset of treatment. There have been very few reports of neutropenia and agranulocytosis after this period. There have so far been no reports of late onset clozapine induced agranulocytosis has been reported from India. A case of late onset clozapine induced agranulocytosis with possible mechanism of the same is reported.
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Post-operative adult onset tic disorder: A rare presentation
Suneet Kumar Upadhyaya, Chintan M Raval, Devendra Kumar Sharma, Devendra Kumar Vijayvergiya
October-December 2014, 36(4):428-430
DOI:10.4103/0253-7176.140740  PMID:25336779
Tics are rapid and repetitive muscle contractions resulting in stereotype movements and vocalizations that are experienced as involuntary. Onset before 18-year is a diagnostic criterion for tic disorders. Children and adolescents may exhibit tic behaviors after a stimulus or in response to an internal urge. Tic behaviors increase during physical or an emotional stress. Adult onset tic disorders are reported by infections, drugs, cocaine, toxins, chromosomal disorders, head injury, stroke, neurocutaneous syndromes, neurodegenerative disorders and peripheral injuries. Only few cases have yet been reported having onset after surgery though surgery brings both physical and emotional stress to the patient. We report a case of a 55-year-old lady who developed tic disorder as post-operative event of cataract surgery. Our patient had a dramatic response to haloperidol which is in contrast to all earlier reports.
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Atypical delusional content in a case of persistent delusional disorder: Freud revisited
Jayaprakash Ramasamy, Shanmugiah Arumugam, Jaiganesh S Thamizh
October-December 2014, 36(4):431-433
DOI:10.4103/0253-7176.140742  PMID:25336780
Persistent delusional disorder is diagnosed when a person exhibits non-bizzare delusions of at least 1 month's duration that cannot be attributed to other psychiatric disorders. Delusions are subdivided according to their content into various types. Here we report a case with unusual content of delusion.
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Disulfiram-induced reversible hypertension: A prospective case series and review of the literature
Ranganath R Kulkarni, Santosh I Ramdurg, Bhavya K Bairy
October-December 2014, 36(4):434-438
DOI:10.4103/0253-7176.140744  PMID:25336781
Disulfiram (DSF) is one of the recommended aids in the management of selected patients with alcohol dependence. Hypertension (HTN) as an adverse effect of DSF therapy is less understood. In our prospective case series of 7 subjects with co-morbid alcohol and nicotine dependence, a temporal, dose-dependent, and reversible grade 1-3 HTN within 1-6 weeks of initiation of DSF therapy (125-500 mg/day) with no other detectable causes of HTN was noted. Challenges and strategies surrounding diagnosis and treatment along with mean change and percentage rise in blood pressure are described. Literature review and clinical description of case series may suggest neurobiological role in its causation. HTN may be a clinically significant, dose-dependent, and reversible adverse effect of DSF therapy, especially in co-morbid alcohol and nicotine-dependent patients. Awareness amongst clinicians may render better health care delivery to subjects with alcohol dependence.
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Long-term agonist and antagonist therapy for adolescent opioid dependence: A description of two cases
Rajeev Ranjan, Raman Deep Pattanayak, Anju Dhawan
October-December 2014, 36(4):439-443
DOI:10.4103/0253-7176.140754  PMID:25336782
Adolescents constitute only a small percentage of treatment seekers in drug dependence treatment settings. Little research evidence is available for pharmacological treatment of adolescent opioid dependence and no prior case report is available from India. We discuss two adolescent patients with opioid (heroin) dependence visiting a tertiary care center who have been stabilized on agonist (sublingual buprenorphine-naloxone) and antagonist (oral naltrexone) respectively for a substantial period of time. A comprehensive management approach, including intensive psychosocial interventions and family involvement, was followed in addition to pharmacotherapies. More research is needed on the efficacy of pharmacological treatment in adolescent opioid users.
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Medicalizing distress, ignoring public health strategies
P Thangadurai, KS Jacob
October-December 2014, 36(4):351-354
DOI:10.4103/0253-7176.140698  PMID:25336764
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Dermatitis artefacta: Growing awareness
Abhishek Bhardwaj, Supriya Vaish, Sonal Gupta, Garima Singh
October-December 2014, 36(4):447-448
DOI:10.4103/0253-7176.140760  PMID:25336784
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Self-plagiarism: The latest ethical dilemma in biomedical research
Sundar Gnanavel
October-December 2014, 36(4):448-449
DOI:10.4103/0253-7176.140763  PMID:25336785
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Mental health services for older people
UG Nikhil, TP Sumesh, G Anoop, KS Shaji
October-December 2014, 36(4):449-450
DOI:10.4103/0253-7176.140764  PMID:25336786
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Physiological genomics analysis for mania: Supportive evidence for epigenetics concept
Viroj Wiwanitkit
October-December 2014, 36(4):366-367
DOI:10.4103/0253-7176.140700  PMID:25336766
Background: Mania is an important psychological problem. This disorder can be detected anywhere in the world. This psychological disorder becomes an important concern in modern psychological medicine. Aims: There are some researches on the pathogenesis of this disease; however, there is no clear-cut on its etiopathogenesis. The big query is on the genetic underlying of the mania. Materials and Methods: Here, the author uses the physiological genomics study to better understand the pathogenesis of mania. Results: According to this work, the physiogenomics relationship on chromosomes could not be identified. Conclusion: The result from this study shows that mania might not have a genetic, but epigenic origin, which is different from the well-known disorder in psychological medicine, Alzheimer's disease.
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Undergraduate nursing students' attitudes towards mental illness: Implications for specific academic education
Vijayalakshmi Poreddi, Rohini Thimmaiah, Dharma Reddy Pashupu, Ramachandra , Suresh Badamath
October-December 2014, 36(4):368-372
DOI:10.4103/0253-7176.140701  PMID:25336767
Background: Health care professions are not immune to social prejudices and surprisingly share the general public's attitude attributed to people with mental illness. Nursing students are future health manpower research related to nursing students attitudes toward mental illness is limited. Aim: The aim of this following study is to examine the undergraduate nursing students' attitudes toward people with mental illness. Materials and Methods: Cross-sectional descriptive design was adopted for the present study. A total of 148 undergraduate nursing students were purposively selected to complete self-reported questionnaires. Results: The nursing students have significant positive attitudes towards mental illness in three of the six attitudes factors: Restrictiveness (8.59), benevolence (29.8) and stigmatization (9.18). However, these students have negative attitudes in separatism (27.1), stereotype (11.5) and pessimistic predictions (11.7) domains as they rated high. Conclusion: Academic education in this area must be planned so as to favor the change of the attitudes that include greater use of teaching strategies that challenge beliefs and assumptions and promote a commitment to provide holistic care to people with mental illness.
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Enhancing mother infant interactions through video feedback enabled interventions in women with schizophrenia: A single subject research design study
Pashapu Dharma Reddy, Geehta Desai, Ameer Hamza, Sheshachala Karthik, Supraja Thirumalai Ananthanpillai, Prabha S Chandra
October-December 2014, 36(4):373-377
DOI:10.4103/0253-7176.140702  PMID:25336768
Background: It has been shown that mother infant interactions are often impaired in mothers with schizophrenia. Contributory factors include psychotic symptoms, negative symptoms and surrogate parenting by others. Aim: This study describes the effectiveness of video feedback in enhancing mother-infant interaction in mothers with schizophrenia who have impaired interaction with their infant. Materials and Methods: Two women with schizophrenia who were admitted for persistent psychotic symptoms and poor mothering skills, participated in the intervention. Pre intervention parenting assessment was done using video recording of mother infant interaction. Six sessions of mothering intervention were provided using video feedback and a repeat recording was done. Pre-and post-intervention videos were subsequently rated in a blind fashion by an independent expert in perinatal psychiatry using the pediatric infant parent exam (PIPE) scale. Results: Pre and post intervention comparison of PIPE scores indicating significant improvement in several areas of mothering. Conclusions: Video feedback is a simple and inexpensive tool which can be used for improving mothering skills among mothers with postpartum psychosis or schizophrenia even in low resource settings.
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Lipid correlates of attentional impulsivity in first episode mania: Results from an Indian population
Anjana Rao Kavoor, Daya Ram, Sayantanava Mitra
October-December 2014, 36(4):378-384
DOI:10.4103/0253-7176.140703  PMID:25336769
Background: Attentional/cognitive impulsivity has been demonstrated as being associated with an increased risk for suicide and other self-harming behaviors, along with a more severe course in patients with bipolar disorder. That an alteration of the various serum lipid fractions might be associated with increased impulsivity has been proposed in the past, but evidences are ambiguous and mainly based on western population data. Objective: The present study was aimed to analyze the attentional impulsivity and various serum lipid fractions in bipolar patients, from an Indian perspective. Materials and Methods: At presentation, 60 drug free/naïve first episode Mania patients were rated on the Barratt impulsiveness scale-version 11 and Young Mania Rating Scale; body mass index (BMI) was calculated and blood samples were analyzed for total cholesterol (TC), high density lipoproteins, low density lipoproteins and very low density lipoproteins (VLDL), triglycerides (TG) and apolipoproteins A1 and B. Results: The analysis revealed statistically significant negative correlation and inverse linear relationship between TC, TG, VLDL and BMI with attentional impulsivity. Conclusion: The present study adds to the growing literature on a complex relationship between lipid fractions and attentional impulsivity. The findings present interesting insights into the possible substrates of human behavior at biochemical levels. The implications are many, including a need to introspect regarding the promotion of weight loss and cholesterol reduction programs in constitutionally vulnerable population.
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Neural correlates of emotion: Acquisition versus innate view point
Rajakumari P Reddy, Sakshi P Korde, Silpa Kanungo, A Thamodharan, Jamuna Rajeswaran, Rose Dawn Bharath, Neeraj Upadhya, Rajanikanth Panda, Shobini L Rao
October-December 2014, 36(4):385-391
DOI:10.4103/0253-7176.140720  PMID:25336770
Background: Emotion entails cognitive processes that may either be conscious or unconscious. Emotions influence all aspects of cognition. Aim: The aim of the following study was to study the effect of education on neural correlates of emotions in healthy normal volunteers. Materials and Methods: Sample consisted total of 61 healthy young educated adults in the age range of 18-40 years. The volunteers were asked to view neutral, pleasant and unpleasant pictures from international affective picture system in a magnetic resonance imaging (MRI) scanner. Statistics Analysis: Rest-active block design paradigm, functional MRI results analyzed in statistical parametric mapping 8. Results and Conclusion: Activations associated with emotions were present in cerebral and cerebellar regions. Education influences emotion.
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Medication adherence, work performance and self-esteem among psychiatric patients attending psychosocial rehabilitation services at Bangalore, India
Sailaxmi Gandhi, Rajitha Pavalur, Sivakumar Thanapal, Nirmala B Parathasarathy, Geetha Desai, Poornima Bhola, Mariamma Philip, Santosh K Chaturvedi
October-December 2014, 36(4):392-396
DOI:10.4103/0253-7176.140724  PMID:25336771
Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals' self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Material and Methods: Data was collected from a convenience sample of 60 subjects using the 'Medication Adherence Rating scale', 'Griffiths work behaviour scale' and the 'Rosenberg's Self-esteem scale'. Statistical analysis used: Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. Results: There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self-esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Conclusions: Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.
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Assessing abnormal illness behavior in post-stroke patients: A preliminary report
Geetha Desai, Avinash Waghmare, Santosh K Chaturvedi
October-December 2014, 36(4):397-399
DOI:10.4103/0253-7176.140725  PMID:25336772
Background: Abnormal illness behavior (AIB) can contribute poor functioning in an individual along with significant increase in health care utilization. It has been studied in various disorders. This study examined the feasibility of assessing abnormal illness behavior in individuals with stroke who were undergoing treatment in a psychiatric and neurological rehabilitation center. Materials and Methods: Subjects who were admitted to the department of psychiatric and neurological rehabilitation ward for post-stroke rehabilitation treatment were assessed using screening version of Illness Behavior Questionnaire (SIBQ). Results: The total number of subjects who were screened was eight. The mean score of SIBQ was 6.125 ± 1.35. With the cut off score of 7, five subjects had abnormal illness behavior. Conclusions: The above study highlights that it is feasible to screen individuals with stroke undergoing rehabilitation for possibility of abnormal illness behavior.
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Mirror image agnosia
Sadanandavalli Retnaswami Chandra, Thomas Gregor Issac
October-December 2014, 36(4):400-403
DOI:10.4103/0253-7176.140726  PMID:25336773
Background: Gnosis is a modality-specific ability to access semantic knowledge of an object or stimulus in the presence of normal perception. Failure of this is agnosia or disorder of recognition. It can be highly selective within a mode. self-images are different from others as none has seen one's own image except in reflection. Failure to recognize this image can be labeled as mirror image agnosia or Prosopagnosia for reflected self-image. Whereas mirror agnosia is a well-recognized situation where the person while looking at reflected images of other objects in the mirror he imagines that the objects are in fact inside the mirror and not outside. Material and Methods:: Five patients, four females, and one male presented with failure to recognize reflected self-image, resulting in patients conversing with the image as a friend, fighting because the person in mirror is wearing her nose stud, suspecting the reflected self-image to be an intruder; but did not have prosopagnosia for others faces, non living objects on self and also apraxias except dressing apraxia in one patient. This phenomena is new to our knowledge. Results: Mirror image agnosia is an unique phenomena which is seen in patients with parietal lobe atrophy without specificity to a category of dementing illness and seems to disappear as disease advances. Discussion: Reflected self-images probably have a specific neural substrate that gets affected very early in posterior dementias specially the ones which predominantly affect the right side. At that phase most patients are mistaken as suffering from psychiatric disorder as cognition is moderately preserved. As disease becomes more widespread this symptom becomes masked. A high degree of suspicion and proper assessment might help physicians to recognize the organic cause of the symptom so that early therapeutic interventions can be initiated. Further assessment of the symptom with FMRI and PET scan is likely to solve the mystery of how brain handles reflected self-images. Conclusion: A new observation involving failure to recognize reflected self-images is reported.
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Validation of sexual functioning questionnaire in Indian patients
Kodakandla Krishna, Ajit Avasthi, Sandeep Grover
October-December 2014, 36(4):404-407
DOI:10.4103/0253-7176.140727  PMID:25336774
Objective: To establish norms for sexual functioning questionnaire (SFQ) in Indian population. Materials and Methods: 100 male subjects, diagnosed with depressive disorder and currently in a state of clinical remission for a period of at least 4 weeks were evaluated on SFQ and Arizona Sexual Experience Questionnaire (ASEX). Result: By using receiver operating characteristics (ROC) curves a score of 14 was considered to be a cutoff for sexual dysfunction as per SFQ. This cutoff yielded a sensitivity of 91.7% and specificity of 86.4% for the detection of sexual dysfunction. The PPV of the instrument at this cutoff was 87%. Conclusion: A cutoff of 14 should be used to define sexual dysfunction as per SFQ.
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The impact of comorbid clinical depression on the health-related quality of life of adults on highly active antiretroviral therapy in Maiduguri, northeastern Nigeria
Ibrahim Abdu Wakawa, Jidda Mohammed Said, Wakil Musa Abba, Saleh Shehu, Isa Bukar Rabbebe, Omeiza Beida
October-December 2014, 36(4):408-417
DOI:10.4103/0253-7176.140731  PMID:25336775
Background: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. Materials and Methods: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. Results: The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm 3 and diagnosis of depression were significant predictors poor QOL. Conclusion: Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care.
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The clinical and demographic profile of male patients with alcohol dependence syndrome
M Pramod Kumar Reddy, R Sateesh Babu, Satish M Pathak, S Venkateshwarlu
October-December 2014, 36(4):418-421
DOI:10.4103/0253-7176.140735  PMID:25336776
Aims: To study the demographic factors associated with alcohol dependence syndrome so that the problems of alcohol related co morbidities can be prevented with appropriate preventive measures. Materials and Methods: The study was conducted in De-Addiction Clinic of the Department of Psychiatry, Mamata Medical College, Khammam, Andhra Pradesh from July 2008 to February 2009. Patient who fulfills criteria for alcohol dependence, according to diagnostic and statistical manual of mental disorders, fourth edition were included. Results: Mean age (standard deviation) at first drink was 18.93 (3.81) years and at onset of Alcohol dependence was 28.28 (6.55) years. The most common reason being given by the patients was financial strain (70% of the patients) due to alcohol use and its consequences. Educational qualification of 12th standard or above was seen only in 7.5%. Alcohol dependence syndrome was more common in unemployed, unskilled and semi-skilled patients. Majority of patients (80%) belonged to lower socio-economic class. Conclusion: Alcohol dependence syndrome and its related co morbidities can be minimized to a great extent if the educational and socio-economic standards are improved in countries like India where there is increase in alcohol consumption as a life style choice.
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Sexual dysfunction in patients with alcohol and opioid dependence
Sandeep Grover, Surendra K Mattoo, Shreyas Pendharkar, Venkatesh Kandappan
October-December 2014, 36(4):355-365
DOI:10.4103/0253-7176.140699  PMID:25336765
There are limited numbers of studies which have evaluated the sexual dysfunction (SD) in patients with alcohol and opioids dependence. This article reviews the existing literature. Electronic searches were carried out using the PubMed, Google Scholar, and ScienceDirect to locate the relevant literature. Subjects addicted to heroin or on methadone maintenance treatment (MMT) or buprenorphine maintenance treatment (BMT) show higher rates of SD in comparison to the general population. SD rates have ranged 34-85% for heroin addicts, 14-81% for MMT, 36-83% for BMT, and 90% for naltrexone maintenance. The rates of SD in alcohol-dependent population have ranged 40-95.2%, with rates being consistently much higher in alcohol-dependent population than in the healthy controls or social drinkers. The common SDs reported have been erectile dysfunction followed by premature ejaculation, retarded ejaculation and decreased sexual desire among men, and dyspareunia and vaginal dryness among women. This review suggests that long-term use of alcohol and opioids are associated with SD in almost all domains of sexual functioning. There is a need to increase the awareness of clinicians about this association as many times SD in patients with substance abuse lead to poor treatment compliance and relapse. Further, there is a need to carry out more number of studies to understand the relationship in a better way.
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