Showing papers by "Sujita Kumar Kar published in 2015"

Understanding normal development of adolescent sexuality: A bumpy ride

Abstract: Adolescence, derived from the Latin word "adolescere" meaning "to grow up" is a critical developmental period. During adolescence, major biological as well as psychological developments take place. Development of sexuality is an important bio-psycho-social development, which takes an adult shape during this period. During adolescence, an individual's thought, perception as well as response gets colored sexually. Puberty is an important landmark of sexuality development that occurs in the adolescence. The myriad of changes that occurs in adolescents puts them under enormous stress, which may have adverse physical, as well as psychological consequences. Understanding adolescent sexuality has important clinical, legal, social, cultural, as well as educational implications.

Sources of occupational stress in the police personnel of North India: An exploratory study.

Abstract: Background: Police personnel in India are subjected to several distinct occupational stressors which impact their mental health and their work performance negatively. Aim: The study aimed to explore various sources of stress among police personnel. Method: In this study, 100 constables, 100 inspectors and 100 police officers of Uttar Pradesh, were evaluated using the occupational stress questionnaire. This was subjected to the quantitative as well as the qualitative analysis. Result: Occupational stress was commonly perceived among all police personnel, but the major attributes of stress in various groups were diverse.

Dhat syndrome: Evolution of concept, current understanding, and need of an integrated approach.

Abstract: Dhat syndrome has often been construed as a culture-bound sexual neurosis of the Indian subcontinent. Symptoms similar to that of Dhat syndrome has been described in other cultures across different time periods. The present paper looks at the evolution of the concept of Dhat syndrome in India. The review also takes an overview of the current understanding of this syndrome in terms of nosological status as a distinct entity and its "culture-bound" status. The narrative finally attempts to discuss the integrated approach for the treatment of this disorder.

Psychiatric manifestation of chronic subdural hematoma: the unfolding of mystery in a homeless patient.

Abstract: The clinical manifestation of chronic subdural hematoma is not limited to neurological deficits or cognitive impairment. It may present with behavioral abnormalities. When the behavioral abnormalities present without obvious neurological deficits and in the absence of trauma, it leads to misdiagnosis. A trivial trauma may cause intracranial bleed that is either missed or ignored in the clinical history. This case report highlights the clinical picture of a homeless patient who presented with withdrawn and disorganized behavior, apathy and poverty of speech in the absence of any neurological deficit. His clinical presentation led to a possibility of psychosis and he was started on antipsychotics. He had developed extrapyramidal side effects in low dose of antipsychotic without any clinical benefit in his clinical picture. Neuroimaging done to rule out any possible organicity-revealed bilateral subdural hematoma, which was later evacuated by neurosurgical intervention in multiple settings and the patient had improved. This case report unfolds the mystery behind the psychotic presentation in a homeless adult.

Pica and psychosis - clinical attributes and correlations: A case report

Abstract: Sir, Pica is a sustained, compulsive eating behavior of nonedible substances.[1] Iron deficiency is commonly associated with pica and it improves with iron supplementation.[1,2] Geophagy (eating of clay) is a common variant of pica. In the context of schizophrenia, pica is believed to be a rare, independent and discrete behavior,[3] which is often missed in the diagnosis and as a result, complications such as intestinal obstruction, electrolyte disturbances, and heavy metal poisoning may occur.[1]

Evolving concept of abnormal illness behavior & clinical implications

Abstract: Objectives: The concept of “Abnormal illness behavior (AIB)” has been evolved to a greater extent in the last century. Henry Sigerist introduced the concept of “illness behavior” in 1929. Mechanic & Volkart defined and further conceptualized the impression on illness behavior. Talcott Parson had given the concept of “Sick role,” and Issy Pilosky had familiarized the notion of “abnormal illness behavior.” The main objective of this article is to review the conceptual evolution on “abnormal illness behavior” and to analyze its current clinical implications. Methods: Extensive search of literature was performed regarding abnormal illness behavior, illness behavior and sick role in online web searching sites like – Google Scholar, PubMed and individual journal sites as well as google books. The literature was critically reviewed with personal inputs from authors. Results: Abnormal illness behavior ranges from denial of illness in one extreme to conscious amplification of symptoms on the other. Abnormal illness behavior is noticed in various clinical conditions like stress-related disorder, stress-related disorders, factitious disorder and malingering. Conclusions: Identifying abnormal illness behavior can prevent unnecessary and excessive utilization of medical aids for the same. Please click PDF below to download the full paper...

Unfolding the mystery: Rare presentation of Japanese encephalitis as catatonia

Abstract: Catatonia is a syndrome of specific motor abnormalities, closely associated with disorders of mood, thought, and cognition. The principal symptoms of catatonia are mutism, immobility, negativism, posturing, stereotypy, and echo phenomena. Catatonia occurs in various psychiatric illnesses as well as medical disorders like infections of the central nervous system such as encephalitis, autoimmune disorders, cerebrovascular events, systemic metabolic disturbances, and toxic drug states. Catatonia may often mislead the clinician and the patient may be misdiagnosed as primarily suffering from a psychiatric disorder and be treated accordingly. Encephalitis may present with various psychiatric symptoms including catatonic features as its sequel that may sometimes be misunderstood as a primary psychiatric disorder. We highlight a case of a young female in her postpartum period, who presented with initial aggressive behavior and sleep deprivation followed by features of catatonia accompanied with fever. She initially responded well to benzodiazepines; however, her subsequent response was poor. When she was subjected to neuroimaging, it revealed signal intensity alteration in the bilateral basal ganglia and temporal regions suggestive of encephalitis; cerebrospinal fluid (CSF) viral markers examination revealed immunoglobulin M (IgM) positivity for Japanese encephalitis (JE). This case report highlights the diagnostic dilemma and management issues of a case of JE with catatonic symptoms.

Subspecialization in psychiatry: Does it fit with India's need?

Abstract: Going back to the early 19 century, psychiatry separated from the mainstream of general medicine and now has established its unique identity as a major discipline in developing nations. In India, postgraduate courses in psychiatry started in the 1940s. Like other medical specialties, the development of subpecialization within psychiatry is growing. In recent years some premier institutes in India have initiated subspecialization courses in psychiatry, including geriatric psychiatry, child and adolescent psychiatry and de-addiction psychiatry.

Chlorpromazine-induced severe exfoliative photoallergic reaction

Abstract: Despite the availability of newer antipsychotic drugs, chlorpromazine is still widely used due to its cost-utility and effectiveness in many parts of India, particularly for patients in whom marked psychomotor excitement and sleep disturbances are present. The side effects of chlorpromazine include photo-induced skin reactions. Chlorpromazine causes both phototoxic as well as photoallergic cutaneous reactions. We present the case report of an adult male who developed severe photoallergic skin reactions to chlorpromazine. The skin lesions largely resolved on stopping the drug, but reappeared in a more severe form when the drug was inadvertently restarted by the patient. This highlights the need for awareness and education of patients about the skin effects of psychotropics such as chlorpromazine.

The burning issue of human immunodeficiency virus infection/acquired immune deficiency syndrome in injection drug users: Global scene with a specific focus to India

Abstract: Intravenous drug use (IDU), initially confined to developed countries, specifically the western countries is no more bound by boundaries. In last few decades, the prevalence has been increased several fold and is a matter of serious concern. IDUs indulge in high-risk activities like sharing of the needle and unprotected sexual activities, which make them more vulnerable to acquired human immunodeficiency virus (HIV) infection (acquired immune deficiency syndrome [AIDS]). They silently spread the infection in the community (other IDUs, spouses and sexual partners). There is an increasing trend of HIV infection/AIDS among intravenous drug abusers across the world including India being no exception. The article highlights the global epidemiological data, specific focus of India.

Recent advances in pharmacological management of substance use disorders

Abstract: Pharmacological management is an important pillar in the treatment of substance use disorders. Decades back, researchers were struggling to find specific pharmacological agents for management of different substance use disorders. However, in the past two decades many effective pharmacological interventions have been discovered, approved, and recommended by several international management guidelines. In recent years, many novel pharmacological agents have been introduced or are in different phases of trial. This review focuses on the current understanding about different pharmacotherapeutic options and recent advances in the management of substance use disorders.

Carbamazepine induced optic neuropathy in an adolescent boy with conduct disorder: A rare case report.

Abstract: Byline: Sujita. Kar, Manish. Borasi, Deepak. Kumar, Sumit. Gupta Sir, The etiology of optic neuropathy is multi-factorial and toxin-induced (toxic) optic neuropathy (toxic amblyopia) is one of the common cause of optic neuropathy.[sup][1] The clinical manifestations can be in the form visual impairment, which is usually progressive, painless and involve both eyes.[sup][1],[2] Involvement of the color vision is the earliest sign which usually out of proportion to the visual impairment in totality.[sup][1],[3] Abnormal pupillary response to light, optic disc changes and disc hemorrhage may be seen in ophthalmoscopic examination in toxic optic neuropathy.[sup][1],[3] An antiepileptic drug like carbamazepine is known to cause ocular adverse effects like nystagmus, diplopia and paralysis of extra-ocular muscles, abnormalities of saccadic eye movements.[sup][4],[5] The diagnosis of toxic optic neuropathy is based on detail medical history, ocular examination, hematological investigations, visual field examination, neuro-imaging and electrophysiological tests.[sup][1] Withholding the offending medications, intravenous steroids, multivitamin supplementation are the mainstay of treatment in toxic optic neuropathy.[sup][1] A 15-year-old boy with features of conduct disorder was brought for psychiatric consultation by a nongovernment organization for his attempts of deliberate self-harm. The patient was hospitalized for his high-risk behavior. Behavioral therapy in the form of positive reinforcement was initiated for his conduct problems. For his impulsive behavior, tablet carbamazepine (controlled-release) 200 mg/day was initiated, which was later escalated to 400 mg over next 3 days, immediately after which he had developed generalized pruritic rashes all over the body, pain in both eyes, difficulty in identifying colors and difficulty in vision. He was very much distressed about his visual difficulties. There was no history of trauma to eyes or history of any form of visual difficulty, prior to this episode. Ophthalmology and dermatology opinion was taken for his above-mentioned complaints. His visual acuity was found to be 3/60 in the right eye and 6/24 in the left eye. Ophthalmological examination revealed anisocoria and sluggish pupillary response to light in the right eye. Ophthalmoscopic examination revealed bilateral mild disc hyperemia with nasal bulging of disc margin and mild venous tortuosity. On slit lamp examination, the anterior chamber of both eyes appears to be normal. Hematological investigations, including folic acid and Vitamin B12 levels and neuro-imaging (magnetic resonance imaging) were within normal limits except raised eosinophil percent (11% in differential leukocyte count). There was no concomitant use of any other medication in this patient. A diagnosis of carbamazepine-induced optic neuropathy was considered for which he was prescribed an intravenous injection of methyl-prednisolone (1 g/day) for 3 consecutive days. Immediately, carbamazepine was stopped. There was a significant improvement in vision and retro-orbital pain with this treatment. …

Nicotine dependence in resistant schizophrenia: A compensation for trihexyphenidyl dependence or just comorbidity

Abstract: A 42-year-old male, suffering from schizophrenia with nicotine dependence and on regular treatment, had reported the overuse of trihexyphenidyl (40-50 mg/day) for the last 2 years in a dependence pattern, which was temporally correlated with increased consumption of nicotine over the same time frame. The patient used to report withdrawal symptoms and craving for trihexyphenidyl, when it was not available. This case report attempts to discover the possible links between nicotine dependence and trihexyphenidyl dependence in schizophrenia with emphasis on the compensatory measure to counter the imbalance in cholinergic system.

A rare case of very early onset obsessive compulsive disorder with co-morbid Agoraphobia

Abstract: Obsessive compulsive disorder (OCD) is a psychiatric disorder of heterogeneous phenomenology and its onset follows a bimodal pattern. The onset of OCD can be very early or late. The clinical presentation, co-morbidities as well as treatment outcomes are affected by the age of onset of obsessive compulsive disorder. The most accepted explanatory model to explain OCD is bio-psycho-social model, which explains the interplay of biological, psychological as well as social factors in the causation of OCD. In this case report, a rare case of very early onset OCD in an adolescent boy with co-morbid agoraphobia where the onset of OCD was as early as infancy is being discussed.

An extremely rare association of dyggve-melchior-clausen syndrome with mania: coincidence or comorbidity.

Abstract: Dyggve-Melchior-Clausen syndrome is a progressive spondylo-epi-metaphyseal dysplasia associated with mental retardation, characterized by a triad of skeletal deformities (short trunk dwarfism, scoliosis, microcephaly, and limb deformities), facial dysmorphism, and intellectual disability. It an extremely rare condition. Till now, there was no evidence of association of Dyggve-Melchior-Clausen Syndrome with mood disorder. This case report highlights the extremely rare association of Dyggve-Melchior-Clausen syndrome with bipolar affective disorder. The patient had responded well to the combination of mood stabilizer and antipsychotics (sodium valproate and risperidone). To the best of author's knowledge, this is the first case report depicting such association. Both Dyggve-Melchior-Clausen syndrome and bipolar affective disorder are associated with 18q chromosome. This background information raises the possibility of co-morbid association of two disorders rather than a chance association due to genetic linkage.

Can the combination of lithium and olanzapine be an effective treatment strategy in the management of bipolar disorder with Wilson's disease?

Abstract: Wilson's disease is a disorder of copper metabolism, which frequently has neurobehavioral manifestations due to the involvement of the central nervous system (CNS). Depression is the commonest neuropsychiatric manifestation; however, recent studies have revealed the association of bipolar disorder with Wilson's disease. Lithium is a safe and efficacious medication in the management of bipolar disorder in Wilson's disease. Our case report highlights the efficacy of the combination of lithium and olanzapine in the management of bipolar disorder in the context of Wilson's disease.

Biological correlates of attention deficit hyperactivity disorder and specific learning disability, following stroke in a young child.

Abstract: Industrial Psychiatry Journal ■ Jul-Dec 2015 | Vol 24 | Issue 2 211 resolved spontaneously within 3–6 h without any sequel, so no medical help was sought for the first them. The child then developed a stroke for which medical opinion sought and was characterized by left ataxic hemiparesis and left upper motor neuron facial palsy. Magnetic resonance imaging of brain had revealed the involvement of both anterior and posterior circulation with acute infarct in bilateral deep temporal, parietal, and thalami with chronic infarcts in bilateral cerebellar hemispheres. Magnetic resonance angiography and venography were unremarkable. The cardiac status and coagulation profiles were normal. He was treated conservatively for stroke and had improved without any focal neurological deficits. Family history was not significant. The child had a normal birth and developmental history with all milestones being achieved at appropriate ages. After detailed clinical evaluation (on Conners rating scale for ADHD) and psychometric assessment (NIMHANS battery for SLD), child was diagnosed with specific learning disabilities (mixed disorders of scholastic skills) with ADHD and was treated with methylphenidate 20 mg/day with significant improvement in the symptoms of ADHD. However, the symptoms of SLD had persisted for which cognitive remediation was suggested.