Showing papers in "Indian Journal of Psychiatry in 1982"

Socio-cultural factors in late onset depression.

Abstract: An epidemiological survey of subjects aged over 50 in a sub urban area of India was carried out. 406 subjects aged over 50were examined by making house visits. 13 were diagnosed as suffering from organic psychoses, 3 from schioephrenia, 98 from depression and 28 from other functional disorder. Depression was the commonest diagnosis made. 24.1% of the subjects aged over 50 in the community were found to suffer from depression. Female sex, low social class, widowed state, unemployed condition, low educational level, nuclear family, living alone and high incidence of physical illness was found associated with depression. The significance of these factors, Hindu philosophy and Indian family system is discussed.

Gerospsychiatric morbidity survey in a semi-urban area near madurai.

Abstract: Tiruppuvanam, with a population of 15,668 a semi-urban area near Madurai was chosen for a door to door survey to assess the psychiatric and physical morbidity in all those aged 60 and above. There were 686, in this age group. The socio economic status, family structure, social integration, occupation, literacy, physical illness and handicaps in the total population were assessed and compared with the psychiatrically morbid group. The prevalence of psychiatric morbidity was estimated at 89/1000. 48.84% suffered from physical morbidity. 57% of the psychiatric group suffered physical morbidity and 85% from sensory handicaps. The findings indicated that lack of social integration rather than social isolation, and lack of occupation were significantly related to psychiatric morbidity. The type of family structure did not relate to the degree of social integration. Depressive illness contributed to 67% of total psychiatric morbidity, some intervention measures are suggested.

The koro epidemic in lower assam.

Abstract: This paper deals with the recent epidemic of kore which occurred in four districts of Assam lasting from later part of June, 1982 to middle of September, 1982, In a survey of 83 cases including 19 females seen by the Psychiatry department of Gauhati Medical College-various socio-economic-Cultural factors and clinical symptomatology are analysed. The significant findings are : Koro affected mostly young males below 30 years belonging to Hindu Assamese community, coming from middle class families, suffering preponderantly from genital symptoms. Koro attacks mostly occurred during the night when the patients are indoor. Exposure to hearsay and/or witnessing a koro case is an important predeterminant of the episode of illness. In the series, marriage educational status and skill in occupation did not seem to offer any immunity to the victims. Relapses are few. The epidemic subsided without any fatality after massive reassurance to the public through mass media.

A study of emergency psychiatric referrals in a teaching general hospital.

Abstract: The socio-demographic and clinical characteristics of one hundred consecutive referrals from emergency O.P.D. of a teaching general hospital were studied. The referral rate was 5.4%. The source, reason and purpose of the referrals were studied. Half of the patients had presented with somatic symptoms. Altered sensorium, suicidal attempt and excitements together constituted one third of all emergency referrals. The diagnosis of neurosis was given in half of the patients and one third of all patients were labelled as suffering from hysterical neurosis. The nature of the presenting complaints and psychiatric diagnoses were comparable to that of the other studies.

Mental health delivery through rural primary care-development and evaluation of a training programme.

Abstract: There is a growing consensus of opinion (WHO 1975) that in developing countries, doctors and para-medical staff of the existing health care cadres should, after a short course of problem oriented training, deliver basic mental health care. This paper describes the development and evaluation of such a training programme.

Lithium prophylaxis in affective disorder.

Abstract: Out of 108 patients on the rolls in the Lithium clinic, Madurai Medical College and Govt. Rajaji Hospital, Madurai, India, 47 patients suffering from affective disorders receiving lithium continuously for more than three years were analysed with a view to study the recurrences. Thirteen suffered no relapses while on lithium while nineteen experienced them while on lithium. Four were free from recurrences after lithium was withdrawn- Seven defaulted but suffered recurrences while in four the drug was withdrawn and in both the groups remission was achieved with re-administration of lithium. The study reveals that lithium besides averting the recurrences can reduce the frequency, number, duration, intensity of episodes and improve the amenability to drugs. Among the symptoms, suicidal ideas and behaviour and insight were found to be influenced favourably by lithium. Among the factors that help favourable response to lithium were a positive family history of affective disorder, in the first degree relatives and lesser frequency and number of episodes in the pre-lithium period. A reappraisal of the natural history of the illness is called for in the light of lithium prophylaxis of manic depressive psychosis.

Evaluation of disulfiram in the treatment of alcoholism.

Abstract: Seventy five male patients with the diagnosis of alcohol dependence syndrome were given disulfiram and an alcohol challenge was administered to all of them. They were kept on maintenance dose of the drug and followed up for six months, note being made of their improvement on several parameters, viz. the number of drinking episodes, the sevarity of reaction suffered, the side effects experienced etc. Twenty one patients were considered as drop outs and four were abstainent without the aid of the drug. 54 % of the fifty patients who continued taking the drug showed good to moderate improvement. 42% had one or more drinking episode while consuming the tablets. Older patients, and those brought by relatives and friends did better than the others. Results are discussed.

Psychiatric aspects of hysterectomy.

Abstract: A prospective psychiatric study of women undergoing hysterectomy conducted in Christian Medical College, Vellore, is described. About 20% of patients who had Hysterectomy developed depressive symptoms during the first year of follow up. Those who developed these symptoms had higher N score on Eysenck Personality Inventory and a higher M. R. Score on Cornell Medical Index before the operation when compared to those who did not develop psychiatric symptoms which suggests that the patients who have a higher score on Neuroticism are more prone to get psychiatric illness. It is emphasised that an attempt must be made to identify such patients who are more prone to get psychiatric disturbance in order to prevent or minimise these psychiatric disturbances. Prior consideration to these complications should be given before doing hysterectomy.

A follow up study of hysteria.

Abstract: The present study undertook to examine the outcome of a group of cases who were diagnosed as hysteria, six or more years ago in a general hospital psychiatric unit and correlate various clinical factors with good or bad outcome. Of the 81 cases selected for the study, 57 (67%) could be located and followed up after a gap of 6-8 years. Majority of the cases (74%) had either no symptoms or symptoms less than before at the time of the follow up. In only 3 cases, there was evidence of an underlying organic illness which seemed to have been missed at the initial assessment. A new sub-classification of hysteria with glossary of terms used for this study is presented for future research work.

Psychotherapy for the economically less privileged classes (with special reference to India).

Abstract: A question has invariably been asked whedier psychotherapy as practised in the abundant west is applicable or possible in countries or communities which are developing very fast but have a deeply ingrained tradition of both the patterns of disease and the format of treatment. Among the many myths that are to be explored is the notion that the poor somehow are happier than the affluent. It is of ton mentioned that the materially prosperous westerner is more severely affected with mental illness than an economically inferior but spiritually richer Indian. This should lead to a revelation that mental illness is rare in poor countries because life is simpler to live and where urbanization and industrialization are not yet at the very peak. Furthermore that emotional and mental tensions arise more from the degree of complexity which the society has developed for itself. It is however safe to state that dimensions of mental illness are bigger in economically poorer countries as compared to rich countiies. Mental illness is just about equal in developing and the developed countries. Absolute figures for the rich countries are higher than the poor ones. This may be so because of stigma attached or inadequacy of the facilities or inaccessibility of the professional units or greater availability and utilizations of alternative but ineffective traditional facility.

Extension of mental health service through psychiatric camps : a new approach.

Abstract: SUMMARY Psychiatric camps in the manner they are usually conducted serve no useful purpose in the long run, except to identify cases and to increase people's awareness about mental illnesses. The main drawback is poor follow up of the cases detected. To overcome these drawbacks and to make these camps more useful in delivering mental health services to the community, a new approach is being worked out. Screening and selection of the patients for the camp by the local doctors with the help of symptom check-list, a good propaganda well in advance in­ corporating the cardinal symptoms through mass media, training of the local doctors to gain basic skills and knowledge to manage cases during follow up, periodic visits by the psychiatrists to help these doctors in this job for some time, mental health exhibition during the camp were some of the strategies adopted in Kollegal Neuropsychiatric camp by community psychiatry unit of NIMHANS. It was a three days' camp. 312 cases were registered after screening. Only 6.7% cases were nonpsychiatric. 30% epileptics, 30% neurotics, 12% Headache, 9% MR, 9% neurological cases, 5% psychoses. 25 doctors participated in training programme and camp patients were allotted to them for follow up. Monthly follow up is in progress. Findings and experiences are discussed. Psychiatric camps as a means of extension of mental health services to the community is being tried for many years all over the country. Only a few of them are reported in literature (Deb Sikdar, et al 1976, Luktuke et al 1978, Narayana

A study of patients attending mehandipur balaji temple : psychiatric and psychodynamic aspects.

Abstract: A sample of 100 patients were selected randomly from 10 dharamshalas who qualified the diagnosis of neuroses and developed "trance". They were subjected to tests of suggestability, intelligence, guilt, hostility and neuroticism. Patients with "trance" were significantly more suggestible and expressed more hostility and guilt as compared to those who did not develop trance. Significant differences were found on I.Q, and level of neuroticism in trance and non-trance patients as well. No significant differences were observed on suggestibility, I.Q., hostility, guilt and level of neuroticism in patients who developed trance either early or delayed.Hysterial patients with trance and non-hysterical patients with trance failed to differ on suggestibility, I.Q. and projective measures of hostility and guilt. The significance of these factors in the development of trance and cure of psychoneurotic patients in context of our cultural background and faith healing practices has been discussed.

Reality of auditory hallucinations in schizophrenia.

Abstract: 25 untreated urban living schizophrenics fulfilling the criteria of Feighner et al., having Schneiderian auditory hallucination were studied with the aim of examining the experienced reality of auditory hallucination and the influence on this reality of certain variables. It was found that the hallucinations were more real than unreal. Duration of illness, presence of anxiety prior to hallucination, reality testing ability, duration of each episode of hallucination, and socio-economic status scores influenced the reality negatively. The number of hallucinating days per mouth, position of voice outside sensory range, psychotocism scores, insight scores (higher scores for poorer insight) and duration of hallucination influenced the reality positively. The variables explained 72% of the variations in reality of hallucinations. Findings are discussed and suggestions for future studies are offered.

Post partum psychiatric syndromes-an analysis of 100 consecutive cases.

Abstract: 100 consecutive out patients with onset of Psychiatric illness within 40 days of child birth were studied by using Indian Psychiatric Interview Schedule and a specially designed Proforma. It was found that post partum psychiatric syndromes occurred most frequently in patients less than 25 years of age. Stress of Physical illness was present in a considerably high number of patients (74%). In 66% the Psychiatric illness was associated with first child birth and risk of Puerperal Psychosis in subsequent deliveries was found to be 32%.; Onset of illness is seen most frequently (85% cases) within 3 weeks of child birth. The Diagnostic breakup showed Schizophrenic reactions (68%) affective disorders (25%) and neurotic reactions (7%). Findings have been discussed.

A clinical study of hysteria in children and adolescents.

Abstract: The concept of hysteria has been extensively writ ten about in the adult l i terature. Attention has been paid to defining terminology and constructing an operational definition by which pioper clinical studies can prccecd and evidence has been reported to support a distinction between hysterical personality and hysterical conversion teaction (Chodoff and Lyons, 1958 ; Guze, 1967). S udies on childhood populations are sparse by comparison and have suffered from a lack of clarity over definition of what constitutes a conveision reaction. Rock (1971) in a study of ten cases of conversion hysteria provides criteria for diagnosis. He requires a prominent somatic symptom (motor or sensory) with no apparent anatomical or physiological basis, on^et or exacerbation with an emotionally significant event and that psychiatric examination leveals that the symptom is psychologically or emotionally derived and serves an unconscious need. Most studies suggest that the age of inception is unlikely to be before five years (Goodycr, 1981).

Depressive symptoms-an intercentre comparison.

Abstract: 45 Psychotic Depressives from PGI, Chandigarh have been compared with 90 Psychotic Depressives from Madurai Centre on 40 symptoms using SADD schedule. Differences in the symptomatology have been highlightened.

A study of patients attending emergency out-patient services of a large teaching institution.

Abstract: Authors have studied the pattern of psychiatric morbidity at the general emergency out-patient services and at the emergency psychiatric services being run concurrently at a large teaching institution. The percentage of psychotics was observed to be maximum at emergency psychiatric services. Non-psychiatric medical officers were observed to deal with non-psychotic psychiatric emergencies themselves rather than referring them to emergency psychiatric services.

A study on perception of facial expressions of emotions in depression.

Abstract: The study was designed with a view to examine the relationship between perception of facial affects and psychopathology. Forty normal and twenty depressive subjects were asked to recognize the facial emotions provided and to discriminate the emotional tone in terms of intensity of expression while presented in pairs. A pair comparison solution indicate that the depressives were highly evaluative in the effect of sadness and less evaluative in happiness, in comparison to normals.

Guilt in India (social, cultural and psychological perspectives).

Abstract: Guilt according to the psychodynamic model occupies a pivotal spot in the understanding of depression. In fact, depressions with and depressions without guilt are often considered totally different entities according to some. I t is extremely interesting to observe that the occurrence of guilt across different cultural groups varies and that this phenomenon is essentially re' lated to the cultural traditions and social influences of that part icular culture.

Homosexuality : treatment by behaviour modification.

Abstract: We present here the treatment of thirteen homosexuals by behaviour modification techniques With classical electrical aversion and positive conditioning 8(61%) out of thirteen patients showed a change in orientation lasting on a six-month 1 year follow up A marriageable age and indirect social pressures were positively correlated with improvement whereas the presence of a steady homosexual partner and habitual passive anal intercourse indicated a poor response The techniques, the assessments, the onset and course of improvement and complications arc discussed Our results and techniques are compared with those of other workers

Detection of alcoholism among psychiatric inpatients.

Abstract: One hundred and eighty four consecutive admissions to male psychiatric open and closed wards were examined for evidence of alcoholism. Michigan Alcoholism Screening Test (MAST) was used for this purpose. The present study shows a prevalence rate of alcohol users to be 41.3 per cent. Nineteen percent could be called alcoholic. MAST correlated well with Spitzer's RDG criteria for alcoholism. The family history of non-users was significantly different from that of the alcohol users. The findings are discussed in the light of existing literature both in India and in the West.

Life event research : a review of methodology (with special reference to India).

Abstract: In spite of extensive work having been done on the correlation between significant life events and development of physical as well as psychiatric illnesses, major controversies remain on the methodological issues involved. The present paper deals with some of these issues, e.g., selection of events and formation of event lists, severity rating of individual events, summation of event scores, reliability of reporting and provision of adequate control groups. Different modes of categorization of events are discussed. Need for caution regarding straight correlation of experienced events with illness has been pointed out. Special emphasis has been given to methodological modifications necessary for life event research in India. These include the issue of culture specificity of events and relatively prolonged stresses, reliability testing from a family member and use of semi-structured interview method in preference to paper and pencil questionnaires. Suggestions are offered for better controlled and methodologically superior studies on life events in India.

Male homosexuality : a psychiatric study of thirteen cases.

Abstract: 13 male homosexuals who approached us for treatment were studied. They came from unusual family back-grounds, had early homosexual experiences which were repeated and later became pleasurable. They showed a variety of homoerotic activity. Belonging to a marriageable age group, the social disadvantages of their homosexual behaviour prompted them to seek treatment. It was observed that early childhood experiences are important in the causation of homosexuality, early channelization of the sexual drive or to objects of the same sex by homosexual seduction and subsequent habituation also played an important part.

Linguistic competence and psychopathology : a cross-cultural model.

Abstract: The present paper discusses the possible role of linguistic competence in determining the manifest psychopathology of schizophrenia. It is hypothesised that the linguistic competence may be a significant determinant of psychopathology and may explain the differences in the manifest signs and symptoms, course and prognosis between the various sub-types of schizophrenia and may explain the cross-cultural differences in the phenomenology and outcome of the disease. It is proposed that research should be undertaken in measurement to linguistic differences to test out the above hypotheses.

Craniopharyngioma presenting as 'mania'-case report.

Abstract: We are reporting a case of craniopharyngioma presenting with features of mania. To our knowledge, this is the first reported case of craniopharyngioma with presenting features of mania- The patient is a six years old child with history of maniac behaviour of six months duration. There is no significant family history. During the course in the hospital he was found to be having craniopharyngioma. The patient recovered completely following the surgical intervention without any aid of antipsychotics.

Trichotillomania-a brief review and case report.

Abstract: Trichotil lomania is a compulsive desire to pull out one's ha i r ; infrequently, eyelashes or eyebrows may be involved. Loss of hair from the scalp frequently leads to baldness (Tiling, 1975). Alter reviewing a large number of behaviour therapy studies it occurred to us that all cases of trichotillomania were of the maladjusted females, ranging in age from early teens to about 40 (Home, 1977). It is also found in children (Stadeli, 1963, and Ormsby and Montgomery, 1948). However one most unusual case, an adult male, has also been treated (Home, 1977). Trichotil lomania or any manipulation of ones own body parts has been considered as a manifestation of a conflict situation such as disturbed mother-child relationship, inadequate or deficient communication in the family or a continuous stress in school (Tiling, 1975) or an inadequate emotional satisfaction (Monioe & Abse, 1963; Stockmann, 1962; and Stadeli, 1963). Stressful patterns of life may lead to some setbacks (Schachter, 1961 and Stockmann, 1962). Tiling (1975) had also seen two patients who had psychotic episodes. Bogaert-l ' i teca & Demaret (1977) on the basis of similarities between history of treatment of patients of nail biting and trichotillomania found that these are tics and learned responses which later become non-adapted are present in a given situation, are reinforced by time and are more resistant to extinction, These are also considered ritual activities, triggered by some attitudes and facilitated by fear affects, aggressivily, or sexual drive. I t may also manifest as a symptom of unconscious conflict in sexual area, as a behaviour which is indicative of some stage specific conflict and its transitional fixation (Vlatkovic-prpic, 1977). I t is also thought to be a manifestation of regression to pregenital levels of development and incomplete identifications (Philippepoules, 1961 and Stadeli 1963). Nakona (1977) studied die psychodynamics and found that raised inner psychic aggression against the parents (specially mother) , seIf-abho;ence combined with habi tual acts like hair pullhig or hair fingering were usually present before the onset of this disease. Sethi et al. (1968) had icpoi ted one case who had parental separation in early childhood, lack of competitive environment, overindulgence by parents, mari tal discord, identification with mother to indulge in the service of God, autoaggressiveness and guilt resulting in incomplete identification leading to trichotillomania. The disease may be a manifestation of inhibited aggression which later becomes autoaggressive, which is due to frustrations resulting from ron-fulfilmcnt of the basic needs of the child or unspecified organic damage of the brain e.g. minimal brain dysfunction, autism and post-encephalitic syndrome (Harbauer, 1978), while Ormsby & Montgomery (1948) and Freedman & Kaplan (1967) found mental subnormality, generalized dementia, G P I & postencephalitic syndromes associated with trichotillomania. Aleksandrowicz & Mares

Long stay patients in a state mental hospital.

Abstract: A study of the long stay patients in a state mental hospital on 30th June 1980 revealed that 70 per cent of the total 1,434, i.e. 1015 had spent more than two years continuously; most of them are chronic schizophrenics, admitted by the police, lacking social support. The need for rehabilitating them both within and outside the hospital is stressed.