Showing papers in "Indian Journal of Psychological Medicine in 2016"

Cognitive Impairment and Rehabilitation Strategies After Traumatic Brain Injury.

Abstract: Traumatic brain injury (TBI) is among the significant causes of morbidity and mortality in the present world Around 16 million persons sustain TBI, whereas 200,000 die annually in India, thus highlighting the rising need for appropriate cognitive rehabilitation strategies This literature review assesses the current knowledge of various cognitive rehabilitation training strategies The entire spectrum of TBI severity; mild to severe, is associated with cognitive deficits of varying degree Cognitive insufficiency is more prevalent and longer lasting in TBI persons than in the general population A multidisciplinary approach with neuropsychiatric evaluation is warranted Attention process training and tasks for attention deficits, compensatory strategies and errorless learning training for memory deficits, pragmatic language skills and social behavior guidance for cognitive-communication disorder, meta-cognitive strategy, and problem-solving training for executive disorder are the mainstay of therapy for cognitive deficits in persons with TBI Cognitive impairments following TBI are common and vary widely Different cognitive rehabilitation techniques and combinations in addition to pharmacotherapy are helpful in addressing various cognitive deficits

Suicide and Suicidal Behavior among Transgender Persons.

Abstract: Background: Suicide rate and suicidal tendencies among transgender persons are considerably high compared to general population. Hence, this review is an attempt to understand the issues around the suicide and suicidal behavior among transgender persons. Methodology: The literature search conducted using three sources, i.e., electronic databases (PubMed, ProQuest, Google Scholar, PsycInfo), manual search (library catalog), and gray literature (consultation with experts). Results: The suicide attempt rate among transgender persons ranges from 32% to 50% across the countries. Gender-based victimization, discrimination, bullying, violence, being rejected by the family, friends, and community; harassment by intimate partner, family members, police and public; discrimination and ill treatment at health-care system are the major risk factors that influence the suicidal behavior among transgender persons. Conclusion: In spite of facing a number of hardships in their day-to-day life, the transgender community holds a number of resiliency factors. Further, this community needs to be supported to strengthen their resiliency factors and draw culturally sensitive and transgender-inclusive suicide prevention strategies and increase protective factors to tackle this high rate of suicidality.

Caregiver burden and quality of life of key caregivers of patients with dementia

Abstract: Background: Dementia is the most devastating cognitive disorder of the elderly and needs extra attention to care. Therefore, this study was conducted to identify the caregiver burden of dementia key caregivers and their Quality of Life (QOL). Materials and Methods: Sample consisted of purposively selected 24 dementia key caregivers fulfilling the inclusion criteria from the in-patient of the Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India. Zarit Burden Interview and World Health Organization QOL-BREF were administered. Mean, standard deviation, t-test, Chi-square with Yate's correction were used to analyze the data. Results: All key caregivers felt mild to moderate level of burden. Gender-wise significant difference was found on burden area of expectation (P < 0.05). Mean scores on physical, psychological, social relationship, and environmental QOL were found to be on lower side. A negative correlation was found between burden and QOL. Conclusion: Professional help and supportive psychotherapy can be provided to the key caregivers of dementia patients to reduce their burden, strengthen the coping skill and thus improve their QOL.

Mental Health Literacy Among Late Adolescents in South India: What They Know and What Attitudes Drive Them:

Abstract: Background: Early recognition of mental health problems gives an individual the opportunity for better long-term outcomes if intervention is initiated early. Mental health literacy is a related concept which is increasingly seen as an important measure of the awareness and knowledge of mental health disorders. Aim and Objectives: This study aimed at assessing the mental health literacy, help-seeking behavior and beliefs and attitudes related to mental illnesses among adolescents attending preuniversity colleges. Materials and Methods: A cross-sectional study was conducted among randomly selected preuniversity college students (n = 916). Data were collected through self-administered questionnaires. Data were computed using STATA. Analysis and interpretation were carried out using descriptives and Chi-square test. Results: Of the 916 respondents, 54.15% were male while 45.85% were female. The majority (78.60%) of the respondents ascribed to the Hindu religion, hailed largely from rural areas (57.21%) and were mostly studying in the 11th standard (72.49%).The percentage of mental health literacy among the respondents was very low, i.e., depression was identified by 29.04% and schizophrenia/psychosis was recognized by 1.31%. The study findings indicate that adolescents preferred reaching out more to informal sources including family members such as mothers than formal sources for self than for others indicating deeply prevalent stigmatizing attitudes toward mental health conditions. Conclusions: There is a need for immediate improvement in the knowledge of adolescents on mental health literacy which suggests that programs need to be developed such that adolescents can seek help from valid resources if the need were to arise and have appropriate knowledge on whom to approach for help.

Risk factors for farmers' suicides in central rural India: Matched case–control psychological autopsy study

Abstract: Background: Despite more than two decades since recognition of suicides by farmers in India, systematic studies comparing various risk factors are lacking. This is major hurdle for the formulation of strategies for farmers' suicide prevention. Objective: To identify socioeconomic and psychological risk factors and their relative contribution in suicides by farmers. Materials and Methods: A matched case–control psychological autopsy was done on 98 farmers' suicide victims and 98 controls in Central India. Results: Economic problems, psychiatric illness, and stressful life events were found to be important contributors to farmers' suicides. Important economic risk factors were procurement of debt, especially from multiple sources and for nonagricultural reasons and leasing out farms. Psychiatric illness was present significantly in higher proportion among cases than controls. Crop failure, interpersonal problems, medical illness, and marriage of female family member were significant stressful life events. Conclusions: There are socioeconomic and psychological risk factors for suicide by farmers which can be targets of prevention policy.

Antenatal Depression in a Tertiary Care Hospital.

Abstract: Context: Antenatal depression is not easily visible, though the prevalence is high. The idea of conducting this study was conceived from this fact. Aims and Objectives: The aim of this study was to estimate the prevalence of antenatal depression and identify the risk factors, for early diagnosis and intervention. Settings and Design: The study conducted in a Tertiary Care Hospital was prospective and cross-sectional. Materials and Methods: Pregnant women between 18 and 40 years of age were studied. The sample size comprised 318 women. They were assessed using Edinburgh Postnatal Depression Scale (EPDS) score, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Life Event Stress Scale (LESS), and Life Distress Inventory (LDI). Statistical Analysis Used: The Statistical Package for Social Sciences (SPSS) Version 15 software was used to measure percentages, mean, correlation, and P Results: Prevalence of antenatal depression in the study was 12.3%. Correlation of the sociodemographic factors, obstetric factors, LDI, and LESS with EPDS scores showed statistical significance for unplanned pregnancy, distress associated with relationships, physical health, financial situation, social life, presence of personality disorder, being a homemaker, and higher educational status. Conclusion: The study showed a high prevalence rate of depression and identified risk factors.

Screening for Depression among Community-dwelling Elders: Usefulness of the Center for Epidemiologic Studies Depression Scale.

Abstract: Context: Though common, depressive disorders often remain undetected in late life. Aim: To examine the usefulness of Center for Epidemiologic Studies Depression (CES-D) for identifying depression among older people. Settings and Design: Community resident older people (aged 65 years or more), were evaluated by clinicians trained in psychiatry, as part of a cross-sectional study of late-life depression. Assessments were done in the community. Methods and Material: The participants were assigned ICD-10 diagnoses and assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and CES-D. A short version of CES-D with 10 items, translated to the local language Malayalam, was used. Statistical Analysis: The sensitivity and specificity of CES-D was evaluated against ICD-10 clinical diagnosis of depression. The correlation of CES-D and MADRS was assessed using Pearson correlation coefficient. Results: 220 consenting adults from 3 wards of the Panchayath were assessed. On analysis of the Receiver Operating Characteristic (ROC) curve of CES-D scores in relation to clinical diagnosis, the large Area Under Curve (AUC) showed efficient screening and a cut off score of 4 in CES-D had a sensitivity of 97.7% and a specificity of 79.1% for depression. There was also good correlation between the MADRS and CES-D scores (0.838). Conclusion: CES-D is a short simple scale which can be used by health care professionals for detecting depression in older people in primary care settings.

Persistent genital arousal disorder

Abstract: Persistent genital arousal disorder (PGAD) is a phenomenon, in which afflicted women experience spontaneous genital arousal, unresolved by orgasms and triggered by sexual or nonsexual stimuli, eliciting stress. The current case is a 40-year-old female who experienced such orgasms for about a month. Physical examination, investigations, and psychological testing were noncontributory. Carbamazepine (600 mg) was discontinued due to a lack of response. She improved significantly with supportive therapy. Various neuropsychological conditions, pelvic pathology, medications, etc., have been associated with this disorder. Pharmacologic strategies have included the use of antidepressants, antipsychotics, mood stabilizers, and analgesics. Validation, psycho-education, identifying triggers, distraction techniques, and pelvic massage have been tried. Living with PGAD is very demanding. There is a lack of understanding of the problem, shame, and hesitation to seek help. The syndrome has been recently described, and understanding is still evolving.

Salami Slicing of Data Sets: What the Young Researcher Needs to Know.

Abstract: Sir, With increasing emphasis on publications for career advancement and obtaining research grants, there is a veritable proliferation in the number of manuscripts being submitted to journals. Among the many ethical and academic dilemmas that this phenomenon has thrown up, salami slicing of research data poses several unique questions. In essence, salami slicing refers to splitting of data derived from a single research idea into multiple smaller “publishable” units or “slices.”[1] This practice is neither new nor entirely culpable. However, because of a poor understanding of the situations where salami slicing can be justified, young researchers may get used to looking at data in smaller pieces and not as a whole. This is dangerous from an academic perspective as often, valuable conclusions, that could have been derived if the data were presented as a whole, are missed and contributes to stall scientific advancement. Instead, what we would get is merely incremental or repetitive findings that are at best, of limited value and worse still may end up distorting scientific literature. Further, salami slicing of data may do more harm than good to a researcher’s career over time because it significantly reduces their chances of publishing in high impact journals, thereby lending lesser weight to their accrued body of work.

Self-limiting atypical antipsychotics-induced edema: Clinical cases and systematic review

Abstract: A number of atypical antipsychotics have been associated with peripheral edema. The exact cause is not known. We report two cases of olanzapine-induced edema and a brief review of atypical antipsychotic-induced edema, possible risk factors, etiology, and clinical features. The recommendation is given on different methods of managing this side effect.

Attitudes toward selfie taking in school-going adolescents: An exploratory study

Abstract: Background: Smartphones have become a necessary evil in our lives. Selfies have become the newest technological fad to take over the youth, due to the wide and easy availability of mobile phones. There is paucity of scientific data on selfies in general, and from our country in particular. This study aimed to analyze the attitudes toward selfie taking, body image acceptance, and narcissism personality traits among an urban school-going population in Mumbai. Materials and Methods: Two hundred and fifty-two students of 11 th standard, belonging to an urban Mumbai school, were interviewed in a single centric cross-sectional study. Scales used were - attitude towards selfie-taking questionnaire, body image acceptance, and action questionnaire (BIAAQ) and Narcissistic Personality Inventory (NPI). Statistical Analysis Used: Scores obtained were computed using basic descriptive statistics as well as computerized statistical software. Results: Of the 230 completely filled questionnaires, 54% were males. About 42.6% reported that they regularly clicked selfies of themselves. No gender difference was noticed. On an average, 18.1% girls and 15.2% boys clicked more than 4 selfies/day. The gender difference was statistically not significant ( P = 0.5273). Difference in mean BIAAQ between the two genders was noticed to be statistically significant, whereas the NPI scores difference was insignificant. Conclusions: This study is a pioneering/novel/innovative work in the field of selfies. It gives us an insight into the youth's viewpoint towards selfies, which was positive in the majority of the population. A worrisome aspect is the higher body image dissatisfaction among girls. Behavioral addictions such as selfies need more focused research in the future.

A Cross-sectional, Comparative Study of Insight in Schizophrenia and Bipolar Patients in Remission.

Abstract: To study insight correlates in schizophrenia and bipolar mood disorder in remission among out-patients attending the Psychiatry Department of a Tertiary Care Hospital. Settings and Design: In a cross-sectional, naturalistic study, adult patients with schizophrenia and bipolar mood disorder in remission (n = 80; schizophrenia-40, mania-20, bipolar depression-20) were compared on insight measures and clinical correlates. Materials and Methods: Scale to Assess the Unawareness of Mental Disorders (SUMD) was used as the main tool to assess current and past measures of insight. Hogan’s Drug Attitude Inventory was used to assess the drug attitude and compliance. Positive and Negative Symptom Scale for Schizophrenia, Young’s Mania Rating Scale, and HAMD were used to rate psychopathology. Clinical Global Improvement was used as a screening tool for remission. Statistical Analysis: For comparison of the three clinical groups, analysis of variance and Chi-square test were used. In the post-hoc analysis, the Ryan-Einot-Gabriel-Welsch test was used to find the group difference. Results: About 40% in the schizophrenia group were unaware of their mental illness as against none in the bipolar group. The awareness of mental disorder for the current period, the awareness of the achieved effects of medications, and the awareness of social consequence was better in the bipolar group. The drug attitude (compliant positive attitude) increased as the SUMD item scale decreased or in other words, as the insight improved. Conclusions: Insight, both current and retrospect, showed significant differences between the schizophrenia and bipolar patients. Insight is significantly correlated with the observed compliance and drug attitude of the patient groups.

Is Depression an Inflammatory Disease? Findings from a Cross-Sectional Study at a Tertiary Care Center.

Abstract: Background: Evidence linking inflammation and depression is marred by several methodological inconsistencies. Further, varying information is present on the role of gender as a potential confounder in this association. Aims: To assess systemic inflammation in drug naοve depression by measuring selected pro-inflammatory (tumor necrosis factor-alpha [TNF-α], interleukin-6 [IL-6]) and anti-inflammatory cytokines (transforming growth factor-beta [TGF-β]) and comparing them with a matched control group. We also aimed at exploring the differences in these markers between genders. Setting and Design: The study was a cross-sectional one carried out a teaching cum Tertiary Care Hospital. Materials and Methods: We recruited 55 drug naοve cases diagnosed with major depression and compared them for inflammatory markers with a matched apparently healthy control group ( n = 42) at baseline. The inflammatory markers were also compared between the genders. Baseline depression and stress levels were assessed using standard measures. Statistical Analysis Used: Mann-Whitney U-test. Results: In comparison with healthy controls, drug naοve depressed individuals demonstrated significantly raised baseline levels of TNF-α and IL-6 ( P P = 0.433). Neither the baseline depression nor the stress scores correlated with any of the inflammatory markers ( P = 0.955 and 0.816 for TNF-α respectively). Males and females were comparable on the levels of markers studied ( P = 0.986, 0.415, and 0.430 for TNF-α, IL-6 and TGF-β respectively). Conclusion: There is evidence for higher baseline inflammation in depression prior to starting anti-depressant therapy. Gender does not mediate this observed link between inflammation and depression.

Is metformin-induced vitamin B12 deficiency responsible for cognitive decline in type 2 diabetes?

Abstract: Introduction: Diabetes mellitus has its deleterious effects on various aspects of cognition such as memory function, executive function, and information-processing speed. The present study aims to assess cognition in diabetes patients and also tries to find its association with Vitamin B12 deficiency induced by metformin. Materials and Methods: Thirty diabetics taking metformin and thirty nondiabetic controls were enrolled. Event-related potentials (ERPs) and serum Vitamin B12 levels were evaluated in them. Results: Vitamin B12 levels were found to be deficient, and latencies of waves P200 and P300 were prolonged in the diabetics as compared to the controls. The dose and duration of metformin had no association with the ERPs. Conclusions: Although the Vitamin B12 levels were deficient in diabetics on metformin, this is not the reason behind the cognitive impairment found in them.

Insight in Psychosis: An Indicator of Severity of Psychosis, an Explanatory Model of Illness, and a Coping Strategy.

Abstract: Recent studies related to insight, explanatory models (EMs) of illness and their relationship to outcome of psychosis are reviewed. The traditional argument that insight predicts outcome in psychosis is not supported by recent longitudinal data, which has been analyzed using multivariable statistics that adjust for severity and quality of illness. While all cognition will have a neurobiological representation, if "insight" is related to the primary psychotic process, then insight cannot be seen as an independent predictor of outcome but a part of the progression of illness. The evidence suggests insight, like all EMs, is belief which interacts with the trajectory of the person's illness and the local culture to produce a unique understanding of the illness for the particular individual and his/her family.

Age at Onset of Alcohol Use and Alcohol Use Disorder: Time-trend Study in Patients Seeking De-addiction Services in Kerala.

Abstract: Background: Declining age at onset of alcohol consumption over years has been one of the alarming findings in the epidemiology of alcoholism. The study was done to examine whether there was a decline in the age at onset of alcohol use and use disorder in subjects categorized as birth cohorts over the last 60 years seeking de-addiction services from a teaching hospital. Materials and Methods: A time-trend study, based on data collected from records, was done among 700 randomly selected subjects seeking de-addiction services. The study was done in a Government Medical College. Besides birth year, family history of alcohol use disorder and psychiatric comorbidity were the main independent variables studied. Trend was tested by linear regression. Results: There was a significant linear decline in the age at onset of alcohol use and use disorder. The mean age at onset of alcohol use and alcohol use disorder declined from 24 to 17 years and 46 to 21 years, respectively, from the pre-1950 birth cohort to the post-1985 birth cohort. Surprisingly, there was a plateau for mean age at onset of alcohol use during 1960s. The trend was significant even after adjusting for variables related to age at onset of alcohol consumption. Conclusions: The trend of decreasing age at onset of alcohol use and alcohol use disorder over time has policy implications. Further studies are needed for exploring mediating or causal factors for the decline in the age at onset of alcohol use and use disorder.

Neuroimaging Studies in Obsessive Compulsive Disorder: A Narrative Review.

Abstract: Obsessive compulsive disorder (OCD) is a relatively common psychiatric illness with a lifetime prevalence of 2–3% in general population. The pathophysiology of OCD is not yet fully understood, however over the last few decades, evidence for abnormalities of cortico-striatal-thalamic-cortico (CSTC) circuitry in etiopathogenesis of OCD has accumulated. Recent brain imaging techniques have been particularly convincing in suggesting that CSTC circuits are responsible for mediation of OCD symptoms. Neuroimaging studies, especially more recent studies using functional neuroimaging methods have looked for possible changes seen in the brain of patients with OCD, the specificity of the findings (as compared to other psychiatric illnesses) and the effects of treatment (pharmacotherapy/psychotherapy) on such changes were observed. This narrative review discusses the neuroimaging findings seen in patients with OCD with a special focus on relatively more recent neuroimaging modalities such as magnetic resonance spectroscopy and magnetoencephalography.

A Retrospective Chart Review of Treatment Completers Versus Noncompleters Among In-patients at a Tertiary Care Drug Dependence Treatment Centre in India.

Abstract: Background and Aims: Engagement into treatment is crucial for improving outcomes among patients with substance use disorders. This study aimed to find the rates and characteristics of treatment noncompletion in patients who were admitted to a drug dependence treatment center in north India. Methods: This retrospective record review analyzed data from consecutive patients admitted between January 1, 2014, and December 31, 2014, at the National Drug Dependence Treatment Centre, Ghaziabad, India. The type of discharge was discerned from the records, along with selected demographic and clinical characteristics of the patient. Results: A total of 942 in-patients were included in the analysis, 936 (99.4%) of whom were males. The mean duration of ward stay was 12.7 (±8.1) days. Of the 942 patients, 779 (82.7%) completed the inpatient treatment while 163 (17.3%) did not complete ( n = 95, 10.1% were discharged against medical advice; n = 44, 4.7% were discharged on disciplinary grounds and n = 24, 2.5% absconded or left without intimation). The inpatient treatment noncompleters had a shorter duration of ward stay (8.3 ± 6.9 days vs. 13.6 ± 8.0 days, P P = 0.002), were more likely to be dependent on opioids (71.2% vs. 59.1%, P = 0.004) and less likely to be dependent on alcohol (30.1% vs. 42.9%, P = 0.002) than treatment completers. Conclusion: Understanding the characteristics of patients with substance use disorders who do not complete inpatient treatment may help in identifying those at-risk of having poor outcomes. Efforts are required to address their concerns so that the overall patient outcomes can be improved.

Suicide in India: Distinct Epidemiological Patterns and Implications:

Abstract: Suicide is a societal crisis which also deeply impacts the personal and family realms. Indian suicidal data present distinctive epidemiological patterns when we compare it with the global suicide rates and trends. Higher proportions of young individuals are resorting to suicide compared to any other country in the world, and Indian suicide rates, especially South Indian rates, are one of the highest in the world. In this article, we present various historical aspects and theories of Indian suicide and review of available Indian research from various sources such as community, hospitals, schools and forensic settings. We discuss our findings which reveal the distinctiveness of Indian data when we compare these with global data and draw implications for practice and policy.

Catatonic Syndrome in Anti-NMDA Receptor Encephalitis.

Abstract: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a newly recognised autoimmune condition. With its typical clinical pattern, consistent association with the presence of auto antibodies and rapid improvement with immunotherapy, this condition is giving insights into the boundaries between psychiatry and other neurosciences, and is opening avenues for future research. In a young lady who presented with catatonia, we considered anti-NMDA receptor encephalitis, after ruling out other aetiologies. After a positive antibody test we treated her with immunotherapy. She showed gradual improvement in her psychotic and catatonic symptoms. Knowledge regarding the nature and function of NMDA receptors and pathophysiology of this particular encephalitis is important for psychiatric practice. The great opportunity for research in this area due to its association with psychotic disorders is evident but an appeal to temper the enthusiasm by considering the historical lessons learnt from Karl Jaspers' critique of General Paresis of Insane, is in place. Catatonic syndrome has to be conceptualised broadly and should be recognised with a separate nosological position.

A Review of Indian Research on Co-occurring Psychiatric Disorders and Alcohol use Disorders.

Abstract: Excessive use of alcohol has been identified as a major contributor to the global burden of disease. Excessive use of alcohol is a component cause of more than 200 disease and injury conditions. Alcohol use has been associated with increased morbidity and mortality across all regions of the world including South-East Asia. Epidemiological as well as clinic-based studies from Western countries have reported a high prevalence of co-occurrence of alcohol use disorder and psychiatric disorders. The research has established the clinical relevance of this comorbidity as it is often associated with poor treatment outcome, severe illness course, and high service utilization. Understandably, dual disorders in from of alcohol use disorders and psychiatric disorders present diagnostic and management challenge. The current article is aimed to review systematically the published Indian literature on comorbid alcohol use disorders and psychiatric disorders.

Aripiprazole-Induced Hyperprolactinemia in a Young Female with Delusional Disorder

Abstract: Hyperprolactinemia is a common adverse effect of antipsychotic medication Switching over to aripiprazole or adjunctive aripiprazole has been advocated for optimal management of antipsychotic-induced hyperprolactinemia Adjunctive treatment with aripiprazole has been shown to normalize prolactin levels without affecting already achieved improvements in psychotic symptoms However, here, we present the case of a 36 year old female with delusional disorder who developed symptomatic hyperprolactinemia while on aripiprazole treatment Dopamine acts as a tonic inhibitor of prolactin secretion through the tubero-infundibular dopaminergic system Aripiprazole being a partial agonist has a lower intrinsic activity at the D2 receptor than dopamine, allowing it to act as both, a functional agonist and antagonist, depending on the surrounding levels of dopamine Hence, in the absence of a competing D2 antagonist and the presence of dopamine (the natural agonist), aripiprazole could act as a functional antagonist and thus elevate prolactin levels

Metabolic disturbances, side effect profile and effectiveness of clozapine in adolescents

Abstract: Introduction: Data on effect of clozapine on metabolic syndrome in adolescent patients with psychosis are limited. This study aimed to evaluate the prevalence and incidence of metabolic syndrome in children and adolescents with psychotic disorders prior to clozapine and while receiving clozapine. Secondary aims were to study the effectiveness and side effect profile of clozapine. Materials and Methods: Thirteen child and adolescent patients were evaluated at baseline, 3 months, and a follow-up beyond 6 months. Assessments were made for metabolic profile, effectiveness by positive and negative syndrome scale (PANSS), and side effects. Results: Prior to starting of clozapine, the prevalence of metabolic syndrome was 23%. After 3 months on clozapine, 38.5% (5/13) patients fulfilled criteria of metabolic syndrome and further on follow-up beyond 6 months (with last observation carried forward) 46.2% (6/13) had developed metabolic syndrome. There was a significant reduction in PANSS scores at 3 months and follow-up more so in those who developed metabolic syndrome at 3 months. Among the other side effects, hypersalivation was the most common side effect (100%) followed by sedation (69%). Conclusion: Half the prevalence of metabolic syndrome in adolescents on clozapine can be attributed to other factors prior to starting of clozapine, and another half can be attributed to clozapine. Clozapine is effective in an adolescent population.

Disability and Quality of Life of Subjects with Bipolar Affective Disorder in Remission.

Abstract: Background: Despite significant advances in pharmacological and psychological therapies for bipolar disorder, many people continue to have less than optimal outcomes, which are associated with significant disability and poor quality of life (QOL). This study aimed to assess the disability and QOL and factors associated with such suboptimal outcomes in subjects with bipolar disorder in remission. Methods: Consecutive patients diagnosed to have bipolar disorder in remission attending the Department of Psychiatry, MOSC Medical College, Kerala, India were recruited for the study. They were assessed using the International Classification of Diseases Diagnostic Criteria for Research-10, Hamilton Scale for Depression, Young's Mania Rating Scale, World Health Organization-QOL (WHO QOL-BREF), WHO-Disability Assessment Scale (WHO-DAS), and Kuppuswamy's scale for socioeconomic status assessment. Results: Eighty-four patients were evaluated. The mean total WHO-DAS score was 19.2 ± 2.09, the maximum disability in domain 4 (getting along) followed by domain 2 (mobility). The mean total WHO-QOL BREF score was 54.26 ± 2.85, the lowest subscore in domain 3 (social interactions). Disability scores were significantly associated with increasing age, female gender, not being an earning member of the family, and lower QOL scores. Poorer QOL scores were significantly associated with increasing age and higher disability score. Conclusions: Many bipolar patients in remission have significant disability and poorer QOL. There is a need for longitudinal studies to explore such associations and develop interventions to reduce the disability thereby enhancing the QOL.

Rehabilitation Needs of Chronic Female Inpatients Attending Day-care in a Tertiary Care Psychiatric Hospital:

Abstract: Background: Female patients hospitalized for a long duration in psychiatric hospitals are a special population with unique needs. Aims and Objectives: To assess rehabilitation needs of chronic female inpatients attending psychiatric rehabilitation services in a tertiary care psychiatric hospital. Materials and Methods: Rehabilitation needs of nine chronic female inpatients were assessed with an interview schedule developed by expert consensus. The needs were elicited from the patients. Perspectives of nursing staff, vocational instructors, and treating psychiatrists were also sought. Results and Conclusion: Most patients expressed the need for more incentives for working in day-care, variety in food and grooming items. The nursing staff felt many patients could be placed outside, and the family members should come more frequently to meet them. Vocational instructors felt that patients need more incentives, variety in food and work. Treating psychiatrists said that major barriers in discharging and placing them were nonavailability or poor involvement of family members. Services like supported housing, supported education and supported employment are necessary to cater to their complex needs.

Nonpharmacological Interventions for Children with Attention Deficit Hyperactivity Disorder in India: A Comprehensive and Comparative Research Update.

Abstract: The nonpharmacological treatments for children with attention deficit hyperactivity disorder (ADHD) have witnessed a sea change from a rudimentary and haphazard psychosocial to cognitive interventions to social and behavioral skills to body oriented interventions to more sophisticated neurocognitive interventions. As the objective of each treatment varied, the method or procedure of each treatment also differed across studies. Indian research although not very rigorous, did witness changes emphasizing on exploring interventions in reducing symptoms and improving overall behavior. The research literature between 2005 and 2015 was searched using PubMed, Google Scholar, IndMED, MedIND, ResearchGate, and other indexed databases. Results of 110 studies were organized into five broad categories of themes of interventions such as psychosocial, body-focused, cognitive/neuro-cognitive, and cognitive behavioral. Effects of ADHD on cognitive, academic, and behavioral outcomes were also highlighted before the themes of intervention to establish linkage with discussion. However, a limited number (n = 9) of reported Indian studies focusing either on the impact of ADHD on the function of children or on interventions were found, suggesting a huge gap between global and Indian research in the area of children with ADHD. It also highlights the need for development and efficacy testing of indigenous intervention program in different areas of intervention for research and clinical practice.

Cytokines in schizophrenia: Hope or hype?

Abstract: Although there is a cumulative evidence for the inflammation pathophysiology in schizophrenia, it has not been conclusively proven yet. One reason for this is the lack of studies that have controlled for major confounding factors such as obesity, smoking, antipsychotic use, and stress. The studies in which the major confounding factors were controlled were done in subjects in acute relapse and in treatment-resistant schizophrenia. To date, no studies have been done in stable outpatients with schizophrenia controlling for major confounding factors. Data on cerebrospinal fluid cytokines in large sample independent of confounding factors are also lacking. The efficacy signal from anti-inflammatory medications in schizophrenia has been modest. In this study, the inconsistent and nonvalidated cytokine findings independent of the confounding factors are discussed.

Effectiveness of metacognitive therapy in patients with social anxiety disorder: A pilot investigation

Abstract: Metacognitive therapy (MCT) is a recent psychological intervention for emotional disorders. Its efficacy in social anxiety disorder (SAD) is yet to be established. Aims: We examined the effectiveness of an MCT in patients with SAD. A two group case–control design with baseline, post, and 3 months follow-up was adopted. The control group received training in applied relaxation (AR). Four patients with Diagnostic and Statistical Manual-IV diagnosis of social anxiety were sequentially allotted to receive either MCT or AR. Patients were assessed on postevent processing (PEP), social anxiety, depression, and fear on negative evaluation. Clinical significance was calculated. MCT was more effective than AR in reducing social avoidance, PEP, and self-consciousness. While overall both interventions were effective in reducing social anxiety, MCT was marginally more effective. MCT may be a promising therapeutic approach in the management of SAD.

Reasons for schizophrenia patients remaining out of treatment: Results from a prospective study in a rural south indian community

Abstract: Background: A few studies have examined the factors associated with schizophrenia patients remaining untreated in India. Materials and Methods: We identified 184 schizophrenia patients in a rural community, offered the treatment with antipsychotics and followed them up in their Primary Health Centers for 1-year. Twenty-nine (15.8%) patients remained untreated at both the baseline and 1-year follow-up despite our best attempts to keep them under the treatment umbrella. They were interviewed in detail regarding the reasons for remaining untreated. This group was compared with another group of patients ( n = 69) who had stopped the treatment at baseline but were successfully brought under the treatment umbrella throughout the 1-year follow-up period. Results: The reasons for remaining untreated were ( n ; %): (a) Unsatisfactory improvement with previous treatment attempts (19; 65.5%), (b) poor bond between the patients and the families (6; 20.7%), (c) active symptoms not allowing any treatment efforts from the family members (6; 20.7%), (d) magico-religious beliefs about the illness and its treatment (4; 13.8%), (e) poor social support (3; 10.3%), (f) adverse effects of the medications (2; 6.9%), and (g) perception of recovery and cure (1; 3.4%). For many patients, a constellation of these reasons was responsible for them remaining untreated. In contrast, the common reasons for those who restarted medications to have stopped the treatment at some time were the lack of awareness, the need to continue medications (47; 68.1%), and the financial constraints (28; 40.6%). Conclusion: The predominant reason for schizophrenia patients not remaining on the treatment in this rural community was the families' lack of faith in antipsychotic treatment. Provision of comprehensive treatment package including medical, psychosocial and rehabilitative services, and sensitizing the community about benefits of the treatment may help in ensuring that all patients with psychosis receive the best care.

Lack of insight in psychiatric illness: A critical appraisal

Abstract: Byline: M Reddy Setting the Stage for Discussion: Evolution of The Concept and Importance The concept of insight in psychiatric discourse has evolved through various stages Psychiatrists or 'the doctors of the soul' have sincetimes immemorial been curious about the attitudes and perspectives of persons with mental illness towards their disturbed minds/selves Though discussed by alienists in the mid-19th century and few psychopathologists in the early 20th century, the concept has seen a great progress in its understanding over the last 25 years The concept has progressed through the following stages: *Insight into illness as present or absent dichotomy (eg, IPSS)[sup][1],[2] *One dimensional grading of Insight[sup][3] from Complete Denial (grade 1) to True Emotional Insight (grade 6) This model incorporated understanding of causation as due to internal or external factors *Multidimensional models[sup][4],[5] which are referred to as 'biomedical models' by their anthropological critics *The socio-cultural modifications of multidimensional models[sup][6] and the concept of Narrative Insight[sup][7] The reason so much of global discussion and research is going into this one topic is its clinical, administrative and legal importance The clinical practice of covert (or surreptitious) medication and involuntary admission into a psychiatric health facility are very difficult things to come to terms with Not only is the practice of involuntary treatment/admission a clinical concern, it is also an administrative concern for the psychiatric health facility Issues like use of physical restraints and involuntary treatment/admission usually go against the liberal understanding of Human Rights Apart from the clinical and administrative concerns, even the legal concerns of criminal responsibility, capacity for informed consent and validity of a will depend upon the understanding of the concept of insight (or the related issues of personal, social and moral judgment) of the person suffering with a mental illness So, the establishment of the lack of insight in a person suffering from mental illness is of utmost importance for the clinical, administrative and legal reasons Difficulty in The Clarity and Utility of The Concept of Insight The concept of lack of insight, because of its importance needs clear conceptualization Clarity in its conceptualization and its utility remain as major problems for four reasons: *Lack of insight means different things in different psychiatric conditions For example lack of insight means various things in the following conditions: psychosis, depression, obsessive-compulsive disorder, personality disorder, paraphiliac disorders, substance addictions etc *Criteria or definitions used even for a particular condition like Schizophrenia are different when used by different researchers Some of which seem very utopian and almost unachievable when applied in routine clinical practice (example: Karl Jaspers' need for a 'completely objective attitude'[sup][8] or Amador & David's need for meeting the five criteria in a fullest sense)[sup][5] Some like Aubrey Lewis' definition[sup][9] are broad and vague *Different schools of psychiatry ascribe different etiological reasons or reformulations of the concept of lack of insight The understanding of causation and treatment vary among various schools of psychiatry whereby if one school considers that the person who takes western medical treatment is the one with optimal insight, the other school thinks that use of non-medical treatment is also a correct attitude towards treatment Cultural psychiatrists[sup][7],[10],[11] discuss the lack of insight as only a coping strategy (or as just a way of explaining the disorder to oneself) without taking neurobiology of disorder into consideration *The ontological nature of the Human Insight into subjective experiences or lack of it is very complex …