48th Annual National Conference Indian Psychiatric Society
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48th Annual National Conference
Indian Psychiatric Society
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48th Annual National Conference
Indian Psychiatric Society
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PROGRAMME
and
ABSTRACTS
ANCtPS '96
Bangalore
CONTENTS
PROGRAMME
Overview of the Conference
iv
Concurrent Sessions
v
Chairpersons for inauguration, orations & awards sessions
vi
Chairpersons for Scientific Sessions
vii
CME
vm
Symposiin
x
AWARD PAPERS
Col. Kripal Singh Award
xii
D L N Murthy Rao Oration
XIV
Marfatia Award
XV
Tilak Venkoba Rao Oration
xvi
Bhagwat Award
xvii
BPS Silver Jubilee Award
xxi
ABSTRACT PAPERS
Session -
1
Electroconvulsive Therapy
1
Session ■
2
Community Psychiatry
7
Session -
3
Epidemiology
13
Session ■
4
Suicide
20
Session -
5
Neurosis -1
25
Session ■
6
7
Psychopharmacology
31
Alcoholism -1
4Q ..
47 •
Session ■
Child Psychiatry • I
Session -
8
9
Session -
10
Administrative, Legal, Forensic Psychiatf’y
Session ■
Mania
'I*'*-54''
62..
• r”. '
69
74
Session ■
11
Organic Psychiatry -1
Session-
12
Alcoholism - II
Session-
13
Schizophrenia
Session-
14
Biological Psychiatry -1
Session-
15
Consultation Liaison - Psychiatry-1
78
82
85
Session- 16
Organic Psychiatry
91
Session-
17
Psychiatric Aspects of HIV
Session-
18
Psychoses
95
99
Session- 19
Biological Psychiatry ■ II
103
Session ■ 20
Consultation Liaison Psychiatry
107
Session ■ 21
Drug Abuse
112
Session - 22
Biology of alcoholism
119
Session • 23
Miscellaneous -1
Session - 24
Miscellaneous - II
125
130
Session - 25
Miscellaneous - III
136
Session - 26
Sexual Behaviour and dysfunctions
143
Session • 27
Child Psychiatry - II
149
Session ■ 28
Depression
152
Session ■ 29
Psychotherapy
156
Session • 30
Neuroses - II
160
AUTHOR INDEX
165
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PROGRAMME
iii
PROGRAMME OVERVIEW of the CONFERENCE
Time
12.1.96
FRIDAY
13.1.96
SATURDAY
14.1.96
SUNDAY
15.1.96
MONDAY
9.00 to 10.30 am
CME
(Krishna)
Presidential
Address
Col.Kirpal Singh
Award Session
(Cauvery)
8.30-10.00
BPS Silver
Jubilee Award
(Cauvery)
Guest Lecture
10-10.30
(Cauvery)
8.30-10.00
Concurrent
Sessions
(21-25)
Guest Lecture
10-10.30
(Cauvery)
10.30 to 11.00 am
TEA
TEA
TEA
TEA
DLN Murthy Rao
Oration
(Cauvery)
Concurrent
Sessions
(6-10)
Concurrent
Sessions
(speciality
section)
(A-E)
Marfatia Award
Session
(Cauvery)
Concurrent
Sessions
(11-15)
LUNCH
LUNCH
LUNCH
TVR Oration
(Cauvery)
Bhagwat Award
Session
(Cauvery)
Concurrent
Sessions
(16-20)
Concurrent
Sessions
(26-30)
11.00 to 12.noon
CME
(Krishna)
12 noon to 1.00 pm
1.00 to 2.00 pm
LUNCH
2.00 to 3.00 pm
3.00 to 4.00 pm
CME
(Krishna)
3.00 to 4.30
4.00 to 4.30 pm
TEA
TEA
TEA
4.30 to 6.00 pm
Inauguration
Concurrent
Sessions
(1-5)
A.G.B.
Meeting
iv
Valedictory
(Cauvery)
TEA
PROGRAMME
of
CONCURRENT SESSIONS
V
Chairpersons for inauguration, orations & awards sessions
Chairpersons for
Inauguration, Orations & Awards Sessions
★
★
★
PRESIDENTIAL ADDRESS
Chairperson
Dr James Antony, Trichur
Co-Chairperson
Dr S S Jayaram, Bangalore
COL KIRPAL SINGH AWARD
Chairperson
Dr P K Chakraborty, Pune
Co-Chairperson
Dr Col. M B Pethe, Bangalore
DLN MURTHY RAO ORATION
Dr Col G R Golechha, New Delhi
Chairperson
Co-Chairperson
★
MARFATIA AWARD
Dr M Vaidyalingam, Madras
Chairperson
Co-Chairperson
★
Dr K Kuruvilla, Vellore
Co-Chairperson
★
Dr V Venkataramaiah, Bangalore
TVR ORATION
Chairperson
★
Dr K Bhaskaran, Bangalore
Dr H S Subrahmanyam, Bangalore
BHAGWAT AWARD
Chairperson
Dr Ravi Abhyankar, Bombay
Co-Chairperson
Dr R Raguram, Bangalore
BOMBAY PSYCHIATRIC SOCIETY SILVER JUBILEE AWARD
Chairperson
Dr R Ponnudurai, Madras
Co-Chairperson
Dr K N Srinivas, Bangalore
vi
Chairpersons for Scientific Sessions
Chairpersons for Scientific Sessions
Session
1
Chairperson
Co-Chairperson
Session
Dr P Ramachandra Kutty Dr N S Nambi
Lucknow
Madras
2 Dr Sheela Fenn
Dr A B Patra
Madurai
Burdwan
3 Dr P G Sharma
Dr V Palaniappun
Warangal
4 Dr BK Singh
Kochi
Ur V G Watve
6 Dr S S Raju
Ranchi
7 Dr IB Das
Cuttack
8 Dr Dipali Dutta
Guwahati
Manipal
17 Dr J N Vyas
Jaipur
18 DrRThara
Madras
Co-Chairperson
Dr Lt. Col. Saldhana D
Pune
Dr I Ramasubba Reddy
Vijayawada
Dr R K Mahendra
Kanpur
19
Dr Joseph Varghese
5 Dr MAM Khan
Hyderabad
16 Dr PSVN Sharma
Madras
Patna
Chairperson
20 Dr Baker Fenn
Dr J Mahapatra
Kottayaam
Burla
Dr Harjeet Singh
21 Dr N Janakiramiah
Dr S D Singh
Lucknow
Bangalore
Kochi
Pune
22 Dr J K Trivedi
Dr Mohan Chandran
Dr V A P Ghorpade
Calicut
Lucknow
Bangalore
Dr Alice Cherian
23 Dr P K Chowdury
Dr M V Warunny
Vellore
Dibrugarh
Irinjalkoda
Dr S N Waghray
Hyderabad
9 Dr P B Buckshey
Dr Roy Abraham
24 Dr Peter Fernandez
New Delhi
Kottayam
Madras
10 Dr V S P Bashyam
Dr K Chandrashekar
25 Dr Col. Sabhaney
Madras
Secunderabad
Indore
Bombay
26 Dr Raghurami Reddy
Dr Jacob John
11
Dr Kari Rama Reddy
Rajamundry
Dr K C Gurnani
Hyderabad
Agra
Dr Shubhangi Parkar
Vellore
Dr S K Jayaprakash
Dr G S Bhogale
Belgaum
27 Dr D R Daivasigamani
13 Dr P Ramakrishna
Dr Syed Akhtar
28 Dr P R Paikakode
Tirupati
Ranchi
Salcete
14 Dr Shiv Gautam
Dr E Mohandas
29 Dr D M Dhavale
Jaipur
Trichur
Pune
Madras
15 Dr Manila! Gada
Dr K Srinivasan
30 DrSKTandon
Dr K S Ayyar
Bombay
Bangalore
Bhopal
Bombay
12 DrGKVankar
Baroda
Thirunelvelli
Bangalore
Dr Abdul Jabbar
Salem
Dr M Matrubootham
vii
I
Annual CME Program
ANNUAL CME PROGRAM
Time 9.00 am to 4.00 pm
12.01.1996
THEME
ANXIETY DISORDERS I
UNDERSTANDING ANXIETY DISORDERS (ETIOLOGY, CO-MORBIDITY)
POSTER PRESENTATION: DIAGNOSTIC/ CLINICAL CRITERIA
9.00 am ■ 9.30 am
Inauguration
9.30 am ■ 9.45 am -
Tea
SESSION 1
Chairperson:
Dr James Antony, Trichur
Co-Chairperson:
Dr S N Channabasavanna, Bangalore
TOPIC
ETIOLOGY
09.45 am - 09.50 am
Introduction of the faculty
09.50 am -10.30 am
Neuro-Biochemical theories, Dr S K Shanna. B'bay
10.30 am-11.00 am
Discussion
11.00 am-11.30 am
Psycho-Social Theories
11.30 am- 12-noon
Discussion
12.noon-1215 pm
Surmary of the Session
Dr R Raguram B'lore
SESSION 2
Chairperson
Dr Col G R Golecha Delhi
Co-Chairperson
DrH S Narayan, Bangalore
TOPIC
01.20 pm - 02.00 pm
GUEST LECTURE
Lunch
viii
Annual CME Program
ANNUAL CME PROGRAM - CONTINUED
SESSION 3
Chairperson
Dr Ravi Abhyankar, Bombay
Co-Chairperson
Dr M Ramachandran, Bangalore
TOPIC
02.00 pm - 02.05 pm
02.05 pm ■ 02.25 pm
CO MORBIDITY
Introduction of the faculty
Co-morbid Axes I & II disorders
■Dr J KTrivedi, Lucknow
02.25 pm - 02.55 pm
02.55 pm-03.15 am
Discussion
Co-morbid Axes III, disorders- Dr Soiid.< Derasari
Co-morbid Axes IV & V states
03.15 pm-03.45 pm
03.45 pm - 04.00 pm
Ahmedabad
Discussion
Summary of the Session
POSTER PRESENTATION DURING LUNCH AND AFTER 04.00 PM
CONCLUSION
ix
Specialty Section
Symposim-Rrogramme
Hall ■ Cauvery
SYMPOSIUM
SPECIALITY SESSION A REHABILITATION
TECHNIQUES IN PSYCHOSOCIAL REHABILITATION
Chairman
Dr S Kalyanasundaram, Bangalore
Co-Chairman
Dr S K Tandon, Bhopal
Topic
Speakers
Skills Training for Chronic Mentally III
Dr T Murali, Bangalore
Yoga for structuring activities in
Dr Usha Sundaram, Bangalore
Schizophrenia
Neuropsychological Rehabilitation in
Dr Shobini Rao, Bangalore
Schizophrenia
Dr Kiran Rao, Bangalore
Scales for assessing disability in
Chronic Schizophrenia
Dr K L Narayan
Vocational Rehabilitation for Chronic
Mentally III
x
Specialty Section
Symposun-Programme
Hall - Krishna
SPECIALITY SECTION B MEDICAL EDUCATION
Integrating Psychiatry & Sociobehavioural Sciences in
the Basic Subjects of Medical Undergraduate Training
- Case Study Examples
Chairperson
Dr James T Antony, Trichur
Co-Chairperson
Dr A K Agarwal,
Topic
Speakers
Medicine
Dr N G Desai, New Delhi
Dr Dm Prakash, Bangalore
Paediatrics
Dr Usha Naik, Bombay
Dr Swarna Rekha, Bangalore
Comm.Medicine
Dr Jacob K John, Vellore
Dr Ravi Narayan, Bangalore
Discussion
Specialty Section
Symposium-Programme
SPECIALITY SESSION
C
Hall - Tunga
CHILD PSYCHIATRY
CHILD PSYCHIATRY
Chairman
Dr P C Shastri, Bombay
Co-Chairman
Dr Jharna Basu, Calcutta
Topic
Speakers
:
Genetics in Child Psychiatry
Psychosomatic disorder in childhood :
Dr P C Shastri, Bombay
Dr Deepali Dutta, Guwahati
Affective disorder in Adolescent
:
and Childhood
xi
Dr Shoba Srinath, Bangalore
Specialty Section
SymposiimProgramme
Hall ■ Bhadra
SPECIALITY SECTION D ■ COMMUNITY PSYCHIATRY
COMMUNITY PSYCHIATRIC SERVICES FOR INDIA
(Organized by Community Psychiatric Section, Indian Psychiatric Society)
Chairperson
Dr Anil Shah, Ahemadbad
Co-Chairperson
Dr D M Dhavale, Pune
Topic
Speakers
Community Psy.Services for Old
Dr A.Venkoba Rao, Madras
Community Psyc.Services Child & Adolescent:
Dr LalitP Shah, Bombay
Community Services for Disaster
& Special Groups
Dr Mohan Agashe, Pune
Blue Print for Com.Psych Services
Specialty Section
Dr Channabasvanna, Bangalore
Symposun- Programme
Hall ■ Sharavathy
GERIATRIC PSYCHIATRY
SPECIALITY SECTION ■ E
GERIATRIC PSYCHIATRY
PROGRAMME NOT YET RECEIVED
Chairperson
Dr
Co-Chairperson
Dr
Specialty Section
Symposiim-Programme
SPECIALITY SECTION
F
FORENSIC PSYCHIATRY
FORENSIC PSYCHIATRY
PROGRAMME NOT YET RECEIVED
XII
Hall-Sharavathy
Col. Kripal Singh Award
Hall-Cauvery
Col. KRIPAL SINGH AWARD
Study of PTSD in Battle Casualties Admitted at 92 base Hospital
Abhaykumar
Srinagar
Militancy has been active in the valley of J&K since late 1989. Since then the anned forces have been
continuously undertaking measures to prevent insurgency and violence. Gunshot wounds and bomb
blasts live many of our jawans physically and psychologically crippled. Psychiatry dept of 92 BH studied
PTSD in many battle casualties admitted from 01 Jan to 25 Apr 95. The aim was to find out (1)
incidence and symptom profile of PTSD (2) to apply therapeutic modalities in PTSD 150 casualities
admitted were studied. Diagnosis was as per DSM III R. Only troops in active combat were included in
the study. A simple questionnaire based on DSM III R was used to assess PTSD.
PTSD was noted in 18% of our cases which was significantly lower than in other comparable combat
actions. 81% had symptoms falling short of full blown PTSD. 83% of our cases were less than 35
years of age. Concommitant depression was found in 80% of our cases. Paucity of literature on
therapeutic modalities made us to evolve our own treatment plan which is open to comments and
suggestions. We have been successful in most of our cases. A larger study with long term follow-up
would help clear some of our own questions. We sincerely hope that militancy comes to an end and
suffering to all is reduced.
Depression in Negative Schizophrenia Rationale of Adjunctive
Antidepressive Therapy
Kausha! A, Ramesh K M, Vasanthy M
Lack of drive affective flattening and poverty of ideation are some notable symptoms encountered in
chronic or residual Schizophrenics. These negative symptoms are quite akin to the reduced energy,
feeling of emptiness and impoverished thinking of depressed patients. Clinically the distinction between
these symptoms is hazy. Benefit of antidepressive medication in such patients has received scant
attention. A Study was conducted amongst inpatients at a zonal Military Hospital over a period of 18
xiii
Col. Kripal Singh Award
Hall-Cauvery
months. Positive and Negative syndrome scale was used to screen 142 chronic Schizophrenic patients
of duration of illness over 1 year. 33 of these patients who exhibited a predominant negative syndrome
were rated on Hamilton depression rating scale. An index group of 18 patients assigned randomly
received Imipramine hydrochloride in addition to trifluperazene 5 mg per day. The control group of 15
patients received only the latter medication. After six weeks the tests were repeated. More than 80%
of the index group had shown a significant response to antidepressive medication. The scores of control
group on Hamilton depression ratina scale remained virtually unchanged.
The study highlights the clinical dilemma ■ whether the residual Schizophrenic is depressed ? Our study
reveals that some of them undoubtedly are. They are also likely to benefit from a trial of standard
antidepressants.
Key words: Negative Schizophrenia. Depression, antidepressants.
Profile of Militants
(An attempt to study the mind of Militants)
Saldana D
31 militants who were evaluated through somatic inkblot psychological tests of Cassell and
personalised interviews were divided into hard core (67.74%), moderate core (22.58%) and soft core
(19.68%) types. They were drawn from 8 recognised militant groups operating in the valley. 74.19%
were below 30 years. 61.29% were unmarried. 93.55% were matric and below. 83.89% belonged to
large families. 74.19% had volunteered for militancy. 61.29% showed hostile and aggressive responses
on SIS scale. Concordance rates between psychological (SIS) and intelligence reports was as high as
77.77%. Psychological stress was revealed only in 3.22%. 67.74% were unlikely to benefit from
rehabilitative measures. The usefulness of somatic inkblot tests understanding militant psychology is
discussed.
Key words: Somatic ink blots (SIS) Militants.
xiv
Martatia Award
MARFATIA AWARD
Abstracts not yet received from the Awards Committee
Hall-Cauvery
Tilak Venkoba Rao Oration
Hall-Cauvery
TILAK VENKOBA RAO ORATION
Psychosis in relation to epilepsy - a clinical model of neuro - psychiatry
Amresh Kumar Shrivastava
Bombay
Psychosis occuring in epileptics has always been an area of research interest, particularly, because of
possible link of mental illness, organic lesions, convulsive process and behavioural abnormality, all
occuring together in the same subject. Vast amount of investigation on this subject has been with a
view to understand something more fundamental in brain - behaviour connection. Occurence of interictal phase of psychosis long after cessation of seizure has driven investigators to conclude the two
being unrelated, which has brought important issues of brain pathology and behavioural abnormality
into focus of research from dimension of genetics, neuroendocrine and environmental influences. The
aspects of behavioural neurology, behavioural genetics, genetics of epilepsy and shared common
genetic diathesis for development of psychosis, possibly converge in the neuropsychiatric model of
psychosis in relation to epilepsy'. EEG ■ spiking and regional slow waves in inter-ictal phase is emerging
as correlates determining behaviour. Status of prolactin • dopamine relationship and its correlation to
neurocognition may be another pointer in guiding some of these complex issues. It is expected that
current focus should be able to develop on the profile of psychotic brain as well. One of the major
clinical issue is identifying epileptic subjets prone to develop psychosis with precision on nature and
type, not only because such developments jeopardises and compromises the state of art treatment
done for epilepsy, but also because of devastating deterioration in quality of life of patients and
relatives, besides having pharmacoeconomic devaluations. Studies have revealed that more detailed
work-up in the beginning may possibly identify high risk groups based upon clinical phenomenology,
EEG, topography, endocrine status, regional brain damage, etc. The presentation attempts to focus
some of the relevant clinical issues with reference to a particular comparative study of psychosis in
epilepsy and functional psychosis (schizophrenia) to understand co-existence of divergent clinical
condition.
Oration by Dr A K Shrivastava
xvi
Bhagwat Award
Hall-Cauvery
BHAGWAT AWARD
Impact of Substance Abuse Comorbidity on Psychopathology
And Pattern of Remission in Mania
P.J\I. Suresh Kumar, S.S.Raju
Ranchi, Bihar
This prospective study was conducted to explore the onset, psychopathology and the
pattern of remission of bipolar affective disorder (mania) complicated by substance abuse.
Hundred patients with a diagnosis of bipolar affective disorders, currently mania were
interviewed using the structured clinical interview for PSM IIIR (SCID-P), D.S.M.IIIR check
list for mania, Beck-Rafaelson mania scale and a questionnaire concerning socio
demographic and clinical profile. The life time prevalence of substance abuse including
alcohol was 52%. Substance abusers were younger, unmarried, unemployed and had more
dysphoric symptoms, irritable mood and persecutory delusions with an age of onset less
than 20 years. At the end of 3 months follow up substance abusers were significantly more
symptomatic than non-abusers. A risk factor analysis showed that substance abuse is con
sistently associated with a negative outcome in mania, inspite of receiving adequate dose
of lithium and antipsychotics. The implication of these findings are discussed.
Stability of Neutoric Syndromes
D.G.Mukherjee
Calcutta
Proper methodological studies regarding stability of 'Neurotic Symptoms' in relationship to
’Neurotic Diagnosis’ are rate. The aim of the present study was to examine (i) Whether
there are significant differences between the major neurotic syndromes with regard to their
symptom profile, cross-sectionally at an initial contact level and later after a six months
interval, (ii) Whether particular pattern of symptoms or symptom ■ groups in a particular
xvii
Bhagwat Award
Hall-Cauvery
neurotic syndrome remains stable over a period of time, distinguishing them from others, (iii)
Whether occurrence of a particular symptom in a syndrome can discriminate it from other
syndromes. 46 subjects (30 males and 16 females) with a diagnosis of a major neurotic
syndrome (Anxiety Neurosis, Depressive neurosis, Phobic State and Obsessive Compulsive
Neurosis according to the ICD-9) were assessed for their symptom profile with the
standardised instrument, the Present State Examination, 9th Edition, at an initial contact
level and after a six months level. Cross-sectonally three obsessive symptoms were found
to be stable and discriminatory for the diagnostic syndrome of 'Obsessive Compulsive Neu
rosis'. Heterogeneity regarding the symptom profile was evident for all the other diagnostic
groups. However, following grouping of the 36 symptoms according to six groups. (Anxiety,
Depressive, Obsessive, Mixed anxiety - depressive, Phobic and Hypochondriacal) hierarchial
presence of obsessive, phobic and depressive symptom - groups were found to be prevalent
among 'Obsessive Compulsive Neurosis', 'Phobic State' and 'Depressive Neurosis'
respectively. The implications of 'specific' symptoms or 'symptom groups' for assessment
of diagnostic stability in the various categories are discussed.
Key words : Stability ■ Neurotic disorders - psychopathology - cross sectional ■ short term
longitudinal
xviii
Bhagwat Award
Hall-Cauvery
Predictors of Adherence to Treatment in Chemical Dependence
Hemraj P, Kishore C, Agarwal S, Sharan P, Pandey R M
New Delhi
Treatment in chemical dependence is fraught with a very high rate (30%-50%) of dropouts.
Factors associated with this have been focused upon though no consensus in differentiation
has been achieved. The study addresses to the issue of differentiating factors. The subjects
comprised of 268 cases of drug dependence admitted to the treatment centre in one year.
Results indicate that about 68% of inpatients do not complete a 28 day package consisting
of detoxification and psychosocial management. Multivariate strategies using stepwise
logistic regression yielded three parameters, viz, heroin as the primary drug of dependence,
associated use/dependence of another substance excluding tobacco and presence of legal
problems as differentiating the group of completers from drop outs. The limitations of the
study and implications in treatment planning are highlighted.
Key words: Substance abuse, Treatment, Adherence.
xix
Bhagwat Award
Hall-Cauvery
An Investigation into the Psychobiology of Social Phobia
Personality Domains and Serotonergic Function
Sudipto Chatterjee, MD TA. Sunitha, M.Sc. Ajay Velayudam, D.P.M.
Sumant Khanna, MD, Phd
Bangalore
The current study explored a psychobiological perspective in the etilogy of social phobia.
The emphasis was on serotonergic function and personality. Twenty social phobics accord
ing to ICD-10 OCR were assessed on Schedule for Clinical Assessment in Neuropsychiatry
and International Personality Disorder Examination. They were compared with an age
matched normal population on Fear of Negative Evaluation scale, Social Avoidance and
Distress Scale, Temperament and Character Inventory, and platelet 5HT2 receptor function.
Other axis I disorders and Cluster C Personality Disorders were frequently encountered. The
social phobia group was characterised by having high Harm Avoidance, low Novelty
Seeking, low Co operativeness and low Self Directedness. Platelet 5HT2 receptor density
did not differentiate between groups, but was associated with severity of the disorder in
social phobia. An integrated psychobiological model is presented.
Key words: SocialPhobia, Personality, Serotonin
xx
BPS Silver Jubilee Award
Hall-Cauvery
BOMBAY PSYCHIATRIC SOCIETY
SILVER JUBILEE AWARD
Gamma Glutamul Transpeptidase and mean corpuscular volume
-Their relationship to alcohol consumption
Dr. M.Shajahan, Dr. M.Suresh Kumar, Prof. N.Mathrubootham, Prof. K.S.Subbaiah
Madras, Dr. Ibrahim Haroon(USA)
The study aims to test the utility of GGT & MCV as indicators of excessive alcohol consumption
and alcohol related health problems in alcohol dependent individuals. The study sample
consisted of 74 consecutive DSM lll-R defined alcohol dependents seeking admission into the
de- addiction ward of the Institute of Mental Health, Madras-10 during the month of February,
1991: and 65% persons recruited from a community sample of 'current alcohol users' detected
by an epidemiological study in a rural setting (Mathrubootham et al'91). The study population
was interviewed using structured proforma to collect relevant data including alcohol depen
dence and problem related issues. Apart from extensive clinical examination and routine blood
alalsis, GGT & MCV tests were performed. The data was analyzed and univariate statistical
test, pearson correlation matrix and multiple logistic regression analysis were done. Results
indicate that GGT & MCV serve as good indicators of excessive alcohol consumption in
hospitalized alcohol users and the combination of the two tests to yield a composite index
improved the overall accuracy in hospitalized alcoholics. GGT as well as the combination of
GGT + MCV predicted excessive alcohol consumption in multiple logistic regression analysis.
There was association between poor health status and both tests being positive in hospitalized
sample: the odds of having poor health status was higher (0R:4.5 (1.8, 5.6) when the two tests
were positive. Results indicate that the tests are useful tools in indentifying excessive alcohol
consumption and poor health status in hospitalized patients.
xxi
BPS Silver Jubilee Award
Hall Cauvery
A study of Event Related potentials and Temperamental Traits
in Children of Alcoholics
Dr. Avneet Sharma, Dr. Savita Malhotra, Dr. Murugeschachetty, Dr. Anil Malhotra,
Chandigarh
We studied event related potentials and temperamental traits in children of alcoholics
(CoAs) and compared the findings with control group. Amplitude P300 was found to be
significantly smaller in CoAs; CoAs also showed significant deviations on traits like activity,
distractibility, conduct problems etc. Multiple regression analysis with P300 amplitude as
the dependent variable revealed that activity and conduct problems seen to be important
psychological variables affecting P300 amplitude in our study. The implications of the
findings are discussed especially with reference to markers of risk in alcoholism.
Clinical Validity of Schizoaffective Disorder - Two Years follow up study
Shrivastava Amresh K, Rao, Sangeeta.
Bombay
Schizoaffective disorder, though an established clinical diagnosis in almost all systems of classification,
remain an area of investigation for validity because of various data bringing out information in support
and also against it. Various models of coexistence of affective and schizophrenic symptoms have been
proposed. There is some evidence of its proximity to schizophrenia and also to depression. A possibility
of third psychosis has also been suggested. However biological, family studies and long term out come
support is not established. The present study attempts to examine the outcome and diagnostic validity
over two year follow up of schizoaffectives.
Method : In a psychiatric treatment setting, 103 patients diagnosed as schizoaffective using DSM III R,
ICD 9 and RDC, were subjected to detailed semistructured data collection and studied using
schizophrenics (50) and major depression (50) as control groups. Clinical, phenomenological, treatment
variable (open, three treatment design) and out come of progress over two years were studied. Clinical
and psychometric assessment tools were used.
xxii
BPS Silver Jubilee Award
Hall-Cauvery
Results : The present study found younger schizoaffective population, with severe psychopathology,
parallel out come to schizoaphrenics at 12 weeks and 2 years. Significant number (72.3%) changed the
initial diagnosis to schizophrenia (61.8%), mood disorder (10.5%) and 9.2% remitted. Treatment design
and psychosocial stress does not correlate with change, however patients with conceptual
disorganisation, unusual thought content and hallucinatory behaviour are found to predict change to
schizophrenia whereas motor retardation indicates change to mood disorder.
Conclusion : Schizoaffective disorder is an inconsistent diagnosis. More support would be required to
retain it in its present form. It seems schizoaffectives seen in our population are closer to schizophrenics
in terms of clinical features, treatment response and outcome.
Keywords: Schizoaffective, Diagnosis, Validity, Change of Diagnosis, Course and Outcome
xxiii
Electroconvulsive Therapy
Session -1
Hall-Cauvery
ELECTROCONVULSIVE THERAPY (ECT)
1-1
Factors influencing decision for ECT
Reddy B, Akhtar S, Khanna R
Ranchi
Electroconvulsive therapy (ECT) continues to be one of the most useful alternative for
treatment of psychiatric patients. In making decision in favour of ECT, apart from clinical
diagnosis, several other factors are taken into account. It was our endeavour to delineate
those factors which contributed to decision making for ECT. The study was conducted in
CIP. The patients admitted were treated by the concerned unit and when the patients were
advised ECT by the consultant or the Sr.Resident, the investigators immediately took up the
case for analysis. Of 310 admissions over a period of 3 months, ECT was advised in 52
patients. Patients were rated on BPRS and through a Symptom Checklist specifically
designed to delineate factors responsible for decision making for ECT. Restlessness and
increased psychomotor activity ( 36.53%) was the commonest reason for advising ECT,
closely followed by feeding problems (25%), violence (23%), catatonia (21%) and non
response to pharmacotherapy. Other factors were disorganised behaviour, suicidal risk,
absconding tendency and past history of response to ECT.
1-2
Evaluation of pre-ECT antihypertensive drug administration in
the minimization of ECT-induced retrograde amnesia.
Chittaranjan Andrade, Shridhar Kamath, Ramteke S, George J, Venkataraman B I/,
Naratan N, Suresh Chandra J
Bangalore
The sharp rise in systolic blood pressure during ECT may disrupt the blood-brain barrier,
releasing macromolecules into the intercellular fluid in the brain; it is hypothesized that
temporary neuronal dysfunction may result, leading to the familiar constellation of cognitive
i
Session -1
Electroconvulsive Therapy
Hall-Cauvery
impairments induced by the treatment. To test this hypothesis, in 3 separate experiments
using the Hebb-Williams complex maze and the T-maze, adult, male, Sprague-Dawley rats
which had undergone maze training received either 2 once-daily electroconvulsive shocks
(ECS) or sham ECS, and either antihypertensive drug (subcutaneously) half an hour pre-ECS
or vehicle alone. Assessment of retention of pre-ECS learning on the day(s) post-ECS found
that verampamil and felodipine but not clonidine attenuated ECS-induced retrograde
amnesia. It is concluded that the administration of calcium-channel blockers immediately
pre-ECT may reduce the cognitive adverse effects induced by the treatment.
1-3
Effect of stimulus energy on the seizure EEG response to
bilateral ECT.
Sanjana Motreja
Bangalore
Seizure EEG was recorded on two channels during the ECT procedure from forty patients
receiving bilteral ECT, on the 1st ECT session of each of three consecutive weeks of
treatment. Twenty patients received high-energy (240 mC) stimulus and the other twenty
low-energy(threshold) stimulus; this allocation being done randomly. The two groups had
comparable severity of illness at onset of treatment and did not differ on most of the
independent variables, except medication status, with the high-energy group having a larger
number of patients (n = 9) on antidepressants. The coded seizure EEG data was visually
analysed using a Manual Rating Scale. The Spectral power in the 2-5.5 Hz and the 2-30 Hz
frequency bands and the Fractal Dimension (FD) were computed for the early, mid- and the
post-seizure EEG phases. The seizure duration was also assessed by an automated method.
Using a step-wise discriminant function analysis, it was observed that at the 3rd week,
80% of the patients could be correctly classified into either high or low-energy groups,
based on five of the seizure EEG variables. Among the drug-naive patients (n = 29), it was
possible to correctly classify 83.3% of the patients into the two treatment groups, using
three of the EEG variables (viz, average amplitude and duration of polyspike phase and
global seizure pattern). At the 3rd week, the high-energy ECT seizure EEGs were
2
Session -1
Electroconvulsive Therapy
Hall-Cauvery
characterised by greater seizure intensity, better seizure pattern (regularity) earlier onset of
slow-wave activity and shorter seizure duration, as compared to the low energy seizures.
These observed differences between low and high-energy seizures suggest that high energy
stimuli yield more 'robust' seizure activity, with earlier seizure generalisation and an earlier
onset of seizure-inhibitory responses.
1-4
An audit of the transition from unmodified to modified ECT
Prathap Tharyan, Pau! Russell, Jacob K John
Vellore
In the wake of the transition from predominantly unmodified ECT given by psychiatrists to
modified ECT given under anaesthetist supervision, we conducted an audit to assess
standards of practice, training and supervision of ECT at this centre. The recommendations
of the Royal College of Psychiatrist (1989 & 1995) the APA Task Force Report (1990) and
the National Workshop on ECT (1992) were amalgamated into a set of guidelines against
which we compared our ECT facilities and equipment, patient selection and indications for
ECT, obtaining consent, preparation of patients, modification procedures, monitoring of
seizure activity, ensuring adequacy of treatment evaluation of progress and adequqacy of
training. Deficiencies in practice and training were discussed with the team and
recommendations for improvement formalised. A limited re-audit was undertaken 2 months
later to assess the implementation of these recommendations and close the audit loop. The
usefulness of clinical audit as a tool to improve clinical practice and the implications of our
findings on training in ECT are highlighted and discussed.
3
Session -1
Electroconvulsive Therapy
Hall-Cauvery
1-5
Prolonged ECT seizures: When to terminate ?
Gangadhar B N, Jayaprakash M S, Girish K, Janakiramaiah N
Bangalore
Although seizure elicitation is an essential component of ECT, the duration of the seizure
should be timed. While 30 seconds or more of EEG seizure is defined as adequate, prolonged
seizures have adverse CNS consequences. Seizures were monitored using both cuff method
and EEG, during the first ECT session in 83 consecutive patients. Twentyone (25%)
patients developed seizures beyond 120 seconds and nine of them had prolonged seizures
(>180 secs). Patients were divided into two groups-those with a duration of <120 secs
of EEG seizure (Group A) and those with duration of 120 secs or more (Group B). The motor
and EEG seizure duration correlated well in the Group A (r=0.8, p= <0.01) but did not
correlate in Group B(r=0.4, p > 0.05). This suggests that motor seizure monitoring alone is
unreliable to detect prolonged seizure and hence the need for EEG seizure monitoring. Also
the risk of developing prolonged seizure increases by four fold once seizure exceeds 120
seconds and hence should be terminated using intravenous diazepam when the EEG seizure
duration ( or that predicted on the basis of motor seizure duration) exceeds 120 seconds.
1-6
Prolonged seizures in ECT
Ramachandra R, Gangadhar B N
Bangalore
Seizure duration of atleast twenty five seconds is to be ensured during ECT.Any seizure
lasting for more than one hundred and eighty seconds is labelled as a "prolonged seizure".
Twenty eight consecutive patients of acute mania were treated with bilateral, brief pulse,
bidirectional, EEG monitored, modified ECTs. Seizure threshold was estimated both at the
start and during the course of treatment. Seven out of twenty eight patients had prolonged
seizures. Interestingly, it was only in these seven patients that cognitive side effects were
noticed. Thus, prolonged seizures were directly related to cognitive side effects.
Implications of these findings will be discussed further.
4
Session -1
Electroconvulsive Therapy
Hall-Cauvery
1-7
Deriphylline use as proconvulsant
Girish K, Asha H M, Jayaprakash M S, Gangadhar B N,
Janakiramaiah N
Bangalore
A small number of patients do not develop adequate seizures with even a maximum stimulus
dose available in the ECT machine either during the course of the ECT or in first setting
itself. Several methods like IV caffeine or hyperventilation just before giving stimulus or
using ketamine anaesthesia have been suggested to decrease the seizure threshold and/or
prolong the seizure duration. Deriphylline which contains xanthine alkaloids which are
adenosine inhibitors are known to decrease seizure threshold and also induce prolonged
seizure. We studied five patients ( Age range 12-53 yrs, 3 males and 2 females, 2 patients
were psychotic depression and 3 were paranoid schizophrenic) who did not develop seizure
with the maximum stimulus dose ie 540 mC. None of these patients were on antiepileptics,
one was on lithium carbonate and 2 were on diazepam 10 mg. In the next session 1 amp of
Inj deriphylline (220 mg) was given intravenously just before giving anaesthesia and
stimulus dose was started at 360 mC and increased in steps of 60 mC if patient did not
have adequate seizure. Seizures were monitored by cuff method and EEG. All patients
developed adequate seizure. Hence in patients who do not develop seizure at maximum
stimulus Inj deriphylline can be used effectively as a proconvulsant.
1-8
Relapse following treatment with ECT
Raghuthaman G, Prathap Tharyan, Jacob K John
Vellore
Electroconvulsive therapy is effective in 80-90% of depressed patients. In medication
resistant cases, however, the effectiveness drops to 50% and relapse rates are as high as
65%, inspte of continuation pharmacotherapy. This naturalistic retrospective study
evaluated relapse rates after ECT given to patients with an ICD-10 diagnosis of depressive
5
Session -1
Electroconvulsive Therapy
Hall-Cauvery
disorder treated over a two year period, and given continuation pharmacotherapy. We used
operational criteria to define relapse, and compared socio-demographic, illness and
treatment variables between patients who relapsed and those that did not. The results and
clinical implications are discussed.
1-9
Lack of effect of Shankapushpi in the attenuation of ECS-
induced memory deficits
Chitttaranjan Andrade, Mathews M, George I/, And M, George J, Nagarani M A
Bangalore
In Ayurveda, shankapushpi has been claimed to have cognition-enchancing properties.
Adult, male, Sprague-Dawley rats were treated with either shankapushpi or vehicle alone;
the rats then received either 2 once-daily electroconvulsive shocks (ECS) or sham ECS.
Evaluation of learning in the Hebb-Williams complex animal maze obtained the following
findings; shankapushpi did not enhance learning in naive rats; shankapushpi did not protect
against ECS-induced retrograde amnesia; shankapushpi did not protect against ECS-induced
anterograde amnesia. It is concluded that shankapushpi is unlikely to be useful in the
containment of the cognitive deficits induced by ECT.
6
Session - 2
Community Psychiatry
Hall-Krishna
COMMUNITY PSYCHIATRY
2-1
Indigenous practices among psychiatric patients in Northern
India
TusharJagawat, Dash D K, Vivek Katoch, Pradhan S C
Delhi
To assess the prevalence of indigenous practices (Ayurvedic, Unani, faith healing, Exorcism,
Baba and other megico-religious modalities) among psychiatric patients, this study was
carried out in the Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, which is
one of the biggest psychiatric hospital in Northern India, having a wide catchment area
covering patients from Delhi, Rajasthan, U.P., Punjab and Haryana and other neighbouring
states. Only newly registered psychiatric outpatients fulfilling the including criteria over the
period of 6 months were screened in detail for their socio demographic and clinical variables
and prior use of any indigenous modality of treatment and reaons for visiting psychiatric
hospital and they were compared with those patients who had no previous exposure of
such indigenous practices or modality. Out of total 270 patients, more than 50% of the
patients were found to have use one or more methods of indigenous ways of treatment.
Majority of them were young, unmarried, unemployed, from poor and less educated
background, having first episode of psychotic disorder as compared to those who had no
exposure of indigenous practices. The implications of these findings are discussed in the
paper.
7
Session - 2
Community Psychiatry
Hall-Krishna
2-2
Preparation of psychoeducational material in Bengali for family
members of schizophrenic patients
Ash S, Basu S, Deb A, Chatterji D.
Gopalpur, West Bengal
Based on existing literature, available information in English and Bengali and interviews
with family members, a psychoeducational booklet for family members of schizophrenic
patients were prepared. To find out the utility of this material, pre and post exposure
assessments were conducted on thirty family members. Implications of the study will be
discussed in the presentation.
2-3
Health modernity in rural drug users
Renuka Jena, Shukla T R
Modernity is aggregate of certain attitudinal and personality factors conducive to social
and economic development. Health modernity (HM) refers to scientific knowledge and
attitudes to health and disease resulting in physical and mental well-being. In this study on
correlates of drug use in a rural community HM was also focussed. HM was measured using
the Health Modernity Scale devised by Singh et al in 1984 in a group of drug users and
compared with non users from the same community. There were 85 drug users (current)
comprising 44 males and 41 females. There were 121 sex matched non users comprising 61
males and 60 females. The commonly used drugs were tobacco, alcohol especially the
locally brewed handia and cannabis. Assessment of HM revealed significant differences on
the attitudinal and behavioural subscales. Further analysis of attitudinal factors revealed
significant differences in mental health (t = 2.37, p < 0.01), diet and nutrition (t = 3.32,
p<0.01) and family planning (t = 2.14, p < 0.05). Non users scored significantly higher
than the users on all the above factors. Users in the younger age group ( 20-34 yrs) scored
more on attitudinal HM compared to the 35-50 yrs age group. The results and the relevance
to drug taking behaviour is discussed.
8
Session - 2
Community Psychiatry
Hall-Krishna
2-4
Student's counselling services in colleges through trained
teacher volunteers.
Chandrasekhar C B, Ahalya B, Parthasarathy H, Sekhar K, Mody S, Nagarajaiah,
Sharma M P, Kishorekumar K
Murthy R S, Channabasavanna S M.
Bangalore
9-20% of students are suffering from mental health problems. (Sharma'76; Premarao,'78;
Chandrasekhar et al.,'80). These problems are associated with poor performance, irregular
or dropping out, unusual behaviour, aggression. Anxiety, depression, personality disorders
are reported in students who seek psychiatric help. (Wig et al.,'67) Because of inadequate
services and stigma, these students do not get professional help. A trained teacher is able
to counsel them. (Kapur'93). Department of Collegiate Education, Karnataka & NIMHANS
have launched a two weeks training progress for volunteer college teachers in student's
counselling. In July '95, 23 teachers underwent training. Establishing counselling centres,
sensitizing co-teachers and students in groups about students' problems and their remedies,
offering individual or group counselling were the strategies adopted. Issues related to
training, organisation of services, record keeping and monitoring are discussed in this paper.
2-5
The culture of affluence
Sharmila Basu, Soumitra Basu
Calcutta
Due to the effect of globalisation and open market economy, a culture of affluence is being
slowly built up through the communication media. This extends from the use of household
items to counselling sessions in 5-star hotels and even promoting anti depressants through
TV programs. The effects of this influx in the Indian context on growing children has to be
properly assessed.
9
Session - 2
Community Psychiatry
Hall-Krishna
2-6
Psychiatry of begging
Somasundaram 0, Alexander, Vivekanandan S, Bashyam V S P
Madras
Institute of Mental Health, Madras, renders psychiatric care services to one of the satellite
centres situated at Melpakkam for beggars. Psychiatric status of the inmates of the
beggars camp was assessed and the details are presented and discussed.
2-7
Pathways to Psychiatric Care: An Eastern Indian experience
Pradhan S C, Das J, Kothari S, Dey N, Ham D
Ranchi
The sequential contacts that a person makes prior to coming to a psychiatric set up is
known as the psychiatric help seeking pathway. 100 consecutive cases visiting the OPD,
were studied using a semi-structured demographic data sheet.
Results: 54% of the population first contacted a faith healer followed by a psychiatric
(15%) general practitioner (12%) exorcist (8%) and etc. 43% visited only one care giver,
followed by 24% who visited two and 14% who visited 3 to 4 care givers prior to coming to
a psychiatrist. 74% of people reached a definitive psychiatric set up within one year of the
onset of symptoms. The implications of these findings have been discussed in this paper.
2-8
A comparative study of family burden and dysfunction in
obsessive compulsive disorder and schizophrenia.
Josy K Thomas, Suresh Kumar P N, Sinha V K, Verma A N.
Ranchi.
This prospective study was conducted to assess the extent of family burden experienced by
the relatives of OCD patients and scnizophrenics and to compare the pattern of dysfunction
10
Session - 2
Community Psychiatry
Hall-Krishna
in the two groups. A series of 24 OCD patients and 30 schizophrenics attended the
psychiatric ORD of CIP, Ranchi and diagnosed as per ICD-10, with a minimum of one year
illness, were studied using Family Burden Interview Schedule, Dysfunction Analysis
Questionnaire and Socio-economic status scale. Family Burden (p < 0.001) and
dysfunction (p< 0.001) were significantly high in schizophrenia. Individual item analysis of
family burden shows that financial area, family activities, family leisure and interactions
were significantly impaired in schizophrenia. They also had high dysfunction score in social,
vocational, personal, family and cognitive areas on dysfunction analysis. The implications of
the findings will be discussed.
2-9
A psychosocial study of treatment adherence in psychotic
patients
Ahalya Raguram, Arpita Roy
Bangalore
While effective pharmacological and psychosocial therapies are available today, for the
treatment of psychotic illnesses, compliance is a major problem in management. Estimates
of non-compliance in psychotic patients varies from 7 to 70 percent. Compliance with
treatment is a crucial issue in mental illnesses owing to their chronic nature and the high
risk of relapse. The present study was undertaken to examine treatment adherence in
psychotic patients and their relatives and to identify psychosocial factors which influence
adherence. The sample consisted of 40 patients and 40 relatives of these patients fulfilling
specific inclusion and exclusion criteria. The treatment adherence, the families orientation
to mental illness, the burden perceived by them and their locus of control were studied
using relevant tools. The findings, and their implications for treatment will be discussed.
11
Session - 2
Community Psychiatry
Hall-Krishna
2-10
Mental morbidity and personality pattern in the spouses of
schizophrenic patients
Mahendru R K,
Kanpur
Since schizophrenia many times tend to become a chronic illness, its association with
patient's spouses may lead to emotional ill health in them. The present study aimed to
study the pattern and occurence of psychiatric morbidity in the spouses of male
schizophrenic patients. The sample consisted 30 consecutive schizophrenic patients and
their spouses attending psychiatric clinic of LLR Hospital, Kanpur. Twenty normal healthy
couples matched in age and socio economic status without obvious clinical evidence of any
psychiatric illness in the past or present were taken as controls. Besides usual psychiatric
assessment, the current health status of both patients as well as control pairs was
evaluated on Krietman's (1970) five point scale. The personality pattern of the individuals
taking part in the study was determined by the Middlesex hospital questionnaire. Twelve
out of thirty (40%) spouses of schizophrenic patients were having psychiatric illnesses.
Nearly half of the sick spouses were suffering from neurotic illnesses. The current health
rating scale revealed, that patients spouses with longer duration of marriage were having
higher rate of psychiatric morbidity as compared to control spouses. The patients pairs
scored significantly higher on all the six sub scales of the Middlesex Questionnaire as
compared to control pairs. Except for the free floating anxiety and somatic traits the
patients spouses also scored higher on the remaining four sub scales of the Middlesex
questionnaire. The implications of these findings are discussed.
12
Session - 3
Epidemiology
Hall-Tunga
EPIDEMIOLOGY
3-1
Assessment of psychiatric morbidity in a rural population during
a community health camp.
Shajahan M, Gurunathan S, Bashyam VS
Madras
In a primary health centre area during a medical camp conducted for screening diseases
with the help of all the speciality doctors in which a psychiatrist also formed the tram. GHQ
21 item scaled version was applied to randomised health care seekers. Patients attending
OPD in a General Hospital in a urban area formed the control group and are taken for
comparative analysis. The utility of the instrument in different population and the findings
in the light of cultural and socio-economic background implicate the psychiatric screening at
the primary health care setting are discussed.
3-2
Psychological morbidity in industrial township II
Vivekanandan S, Murugappan M, Shajahan M, Jeyaprakash, Rajarathinam,
Bashyam V S P
Madras
Institute of Mental Health, Madras was entrusted with the task of screening the employees
of one of the energy establishments rsraprising around 3000 employees for psychological
morbidity. Shortened version of PSE 10 with some modifications was the screening
instrument used. Analysis of data reveals the prevalence of various symptoms, symptom
clusters, among the employees. Psychoeducational programmes were conducted based on
the prevalence data.
13
Session ■ 3
Epidemiology
Hall-Tunga
3-3
Mental health problems of medical and engineering college
entrants
Nathawat S S, Sanjay Gehlot, Banwari C S
Jaipur & Jodhpur
In recent times, there has been a growing awareness about the problems of student mental
health in India. Medical and Engineering students make a special group altogether among
student population as they are subjected to great academic stress and strain. So their
mental health is important not only in its own right but also as contributing to their larger
society's well being. Their mental health assessment for any problem is therefore of great
significance. The objective of this study was to compare the prevalence of problems of
mental health of medical and engineering college entrants and to study gender effect if any.
A corollary of this was to investigate the role of family environment in the development of
mental health problems in these students pursuing for professional courses. The sample
consisted of 60 1st semester medical students taken from SMS Medical College, Jaipur,
and another 60 1st semester engineering students drawn from Malviya Regional
Engineering College, Jaipur. They were subjected to G.H.Q.(Goldberg); Middlesex Hospital
Questionnaire (Crown & Crisp) and Family Environment Scale (Moos). The incidence of
mental health problems were suspected to be more in medical college entrants than
engineering college entrants ( 45% Vs 37% respectively). In both the groups, male students
were found to be more vulnerable to emotional problems than female students. Medical
students score significantly high on phobic and somatic anxiety than engineering students.
Conflictual interactions in the family; ambiguity in family rules and responsibilities and the
rigidity of family rules contributed more in the genesis of emotional problems of engineering
students than medical ones. Whereas family dependency played a significant role in making
medical students more prone tp emotional ill-health than the engineering ones. The
importance of course load, career stress and family environment is discussed in the
development of mental ill-health of students of professional courses.
14
Session ■ 3
Epidemiology
Hall-Tunga
3-4
Psychiatric morbidity among medical students
Mandhekar D N, Chander Shekhar C R, Sriram T G
Bangalore.
The study was carried out to evaluate prevalence and pattern of psychiatric disorders
among medical students. An attempt was made to understand the relationship between
socio-demographic variables and psychiatric morbidity. Out of a total of 249 medical
students, 235 students filled up socio-demographic and GHQ-60 proformas. All the students
who scored 12 or more on GHQ-60 were interviewed by using PSE. This study showed the
prevalence rate to be 16.5%. 39 students met the ICD-9 criteria for psychiatric illnesses.
Depression (48%) and anxiety states (37%) were the most commonly diagnosed disorders.
Male students were having more psychiatric morbidity (17%) than females (14%). The
psychiatric symptoms, as per PSE, has shown the following trends, in order of decreasing
frequency, socially withdrawn, tiredness, poor concentration, worrying and muscular
tension. Details of these findings will be discussed alongwith other data.
3-5
An epidemiological study of psychiatric morbidity in a slum of
Jaipur city.
Pradeep Sharma, Gehlot P S, Anshuman Pant
Jaipur
Background and purpose: Outstanding thinkers are perturbed over the unnatural cancerous
outgrowths of cities called slums with its attendant milieu of socioeconomic
impoverishment, unhealthy ways of life, social isolation, extremes of social mobility, fickle
existence and evils like suicide, vices, prostitution, crime and gangsterism. From a research
perspective, an epidemiological study of psychiatric morbidity in slum provides an unique
opportunity to acquire insight into the social causes of mental illness. In this cross sectional
study, 203 families randomly selected out of 650 family units in Jawahar Nagar slums of
15
Session - 3
Epidemiology
Hall-Tunga
Jaipur city were studied. Case seeking was done by key informant schedule and detailed
assessment of the case was done by IRIS. The diagnosis were based on ICD criteria.
Results: Mental illness was found in 9.16% of the population. The children and elderly
showed shigher prevalence of mental illness. Other major determinants of mental illness
were sex, marital status, literacy, occupation, family size and structure, migration and
social class. The major diagnostic categories were - affective psychoses 0.4%, neuroses
3.15%, drug abuse and adjustment reaction. Other significant categories were pica,
enuresis and mental retardation. Results were analysed based on the unique characteristics
of the slum and special characteristics of the study slum.
3-6
Psychiatric morbidity in children & adolescents
Sinha A Kf Srivastava A S
Varanasi
An analysis of one year case records of the patients who are attending the Child Guidance
Clinic of Department of Psychiatry, Institute of Medical Sciences, BHU, Varanasi, was
carried out. The aim of the study was to find out the incidence of various types of
psychiatric disorders in children. The majority of the patients belong to mental retardation
group followed by neurotic disorders, seizure disorders, cases of chilhood schizophrenia,
manic excitement and depression were also found. Details regarding the data and analysis
will be presented in the conference.
3-7
An epidemiological study of psychiatric morbidity in a village
Anil Thambi, Vyas J N, Pradeep Sharma,
Jaipur
Well conducted epidemiological studies, by throwing light on the association between
psychiatric disturbances and demographic and sociocultural variables, greatly enhance the
planning of psychiatric facilities in the community. In this cross sectional study psychiatric
16
Session ■ 3
Epidemiology
Hall-Tunga
morbidity in village Goner which lies in the outskirts of Jaipur city and has been provided
with most of the urbait amenities was surveyed.
Methods: The study units were families. 235 families randomly selected out of 470 families
registered with panchayat were studied. The key informant schedule was administered to
the head of the families and information generated therefrom were used to identify possible
cases, to whom, in turn, IRIS was administered. Results: Psychiatric disorders were found
in 8.87% of the sample ( 11.29% in adults and 4.53% in children). Main socio demographic
determinants for psychiatric disorders were age, sex, marital status, literacy, social class,
occupational status and size and type of the family. Major psychiatric disorders found
among the adult population in the order of frequency of occurence were neurotic disorders -
3.23% (neurotic depression 1.32%, anxiety neurosis 1.17%) psychotic disorders 1.39%
(schizophrenia 0.29%) drug abuse (1.39%) and organic mental disorders (0.59%). Among
children the major syndromes identified were mental retardation 0.73%, enuresis 0.73%
and conduct disorder 0.29%.
3-8
Mental health of rural women
Indira Jai Prakash
Bangalore
Health statistics show that while women have biological and behavioural advantage over
men with regard to mortality, they appear to have greater morbidity than men. Though
major questions still remain as to conceptualizing mental health and identifying the sources
of morbidity, there is a general trend for women to report more distress in community
surveys. This study reports findings from interviews and assessment of 253 women from
two villages of Bangalore district. All the women were above 40 years of age and an
alarming 47% of them had higher scores on Self Report Questionnaire, which is a first stage
screening device, indicating possible morbidity. Negative affect, poor self rated health and
low satisfaction were related to SRQ scores. Rural environment that combines illiteracy
with poverty acts as stressor affecting the mental health of rural women.
17
Session - 3
Epidemiology
Hall-Tunga
3-9
Mental health care:Perception and expectations of rural
population in U P
Tiwari S C, Sethi B B, Sitho/ey P
Lucknow
A study was carried out in randomly selected nine villages falling under a PHC close to
Lucknow with objectives to explore the perception and expectations of rural subjects about
mental health care. The data was analysed using percentage and Chi-square tests. The
results showed that the community was largely (88.21%) aware of mental symptoms and
majority reported drugs (86.28%) to be the main treatment followed by faith healing
(12.94%). Although more than half (52.59%) knew about general hospitals as a place of
treatment, only 26.71% were aware of mental hospitals. The available treatment facilities
were far from villages (55.36%) and majority felt that such facilities should be located in
the village. Majority (75%) favoured free consultation and medicines. About 61.28% availed
the mental health treatment facilities but almost all (80.08%) were totally dissatisfied.
Large number of subjects (66.96%) felt medicines to be the only treatment followed by
26.71% who favoured combination of all treatments. Almost all (95.29%) favoured clinic
based treatment by psychiatrists offering services at least once a week (55.44%). The
implications of findings are discussed in the light of the ongoing National Mental Health
Programme and expectations of the rural community.
3-10
Prevalence of obsessive compulsive disorder in rural population
in Karnataka
Guruswamy H, Sumant Khanna
Bangalore
Recent reports suggests a life time prevalence of 1.6% to 2.5% of Obsessive Compulsive
Disorder (OCD) in the general population from the Epidemiological Catchment Area in the
18
Session - 3
Epidemiology
Hall-Tunga
USA. The prevalence rate of OCD in Bangalore has been found to be 0.4% (Khanna
unpublished data). The current study aims at looking at the prevalence of OCD in the adult
population of a rural village. 148 adults from the village Thimmanahally were interviewed
directly (n = 115) or information about them was obtained from others (n = 33) covering 98%
of the population. All subjects were assessed on SCAN. 3.38% of the subjects had OCD.
5.4% had DC symptoms not amounting to OCD (combined 8.78%) and 0.68% had tic
disorders. These observations will be discussed in the light of Western reports.
19
Session - 4
Suicide
Hall-Bhadra
SUICIDE
4-1
Socio demographic study of cases of attempted suicide admitted
in a teaching-cum-referral hospital of West Bengal
SrHekha Chatterjee, Das S, Debnath C, Biswas S, Banerjee S,
Calcutta.
Five hundred cases of attempted suicide who were admitted in medical indoor and
subsequently referral to psychiatry department were examined and possible causes and
future remedial measures are discussed.
4-2
A study of "psychological autopsy' of 50 unnatural female
deaths
Jyoti Mahapatra, Mahapatra S C, Bardhan >4 K
Orissa
The study was conducted during a period of 3 years jointly by the psychiatrist and forensic
medicine specialist. 50 consecutive cases of unnatural death of married females were
noted, which came for autopsy in the F.M.T.dept. Their mode of death was ascertained by
help of post-mortem findings. Then the close relatives of the dead women were interviewed
and a 'psychological-autopsy' was done to know the mental status of the victim and the
possible factors leading to unnatural death. It was also ascertained whether death was due
to suicide, homicide or accident. On analysis of the data it was found that majority of the
women committed suicide due to (1) marital and family problems and (2) a significant
number due to chronic mental illness. Clearcut findings to point towards homicide was
present in 7 cases, the provoking factors being mental illness of the husband in some cases
and dowry problems in others. Accidental death was proved only in 3 cases.Implications of
the findings are discussed in detail in the paper.
20
Session - 4
Suicide
Hall-Bhadra
4-3
Personality profiles of self-immolators
Kannabiran, Ebrahim Haroon, Vivekanandan S, ArunagiriS, Bashyam VSP
Madras
31 self-immolators were compared with 31 suicide attempters by consuming organo
phosphorus compounds in spheres like their personality, presence and nature of life events
and presence of depression. The personality of self immolators was unique in the sense that
they lack ego strength and superego strength. They were aggressive and sensitive. They
were not depressed. Life events score was more among the self-immolators.
4-4
Hopelessness, suicidal intent and depression in suicide
attempters
Sudhir Kumar, Vikas Jain, Singh H
Lucknow
The study has been undertaken to find out severity of depression in suicide attempters and
to find out relationship of hopelessness and suicidal intent. 56 individuals attempting
suicide who were admitted to medical and surgical wards of the King George's Medical
College and Hospitals, constituted the sample of the study. ICD-X was used for diagnosing
psychiatric morbidity in the subjects. Hamilton Rating Scale for depression; Suicidal Intent
Questionnaire (SIQ) and Beck's Hopelessness Scale were administered to all subjects. Male
to female ratio was 3 to 2. Majority were young in age. Organophosphorus ingestion was
the main method for attempting suicide. Family quarrel, financial and examination stress
were main precipitating factors. Depression was the main diagnosis in the sample. There
was a highly significant correlation (p < .001) between suicidal intent, hopelessness and
depression among the suicidal attempters. The study demonstrates important implications
in the therapy of individual at high risk of suicide.
21
Session - 4
Suicide
Hall-Bhadra
4-5
Personality variables and neuroticism in alcoholics who attempt
suicide
Jayita Choudhary, Shubhangi R Parkar
Bombay
Alcoholism is a psychiatric disorder associated with an increased risk of suicidal behaviour.
The lifetime risk of alcoholism in suicide is about 15%. Personality characteristics play an
important role in the alcoholic who attempts suicide. Some studies have shown increased
"neurtoticism" score or Eysenck Personaltiy Inventory in the population of alcohol
dependent persons who attempted suicide. Two groups of 30 alcohol dependent patients in
each group, - (1) with history of suicide attempt and (2) without history of suicide attempt
were compared to detect the presence of and differences in the personality variables and
"neuroticism" scores ( on EPI), using structured clinical interview for DSM lll-R personality
disorders (SCID-II) and Eysenck Personality Inventory. Alcoholics who attempted suicide
had a greater incidence of personality disorder and traits (90%) as compared to those
without suicide attempt ( 40%); which include antisocial personality disorder being most
common followed by borderline personality disorder. The study also revealed that in this
sample, alcoholics with and without history of suicide attempt had a higher "neuroticism"
score on EPI but the significant finding was that unlike other studies, the index group had a
lower "neuroticism" score than the control group.
4-6
Evaluation of crisis intervention in patients with suicide
attempt
Shubhangi Parkar, Bindoo Maru, Sadhana Bhatkhande
Bombay
It is important to emphasize the fact that both suicidal behaviour and self-destructive
behaviour are not always pathogromonic of mental illness, they merely denote the presence
22
Session - 4
Suicide
Hall-Bhadra
of psychopathology due to emotional disturbances. In this context, it becomes more rational
to view an individual with suicidal behaviour as in a state of crisis. The crisis can probably
and potentially be related to psychological disturbances which are either situation-specific
or stress related. Crisis intervention, as a therapeutic process, in the management of
patients with suicide attempt has been the subject of considerable scrutiny. Crisis
intervention, as a short-term therapy, has become increasingly popular over the years. It is
less time consuming, more productive and an effective line of psychological intervention. In
this paper, the description of the process of crisis intervention in relation to its impact on
patients is described with a narrative experience.
4-7
Suicide by self poisoning - admissions in one year in a general
hospital
Pradhan P I/, Vandana Mahajan; Dushyant BhadHkar, Meena Maria
Bombay
Self poisoning is a common method of attempting suicide in India. In order to understand
extent of this problem, this study was conceived. A retrospective analysis of demographic
variables and outcome in cases of self poisoning was done. Data was obtained from
admission register of medical wards and medical record department of KEM Hospital,
Bombay.
8.34% of total admissions in general medical wards were due to self poisoning. 57.76%
patients were young (15-25 yrs). There were more females in younger age group however,
males predominated in older age group. 17% of patients of self poisoning required
management in intensive care unit and 3.9% of them died. Fatal outcome was highest in
group of elderly patients (>45 yrs). Organophosphorus insecticides were used by 78.7%
patients. These and other findings of the study were compared with studies done earlier.
23
Session ■ 4
Suicide
Hall-Bhadra
4-8
Stressful life events in adolescents who attempted suicide
Vandana Mahajan, Shubhangi Parkar, Pradhan P V
Bombay
Suicide attempts by adolescents has become a major problem recently. It is observed that
more adolescents attempt suicide while completed suicide are observed in older group.
The aim of this study is to study recent stressful life events in adolescents who attempted
suicide. Adolescents who attempted suicide were from age group 16-24 years. Patients
were assessed using a specially designed proforma and necessary demographic and clinical
data was collected. These patients were administered suicide intent scale and presumptive
stressful life event scale. Findings were compared with matched control group. In the study
females outnumbered males. 75% of them acknowledged suicide, 54% of the sample
attempted suicide to solve problems or to escape from the stressful situations. Adolescents
who attempted suicide had more stressful life events in one year before they attempted
suicide. Acute stressful events were interpersonal conflicts; especially family and marital
conflicts, and financial problems. Findings are compared with control group and results are
discussed.
4-9
Suicide prevention service
Singh S D
Cochin
It is an observed universal truth that number of suicides is increasing. To work more
effectively in a semi scientific method we have formulated a telephone counselling system.
The methodology and statistics of one year is presented for discussions.
24
Session ■ 5
Neurosis I
Hall-Sharavathy
NEUROSIS I
5-1
Quantitative EEG correlates of phenomenology and symptom
severity in obsessive compulsive disorder
Bagchi J, Raju S S, Haque S
Ranchi
This study is an attempt to detect quantitative EEG abnormalities in 16 Obsessive
Compulsive Disorder (OCD) patients (DSM IV criteria), as compared with normal age and sex
matched control population and correlate them with forms and contents of obsessions and
compulsions as well as severity of illness. The age range of the patients was 15-45 years.
Yale Brown Obsessive Compulsive Scale and Padua inventories were administered and
QEEG was done. A mean score of 13.64 (time spent on obsessions) 12.28 (time spent on
compulsions) 5.88 (insight into O.C.symptoms) in YBOCS and 30.64 in Padua invetory were
obtained respectively. Further statistical comparisons were done between quantitative EEG
findings in OCD patients and age, sex matched control group (N = 16), details of which
including discussion and conclusions would be elaborated.
5-2
Guilt feeling reaction and marital adjustment in OCD &
Dysthymia
Ushma Rani
Ranchi
OCD and dysthmia, both illness of an affective spectrum, have many similarities and
striking differences. This study was undertaken to find out similarity and differences in the
sociodemographic variables and in the guilt feeling reaction and marital adjustment in
depression and dysthymia. 15 cases each of OCD and dysthymia as per DSM IIIR criteria.
25
Session - 5
Neurosis I
Hall-Sharavathy
constitutes the purposive sample. Patients' sociodemographic and clinical data was
collected by a semi-structured interview. Each of the patient was administered M.H.Q, Guilt
Feeling Questionnaire and Relationship Questionnaire. The obsessive patient had higher free
floating anxiety, phobic anxiety and it was found that obsessive patients react more
vigorously (p < .001) with anxiety to the guilt provoking situation than dysthymics
wherever self agression, shame, sorry are not found to be significantly related. The marital
adjustment was significantly worse in OCD patients. The implications of these findings in
the psychotherapeutic management will be discussed.
5-3
Demographic features in OCD: A comparison with mania
Christoday R J Khess, Mukherjee T
Ranchi
This study was conducted at Central Institute of Psychiatry. 52 first contact OCD patients
were compared with 51 first contact manic patients. All consecutive cases who fulfilled the
DSM-III R Criteria for the above disorders were included in the study. The study showed
some distinct demographic differences between the two groups on comparison. The OCD
group had significantly more number of female patients ( 32.70% compared to 25.49%)
which was statistically significant. Further there were more patients who were single in the
OCD group ( 44.23% versus 25.49%) which again was significant. The OCD patients had
significantly more family history of psychiatric disorders compared to manic patients (
51.92% versus 25.49%), however 92.30% of manic patients with a positive history of
psychiatric illness had history of mood disorder, while amongst the OCD patients with a
family history of psychiatric illness only 18.51% patients had history of OCD and 29.62%
patients had history of O.C. traits. It was also noted that in the manic group there were
7.84% tribal patients compared to 0% in the OCD group. The patients in the two groups did
not vary on religion on comparison. The increased preponderence of females in the OCD
group, even when the absolute number of female cases was less has been discussed with
26
Session - 5
Neurosis I
Hall-Sharavathy
special reference to the Indian set up. We have also discussed the increased celibacy rate,
absence of any tribal patients and the difference in the rate of family history of the specific
disorder in the two diagnostic groups.
5-4
Symptom patterns in obsessive compulsive disorder patients
attending general hospital psychiatry unit.
Chaukimath S P, Bhairwadgi S S
Bijapur
Four main symptom patterns are described usually for Obsessive Compulsive Disorder
patients. Obsession of dirt with compulsion of washing being the commonest. Twentyfive
obsessive compulsive patients who attended Psychiatry Unit of a general hospital in thelast
two years are being analysed for their symptom patterns, at presentation. The demographic
profiles are compared. The results are being analysed.
5-5
Stressful life events and somatoform disorders
Chandrasekhar C R, Veirkataswamy Reddy
It
Bangalore
Somatoform disorders (SD) constitute major morbidity in medical and psychiatric practice.
5% in general population and 30-40% of people seeking medical help suffer from SD. They
use bodily symptoms to communicate their psychosocial distress. (Barsky'83). The
a
relationship life events with mental disorders is well established. (Kulhara & Prasad Rao'86;
Sharma & Ram'88; Singhal et al'84). The presumptive stressful life events scale (PSLES)
(Gurumeet Singh et al/84) was administered to 137 patients who sought help from primary
health care agencies and who had 3 out of 12 problems (screener for SD designed by WHO)
0
0
O
<1
O
lasting for a month or more. 50% patients suffered from physical ilnesses, 33% from
psychiatric disorders other than SD, 17% from SD. 12 life events were not reported by all
27
Session ■ 5
Neurosis I
Hall-Sharavathy
patients. 7 heirarchical cluster analysis methods (Reddy '94) each with two measures of
proximity were employed to classify these patients on 39 items on PSLES. 5 clusters
emerged. One cluster had several ambiguous life events related to loans, pilgrimage, son or
daughter leaving home/getting married. This was significantly related to SO. The details of
the other clusters are discussed in the paper.
5-6
Dissociative disorder and persistent somatoform pain disorder
Alice Cherian, Sarojini George, Sharmila Chari
Vellore
Objective: To compare the sociodemographic pattern, level of intelligence and response to
treatment. Method: 25 children with persistent somatoform disorder were recruited and
studied prospectively from June '92 to December '93. Results: Children with dissociative
disorder belonged to the first or second order of birth, they belonged to low socio economic
group, their I.Q. was lower as compared to children with Persistent Somatoform Pain
Disorder. I.Q. of children was lower when either parent was illiterate. There was no
differences between the two groups in other variables. Conclusion:A comparative study
between these two disorders showed that they are similar in most aspects except that as a
group children with dissociative disorder had a lower IQ than children with persistent
somatoform disorder.
5-7
Hysteria in a female hospital
Sandeep Choudhury, Bhatia M S, Malik S C
New Delhi
Aim: The socio-demographic variables and the clinical presentations of hysteria have been
variously described by different authors but no consistent picture has emerged from the
research. Therefore the present study was undertaken to find out the epidemiology and
28
e
Session - 5
Neurosis I
Hall-Sharavathy
phenomenology of hysterical neurosis patients attending a female hospital. Methodology:
e
e
of 644 consecutive patients, 60 new cases of hysteria (ICD-9) were evaluated on a
semistructured interview schedule using, socio demographic recording and symptoms check
list. Observation: The results were analysed using various statistical techniques and it was
found that a najority of patients were between 11-30 years (66%), illiterates (42%);
housewives (68%); from an urban background (83%); from socio-economic class II (57%);
Hindus (87%) and with an insidious onset (67%). Most of the patients presented with
multiple complaints ( 58%) in 11-20 symptoms range with Motor or Pseudoneurological
being the commonest (73%) followed by GIT and Pain (50% each). Conclusion: Thus we
conclude that hysteria is more prevalent in young, non-working married females from lower
income groups but owing to the limitations of the community under study and lack of
proper controls, we believe that lot more work is needed before any definite conclusions
can be drawn out.
5-8
AFexithymia and illness behaviour among women with
somatization
Jaideep Sarkar, Prabha S Chandra
Bangalore
The aim of the study was to assess illness behaviour patterns and alexithymia among 60
women with somatic complaints. Among these women, 50% were on psychiatric treatment
and 50% were newly diagnosed. They were assessed on the illness behaviour assessment
schedule and the Toronto Alexithymia Scale. 68% were from an urban background, 39%
had less than five years of education and 85% were married. 33% had a somatic disease
conviction and 27% a psychological disease conviction. 62% had inhibitions of
communicating feelings and 46% had denial. The mean alexithymia score on TAS ( 71 +
14.7) in the new patients was significantly less than among those on treatment. The paper
focusses on the relationship between alexithymia, nature of explanations given, treatment
and illness behaviour.
29
Session - 5
Neurosis I
Hall-Sharavathy
5-9
Globus pharyngis and psychiatry - a newer treatment probe
Rajesh Sagar, Sunil Kumar
New Delhi
Globus has received little systematic interest from the psychiatrists despite the fact that it
is the common problem as well as it has important associated psychiatric symptomatology,
moreover there is no specific treatment for globus. The present study aimed to (1) explore
the association between globus and psychiatric disorders (2) study the efficacy of
alprazolam in these patients. Twenty six adult patients with globus were assessed by DSM
lll-R criteria. Patients received alprazolam or placebo in a double blind fashion. Treatment
outcome was assessed using throat questionnaire, Beck depression inventry, Hamilton
anxiety scale and General health questionnaire. Nine patients met the DSM lll-R criteria for
current psychiatric disorders. Alprazolam provided good therapeutic relief in these patients.
Explanations and implications are discussed.
30
Session • 6
Psychopharmacology
Hall-Cauvery
PSYCHOPHARMACOLOGY
6-1
Do EPS and chronicity go hand in hand?
Gopa/a Sarma P
Warangal, A.P.
Objective: To see if EPS indicates chronicity. Design: Retrospective analysis of outpatients.
Setting: Consultations and general hospital based study. Patients: 400consecutive patients
seen in consultation and general hospital psychiatry unit. Main outcome measures: Nature
(chronic/non) reaction (EPS/non), follow-up, workoutput. Results: EPS was more in chronic
cases. Both the sexes, who had EPS, were over represented in chronic cases. Those with
EPS had good follow-up, both number of visits and months wise with no/poor work output.
6-2
Loxapine induced, neuroleptic malignant syndrome - a case
report
Jayanta Chatterjee, SrHekha Biswas
Calcutta
Loxapine was introduced in Indian market about five years ago, although it is introduced in
USA for twelve years and in UK for last eight years. This is probably first case of NMS
secondary to loxapine reported in India, though few cases were reported in UK and USA.
31
Session ■ 6
Psychopharmacology
Hall-Cauvery
6-3
A comparative study of secondary placebo response between
schizophrenics and major depressives
Ravi S Pandey, Arya S C, Sanjay Agarwal
Delhi
Aim: To compare the secondary placebo response between schizophrenics and major
depressives. Methodology: Patients of schizophrenia and major depression who were
already maintained on a fixed dose drug combination were included in a six week protocol.
They were continued for the first two weeks on the fixed dose drug combination, next two
weeks on the same drugs but given separately in tablet form and next two weeks again on
fixed-dose drug combination. Nowak's mean analogue scores were calculated at the
beginning of trial and fortnightly thereafter. Observation and result: An analysis of Nowak's
mean analogue scores of schizophrenics (n = 12) and major depressive (n = 7) on CEPT IV
software did not reveal any statistically significant difference (p > 0.0.5) between
schizophrenics and depressives. Conclusion: Secondary placebo responsiveness of
schizophrenics is not different from the secondary placebo responsiveness of depressives.
6-4
Assessment of safety and efficacy of 'Zopiclone' (a hypnotic):
An open trial
Agarwal A K, Shashi Rai
Lucknow
This study was an open trial conducted on thirty three depressed patients, to assess the
safety and efficacy of a new hypnotic agent, 'zopiclone'. Zopiclone is a cyclopyrralone
which acts by facilitating the inhibitory action of gamma amino butyric acid. Efficacy was
assessed using sleep disorder symptom checklist and safety by thorough physical
examination and various laboratory tests. The drug was found to be an effective and safe
hypnotic agent with minimal rebound insomnia and few adverse effects. Dependence
32
Session - 6
Psychopharmacology
Hall-Cauvery
potential and long term effects of the drug cannot be commented upon owing to a short
trial period.
6-5
Long term outcome of lithium prophylaxis in recurrent affective
disorder: (.Background data and main outcome.
Kulhara P, Basu Z7, Mattoo S K, Chopra R
Chandigarh
Indian studies on prophylactic efficacy of lithium in mood disorders are few, based on small
samples and on relatively short follow-up periods. In this study, long-term outcome of
patients attending one of the earliest lithium clinics in the country is presented (follow up
period 2-27 years, mean 11 years), the patients (n = 122) were predominantly married
(80%), from urban background (72%), with at least primary education (90%), males
outnumbering females (2.5:1). They had been ill for a mean of 8.3 years before lithium was
started. During this period they suffered a mean of 6 affective episodes. Many (44%) had
mental illness in family members of whom some (13%) had received lithium as well. During
the follow up most were regular in reporting (88%) and were compliant (90%). The long
term outcome analysis of 118 patients of the original cohort (97%) shows that they had a
mean of 4.6 relapses while on lithium (manic:2.8; depressive:! .8). Adjusted for the duration,
this was significantly less (p < 0.01) than the pre-lithium episode freqeuncy. Further, the
relapses were mostly milder in nature, resulting in lesser occasions and days of
hospitalisation. Only 28 patients, however, did not suffer a single relapse while on lithium
(24%) the rest having some episodes (range:1 -34; median and mode =3). Using the modal
number as cut-off, 49 patients (41.5%) emerged as good responders to lithium.
33
Session ■ 6
Psychopharmacology
Hall-Cauvery
6-6
Long term outcome of lithium prophylaxis in recurrent affective
disorder: II Characteristics of good responders
Kulhara P, Basu Df Mattoo S K, Chopra R,
Chandigarh
Out of 122 patients attending a lithium clinic for prophylaxis of recurrent affective
disorders and taken in for a study in 1989-90, long term outcome data were available for
118 (97%) patients. Of these, 49 (41.5%) were categorised as "good responders" and the
rest as "partial/poor responders" depending upon the modal number of relapses suffered
while on lithium. These two groups were then compared on demographic, clinical, and
psychosocial variables so as to determine the characteristics and correlates of good
response to lithium prophylaxis versus partial/poor response. In the analysis, role of drug
compliance was also taken into consideration. Certain demographic, clinical and
psychosocial variables emerged as differing significantly between the two groups. A subset
of the poor lithium responders did better with addition of carbamazepine.
6-7
Clozapine in the treatment of resistant schizophrenia
Sandip Choudhury, Deshmukh D K, Ananta Dave, Matcheswa/a Y, Sheeta! Choksi,
Gayatri
Bombay
Schizophrenia has long been the bane of every society. It takes an alarming implication in a
poor and developing country like India due to enormous damage involved in the social and
occupational spheres. Resistant schizophrenia's which till recently had a few satisfying
answer. With advent of atypical antipsychotic, clozapine in Indian market there seems to be
a ray of hope for these patients. Our aim was to study the efficacy of the drug in Indian
patients with resistant schizophrenia and systematically assess its adverse effects. The
inclusion criteria were:1. Patient within age group 22-45 years. 2.Patients satisfying
34
Session - 6
Psychopharmacology
Hall-Cauvery
criterias of DSM IV for continuous schizophrenia. 3.Patient already undergone trial for 6
weeks with adequate dosage of atleast 2 groups of typical antipsychotics. 4.Patient having
significant and persistant EPR on these antipsychotic even while responding to medication.
Patients had no other confounding factors like medical illness, substance abuse or under
any other medication. Of the 30 patients currently undergoing open, non-comparative trial,
we are provisionally reporting on 18 patients who underwent trial for atleast 6 weeks with
Rx clozapine dosage ranging from 12.5 ■ 25 mg to 400 mg. Prior to starting medication
routine investigation including baseline Hb, CBC count, X-ray, ECG were performed. Baseline
BPRS, SANS, SAPS, CGI, GAS, EPR rating scales were applied and subsequently these
tests were performed on a weekly basis. Majority of patients started showing improvement
by 4th week and in the dose ranging from 200-400 mg per day. Contrary to the report in
western literature there was statistically insignificant side-effects like sedation,
hypotension, hypersalivation, agranulocytosis. None of the patient developed EPR. We
report our findings in the paper on clozapine.
6-8
A comparison of prevalence of tardive dyskinesia in patients
with schizophrenia and mood disorders.
Gurunathan, Murugappan M, Kumarababu, Vimalarao
Madras
Tardive dyskinesia (TD) is being reportedly a high morbid risk for patients receiving long
term neuroleptics. There exists a controversy whether TD is more prevalent among
schizophrenics or mood disorder patients. The aim of the study is to compare age, sex
matched sample population of the two major psychoses for TD who are receiving
neuroleptics on long term basis (more than 2 years). An internationally valid tool namely
assessment of involuntary movements scale (A.I.M.S.) is used to measure the TD. A
stratified sample technique is used. The results are analysed and discussed.
35
Session - 6
Psychopharmacology
Hall-Cauvery
6-9
Neuroleptic malignant syndrome - a prospective study
John Alexander P, Ranji Mathai Thomas, Arunava Das
Manipal, Karnataka
There is no general consensus regarding the phenomenology, prevalence, pathophysiology,
risk factors and treatment of neuroleptic malignant syndrome (NMS). As most studies on
l\IMS are based on retrospective case reports, we decided to do a prospective study of
patients with NMS, admitted in a general psychiatric unit over a period of one year. The
prevalence of NMS was 1.89%, with a 50% incidence below 40 years and a 66% incidence
in males. All the patients were on antipsychotics, with 83.3% being on lithium concurrently
and having a comorbid physical illness. There was a 50% incidence of hyperpyrexia and a
83.3% incidence of affective disorder, with one patient having post-partum psychosis. All
the patients had rigidity, altered consciousness, autonomic symptoms, raised CPK values
and electrolyte imbalances. All were treated with 5-10 mg of bromocriptine and symptoms
resolved within 12-60 days. The incidence of age, sex and alterations in laboratory values
were consistent with available literature. High prevalence of affective disorder has also
been recently reported. The combination of lithium and neuroleptics along with concurrent
physical illness and electrolyte imbalances increases the risk of NMS. The 50% incidence of
hyperpyrexia shows that it may not be a consistent feature of NMS.
6-10
A study of pharmacologic treatment instructions to patients and
compliance in a general hospital psychiatric OPD
Paralikar VP, Susan Zachariah, Dha vale D M, Rajendra Kale
Pune
The efficacy of pharmacologic treatment has been well established in schizophrenia and
affective disorder, which form the bulk of patients attending general hospital psychiatric
OPD. Despite the clear benefits of long term maintenance medication, many patients still
36
Session - 6
Psychopharmacology
Hall-Cauvery
relapse. The major reason for high relapse rate is non-compliance (Kane 1985, Kissling
1989). For the first episode patients, this noncompliance rate is even as high as 75%
(Goebel and Pietzcker 1983).Aside from illness-related factors, this high noncompliance is
also due to the fact that patients and their relatives are not well informed about their illness
and treatment.
We carried out a study of all patients attending psychiatric OPD in Sassoon Hospital (a
large public hospital in Pune) on a single day.A total of 90 patients and their relatives were
interviewed on a special proforma after their examination and dispensing of medication was
completed. As many as 40% made more than one error in restating the pharmacologic
instructions which were given to them earlier. A simple intervention was planned which
emphasises not only all the details of pharmacologic treatment but also included a
motivational process carried out with patients and relatives. The assessment was repeated
after 1 month. The results will be discussed in relation to improving compliance in long term
therapy and prevention of relapse.
6-11
Comparison of mianserin and diazepam in depression and
anxiety: A pilot study
JHoha R Cf Renuka Jena, Sagar R
New Delhi
Anxiety and depression are very frequently associated. Hamilton (1983) and Dubovsky
(1990) suggested that 70-95% of depressed patient's have associated anxiety. In the
present study the aim was to evaluate the anxiolytic property of Depnon (Mianserin HCL) in
comparison to Diazepam in depressed patients with anxiety. Patients in the age group 2045 years were taken from the psychiatric OPD at the GB Pant Hospital at New Delhi. The
diagnosis was made according to the ICD-X. the patients were divided into two groups. In
an open comparative clinical study Group I was treated with Depnon and group II with
diazepam and Imipramine. There were 25 patients in each group.Assessments were made at
intake (base-line) and weekly intervals for 5 weeks. The severity of depression was
37
Session - 6
Psychopharmacology
Hall-Cauvery
assessed using Hamilton Depression Rating scale. The dosage of drugs were monitored by
the psychiatrist. The results, conclusions and implications are discussed.
6-12
Neuroleptic associated thermoregulatory abnormalities and the
neuroleptic malignant syndrome
Singh NJ
Calgary, USA
Antipsychotic medications impair several important physiological thermoregulatory
mechanisms. These include an inhibition of sweating due to cholinergic blockade and
impairment of central thermoregulation resulting from the blockade of dopamine receptors.
Acutely psychotic agitated patients are exposed to a sizable endogenous heat load while
their physiological thermoregulatory mechanisms may be impaired by antipsychotic
medications. These two factors, in combination, can lead to clinically significant
thermoregulatory abnormalities. In this presentation, the clinical course of an acutely
psychotic 19 year old East Indian female is described. While acutely ill and under treatment
with chlorpromazine, she developed hyperthermia, catatonia, and displayed autonomic
instability. In addition, creatinine kinase was elevated to approximately three times the
normal range.A septic workup, including blood cultures and a lumbar puncture, was
negative. The syndrome is illustrative of a spectrum of disorders involving thermoregulatory
abnormalities neuroleptic malignant syndrome, lethal catatonia and endogenous heat
stroke. In cases such as this, management of psychomotor retardation is a priority. In this
case, the use of barbiturates for sedation was complicated by the possibility of acute
intermittent porphyria. Electroconvulsive therapy was eventually successful in controlling
the agitation. Subsequently, the patient was successfully treated with lithium, and was
later uneventfully challenged with low doses of haloperidol.
38
Session ■ 6
Psychopharmacology
Hall-Cauvery
6-13
Use of clozapine to control acute maniac excitement
Madhava Rao K S
Mangalore
18 patients who were in acute excitement due to mania were put on clozapine 50 to 150
mgs/day for 7-10 days only and the medication was stopped abruptly. The patients
selected were either (a) not responding to parenteral haloperidol, (b) required higher doses of
haloperidol to control excitement, (c) were developing severe BPS and akathisia with
haloperidol.
Results with clozapine appear to be encouraging. Details to be discussed.
39
Session ■ 7
Alcoholism -1
Hall-Krishna
ALCOHOLISM -1
7-1
Brief addiction rating scale (BARS) for alcoholics
Janakiramaiah N, Naga Venkatesha Murthy, Raghu R M, Subbakrishna,
Gangadhar B N, Pratima Murthy
Bangalore
The multidimensional impact of alcoholism and the need for efficient measurement of the
same are noted. The currently available scales are unwieldly and largely inapplicable. A new
scale, "Brief Addiction Rating Scale (BARS)" developed at De-addiction unit, NIMHANS with
10 items, each rated on seven points (0-6) is reported. The inter-rater reliability(n = 20) is
remarkably high (intra class correlation^.9-1.0) for all the 10 items. The validity of selected
scale items and illustrative application of the scales to characterise 40 male (age: 39.9 +/9.3 yrs) inpatient alcoholics with mean BARS scores on different items ranging from (0.09
for legal problems - 4.76 for dyscontrol of substance use) are presented.
7-2
Physician explanatory models (EMs) in alcoholism
Saju P J, John J K
Vellore
Explanatory model is a clinical anthropological concept, and is notions of a particular
sickness and its treatment employed by patients, family and physicians. The study of
physicians EMs tells us something about how physicians understand and treat alcoholism.
All psychiatrists, psychiatric trainees and psychologists in our department were given a
rating scale to assess their ideas regarding alcoholism. The results are discussed; and their
implications regarding patient ■ physician relationship, compliance with recommended
regimen are discussed.
40
Session - 7
Alcoholism -1
Hall-Krishna
7-3
Personality patterns of alcoholics
Malini S, Gangadhar B N, Janakiramaiah N J, Mukundan C R, Rohrbaugh J Wr
Cloninger CR, Subbakrishna D K
Bangalore
Ths study examined personality pattern of two groups of alcohol dependent individuals
diagnosed by ICD-10, with and without family history of alcoholism using Temperament and
Character Inventory(TCI). Each group consisted of 20 patients. The TCI was translated to
Kannada and standardised and it was administered on the two groups of patients. Family
history of alcoholism was ascertained by administering family history screener. The
performance on the TCI was compared between the two groups using 'f test. The results
indicate that both the group differs significantly (p < 0.01) on Temperament dimensions of
Harm Avoidance and Character dimensions of Self-directedness, cooperativeness and
selftranscendance.
(The project supported by U.S.-lndia Fund N-424-645)
74
Impact of prohibition in Andhra Pradesh - Mental Health
perspective
Keshav Rao D, Raghurami P Reddy, Krishna Murthy K,
Ashok K A/im Chandani
Hyderabad
The introduction of prohibition by the Government of Andhra Pradesh from January 1995
provided unique opportunity for psychiatrists interested in deaddition services, to study the
impact of such a measure of far reaching consequences on the population as a whole, and
on addicts of alcohol in particular. Twenty five patients of alcohol dependence registered
with the Institute of Mental Health, Hyderabad, and their family members were contacted
at home, their present pattern of drinking was assessed, in addition to the impact of
41
Session - 7
Alcoholism -1
Hall-Krishna
prohibition on their life style. Statistics about crime, suicides and accidents were collected
from the government records and were analysed for trends. The findings will be discussed.
7-5
Depression as a predictor of relapse among alcohol dependents
Shanthi Nambi, Nambi S, Suresb Kumar M, Pataniappan 1/
Madras
The objective is to study depression as a predictor of relapse among alcohol dependents in a
deaddiction units placed in a state mental hospital. A sample of 30 alcohol dependents
seeking admission for relapse and 30 persons abstaining from alcohol for a minimum period
of 6 months and attending the follow up were recruited for the study. They were assessed
for socio demographic information, drinking pattern, severity of alcohol dependence and
depression. Analysis was done to denote the differences between the two groups for
depression controlling for other factors. The results and its clinical implications are
discussed.
7-6
Adjustment patterns and perception of family environment
among children of alcoholics
Nagash Pai, Padmini Pai, Baig M A
Mangalore
Preadolescent children with alcohol dependent fathers were compared with children with
teetotaller fathers with respect to their adjustment patterns and perception of family
environment. Children of alcoholics perceived their family environment to be less congenial
and had poorly adjusted than those children with teetotaller fathers. Implications of the
study will be discussed.
42
Session ■ 7
Alcoholism ■ I
Hall-Krishna
7-7
Young doctors on smoking
Ismail Paia, Praveen T, Shabari Dutta, Vankar 6 K
Baroda
For the commonest substance use disorder, smoking, the physician interventions remain far
from satisfactory. This study explores smoking behaviours and attitudes on relevant clinical
issues of post graduate doctors through an anonymous questionnaire. Analysis of 208
reponses revealed that 74 (35.6%) had smoked atleast once, 34 (16.3%) had smoked daily
for more than 6 months, 40(19.2%) were current smokers ■ 21(15.1%) smoked daily and
the rest occasionally. All current smokers were men. Majority were single with urban
background. The reasons most cited for smoking were for pleasure and for relieving tension.
Emotional stress, social occasions, and examinations increased smoking. Non smokers did
not smoke in order to protect health (94.6%) and as a self discipline (85.1%). Financial and
peer pressure were not important considerations for non smokers. 1/3 smokers began
smoking before their 20th birthday. Only 1 /3rd respondents advised smoking cessation even
if patients themselves did not raise the issue. Smokers and non smokers had similar
opinions on most smoking related issues. Most considered their smoking cessation
counselling knowledge adequate yet welcomed training programmes. Most considered
smoking as definitely harmful to health. Although they accepted role responsibility for
smoking interventions, majority were pessimistic about the outcome. More smokers
compared to non smokers favoured sharp rise in price of tobacco products. The implications
of these observations for physician education are discussed.
43
Session ■ 7
Alcoholism -1
Hall-Krishna
7-8
Temperamental characteristics and psychopathology among
children of alcoholics
Narang R L, Gupta R, Mishra B P, Mahajan R
Ludhiana, Punjab
The impact of family and child rearing practices on personality development and psychiatric
illnesses are well established. The present investigation is directed towards the study of
psychopathology and temperamental characteristics of children of alcoholic parents, to find
out correlation between these two areas and the role of alcoholism in child rearing
practices. A group of 100 children of alcoholic parents were selected through random
sampling between the age range of 4-12 years. This group were compared with the children
of non-alcoholic parents (n = 100). Both groups were assessed on temperamental
measurement schedule. The student T test was computed for comparative purpose.
Product moment method was used to sae the correlation between two variables. The
children of alcoholics were found to be manifesting marked psychopathological
disturbances in the areas of conduct disorders, anxiety, emotional problems, and
somatization. These children were also found to be more arrhythmic manifesting negative
mood and low persistence as compared to the children of control group. The positive
correlation between psychopathological and temperamental characteristics were indicated.
The study confirms the notion that family has greater influence in the development of
personality traits and psychiatric illness.
7-9
Personality profile of alcoholics
Chakraborty P K, Srivastava K, Basannar D R
Pune
The study was conducted to find out the personality profile of alcoholic by 16 PF tests. 16
PF tests were administered to 30 alcoholics diagnosed on ICD-10 criteria and to equally
44
Session - 7
Alcoholism ■ I
Hall-Krishna
matched 30 healthy teetotaller subjects. Findings revealed significant difference in Factor F
and Q2 between experimental and control group. The implication of the findings are
discussed in the paper.
7-10
Assessment of atittude towards alcoholism
Radhakrishnan V K, Murthy K S D, Channabasavanna S M
Bangalore
A scale to measure the individuals attitude towards alcoholism. Forty six item questionnaire
was formed. The study explains the standard procedure and different methodologies
adopted to select the absolutely necessary items using various statistical tests.
7-11
Age of onset: Influences of family history and personality in
alcoholics
Preethi K, Gangadhar B N, Janakiramaiah N J, Mukundan C Pf Rohrbaugh T W,
Cloninger C R, Subbakrishna D C
Bangalore
Aim of the present study was to compare the personality traits and family history of
alcoholism. Two groups of patients with a diagnosis of alcohol-dependent syndrome with
simple withdrawal state (on ICD-10) one with an earlier age of onset (18 years and below)
and the other with a later onset (30 years and above) were compared on variables of family
history and personality characteristics. Tools included the Temperament Character
Inventory and the Family History Screen. Results concerning the influence of family history
and personality on the age of onset of alcohol-abuse will be discussed in the presentation.
(The project supported by U.S.India Fund N-424-645)
45
Session - 7
Alcoholism -1
Hall-Krishna
7-12
The cost of alcoholism
Leela S, Ba/aji W' Senegal K Jain S, Chandrasekhar CR
Bangalore
Direct and indirect costs of psychiatric disorders need to be studied in our setting.
Monetary values on morbidity and mortality are necessary for calculating the actual impact
of alcoholism. Direct losses (money spent on alcohol, treatment of alcoholism) and indirect
losses (decreased productivity, premature death) are important parameters. We calculated
the amount of alcohol being consumed, proportion of income being spent on drinking and
health consequences in 50 patients admitted for de-addition. The findings suggest that in
the three months prior to admission, patients were using on the average, 240 gms of
alcohol per day and were hospitalised for 22 days for treatment of neuro-psychological
consequences of alcohol use. Even taking the cost of the cheapest beverage used, this
amounted to a monthly spending of Rs 1290 per month. The average income for this group
was Rs 1300 per month. Taking into account other direct losses like the cost of treatment,
etc., this amounts to significant losses from alcoholism which needs to be taken note of.
46
Child Psychiatry I
Session - 8
Hall-Tunga
CHILD PSYCHIATRY I
8-1
Utilisation of child and adolescent psychiatry services in an
urban setting
Basu S, Chatterji D, Deb S, Ash S
A child and adolescent psychiatry service, as a referral centre, was started in Calcutta from
1992. Sex, age and diagnostic characteristics of first 100 cases registered were analysed.
72 boys and 28 girls, age-range 2-16 years, comprised the population. 82 had diagnoses on
Axis I while 43 had multiaxial diagnoses. Common diagnoses, according to ICD-10, were
F90(22%), F84(15%), F91(14%), F93(12%). F93 were common in girls, while other
categories were common in boys. There were relatively few cases of mental retardation.
Implications of the study will be discussed.
8-2
A study of mothers orientation to child rearing practices, their
knowledge of Down's syndrome and their attitude to their
children with Down's syndrome
Alphonsa, Nagesh Pai, Mary Verghese
Mangalore
The study indicates that most of the mothers possessed a positive attitude to their children
with Down's syndrome and had fairly good knowledge of Down's syndrome. The fact that
their children are attending the school and are kept at home can help in changing the
mothers attitude and increasing their knowledge. Implications of the results will be
discussed.
47
Session - 8
Child Psychiatry I
Hall-Tunga
8-3
Evaluation of the psychometric properties of the Hindi version
of preschool behaviour checklist
Shashi Sai, Bano N, Asif Akhtar
Lucknow
This study was undertaken to translate the 'Preschool behaviour chekclist' (PBCL) devised
by J Mcgurie and Naomi Richman (1986) into Hindi and to assess the interrater reliability
and validity of the scale. The interrater reliability of the composite scores by the two raters
was found to be 0.82. The sensitivity and specificity of the scale was found to be 80% and
91.11% respectively.
8-4
FISC MR: A tool to measure stress and coping in families of
children with mental retardation
Girimaji SR, Srinath S, Shekhar S P
Bangalore
Family interview for stress and coping (FISC-MR), a semi-structured interview schedule,
was developed as a part of ICMR funded 2 year prospective study of efficacy of brief
family intervention for 157 children with mental retardation (mean SQ=31). Tool consists
of 2 sections ■ one measuring stress ( daily care, emotional, social and financial) and other
measuring mediators of stress (awareness, attitudes, expectations, rearing practices, and
social supports). Measures of standardization were as follows - test retest r=0.5; interrater
ICC = 0.9 and concurrent validity r = 0.6. Results were satisfactory with other measures
also. FISC(MR) is a useful, reliable and valid instrument.
48
Session ■ 8
Child Psychiatry I
Hall-Tunga
8-5
Assessment of needs of the parents with mentally retarded
children
Hemavathy, Muthalagan J, Vivekanandan S, Bashyam VS P
Madras
All the parents with mentally retarded children attending the Child Guidance Clinic of
Insitute of Mental Health, Madras between the period Jan 95 to Oct 95 were assessed for
parental needs by using the NIMH ■ Family Needs Schedule (Parents). The score of the
NIMH FAMS (P) is correlated with the degree of retardation in the child and the various
problem areas. The results are discussed.
8-7
Poor appetite and stressful family life events
Sharma K P, Sinha S K
Patna.
A child's refusal of food has indeed many connotations. Refusal of food can indeed take on
various forms and many instances the complaint exists even though child is infact
nutritionally normal. Besides normal fluctuation of appetite, drugs and various psychological
factors can cause poor appetite. The present study is planned to assess the correlation
between stressful events in family and reported poor appetite in normal children. 100
children aged 1-5 years brought with complaint of poor appetite were studied after
exclusion of organic causes. Stressful life events in last 1 yr based on Beautri's modified
version of Holmes and Rahe social readjustment rating scale.
49
Session - 8
Child Psychiatry I
Hall-Tunga
8-8
Third daughter syndrome - crystallised
Rath N M, Dash S, Nayak M S
Cuttack.
Effects of ordinal position among female siblings in our setting were studied in female
patients of the Paediatric Psychiatric Unit of Cuttack. Associated behavioural and
emotional problems were analysed. Neurotic stress related somatoform disorders
predominated among third daughters. Depressive conduct disorder and oppositional defiant
disorder confined to family context, sibling rivalry in early and reactive attachment and
disinhibited attachment disorders in late childhood predominated.
8-9
Enuresis revisited
Rath N M, Swain A, Nayak M S, Dash S
Cuttack.
A study involving 30 enuretics carried out at Paediatric Insitute, Cuttack, revealed trends
peculiar to our setting. 60% of patients were secondary enuretics, 80% were female
children. Psychosocial stressors and outcome were analysed. Psychiatric disturbances were
in 40% of female enuretics compared to only 18% in males. Outcome of care was
satisfactory in changing the behaviour and social adaptability rather than addressing to the
problem of enuresis.
50
Hall-Tunga
Child Psychiatry I
Session - 8
8-10
A study of parental attitude and behaviour problems in mentally
handicapped children.
Madhu Nijhawan, Preet Kamal, Renu Joshi, Suresh Babu Sharma
Jaipur
Behaviour problems were studied in both institutional and non-institutional mentally
handicapped children by means of a problem Behaviour Check List (NIMH). Parental attitude
towards mentally handicapped children was also studied by using Parent Attitude Scale.
The result revealed that problem behaviours were almost equally present in both
institutional and non-institutional mentally handicapped children except few differences eg.
homosexual behaviour, discipline, hyperactivity, bullying others, etc. The results were
further analysed in relation to age, degree of retardation, family structure and parental
attitude. The findings have been discussed in light of previous studies. The study is a part
of an ongoing study for the management of behaviour problems in mentally handicapped
children.
8-11
A study of behaviour patterns and intelligence in neglected
children living in an institution.
Madhu Nijhawan, Preet Kamal
Jaipur
40 children in the age group of 6-16 years living in a Government institution for neglected
children were evaluated by coloured Raven's Progressive Matrices for intelligence and
Corner's Teacher's Rating Scale (1969) for their behaviour patterns. A matched group of
children living with parents was also studied. The children had average or below average
intelligence and showed a variety of behaviour patterns. The results will be discussed in the
light of previous studies
MH'-l 0O
51
;'rzuw«w 'A
*H0
. £
0ocum^™'OM ? J
Session - 8
Child Psychiatry I
Hall-Tunga
8-12
A comparative study of temperament among children with
prominent functional somatic symptoms and with other child
psychiatric disorders.
Ku! Bhushan, Sitholey P, Prasad M, Kumar S, Katiyar M
Lucknow
30 children with prominent functional somatic symptoms (belonging to diagnostic
categories dissociative disorder and somatoform disorders • I.C.D.-10) and those with other
child psychiatric disorders (conduct disorder, Hyperkinetic disorder, depressive disorder etc)
were compared for temperament using Temperament Measurement Schedule of Malhotra &
Randhwa ( 1982). Of the nine dimensions the groups differed on 6 dimensions ie.
adaptability, mood, persistence, activity level, intensity and distractibility. Of these the
group of children with promiment functional somatic symptoms scored more on dimensions
of adaptability, mood, persistence, activity level, intensity and distractibility while the group
of children with other psychiatric disorders scored significantly higher on dimensions of
activity level and intensity of reaction. When the scores were compared on factors given by
Malhotra et al (1983) significant differences were found on four factors • sociability,
emotionality, energy and attentivity.
8-13
A study of psychosocial stressors among children with
promiment functional somatic symptoms and with other
psychiatric disorders.
KumarS, Ku! Bhushan, Sitholey P, Mata Prasad, Katiyar M
Lucknow
30 children with prominent functional somatic symptoms (belonging to diagnostic groups
dissociative disorder and somatoform disorder ■ I.C.D.-10) and 30 children with other child
52
Session ■ 8
Child Psychiatry I
Hall-Tunga
psychiatric disorders (conduct disorder, hyperkinetic disorder, depressive disorder etc) were
compared for abnormal psychosocial stressors using WHOs classification of associated
abnormal psychosocial situations after interviewing both child and atleast one parent. The
results were compared using Kruskall-Wallis test and there were no significant differences
between the groups except for in the case of category physical child abuse in group of
children presenting with other child psychiatric disorders. This group consisted of 43%
children with conduct disorder and 13% with hyperkinetic disorder. This might be the
reason for increased presence of physical child abuse in this group. The findings suggest
that the children with prominent functional somatic symptoms and those with other child
psychiatric disorders do not differ significantly as regards presence of abnormal
psychosocial stressors.
8-14
A clinical study of children with hysteria, presenting to child
and adolescent Psychiatry clinic of Trivandrum Medical College
Praveen Lal K, Pfizer, Prethibha, Krishankutty N
Trivandrum.
Case records of children attending child and adolescent clinic of Psychiatry department of
Trivandrum Medical College, for a period of one year from March 1993 were screened. Out
of 80 cases, 18 cases were hysteria. Their sociodemographic variables and mode of
referral, clinical presentation, managment offered and outcome were reported. Relevant
literature briefly reviewed.
53
Session - 9
Mania
HalIBhadra
MANIA
9-1
Age at onset in bipolar disorders
Shabhari Dutta, Vankar G K
Baroda
A retrospective chart review of bipolar patients hospitalised to SSG Hospital during one
year period focussed on age of onset and its correlates. 92 (60 men and 32 females) bipolar
disoder patients had mean age of onset as 39.5 years. Men and women did not differ
significantly as regards age of onset, current age, age at first treatment and age at first
hospitalisation. 51% patients had early age of onset (<30 years). Early and late onset
patients did not differ significantly on any socio demographic characteristics. Both the
groups regarding family history, suicidal attempt, substance use disorder or presence of
precipitating event prior to the first or index episode. 34(36.9%) patients had unipolar
maniaO 3 manic episodes without any history of depressive or mixed disorder). Onset of
illness occured in 25% women after child birth. The observations are discussed in light of
earlier literature.
9-2
Life events and mania - a controlled investigation
Kamlesh Patel, Vankar G K
Baroda
Forty DSM III R manic disorder patients were interviewed using the presumptive stressful
life events (Singh 1984) to find out presence and patterns of life events prior to the onset
of recent manic episodes. 40 matched general practice attenders without psychiatric
morbidity were also interviewed with the same instrument. Compared to the control groups
manic patients reported life events more often for a 4 week period proceeding the onset of
a nanic episode (35% Vs 10%). The same was observed for a period of 6 months prior to
54
Session ■ 9
Mania
Hall-Bhadra
the current episode ( 45% Vs 22.5%). Female manic patients reported events concerning
personal relationships more often. Work related and financial stressors were more common
for males. Experiencing of life events was not associated with more severe manic episodes
currently.
9-3
The profile of manic disorder - a study of 40 patients
Kamlesh Patel, Vai.kar G K
Baroda
Forty DSM III R manic disoder patients hospitalised at psychiatry department SSG Hospital,
Baroda, were prospectively studied for socio demographic and clinical characteristics.
Current age of the patient was between 16 to 45 years with mean age of 32.6 years. 25
(62.5%) has early age o'f onset (<30 years). Majority were men, currently married,
belonged to nuclear families, had secondary or higher education, rural background and had
monthly income above Rs 1000. The clinical manifestations were as follows; increased self
esteem or grandiosity.(100%), decreased need for sleep (85%), flights of ideas or subjective
experience that thoughts are racing (77.5%), increased goal directed activity or
psychomotor agitation (77.5%), excessive involvement in pleasurable activities ( 72%), more
talkative than usual or pressure to keep talking (62.5%) and destructibility (60%). The
Schneiderian first rank symptoms were reported by 7 (17.5%) patients. 55% patients had
comorbid substance use disorder - nicotine dependence, cannabis abuse or dependence and
alcohol abuse and dependence. 8(20%) patients had family history of mood disorder. There
were no statistically significant differences in severity of mania amongst early onset and
late onset patients, as well as amongst bipolar and unipolar patients.
55
Session ■ 9
Mania
Hall-Bhadra
9-4
Impact of substance abuse comorbidity on psychopathology and
pattern of remission in mania.
Suresh Kumar P N, Raju S S
Ranchi
This prospective study was conducted to explore the onset, psychopathology and the
pattern of remission of bipolar affective disorder (mania) complicated by substance abuse.
Hundred patients with a diagnosis of bipolar affective disorders, currently mania were
interviewed using the structured clinical interview for DSM III R (SCID-P), D.S.M.III R check
list for mania, Beck-Rafaelson mania scale and a questionnaire concerning socio
demographic and clinical profile. The life time prevalence of substance abuse including
alcohol was 52%. Substance abusers were younger, unmarned, unemployed and had more
dysphoric symptoms, irritable mood and persecutory delusion with an age of onset less than
20 years. At the end of 3 months follow up substance abusers were significantly more
symptomatic than non-abusers. A risk factor analysis showed that substance abuse is
consistently associated with a negative outcome in mania, inspite of receiving adequate
dose of lithium and antipsychotics. The implication of these findings are discussed.
9-5
Predictors of response in manic patients on antipsychotics
Christoday H J Khess, Das J
Ranchi
Various factors have been reported in the literature which are predictive of response in
acutely manic patients. These factors like, the age of onset, presence of psychotic
features, family history of affective illness and history of drug or alcohol abuse, have also
been identified as predictors of lithium response. Most of the studies in acutely manic
patients have studied these factors on patients receiving both lithium and antipsychotics. In
our study we have studied patients who were only on antipsychotics to find out whether
56
Session - 9
Mania
Hall-Bhadra
the above mentioned factors also act as predictors of response in patients only on
antipsychotics, whereby proving to be predictors of response irrespective of the treatment
or that they are predictors specific to lithium therapy. 51 hospitalised first episode manics
who fulfilled the DSM-III R criteria who were on antipsychotics were assessed on a weekly
basis using the Comprehensive Psychopathological Rating Scale (Asberg et al, 1978). At the
time of discharge 39 (76.47%) patients had become asymptomatic whereas 12 (23.53%)
patients were still symptomatic. The symptomatic patients were compared with the
asymptomatic patients. The mean age of the symptomatic patients was 26.92 + 7.72
years compared to 28.79 + 9-.49 years for asymptomatic patients. On comparing the two
groups it was found that there were more females, more patients with family history of
affective disorder, more patients with psychotic features and less patients with history of
alcohol and drug abuse in the symptomatic group compared to the asymptomatic group, but
none of the these differences were significant. The above findings and their implications
have been discussed.
9-6
Quantitative EEG profile in Mania
Nizamie Haque S, Ramanan K li
Ranchi
EEG abnormalities have been reported in a number of studies on affective disorder (Abrams
& Taylor, 1979; Cole et al 1993; Nizamie & Banerjee, 1995). Most of the studies have used
visual interpretation of conventional paper EEG recordings which are not free from
subjective bias. In recent years computerized EEG is being used to assess electrical
disturbances in psychiatric disorders because it is much sensitive and objective a tool (Kano
et al, 1992; Kole et al, 1994). The present study intended to detect qEEG abnormalities in
manic patients and whether a particular subgroup of manic patients had greater proportion
of EEG abnormalities. The study sample comprised 15 male inpatients (age 15-60 years;
mean 32.40) diagnosed to have mania according to OCR criteria of ICD-10 & DSM-IV. The
sociodemographic and clinical details were recorded on a specially designed semi-structured
proforma. The patients were rated on brief psychiatric rating scale (BPRS), Bech-Rafaelsen
57
Session - 9
Mania
Hall-Bhadra
Mania Rating Scale (BRMS) and an Akathisia Rating Scale (Barnes, 1989). The mean BPRS
score was 29.73, mean BRMS score was 21.40 and mean akathisia score was 1.26. In
order to reduce artifacts the patients also underwent Jacobson's Progressive Muscular
Relaxation (JPMR) training before qEEG was recorded. The EEG findings were compared
with that of age, sex and education matched normal, non-patient control (n = 10). Fifteen
minutes of EEG were recorded while subjects rested with their eyes closed but in alert state
in a sound-proofed, light attenuated room. A 32 channels digital EEG (Neurofax EEG 2100,
Nihon Kohden, Japan) from 25 monopolar electrodes (FP1, FP2, F3,F4,C3,C4,
P3,P4,01,02,F7,F8,T3,T4,T5,T6,Fz, Cz,Pz, PGI, PG2, Al, A2,T1,T2) of 10/20 system
referred to linked earlobes was stored on an optical disk for offline analysis. Two minutes
of artifact free data were extracted for analysis with Rhythm V9.0 software (Stellate
systems, Canada). A 4 pole filter with a 70 Hz cut-off frequency was used and the time
constant was set at 0.1 sec. The digitizing rate was 200 samples/sec/channel. Spectral
analysis was performed on sections of 2.56 sec (512 points) to calculate power and
coherence spectra by Fast Fourier Transformation. Absolute and relative power values in six
frequency bands were calculated and were found to be different in patient and normal
population.
9-7
Seasonal recurrence of affective disorders
Srivastava, MukulSharma
Lucknow
The present study was undertaken to find out the existence of seasonality in patients with
Recurrent Mood Disorder (RMD), their symptomatology and applicability of Rosenthals'
criteria (RS) and DSM-III R Criteria (DS) lor seasonsal affective disorder in such patients. 99
patients of RMD were evaluated on SADD scale, HRSD scale and Bech-Rafaelsen Mania
scale. 24 patients fulfilled RS and DS criteria but the number in each group differed:
DS = 18, RS = 9, with 3 subjects overlapping. In DS group the majority of manic patients had
onset in April, June and November while it was May in case of depressed patients. The RS
depressed patients had peak occurence for mania in June and for depression in April. On
SADD scale the symptoms of helplessness inadequacy, worthlessness and insufficiency
were more in RS and DS depressed group as compared to non-seasonal group.
58
Session ■ 9
Mania
Hall-Bhadra
9-8
Rapid cycling affective disorder - A retrospective analysis of 33
cases
Ajit Avasthi, Avneat Sharma, Sameer Malhotra, Sa vita Malhotra
Chandigarh
Rapid cycling of frequent shifts among mania, euthymia, and depression has been a focus
of interest among researchers. We studied case files of 770 cases of affective disorder who
attended our clinic from 1989-1993 and identified RCAD as per the criteria given by Coryell
et al (1992). Thirty three (5%) such cases were identified. Males constituted about 60% of
sample, mean age of sample ■ 41.06 yrs; all cases had a rapid cycling bipolar course, family
history for bipolar illness was positive in 40% cases. Regarding treatment, patients received
various combination treatment, received lithium in around 60% cases, carbamazepine in
33% and antipsychotics in 66% case
The rapid cycling bipolar group was compared with
non rapid cycling bipolar disorder (n = 237); the comparison and its implications will be
discussed in detail.
9-9
Symptom resolution in hospitalised first episode manics
Christoday R J Khess, Das J, Bagchi D J
Ranchi
According to Winoker et al (1969) the disappearance of symptoms in mania depends on the
quantity of therapy and the natural course of illness. Studies comparing the short term
outcome in first episode and multiple episode manic patients have shown the outcome to be
better in first episode patients. To ensure that the study sample was as homogenous as
possible, 51 first episode manic patients who fulfilled the DSM lll-R criteria for mania and
were admitted in the hospital were studied. They were rated on a weekly basis on the
Comprehensive Psychopathological Rating Scale (Asberg et al 1978). The patients were
treated with antipsychotics (dose range of 10-30 mg equivalent of Haloperidol) along with
59
Session ■ 9
Mania
Hall-Bhadra
injection haloperidol on a S.O.S.basis. 6(11.76%) patients received a course of ECTs also.
The patients were admitted for an average duration of 6 weeks. The mean age of the
sample was 28.07 + 68.12 days. At the time of discharge 12 (23.53%) patients were still
symptomatic, while 39 (76.47%) had become asymptomatic. The mean duration of the
episode was 108.26 + 68.12 days. The age wise break up of the duration of the episode
showed that the patients having an onset after 40 years had longer mean duration of
episoded 50.50 + 62.92 days). When the pattern of symptom resolution was studied it
was found that 'hostile feelings' and 'hostile behaviour' was the first to disappear. This
was followed by 'emotional liability', 'flight of ideas' and 'overactivity'. The next group of
symptoms to disappear were 'auditory hallucination', 'delusion of persecution', 'increased
libido' and 'pressure of speech'. The next group of symptoms to disappear were
'distractibility', 'reduced sleep' and 'delusion of grandeur'. The symptom that disappeared
last were 'reported elation' and 'elated mood'. The findings have been compared with
western as well as Indian studies and discussed in the light of relevant literature.
9-10
Restriction of light entering the eyes of mania
Reddy B, ChakrabartH, AkhtarS, Khanna R
Ranchi
Phototherapy has been found to be an effective treatment in winter depression. On this
analogy it was hypothesised that restriction of light entering the eyes may have therapeutic
effect on mania. The sample consisted of 62 consecutive patients diagnosed as current
manic episode by DSM-III R criteria. While treatment of the concerned unit was not
interfered with, the group was assigned randomly to 2 different additional treatment
regimen. (1) experimental group who wore dark sunglasses allowing approximately 10% of
the sunlight to enter the eyes and (2) placebo group who applied a well known propriety
hair oil which has a cooling effect. Patients were rated on Bech-Raefelsen Mania Rating
Scale and HIGH-SAD, on admission and at a weekly interval. There was no significant
difference in the sociodemographic and treatment schedule between the two groups. The
analysis of the data showed that restriction of light did not have any significant beneficial
effect on manic symptoms.
60
Session - 9
Mania
Hall-Bhadra
9-11
Family genetic study of childhood onset bipolar affective
disorder
Somashekar B S, PrasadKMR, Sanjeev Jain, Shobha Srinath, Sat/sb Girimaji,
Shekhar Seshadri
Bangalore
Early onset probands with bipolar disorder may have a more severe form of illness with a
greater familial incidence of bipolar disorder. Increased multifactorial polygenic liability,
anticipation or a subgroup of families with x-linked transmission may account for this
heterogenicity. Most of the reports have defined early onset of bipolar disorder as 30 years.
We analysed the records of the child and adolescent psychiatry services of NIMHANS with
an age at onset at first episode of mania less than 16 years. The records of 37 children
were analysed and found that there was male preponderance (about 2:1), one-third with
family history of mental illnesses in the relatives and no significant difference in the age at
onset between those with and without family history of mental illness. There were three
children with matrilineal transmission that seemed to be x-linked transmission. Besides, age
of onset did not affect the gender affliction or the family history. The implications will be
discussed.
61
Session -10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
ADMINISTRATIVE, LEGAL, FORENSIC PSYCHIATRY
10-1
The 'Mad Natives' - diagnosis and outcome, Circa: 1900
Satish Chandra, Sanjeev Jain, Pratima Murthy, Kallaperumal, Joseph M
Bangalore
We analysed hospital records between 1897 and 1903. The total hospital population in
1903 was 258 ( 78% males, 22% females). These patients had been admitted between
1865 and 1903. Recovery rates were more than 30% for patients admitted after 1895.
These outcomes will be compared to the outcomes in 1870. The socio-demographic
patterns and outcomes of these patients at these two points will give us an understanding
of the practice of psychiatry in India at that time.
10-2
Pattern of distribution of mental health manpower: An
international scene
Venkataswamy Reddy M
Bangalore
The pattern of distribution of four specialised mental health manpower categories was
studied by employing cluster analytic methods on data of 68 countries. Six clusters of 61
countries were identified. Majority of the countries in each of these clusters were located
geographically at North West Europe, South East Europe, Islands and peninsulas, South
America, Asia and Africa respectively. The number of psychiatrists, clinical psychologists,
social workers and psychiatric nurses per one lakh population in each of the clusters are:
Cluster 1: (11.5; 8.6; 24.0; 89.8),
Cluster 2: (6.9; 1.4; 1.1; 31.5),
Cluster 3: ( 2.2; 0.4; 1.3; 6.1),
Cluster 4: (1.2; 5.5; 1.1; 0.6),
62
Session -10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
Cluster 5: ( 0.4; 0.1; 0.5; 0.4),
Cluster 6: (0.1; 0.05; 0.03; 1.5). The manpower indices in these clusters were correlated
with demographic indices such as per capita income, density and rate of growth of
population. The findings were explained in the light of the views expressed in the literature.
10-3
Mental Health delivery system by mental hospitals: An
international scene
Venkataswamy Reddy Mf Channabasavanna S M
Bangalore
International indicators of mental health delivery system by government mental hospitals
were obtained by employing sound methodological design and analysis of data pertaining to
31 hospitals in eight countries. The average bed strength was 749 beds while the average
bed occupancy was 716 patients during the year 1993. More than half (56.8%) of the beds
were occupied by chronic patients. Organic psychosis (10.2%) and functional psychosis
(62.8%) formed 73% of all the total discharged patients. The hospital death rate (36.2)
seems to be higher than those of the general population. The average length of stay was
228 days. The average number of new out-patients registered per hospital worked out to be
1845 and the follow up attendance was about 10 times more than the new patients. There
were 81 inpatients per psychiatrist in this system. The consistency and the utility of the
findings were discussed in the light of the information reported in the literature.
10-4
Protection of rights of mentally ill - psychiatric view point
Krishna Murthy K
Hyderabad
The treatment care and rehabilitation of the mentally ill has undergone rapid changes over
the last few decades. The history of psychiatric treatment has evolved over the years from
moral therapy to custodial care in mental asylums to active psychiatric treatment in mnetal
63
Session -10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
hospitals with rehabilitation programs. The emphasise has now shifted towards community
care and improving the quality of the life of the mentally ill. In this scenario where
psychiatry is emerging from the confines of the mental hospitals to community oriented
progamms, it is important that we keep in mind and take measures to protect the human
rights concerning the mentally ill in society at large. The present state of legislation for the
mentally ill has unfortunately not dealt with the protection of the rights of mentally ill in
great depth. In addition to sensitising mental health professionals on these aspects, there is
also need for appropriate legislation to safe guards these rights. This paper discusses about
the salient aspects of the rights of mentally ill that need to be protected and about the need
for appropriate legislation and other measures concerning the mentally ill.
10-5
Restrained patients at OPD: Injuries and cost of bringing them
Sayeed Akhtar, Simlai J, Paria/ A, Mishra A K
Ranchi
A large number of patients are brought tied up to a psychiatric facility (Akhtar and
Jagawat, 92). The aim of this study was to study different types of injuries sustained as a
result of restrain and cost of bringing them to the hospital. In a prospective design, the
study was carried at CIP, Ranchi, for a period of 3 months. All patients brought restrained
were examined for the restraining material used, parts of the body restrained and the
injuries on the body parts likely to have resulted from restrains. On the slightest doubt, xray of the part were taken. Patients were mostly restrained at the wrists and commonest
injury was abrasion. Oedema and cellulitis were also very common. Neural and bony injuries
were infrequent. The cost of bringing these patients were considerably high. The authors
will discuss the implication of these findings and intends to suggest the strategies to deal
with potentially aggressive patients at the source of referral in order to alleviate the
suffering of the patients and their relatives.
64
Session ■ 10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
10-6
Who prescribes what to whom ?
Gopala Sarma P
Warangal.
Objective: To find out the types of psychiatric drugs prescribed by non-psychiatrists to
psychiatric patients. Design: Retrospective analysis of prescriptions to psychiatric patients
by non-psychiatrists. Setting: Psychiatric consultation. Material: All the prescriptions seen
over a period of six months. Outcome measures: Doctor-qualification, speciality,
nature:drugs-type, appropriateness, adequacy; patient-sex, residence, disease. Results:
Most of the prescriptions were from specialists of all branches commonest being
Gen.Medicine. Majority of them were/are in Govt, service.
Drugs: Alprazolam was the most prescribed, most of the time the drug was inappropriate
and if appropriate inadequate; patients - more females, urban, multiple consultations,
anxiety neurosis, and psychoneurosis most common diagnoses. Conclusion: Most of the
specialists do not stick to their speciality only.
10-7
Factors leading to escape from psychiatric hospitals - an
exploratory study
Suresh Kumar P N, Josy Thomas, Bagchi D J, Sinha V K
Ranchi
Escape/abscondence from psychiatric hospitals has been recognised as a ubiquitious
phenomenon and it has important implications at administrative and legal arenas. The
purpose of this study was to analyse the pattern of escape behaviour, to outline some
characteristics of escapees and to compare the data from other psychiatric hospitals in
India and West. Case record files of all the patients admitted in CIP, Ranchi,between
January 1992 to December 1994 were analysed, using a specially designed proforma
documenting the details like socio-demographic and illness profiles, characteristics of
65
Session ■ 10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
escape and psychiatric diagnoses as per DSM-III R Criteria. The incidence of escape was
1.4% over 3 year period. The majority had escaped during night (4 pm ■ 8 am) and were
symptomatic or partially improved. The mean duration of hospitalisation before escape was
22 days. Incidence of escape was maximum among manics and schizophrenics. Majority of
early escapees (less than one month) were symptomatic at the time of escape (P < 0.05)
and had a past history of escape. This study concludes that incidence of escape is less in
our set-up as compared to earlier studies elsewhere. A preventive strategy to reduce the
incidence of escape is proposed.
10-8
Need of admission, in a mental hospital: The relatives
perspectives
Sayeed Akhtar, Verma A N, Omega Jyotsana, Sangita Sinha
Ranchi
A large proportion of patients brought to the ORD of a mental hospital mainly for being
admitted. However, there are other patients whose relatives do not like their patients to be
admitted. The study has been carried to find out why the relatives of some patients
vigorously request admission while relatives of other patients do not abide by the advice of
the psychiatrists to admit them. First contact patients were randomly selected from ORD
and data were collected by a structured schedule which contained items for socio
demographic informations, distance from which the patient had been brought, use of
restraint if any and employment. The exact reasons why patients' relatives requested
admission or otherwise were specially enquired. Preliminary analysis revealed that the
distance from hospital was signficcantly related to request for admission. However,
crowding at home, open space in front and back of house, education in the family and
employment had no significant relationship. The important reasons for seeking admission
were hope of quick recovery, assaultive behaviour, fear of further deterioration of illness,
indecent behaviour, wandersome and suicidal tendencies. On the other hand, the important
reasons for refusing admission were fear of deterioration in the company of the mentally ill,
better care at home and adverse effect on job prospects. The social implications of these
findings will be discussed.
66
Session ■ 10
Administrative, Legal, Forensic Psychiatry
Hall-Sharavathy
10-9
Emergency psychiatric service:The need and utilisation
Raju S S, Akhtar S, Bagchi D J, Paria! A, Chopra V K, Suresh Kumar, Mishra B
Ranchi
This study presents an analysis of 426 cases seen in emergency psychiatric services at
Central Insitute of Psychiatry, Ranchi, from February 1994 to February 1995. Mean age of
the cases was 30.4 years. Men outnumbered women in ratio of 3.6:1. ICD-10 was used for
diagnosis. Bipolar affective disorder, manic type was the commonest psychiatric emergency
encountered with 51.4% cases, followed by schizophrenia 13.4%, psychoses 8.7%,
depressive disorders 6.1%, acute and transient psychoses 4.5%, alcohol and drug-related
disorders 2.8%, drug induced side effects 2.8%, organic mental disorders 2.1%, neuroses
1.8% and the rest other disorders. The implications of these findings are discussed
concerning the need, utilisation and management of emergency psychiatric services.
10-10
Prospective study of 60 juvenile female offenders
Pate! R R, Ajita Rane, Armity Mody
Bombay
(Abstract not received)
10-11
Forensic aspect of major affective disorders in Indian context
Sayeed Akhtar, Verma A N, Manisha Kiran
Ranchi
Bipolar disorders and major depression constitute a small group of psychiatric patients who
commit crime. However, some of the manic patients can commit severe assault and
intrafamilial violence leading to crime such as murder, attempted murder and arson. Theft,
67
Session -10
Adm'-:' .alive, Legal, Forensic Psychiatry
Hall-Sharavathy
fraud, outraging the modesty of females and rape have also been reported. Chronic cases of
mania may simulate person with antisocial personality. Depressive illness on the contrary,
may result in different types of crimes such as suicide, extended suicide and kleptomania.
The authors propose to review the current literature with special reference to Indian
context with the help of case vignettes and discuss the criminal responsibility of the
patients committing these crimes.
10-12
Restriction of human rights of the mentally ill within the family
environment
Kishan, Krishna Murthy, Anand
Hyderabad
The International Community in general has been focussing on issues concerning human
rights at various forums. While violation of human rights takes various forms in various
societies. As far as mentally ill are concerned, such violations are common place. This
violation might range from extreme level like physical torture or annihilation to denial of
participation. In the Indian context there is need for creating greater awareness among
mental health professionals about the restriction of the human rights of mentally ill.
The present paper discusses about some aspects concerning restrictions of human rights of
mentally ill. There is a general feeling among mental health professionals that the family is
best place for chronic mentally ill to stay. This paper critically evaluates this aspects and
highlights about the restrictions placed on the mentally ill within their own family
environment. A rating scale is designed with consensual validity consisting of 10 broad
areas focussing on human rights available for mentally ill in the family environment. Those
restrictions have been examined and results presented, with discussion of their implications
in the light of present day family structure.
68
Organic Psychiatry I
Session -11
Hall-Cauvery
ORGANIC PSYCHIATRY I
11-1
Home based cognitive remediation in post concussion syndrome
Amita Sarkar, Shobhini L Rao
Bangalore
The study was aimed to develop and test the efficacy of a home based cognitive
remediation program for the treatment of cognitive deficits after post concussion syndrome
(PCS), the program was tested on 3 groups of 4 patients each. Group A received the
treatment at home conducted by a significant other and supervised weekly by the therapist.
Group B received the same in the hospital everyday conducted by the therapist. Group C did
not receive any treatment. Pre and post assessment was done using neuropsychological
test battery, symptom ratings and disability assessment schedule which revealed the
effectiveness of the remediation. It was equally effective in home and hospital settings and
it improved cognitive and behavioural functioning of the patients as well as reduced the
symptoms. The non-pharmacological home based remediation is a viable cost effective
mode of treating post concussion syndrome.
11-2
Pattern of psychiatric morbidity in postJapanese encephalitis
patient
Chakrabarti S, Day P, Roy K, Mukherjee B
Burdwan, West Bengal.
Eighty cases of serologically positive Japanese encephalitis referred for psychiatric problem
were studied and categorised according to ICD-9. Age-matched, other eighty control cases
were also studied and similarly categorised. Data from the two studies were compared. It
was found that psychosis was significantly more in the Japanese encephalitis group while
it was almost equal to non psychosis in the other group. It was also found that affective
69
Session -11
Organic Psychiatry I
Hall-Cauvery
disorder (37.5%) was more prevalent than Schizophrenia (20%) in the JE patients, while
among the non-JE patients, neurotic depression (38.5%) was the most frequent entity. This
shows that psychosis may be aetiologically linked to the involvement of subcortical
structure in the brain which is associated with Japanese encephalitis.
1-3
Paranoid schizophrenia with right hemisphere degeneration: A
case report
Chaukimath S P, Bhairwadgi S S
Bijapur
Non specific and non progressive degeneration of cerebral cortex is reported in
schizophrenia. Here we report a patient of paranoid schizophrenia with generalised seizures
aged 24 years. The duration of illness being 6-7 years. A CT scan head taken in 1990
showed Rt.hemisphere degeneration more prominent in rt.frontal region. A repeat scan in
Oct.1995 after exacerbation of symptoms showed same changes and no progression of
degeneration. Relevance of these changes to schizophrenia and seizures is discussed.
11-4
Quantitative EEG profile in epileptic patients with and without
psychiatric morbidity and normal controls
Nizamie Haque S, Cuba P
Ranchi
Advent of computerised EEG has opened up the possibility to study hitherto uncharted
areas of electrophysiological disturbances in various groups of neurological and psychiatric
conditions. A number of studies have demonstrated superiority of qEEG in analysing various
components of elctroencephalogram in epilepsy (Rogozea et al; 1993; Gillain et al; 1994;
Popoviciu et al; 1993; Fisher et al; 1992). Recent advances have led to a greater
sophistication and versatility in the evaluation of electrophysiological events underlying
70
Session -11
Organic Psychiatry I
Hall-Cauvery
epilepsy and its associated conditions. Inspite of this fact there are very few studies which
have sought to compare qEEG measures between epileptic patients with and without
psychiatric morbidity (Hernandez-Fustes et al; 1994). The present study was undertaken to
compare the different qEEG variables between epileptic patients (with and without
psychiatric morbidity) and normal controls. The study was conducted on 16 patients of
epilepsy (M 10,F6) attending epilepsy clinic, CIP, Ranchi. Their mean age was 27.6 years
(range 18-51) and 11 patients had education of more than 10 years. The diagnosis of
epilepsy was made according to ILAE classification 1989. Mean duration of epilepsy was
10.4 years. Psychiatric morbidity after the onset of seizures was assessed by the
Structured Clinical interview ■ DSM lll-R (SCIO) after initial screening with Goldberg's
General health questionnaire ■ 12. Eight patients were found to have psychiatric morbidity.
All the patients were on antiepileptic drug monotherapy and five patients received either a
single antidepressant or antipsychotic drug too. Quantitative as well as polygraphic EEG
were done for all the patients and 15 age and sex matched normal, nonpatient controls.
Fifteen minutes of EEG were recorded while subjects rested with their eyes closed but in
alert state in a sound-proofed, light attenuated room. A 32 channels digital EEG (Neurofax
EEG 2100, Nihon Kohden, Japan) from 25 monopolar electrodes (FP1, FP2, F3 ,F4, C3, C4,
P3, P4, 01, 02, F7, F8,T3, T4, Fz, Cz, Pz, PGI, PG2, Al, A2, Tl, T2)0F 10/20 system
referred to linked earlobes was stored on an optical disk for offline analysis. Two minutes
of artifact free data were extracted for analysis with rhythm V9.0 software (stellate
systems, Canada). A 4-pole filter with a 70 Hz cut-off frequency was used and the time
constant was set at 0.1 sec. The digitizing rate was 200 samples/sec/channel. Spectral
analysis was performed on sections of 2.56 sec ( 512 points) to calculate power and
coherence spectra by Fast Fourier Transformation. Absolute and relative power values in six
frequency bands were calculated and were found to be different in patient and normal
population.
71
Session -11
Organic Psychiatry I
Hall-Cauvery
11-5
Life style changes and life events in patients with seizure
disorder
Dilip Kumar Dash, Anand K S, Jagawat T
Delhi
It has been known since long that the pattern of behaviour personality type and stress are
positively related with illness both physical and psychological. There is a definite correlation
of life stress with patients of chronically ill due to seizure disorder who ultimately show
signs and symptoms of depression, and also their way of adoption to family situation and
lifestyle. Here in cur study we have taken 100 cases in follow up study in the psychiatry
and neurology OPD for 6 months. Cases were taken irrespective of sex and from the age
group of 20-60 years. Each patient is administered the presumptive stress life event scale
devised by Dr Gurmit Singh. Control group taken, as chronic schizophrenics who come in
follow up in psychiatric OPD. Both groups are matched according to the data and statistical
significance is shown by using X2 and P value. The results of the study is discussed in
detail in the paper.
11-6
Delusion of infestation and multimodal hallucination due to a
corpus callosal gltoma
Pratima Murthy, Jayakumar M
Bangalore
Delusions of infestation and multimodal hallucinations are known to occur in a variety of
psychiatric conditions, including schizophrenia, delusional disorders, alcohol and drug
toxicity, as well as in conditions such as dementias and brain damage. This is a case report
o.f a 50 year old lady, with no contributory past or family history, who was brought for
psychiatric evaluation with a 3 month history of repeatedly washing her hands and feet,
complaining that she was being bitten by ants, and reporting seeing insects in the
72
Session -11
Organic Psychiatry I
Hall-Cauvery
bathroom. She often left water for these insects, and enjoyed watching them drink. She
had become socially withdrawn and apathetic. Physical examination revealed no
abnormalities. Mental status examination revealed delusions of infestation, tactile and
visual hallucinations. Cognitive functions were intact. Investigations including a CT scan
were done, which revealed a large corpus callosal glioma. Details of the patients clinic
presentation, the change in phenomenology following surgery are discussed and an
explanatory model is attempted.
73
Session -12
Alcoholism II
Hall-Krishna
ALCOHOLISM II
12-1
Duration of hospital stay and confidence to control drinks in
alcoholics
Raghu T Mf Pratima Murthy, Subbakrishna D K, Gangadhar B N, Janakiramaiah N
Bangalore
It is difficult to decide about the optimal treatment inputs and the duration of inpatient stay
in case of alcoholism. This study addresses the differential effect of Counselling Group (CG)
and relapse prevention Training group (TG) on 'temptation' and 'confidence' in alcoholics.
40 male alcoholics participated in the prospective study after consent randomly allocated to
either of the groups. Temptation and confidence were assessed on the alcohol abstinence
self efficacy scale (AASES) at admission and at discharge. Initially in both groups
temptation was high (CG mean 77 + 15.7 and TG mean 72.8 +■ 16.3) and confidence was
low ( CG mean 44.25 +- 15.7 and TG mean 44.5 +- 16.7). Temptation and confidence in
both groups improved significantly before discharge. Temptation decreased (Cg mean 27.3
+ - 10.5 and TG mean 34 +-16.6) and confidence increased (CG mean 92.7 +■ 9.8 and TG
mean 83.2 +- 16.5). At the time of discharge the CG group had a higher confidence score
than TG group (t = 2.20, p = .O36), temptation scores were comparable between the two
groups at discharge (t-1.60, p = .119). This study shows that relapse prevention training is
possibly reducing denial and facilitating a more realistic self appraisal of the problem in
adhering to abstinence. The implications of this finding will be further discussed in the
presentation.
74
Session ■ 12
Alcoholism II
Hall-Krishna
12-2
Brief detoxification schedule for alcohol withdrawal - a double
blind trial.
Balaji \N, Leela S, Benega11/, Jain S, Chandrasekhar C B
Bangalore
Most current detoxification regimes during alcohol withdrawal involve a minimum of one to
two weeks during schedule of benzodiazepines. This period contributes to a prolonged
inpatient admission, with its implications for the cost of treatment for alcohol dependence.
The present study attempts to examine the viability of a reduced duration of treatment for
alcohol withdrawal. 20 patients admitted for a treatment of alcohol dependence with
uncomplicatd withdrawal (ICD 10), to the inpatient facility of the National Institute of
Mental Health and Neuro Sciences, were adminstered a bolus intravenous dosage of 40 mg
of diazepam at intake. Depending on the rate of abolition of withdrawal of symptoms (
individually rated by a blind rater, at fixed intervals over 48 hours) further doses of 10-20
mg were administered p.r.n. The majority showed approximately 50% symptoms reduction
after the first dose and required no further addition of diazepam after 48 hours. The
cumulative dosage required per patient was 60 to 80 mg over 48 hours. Anxiety and
tremulousness were the two symptoms which showed the most rapid response. The
possibility raised from this study, of completing treatment for alcohol withdrawal within 48
hours for a large proportion of patients coming to detoxification facilities implies a need to
reformulate the prolonged alcohol detoxification strategies currently in use.
12-3
Disulfiram treatment of alcoholism
Sharma K Pf Singh N P, Seama
Patna
This study was carried out to find the efficacy of disulfiram in treatment of alcoholism.
Fifty pts. with dagnosis of alcoholism admitted at DISHA drug deaddiction Centre, Patna,
75
Session -12
Alcoholism II
Hall-Krishna
were given 500 mg of disulfiram after 1 week of admission for four days and on 9th day
fifty ml alcohol of their choice was given to them. All patients experienced unpleasant
reactions within 15-40 minutes. After giving instructions to use 250 mg disulfiram per day
daily under supervision, patients were discharged and were requested to report every
fifteenth day. Out of fifty, 12 did not report for our follow-up and in one year follow-up 10
did not consume alcohol in any form.
12-4
Primary and secondary alcoholism
Ramesh R, Sengupta S N, Sharma PSVN
Manipal.
This study examines the variables that distinguishes primary from secondary alcoholism. A
retrospective chart review of 16 cases of secondary alcoholism diagnosed using ICD-10
criteria during the last calendar year and 20 age and sex matched, randomly selected
primary alcoholics was undertaken. Primary alcoholics had increased rates of interpersonal
problems (p = 0.002) and dependence severity (p = 0.01) as compared to secondary
alcoholics. A large number of secondary versus primary alcoholics maintained 1 year follow
up (60% versus 21%) and total abstinence (33% versus 10.5%). Although preliminary, such
findings argue for a nosology that incorporates-primary and secondary forms of alcohol
dependence. Prospectively designed studies with larger sample populations are necessary to
resolve this nosological issue.
12-5
Relapse of alcoholics on disulfiram
Saji J, Sengupta S N, Kumar B K Sharma PSVN
Manipal
In a retrospective design alcoholics (n-19) maintained on disulfiram and relapsing over 1 to 2
year period were recruited for the study. The most frequently reported causes of relapse
were interpersonal problems, desire to drink and mood change. About 68% of the patients
76
Session -12
Alcoholism II
Hall-Krishna
relapsed in the first year and 31.5% by the second year. Nearly 80% of the subjects were
abstinent for 75% of their follow up periods. The duration of abstinence following
intervention negatively correlated with subsequent drinking days. We conclude that relapse
is common during the first year of intervention and longer the initial abstinence, fewer are
the subsequent drinking days.
12-6
Use of nitrous oxide in delirium tremens
Suresh T R, Srinivasan T N
Madras
Delirium Tremens (DT) is a serious complication occuring during alcohol withdrawal state. It
requires vigorous medical and psychiatric treatment including use of high doses of
tranquillisers. In some patients the delirium does not respond adequately and quickly to
drugs. Effective and safe use of analgesic dose of nitrous oxide in 4 cases of DT who were
not responding to conventional treatment is reported in this paper.
12-7
Alcoholic paranoia
Sujit R Varma, Sengupta S N, Kumar B V, Sharma P S V N
Manipal
In a retrospective study the frequency and characteristics of patients with alcohol paranoia
were examined. Seven out of 352 inpa^ent alcoholics fulfilled ICD-10 criteria of acoholic
paranoia. Compared with 15 other alcoholics with comorbidity no significant difference was
found on alcohol use data. However, higher frequency of family ( 71.5% Vs 26.7%) and
psychosexual (28.6 Vs 0%) problems were seen among the psychotics. Delusion of
persecution was present in all whereas 3 patients had delusion of infidelity. None had
family and past history of psychosis. One patient had premorbid paranoid traits and another
antisocial traits.
77
Session ■ 13
Schizophrenia
Hall-Tunga
SCHIZOPHRENIA
13-1
Relationship between physical anomalies, age at onset and
positive and negative symptoms in schizophrenia
Pradeep Sharma, Anshuman Pant, Singh N, Advani 6 B
Jaipur
In at least a group of schizophrenic patients, the disorder appears to be associated with
cerebral dysfunction. In addition, and possibly related to the dysfunction, schizophrenic
patients have shown an increased prevalence of minor physical anomalies, which are
associated with insult to the fetus during the first trimester of pregnancy. These anomalies
could be due to genetic as well as a variety of teratogenic factors. Similar increase in such
anomalies have been noted among autistic and schizophrenic children. Moreover, to our
knowledge the relationship between the presence of such anomalies and positive and
negative symptoms in schizophrenia has not been addressed. Given the evidence, although
tentative, of increased cerebral insult among patients with an early onset and also with
that of preponderence of negative symptoms, it seems worthwhile to consider their
potential relationship. In the proposed study the relationship between physical anomalies
age at onset of schizophrenia and positive and negative symptoms, assessed by Waldrop
scale and scales for the assessment of positive and negative symptoms (devised by
Andreasen) is being explored in 100 schizophrenics, diagnosed based on ICD-10 criteria.
78
Session -13
Schizophrenia
Hall-Tunga
13-2
Depression in negative schizophrenia rationale of adjunctive
antidepressive therapy
Kausha! A, Ramesh K M, Vasanthy N M
Bareilly
Lack of drive, affective flattening and poverty of ideation are some notable symptoms
encountered in chronic or residual schizophrenics. These negative symptoms are quite akin
to the reduced energy, feeling of emptiness and impoverished thinking of depressed
patients. Clinically the distinction between these symptoms is hazy. Benefit of
antidepressive medication in such patients has received scant attention. A study was
conducted amongst inpatients at a zonal Military Hospital over a period of 18 months.
Positive and negative syndrome scale was used to screen 142 chronic schizophrenic
patients of duration of illness over 1 year. 33 of these patients who exhibited a
predominant negative syndrome were rated on Hamilton depression rating scale. An index
group of 15 patients assigned randomly received imipramine hydrochloride in addition to
trifluperazine 5 mg per day. The control group of 15 patients received only the latter
medication. After six weeks the tests were repeated. More than 50% of the index group
had shown a significant response to antidepressive medication. The scores of control group
on Hamilton depression rating scale remained virtually unchanged. The study highlights the
clinical dilemma - whether the residual schizophrenic is depressed ? Our study reveals that
some of them undoubtedly are. They are also likely to benefit from a trial of standard
antidepressants.
79
Session -13
Schizophrenia
Hall-Tunga
13-3
Recovery in schizophrenia - pilot study of 30 cases on maintenance
treatment
PradhanPV, HariEaswar Subramanian, NagpurkurJL,
Jayant Deshmukh
Bombay
The prognosis and outcome in cases of chronic schizophenia have traditionally been described to be poor.
Literature mentions that over a five to ten year period after the first psychiatric hospitalisation, only about 1020% of patients have good prognosis with more than 50% being classified as poor outcome groups. Range
of recovery rates reported vary from 10-60% and 20-30% of all schizophrenics are able to lead somewhat
normal lives, another 20-30% experience moderate systems and 40-60% of patients remain significantly
impaired. This study sought to review the situation as seen in the present day context. A pilot study was
done from chronic schizophrenics attending the outpatient department of KEM Hospital. A cross sectional
study was done of 30 patients who attended the OPD over a predecided period of two weeks, at the rate of
5 random patients per OPD. The patients selected had the disease for more than two years, were looked
after by close relative throughout (or a major part) of the illness and were willing to follow up for a detailed
interview later on. They were interviewed in detail for overall functioning by the residents and the professor
pf psychiatry independently. A specially designed proforma including the items in the global assessment scale
of functioning (GAF) (DSM III R) was administered. A cun-ent score on the GAF scale was given and the
relatives were asked retrospectively to judge the score at the time of diagnosis of the disease. The
improvement percentage of each patient and hence the improvement percentages during different duration
of the disease were calculated. The results showed that when the disease was less than 4 years' duration,
improvement was 57.5% (constituting 37% patients): 4 to 6 years improvement was 68.5% (20% patients):
6 to 10 years improvement was 70.8% (27% patients): 10 to 15 years improvement was 50%(6.6%
patients) and 15 to 20 yeas disease improvement was 70% (6.6% patients). We found that patients
attending the outpatient department included in the study were regular in follow up, overall recovery range
from 50 to 70%; 13% patients had post-psychotic depression and 6% patients had tardive dyskinesias. The
patients who continue to maintain follow up inspite of the long duration of the disease, did
reasonably well in overall recovery. A detailed study to assess recovery and residual impairment
in different fields of functioning is now under progress, subsequent to the findings of this short
OPD study.
80
Session ■ 13
Schizophrenia
Hall-Tunga
13-4
Movement disorders in unmedicated patients
Thara R, McCreadie R G
Madras
Movement disorders were examined in 308 elderly individuals in Madras using the AIMS, the SimpsonAngies Parkinsonism scale and the Barnes Akathisia scale. The PANSS was used to assess mental
status. Dyskinesia was found in 15% of normal subjects, 15% of blood relatives of schizophrenic
patients, 38% of never medicated and 41 % of medicated patients. Dyskinesia was associated with
negative symptoms. (Collaborative project between Dr McCreadie R G, Scotland and SCARF)
13-5
Persistence of symptoms in hospitalised chronic schizophrenics
RenjuJoseph, RajkumarR, Suresh KumarM, Bashyam VSP
Madras
There is evidence that some schizophrenics have persistent symptoms at follow-up. The present
investigations aim to study persistence of symptoms in hospitalised chronic schizophrenics. The study
recruited a sample of 50 schizophrenics whose duration of continuous stay is more than five years. The
case records were analysed for symptoms both positive and negative at the time admission. The
current symptomatology was assessed using SANS, SAPS, PANS and BPRS. A symptom checklist
developed for this study was used to assess the symptoms both at the time of admission and current
examination. The results are analysed for persistence of symptoms. The relationship of medication
duration of stay, and social support to persistence of symptoms are discussed.
13-6
Puerperal psychosis - are they schizophrenia by majority ?
Nagaraj S
Madurai
Aim: To find our the types of puerperal psychosis. Method: Prospective study of 45 cases - last 4
years. Observation: Out of 45 cases, 40 cases are schizophrenic; 2 cases are schizoaffective; 3 cases
of Sheehan's syndrome wrongly diagnosed as depression. Conclusion: About 90% of cases are
schizophrenic. About 5% are schizoaffective. No case of depression; Sheehan's syndrome missed as
wrong diagnosis of depression.
81
Session -14
Biological Psychiatry I
HalIBhadra
BIOLOGICAL PSYCHIATRY I
14-1
Sex difference in language related brain inhibitions: A PET
study
Rao S, Fox P T, Jerabek P, Martin C, Downs H, Glass T,
Lancaster J
Bangalore
We studied brain blood flow during language with positron emission tomography using 150
labelled water. Five men and five women normal volunteers were scanned with three scans
each during picture naming, verb generation and fixation control. As expected the semantic
task of verb generation compared with the rest was associated with activations in the left
frontal region in both sexes. However, significant decrease of blood flow were present.
Right frontal and superior parietal decreases were greatest in men; while right precuneus
decreases were greatest in women, indicating sex differences in brain inhibitions associated
with language. Men inhibited exteroceptive attention and women inhibited visual imagery
during semantic processing. Inhibition of functional systems external to language highlights
the interactive mode of brain functioning during psychological processes.
14-2
A comparative study of cough reflex and gag reflex patterns in
schizophrenics and their first degree relatives
Bhagat R N, Nizamie S Hf Pradhan S Cr Agarwal S
Ranchi
The cough and gag reflexes which are preliminarily brain stem reflexes have been the focus
of attention in this study. These reflexes have been studied in twenty seven schizophrenics,
each satisfying DSM-III R. The cough reflexes were elicited by using metered doses of
82
Session -14
Biological Psychiatry I
Hall-Bhadra
citrate aerosol of various strengths. Results: There was a significant change between the
cough reflex pattern in the patients prior to and after six weeks of treatment. The t value
was 2.566 which was significant at P <0.01 level. The occurence of gag reflex response
did not vary significantly before and after treatment. (X2 = 4.57 (df = 2). The implications
of the findings have been discussed in this paper.
14-3
Comparative diagnostic accuracy of qEEG and LNNB in a mixed
psychiatric and brain damaged patients
Jahan M, Nizamie A, Nizamie S Haque
Ranchi
The Luria-Nebraska Neuropsychological Battery (LNNB) is a widely used tool. It detects the
presence of hemisphere laterality and regional localisation of focal brain lesions. LNNB has
been found to be a sensitive measure of specific pattern of cognitive deficits which are
associated with lesions in regional cerebral zones (Moses and Maurish, 1988). A number of
studies using LNNB have been reported to assess its efficacy vis-a-vis various diagnostic
tools (Golden et al; 1981; Malloy & Webster, 1981; James et al; 1991) however, the
relationship of physiological, behavioural and cognitive parameters is not very clear. Moses
and Maurish (1991) suggested that further investigation of the LNNB pattern of cognitive
deficit is warranted particularly with criterion medical information such as qEEG, and
structural or functional brain imaging. This will help to validate the diagnostic accuracy of
LNNB. The dynamic relationship between cognitive deficits and various measures of brain
function may also be better understood. In the present study 15 right handed subjects (age
range 20-60 years) who had basic reading writing ability were taken for the study. They
were diagnosed to have organic mental disorders or other psychiatric disorders (OCR
criteria of ICD-10). A normal, nonpatient control (n = 10) was also taken. A computerised as
well as polygraphic, paper EEG were done for all the cases. Within a week of EEG LNNB
was administered in various sessions. At the time of the testing the tester was blind to
qEEG findings. After completion of LNNB testing, details of clinical data were gathered.
Data were analysed using't' test and correlation. Both quantitative and qualitative
83
Session -14
Biological Psychiatry I
Hall-Bhadra
methods of interpretation as proposed by Golden et al were used to arrive at a syndromal
interpretation of cognitive deficits. It was attempted to lateralize and localize the deficits.
The LNNB findings were compared with that of qEEG and where available with MRI and CT
scan of the brain. LNNB was found to be an effective neuropsychological tool and it
compared well with qEEG.
14-4
Soft neurological signs as markers of diffuse neurological
deficit in type II schizophrenia
Narendra Singh, Anshuman Pant, Pradeep Sharma, Advani GB
Jaipur
Background and purpose: Type II schizophrenia or schizophrenia with negative symptoms is
said to have a strong biological diathesis in terms of familial transmission, age of onset,
poor pre-morbid adjustment, robust structural anomalies in the brain and poor prognosis.
Soft neurological signs or non-localising neurological signs are said to be markers of diffuse
neurological deficit. In this cross sectional study, schizophrenic patients with positive and
negative symptoms were compared for soft neurological signs. Methods: The study sample
comprised of 38 schizophrenic patients diagnosed on ICD-10 criteria. Positive symptoms
and negative symptoms were assessed using SAPs and SANs respectively. Soft
neurological signs were assessed using the Modified Soft neurological signs scale. Results:
There were 22 schizophrenic patients with positive symptoms and 16 schizophrenic
patient's with negative symptoms. There is a significant difference among groups in terms
of total score for soft neurological signs. The validity of the positive - negative dichotomy
of schizophrenia is discussed.
84
Session -15
Consultation Liaison - Psychiatry-1
Hall-Sharavathy
CONSULTATION LIAISON ■ PSYCHIATRY-1
15-1
Study of Psychological Status of Cancer patients in Armed
Forces
Dinker N L (Major)
It is well known fact that cancer has struck fear in the hearts of the human beings for centuries.
Psychological distress it to be expected as the patient confronts the implications of caner: possible
death, pain, dependence onothers; dis-ability; disfiguring changes in the body and loss of functions. The
study group consisted of 50 in-patients suffering from cancer of different sites and of various types.
The study was carried out to knbw (1) The prevalence of psychiatric illnesses in cancer patients and (2)
The influence of various psycho-social factors, the site, nature of disease and treatment modality on
development of psychiatric illnesses. Mental status examination, PGI Health Questionnaire N1 in Hindi
and Hamilton Rating Scale for Depression (HSRD) were used to evaluate the patients. Depression
(Adjustment Disorder with depressed mood) was observed in 13(26%) patients, Acute Organic Brain
Sundrome (Delirium) in 2(4%) patients and psycho-sexual dysfunction (Male Erectile Impotence) in 1 (2%)
patient. In addition 17(34%) patients had fear of disease and anxiety about their family responsibilities.
Young, less educated and more religious cancer patients from rural backgrounds and low socio
economic class were found more at risk of psychiatric morbidity. It is evident from above that the study
showed a considerable amount of psychiatric morbidity in cancer patients: this confirms to Derogatis
"LR et al (1983) study in which be found psychiatric diagnostic entity in 47% cases (in present study
26% depression, 4% Acute DBS and 2% psycho-sexual dysfunction which equals to 32%, a sizable
amount of psychiatric illness). In view of the above it is recommended that a detailed
psychiatric work up be sought by treating physician in all cancer patients so psychiatric
morbidity is not missed as many patients may deny and hide their psychological problems.
85
Session -15
Consultation Liaison - Psychiatry-1
Hall-Sharavathy
15-2
Psychiatric Study of Patients of Non-ulcer Dyspepsia
l/yas J N, Dinesh Tyagi
Bikaner
Fifty Patients of Nonulcer dyspepsia and equal number of properly matched controls were
taken from department of psychiatry, S.P.Medical College, Bikaner. All the relevant
investigations were done to rule out the organic pathology. The psychiatric diagnosis was
made accordingly to ICD10. Maudsley personality inventory. Presumptive stressful life
events scale, Beck depression inventory, Max-Hamilton anxiety rating scale were
administered for assessment of personality factors, stressful life events and severity of
anxiety and depression. Results show that eighty two percent of NUD patients had
psychiatric morbidity. Dysthymia was the commonest diagnosis (38%), followed by
generalised anxiety disorder (14%) and episode of depression (12%). No statistically
significant differences were observed between two groups for personality traits &
occurrence of stressful life events during preceding year, however, study group scored
significantly high for anxiety and depression in comparison to control group.
15-3
Psyciatric Aspects of the Amputees
TrivediJK, MallC P, Sharma VP, DalalP K, KatiyarM, Sinha PK
Lucknow
To study psychiatric problems following amputation of limbs.
The sample consisted of two groups of patients between the age of 16-55 years - Gp.l -
Patients admitted on specified beds in department of Orthopedics, KGMC, Lucknow in
whom amputation had been done within six weeks (N = 26). Gp.ll-Subjects who had
undergone amputation atleast 6 months to 2 years ago and attended OPD of the
department of Physical medicine and rehabilitation, KGMC, Lucknow (N = 28). Both the
group of patients were administered semistructured proforma (which had information
regarding socro-demographic variables and clinical details regarding amputation) and SCID
86
Session -15
Consultation Liaison - Psychiatry-1
Hall-Sharavathy
(Semistrctured clinical interview for DSM-III-R). 34.6% in the Gp.l and 37.9% in Gp.ll had
psychiatric illness. The commonest diagnosis was post traumatic stress disorder (88.9%) in
Gp.l and depressive disorder NOS (54.6%) in Gp.ll. The two groups did not differ in relation
to the presence of psychiatric sickness.
15-4
Psychiatric Evaluation of Leg Fracture Patients
Chaudhury S, Dirdsr N L, Sharma A K
Meerut
To study the prevalence of psychiatric disorders in leg fracture patients. Fifty consecutively
admitted leg fracture patients and an equal number of age and sex matched normal controls
were assessed by psychiatric interview, Michigan alcoholism screening test, Sinha's anxiety
scale (SAS) and Hamilton depression rating scale (HORS). Of the leg fracture patients 48%
were diagnosed as psychiatric cases compared to 2% of the control subjects. Detailed
evaluation revealed high prevalence of substance use disorders (34%) and depression (8%)
in leg fracture patients. Patients with leg fracture obtained significantly higher scores on
HDRS and significantly lower on SAS as compared to the control subject. Psychiatric
assistance would greatly aid in the rehabilitation of these patients.
15-5
Psychiatric comorbidity in patients suffering from epilepsy and
bronchial asthma.
Tushar Jagawat, Nizamie S H
Delhi
The relationship between epilepsy and psychiatric comorbidity have been associated and disputed since
antiquity. The primary aim of the present study was to find out the prevalance and nature of psychiatric
comorbidity in adult epileptic patients (n=61) and to compared it with matched bronchial asthma
parents (n = 33). Detailed socio demographic data, history, of different seizure variables
87
Session ■ 15
Consultation Liaison ■ Psychiatry-1
Hall-Sharavathy
were collected. Epileptic seizures were classified according to ILAE-1981. General Heath
Questionnarire (GHQ-12) were given to all subjects anrf those who scored two or more on
GHQ-12 were considered as probable psychiatric cases and given SADS-L for detailed
psychiatric evaluation. Results showed that around three-fourth of total epileptic patients
had some psychiatric diagnosis as compared to only around one-fifth of total bronchial
asthma patients. In the epileptic group depression, anxiety, schizophrenia and psychosis
NOS were common diagnosis. The implications of these findings are discussed in the paper.
15-6
A study of cases of Functional Bleeding
Mendhekar D N, Srivastav P K, Ramesh S, Chauhan R K
New Delhi
A total of 5 patients were referred with a tentative diagnosis of functional bleeding from
the Department of Gastroenterology after detailed investigations including endoscopy,
barium swallow, ultrasound, etc. and having ruled out any organic cause for bleeding. The
study showed predominance of female patients (80%). They were mainly from urban family,
majority being married and all cases belonged to joint family. Duration of illness varied from
15 days to 10 years. 80% cases were complaining of Haematemesis and only one case had
multiple bleeding like bleeding per nose, ear, mouth. We were able to collect the blood
sample from only one patient which showed vegetable fragment without any real content
of blood. Most of the patients reported stressors proceeding the bleeding. Stressors were
mainly of sexual and discordent family environment. In two cases minor physical trauma to
head acted as a precipitating factor. 3 Patients were not willing to undergo
pharmacological or psychological therapy or any investigation procedure. Patients had
shown good improvement with aversion therapy.
88
Session ■ 15
Consultation Liaison - Psychiatry-1
Hall-Sharavathy
15-7
Fibromyalgia/Chronic Fatigue Syndrome-A Role for Psychiatric
Management
Usha S P, Deepak Gopa!
Canada
Doctors are men (and Women) who prescribe Medicines of which they know little, To cure
Deseases of which they know less, in Human Beings of which they know nothing.
Introduction :The above quotation by the French philosopher Voltaire is most appropriate
when beginning a discussion on the topic of Fibromyalgia/Chronic Fatigue as syndromes
that have emerged with much controversy regarding criteria for diagnosis, potential
pathophysiology, and treatment. These syndromes do not conform to the usual "Medical
Model" of disease, with the traditional emphasis on the rational evaluation of presenting
signs and symptoms, leading to a probable diagnosis, confirmatory investigations, and
scientifically proven treatment regimens. Most physicians are uncomfortable when
confronted by entities of "disordered function" but "normal anatomy" as in the absence of
strong criteria, radiographic or serological abnormalities their may be scepticism regarding
their diagnostic validity. However, from our past experience, the absence of firm clinical
signs and tissue pathology should not preclude the existence of a recognizable syndromes.
It is crucial that signs and symptoms of these syndromes be classified and characterized in
a manner where the uniformity of those features are evaluated in populations suspected of
having the condition and populations suspected of not having the disorder; especially when
defining an illness lacking "objective" pathology. Objective : The primary objective of this
paper is to review the current criteria for both syndromes of Fibromyalgia/Chronic Fatigue,
to discuss potential pathophysiological mechanisms that may be involved, and to review
current treatment approaches (with an emphasis on psychotherapeutic and
psychopharmacological approaches) that are recommended. Methods : A review of a case
report experience and recent literature update on Fibromyalgia/Chronic Fatigue syndrome
was performed using Medline(computer search) from 1989-1995. Based on these results a
discussion of the current concepts of psychobiological models as well as psychotherapeutic
89
Session • 15
Consultation Liaison ■ Psychiatry-1
Hall-Sharavathy
and psychopharmacological approaches to the treatment of Fibromyalgia/Chrinic Fatigue is
reviewed. Discussion/Conclusions : Controversy exists amongst the medical community as
to wether fibromyalgia/Chronic Fatigue actually exists as an organic disorder alone, a
functional disorder or a combination of the two. Current organic models of disease include
abnormalities in neurohormones (such as disturbances of the hypothalamic-pictuitary-
adrenal axis) as well as neurotransmitter abnormalities which would point to the Central
Nervous system as potential source of pathology. Yet other studies have investigated the
relationship between Fibromyalgia/Chronic Fatigue to the mood disorders, specifically
depression. Three possible relationships between fibromyalgia/CFS and depression: (1)
Fibromyalgia is a symptom of depression (2) Depression is caused by fibromyalgia/Chronic
Fatigue; and (3) these two conditions have a common physiologic basis. What is more
probable is a model that encompasses both the Central Nervous System abnormalities, and
Psychiatric abnormalities leading to a common pathophysiology. Moreover, tricyclic and
tetracyclic as well as atypical anti-depressan.ts have shown to be beneficial in the
management of Fibromyalgia/Chronic Fatigue and the evidence for this is also reviewed in
this paper.
15-8
Psychological profile of female with chronic pelvic pain
Pradeep Agrawai, Udayan Khastgir, Bhatia M S, Naana Bohra, Malik S C
Delhi
The study was conducted on 90 females with nonorganic pelvic pain selected from
Gynaecology OPD of Smt.S.K.Hospital and Swami Dayanand Hospital. Majority of patients
were young, married, Hindu, illiterate, housewives, belonging to low socioeconomic group
and lived in a nuclear family. Majority of the patients had pain for duration between 1 year
to 5 years and pain was of dull, mild type. These patients scored significantly more than
the controls in Free Floating Anxiety, Somatisation, Depression and Hysteria subscales of
Middlesex Hospital Questionnaire, 54.4% of the patients had Hamilton Rating Scale for
Depression score between 8 to 15, in the study group.
90
Session -16
Organic Psychiatry
Hall-Cauvery
ORGANIC PSYCHIATRY
16-1
Sodium Valproate in Organic Psychosis
Mzamie Haque S, KothariS, Kumar R, Bannerji A
Ranchi
Conventionally, organic psychosis is treated with antipsychotic drugs or psychotropic
medicines. However, it has been observed that a number of cases develop side-effects to
these medicines readily even on smaller dosage and antipsychotic drugs alone may not be
very effective (Nizamie et al., 1994a). Antiepileptic drugs such as carbamazepine (CBZ) and
sodium valproate (SV) have been used in various psychiatric disorders. SV is reported to be
especially effective is organic mood disorder (Pope et al., 1988; Kahn et al., 1988; Nizamie
et al., 1994a; 1994b). Though there are preliminary indications that SV may be useful in
organic mental disorders this approach has so far not been adeauately explored. Some of
the recent texts on Psychiatry have chapters on CBZ & SV but there is no mention of
Oiganic mental disorders in the list of indications of their use (Post, 1995; Pope & McElroy
1995). The efficacy of SV in organic psychosis is based on various case reportes. There is
no study on a significant number of cases to ascertain the worthiness of this medicine. For
the present study case record files of patieints admitted in one of the Units in the Central
Institute of Psychiatry, Ranchi from Jan 1989 to Dec 1994 were reviewed. There was a
total of 1834 admission during this period. There were a total of 43 cases of organic
psychosis of which 8 cases were excluded from the study since their case records could not
be retrieved. Of the remaining 35 cases 30 were on SV either in combination with small
doses of haloperidol, lithium, chlorpromazine, CBZ etc. or on SV alone. The cases were
followed up for a period of one month to 4 years. The outcome recorded at the time of
discharge from the hospital or at subsequent follow up in the outpatient department
showed that there were 4 cases who recovered completely, 11 had marked improvement, 8
had moderate improvement and there was no change in 7 cases. Detailed findings regarding
clinical profile and outcome will be discussed. This study highlights the utility of SV in the
management of organic psychiatric disorders.
91
Session -16
Organic Psychiatry
Hall-Cauvery
16-2
A study of Chloroquine induced psychosis
Gupta /I K
Jamshedpur
Twenty five cases (age ranging 15 to 45 years) with Chloroquine Induced Psychosis were
seen in a span of 36 months at Tata Main Hospital, Jamshedpur. All the patients received
chloriquine for Malaria. The female patients were found much more in number (70%). The
total dose of choloroquine ingested was compatible as recommended for Malaria (varying
from 1 to 6 grm.). The symptom of psychosis were reported within 20 to 100 hours. The
features suggestive of organic psychosis were reported in 12 patients while the features
resembling those of schizophrenia - 8 (cases), Mania 3 (cases) and Depression 2 (cases). The
symptom disappeared completely within 4 to 16 days.
16-3
Neuro-Psychiatric Manifestations of Sickle cell disease
Jyoti Mahapatra, Bardhan A K
Orissa
A clinical study of the neuro-psychiatric manifestations of sickle cell disease was carried on
in the psychiatry Dept, on 50 consecutive sickling test positive cases during a period of 3
years 50 Sickling Negative Psychotic patients admitted to the wards with similar
symptoms, age, sex and socio-economic status were taken as control. The symptom profile,
response to drugs and physical treatment and outcome of the Psychotic episode were
compared in both the groups after establishing diagnosis as per I.C.D.-10 criteria. It was
seen that the 42 sickling positive cases (with only Trait Defect- i.e. A.S), though less
tolerant to higher doses of antipsychotic drugs, showed better response to treatment and
had no incidence of sickle cell crisis. Frank cases of Sickle cell disease (S-C and S-D), total 8
in number were more disoriented and showed crisis like high fever, joint pain, nausea and
physical discomfort requiring reduction of dose of antipsychotic drugs.
92
Session -16
Organic Psychiatry
Hall-Cauvery
16-4
C T Scan Findings in Post-stroke Depression
Ravish Thunga, Joshi U G
Mangalore
In stroke patients, it has been observed that depression is common in post-stroke period.
This depression is qualitatively different and quantitatively more than the one expected due
to physical disability. Different characteristics of CNS lesions in stroke patients have been
correlated with post-stroke depression. In our study of 40 post-stroke depressive patients
fulfilling Research Diagnostic Criteria (RDC) CT Scan findings were analysed in 27 patients.
It has been found that the position and volume of CNS lesions have decisive role in cauring
poststroke depression. Detailed analysis of the results will be presented and discussed.
16-5
Cognitive impairment after stroke : relationship to depression,
lesion characteristics and functional impairment
Advani G B, Pradeep Sharma, Vidhu Kumar
Thiruvananthapuram
Conceptualization of 'reversible' and 'pseudo' dementia have been engaging our attention
for almost three decades. Cerebrovascular accident can cause, amongst other syndromes,
both dementia and depression. Therefore it is logical to postulate that congnitive
impairment following stroke is determined by both, severity of depression and lesion
characteristics. This cross sectional sti^y was undertaken to test the above postulate. 30
stroke patients with unilateral, unifocal ischaemic or haemorrhagic lesions were examined
for severity of depression, cognitive impairment, aphasia and functional impairment using
standardises rating scales. Location and volume of the lesion were determined using Ct
scan. There was a significant correlation between cognitive impairment and severity of
depression. Although there was no evidence of correlation between cognitive impairment
and volume of lesion in the total sample, these variables correlated significantly with each
93
Session ■ 16
Organic Psychiatry
Hall-Cauvery
other in patients with left hemispheric stroke. There were no significant correlations among
other variables. Thus the study showed that cognitive impairment following stroke is
determined by both severity of depression and lesion characteristics. Heuristically the study
sheds some light on the biology of the so called pseudodementia. A tentative hypothesis
can also be made regarding the efficacy of antidepressants in post stroke dementia.
16-6
Depression and Anxiety Disordes in post stroke patients
Alka S Ahuja, Vivek Chincholkar, Shubhangi R Parkar, Yeolekar M Ef
Karnad D R
Bombay
Behaviour and psychological changes following cerebro vascular accidents have been
known and identified. However, Depression is the most common emotional problem among
poststoke patients.
Two groups of possible causes of depression in this group are - i) Those directly relating to
the brain lesion i.e. its location. ii)Those unrelated or only indirectly related to the lesion
such as demographic characteristics, social circumstances and patient's perception of his
illness. Fifty indoor patients with stroke admitted in a general medical ward were studied.
The aims of the study were ■ i) To associate the site of lesion with the affective and
neurotic disorders, ii) To highlight the patient's perception of his illness and the resulting
disability.
Data was obtained using a specially structured proforma designed for the study. Affective
and neurotic disorders were assessed using ICD-10 classification of Behaviour and Mental
disorders using symptom check list. These were then correlated with the CT scan findings.
The resuts will be discussed.
94
Psychiatric Aspects of HIV
Session -17
Hall-Krishna
PSYCHIATRIC ASPECTS OF HIV
17-1
Shifting Paradigms in Aids
Soumitra Basu, Sharmila Basu
Calcutta
AIDS is not an isolated event but must be viewed along three paradigms in a hierarchical
order: a) sexual perspective, b) faulty immune mechanisms due to damage by unwanted
chemicals and toxins for the last 50 years, c) an erosion in living systems due to
devaluation, hedonism and materialism. The third aspect has not been properly appreciated
resulting in improper stress in awareness programs. The result - social boycott of AIDS
victims due to overemphasis on bad sex in ads on AIDS. Primary prevention should be
directed to improve the quality of human life.
17-2
A Study of HIV Risk Behaviour Among Hospitalised injecting
opiate users
MashU Sathish Lal G, Bhaskar C, Rajkumar R, Suresh Kumar M,
Palaniuppun 1/
Madras
Injecting drug users are at high risk towards HIV infection,. A consecutive sample of
injecting opiate users (N = 50) were recruited from the Deaddiction clinic of Institute of
Mental Health, Madras-10. They were assessed for both injecting and sexual high risk
behaviour apart from socio demographic information and drug use pattern. HIV antibody
testing was done with pre and post test counselling for all the persons. The relationship of
positive sero status to the high risk behaviour and pattern of drug use is studied. The
results and its implications for preventive strategies aiming to reduce HIV infection among
drug injectors are discussed.
95
Session ■ 17
Psychiatric Aspects of HIV
Hall-Krishna
17-3
Exploration of unpopularity of HIV test result seeking among the
injecting Drug users of Manipur
Hangzo C Z, Das N, Chatterjee A
During the initial years (1992-1993) of voluntary, confidential HIV testing offered to the
injecting drug users in Manipur, only a few (15-20%) turned up for result notification.
Among these clients who did not turn up for six months, a list of seventy five clients in
Imphal city was randomly prepared and sixty of them could be interviewed using a pre
tested semi-structured schedule. Data was entered and analyzed by using epi-info 6 and
SPSS software. Various reasons for not coming for the test result could be categorized as 1
can guess it, what's the use' (21.3%) 'scared to face the truth' (24.6%), 'excuse' responses
(34.4%) and 'no specific reason' responses (19.7%). In chi-square test, higher educational
status (more than high school) was significantly associated with 'no specific reason'
(p = 0.02) and 'excuse' (p = 0.05) responses.Ongoing counselling after drawing of the blood
sample was significantly associated with 'scared to face the truth' (p = 0.04) response. In
multiple logistic regression, higher educational status predicted 'no specific reason'
response. Implications of the findings will be discussed.
17-4
HIV infection in a psychiatric inpatient population
Prabha S Chandra, Ravi K Anita Desai, Puttaram S, Premanand
Bangalore
There is meagre data in Asia on HIV infection among the psychiatrically ill. The current
study was conducted to assess HIV seroprevalence among psychiatric inpatients and
describe the clinical profile of those infected. Among the 2136 patients tested between Jan
1992 and Sep 1995, 1120 had definite history of risk behaviour, of which 33 were
seropositive. While the overall prevalence was 1.1%, among those with definite risk
behaviour, the prevalence was 3%. 18% of the seropositives were women. Alcohol
96
Session -17
Psychiatric Aspects of HIV
Hall-Krishna
dependence or abuse was present in 78% and multiple heterosexual partneers was the
commonest risk factor. 70% had psychiatric illness and 30% had only alcohol or substance
dependence. Among the psychiatric illnesses, the commonest was personality disorder
(50%) followed by psychosis (20%), affective disorder (20%) and dementia (10%). The
paper discusses the implications of these findings in the prevention and management of HIV
infection among the mentally ill.
17-5
Psychiatric Morbidity in Hiv Deseased Inpatients
Cyriac Mathew, Nair S, John J K
Vellore
Human immunodeficiency virus (HIV) infection was found to be accompanied by significant
psychiatric morbidity. There is a paucity of data regarding the prevalence of psychiatric
morbidity in HIV diseased (CDC Group IV) hospitalised patients in India. This study was done
to assess the psychiatric disorders among the HIV diseased patients admitted in a general
hospital. Thirty consecutive inpatients satisfying the inclusion criteria were evaluated
prospectively. The psychiatric diagnoses were made based on DSM lll-R criteria. Fifty per
cent of patients had psychiatric morbidity of which major depression was the most
common. The implications of psychiatric morbidity in HIV diseased inpatients are discussed.
17-6
Struggling with identity : A qualitative exploration of a group of
men having sex with men in Calcutta
Amit R Basu
Calcutta
Homsexuality is increasingly being recognised as a gender construction than a mental
disorder. In our country, participatory studies have started surfacing recently with the AIDS
intervention. This study tries to explore the narrative of identity formation and also
97
Session -17
Psychiatric Aspects of HIV
Hall-Krishna
question the terms 'homsexuality', 'gay' etc. A focus group was conducted with six young
men having sex with men. Questions were focused on formation of sexual identity and
psychosocial streses confronted by them. Implications of early psychosocial intervention
and attitudinal change among mental health professionals is discussed.
17-7
Koro-Like Symptoms in a Male person following descovery for
of being HIV Positive, a case report
Jayanta Chatterjee, SrHekha Biswas
Calcutta
This report describes a thirty six year old marine Engineer presented Koro like symptom
with acuture depressive illness following discovery of HIV positive results.
98
Psychoses
Session ■ 18
Hall-Tunga
PSYCHOSES
18-1
Delusional Parasitosis 237A A Series of 25 Cases
Bhatia M S, Shame S, Gautam R K
Delhi
A series of 25 cases of Delusional Parasitosis is being reported. There were three cases
below 45 years of age whereas 12 cases between 46-55 years and 11 cases above 55
years of age. 64% cases were females. A majority of cases (92%) had insidious onset. The
duration of symptoms in all the cases (except one) was 6 months or more. 13 cases
presented with infestation with insects over body, 10 cases with insects crawling over
scalp. There were three cases each with diabetes mellitus and leprosy. Three cases had
dementia, 2 cases had depression and one case presented with trichotillomania. Pimozide
was used in 22 cases, amitriptyline in 2 cases and fluoxetine in one. 14 cases (52%)
showed partial improvement and
cases did not respond.
18-2
Psychosis following charismatic retreat
Roy Abraham K
Kottayam
Charismatic Retreat is an intense from of religious experience, in which the person, listens
to preachers and participates in religious rituals and prayers. This is an intensely emotional
experience. 40 cases of Psychotic breakdown following the above type of 'Charismatic
retreat' seen both at Medical College Hospital, Kottayam and in private practice has been
included in this study. Socio-demographic profile, presence of other precipitating factors
and the clinical diagnosis has been evaluated. The results on six months follow-up is
discussed.
99
Session -17
Psychiatric Aspects of HIV
Hall-Krishna
18-3
Psychosis during pregnancy-6 cases
Nagaraj S
Madurai
Aim : Unlike puerperal Psychosis, Pregnancy psychosis is not reported. Method : In the last
10 years, 6 cases have been seen. They are studied prospectively. Observation : All 6 cases
are seen during last trimester of pregnancy; there is incidence of psychosis in first degree
relatives of 4 patients. All were less than one month in duration. Conclusion : The rarity,
mild nature of psychosis is reported in this rare clinical study.
18-4
Acute non-organic Psychosis outcome after 10 years
Gupta L /!/, Bhardwaj Pramod, Verma K K
Udaipur
62 out of 68 Acute Psychosis patients who were initially recruited from Bikaner Centre in
1982 for Indian Council of Medical Research Study on "Phenomenology and Natural History
of Acute Psychosis" were assessed after completion of 10 years in 1992-93 on SCAN &
PSE. The results show that 35 (56.45%) patients"of Acute brief episode of psychosis never
had any psychotic illness during the course of follow up. These recovered patients (N = 35)
were compared with other (N = 27) who had relatively poor prognosis. Recovery was
significantly better in younger, unmarried, Hindu and in those who developed the full blown
psychosis abruptly within 48 hours. Other sociodemographic, personal history variables and
symptomatology could not distinguise this recovered group of patients with other
categories of psychoses.
100
Session -17
Psychiatric Aspects of HIV
Hall-Krishna
18-5
Declerambault's Syndrome - A case Report
Rajaram Mohan R, Banesan R
Salem
A 34 year old unmarried Hindu Woman came from a Joint family of Middle Class without
any History of Mental Illness in the family. Ohe was brought so Psy. O.P. for
Sleeplessness, Hearing 'Voices', Irrelevant Talk of 10 years duration. The symptoms were
increasing in intensity for the past 2 years. The Predominant Symptom had been a Delusion
of being loved. The Psycho Dynamics of this case was discussed.
lfc-6
A Descriptive study of acute and transient psychosis
Bhaskar C, Vivekanandan Sf Suresh Kumar M, Bashyam VSP
Madras
The incidence of acute and transient psychosis is much higher in developing countries than
in developed countries. The potential utility of a separate diagnostic grouping for acute and
transient psychosis has been underscored in some studies. The present study aims to
describe the symptom patterns in acute and transient psychotic disorders. The sample was
chosen from the Outpatient department of the Institute of Mental Health, Madras ■ 10.
Consecutive patients meeting the following criteria were included.
1. Onset of psychosis is was acute, (psychotic symptoms developed over less than a week
without prodromal symptoms)
2. Age 15-60 years
3. Psychosis not related to drug or alcohol or seizure disorder
4. The Patient was not treated with psychotrophics/ECT.for more than a week. They
were evaluated with SCAN and symptom patterns studied in detail. After follow up 30
cases remitting within a period one month were compared with non-remitting group.
I oo
It X WViM’
"3
Session -17
Psychiatric Aspects of HIV
Hall-Krishna
18-7
Assessment of insight in psychotic patients
Srinivas S, Kulhara P, Mattoo S K
Chandigarh
67 psychotic patients who were admitted to Psychiatric Unit of PGIMER, Chandigarh were
interviewed to assess insight and its relationship to psychopathology and other variables.
Assessment was done at intake, at 2 weeks and at 4 weeks to measure psychopathology
on BPRS and insight on David's scale (1990). In mixed psychotic sample (n = 67) results
show that socio demographic variables and clinical characteristics did not have any bearing
on insight. Insight was inversely correlated to psychopathology at all points of assessment.
Grandiosity and total duration of psychotic illness contributed about 21% of variance of
insight (variance of insight on multipleOregression) in this group. At initial assessment,
grandiosity played a significant role in explaining variance of insight, but at subsequent
assessments insight depended more on total BPRS score than on grandiosity. Though
insight was partly explained by psychopathology, mostly it seems to be independent of
other variables, in our study.
102
Biological Psychiatry II
Session -19
Hall-Bhadra
BIOLOGICAL PSYCHIATRY II
19-1
Is routine monitoring of thyroid antibodies necessary in patients
on lithium prophylaxis?
Prathap Tharyan, Colin John Vas, Jacob K John, Sheshadri M S
Vellore
Routine evaluation of thyroid antibody titres before and during lithium prophylaxis is now
recommended in the West, based on reports of elevated titres of thyroid antibodies in
19.24% of patients on long term lithium therapy and in 16.43% of lithium free patients
with affective disorder, as op~osed to 5-10% of the normal population. We evaluated the
relevance of these recommendations in our patients by studying 149 consecutive patients
with affective$disorder on continuous lithium therapy for 10 months or more and 90 lithium
free patients with affective disorder. We estimated titres of antibodies to thyroxine (T4),
free thyroxine concentration (FTC), and thyroid stimulating hormone (TSH). Odds ratios and
confidence intervals were calculated for the presence of elevated antibody titres in lithium
treated and lithium free patients. The results and recommendations are presented and
discussed.
19-2
Development of Acute tolerance to morphine in albino rats
Jain R, Ray R, Sethi H
New Delhi
The aim of the present study was to quantify the rate and extent of development of acute
tolerance in albino rats via activity measures. Male adult albino Wistar rats (60 - 90 days
old, 125-150g, n = 18) were used in the study. Rats were divided in three groups (l/ll/lll,
i. = 6, each). Rats of each group were habituated to the test cage for 30 mins, for five days
prior to the beginning of the experiment. Rats of group I and group II received morphine 10
103
Session -19
Biological Psychiatry II
Hall-Bhadra
mg\kg, body wt, i.p. and n-saline i.p. respectively, cnce per day for five days. Group III rats
were not treated with any drug/saline. Group II and Group II rats served as Controls I and II
for the current study. Motor activity of all the rats was measured in Colbourn Video path
analyser equipped with Video Activity Monitor at 5 mins, interval for a period of 30 oins.
which reports 15 measures of activity. Six measures (Locomotion, Rest, Stereoevents,
Movement, Distance and Average speed, were selected to study the development of
tolerance. Activity of group I (Experimental, gp) and Control group I were measured on 1st
day prior administration of morphine I saline for pre-drug assessment and thereafter activity
was recorded in two sequences, immediately and after <30 mins, of injection morphine I
saline for five days. No pre-drug assessment was made in Control group II and activity of
rats was noted in two sessions, each of 30 mins, duration for five days. All measurements
of activity were made on fixed hours every day. The results of 1st day were compared with
rest of the days, within group and between groups. However, the activity results of post 30
mins, session were selected as it relates to peak blood level. Inspite of wide variability in
data, tolerance developed as evidenced by six activity measures. The results of present
study suggest that acute tolerance occurred in brief duration of morphine exposure.
19-5
Measuring chaos in Brain-1: Methodology
Pradhan N, Sadasivan P K
Bangalore
Chaotic systems are now realized to be pervasive in nature and have emerged as one of the
front line areas of research in many fields of science. The biological systems are inherently
nonlinear and exploring their dynamics has currently led to wide use of theory of chaos
specifically for the biological oscillatory systems. In the methodology paper, we introduce
certain fundamental concepts of chaos theory such as state-space, strange attractor,
fractals, bifurcation, correlation dimension, Lyapunov exponent etc. We then develop a fast
computational method for quantification of chaos in brain i.e. the dimension of the strange
attractor of brain activity. The dynamics of a system can be visualized from its trajectory
which may be depicted as the motion of a point in its state-space. A system whose
104
Session -19
Biological Psychiatry II
Hall-Bhadra
dynamics is linear (output linearly increasing with increasing input) has a point attractor. A
periodic system is seen as a limit-cycle or circle in state-space. A stochastic system
occupies the entire state-space randomly whereas a chaotic system gives rise to a strange
attractor that is fractal in nature. Estimation of correlation dimension (D2) is one of the
commonly used parameters to characterize a chaotic system. The record of dynamical
activity of the brain can be obtained from its electroencephalogram (EEG). The EEG time
series is converted to state-space vectors by time-delay embedding. The D2 value of brain
activity in various brain states is estimated by Singular Value Decomposition (SVD) of the
state space matrix. The efficiency and accuracy of this method is compared with
Grasberger-Procaccia and Taken-Ellner methods. It's application to schizophrenia research
in understanding the basic pathology of the disorder is presented in the next paper.
19-4
Measuring Chaos in Brain-Il: Application to Schizophrenia
Research
Pradhan N, Sadasivan P K
Bangalore
Understanding the pathophysiology of schizophrenia remains as a challenge to
neuroscience. It has been realized that the problem may have similar theoretical implications
like cancer or genetic research in terms of its complexity. The co-operative nature of neural
systems gives rise to the possibilities of unimaginable emergent behaviors. The science of
nonlinearity and complexity has taken root in the theory of chaos and it owes its
development to modern supercomputers. From the basic neurophysiological evidences, it
may be safely assumed that the brain's dynamical behaviour is well reflect}d in EEG. The
nonlinear dynamics views the EEG time series as deterministic and of relatively low
dimension, with their 'complexity' being due to their inherent nonlinearity. This basic idea,
inspired by recent advances in the area of nonlinear dynamics, and especially the theory of
chaos, is based on the following conjecture: The EEG is a very complex signal, hence it may
be produced by a simple, but nonlinear system. Nonlinear systems are capable of chaotic
behaviour, in which time series predictability falls off exponentially as a function of time.
105
Session -19
Biological Psychiatry II
Hall-Bhadra
Despite this temporal unpredictability, the deterministic nature of chaotic time series allows
a great deal of information to be recovered regarding their dynamics e.g. their state-space
dimensionality. We have analysed the resting whole night EEG of drug-naive male
schizophrenics (ICD-10, DOR, N = 10) with age matched normal controls (n = 12). Under
normal resting state the EEG is that of activation and high dimension. In sleep the brain
relaxes to a low dimension state. Our results reveal that in schizophrenic brain there is
uncontrolled relaxation and gross loss of dimensional complexity indicating a degenerative
pathology.
106
Consultation Liaison Psychiatry
Session ■ 20
Hall-Sharavathy
CONSULTATION LIAISON PSYCHIATRY
20-1
Alexithymia, Stressful Life Events and Dermatitis
Meet VD, Shiv Gautam
Jaipur
The relationship of different kind of Psychosomatic disorders and inability to verbalise
emotions (Alexithymia) has been widely reported. An attempt has been made to: i).Measure
alexithymia in patients of different types of dermatitis, ii). Whether alexithymia has a
relationship to presentation of neurodermatoses, iii). Whethers alexithymia has any
relationship to stressful life events. Sixty cases of neurodermatosis and lichen planus
(Experimental group) and 60 cases of Pyoderma and matched normal control (Control group)
were randomly selected from patients attending the dermatology out patient department
S.M.S. Medical College Hospital, Jaipur. Toronto alexithymia scale, P.S.L.E. scale were
administered to both the groups after recording their socio demographic data. When looked
at the scores of alexithymia among different types of dermatosis, comparatively,
neurodermatosis had highest scores followed by lichen planus, while pyoderma and normal
control group had significantly lower scores. Findings have been discussed and
interpretation have been highlighted. The results revealed that the experimental group has
highest alexithymic scores (126.78 mean) than control group (116.36 mean). Patients with
three or more life events have higher alexithymic scores (125 mean) as compared to 2 or
less stressful life events (115 mean).
20-2
Secondary Anxiety & Management
Pataksha G S
Bangalore
920 persons with various physical illnesses were screened for associated anxiety & 40% of
them were positive for anxiety on Hamilton Anxiety Scale. The Anxiety was treated with
107
Session - 20
Consultation Liaison Psychiatry
Hall-Sharavathy
Alprazolam and the treatment for physical illness was instituted. The adverse effects of
Alprazolam is noted. Details will be presented.
20-3
Treatment of Late Luteal Phase Dysphoric Disorder (A Trial of
Fluxetine Vs Alprozolam)
Vinay Kumar, Singh B K
Patna
Selective Serotonin Reuptake Inhibitors and Alprazolam have been tried successfully for
treating cases of Late Luteal Phase Dysphoric Disorder (LLPD). Present study compares the
efficacy of Fluxetine and Alprazolam in 30 cases, who met the DSM lll-R criteria for LLPDD.
These 30 cases were divided in demographically matched two groups. Group A cases were
treated with Fluxotine 20 mg O.D. and group B with Alprazolam 0.25 mg three times a day
for 3 menstrual cycles. Cases were assessed according to a prefixed scoring pattern. 10
out of 13 i.e. 76.92% (2 dropouts) cases of group A reported good or very good responses
as compared to 5 out of 12 i.e. 41.66% (3 dropouts) cases of group B at the end of study.
From group A one case i.e. 7.67% reported partial response and 2 cases i.e. 15.38% no
response. From group B 6 cases i.e. 50% reported partial response and one case i.e. 8.33%
no response.
20-4
Post Hysterectomy Anxiety & Depression
Gupta / D, Preet Kamal, Sudhir, Adarsh Bhargava
Jaipur
A prospective study was planned to find out the effects of pre-operative anxiety &
depression on post operative behaviour of patients undergone hysterectomy & sterlisation.
200 consecutive patients were evaluated by administering Hindi version of Goldberg's
General Health Questionnaire (Gautam et.al. 1987) and Irritability, Depression and anxiety
108
Session - 20
Consultation Liaison Psychiatry
Hall-Sharavathy
scale (Snaith et.al. 1978) alongwith the especially designed proforma which included the
details of sociodemographic veriables, menstrual history & obstetric history. A significant
increase in the GHQ & Depression was observed in the patients who have undergone
hysterectomy while there was a minor increase in the GHQ & depression scores of patients
with sterilisation. But there was no change in the anxiety scores in the patients of both the
groups. In comparison to patients who had sterilization there was a significant increase in
the depression scores of patients undergone hysterectomy. Results are discussed in the
light of previous studies.
20-5
Relationship between awareness of illness and psychiatric
morbidity in cancer patients
Gandi Babu Rf Alexander PJf Ram Kumar S, Vidyasagar M S
Manipal
Clinical experience and research evidences suggest that many cancer patients, are neither
aware nor informed about their diagnosis and prognosis, especially in developing countries
like India, we studied perspectively 63 patients consecutively admitted to a general
oncology unit, attached to a teaching general hospital. A detailed psychiatric interview was
done and ICD-10 diagnostic criteria for research (DCR) diagnosis was made. All these
patients were assessed independently by another investigator for awareness of the
diagnosis of cancer, prognosis, their expectation of the outcome of the treatment,
knowledge about cancer in general, and their satisfaction to the discussion with the
treating oncologists about their illness. Forty six percent of patients had psychiatric illness.
Forty six percent were aware of their diagnosis, 27% were unaware and we could not
reliably determine in 27% whether they were aware or not. Twenty five percent were
aware of the prognosis, 38% were unaware and 37% were noncomittal. Fifty two percent
expressed that they will be cured by the treatment, 27% feet that it is palliative, and 19%
were noncomittal. Only thirty eight percent were satisfied with discussion with the treating
doctor. However no significant difference in the awareness of diagnosis, prognosis,
knowledge about cancer, expectation of outcome of the treatment, and the satisfaction
109
Session ■ 20
Consultation Liaison Psychiatry
Hall-Sharavathy
with doctors discussion, between the patients with and without psychiatric diagnosis. The
prevalence and nature of psychiatric morbidity in out study is similar to the prevalence
reported in literature. Our study reveals the difficulty in assessing reliably the awareness of
the illness and prognosis in cancer patients. The defence mechanism of denial may be
operating in many patients. Unlike the earlier studies we did not find any significant
difference in awareness and expectation of outcome depending upon psychiatric morbidity.
There is need for further studies in this important area.
20-6
Are Mentally ill more sick than physically ill
Pradhan S C, Kar P, Dey N, Bhagat B N, Jagawat T
Ranchi
The illness Behaviour is the way of perceiving, evaluating and reacting to the factors
responsible for the illness which may in itself by pathological. The assessment has been
done using Illness Behaviour Assessment Schedule (IBAS, Pilowsky 1983) in a group of
30 Psychiatric patients and 30 medically ill patients. The study was conducted in the
Central Institute of Psychiatry, Ranchi, and one of the Central Coalfields hospital in South
Bihar. Results: Considerable differences were found between the Psychiatric and non
psychiatric groups in their perceptions of illness and response to it. More physically ill
patients than Psychiatric patients had received explanations regarding their illnesses. Most
mentally ill patients were convinced of the presence of a psychological factor whereas the
medically ill patients thought a physical factor to be causative. The implication of these
findings has been discussed in this paper.
20-7
Headache Clinic in a Mental Hospital: An Experiment
Sayeed Akhtar, Chopra V K, Simtai J
Ranchi
The pervasive stigma of high walls of the mental hospital has kept the patients of minor
psychiatric ailments and primary headache away. The aim of organizing a headache clinic in
110
Session ■ 20
Consultation Liaison Psychiatry
Hall-Sharavathy
a mental hospital was 1. treatment 2. focus on education and training, and most
importantly 3. removal of stigma of mental hospitals. The composition of team, which
differs from center to centre, consisted of a Psychiatrist, a Senior Resident (Neurology), a
Medical Officer and a Clinical Psychologist. The organic cases were referred to relevant
specialities. Preliminary analysis of the result revealed that the cases of primary headache
consisted of tension headache followed by common migraine. The cases of classical
migraine and cluster headache were rare. Most importantly a large number of cases who
registered themselves in the headache clinic had a primary psychiatric diagnosis. The
authors propose to discuss the implication of these findings with an emphasis on need to
have a headache clinic in each mental hospital in order to remove stigma attached to mental
hospitals and to make the services more attractive.
20-8
Consultation - Liaison Psychiatry
a teaching hospital
experience in Calcutta
Gautam Saha, Roy S, Kar P
West Bengal
We have analysed one hundred consecutive cases referred to the Psychiatry Unit of a
teaching hospital from its different departments. The aim of the study was ■ to classify the
cases according to the source of referral, cause of referral, demographic variables, and
diagnosis.
Of the hundred cases 61 were referred from the department of Medicine, 10 from Surgery,
8 from Cardiology, 5 from Gynae. & Obst. and the remaining 16 from the other
departments. About half of the cases (47%) wer aged 26 to 45 yrs. One quarter (25%) of
them were aged 46 years or more. Delirium, Depressive episode, Schizophrenia and
Conversion disorder accounted for 60% of cases. No psychiatric diagnosis could be
established in 10% of cases. No significant difference was observed in the referred cases.
Majority of depressives are aged 36 yrs. Half of the delirium cases below 36 yrs. 65% of
the schizophrenics are aged between 25 yrs. and 40 yrs. No physical illness was
significantly associated with particular psychiatric illness.
111
Session - 21
Drug Abuse
Hall- Cauvery
DRUG ABUSE
21-1
A study of opioid induced psychotic disorders during
withdrawal - hallucination
Sharma K P, Seema
Patna
This study was conducted at DISHA Drug De addiction Centre, Patna, Bihar to study the
prevalence & nature of hallucinations during opioid withdrawal. Only patients with no
history of previous psychiatric illness were excluded from study. This study will be helpful
to all dealing with de-addiction programme.
21-2
Opiate Dependance and Endorphins
Haridas R M
Bombay
Aims & Objectives : Several endorphins have been identified in the physiological state as
well as in such mental illnesses as schizophrenia. This study aims to correlate and
understand clinical profiles of opiate dependents and the possible role of endorphins and
review management strategies. Material & Methods : 50 cases of opiate dependance
attending the Dept, of Psychiatry were clinically assessed to establish the genesis of
dependance individually, to study the pattern and associated psychological problems.
Observations : On the above basis they appeared to fall into three distinct categories as
follows:- (1) Primary Opiate Dependance (48%) Pts. were middle aged (mean age 47.7)
opium eaters, long standing dependants (21.25 yrs) with a stable pattern and fixed dose.
They showed no significant psychological or physical deterioration and continued to
function as responsible members of society. Constitutional and cultural factors were
domonant.
112
Session ■ 21
Drug Abuse
Hall- Cauvery
It is hypothesised that on initiation with exogenous opiate, the production of endogenous
opiate was suppressed and resulted in withdraw!.Exogenous opiates were thus used to "top
up". 2) Mental illness causing Opiate dependance (36%). These pts. were obviously
psychotic and became dependant through psychotic experimentation. Dependance was thus
a symptom of psychosis. Possibly exogenous opiates can suppress production of existing
abnormal endorphins with initial relief, rapid tolerance and gradual deterioration. 3) Opiate
dependance causing Mental illness (16%). In these personality changes developed as a
result of opiate abuse. Perhaps induction of exogenous opiates disturbed the physiology to
the extant that abnormal endorphins were produced causing symptoms of mental illness.
Conclusions: Though these theories need validation on a large scale, they do question the
stereotyped therapeutic model. The classification of patients into the above categories
suggests different management strategies and may be of practical importance. The foil, are
c
suggested: (1) Social acceptance, opium permits, methadone, gradual decrease. (2)Primary
management of mental illness, scaled withdraw! methadone or B-endorphin. ECTs may
help.(3) Nalorphin may be of use + symptomatic treatment.
21-3
Predectors of Adherence to Treatment in chemical Dependance
Kishore P, Agarwal S, Sharan P, Pandey R M
Treatment in chemical dependence is fraught with a very high rate (30%-50%) of drop outs.
Factors associated with this have been focussed upon though no consensus in
differentiation has been achieved. The study addresses the issue of differentiating factors.
The subjects comprised of 268 cases of drug dependance admitted to the treatment centre
in one year. Results indicate that about 68% of in patients do not complete a 28 day
package consisting of detoxification and psychosocial management. Multivariate strategies
using stepwise logistic regression yielded three parameters, viz, heroin as the primary drug
of dependance, associated use/dependance of another substance excluding tobacco and
presence of legal problems as differentiating the group of completers from drop outs. The
limitations of the study and implications in treatment planning are highlighted.
113
Session - 21
Drug Abuse
Hall- Cauvery
21-4
Ethnographic observations of drug injecting in Manipur and
Calcutta: implications for intervention
Chatterjee A, Zomi 6 T, Hangzo C Z
Several sessions of injecting Heroin, 'Spasmoproxyvon' in Manipur and Buprenorphine alone
or in combinations with various injectable in Calcutta among the drug injectors were
observed in natural settings. Observations and subsequent interviews show that knowledge
and risk perception of HIV associated with sharing needles and syringes are quite high in
Manipur and the users were mostly either using their own syringe and needle or cleaning
with bleach. However, potentially dangerous practice of 'indirect sharing' of water
container and water for rinsing blood stained syringe and needle and sharing the same
water for drug mixing, cotton used as filter is common and knowledge of the risks involved
in such practices is low. Injectors in Calcutta, though perceives the risks involved in sharing
syringe and needles as 'disease from one may be transmitted to the other', AIDS did not
figure in their knowledge or perceptions of risk. Sharing syringe and needle is quite
common. Most sharing takes place to save maximum amount of money or optimum
utilization of the drugs and not primarily because of any 'ritual' of injecting drugs. Certain
cross cultural comparisons are made and implication for interventions will be discussed.
21-5
Psychosocial Factors Contributing to relapse in opiate
Dependence
Rakesh Ghildiyal, Shubhangi Parkar, Anupam Iyer
Bombay
In the management of drug addiction, "relapse prevention" is a major issue. The main
obstacle in the treatment of drug addiction is "relapse". As there are factor contributing to
the onset of addictive behaviours there are specific contributing factors towards relapse.
The focus of intervention is shifting to preventive strategies aiming at relapse prevention. In
114
Session - 21
Drug Abuse
Hall- Cauvery
this study we have attempted to highlight factors like craving, rejection and interpersonal
stressors perceived by the patients as significant in a group of 100 patients of opiod
dependence. The data is statistically analysed and the findings are discussed.
21-6
Substance Abuse Among Women a clinical profile
Shdpa Desai, Shubhangi Parkar, Anupama /yer
Bombay
In terms of sociocultural context substance abuse in women is not a "visible"and
acceptable phenomenon. It is also noticed that with increasing concept of empowerment of
women in Western countries, the number of women drug abusers is also increasing. The
pattern of'drug abuse is different, depending upon the social profile of a woman e.g.
sociodemographic, prevalence of single or multiple drug abuse, and treatment seeking
behaviour. The profile of drug abuse in women from developed countries differs from those
from developing countries. In this study, the clinical profile of 35 male and 35 female drug
addicts is compared. The data is statistically analysed and the findings are discussed.
21-7
Pattern of Multiple Substance use in Heroin Dependent
Individuals
Dhanesh K Gupta, Desai N G, Kishore C, Choudhary G
New Delhi
Hundred patients with current or past diagnosis of Opioid Dependence Syndrome (Heroin) on
DSM-III R consequently screened from the out patient services of Drug Dependence
Treatment Centre, Department of Psychiatry, AllMS, New Delhi constituted the sample.
These patients were evaluated for other substance use with a semistructured interview
schedule eliciting life-time and current pattern of use, combination of substances used and
type of their use. Sixty five of the total patients were found to be dependent on one
115
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Drug Abuse
Hall- Cauvery
substance (excluding Nicotine) (50% Heroin, 13% injectable Buprenorphine, 2% opium) at
the time of assessment. 27% were dependent on two substances ( mostly opioid +
Benzodiapepine) and 8% were dependent on more than two substances. Evidence for
Nicotine dependence was found in 97% of the cases and Alcohol use in 50% cases. After
excluding Nicotine and Alcohol use, 60% of the heroin dependent individuals were found to
be currently using other substances also ■ Cannabis (32%), non-injectable opioids (22%),
Benzodiazepines (20%), Antihistaminics (20%) & Alcohol (10%). The rate of current or past
other substance use (except nicotine and alcohol) was found to be 82%. The substance use
pattern in these patients was categorised as per the commonly described three types. The
most frequent was sequential use (34%) followed by concurrent use (26%) and ancillary
use (22%). The further analysis revealed that abuse of alcohol and cannabis in heroin
dependents is unrelated to heroin use while abuse of marketed combinations of
benzodiazepines and antihistaminics, in most cases was initiated as ancillary use, but
turned out to be concurrent. Use of opioid compounds other than heroin was found to be
ancillary in most of the heroin dependent cases. The findings of the study provide evidence
for emerging patterns of multiple substance use in heroin dependence.
21-8
Reasons Behind Increasing Buprenorphine Abuse
Vinay Kumar, Singh B K
Patna
Buprenorphine Abuse is becoming increasingly popular among substance abusers. 100
cases of Buprenorphine abuse, who met DSM lll-R criteria for opiate abuse were studied to
find out the etiological factors. Following pattern of abuse emerged:
Group A: Heroin + Buprenorphine S.O.S. ■ 56%, Group B: Post-Heroin Buprenorphine - 32%,
Group C: Only Buprenorphine ■ 22%. History of prior Cannabis abuse was present in 75%
cases of Group A; 56.44% cases of Group B and 13.65% cases of Group C. Following were
the prominent reasons behind preference to Buprenorphine: Easy availability, Low cost.
Purity, History of Detoxification with Buprenorphine and latrogencity.
116
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Drug Abuse
Hall- Cauvery
21-9
Help line Imphal - An outreach Programme to Hiv/Aids and Drugs
Gyaneshwar Sharma
Imphal
Help line telephone service Imphal is run by a Voluntary Organisation SASO with objective
of providing outreach services at the doorstep to HIV/AIDS and drug related problems.
During May 1995 to September 1995, 35 families called for help. All 35 cases are attended
and all are found to be a former or current Heroin intravenous user. 11 requested help for
heroin addiction treatment, out of which 5 are escorted to rehabilitation centre, 3 referred
to rehabilitation centre, 1 referred to hospital, 2 motivated only. 3 called for help where
only counselling for HIV/AID is required. Remaining 21 called for help in the treatment of
Physical illness. Pulmonary tuberculosis is the commonest associated physical illness
followed by fever, weight loss and diarrhoea. Out of 35 cases, 9 are HIV seropositive, 26
are unknown status. 2 meet the criteria of diagnosis of AIDS and 8 are suspected to be
AIDS and 5 are dead. Help-line Imphal is perhaps the only one of its kind in the North-East
India providing need based community service to HIV/AID and Drug related problem. Data of
this short period, symptoms of associated illness, Psychosocial problem and nature of help
provided is being analysed and discussed.
21-10
Psychiatric Morbidity in Cannabism
Jaideep Sarkar, Pratima Murthy, Kaliaperumal V 6, Channabasavanna S M
Bangalore
Although cannabis use may not be viewed as a serious health problem, "cannabism" is
associated with significant psychiatric morbidity. This study reviews cannabis abusers seen
at a psychiatric facility in the last 10 years. Case records of 244 cannabis abusers were
reviewed using DCR/ICD 10 criteria.164 (67.2%) of this population had a psychiatric
disorder other than harmful use and dependence. Most of the patients(87.5%) developed
117
Session ■ 21
Drug Abuse
Hall- Cauvery
the psychiatric disorder subsequent to drug use. 64% of the patients had not used any
other drugs. Behavioural problems were the commonest reasons for referral (56%). While
58(35%) received a diagnosis of cannabis psychosis, 52(31.7%) a diagnosis of
schizophrenia, delusional disorder or unspecified psychosis. 33(20%) received a diagnosis of
affective psychosis, and 21(12.8%) a diagnosis non-psychotic psychiatric syndromes.
Details of sociodemographic background treatment, follow up and outcome are presented.
The changing patterns of referrals of cannabis users and the relationship between cannabis
and psychiatric illness are discussed.
118
Biology of alcoholism
Session - 22
Hall-Krishna
BIOLOGY OF ALCOHOLISM
22-1
Factors Associated with Hepatic Dysfunction in Alcholics
Leeia S, Baiaji W, Benegai
Chatterjee S, Jain S,
Chandrashekar C R
Bangalore
Alcoholic fatty liver and other forms of hepatic dysfunction invariably accompany the
syndrome of alcohol dependence. However there is not often a straight linear relationship
with the amount of alcohol used. Family loading, age at onset of dependence and the type
of alcoholism have variously been implicated as factors affecting differential tissue damage
due to alcohol. The current study is an attempt to examine the relationship of 1) Family
history of alcohol dependence, 2) age at onset of dependence, 3) duration of dependent
months, 5) type of beverage, 6) comorbid diagnoses and particular indices of liver damage
(SCOT, SORT and gamma glutamyl transpeptidase) in a sample of 100 patients admitted for
deaddiction to the inpatient facilities of the National Institute of Mental Health and Neuro
Sciences.
22-2
Neuropsychological Deficits in Patients with Alcohol
Dependence Syndrome
Shenoy J, Senegal K Matam Pf Chatterjee S, Jain S, Pasricha S,
Chandrashekar C R
Bangalore
There have been some reports from Western literature, of neuropsychological deficits in the
absence of clinically evident brain damage in alcoholics. Some preliminary evidence
indicating association between type of alcoholism and nature of deficit have recently been
noticed. In the absence of comparable Indian data, the present study was planned to
119
Session ■ 22
Biology of alcoholism
Hall-Krishna
examine the neuropsychological status of patients with alcohol dependence. 50 patients
with a diagnosis of alcohol dependence (ICD 10) without other comorbid diagnoses,
screened for the absence of clinically evident central nervous system deficits were
assessed on the Neuropsychological Test Battery. More than 70% of the sample were
found to have significant Right Temporal Lobe deficits and a lesser proportion Frontal lobe
deficits. Associations between these deficits and the type of alcoholism were observed
which have significant implications for planned interventions in alcoholism.
22-3
A study of Working Memory in Alcoholics
Sharma S, Mukundan C R, Rao S L
Bangalore
Working memory is defined as online memory which interacts with ongoing processing of
information. Individual holds on to relevant information as long as required and is made
available for processing as and when required. It has been suggested that the frontal lobes
are closely associated with working memory. A delayed response test as a test for working
memory and tests of visual and verbal learning and memory functions were used on three
groups of subjects: alcohol dependent patients, frontal lesion patients and normal controls.
The performance of the three groups were statistically compared to determine the
involvement of working memory in alcoholism as well as its relationship with learning and
delayed recall, which are presented in the paper.
22-4
Electrocardiographic abnormalities in alcohol dependence
syndrome
ChaudhuryS, Bhardwaj P
Meerut
This study comprised 80 consecutives male patients with alcohol dependence admitted to a
service hospital over a period of two years and an equal number of age and sex matched
controls. The age ranged from 24-54 years. ECG alterations due to other conditions were
120
Session - 22
Biology of alcoholism
Hall-Krishna
excluded. ECGs were recorded within 6 hours of admission and repeated after five weeks of
enforced abstinence. During initial evaluation ECG abnormalities were noted in 59 patients
and 8 control subjects (Difference statistically significant). Commonest ECG abnormalities
were QTc prolongation (n = 18), sinus tachycardia (n = 11) sinus bradycardia (n = 9),
intraventricular conduction defects (n = 8) and Tall T waves (n = 8). After five weeks of
abstinence there was a statistically significant reduction in ECG abnormalities.
22-5
Heart rate variability in alcoholics
Jayaprakash M S, Ramakrishnan A G, Asha H M, Gangadhar B N, Janakiramaiah N
Bangalore
Alcohol dependence leads to deleterious effects on nervous system including Autonomic
Neuropathy. The latter indirectly results in Cardiac Dysfunction. Newer techniques using
computers allow assessment of this dysfucntion by noninvasive method - Heart Rate
Variability (HRV). Twenty male patients (mean age = 38.8 years, SD = 7.2) with a
diagnosis of alcohol dependence and twenty age - sex matched normal controls (mean age
= 37.7 years, SD = 8.2) participated in this study following consent. ECG was recorded in
supine position from chest leads using a commercial monitor after acclimatizing the subject
in a sound attenuated quiet room for 15 minutes. Four minutes artifact free ECG was
digitized at the rate of 500 Hz using a 12 bit ADC and was acquired into a computer. ECG
was later analysed without knowledge of clinical details using a specially developed
software. The mean, Sd, Coefficient of variation in R-R intervals (CVr-r) in patients (2.9,
1.2) was significantly smaller than that observed in controls (4.4, 1.7) suggesting cardiac
autonomic dysfunction in alcoholic patients.
121
Session ■ 22
Biology of alcoholism
Hall-Krishna
22-6
Event-Related Potential study in alcoholism
George M R M, Mukundan C R
Bangalore
The study aimed at examining the nature of visual EBP components in a group of alcohol
dependent individuals. The sample consisted of 10 alcohol dependent individuals and 10
normal controls. The tests consisted of (1) verbal recognition test in which the subject had
to identify a meaningful English words and respond with a key press, (2)a visual search test
wherein the subject had to identify a target stimulus from an array of stimuli presented on
a monitor. If the target was present in the array, the subject had to respond to it by a key
press. A 19 channel recording was conducted using the 10-20 electrode placement system.
The EBP analysis was done on a Biologic Topographic Brain Mapping system. The mean
latencies and amplitudes of the significant wave forms were compared between the two
groups. The significant findings are discussed in the paper.
22-7
Visual P300 response in alcoholics
Dwivedi P, Mukundan C P, Rohrbaugh J W, Gangadhar B N, Janaki Ramaiah N J,
Subbakrishna D K
Bangalore
The study was undertaken to assess visual information processing among alcohol
dependent individuals using Event-Belated Potential (EBP) methodology. Two groups of
alcoholics (differing in the presence of family history) and a group of normal controls
performed two tasks: while the first was a simple oddball task requiring detection of an
infrequently-appearing, vertically oriented rectangle, the second task involved detection of a
repeating stimulus in a continuous sequence of non-verbalizable shapes presented on a
monitor. EEG was recorded and analyzed using a 32-channel system. Besults cocerning
topographical and amplitude differences among the groups and across task-levels, and
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Session ■ 22
Biology of alcoholism
Hall-Krishna
implications thereof, will be discussed inthe presentation. (The project supported by USIndia Fund N-424-645).
22-8
Contingent negative variation in alcoholics
Mukundan C /?, Rohrbaugh J \N, Gangadhar B N, Janakiramaiah N J, Dwivedi P,
Rangaswamy M, Subbakrishna D K
Bangalore
CNV is a slow negative DC shift associated with anticipation and vigilance. Twenty alcohol
dependent patients with family history of alcoholism and 20 patients without such family
history were compared with 20 normal control subjects on CNV. The task consisted of an
auditory warning signal followed by either of two visual stimuli of whichthe subject was to
respond to one. Thirty channels of bioelectric activity was recorded using scalp electrodes.
The amplitudes of an early and a late CNV components between the two stimuli were
computed whenever present. The third response seen was a positivity whenever the subject
responded to one of the visual stimuli. Results and their implications are discussed in the
paper.
(The project supported by U.S.-India Fund N-424-645.)
22-9
Mismatch Negativity in Alcoholics
Rangaswamy M, Mukundan C Rf Rohrbaugh J W, Gangadhar B N,
Janakiramaiah N J, Subbukrishna D K
Bangalore
Mismatch Negtivity (MMN) is an event related potential (ERP) elicited by infrequent,
nonattended, physically deviant stimuli in a series of frequent standard, nonattended
stimuli. The component reflects a preattentive deviance detecting process which is
automatic. The present study evaluates automatic processing in two groups of 20
123
Session ■ 22
Biology of alcoholism
Hall-Krishna
alcoholics, with and without family history and 20 normal subjects using an EBP paradigm.
ERPs were recorded using a 32 channel system. The potentials were recorded for the
ignored auditory oddball paradigm while the subject attended to a visual task. The MMN
component is obtained from the difference waveform. The latencies and amplitudes of this
component was compared. The findings and their implications will be discussed. (The
project supported by US India Fund N-424-645).
124
Session - 23
Miscellaneous I
Hall-Tunga
MISCELLANEOUS I
23-1
A study of hypochondriacal symptoms in psychiatric disorders
Sudhir Kumar C T, Rajesh Mohan, Chandrasekaran R
Pondicherry
One hundred consecutive patients who underwent a detailed evaluation at the outpatient
Psychiatry unit in a General Hospital were included in the study. The screening instrument,
Whiteley Index was administered to detect the presence of Hypochondriacal symptoms in
these patients by a rater who was blind to the diagnosis. The prevalence and the extent to
which these symptoms occured in association with other psychiatric illnesses will be
discussed.
23-2
Neuropsychological Rehabilitation in schizophrenia - A case
study
Shobini L Rao, Sydipta Mukherjee, Prabha Chandra, Jamuna N,
Mukundan C R
Bangalore
Neuropsychological rehabilitation improves brain functioning by treating cognitive,
emotional and behavioural deficits. The functional impairment in schizophrenia was
targetted through this approach. Mr.X a 25 year old male, educated upto 4th yr. M.B.B.S.,
with chronic schizophrenia had deficits in cognitive, emotional, social and occupational
functioning. Despite neuroleptic medication he had active symptoms, was amotivated,
withdrawn with poor eye contact, distinterested in studies, work, family and social
activities. Neuropsychological assessment found deficits in visual memory and information
processing. He underwent neuropsychological rehabilitation for 6 months as an inpatient.
125
Session - 23
Miscellaneous I
Hall-Tunga
Neuroleptic medication was continued. Information processing, memory organization,
emotional encoding and emotional expression were trained. The trained functions improved.
Improvement generalized to social and occupational functioning. The psychotic symptoms
remitted. Improvement maintained at 3 month follow up.
23-3
Psychiatric Morbidity in an after care home for women
Srinivasa Reddy P, Sanjiv Jain
Bangalore
Women with chronic Psychiatric problems are known to be more likely to be
institutionalised. In the absence of any long term care services several non-psychiatric
institutions have been used for this purpose, e.g. Jails, Remand Homes etc. We studied the
resident population of one such home in Bangalore. All inmates were personally evaluated
and a clinical diagnosis arrived at as per ICD ■ 10. A signigicant percentage (39%) had neuro
psychiatric morbidity with psychosis constituting 72% of these. The mean duration of
illness for psychosis was 113 months and mean duration of treatment was 50 months.
Provision of long term care by non-psychiatric institutions exposes the lacunae in
psychiatric services. Long stay facilities thus need to be significantly expanded.
23-4
A study on working schizophrenic in patients of a mental
Hospital
Mataiappan M, Chandrateka, Murugappa M, Vivekanandan S,
Bashyam V S P
Madras
52 Schizophrenic inpatients working in the occupational therapy unit and the Industrial
Therapy unit of Institute of mental Health, Madras-10, were assessed for their work
performance. The relationship of the work performance with the present positive
126
Session - 23
Miscellaneous I
Hall-Tunga
symptoms, negative symptoms, cognitive deficits and record variables were studied. The
role of incentives on work performance was analysed.
23-5
Burden Assessment Scedule (BASS)
Thara R, Padmavati R, Shubha Kumar Ms
Madras
Care of the chronic mentally ill involves a lot of subjective distress and burden which take a
heavy toll of families. It was therefore decided to develop in instrument to assess this
aspect of burden based on ethnographic methods Unstructured and semistructured
interviews, and focus group discussions followed by qualitative validation resulted in the
"Burden Assessment Schedule of SCARE ■ SEARO (BASS)". Factor analysis yielded 10
fOctors. Using the BASS, it was found that burden of families of Schizophrenia patients
was associated more with patients' disability than with psychopathology.
23-6
Sanjivani experience : Issues in Psychiatry Rehabilitation in a
rural area
Radhakrishnan VK, Antony Mannarkalam, Joan C, Channabasavanna S M
Bangalore
The importance of psychiatry rehabilitation is gaining momentum in the recent past.
Professionals starts showing more interest in setting up day care centres, half way homes,
and rehabilitation centres. But setting up a rehabilitation centre is a challenging task. This
study presents the problems faced during the initial phases of setting up a rehabilitation
centre in a rural areas in Kerala, a Sanjivini experience.
127
Session ■ 23
Miscellaneous I
Hall-Tunga
23-7
A study of Neuropsychological features in different clinical
groups
Savita Jagawat, Jagawat T, Shukla T R
Delhi
The study was carried out to find out Neuropsychological features of different clinical
groups as revealed by new inkblot technique which is developed at CIP, Ranchi. Total 100
chronic schizophrenic cases, 100 organic cases and 100 normal controls were taken for the
sample of the study. ICD-9 criteria were used to diagnose the psychiatric cases. 10 new
inkblot cards, B.G.T. cards and MFDT cards were used. Out of total 18 variables of new
inkblots, total 9 variables were found to be significantly differentiating between chronic
schizophrenics and organic cases, these were ■ Total number of responses, initial reaction
time, rejection, form definitness, goodness of form, color, movement, pathological finding
and anatomy. The implication of these findings are discussed in the paper.
23-8
A comparitive study of General Well-being and Psychological
distress of the instutionalised and non-instutionalised elders
Sr. Anice, Nagesh Pai, Mary Varghese
Mangalore
Fifty institutionalised elderly subjects were compared with fifty non-institutionalised elderly
on PGI General well-being scale and GHQ. The General Well-being of those aged living with
their family is comparitively higher than that of instiutionalised elderly. However on their
level of Psychological distress, the two groups are comparable. Implications of the results
will be discussed.
128
Session ■ 23
Miscellaneous I
Hall-Tunga
23-9
Psychiatric Morbidity in Geriatric Population
Sharma K P, Singh B K, Singh / D
Patna
The present study was conducted at Boring Canal Road, Patna, a urban population to
investigate the prevalence of psychiatric morbidity in population aged sixty yrs & above.
Patients were analysed in relation to Age, sex, Religion, family type, education socio
economic status and physical illness. This study will show more light into the present urban
geriatric psychiatric morbidity pattern so that we can plan our national programmes to suit
those who are in need.
23-10
Profile of Geriatric patients attending general hospital
psychiatry unit
Chaukimath S P, Bhairwadgi S S
Bijapur
People in geriatric age group make significant bulk of our population. Psychiatric facilities
available for this group is woefully less in this country. A retrospective analysis of 212
geriatric patients who attended Psychiatry unit of a general hospital in the last 3 years, is
undertaken. The demographic profiles, major diagnoses, and support system available are
checked. The results are being analysed.
129
Session - 24
Miscellaneous II
Hall-Bhadra
MISCELLANEOUS 11
24-1
Does Mental Health Nursing course brings out a attitudinal
change in the students towards mental illness?
Anoopa, Nagesh Pai, Mary Varghese
Mangalore
Tha attitude towards Mental illness of fith semester B.Sc Nursing students who have
completed Mental Health Nursing course was compared with those who have not
undergone the same training using orientation towards mental illness (OMI) scale. It was
revealed that the group who have not undergone the Mental Health Nursing course did not
differ significantly from the other group who have not undergone the said course in the
matter of their attitude towards mental illness on the five domains of their attitude as given
in the OMI scale. Results of the study will be discussed.
24-2
Senior Medical Students' attitudes towards psychiatry
KamleshPatel, Praveen T, Sandeep Shah M D, Shabari Dutta,
VankarGK
Baroda
Ninety eight (56 males and 43 females) senior medical students responded anonymously to
the 'Attitudes Towards Psychiatry Questionnaire' (Nielson anmd Eaton 1981).
Majority had positive attitudes towards psychiatry. 18% students considered psychiatry
unscientific and imprecise. 1 /3rd considered psychiatry as having a low status among
medical specialities, while 31% believed that psychiatrists made less money. Half of the
respondents considered psychiatric referrals for medical and surgical patients as not useful.
Attitudes were similar on most items in both sexes and at all levels of academic
performance. The relevance of these findings are discussed.
130
Session - 24
Miscellaneous II
Hall-Bhadra
24-3
Knowledge about psychiatric disorders among undergraduate
medical students
Kamlesh Patel, Sandeep Shah, Gautam Amin, Ismail Paia, Vankar G K
Baroda
Knowledge about psychiatric disorders among 106 undergraduate medical students was
assessed through objective test as a part of term ending written examination. The test
consisted of questions on various psychiatric disordes as well as questions on four case
vignettes. All students had lectures on psychiatry and a two week clinical posting in
psychiatry department. For the test of 100 marks, range of score was 33.5 to 80.0 with
mean score being 54.5. Performance on case vignettes was better. Deficits in knowledge
observed were in areas of psychiatric disorders due to a general medical condition,
substance use disorders and child psychiatry including mental retardation. The implications
for undergraduate psychiatric education are discussed.
24-4
Knowledge, attitudes and practices of post graduate doctors
regarding diagnosis and treatment of alcohol use disorders.
Shabari Dutta, Gautam Amin, Vankar G K
Baroda
Knowledge, attitudes and practices of post graduate doctors in training at S S G Hospital,
Baroda regarding diagnosis and treatment of Alcohol Use Disorers (AUD) were surveyed
using a questionnaire modified from Geller et al (1989). We report the analysis of 224
responses. Knowledge level was generally low, particularly in areas of physiology and
biochemistry. Respondents from psychiatry had highest mean knowledge, those from
anatomy had the lowest.
Most postgraduates have positive attitudes regarding character weakness, prognosis and
treatability. However majority did not consider alcohol dependence as a disease.
131
Session - 24 •
Miscellaneous II
Hall-Bhadra
Not more than 55% of postgraduates had high confidence for any of the clinical activities
for AUD-screening, patient and family counselling and referral. 50% had high confidence in
screeniong and referral, 60% had the same in treatment and diagnosis. Referral rates were
low. High confidence and assumption of major responsibility for screening were strongly
associated with higher reported screening. Higher level of traning or belonging to a clinical
or non clinical speciality were not associated with higher knowledge levels, positive
attitudes, high confidence or acceptance of major role responsibility. Thus implications of
post graduate education in A U D are discussed.
24-5
Hazards of the shift work
Kar N, Dutta S, Kar 6 C, Das I
Bhubaneswar
There is a growing concern over the accidents in night shift work. The injuries of 66
workers in different shifts, their relation to nature of work and the age of worker were
studied in a large engineering company where the accident risk appeared to be constant
over the three shifts. There was a slight increase of frequency of injuries during night
(38.7%) with preponderance of severe injuries occured with on track jobs with
comparatively more severity in night, than those from off tract jobs. Younger people were
more vulnerable to accidents during night.
24-6
Election
A Stressful life event
Shiv Gautam, Agarwal R, Sharma H
Jaipur
54 patients who reported developing psychiatric illness following local bodies (Panchayat)
elections in Rajasthan state, presenting at Psychiatric Centre, Jaipur, were studied to find
out whether election is a stressful life event, relationship of socio demographic
characteristics, role of process of election, and nature of psychiatric illness as related to
132
Session - 24
Miscellaneous II
Hall-Bhadra
election stress. This study group was compared to general psychiatric patients reandomly
selected from the same hospital, with or without other stressful life events (n = 60). It was
found that election stress is significantly more among male sex (94.5%), between 21-40
years (65%). This being a panchayat election there was significantly higher number of rural
persons (100%) and farmers (55%) by occupation. Significantly higher number of persons
presented with Acute and Transient Psychotic Disorder (52%) in the election stress group,
while Schizophrenia and Affective Disorder was more common in the control group (82%).
Ways of coping the stress and relationshp of predisposition to mental illness has also been
studied in both groups and findings have been discussed and implications have been
highlighted.
24-7
Issues in the care of female psychiatric patients
Sathyanarayana K Prabha, Chandra S
Bangalore
There is paucity of data examining gender specific issues in psychiatric illness Aims: (1)
To examine genderspecific psychosocial, marital & reproductive factors associated with
female psychiatric patients (2) To study relationship of these factors to diagnostic groups
& sociodemographic factors. Methods: Case files of female inpatients (n = 144) in a unit
during 1 year (1994-95) were traced & analysed. Results: 58% were aged < 30 years.
55% married & 27% single. 23% had reproductive problems, 50% marital issues, 26%
psychological problems in relation to psychiatric illnesses. 12% had onset in relation to child
birth, 9% had child birth before 18 years of age (28% got married before age 18 years). Of
the psychological issues 13% were self esteem problems, 13% unfulfilled ambitions. The
relationship between different diagnostic categories & gender specific issues will be
presented & the implications of the study on the understanding & management of different
psychiatric illness will be discussed.
133
Session - 24
Miscellaneous II
Hall-Bhadra
24-8
Assessment of Dangerousness
Utpal Goswami
New Delhi
Direct links with particular diagnoses and mental states in relation to harm to self and
others is controversial. The emphasis varies from 'madness' to 'badness'. Inter-individual
variations exist with reference to "dangerousness" which is predictive construct. Infering
dangerousness based on specific diagnostic/mental state is difficult. Violence can be
assessed after its occurrence, but dangerousness is the probability of a given (future)
violent act (and harm) occurring. Assessment of dangerousness is individually tailored. The
best predictors of future violence are the person's past behaviour, psychological
understanding, correlation of past mental state with past violence and linkage with
functional or organic diagnoses and psychopathology. Personality factors & criminological
data are helpful. It is necessary to identify potential victims and risk factors for therapists.
Management required recognition of the roles of treatment setting, management strategies
and legal context.
24-9
Milking a Miracle
Pradhan P K Alka S Ahuja, Madhuri GangoHa, Vandana Mahajan
Bombay
The recent milk miracle on 21st September 1995, in which hundreds of thousands of people
queued up to feed "milk drinking" idols of Lord Ganesha and Shiva, raised a number of
intriguing questions like
1)
2)
What did the people think of the Milk Miracle?,
Why did so many otherwise normal individauls participate in a mass outburst of
emotional and excited behaviour?
134
Session ■ 24
3)
Miscellaneous II
Hall-Bhadra
Did it represent the triumph of anti-science over science? and
How did it influence the life of a comon man?
4)
In an attempt to answer these questions a study was carried out in the outpatient
department of a general municipal hospital. 100 people i.e. 50 patients with a psychiatric
illness and 50 people as a control group were interviewed using a specially prepared
proforma. The results of this study are almost 60% of the patients believed in the miracle*
However, the neurotics and depressed patients belief was more than that of the psychotic
patients. Females as compared to males had stronger views regarding this event. Findings
of this group were compared with the control group.
135
Session - 25
Miscellaneous III
Hall-Sharavathy
MISCELLANEOUS III
25-1
Do Astrological Forecasts Predict Behaviour and Experiences?
Chitra Andrade A, Chittaranjan Andrade, Lakshmi R, Reshma M
Bangalore
In a study of the validity of astrological forecasts, 34 female college students were asked
whether their behaviour and experiences in the past week represented a hit or a miss for
each of 15 statements. Five of these 15 were statement valid for each student's sun sign
for the period under assessment, taken from the published weekly forecast of a popular
astrologer. Five more were statements valid for a sun sign that was different from that of
the student being investigated. The remaining 5 were dummy statements, prepared with no
reference to astrology, and matched for content and character with the astrology
statements. The 15 predictions were presented in random sequence with the rater and
subjects blind to their source. The results showed that the predictions from the correct sun
sign, from the wrong sun sign and from the dummy set were (on average) 43%, 44.2% and
48.8% correct respectively (p > 0.50). It is concluded that astrological forecasts do not
predict behaviour and experiences with greater accuracy than random predictions or
cultivated guesses.
25-2
Pathological Gambling-A Study
Hemant Naidu, Thacore A S
Lucknow
564 urban individuals were screened on a 15 item questionnaire derived from DSM-III-R
criteria for pathological gambling. Subjects meeting the criteria (46) were then assessed on
the NIMH Diagnostic Interview Schedule (DIS-III-R) leading to a diagnosis of pathological
gambling in 21 (3.72%) individuals. These subjects were subsequently assessed in detail on
136
Session - 25
Miscellaneous III
Hall-Sharavathy
SCIO & SCID-II (Structured Clinical Interview for DSM-III-R) for associated Axis I & II
disorders, 11 (52.8%) subjects had an additional psychiatric diagnosis (6 on Axis I & 5 on
Axis II). Associated findings regarding the nature of gambling & demographic variables are
discussed.
25-3
Hindi Adaptation of Eating Attitude Test-Preliminary Endings
Pratap Sharan, Ritu Nehra, Manju Mohanty, Dwaraka Pershad
Chandigarh
Eating attitude Test-26 (Garner et.al.1982) was translated into Hindi, with the aim to adapt
it for use in the Indian population. Five mental health professionals translated the test
independently. The simplest and direct expressions, conveying the meaning of the original
were compiled in the first draft. This was scrutinized by a team of three experts. They
suggested modifications in the translation of four items (1,4,5,22)and a switch from Lickert
type scoring to a forced choice format. The second draft incorporating these suggestions
was made. The English and the Hindi versions were administered to thirty young ladies (age
range 15-30 years) in a cross over design. Twenty-eight completed responses were
obtained. Endorsement rate for items ranged from 0 to 16 (57%) on either version. The
mean endorsement rate per item was 6.54 (23.6%) in English and 6.46 (23.1%) in Hindi. A
significant difference in endorsement was observed only for one item (number 20)
(x2=4.67, df = 1, p 0.05). Eleven items were endorsed more often in English and nine in
Hindi. There was no difference in endorsement rate for the scale (t= 0.06 NS). Agreement
on each item ranged from 57.1% to 100% average being 86.54% correlations were good
for most of the items. Non significant correlations were obtained only for items 4, 5 and
20. Product moment correlation for the whole scale was 0.75 (p 0.01).
137
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Miscellaneous III
Hall-Sharavathy
25-4
Eating Disorders in India
Srinivasan T N, Suresh T R, Vasantha Jayaram, Peter M Fernandez
Madras
Eating Disorders often do not manifest in severe forms like Anorexia nervosa and Bulimia in
non-western cultures like India, Where they are milder in nature with fewer symptoms. In
the absence of major disorders, standard questionnaires for detecting them like Eating
Attitudes Test are not appropriate for use in populations with very low or nil prevalence of
major disorders, but where minor forms of eating disorders occur. One such milder disorder,
Eating Distress Syndrome described by the authors in an earlier study, is replicated here and
its associated variables are studied. The paper discusses the factors influencing the
presentation of eating disorders in a milder form rather than as Anorexia nervosa or Bulimia
in India.
25-5
Anorexia Nervosa : A retrospective Study
Prashanth Mayur, Raghuram R
Bangalore
Anorexia nerosa has been rarely reported from India and there has been no reports of its
prevalence in institutional settings. On this background, the present study was undertaken
to examine the occurrence of this disorder in a large mental hospital. A retrospective file
review of both the inpatients and outpatients seen at the National Institute of mental
health and neurosciences was undertaken for the period 1982-1994. The prevalence of
anorexia nervosa during this 14 year period was .013%. 6 cases met the Diagnostic criteria
for research 10 (OCR 10) for anorexia nervosa, 5 of which were typical and 1 case was
atypical (without amenorrhoea). As anticipated there was a striking preponderance of
female cases with the average age of onset of the illness among the females being later
then that of the male case. The average duration of the illness prior to the consultation was
12 months. Majority of the cases had a co-morbid depressive disorder. In most of the cases,
138
Session ■ 25
Miscellaneous III
Hall-Sharavathy
improvement was not significant at discharge. The impact of this preliminary study and the
future course of research in this area would be discussed in the text.
25-6
Simple Schizophrenia: A fossil or a chameleon?
Tushar Jagawat, Dash D K, Pradhan S C
Delhi
Due to contributions of Diem, Bleuler and Kraepelin, simple schizophrenia was accepted as a
psychiatric entity in various psychiatric nosology. The traditional diagnosis has a long and
chequered history. In time the concept become unclear, was used infrequently and exhibited
poor reliability and doubtful descriptive validity, so it has taken as some of the attributes of
both a fossil and chameleon. Of the two main classification system used in psychiatry, the
ICD and DSM, the former (ICD-10) continues to retain it but it was not included under
schizophrenia in DSM-IV and renamed it as simple deteriorating disorder under rubric of
other psychotic disorders. To find out the current status of this controversial diagnosis, the
study included only those new cases who had attended Psychiatric OPD and received ICD10 diagnosis of schizophrenia during the 6 months period. Not even a single patient was
diagnosed as a case of simple schizophrenia. The implication of these findings are discussed
in the paper.
25-7
Life Events and Psychopathology in first Episode Depression,
Mania and Schizophrenia
Joseph P. Anto, Sharma L N
Bombay
Aim:
1) To compare the quantity and quality of life events in First episode Depression,
Mania and Schizophrenia within 1 year, 6 months, 3 months and 1 month prior to the onset
of illness. 2) To explore the relation between severity of events and severity of
139
Session - 25
Miscellaneous III
Hall-Sharavathy
psychopathology.
Methodology : Consecutive patients attending outpatient department of Central Institute of
Psychiatry, Ranchi over a period of 6 months (1st November 1994 to 30th April 1995) were
screened. All patients with a diagnosis of 1st episode depression, mania and schizophrenia
based on ICD-10 criteria were included in the study. Instruments used include specially
designed clinical proforma, Gurmeet Singh's Presumtive stressful life events scale,
Blackburn's Modified mania rating scale, Hamilton Depression rating scale and Positive and
negative syndrome scale. A comparison of frequency of life events, stress scores and type
of life events across 3 diagnosis was done by using parametric and non parametric tests.
Correlation coefficient was used to esamine the correlation between life events and
severity of psychopathology. Results : A total of 90 patients diagnosed as depression,
mania and schizophrenia (First episode) between ages of 18-45 years attended OPD during
the study period. A great majority of patients (93%) had an average of 3 life events 1 year
prior to the onset of illness. There was a marked increase in frequency and stress scores in
all diagnostic groups of patients during 3 months prior to the onset of illness. Manics
scored over depressive and schizophrenics with regard to the frequency and stress scores 1
month prior to the illness (p < .001). 93% of total sample had minimum of 2 undesirable
life events over a period of 1 year prior to the illness. The quality of life events reported by
depressives, manics and schizophrenics was different. A positive correlation has been found
between life events and severity of psychopathology in manics (p < .05). Conclusion:There
is positive relationship between stressful life events and first episode depression, mania and
schizophrenia but the frequency of life events and stress scores varied over different
periods. Manic episode and life events are closely related in time compared to depressive or
schizophrenics. No significant correlation between life events and psychopathology could be
found in any of the diagnostic categories except in manics. The implication of these findings
will be discussed.
140
Session - 25
Miscellaneous III
Hall-Sharavathy
25-8
Penis Image Perception in Depression and Mania
Kothari S, Roy Df Nizamie S Haque
Ranchi
Disturbance of libido is a common feature in depression and mania. Whether a changed
libido is only a state of mind or it also affects the perception regarding the size of the sex
organ is not known. During clinical interview, occasionally, depressive male patients report
a subjective feeling of morphological changes in the size of their penis. Some cases of
incomplete koro which are grafted on a depressive illness suggest that affective illness may
generate a dysmorphic penis image. Incomplete Koro has been reported as a forerunner of
mood disorder (Damodaran & Nizamie, 1993). Whether a biological symptom of increased or
decreased libido may also have a perceptual concomitant regarding external genitalia is not
known. In the present study it was attempted to assess the subjective perception of penis
image by using Draw-A-Penis Test (DART) (Chowdhury, 1989) in 20 cases of bipolar
affective disorder, depression or recurrent depressive disorder; 40 cases of manic episode
or bipolar affective disorder, mania (ICD-10) and 20 normal, nonpatient control. The
sociodemographic and clinical details were recorded on a semistructured proforma designed
for this study. All the patients were administered Brief Psychiatric Rating Scale (BPRS) and
depressives were rated on Hamilton Depression Rating Scale (HDRS) and manics on Young's
Mania Rating Scale (Young et al., 1978) by one of the authors (SK) who was blind to their
performance on DAPT. Analysis of the data demonstrated that depressed patients
perceived their penises smaller than what they thought to be a normal size. The opposite
was true for the manics. Implications of the findings in relation to perceptual, clinical and
cultural variables will be discussed.
141
Session - 25
Miscellaneous III
Hall-Sharavathy
25-9
Cannabis Psychoses - the Affective Angle
Jaideep Sarkar, Pratima Murthy, Kaliaperumal VG, Channabasavanna S M
Bangalore
While there is a prima facie case for believing that cannabis use leads to a putative "cannabis
psychosis", much of the research in this area has looked at its similarity to or its relationship with
schizophrenia. In this study, we focus on the similarities between cannabis psychosis and affective
disorders. Case records of 244 cannabis users refered to a psychiatric facility in the last 10 years were
reviewed. 143 (58.6%) had a psychotic disorder, with 58(40%) diagnosed as cannabis psychosis,
52(36%) as non affective psychosis (schizophrenia, delusional disorder, non organic unspecified
psychosis), and 33 (23%) as affective disorder. These 3 groups on comparison showed no significant
differences on measures of duration and self reported quantity of cannabis use. Phenomenologically,
patients with cannabis psychosis showedsignificantly more elation (p < 0.01) compared with the non
affective psychosis group. Delusions of grandeur, psychomotor disturbances were more common in the
former. On Canonical discriminant function analysis using 12 variables known to have some predictive
validity, predicted group membership to the cannabis psychosis and affective disorder group was 48%
and 52% respectively. 17% of the cannabis psychosis could be reclassified as nonaffective and 19% as
affective psychosis. Detailed methodology and implications of the findings are discussed.
25-10
Gender-Identity Confusion in Cases of the Reincarnation type
Satwant Pasricha
Bangalore
Nearly 2500 cases of persons (mostly children)who say that they remember a previous life, have been
reported and investigated from several cultures including Western ones. In 67 percent of the 856 cases,
a person satisfactorily matching their statements concerning previous life was identified. The subjects in
106 (out of 668) cases remembered having been a member of the opposite sex; some of them showed
corresponding behaviour in the form of either rejecting their anatomical sex or showing gender-identify
confusion. The presence of this feature in the investigated sex change cases of the reincarnation type
may also help in understanding the origin of gender-identity confusion or dysphoria (and homosexuality) in
a previous life even in cases where the persons may not have any imaged memories of that life.
142
Session - 26
Sexual Behaviour and dysfunctions
Hall-Cauvery
SEXUAL BEHAVIOUR AND DYSFUNCTIONS
26-1
Sexual Behaviour in Elderly Males
Mahendru R K
Kanpur
Despite the fact that normal and satisfying sexual activity can be continued in elderly
persons, the sexual matters usually take a back seat in the lives of aging people.
The present study initially attempts to report certain observations on the sexual behaviour
of elderly males and identifying the factors associated with normal and reduced sexual
functioning. 28 out of 60 (46.6%) relatively healthy married male morning walkers randomly
selected from important locations in the city of Kanpur, were found to be sexually active
(indulging In some or the other form of sexual activity at least once in two months). The
sexually active subjects were married happily and had a more satisfying sex life. They were
mainly seen in their sixties and early seventies and mostly came from middle and upper
middle socio-economic conditions commanding a respectable place in the family. The
sexually inactive subjects were commonly influenced by weak sexual feelings and interests
in their youth, social and religious misconceptions(where sex in elderly is associated with
feelings of guilt and sin), lower socioeconomic status and illness of the spouses thereby
leading to forced celibacy. Identification of social and behavioural factors influencing the
sexual attitude of the elderly by medical profession is mandatory in order to make the lives
of aging population complete, satisfying and meaningful.
26-2
Fear of Failure in men
Verma P, Mishra A K, Menon S D
Jamshedpur, Bihar
Sexual health is closely connected to good physical and emotional health. It has been found
that about 15% of medical outpatients in industrial hospitals have sexual complaints.
143
Session ■ 26
Sexual Behaviour and dysfunctions
Hall-Cauvery
Primary impotence occurs in about 1% of men under age of 35. Secondary over the age of
60. Since all men experience occasional erectile failure due to fatigue, alcohol and other
transient unfavourable circumstances the diagnosis of secondary impotence should not be
made unless there is a failure of intercourse in 25% of attempt. In a pilot study of 50 cases
who attended the Psychiatry OPD of Tata Main Hospital, it was found contrary of belief
the rate of failure was more in younger age group due to performance anxiety. Marker
improvement was seen with reassurance psychotherapy and giving proper sex education
along with anxiolytic.
26-3
Sexual Misconceptions in male patients Attending sex group
Bharati Patil, Rajesh Nadkarni, Dhavale H S
Bombay
Sociocultural factors profoundly influence and determine every aspect of psychiatric
disorder. The clinical picture may be modified to such an extent that appropriate nosological
consideration is necessary. Sexual misconceptions are formed by the beliefs and
assumptions prevalent in the native culture. As these misconceptions are one of the
significant factors for sexual problems were studied in a present study. 30 male patients
with sexual problems attending sex group of psychiatric outpatient department of Nair
Hospital were taken to study sexual misconceptions in them. Proforma containing sexual
misconceptions was administered to them. The patients were throughly investigated
whenever rquired. Patients sexual problems were diagnosed according to ICD-10 criteria.
Exclusion Criteria -h/o physical illness, psychiatric disorders or drug abuse. Results :
Patients were from age group 15-45 yrs. but maximum patients were from 15 -30 yrs.
maximum were married and literature. 63% had diagnosis of Dhat syndrome and 60% had
diagnosis of premature ejaculation.
Common misconceptions
1)
2)
3)
Loss of semen from body in any manner is harmful.
Baby while growing in the mothers body gets food through?
Semen foul smelling, less viscous
144
Session - 26
Sexual Behaviour and dysfunctions
4)
Loss of semen gives mental weakness
5)
Loss of semen gives mental and physical weakness.
6)
Penis small, not straight.
7)
Is passage of urine same for the menstrual flow?
Hall-Cauvery
Commonest cause of Dhat syndrome was found to be masturbation and excessive sex.
Less common misconceptions:
Loss of semen gives rise to sexual dysfunction.
1)
2)
Loss of semen gives rise to production of more female children.
3)
Loss of semen gives deformed fetus.
26-4
Side Effect of Drug on Sexual Function
Bharati Patil, Shastri P C
Bombay
The thread of sexuality is woven densely into the fabrics of human experience. There are
few people for whom sex has not been important at some time and many for whom it has
played a dominant part in their lives. Sexual function is such a multifaceted,
multidimensional, (sic) multifactorial was studied in patients with mental illness. So aim of
this study was to find out effect of psychopharmacotherapy on sexual function prior to
illness, during pathology, during treatment and follow up. 53 indoor patients of Nair
Hospital meeting ICD-10 criteria were selected. A proforma containing following sexual
functions was administered to them and then analysed according to 4 phases. A Prior to
illness, B ■ During psychiatric illness, C ■ During treatment, D - On follow up maximum 1 ■ 6
months. Sexual function ■ 1) Ejaculation too quickly, 2) Inability or difficulty in ejaculating in
vagina, 3) Inability to get or keep an erection, etc. were administered. No specific treatment
for sexual funtion was given. Results : 1) Maximum no. of patients had received
antipsychotic drugs. On co factor analysis 62% of patients with erectile dysfunction were
on antipsychotic drugs, out of which 75% developed on treatment and follow up, indicating
effect of pharmacotherapy on this sexual dysfunction. Patient's with painful intercourse
none showed improvement. Maximum no. of patients with low sex drive continued to have
this problem while maximum no. of patients with high sex drive improved on treatment and
145
Session - 26
Sexual Behaviour and dysfunctions
Hall-Cauvery
follow up.
2) Antidepresant drugs ■ 21% of patients received these drugs. Patients with premature
ejaculation - 50% improved. Maximum no.of patience with inability to get any enjoyment
out of sex improved on treatment and follow up.
3) Anti anxiety drugs ■ 19% of patients received these drugs. Maximum no. of patients with
low sex drive continued to have this problem while maximum no. of patients with high sex
drive improved on treatment and follow up indicating effect of pharmacotherapy.
26-5
Sexual Dysfunctions in patients on Lithium Therapy
Pradhan S C, Akhtar S, Roy D, Bhagat R Nf Ritu Pandey
Ranchi
Sexual dysfunction after the introduction of lithium has been described earlier. The current
study was undertaken in Central Institute of Psychiatry on all male patients (N-50)
attending Lithium clinic who were exclusively on lithium either as a therapeutic or
prophylactic agent and had not taken any other drugs within last three months. All patients
were interviewed for sexual dysfunctions by a structured proforma designed to elicit sexual
dysfunctions as per ICD-10. Clinically no one had significant depression. Results :
Priliminary analysis reveals approximately 40% of the patients had atleast one sexual
dysfunction which started after lithium therapy. Premature ejaculation was found to be
present in approximately 30% of patients followed by decreased libido (lack of sexual desire
and sexual enjoyment). Approximately 8% of the patients described increased sexual drive.
Further details of the result and the implications of these findings have been discussed in
this paper.
146
Session - 26
Sexual Behaviour and dysfunctions
Hall-Cauvery
26-6
Factors associated with the choice and success of Master's and
Johnson's Therapy
Ajit A vasthi, Ritu Nehra, Pratap Sharan
Chandigarh
In a retrospective analysis of 178 registrations to Marital and Psychosexual Counselling
Clinic at PGIMER, Chandigarh, it was found that the commonest diagnoses made were
failure of genital response (F 52.2), in 61.8% and premature ejaculation in 47.2% of cases.
Treatment protocols instituted consisted of sex education (62.9%), other psychotherapies
(37.7%), Master's and Johnson's Therapy (25.84%) and pharmacotherapy (29.8%). The
factors associated with choice of M J therapy as treatment recommendation were marriage
(x2= 16.99, df = 2, p < 0.05), medium level of education (x2=42.6, df = 2, p < 0.05),
medium range of income (x2 =9.62, df = 2, p < 0.05), Joint/extended family type (x2
= 24.85, df = 2, p < 0.05), participation of partner in the evaluation process (x2 =18.05,
df = 2, p < 0.05) and a liberal attitude towards sexuality on the part of the couple (x2 =
29.25, df = 2, p < 0.05). Outcome of M-J therapy was not found to be associated with
any pre-treatment sociodemographic or clinical variable, but significantly associated with
treatment adherence (x2 = 9.93, df = 2, p < 0.05). Conjoint sex therapy usually resulted in
good treatment adherence. Modifications necessary in the practice of M-J therapy in the
Indian setting will be discussed.
26-7
Intra Cavernosal Papavarine Injection Therapy in Management
of Impotence
Katiyar M
Lucknow
This presentation highlights the practical aspects of penile intracavernosal papaverine
administration in the management of erectile dysfunction. Indications, contraindications,
147
Session - 26
Sexual Behaviour and dysfunctions
Hall-Cauvery
dosage, method and complications especially priapism are discussed. Used judiciously
intracavernosal papaverine injection is a safe and effective technique of producing penile
erections in impotence of diverse etiologies. Past five years experience with the method will
be shared.
148
Session - 27
Child Psychiatry II
Hall-Krishna
CHILD PSYCHIATRY II
27-1
Chloroquine - induced recurrent psychosis in children
Bhatia M S
Delhi
In India, Chloroquine is commonly used for the treatment of malaria. It causes a number of
psychiatric complications such as psychosis, anxiety disorders and seizures but recurrent
psychosis due to chloroquine has not yet been reported. The present series report 10 cases.
A majority belonged to 7-9 years (50%) and 60% were girls. The average dose of
chloroquine taken by the cases was 1.0 to 2.4 g. In a majority, the symptoms appeared
within 72 hours and disappeared within 2 to 14 days after discontinuing the offending drug.
The implications of the study will be discussed in detail.
27-2
Gilles De La Tourette Syndrome
Chaukimath S P, Bhairwadgi S S
Bijapur
Gilles de la Touretta syndrome is less commonly reported in our setup compared to Western
literature. A case of Tourette's syndrome is reported here. There were no obsessive
features, no Psychotic symptoms. Patients symptoms improved markedly after addition of
clonazepam to haloperidol. The case is presented with emphasis on treatment aspect.
27-3
Efficacy of Feneluramine in Autism & Pervasive Developmental
Disorders
Usha P. Dave, Vrajesh P. Udani, Sunila Ambegaokar
Bombay
Autism or pervasive developmental disorders (PDD) are the challenging behavioural
syndromes of brain dysfunction, still lacking the understanding of pathophysiology, &
149
Session - 27
Child Psychiatry II
Hall-Krishna
therefore poor progress in pharmacotherapy. A prospective open trial of fenfluramine was
therefore conducted to study the hitherto reported controversial use of this serotonin
antagonist. Evaluation of 51 patients & confirmation by DSM III R initially formed a study
protocol. Ritvo-Freeman Real Life Rating Scale specific for autism, covering 5 different
areas of child development was used before & after the drug (1.0-1.5 mg/kg body
wt.)treatment (3 months) in addition to the routine psychological assessments. Though 16
patients (mean age 6.21 years) could satisfy all the criteria of a trial, the clinical monitoring
was continue in the remaining patients. It was concluded that fenfluramine was
significantly effective in improving (1) sensory motor behaviour, (2) affectual & (3) social
reactions in children with autism/PDD with SQ > 50 in copmarison with those having SQ
< 50. The drug showed little effect on language & sensory responses. Loss of weight &
appetite were treatment limiting side effects which required careful monitoring of the
patients.
27-4
A clinical study of children with Mood Disorders, presenting to
Child and Adolescent Psychiatry Clinic of Trivandrum Medical
College.
PraveenlalK, Prathibha, Pfizer, Krishnakutty N
Trivandrum
Speciality clinics offering care to children suffering from Psychiatric Syndromes are
uncommon in Kerala. Since March 1993, one such clinic is functioning in the Department of
Psychiatry of Trivandrum Medical College. Within a period of one year, out of 80 cases
registered, 5 children fulfilled the criteria for diagnosis of Mood Disorder. 4 cases were
Depression and 1 case was Mania. Socio demographic variables, source of referral, clinical
presentation and diagnostic categories of all the cases were reported and discussed.
150
Hall-Krishna
Child Psychiatry II
Session ■ 27
27-5
Left Hand Mirror Writing in a Tri Literate Dyslexic Child:
Implications for Hemispheric Suppression Failure and the role of
the Basal Ganglia
Ravi Nehru, Anju Garg, Meena Gupta
New Delhi
A 9 year old tri-literate right handed girl presented with acute onset tremors of the right
upper limb. CT and MRI scans, and biochemical investigations were normal. Left hand mirror
writing was first noticed on routine Neurobehavioural examination. Neuropsychological and
neurolinguistic assessment was done while the tremor was controlled on beta blockers. IQ
was assessed on Raven's Coloured Progressive Matrices. Left hand writing revealed
complete reversals of letters, words, sentences, and numerals. Right hand writing also
showed some mirror reversal of letters and numerals. Reading aloud and reading
comprehension was impaired. Writing to dictation was markedly impaired (error rate: 90%
non-words, 50% regular words)as was oral spelling (error rate: 100% non-words, 20%
regular words). Findings were comparable across three languages, Hindi (Devnagri script),
Urdu (Perso-Arabic script) and English (Latin script).
Performance on the RCPM revealed errors on almost all cards involving directionality. Figure
copying performance resulted in directional reversal of all figures selected from the Bender-
Gestalt and the Benton Visual Retention Test. Results suggest bilateral representation of
linguistic mechanisms of dyslexia as well as cognitive mechanisms of directional perception,
along with a failure of developmental right hemispheric suppression, probably associated
with an additional striatal release of ontogenetic right hemispheric mechanisms. This
implies a role for the basal ganglia in the normal developmental suppression of the right
hemisphere and developmental dominance of the left hemisphere acquired in childhood. A
serious limitation of using the RCPM for IQ assessment of children with dyslexia is also
illustrated.
and
M H -1 o O
151
4
G A1
’ r
Session ■ 28
Depression
Hall-Tunga
DEPRESSION
28-1
Clinical Characteristics of Depression in General Practice
Gautam Amin, Sandeep Shah, Vankar G K
Baroda
Two hundred patients attending curative and preventive General practice at the S S G
Hospital, Baroda were randomly investigated in a two stage study using Beck Depression
Inventory Abridged (Beck 1974) and Clinical Interview for Depression (Paykel 1985). Forty
two met criteria for depression. Depressed patients were more often women, divorced or
widowed, belonged to nuclear families. Unemployment and lack of confiding relationships
were associated with depression. The most frequent manifestations in depressed general
practice patients were ■ depressed mood, lack of energy and fatigue, depressed appearance,
pessimism and hopelessness, decline in work and interest, guilt, low self esteem and
worthlessness, anorexia, initial and middle insomnia, suicidal tendencies and decreased
reactivity to social environment. The most common manifestations did not have high
discriminatory power for diagnosis of depression. Problems in screening depression in
general practice are discussed.
28-2
Screening for Depression in General Practice -The Usefulness of
back Depression Inventory
Sandeep Shah, Gautam Amin, G.K. Vankar
Baroda
Two hundred patients (133 men and 67 women) attending Curative and Preventive General
Practice (CPGP) at the S S G Hospital, Baroda, were randomly screened for depression in a
two stage study. On the Gujarati version of Beck Depression Inventory (BDI) abridged,
(Beck 1974), 60 (30%) patients scored 8 or more suggesting moderate or severe
depression. Blind to BDI data, investigators interviewed all patients using'Clinical Interview
152
Session ■ 28
Depression
Hall-Tunga
for Depression (CID) (Paykel 1985) to generate the diagnosis of depression. Forty two
(21%) patients had depression. At cut off score 8/9, BDI had sensitivity 83.3%, specificity
89.2% and overall accuracy 89%. Below and above this cut off score overall accuracy
declined. Treating physicians identified depression correctly only in 13 out of 42 cases
missing almost 70% depressions. The usefulness of BDI for screening depression in general
practice is discussed.
28-3
Role of Physical contact experience in depression
Sharma S N, Mahapatra P
Varanasi
Thirty major depressives 15-60 years old meeting DSM III R Criteria, able to give consent,
understand and answer questionnaire and 30 normal first degree relatives of other patients
attending University Hospital used as controls were studied. Both groups met fixed
inclusion & exclusion criteria and were matched for age, sex, domicile and socioeconomic
status. Biographical, detailed physical and psychiatric examination was done. Both groups
were administered Hindi translation of questionnaire for physical contact experience
(Cochrane 1990) and HDS (Bech 1986), both during and after remission of depression.
Patients and controls with satisfactory and unsatisfactory physical contact experience
were compared using 't'/z' and 'x2' tests. UPCE was higher in depressive than controls (P0.01). Severely depressed patients reported UPCE more frequently than SPCE (P-0.005).
The finding will be discussed.
28-4
Physical Contact Experience in Manics Compared To Normal
Controls.
Sharma S N, Mahapatra P
Varanasi
Thirty Bipolar manics 15-60 years old meeting DSM III R Criteria, able to give consent,
understand and answer questionnaire and 30 normal first degree relatives of other patients
153
Session • 28
Depression
Hall-Tunga
attending University Hospital used as control were studied. Both groups met fixed inclusion
and exclusion criteria and were matched for age, sex, domicile and socio-economic status.
Biographical, detailed physical and psychiatric examination was done. Both groups were
administered Hindi translation of questionnaire for physical contact experience (Cochrane
1990) and mania assessment scale (Bech 1986). Patients and controls with satisfactory
and unsatisfactory physical contact experience were compared using 't','z' & 'x2' tests.
Manics reported unsatisfactory physical contact experience more frequently than the
controls but the difference fell short of statistical significance.
28-5
Depression : A Comparative Study of Symptomatology between
two age groups from North India
Narang R L, Gupta R, Mishra B P, Mahajan R
Ludhiana
The behavioural manifestations of what today is labelled as depression has been observed
and reported since ancient times. Many and varied explanations of the classic symptoms of
depression have been given previously. Keeping in view the high prevalence of depression in
North India and the mounting morbidy due to depression in different age groups, a
comparative study has been conducted. Two groups of forty consecutive patients each
with depressive illness diagnosed according to DSM-III-R in the age group of 18-24 yrs. and
above 50 years were compared on schedule for standardised Assessment for Depressive
Disorders (SADD), Hamilton rating scale for depression (HRSD), Hamilton anxiety rating
scale (HARS), the Brief Psychiatric Rating Scale, (BPRS)and the Mini Mental state
Examination (MMSE) There was no significant difference between the two groups on the
HRSD, HARS, BPRS, & MMSE. On SADD, clinical symptomatology showed that there were
7 symptoms common to 75% or more amongst both groups. These include sadness of
mood, joylessness, hopelessness, lack of energy, lack of confidence, loss of interest and
anxiety. The following were reported by a significantly more number of depressed youth;
aggression, indeciveness, decreased libido, change of perception of time, and hypersomnia.
However subjective loss of memory, lack of appetite, change of body weight, somatic signs
154
Session ■ 28
Depression
Hall-Tunga
and symptoms, hypochondriasis and physical disease or infirmity were reported by a
significantly more number of depressed elderly. Thus it has been concluded that in this
study the two groups did not differ on severity of depression and presence of core
symptomatology. Other symptoms are reported by varying numbers from both groups.
These findings are useful to understand the clinical presentation of depression amongst two
different age groups.
28-6
Evaluation of Axis I Comorbidity in Chronic Depression
Suyog Dhakras, Shubhangi Parkar, Jayant Apte
Bombay
Patients of Chronic Depression form a large volume in the attendance at any Psychiatry
O.P.D.
The aim of this study was -
a) to evaluate the axis I comorbidity in patients of chronic depression, and b) to compare the
same between male and female patients, 30 male and 30 female patients were selected
from the follow up psychiatry OPD after confirming diagnosis of chronic depression using
DSM III R criteria.
The SCID was then applied to find any axis I comorbidity.
Approximate statistical analysis was then done to evaluate the axis I comorbidities and to
compare the same between the male and female patients. The results of this analysis are
detailed in the study.
155
Session - 29
Psychotherapy
Hall-Bhadra
PSYCHOTHERAPY
29-1
Meditative Reconditioning
Baker Fenn
Kottayam
We function in a world where our understanding of reality is continuously influenced by
theories regarding matter, sub atomic particles and energy systems, Concepts such as the
Holographic paradigm, and the transcendental dimension of the universe, raises questions
about the essential nature of man and the response required from a therapist in the total
context. Meditative reconditioning is a method evolved out of the author's 30 years
experience in three different countries. The theoretical assumption is that the universe
inherently contains cosmic and spiritual forces related to creation, growth, repair, healing
and sustenance of life. By the process of transcending, the individual can facilitate the flow
of these forces. The method can be and is often combined with traditional methods of
psychiatric treatment. Techniques used in psycho-analytically oriented psychotherapy,
behaviour therapy, hypnotherapy and certain methods in meditation such as transcending,
freezing, reaching the zero state are described. Some examples are also described.
29-2
Jane and Janki
Veena Kapoor
New Delhi
Having spent early years in Delhi, India, mid years in U.K. and USA and now later ones here
in India again, the writer presents an experience of therapy with women in East and West.
While Indira Gandhi, Begum Khalida Zia and Benazir Bhutto in the East and Mrs.Margaret
Thatcher and Hillary Clinton are representatives of power it is universally acknowledged
that women suffer more.There are deep rooted cultural which create peculiar paradoxes for
156
Session - 29
Psychotherapy
Hall-Bhadra
a woman globally. She experiences conflict of wanting to be free and wanting to be
enclosed by the ~ other ~. This has hidden — gains ~. It prevents her from developing an
inner clear identity ■ This division of the mind eclipses her personality. Women in the West
present earlier in therapy, are more amenable for —SELF — growth and open to exercise
other options. Those in the East stay trapped within a neurotic system, wish others to
provide immediate miraculous cures and afraid to risk a "CHANGE". Responsibility for the
change has to be accepted by the therapist and patient to make a meaningful shift, seek a
solution and free the inner latent strength to be a force in life.
29-3
Mental Formations & Possessions
Soumitra Basu, Sharmi/a Basu
Calcutta
The mind with its power of imagination and with reinforcements from the unconscious can
construct catastrophic 'mental formations' that can 'possess' one's mind and can cause
illnesses. In fact, the shift in the educational level from the villager to the modern man has
shifted the onus of 'possession' from 'spirits' to 'mental formations'. Likewise, positive
mental formations can also be constructed. Use of such positive imagery has immense
psychotherapeutic importance. This hypothesis is presented with clinical illustrations.
29-4
Efficacy of cognitive Behaviour Therapy in Somatized Patients
Anita Vasudevan, Shubhangi Parkar
Bombay
Most of the patients seeking medical help are patients who have bodily symptoms. Many a
times, these bodily symptoms are attributed to organic disease by patients although they
have no appropriate organic basis. It is clinically important to know that bodily complaints
coexist with physical illness or with psychological complaints. Somatization is the concept
which many a times is utilized to describe the process of bodily symptoms. It is definitely a
157
Session • 29
Psychotherapy
Hall-Bhadra
common problem in developing countries. The challenge is to provide effective intervention
to these patients, especially when they do not meet the criterial for particular psychiatric
diagnosis. Cognitive behaviour therapy provides broad spectrum systematic intervention in
these kinds of patients. In this paper the process of cognitive behaviour therapy in providing
effective intervention is being discussed in detail.
29-5
Family Mental Health And Tirukkural
Murugappan M
Madras
The objective of this paper is to unravel some important tenets of the epic Tirukkural with
relevance to the contemporary concepts, analysis of, and the understanding of family
therapy. A modified network formulated by Elizabeth Bett in family crisis is taken as the
frame of reference to compare the couplets from Tirukkural. The paper focuses 'family' as
the elemental brick of a healthy individual, firmly linked to the cohesiveness of the family ;
and the discussion is on the directive principles as defined by John Sutherland of this
century which reflects almost eloquently the norms of an ideal family envisaged by the
great Tamil sage, Thiruvalluvar the author of Tirukkural.
29-6
Yoga and Heart Rate Variability
Naga Venkatesha Murthy P J, Ramakrishnan A Gf Gangadhar B N, Janakiramaiah N
Bangalore
Yoga is known to have significant beneficial effects on autonomic functions. The present
study is addressed to examine the effects of Sudharshana Kriya Yoga (SKY), on heart rate
variability, an important indicator of autonomic status. Nine patients participating in a
research project on SKY therapy in depression, were taken up for this study. On the day of
first complete practice of SKY-usually the 6th day of training, ECG was recorded in supine
158
Session - 29
Psychotherapy
Hall-Bhadra
►
and standing positions, both before practice and immediately after practice of SKY. The
recorded ECG was digited at the rate of 500Hz using a 12 bit ADC and stored into a
computer. A specially devised software was used to analyse the ECGs offline blind to
patient details. There was a fall in the mean heart rate (MHR) after SKY, despite the
practice being strenuous. Before SKY-MHR = 84.4, SD = 13.9 and after SKY-MHR = 79.1,
SD = 12.9. The low frequency of the hrv spectrum (reflecting the sympathetic tone) showed
a significant increase after the SKY (t = 2.8, p = 0.023), while the high frequency (reflecting
the parasympathetic tone) remained unchanged. These findings will be explained and
further discussed in the presentation.
i
159
Session - 30
Neuroses ■ II
Hall-Sharavathy
NEUROSES - II
30-1
Post Traumatic Stress Disorder in Battle Casualities
Abhaykumar Matkar (Major)
AIM : 1. To find out the incidence and symptom profile of PTSD.
2. To apply therapeutic modalities in PTSD.
Methodology : 150 battle casualties of armed forces admitted between 01 Jan 95 to 25
Apr 95 to a zonal hospital were interviewed on a questionnaire based on DSM III R (1987)
alongwith detailed psychiatric work up.
The findings were tabulated age wise, quantitative responses to questionaire, percentage
of PT SD, social breakup of personnel, comparative datas etc.
OBSERVATIONS:
1)
2)
3)
Majority of casualties were less than 35 yr age.
All except one individual had PTSD symptoms though not all qualified for
disorder diagnosis.
27 (18%) had full blown PTSD disorders
4)
122 (81%) had PTS symptoms
5)
PTSD was more than ten times common than in general population.
6)
PTSD was significantly less than seen in World War II veterans, Vietnam
veterans, Nazi concentration camp etc.
7)
Therapeutic modalities practised were tailor made but proved encouraging.
CONCLUSION:
PTSD is significantly and expectantly higher than in general population. Counter
insurgency has been causing devastating impact on the life of all concerned. We wish to do
our bit in the long battle for peace in the nation.
160
Session ■ 30
Neuroses - II
Hall-Sharavathy
30-2
Fear Questionnai® - Survey in Adolescent Age Group
Gurmukh Singh, B Arvindakshan
Bangalore
Fear questionnaire (1) provides scores on diffused symptomatology relating to
agarophobics, blood phobics and social phobics. In general agarophobics tend to feel more
dizzy, blood phobics more faint and social phobics more worried about others opinion of
them (2). No survey related to prevalence of phobic symptomatology has been carried out in
our society. We administered fear questionnaire to 406 adolescents (Age 16 to 18 years)
studying in various secondary schools in Bangalore. Our sample included 282 males and 124
females, 108 hostelers and 284 day scholars, 278 of our subjects had upbringing in city
and 102 of them were brought up in towns/villages. Fear questionnaire was scored on 0 to
8 scale wherein 5 denoted definite avoidance of feared objects/situations. The
questionnaire has 5 items for each major group of agaro, blood-and social phobia. Thus total
score of 25 or more in any major group was considered to reflect evidence of sub-clinical
problem. Our results showed that 9.6% males and 15.9% females were above this
threshold for agarophobia, 22.7% males and 36.3% females showed problems in blood
injury phobia, 10.6% males and 21.8% females had similar evidence of social phobia. In the
total score 4.1% males and 17.9% females were above the mark of 75 on the fear
questionnaire. AN0VA showed that agarophobics were significantly differentiated on sex (F
10.62, p 0.001), hostelers (F 8.66 p 0.003), marks (F 3.58 p 0.061). Blood injury phobics
were diffentiated on sey (F 6.06 p 0.014) and sports (F 2.94 p 0.015). Social phobics were
differentiated on sp> F 5.23, p 0.023), hostelers (~ 14.85 p 0.000) and upbringing (F 3.09
p 0.048). Total score on this questionnaire was significantly differentiated on sex (F 13.01
p 0.000) and hostelers (F 6.44 p 0.012). These results corroborate with the western figures
on prevalence of phobia in general population.
161
Session - 30
Neuroses - II
Hall-Sharavathy
30-3
Occupation-Induced Post-Traumatic Stress Disorders
Jyoti Mahapatra, Mahapatra S C, Bardhan >4 K
Orissa
The study was conducted on 31 workers of 'Jayashree Chemicals' of Ganjam, Orissa during
a period of 2 years who reported for treatment in the factory dispensary for medically
unexplained symptoms. Persistent somatic symptoms pointed towards the diagnosis of
post-traumatic stress disorder in majority of the cases. The rest were diagnosed to
have > Depression with somatic manifestations. The symptoms were mostly due to
autonomic features of anxiety.
The role of personality and exposure factors were examined in all the patients. The type of
work done by them and the periods of absenteeisms were also noted. All the findings are
analysed and discussed in detail in the paper.
30-4
Coping patterns of working women across stressful episodes
Murthy K Rao K, Subbukrishna D K
Bangalore
The relation between stress and coping behaviour was assessed in 48 married working
women. Data was collected using the Coping Checklist, the description and appraisal of
stressor faced by the individual. The GHQ was used as a screening tool. The married
working women used approximately 31 coping behaviours. A combination of emotion
focussed, pro ~lem focussed and support seeking behaviours were used by the majority of
the group. Stressors reported were from both the family and work domain. The type of
stressor, the domain in which it occurred and the perception of control over it influenced
the coping behaviour used.
162
Session - 30
Neuroses - II
Hall-Sharavathy
30-5
Panic Disorder: Clinical Profile
Basu D, Gupta S
Chandigarh
Nosologically panic disorder is a new entity, introduced in ICD-10 and DSM III. Prior to this.
it was included under the broad rubric of anxiety neurosis. In order to study the
presentation and treatment response, a retrospective analysis of out —atients records
from February 1993 to October 1995 was done in which total 44 cases of panic disorder
were diagnosed. The mean age of the sample was 32.6 years (range = 16-60 years),
majority of which were married and belonged to low socio-economic status. The
commonest symptoms were palpitation (90%), trembling or shaking (73%), sensation of
shortness of breath (79%), feeling of choking (73%), and fear of dying (59%). Regarding
associated symptoms agarophobia was present in 10 (23%) patients while depressive
symptoms were noted in 12(27%) patients. Most of the patients were treated with
antidepressants and anxiolytics for a period ranging from 1 month to 3 years. About 68%
showed significant improvement with medication. Implications of the findings will be
discussed.
30-6
BPD - Markers on Rorschach’s Inkblot Technique
Sangeeta Rao, Shrivastava A K
Thane (w)
Borderline Personality Disorder has been found to share a close boundry with schizophrenia
as well as with mood disorder.
Aim : The present study was undertaken to assess the psychological markers on
Rorschach's Ink-Blot Technique which differentiate BPD from schizophrenia & major Mood
disorder, in Indian sociocultural milieu.
Methodology • The Index group (N = 30) wOth primary diagnosis of BPD as per DSM-IIIR
were teDted on Rorschach's Ink-blot technique & compared with control groups of
163
Session - 30
Neuroses ■ II
Hall-Sharavathy
schizophrenia (N = 30) and major mood disorder (N = 30).
Result ■ Patients with BPD differed significantly from schizophrenics & MMD with respect
to the level of touch with reality, RT & number of popular responses.
Conclusion - Rorschach's Ink-blot Technique has clinical utility in the diagnosis, and
treatment of BPD.
30-7
Clinical Trial With Mianserin (Depnon) in Mixed Anxiety-
Depressive Disorder
Chowdhury A N
Calcutta
An open comparative clinical trial (6 weeks) with Mianserin (Depnon) was done on 49
patients of mixed anxiety-depressive disorders (ICD 10 code F 41.2). The therapeutic
response of mianserin was compared with 52 patients of the same diagnosis. The results
shows an excellent therapeutic effect of mianserin both on depression and anxiety and the
responses were somewhat superior to that of standard antidepressant imipramine. Side
effects profile of mianserin is virtually nil. The different aspects of therapeutic advantage
of mianserin in treatment compliance is discussed. The clinical utility of mianserin (Depnon)
as a monopharmacotherapy in mixed anxiety-depressive disorder is the greatest therapeutic
advantage.
164
Author Index
Author
Author
Page No.
36
32
Ash S
8, 47
Asha H M
5, 121
41
Ashok K Alim Chandani
48
Asif Akhtar
Avneet Sharma
59
B Arvindakshan
161
Bagchi D J
59, 65, 67
25
Bagchi J
42
Baig M A
Baker Fenn
156
Balaji W
46, 75, 119
Banerjee S
20
91
Bannerji A
48
Bang N
14
Banwari C S
Bardhan A K
20, 92, 162
Basannar D R
44
Abhaykumar Matkar (Major)
160
Arunava Das
Adarsh Bhargava
108
Arya S C
Advani G B
78, 84, 93
Agarwal A K
32
Agarwal R
132
Agarwal S
82, 113
Ahalya R
9
Ajita Rane
11
59, 147
67
Akhtar S
1, 60, 67, 146
Alexander
Alice Cherian
10
109
28
Alka S Ahuja
94, 134
Ahalya Raguram
Ajit Avasthi
Alexander P J
Alphonsa
47
Amit R Basu
Anita Vasudevan
97
69
68
72
34
6
16
96
157
Anju Garg
Anoopa
Amita Sarkar
Anand
Anand K S
Ananta Dave
Anil M
Anil Thambi
Anita Desai
Anshuman Pant
Antony Mannarkalam
Page No.
Bashyam V S
Bashyam V S P
13
10, 13, 21, 49
81, 101, 126
Basu D
Basu S
33, 34, 163
8, 47
Benegal V
46, 75, 119
151
Bhagat R N
82, 110, 146
130
Bhairwadgi S S 27, 70, 129, 149
15, 78, 84
Bharati Patil
Bhardwaj P
127
Anupam Iyer
114, 115
Armity Mody
67
Bhaskar C
Arpita Roy
11
Bhatia M S
Arunagiri S
21
Bindoo Maru
Bhardwaj Pramod
166
144, 145
120
100
95, 101
28, 90, 99, 149
22
Author
Author
Page No.
20
60
Chakrabarti S
69
Chakraborty P K
44
Chander Shekhar C R
15
Chandra S
133
Chandraleka
126
Chandrasekaran R
125
Chandrasekhar C R
9, 27, 46
75, 119
Channabasavanna S M 9, 45, 63
117, 127, 142
Chatterjee A
96, 114
Chatterjee S
119
Chatterji D
8, 47
Chaudhury S
87, 120
Chauhan R K
88
Chaukimath S P 27, 70, 129, 149
Chitra Andrade A
136
Chittaranjan Andrade
1, 6, 136
Chopra R
33, 34
Chopra V K
67, 110
Choudhary G
115
Chowdhury A N
164
Christoday R J Khess 26, 56, 59
Cloninger C R
45
Cloninger CR
41
Colin John Vas
103
Cyriac Mathew
97
Dalal P K
86
Das I
132
Das J
10, 56, 59
Das N
96
Page No.
20
Biswas S
Das S
Chakrabarti I
Dash D K
7, 139
Dash S
50
69
8
47
20
89
115
34
10, 110
115
36
144
72
86
87
85
82
23
132
137
122, 123
21
82
109
101
Day P
Deb A
Deb S
Debnath C
Deepak Gopal
Desai N G
Deshmukh D K
Dey N
Dhanesh K Gupta
Dhavale D M
Dhavale H S
Dilip Kumar Dash
Dinesh Tyagi
□inker N L
Dinker N L (Major)
Downs H
Dushyant Bhadlikar
Dutt a S
Dwaraka Pershad
Dwivedi P
Ebrahim Haroon
Fox P T
Gandi Babu R
Ganesan R
4, 5, 40, 41, 45
74, 121, 122, 123, 158
Gangadhar B N
Gautam Amin
Gautam R K
Gautam Saha
Gayatri
167
131, 152
99
111
34
Author
Author
Page No.
Page No.
46, 75, 1 19
125
122
Janaki Ramaiah N J
Janakiramaiah N
4, 5, 40
74, 121, 158
Janakiramaiah N J
41, 45, 123
72
Jayakumar M
J ay ant Arte
15
Jayant Deshmukh
80
Jayanta Chatterjee
31, 98
Jayaprakash M S
4, 5, 121
Jayita Choudhary
22
82
Jerabek P
Jeyaprakash
13
37
JlLOHA R C
127
Joan C
36
John Alexander P
John J K
40, 97
62
Joseph M
Joseph P Anto
139
93
Joshi U G
Josy K Thomas
10
65
Josy Thomas
20, 92, 162
Jyoti Mahapatra
Kaliaperumal V G
117, 142
62
Kallaperumal
Kamlesh Patel 54, 55, 130, 131
21
Kannabiran
132
Kar G C
132
Kar N
Kar P
110, 111
94
Karnad D R
Katiyar M
52, 86, 147
15
1, 6
George M R M
122
George V
6
Girimaji SR
48
Girish K
4, 5
GKVankar
152
Glass T
82
Gopala Sarma P
31, 65
Guha P
70
Gupta A K
92
Gupta I D
108
Gupta L N
100
44, 154
Gup'ia R
Gupta S
163
Gurmukh Singh
161
Gurunathan
35
Gurunathan S
13
Guruswamy R
18
Gyaneshwar Sharma
117
Hangzo C Z
96, 114
Haque S
25
Haf.i Easwar Subramanian
80
112
Haridas R M
Hemant Naidu
136
Hemavathy
49
Indira Jai Prakash
17
Ismail Pala
43, 131
Jacob K John
3, 5, 103
J ag awat T
72, 110, 128
Jahan M
83
Jaideep Sarkar
29, 117, 142
Jain R
103
Gehlot P S
Jain S
George J
Jamuna N
168
Author
Kaushal A
Keshav Rao D
Khanna R
Kishan
Kishore C
Kishore P
Kishorekumar K V
Kothari S
Krishankutty N
Krishna Murthy
Krishna Murthy K
Krishnakutty N
Kul Bhushan
Kulhara P
Kumar B V
Kumar R
Kumar S
Kumarababu
Lakshmi R
Lancaster J
Leela S
Madhava Rao K S
Madhu Nijhawan
Madhuri Gangolia
Mahajan R
Mahapatra P
Mahapatra S C
Mahendru R K
Malaiappan M
Malik S C
Malini S
Mall C P
Mandhekar D N
Page No.
Author
79
41
1, 60
68
115
113
9
10, 91, 141
53
68
41, 63
150
52
33, 34, 102
76, 77
91
52
35
136
82
46, 75, 119
39
51
134
44, 154
153
20, 162
12, 143
126
28, 90
41
86
15
Manisha Kiran
Page No.
67
137
Martin C
82
Mary Verghese
47, 128, 130
Mashil Sathish Lal G
95
Mata Prasad
52
Matam P
119
Matcheswala Y
34
Mathews M
6
Mattoo S K
33, 34, 102
McCreadie R G
81
Meel V D
107
Meena Gupta
151
Meena Haria
23
Mendhekar D N
88
Menon S D
143
Mishra A K
64, 143
Mishra B
67
Mishra B P
44, 154
Moily S
9
Mukherjee T
26
Mukul Sharma
58
Manju Mohanty
Mukundan C R 41, 45, 120, 122
123, 125
45
Murthy K S D
Murthy RS
9
Murthy V
1 62
Murugappa M
126
Murugappan M
13, 35, 158
Muthalagan J
49
Naga Venkatesha Murthy
40
Naga Venkatesha Murthy P J
158
Nagaraj S
169
81, 100
Author
Author
Page No.
9
6
Nagarani M A
42, 47, 128, 130
Nagesh Pai
80
Nagpurkur J L
97
Nair S
42
Nambi S
44, 154
Narang R L
1
Naratan N
84
Narendra Singh
14
Nathawat SS
50
Na yak M S
90
Neena Bohra
83
Nizamie A
57, 70, 91
Nizamie Haque S;
82, 87
Nizamie S H
83, 141
Nizamie S Haque
66
Omega Jyotsana
127
Padmavati R
42
Padmini Pai
107
Palaksha G S
42, 95
Palaniappan V
113
Pandey R M
36
Paralikar V P
64, 67
Parial A
9
Parthasarathy R
119
Pasricha S
67
Patel R R
3
Paul Russell
138
Peter M Fernandez
53, 150
Pfizer
133
Prabha
125
Prabha Chandra
29, 96
Prabha S Chandra
Nagarajaiah
Page No.
Pradeep Agrawal
90
Pradeep Sharma
15, 16, 78
84, 93
Pradhan N
Pradhan P V
Pradhan S C
Prasad K M R
104, 105
23, 24, 80, 134
7, 10, 82, 110
139, 146
61
52
138
137, 147
Pratap Sharan
3,
5, 103
Prathap Tharyan
150
Prathibha
40, 62, 72, 74
Pratima Murthy
117, 142
53
Praveen Lal K
43, 130
Praveen T
150
Praveenlal K
51, 108
Preet Kamal
45
Preethi K
96
Premanand
53
Prethibha
96
PUTTARAM S
45, 127
Radhakrishnan V K
40
Raghu R M
74
Raghu T M
138
Raghuram R
41
Raghurami P Reddy
5
Raghuthaman G
101
Rajaram Mohan R
13
Rajarathinam
36
Rajendra Kale
125
Rajesh Mohan
Prasad M
Prashanth Mayur
170
Author
Page No.
Rajesh Nadkarni
144
30
81, 95
25, 56, 67
114
10
109
4
121, 158
57
79
76
88
1
123
36
162
82
120
50
151
32
96
93
103
1, 60
81
Rajesh Sagar
Rajkumar R
Raju S S
Rakesh Ghildiyal
Ram D
Ram Kumar S
Ramachandra R
Ramakrishnan A G
Ramanan K V
Ramesh K M
Ramesh R
Ramesh S
Ramteke S
Rangaswamy M
Ranji Mathai Thomas
Rao K
Rao S
Rao S L
Rath N M
Ravi Nehru
Ravi S Pandey
Ravi V
Ravish Thunga
Ray R
Reddy B
Renju Joseph
Renu Joshi
Renuka Jena
Reshma M
Ritu Nehra
Ritu Pandey
Rohrbaugh J W
Author
Page No.
Rohrbaugh T W
Roy Abraham K
Roy D
Roy K Mukherjee B
Roy S
45
99
141, 146
69
1 11
Sadasivan P K
Sadhana Bhatkhande
Sagar R
104, 105
22
37
Saji J
76
Saju P J
Sameer Malhotra
Sandeep Choudhury
Sandeep Shah
Sandeep Shah M D
40
59
28
131, 152
130
Sandip Choudhury
34
Sangeeta Rao
163
Sangita Sinha
66
Sanjana Motreja
2
Sanjay Agarwal
32
San jay Gehlot
14
Sanjeev Jain
61, 62
Sanjiv Jain
Sarojini George
126
28
Sathyanarayana V
133
Satish Chandra
62
Satish Girimaji
61
Satwant Pasricha
142
51
Sa vita Jagawat
128
8, 37
136
137, 147
146
41, 122, 123
Savita Malhotra
59
64, 66, 67, 110
Sayeed Akhtar
Seema
Sekhar K
. Sengupta S N
171
75, 112
9
76, 77
Author
Sethi B B
Author
Page No.
Sinha S K
22, 94
8, 128
64, 110
108, 116, 129
21
129
78
38
75
24
16
86
49
Sjnha V K
65
Sinha V K
10
Sitholey P
18
52
61
10
9, 95, 157
128
31, 98
20
48
102
126
77, 138
15
88
58
16
44
40
Shubhangi R Parkar
18
103
Shabari Dutta 43, 54, 130, 131
Shajahan M
13
42
Shanthi Nambi
Sharan P
113
87
Sharma A K
Sharma H
132
Sharma K P
49, 75, 112, 129
Sharma L N
139
Sharma M P
9
Sharma P S V N
76, 77
Sharma S
120
Sharma S N
153
Sharma V P
86
Sharmila Basu
9, 95, 157
Sharmila Chari
28
32, 48
Shashi Rai
145
Shastri P C
34
Sheetal Choksi
Shekhar S P
48
Shekhar Seshadri
61
119
Shenoy J
Shukla T R
103
Srinath S
115
107, 132
61
69, 125
99
1
163
127
15, 22, 24
114, 115, 157
Srinivas S
Sethi H
Sheshadri M S
Shilpa Desai
Shiv Gautam
Shobha Srinath
Shobhini L Rao
Shome S
Shridhar Kamath
Shrivastava A K
Shubha Kumar Ms
Shubhangi Parkar
Simlai J
Singh B K
Singh H
Singh I D
Singh N
Singh N J
Singh N P
Singh S D
Sinha A K
Sinha P K
SlTHOLEY P
SOMASHEKAR B S
SOMASUNDARAM O
Soumitra Basu
Sr Anice
Srilekha Biswas
Srilekha Chatterjee
Srinivasa Reddy P
Srinivasan T N
Sriram T G
Srivastav P K
Srivastava
Srivastava A S
Srivastava K
SuBBAKRISHNA
SUBBAKRISHNA D C
172
Page No.
45
Author
Page No.
SUBBAKRISHNA DK
41, 74, 122
123, 162
108
21
125
77
18
30
149
51
1
67
SUDHIR
Sudhir Kumar
Sudhir Kumar C T
Sujit R Varma
Sumant Khanna
Sunil Kumar
SUNILA AmBEGAOKAR
Suresh Babu Sharma
Suresh Chandra J
Suresh Kumar
Author
Suresh Kumar M 42, 81, 95, 101
Suresh Kumar P N
Suresh T R
10, 56, 65
77, 138
Susan Zachariah
36
Suyog Dhakras
Swain A
15
50
Sydipta Mukherjee
125
Thacore A S
Thara R
136
81, 127
Tiwari S C
18
Trivedi J K
86
Tushar Jagawat
U DAYAN KhASTGIR
7, 87, 139
90
Usha P Dave
149
USHA S P
89
Ushma Rani
Page No.
25
134
Vandana MahajanJ
23, 24, 134
Vankar G K
43,
54, 55, 130
131, 152
Vasantha Jayaram
138
Vasanthy N M
79
Veena Kapoor
156
Venkataraman B V
1
Venkataswamy Reddy
27
Venkataswamy Reddy M
62, 63
Verma A N
10, 66, 67
Verma K K
100
Verma P
143
Vidhu Kumar
93
VlDYASAGAR M S
109
Vikas-Jain
21
VlMALARAO
35
Vinay Kumar
108, 116
Vivek Chincholkar
94
Vivek Katoch
7
VlVEKANANDAN S
10, 13, 21, 49
101, 126
Vrajesh P Udani
149
Vyas J N
16, 86
Yeolekar M E
94
Zomi G T
114
Utpal Goswami
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