Indian Journal of Psychological Medicine

Published by Medknow Publications
Print ISSN: 0253-7176
Current nosological status of eating disorders
Current diagnostic criteria of anorexia nervosa
Current diagnostic criteria of bulimia nervosa
Strength of evidence for the new proposed categories of eating disorders (based on Robins and Guze criteria)
Two of the most commonly used nosological systems- International Statistical Classification of Diseases and Related Health Problems (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV are under revision. This process has generated a lot of interesting debates with regards to future of the current diagnostic categories. In fact, the status of categorical approach in the upcoming versions of ICD and DSM is also being debated. The current article focuses on the debate with regards to the eating disorders. The existing classification of eating disorders has been criticized for its limitations. A host of new diagnostic categories have been recommended for inclusion in the upcoming revisions. Also the structure of the existing categories has also been put under scrutiny.
Scissoring of the lower extremities with stretching of the body Figure 2: Evidence of being conscious during the event
Gratification disorder is common in younger children, but is often unrecognized because unlike in adolescents, it does not involve manual genital manipulation and the clinical features are quite variable; therefore a thorough history, physical examination, and video recording of the events will go a long way in making the correct diagnosis, otherwise it could easily be misdiagnosed as epilepsy, nonepileptic paroxysmal movement disorder, or even gastrointestinal disorder.
Results of digit symbol substitution test
Results of digit vigilance test
Showing results of one-letter cancellation task
Showing results of three-letter cancellation task
Sleep deprivation is known to have detrimental effects on attentional resources and cognitive functions. The aim of this study is to assess the changes in performance, due to 24 h of sleep deprivation, in medical students The performance was assessed using simple paper-pencil tasks, such as digit symbol substitution test, digit vigilance test, and letter cancellation tasks. The results revealed an increase in the number of errors in letter cancellation tasks and digit vigilance test, with a significant decrease in the number of correct responses on the letter cancellation task. The time taken to complete the tests increased with lack of sleep, with the digit symbol substitution test being affected the most. This study infers that sleep deprivation for 24 h affected the judgment ability more than the response speed. Sleep deprivation might lead to compromised performance of medical students in examinations.
Late onset psychiatric disorders are often associated with organic factors, either medical or neurological. Mania occurring for the first time in the elderly population is rarely reported. We hereby report a patient with first episode mania who was investigated in detail, but no organic factors were found. He was diagnosed as first episode mania and was managed with divalproex and olanzapine.
Clinical and demographic details of the subjects
Background: Abnormal illness behavior (AIB) can contribute poor functioning in an individual along with significant increase in health care utilization. It has been studied in various disorders. This study examined the feasibility of assessing abnormal illness behavior in individuals with stroke who were undergoing treatment in a psychiatric and neurological rehabilitation center. Materials and Methods: Subjects who were admitted to the department of psychiatric and neurological rehabilitation ward for post-stroke rehabilitation treatment were assessed using screening version of Illness Behavior Questionnaire (SIBQ). Results: The total number of subjects who were screened was eight. The mean score of SIBQ was 6.125 ± 1.35. With the cut off score of 7, five subjects had abnormal illness behavior. Conclusions: The above study highlights that it is feasible to screen individuals with stroke undergoing rehabilitation for possibility of abnormal illness behavior.
Difference in digit ratio between schizophrenia patients and healthy controls
Comparison of digit ratio between schizophrenia patients and healthy controls
Comparison between family history positive and healthy control groups
Comparison between family history negative and healthy control groups
The differences in digit ratio are proposed to arise due to differential effects of sex steroids on the growth of finger bones. In this study, we sought to examine the sex differences and the influence of family history of psychosis on digit ratio in patients with schizophrenia compared to matched healthy controls (HCs). Digit ratio (2D: 4D) was examined for a large sample of schizophrenia patients (n=200) and HC (n=177) to evaluate the potential effects of family history. The right hand 2D: 4D digit ratio was lesser in schizophrenia patients compared to HC (0.97±0.05 vs 0.98±0.04, t=2.2, P=0.02). There was a significant difference in the right hand 2D: 4D digit ratio of female patients with schizophrenia when compared to female HCs (0.96±0.05 vs 0.98±0.03, t=2.1, P=0.03) while males showed no such difference on either hands. On the contrary, family history‑positive males showed a significantly greater digit ratio for the left hand (FH present (0.99±0.04) vs HC (0.97±0.04), t=2.15, P=0.03), while there was no difference between family history‑positive females and HC. Overall, in patients, reversal of expected "directionality" in digit ratio was observed in our study with greater left 2D: 4D in male patients having a family history of schizophrenia being a novel finding. Reversal of sexual dimorphism has been linked to the pathogenesis of schizophrenia. It is possible that such reversal might have a putative genetic basis, perhaps only in men with schizophrenia.
The differences in regions of thalamus between schizophrenia patients and healthy controls (significant inward deformation in blue)
The regions of thalamus having inward deformity in correlation with the negative syndrome score in patients with schizophrenia (Significant areas in green and yellow)
Sociodemographic details of the study group
Neurodevelopmental hypothesis of schizophrenia states abnormal pruning as one of the pathogenetic mechanism in schizophrenia. Though thalamic volume abnormalities have been documented, the shape differences of thalamus in antipsychotic-free schizophrenia in comparison with age- and sex-matched healthy volunteers need validation. We examined antipsychotic naïve schizophrenia patients (n=60) and age- and sex-matched healthy volunteers (n=44). The thalamic shape abnormalities were analyzed from their coded structural magnetic resonance imaging (MRI) data using three-dimensional automated image analysis software, FMRIB's (Oxford Center for the functional MRI of the brain) tools-FIRST (FMRIB's Integrated Registration and Segmentation Tool) by creating deformable mesh model. Correlation with the psychopathology scores was carried out using F-statistics. Patients with schizophrenia showed significant inward deformations in the regions corresponding to anterior, ventromedial, mediodorsal, and pulvinar nuclei. There was a direct correlation between negative syndrome score and the deformation in the right mediodorsal and right pulvinar nuclei. The inward deformations of thalamus in antipsychotic naive schizophrenia patients correspond to those nuclei which have reciprocal connections with frontal, superior temporal, and anterior cingulate regions and support the neurodevelopmental hypothesis of schizophrenia.
Sagittal section of MRI showing the 3D reconstruction of the anterior (blue) and posterior (green) subregions of insula, with the central insular sulcus dividing them 
Clinical characteristics of study subjects 
Coronal section of MRI showing the tracings of all four subregions of insula 
Left insular volume between patients and controls 
Context: Insula, which is a vital brain region for self-awareness, empathy, and sensory stimuli processing, is critically implicated in schizophrenia pathogenesis. Existing studies on insula volume abnormalities report inconsistent findings potentially due to the evaluation of 'antipsychotic-treated' schizophrenia patients as well as suboptimal methodology. Aim: To understand the role of insula in schizophrenia. Materials and methods: In this first-time 3-T magnetic resonance imaging study, we examined antipsychotic-naive schizophrenic patients (N=30) and age-, sex-, handedness- and education-matched healthy controls (N=28). Positive and negative symptoms were scored with good interrater reliability (intraclass correlation coefficient (ICC)>0.9) by using the scales for negative and positive symptoms. Gray matter volume of insula and its anterior/posterior subregions were measured by using a three-dimensional, interactive, semiautomated software based on the valid method with good interrater reliability (ICC>0.85). Intracranial volume was automatically measured by using the FreeSurfer software. Results: Patients had significantly deficient gray matter volumes of left (F=33.4; P<0.00001) and right (F=11.9; P=0.001) insula after controlling for the effects of age, sex, and intracranial volume. Patients with predominantly negative symptoms had a significantly deficient right posterior insula volume than those with predominantly positive symptoms (F=6.3; P=0.02). Asymmetry index analysis revealed anterior insular asymmetry to be significantly reversed (right>left) in male patients in comparison with male controls (left>right) (t=2.7; P=0.01). Conclusions: Robust insular volume deficits in antipsychotic-naive schizophrenia support intrinsic role for insula in pathogenesis of this disorder. The first-time demonstration of a relationship between right posterior insular deficit and negative symptoms is in tune with the background neurobiological literature. Another novel observation of sex-specific anterior insular asymmetry reversal in patients supports evolutionary postulates of schizophrenia pathogenesis.
Bereavement reactions are associated with numerous physical and mental complications. Atypical bereavement reactions have been described but their place in the classificatory system has not been established. We present the case of an eighty-year-old woman who came with the belief that her deceased son was alive. We discuss the diagnostic dilemma she posed and conclude that it may be difficult to differentiate atypical bereavement from other psychiatric illnesses.
Demographics of the study subjects
Alcohol abstinence with respect to depression
Alcohol abstinence with respect to social support
Two co-morbid conditions which have been found in high proportions among treatment-seeking alcohol-dependent subjects are depression and low social support. We attempted to study both the factors simultaneously in the setting of Alcoholics Anonymous centers in Mumbai. The study intends to understand (1) if pre-existing depression affected the probability of a person abstaining from alcohol and (2) if social support affected the probability of a person abstaining from alcohol. A thorough review of the existing literature was done before initiating the study. A single-observer, cross-sectional study was conducted. Subjects with a history of alcohol dependence were included. However, those with other substances abuse and those with a history of anti-depressant usage were excluded. Questionnaires were administered. The Hamilton Depression Scale assessed depression. Similarly, social support was assessed by Social Provisions Scale by Weiss. According to this study depression does not affect alcohol abstinence as the χ(2) test shows an insignificant result. Social support also showed a negative correlation with alcohol abstinence. This result is consistent with the findings of other studies such as Davidson et al. (1998). However it is not consistent with the results of the studies having a longer follow-up period. The study had some limitations primarily due to time constraints, the main one being that this study would reveal more significant results if done as a longitudinal study as opposed to a cross-sectional study. Also while interacting with subjects in a group like Alcoholics Anonymous it is important to gain the confidence of the group before obtaining confidence of the individual.
The potential factors that would help change behavior
The preventive factors for substance abuse
Substance abuse is one of the major health challenges across the globe. Adolescents are among the most affected. This study aims to examine the reasons for initiation, maintenance of harmful use of substances and abstinence among adolescents and young adults by comparing the users and non-users. Accordingly, 40 users and 40 non-users of substances, aged 15-24 years were selected through convenient sampling method. It was found that most of the users had initiated substance abuse during 15-18 years of age, with peer influence, curiosity and sense of growing being the major reasons for the same. 'Feel good' and socialization were the main reasons for maintenance. The non-users never gave into substances because of personal values, awareness of the impact on health and family values. Both users and non-users had specific personal reasons for their respective behaviors. Young population would use substance for various psychosocial reasons despite knowing the harmful effects of substance. These findings have specific implications for preventive programs.
Long acting naltrexone preparations 
Long acting buprenorphine preparations 
Many pharmacological approaches have been used in managing substance use disorders. Conventional pharmacological agents have relatively short durations of action which make them vulnerable to non-adherence and relapse to substance use disorder. To overcome this problem, long-acting preparations have been developed with the aim of reducing the frequency of use and hence improving adherence. This review takes a broad overview of the long-acting preparations available for the management of substance use disorders. The pharmacology, advantages and disadvantages of these preparations are discussed. Many of these preparations hold promise for improving patient outcomes.
Traditionally, sexual abuse is under-reported and under-recognized when the victims are boys. A study carried out by the Government of India in 2007 suggests that every second child/adolescent in the country faces some form of sexual abuse and it is nearly equally prevalent in both sexes. The significance of the problem is undermined all the more when the abuse is perpetrated by a peer. Sexual activity between children and adolescents that occurs without consent or as a result of coercion is tantamount to abuse. A majority of the victims do not disclose the occurrence to anyone. This often neglected issue of adolescent male peer sexual abuse in a sexually conservative country like India is highlighted and discussed through this case, which came to light only after the victim developed a venereal disease.
We have reporting herein two cases of victims of sexual abuse, both 8 years old girls, both presented with symptoms of irritability, withdrawn behavior, fearfulness, anxiety, and abusive language toward family members. These symptoms appeared following sexual abuse. We are highlighting early identifications of child sex abuse and discussed the legal aspects of child abuse and "protection of children from sexual offences act" 2012. Finally, we have discussed how to prevent such incidences including incorporating school awareness programs in targeted girls' group.
In-between group comparisons for the sociodemographic variables
In-between group comparisons for substance use variables
In-between group comparisons for family history and inhalant use parameters
In-between group comparisons for inhalant use and withdrawal effects
Inhalant abuse is the deliberate inhalation of a volatile substance to achieve an altered mental state. Inhalants continue to be a poorly recognizable risk for morbidity and mortality globally. The current study explores the pattern of inhalant abuse across different year groups among the individuals seeking treatment form the de-addiction center of a tertiary care hospital. The study was conducted at a tertiary care multi-specialty hospital. The current study is a chart review of the cases with inhalant abuse/dependence presenting to the clinic. All the treatment records of the de-addiction clinic were reviewed and information was gathered regarding patients with inhalant abuse/dependence. The comparisons have been made across two different year groups. The two groups were compared for various continuous and categorical variables using the independent sample t test and χ(2) test/Fisher's exact test, respectively. The level of statistical significance was kept at P<0.05 for all these tests. The two study groups have been found comparable for various socio-demographic and inhalant use patterns. The findings of the current study suggest that the pattern and parameters associated with inhalant use among those presenting to a tertiary care drug dependence center tend to remain stable.
Attention deficit hyperactivity disorder (ADHD) persists in a majority of adolescents. It has been reported that ADHD patients have poor social functioning and risk for developing co-morbid psychiatric illnesses. To determine the retention of diagnosis of ADHD and to assess social adjustment, academic functioning and co-morbidities at follow-up. Retrospective cohort study. ADHD patients of 5-14 years of age who came to the out-patient department from 2005 to 2008 were contacted telephonically. Fifty one patients could be contacted. Parents of patients were interviewed using Vanderbilt ADHD Diagnostic Parent Rating Scale for diagnosing ADHD and co-morbidities. Social Adjustment Inventory for Children and Adolescent was administered for assessing their academic and social functioning. Chi square test, Mann-Whitney Test, Kruskal-Wallis Test, and Pearson's product moment correlations were used for statistical analysis. At current assessment, out of 51 patients, 38 were still fulfilling diagnosis of ADHD. Of these, 21 were of inattention type, 3 were hyperactive, and 14 were of combined type. Social functioning and academic functioning were significantly better in those who currently did not fulfill the criteria for ADHD (N=13). Twelve patients developed features of oppositional defiant disorder (ODD)/conduct disorder (CD) at follow-up. ADHD persists in the majority of adolescents. Decline with age is seen more in hyperactive/impulsive symptoms than inattentive symptoms. Several adolescents also develop features of ODD/CD in addition to poorer functioning. Continuation of treatment is crucial to prevent such consequences.
Mean scores of responses of the participants to the attitude towards mentally ill scale 
Background: Health care professions are not immune to social prejudices and surprisingly share the general public's attitude attributed to people with mental illness. Nursing students are future health manpower research related to nursing students attitudes toward mental illness is limited. Aim: The aim of this following study is to examine the undergraduate nursing students' attitudes toward people with mental illness. Materials and methods: Cross-sectional descriptive design was adopted for the present study. A total of 148 undergraduate nursing students were purposively selected to complete self-reported questionnaires. Results: THE NURSING STUDENTS HAVE SIGNIFICANT POSITIVE ATTITUDES TOWARDS MENTAL ILLNESS IN THREE OF THE SIX ATTITUDES FACTORS: Restrictiveness (8.59), benevolence (29.8) and stigmatization (9.18). However, these students have negative attitudes in separatism (27.1), stereotype (11.5) and pessimistic predictions (11.7) domains as they rated high. Conclusion: Academic education in this area must be planned so as to favor the change of the attitudes that include greater use of teaching strategies that challenge beliefs and assumptions and promote a commitment to provide holistic care to people with mental illness.
Results of the pilot testing
A substantial proportion of patients with severe mental disorders remain untreated in India. Qualitative research has highlighted the complex interplay of multiple factors that preclude schizophrenia patients in rural Indian settings from accessing treatment. (a) To establish the face and content validities of an interview schedule titled "Schedule of Factors Influencing Access (SOFIAc) to Psychiatric Treatment in Persons with Schizophrenia", which comprehensively assesses the factors that prevent schizophrenia patients from accessing psychiatric treatment. (b) To assess the feasibility of its administration. SOFIAc contains 15 items. This schedule involves three phases of interviewing patients and family members. This was given to 12 experts. They used Likert scales (1=not at all satisfactory to 5=very much satisfactory) to rate each item of the schedule. In addition, the experts rated (the same way as above) the following five dimensions of the schedule (as a whole) separately: A (comprehensiveness of the factors), B (scoring system), C (interviewing method), D (general instructions given to the raters), E (overall schedule). Later on, 10 persons with schizophrenia were interviewed with SOFIAc to test the feasibility of administration. Thirteen items were rated as either satisfactory (score=4) or very much satisfactory (score=5) by all 12 experts; remaining two were rated as 4 or 5 by 11 experts. Regarding comprehensiveness of the factors, scoring methods and general instructions given to the interviewers, all provided scores >4; regarding the method of interviewing, 11 provided the score of >4; with regard to overall interview schedule, all experts provided scores >4. Pilot testing revealed that it took 60 min to administer SOFIAc. SOFIAc has satisfactory face and content validities. It is also feasible to administer SOFIAc.
Depression is one of the commonest disorders encountered in general hospital psychiatry. Acromegaly is a condition with excessive growth hormone secretion that may at times present with oversychopathology. We present the case of a 33-year-old lady with depression and acromegaly that successfully resolved after treatment with escitalopram and cognitive therapy.
Psychiatry nurses are an integral component of a multidisciplinary mental health-care team. The current study aimed at understanding the attitude of undergraduate nursing students toward psychiatry. Additionally, the attitudes toward psychiatry have been compared across the training years among these students. The study was carried out at a tertiary care nurse-training institute. All the nursing students enrolled with the institute at the time of the study constituted the sample frame. The study questionnaire used in the current study was a 29-item questionnaire that assessed attitudes toward psychiatry. The data were analyzed using SPSS ver 17. Overall, the majority of the nursing students from all four groups had a favorable response to the statements of the Likert scale. Most of the significantly positive responses (as assessed by the Kruskal-Wallis analysis of variance of the rank order) were from the third-year and internship students. These findings were supported by the significant correlation between these statements and ranked order of the nurse-training years. The findings of the current study present some interesting insights into the attitude of nursing students toward psychiatry.
Conventional antidepressants take two weeks before their therapeutic action begins. Recent studies have reported on the rapid antidepressant effect of ketamine when given as an intravenous (I.V.) infusion. Little is known about its intramuscular (I.M.) use in depression. Hence this study was conducted to compare the safety, tolerability and efficacy of I.M. versus. I.V. ketamine in Major Depression (ICD-10). It was a randomized open label parallel group study in a tertiary care teaching hospital. Study sample consisted of 27 subjects having major depression divided randomly into three groups of nine subjects each. Ketamine administered to each group in the dose of 0.5 mg/kg as an I.V. infusion, as 0.5 mg/kg I.M. or 0.25 mg/kg I.M. respectively. Depression rated on the Hamilton Depression Rating Scale (HAM-D) before the injection, two hours later, the next day, and after three days. Data analyzed using the Statistical Package for Social Sciences (SPSS). Mean age of the sample was 36.81 years (SD 11.815). Two hours after the injection, HAM-D fell by 58.86%, 60.29% & 57.36% in each group respectively. The improvement was sustained for next three days. Adverse effects noticed were rare, of mild nature and transient, lasting less than an hour. Intramuscular ketamine in the dose of 0.25 mg/kg is as effective and safe as 0.5 mg/kg given either I.M. or I.V., substantially alleviating depressive symptoms within a few hours and sustained for 3 days.
The demographic pattern of the study group
Mean±S.D. of latencies (ms) of different ERP waves before and after doing exercise
Mean±S.D. of interpeak latencies (ms) between different ERP waves before and after doing exercise
Effect of acute moderate exercise on cognition has been studied recently, although there are controversial reports in this context. This is the reason we performed this study, to observe the effect of acute moderate exercise on the cognitive functions of persons having a sedentary lifestyle, by measuring the latencies of event-related potentials N100, P200, N200, and the inter-peak latencies N100-P200, P200-N200, and N200-P300. Sixty right-handed participants (34 males, 26 females) of age group 15 - 30 years, having a sedentary lifestyle, were recruited for the study. A baseline recording of event-related potentials was conducted and then they were subjected to acute moderate exercise (60 - 80% of the maximum load of effort during exercise, where 100%=200 - Age), again the recording was carried out using the paired student's 't' test, to compare the present values with the initial values. After performing the exercise there was a significant decrease in the latency of wave N1 and P2 of females for both frequent and rare stimuli. A significant decrease in the latency was seen in wave N2 with rare stimulus in both females and males. While, for frequent stimulus a significant decrease was seen only in females. Also the N2-P3 interpeak latency significantly decreased in males, while there was no significant decrease in females. There was a definite role of exercise in enhancing the cognitive functions as evidenced by its effect on the latencies of event-related potentials N100, P200, N200, and interpeak latencies.
Sociodemographic and clinical parameters 
Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57) over 1 year (2004) were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44) and 75.4% (n=43) of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.
Acyclovir, a commonly used antiviral drug can rarely result in neuropsychiatric complications especially in elderly. We for the first time report acyclovir associated hypomania in an elderly woman. Our report suggests that acyclovir is a risk factor for mood episode in vulnerable individual and one need to be cautious while using antiviral agents in patients with psychiatric disorders.
Antipsychotic induced weight gain is the most common and distressing side effect. This also affects the compliance toward the treatment and hence the prognosis. Non - pharmacological interventions such as exercise and diet modifications alone might not be sufficient most of the times; also ensuring compliance toward this is difficult in patients with psychiatric illness. So, the role of weight - reducing drugs become important. In this case report, we describe the use of low - dose topiramate as a weight - reducing agent, in a patient with a bipolar affective disorder - mania with psychotic symptoms, who had significant risperidone - induced weight gain.
Age, first use age of internet, and Yang score of the study participants
Association of demographic variables with internet addiction in the participants of the study
Association between computer and internet awareness and internet usage in the participants of the
Results of logistic regression for factors affecting internet addiction
Today's internet is a usual and common method for identifying and fulfilling unknown practices. Internet network has been prepared rapid and comfortable access to information. Internet addiction is a new and attractive subject that has been regarded as behavior-based addiction recently. To estimate the prevalence of internet addiction and some of the related factors among medical students, Iran. An analytical cross-sectional study was conducted on 426 students selected through two-stage sampling method. Yang standard internet addiction questionnaire was used for data collection. After data entry, χ(2), t-test, and Pearson coefficient statistical tests were applied. 0.05 was considered as the significance level. The overall prevalence of internet addiction was 10.8%, with moderate and severe internet addiction equal to 8% and 2.8%, respectively. Mean and standard deviation of Yang internet addiction score was calculated as 32.74±14.52. Internet addiction was associated with sex, marital status, father's job, rate of knowledge about computer and internet, and educational level (P<0.05). But it was not associated with the parents' education, residential area, field of study and level, and school of education (P>0.05). Because internet addiction leads to wasting of the students' leisure time and also useful time, it affects the educational situation inversely. Some measures should be taken to plan and improve the use of internet.
Explanatory theories for gambling behaviour
Some reasons for gambling and solutions
Gambling, including pathological gambling and problem gambling, has received increased attention from clinicians and researchers over the past three decades since gambling opportunities have expanded around the world. Gambling disorders affect 0.2-5.3% of adults worldwide, although measurement and prevalence varies according to the screening instruments and methods used, and availability and accessibility of gambling opportunities. Several distinct treatment approaches have been favorably evaluated, such as cognitive behavioral and brief treatment models and pharmacological interventions. Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported. Gambling disorders are highly comorbid with other mental health and substance use disorders, and a further understanding is needed of both the causes and treatment implications of this disorder. This article reviews definition, causes and associated features with substance abuse, screening and diagnosis, and treatment approaches.
Attention deficit hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders. Study objective is to report impact of comorbidities on short-term outcome in children with ADHD followed in a child guidance clinic. This was done in a child guidance clinic run jointly by the pediatric and psychiatry department at a tertiary teaching hospital. This is a 3 month prospective follow-up study to assess the outcome in ADHD children. Children attending pediatric department with behavioral problems or poor scholastic performance were screened for ADHD and further confirmation of diagnosis was done by semistructured interview of the child and parent. Children functional assessment and ADHD symptom profile was compared at baseline and at follow-up. We screened for and excluded those showing autistic spectrum disorder and having worse than mild mental retardation. Baseline variables were compared between improved and not improved subgroups and impact of these variables on outcome at 3-month follow-up was analyzed. Descriptive statistics. Of the 25 children completing the study, at the end of 3 months, 15 improved (not fulfilling criteria for ADHD) and 10 did not improve. Applying Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) for diagnosis of psychiatric comorbidities, six had associated psychiatric comorbidities. This was significantly higher in those who did not improve. Presence of comorbidities at baseline was found to affect outcome at 3 month assessment in this preliminary study. Future studies with larger sample and longer follow-up are needed for finding the predictors of outcome in ADHD children in developing nations.
Socio-demographic characteristics of patients and caregivers
Pattern of objective score at category and item levels
Association between GAF score, PANSS score, and FBIS score
Relationship between family burden and compliance with medication
The aim of the study was to determine the effects of the level of psychopathology and anti-psychotic medication adherence on caregivers' burden in schizophrenia. Three hundred and sixty-seven schizophrenia patient/caregiver dyads were interviewed. Caregiver's burden was assessed using the Yoruba version of the Family Burden Interview Schedule (FBIS) and 12-Item General Health Questionnaire (GHQ-12). Patients were assessed using the Global Assessment of Functioning (GAF) scale, Positive and Negative Symptoms Scale (PANSS), and medication compliance questionnaire. Mean age of the patients was 29.7 SD (8.6) years. About 82% of the 368 caregivers were parents of the patients with mean age of 58.1 years (SD 19.6). Total mean objective FBIS score was 22.69 (6.21), with 324 caregivers (85.3%) reporting total objective burden and 310 (84.2%) reporting subjective burden. FBIS scores were positively associated with PANSS scores but negatively with GAF P<0.001, respectively. Mean FBIS reduced with medication compliance categories A and B, P<0.01, respectively, but increased in category F, P<0.001. In all, 51.1% scored ≥3 on GHQ. Caregivers of schizophrenia patients experience enormous burden and are at risk for mental disorders. The severity of this burden is related to the level of psychopathology and medication adeherence, thereby adding to the available evidence pointing to the need for clinicians to optimize patients' management to prevent psychological distress in carers of such patients.
Demographic, clinical and treatment details†
Adherence with and continuation of treatment
Adherence with treatment: Related details
Despite a large body of evidence, the issue of differences in adherence and continuation of treatment with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in schizophrenia remains unresolved. This study compared adherence and continuation of treatment between patients on SGAs and FGAs and examined the influence of several socio-demographic and clinical variables on adherence in the two antipsychotic groups. Two groups, one of 40 patients with schizophrenia on SGAs and the other with 30 patients on FGAs, were compared on clinician-rated and patient-rated measures of adherence over 6 months; a 3-month period prior to intake and a 3-month follow-up period. Mean scores on these measures and the proportion of adherent/non-adherent patients was estimated for both groups. The two groups did not differ in the 3-month period prior to intake. Over the subsequent 3 months of follow-up, a-fifth of the patients on FGAs became non-adherent, while about 10% of those on SGAs became more adherent. These differences in continuation rates resulted in patients on SGAs being rated as significantly more adherent at the end of this 3-month follow-up period and over the entire 6 months of the study. Differences in adherence and continuation rates between the two groups were primarily driven by the differences between olanzapine and the FGAs. Supervision of treatment by relatives emerged as the only consistent determinant of adherence, but explained only 8% of the variance. Patients on certain SGAs, notably olanzapine, are more likely to continue with their treatment that those on FGAs.
Context: Work benefits mental health in innumerable ways. Vocational rehabilitation can enhance self-esteem. Medication adherence can improve work performance and thereby the individuals’ self-esteem. Aim: To test the hypothesis that there would be a significant correlation between medication adherence, work performance and self-esteem. Setting and Design: A quantitative, descriptive correlational research design was adopted to invite patients attending psychiatric rehabilitation services to participate in the research. Material and Methods: Data was collected from a convenience sample of 60 subjects using the ‘Medication Adherence Rating scale’, ‘Griffiths work behaviour scale’ and the ‘Rosenberg's Self-esteem scale’. Statistical analysis used: Analysis was done using spss18 with descriptive statistics, Pearsons correlation coefficient and multiple regression analysis. Results: There were 36 males and 24 females who participated in this study. The subjects had good mean medication adherence of 8.4 ± 1.5 with median of 9.00, high mean self-esteem of 17.65 ± 2.97 with median of 18.0 and good mean work performance of 88.62 ± 22.56 with median of 93.0. Although weak and not significant, there was a positive correlation (r = 0.22, P = 0.103) between medication adherence and work performance; positive correlation between (r = 0.25, P = 0.067) medication adherence and self–esteem; positive correlation between (r = 0.136, P = 0.299) work performance and self-esteem. Multiple regression analysis showed no significant predictors for medication adherence, work performance and self-esteem among patients with psychiatric illness. Conclusions: Medication monitoring and strengthening of work habit can improve self-esteem thereby, strengthening hope of recovery from illness.
Use of drug as self.medications by medical and nonmedical students
Nonmedical self-medication rate from the present study versus medicine acquaintance rate from a previous study[4]
All kinds of drugs are available over the counter in Bangladesh. The objective of this study was to investigate the over the counter use of self medicated drugs for primary and adjunct therapy in psychiatric diseases among medical and nonmedical students. 101 medical students and 186 nonmedical students were found, who used at least one of the nine drugs (believed as antipsychotics among nonmedical people) under survey within 6 months prior to survey date. The nine drugs used for survey were domperidone, sertraline, amitriptyline, midazolam, diazepam, prochlorperazine bromazepam, flupentixol-melitracen, and clonazepam. Snowball sampling method was used. The symptoms, diseases, etc. of the students and the length of therapies they had followed for the respective drugs were noted. Among nonmedical students, several cases were found where drugs were being self medicated in wrong indications, for example, use of flupentixol melitracen and domperidone to treat headache. The nonmedical students chose the fast acting drugs having the strongest effects for self medication.
Functional hallucinations are a rare phenomenon, wherein hallucinations are triggered by a stimulus in the same modality, and co-occur with it. Although hallucinations in schizophrenia are normally treated using antipsychotics, not all patients respond to them. The following is the report of a patient with paranoid schizophrenia who experienced persistent functional hallucinations, triggered by the sound of machines in his factory, in the absence of other psychotic symptoms. These occurred despite adequate doses of risperidone, which had controlled his other symptoms. The addition of sodium valproate, titrated up to 1700 mg/day based on response and tolerability, resulted in a marked improvement in this phenomenon and enabled him to return to work. The implications and possible mechanisms of the patient's response are discussed.
ICD 10 and DSM IV TR conceptualization of adjustment disorder
Subtypes of adjustment disorder
Differential diagnosis of adjustment disorder
Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity. However, diagnostic criteria are vague and not much helpful in clinical practice. Also there has been relatively little research done on this disorder. In this article, we review the information that is available on the epidemiology, clinical features, validity, and current diagnostic status of adjustment disorder. In this article, the controversy surrounding the diagnosis is also highlighted. It also discusses the differential and comorbid diagnosis. The various recommendations for DSM-V and ICD-11 conclude the article.
Relationship of psychiatric disorders on work and social adjustment
Frequencies and percentages of psychiatric disorders among the survivors extricated from under the rubble
Percentages of psychiatric co-morbidities among male and female survivors
This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble. Individuals (N=40) belonging to district Muzaffarabad, a severely earthquake affected area on 8(th) October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure. The most prevalent disorders were posttaumatic stress disorder (32.5%), major depressive disorder (17.5%), dysthymia (15.0%), agoraphobia (25.0%), and panic disorder (20.0%). Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity. Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.
A cross-sectional study was conducted to get an insight into the psychological world of adolescence and to study the influence of locality and school-going activity on it. The study group comprised of 240 girls in the age group 12-18 years equally representing urban and rural areas. Using two psychological tests, namely Strengths and Difficulty Questionnaire and Health-Related Quality of Life Inventory, the results revealed that two-third of them were in the problematic and borderline category as per SDQ and one-third as per PedsQL. Further, there was a definite linear relationship between the total problem score of both scales. This was irrespective of the locale and school-going activity. The results indicate the need for building psychological infrastructure into the social system to help adolescents girls grow to their potential.
Eating problems are commonly encountered in childhood and adolescents, and may be manifestation of a variety of psychiatric disorders when medical causes are excluded. We present the case of a young lady presenting with problems of eating which presented with difficulties of ascribing a diagnostic label for eating problems. The patient, a 12-year-old girl with history suggestive of mild mental retardation and juvenile myoclonic epilepsy presented with selective eating of foodstuffs which improved spontaneously in 2 months. The different diagnostic possibilities entertained for the case are discussed.
Presumptive stressful life events scale
Presumptive stressful life events scale
Multivariate logistic regression analysis to assess risk factors
Different risk factors associated with adolescent suicide attempts have been identified including those of socio-demographic and clinical variables. Relatively, little research has been done in the area of their stressors and coping patterns. To study the recent psychosocial stressors and patterns of coping associated with adolescent suicide attempts. Tertiary care hospital, case-control study. One hundred consecutive cases of adolescent attempted suicide admitted to the hospital and an equal number of controls, matched individually for age and sex, from the relatives and friends of other patients in the ward, were studied. Assessment included details regarding socio-demographic data, psychiatric and physical morbidity, their recent stressors, and patterns of coping. Stressors were assessed using Presumptive Stressful Life Event Scale and coping strategies by Ways of Coping Questionnaire (revised). Chi-square test and multivariate logistic regression analysis. The number of stressful life events and mean stress scores in the preceding 1 month and certain coping strategies such as confronting, distancing, and escape-avoidance were found to be significant risk factors associated with adolescent suicide attempts. Strategies such as self-control, seeking social support, accepting responsibilities, problem solving, and positive appraisal act as protective factors. Recent stressors and strategies such as confronting, distancing, and escape-avoidance are significant risk factors associated with adolescent suicide attempts, whereas certain coping strategies act as protective factors. Teaching adolescents these protective coping patterns may be a promising strategy for prevention of adolescent suicide attempts.
Psychotherapeutic processes in PAT
Review of reviews and randomized control trials on PAT for the past 5 years published in English
Pet assisted therapy (PAT) is a form of complementary psychosocial intervention used in the field of mental health and disability. The form of therapy has the potential to augment the other forms of psychotherapies and pharmacotherapy. This article is an overview of history and clinical origins of PAT, classification and therapy models, scientific basis, the current use in specific disorders, preventive and diagnostic role as well as the potential risks among children and adolescents with mental health needs with a special focus on the Indian needs. A systematic electronic search strategy was undertaken to identify the intervention effectiveness of PAT in MedLine (PubMed), cochrane database of systematic reviews, high-wire press and Google Scholar. We augmented our electronic search with a search of additional articles in reference lists of retrieved articles, as well as a hand search available journals that were not indexed in any electronic database in consultation with colleagues and experts. To qualify for inclusion, studies were required to meet predetermined criteria regarding study design, study population, interventions evaluated and outcome measured to reduce the publication bias.
Adolescents constitute only a small percentage of treatment seekers in drug dependence treatment settings. Little research evidence is available for pharmacological treatment of adolescent opioid dependence and no prior case report is available from India. We discuss two adolescent patients with opioid (heroin) dependence visiting a tertiary care center who have been stabilized on agonist (sublingual buprenorphine-naloxone) and antagonist (oral naltrexone) respectively for a substantial period of time. A comprehensive management approach, including intensive psychosocial interventions and family involvement, was followed in addition to pharmacotherapies. More research is needed on the efficacy of pharmacological treatment in adolescent opioid users.
Pact suicides involving families have been reported in the scientific literature, but reports have been few from India. We report the case of a family, in which the father and three children had entered into a suicidal pact and executed it due to social reasons. A 41-year-old man, with no past psychiatric or substance use history, had reportedly come to know that his wife had been involved in an extra-marital affair. As expressed by him in a suicide note, he could not bear the humiliation due to this and also did not want his children to face disrespect from the society. He along with his daughter and 2 sons, aged 14, 12 and 11 years respectively, thus entered into a suicide pact to end their lives and wrote a suicide note. Man and two of his children consumed aluminum phosphide. However, the youngest son did not consume the poison and raised alarm, following which they were rushed for medical care. The father died, but the three children recovered completely. The case highlights the rare phenomenon of suicide pacts involving an adult and children.
With the increase in the trend of social networking, celebrations, over a couple of decades weather in the hostel or at home. Snacking has become an important aspect of activity. Today teen prefer snacks more than a proper meal. Skipping of meal and nibbling in between meal is a common practice. The main meals (breakfast, lunch and dinner) are missed and total proportions of calories are consumed from the snacks eaten. Hence, this disordered eating behavior when continued may further lead to development of serious syndrome i.e., night eating syndrome. A purposive random sample comprising 188 males and 192 females (N=380), adolescents (18-22 years) were selected including hostlers and day scholars. The subjects were administered with self-organized questionnaire so to analyze the pattern of NES among them. Out of total 380 respondents, the numbers of hostlers were 211 and day scholars 169, while boys were 188 and girls were 192 in number. Results indicated that nearly half the percentage of adolescents snacked at night, out of which very few respondents met the criteria of NES, in which the number of hostlers were quite more than the day scholars, i.e.,76.3%.
Depression is a neurological disorder characterized by sad mood, loss of pleasure, agitation and retardation. Though most relevant neuronal pathophysiology is characterized by decrease in monoamine namely; serotonin (5-HT), dopamine, noradrenaline level in central areas regulating mood and behavior, it inadequately explains the exact mechanism involved. Buspirone (BUS), a partial 5-HT1A receptor agonist has shown promising anti-depressant and anxiolytic properties in various pre-clinical and clinical studies, but the molecular and cellular mechanisms are still unclear. The aim of this study was to investigate, in vivo, the role of hypothalamic-pituitary-adrenal (HPA) axis dysregulation in pathophysiology of depression-related disorders and the anti-depressant like activity of BUS. To simulate HPA axis dysregulation, rats were subjected to bilateral adrenalectomy (ADX). We have analyzed effect of BUS (10 mg/kg, i.p.) in ADX and sham rats using open field, sucrose consumption, elevated plus maze and hyper-emotionality tests. In all animal models tested, ADX rats exhibited significant depressive and anxiogenic states while BUS was effective in reversing the psychological diseased condition developed. Taken together, these data showed a prominent role of HPA axis in depression and neuronal mechanism of BUS as anti-depressant and anxiolytic agent. Moreover, our findings suggest that BUS can be a better candidate for stress related depression and anxiety.
Tics are rapid and repetitive muscle contractions resulting in stereotype movements and vocalizations that are experienced as involuntary. Onset before 18-year is a diagnostic criterion for tic disorders. Children and adolescents may exhibit tic behaviors after a stimulus or in response to an internal urge. Tic behaviors increase during physical or an emotional stress. Adult onset tic disorders are reported by infections, drugs, cocaine, toxins, chromosomal disorders, head injury, stroke, neurocutaneous syndromes, neurodegenerative disorders and peripheral injuries. Only few cases have yet been reported having onset after surgery though surgery brings both physical and emotional stress to the patient. We report a case of a 55-year-old lady who developed tic disorder as post-operative event of cataract surgery. Our patient had a dramatic response to haloperidol which is in contrast to all earlier reports.
(a) Right fundus montage showing subhyaloid hemorrhage in boat-shaped pattern with multiple blotch hemorrhages and grade-1 hypertensive retinopathy changes. (b) Left fundus showing grade-1 hypertensive retinopathy changes with absence of intraocular hemorrhages
Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi
(a) Cranial magnetic resonance imaging showing minimal subarachnoid hemorrhage in the anterior inter-hemispheric fissure and adjacent cortical sulci with edema in adjacent frontal lobes, and hyperacute subdural hemorrhage in bilateral fronto-temporo-parietal regions along the cerebral convexities (5 mm), with no mass effect or midline shift. (b) Magnetic resonance angiography showing a small aneurysm (6 × 6 × 4 mm) arising from the anterior communicating artery, with the neck of aneurysm measuring 1.5 mm in medio-lateral direction
(a) Right fundus montage showing complete resolution of subhyaloid hemorrhage with resolving blotch hemorrhages, a week following Nd:YAG laser photocoagulation. (b) Cranial computed tomography showing near-complete resolution of intracranial hemorrhages with mild enlargement of lateral and third ventricles
Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin. Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes that resemble primary depressions both clinically and therapeutically in about half of the patients following acute stroke. Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting. Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds. We report an unusual case of organic depression and Terson's syndrome in a 50-year-old female with polycystic kidney disease and hypertension, following anterior communicating artery aneurysmal subarachnoid bleed with bilateral subdural extension. Management included anti-hypertensives, antiepileptics, neodymium: YAG laser photocoagulation, and aneurysmal clipping.
The lack of baseline understanding of what young adults' needs and expectations are from marital and family life is the context in which this study has evolved. The author believes that the findings from this study could fee into the contents of a more relevant and useful Family Life Education program for young adults in urban India. To explore and analyze the needs and expectations of single young adults with respect to marital and family life. A college in Bangalore with students from graduate and post-graduate courses in the age group of 18 to 25 years. A semi-structure interview schedule prepared by the author was administered on 100 students. Qualitative and Quantitative. The results showed that a large number of the participants had very specific emotional, cognitive and physiological expectations from marital and family life. They also expressed an active need for education on mate selection, sexuality, parenting, interpersonal relationships, intimacy, conflict resolution, among other areas of need. The findings from this study would find great relevance in the preparation of a relevant and practical Family Life Education program for single young adults which in turn would be useful in colleges, workplaces, family counseling centers or any platform where single young adults wish to access such family base services.
Sociodemographic and clinical characteristics of the respondents at the ART clinic of UMTH in Maiduguri, northeast Nigeria 
Comparison of the quality of life (QOL) scores of depressed and nondepressed HIV positive respondents at the University of Maiduguri Teaching Hospital, Nigeria 
Background: Globally, depression compromises the quality of life (QOL) of people suffering from it. We assessed the impact of comorbid depression on the health-related quality of life (HRQOL) of adults on highly active antiretroviral therapy (HAART) in northeastern Nigeria in this study. Materials and Methods: Three hundred and three adults on HAART were recruited for this study from the ART clinic of the University of Maiduguri Teaching Hospital in northeastern Nigeria. The depressive disorder module of the Composite international diagnostic interview (CIDI version 3.0) and the WHO quality of life instrument (WHOQOL-BREF) were used for the evaluation of depression and quality of life respectively. Results: The prevalence of depression in this study was 19.8%. The depressed respondents rated their HRQOL poorer than their nondepressed counterparts on the physical, psychological, social relationships and environmental domains as well as the global outcome, as shown by these statistically significant findings (T = 9.739, P = <0.001), (T = 8.972, P = <0.001), (T = 6.533, P = <0.001), (T = 8.913, P = <0.001), and (T = 10.018, P = <0.001), respectively. Female gender, CD4 counts <200/mm3 and diagnosis of depression were significant predictors poor QOL. Conclusion: Depression has a negative impact on the QOL of the respondents. We therefore recommend incorporation of the routine screening of this important psychiatric comorbidity into the care of this vulnerable group in order to optimize patient care.
Top-cited authors
Jaykaran Charan
  • All India Institute of Medical Sciences Jodhpur
Chittaranjan Andrade
  • National Institute of Mental Health and Neuro Sciences
Vikas Menon
  • Jawaharlal Institute of Postgraduate Medical Education & Research
Suresh Bada Math
  • National Institute of Mental Health and Neuro Sciences (Institute of National Importance)
Sandeep Grover
  • Postgraduate Institute of Medical Education and Research