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Role of Play Therapy in Childhood Grief: A Case Report

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POSTERS
POSTERS DAY 2 FORENOON
Child and Adolescent Mental Health
Improving Student Functioning and Access to Care in Nicaragua
Through a School–Based Mental Health Program: A Pilot Project
Ravindran A, Herrera A, Kutcher S, Henderson J, Castrillo M, Da Silva T
Centre for Addiction and Mental Health and University of Toronto,
Ontario, Canada. E-mail: arun.ravindran@camh.ca
Background/Objectives: Rates of mental illness and addictions are
high in Nicaragua, particularly among youth, who have the highest
suicide rates in the region. However, mental health resources and
public awareness of mental health issues are very limited. Schools
could be used as a source of mental health knowledge and support
for youth. The objective of this project was to evaluate the efficacy of
a school-based mental health program in enhancing well-being and
access to care among youth in Leon, Nicaragua.
Methods: Students (15-19 years) at the 4 high schools and the local
university in Leon participated in the project. They were divided by
school/university department to a 12- week mental health curriculum
(intervention group), or a control group. Intervention group teachers
were trained to deliver the curriculum, to identify and support distressed
students, and to make referrals to local agencies for additional care,
as needed. Students completed self-report measures of mental health
knowledge and personal functioning at baseline, 12 weeks and 6
months. Chi square tests and mixed analysis of variance analyses
were used to examine group differences over time.
Results: The total sample consisted of 913 students (567 intervention,
346 control). There were no differences in demographics or baseline
scores between the groups. After 12 weeks, intervention students had
better mental health knowledge and health behaviours and lower stigma
and perceived stress than controls (percentage 0.05), and increased
help-seeking compared to baseline (percentage 0.05). There was
also a significant increase in student referrals by intervention teachers
compared to control teachers (percentage 0.05). These findings were
sustained at 6 months.
Conclusion: A school-based mental health program was effective
in improving functioning, mental health knowledge and help-seeking
among Nicaraguan youth. Use of schools as a hub for mental health
education and support was also effective in improving early detection
and access to care.
A Study of Behaviour and Temperamental Characteristics in
Offspring of Patients With Acute and Transient Psychotic Disorder
Saha R, Bhatia MS, Unni KES
University College of Medical Sciences & GTB Hospital, 494 Hardevpuri,
Gautamnagar, New Delhi, India. E-mail: dr.saharashmita@gmail.com
Background/Objectives: Acute and transient psychotic disorder (F 23)
was introduced as a diagnostic entity with the advent of International
Classification of Diseases 10 (ICD-10) in 1992. It generally affects
people of child-bearing age and most of them are parents. Research
has revealed the potential impact that parental psychiatric disorder
can have on children. Children may exhibit adjustment problems,
temperamental variations besides manifest psychiatric conditions.
The current study was conducted at a tertiary care hospital in New
Delhi, India with the aim to study the behaviour and temperament of
children of patients suffering from ATPD as compared to children of
healthy parents.
Methods: Two groups, each comprising of 60 children, in the age
group of 4-16 years, belonging to parents with ATPD and healthy
parents were selected and considered as the case and control group
respectively. The selected subjects were assessed based on the
response given by their parents (healthy parent for case group) for
each of the individual items of the Child Behaviour Checklist (CBCL),
modified version by ICMR task force, NIMHANS, Bangalore and the
Temperament Measurement Schedule (TMS), modified version by Dr.
Savita Malhotra, PGI, Chandigarh.
422 © 2016 Indian Journal of Social Psychiatry | Published by Wolters Kluwer - Medknow
Results: The mean age of test group was 6.65±3.27 years and that
of control group was 7.70±3.55 years. The children in the test group
showed significantly greater scores (19.15±7.33) on CBCL than
control groups (11.60±4.076) with p<0.001. Children of parents with
ATPD had significantly poor adaptability, low mood, poor rhythmicity,
lesser distractibility and higher intensity when compared to children
of healthy parents.
Conclusion: Our findings suggest that children of patients suffering
from ATPD suffer greater behavioural difficulties and difficult
temperament when compared with the children of healthy parents.
Further research in this direction may help detect at risk children and
assist in early intervention.
Key words: acute and transient psychotic disorder, offspring,
temperament
A Case of Heller's Syndrome
Hussain N, Chary RPS, Raj VS
SVS Medical College, Mahbubnagar, Telangana, India. E-mail:
neiloforhussain@gmail.com
Background/Objectives: Heller’s syndrome , also known as Childhood
Disintegrative Disorder, a part of Autism Spectrum Disorders is a rare
condition (incidence - 0.002%) characterized by a late onset (2-10
years) loss of previously acquired language and social skills and results
in persistent delay in these areas, in addition to restricted, repetitive, or
stereotyped patterns of behaviour and other behavioural abnormalities.
Case Discussion: We present the case of a 9 year old male child. The
patient had normal development till the age of 5 years, then he started
to develop regression of previously acquired language and social skills
along with repetitive, stereotyped behavior and behavioural abnormality
in the form of aggression suggestive of Heller’s syndrome. The aim is
to report a case of Heller’s syndrome in detail. The details of the case
will be presented at the conference.
Key words: Heller’s syndrome, Childhood Disintegrative Disorder,
Autism Spectrum Disorders
Comparison of Efficacy of non-specialist (parents) vs Professional
Provided Behavioural Therapy in Children Under 3 years Old With
Pervasive Developmental Disorders
Martsenkovsky I
URISFPTMHU, 19/3 Pravda Ave, Apt.103, Kyiv, Ukraine. E-mail:
martsenkovsky_urisfpda@ukr.net
Background/Objectives: Applied Behavioural Analysis (ABA)
Interventions used for PDDs children include Early Intensive
Behavioural Intervention (EIBI) and the Lovaas Model for older
children. Pivotal Response Treatment (PRT), formerly called the Natural
Language Paradigm, Positive Behaviour Support (PBS) is a play-based
teaching methodology that utilizes the to modify behaviour. Many
children with PDDs, particularly those in low-income countries have
limited access to certified ABA therapists. If trained non-specialists were
able to provide such care, more children were able to receive treatment.
Methods: We examined 240 toddlers with PDDs from 18 to 36-month
old. For diagnostic we used: ADI-R, ADOS, and for assessment of
development: ASQ: SE, PEPR, and Vineland. The toddlers were
randomized in two groups that received 20 hours of therapy per week
for 40 weeks: the first group (FG) received EIBI provided by certificated
therapists, and the second group (SG) PBS Intervention provided by
parents after 4 hours long training with supervision of specialists every
two weeks.
Results: In the end, the IQs in the FG had improved by an average
of approximately 20 points (p<0.05; η2=0,652), compared to
12 points in SG (p<0.05; η2=0,458). The FG also had a nearly
14-point improvement (p<0.05; η2=0,610) in receptive language
(listening and understanding) compared to approximately 9 points
in the SG (p<0.001; η2=0,460). It was found that for EIBI, the best
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Abstracts
outcomes were shown for developmental and daily skills. Cognitive
rehabilitation, training, and support were found to be most effective for
improving developmental outcomes; and parent training interventions
to be most effective for improving developmental, behavioural, and
family outcomes.
Conclusions: All toddlers from 18 to 36-month-old should be screened
for PDDs. EIBI provided by certified therapist was more effective
than Behavioural Interventions of non-specialist, but it can be useful
especially in low-resource settings.
Childhood Psychopathology in Children of Alcohol Dependent
Parents
Purushottam, Kumar K, Kumar V, Gupta R
IMH, PT BDS UHS Rohtak, Haryana, India. E-mail: docpuru71@
gmail.com
An estimated 6.6 million children under the age of 18 years live in
households with at least one alcohol dependent parent. Current
research findings suggest that these children are at risk for a range
of cognitive, emotional, and behavioural problems. In addition,
genetic studies indicate that alcoholism tends to run in families and
that a genetic vulnerability for alcoholism exists. Children of alcohol
dependents (COAD) have reported to have an elevated risk for
externalizing, attention problems, aggression and delinquency and
conduct or antisocial personality disorder. Longitudinal research also
suggests that these behaviour problems are robust predicator of
future alcohol and other substance used disorder. Research suggests
that these children are at greater risk for having emotional problems
than children whose parents are not alcohol dependents. Alcoholism
runs in families, and COAD’s are four times more likely than other
children to become alcohol dependents. Most children of alcohol
dependents have experienced some form of neglect or abuse. The
present study evaluates whether there is any relationship of childhood
psychopathology and alcohol dependent parents. With the above
mentioned aim current study will be design at institute of mental health,
UHS Rohtak with the sample size of 50. Tool will be Socio-demographic
data sheet, Child Behaviour checklist. (T.M. Achenbach. 1991), AUDIT:
- Alcohol use Disorder Inventory Tool. (Babar.T.1996).
Results: will be discussed further.
Key words: childhood psychopathology, children of alcohol dependents
(COAD), externalizing and internalizing behaviour, alcohol dependence
parents
Attitude towards selfie
Dikshit R, Dutta E, Sharma P, Shah N, Sonavane S, Desouza A
L.T.M.M.C Mumbai, Maharashtra, India. E-mail: reetikadikshit@yahoo.
com
Background/Objectives: Smartphones have become a necessary evil
in our lives. Selfies have become the newest technological fad to take
over the youth, due to the wide & easy availability of mobile phones.
There is paucity of scientific data on selfies in general, and from our
country in particular. This study aimed to analyse the attitudes towards
selfie taking, body image acceptance and narcissistic personality traits
amongst an urban school going population in Mumbai.
Methods: 252 students of 11th standard, belonging to an urban Mumbai
school were interviewed in a single centric cross-sectional study. Scales
used were Attitude towards selfie taking questionnaire (ATSQ), Body
image acceptance and action questionnaire (BIAAQ) and Narcissistic
personality inventory (NPI). Statistical analysis used: Scores obtained
were computed using basic descriptive statistics using computerized
statistical software.
Results: Of the 230 completely filled questionnaires 54% were males.
42.6% reported that they regularly clicked selfies of themselves. No
gender difference was noticed. On an average, 18.1% girls & 15.2%
boys clicked more than four selfies per day. The gender difference
was statistically not significant (p= 0.5273). Difference in mean BIAAQ
between the two genders was noticed to be statistically significant,
whereas the NPI scores difference was insignificant.
Conclusion: The present study is a pioneering/novel/innovative work
in the field of Selfies. It gives us an insight into the youth’s viewpoint
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
towards selfies, which was positive in the majority of the population.
A worrisome aspect is the higher body image dissatisfaction amongst
girls. Behavioural addictions like selfies need more focused research
in the future.
Key words: selfie, adolescents, smartphone, narcissism, body image
Post-traumatic Psychopathological Phenomena Among Children
and Adolescents Living in Conflict Region and Surrounding Areas
in Eastern Ukraine
Khaustova O, Chaban O, Trachuk L
Ukrainian Research Institute of Social Psychiatry, Road Clinical
Hospital, Kyiv, Ukraine. E-mail: oksana.v@dinadis.ua
Background: It is known that in the conditions of protracted conflict
children and adolescents have a much higher level of mental disorders
compared with peers in peaceful regions. Many children subsequently
develop mental health problems, including post-traumatic stress
disorder (PTSD) symptoms.
Objectives: To study post-traumatic psychopathological phenomena
in children and adolescents who live in conflict region and surrounding
areas in Eastern Ukraine.
Methods: The pilot clinical and epidemiological research was
conducted in 2015-2016. 72 children and adolescents who live in
conflict region in Ukraine participated in the study. Participants varied
in age from 6 to 17 years (mean age 11.50 years, SD 2.48). Female
children and adolescents comprised 60.2% of the sample. We used a
structured interview and the children's version of the psychosomatic
orientation questionnaire.
Results: In the study of regional migration (Kharkiv, Dnipropetrovsk
and Zaporizhia regions), as well as parts of the occupied territories
of Donetsk and Lugansk regions, we have found that 83% of
surveyed children and adolescents have following psychopathological
phenomena: anxiety (58%), fear (56%), stress (47%), mood swings
(40%), sadness (28%), sleep disorders (36%), aggression (11%).
Significantly more female (16.7%) than male children and adolescents
(4.6%) reported about the anxiety and fear of death during the war
(t21,21 = 5.85, P < 0.05). Older children showed more psychological
problems than younger children Rare seeking professional help to
assist children in dealing with stress is common problem in these
regions, despite the fact that the volunteer psychological support
currently widely available in these regions. Usually they search for
support from their family and friends.
Effect of Family Environment in Development and Management
of Depression in Adolescence: A Case Study
Gupta P, Shallu, Dogra R, Gupta R
Department of Psychiatry PGIMS Rohtak, Haryana, India. E-mail:
poonamgupta1969@gmail.com
Background: Psychosocial theories of developmental
psychopathology reports that family environment play a significant
role in forming both adaptive and maladaptive functioning of their
children. Family psychopathology and environment have been the
focus of most researches on depression in adolescents. Pathogenetic
factors within the family environment, such as parental depression,
changes of family structure, violence or neglect can also contribute
to depression in adolescents. Children of depressed, anxious and
disturbed individuals are significantly more maladjusted, depressed
and anxious. Adolescents are more likely to benefit from treatment if
they and their families accept that there is problem and are committed
to resolve it.
Objectives: The objectives of the study were to study the effect of
family environment in development of depression in an adolescent boy,
and to study the effect of psychosocial intervention in management of
depression in an adolescent boy.
Methods: A case study of an adolescent boy of 17 years, who
was brought by his parents with chief complaints of school refusal,
decreased interest in studies with sadness of mood, irritability and
withdrawal behaviour along with disturbed sleep and self-care since 1
year for treatment and management in the department of Psychiatry,
Institute of Mental Health, U.H.S. Rohtak. For intervention family
423
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Abstracts
environment scale and psychological tests were used and 16 sessions
of family psychosocial intervention were given.
Results: to be discussed later
Conclusions: to be discussed later
Tourette’s Severity and Parental Handling
Sen MS, Chauhan N, Shah R
PGIMER, Chandigarh, India. E-mail: mahadevsinghsen@gmail.com
Background/Objectives: In patients with Tourette’s Disorder, severity
of illness correlates with the children's reports of behaviour disturbance
and dysphoria. Parental counselling and psychosocial intervention can
be an effective treatment option in such cases.
Case Description: Eight year old boy with a birth history of emergency
lower segment caesarean section done because of fatal distress, born
normal. Had recurrent throat infections during early childhood and a
background history of hyperactivity and inattention. Presented with a two
year history of repeated urge to clear his throat and shrug his shoulder.
These movements were automatic and would help relieve anxiety.
There was increase in frequency and intensity of these movements
over time and with stress. Over time, patient started having repeated
thoughts about contamination and compulsive washing. Treatment
was sought from general physicians and received valproate, lithium
and clomipramine (25mg) with no improvement. Further after three
months, patient also developed coprolalia and resulted in inattention
and decrease in scholastic performance. With these complaints, he
was admitted in PGIMER. On exploration, patient had history of OCD
in grandmother and high degree of expressed emotions from father
in form of critical comments and hostility. The symptoms varied with
extreme parental encounters. Mental state examination showed
repeated movements & sounds with obsessional doubts and yielding
compulsions. All investigations including EEG and MRI were normal and
PANDAS ruled out. Diagnosis of Tourette's syndrome with Obsessive-
compulsive disorder was kept, patient was started on Haloperidol 1
mg/d along with Fluoxetine (increased to 30 mg/d). Behaviour analysis
was done followed by behaviour therapy and parental interventions.
Patient was then discharged to be followed up on OPD basis.
Conclusion: The case is discussed in the light of parental handling in
the tic severity. Also stressing on the role of Parental counselling and
psychosocial intervention in treatment.
Key words: Tourette’s, psychosocial intervention, Parental handling
Stress and Coping Among Parents with Mentally Retarded Child
Kattimani S, Hemlatha K, Sarkar S, Roy G
Department of Psychiatry, JIPMER, Dhanvantari Nagar, Puducherry,
India. E-mail: drshivanand@gmail.com
Background/Objectives: To assess the perceived stress among
parents having a child with mental retardation (MR) and to know their
ways of coping the stress.
Methods: Study recruitment happened between January 2010 to March
2012. Children aged 19 year or younger, studying in special schools
in Puducherry. We recruited 181 parents (93 mothers and 88 fathers)
of children with varying degree of mental retardation (Mild MR=32,
Moderate MR=32, and severe MR=32). We assessed perceived stress
using Family Interview for Stress and Coping in Mental Retardation
(FISC- MR) Scale. Higher scores in each subscale represented a high-
stress level in that domain. Coping was assessed using ways of coping
questionnaire (Folkman and Lazarus, 1988). It yields eight subtypes of
coping: confrontive coping, distancing, self-controlling, seeking social
support, accepting responsibility, escape avoidance, planful problem
solving, and positive reappraisal.
Results: Mothers showed higher total stress score than fathers (14.12±
7.57 vs. 9.43± 6.25, t=4.549; p< 0.001). Among the coping strategies,
there was no difference in problem-focused coping between fathers
and mothers. However, emotional focused coping was significantly
higher among fathers (58.78± 13.35 vs. 54.27± 11.68, t=2.424, p<0.01)
especially on distancing and self-control subscales.
Conclusion: Total perceived stress and especially care stress was
higher among mothers. Care stress was influenced by severity of MR,
presence of comorbid cerebral palsy especially among mothers. None
of child and family related variables influenced the ways of coping used
424 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
by the parents. This knowledge paves the way for adapting appropriate
interventional strategies to reduce stress.
Keywords: mental retardation, subnormal intelligence, intellectual
impairment, children, adolescence, female, stress, coping
NMDA Encephalitis Presenting as Cataton
Prathap A
MOSC Medical College Hospital, India. E-mail: chandranaparna@
yahoo.com
Background/Objectives: Anti N-Methyl-D-Aspartate (NMDA) receptor
encephalitis often mistaken for viral infection presents a bewildering mix
of behavioural, psychiatric, movement, speech, autonomic and brainstem
function symptoms in children and adolescent that occur when the body’s
immune system attacks the NMDA receptors in the brain.
Case report: Nine-year old girl presented with one episode of GTCS
and fever, treated as viral meningoencephalitis in ICU for 6 days,
after which noticed to have sleep, altered sensorium, hallucinatory
behaviour and cognitive disturbance. She presented at a tertiary
centre with mutism, posturing, urinary retention and not taking orally.
USG abdomen showed no abnormality. Serum and CSF NMDA
antibodies came positive and she was treated with IV MP, IV IG and
plasmapheresis. After catatonic symptoms subsided, she was noted
to have difficulty in recall and naming, stubbornness and verbal
perseveration for which she was started on Quetiapine.
Discussion: Major aims in management include: identification
ad resection of any tumor, early initiation of immunotherapy and
management of comorbidities. Recovery process typically occurs over
months in reverse of the order in which symptoms present.
Conclusion: Anti NMDAR encephalitis, an autoimmune disease that
may be associated with ovarian teratoma, is more common in females
and should be suspected in any child, adolescent or young adult who
develops a rapid and persistent profound change in behaviour or
distortion of cognition, abnormal postures or movements, new onset
seizures and/or signs of autonomic instability. The diagnostic test is titre
for anti NMDAR antibodies in both serum and CSF. Imaging of abdomen
and pelvis is mandatory in all female patients. Earlier immunotherapy
with corticosteroids and IVIG and surgical excision of teratoma is
associated with improved outcomes. Death is rare but recovery is slow.
Comprehensive care of this disorder requires a multidisciplinary team
to effectively treat all aspects of this disease.
Key words: NMDA, Encephalitis, Catatonia
Child Rearing in Ancient India
Konar D
Mental Health Care Centre, Kolkata & Burdwan, India. E-mail:
devkon59@yahoo.com
Child rearing as a subject is not given its due importance in today’s
academic and social fora. In contrast, seeing Indian scriptures you feel
that it occupied an important place in ancient India. Kaumarabhratya
or the care of the children is one of the eight branches of Ayurveda.
Ayurveda is quite elaborate on the topics related to development and
child care practices. Fetal stage is considered in detail as an important
prelude to child rearing. Mother and young child are considered a
symbiotic unit. Kashyapa Samhita discusses the period up to 16 years
quite elaborately into three stages, namely infancy, early childhood and
adolescence. The construct of temperament in ancient Indian thought
was based on triguna from the Samkhya tradition. The samskaras
are widely practiced cultural rituals, which contribute to promote the
achievement of developmental tasks. While the gunas and doshas
reflect inherited predispositions, the samskaras are socially sanctioned
rituals carried out at the developmentally appropriate stages. Of the ten
samskaras related to child, three are carried out before birth and seven
through childhood. Many of these rituals are to boost up the morale of
the mother and child. Vivekananda observed that spirituality was quite
important in the holistic education system as was practiced in ancient
India. The child centeredness as depicted in Mahabharata, the ancient
Indian epic, is mostly limited to boys. Indian tradition is indifferent, if
not hostile, to the development of the girls. This seems to be a major
fault line in ancient Indian child rearing.
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Abstracts
A Comparative Study of Aggression and Family Involvement in
Juvenile Delinquents and Normal Juveniles
Ambikar Y
Jai Narayan Vyas University, Jodhpur (Rajasthan). E-mail:
ambikary1688@gmail.com
Background/Objective: The present study aims to investigate the
relationship of family involvement with aggression between juvenile
delinquents and non-delinquent adolescents. Family involvement refers
to the psychological involvement with family and importance of family
to the individual. It is likely to generate internal pressure to devote
more time to meet family role demands, and therefore demonstrates a
positive relation to time commitment to family. It is an important aspect
of behavioral research in 21st century because of changing nature of
society that affects people in general and adolescents in particular.
Aggression refers to antipathy resulting in hostile or violent behavior
with readiness to attack or confront. There is a great concern about
the incidence of violent behavior among children and adolescents.
Aggressive behavior may represent a normal developmental stage or
indicate a serious ongoing mental health disorder that poses a safety
concern.
Methods: The present study is an ex post facto correlation, non-
experimental research. The sample consisted of 60 juveniles (30
juvenile delinquents and 30 normal juveniles) which were selected using
purposive sampling with age range of 14-18 years. Data from Juvenile
delinquents was collected from Juvenile Reform home Jodhpur. The
scales used for this study were “Family Involvement scale” by A.P.
Singh and Dr. Akhilendra K. Singh and Aggression Questionnaire by
Dr. G.C.Pati. The data obtained was statistically analyzed using mean,
standard deviation, Pearson’s product moment correlation and test.
Result: The results indicated slightly negative correlation in aggression
and family involvement among juvenile delinquents. The significant
difference was not visible in juvenile delinquents and normal juveniles
in regards of their aggression level.
Conclusion: Thus it can be concluded that aggression and level of
family involvement are not the sole reasons for delinquent behavior
among juveniles. There are other psychological and familial factors
also that result in delinquent behavior.
Child Sexual Abuse Awareness Among Adolescents
Kumari L
AIIMS, New Delhi, India. E-mail: laxmisainivd@gmail.com
Background: Adolescents are vulnerable group of our society. There
is less data on the child abuse and adolescent maltreatment in our
nation. This is the group where timely intervention will result in increased
benefits. Childhood maltreatment resulted in increased risk for major
psychiatric disorders.
Methods:The objective of the study was to find out the awareness
of child abuse and the effectiveness of awareness program among
adolescent boys from selected centre of New Delhi. A descriptive,
cross sectional study on 50 adolescents from selected centre of east
Delhi was conducted from age group 11 to19. Tools: a demographic
data sheet with selected variables and The Children’s Knowledge of
Abuse Questionnaire to assess the awareness of child sexual abuse.
Data analysis is done by using STATA 11.1.
Results: Mean age of adolescents was 13 years. About 95% of them
were living in nuclear family. The awareness of child abuse was average
with a mean score of 20, the score ranges from 12-25.60% of the
adolescents reported that they were abused. 33% of adolescents were
at the age of 10 at the time of first incident. 37% of adolescents were
still under threat. Males were the most frequent abusers 93%. Majority
of abusers were well known to the victim. Only 13% were stranger. 67%
of adolescents never informed anyone about the incidence. Parents
were most frequently informed (20%) but 11% reported that they were
not trusted and 39% were told to keep it as secret. The awareness
program was effective overall but on sub analysis efficacy seen only
to appropriate touch but not on in-appropriate touch.
Conclusion: Educating and creating awareness among children is
important to build up a strong healthy future of the country.
Key words: adolescents’ child sexual abuse
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
MAANASA: A School Level Teacher’s Early Identification and
Intervention Model for Children with Scholastic Backwardness
Raghavan J
SAT Hospital Medical College, Trivandrum. E-mail: laxmisainivd@
gmail.com
Background: Learning is not a unitary process involving teacher and
student. Biological and developmental status of the child also plays
an important role. It depends on interplay of familial, psychological,
educational, social and economic atmosphere in and around the child.
In a normally developing child having normal vision and hearing with
adequate psycho social stimulation and school exposure, the basic
learning skills including reading writing and basic arithmetic will be
attained by the end of 4th standard. Scholastically backward children
are backward in relation to average attainment of scholastic skills for
that age and grade. Children with scholastic backwardness are not
properly identified and intervened at school level. Early identification,
analysis and intervention of scholastic backwardness at the school level
itself by trained teachers is the need of the school education system.
Objectives: To develop an upper primary school level teacher’s model
of early identification and intervention for children with scholastic
backwardness.
Methods: Early identification and individualized educational and
family based psycho social interventions were carried out by trained
resource teachers who were appointed in all upper primary schools
as part of MAANASA project under the South Mararikulam Grama
Panchayath, Kerala.
Results: Out of total 629 students in four upper primary schools, 147
had scholastic backwardness (23.7%). Among them, reading skill
grading showed that, 68 mild, 60 moderate and 19 severe grade of
scholastic backwardness. Family psycho social problems were noticed
among 48.7% of the children. Common family psycho social problems
observed were domestic violence, alcoholism, quarrelsome events and
abandoned family. After one year of individualized educational and
family based psychosocial interventions, 54.88% of students improved
in their reading and writing skills and moved to higher grade.
Conclusion: MAANSA is an effective teacher’s early identification
and intervention model for children with scholastic backwardness at
the school level.
Psychopathological Co-Morbidities in Specific Learning
Disorders: A Cross-Sectional Study
Sahu A, Bhargava R, Sagar R, Mehta M
All India Institute of Medical Sciences, New Delhi, India. E-mail:
cpanamika159@gmail.com
Background/Objective: Specific Learning disorder (SLD) is a
neurodevelopmental condition that affects approximately 0.38%-15.2%
Indian children. Children with SLD frequently exhibit co-morbidities
with other disorders, including Attention Deficit Hyperactivity Disorder
(ADHD), Conduct disorder (CD), Anxiety, depression etc. The present
study examined the psychiatric co-morbidities among children with
SLD who registered in child guidance clinic.
Methods: The sample consisted of 41 patients from 7 to 12 years of
age with a diagnosis of SLD. Clinical and psychological assessment
included the following tests for behavioural, anxiety, mood and
interpersonal problems: Child Behaviour Checklist, Mini International
Neuropsychiatric Interview for Children and Adolescents (MINI-KID)
and Conner’s 3TM Parent Short form (CPSF-45). This study was
conducted between January 2015 and August 2015 at the psychiatric
department of All India Institute of Medical Sciences, New Delhi, India.
Results: The mean age of the participants was 9.8 years. 76% of
participants were male and majority of them were studying in primary
class (63%). All participants were diagnosed with SLD-Mixed type
(100%). Among the all participants, 22% were reported to have
symptoms of ADHD, 37% had Attention Deficits Disorder (ADD),
2.4% exhibited ODD and 2.4% had social anxiety. Additionally,
male participants reportedly exhibited greater AD/ADHD problems
(32%/22%) than females (4.9).
Conclusion: This study suggests that SLD children are likely to exhibit
signs of ADHD/ADD. Identification of co-morbidity with SLD is essential
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Abstracts
considering the worse effect of it on child’s learning. Additionally, the
management of co-morbid conditions are recommended along with
remediation of learning problem to overall educational and behavioural
achievements and development of child.
Key words: Specific learning disorders, co-morbidities, Attention Deficit
Hyperactivity Disorder
Relationship Between Psychological Variables (Anxiety,
Depression, and Coping) Among Adolescents from Selected
Schools of New Delhi
Thomas N, Gupta S, Bhargava R
College of Nursing, All India Institute of Medical Sciences (AIIMS),
Ansari Nagar, New Delhi, India. E-mail: nithish174@hotmail.com
Background: Adolescence is one of the most rapid periods of human
development. Whatsoever changes occur in this phase of life has
consequences both in adolescence as well as in the future course of life.
Objective of study was “To find out the relationship between Anxiety,
Depression, and coping of adolescents from selected schools of New
Delhi”
Methods: A descriptive, cross sectional study on 845 adolescents
randomized from two selected schools from south Delhi was conducted
from classes 7 to 12. Ethical clearance was obtained from AIIMS.
After taking permission from the school authorities the assent from
adolescents and consent from parents were obtained. Tools: a
demographic data sheet, Revised Child Anxiety and Depression Scale
short version (RCADC 25) to assess anxiety and depression; and Brief
COPE to assess coping.
Results:Mean age of adolescents was 14.38 ± 1.80 years. More than
half (54.4%) of the adolescents were males, while 45.6% were females.
Anxiety score was significantly more in males than in females (p- value
0.013). Coping strategies self-distraction, use of emotional support, and
religion were significantly more in females than males at p- value 0.008,
0.011, and 0.002 respectively. However, coping strategies substance
use and humor were significantly more in males than females at 0.001
each. Healthy coping strategies were used more by females than males.
As a result, anxiety was found more in males than in females. The
gender of adolescents had a significant relationship with their levels
of anxiety and coping strategies; self-distraction, substance use, use
of emotional support, humor and religion.
Conclusion: It is imperative for parents and teachers to guide the male
and female adolescents differently in appropriate manner, well in time
in order to prepare them for best adjustment practices.Adolescents
should take counselling from appropriate professionals for anxiety,
depression and coping.
Profile, Pattern and Correlates of Mental Health Disorders Among
Children and Adolescents Visiting Child Guidance Clinic in a
Tertiary Care Center of North-Eastern India
Jain S, Yadav JS, Shrivastav AS
Institute of Medical Sciences, Banaras Hindu University, Varanasi,
Uttar Pradesh, India. E-mail:jainshobhitji@gmail.com
Objectives: In India, children and adolescents constitute approximately
40% of total 1.25 billion population (Census, 2011). About half of
all lifetime mental disorders begin before 14 years age. Worldwide
prevalence for child and adolescent mental disorders are around
10%-20% whereas in India 6.5% (Community Studies) and 23.3%
(School Studies). Due to differences in sociocultural factors and health
systems in various part of country, makes it necessary to report profile,
pattern and correlates of mental health disorders among children and
adolescent with mental health disorders visiting child guidance clinic
of our centre.
Method: This is a retrospective case records study of patients visiting
child guidance clinic (CGC) of our centre.
Results: Preliminary findings of 55 records reveal that among
patients attending our CGC clinic, mental disorders were more among
adolescent (67%) than prepubertal (23%) and pubertal (10%) age
group, male (64%) than female (36%), urban (79%) than rural (21%)
residence, Hindu (95%) than Muslim (5%), lower(72%) than middle
(28%) economic status and nuclear (72%) than joint (28%) family type.
Average years of education were 6.5. Family history of psychiatric
426 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
illness was 13% and medical illness was 7.5%. Past history of medical
illness was present among 33% cases. Average 2.5 years were lived
with mental health problem before presenting to our centre. Patients
mostly suffered from Dissociative Disorder (23%), Mental Retardation
(18%), Psychosis (15%), Anxiety Disorder (10%), Substance Use (5%),
Bipolar Disorder (5%), and Depression (2.5%). Detailed results shall
be discussed during presentation.
Conclusion: Due to hospital based setting, our study may have
several limitations but findings definitely represent a tip of iceberg
phenomenon. The variation in sociodemographic profile raises
concerns over awareness of mental health problems by various strata
of our community and highlights role of various socio-cultural factors
and pathways of care in mental health. A large amount of time was
spent with suffering before seeking treatment. Such data from various
parts of country can contribute to planning of community specific child
and adolescent mental health program.
Psycho-Social Aspects of Childhood Obesity
Gupta T, Mehta M, Sagar R, Jain V, Ammini AC
AIIMS, New Delhi, India. E-mail: drtanugupta2015@gmail.com
Background: Childhood obesity has been declared as a global
epidemic. Literature is full of documented evidences about the
association of childhood obesity with physical health risks both during
childhood and later in adulthood. Western studies are available on
psychosocial aspects of childhood obesity however literature from India
is sparse on this topic. The present study was an attempt to understand
the psycho-social aspects of childhood obesity in Indian context.
Objectives: The main objective of the study was to compare the
psychosocial functioning (psychopathology, stress, impulsivity and
body shape concerns) of overweight/ obese children with age and sex
matched normal weight controls.
Methods: The cross sectional study design and purposive sampling
was used to collect the sample of 60 overweight/obese children (cases)
seeking consultation at Paediatrics or Endocrinology OPD and 60 age
and sex matched normal weight children (controls) from Paediatric
OPD and community. All children were assessed for their socio-
demographic details and psycho-social functioning (Psychopathology,
stress, impulsivity and body shape concerns).
Results: Psychopathology (hyperkinesis; conduct disorder; learning
disorder; emotional disorder and somatisation) were observed
more frequently in obese children compared to their normal weight
counterparts (p<0.05). Obese children reported more number of
stressful life events in comparison to normal weight controls (p<0.001).
The mean score of impulsivity was also high in obese children
compared to their normal weight peers (mean: 61.4 (10.4) vs 49.9 (6.9),
p<0.05). Obese children expressed higher level of body shape concerns
compared to the controls (mean: 34.3 (4.0) vs 12.2 (2.8), p<0.01).
Conclusion: Poor psycho-social functioning of overweight/obese
children warrants need for comprehensive evaluation and management
of these issues to control the global epidemic of childhood obesity.
Key words: Psychopathology, Stress, Psycho-social, impulsivity, Body
Shape Concerns
Role of Family Environment in Mental Health Disorders Among
Children and Adolescents
Gupta N
Subharti Medical College. E-mail: drnimishgupta9010@gmail.com
Background/Objectives: Mental health in child and adolescent is
an essential component of overall health and its importance is being
recognised. The World Health Organisation (WHO) reported that 20%
of children and adolescents suffer from different types of mental health
problems worldwide. Family environment plays a major role in the
development of various mental health disorders among children and
adolescents. The objective of the study is to study the association of
mental health disorders in children with the family environment.
Methods: A cross-sectional design study was conducted with 30
children and adolescents aged between 6 to 14 years after obtaining
an informed written consent from the parents/ guardians. After
providing Patient Information Sheet, socio-demographic profiles of the
patients were recorded and Childhood Psychopathology Measurement
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Abstracts
Schedule by Dr. Savita Malhotra was applied to measure the overall
psychopathology as well as the type of psychopathology and Family
environment and interpersonal relationships were measured by Family
Relationship Inventory Indian version.
Results: Will be discussed at the time of poster presentation.
Conclusions: Will be discussed at the time of poster presentation
A Study on Impact of Stress, Social Support, Coping and
Resilience of Families of Autism Spectrum Disorder: A North
East Based Study
Das B, Nath K, Das S
Gauhati Medical College Hospital. E-mail: bornali.d@rediffmail.com
Background/Objectives:Autism spectrum disorder (ASD) is a neuro-
developmental disorder and the families or the caregivers experience a
significant stress. As previous research has shown having a child with
a disability as ASD presents unique set of challenges that impacts the
entire family unit and individualized members health, wellbeing and
experiences across the life span. Till date there have been few service
providers and even lesser research to examine the nature and severity
of issues faced by the parents and caregivers. This study is an attempt
to assess and explore the link parental stress, social support, coping
and resilience.The aim will be to study impact of stress, social support,
coping and resilience of families of ASD and theobjective will be 1) To
assess the socio demographic profile of families of ASD as well as to
test the hypotheses 2) Higher the social support lower is the parental
stress and 3) Higher is the resilience lower is the parental stress.
Methods:Cross-sectional one-time interview with descriptive research
design will be undertaken for the study. In order to enhance the
description of the study population, sample of 60 primary caregivers
of children between the ages of 3-12 years diagnosed with Autism
Spectrum disorders will be undertaken. Also socio-demographic data
(e.g. personal profile, social profile and family profile) will be collected
in a separate semi structured proforma.
Results:Statistical analysis will be done with chi-square, t-test, analysis
of variance (ANOVA) and correlation using SPSS.
Conclusion:The study will attempt to highlight the relationship between
stress, social support, family resilience and parental stress in families
with child diagnosed with ASD, and explore the relationship between
the variables.
A Descriptive Study to Assess the Knowledge and Attitude
Regarding the Use of SNS (Social Networking Sites) Among
Undergraduate Nursing Students
Sharma S, Anjana Ankita Anu, Manju
NINE, PGIMER, CHANDIGARH. E-mail: sanitasuni@yahoo.com
Background: The social networking sites are making their place in our
daily life rapidly. They may be used judiciously rather than just wasting
time, as it is becoming an addiction especially among the youth.
Methods:The main objective of the study was to assess the knowledge
and attitude regarding use of SNS among the undergraduate nursing
students of NINE, PGIMER, Chandigarh. The research approach was
quantitative and design was descriptive in nature. Random sampling
technique was used and 100 students of first year and second year
who were using SNS for minimum six months were taken for the
study. A semi-structured questionnaire was administered to assess the
knowledge and attitude towards social networking sites. Permission
was taken from the Institute ethical committee and informed written
consent was taken from the study subjects.
Results: The analysis was done using SPSS version16.0. The results
revealed that most commonly used SNS was Facebook. Majority (74%)
were having positive attitude towards SNS and some of them (26%)
were having neutral attitude and none of them was having negative
attitude towards the use of social networking sites. The internet
addiction was found to be mild in majority (70%) of the subjects and a
few of them were having moderate addiction (29%). Only (1%) of the
study subject was severely addicted to the internet.
Conclusion: There is need to improve the knowledge and
attitude towards the use of social networking sites so that harmful
consequences of internet addiction like poor communication skills,
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
unsatisfactory relationships and altered physical and mental health,
etc., can be avoided
Key words: Social Networking Sites, Internet addiction, attitude,
knowledge of SNS
Sociodemographic and Clinical Profile of Patients Attending Child
and Adolescent Psychiatry (CAP) Clinic of a Tertiary Care Centre
Patra BN, Rajkumar S, Bharhava R, Sagar R
Department of Psychiatry, All India Institute of Medical Sciences, New
Delhi, India. E-mail: patrab.aiims@gmail.com
Background: Information regarding the morbidity profiles of children
and adolescents would help to define needs and priorities. It will also
help to increase the awareness about these problems. Cross-sectional
clinic based prevalence studies help in a preliminary assessment of
service utilization, morbidity, treatment and follow-up. Clinic based data
are important, particularly for service planning and resource allocation.
Methods: The objective was to study the socio demographic and
clinical profile of children and adolescents attending a tertiary care
child and adolescent psychiatry clinic in India. Fifty traceable detailed
work-up records of children and adolescents attending a tertiary care
child and adolescent psychiatry clinic at All India Institute of Medical
Sciences, New Delhi, India have been reviewed.
Results: Most of the individuals presenting to clinic were boys (72%).
The mean age of the sample was 11.96 years and mean year of
education was 5.78 years, 68% were from nuclear families and around
two-third were from urban areas. Forty-four percentage of the sample
had a diagnosis of mental retardation. Other common diagnoses were
hyperkinetic disorder (18%), dissociative Disorders (10%), learning
disability (8%) and psychotic disorders (6%). Around 20% patients
were on medication at the time of evaluation and 10% of patients had
a precipitating factor for the illness. Also one fifth patients had a co-
morbid medical condition and 24% had a co-morbid psychiatric illness.
Conclusions: The profile of the children and adolescents attending a
tertiary care psychiatric clinic is in congruent with similarly conducted
study.
Life Satisfaction in Adolescents With the Effects of Perceived
Stress Among Students of Selected Schools of Dharan
Municipality
Pradhan N, Lama S, Pandey A
B.P. Koirala Institute of Health Sciences. E-mail: neeru.213@gmail.com
Background/Objectives: To assess the life satisfaction among
adolescents and to find out the association between the life satisfaction,
perceived stress and the selected socio-demographic variables.
Methods: A descriptive, cross sectional study design was used. Simple
random sampling technique was adopted to select the schools and
systematic sampling technique for selection of students. Sample size
was160 students who fulfil the selection criteria. Data were collected
by self-administered method using Scott Heubner’s Multidimensional
students Life satisfaction scale (MSLSS) and Cohen’s Perceived
stress scale.
Results: Majority 67.5% of the respondent were from the age group
above 15 years. In case of residence majority 84.4% of them were
from urban. Maximum 96.2% were belonging to Hindu religion. As
about parental education, 73.8% father had done their secondary
education while 83.1% mother had done their education up to
secondary level. In matter of occupation of parents, maximum 32.5%
were doing business as their source of income likewise as of mother,
73.6 % were housewives. Total 160 students were satisfied with their
lives. The association with the perceived stress and the selected
socio-demographic variable was found to be significant only with the
education of mother (p=.023). The correlation between perceived stress
and life satisfaction showed highly significant with “r”= .480 at p<0.01.
Conclusion: Good relationships in the home, school and
neighbourhoods play a vital part in ensuring that young people can
develop good mental health. Therefore it can be concluded that good
communication and living environment is the contributing factor for life
satisfaction among adolescents.
Key words: Perceived stress, Life satisfaction, Adolescents
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Abstracts
Social Media and Self-Harm Contagion
Rai A, Garg G
Wide Bay HHS, Australia. E-mail: amritash@gmail.com
Background: Social media is a relatively recent phenomenon that
fuses technology with social interaction via Internet-based applications
that allow the creation and exchange of user-generated content. Social
media such as Facebook is an important source of local news and social
interaction particularly for children and adolescents. There is increasing
evidence that the Internet and social media can influence suicidal and
self-harming behaviour. In this presentation, we explore the scientific
evidence of the link between social media and contagion. We also
discuss our local experience from a small regional area in Queensland.
We found a substantial upsurge in referrals to our service following the
suicide of a young person which was widely reported and commented
upon on social media. We discuss factors at play and delineate the
impact of social media on presentations to our service following this
tragic event. We also make suggestions on how social media can be
used positively in preventing self-harm behaviour.
Physiotherapy as a Treatment Modality in a Child With Somatoform
Pain Disorder
Kathiresan P, Gupta R, Patra BN, Sagar R
Department of Psychiatry, AIIMS, Delhi, India. E-mail: preethymmc@
yahoo.co.in
Background: Somatoform Pain Disorder is characterised by severe
persistent, distressing pain unexplained by any physical cause lasting for
more than 6 months. Patients believe in the somatic nature of their illness
and repeatedly request for investigations. It leads to severe impairment
in social and occupational functioning of patients. These patients are
typically difficult to treat for physicians and mental health specialists
alike. The usual modalities of treatment include psychotherapy, and
psychotropics to address the underlying anxiety/depression.
Case Description: We are presenting a case of a 12 year old male
child who presented with severe pain in all his joints leading to severe
disability in the form of inability to sit, stand, walk or perform routine
activities like brushing teeth and required his mother’s assistance. His
parents were over concerned and helped him in all activities and he
did not go to school. He was evaluated by multiple private physicians,
rheumatologists, paediatricians, ophthalmologists but no physical
cause could be found despite being investigated thoroughly. He was
admitted in psychiatry ward at a tertiary care centre and graded exercise
therapy was started along with psychotherapy sessions and he started
showing marked improvement in his ability to perform activities of daily
living though his pain complaint continued as before. Within a month,
he was able to walk on his own and started going to school and within
9 months he showed complete improvement in personal and socio-
occupational functioning.
Conclusion: This case highlights the gradual progression of symptoms
to disability and factors that maintained the disability in Somatoform
Pain Disorder. It also shows that inclusion of physiotherapy as part of
treatment regime along with psychotherapy could lead to faster and
complete resolution of functional disability in patients with Somatoform
Pain Disorder.
A Study of Psychiatric Morbidity in Parents of Children with
Intellectual Disability
Tak N, Sushil CS, Sharma DK
AIIMS, New Delhi, India. E-mail: drnktak@gmail.com
Background/Objective: intellectual disability is made if an individual
has an intellectual functioning level well below average and significant
limitations in two or more adaptive skill areas It is highly burden over
caregivers of mental retarded children. The objective of the study
was to determine the frequency of psychiatric morbidity and find out
correlation between sociodemographic factors & psychiatric morbidity
in parents of children with intellectual disability.
Methods: This study was carried out among sixty parents of mentally
retarded children at OPD of Govt and new medical college hospital kota
over a period of 6 months from march 2013 to August 2013 by using
tools Beck depression inventory and Hamilton anxiety rating scale and
brief psychiatric rating scale and AUDIT.
428 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: Depressive disorder was found in 28.33% subjects, GAD
in 18.33% and others 8.33%, total psychiatric morbidity was found in
about 55%.
Conclusion: According this study it was shown that intellectual
disability is quite burdensome for the parents as far as psychiatric
morbidity is concerned. Psychiatric screening should be considered
among parents of children with intellectual disability.
Key words: psychiatric morbidity, intellectually disability
Consultation Liaison Psychiatry
Subacute Sclerosing Pan-Encephalitis (SSPE) Presenting with
Psychosis: a Case Report
Parmar A, Ranjan R, Sagar R
Department of Psychiatry, All India Institute of Medical Sciences, 4th
Floor, Teaching Block, New Delhi, India. E-mail: dr.arpitparmar@
yahoo.in
Background/Objectives: Subacute Sclerosing Pan-Encephalitis
(SSPE) is a progressive illness with an invariably fatal outcome.
Although psychiatric symptoms have been reported in patients with
SSPE, such presentations are rare. We report an unusual case of
an adolescent with SSPE who presented with prominent positive and
catatonic symptoms.
Methods: A 15-year-old boy with no past or family history of psychiatric
illness presented to a tertiary care hospital with an illness of 4-5 months
duration. His illness started with a behavioural change first observed by
his parents. He initially became severely restless. After a few days, his
sleep became disturbed. He now developed referential and persecutory
ideas. He also reported seeing Bajrang Bali (a Hindu God) in his clear
consciousness during awake state multiple times. There were instances
of unprovoked anger outbursts and violence towards family members.
He started passing urine in his clothes. Posturing and perseveration
also started appearing. Within 4 weeks of symptom onset, he became
completely mute. His self-care also became impaired.
Results: An initial diagnosis of Schizophrenia undifferentiated
subtype Vs organic psychotic disorder (ICD-10) was kept. He had
received risperidone and lorazepam before presenting to us which
was prescribed by a local psychiatrist. The dose of these medications
was further optimized. As the symptoms didn’t improve, a neurology
referral was sought. Brain MRI demonstrated periventricular white
matter lesions. EEG reported typical findings suggestive of SSPE.
Subsequently, anti-measles antibody titters were also performed which
were found to be increased. A diagnosis of SSPE was made and the
patient was referred to neurology for further management.
Conclusion: This case suggests the need to screen children presenting
with psychosis and catatonia for an illness like SSPE. Atypical SSPE
can be detected by a high index of suspicion by psychiatrists.
Key words: SSPE, Psychosis, Catatonia, Subacute Sclerosing Pan-
Encephalitis
Psychological Interventions for Paediatric Cancer Patients: A
Review
Kaushal T, Satapathy S, Bakhshi S, Sagar R, Chaddha R, Sapra S
Department of Psychiatry, All India Institute of Medical Sciences, New
Delhi, India. E-mail: tanujakaushal19@gmail.com
Background/Objectives: The purpose of this review is to summarize
literature on evidence based psychological intervention in the area of
childhood cancer in last 20 years and to address the wide gap that exists
between intervention studies worldwide and India so as to highlight the
need for research and appropriate patient care services.
Methods: Relevant studies were identified by entering the following
search terms into Medline, PubMed, PsycINFO, and Google Scholar:
[Paediatric cancer OR Childhood cancer OR Psycho-oncology AND
Intervention OR Management OR Psychotherapy OR Treatment
AND Research OR development OR Randomized Controlled Trial
OR Case Study.
Results: 16 studies published from 1996 to 2016 that included
children younger than 18 years met the inclusion criteria. Out of
16 studies, 13 studies were conducted on children who were under
treatment and 3 studies were conducted on survivors. Cognitive
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Abstracts
behavioural intervention has been used in 4 studies, psychosocial
remediation has been used in 3 studies, 5 studies have used physical
intervention (aerobics, yoga, adapted physical intervention etc.), and
Music Art therapy and play therapy have been used in 4 researches.
Only one study was reported from India. Generally, interventions
tested were either in-hospital supervised intervention or home based
programs designed to promote psychological well -being. A descriptive
analysis is done on the details of intervention in practice. In the view
of dramatic increase of childhood cancer, a SWOT analysis has been
done to highlight the need in India.
Conclusion: Although, psychological interventions are found be more
in customized formats in these studies, no generic intervention module
is available. Development of culture-specific generic intervention
module and using the same in randomized control studies with larger
effect size are need of the hour in India.
Alcohol Addicts Hazardous behavior at Work in the Health Zone
Ouidah-Kpomasse`-Toriduring 2013
Houngbe EIJ, Dismand H, Magloire G
University of Abomey calavi. E-mail: houngbejosiane@yahoo.fr
The use of psychoactive products is an issue of public health. According
to World Health Organization, seven million of the population are
involved globally. The key subjects are aged from 15 to 25 years old.
And then, the alcohol remains the most important consumed product.
This study aims at examining the behavior in the course of the survey
in rural by including the alcohol addicts from Ouidah, Kpomasse`and
Tori regions during the year 2013. Those subjects without any prior
meeting among them decide systematically to refuse health care
administration after an adequate screening during the survey. So, many
hypotheses can be stated. In effect, it may seem that the subjects do
not understand their state of vulnerability or may be the core issue of
socio-cultural context is revealed.
Quality of life (QOL) of Married Females Undergoing Hysterectomy
in and Around Western Uttar Pradesh (U.P)
Dahuja M, Sudarsanan S, Agarwal S, Tyagi M
Netaji Subhash Chandra Bose Subharti Medical College,
Swami Vivekanand Subharti University, Meerut, India. E-mail:
malvikadahuja89@gmail.com
Background/Objectives: Hysterectomy is the second most common
operation during child bearing years of married females, mainly the
peri-menopausal women and is associated not only with stress
of surgery and potential post-operative complications like "Post
Hysterectomy Syndrome", but also the social stigma it bears in the
Indian society. Freud's psychoanalytical theory clearly explains the
impact of hysterectomy on quality of life. According to him, surgical
operations on the uterus are productive of an "insult" to the emotional
"equilibrium". The objectives of our study are: To study thesocio-
demographic profile of patients undergoing hysterectomy; to observe
the effect on their quality of life and to compare the above parameters
with a matched normalcontrol group.
Methods: Observational prospective design with 2 randomly selected
groups. Group1- thirty married females (30-60 years) having indication
of hysterectomy; whether abdominal, vaginal or laparoscopic. Group
2- A matched normal control group of 30 married females (30-60
years); relatives of participants not indicated for hysterectomy. After
giving Patient Information Sheet and taking informed written consent;
socio-demographic profile of patients was recorded and WHO-QOL
BREF Scale (June, 1997) (World Health Organization- Quality of Life
BREF Scale) was applied 1 week prior, 1 week post and 1 month after
hysterectomy.
Results: Will be discussed at the time of presentation of paper.
Conclusions: Will be discussed at the time of presentation of paper.
Key words: Hysterectomy, Quality of Life and Social Stigma
Obsessive Compulsive Disorder (OCD) Co-Morbid with Miyoshi
Myopathy: A Case Report
Parmar A, Verma R
Department of Psychiatry, All India Institute of Medical Sciences, Delhi,
India. E-mail: dr.arpitparmar@yahoo.in
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Objective: Obsessive Compulsive Disorder (OCD), especially the
late onset cases are commonly associated with illnesses involving the
CSTC (Cortico-Striato-Thalamo-Cortical) circuitry (for i.e. Parkinson’s
disease, Sydenham’s chorea etc.). However, such associations are
uncommon in young patients. We hereby report a rare case of OCD
comorbid with Miyoshi myopathy (A rare subtype of dysferlinopathy
with less neurological involvement) and discuss the relevant literature
which suggests the involvement of CSTC circuit in Miyoshi myopathy.
Methods: Our patient, Mr. R presented to us with an illness of 4 years
duration. It started with repeated doubts about dirt and contamination.
This lead to repetitive hand washing until he would feel almost clean. He
considered the thoughts to be useless, but his own. Attempts to control
these thoughts would invariably fail and so he had to wash his hands
repeatedly. By the end of 1st year, he would spend almost 3 hours a
day on such thoughts/repetitive acts. During the same time, he started
experiencing weakness involving his leg muscles. It progressed gradually
from initial difficulty in standing tiptoe to difficulty climbing stairs and
standing up from squatting position. He also reported calf enlargement.
After 2 years of onset, he also developed weakness involving upper
limbs leading to difficulty in weight bearing. As he didn’t improve with
symptomatic treatment, he came to us for further treatment.
Results: A diagnosis of OCD and myopathy was kept. The diagnosis of
Miyoshi myopathy was confirmed by Electromyography, muscle biopsy
and serum CPK levels. MRI brain was normal while SPECT revealed
higher regional blood flow in areas forming CSTC circuitry. He was
started on Fluoxetine but lost to follow-up in 2 months.
Conclusion: It is possible that OCD and Miyoshi myopathy, in this
case, might be related (due to altered expression of dysferlin in
subcortical areas).
Pattern of Psychotropic Prescriptions by Non-Psychiatrist Doctors
in a Tertiary Care Hospital in South India
Naeem A, Renjith J, Uvais Na
JDT Islam College Of Pharmacy, Athiyanathil Chelannur, Calicut,
Kerala, India. E-mail: naeem.clr@gmail.com
Background/Objectives: Psychotropic drugs are prescribed when
symptoms of mental illness are severe and interfere with normal
functioning. Since they are associated with potential serious side
effects and dependence, clinical indications and monitoring are needed
to avoid inappropriate use. Though the important role of general
practitioners in prescribing antidepressant medications and treating
depression has been documented, the extent to which non-psychiatric
doctors prescribing various types psychotropic medications received
less emphasis. The aim of the study was to determine the pattern of
psychotropic drug prescription by non-psychiatrist doctors in a tertiary
care hospital in south India.
Methods: Cross-sectional descriptive design was adopted for the
present study. 92 patients who visited other than psychiatry department
of the tertiary care hospital in South India and prescribed psychotropic
drugs were analyzed.
Results: The age group of the patient who was prescribed psychotropic
range from 8 years to 87 years. 25% of patients were above 60 years
of age, predominantly females (56.52%). Most ofthe prescriptions were
by physicians (34.78%) followed by neurologist (19.57%) and general
practitioner (9.78%). Symptoms for which the drug was prescribed
mentioned in 54.34% of prescriptions and a diagnosis mentioned in
14.13%. Only 6.52% patients were referred to psychiatry department
for further treatment. Mostly prescribed psychotropics were clonazepam
(70.65%), followed by escitalopram (25%) and sertraline (8.69%).
Conclusion: The findings of the present study have important
implications for improving awareness about psychiatric diagnosis and
treatment among non-psychiatrist doctors as very low percentage of
patients were prescribed psychotropic drugs with adequate diagnosis
and referred to psychiatric department for further management.
Key words: psychotropic drugs, prescriptions, non-psychiatrists
Functional Dysphonia in a Middle Aged Male: Diagnostic and
Management Issues- A Case Report
Modak T, Kumar S, Kumaran S
All India Institute of Medical Sciences, New Delhi. E-mail: tamonud4@
gmail.com
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Abstracts
Background: Functional dysphonia (FD) refers to a voice disturbance
that occurs in the absence of structural or neurologic deficits.
Psychogenic stress has been implicated the pathogenesis of this
clinical entity but may not always be present. It is a rare form of
dissociative disorder and this case was unusual in several aspects.
This presentation focuses on diagnostic issues in first time occurrence
of a functional symptom in a middle aged male and its management.
Case outline: The patient was a 40-year-old male patient who presented
with acute onset dysphonia. MRI, Direct laryngoscopy and other
diagnostic procedures failed to find an organic cause. The patient was
treated as a possible case functional dysphonia. Functional MRI was
done to rule out disturbances in cortical speech comprehension and
articulation. No psychogenic stressor other than being witness to an RTA
was apparent in the interviews. The patient was slightly able to articulate
during the first Lorazepam assisted interview but no new stressor was
elicited. The patient was treated with a modified form of speech therapy
performed under lorazepam assistance, where he was initially instructed
to enunciate simple phonemes and gradually produce more complex
ones. He recovered completely after about 10 such sessions.
Conclusion: We present the rare case of a person with late onset
complete functional dysphonia. The case is interesting unique with
regards to the age of presentation, the slow onset of symptoms, the
resistance prolonged course with resistance to usual treatments. FMRI
findings in such acase are described for the first time. The treatment
adopted a new method of speech therapy with gradual recovery of
the patient.
Key words: FMRI, psychogenic dysphonia, Dissociative disorder,
Speech Therapy, Drug assisted Interview
Is There a Need for Psychiatric Intervention in the Management
of Per-Anal Insertion of Foreign Bodies (IFB)? A Retrospective
Audit which Aimed to Assess This
Yahya AS, Chukwuma J, Lekkos P
Barnet Enfield Haringey Mental Health NHS trust. E-mail: yahyaas@
live.co.uk
Background: Most patients with per-anal IFB present to the Emergency
department and are largely managed by the surgical team. Per-anal
IFB can be a type of self-harm; the factors leading to self-harm and
per-anal IFB mandates risk assessment and appropriate Psychiatric
interventions.
Methods: The objective of the study was to establish the current
practice in the management of per-anal IFB and update a framework
for the initial work-up, surgical intervention and appropriate mental
health intervention.A literature search of electronic databases
(Medline, Embase, PubMed and PsychInfo)identified relevant
publications from January 2005 to September 2013. Further searches
were done on Google’s search engine and by hand-searching
relevant journal bibliographies. Using local audit guidelines, we
retrospectively reviewed operative logged interventions and
clinically coded procedures for per-anal IFBs between May 2009 and
September 2013.
Results: Our literature search yielded one systematic review, twenty
one multiple case series reviews, two clinical practice guidelines and
seven case reports. Our retrospective review yielded 10 patients, aged
14-70 years (mean 26.2 years) who underwent emergency surgery
following IFB. The male to female ratio was 5:1 respectively. Of these
40% resulted from a misadventure with a “sex-toy”. One in four patients
had recurrent presentations and a psychiatric history. There were no
records of psychiatric assessments, intervention or follow up with
these patients. No records were found of involvement of or referrals
to mental health services.
Conclusions: Most patients presenting with per-anal IFB don't have
a mental disorder. However, 25% were people with a mental disorder.
Those with a mental disorder were more likely to have repeated
presentations. We found no evidence to suggest that those with mental
disorder had any form of specific psychiatric input. A multi-disciplinary
and holistic approach to the management of per-anal IFB including
430 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
the involvement of mental health services may reduce the potential
for recurrence.
Mode of Help and Source of Referrals in Patients with Somatoform
Disorders
Yadav S, Desai G, Chaturvedi SK
National Institute of Mental Health and Neuroscience, Bengaluru,
Karnataka, India. E-mail: suresh.yadav22@gmail.com
Background: Somatoform disorders and Medically Unexplained
Symptoms (MUS) are common in clinical practice and cause
considerable suffering and impairments. Despite available investigations
they are often under diagnosed or misdiagnosed. The pathway of care
in somatoform disorders is tortuous with patients visiting various other
specialists and faith healers before first contact with apsychiatrist.
Methods: The aim of the study was to assess the mode of help sought
and source of referrals in patients presenting with bodily symptoms
seeking treatment at a tertiary care psychiatric centre in India. The
study population consisted of 301 patients with chief volunteered bodily
complaints seeking care at a tertiary care psychiatric centre in India.
Sociodemographic data,the number of prior contacts and referrals
were collected. Descriptive analysis was used to study the frequency
distribution of the variables of interest.
Results: Majority of the patients sought help from family practitioners
(n=210, 70%), followed by self-medications (n=171, 57%), Ayurveda
(n=47, 16%), faith healers (n=35, 12%) and homemade remedies
(n=33, 11%). Among consultations from various other medical
specialists, majority were from physicians (n= 30), neurologists (n=28),
ophthalmologists (n=17) and orthopedicians (n=14). The source of
referral was self in 204 patients (68%), general physician in 47 (16%)
other specialists in 31 (16%) and others in 19 (6%).
Implications: Understanding the mode of help sought and referral
systems in somatoform disorders will help in their early identification
and treatment and help ease the burden on the patient, family and the
systems of health care in place.
Key words: Somatoform disorders, medically unexplained symptoms,
mode of help, referral
Identification of Stressors With Rorschach Ink Blot Test and
Feasibilityof Cognitive Behavior Therapy in Psychogenic Non
Epileptic Seizures
Singh V, Sharma S
All India Institute of Medical Sciences, Delhi, India. E-mail:
vasudhairya@live.in
Objective: To identify stressors with Rorschach Ink Blot Test in
psychogenic non-epileptic individuals. To assess the feasibility of
cognitive behaviour therapy in psychogenic non epileptic individuals.
Methods: Individuals screened from Neurology clinic of Subharti
medical college were selected after informed consent by purposive
sampling technique, further randomly selected into two groups. A
sample of 60 individuals were screened by Rorschach ink blot test
for card rejection. Thirty each in the two groups were compared
giving CBT Sessions. First was the control group which did not
received CBT session but only basic psychoeducation. The second
was intervention group receiving 6-8 CBT Sessions on weekly basis.
Outcome measures were assessed by Cohen Perceived stress
scale. Analysis of variance was used to see the statistical difference
between the two groups.
Results: showed card rejection in male sex card, female sex card and
emotional tolerance card. Further intervention group after completers
of sessions showed decreased rating on perceived stress scale and
decreased in severity of symptoms.
Conclusion: Identification of stressor is important in psychogenic non-
epileptic seizures. Areas of conflict identified helps in the therapeutic
process of cognitive behaviour therapy bringing about changes in
pseudoseizures and improvement of outcome measures. Details to
be presented in the oral paper.
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Abstracts
Sanofi Grants
Interactive Multimedia Tool and Training for Mental Health
Professionals
Bennegadi R
Minkowska Centre, Paris.
Background: The majority of mental health and social professionals are
not equipped to understand the complexity of social and anthropological
determinants of mental health. We will develop a multimedia tool, which
will help address this issue by facilitating the accessibility of training
for these individuals through means of multimedia platforms such as
smart phone applications, tablets and websites.
Methods: This multimedia tool will be created from an interactive
software and will allow for the training of mental health professionals
in regards to social, psychological, anthropological and ethical
determinants of mental health. Mental health professionals who will
be trained using this tool will have the possibility of being in a learning
situation that will be interactive and verbal thanks to this tool, a modern,
pedagogic method of presenting the complexity of the interactions of
well-being. Furthermore, this multimedia tool will allow for an approach
towards mental health that is in line with that of the World Health
Organization, as in, a state of well-being that is more than just the
absence of mental illness.
Results & Conclusions: A demonstration of the possibilities and
the easy utilization of this tool will be made. This tool will be made
available in 3 languages: English, Spanish and French. Support from
public services will be sought, specifically from the National Institute
for the Prevention and Education of Mental Health (INPES), who deals
with everything regarding the prevention of illness and the promotion
of health, including mental health. This multimedia tool will be held by
the standards and evaluations by its users.
Project supported by an unrestricted grant from Sanofi.
Key words: Training, Multimedia, Interactive
Prevalence of Mental Disorders in the Health districts of Ouidah,
Kpomassè and Tori-Bossito in Benin
Houinato D, Houngbe J, Kpadonou-Fiossi E, Ganssou M
Laboratoire d’Epidémiologie des Maladies Chroniques et
Epidémiologique de l’Université d’Abomey Calavi, Benin.
Background: According to WHO, Mental wellbeing is a key component
of health. There is no national information system on mental health in
Benin. To fill this gap we decided to assess the prevalence of mental
disorders in the Health districts of Ouidah, Kpomassè and Tori-Bossito
(OKT) in Benin.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Methods: A cross sectional, descriptive and analytical survey was
conducted. Thanks to a three-stage cluster sampling a representative
sample of the general population of the districts aged 15 and over
was selected. Face to face interviews using the Mini version 5.00
questionnaire in French were conducted. Comparison of frequencies
was made using X2 test and p<0.05 was considered as statistically
significant.
Results: A total of 1520 people were included (865 women). The
average age was 36 (SD 16.3) years; 2 persons out of 3 lived in a rural
area, 41.4% never went to school, 14% were unemployed and 21.6%
had a family history of mental disorders and/or suicide. At least one
mental disorder was identified in 778 people (50.8%). The prevalence
of the different mental disorders was as follows: Mood Disorder: 36.7%;
Anxiety Disorder: 17.9%; Addiction: 12.9% and Schizophrenia: 1.1%.
Psychotic disorders were mainly associated with a family history
although other mental disorders were associated with environmental
factors.High suicidal risk was associated with mood disorders.
Conclusion: The prevalence of mental disorders in the general
population in OKT is high and associated with environmental factors and
related to socio-cultural changes. Prevention and early management
of these diseases should be set up to improve the mental health of
the population.
This survey was supported by a grant from Sanofi
Depression in Type 2 Diabetes: INTERPRET-DD Study in
Bangladesh
Rabbani MG, Ahmed HU, Lloyd CE, Gerard D, Sartorius N, Cimino
LC, Chaturvedi SK et al.
Bangladesh Association of Psychiatrists, Bangladesh. E-mail:
rabbanigolam33@gmail.com
Background: The “International Prevalence and Treatment of Diabetes
and Depression” (INTERPRET-DD) study was initiated in Bangladesh
in 2014.
Methods: 200 participants were screened for depressive symptoms
at entry to the study using the PHQ-9 and WHO-5 questionnaires and
examined by a psychiatrist using Hamilton Rating Scale for Depression
and Mini International Neuropsychiatric Interview (MINI). The second
phase is currently ongoing regarding the impact of depression on the
course of diabetes and potential risk factors for depression. The study
will examine whether the presence of depression leads to a higher
incidence of complications of diabetes by comparing the frequency
of complications of diabetes and the emotional impact of diabetes in
(i) patients with diabetes and unrecognized depression, (ii) patients
with diabetes and previously diagnosed and currently treated depress
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POSTERS DAY 2 AFTERNOON
Homelessness
Re-storying Experiences of Social Suffering of Homeless Mentally
Ill Women in Indian Context-A Qualitative Inquiry
Bhattacharya P, Ravi Priya K
Indian Institute of Technology, Kanpur, India. E-mail: prama@iitk.ac.in
Background/Objectives: The purpose of the present study has been to
understand through the lived-experience of formerly homeless women
diagnosed with severe mental illness the experience of social suffering
associated with the familial and relational world.
Methods: Life-story Interviews have been conducted on four formerly
homeless women diagnosed with a severe mental illness at an
NGO shelter house run in Kolkata for the marginalized population
of homeless mentally ill. A Grounded Theory Methodology with a
Social Constructionist Paradigm has been followed for the purpose
of the current study. Constructionist Grounded Theory Analysis of the
narratives have been done using initial coding, focused coding and axial
coding through the process of constant comparison (Charmaz, 2006).
Results: The qualitative analysis of narratives highlighted how suffering
has been induced on these women by different stakeholders including
familial and relational processes that not only have shaped their past
experience of social suffering through the disrupted relationships, denial
of care by primary caregivers but also affect their future that oscillates
between hope and hopelessness with a search of new relational
anchors as well as the overwhelming powerlessness and helplessness.
These resonating categories across the interviews would be discussed
through the lens of social suffering.
Conclusion: The study promises to look into the paradox that these
women are living through where they face two extreme form of Indian-
ness in which the same relational world becomes the foundation of both,
a sense of loss and suffering as well as hope and recovery.
Homelessness and Addiction: Case Vignette and Discussion
Choudhury S, Somani A, Ghosh A, Basu D
PGIMER, Chandigarh. E-mail: cjini2584@gmail.com
Background: Caregiving is a dynamic process including patient, and
a person involved in long term care of patient. In disabling mental
disorders like schizophrenia and bipolar disorder, long term care is
involved, often leading to experience of burden in caregivers. There
is growing body of literature on the caregiver burden, poor caregiver
outcomes, lack of caregiver support, and equivocal success, with
interventions aimed at alleviating care-giving burden.
Methods: The aim of the study isto assess caregiver burden in
psychiatric patients.The specific objectives include: assess prevalence
of caregiver burden in psychiatric illnesses, assess gender differences
in caregivers, correlation of severity & duration of psychiatric symptoms
with measure of caregiver burden and correlation of relationship of
caregiver with patient to severity of burden.The participants will be
the caregivers of patients attending Psychiatry OPD, Bharati Hospital.
After institution ethics committee approval, an information sheet
containing all necessary details of the study will be provided following
which due written informed consent will be taken. Those consenting to
participate,will be asked to answer a specially designed questionnaire
that will be scored and assessed in the Department of Psychiatry.This
study will be conducted from August 1st, 2016 to September 30, 2016.
Tools Description: Socio demographic sheet; Caregiver Burden Scale;
Coping strategies inventory; DASS scale.
Discussion and Results: Finding of the study will be discussed once
it completed.
Key words: caregiver, burden, psychiatric illness
Responding to the Needs of Homeless Persons with Severe
Mental Disorders
Gaonkar D, Bapat S, Adawadkar J, Lokhonary S, Das R, Nulkar A,
Dabholkar H, Chatterjee S
Lead Program Manager - INCENSE Program, Tezpur, Assam. E-mail:
dilip.parivartantrust@gmail.com
432 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Background/Objective: Homeless persons with co-existing severe
mental disorders (SMDs) represent one of the most vulnerable groups
in society. Responding to their health and social needs is an ethical and
health imperative. To develop care pathways for homeless persons with
SMDs by connecting mental hospitals with other community agencies.
Methods: At Pune and Tezpur, the INCENSE program is working with
two mental hospitals and a range of local partners to address entry
(like admission procedures) and exit barriers (like supported community
housing and livelihood options) for homeless persons with SMDs
combined with individual case management support.
Results: A total of 110 homeless persons with SMDs were identified,
out of whom 65 persons could be provided with the intervention. 21
(32%) such persons were successfully reintegrated with their family
while 17 (26%) were successfully relocated to supported community
housing facilities. However, for 27 (42%) persons, outcomes were not
as positive- 15 (23%) persons were in mental hospitals, 7 (11%) of
those who had been reintegrated with their family became homeless
again while 5 persons (8%) died.
Conclusion: While it is feasible to develop multi sectoral partnerships
with mental hospitals to improve care for homeless persons with SMDs,
the results indicate that much more needs to be done to address the
serious unmet needs of this highly vulnerable group on a priority basis.
Disaster and Mental Health
Subjective and Objective Measures of Function as Predictors of
Return to Work
Tuisku K, Holi M, Heikinheimo S, Saarni SEM, Saarni SI
Helsinki University and Helsinki University Hospital, Finland. E-mail:
katinka.tuisku@hus.fi
Background/Objectives: Patients with common mental disorders
often have negative expectations and interpretations of their own
functional capacity, and future options in working life. The pessimistic
self-expectations are associated with lower return to work-rates.
Therefore, our aim was to test the predictive values of objective and
subjective assessments, and their inter-correlation.
Methods: The study sample consisted of 132 consecutive psychiatric
patients referred to assessment of work ability. We examined the
correlation between an objective measure of function, (Social and
occupational functioning assessment scale, SOFAS), and subjective
measure of function, (Sheehan disability scale, SDS), and their
predictive values for return to work (RTW) during one-year-follow up.
Results: The mean SOFAS score was 52.7 and the mean SDS scores
at “Work”-,”Social life” and “home” subdomains were 7.8, 6.6 and 6.0,
respectively. Higher mean baseline SOFAS scores predicted RTW (58.7
vs 50.8, p=0.002). “Work” subdomain (unlike “Home” and “Social life”
subdomains) of SDS predicted RTW in analysis of variance (8.2 vs. 6.3,
p=0.002). SOFAS and all the SDS subdomains were inter-correlated.
Conclusion: Both objective (SOFAS) and subjective (the “Work”
subdomain of SDS) measures of function predicted independently
RTW and they seemed to complement each other. Thus, the
subjective factors should be taken into account in rehabilitation
planning. We conclude that basis for rehabilitation planning and RTW
prognosis is the objective assessment by validated functional rating
scale, complemented by structured subjective self-report, related to
psychosocial environment, and the functional roles of the patient.
Key words: Assessment, Disability, Function, Mental disorders, Return
to work, Work ability
Episodic Obsessive Compulsive Disorder Associated with Bipolar
Mania-A Case Report
Chandran N, Parmar A, Deb KS
All India Institute of Medical Sciences, New Delhi, India. E-mail:
drnimmychandran@gmail.com
Background/Objectives: Obsessive Compulsive Disorder (OCD) is
known to have an episodic course in some cases, especially when
associated with comorbid bipolar affective disorder (BPAD). Previous
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Abstracts
reports suggest that such OC symptoms generally appear or worsen
during periods of depression and subsequently improve during mania/
hypomania. Here, we present a very unusual case of episodic obsessive
compulsive disorder with comorbid BPAD, in which OC symptoms
occurred only during manic episodes.
Methods: A 36 year old married male presented to us in a manic
episode along with OC symptoms with his mental status examination
revealing increased speech output, ideas of grandiosity and obsessive
thoughts related of dirt/contamination. The patient’s history showed
that he suffered from an episodic illness of 10 years, characterized
by 2 episodes of depression (lasting for 4-5 months) and 3 episodes
of mania (lasting for 3-4 months). During each manic episode, the
patient reported of having recurrent intrusive thoughts about dirt and
contamination, leading to repeated hand washing and cleaning rituals.
The patient considered these thoughts to be excessive and attempts
to control them led to anxiety. The thoughts lasted for around 7 hrs in
a day and caused significant dysfunction, which was separate from
that caused by manic symptoms. These symptoms would always remit
with remission of mania, and the patient had no OC symptoms during
the inter-episodic period.
Results: A clinical diagnosis of BPAD, current episode Mania
with comorbid OCD was considered and the patient was treated
with Olanzapine (up to 15 mg) and lithium (up to 900 mg). With
therapy, there was significant improvement in manic and obsessive
compulsive symptoms within 4 weeks, with remission of all symptoms
by 7 weeks.
Conclusion: Comorbid OCD in a case of Bipolar Mania poses multiple
diagnostic as well as management challenges. OC symptoms might be
misinterpreted as manic symptoms or vice versa. Mood stabilizers might
worsen OC symptoms while OCD treatment (with antidepressants) may
worsen bipolar illness course. Clinical judgement and awareness of
such a possibility is required for successful management of the case.
Key words: OCD, BPAD, Mania
Happiness and Mental Health of Physically Disabled Adolescence
Yadav B
KNIPSS, Sultanpur, U.P., India. E-mail: bajrangi24@gmail.com
Happiness research on has identified seven factors contributing
to happiness:1. Family Relationship, 2. Financial Situation, 3. Job
Satisfaction, 4. Social Environment, 5. Health, 6. Personal Freedom and
7. Life Philosophy. In this research mental disorders is used to describe
a set of symptoms that are clinically diagnosable under Diagnostic
and Statistical Manual of Mental Disorders. The purpose of the study
was to explore happiness and mental health of physically disabled
adolescence. The methodology of this research was descriptive and
correlational. The Oxford Happiness Questionnaire and Mental Health
Battery were administered on 300 participants in Sultanpur city of Uttar
Pradesh, India. Results of the study showed that physically disabled
adolescence in happiness and mental health scored over average,
positive correlation was found between happiness and mental health
of physically disabled adolescence.
Key Words: Happiness, Mental Health, Physically Disabled
Adolescence, Instructional Strategies
A Clinical Study on Cognitive Dysfunction in Depressed Patients
Kishore K, Medhi D
Central Institute Of Psychiatry, Ranchi, India. E-mail: imkarnik@
yahoo.co.in
Background/Objectives: This study aimed at assessing the
prevalence and severity of cognitive deficits in patients suffering from
depression and to study the cognitive domains affected.
Methods: A Total of 40 patients with Depression diagnosed according
to ICD-10 Research Diagnostic Criteria and 40 healthy controls
were included. PGI Battery of Brain Dysfunction (PGI-BBD), Frontal
Assessment Battery and Hamilton Depression Rating scale (HAM-D)
was administered and analysis as done using Chi-square test, Unpaired
t test and Pearson’s correlation.
Results: The study revealed significant differences in the dysfunction
scores between the study and control population. In the study group
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
more than 80% of patients had cognitive dysfunction and a positive
correlation was found between dysfunction and HAM-D scores.
Conclusion: Depression is associated with significant disturbance
in cognitive functioning and the cognitive dysfunction increases with
increase in the severity of depression.
Key Words: Depression, Cognition dysfunction, correlation
Male Child with Mental Retardation and Stimulus Induced Drop
Episodes: A Case of Coffin-Lowry Syndrome
Jain S, Yadav JS, Kapoor HK, Shrivastav AS
Institute of Medical Sciences, Banaras Hindu University, Varanasi,
Uttar Pradesh, India. E-mail: jainshobhitji@gmail.com
Background/Objective: Prevalence of mental retardation in India
is around 2.5% and constitutes major proportion of patients visiting
child guidance clinic. More than 500 causes and syndromes have
been reported and list is still growing. Often such cases have various
comorbid medical and psychiatric problems. Coffin Lowry Syndrome
is a rare and X-linked genetic condition characterized by mental
retardation, facial dysmorphism, and skeletal deformities. Twenty
percent patients also have sudden stimulus induced paroxysmal
cataplexy. To our best knowledge only one case have been reported
from India so far, so it is required to report such cases and develop
database for further research on such rare genetic conditions.
Methods: The case presented here is a 4 year old male child who
presented with delayed developmental milestones, speech difficulty,
and sound induced paroxysmal sudden loss of muscle tone. The
sound would be sudden unexpected loud noise as loud sneezing, cry
or clap by others, horn of motor vehicle, etc. Such sound induced drop
episodes would occur suddenly without any previous warning with
preserved consciousness during episodes following which he would
spontaneously get up or call for help. Due to such drop episodes he
would frequently face physical injuries.
Results: Physical examination revealed facial dysmorphism, wide
forehead, hypertelorism, dental and digital deformities. IQ assessment
reported moderate mental retardation with normal routine blood and
CT brain reports. Based on clinical presentation diagnosis of Coffin
Lowry Syndrome was made. Further detailed management shall be
discussed during presentation.
Conclusion: Patients with mental retardation almost always present
to psychiatrist during lifetime due to their disabling health condition.
Besides focusing on psychological aspects of mental retardation, it
is important to explore causative factor, provide genetic counselling,
and plan further medical support and case prognostication. Such rare
cases should be regularly reported for development of database and
further research.
Is Disordered Eating Behavior Associated with Autism Spectrum
Tendency in Japanese Female University Students?
Hayakawa N, Ozaki N, Tanaka S, Hirata N, Ogino S
Nanzan University, Aichi, Japan. E-mail: norika1@mac.com
Background/Objectives: Little evidence of anorexia nervosa (AN) in
the Japanese population has been detected. While the associations
between AN, eating disorders (ED) and those characteristic of
the autism spectrum (AS) have been shown in several overseas
epidemiological studies, the epidemiological investigation in Japan has
yet to be done. Although a Japanese version of the Autism-Spectrum
Quotient (AQ-J) is widely used to measure autism spectrum tendency,
the AQ-J it has been reported that it measures mental health problems
other than autistic traits like non-psychotic depression. This research
is designed to investigate the association between disordered eating
behaviors and AS traits among Japanese female university students
and confirm that the association is independent from depressive state.
Methods: A self-reported questionnaire survey was administered
to 2752 new Japanese female university students from the same
university between 2012 and 2015. Disordered eating behaviors were
evaluated using the Eating Attitudes Test (EAT-26) with a cutoff score
of 20. AS tendencies were assessed using the AQ-J. Characteristic
attitudes and symptoms of depression were also measured using the
Beck Depression Inventory-I (BDI-I). Associations were investigated
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using multiple logistic regression analysis adjusted for confounders.
Results: In the multivariate analysis, the attention to detail was
positively (odds ratio [OR]: 1.93; 95% confidence interval [CI]: 1.05-
3.76) and the BDI was also positively (OR: 6.09; 95% CI: 2.89-14.55)
associated with disordered eating behaviors. No significant interaction
was observed between the five AQ sub-scales and the BDI.
Conclusion: The association between AS trait and disordered
eating behaviors was shown in this research. The attention to detail
in AS traits was significantly related to disordered eating behaviors.
Furthermore, though depression risk was elevated in individuals with
disordered eating behaviors, it was suggested that the attention to
detail was related to disordered eating behaviors from depressive
state independently.
A Framework for CBT in Holistic Management of Schizophrenia
Ganguly P, Moustafa A
University of Western Sydney. E-mail: pronabganguly@gmail.com
Background/Objectives: CBT (Cognitive Behaviour Therapy)
is recently gaining more interest and acceptance as a standard
counselling technique for schizophrenia patients. Initially developed to
treat acute symptoms, more recent studies have focused on treating
persistent positive and negative symptoms in patients with incomplete
remission on antipsychotics alone. There is hope that the broader use
of CBT in rehabilitation settings may lead to improvement in holistic
management of schizophrenia. With respect to deploying typical CBT
techniques there is a need for building trust and engagement; working
collaboratively to understand the meaning of symptoms. These are
following important issues: understanding the patient’s interpretation
of past and present events, especially those that the patient feels are
related to the development and persistence of their current problems;
normalizing these experiences and enlightening the patient about the
stress-vulnerability model; socializing the patient to the cognitive model,
including the relationship between thoughts, feelings, and behaviors.
Methods: With our review of existing data, it is noted that with only
adherence to antipsychotic medications, many patients experience
both relapse and residual symptoms. It is noted that 14 to 19 percent
develop chronic, unremitting, psychotic symptoms. A more recent
first-episode psychosis study reported that 15.1 percent of patients
had persistent psychosis at two years. These persistent symptoms
are often the target of CBT.
Results: Our extensive review shows that in a study, 90 patients were
randomized to CBT, which received 19 individual treatment sessions
over nine months. Both groups experienced significant decreases
in positive and negative symptoms of schizophrenia, but only the
CBT group continued to improve at follow up. Only the CBT group
experienced a significant decrease in suicidal ideation.
Conclusion: With better application of CBT, there is a great possibility
for improved holistic management of schizophrenia patients.
Neuropsychological Outcome Following Head Injury in Elderly
Mohanty M, Kamali NI, Tewari M K
Department of Neurosurgery, Postgraduate Institute of Medical Education
and Research, Chandigarh, India. E-mail: manjumohanty2011@gmail.
com
Background:There is a significant increase in geriatric population at
global level. By the year 2030, twenty percent of the population will be
65 years of age or older. Elderlypatients with traumatic brain injury (TBI)
present a unique and complex challenges because of various reasons.
Objectives: The aim of the study was to assess the neuropsychological
outcome in elderly persons presented with head injury (>60 years of
age).
Methods: It was a prospective study carried out at the Advanced
Trauma Centre, PGIMER, Chandigarh. Ethical approval was sought
from Institute Ethics Committee. One hundred andsix patients with head
injury aged 60 years and above were included in the study. The patients
with prior history of head injury, dementia, psychiatry or neurological
illness were excluded. The sociodemographic and clinical details (age,
sex, education, marital status, mode of injury, injury severity, associated
injuries, comorbidities, and surgical intervention) were obtained using
a semi structured Proforma. Mini Mental State Examination (MMSE)
434 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
was administered to assess neuropsychological outcome at discharge,
3 weeks and 3months.
Results: The mean age was 66.36 (SD=7.06). There were 74 (69.8%)
males and 32 (30.2%) females. Eighty two % were married and all
belong to joint families. About 50 % were illiterate. Comorbid illness
was present in 36 (34%) patients. At the time of discharge 87 (82.1%)
patients had severe neuropsychological impairment. At 3 weeks 48
(45%) patients had severe impairment and at 3 months 35 (33%) had
severe neuropsychological impairment.
Conclusions: Greater age, lower education and severe head injury were
found to be significantly associated with neuropsychological impairment.
Key words: Traumatic brain injury, neuropsychological impairment,
elderly, MMSE
Impact of Immigration on the Mental Health of Children and their
Families
Madan P
1712 Picasso Ave, Ste D, Davis, United States. E-mail: pmadan@
cpsych.com
Background/Objectives: To improve the cultural sensitivity of
providers treating immigrant families, and to discuss the impact of
immigration and the acculturation process on family structure and
mental illness.
Methods: Systematic literature review was done using various
databases to identify publications that highlight the impact of
immigration on mental health.
Results: Over the last several decades, several countries have witnessed
a steady increase in the proportion of foreign-born population due to various
social, political, and economic reasons, and this number is expected to
grow over the next several decades. The process of immigration can
be immensely stressful and may affect several generations. Studies
have shown that maternal ethnicity and nativity can significantly impact
attachment during early childhood. Perception of discrimination by ethnic
minorities can significantly impact the health of its perceiver and their
children. Several minority groups have high stigmatization rates and poor
treatment engagement with mental health professionals. Immigration
and ethnic background may also affect psychopathology. As compared
to native-born population, first generation migrants are more likely to be
diagnosed with schizophrenia, but less likely to be diagnosed with mood
and anxiety disorders. Second generation immigrants are more likely to
be diagnosed with these illnesses than their parents. The number of years
of the residence in the host country may significantly impact the risk of
suicidal ideation and attempts among immigrants. Despite the numerous
risk factors, children of immigrant parents are less likely to be diagnosed
with depression and behavioural/emotional health problem as compared
to children of native-born parents. They also have higher attendance rates
at schools and perform better on standardized testing.
Conclusion: Immigration status and ethnic background of patients
and their families may have a significant impact on the development
of mental health problems, school attendance and performance, and
engagement in treatment.
Key words: Immigration, mental health, children
The Dilemma of the Syrian Refugee Migration to the West
May C, Perras NN, Denduluri S, Dyer A, Kocher E, Mihajlovic K, King
A, Krueger C, Mihajlovic A
George Washington University, 2800 36th St NW, Washington, DC,
United States. E-mail: csmaymd@gmail.com
The exodus of Syrian refugees has been growing steadily since the
beginning of the civil war. The emergence of ISIS, escalation of conflict
to Iraq, and growing instability in other countries have increased the
flow of refugees dramatically. The closing of land routes has led to a
marked increase in the refugees attempting to reach the EU by sea.
During 2015, up to 1 million refugees fled Turkey through Greece in
an attempt to reach destinations in Western Europe. These refugees
have experienced repeated traumas beginning with exposure to
violence in their war torn homeland, lengthy stays in refugee camps in
Turkey, exploitation and abuse by smugglers, perilous crossing by sea.
Once in Greece, they confront an overwhelmed immigration system
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Abstracts
and multiple obstacles to their continued journey to often uncertain
destinations and uncertain receptions. The literature describes the
degree of psychological trauma and need for treatment for those in
refugee camps in Turkey, Jordan, and other countries. What is less
well developed is an understanding of the psychological needs of
populations in transit and how NGOs and local authorities can best
address these needs. The implication for the field of social psychiatry
is how sectarian violence infects our response to the refugees and
the crisis. In the aftermath of the Paris attacks, western nations are
facing their own dilemma of fulfilling the obligation to protect refugees
fleeing war and persecution while managing the backlash of the
anti-immigration movements and protecting national security. The
observations in this report are based on the experience of clinicians
during November and December 2015 receiving refugees upon their
arrival in Molivos and Skala and at refugee camps in Lesbos, Chios,
Athens, and in Idomeni, at the border with Macedonia.
The Co-Development of Services “Promoting Recovery Enabling
Roles for Mental Health Rehabilitees” (SYMPOSIUM:Promoting
recovery - polyphony of experts’´ and service users’´ standpoints)
Hietala O
Rehabilitation Foundation, PO box-39, Helsinki. E-mail: Outi.Hietala@
kuntoutussaatio.fi
Objectives: Peer support has played a strong part in third sector as
well as and in rehabilitation and mental health services. On the other
hand patient/client involvement has been highlighted in social and
health care services. Still the position of a client/patient is often defined
with attributes of dependency, lack of reciprocity and subordination
in relation to experts and services. This causes challenges to the
rehabilitation specially when pursued to promote recovery. In this
presentation, Hietala will introduce preliminary results of qualitative
research, which is carried out as part of co-development of social
rehabilitation services in national, EU-funded SOSKU-project (2015-
2018). The co-development in SOSKU is carried out by combining two
virtues of peer support and client involvement. The aim is to recruit
rehabilitees from clients of mental health services and to train them
to become the experts of experience and providers of peer support.
Professionals in social and health care services participate in the same
process with rehabilitees and thus learn to work as partners.
Methods: The research is integrated into development processes and
carried out by applying qualitative methods, participant observation
and loosely structured interviews (gathered during training and co-
development processes).
Results: The rehabilitees learned how to bring their experiences of
mental health problems, service use and recovery as one standpoint
in the service co-development. They reflected personal experiences
and combined them with the knowledge of the professional experts.
Co-development of services seem to enable reciprocal roles for clients/
patients, and the same time professionals seem to develop new kind
of understanding of their own role as promoters of recovery.
Key words: peer support, expert by experience, recovery
Migrants and Mental Disorder in South Asian Countries: a Case-
Based Discussion and Brief Review of Literature
Shah B, Mahapatra A, Pattanayak R, Khandelwal SK
All India Institute of Medical Sciences, Delhi, India. E-mail: shahbigya@
gmail.com
Background/Objectives: There has been a global rise in forced
displacement of people due to war, terrorism, poverty etc. It has socio
occupational, legal and financial consequences. It also increases
vulnerability to mental disorder in the displaced population. However
this area remains understudied in South Asian countries. The objective
of the paper is to demonstrate and discuss the clinical profile,
psychosocial issues and management of a case of displaced girl
seeking treatment to a tertiary hospital and brief review of literature on
mental disorder in migrants in South Asian countries.
Methods: An 18 year old unmarried Muslim girl of low socioeconomic
status migrated from Afghanistan to urban city of India due to threat to
her family one and half year back. Due to peer pressure and personality
traits, she was introduced to nicotine, alcohol, opioids and substances
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
of unknown compositions which she started consuming in a regular
pattern. She presented with muttering, gesturing, smiling to self,
decreased need of sleep, self-care and appetite since last 6-7 months
with symptoms of mania since 1 month precipitated by antidepressants.
There was past history of dissociative disorder 4 years back.
Result: Diagnosis of bipolar affective disorder not otherwise specified
with mixed dissociative disorder with opioid and nicotine dependence
syndrome and multiple drug use and use of other psychoactive
substances currently abstinent in protective environment was
entertained. Antidepressant was stopped and she was stabilized on
tablet Quetiapine (450mg). Relevant interpersonal and psychosocial
issues were identified and patient was encouraged to follow-up for
nonpharmacological interventions.
Conclusion: The case highlights the issues pertaining to psychiatric
illness among migrants to South Asian countries. It imparts necessity
for treatment services to be equipped for language and culture barriers
to target interventions to such group of people.
Key words: migrants, mental disorder, South Asia
Food Deserts and its Impact on Mental Health
Walsan R, Pai N, Rajan B
University of Wollongong, 18 Prosser C1, Tarawanna, NSW, Australia.
E-mail: ramya_valsan@yahoo.com
Background: Areas with limited access to healthy, reasonably priced,
nutritious food are often referred to as food deserts. These areas are
often concentrated in lower socioeconomic neighbourhoods where
mental health disorders are most prevalent as well. Unhealthy food
choices are increasingly identified as a risk factor that promote mental
illness and impede its management. Mentally ill can be adversely
affected by this differential access to healthy food due to their lower
income, inability to travel, physical and psychological limitations for
food shopping. The objective of this study is to assess the potential
impact of food deserts on mental illness.
Methods: Published literature was reviewed in order to assess the
burden of food deserts on mental illness using databases like Scopus
and Medline.
Results: Inequity in food access has been reported to contribute to
disparity in eating habits and health outcomes. While food deserts
have been studied extensively in the context of obesity and diabetes,
its impact on mental illness still remains unexplored. One challenge in
this direction would be to delineate the impact due to food access from
other socioeconomic determinants affecting mental health.
Conclusions: Further research is needed to understand the impact
of food desert on mental illness.
Attitude of Patients with Severe Mental Illness Towards the
Psychiatric Advance Directives
Tekkalaki B, Patil V, Patil S, Dhabale R, Chate S, Patil NM
KLE University's J.N Medical College, India. E-mail: tbheemsain@
gmail.com
Background: The Psychiatric advance directives are being considered
in up-coming mental health care bill of India. However, there is no data
regarding how Indian patients receive this new concept.
Methods:The objectives of the study are:to study the attitude of patients
of severe mental illness towards advanced directives, and to study
the pattern of possible treatment choices patients make if a provision
of advance directive is made. This is a descriptive cross-sectional
clinical study. Study sample is formed by patients with the ICD-10 DCR
diagnoses of either Bipolar disorder or Schizophrenia, aged 18-65
years, attending OPD, who are currently asymptomatic, maintaining
well on treatment. Patients with Mental retardation and other significant
medical/Psychiatric co-morbidities were excluded. Informed consent was
taken. Young’s Mania rating Scale, Hamilton Depression Scale, Brief
Psychiatric rating scale were applied for the patients with schizophrenia,
Bipolar mania and Bipolar depression respectively to confirm that they
are asymptomatic. Semi structured proforma was used to collect the
socio-demographic and clinical details of the patients. A newly designed
questionnaire was applied to assess the attitude of patients towards
advance directives and the possible treatment choices patients make if
the provision of the advance directives is made.
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Abstracts
Results and Conclusions: will be discussed during the presentation
as study is still ongoing.
A Study of Suicide Attempters and Family Awareness of Suicide
Law in India and Attitude Towards Existence of Such a Law
Kumar RS, Das K
Adichunchanagiri Institute of Medical Sciences, Karnataka, India.
E-mail: dr.ravikumar14@gmail.com
Background: The years gone by has witnessed the decriminalisation
of suicide in several countries. However, it continues to remain a
punishable offence in India as per the IPC. The need for the existence of
said law could be in the hopes that it act as a deterrent for the masses.
As there is no clear evidence as to how helpful the law remains in
stopping further suicide attempts, we undertook this study with the
aim to assess the awareness of the suicide attempters that the act of
suicide is punishable by Law and subsequently their and family attitude
towards existence of said Law. The objective of the study is to study
the awareness of existence of Law pertaining to suicide attempts in
Suicide attempters, Family of suicide attempters, Attitude towards
existence of law in Suicide Attempters, Family of suicide attempters.
Methods: 60 patients, admitted in the tertiary hospital in rural south
India for attempted suicide were included randomly for the study.
Following informed consent being taken from the patients and family,
and having attained medical stability they were given a semi-structured
questionnaire and interviewed individually. Ethical Clearence from
the ethical body of the institute was taken. Analysis of Data was done
using SPSS.
Conclusion: Further research into people perspectives into Laws
pertaining to suicide in India remain the need of the hour, more so
suicide attempters. The detailed discussion with related graphs and
charts will be presented at the CME.
Key words: suicide attempt, suicide law, awareness, attitude
Others
Familiar Mediterranean Fever and Psychiatric Disorders
Sirin A, Cetinkaya O
Avcilar Murat Hospital, Istanbul, Turkey. E-mail: siamakshahidi@
yahoo.com
Background/Objectives: Familiar Mediterranean Fever (FMF)
is a genetic disease characterized by recurrent febrile episodes
and inflammation of serious membranes and polyserositis such as
peritonitis, arthritis, and pleuritis. The episodes often last for 12-72
hours. Amyloidosis is the most common complication of FMF in which
the treatment is colchicine. Regular use of colchicine decreases the
frequency of FMF episodes and amyloidosis. In this case report, two
FMF patients who have comorbid psychiatric diseases are presented.
Case1: 29-year-old male patient who has been treated and followed up
with schizophrenia diagnosis for 2 years, had FMF disease for 16 years.
Case2: 47-year-old male patient who has been hospitalized 17 years
ago first time with the diagnosis schizophrenia, had FMF for 27 years.
Discussion:Comorbidity of psychiatric disease and FMF is rarely
seen. We could not find any manuscript reporting FMF and psychiatric
disorders. All of our patients were diagnosed schizophrenia.
Unpredictable prognosis and pain are main problems for FMF which
is a chronic disease and it causes patients to feel anxiety, insecurity
and helplessness. The necessity of using drugs regularly, side
effects of drugs and complications of the medical diseases cause
psychological burden. Patients with psychiatric disorders can have
difficulty in explaining their problems or be given less attention to patient
complaints. It is a risk for prognosis for FMF. Multidisciplinary approach
provides prognosis to be better in those patients.
Interactions of Methamphetamine and Buprenorphine on Anxiety
and Locomotion
Komaki A, Etaee F, Asadbegi M, Taslimi Z, Shahidi S, Sarihi A
Neurophysiology Research Center, Hamadan University of Medical
Sciences, Hamadan, Iran. E-mail: alirezakomaki@gmail.com
Background/Objectives: Methamphetamine (Meth) abuse and
dependence present a major global problem. There are controversy about
436 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
the effect of Meth on anxiety. On the other hand, buprenorphine (Bup) is
used for the treatment of anxiety-related behaviours. However, there is little
information about the interaction between Meth and Bup on phenomenon
of anxiety. The elevated plus-maze (EPM) and open field (OF) are two of
the most widely used models to assess anxiety in small rodents.
Methods: Forty male Wistar rats, weighing 300 to 350 g, were categorized
into four groups: sham, Meth, Bup, Bup+Meth. In all groups, related
substances were administrated for one week. Then, the time spent in
open arms, the percentage of entries into the open arms and the number
of total entry to the all arms (total activity) in the EPM were recorded. Also,
locomotor activity, the number of entrance into centre area, the percentage
of time spent in centre area in the OF were recorded.
Results: Administration of both Meth and Bup alone for one week,
increased open arms exploration in EPM. Combined administration of
Bup+Meth had conflicting effects on the responses of each of these
two compounds alone. Meth and Bup had no effects on the total and
locomotor activity. Furthermore, our study showed that, rats in both
Meth and Bup groups spent more time in the centre of OF. Whereas,
Bup+Meth groups spent less time in the centre of OF.
Conclusions: Administration of Meth and Bup alone might have
an anxiolytic profile in rats, whereas co-administration of Bup+Meth
produces anxiogenic effects.
Generalized Dystonia with Lurasidone: A Case Report
Garg J, Chavan BS, Sidana A, Arun P
Department of Psychiatry, 5th level, D Block, Govt. Medical College
and Hospital, Sector 32, Chandigarh, India. E-mail: jasmin.arneja@
gmail.com
Background/Objectives: Drug induced dystonia’s are frequently
encountered with typical antipsychotics. Atypical antipsychotics are
less likely to cause dystonias or other extra-pyramidal side effects.
Lurasidone is a novel atypical antipsychotic drug recently approved in
India for schizophrenia. The available literature from other countries
about lurasidone states that among exprapyramidal symptoms,
lurasidone has a higher chance of causing akathisia instead of dystonia
when compared to placebo. There is lack of Indian data about the
tolerability profile of this drug. This case report demonstrates dystonia
as an adverse effect in a patient due to lurasidone.
Methods and results: A 21 year male patient with schizophrenia was
administered single dose of 80mg lurasidone orally. He presented
again within one day with generalized body dystonia. It resolved with
injection promethazine but it lead to significant patient distress and
ultimately changing of antipsychotic.
Conclusion: A caution should be taken while prescribing lurasidone
keeping in mind the possibility of occurrence of severe dystonic
reaction with it.
Key words: Lurasidone, dystonia, schizophrenia
Toward a Research of Identity: A Disappointed Hope and an
Increasing Moral Suffering
Arlette JI, Justin AC, Magloire G, Guy-Gérard A, Elvyre K, Florent A
University of Abomey Calavi, Cotonou, Benin. E-mail: houngbejosiane@
yahoo.fr
Lady Mary was born in North America from slave parents. After her
studies, she decided to work in Africa particularly in the republic of
Benin as her first post. Her decision is simple to explain. In fact, she
was taught that Benin is also a slave coast and thought she could
meet there members of her family because she was labelled as a
'person with origin'. Therefore, she did everything possible to find
her first job in Benin as Black American Volunteer with the help of a
voluntary international institution which sent her there. She stayed in
Allada which is recognized to be famous in the history of slavery and
the birthplace of Toussaint Louverture. But she was soon disappointed.
For her, everyone looked alike, she could not identify a family to which
she belonged to, and could not meet people having the same names.
In fact, the great question is 'Who is this person who could neither
recognize where she came from nor her origins? What suffering?'
Key words: Identity, increasing suffering, Origin, sense of being a
part for
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Abstracts
Intentional Production of Symptoms: How to Resolve the
Unrequited Issue?
Chandran N, Bagra I, Pattanayak R
Room no.4096, Department of Psychiatry, All India Institute of Medical
Sciences, New Delhi, India. E-mail: drnimmychandran@gmail.com
Background/Objective: History of illness deception starts from
the biblical time onwards but it gained more attention after the rise
of workmen compensation acts. Illness deception comprises of
malingering and factitious disorders. Theoretically the key difference
between them is the requirement that factitious patients are motivated
to assume the sick role and there is lack of incentives of their behavior.
Is the distinction between them conceptually meaningful and empirically
valid?
Methods: A pub med based literature review was done using
appropriate search terms which generated 198 publications, and it
was supplemented with cross references and literature search using
Google scholar.
Results: How to approach a case of illness deception? Isolation of
sick role as a sole motivation is very tricky. There are certain warning
signs which we should keep in mind before looking into such case.
Apart from those warning signs, there are specific interview techniques,
clinical scales, many psychological tests, specific strategies like video
surveillance, hand dynamometer, two way mirrors, polygraph, EEG
based methods, Narcoanalysis and neuro imaging methods which help
us to diagnose such cases. How to manage if the patient is diagnosed
as malingering or having factitious disorder? Management of such
cases are complicated by many ethical and legal issues.
Conclusion: Clinician should consider a possibility of illness deception
whenever he is in doubt and extreme care needs to be taken in
documenting such cases. Further research is needed in this area to
clarify the current controversies in the concept in order to help in better
assessment and management of such cases.
Supernatural Beliefs Among Patients with Depression
Dua D, Grover S, Avasthi A
PGIMER, Chandigarh, India. E-mail: devakshi.dua@gmail.com
Background/Objectives: To study supernatural beliefs in terms of
personal beliefs, etiological models and treatment practices among
patients with depression.
Methods: 96 patients with depression, currently in clinical remission
were evaluated on Supernatural Attitude Questionnaire and Hamilton
Depression Rating scale (HDRS).
Results: The mean age of the study sample was 43.6 (SD-12.4)
years and mean duration of formal education was 10.6 (3.71) years.
More than half of the participants were females (N=54; 56.3%),
educated below matric (N=53; 55.2%), belonged to nuclear families
(N=49; 51%), were currently on paid employment (N=56; 58.35)
and earning more than 7,000 rupees per month. About two third of
the patients belonged to urban locality (N=64; 66.7%), and majority
were married (N=78; 81.3%). Majority of the patients had only single
episode of depression (N=70; 72.9%) in their lifetime at the time of
assessment. Mean HDRS score at time of assessment was 1.90
(SD - 2.43). About half of the patients (N=45; 46.9%) held personal
magico-religious beliefs while more than half (N=58; 60.4%) felt that
these beliefs were also held by others in their community. In terms
of supernatural etiological model, about two-third (N=60; 62.5%) of
the patients believed that depression experienced by them was an
outcome of one of the supernatural cause like sorcery/ witchcraft,
ghosts, spirit intrusion/divine wrath, planetary influences, evil spirits
and bad deeds in previous life. Majority of the patients (N=84; 87.5%)
also attributed their illness to social and biological causes in the form
of stress and chemical imbalance. About two-thirds (N=65; 67.7%) of
patients took magico-religious help during their most recent episode.
There was no association between age, sex, education, locality and
occupation of the patient with supernatural beliefs.
Conclusion: Majority of the patients with depression attribute their
symptoms to both supernatural and biopsychosocial causes and seek
magico-religious help along with medical treatment.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Prevalence of Metabolic Syndrome in Patients with Schizophrenia
Treated with First Generation and Second Generation Anti
Psychotics
Guyton A, Dinesh P, Vunnam S, Anusha N
Narayana Medical College, Nellore, AP, India. E-mail: guytonanuhya@
gmail.com
Background/ objectives: To study the prevalence of metabolic
syndrome in patients of schizophrenia treated with first generation and
second generation anti psychotics and to compare the prevalence of
metabolic syndrome between first generation and second generation
anti psychotics.
Methods: The sample of patients was obtained from patients attending
the outpatient clinic or admitted to the inpatient unit of the Department
of Psychiatry at NMCH, Chinthareddypalem, Nellore. The sample
comprises of 25 patients with schizophrenia on treatment with first
generation antipsychotics and 25 patients of schizophrenia on treatment
with second generation antipsychotics for a minimum duration of 4
months. The samples were measured for blood pressure, fasting blood
glucose, fasting blood triglycerides, fasting high density lipoprotein
(HDL) and waist circumference. Adult Treatment Panel (ATPIII)
diagnostic guidelines were used to diagnose metabolic syndrome.
Results: Prevalence of metabolic syndrome in first generation
antipsychotic group was (18%) and second generation antipsychotic
group was (40%). Comparison of prevalence between two groups
showed Mann-Whitney value of -2.412*, which was significant at p value
< 0.05 .There was significant difference found in the chlorpromazine
equivalent dosage of antipsychotics at p value < 0.001. It signifies
that though the second generation antipsychotic group had received
lesser amount of antipsychotic dose when compared to first generation
antipsychotic group, prevalence of metabolic syndrome was more in the
second generation antipsychotic group as compared to first generation
antipsychotic group.
Conclusion: Metabolic syndrome is seen in both the group of patients
taking antipsychotics. However, in line with previous studies our study
also found the prevalence of metabolic syndrome is more in patients
taking second generation antipsychotics.
Healers and Healing Practices of Mental Illness in India: A Review
Subudhi C
National Institute of Technology, Rourkela, India. E-mail: chittaranjan.
subudhi@gmail.com
Much of the debate on mental health has centred on cultural difference
as a way of dealing with the health care practices. The varieties of
health care system induces medical pluralism. In India, this medical
pluralism can be observed through the assortments of healers and
healing practices. The cultural determinism of any health care practices
comprises traditional or indigenous and modern healthcare practices
which are embedded in the health culture of country’s healing system.
This medical pluralism not only provides the different forms of healing
practices but also addresses different ways of perceiving, explaining
and managing the illness. Nevertheless, consultation with a particular
healer is governed by a set of sociocultural beliefs, background of the
patients along with the family members which has also been followed
through the accessibility and availability of such healers. By exploring
the dominance of different types of healers and their healing practices
toward mental illness from the pre -existing research in India the
present paper tries to show how health care system in mental illness
also represents the kaleidoscope of medical pluralism.
A Socio-Cultural Analysis of Borderline Personality Disorder
Ahluwalia H, Sidheek F, Satyanarayan V, Jain S
NIMHANS, Bangalore, India. E-mail: gunn1802@gmail.com
Background/Objectives: To examine the developmental experiences,
clinical presentation, diagnosis and contextual factors of women with
BPD from a social- constructionist lens.
Methods: A case series of five women with BPD who were referred
for individual and/or couples psychotherapy at NIMHANS, Bangalore.
Patients hailed from geographically and culturally distinct urban and
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Abstracts
rural regions in India. The case data was obtained from case records,
psychotherapy intake interviews as well as psychotherapy session
material.
Results: The analysis of case material indicated that the statistic that
BPD is disproportionately higher in women itself warrants a gender fair
scrutiny. Externalizing symptoms, that are characteristic of BPD, are
not acceptable in the cultural milieu of India. In Indian families, these
are objectionable symptoms, which bestow considerable stigma to
the person as well as the family. This is particularly true for families
hailing from relatively closed communities in rural parts of the country.
This population of women report greater incidences of experiences
of trauma and childhood adversity as well as greater incidences and
qualitatively different presentations of Axis I and Axis II disorders. These
experiences and diagnoses themselves may be intertwined in their
gender status and cultural context. Scrutiny must also be extended to
clinician biases in diagnosis, which are not necessarily gender neutral
and culturally sensitive.
Conclusion: The cases offer a perspective to re-evaluate approaches
to diagnosis and intervention for BPD so as to offer services that are
gender and culture sensitive.
Key words: Borderline personality disorder, gender, stigma, culture
Experience of Psychological Trauma: A Nuanced Analysis of
Psychological, Social And Cultural Issues
Sidheek F, Ahluwalia H, Satyanarayan V, Suman LN
NIMHANS, Bangalore, India. E-mail: fasli.sidheek@yahoo.com
Background/Objectives: To examine the nature of psychologically
traumatic experiences of clients seeking help at the Trauma Recovery
Clinic.
Methods: The Trauma Recovery Clinic (TRC) was started in 2014 at
NIMHANS centre for well-being located in an urban residential area
in Bangalore, and is documented as a best practice model in the
area of psychological trauma. Data for this comes from case records
of clients attending TRC between 2014 and March 2016. Relevant
socio-demographic and psychological trauma related variables were
abstracted and examined from a socio-cultural lens.
Results: The age range of clients who sought help from the clinic
ranged from 17-64 years with a mean age of 32.06, with 79% of clients
being female. The nature of traumatic events included a range of acts
of interpersonal violence, adult consequences of child sexual abuse,
and traumatic grief. A range of psychiatric disorders such as Post
Traumatic Stress Disorder, Depressive and Anxiety Disorders were
found. Trauma Checklist was administered to document the nature
and severity of trauma symptoms. Gender norms, and patriarchy were
seen to strongly influence experience of trauma in vulnerable groups
in our society.
Conclusion: Several men sought help from TRC, despite their being
a positive bias towards women. The deep rooted psychological, social
and cultural issues involved in and the exposure to or experience of
trauma will be discussed in the presentation.
Key words: Psychological trauma, gender, interpersonal violence,
socio-cultural factors, mental health
Prospective Study of the Extent of Coverage of Women Mental
Health Issues in Newspaper
Goel A, Kataria D
Lady Hardinge Medical College, New Delhi, India. E-mail:
KAPOORCHAND138@GMAIL.COM
Background/Objectives: The present study was done to find out
the extent of coverage of issues related to women mental health in
newspapers over a four week period in a prospective study.
Methods: All matter related to women mental health were searched
manually in four leading newspapers of the Delhi region over a four
week period extending from September 1, 2015 to September 30, 2015.
The four newspapers that were analyzed included, ‘Dainik Bhaskar’,
‘Dainik Jagran’, ‘The Times of India’ (TOI), and ‘The Hindu’.
Results: Out of the 181 newspaper cuttings identified during the study
period, most belonged to Hindi newspaper Dainik Bhaskar i.e. 28.7%,
Dainik Jagran i.e. 25.4% followed by the English newspapers, The
Times of India i.e. 24.3% and The Hindu i.e. 21.5 %.
438 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Conclusion: Newspaper coverage mirrors existing reality and social
concerns. It is important to sensitize both the print media as well as
mental health professionals to the nature of coverage of issues related
especially to women mental health. This could form the basis of a new
relationship between the two which is more open, frequent and objective.
Key words: Newspaper, women mental health, coverage
Workplace Conflicts and Stress Among Nurses
Bisht B
Chitkara College of Nursing, Chitkara University, Punjab, India. E-mail:
ourpgi@yahoo.co.in
Background/Objectives: A phenomenological study was conducted
to explore lived experiences of workplace conflicts and stress among
nurses of selected hospitals in Chandigarh and Punjab.
Methods: The researcher conducted a study with six participants
selected through purposive and snowball sampling. The study was
conducted by using face-to-face, audio taped, unstructured interviewing
techniques asking open-ended questions about workplace conflicts.
Two participants were recruited from a private hospital, two from
government hospital and two from government on contractual post.
Each participant was contacted and a convenient location and time was
determined for the interview. Prior to the interview, the researcher asked
the participants to sign the consent form and completed a demographic
form. Participant chose not to identify themselves throughout the study.
The researcher transcribed the interviews verbatim. Audio recording
of the interviews was done in ˜Sony Audio recorder™ to avoid missing
any aspect of experience. The researcher conducted audio-taped face-
to-face interviews with each nurse participant.
Results: Data were analyzed using Colaizzi's (1978) phenomenological
method because this method of data analysis is associated with
descriptive phenomenology. The participants were given a report of
the analysis to ascertain that the emerging meaning of their interviews
mean what they actually experienced. The main themes which
emerged from the study are: Diverse workplace conflicts due to high
expectations of patients & their relatives, shift duties and complaints
against nurses and problems in choosing conflict management styles
as the participants are not assertive.
Conclusion: Nurses face workplace conflicts. Various sources
identified for workplace conflicts are high expectations of patients &
their relatives, shift duties and complaints against nurses. Among the
five conflict management styles, most commonly styles used by nurses
were avoidance and accommodation. Consumer’s grievances add to
the nurses’ stress and job dissatisfaction
Neuropsychological Functioning in Euthymic Phase of Bipolar
Affective Disorder
Bhatia P, Sidana A, Das S, Bajaj M
Psychiatry office, D-Block,5th floor,GMCH, Chandigarh, India. E-mail:
pb1150926@gmail.com
Background/Objectives: The study is aimed to explore the nature of
neuropsychological functions and soft neurological signs, in euthymic
phase of bipolar affective disorder.
Methods: The study was an exploratory, single group, cross-sectional
and was conducted at the Department of Psychiatry, Government
Medical College and Hospital, Chandigarh. 35 individuals diagnosed
with BPAD as per ICD - 10 DCR criteria with total duration of illness
of at least 2 years and 3 months of euthymia, (HAM-D and YMRS
Score) meeting the inclusion criteria were inducted. Sociodemographic
details and clinical details including treatment were recorded in a semi-
structured performa, available in the Department of Psychiatry, GMCH.
Standardized tools were applied to assess neuropsychological function
(NIMHANS Battery). Statistical analysis was done using descriptive
and inferential statistical methods.
Results: In more than 60% of patients in euthymic phase of bipolar
disorder, deficits were found in domains of memory and executive
functions and in approximately 25% patients in domain of attention.
Conclusion: Deficits were found in cognitive domains in euthymic
phase of bipolar disorder which needs to be taken care in treatment
strategy for improvement in functioning of patients in euthymic phase
of bipolar disorder.
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Abstracts
Social Anxiety Disorder: Lack of Indian Research
Chawla N, Kumar S, Dhawan A
All India Institute of Medical Sciences, New Delhi, India. E-mail: nishtha.
chawla@gmail.com
Introduction: Social anxiety disorder is emerging as a significant
mental health concern in India. It is an important cause for significant
distress. Despite being a common entity, there is paucity of literature
from India. In this review we intend to give an overview of studies that
have been done in Indian settings on social anxiety disorder.
Methods: Search was done using search tools: PubMed, Embase,
Medline, ScienceDirect and Cochrane library. Search terms used
were”social anxiety disorder” or”social phobia”. To this search, term
“India” was added to include articles on Indian population. Only those
articles pertaining to social anxiety disorder/ social phobia published
after the year 2000 and written in English were included. Articles on
primarily other disorders, with just the mention of social anxiety in their
text, were excluded.
Results: The initial search yielded a total of 2581 and 1692 articles
with the respective terms. When the term “India” was added to the
search field, the number of articles respectively reduced to 94 and 31
articles. After applying the inclusion and exclusion criteria, a total of
seven relevant studies were found in the past sixteen years including a
case report and a correspondence. Rest of the studies were mainly on
phenomenology and comorbidities of social anxiety or one prevalence
study done in adolescents.
Conclusion: Most of the studies done in India were limited by small sample
size, bias due self-administered questionnaire, non-standardization of
questionnaires on the population being studied or heterogeneity of the
groups involved. There were no studies available on management options,
efficacy of the treatment, cost effectiveness of various approaches or
on cultural aspects of the illness. We emphasize on the need for more
research on social anxiety disorder in Indian settings, a common, yet often
missed and significantly distressing clinical entity.
Effectiveness of Rajyoga Meditation as an Adjunct to First Line
Therapy in Patients With Obsessive Compulsive Disorder
Mehta S, Mehta K, Thaman RG, Chalana H, Singh H
GMCH, Chandigarh, India. E-mail: shivangi02@gmail.com
Background/Objectives: To study the effectiveness of Rajyoga
meditation as an adjunct to the first line treatment in patients with
obsessive compulsive disorder (OCD).
Methods: Patients with OCD, diagnosed according to Diagnostic
and Statistical Manual of Mental Disorders fifth edition (DSM-V),
were divided into two groups - The Meditation Group (MG; n=28)
and the Non-Meditative Group (NMG; n=22). MG practiced Rajyoga
meditation protocol for 3 months duration. Baseline and 3-month interval
assessment was done using the Yale-Brown Obsessive Compulsive
Scale (Y-BOCS). Statistical analysis was done using student’s paired
t test.
Results: 57% (16/28) patients in MG group and 68% (15/ 22) patients
in NMG group completed the study protocol. Both groups demonstrated
significant improvement in symptoms; MG group had reduction of
9.00±3.16 (49.76±9.52%) points on YBOCS, while NMG group had
reduction of 3.13±2.59 (18.10±14.69%) points on YBOCS. Within group
statistics showed that Y-BOCS scores in MG group were significantly
improved in comparison to NMG (p=0.003).
Conclusion: The present study suggests that the adjunctive techniques
of Rajyoga meditation provides an effective alternative therapy to other
strategies available to reduce anxiety associated with obsessions and
compulsions in OCD patients.
Key Words: Obsessive Compulsive Disorder (OCD), Rajyogameditation,
Y-BOCS scale
Functional Neuroimaging as a Tool to Supplement Cognitive,
Affective and Social Functioning Assessment and Psychotherapy-A
Postgraduate Student Perspective
Malik A, Kochhar KP, Patil A, Chhabra D, Babu N
Department of Psychology, University Of Delhi, India. E-mail: malik.
apoorva@gmail.com
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
The most prevalent critical test of the field of clinical psychology is
unifying the firmly grounded theoretical principles not only with the
real time clinical practice but also keeping up with neuroimaging
assessment advances. The present paper purports at determining the
applicability of putting into use the functional near-infrared spectroscopy
(fNIRS) as a tool to supplement the cognitive, affective assessment,
social functioning, psychotherapy and rehabilitation through rigorous
review of literature. fNIRS is used to measure cortex activation by
recording changes in brain wave activities in relation to oxygenated and
deoxygenated hemoglobin. Given advantages and wide applicability of
neuroimaging techniques, fNIRS can be effectively employed to assess
actual time affective, perceptual, visual, motor and language functioning
of adults as well as infants. Summarily, fNIRS is a potential measure for
comprehensive assessment of both healthy and pathological cortical
working. The current status and applications shall be discussed.
A Case Series of Patients with Schizoaffective Disorder in a Mood
Disorder Unit
Jiangbo Y, Chern TP, Ming MY
Institute of Mental Health, Singapore. E-mail: yingjiangbo@gmail.com
Background/Objectives: The diagnosis of schizoaffective disorder is
frequently used to describe the co-occurrence of both schizophrenic
and affective symptoms, but the conceptualization and nosological
status of this disorder remain contentious. The inter-clinician reliability
of a diagnosis of schizoaffective disorder has been reported to
range between poor and moderate. The temporal stability of the
schizoaffective disorder diagnosis is relatively low. We aimed to
describe the clinical characteristics obtained from medical records
and tried to exam to what extent the daily use of the schizoaffective
disorder diagnosis was in accordance with the DSM-IV-TR criteria.
Methods: We presented all three patients who were diagnosed with
schizoaffective disorder and were admitted in a specialist Mood
Disorder Unit in the Institute of Mental Health from 1 May 2012 to 31
March 2015. The cases of the three patients who enrolled in this study
were described in detail with regard to demographics and psychiatric
history. We obtained all the information from our medical records.
This study was approved by the Clinical Research Committee of the
Institute of Mental Health and the National Health Group Domain
Specific Review Board.
Results: All three patients were diagnosed with schizoaffective disorder
on discharge, but the information from the medical records did not
support this diagnosis. We found that two patients might have bipolar
disorder and one patient might actually suffer from schizophrenia.
Conclusion:This study demonstrates that the clinical use of the
schizoaffective disorder still has some limitations. There still remains
a lack of consensus regarding the conceptual and clinical aspects
of schizoaffective disorder. Clinicians need to be cautious when
diagnosing patients with schizoaffective disorder. Since the treatment
guidelines for schizophrenia and bipolar disorder are well established
and are substantially different, an overuse of schizoaffective disorder
may encourage non-evidence based polypharmacy which may not be
of benefit to patients.
Myxedema Madness Revisited: A Case Report in Elderly Female
Miglani M, Garg J, Das S
Government Medical College and Hospital, Chandigarh, India. E-mail:
mitthatmiglani@gmail.com
Background: Myxedema madness is an uncommon entity which
occurs due to severe hypothyroidism, characterized by psychiatric
symptoms ranging from delirium to frank psychosis with or without
physical symptoms. It’s difficult to make diagnosis for the psychiatrist
especially in elderly population where manifestations maybe
indistinguishable from the aging process.
Methods: The objective of the paper is to present a case of an 84
years old female presenting with acute onset behavioural changes
with no relevant past or family history of any psychiatric illness. The
patient was admitted in psychiatry ward with complaints of acute
onset irritability, aggression, irrelevant talks, restlessness, reduced
sleep & forgetfulness for 5 days. HMSE score 21. She had fluctuating
orientation, remain confused and irritable. General physical examination
439
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Abstracts
and baseline investigations were normal. MRI brain was normal. She
was put on low dose antipsychotic for symptom control, tapered off
in a few days. Thyroid profile showed high S.TSH (>100.00 uIU/ml).
Thyroid replacement therapy started with loading dose of thyroxin
300ug followed by 100ug daily.
Results: Patient responded to treatment within 2 days of initiation.
Her successive HMSE scores ranged from 25-26 after initiation of
replacement therapy. Patient was discharged on oral thyroxin and
maintained well after that.
Conclusion: Presentation at such a late age, with no significant past or
family history, our first aim should be to rule out any organic pathology.
Physical signs and symptoms maybe absent in spite of psychiatric
symptoms. Hence, whoever presents with acute psychosis or marked
behavioural change, hypothyroidism should be considered as a
differential diagnosis and thyroid workup should be done. Hormonal
replacement therapy to be initiated to achieve an excellent outcome.
Development and Validation of Indian Affective Picture Database
Sharma U, Bhushan B
Department of Humanities and Social Sciences, Indian Institute of
Technology, Kanpur. E-mail: usharma@iitk.ac.in
Background/Objectives: Correct interpretation of others’ expressions
is a basic requirement of effective interaction. In behavioural science,
this ability is assessed by using faces, hybrid faces, eye gaze, and
voice. Although, facial expressions have been extensively used in
emotion recognition research culturally salient standardized picture
database suitable for Indian context is scarce. Therefore, we wanted
to develop a relevant database of affective stimuli.
Methods: We developed and standardized a set of 140 coloured
pictures of the six basic emotions along with neutral expression. Four
expressers, 2 males and 2 females with mean age of 25.25 (SD 3.77)
years posed seven expressions which were captured from five different
angles with uniform background. For the purpose of standardization,
these pictures were shown to 350 undergraduates who labeled the
emotion and rated its intensity. The pictures were presented for 5
seconds with an intermediate duration of 10 seconds. After removing
the incomplete responses the final analysis was performed on 339
participants. For analysis, hit rates, unbiased hit rates, ANOVA and
paired t-test were performed.
Results: The mean biased hit rate was 93.02 (SD 7.33) and mean
unbiased hit rate was 0.519 (SD 0.015). Within subjects ANOVA with
emotion category as independent variable and hit rate and arcsine
transformed unbiased hit rate as dependent variables revealed a main
effect of emotion F(1,6)=7.598 , p<0.0001. The t-test value 23.116,
p<000.1 showed that participants selected the intended emotion at a
rate far higher than chance. The mean intensity rating was 5.94 (SD
0.77).
Conclusion: Results reveal that the pictures are a valid set of affective
stimuli. This database can prove to be a robust tool for studying
developmental disorders and other conditions that adversely affect
effective social interaction.
Key words: Emotion recognition, social interaction, database of
affective stimuli
Vilazodone Induced Decreased Libido: A Case Report
Kathiresan P, Chawla N, Sharan P
All India Institute of Medical Sciences, Delhi, India. E-mail:
preethymmc@yahoo.co.in
Background: Sexual dysfunction is a common side effect of
antidepressants, especially selective serotonin reuptake inhibitors.
Vilazodone was approved by FDA for the treatment of major depressive
disorder in Jan 2011. It combines the action of SSRI and Serotonin
Partial agonist and hence is termed as Serotonin partial agonist
Reuptake Inhibitor (SPARI) and has been mostly associated with
mild adverse effects like GI symptoms. It has been postulated that
vilazodone is associated with lower sexual side effects. The literature
regarding the same is scarce and remains controversial.
Case summary: We present the case of a 32 year old female who
presented with depressive symptoms with normal sexual functioning at
baseline. She had had a previous episode of depression and therefore
440 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
was started on SSRI on the onset of second episode. Vilazodone was
started after not getting adequate response on SSRI. She developed
decreased libido after starting vilazodone and reduced the dose on her
own and eventually had to be shifted to mirtazapine due to persistence
of the possible sexual side effect.
Discussion: The literature concerning the sexual side effects of
vilazodone is scarce. Most studies till date claim vilazodone to have
low and less bothering sexual side effects. However, our patient
discontinued the drug due to this bothersome side effect. It is, hence,
important to be vigilant in recognising such side effects as it can affect
the compliance and thus hamper management of the patient.
Key words: Vilazodone, sexual dysfunction, libido, drug related side
effects
Reaching the Unreached: Role of Tele Psychiatry
Munoli R
Kasturba Medical College, Manipal, India. E-mail: ravindra.nm@
hotmail.com
Background/Objectives: To describe the role of Tele-psychiatry in
providing service in unreachable areas.
Methods: Telemedicine is another application, which is used to reach
out remote users for specialist care. Tele psychiatry/ Tele mental
health/ E-mental health is another offshoot of it. This helps the mental
health professionals to deliver expert service to patients in remote
areas. It can be used for assessment, diagnosis, pharmacological
and nonpharmacological interventions. Interest in tele psychiatry is
growing since last decade and with this evidence is also emerging
about its efficacy and effectiveness, which are in favour of this model.
Tele psychiatry in India is emerging as a promising model. Institutes
like Schizophrenia Research Foundation (SCARF), Chennai and Post
Graduate Institute of Medical Education and Research (PGIMER),
Chandigarh are successfully using this. Tele psychiatry module is used
with little modification to cater unreached population in remote area
of the Udupi district, Karnataka state, India. Investment for the project
was just two laptops as University and Primary health centre provides
free internet service.
Results: Primary health care centre was chosen to run the services.
Using simple video conferencing platforms skype and hangouts, it was
started with a post graduate visiting the PHC and interviewing patient
in front of laptop. This was seen live at the other end with consultant
asking for clarifications and suggesting interventions. First Monday of
every month camp is organized with help of local authorities/officials.
Conclusion: Tele psychiatry is a promising tool to reach the unreached.
Beneficiaries expressed happiness with the service provided and
technology used. Further, it can be used for primary care physicians
and general health care workers for training and empowering them
to deliver mental health care. By this approach as a long term goal
mental health can be gradually integrated in general health care using
existing resources.
The difference of Serum BDNF Levels Between Schizophrenic
Patients with Smoking in Batak Male and Controls
Hendriati D, Effendy EM, Amin M
Department of Psychiatry Faculty of Medicine Universitas Sumatera
Utara, Medan, Indonesia. E-mail: deasyhendriati@yahoo.com
Background/Objective: Schizophrenia is a severe psychiatric
disorder, generally affects approximately 1% of the world population
but the pathogenesis of schizophrenia is still unclear. Accumulating
evidence shows that brain-derived neurotrophic factor (BDNF) maybe
involved in the pathophysiology of schizophrenia. Use of nicotine
associated with upregulation of BDNF in the serum. Based on the
higher smoking rates among schizophrenic patients and the close
relationship between nicotine and BDNF, as well as the repeatedly
found alternations of BDNF levels in schizophrenia,many studies have
suggested that smoking could play a role in the altered BDNF levels
of schizophrenic patients. The objective of the study is to determine
the difference of serum BDNF levels among schizophrenia and non-
schizophrenia smoking in Batak male.
Methods: Serum BDNF levels were measured in 68 Batak male who
smoke (34 subjects with chronic schizophrenia and 34 subjects non
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Abstracts

schizophrenia as controls), aged 20 -60 years old, did not suffer from
other mental disorders, neurologic disease and no history of alcohol
and other substances except tobacco. Serum BDNF was analyzed with
the quantitative sandwich enzyme immunoassay.
Results: On going
Conclusion: On going
Key words: Schizophrenia, Batak male, Smoking, Brain-derived
Neurotrophic Factor
Pathways to Care Among Patients Accessing Community
Outreach Satellite Psychiatry Clinics in Haryana and Punjab
Singh SM, Kumar E, Saroj R, Subodh, Akhilesh
Department of Psychiatry PGIMER Chandigarh, Punjab, India. E-mail:
shubhmohan@gmail.com
Mental disorders are extremely common but accessing care is difficult
for many sufferers and caregivers. The pathway that a patient uses
to reach an appropriate place of treatment is called the pathway to
care (PC). It is modulated by various factors such as availability of
resources, cultural and magico-religious beliefs and geographical
factors. Studying the pathway of care helps us in analyzing health
services use, identification of the sources of delay in attending the
right care, and to find out the possible remedies. Previous studies in
this area have focussed on tertiary level hospitals and also mental
hospitals. There is paucity of information with regards to common
mental disorders in patients from rural backgrounds.
The community psychiatry service of the department of psychiatry
PGIMER runs satellite clinics in four pre-existing health facilities in
rural and semi-urban areas, namely Civil Hopitals in Raipur Rani,
Naraingarh (both in Haryana) and Boothgarh (Primary Health Center)
and Civil hospital Kharar (Punjab, India). Each of these clinics runs on
a weekly basis. This study aims to investigate PC in patients attending
these health facilities.Consecutive patients attending these clinics will
be approached for entry into the study. Written informed consent will be
obtained. Sociodemographic details will be obtained from the routine
profile sheet used in the clinic. Clinical details will be obtained from
routine clinical interviewing and investigations. PC will be evaluated
using the pathways to care encounter form previously used in a study
conducted by the World Health Organization (WHO).

Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4 441

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Abstracts
POSTERS DAY 3 FORENOON
Attitude to health and prevention: gender differences
Gafarov V, Gromova E, Panov D, Gagulin I, Gafarova A
Research Institute of Internal and Preventive Medicine, Novosibirsk,
Russian federation. E-mail: anunah@eml.ru
Background/Objective: Analysis of gender differentiation in relation
to their health and awareness of CVD risk factors among the open
population of Siberia the population aged 25-64 years.
Methods: Within the framework of WHO program "MONICA-
psychosocial" representative sample of the population in Novosibirsk
was examined in 1988 (847 women and 739 men, aged 25-64 years).
We used the questionnaire "Awareness and attitude towards their health".
Results: In an open population 25-64 years in Siberia women (89.5%
-91%) more often than men (70.5%-74.8%) had complaints to their
health. The majority of respondents believed that not enough care
of their health. Two-thirds of examined participants consider to ill a
serious disease over the next 5-10 years, if not in advance to take
preventive measures, and modern medicine can prevent and treat
heart disease are just a few. Men are 2-3 times more likely than women
were checked by a doctor. Women (53.3%) were more likely to continue
working than men (42.7%). More than half of men and women stay
home if the disease has been caused by influenza or accompanied
by a fever. Most participants in the study believed that a preventive
check is useful for health.
Conclusion: Despite the positive motivation in terms of prevention, as
well as adequate awareness of CVD risk factors persist negative trends
with regard to their own health, both men and women.
Key words: male population, female population, knowledge and
attitude to the health
Impact of Social Changes on Duration of Untreated Psychosis
(DUP) at Psychiatric Institutions: Ten Years Retrospective Study
Suzuki K, Yamazawa R, Niimura H, Nemoto T, Fujii C, Murakami M,
Mimura M, Mizuno M
Keio University Graduate School of Medicine, Shibuya-Ku, Tokyo,
Japan. E-mail: kouta.1027@gmail.com
Background/Objectives: Recently, the stigma for mental illness
seemed to be reduced and the number of mental clinics has been
increasing in Japan. It is assumed that the DUP has reduced due
to this change. In this regard, the mean DUP we investigated at the
psychiatric hospital 10 years ago was 14.3±17.5 months and this
result was comparable to those in other studies. Thus, we carried out
the new research using the same method.
Methods: We recruited First Episode Schizophrenia (FES) patients at
the same psychiatric hospital with emergency units and the mental clinic
close to the station from April 2009 to March 2011. The DUP, age and
other sociodemographic data were investigated and compared with the
results of the previous study. Moreover, we conducted questionnaire
survey concerning the situation of the onset to patient’s families in the
family groups.
Result: The number of subjects at the same psychiatric hospital was 42
(mean age 32.5 ±9.1 years) and that of mental clinic was 15 (mean age
27.2 ±9.4 years). The mean DUPs at the psychiatric hospital and mental
clinic were 16.0 ±18.7 months and 21.6 ± 24.0 months, respectively.
There was no significant difference in mean DUP between the results
of this study and the previous one, nor was significant difference
observed between the results of psychiatric hospital and mental clinic
in 2009. According to the questionnaire, families did not have accurate
knowledge about mental illness and psychiatric services, and did not
know how to consult the specialists.
Conclusion: Though the number of mental clinics increased recently,
more FES has visited psychiatric hospitals than mental clinics. Our
research found increasing number of mental clinics did not lead the
reduction of DUP. As a consequence, DUP will not change without
early intervention, including active searching and awareness program
in community.
442 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Twelve-Month Prevalence and Socioeconomic Correlates of
Anxiety Disorders in Finnish Population-An Eleven-Year Follow-
Up of the Finnish Health 2000-2011 Survey
Saarni S, Härkänen T, Markkula N, Viertià S, Mattila AK, Lindfors O,
Strehle J, Koskinen S, Saarni SI, Suvisaari J
National Institute for Health and Welfare, Department of Health, Mental
Health and Substance Abuse, Turku, Finland. E-mail: suoma.saarni@
helsinki.fi
Background/Objectives: Research into the prevention of anxiety
disorders has increased dramatically during the last years. Up-
to-date knowledge of the prevalence rate of anxiety disorders is
needed for planning and allocation of prevention and treatment
resources. The aim of the study was to compare prevalence rates
and socioeconomic correlates of anxiety disorders in Finland in
years 2000 and 2011.
Methods: The Health 2000 (N=8028) and 2011 (N=7964) Studies were
nationally representative surveys of the Finnish adult population aged
30 years and over. At both time points the 12-month prevalence of
psychiatric disorders were assessed with the Composite International
Diagnostic Interview, Munich version (M-CIDI). The anxiety disorders
included were general anxiety disorder (GAD), panic disorder with and
without agoraphobia, agoraphobia without panic disorder and social
phobia. Nationwide health care register data on hospitalization for
psychiatric disorders was used to take non-participation into account
using multiple imputations.
Results: In year 2011 the 12-month prevalence of anxiety disorders
was 5.1% (95%CI 4.5-5.7) whereas at year 2000 it was 3.8% (3.3-
4.3). The increase was mainly due to the significant increase in GAD
prevalence from 1.2% (0.9-1.5) at year 2000 to 2.8% (2.4-3.3) at year
2011. The trend of increasing prevalence was statistically significant
(p=0.000) and seen in both sexes and in all ages except the age group
45-54 years. At year 2011 female sex (OR 1.4, 95%CI 1.1-1.8), younger
age, being single (OR 2.0, 95%CI 1.5-2.5), and low education, were
associated with increased risk for anxiety disorder.
Conclusions: In the current study we combined the strengths of
register-based approach and nationally representative population
based study to investigate prevalence and socioeconomic correlates
of anxiety disorders, and changes of prevalence rates during the 11
years follow-up. The prevalence of anxiety disorders, mainly of GAD
increased during the follow-up remarkably.
Study of Psychiatric Morbidities Among Subjects with Vaginal
Delivery and Caesarean Sections
Sharma P, Sudarsanan BS, Choudhary S, Sharma A, Antil S, Malvika
Subharti Medical College, A-3/14 Sector-3 Rohini, New Delhi, India
E-mail: leopriyanka.sharma@gmail.com
Background/Objectives: To assess psychiatric morbidities of women
undergoing caesarean section andvaginal delivery.
Methods: This cross-sectional study was carried out in Subharti
medical college Meerut. 100 subjects were selected after fulfilling
exclusion and inclusioncriteria,50 undergoing caesarean section
and o 50 undergoing vaginal delivery. BPRS, BDI and HAM-A were
administered Before delivery, immediately after delivery, 3 days after
delivery and one month after delivery. Data so collected were subjected
to suitable statistical analysis (mean, standard deviation, t test) using
Microsoft Excel and conclusions were drawn.
Results: The prevalence of depression at three point of time were
(immediately after delivery, 3 days after delivery and 1 month after
delivery) 12%, 18.75% and 9.5% in caesarean group, 4%,10.63%
and 7.5% in normal delivery group, respectively. None of the patient
had psychotic symptoms and none filled criteria for anxiety disorders
Conclusion: The study was done to screen psychiatric disorder in
female during and after pregnancy so that the timely intervention
(pharmacological & non- Pharmacological) can be given to the females.
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Abstracts
Post-Partum Depression in India: A Systematic Review of
Epidemiological Studies
Mahapatra A, Gupta R, Choudhary V, Sagar R
All India Institute of Medical Sciences, New Delhi. E-mail: nnyaa09@
gmail.com
Objectives: Post-partum depression is defined as any depressive
episode which occurs within 6 weeks of child birth. Post-partum
depression has been established as a significant contributor to poor
mental health outcomes in women of reproductive age groups. Several
studies have been conducted to explore the various facets of this
disorder in India. We aimed to review the existing literature pertaining
to epidemiological studies on post-partum depression from India, and
to establish the risk factors, protective factors and physical and mental
health outcomes of the same.
Methods: The electronic databases MEDLINE (via PubMed) and
Google Scholar were searched using the keywords “post-partum
depression” and “India”. Relevant articles were identified from the
search results, and from cross references in selected articles. Only
original studies from India, published in English, involving patients with
a diagnosis of post-partum depression were included.
Results: A total of 57 results were obtained, out of which 24 were relevant
to the topic. Twelve articles met our inclusion criteria, comprising of 8
cross-sectional studies and 4 prospective studies. The prevalence of
post-partum depression was found to be 6%-48.5%. However, it was
not uniform across the country. The incidence of post-partum depression
was found to be 11%. Suicidal ideations were observed in 38% of the
women and suicide attempts were recorded in 18%.
Conclusion: Post-partum depression is a significant contributor to
physical and psychological morbidity amongst women of reproductive
age group in India. There is a need for further research into the
longitudinal course and prevention of post-partum depression.
Key words: post-partum depression, mental health, women, India
Development of a Common Answer for Depressed Patients and
Mania Patients
Ishida T, Takagi K, Tanahashi N, Sunami Y, Kawanoguchi J, Mizuno
K, Nishimura K
Suzuka University of Medical Science, 1001-1 Kishioka-cho, Suzuka,
Japan. E-mail: ishida-t@suzuka-u.ac.jp
Background/Objectives: The purpose of this study is to develop a
common answer for depressed patients and mania patients.
Methods: 198 adult subjects were divided into the non-stimulation
groups, the stimulation at acupoint groups of DU20, EX-HN4, DU20 +
EX-HN4, SP6, ST36, HT7 used for depressed treatment and of LU6
not used for depressed treatment. Evaluation of regional cerebral
blood flow at forehead part (rCBF) during verbal fluency tests were
performed before and after acupoint stimulation with Near-infrared
Spectroscopy. The relation between oxyHb before stimulation and Δ
oxyHb after stimulation was analyzed with SPSS software. Statistical
tests were performed by variance analysis.
Results: The relation between oxyHb before stimulation and Δ oxyHb
after stimulation was expressed in the figure of Y=AX+B with statistical
significance in all cases of acupoint stimulation, were A is the inclination
of the straight line, the coefficient of correlation, B is Δ oxyHb after
stimulation where oxyHb before stimulation is a zero, −B/A is oxyHd
before the stimulation to be a turning point of whether oxyHb decreases
or increases by stimulation. A, B, −B/A are different depending on
the constitutions of the subject, stimulated acupoints and stimulation
methods. However, A is always a negative and −B/A is a positive in
case of the above acupoint stimulation used for depressed treatment but
zero in case of the above acupoint stimulation not used for depressed
treatment. These results indicated that acupoint stimulation used for
depressed treatment decreases the rCBF of the man with the high
oxyHb before stimulation such as a mania patients and increases
the rCBF of the man with the low oxyHb before stimulation such as a
depressed patient.
Conclusion: The stimulation at acupoint used for depressed treatment
may be a common answer for depressed patients and mania patients.
Key words: Depressed, Mania, Acupoint, rCBF, NIRS
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Prevalence and Descriptive Clinical Profile of Patients Previously
Diagnosed with Depressive Disorders who Screened Positive
for Bipolarity in an Out-Patient Psychiatric Setting: Emphasizing
the Need
Jha M, Pattanayak S, Aggarwal S
VIMHANS Hospital, New Delhi, India. E-mail: medmrinal@yahoo.co.in
Background: Although recurrent major depressive episodes (MDEs)
are characteristic of unipolar depression, they also occur frequently in
patients with Bipolar Affective Disorder. Because depressive episodes
are generally more frequent and distressing than hypomanic episodes
in bipolar disorder, the latter may be unrecognized with a misdiagnoses
of unipolar depression. This issue is of high clinical importance because
of an increased risk for suicide, and other adverse outcomes related
to un-treated bipolarity.Most available studies are, however, almost
entirely based on western populations.
Objectives: The study aims to examine the clinical prevalence as
well as describe the sociodemographic and clinical-phenomenological
profile of patients with depression who screen positive for bipolarity.
Methods: This was a cross-sectional hospital based study, which
included 120 patients who were previously diagnosed with Recurrent
Depressive Disorder. Socio-demographic and clinical data was
collected and previous episode suggestive of hypomania/mania was
screened for with the Mood Disorder Questionnaire.
Results: The study found that 25.8% of the total patients who had been
previously diagnosed with Recurrent Depressive Disorder were actually
suffering from Bipolar Affective Disorder. Mean age of the patients in
this group was 34.13 years, and gender distribution was 64.5% males
and 35.5% females. The details pertaining to the descriptive clinical
profile shall be described as study findings.
Conclusion: This study not only highlights the burden of misdiagnosed
bipolar disorder in an Indian setting, it also identifies factors that are
associated with bipolarity, and shall help in better diagnosis of the
condition.
Key words: Bipolarity, Recurrent Depressive Disorder, Clinical profile,
India
Alexithymia and Self-Esteem in Patients with Premature
Ejaculation and Erectile Dysfunction
Singh K, Kumar R
Government Medical College Nalhar Nuh, Bhiwani, India. E-mail:
kuldeep.olla@gmail.com
Background/Objectives: Sexual dysfunction has always harmful
consequences on a person’s mental health. Psychological constructs
also play a significant role in developing and maintaining sexual
dysfunction and treatment seeking behaviour. Therefore, the present
study was carried out to assess the alexithymia and self-esteem in
patients with premature ejaculation as these constructs are not well
studied particularly in Indian context.
Methods: It was a cross sectional study, in which fifty (50) patients
with premature ejaculation and fifty (50) healthy control were selected
by purposive sampling. Assessment was done by using Toronto
Alexithymia Scale (Hindi) Rosenberg Self Esteem Scale (Hindi). The
statistical analysis was carried out using the SPSS Windows 16.0
software package. The analysis of the obtained data was done using
various descriptive and inferential statistics.
Results & Discussion: On alexithymia, patients with premature
ejaculation scored significantly higher than healthy control subjects.
On self-esteem, patients with premature ejaculation scored lower than
healthy controls but it was not significant.
Conclusion: Findings should be taken seriously and effective treatment
strategies should be planned to help this population suffering from high
level of alexithymia.
Psychosocial Interventions in Community
Role of Psychiatry Social Work in Rehabilitation of Person
Suffering from Mental Illness - Case Study
Bala C, Singh J, Tyagi S, Chavan BS
GMCH 1616 G.F. Sector 32, GMCH Staff Campus, Chandigarh, India.
E-mail: cbmankotia@gmail.com
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Abstracts
Background: Psychiatric rehabilitation comprises of two intervention
strategies- individual central and ecological strategies. It is important
to target the intervention as per patient’s needs rather than providing
formulated packages.
Objectives: To present a case report of a young girl suffering from
non-organic psychotic disorder who lost her both parents in a short
span and just had younger sibling who herself had no understanding
of her illness and refused help her.
Methods: Patient was admitted in Psychiatry ward by Crisis Intervention
Team as she was very disruptive and neighbours made a complaint to
police. After treatment of acute symptoms with medication, a detailed
assessment was carried out using NIMHANS family assessment
Performa and psychosocial rehabilitation was planned. The major
issues which required intervention in the present case were: Poor social
support as there was no relative and her younger sister deserted her,
safety and security, financial issues, and accommodation as she had
to vacate the government house within 3 months.
Intervention: After the discharge from the ward, it was decided to bring
her for day care facility at Disability Assessment, Rehabilitation and
Triage (DART) being run by the department from 9.00-5.00 pm. Her
breakfast and lunch was arranged and grocery items were provided
by an NGO. At DART, she was made to attend Social Skills Training
(SST) along with Daily Activity Living and Vocational Training. The
visits to office of patient's father were made for the post death benefits
and extension government accommodation. With persistent efforts the
patient has been provided a suitable job on contract basis.
Results: Currently the patient is managing well along with support
from the department and good interpersonal relations with sister and
neighbours adding to the social support.
Key Words: Rehabilitation, Social Support, Intervention strategies
Psychosocial Interventions in an Employment Transition Support
Center: Support Staff Psychological Balance
Takeshita H, Fujita N
Polytechnic University, Kodaira-Shi, Tokyo, Japan. E-mail: takeshita@
uitec.ac.jp
Background/Objectives: Employment Transition Support (ETS) is
government policy for handicapped persons who wish to work and
are less than 65 years old. Certificated centres provide two years
services such as work training, OJT and support for job seeking and
job retention. Previous research addressed support staff’s recognition
about autism person’s status and emotion in developmental disability
centres by factor analysis. But the mechanism of how does the support
process influence on staff’s psychological state has not been explored.
By revealing this, less experienced staff can understand the ongoing
situation and predict the situations occur in the future.
Method: We carried out semi-structured interviews on support staffs
(N=15) who work in an ETS Center. Approximately 80% of users has a
mental disorder (of which about 30% is developmental disorder). The
obtained qualitative data were analysed by M-GTA (Modified Grounded
Theory Approach).
Result: The phenomenon characteristic of psychological process of
support staff was compensation for the negative emotional factors with
positive cognitive factors. They feel mild stress such as communicative
anxiety caused by the characteristics of disorders, through interactions
with users. However, unlike the interactions with non-handicapped
persons, it did not lead to negative emotions such as anger and
frustration. Instead, they were motivated to understand users and
to consider more appropriate interventions. Severe stress included
user’s refusal and employment failure. Meanwhile, they are gaining
mild psychological rewards by behaviour modification and intervention
skills development. Primary reward included self-realization by career
enhancement and by improving support system of local community.
Conclusion: A specific psychological mechanism of employment
support staff for mentally handicapped persons are presented. The
originality of this paper is presenting new framework which cannot be
explained by the existing theories such as emotional labour and equity
theory. By applying the results presented above, more effective training
program can be designed.
444 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
A new Approach to the Evaluation of the Mental State of People
Lilit B, Samvel S, Armen S
Armenian pedagogical university aft. Abovyan, Armenia. E-mail:
l.v.baghdasaryan@mail.ru
Following the leading modern trends of development of society and
the field of mental health the Government of Republic of Armenia
has adopted the strategic action plan for mental health development
and protection 2014-2019. This strategy was the basis for a range
of researches as well as the adaptation of new techniques to identify
both clinical status and social skills and external resources of persons
with mental disorder. The strategic plan aimed at development of
new methods and approaches, leading to the de-institutionalization
of psychiatric hospitals and strengthening of psycho-rehabilitation
service level. This approach requires new way of person evaluation
in terms of its ability for re-socialization and reintegration into
society. New methodology of persons` status assessment was
developed, comprising three blocks: clinical, social and psychological,
demographic. For clinical block evaluation we developed a special
questionnaire for mental health state assessment. It includes the
assessment of preservation of critics, compliance, the need for a
particular amount of treatment (active, supportive, episodic), as well
as the assessment of the severity of negative symptoms (including
a degree of intellectual decline).
For socio-psychological block assessment we used adapted CANSAS
technique. This tool allows to evaluate the preservation level of
everyday life and hygienic skills, activity and presence of interests, the
ability to organize their day, potential and real danger to themselves
and others, the presence or absence of alcohol or drug dependence,
emotional state during the day. The demographic block provides
information of biographical nature, information on the patient\'s social
status. Such a comprehensive approach to the examination of the
patient allows differentiating different groups of people according to
their need for social, medical and psychological support.
Key words: assessment, psycho-rehabilitation
The Approach to the Humanization of Mental Health in Armenia
Sukiasyan S, Armen S, Lilit B
Medical Rehabilitation Centre, Armenia. E-mail: doc.sukiasyan@
gmail.com
The formation of the modern approach to persons with mental health
problems based on respect for human and aimed at re-socialization
and re-integration into human society is imperative of our time and is
one of the leading trends of social development. Armenia, as one of the
Post-Soviet countries, makes the first positive steps in this direction.
First of all we are talking about people with severe chronic mental
disorders, who are more likely to find themselves below the poverty
line, on the verge of existence, and, at best, to state guardianship in
specialized boarding houses or psychiatric hospitals. There are more
than thousand people living in this kind of residential homes. There
are 450 people with chronic mental health disorders are living only in
Vardenis Psychoneurologic Boarding House.
The primary task for the Government is a deinstitutionalization of such
kind of institutions - “gigants. The first phase was a comprehensive
psychological and psychiatric examination of all residents, including
assessment of psychopathological status, preservation of social
skills, the level and type of preservation of the individual. We
differentiated three groups of residents requiring a greater or lesser
degree of medical, psychological and social support in different living
conditions (hospital, community). In addition, each group of patients
was differentiated according major nosology: psychotic patients
and patients with mental retardation. The first group \"A\" included
patients with a stable remission and preservation of psychosocial
skills. These persons can live in the community. Groups \"B\" and
\"D\" included persons who, need to stay in specialized institutions
for health reasons. This differentiation contributes to a more adequate
and humane approach to the patient, with respect for their rights,
opportunities and desires.
Key words: deinstitutionalization, re-socialization, re-integration
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Abstracts
Delivering Psychosocial Interventions Through Non-Professional
Health Workers: A Community Based, Naturalistic Study
Bose R, Kumar M, Cherian A
Mental Health Action Trust, Calicut, Kerala, India. E-mail: rekhabos@
gmail.com
Background/Objectives: As part of a large community mental health
program for economically backward rural people with severe mental
disorders, we developed a psychosocial intervention package and
evaluate in a naturalistic manner, the feasibility and effectiveness when
delivered by non-professional health workers.
Methods: We reviewed the literature and chose intervention
components that demonstrated evidence of effectiveness in areas
such as family functioning, negative symptoms and relapse prevention.
We then developed an intervention package and conducted eight
sessions of training, which included both common and specific factors
important in psychological interventions. The package consisted of
seven components: family psycho-education, activity scheduling,
social skills training, assertiveness training, relapse prevention training,
communication training and problem solving training. The recipients of
the intervention package included patients and their family members
and the settings, both outpatient clinics and homes. All the sessions
were supervised by professionals and fidelity was checked. The
process of intervention was evaluated by observation, implementer
interviews and continuous assessment of recipients. For evaluating
the feasibility, individual case studies were used. For evaluating the
effectiveness of interventions, the Positive and Negative Syndrome
Scale, Clinical Global Impressions Scale and Global Assessment of
Functioning were used.
Results: 15 volunteer, non-professional, health workers were trained
in the delivery of the psychosocial intervention package. Qualitative
analysis of their pre-training and post-training knowledge and attitudes
showed a significant improvement after training. Case studies using
in-depth interviews of representative recipients of interventions showed
good acceptability and feasibility. 100 patients with chronic psychoses
and 400 family members received the psychosocial intervention
package. Statistical analysis showed significant changes in symptoms
and functioning
Conclusions: All the components were acceptable and most were
feasible. That non-professional health workers can successfully
administer psychosocial interventions in rural communities holds great
promise for community based rehabilitation.
Key words: Psychosocial intervention, non-professional health
workers, community setting
Training Non-Professional Mental Health Workers in Delivering
Family Focused Therapy for People with Severe Mental Illness
in the Community
Jamwal S, Bose R, Kumar M
Mental Health Action Trust, Calicut, India. E-mail: rekhabos@gmail.com
Background/Objectives: Paucity of trained mental health workers
makes it imperative that we need to train non-professional health
workers in the area of community mental health. Family focused
therapy has been found to be of use in a variety of situations. The aim
of this study is to develop an intervention module of non- professional
mental health worker-led Family Focused Therapy for people with
severe mental illness.
Methods: The design of the present study is exploratory, using a case
series with a qualitative approach to evaluate training and pre and post
assessments using interview schedules for patients and care givers.
The sample is drawn out of 5 MHAT Clinics by purposive sampling.
Multi-level sampling procedure was used to select respondents, i.e.
1 non-professional mental health worker from a clinic making it 5 in
total. Each mental health worker had two or more clients assigned
to them. These clients were screened using the Modified MINI and
their caregivers were recruited for the intervention program. Data
saturation was achieved by oversampling to ensure that there was no
drop in sample size 5 health workers for the training; 10 clients (2 per
volunteer) for screening-in; and 10 caregivers underwent the training
given by the health workers].
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: Qualitative analysis of the health workers pre and post
training showed some changes in knowledge and attitudes. Pre and
post assessments of the patients and care givers on satisfaction,
psychoeducation and parameters of functioning showed significant
changes.
Conclusions: Training non-professional mental health workers
in the delivery of interventions such as Family Focussed therapy
is feasible and shows good acceptability and effectiveness. The
study needs to be replicated using a larger sample and in different
settings.
Key words: Family focused therapy, non-professional mental health
workers
Psychosocial Problems Among Vulnerable Adolescent Girls in
Tamil Nadu (Survey and Semi-Structured Interview Method)
Maharishi R, Athilakshmi R, Rathnasabapathy M
VIT University, Chennai, India. E-mail: maharishipsy@gmail.com
Background/Objectives: In the recent scenario adolescents girls
are facing numerous psychosocial problems in our society. There are
many psychological factors that influence adolescent girls’ life such
as resilience, stress, depression, self-esteem, optimism, emotional
intelligence, adjustment problem, interpersonal competence, general
self-valuing, anxiety, suicidal thought, coping skills and aggression.
Adolescent girls face many social related problems like, sexual abuse,
rape and gender discrimination. Family Environment also takes main
role in the adolescent girl’s life like cohesion, expressiveness, conflict
acceptance, caring, independence, active, recreational orientation,
organization and control.
Methods: They are 400 samples selected from adolescent girls in
Tamil Nadu through systematic random sampling method. The data
were collected by using the tools like Youth Problem Inventory (YPI)
by Verma, Resilience Scale by Wagnild, Family Environmental Scale
(FES) by Bhatia, Perceived stress Scale by Kamarck and Emotional
Intelligence Scale by Bar-On. For the quality of study we adopted
survey and semi-structured interview method.
Statistical Analysis: The statistical techniques such as measures of
central tendencies, t-test, ANOVA, Correlation and Regression was
used for analyzing data by using SPSS 20.0 software (Licensed).
Results: The results will be discussed in full paper.
The Study of Burnout &Coping Strategies in Health Care
Professionals Working in Tertiary Care Centre
Rai A, Koushal V
PGI Chandigarh, India. E-mail: atul.sw2007@gmail.com
Background: Role of Health Care Professionals in Tertiary Care Centre
has been widely acknowledged throughout the globe. The work carried
out by these Health Care Professionals has been phenomenal. In
Health Care Professionals Career burnout has turned into a common
phenomenon in recent times. The basic reason is that every profession
is susceptible to exhaustion and mental strain. To deal effectively with
this problem, people need to differentiate normal stress from more
serious issues that cause career burnout and found to be poor coping
strategies with these kinds of problems.
Objectives: The aim of the present study is to assess the burnout
& Coping strategies in Health Care Professionals in Tertiary Care
Centre.
Methods: This study is carried out at the PGIMER, Chandigarh. The
study will be a cross sectional, hospital based and the sample will
be selected through purposive sampling technique. The sample will
consist of 90 Health Care Professionals those who are working in
Tertiary care centre. Sample will be selected as per the inclusion and
exclusion criteria of the study. Written informed consent will be taken
from the samples of either group before starting data collection. The
socio-demographic sheet and Copenhagen Burnout Inventory and
Coping Orientations to Problems Experience will be applied on the
selected sample.
Result & Conclusion: The results of the study will be discussed at
the time of presentation.
Key words: Health care, burnout, coping strategies
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Abstracts
Psychosocial Issues in a Patient with Schizophrenia During First
Pregnancy: A Case Report
Thakur A, Dua D, Aggarwal A, Mehra A, Sikka P, Grover S
PGIMER, Chandigarh, India. E-mail: anitaminhas82@gmail.com
Background/Objectives: To present the case of a 25 year-old
female patient with schizophrenia, whose illness was not disclosed
to the husband and in-laws family prior to marriage, having multiple
psychosocial issues related to marriage and pregnancy.
Methods: Patient had been suffering from schizophrenia since the
age of 12 years, characterised by fearfulness, auditory hallucinations,
delusion of persecution, delusion of love, delusion of control, poor
scholastic performance, negative symptoms and marked psychosocial
dysfunction. She was stabilised on olanzapine and valproate
combination. At the age of 24 years, she was married, without informing
her husband and in-laws family about her illness. Immediately after
marriage, her husband was told that patient is on treatment and was
asked to supervise medications. However, her husband stopped
the medications due to lack of sexual satisfaction on the part of the
patient. After stoppage of medications her symptoms worsened and
she conceived. Patient refused to accept her pregnancy and did not
cooperate for antenatal care. When she presented to us, she was
in the last month of pregnancy, was refusing to accept that she was
pregnant, refusing to eat and was not cooperating for gynaecological
examination. All the family members were very distressed about her
behaviour. She was managed with psychotropic medications and
electroconvulsive therapy, with which her psychopathology improved
partially and she delivered without any complications. However, within
few days, she refused to accept her baby and stopped breast feeding.
This further complicated the distress of family members and there was
lot of blame-game between her in-laws family and parental family.
Family sessions were taken to address the issues with which patient
was accepted at her in-laws family.
Conclusion: This case highlights the issues which can arise for female
patients with schizophrenia when they are married without proper
information to the in-laws family.
Psycho-social Rehabilitation to Recovery of Schizophrenia-A
Review of Empirical Evidence
Sharma M, Nikita
IGNOU, 133, sector-46, Gurgaon, Haryana, India. E-mail: sharma.
megha333@gmail.com
With the growing recognition of serious mental health problems, it
is important to sensitize the general public (at community level) in
addressing the disabilities resulting from mental disorders. The use of
the term community approaches represents a clear contrast to individual
oriented approach to mental health. It is often a part of psycho-social
work involving a holistic approach towards the well-being of an individual
including recovery and resilience. The present paper reviews the efficacy
of psycho-social interventions for schizophrenia in a community set up.
For the same purpose, a systemic review of articles using comprehensive
search terms was done of electronic database articles of past 10 years.
The paper further discusses about recommendations and evaluation of
researches done so far in recovery of schizophrenia.
Key words: Community, Psycho-social Interventions, schizophrenia,
Efficacy, recovery
A Descriptive Study to Assess the Prevalence of Depression and
its Association Factors Amongantenatal (37 weeks onward) and
Postnatal Mothers, Nehru Hospital, PGIMER, Chandigarh, 2014-15.
Das K, Rana AK, Lakshmi V, Rohila M, Kaur C, Meenakshi Kaur P,
Narula S
National Institute of Nursing Education, Post Graduate Institute of
Medical Education and Research. E-mail: karobi20@gmail.com
Background/Objectives:Depression during the pregnancy has been
associated with increased incidence of psychological and obstetrical
complications. The current descriptive study was undertaken with the
objective to assess the prevalence of depression and its associated
factors among antenatal (37 weeks onwards) and postnatal mothers,
Nehru Hospital, PGIMER, Chandigarh.
446 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Methods:Using Total enumeration technique 200 mothers (100
antenatal and postnatal mothers) were enrolled in the study. The tools
used in the study were: Socio-demographic profile of participants,
Edinburgh postnatal depression scale, and Antenatal and Postnatal
depression risk factors questionnaire.
Results: The result of the study revealed that majority of the antenatal
(81%) and postnatal mothers (89%) were not having any depression.
It was also observed that 95% antenatal and 89% postnatal mothers
did not have any associated risk factors of depression. The study
further revealed that associated risk factors for depression were high
in the post-natal women as compared to antenatal mothers (05% of
antenatal and 11% of postnatal) whereas the prevalence of depression
was high in the antenatal period as compared to postnatal mothers
(19% of antenatal and 11% postnatal).
Feasibility of Professional Home Care Support for Patients with
Dementia in an Urban Setting in India
Kumar SCT, Varghese B, Jacob M
ARDSI, Chalitharayil Thejas Karazhma Vallikunnam PO, Allepey,
Kerala. E-mail: sudhirkumarct@gmail.com
Background/Objective: While many developed countries have
government and social security funded home care support for people
with dementia and their families, this is not the situation in most low and
middle income countries. In a neuropsychiatric condition like dementia
which is chronic, poses several psychosocial challenges and where no
curative medical treatment is available, professional support at home is
essential to improve the quality of life of the patient as well as the family
carers.In this study we aimed to identify the factors associated with
the feasibility of providing professional home care support for patients
with dementia and the challenges associated with it.
Methods: The patients were identified from an ARDSI database which
was part of a comprehensive dementia care programme. The details
were gathered using sociodemographic and clinical data sheets and
appropriate checklists. Activities of daily living care giver burden and
neuropsychiatric symptoms were also assessed.
Results: 42 patients were identified to benefit from professional home
care support by community health worker, supported by a medical
doctor. 31 (76%) of these patients were women. Four patients were
receiving end of life care in terminal stages of dementia. 19 (45%)
patients were using ambulatory aids and 21 (50%) had incontinence.
40 (95%) patients had agitation/aggression, 33 (78.6%) had night
time behavioural problems, 32 (78%) had anxiety and 28 (66.7%) had
hallucinations. Nineteen (45.2%) care givers suffered from significant
stress associated with caring.
Discussion: The role of specific inputs from medical professionals
in home care for patients with dementia will be discussed. We will
also discuss how we arrived at a consensus at the provider level in
prioritising needs. The role of other agencies which provide palliative
care in supporting these patients need to be explored. There is also
scope for skills transfer among different professionals involved in
dementia care.
Profile of Patients Attending Mental Health Services in Rural
Primary Care Setting: Data From CCMH Clinics
Kumar S, Aiman A, Prabhu S, D'Souza DP, Bhat A, Bhat A, Cherian AV
KS Hegde Medical Academy, Nitte University, Mangalore and Center
for Community Mental Health (CCMH), Karnataka, India. E-mail:
shishiramin@yahoo.com
Background: The unmet needs of mental health care delivery are high
in low-middle income countries (LMICs). However, there is international
consensus on integrating mental health care into primary care to reduce
the treatment gap, provide continued care and deliver cost effective
care for the mentally ill in resource scarce LMICs setting. The aim of
the present study is to understand the profile of patients utilizing mental
health services delivered at rural Primary Health Centers (PHCs).
Method: All the consecutive patients registered at Center for
Community Mental Health (CCMH) clinics were assessed. The CCMH
is a Non-Government Organisation (NGO) that delivers mental health
services in rural resource-scarce areas through partnering with the
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Abstracts
state government run PHCs in rural Mangalore. We have analyzed the
data of patients registered under two clinics at Vittala and Mani PHCs
between January and June 2016.
Result: Among the 219 patients registered, 84.6% were female and
the mean age was 39.2±13.02 years. They were largely un-educated
or studied less than seventh grade (76.4%), homemakers (41.8%)
and from a low income background (76.1%). The mean duration of
illness was 5.18±6.83 years with majority of them (88.1%) having
received no psychiatric treatment before the present consultation. The
common diagnoses were depressive disorder (48.3%), somatoform
disorder (16.8%), anxiety disorder (7.8%), psychoses (5.2) and alcohol
dependence syndrome (2.8%).
Conclusion: The results indicate that there is delay in seeking mental
health services among women with mental illness in rural areas.
The mental health services delivered at PHCs would facilitate early
identification, treatment initiation and better treatment adherence
among women with common mental disorders.
Knowledge About Mental Health Among Community Health
Workers (ASHAs): A Cross Sectional Assessment
Aiman A, Prabhu S, Kumar S, Bhat S, Rao S, Cherian AV
Department of Psychiatry KS Hegde Medical Academy, NITTE
University, Deralakatte, Mangalore India. E-mail: agneitarun7280@
gmail.com
Background/Objectives: The Accreted Social Health Activists (ASHAs)
have been involved in improving maternal and child health over a
decade, especially in rural India. There is international consensus that,
in mental health resource poor settings, a “task shifting” strategy would
be advantageous, where the community or the lay health workers (like
ASHAs) provide frontline mental health care, instead of mental health
professional at a primary care level. However, there is limited data on
deliveringthe mental health services delivered through ASHAs in mental
health resource scarce rural setting. The aim of the present study is to
assess the knowledge about mental health among ASHAs serving rural
village in Mangalore. This would facilitate developing training module for
ASHAs to identify and refer the people with mental illness.
Methods: A cross sectional study was conducted among randomly
selected ASHA workers (n = 406) in rural Mangalore. Data was collected
through Mental Health Knowledge Schedule (MAKS), self-administered
questionnaire designed to assess mental health knowledge. Data were
computed using SPSS. Analysis and interpretation were carried out
using descriptive and Chi-square test.
Results: The mean age of the participants was 38.6± 5.68 years and
educated at least tenth grade (66.1%) or above (20.2%). The mean
year experience in the health field as ASHAs was 4.27 ± 2.36 years.
The ASHAs had lower score on MAKS.
Conclusions: Our results show relatively lesser knowledge about
mental health among ASHAs. Thus, indicating the need to develop
training module to train the ASHAs for early identification of mental
illness in the community and refer to available mental health service.
Rehabilitation
Factors Affecting Marriage in Schizophrenia: A Cross Sectional
Study
Tale M, Deshmukh V, Bhagat A, Sonavane S, De Souza A, Shah N,
Rupani K
L.T.M.M.C.& G.H.Sion, Mumbai, Maharashtra, India. E-mail: dr.
manishtale@yahoo.in
Background/Objectives: Schizophrenia is a chronic psychiatric
disorder with a profound effect on the patient’s life course. Marriage
has been shown to be both protective and detrimental to the course
of recovery in schizophrenia. The study was planned to elucidate the
factors that influenced marriage and the sustainability of marriage in
patients with schizophrenia.
Methods: The study sample was 101 patients with schizophrenia
that attended the out-patient department of tertiary general hospital.
Informed consent was taken and data collected from the patients and/
or relatives on a special semi-structured proforma. The data collected
was subjected to appropriate statistical analysis after further subdividing
the sample into subgroups.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: 69.3% of the total sample was married while 30.7% were
unmarried. A significantly greater number of patients who were
educated were unmarried (p=0.026). Age of onset of illness below 25
years (p = 0.002) was a significant factor in those who were unmarried.
When marital outcomes were considered, it was noted that greater male
patients had stable marriages though not statistically significant while
earlier age of onset of illness was a significant factor that resulted in
poor marital outcome (t=2.96, df=68, p=0.0021).
Conclusions: The effect of marriage on schizophrenia and factors
that may influence marital sustainability in patients with schizophrenia
need further study and are multipronged. Larger studies in this area
of research are warranted.
Key words: marriage, gender, age of onset, schizophrenia
Two-stage Psychological Rehabilitation Program for Patients
with PTSD
Khaustova O, Drab Y, Sapon D, Taltanova O
Ukrainian Research institute of Social Psychiatry, Road Clinical
Hospital, Kyiv, Ukraine. E-mail: oksana.v@dinadis.ua
Background/Objectives: Medical and psychological rehabilitation of
veterans based on the main provisions of coping integrative concept
of overcoming stress.
Methods: We have developed the two-stage program of rehabilitation
for patients with PTSD (assertive-communicative training + cognitive-
behavioural training) and it was tested on 46 IDPs.
Results: During first stage of rehabilitation (assertive-communicative
training) were used strictly assertive training, training of self-affirmation
and training of the protection from aggression from others. Confident
behaviour leads to improvement in self-esteem, confident answers
help participants to achieve "adult" behavior and self-actualization.
The second stage of the program of psychological rehabilitation for
patients with PTSD was cognitive-behavioural training (behavioural
modeling). Cognitive-behavioural preparation helped to master skills
of stress-resistant adaptive thinking, optimistic cognitive style and
coping mechanisms that ensure the successful adaptation. 46 IDPs
from 21 to 67 years old, who were witnesses / participants of the armed
conflict, were involved in rehabilitation program. The program shown
its effectiveness in reducing the symptoms of PTSD (first decreasing
negative cognitions and mood, next was avoidance reduction, and
further reducing of hyperarousal, the last was intrusion) and the
increasing quality of life with successful resocialization.
Conclusion: These pilot study allow us to recommend this two-stage
program of rehabilitation for patients with PTSD
Key words: psychological rehabilitation, PTSD,
The Possibility for Re-Socialization and Social Integration for
Persons with Mental Health Problems Living in Boarding Houses
Armen S, Lilit B, Sukiasyan S
Centre for psycho-social regulation, Armenia. E-mail: soghoyan@
yahoo.com
The problem of persons with mental health disorders living in boarding
houses is still one of the most topical issues of Armenian mental health
system both in moral and administrative sense. The problem of the
reintegration of such persons into society is an absolute thoroughness
of the moment.
The objective was to return some of such persons from the close type
specialized boarding houses and psychiatric hospitals to community.
In this regard, it has been tasked to carry out a screening study among
people with mental health problems living in large boarding houses.
The assessment included 1048 patients of which 213 (20, 3%) were
chosen to live in community based on preservation of above mentioned
parameters. Out of them 136 (13%) were with chronic mental disorders
and 77 (7.3%) -with mild mental retardation. At the same time, 430
patients (41%), including 258 persons (24.6%) with chronic mental
disorders and 172 (16.4%) with mental retardation need constant care
and supervision at boarding house.
Finally, 328(31.3%) patients 99 (9.4%) of which suffered from chronic
mental disorders and 229 (21.9%) from mental retardation, need a
maximum amount of care and supervision, therefore, would have to
remain under care of boarding house. The study revealed that in these
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Abstracts
institutions were patients whose diagnosis should be clarified (14 obs.,
1.3%) and patients (27 obs., 2.6%), requiring intensive pharmacotherapy.
Our findings are optimistic for mental health services reforms. We
should actually begin the process of deinstitutionalization and social
integration of such persons by establishing rehabilitation services and
community-based forms of housing.
Key words: mental health system, chronic mental disorders
Social Determinants in People with Alcohol Dependence
Kumar P, Supriti, Gupta R
State Institute of Mental Health, Rohtak, India. E-mail: pradeep.
meghu@gmail.com
Background: Alcohol abuse is considered a major public health
issue worldwide. It impairs familial, vocational, psychological, legal,
social, or physical aspects of life. The objective was to study the social
determinants and severity of alcohol abuse.
Methods: Cross-sectional hospital based study. One hundred alcohol
dependent patients diagnosed as per the text revision of the fourth
edition of the Diagnostic and Statistical Manual of Mental Disorders
were selected by purposive sampling. Assessment was done using
socio demographic Performa and Alcohol Use Disorder Identification
Test (AUDIT). The statistical analysis was carried out using the
Statistical Product and Service Solutions (SPSS) Windows 16.0
software package. The analysis of the obtained data was done using
various descriptive and inferential statistics.
Results: Study revealed no significant difference on the domain of
religion, family type, marital status, occupation, and marital status within
the alcohol dependent group; on the contrary, we found significant
difference in alcoholic population in regard to residential status. The
urban alcohol dependents scored significantly high on AUDIT.
Conclusion: Our study suggests that alcohol consumption is more
prevalent among urban residents, and the prevention and treatment
of alcohol dependence should lay special focus on urban area. This
findings can be explained by the fact that generally urban population
have lack of social support, which could exacerbate stress/frustrations
that further lead to increased dependence on alcohol as a coping
mechanism. Present findings are generating and passing out relevant
knowledge, which would be helpful and beneficial in reducing alcohol
abuse, its harmful health effects, as well as in developing new
treatments approach for alcohol dependency.
Key Words: Alcohol, Family Type, Religion, Occupation, Marital Status,
Residential Status
Burden of Common Mental Disorder in a Tertiary Hospital
Rana S, Hooda S, Gupta R
Sadbhawana Hospital, G.T Road, Bhattian Khanna, Ludhiana, Punjab,
India. E-mail: rana117@gmail.com
Background/Objectives: In India, number of psychiatrists is 0.2 per
lakh population and total psychiatric beds are 0.2 per lakh population
(E. Mohandas, 2009). Common mental disorders (CMD) can be
treated by both general physicians as well as Psychiatrists but Severe
mental disorders (SMD) is better treated by Psychiatrists. It is seen
in clinical practice that patients with CMDs take up most of the time
of Psychiatrist, even in Tertiary Hospital, and Severe Mental Disorder
Patients are unable to get due attention, and hence the quality of
management of SMDs suffers. This leads to inadequate efforts towards
their rehabilitation. In this paper we tried to find out the exact percentage
of CMD and SMD patients among newly registered patients coming to
a consultant in Psychiatry Department, PGIMS Rohtak.
Methods: Setting: Tertiary Hospital. Design: Observational Study.
We analysed first 100 newly registered patients coming to a single
consultant starting in April, 2014 onwards. Diagnoses were made by the
consultant psychiatrist as per ICD-10 criteria. Basic Statistics including
mean and percentages were used.
Results: 72% of patients were suffering from CMD whereas 28% of
patients were suffering from SMD. Females outnumbered males in
CMD category.
Conclusion: Majority of patients (72%) were suffering from CMDs.
If CMD are managed at primary or secondary healthcare level then
448 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
tertiary healthcare services can provide better quality of management
to SMDs including Rehabilitation services.
Key words: Common Mental Disorder, Tertiary Hospital, Severe
Mental Disorder
Cognitive Rehabilitation in Acute Phase of Schizophrenia:
Effectiveness and Subjective Satisfaction
Nemoto T, Funatogawa T, Niimura H, Ito R, Kojima A, Iba M, Yamaguchi
T, Katagiri N, Tsujino N, Mizuno M
Toho University School of Medicine, 6-11-1 Omori-nishi, Ota-ku, Tokyo,
Japan. E-mail: takahiro.nemoto@med.toho-u.ac.jp
Background/Objectives: Cognitive rehabilitation has attracted
attention as a novel and promising treatment to improve functional
outcome in schizophrenia. Robust evidence of the efficacy of
cognitive remediation has been mainly established in patients with
chronic schizophrenia. Although rehabilitation in psychiatry is usually
implemented in chronic phase, the importance of rehabilitation in acute
phase is emphasized in the field of physical medicine. Psychiatric
rehabilitation in acute phase includes a number of problems to be
resolved. The aims of the present study were to examine the subjective
satisfaction to and the effectiveness of cognitive rehabilitation in acute
phase of schizophrenia.
Methods: Inpatients with schizophrenia (15 to 50 years old) who were
newly admitted to the Toho University Omori Medical Center were
recruited for the present study. Patients who could start cognitive
rehabilitation within 2 weeks from the admission were considered to be
candidates for the study. We developed several rehabilitation programs
that consisted of an 8-week workbook. This study was approved by the
Ethics Committee of the Toho University School of Medicine.
Results: Eighty-three patients with schizophrenia were newly admitted
to the hospital for a period of 15 months. Forty-nine patients were
considered introduction into the study. Twenty-two patients (45%)
agreed to participate in the cognitive rehabilitation programs. The
mean time between the admission and starting the programs was 9
days. Sixteen patients (73%) completed the programs and the mean
GAF score was significantly improved (32 to 51). Their own satisfaction
with the cognitive rehabilitation programs was also good (6.8 out of
10 points).
Conclusion: About one third of patients with schizophrenia could
complete cognitive rehabilitation and their own satisfaction with the
programs was good even in acute phase in which psychotic symptoms
and disabilities were obvious.
Key words: acute phase, cognitive function, rehabilitation,
schizophrenia
Socio-Demographic and Clinical Profile of Patients with Difficult
to Treat Severe Mental Illnesses Attending a Tertiary Care General
Hospital
Gupta P, Chawla N, Verma R, Sood M
All India Institute of Medical Sciences, New Delhi, India. E-mail:
pg_aiims@yahoo.co.in
Background/Objectives: Amongst patients with serious mental
illnesses (SMIs) exists a subgroup whose management poses
significant challenge due to the persistent dysfunction, and requires
specialized services. In this study, we aim to study the socio-
demographic and clinical profile of patients attending a recently
established SMI clinic in a tertiary care general hospital.
Methods: A retrospective chart review was done for the detailed
evaluation of all patients aged 18-65 years, of either sex, meeting ICD-
10 diagnostic criteria for Schizophrenia and related disorders (F20 to
F29), with illness duration 2 years, attending the clinic for difficult to
treat SMIs at AIIMS, New Delhi. These patients had continued to have
persistent significant dysfunction despite receiving regular treatment
for at least 6 months at our centre. Data was collected using structured
proforma designed for the study.
Results: A total of 25 patients (males=48%) with mean age of 37.3
(±13.02) years and mean duration of illness 13.6(±7.20) years were
seen. Majority of the patients were unemployed and unmarried, and
lived in a nuclear family in an urban setting. Three-fourths of the patients
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Abstracts
(72%) were diagnosed cases of Schizophrenia, while the rest had
Schizoaffective disorder (8%), Unspecified Non-Organic Psychosis
(16%) and Persistent Delusional Disorder (4%). Most had an insidious
onset (76%) and continuous course (96%). 40% patients had comorbid
medical illnesses. They received an average 11.14(±6.77) years of
treatment and about 4 drugs prior to recruitment in the clinic. 32%
patients were on Clozapine and 16% fulfilled the criteria for treatment
resistance.
Conclusions: Difficult to treat patients with SMIs have early
onset of illness with a chronic course. Despite receiving extensive
pharmacological treatment, they had significant persistent dysfunction.
There is need to augment their treatment with psychosocial
interventions, and establishment of specialized SMI clinics may aid
this process.
Key words: difficult to treat, SMIs, schizophrenia
Only I Can Change My Life!!
Bhandary RK, Kaja M, Sharma PSVN
Kasturba Medical College, Manipal, India. E-mail: vinnu.manasa@
gmail.com
Objectives: To highlight the importance of patient perspective about
their own future and career through a case report.
Case summary: A 44yr old male of middle socioeconomic status
presented with 16 years history of illness characterized by delusion
of persecution, grandiose ideas, 2nd and 3rd person auditory
hallucinations, preoccupation with black magic with impaired socio-
occupational functioning, poly substance use, treated in multiple settings
with partial improvement. He got admitted later in a rehabilitation centre
and on treatment & training, his symptoms subsided and he worked from
the centre on trial basis fairly well. Despite the phenomenal progress,
his family members were not ready to support the discharge process
or provide any forms of support. This scenario left him and us with a
question of ’’What to do next??’’
Self-made success towards independent living: Despite lack of
support from family and not having complete insight into the illness,
patient seeks permission to opt for independent living. With the
centre help for guidance, he makes consistent efforts to search for a
job & a place to stay addressing our concerns about substance use
and compliance. He is currently maintaining well monitoring his own
medications and coming for regular follow up since 4 months.
Conclusion: There is always a consensus that patients with severe
mental illness cannot decide or care for themselves. This case report
highlights the importance of giving these individuals an opportunity to
explore their own strategies towards societal reintegration.
Long Term Rehabilitation of People With Severe Mental Illness -A
Community Based, Volunteer-Led Model
Kumar M
MHAT, Calicut, India. E-mail: mk010908@gmail.com
Background/Objectives: To describe the experience of providing a
comprehensive community based service for people with severe mental
illness with the focus on volunteer-led rehabilitation in a resource scarce
setting in Kerala, India.
Methods: The settings of the study are the 46 community clinics of
the Mental Health Action Trust, an NGO providing free psychiatric
care to over 3500 economically deprived people with severe mental
illnesses. The study design is one of descriptive type, using data
collected from the paper and electronic records maintained by MHAT.
The service depends on over 600 volunteers and non-professional
health care workers for delivery of care, particularly, psychosocial
rehabilitation. The predominant model is one of task sharing whereby
clinical roles are carried out by less qualified or unqualified people
but who are trained and supervised. This is combined with the use
of modern technology such as videoconferencing (tele-psychiatry)
and the use of mobile phones. Descriptive statistics are used.
Discontinuation rates, measures of continuity of care and outcome
measures are reported.
Results: Over a period of 8 years, more than 3500 severely
mentally ill people from extremely poor backgrounds have been
enrolled in a rehabilitation based mental health care model. Over
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
600 nonprofessional mental health care workers most of whom are
volunteers coordinate care along with a small team of professionals.
On a number of parameters, good outcomes are observed.
Conclusion: In resource scarce settings, novel models of mental health
care delivery are required. It is possible to provide a rehabilitation
focussed, volunteer-led comprehensive model of mental health care
for poor people with severe mental illness, which is cost effective.
Key words: rehabilitation, task sharing, tele psychiatry, community
psychiatry
CogCardio: Is it effective?
Sharma S, Sharma G, Chouhan S, Nehra A
Department of Psychology, Arts Faculty Extension Building, University
of Delhi, India. E-mail: ashimanwadhawan@gmail.com
Cognitive deficits pose serious challenges for cardiac patients. Various
paper-pencil and computerized intervention paradigms have been
developed and explored in pilot and feasibility studies. However, they
are limited in scope and applicability. Therefore, there is a growing
need to develop and standardize cognitive retraining activities that
address all affected domains in the different cardiac conditions and
ensure functional independence.
Key words: Heart disease, cognitive impairment, functional capacity,
quality of life
Is Cognitive Rehabilitation in Schizophrenia Effective?: A
Systematic Review
Joshi G, Prasad K, Sharan P, Kumar N, Sreenivas V, Nehra A
AIIMS, New Delhi. E-mail: garima.joshi@hotmail.com
Schizophrenia is a debilitating disorder and is marked by cognitive
impairment, which deleteriously impacts the social and professional
functioning along with the quality of life of the patients and the
caregivers. Often the cognitive symptoms are in their prodromal state
and worsen as the illness progresses; they have proven to have a good
predictive value for the prognosis of the illness. It has been shown
that intensive cognitive rehabilitation (CR) leads to improvements in
the healthy as well as cognitively-impaired subjects. Since induction
of technology, CR has evolved with introduction of newer modalities,
using neurosciences-informed CR techniques and targeting cognitions
using traditional paper-pencil and computerized modules. This review
of the holistic perspective of the effects of CR on the patients with
schizophrenia as well as the caregivers, and its extended effects on
the family’s social, mental and economic health would be presented
with emphasis on the need of developing neurorehabilitation facilities
including neuropsychological rehabilitation and the urgency to
recognize the importance of making neurological disability issues a
public health priority in India.
Key Words: Neuropsychology, Schizophrenia, Cognitive Rehabilitation,
Disability, Quality of Life
Social Psychiatry in Medical Curriculum
Prevalence of Stress, Anxiety and Depression in Medical Students
Oberoi R, Sharma R, Kumar R, Mahajan S
Indira Gandhi Medical College, Shimla, Mohali, Punjab, India. E-mail:
rko.medico@gmail.com
Background/Objectives: Medical school is recognised as a stressful
environment and it has been observed that this rigorous training period
often leads to a negative impact on students’ academic performance,
physical health, and psychosocial well-being. The objective of this
study was to assess the prevalence of stress, anxiety and depression
and their correlates among medical students.
Methods: DASS inventory was applied on participating MBBS students
and scores on each of the sub-scales; Depression, Anxiety and Stress
were calculated as per the severity-rating index. Descriptive statistics
were applied for the socio-demographic variables of the participants.
Results: A total of 244 students participated in the study, of which 73
students belonged to 1st year, 100 students to 2nd year and 71 students
to 3rd year. 59.01% of participating students were females and 40.98%
were males. Depression anxiety and stress was observed in 19.26 %,
22.13% and 15.16 % students respectively.
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Abstracts
Conclusion: Significantly more males reported depression and anxiety
whereas females reported more stress. Students in their first year of
MBBS as well as third year were found to report more depression,
anxiety and stress as compared to students in the second year.
Key Words: Stress, depression, anxiety, medical students
Empowering Psychiatrists on Mental Healthcare Needs of
Transgendered Clients
Briklin O, Aloezos C, Patterson D
Montefiore Medical Center, United States. E-mail: obriklin@montefiore.
org
Background/Objectives: As the demand for mental health services
grows, transgender clients are finding it increasingly difficult to
navigate healthcare. In previous surveys, transgender clients
reported a prominent limiting factor was lack of provider knowledge
on transgender-specific issues. Studies have found that transgender
clients subsequently have disparately negative mental health outcomes,
related to depression, anxiety, and suicidality as compared to their
cisgender counterparts.
Methods: Trainees at an urban mental health clinic partnered with a
group of trans-knowledgeable individuals to develop a workshop aimed
to educate mental-health providers on transgender-specific health
issues. Clinicians were provided with pre- and post-surveys assessing
their understanding of gender-identity issues and healthcare disparities.
A secondary workshop was subsequently piloted as a case conference
led by trans-knowledgeable providers to empower psychiatry trainees in
providing gender affirming care. Similarly, workshop participants were
assessed using pre- and post-surveys.
Results: On review of the training opportunities, it was surprising
to learn the lack of resources to train providers on transgender-
specific issues. The uncertainties transgender clients experienced
when navigating mental healthcare systems was mirrored by similar
challenges clinicians encountered. Through the use of pre- and post-
surveys, we conclude that the workshops strengthened clinician’s
knowledge base with this population. This translated into an increased
level of sensitivity towards gender-identity issues and decreased the
delay in treatment for transgendered clients.
Conclusions: As the health disparities pertaining to transgender-related
issues continue to be prominent in mental health, we attempted to better
equip clinicians to provide quality care for clients with gender-identity
issues. Our long-term goal is to expand the training and develop a
curriculum for mental health providers. In the more immediate future, we
expect that this series of workshops can be reproduced in other mental
health clinics, ultimately training additional providers on trans-sensitive
issues and increasing access to quality care for this population.
Ragging: Views of Medical Students
Sharma K, Sharma RC, Kumar R
IGMC, Shimla, India. E-mail: drkirtisharma5@gmail.com
Background/Objectives: This study was conducted to assess the
attitude and views of undergraduate medical students in a tertiary
medical institute in India towards the sensitive issue of ragging.
Methods: A cross-sectional study was conducted on the undergraduate
medical students. All students were asked to anonymously fill out a
self-devised, self-reported, structured questionnaire about ragging. The
questionnaire consisted of 15 questions with 3 options as answers-
Yes/No/Not sure. Data was analysed using Epi Info Version 7 by CDC.
Results: A total of 322 students participated in the study, of which
44% were males. The mean age of participants was 19.4 years. 97%
were aware that ragging is an offence punishable by law. 83% said
that ragging can decrease self-esteem and adversely affect studies.
71% agreed that ragging can promote tobacco/alcohol/drug taking
behaviour. However, 71% males and 62% females were of the opinion
that mild ragging was fun and acceptable. 34% felt that ragging makes
juniors bold and strong. 75% girls said that they would complain
to college authorities if ragged but only 45% boys said they would
complain, 30% would complain if there was severe ragging while 23%
would never complain.
Conclusion: Ragging has been a severe menace in the various
medical colleges of our country for many years. Ragging of first year
450 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
students by seniors was considered a tradition. As per the law of our
country ragging is a punishable offence. However, students consider
ragging as an acceptable part of their culture. Although the students
are aware of the pitfalls of ragging, they also think that ragging is fun
and makes juniors bold and prepares them for the stressful medical
life ahead.
Internet Addiction and Associated Psychopathology Among the
Medical Students
Modi L, Gedam SR, Goyal A, Babbar V, Patton S
Jawahar Lal Nehru Medical College, Sawangi Meghe, Maharastra,
India. E-mail: vickymodi1989@ymail.com
Background: Internet becomes an integral part of the daily lives of
people and has influence on all aspects of society. Internet is being
used extensively throughout the world including India from last decade.
The excessive undisciplined use of the internet has huge impact on
communication and interpersonal behavior. The objective of the study
was to determine the prevalence of internet addiction and associated
psychopathology among the medical students.
Methods: A cross sectional survey was conducted on 415 medical
students through simple random sampling from Jawaharlal Nehru
Medical College, Sawangi, Wardha, Maharashtra. The instruments
such as semi-structured profroma, Young’s Internet Addiction Test and
Mental Health Inventory were applied to collect the data.
Results: Out of the 415 students, 390 participants were included in the
study taking into consideration incomplete and incorrect forms. Mean
age of the students was 19.57 (±1.52) years. The moderate and severe
internet addictions were found to be 21.0% and 2.3% respectively.
The internet addiction was associated with male gender (X2=10.63,
P=0.001) of the students. It was also found to be associated with anxiety,
depression, and loss of emotional/behavioral control, life satisfaction,
psychological distress and psychological well-being (P < 0.05).
Conclusion: The results of study reported significant relationship
between internet addiction and psychopathology, so preventive
measures should be taken to promote appropriate internet use and
create awareness among students. The students at risk of internet
addiction need to be identified and should be addressed to prevent the
compulsive internet use and to promote the healthy growth.
Key words: Internet addiction, Medical students, Pattern of internet
use, Psychopathology, Prevalence
Creating a Common Language: An Integrated Family-Client
Curriculum to Empower Clients and Dispel Stigma
Patterson D, Briklin O, Samuels A, Allen N, Abrams M
Montefiore Medical Center, Brooklyn, New York, United States. E-mail:
danielkennithpatterson@gmail.com
Background/Objectives: Clients and their families must navigate
complex systems when accessing psychiatric care. At a time of rapid
transitions in healthcare, they often feel powerless. Loved ones are
expected to navigate systems of care that function separately and,
frequently, in opposition to each other. The challenges they confront
include understanding the overall healthcare delivery system;
advocating for family members; coping with the bureaucracy of
the forensic system; confronting ethical dilemmas of beneficence
versus autonomy; and dealing with the pain generated by mental
illness. Our objective was to enrich families’ understanding of mental
health systems and improve their ability to navigate these systems.
We hypothesized that through a family-client curriculum; psychiatry
trainees could empower clients and their families and ultimately
improve outcomes.
Methods: The family-client curriculum was piloted at Bronx Psychiatric
Center (BPC), a state intermediate care inpatient facility that serves as
a training site for psychiatry residents from Montefiore Medical Center.
The client population consisted of inpatients hospitalized on a long-term
stay unit in both civil and forensic cases. This curriculum parallels an
established systems training program instated for residents.
Results: Through the newly designed family-client curriculum, we were
able to use common language to enable more effective negotiation
of systems challenges for clients and their families. A pre and post-
curriculum survey was used to assess the success of the program.
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Abstracts

We present a case study to highlight some of the important effects of
this therapeutic intervention.
Conclusion: We propose a humanistic, rather than formulaic approach
to systems problems. This curriculum can be adapted to different
contexts, whether in varied treatment settings or at various points
within the course of a serious mental illness. Included in the training are
important questions families should ask upon considering or entering
into an inpatient service, outpatient clinic, vocational program, medical,
or residential system.
Multimodal Treatment for ADHD Children and Adolescents: A
Norwegian Long-term Randomized Controlled Study
Duric NS
Child and Adolesent Psychiatrist, Helse Fonna Hospital Haugesund,
Norway. E-mail: nezlad@gmail.com
Despite the beneficial effects of most treatment approaches, challenges
such as side effects, intolerance and non-responders still exist. They
have spurred the growth for alternative or complementary treatment.
A randomized controlled clinical study was performed to evaluate the
use of short and long-term efficacy of standard stimulant medication
(methylphenidate) and neurofeedback (NF) as a single treatment
approach and as a combined multimodal treatment for ADHD in
children and adolescents. The ADHD population was selected from
an outpatient clinic for Child and Adolescent Mental Health in Norway.
Ninety-one children and adolescents, ranging in age from 6 to 18
years, were effectively randomized by age, sex, intelligence and
distribution of ADHD core symptoms into three groups due to different
type of treatment (single NF, single methylphenidate, and combined
multimodal). ADHD core symptoms, academic performance and social
skills were reported by parents and teachers using the parent and
teachers form of the Clinician’s Manual for Assessment by Russell A.
Barkley, and a Self-Report Questionnaire (SRQ).
Significant improvements of ADHD core symptoms were observed from
parents, teachers and participants in all three groups in the six-month
follow-up period. Improvements concerning attention were found in
all reported groups. However, no significant improvements regarding
hyperactivity or academic performance were found in the groups reported
from teachers and children/adolescents. No significant improvements for
hyperactivity, academic performance and improving of social skills were
found in the groups reported from teachers and children/adolescents.
However, the Barkley score changes after the follow-up period was
highest for multimodal treatment. NF was as effective as methylphenidate
at treating the attention and hyperactivity symptoms of ADHD, based on
parental, teachers and self reports shortly after treatment. Our findings
provide new evidence for the long-term efficacy of multimodal treatment,
and indicate multimodal treatment being promising in comparison with
medication. Findings suggesting multimodal treatment being possible
as an alternative treatment for children and adolescents who do not
respond to single MPH or who suffer side effects. Further long-term
follow-up research is needed.

Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4 451

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Abstracts
POSTERS DAY 3 AFTERNOON
Substance Use
Delusional Infestation in Synthetic Cannabinoid Bonsai Induced
Psychotic Disorder: A Case Report
Cetinkaya O, Bay O, Maner F, Ipekcioglu D
Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for
Psychiatry, Neurology & Neurosurgery 4th Psychiatry Clinic, Bakirkoy,
Istanbul, Turkey. E-mail: ozlemcetinkaya@yahoo.com.tr
Delusional infestation (delusional parasitosis) or Ekbom’s Syndrome
is a rare psychiatric disorder which is characterized by, a person
misconception of being infested by bugs or parasites despite the
absence of any medical evidence. It is classified as primary or
secondary delusional parasitosis according to precipitating causes. It
is presumed that the prevalence is less than 3 per cent in psychiatry
clinics and 0.004 percent in general population which is 40 patients
per a million population. Antipsychotics as well as antidepressant
and anxiolytic agents are preferred for treatment. In literature, there
are some cases treated with electroconvulsive therapy (ECT) and
supportive psychotherapy.
Case 1: A 33 year-old, single male, elementary school graduate and
has no occupation. He was internalized due to synthetic cannabinoid
abuse, treatment noncompliance, insulting speech and homicidal acts
towards family members. He has been internalized multiple times
before with a diagnosis of substance induced psychosis. He has
delusions of infestation and religious delusions together with auditory
and visual hallucinations. He has been lately abusing only synthetic
cannabinoids, bonsai and has been used the day before internalization.
His delusional infestation was improved with ECT.
Case 2: A 23 year-old, single male, high school graduate and has no
occupation. He was internalized due to homicidal acts, delusions of a
permanent black spot seen first on his hands and spread throughout
his body and of bugs infesting his body and an attempt to get an MRI
for these complaints. He has been internalized twice with a diagnosis
of psychoactive substance abuse. He has been abusing cannabinoid
for five years and synthetic cannabinoid for last two years in admission.
He has bizarre and infestation delusions. He had no hallucinations. His
delusions improved with antipsychotic therapy.In literature, for the first
time delusional infestation induced by a synthetic cannabinoid, bonsai,
is reported via these two cases.
Heroin Use Among Married Females: Are they Unwilling Victims?
Dayal P, Balhara YPS, Prasad S
Room No. 4096, Department of Psychiatry, AIIMS, New Delhi, India.
E-mail: prabhudayal.aiims@gmail.com
Background/Objectives: There are few studies exploring correlates
of heroin use among females in India. The current study aimed to
explore the dynamics of heroin use among married females seeking
treatment at a tertiary care drug dependence treatment centre in India.
Methods: Case records of all married female patients admitted with
heroin dependence disorder at the treatment centre across five years
(January 2008-December 2012) were reviewed. The information was
gathered using a semi-structured proforma.
Results:Mean Age of onset of heroin was 24.33+7.21 years. Mean
duration of use of heroin was 6.44+50.52 months. Mean age at first
treatment seeking attempt was 29.66+5.12 years .Tobacco use was
present in all cases and mean age of onset of tobacco was 23.55+11.84
years. Currently all spouses were using heroin and tobacco. All
married females used heroin with their husbands and in eight cases,
the husband procured heroin. Only one female was involved in sex
work and peddling to sustain substance use as her husband was not
contributing. Five females started using heroin with husband due to
pressure of husband to enhance sexual activity after marriage. Two
patients had depressive symptoms and on recommendation of their
husbands started taking heroin to get relief from mood symptoms as
self-medication. One was already involved in illegal activities and got
married with heroin dependent male to sustain substance. One female
452 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
started taking heroin after first husband’s death and remarried with
heroin dependent male to sustain substance.
Conclusion:The findings reflected the role of husband’s heroin use
in initiation and maintenance of heroin use among married females
in India. Also all the married females with heroin dependence were
dependent on their husbands for treatment.
Key words: Heroin, dependence, females
The State of Alcohol-Related Problems and the Environment
Surrounding Alcohol in Japan
Kawaida K, Takahashi S
National Defence Medical College, Tokorozawa, Saitama, Japan.
E-mail: kawaidak@ndmc.ac.jp
Background/Objectives: Binge drinking is a pattern of drinking that
brings a person’s blood alcohol concentration to 0.08% or higher with
drinking more than 5 drinks for men or more than 4 drinks for women in
about 2 hours. Binge drinking is hazardous drinking may cause acute
alcohol intoxication and car accidents under the influence of alcohol.
For all that, there are many restaurants which introduce the system
of all-you -can-drink free refill by fixed price within 2 hours which may
lead to binge drinking. This study aims to explore the environment
surrounding binge drinking and identify problems and thereby lead the
result to alcohol policy measures.
Methods: To identify the ratio of the number of restaurant which
introduce the system of all-you-can-drink within 2 hours by searching
Taberogu web-site that used as restaurant guide all over Japan.
Results: The ratio of the number of restaurant which introduce the
system of all-you-can-drink within 2 hours is approximately 23%.
Focusing on just izakaya (Japanese bar), the ratio is approximately
43%. Also, Approximately 35% of these izakaya provide the system
for under 3000yen.
Conclusion: Taking notice of the date concerning alcohol related
problem, especially caused by binge drinking, the number of people
transported to hospital because of acute alcohol intoxication have
been over ten thousands every year and been increasing. The ratio
of the drivers who were arrested for drunken driving and been deeply
intoxicated has increased from approximately 51% in 2005 to 66% in
2014. Although these problems may be caused by hazardous drinking
like binge drinking, the environment surrounding alcohol especially the
service at restaurants including izakaya could further binge drinking.
Alcohol policy measures have focus on alcohol dependent so far. We
have to shift to the effort to reduce hazardous drinking like binge drinking.
Addiction in Women: Case Vignette and Discussion
Thakur A, Ghosh A, Mattoo SK
PGIMER, Chandigarh, India. E-mail: anitaminhas82@gmail.com
Background/Objectives: With changing social milieu and gender role,
in India addiction in women is increasing and necessitates immediate
attention. We present case of addiction in woman to elucidate the
underlying bio-psycho-social substrate.
Method: Case report
Results: 45-year old female, working as paramedic reported with
substance use related problems. Premorbidly, she had hyperthymic,
borderline, histrionic traits. She had strong family history of mood
disorders, substance use disorders and suicide. She had consensual
marriage to an unemployed man at age 30. At age 37 a new employee
joined her workplace. Their mutual liking soon progressed to regular
sex. However, frequent verbal altercations led to fear of abandonment,
stress and sleeplessness. She started using SOS Alprazolam 0.5 mg,
increasing the dose gradually. In 5 years husband came to know of the
affair, leading to persistent feeling of guilt, worry over possible public
revelation, frustration, poor sleep, sadness, suicidal ideas, reduced
socialisation, self-care and appetite. Gradually use of Alprazolam
increased to 20 mg daily, and also added Injection Pentazocine 60
mg daily both in dependent pattern. Worsened depression and social-
occupational-family dysfunction led to successful psychiatric treatment
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Abstracts
with escitalopram. However, the extra-marital affair continuing her
depression recurred and she resorted to dependent use of Zolpidem
(prescribed) and Alprazolam. Several episodes of withdrawal
seizures, cerebellar dysfunction and multiple treatment failures, forced
admission to our Centre. She was found to have strong bipolarity
and moderate cognitive dysfunction. Pharmacological management
included Venlafaxine (poor response to escitalopram) and gradual
taper of Diazepam. Non-pharmacological management (supportive
psychotherapy, environmental modification) focussed on insomnia,
forgetfulness, marital, social and workplace issues.
Conclusion: The bio-psycho-social model might be a necessity for a
comprehensive understanding and management of addiction in women.
Key words: Addiction, Women, and Bio-psycho-social model
Prevalence of Tobacco use Among Pharmacy and Nursing
Students in Bagalkot
Mara B, Vinod A
S.N. MEDICAL College and HSK Hospital, Bagalkot, Karnataka, India.
E-mail: bmara21@gmail.com
Background: Tobacco use is a major public health problem globally.
Tobacco is the most important preventable cause of disease and death
all over the World. It is currently estimated to be responsible for about
6 million deaths each year Worldwide. The total tobacco-attributable
deaths are projected to rise from 6 million to 8 million by 2030, with
80% of these premature deaths among people living in low and middle
income countries. The present study was conducted to find out the
prevalence of tobacco use and assess nicotine dependence among
pharmacy and nursing students in Bagalkot city.
Methods: A Cross sectional study conducted among pharmacy and
nursing college students in an age group of 18-25 years under universal
sampling using a pretested anonymous closed and open ended self-
administered tobacco survey 2012 Questionnaire. Data analysed by
using SPSS v 16.
Results: Will be dealt at the time of presentation
Conclusion: Will be dealt at the time of presentation
Key words: Tobacco use, nicotine dependence, tobacco survey 2012
Questionnaire
Resurgence of Snake Bite for Recreational Purposes
Tiwari S, Matcheswalla YS, Dakshikar S
Grant Government Medical College, Mumbai, Maharashtra, India.
E-mail: tsumedha05@gmail.com
Background/Objectives: To understand the current trends of use,
effects and after effects of snakebite use.
Methods: We report a series of 5 patients admitted in a State run
De-Addiction centre in a Metro city from July 2015-January 2016 tried
snake bite. The patients were in the age group of 19-28 years with the
education level ranging from middle school to graduate.
Results: For different reasons such as peer pressure, prove oneself
and to get a kick, all 5 patients tried snake bite. 3 of them had academic
failure and 3 were from lower socio-economic strata. 2 patients had
anti-social personality disorder, while others had predominantly cluster
B personality traits. Description of the snake was more or less similar.
While most patients were under the influence of some substance,
an earthenware pot was brought which contained the snake and the
patients were asked to protrude their tongue where the snake bit them.
The after effects were similar in all and included tingling, numbness,
heaviness of tongue, spreading over to the body followed by prolonged
sleep and amnesia, although, 1 patient had grandiose feeling and
another one described no special effect.
Conclusion: As treating psychiatrists, we need to be aware of the
newer addictions and prepare to combat them and also spread
awareness about the same. What we have identified could be smaller
than the tip of the iceberg and there is a big number which still hasn’t
reached any psychiatrist. To the best of our knowledge there are only
3 case series published in this regard.Youth education programs with
general guidelines on how to avoid temptation of being trapped in
substance use is need of the hour.
Key words: snake bite, recreational substance abuse, and addiction
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
The Prevalence of Psychiatric Disorders and Quality of Life in
Wives of Patients with Alcohol Use Disorders
Simsek S
Government State Hospital, Ankara, Turkey. E-mail: selcuk_simsek@
yahoo.com
Background/Objectives: To investigate the psychiatric disorders in
wives of men with an alcohol use disorder admitted to the psychiatry
outpatient clinic of a state hospital in Ankara, Turkey and to examine
the relevance of disease severity and quality of life (QOL) detected
in these women with the severity of alcohol-related problems in men.
Methods: In a cross-sectional study, 52 men with alcohol use disorders
(both abuse and addiction) were assessed by using the Alcohol Use
Disorders Identification Test (AUDIT) questionnaire. Meanwhile, women
were assessed for psychiatric disorders separately by a structured
interview (MINI; Mini International Neuropsychiatric Inventory). The
quality of life was tested by using WHOQOL-Bref in women with an
existing current psychiatric disorder. Using logistic regression, the
association between the current and past history of a psychiatric
disorder, the quality of life in women and the different indices of alcohol
related problems and domestic violence in men was examined.
Results: The prevalence of any psychiatric disorder in the women was
detected as 48.3%. Once adjusted for other factors, morning drinking
and domestic violence detected in men and the past psychiatric disorder
history significantly increased the odds of current psychiatric disorder.
The QOL scores of women with a current psychiatric disorder for
physical, psychological, social, environment and national environment
were 15.0, 14.5, 14.0, 12.9 and 13.0 respectively.
Conclusion: The prevalence of any psychiatric disorder in women with
an alcoholic husband is markedly higher than in general population that
has been reported previously in Turkey. Especially, major depressive
disorder and generalised anxiety disorder were significantly higher than
that in general population. The quality of life in women with a current
disorder were significantly decreased and was associated to morning
drinking pattern, presence of domestic violence and past psychiatric
disorder of affected women.
Personal and Social Networks among Women with Alcohol Use
Disorders (AUDs)
Malik K, Chand PK, Marimuthu P, Suman LN
National Institute of Mental Health and Neuro Sciences (NIMHANS),
India. E-mail: kanika.mar3@gmail.com
Abstract: The aim of the study was to examine the interpersonal and
social networks among women with AUDs. A sample of 35 women with
AUDs was drawn from the Center for Addiction Medicine, NIMHANS.
A subsample of 10 patients was drawn from the main sample for
semi-structured interviews. The mean age of the sample was 38.51
(S.D=7.42) years. The patients, on average, had 8.88 (S.D=6.18)
years of alcohol dependence. The majority of the patients had, at least,
one family member (83%) and/or spouse (63%) with psychoactive
substance use problem. The participants were administered the
Social Provision Scale (SPS) (Cutrona and Russell, 1987)and a Semi-
structured Interview Schedule (SIS) developed for the study. The data
was analyzed using descriptive statistics and thematic analysis. The
findings of the study revealed that on SPS, the mean Global Support
score was 74.97 (S.D.= 10.277), indicating supportive interpersonal and
social networks that provided the patients affection, support, integration
and guidance. Thematic analysis indicated that majority of the patients
had good support from family members and significant others. Most of
the patients were able to maintain their interpersonal networks despite
alcohol related problems. Only one-third of the patients reported
adverse consequences of AUDs on their social networks. The analysis
also indicated the significant role of personal and social networks in
patient’s recovery post treatment. These findings have implications for
the treatment of women with AUDs.
Efficacy of Brief Interventions in Reducing Hazardous or Harmful
Alcohol Use in Developing Countries
Joseph J, Basu D
College of Nursing, Pt. B.D.S.U.H.S. Rohtak, India. E-mail: jaisonjsph@
yahoo.com
453
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Abstracts
Background/Objectives: Although brief intervention is increasingly
becoming popular over the last decades in reducing harmful and
hazardous alcohol use, evidence on its efficacy is missing in the
developing countries. This review assess the efficacy of randomized
controlled trials on alcohol brief interventions in reducing hazardous or
harmful drinking conducted in different settings of developing countries.
Methods: A systematic review of randomized controlled trials
(RCTs) conducted in developing countries in which a face to face
brief motivational interventions aimed at reducing heavy alcohol use
were identified through electronic databases: Medline, EMBASE
and Cochrane Library published in the period from 2005 to 2015.
Methodological quality assessment of the RCTs was made by using
two validated tools (Cochrane Collaboration’s tool and Miller and
Wilbourne’s (2002) 12-item methodological quality rating scale).
Results: The systematic review identified nine randomized controlled
trials of alcohol brief intervention conducted in developing countries
and the results of five trials suggest a superior benefit for brief
intervention in reducing self-reported hazardous or harmful alcohol use.
Methodological quality was found to be adequate as per standard tools
without any serious methodological issues or biases in more than half
of the selected trials. The content of brief intervention was based on
the principles of motivational interviewing and was delivered by trained
nurses in almost all the trials.
Conclusion: The systematic review of randomized controlled trials on
alcohol brief intervention conducted in developing countries suggests that
brief intervention resulted in reducing self-reported hazardous or harmful
alcohol use in primary care population and hospital outpatient settings.
Key words: alcohol, brief intervention, hazardous or harmful alcohol
use, developing countries
Benzodiazepines use in Elderly Patients in Latin America
Rodriguez TL, Gomez S, Macuer M, Alves M, Ruiz S
Pontificia Universidad Catolica de Chile. E-mail: tileon@uc.cl
Background/Objectives: Benzodiazepines (BZD) are widely used in
clinical practice, in both psychiatry and general medicine due to their
anxiolytic and/or hypnotic effect. The use of BZD in elderly patients
(EP) should be avoided, because of the increased risk of falling, hip
fracture, confusion and other adverse effects. However, these drugs
are often prescribed to these patients, usually by general physicians.
The aim of this study is to make an up-to-date review of the use of
BZD in elderly patients in Latin America.
Methods:A systematic review was done in PubMed using the MeSH
terms “Elderly”, “Latin American”, and “Benzodiazepines”. Additionally,
in PubMed, the name of each Latin-American country and “elderly AND
benzodiazepines” were included in the search. 72 papers were found.
We repeated the same search in Scielo and LILIACS finding 2 and
52 papers respectively Inclusion criteria for selected articles were to
include Latin American population of EP.
Results: The main results were: The prevalence of use of BZD on EP
varies from 9.4-61.4% in outpatients and from 7.4-50.8% in inpatients.
The most frequently prescribed BZD in EP were Diazepam (77.8%) and
others mid- to long- half-life BZD like Clonazepam and Lorazepam.The
BZD were used in EP mainly to treat anxiety and sleep disorders. The
use of BZD were associated with an increased risk of falling, hip fracture
and cognitive impairment Up to 54.4% of EP consume BZD without a
medical prescription or in a different doses to the prescribed doses (ref)
Conclusions: Although the use of BZD in EP should be avoided,
they are frequently prescribed in Latin American populations. Even
though restrictions for the commercialization of BZD, the misuse and
self-prescription in EP is a frequent phenomenon in Latin America and
should be seen as a public health problem.
Factors Contributing to Abstinence and Relapse: Experiences
of Persons with Alcohol Dependence Syndrome-A Qualitative
Study from India
Pandian D, Joseph AJA, Murthy P
NIMHANS, Bangalore, India. E-mail: vnrpandian@gmail.com
Background: Subjective experiences of persons with substance use
disorders can serve as pivots of change and pave way towards lasting
periods of abstinence. However, there is a lack of qualitative research in
454 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
this area from India. The current study aims to explore the experiences
of persons with Alcohol Dependence Syndrome with regard to factors
that play a defining role during their abstinence and relapse.
Methods: Semi structured interviews were conducted with 25 persons
diagnosed with Alcohol Dependence Syndrome who were admitted at
the Centre for Addiction Medicine - a tertiary care centre at Bangalore,
India. The interviews were audio recorded, transcribed and later
analyzed using phenomenological approach.
Results: All the respondents were males with a mean age of 36.28 (SD
± 6.3) years; mean duration of dependence was 12.96 (SD ± 7.73)
years and mean duration of abstinence 4.80 (SD ± 2.78) months in the
past. Qualitative analysis revealed seven (7) themes that were found in
the current study which patients attributed as contributing towards both
abstinence and relapse. They include family relations, family rituals,
work habits, personal reasons, social relations, treatment adherence
and religious acts. Respondents reported that carrying out and involving
in activities related to the above mentioned themes helped them to stay
abstinent whereas these similar areas also contributed to their relapse.
Conclusion: The analysis gives insight into the experiences of
persons with Alcohol Dependence Syndrome and portrays distinctive
ways of dealing with either abstinence or relapse. Focusing on
these experiences during therapeutic interventions will help both the
service provider and service users in moving towards longer periods
of abstinence.
Key words: Alcohol Dependence Syndrome, Experiences, Abstinence
and Relapse
A Study of Sociodemographic and clinical profile of Opioid
Dependence Patients Attending Deaddiction Clinic of Tertiary
Care Centre at Bikaner (North Rajasthan)
Kesharwani S, Baniya GC, Verma KK, Saini VK
Department of Psychiatry, S.P. Medical College, Bikaner, India. E-mail:
skk0207@gmail.com
Background/Objectives: Psychoactive substance abuse in India
continues to be a substantive problem for the individual as well as
for the society. Bikaner medical college covers the large population
of north Rajasthan, where opioid dependence is more prevalent than
any other part of Rajasthan. Aim of the present study was to study
the sociodemographic, clinical profile and geographical distribution of
opioid dependence patients attending psychiatry clinic in tertiary health
care centre at Bikaner.
Methods: This was an observational cross-sectional study conducted
at de-addiction clinic, psychiatric department of S.P. medical college,
Bikaner, Rajasthan. Total 1200 patients with diagnosis of opioid
dependence were assessed on sociodemographic and clinical
variables.
Results: Regarding the sociodemographic profile, mean age was 42.86
years. Majority of patients were male (97.75%), married (87.50%),
illiterate (41.00%) and farmer (53.50%) by occupation. Mean age of
initiation of substance abuse was 27.23 years and mean duration of
taking substance was 15.47 years. 43% of patient belong to Bikaner
district, 27.50% from Hanumangarh district, 12.50% from Punjab and
2.25% from Haryana. 76 % patients were taking only opioid, 9.75% were
taking both opioid and alcohol and 9.25 % were taking poly substance
(opioid, alcohol, and benzodiazapines).
Conclusion: This study searched pockets of opioid dependence prone
zone and their sociodemographic profile. This is useful for planning
for deaddiction camp and other programme related to deaddiction.
Key words: Geographical distribution, Substance abuse, Bikaner,
Opioid Dependence
Domestic Violence among Psychoactive Substance Users and
its Potential Effects on Psychological Well-Being and Quality of
Life of Intimate Partner
Pannu N, Divya, Dogra R
IMH, PGIMS, Rohtak, Haryana, India. E-mail: nickiepannu@gmail.com
Background: Domestic violence is a pattern of behavior which
involves violence or abuse by one person against another in a domestic
setting. Domestic violence has number of forms, including physical,
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Abstracts
verbal, emotional, economic, religious, and sexual abuse. Victims of
abuse may experience physical disabilities, chronic health problems,
mental illness etc. Victims may experience psychological problems,
such as post-traumatic stress disorder, poor psychological well-being,
and poor quality of life. Psychological well-being of a person may be
defined as the self-satisfaction with his/her quality of life. Quality of life
is the perceived quality of an individual's daily life. Substance abuse
is a maladaptive pattern of substance use that leads to physical,
psychological and behavioral problems.
Objectives: To find out Domestic violence among psychoactive
substance users and its potential effects on psychological well-being
and quality of life of intimate partner.
Methods: A sample of 50 substance users was taken from the Durg
De-addiction center in department of Psychiatry, PGIMS, Rohtak. All
patients receive the diagnosis of mental and behavioral problems due
to use of psychoactive substance according to ICD-10 under the care
of investigating consultants. Sociodemographic details were collected
using semi-structured proforma. A written informed consent was taken.
The domestic violence, psychological well-being, and quality of life
would be assessed using various psychological assessment tools.
Results: Results to be discussed.
Conclusion: substance abuse is directive correlated to domestic
violence.
Key words: Domestic violence, Quality of life, Psychological well-being,
Substance abuse
Comparative Study of Metacognition in Alcohol Dependence
Syndrome and Other Substance Dependence
Chaudhary S, Gupta P, Dogra R
PGIMS Rohtak, India. E-mail: joonshallu@gmail.com
Background/Objectives: Alcoholism is defined as a chronic disease
with genetic, psychosocial, and environmental factors influencing its
development and manifestations. A cluster of physiological, behavioral,
and cognitive phenomena in which the use of alcohol takes on a much
higher priority for a given individual than other behaviors that once
had greater value. Metacognition is defined as higher order thinking
which involves active control over the cognitive processes engaged in
learning. It involves a wide range of semi-independent faculties which
allow persons to represent their own mental states and the mental states
of others. It involves the capacities needed to form, revise and reform
ideas of what is believed, felt, dreamt of, feared, feigned or pretended
both by oneself and by others. Both alcohol and other substances are
utilized for emotional and cognitive regulation. The study is aimed at
comparison of metacognitive styles in patients with alcohol and other
substance dependence.
Methods: The data for the study will be collected from in/out patients of
Drug de-addiction centre of U.H.S, Rohtak. 30 patients who will meet
the diagnosis of alcohol dependence syndrome, 30 patients with other
substance dependence according to ICD-10 will be enrolled in the study.
Metacognition would be assessed by using metacognitions questionnaire.
Result: To be discussed.
Conclusions: To be discussed.
Key words: cognition, emotions, substance dependence
Defence Mechanism Used, Self-acceptance, and Self-Esteem
Among Young Adults Using Psychoactive Substance
Dahiya D, Nikki
IMH, PGIMS, Rohtak, Haryana, India. E-mail: divya.libra10@gmail.com
Background: Defence mechanism is a coping technique that reduces
anxiety arising from unacceptable or potentially harmful stimuli. They
are usually unconscious and may results in healthy or unhealthy
consequences depending on the circumstances and frequency with
which they are used. Addicts have an accounting system that justifies
why they don’t have a problem by usually using certain defence
mechanisms. Self-acceptance can be defined as an affirmation or
acceptance of self in spite of weaknesses or deficiencies. It is closely
related to self-esteem but there is important difference between them.
There are some things in life that the individual will not be able to change
like giving up addictive behavior as they usually refuse to accept these
things that it will only lead to suffering.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Objectives: To clarify the relationship between defence mechanism
and its effect on self-esteem, self-acceptance among young adults
using psychoactive substance with implication in treatment
Material and Method: A sample of 50 substance users was taken
from the drug de-addiction center in department of psychiatry, PGIMS,
Rohtak. All patients receive the diagnosis of mental and behavioral
problems due to use of psychoactive substance according to ICD-
10 under the care of investigating consultants. Socio-demographic
details were collected using semi-structural Performa. Awritten
information consent was taken. The defence mechanism, self-esteem
and self-acceptance would be assessed using various psychological
assessment tools.
Results: Results to be discussed.
Conclusion: Substance abuse is directly correlated to level self-
acceptance and self-esteem.
Key words: Defence mechanism, Self-acceptance, Self-esteem
A Retrospective Chart Review of Female Substance Users
Attending Outpatient Clinic at Tertiary Care Drug Dependence
Treatment Centre in India
Parmar A, Mandal P, Therthani S, Ambekar A
Department of Psychiatry, All India Institute of Medical Sciences, Delhi,
India. E-mail: dr.arpitparmar@yahoo.in
Background/Objectives: To study the socio-demographics and
substance use profile of the female patients attending National Drug
Dependence Treatment Centre (NDDTC), All India Institute of Medical
Sciences (AIIMS), Ghaziabad.
Methods: A cross-sectional, retrospective chart review design was
employed. All the available medical records of patients registered
between 01/01/2011 and 31/12/2015 at NDDTC, AIIMS, Ghaziabad
were screened. Records of female patients seeking help for substance
use problems were reviewed and data were entered into a specially
designed format using MS Excel and was analyzed using SPSS. IEC
clearance was obtained.
Results: In the five-year period, 313 female patients were registered
at NDDTC. Out of which, records of 217 female patients with
substance use problems (69.32% of the total) were reviewed and
analyzed. The mean age of female patients was 36.75±11.84 years
and majority were married (75.6%), Hindu (71.4%), literate with
some years of education (60%), home-maker (53.5%), and from an
urban background (70%). The common substances being currently
used were opioids (61.3%), nicotine (21.2), and alcohol (10.1%).
The most common primary opioids used were heroin (30%) and
pentazocine (16.1%). Forty-eight (22.1%) patients reported injecting
opioids (most commonly pentazocine)˜ever while 44 (20.3%) reported
recent injecting (in last month). Mean age of onset for opioid use was
29.56±11.59 years while for alcohol use, it was 28.24±11.73. Only 42
(19.4%) patients reported at least one significant abstinence attempt.
47 (21.7%) patients had a comorbid psychiatric illness. Almost half
(47.4%) reported major physical complications.
Conclusion: Majority of female substance users are young, married
urban women. Majority seek treatment for opioid use, particularly
heroin (in contrast to previous studies suggesting pentazocine as most
common among female patients). Comorbid psychiatric illness is not
very common. Despite physical complications, significant abstinence
rates are low. Data indicates the need of specialized services for this
population.
Key words: Substance, Females, Women
Personality of Wives of Patients with Alcohol Dependence
Syndrome
Rana S, Jiloha RC
Sadbhawana Hospital, G.T Road, Bhattian Khanna, Ludhiana, Punjab,
India. E-mail: rana117@gmail.com
Background/Objectives: Central theme of “Disturbed personality model”
model is that alcoholism in the husband is caused by the psychopathology
of the non-alcoholic spouse. It was held that a women who is in some
way psychologically maladjusted, dependent, hostile, domineering,
masochistic, sadistic marries the vulnerable person to fulfil her own neurotic
needs. Being psychologically disturbed herself, she often contributes to
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the alcoholism of her husband. We studied the personality disorders in
the wives of patients with Alcohol dependence syndrome.
Methods: Severity of alcohol dependence was assessed in patients
diagnosed with Alcohol Dependence Syndrome. Their wives were
assessed for personality disorders using SCID- II (Structured Clinical
Interview for DSM-IV Axis II Disorders).
Results: None of them had any Axis II (personality) Disorders.
Conclusion: It’s wrong to blame wives of patients with alcohol
dependence syndrome for the alcohol use by their husbands. They
appear to be victims rather than culprits.
Key words: Alcohol, Wife, personality
Prevalence and Pattern of Nicotine Use Amongst Students
Singh M, Sinha V, Gurnani KC, Agrawal R
Department of Psychiatry, S.N. Medical College Agra, Uttar Pradesh,
India. E-mail: msjgang@gmail.com
Background: Pattern and prevalence of nicotine use is important to
understand in the youth, with their ubiquitous availability, changing
availability of products (eg. E-cigarettes) and life-style factors like
stress, peer-pressure etc. Further, Nicotine also forms the gateway to
harder drugs like cannabis, alcohol, LSD and opioids.
Objectives: We studied prevalence and pattern of nicotine use,
socio-demographic characteristics, and adverse effects of nicotine
amongst the college going students at Agra. This study also aimed
at seeking perception regarding regulation of nicotine use among
young adults.
Methods: This was a cross sectional study and included two groups
from various colleges of Agra city (professional and Non-professional).
All data was collected using self-administered semi-structured proforma
after obtaining written consent from the participants. Assessment tools
like Fagerstrom scale for nicotine use, General Health Questionnaire
and WHOQOL-BREF were used for quantifying various domains.
Statistical analysis was done using SPSS software.
Results and Discussion: To be presented during the conference.
Key words: Students, Nicotine, Prevalence
Prevalence of Substance Use in Undergraduate Medical Students
Singh A, Sharma RC, Sharma DD
Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
E-mail: ranjananu26@gmail.com
Background/Objectives: To evaluate the prevalence of substance use
among undergraduate medical students, the type of substance used
and the cause of initiation and continuation of its use.
Methods: A cross-sectional study was conducted on participating
M.B.B.S students. A self-devised, self-reported, anonymous semi
structured proforma was administered to the students. Compilation
and analysis of data was done using proportion and Chi square test
as statistical test.
Results: A total of 259 students participated in the study of which
62.16% were females and 37.83% were males. The prevalence of
substance use among males and females was 32.7% and 11.8%
respectively (p<0.001).47.4% interns used substance followed by
37.5% (final year), 22% (3rd year),15.2% (2nd year),10.3% (1st
year).20.7% hostellers used substance followed by 11.3% of students
who stayed at home. Among students from rural background, the
prevalence of substance abuse was 17.7% & among students from
urban background,it was 21.2%. Most common substance used overall
was alcohol (13.51%) followed by tobacco (6.17%).
Conclusion: More males used substance compared to females.
Students in later years of medical life were more prone to substance
use. This may be due to increasing pressure of studies due to complexity
of syllabus, peer pressure and way to cope up with increasing stress.
More hostellers used substance compared to those who stayed
at home. Substance use was higher among students belonging to
urban background compared to those with a rural background. Most
common substance used was alcohol in all age groups. Acceptance
among peers, enjoyment, relief of stress and curiosity were the main
reasons cited for substance use. A positive correlation was seen with
a positive family history of substance use and its increased prevalence
among students.
456 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Key words: Undergraduate Medical students, substance use, alcohol,
tobacco, cross-sectional study
Alcohol and Bipolar Affective Disorders-Their Relationship with
Respect to Onset, Symptoms and Clinical Profile
Rasheed R, Suseelan A, Sudhakar S, David T, Mohamed F, Kallivayalil
RA
PushpagiriInstitute of Medical Sciences and Research Centre,
Thiruvalla, Kerala, India. E-mail: raihanarasheed@gmail.com
Objective: Alcohol use disorders are associated with poor outcome
in bipolar disorders. In contrast to their prevalence, there is paucity of
data that examines the relationship among co-existing bipolar illness
and alcohol use. Understanding this would help in devising different
treatment approaches for such patients. Hence the study was conducted
to evaluate the socio demographic and clinical profile of bipolar patients
based on the relative order of onset of co-existing alcoholism.
Methods: The study was conducted at the Deaddiction clinic of the
Department of Psychiatry, Pushpagiri Institute of Medical Science and
Research Center. It was a retrospective case study of all the male
bipolar disorder inpatients from 1st July 2012 to 31st March 2016,
using their case records and a data form for sociodemographic and
clinical characteristics. We then classified the patients into 3 groups
based on the temporal association of alcohol and bipolar disorder, to
examine the relationship between them. Group 1 (ALCOHOL FIRST)
consisted of those patients whose bipolar disorder began after the
onset of harmful use of alcohol/ dependence, Group 2 (ALCOHOL
SECOND) in whom the harmful use of alcohol began after the onset
of bipolar disorder and Group 3 (NO ALCOHOL USE DISORDER) of
those bipolar disorder, who had no past or present history of harmful
use of alcohol. Normality of the sample would be assessed using
the Shapiro Wilk test. Continuous variables in each group would be
compared using Kruskal Wallis/ANOVA test and categorical variables
using Chi- Square test.
Results and conclusion: The data is being submitted for statistical
analysis and the results would be presented at the conference.
Key words: Alcohol, Bipolar, Onset, Relationship
Risk of Transition to Injecting Among Non-Injecting Opioid Users:
A Multi-Site Study from North India
Ambekar A, Singh T, Mishra A, Rao R, Agrawal A
National Drug Dependence Treatment Centre, AIIMS, New Delhi, India.
E-mail: atul.ambekar@gmail.com
Background/Objective: Most People Who Inject Drugs (PWID), begin
their drug-use with use of non-injecting opioid drugs. In the career-
trajectory of a drug user, the switch to the injecting route may occur due
to a variety of factors, which have been poorly studied. We examined
the factors associated with the self-reported likelihood to start injecting
drugs among non-injecting opioid users.
Methods: After obtaining Institute Ethics Clearance for this cross-
sectional study, trained interviewers - after obtaining informed consent
“interviewed people who use opioid drugs through non-injecting route
(oral/smoking). The non-biased purposive sample was recruited
from various sites in seven north Indian states. The semi-structured
questionnaire included data on socio-demographic, drug-use practices
and likelihood to start injecting. Factors associated with the response
“yes” to the question “are you likely to start injecting?” were analysed
using Pearson’s Chi-Square test.
Results: The sample of 752 males had the mean age 31.2 years
(SD 9.1). Of these, 34% reported heroin chasing while 42% and 25%
respectively reported using pharmaceutical opioids or opium, orally.
About 49% reported association with PWID, 40% had witnessed
acts of injecting, while 35% were offered injecting drugs. Only 33%
had ever received any specific information on risks and harms of
injecting. Ninety-two non-IDUs (12%) reported that they were likely to
start injecting. Factors significantly associated (p<0.05) with this self-
reported likelihood were: “knowing an IDU personally”, “witnessing an
act of injection “history of having received an offer to inject”, and beliefs
that injections “act faster”and are “cheaper”.
Conclusion: Sizable numbers of non-injecting opioid users are in
close contact with PWID and are at risk of switching to injecting route.
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Abstracts
Unfortunately these non-injecting PWUD do not receive appropriate
services or information to make informed choices. The ambit of harm-
reduction services should be expanded to prevent this risk.
Effectiveness of brief intervention for moderate/High Risk Alcohol
Use Among Opioid Dependent Patients on Buprenorphine
Maintenance
Thapaliya S, Jain R, Ambekar A, Mishra A, Yadav D
All India Institute of Medical Sciences, New Delhi, India. E-mail: suresh.
thapaliya@gmail.com
Background/Objectives: To study the effectiveness of Brief
Intervention compared to Simple Advice in reducing harmful/
hazardous alcohol use in opioid dependent patients on Buprenorphine
maintenance.
Methods: In this longitudinal study, 43 opioid dependent male patients
receiving Buprenorphine maintenance treatment in a drug dependence
treatment centre, with scores on Alcohol Smoking and Substance
Involvement Screening Test (ASSIST) more than or equal to 11 (11
to 26 = Moderate risk and > 26 = High risk) were randomly allocated
to either of the interventions - Brief Intervention (BI) or Simple Advice
(SA), delivered in a single structured session, after obtaining their
informed consent. Treatment as usual continued for both the groups.
Reassessment was done at follow-up after three months of intervention.
IEC clearance was obtained.
Results: At follow up after three months, there was a reduction in
ASSIST scores compared to baseline in both the groups but it reached
statistical significance only in the BI group (mean reduction in ASSIST
score 7.7 ± 3.67,p<0.001) as compared to baseline. The proportion of
subjects in the Moderate/High Risk category (ASSIST>11) was also
statistically lower in the BI arm compared to SA (P value<0.001) at
three months follow up.
Conclusion: It was feasible to deliver BI to opioid dependent patients
on Buprenorphine. BI had significant effect over SA in these patients
to reduce alcohol use. Long term effectiveness of BI needs to be
further explored.
Should Drugs Be Criminalised?
Jain S, Pakhare A, Pattanayak RD, Dhawan A, Ray R
Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar
Pradesh, India. E-mail: jainshobhitji@gmail.com
Background/Objectives: The drug use and trafficking is pandemic
and becomes major challenge for all countries to control it. The drug
policies framed by countries are based on three basic principles namely
demand reduction, harm reduction and supply reduction. Further the
drug policies may be categorized as either prohibitive/criminalize (e.g.
USA, China) or liberal (e.g. Portugal, Netherland). Aim of this paper is
to evaluate which policy among the two is better.
Methods: A search was conducted on PubMed and Google using
search terms (e.g. war on drugs). Relevant articles and reports
were selected for the review after manual screening of title/abstract.
Additional sources were referred to using cross-references.
Results: Criminalization and prohibitive drugs policies are directed
at producers, traffickers and consumers of illegal drugs have failed to
effectively reduce supply or consumption despite of heavy expenditure.
Success in elimination of trafficking from one source was defeated
by expansion of other trafficking sources. Despite efforts HIV/AIDS,
overdose fatalities and other harmful consequences of drug use
remained major public health problem. Incarceration of consumers
leads to overcrowding of prison, racial discrimination, labelling,
unemployment, poverty. It raised drug price and black money in illegal
market and profit margin for traffickers. Liberal policies are based on
harm reduction, decriminalization, treatment of drug use, generates
revenue, decreases black money and dug price in illegal market.
Although increases drug availability but not increases drug problem.
Conclusion: The national drug policy should de-criminalize, de-
marginalize and de-stigmatize people who use drugs but do not harm
others. It should encourage harm reduction and treatment of users. It
should categorize drugs based on health hazard and regulate the supply
by taking control over it. Law enforcement and punishment for traffickers
and mafia should be ensured. Evidences favors for balanced drug policy.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Selfie Addiction Scale
Solanki APS, Roy PK
Institute of Psychiatry, Kolkata, West Bengal, India. E-mail: awadhesh_
solanki1988@yahoo.com
Background: This is probably first Selfie Addiction Scale developed
according to different sources.
Objectives: The aim of this study was to develop a self-diagnostic
Selfie Addiction Scale. In addition, the reliability and validity of the
Selfie Addiction Scale was demonstrated.
Methods: A total of 200 participants were recruited from July to
September 2015 to complete a set of questionnaires including 47
items. The participants consisted of 88 boys and 112 girls; with ages
ranging from 18 to 28 years (Mean=21.15, SD=2.95 years). Factor
analysis, t-test, ANOVA, and correlation analysis were conducted to
verify the reliability and validity of this scale. For concurrent validity
we used Smartphone Addiction Scale-Short Version (SAS-SV),
Internet Addiction Test (IAT) by Dr. Kimberly Young, Measure of
Body Apperception (MBA), Visual Analogue Scale (VAS), Barratt
Impulsiveness Scale (BIS-11), Rosenberg-self Esteem Scale,
Narcissistic Personality Inventory (NPI16), CAGE questionnaire and
substance dependence and abuse diagnosis of DSM-V.
Results: The internal consistency and concurrent validity of selfie
addiction scale were verified (Cronbach's alpha= 0.962). Selfie
Addiction Scale and its sub-scales were significantly correlated with
other scales. The visual analogue scale of each factor also showed a
significant correlation with each sub-scale.
Conclusions: As selfie is becoming a new form of addiction among
people in the community, Selfie Addiction Scale which showed good
reliability and validity for the assessment of selfie addiction can be
used efficiently for the evaluation of selfie addiction in the community
and for the research purposes. In addition, it also showed correlation
with related psychopathology of the respondent in study population.
This scale also covers different domains like narcissistic personality,
feeling of self-worth, body apperception and body dysmorphic disorder.
Ultimately it will help to prevent harmful effects of selfie addiction.
Non-Commercial Alcohol Drinking Among Rural Residents in
Belarus
Razvodovsky Y
Grodno State Medical University, Grodnoa, Belarus. E-mail: yury_
razvodovsky@mail.ru
Background/Objectives: Although a substantial body of evidence
has shown that heavy alcohol use has had a catastrophic impact
on health in both the urban and rural population in Belarus, there is
some indication that the situation has become especially bad in rural
areas, with alcoholism becoming endemic in the countryside, in part,
due to the collapse of customs and traditions regulating drinking. With
this in mind, the aim of this study was to examine hazardous drinking
behaviors (binge drinking and the use of non-commercial alcohol)
among rural residents in Belarus.
Methods: Information was obtained from 502 respondents (253 men
and 249 women) using a structured interview that included questions
on the prevalence and use of legal and illicit alcohol (samogon and
surrogate alcohols).
Results: When asked about heavy drinking behavior, 78.8% of men
and 36.1% of women reported that during one drinking occasion they
consumed more than 150 ml of vodka. Homemade wine, which is
produced from various types of berries and fruits, was consumed by
42.3% of men and 50.7% of women in the previous month. The most
frequently used illicit alcoholic beverage was samogon, which was
consumed by 79.5% of men and 42.3% of women. In addition, 10.3% of
men and 1.5% of women consumed alcohol surrogates, most commonly,
industrial alcohol and alcohol-containing medicinal preparations.
Conclusions: this study has shown that heavy episodic drinking is
widespread among rural men, and fairly common among rural women
in Belarus. In addition, non-commercial alcohol is also commonly used
in the rural population even though it is possible that the true level of
consumption may have been underreported. Thus, despite a recent
policy initiative to reduce the harmful effects of alcohol this study has
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highlighted that the use of non-commercial alcohol remains a significant
problem in rural areas of Belarus.
Alcohol Use Disorder and Adverse Consequences of Treatment
with Baclofen in a Bipolar Patient-A Case Report
Singla H, Shah R
Department of Psychiatry, PGIMER, Chandigarh, India. E-mail:
himanshu89_singla@yahoo.com
Objectives: To present a case of 47 yrs old male with alcohol use
disorder who was suffering from bipolar depression and developed
manic switch after using Baclofen and discuss literature review.
Methods: (Review of literature): Baclofen is a GABA-B receptor agonist
used mainly for spasticity and also found to be effective in alcohol use
disorder. Baclofen induced mania/disinhibition has been reported by
5 studies (in doses 30-180mg/d) and half the cases are reported in
bipolar I disorder.
Case description: Patient presented with moderate depressive
episode characterized by sadness, easy fatigability, disturbed sleep
and appetite, decreased self-esteem for past 2 months and had
similar episode 15 years back. So far he had 4-5 hypomanic episodes
each lasting for 2-3 weeks, first episode 4 years back with complete
interepisodic remission. He was started on Valproate 250 mg/d but
compliance remained poor. Diagnosis of bipolar II disorder was kept and
Valproate 250mg was continued. He was taking alcohol in dependent
pattern for last 19-20 years. On persuasion of family members, he tried
to cut down but would fear losing his friend circle because of stopping
alcohol and would have craving also, hence didn’t stop completely.
It was suspected that his hypomanic/manic episodes were possibly
linked with alcohol intake and decided to start him on Baclofen 20mg/d.
On 2nd day, he became cheerful, very talkative, had decreased need
feeling and very confident for 1 week and ended up having an argument
with his senior. During this time, he took Valproate 250mg/d with good
compliance and depressive symptoms disappeared. Baclofen was
withheld and after 2 days all symptoms disappeared. Patient has not
reported any manic symptoms in 6 month follow up so far.
Conclusion: Baclofen can induce mania and in patients of bipolar II
disorder, this can happen at doses as low as 20mg/d.
Association of Alcohol Use Pattern with Liver Enzyme Levels:
Report from a Tertiary Care Treatment centre in India
Quraishi R, Jain R, Bera SC, Ambekar A
NDDTC, All India Institute of Medical Sciences, New Delhi. E-mail:
rizwanaquraishi@gmail.com
Background/Objectives: Alcohol Dependence is associated with a
range of adverse health effects, including elevation of liver enzymes,
which are markers of hepatic dysfunction. The dose-response
relationships between ethanol intake and marker changes have
remained less understood. This study aimed to examine the association
of alcohol use pattern with hepatic enzyme levels.
Methods: A retrospective chart review was conducted for alcohol
dependent patients (N=316), who sought treatment from the centre
within one year period. Data on socio-demographic profiles, alcohol use
pattern and hepatic enzyme levels were obtained from medical records
and were analysed using SPSS version 16.0. Descriptive statistics was
used to analyze the socio-demographic and alcohol use profile of the
subjects. Group mean differences and biochemical parameters were
tested by Man Whitney.
Results: The mean age of the subjects was 37.6 + 7.8 years. Around
52.2% had onset of alcohol use at < 25 years of age. The mean duration
of alcohol use was < 10 years (53.5%). About 53.5 % reported using 750
ml or more of distilled spirits daily. An elevation in the enzymes levels
(AST, ALT, and GGT) was found in 51.9 %, 41.1 %, and 67.4 % subjects
respectively. The GGT levels were significantly raised among groups with
lower age of initiation (below 25 years) and longer duration of use (< 10
years). Total duration of alcohol use and quantity of alcohol consumption
emerged as variables associated with hepatic enzymes level.
Conclusion: The results indicate that the amount and duration of
alcohol use must be taken into consideration while interpreting the
results of hepatic enzyme.
Key Words: Alcohol, use pattern, duration, liver enzymes
458 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Alcohol Dependence Syndrome: 6 Month Outcome Study
Debbarma A, Sidana A, Das S, Singh J
Government Medical College, Chandigarh, India. E-mail: anadrikadb@
gmail.com
Background/Objectives: The study was planned to see the
effectiveness of different pharmacological intervention in alcohol
dependence syndrome.
Methods: Case record files of Alcohol Dependence Syndrome
(ADS,ICD-10) patients, who were registered in the De-addiction clinic
of Dept. of Psychiatry, Govt. Medical College & Hospital (GMCH), India
during the year 2015, were retrieved and analyzed after applying the
coding system. A total of 494 patients of alcohol dependence syndrome
were registered during this period. Patients received Baclofen,
Acamprosate, Topiramate, Disulfiram, Naltrexone or combination
following an Alcohol detoxification treatment. Abstinence was assessed
by Patient’s own self report and overall Clinician’s Rating in the case
record file of the patient. Statistical Analysis was done using Non-
Parametrical statistical method.
Results: Majority of the patients (70%) were prescribed Baclofen,
followed by other medications. Baseline data in terms of current
addictive behaviour and course of disease differed between groups
.Topiramate, Naltrexone, Acamprosate and Disulfiram were prescribed
in 20%, 5%, 4.5% and 0.5 % respectively. Time elapsed before the
first alcohol relapse as well as follow up to outpatient treatment and
cumulative alcohol abstinence achieved in Baclofen group was explicitly
longer.
Conclusion: Baclofen is the most commonly prescribed molecule
for Alcohol dependence syndrome, followed by Topiramate and other
molecules .Baclofen seems to be a Good Drug in terms of Prolonging
Relapse when compared with Other Drugs used in Alcohol dependence
syndrome.
Consequences of Harmful/Hazardous Alcohol Use: A Cross-
Sectional, Community Based Study
Gupta S, Rao R, Ambekar A, Mishra AK, Lal R
All India Institute of Medical Sciences, New Delhi. E-mail: snehil2161@
gmail.com
Background/Objective: To study the lifetime and recent consequences
among non-treatment seeking harmful/hazardous alcohol users from
an urban slum of India.
Methods: Using cross-sectional study design, a purposive sample of
75 adult males with harmful/ hazardous alcohol use recruited through
snowball sampling were interviewed using Drinkers Inventory of
Consequences (DrInC), and a semi-structured questionnaire. DrInC
scores for consequences incurred by alcohol users in their lifetime
and past three months in five domains intrapersonal, interpersonal,
impulse-control, physical and social responsibilities.
Results: The mean age of the subjects was 36.78 (SD: 11.96) years,
67% were married, 10% illiterate, and 66% were full-time employed.
The mean age of initiating alcohol use was 21.5 (6.9) years; median
duration of alcohol use was 21 (IQR 7, 21) years. About 92% subjects
consumed alcohol daily and an equal proportion had heavy episodic
drinking episodes; 83% were alcohol dependent. DRInC scores showed
that 27% faced adverse consequence in the “medium-very high” range
over lifetime; this proportion increased to 48% for past three months.
Adverse consequences were reported across all the five domains, with
severer scores in “Intrapersonal” and “Social responsibility” domains.
More than half reported that they missed work or school, their “quality
of work suffered”, or they were “suspended/ fired/left job or school”,
due to alcohol use. About 90% participant reported that their “family/
close friends expressed worry about drinking and in 70% subjects, the
family/ social relationship get damaged because of drinking. About
55% reported driving under alcohol influence (DUI) over lifetime, while
19% had an accident due to DUI. About 43% indulged in risk taking
behaviour after drinking.
Conclusion:Harmful/hazardous alcohol users face significant adverse
consequences across various domains due to their alcohol use.
Despite such consequences, their non-treatment-seeking is a matter
of concern and thus strategies to provide help to such individuals are
urgently needed.
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Abstracts
Ketamine Dependence in Veterinary Physician: Case Report
Patil V, Ambekar A
AIIMS, New Delhi. E-mail: drvaibhav173@gmail.com
Ketamine hydrochloride is a rapid-acting non-opioid anaesthetic used
for medical and veterinary purposes. It produces a state of "dissociative
anaesthesia", probably from action on N-methyl-D-aspartate
(NMDA) receptors. The psychotropic effects of ketamine range from
dissociation and depersonalization to psychotic experiences. Its use
among medical professionals is cause for concern due to ease of
availability. We discuss a case demonstrating ketamine dependence
in a Veterinary physician from India. Issues related to management of
health professionals are also discussed
Correlates of Treatment Retention Among Children & Adolescent
Substance Users Seeking Treatment in Tertiary Hospital in North
India
Kuppili PP, Bhargava R, Mandal P, Mishra AK, Gupta A, Dhawan A
AIIMS & NDDTC, Delhi, India. E-mail: poojapatnaik.aiims@gmail.com
Background/Objectives: Child and adolescent substance use is an
important public health problem. Though the problem over the years is
rising significantly yet in India, special efforts in the specific population
are limited in terms of treatment modalities.
Methods: Retrospective chart review of patients attending adolescent
drug use clinic at National Drug dependence Treatment Center between
April, 2003 to July, 2014 was done. Follow up duration was defined as
number of weeks from first visit to the last visit to the hospital.
Results: A total of 713 records were reviewed. Tobacco was the
most common drug ever used (86%) followed by cannabis (46.7%),
volatile solvents (45%), opioid (33.7%) and alcohol (33%). Majority
of the cases, about 55.5% were using at least two substances in
dependent pattern.21.6% were nicotine dependent,5.5% were volatile
solvent dependent,4.3% were opioid dependent,0.6% were cannabis
dependent and 12.5% of patients were not using any substance
in dependent pattern. Median duration of follow up was one week.
Significant correlation was noted between duration of follow up and
high risk sexual behaviour (rs=0.08), family history of psychiatric illness
(rs= 0.08), age of the patient at entry into treatment (rs =0.11) and age
of starting any substance (rs =0.09).
Conclusion: Study results emphasize theneed for efforts at retention.
The study highlights the need to focus on factors associated with
treatment retention during initial contact as contact with the treatment
centre has been a well-documented indicator for ensuring abstinence.
Prevalence of Depression in Patients of Alcohol Dependence
Priya J, Jiloha RC
Maulana Azad Medical College, New Delhi, India. E-mail: jyotipriya@
icloud.com
Background/Objectives: 1)To study the prevalence of depression
among patients with alcohol dependence. 2) Prevalence of comorbid
tobacco dependence among patients of alcohol dependence.
Methods: Ninety patients with alcohol dependence (diagnosed as per
ICD 10) aged 18-60 years consulting the department of Psychiatry,
GB Pant Hospital were taken up for the study as per inclusion and
exclusion criteria with written informed consent. Patients with major
medical illness were excluded. Patients with a score of 15 or more
on CIWAAr (Clinical Institute Withdrawal Assessment of Alcohol
Scale, Revised) were excluded. Severity of alcohol dependence was
assessed and graded by SADQ (Severity of alcohol dependence
questionnaire). Diagnosis of depression was made as per criteria
of ICD 10. HAMD (Hamilton depression rating scale) was applied to
patients diagnosed with comorbid depression and severity rating was
done. Data was analysed and statistical tests like Chi square test and
Pearson correlation were used.
Result: 32.2% patient s with alcohol dependence had comorbid
depression. Out of these 7.8% had mild, 18.9% had moderate, 5.6%
had severe depression. 54.4% patients of alcohol dependence also
had concurrent tobacco dependence.
Conclusion: Depression as well as comorbid tobacco dependence
is common among patients of alcohol dependence. Depression was
commoner among patients dependent on both the substances.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Key words: Alcohol dependence, Depression, Tobacco dependence
Cannabis Use Disorder: Review of Treatment Options
Ganesh R, Chatterjee B
AIIMS, Delhi, India. E-mail: ragulganesh.r@gmail.com
Background: Cannabis is the most prevalent illicit drug used
worldwide. Treatment seeking for cannabis use disorder has risen
in recent years. While few nonpharmacological interventions are
approved in the management, no pharmacotherapy has been approved
for the treatment of cannabis use disorder till now. However, many
pharmacological drugs have shown promise but are still in various
stage of development.
Objectives: The presentation intends to review the current state and
recent advances in the treatment of cannabis use disorder. Studies
on both pharmacological and non-pharmacological interventions have
been included in this presentation.
Results: The studies included both cannabis abuse and cannabis
dependent population. Among treatment seekers, studies have
been done in both inpatients and outpatient setting. The studies on
pharmacological interventions have mainly evaluated their efficacy on
management of cannabis intoxication, withdrawal state and prevention
of relapse. Among pharmacotherapies, studies have shown significant
results with Dronabinol and Lofexetidine in terms of average amount of
cannabis use and number of days of cannabis use. Recent studies have
shown significant increase in the days of abstinence and reduction in
severity of withdrawal with fatty acid amidehydrolase(FAAH), cannabidiol,
gabapentin and N-Acetyl cysteine. The studies on nonpharmacological
intervention, significant results were seen with motivation enhancement
therapy, cognitive behavioural therapy and contingency management.
Irrespective of the type of intervention studied, most of the studies are
limited by small sample size and heterogeneity of samples.
Conclusion: The authors conclude the need for more research on
treatment for cannabis use disorder.
Does Patients With Familial Alcoholism have Earlier Drinking
Milestones and Greater Drinking Severity?
Praharaj SK, Munoli RN, Sharma PSVN
Kasturba Medical College, Manipal, India. E-mail: samirpsyche@
yahoo.co.in
Background/Objectives: To compare the drinking milestones and
drinking severity in those with and without familial alcoholism.
Methods: 30 consecutive patients, aged 18 to 60 years, ICD10
Diagnostic Criteria for Research for alcohol dependence syndrome,
were assessed for familial alcoholism, drinking milestones and
severity of alcohol dependence using Severity Alcohol Dependence
Questionnaire (SADQ).
Results: 19 patients had familial alcoholism. The age of onset of problem
drinking (p=.004), age of binge drinking (p=.001), age of heavy drinking
(p=.01) and age of alcohol dependence (p=.002) were significantly lower
and SADQ total score (p=.044) was significantly higher in those with
familial alcoholism. The degree of familial alcoholism was significantly
negatively correlated with age at regular drinking (r=0.377), age of onset
of problem drinking (r=0.467), age of binge drinking (r=0.474), age of
heavy drinking (r=0.460) and age of alcohol dependence (r=0.422), and
positively correlated with SADQ total score (r=0.490).
Conclusion: The drinking milestones were achieved at significantly
earlier age in those with familial alcoholism. Higher degree of familial
alcoholism was associated with lower age of drinking milestones and
higher drinking severity, with moderate effect sizes.
Socio-demographic and Biochemical Profile of Adolescent
Inhalant Users Seeking Treatment at a Tertiary Care Centre of India
Verma A, Jain R, Dhawan A, Lakshmy R
AIIMS, Delhi, INDIA. E-mail: arpitaverma1988@gmail.com
Background/Objectives: Inhalant use is one of the poorly understood
forms of substance use among adolescents worldwide. The study aimed
to report the sociodemographic and biochemical profile of adolescent
inhalant users seeking treatment at a tertiary care centre of India.
Methods: Male subjects, aged between 12-18 years seeking
treatment for inhalant use from June 2012 to December 2015 were
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included. A structured sociodemographic abstraction tool was used
to record patient’s characteristics. Blood and Urine samples were
collected for laboratory investigations and were analyzed using Gas
Chromatography and Biochemistry auto analyzer. Descriptive statistics
was used to analyze the socio-demographic and biochemical profile
of the subjects.
Results: The sample consisted of 70 subjects with mean age of 14.75±2.8
years, living with family (85.2%), with friends (13.3%) and street/footpath
(1.5%). About 51.5% of the subjects were educated till primary (51.5%)
and 38.2% of the subjects were employed as unskilled workers. Mean
family income was INR 5055 ± 5367.75. The most common inhalant
used was adhesive (83.6%) followed by eraserfluid (16.4%). The mean
age of onset of inhalant use was 12.2±1.8 years. Mean Hippuric Acid
to urinary creatinine ratio was found to be 2.03±2.17g/g. Current use of
Nicotine (82.1%) and Lifetime use of alcohol, cannabis & opioid was also
found. Random blood sugar, liver function tests and renal function tests
were within the normal range. However, serum Bilirubin and Alkaline
phosphatase were found to be below the normal values (0.5±0.9 and
234.8±112.6, respectively). Lipid profile analysis showed the signs of
under nourishment among subjects.
Conclusion: Inhalant use may be a marker for adolescents with a
highrisk profile for subsequent illegal drug use. This study contributes
to the scarcity of literature available on the adolescent inhalant users
from India. There is a need for strategies to prevent this emerging
health care problem.
Quality Of Life of Spousal Caregiver’s of Alcohol Dependence
Patients-A Comparative Study
Agarwal S, Shekhawat BS, Gupta N, Kumar V
Dept. of Psychiatry, Subharti Medical College, Meerut, India. E-mail:
drsupriyavaish@gmail.com
Background/Objective: To evaluate quality of life (QOL) of spousal
caregivers of alcohol dependent patients and to formulate methods of
improving their psychological health
Methods: A case control study was carried out in the de-addiction
ward of the department of Psychiatry at Subharti Medical College,
Meerut using self-designed semi-structured socio-demographic data
sheet and clinical data sheet to procure details of the patient and the
spousal caregivers of alcohol dependence syndrome diagnosed as per
ICD-10 criteria. The QoL data was collected for 30 spousal caregivers
randomly selected as per pre-defined criteria of a ‘person who was
named for reference or were responsible for taking care of daily routine
of the patient using WHO-QoL BREF scale (Hindi version). The well
matched control group was also selected and evaluated on the above
mentioned tools. The observations were statistically analysed using
chi- square test and co-relation coefficient quotient statistical tools.
Quality of life of spousal caregivers was observed to be significantly
impaired in comparison to the control.
Conclusion: Thus, it is advisable that while dealing with alcohol
dependent patients not only the patient but also the caregiver who
is also at risk of developing various health related problems, has
poor QoL should also receive attention and there should be focus on
improving their health and QoL through pre-determined formulated
plan of management.
A Comparative Study of Cognitive Representations Among
Individuals With Alcohol Dependence Syndrome and Healthy
Individuals
Singh G, Kaloiya G, Dhawan A, Balhara YPS, Mishra AK
All India Institute of Medical Sciences, Delhi, India. E-mail: singh.
geet.44@gmail.com
Background: Alcohol dependence has become a worldwide crisis
as it is associated with adverse social, economic, physical and
mental consequences. As per World Health Organization report
alcohol consumption led to 5.9% of all global deaths in year 2012.
Less number of studies has carried out comprehensive & objective
evaluation of cognitive elements among individuals with substance
use and examined the differences in their cognition from healthy
individuals. Here, we made an attempt to identify underlying deeper
cognition among these individuals as it is well proved that dysfunctional
460 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
cognition leads to dysfunctional behaviour and which may be in form
of addictive behaviours.
Methods: This is a cross sectional study wherein total 10 male adults
diagnosed with Alcohol Dependence Syndrome (ADS) recruited from
National Drug Dependence Treatment Centre, AIIMS and 10 healthy
individuals from community or clinical set up. The two groups are
matched in terms of age and socioeconomic status and compared on
a diverse set of cognitive measures (Young Schema Questionnaire,
Dysfunctional Attitude Scale, Automatic thought Questionnaire and
Cognitive Distortion Scale) using t test.
Results: Findings demonstrates that the ADS group scored higher
than the healthy individuals on 11 of the 18 early maladaptive schema.
Both groups also differed on cognitive distortion of mind reading,
catastrophization, emotional reasoning, over-generalization and
personalization. In addition, ADS groups scored higher on dysfunctional
attitude and automatic thoughts.
Conclusion: Findings suggest that identification and subsequently
modification of underlying dysfunctional deeper cognition may be
an important target of intervention for alcohol dependence treatment
programs and may result in improved treatment outcomes and
decreased relapse rate.
Key Words: Alcohol dependence, Cognition, Addictive Behaviour
Perceptions About Hookah Smoking in Patient Attending
De-Addiction Centre
Arya S, Kumar V, Sunila, Gupta R
Institute of Mental Health Pt BDS UHS, Rohtak, India. E-mail:
draryasid3188@gmail.com
Hookah smoking is a common social custom in Middle Eastern, North
African and Asian countries. In India, especially in the Northern states,
hookah is seen as a status symbol and hookah smoking is considered
to have high social sanction. Because of its unique properties, Hookah
smoking is considered as a safe mode of smoking by majority of
people. However, recent findings have highlighted that physical harm
by Hookah smoking are comparable to other methods of smoking.
A survey was carried out to explore the perception about hookah
smoking in treatment seeking substance abusers in a tertiary hospital
of North India. Randomly selected 100 patients attending De-addiction
clinic were assessed using a structured proforma constructed from
questionnaire used in previous studies and contained questions related
with use patterns, harm caused by hookah smoking, addiction potential
and perception of family member about hookah smoking. Study showed
interesting factors responsible for popularization of the hookah smoking.
The implications are discussed.
Changing Trends of Substance Abuse in Emerging Adults
Sunila, Arya S, Kumar V, Gupta R
Institute of Mental Health Pt BDS UHS, Rohtak, India. E-mail:
draryasid3188@gmail.com
In recent times emerging adulthood has been recognised as a separate
phase of life, ranging from 18-25 years, distinct from late adolescence or
transition to adulthood. One of the most notable feature of this group is
increased rates of substance abuse. Over the past decade, substance
abuse has grown into a major public health issue in India. This study
was undertaken to examine the changing patterns of substance abuse
in emerging adults over the last five years. The treatment records of
all the patients between 18-25 years, who sought treatment in De-
addiction centre, Institute of Mental Health from 1st January 2011 to
31st December 2015 were reviewed. Data was analyzed for changing
trends both in terms of quality and pattern of drugs abuse in the specific
group of emerging adults. The implications and insights derived from
the study are discussed.
Pattern of Substance Use in Patients Attending Drug De-addiction
Centre: A Chart Review of the last 5 Years
Kumar V, Singh P, Sunila, Gupta R
Institute of Mental Health Pt BDS UHS, Rohtak, India. E-mail:
draryasid3188@gmail.com
The pattern of psychoactive substance use change over time. Though
National level prevalence has been calculated for many substances,
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regional variations are quite common and cannot be ignored. The
estimates are liable to change over time depending upon diverse factors
like socio-political milieu, cost, availability and public attitude towards
drug abuse. The present study is a retrospective chart review from the
Drug De-addiction centre, Institute of Mental Health which caters to
large population of North India. We reviewed hospital records of all the
5155 patients registered in the centre from June 2011 to June 2016
and the trends emerged are illustrated in the poster.
Unemployment and Mental Health
A Survey of Supports for Social Withdrawal in a Provincial Capital
in Japan
Kawanori Y, Kambara M
Iwate Perfectural University, Takizawa, Iwate, Japan. E-mail:
kawanori@iwate-pu.ac.jp
Background/Objectives: In Japan it is one of the major issues that
young adults with social withdrawal called Hikikomori would neither
relate others personally nor work and spend almost whole time at home
after their graduation. Hikikomori is defined as people who refuse to
communicate others except family members, isolate themselves from
society in their homes for a period exceeding six months and are
not given a diagnosis as schizophrenia. The number of Hikikomori
is estimated to be more than 600,000. Though it has been believed
that Hikikomori is the phenomenon peculiar to Japan, recently the
emergence of Hikikomori has been reported in Taiwan and Korea
(Cabinet Office, 2010). The purpose of this study is to research current
situations of Hikikomori in a provincial capital Morioka andinvestigate
explorative the effective supports for Hikikomori.
Methods: Twenty welfare commissioners working in two model
welfare districts in Morioka were interviewed on social withdrawal
of family members in 3,000 households. Further a questionnaire
was administered to eighteen institutions on supportive activities for
Hikikomori to explore effective supports.
Results: It is found that outreach would be most effective but it has
some problems such as the difficulty of direct contact with Hikikomori.
Also the result showed that the great part of institutions is managed
by non-profit organizations with limited members and had financial
difficulties as continuous and long term treatment would be needed. A
lot of Hikikomori had the period of school refusal, have not ever worked
after their graduation and have isolated themselves from society.
Although corporations supporting NEET are subsidized, adults older
than thirty five are not applicable to NEET in Japan. This study has
found that a considerable of Hikikomori is left out of official financial
supports as the increase of average age of them.
A New System of Reference for the Training of Employment
Accompanying Qualified Professionals, Dedicated to People
Suffering from Mental and Psychological Disabilities
Fond-Harmant L, Deloyer J, Catalin N, Michel P, Michel SJ, Gabriela K
Luxembourg Institute of Health, 1a, rue, Thomas Edison, Strassen,
Luxembourg. E-mail: Laurence.fond-harmant@lih.lu
The Employment crisis provides an opportunity to improve the
qualifications of the core of mental health professionals who make
the users integration into working life possible.The Global Action Plan,
WHO Mental Health 2013-2020, request the empowerment of users.
The SPSM Employability project is based on the improvement of the
core skills and good practices of these social professionals who are
dedicated to helping vulnerable people settling into a job.
To date, at a European level, there is no predictive models nor good
practices guide that enable us to deal with an increasingly demanding
job market. The field professional’s initial and ongoing training courses
may quickly become obsolete unless it is upgraded and adjusted to the
job market requirements. Funded by the European funds (Erasmus+
Programme), the SPSM - Employability project aims at 3 targets: The
joint creation of a training reference system, validated by a federated
teamwork; - The setting up of a pilot seminar; -And in accordance with the
European expectations: the drawing up of a transferable and accessible
set of recommendations, to both macro-political and micro-structural
levels (setting up of academic courses). The project builds on the
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
shared expertise of the partnership of 5 European countries: Romania,
Switzerland, France, Luxemburg and Belgium. It is comprised of:-
Employment orientated psycho-social services, Mental and psychological
disabilities training centres,Academic research centres, experts. We
therefore propose to work at identifying the next stages for the setting of a
new training reference system, based on a new professions repository (in
the field of employment integration, reflecting the functions, the activities
and the generic skills requested). Account will also be taken of the new
economic framework, as well as the diagnosis and existing community
strategies (users, professionals and companies needs analysis).
Designed for European Research, Education (Ministries of Research,
ongoing training and Universities) and Health (Ministry of Health)
authorities, the project proposes the implementation of pilot modules
at academic European courses level (Master). In an economic crisis
context, it will be able to take up the current and upcoming challenges
of today’s jobs of Public Mental Health.
Key words: mental and psychological disabilities, employment, social
professionals, training of employment
Study of Working Life of Patients with Psychiatric Illness Admitted
in Psychiatry Ward
Khare A, Kirpekar V, Bhave S, Tadke R, Gawandfe S, Faye A
NKPSIMS and LMH Nagpur, India. E-mail: drakhare1717@gmail.com
Background/Objectives: Work is an important domain of life in
maintaining mental health and in recovery of those with psychiatric
illness. Patients with good working profile have better prognosis.
Unemployment and poor working profile as an effect of psychiatric
illness adds to the burden due to disorder and vice versa. Thus it
is important to analyse working profile of patients with psychiatric
disorders. This study was aimed to analyse presence, type and pattern
of employment in patients with psychiatric illness admitted in psychiatry
ward and its correlation with clinical factors.
Methods: After written informed consent 40 consecutive patients
admitted in psychiatry ward of a tertiary care hospital were included in
the study. Those aged 18 to 60 years willing to participate and provide
details of work were included. Data was collected along a proforma
prepared for the study which included demographic profile, clinical
profile, diagnosis, and work profile questionnaire.
Results and discussion: Mean age of the participants was 33
years, predominantly males, married with urban background. The
diagnoses were psychoses 40%, mood disorders 20%, substance
related disorders 30%, and others 10%. 17% never worked, 17%
self-employed and rest were working under others before admission.
Majority were working for 8 hours per day for more than 2 years and
30% had shift duty. Income decreased in half of them after illness and
one third reported job removal at least once. In majority of them work
efficiency was affected and about 40% faced difficulties and conflicts
at work place. 40% of them were able to provide financial support
to the family. Work efficiency was significantly affected in those with
higher BPRS scores.
Conclusions: Significant attention should be given to work profile of
patients in planning their treatment. Efforts should be made to keep
them working.
Key words: Work profile, Work efficiency, Psychiatric patients
Pain Behavior and Mental Disorders in Patients with Chronic
Pain Syndromes
Khaustova O, Avramenko O
Ukrainian Research institute of Social Psychiatry, Road Clinical
Hospital, Kyiv, Ukraine. E-mail: oksana.v@dinadis.ua
Background/Objectives: Specific pain behavior is formed in some
patients with chronic pain syndrome (CPS) and interferes with the
healing process or significantly extend.
Methods: We assessed pain behavior predictors in 135 patients with
CPS non-cancer genesis, depending on comorbid psychiatric disorders
such as depressive episode (MDD), generalized anxiety disorder
(GAD), and anxiety-depressive disorder (ADD). Patients divided into
study groups (SG): SG1 was CPS+MDD (R52.1-2 + F32-33); SG2
was CPS+GAD (R52.1-2 + F41.1); SG3 was CPS+ADD (R52.1-2 +
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F41.2-3, F43.22). Control group (CG) was CPS only. We used Pain
Catastrophizing Scale (PCS) and SPAASMS.
Results: According to PCS points "exaggeration", "hopelessness" and
total catastrophizing level in all SG groups were significantly higher
compared to CG (for all p<0.05). Higher catastrophizing level by PCS
was marked link between the sense of helplessness and tendency to
exaggerate the problems with the phenomenon of pain (r=0, 69 and r=0,
63, respectively, p<0.05). According to SPAASMS patients from SG2
significantly more take medication compared to CG (p<0.05). Additional
visits were also significantly more frequent in SG2 and SG3 group
(both p<0.05). Significant decrease mood was expected in SG1 and
SG2 groups (both p<0.05). Quality of sleep, side effects and physical
activity tended to increase in all SG groups, but not reached the level
of reliability. The total SPAASMS rating was significantly higher in all
SG groups compared to CG group (all p<0.05).
Conclusion: Formation of pain behavior in patients with CPS
occurred respectively by the presence of non-psychotic mental
disorders (MDD, GAD, and ADD): from sensor sensitization to
affective response with additional modifications of the motivational
component. Then the behavioural component was added first as an
active use of medical aid (additional drugs and visits to the doctor),
but not the total activity.

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POSTERS DAY 4 FORENOON
ImPact of Globalization
TuTo-European Tutoring Process in Psychiatry and Mental Health:
What Evaluation Criteria?
Fond-Harmant L, Deloyer J
Luxembourg Institute of Health, 1a, rue, Thomas Edison, Strassen,
Luxembourg. E-mail: Laurence.fond-harmant@lih.lu
Financed by the European Erasmus+ fund, the TuTo project (2014-
2017) offers a European tutoring programme addressed to young
professionals in the field of psychiatry and mental health. It is widely
recognised that there is a shortage of young practitioners in Europe.
Vocational crisis? To motivate young people, TuTo encourages
exchange and the discovery of other European professional practices.
The project is supported by the expertise of partner psychosocial
facilities, psychiatric hospitals, training centres and university research
institutes from six European countries: Spain, Germany, France,
Luxembourg, Belgium and Greece. The objective of the study is to set
forth the six evaluative criteria and indicators of the TUTO project and
present outcomes. Integrating the major health promotion principles
contained in the Ottawa Charter (WHO -1986), the valuation grid jointly
developed with the partners makes it possible to share the same culture
for promoting mental health and psychiatry in Europe.
The evaluation provides numerical and qualitative elements. It shows
that the tutoring process has expanded to other European countries,
including Sweden, Iceland, Spain and the United Kingdom. The project
combines didactic training, tutoring processes and university education.
According to the Ottawa Charter, the host institutions should improve
the training of tutors for contacts with professionals outside the hospital,
in order to build a multisector approach. It is essential to train young
European professionals so as to de-compartmentalise therapeutic
activities and those of mental health prevention and promotion. For
a modern public mental health system, the acquisition of individual
skills will enable these young professionals to strengthen community
action in urban settings. It will facilitate a mobilisation that involves
the patients-users of psychiatry, with a view to achieving better living
conditions and greater well-being.
Key words: young professionals, tutoring programme, evaluation,
European countries, acquisition of individual skills
Attitude and Pattern of Internet Use Among Psychiatric Patients
Raj A, Saha S, Khurana H
Institute of Mental Health, University of Health Sciences, PGIMS,
Rohtak, Haryana, India. E-mail: aish24raj@gmail.com
Background: Internet now a day has become a necessary evil. Online
shopping, banking, business transactions,social networking a have
become part of modern life style. Many social sites like twitter and
Facebook have provided a creative platform for those who wouldn’t
have expressed themselves in public. However, indiscriminate and
unscientific use of internet has led to several problematic behaviors
such as social isolation, relying too much on internet based information,
internet addiction and the most severe being the cyber-crimes. Several
studies have highlighted these facts. Few studies have also examined
the internet use by psychiatric patients. These results of these reveal
that most of the times the psychiatric patients use internet for searching
treatment options which may or may not be reliable depending upon
the source. Many studies also reported about the psychopathological
use of internet by psychiatric patients and general population. This may
have adverse effect on the outcome of disorder. Since there are only a
few studies on this aspect from India hence we preferred to study the
internet use among the patients utilizing outdoor psychiatric services.
Such studies are important keeping in view the increasing accessibility
and applicability of internet in various aspects of life. The objective of
the study was to assess and analyze the pattern of internet use among
outdoor psychiatric patients.
Method: One hundred patients visiting the investigators in psychiatry
outdoor of Institute of Mental Health, Rohtak were selected randomly.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
The socio-demographic, clinical profile and internet use pattern was
assessed using specially designed proforma and Young’s internet
addiction test.
Result: Data were analyzed using descriptive statistics. The results
suggest a need to educate the patients about rational use of internet.
Conclusion: There is a need of such studies to be replicated and
carried out on the general population and psychiatric patients.
Key words: Internet, Psychiatric disorders, Internet addiction
Care Givers of Elderly Patients India: The Needs and Gaps in
Service -A Pilot Study
Raj A, Saha S, Khurana H, Singh B
Institute of Mental Health, UHS, Rohtak, Haryana, India. E-mail:
aish24raj@gmail.com
Background/Objectives: The family members have always played an
important role in provided care to the elderly patients. However with
rapid growth of India, burden on the family members is continuously
on rise especially in the paucity of mental health services. India is
aware of it and launched specific policies for taking care of elderly
people as well as patients. In this study we have planned to assess
the care givers needs and expectation from health care providers in
a structured way. Besides that we have also assessed the available
health resources in the region of study to evaluate their quantitative
and qualitative adequacy to address the needs of these care givers.
Methods: Fifty patients aged 60 years and above attending outdoor
services at the Institute of Mental Health, Rohtak are being randomly
chosen for this study. Their primary care givers are being assessed
using the C.A.R.E Need assessment tool, C.A.R.E. screening tool and
Sociodemographic clinical details proforma developed by the authors
after consent from care givers and patients.
Results: The preliminary results suggest the care givers feel need of
information about the illness and treatment. Many of them also feel
need of training in care giving and the need of old age homes. Financial
concerns were also reported by the majority of the care givers. However,
the findings are at a preliminary stage. The details would be presented
on completion of sample collection which is expected in short time.The
services were assessed by counting the number of available health
resources, psychiatrists, geriatric specialist, and availability of indoor
and outdoor services available at primary to tertiary level.
Conclusions: The findings and their implication would bediscussed
in detail in the poster.
Key Words: Care giver, elderly, psychiatric services, India
Internet use pattern, mental health and Big-Five personality traits
in Indian students
Saha S, Khurana H, Raj A
Institute of Mental Health, UHS, Rohtak, Haryana, India. E-mail:
srinjaya.saha@gmail.com
Background: The internet is of great importance in a student’s life as
they can access a variety of academic resources like tutorials, lectures
by renowned authors and use resources of other academic institutions
based in different countries. However, the literature suggests that
indiscriminate use of internet by students for social networking, gaming,
and movies make them vulnerable to psychological morbidities like
internet addiction, symptoms of anxiety, depression and attention and
cognitive problems.To the extreme side it also makes them vulnerable
to cyber-crimes. The data from the west has suggested that, impulsivity,
novelty seeking, boredom proneness are few of the traits that make the
person vulnerable to such pathological states through internet. Hence
we prefer to carry out the study predicting the use of internet and its
association with different personality traits and mental health as there
is only limited data from India on this aspect. The objective of the study
was to investigate the association between internet use pattern, mental
health and Big-Five personality traits in Indian students.
Methods: The proforma were distributed randomly to 500 students
residing in any of the 15 hostels of Maharshi Dayanand University
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and University of health Sciences Rohtak.Those who did not return
the proforma were reminded after a week.The proforma included
questions to assess socio-demographic details and internet use.
Young’s Internet Addiction Test, NEO-PI questionnaire and General
Health Questionnaire were used to assess internet addiction personality
traits and general mental well-being respectively.
Result: The data collected were analysed using descriptive statistics;
results are discussed in the poster presentation.
Conclusion: Keeping in view the sample for study there is a need for
replicating the results in other populations also.
Key words: internet use, internet addiction, students, personality traits
Impact of Urbanization on Child Mental Health: A Review
Namita, Sarkar S
All India Institute of Medical Sciences, New Delhi, IndiaE-mail:
namitakgmc@gmail.com
Background: According to the Indian 2011 Census, the level of
urbanization in the country as a whole increased from 27.7% in 2001
to 31.1% in 2011. By 2025, 6 of 10 children will live in cities.The link
between degree of urbanization and a number of mental disorders is
well established across all age groups, however impacts of urbanization
affect more to the vulnerable section: elderly, children and women. The
purpose of this poster is to review the literature available regarding
impact of urbanization on child mental health.
Method: A Pubmed and Google scholar based literature review was
done using appropriate search terms. It was supplemented with cross
references.
Results:Urbanization in developing countries creates multitude of
interrelated problems such as unemployment, poverty, malnutrition,
drug abuse and breakdown of the protective influences of the family.
The vast majority of the world’s children is exposed to these and is at
an increased risk of mental health problems. In studies schizophrenia,
psychosis and depression have been found to occur more frequently
in urban areas in all age groups. Increase in behavioural problems
and eating disorders have also been found to increase in children
who migrated from a rural to urban area and living in nuclear
families. Homeless children in cities are subjected to economic and
sexual exploitation; they have limited opportunities for intellectual
development. Studies have shown that women in urban settings suffer
more socioeconomic distress and violence than men, which in turn
compromise mental health of women and children both.
Conclusion: Urbanization is vital for any country’s economic growth.
There is further need to assess influence of urbanization on health
particularly mental health of children and to create awareness in the
society. This will facilitate better care for child mental health along with
balanced approach to development of countries.
Social Psychiatry and NGOs
Effectiveness of Training for Camp Teachers on Life Skills
Education for Street Children
Manikappa SK, Sekar K
KMC, Manipal University, Department of Psychiatry, Udupi District,
Manipal, Karnataka, India. E-mail: sanjeeva222@gmail.com
Background/Objectives: To enable camp teachers through training
program on life skills education to impart the same to street children
attending one month home placement camp services. To assess
the knowledge gain among camp teachers on life skills education.
Hypothesis: Life skills education participatory training increases the
knowledge of camp teachers.
Methods: Through block random sampling procedure 11 camp
teachers were selected and trained on life skill education for street
children in a five days training program. The gain in teacher’s knowledge
from the training was systematically both before and after the training
assessed by using Knowledge level questionnaire on Life skills
education (KLQLSE) and Semi structured questionnaire for assessment
of knowledge on Life skills education (SQAKLSE). The data collected
were analysed through descriptive statistics to find out the basic
features and observations and the paired t-test to find out the mean
difference between pre and post assessment of the camp teachers.
464 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: The scores on KLQLSE and SQAKLSE indicated that there
was significant increase in knowledge of the camp teachers following
the five days training program on life skill education. This means
that their understanding about the basic concepts, various life skills,
methodologies, different issues of street children moved upward.
Conclusion: This knowledge and skills acquisition among the camp
teachers can be attributed to the effectiveness of the training program
they attended. For getting such results, the factors like methodology,
duration, content and medium of instruction of any training program
must be given due attention while designing an intervention package.
Key words: Camp teachers, Life skills education, street children &
training
Assessing Stress and Coping of Caregivers of Patients with
Alcohol Dependence in Gurgaon
Kapoor A, Sharma P, Walia V
Department of Psychiatry, SGT Medical College, Gurgaon, Haryana,
India. E-mail: dr.abhishekkapoor82@gmail.com
Background/Objectives: Alcohol abuse in patients contributes to
psychological stress and challenges to the caregivers. In current study,
we compared caregivers of patients with alcohol dependence in rural
and urban area of Gurgaon, on ways of coping and impact of illness
on psychological and physical health.
Methods: 100 patients admitted in three rehabilitation centres run by
non-profit organization (NGO) in Gurgaon were screened and seventy
patients fulfilled the ICD-10 criteria for alcohol dependence, which were
taken for the study. 37 and 33 caregivers belonged to rural and urban
areas respectively. Caregivers in both groups were compared using
coping questionnaire, family member impact questionnaire, symptom
rating test and hopefulness- hopelessness scale.
Results: No significant difference was found in coping. However,
caregivers of patients from urban background scored high in engaged
and tolerant coping as compared to rural patient’s family members who
scored high in withdrawal coping. No significant difference was found on
family member impact scale as well as Symptom rating scale. Spouse
of patients from urban background scored high on psychological
symptoms as compared to spouse from rural background that scored
high on physical symptoms.
Conclusion: Tolerant-inactive coping may lead to adverse effects on
psychological health of caregivers. Certain socio- cultural factors are
involved in understanding the coping strategies and kind of impact of
illness on caregivers.
Key words: Coping, caregivers, alcohol dependence
Recruitment, Ideology and Strategic Prevention in Radical
Extremism: A Literary Review
Mihajlovic A
University of Illinois Chicago Illinois, USA. E-mail: md60181@yahoo.
com
Abstract Radical Extremism has become an increasingly significant
issue facing our society today. Groups ranging from Islamic State
of Iraq and the Levant (ISIL) to the Aryan Nation continue to grow
in power and have an influence both abroad and here in the United
States. This review aims to understand the recruitment strategies and
ideologies used by radical extremist groups in attempt to develop
effective opposition and preventive strategies that can be implemented
in various clinical applications. Eleven articles were reviewed and
studied. Inclusion criteria for this research included key words:
counter narrative, terrorism, Islam, White Power, radical extremism,
prevention of radicalization. Exclusion criteria included articles written
by members of radical extremist groups themselves, as well as articles
written before September 11, 2001. Based off eleven articles, individual
anti-radicalization counter-measures should focus on countering the
perceptions of victimization, undermining the "champion" narrative, and
emphasizing non-violent alternatives. In the clinical setting, one should
provide options that can fulfil the psychological needs of closure, sense
of identity/belonging, and personal significance. Understanding these
various strategies will allow for improved patient care particularly with
adolescent psychiatric behaviour within at-risk community members.
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Abstracts
Marital Quality and its Relation with Depression: A Case-Control
Study
Jaiswal P, Jilani AQ, Tripathi A, Singh S, Dalal PK
King George Medical University, Lucknow, India. E-mail: jaiswal.
priya21@yahoo.co.in
Background: Marital relationship may be adversely affected due
to depression in spouse. Usually the non-affected partner is main
caregiver and responsible for caregiving.
Objectives: To compare marital quality of depressed patients in
comparison to healthy controls.
Methods: This was cross sectional case control study with sample size
of 252 subjects (151 cases and 151 healthy controls). People with major
depression as per DSM-IV-TR criteria were recruited from outdoor of
department of psychiatry, King George Medical University, Lucknow.
Controls were recruited from selected urban and rural locality of the
same district with the help of NGO. Quality of marriage was assessed
using Marital Quality Scale.
Results: Quality of marital relationship was significantly poor among
cases. There was positive correlation of marital quality with severity
of Depression. Furthermore, the quality of marriage was not affected
by sociodemographic variables except domicile status.
Conclusion: Depression negatively affects quality of marriage.
Family Functioning and Expressed Emotions in Depressed Married
Patients in North India-A Case Control Study
Jaiswal P, Jilani AQ, Shukla D, Tripathi A, Singh S
King George Medical University, Lucknow, India. E-mail: jaiswal.
priya21@yahoo.co.in
Background: Family plays vital roles and affects the course, prognosis
and treatment outcome of depressed patient. In developing worlds, patient
is cared by their own family unlike institutional care in developed countries.
Objectives: The aim of the study was to explore family functioning and
expressed emotion including emotional over involvement and perceived
criticism in families of married patients of Depression.
Methods: The study sample size consisted of 252 subjects (151 cases
and 151 healthy controls). The diagnosis of depression was made using
DSM-IV-TR criteria. The functioning level and expressed emotions of
family of depressed patients and healthy controls was assessed by
applying FFS (Family Functioning Scale) and FEICS (Family Emotional
Involvement Criticism) scale respectively.
Results: The functioning and expressed emotions of family of cases
were significantly lower than of controls. On comparison of various
domains of family emotional involvement and criticism scale, the
functioning of the family was significantly poor among cases than
controls. Similarly, the perceived criticism was significantly more among
cases. Further, the expressed emotion and criticism by family of cases
increased with severity of depression.
Conclusion: Depression is associated with poor family functioning
and increased perception of criticism.
Key words: Family Functioning, Expressed Emotion, family of
depressed patients
Marriages of Women After Taking Treatment for Mental Illness-
Positive Social Outcome Case Reports from Community Based
Project in Kerala
Viswanath SS, Anupama V Prabhu, Aiswarya S, Venkateswaran C
MEHAC Foundation, Kochi, Kerala, India. E-mail:silpsviswam@gmail.com
Background: The objective of the study wasto highlight a positive
outcome (acceptance and marriage) in the society, related to women
suffering from severe mental illnesses. MEHAC Foundation is a not
for profit organization in the field of community mental health. It has
partnerships with local government bodies and NGOs to provide long
term clinical care and comprehensive psycho-social interventions.
Societal values and attitudes towards marriage in Indian society
are heavily discriminating toward women with mental illnesses.
This is a reflection of social stigma for mental illness and patriarchal
attitude towards women. Awareness programs, regular treatment and
information about good outcome of severe mental illness can bring an
improvement in societal attitudes.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Case description: Five stories of women treated under MEHAC
Foundation who have got married after informing the other party
regarding client’s psychiatric history, importance of treatment
adherence and the related challenges. All marriages happened after
taking consent from parties, their families and consultation with the
multidisciplinary team.
Conclusion: Psycho-education led to treatment adherence and
willingness to come for consultation together, when issues arise apart
from usual follow up. These women were found to be confident while
taking care of responsibilities, felt less anxious and safer, since the
spouse knows about their psychiatric history. Spouses were also
willing to provide support in terms of motivating them to continue taking
medications and also seeking for mental health services. This is a
positive social outcome which would be an example for other people
receiving mental health care.
Key words: Stigma, marriages in mental illness, societal attitudes
Internet Addiction Prevalence and Associated Psychosocial
Factors Among Young Adults
Bhat AS, Thomas C, Thomas C, Arnhanthabailu P, Young KS, Math
SB, Cherian AV
MIMER medical college, Talegoan Dabhade, Pune India and Center
for community mental health, Mangalore, India. E-mail: bhataneesh@
gmail.com
Background/Objectives: Internet addiction has been increasingly
being considered as a major public health concern among young adults
globally. However, there is a paucity of data related to excessive or
problematic internet use among young adults in India. The present study
is aimed assessing the prevalence of internet addiction and associated
psychosocial factors among this vulnerable group.
Methods: The sample consisted of 6100 undergraduate students of
various faculties across the city of Mangalore, Karnataka. The study
was approved by Nitte University Institutional Ethics Committee and
permission was sought from the concerned colleges. Students were
cross sectionally assessed with a specially constructed semi structured
proforma and The Internet Addiction Test (IAT; Young, 1998) which was
self-administered by the students after giving them brief instructions.
Subjects were classified into mild users, moderate users, and addicts
for comparison. The participants were administered with Self Reporting
Questionnaire20 (SRQ20), which 20 item questionnaire with a score
of 6 or above indicating distress.
Results: Of the 6100 participants who took part in the study, 3613
(59.2%) were female and 2487 (40.8%) were males. The mean age
of a participant was 19.26 ± 1.4 years. About 2.3% of total participants
were using internet for more than 4 years. As per the Young’s original
criteria, about 36.7% were mild to moderate problematic users and
0.2% were found to be addicts. However, 27.7% of participants felt
that they are addicted to internet and 1.9% of them sought professional
psychiatric help for the same.
Conclusion: Our result shows that problematic internet usage
among young adults is prevalent and this population might be at risk
of addiction. It indicates that there is a higher need for designing an
interventions and treatments for this susceptible group.
Key words: Internet addiction, problematic internet use, young adults
Structural Equation Model of Factors Related to Quality of Life for
Community-Dwelling Schizophrenic Patients in Japan
Nakamura H, Watanabe N
Ibaraki Prefectural University, Japan. E-mail: nakamurahir@ipu.ac.jp
Background/Objectives: This study aimed to clarify how community
mental healthcare systems can be improved.
Methods: We included 79 schizophrenic patients, aged 20 to 80
years, residing in the Tokyo metropolitan area who regularly visited
rehabilitation facilities offering assistance to psychiatric patients and
were receiving treatment on an outpatient basis. No subjects had
severe cognitive disorders or were taking medication with side effects
that could prevent the completion of questionnaires. Questionnaires
included items related to quality of life, self-efficacy, self-esteem,
psychosis based on the behaviour and Symptom Identification Scale,
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Abstracts
health locus of control, and socio demographic factors. We performed
multiple linear regression analysis with quality of life as the dependent
variable and, based on covariance structural analysis, evaluated the
goodness of fit of the resulting structural equations models.
Results: Self efficacy, self-esteem, and degree of psychosis
significantly impacted quality of life. Marital status, age, and types of
medications also influenced quality of life. Multiple linear regression
analysis revealed psychiatric symptoms (Behaviour and Symptom
Identification Scale32 [daily living and role functioning]) (Beta = 0.537,
p < 0.001) and self-efficacy (Beta = 0.249, p < 0.05) to be predictors
of total quality of life score. Based on covariance structural analysis,
the resulting model was found to exhibit reasonable goodness of fit.
Conclusions: Self efficacy had an especially strong and direct impact on
QOL. Therefore, it is importantto provide more positive feedback to patients,
provide social skills training based on cognitive behavioural therapy, and
engage patients in role playing to improve self-efficacy and self-concept.
Working With NGO’s: Comparing Social Domain With Quality of
Life
Sudhakar S, Varghese JJ, Kallivayalil RA
Department of Psychiatry, Pushpagiri Institute of Medical Sciences,
Tiruvalla, India.
Objectives: To evaluate a cost effective Psychosocial Rehabilitation
(PSR) on social functioning of inmates in a mental health rehabilitation
center. To compare their social domain with Quality of Life (QOL).
Methods: The study was conducted at psychosocial rehabilitation
center run by an NGO at a semi urban area in Southern India.A total
of 111 inmates were recruited for the cross sectional study in whom a
specially designed proforma and World Health Organization Quality
Of Life Instrument-Short Form (WHOQOL BREF) was applied. This
residential care center provides cost effective PSR to these individuals
which is suitable for a low middle income country (LMIC). The social
functioning of these individuals were evaluated using the Social
Domain of WHOQOL BREF scale and then compared to the total score
of WHOQOL BREF. Statistical analysis would be done using SPSS
software, the mean would be compared using appropriate tools with
appropriate statistical significance.
Results: The data has been entered and is currently under the process
of statistical analysis.
Conclusion: If this cost effective rehabilitative measure is found to
be beneficial, it could be replicated in other centers across LMICs like
India for upliftment of the QOL of individuals suffering from chronic
psychiatric illness.
Key words: NGO’s, Psychosocial Rehabilitation, Social Functioning,
Quality of Life
Social Psychiatry and Old Age
The Clinical Characteristics of Late-Onset Mania
Cetinkaya O, Derya Y, Fulya A
Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for
Psychiatry, Neurology & Neurosurgery 4th Psychiatry Clinic, Bakirkoy,
Istanbul, Turkey. E-mail: ozlemcetinkaya@yahoo.com.tr
Background/Objectives: It is discussed whether mania of late-onset
is a separated unique disorder. There are some studies about manic
states among the elderly. We tried to determine the importance of such
a discrimination in clinical practice.
Methods: Twenty four elderly patients diagnosed as having bipolar
mood disorder type-1 manic episode who had been treated in the
inpatient clinic in the Department of Psychiatry, Bakirkoy Prof. Dr.
Mazhar Osman Training and Research Hospital were classified into
two groups of early and late-onset mania by accepting the age of 50 as
the differentiating point. These 24 elderly patients were then compared
retrospectively with 29 younger patients according to sociodemographic
features, family history, prophylactic treatment they received, clinical
manifestations, physical disorders, the duration of staying in hospital,
the treatment given and clinical improvement.
Results: It was found that the bipolar disorder had a higher prevalence
among women. The frequency of a positive family history was higher
among the younger patients and among the elderly whose disorder was
466 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
of early-onset. The elderly patients whose disorder were of late-onset had
a higher prevalence of physical diseases. The duration of education was
longer among the younger patients and among the elderly whose disorder
were of early onset. Flight of ideas and pressure to keep speech were
more frequent among the younger patients and among the elderly whose
disorder were of early-onset. The younger patients had more frequently
erotomanic delusions. The valproate was more frequently preferred as
a mood-stabilizing drug among the elderly, and the elderly patients with
late-onset mania used antipsychotic agents more commonly as compared
with those of early-onset mania. The total duration of inpatient treatment
was longer among the elderly patients than the younger ones.
Conclusion: Our findings support the view that late-onset mania is a
separate unique disorder although more detailed further studies are
needed.
Waiting for Moon Rays at Dusk
Subhalakshmi TP, Prathap A
MOSC Medical College Hospital, Ernakulum, Kerala, India. E-mail:
subhalakshmitp@yahoo.com
Background/Objectives: Old age may be a risk factor for depression
and suicide. Absence of the spouse by death or separation increases
the risk further. The attempts at remarriage may be viewed differently
by the individual, family members and society. An attempt is made to
share the narratives of two elderly men who came to the Psychiatry
OPD with a similar desire- remarriage.
Case report: Two men in their 60s are viewed in the context of their
Psychiatry consultation. One had come alone and the other was brought
by his daughter and son in law after a suicide attempt. Religion was
different. Both were retired but earning. Both are married, and having
children. However both have lost their wives- one by death and the other
by separation imposed by the wife. Both want to get married again.
The context of their desire and their perspectives about the obstacles
and aids to their desire are described.
Discussion: The social context of their suffering and their perceived
inability to carry out their decision at this stage, unlike in their adulthood
and midlife are important. Hindering factors are many- money/
obligations towards family/ expectations about and from others and
society. The second person found it socially unacceptable to stay with
the married daughter and son in law, when his four sons are alive,
though the daughter was supportive.
Conclusion: Decision making and its implementation are complex
processes even for the so called heads of the family, in their late life.
Teasing out the social, marital, psychological, religious and economic
factors underlying and complicating the situation may be an exacting
but satisfying task for the therapist.
Key words: Old age, decision making, barriers
Explanatory Models of dementia among caregivers: a qualitative
study from a Tertiary Care Centre of India
Hossien A, Loganathan S, Meena KS
Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India.
E-mail:altafhossien@gmail.com
Background:In India, a large number of people living with dementia
have not received formal diagnosis. The awareness and knowledge
about the illness is very poor among population. Symptoms of dementia
are considered normal consequences of aging. People harbour a belief
that nothing could be done. Help seeking is also very less.
Objectives: We have interviewed the caregiver to examine their
explanatory model of the illness dementia.
Methods: Caregivers of 35 elderly persons (age>55yrs) diagnosed
with any type of dementia were chosen from the Geriatric Clinic and
Services of the National Institute of Mental Health And Neuroscience
(NIMHANS). Caregiver’s perception of illness, their interpretation of
abnormal behaviour and reaction in terms of help seeking or avoidance
was elicited by using Short explanatory model interview (SEMI).
Qualitative data analysis was done with ATLAS.ti. The translated
scripts were examined thoroughly, read and re-read several times and
emerging themes were identified.
Results: As we analysed the responses, multiple themes came out
in different areas of understanding of dementia. Reason for help
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Abstracts
seeking for most was found to be both cognitive symptoms as well as
behavioural symptoms like agitation or apathy. As far as understanding
of causal factor, most of the caregivers attribute the symptoms as
‘consequences of normal aging’. Other considered it was because of
‘brain disease’, ‘personality’ or ‘psychosocial factor’. Most of them can
identify that the illness lies inside the brain. They believe that medical
intervention can slow the progress of illness, though many of them
seek for a ‘cure’.
Conclusion:We have found that people have an understanding that
dementia is a biological condition which involves brain but it was
attributed mostly to aging or other psychosocial factor. At the same
time people also felt the need for intervention. There is a need for
awareness raising campaign for dementia in community at large with
regards to its cause, symptoms, course and progression and most
importantly locally available resources.
Factors of Geriatric Mental Status and their Abilities
Kashyap A, Kumar N, Singh TK, Das S
Government Medical College & Hospital, Chandigarh, India. E-mail:
thiyamkiran@hotmail.com
The main purpose of the study was to find out the factors of areas,
income and education in geriatric mental status and their abilities.
2x2x2 factorial design was employed in this study. The study was
conducted at Department of Psychiatry, Government Medical College
and Hospital, Chandigarh. The total samples of 70 were collected from
available data record of Geriatric Clinic, Government Medical College
and Hospital, Chandigarh. All the participants were administered: 1.
Hindi Mental Status Examination (HMSE) and 2. Everyday Ability Scale
for India (EASI) to assess their mental status and daily living activities.
The result found area, income and education were influencing factors
of geriatric mental status and their abilities.
Key Words: Geriatric mental status, Geriatric abilities, Areas, Income,
Education
A Comparative Study of the Institutionalised and Non-
Institutionalised Elderly on some Psychological Dimensions
Mongia M
Amity University, NOIDA, India. E-mail: monicamongia@gmail.com
Background/Objectives: To compare the institutionalised vs
non-institutionalised elderly on psychological dimensions such as
adjustment, coping and security.
Methods: Data was collected from 30 elderly men, above 60 years of
age, including 15 institutionalized elderly residing at an old age home in
Delhi and 15 elderly living with their families in Delhi/ NCR. Assessment
was done using semi structured interview, Bell's Adjustment Scale,
Coping Resources Inventory and the Security-Insecurity Inventory.
T-tests and Chi squares were applied as appropriate.
Results: The two groups were statistically comparable on general
adjustment, security-insecurity, and coping strategies dimensions.
Security- insecurity scores were positively correlated with scores
on adjustment. Additionally, the level of education was significantly
associated with institutionalization. Also, there was a positive
relationship between functioning and quality of relationships in the
elderly men's family and the ability to adapt to changes in old age.
Conclusion: The study was done on a non-representative sample,
hence, the generalisability of study results is questionable. Nonetheless,
the results point to the importance of social support and education in
adjustment, sense of security as a contributor to life satisfaction and
wellbeing, and self and general perceptions of the elderly. Implications
for holistic care of elderly are discussed.
Complicated Grief Behind Depression in the Elderly, in Modern
Japanese Society
Shimizu K, Kobayashi T, Suda S
Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, Japan.
E-mail: d1413@jichi.ac.jp
Background/Objectives: The loss of a close relative has been
conventionally regarded as the most stressful event for humans,
especially for the elderly. Recently, complicated grief (CG) was
proposed as a bereavement-related clinical category and in DSM-5 it
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
is adapted as “persistent complex bereavement disorder”, which should
be examined in the future.
Methods: We studied depression in the elderly after the death of their
loved one, and investigated whether CG was involved. We reviewed all
cases of over 50 years of age that led to admission to our hospital with
depression after the death of close relatives. The period covers the past
6 years. We interviewed patients, using The Brief Grief Questionnaire
to determine whether they were suffering from CG. We recorded
information including age, sex, past and family history, cause of death
of the relative, relationship with the deceased, economic status, social
environment and so on.
Results: The objective rate was 25.1% (n=38) among all depressive
inpatients over 50 years of age during the same period, which was a
relative majority. We interviewed 73.7% (n=28) of them. Among them,
61% (n=17) were female, and the average age was 65.8 years old. The
rate of CG was 57.1% (n=16). Those suffering from CG were mainly
female 81.3% (n=13) and 18% (n=5) had been involved in nursing
the deceased for a period of more than 10 years. We could also see
evidence of the breakdown of a family relationship 43.8% (n=7) in the
patients suffering from CG.
Conclusion: CG could be seen in more than half of elderly depressive
inpatients after the loss of a close relative. We assert the existence of
CG behind prolonged depression and report its features, taking into
account the social environment of Japan.
Frailty in Elderly and Persons with Alzeihmer's Dementia
Dhanasekaran S, Varghese M, Bharath S, Sivakumar PT, Loganathan
S, Sinha P
Geriatric Clinic and Services, NIMHANS, Bangalore, India.
E- mail:saranya296@gmail.com
Background/Objectives: Frailty is an age-related reduction in
physiological reserve and resistance to stress and is influenced by
social and environmental factors. It increases the risk of health decline,
disability and mortality. It has been shown to contribute to poorer
functional performance and outcomes in patients with dementia. This
study aimed to assess frailty among patients with Alzheimer’s dementia
in comparison with age and sex matched healthy elderly.
Methods: This sample consisted of 25 patients with Alzheimer’s
dementia attending the Geriatric clinic outpatient department at the
National Institute of Mental Health and Neurosciences, Bangalore, and
25 age and sex matched healthy elderly. Fried’s frailty criteria were used
in the study in which the frail state is defined by the presence of three or
more of the following five components: exhaustion, unintentional weight
loss, weakness (by hand grip strength), slow walking speed and low
levels of physical activity. Participants with 0-1 criterion present were
determined as non-frail and those with two criteria as intermediately
frail. The patients were also assessed on the NPI (Neuropsychiatric
Inventory), EASI (Everyday Abilities Scale for India) and the HMSE
(the Hindi Mental State Examination). Patients were excluded if they
had other causes of disability.
Results: There were significantly more frail (24% versus 4%) and
prefrail (72% versus 56%) individuals in the Alzheimer’s dementia group
as compared to the controls (p<0.05). In the patients with Alzheimer’s
dementia, frailty scores were found to have significant correlation with
the NPI (p=0.01), EASI (p=0.009) and the HMSE scores (p=0.03).
Conclusion: Frailty, a vulnerable health state, is more prevalent among
the older adults with dementia. Its longitudinal correlation with the
progression of dementia and its correlates warrant further investigation,
and may have implications in the planning of preventive public health
interventions in this patient population.
Psychosocial Rehabilitation of Elderly Females with Late Onset
Anxiety Disorders and Comorbid Depression: A Case Series on
Late Life Psychosocial Issues in Late Onset Anxiety Disorders
in India
Ratnakaran B, Babu S, Mathew A
Dr.Kunhalu's Nursing Home, Ernakulam, Kerala, India. E-mail: dr.
badrratnakaran@gmail.com
Background/Objectives: Anxiety disorders in elderly have a higher
prevalence than depression and dementia. Psychosocial factors in
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Abstracts
elderly are important risk factors for late onset mental illness and need to
be addressed not only due to its importance in treatment of mental illness
but also improving quality of life. We report a case series of a 4 females
who are more than 60 years of age, presenting with late onset anxiety
disorders with comorbid depression of more than two years duration
Methods: We report two cases of generalised anxiety disorder, one case of
panic disorder without agoraphobia and one case of social anxiety disorder.
Their illness occurred following stressors and medical causes of anxiety
disorders and dementia were ruled out. Stigma of visiting a psychiatrist
was the reason of delay in psychiatric consultation. Pharmacotherapy was
started and by the end of two months their symptoms subsided but still
had residual depressive and anxiety symptoms. Various psychological
and late life psychosocial issues were identified including fears of isolation,
neglect, dependency, difficulty in decision making, suffering from medical
problems, etc. Principles of cognitive behavior therapy, relaxation training,
activity scheduling, family intervention, problem solving therapy, assertive
skills were tried in the patients over six months.
Results: After 8 months of treatment, our patients’ anxiety and
depressive symptoms remitted.
Conclusion: Various challenges can be encountered in treatment of
late onset mental illness. Psychosocial factors related to late life need
to be addressed when planning rehabilitation in elderly patients.
Psychiatric Morbidity and Social Support Systems in the Elderly
Thomas S, Kallivayallil RA, Mohamed AM
Dept. Of Psychiatry, Pushpagiri Institute of Medical Sciences
&Research Centre, Thiruvalla, Kerala, India. E-mail: sharon_091@
yahoo.com
Background/Objectives: Ageing is a universal phenomenon. This age
group requires special care and attention, since India is currently in a
state of demographic transition, and studies with respect to geriatric
population is scarce. Hence this study was conducted:to study the
various types of psychiatric illnesses in patients aged 60 yrs and above,
to explore the sociodemographic details and social support systems,
and relation between social support and the psychiatric illnesses
Methods: This study was conducted in Geriatric Psychiatry Clinic,
Pushpagiri Institute of Medical Sciences and Research Centre, Kerala.
It was a cross sectional study and convenient sampling was done
where a sample of 90 elderly patients (>60years) attending Psychiatric
OPD were interviewed with a semi structured proforma for recording
socio demographic details, clinical profile and social support systems.
Diagnoses of mental disorders were made with the ICD-10 Diagnostic
Criteria. Statistical Analysis - Comparison would be made out on all
parameters and results would be analysed using Chi square test for
categorical variables and t test, ANOVA for continuous variables.
Results &Conclusion: The data is being submitted for statistical
analysis and the results would be presented at the conference.
Key Words: Elderly, psychiatric, illness, social support
Suicide
Suicidal Ingestion of Olanzapine and Trihexyphenidyl by a Patient
with Schizophrenia: A Case Report
Hussain N, Chary RSS, Raj VS
SVS Medical College, Mahbubnagar, Telangana, India. E-mail:
neiloforhussain@gmail.com
Background/Objectives: Olanzapine is a second generation
antipsychotic which is commonly used as first-line drug to treat patients
with schizophrenia. Olanzapine is associated with toxicity in certain
overdose situations, but evidence of any relation is limited and likely
influenced by the higher rates of cardiovascular disease and sudden
death in subjects with schizophrenia. Trihexyphenidyl is a potent
anti-cholinergic drug used in the treatment of Parkinsonism and in the
control of drug induced extra pyramidal side effects in patients with
Schizophrenia.
Case description: We report a case of a 35 year old man diagnosed
with schizophrenia 4 months back, brought to the emergency room with
suicidal ingestion of Olanzapine and Trihexyphenidyl in an unconscious
state with constricted pupils. Patient was given supportive treatment
and managed conservatively.
468 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Discussion: There are some case reports regarding over-dosage of
Olanzapine and Trihexyphenidyl alone but no such case reports on
combined over-dosage of Olanzapine and Trihexyphenidyl. The present
case report is intended to document one such case with the details of the
clinical picture and outcome of the above case and discuss its implications
on the future directives for diagnosis and management of similar cases.
Key words: Suicidal ingestion, Olanzapine, Trihexyphenidyl,
Schizophrenia
Making Suicide Nonsensical the Way in which the Rules of Incest
Related Matrimonial etc. Laws Including Mental Hygiene Laws do it
Barnabas T
35 Sobieski Janos utca, Budapest. E-mail: tombarnabas@freemail.hu
Background/Objectives: In 2010, I masterminded the popular modus
vivendi program of making suicide nonsensical and euthanasia sensical
which has brought added value to suicidology and euthanasiology. How
do the pros and cons of the contemporary issues of euthanasia effect
the 21st century anti-suicide crusades and its action takings? This is
one of the quintessential questions of suicidology with regard to the
contemporary developments of euthanasia and its enterprises. The
scholars of suicidology and euthanasiology are challenged to make
suicide nonsensical and euthanasia sensical in updated, renewed
fashions. The presentation attempts to apply the jurisprudence, medical
and ethical wisdom of the so-called Oedipus module of incest and
bestiality to suicide and suicidal behavior and their better understanding.
Methods: Historical deconstructionization of the incest and bestiality
related laws as well as mental hygiene laws will constitute the
methodology of the presentation. The rule of these laws is construed
by the naivete of the author’s amateur experience of penniless clochard
life, vagrancy and many criminal court appearances and detentions
in a variety of correctional facilities and mental health institutions in
different countries.
Results: The scientific medical, legal and ethical relevance of the
so-called Oedipus module of incest and bestiality is discussed in the
presentation. The discussion highlights the ways in which the rule
of law is instrumental in building up resistance against suicide and
correcting suicidal behaviors.
Conclusion: The presentation will conclude with some thoughts on
key mental health issues embedded in sexuality related laws.
Key words: Making suicide nonsensical and euthanasia sensical, the
Oedipus module of incest and bestiality, the case of incest and bestiality
in the past, present and future, the rule of law
Positive Affirmative Pledge as an Attempt In Suicide Prevention
Rajini T, Ramakrishna P, Shriff AM, Harihar C
Deccan College of Medical Sciences, Hyderabad, India. E-mail: rajini.
clinicalpsy@gmail.com
Background/Objectives: Suicide is a leading cause of death globally
as is evident in all age groups irrespective of socioeconomic status,
gender, caste, creed and culture. Suicide can result from a combination
of complex factors like personal, social, physical and mental health
issues. Most of us cannot predict a suicide, but a trained professional
has the skills for assessing suicide risk behaviour.
Management of suicide in nonemergency situations like outpatient
department includes psychotherapy, medications, family support and
education, avoidance of drugs and alcohol, form a strong support
network, being active in a few hobbies or skills, learning about one’s
own condition, paying attention to warning signs, making a plan what to
do if suicidal thoughts come and, eliminating potential means of harming
self. The concept of taking pledge against suicide was non-existent.
Hence, this novel attempt was tried as a preventive community measure
against suicide. Targeting persons not individually but in groups was
the focus of area in our research.
Methods: Research team administered pledges against suicide in
various schools, colleges, work places, hostels, transport stations,
restaurants, and entertainment places in few Indian languages and given
handouts educating them on how to lead a happy life. We analyzed if
positive affirmative pledges may inculcate an idea in the participants that
suicide should never be an option at any time of distress.
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Abstracts
Results: Individuals reported that it is an innovative idea and that they
felt relief by talking about suicide. They realised suicide is no longer a
social taboo, that, feeling suicidal is common but reacting to it is never
a solution, that, being in emotional pain and unable to express is the
sign they noticed, that, listening is an art which every individual should
learn, and that, when in distress shall speak to professionals rather
opt for attempting suicide.
A Comparative Study of Suicide Reporting in Indian and Australian
Newspapers
Gill N, Gul D
SAT Hospital Medical College, Trivandrum, Kerala, India. E-mail:
laxmisainivd@gmail.com
Background/Objectives: To compare the quality and extent of
reporting of suicides in Indian and Australian Newspapers, andto find
out whether the suicide reporting in Indian and Australian Newspapers
conforms to the WHO guidelines for suicide reporting.
Methods: Retrospective quantitative analysis of extent and qualitative
discourse analysis of quality of suicide reporting over six months in
three popular newspapers each from India and Australia. The data so
collected would be analysed by an Indian and an Australian psychiatrist
for themes highlighted by WHO guidelines on suicide reporting e.g.
headline on front page, sensational headline, gory details of the method,
glorifying suicide, over-emphasising single cause of suicide, having a
picture of the deceased or the site of suicide and whether or not helpline
phone numbers or suicide reporting prevention agencies were reported.
Results and Conclusions: Will be presented in the conference.
Association of Self-Esteem and Suicidal Ideation with Cortisol
Levels in First Episode Drug Naive Mania
Ranjan R, Das B
Central Institute of Psychiatry, Ranchi, India. E-mail: rajeev.pmc03@
gmail.com
Background/Objectives: Dexamethasone suppression test (DST)
is proposed as indicator of degree of depression in affective disorder
including mania. Cortisol levels and DST have not been studied in first
episode drug naive mania. This study intended to investigate relationship
of cortisol levels and DST with self-esteem and suicidal ideation in mania
and their correlation with degree of depression in mania.
Methods: This was a cross sectional study including 60 first episode
drug naive mania patients and 30 controls to study association of self-
esteem and suicidal ideation with cortisol levels. Scale for manic states
was used for assessment of mania, brief psychiatric rating scale for
degree of psychosis, Hamilton rating scale for measuring depression,
Beck’s scale for suicidal ideation for measuring suicide and Rosenberg
self-esteem scale for self-esteem. Cortisol levels were measured at 11
pm. After that 1mg dexamethasone was administered. Next day 8 am
cortisol levels were measured. Cortisol levels were measured using
Enzyme-linked immunosorbent assay. Within patient group, Pearson
correlation assessed correlation of cortisol level with clinical parameters
and Phi correlation for DST.
Results: Cortisol levels were higher both at 11 pm and 8 am in patient
group. Cortisol at 11 pm was found to have positive correlation with
scale for manic states (SMS) pure mania, SMS mixed mania, SMS total
score but at 8 am was found to have significant positive correlation
with SMS mixed mania and SMS total score.
Conclusion: This study confirms the findings that despite increased
cortisol production in mania, DST could not be correlated with suicidal
ideation in mania. It is correlated to mixed mania rather than pure mania.
Key words: mania, suicide, dexamethasone suppression test
The Potential Overprescription of Psychotropic Drugs in People
with Suicide Attempt History
Uchino T, Yamaguchi T, Nemoto T, Takeshi K, Katagiri N, Tsujino N,
Fujii C, Mizuno M
Department of Neuropsychiatry, Toho University School of Medicine,
Omori-Nishi, Ota-ku, Japan. E-mail: takashi.uchino@med.toho-u.ac.jp
Objectives: Repeated suicide attempts are more common in patients
with drug overdose than in patients using any other methods. We
examined patients who had attempted suicide and been admitted to
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
the Intensive Care Unit (ICU) to reveal the features of drug overdose
and repeated suicide attempts.
Methods: There were 396 patients (31.0% males, mean age 40.1 years)
who were admitted to the ICU at the Toho University Omori Medical
Center in Tokyo for suicide attempt from April 2011 to March 2016. Based
on medical record, the patients were divided into two groups: patients
who attempted suicide for the first time (first attempt group) and patients
who had attempted suicide repeatedly (repeated attempts group). We
compared the features of drug overdose between the two groups.
Results: As a whole, drug overdose was the most common method
(73.0%). About sixty percentages of patients had a history of repeated
suicide attempts. The proportion of drug overdose was significantly
higher in the repeated attempts group (82.0%) than in the first attempt
group (59.9%). Female, unemployment and living with someone were
features of the repeated attempts group. More than 90% of patients
in both groups had been given a prescription of psychotropic drugs
and benzodiazepines were the most common. The number of types of
psychotropic drugs prescribed was significantly larger in the repeated
attempts group (mean 4.4 drugs) than in the first attempt group (mean
2.2 drugs). The number of ingested tablets for drug overdose was
significantly larger in the repeated attempts group (mean 118.1 tablets)
than in the first attempt group (mean 91.9 tablets).
Conclusion: Patients who have a previous history of suicide attempt
may store a large amount of prescriptions. Psychotropic drugs should
be prescribed for high-risk patients with the greatest circumspection
to prevent repeated suicide attempts.
Alcohol Consumption and Suicide Trends in Russia, Belarus
and Ukraine
Razvodovsky Y
Grodno State Medical University, Belarus. E-mail: yury_razvodovsky@
mail.ru
Background/Objectives: The Slavic countries of the former Soviet
Union (fSU) Russia, Belarus and Ukraine retain one of the highest suicide
rates in the world, despite a gradual decline over the past decade. The
dramatic fluctuations in suicide mortality in fSU over the past decades
have been widely discussed in the scientific literature and are still relatively
unexplored. The present study aims to analyze whether population drinking
is able to explain the dramatic fluctuations in suicide mortality in Russia,
Belarus and Ukraine from the late Soviet to post-Soviet period.
Methods: Trends in sex-specific suicide rates and alcohol sales per
capita from 1980 to 2010 in Russia Belarus and Ukraine were analyzed
employing a Spearman rank-order correlation analysis. Results: In
general, the gender-specific temporal pattern of suicide mortality
fluctuations was similar for three countries: sharp decrease in the
mid of 1980s, dramatic increase in the first half of 1990s followed by
a decline. While the trends in suicide mortality have been similar in
three countries during the Soviet period, there was market discrepancy
after the collapse of the Soviet Union. The estimates based on the
Soviet data suggest a strong association between alcohol sales and
suicide rates in Russia, Belarus and Ukraine. At the same time, the
relationship between alcohol sales and suicide rates was negative in
the post-Soviet period.
Conclusions: The findings from present study suggest that the
suicide mortality fluctuations in Russia, Belarus and Ukraine in the
Soviet period were attributable to alcohol. Alternatively, alcohol
cannot fully explain the fluctuations in the suicide mortality observed
in these countries in the Soviet period. Similar regional pattern of
suicide trends do not support the hypothesis that alcohol control
policy was responsible for the decline in Russian suicide mortality
during recent decade.
Key words: alcohol sales, suicide rates, Russia, Belarus, Ukraine,
1980-2010
Higher Suicidal Ideation Among Young Adults in India - A Cross
Sectional Study From a Semi-Urban Setting
Bhat S, Bhat A, Dâ Souza DP, Arahantabailu P, Aiman A, Kumar S,
Prabhu S, Rao S, Cherian AV
K. S. Hegde Medical Academy, Nitte University. E-mail: shrinivasabhat@
yahoo.co.in
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Abstracts
Background/Objectives: Suicide rates are higher among young
adults India. However, there is scarcity of data on prevalenceof suicidal
ideation among young adults in India. The present study aims at
assessing suicidal ideation among young adults in a semi-urban town.
Method: The sample consisted of 4839 undergraduate students of
various faculties across the city of Mangalore, Karnataka. The study
was approved by Nitte University Institutional Ethics Committee
and permission was sought from the concerned colleges. Students
were cross-sectionally assessed with a specially constructed semi-
structured proforma and Self Rating Questionnaire (SRQ) which was
self -administered by the students after giving those brief instructions.
A score of 6 and above on the SRQ -20, which indicated a moderate
to severe degree of depressive symptoms.
Results: Of the 4839 participants who took part in the study, 1958
(40.5%) were male and 2881 (59.5%) were females. The mean age
of participants was 19.25 ± 1.5 years. About 34.2% had a score of 6
on SRQ with about 13.6% of them reporting to have thoughts about
ending their life. There was no significant gender difference with regard
to symptoms (31.9% Vs 34.8%, p =0.227).
Conclusion: The prevalence of depressive symptoms with suicidal
ideation was significant high among young adults. It indicates
the essentiality of developing a psycho-social intervention for this
vulnerable group.
Key words: suicidal ideation, depressive symptoms, young adults
Violence and Mental Health
Evaluation of the Distribution of Psychiatric Diagnoses, Dyadic
Adjustment and Quality of Sexual Life Among Women Subject to
Domestic Physical Violence
Tuz C
State Hospital for Physical Medicine and Rehabilitation, Istanbul,
Turkey. E-mail: cemtuz@live.com
Background: Violence refers to any single or collective act which
causes physical and mental harm or injury for an individual. Domestic
violence is the occurrence of such acts and behaviours within the family.
Domestic violence causes the victims to experience various mental
symptoms and conditions. Post-traumatic stress disorder, depression,
suicide attempts, alcohol- substance abuse and aggressive behaviour
towards children are commonly seen.
Objectives: The higher prevalence of mental disorders such as
somatization disorder, depression and anxiety disorders among women
compared to men suggests that women encounter more difficulties
in the family and that gender roles specific to the culture attributed
to females are more challenging. In this context, the present study
aims to investigate the frequency of domestic violence among female
patients admitted to general psychiatry polyclinics with mental, somatic
and sexual complaints.
Methods: The study was conducted with 200 married women
participants who were admitted to psychiatry polyclinic in 2015 and
agreed to participate in the study. SCID 1, Sociodemographic data
form, domestic violence question form and sexual life quality scale
were used for the subjects.
Conclusion: Results were obtained by employing qualitative and
quantitative statistical methods. Women who are subject to domestic
violence exhibit more prevalent and severe psychiatric diagnoses
compared to those who are not subject to domestic violence. The
presentation will discuss the findings in detail.
Trends in Hanging In Mthatha Region of South Africa (1996-2015)
Meel B
Walter Sisulu University, South Africa. E-mail: meelbanwari@yahoo.com
Background/Objectives: Hanging was not common among Xhosa
people, and considered as bad in the culture, but now it has been
increasing in this region. Poverty, unemployment and HIV could have
played a role in these deaths. The objective of the present study was
to study the trend of hanging in Mthatha region of South Africa.
Methods: A record review was undertaken from 1996 to 2015 of 24,419
medico-legal autopsies performed at Mthatha Forensic Pathology
Laboratory.
470 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: Between 1996 and 2015 (20 years), 24,419 autopsies were
performed on victims of unnatural deaths who brought to Mthatha Forensic
Pathology Laboratory. Of this, 1734 (7.10%) deaths were related with
hanging. Majority, 1555 (89.67%) were males. The average hanging is
17.2 per 100000 per year. Among males, the average is 15.2 per 100000,
while 1.9 per 100000 per year in females. The highest rate 26.7 per
100000 has recorded in the year 2007, and least 8.3 per 100000 in 1996.
The rate of hanging has increased from 8.3 per 100000 of population in
1996 to 16.7 per 100000 deaths in 2015. Among females it has increased
from 1.7 per 100000 in 1996 to 2.2 per 100000 in 2015, while it has
increased from 6.6 to 14.5 per 100000 among males in the same years.
Conclusion: There is increasing trend of hanging in Mthatha region of
South Africa. There is urgent need to address this problem.
Awareness of Undergraduate Girl Students About Avoidance
Strategies for Sexual Harassment
Mohanan K, Gupta S, Sagar R
Ved Nursing College, Panipat, India. E-mail: keerthimohanan36@
gmail.com
Background/Objectives: To find out the awareness of young female
adults about strategies to be used to avoid sexual harassment.
Methods: A descriptive, cross sectional survey design on 200 female
undergraduate students from the University of Delhi, India was
undertaken using convenient sampling technique. A semi structured
interview and a structured awareness questionnaire developed by
researcher was used.
Results: Most of the subjects feared for facing sexual harassment of
self whenever they went out alone. Most of the subjects reported high
level of alertness from strangers and identified dark, isolated, lonely
streets as most probable place for sexual harassment. More than half
of the subjects were unaware about legal provisions and two fifth of
the subjects never complained to any higher authority or police official.
Nearly half of the subjects had fair level of awareness about avoidance
strategies for sexual harassment Awareness was not found to be
correlated to any of the variables and the type of college (women or
coeducational college) they attended. Implications: Youth need to be
aware and avoid risk factors for safety of self and how to report the
incident to prevent further harassment.
Conclusion: Overall awareness about avoidance strategies for sexual
harassment of undergraduate females of the University of Delhi was
found to be less than satisfactory.
Key words: Young female adults, Awareness of sexual harassment,
Avoidance strategies for sexual harassment
Psychiatric Co-Morbidities in Married Female Patients of Domestic
Violence Attending Psychiatry OPD and as Inpatient in and Around
Meerut (Uttar Pradesh)
Antil S, Sudarsanan S, Choudhary S, Agarwal S, Sharma P
Swami Vivekanand Subharti University / Subharti Medical College,
Meerut, India. E-mail: drsandeepantil@gmail.com
Background/Objectives: The most common type of violence against
women worldwide is â domestic violence or the threatened physical,
emotional, financial and or sexual abuse of women by their intimate
partners, which as reported by World health organization (WHO)
ranged from 20% to as high as 50%. There are few studies of domestic
violence in the regions of Uttar Pradesh in India. In view of these facts,
we designed the study with the objective to study the prevalence of
domestic violence in all married female patients between 18 and 50
years of age attending psychiatric outpatient unit or being admitted in
the psychiatric inpatient unit for evidence of domestic violence.
Methods: 60 married female patients of domestic violence who would
be consecutively selected and would be found to be facing domestic
violence as per HITS (Hurt, insult, threaten and scream) criteria will
be evaluated using socio demographic data sheet and for psychiatric
co-morbidities using ICD-10 criteria. Severity of psychiatric disorders
would be assessed using Beck’s Depression Inventory (BDI), Hamilton
Anxiety Rating Scale and Clinician Administered post-traumatic
stress disorder scale (CAPS), Brief Psychiatric Rating scale (BPRS).
Appropriate statistical tools would be applied.
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Abstracts
Results and Conclusions: In the initial part of the study, we found
significant psychiatric co-morbidities in married female patients of
domestic violence, final results and conclusions would be discussed
later at the time of presentation.
Key words: Domestic violence, prevalence, HITS
Effectiveness of Awareness Program on Child Abuse on Good
Touch and Bad Touch for Adolescent Boys from Selected NGO
of Urban Slum, New Delhi
Kumari L, Gupta S, Singh M, Geetanjali
AIIMS, New Delhi, India. E-mail: laxmisainivd@gmail.com
Background: Adolescents are vulnerable group of our society and child
abuse and adolescent maltreatment is a serious issue. This is the group
where timely intervention will result in increased benefits. Childhood
maltreatment resulted in increased risk for psychiatric disorders. The
objectives of the study were to find out the awareness of child abuse
in adolescents,and to find out effectiveness of educational program on
child abuse and a good touch and bad touch for adolescent boys from
selected NGO of urban slum, New Delhi.
Methods: An experimental one group pre-post design was chosen
for the study. Fifty adolescents from an NGO- vocational centre, East
Delhi were included in the study. Tools: a demographic data sheet and
“Knowledge of Abuse Questionnaire” to assess the awareness of child
sexual abuse were used. For intervention, Video based educational
program of one hour was given to adolescents after pre-test followed
by discussion and post-test was taken after the program.
Results: Mean age of adolescents was 13 years (from age group
11 to19). The awareness of prevention of child abuse was less than
adequate , the score ranges from 12-25, 60% of the adolescents
reported that they were abused, 33% of adolescents were at the
age of 10 at the time of first incident, big boys and adults were the
most frequent abusers 93%. Most were abused by well-known to the
victim, 67% of never informed anyone about the incidence. Parents
were informed by 20% and 39% were told to keep the secret. There
was significant difference between pre-test and post-test scores, the
awareness program was effective overall but on sub-group analysis
efficacy seen only to appropriate touch but not on in-appropriate touch.
Conclusion: The intervention program was effective in enhancing
knowledge of good and bad touch and what action to be taken if
abuse occurs.
Comparative Study of Domestic Violence in Partners of Patients
with Alcohol Dependence and Schizophrenia
Deeman N, Singh P, Singh B, Gupta R
Institute of Mental Health, UHS Rohtak, India. E-mail: nehadhiman06@
gmail.com
Background: Partner violence is defined as behaviour within an
intimate relationship that causes physical, sexual or psychological
harm, including acts of physical aggression, sexual coercion,
psychological abuse and controlling behaviours according to The
WHO. Physical violence can be in the form of slapping, hitting or
beating, psychological abuse in the form of constant belittling or
humiliation and forced sexual intercourse or any other controlling
behaviour such as isolating a person from family and friends,
monitoring their movements and restricting access to information or
assistance. Links have been found between alcohol use and partner
violence as well as schizophrenia and partner violence although
other factors such as personality etc. also play role. So this study
is conducted to find domestic violence and its outcome on partners’
health. The objectives of the present study were to study domestic
violence in partners of patients with alcohol dependence, and to
study domestic violence in partners of patients with schizophrenia.
Methods: The data for the study was collected from patients visiting
institute of mental health and drug de-addiction centre of U.H.S. Rohtak.
30 consecutive patients each who meet the diagnosis of alcohol
dependence and schizophrenia according to ICD-10 will be enrolled in
the study. Partner violence will be measured using the scale-domestic
violence scale.
Results: to be discussed later
Conclusions: to be discussed later
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Women with Mental Illness and Intimate Partner Violence (IPV)
Kamran A, Gupta M
Maulana Azad Medical College, New Delhi, India. E-mail: akritikamran@
gmail.com
Background/Objectives: Intimate partner violence (IPV) is an
international public health problem that affects the lives of thousands of
people across the globe. Domestic or intimate partner violence is related
to significant physical and mental health consequences. The present study
aims to test prevalence of intimate partner violence in female subjects with
a mental illness. The study also aims to assess the sociodemographic and
clinical variables related with the occurrence of intimate partner violence.
Methods:100 consecutive female subjects visiting psychiatry OPD
of GB Pant Hospital, New Delhi and fulfilling the selection criteria
were recruited after informed consent. Mental illness was diagnosed
according to ICD-10 clinical guidelines. Semi-structured proforma for
sociodemographic and clinical characteristics of the subjects and WHO
domestic violence study questionnaire were used as assessment tools.
Statistical analysis used Chi-Square test, Fischer’s exact test and
Student’s t-test. A p-value <0.05 was taken as statistically significant.
Results: The prevalence of intimate partner violence (IPV) in female
subjects with mental illness was 27%. The subtypes of IPV reported
were physical violence 24%; emotional violence 27%; and controlling
behaviors 23%. Age between 20-40 years, lower socio-economic class,
unskilled occupation of the husband, agoraphobia/specific phobia,
somatoform disorders and dissociative disorders were the factors
found to be significantly (p<0.05) correlated with higher prevalence of
intimate partner violence.
Conclusion: Our study draws an important conclusion that females
with mental disorders carry the added burden of domestic abuse. Until
this hidden factor is addressed in females with mental illness, their
condition will not improve.
Key words: Intimate partner violence, mental illness, marriage
Effects of Spousal Emotional Violence on Reproductive Outcomes
of Women in India: Findings from Cross-Sectional Analysis of the
2005-06 National Family Health Survey
Tiwari S, Gray R, Jenkinson C, Carson C
Universityof Oxford, National Perinatal Epidemiology Unit, New Delhi,
India. E-mail: sucheta.tiwari@gmail.com
Background/Objectives: To assess the influence of spousal emotional
violence on reproductive outcomes of Indian women.
Methods: Data on 47,381 women, collected as part of the Third Indian
National Family Health Survey were analysed to assess the impact of
emotional violence (alone, and where reported alongside sexual and/or
physical violence) on seven reproductive outcomes: age at first birth,
number of children, terminated pregnancies, unwanted pregnancies,
access to prenatal care, to skilled delivery care, and breastfeeding.
Multivariable logistic regression was used to compare poor outcomes
among women who experienced emotional violence and those who
did not, adjusting for confounding factors.
Results: Some 18% of women reported emotional violence; 4%
experienced emotional violence in the absence of sexual or physical
violence. Women reporting “any emotional violence” were significantly
more likely to report a first birth under 18 years, a greater number
of children, more terminated pregnancies and more unwanted
pregnancies, compared to women who had never experienced any
form of spousal violence. They were also less likely to access prenatal
and skilled delivery care. However, emotional violence alone was not
significantly associated with any of the outcomes.
Conclusion: Spousal emotional violence is associated with poor
reproductive outcomes but is rarely seen in the absence of physical
and/ or sexual violence.
Key words: emotional violence, reproductive health, women's health,
gender
Intimate Partner Violence and Women's Agency: Evidence from
Rural Indian Mothers
Richardson R, Schmitz N, Nandi A, Harper S
McGill University, #3, 4055 Drolet, Montreal, Quebec, Canada. E-mail:
robin.richardson2@mail.mcgill.ca
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Abstracts
Background/Objective: Intimate partner violence (IPV) might be a
barrier to women’s agency. We estimated the association between IPV
and aspects of women’s agency among women in rural Rajasthan, India.
Methods: We interviewed 3141 married women with young children
living in 160 village hamlets (participation rate = 89%). We measured
IPV exposure with questions pertaining to emotional abuse and
physical abuse. We measured women’s agency with questions about
involvement in household decisions, spending of household income,
and freedom of movement. We estimated the association between
exposure to IPV and women’s agency using logistic regression models
that controlled for potential confounding variables (i.e., age, income,
wealth, education) and clustered standard errors at the hamlet level. We
expressed results as the difference in the prevalence of having agency
due to exposure to violence (i.e., prevalence difference).
Results: Many women reported emotional abuse (33%) or physical abuse
(37%) by their partner. The majority of women were free to travel alone to
all locations within their villages (80%), although less than half of women
were involved in all household decisions (35%) or all decisions regarding
spending of household income (48%). Women who experienced emotional
abuse were less likely to have freedom to travel alone (difference= 0.05,
95% CI: 0.01, 0.09), to be involved in household decisions (difference=
0.07, 95% CI: 0.03, 0.12), or to be involved in decisions about family income
(difference= 0.09, 95% CI: 0.04, 0.14). Women experiencing physical
abuse were less likely to have freedom to travel alone (difference= 0.04,
95% CI: 0.00, 0.08), to be involved in household decisions (difference=
0.10, 95% CI: 0.06, 0.15), or to be involved in decisions about family
income (difference= 0.13, 95% CI: 0.09, 0.17).
Conclusion: We found IPV associated with low agency. Future
research using longitudinal study designs could investigate if IPV
leads to low agency.
Sequential Integrative Psychotherapy in Complex Posttraumatic
Stress Disorder: A Case Report
Nebhinani N, Basu D
AIIMS, Jodhpur, Rajasthan, India. E-mail: drnaresh_pgi@yahoo.com
Background/objectives: Post-traumatic stress disorder (PTSD)
is a whole-body tragedy, a complex event of enormous proportions
with massive repercussions for entire life. This case report details
psychotherapeutic management of a young male who was kidnapped,
tortured and subsequently presented with complex PTSD.
Casedetails: A 20 year old male, from northern India was allegedly
abducted by his classmates and was badly beaten up. Following that he
became fearful and started re-experiencing traumatic event repeatedly.
After few months he also started repeating sentences spoken by family
members and touching/ slapping to nearby persons. Such behaviors
were repetitive, intrusive with intense distress on resisting them and
despite feeling absurd he would repeat or do those for a fixed number
of times. He would remain irritable and sad with frequent unprovoked
anger outbursts. He was diagnosed with OCD mixed thoughts and
acts and Reaction to severe stress NOS (Complex PTSD). During
hospital stay, his significant problems were violent behavior, poor
compliance for therapies/ instructions, rigid and blaming attitude, with
one episode of trauma re-enactment. He received Olanzapine 20 mg,
Clomipramine 250 mg, Fluoxetine 40 mg, Clonazepam 2 mg.Later in
view of minimal improvement with above measures, we have added
three-phase sequential integrative psychotherapy (alliance formation
and stabilization, trauma processing, and functional reintegration).
He had significant improvement in affective/behavioral disturbances,
interaction with others and trauma related memories but minimal
improvement in obsessive compulsive symptoms.
Conclusions: Sequential integrative psychotherapy with antidepressants
have shown good outcome in index case. It calls for psychiatrists’
awareness and expertise for effective management of such cases.
Key words: Sequential Integrative Psychotherapy, Complex
Posttraumatic Stress Disorder, PTSD
Role of NGO and Hospitals in Provision of Sustainable Mental
Health Services in Cases of Domestic Violence in Pakistan
Mansoor T
Fatima Jinnah Women University, Islamabad, Pakistan. E-mail:
itstaskeen@gmail.com
472 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
With the introduction of the SDG’s, mental health has been
recognized as one of the health related development goals. This
paper examines the role of NGOs and hospitals in the provision of
mental health services for cases of domestic violence in Pakistan.
In the first phase of the study, the various facilities in the form of
helplines, clinics, healing or rehabilitation centers for individuals,
and families affected by domestic violence were explored. Next,
semi-structured interviews were conducted with the representatives
from hospitals and NGOs to assess the functions and policies related
to these facilities.
The results showed that NGOs have helplines which provide counselling
support to women, youth and children. It specifically addresses violence
against women, child sexual abuse, sexual and reproductive health,
and other psychological and emotional concerns. There is telephonic,
email, letter, group and in person counseling. In crisis cases, e.g. acid
burn or child abuse victims, there is also referral for medical or legal
support along with shelter. This strength based counseling, awareness
of rights and intervention services assist youth and families to realize
their life goals despite past experiences of abuse or violence. In most
tertiary care hospitals, health care personnel in emergency department,
general practitioners and family physicians usually are the first point of
contact for the cases of domestic violence. These doctors and nurses
are trained to screen for domestic violence in suspected cases, and
refer them to the medico-legal department for further support and
management. Sadly, a vast number of such cases go undetected due to
inadequate screening protocols. Departments of Psychiatry and mental
health at hospitals manage clinical manifestations and psycho-social
sequel of domestic abuse such as depression, anxiety, sleep difficulties
and post-traumatic stress disorder. For long term rehabilitation, further
resources are needed.
Key words: NGO, Hospitals, Domestic Violence, Mental health
Intimate Partner Violence and its Association with Common Mental
Disorders Among Spouses of People with Alcohol Dependence
Syndrome
Deepthi VH, Bhat A, Rao R, Cherian AV
Department of Psychiatry, K S Hegde Medical Academy, NITTE
University, Deralakatte, Mangalore, India. E-mail: dr.deepthi.vh@
gmail.com
Background: Spouses of people with Alcohol Dependence Syndrome
(ADS) experiencing Intimate Partner Violence (IPV) is increasingly
being seen as a major mental and physical health concern. Alcohol
related problems along with IPV faced by the women have been
associated with increased common mental disorders (CMDs), poor
quality of life with increased burden imposed on women. Though IPV
and mental health problems among spouses of people with ADS are
often encountered, it has nt received adequate research attention.
The objective of the present study was to study the prevalence of IPV
and CMDs and their interrelation among spouses of people with ADS.
Methods: A cross sectional study was done on 65 spouses
(participants) of people with ADS admitted in the inpatient deaddiction
services. Alcohol Use Disorder Identification Test (AUDIT) was applied
to note the pattern of alcoholism. Participants were administered with
Self Reporting Questionnaire20 (SRQ20). Those who had a score of
6 and above on the SRQ20 were administered with specific modules
of M.I.N.I. International Neuropsychiatric Interview PLUS to obtain
specific diagnosis of CMDs. Privacy was ensured and the participants
were administered with Demographic and Health Survey Tool, Domestic
Violence Module (DVM) to assess the IPV.
Results: The sample consisted of spouses with a mean age of 35.9
(7.39) years. The mean AUDIT score and the duration of alcohol
consumption of people with ADS was 29.9 (4.5) and 17.3 (7.7) years
respectively. IPV was present either in the form of emotional, physical
or sexual violence (84.6%). Physical (72.3%) and emotional violence
(66.2%) was noted to be the most commonly experienced violence
followed by sexual violence (30.8%). The emotional violence was found
to be associated with CMDs (p <0.05).
Conclusion: The results stress the need to develop and integrate
psychosocial interventions focusing on the spouses of people with ADS
and to integrate in the routine deaddiction Programme.
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Abstracts
POSTERS DAY 4 AFTERNOON
Quality of Life and Mental Health
New Quality of Life Scale in Ukraine: Reliability and Validity
Khaustova O, Chaban O, Bezsheyko V
Ukrainian research institute of Social Psychiatry, Road Clinical Hospital,
Kyiv, Ukraine. E-mail: oksana.v@dinadis.ua
Background/Objective: Patient`s quality of life is one of the principal
component in clinical decision-making. Unfortunately to date there
isn`t any brief quality of life scale for which reliability and validity was
established on the Ukrainian and Russian-speaking population.The
objective of the study was to assess the reliability and validity of the
Chaban Quality of Life Scale (CQLS).
Methods: 102 Ukrainian young volunteers in the age 19-30 years
were evaluated with 2 quality of life scales CQLS (10-item scale) and
Q LES-Q-SF. The retest was done at 3-7 days after initial assessment.
Results: Overall both scales had acceptable internal consistency
with Cronbach`s α 0,804 in Q-LES-Q-SF and 0,905 in CQLS. The
first scale had lower internal consistency because of relatively low
correlation of items 3 and 13 with total score. The correlations matrix
with assessed variables revealed high association between Q-LES-Q-
SF and CQLS (r=0,845; p<0,001) and low but statistically significant
correlation (spearman coefficient) between both scales and presence
of the disease. Correlation coefficient between test and retest scores
confirmed reliability of CQLS (r=0,923; p<0,001) and Q-LES-Q-SF
(r=0,862; p<0,001) (Table 2). Principal component analysis of CQLS
extracted only 1 factor (component) which proves unidimensional
nature of the scale. The same analysis for Q-LES-Q-SF revealed 4
components that reflect not homogeneous construct.
Conclusion: Both scales have acceptable internal consistency, test-
retest reliability, convergent and discriminant validity with slightly better
estimates in CQLS. The latter scale had also preferable construct validity.
Together with small number of items this makes CQLS a good candidate
for evaluation quality of life on Ukrainian and Russian-speaking population.
Quality Of Life Among People With Psychiatric Disabilities - Does
Day Centre Attendance Make A Difference?
Argentzell E, Tjörnstrand C, Eklund M
Lund University, Department of Health Sciences, Occupational Therapy
and Occupational Science Box 157, SE 221 00 Lund, Sweden. E-mail:
elisabeth.argentzell@med.lu.se
Background/Objectives: the purpose of the study was to investigate:1)
How people with psychiatric disabilities (PD) who attend day centres
experience their quality of life compared to non-attendees, 2) if there
are any differences in quality of life between those who attend meeting
place-oriented centres and those who attend work-oriented centres,
and 3) Possible correlates of quality of life among day centre attendees.
Methods: 175 participants, 93 attended a day centre and 82 did not.
39 of the 93 attendees visited meeting place-oriented day centres
and 54 attended work-oriented ones. Self-ratings and interview-
based instruments were used to assess quality of life, occupational
engagement, and motivation to attend a day centre, hours spent at day
centre, self-mastery, and socio-demographic factors. Non-parametric
statistics were used when analysing the data.
Results: There were no differences between day centre attendees and
non-attendees regarding quality of life. Nor was there any difference
between participants from the two day centre orientations. Factors related
with a good quality of life were high levels of self-mastery and motivation.
Conclusion: Attending a day centre does not appear to generate greater
quality of life for people with PD, but promoting day centre attendees
self-mastery and motivation might enhance their quality of life.
Correlation of Quality of Life to Spirituality, Religiosity and
Personal Beliefs of Caregivers of Patients with Mental Illness: A
Cross-Sectional Study
Gupta S, Kataria D, Verma R, Ramesh OS, Prasad S
Room no 118, House Surgeon Block, Lady Harding Medical College,
and Connaught Place, New Delhi. E-mail: dr.sakshi.lh06@gmail.com
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Background/Objectives: To assess the quality of life (QOL) in domain
of spirituality, religiosity and personal beliefs (SRPB) of caregivers of
patients with mental illness, and to study the correlation amongst the
QOL and SRPB.
Methods: A cross sectional study was conducted in the Department
of Psychiatry, Lady Harding Medical College, New Delhi. Hundred
caregivers of individuals with an Axis 1 disorder (ICD-10), meeting the
inclusion criteria were recruited by random sampling. Written informed
consent was taken. Hindi version of WHO Quality of Life- Brief version
(WHOQOL-BREF), WHOQOL-SRPB and MINI were administered in
the caregivers. Student’s t-test, ANOVA and Pearson’s correlation
coefficient were used to analyse the data using SPSS 17.
Results: The mean score of QOL in the caregivers was 83.51 ± 12.52
and SRPB was 04.08 ± 15.83. QOL was highest in caregivers of patients
with anxiety disorders and least in psychotic disorders. QOL decreased
with an increase in duration (p=0.001) and hours (p=0.004) of caregiving
and increased number of hospitalisation of patients (p=0.001). A higher
QOL and SRPB were associated with upper socio-economic status.
Moreover, QOL and SRPB were positively correlated with each other
(r=0.578).
Conclusions: The quality of life of caregivers is affected by psychiatric
illness in the patient. The spirituality, religiosity and personal beliefs enhance
the quality of life of the caregivers; subsequently aids in maintaining the
mental health of patient and in improving the family functioning.
Key words: Quality of life, caregiver, spirituality, religiosity, personal
beliefs
A Study on Quality of Life and Metabolic Profile in Schizophrenia
Patients who are Receiving Treatment in Outpatient Setting
Srivastava S, Bhatia MS, Sharma A
University College of Medical Sciences & Guru Teg Bahadur Hospital,
Delhi. E-mail: srivastava_shruti@hotmail.com
Background/Objectives: Schizophrenia, a severe mental illness
has an impact on quality of life (QOL) of the patients. The purpose
of the study was to assess QOL, metabolic profile, severity of illness
in patients of schizophrenia who are already receiving antipsychotic
medication.
Methods: A cross-sectional study in 92 patients of schizophrenia who
were stable, were administered quality of life instrument (WHOQOL-
BREF), disease severity (PANSS), duration of illness, Body mass
index, lipid profile, blood sugar estimations, waist circumference and
blood pressure were noted.
Results: Positive and negative symptoms of schizophrenia (PANSS
Scores) and duration of illness showed significant negative correlation with
physical, psychological, social and environment domains of WHOQOL-
BREF. Out of the 92 patients of schizophrenia, detection of dyslipidaemia
(N=33), Diabetes (N=5) MI>25(N=51). Triglycerides levels also correlated
significantly with physical, environment domains of WHOQOL-BREF.
Typical or atypical antipsychotics did not make any significant difference
in the metabolic profile (waist circumference, BMI, blood pressure, blood
sugar, lipid profile) of the patients with schizophrenia.
Conclusion: Metabolic profile and severity of illness may be
considered as factors that contribute to poor quality of life in patients
of schizophrenia.
Bigorexia: A Case Report
Shouan A, Balachander S, Singh SM
PGIMER, Chandigarh, India. E-mail: anishshouan@gmail.com
Background: Bigorexia, formerly called Reverse Anorexia Nervosa
and formally termed Muscle dysmorphia is a rare disorder described
typically in men, characterised by a body image distortion of being too
thin, and an excess preoccupation with trying to gain weight or muscle
mass. Reports of women presenting with this disorder are emerging,
albeit rare in scientific literature. We report a case of a 20 year old
female, with obesity along with an excess preoccupation to gain even
more weight in order to look physically attractive.
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Abstracts
Case description: The patient presented with a three years history of a
belief that she was not fat enough, and that she would appear attractive
only if she put on more weight. Despite repeated attempts by family,
friends and doctors to reason with her, she started eating very large
portions of meals, high in fat content, along with weight gainers. She
also wore multiple layers of large, loose clothing and wrapped clothes
around her abdomen so as to look fatter. Though she agreed to the
prevailing notion of thin-ness being more attractive for others, she would
insist on the opposite in her case. She repetitively checked her weight,
kept looking at mirrors and sought reassurances from others if she was
fat enough. There was also an associated exaggerated concern about
facial acne and hyper pigmented scars, with excess use of make-up
to hide the lesions. She was tried previously on many medications
including anti-psychotics, mood stabilizers, anti-obsessionals which
did not result in any improvement. With behavioural measures along
with Fluoxetine 80 mg there was some improvement in her symptoms.
Conclusion: Bigorexia is a rare condition but needs to be considered.
Key words: Bigorexia
SSRI-Induced Sexual Dysfunction & Quality of Life
Mehta P, Gupta M
Maulana Azaad Medical College, New Delhi, India. E-mail: parth.
athem@gmail.com
Background/Objective: SSRI induced sexual dysfunction is
the commonest side effect and has a major impact on treatment
compliance. The present study aims to assess the quality of life in
male patients (currently in remission from depressive episode) having
SSRI-induced sexual dysfunction.
Methods: The study was a cross sectional hospital based observational
study, conducted among male patients visiting the O.P.D. of Department
of Psychiatry, G. B. Pant Hospital, New Delhi. 75 male patients fulfilling
the selection criteria were taken and semi-structured proforma,
Arizona Sexual Experiences Scale-Hindi version & WHO Quality
of life (WHOQOL)-BREF Hindi Version were applied. Results were
obtained using statistical methods like Chi-Square test, Student’s t-test
& Pearson correlation coefficient.
Results: The prevalence of sexual dysfunction in males on SSRIs
was 36% in our study. There was statistically significant lower Quality
of Life (QOL) scores in patients having sexual dysfunction (p< .001)
& there was negative correlation between sexual dysfunction (ASEX
total score) and all the domains of WHO-QOL BREF scale and its total
score (r=-0.690, p<0.01).
Conclusion: Even though the patients in our study had achieved
clinical remission from their depressive episode, SSRI-induced sexual
dysfunction leads to a poorer quality of life in them as compared to
those without this side effect. Hence identification and management
of this adverse effect is necessary to improve the overall outcome of
the depressive episode.
Key words: Antidepressant, Sexual dysfunction, Quality of Life
Quality of Life of Rural Secondary School Children in Karnataka
Sumathi R, Ramachandra, Parthasarathy R
Department of Nursing, NIMHANS, Bangalore, India. E-mail:
sumathirkas@gmail.com
Background/objectives: In the last decade, interest in QOL has
been generated as part of the larger drive toward Health for All and
the promotion of physical, mental and social well-being. WHO defined
quality of life as an Individual’s perception of his/her health position
in the context of the culture and value system, in which he/she lives
and in relation to his/her goals, expectation, standard and concern.
It is a broad ranging concept incorporating in a complex way the
person’s physical health, psychological state, level of independence,
relationship to salient feature of their environment. The school children
in our society go through an especially stormy period of life before they
become adults. Studies on quality of life among the school children
have been researched in the developed countries. The present study in
an attempt to study the quality of life of rural secondary school children
in Karnataka State of India
Methods: The present study has adopted descriptive research design
as a method of research for the current study. The study assessed the
474 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
quality of life of 600 rural school children of Karnataka and examined
with various socio-demographic variables.
Results and conclusion: The overall quality of life of the rural school
children score is varied from 62.00 to 110.00. The mean score of quality
of life of the rural school adolescent children is 88.13 with the standard
deviation of 9.13. Highly significant difference is found between the
mean scores of overall quality of life of the rural secondary school
children from the Kannada medium government school, Kannada
medium private aided school, English medium private unaided school
and Kannada medium private unaided school and the difference
assumes statistical significance.
Key words: Quality of life, Rural School, Children
Quality of Life and Burden of Caregivers of Chronic Mentally Ill
Patients
Kondapuram N, Pathak A, Muliyala KP, Angothu H, Thirthalli J,
Chaturvedi SK
NIMHANS, Bengaluru, India. E-mail: kondapuramnithin@gmail.com
Background/Objectives: Caring for those with Psychiatric disorders
requires tireless effort, energy and empathy. This greatly impacts the
daily lives of caregivers. The consequences of care-giving for mentally
ill persons have been associated with burden reflected in their physical
and psychological health of the caregiver. Despite the large number
of caregivers suffering from significant stress and burden, research
in South India, especially in chronic mentally ill is very minimal. The
current study examined perceived burden and its influence on the
Quality of Life in caregivers of persons suffering from severe and
persistent psychiatric illness attending day care services in a tertiary
care hospital in urban city of South India
Methods: 56 Caregivers of persons suffering from mental illness
of three groups viz., Schizophrenia, Affective Disorder and Mental
Retardation attending the day care services of a tertiary psychiatry
hospital were assessed on and World health organization Quality of Life
-Bref (WHOQOL-Bref) and Zarit Burden interview. Data was analyzed
using SPSS software.
Results: More than 2/3 (38) of caregivers had reduced quality of life in
the domains of physical health, social relationships and environment
Burden was moderate to severe in almost 50% (29) of cases. Among
the three groups, caregivers of Schizophrenia had the poorest QoL
and highest burden
Conclusions: Caregiving often results in chronic stress, which
comprises caregiver’s physical psychological health. The findings
from this study suggest that caregivers need social support and family
intervention programs to cope with the burden of care-giving and
enhance their quality of life.
Key words: Caregivers, Perceived burden, Quality of Life, Chronic
mentally ill
Prevalence of Psychiatric Disorders in Coastal Karnataka
Singh S, Sharma PSVN, Rao GS, Sreejayan K
Kasturba Medical College, Manipal, India. E-mail: singhsunny@live.ca
Background: According to the World Health Organization (WHO),
mental health disorders are one of the leading causes of disability
worldwide. Epidemiological studies report prevalence rates from 9.5
to 370/1000 populations in India. Most of the epidemiological studies
done in India neglected anxiety disorders, substance dependence
disorders, co-morbidity and dual diagnosis. In Southern India, little
is known about the extent, severity and unmet need of treatment
mental disorders. Thus, there was a need to carry out general
population surveys that estimate the prevalence of mental disorders
among rural population in Coastal Karnataka. The study attempted to
address unmet needs and to form a basis for formulating the mental
health need of the community. The aim was to study the prevalence
of psychiatric disorder in coastal Karnataka. The objectives were to
study the prevalence of Psychiatric disorders in the community from
coastal Karnataka, and to compare the quality of life of patients with
different diagnosis.
Methods: One panchayat from Udupi district, Karnataka was selected
for the study. The whole population was screened on GHQ - 28 by a
grass root worker who was trained in administration of the tool. Subjects
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Abstracts
who scored more than 10 on GHQ were clinically interviewed by a
consultant psychiatrist and a diagnosis based on ICD 10 was made.
WHO-QOL Bref was administered to assess the quality of life.
Results and Conclusion: Data collection is over. Data entry and
analysis is going on. The results will be presented at the conference
Prospective Change in Quality of Life of Patients with Substance
Use Disorder with and without Co-Morbid Psychiatric Illness after
Inpatient Deaddiction Treatment Programme
Baby RS, Gupta S, Varghese PJ
MOSC College of Nursing, Kolenchery, Ernakulam, Kerala, India.
E-mail: renjususane@gmail.com
Background: Substance use disorder is viewed as a chronic relapsing
disorder which consists of a course of remissions and relapses that
negatively affects all spheres of life of the substance user. The quality
of life is an area that plays a significant part in the recovery process of
individuals having substance use disorder. The aim of the study is to
assess the prospective change in quality of life following De-addiction
treatment programme among patients having substance use disorder
(SUD) with and without co-morbid psychiatric illness.
Methods: Quantitative approach, prospective cohort design was used
for the study. 200 patients having SUD admitted for 31 days inpatient
De-addiction treatment program at MMM De-addiction center, Kolenchery
between January to November 2014 and who met the inclusion criteria
were enrolled using total enumeration method. WHO Quality of Life (QOL)
BREF scale were used to assess quality of life. Ethical clearance was
obtained from the Institutional Review Board; informed written consent
was taken prior to data collection. The QOL was assessed on the day
of enrollment at 3, 6 and 12 months after discharge.
Results: QOL scores in all four domains was low for both the groups
at baseline There was a significant improvement in all domains at
3 months post treatment in both groups(p=0.001). There was no
significant change in the mean QOL scores in all four domains after
three months until12 months after treatment respectively. SUD subjects
without co-morbid psychiatric illness and who remained sober had
significantly higher quality of life than those subjects with co-morbid
psychiatric illness at 12 months than those with co-morbid psychiatric
illness and who relapsed to their substance use. Conclusion SUD
patients with co-morbid psychiatric illness are more susceptible to
develop recurrent relapses thereby resulting in poorer quality of life.
Prevalence and Clinical Correlates of Somatic Symptoms
in Patients with Schizophrenia and Related Disorders: An
Exploratory Study
Mahapatra A, Verma R, Sood M, Chadda RK
All India Institute of Medical Sciences, New Delhi. E-mail: nnyaa09@
gmail.com
Background/Objectives: Somatic symptoms in schizophrenia have
been reported but mostly in the context of co-morbid physical illnesses.
There is limited knowledge regarding theprevalence and presentation
of somatic symptoms in the absence of physical illness, in patients
with schizophrenia and related disorders. This study aims to explore
the prevalence of and the clinical correlates of somatic symptoms in
patients with schizophrenia and related disorders.
Methods: A cross-sectional study of 20 adult subjects (18-60 yrs.)
with schizophrenia and related disorders according to ICD10 of a
total duration of >=2yrs. A semi-structured performa was used to
obtain patient details, and Hamilton Rating scale for Depression
(HAM-D), Scale for assessment of Positive Symptoms (SAPS), Scale
for assessment of negative symptoms (SANS), and Patient Health
Questionnaire-15 (PHQ-15) were applied.
Results: The mean age of the patients was 32.5±18.1 yrs. Seventy-
five percent were men and 25% were women. The mean duration of
illness was 8.3 yrs. The mean SAPS score was 50±9.3 and the mean
SANS score was 69±12.7 in the patients. The mean PHQ-15 score was
7.93±4.2 indicating mild level of somatisation. The symptom distribution
constituted 75% positive symptoms, 70% negative symptoms, and 20%
disorganisation. The mean HAM-D score was 10.95±2.47. Amongst the
physical symptoms, low physical energy predominated (65%), followed
by pain related symptoms (60%) and gastrointestinal symptoms (60%).
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Conclusion: Although the patients overall reported mild levels of
somatisation, particular somatic symptoms were observed more
frequently in patients of schizophrenia related disorders. Further studies
are required to delineate the clinical correlates of these symptoms so
they can be factored in while planning for interventions.
Key words: Schizophrenia, somatic symptoms, somatisation
Quality of Life in Patients with Fungal Infection of Nose and
Paranasal Sinuses: A Study from North India
Kaushal T, Gupta N, Chavan BS, Singhal S, Arshad R, Chander J
All India Institute of Medical Sciences, New Delhi. E-mail:
tanujakaushal19@gmail.com
Objective: Fungal infections of nose and paranasal sinuses have a
protracted course with frequent relapses and recurrences. Quality of
life (QOL) of such patients is severely affected. The aim of this study
was to assess quality of life of patients with fungal infection of nose
and paranasal sinuses. The objective was to assess disease specific
QOL, health related QOL and global QOL.
Methods: Cross sectional assessment was carried out on thirty patients
with the diagnosis of fungal infection of nose and paranasal sinuses.
Results: The total SNOT score was indicative of 'moderate degree
of problem'. Regarding generic QOL, as assessed using WHOQOL-
Bref, the sample had overall moderate QOL and also in all domains.
On the other hand, on the SF-36, highest scores were obtained on
the individual domains of 'Physical functioning' and 'Pain' with lowest
scores on the domains of 'General health' and 'Role limitation due to
Physical health'.
Conclusion: It can be concluded that Indian patients with fungal
rhinosinusitis report moderate degree of QOL on both disease specific
(SNOT-20) and global (WHOQOL-Bref) scales with mild to moderate
limitation on health related QOL scale (SF-36).
Key words: Quality of life, paranasal sinuses, generic, disease-specific,
psychological
Stigma to Mental Illness
Attitudes of Dental Interns Towards Mental Illness
Uvais NA, Rasmina V, Sreeraj VS
IQRAA International Hospital and Research Centre, Calicut, Kerala,
India. E-mail: druvaisna@gmail.com
Background/Objectives: Dental illness and psychiatric illness are
among the most prevalent health problems all over the world. Evidence
suggests that people with mental illness are more vulnerable to dental
neglect and poor oral health. Health care professions including dentists
are not immune to social prejudices and share the general public's
attitude attributed to people with mental illness, affecting quality of
care. The aim of the study was to determine the extent to which dental
interns are formally prepared to care for patients with mental illness, by
assessing their attitudes towards people with mental illness.
Methods: Cross-sectional descriptive design was adopted for the
present study. A total of 36 dental interns were purposively selected
to complete self-reported questionnaires, which consist of four items
to seek the background of the participants in the study, which include
age, gender, residence and contact with persons with mental illness and
Attitude scale for mental illness (ASMI), which is a valid and reliable,
self-report measure of attitudes.
Results: Dental interns have significant positive attitudes towards
mental illness in two of the six attitudes factors: Benevolence
(30.58±3.14) and stereotyping (5.61±1.02). However, they have
negative attitudes in stigmatization (10.08±3.02), separatism
(26.33±4.83), restrictiveness (10.08±2.96) and pessimistic predictions
(13.47±3.61) domains as they rated high.
Conclusion: The findings of the present study have important
implications for care of persons with mental illness and thereby on
dental training. Thus, academic education from courses in this area
must be planned so as to favour the change in the attitudes and promote
a commitment to provide holistic care to people with mental illness.
Key words: Academic education, attitudes, mental illness, dental
interns
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Abstracts
Voices of the Unheard: Experiences and Perceptions of
Motherhood in Mothers with Severe Mental Illness-A Qualitative
Perspective
Banerjee D, Desai G, Chandra PS
National Institute of Mental Health &Neurosciences, Bangalore, India.
E-mail: dr.Djan88@gmail.com
Background/Objective: Desire of the female to bear children can
surpass the most extreme of situations. Over and above that, majority
of mentally ill women are mothers with increasing number of them
seeking help. Little is known about their own experiences in this regard
and the extent to which their needs are met. The objective of the study
was to assess the needs and experiences of pregnancy & motherhood
in women with severe mental illness.
Methods:The study used qualitative design with social constructivist
paradigm. A purposive sample of 30 mothers with severe mental illness
was obtained. Data was collected through one-to-one in-depth semi-
structured interviews. After verbatim transcription, inductive thematic
analysis was used to explore transcripts.
Results:The varied experiences were arranged along the pre-
pregnancy and post-pregnancy timelines. Overall: feelings for the child
(ambivalence, possessiveness, and guilt), impact of illness (stigma,
symptoms, and medication), unmet needs (for shared responsibility,
emotional support, and support groups) & caregiver reaction (blame,
discrimination, custody threats) appeared as the main categories (and
themes). Most women considered motherhood “central” to their lives &
almost all of them experienced the burden of “a dual role”. A widespread
idea that mentally ill women cannot be “good mothers” was common
and the services for parenting were inconsistent and lacking.
Conclusions:Women who are mothers and also users of mental
health services do prize motherhood though facing special challenges
in managing the contradictory aspects of their dual identity. Hearing
their voices are essential for service provision and ensuring adequate
mental health needs. Strategies to understand and address their unmet
needs are critical for the well-being of both mother and child.
Casting Off Demons? When Faith Healing Precedes Medical Care
in Psychiatric Illness
Jose N, Elwadhi D, Makkar D
GB Pant Institute of Post graduate Medical Education and Research,
New Delhi, India. E-mail: nimjos10@yahoo.com
Background/Objectives: This study was planned to evaluate the
proportion of mentally ill patients attending a tertiary mental health
facility in New Delhi who first resort to faith healing before seeking
medical help.
Methods: 50 patients who attended the Out Patient Department of
Psychiatry, Govind Ballab Pant Institute of Post Graduate Medical
Education and Research (GIPMER), New Delhi, India for the first time
were enrolled for the study. The family members of the patients were
interviewed to evaluate the pathway to care using structured clinical
proforma. The data was analyzed using Microsoft excel version 12.0.
Results: 56% of patients resorted to faith healing, of which 40%
reached for faith healing prior to seeking medical care. 16% of patients
resorted to faith healing after first going for medical care. Amongst
those who went for faith healing, maximum number of cases were of
psychotic disorders and anxiety disorders (21% each), followed by
depressive disorders (17.9%) and somatoform disorders (14.3%). The
common types of faith healing were taweez/holy prescription (53.6%),
holy thread (50%), spiritual healer (39.3%), visit to shrine and using holy
water (35.7% each). 82% resorted to two or more types of faith healing.
Conclusion: Faith healing is a fairly common resort in the pathway
to care of mentally ill patients. It could be due to ingrained religious
beliefs as well as well as the stigma associated with mental illness. A
dearth of trained mental health professionals in India could also be a
possible reason as to why faith healing is so popular in the Indian setup.
Key words: mental illness, faith healing, stigma
A Qualitative Study to Explore the Perception About “Marriage”
of Person with Mental Illness Among Mentally Ill Patients
Sharma N, Pramod, Sandhya, Sandeep
PGIMER, Chandigarh, India. E-mail: nitasha470@yahoo.com
476 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Marriage is considered to be a customary practice & sacrament in Indian
society. While every person has a right to marry, marriage of person
with mental illness has always been a controversial issue taking into
account various factors associated with marriage like risk of relapse,
inability to carry out responsibilities arising out of marriage, high
probability of marital discord etc. The present study aimed to explore
the perception about marriage of person with mental illness among
mentally ill patients using qualitative research approach. A total of thirty
patients with a known psychiatric illness were interviewed during their
lucid intervals to explore their perception about marriage of person
with mental illness. The in-depth interviews were audio taped and then
transcribed. The thematic analysis was done to identify underlying
perceptions. Almost 50 % of subjects felt that person with mental illness
must get married. The underlying factors included family proliferation,
family happiness, social productivity, custom and marriage as a human
right. The exploration on how marriage can affect the course of mental
illness was done. The issues of revealing the illness to other party were
too explored in depth.
Key words: Marriage, Mental Illness, Qualitative
Stigma And Discrimination Faced By Mentally Ill Patients And
Their Care Givers: A Pilot Study
Annamalai A
Department of Psychiatry, Stanley Medical College, Chennai,
Tamilnadu, India. E-mail: arunkoc2003@gmail.com
Background/Objectives: Mentally ill patients face stigma and
discrimination in the form of poor access to treatment, social isolation
and lesser education and work opportunities. In addition, caregivers
of the mentally ill patients face stigma and discrimination in various
forms. We aimed to explore various types of stigma and discrimination
faced by mentally ill patients and their care givers.
Methods: Between August 2015 and March 2016, we conducted 20 in-
depth interviews with 10 Male patients and 10 female patients attending
psychiatry outpatient department of government tertiary care center
(who could give consent and were able to take part in the interview)
and their care givers (N=20). Key informants (N=10) were health care
providers (Psychiatrists=4, Psychologists=3 and private rehabilitation
center founders =3). Audio recorded interviews were transcribed and
translated; and analyzed thematically using NVivo10.
Results: The mean age of the participants was 36.3 years. They
came from middle and lower socio-economic status. Self-Stigma and
self-discrimination was reported by majority of the people in the form
of not applying for a job, not applying for education or training courses
and stopping oneself from having a close personal relationship. Other
forms of stigma and discrimination were faced among friends who
ostracised them, neighbourhood people did not treat them well, and
education was denied, marriage was ended, family inheritance was
denied, employment was refused and housing not provided.
Conclusions: Care givers faced courtesy stigma in the form of denial
of housing, marriage denied because of having a mentally ill patient
at home and social isolation during festivals, household events
and functions. Large scale awareness program among the general
population was stated as the main need by the key informants. Further
research is required to develop an intervention program specifically
aimed to reduce various forms of stigma and discrimination for mentally
ill patients and their care givers.
Barriers to Mental Health Seeking Behaviour of Rural Male to
Female Transgender/MSM: A Qualitative Study
Annamalai A
Department of Psychiatry, Stanley Medical College, Chennai,
Tamilnadu, India. E-mail: arunkoc2003@gmail.com
Limited studies illustrate that there is a paucity of information on the
mental health seeking behaviour of urban Indians. We conducted an
exploratory study to analyse the barriers to mental health seeking
behaviour of urban south Indians. Between October 2015 and March
2016, we conducted 40 in-depth interviews with 20 Male patients and
20 female patients attending outpatient department of government
tertiary care center (who could give consent and were able to take
part in the interview). Key informants (N=10) were health care
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Abstracts
providers (Psychiatrists=4, Psychologists=3 and private rehabilitation
center founders =3). Audio recorded interviews were transcribed and
translated; and analyzed thematically using NVivo10. The mean age
of the participants was 33.7 years. They came from middle and lower
socio-economic status. Most of them stated stigma and discrimination
as the major reason for not seeking mental health immediately. Self-
stigma, fear of being called “Paithiyam” or “mental”, fear of losing job,
fear of losing life partner, fear of losing the significant others were cited
as major personal barriers in addition to the belief that mental illness
cannot be cured. Majority of them thought that mental illness is caused
by Spiritual possession, Evil eye, and Sinful acts. Low significance
associated with mental health, lack of awareness on mental health
disorders, ignorance on where mental health services can be obtained
and approaching traditional healers and/or religious leaders emerged
as the societal factors. Large scale awareness programs among the
general population are necessary to address these barriers. Programs
should also emphasize on the importance of mental health and their
inclusion into the curriculum in early school life. Further research into
the type of program and the preferred mode of delivery is required.
Key words: Mental Health seeking behaviour, Urban Indians,
Qualitative study
Internalized Stigma and its Association with Quality of Life and
Drug Adherence in Remitted Patients of Schizophrenia
Saini V, Chaturvedi SK, Sinha P
AIIMS, New Delhi, India. E-mail: vsaini.saini4@gmail.com
Background:Internalized stigma referred to as self or felt stigma, exists
at the individual (i.e., micro) level and, in the context of mental illness,
can be described as a process whereby affected individuals endorse
stereotypes about mental illness, anticipate social rejection, consider
stereotypes to be self-relevant, and believe they are devalued members
of society. This study attempted at looking into influence of internalized
stigma and its various components on drug adherence behavior and
quality of life in remitted patients of Schizophrenia. The objective of
the study was to explore pattern and degree of internalized stigma in
Indian clinical populations of persons with remitted schizophrenia and
to study correlation between internalized stigma and drug adherence
and its impact on various aspects of quality of life.
Methods: In this cross- sectional study, 58 persons diagnosed with
Schizophrenia and currently under remission since more than 6
month, by using different standardized assessment scales, there
level of internalized stigma assessed and correlated with current drug
adherence level and quality of life score.
Results: Respondents displayed signs of internalized stigma and
reported endorsing stigmatizing notions. The relationship between
subjective scale for medication adherence (CRS) and quality of
life found to be statistically insignificant. The relationship between
objective scale for medication adherence (MARS) and quality of life
found to be statistically insignificant. The relationship between total
drug adherence (CRS+ MARS) and internalized stigma negatively
correlated, however statistically insignificant. Statistically significant
negative correlation exists between internalized stigma and quality of
life of respondents. Statistically significant negative correlation exists
between individual dimensions of internalized stigma like Alienation,
Stereotype endorsement, Social withdrawal, discrimination experiences
and quality of life of respondents.
Conclusion: Internalized stigma affects the patients in all aspects of
life including emotional, social life, work related, treatment related and
others and it need to be considered as important contributor of outcome
of psychiatric illnesses and appropriate intervention should be needed.
Associations Between Expressed Emotions and Stigma
Experienced by the Families of Persons with Schizophrenia
Sahu KK, Basu SM, Sahu S
Department of Psychiatry Government Medical College & Hospital,
Chandigarh, India. E-mail: withkamlesh@gmail.com
Background/Objectives: To examine the associations between
stigma experienced by the families of persons with schizophrenia and
expressed emotions toward the persons with schizophrenia (PWS).
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Methods: A cross-sectional descriptive method was employed for
the study. Data was collected based on criteria based sampling from
the 100 families of a PWS who were living in the community with a
person suffering from schizophrenia and attending OPD of Psychiatric
Institutes (either Govt. or Pvt.) in and around Kolkata with their written
consent using following tools: General Health Questionnaire-5,
Socio-demographic and Clinical Datasheet especially designed
for the study, Family Interview Schedule-Stigma section, Attitude
Questionnaire. 
Result: Family members of PWS experienced a great degree of stigma
which was higher when their having negative expressed emotions
towards the PWS.
Conclusion: There is a need of imparting knowledge about
schizophrenia among family members of PWS to dispel stigma.
Your Illness does not Define You
Kumar S, Moirangthem S
NIMHANS, Bangalore, India. E-mail: drsanthos@gmail.com
Background: Stigma about mental illness is so severe that it impairs
all the domains of life. It impairs the patient from receiving the best
treatment and chances of improving. The major problem in combating
stigma is the lack of public awareness about the advancement in the
field of psychiatry in the last 100 years.
Case:A 34 year old lady, qualified up to 12th grade, separated from
husband, from Hindu nuclear family, hailing from rural Karnataka
presented with long standing 10 years history of untreated illness
characterized by fearfulness, suspiciousness, delusion of persecution,
delusion of reference, auditory hallucinations and depressive symptoms
secondary to the same. As she reported alone to the psychiatry set
up, further exploration revealed that she was kept outside her home,
separated from the rest of the family, was preparing separate food
for herself. The stigma and understanding about the illness was so
poor that the children in the family were not allowed to speak with
her. She was taken to many astrologers and faith healers, but her
symptoms were worsening. She was planned for in patient care and
family members were contacted through the psychiatric social worker
team. She improved in symptoms with medications. Family members
understanding of illness was evaluated and after psycho education
regarding the illness, family accepted her.
Conclusion:Mental illness can destroy families. Psychiatrist must
play an important role with these families emphasizing that treatment
involves not only biological intervention but also psychosocial
rehabilitation and environmental manipulation.
“Dignity in Mental Health” in the Digital Era: A Case Report of
Stigma in the Caregivers of a Patient with Schizophrenia
Shanbhag V, Chander R, Khate R, Devasthali G, Virupaksha HG,
Kesavan M
National Institute of Mental Health and Neuro Sciences, Bangalore,
India. E-mail: vandita.shanbhag@gmail.com
Background: Persons with schizophrenia carry an additional burden
of stigma, both associative and affiliate stigma, often from their
primary care givers. Families experience shame, embarrassment
and uncertainty in their lives due to their association or affiliation with
schizophrenia patients, which leads to illness concealment, delayed
treatment seeking, and often, alienation of the patient. Previous Indian
studies have reported stigma in 38-62% of caregivers in schizophrenia.
Case Report: Ms. K, 25-year-old female, 10th class educated, from
lower socioeconomic status, was brought to our centre, by the State
Commission for Women, and the orders of the District Magistrate. She
was found locked and chained for 15 days, with very poor personal
hygiene. She had a 9-year illness characterized by disorganization
of thinking and behavior, paranoid delusions, catatonic symptoms
periodically, and poor self-care. Due to stigma, she would be periodically
chained inside a room during important events, recently her father’s
funeral. She was diagnosed to have schizophrenia and treated
with ECT and Risperidone, nutritional supplementation and activity
scheduling. She improved significantly with inpatient treatment over two
months. The patient wanted to return home. Initially, her family refused
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psychoeducation or to take her back. On repeated attempts made by
social worker team, family agreed to monitor patient and bring her follow
up. At the last follow-up, her brother was facing marital problems over
care-giving. The patient has continued to maintain well.
Stigma in caregivers of schizophrenia patients in India is under reported.
The family had associative stigma, which remained, while the affiliate
stigma in the brother improved with psychoeducation. The patient’s
wishes remain unfulfilled but live with some dignity now. This report
highlights the lack of public awareness and stigma about mental illness.
Avoiding negative portrayal of mental illness in the media and promoting
awareness is needed to ensure dignity in mental health.
Key words: stigma, mental illness, schizophrenia, associative, affiliate,
dignity
Relationship Between Perceived Stigma and Functioning Among
Bipolar Patients in Rural Community Mental Health Settings
Nikhil S
Tata Institute of Social Sciences, Calicut, India. E-mail: nikhilshekhar.s@
gmail.com
Background/Objective:Stigmatising attitudes towards people with
mental health problems are widespread and commonly held. Apart from
social stigma, patients also experience self-stigma. Self-stigma refers to
the stigma a person has towards himself. This stigma further aggravates
the problems faced by the patients. It affects their functioning and can
lead to poor treatment outcomes. Stigma and functioning in patients with
BPAD was studied by Vazquez et al (2010) on two hundred and forty
one participants. The results of the study show that higher scores of self-
perceived stigma were correlated with lower scores of functioning that,
in turn, may lead to discrimination. Regression analysis indicated that
there exists a bidirectional relationship between perceived stigma and
functioning. Therefore, the aim of the present study is to demonstrate
the relationship between perceived stigma and functioning among
bipolar patients in rural community mental health settings.
Methods: The design of the study is descriptive. Quantitative approach
will be used for the present study. For collection of data, MHAT clinics in
Malappuram, Kozhikode and Wayand districts will be considered. MINI
plus International Neuropsychiatry Interview will be used as a screening
instrument. Purposive sampling will be employed to get a sample
of hundred BPAD patients under remission. A socio-demographic
performa will be designed for the purpose of the study. Perceived stigma
will be measured using Internalised Stigma of Mental Illness Scale
(ISMI). Functioning will be measured using Functioning Assessment
Short Test (FAST). Data collection will be conducted during April-May
2016. After the conduction of the study, appropriate statistical tools will
be used to analyse the data. We anticipate the study to show that with
higher level of perceived stigma there will be low level of functioning
among Bipolar patients.
Results: to be discussed during presentation.
Key Words: Perceived Stigma, Functioning, Community Mental Health
Psychoeducation in Reducing the Self-Stigma: Patients’
Empowerment Program
Strkalj-Ivezic S, MuzinicLana, Sesar MA
Psychiatric hospital Vrapce, Zagreb, Republic of Croatia. E-mail:
sladjana.strkalj-ivezic@zg.t-com.hr
Objectives: Self stigma is related to the process of accepting negative
attitudes of the public associated with mental illness, by a person with
a mental illness, as being personally relevant Self-stigma adversely
affects recovery from schizophrenia. About half of the patients treated
because of schizophrenia suffer internalized stigma The objective of
this study was to determine whether psychoeducation based on the
principles of recovery and empowerment using therapeutic group
factors assists in reduction of self-stigma, increased empowerment
and reduced perception of discrimination in patients with schizophrenia.
Methods: 40 patients participated in psychoeducation group program
and were compared with a control group of 40 patients placed on the
waiting list for the same program. A Solomon four group design was
used to control the influence of the pretest. Rating scales were used
to measure internalized stigma, empowerment and perception of
478 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
discrimination. Two-way analysis of variance was used to determine
the main effects and interaction between the treatment and pretest.
Simple analysis of variance with repeated measures was used to
additionally test effect of treatment on self-stigma, empowerment and
perceived discrimination.
Results: The participants in the psychoeducation group had lower
scores on internalized stigma (F(1,76)=8,18; p<0,01) than the
patients treated as usual. Analysis also confirmed the same effect
with comparing experimental group before and after psychoeducation
(F(1,19)=5,52; p<0,05).All participants showed a positive trend for
empowerment. Psychoeducation did not influence perception of
discrimination.
Conclusion: Group psychoeducation decreased the level of self
stigma. This intervention can assist in recovery from schizophrenia.
Key words: Self-stigma, Schizophrenia, Empowerment
Stress and Mental Illness
Stress Management Skill Training: An Exploratory Study among
First Year MBBS Students in North India
Nebhinani N, Mamta
AIIMS 401/5 AIIMS Residential Complex, Jodhpur, Rajasthan, India.
E-mail: drnaresh_pgi@yahoo.com
Background/objectives: Medical curriculum recommends mastery on
multiple domains, which generates significant stress and pressures.
This study was aimed to assess the impact of stress management skill
training among first year medical students.
Methods: After ethical approval and informed consent, we recruited
100 first year medical students and imparted comprehensive stress
management skill training. Outcomes were evaluated through serial
measurements of their stress, stressors, burnout, and coping at
baseline, one and three months.
Results: Baseline stress was higher among girls (academic,
interpersonal, teaching-learning, group activities related stressors
and total stress score), and students from nuclear family and urban
locality. The comprehensive stress management skill training has
significantly reduced their stress scores (in academic, intrapersonal,
interpersonal, and teaching-learning related stressors), and burnout
levels (for exhaustion) at 1 and 3 months after skill training.
Conclusion: The comprehensive stress management program was
effective in reducing medical students stress and burnout in a short-
term period.
Key words: Stress management skill training, medical, students
The Role of Post-Disaster Recovery Centres in each Phase of the
Recovery Process
Fukuchi N, Seto M, Matsumoto K, Kodaka A
Miyagi Disaster Mental Health Care Center, Takeda-Sendai Building
3F, 2-18-21 Honcho, Aoba-Ku, Sendai, Miyagi, Japan. E-mail:
narufukunarufuku@gmail.com
Background/Objectives: In December of 2011, the Miyagi Disaster
Mental Health Care Center (MDMHCC) was established in response to
the Great East Japan Earthquake and Tsunami on March 11, 2011. The
primary role of MDMHCC is to act as a post-disaster recovery centre
and has, on request, engaged in supporting the people who are living
in the disaster-affected areas. The aim of this study was to examine
the active data records of MDMHCC and analyse what a post-disaster
recovery centre should do in each phase of the recovery process.
Methods: All of the active data records were categorized by support
methods and all the people who needed support were analysed by
certain characteristics.
Results: In four years, there were 27,883 cases of support of which
15,883 (57%) were provided through home visits. Although the majority
of people who sought support in the first year were elderly women,
the number of middle-aged men increased with time. According to the
ICD-10 classification of patient’s diagnoses in the first year following the
disaster, the majority were class F2 (Schizophrenia), which had been
diagnosed prior to the disaster. However, post-disaster diagnoses of
class F3 (Mood disorders) steadily increased with time.
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Abstracts
Conclusion: The post-disaster recovery centre needs to have
1) outreach skills, 2) knowledge about the prevention of physical
weakness and social isolation, and 3) the skills to identify people with
severe mental illness, and refer them to appropriate support services.
It is possible that the requirements in disaster-affected areas change
depending on the phase, and therefore the post-disaster recovery
centre has to monitor the community at all times.
PTSD in Patients with History of ADHD: Clinical Polymorphism
and Features of Therapy
Inna M, Ilynska T
Ukrainian Research Institute of Social and Forensic Psychiatry and
Drug Abuse, Kyiv, Ukraine. E-mail: inna.martsenkovska@gmail.com
Background/Objectives: Activity and attention impairment are
common symptoms of post-traumatic stress disorder (PTSD). Many
patients with PTSD fulfilled the diagnostic criteria of ADHD in premorbid.
Methods: We randomized 76 patients (veterans of military actions on
the East of Ukraine) that fulfilled the DSM-5 criteria for PTSD and ADHD.
Patients were randomly divided into two groups: the first received Brief
psychosocial intervention (BPI, 3 sessions) and cognitive behavioural
trauma-focused therapy (TF-CBT, 5 sessions); second group - BPI , 3
sessions and atomoxetine in dosage of 40-60 mg (mean dosage 54 ±
7 mg). The length of controlled therapy was 16 weeks. The evaluations
were conducted before and after the BPI course, after 8 and 16 week
of therapy and included: Clinician Global Impression, Conner’s Adult
ADHD Rating Scale (CAARS), Wender-Reimherr Adult Attention Deficit
Disorder Scale and PTSD Checklist civilian (PCL).
Results: We allocated two options of PTSD clinical phenotype: 1)
the prevalence of behavioural disorders and impulsivity and history
of ADHD in premorbid (22 patients); 2) with sleep disorders and
flashbacks with recurrent depression and/or anxiety disorders in the
premorbid (54 patients). Results of the study indicate a more rapid
reduction of symptoms of PTSD and improvement of psychosocial
functioning after cognitive-behavioural therapy (p1<0.01, p2=0.640;
p2>0.05, p2=0.315). In patients with behavioral disorders atomoxetine
therapy was more effective (p3<0.05, p2=0.630; p4<0.05, p2=0.551)
Conclusion: ADHD in a personal and family history of war veterans is
a predictor of more severe disorders of social adaptation in the future.
Atomoxetine therapy along with BPI and CBT should be recommended
in these cases.
A study of Resilience Amongst People who lost their Relatives in
Natural Calamity: Uttarakhand in Northern India
Tale M, Lokhande C, Shrivastava AK, De Souza A, Shah N
L.T.M.M.C. & G.H.SION Mumbai, Maharashtra, India. E-mail: dr.
manishtale@yahoo.in
Background/Objectives: In this study, we attempt to examine
whether the level of resilience differs with nature of loss, in this case
a natural calamity. Resilience is one attribute that helps an individual
recovers from a disastrous event and allows them to bounce back. The
disaster was due to heavy rainfall, which was about 75% more than the
benchmark of a normal monsoon season. The study was conducted
one year after the landslide. In a preliminary study we attempted to
examine level of resilience amongst people who had lost their relatives
in comparison with those who did not.
Methods: Trained research officers in mental health from Mumbai went
in the affected region and arranged for local psychiatric help prior to
starting the study. Consenting subjects participated. Clinical details,
level of resilience; psychological stress, life events and effect of trauma
were assessed between two groups of subjects.
Results: The level of resilience was low and closely related to
psychopathology in both the group of survivors. Individuals who had
lost their relatives showed relatively very poor resilience, (CD-RISK
20.61 (SD 8.33) vs. 40.57 (SD 13), p=>0.01); had high levels of stress
(GHQ, 27.44 (SD 3.82) vs. 23.36 (SD 5.44), p=0.001). Need for high
social support (11 (SD 30.5) vs. 2 (SD 7.1) p=0.021) did not express
any significantly higher requirement for financial support. Level of
resilience was negatively correlated with experience of adverse life
event in previous year and number of relatives lost.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Conclusion: Resilience is a personal characteristic, which is severely
affected with experience of disaster. Individuals who were already
vulnerable suffered the most. People who had lost relatives showed
very poor level of personal strength and need for better social support
and specific psychological intervention.
Occupational Stress and its Impact on Mental Health in Academic
Faculty
Shah J, Sethi P
Institute of Pharmacy, Nirma University, Ahmedabad, India. E-mail:
jigna.shah@nirmauni.ac.in
Background: Stress is a nonspecific response of the body to any
demand for change. It is very common in this rapidly changing world
due to the knowledge/technology revolution, IT advancement in the
age of globalization at any workplace of the world at present. Now a
days, academics professionals are also experiencing occupational
stress as new challenges are increasing day by day leading to various
health issues. The objective of the study is to study occupational stress
amongst faculty members and its impact on mental health in academic
faculty professionals.
Methods: A prospective, multi-centric, randomized study was undertaken
involving 180 faculty members (106 male, 74 female) working in academic
organisations. The faculty members were contacted and invited to
participate in the study. Those who chose to participate first completed a
demographics questionnaire and then the stress related questionnaire.
Parameters like age, sex, BMI, blood pressure, physical health, designation
at the work place, symptoms of stress, workload factors were recorded.
The data was analysed using Karl-Pearson Correlation.
Results: Our study showed that 50% of faculty members included in
the study were belonging to the age group of 26-35 and this group
faculty members were more prone to stress as compared to other age
group. Positive correlation was found between blood pressure and
stress levels. Problems like headache, insomnia, appetite loss, anxiety
and/or depression were found to be at surprising level. The prominent
work relationship factor (46.55%) affecting stress was a competition
among Employees.
Conclusion: Occupational stress is increasing at alarming levels and
has a notable impact on mental health in academic faculty.
Are Life Events And Social Support Different Across Depressive
Disorders?
Soman S, Bhat SM, Latha KS, Praharaj SK
K.M.C. Manipal, India. E-mail: savithasoman@yahoo.com
Background/Objective: To study the stressful life events and
perceived social support in patients with adjustment disorder, first
episode depression and recurrent depressive disorder.
Methods: 146 patients aged 18 to 60 years, visiting the outpatient
department or admitted as in patients, diagnosed to have adjustment
disorder, first episode depression or recurrent depressive disorder
according to DSM-IV-TR were evaluated using the Presumptive Stressful
Life Events Scale and Multidimensional Scale of Perceived Social
Support. The study was cross-sectional in nature and convenience
sampling was used. Data obtained was analyzed using Statistical
Package for the Social Sciences (SPSS) for Windows version 16.0.
Results: There was no difference in mean number of total life events
and subgroups as well as perceived stress score in past one year
between the groups. There was no difference in the perceived social
support scale total score, as well as from family and friends, across
the three groups. However, the mean perceived social support from
significant others in those with recurrent depressive disorder was lower
as compared to those with adjustment disorder.
Conclusion: Stressful life events do not differ in adjustment disorder,
first episode depression and recurrent depressive disorder. Also, the
perceived social support was similar across the three groups, except
for perceived social support from significant others, which was less in
those with recurrent depressive disorder.
A Study of Depression Among Female Medical Students in Rohtak
Bisla P, Punia R, Behmani R
PGIMS Rohtak, India. E-mail: rajpunia11@gmail.com
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Background/Objectives: Psychological well-being is important for
medical students, for the patients they meet and for their future medical
practice. Medical students with depression more commonly consider
dropping out of their course. Presence of psychological morbidity
in medical undergraduate students has been reported from various
countries across the world. Studies indicate more prevalence of
depression in female students as compare to male students. Therefore,
the present study was carried out to assess the depression among
female medical students in PGIMS, Rohtak.
Methods: It was a cross sectional study, in which one hundred (100)
medical students were selected by purposive sampling. Assessment
was done by using Beck Depression Inventory (BDI). The statistical
analysis was carried out using the SPSS Windows 16.0 software
package. The analysis of the obtained data was done using various
descriptive and inferential statistics.
Results: Near about half of students are suffering from depression.
Conclusion: There is a need for the counselling services to be made
available to the students in the medical colleges.
Key words: Depression, Female Medical Students
Cumulative Trauma and Psychotic Experiences: Results from The
Thai National Mental Health Survey 2013 (TMNHS2013)
Supanya S, Thai, Morgan C, Reininghaus U
Institute of Psychiatry, Psychology and Neuroscience, King's College
London, United Kingdom. E-mail: suttha.supanya@kcl.ac.uk
Background/Objectives: The World Mental Health Survey (WMHS)
reported that 70% of their global sample experienced at least one
trauma in their lifetime; 30.5% reported four or more events. Given
that traumatic events are associated with multiple psychopathologies,
including psychotic experiences, we sought to explore the association
between cumulative traumatic exposure and psychotic experiences in
the Thai population.
Methods: Analyses were conducted with data from the Thai National
Mental Health Survey 2013 (TNMHS2013), a cross-sectional survey
of representative samples that uses the same methodology as the
WMHS but is not included in previous analyses. Number of traumatic
events was grouped into 0, 1, 2, 3 and 4 or more and their association
with psychotic experiences was examined using logistic regression.
Results: Of the 4727 respondents, 2477 (51.13%) experienced a
traumatic event, with 1397 (29.29%) reporting one, 624 (12.83%) two,
253 (5.32%) three, and 203 (3.70%) four or more events. Respondents
were more than twice as likely to endorse psychotic experiences if
exposed to any traumatic event (adj. OR=2.38, 95%CI=1.52-3.73).
Further, the odds of reporting psychotic experiences increased with
each additional trauma: one event, adj. OR=1.51, 95%CI= 0.90-2.52;
two events, adj. OR= 2.65, 95%CI=1.54-4.60; three events, adj.
OR=3.97, 95%CI=2.04-7.73; four or more events, adj. OR=8.18,
95%CI=4.31-15.52.
Conclusions: Consistent with previous research, we found some
evidence of a linear association between exposure to traumatic events
and psychotic experiences in this population. To better understand
the nature of these associations, further analyses will be conducted to
investigate the differential impact of the type of trauma on this association.
Natural Disasters and Mental Health Issues in India: A Systematic
Review of Epidemiological Studies
Mahapatra A, Gupta R, Deb KS
All India Institute of Medical Sciences, New Delhi. E-mail: nnyaa09@
gmail.com
Objectives: Disaster is defined by WHO as a disruption, ecological and
psychosocial, which greatly exceeds the coping capacity of the affected
community. India, due to its location and geo-climatic conditions, is
one of the most disaster prone areas of the world. We aim to review
the existing literature on epidemiological studies post natural disasters
from India, and to establish risk factors, protective factors and physical
and mental health outcomes of the same.
Methods: The electronic databases MEDLINE (via PubMed) and
Google Scholar were searched using the keywords “disaster”,
“psychiatry” and “India”. Relevant articles were identified from the
search results, and from cross references in selected articles.
480 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Results: A total of 65 results were obtained, out of which 26 were
relevant to the topic. Fourteen studies were conducted on population
exposed to tsunami, 5 to floods, 2 to earthquake, 5 to cyclones.
The prevalence of significant mental health problems ranged from
5%-64%. The most common psychiatric morbidity observed among
survivors were adjustment disorder, depression, panic disorder, and
post-traumatic stress disorder. Female gender, older age, poor quality
marital life before the disaster and death of a primary family member
due to the disaster were found to be the risk factors were associated
with development of common mental disorder (CMD).
Conclusion: Natural disaster contributes significantly to occurrence
of psychological morbidity amongst survivors. The psychological
aftermath of such calamities is found to be more prominent in the
geriatric population as well as children and adolescents. Gender and
culture specific factors also play a role in determining the trajectory
of mental health related outcomes and need to be delineated further.
Key words: natural disaster, India, mental health
Cognitive Neurophysiological and Autonomic Reactivity
Correlates of Anxiety and Pain Perception in Contingent Stress
an Exploratory Study
Amin S, Kochhar KP, Patil A, Babu N, Chhabra D, Gupta S, Verma
R, Kumar N
Delhi University, Delhi, India. E-mail: sharika.amin1@gmail.com
In our country of 1.3 billion, one in every fourth adult is suffering from
anxiety with 20 per cent of the population living with stress. Anxiety,
stress and pain as separate entities have seen robust research,
however the relationship between anxiety and pain perception in
presence or absence of external stress, is a domain that has been
relatively left unexplored. We have tried a novel approach to elicit the
neuro physiological, psychophysiological and autonomic correlates
of anxiety in presence or absence of stress by designing a protocol
that tests pain perception in response to CPT (Cold Pressor Test) as
measured by fNIRS. fNIRS is used to measure frontal cortical activation
by recording changes in cerebral haemodynamics in relation to infra-
red quantification of oxygenated and deoxygenated haemoglobin A
sequence of mental math tasks coupled with performance evaluation
of the same is used as an external stressor. Quantification of stress
response is done by wireless physiological monitoring and changes in
cardio respiratory, electro dermal activity and electro muscular activity
that is recorded and then analysed. The data from this exploratory study
shall be presented and discussed. This integrated neurophysiological
model helps us gain insight into the functional pathways and
connections of pain, stress and anxiety in health and disease. This
approach has further implications for better pain, anxiety and stress
management for mental and physical health.
Sociodemographic and Clinical Profile of the Patients who had
New Onset Psychiatric Symptoms following an Earthquake
Kafle K, Adhikary SR, Sedhain CP
Chitwan Medical College, Bharatpur, India. E-mail: khagendrakafle@
gmail.com
Background/Objectives: Having first-hand experience of strong
earthquake and witnessing destruction caused by it can have immediate
and long term psychological consequences. We planned to study about
sociodemographic and clinical profile of the patients who had new onset
psychiatric symptoms following April 2015 earthquake and series of
subsequent aftershocks in Nepal.
Methods: Previously asymptomatic patients who had developed
psychiatric symptoms within 24 hours of April earthquake or its
aftershocks and having such symptoms for less than 1 month at the
time of first visit were included in the study. Patients were assessed with
study specific sociodemographic profile sheet and Trauma Symptom
Checklist 40. Descriptive statistics were used for analysis of result.
Results: Around 59% patients were female. Most of them were
residing in urban locality. More than 50% patients were referral from
other specialties as many patients had first consulted non-psychiatric
medical specialties because of predominant somatic presentation.
More than half of the patients had onset of symptoms after subsequent
aftershocks. Among all, around 22% fulfilled diagnosis of comorbid
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Abstracts
alcohol use disorders and around 11% had history of mental illness in
first degree relatives. Most common presentations were Anxiety and
Dissociative symptoms. Dizziness, Anxiety attacks and Restless sleep
were the individual symptoms which most patients reported.
Conclusion: Females are more likely to suffer as in the case of other
neurotic and stress related disorders. Aftershocks of lesser magnitude
can lead to onset of distressing symptoms in significant number of
people. Somatic presentation can render patients to seek help from
other specialties and psychiatric assessment can be missed. Long
term follow ups are necessary to know how these immediate symptoms
changes over time.
Multidimensional Stress and Family Violence During the Course of
Pregnancy and its Relation to Pregnancy and Maternal Outcomes
Supraja TA, Jangam K V, Desai G, Venkatram L, Muralidhar A, Chandra
PS
National Institute of Mental Health and Neuro Sciences, Bangalore,
India. E-mail: supraja.t.a@gmail.com
Background/Objectives: In this inquiry, we studied the course of
various dimensions of stress during the antepartum period and identified
the relationship of this multidimensional stress as well as family violence
with poor pregnancy and postpartum maternal outcomes.
Methods: In this prospective study, 286 women were followed up
through pregnancy to assess for different forms of stress namely
interpersonal and family stress, stress from daily hassles and stress
due to major negative life events and for family violence during each
of the antenatal trimesters. The pregnancy outcomes gestational
age of foetus at delivery, birth weight, neonatal intensive care unit
admission, still birth, neonatal death and spontaneous abortion
were recorded. Postpartum maternal mood was examined as a
maternal outcome.
Results: Bivariate analyses revealed significant differences in the
levels of each of the various forms of antepartum stress among
women with and without a poor pregnancy outcome (p < 0.05).
Further, even in the group of women who did not have antepartum
depression (261/286), antepartum stress was significantly associated
with postpartum depression (p< 0.01). Although antepartum violence
was present among 15% of the women (43/286), it was not related
any poor pregnancy or maternal outcomes. Logistic regression was
performed to establish the predictors of poor pregnancy outcomes and
postpartum mental health outcomes.
Conclusion: It is important to consider stress in its multidimensional
form to gain a holistic understanding, as stress during pregnancy might
be a risk for both poor pregnancy outcomes as well as for the mental
health of the mother in the postpartum.
Key words: stress, pregnancy, women, India
Interplay between Impairment, Quality of Life and Remediation
Techniques in Cancer Patients
Sharma S, Biswas A, Nehra A
Department of Psychology, Arts Faculty Extension Building, University
of Delhi, India. E-mail: ashimanwadhawan@gmail.com
Psychology plays an inevitable role in the cancer care process as
researchers and clinicians are becoming increasingly cognizant of the
impact cancer and cancer related treatment can have on the social,
psychological, cognitive and economic aspects of the lives of patients and
their caregivers. Understanding the interplay between these mechanisms
can aid intervention planning and thus improve Quality Of Life (QOL).
Key words: Chemobrain, stressors, rehabilitation, quality of life, India
Urbanization
An Epidemiological Survey of Psychiatric Disorders in Patients
Attending Psychiatry OPD of Tertiary Care Centre at Bikaner
(North Rajasthan)
Thamke S, Verma KK, Baniya GC
SPMC, Bikaner, Rajasthan, India. E-mail: snehal.thamke510@gmail.
com
Background/Objectives: Mental health is an important component
of health without which holistic health could not be achieved. A review
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
of epidemiological studies on psychiatric disorders reported that
around 10% of the total population suffer from mental and neurological
problems requiring professional help at any point of time. Aim of the
present study is to study the psychiatric morbidity amongst the patients
attending psychiatry clinic in tertiary health care centre at Bikaner.
Methods: Profiling of the patients (N=4064) attending psychiatric
OPD in the month of January in 2016 was done from the departmental
records. Parameters like age, sex, religion, residential address,
diagnosis and admission to the hospital were considered.
Results: Out of 4064 patients, majority were males, 2728, and 1336
were females, with mean age of the patients being 40.39 years and
around 90% patients were Hindus. 1884 (46.35%) out of total patients
came from Urban Bikaner and 804 (19.78%) from Rural Bikaner. Out
of 4064 patients, 186 patients were admitted. Majority of patients
suffered from mood (affective) disorders (31.7% females and 27.2%
males); followed by neurotic, stress related and somatoform disorder
(38.2% females and 17.6% males); and schizophrenia, schizotypal and
delusional disorders (females-16.2% and males-18.2%). Substance
abuse and dependence was found to be present in 27.8% males and
only 1.9% females.
Conclusion: There are more of neurosis and substance dependence
patients in Bikaner belt of Rajasthan than psychosis patients,
which could be due to awareness towards the symptoms or due to
urbanization.
Key words: Sociodemographic Profile, Psychiatry morbidity,
Substance abuse, Bikaner, Rajasthan
Social Networking Sites: Association with Depression and Social
Anxiety Among Youth??
Jain KK, Vankar GK
B.J. Medical College, Ahmedabad, India. E-mail: khushi.kansal@
gmail.com
Background/Objectives: This is a cross-sectional study aimed to
evaluate: Intensity of Facebook use amongst college going students,
Prevalence of depression and social anxiety among students and its
association with intensity of Facebook use and Risk factors for Intensity
of Facebook use, depression and Social anxiety disorder.
Methods: The study was conducted during a period of one year, in
four colleges of Ahmedabad during stress-free period for students.
Institutional ethics committee and Principals of respective colleges’
approval was taken. In a classroom setting questionnaires including
Facebook Intensity Scale, Patient Health Questionnaire 9 and Severity
Measure for Social Anxiety were given to students to fill. SPSS version
17 was used to analyse the data. Linear regression models were made
to see the predictors related to Facebook Intensity Score, depression
and social anxiety disorder. P-value <0.05 was considered statistically
significant.
Results: About 8% students were frustrated to see others always
having good time on social media and around 16% believed that their
friends had much better life than them. 30-35% students reportedly
agreeing to the fact that Facebook has become an integral part of
their daily routine and that they would be sorry if it shuts down. Major
Depressive Disorder is clearly present in around 5% of students.
Also, there is a grey zone of around 13% students who are needed
to be evaluated in detail. 4% of students reported to have significant
social anxiety. Neither Depression nor Social anxiety were significantly
associated with the intensity of Facebook use. Social anxiety disorder
and depression were correlated significantly (p<0.001).
Conclusion: Intensity of Facebook use is not associated with
depression or social anxiety. Depression and Social Anxiety disorder
were significantly correlated.
Key words: Social Networking Sites, Facebook, Depression, Social
Anxiety disorder
Depiction of Women in Advertising: Implications for Women’s
Social Health
Saha S, Raj A, Khurana H
Institute of Mental Health, University of Health Sciences, Rohtak, India.
E-mail: srinjaya.saha@gmail.com
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Abstracts

Background/Objectives: Men and women have a different perception
about the attitude and behaviour in daily life which influences their
behaviour while interacting with opposite or same sex individual. In Indian
culture women are generally considered to have a socially superior position
but there is no shortage of instances depicting women being harassed or
insulted unreasonably both in the family, friends, and strangers. Thus, this
mandated the state to formulate different kind of legislation like prevention
of sexual harassment act, protection of women against domestic violence
etc. However, the print media and the electronic media seem to be over
representing women in order to catch the attention of public and be
commercially successful. This particular fact has also caught the attention
of sociologists and feminists and such attitude has been criticized in
India and abroad. Despite the enforcement of prevention of indecent
representation of women act, the Indian media, especially the adverting
media seems to be taking it casually. This preliminary observation made
the authors take up this study.
Methods: The authors randomly chose the advertisement of different
product including the daily use commodities such as clothing, eatables,
health and hygiene products, cosmetics, electronic gadgets, and
pharmaceutical etc. A total of 100 advertisements appearing in print
and electronic were reviewed. These advertisements were qualitatively
analyzed regarding appearance as representative of cultural pattern,
number of males and females in the advertisement, appropriateness
of their representation as per the product being advertised. The quality
analysis was based on an inventory specifically designed for this study
after consultation with people from different groups of community.
Results: The findings are suggestive the women are over and
inappropriately represented by the advertising media.
Conclusions: The findings are discussed with social health implications
for women and community in this poster.
Key Words: Women, media, gender bias

482 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4

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Abstracts
POSTERS DAY 5 FORENOON
Caregiver Burden
Care Giver Burden in Mental Health in India - An Unrecognized,
Underestimated and Unmet Aspect
Pakhre A, Jain S, Pakhre A, Jain S
Department of Psychiatry, Deen Dayal Hospital, New Delhi, India.
E-mail: sjmc.ashish@gmail.com
Background/Objectives: Adverse mental health effects of care giving
of patients with psychiatric disorder is well known. To find out the factors
associated with care giver burden and issues in India.
Methods: A review of literature was done using electronic and manual
searches on care giver burden studies from India published up to April
2016.
Results: Patients with mental illness cause significant burden on care
givers. Severity and duration of illness, family support and personality
factors are important in determining care giver burden. It is an ignored
aspect of mental health care.
Conclusions: Regular assessment of care giver burden on family
members of patients with mental illness will reduce the impact of stress
and help in early psychosocial intervention for care givers.
Burden of Care of Caregivers of the Patients with Adolescent
Psychosis and Epilepsy
Mahto V, Kiran M
RINPAS, Ranchi, India. E-mail: vibhamahato17@gmail.com
Background/Objectives: Epilepsy and psychosis are two
neuropsychiatric conditions that do not distinguish the geographic,
social, gender, religious, ethnic or racial boundaries; both these disorders
affect people of all ages and societies. Certain things are in common
among the people with the children and adolescents with neurological
disorders and functional psychosis, i.e., in both the disorders caregivers
develop the sense of burden, stigma, apprehension, despair and loss.
Due to impact of illness socio-occupational functions of the affected
people are severely compromised and because of this people associated
with them have the sense of burden, stigma, negative attitude and
despair. The objectives of the study were to examine the burden of care
of caregivers of the patients with adolescent psychosis and epilepsy
and to compare the differences in both the groups.
Methods: This study was conducted in the RINPAS, Ranchi. It was
cross-sectional hospital based single contact study. Purposive sampling
was used for selecting the samples of either group. Samples were
60 subjects, 30 each caregivers of adolescents with psychosis and
epilepsy respectively.
Results: Mean age of the patients as 15.15±1.35 years (N=30) and
14.83±1.51 years (N=30) and in both the groups majority of the patients
were boys and from the rural areas. Significant difference was found
in the marital status & type of the family. Mean age of the caregivers
as 40.40± 9.48 years and 41.63 ±6.04 years.
Conclusion: There was high level of burden of care in caregivers of
the patient with psychosis as compared to caregivers of the patient
with epilepsy.
Key words: Caregivers Burden, Psychosis, Epilepsy
Suffering in silence: burden and coping of the caregivers of
alcohol dependence syndrome patients
Khakha D, Thomas L, Balhara YPS
College of Nursing, All India Institute of Medical Sciences, Ansari Nagar,
New Delhi, India. E-mail: dckhakha@gmail.com
Background/Objectives: Alcohol is a psychoactive substance with
dependence-producing properties that has been widely used in many
cultures for centuries. Having a family member with alcohol use
disorders put a significant stress on all family members. Frequently,
burden of care is more defined by its impacts and consequences on the
caregivers. The aim of the study was to assess the caregiver burden
and the coping strategies of primary caregivers of patients with alcohol
dependence syndrome.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Methods: A cross sectional descriptive study was conducted among
120 primary caregivers of patients with alcohol dependence syndrome
attending the OPD of a tertiary care centre. Ethical permission
was taken. After obtaining informed written consent, demographic
characteristics of caregiver were collected. Caregiver burden was
assessed using family burden interview schedule developed by
Pai and Kapur. Coping strategies were assessed using coping
questionnaire developed by Jim Orford et al. Data was collected from
July to December 2015. Data was analysed using Independent t -
test, Pearson chi square/ fisher’s exact test and Wilcoxon rank- sum
(Mann-Whitney) test.
Results: Most of the (59.17%) caregivers had moderate level of
objective burden and 40.83% had severe objective burden. Majority
of them (74.17%) had moderate subjective burden and remaining
(25.83%) had severe subjective burden. The primary coping strategy
used by the caregivers was engaged coping followed by tolerant
inactive and withdrawal coping. There was a significant association
(p=0.040) between level of objective burden and the frequency of use
of engaged coping.
Conclusion: Moderate to severe burden was experienced by the
caregivers in all the domains of burden. The primary coping strategy
used by the caregivers was engaged coping. Caregiver stress should
be addressed for the better outcome of the patient
A Paradigm Shift in Caregiving-A flow of Nectarine Love
Prabhu N
Human Resource Consultant & Counselling, Sri Sathya Sai
Central Trust, Anantapur Dist, Andhra Pradesh, India. E-mail:
prabhunarayan7@gmail.com
Background/Objectives: Caregiving, suffused with nectarine love,
providing care for those over 60 years of age, with no near relations, and
with physical, psychological and/ or developmental needs. The service
is pure honorary [unpaid] in an Ashram [aʃrəm] [Spiritual Hermitage] in
Southern part of India. The recipients of care are themselves residents
of the Ashram, who have provided about four decades of SEVA [selfless
service] in their erstwhile serene years of life.”the only cure for their
loneliness, despair, and hopefulness is love” {Mother Teresa}. A number
of caregiving interventions [with high intensity] are tried by a committed
band of 20 Caregivers for 62 recipients and the resultant benefit is
studied on general and critical recipients, who could be males, females,
staying in apartments or dormitories. The purpose of the study is to
examine the resultant benefits, for significance in terms of interventions
made in a two year period.
Methods: Discussions with the Caregivers, Care Recipients and other
Role Holders of the Ashram about the various interventions initiated in
the last two years by the 20 Caregivers and received by the 62 recipients
[composing of males, females, general, critical, staying in apartments,
dormitories] whether the intensity of the interventions as per the services
log has resulted in benefits [intensity] and whether there is any significant
difference [improvement] as far as the beneficiaries are concerned.
Results:The Study would indicate whether a continuous stream of
high intensity interventions would provide the desired outcome at the
same level of intensity.
Conclusion: The objective study of the benefits would indicate whether
there is a need for more focused interventions.
Key Words: Ashram [aʃrəm] [Spiritual Hermitage], SEVA [selfless
service], Services log
Assessment of Caregiver Burden in Psychiatric Patients
Agarwal S, Shetty J, Napade N
Bharati Hospital, Bharati Vidyapeeth Deemed University, Pune,
Maharashtra, India. E-mail: surabhiagarwal02@gmail.com
Background/Objectives: Caregiving is a dynamic process including
patient, and a person involved in long term care of patient. In
disabling mental disorders like schizophrenia and bipolar disorder,
long term care is involved, often leading to experience of burden
483
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Abstracts
in caregivers. There is growing body of literature on the caregiver
burden, poor caregiver outcomes, lack of caregiver support, and
equivocal success, with interventions aimed at alleviating care-giving
burden. The objectives of the study were to assess caregiver burden
in psychiatric patients, Prevalence of caregiver burden in psychiatric
illnesses, gender differences in caregivers, correlation of severity &
duration of psychiatric symptoms with measure of caregiver burden,
and correlation of relationship of caregiver with patient to severity
of burden
Methods:The participants will be the caregivers of patients attending
Psychiatry OPD, Bharati Hospital. After institution ethics committee
approval, an information sheet containing all necessary details of the
study will be provided following which due written informed consent will
be taken. Those consenting to participate, will be asked to answer a
specially designed questionnaire that will be scored and assessed in the
Department of Psychiatry. Study Period: This study will be conducted
from August 1st, 2016 to September 30, 2016. Tools Description
Socio demographic sheet Caregiver Burden Scale Coping strategies
inventory DASS scale
Discussion and Results: Finding of the study will be discussed once
it completed.
Key words: caregiver, burden, psychiatric illness
Caregiver Separation for Management-Legal, Social and
Management Issues-Case Report
Mukhopadhyay S, Agrawal A, Narayan S C, Prasad S
Lady Hardinge Medical College, New Delhi, India. E-mail:
mukhopadhyayasanchari@gmail.com
Background: Caregivers play an essential role in the management of
psychiatric disorders. Their active participation has been associated
with decreased hospitalization and better prognosis. However, in the
rarest of cases caregivers might negatively affect the management of
a patient. We present the case of a depressive patient from a broken
family whose management was complicated by poor dynamics between
caregivers.
The case: The patient was 21 year old female hailing from a Hindu
broken family presenting to us with a second episode of major
depressive disorder with borderline personality disorder, precipitated
by a breakup. She lived with her biological mother and the stepfather
visited occasionally. She had a history suggestive of possible sexual
abuse by her stepfather. She had ambivalent relations with him.
During course of the treatment it was observed that the mother had
cluster B personality traits and formed an emotionally co-dependent
dyad with her husband. Mother would alternately fight and cling
to her husband while neglecting her caregiver role. For optimal
management the caregivers were made aware of the problem
and counselled to live separately. Supportive psychotherapy was
undertaken for all members. During management the treating team
had legal and moral dilemma whether to take an active or a passive
role. The patient recovered completely and in follow up the mother
expressed relief in her new role.
Conclusion: The caregivers of the case we present were advised
to live separately by the treating team. The legal, ethical and moral
issues of such interventions are discussed. This case illustrates that
sometimes physicians must undertake social interventions in the social
milieu for optimal management.
Caregiving: A Risk Factor for Dementia?
Sharma S, Nehra A
Department of Psychology, Arts Faculty Extension Building, University
of Delhi, India. E-mail: ashimanwadhawan@gmail.com
Dementia is a syndrome, usually of a chronic or progressive nature,
caused by a variety of brain illnesses that affect memory, thinking,
behaviour and ability to perform everyday activities. It has been
identified as an “International health priority” both for patients as well as
their caregivers. The latter have been referred to as the “hidden patient”
or the “forgotten client”. Aside from the debilitating psychological
impact, new evidence reveals that caregiving for such patients can be
a potential risk factor for developing dementia in caregivers themselves.
484 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Thus, it is imperative to identify, prevent and treat caregiver burden
of these patients.
Key words: Burden, interventions, coping
Childhood Adversity
Childhood Abuse, Life Events and Social Support in Children and
Adolescents with Severe Mental Disorders
Singh NK, Nayar N, Goyal N, Sinha VK
Central Institute of Psychiatry, Ranchi, India. E-mail: narendrapsw@
gmail.com
Background: Research indicates that the childhood abuse experiences
are important factors in the causation of psychiatric disorders. Several
additional studies suggested that there is a relationship between
childhood social support and psychiatric disorders. Although these
relationships are documented, few studies examined the relationships
between childhood abuse experiences, life events, social support and
psychiatric disorders in one comprehensive analysis. So, this study is
planned to assess the relationship between these as a whole in the
inpatient population of Children and Adolescents with Severe Mental
Disorders in Indian setting. The present study focuses to examine the
relationship between childhood abuse, trauma, life events and social
support in inpatient population of Children and Adolescents with Severe
Mental Disorders.
Methods: This will be a cross-sectional study and purposive sampling will
be used to select the sample. The sample will be consisting of 30 inpatients
with the diagnosis of psychiatric disorder as per the ICD-10-DCR (WHO,
1992). Age range of the patients will be 6-18 years. Neurodevelopmental
disorders will be excluded in the present study. For the assessment,
Childhood trauma questionnaire, life events scale for Indian children,
BPRS, C-YBOCS, YMRS, CDI and Student Perceived Availability of Social
Support Questionnaire will be applied on the selected children. Data will
be analyzed using appropriate statistical measures for correlation.
Results: Finding of the present study will be discussed at the time of
the presentation.
Key Words: childhood trauma, social support, children
Childhood Maltreatment and Depression: Exploring Difficulties
in Emotion Regulation in the Indian Context
Gupta A, Daya Ram, Rai S
Indian Institute of Technology, Kanpur, India. E-mail: apgp@iitk.ac.in
Background/Objectives: Childhood Maltreatment is an overlooked
reality in India where children (5-12 years) are most vulnerable
towards abuse and exploitation. The present study was undertaken to
investigate the trajectories of development of emotional vulnerabilities in
individuals with depression having a history of childhood maltreatment.
Methods: A cross-sectional study was carried out in a clinical setup
utilizing purposive sampling technique. The sample consisted of 25
adults diagnosed with depression and demographically matched
control group (n=25), assessed using BDI-II, CECA.Q, DERS, and
WHOQOL-BREF.
Results: Majority of individuals with depression (mean age= 34, SD=
8.92) were male (56%), married (84%), from a joint family (56%),
residing in rural areas (52%), having below graduate level education
(68%), and involved in semi-skilled occupations (56%). It was found that
adults with depression experienced significantly higher levels of abuse,
X2(1, 50)= 8.01, p=0.01, neglect by mother, t(48)= 3.93, p<0.001,
and absence of support, x2(1, 50)= 4.15, p=0.04, during childhood
as compared to normal controls. However, no significant association
was found between various forms of childhood maltreatment and
severity of depression. Individuals with depression were also found to
have significantly higher difficulties in emotion regulation, t(48)= 5.34,
p<0.001 and poorer quality of life, t(48)=6.18, p<0.001 in adulthood as
compared to normal controls. Total difficulties in emotion regulation (β=
0.48, p<0.01) psychological quality of life (β= -0.40, p<0.05) predicted
56% of variance in severity of depression.
Conclusion: Current findings emphasize the necessity to address
social maladies like paternal physical abuse, maternal neglect, and
absence of support figures during childhood as a preventive measure
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Abstracts
towards depression. Moreover, specific difficulties in emotion regulation
and psychological well-being are identified as important areas of
psychological intervention in depression.
Key words: Childhood Maltreatment, Emotion Regulation, Depression,
Quality of life
A study on Prevalence of Psychiatry Disorders Among the Inmates
of a Children Home
Yalla N, Kiran VP, Babu RS
Alluri Sitaramaraju Academy of Medical Sciences, Andhra Pradesh,
India. E-mail: navya.rao116@gmail.com
Background: Provisions to improve the quality of care can be
contemplated holistically when there is better knowledge about the
current scenario of child and adolescent care. Hence, the study
was conducted. The objectives of the present study were to assess
the prevalence of mental health problems/disorders of children at a
residential care and to assess the relationship between multiple mental
health problems (co-morbidity).
Methods: Study setting: Government Children Home for Boys, Eluru,
AP.Study. Period: One month (May 2016). Study Design: Analytical -
Cross sectional study. Study Tool: Mini International Neuropsychiatric
Interview for children and adolescents. Subjects: A total of 158 boys
in the age group 6 to 18 years, who were residents of the home.
Informed consent was taken from the concerned authority prior to the
study. Statistical analysis: The Statistical Package for Social Sciences
(SPSS) software, v.16 was used to analyze the data. For inferential
statistics, One-way ANOVA and Correlation tests were used to assess
the relationship between multiple mental health problems. P value <0.05
was considered significant.
Results: This study shows significant prevalence of psychiatry
disorders like Anxiety related disorders, Major depression, Alcohol
dependence and Attention deficit hyperactivity disorder at 23.4%, 7.5%,
7.5% and 5% respectively. Other illnesses like Conduct, Oppositional
defiant disorder, Dysthymia and Pervasive developmental disorder
at 3.7%, 3.1%, 3.1% and 2% respectively. There was statistically
significant association between substance abuse, conduct, attention
deficient hyperactivity and oppositional defiant disorder.
Conclusion:The prevalence of psychiatry illness is common among
the study population. Well established institutional care facilities are
the ways in taking care for this vulnerable population, hence there is
a need for collaborative efforts from various private and government
stakeholders. Measures need to be taken to include mental health
services in these facilities.
Key words: Children home, Co-morbidity, MINI KID, Prevalence
Alexithymia and Obesity in Children of Punjabi Diaspora
Kaur H, Kaur P
Department Of Psychology, Punjabi University Patiala, India. E-mail:
harprit.kaur@yahoo.com
Background/Objectives: Obesity is one of the most debilitating causes
of physical and mental health threat for the forthcoming generations.
Alexithymia is a measure of deficits in emotional health characterized
by difficulties in identifying and expressing ones emotions, and an
externally oriented thinking style. The present study aims to explore the
relationship of obesity with Alexithymia in children of Punjabi Diaspora.
Methods: The study was conducted on 463 children, of whom 303
children were obese and 160 were non-obese matched controls (as
per their age specific BMI norms). Of these 306 children were residing
in Punjab while 157 were matched NRIs settled in Australia since at
least five years. The children were examined on a socio-demographic
profile and Alexithymia questionnaire for children (Rieffe, Oosterveld &
Terwogt, 2005). Analysis of data was carried out using t-test, correlation
and regression.
Results: Alexithymia is significantly more in Indian Punjabis than in NRI
Punjabi children. In Indian Punjabis BMI was significantly negatively
related to all parameters of alexithymia. In NRI children this relation
was in positive direction on EOT. Interestingly, this relationship became
insignificant in the obese Indian as well as NRI Punjabi children. There
were no gender differences on alexithymia in both groups, but overall
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
boys exhibited significant externally oriented thinking. Also, the Indian
Punjabi obese children were significantly higher on alexithymia than
their NRI counterparts, and this was true across Difficulties in identifying
and expressing feelings. The three factors of alexithymia predicted
19.1% of the variance in obesity.
Conclusion: Remedial steps towards management of obesity in
children need to focus on alexithymic traits.
The life of Rama-the Journey from Freedom to Bondage to
Autonomy
Prabhu N
Human Resource Consultant & Counselling, Sri Sathya Sai
Central Trust, Anantapur Dist, Andhra Pradesh, India. E-mail:
prabhunarayan7@gmail.com
Background: Rama was born as a Brāhmaņa, in the idyllic Kerala,
God’s own country, India. ‘Born Free’ in an exotic world: despised by his
own biological parents [devoid of filial love] was cared for by sociological
parents. From a loving child to loathsome one, paradigm shift from joy
ecstasy to pain, thrown from heaven to hell, with no chance to revert
back. The personal, physical as well as psychological abuses and
disastrous orders, from the biological parents traumatized the young
Rama. He developed several disorders. The psychotic drugs and
the 13 ECTs that were administered bore minimal results. It is at this
stage counseling sessions were held for him with significant improved
results. He recovered from being a ‘Schizophrenic’ and permeated the
‘One who flew over the Cuckoo’s Nest’ [ECT – torture rack] syndrome.
The Recovery Phase heralded the experience of going through various
therapeutic interventions and giving up the psychotic drugs. The freedom
from bondage was now like a dream realized, with some residual issues
reminiscent of those grueling years; two decades of perseverance to
come out of the woods. The paper seeks to capture the trails of young
frolic Rama, progressing into a battered adolescent, struggling to get
rid of fetters and finally emerging as an autonomous ‘normal’ person.
Methods: Detailed Interviews with diverse set of people and reviewing
documents for the period [1990 - 2010]: the progression in the life of
Rama.
Results: The joy disrupted by the spine chilling messages and
abuses resulting in being Schizophrenic. The disorders dissolved with
interventions.
Conclusion: The objective response to various therapeutic
interventions, the resolutions made and the gradual decline in the
residual issues marks the freedom.
Key Words: Brāhmaņa, biological sociological parents, disorders,
psychotic drugs
A Typical Case of Encopresis
Batra P, Sharma A, Grover S
PGIMER, Chandigarh, India. E-mail: parveshbatra84@gmail.com
Background/Objectives: To present the case of an 11.5 years old
boy who presented with primary encopresis which was traced to
psychosocial problems in family dynamics and poor parenting.
Methods: Patient achieved bladder control at ~4 years but he never
attained bowel control and showed toilet-refusal. Despite laxatives since
age of ~4 years, soiling continued. He would postpone defecation by
adducting legs and flexing his body. He had daily nocturnal soiling,
occasionally in school, showed indifference to soiling, passed stools at
various places and tried hiding faeces leading to stigma and punishment
though he maintained his scholastic performance. Exploration of
history revealed stressors including conduct problems in brother, mild
mental retardation in mother, interpersonal problems between parents,
stigmatization by peers and punishment by parents and teachers.
Examination showed severe malnutrition but no other abnormality.
Investigations to rule out organic cause were non-contributory.
Diagnosis of Primary Encopresis, Retentive type was kept as other
psychiatric disorders were ruled out. Psychoeducation regarding
bowel functioning and behaviour therapy in form of toilet training
under parental supervision, positive practice and simple correction
were initiated with positive reinforcements. Marital counselling for
parents was done.
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Results: Patient achieved daytime bowel continence, started reporting
urge to defecate and going to toilet himself but nocturnal soiling
continued. Criticism of patient by parents stopped and parental conflicts
decreased significantly.
Conclusion: Primary encopresis is a multifaceted disorder requiring
management of associated psychosocial issues. Index case presented
with nocturnal soiling, indifference to soiling and voluntary withholding
of defecation as unusual features.
Key words: Primary encopresis, Soiling, Toilet Refusal, Stigma
Role of Play Therapy in Childhood Grief: A Case Report
Sen MS, Jhanda S, Malhotra S
PGIMER, Chandigarh, India. E-mail: mahadevsinghsen@gmail.com
Background: Play therapy is a technique using therapeutic and
developmental properties of play, for expression of a child’s feelings
and concerns. The following case report demonstrates case of a nine
year old boy diagnosed with grief and how play therapy helped in his
management.
Case Description: A nine year boy with normal development; was
noticed since 1.5 years of age to remain irritable, stopped playing
with friends; clinging excessively to mother after his sister expired.
Maintained same till 9 years of age when his mother expired due to
renal disease. He reacted by shouting loudly and denied her death. He
would avoid interaction with others at school, and not follow instructions.
Got startled easily, would enquire about mother on hospital visits.
Gradually, his appetite decreased and complained of stomach-ache.
On examination his weight was low for age, made poor eye contact
and spoke in few words. He was diagnosed to be having grief reaction.
Fluoxetine was started 10mg/day. Rapport was established by involving
patient in activities and play techniques. As patient started interacting
he was encouraged to express verbally and through play techniques.
Children’s apperception test was performed and revealed underlying
conflict regarding mother. These findings were incorporated to further
help the treatment sessions. At discharge patient started maintaining
eye contact and talking even with strangers.
Conclusion: This case highlights the features how grief presents
in children. It becomes important for a psychiatrist to correctly
recognize childhood grief and henceforth manage it. Experience
of grief shifts with age, as children develops cognitively as well as
emotionally. There is lack of prospective studies on the process of
grief. The case report also emphasizes on how play therapy works
for the child. It thus encourages employment of such techniques
for childhood disorders.
HIV and Mental Health
Quality of Life of Women Living with HIV/AIDS in Rural India: A
Cross-Sectional Study
Cherian AV, Helena J Chapman, Bhat S, Sathyanarayana V, Rao S,
Isaac MK, Thornicroft G
K. S. Hegde Medical Academy, Nitte University & Center for Community
Mental Health (CCMH), India. E-mail: anishvcherian@gmail.com
Background/Objectives: There are limited data on quality of life
(QOL) in women living with HIV/AIDS in rural Indian settings. The aim
of this study is to assess QOL in rural women living with HIV/AIDS,
using the World Health Organization Short HIV Quality of Life Scale
(WHOQOL-HIV-BREF).
Methods: A cross-sectional sample of 905 HIV-infected rural
women aged between 18 and 49 years was recruited from a District
Anti-Retroviral Therapy centre. Trained psychiatric social workers
interviewed participants for perceived QOL, perceived stigma, stress,
and social support, and screened for depression. Those who had a
score of 6 or above on Self Rating Questionnaire (SRQ) were further
evaluated for Major Depressive Disorder (MDD) using the Mini
International Neuropsychiatric Interview (MINI.5.0.0) by mental health
professionals experienced in administering psychiatric rating scales.
Results: Participants had a mean age of 36.69 ± 7.06 years, were
largely uneducated or studied less than seventh grade (83.6%), and
worked as unskilled labourers (81.9%). About half of the respondents
had lost their spouses due to HIV infection (45.5%). Many respondents
486 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
disclosed their HIV status only to their closest relatives (82.2%). In
addition, they perceived it as risk to disclose their HIV status to others
(86.5%). The total QOL score was 107.08 ± 10.8, where physical,
psychological, level of independence, social relation environmental
and spirituality domains were 14.93 ± 2.56, 13.66 ± 1.94, 13.70 ± 1.58,
14.92 ± 3.32, 12.87 ± 1.54 and 14.10 ± 2.73, respectively. Lower QOL
scores were associated with poorer scores on perceived stigma, self-
efficacy, stress level and depression scale.
Conclusions: QOL is associated with several modifiable psycho-social
risk factors among HIV-positive women. This study highlights that there
is a need for developing a context-appropriate psycho-social intervention
to improve QOL among women living with HIV in rural Indian settings.
Key words: Women living with HIV/AIDS, quality of life, depression
My Beauty Got Spoiled and I Have No Peace of Mind-Concerns
Shared by Rural Women with HIV in India as Part of A MHealth
Intervention
Varghese M, Parameshwaran S, Dharmappa A, Satyanarayana VA,
Reynolds N, Duggal M, Chandra PS
NIMHANS, Bangalore, India. E-mail: memeiya84@gmail.com
Background/Objective: Women with HIV who have multiple
psychosocial vulnerabilities also have difficulties with treatment
adherence. This qualitative study on psychosocial concerns is part of
a pilot RCT on mHealth counselling provided by nurses for HIV infected
women in rural Karnataka.
Method: Each of the 60 women in the intervention arm received
1250 phone calls from the trial nurses. Calls were recorded following
informed consent. Nurses also maintained phone logs and recorded
predominant themes after each call. Logs of 1250 calls were scanned
for psychosocial themes and the corresponding recordings listened
to. Themes related to psychosocial concerns were identified by two
independent raters.
Results: Of the 1250 logs studies 308 (24.64%) logs had at least one
psychosocial concern and 58 (4.64%) had three concerns, 34 of 60
(56.7%) women in the intervention arm reported at least two major
psychosocial concerns. Some of the major themes identified were
worries about their own and their children’s future due to HIV, sleep
disturbances, loneliness, stigma, social isolation, self and inadvertent
disclosure, issues related to death, abandonment by spouse, financial
difficulties and work pressure, sadness, guilt, anger and fear, body
image concerns, lack of social support and need for social services.
Concerns related to the mobile phone based intervention also emerged.
Some statements made were “my beauty got spoiled” ‘’my brothers
have stopped calling me since they came to know about my illness’’,
‘’I haven’t told my employers for the fear that they may remove me
from myjob’’
Conclusions: Women with HIV have several psychosocial concerns
which they are able to share over the mobile phone even though they
have never met the nurses face to face.
Key words: Women with HIV, psychosocial issues, mHealth
Human Rights and Mental Health
Emergence Of Psychiatric Clinics At The Chamatkarik Hanuman
Temple, Mehandipur Balaji Temple And Baba Ramdev Temple - A
Milestone Endeavor For The Human Rights Promotion Of The
Persons With Mental Illness
Ray TK
SEVAC Mental Health Felicity, 135A Vivekananda Sarani. P.O
-Thakurpukur. Kolkata, India. E-mail: sevacindia@gmail.com
Persons with mental illness are the easy prey of varied human rights
violations. As for instance a large number of these ailing persons are
dumped in different shrines across India in a subhuman condition
in the name of Faith Healing. Chamatkarik Hanuman Temple of the
Chindwara District of Madhya Pradesh is such a shrine where a large
number of persons with mental illness belonging to the poorest of
the poor section used to languish in a subhuman state. Hence with
the support of the National Human Rights Commission, European
Union and M.P. Government the Operation Commitment Project was
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launched by SEVAC (a Kolkata based NGO) in 2012 to operate a
weekly Psychiatric Clinic in the vicinity of this shrine . People who
opted for psychiatric treatment became considerably stable. Their
improvement and wellbeing motivated others to accept the psychiatric
treatment. Around 2300 patients registered their names to this clinic
from August 2012 to March 2016 and many of them are now stable
and engaged in meaningful work. From April 2016 the Government of
M.P has taken over this clinic as a component of the National Mental
Health Programme. Meanwhile, SEVAC identified the Mehandipur
Balaji Temple and Baba Ramdev Temple of Rajasthan where persons
with mental illness languish in the similar manner. Following the
intervention of NHRC and European Union two Psychiatric Clinics are
now being operated in the vicinity of these two shrines by the Rajasthan
Government in collaboration with SEVAC. It is a matter of fact that in the
name of Faith Healing a considerable number of persons with mental
illness are mal-handled in several shrines across the country. Hence it
is the need of the hour to replicate the Operation Commitment Project
in those shrines to bring succour to them.
Attitude of Adults Towards Elderly Mistreatment in a Selected
Community
Gupta S
AIIMS, New Delhi, India. E-mail: drsandhyag407@gmail.com
Background/Objectives: Elder abuse is recognised as a socially
and culturally constructed phenomenon and is a global burden.This
quantitative cross sectional survey was carried out to ascertain the
knowledge, attitude and perception of elder abuse among semi-urban
dwellings on 160 participants of Delhi by consecutive sampling method.
Tools: A 34 items questionnaire on abuse of elderly.
Results: Out of 160 participants, 42 (52.5%) were female, three fourth
(75%) lives in nuclear family and 65% of the participants were educated
up to higher secondary or above. The mean age of the respondents
was 43 ± 5 years. Thirty eight percent of the participants stated that the
demanding behaviour of the elderly leads to violent behaviour of the
people in their household. Most (60%) of the respondents agreed that the
behaviour of the elderly is provocative which leads to abuse. Two third
(70%) of the respondents stated that it is their individual responsibility to
report elderly abuse and neglect if they witness any. All the participants
agreed that the elderly abuse and neglect is a criminal act and they have
the responsibility to prevent such abuse and neglect. All the respondents
(100%) were aware of financial abuse and half (52.5%) of the subjects
believed that using swear words some times are due to part of their culture.
Most (92.5%) agreed that occasional manhandling of elderly is violence/
abuse. There was a positive attitude from almost all the participants
regarding avoidance or negligence of the elderly. Public awareness and
attitude related to some common issues of elderly abuse is poor especially
regarding physical abuse, intolerance towards demands of elderly, cultural
influence, sexual abuse and reporting of incidents.
Conclusion:Creating awareness regarding elderly abuse and neglect
and changing the attitude of public toward elderly may bring positive
result in prevention of elderly mistreatment.
Key words: Elderly abuse, Elderly mistreatment, neglect, knowledge
and attitude
Are Nurses Well Equipped to Provide Psychological First Aid To
Trauma Victims?
Lalengkimi C, Gupta S, Satapathy S, Gupta A, Aggarwal P
AIIMS, New Delhi, India. E-mail: kimchawngthu22@gmail.com
Background: Traumatic experiences are strongly associated with
subjective emotional experience of the event such as road accidents,
disaster etc. Providing Psychological first-aid to trauma survivors
can have an immediate positive impact and lasting consequences in
preventing post-traumatic stress disorder in victims of trauma. Nurses
working with trauma victims need to give psycho-social care along with
physical care. The objective of the study was to find out knowledge of
nurses regarding Psychological First Aid.
Methods: A survey approach was chosen for the study on sixty
bedside nurses working in Trauma unit, AIIMS, New Delhi. Simple
random sampling technique was used for sample selection. Ethical
clearance for study and Informed consent was obtained before
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
data collection. Tools used were subject data sheet and knowledge
questionnaire regarding Psychological First Aid. Data was analysed
using descriptive statistics.
Results: The mean age of nurses was 29 years (SD±2.69). Mean
working experience was 5 years. Most of the nurses were female and
married. More than half of nurses were GNM diploma holders and had
work experience in ICU. Nurses have inadequate knowledge regarding
Psychological First Aid as depicted by their mean knowledge scores
(9.3 ± 0.766), Range of score is 8-10) where in maximum possible
score was of knowledge questionnaire was 15.
Conclusion: Nurses have very high learning need in the area of
Psychological First Aid, therefore the nurses can provide PFA to all
victims of trauma in emergency unit and disaster care units only if
they are given training programme on PFA. A mandatory training in
PFA should be given to all pre-service and in-service nurses in order
to provide skills required to enhance quality of patient care and reduce
risk of developing mental symptoms specially post traumatic disorder
and acute anxiety disorders. The study shows that nurses can provide
PFA as an early crisis intervention
Key words: Psychological first aid (PFA), Knowledge of Nurses
Positive Mental Health
Creativity-A Hidden Resource at Hospital Work?
Tuisku K, SEM S, Appelqvist-Schmidlechner K, Saarni SI, Holi M
Helsinki University and Helsinki University Hospital, Helsinki, Finland.
E-mail: katinka.tuisku@hus.fi
Background/Objectives: Building positive mental health is important
when the sources of stress cannot be eliminated. However, it has
not gained as much attention as burnout and stress among hospital
employees. Hospital work calls for coping with stress, learning new
and solving problems with a creative working mode. The aim of our
study was to find out the frequency of creative working mode, and it’s
associations with socio-demographic factors, cultural activities, type
of employment and occupational wellbeing.
Methods: A digital self-report questionnaire was filled in by public
sector hospital personnel (N = 769). Creative working mode was
measured by asking a standardized question of frequency of creative
ideas and practices at work during the last month. Recovery from work
and stress were asked by single standardized Likert-scale questions.
The associations with background factors were tested by ANOVA, and
correlations with wellbeing experiences by Spearman.
Results: Creative working mode was reported daily by 11%, weekly
by 16%, occasionally by 50% and never by 23% of the respondents.
It was associated with cultural leisure activities (F 3.96, p=0.002) and
stable work (F 8.24, p=0.005), but not with age, gender, working hours
nor with profession. It was weakly correlated with recovery (CC 0.109,
p=0.003), but not with stress.
Conclusions: Stable works seems to favour creativity, possibly
encouraged by continuity and engagement. The association between
cultural activities and creativity may be bidirectional, but considering
earlier studies, creativity and recovery seem to be positive mental health
outcomes of cultural activities. Stress was uncorrelated with creativity,
causing no selection bias. Creativity is an important resource of coping
even in the highly disciplined and hierarchical working environment of
hospitals. Achievements in human societies and organizations depend
on the ability to call forth hidden creativity.
Positive Psychology
Dikshit R, Shrivastava, Belmont C, De Sousa A, Campbell R, Stitt L,
Shah N
L.T.M.M.C Mumbai, Maharashtra, India. E-mail: reetikadikshit@yahoo.com
Positive psychological characteristics among recently discharged
patients: strategy for prevention of re-hospitalization. More than 50% of
patients with severe mental disorder recover poorly, and about 40% are
re-hospitalized within six months of discharge. Not much attention has
been paid to identifying factors related to the patient and their ability to
respond to symptoms and distress that lead to hospitalization. Positive
psychological characteristics like resilience and the factors that constitute
resilience also play a role in hospitalization. In this cross-sectional cohort
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study, we examined positive psychological characteristics of resilience
and their determinants among those who are repeatedly hospitalized.
We measured psychopathology (i.e., psychosis [BP], depression [HDRS],
life events [LEQ], suicidality [SISMAP] and resilience [CD-RISC]), and
PPCs were measured by individual items of the scale of resilience. 48
of 78 patients were male, mean age was 42.8 and more than 70% were
single.38 of 78 patients were hospitalized more than once during the
previous year, with the mean number of hospitalizations being 5.4 and
length of stay 11.3 weeks in the latest admission. About 56% of subjects
had moderate to severe suicidal ideation. Level of resilience was low
(71% less than 60 and 37% less than 50).Those who were admitted
only once scored high on resilience, suggesting inadequate levels in
patients with multiple readmissions, particularly on six parameters: 1)
High resilience (28 [51.9%] vs. 4 [19.1%], p<0.010); 2) Took pride in their
achievements (18 [58.1%] vs. [31.8%], p<0.024); 3) Had a strong sense
of purpose (31 [48.4%] vs. 14 [31.8%], p<0.024); 4) Stayed focused under
pressure (28 [50.0%] vs. 4 [21.1%], p<0.028); 5) Did not give up under
pressure (25 [53.2%] vs. 7 [25.0%], p<0.017;, and 6) Dealt positively with
whatever came up (27 [48.2%] vs. 5 [26.3%]. p<0.095). We suggest the
therapeutic measures to build PPC can help reduce re-hospitalisation.
Yoga for Mental Health Prevention and Promotion: Evidence Based
Community Interventions
Jagannathan A, Gangadhar BN, Nagendra HR
National Institute of Mental Health and Neurosciences (NIMHANS),
Bangalore, India. E-mail: jaganaarti@gmail.com
Background/Objective: Liberalization, privatization and globalization
(LPG) of mental health care has caused: (1) rise in the costs of
medication and mental health care treatment and (2) brain drain of
mental health professionals from India. To tackle this growing issue,
introduction of yoga as an alternative and complementary treatment
for patients with psychiatric disorders could be an effective solution for
three basic reasons: (1) yoga which originated in India, is seen to be
a practical and accepted intervention for patients to practice at home,
(2) the number of yoga therapists is more than the number of mental
health professionals available in India, (3) yoga is cost-effective and
has no side-effects as in the case of psychiatric medications.
Methods: The research team conducted evidence based research in yoga
to understand its importance in mental health promotion and prevention
Results: Research from our team has focused on yoga as an add-on
treatment for patients with schizophrenia, depression and caregivers.
The effect of specific yoga practices such as ‘trataka’ on cognitive
functions in the elderly has also been researched. Research on
barriers to yoga therapy for schizophrenia, lead to the development
of a community project (ICMR) on yoga (using digital technology) for
out-patient caregivers living in the Indian rural/semi-urban communities.
Conclusion: The psychiatric illness outcome with yoga as treatment
modality would depend on (1) whether yoga can be effective as an
independent or add-on treatment to pharmacology, (2) compliance to
yoga - effectiveness of brief yoga practice versus continued practice,
(3) establishment of community yoga groups - where the patient can
get supervised and continued training. Answers to the above questions
could help propagate yoga as an effective solution to accessing,
affording and availing quality mental health care services in the Indian
community.
Key words: Yoga, Mental Health Promotion, Community Based
interventions,
Women Coping with Sexual Harassment, A Case Study of Urban
Slum
Singh M, Gupta S, Kumari L, Singh G
All India Institute of Medical Sciences, New Delhi, India. E-mail:
singhmps2006@gmail.com
Background: Awareness about prevention of sexual harassment
among women is very low and violence towards them is increasing
day by day. There is need to find out whether the women in urban slum
have required awareness about sexual harassment prevention and
training to act against sexual harassment. The objective of the study
was to find out awareness of women about prevention strategies and
sexual harassment.
488 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Methods: A case study of 45 women, visiting a NGO-for vocational
training in an urban slum area of Delhi. A structured awareness
questionnaire was used to assess the awareness of women about
prevention of sexual harassment. Permission was taken from the
NGO and consent was taken from all subjects before data collection.
Results: Mean age of women was 23.48 ± 6.27 years, ranging between
15 to 50 years. Most of the subjects feared for facing sexual harassment
of self whenever they went out alone. Most of the women reported
high level of scare-alert from police due to fear of harassment. Only
few women were aware of legal provisions and facilities available for
prevention of sexual harassment. Only a few of the women felt safe
with the police officials. Most of them do not have knowledge about
Protection of Women Against Domestic Violence Act (498A).
Conclusion: Overall awareness about prevention of sexual harassment
of female adults of Delhi was inadequate. Hence there is urgent need
for creating awareness about ways to recognize harassment and
anticipate danger in time.Police need to know that women are not
confident to talk to police regarding sexual harassment hence police
should try to remove reasons for their hesitation to approach police for
help. After the survey two hours session was conducted on prevention
of sexual harassment, related Laws of IPC and provisions assured by
Government of India for women.
Gender, Quality of Life and Perceived Social Support Among
Rural Elderly Population: A Study from Sonitpur District, Assam
Ali A, Hazarika PK
Department of Psychiatric Social Work, LGB Regional Institute of
Mental Health, Tezpur, Assam, India. E-mail: arifafi@gmail.com
Background/Objectives: The present study aim to examine the
gender difference in quality of life and perceived social support among
elderly population.
Methods: It was a cross-sectional community based study. People
in age group of 60 years and above, were selected from two villages
in Tezpur, Sonitpur district of Assam. There were around 104 people
of age 60 and above in the electorate list in a total adult population
of 1490. Total enumeration method was used for selection of sample.
Socio-demographic data sheet, Multidimensional scale of perceived
social support and World Health Organization Quality of Life Scale
[WHOQOL-BREF] were administered to the respondents.
Conclusion: The findings of the study shows that significant gender
difference was not found in domain of physical health, psychological,
social relationships and environment domain of quality of life [WHOQOL
scale] among male and female elderly population. On the basis of the
results obtained it can be said that the female elderly respondents were
having better perceived social support than the male elderly population
and significant gender difference was found in the all the domain of
multidimensional scale of perceived social support scale.
A school based cross sectional study on health related behaviours
of adolescents
John S, Pandian RD, Raj EA
NIMHANS, Bangalore India. E-mail: soyuzjohn@gmail.com
Background/Objectives: Adolescence is a crucial period in the
life course of an individual. Opportunities for prevention of multiple
conditions like mental illness, non-communicable diseases and injuries
lie in this period. Many health related behaviours such as physical
exercise, food habit, alcohol and smoking, initiated during adolescent
period, are going to determine the future health of an individual. It is
very important to understand the health related behaviours and lifestyle
practices of adolescent to plan corresponding policies and programme
to address the same. So the current study aimed at studying health
related behaviours of adolescents in school.
Methods: 150 students from 8th, 9th and 10 classes of a school were
selected for the study. Both boys and girls were chosen for the study.
A semi-structured questionnaire was used to assess the health related
behaviour of the students. The questionnaire assessed the areas such
as general information, physical health and physical activities, tobacco
use, alcohol, drugs, and food habits.
Result and conclusion: Around ten percent of the students had ever
alcohol use, fifteen percent had ever tobacco use and majority of the
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students had adequate physical activities. Majority of the students drink
or eat fast food and soft drinks at least once in a week.
Key words: adolescents, school, health related behaviours
Third Wave Cognitive Behaviour Therapies in Emotional Disorders
Chavan BS, Kumar M, Singh TK, Sharma A, Kumar A
Government Medical College Hospital, Chandigarh, India. E-mail:
mkbajaj@gmail.com
Third wave cognitive behavioural therapies are a group of emerging
approaches to psychotherapy that represent both an extension of and
deviation from traditional cognitive behavioural treatment approaches.
Third wave therapies prioritize the holistic promotion of health and
wellbeing and are less focused on reducing psychological and
emotional symptoms, although that typically is a side benefit. These
third wave therapies all, to some degree, abandon key assumptions
associated with traditional cognitive therapy informed by emerging
research in cognitive psychology and neuroscience. Concepts such
as metacognition, acceptance, mindfulness, personal values, and
spirituality are frequently incorporated into what might otherwise be
considered traditional behavioural interventions. The speaker will be
sharing the current status of third wave CBT, starting from classical
CBT, Mindfulness, and metacognitive therapies with ancient Indian
therapies in connection with rapidly changing world.
Telemental Health: Role and Application in Indian Psychiatric Setting
Sharma P, Mehta M, Parmar A
AIIMS, Delhi, India. E-mail: pragya.cp@gmail.com
Computers, mobiles and tablets have taken over the Indian consumer
population. In such a scenario, telemental health (TMH) is seen as
an upcoming field. Telemental health refers to the provision of mental
health care from a distance. The professional makes use of internet
programs, telephone and smartphone applications to diagnose, assess,
track symptoms and hold therapy sessions with clients.The need for
TMH is especially highlighted for Indian population as it aims to solve
some of the major shortcomings that lead to treatment gaps in our
country. Mobile apps have been used as self-monitoring devices and
have been seen to be efficacious at both post-treatment as well as three
months follow-up. TMH is still in its nascent stage in India. Although
several websites and apps boast of providing mental health services,
majority of it is limited to consultation through email services. Web
based psychological testing is being planned by some researchers
while Chennai has initiated a mobile telepsychiatry unit with video
conferencing facility to cater to one district. The presentation focuses
on the role and application of telemental health in Indian psychiatric
setting. It illustrates the major treatment gaps in our country and how
TMH can fill in those gaps. The symposium elucidates in detail the
current status of smartphone apps and catering to TMH in India with a
focus on its advantages, limitations and future directions. Challenges
and ethical issues are also discussed.
Dialectical Behaviour Therapy for Borderline Personality Disorder
Srivastava P, Chhibber K, Singh M, Sinha C
Fortis Helathcare, New Delhi, India. E-mail: paakhisrivastava@gmail.com
Current practices in psychiatry are evidence based. Treatment services
extend beyond treatment of biological causes to offer solutions to
handicaps in social contexts. Borderline Personality Disorder can be
debilitating given the associated bio psychosocial impairments. With
a significant evidence base1, DBT is considered to be the paradigm
of choice for treatment of Borderline Personality Disorder. Dialectical
Behaviour Therapy (DBT), addresses the impairments in interpersonal
context by imparting specific set of skills to people with this condition.
Of these skills, the relevance of mindfulness and interpersonal
problem solving is significant in Indian context which is also why DBT
is acceptable and adaptable in our country. The rise in incidence of
Borderline Personality Disorder2 indicates the needs for acquisition
of principles and skills of DBT in routine training of psychiatrists and
psychologists. This will also be step towards increase treatment
availability to people with Borderline Personality Disorder. The inherent
modular and hierarchical approach of DBT makes it easy to learn and
apply in clinical settings.
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
This presentation offers an in-depth understanding of DBT, along with
hands-on training on its implementation. The emphasis will be case
discussions, rehearsals of techniques, dissemination of handouts and
skill building.
Key words: Dialectical Behaviour Therapy, Borderline Personality
Disorder, Mindfulness, Emotion Regulation Strategies, Training
Recovery and Peer Support
A Social Networking Based Adaptive Software for Automated
Delivery of Cognitive Behavioural Therapy
Ghosh A, Bajpai A, Bhushan B, Gupta N
Indian Institute of Technology, Kanpur, India. E-mail: arkaghosh024@
gmail.com
Background/Objectives: Depression is a major psychiatric disorder
globally, including India. Cognitive Behavioural Therapy (CBT) is one
of the effective approaches to treat depression, but its reach is limited
by factors such as dearth of psychiatrists and counsellors, especially
in remote areas, cost of clinical sessions and social stigma associated
with visit to a psychiatrist. Delivering CBT through a computer interface,
without regular intervention of a psychiatrist, could address these
limitations. Computerized Cognitive Behavioural Therapy (CCBT)
is thus emerging as an accessible and economical approach for
delivering CBT. Despite some evidence of its efficacy, the use of
CCBT is limited because the existing CCBT software provides lower
level of personalization and engagement than in-person therapy. We
have developed a stand-alone website that delivers CBT interactively
using several new features. We hypothesize that our novel features
will make the website effective, engaging, and reduce user attrition.
Methods: The website is designed to deliver tailored CBT through
multimedia elements over a period of 6 weeks. The website adapts
to individual users based on their profile, dysfunctional thoughts,
behaviours, and beliefs. A peer support network has been incorporated
to increase user engagement and reduce attrition rate. To solve real-life
problems, users will have access to a support group that works on the
idea of crowdsourcing. Change in the depression scores of the users,
as measured by Patient Health Questionnaire-9 (PHQ-9), over the
duration of usage will indicate the efficacy of the program.
Results: A prototype version of the website to deliver CCBT has been
developed and is currently being refined and prepared for randomized
trials.
Conclusion: CCBT is a promising approach for providing CBT. The
results of our clinical trial will provide new insights on the efficacy of
CCBT.
Key words: CBT, online, peer-support, crowdsourcing, personalization
Perceived Expressed Emotions in Patients with Somatoform Disorder
Elwadhi D, Das A, Mehta P, Gupta M
G B Pant Institute of Medical Education and Research, New Delhi,
India. E-mail: elwadhideeksha@gmail.com
Background/Objectives: Expressed emotions (EE) refer to the
emotions, attitudes, and behaviors expressed by relatives toward an ill
family member. It is an important predictor of the course and relapse of
psychiatric illnesses. Somatoform disorders are characterized by physical
signs and symptoms, with underlying health anxiety and excessive illness
worry as major psychological hallmarks. This study cross-sectionally
examines the level of perceived EE of patients with somatoform disorders
and tries to correlate the severity of the disorder with EE.
Methods: 30 patients aged 18 years and above, of either gender, with
a diagnosis of somatoform disorder as per ICD10, were recruited from
outpatient Psychiatry clinic of GIPMER. Patients with a major medical or
psychiatric co-morbidity were excluded. After taking informed consent a
Semi-structured Performa for socio-demographic and clinical variables
was used to collect data. Level of Expressed Emotion (LEE) scale was
used to assess the perceived EE. PHQ-15 and Bradford Somatoform
inventory measured the severity of the illness. Descriptive analysis of
the socio-demographic and outcome variables was done, along with
correlation analysis between EE and illness severity, using SPSS 20.0.
Results: 67% of the study population was female with a mean age
of 37 years. Most of the population was married, with 60% being a
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home maker. 25 out of 30 test subjects were diagnosed as moderate
to severe somatisation disorder. Trends indicate high levels of perceived
expressed emotions in patients with somatoform disorder, which directly
correlated with the severity of illness.
Conclusion: EE give a general view of the emotional climate of the family
and henceforth can affect the course and outcome of common mental
illnesses like somatoform disorders. Interventions focused at reducing
EE need to be included in the treatment paradigm of this disorder.
Key words: expressed emotion, somatoform disorder, PHQ15, LEE
Social Determinants in Biological Treatments
Psychosocial Impact of Infertility - A Super-Speciality Clinic Based
Study from WBUHS, India
Ashik Uz Zaman SK, Ghosh Dastidar S, Ghosh Dastidar K, Neogi R
WBUHS, 119, Southern Avenue, Kolkata, India. E-mail: truegood001@
gmail.com
Background/Objective:As per assessments done by WHO, 60 to 80
million couples worldwide currently suffer from infertility affecting 8 -12%
of couples worldwide. The aim of this study was to assess the effect
of infertility on quality of life, anxiety and stress of couples. This is one
of the first studies to be conducted in the Indian context to assess the
quality of life and stress among infertile couples.
Methods: Couples visiting the OPD of one of Kolkata’s IVF centres were
randomly selected. Respondents completed Bengali standardized versions
of Becks Depression Inventory-to measure intensity of depression; Cattle
Inventory- to assess anxiety; SF -36 (22) and SCL-90-R-to assess quality
of life , psychological disturbances and sexual satisfaction.
Results: Preliminary findings indicate that infertility in couples has a
detrimental effect on mental health and quality of life. Greater so in
couples with prolonged duration of illness with multiple failure attempts
in IVF /ICSI cycles. We have noted greater degree of anxiety in couples
experiencing infertility for duration of 2-3 years than less than 1 year or
more than 6 years. Infertile Couples belonging to upper socio economic
strata with greater social support and educational background have
improved quality of life as compared to infertile couples belonging to
poor educational and financial background.
Conclusion: Infertility is a growing medical problem with 8-12 percent
of married couples suffering from this ailment. In the South Asian
context, this poses as a serious stress factor in our society as majority
of couples cannot avail expensive Artificial Reproductive Therapy such
as IVF due to high costs and high failure rates. It is imperative that
healthcare policy making institutions place greater emphasis on access
of infertility treatment to general masses.
The Role of Metabotropic Glutamate Receptors in the Nucleus
Accumbens in Establishment and Maintenance of Morphine-
Induced Conditioned Place Preference in Animal Model
Sarihi A, Haghparast A, Roohi N, Baharlouei N, Komaki A, Shahidi S
Hamadan University of Medical Sciences, Neurophysiology Research
Center, Hamadan, Iran. E-mail: asarihi@yahoo.com
Background/Objectives: Glutamate transmission into the nucleus
accumbens (NAc), as one of the important structure of the reward
circuitry play role in the rewarding properties of morphine. We
investigated the role of metabotropic glutamate receptors types 2/3
(mGluR2/3) and 5 (mGluR5) into the NAc by using microinjection
method and morphine induced conditioned place preference (CPP)
task in male rats.
Methods: Drugs were directly injected into the NAc through the guide
cannula implanted using stereotaxic surgery. CPP paradigm is one
of the most widely used experimental protocols for measuring drug
reward in laboratory animals.
Results: Our results indicated that bilateral intra-accumbal
administration of LY379268 (an mGluR2/3 agonist) decreased both
acquisition and expression of morphine induced CPP dose dependently.
On the other hand blockade of mGluR5 into the NAc by MTEP
attenuated the acquisition but not expression of morphine induced CPP.
Conclusion: Our findings suggested the role of these receptors in
establishment and maintenance of morphine induced CPP and the role
of this system as a potential therapeutic target for addiction
490 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Impulsivity and Lipid Profile: Role in Patients with Dissociative
Disorders
Ansari MH, Sinha V, Gurnani KC, Lavania S, Kumar H
S. N. Medical College, Agra, Uttar Pradesh, India. E-mail: mha.snmc@
gmail.com
Background: Impulsivity and self-harming behaviors have been
found to correlate negatively with serum lipid fraction in subjects
with psychiatric co-morbidities, and especially in those with affective-
spectrum disorders.Present study aimed at exploring the relationship
between serum lipid fractions, impulsivity and self-harming behaviors
in patients with dissociative disorders, who attended a tertiary-level
psychiatry care facility.
Methods: This was a cross sectional study, and included 30 consenting
adult patients with a diagnosis of Dissociative disorders as per ICD
10 DCR, and 30 age-sex matched healthy controls (GHQ<3). All data
were collected using self-administered semi-structured proforma after
obtaining written consent from the participants. Barratt impulsiveness
scale 11 and Hamilton depressive scale were applied on the patients.
Appropriate statistical analyses were done using SPSS software.
Results and Discussion: To be presented during the conference.
Key words: Dissociative disorders, self-harm, serum cholesterol,
serum lipid profiles, suicide
A Cross-Sectional Study on Pathways of Care and Reasons for
First Admission in the Psychiatry In-Patient Setting in VIMHANS,
A Tertiary Care Hospital in New Delhi, India
Maiti T, Pattanayak S
CMC Vellore, P2 Office, 1st Floor, Mental Health Center, Bagayam,
Vellore, Tamil Nadu, India. E-mail: drtanaymaiti@gmail.com
Background: Different cultural values, myths and beliefs often hinders
the road to reach the proper mental health care after wasting valuable
time which certainly leads to poor prognosis. Understanding about
various clinical pathways are hence carries added significance specially
in mental health considering its complex presentations, lack of awareness
and delay to identify the symptoms.The objective of the present study
was to understand the pathways of care leading to psychiatric in-patient
admission in a tertiary care setting from urban background and identify
different service providers approached by the patientsand their family
members before seeking admission in a tertiary care centre.
Methods: Following the screening total 151 patients and their family
members were interviewed. Semi-structured questionnaire using MINI
Version 5.0.0 was used along with adapted form of Pathways of Care
Assessment provided by World Health Organisation. Statistical analysis
was done using descriptive statistics and categorical and metric variables.
Results: Among the study population, highest number of first contact
with the patients remained general practitioners (39%) where native/
religious healers and proper psychiatric services became 26% and 22%
of first contacts respectively. Maximum patients (33%) visited atleast
2 different service providers before meeting any psychiatric or mental
health service providers.
Conclusion: The present cross-sectional study shows different
important findings of both treatment providers and treatment seekers,
from the socio-economic background to factors deciding the dyadic
relationship between the two. Similar kind of studies are further needed
both to understand and implement the healthcare model especially in
the developing countries.
Key words: myths, pathways of care, health-care providers
The Demographics and Psychiatric Symptoms Influencing Spatial
Attention in Patients with Schizophrenia
Kurebayashi Y, Otaki J
Kansai University of Health Science, Japan. E-mail: love_love_chiple@
yahoo.co.jp
Background/Objectives: Schizophrenia have shown not only
psychiatric symptoms but also neurocognitive functions. Of
neurocognitive functions, deterioration of spatial attention have been
recognized as trait maker in schizophrenia. Moreover, disability of
spatial perceptions could lead to problems on daily living such as injury
and fall. Therefore, the treatment such as maintain or improve spatial
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attention are needed.This study aimed to examine the demographics
and psychiatric symptoms influencing spatial attention, and to get the
suggestions for treatments of patients with schizophrenia.
Methods: The participants were in-patients and out-patients with
schizophrenia underwent treatment in 2 psychiatric hospitals in Tokyo,
Japan. We investigated the participant’s demographics, and assessed
the severity of their psychiatric symptoms using PANSS and their
neurocognitive functions using the Cog Health software. Of the 6 domains
on Cog Health software, “spatial attention” task’s score was used to
analysis. In “spatial attention” task, the participants were asked to push
button when the cards randomly moving reached the line in displays.
The reaction time of the task were measured. In statistical analysis,
first, Pearson’s correlation coefficient was calculated, then the multiple
regression analysis by the stepwise method was conducted.This study
was approved by the ethical committee of the Kyorin University.
Results: The 129 (66 inpatients, 63 outpatients) were included in this study.
The multiple regression analysis showed that lower of spatial attention
were predicted by older age, longer length of stay, and severe on “Poor
attention (G11)” and “Luck of spontaneity (N6)”, accounting for 47 %.
Conclusion: Early discharge may maintain or improve the spatial
attention of patients with schizophrenia. And for patients presenting
disability on attention and “spontaneity and flow of conversation”, the
arrangement facilitate the perception of spatial information is needed.
Physical Activities and Neurocognitive Functions in Inpatients
with Non-Remitted Schizophrenia
Kurebayashi Y, Otaki J
Kansai University of Health Science, Japan. E-mail: love_love_chiple@
yahoo.co.jp
Background/Objectives:Neurocognitive dysfunction is a target
symptom of schizophrenia treatment. The relationship between
neurocognitive functions and physical activities has been reported
among healthy individuals but not among schizophrenia patients. The
aim of this study was to examine whether neurocognitive functions
associated with physical activities in schizophrenia inpatients and to
suggest appropriate rehabilitation measures.
Methods: Participants were schizophrenia inpatients undergoing
treatment in a psychiatric hospital in Osaka, Japan. We investigated
the demographics, psychopathological symptoms (using PANSS)
and neurocognitive functions (using Cognitrax). Cognitrax measures
the neurocognitive index as a total composite score and 11 domain
scores. These scores were converted to standardized scores so that
the average score = 100 and one standard deviation = 15. Finally, the
participants wore an HJA-750C at the waist for 1 week to measure
physical activity. A rank correlation coefficient analysis was performed
and P < 0.05 was considered significant. This study was approved
by the ethics committee of the Kansai University of Health Science.
Results:Thirteen men and three women (mean age 59.4 ± 12.1 years)
participated in this study. The average duration of stay at the hospital
was 207 ± 175.9 months, cumulative dosage of antipsychotics was
1185.0 ± 890.4 mg, PANSS score was 73.6 ± 13.3 and neurocognitive
index was 56.1 ± 21.6. Spending a long time on physical activities of
>4 METs was associated with lowest neurocognitive index complex
attention, cognitive flexibility and executive functions.
Conclusion: Although the geriatric non-remitted schizophrenia
patients were administered high dosages of antipsychotics, they
showed moderate psychiatric symptoms. Associations between higher
physical activities and worse neurocognitive functions were observed.
In summary, to maintain neurocognitive functions, non-remitted geriatric
inpatients should be prevented from spending longer time on physical
activities of >4 METs.
Transcultural Psychiatry
Culture Bound Syndromes - Controversial Existence in
Classification System
Pakhre A, Sircar A
Deen Dayal Upadhyay Hospital, New Delhi, India. E-mail: sjmc.
ashish@gmail.com
Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
Background/Objectives: Culture bound syndromes is a broad term
to denote somatic, cognitive and behavioural symptoms seen in
specific cultures across the world. To study the phenomenology and
controversies associated with culture bound syndromes.
Methods: Electronic and manual searches were done to find out the
information on description in classification system and phenomenology
of culture bound syndromes.
Results: Most studies available are for Dhat syndrome and mainly
from Southeast Asian region. Few research trials conducted due to
nosological issues. It has been described universally in other cultures
in western countries. Nosological status of culture bound syndrome in
classification system is controversial.
Conclusions: It is crucial that psychiatrists are aware of transition in
culture and changes in perception of distress. Better understanding of
culture will promote a logical and appropriate approach to diagnostic
categories of culture bound syndromes.
Key words: Culture bound syndrome, Culture specific syndrome, Dhat
syndrome, Cultural concept of distress
Mutism Presenting Symptom of Non-Catatonic Schizophrenia:
A Case Report
Du B, Singh S, Rao P, Umate MS, Kale VP
Grant Government Medical College, Mumbai, Maharashtra, India.
E-mail:bharathdu@gmail.com
Background/Objectives: Mutism is the loss of faculty of speech due
to functional or organic causes. Amongst psychiatric causes, it is a
common accompaniment of catatonic schizophrenia, but can occur
in non-catatonic schizophrenia and other disorders as well; posing a
clinical conundrum for diagnosis and management. There is dearth of
data and understanding of psychopathology of non-catatonic mutism
in schizophrenia.
Methods: A case of non-catatonic mutism in schizophrenia is
described, along with the review of similar reported cases.
Discussion: A 40 year old woman with complaints of cessation of
speech, irritable behaviour and refusal to have food unless prepared by
herself, since 6 months, was admitted in view of gradually decreasing
food intake; however all her other routine activities and self-care
remained unaffected. Organic causes for mutism were ruled out. She
was started on benzodiazepines and antipsychotics. Considering
her deteriorating nutritional condition, electro-convulsive therapy
(ECT) was initiated. Patient showed improvement after first ECT,
and admitted having auditory hallucinations. She was discharged
after symptom resolution. She presented with similar complaints
after 2 months following a family conflict, but this time reported not
speaking willingly, to avoid unpleasant conversation. She improved on
maintenance ECT and depot antipsychotic. Similar cases were reported
from developing nations, especially India (5 cases) and showed
resistance to conventional catatonia treatment. Non-catatonic mutism
in schizophrenia might be a cultural variant of psychopathology in
Indian context. It can be explained as - primary psychotic phenomenon
- extreme form of alogia- adaptive behaviour to psychotic symptoms of
delusions and hallucinations - faulty coping mechanism
Conclusion: Mutism, as a symptom, needs detailed evaluation
for appropriate diagnosis and management. It can be an atypical
presentation of schizophrenia with respect to symptomatology and
response to treatment; which in our case showed rapid response to
ECT. However, conclusive results warrant further.
A Study on Distress Pattern, Disease Related Perception, Help
Seeking Behavior Among the Depressed Patients
Sanyal D, Mukherjee B
KPC Medical College, Jadapur, Kolkata, India. E-mail: dsanyal99@
hotmail.com
Background/Objectives: Difference in cultural perspective of illness
has been proposed as contributing reason for depression remaining
mostly undetected and untreated. This study planned to study distress
pattern, disease related perception, help seeking behaviour among
the depressed patients. Our hypothesis is that our culture’s view of
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Abstracts
depression is likely to be different which in turn might influence help
seeking behaviour.
Methods: This study was conducted in a mental hospital in a rural
area. Major depressive disorder patients (n=50) were assessed using
EMIC (Explanatory Model Interview Catalogue) to get emic (insider or
person’s own cultural) perspective of distress pattern, perceived cause
and help seeking behavior.
Results: Depressed patients mostly presented with physical pain (32%),
only 20% presented with depressed feeling. Ayurvedic concepts like
vayu (34%), physical illness (34%), and sexual weakness (32%) were
commonest and psychological reason rarest (0%) perceived cause. None
of the subjects came in contact with any mental health care facility. Most
sought help of local quacks (60%) and local health centre (60%). Using
Exhaustive CHAID analysis, physical pain as distress was strongest
predictor of local health centre visit, while an Ayurvedic concept as
perceived cause is strongest predictor of quack consultation.
Conclusion: Need to understand the common people’s paradigm
regarding depression for success of any campaign aiming increase
awareness about depression. Our study also shows role of non-
traditional healthcare providers in depression management, thus they
may need to be involved during public health campaign.
Key words: emic, depression, distress, perceived cause, help seeking
Trance and Possession Disorders or Psychosis: Diagnostic Issues
in a Case of Hypoparathyroidism- A Case Report
Modak T, Mohan S, Kumar S, Verma R, Kumar N
All India Institute of Medical Sciences, New Delhi. E-mail: tamonud4@
gmail.com
Background: Possession trance is characterized by a transient
alteration in identity whereby one's normal identity is temporarily
replaced (possessed) by a spirit, ghost, deity, or other person. The
clinical challenge lies in differentiating it from epilepsy, psychosis and
culturally sanctioned “possession” states. Our case illustrates a similar
situation where the clinical picture was complicated by the presence
of neurological and endocrinological abnormalities.  a strong need for approval from authority figures as an adolescent.
Case outline:The patient was a 27-year-old lady who had a history of
mild mental retardation with I.Q. of 66 and seizures in childhood which
had been with Valproate. Four years ago the patient presented with a
possession state lasting initially for 3 days and then after indigenous
treatment for periods lasting for a few hours to a day. At the end of the
possession spells the patient would present with breathlessness and
spasmodic rapid shallow breathing followed by loss of consciousness.
The patient also began to have regression in her reading, mathematic
ability, social skills along with 2nd person auditory hallucinations and
visual hallucinations. MRI scans of the patient showed calcifications in
the basal ganglia and laboratory tests showed decreased parathormone
levels. She was started on PTH replacement and antipsychotics
which controlled her behavior. The patient however continued to
have possession spells and episodes of breathlessness which were
managed with supportive psychotherapy. She gradually recovered and
is doing well in follow up.
Conclusion:Dissociative disorders and epilepsy share many clinical
features including amnesia, fugue, depersonalization, de-realization,
and identity change. It can therefore be misdiagnosed as epilepsy in
the absence of an ictal EEG. Awareness of cultural nuances, careful
history taking, strict adherence to diagnostic criteria, use of structured
interviews, neurological investigations, and longitudinal follow-up
facilitates accurate diagnosis and appropriate care.
Meditation Masquerading as Catatonia: Diagnostic and
Management Issues- A Case Report
Singh J, Prajapati DC, Modak T, Kumar S, Deb KS
AIIMS, New Delhi. E-mail: drjawaharaiims@gmail.com
Introduction:Meditation is a form focusing the mind which can be
described as a transcendence of conscious awareness. The DSM
described a form of acute self-limited psychotic reaction which occurs
as a consequence to meditation. We describe a case of a middle aged
woman who presented to us with predominant symptoms of catatonia.
She was later diagnosed to be meditating.
Caseoutline:The patient was a 52-year-old married female belonging
492 Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4
to a popular sect In North India who presented to us with an 8 month
history of progressive social withdrawal and repeated episodes
lasting for 2-3 days during which the patient would demonstrate
mutism, posturing, stupor and negativism. The patient’s self-care,
appetite and sleep gradually deteriorated over the period. Members
of the same sect would be divided as to whether her behavior was
sanctioned meditation or deviation from normality. The patient was
finally brought by her son- a cardiologist when her medical condition
deteriorated. After admission, the patient was mute for 2 days before
she recovered and explained that she was meditating. Psychosocial
stressor was in the form of guilt over an abortion by the daughter in
law. No other psychopathology was elicited and the patient continued
to maintain well on follow up,
Conclusion:This case describes a middle aged female who developed
symptoms of catatonia following a period of intense meditation. Over the
decades various cases of short lasting self-limited cases of psychosis
as a result of meditation have been reported. This case was unique
with respect to the lack of psychiatric history, the late age of onset and
the recovery without need for psychotropics. In conclusion, meditation
may act as a stressor in vulnerable subjects and may result in catatonic
state that most probably is self-limiting and therefore does not always
require antipsychotic treatment.
Existential Exuberance: A Case Report
Narayan S
Lady Hardinge Medical College and SSK Hospital, New-Delhi. E-mail:
sowmyashree.kavadike@gmail.com
Background: Personality traits complicate the presentation and
management of psychiatric disorders. In this case report, I try to
present how a combination of narcissism, creativity and social isolation
pose multiple challenges in the initiation and continuation of individual
psychotherapy.
Case 1: 25 year old gentleman, temperamentally slow to warm up,
felt controlled by his anankastic father as a child, which reflected in
Presented with a crisis wherein he contemplated to end his life due
to intolerable “rat race”. After the crisis intervention, though multiple
cognitive errors were evident, initiation of cognitive behaviour therapy
was difficult and an unconventional method was used for the same
because of the narcissism and excessive indulgence in the 20th century
existential philosophy.
Case 2:26 year old gentleman, temperamentally slow to warm up,
raised by an overbearing anankastic and high achieving father,
with schizoid traits in childhood, with past history of one episode
of mania and one episode of severe depression requiring inpatient
care and electroconvulsive therapy. Presented with a crisis wherein
he experienced disabling ambivalence leading to indecisiveness
culminating in frequent attempts to end life, which was intricately
influenced by the existential philosophy.
Conclusion: In both the cases, the knowledge of existential philosophy
hindered the complete understanding of the illness in combination
with inherent narcissism which hindered the development of a client-
therapist relationship. Innovative methods like bibliotherapy and music
therapy were included in the eclectic approach in both the cases with
significant improvement.
A Study of Family and Interpersonal Correlates in Dissociative
Disorder Among Women
Gupta N, Grover N, Desai NG
Dr. R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi. E-mail:
namrata.gupta14@gmail.com
Background: Dissociative disorder is a disabling psychiatric condition
with preponderance among females. It not only disrupts the index
patient’s life but also causes significant impairment and disruption
of family functioning and interpersonal relationships. The clinical
presentation and experience of illness are seen to vary across cultures.
Aim: The Qualitative study to explore family and interpersonal
correlates in dissociative disorder among women.
Methods: The sample consisted of 20 female out patients diagnosed
with the dissociative disorder (Considering the inclusion and exclusion
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Abstracts

criteria, and written informed consent) and their significant family
members as informants, in a Tertiary Mental Health Care Center of
North India. A semi-structured interview schedule was formulated
keeping in mind the objectives of the study with an intention to explore
patient and family’s view of symptoms, family’s reaction towards
patient’s symptoms and their feedback, and misconceptions held
towards illness. Interviews were transcribed and content analysis
was done.
Results: Mixed dissociative disorder was found among 55% of the
sample, followed by Dissociative motor disorder. Co-morbid symptoms
of depression and anxiety were found among 75% of the patients.
Both patients and informants reported several stressors, and family
issues as causing and/or maintaining the symptoms, though only 20%
reported illness to psychological causes. Several culturally grounded
misconceptions were identified; Black magic was seen to attribute to
illness by 60% of participants in the current study. 80% of informants
reported detrimental impact on the entire family unit.
Conclusion: A causal relationship can be drawn between clinical
symptoms and interpersonal and family correlates. Cultural formulation
of diagnosis would aid in effective management of symptoms.

Indian Journal of Social Psychiatry | October-December 2016 | Volume 32 | Issue 4 493

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