Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder

BACKGROUND

Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample.

METHODS

Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001.

RESULTS

The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger.

CONCLUSION

UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.

Association between polarity of first episode and solar insolation in bipolar I disorder

OBJECTIVE

Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth.

METHODS

Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer.

RESULTS

The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001).

CONCLUSION

Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.

Cognitive Impairment within Patients of Schizophrenia and Mood Disorder: A Comparative Study

Background: Memory dysfunction, deficits in attention and executive functions as well impairment in cognition is found among patient suffering from Schizophrenia and Mood Disorder throughout the course of illness. All these significantly impact various domains of life in them. It also affects the patient’s insight into the illness and thus impairs therapeutic compliance. Objectives: To evaluate Cognitive functions in patients with Schizophrenia and Mood Disorder. To compare both groups to see whether cognitive dysfunction varies between them. Methodology: Study Design: Cross-sectional study which is Hospital-based. Study-Setting: The IPD and OPD of Psychiatry Department, AVBRH, Sawangi (M), Wardha. Sample Size: 240 (120 patients with Schizophrenia and Mood Disorder each). Patients clinically diagnosed having Schizophrenia and Mood disorder using ICD-10 criteria of age group 18-55 years, with at least 8 years of schooling will be included in the study after taking written informed consents. After collecting socio-demographic data and screening the patients with the Brief Psychiatric Rating Scale, the PGI Battery of Brain Dysfunction will be applied to the patients. Results: This study will assess of impairment of Cognitive functions Schizophrenia as well as Mood Disorder patients would tell whether the cognitive impairment is the same or different in both groups. Conclusion: Comparison of impairment in cognitive functions in Schizophrenia as well as Mood Disorder patients would be done. Co-relation of Cognitive impairment with Metabolic syndrome in both groups can be established.

Psychosocial aspects of suicide in largest industry of farmers in Vidarbha Region of Maharashtra

India consists of 16% of the world's population, but sustains only 2.4% of land resources. The agriculture sector is the only livelihood to two-third of its population, which gives employment to 57% of the workforce and is a raw material source to a large number of industries. Farmer suicides account for approximately 10% of all suicides in India. The national suicide rate is 10.6/lac, whereas in Maharashtra it is 14.2/lac, in Andhra Pradesh 12.1/lac, in Telangana 27.7/lac, and in Chhattisgarh 27.7/lac. The National Crime Records Bureau data from 1995 to 2006 show that 200,000 farmers had committed suicide, with an average rate of 16,000/year. Every 7^th suicide in the country is a farmers' suicide. The first state where suicides were reported was Maharashtra with particularly in the Vidarbha region. In Maharashtra, farmers' suicide rate is 60% higher than the general suicide rate. Every 5^th farmers' suicide committed in the country had occurred in Maharashtra, Vidarbha being a particularly sensitive region but also in Punjab, Uttar Pradesh, Kerala, and Karnataka. In a country of 70 million farmers, 10 in every 100,000 farmers commit suicide. Many inquiry commissions were formed and recommendations were implemented, especially in Punjab. The problem of suicide is not only reported in India but also reported in different parts of the world like England and Wales. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step.

Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India

Background  This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method  It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results  Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion  Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background

Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries.

Methods

Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries).

Results

This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01.

Conclusion

A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

Diseased Body and Diseased Mind: Mind Your Psychological Health during Lockdown

The novel Corona virus also known as 2019-nCoV that originated in China in December 2019 has quickly spread all over the world. In absence of specific treatment or vaccine, with no natural immunity, we are forced to rely on old public health measures like Quarantine, Social distancing and Isolation for prevention of spread among community. Although isolated incidents of epidemics have required isolation and quarantine in the past, no pandemic has required social distancing to a national and international scale before. Despite the obvious physical health and economic concerns of this situation, all the above measures bring forth challenges of emotional and psychological nature which can be especially severe in special populations like elderly, young children and adolescents, health care workers, persons with mental illness. Also, certain aspects like death, role of mass media, and ethics also arise during isolation and quarantine. With mass media playing a significant role in drumming up the perceived threat, people may resort to panic behaviours like hoarding essential day to day use items and masks and other medical supplies leading to shortage. Problem of fake news related to COVID 19 lead to Govt. of India launching of AAROGYA SETU app as well as websites to centralise all COVID 19 related information to people of India. Death in isolation deprives family members and friends of opportunity to grieve for near and dear ones lost due infection or due to natural causes. The requirement of isolation and quarantine during this distressing pandemic has paved way for recognising the importance and advantages of telemedicine as a whole which has led to various government bodies including the Government of India to draw primary guidelines for medical practitioners to follow and ensure ethical concerns are addressed.

Medical Students Attitude & Knowledge of Psychiatry an Impact of Psychiatry Posting

India being a signatory to Alma-Ata declaration, envisaged ‘Health for all by the year 2000” and hence should look into training undergraduates in psychiatry. Medical students’ attitude towards psychiatry are determined by complex inter lacing variables. Low recruitment is a serious challenge for psychiatry worldwide. Moreover, psychiatry is poorly represented in medical education and undergraduate training in psychiatry and behavioral sciences in most medical colleges in India is unsatisfactory. Keeping these facts in mind, this study was carried out to assess the influence of psychiatry training, including direct patient contact on attitude of medical students towards mental illness. This study was conducted at Department of Psychiatry, Mahatma Gandhi Institute of Medical Science, Sevagram, Wardha, Maharashtra. Second year MBBS students were evaluated with a pre and posttest during their 2 weeks posting in the Psychiatry department. There was some improvement in attitude & knowledge of undergraduate medical students about mental health after two weeks of psychiatry posting. The improvement in male medical students is more than three times of that seen in female medical students, after two weeks of training. The existing M.C.I. recommendations need serious considerations for implementation in each & every Medical College of India. As per the current curriculum, the introduction to psychiatry is in the 1st term during lectures on behavioral sciences following which they not exposed again until the 5th semester when the undergraduate students are required to attend 40 hours lectures parallel to 4 weeks clinical posting culminating with compulsory short note questions worth 20 marks included in paper II of the General Medicine exam. Finally, another two weeks of psychiatry posting is mandatory during internship. Female medical students have shown deterioration in their attitudes & knowledge over more questions than male counterparts. Hence it can be deduced that, males tend to learn better by experience.

Woman Mental Health - Midlife

Woman’s mental health, is an important issue and easily one of the most neglected domains, especially so for a woman in her middle age full of physiological and psychological turmoil. Mental health problems occur in higher frequency in women in general. Depression is more common in women as compared to men, women are twice as likely to experience anxiety as men and about 60 % of persons suffering from an OCD or a phobia are women. The greater gender predisposition necessitates an in-depth analysis of the biological and environmental factors of women which cause them to be more predisposed to mental illnesses. A recent report on Women of Tomorrow, reported women in India to be the most stressed female population of the world. Overall, the women of the developing nations were found to be more stressed than their sisters in the developed world. This led us to think about the cultural and environmental influences on the disorders, along with attitudes and perceptions of the society in the mental make-up of a woman. The contributing factors discussed in this article need extensive research to help modulate the implicated factors and in turn amount to primordial prevention. This article emphasizes the priorities to be studied in the context of a woman’s mental health, explores deeper issues and interrelationship of multi factorial determinants.

Schizophrenia with Co-morbid Obsessive-Compulsive Disorder: A Case Series

The frequency of co-morbidities like Obsessive Compulsive Disorder (OCD) is common in schizophrenia. Some studies have reported earlier age of onset, more positive and negative symptoms, more depressive symptoms, and worse prognosis in such patients. The phenomenology and management of OCD in schizophrenia is understudied. Evidence claims that the course of illness of both schizophrenia and bipolar disorders may be affected by obsessive-compulsive disorder whereas in other cases antipsychotic induced obsessive-compulsive symptoms have been observed. A meta-analysis of of schizophrenia and its co-morbid psychiatric conditions, found a prevalence of 12.1% for obsessive compulsive disorder, 9.8% for panic disorders, 12.4% for post-traumatic stress disorder and 14.9% for social phobia. SGAs like amisulpride and aripiprazole are found to be useful in the treatment of comorbid OCD in schizophrenia due to their negligible serotonergic properties. A combination of selective serotonin reuptake inhibitors (SSRI) with antipsychotics has been recommended by the American Psychiatric Association (APA) for treatment of comorbid OCD in schizophrenia. Escitalopram at a dose of 20 mg/day has been found to be beneficial in such cases while psychosis worsened with the use of fluvoxamine and clomipramine. Below is a series of seven cases of schizophrenia with co-morbid obsessive-compulsive symptoms who are on treatment for their illness from the psychiatric outpatient department of a rural hospital in central India.

Pseudocyesis Leading to Folie-à-Deux

Pseudocyesis or false belief of pregnancy is the emergence of classical manifestations of pregnancy—nausea, breast enlargement and pigmentation, abdominal distention, amenorrhea, and labor pains—in a nonpregnant woman. It is a multifactorial disease and its development is influenced by many different elements such as neuroendocrine, social, psychodynamic, and cultural issues. “Folie-à-deux,” is shared psychotic disorder, describes a syndrome in which delusion is transferred to another person who is more susceptible. Both individuals are closely related or know each other for a long time and typically live together in relative social isolation. In its commonest form, the individual who first develops the delusion (the primary case) is often chronically ill and typically is the dominant member in a close relationship with a more suggestible person (the secondary case) who also develops the delusion. Treatment options should also be kept in mind as antipsychotics themselves can increase prolactin levels and can lead to amenorrhoea and galactorrhea and can further strengthen patient’s belief about her pregnancy. This case highlights that the most important therapeutic step in the treatment of folie-à-deux is separation of the inducer and the induced. Here we describe a case of folie-à-deux of a married couple in which the female had delusional pregnancy while the husband shared and supported her delusion against substantial medical evidence.

Innovation in Community Psychiatry for the Delivery of Mental Health Services: The Sawangi Model

Objectives  Can undergraduate medical students (UGs) adopt a village model to identify mentally ill persons in an adopted village successfully?

Materials and Methods  UGs during their first year adopt a village, and each student adopts seven families in the villages. During the visit, they look after immunization, tobacco and alcohol abuse, nutrition, hygiene, and sanitation. They help in identifying the health needs (including mental health) of the adopted family. The Indian Psychiatric Survey Schedule containing 15 questions covering most of the psychiatric illnesses were used by UGs to identify mental illness in the community. Persons identified as suffering from mental illness were referred to a consultant psychiatrist for confirmation of diagnosis and further management.

Statistical Analysis   Calculated by percentage of expected mentally ill persons based on prevalence of mental illness in the rural community and is compared with actual number of patients with mental illness identified by the UGs. True-positive, false-positive, and true predictive values were derived.

Results  In Umri village, UGs were able to identify 269 persons as true positives and 25 as false positives, whereas in Kurzadi village, UGs were able to identify 221 persons as true positives and 35 as false positives. It suggests UGs were able to identify mental illnesses with a good positive predictive value. In Umri village, out of 294 mentally ill patients, it gave a true positive value of 91.49% and a false positive value of 8.5%, whereas in Kurzadi village, out of the 256 mentally ill patients, it gave a true positive value of 86.3% and a false positive value of 13.67%.

Conclusion  The ratio of psychiatrists in India is approximately 0.30 per 100,000 population due to which psychiatrists alone cannot cover the mental health problems of India. Therefore, we need a different model to cover mental illness in India, which is discussed in this article.

Effect of Marriage on Pre-existing Psychoses: A Convenient or Futile Solution for Severe Mental Disorders?

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation.

Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding.

Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment.

It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

Rise in Cases of Alcohol Withdrawal following Lockdown in Dry District of Wardha

On March 11, 2020, the World Health Organization declared the SARS-CoV-2 outbreak to be a pandemic which has sent all countries in a frenzy. We cannot be callous about treatment of non-COVID-19-related patients. The Wardha district of Maharashtra is a declared “dry area” which makes the sale, purchase, and consumption of alcohol illegal. On March 24, 2020, Indians were informed of a 21-day long lockdown which was subsequently extended for another 3 weeks during which all modes of public transportation, educational institutions, offices, and other nonessential businesses were closed and people expected to remain at home unless necessary. Since then admissions of alcohol-dependent patients showed a spike from14% in the prelockdown period to 27% of patients of alcohol dependence syndrome. It is most likely due to poor availability of liquor, inability to earn money to buy the alcohol, or restricted movement of individuals.

A Systematic Review on Effect of Electronic Media among Children and Adolescents on Substance Abuse

Background:

Substance abuse is one of the most significant global public health issues among youths. Electronic media has become a part of day-to-day life for all. This systematic review is undertaken to comprehensively explore the effect of electronic media on substance abuse among children and adolescents.

Methodology:

Two review authors independently searched various electronic databases and other sources.

Selection Criteria:

Randomized control trials that assessed the effect of exposure of electronic media (defined as television, internet, gaming, mobile phones/phones, and radio) among participants in the age range of 5–19 years on substance abuse were included in the review.

Data Collection and Analysis:

Two reviewers independently extracted data. We used an approach proposed by the Cochrane Collaboration. We used GRADE profiler to assess the overall quality of the evidence.

Main Results:

We retrieved 6003 studies and found 15 studies that fulfilled our inclusion criteria. Since included studies differed in the type of intervention and reporting of outcomes, we did not undertake meta-analysis and choose to describe studies narratively. Quality of evidence was rated as “very low” due to too little information or too few data to be able to reach any conclusions.

Authors' Conclusions:

Clinicians, policymakers, and educators to partner with caregivers and youth to support electronic media use that promotes positive outcome in these areas.

Registration of Systematic Review:

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 86935.

Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India

Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.

Psychiatric morbidity in children of alcoholic parents

CONTEXT

Children of alcoholics (COAs) are children who have grown up in families in which either one or both parents are alcoholic. The interplay of several factors such as environmental, cognitive, and genetic vulnerability has been linked to the psychopathology among COAs.

AIMS

To assess psychiatric morbidity in COAs and to compare these children with the children of nonalcoholic parents.

SETTING AND DESIGN

This cross-sectional study was conducted on children of outpatients and inpatients of a tertiary health-care center in Central India, for 18 months.

SUBJECTS AND METHODS

A total of 100 children, fifty children of alcoholic parents and fifty children of nonalcoholic parents between the age groups of 4 and 14 years, were assessed using childhood psychopathology measurement schedule.

STATISTICAL ANALYSIS USED

Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test. SPSS version 22.0, were used for statistical analysis, and P < 0.05 was considered as level of significance.

RESULTS

Most of the children were in the age group of 8-11 years. Depression and anxiety were found to be statistically significant (P < 0.05) in COAs than in children of nonalcoholics. Whereas, there was no difference (P > 0.05) for low intelligence and behavioral problems, conduct disorder, psychotic symptoms, special symptoms, physical illness, emotional problems, and somatization.

CONCLUSIONS

Thus, there is a high need to address the stress to children of persons with substance abuse. Early detection of psychiatric morbidities in such children and appropriate intervention can produce beneficial changes in such children.

A Systematic Review on Effect of Electronic Media on Diet, Exercise, and Sexual Activity among Adolescents

Context

Electronic media has become a part of day-to-day life for all, and particularly more so for children and adolescents. Exposure to electronic media may be beneficial as well as harmful.

Aim

The aim of the study is to systematically synthesize existing published and non-published empirical evidence on the effect of exposure to electronic media on diet, exercise, and sexual activity.

Methodology

Two reviewers independently searched online databases such as MEDLINE, CENTRAL, and EMBASE. We applied no language, date, or publication restrictions.

Selection Criteria

We included randomized control trials that assessed the effect of exposure of electronic media on diet, exercise, and sexual activity in participants between 5 and 19 years.

Study Selection Data Extraction

Two reviewers independently screened studies identified in electronic search and independently extracted data and assessed the risk of bias of included studies.

Data Analysis

We had planned to use the risk ratio or odds ratio for dichotomous data, and mean difference (MD) or standardized MD for continuous data. However, as included studied differed in types of intervention and reporting of outcomes, we did not undertake meta-analysis.

Main Results

All included trials were parallel randomized controlled trials except for one that was a crossover trial. Eight studies reported the effect of electronic media on diet and exercise, two on diet, two on exercise, and one on sexual activity. Quality of evidence was rated as "very low" for all outcomes due to too little information or too few data to be able to reach to any conclusions.

Conclusions

There is a little body of evidence that limits conclusions. We need to comprehend as to how to swap undesirable effects of electronic media and make it more desirable.

Registration of Systematic Review

This systematic review has been registered at PROSPERO International prospective register of systematic reviews (Registration number: PROSPERO 2018 CRD42018086935) available at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=86935.

Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study

AIM

To assess the phenomenology and associated beliefs in patients with Dhat syndrome.

METHODS

A total of 780 male patients aged more than 16 years were recruited from 15 centers spread across the country and were assessed on Dhat Syndrome Questionnaire.

RESULTS

The most commonly reported reasons for passage of Dhat were excessive masturbation (55.1%), sexual dreams (47.3%), excessive sexual desire (42.8%) and consumption of high energy foods (36.7%). The most common situation in which participants experienced passage of Dhat were as 'night falls' (60.1%) and 'while passing stools' (59.5%). The most common consequence due to passage of Dhat was weakness in sexual ability (75.6%). In terms of psychological and somatic symptoms, the common symptoms included bodily weakness (78.2%); feeling tired or having low energy (75.9%); feeling down, depressed, or hopeless (67.9%); and little interest or pleasure in doing things (63.7%). In terms of treatment expectations, about half of the patients (49.1%) expected that energizing medications like vitamins/tonics/tablets were required and more than one-third (38.2%) expected that there was a need for taking energizing injections.

CONCLUSION

Present study shows that Dhat syndrome is a distinct clinical entity seen all over India, with its characteristic features.

Comorbidity in patients with Dhat syndrome: a nationwide multicentric study

INTRODUCTION

There are limited numbers of studies on Dhat syndrome. Major limitations of the existing literature are heterogeneous assessment methods used to describe the comorbidity and small sample size from isolated centers.

AIM

To assess comorbidity with a common methodology in patients with Dhat syndrome from multiple centers across India.

METHODS

Using a cross-sectional design, this multicentric study involved assessment of 780 male patients, aged more than 16 years, across 15 study centers.

MAIN OUTCOME MEASURES

ICD-10 criteria (for evaluation of psychiatric morbidity and sexual dysfunction)

RESULTS

About one-third (32.8%) of the cases had no comorbidity. One-fifth (20.5%) of the patients had comorbid depressive disorders and another one-fifth (20.5%) had comorbid neurotic, stress-related and somatoform disorders. Half (51.3%) of the study sample had comorbid sexual dysfunction. When various combinations of comorbidities were evaluated, it was seen that more than one-fourth (28.7%) of the patients had only comorbid sexual dysfunction and one-sixth (15.9%) had only comorbid depressive/anxiety disorders. A little more than one-fifth (22.6%) had comorbidity of both sexual dysfunction and depressive/anxiety disorders.

CONCLUSION

Comorbid sexual dysfunction is seen in half of the cases of Dhat syndrome, and it is more common than comorbid depressive and anxiety disorders.

Ayurvedic concepts related to psychotherapy

The perfect balance of mind, body and soul is considered as complete health in Ayurveda. Ayurveda has its own identity as most ancient and traditional System of Medicine in India. Even Ayurveda emphasizes its treatment modalities into three parts viz. Satwawajay Chikitsa, Yuktivyapashray and Daivyapashray Chikitsa. Sattvavajaya therapy mentioned in Charakasamhita and it used as new concept of psychotherapy in Ayurveda. The effectiveness of "traditional mental health promoting practices" was identified as health regimens (swasthvrtt), correct behavior (sadvrtt), and yoga. Sattvavajaya as psychotherapy, is the mental restraint, or a "mind control" as referred by Caraka, is achieved through "spiritual knowledge, philosophy, fortitude, remembrance and concentration. Ayurvedic psychotherapy would play a dual role: First, as a revival of authentic medical culture, the exercise of a practice with an assumed primordial dimension, and second as a discovery of authentic subjectivity, the revelation of a self with an assumed interior depth. When we integrate the contemporary art of psychotherapy with the ancient science of Ayurveda, it becomes a powerful combination that is called Psycho Veda. The integration of Psycho and Veda is motivated by the complete integration of the immense but fairly contemporary view of the mind, emotions and psyche and how this performs in our lives. Integrating Psychotherapy and Vedic principles teaches us how to rediscover critical knowledge and awareness of the natural forces and rhythms that compliment and strengthen our human experience, through the understanding of the psyche and what our inner experiences are and also involving practical daily activities with thorough attention to our total environment to bring about radical changes in our mental outlook and in physical health.

Religion and mental health

In this chapter, the relation between religion and mental health and vice versa has been described. From primitive times different religions have different beliefs and systems of worshipping. Every religion with their belief system has implications on mental health and illness. We described how Hindu system of beliefs and rituals may have an effect in causation of various mental illnesses. It is also described how religion can help an individual to sustain one's life in various domains. The relationship between different religion and symptomatology is described. The impact and outcome of religion on mental health have been highlighted.

A comparative study of stress among students of medicine, engineering, and nursing

BACKGROUND

In today's ultra competitive environment, students face more stress than ever - be it related to studies, examination, peer, teachers or parent's pressure. Stress is the "wear and tear" our bodies experience as we adjust to our continually changing environment. On one hand, stress compels us to action. However, it can result in feelings of rejection, anger, and depression, leading to health problems such as headaches, upset stomach rashes, insomnia, ulcers, high blood pressure, heart disease, and stroke.

MATERIALS AND METHODS

A cross-sectional questionnaire-based survey of 100 randomly selected students each from Medical College Engineering College and 50 Nursing College was done. For reliability, anonymity and confidentiality were maintained. Stress was measured by using stress measurement scale having 24 Yes/No questions. The questionnaire was in English and Hindi so that language would not be problem.

RESULTS

Stress as an entity is universally present among students of all three streams, irrespective of age, sex, and other variables. Students in all three streams have shown denial to existence of problems, with maximum among nursing students. Medical and Engineering students had stress level of such a degree that requires clinical attention, while none of the nursing students belonged to this category.

CONCLUSIONS

There is attitude among students of turning a blind eye toward existing stress which is a serious problem and may be harbinger of serious mental and psychosocial problems.

A single blind comparative clinical study of the effects of chlorpromazine and risperidone on positive and negative symptoms in patients of schizophrenia

OBJECTIVES

The present study was undertaken to test the comparative efficacy of chlorpromazine and risperidone in patients of schizophrenia in a tertiary care hospital of Maharashtra.

MATERIALS AND METHODS

About 100 subjects of either sex between 15 and 75 years of age were randomly assigned either chlorpromazine or risperidone. Only those patients were included who met International Classification of Diseases 10 revision criteria by World Health Organization. To avoid bias, the test drugs were coded as A and B. The study coordinator was unaware of the prescribed drugs; however, the prescribing psychiatrist knew about the drug treatment.

RESULTS

Both chlorpromazine and risperidone significantly decreased the mean score of positive and general symptoms in patients of schizophrenia. Although chlorpromazine decreased the mean score of negative symptoms, it was not statistically significant. Risperidone reduced the mean score of negative symptoms to a significant extent. The cost (Rs. 3000-4000) of risperidone was more than the cost (Rs. 700-1000) of chlorpromazine per patient per annum. The dropouts were less (25%) in the risperidone group than in the chlorpromazine group (75%). The more purchase of risperidone than of chlorpromazine was observed in our study.

CONCLUSION

The response rates for positive and general symptoms were found to be equal for both chlorpromazine and risperidone. However, risperidone was found to be more effective than chlorpromazine in treating negative symptoms. The dropout rate was less in the risperidone group than in the chlorpromazine group. The compliance was also better in the risperidone group, even though the cost of risperidone was more than that of chlorpromazine.

Dislocation of the unilateral temporomandibular joint a very rare presentation of epilepsy

Epilepsy can present in various forms, common and uncommon. Unilateral TMJ dislocation is one of the rare presentation of epilepsy. A case report of such unusual presentation of epilepsy.

Farmers' suicide in Vidarbha region of Maharashtra state: A myth or reality?

Incidence of farmers ending their lives in Vidarbha region had hit epidemic proportions recently. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step. Suicide in farmers is public health problem and we suggested some immediate and serious interventions to prevent suicide.

Quality of life in patients with early and advanced carcinoma of the breast

AIM

Emotional disturbances are known to occur in patients suffering from malignant diseases even after treatment. This is mainly because of a fear of death which modifies quality of life (QOL). QOL has gained an important place in the management of cancer in industrialized nations, with the increase in survival. However, in developing countries like India, very little attention has been paid to this issue. Developing countries have poor infrastructure and lack proper treatment facilities at most centres, this leads to poor survival rates and hence much emphasis is on attaining quantity of life rather than quality. This study was carried out to assess the quality of life determinant in patients with breast cancer and the impact of treatment on quality of life indices.

METHODS

We carried out QOL assessment in 50 patients with breast cancer using the modified linear analogue scale for self assessment (LASA).

RESULTS

Significant deterioration was seen in health-related parameters in terms of recreation (P=0.01), social life (P=0.002), mobility (P=0.03), physical activity (P=0.4) and sleep and appetite (P=0.05). Treatment related parameters deteriorated in both early and advanced carcinoma. Similarly, weight loss was seen in both the groups, however, this was not statistically significant. Self-care and recreation were found to be the most important parameters influencing the QOL in breast cancer patients.

CONCLUSIONS

Breast cancer detection programs, health education and better awareness among women in industrialized nations has helped in downstaging of the disease, thus improving overall survival. It has not been so in developing countries, where the majority of patients present with advanced disease (T3 and T4). These are usually managed with surgery and adjuvant chemotherapy, which duly interferes with general health-related parameters and the social life of these patients, thereby adversely affecting the QOL.

Psychosocial characteristics of literate blinds: a study

Blindness leaves a person in a state of physical, psychosocial and economic dependence. Aberrant mental attitudes and even frank mental illnesses can develop among the aged blinds. The present study shows that acceptance towards their disability was much higher (in 68.75% cases) among the aged blinds in group 'A' (mean age 42.2 years) than the younger student (in 47% cases) in group 'B' (mean age 17.6 years) All the younger blinds were found to be optimistic for their future but the level for this mental attitude among older subjects was relatively lower (in 68.75% cases). The aberrant mental attitude like rejection, guilt and aggressiveness which reflected negative attitude towards life were more prevalent among students. Older blinds were found to be relatively more shameful for their disability (in 43.75% cases). The negative attitude towards life was evaluated to be present among 12.5% cases in group 'A' and among 76.5% cases in group 'B'. Anxiety and depression were the mental illnesses evaluated among blind and were displayed by 6.25% and 0% cases in group 'A' i.e. the group of teachers and trained workers and in 35.3% and 43.7% cases among group 'B' i.e. the group of blind students respectively. Aberrant mental attitudes have shown no definite relation with the age at the onset of blindness or otherwise they appeared to change with age.

First-onset schizophrenia in the community: relationship of urbanization with onset, early manifestations and typology

As part of a World Health Organization collaborative study in 12 centres in developing and developed countries within defined urban and rural catchment areas with populations of 348,786 and 103,865, respectively, a total of 155 and 54 cases of first-onset schizophrenia, respectively, were identified over a 24-month period by a comprehensive and active recruitment of all cases. Approximately 50% of the subjects in both cohorts were in the age range of 15-24 years. There was a preponderance of males in the younger age group and of females in the older age group. The majority of cases had no family history and had shown good adjustment in childhood and adolescence. The onset was much more frequently acute and much less often insidious in our samples and (more so in the rural cohort), compared to the figure for all developed countries' sites. With regard to early manifestations of the disorder, there was a much higher incidence of loss of interest in appearance and cleanliness, being irritable and angry without reason, and loss of appetite, sleep or interest in sex in both of our samples, and of being excited or overactive for days or weeks in our rural cohort than in the developed countries' centres as a whole. On the other hand, claiming impossible things, behaving as if hearing voices and feeling persecuted, harmed or bewitched were much less frequent in our rural cohort than in the urban cohort or the developed countries' centres as a whole. With regard to the clinical diagnosis of schizophrenia, paranoid, hebephrenic/disorganized and residual types were under-represented in our samples (more so in the rural sample), and catatonic type and acute schizophrenic episode were over-represented compared to the developed countries' centres. Moreover, the proportion of subjects of CATEGO class S+ was lower in our samples. With regard to onset, early manifestations and clinical subtypes of schizophrenia, our rural cohort deviated most from developed countries' centres as a whole, with our urban sample falling in between, thus indicating the role of socio-cultural factors in general, and urbanization in particular, in these variables in schizophrenia.

Effect of seizure control on improvement of cognitive functions in epileptic patients

A group of fifty epileptic patients were tested with neuropsychological tools for cognitive functions like memory, intelligence, visuomotor coordination, spatial perception and body schema perception. Patients were on carbamazepine and were tested after three months. Seizure improvement was shown to have different effects on different cognitive functions. Memory and intellectual deficits improved, while no difference was observed in visuomotor coordination, spatial and personal perception.

The right-ear advantage in schizophrenia

Schizophrenics, patients with affective disorder and normal controls were tested on a verbal dichotic listening task at three time periods, 0-2, 4-6 and 14-16 weeks. Schizophrenics had non-significant ear difference during the acute state of illness (0-2 weeks) and the normal right-ear advantage emerged when acuteness subsided (14-16 weeks).

Effect of lithium therapy on thyroid function: a retrospective study on Indian patients

Thirty patients with Bipolar affective disorder who were on Lithium therapy for 6 months to 24 months, were tested for any alteration in their thyroid function. Eight (26.67%) patients had elevated serum TSH level and four (13.33%) patients had decreased serum T(4) level than the normal range. Serum T(3), although showing a declining trend was found within the normal range in all the patients.

An incidence study of schizophrenia in India

Under a WHO collaborative study, the Chandigarh center monitored two geographically defined populations over a 2-year period. Using helping-agency-coverage and other methods along with a set of specified criteria, 268 first-onset potentially schizophrenic cases were actively identified. Of these, 232 cases could be assessed in detail which included 209 schizophrenics as per specified ICD-9 or Catego criteria. The annual incidence rates obtained were 4.4 and 3.8 per 10,000 for rural and urban areas, respectively. The rural cohort had a higher incidence for each of the three diagnostic definitions. In the urban cohort, sex and diagnostic definition did not affect the incidence. In the rural cohort, females had a lower incidence for Catego S+ and a higher incidence for other diagnostic definitions.

A study of cerebral dominance by laterality score and order of reporting in dichotic listening test

The Dichotic listening test was performed on 8 schizophrenics and 8 normal healthy controls. A positive correlation between laterality score and shift of order of reporting from one hemisphere to other was found in light handed scliizophrenics during active stage of the disease. Order of reporting alone may be a factor responsible for this shift of laterality in these patients. Further, on follow-up the abnormalities returned back to normal as these patients recovered. This suggests that schizophrenia is a left hemisphere abnormality with tempcral lobe dysfunction.

Changing diagnosis in psychiatry

The present study was conducted to find out changes in the diagnosis of hospitalized patients. Out of 421 hospitalized psychiatric patients from 1974 to 1976, the diagnosis was changed in 54 (12.8%) patients. The change in diagnosis occured once in 51 and twice in 3 cases. Finally reasons for change and its implementations are discussed.

Humoral concepts of mental illness in India

Based on interviews with patients at three allopathic psychiatric clinics in Bombay, Bangalore and Varanasi, employing a preliminary version of the Explanatory Model Interview for Classification (EMIC) to elicit indigenous explanations of illness and patterns of prior help seeking, we discuss popular humoral theories of mental disorder. Even though most laypersons are unfamiliar with the content of the classical treatises of Ayurveda, the humoral traditions which they represent influence current perceptions. Case vignettes clarify the nature of the relationship between cultural, familial and personal factors that influence the experience of illness.

Dhat syndrome: the phenomenology of a culture bound sex neurosis of the orient

Indian Dhat syndrome which is symptom complex most commonly seen in younger group of patients in between 16 to 23 years of age. These patients present with whitish discharge with urine (patients believe it to be semen). This is associated most commonly with impotency, marked anxiety, general weakness, premature ejaculations and hypochondriasis. All the patients were either from low or average socioeconomic status. Majority of the patients attributed masturbation as a causative factor for this problem.

A study of prophylactic value of antiparkinsonian drug

The present prospective study is conducted to determine the prophylactic value of antiparkinsonian drug (A.P.) at the time of initiation of antipsychotic therapy. Seventy patients were selected who fulfilled the selection criteria. Thirty five patients received antipsychotic drugs alone (Group A), while another thirty five patients received A.P. drugs concurrently with antipsychotic drugs (Group B.) These patients were assessed weekly for 4 weeks for any extra pyramidal symptoms (E.P.S.). There was no statistically significant difference between E.P.S. scores of the two groups in different weeks. The difference in percentage of patients who developed E.P.S. in different weeks in both the groups was statistically non-significant (p<0.05). None of the female subjects developed E.P.S. in either group.

Psychological reactions to leprosy

The study was conducted to find out the psychological reactions to leprosy, to correlate psychological symptomatology with duration of leprosy and to find out suicidal attempts among leprosy patients. 24 patients were randomly selected from "Kashi Kusth Swasth Shala and Punarvas Mandir". They were administered the Hindi adaptation of Middlesex Hospital Questionnaire. 14 patients verbalised suicidal ideas and 2 have had suicidal attempts. Psychological symptomatology was less reported by those whose duration of illness was longer and more symptoms were reported by those whose illness was of shorter duration. The various findings are discussed in length.