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 Table of Contents  
Year : 2017  |  Volume : 33  |  Issue : 5  |  Page : 11-30

Oral Papers/Posters

Date of Web Publication8-Nov-2017

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How to cite this article:
. Oral Papers/Posters. Indian J Soc Psychiatry 2017;33, Suppl S1:11-30

How to cite this URL:
. Oral Papers/Posters. Indian J Soc Psychiatry [serial online] 2017 [cited 2017 Nov 20];33, Suppl S1:11-30. Available from: http://www.indjsp.org/text.asp?2017/33/5/11/217846

Quality of Life, Family Stigma and Impact of Stigma among the Siblings of Individuals With Intellectual Disability

Chandra Bala, B. S. Chavan, Shikha Tyagi, Kamlesh Kumar Sahu

Department of Pscyhiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: cbmankotia@gmail.com

Introduction: The persons with a disability might experience the strongest effect both in physical limitation and social stigma. However, the impact of disability is also experienced by those who live with him including parents, grandparents and siblings. The present study gave siblings' perspective on stigma which showed deviation from parents' reports.

Aims and Objectives: The study was carried to study stigma among siblings of children with ID and to further find out socio-economic and clinical predictors of stigma among siblings of children with ID.

Methodology: A cross-sectional institutional based study with purposive sampling technique was done. The study sampled 45 normal siblings of individuals with ID studying in a special school (equally from mild, moderate and severe) with either sex between 14-18 years of age after taking informed consent of their legal representative. WHO quality of life-brief scale, family stigma scale, stigma impact scale was used to assesses QoL, family stigma and stigma impact respectively.

Results: In the present study siblings with ID have a better quality of life low experience of stigma and obvious minimal impact of stigma on their life. The level of severity of siblings' disability has no influence on the study variables except the overall quality of life perceived by them. In socio-demographic correlations education, religion, family types, domicile has a significant level of correlations with some study variables.

Conclusion: As there is a scarcity of research done in this area in India, study like this has important clinical implications. It helps in better understanding the perspective and needs of the siblings of children with intellectual disability and formulating a comprehensive management plan for families having children with intellectual disability.

Keywords: Intellectual disability, siblings, stigma, quality of life

A Cross-Sectional, Comparative Study of Younger Versus Older Users Seeking Treatment for Natural Opiates at a Tertiary Care Centre in India

Arpit Parmar, Vaibhav Patil, Siddharth Sarkar, Ravindra Rao

Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India. E-mail: dr.arpitparmar@gmail.com

Background: Though natural opiate use is illegal, its use is culturally sanctioned and prevalent in South Asian region, including in India. Various studies suggest that the substance use profile and their addiction severity is different among younger and older subjects across various substance use disorder. However, there are no studies that have compared younger and older users of natural opiates on their profile of use, severity of addiction and their quality of life.

Aims and Objectives: To compare the socio-demographic and substance use profile, severity of addiction, and quality of life of younger natural opiates users with their older counterparts seeking treatment at a tertiary care centre in India.

Methods: The study followed a cross-sectional design. A total of hundred male patients seeking outpatient treatment for their natural opiates (poppy husk/opium) use were included in the study. Socio-demographic and substance use details were assessed using a semi-structured proforma, while the severity of dependence and their quality of life were assessed using ASI-Lite and WHO-QOL Bref scale respectively. The subjects were further divided on the basis of the group mean age (44.6 years) into two groups: younger (less than 45 years, n=53) and older subjects (more than 45 years, n=47), and the two groups were compared on the various domains.

Results: Younger subjects had significantly higher levels of education compared to the older subjects. The rates of alcohol use in past one year and sedatives use (ever use, past one-year and one-month use) were significantly higher, while the age of onset of these substances was significantly lower in younger patients. Significantly higher proportion of younger subjects initiated their natural opiate use to relieve withdrawals of other substances, while significantly higher proportion of older subjects initiated their natural opiate use to relieve physical pain. There was no significant difference in the addiction severity and the quality of life scores between the two groups.

Conclusion: Younger opiate users have different drug use profiles as compared to older opiate users which would be an important consideration during treatment of this specific sub-population of opioid users.

Keywords: Natural opiates, opiates, quality of life

A Comparative Study on Identity Development and Identity Crisis in Adolescent Girls and the Effectiveness of a Supported-Self Management Approach in 14 Villages of Aurangabad, District, and Maharashtra, India

Madhuri R. Gavit

Project Coordinator, Sanjeevani -Arunodaya Mental Health Project, Savitribai Phule Mahila Ekatma Samaj Mandal, C/o Dr. Headgwar Hospital, Aurangabad, Maharashtra, India. E-mail: ravjimadhurig@gmail.com

Background: Mental and behavioural problems are increasing global burden of disease. Proportion of mental and developmental disorders in adolescent age around the world is dramatically increasing including in India. Adolescence is transitional period of growth and change in the development of mature forms of thought, emotion and behaviour.

Aurangabad a district of Marathwada region in Maharashtra India, predominately drought prone region has seen rise in suicides in past few years.

Aim: Based on multiple issues. We conducted comparative study on identity development and identity crisis in adolescent girls and the effectiveness of supported self-management approach. Our hypothesis was that adolescent girls who show high scores on supported self management approach have high identity development and low on identity crisis than adolescent girls low on supported self-management approach.

Methodology: A Cross -Sectional descriptive study on purposive sample of adolescents girls age group of 13 to 18 year from 14 village of Aurangabad district were selected for the study, by using standardised scale of identity development of adolescents developed by Cheek and Briggs (2013), Personal Identity Crisis inventory developed by Ahmadi (1999) and Multidimensional Scale of Perceived Social Support by Zimet, Dahlem, Zimet and Farley, 1988) and Personal interview based on adolescent girl program activity.

Results: Will be presented during the presentation.

Keywords: Adolescence, identity crisis, identity development

Relationship between Substance Use and Executive Cognitive Functioning: a Critical Review

Pallavi Sharma, Sangeeta Bhatia

Delhi University, Delhi, India. E-mail: pallavi.psych@gmail.com

Objective: Executive cognitive functions (ECF) represents a “higher-order” cognitive construct involved in planning, organizing, problem solving, decision-making, initiating and self-regulating behaviour. Individuals with substance dependence have been found to have measurable executive cognitive deficits including disinhibition, task shifting disabilities, and problems with decision making and processing of new information. We aim to review the recent five years' literature to understand if poor ECF could be a predictor of Substance use in adolescents.

Methods: Relevant publications were identified using the following terms: Substance Use, Executive cognitive functions, Working memory, Reward Processing and Cognitive control, reported in the last five years in English language.

Results: A couple of inconsistent findings could be observed from the existing literature with some studies showing individuals with even low consumption, performing poorly on ECF tests while in other studies even individuals consuming moderate to high doses were found to have no deficit in their cognitive functioning. Furthermore in several studies cognitive deficits were found only after acute intoxication, which often returned to normal with abstinence. Also, there are inconsistencies in ECF measured through behavioural ratings and those through computerized neuropsychological batteries.

Conclusion: With existing literature it is difficult to conclude if deficits in ECF could be a predictor of substance use in adolescents. We plan to use this information to further examine ECF of adolescents with the use of comprehensive neuropsychological battery and to see its relationship with their type and amount of substance consumption.

Keywords: Congnitive functioning, executive functions, substance use

Mental Health Camp Approach: Demand, Opportunity and Utility: Perspective and Ground Reality

Rohit Verma

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: rohit.aiims@gmail.com

Background: Nearly 10-20 million (1-2% of the population) Indians suffered from severe mental disorders such as schizophrenia and bipolar disorder, and nearly 50 million (5% of population) suffered from common mental disorders like depression and anxiety at the end of 2005. The recent national survey in 2016 reports a life time prevalence of mental disorders being 13.7%. Apart from epilepsy, all the other mental disorders report a treatment gap of more than 60%. Most of those identified, had not sought care or were not able to access appropriate care despite seeking. Multiple factors ranging from lack of awareness to affordability of care appear to critically influence these wide treatment gaps. With need to develop effective treatment settings to address such issues in the current era of community psychiatry, the 'psychiatric camp approach' is suggested as an alternate form of treatment. This approach though envisaged to provide appropriate “care to all”, has its own practical shortcomings and loopholes.

Camp Based Approach to Mental Health: The current article reports about such a “camp based approach” to manage mental illness in the community in a rural setting at Shahdol, Madhya Pradesh. The mental health camp (2 days) was part of an overall medical camp (7 days) with treatment facility for all medical illnesses.

Results: One hundred seventy nine patients were seen in the psychiatric camp. Majority of patients presented with mental retardation (31%), depression (29%), migraine (12%), psychosis (6.7%) and epilepsy (6%). Surprisingly, there were only 3 patients that sought treatment for substance dependence. There were limited psychotropic medications available at hand for disbursement.

Conclusion: Multiple factors may play role in determining the logistics of patient presentation to a camp. An understanding of such reasons and better mechanisms to address such factors is needed before subsuming that such a “camp approach” is feasible and effective.

Keywords: Camp, community, mental health, policy, psychiatry

Study on Explicit Attitudes of University Students Toward Persons With Mental Illness

Pragya Malik

E-mail: pragyamalik22@gmail.com

Background: Individual with mental illness suffers social distance and discrimination across various contexts, including the educational care setting, health care setting. Attitudes play an important role in perpetuating discrimination and social distance. Researchers have demonstrated that mental illness stigma is both prevalent in our society and has serious negative consequences for mentally ill persons and their friends and families (Corrigan, 2004). The present study conducted to assess the impact of two variables (Attitude and Discrimination) on university undergraduate students at Amity University, Gwalior.

Methodology: A Fifty undergraduate students; samples were selected using simple random sampling technique, and the data was collected using structured socio-demographic Performa, Devaluation–Discrimination Scale (DD) and Attitudes towards mental Illness Scale (Shokeer, 2002).

Results: There was a statistically no significant difference in attitude change and discriminationof undergraduate university students with respect to Attitude Discrimination.

Conclusion: Findings concludes that structured education regarding attitude change and discrimination would be an effective in increasing knowledge among -university students.

Keywords: Attitude, discrimination, social distance

Electromyography Biofeedback: Treatment Outcome in Patients With Anxiety Disorders

Shaily Mina

Assistant Professor, VMMC College and Safdarjung Hospital, New Delhi, India. E-mail: shailymina@gmail.com

Introduction: Research has evidenced significant improvement with the utilization of electromyography (EMG) biofeedback as a treatment modality (either alone or in combination) in patients presenting with anxiety. The principle mechanism is through modification of autonomic nervous system.

Aim and Objective: Present research attempted to assess the physiological and psychological measures before, during and after the biofeedback session in patients presenting with anxiety disorder.

Methodology: Five cases having primary diagnosis of anxiety disorder in accordance with ICD-10 were included for evaluation. These patients were assessed over 10 sessions in 16 weeks period (approx. one session/week). Psychological measures used in the present research were- HAM-A (Hamilton Anxiety Rating Scale), Cognitive Somatic Anxiety Scale (CSAQ) and State and Trait Anxiety Inventory (STAI). Physiological measurement was through Biofeedback EMG Module- Frontalis muscle.

Result: The subjects were found to be having significantly less scores on HAM-A after the biofeedback session. Data analysis showed subjects to be successful in controlling the tension of frontalis muscle in both with and without biofeedback sessions. The inter-correlations among the outcome measures explain that control of muscle tension was related to change in anxiety symptoms.

Conclusion: EMG Biofeedback when used as a relaxation technique aids in decreasing both state and trait anxiety by modifying the cognition in individuals with anxiety disorder.

Keywords: Anxiety, biofeedback, electromyography

Developing Behavioral Problems among Adolescents Scale: a Brief Screening Tool

B. S. Chavan, Wasim Ahmad, Navneet Kaur, Rosy Arora

Department of Psychiatry, GMCH, Chandigarh. E-mail: wasimarid@gmail.com

Background: Behavioral problems among adolescents is a major issue emerging now days. Teachers, parents and mental health professionals are working closely with these adolescents. Early diagnosis and prevention can help to reduce burden of future illness.

Objective: The purpose of the research was to develop a screening tool identification of common behavioral problems among adolescents in school settings that can be used by school teachers.

Sample: The current sample will be the school going 12-16 years old adolescents from Govt and private schools of UT Chandigarh. The sample are being selected from UT Chandigarh by dividing it into four zones and zone wise list is prepared and by making use of lottery method schools have been selected.

Design: Area sampling design using simple random sampling will be employed to establish the reliability and validity of brief scale for diagnosing common mental health problems among school going adolescents.

Tool: A brief questionnaire has been developed by Chavan et. al which covers six major areas i.e. Learning problems, depression, self harm, aggression, substance abuse and conduct disorder. The questionnaire was developed after discussion among mental health professionals.

Result: Results will be discussed at the time of presentation since, the present study is still under progress.

Keywords: Adolescents, behavioral problems, mental health

A Qualitative Study on Perception on Mental Health by Employees of Lal Bagh Botanical Gardens, Karnataka, India

K. S. Meena

Department of Mental Health Education, NIMHANS, Bengaluru, Karnataka, India. E-mail: meenaksiyer@gmail.com

Introduction: The stigma and the experience of discrimination faced by people suffering from mental disorders rises from the myths and misconceptions that the community at large faces. Poor knowledge contributes to low levels of mental health literacy among the community members. There is a need to understand cultural beliefs that community holds to develop an effective program.

Methodology: A cross-sectional qualitative study was undertaken to understand different views and perspectives of the people of Bangalore, prior to developing a mental health awareness program. Sample comprised of 15 employees from Bangalore Urban District. Two Focussed Group Discussions were conducted with 5 female gardeners (only versed in Kannada) and 10 Junior level officials. Data was analysed manually by the method of Directed Content Analysis.

Results: The average age of the Employees at Lal Bagh was 40 years. All of them described mental illness in terms of symptoms associated with psychosis. The employees of Lal Bagh explained the causes of mental health problems to traumatic situations. The Employees at Lal Bagh expressed the need for getting professional training to work with persons with mental illness in the community and create awareness.

Conclusions: Efforts to improve mental health literacy among the community members is the need of the hour. This study indicates that the Employees, have an decreased level of knowledge of mental health problems, which could be leading to its low recognition and treatment. They will benefit from a well structured training program which can bring down the level of stigma and accelerate early identification and prompt referral.

Keywords: Mental health literacy, stigma, training

Barriers to Treatment and Psychosocial Complications of Prescription Opioid Dependence in Women in Indian Context: a Case Report and Brief Review

Surbhi Sharma, Piyali Mandal, Monica Mongia, Atul Ambekar

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: surbhisharma.aiims@gmail.com

Background: Substance Use Disorders among women have been inadequately studied and understood. The externalising behaviours generally seen in men using substances are not commonly seen in women, hence they are vulnerable to deviation from the social norms, high risk of violence and other forms of abuse by outsiders as well as their own family members. Trajectory of substance use by women is characterized by a quicker development of dependence and experiencing more serious physical consequences. Despite this, treatment seeking among women using substances remains poor, for which multiple barriers to treatment exist, especially in India. Delay in recognition of the problem, social stigma, lack of support-systems in family, inadequate compliance and other social and psychological issues compound the problem. Globally, as well as in India, women are known to be more vulnerable to prescription drug use disorders especially since often such drug use begins with a legitimate prescription for pain management.

Aim: To present and discuss opioid dependence in a woman.

Case Description: The case of Ms. X, 44 years, brings to fore most of such issues pertaining to women using drugs. She was prescribed injection pentazocine for management of body pains and later developed dependence leading to social, familial, financial and physical complications. She was managed effectively on OST and major challenge faced was involving family members in the treatment.

Conclusion: This case highlights the problems unique to women using substances in India, as knowledge of such issues is necessary for effective clinical management of individual cases as well as provides broader insights for developing gender sensitive treatment services.omen Substance use

An Unusual Presentation of Impulse Control Disorder and Hoarding Behavior in a Case Frontotemporal Dementia: A Case Report and Review

S. Sharma, S. Gupta, A. Pandey, N. Kumar

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: surbhisharma.aiims@gmail.com

Introduction: Frontotemporal dementia (FTD) is a neurodegenerative disorder of pre-senile onset, characterised by progressive cognitive decline and behavioural changes. Only few reports have described the presence of impulse control and compulsive spectrum disorders (ICDs) in a variant of FTD patients although these have been described among the core clinical features in FTDs.

Objective: To describe behaviors seen frontotemporal dementia (FTD) presenting with impulse control disorders (ICDs) managed on resperidone.

Case Description: A 50 years old woman presented with pathological stealing, hoarding behaviours associated with progressive cognitive decline and evidence of fronto-temporal cortical atrophy in MR scan and a known missense variance (HGMD site) in MAPT gene was observed in patient and one sibling contributing to the diagnosis of FTD. Behavioural symptoms were managed on Resperidone.

Conclusion: Psychiatric symptoms of the compulsive–impulsive spectrum can be present at onset as well as during the disease course of FTD. Behaviours like hoarding might be present as early symptoms. This case report elaborates on the range of impulsive-compulsive symptomatology that can be seen in FTDs and additional treatment challenges imposed due to them.

Keywords: Frontotemporal dementia, hoarding, impulse control disorders, MAPT gene

Disconnection Hypothesis of Schizophrenia: an Electrophysiological Perspective

Kiran Jakhar, Rohit Verma

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: kjakhar48@gmail.com

Objective: Literature regarding disrupted structural and functional connectivity in schizophrenia has labeled it as “disconnection syndrome”. Patients with schizophrenia display altered neural oscillations which are postulated to play major role in synchronization between cortical areas. This disrupted neural oscillation may reflect a core pathophysiological mechanism underlying cognitive disturbances like perception, attention, memory, facial recognition and consciousness as well as other symptom domains of schizophrenia like positive, negative or catatonic symptoms. The current review aims to determine changes in electroencephalograhy (EEG) frequency bands for appreciating support to the disconnection hypothesis.

Data Source: The literature search included PUBMED, GOOGLE SCHOLAR, MEDLINE.

Study Selection: Search terms used included “schizophrenia”, “psychosis”, “EEG changes”, “EEG frequency”, “slow waves”, “delta and theta waves” in different combinations.

Data Extraction: We included EEG changes in frequency domain in first episode psychosis, high risk subjects, ultra high risk subjects, changes with respect to negative, positive and cognitive domains and various neuro-cognitive functions. No limit to the publication year of the searched articles was applied but the search was restricted to all the articles in English only. The abstracts of the retrieved articles for the search were scanned manually.

Data Synthesis: Decreased alpha power, increased occurrence of slow rhythms (theta and delta waves, particularly over the frontal regions), increased beta waves and dysfunctional gamma oscillations were observed in schizophrenia. Dysfunctional gamma oscillations can be used as a putative endophenotype in diagnosis and a promising biomarker for the identification of high risk subjects with increased risk of conversion. Both elevated (unmedicated patients experiencing positive symptoms corresponding to symptom load) and reduced (suffering from negative symptoms) gamma activity has been reported. Reduced alpha and increased theta and delta spectral powers was present in those with prominent negative symptoms while increased delta was present in both medicated and unmedicated patients in the temporal and parietal areas with significant correlations to both positive and negative symptoms.

Conclusion: There is mixed finding of the changes in EEG frequency and definitive evidence towards disconnection hypothesis in regards to electrophysiology needs to be determined.

Keywords: Delta, electroencephalograhy, electrophysiology, schizophrenia, slow waves, theta

Delusional Disorder With Trihexyphenidyl Misuse: a Case Report Exploring the Diagnostic Conundrums

Pankaj Mahal, K. N. Nishanth, Ananya Mahapatra, Siddharth Sarkar, Yatan Pal Singh Balhara

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: pankaj.mahal26@gmail.com

Background: Delusional disorder has been associated with multiple comorbid psychiatric disorders, including substance use disorders.

Aim: To report the case of a patient who presented with multiple substance use including prescription medicine and was taking trihexyphenidyl medication in excess doses on a regular basis, without reporting any pleasurable effects.

Case Description: A 32-year-old gentleman presented to us with history of using a combination of trifluoperazine and trihexyphenidyl (trinicalm plus) since about 16 years. He had been initiated on this medication after he developed delusion of infidelity towards his spouse. The patient continued the use of this medication as he felt relaxed, and gradually increased the dose. Features of tolerance, craving, diminished control and pre-occupation with use could be identified in the patient. He continued this medication without prescription. Later on, he also started to take antidepressants in the form of amitriptyline, benzodiazepines in the form of clonazepam and opiates in the form of tramadol and paracetamol combination by self. The diagnostic challenge in this patient remained of considering whether trihexyphenidyl use in the patient was a part of polysubstance dependence, a dependence syndrome itself, or abuse of non-dependence-producing substances.

Conclusion: The case highlights that though trihexyphenidyl misuse has been reported in the literature, it may be difficult to place it in a clear diagnostic category.

Keywords: Delusion, delusional disorder, trihexyphenidyl misuse

When Technology Becomes Toxicity - Smart Phone Addiction and Mental Health Issues: a Narrative Review

Ashish Pakhre, Snehil Gupta

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: sjmc.ashish@gmail.com

Introduction: Smart phone addiction is a new kind of addictive disorder which poses new and unique challenges to health policy makers globally to think on this rapidly emerging issue. Public across the world is affected by this excessive smartphone engagement leading to dependence pattern and showing various mental health issues. Considerable debate on addiction and abuse to Smartphone and its consequent impact on the mental health is an issues of global importance.

Methodology: To find appropriate studies, a thorough search of literature was conducted with electronic search engine databases e.g. PubMed, Educational Resources Information Clearinghouse (ERIC), PsycINFO and Google Scholar. Studies published in peer reviewed English language journals were included. Unpublished material and non-peer reviewed materials were not included as a part of this review.

Results: Smart phone abuse/addiction is associated with stress, anxiety, insomnia, depression, delinquency, aggressiveness and dysfunctional relationships. There is also increased risk of debt, violation of privacy and damaged interpersonal skills.

Conclusion: Available literature implies that increased use of smart phones has caused concern about social and psychological ill effects of smartphone addiction. Loss of control over use and other psychological factors can lead to smartphone addiction. Smartphone abuse to addiction has become more serious as this issues has been ignored. More in-depth qualitative and quantitative research studies with larger sample sizes needed to better understand the neurobehavioral aspect of smartphone addiction. Development of policies to raise awareness and treatment of smartphone addiction has become a crucial issue.

Keywords: Behavioral addiction, smart phone abuse, smart phone addiction

A Study of Transitions From first Substance Use to Opioid Use Disorder in Drug Deaddiction Center in Mumbai

Pranad D. Joshi, Shubhangi R. Parkar, Kranti Kadam

Department of Psychiatry, Seth GSMC and KEMH, Mumbai, Maharashtra, India. E-mail: drpranadjoshi@gmail.com

Background: Very few studies have assessed the substances of initiation, age at onset, duration of transition and family history in opioid use disorders.

Aim: To determine the age of onset of substance use, the progression of the substances used and to understand the Transitions from first substance used to opioid use disorder. Settings and Design: This is a Cross sectional observational study conducted in a deaddiction centre of KEM Hospital, Mumbai. 97 patients who fulfilled the selection criteria were included in the study over a period of one month.

Methodology: A semi-structured case record form to record socio-demographic and clinical variables based on aims.

Results: Nicotine (62.89%) remains the first gateway drug followed by alcohol (19.58%) and inhalants (7.22%). Cannabis (53.6 %) remains the most predominant drug in 2nd stage of progression followed by alcohol (18.5%). Patients with family H/O substance have significantly earlier age of onset of gateway drug (14.03 ± 2.61) than patients without family H/O substance use (16.48 ± 3.32). Patients with family H/O substance use had lesser duration of transitions (13.64 ± 3.38 versus 16.48 ± 3.32) from gateway to opioid use disorder. In use of gateway drugs, peer influence (58.46%) was predominant followed by novelty seeking (17.52%) and parental influence (10.30%).

Conclusion: A positive family history of substance use disorders is associated with earlier age of onset and rapid transition. By identifying and preventing the gateway drug as initiating addictive career, one can limit and possibly ward off the development of substance dependence syndromes in future.

Keywords: Gateway drugs, opioid dependence, opioid use disorder, patterns

Gender Disparities in Utilization of Mental Health Services

Madhushree Baruah, Uddip Talukdar

Department of Psychiatry, FAAMC, Barpeta, Assam, India. E-mail: baruahmadhushree2010@gmail.com

Background: Research has shown that women all over the world are more likely to use mental health services than men, which has been attributed to various factors like higher levels of distress among women and stigma among men. But in an economically underdeveloped country like ours it is necessary to see if there is any gender disparity in the follow up and care of such patients.

Methods: A hospital record based observational study was carried out in Fakhruddin Ali Ahmed Medical College, Barpeta. Data were collected from Psychiatry “OPD tickets” for the first 6 months of the year 2016. Data for study included demographical information, clinical information, medications prescribed and review visits which were categorised based on their review states and gender with other socioeconomic factors. Patients that were immediately referred from the OPD were excluded from the study. Analyses were performed using Chi squred test along with Pearson's chi squared test in the categorical data and t test for numerical data.

Results: Out of 811 patients visiting the Psychiatry OPD, 142 were referred and remaining 669 patients were taken up for the study, which included 306 males and 363 females. 158 patients turned up for review and 511 did not come for follow up. The average age of the population under study was 31.89 ± 15.59. No significant difference was observed between the total average female Vs male age, average age in review Vs non review patients and average age of review and non review females and males respectively. Similarly no significant difference was observed for religion, district, and duration of illness, education and number of medications. However regarding availability of information in study population across groups a significant difference was noted. Pearsons chi squared test was applied to check for gender variation across review and non review groups and significance was noted in duration of illness (0.0017) and number of medications (0.0378).

Conclusion: Our study showed that duration of illness and the number of medications affected the review of female patients. Also, detailed examination of the patient shows improvement in follow-ups. So in future a study can be carried out to look into ways to increase the utilisation of such low cost public services provided by the government.

Keywords: Gender disparity, mental health services, utilization

Substance Use Disorder in an Older Woman in a Traditional Indian Joint Family: Is 'whole' More Than the Sum of Its Parts?

A. Rabha, A. Basu, S. K. Mattoo

Department of Psychiatry, PGIMER, Chandigarh, India. E-mail: arabha818@gmail.com

Objectives: To understand the multiple co-morbidities and management of opioid dependence in a 55 year old married lady living in a middle socio-economic status, Hindu joint family.

Case Presentation: Mrs K, having well-adjusted premorbid personality, with family history of substance use disorder in siblings, who started tobacco (bidi) during her adolescence as part of social custom which progressed to dependence subsequently in response to life-stressors. Though her husband was the nominal head she assumed dominance both in domestic and family business, to cope with such psychological stressors, later medical illnesses DM (type II), HTN, iron deficiency anaemia, restless legs syndrome, she started using benzodiazepines, pentazocine injections, and developed dependence in due course of time. Difficulty in role transitions, co-dependence, enabling behaviour by the husband, development of subsystem within the family, rigid boundaries, coalition, disengaged relationship, shifting power dynamics and altered communication between family members, decreased involvement in religious activities and heavy burden of medical co-morbidities led to increased severity and worsening of substance use.

Management: Simultaneous pharmacological management of medical and substance use disorder was done. Relapse prevention sessions, invoking cultural resilience via spending more time in social and religious organizations, involving same age peers, spending quality time with grandson and other age appropriate issues were focussed upon. An understanding in terms of 'systems theory' perspective, subsequent family sessions and discussing her life goals from the traditional 'chatur-asharama' viewpoint were done for better management.

Conclusion: The concept of 'whole - more than the sum of its parts' is one of the pivotal understandings of 'family systems' perspective and is essential for addressing the biopsychosocial and cultural unique ness of this case.

Keywords: Family, substance use, woman

Aggression among Security Guards, Auto Rickshaw Drivers and Housekeeping of Gwalior City: Is There Any Difference?

Ritu Rani

MPhil Clinical Psychology Student, Amity University, Gwalior, Madhya Pradesh, India. E-mail: Mokshreetudagar@gmail.com

Background: Security guards play a crucial role and deal with lots of work responsibilities which include monitoring, maintaining and preventing crimes. Similarly, auto rickshaw drivers tend to display aggressively in handling the passenger in terms of charging extra and rash driving on the road, moreover housekeeping persons work vigorously in maintaining the sanitation of any organization.

Objective: The current study aimed to assess the difference in aggression among security guards, auto rickshaw driver and housekeeping of Gwalior city.

Methods: Semi structured interview was conducted among 120 individuals which comprised of security guards (n=40), auto rikshaw drivers (n=40) and housekeeping staff members (n=40). It was a cross sectional study and purposive sampling method was used to obtain data. The data was analyzed using One Way Anova.

Results: Result shows that auto rikshaw drivers have more aggression than security guards and housekeeping staff. Similarly security guards have more aggression than housekeeping staff.

Conclusion: Findings were discussed under psychological, physiological, social and behavioral domains among these three groups.

Keywords: Aggression, auto rikshaw driver, house keeping, security guards

Socio-Familial Correlates of Self-Concept among School Going Adolescent

Narendra Kumar Singh, Nishant Goyal1

Department of Psychiatric Social Worker, 1Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail: narendrapsw@gmail.com

Background: Self-concept is one of the oldest and important constructs in social sciences. Self-concept in children and adolescents require an environment that provides freedom to explore and experiment also providing protection from danger. Earlier research has discussed the importance and benefit of self-concept in educational settings and has led to studies examining the role of self-concept in school performance. There is scarce information in the general setting therefore, this study will look into the social and familial correlates of school going adolescents with their perception of self-concept in Indian school settings.

Objective: The purpose of this study is to determine social and familial correlates of self-concept in school going adolescents.

Methods: This study will be a cross sectional, school based study. Sample will be selected through simple random sampling technique. The sample will consist of 200 (100 Boys and 100 Girls) from (government and convent) schools in adjoining areas of Ranchi in the state of Jharkhand. Age of the adolescents would be 13-18 years in both groups. Socio-demographic datasheet and Self Concept Questionnaire will be used for the data collection. GHQ-12 will be used to exclude any morbidity in the sample population.

Result and Conclusion: The results of the study would be discussed at the time of presentation.

Keywords: Adolescents, development, self-concept

Electroconvulsive Therapy: Knowledge and Attitude among Patients and Their Relatives

S. R. Adhikari

Professor, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal. E-mail: shailendra_adhikary@hotmail.com

Introduction: There is widespread negative view of Electroconvulsive Therapy (ECT) in common people and other medical fraternities. Clinical efficacy of ECT does not necessarily predict patients and relatives knowledge and attitude regarding the procedure.

Materials and Methods: This is a cross-sectional, retrospective study. Socio-demographic data of patients and relatives were collected. Knowledge, attitude and experience toward ECT were assessed by using an internationally validated instrument.

Results: Majority of patients and relatives replied positively that they could have refused ECT if wanted to; they received adequate information from health professionals in giving consent to ECT, therapeutic uses, processes and side effects/risks of ECT. All agreed that viewing video tapes before treatment would have been helpful. Almost all patients and relatives agreed that- ECT is not used as punishment; it does not cause permanent brain damage; ECT is not dangerous; it is given only if patients agree; patients have full autonomy about its use and it is not used to control their behavior. All patients and relatives disagreed that ECT is inhumane; it's cruel; illegitimate; should be outlawed. All agreed that they felt satisfied with ECT and glad it was given to their relatives.

Conclusion: It is very important to give reliable and adequate information to patients and relatives about ECT. After beneficial effects of ECT and improvement in post-ECT psychopathology, subjects will have favorable attitude and increased satisfaction toward ECT. Positive experience of treatment will have enduring impact on subjects' perceptions. Information leaflets and audio-visual aids play additional benefit when given information about the procedure.

Keywords: Attitude, electroconvulsive therapy, knowledge

Proportion of Metabolic Syndrome in Patients With Schizophrenia

S. R. Adhikari

Professor, Chitwan Medical College Teaching Hospital, Bharatpur, Nepal. E-mail: shailendra_adhikary@hotmail.com

Introduction: Schizophrenia has been associated with an increased risk of cardio-metabolic morbidity and mortality. Metabolic syndrome and other cardiovascular risk factors are highly prevalent as treatment with antipsychotics has been recognized as additional risk factors of development of metabolic syndrome.

Materials and Methods: Cross-sectional analytical study design was used to find out the proportion of metabolic syndrome among patients with schizophrenia receiving antipsychotics. Total of 85 patients were selected for the study by using random sampling technique from out-patient department. Data were collected by using semi-structured interview schedule, physiological measurement and record review. Obtained data were entered in SPSS version 19.0 and analyzed by using descriptive and inferential statistics. The presence of metabolic syndrome was assessed according to International Federation of Diabetes (IFD) definition criteria based on gender specific. Findings were presented in different tables.

Results: Among 85 patients receiving antipsychotics, 24.7% of patients had metabolic syndrome according to IDF criteria. The most common metabolic syndrome parameters in patients were central obesity (64.7%), elevated fasting glucose (54.1%), hypertriglyceridemia (44.7%), and low HDL cholesterol (18.8%) while the least prevalent metabolic parameter was elevated blood pressure 4 (4.7%). Statistically significant differences were found in all metabolic syndrome parameters, except HDL cholesterol. Proportion of metabolic syndrome was higher in patients receiving atypical antipsychotics in compared to patients prescribed with typical antipsychotics (25.0% vs 23.8%). More women than men have metabolic syndrome (31.1% vs 17.5%). There was significant relationship between metabolic syndrome with age (p=0.009), education (p=0.048), occupation (p=0.025), body mass index (p=0.013) and duration of treatment with antipsychotics (p=0.025) whereas there was no relationship between metabolic syndrome with type of antipsychotic drugs (p=0.913), drugs (p= 0.757), tobacco use (p= 0.591), type of food (p= 0.972), habit of exercise (p= 0.568) and ethnicity (p= 0.268).

Conclusion: Metabolic syndrome is high in schizophrenia patients who are receiving antipsychotics for their treatment. Therefore treating physicians and health workers need to monitor metabolic syndrome parameters regularly, intervene appropriately when needed and refer the patients for the treatment of any other physical illnesses.

Keywords: Antipsychotics, metabolic syndrome, schizophrenia

Cross-Sectional Study to Evaluate Relationship between Disability, Depression and Anxiety in Patients With Chronic Low Backache

Neha Dhiman

Department of Psychiatry, PGIMS, Rohtak, Haryana, India. E-mail: nehadhiman06@gmail.com

Introduction: Pain is a common problem for which a patient approaches a physician. Chronic Low back pain (CLBP) is defined as the pain localized in the area between twelfth rib and the inferior gluteal folds which has persisted beyond 3months. CLBP is a bio-psychosocial problem commonly associated with depression and anxiety.

Aim: The aim of this study was to assess the severity of symptoms of depression and anxiety in patients with chronic low back pain and correlate with the disability due to CLBP.

Materials and Methods: The study is a cross-sectional study conducted on 75 patients of CLBP. Depression and anxiety was assessed using Hospital Anxiety and Depression Scale (HADS) and disability due to CLBP was assessed using Oswestry Disability Index (ODI).

Results: Out of 75, 22 (29.3%) were males and 53 (70.1%) females. Mean age of the patients was 39.6 ± 8.48years. Average duration of pain was 4.67 ± 5.84 years. Average scores on Oswestry disability index was 22.10 ± 7.67. 46 out of 75 (61.3%) patients had abnormal scores on depression domain of HADS (HADS-D) and 37 out of 75 (49.3%) had abnormal scores on anxiety domain of HADS (HADS-A). Correlation coefficient for HADS-D and ODI percentage came out to be 0.55 (p<0.05) and for HADS-A and ODI percentage-0.49 (p<0.05) which represents significant correlation.

Conclusions: Patients with CLBP have high co-morbidity of depression and anxiety which is significantly correlated with the disability due to low backache. Thus it becomes important to screen the patients for depression and anxiety for better outcomes and quality of life.

Keywords: Anxiety, depression, disability, low backache

Diagnostic and Management Difficulties in Simple Schizophrenia: a Case Report

Pooja Shakya, Gagan Hans

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: drpjshk@gmail.com

Introduction: Simple schizophrenia occupies an extreme position of the schizophrenic continuum where prefrontal deficits and negative symptoms are most purely manifested. The available literature on it is quite limited, especially from India. We report a case which explores if absence of positive symptoms results in long duration of untreated symptoms, increased morbidity and subsequent management difficulties.

Case: 26 years old years old unmarried female was brought by parents to the psychiatry unit of a tertiary care hospital with 6 to 7 years history of compromised selfcare, decreased food intake, weight loss, lack of activity, a self-absorbed attitude, decreased speech, decreased interaction with family members, poor non-verbal communication and marked decline in social and scholastic performance which started gradually and progressed. On MSE patient was ill groomed, with attention and concentration aroused but ill sustained, speech was monotonous, decreased in productivity with blunting of affect with no abnormality detected in the thought and perception of the patient, specifically when interviewed for presence of any delusions and hallucination. IQ Assessment, MRI and executive functioning along with routine CBC, LFT, KFT of the patient were normal. Simple Schizophrenia was kept as provisional diagnosis and patient was started on antipsychotics along with psycho-education of the parents about the nature of illness, need for treatment and regular follow up. Interventions like activity scheduling and cognitive exercises were also initiated. Although there was significant delay in treatment following the onset of symptoms she has made consistent improvements in functioning following the initiation of the treatment.

Conclusion: The case report is discussed in context of limited available literature, diagnostic and management difficulties in these sub-group of patients.

Keywords: Management, simple schizophrenia, diagnostic difficulties

A Comparative Study of Depression and Suicidality between Male and Female Prisoners of Guwahati Central Jail

Swapanjit Sarma

Consultant Psychiatrist, Institute of Neurosciences, Kolkata, West Bengal, India. E-mail: raak84@gmail.com

Background: Prisoners are consistently reported to suffer more from affective disturbances and higher suicide rates than general population.

Objective: To compare the prevalence of depression and suicidality between male and female inmates and to probe possible association of the internal turmoil and psychological burden consequent of the committed crime with these morbid occurrences. Methods: Forty male and 40 female prisoners of Guwahati Central Jail, Assam were evaluated by clinical interview and socio-demographic questionnaire, Beck Depression Inventory II, and Columbia Suicide Severity Rating Scale were administered. Appropriate statistical tests for categorical and continuous variables were performed with significance defined as p<0.05.

Results: Prevalence of depression was 62.5 per 100 males and 85 per 100 females (p=0.04), that of suicidal ideation were 10 and 30 per 100 male and female prisoners respectively (p=0.04). The relative risk of suicide was 0.33. Depression and suicidality were significantly associated with longer duration of stay, convict status, presence of physical illness, any substance abuse and with higher age of their children in female prisoners; whereas male prisoners had a striking association of the studied morbidities with under trial status and being free from any physical illness.

Conclusions: Although limited in its inability to attribute causality, our study conclusively demonstrated increased prevalence of depression and suicidality in female prisoners. Penal status, duration of stay, co morbid physical illness, substance abuse and factors related to motherhood negatively influenced the fairer sex in custody.

Keywords: Depression, factors, prisoner, psychological, suicide

Association of Caregiver Needs With Psychopathology and Functioning in Patients With first Episode Schizophrenia

Ragul Ganesh, Rohit Verma, Mamta Sood, Rachna Bhargava

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: ragulganesh.r@gmail.com

Introduction: Caregivers of patients with first episode schizophrenia (FES) play significant role the treatment and recovery of their ill relatives. The behavioural manifestations of schizophrenia in their loved ones, causes significant distress for the caregivers.

Objective: The study was aimed at evaluating caregivers' needs and their correlation with psychopathology and functioning in patients with FES.

Methodology: Patients with FES diagnosed on DSM 5 with illness duration ≤ 2 years and their caregivers were recruited for the study. The patients were evaluated on SAPS and SANS for assessment of psychopathology and WHODAS 2.0 for assessment of the functioning. Caregivers of symptomatic patients with FES (n=15) and patients of FES with minimal/no symptoms (n=15) were compared on CANSAS.

Results: Symptomatic and minimal/no symptoms patient with FES were comparable on various socio-demographic variables, age of onset of illness and illness duration. The scores on SAPS, SANS and WHODAS 2.0 for symptomatic patients with FES were 12.47 ± 7.36, 9.67 ± 5.49 and 28.53 ± 3.70 respectively and for minimal/no symptom patients with FES were 1.87 ± 3.64, 8.93 ± 3.97 and 19.60 ± 3.18 respectively. On CANSAS, total, met and unmet needs of caregivers of symptomatic patients with FES were 10.27 ± 1.87, 9.00 ± 1.64 and 1.27 ± 1.66 respectively and minimal/no symptoms patients with FES were 19.00 ± 3.35, 11.20 ± 4.17 and 7.80 ± 2.24 respectively. The total (t = 77.4, p <0.05) and unmet needs (t = 81.98, p<0.05) of caregivers of patients with symptomatic FES were significantly more than that of patients with FES having minimal/no symptoms.

Conclusion: Caregivers' needs of patients with FES are more when their ill relative has long duration of illness, more psychopathology and poor functioning. The caregivers of symptomatic patients have more unmet caregiver needs as compared to the caregivers with minimal symptoms. Therefore, it is important to assess and address caregivers' needs while developing intervention care plans for patients with FES.

Keywords: Caregivers, first episode, functioning, needs, psychopathology, schizophrenia

Quality of Life and Its Correlates in Schizophrenia and Related Disorders: an Exploratory Study

Ragul Ganesh, Ananya Mahapatra, Mamta Sood, Rohit Verma, Rakesh K. Chadda

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: ragulganesh.r@gmail.com

Background and Aims: Quality of life (QoL) has been recognized as one of the most important outcome of schizophrenia treatment and essential for functional integration of the patients in their community. However, the determinants of QoL are not extensively researched, especially in a lower-middle income setting. This study aims to evaluate the relationship of the socio-demographic and clinical correlates with various domains of Quality of Life in patients with schizophrenia and related disorders.

Methodology: A cross-sectional study of 85 patients (18-60 yrs.) diagnosed with Schizophrenia and related disorders (F20 to F29) according to ICD10, with total duration of >=2 yrs. Scale for assessment of Positive Symptoms (SAPS), Scale for assessment of negative symptoms (SANS), and WHO Quality of Life- Bref, Hindi Version (WHO-QOL-BREF) were applied following informed consent. Permission from Institute Ethics committee was obtained.

Results: The mean age of the patients was 30.92 ± 9.3 yrs. (males = 57.6%). The mean duration of illness was 7.85 ± 6.21 yrs. The mean SAPS score was 20.0 ± 8.8, and mean SANS score was 19.5 ± 10.6 in the patients. The mean PHQ-15 score was 7.03 ± 3.9 indicating mild level of somatisation. The means transformed scores (on a scale of 0-100) of the four domains of Quality of Life are as follows: Physical (35.94 ± 26.6), Psychological (36.6 ± 17.6), Social (19.2 ± 17.9), Environmental (38.5 ± 14.4). There was a significant negative correlation between scores on all four domains of WHO-QOL-BREF and patient's total duration of illness, and SANS score (p<0.01).

Conclusion: Patients of schizophrenia spectrum disorder demonstrated a poor quality of life in all the domains of quality of life. All domains of quality of life were found to be inversely associated with longer duration of illness and more negative symptoms.

Keywords: Functioning, quality of life, schizophrenia

Prevalence and Psychosocial Determinants of Internet Addiction among Post Graduate College Students in Ranchi

Abhijeet Singh, C. R. J. Khess, K. J. Mathew, Sourav Khanra

Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail: abhijeetsingh141089@gmail.com

Background: There has been an explosive growth in the use of internet not only in India but also worldwide in the last decade. There were about 42 million active internet users in urban India in 2015 as compared to 5 million in 2008. The internet is used to facilitate research, to seek information, for interpersonal communication. On the other hand, it can be used by some to indulge in pornography, excessive gaming, chatting for long hours, and even gambling. There have been growing concerns worldwide for what has been labeled as “internet addiction.” Internet addiction has emerged as a public health concern. Effects of internet addiction on physical and mental health are well documented. Previously study conducted in India and in other countries, helped to identify the presence of internet addiction among adolescents and associated it with personality, impulsivity, depression and anxiety. The role of psychosocial variables including family factors has not been studied in internet addiction especially among population of young adult like college students The present study is a preliminary attempt to fill this gap.

Objective: To examine the prevalence and psychosocial determinants of Internet Addiction among Post Graduate college students in Ranchi.

Materials and Methods: A cross sectional community based study in University setting. A total of 100 students (25 students from each four departments of Ranchi University including dept. of English, Hindi, Philosophy, and History). According to the type of data appropriate statistical analyses was done using SPSS version 23.

Conclusion: Internet provides a vehicle to promote cognitive, social and physical development, but if it is not utilized carefully, it can lead to crime and online harassments. Overall researches suggest that specific and targeted efforts may be needed to counter online risk in order for youth to benefit from the many opportunities offered by the Internet.

Keywords: Internet addiction, prevalence, psychosocial determinants

A Clinical Study of the Prevalence of Psychiatric Comorbidity among Male Patients of Sexual Dysfunction and Dhat Syndrome Attending Psychiatry Opd of a Tertiary Care General Hospital

Rajvardhan Narayan, Utpal Bora

Department of Psychiatry, Guwahati Medical College and Hospital, Guwahati, Assam, India. E-mail: dr.rvnarayan@gmail.com

Introduction: Sexuality is an important aspect of health which can impact the overall well being of men and women. According to the tenth revision of the International Statistical Classification of Diseases and related health problems (ICD-10), sexual dysfunction refers to a person's inability to participate in a sexual relationship as he or she would wish. Dhat Syndrome is a culture bound syndrome characterised by preoccupation with semen loss and attribution of physical and psychological symptoms to the same. In spite of the high prevalence of sexual dysfunction it has received little attention from researches in India. There are no reliable estimates of sexual disorders and even basic clinical data are not available from India. Particularly in the north-eastern part of the country research in this area are even more less. Purpose of the present study is to describe the pattern of sexual dysfunctions and Dhat syndrome in male patients and to study the prevalence of additional psychiatric co morbidity among them.

Aim: To study the socio -demographic variables of male patients of sexual dysfunction and Dhat syndrome attending psychiatry OPD of a tertiary care hospital. To study the prevalence of psychiatric comorbidity among these male patients of sexual dysfunction and Dhat syndrome attending psychiatry OPD of a tertiary care hospital.

Methods: 50 male patients in the age group of 18-50 years attending the psychiatry OPD, Gauhati medical College and Hospital, Guwahati and diagnosed with sexual dysfunction or Dhat syndrome or both (according to ICD 10) were selected for the study.

Results: Will be discussed during the presentation.

Keywords: Prevalence, sexual dysfunction, shat syndrome

Study of Day Time Sleepiness, Sleep Quality and Sleep Habits between Male and Female Undergraduate Students of Amity University, Madhya Pradesh, India

Nandha Kumara Pujam

Department of Psychology, Amity University, Gwalior, Madhya Pradesh, India. E-mail: nandhakumara2008@gmail.com

Background: The growing level of stress on students, is affecting their health and life style. Sleep deprivation and symptoms related to sleep disorders have been ignored and inadequately understood. Good quality sleep and adequate amount of sleep are pivotal in order to have better cognitive performance and avoid health problems.

Aim: To Study the day time sleepiness, sleep quality and sleep habits of undergraduate students of Amity University, Madhya Pradesh.

Methods: Sleep Quality and habits were investigated using a random sampling method from the student of Amity University, Gwalior, Madhya Pradesh, India. The study was carried out during June – August 2017 with 202 students. The scales administered were Epworth Daytime Sleepiness scale, Sleep hygiene Index and Pittsburg Sleep Quality Index. Data was analyzed by using statistical Package of social sciences (SPSS) version 16.0.

Results: The present study found that female students reported significant higher day time sleepiness than male students. Similarly female students showed poor sleep hygiene and sleep quality than the male students. Furthermore on Pearson correlation it was found significant positive correlation between day time sleepiness and sleep hygiene. Likewise there was a significant positive correlation between sleep quality and sleep hygiene.

Conclusions: Sleep disturbance are an important issue among university students. They should be taken for sleep counseling as first line of treatment. Numerous studies show that poor quality of sleep and increased day time sleepiness leads to cognitive decline in the area of attention and memory and also leads to emotional problems.

Keywords: Day time sleepiness, sleep hygiene, sleep quality

Socio-Demographic Profile of the Patients With Psychiatric Illness Admitted in Regional Geriatric Centre, Gauhati Medical College and Hospital, Guwahati

H. R. Phookun, S. Mazumdar

Department of Psychiatry, Guwahati Medical College and Hospital, Guwahati, Assam, India. E-mail: su4dreamz@gmail.com

Introduction: The elderly population is vulnerable for various psychological and sociological changes. It is associated with different life stressors, life events for which the mind is not totally capable of handling those issues. There is a definite association of simultaneous deterioration of physical and mental health. However psychiatric morbidity in elderly either singly or comorbidity with other medical illness is one of the less focussed area in our country and much of this co-morbidity remains undetected, and therefore, remains untreated. This further prolongs the duration of suffering and the outcome of the illness as well as the management of the medical illnesses also.

Aims: To assess the socio-demographic profile of the geriatric patients with psychiatric illness.

Methodology: The present study was carried out in 85 patients at the Regional Geriatric Centre, Gauhati Medical College and Hospital from August 2016 to July 2017. Psychiatric diagnosis was made using ICD-10 classification of mental and behavioural disorders and a semi-structured interview was done to assess the socio-demographic variables.

Results: The study results showed the prevalence of psychiatric morbidity in 40 patients (47.05%) out of 85. Among the group of patients with psychiatric illness, depression was the most common followed by dementia and substance use disorder. Among these patients, male, age group 60-69 years, Hindu, married, unemployed, from rural background and those from joint families were found to be most vulnerable group for having psychiatric morbidity.

Conclusion: The study results establish the fact that psychiatric morbidity is seen among the geriatric patients and different socio-demographic variable play a definite role in psychiatric illness of elderly age group.

Keywords: Geriatric population, prevalence, psychiatric morbidity

Study of Psychiatric Disorders in Children and Adolescents to Introduce a Newer Classification System

Jyotismita Choudhury, Suranjita Mazumdar, Shyamanta Das

Department of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam, India. E-mail: gunjashreechoudhury@gmail.com

Introduction: Majority of mental illnesses exhibit their first manifestation before adulthood. The available adult criteria although applied to children have its own limitations. Also, data on which such estimates are build are sparse.

Aim of Study: To study the childhood and adolescent psychiatric disorders in order to arrive at a newer classification system.

Methodology: A different way of classifying psychiatric disorders in children and adolescents into emotional, disruptive and developmental disorders. Diagnoses were made according to the ICD-10 'Clinical descriptions and diagnostic guidelines' (WHO 1992).

Results: Sample consists of children and adolescents upto 18yrs of age. The sample was distributed in 3 groups (emotional, disruptive and developmental disorders). We also looked into the comorbidity within groups and across groups.

Conclusion: In the recent years, the work in classification of childhood and adolescent psychiatry has progressed by leaps and bounds and they provide stronger empirical basis to support the current schemes.

Keywords: Disruptive disorders, developmental disorders, emotional disorders

A Comparative Study of Crp Levels in Patients With Bipolar Disorder and Healthy Controls

D. Bhagabati, J. Gupta

Department of Psychiatry, Guwahati Medical College and Hospital, Guwahati, Assam, India. E-mail: juhi.gupta27@gmail.com

Introduction: Bipolar Disorder are one of the most debilitating psychiatric illness. Hereditary factors play a vital role in the etiology yet the pathophysiology of the disease remains poorly understood. Various studies and meta-analysis have shown significant role of pro-inflammatory markers like IL-6, CRP, TNF-a in the causation of the disease highlighting the role of inflammation as a possible mechanism in the disease process. This possibility opens up avenues for newer techniques and future prospects for the management of the illness in a more scientific way.

Aims: To compare the CRP levels in case of Bipolar Disorder patients with healthy controls.

Methodology: The present study was carried out in 30 admitted patients of Bipolar Disorder in psychiatry department, Gauhati Medical College and Hospital from August 2016 to July 2017 and 30 healthy age and sex matched controls were taken who volunteered for the study. Psychiatric diagnosis was made using ICD-10 classification of mental and behavioural disorders and a semi-structured interview was done to assess the socio-demographic variables for both cases and controls.

Results: On comparing the mean CRP level in case of bipolar patients with healthy controls showed that bipolar patients had a higher mean CRP (p value-0.0031) which was very significant. Elevated CRP levels were seen in 66.67% of the total bipolar manic patients as compared to 26.7% of the bipolar disorder depressed patients. Male patients reported a higher levels of CRP than female patients.

Conclusion: This study corroborates with the inflammatory hypothesis of Bipolar Disorder and future use of CRP as prognostic marker as well as opens the avenues for use of anti-inflammatory drugs as adjuvant in the treatment of Bipolar Disorder.

Keywords: Bipolar disorder, CRP levels, healthy controls

Prevalence of Suicidality and Preferred Crisis Intervention Strategies among Young Adults: a Cross-Sectional Survey in a Semi-Urban Indian City

Anish V. Cherian, T. Sreeranjini, Agneita Aiman, Shalinini Aiyyappa, Shishir Kumar, Santosh Prabhu, Shrinivasa Bhat

Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. E-mail: anishvcherian@gmail.com

Introduction: Suicide is a leading cause for mortality among young-adults across globe, especially in low-middle income countries, including India. However, there is paucity of data among the young adults about the prevalence of suicidal ideation, lifetime suicide attempt and its association with depression. Further, there is limited data on the knowledge and pattern use of crisis support system available for suicide prevention.

Methods: We screened about 1500 young adults (aged between 18 to 25 years), registered in the colleges for depression and suicidal ideation using Patients Health Questionnaire and Beck's Hopelessness questionnaire. Further, questions were asked about their knowledge and preferred choices of crisis support services for the young adults by the scale specifically developed for the study.

Results: The present study estimated that nearly 20% of the young adults have depression and about 7.3% of them have suicidal thoughts and hopelessness. The study estimated that about 9.3% have seriously thought about committing suicide and 3.4% have life-time attempt of committing suicide. The participants preferred following crisis support help-lines; the peer support, one to one counselling and psychiatric counselling followed by crisis help line and mobile applications.

Conclusions: Our study highlights that there is higher prevalence of depression and suicidal thoughts among young adults. Thus, the current national policies and programs for young adults prioritize the suicide prevention and tackling depression among young adults, including providing support helplines and peer supports in the college premises.

Keywords: Depression, suicidality, young adults

Group Psychoeducation With Family Members of People With Schizophrenia

Bhupendra Singh, Priti Singh, Rajiv Gupta

Assistant Professor, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. E-mail: 33bhupendrasingh@gmail.com

Introduction: Families constitute a primary source of care for people with mental illness but often face extensive trouble in fulfilling their role. Family psychoeducational interventions have been developed to address these problems with established efficacy and effectiveness. Psychoeducation of patients and families seems to be a useful first step in the psychological treatment of schizophrenia. However, the content and dimensions of efficacy of well-structured family psychoeducation have not yet been established. The family member's perspective and understanding may have an impact on efficacy in the areas of attitude, motivation, and continuation/dropout rate.

Aim: The present study was planned to assess the effectiveness of Family group psychoeducation in improving family cohesion, alleviating caregivers' burdens, and reducing stress in relatives of those suffering from schizophrenia spectrum disorders.

Methods: 214 family members of the admitted patients in Institute of Mental Health, UHS, Rohtak with a diagnosis of schizophrenia, in the year of 2016, were included in the study. On the basis of random assignment 54 received intervention, and 54 were taken as the control (treatment as usual) groups. Self structured socio-demographic datasheet, Family Burden Scale, and DASS were administered to the subjects. Informed consent was sought from the patients and their caregivers as well.

Result: Family Psychoeducation showed positive effect in the area of understanding and knowledge, objective and subjective family burden, it also decreased the depression, anxiety and stress throughout the study period. Family psychoeducation constitutes a valuable non stigmatizing intervention that empowers relatives of people with severe mental illness and enables them to cope effectively with the illness.

Keywords: Family, group psychoeducation, schizophrenia, stress

Domestic Violence in Female Patients With Schizophrenia: a Prevalence Study

Neha Dhiman

Department of Psychiatry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India. E-mail: nehadhiman06@gmail.com

Introduction: According to World Health Organization, 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”. Physical violence can be in the form of slapping, hitting or beating, psychological abuse in the form of constant humiliation, forced sexual inter- course or any other controlling behaviour such as isolating a person from family and friends, monitoring their movements and restricting access to information or assistance. Women constitute vulnerable group for partner violence and further suffering from schizophrenia adds to the vulnerability. This study is conducted to find domestic violence in female patients with schizophrenia and the need to address the problem.

Aim: To study domestic violence in female patients with schizophrenia.

Materials and Methods: This is a cross sectional study. 30 female patients who meet the diagnosis of schizophrenia according to ICD10 will be enrolled in the study. After taking consent, socio-demographic data, psychopathological status using Brief Psychiatric Rating Scale and partner violence using Hurt Insult Threaten Scream scale (HITS) will be measured. Descriptive statistics will be applied and relation between psychopathology and violence will be measured.

Results: Results will be presented and discussed.

Keywords: Domestic violence, prevalence, schizophrenia

Academic and Interpersonal Stressors, Perceived Social Support, Coping Responses on Subjective Well-Being in Students Pursuing Professional and Nonprofessional Courses: a Comparative Study

Amit Khawas, Nishant Goyal, Dipanjan Bhattacharjee, Aniruddha Mukherjee

Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail: amitmarx@hotmail.com

Background: In India, little research has been done to compare academic and interpersonal stress, perceived social support and coping responses on the subjective well-being in students studying professional and non professional courses. Those students, who fail to adjust to the stressful demands that are placed upon them, may experience a variety of problems and may be at risk for developing psychiatric illnesses. The newly enrolled students of these streams are at higher risk of developing academic and other stress induced problems, which might negatively affect their academic performance and training.

Objective: To compare the level of academic and interpersonal stressors, perceived social support and coping response and subjective wellbeing between the first year students studying professional (engineering and medical) and non-professional courses (General stream BSc) and to assess the association between academic and interpersonal stress, perceived social support, coping responses subjective wellbeing and various socio-demographic variables in students pursuing professional courses.

Materials and Methods: The samples for the study group consist of 30 first year engineering students and 30 first year MBBS students. In the control group 60 age matched first year General Stream (BSc) students were selected. The socio-demographic data was collected. The following scales were applied: College undergraduate stress scale, Social support questionnaire, Brief COPE, Psychological well-being Scale, General Health Questionaire-28 and Scale of Positive and Negative experience. The two groups were compared on academic and interpersonal stress, perceived social support, coping responses and subjective well-being. Appropriate statistical analysis was done.

Results and Conclusion: Will be discussed during the presentation.

Keywords: Academic stressor, coping and subjective wellbeing, social support

Attitude Towards Sexual Health Education among Parents of Adolescent With Intellectual Disability

Nazli, Wasim Ahmad, B. S. Chavan

Government Medical College and Hospital, Chandigarh, India. E-mail: nazlirimh@gmail.com

Background: Sexuality is an integral part of Human life. As per Maslow's hierarchy of needs, the sex comes under the very basic need of human being and in the era of the right base world for persons with intellectual disability, we cannot neglect this issue simply. Unfortunately, the topic is not included in any of the curriculum of children with intellectual disability. Although, parents can play a significant role in imparting sexual health education, their own knowledge and expertise is also limited. Awareness of the parents/care takers in relation to sexual health education can bring a paradigm shift in the lives of Adolescent with Intellectual Disability (AwID).

Objective: The present study was conducted to assess the general awareness of parents of adolescent with intellectual disability, towards imparting sexual health education.

Sample: This was a cross sectional, non-randomized and convenient sampling method. 50 parents whose wards with intellectual disability were studying at GRIID, Chandigarh selected as sample.

Design: The cross sectional method was adopted for the present study.

Tool: A set of ten questions (Open Ended) was prepared for the parents of children with intellectual disability seeking their opinions towards sexual health education.

Results: Findings of the study revealed that majority of the parents (84%) have positive attitude to impart sex education for children with ID. 70% of them admitted that sex education for AwIDs has a valuable role in safe guarding them from sexual exploitation and these AwIDs have right to marriage. Nearly half the subjects did not consider the sexual behavior as a major problem. Parent also supported to practice of taking consent for sterilization, but majority of them 64) did not support the practice of masturbation. 46% parents had belief that these AwID have less sexual interest than other.

Conclusion: The study highlighted the need to provide more orientation and sensitization for the parents to the understand importance of imparting sexual health education to their challenged children.

Keywords: Adolescent with intellectual disability, attitude, parents, sexual health education

Codependency Scales: a Review of Existing Literature

Nileswar Das, Siddharth Sarkar

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: dr.nileswar@gmail.com

Background: Codependency or Co-dependence is a highly contested construct in the field of psychiatric disorders, more so in substance (alcohol) use disorder. The entity has been conceptualized from various perspectives ranging from: Illness spectrum, personality traits to dysfunctional relationship states. Scales used to assess codependency by various researcher have also varied accordingly. This paper attempts to review the available codependency scales in order to explore the factors assessed by the various scales and their psychometric properties.

Methods: Extensive search was done from MEDLINE (via PubMed) and Google scholar using the keywords “Codependency”, “Co-dependence”, “Codependence”, “Scale” and “Tools” in various combination. Extensive search of manual, journals and cross references was also done. Articles published in English Language were only considered for the review.

Results: Initial search strategy yielded 50 articles on various Codependency measurements. We reviewed 10 scales and found differences with regard to Components and Domains, Nature of the scale, Duration of administration, Illness wise, Internal-consistency, Test and re-test reliability, Concurrent validity, Copyrights, Cut-off score, Need for extra equipment, Number of people required and Training for users of each scale. The most cited instruments were: Spann-Fischer Codependency Scale (SF CDS), Co-dependency Assessment Questionnaire (CAQ) and Friel Codependency Assessment Inventory (CAI).

Conclusion: There was a lack of consensus regarding the factors that operationalize the construct of Codependency amongst the various scales. Heterogeneity in the study population based on which the scales were constructed was one of the important factors leading to lack of consensus. There is an imminent need for a unified conceptualization in order to carry on further research.

Keywords: Codependency, codependence, co-dependence, scales, tools

Regular 'exercise' in Group Format: a Nonpharmacological Intervention for Inpatients in General Hospital Psychiatry Ward

S. Vijay, V. Patil, M. Sood

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: induvijuswethasaanvi@gmail.com

Background: Mental disorders account for 13% of the global burden of disease. Chronic mental illnesses are associated with poor patient and caregiver outcomes, excess morbidity and mortality along with increased caregiver stress. In low and middle-income countries like India, there is huge mental health gap of 75%. Due to lack of treatment facilities and limited access, it is important to focus on non-pharmacological treatment modalities in addition to pharmacological treatment. In India, in general hospital psychiatry units, most of the patients receive outpatient treatment; only patients with management or diagnostic difficulties are hospitalized. Most of the inpatients have no daily routine and rarely do exercise. Physical exercise has been reported to be beneficial in patients with both common and severe mental illnesses. Activities like ability to operate mobile phone and computers can also help in improving functioning in these patients. In a GHPU, an occupational therapist can play an important collaborative role in the care of the patients by organizing such activities effectively.

Intervention: We have recently introduced two activities for all the inpatients at our hospital: physical exercise and how to operate mobile phone which are conducted in a group format where all the patients admitted in the ward are requested to join in group exercise for half an hour. Following this activity, they are trained in skills to operate mobile phone.

Results: We will present results of these activities in the paper.

Keywords: Exercise, general hospital psychiatry unit, inpatients

Repetitive Transcranial Magnetic Stimulation in Treating Obsessive Compulsive Disorder Refractory to Repetitive Transcranial Magnetic Stimulation: a Case Series

Vaibhav Patil, Ragul Ganesh, Saurabh Kumar, Rohit Verma

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: drvaibhavp317@gmail.com

Background: Significant proportion of patients with obsessive compulsive disorder (OCD) fail to respond satisfactorily to standard medications, psychotherapy or a combination of both. Repetitive transcranial magnetic stimulation (rTMS) has been explored as a treatment option for OCD refractory to standard treatment. Several brain areas in corticostriatal network have been investigated as target site for rTMS. Efficacy of rTMS over supplementary motor area (SMA), orbitofrontal cortex (OFC), dorsolateral prefrontal cortex (DLPFC) have been studied but the results are mixed. Change of target site of rTMS in patients who fail to improve with rTMS has not been studied. We analysed the outcome of rTMS over SMA in patients with OCD refractory to rTMS over either OFC or DLPFC and multiple medications.

Methods: Low-frequency rTMS was delivered over the SMA in three patients with OCD failed to improve with multiple medication, cognitive behavioural therapy and rTMS. Treatment response was assessed by at least 25% reduction Yale-Brown Obsessive-Compulsive Scale scores.

Results: Three patients were given rTMS over SMA. No major adverse effects were observed in any of them. Initial target area of rTMS in two patients was OFC and in one patient the initial target area of rTMS was DLPFC. Two patients showed improvement of 25% and 35% in YBOCs after 20 sessions of rTMS delivered to SMA. One patient showed only 15% improvement in YBOCs. In our study, the patients with predominant motor compulsions of hand washing improved with rTMS over SMA. The patient with predominant obsessive ruminations without motor compulsion didn't improve with rTMS over SMA.

Conclusions: Low-frequency rTMS over the SMA may be effective in patients with OCD refractory to rTMS delivered to other target area of stimulation. Selection of psychopathology specific target area of rTMS needs to be studied further.

Keywords: Obsessive-compulsive disorder, repetitive transcranial magnetic stimulation, supplementary motor area

Prevalence and Patterns of Tobacco Use among Auto Rickshaw Drivers of Rohtak City

Vinay Kumar, Sunila, Sidharth Arya, Rajiv Gupta

Department of Psychiatry, PGIMS, Rohtak, Haryana, India. E-mail: drvinaypgimsrohtak@gmail.com

Introduction: India is the second largest consumer and third largest producer of tobacco. It accounted for five million deaths worldwide which are expected to raise over eight million deaths worldwide by 2030. According to Global Adult Tobacco Survey (GATS) 2016-2017 the prevalence of tobacco use is 28.6 percent. Studies among auto rickshaw drivers have shown prevalence of smoking to be 75.9% which is much higher compared to that of the general population. Understanding the pattern of smoking in higher prevalence group can give insights for further preventive strategies. Therefore, this study was undertaken to explore the prevalence and pattern of tobacco use among auto rickshaw drivers in Rohtak city.

Methodology: A cross-sectional study was conducted among 50 Auto Rickshaw Drivers in Rohtak City. They were asked to participate in the study. Auto drivers who were willing to participate in the study were included. The study tool was a semi structured questionnaire with questions regarding socio demographic profile of auto rickshaw drivers, tobacco use pattern, and knowledge about harmful effects of tobacco use. Appropriate statistics would be used to test for various significations and associations. Results: The results and implications of the study will be discussed.

Keywords: Tobacco, substance use, prevalence

Stigma and Substance Use Disorders: an Overview

Romil Saini, Udit Kumar Panda, Biswadip Chatterjee

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: saini.romil@gmail.com

Introduction: Substance use disorders (SUDs) are complex disorders associated with considerable harm both to the individuals and to the society as a whole. Stigma poses an important barrier for treatment seeking among substance users. As an attribute, it is deeply discrediting often leading to prejudice and active discrimination. There has been a dearth of research on drug use-related stigma compared to mental illness stigma.

Nature and Impact of Stigma Related to Substance Use Disorders: Public stigma towards individuals with SUDs is more compared to those with mental illness. They are often perceived to have some control over their illness, thus deserving more of punitive treatment. Stigmatizing attitudes include perceiving them as dangerous, unpredictable, unable to make decisions, to blame for their own conditions, willingness to coerce treatment, and maintaining a social distance. Thus, individuals are subjected to exclusion and discrimination. Professional attitudes also reinforce stigma and lowers the expectations of recovery. It also puts barriers in the way of recovery and reintegration. Overall, resulting in detrimental effects on psychological and social well-being among individuals who use drugs.

Interventions to Reduce Stigma Related to Substance Use Disorders: Evidence-based programs are needed that can reduce societal-level stigma toward those with SUDs. Various interventions can be facilitating the grassroots efforts like community programming, contact strategies, training and work force development, removing legislative and administrative restrictions, promoting the dignity of people in treatment and recovery thereby encouraging the respect for their rights as in other illnesses.

Conclusion: Tackling stigma related to SUDs has been a challenge in its self, owing to increased prevalence of SUDs over years. Society should look at itself to begin challenging its negative attitudes and barriers that can keep those with substance use disorders locked into their dysfunctional lifestyles. Thus, promoting recovery from SUDs go hand in hand with challenging stigma towards SUDs.

Keywords: Stigma, substance use, overview

Comparative Study of Early and Late Psychiatry Treatment Seekers among Patients With Bipolar Disorder-I

Anamika Sahu, Vaibhav Patil, Sumedha Purkayastha, Raman Deep Pattanayak, Rajesh Sagar

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: cpanamika159@gmail.com

Objective: Studies on pathways to mental health care are important from public and socio cultural perspective. Few Indian studies have focused on pathways to care of individual mental disorders especially common mental disorder including Bipolar disorder-I (BD-I). The present study was planned to describe and compare the socio-demographic, clinical profile and help-seeking behaviour among early and late treatment seeking patients with BD-I and their caregivers.

Methods: Sixty fourpatients with BD-I and their caregivers visiting the psychiatric outpatient clinic at a tertiary care hospital were assessed using a specially designed semi-structured questionnaire. Based on median time duration of first contact with psychiatric services (45 days), we divided sample in two groups i.e. early treatment seeker (n=32) and relatively late treatment seeker (n=32). Two groups were thereafter compared on socio-demographic profile, clinical profile and help seeking behaviours.

Results: Both groups were similar on socio-demographic variables except locality/residence (p= 0.01). Significant difference was not found in terms of age of onset (p=0.117), duration of illness (p=0.129), family history (p=1.00), awareness about psychiatric treatment at time of first contact (0.078) and intention to continue with faith-healing practices alongside psychiatric care (p=1.00). However, significant difference was observed in pathway of care between groups (p=.001), with late seekers being more likely to have their first contact with faith healers or general physician.

Conclusion: The early and late treatment seekers were largely similar in terms of socio-demographic and clinical characteristics. The late treatment seekers were more likely to have contacted faith healers and general physicians. Further study, focusing on patient's belief system and having a larger sample of chronic BD patients who sought help after a long period of delay, may provide useful insights.

Keywords: Bipolar disorder, help-seeking behaviour, pathways to care, treatment seeking

Relationship between Self-Esteem, Stress and Depression among College Students

Nabanita Barman

Lecturer, Regional Institute of Nursing, Guwahati, Assam, India. E-mail: nitubarman@yahoo.in

Background: Research shows that perceived stress and maladaptive stress management can lead to harmful outcomes including depression, morbidity, and mortality. College students have more difficulty dealing with stress, which can increase their susceptibility to engage in high risk behaviors.

Objectives: The objectives of the study were-

  • To assess self- esteem, stress and depression among college students
  • To find out the relationship among self-esteem, stress and depression.

Methods: A descriptive study was conducted among 50 students studying in a selected Government College of Guwahati city, Assam selected through purposive sampling. The tools used for data collection were socio-demographic Proforma, Rosenberg's Self-Esteem scale, Cohen's Perceived Stress Scale and Beck Depression Inventory.

Results: Most of the participants had low self- esteem (48%), moderate stress (48%) and moderate depression (38%). There was significant relationship between depression and stress (r=.766, p=.000). Meanwhile, there was a significant negative relationship between depression and self-esteem (r=-.745, p=.000) and between stress and self-esteem (r= -.673, p=.000).

Conclusion: This research suggests that addressing these factors may be important to prevent and reduce depression among college students. This study provides empirical evidence that there is a significant relationship among self-esteem, perceived stress and depression among college students.

Keywords: College students, depression, self-esteem, stress

Quality of Life of Elderly People Living in a Selected Old Age Home of Guwahati, Assam

Kalpana Nath

Lecturer, Guwahati Nursing College, Guwahati, Assam, India. E-mail: kalpananath84@gmail.com

Introduction: Aging is an inevitable developmental phenomenon bringing along a number of changes in the physical, psychological, hormonal and the social conditions. There are changes in the appearance, slowing down of functioning of the body organs, changes in day to day interest, attitude and life styles. Health problems begin to plague the elderly. These changes are expected to affect the quality of life of the elderly. India has around 100 million elderly at present. The number of elderly people is expected to increase up to 323 million, constituting 20% of the total population, by 2050.

Methodology: A cross-sectional descriptive study was undertaken to assess the quality of life among 30 numbers of elderly people living in a selected old age home of Guwahati, Assam, using a Standardized tool- Older People Quality of Life Questionnaire (OPQOL- 35).

Major Findings: Result of the study revealed that majority (85%) of the participants were female, majority (45%) were in the age group of 60-70 years, majority (45%) were illiterate, 80% were unemployed, half of the participants had no source of income and majority (60%) were widow. According to the participants' perception majority reported the rating of quality of life as alright. Assessing the quality of life of the participants majority was seen to have medium level of quality of life. area wise highest mean score was found in life 'overall', 'Home and neighbourhood' and 'leisure activities' and lowest mean score was found in 'financial circumstances.

Conclusion: Present study is limited only to a selected old age home of Assam. Further, studies can be taken up with larger sample.

Keywords: Elderly people, old age home, quality of life

Internet Addiction and Stress, Anxiety, Depression among Adolescents

Geeta Baishya

Lecturer, Regional College of Nursing, Guwahati, Assam, India. E-mail: geetabaishya1984@gmail.com

Background: Use of internet among adolescents has increased dramatically in recent years leading to pathological use or internet addiction for some and found to be associated with psychological problems like depression, anxiety, stress, loneliness among adolescents.

Aims: To find out the prevalence of internet addiction and its relation with stress, anxiety and depression among adolescents.

Methodology: Survey Design was adopted for the study selecting 50 adolescents purposively studying in class X of Maharishi Vidya Mandir, Kalipur, Guwahati, Assam following cosent of the school authority and adolescents as well. The data were collected by using a tool comprised of three parts - part-1, the socio demographic profile, part-2 IAT by Young and part-3, DASS by Dr. Kumbley. The data were analysed by using both descriptive and analytical statistics.

Results: Among the adolescents, 64% were male and 36% were female, 72% were from nuclear family and 28% were from joint family. 100% of the adolescents had exposure to internet use and 60% of them were using their personal mobile phone, 30 % were using other's for accessing internet. Regarding internet addiction, 22% of the adolescents were normal user, 44% were having mild level of internet addiction, 34% were having moderate level internet addiction. Correlation was calculated between internet addiction and depression, anxiety and stress separately. A positive correlation was found between internet addiction and depression, anxiety and stress with “r” value 0.854, 0.333 and 0.777 accordingly.

Conclusion: The study findings are similar with some other research findings. However, the findings of the study cannot be generalised as the study sample was very small and was conducted in one setting. Finally, similar studies can be carried out at large scale and some preventive and corrective measures can be developed for the adolescents in this regard.

Keywords: Adolescents, anxiety, depression, internet addiction, stress

Cross-Sectional Study to Evaluate Relationship between Depression and Anxiety in Patients With Chronic Headache

Navya Saluja

Junior Resident, PGIMS, Rohtak, Haryana, India. E-mail: navyasaluja@gmail.com

Introduction: Chronic daily headache refers to a group of disorders in which headache occurs 15 or more days per month for at least 3 months. Headache and psychiatric disorders have many links and parallels in their classification, diagnosis, comorbidity, mechanisms, and treatment. Depression and anxiety disorders are commonly associated with chronic headache.

Aim: The aim of this study was to assess the severity of symptoms of depression and anxiety in patients with chronic headache.

Materials and Methods: The study is a cross-sectional study conducted on 50 patients of chronic headache recruited from neurology department of PGIMS, Rohtak. Depression and anxiety was assessed using Hospital Anxiety and Depression Scale (HADS). Diagnosis of headache was based on international classification of headache disorder 3rd edition.

Results: Will be presented and discussec.

Keywords: Anxiety, backache, depression

Perception of Mental Illness and Healing Practices among Villagers in Gwalior District

Nikita Hazarika, Gargee Kanhere, Nandha Kumara Pujam

Department of Psychology, Amity University, Gwalior, Madhya Pradesh, India. E-mail: nikitahazarika12@gmail.com

Background: Mental illness is on rampant increase in India. Despite this, the resources for treatment and prevention are scarce. Therefore, individuals are easily drawn towards alternative traditional methods of healing. These practises have a long history of prevalence in India; however, their perception and application have rarely been documented systematically.

Objective: The present study aimed to understand the perception of mental illness, and various approaches to treatment, among rural population around the city of Gwalior, Madhya Pradesh.

Methods: A semi structured interview was conducted with 20 individuals that included villagers and faith healers. Sampling technique utilized for community members (n = 18) and faith healers (n = 2) were purposive sampling and snowball sampling, respectively. The sample was obtained from villages named Soni, Ganeshpura, and Maharajpura located around Gwalior. Phenomenology approach was applied, and the data was analysed through thematic analysis.

Findings: The community members consider mental health as important but the concept and management of it remain obscure. They identify mental illness using certain common signs and generalized notions. The villagers seem to be open to seeking treatment and the first choice includes seeing doctors in local dispensaries and aanganvadis. Failure in the former encourages the villagers to go for traditional healing practises which is considered a more reliable, reasonable, and easily accessible form of treatment.

Conclusion: The villagers consider mental illness as curable and are open to various methods of healing. They show inclination towards medical help but are partially aware about the treatment facilities specifically available catering to mental health. Despite their emerging beliefs in medical model, they are still rooted in traditional healing practises that have been prevalent across generations. A collaboration between traditional healers and the medical model can help sensitize the community members about mental illness and build better integrative models of treatment.

Keywords: Gwalior, mental illness, rural population, traditional healing

Impact of Cognitive Deficits on Quality of Life and Social Functioning in Schizophrenia

Sunaina Soni1, Suriya Prakash Muthukrishnan1, Mamta Sood2, Simran Kaur1, Nalin Mehta1, Ratna Sharma1*

1Department of Physiology, 2Department of Psychiatry, All India Institute of Medical Sciences, New Delhi. E-mail: ratnaaiims@gmail.com

Sunaina Soni1, Suriya Prakash Muthukrishnan1, Mamta Sood2, Simran Kaur1, Nalin Mehta1, Ratna Sharma1*

Background: Neurocognitive deficits are considered core component of schizophrenia and independent of clinical symptoms. Cognitive deficits explain functional outcomes better, such as work performance and independent living, than positive or negative symptoms. In the present study the aim was to study impact of cognitive deficits on quality of life and social functioning in schizophrenia.

Methods: Thirty-seven patients with schizophrenia (DSM-5) on medications were recruited for this cross-sectional study from a general hospital psychiatric unit of a public funded tertiary care medical school in North India. They were administered Scale for Assessment of Negative Symptoms (SANS), Scale for Assessment of Positive Symptoms (SAPS) (Andreasen et al, 1995), Schizophrenia Cognition Rating Scale (SCoRS) (Keefe et al, 2006) and World Health Organization Quality of Life Scale (WHOQOL-BREF) (WHO, 1996; Saxena et al, 1998). SCoRS ratings from three different sources (patient, informant, and interviewer) were correlated with quality of life ratings. The study was approved by Institution Ethics Committee.

Results: Patients with mean age-27.29 (5.98) years and mean duration of illness 3.7 (1.7) years had scores on SANS and SAPS as 66.51 (21.01) and 46.81 (19.84) respectively. SCoRS ratings from patients [40.95 (11.88)] were significantly different from interviewer [46.38 (12.48)], p=0.034. SCoRS ratings from patient, informant and interviewer were positively correlated with duration of illness [(r= 0.577, r= 0.504, r= 0.475), p< 0.05] and negatively correlated with scores on physical health domain [(r= -0.508, r= -0.395, r= -0.454), p< 0.05] and psychological health domain [(r= -0.376, r= -0.464, r= -0.342), p< 0.05] of WHOQOL-BREF.

Conclusion: Cognitive deficits increase with duration of illness but decrease with better physical and psychological health domains of quality of life.

Key words: Schizophrenia, cognitive deficits, quality of life

Psycholosocial Aspects of Blue Whale Challenge

Indira Sharma1, Abhijeet Dwivedi2

1Former Professor and Head Department of Psychiatry, IMS BHU, Varanasi. India, 2Consultant Psychiatrist, Positive Clinic, Tagore town Allahabad. Email: indira_06@rediffmail.com

Background: A petition in the Supreme Court has sought ban on the BLU Whale challenge and the Delhi High Court today sought the response of Facebook, Google and Yahoo on a plea to direct them to take down the links of Blue Whale challenge.

Aim: To study the psychosocial aspects of Blue Whale game in terms of: Who are the victims, why they attracted, what keeps them going, and what are the adverse mental health consequences.

Methodology: Articles and news items published in leading news papers, Times of India, Dainik Jagran and THE WEEK during the past 6 months etc. are reviewed

Findings: Blue Whale challenge is made accessible to vulnerable children, who are in depression, and receive invitation to join. Some children get attracted in the false hope that through the game their personal problems would be solved. Once the child gets hooked on to the game he does not leave it because of mixed feelings. Eg if I continue I will win and get what I want; if I back out my parents may be killed; or why should I leave it, I am not weak, I will face the challenge. There have been adverse consequences such as self harm, suicidal behavior, suicide.

Conclusion: Victims of Blue whale game have mental health problems which get worse by getting involved in the game. Further it compels the player to maintain secrecy

Key words: psychological aspects, children, articles

Prevalence of Internet Addiction and Its Correlation With Depression among Medical Students of Gauhati Medical College, Gauhati Medical College and Hospital

H. R. Phookun, S. Singh

Department of Psychiatry, Gauhati Medical College and Hospital, Guwahati, Assam, India. E-mail: dr.sanjaysingh46@gmail.com

Introduction: The use of the Internet has increased dramatically due to the development and spread of cheaper and more user-friendly computer technology and software. Despite its inherent benefits, the Internet is not without its problems, especially when its use becomes excessive. The Internet itself is mostly a harmless tool, but the overuse and incorrect use of it encourages the risk of addiction and psychiatric co-morbidity.

Aims: To assess the prevalence, pattern and factors influencing internet addiction and its correlation with depression.

Methodology: The study was carried out in 100 students of Gauhati Medical College, GMCH. IAT and DASS 21 was applied and a semi-structured interview was done to assess the socio-demographic variables.

Results: The study results showed the prevalence of internet addiction was 33% and depression was found in 58% clients and among those 16.7% having mild, 38.5% having moderate, 54.5% having severe and 88.9% of the clients having extreme severe depression were having internet addiction.

Conclusion: The study results show that most of the internet addicts were in the 24-26 years of age group though no significant relation was found between gender, domicile and educational level and internet addiction. A significant correlation was observed between internet addiction and depression (P value <0.001).

Keywords: Internet addiction, depression, medical students


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