|ABSTRACTS OF THE 26TH NATIONAL CONFERENCE OF IASP, BHUBANESHWAR
|Year : 2019 | Volume
| Issue : 4 | Page : 285-304
Free Papers (Oral Papers and Posters)
|Date of Web Publication||15-Nov-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Free Papers (Oral Papers and Posters). Indian J Soc Psychiatry 2019;35:285-304
| FP 1: Experimental study to assess the effect of multigrain panjiri dietary supplementation on haemoglobin level and body mass index in anorexia nervosa underweight women of Chhattisgarh|| |
PT. Ravi Shankar Shukla University, Raipur, Chhattisgarh, India. E-mail: [email protected]
Introduction: Anorexia Nervosa is an eating disorder characterized by refusal to maintain a healthy body weight & an obsessive fear of gaining weight. that is, it involves self-starvation. the body is denied that essential nutrients it needs to function normally, so it is forced to slow down all of its processes to consume energy. this slowing down can have serious medical consequences. it occurs mainly in young women from age of 15-24 and is defined as a loss of extreme weight through dieting. the person suffering from anorexia nervosa will eat very less, often actually making themselves sick after eating or use laxative in striving towards losing weight. Aims and Objectives: The aim of the present study was to assess the impact of soyamultigrain panjiri dietary supplementation on haemoglobin level and body mass index of anorexia nervosa underweight women. Methodology: 200 anorexia nervosa women between 19 to 25 years of age from Govt. Dr.BRAM hospital Raipur, Chhattisgarh were selected as sample. The inclusion criteria for selection of subjects was NIN classification for anaemia and WHO classification of BMI calculation. Cyanmethaemoglobin method was used for estimation of haemoglobin. There 80 women were found to be under anaemia. To fulfil the objectives of the study two groups were created with equal number of subjects in both the groups. The experimental group received dietary supplementation in the form of multigrain panjiri for three months while subjects belonging to control group were not supplemented the additional soya multigrain panjiri. Results: Results reveal that after the completion of study period more percentage of selected women from anorexia nervosa underweight women experimental group had normal haemoglobin levels as compared to their counterpart i.e. belonging to control group. Height and weight of these subjects with the help of standard procedures. After calculating BMI, The anorexia nervosa underweight women belonging to experimental group were supplemented with soya multigrain panjiri for a period of three months. The anthropometric parameter weight was again reassessed after three months. Pre-post test frequency distribution revealed that after supplementation 30% subjects from experimental group were classified into normal weight categories while only 5% subjects from control group were classified into normal weight category. Conclusion: It was concluded that addition of dietary supplementation in form of soya multigrain panjiri is an effective measure to enhance the nutritional status of anorexia nervosa underweight women.
Keywords: Anaemia, anorexia nervosa underweight women, BMI, cyanmet haemoglobin, multigrain panjiri
| FP 2: Stigma among patients with epilepsy|| |
Yogender Malik, S. K. Mattoo, Sandeep Grover, Parampreet Singh1
Departments of Psychiatry and1Neurology, PGIMER, Chandigarh, India. E-mail: yogendermalik187gmail.com
Background: Epilepsy is a chronic medical condition with significant psychosocial consequences including “stigma”. Although data is available from other parts of the globe, there is scant research on this social issue especially from India. Aim: To measure internalised stigma in patients with idiopathic epilepsy. Methods: 120 patients with idiopathic epilepsy were assessed on Internalized Stigma scale (Hindi version) and MINI Plus. Results: One-sixth (16.7%) of the patients scored above the cut-off for being labelled as having internalised stigma. Internalized Stigma was highest for the domain of resistance (70.8%), followed by the domains of stereotype endorsement (26.7%), social withdrawal (23.3%), alienation (20.8 %) and discrimination experience (19.2%). Internalised sigma towards epilepsy was higher among those with psychiatric co morbidity, compared to those without psychiatric co morbidity. Higher stigma was significantly correlated with lower socioeconomic status and poor educational profile and numbers of episodes in last 6 months. Presence of stigma as assessed by ISMIS scale (all the domains and total score) was associated with poor quality of life in all the domains. Conclusion: Higher Internalised stigma among patients with epilepsy is associated with psychiatric co morbidity and poor quality of life.
Keywords: Idiopathic epilepsy, stigma, psychiatric disorders
| FP 3: Perceived social support and psychological problems of spouses with alcohol dependence patients|| |
Narendra Kumar Singh, Nishant Goyal1
Departments of Psychiatric Social Work and1Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India.
E-mail: [email protected]
Introduction: Alcohol dependence has a significant impact on public health in India. Factors like perceived social support and psychological distress of spouses of alcohol addicted people may have implications on the course and outcome of illness. Aim and Objectives: This study aimed to examine the perceived social support and psychological problems of the spouses of the patients with alcohol dependence. Materials and Methods: It was a cross sectional, hospital based study and the sample was selected by purposively. This study included 200 spouses (100 spouses of the patients diagnosed with alcohol dependence syndrome as per ICD -10 and 100 spouses of the normal individuals). Social Support Questionnaire and General Health Questionnaire–28 were applied on all the participants (spouses) for the assessment of social support and psychological problems. Results and Conclusion: Spouses of the patients with alcohol dependence were having lower social support and more psychological problems as compared to spouses of the normal individuals.
Keywords: Alcohol dependence, social support and psychological distress
| FP 4: The effect of priming and extrinsic motivation on attention: Cognitive quasi-experimental study|| |
Santona Panda, Cathlyn Niranjana Bennett
Christ (Deemed to be) University, Bengaluru, Karnataka, India. E-mail: [email protected]
Introduction: Attention is a process of focusing on a stimulus which forms the basis of higher cognitive processing. In a study by Daniel Kahneman (1973) it was found that arousal and state of alertness is dependent on allocation policy which gives way to consider motivation as a variable. Another model by Anne Triesman (1960) focuses on characteristics such as physical properties, linguistic and semantic feature. Another closely linked concept to attention is priming which refers to a process where exposure to a prior stimulus influences the subsequent stimuli operation. Taking these two variables such as priming and extrinsic motivation, an experimental study is designed to study their effect on attention as well as to compare the performance and influence of each of the variable on the task. This gives a comparative analysis as to which of the two variables is favorable for attention. Aims and Objective: The aim of the study is to evaluate the influence of priming and extrinsic motivation (independently and together) on attention. Methodology: It is a quantitative study following an experimental setup. Using non probability sampling the sample were chosen from the population. The total sample size was 120 , participants were equally distributed among 4 groups with each group having 30 members .The four groups were No condition group, Only Priming group ,Only Extrinsic motivation group and Priming and Extrinsic motivation group. The experiment included self designed stimulus. The first stimuli includes a video for 3minutes that is used for the priming group and the second stimuli includes 16 pictures presented in a grid format with targets and distracters. All the stimuli were presented with the help of a computer. Results: Initially the normality test was carried out. The value being less than 0.05 and even after using log transformation not being able get the value over 0.05, non parametric test was used. In order to check for the association between the variable the non parametric version of ANOVA that is Kruskal Wallis H test was used. The results generated were discussed in accordance with the 8 hypothesis that were generated using the test on the variable. The distribution of Green Nature (Primed)items were different across all the group with a p value of 0.002 and upon carrying out the post Hoc test it was found out the primed group contributed to the difference thus leading to the acceptance of first hypothesis that is priming has an effect on attention. In case of the second hypothesis that is extrinsic motivation has an effect on attention gets rejected as the total distribution of item even though had a significant result of 0.006, the post hoc accounted this for the difference between Priming and Priming and extrinsic motivation group. And the scores else where in the hypothesis generated accounted the same as that of no condition group leading to the rejection of the hypothesis. Due to the same significant level of difference where distribution of items were different for different group with a p value of that of 0.006 accounted by the priming and extrinsic motivation group in the post Hoc analysis leads to the acceptance that the interaction between priming and extrinsic motivation has an impact on attention. Conclusion: Therefore priming has an effect on attention but extrinsic motivation alone does not contribute much to it. Whereas both priming and extrinsic motivation have a greater impact on attention. The implication of such findings could be used in classroom settings, treatment modification for ADHD and in neuromarketing.
Keywords: ADHD, attention, experimental study, extrinsic motivation, priming
| FP 5: Cognition in late life depression|| |
Saloni, A. Q. Jilani, A. Agrawal, S. B. Gupta, R. Sinha
Department of Psychiatry, Eras Lucknow Medical College, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
Introduction: Cognitive impairment may be part of aging as an independent phenomenon or may as a subset of depressive phenomenology in late life depression. These symptoms vary from deficits in executive function (problem solving, decision making, and judgment), memory, and attention to their daily activities. It has been seen that these deficits can occur before, during, or after a depressive episode and may serve in older adults as a precipitating factor to subsequent depression. These cognitive symptoms may persist for long time even after remission of depression; and the residual cognitive symptoms also act as a predictor of poor outcomes in depression. Hence, for complete functional recovery, cognitive impairment should be addressed. Realizing the importance of associated cognitive deficits, the present study aimed to explore the cognitive aspects of late life depression, as there is dearth of information regarding same from our country. Aim: To assess cognition in late life depression and evaluate the severity of depression, anxiety and cognitive score. Method: This is a cross-sectional, single point assessment study, including 40 patients aged >45 years, visiting outdoor of Era's Lucknow Medical College, Lucknow. The cases were having their first episode of depression after the age of 45 years as per criteria of DSM-V. HAM-D , HAM-A, and HMSE were applied to assess the severity of depression, anxiety and the cognitive score. Results and Conclusion: The results indicate the negative correlation between severity of depression and cognitive deficits.
Keywords: Cognition, depression, severity
| FP 6: Effective use of social media platforms for promotion of mental health awareness|| |
K. Latha, K. S. Meena, S. K. Chaturvedi, Madhuporna Dasgupta
Department of Mental Health Education, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]
Introduction: Use of social media has become a part of everyday life for over a large mass of the population. According to studies around 197 million people in India are active social media users. Social Media platforms are progressively developing as a rich source of mass communication. Increasing Mental Health awareness with the help of social media can be a good initiative to reach a large number of people in a short time frame. Aims and Objectives: To understand the usefulness of social media platforms to host mental health campaigns. Methodology: This qualitative study describes 3 series of social media campaigns in the field of mental health which were observed over a year with an objective of reaching more people through social media for effective information dissemination with respect to mental health: 1. The Buddies for Suicide Prevention was an online campaign to create awareness about suicide prevention. The campaign included-script writing, slogan writing, poster making and short films making. 2. The #Iquit tobacco was a 21 days campaign with an idea of tobacco cessation in the community. 3. #Migrainethepainfultruth was yet another campaign educating people the myths and facts about migraine. All the campaigns were conducted in two famous social media platforms commonly used by young adults. Results: The Facebook and Instagram posts with respect to all the campaigns brought about a considerable amount of reach to the targeted population. After the campaigns the page reached to around 10.3k people (Both fans and non-fans). Conclusion: Use of social media to conduct mental health campaigns is an effective initiative as one can reach out to a number of people in a short span of time. With the help of technology participants could virtually be a part of the campaign easily. There is an increasing trend in the awareness towards mental health with the effective use of digital media as a platform for disseminating information.
Keywords: Awareness, mental health campaign, social media
| FP 7: Acceptance and commitment therapy in hallucinations: A case report|| |
Archana Kashyap, Aarzoo Gupta, Ajeet Sidana
Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: [email protected]
Introduction: Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies. Traditional psychotherapies like Behavior therapy and cognitive behavior therapy have proved its role in dysfunction and delusions. In addition, there are therapies as adjunct interventions in psychosis with encouraging outcome. ACT using a relational framework theory, modifies the relationship with private experiences (hallucinations). Aims and Objectives: To study outcome of ACT in psychosis. The objective was diffusion of real auditory stimuli and hallucinations to reduce distress and improve functioning. Methodology: Index case was presented with chief complaints of auditory hallucinations with 9 years of duration of illness. The other features were depressive symptoms, rumination and significant occupational dysfunction. Clinical interview revealing significant distress, dissatisfaction and dysfunction due to hallucinations, in spite being compliant to pharmacotherapy. To address the plateau in response to treatment, psychotherapy (ACT) was planned. The pre-post case design was used to assess outcome on Brief psychiatric rating scale (BPRS), Acceptance and Action Questionnaire-revised (AAQ-R); and WHO (Five) Well Being Index. Therapeutic management aimed at social as well as occupational functioning and auditory hallucination through core ACT processes. The psychotherapy has been continued for last 7 months and currently termination is in progress. Results: There has been significant improvement in level of functioning and decreased distress related to hallucinations as well as side-effects in 14 sessions, where 12 weekly sessions and 2 booster sessions have been taken. Conclusion: The case reports highlight role of diffusion and acceptance, as core ACT processes in bringing the outcome of using ACT in patients with hallucination. ACT might be useful in patients reporting auditory hallucinations in psychotic illnesses.
Keywords: Acceptance and commitment therapy, hallucination, psychosis
| FP 8: Perceived stigma in female opioid users and their family members: A cross sectional comparative study|| |
Verma Kamini, Mandal Piyali, Mongia Monica, Ambekar Atul
Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]
Introduction: Stigma associated with substance use poses considerable burden on the patient as well as family members, more so in female substance users. Experience of the same prejudice and discrimination as the stigmatised individual leads to psychological distress and diminished quality of life of caregivers which may further hinder treatment seeking. Aims and Objectives: To compare Perceived stigma in female opioid dependent patientsand their husbandsand also to measure Affiliate stigma among husbands of women seeking treatment for opioid use disorder. Methodology: This is a cross sectional, comparative, observational study. Sample consisted of 40 (20 in each group) female opioid dependent patients(as per ICD10) seeking treatment at a tertiary addiction treatment centre and their husbands. After applying exclusion and inclusion criteria participants were assessed using a semi-structured questionnaire (Socio-demographic), perceived stigma of substance abuse scale (PSAS) Affiliate stigma scale (ASS). Results: Nine females( 45%) were primarily using inj. pentazocine followed by smack and tablet tramadol. Mean duration of opioid use was 5.75 ±4.09 years. The perceived stigma of substance use was higher in the husbands as compared to the female users (3.48 ± 0.36 vs 3.762± 0.28, p=0.01). No significant correlation was observed between any of socio-demographic variables (age, years of schooling) and the perceived stigma in both the groups (p>0.05)The affiliate stigma measured in husbands of women susbatnce user was 72.82 ±8.0, which is very high ( maximum score on ASS is88). Conclusion: This finding contributes to better understanding of increased stigmatization in female substance using population and specially from their close ties like husbands which leads to delay in treatment seeking and underscores the need for involving family members in treatment.
Keywords: Family member, opioid use, stigma, women
| FP 9: Effect of a mindfulness based intervention on stress and mindfulness among primary caregivers of patients with alcohol dependence syndrome|| |
Ambily Joy, Renju Sussan Baby, N. A. Sheela Shenai
M.O.S.C College of Nursing, Kolenchery, India.
E-mail: [email protected]
Introduction: Alcoholism is considered as an ongoing stressor, not only for the individual, but also for the familymembers and affects their physical, emotional, psychological and social wellbeing. Alcohol abuse isassociated with an increased risk of committing criminal offences against family members includingdomestic violence, marital conflict, divorce, assault, child neglect and abuse etc. Majority of wives of patients with alcohol dependence syndrome had severe psychological (33.3%) and social (46.4%) problems. Mindfulness based intervention is one of the relaxation techniques that has found to beeffective in improving physical health and overall mental health by reducing stress, decreasing anxietyand depression. Methods: Research approach- quantitative research approach Research design-pre experimental with one group pretestpost test design Settings-inpatient unit of MMM de-addition centre, Kolenchery Population- primary caregivers of patients with ADSSample and sampling technique -36 subjects and total enumerative sampling method. Tool-socio demographic performa, was developed by researcher, perceived stress scale by cohenetal,five-facet mindfulness questionnaire by baeretal. Results: Out of 83.3% of subjects were experiencing moderate stress and 16.7% of subjects were experiencinghigh stress before the intervention. There was significant reduction in the mean pss score (md= 7.5) aftermindfulness based intervention. There was significant reduction in the level of stress among the subjectsafter mindfulness based intervention (t=- 13.74 p=0.001). There was significant increase in the meanmindfulness score (md= -28.2) after mindfulness based intervention. There was significant improvementin the mindfulness among the subjects after mindfulness based intervention (t=-11.08 p=0.001). Nosignificant correlation was found between stress and mindfulness (r= -0.001 p=0.9). Conclusion: Mindful based intervention significantly stronger reductions of perceived stress and vitalexhaustion and stronger elevations of positive affect, quality of life,as well as mindfulness.
Keywords: Alcohol dependence syndrome, caregivers, mindfulness
| FP 10: Socio-demographic and clinical profile of patients of relapse in substance use disorder seeking treatment-a hospital based study|| |
Sasanka Kumar Kakati
Gauhati Medical College and Hospital, Guwahati, Assam, India. E-mail: [email protected]
Introduction: Substance use disorders are chronic, relapsing disorders, which affect various aspects of physical, psychological and socio-occupational functioning. Relapse is defined as there occurrence, upondisc ontinuation of an effective medical treatment,of the original condition from which the patient suffered. The changes in substance used is orders are seen interms of availability, choice of psychoactive drugusers, and their socio-demographic characteristics. Aims and Objectives: Toaccessthesocio-demographic variables in patients of substanceuse disorders who have relapsed. Methodology: This study has been conducted in the department of psychiatry, Gauhati Medical College and Hospital, Guwahati.The time period of the study extended from 1st July 2018 to 30th June 2019. The study has been approved by the Institutional Ethics Committee of Sankardeva University, Guwahati. The sample size was 50. Results: In the present study, majority of the subjects were in the age group of 21- 30 years (34%), and 31-40 years (34%). We also found that majority (84%) of relapse patients were males and, 78% had low level of education. The sample was mostly from the Urban background and 68% were Hindus. Around 70% were single. Conclusion: The present study analyses the socio-demographic variables of patients, which can help us find those who are more vulnerable to relapse in substance use disorders.
Keywords: Relapse, substance use disorders
| FP 11: “An ode to scarred faces”: A qualitative study to explore the experiences of female acid attack survivors living with facial disability working in a selected NGO of Delhi|| |
Delhi University, New Delhi, India.
E-mail: [email protected]
Introduction: Having your face disfigured and burned in a matter of seconds is not what any women has in mind as a consequence when they refuse to go on a date with a man. It exerts traumatic effects on lives of women regardless of their culture, religion, socio-political background or country. Aims and Objectives: The purpose of the study is to investigate how acid attack survivors view their lives after having facial disability and to address the socio -cultural taboos associated with facial disability. Methodology: Research approach - qualitative approach, Research design - phenomenological design, Setting- selected NGO, population - female acid attack survivors with facial disability, Sample - female acid attack survivors who are in collaboration with a selected NGO, Sampling technique - purposive sampling, Sample size - till data saturation is achieved, Data collection tool- in depth interview guide, Data analysis- thematic analysis. Results: The scars left by acid may seems to be mainly physical in nature however, the trauma, disabilities and disfigurements that they cause may also result in negative psychological consequences (i.e. psychological breakdowns, identity crisis, anxiety, depression, post-traumatic stress disorders), stigma and rejection from the community and society. However, there is no adequate planning by government to reduce the problems of victims. The female acid attack survivors living with facial disability have to lose their jobs and to face discrimination in society. Mostly unmarried females remained bachelors. Conclusion: On the basis of predicted results it was recommended that government should improve in police and the legal system to control such incidents. Change should begin at home to encourage such females to live a routine life, media should play its effective role to educate the society about their behavior with such females, and government should develop adequate health care centers for free treatment and the trails should be speedy and heavy punishment will be given to the criminals to reduce the rate of such incidents in society.
Keywords: Acid attack, discrimination, facial disability, trauma
| FP 12: A clinical study to assess the personality profiles in patients of substance use disorder|| |
Department of Psychiatry, Gauhati Medical College, Guwahati, Assam, India. E-mail: [email protected]
Introduction: It has been seen that personality of individuals has a direct relationship with their substance abuse behaviour so that it influences and predisposes them into falling a prey to the vicious habit of substance abuse from which escape becomes utterly difficult. Since there is a dearth of adequate number of works to study the personality profiles of such individuals of substance use disorder, more so in this part of the country, it was found apt to carry out a study in this regard. Aims and Objectives: To study the socio-demographic profile of patients diagnosed with substance use disorder, to assess the personality profile of patients with substance use disorder and to study the relationship of various substances of abuse with the socio-demographic variables of the patients. Methodology: Study period: September, 2018 to august, 2019, study type: cross-sectional, sample size: 80, tools used: semi-structured proforma for socio-demographic profile of participants, icd-10, 6pf questionnaire (form a). Statistical Analysis: Descriptive and inferential statistics. Ethical clearance was obtained from the Institutional Ethics Committee. Results: In the study sample of 80 patients, more participants scored highly for Factors A, B, E, F, H, I, L, M, N, O, Q1, Q2, Q3 and Q4 whereas for Factor G, low scores were obtained. Significance was found between all parameters of socio-demographic data that were included in the semi-structured proforma with substance use behavior except for the parameter, family history of psychiatric illness. Conclusion: The study provides an interesting insight into the personality profiles of substance use disorder patients which may be applied into creating more wholesome approaches into the treatment of such individuals.
Keywords: 16 PF, personality, substance use disorders
| FP 13: Short term impact on knowledge, attitude, and practice in mental health and substanceuse disorder among general practitioners enrolled in nimhans digital academy fromodisha|| |
Prashant Sahu, Sumit Kumar Durgoji, G. Aurobind, Prabhat Chand, Pratima Murthy
E-mail: [email protected]
Background: There is a significant treatment gap for mental health and substance use disorders. Odisha has a population of 41974218, and estimated psychiatric disorders of 2800000, for which there are only 25 psychiatrists (including private) (Murthy et al., 2016). There is thus an urgent need to build capacity to bridge the treatment gap. A technology-enabled training was initiated by NIMHANS Digital Academy between Mid-January- Mid April 2019. Forty-seven Government Medical Officers from various underserved areas of Odisha State joined in the Hub and spokes model through a simple multipoint video conference facility. It consists of 10 hours of synchronous (live) session with a brief didactic along with 20 hrs of self-paced asynchronous (e-learning). The doctors presented their cases during live sessions and asked their peers as well as NIMHANS hub expert about the best-practices of management. There is an approved curriculum that was followed during the training. Methodology: The five-level outcomes model1 focusing on principles of participant engagement, satisfaction, learning, competence and performance, was used for evaluation of the outcome of the training. Results: Over a period of three months, 22 case summaries were discussed by the doctors with NIMHANS Hub Specialists. Majority of doctors could join >80% live session and overall there were no drop-outs. There was a significant improvement in self-confidence among the doctors in handling mental illnesses after the course (pre training mean 5.5/10 Vs post training mean 7.4/10). The program helped to reach to 2452 people in Odisha who required interventions for mental health (which included Psychosis, Depression, Anxiety disorder, Alcohol use disorder). Conclusion: The results suggest that this digital training programme can be a useful tool to improve capacity of mental health care especially in the rural and unserved areas of Odisha. This model of learning can potentially be applied in other states of the country as well. The challenge will be the retention and motivation of the doctors to continue engaging in learning process.
Keywords: General practitioners, knowledge, training
| FP 14: “When the old is no longer golden!” The prevalence, correlates and victimperspectivesof elder-abuse, a mixed-method study from southern India|| |
Debanjan Banerjee, Migita D. Cruza, P. T. Sivakumar, Mathew Varghese
Department of Psychiatry, Geriatric Psychiatry Unit, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]
Background: Elder abuse is defined as single or repeated acts of omission or commission causing harm ordistress to the elderly, usually by a trusted person. It can range from physical to psychological,social or even be sexual. Despite multiple highlights in literature and consistent concerns raisedby the World Health Organization (WHO), only the 'tip of iceberg' comes to detection andelder abuse stays as a 'silent-evil' in old-age homes, residence and hospitals alike, neglected inthe daily clinical practice. For developing nations like India with increasing aged populationand familial dependency, such a social issue can assume paramount significance. Methodology: All geriatric patients (above 60 years) attending a tertiary mental-health care centre in SouthIndia in the last six months were screened for any form of elder abuse. It was best corroboratedwith a reliable informant. The socio-demographic and clinical correlates of abuse wereexplored. The elderly who suffered 'abuse' were interviewed with consent and thematicanalysis of the data was performed. Ethical considerations and confidentiality were maintained.Necessary actions within the clinical and legal per-view were taken. Results: Total 642 patients were screened. 30% reported some form of abuse. Male and females wereequal in the reported cases. Psychological/emotional followed by physical, abandonment andfinancial were the most common forms. 'In-residence abandonment' was widely prevalent.Low education, low financial security, retirement and loss/lack of spouse were significantlyassociated with abuse. The perpetrators of abuse were mainly the first-degree relatives and staffof the residential old-age care facilities. Diagnoses most commonly associated with abuse weredementia, depression, sensory deficits and gait difficulties. Weight loss, multiple-stagedinjuries, over-use of analgesics, lack of cleanliness and frequent falls were the early signs.Passive death wishes, helplessness, grief and refusal to disclosure were widely prevalent amongthe victims. Spirituality, time with grand-children and same-age group-activities were the maincoping factors. The reasons attributed to abuse by the victims were 'Karma', 'old age', 'lackof usefulness', 'loss of autonomy', 'fear of consequences', 'lack of awareness of legalprovisions' and 'significant stigma related to disclosure'. Conclusion: Elderly population has a wide range of vulnerabilities; however, they also add to the globalhealth of the population. Abuse in any form affects all dimensions of 'health'. Preventing it isan important strategy to rebuild the respect of the elderly, helping them to counter frailty andimproving the quality of life. Failure to detect and address this important issue can perpetuatethe abuse further: both the victims and perpetrators staying unaware of its implications. Regularscreening, awareness, psychoeducation, appropriate medical and psychological aids as well asnecessary liaison with the media and legal services are necessary to battle this incessant evil.
Keywords: Abuse, elder, geriatric, stigma
| FP 15: Diagnostic and therapeutic challenges in a patient with dissociative aphonia with epilepsy versus psychogenic nonepileptic seizures|| |
Jaswant, Ashish Pakhre, Koushik Sinha Deb, R. K. Chadda, Renu Sharma
Department of Psychiatry, All India Institute of Medical sciences, New Delhi, India
Introduction: Patients presenting with speech loss can pose difficulties in accurate diagnosis. Complex presentation with mixed picture of neurological and psychogenic causation and clinical symptomatology becomes more challenging. Psychogenic nonepileptic seizures (PNES) at times are similar to epileptic seizures in presentation. There is no single feature that absolutely distinguishes true epileptic events from PNES. So, there is considerable diagnostic uncertainty for the condition. It is important to distinguish true epileptic events from psychogenic nonepileptic seizures (PNES) and to address challenges and issues in assessment and management of long standing aphonia. Case Description: In our OPD, 18-year-old unmarried female presented with loss of speech and weakness in bilateral lower limbs for 3 ½ years having no identifiable organic cause upon evaluation. In view of diagnostic clarification and difficulty in management on OPD basis patient was admitted. After admission, ENT and Neurology consultations were sought and organicity was ruled out after detailed evaluation by respective teams. Both EEG and MRI were done. Psychological assessment was done and psychotherapy was started. Drug-assisted interviews using intravenous Lorazepam and dexmedetomidine was done. Gradually there was significant improvement in aphonia and reduction other clinical complaints. Literature review was done by going through previous studies using PubMed, Google Scholar and PsycINFO regarding assessment and management of dissociative disorders. Conclusion: It is important to thoroughly assess and diagnose evaluate such complex cases with dissociative as well as neurological disorder. Because diagnosis is difficult and challenging and many times stressors become difficult to elicit. Long standing dissociative disorders are refractory to treatment. So, early assessment and treatment is important. This case illustrates the atypical presentation, diagnostic and management difficulty in the patient.
Keywords: Dissociative aphonia, epilepsy and psychogenic nonepileptic seizures, psychogenic aphonia
| FP 16: Stigmatization in paranoid schizophrenia: A qualitatve analysis|| |
Sanimar Kochhar, U. K. Sinha1
AIIMS, New Delhi,1Department of Clinical Psychology, IHBAS, Delhi, India. E-mail: [email protected]
Introduction: Schizophrenia is a severe mental illness which is very prevalent and disabling worldwide. Individuals so labelled are often seen as constituting a stereotyped and devalued identity. These negative attitudes may cause discrimination and internalization of stigma. Thus, stigmatization and the reactions to it make up an important area of inquiry. Objectives: to explore and understand the nature of stigma faced by persons with paranoid schizophrenia, their reaction to it and its relationship with the illness. Methods: A purposive sample of 16 patients was recruited from IHBAS OPD from May 2016 to July 2016. A semi-structured interview was utilized. Thematic analysis was carried out on the interview transcripts. Results: Revealed core themes of close to nil understanding of the illness and diagnosis, insensitivity on the part of others, some extreme instances of stigma and bad behaviour meted out, being wary of disclosing the illness, internalized stigma, varied perspectives on mental illness versus diabetes; and perceptions of an uncertain future. Conclusion: the patients perceive and experience a high level of stigma; and their narratives reflect authentic and moving accounts of stigmatization as well as their efforts to cope. Efforts towards de-stigmatization, rehabilitation and ultimate recovery need to take note of these findings.
Keywords: Discrimination, Indian, qualitative, schizophrenia, stigma
| FP 17: Acceptance and commitment therapy in obsessive compulsive disor: A case report|| |
Aarzoo, Archana Kashyap, Ajeet Sidana
Department of Psychiatry, Government Medical College and Hospital (GMCH-32), Chandigarh, India. E-mail: [email protected]
Background: Obsessive compulsive disorder (OCD) can be extremely disabling, with fluctuation in course as well as symptoms of the illness. Evidence-based practices like behavior therapy (BT) and cognitive behavior (CBT) have been widely used. There has been research highlighting the effectiveness of ACT in various psychiatry disorders. Meta-analysis reveal ACT to be equivalent or superior to CBT in OCD. With this background ACT was attempted with the index patient after failure in attempt to address the symptoms using BT. Methodology: B, 36 years old 12th pass housewife from a urban nuclear family presented complaining repetitive intrusive thoughts and images of blood-stained skirt, distorted face, dirty feet etc; and repetitive washing of hands and feet, mental rituals like replacing obsessions with images or thoughts of God or flower. This resulted in reduction of anxiety. The duration of illness was 20 years with acute onset and continuous course. History of alcohol dependence in father, sexual abuse, bed wetting, molestation by group of school boys, failure in school. Interpersonal conflicts with husband were reported due to his daily/heavy alcohol intake. Results: Seventeen sessions of ACT have been taken in last one an half years. She has been responding well to treatment. Except that regression in improvement is triggered by IPR with husband. The reduction in scores on Yale-Brown Obsessive Compulsive Scale (YBOCS) was from 33 (severe) to 20 (mild). Conclusion: ACT was useful in dealing with not only OCD but also underlying issues. ACT was effective and convenient in addressing all issues simultaneously. ACT might be useful in addressing fluctuating symptoms or themes of obsessions of compulsions in OCD and in patients where exposure is not feasible.
Keywords: Acceptance and commitment therapy, obsessive compulsive disorder
| FP 18: Mindful eating intervention on blood glucose, BMI and stress among adults with type2 diabetes mellitus|| |
V. V. Mahalingam, Amrita S. Shekhar1, J. Mano Ranjini1
AIIMS, Bhubaneswar, Odisha,1Himalayan College of Nursing, SRHU, Dehradun, Uttarakhand, India. E-mail: [email protected], [email protected]
Introduction: Health is a state of functional or metabolic efficiency of a living organism. Todaydiabetes is considered to be a major health problem in India. It is a chronic progressive disease of anepidemiological character, causing consideration human as well as social and economical distress. Objectives of the study were to measure the effectiveness of mindful eating on the glycemic control, BMI and to assess the effectiveness of mindful eating on stress. Materials and Methods: A randomized control research design was used for study to measure theeffectiveness of mindful eating on blood sugar level, BMI and stress. The study was conducted in amultispecialty Hospital. Simple random sampling was used to select 70 patients from thepopulation and randomly assigned 35 in experimental and 35 control group who were diagnosedwith type 2 diabetes since (0-5) year, taking oral hypoglycemic drug, routinely attending OPD andmeasuring their random blood sugar. Routine laboratory test was used to measure the Blood glucoselevel, for defining BMI all the related physiological parameters have been measured. Questionnaireon Stress in Patients with Diabetes – Revised (QSD-R) was used to measure the stress. Results: The study findings illustrated that in baseline the random blood sugar score was higher inboth experimental and control group but after a two month of mindful eating intervention the meanrandom blood sugar score was significantly reduced in experimental group at the significant levelP=0.05. In baseline the BMI score was higher in both experimental and control group but after atwo month of mindful eating the BMI mean score significantly reduced in experimental group at thesignificant level P=0.05. In baseline the stress on diabetes (leisure time, depression/future fear andhypoglycemia, self-medication, physical complaints, work, partner, doctor patient relationship)related stress score higher in pretest and after a two month of mindful eating the stress mean scorewas significantly reduced in experimental group at the significant level P=0.05. Conclusion: Mindful eating program will be help in reduction of blood sugar level, weight management and improvement in psychological aspect (stress) of diabetes patients.
Keywords: Adult with types 2 diabetes mellitus, blood glucose, bmi, mindful eating, stress
| FP 19: Sleep hygiene in patients with current depressive episode|| |
Abhinav Shekhar, Shantanu Bharti, Ajay Kohli, Anju Agarwal, Abdul Qadir Jilani
Department of Psychiatry, Eras Lucknow Medical College, Lucknow, Uttar Pradesh, India. E-mail: [email protected]
Background: Patient presenting with a depressive episode generally also present with disturbed sleep. It is also one of the most common complaints in patients presenting with depression. It is clinically important to evaluate the presence of sleep hygiene in the patients of depression suffering from comorbid insomnia. Knowledge about the association of sleep hygiene in patients of depression suffering from comorbid insomnia will help in their better management. Objective: To evaluatethe association of sleep hygiene in patients of depression suffering from comorbid insomnia. Methods: In this cross sectional study, we had recruited 105 patients with current depressive episode. MINI international neuropsychiatric interview was applied to rule out other psychiatric disorders. BDI II was applied to make a diagnosis of current depressive episode and subsequently SHPS (sleep hygiene practice scale) was applied to assess the sleep hygiene in these patients. Correlation was examined using chi-square (x^2) test. A two-sided (a = 2) p <0.05 was considered statistically significant. Software's MS-Excel and SPSS latest version were used for analysis. Results and Conclusion: The result of this study indicates that the patients of current depressive episode have abnormal sleep hygiene. The overall result of this study also indicates that the patients of depression score high in SHPS scale, and the score is significantly higher in sub scales of arousal related behaviour and sleep environment. The direct effects of sleep hygiene on depression and subjective well-being are noteworthy; perhaps the achievement of maintaining good, regular sleep hygiene behaviors produces satisfaction that improves well-being and buffers depressive symptoms
Keywords: Depressive episode, sleep hygiene
| FP 20: Impact of motivational enhancement therapy in medical students having internet use disorder|| |
SCBMCH, Cuttack, Odisha, India. E-mail: [email protected]
Introduction: Internet addiction is a behavioural addiction & along with it is the most modern form of addiction. Aims and Objectives: To study the impact of motivational enhancement therapy in medical students having internet use disorder. Methodology: This study was conducted among the medical students of S.C.B.M.C.H. Odisha. The study sample consisted of 250 medical students of the college. Subjects were selected through the purposive sampling method for initial assessment and allocation of samples for intervention selected by random table generated by computer. Semi structured proforma containing socio-demographic details and internet use details,Internet addiction test (Young,1998), SAS-SV(Kwon, Kim et al,2013),GHQ 28 were used.motivational enhancement therapy (MET) was used for intervention. Statistical analyses were performed using SPSS Statistics software 16 and a significance level of 0.05 was adopted throughout. Results: After analysis of data, MET was effective in decreasing internet addiction scores and distress levels among the subjects. Conclusion: MET can be very useful for internet addiction though further research exploring the other aspects and long term follow up studies should be planned for better planning of the management of internet addiction.
Keywords: Internet addiction, medical students, motivation enhancement therapy
| FP 21: Online dating apps sabotaging the mental health: Two case reports|| |
Roshni Basu Roy
Gauhati Medical College, Guwahati, Assam, India. E-mail: [email protected]
Introduction: Online dating services changed the landscape of dating in India since its inception. Although it has paved the way for easier access and communication between potential partners, but it has its own negative impact specially on mental health which is reflected in the following case studies. Case 1: A 27 years old unmarried woman of urban backround working as a banker came to Psychiatry OPD with chief complaint of low mood, feeling of emptynessinside, not being able to emotionally connect with anyone. Premobidly she was reserved and never got much attention from the opposite sex. 2 years ago she started using a dating app named TINDER, which gave her much attention but she could feel that those sweet spoken words, compliments and feelings, shown by the person across the screen are mostly not real. She went to a few dates also but stopped contacting after the initial few days as she harboured the insecurity that she may be rejected soon as there many options available on the app in just one click.But however she somewhat got addicted to using the app,which ultimately resulted into loneliness, not being able to get involved in a real life romantic relationship thinking that person may also be putting a charade on. Case 2: A 29 year old central govt employee came to Psychiatry OPD with complaint of low self esteem and insecurity about own body image.On further probing he mentioned about joining tinder app about 11 months ago where he faced numerous rejections daily with the left swiping and stream of short lasting conversation soon fizzling out, which left him feel dejected, with body confidence problem and feeling of worthlessness because of the constant unhealthy competition. Discussion: The repercussions of online dating services are noteworthy with the most common problems faced by users being regular rejection ,sudden ghosting of the partner causing low self esteem in the user .According to a study conducted in University of North Texas it was found that men are at more risk for reduced self esteem while using these services. The constant need to look good and appear attractive to others creates a unnecessary burden on the users. Studies have found out that these issues are also hampering the peace of minds of the user of other social medias that encourages evaluative behavior. Other demoralizing experiences by the users are anonymity or fake accounts resulting into deceit and chronic dissatisfaction and not trying to make a particular connection work owing to the tyranny of choices available on the site. Several studies have shown high rates of sexual addiction and psychiatric comorbidities in the online dating app users like depression and anxiety, social anxiety, dysthymia, ADHD and PTSD. It is ambiguous whether the excessive usage of online dating apps which can be considered under behavioral addiction root from faulty way of coping with depression or anxiety or whether depression and anxiety are the aftermath of this type of behavioral addiction. Conclusion: Dating apps have opened the door for people seeking new connections and friendship and can be really useful for introvert and lonely people. But these apps come with its shadow side which may be harmful for the mental health of the users.
Keywords: Addiction, online dating apps, psychiatric morbidity
| FP 22: Training of primary care physicians in the assessment and management of perinatal mental health disorders including psycho social factors|| |
Madhuri H. Nanjundaswamy
NIMHANS, Bengaluru, Karnataka, India.
E-mail: [email protected]
Introduction: Primary care physicians and obstetricians/gynaecologists are the first line responders for women with perinatal mental health problems. Hence, training becomes important in this particular topic. Aims and Objectives: To understand the pre-existing knowledge of perinatal mental health among the primary care physicians and to analyse the effectiveness of the short-term training program that focussed on assessment, management of perinatal mental health issues. Methodology: A two-day training program was conducted for primary care physicians at Raipur, Chhattisgarh focusing on clinical assessment and management of perinatal mental health conditions including psychosocial risk factors. Diverse teaching-learning methods for adult learning like participative learning, small group activities, use of audio-visuals were used. The pre-assessment form included questions on details of the clinical practice, psychosocial risk factors, screening, management and referral pathways for mental illness. The feedback form included questions on the relevance of the topic, time allocated for training, confidence levels in assessing and managing cases in the clinical setting. Results: Of the 44 doctors who attended, pre-assessment and feedback data were available for 36 and 33 participants, respectively. Participants reported that they regularly have diagnosed, managed or have referred women with perinatal mental health in their practice. Usually, physicians had assessed for anxiety, depression, psychosis and suicidality. More than half the doctors (N=21;58.33%) reported that they had assessed for psychosocial risk factors and the main factors were financial issues, support system, violence, substance use. The confidence of physicians in treating psychiatric conditions was assessed at pre and also at post-training. 4 out of 36 doctors (11.1%) were very confident, 5 (13.9%) were quite confident, 17 (47.2 %) were somewhat confident, and 10 (27.8%) were not confident in treating mental illness during the perinatal period. However, after undergoing the training program, 19 out 33 (57.6%) were very confident, 13 (39.4%) were somewhat confident and 1(3%) not confident in assessing mental health issues. Regarding management of mental health issues, 17 (51.5%) were very confident, 15 (45.5%) were somewhat confident and 1 (3%) was not confident. Conclusions: The findings from our study suggest that a training program can help increase the confidence among physicians in approaching patients with perinatal mental health issues.
Keywords: Mental health, perinatal, physicians, training
| FP 23: A case report of injectable pheniramine dependence in a young male with psychiatric co-morbidity|| |
Manmeet Kaur, Ashish Pakhre, Anju Dhawan
National Drug Dependence Treatment Centre, AIIMS, Ghaziabad, India. E-mail: [email protected]
Introduction: Prescription drug abuse is a major problem worldwide. Several of the antihistamines like Pheniramine are included in Schedule G. Pheniramine is frequently prescribed for allergic conditions. However, its abuse liability and toxicity has been described in few case reports. The available literature mostly describes use of pheniramine in tablet form resulting in toxicity symptoms and in patients with pre-existing psychiatric illness or with other substances of abuse. Case: In the current case, injectable pheniramine with dexamethasone was used intravenously initially for dermatological condition and within a few months progressed to regular use of pheniramine only, primarily to elevate mood and occasionally to increase confidence resulting in developing tolerance to some of its pharmacological effects, developing complications of injecting drug use and experiencing withdrawal on discontinuation with predominant anxiety symptoms with treatment seeking within a year of use in a dependent manner. Also, patient was diagnosed with social phobia. Conclusion: The current report highlights the addiction potential of pheniramine, which can be attributed to its euphoric effect and its management. Further report emphasizes the need of judicious use of injectable antihistamines especially in populations at high risk including with those having psychiatric co-morbidity.
Keywords: Injecting drug abuse, pheniramine dependence, social phobia
| FP 24: Atypical psychological presentations of autoimmune diseases: rational approach, appropriate referral and collaborative management|| |
Sucheta Chatterjee, G. Akhila, Shivani Dua, M. Anupam, P. V. R. Pratheek, J. P. R Ravan, Prasanta Padhan
Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India. E-mail: [email protected]
Introduction: Understanding immune system interactions with CNS is crucial in maintaining homeostasis and development of various neuropsychiatric manifestations. In turn, CNS can influence both immune system and the HPA axis causing various physical and psychiatric symptoms. Aim and Objectives: To identify red flag clinical signs and appropriate screening tests for possible underlying systemic auto-immune disorders in psychiatric practice. Methodology: We have considered 20 cases who were not responding to adequate dose of antidepressants. They were screened for comorbid medical conditions and 5 cases were found to have autoimmune disorders. Conclusion: It is important to consider autoimmune disorders in treatment refractory depression
| FP 25: A cross-sectional analysis of correlates of quality of life in medically unexplained physical symptoms|| |
Sharmi Bascarane, Vikas Menon
Department of Psychiatry, JIPMER, Puducherry, India. E-mail: [email protected]
Introduction: Medically unexplained physical symptoms (MUPS) are common in medical settings as well as in the general population. They are associated with psychiatric morbidity, impaired quality of life and poor functioning. Aims and Objectives: In this study we aimed to assess factors associated with quality of life in individuals diagnosed with MUPS. Methodology: Participants were adults with medically unexplained physical symptoms (MUPS) (n=171), diagnosed using standard criteria. Apart from socio-demographic variables, we systematically assessed psychological distress, co-morbidity, disability, coping, personality traits and social support in this group using standard measures. Multivariate linear regression was used to identify predictors of quality of life in MUPS. Results: The mean age of sample was 38.8(±11.2). Majority of the sample comprised of females (n=102, 59.6%). High levels of psychological distress (B= -0.572, 95% CI = -0.913 to -0.230, p=0.001) and high neuroticism (B= -1.891, 95% CI = -3.263 to -0.519, p=0.007) were associated with poorer quality of life scores. Among demographic variables, those hailing from a nuclear family (B= -3.880, 95% CI = -7.375 to -0.385, p=0.019) had lower quality of life scores. None of the other variables were associated with quality of life in MUPS. Conclusions: Personality traits such as neuroticism and psychological distress are associated with quality of life in patients with MUPS.
Keywords: Neuroticism, psychological morbidity, quality of life, somatization, somatoform disorders
| FP 26: Correlates of depression in patients with type 2 diabetes mellitus and its relationship with diabetes distress and self-management|| |
Jogamaya Mantri, Suravi Patra, Susanta Kumar Padhy
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Diabetes is a chronic metabolic disease. About 422 million people worldwide and 69.1 million people in India have diabetes. The most common is type 2 diabetes. Depression is another condition which has a high prevalence. Globally, more than 300 million and in India 57 million people of all ages suffer from depression. The relationship between type 2 diabetes and depression is bidirectional. The aim of the study was to find out the correlates of depression in type 2 diabetes mellitus and its relationship with diabetes distress and self management. Methods: This study was conducted in the Non Communicable Disease Clinic at AIIMS, Bhubaneswar. Depression was assessed by Hamilton Depression Rating Scale, diabetes distress by Diabetes Distress Scale and self management by Diabetes Self Management Questionnaire. Results: Total 107 patients were included in the study. Out of which, 62.6% had mild depression and 37.4% had moderate depression. Depression was highly prevalent among female (54.2%), 41-60 age group (72.9%), unemployed and unskilled worker (65.4%), nuclear family (71.9%), and people from rural areas (53.2%). This study reveals that there is low positive correlation between depression and diabetes distress (r=0.29) and low negative correlation between depression and self management (r=-0.19). Conclusion: Depression is more common among females, middle age adult, unemployed, rural people and those belonging to nuclear family. However it has weak relationship with diabetes distress and self management.
Keywords: Depression, diabetes distress, diabetes mellitus, self management
| FP 27: Public education as a method of social psychiatric intervention: Exploring possibilities and effectiveness|| |
Nilamadhab Kar, Susanta Kumar Padhy
Black Country Partnership NHS Foundation Trust, Wolverhampton, United Kingdom, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. E-mail: [email protected]
Introduction: It is well known that most patients with psychiatric illnesses come for medical intervention late; and some never. The reasons are inadequate awareness about symptoms, availability of effective treatment, and last but not the least 'social stigma'. On the other hand, sometimes people use psychiatric services for inappropriate reasons, be it for any real or apparent gains, getting absolved from responsibilities or many other obscure reasons. There are disproportionately more misinformation in the communities and online creating a lot of issues including many self-diagnosed worried-wells. Aims and Objectives: This discussion paper highlights core issues and reviews the possibilities of public education and its effectiveness. Methodology: The relevant literature was searched from electronic databases including PubMed. Results: It cannot be overemphasized that social factors associated with mental illnesses need to be addressed at the community level. One of the obvious ways would be to have an effective public education system sharing accurate and appropriate information. In a positive note, there are excellent materials in the public domain which are extremely user-friendly and practical. However, they are rather passive and need to be actively searched and are often lost in the cobweb of misinformation. Often these do not convey answer to the specific question of the person. Besides, the information is not always available in the local language. TV is a great communicator but it also has its own limitations. Sometime it is essential for psychiatrists to reach out to the masses, in active interaction, discussion and answering queries. There is a great role of psychiatry beyond the confines of the clinics, out in the communities. Public lectures, discussion forums, phone-in programmes in radio and TV, even road shows are just some of the examples. Participating in mental health first-aid in mass trauma situations are other avenues for mental health professionals to interact directly with general public. Conclusion: Increasing awareness, fighting stigma and getting the best help to patients early, and campaigning against misinformation - there is a public education role cut out for social psychiatry.
Keywords: Media, mental health, public education, social psychiatry, stigma
| FP 28: Social relationship in families with mental illness|| |
Swagatika Debata, Bhaswati Patnaik
Department of Psychology, Utkal University, Bhubaneswar, Odisha, India. E-mail: [email protected]
Introduction: There are particular challenges within families where parents are mentally ill and are unable to support their families. Caregiver burden commonly refers to the psychological, physical, emotional, social and financial challenges faced by family members caring for a mentally ill relative. There are many studies on family burden with mental illness, i.e., the financial impact if a member in the family is mentally ill. But there is a dearth of research studies on social relationships matters of families with mentally ill members. Objectives: The main objective of the study was to examine the impact of mental illness on a family's social relationships as reflected in its different dimensions, such as, social support, social rejection, social interaction and social integration. Methods: The study follows a correlational design.A questionnaire was administered on 20 participants who had one family member with mental illness (such as schizophrenia, bipolar, psychosomatic symptoms, depression, etc). Results: Both qualitative and quantitative analysis of data revealed that the extent and the quality of perceived social relationship remained poor in families with mental illness. Conclusion: The study provided useful insights for formulation of steps to address the societal needs of families with mental illness.
Keywords: Mental illness, perceived social support, social relationships
| FP 29: Profile of adolescent and young adults utilising tertiary level psychiatry services incentral India|| |
Pooja Chaudhary, Lekhansh Shukla1, Abhijit Rozatkar
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, Centre for Addiction Medicine, National Institute of Mental Health Sciences, Bengaluru, Karnataka, India.
E-mail: [email protected]
Introduction: Psychiatric morbidity due to severe as well as common mental illnesses peaksduring adolescence and young adulthood. Unlike developed countries, dedicated Child andAdolescent mental health services are not widely available in India. In this background it isimportant to document the treatment needs and profile of this group of patients who seek help atdereregional centres like AlIMS. Aims and Objectives: To report the number and profile of Adolescent and young adults whosought psychiatric treatment at AIIMS Bhopal between 01/12/2017 and 31/08/2018. Methodology: Clinical audit of outpatient treatment records which consist of a semistructuredscreening proforma filled by a psychiatrist. Case records of patients between 10 to 20years of age at the time of consultation are included in this study. Results: During the study period of 9 months, 175 adolescent and young adults soughtoutpatient treatment. The modal patient is an adolescent (median age = 17 years) male (n =111, 63%) who is self-referred (n = 137, 78 %). The consultation entailed up to 20 hours oftravel time (mean = 3 hours) and 3000 INR travel expense (mean = 172.8 INR). Amongst aminority of patients (n = 29) in whom a stressor was identified, stress due to studies (n = 8) wascommon. A definite diagnosis was made in 157 cases (90 %). Interestingly, 'nil psychiatry' wasthe most common diagnosis (n = 20), followed by dissociative & conversion disorder (n = 13), adjustment disorder (n=12) and bipolar affective disorder (n=12). Most of the patients (n = 121, 69 %) did not come for even a single follow-up visit. Conclusion: There is a rapid uptake of psychiatric services. Adolescents and young adultsmostly seek a consultation directly; however, follow up is poor in this group.
Keywords: Adolescent, compliance, pathway
| FP 30: To study effectiveness of training module for auxiliary nurse midwives to upgrade their knowledge and attitude regarding perinatal mental health problems|| |
Shubhangi S. Dere, Pradip Savardekar1, Abhishek Gupta2, Rakesh Ghildiyal2
Department of Psychiatry, MGM Medical College, Departments of1Community Medicine and2Psychiatry, MGM Medical College and Hospital, Navi Mumbai, Maharashtra, India. E-mail: [email protected]
Background: Perinatal mental health problems carry serious consequences on foetal growth, pregnancy outcomes, and postnatal care, yet are often missed. In preview of scarcity of mental health professionals in developing country like India, effective interventions can be delivered by well-trained non-specialist health providers like ANMs. Aims: To study effectiveness of training module for ANMs to develop capacity of early detection through screening, referral in management of perinatal mental health problems. Methods: Forty ANMs serving in district were enrolled for one-day workshop after obtaining institutional ethics committee approval and permission from Taluka Health Officer. Training had following sessions: I: Overview and impact of mental disorders. II: Understanding types, risk factors of common and severe maternal mental health disorders. III: Mother- baby bonding, maternal mental health assessment. IV: Role of ANMs in promotion of maternal mental health, basic counselling skills. Participant's existing and changed knowledge and attitude was assessed using pre and post-test questionnaire respectively. Data was analysed using Microsoft Excel ver.2016. Paired t-test measured impact of training program based on difference between pre and post-test mean knowledge scores. Results: Three fourth ANMs reported that they never received training about maternal mental health. Mean knowledge score improved significantly with training (pre-test score: 8.53; post-test score: 10.45; p-value: 0.001). Training also improved ANM's attitude towards maternal mental health problems and understanding of their role in identification, referral and follow-up of these significant ailments. Conclusion: Knowledge of ANM regarding perinatal mental health was inadequate and improved significantly post training. Enabling ANMs to evaluate psychological health of woman during ante-natal and post- natal visits can serve as key step towards integration of perinatal psychiatric services in reproductive health and promotion of maternal mental health.
Keywords: Knowledge, mental health, nurses, training
| FP 31: Conflict resolution styles and mental wellbeing: A comparative study among three professions|| |
Prangya Paramita Biswal, Lucy Sonali Hembram
Utkal University, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Increasing specialization and professionalization, coupled with high degrees of work independence over the past years, have increased the conflict potential in every sector. Conflict, if not properly managed, can lead to “stress, frustration, dissatisfaction and poor work performance. Poor mental health impacts individuals overall health, their relationship with others, and societal cost related to unemployment, poor work place productivity and many more. So both conflict resolution and mental wellbeing are two important factors that can directly influence an individual, organization and a society. Aim: The main aim of the study was to examine the relationship between conflict resolution style and mental wellbeing among three different professions, and it also examined the impact of profession on conflict resolution style and mental wellbeing. Methods: Samples were taken from three different professions (i.e medical, teaching & human resource professions). The sample consisted of one hundred and fifty subjects (50 from each profession).Two different instruments were used in this study. The Rahim's scale for interpersonal conflict-handling style was used to measure conflict resolution style and Psychological Well-being Scale by F.M Sahoo was used to measure mental wellbeing. Correlation and ANOVA were used in this study. Correlation was used to find out the relationship between conflict resolution style and mental wellbeing and ANOVA was used to find out the impact of profession on conflict handling style and mental wellbeing of professionals. Result: The correlation analysis indicated a significant relationship between conflict resolution style (r=.301, p<0.01) and mental wellbeing and the analysis of variance shows that profession has insignificant effect on conflict resolution style F (2.147) = 1.07) and significant effect on mental wellbeing F (2.147) = 8.12, p> 0.01). Conclusion: Type of profession has effect on well being but not conflict resolution style.
Keywords: Conflict resolution style, mental wellbeing, profession
| FP 32: A cross sectional analysis of socio-academic outcome and quality of life in patients with early onset bipolar affective disorder|| |
Geetha Ganesan, Sandhiya Selvarajan1, Preeti Kandasamy
Departments of Psychiatry and1Clinical Pharmacology, JIPMER, Puducherry, India
Background: Early onset Bipolar disorder (EOBD) is known to have a malignant course with delayed functional recovery. The mean age at onset of EOBD typically coincides with the secondary school age in our Indian context. Even when these groups of patients improve clinically with medications their educational and employment statuses continue to remain poor suggesting that they are more vulnerable in terms of their socio-academic outcome. While there is large data available for adult population on these aspects data is lacking for EOBD patients. Methods: The participants were adults with early onset Bipolar Disorder defined as onset of first episode before 18 years on mood stabilizers for more than two years as part of treatment as usual (n=30).In the sociodemographic variables we have particularly looked into the educational and employment status and assessed quality of lives using Brief Qol.BD and Global Assessment of functioning scale(GAF). Results: The quality of lives and global assessment of functioning and its correlation with the educational and employment status of the patients will be analyzed. Conclusions: More intensive and earlier psychosocial interventions are required in patients with early onset Bipolar Disorder in order to improve their long-term socio-academic outcome.
Keywords: Bipolardisorder, early-onset, quality of life, socio-academic outcome
| FP 33: Non-adherence, risk factors, medications influence inschizophrenia and depression|| |
P. V. R. Pratheek, Akhila Ganta, Prasanth Ampalam1, Narasimha ReddiK1, J. P. R. Ravan
Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha,1Maharajah's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
Introduction: Schizophrenia affects more than 21 million people worldwide and isassociated with considerable disability. Depression affects more than 300 millionpeople globally and leading cause of disability worldwide. Reviews of adherenceconclude that approximately 50% of people do not take their medication asprescribed, and these rates are similar across chronic physical and mental disorders. Improving medication adherence in persons with mentally ill reduces morbidity and suffering of patients and their families, along with reducing rates of relapse and rehospitalization. Aims and Objectives: To measure the prevalence of treatment non-adherence, associated risk factors with non-adherence and medication influences in patients suffering from schizophrenia and depression. Methodology: The current study was conducted at Department of Psychiatry, MIMSGeneral Hospital, Vizianagaram with a total sample of 80 patients (40 Schizophrenia,40 Depression) for a period of 1 year 6 months (January 2016 – July 2017) using aself-structured proforma, socio-demographic variables and ROMI scales. Adherenceis the extent to which a person's behavior coincides with medical or health adviceand treatment standards. Criteria for defining non-adherence are less than 80% ofprescribed medication taken or gaps in the medication of at least 7 days. Results: The prevalence of non-adherence in schizophrenia is 65% and Depressionis 55%. In ROMI scale for medications influence feeling that medications currentlynecessary, no perceived daily benefit are important reasons for treatment nonadherencein bothSchizophrenia and Depression. Stigma and Denial of illness aresignificant reasons for non-adherence in schizophrenia which is not present indepression patients. Discussion: Higher non-adherence in schizophrenia can be mainly due to denial ofillness. Rural area of residence, unemployment, and financial obstacles areimportant risk factors for non-adherence. Conclusion: Non-adherence is commonly under-recognized in current psychiatricsetup which may have a significant impact on the course of illness and thereby on the day to day functioning. Programs aiming at finding out the reasons for nonadherence and necessary interventions to improve adherence should be initiated. There is a need to provide psycho-education to the patient and family about the illness and need for treatment adherence.
Keywords: Depression, nonadeherence, schizophrenia
| FP 34: Parental perception on usage of touch screen device in children 0-6 years|| |
J. Hepsi Bai, K. Sandhiya
AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Technology progress is leading to an increase usage of media among people from infant to adults. Nowadays young children are growing up in environment saturated with media devices in hand that catch their attention. Parental perception plays a vital role to decide to provide digital devices to their children. Objectives: To assess perception of parents on usage of Touch Screen Device (TSD) among children aged 0-6 years. Methodology: A cross sectional survey was conducted among 69 parents of children aged 0-6 years using non-probability convenient sampling technique. Data were collected using a pretested validated questionnaire to assess perception of parents on usage of Touch Screen Device among their children. Results: The mean chronological age of the children surveyed was 34±16 months with 8 (11.6%) infants, 29 (42%) toddlers and 32 (46%) pre-schoolers. The mean age at initial use of TSD was 15.5 ±9 months. Majority of parents 48 (68.8%) mentioned that there was no fixed time to use TSD in a day and the average daily use TSD by parents was comparatively high extended from 5 to 300 minutes than children's usage from 6 to 60 minutes in a day. Nearly 49 (86%) children used TSD every day without any specific time. Out of 69 children used TSD 49 (71%) watched Television and 28 (41%) of them watched for 30 minutes to 1 hour in a day. In regard to perception 81% of parents perceived using touch screen device was not good for their child's brain development, and 10% believed that only TSD can makes their child to enjoy and relax. Nearly three forth 75.4% of them agreed TSD may affect their child's outdoor play. Half of them agreed that they can do household work when their child was occupied with TSD. 82% of parents accepted TSD usage will not help to spend more time with her/his siblings at the same time they felt their child should know to use touch screen device when other children of same age knows/ does. 74% parents believed TSD was the only option to keep their child calm while feeding/ crying/ meeting child's basic needs and they also agreed they were aware that usage of touch screen device can harm their child's health (vision/ communication/ development) at young age. Only 23% mothers perceived they doesn't have any option other than touch screen device to engage their child. It was also found that there was positive correlation between parental TSD usage time and duration of child's TSD (r=0.2, p=0.01), age at started TSD usage and duration of child's TSD usage (r=0.3, p=0.001). Conclusion: It is important for the physicians and parents to be aware about the negative effects of TSD by young children whether it will be TV, smart phone or other electronic devices.
Keywords: 0- 6 years children, parental perception, touch screen device use
| FP 35: Touch screen device usage and its correlation with sleep pattern among infants and toddlers|| |
J. Hepsi Bai, K. Sandhiya
AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: American Academy of Pediatrics has recommended that children younger than 2 years should avoid digital media other than video chatting. The adverse effects of early and prolonged exposure to digital technology has reported as interference with neuro-cognitive development, learning, sight, listening and wellbeing. The association between touch screen device usage and sleep of infants and toddlers has not much explored in Indian Scenario. Objectives: 1. To assess usage of Touch Screen Device (TSD) among infants and toddlers. 2. To determine the relationship between touch screen device usage and sleep of infants and toddlers. Methodology: A cross sectional survey was conducted among 76 families with infants and toddlers recruited using convenient sampling technique. Data were collected using a pretested validated survey questionnaire to assess the pattern of using touch screen device and Brief Infant Sleep Questionnaire (BISQ) to assess the sleep pattern and problems among infants and toddlers. Results: Out of 76 families surveyed 73 (96 %) reported owning touch screen devices in home. Of these, 57 (78%) reported touch screen device used by infants and toddlers. 51 (89.5%) own smart phone. Parental use of TSD was 47.7± 7 minutes in a day. The mean age at initial use of TSD was 15.6 ±5.8 months and average daily use of TSD extended from 5 to 360 minutes with average use of 65±9.6 minutes in a day. 49 (86%) children used TSD every day without any specific time 44 (77%). Majority of parents 31 (54%) cited multiple reasons for using TSD like watching songs, watching non educational you tube videos/children's movies/films, pressing button on screen aimlessly. Nearly half of the mothers 29 (51%) mentioned “Feeding the child” was the main circumstance to use TSD. Majority 40 (70.2%) of children watched TV along with TSD for 38 ±5.8 minutes. Regarding the sleep, nearly 51 (89%) children slept <12 hours at night with <5 episodes of awakening 33(57%), and majority of children 55 (96%) slept less than 4 hours at day time and 9 (16%) parents were considered their children's sleep as a small problem. There was a significant negative co relation between night time sleep duration and TSD time usage (r= -0.35, p = 0.007). Conclusion: WHO also suggested that parents should replace screen time and screen devices with more enriching activities. Parents have to limit their own digital device usage. A more interaction of play, recreational activities other than media usage help children to engage their time effectively.
Keywords: Infants and toddlers, sleep pattern, touch screen device use
| FP 36: Opioid use in women of northern India: A case series|| |
Bhavika Rai, Aniruddha Basu, Anindya Das
All India Institute of Medical sciences, Rishikesh, Uttarakhand, India. E-mail: [email protected]
Introduction: Amongst Substance use disorders, Opioid use disorder has beenextensively studied, but limited literature is available with respect to opioid use inwomen, with category of opioid used, reasons for initiation and factorsmaintaining the use different in both the sexes. Even lesser data has beenreported from the Northern part of Indian subcontinent. Aims and Objectives: To study the profile of women in Northern India withOpioid use disorder. Methodology: Case records of three women, visiting the De-addiction clinic ofAll India Institute of Medical Sciences, Rishikesh, India, diagnosed as Mental andBehavioral Disorder due to substance use: dependence syndrome, according toICD-10, were reviewed. The review focused on demographic, clinical and socialaspects pertaining to opioid use. Results and Conclusion: All the three women were middle aged women from arural background, having prescription opioid use in injectable form, initiated ondrugs in order to alleviate pain complaints prescribed by practitioners, maintainedbecause of pertaining interpersonal issues with spouses or family members,psychiatric co-morbidities like depressive disorders and personality traits; andresulted in physical co-morbidities like ulcers over both upper and lower limbsand infection with Hepatitis C.
Keywords: Co-morbidities, India, opioid use, women
| FP 37: Mental health care act 2017|| |
Tathagata Biswas, Dhritiman Das, TanayMaiti, JigyansaIpsita Pattnaik, Susanta Kumar Padhy
AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Mental Health Acts in India has a long history having its roots in the pre-independence time as the Indian Lunatic Asylum Act of 1858 and the Indian Lunacy Act of 1912. Post-Independence the establishment of Indian Psychiatric Association in 1947, paved the way for the Mental Health Act of 1987. The more than 30 years old legislation needed revision at the present age with added importance to the right to mental health and rights of patients with mental illness. Thus, The Mental Health Care Bill was proposed in 2013 and subsequently the Mental Health Care Act (MHCA) was passed on 7 April 2017. The novice Act aims to achieve a greater degree of mental health and justice in the Indian Society. However, its provisions have greatly been debated for numerous shortcomings. Aims and Objectives: To discuss the changes brought by the MHCA and its impact on the mental health and to identify and discuss the gaps/lacunae in the MHCA. Methodology: Literature and web-based search, with search phrases like the Mental Health Care Act, MHCA impact, Gaps in MHCA, MHCA Debate etc. Discussion: MHCA 2017 promises to 'provide mental healthcare and services for persons with mental illness' while at the same time aims 'to protect, promote and fulfil the rights of such person during delivery of health care and services.' It empowers the people with mental illness with advanced directives, nominated representatives and voluntary admission. But challenges like inadequate resources to meet the ambitious structures proposed in the act, minimal importance to prevention and promotion of mental well-being, paradoxical features causing possible barriers (advanced directives being overridden by MHCB), possible delay in treatment initiation due to reduced rights of the caregivers etc might weaken the objectives of the Act.
Keywords: Future, gaps, mental health care act
| FP 38: Dissociative suicide attempt in an adolescent male with borderline intelligence: A case description|| |
Ankita Chattopadhyay, Ragul Ganesh,
Bichitra Nanda Patra, Rajesh Sagar
Department of Psychiatry, AIIMS, New Delhi, India.
E-mail: [email protected]
Introduction: Suicide or self harm attempts are common in patients suffering from dissociative disorder. In such patients, suicide attempts increase the risk of mortality. Aims and Objectives: We, hereby, present the description of an adolescent male, attempting suicide during the dissociative episodes. Case Description: A 18 year old adolescent male, studying in tenth standard, presented to the medical emergency, after an attempt to kill self by hanging. Detailed history taking and examination were done for evaluation. Detailed history revealed onset of dissociative convulsions after the failure of the patient to pass his board examination, aggravated by any critical comments regarding his academic failure. Subsequently, he would also have possession spell in which he would be acting like a person of different religion and performing their religious rituals. Further exploration, along with lorazepam assisted interview, revealed conflicts with family members regarding his friendship with people of the other religion. About 3 months later, the patient would be seen attempting to harm self during the dissociative spell, all of which would be of high lethality and would have to be interrupted by family members. Mental status examination revealed euthymic affect, without any pessimistic views or wish to die or suicidal ideation. IQ assessment revealed borderline intelligence. In the ward course, apart from the dissociative episodes, he would be interacting and engaging in ward activities. No persistent mood symptoms could be observed. But the concomitant suicide attempts during dissociation in background of borderline intelligence, were posing difficulty in carrying out non pharmacological interventions initially. However, he continued to show improvement during the sessions on OPD basis. Conclusion: The co-morbidity of self harm attempt with dissociation is too great to be neglected. This case not only adds to the fact that there might be a common psychodynamic origin, but that suicidality occurring during dissociation, leads to difficulty in management of such patients.
Keywords: Adolescent, dissociative, self harm, suicide
| FP 39: Are children safe? The societal underpinnings of increasing childhood sexual abuse|| |
Jigyansa Ipsita Pattnaik, Tanu Sharma,
Susanta Kumar Padhy
AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]
Introduction: India leads the world in child sexual abuse country. Every 15 minutes, achild is sexually abused in India. The dynamics of child sexual abuse is different from adultabuse. There are increasing instances of sexual crimes with perpetrator-glorification ofsexual abuses and multiple loopholes in the Indian Judicial system. In the light of rise in theincidence of quite frightening and emotionally disturbing sexual offenses on children, thereason behind such acts on children needs deep reflection. Aims and Objectives: to study the societal underpinnings of increasing childhood sexualabuse. Methodology: Existing literature on Child Sexual Abuse is studied and its varied scenarioare delineated. The Pubmed database was extensively searched using key words: child sexualabuse, children and rape, rape and society, childhood abuse. A descriptive study was performed focusing on the societal underpinnings and psychodynamic perspective. Conclusion: The Indian society is in a state of chaos with an amalgamation of Westernculture and changings stands on morality. Sexual liberation with pornography enacting onunusual sexual fantasies opens way for experimentation. This cultivates perverted sexualdesires that pave way for seeking instant gratification without fear of the law or any moralinhibition. In the absence of adequate marital sexual satisfaction, with partner-specificincompatibility, is the target of sexual gratification is probably shifting towards a morevulnerable class- the Children.
Keywords: Child sexual abuse, childhood abuse, children and rape, rape and society
| FP 40: Psychogenic vomiting: A comprehensive review of existing scientific publications and way forward for mental health professionals|| |
Tathagata Biswas, Jigyansa Ipsita Pattnaik, Tanay Maiti, Jayaprakash Russell Ravan
AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]
Introduction: Recurrent or self-induced vomiting can be caused independently by aplethora of surgical and medical reasons, all of which needs to be effectively ruled out beforetreating in lines of psychogenic origin. Also, the difficulty in stopping the behaviour calls for amore scientific approach for its management. Aims and Objectives: To propose a scientific and logical approach for diagnosis andmanagement of Psychogenic vomiting. Methodology: Existing literature on recurrent vomiting is studied and its varied causes(including surgical and medical) are delineated. An algorithm to clinical approach is therebyproposed keeping in view of the non-psychiatric causes. Finally, an effective treatment forpsychogenic recurrent/self-induced vomiting is provided. Results: Psychogenic is not simple behaviour easy to stop. A mental health professionalmust also consider the non-psychiatric causes of recurrent vomiting before starting ontreatment. This includes common aetiologies such as gastritis, peptic ulcer disease, hepatitis, appendicitis, pancreatitis, cholecystitis, gastro-intestinal obstruction, irritable bowelsyndrome, pregnancy, uncontrolled diabetes, constipation and sore throat. A detailed history accompanied by investigations like complete hemogram, ABG, antibodytitres, plain abdominal X-ray or CECT, etc. often becomes indispensable in clinching the diagnosis. Conclusion: A rational approach to such a case is needed to prevent under treatment or wrong-treatment and assure effective management.
Keywords: Eating disorder, psychogenic vomiting, recurrent vomiting, self-induced vomiting
| FP 41: Delirium research in India: A bibliometric study|| |
K. Sanjana, Devakshi Dua, Sandeep Grover
Post Graduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]
Background: Delirium is fairly common diagnosis seen in medically ill patients, in all the treatment set-ups, with relatively higher incidence and prevalence in intensive care units. Considering the fact that, delirium is encountered in multiple specialties, it is important to understand the research on this diagnosis. Objectives: To assess the research output involving patients of delirium from India. Materials and Methods: A comprehensive search was undertaken using Medline (PubMed) as database. Search words included were “delirium” AND “India”. No filters were used. Inclusion criteria were studies conducted or reported from India, with delirium as the research subject or a reported outcome. Results: A total of 264 articles were identified out of which 222 met the eligibility criteria. The available data suggests that most of the published papers are in the form of case reports and have reported delirium as an adverse event of certain medications or interventions. There are limited number of original research papers, and most of this research has been carried out by the psychiatrists. Some of these original studies have included specialists from more than one specialty. Most of the original papers have either focused on epidemiology (incidence, prevalence, outcome, etc.), symptom profile, with some of the studies evaluating the efficacy/effectiveness of various pharmacological interventions. Most of the centres across the country have not produced any research on delirium. There are no multi-centric studies involving multiple centres from India. Conclusion: There is a dearth of research in the field of delirium from India. There is a lack of studies on biomarkers, evaluation of non-pharmacological interventions, and strategies evaluating the prevention of delirium. It is the need of the hour to carry out more studies to further our understanding of delirium in Indian context.
Keywords: Delirium, India, research
| Kleine-Levin syndrome More Details (East vs. West) from phenomenology to intervention"> FP 42: Cross cultural variation in Kleine-Levin syndrome (East vs. West) from phenomenology to intervention|| |
Abhipsa Das, Akhila Ghanta, Vijay Raj Pratheek, M. Anupam, R. A. Deepthi, K. Tannu, P. JigyansaIpsita, Santanu Nath, M. Tanay, J. P. R. Ravan, S. K. Das, Sushant Padhy, R. C. Das
E-mail: [email protected]
Background: Kleine–Levin syndrome (KLS) is a rare self remitting disorder of unknownorigin that usually affects adolescent males.It is characterized by episodes lasting from 1 toseveral weeks, and comprises neurological (hypersomnia, confusion, slowness, amnesia) andneuropsychiatric symptoms (derealization and apathy). Some psychiatric symptoms(megaphagia, hypersexuality, anxiety, depressed mood, hallucinations, delusions) arise duringepisodes, albeit less frequently, while patients are normal between episodes. Aim and Objective: To study the phenomenological characteristics of KLS in our Easternethnic populations of India and to study the difference in associated diagnostic marker &management techniques. Case Description: we report 5 cases observed in the department of Psychiatry andbehavioural sciences at Kalinga institute of medical sciences and AIIMS Bubaneswar. Thediagnosis was clinical, based on the recurrence of hypersomnia, cognitive and behavioural disorders during the periods of hypersomnia, and the return of patients to normal statebetween episodes. We compared the clinical characteristics of 5 adolescent patients withKLS,3 females and 2 males, to those in other published cohorts.As described in the literature,our patients had recurrent hypersomnia, which was sudden in onset. This hypersomnia waslong, 16-24 hours a day.The mean duration of the episode was 10 days.Our patientseffectively recovered and achieved a clinically normal state between episodes. Discussion: All the five patients presented with predominantly hypersomnolence and hyperphagia without hypersexuality in contrast to western findings where hypersexuality isfound more commonly. Patients tend to eat compulsively and in large amounts. They have apredilection for sweet food and in western culture for junk food such as burgersetc. However, keeping in line with our cultural background, all our patients reported to eatlarger amounts of food (megaphagia) with a preference for local snack items (such as puffedrice (Moodi),Maggiand mixture etc. The EEG is the examination which is most frequently abnormal in the KLS. However, our patients did not have any specific eeg changes or raised prolactin levels. Inspite of the various psychotropic agents, including lithium, anticonvulsants and antidepressants.By and large lithium is considered to be preferred drug for treatment aswell as prophylaxis. Here we report good clinical response with Lamotrigine (~200mg per day on an average) in all the five cases which is not one of the routinely advocated treatments. Conclusion: The Kleine-Levin syndrome is a rare neurological pathology. Patients with KLS treated in our setup exhibited differences in clinical characteristics during episodes compared to patients with KLS of different ethnicities. However the difference in the manifestations over a wide cultural background, phenomenology, investigations and newer treatment modalities should be given consideration while diagnosing and treating these patients for afavourable outcome.
Keywords: Intervention, Klein Levin syndrome, phenomenology
| FP 43: A comparative study of quality of life among elderly in old age homes and family setup in urban Raipur, Chhattisgarh|| |
Soumya Swaroop Sahoo, Vazinder Kaur1, Udit Kumar Panda2
Department of Community Medicine, AIIMS, Bathinda, Punjab,1NHM, Raipur, Chhattisgarh,2Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]
Introduction: Population ageing is an irreversible and imminent demographic reality. Elderly represent a vulnerable group needing special care and support. QOL among the elderly is an important area of concern as it reflects their overall health status and well-being. Aims and Objectives: To compare the quality of life of elderly residing in the family set up and old age homes and to assess the factors affecting it. Materials and Methods: A cross sectional study was conducted among 100 elderly persons (50 each from old age home and community) in an urban locality of Raipur. A pretested predesigned questionnaire was used to collect information regarding socio-demographic variables and co-morbidities. Older people quality of people (OPQOL-35) scale was used to assess the quality of life. Data entry and analysis were performed using SPSS version 17.0. Results: The mean age of the respondents was 70.28±8.34 years. The QOL of the elderly residing in the old age homes (112.74±10.71) was found to be better than in the community (95.34±6.51). Gender wise, QOL of males were better than females. In multivariate analysis, increasing age, financial dependence and education upto primary and below were found to be associated with a poor quality of life. Conclusion: Health promotion strategies, social support, counseling with financial assistance, early identification and management of chronic diseases can bring a considerable reduction in the morbidity and mortality along with improving the QOL among the elderly.
Keywords: Elderly, old age home, QOL
| FP 44: A cross sectional study of long term course of bipolar disorder|| |
S. Dhiman, B. N. Subodh, S. Chakrabarti
Department of Psychiatry, PGIMER, Chandigarh, India. E-mail: [email protected]
Background: Even though the course of bipolar disorder has been well documented by several large scale studies, but the studies on the course of Bipolar Disorder in India are sparse. Few of the studies that have been conducted in India, indicate the possibility of differences in the course of BD in Indian population. There are several methodological lacunae, lack of standardized instruments and relative absence of information on key aspects such as disability, co-morbidity, treatment adherence and suicidal behavior. Methods: 200 patients aged 18-65y, diagnosed to be suffering from bipolar disorder on Mini International Neuropsychiatric Interview- PLUS (MINI-PLUS), selected by systematic random sampling, were assessed cross-sectionally on National Institute of Mental Health-Retrospective Life Charts-Clinician and Self rated versions NIMH-LCM(C and S/R),Young Mania Rating Scale( YMRS), Hamilton Depression Rating Scale (HDRS), Columbia Suicide Severity Rating Scale (C-SSRS), Indian Disability Evaluation and Assessment Scale(IDEAS), Medication Adherence Questionnaire(MAQ) and Presumptive Stressful Life Events Scale (PSLES). Results: Mean age of onset was around 25 years, each patient suffered from an average of 9.25 episodes in his/her lifetime with mania being the predominant polarity and manic episodes outnumbered depressive episodes. Mean duration of untreated illness around 2.5y.Around half of the cases had a positive family history of mental illness, life events preceded the onset of episodes in more than 2/3rd cases. 43% had psychiatric co-morbidity and 37% had medical co-morbidity. The prevalence of lifetime suicide attempts came out to be 16.5%. Benchmark disability seen in 74% of cases. 58.5% of the cases were non adherent to treatment. Conclusion: The present study suggests that in Northern part of India, mania is the predominant polarity, as opposed to depression in the Western population. Patients suffer from more number of manic episodes as compared to depressive ones. Nearly half have psychiatric co-morbidity and one third have medical co-morbidity. Around 1/5th of the patients attempted suicide at least once in their lifetime. More than 2/3rd suffer from significant disability. So the present study negates the traditional view that Bipolar Disorder has good outcome and complete recovery.
Keywords: Bipolar disorder, course, India
| FP 45: Caregiver burden and disability in somatoform disorder: A cross-sectional comparative study|| |
Esther Chinneimawei, Padmavathy Nagarajan, Vikas Menon1
College of Nursing,1Department of Psychiatry, JIPMER, Puducherry, India. E-mail: [email protected]
Introduction: There is a paucity of systematic data on caregiver burden and disability among patients with somatoform disorders. Aims and Objectives: To assess levels of disability among patients with somatization disorder and levels of burden among their caregivers and compare these parameters against patients with schizophrenia. Methodology: Participants included adults with a stable diagnosis of somatoform disorders (F45.0 – F 45.9) (n=28) or schizophrenia (F20.0- F20.9) (n=28) diagnosed as per International Classification of Diseases (ICD) -10, clinical descriptions and diagnostic guidelines, as well as their caregivers. WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent student t-test or Chi-square analysis was used to compare relevant socio-demographic and clinical parameters. Results: The mean age of sample was 38.6(±10.5). Females constituted a slender majority of sample (n=29, 51.8%). The mean disability scores of patients with somatoform disorders was 83.6 (+20.9). Mean disability scores were comparable between the two groups (t=0.26, df=54, p=0.80) as were the mean scores for caregiver burden (t=1.26, df=54, p=0.21). Conclusion: Patients with somatoform disorders experience significant levels of disability and inflict levels of caregiver burden comparable to severe mental illnesses such as schizophrenia.
Keywords: somatization, somatoform disorders, schizophrenia, disability, caregiver burden
| FP 46: Level of anxiety among patients undergoing coronary angiography|| |
Mahalingam Venkateshan, Shobha Masih1, Nayan Paul2
AIIMS Bhubaneswar, Bhubaneswar, Odisha,1Himalayan College of Nursing, SRHU, Dehradun, Uttarakhand,2Sardar Patel College of Nursing, Lucknow, Uttar Pradesh, India. E-mail: [email protected], [email protected]
Introduction: Invasive procedure induced anxiety is associated with worst outcome in coronary artery disease patients. Very limited data been available in exiting literature about the anxiety in patients undergoing coronary procedure. The Aim of this study was to measure the level of anxiety among patients undergoing coronary angiography. Methods: A cross sectional study was conducted in 2017 at Multi-speciality Hospital, Uttarakhand. Clinically diagnosed coronary artery disease patients, aged between 30-60 years and both male & female patients were included in the study and clinically diagnosed patients with other chronic disorders were excluded from the study. Sixty patients undergoing corony angiography were consecutively selected from the study population to study the variables. All the study participants were interviewed about their level of anxiety by using fourteen items Max Hamilton a Scale. Written informed consent was obtained from each study participants before starting the data collection and ethical committee permission was obtained from the concerned authority. Results: More than half (58.3%) of the coronary artery disease patients undergone coronary angiography reported moderate to severe level of anxiety and 40% of cardiovascular patients were reported mild to moderate level of anxiety. Level of anxiety mean score (25.83±4.8) among study sample significantly lower than the population anxiety mean score (115.97) at the level of significance p=0.05. Previously hospitalized (0.017) and Patients diagnosed with Myocardial infarction (0.011) shown significant association with their level of anxiety. Conclusion: Majority of the coronary artery disease patients undergoing coronary angiography reported Moderate to Severe level of anxiety. Patients undergoing coronary angiography must be screened for level of anxiety and interventions can be planned for reducing the anxiety which will fasten the prognosis of the patients.
Keywords: Coronary angiography, coronary artery disease, level of anxiety
| FP 47: The relationship between alexithymia and cognitive abilities in gaming addiction|| |
Christ University, Bengaluru, Karnataka, India.
E-mail: [email protected]
As with addictions of all kinds, gaming addiction is likely the symptom of underlying issues that have not been addressed in Indian context. Constricted imaginal process or difficulty in describing feelings or utilitarian way of thinking may be positively associated with addiction. Objective: First objective is to review the literature on cognitive profile of individuals with gaming addiction. Second objective is to describe the investigated relationship between alexithymia and cognitive abilities among individuals with gaming addiction. Methods: Article search of 15 published articles between 2000 and 2019 in Medline, PubMed, Google Scholar, Bielefield Academic Search Engine, Proquest, on cognitive function and alexithymia relation with video game addiction. Nine abstinent “ecstasy” hard core gamers and 8 control subjects were scanned at baseline using screening test Clinical scales (IGD 20 and GHQ and TAS-20) and Cognitive Scales (NIMHANS Neuropsychological battery) was used to assess varying cognitive processes underlying gaming addiction and aspects associated with alexithymia. Results: The findings would indicate a comprehensive cognitive profile of individuals with gaming addiction and result would further indicate whether any relationship exist between alexithymia and cognitive abilities among individuals with gaming addiction and differences in basic cognitive functions between IGD group and healthy controls. Implications: The study has future implications for developing early identification of problematic symptoms associated with gaming disorder. Developing awareness and understanding on problematic gaming and its relationship with alexithymia; that would aid in designing effective strategies (interventions) for treating gaming addiction. In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction and be vigilant about psychopathology.
Keywords: Alexithymia, cognitive abilities, gaming addiction
| FP 48: A qualitative study of phubbing phenomena in students in digital online world|| |
Christ University, Bengaluru, Karnataka, India. E-mail: [email protected]
Introduction: Issue of ignoring conversational partners as a result of getting inclined towards one's phone is also known as phubbing. Phubbing behavior is associated with a host of negative interpersonal consequences. Aims and Objectives: To explore phubbing behaviour in students. Methodology: Guwahati Commerce college is an institution that provides general upper secondary education in commerce to students aged approximately 16–20 years. After 6 months of open ethnographic participant observation in numerous lecture rooms, individual students are formally interviewed regarding their use of technologies. Informed consent was valued.25 students were interviewed in the campus. All participants actively responded and volitionally engaged in the study.Semi-structured interview was conducted, which implied that they followed an interview guide. In the beginning, queries rotated around students' pattern of use of technologies during class hours; other questions on students' use of digital devices in their leisure time for instance questions whether one's use technology outside of school if yes, then how?”, or they prefer using social media conjointly when they are with their friends”. The interviews lasted nearly 20 minutes on an average (some shorter, some a good deal longer). Sound recordings were soon transcribed to text. As a qualitative research, an interpretive approach was used in data analysis procedure. The excerpts have been accustomed best mirror the points of interest. The researcher explores young people's normative relationship to phubbing. Results: Students' attitudes toward the use of phones during social interactions are characterized by an “ambivalence”: On one hand, they resent when other people phubb them (ignoring another person by fiddling to mobile phones or any other technology use) whereas on the other hand, they often proceed to phubb others. It was found students exhibit negative attitude toward phubbing and her own technologically mediated actions. This discrepancy would turn out to be quite common among students. Conclusion: A factor that appears to outline phubbing is lack of purpose inherent in absentmindedly or arbitrarily checking social media. Sttudents are fairly aware of the negative consequences of phubbing. Even after knowing that phubbing has adverse effect in relationships, they desire to abstain from it, yet they continue to engage in this behaviour.
Keywords: Akratic, digital, phubbing behaviour