Year : 2020 | Volume
: 36 | Issue : 1 | Page : 37--46
Pending Abstracts of NCIASP-Bhubaneswar 2019
|How to cite this article:|
. Pending Abstracts of NCIASP-Bhubaneswar 2019.Indian J Soc Psychiatry 2020;36:37-46
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. Pending Abstracts of NCIASP-Bhubaneswar 2019. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Dec 5 ];36:37-46
Available from: https://www.indjsp.org/text.asp?2020/36/1/37/280834
Symposia 1: Internet addiction: Virtual relationships and developing sexual orientation in adolescents
Aakanksha Singh, Sabah Singh
Crayons Clinic, Chandigarh, India. E-mail: a [email protected]
There has been a striking escalation in the number of adolescents using Internet. The main objective is to communicate with peers. The social networks of the adolescents are strengthened via online activity. Evidence reports that internet addiction and approach to friendship are reciprocal as individuals are inclined toward making more online friends and favoring online communication. Internet addicts lead to withdrawal from social and interpersonal interactions. This leads to deterioration in family relationships and academic or occupational functioning. The adolescents are inclined toward online teen chat rooms and other online games that provide them with an anonymous social context to discuss topics related to ones' identity and developing sexuality. Adolescents, therefore, use Internet to form casual relationships, dating, partner selection, and online romances. Thus, Internet performs functions regarding the youth exploring accepting sexual orientation through self-awareness, learning about the gay/bisexual community life, communicating and meeting with them, finding comfort and acceptance, and facilitating the same. For the same, adolescent cases regarding Internet addiction and formation of virtual relationships and sexual orientation were psychologically evaluated and clinically correlated. The conflicts regarding the same were checked as per the manifested symptoms.
Keywords: Adolescents, internet addiction, sexual orientation, virtual relationships
2: Psychosocial skills to cope with stigma and stress in digital age
Kanwal Preet Kochhar, Rekha Sapra1, Sudarsan Behera1, Sanimar Kochhar
AIIMS,1Delhi University, New Delhi, India. E-mail: [email protected]
Topics and Speakers
Stress, stigma, and social erosion in medical education: Dr. Kanwal Preet Kochhar.Social and emotional learning in digital age: Future trajectories for children and adolescents: Dr. Rekha Sapra.Moderating role of emotional state and social support toward the relationship between PTDS and PTG among youth in New Delhi: Dr. Sudarsan Behera.Self-concept and stigma: Construct and domains: Ms. Sanimar Kochhar.Themes in stigma experience: Students and caregiver narratives – Challenges and way forward: Dr. K. P. Kochhar and Ms. S. Kochhar.
Reduce social erosion, enhance self-actualizationDevelop tolerance for ambiguities and alternatives, enrich cultural diversityEngender bonding and rapport formationSuccor and comfort for end-of-life careReduce incidents of aggression, meltdowns, and violence perpetration on resident physiciansImprove quality of life for doctors.
The preservation of physical, mental, social, emotional, and spiritual health is a duty as well as a moral responsibility toward self and society. Today in the digital age, social needs and healthcare are in a period of rapid flux and evolution. Medical students are now put in contact with patients much earlier in their career than ever before. A medical student, a young person with experience and emotions of an adolescent enters medicine after a rigorous entrance test, experiences conflicts to be a good doctor or a good human being and trials and tribulations of academic, financial, parental, societal, and peer-enforced stress. Passage through a medical school is a pilgrim's progress, both a privilege of a sublime satisfaction of cure and care, and a penance because of the social erosion concomitant in the shaping of a doctor's persona, including breaking a lot of taboos of privacy, shunning excreta, the deviant, the dirty, and the dying. The journey through a stringent and structured system of medical education in India is stressful and demanding and much more so for those with psychiatric disabilities.
In India too, with the introduction of new mental health bills as well as a rising social awareness and sense of social responsibility, there is a more enabling environment for mainstreaming students with schizophrenia, depression, and anxiety disorders. Psychiatric comorbidities and stigma associated with mental health issues also are being addressed in more positive ways. There is a need for educating the peers, teachers, laboratory staff, as well as campus community on the issues of destigmatization, acceptance, accessibility, and tolerance for diversity, alternatives, and ambiguities. The role and responsibility of a medical teacher becomes eminent and imperative in this scenario. Sensitization courses in faculty–mentorship roles, psychosocial skills, empathy training, cognitive behavioral therapy, psychological first aid, and dialectical behavior therapy can bridge the gap and make the faculty and higher education delivery professionals more competent to deal with episodic issues of crisis and conflict resolution.
The charge of a good medical teacher is to guide the student to navigate wards, emergency rooms, and critical care settings, with humanity, sanity, and integrity intact. There is a perceived need to shape physician identities and competencies by a formal curriculum in medical humanities, sensitivity training, competencies in dealing with disabilities, and stigma.
Keywords: Emotional skills, empathy training, psychosocial skills, PTDS, PTG, social support, stigma, stress, youth and peer collaboration
3: Sociocultural dimensions of dissociative disorder
Biswa Ranjan Mishra, Shree Mishra, Rajeev Ranjan1, Santanu Nath
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha,1Department of Psychiatry, AIIMS, Patna, Bihar, India. E-mail: [email protected]
Topics and Speakers
Cultural influences on etiogenesis of dissociative disorders: Dr. Biswa Ranjan MishraGender differences in dissociative disorders: Dr. Shree MishraDissociative symptoms in children: Dr. Rajeev RanjanSociocultural role in treatment of dissociation: Dr. Santanu Nath.
This symposium will enrich us with understanding dissociative disorders from a sociocultural perspective. At the end of the symposium, the audience is expected to learn to manage their clients suffering from dissociative disorder after understanding from which sociocultural milieu they belong from and how to manage the symptoms from a sociocultural perspective.
Dissociative disorder, otherwise known as conversion disorder, is a neurosis characterized by varied pseudoneurological symptoms ranging from convulsive motor movements, frank unconsciousness, to loss of motor and sensory functions. Society and culture, including its various practices within it, have been found to color the expression and manifestation of dissociative presentation and these have been found within cultures and also across continents. One prominent factor that shapes the symptoms is gender. There has been prominent shewing toward the fairer gender both in the prevalence as well as in the presentation. A holistic knowledge of dissociative disorder from a sociocultural perspective is important so as to tailor proper and adequate management. The current symposium will try to bring out the relevance of sociocultural milieu in symptom manifestation of dissociative disorder which will be helpful in handling such patients.
Cultural Influences on Etiogenesis of Dissociative Disorders: Dr. Biswa Ranjan Mishra
This section will deal with the etiopathogenesis of dissociative disorders and the intimate role of culture, with its varied practices and nuances in the pathogenesis of the disorder. This will also entail a detailed discussion on the folk practices, mass dissociation, etc.
Gender Differences in Dissociative Disorders: Dr. Shree Mishra
This section will deal with the subtle differences that gender plays in both the etiopathogenesis and the clinical manifestation of the disorder. The discussion will be made on real-life case vignettes from cases which are seen by the authors in their practice.
Dissociative Symptoms in Children: Dr. Rajeev Ranjan
This section will deal with the childhood presentations of dissociative disorder and the cultural, educational, learning, and behavioral factors, responsible for such manifestation. It will also entail a discussion on the management in children as a whole.
Sociocultural Role in the Treatment of Dissociation: Dr. Santanu Nath
This section will deal with the management of dissociative disorder in broad and the sociocultural role in proper treatment of dissociative disorder. It will entail a case-to-case-based management based upon their sociocultural milieu, their religious practices, belief systems, etc., thus entailing a holistic approach in management, which is an important aspect of treatment more important than pharmacological management.
Bale TL, Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci 2015;18:1413-20.Asadi-Pooya AA. Psychogenic nonepileptic seizures are predominantly seen in women: Potential neurobiological reasons. Neurol Sci 2016;37:851-5.Avbersek A, Sisodiya S. Does the primary literature provide support for clinical signs used to distinguish psychogenic nonepileptic seizures from epileptic seizures? J Neurol Neurosurg Psychiatry 2010;81:719-25.Benbadis SR, Allen Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure 2000;9:280-1.
Keywords: Bio-psycho-social model, culture, dissociative disorder, gender, society
4: Challenges in psychiatric practice after MHCA 2017
N. Manjunatha, C. Naveen Kumar, Suresh Bada Math
NIMHANS, Bengaluru, Karnataka, India.
MHCA 2017: The heart and soul: Dr. N. ManjunathaMHCA 2017: Challenges to psychiatric practice: Dr. C. Naveen KumarMHCA 2017: The way out, for the clinician: Dr. Suresh Bada Math.
MHCA 2017 as we all know is a right-based legislation, promising to provide mental healthcare and services for persons with mental illness. Chapter 5 on “Rights of the persons with mental illness” is the heart and soul of MHCA 2017. Accordingly, many states have started the process of establishing institutions for implementing the Act. Consequently, the psychiatric practice is bound to see a sea change. There are many reasons for the same. For example, the psychiatric fraternity of the country, while on the one hand, recognizes many parts (of the Act) as progressive, they view certain other parts as a hindrance to smooth psychiatric practice. There are voices that say that the act focuses only on the rights of the PMI while neglecting those of caregivers and family members. In a country such as ours, family members act as guardians/case managers and everything for the patients. Another major criticism is on the definition of “mental illness” itself. One section is of the opinion that strict interpretation of the definition will limit the scope of the Act to include only the persons with severe mental disorders. Another area of contention is about the practice of general hospital psychiatry, particularly when we consider the definition of “mental health establishment.” There is an apprehension that general hospital psychiatric units may hesitate to admit persons with psychiatric disorders fearing the need to “register” the establishment. Finally, the issue of “emergency treatment” and what treatments are allowed/not allowed is important.
The above-mentioned issues are bound to be dissected threadbare before mental health professionals start imbibing the letter and spirit of MHCA 2017. This symposium will hope to bring these issues to the fore by way of the proposed symposium.
5: Current trends in suicide in India: What is the way forward?
Senthil Reddi, Sydney Moirangthem,
NIMHANS, Bengaluru, Karnataka,1Hi-tech Medical College and Hospital, Bhubaneswar, Odisha, India.
Suicide is a public health problem of epidemic proportion. Suicide has been defined as death caused by self-directed injurious behavior with an intent to die as a result of the behavior; whereas suicide attempt is as a nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior even if the behavior does not result in injury.
Suicide is a complex and multidimensional phenomenon with more than 8 lakh people committing suicide every year worldwide. For the year 2020, the WHO estimates that approximately 1.53 million people will die of suicide while suicide attempters will be 10–20 times higher. Suicide and suicide behavior together are the sixth and ninth leading causes of global disease burden among men and women aged 15–44 years, respectively. Suicide rate was 10.6 in India according to the National Crime Research Bureau data 2015, and 71% of suicides in India are below the age of 44 years imposing huge socioeconomic burden on the society.
In this symposium, we discuss the socio-cultural-clinical factors and the biological underpinnings, including the genetic vulnerability factors and means to address this health problem.
6: Role of pharmacogenetics in psychiatry: Promises and challenges in digital era
Debadatta Mohapatra, Jitendriya Biswal, Soumya Ranjan Dash
IMS and SUM Hospital, Bhubaneswar, Odisha, India.
Topics and Speakers
Why we need pharmacogenomics: Debadatta MohapatraReal-world applications; pros and cons: Jitendriya BiswalFuture directions in digital era: Soumya Ranjan Dash.
Psychiatric disorders are well known to have genetic origin. Candidate gene studies and genome-wide approaches can help in understanding the complex genetic architecture and offer insight into the neurobiology of psychiatric disorders and their proper management.
Since pharmacogenomically avoidable events are reported, such as the death of a child exposed to fluoxetine, with CYP2D6 poor metabolism, it is important that clinicians act on the available evidence. de Leon suggests that the approach of psychiatric pharmacologic treatment should change: Clinicians need to personalize their pharmacologic interventions as much as possible, but the field needs to also consider subdividing psychiatric syndromes into groups that may be more homogeneous based on treatment responses.
The Food and Drug Administration (FDA) listed over 100 medications with pharmacogenomics biomarkers in drug labeling and 26 of these are psychotropic medications.
The FDA now recommends that all patients of the Asian descent be tested for a specific variant of the HLA-B gene before initiating therapy to avoid carbamazepine-induced Stevens–Johnson syndrome/toxic epidermal necrolysis. While this is a valuable, and potentially lifesaving, discovery, it is clearly only a first, small step toward a broader application of pharmacogenomics in psychiatry.
One thing is already clear from pharmacogenomics in psychiatry: Tests do not select drugs. Prescribers do. That is, it is highly unlikely that any single test will ever dictate which drugs to prescribe or not to prescribe in most cases.
Despite notable progress over the past decade, the promise of pharmacogenetics in psychiatry has not yet been fully realized yet. The major obstacle to translating the promise into reality is that we still do not have a clear understanding of how genetic factors influence treatment response to psychotropic medications. The studies carried out, to date, suggest a number of intriguing hypotheses that merit further studies, but they do not point to any definitive associations that can be used with confidence to predict how a patient will respond to a particular treatment. The difficulty with the pharmacogenomic associations thus far reported is the lack of consistent findings.
By personalizing treatments to psychotropic medications, pharmacogenomic testing holds great promise to dramatically improve care in psychiatry. Pharmacogenomic test results orient the advanced prescriber's thinking along a neurobiological perspective to select treatments that are biologically plausible, rather than just utilizing intuition, habit, or trial and error. This appears to have the potential to improve drug selection and treatment cost-effectiveness.
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7: Nature and nurture: 1000 days – The critical period for emergence of autism and autistic spectrum disorders
Manoj Kumar Das, Arun Kumar Singh1
The INCLEN Trust International,1RBSK, Ministry of Health and Family Welfare, Government of India, New Delhi, India.
E-mail: [email protected]
To discuss the various potential causes and risk factors of autism and autistic spectrum disordersTo discuss the critical factors that can be modified or adopted for preventing or minimizing the severity of autismTo discuss the relevance of these for clinical and social practices for the management of ASD.
Autism spectrum disorder (ASD) is an early-onset neurodevelopmental condition characterized by alterations in social communication and interaction in conjunction with repetitive, inflexible behaviors and circumscribed interests causing significant impairment in major life areas and reduced quality of life. ASD is an umbrella term inclusive of disorders arising from extreme variations or qualitative alterations in the maturation, architecture, and functioning of the developing brain. The global prevalence and diagnoses rates of ASD have risen substantially in the last two decades reaching 1%–2.5%, with some male predominance. In India, the pooled prevalence is 1%–1.4% with some variation across regions. Usually, ASD is diagnosed around 3–4 years and studies suggest that the symptoms emerge in the first 2 years of life.
The exact cause of ASD is not known; multiple etiologies related to genetic, host, and environmental interaction have been proposed. The biological risk factors include maternal and paternal age, prenatal fetal environment (sex steroids, maternal infections, immune activation, obesity, diabetes, and hypertension), perinatal events (fetal stress and hypoxia), medication (valproate and serotonin reuptake inhibitors), smoking/alcohol use, nutrition (Vitamin D, iron, and folate), toxin exposures (air pollution, heavy metals, pesticides, and organic pollutants), and fetal factors (low birth weight). The prenatal and postnatal psychosocial environment, stress, deprivation, and migration/immigration have also been proposed as risk factors for the neurobehavior modeling. Many of these factors may not be directly causal and operate through the gene–environment interactions, which require further exploration. While genetic factors have been estimated to be around 38%–55% for ASD, the twin and family studies suggest a smaller role for genes than previously thought, indicating a greater role for gene–environmental interaction., Immune dysregulation, inflammatory responses, altered gut microbiome associated with gut–brain–immune axis disturbance have been suggested to be responsible for ASD.
Although different patterns of long-range under-connectivity or short-range over-connectivity between multiple brain regions or networks, including corticostriatal, thalamocortical, and other regions, abnormal segregation and integration of resting-state networks and idiosyncrasy of connectivity have been hypothesized in autism. There was poor generalizability for functional connectivity across sites. The functional connectivity features did not correlate with different types of autism symptoms. The first 2 years represents a crucial period of brain development characterized by both axonal pruning and synaptogenesis to build up and strengthen cortical networks.
The family and immediate social environment and the interaction with the child during first 1000 days related to the sociocultural, migration, language, economic status, dietary, and other child development stimulation exposures shape the emergence and modulation of severity.
While there is limited understanding about the exact cause and risk factors that influence emergence and modulation of ASD severity, the management strategies include behavioral analysis, speech and language, occupational and behavioral therapy, and dietary and medical interventions, which require parents and family involvement with creation of a conducive environment. Although a generic guidance for management is followed, an individualized plan and execution based on the status, skill acquisition, and family support is adopted. Under the Rashtriya Bal Suraksha Karyakram, the children are screened for neurodevelopment disorders including ASD, followed by diagnosis using confirmatory tools. The program provides option of intervention for such children through the district early intervention centers and referral centers.
Despite the available evidence, there is further need for improving the evidence base on genetic and environmental etiological or risk factors for autism/ASD, mapping the critical time points of vulnerability.
Lyall K, Croen L, Daniels J, Fallin MD, Ladd-Acosta C, Lee BK, et al. The changing epidemiology of autism spectrum disorders. Annu Rev Public Health 2017;38:81-102.Arora NK, Nair MK, Gulati S, Deshmukh V, Mohapatra A, Mishra D, et al. Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India. PLoS Med 2018;15:e1002615.Sandin S, Lichtenstein P, Kuja-Halkola R, Larsson H, Hultman CM, Reichenberg A. The familial risk of autism. JAMA 2014;311:1770-7.Hallmayer J, Cleveland S, Torres A, Phillips J, Cohen B, Torigoe T, et al. Genetic heritability and shared environmental factors among twin pairs with autism. Arch Gen Psychiatry 2011;68:1095-102.Sharon G, Cruz NJ, Kang DW, Gandal MJ, Wang B, Kim YM, et al. Human gut Microbiota from autism spectrum disorder promote behavioral symptoms in mice. Cell 2019;177:1600-18.e17.King JB, Prigge MB, King CK, Morgan J, Weathersby F, Fox JC, et al. Generalizability and reproducibility of functional connectivity in autism. Mol Autism 2019;10:27.Rashtriya Bal Swasthya Karyakram (RBSK), Ministry of Health & Family Welfare, Government of India. Available from: https://rbsk.gov.in/RBSKLive/. [Last accessed 17 Oct 2019].
8: What's new in ICD-11: From conceptualization to impact in psychiatry
Jayapaprakash Russell Ravan, Jigyansa Ipsita1, P. V. R. Pratheek
Department of Psychiatry, Kalinga Institute of Medical Sciences,1Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
ICD-11: Introduction, conceptual differences from ICD-10 in psychiatric diagnoses: Dr. PVR PratheekNewer diagnostic entities in ICD-11 related to psychiatry: Dr. Jigyansa IpsitaCoding and possible impact of ICD-11 at various levels – Social, research, day-to-day practice: Dr. Jayaprakash Rusell Ravan.
The advance preview and understanding of ICD-11 will allow in future planning and clinical utility of the new version. Our symposium will help the participants to have insight into the process of development of ICD-11, conceptual changes of future nosological system, as compared to ICD10. Other important learning objective would be to find out new diagnostic entities in the field of mental health and psychiatric illnesses. The proposed symposium would also throw light upon the possible coding system and its future implication in the area of research and clinics, which might revolutionize the understanding of psychiatric disorders.
Substantial advancements in medicine and biological sciences have occurred over the last few decades. In the current scenario, ICD-10 is gradually perceived as outdated, both clinically and from a classification point of view. The ICD is the foundation for identifying health trends and statistics worldwide and contains around 55,000 unique codes for injuries, diseases, and causes of death. It provides a common language that allows health professionals to share health information across the globe. The development of the ICD-11 over the past decade is based on the principles of clinical utility and global applicability. ICD-11 will be one of the broadly international, multilingual, multidisciplinary, and participative revision processes ever implemented for a classification of mental disorders. There is a felt need in the area of mental illness for crucial structural and conceptual changes. These changes are proposed and adopted through a rigorous process in psychiatric diagnosis, such as neurodevelopmental disorders, neurocognitive disorders, obsessive–compulsive (OC)-related disorders, and PTSD. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
Abstract for Each Presentation
Topic 1: ICD-11: Introduction, Conceptual differences from ICD-10 in Psychiatric Diagnoses
Changes in the ICD-11 include the provision of consistent and systematically characterized information, lifespan approach, and culture-related approach for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence. Here, we describe major conceptual changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, such as in the area of neurocognitive disorders, neurodevelopmental disorders, anxiety/fear-related disorders, and OC-related disorders.
Topic 2: Newer Diagnostic Entities in ICD-11 Related to Psychiatry
To demonstrate set of new categories, those have been added to the ICD-11 and present the rationale for their inclusion. Based on scientific validity, consideration of clinical utility, and global applicability, a number of new disorders have been added to the ICD-11. Description of these new diagnostic entities at various levels includes bipolar II disorder, Internet gaming disorder, prolonged grief disorder, complex PTSD, AFRID, and bodily distress disorder.
Topic 3: Coding and Possible Impact of ICD-11 at Various Levels – Social, Research, Day-to-Day Practice
To bring the uniformity in the registry of mental illnesses, appropriate coding is essential across counties and regions of the world. Coding pattern of various psychiatric disorders under ICD-11 is being changed. The digital version of coding tool – ICD-11 Coding Tool, Mortality and Morbidity Statistics, April 2019 will be demonstrated. The psychiatric disorders are coded from 6A00 to 6Z99. Some disorders such as sleep-related and sexual-related health problems are coded elsewhere. This new version of ICD-11 can have significant impact at various levels, such as epidemiological prevalence of disorders, research on newer diagnostic entities, and changes in day-to-day clinical practice.
Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, et al. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019;18:3-19.ICD-11, Classification of Diseases by WHO. Available from: https://www.who.int/classifications/icd/en/. [Last accessed 2019 Oct 17].ICD-11 Coding Tool, Mortality and Morbidity Statistics. Available from: https://icd.who.int/ct11/icd11_mms/en/release. [Last accessed 2019 Oct 17].
Keywords: Coding, conceptual changes, ICD-10, ICD-11, new psychiatric diagnosis
1: 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 are large data available for adult population on these aspects, data are lacking for EOBD patients.
Methods: The participants were adults with EOBD defined as onset of first episode before 18 years on mood stabilizers for more than 2 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 (QoLs) using Brief QoL.BD and global assessment of functioning (GAF) scale.
Results: The QoLs and GAF 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 EOBD to improve their long-term socio-academic outcome.
Keywords: Bipolar disorder, early onset, quality of life, socio-academic outcome
2: A study to assess psychological well-being and quality of life among caregivers of cancer patients at AIIMS, Bhubaneswar
Geetanjali, Neetu Kataria
E-mail: [email protected]
Introduction: Cancer is a chronic illness. It evolves throughout the patient's lifetime. Prevalence of psychological issues such as depression was varied from 21% to 62% among caregivers of cancer patients. The impact of this disease also affects the quality of life of the caregivers.
Aim: To assess the psychological well-being and quality of life among caregivers of cancer patients at AIIMS, Bhubaneswar.
Materials and Methods: A descriptive cross-sectional survey was done on 64 caregivers of cancer patients admitted to the Medical Oncology, AIIMS, Bhubaneswar, with the use of purposive sampling technique.
Tools: A subject profile including demographic and clinical variables was used in this study. Hospital anxiety and depression scale (HADS) and WHOQOL-AGE were used.
Results: It will be disclosed in scientific paper presentation.
Keywords: Caregiver, psychological well-being, quality of life
3: The relationship between alexithymia and cognitive abilities in gaming addiction
Christ University, Bengaluru, Karnataka, India.
Introduction: As with addictions of all kinds, gaming addiction is likely the symptom of underlying issues that have not been addressed in the 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. Moreover, second objective is to describe the investigated relationship between alexithymia and cognitive abilities among individuals with gaming addiction. Article search of 15 published articles between 2000 and 2019 in Medline, PubMed, Google Scholar, Bielefield Academic Search Engine, and ProQuest, on cognitive function and alexithymia relation with video game addiction was carried out. Nine abstinent “ecstasy” hard core gamers and eight control subjects were scanned at baseline using screening test. Clinical scales (IGD 20 and GHQ and TAS-20) and cognitive scales (NIMHANS Neuropsychological Battery) were 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 the results would further indicate whether any relationship exists 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 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.
4: 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: here is a paucity of systematic data on caregiver burden and disability among patients with somatoform disorders.
Aims and Objectives: To assess the 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 the International Classification of Diseases (ICD)-10, clinical descriptions, and diagnostic guidelines, as well as their caregivers. The WHO Disability Assessment Schedule 2.0 and Family Burden Interview Schedule were used to assess patient disability and caregiver burden, respectively. Independent Student's t-test or Chi-square analysis was used to compare relevant sociodemographic and clinical parameters.
Results: The mean age of sample was 38.6 (±10.5) years. Females constituted a slender majority of sample (n = 29, 51.8%). The mean disability score 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: Caregiver burden, disability, schizophrenia, somatization, somatoform disorders
5: A case with both obsessive–compulsive disorder and psychosis: Diagnostic dilemma
Tathagata Biswas, Suravi Patra, Santanu Nath, Tanay Maiti, Susanta Kumar Padhy
AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]
Background: It is not uncommon for nonaffective psychosis such as schizophrenia and related disorders to present with obsessive–compulsive (OC) symptoms at the initial phase of illness. Again, there have been reports of severe OC disorder (OCD) presenting with poor insight and psychosis.
Summary: We discussed a case of 30-year-old male presenting with a 5-day history of psychotic symptoms, such as fearfulness, persecutory delusions, auditory hallucinations, self-muttering, and disturbed biological functions. Before the onset, he was suffering from marked OC symptoms for 2 years, such as ordering/arranging compulsions, compulsive rituals, and magical thinking with secondary depression and somatic complaints. He had a history of a severe depressive episode without psychotic symptoms remitting completely with pharmacotherapy. The family history was noncontributory. In the ward, he was managed with aripiprazole gradually hiked to 20 mg/day. His psychotic symptoms rapidly resolved in 7 days, and the underlying OC symptoms resurfaced. However, the patient lacked insight, and escitalopram was added at 10 mg/day along with psychotherapy. He responded well.
Conclusion: For this case, a DSM-5 diagnosis of OCD with absent insight/delusional beliefs was kept. However, ICD fails to incorporate psychosis in OCD symptomatology. Using ICD-10, the diagnosis would be acute transient psychotic disorder with a separate diagnosis of OCD.
Since the primary diagnosis (psychosis or OCD) of the present state decides the current management, diagnostic dilemma initially posed the problem of prescribing an antipsychotic or an antidepressant in this patient. Such dilemmas provide room for modifications in the diagnostic criteria and further study about the illness course.
Keywords: Obsessive–compulsive disorder with delusions, obsessive–compulsive disorder with poor insight, obsessive–compulsive disorder with psychosis, prodrome, psychosis with obsessive–compulsive symptoms, severe depression
6: 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 Ravan1
AIIMS,1KIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Recurrent or self-induced vomiting can be caused independently by a plethora of surgical and medical reasons, all of which need to be effectively ruled out before treating in lines of psychogenic origin. Further, the difficulty in stopping the behavior calls for more scientific approach for its management.
Aims and Objectives: To propose a scientific and logical approach for diagnosis and management 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 thereby proposed keeping in view of the nonpsychiatric causes. Finally, an effective treatment for psychogenic recurrent/self-induced vomiting is provided.
Conclusion: Psychogenic is not simple behavior easy to stop. A mental health professional must also consider the nonpsychiatric causes of recurrent vomiting before starting on treatment. This includes common etiologies such as gastritis, peptic ulcer disease, hepatitis, appendicitis, pancreatitis, cholecystitis, gastrointestinal obstruction, irritable bowel syndrome, pregnancy, uncontrolled diabetes, constipation, and sore throat.
A detailed history accompanied by investigations, such as complete hemogram, ABG, antibody titers, plain abdominal X-ray, or contrast-enhanced computed tomography, often becomes indispensable in clinching the diagnosis. Therefore, a rational approach to such a case is needed to prevent undertreatment or wrong treatment and assure effective management.
Keywords: Eating disorder, psychogenic vomiting, recurrent vomiting, self-induced vomiting
7: 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 min, a child is sexually abused in India. The dynamics of child sexual abuse is different from adult abuse. There are increasing instances of sexual crimes with perpetrator–glorification of sexual abuses and multiple loopholes in the Indian Judicial system. In the light of rise in the incidence of quite frightening and emotionally disturbing sexual offenses on children, the reason behind such acts on children needs deep reflection.
Aims and Objectives: To study the societal underpinnings of increasing childhood sexual abuse.
Methodology: Existing literature on child sexual abuse is studied and its varied scenario is delineated. The PubMed database was extensively searched using Keywords: child sexual abuse, children and rape, rape and society, and 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 western culture and changings standing on morality. Sexual liberation with pornography enacting on unusual sexual fantasies opens way for experimentation. This cultivates perverted sexual desires that pave a way for seeking instant gratification without fear of the law or any moral inhibition. In the absence of adequate marital sexual satisfaction, with partner-specific incompatibility, the target of sexual gratification is probably shifting toward a more vulnerable class – the children.
Keywords: Child sexual abuse, childhood abuse, children and rape, rape and society
8: A case report of chronic subdural hemorrhage presenting as dissociative stupor
Sujata Sahoo, Saswati Sucharita Pati
Department of Psychiatry, SCB MCH, Cuttack, Odisha, India.
Introduction: Conversion disorder can be a misleading diagnosis; up to 30% of patients diagnosed with conversion symptoms were subsequently discovered to have misdiagnosed organic illness. However, with the availability of neuroimaging techniques, such as magnetic resonance imaging, and other new investigative methods, missed organic illness may account for 4%–15% of individuals initially given a diagnosis of conversion disorder. To avoid this error, all patients must be medically investigated thoroughly before a diagnosis of conversion disorder is given.
Aims and Objective: To follow and review a case of chronic subdural hemorrhage (SDH) presenting as dissociative stupor.
Methodology and Results: SD, 36 years HM from Bhadrak, presented with c/c of remaining withdrawn, excessive drowsiness for 2 months and not taking food and water for 5 days after the incident of one female in her village accusing him for doing black magic to her and financial crises, with acute onset and fluctuating course admitted with a provisional diagnosis of dissociative stupor. All the blood parameters and computed tomography (CT) scan were found to be normal. After giving injection lorazepam, the patient deteriorated. The case was reviewed with neurology and neurosurgery department after the brain magnetic resonance imaging report of SDH bilateral frontontoparital convexity and RBC+++ in the cerebrospinal fluid after lumbar punctur. Immediate craniotomy was done and he recovered with Glasgow coma scale 15.
Conclusion: 25%–50% of cases classified as conversion disorder eventually receive diagnoses of neurological or nonpsychiatric medical disorders such as brain tumors, SDH, and basal ganglia disease; hence, possible causes need to be rule out before diagnosis dissociative disorder for better patient care.
Keywords: Conversion disorder, chronic subdural hemorrhage, neurological disorder
9: Mental health at workplace and risk of substance abuse in India
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Background: The changing world of work in India has undermined the relevance of mental health, despite this issue being in limelight for the past two decades. Unhealthy workplace opens the gate to various occupation-related mental health problems such as depression, anxiety, sleep disturbances, and substance abuse.
Discussion: Substance abuse being precipitated, maintained, or aggravated due to strenuous or stressful jobs is a well-known phenomenon. The demand control model for psychosocial work environment suggests that risk of substance abuse among those working at high strain or demanding workplace should be more as compared to low strain workplace, more so among males. Occupational characteristics of increased working hours, physically risky environment, job insecurity, sense of powerlessness, lack of control over work conditions, and fear of layoffs are associated with high risk of substance abuse, especially alcohol. Other workplace characteristics such as access to substance, workplace subculture including values and beliefs associated with substance intake, and low organizational bond also play a substantial role. Individual characteristics such as age of onset, personality, low self-esteem, history or comorbid psychiatric illness, family discord, family history of substance abuse, and self-selection process influence such risk. Indian data are unclear, limited to single occupations, and scanty to substantiate the problem picture.
Summary: Workplace and individual characteristics dynamically influence risk of substance abuse. Although there are some data from the west, Indian literature is scanty to substantiate the problem figure. Hence, this area is subject to further research to calculate vulnerable groups and organizations to address their needs.
10: Cybersex addiction – Future in India
Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India.
E-mail: [email protected]
Introduction: Easy and cheap availability of Internet in India has considerably increased the internet surfers in the last 20 years. A large population uses it for online sexual activities (OSAs). Cybersex is one of the subcategories of OSA. Cybersex is an upcoming form of behavioral addiction, involving interactive erotic experience, where participants have real-time sexual exchanges online (through texts, audios, videos, etc.) with the purpose of sexual arousal and stimulation.
Aims and Objectives: To see the risk factors and implications of cybersex addiction in India.
Methodology: Indian and western literature was reviewed for this purpose.
Results:“Cybersex addiction” (CA) is an excessive and uncontrolled use of OSAs associated with tangible negative outcomes and functional impairment. There are no defined diagnostic criteria for it. Cyber-affairs have led to breach of trust and emotional alienation among partners and thus offline infidelity. Marriages fail due to dissatisfaction in sexual relations, divorce, or separation. Broken homes may have tragic effects on mental health of bereaved family, especially children. Society suffers due to secondary adultery, pedophilia, cybercrimes, and loss in finances and occupation. Risk factors of CA are problems in attachment, distorted body image, low self-esteem, untreated sexual dysfunction, thrill seeking, and prior sexual addiction. On the contrary, being in a relationship, satisfaction with sexual contacts, and use of interactive cybersex are not associated with CA. An integrative approach in the management with psychosocial, cognitive, behavioral, and pharmacological methods is required.
Conclusion: CA has huge implications to individual and society. Therefore, the proper address and management are warranted. However, it is untested water in India; future research should be directed to address the issue.
Keywords: Cybersex, cybersex addiction, online sexual activities
11: Religious delusions in mania – An outcome study
Prathamesh Hemnani, Basudeb Das, Roshan Khanande
Central Institute of Psychiatry, Ranchi, Jharkhand, India.
E-mail: [email protected]
Introduction: Religion and spirituality exert a significant role in the lives of many individuals, including people suffering from psychiatric disorders. Understanding more about the relationship between religion/spirituality and bipolar disorder is particularly important in that the symptoms of bipolar disorder often include religious delusions. Individuals with bipolar disorder, particularly during episodes of psychosis, frequently report mystical experiences with religious themes.
Aims of the Study: To assess the parallels between personal religiosity in patients and religious practices in key caregivers of mania ( first episode or bipolar) patients with religious delusions.
Methodology: Patients having mania ( first episode or bipolar) were selected and recruited into two groups of religious delusions and nonreligious delusions after applying Siddle's algorithm for religious content. The BMMRS (item of private religious practices) would be applied on the patient when amenable and also on the caregiver where possible to assess the premorbid religiosity. The Supernatural Attitude Questionnaire for magico-religious beliefs would be applied on key caregivers of both the groups either at the time of admission or at the time of discharge.
Results and Discussion: It would be presented at the time of presentation.
Keywords: Magico-religious beliefs, mania, religion
12: A Study of sociodemographic profile, serostatus of anti-HCV antibodies and HBsAg antigen, and prevalence of psychiatric comorbidity among patients of substance dependence syndrome presenting to tertiary care de-addiction center
Avinash Jhajharia, Arvind Sharma
Department of Psychiatry, GGS Medical College, Faridkot, Punjab, India. E-mail: [email protected]
Introduction: Studies have shown that the prevalence rates of the blood-borne viral infections as well as the co-occurrence of mental disorders are higher among individuals with prolonged drug use. However, there is a paucity of published data to assess the extent of seroprevalence of viral markers along with psychiatric comorbidity in patients of substance dependence syndrome other than injection drug users.
Aims and Objectives: To study the sociodemographic profile, the seroprevalence of anti-HCV antibodies and HBsAg antigen, and the prevalence of comorbid psychiatric disorders among patients of substance dependence syndrome.
Methodology: The present study was a cross-sectional, tertiary care drug de-addiction center-based study with a sample size of 100. Sociodemographic profile was noted with sociodemographic pro forma. Blood samples (5 ml) were analyzed for anti-HCV antibodies and HBsAg antigen using ELISA test. Screening for any psychiatric illness was assessed by SRQ 20 on day 10 of detoxification. The persons scoring more than 7 on SRQ 20 were administered MINI for making final diagnosis as per the ICD-10 criteria that was further confirmed by the consultant of psychiatry department.
Results: The overall seroprevalence of hepatitis B and hepatitis C infection in 100 patients of substance dependence syndrome in our study was 5.0% and 14%, respectively, and among injecting drug users was 9.5% and 33.3%, respectively, and 29% of patients had comorbid psychiatric illness according to the MINI scale.
Conclusion: Irrespective of the main route of drug administration, individuals with substance dependence syndrome were at increased risk of blood-borne viral infections and psychiatric disorders.
Keywords: Hepatitis B, hepatitis C, psychiatric disorders