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   Table of Contents - Current issue
Coverpage
January-June 2016
Volume 25 | Issue 1
Page Nos. 1-121

Online since Monday, December 19, 2016

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EDITORIAL  

Empathy: Process of adaptation and change, is it trainable? p. 1
Kalpana Srivastava, RC Das
DOI:10.4103/0972-6748.196055  PMID:28163400
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REVIEW ARTICLE Top

Psychological effects of amputation: A review of studies from India p. 4
Anamika Sahu, Rajesh Sagar, Siddharth Sarkar, Sushma Sagar
DOI:10.4103/0972-6748.196041  PMID:28163401
Amputation is a major health burden on the families, society, and on medical services as well. Traumatic limb amputation is a catastrophic injury and an irreversible act which is sudden and emotionally devastating for the victims. In addition, it causes inability to support self and the family and driving many patients toward various psychiatric disorders. Extensive information regarding the effects of amputation has not been ascertained and therefore it was decided to do a systematic review. The goal of this review was to provide comprehensive information of peer-reviewed papers examining the psychological distress among amputees in India. A search of the literature resulted in a total of 12 articles with varied sample size from 16 to 190. The sample has been largely comprised males with lower limb amputation caused by primarily traumatic ones, i.e., motor vehicle accident, railway track accidents, machinery injury, blasts, etc., The prevalence of psychiatric disorders among amputees has been found to be in the range of 32% to 84% including depression rates 10.4%–63%, posttraumatic stress disorder 3.3%–56.3%, and phantom limb phenomenon 14%–92%. Although the studies reported that symptoms of anxiety and depression become better over the course of time, however surgical treatment providers need to liaise with psychiatrists and psychologists to support and deal with the psychological disturbances.
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ORIGINAL ARTICLES Top

Clinical experience of baclofen in alcohol dependence: A chart review p. 11
Abhijit R Rozatkar, Abhishek Kapoor, Ajeet Sidana, Bir Singh Chavan
DOI:10.4103/0972-6748.196043  PMID:28163402
Introduction: Craving is recognized as a formidable barrier in the management of patients with alcohol dependence. Among pharmacological agents that have been used in experimental studies for reduction in craving, baclofen appears to have a significant advantage over other agents. Methodology: The study is retrospective chart review of patients (n = 113) who have been treated with baclofen for alcohol dependence in a tertiary hospital of North India. Baseline assessments included sociodemography, motivation, quantity-frequency of alcohol use, and other alcohol-related clinical parameters. Weekly assessments, for a period of 4 weeks, were extracted from records which included dose of baclofen, craving intensity, and alcohol consumption. Results: The study sample was predominantly male, mean age of 41.49 (±9.75) years, most having a family history of substance use (70.97%), and many reporting binge use pattern in last year (49.46%). Baseline assessment revealed 48.7% of the sample was in precontemplation phase for alcohol use and 70% reported severe and persistent craving. This persistent craving was reported by only 15% of the sample by the end of 4 weeks treatment with baclofen (20–40 mg/day). Thirty-four percent of patients reported continued problematic use of alcohol by the end of 4 weeks. Conclusion: Our clinical experience suggests that baclofen reduces craving and alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol. Considering that baclofen is safe in those with liver cirrhosis and reduces withdrawal symptoms due to alcohol, a controlled trial comparing it with standard treatment is required.
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Medical students' attitude toward suicide attempters p. 17
Naresh Nebhinani, Savita Chahal, Amit Jagtiani, Mamta Nebhinani, Rajiv Gupta
DOI:10.4103/0972-6748.196050  PMID:28163403
Background: Majority of health professionals have unfavorable attitudes toward the patients presenting with self-harm, which further compromises their therapeutic endeavors and outcomes. Objectives: This study was aimed to assess the medical students' attitudes toward suicide attempters. Materials and Methods: A cross-sectional study was conducted in a tertiary care medical institute of Haryana, a Northern state of India. Two hundred and five final year medical students were recruited through total enumeration method. “Suicide Opinion Questionnaire” was administered to assess their attitudes toward suicide attempters. Results: Only minority had previous exposure of managing any suicidal patient and attended suicide prevention programs. Majority agreed for suicide attempters being lonely and depressed. Nearly half of the students reported small family, disturbed interpersonal relationship, weak personality, self-punishment approach, cultural inhibitions in emotional expression, national instability, and disbelief in afterlife, as a major push to attempt suicide. Compared to boys, girls reported the greater contribution of weak personality and self-destructive behaviors and lesser contribution of family disturbances and religious convictions as suicide triggers. They held favorable attitude for only one-third of the attitudinal statement, and they were uncertain for two-third of the attitudinal statements. Conclusions: Such a high proportion of uncertain responses imply toward lack of awareness and clinical expertise for managing suicide attempters. It also signifies the urgent need for enhancing their educational and clinical exposure, to improve their attitudes toward patients presenting with self-harm.
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Self-injurious behavior, emotion regulation, and attachment styles among college students in India p. 23
Naphisabet Kharsati, Poornima Bhola
DOI:10.4103/0972-6748.196049  PMID:28163404
Context: Intentional self-directed acts of injury are the most common among adolescents and young adults. Developmental psychopathology theories that conceptualize pathways to self-injurious behaviors (SIBs) implicate insecure attachment representations and inadequate self-regulatory skills to cope with emotional distress. Aims: The study aimed to examine relationships between SIBs, attachment, and emotion regulation among college students. Materials and Methods: A total of 470 participants from undergraduate and postgraduate colleges completed the functional assessment of self-mutilation questionnaire, attachment style questionnaire, and the difficulties in emotion regulation scale. Results: Results indicated that 31.2% of the participants reported SIB in the past year, with the mean age of onset being 15.9 years. Moderate/severe forms of self-injury (e.g. cutting, burning) were reported by 19.8% of the sample. Self-injuring youth reported higher levels of anxious attachment, preoccupation with relationships and need for approval in relationships, and difficulties in all domains of emotion regulation. Logistic regression analysis identified preoccupation with relationships and impulse control difficulties as predictors of SIB. Conclusions: The findings have implications for comprehensive interventions for self-injuring youth.
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Comparison of psychiatric morbidity in patients with irritable bowel syndrome and non-ulcer dyspepsia p. 29
Susanta Kumar Padhy, Surbhi Mishra, Siddharth Sarkar, Govind Bang, Mahima Panigrahi
DOI:10.4103/0972-6748.196038  PMID:28163405
Background and Aims: The present study aimed to find psychiatric morbidity, stress, anxiety, and depression in patients with irritable bowel syndrome (IBS) and compare it with patients having non-ulcer dyspepsia (NUD). Methods: This case NUD study compared 50 patients each with IBS and NUD. The two groups were compared on demographic data, psychiatric diagnosis using the Structured Clinical Interview for DSM-IV Axis 1 disorders, anxiety levels using the Hamilton Anxiety Rating Scale (HAM-A), and depression using the Hamilton Depression Rating Scale (HAM-D). The Presumptive Stressful Life Events Scale (PSLES) was used to measure stress. Results: The cases of IBS were more likely to be of female gender (P = 0.012), married (P = 0.009), and employed (P < 0.001). Psychiatric diagnoses were more common in the cases of IBS than NUDs (88% vs. 30%, P< 0.001), the most common being major depression and somatization disorder. Symptoms of anxiety and depression were more common in patients with IBS (P < 0.001 for HAM-A and HAM-D). Logistic regression revealed that having IBS and increased age were independent predictors of having a psychiatric diagnosis. Conclusions: IBS is associated with the considerable degree of psychiatric morbidity. Adequate attention should be paid toward comorbid psychiatric illnesses, and prompt treatment should be instituted.
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Prevalence of comorbid anxiety disorders in schizophrenia p. 35
Chandra Kiran, Suprakash Chaudhury
DOI:10.4103/0972-6748.196045  PMID:28163406
Background: Diagnostic and treatment hierarchical reductionisms have resulted in an oversight of anxiety syndromes in schizophrenia. Aim: The aim of this study was to find the prevalence of different anxiety disorders in schizophrenia patients. Materials and Methods: The study was conducted on inpatients of a tertiary care psychiatric hospital using a prospective, purposive sampling technique. The study consisted of 93 schizophrenia patients and a similar number of normal controls. The schizophrenia patients and controls were evaluated for psychopathology and the presence of anxiety disorder. Results: The prevalence of anxiety disorder was significantly higher in schizophrenia patients (45.16%) compared to controls (16.12%). Further, the prevalence of panic disorder, social anxiety disorder, and obsessive-compulsive disorder (OCD) was significantly higher in schizophrenia patients. No significant correlation was observed between anxiety disorder scores and psychopathology scores. Conclusions: The prevalence of comorbid anxiety disorders (panic disorder, social anxiety disorder, and OCD) in schizophrenia is significantly higher in the general population. The onset of anxiety disorder commonly precedes the onset of schizophrenia.
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Personality correlates of criminals: A comparative study between normal controls and criminals p. 41
Sudhinta Sinha
DOI:10.4103/0972-6748.196058  PMID:28163407
Background: Personality is a major factor in many kinds of behavior, one of which is criminal behavior. To determine what makes a criminal “a criminal,” we must understand his/her personality. This study tries to identify different personality traits which link criminals to their personality. Materials and Methods: In the present study, 37 male criminals of district jail of Dhanbad (Jharkhand) and 36 normal controls were included on a purposive sampling basis. Each criminal was given a personal datasheet and Cattel's 16 personality factors (PFs) scale for assessing their sociodemographic variables and different personality traits. Objective: The objective of this study was to examine the relation between personality traits and criminal behavior, and to determine whether such factors are predictive of future recidivism. Results: Results indicated high scores on intelligence, impulsiveness, suspicion, self-sufficient, spontaneity, self-concept control factors, and very low scores on emotionally less stable on Cattel's 16 PFs scale in criminals as compared with normal. Conclusion: Criminals differ from general population or non criminals in terms of personality traits.
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A Comparative study of Personality as a common pathway in HIV Sero-positive and Alcohol dependent cases on Five Factor Model p. 47
Kalpana Srivastava, Amool R Singh, Suprakash Chaudhury
DOI:10.4103/0972-6748.196052  PMID:28163408
Aim: The aim of this study was to identify the personality traits of alcohol and human immunodeficiency virus (HIV)-positive patients and to compare them with normal controls. Materials and Methods: This cross-sectional study included 100 consecutive patients with alcohol dependence and HIV each and a control group of 100 normal cases without any physical or psychiatric illness. A score of 2 or less on the General Health Questionnaire was taken as cutoff, and the participants were included in the study with written informed consent. All participants were assessed with the NEO personality inventory revised and sensation-seeking scale (SSS). Results: There were significant differences among the study group on all the five factors, i.e., neuroticism (N), extraversion (E), conscientiousness (C), openness to experience (O), and agreeableness (A). On factor “N,” HIV and alcohol group scored significantly more as compared to normal group. Odds ratio revealed high neuroticism to be a risk factor in alcohol-dependent and HIV cases (P < 0.05). The normal group scored significantly higher on factor “E” as compared to HIV and alcohol cases. High scores on factor “E” and “C” have a protective. Odds ratio found low score of factor “C” as a risk factor; however, “O” did not emerge as a risk factor. The logistic regression revealed that high scores on “N” and “E” and low “A” score had a significant association with alcohol dependence (P < 0.05). Among HIV cases, high score on “N” and “E” and low “C” score emerged significant. Alcohol cases scored significantly more on boredom susceptibility (BS) on SSS as compared to HIV and normal controls. On disinhibition (DIS), HIV cases and alcohol cases scored significantly higher as compared to normal group (P < 0.05). Conclusion: High “N” scores on NEO personality inventory are significantly associated with alcohol dependence and HIV while high scores on “E” and “C” have a protective effect. On SSS, HIV-positive cases are characterized by high DIS scores while alcohol dependence is associated with high scores on BS and DIS.
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Validation of vocational assessment tool for persons with substance use disorders p. 59
Lakshmanan Sethuraman, BN Subodh, Pratima Murthy
DOI:10.4103/0972-6748.196051  PMID:28163409
Background: Work-related problems are a serious concern among persons with substance use but due to lack of a standardized tool to measure it; these problems are neither systematically assessed nor appropriately addressed. Most existing measures of work performance cater to the needs of the workplace rather than focusing on the workers' perception of the difficulties at work. Aim: To develop a standardized instrument to measure work-related problems in persons with substance use disorders. Methods: Qualitative data obtained from interviews with substance users were used to develop a scale. The refined list of the scale was circulated among an expert panel for content validation. The modified scale was administered to 150 cases, and 50 cases completed the scale twice at the interval of 2 weeks for test–retest reliability. Results: Items with a test–retest reliability kappa coefficient of 0.4 or greater were retained and subjected to factor analysis. The final 45-item scale has a five-factor structure. The value of Cronbach's alpha of the final version of the scale was 0.91. Conclusions: This self-report questionnaire, which can be completed in 10 min, may help us in making a baseline assessment of the work-related impairment among persons with substance use and the impact of substance use on work.
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Living with an alcoholic partner: Problems faced and coping strategies used by wives of alcoholic clients p. 65
Nitasha Sharma, Sunita Sharma, Sandhya Ghai, Debashish Basu, Deepika Kumari, Dharamveer Singh, Gagandeep Kaur
DOI:10.4103/0972-6748.196053  PMID:28163410
Background: Alcoholism is considered as a major health as well as a social problem. Often the family members of alcoholics suffer intense psychological, physical and social trauma due to the core drinking problem of the family member. Most deeply affected are the wives of alcoholics. Aim: The present descriptive study aimed to investigate the problems faced and coping strategies used by the wives of alcoholics. Methodology: A total of 30 wives of alcoholic clients seeking treatment in De-addiction Centre were interviewed for the same. The problems were identified using a non standardized 17 item structured questionnaire while coping in wives of alcoholics was assessed using standardized tool. Results: The findings revealed the problems faced by alcoholics wives were in multiple domains viz. physical, psychological and social. While most highly reported were the emotional problems and least reported were the problems of physical violence. Coping strategies used by wives of alcoholics were reported in three major styles: engaged, tolerant and withdrawal. Conclusion and Recommendations: The problems faced by alcoholics have often wedged the attention in society yet finding and applying effective interventions to reduce the pain and suffering of being a partner of alcoholic is still a challenge.
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Pathway of care among patients with Dhat syndrome attending a psychosexual clinic in tertiary care center in North India p. 72
Sandeep Grover, Sunil Gupta, Sudhir Mahajan, Ajit Avasthi
DOI:10.4103/0972-6748.196040  PMID:28163411
Aim: The aim of this study was to understand the pathway to care among patients with Dhat syndrome and to study the factors leading to delay in seeking professional psychiatric help. Materials and Methods: Forty-seven patients diagnosed with Dhat syndrome as per the International Classification of Diseases-10 criteria were assessed for sociodemographic and clinical details and information regarding previous treatment taken to determine the pathways to care at their first contact with the outpatient psychosexual clinic. Results: Majority of the patients were single (70.2%), received formal education for at least more than 10 years (66.0%), were employed (59.6%), followers of Hinduism (68.1) and from middle socio-economic class (59.6%), nuclear family setup (53.2%), and rural locality (63.8%). Comorbidity in the form of any psychiatric illness or sexual dysfunction was present on 61.7% of the patients. The mean age at onset of symptoms of Dhat syndrome was 20.38 years (standard deviation [SD] - 6.91). The mean duration of symptoms of Dhat before the patients presented to our psychosexual clinic was 6.78 years (SD - 6.94) while the mean number of agencies/help contacted before was 2.85 (SD - 1.40; range: 1–5). The favorite choice for the first contact was indigenous practitioners, followed by asking for help from friends or relatives, allopathic doctors, and traditional faith healers or pharmacists. The preference to visit indigenous practitioners gradually declined at each stage. Ayurvedic doctors remained the most preferred among all indigenous practitioners. The absence of any comorbid sexual dysfunction in patients with Dhat syndrome predicted an earlier visit to our center as compared to the patients with any comorbid sexual dysfunction. Conclusions: Majority of the patients with Dhat syndrome present very late to specialized psychosexual clinics. There is a need for improving the sexual knowledge and attitude at the community level which will facilitate the early help seeking in patients with Dhat syndrome.
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Quantitative analysis of Euclidean distance to complement qualitative analysis of facial expression during deception p. 78
Ananya Mondal, Pritha Mukhopadhyay, Nabanita Basu, Samir Kumar Bandyopadhyay, Tanima Chatterjee
DOI:10.4103/0972-6748.196048  PMID:28163412
Background: Accurate evaluation of an individuals' veracity is a fundamental aspect of social functioning that allows individuals to act in adaptive ways. The domain of deception detection ability is still young, and many components in this field are yet to be touched which demands more research in this field. Aims: The present study aims at deciphering the structural composition of face during felt, posed, and deceived emotions in facial expression unique to Indian culture, using Facial Action Coding System (FACS). Quantitative analysis of Euclidean distance has been done to complement qualitative FACS analysis. Methods: In this study, thirty female, young adults with age range of 23–27 years were chosen randomly for portraying their (felt, posed, and deceived) facial expression. All facial expressions were captured through instruction, and videos were converted into static images. The static images were coded on the basis of FACS to decipher the felt, posed, and deceived expressions. Quantitative analysis of the data has been done using MATLAB to meet the objectives of the study and to complement the qualitative analysis. Results: Felt and posed emotions differ in terms of intensity of the expression and subjective experience. Posed emotional and deceived expressions differ in intent. Facial asymmetry is an important indicator for detecting deception.
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Psychiatric morbidity in perimenopausal women p. 86
Biswajit L Jagtap, B. S. V. Prasad, Suprakash Chaudhury
DOI:10.4103/0972-6748.196056  PMID:28163413
Background: Women in the perimenopausal period are reported to be vulnerable to psychiatric disorders. Aim: To assess the psychiatric morbidity in perimenopausal women aged 45–55 years. Materials and Methods: This cross-sectional, observational, hospital-based study was conducted at the Department of Psychiatry in a tertiary care hospital attached to a medical college. The study sample consisted of consecutive women in perimenopause as diagnosed by a gynecologist and written informed consent for inclusion in the study. Women with a previous history of psychiatric illnesses, with a major medical illness, or who had undergone surgical menopause were excluded from the study. All women were evaluated with a brief questionnaire for collecting demographic and clinical information and the Mini International Neuropsychiatric Interview for assessing psychiatric disorders. Results: Of the 108 women in perimenopause included in the study, 31% had depressive disorder, 7% had anxiety, while 5% had depressive disorder with anxiety features. Psychiatric morbidity was significantly more in women having lesser education, from rural background, with a history of psychiatric illness in the family, a later age of menarche, and in the late stage of perimenopause. Conclusions: Women in the perimenopause affected by psychiatric morbidity were most commonly diagnosed with depression. As perimenopause is a time of vulnerability in women, attention to signs and symptoms of depression may be required so that they may lead a more productive life.
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Accelerated antidepressant response to lithium augmentation of imipramine p. 93
Rajiv Saini, M. S. V. K. Raju, Suprakash Chaudhury, Kalpana Srivastava
DOI:10.4103/0972-6748.196057  PMID:28163414
Background: Treatment of depressive episode often poses a challenge. Although there are numerous medicines available for its treatment but they all have a lag period of 2–3 weeks before they start showing their result. Aim: The aim of the present study was to test the hypothesis that an initial lithium-tricyclic antidepressant (TCA) combination has a quicker and better antidepressant effect than standard TCA treatment in unipolar depression. Materials and Methods: Twenty unipolar depressed inpatients under lithium-TCA treatment were compared with twenty patients with similar diagnosis treated with TCA-placebo combination. The duration of the study was 4 weeks under double-blind conditions. Results: Initial lithium-TCA treatment reduced depressive symptoms significantly more than TCA alone. The difference was evident from 1st week onward and persisted at 4 weeks. Conclusion: Lithium augmentation of TCA at the outset offers a strategy to reduce the lag period of antidepressant action. The choice can be made for those patients who are likely to benefit from long-term prophylaxis.
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Childhood sexual abuse in adult patients with borderline personality disorder p. 101
Preethi Menon, Bhushan Chaudhari, Daniel Saldanha, Spandana Devabhaktuni, Labanya Bhattacharya
DOI:10.4103/0972-6748.196046  PMID:28163415
Background: Researchers have found elevated rates of childhood sexual abuse (CSA) in borderline personality disorder (BPD) patients. They have also implicated the role of CSA later in BPD. However, there has been a scarcity of studies regarding this in Indian population. Objectives: To profile the occurrence of CSA and its parameters in BPD patients and to document symptomatology of BPD associated with CSA. Materials and Methods: Thirty-six consecutive patients with BPD were administered with a two-staged semi-structured interview by different interviewers with the first stage for collecting sociodemographic details and confirming BPD diagnosis and the second stage for collecting information about CSA. Results: Of 36 BPD patients, 16 (44.44%) reported a history of definite CSA. The majority of CSA associated with BPD were having characteristics of onset at 7–12 years, <10 occasions of abuse, perpetrator being a close relative or a close acquaintance and genital type of CSA. Identity disturbances (P = 0.0354), recurrent suicidal/self-harm behavior (P = 0.0177), and stress-related paranoid/dissociative symptoms (P = 0.0177) were significantly associated with the presence of CSA while unstable interpersonal relationships (P = 0.001) were significantly associated with the absence of CSA. Conclusion: Significant proportion of BPD patients reported CSA. The specific symptom profile of BPD patients can be used to predict the presence of CSA in these patients, which has a direct implication in the treatment of these patients.
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CASE REPORTS Top

Wikipedia use: Risk for developing technology addiction p. 107
Manoj Kumar Sharma
DOI:10.4103/0972-6748.196054  PMID:28163416
The present case highlights the addictive potential of Wikipedia usage. The users approached a technology addiction clinic for the management of excessive use of technology. A clinical interview was used to elicit information about usages. It indicates the addictive use of Wikipedia and associated dysfunction in lifestyle. It has implication for promotion of healthy use of technology.
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Disseminated neurocysticercosis presenting as acute stress reaction p. 110
Shruti Srivastava, Manjeet Singh Bhatia, Priyanka Gautam
DOI:10.4103/0972-6748.196047  PMID:28163417
Neurocysticercosis is the most common and preventable parasitic infection of the central nervous system, but disseminated cysticercosis is said to be rare. We report a case of a 31-year-old male, who presented with anxiety manifestations temporally associated with stress related to job. After initial clinical improvement, he presented with an incapacitating headache which was diagnosed as disseminated neurocysticercosis after thorough evaluation and investigations. Magnetic resonance imaging of the brain with contrast showed multiple small hyperintense lesions involving bilateral, temporoparietal, occipital, gangliothalamic with ring enhancement. His cysticercosis antibody IgG serum (EIA) was 2.05. The clinical management consisted of antihelminthic and antiepileptic drugs along with stress management.
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Repetitive urges to inflict burns: An unusual presentation of impulse control disorder p. 113
Arghya Pal, Arpit Parmar, Raman Deep Pattanayak
DOI:10.4103/0972-6748.196042  PMID:28163418
Impulse control disorders (ICDs) are characterized by an inability to resist an intense impulse or drive to perform a particular act that is excessive and/or harmful to self/others. Till date, there is no published report of an ICD presenting with repetitive urges to inflict burns. We describe the case of an adult male in regular follow-up for 6 months who presented with intense, irresistible, and repetitive urges and acts of causing burns on his skin for past 1 year. The phenomenology shared the core qualities described for ICDs and patient showed adequate response to treatment. The case report describes an unusual type of ICD classifiable as not otherwise specified. More clinical and research attention is warranted toward ICDs in general, with implications for ICD-11.
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A rare case of alektorophobia treated successfully with graded exposure therapy p. 116
Satyakant K Trivedi, Ajish G Mangot, Ravindra N Munoli
DOI:10.4103/0972-6748.196039  PMID:28163419
Phobia is a type of anxiety disorder characterized by circumscribed, marked fear or anxiety to a specific object or situation which is out of proportion to the actual danger posed by the concerned object or situation. Worldwide, the prevalence of specific phobia has been found to be 16% in 13–17 years olds. In India, specific phobia has been identified as one of the most common disorders in the school-going age group, with the prevalence of approximately 4.2%. Alektorophobia is the specific term for phobia to hen/chickens. We hereby report an 18-year-old female presenting with alektorophobia and successfully treated with graded exposure therapy. It has not been described in extant literature to the best of our knowledge.
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Aripiprazole-induced priapism p. 119
Satya K Trivedi, Ajish G Mangot, Siddhartha Sinha
DOI:10.4103/0972-6748.196044  PMID:28163420
Priapism is a urologic emergency representing a true disorder of penile erection that persists beyond or is unrelated to sexual interest or stimulation. A variety of psychotropic drugs are known to produce priapism, albeit rarely, through their antagonistic action on alpha-1 adrenergic receptors. We report such a case of priapism induced by a single oral dose of 10 mg aripiprazole, a drug with the least affinity to adrenergic receptors among all atypical antipsychotics. Polymorphism of alpha-2A adrenergic receptor gene in schizophrenia patients is known to be associated with sialorrhea while on clozapine treatment. Probably, similar polymorphism of alpha-1 adrenergic receptor gene could contribute to its altered sensitivity and resultant priapism. In future, pharmacogenomics-based approach may help in personalizing the treatment and effectively prevent the emergence of such side effects.
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