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   Table of Contents - Current issue
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January-June 2017
Volume 26 | Issue 1
Page Nos. 1-109

Online since Tuesday, January 16, 2018

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EDITORIAL  

Child sexual abuse: The suffering untold Highly accessed article p. 1
Kalpana Srivastava, Suprakash Chaudhury, PS Bhat, Prajakta Patkar
DOI:10.4103/ipj.ipj_83_17  
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REVIEW ARTICLE Top

Child sexual abuse and the development of psychiatric disorders: a neurobiological trajectory of pathogenesis p. 4
Amresh K Shrivastava, Sagar B Karia, Sushma S Sonavane, Avinash A De Sousa
DOI:10.4103/ipj.ipj_38_15  
Child sexual abuse (CSA) is an important public health problem with long-standing neurobiological, developmental, and psychiatric abnormalities. The present review analyzes the long-term effects of CSA from a developmental, psychiatric morbidity, neurochemical and neurobiological perspective and then tries to posit a developmental neurobiological trajectory from CSA to the genesis of psychopathology in later life. The role of various neurotransmitters such as serotonin and dopamine affected by CSA are discussed. Serotonin abnormalities have been reported in various studies among participants exposed to CSA. Structures such as the prefrontal cortex, superior temporal gyrus, corpus callosum, parietal lobes, hippocampus, and cerebellum all demonstrate volumetric and structural changes in response to the trauma of CSA. Neurocognitive studies demonstrate memory and spatial awareness as well as decrements in general cognitive performance and memory when compared to normal individuals. The hypothalamic–pituitary–adrenal axis has also been implicated in CSA, and there is an alteration in corticotropin-releasing hormone response due to the continuous cumulative trauma of CSA. This paper also reviews a section on the role of genetic and epigenetic factors in the development of psychiatric disorders as a result of exposure to episodes of CSA where studies have demonstrated changes in DNA methylation in response to CSA. This review tries to hypothesize a developmental trajectory framework which is individual for every case where exposure to CSA may lead to psychopathology and psychiatric morbidity later in life. Rapid and emerging fields such as developmental traumatology in relation to CSA are also discussed.
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ORIGINAL ARTICLES Top

Stressful life events and severity of alcohol consumption in male psychiatric inpatients p. 13
Amitabh Saha, Suprakash Chaudhury, Daniel Saldanha, Kalpana Srivastava
DOI:10.4103/ipj.ipj_6_16  
Aim: To assess the levels of alcohol consumption and the level of stress faced by male patients hospitalized with psychiatric disorders in a military hospital. Materials and Methods: This cross-sectional study was conducted on 100 consecutive patients admitted to a tertiary care psychiatric center and 100 controls. The patients with psychiatric ailments were first stabilized mentally and physically and then assessed. For the collection of demographic data, a questionnaire was prepared which was administered to all patients. The Armed Forces Medical College Life Events scale was used for the assessment of stressful life events. The Michigan Alcohol Screening Test (MAST) was applied as a screening procedure for alcohol use disorder. For assessing the severity of alcohol consumption, the Hilton Drinking Behavior Questionnaire (HDBQ) was utilized. Results: Analysis revealed that 16% of the psychiatric patients scored above the cutoff score on the MAST compared to 2% of controls. On the HDBQ, 22% of the psychiatric patients had a significant score compared to 4% of controls. Patients with psychiatric disorders experienced significantly more number of life events compared to the controls irrespective of the length of service. The Psychiatric group experienced significantly more life change units both in 1-year prior and in lifetime period. Conclusion: Psychiatric patients face significantly higher stressful life events, experience significantly more life changes, and consume significantly more alcohol as compared to healthy participants.
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Prevalence and patterns of tobacco use and nicotine dependence among males industrial workers p. 19
KJ Divinakumar, P Patra, Jyoti Prakash, Arun Daniel
DOI:10.4103/ipj.ipj_14_17  
Background: Tobacco use is an important preventable health risk factor in India. Aim: This study was carried out to estimate the prevalence of current tobacco use, factors and extent of dependence associated with its use among male workers of an industrial organization. Materials and Methods: A total of 759 participants randomly selected from the population of employees were administered questionnaire in Hindi containing demographic profile, patterns of smoking, and use of smokeless tobacco and alcohol. Results: Forty-one percent of the surveyed males (n = 750) used tobacco either by smoking or smokeless method or both (9.7% used both, 23.4% smoked, and 27.3% used smokeless tobacco). The maximum percentage was among the 26–30 years' age group, and the married persons (45.4%, OR = 2.17, P < 0.05). Tobacco use was associated with lower educational qualifications, history of tobacco use in family members, and drinking alcohol. Seventy-two percent of the nicotine users reported being influenced by their peers in initiating the habit, 59.4% of the users reported being advised to stop tobacco use by a health professional, and 52.9% had attempted quitting the habit more than once. Twenty percent of our sample were dependent on nicotine and the highest prevalence was seen in those using both smoking and the smokeless tobacco. Conclusions: The Prevalence of Tobacco Use and Nicotine Dependence among male industrial employees is significant and necessitates Tobacco awareness and cessation programs regarding Tobacco use.
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Clinico-psycho-social profile of patients brought under consultation-liaison psychiatry care in a large tertiary care referral hospital p. 24
P Patra, KJ Divinakumar, Jyoti Prakash, B Patra, R Chakraborty
DOI:10.4103/ipj.ipj_13_17  
Objective: The aim of this study was to access the clinico-psycho-social profile of patients brought under consultation-liaison (CL) psychiatry care in a large tertiary care referral hospital. Materials and Methods: This study included all patients who were referred for CL psychiatry from among the inpatients in the hospital and the emergency department (during off working hours of the hospital) over a period of 1 year. Data were obtained and analyzed in terms of where was the referral placed, by whom, the reason for placing the referral, the primary medical/surgical diagnosis of the patient, the presenting complaints, any past psychiatric history, the psychiatric diagnosis (as per the International Classification of Diseases, Tenth Edition), the investigations advised and their reports, the treatment advised (psychotherapeutic and psychopharmacological), the sociodemographic profile of the patients, and the follow-up details. Results: A total of 157 patients were referred to the CL unit over the study period. Out of these, 125 patients were referred among the inpatients and 32 from the emergency department of the hospital. Majority of the patients were in the age group of 25–50 years and were male. The majority of the referrals were made by general physician; most of the referrals were placed from emergency department. The most common reason for referral was for altered sensorium and behavioral abnormalities. The most common diagnosis was delirium followed by depressive episode and alcohol dependence syndrome. Conclusion: There was higher representation of delirium and alcohol-related cases in our study compared to older studies.
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Characteristics of suicidal attempts among farmers in rural South India p. 28
Ravi S Kumar, Uzma Hashim
DOI:10.4103/ipj.ipj_6_17  
Background: Globally, farming as an industry is considered a high-risk occupation for suicides. Certain states in India like Karnataka have a suicide rate higher than the national average, and this is generally attributed to the farmers' suicide. Aims: The aim is to study the characteristics of suicidal attempts among the farmer community in South India, with special emphasis on gender differences, modes used, and the immediate precipitant causes. Materials and Methods: Retrospective, case register-based, explorative-descriptive study of 426 consecutive medicolegal case files of patients whose stated occupation was farming and who were admitted as cases of deliberate self-harm or suicide attempt to a rural tertiary care hospital in rural South India. Results: Out of the 426 farmers who attempted suicide, majority were male (355, 83.3%), in the age group of 21–40 years (318, 75%), married (358, 84%), and belonging to lower socioeconomic status (268, 62.9%). About 54% of them had attempted suicide by consuming pesticides (230). Surprisingly, 183 (43%) and 86 (20.2%) reported the immediate precipitant as being relationship issues and marital conflict, respectively, and only 100 (23.5%) attributed it to financial reasons. Females were significantly associated with a past history of suicidal attempt while males tended to abuse alcohol before an attempt more frequently. Conclusions: Pesticide poisoning was the most common mode for attempting suicide among the farmers. Contrary to public perception and other studies, relationship, and marital issues, not financial reasons were found to be the most common immediate precipitant for the attempters in our study.
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Lifetime alcohol consumption and severity in alcohol dependence syndrome p. 34
Arun Kumar Dwivedi, Kaushik Chatterjee, Ranveer Singh
DOI:10.4103/ipj.ipj_26_17  
Introduction: Alcohol dependence syndrome is a major public health issue globally and is responsible for significant morbidity and mortality. The total dose of alcohol consumed has been linked to liver diseases, pancreatitis, and other alcohol-related medical consequences. However, this has not been studied in relation to severity of dependence; although it is well known that alcohol causes neuronal damage, which in turn potentiates dependence. Thus, there is a need to study the relationship between the amount of alcohol consumed and severity of dependence. Materials and Methods: A total of 165 consecutive cases of alcohol dependence syndrome were studied in a General Hospital Psychiatry Unit at a tertiary care hospital. Addiction Severity Index (ASI) was used to evaluate the severity of alcohol dependence, and Life Time Alcohol Consumption (LTAC) was evaluated by taking careful history. Correlation coefficients were calculated between ASI and LTAC. Group differences were analyzed using t-test. Results: There was a significant correlation between ASI and LTAC (r = 0.162, P = 0.032), which was highly significant in the subgroup without medical complications (r = 0.250, P = 0.003). A similar correlation in the medical complications subgroup was not significant. Conclusions: Lifetime alcohol consumption co-related with the severity of alcohol dependence, particularly in those presenting without medical complications (i.e., those with behavioral and social consequences, and injuries).
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Failure to utilize feedback during explicit decision-making task in alcohol-dependent patients p. 39
BN Roopesh, Manoj K Sharma, Saswatika Tripathy, Vivek Benegal
DOI:10.4103/ipj.ipj_82_16  
Background: Patients who are diagnosed with alcohol-dependent syndrome (ADS) are shown to have neuropsychological deficits, especially executive function (EF) deficits. Among the EFs, decision-making is one such function which has consistently been shown to be impaired in people who are dependent on alcohol, compared to controls. Decision-making in this population is usually assessed with gambling-type tasks. However, some of these tasks are ambiguous, work on chance factors, rarely match with real-life gambling situations, and/or involve nonconscious mechanisms. Materials and Methods: The current study compared 26 male patients with ADS (P-ADS) with equal number of their nonalcohol-dependent male siblings on sensation seeking and explicit gambling task (EGT). EGT is similar to the Iowa gambling task in administration, but varies from it as it involves a single outcome and provides unambiguous, explicit, and continuous feedback for the participants. Results and Conclusion: The results did not show any significant relationship between decision-making variables and sensation seeking. However, despite unambiguous, explicit, and continuous feedback, patients showed significantly poor decision-making as compared to the siblings of the P-ADS group. This study throws light on why people who are addicted to alcohol have difficulties in decision-making, despite knowing the adverse effects.
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Study of personality traits, individual coping resources, and their association in HIV-seropositive males p. 45
Prateek Yadav, Debajyoti Bhattacharyya, Kalpana Srivastava, Neha Salhotra
DOI:10.4103/ipj.ipj_34_17  
Background: HIV infection is an unfortunate consequence of a defined set of behaviors. Individuals with continued high-risk behavior either due to personality factors or due to maladaptive coping skills have higher viral loads and morbidity. Research has shown significant interactions between less effective coping styles and personality factors. Aim: This study aimed to evaluate personality traits, coping skills, and their association in male HIV-seropositive cases. Materials and Methods: This was a cross-sectional study, conducted on 86 patients. Informed consent and sociodemographic details, by a structured questionnaire, were obtained. Scales pertaining to personality factors and coping were applied. Statistical analysis was done by SPSS 16. Results: Neuroticism, extraversion, and conscientiousness traits were in the average range. Scores on openness and agreeableness were below average. The results pertaining to coping showed an overall mean score of 50.78, with the highest on physical domain and then on the philosophical domain, the lowest was in social domain. The research sample perceived their coping resources as average. Neuroticism was negatively related to all the coping styles. Extraversion showed relation with physical, emotional, social, and philosophical scales. Openness was related to philosophical and emotional scales. Agreeableness correlated with all domains of coping except the social. Conscientiousness correlated significantly with all the domains of coping. Conclusion: The various personality traits associated with male HIV-seropositive patients were identified and various coping resources used by these were also delineated. Further, the association among them was identified which can help in primary prevention and mental health professionals to have a targeted approach for counseling.
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Images of psychiatry: Attitude survey of teaching medical specialists of India p. 52
Suravi Patra, Binod Kumar Patro, Naresh Nebhinani
DOI:10.4103/ipj.ipj_36_16  
Context: Attitude of teaching medical specialists shapes those of future doctors. Region-specific data on teaching medical specialists' attitudes toward psychiatry (ATP) are lacking from India. Aims: This study aimed to assess the attitudes of teaching medical specialists toward psychiatry and its association with sociodemographic profile and career stage. Settings and Design: This is a cross-sectional descriptive survey. Materials and Methods: Attitude towards psychiatry (ATP) was assessed from 188 specialists from All India Institute of Medical Sciences (AIIMS) Bhubaneswar and AIIMS Jodhpur using modified ATP scale-30. Statistical Analysis: Descriptive statistical analysis was done using SPSS version 16.0. Associations of ATP with sociodemographic status, career stage, and family history of psychiatric illness were done using logistic regression analysis. Results: Overall response rate was 81.68%, and gender (confidence interval [C.I.]: 2.026–7.410, P = 0.000) and super-specialization (C.I.: 2.167–19.479, P = 0.021) were independent significant predictors for difference in attitudes. Female gender and super-specialization were associated with better attitudes. Ninety percent of participants had favorable attitude toward psychiatric illness. Four-fifth felt psychiatric patients to be as human as other patients and found psychiatric treatments effective. More than half felt that psychiatry does not stand among the three most exciting specialties and psychiatrists get less work satisfaction. Only one third said that they would have liked to be a psychiatrist. Conclusions: Attitudes were favorable toward patients and psychiatric interventions whereas unfavorable toward psychiatry as a discipline.
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Cross-sectional study of anxiety symptoms in students in preexamination period p. 56
Prateek Yadav, Vinay Singh Chauhan, PS Bhat, Nidhi Agarwal, Charu Yadav, Sameer Bhatia
DOI:10.4103/ipj.ipj_40_17  
Background: Preexamination period is an exceptionally stressful time for schoolgoing children and adolescents, and the propensity of having anxiety symptoms increases. Aim: This study aimed to assess the presence of anxiety symptoms in students in preexamination period. Materials and Methods: The study was carried on 619 children from Class VIII to XI. All of them were given a structured questionnaire for sociodemographic profile and Screen for Child Anxiety Related Emotional Disorders questionnaire. Association of various variables with presence of anxiety symptoms was assessed. Statistics was analyzed with SPSS version 17.0 software. Results: Totally 170 children (27.5%) had anxiety symptoms, similarly the various subgroups had increased frequency compared to the known prevalence in this age group. Age, years spent in the current school, living with parents, presence of domestic stressors, and grade deterioration, all were significantly associated with increased frequency of these symptoms. Similarly, association with various subgroups is described. Conclusion: This study attempts to give evidence of increased anxiety symptoms, during preexamination phase, compared to the reported prevalence in this age group, and thus to address this becomes imperative which will improve their performance and also the mental health preventing distress along with psychological and behavioral problems.
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Stress and suicidal ideation among adolescents having academic difficulty p. 64
Priti Arun, Rohit Garg, Bir Singh Chavan
DOI:10.4103/ipj.ipj_5_17  
Background and Objectives: Academically typically achieving adolescents were compared with students having academic difficulty on stress and suicidal ideas. Materials and Methods: In a cross-sectional study, 75 academically typically achieving adolescents were compared with 105 students with academic difficulty and 52 students with specific learning disability (SLD). Academic functioning was assessed using teacher's screening instrument, intelligence quotient, and National Institute of Mental Health and Neurosciences index for SLD. Stress and suicidal ideas were assessed using general health questionnaire, suicide risk-11, and Mooney Problem Checklist (MPC). Appropriate statistical methods were applied. Results: Three groups were comparable on age, gender, mother's working status, being only child, nuclear family, self-reported academic decline, and type of school. About half of adolescents reported psychological problems on General Health Questionnaire (mean score >3 in all the groups). Academically typically achieving adolescents showed higher stressors in peer relationships, planning for future and suicidal ideation compared to adolescents with academic difficulty. Adolescents face stress regarding worry about examinations, family not understanding what child has to do in school, unfair tests, too much work in some subjects, afraid of failure in school work, not spending enough time in studies, parental expectations, wanting to be more popular, worried about a family member, planning for the future, and fear of the future. Significant positive correlation was seen between General Health Questionnaire scores and all four subscales of MPC. Suicidal ideas showed a negative correlation with MPC. Interpretations and Conclusions: Adolescents experience considerable stress in multiple areas irrespective of their academic ability and performance. Hence, assessment and management of stress among adolescents must extend beyond academic difficulties.
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A study on different forms of intelligence in Indian school-going children p. 71
Yashpal Singh, Archita Makharia, Abhilasha Sharma, Kruti Agrawal, Gowtham Varma, Tarun Yadav
DOI:10.4103/ipj.ipj_61_16  
Introduction: Most definitions of intelligence focus on capabilities that are relevant to scholastic performances. However, there are seven forms of intelligences. There is a lack of data on multiple intelligences in Indian children. Hence, this study was conducted to assess different forms of intelligences in students and compared these diverse intelligences with intelligence quotient (IQ) scores. Materials and Methods: In this cross-sectional observational study, we recruited 1065 school children between the age of 12 and 16 years from two government and 13 private schools in five towns, six cities, and two villages across India. All the children were administered multiple intelligences questionnaire by Armstrong, consisting of thirty true/false types of questions to assess the intelligences of a child in seven domains including linguistic skills, logical/mathematical abilities, musical skills, spatial intelligence, bodily-kinesthetic skills, intrapersonal intelligence, and interpersonal intelligence. IQ scores were assessed by Ravens Standard Progressive Matrices. Results: We found that different students possessed different forms of intelligences and most students had more than one forms of intelligence. Of seven forms of intelligence, only three forms of intelligence such as logical/mathematical, musical, and spatial were positively correlated with the IQ score. Conclusions: Even in the children with low IQ, many students had other forms of intelligences. The IQ scores correlated with only logical/mathematical, spatial, and musical intelligence. Hence, tapping the intelligences of students can help enhance their learning process. Our curriculum should have an amalgamation of teaching for all kinds of intelligences for maximum productivity.
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Effect of type of schooling and gender on sociability and shyness among students p. 77
Archana Singh, Rajbir Singh
DOI:10.4103/ipj.ipj_25_14  
Background: Sociability and shyness are orthogonal personality traits, wherein both are characterized by varying behavioral and psychophysiological correlates. Shyness should not be equated with the lack of sociability, as shyness relates to discomfort that occurs in the presence of others and sociability is identified with an individual's preference for being with others rather than alone. Objectives: The objective of this study was to examine the effect of type of schooling on sociability and shyness among students and to study the gender differences between sociability and shyness among students. Methodology: The sample comprised 210 students from both private and government schools situated in Delhi. Data were collected using Eysenck Personality Profiler for measuring sociability and Revised Cheek and Buss Shyness Scale. Results and Conclusion: The results obtained from ANOVA revealed that government school students were observed to be more sociable as compared to private school students. On the other hand, private school students were found to be more shy as compared to government school students. Females were observed to be more shy as compared to males. In addition, significant interactive effect was observed for sociability when school and gender were taken altogether.
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Study of insomnia in rotating shift-workers p. 82
Kaushik Chatterjee, Prakash Ambekar
DOI:10.4103/ipj.ipj_59_17  
Background: Shift-workers commonly suffer from insomnia. This study evaluates different domains of insomnia. Aim: This study was aimed to study sleep and insomnia in rotating shift-workers and compare with day-workers. Materials and Methods: This was case–control study. The sleep of rotating shift-workers is compared with day workers using Athens Insomnia Scale. Results: Rotating shift-workers had significantly higher scores on Athens insomnia scale on domains of initial, intermediate and terminal insomnia than day workers. Duration and quality of sleep and sense of well-being are lower in rotating shift-workers. Rotating shift-workers also experienced more day-time sleepiness than day workers. However, there was no difference in perceived physical and mental functioning between the two groups. Conclusion: Individuals working in rotating shifts for more than 15 days have significantly higher prevalence of insomnia than day-workers.
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Prevalence of depression and its relation to stress level among medical students in Puducherry, India p. 86
S Ganesh Kumar, Shivanand Kattimani, Sonali Sarkar, Sitanshu Sekhar Kar
DOI:10.4103/ipj.ipj_45_15  
Background: Currently, depression among medical students is an important health issue at the global level. There is also a paucity of information on its relation to the stress level. Objective: The aim of this study is to assess the prevalence of depression and its relation to stress level and other factors among medical students. Materials and Methods: A cross-sectional study was conducted among medical students at a tertiary care medical institution in Puducherry, coastal south India. Beck Depression Inventory Scale was used for screening of depression and Cohen's Perceived Stress scale to assess perceived stress level. Data on associated factors were collected by self-administered questionnaire. Results: The overall prevalence of depression was found to be 48.4% (215/444). According to the cutoff scores, 229 (51.6%) students scored as normal (0–9), 149 (33.6%) as mild (10–18), 60 (13.5%) as moderate (19–29), 3 (0.7%) as severe (30–40), and 3 (0.7%) students scored as very severe (>40) depression. Depression was significantly less among those with mild stress (adjusted odds ratio [OR] = 0.010) and moderate stress level (adjusted OR = 0.099) compared to severe stress level and those without interpersonal problems (adjusted OR = 0.448). Conclusion: Depression is more common among medical students. Stress coping mechanisms and improvement of interpersonal relationship may help to reduce depressive symptoms among medical students.
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A descriptive study of behavioral problems in schoolgoing children p. 91
Anindya Kumar Gupta, Monica Mongia, Ajoy Kumar Garg
DOI:10.4103/ipj.ipj_39_17  
Background: Behavioral problems among schoolgoing children are of significant concern to teachers and parents. These are known to have both immediate and long-term unfavorable consequences. Despite the high prevalence, studies on psychiatric morbidity among school children are lacking in our country. Materials and Methods: Five hundred children aged 6–18 years were randomly selected from a government school in Kanpur, Uttar Pradesh, and assessed for cognitive, emotional, or behavioral problems using standardized tools. Results: About 22.7% of children showed behavioral, cognitive, or emotional problems. Additional screening and evaluation tools pointed toward a higher prevalence of externalizing symptoms among boys than girls. Conclusion: The study highlights the importance of regular screening of school children for preventive as well as timely remedial measures.
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A study of individuals with intentional self-harm referred to psychiatry in a tertiary care center p. 95
Bheemsain Tekkalaki, Anil Nischal, Adarsh Tripathi, Amit Arya
DOI:10.4103/ipj.ipj_53_15  
Background: Intentional self- harm (ISH) is one of the commonest yet neglected entities of Consultation liaison Psychiatry. More researches in the field of ISH are needed to effectively manage this problem. Aim: To study the socio-demographic and clinical profile of subjects of ISH referred to Psychiatry in a tertiary care hospital. Materials and Methods: All subjects of ISH referred to department of Psychiatry, of a tertiary centre, on specified days were recruited in to the study after obtaining an informed consent. Socio-demographic details, details of psychiatric assessment were documented using a semi structured proforma. Appropriate management was done. Results: Forty one subjects were included in the study. About two third of them belonged to the age group of 18 to 35 years. 56% of them were males, and 71% were married. House wives and students formed a significant proportion of sample. Most common method of ISH was self-poisoning. About two third of the patients had no diagnosable psychiatric illness. Interpersonal conflicts with family members (47%), conflicts with spouse (22%), broken emotional relationship (18%) were common causes for impulsive acts of ISH. Conclusions: ISH is common amongst young, married males. About two third of those who attempt ISH have no diagnosable psychiatric illness, in rest, neurotic stress related disorders, personality disorders and substance use disorders were predominant.
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CASE REPORTS Top

Valproate induced hyperammonemic encephalopathy treated by haemodialysis p. 99
Vinay Singh Chauhan, Siddarth Dixit, Sunil Goyal, Sudip Azad
DOI:10.4103/ipj.ipj_37_16  
Valproate (VPA)-induced hyperammonemic encephalopathy is an unusual, but serious, adverse effect of divalproex sodium (DVPX) treatment and if untreated can lead to raised intracranial pressure, seizures, coma, and eventually death. It can, however, be reversed if an early diagnosis is made. It is therefore extremely important to recognize it and discontinue DVPX treatment. Our patient developed sudden deterioration of sensorium, drowsiness, lethargy, and later severe comatose state after few days of starting DVPX with high levels of serum ammonia despite therapeutic levels of VPA and normal liver function test. He responded to hemodialysis, cerebral decongestants, and other intensive supportive measures.
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Clozapine-induced hypertension: A case report and review of literature p. 103
Sandeep Grover, Swapnajeet Sahoo, Sonali Mahajan
DOI:10.4103/ipj.ipj_9_16  
There are very few reports which suggest an association between clozapine and hypertension. We report a case in which a direct link of initiation of clozapine to development of hypertension which required pharmacological intervention. A 32-year-old male who did not have any history of hypertension and had normal blood pressure at the baseline developed high blood pressure (i.e., 150/90 mmHg) while on clozapine 100 mg/day. Reduction of the dose of clozapine to 75 mg/day led to the return of blood pressure to baseline, with increase in blood pressure to 150/90 mmHg on increasing the dose of clozapine again, requiring tablet atenolol 50 mg/day for normalization of blood pressure with concomitant continuation of atenolol. Later, clozapine was increased to 350 mg/day, with no recurrence of raise in blood pressure. After 6 months, tablet atenolol was stopped with no evidence of hypertension in follow-up. To conclude, this case report suggests that clozapine can rarely lead to hypertension during the initial phase of treatment.
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Selfie use: The implications for psychopathology expression of body dysmorphic disorder p. 106
Anisha Khanna, Manoj Kumar Sharma
DOI:10.4103/ipj.ipj_58_17  
Preoccupation with a body part can lead to indulgence in various forms of coping behavior. Users are frequently using technology as well as selfie to overcome their anxiety to relate to a body part as well as get approval from other online users. The present case highlights the excessive use of selfie to manage the distress-related body dysmorphic disorder (BDD). Psychiatric interview and assessment tools were used to elicit information about BDD, technology use, and affective states. Repeated use of selfie has been thought to manage the distress associated with appearance. It implies the need for screening excessive use of technology as comorbid condition and psychoeducation for promotion of healthy use of technology.
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