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   2013| July-December  | Volume 22 | Issue 2  
    Online since May 21, 2014

 
 
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REVIEW ARTICLE
Clinical management of alcohol withdrawal: A systematic review
Shivanand Kattimani, Balaji Bharadwaj
July-December 2013, 22(2):100-108
DOI:10.4103/0972-6748.132914  PMID:25013309
Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.
  14,561 386 4
EDITORIAL
Emotional intelligence and organizational effectiveness
Kalpana Srivastava
July-December 2013, 22(2):97-99
DOI:10.4103/0972-6748.132912  PMID:25013308
  5,094 130 -
ORIGINAL ARTICLES
Anxiety in school students: Role of parenting and gender
Ajay Kumar Bakhla, Prakriti Sinha, Rajiv Sharan, Yashi Binay, Vijay Verma, Suprakash Chaudhury
July-December 2013, 22(2):131-137
DOI:10.4103/0972-6748.132927  PMID:25013314
Background: The prevalence of anxiety is high in school going children; however pattern of parenting and gender of the child are important factors for the development of anxiety. Gender role and parenting patterns are important construct that vary across different sociocultural setting hence are important to be studied in Indian context. Materials and Methods: In a cross sectional study all students of both sexes studying in class VIII, were assessed using the Spence anxiety scale (children version). Results: The sample consisted of 146 (55% male and 45% female) with a mean age of 12.71 years. A total of 16 (11%) students scored above cutoff for high anxiety, the mean scores across gender shows that female students scored significantly higher in total and all sub types of anxiety. Most of the students perceived their parents 'Democratic' and other two authoritarian and permissive type of parenting were almost equal. There was significantly higher anxiety among the students who perceived their parents as authoritarian. Conclusions: The prevalence of high anxiety was 11% in class VIII students. High anxiety in students was significantly associated with female gender and authoritarian parenting pattern as perceived by the children.
  3,694 169 -
CASE REPORTS
Juvenile obsessive-compulsive disorder: A case report
Vikas Menon
July-December 2013, 22(2):155-156
DOI:10.4103/0972-6748.132932  PMID:25013319
Obsessive-compulsive disorder (OCD) is one of the more disabling and potentially chronic anxiety disorders that occurs in several medical settings. However, it is often under-recognized and under-treated. The condition is now known to be prevalent among children and adolescents. Obsessional images as a symptom occur less frequently than other types of obsessions. In this report, we describe a young boy who presented himself predominantly with obsessional images. The diagnostic and treatment challenges in juvenile OCD are discussed.
  3,083 83 -
Olanzapine-induced neuroleptic malignant syndrome in a patient with bipolar affective disorder: Does quetiapine holds the solution?
Praveen Tripathi, Hemika Agrawal, Priyanka Goyal, Sujita Kumar Kar
July-December 2013, 22(2):159-160
DOI:10.4103/0972-6748.132934  PMID:25013321
Neuroleptic Malignant Syndrome (NMS) is a rare, severe and life threatening condition induced by antipsychotic medications. It is commonly encountered with the use of first generation antipsychotics, however cases of NMS have been reported with the use of second generation antipsychotics like Olanzapine, Risperidone, Paliperidone, Aripiprazole, Ziprasidone, Amisulpride, Quetiapine and Clozapine, though the incidence of such reports is rare. Due to decreased use of first generation antipsychotics, NMS is reported less frequently now a days. In this case report- we highlight the management issues of a patient suffering from bipolar affective disorder, who had developed NMS following intramuscular injection of haloperidol, which was withdrawn and olanzapine was given later on. The patient had again developed NMS with olanzapine. Finally the patient was managed with modified electroconvulsive therapy and discharged on Lithium carbonate and Quetiapine.
  2,962 98 -
ORIGINAL ARTICLES
Racial differences in suicidal ideation among school going adolescents
Santosh Kumar, Vidhata Dixit, Suprakash Chaudhury, DK Kenswar
July-December 2013, 22(2):118-124
DOI:10.4103/0972-6748.132924  PMID:25013312
Background: Young adults are at increased risk for suicidal behavior and there is growing concern about racial differences in suicidal ideation, especially in the younger population. Aim: The aim of this study is to assess suicidal ideation in school going tribal and nontribal adolescents and to study its relationships with psychological well-being, depression, and anxiety. Materials and Methods: A total of 259 students of Classes X, XI, and XII of three Schools of Ranchi, who fulfilled inclusion and exclusion criteria, were screened for suicidal ideation by Suicidal Ideation Questionnaire (SIQ) and psychological well-being by General Health Questionnaire-12 (GHQ-12). The level of anxiety and depression was assessed by Hospital Anxiety Depression Scale (HADS). Results: Overall 33.2% of the adolescents had suicidal ideation out of which 34.2% were tribal-students and 32.8% nontribal-students with no significant intergroup difference. Psychological discomfort (GHQ-12 Score ≥3) was noticed in 59.1% of adolescents, but no racial difference was found. However, the mean HADS depression score was significantly higher in tribal adolescents, more so in tribal boys than nontribal adolescents or boys, respectively. There was a significant positive correlation of SIQ total score in all the adolescents with GHQ-12 total score, HADS total score, HADS anxiety score, and HADS depression score. Conclusion: There were no racial differences in suicidal ideation and psychological discomfort among tribal and nontribal adolescents. Tribal adolescents, and more specifically tribal boys, had more depression than their nontribal counterparts. Suicidal ideation was positively correlated with psychological discomfort, anxiety, and depression.
  2,901 78 -
Internal consistency and factor structure of 12-item general health questionnaire in visually impaired students
Ajay Kumar Bakhla, Vijay Verma, Mahesh Hembram, Samir Kumar Praharaj, Vinod Kumar Sinha
July-December 2013, 22(2):109-113
DOI:10.4103/0972-6748.132918  PMID:25013310
Background: As there are no instruments to measure psychological wellness or distress in visually impaired students, we studied internal consistency and factor structure of GHQ-12 in visually impaired children. Materials and Methods: Internal consistency analysis (Cronbach's alpha and item total correlation) and exploratory factor analysis (principal component analysis) were carried out to identify factor structure of 12-item general health questionnaire (GHQ-12). Results: All items of GHQ-12 were significantly associated with each other and the Cronbach's alpha coefficient for the scale was 0.7. On analysis of principal component, three-factor solution was found that accounted for 47.92% of the total variance. The factors included, 'general well-being', 'depression' and 'cognitive', with Cronbach's alpha coefficients being 0.70, 0.59, and 0.34, respectively. Conclusion: Our study findings suggest GHQ-12 is a reliable with adequate internal consistency scale and multidimensional factor structure in visually impaired students.
  2,884 82 1
An open-label trial of memantine in treatment-resistant obsessive-compulsive disorder
Ajay Kumar Bakhla, Vijay Verma, Subhas Soren, Sujit Sarkhel, Suprakash Chaudhury
July-December 2013, 22(2):149-152
DOI:10.4103/0972-6748.132930  PMID:25013317
Background: Obsessive-compulsive disorder (OCD) is often refractory to treatment. Glutamatergic neurotransmission modulating agents like memantine, an N-methyl-D-aspartate receptor open channel blocker (antagonist), has been reported to be beneficial in OCD. Materials and Methods: Twelve subjects of OCD who had been on various medications for over 5 years, but were poor responders, were enrolled for a 12-week open-label trial with fixed dose trial of memantine as an augmenting agent. The OCD symptoms and adverse effects of the drug were monitored. Results: Out of 12 subjects, eight had clear benefit, with reduction of 25% or more on Yale-Brown Obsessive-Compulsive Scale, and there were no side-effects with the medication, Conclusion: Memantine may be beneficial for treatment-resistant OCD as an augmenting agent.
  2,714 64 1
Nursing students' attitude toward suicide prevention
Naresh Nebhinani, Mamta , Achla D Gaikwad, L Tamphasana
July-December 2013, 22(2):114-117
DOI:10.4103/0972-6748.132922  PMID:25013311
Background: Preventing suicide depends upon different health professionals' knowledge regarding suicide, attitude toward suicide attempters, skills to assess and manage suicidal risk. Objectives: This study was aimed to assess the attitude of nursing students toward suicide prevention. Materials and Methods: 308 nursing students were recruited from the two institutions through total enumeration method. Attitude toward suicide prevention scale was administered. Study design was cross-sectional. Results: Majority were single females, from urban locality, who were pursuing BSc Nursing with the mean age of 20 years. Only minority had previous exposure to suicide prevention programs or workshops. Nearly half of the subjects had positive attitude toward working with suicidal patients. Again half of the subjects considered unemployment and poverty as main causes of suicide and were quite hopeless about it and they also perceived that most of the suicidal people would not reveal their suicidal plans to others. Conclusions: Merely half of the students had positive attitude toward working with suicidal patients. Hence, there is strong need to organize more educational and training programs on suicide prevention so that these budding health professionals could be more equipped and trained to manage these suicidal patients.
  2,475 74 1
CASE REPORTS
Neuropsychiatric manifestations of Fahr's disease pathogenesis and potential for treatment
Raheel Mushtaq, Sheikh Shoib, M. S. V. K Raju, Nilesh Naphade, Tabindah Shah, Alka Pawar
July-December 2013, 22(2):153-154
DOI:10.4103/0972-6748.132931  PMID:25013318
Fahr's disease (FD) is a rare neuropsychiatric disease consisting of bilateral basal ganglia calcification with neurological, cognitive, and psychiatric manifestations. We report here a sporadic case of FDs with its neuropsychology.
  2,188 57 2
ORIGINAL ARTICLES
Family burden in injecting versus noninjecting opioid users
Naresh Nebhinani, BN Anil, Surendra Kumar Mattoo, Debasish Basu
July-December 2013, 22(2):138-142
DOI:10.4103/0972-6748.132928  PMID:25013315
Background: A substance-dependent person in the family affects almost all aspects of family life that also impact the lives of the significant others and causes enormous burden. Objectives: This study was aimed to assess the pattern of burden borne by the family caregivers of patients with opioid-dependence-injecting drug users (IDU) and noninjecting drug users (NIDU). Materials and Methods: A cross-sectional study was conducted with ICD-10 diagnosed-opioid-dependent subjects (IDU and NIDU, N = 40 in each group) and their family caregivers attending a de-addiction centre at a multispecialty teaching hospital in North India. Family Burden interview schedule was used to assess the pattern of burden borne by the family caregivers. Results: The IDU group was characterized by older age, longer duration of substance dependence, greater subjective and objective family burden in all the areas compared to NIDU group, and single status and unemployment were associated with severe objective burden. The family burden was associated neither with age, education, or duration of dependence of the patients, nor with family size, type of caregiver or caregiver's education in either group. Conclusion: All caregivers reported a moderate or severe burden, which indicates the significance and need for further work in this area.
  2,019 78 -
Psychiatric morbidity in asymptomatic human immunodeficiency virus patients
VS Chauhan, Suprakash Chaudhury, S Sudarsanan, Kalpana Srivastava
July-December 2013, 22(2):125-130
DOI:10.4103/0972-6748.132925  PMID:25013313
Background: Psychiatric morbidity in human immunodeficiency virus (HIV) patients is being studied all over the world. There is paucity of Indian literature particularly in asymptomatic HIV individuals. Aim: The aim of the following study is to establish the prevalence and the determinants of psychiatric morbidity in asymptomatic HIV patients. Materials and Methods: A cross-sectional study was undertaken to assess psychiatric morbidity as per ICD-10 dacryocystorhinostomy criteria in 100 consecutive asymptomatic seropositive HIV patients and an equal number of age, sex, education, economic and marital status matched HIV seronegative control. All subjects were assessed with the general health questionnaire (GHQ), mini mental status examination, hospital anxiety and depression scale (HADS) and sensation seeking scale (SSS) and the scores were analyzed statistically. Results: Asymptomatic HIV positive patients had significantly higher GHQ caseness and depression but not anxiety on HADS as compared to HIV seronegative controls. On SSS asymptomatic HIV seropositive subjects showed significant higher scores in thrill and adventure seeking, experience seeking and boredom susceptibility as compared to controls. HIV seropositive patients had significantly higher incidence of total psychiatric morbidity. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. Conclusion: Psychiatric morbidity is higher in asymptomatic HIV patients when compared to HIV seronegative controls. Among the individual disorders, alcohol dependence syndrome, sexual dysfunction and adjustment disorder were significantly increased compared with HIV seronegative controls. High sensation seeking and substance abuse found in HIV seropositive patients may play a vital role in engaging in high-risk behavior resulting in this dreaded illness.
  1,934 50 1
CASE REPORTS
Acute psychosis: A neuropsychiatric dilemma
Daniel Saldanha, Preethi Menon, Bhushan Chaudari, L. Bhattacharya, Sameer Guliani
July-December 2013, 22(2):157-158
DOI:10.4103/0972-6748.132933  PMID:25013320
The acute onset of psychotic symptoms in elderly can be the presenting clinical feature for various Central Nervous System as well as other systemic illnesses. The diagnosis and treatment of such presentation require a cautious medical work up and high level of suspicion even if the patient is not showing any cardinal symptoms for organic pathology.
  1,907 49 -
ORIGINAL ARTICLES
Relationship of reasons and fears of treatment with outcome in substance using population attending a de-addiction centre
Siddharth Sarkar, Naresh Nebhinani, Jasveen Kaur, Kamalpreet Kaur, Sandhya Ghai, Debasish Basu
July-December 2013, 22(2):143-148
DOI:10.4103/0972-6748.132929  PMID:25013316
Background: Substance users approach a treatment facility for a variety of reasons as well as avoid or delay in help seeking due to perceived fears with treatment facilities. Sometimes these factors might be associated with treatment outcomes. Objectives: We studied the relationship of reasons and fears of treatment seeking with treatment outcome in substance users. Materials and Methods: One hundred subjects, attending the Drug Deaddiction and Treatment Centre, PGIMER, were prospectively recruited by purposive sampling. A semistructured proforma was used to gather sociodemographic and clinical data. Reasons of help-seeking and fear questionnaire, social support scale, and PGI locus of control scale were then applied. Followup data were available for 69 patients, which were classified into good or poor outcome based on relapse status. Results: At 6 months followup, 22 patients had relapsed, while 47 patients did not relapse. A higher degree of dysfunction due to substance at baseline was associated with relapsed status at followup. Parents or guardians coming to know about resuming substance and being unemployed for a long time were the reasons associated with relapsed status, while needing to consult a doctor immediately was significantly related to abstinent status at followup. Fear of not being able to meet substance using friends was associated with a poorer outcome in the form of relapse. Conclusions: Reasons for treatment seeking as well as fears related to treatment have significant implications on the clinical outcome of substance abusing patients. Addressing these could help in better patient outcomes.
  1,801 54 -
SHORT COMMUNICATION
Assessment of prevalence of tobacco consumption among psychiatric inmates residing in Central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey
Nilesh Arjun Torwane, Sudhir Hongal, R. N. Sahu, Vrinda Saxena, B. R. Chandrashekhar
July-December 2013, 22(2):161-164
DOI:10.4103/0972-6748.132937  PMID:25013322
Aim: The aim of the current cross-sectional study was to assess the prevalence of tobacco consumption among psychiatric jail patients residing in Central Jail, Bhopal, Madhya Pradesh, India. Materials and Methods: The study subjects consisted of prediagnosed psychiatric patients residing in Central Jail, Bhopal, Madhya Pradesh, India. A matched control consisting of cross-section of the population, that is, jail inmates residing in the same Central Jail locality was also assessed to compare the psychiatric subjects. An 18 item questionnaire was used to assess the prevalence of tobacco consumption among study subjects. Results: The total number of subjects examined was 244, which comprised of 122 psychiatric inmates and 122 nonpsychiatric inmates. Among all psychiatric inmates, about 57.4% of inmates had a diagnosis of depression, 14.8% had psychotic disorders (such as schizophrenia), and 12.3% had anxiety disorder. A total of 77% study inmates, which comprised of 87.7% psychiatrics and 66.4% nonpsychiatrics had a habit of tobacco consumption (smokeless or smoking). Conclusion: The information presented in this study adds to our understanding of the common tobacco related practices among psychiatric inmate population. Efforts to increase patient awareness of the hazards of tobacco consumption and to eliminate the habit are needed to improve oral and general health of the prison population.
  1,735 50 -
LETTER TO EDITOR
Response to article: Stress and periodontal disease: The link and logic!!
Priti Sondhi, Vipul Bhatia, Shubham Mehta
July-December 2013, 22(2):165-165
DOI:10.4103/0972-6748.132939  PMID:25013323
  1,318 37 -
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