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   2013| January-June  | Volume 22 | Issue 1  
    Online since December 24, 2013

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Stress and periodontal disease: The link and logic!!
Sachin Goyal, Garima Gupta, Betsy Thomas, KM Bhat, GS Bhat
January-June 2013, 22(1):4-11
DOI:10.4103/0972-6748.123585  PMID:24459366
Stress is an equated response to constant adverse stimuli. At one point or another everybody suffers from stress. Stress is compatible with good health, being necessary to cope with the challenges of everyday life. Problems start when the stress response is inappropriate to the intensity of the challenge. Psychological stress can down regulate the cellular immune response. Communication between the central nervous system and the immune system occurs via a complex network of bidirectional signals linking the nervous, endocrine, and immune systems. Stress disrupts the homeostasis of this network, which in turn, alters immune function. Direct association between periodontal disease and stress remains to be proven, which is partly due to lack of an adequate animal models and difficulty to quantifying the amount and duration of stress and also there are many factors influencing the incidence and severity of periodontal disease. Nevertheless, more recent studies indicate that psychosocial stress represents a risk indicator for periodontal disease and should be addressed before and during treatment. This paper discusses how stress may modulate host response to bacteria and influence the course and progression of periodontal disease.
  6,805 453 2
Depression during pregnancy: Prevalence and obstetric risk factors among pregnant women attending a tertiary care hospital in Navi Mumbai
Shaunak Ajinkya, Pradeep R Jadhav, Nimisha N Srivastava
January-June 2013, 22(1):37-40
DOI:10.4103/0972-6748.123615  PMID:24459372
Context: Depression affects about 20% of women during their lifetime, with pregnancy being a period of high vulnerability. Prevalence of depression during pregnancy ranges from 4% to 20%. Several risk factors predispose to depression during pregnancy including obstetric factors. Depression during pregnancy is not only the strongest risk factor for post-natal depression but also leads to adverse obstetric outcomes. Aims: To study the prevalence of depression during pregnancy and its associated obstetric risk factors among pregnant women attending routine antenatal checkup. Settings and Design: Cross-sectional observational survey done at the outpatient department (OPD) of the department of obstetrics of a tertiary care hospital in Navi Mumbai. Materials and Methods: One hundred and eighty-five pregnant women were randomly administered the Beck Depression Inventory (BDI) for detecting depression. Additional socio-demographic and obstetric history was recorded and analyzed. Results: Prevalence of depression during pregnancy was found to be 9.18% based upon BDI, and it was significantly associated with several obstetric risk factors like gravidity (P = 0.0092), unplanned pregnancy (P = 0.001), history of abortions (P = 0.0001), and a history of obstetric complications, both present (P = 0.0001) and past (P = 0.0001). Conclusions: Depression during pregnancy is prevalent among pregnant women in Navi-Mumbai, and several obstetric risk factors were associated to depression during pregnancy. Future research in this area is needed, which will clearly elucidate the potential long-term impact of depression during pregnancy and associated obstetric risk factors so as to help health professionals identify vulnerable groups for early detection, diagnosis, and providing effective interventions for depression during pregnancy.
  5,323 174 7
Psychological vulnerability, burnout, and coping among employees of a business process outsourcing organization
Tanya Machado, Vidya Sathyanarayanan, Poornima Bhola, Kirthi Kamath
January-June 2013, 22(1):26-31
DOI:10.4103/0972-6748.123609  PMID:24459370
Background: The business process outsourcing (BPO) sector is a contemporary work setting in India, with a large and relatively young workforce. There is concern that the demands of the work environment may contribute to stress levels and psychological vulnerability among employees as well as to high attrition levels. Materials and Methods: As part of a larger study, questionnaires were used to assess psychological distress, burnout, and coping strategies in a sample of 1,209 employees of a BPO organization. Results: The analysis indicated that 38% of the sample had significant psychological distress on the General Health Questionnaire (GHQ-28; Goldberg and Hillier, 1979). The vulnerable groups were women, permanent employees, data processors, and those employed for 6 months or longer. The reported levels of burnout were low and the employees reported a fairly large repertoire of coping behaviors. Conclusions: The study has implications for individual and systemic efforts at employee stress management and workplace prevention approaches. The results point to the emerging and growing role of mental health professionals in the corporate sector.
  4,140 113 2
Cognitive function in schizophrenia and its association with socio-demographics factors
Bharti T Talreja, Sandeep Shah, Lakhan Kataria
January-June 2013, 22(1):47-53
DOI:10.4103/0972-6748.123619  PMID:24459374
Background: Schizophrenia is a chronic and debilitating psychiatric illness consisting primarily of positive and negative symptoms. However, cognitive deficits in various domains have been consistently replicated in patients with schizophrenia. Therefore, the present study was designed to assess cognitive impairment in schizophrenia and to correlate the same with sociodemographic factors. Materials and Methods: Cognitive function in 100 patients with schizophrenia as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM IV-TR) criteria attending the psychiatry outpatient department (OPD) of Department of Psychiatry, SBKS MIRC was assessed using Addenbrooke's Cognitive Examination Revised (ACER) rating scale and Mini Mental State Examination (MMSE) and sociodemographic details was obtained using semistructured proforma. Data was analyzed by Chi-square and t-test. Results: About 70% patients of schizophrenia were found to have cognitive dysfunction for attention, concentration, memory, language, and executive function. Positive symptoms were associated with memory (P<0.001) and attention impairment (P<0.05). Patients with duration of illness >2 years and belonging to urban habitat showed more cognitive dysfunction. Male patients were associated with impairment in two domains of ACER: Language and memory. Conclusion: The study findings depict that persistent cognitive deficits are seen in patients with schizophrenia. Its correlation with sociodemographic factors showed that patients with >2 years of illness and belonging to urban habitat showed more cognitive dysfunction. Male patients were associated with language and memory impairment. Our study recommends that the neurocognitive impairment should be included in the DSM-V diagnostic criteria for schizophrenia.
  3,814 80 4
Demographic and clinical profile of substance abusing women seeking treatment at a de-addiction center in north India
Naresh Nebhinani, Siddharth Sarkar, Sunil Gupta, Surendra Kumar Mattoo, Debasish Basu
January-June 2013, 22(1):12-16
DOI:10.4103/0972-6748.123587  PMID:24459367
Background: In the recent decades increasing number of women have been seeking deaddiction services. Despite that the report data is very limited from India. Objectives: The present research aimed to study the demographic and clinical profile of women seeking deaddiction treatment at a tertiary care center in North India. Materials and Methods: Retrospective structured chart review of 100 women substance abusers seeking treatment at a deaddiction center between September 1978 and December 2011. Results: A typical case was of 36.3 years age, married (65%), urban (61%), nuclear family (59%) based housewife (56%), with good to fair social support (69%). The commonest substance of abuse was tobacco (60%), followed by opioids (27%), alcohol (15%), and benzodiazepines (13%). The common reasons for initiation of substance use were to alleviate frustration or stress (49%) and curiosity (37%). Family history of drug dependence (43%), comorbidity (25%), and impairments in health (74%), family (57%), and social domains (56%) were common. Only a third of the sample paid one or more follow visit, and of those 58% were abstinent at the last follow-up. Significant predictors identified were being non-Hindu and higher educational years for abstinent status at follow-up. Conclusion: The common substances of abuse were tobacco, opioids, and alcohol and benzodiazepines; and family history of drug abuse and comorbidity were common. The follow-up and outcome were generally poor. This profile gives us some clues to address a hidden health problem of the community.
  3,615 175 3
Quality of life as an outcome measure in the treatment of alcohol dependence
Shruti Srivastava, Manjeet S Bhatia
January-June 2013, 22(1):41-46
DOI:10.4103/0972-6748.123617  PMID:24459373
Background: Quality of life has emerged as an important treatment outcome measure for alcohol dependence whose natural course comprises of remission and relapse. Materials and Methods: The purpose of this study was to examine the prospective change in Quality of life (QoL) in 56 patients aged 18-45 years of alcohol dependence over a three months' period and compare it with QoL of 150 age- and gender- matched healthy controls using WHOQoL-BREF. Severity of alcohol dependence and drinking parameters were assessed. Results: Significant improvement in QoL of patients of alcohol dependence over three months' abstinence. The physical, psychological, social, and environment domains of QoL in alcohol dependence subjects were significantly lower before treatment initiation than the healthy controls. Alcoholic liver disease emerged as a predictor of improvement in psychological and social domains of QoL. Conclusion: The study confirms poor quality of life in patients of alcohol dependence before intervention. The regular follow-up with the family members in out-patient setting enables the patients achieve complete abstinence, thereby improving their quality of life.
  3,263 132 2
Psychiatric ethics in war and peace
M. S. V. K. Raju
January-June 2013, 22(1):71-76
DOI:10.4103/0972-6748.123637  PMID:24459379
Practice of psychiatry is a complex activity because the psychiatrist generally practises his art in an emotionally charged environment with patients who may not be in a in a state of mind to exercise autonomy as a result of cognitive impairment and preoccupation with symptoms. No one principle of ethics will be suitable to guide right conduct in widely variable situations. Making ethical judgements in the military context can be difficult and may have potential for abuse as for an uniformed psychiatrist mission takes priority over man. However mission centered and medical text book centred ethics need not be compartamentalised. The present paper seeks to offer a brief overview of ethical principles and specific situations in which one may have to make ethical judgements.
  3,326 67 -
Hindi translation and validation of dysfunctional beliefs and attitudes about sleep (DBAS - 16)
Mohan Dhyani, Richa Rajput, Ravi Gupta
January-June 2013, 22(1):80-85
DOI:10.4103/0972-6748.123639  PMID:24459381
Objectives: The objective of this study is to translate and validate the Dysfunctional Beliefs and Attitudes about Sleep Brief Version (DBAS-16)) in Hindi language. Materials and Methods: The scale was obtained online, and the permission for translation was obtained from the author. The translation of the scale was carried out following back translation method. The scale was applied on 63 participants attending the adult psychiatry OPD who were included in the study. Results: Thirty-two patients were having insomnia, and 31 patients were controls without insomnia. The results show that the translated version had good reliability with internal consistency (Chronbach alpha = 0.901). Conclusion: The Hindi translation of DBAS-16 is a reliable tool for assessing the dysfunctional beliefs and attitude about sleep.
  3,273 64 2
Personality pathways of successful ageing
Kalpana Srivastava, RC Das
January-June 2013, 22(1):1-3
DOI:10.4103/0972-6748.123584  PMID:24459365
  3,186 82 1
Catatonia: Etiopathological diagnoses and treatment response in a tertiary care setting: A clinical study
Santosh Ramdurg, Santosh Kumar, Mukesh Kumar, Vijender Singh, Deepak Kumar, Nimesh G Desai
January-June 2013, 22(1):32-36
DOI:10.4103/0972-6748.123612  PMID:24459371
Aim: Catatonia is caused by a variety of psychiatric and organic conditions. The onset, clinical profile, and response to treatment may vary depending on the underlying cause. The study is an attempt to explore clinical profile, possible etiological correlates with neurotic/psychotic spectrum illnesses, and response to treatment and outcome in patients of catatonia. Materials and Methods: Retrospective chart analysis by using semistructured data sheet for the analysis of sociodemographic data, clinical profile, precipitating event, and response to treatment in patients with catatonic symptoms admitted to IHBAS (Institute of Human Behaviour and Allied Sciences, New Delhi, India) from January 2009 to December 2010 was undertaken. Results: Catatonia was commonly observed in patients with the following profile - late twenties, female, Hindu religion, urban background, and housewives. Psychotic spectrum disorder (57%, N=35) was the most commonly entertained diagnosis and affective disorder (18%, N=11) being the second common. Thirty four percent of the subjects responded to lorazepam treatment and rest required modified electroconvulsive therapy (MECT). Conclusion: Catatonia is more likely to be associated with Schizophrenia and Other Psychotic Disorders in Indian settings. Majority of patients responded to therapy either by lorazepam alone or to its augmentation with modified ECT. The study being a retrospective one, the sample being representative of the treatment seeking group only, and unavailability of the follow up data were the limitations of the study
  3,140 98 1
An analysis of paramilitary referrals to psychiatric services at a tertiary care center
Rohit Verma, Shaily Mina, Smita N Deshpande
January-June 2013, 22(1):54-59
DOI:10.4103/0972-6748.123622  PMID:24459375
Background: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrist's clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. Materials and Methods: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. Results: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. Conclusion: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.
  2,997 64 1
Impacts of mustard gas exposure on veterans mental health: A study on the role of education
Gholam-Reza Karami, Javad Ameli, Rahim Roeintan, Nematollah Jonaidi-Jafari, Amin Saburi
January-June 2013, 22(1):22-25
DOI:10.4103/0972-6748.123604  PMID:24459369
Background: The mustard gas (MG) exposure can impair physical health and therefore increase the probability of the posttraumatic stress disorder (PTSD) and psychological disorders. Aim: The aim of this study was to investigate long-term effects of MG exposure on veterans' mental health. Materials and Methods: This was a cross-sectional study. In order to assess prevalence of mental health and PTSD of 100 MG victims 25 years after the exposure to MG in Iran-Iraq conflict, the general health questionnaire (GHQ-28) and Impact of Event Scale-Revised, respectively was administered. Results: The mean (±standard deviation (SD)) age of participants was 40.63 (±5.86) years. The mean GHQ-28 (47.34) of the study group was higher compared to standardized cutoff point (23) of the Iranian community. Also, it was found that 38 participants (38%) suffer from PTSD. The results of this study showed that academic education in the PTSD group was less than that in the non-PTSD group (P=0.03). In addition, in multivariate analysis it was found that only education level of the veterans and their wives were effective on the mental health score (adjusted P=0.036 and 0.041, respectively). The mean score of depression and psychosocial activity subscale in patients at higher education level was lower than patients at lower education level (P<0.05). Conclusion: This study found that sulfur mustard (SM) exposure can be effect on mental health even 25 years after exposure. Therefore, the psychological state should be more considered in chemical injured veterans and it is important that providing more mental health centers for this community.
  2,935 33 1
Socio demographic and clinical predictors of absenteeism A cross sectional study of urban industrial employees
Suhash Chakraborty, Anantha H. C. Subramanya
January-June 2013, 22(1):17-21
DOI:10.4103/0972-6748.123589  PMID:24459368
Context: Public sector undertakings are facing a threat of privatization due to unsatisfactory performance putting pressure on management and in turn to employees. There is an increasing trend of absenteeism observed amongst employees citing job stress. Aim: To find an association between job stress and absenteeism in relation to socio-demographic and clinical profile. Materials and Methods: The study was conducted in an urban aeronautical industry with 68 employees who mentioned stress at workplace during evaluation. Job stress was assessed using Professional Life Stress Scale (David Fontana). Those who scored more than 30 (n = 43) were taken up for the study after an informed consent. A semi-structured questionnaire was administered to find socio-demographic and clinical profile. Employees who reported taking leave in last six months just to avoid work or workplace constitute the "absenteeism" group. The absenteeism group was compared to non-absenteeism group using Fisher exact/Chi-square test or independent t-test depending on type of variables. Results: Out of 43 subjects, 18 had absenteeism while 25 did not have absenteeism. Comparing the two groups, interstate migration, having more than one previous job, commuting time more than an hour, co-morbid anxiety/depression, and alcohol abuse were significantly associated with absenteeism (P < 0.05). Absentees complained more about fatigue and relationship problem with colleagues than non-absentees (P < 0.05). Factors like age, sex, marital status, education, gross pay, job tenure, past or family history of psychiatry illnesses had no significant association with absenteeism (P > 0.05). Conclusion: In absenteeism research, one of the widely accepted models is Steer and Rhode's "Process model of absenteeism." The model postulates job stress as one of the barriers for attendance. Thus, knowing the factors for absenteeism would help in preventing absenteeism.
  2,897 66 1
Metabolic syndrome among substance dependent men: A study from north India
Surendra Kumar Mattoo, Naresh Nebhinani, Munish Aggarwal, Debasish Basu, Parmanand Kulhara
January-June 2013, 22(1):60-64
DOI:10.4103/0972-6748.123631  PMID:24459376
Background: Substance abuse, alcohol in particular, is associated with increased risk of diabetes and metabolic syndrome (MS). The relationship between the substance abuse and MS is complex and the literature is sparse. Objectives: The present research was aimed to study the prevalence and predictors of MS among outpatients with substance dependence. Materials and Methods: Patients with substance dependence were recruited from a deaddiction center in North India, who attended outpatient clinic from 1 st January, 2010-31 st December, 2010. MS was assessed using International Diabetes Federation (IDF) criteria. Results: Out of 250 subjects, 34 (13.6%) of the subjects met the IDF criteria for MS and highest being in alcohol group (21.6%). The commonest abnormality was increased triglycerides (TG; 54%) and increased waist circumference (36.8%). Age, body weight, body mass index, and obesity were significant predictor of MS. Conclusion: MS was highest in subjects with alcohol dependence with the commonest abnormality of TG and blood pressure. Hence, routine screening is advisable in this population to address emerging MS.
  2,656 69 3
Psychiatric morbidity at secondary level health facility in Ballabgarh, Haryana
Harshal Salve, Pradip Kharya, Puneet Misra, Sanjay K Rai, Shashi Kant
January-June 2013, 22(1):86-88
DOI:10.4103/0972-6748.123602  PMID:24459382
Background: There is dearth of information about psychiatric morbidity at secondary level health facility in India. Aim: To study psychiatric morbidity amongst patients attending psychiatry clinic in secondary level health facility. Settings and Design: Present study is based on hospital record review of psychiatry clinic at secondary care hospital in Ballabgarh, Haryana. Materials and Methods: Service record of psychiatry clinic at civil hospital Ballabgarh was reviewed. Diagnosis of psychiatric morbidity was done according to DSM IV and ICD 10 classification. Statistical Analysis: Descriptive analysis of data was carried out. Results: A total of 724 (0.7%) new OPD patients consulted psychiatry clinic. Common Mental Disorders comprising of mood disorders, neurotic stress -related and somatoform disorders were the most commonly diagnosed disorders (60.5%) amongst reported psychiatric morbidity in the hospital. Conclusion: Substantial burden of psychiatry morbidity highlights necessity of psychiatry clinic at secondary care hospital in India.
  2,658 65 -
Cycloserine induced mania
Ajay Kumar Bakhla, Prakash S Gore, Sanjay Lal Srivastava
January-June 2013, 22(1):69-70
DOI:10.4103/0972-6748.123636  PMID:24459378
We report a 21-year-old male who developed manic symptoms after addition of second line anti-tuberculosis treatment for his multidrug resistant tuberculosis. We identified cycloserine as offending drug; and discuss the management and possible neurobiological mechanisms as etiological explanation and implications of manic switch caused by cycloserine.
  2,635 52 -
Current social functioning in adult-onset schizophrenia and its relation with positive symptoms
Partha S Kundu, Vinod K Sinha, Sarita E Paul, Pushpal Desarkar
January-June 2013, 22(1):65-68
DOI:10.4103/0972-6748.123635  PMID:24459377
Background: In schizophrenia, relation exists between psychopathology and social functioning. Aim and Objectives: Determining relationship of positive symptoms with current social functioning in adult-onset (≥19 years) schizophrenia. Materials and Methods: Eighty schizophrenia patients [ICD-10-DCR], of both sexes (18-60 years), on follow-up for ≥6 months, with no change of diagnosis and without co-morbidities, having onset of illness ≥19 years of age, accompanied by informants having contact with the patient for a period of >12 months prior the first psychiatric contact or symptom onset were assessed with SCARF- Social Functioning Index and SAPS. Results: Family role, occupational role, and other social role have negative correlation with all positive symptoms. Conclusion: Current social functioning has significant negative correlation with concurrent positive symptoms.
  2,611 60 1
How to stop tobacco use? Tobacco user's perspective
Siddharth Sarkar, Akhilesh Sharma, Debasish Basu
January-June 2013, 22(1):77-79
DOI:10.4103/0972-6748.123638  PMID:24459380
Objectives: To explore the tobacco-dependent subject's perspectives of what measures are likely to work for tobacco cessation. Materials and Methods: Nicotine-dependent male subjects attending a tertiary level de-addiction center in North India were recruited. Demographic and clinical data was recorded. Open-ended questions were asked to know user's perspective about the measures by which tobacco use can be effectively stopped in the country. The subjects were allowed as many responses as they desired. Results: A total of 46 subjects were recruited. The median age of the sample was 35 years, with median duration of tobacco use being 12 years. All subjects were males, and most were married, employed, and had urban residence. Supply reducing measures were the most commonly reported to stop tobacco (67.4% of subjects) followed by people quitting tobacco use by themselves (19.6%) and raising awareness through media (13.1%). Conclusion: This pilot study reflects the perspectives of tobacco users for the measures likely to be effective in tobacco cessation. Evaluating the effect of implementation of individual policies may help focusing towards measures that yield greatest benefits.
  2,374 53 -