Ananya Mahapatra

Violence and mental illness: what is the true story?

In public perception, mental illness and violence remain inextricably intertwined, and much of the stigma associated with mental illness may be due to a tendency to conflate mental illness with the concept of dangerousness. This perception is further augmented by the media which sensationalises violent crimes committed by persons with mental illness, particularly mass shootings, and focuses on mental illness in such reports, ignoring the fact that most of the violence in society is caused by people without mental illness. This societal bias contributes to the stigma faced by those with a psychiatric diagnosis, which in turn contributes to non-disclosure of the mental illness and decreased treatment seeking,1 and also leads to discrimination against them. The association of violence and mental illness has received extensive attention and publicity. Public perception of the association between mental illness and violence seems to have fuelled the arguments for coerced treatment of patients with severe mental illness.2 ,3 However, this perception is not borne out by the research literature available on the subject. Those with mental illness make up a small proportion of violent offenders. A recent meta-analysis by Large et al 4 found that in order to prevent one stranger homicide, 35 000 patients with schizophrenia judged to be at high risk of violence would need to be detained. This clearly contradicts the general belief that patients with severe mental illness are a threat. There are numerous ways of conceptualising the definition of violence, although at present there is no consensus as to which of these is the most appropriate. The WHO has defined violence as ‘the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, …

Role of psilocybin in the treatment of depression

Psilocybin is a naturally occurring alkaloid, pharmacologically similar to the classic hallucinogen lysergic acid diethylamide (LSD). Although primarily used as a recreational drug or an entheogen in particular cultural settings, recent population based studies have shown that it does not lead to serious physical or mental health problems or dependent use. In view of recent work demonstrating psilocybin’s potential to increase subjective sense of wellbeing and because of its novel mechanism of 5-HT2A serotonin receptor agonism, it is being explored for possible therapeutic utility in mood and anxiety disorders.

A diffusion tensor imaging tractography study in bipolar disorder patients compared to first degree relatives and healthy controls

We aimed to compare white matter structural changes in specific tracts by diffusion tensor imaging (DTI) tractography in patients with bipolar disorder (BD) I, non‐ill first‐degree relatives (FDR) of the patients, and healthy controls (HC).

Trihexyphenidyl misuse in delusional disorder

Trihexyphenidyl is an anticholinergic medication that is routinely used for the management of extrapyramidal symptoms in patients who receive antipsychotic medications. Trihexyphenidyl has been reported to be abused by some patients, who start to take it in increasing doses and tend to report a sensation of relaxation or pleasure with this medication. Hence, whether trihexyphenidyl should be considered a psychoactive substance and whether nonprescription misuse of this medication should be considered under the purview of substance use disorders need further clarity. We present here two cases of trihexyphenidyl misuse which developed in the context of persistent delusional disorders and highlight the challenges in diagnosis in such a situation.

Effectiveness of tDCS augmentation for co-morbid obsessive compulsive disorder in chronic schizophrenia: A case report

Management of obsessive compulsive disorder (OCD) remains a challenge, particularly in individuals having co-existing psychotic symptoms. Even in patients with schizophrenia having a fair to good response in psychotic symptoms, these obsessive-compulsive symptoms defy response to antipsychotic and anti-obsessive pharmaco-therapeutic approach to a great extent. Recently developed neuromodulation techniques such as transcranial direct current stimulation (tDCS) can serve a viable and effective approach to manage such cases. The present paper documents the first utilization of tDCS (cathode: supplementary motor area; anode: right occipital cortex) as an add-on approach to pharmacotherapy to manage co-morbid OCD in a case of chronic schizophrenia.

Association of Internet addiction and alexithymia – A scoping review

It has been hypothesized that individuals with alexithymia who have difficulty in identifying, expressing, and communicating emotions may overuse Internet as a tool of social interaction to better regulate their emotions and to fulfill their unmet social needs. Similarly, an increasing body of evidence suggests that alexithymia may also play an essential role in the etiopathogenesis of addictive disorders. We conducted a scoping review of questionnaire-based studies of problematic Internet use/Internet addiction and alexithymia. From initial 51 studies, all of the final 12 included studies demonstrated a significant positive association between scores of alexithymia and severity of Internet addiction. However, the causal direction of the association is not clear because the interplay of numerous other variables that could affect the relation has not been studied. There are limitations in the methodology of the studies conducted. Hence, we emphasise the need for longitudinal studies with stronger methodologies.

Diffusion tensor imaging tractography study in bipolar disorder patients compared to first-degree relatives and healthy controls: DTI tractography in bipolar disorder

We aimed to compare white matter structural changes in specific tracts by diffusion tensor imaging (DTI) tractography in patients with bipolar disorder (BD) I, non‐ill first‐degree relatives (FDR) of the patients, and healthy controls (HC).

Delusion of Triplet Pregnancy in Abdominal Cavity: A Case Report with a Review of Literature

The two terms, pseudocyesis and delusion of pregnancy, were frequently used for pseudopregnancy. Delusion of pregnancy is a special form of hypochondriacal/somatic delusion reported in various psychiatric and organic disorders. The origin of the delusion of pregnancy in schizophrenia has often been explained by psycho-analytic interpretations attributing wish fulfilling, protective role to false beliefs, and mother establishes an undisturbed union with her fetus during pregnancy, which eliminate loneliness and helplessness. The current case is a 49-year-old married female with an illness of total duration of 10 years. Initial symptoms were delusion of infidelity and persecution and 2nd and 3rd person auditory hallucination; however, the patient started reporting around 2 years back that she was pregnant and there were three female children inside her abdominal cavity rather than in uterus. She was firm on this belief and was not convinced by family members even giving evidence contrary to her belief like showing ultrasonography report. She firmly believed that these are gift of God, and they are special children who would be delivered through special procedure. Blood investigation revealed raised prolactin level, blood sugar and ultra sonography suggestive of cholelithisis. Patients psychiatric symptoms including delusion of pregnancy were significantly improved with treatment, and medical and surgical comorbidities were managed with appropriate consultations.

Examining the psychometric properties of the Hindi version of Family Accommodation Scale-Self-Report (FAS-SR)

CONTEXT Family accommodation (FA) is the phenomenon whereby caregivers assist or facilitate rituals or behaviours related to obsessive compulsive disorder (OCD). There is a need for a self-rated instrument to assess this construct in resource-strained clinical settings of India. AIM To explore the factor structure of Hindi version of Family Accommodation Scale-Self Rated version (FAS-SR) and compare its validity with the gold standard Family Accommodation Scale-Interviewer Rated (FAS-IR) scale. MATERIAL & METHODS The Hindi version of FAS-SR scale and FAS-IR scale was applied on 105 caregivers of patients with OCD. RESULTS The initial factor analysis yielded three-factor models with an eigenvalue of >1 and the total variance explained by these factors was 72.017%. The internal consistency of the 19-item scale was 0.93 indicating good inter-item correlation. There was a significant positive correlation between FAS-IR scale total score and all the factors of the FAS-SR Scale. The average measure ICC was 0.889 with a 95% confidence interval from 0.783 to 0.981 (F (62,84)=37.547, p<001) indicating high degree of reliability between the Hindi version of FAS-SR and the FAS-IR scale. CONCLUSIONS FAS-SR is a practical alternative to FAS-IR and has the potential to be used widely in an Indian setting.

Multiple Meningioma in a Patient of Bipolar Disorder: The Dilemma of Detecting Structural Brain Lesions in the Backdrop of a Long Standing Psychiatric Illness.

Multiple meningioma often can be clinically silent and may present with only psychiatric symptoms. We report a case of 43-year-old, right handed woman with a 23 year history of long standing bipolar affective disorder, who presented with a mixed episode with psychotic symptoms which did not respond to usual treatment and was further complicated with a different set of symptomatology. MRI brain revealed multiple dural based mass lesions identified to be multiple meningiomas. Patients symptoms improved after gamma knife stereotactic radiosurgery for the multiple meningioma. Our finding illustrates the need to assess for brain lesions in presence of atypical symptoms, along with unresponsiveness to traditional management with psychotropic medications in patients with bipolar affective disorders.