Avinash Desousa

Resilience: A Psychobiological Construct for Psychiatric Disorders

Understanding of psychopathology of mental disorder is evolving, particularly with availability of newer insight from the field of genetics, epigenetics, social, and environmental pathology. It is now becoming clear how biological factors are contributing to development of an illness in the face of a number of psychosocial factors. Resilience is a psychobiological factor which determines individuals response to adverse life events. Resilience is a human capacity to adapt swiftly and successfully to stressful/traumatic events and manage to revert to a positive state. It is fundamental for growth of positive psychology which deals with satisfaction, adaptability, contentment, and optimism in peoples life. Of late, there has been a paradigm shift in the understanding of resilience in context of stress risk vulnerability dimension. It is a neurobiological construct with significant neurobehavioral and emotional features which plays important role in deconstructing mechanism of biopsychosocial model of mental disorders. Resilience is a protective factor against development of mental disorder and a risk factor for a number of clinical conditions, e.g. suicide. Available information from scientific studies points out that resilience is modifiable factor which opens up avenues for a number of newer psychosocial as well as biological therapies. Early identification of vulnerable candidates and effectiveness of resilience-based intervention may offer more clarity in possibility of prevention. Future research may be crucial for preventive psychiatry. In this study, we aim to examine whether resilience is a psychopathological construct for mental disorder.

Prescription pattern of antidepressants in five tertiary care psychiatric centres of India

Background & objectives: Limited data are available on prescription patterns of the antidepressants from India. We studied antidepressants’ prescription pattern from five geographically distant tertiary psychiatric care centers of the India. Method: In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol. Results: A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%). Interpretation & conclusions: About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

Hypnic jerks possibly induced by escitalopram.

Hypnic jerks or sleep starts are benign myoclonic jerks that usually occur on falling asleep. Various factors like excessive caffeine intake, physical, and emotional stress can increase their frequency. Here we report a case of a female who suffered from hypnic jerks with use of selective serotonin reuptake inhibitor drug escitalopram and responding to treatment with clonazepam.

Attitude toward selfie taking and its relation to body image and narcissism in medical students

Background: The recent and rapidly popularized social phenomenon of selfie taking has been showing an increasing trend. It is thus imperative to assess the knowledge, attitude, and perception of the groups toward this phenomenon. Selfie taking is associated with younger age groups and hence, we aimed to explore the attitudes toward selfie taking and its relation toward body image and narcissism in medical college students. Methodology: This was cross-sectional study and had two groups with Group A comprising 92 first year medical students and Group B including 103 postgraduate (PG) medical students from various specialties. They were interviewed in a single session using the scale of attitude toward selfie-taking questionnaire, Body Image Acceptance and Action Questionnaire (BIAAQ), and the narcissistic personality inventory. Scores obtained were computed using basic descriptive statistics and t-test where appropriate. Results: A strong positive favorable trend toward selfie taking was noticed among both groups (A = 56.5%, B = 45.6%). There was no difference in attitude between the two groups, or difference in the gender between those clicking their own selfies regularly within each group. BIAAQ reflected a significant difference among male subjects of the two groups with PG students was more concerned about body image (P = 0.001), whereas female subjects of both groups showed no such difference. The narcissism traits also showed a significant difference, only when males of both groups were compared again in favor of PG medical students (P = 0.022). Conclusion: This study revealed that selfie-taking is popular among medical students both in their undergraduate and PG period. Further research in diverse clinical and nonclinical populations is warranted to explore the relation between this phenomenon and body image acceptance or narcissistic traits.

Contemporary Perspective on Addictive Behaviors: Underpinning Mechanisms, Assessment, and Treatment

1Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy 2Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru 3Masaryk University, Czech Republic 4Uninettuno Telematic International University, Rome, Italy 5Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Mumbai, India 6Department of Psychiatry, North-Western Tuscany Region Local Health Unit, Versilia Zone, Viareggio, Italy

Unraveling the dynamic interplay between family functioning and substance use among adolescents: an Indian perspective

Substance abuse is a common problem seen in adolescents all over the world. It has been noted that the early antecedents of substance abuse in adolescents include dysfunctional family environments and broken or disrupted families. The family systems theory is reviewed to elucidate the optimal and abnormal functioning of a family and the difference between normal and postdivorce and single parent families are considered. There is a theory built based on available literature regarding the process that causes a transition from broken families and single parent families to substance abuse in adolescence. Adolescence is a period of stress and along with hormonal and physical changes any other turmoil during the middle years of life shall serve to push the adolescent into either internalizing behavior leading to anxiety and depression or externalizing behavior manifesting as conduct problems and aggression which may soon progress to substance abuse and other forms of dangerous behavior. This trajectory for the development of substance abuse in adolescents must be considered when planning out the long-term treatment and management of such patients.

Factors affecting marriage in schizophrenia: A cross-sectional study

Background: Schizophrenia is a chronic psychiatric disorder which has a profound effect on the patient′s life course. Marriage has been shown to be both protective and detrimental to the course of recovery in schizophrenia. The study was planned to elucidate the factors that influenced marriage and the sustainability of marriage in patients with schizophrenia. Materials and Methods: The study sample was 101 patients with schizophrenia that attended the outpatient department of tertiary general hospital. Informed consent was taken and data collected from the patients and/or relatives on a special semi-structured pro forma. The data collected were subjected to appropriate statistical analysis after further subdividing the sample into subgroups. Results: About 69.3% of the total samples were married while 30.7% were unmarried. A significantly greater number of patients who were educated were unmarried (P = 0.026). Age of onset of illness below 25 years (P = 0.002) was a significant factor in those who were unmarried. When marital outcomes were considered, it was noted that greater male patients had stable marriages though not statistically significant, whereas earlier age of onset of illness was a significant factor that resulted in poor marital outcome (t = 2.96, df = 68, P = 0.0021). Conclusions: The effect of marriage on schizophrenia and factors that may influence marital sustainability in patients with schizophrenia need further study and are multipronged. Larger studies in this area of research are warranted.

Probable respiratory dyskinesia in an elderly patient after sudden stoppage of antipsychotics

Antipsychotic drugs are widely used in the management of schizophrenia in the elderly. Extrapyramidal reactions to these drugs and tardive dyskinesia are a dreaded side effect of these drugs that may be seen in the elderly. We present herewith, a case of probable respiratory dyskinesia, a rare but important variant of tardive dyskinesia seen in an elderly patient with schizophrenia after the sudden stoppage of antipsychotic medication.

RISK ASSESSMENT OF SUICIDE IN CLINICAL PRACTICE

Suicide is a global public health problem. Its management in clinical practice is complex and challenging .Studies show about 26% suicide in mental health system. Out of these, 14% commit suicide during hospital stay; about 50 90% have at least one psychiatric diagnosis. 60 70% of patients are hospitalized due to an attempt or potential crisis, about 15 20% attempt suicide prior to admission. Suicide is also common in post-discharge period. Every psychiatrist on an average loses atleast on client due to suicide in an average span of 20 years of practice. In about 70% of cases, suicide behavior is there as on for hospitalization in acute settings. Continuous training and skill development are two of the most important measures in clinical practice for dealing with suicide behavior. High suicide rates are reported in prodromal stage, acute illness, post-hospitalization and soon after discharge in the community. A clinician faces challenging situations while determining the level of care and referral for a patient with a high suicide potential. There is continued struggle amongst clinicians for decision-making in regards to the need for hospitalization, level of monitoring, voluntary status, and time of discharge. It is generally agreed that suicide is difficult to predict and prevent; however, in order to develop clinical excellence and offer a standard of care, continued education and knowledge translation for bringing research into practice is the least that can be done. Inspite of this need, continued education for mental health professionals and psychiatrists in-training remains limited. *Corresponding author: Amresh Shrivastava, Parkwood Institute, Mental health, 550 Wellington Road, London, ON N6C 0A7, Tel: (519) 646-6100; E-mail: dr.amresh@gmail.com Received Date: October 30, 2015 Accepted Date: November 29, 2016 Published Date: December 03, 2016

Secondary narcolepsy in a child after resection of a craniopharyngioma

Narcolepsy is a neurological disorder of sleep characterised by excessive daytime sleepiness and has been reported following the removal of a craniopharyngioma due to a host of neurological and endocrinological causative factors. We present here a case of a child that developed secondary narcolepsy following resection of a craniopharyngioma.