Daniel Saldanha

An Epidemiological Study of Dementia under the Aegis of Mental Health Program, Maharashtra, Pune Chapter

Background: There has been an exponential growth in the number of elderly population in India. This study aims to determine the prevalence of dementia in an urban center of Pune and to evaluate the corresponding socio-demographic correlates along with psychiatric morbidity in the study sample. Materials and Methods: The study population in Pune and Kirkee cantonments was selected based on 2001 census data. The number of people over 65 years numbered 6721 and 2145 of them were randomly selected for a door-to-door survey. They were initially administered household questionnaire and then subjected to a screening tool. Each participant underwent a brief mental state examination and data was collected on the basis of a structured proforma. Patients underwent a detailed cognitive profile using subtests from CSI-D (community screening instrument – dementia), which included a Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) word list, word fluency and delayed recall. Information pertaining to socio-demographic factors in participants and caregivers, caregiver-burden and behavioral and psychological symptoms in participants too were collected from the questionnaire. Radio imaging investigation was also carried out to quantify the deficit. Statistical Package for the Social Sciences (SPSS) software was used to compute the results. Results: Findings revealed that prevalence of dementia in the sample population of elderly aged above 65 years was 4.1%. Socio-demographic factors which conferred a statistically higher risk for dementia were identified to be older age, low socio-economic status, low level of education, presence of family history, whereas, marriage was found to be protective. Burden of care was associated with caring for elderly with dementia with increasing severity of dementia. Patients with dementia performed poorly on cognitive test battery. Social network had a protective effect in respect with severity of dementia. On magnetic resonance imaging (MRI) majority of cases of Alzheimer’s Dementia (AD) and Vascular Dementia (VaD) were noted to have both gray and white matter involvement. Conclusion: Poor awareness is a key public-health problem. Society plays an important role in the ageing process. The withdrawal of the elderly from the previous societal roles,reduction in all types of interactions i.e. shift of attention from outer world to the inner world, reduction in the power and prestige of the elderly enhance aging process. Aging in Indian culture though a disability is much stressful today in Indian culture as in others.

Internet addiction and its determinants among medical students

Background: Exponential use of internet has resulted in internet addiction in recent times. Students are particularly at risk because of their unique personal, social, and academic needs. Objectives: The study was designed to evaluate the prevalence of internet addiction and its determinants among medical students. Materials and Methods: A cross-sectional study was conducted in 282 medical students with the help of semi-structured questionnaire consisting of questions related to demographic information, information related to internet use, and Youngs internet addiction test. Results: We found prevalence of internet addiction among medical students to be 58.87% (mild – 51.42%, moderate –7.45%) and significantly associated factors with internet addiction being male gender, staying in private accommodation, lesser age of first internet use, using mobile for internet access, higher expenditure on internet, staying online for longer time, and using internet for social networking, online videos, and watching website with sexual content. Conclusion: Medical students are vulnerable for internet addiction and efforts should be taken to increase awareness and prevent the problem of internet addiction in them.

Effect of Progressive Muscle Relaxation in Female Health Care Professionals

Background: Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times. Aim: The aim of the following study is to detect the stress levels among female health care professionals in the age group of 25-35 years and its impact on health. Subjects and Methods: A prospective cross-sectional pilot project was conducted in a tertiary care hospital in Eastern part of India, after receiving approval from the Institutional Ethics Committee and informed consent form was taken from the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale. Females with scores above 200 were selected. For these, initial assessment of anthropometric measurement, electrocardiogram and lipid profile analysis, resting pulse rate, blood pressure, physical fitness index (PFI), breath holding time (BHT), isometric hand grip (IHG) test results were evaluated and recorded. All subjects were given training of progressive muscle relaxation (PMR) for 3 months. After 3 months, the lipid profile and vital parameters, Perceived Stress Scale values were re-evaluated and subjects were asked to repeat the same exercises and data thus recorded were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.). Results: Significant decrease in resting heart rate, blood pressure and Perceived Stress Scale levels was seen after PMR training in the subjects. Results of BHT, IHG tests and PFI were significantly increased after PMR training. There was a significant decrease in total cholesterol, triglyceride and low-density lipoprotein cholesterol in subjects after practicing PMR for 3 months. Conclusions: Increasing stress among female health care professionals is a cause for concern and there is a need to adopt early life-style modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality-of-life in general, but patient care in particular.

Elimination disorders: Enuresis

Enuresis is a common childhood condition which is usually treatable. Enuresis at any age can lead to embarrassment. This coupled with teasing by peers resulting in social withdrawal, avoidance of overnight stay at relatives, and friends can have a long term effect in relationships than the enuresis itself. Organic and psychological causes should be considered, especially with the late onset or exacerbation of existing enuresis. Principles of management should be focused to address any precipitating and maintaining factors and also provide appropriate advice and explanation.

Cognitive behavior therapy

Cognitive behavior therapy (CBT) is one of the most extensively researched psychotherapeutic modalities which is being used either in conjunction with psychotropic drugs or alone in various psychiatric disorders. CBT is a short-term psychotherapeutic approach that is designed to influence dysfunctional emotions, behaviors, and cognitions through a goal-oriented, systematic procedure. Recent advances in CBT suggest that there is a fresh look on a third wave CBT that has a greater impact and newer application that may mitigate the sufferings of mentally ill patients.

Quality of life impairment in depression and anxiety disorders

Background: Most common mental disorders (CMDs) such as anxiety disorders and depressive disorders run a persistent and long course. This results in significant impairment of quality of life (QOL) of patients and their families. Evidence-based psychosocial interventions using findings in our own socio-cultural context would help clinicians in holistic management. Objectives: To document illness profile, treatment satisfaction, and QOL in various domains of life in study population and normal controls. Study Design: Cross-sectional analytical study of patients group and their normal family members as a comparison group. Materials and Methods: A total of 100 consecutive patients of depressive disorders and anxiety disorders (ICD-10 clinical diagnosis) attending outpatient clinic of the medical college hospital and their age- and gender-matched relatives as the control group were recruited. Socio-demographic profile was documented along with illness parameters: Severity of illness, treatment satisfaction, and QOL was measured using semi- structured interview, HAM, Becks depression Inventory, and WHO-QOL scale. Results: The study group measured significantly low on QOL than the comparison group. The two groups differed significantly on the paired t test of significance and the variation had a genuine assignable cause. Notwithstanding some variables having a confounding effect and the limitations of a cross-sectional study, the study was conclusive in demonstrating statistically significant impairment of QOL of patients with CMDs, making a strong case for clinicians to pay attention to holistic management of patients. The study has generated QOL data on a small but significant normative population which may serve purpose in future QOL studies.

A study of autonomic functions and obesity in postmenopausal women

Background: Easy accessibility to Medicare and better living conditions has increased life expectancy in recent years. There are over 60 million postmenopausal women above 55 years in India. Obesity, physical inactivity, and altered estrogen metabolism play an integrated role in contributing to the disease risk profile of postmenopausal women. These same risk factors also affect modulation of the autonomic nervous system. A study was undertaken to test the hypothesis whether there is indeed an alteration in autonomic functions in obese postmenopausal women. Materials and Methods: 60 postmenopausal women without any gross systemic disease whose body mass index and waist/hip ratio were recorded. Subjects were divided into two groups of 36 Non-Obese and 24 Obese. The two groups were well matched for age and menopausal duration. The physical as well as physiological parameters like valsalva ratio, heart rate variation with deep breath test, heart rate response to postural change (30:15 R-R interval ratio), orthostatic tolerance test, and isometric handgrip test were recorded. Results: Results of valsalva ratio, deep breath test, and 30:15 R-R interval ratios and isometric handgrip test were significantly decreased and orthostatic tolerance values were significantly increased in Obese subjects. Conclusion: Findings show decreased sympathovagal activity with obesity in postmenopausal women.

Childhood sexual abuse in adult patients with borderline personality disorder

Background: Researchers have found elevated rates of childhood sexual abuse (CSA) in borderline personality disorder (BPD) patients. They have also implicated the role of CSA later in BPD. However, there has been a scarcity of studies regarding this in Indian population. Objectives: To profile the occurrence of CSA and its parameters in BPD patients and to document symptomatology of BPD associated with CSA. Materials and Methods: Thirty-six consecutive patients with BPD were administered with a two-staged semi-structured interview by different interviewers with the first stage for collecting sociodemographic details and confirming BPD diagnosis and the second stage for collecting information about CSA. Results: Of 36 BPD patients, 16 (44.44%) reported a history of definite CSA. The majority of CSA associated with BPD were having characteristics of onset at 7–12 years, <10 occasions of abuse, perpetrator being a close relative or a close acquaintance and genital type of CSA. Identity disturbances (P = 0.0354), recurrent suicidal/self-harm behavior (P = 0.0177), and stress-related paranoid/dissociative symptoms (P = 0.0177) were significantly associated with the presence of CSA while unstable interpersonal relationships (P = 0.001) were significantly associated with the absence of CSA. Conclusion: Significant proportion of BPD patients reported CSA. The specific symptom profile of BPD patients can be used to predict the presence of CSA in these patients, which has a direct implication in the treatment of these patients.

Cardio-respiratory response of young adult Indian male subjects to stress: Effects of progressive muscle relaxation

Background: Stress and anxiety have become an integral part of our lives. Of late, this has resulted in the increase in incidence of hypertension and coronary heart disease. Objectives: To assess the effect of progressive muscle relaxation (PMR) on young adult males and its role in the modulation of cardio-respiratory response on exposure to stress. Materials and Methods: This prospective cross-sectional study was conducted in a tertiary care referral hospital. Undergraduate male students under stress were chosen for the study. Fasting blood samples were drawn to analyze sugar and lipid profile, followed by anthropometric measurements and ECG. In the resting condition, blood pressure, pulse rate, and spirometric parameters; forced vital capacities (FVC), and forced expiratory volume in 1 sec (FEV 1 %) were measured. Then, they were made to exercise with bicycle ergometer and post exercise, the vital parameters were recorded. All subjects were given a training of Jacobsons Progressive Muscular Relaxation and asked to practice this technique for 3 months. All parameters were re-evaluated. Results: Significant decreases in resting heart rate, systolic blood pressure and diastolic blood pressure, total cholesterol, triglyceride, and low density lipoprotein (LDL) cholesterol levels of subjects were seen after PMR training. Exercise-induced rise in heart rate and blood pressure were also significantly less in subjects following PMR training. Conclusion: Progressive muscle relaxation helps in modulation of heart rate, blood pressure, and lipid profile in healthy normal adult male individuals.

Incidence and evaluation of factors contributing towards postpartum depression

Background: Pregnancy and childbirth produce a variety of physiological, psychological and social consequences. Attitudes toward pregnancy and childbirth vary from culture to culture. There is evidence to suggest mothers with young infants experience depressive symptoms and 10-15% major depression. Aim: To study the incidence and factors contributing toward postpartum depression Materials and Methods: Married women 18-35 years of age attending the antenatal and postnatal out-patient clinic were studied during 2007 and January 2008. 200 women who had delivered between 1 June 2007 and 1 January 2008 were included in the postpartum phase to calculate the incidence of postpartum depression. The prospective mothers were approached in their 3 rd trimester of pregnancy. Critically ill, past history of depression, co morbid medical or psychiatric illnesses were excluded. The diagnosis of postpartum depression (PPD) was made as per international classification of diseases (ICD 10). They were administered the beck depression inventory (BDI), Presumptive stressful life event scale, Edinburgh Postnatal Depression Scale (EPDS) and General Health Questionnaire (GHQ-12) scale. The women were subsequently reviewed in their postpartum phase in the postnatal out-patient/child immunization clinic at 2, 4 and 6 weeks after delivery. The non-depressed mothers acted as the controls. Results: A Total of 186 women out of 200 registered for the study 40 had scores above 13 on EPDS and grouped as depressive met ICD 10 diagnostic criteria. The remaining 146 were non depressive. 14 women dropped out of the study. Incidence of PPD was 21.51%. The study found 14/27 (51.8%) of the risk factors associated with PPDs were statistically significant. Significant number of mothers had high antenatal GHQ and both antenatal and postnatal BDI scores. BDI and EPDS scores remained high during the postnatal follow-up in the depressed group, which showed the presence of PPD in mothers with young infants. Conclusions: There is a need for sensitizing primary health-care givers regarding PPD and is an important health issue that should not be ignored.