Dinesh Kataria

Comparative efficacy and safety of oxcarbazepine versus divalproex sodium in the treatment of acute mania: a pilot study.

OBJECTIVE This study compared the efficacy and safety of oxcarbazepine and divalproex sodium in acute mania patients. SUBJECTS AND METHODS In this 12 week, randomized, double-blind pilot study, 60 patients diagnosed with acute mania (DSM-IV) and a baseline Young Mania Rating Scale (YMRS) score of 20 or more received flexibly dosed oxcarbazepine (1,000-2,400 mg/day) or divalproex (750-2,000 mg/day). The mean decrease in the YMRS score from baseline was used as the main outcome measure of response to treatment. A priori protocol-defined threshold scores were <or=12 for remission and >or=15 for relapse. Number of patients showing adequate response and the time taken to achieve improvement was compared. Adverse events were systematically recorded throughout the study. RESULTS Over 12 weeks, mean improvement in YMRS scores was comparable for both the groups including the mean total scores as well as percentage fall from baseline. There were no significant differences between treatments in the rates of symptomatic mania remission (90% in divalproex and 80% in oxcarbazepine group) and subsequent relapse. Median time taken to symptomatic remission was 56 days in divalproex group while it was 70 days in the oxcarbazepine group (p=0.123). A significantly greater number of patients in divalproex group experienced one or more adverse drug events as compared to patients in the oxcarbazepine group (66.7% versus 30%, p<0.01). CONCLUSION Oxcarbazepine demonstrated comparable efficacy to divalproex sodium in the management of acute mania. Also the overall adverse event profile was found to be superior for oxcarbazepine.

Impact of psychiatric education and training on attitude of medical students towards mentally ill: A comparative analysis.

Background: A number of studies from the western world have explored the negative beliefs held by individuals towards people with mental illness. The knowledge of attitude and awareness of undergraduate medical students towards psychiatry, mental health and mental disorders is of utmost importance. Objective: The current study aims at assessment of attitudes of medical students towards mental illness and mentally ill. Materials and Methods: The study used a cross-sectional survey design. The instruments used included Beliefs toward Mental Illness (BMI) scale, Attitudes to Mental Illness Questionnaire (AMIQ). ANOVA was carried out to compare the in between group differences for the four study groups. Additionally Bonferroni correction was used to conduct the post hoc analysis. Results: The interns were significantly more likely to agree with the statement that the mental disorders are recurrent; less likely to be of thought that the behavior of people with mental disorders is unpredictable; more likely to disagree with the fact that diagnosis of depression as described in the case vignette was going to damage the career of the individual; more likely to agree with the option of inviting a depressed person to a party; more likely to believe in fact that mentally ill individuals are more likely to be criminals as compared to medical students in different professional years. Conclusions: Adequate modifications to existing medical curriculum would help improve attitude of medical students towards mentally ill.

Pseudocyesis Versus Delusion of Pregnancy: Differential Diagnoses to be Kept in Mind

Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. The literature on delusions of pregnancy in schizophrenia is however scanty. We hereby present a case of delusion of pregnancy. The case highlights the possibility of delusion of pregnancy if a patient presents with features suggestive of pseudocyesis. The obstetricians being more familiar with pseudocyesis might tend to overlook the other possibility in such cases. This would be especially true if there are no associated clearcut psychotic features.

A comparative study of quality of life and marital satisfaction in patients with depression and their spouses

Spouses of patients suffering from depression experience various forms of burden. Present study assesses and compares the marital satisfaction and quality of life (QOL) of the patients and their spouses. Further it assesses these variables in terms of illness severity, duration of untreated illness (DUI) and other demographic parameters especially gender. In this cross sectional study, 50 patients diagnosed with Depressive Disorder along with their spouses were recruited. Both groups were assessed separately for marital satisfaction and QOL along with demographic details followed by appropriate statistical analysis. A high level of marital distress found amongst both patients and their spouses whereas only patients reported poor QOL. Increasing DUI worsens both marital satisfaction and QOL in spouses with no effects on patients. Illness severity worsens QOL in both groups with no effect on marital satisfaction. Gender was not found to have any impact on either of the groups. Small sample size and cross sectional study design were main limitations. Early and faster intervention will be helpful in patients prognosis, and also the perception and QOL of spouses. A better treatment response may be expected if focus is at improvement in QOL rather than only symptom control. Further work will be needed with a larger population and in a longitudinal study design. Future research also needs to focus upon establishment of better norms for the DUI for depressive disorder.

A Cross-Sectional Study of Body Shape and Eating Attitude among Indian Female Healthcare Students

Objective: The current study aimed at assessing eating attitude and body shape concerns among Indian female healthcare students who had received some teaching/training in Psychiatry. Method: The study was conducted at government medical and nursing college. All the undergraduate healthcare students enrolled with institute at the time of study constituted the sampling frame for the study. Survey-based methodology was used for data collection. Study scales included semi-structured proforma, Eating Attitudes Test-26 (EAT-26) (including the three sub-scales), and Body Shape Questionnaire (BSQ). Data were analyzed using Pearsons and Spearmans correlation statistics and ANOVA with post hoc analysis. Results: A total of 498 students returned the completed study questionnaire. There was significant correlation between Body Mass Index (BMI) and EAT-26 scores) including the sub-scales score of EAT-26). Similarly, BMI and BSQ scores were also significantly correlated. Discussion: The findings from current study help understand the body shape and eating attitudes of Indian female healthcare students who had received some teaching/training in Psychiatry.

Validation of hindi translation of DSM-5 level 1 cross-cutting symptom measure

BACKGROUND The DSM-5 Level 1 Cross-Cutting Symptom Measure is a self- or informant-rated measure that assesses mental health domains which are important across psychiatric diagnoses. The absence of this self- or informant-administered instrument in Hindi, which is a major language in India, is an important limitation in using this scale. AIM To translate the English version of the DSM-5 Level 1 Cross-Cutting Symptom Measure to Hindi and evaluate its psychometric properties. MATERIALS AND METHODS The study was conducted at a tertiary care hospital in Delhi. The DSM-5 Level 1 Cross-Cutting Symptom Measure was translated into Hindi using the World Health Organizations translation methodology. STATISTICAL ANALYSIS Mean and standard deviation were evaluated for continuous variables while for categorical variables frequency and percentages were calculated. The translated version was evaluated for cross-language equivalence, test-retest reliability, internal consistency, and split half reliability. RESULTS Hindi version was found to have good cross-language equivalence and test-retest reliability at the level of items and domains. Twenty two of the 23 items and all the 23 items had a significant correlation (ρ < 0.001) in cross language concordance and test-retest reliability data, respectively. The Cronbachs alpha was 0.95, and the Spearman-Brown Sphericity value was 0.79 for the Hindi version. CONCLUSION The present study shows that cross-language concordance, internal consistency, split-half reliability, and test-retest reliability of the Hindi version of the measure are excellent. Thus, the Hindi version of DSM-5 Level 1 Cross-Cutting Symptom Measure as translated in this study is a valid instrument.

Prevalence and predictors of intimate partner violence in alcohol use disorder

Context: Intimate partner violence (IPV) is a major public health problem because of its detrimental effects on the physical and mental health of the victim. It is well-established that alcohol increases the occurrence and severity of violence between the partners. Aims: To find the prevalence and predictors of IPV in patients with alcohol use disorder (AUD). Settings and Design: This descriptive cross-sectional study was carried out at a De-addiction Centre of a Tertiary Government Hospital in New Delhi. Subjects and Methods: Thirty consecutive male patients were screened using International Classification of Diseases-10th Revision criteria for alcohol dependence syndrome. Their spouses were assessed using abusive behavior inventory for identifying physical, sexual, and emotional abuse. Statistical Analysis: Data were analyzed using descriptive statistics, multiple regression analysis, and Chi-square test. Results: Overall 6 months prevalence of IPV was 90%. Prevalence was 90% for physical and psychological abuse and 76.7% for sexual abuse. Physical abuse score ranged from 1 to 4.5 (mean 2.38, standard deviation [SD] 1.01). Psychological abuse score ranged from 1 to 4.71 (mean 2.64, SD 1.01). Sexual abuse score ranged from 1 to 4 (mean 2.11, SD 0.92). Total IPV score ranged from 1 to 4.4 (mean of 2.5, SD 0.94). Education of patient and spouse were significant predictors of overall abuse. While patients education and family history of alcohol use significantly predicted physical abuse, spouses education predicted psychological abuse. The incidence of abuse (any type) was also significantly associated with the joint family type. Conclusion: Study shows high IPV among spouses of AUD patients. There is a need to screen IPV in AUD patients so that adequate support could be provided to affected women.

Knowledge, attitude and social distance practices of young undergraduates towards mental illness in India: A comparative analysis

The success of the current model of psychiatric care depends on de-stigmatization of mental illnesses, highlighting the need for research on perception of mental illnesses. This study compared the knowledge, attitude and social distancing practices of the young undergraduate sub-population towards mental illness. A cross-sectional survey was done using a pretested questionnaire, which in addition to demographic details assessed exposure, knowledge, attitude and social distancing practices for mental illnesses. The study included (N=289; 55% Females; Average age 20.5 years) responses from nearly equal number of students from medical, psychology and other courses. Medical students chiefly attributed mental illness to biological factors while students from other courses perceived mental illness as Gods punishment. More medical students believed that mental illnesses can be successfully treated and appeared to have less social distancing from the mentally ill. Males mostly reported stress and brain damage as the causative factors while females attributed mental illnesses to other biological factors. Males were found to be less afraid of a communication with mentally ill and more open to the possibility of marriage with someone suffering from a mental illness. Exposure to information about mental illness led to no significant variation in the studied variables. Thus, demographic variables and the academic course contribute to variations in knowledge and attitude of young adults. Education received by medical students has a positive impact on their attitudes, highlighting the need of introduction of informative awareness measures among other courses as well.

Violence against women.

Violence against women (VAW) is a major public health problem in the country. The problem is grossly under-reported. A number of factors have been blamed for crimes against women. An inefficient law enforcing machinery has often been targeted for the increasing number of cases being reported. There is little recognition that psychiatric morbidity can perpetuate such crimes. Of late, there appears to a continuous increase in the number of crimes committed against women; especially the very serious ones like gang rapes. The latter have shaken the very conscience of people. Even harsher legislation does not seem to have made any effect. One wonders how this could be possible in a society heading toward high education, economic and technological development. Media has played a pivotal role by highlighting the problem to the masses. The need for the hour is for mental health professionals to take the challenge and present a comprehensive proposal for definite action to prevent all forms of VAW.

A study of changes in inflammatory markers in patients of depression

Background: Depression may result in unfavorable health outcomes as it has been associated with cardiovascular morbidity. Recent researches have suggested the role of inflammation in the pathophysiology of depression and co-morbidities associated with it although the underlying mechanism relating the two is still unclear. Aim: The present study aimed to explore the association between depression and inflammatory markers including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and high sensitive c-reactive protein (hsCRP). Materials and Methods: Thirty drug-naοve patients of depression diagnosed on the basis of ICD-10 criteria, in the age group of 20-45 years were included in the study. They were compared with 30 age, gender, body mass index, socio-economic and educational status matched apparently healthy controls. The blood samples were taken after an overnight fast and serum samples were immediately stored until the time of analysis. Results: The serum levels of hsCRP were significantly higher (P = 0.042) in depression group as compared to the control group. Although the mean serum levels of IL-6 and TNF-α were higher in patients of depression, they were not statistically significant (IL-6: P = 0.055, TNF-α: P = 0.053). Conclusion: It can be inferred from our study that depression is associated with underlying low-grade inflammation, which might contribute to increased morbidity in patients of depression.