Dipesh Bhagabati

Insight in psychotic disorder: relation with psychopathology and frontal lobe function.

Background/Aims: Through conceptualising poor insight in psychotic disorders as a form of anosognosia, frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. The objective of this study was to compare the relation of insight in patients with psychotic illness to that of psychopathology and frontal lobe function. Methods: Forty patients with psychotic disorder were selected from those attending the Department of Psychiatry in a tertiary care teaching hospital. The evaluation of insight was carried out using the Schedule for Assessment of Insight (SAI), that of frontal lobe function by the Frontal Assessment Battery (FAB) and psychopathology by the Brief Psychiatric Rating Scale (BPRS). The correlation coefficients were determined. Results: A negative correlation between SAI and BPRS scores means that the BPRS score is opposite to SAI scores. When the SAI total score was compared with the FAB total score, the correlation coefficient demonstrated a positive correlation. Better insight predicted lesser psychopathology and also that poor insight would exist with greater psychopathology. Better insight predicted a higher functional status of frontal lobes and prefrontal cortex in particular. Conclusion: Insight deficits in schizophrenia and other psychotic illnesses are multidimensional. Integration of different aetiological factors like biological, psychopathological, environmental ones and others are necessary for a better understanding of insight in psychosis.

Father and son attachment styles in alcoholic and non-alcoholic families

Background The theory of attachment is important to understand a lot of human behaviour. Styles of attachment could be important predictors in developing dependence on alcoholism. Insecure attachment patterns could be significant risk factors for future alcohol use. Methods Participants for this study consist of fathers with alcohol dependence syndrome (ADS) from treatment centres and fathers from the community with no dependency on alcohol, and their sons (n=200). The Michigan Alcoholism Screening Test (MAST), socioeconomic status scale were administered, and attachment styles were derived by the Attachment Style Questionnaire (ASQ). We hypothesised a prior concept reflecting theoretical predictions for the association between attachment styles and alcohol in both the generations. Results Statistics on SPSS-16 was used to test our hypotheses. As predicted, fathers with ADS had insecure attachments styles in comparison to the control group. Substance abuse/dependence and treatment participation were at an all-time low for the secure group. Conclusion The findings from this study identify attachment styles as an influential factor in understanding the divergence between alcohol dependence in treatment seekers. The findings further imply that differential treatment may need to be provided taking into account ones attachment representation to promote successful recovery. It also highlights the need to develop secure ties in children of alcoholic parents to protect them from use of substances as a coping and a learned mechanism. Limitations of the study and suggestions for further research are highlighted and implications for diagnosis and treatment are discussed.

Study of prevalence of depression and impact of depression in patients following acute myocardial infarction

Background: Depression has been found to be associated with cardiovascular diseases in various studies done in different parts of the world. Whether depression really develops after an attack of acute myocardial infarction (AMI) in hospitalised patients was not evaluated in this region of our country prior to the current work. Aim: To evaluate the prevalence of depression and impact of depression in AMI patients during the period of hospitalisation. Materials and Methods: Patients were recruited for the study after fulfi lling the selection criteria and who had documented AMI within four to fi ve days of hospitalisation. Informed consent of the patient and ethical committee clearance was obtained. To collect data semi-structured interview schedule was used. Assamese versions of 21 self-report items Beck Depression Inventory (BDI) and observer-rated 17 items Hamilton Rating Scale for Depression (HAM-D) were administered to 50 AMI patients. Data were analysed with chi-square test, Pearson coeffi cient of correlation, and student t test wherever applicable. p-value<0.05 was considered test of signifi cance in this study. Result: Fifty cases of AMI were evaluated from August 2007 to July 2008. Thirty six per cent of AMI patients and 34% of AMI patients were found to have depression as per BDI and HAM-D scales respectively. Depression has an impact on duration of hospital stay signifi cantly (p<0.019) but not on gender difference (p=0.089). Correlation of mean scores of both HAM-D and BDI scales was done by Pearson coeffi cient of correlation and was found to be signifi cant at .01 level. Conclusion: Depression was found to be high in AMI patients during the period of hospitalisation in both the depression rating scales and it has an impact on prognosis of the patients.

Prevalence of spontaneous dyskinesia in first episode, drug naive schizophrenia, and its relation to the positive and negative symptoms of schizophrenia

Aims and objectives This study aims to assess the prevalence of abnormal involuntary movement in never medicated patients with schizophrenia and to find its relation with demographic variables, and with the positive and negative symptoms of schizophrenia; this study also aims to assess the topography of the dyskinesia. Methodology Socio-demographic data of 100 consecutively selected patients who fulfilled the ICD-10 Diagnostic Criteria for Research were collected in a 12-month period. These patients were rated with the Positive And Negative Syndrome Scale (PANSS) and Abnormal Involuntary Movement Scale (AIMS). Patients were labeled as having spontaneous dyskinesia if they fulfilled the criteria of Schooler and Kane which needs a score of two (mild) in at least two areas or score of three (moderate) or four (severe) in one area. Results Fifty two per cent of the study samples were male and 48% were female with mean age of 30.72 years with standard deviation of 8.7 years. Sixteen per cent of the patients had dyskinesia when examined with AIMS. However, only 14% fulfilled the Schooler and Kanes criteria for spontaneous dyskinesia. A strong correlation was found between the presence of dyskinesia and negative symptoms of schizophrenia. 57.1% of these 14 patients had dyskinesia located in their oral and facial region. Seventy one per cent of these patients with dyskinesia had no awareness of their involuntary movements. Conclusions Spontaneous dyskinesia, negative symptoms, and lack of awareness of the abnormal involuntary movement can be taken as one of the presenting symptoms of schizophrenia.

Assessment of the effectiveness of yoga therapy as an adjunct in patients with alcohol dependence syndrome

1Professor, Department of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India, 2Senior Resident, Department of Geriatric Mental Health, King George’s Medical University, Lucknow, Uttar Pradesh, India, 3Senior Resident, Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India, 4Assitant Professor, Department of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India, 5Psychiatric Social Worker, Department of Psychiatry, Gauhati Medical College & Hospital, Guwahati, Assam, India

Recurrent Mania: Rare or Common

Traditionally we diagnose bipolar disorder if a patient has maniac or hypomaniac episode along with depressive episode. Again there is a diagnostic entity called recurrent depressive disorder in the classification system. But we don’t have a diagnostic entity called recurrent mania although in clinical practice many patients present only with episodes of mania and no depressive episode. Thus cases of recurrent mania might have phenomenological differences with rest of the cases of bipolar disorder. Thus, a 30 years old man patient’s atypical case history has been discussed in the context of bipolar disorder and having the possibility of a new subtype of recurrent mania

Does clinical posting in psychiatry contribute to changing medical interns’ attitude towards psychiatry?

The aims and objectives of the present study were (i) to assess the medical interns’ attitude towards psychiatry, (ii) to ascertain the impact of a clinical psychiatry posting on this attitude and (iii) to gain an understanding of the process of choosing psychiatry as a future professional career. Using a longitudinal design, a questionnaire adapted by Balon et al. (1999) based on Nielsen and Eaton (1981) was administered to the interns before and after completing their training in psychiatry to explore their attitude in the below mentioned six domains: overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, possible abuse and social criticism, career and personal reward and specific medical school factors. Interns participating in the study were asked to complete the same questionnaire before and after completion of their psychiatry training in the year 2010 at Silchar Medical College Hospital, Silchar, Assam, India. A total of 41 interns participated in the study which included 28 (68.29%) males and 13 (31.71%) females. The mean age was 24 years (SD = 1.095). There were no drop-outs. The results obtained in this study clearly indicate that 15 days of regular posting in psychiatry had a favourable impact on the interns’ attitude towards psychiatry. They were more likely to strongly disagree that psychiatry is unscientific and imprecise (from 56.09 to 73.13%) and 90.24% of them agreed both before and after posting that psychiatry is a rapidly expanding frontier of medicine. Most interns regarded psychiatrists to be logical thinkers with a further positive change after rotation (from 68.29 to 75.60%). The participants came to better understand that there is no abuse of legal power in events of compulsory admissions (43.90 to 51.22%). This illustrates how direct contact with psychiatric practice might be effective in changing previously negative attitudes. In areas of career and personal reward, less than half of the participants felt that psychiatry has a low prestige among general public. Most of them believed that psychiatrists had a higher status among other professionals with a positive change after the rotation (58.53 to 70.73%). Only 12.19% of the interns felt that psychiatry was filled with international graduates of low skills which declined further to 7.31% after the rotation. About half of the them reported that they were discouraged by their family members and fellow students to pursue psychiatry as a profession, and that colleagues who are interested in psychiatry are seen as odd, peculiar, neurotic with an insignificant change in their attitude after the rotation. Interns had started feeling less uncomfortable with the mentally ill patients at the end of rotation. Those who strongly disagree with the feeling of uncomfortability had risen from 48.78 to 65.85%. This fact is also suggestive of favourable impact of rotation on the stigma concerning psychiatric patients, reinforcing the need for an increased undergraduate exposure to psychiatry.