Dushad Ram

Suicide prevention is possible: A perception after suicide attempt.

Background: Suicide is a preventable cause of death, inspite of which its incidence is increasing worldwide. Very few studies are done to know the perception of suicide attempters regarding prevention of their suicide attempt. Such information may be helpful in implementing preventive strategies. This study was done to find out whether those who attempted suicide and recovered perceived that their suicide attempt could have been prevented or not. Materials and Methods: Fifty consecutive subjects were recruited by purposive sampling method. These subjects were admitted for suicide attempt and were stable after medical management. Subjects were assessed using socio-demographic and clinical proforma, Pierce suicide intent scale and structured questionnaire to assess their perception regarding suicide. Group differences for categorical variables were examined with the chi-square test, whereas an independent ‘t’ test was used for continuous variables. Results: Analysis revealed that 80% of suicide attempters felt that their suicide attempt could have been prevented. 64% of the study subjects perceived that family members and near and dear ones could have helped in preventing their attempt while 16% of the study subjects perceived that society could have helped. Conclusions: Majority of subjects on recovery from the suicide attempt perceived that their suicide attempt could have been prevented by family members, near and dear ones and society.

A study on professional stress, depression and alcohol use among Indian IT professionals.

Background: Stress has touched almost all professions posing threat to mental and physical health. India being the Information Technology (IT) hub with lakhs involved as IT Professionals, there is a need to assess prevalence of professional stress, depression and problem alcohol use and understand their association. Objectives: (1) To screen for the prevalence of professional stress, risk for depression and harmful alcohol use among software engineers. (2) To study the association between professional stress, risk for depression and harmful alcohol use. Materials and Methods: This is a cross-sectional online study conducted using screeing questionnaires like professional life stress scale, centre for epidemiological studies depression scale and alcohol use disorders identification test. This study was conducted specifically on professionals working in an IT firm with the designation of a software engineer. Results: A total of 129 subjects participated in the study. 51.2% of the study sample was found to be professionally stressed at the time of the interview. 43.4% of the study population were found to be at risk for developing depression. 68.2% of those who were professionally stressed were at risk for developing depression compared with only 17.5% of those who were not professionally stressed. Odds ratio revealed that subjects who were professionally stressed had 10 times higher risk for developing depression compared to those who were not professionally stressed. Subjects who were professionally stressed had 5.9 times higher prevalence of harmful alcohol use compared to those who were not professionally stressed. Subjects who were at risk for developing depression had 4.1 times higher prevalence of harmful alcohol use compared with those who were not at risk for developing depression. Conclusion: Such higher rates of professional stress, risk for developing depression and harmful alcohol use among software engineers could hinder the progress of IT development and also significantly increase the incidence of psychiatric disorders.

Inheritance of Stem and Leaf Morphological Traits in Pointed Gourd (Trichosanthes dioica Roxb.)

ABSTRACT The inheritance of five stem and leaf morphological characters was studied in progeny of a perennial dioecious species, Trichosanthes dioica from the female clone IIVRPG-102 pollinated by the male clone IIVRPG-M. Because mature seeds failed to germinate even after scarification, embryos from almost fully developed seeds were excised and cultured in vitro. Fifty-two plants were raised in a glasshouse, and segregation was observed for sex expression, stem shape (angular > round), stem pubescence (pubescent > smooth), tendril coiling (coiled > uncoiled), tendril branching (branched > unbranched), and leaf pubescence (smooth > pubescent). There was a significant bias for female plants possibly due to lethal/sublethal gene(s) linked to the female determining locus. It is proposed that stem pubescence (sst), stem shape (rst), tendril coiling (stl), tendril branching (utl), and leaf pubescence (plf) are governed by a single gene each. We believe this to be the first such report in T. dioica.

Psychotropic medication-induced sexual dysfunction and its interference with patient's daily performance: a cross-sectional study

Objectives There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to psychotropic medications. Therefore, this study aimed to quantify the frequency of sexual dysfunction and its interference in the patients′ daily performance in a hospital-based population taking psychotropic medications. Materials and methods This cross-sectional study was conducted in the psychiatric unit of a Tertiary Care Teaching Hospital in South India over a period of 2 years. The Udvalg for Kliniske Undersogelser side effect rating scale was used to determine sexual dysfunction. A global assessment of interference in daily performance due to side effects was also evaluated. Results The overall incidence of sexual dysfunction was 20.95%. A higher incidence of sexual dysfunction was observed in women [n = 56 (70.88%)] and in the age group 18-29 years [n = 30 (37.9%)]. Amenorrhea [n = 32 (38.5%)] was the most prominently observed sexual dysfunction, followed by galactorrhea [n = 15 (18.07%)] and decreased sexual desire [n = 14 (16.86%)]. Antipsychotics [n = 54 (65.06%)] constituted the most common class of drug implicated in sexual dysfunction, followed by antidepressants [n = 25 (30.12%)]. Withdrawal of the drug [n = 58 (42%)] was the most common intervention for the management of sexual dysfunction. The majority of reports rated interference in daily performance due to side effects as severe [n = 48 (60.75%)], followed by moderate [n = 26 (32.91%)]. Conclusion The incidence rate of sexual dysfunction was 20.95%. Amenorrhea and galactorrhea were the two most prominent sexual dysfunctions affecting the patients with psychotropic medications. Thus it is important for all healthcare professionals to acknowledge and encourage discussion as well as the impact of drugs on sexual function.

Identification and management of adverse effects of antipsychotics in a tertiary care teaching hospital

Objective: Antipsychotics have revolutionized psychiatry by allowing significant numbers of patients in long-term hospital settings to be discharged and successfully maintained in the community. However, these medications are also associated with a range of adverse events ranging from mostly annoying to rarely dangerous. This study is carried out to identify the adverse drug reactions (ADRs) to antipsychotics and its management in psychiatric patients. Methods: Prospective interventional study was conducted in the psychiatric unit of a tertiary care hospital. Patients of any age and either sex prescribed with at least one antipsychotic were included and monitored for ADRs. Findings: Among the 517 patients receiving antipsychotics, a total of 289 ADRs were identified from 217 patients at an overall incidence rate of 41.97%. Sixty-seven different kinds of ADRs were observed in the study patients. Central and peripheral nervous system was the most commonly affected system organ class (n = 59) and weight gain (n = 30) was the most commonly observed ADR. Olanzapine was most commonly implicated in reported ADRs (n = 92) followed by risperidone (n = 59). Of the 289 ADRs, 80% required interventions including cessation of drug and/or specific/symptomatic/nonpharmacological treatment. Conclusion: This post marketing surveillance study provides a representative data of the ADR profile of the antipsychotics likely to be encountered in psychiatric patients in an Indian tertiary care hospital.

Relationship between consanguinity and depression in a south Indian population

A Pilot study was Carried out to study the association of consanguinity marriage with depression. It was observed that the consanguinity of marriage was associated with depression. The odds ratio was 5.66 (CI: 2.42-13.54). The age and sex had an association with depression. The age and sex adjusted odds ratio of consanguinity marriage was 7.66 (CI: 3.93-19.45) indicating that it is independently associated with depression.

Gender differences in the occurrences and pattern of adverse drug reactions in psychiatric patients: A prospective observational study

Background: The female gender appears to suffer from more adverse drug reactions (ADRs) than the male gender. There are lacunae in epidemiologic studies analyzing gender-based differences in the ADR risks of patient with mental illness. Aim: The aim of this study was to establish a drug risk stratification adjusted to age, number of prescriptions, and drug classes with respect to gender differences. Setting: Prospective study was conducted in mental Health Department of a Tertiary Care Hospital over a period of 2 years. Materials and Methods: Patients of either sex or age prescribed with at least one psychotropic agent were included and monitored for ADRs. Results: A total of 775 ADRs were identified from 426 patients giving an overall incidence rate of 35.5%. Incidence of ADRs in male and females were 33.6% and 45.9%, respectively (adjusted odds ratio [OR], 1.6, 95% confidence interval [CI]: 1.26-2.05, P < 0.001). Female gender was found to be a significant risk factor in age Group 1 (adjusted OR, 1.55, 95% CI: 1.19-2.02, P = 0.001) and Group 2 (adjusted OR, 2.90, 95% CI: 1.01-8.28, P = 0.047). Furthermore, female patients receiving more drugs are at high risk of developing ADRs than the male [OR, 1.72, 95% CI: 1.14-2.72, P = 0.011 for Group 1 and OR, 1.83, 95% CI: 1.12-2.97, P = 0.015 for Group 2]. Conclusion: The incidence rate of ADRs is much higher (45.9) in females than the males with mental illness. To heighten drug safety for females, the complex interaction between pharmacokinetics, pharmacodynamics, and pharmacogenetics needs further research.

Incidence and predictors of adverse drug reactions caused by drug-drug interactions in psychiatric patients: An empirical study

Introduction: Potential drug-drug interactions (pDDIs) are very frequent in psychiatric practice and result in poor tolerability or reduced efficacy, or both, which can negatively impact patient outcomes. Clinically significant drug-drug interactions (DDIs) are the ones that can result in changes in the therapeutic effect of one of the two drugs, that is, adverse drug reactions (ADRs). The aim of this study was to identify the incidence and pattern of ADRs occurring as results of DDIs in patients with mental illness. Materials and Methods: This empirical study reviewed all the patients with a psychiatric diagnosis as per the Tenth Revision of the International Classification of Diseases (ICD-10) and received at least two medications. DDIs were identified using drug interaction software/databases, standard textbooks, and references. Result: A total of 122 ADRs were identified from 97 patients. The majority [n = 98 (68.5%)] of the DDIs involved pharmacodynamic interactions. Risperidone (41 occurrences) exhibited the greatest propensity to interact with other medications, and the most commonly observed ADR was extrapyramidal symptoms (EPS) (n = 33). More than half of the ADRs were “possible” in their causal relationship. Conclusion: The incidence of ADRs caused by DDIs in this study was 12%. Pharmacodynamic interactions accounted for the majority (68.5%) of ADRs. ADRs are an important cause of the increased burden of disease and unnecessary health-care expenditure. Intense monitoring of psychiatric patients for any DDI, and early detection and prevention of the same may result in improved therapeutic outcomes and decreased unnecessary health-care expenditure.

A Case Report of Isotretinoin-induced Manic Psychosis.

Isotretinoin, an oral vitamin A derivative, used to treat severe treatment-resistant acne. Psychiatric side effects of isotretinoin particularly depression and suicidal thoughts have been well documented. We report a case of isotretinoin-induced manic psychosis in a young female without a family history and history of mental illness.

Lorazepam-induced diplopia

Diplopia – seeing double – is a symptom with many potential causes, both neurological and ophthalmological. Benzodiazepine induced ocular side-effects are rarely reported. Lorazepam is one of the commonly used benzodiazepine in psychiatric practice. Visual problems associated with administration of lorazepam are rarely reported and the frequency of occurrence is not established. We report a rare case of lorazepam-induced diplopia in a newly diagnosed case of obsessive compulsive disorder.