Kamal Nath

Koro: Culture Bound or Mass Hysteria?

Koro is a culture-bound syndrome found mainly in southeast Asia often occurring in epidemics and known by various names such as shuk yang , shook yong , and suo yang (Chinese); jinjinia bemar (Assam); or rok-joo (Thai). It is chiefl y characterized by a belief that the sexual organs (penis in males and breast/nipples in females) will retract leading to disappearance of the organ and ultimately death of the individual [1]. We report two cases of koro which presented to our department during the recent outbreak in northeastern India, perhaps more as an ‘ epidemic ’ than a pure culture-bound syndrome. A 30 year old unmarried male carpenter hailing from a remote location of northeastern India, received a mobile phone call from his brother in the evening who told him to be vigilant about a disease in which the penis gets shorter. Twenty minutes after this call he started to experience twisting body movements and a feeling as if his penis was retracting into his abdomen. He grew extremely anxious and so did his family members. The next morning he was brought to our hospital with extreme anxiety and a feeling that he would die if the penis continued to involute. Upon admission to our department his physical and laboratory investigations were within normal limits. He was prescribed a low dose benzodiazepine and was offered supportive therapy. Three days after admission he was relieved of his symptoms and was discharged. A 23 year old male hailing from a remote location of north eastern India, was brought to the casualty department at midnight by his friends and relatives in an anxi ous and distressed condition. He had calcium hydroxide paste applied to his ear lobules. He reported that he had heard television reports of ‘ penis retraction disease ’ and had then felt his penis gradually withdrawing into his abdomen. He also believed that this would ultimately cause obstruction to his intestines and that the chemical applied on his ear

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.

Eslicarbazepine acetate in the management of refractory bipolar disorder.

Eslicarbazepine acetate is a novel third-generation antiepileptic related to carbamazepine and oxcarbazepine with a benign adverse effect profile. We report a patient with bipolar mania with intolerance to multiple antimanic drugs, responding to eslicarbazepine without any serious adverse effect.

Paradoxical worsening of tics with haloperidol

Tourette’s syndrome (TS) is a common childhood onset neuropsychiatric disorder with multiple motor and one or more vocal tics that endure for more than a year [Cath et al. 2011]. Dopamine receptor blocking drugs are an efficacious treatment for tics in TS [Roessner et al. 2011]. Here we present a case of TS which was worsened on haloperidol despite its known efficacy for treating the disorder.

Atypical presentation of tuberous sclerosis and obsessive compulsive disorder in an adult male

Tuberous Sclerosis (TSC) is clinically marked by a triad of adenoma sebaceum, epilepsy and mental retardation. It can however manifest as various neuropsychiatric disorders. We report a patient who presented with TSC and co-morbid Obsessive Compulsive Disorder.

A Cross-Sectional Study on the Prevalence, Risk Factors, and Ill Effects of Internet Addiction Among Medical Students in Northeastern India.

OBJECTIVE To evaluate Internet addiction among medical students in northeastern India and gain detailed knowledge about the prevalence, risk factors, and ill effects commonly associated with the disorder. METHOD The cross-sectional study sample comprised 188 medical students from Silchar Medical College and Hospital (Silchar, Assam, India). Students completed a sociodemographic form and an Internet use questionnaire, both created for this study, and the Youngs 20-Item Internet Addiction Test after they received brief instructions. Data were collected during a10-day period in June 2015. RESULTS Of the 188 medical students, 46.8% were at increased risk of Internet addiction. Those who were found to be at increased risk had longer years of Internet exposure (P = .046) and always online status (P = .033). Also, among this group, the men were more prone to develop an online relationship. Excessive Internet usage also led to poor performance in college (P < .0001) and feeling moody, anxious, and depressed (P < .0001). CONCLUSIONS The ill effects of Internet addiction include withdrawal from real-life relationships, deterioration in academic activities, and a depressed and nervous mood. Internet use for nonacademic purposes is increasing among students, thus there is an immediate need for strict supervision and monitoring at the institutional level. The possibility of becoming addicted to the Internet should be emphasized to students and their parents through awareness campaigns so that interventions and restrictions can be implemented at the individual and family levels.

Alopecia areata associated with haloperidol decanoate long-acting injection

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Telepsychiatry in India – Where Do We Stand? A Comparative Review between Global and Indian Telepsychiatry Programs

A wide discrepancy exists in India between the existing mental healthcare repertoire and the alarmingly high burden of individuals requiring immediate attention from requisite mental healthcare services. Providing equitable mental healthcare across a vast country characterized by profound cultural variations and territorial caveats has remained a major public health concern. Against this gloomy backdrop, the emergence of distant communications technology offers solace and optimism as an ingenious approach to bridge the existing gap between clients and mental health professionals. Using inexpensive equipment and basic technical knowhow, telepsychiatry expands the scope of the discipline to distant and hazy suburbs and villages from its urban centers of excellence. The current academic endeavor intends to perform a systematic review of relevant literature from India as well as from other countries. The various models of telepsychiatry-both asynchronous and synchronous models-in practice have been elaborated on with a focus on effectiveness, feasibility and acceptability of this latest modality. A sincere attempt to chronicle the remarkable journey of telepsychiatry in India, beginning in the dawn of the 21st century to the current Indian scenario, has been made. The legal and ethical issues, along with a few words of caution and contemplation, have been briefly touched on. A set of recommendations has been provided with the hope that policy makers and administrators in the domain of mental health may benefit from them. It is anticipated that telepsychiatry will be adequately utilized in India to tackle the raging menace of inadequate mental healthcare services.

A Rare Case of Mayer-Rokitansky-Kuster-Hauser Syndrome Presenting with Acute Psychosis.

The psychiatric co-morbidities in female population with mullerian agenesis is an area with limited research. This is probably due to the fact that when those patients are diagnosed not much attention or information is given for long term psychiatric follow-up. Owing to their inability to bear children, these subjects often become socially harassed. Thus these constant stressors may lead to development of psychopathology in future. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a congenital abnormality with absence of uterus, cervix and vagina, but normal secondary sexual characteristics and external genitalia and occurs in every 1 out of 4000-10,000 females. There is also limited literature on the probable common chromosomal aetiology for both psychosis and MRKH patients. We, present here a case of MRKH syndrome, whose initial presentation was psychosis only. In this respect, we also highlight the much neglected need of appropriate psychiatric screening and provision of psychiatric care in this population.

“One level more:” A narrative review on internet gaming disorder

Due to explosive growth in technology and internet usage in the last few years, internet gaming disorder (IGD) has manifested as rapidly growing public health problem mainly affecting the teen and preteen population worldwide. It has a negative impact upon physical, psychological, social, and occupational functioning of the affected individual, often leading to severe consequences. It was only recently that it has been recognized as a separate diagnosable disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Not much data is available regarding the exact prevalence and the various sociodemographic, clinical, and other risk factors to identify the individuals vulnerable to develop this disorder, especially in the developing countries such as India. According to a recent report, India ranks 22nd in the list of highest revenue-generating countries from gaming-related businesses, thus highlighting the magnitude of risk faced by Indian population. The aim of this review is to provide an insight about the disorder to identify the risk factors and clinical features, to understand the effect of IGD upon the psychological and physical health with a special focus on neural changes, and to provide information on the various upcoming preventive and treatment strategies.