Kaustav Chakraborty

Management of anorexia and bulimia nervosa: An evidence-based review.

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.

Psychological and clinical correlates of functional somatic complaints in depression

Background: Studies have shown that functional somatic symptoms are common in patients of depression. However, very few studies have assessed the socio-demographic, psychological and clinical correlates of functional somatic complaints in depression. Method: Fifty (50) patients of first-episode unipolar depression (except for severe depression with psychotic symptoms), aged 18 to 50 years, with duration of depression of more than one month, with no comorbid psychiatric disorders and comorbid medical illnesses, and with at least one symptom on Bradford Somatic Inventory were assessed on the Beck’s Depression Inventory, the Comprehensive Psychopathological Rating Scale – Anxiety Index, the Toronto Alexithymia Scale (Hindi version), the Somato-sensory Amplification Scale and the Whiteley Index. Results: The most commonly reported functional somatic complaints were a lack of energy much of the time (98%) and feeling tired when not working (82%). A significant positive correlation (Pearson’s product moment value = 0.362, p < 0.01) was found between severity of depression and number of functional somatic complaints. Significant negative Spearman’s rank correlation (−0.346, p < 0.05) was found between Bradford Somatic Inventory total score and Toronto Alexithymia Scale severity grade. A significant positive correlation between Bradford Somatic Inventory total score and somato-sensory amplification emerged only when common items were taken care of. No correlation was found between Bradford Somatic Inventory total score and any of the socio-demographic variables, age at onset of illness, total duration of illness, melancholic symptoms, suicidality, level of anxiety and hypochondriacal worry. Beck’s Depression Inventory total score alone accounted for 11.3% of the variance in the Bradford Somatic Inventory total score. Conclusion: Functional somatic complaints are more prevalent in patients with higher severity of depression, high somato-sensory amplification and less alexithymia. There is no correlation of functional somatic complaints with level of anxiety and hypochondriacal worry.

IPS multicentric study: Antidepressant prescription patterns

Background: There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression. Aim: To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics. Materials and Methods: Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated. Results: Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth (N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients (N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523). Conclusion: Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription.

Pattern of Internet use among professionals in India: Critical look at a surprising survey result

Background: To study the pattern of Internet use across people of various professions who have access to it; the impact of Internet use on their personal, social, and occupational life; and to evaluate their Internet use on the International Classification of Diseases–Tenth Revision (ICD-10) dependence criteria and Youngs Internet Addiction Diagnostic Questionnaire (IADQ). Materials and Methods: Hundred four respondents were assessed on a 31-items self-rated questionnaire covering all the ICD-10 criteria and Youngs criteria for Internet addiction. Results: The typical profile of an Internet user was as follows: the mean duration of Internet use was 73.43 months (SD 44.51), two-thirds (65.38%) of them were using Internet on a regular basis for a period of more than a year, the mean duration of daily Internet use was 39.13 months (SD 35.97), the average time spent in Internet use was 2.13 h (SD 1.98) everyday, more than half (56.73%) of the sample was using Internet at least for 2 h/day, and the most common purpose of Internet use was educational for two-thirds (62.5%) of the sample. The five most commonly endorsed items were as follows: the need to use the Internet everyday (53.8%), Internet use helping to overcome bad moods (50%), staying online longer than one originally intends to (43.3%), eating while surfing (24%), and physical activity going down since one has started using the Internet (22.1%). When evaluated on ICD-10 substance dependence criteria and Youngs IADQ separately, the prevalence of the ‘cases’ of Internet addiction came out to be 51.9 and 3.8%, respectively. Conclusions: The Internet affects the users’ life in multiple ways. The sharp difference in the prevalence estimates of Internet addiction depending on the type of criteria used shows the fragility of the construct of Internet addiction. A cautious approach should be adopted while revising the nosological system to differentiate users from those who are dependent.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses.

Aim: To assess the health-care needs of the patients with severe mental disorders. Materials and Methods: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. Conclusion: About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

Management of tardive syndromes with clozapine: A case series

Tardive syndromes are among the most debilitating side effects associated with use of antipsychotics. In this case series we present 5 cases of drug induced tardive syndromes, who had not responded to many of the other therapeutic measures but responded to clozapine. The response rate with clozapine varied from 50% to 100% and the response was seen by week 3 in most cases. Over the long term follow-up of as long as 6 years the response to clozapine was sustained. In two cases clozapine could be stopped.

Indian concepts on sexuality

India is a vast country depicting wide social, cultural and sexual variations. Indian concept of sexuality has evolved over time and has been immensely influenced by various rulers and religions. Indian sexuality is manifested in our attire, behavior, recreation, literature, sculptures, scriptures, religion and sports. It has influenced the way we perceive our health, disease and device remedies for the same. In modern era, with rapid globalization the unique Indian sexuality is getting diffused. The time has come to rediscover ourselves in terms of sexuality to attain individual freedom and to reinvest our energy to social issues related to sexuality.

Erectile dysfunction in patients with diabetes mellitus: Its magnitude, predictors and their bio-psycho-social interaction: A study from a developing country

BACKGROUND Persons suffering from diabetes mellitus (DM) are at higher risk of developing erectile dysfunction (ED). Several factors contribute to ED in patients of DM. Only few studies have attempted to explore physical, psychological and social factors in a single study. The aim of the index study was to measure the prevalence of ED in patients of DM and to determine the contributory role of various socio-demographic, physical, and psychological variables. METHOD One hundred and thirteen (N = 113) consenting consecutive male married diabetic patients were assessed on International Index of Erectile Function Questionnaire (IIEFQ-5), Dyadic Adjustment Scale (DAS) and Becks Depression Inventory (BDI) to measure erectile performance, quality of marriage and depressive symptoms respectively. Pretested Bengali versions of these scales were used in the index study. RESULTS Prevalence of ED was 38.94%. ED group significantly differed from non-ED group in current age, family type, type of treatment for diabetes, presence of micro/macrovascular complications, history of current tobacco use, quality of marriage, and presence of depressive symptoms. In logistic regression analysis current age, body mass index (BMI) and presence of depressive symptoms had significant predictive role on occurrence of erectile dysfunction. CONCLUSION Prevalence of ED among diabetic patients is high compared to general population. Both physical and psychosocial factors predict the occurrence of ED in this group. So, both physicians and psychiatrists should remain aware about the multi-faceted causative role of ED in DM.

Methylphenidate-induced mania-like symptoms

Therapeutic dose of methylphenidate is known to cause adverse effects (psychosis or mania), albeit in a small number of cases. Signs and symptoms of adverse effects usually disappear on stopping the medicine. Data regarding the safety of methylphenidate in comorbid attention deficit hyperactivity disorder (ADHD) and mental retardation are nonexistent. We describe a case of an 11-year-old girl with ADHD and mental retardation treated with methylphenidate, who developed mania like symptoms requiring inpatient treatment. The index case required psychopharmacological intervention with sodium valproate and olanzapine as the symptoms did not subside even after 3 days. This case highlights the fact that one has to exercise caution while prescribing methylphenidate in patients with comorbid ADHD and mental retardation.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers

Aim: To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. Materials and Methods: Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregivers stress as the most common need. Conclusions: According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.