Ravindra Kamath

A study on the prevalence of internet addiction and its association with psychopathology in Indian adolescents.

Background: There has been an explosive growth of internet use not only in India but also worldwide in the last decade. There is a growing concern about whether this is excessive and, if so, whether it amounts to an addiction. Aim: To study the prevalence of internet addiction and associated existing psychopathology in adolescent age group. Materials and Methods: A cross-sectional study sample comprising of 987 students of various faculties across the city of Mumbai was conducted after obtaining Institutional Ethics Committee approval and permission from the concerned colleges. Students were assessed with a specially constructed semi-structured proforma and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions. Dukes Health Profile was used to study physical and psychosocial quality of life of students. Subjects were classified into moderate users, possible addicts, and addicts for comparison. Results: Of the 987 adolescents who took part in the study, 681 (68.9%) were female and 306 (31.1%) were males. The mean age of adolescents was 16.82 years. Of the total, about 74.5% were moderate (average) users. Using Youngs original criteria, 0.7% were found to be addicts. Those with excessive use internet had high scores on anxiety, depression, and anxiety depression. Conclusions: In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction and be vigilant about psychopathology.

A Comparison of the Level of Functioning in Chronic Schizophrenia with Coping and Burden in Caregivers

Background: A chronic mental illness such as schizophrenia is a challenging task for caregivers especially in the current era of de-institutionalization. In India, few studies have attempted to directly determine the relationship between coping mechanisms and burden; in the West, studies have found that improved coping in family members can decrease the perceived burden. Aim: To evaluate the burden and coping of caregivers in relation to the level of functioning in patients with chronic schizophrenia. Methods: The sample was 100 patients with their primary caregivers attending a Psychiatry OPD. Patients were assessed on the Global Assessment of Functioning (GAF) scale while caregivers were administered the Burden Assessment Schedule (BAS) and Mechanisms of Coping (MOC) scale. Results: Fatalism and problem-solving were the two most preferred ways of coping. Problem-focused coping, i.e. problem-solving and expressive-action decreased the burden of caregivers, while emotion-focused coping, i.e. fatalism and passivity, increased it. As the level of functioning of the patient decreased, the significance with which the coping mechanisms influenced the burden, increased. The use of problem-solving coping by caregivers showed a significant correlation with higher level of functioning in patients. Conclusion: Coping mechanisms such as problem-solving can decrease the burden of illness on caregivers and may even improve the level of functioning of patients.

Neurological soft signs in children with attention deficit hyperactivity disorder

Context: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with wide repercussions. Since it is etiologically related to delayed maturation, neurological soft signs (NSS) could be a tool to assess this. Further the correlation of NSS with severity and type of ADHD and presence of Specific Learning Disability (SLD) would give further insight into it. Aims: To study neurological soft signs and risk factors (type, mode of delivery, and milestones) in children with ADHD and to correlate NSS with type and severity of ADHD and with co-morbid Specific Learning Disability. Settings and Design: The study was carried out in Child care services of a tertiary teaching urban hospital. It was a cross-sectional single interview study. Materials and Methods: 52 consecutive children diagnosed as having ADHD were assessed for the presence of neurological soft signs using Revised Physical and Neurological Examination soft Signs scale (PANESS). The ADHD was rated by parents using ADHD parent rating scale. Statistical Analysis: The data was analyzed using the chi-squared test and Pearsons co-relational analysis. Results and Conclusions: Neurological soft signs are present in 84% of children. They are equally present in both the inattentive-hyperactive and impulsive-hyperactive types of ADHD. The presence of neurological soft signs in ADHD are independent of the presence of co-morbid SLD. Dysrrhythmias and overflow with gait were typically seen for impulsive-hyperactive type and higher severity of ADHD is related to more errors.

Study of emotional intelligence and empathy in medical postgraduates

Objectives: The important domains of emotional intelligence (EI) are self-awareness and control of emotions, motivating oneself, and empathy. These are necessary to handle any relationship. This study aims to (i) assess emotional intelligence focusing specifically on empathy; (ii) to study the level of anger; and (iii) correlating level of anger with (a) EI and (b) empathy in medical postgraduates. Materials and Methods: Subjects were assessed randomly after obtaining informed consent, through semi-structured proforma and various scales, including Emotional Quotient Self-Assessment Checklist, Multi-Dimensional Emotional Empathy Scale, and Clinical Anger Scale. Data was analyzed using multivariate analysis with analysis of covariance test. Results: On Emotional Quotient Self-Assessment checklist, more than 70% had poor emotional intelligence. Married males in the study were more confident and empathizing. Those with some major problem at home were more aware of their own emotions and others feelings. Residents who had voluntarily chosen their specialty postgraduation training course (eg, medicine, surgery, and others), those who had less work load, those who had time for recreational activities, and exercise had scored high on EI. Good control of emotions in self was associated with good relationship with superiors and colleagues. Score on Clinical anger was moderate to severe in 10.6% of the subjects. EI and clinical anger correlated negatively.

Study of marital adjustment, mechanisms of coping and psychopathology in couples seeking divorce in India

The divorce rate in India is increasing. In some cases, divorce could result from psychopathology in one of the partners or in other cases may lead to major psychopathology. Therefore it is important to identify problems in marital adjustments. This study aims to find probable reasons for divorce, how people cope with it and whether any psychopathology is associated with it. A total of 100 respondents undergoing divorce were selected after obtaining their consent and interviewed using a semi-structured pro-forma, the Dyadic Adjustment Scale, the Mechanisms of Coping Scale and the Symptom Checklist-90-R. Around 57% of divorce cases in our study were filed by women, 31% by men and 12% by mutual understanding. The primary reason for divorce in our respondents was interpersonal problems (34%). Marital adjustment was poor in 91.6% respondents, with a minimum score for dyadic cohesion and affectional expression. Fatalism, expressive action and problem solving were the commonly used coping methods. In all, 64% had significant psychopathology, with depression being the most common. Poor marital adjustment and emotion-based coping were associated with higher psychopathology, whereas parental support and having children were protective factors for psychopathology. Being in a ‘Love marriage’ was associated with good marital adjustment. Women outnumbered men in filing for divorce and in overall psychopathology.

Low serum iron as a possible risk factor for neuroleptic malignant syndrome

Neuroleptic malignant syndrome (NMS) is a rare, but fatal condition characterized by rigidity, fever, dysautonomia and altered consciousness along with elevated serum creatinine phosphokinase levels and leukocytosis. Treatment of NMS includes symptomatic and specific treatment with drugs like bromocriptine may be given. Risk factors for NMS include dehydration, parenteral antipsychotics and high potency antipsychotics. One of the important, but lesser known risk factors for NMS is low serum iron. Pronounced reduction in serum iron suggests that acute phase reactants do have a role in NMS. The present case report focuses on the importance of low serum iron as a risk factor for NMS.

Comparison of Self-Esteem and Maternal Attitude Between Children with Learning Disability and Unaffected Siblings

ObjectivesTo compare self-esteem and maternal attitude between children with learning disability and their unaffected siblings.MethodsThis cross sectional study was conducted at a tertiary care hospital in an urban setting. It comprised of 31 pairs of children with a learning disability, their unaffected siblings and input from their mothers. All children were assessed with Rosenberg self-esteem scale. Mothers were asked to fill Index of parental attitude (IPA) and semi structured proforma with demographic data and questionnaire about her children with a learning disability and his/her unaffected sibling.ResultsSelf-esteem was found to be lower in children with learning disability. They felt they do not have much to be proud of and have a fewer number of good qualities. They are also inclined to consider themselves as failures. In factors affecting self-esteem, index of parental attitude was found to be unfavorable towards children with learning disability. Mothers felt child was interfering with their activities and was getting on their nerves. In addition, they also felt that they do not understand their child, feel like they do not love their child and wished that child was more like others they know off. More academic failures, academic difficulties and negative school report were also perceived by mother as lowering child’s self-esteem.ConclusionsSelf-esteem was lower in children with learning disability. In factors affecting self-esteem maternal attitude, academic difficulties, academic failure and negative school reports was found to be unfavorable.

Study of Spirituality in Elderly With Subjective Memory Complaints

Subjective memory complaints are very common among elderly. They can be due to depression, cognitive decline, or be a part of normal aging process. Spirituality is another important dimension in elderly, and it is believed to help them cope with various adversities. This study was done to find out whether any relation exists between these 2 variables in elderly. A total of 120 elderly individuals, presenting with subjective memory complaints, were divided into 3 groups — controls, elderly with depression, and elderly with mild cognitive impairment (MCI). Spirituality in them was studied by dividing it into the subdomains of self-transcendence, presence of meaning in life, search for meaning in life, and locus of control. Spirituality was the highest in controls, followed by MCI group, and then depression group. Spirituality had a direct negative relationship with severity of depression, while relationship of spirituality with severity of cognitive decline was more complex. Relationship of spirituality with mental health status in elderly patients seemed bidirectional, that is, cause as well as effect relationship.

Study of loneliness, depression and coping mechanisms in elderly

Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p Conclusion: Loneliness is an important distinct factor in predicting depression in elderly. Coping mechanisms used, also affects loneliness and depression significantly.

Study of cognitive profile in the elderly presenting with both depressive and cognitive symptoms

Background: Elderly patients presenting with cognitive and depressive symptoms often create a diagnostic challenge between depression and the dementing process. Various screening and diagnostic instruments have been developed for differentiating the two, one of which is Addenbrooke′s cognitive examination (ACE). However, results have not been consistent across various studies, and not much data is available in the Indian context. Aims and Objectives: To study cognition in elderly patients presenting with both cognitive and depressive symptoms at the baseline and at 3 months follow-up after starting antidepressants, and to compare the two profiles. Materials and Methods: It was a follow-up study with 70 participants who had presented with both depressive and cognitive symptoms. Tablet escitalopram was given and ACE was performed at the baseline and at 3 months after starting antidepressants. Improvement on ACE was present in 37 participants and absent in 33 participants. The cognitive profile of these two groups was subjected to statistical analysis. Wilcoxon signed-rank test was used to study the difference between the full and domain ACE scores between the preintervention phase and postintervention phase within each group. Results: There is a significant difference between preintervention and postintervention full ACE scores and different domain scores in the depression group unlike in the MCI group. Conclusion: Diagnostic tools such as ACE can be utilized for differentiating mood disorder with an actual dementing process. It also reveals the need for periodic assessments of such patients.