Shaily Mina

Gender differences in depression and anxiety among atopic dermatitis patients

Background: Dermatological patients invariably suffer one or the other psychological problems which may escalate to the extent of a mental disorder. One of the most common dermatological disorders is atopic dermatitis (AD), but the literature has limited data on gender differences for psychiatric morbidity in such patients. Aims: To evaluate and compare gender differences in the prevalence of depression and anxiety in AD. Materials and Methods: This cross-sectional study with consecutive sampling was done in an outpatient clinic of Dermatology at a Tertiary Care Center. AD subjects giving informed consent were evaluated on a brief semi-structured performa for collecting demographic and clinical information. Primary Care Evaluation of Mental Disorders (PRIME-MD) was used to assess the presence of psychiatric symptoms in these patients. Descriptive analysis was done for the socio-demographic profile and independent sample t-test, Chi-square and Cramers V test was carried out to find in-between group differences for males and females. Results: A total of 81 patients were included in the final analysis (males = 36, females = 45) with no significant difference in mean age between male and female subjects (36.14 ± 17.62 and 33.98 ± 14.49 years, respectively; P = 0.54). When including moderate to severe grade of depression or anxiety, the current study found prevalence rates of 15% and 12% respectively. Females had significantly more anxiety and depression scores than males (P = 0.04 and P = 0.03 respectively). Conclusions: There is a female preponderance of depression and anxiety disorder in AD patients.

A descriptive analysis of patients presenting to psychosexual clinic at a tertiary care center.

Background: Psychosexual problems are very common presentation, be it with psychiatric or physical illness but there are very few studies available on psychosexual disorders especially in the Indian context. Indian society is deeply ingrained in customs and several misconceptions, myths, prejudices, and social taboos are attached to sex which makes it further very difficult to tackle. Objectives: The aim of this current study was to descriptively analyze the nature of sexual disorders in a tertiary care center. Materials and Methods: The current retrospective chart review included 698 consecutive subjects seeking treatment for their psychosexual problems at the Sexual Clinic, Department of Psychiatry, Dr. Ram Manohar Hospital, New Delhi (between 2006 and 2010). Results: This study observed erectile dysfunction (ED) (29.5%), Premature ejaculation (PME) (24.6%), Dhat syndrome (DS) (18.1%), and ED with PME (17.5%) as the common sexual dysfunctions leading to treatment seeking. DS was the major complaint among younger and unmarried individuals. We observed more married individuals seeking treatment for sexual disorders. Conclusions: These findings provide important information on a relatively under-researched area.

Road Rage: Prevalence Pattern and Web Based Survey Feasibility

Introduction. Incidents of road rage are on a rise in India, but the literature is lacking in the aspect. There is an increasing realization of possibility of effective web based interventions to deliver public health related messages. Objective. The aim was to quantitatively evaluate risk factors among motor vehicle drivers using an internet based survey. Methods. Facebook users were evaluated using Life Orientation Test-Revised (LOT-R) and Driving Anger Scale (DAS). Results. An adequate response rate of 65.9% and satisfactory reliability with sizable correlation were obtained for both scales. Age was found to be positively correlated to LOT-R scores (r = 0.21; P = 0.02) and negatively correlated to DAS scores (r = −0.19; P = 0.03). Years of education were correlated to LOT-R scores (r = 0.26; P = 0.005) but not DAS scores (r = −0.14; P = 0.11). LOT-R scores did not correlate to DAS scores. Conclusion. There is high prevalence of anger amongst drivers in India particularly among younger males. A short web survey formatted in easy to use question language can result in a feasible conduction of an online survey.

Auto cannibalism in mental retardation

Mental retardation (MR) deems an individual more vulnerable to psychopathologies. The individual may develop an array of behavioral disturbances manifesting themselves in the form of aggressive and destructive conduct, violent fits of anger, stereotyped, or self-injuring behavior. Self-injurious behavior is heterogeneous in nature ranging from mild to severe variant. We report a case of a 7-year-old boy with MR with self-inflicted severe oral injuries of cannibalistic nature presenting as cleft lip and palate. A more extensive research is needed on the problem behaviors in mentally retarded patients for early detection and effective and timely intervention leading to a better outcome.

An analysis of paramilitary referrals to psychiatric services at a tertiary care center

Background: There is a dearth of specialized mental health services for Indian paramilitary service personnel. Those requiring psychiatric evaluation are referred to government psychiatric services often with minimal information. Hence, major diagnostic and decision making relies on the psychiatrists clinical evaluation and judgment. The aim of the present study was to quantitatively evaluate the paramilitary referrals to psychiatric services at a tertiary care referral center. Materials and Methods: A retrospective chart analysis of all consecutive referrals by various Indian paramilitary services to a tertiary care hospital (2008-2010) was carried out. Results: Among the sample of 18 referrals, all were males (mean age: 37 years ± standard deviation (SD) =7.79). Various reasons for referral included: Evaluation of fitness for duty (83.3%), fitness to handle firearms (16.7%), and for disability certification (5.6%). There were no informants at all in 22.2%, and family members were available in only 11.1%. Hence, most referrals were admitted to the psychiatry ward for observation for various lengths of time. The mean duration of assessment (outpatient and inpatient) was 17.89 days (SD = 20.74) and final reported diagnoses were schizophrenia, depression, and bipolar disorder in 16.7, 11.1, and 11.1%, respectively. There was concurrent history of alcohol and nicotine dependence (40%). A large group (40%) was diagnosed not to suffer from a major mental illness, while a firm and final diagnosis could not be arrived at in 16.7% subjects. Only one subject was given the fitness to handle firearms, fitness for duty was refused in three (16.7%) subjects, and one subject was referred to neurology after being diagnosed as a case of seizure disorder. Conclusion: There is an urgent need for intensive training both to paramilitary physicians as well as to general hospital psychiatrists regarding proper assessment of paramilitary personnel, as there are frequent chances of the cases being undiagnosed or improperly diagnosed.

Aggression and Psychosis in Patients Seeking Emergency Psychiatric Care in New Delhi, India

Background/Context: There is high risk of violence and aggression in the medical emergency care settings (MECS) of which psychiatric services constitute an important part, forming lateral entry points for patients into the mental health care system. Psychosis has been imposed as the predominant cause for majority of aggressive presentation in MECS. There is scarcity of Indian data towards this facet. Objective(s): The aim of the study is to explore the principal reasons for referral to a psychiatric emergency and explore the disorders most commonly associated with violent and aggressive behavior. Methodology: This cross sectional descriptive study evaluated consecutive psychiatry referrals from the emergency ward for duration of six months at a tertiary care center. Data was gathered using a semi structured proforma and analyzed by SPSS version 17.0. Diagnosis of schizophrenia or related psychotic disorders (SRPD) and other psychiatric disorders was ascertained via ICD-10. Result(s): Majority of the overall emergency psychiatry referrals presented with aggression (42%) with no significant gender difference. About 72% of aggressive subjects were diagnosed with psychiatric disorders, of which 28% suffered from SRPD. Delirium and affective disorders constituted 12% and 16% of the aggressive subjects respectively, while diagnosis could not be ascertained in 28% subjects. Of the 462 referred cases, 13.6% subjects were suffering from SRPD. About 85% of these subjects presented with aggressiveness and behavioral disturbance. Apart from 12% previously diagnosed cases of SRPD, 88% of the subjects were new cases. Conclusion: Aggressive behaviour is the principal presentation in psychiatric emergency services, and schizophrenia & related psychosis contribute a significant proportion of these cases. There is a high rate of previously undiagnosed subjects seeking treatment in emergency, highlighting the role of emergency psychiatric services in not just acute crisis management but also in initiating long term treatment.

Psychological well-being in primary survivors of Uttarakhand disaster in India

Introduction: After the 2004 Tsunami, India faced the worst natural disaster in Uttarakhand causing devastating floods and landslides. Besides the material harm, the disaster also has a massive impact on individuals mental health, and the impact is perceived more in developing countries due to being densely populated with limited resources. The current study is an attempt to evaluate the psychological impact and its risk factors in Uttarakhand disaster. Methods: This cross-sectional study was conducted after 1 month of disaster in the primary survivors. All the included subjects were administered the semi-structured proforma for assessing the sociodemographic profile and the assessment instruments: Impact of events scale-revised (IES-R), depression anxiety stress scale and life orientation test-revised (LOT-R). Data were imputed and analyzed using Statistical Package for Social Sciences version 17.0.1 (SPSS Inc., Chicago, IL, USA). Results: About 58% subjects had posttraumatic stress disorder and significantly severe levels of depression, anxiety, and stress were noted in 45.3%, 57%, and 44.2% subjects, respectively. A physical illness was present in 36% subjects. Loss of at least one family member was reported by 12.8% subjects. LOT-R scores were negatively correlated to IES-R. Conclusion: Psychological morbidity in the immediate post-disaster period is high. Higher levels of depression, anxiety and stress with development of negative outlook regarding their future is observed with increasing age. Increasing age, lower educational levels, physical illness, loss of a family member, and pessimistic expectations were associated with adverse psychological sequelae.

Association of Corpus Callosum Agenesis with Mental Retardation and Attention Deficit Hyperactivity Disorder

Aims: Anomalies of the corpus callosum have been associated with varied brain and somatic malformations. It has been associated with diverse genetic causes with identifiable syndromes. We aim to report a case of corpus callosal agenesis (CCA) associated with mental retardation and hyperactivity. Presentation of case:We report case of a 7 year old boy having CCA, abnormal facial morphological features, mental retardation and attention deficit hyperactivity diso rder (ADHD) , devoid of any chromosomal rearrangements or somatic malformations known to be associated with corpus callosal changes. Discussion: Symptoms in CCA are often related to concurrent migrational disorders, not to the callosal anomaly itself. Although multiple genetic etiologies have been associated, no single gene has been proved to be implied in all cases of CCA. Conclusion: This case highlights importance of recognizing mental retardation and ADHD as a presentation of isolated CCA which mayoccur without any known