Shyamanta Das

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.

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.

Alopecia areata associated with haloperidol decanoate long-acting injection

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Global psychiatry: A LAMIC perspective

This editorial highlights the nouveau approach of OJPAS® to promote psychiatry in low and middle income countries (LAMIC), with research contributions from a global consortium.

An observational study towards a newer classification in child psychiatry

1Assistant Professor, Department of Psychiatry, Gauhati Medical College Hospital, Guwahati, Assam, India, 2Senior Resident, Department of Psychiatry, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, India, 3Senior Resident, Department of Psychiatry, Post Graduate Institute of Medical Education & Research, Chandigarh, India, 4Post Graduate Trainee, Department of Psychiatry, Gauhati Medical College Hospital, Guwahati, Assam, India

Impact of stress, coping, social support, and resilience of families having children with autism: A North East India-based study

Children with autism (CWA) is a segment of population in North East India who are marginalized due to lack of resources like skilled manpower and perceived stress. In comparison to other states and countries whether these children are unique in terms of care and rehabilitation from adult caregivers was the focus of our study. The study assessed level of parental stress, social support, coping mechanisms used by family and resilience in meeting the challenges as caregivers. Parents were selected by simple random sampling from a multi-specialty center dedicated to CWA. They were assessed with the help of structured tools like the Parental Stress Scale, the social support appraisals scale, the coping self-efficacy scale, and the Family Resilience Assessment Scale. Results were analyzed with descriptive statistics and findings suggest definite stress among the parents of CWA. Personal time constraint was noticed in majority of parents, which had adversely affected their professional lives. Despite wide array of stress factors, family members had satisfactory coping skills to work in harmony in adverse circumstances. Regarding secondary social support in terms of family, friends, and neighbors, responses were mixed; religious and spirituality were often resorted avenues. Social desirability, fatigue and the sample being restricted to only one center were though the limitations but, this study throws light on pertinent issues related to families with CWA from a region where specialty centers are a rarity. The future implication could focus on CWAs future, rehabilitation, care and parental concerns which are grossly neglected in North East India.

Aripiprazole-Induced Rabbit Syndrome: How Safe is Its Use in Adolescence?

Aripiprazole (10 mg/day), when given to a 16 year old boy with solvent dependence, he developed rare movement disorder, ‘rabbit syndrome’.

Recurrent Mania: Rare or Common

Traditionally we diagnose bipolar disorder if a patient has maniac or hypomaniac episode along with depressive episode. Again there is a diagnostic entity called recurrent depressive disorder in the classification system. But we don’t have a diagnostic entity called recurrent mania although in clinical practice many patients present only with episodes of mania and no depressive episode. Thus cases of recurrent mania might have phenomenological differences with rest of the cases of bipolar disorder. Thus, a 30 years old man patient’s atypical case history has been discussed in the context of bipolar disorder and having the possibility of a new subtype of recurrent mania

Does clinical posting in psychiatry contribute to changing medical interns’ attitude towards psychiatry?

The aims and objectives of the present study were (i) to assess the medical interns’ attitude towards psychiatry, (ii) to ascertain the impact of a clinical psychiatry posting on this attitude and (iii) to gain an understanding of the process of choosing psychiatry as a future professional career. Using a longitudinal design, a questionnaire adapted by Balon et al. (1999) based on Nielsen and Eaton (1981) was administered to the interns before and after completing their training in psychiatry to explore their attitude in the below mentioned six domains: overall merits of psychiatry, efficacy, role definition and functioning of psychiatrists, possible abuse and social criticism, career and personal reward and specific medical school factors. Interns participating in the study were asked to complete the same questionnaire before and after completion of their psychiatry training in the year 2010 at Silchar Medical College Hospital, Silchar, Assam, India. A total of 41 interns participated in the study which included 28 (68.29%) males and 13 (31.71%) females. The mean age was 24 years (SD = 1.095). There were no drop-outs. The results obtained in this study clearly indicate that 15 days of regular posting in psychiatry had a favourable impact on the interns’ attitude towards psychiatry. They were more likely to strongly disagree that psychiatry is unscientific and imprecise (from 56.09 to 73.13%) and 90.24% of them agreed both before and after posting that psychiatry is a rapidly expanding frontier of medicine. Most interns regarded psychiatrists to be logical thinkers with a further positive change after rotation (from 68.29 to 75.60%). The participants came to better understand that there is no abuse of legal power in events of compulsory admissions (43.90 to 51.22%). This illustrates how direct contact with psychiatric practice might be effective in changing previously negative attitudes. In areas of career and personal reward, less than half of the participants felt that psychiatry has a low prestige among general public. Most of them believed that psychiatrists had a higher status among other professionals with a positive change after the rotation (58.53 to 70.73%). Only 12.19% of the interns felt that psychiatry was filled with international graduates of low skills which declined further to 7.31% after the rotation. About half of the them reported that they were discouraged by their family members and fellow students to pursue psychiatry as a profession, and that colleagues who are interested in psychiatry are seen as odd, peculiar, neurotic with an insignificant change in their attitude after the rotation. Interns had started feeling less uncomfortable with the mentally ill patients at the end of rotation. Those who strongly disagree with the feeling of uncomfortability had risen from 48.78 to 65.85%. This fact is also suggestive of favourable impact of rotation on the stigma concerning psychiatric patients, reinforcing the need for an increased undergraduate exposure to psychiatry.