Eastern Journal of Psychiatry

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2010 | February-August | Volume 13 | Issue 1-2

EDITORIAL

Future of District Mental Health Programme

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:7] [Pages No:3 - 9]

   DOI: 10.5005/EJP-13-1--2-3  |  Open Access |  How to cite  | 

Original Article

Shyamanta Das, Dipesh Bhagabati, Uddip Talukdar

Insight into Schizophrenia: A Comparative Study between Patients and Family Members

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:9] [Pages No:10 - 18]

Keywords: Schizophrenia. Awareness. Self concept. Family relations. Social environment

   DOI: 10.5005/EJP-13-1--2-10  |  Open Access |  How to cite  | 

Abstract

Background: Despite the recognition of the role that sociocultural factors play in the process of acquiring insight, recent research on this issue is scare. Aim of the present study was to compare patients’ insight with family members’ insight. Method: 50 patients with schizophrenia (International Statistical Classification of Diseases and Related Health Problems – Tenth Revision – ICD-10) undergoing treatment and members of their families were interviewed using the Schedule for Assessment of Insight (SAI). It was a cross-sectional study. Results: Family members performed better than patients in the total and partial SAI scores [total: 11 to 6.7 (p < 0.0001); adherence: 3.84 to 2.7 (p < 0.0001); recognition of illness: 4.54 to 2.84 (p < 0.0001); relabeling of psychotic phenomena: 2.62 to 1.16 (p < 0.0001)]. However, when the scores were correlated for each patientfamily member pair, the partial scores had positive correlations (adherence r = 0.07191; recognition of illness r = 0.1632; relabeling of psychotic phenomena r = 0.2052). Conclusion: There was a positive correlation between the scores of family members and patients regarding adherence, recognition of illness and the ability to relabel psychotic phenomena as abnormal. This might be understood as a stronger influence of sociocultural factors in these dimensions. The fact that family members were not assessed for the presence of psychopathology is a limitation of this study.

Original Article

K N Kalita, H R Phookun, G C Das

Association of Anxiety and Depression in Postpartum Period: a Hospital Based Evaluative Study

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:6] [Pages No:19 - 24]

Keywords: anxiety, depression, postpartum

   DOI: 10.5005/EJP-13-1--2-19  |  Open Access |  How to cite  | 

Abstract

Background: Postpartum period is associated with higher rates for depression, blue and psychosis. Anxiety is also significant. These disorders may have serious implications in the cognitive development of the infant. Many symptoms of both disorders overlap with each other. There is relative lack of data in this area. We tried to estimate postpartum anxiety and depression in a group of women and tried to assess their correlation. Material & Method: 100 women were assessed for depression and anxiety using Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale, ICD-10 criteria. They were selected on random basis. Analytical statistical methods were utilized. Result: 18% and 15% depression and anxiety were found respectively. Higher maternal age, parity, any post operative history correlated with it significantly. It was found that anxiety and depression are not associated significantly and are distinct categories. However 1% of variance of symptomatologies of depression can be explained by anxiety and 20% of variance of symptomatologies of anxiety can be addressed by that of depression. Conclusion: Depression and anxiety are separate clinical conditions having significant prevalence in postpartum period. As anxiety, depression, psychosis all are increased in postpartum period a term ‘Postpartum mood disorder’ may be proposed. Using easy screening tools by the paramedical workers will help early detection of the cases and it will have long term effect on cognitive development of the infants.

Original Article

Senjam Gojendra Singh, Sidhartha Debbarma, N. Heramani Singh, Th. Bihari Singh, R.K. Lenin, K. Shantibala Devi

A Comparative Study of Thyroid Hormone Levels among the Normal Healthy Persons, Depression and Schizophrenia

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:7] [Pages No:25 - 31]

Keywords: Thyroid hormone depression and schizophrenia

   DOI: 10.5005/EJP-13-1--2-25  |  Open Access |  How to cite  | 

Abstract

Background: Thyroid disorders can induce virtually any psychiatric symptom or syndrome, although no consistent associations of specific syndromes and thyroid conditions are found. Abnormal thyroid hormone levels are common in psychiatric disorders Material & Method: T3, T4, TSH levels were measured in a sample of 90 (ninety) cases who attended Department of Psychiatry, RIMS hospital. The sample consists 30 (thirty) cases each from three-group viz., Controls consisting of normal healthy persons, Schizophrenia, and Depression. Data was collected for a period of 1 year from the subjects who were fulfilling the DSM IV TR diagnostic criteria of schizophrenia and depression. All the study subjects were evaluated for socio demographic variables on semi structured Proforma. Thereafter the laboratory assessments of T3, T4, TSH levels were conducted in the Dept. of Biochemistry, RIMS. Result: The blood level of T3 and T4 was seen highest among schizophrenic groups followed by control and depressive groups. Highest level of TSH was noticed in the depressive groups followed by controls and schizophrenia Conclusion: This study shows that there is an abnormality in thyroid hormone levels in the psychiatric disorders of depression and schizophrenia. In depression, T3 and T4 levels are lower but higher in case of schizophrenia. TSH is higher in depression and lower in schizophrenia.

Original Article

J. Hazarika, A C Sarmah, M. Das

An Explorative Study on Biomedical Waste Management in a Psychiatric Hospital of India

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:32 - 36]

Keywords: Biomedical waste management (BMW), Psychiatric Hospital

   DOI: 10.5005/EJP-13-1--2-32  |  Open Access |  How to cite  | 

Abstract

Background: In accordance with Bio-Medical Waste (management and handling) Rules, 1998, it is the duty of every “occupier” i.e. a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment. To improve hospital waste management, it is important to begin by surveying the facility of current hospital waste practices. A waste survey should therefore be undertaken about the information of the waste planning process. Methods: A waste survey was undertaken about the information of the waste planning process; as to improve hospital waste management, it is important to begin by surveying the facility of current hospital waste practices. This survey should provide information on types and quantity of wastes, which are arising at each point of production, and methods of storage, handling, treatment and disposal. Results: In our survey it is seen that, management, handling and treatment of Biomedical Waste are done as per Bio-Medical Waste Rules, 1998. Conclusion: After analyzing the study it was felt that the healthcare waste management should go beyond data compilation, enforcement of regulations and acquisition of better equipment. It should be supported through appropriate education, training and the commitment of the healthcare staff, management and healthcare managers within an effective policy and legislative framework.

Original Article

Shweta , K. S. Senger, A. R. Singh, M. Dutta

Efficacy of Psychosocial Intervention on Patients with Schizophrenia

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:37 - 41]

Keywords: Psychosocial intervention, Pharmacotherapy, Schizophrenia

   DOI: 10.5005/EJP-13-1--2-37  |  Open Access |  How to cite  | 

Abstract

Aim: To study the efficacy of psychosocial intervention on patients with schizophrenia. Schizophrenia is a disorder that affects about 1% of the human population with a relatively uniform distribution throughout the world. Pharmacotherapy alone is being considered critical for the successful management of patients with more severe positive symptoms of schizophrenia. The integration and coordination of psychosocial treatment including pharmacotherapy and rehabilitative services is widely advocated. The present study was designed to examine the relationship between the administration of antipsychotic medication and responsiveness to psychotherapeutic interventions. Methodology: The study was based on experimental design. The sample of 20 (experimental-10& control- 10) was selected on the basis of purposive sampling technique. Fisher's exact test and t test were used to analyze the data. Results: The findings suggest that the marked differences have been found in both groups in all the areas i.e. personal, social, occupational, physical, and general. Conclusion: In the absence of psychosocial measures alone or with pharmacotherapy the target to return to the premorbid level of functioning or community rehabilitation cannot be attained.

Original Article

Kiran Bala, Masroor Jahan, Sujit Sarkhel, Ajay Bakhla

Visuospatial Working Memory Deficits in Patient with Schizophrenia

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:42 - 46]

Keywords: visuospatial working memory, schizophrenia

   DOI: 10.5005/EJP-13-1--2-42  |  Open Access |  How to cite  | 

Abstract

Background: Review of Literature suggests that cognitive deficits of patients with schizophrenia can be attributed to an inherent deficit of working memory. Hence, present study was conducted to assess the spatial working memory in schizophrenic patients, to compare it with normal control and to find out clinical and sociodemographic correlates of spatial working memory deficit. Material & Method: The sample consisted of 25 schizophrenic patients (diagnosed according to DCR of ICD-10) and 25 normal participants. Psychopathology was rated on Brief Psychiatric Rating Scale. Normal participants were screened using General Health Questionnaire-12. The Rey–Osterrieth Complex Figure Test was used to assess visuo-spatial working memory. Result: Result shows that schizophrenic patient performed poorly on all the trials of ROCFT than normal control. Increased severity of psychopathology was correlated with poor visuo-spatial working memory. Conclusion: Since severity of psychopathology was correlated with poor immediate recall trial and delayed recall trial, longitudinal studies will be important to know whether these deficits improve with improvement in psychopathology. Findings will help in framing cognitive rehabilitation strategies for management of the schizophrenic patients.

Original Article

Ranjan Kumar, D. K. Kenswar

A Study of Level of Depression, Anxiety and Life Satisfaction in Acute and Chronic Schizophrenia

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:7] [Pages No:47 - 53]

   DOI: 10.5005/EJP-13-1--2-47  |  Open Access |  How to cite  | 

Abstract

Background: The present study focuses upon studying the level of depression, anxiety and life satisfaction in acute and chronic schizophrenics. Schizophrenia is known to be a heterogeneous disorder characterized by positive symptoms, negative symptoms, disorganized state and cognitive deficits. Acute schizophrenia is a disorder consisting of various degrees of psychosis, characterized by the sudden onset of personality disorganization Methods: Thirty acute and thirty chronic schizophrenic patients were taken within the age range of 18 to 55 years of male sex only. A self developed socio-demographic and clinical data sheet was used to assess the socio-demographic correlates. The Beck Depression Inventory (BDI), the Hindi Version of Cattell's Self Analysis Form or IPAT Anxiety Scale Questionnaire (A.S.Q) and the Life Satisfaction Scale were used to assess the levels of depression, anxiety and life satisfaction respectively. Results: Significant differences were found between Acute and Chronic Schizophrenics in depression which was due to the four factors: Sense of Failure, Crying Spells, Social Withdrawal, and in Work Inhibition. No significant differences were found in anxiety (both covert and overt). On Life satisfaction, in the acute and chronic schizophrenia groups, the level of life satisfaction is more among the acute schizophrenia group in comparison to chronic schizophrenia group. Conclusion: The acute schizophrenia group appears to be having relatively higher level of depression than as compared to the chronic group. But at the same time the acute group seems to have better life satisfaction than the chronic schizophrenia group.

Original Article

Sanjay Kumar Nayak, Surekha Kumari, Masroor Jahan, Amool R. Singh

Psychopathology among Primary Caregivers of Major Psychiatric Patients

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:6] [Pages No:54 - 59]

Keywords: perceived burden, mental illness, stigma, depression

   DOI: 10.5005/EJP-13-1--2-54  |  Open Access |  How to cite  | 

Abstract

Background: Perceived stigma and experiencing different kinds of burden for long time by primary caregivers during caring family member suffering from major psychiatric illness may affects their mental health. Present study was conducted to find out the nature of psychopathology experienced by primary caregivers of major psychiatric patients. Material & Method: Forty-four caregivers of major psychiatric patients were selected from outdoor psychiatric unit of Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Ranchi and forty-one normal controls were selected from different location of Ranchi district. They were assessed on Symptoms Checklist–90–Revised (SCL-90) and General Health Questionnaire – 28 (GHQ-28). Statistical analysis was done using SPSS (13.0 ver.). Result: The result suggests that primary caregivers experience psychopathology, namely, somatization, obsessive compulsive symptoms, interpersonal sensitivity, depression, anxiety, anger hostility, phobic anxiety, paranoid ideation and social dysfunction while caring someone family member suffering from major psychiatric illness and the number of caregivers in family definitely has an impact on severity of the caregivers’ psychopathology. Total duration of patient's treatment and total duration of patient's illness also affect caregiver's phobic anxiety and number of patient's hospitalization affects caregivers’ social dysfunction as well. Conclusion: Findings suggest that mental health issues of caregivers should also be addressed while formulating management plan for patients suffering from major psychiatric disorders.

Original Article

Nawab Akhtar Khan, Amrita Kanchan, Archana Singh, K.S. Sengar, A.K. Nag

A Comparative Study of Neurocognitive Impairment in Elderly Patients with Schizophrenia and Elderly Normals

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:60 - 64]

Keywords: Cognitive assessment, Cognitive Impairment, Schizophrenia

   DOI: 10.5005/EJP-13-1--2-60  |  Open Access |  How to cite  | 

Abstract

Background: Cognitive impairment has been known to be a feature of Schizophrenia since the illness was first described in a systematic manner. The course of cognition and functional status in schizophrenia remains an area of significant controversy and is marked by conflicting findings. One of the reasons for this controversy is that cognitive and functional changes occur with normal aging in the population. Method: Total number of samples in the study were 80 (experimental and control), out of which 40 were elderly schizophrenic patients and 40 were normal elderly individuals. Elderly patients with schizophrenia were selected from the inpatient department of RINPAS, Ranchi. Normal elderly people were selected from near by areas of the hospital. On both the groups the Post Graduate Institute- Battery for Assessment of Mental Efficiency in Elderly (PGI- AMEE) test was administered. Result: Significant differences were found in mental efficiency between normal elderly group and elderly schizophrenic patients. The mean score of normal population is 52.90 and for schizophrenic group 40.20. Conclusion: The findings of the index study suggests that the marked differences in cognitive functioning has been found between elderly patient with schizophrenia and normal elderly people. Areas of impairment were difficulty in recalling names of different things, general orientation and visuo-spatial coordination.

REVIEW ARTICLE

Munish Aggarwal, V Umamaheswari, Debasish Basu

Legislation, Society and Substance Use - Impact of NDPS Act, 1985

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:7] [Pages No:65 - 71]

   DOI: 10.5005/EJP-13-1--2-65  |  Open Access |  How to cite  | 

REVIEW ARTICLE

Gurvinder Pal Singh

Polypharmacy in Clinical Psychiatry - A Brief Review

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:72 - 76]

Keywords: Polypharmacy, psychiatry, clinical practice

   DOI: 10.5005/EJP-13-1--2-72  |  Open Access |  How to cite  | 

Abstract

Psychiatrists in clinical practice choose polypharmacy as a therapeutic strategy to control the symptoms. Polypharmacy is much more common than would be expected in contrast to the available treatment guidelines. Higher rates of relapse in patients receiving monotherapy have been documented. Polypharmacy in general clinical practice may be employed with some justification. Unwanted use of these practices may be avoided for better patient care. Limited knowledge and the wide spread marketing has led to widespread acceptance of polypharmacy practices. Some remedial measures are needed in reducing this practice of polypharmacy in our country. In this article an attempt has been made to highlight this important clinical problem for awareness of mental health professionals.

REVIEW ARTICLE

Mahesh Hembram, Suprakash Chaudhury

Treatment Resistant Depression

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:19] [Pages No:77 - 95]

Keywords: Treatment resistant depression, antidepressant, atypical antipsychotic

   DOI: 10.5005/EJP-13-1--2-77  |  Open Access |  How to cite  | 

Abstract

Most of the literature on Treatment Resistant Depression (TRD) has based its definition of resistance on the failure to respond to antidepressant drug treatment of adequate dose and duration. The prevalence of TRD is lowest in primary care settings and progressively increases in outpatient psychiatry settings, inpatient psychiatric settings, and academic/tertiary care settings. Strategies available for the treatment of TRD include optimization, substitution or switching, combination, and augmentation therapies. Currently there are no clear guidelines on when to substitute, combine, or augment therapies in the treatment of patients with TRD. Some new and novel therapies that show promise for the future include addition of an atypical antipsychotic to the initial antidepressant; newer pharmacologic interventions; and non-pharmacologic therapies such as vagus nerve stimulation (VNS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS). The newer models of interpersonal, cognitive, and behavioral therapies offer structured, pragmatic methods to work with such difficult patients. Guidelines for psychotherapeutic intervention for TRD suggested that the therapy should be collaborative and centered on the goal of teaching new skills to improve coping with a chronic illness. A better understanding of the many facets of the etiology of TRD as well as the availability of new and effective therapies hopefully will decrease the morbidity and mortality associated with this condition.

REVIEW ARTICLE

Arabinda Brahma

Socio-Economic and Cultural Aspects of Suicide

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:4] [Pages No:96 - 99]

   DOI: 10.5005/EJP-13-1--2-96  |  Open Access |  How to cite  | 

View Point

Kedar Dwivedi

Mindfulness and Mental Health

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:5] [Pages No:100 - 104]

   DOI: 10.5005/EJP-13-1--2-100  |  Open Access |  How to cite  | 

View Point

Y.P.S. Balhara, S. N. Deshpande

Era of Evidence Based Medicine: Is Clinical Expertise Outdated?

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:3] [Pages No:105 - 107]

   DOI: 10.5005/EJP-13-1--2-105  |  Open Access |  How to cite  | 

Current Theme

Rajiv Jaiswal, Deepshikha

Towards A New Mental Health Act

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:8] [Pages No:108 - 115]

   DOI: 10.5005/EJP-13-1--2-108  |  Open Access |  How to cite  | 

CASE REPORT

Senjam Gojendra Singh, N. Heramani Singh, L. Nelson, N. Biplob Singh, K. Shantibala Devi, L. Roshan Singh

Cerebral Metastasis Masquerading as Late Onset Depression- A Case Report

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:3] [Pages No:116 - 118]

   DOI: 10.5005/EJP-13-1--2-116  |  Open Access |  How to cite  | 

Abstract

A case of a 63 year-old woman with no past psychiatric illness presented with 5 months history of depressive symptoms but minimal neurological signs and symptoms is discussed. She met the ICD-10 diagnostic criteria of depressive disorder. Chest radiograph revealed a radio-opaque lesion and CT scan brain showed a large frontal lobe mass that was neurologically silent. This case demonstrates that intracranial metastasis can manifest as late onset depression without significant accompanying neurological deficits.

Book Review

Chris Nicholson

Transformative Tales: How Stories Can Change People

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:2] [Pages No:119 - 120]

   DOI: 10.5005/EJP-13-1--2-119  |  Open Access |  How to cite  | 

Book Review

Chris Nicholson, Michael Irwin, Kedar Nath Dwivedi

Children and Adolescent in Trauma: Creative Therapeutic Approaches

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:2] [Pages No:121 - 122]

   DOI: 10.5005/EJP-13-1--2-121  |  Open Access |  How to cite  | 

Book Review

B. Sujatha, G. Sushuma

Managing Anger

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:1] [Pages No:123 - 123]

   DOI: 10.5005/EJP-13-1--2-123  |  Open Access |  How to cite  | 

Book Review

Basant Puri, Ian Treasaden

Psychiatry: An Evidence-Based Text

[Year:2010] [Month:February-August] [Volume:13] [Number:1-2] [Pages:1] [Pages No:124 - 124]

   DOI: 10.5005/EJP-13-1--2-124  |  Open Access |  How to cite  | 

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