Psychiatry

Insurance for mental illness: Government schemes must show the way Om Prakash Singh Indian Journal of Psychiatry 2019 61(2):113-114

Distance training for the delivery of psychiatric services in primary care BN Gangadhar Indian Journal of Psychiatry 2019 61(2):115-116

Consultation–liaison psychiatry in India: Where to go from here? Sandeep Grover, Ajit Avasthi Indian Journal of Psychiatry 2019 61(2):117-124 Consultation–liaison psychiatry (CLP) is a young and upcoming subspecialty of psychiatry. When one looks at the history of CLP in India, the progress in the area of CLP paralleled that seen in various developed countries. However, over the years, compared to developed countries, CLP started lagging behind in India. In India, CLP services are mostly been provided as per the consultation model and true liaison model practice is missing. There has been meager research in the area of CLP in India, and there is marked heterogeneity in training across different centers. There is lack of specialized training programs in this country. Considering the increasing emphasis on providing person-centered care, there is a need to shift the focus of training from identifying and managing only primary psychiatric disorders to interphase of psychiatry and other disciplines.

High-risk behavior in patients with alcohol dependence Anupama Korlakunta, C M Pavankumar Reddy Indian Journal of Psychiatry 2019 61(2):125-130 Context: Severity of alcohol dependence is related to the high-risk behavior of alcohol dependents. Aim: To assess the high-risk behavior in patients with alcohol dependence and study the association between them. Settings and Design: This is a descriptive study of high-risk behavior in patients with alcohol dependence, conducted over a period of 15-month duration that is from January 2011 to April 2012 on 200 alcohol-dependent patients (178 men and 22 women) in the Department of Psychiatry, Mamata Medical College and General Hospital, Khammam (TS), India. Materials and Methods: Patients and their caregivers fulfilling the selection criteria were included in the study, and informed consent was obtained. Interview was carried out after 2 weeks to rule out the possibility of the presence of withdrawal symptoms in alcohol-dependent patients. Tools used for data collection include Sociodemographic and Clinical Profile Schedule, Clinical Institute of Withdrawal Assessment for Alcohol, Mini–Mental Status Examination, Severity of Alcohol Dependence Questionnaire, and High Risk Behavior Questionnaire. Statistical Analysis: Descriptive statistics, Chi-square test, and logistic regression test were used. Results: The occurrence of high-risk behavior was substantial among patients with alcohol dependence syndrome. Event analysis method indicated that road traffic accidents associated with prior heavy drinking was the most frequently observed high-risk behavior. Conclusions: The study reiterates the relationship between alcohol and sexual behavior and also highlights that individuals dependent on alcohol are a specifically vulnerable group.

Study of family burden in substance dependence: A tertiary care hospital-based study Anita Sharma, Arvind Sharma, Sanjay Gupta, Satish Thapar Indian Journal of Psychiatry 2019 61(2):131-138 Background: A substance-dependent person affects almost all aspects of family life, for example, interpersonal and social relationships, leisure time activities, and finances. Substance dependence invariably increases conflicts, negatively affects family members, and burdens the families. Aims and Objectives: To assess family burden perceived by primary caretakers (PCTs) of individuals with substance dependence and relevant clinico-socio-demographic profile of individuals as well as PCTs. Materials and Methods: Individuals and primary caretakers (n = 150) attending psychiatry OPD and emergency were included in the study. Individuals were selected by convenient sampling. The individuals and PCTs were administered psychiatric thesis/interview pro forma and drug abuse schedule. PCTs were administered “family burden interview schedule.” Results: Majority of caretakers had moderate objective burden (65.3%) and severe subjective burden (74%). Objective burden was more in areas of “financial burden” and “disruption of routine activities.” Objective burden had correlation (P < 0.05) with monthly family income, monthly expenses on substance, number and type of substances, treatment history, sex and type of caretaker. Subjective burden was dependent on sex and type of caretaker and treatment history of the patient. Conclusion: Our study concluded that substance dependence is associated with substantial burden for family members, more for subjective and objective burden in families with low income and with patients who are dependent on more number of substances and had taken treatment in the past. Higher proportion of severe burden was reported by female caretakers. These findings suggest directions for future research in this area.

Effect of adjunctive intermittent theta-burst repetitive transcranial magnetic stimulation as a prophylactic treatment in migraine patients: A double-blind sham-controlled study Amiya Krushna Sahu, Vinod Kumar Sinha, Nishant Goyal Indian Journal of Psychiatry 2019 61(2):139-145 Background: The left dorsolateral prefrontal cortex (DLPFC) seems to exert a bilateral control of chronic pain states such as migraine. Repetitive transcranial magnetic stimulation (rTMS) is known to modulate brain excitability, neurotransmitters, and endogenous opioids involved in pathophysiology of migraine. Aim: This study was designed to assess the efficacy of adjunctive intermittent theta-burst stimulation (iTBS) to the left DLPFC, as a prophylactic treatment in migraine. Materials and Methods: The study was a double-blind, sham-controlled experiment. Patients with migraine were allotted to active (n = 20) or sham (n = 21) rTMS, respectively. Each patient received ten sessions of iTBS over the left DLPFC. Patients were rated at baseline and at 2, 4, 6, and 12 weeks after receiving the treatment. Scores were obtained from the headache diary and by applying the Migraine Disability Assessment Scale (MIDAS). Results: There was a significant decrease in frequency, duration, and severity of migraine in the active group than the sham group over the study period. The effect was more pronounced during the initial 2 weeks. The MIDAS score reduced significantly in the active group than the sham group at 12 weeks. There were no significant adverse effects observed during the entire period of study. Conclusion: Compared to sham stimulation, adjunctive active iTBS over the left DLPFC was safe and effective in reducing the frequency, duration, and severity of migraine headache and in reducing disability associated with the illness.

Impairment of cognitive functions in congestive cardiac failure patients Ottilingam Somasundaram Ravindran, S Vaishnaruby, MS Karthik, Alex Divya Merciline Indian Journal of Psychiatry 2019 61(2):146-150 Background: Congestive cardiac failure (CCF) patients show several neuropsychological impairments and reduced quality of life and impairment of functioning. Objective: The objective of this study was to recognize the deficits in cognition in CCF patients and comparing this cognitive function in the same number of healthy participants. Materials and Methods: A case–control study design was adopted. The study was conducted in the cardiology department of a tertiary care hospital. Convenience sampling was done. Twenty-one participants with CCF (New York Cardiac Association – Class III severity) and 21 healthy participants participated in the study. Each participant in the control group was screened by the General Health Questionnaire-12-item version. We evaluated both groups for the various domains of their cognitive function using a comprehensive battery of neuropsychological tests. Student's t-test was used to analyze the difference between the means for the study variables. Results: We observed that attention, executive function, working memory, psychomotor speed, and visuospatial ability were impaired in the patients with CCF compared to the controls. However, they did not differ significantly in language function. Conclusions: Cognitive functioning is significantly impaired in CCF patients.

Clinician attitude and perspective on the use of coercive measures in clinical practice from tertiary care mental health establishment – A cross-sectional study Guru S Gowda, Peter Lepping, Sujoy Ray, Eric Noorthoorn, Raveesh Bevinahalli Nanjegowda, Channaveerachari Naveen Kumar, Suresh Bada Math Indian Journal of Psychiatry 2019 61(2):151-155 Background: Use of coercive measures in mental health care is an important issue for research. There are scarce data available on perception and attitudes toward coercion among Indian psychiatrists. Aims: This study aims to study psychiatrists' attitude and perspectives on the use of coercive measure in clinical practice against the background of family and patients' opinion. Materials and Methods: The study was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India. Psychiatrist in charge of the inpatients was asked about their general opinion on coercion and was administered Staff Attitude to Coercion Scale questionnaire. Findings were compared to previously published studies on patients' opinion and family opinion in the same sample. Data were analyzed using descriptive statistics. Results: Coercion proved to be a common measure applied in nearly 70% of the patients studied. The 189 psychiatrists participating in the study almost all perceived coercion as care, protection and safety, and as protection from dangerous situations. About 66% of psychiatrists perceived physical and chemical restraint (sedation) as necessary and acceptable in acute emergency care. One-third of the psychiatrists felt their patients lost autonomy, dignity, and the possibility of interpersonal contact. The same amount agreed that some patients could have been treated with less restriction and fewer coercive measures. Conclusion: Psychiatrists felt that physical and chemical restraints are necessary and acceptable in acute emergencies. Most psychiatrists considered coercion as a caring protective and safety attitude but also acknowledged its potential negative impact on patient dignity and therapeutic relationships.

Impulsivity differences between bipolar and unipolar depression Mustafa Ozten, Atila Erol Indian Journal of Psychiatry 2019 61(2):156-160 Background: Even though particularly bipolar depression and unipolar depression seem to be similar, they show differences in terms of the etiology, phenomenology, course, and treatment process. Bipolar depression is associated with mood lability, motor retardation, and hypersomnia to a larger extent. Early age of onset, a high frequency of depressive episodes, and history of bipolar disease in the family are suggestive of bipolar disorder (BD) rather than major depression. Bipolar and unipolar disorders are also associated with increased impulsivity during illness episodes. However, there is little information about impulsivity during euthymia in these mood disorders. The aim of this study was to illustrate the difference in impulsivity in euthymic bipolar and unipolar patients. Materials and Methods: Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A), in 78 interepisode BD patients, 72 interepisode unipolar disorder patients, and 70 healthy controls. The diagnosis was established by severe combined immunodeficiency. One-way between-groups ANOVA was used to compare the BIS-11A mean scores for all three groups. Results: Impulsivity scores of the bipolar and unipolar disorder patients were significantly higher than controls on total and all subscales measures. There was no difference between the bipolar and unipolar disorder groups on total, attentional, and nonplanning impulsivity measures. However, BD patients scored significantly higher than the unipolar patients on motor impulsivity measures. Conclusions: Both interepisode bipolar and unipolar disorder patients had increased impulsivity compared to healthy individuals. There was no significant difference on attention and nonplanning impulsivity subscales; however, on the motor subscale, bipolar patients were more impulsive than unipolar disorder patients.

Roles of 5,10-methylenetetrahydrofolate reductase C677T and A1298C polymorphisms in early- and late-onset obsessive-compulsive disorder Metin Caliskan, Seda Orenay-Boyacioglu, Ayse Dondu Indian Journal of Psychiatry 2019 61(2):161-166 Background: The C677T and A1298C mutations of 5,10-methylenetetrahydrofolate reductase (MTHFR) have been linked with conditions such as depression, bipolar disorder, and schizophrenia, but there are not clear the relationship between MTHFR polymorphisms and obsessive-compulsive disorder (OCD). Aim: The current study was planned to investigate the link between the MTHFR polymorphisms and OCD in patients to reveal any potential correlations that may be used as a novel marker in diagnosis of people who are in high-risk group of developing OCD. Materials and Methods: Blood samples from 64 highly characterized symptomatic cases and 64 gender- and age-matched control participants were analyzed for MTHFR C677T and A1298C gene variants. The MTHFR gene polymorphisms were detected through real-time polymerase chain reaction, followed by melting curve analysis. The results were tested with analysis of variance test and the differences with P < 0.05 were reported as statistically significant. Results: A statistically significant difference in age, education level, and marital status was found in the comparison of all groups in sociodemographic findings (P = 0.004, P = 0.001, and P = 0.001, respectively). A statistically significant difference was found in the comparison of the tic story of early- and late-onset OCD patients (P = 0.002). There was no significant difference in the genotype frequencies and allele distributions of MTHFR polymorphisms between the patients and controls (P > 0.05). Conclusion: The results suggest that MTHFR polymorphisms are unlikely to play a major role in the pathogenesis of OCD. Further studies are needed in biochemical data on folate metabolism to clarify the effect of the MTHFR polymorphisms in OCD pathophysiology.