Vol 3-4 (i)

Indian Journal of Social Psychiatry, 2013, 29 (3-4), ABSTRACTS OF
XX NATIONAL CONFERENCE OF
INDIAN ASSOCIATION FOR
SOCIAL PSYCHIATRY,
KOLKATA,
8-10 NOVEMBER 2013
2013 Indian Association for Social Psychiatry Indian Journal of Social Ps Indian Journal of Social P y , 2013, 29 (3-4), PRESIDENTIAL ADDRESS, ORATIONS AND INVITED LECTURES
Dr N.N. DE ORATION
What Social Psychiatry has to offer in Contemporary
Bridging The Mental Health Gap
Parmanand Kulhara RK Chadda Formerly Professor & Head, Department of Psychiatry, President, Indian Association for Social Psychiatry Postgraduate Institute of Medical Education & Professor of Psychiatry, All Indian Institute of Medical Research, Chandigarh Currently, Consultant Sciences, New Delhi Psychiatrist, Fortis Health Care, Mohali, (Punjab) Social psychiatry has often been ignored in psychiatry India is a vast country with huge number of patients over almost half a century, the period when the requiring and seeking mental health care from mental advances in psychopharmacology, brain imaging and health professionals. The resources to deal with this biological basis of mental disorders have taken place. gigantic problem of mental ill health are limited. There However, the importance of social psychiatry can't be is appreciable imbalance between residence of people ignored. Infact, it is a branch of psychiatry, which can be and location of mental health facilities-the rural urban said to be emerging with full vigour in the last two divide and disproportionate distribution of mental decades out of the forced hibernation. Social psychiatry health professionals. Most of our general hospital may not look as glamorous as biological psychiatry, but psychiatry units and mental hospitals are inadequately it has lot to offer. The biological research into mental staffed; the scene of private psychiatry is no different. disorders in the last few decades despite having the Undergraduate medical education in relation to advances in brain imaging and huge monetary and psychiatry is perfunctory, postgraduate psychiatric manpower investments has not been able to provide a training is fragmented. National Mental Health breakthrough discovery. The new molecules introduced Programme and District Mental Health Programme for treatment in the last two decades have been found have positively impacted mental health delivery to not much better than the first generation services. The MhGAP initiative of the World Health Organization is a welcome step in the right direction. Mental Health legislation, interventions by the In recent years, increasing burden and disability due to Supreme Court of India and the National Human Rights mental disorders, delay in seeking treatment, poor Commission have energized funding of mental health adherence to treatment, stigma to mental disorders programme. Much more needs to be done to make and increasing suicide rates and violence, and mental health services affordable and accessible so that substance abuse have been of major concern for the those who need these service the most. mental health professionals and need interventions on the part of social psychiatrists. Understanding of the role of social factors in etiogenesis of mental disorders and identifying the causative influences in the individual patient is of paramount importance, so as to develop suitable intervention strategies. Social psychiatry is the centre to understanding the genesis and management of psychiatric illnesses. Its role in preventive as well as therapeutic psychiatry is crucial and it is the need of the hour.
2013 Indian Association f 2013 Indian Associa Indian Journal of Social Psychiatry, 2013, 29 (3-4), A1-A2 Cinema remains one of the cheapest and most easily accessible forms of entertainment. Movies appeal to an Cinema and Psychiatry
individual's unconscious desires and means of self- Indla Ramasubba Reddy identification and wish fulfilment. To many, films offer a Director – VIMHANS, Vijayawada release from the day's frustrations and compensate for the deficiencies of real life. In the course of watching a Cinemas are the world's most popular and powerful art film, the spectator for a while not only loses higher self- form. Some argue that portrayal in the movies reflects consciousness but also identifies with a character- the happenings in the society and it is not true that down trodden or middle class. Psychological effects of movies have an impact on the mental health of the films include influencing fashion, dress, jewellery, hair people. Many movie-makers argue that cinema is only styles, personal mannerisms and speech, but the for entertainment and not to be taken seriously. immediate response may be fear and jealousy, love and However, strong scientific evidence exists that there is a hero worship. Films no doubt influence the conduct of definite influence of movies in shaping the beliefs, individuals and the influence depends upon a number attitudes and behavior of the people.
of factors including social experience and personal Movies act as a 'double edges sword' but the sword is idiosyncrasies. A common platform for moviemakers sharp in portraying the negative image of mental illness and Psychiatrists should be periodically organized at and mental health professionals, which have fuelled different places for mutual exchange of ideas.
further the misconceptions about mental illness. Girindrasekhar Bose and vernacularization of
Violence committed by the mentally ill characters is the psychiatry in Bengal
norm in movie portrayal, where as the reverse is true. The distorted portrayal about the mentally ill instils Amitranjan Basu fears among the public and increases the stigma. The Consultant, Mental Health & Counselling; Guest Faculty fast music, pub culture, dating, premarital and liberal on Behavioural Science and Counselling Course for MBA sex, crime and violence among youth can be largely (Rural Development) at Himachal Pradesh University attributed to the western movie and media impact on Dr. Girindrasekhar Bose was the first psychoanalyst in the Indian conservative youth, which is definitely an the non-western world. After his medical graduation he indication of 'Cultural Attack' by the west.
completed his post-graduation in psychology and In the Indian movies, Psychiatrists are depicted as subsequently a D. Sc. from the newly formed comedians, aggressive, exploitive and as villains, which psychology department at University of Calcutta in would do a lot of harm to people who are already early twentieth century, which also makes him the first Electroconvulsive Therapy is shown as frightful, painful In the last two decades Girindrasekhar attracted and as a punishment to the rivals and also to the scholarly attention for his views on psychoanalysis, patients. The impact of movies is much more on the which was not always in resonance to Freud and he emotionally disturbed individuals than on the average tried to develop a concept that did not exclude or normal people. The impact of movies and their vernacular texts as a potential resource.
popularity has made many cine stars as MPs, MLAs, Ministers and even as Chief Ministers. The strong In this paper, I have tried to read Girindrasekhar's views cinema charisma has a definite impact in changing the on mind and its functions and dysfunctions through his 'Political Psyche' of the masses.
Bengali writings. For this I have selected his texts from the Bengali periodicals and two books. Close readings The impact of horror and violent films and sex crimes reveal the cultural critique to the western knowledge. I due to erotic scenes in movies and glorification of have tried to argue in this paper that, vernacularization suicides in cinemas and other media will also be has actually opened up the epistemic politics and the discussed. A Lot of research is done on the impact of hybrid knowledge produced is not an 'impure' science cinemas on brain functioning.
but a creative discourse that attempts to revise the western science through culture.
2013 Indian Association for Social Psychiatry A2 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 BALINT AWARD
expressed an helping attitude, tended to seek help from parents, and thought sharing worries with others and BEYOND INVISIBLE WALLS: HOW DIFFICULT IS TO
spending time with friends could make them happy. HEAL DEEPER WOUNDS
Conclusions: This questionnaire appears reliable to Naresh Nebhinani assess knowledge and attitude of adolescent girls. Assistant Professor, Department of Psychiatry, All India There is need to inform adolescents about various Institute of Medical Science, Jodhpur, Rajasthan mental health issues. Attitude to help and a sense of cohesion was conspicuous in this population. A larger How do we make treatment decisions about our most and more inclusive study needed to generalize the complex clients? Where trauma has shattered the individual's life and substantially affected one's affective, cognitive, psychomotor domains, and persisted for an extended period of time. Such EPIDEMIOLOGICAL STUDY IN SOUTH INDIAN RURAL
individual's often present with a wide range of psychological difficulties, like emotional distress, T.S. Sathyanarayana Rao, Darshan M.S. Dept. of Psychiatry, JSS University, JSS Medical College dysregulation. Post traumatic stress disorder (PTSD) is a Hospital, M.G. Road, Mysore. whole-body tragedy, a complex event of enormous proportions with massive repercussions for entire life. CONTEXT: The study on assessment of sexual Sorting out how to proceed clinically poses a number of functioning in the elderly was taken up as a part of dilemmas and serial questions at our clinical acumen. major ICMR sponsored epidemiological study for the assessment of psychiatric morbidity in the rural GC BORAL AWARD I
population. It involved door to door survey of the ADOLESCENTS' MENTAL HEALTH ISSUES:
entire population residing at Suttur village which is KNOWLEDGE AND ATTITUDE OF ADOLESCENT GIRLS
about 25 kilometres from Mysore city in South India. It FROM RURAL BENGAL
has a population of approximately 4100 with Prasenjit Ray, RMO cum Clinical Tutor; Amrita predominance of Hindu community. There are about Chakraborti, MD Resident, Amit Kumar Bhattacharyya, 1000 families in the village. There is a Primary Health Associate Professor, Paramita Ray, Assistant Professor Centre run by the Government of Karnataka in Burdwan Medical College collaboration with JSS Medical College and Hospital. The study was designed to interview the entire Background: The aims of this current study were to population of the village with age above 60 years, so prepare and validate a Bengali questionnaire to assess that our findings can reflect the prevalence of knowledge and attitude of adolescents about the psychiatric and sexual disorders in South Indian various mental health issues related to them, and to Villages. OBJECTIVES: Assessment of prevalence of conduct a pilot study with this questionnaire. Method: Sexual disorders among individuals above 60 years. It was a cross sectional study conducted on adolescent METHODOLOGY: Type of study: Descriptive and school girls (N=107, 12 to 18 years age) from rural exploratory, door – to – door epidemiological study. background of West Bengal. A 13 item Bengali Type of sampling: Purposive Sampling. Sample Size: questionnaire was constructed, validated and N=259 males and females above 60 years residing in the administered on the subjects. Statistical analysis was rural area who constituted 8.5% of the total population done using SPSS (16th version). Results: Most of the studied. House by House interview was done to find out items had good test re-test reliability. Mean age of the individuals above 60 years. Inclusion Criteria: Above the population was 13.09 years. Three knowledge based age of 60 years of age. Exclusion Criteria: 1. Less than questions had more correct responses (50.5%, 52.3%, 60 years of age. 2. Above the age of 60 years but with 50.5%) and one had 72% incorrect responses. Majority psychotic symptoms, dementia or mental retardation. of the subjects recognised problem behaviours, 2013 Indian Association for Social Psychiatry A3 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 Tools Used: Sociodemographic data proforma: co mparison of depression and anxiety levels among Socioeconomic status assessment based on Modified B. patients with diabetes and their caregivers. G. Prasad's Classification; Evaluation of sexual Methodology: Fifty consecutive patients–care giver disorders: a. International Index of Erectile function dyads of subjects having type II diabetes were recruited (IIEF) for males, b. Premature ejaculation diagnostic at an out-patient clinic of Medicine at a tertiary care tool (PEDT) for males, c. Female sexual function centre. The dyads were assessed using a semi- questionnaire, d. Structured Interview Schedule for structured proforma for the socio-demographic details diagnosing other sexual disorders based on DSM IV and and for anxiety and depression levels using the Hospital ICD-10 criteria. Statistical Analysis: Both descriptive and Anxiety and Depression Scale (HADS). The data were inferential statistics were employed in the present analyzed using SPSS version 17.0. Correlation analysis study. Contingency coefficient tests were applied to was performed for multiple variables including blood study the association using SPSS for windows (version glucose profile. Results: The mean duration of illness 16.0). RESULTS: Showed majority in the age range of 66 (4.93 ± 3.53 years) and blood glucose parameters were to 75 years, Hindus, living with spouses and more than not found to be associated to depressive or anxiety half being males (55.2%). 27.4% of the subjects were symptoms. Depressive and anxiety disorder was sexually active and it progressively dropped as age observed in 24% and 44% of patients and 10% and 18% advanced and none sexually active after 75 years. of caregivers respectively. Patients had significantly Various myths and misconceptions were present for more HADS anxiety scale scores than caregivers but not being not active. Among those sexually active 43.5% of for HADS depression scale. Female patients were found the male subjects were diagnosed to have male erectile to be having more HADS-D scores than male patients dysfunction, male premature ejaculation was found to (p=0.02) but were not significantly different from be prevalent in 10.9%, male hypoactive sexual desire caregivers. HADS-A scores were comparable among disorder was found in 0.77% and male anorgasmia in male and female gender in intragroup as well as 0.38% of the subjects. Among females the prevalence of intergroup comparison for patient and caregiver female arousal dysfunction was found to be 28%, groups. Conclusion: Diabetes mellitus affects the female hypoactive sexual desire disorder 16%, female psychological health of not only the patients but as well anorgasmia 20% and female dyspareunia in 8% of the as the family caregivers and patients tend to be more female subjects. CONCLUSION: The geriatric sexuality anxious than the caregivers. Also, it was seen that one of the neglected areas and significant prevalence of women with diabetes had higher rates of depression sexual dysfunctions. The data would be presented in than their male counterparts.
the context of psychosocial variables, biological factors BREAKING THE BARRIERS - A QUALITATIVE STUDY OF
and co-morbidities. It is suggested further CARERS' EXPERIENCE OF FIRST EPISODE PSYCHOSIS.
comprehensive studies concerning older individuals Pavitra KS, Shubrata KS, Sridhara KR. and need for sex education for the improvement of quality of life. Sridhar Neuropsychiatric Centre, Shimoga-577204, Karnataka PSYCHOLOGICAL HEALTH OF CARE GIVERS OF
INDIVIDUALS WITH TYPE II DIABETES MELLITUS: A
Background: Long duration of untreated psychosis CROSS SECTIONAL COMPARATIVE STUDY
(DUP) is associated with poor outcomes and low quality of life at first contact with mental health services. Yatan Pal Singh Balhara, Pankaj Jorwal, Rohit Verma However, long DUP is common. We investigated carers' National Drug Dependence Treatment Centre and experiences of the onset of psychosis and help-seeking Department of Psychiatry, All India institute of Medical in a hospital based sample of patients in Shimoga a city Sciences, New Delhi in southern state of Karnataka. Method: In-depth Introduction: The quality of life in individuals with interviews were conducted with carers from a diabetes is also dependent upon the quality of family psychiatric hospital in Shimoga. Interviews covered relationships and general well-being of caregivers respondents' understanding of and reaction to the because the patient depends on them to uphold in the onset of psychosis, their help-seeking attempts and the community. Only limited studies have assessed the reactions of social networks and health services. psychological health of caregivers to individuals with Thematic analysis of interview transcripts was diabetes. Aim and Objective: The current study aims at conducted. Results: Multiple barriers to prompt 2013 Indian Association for Social Psychiatry A4 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 treatment included not attributing problems to in reducing harmful drinking in the workplace setting of psychosis, difficulty in understanding symptoms, class C employees after a 4-month period. Methods: A worries about the stigma of mental illness and sample of 39 workers with moderate and high risk level contacting the mental health services, not knowing of alcohol use was identified by randomly screening 162 where to get help, relying on religious methods for cure employees with ASSIST. Employees who were identified and unhelpful responses from health professionals. as moderate and high risk drinkers by the ASSIST were Help was often not sought until crisis point, despite given brief intervention as per ASSIST-BI. The final considerable prior distress. The person experiencing sample size after 4 months was 31. The individual symptoms was often the last to recognize them as outcomes were compared on the basis of pre and post mental illness. The health professionals and workers ASSIST score and statistical methods. Results The were frequently willing to assist help-seeking but often average ASSIST scores decreased significantly at 4 lacked skills, time or knowledge to do so. Conclusion: months after the intervention relative to pre test (p = Even modest periods of untreated psychosis cause 0.001). There was a significant change in ASSIST distress and disruption to individuals and their families. variables, drinking pattern of the subjects, moderate In India we need to prioritize early detection. Initiatives and high risk use of alcohol (p = 0.001). Moreover aimed at reducing DUP may succeed not by promoting majority of the subjects (77 %) had reduced ASSIST swift service response alone, but also by targeting scores at the 4-month follow up. Conclusion: Brief delays in initial help-seeking. Our study suggests that intervention resulted in a statistically significant strategies for doing this may include addressing the reduction in harmful drinking pattern of the study stigma associated with psychosis and community subjects (p< 0.01) in this workplace setting.
education regarding symptoms and services, targeting ERECTILE DYSFUNCTION IN PATIENTS WITH DIABETES
not only people developing illness but also a range of MELLITUS: ITS MAGNITUDE, PREDICTORS AND THEIR
people in their social networks.
GC BORAL AWARD II
Amitava Dan*, Kaustav Chakraborty**, Manas ASSIST-LINKED ALCOHOL SCREENING AND BRIEF
Mandal***, Somsubhra Chaterjee**** INTERVENTION IN INDIAN WORKPLACE SETTING:
*Assistant Professor, Department of Psychiatry, RESULT OF A 4-MONTH FOLLOW UP
Calcutta National Medical College, Kolkata; **Assistant Jaison Joseph*, Karobi Das**, Sunita Sharma**, Professor, Department of Psychiatry, College of Debasish Basu*** Medicine and J.N.M. Hospital, WBUHS, Kalyani, West Bengal; ***Assistant Professor, Department of *Lecturer, SUM Nursing College (SNC), Siksha O Medicine, N R S Medical College & Hospital, Kolkata; Anusandhan University, Bhubaneswar ****Assistant Professor, Department of Psychiatry, **Lecturer, National Institute of Nursing Education College of Medicine & Sagar Datta Hospital, Panihati, (NINE), Postgraduate Institute of Medical Education & West Bengal Research (PGIMER), Sector 12, Chandigarh Background: Persons suffering from diabetes mellitus ***Professor of Psychiatry, Drug De-addiction & (DM) are at higher risk of developing erectile Treatment Centre, Department of Psychiatry, dysfunction (ED). Several factors contribute to ED in Postgraduate Institute of Medical Education & patients of DM. Only few studies have attempted to Research, Chandigarh explore physical, psychological and social factors in a Introduction: World Health Organization (WHO)
single study. The aim of the index study was to measure attributes 2.5 million deaths every year as a result of the prevalence of ED in patients of DM and to harmful alcohol use. WHO developed an Alcohol, determine the contributory role of various socio- Smoking and Substance Involvement Screening Test demographic, physical, and psychological variables. (ASSIST)-linked Brief Intervention package (ASSIST-BI) Methods: One hundred and thirteen (N=113) to reduce the risk level of alcohol use. Evidence of the consenting consecutive male diabetic patients were efficacy of brief interventions in primary health care assessed on International Index of Erectile Function and hospital settings for harmful use of alcohol is Questionnaire (IIEFQ-5), Dyadic Adjustment Scale (DAS) relatively more as compared to workplace settings. Aim and Beck's Depression Inventory (BDI) to measure and objectives: To study the effectiveness of ASSIST-BI erectile performance, quality of marriage and 2013 Indian Association for Social Psychiatry A5 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 depressive symptoms respectively. Pretested Bengali anxiety and stress were noted in 45.3%, 57%, and 44.2% versions of these scales were used in the index study. subjects respectively. A physical illness was present in Results: Prevalence of ED was 38.94%. Current age, 36% subjects. Loss of at least one family member was family type, BMI, type of treatment, presence of reported by 12.8% subjects. LOT-R scores were negatively correlated to IES-R. Conclusion: micro/macrovascular complications, history of current Psychological morbidity in the immediate post disaster tobacco use, quality of marriage, and depressive period is high. Increasing age has higher levels of symptoms were significantly correlated with severity of depression, anxiety and stress with development of ED. In linear regression analysis age, BMI, quality of negative outlook regarding their future. Increasing age, marriage and depressive symptoms had significant lower educational levels, physical illness, loss of a family predictive role (p<0.05, adjusted R Square 0.629) on member, and pessimistic expectations were associated erectile performance. Conclusions: Prevalence of ED with adverse psychological sequelae.
among diabetic patients is quiet high and many of them HARNESSING THE POWER OF THE FAMILY: USE OF
were even reluctant to discuss about their sexual FAMILY-CAGE TO DETECT SUBSTANCE DEPENDENCE IN
function with physicians. Both physical and psychosocial factors predict the occurrence of ED in this Abhishek Ghosh, Debasish Basu, Nandita Hazari, Preeti group. So, both physicians and psychiatrists should remain aware about the multi-faceted causative role of ED in DM.
Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh AN EVALUATION OF PSYCHOLOGICAL WELL BEING IN
PRIMARY SURVIVORS OF UTTARAKHAND DISASTER
Background: CAGE questionnaire has proved to be useful in the screening of alcohol use disorders. But the 1 Rohit Verma, 2 Yatan Pal Singh Balhara, 3 Shrikant validity of Family CAGE questionnaire for the diagnosis Sharma, 4 Shaily Mina of substance dependence is still under researched. Aim: 1 Assistant Professor, 4Senior Resident, Department of To assess the validity of Family CAGE questionnaire for Psychiatry, Lady Hardinge Medical College & Smt. S. K. various substance users in both treatment seekers and Hospital, New Delhi; 2 Assistant Professor, Department non treatment seekers. Methodology: Two hundred ten of Psychiatry, All India Institute of Medical Sciences, subjects were recruited from two different treatment New Delhi; 3 Senior Resident, Department of Psychiatry, settings. For the representation of treatment seeking Post Graduate Institute of Medical Education and population a convenient sample was collected from de- Research, Dr. Ram Manohar Lohia Hospital, New Delhi addiction centre and non-treatment seekers were Introduction: After the 2004 Tsunami, India faced the obtained from the psychiatry outpatient. CAGE and worst natural disaster in Uttarakhand causing Family CAGE questionnaire were applied in a self devastating floods and landslides. Besides the material administered format. ICD 10 criteria and subsequent harm, disaster also has massive impact on individual's detailed clinical interview by a trained psychiatrist were mental health and the impact is perceived more in used for the final diagnosis of substance dependence. developing countries due to being densely populated Results: Majority of the subjects were alcohol (60%) with limited resources. Objective: The current study is users followed by opioid (35.2%) and cannabis (3%). an attempt to evaluate the psychological impact and its The scores of CAGE (r2=0.51) and Family CAGE (r2=0.57) risk factors in Uttarakhand disaster. Methodology: This questionnaire were highly correlated with the ICD 10 cross sectional study was conducted after 1 month of symptom score. In the Psychiatry outpatient group, disaster in the primary survivors. All the included there has been a substantial inter rater agreement subjects were administered the semi-structured between the Family CAGE and the CAGE questionnaire proforma for assessing socio-demographic profile and (Cohen's kappa= 0.79). Though the inter-rater reliability the assessment instruments: Impact of events scale- of the Family CAGE and the ICD 10 diagnosis of revised (IES-R), Depression Anxiety Stress Scales (DASS) substance dependence was moderate (Cohen's and Life Orientation Test – Revised (LOT-R). Data was kappa=0.61). In both the subgroups, a cut off score of 2 imputed and analysed using SPSS ver 17.0. Result: of Family CAGE was found to be 100% sensitive for the About 58% subjects had post traumatic stress disorder diagnosis of substance dependence. But with same cut (PTSD) and significantly severe levels of depression, off score, the specificity of diagnosis obtained from the 2013 Indian Association for Social Psychiatry A6 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 psychiatry outpatient was 33.3%. On the contrary in Introduction: Substance dependence is a chronic, the same subgroup, cutoff of 3 was 95.8% sensitive and relapsing disorder and requires long term care and 100% specific. Conclusions: Self administered Family- treatment. Community based treatment is cost CAGE questionnaire is a valid instrument for the effective, closer to the community, community diagnosis of substance dependence. The sensitivity and participation is more, it is less stigmatizing and patient specificity of a cutoff score of 3 of the family CAGE can stay with his family during the treatment. questionnaire for the diagnosis of dependence are Objectives: To see the outcome of patients of alcohol reasonably acceptable. This simple questionnaire can and drug abuse admitted in community de-addiction. be used for screening purpose especially in the Method: The patients of community de-addiction epidemiological studies. camps who were admitted from 1999-2010 were followed up in June, 2012 for the purpose of outcome. BB SETHI AWARD
Results: Out of 172 patients, 147 patients could be NURSING STUDENTS' ATTITUDES TOWARDS PATIENTS
contacted (85.46%). More than 52% of patients of WHO SELF HARM: AN EXPLORATORY STUDY
alcohol and drug abuse could maintain abstinence for Naresh Nebhinani, Mamta more than 10 years and more than 42% of patients could maintain abstinence between 2-10 years. Department of Psychiatry, All India Institute of Medical Conclusion: Community based de-addiction camps is Science, Jodhpur, Rajasthan cost effective interventional strategy even for long term Background: Majority of health professionals have care of patients of alcohol and drug abuse.
unfavorable attitudes towards patients presenting with NURSING PERSONNEL ATTITUDE TOWARDS SUICIDE
self-harm, which further compromises their willingness and outcome of care. This study was aimed to assess the nursing students' attitudes toward patients who self Naresh Nebhinani, Mamta harm. Methodology: By employing cross-sectional Department of Psychiatry, All India Institute of Medical design, 308 nursing students were recruited through Science, Jodhpur, Rajasthan total enumeration method from May–June 2012. Background: Preventing suicide depends upon the 'Suicide opinion questionnaire' was administered to different health professionals' knowledge about assess their attitudes towards patients who self harm. suicide, attitude towards suicide attempters, skills to Descriptive statistics was employed with SPSS version assess and manage suicidal risk. This study was aimed to 14.0 for Windows. Results: Majority were single assess the attitude of nursing students toward suicide females, from urban locality, with the mean age of 20 prevention. Methods: By employing cross-sectional years. Only minority had previous exposure to suicide design, 308 nursing students were recruited from the prevention programmes and management of such two institutions through total enumeration method. cases. Majority of students agreed for mental illness, 'Attitude towards suicide prevention scale' was disturbed family life, and depression as major push to administered. Results: Majority were single females, attempt suicide. They held favorable attitude for half of from urban locality, who were pursuing B.Sc Nursing the attitudinal statement, but they were uncertain for with the mean age of 20 years. Only minority had rest half of the statements. Conclusions: They generally had favorable attitude towards suicide attempters. programmes/workshops. About 47% of the sample Their uncertain response highlights the need for showed positive attitude towards working with suicidal enhancing educational exposure of nursing students patients whereas 49% agreed that most of the suicidal and new staff at the earliest opportunity, to carve their people won't reveal their suicidal plans to others. More favorable attitude towards patients presenting with than 50% consider unemployment and poverty as main causes of suicide and were quite hopeless about it. LONG TERM OUTCOME OF SUBSTANCE ABUSE
Attitude towards suicide prevention was significantly T REAT M ENT T HRO UG H INT EG R AT ED C A M P
different for 5 out of 14 statements among students from two different nursing colleges. Conclusions: Ajeet Sidana, BS Chavan, Rohit Garg, Jasvir Singh Merely half of the students had positive attitude towards working with suicidal patients. Hence there is Department of Psychiatry, Government Medical College strong need to organize more educational and training & Hospital-32, Chandigarh 2013 Indian Association for Social Psychiatry A7 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A3-A8 programmes on suicide prevention so that these somatoform disorders. A significant positive correlation budding health professionals could be more equipped was found between total number of somatic symptoms and trained to manage these suicidal patients.
and severity of depression, anxiety and level of somatosensory amplification n both the groups. DO THE VARIOUS CATEGORIES OF SOMATOFORM
Conclusion: There are no significant differences DISORDERS DIFFER FROM EACH OTHER IN SYMPTOM
between the various sub-categories of somatoform PROFILE AND PSYCHOLOGICAL CORRELATES
disorders of ICD-10 with regard to the prevalence of Jitender Aneja, Sandeep Grover, Debasish Basu, somatic symptoms, anxiety or depression and clinical Akhilesh Sharma,Rama Malhotra, Sannidhya Varma, correlates of alexithymia, hypochondriasis and somato- Ajit Avasthi sensory amplification. Department of Psychiatry, Post-Graduate Institute of EFFECT OF ANXIETY AND DEPRESSION ON LONG TERM
Medical Education and Research, Chandigarh OUTCOME OF MYOCARDIAL INFARCTION
Background: Somatic symptoms are common Siddharth Sarkar1, Rakesh Chadda2, Rajiv Narang3, presentations in primary care and specialty clinics Nand Kumar2 worldwide and many of these patients are diagnosed to 1 Department of Psychiatry, PGIMER, Chandigarh; have somatoform disorders. However, in routine clinical 2 Department of Psychiatry, AIIMS, New Delhi; practice, the sub-categories of various somatoform 3 Department of Cardiology, AIIMS, New Delhi disorders are used rarely and there is lack of data to suggest the difference in the clinical manifestations of Objective: Anxiety and depressive symptoms are these sub-categories. Aim: To examine the prevalence common following myocardial infarction (MI). The of various somatic symptoms, anxiety and depression in present study was conducted to assess the effect of patients diagnosed with various subtypes of anxiety and depression on clinical outcome at 18 somatoform disorders and to compare the symptom months in patients with a recent MI. Methods: Patients profile of patients with persistent somatoform pain with a recent MI attending the cardiology outpatient of disorder with other subtypes of somatoform disorder. a tertiary care center formed the sample of the study. Method: One hundred nineteen (119) patients Demographic and clinical data was recorded. Anxiety diagnosed with somatoform disorders according to the and depressive symptoms were assessed at the International Classification of Diseases- 10th revision baseline using standardized instruments. The patients (ICD-10) were evaluated for prevalence of somatic were contacted telephonically at 18 months to symptoms, anxiety, depression, alexithymia, ascertain the outcome. Results: Out of original sample hypochondriacal worry and somatoform sensory of 103, 66 patients could be contacted at 18 months. amplification. Patients with persistent somatoform Out of the patients who could be followed up, about pain disorder were compared with those with other one third had a poor outcome at 18 months in the form subtypes of somatoform disorders on all the of adverse cardiac event or death. Anxiety and parameters. Results: The most commonly reported depressive symptoms or having a psychiatric illness at symptoms were headache, excessive tiredness on mild the baseline did not influence outcome in this particular exertion, pain in limbs, bloating and backache. cohort. Conclusions: Anxiety or depression by itself may Persistent somatoform disorder was the most common not be a poor prognostic factor in patients with MI. diagnosis given to more than half of study participants. No significant differences were found in the prevalence of various somatic complaints between those with persistent somatoform pain disorder group and those diagnosed with other somatoform disorders. Comorbid anxiety and depression were seen in two-third of the patients, but again there was no difference in the prevalence of the same between the two groups. Similarly, no significant differences were found on the alexithymia, hypochondriasis and somato-sensory amplification scales between the persistent somatoform pain disorder group and other 2013 Indian Association for Social Psychiatry A8 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 S1 - THEME SYMPOSIUM: MENTAL HEALTH IN
now which show that people who have family, friends CHANGING SOCIAL MILIEU
and relatives who provide emotional and material support are in better health. The social support can Changing social milieu in contemporary society:
have buffering effect from stress. The environment is SK Khandelwal undergoing rapid change and thus it is expected that it Effects of changing social milieu on mental health:
will affect our mental health. The social psychiatrists Amool Ranjan have a larger responsibility to to keep a contant vigil on Social milieu and mental health: role of a mental
these factors and provide better strategy to deal with health professional
these changing factors.
S2 - MENTAL HEALTH PROGRAMME, POLICY AND
Social milieu and mental health: Perspectives of a
LEGISLATION: A CASE FOR COHERENCE
social scientist
Mental Health Programe-
Manju Mohan Mukherjee Roy Abraham Kallivayalil The broader concept of health now accords greater Mental Health Policy-
prominence than ever to the mental and social determinants of health. Most significantly, this new Mental Health Care Bill-
understanding of health dwells less on individual (Late) JKTrivedi & Adarsh Tripathi attributes, but more on the nature of their interaction Situation Appraisal and future directions. -
with the wider environment. The "environment" in its Rakesh Chadda broadest sense includes not only our physical surroundings, but also the social, cultural, regulatory India has a large burden of mental and behavioural and economic conditions. Thus, with definition, mental disorders. There is a huge treatment gap due to scarcity health moves into the realm of the relationship of available mental health resources, inequities in their between the individual, the group and the distribution, and inefficiencies in their use. To improve environment. Mental health is no longer conceived of the mental health of our population, it is essential for all as an individual trait, such as physical fitness; rather it is the stock (stake) holders' namely mental health regarded as a resource consisting of the energy, professionals, their organizations, policy and law strengths and abilities of the individual interacting makers, health care providers, advocacy groups and effectively with those of the group and with Non Governmental Organizations to commit to a opportunities and influences in the environment. This systematic and proactive strategy. Advocacy efforts by conceptualization leads to certain conclusions about international organizations, national opinion makers the factors that can enhance or weaken mental health. and users are necessary to generate sufficient political For example factors like poverty, prejudice, will to prioritize mental health services. We should have discrimination, disadvantage and marginality are a a mental health policy, and a dedicated mental health threat or barrier to mental health. Although in the budget. A mental health programme to integrate recent years biological understanding of mental mental health care with primary health care and disorders, has improved significantly, however the provision of universal, accessible, affordable mental stress originating from the environment is still health care at community level is being implemented to perceived as a significant factor causing psychological improve the situation. However, its functioning at disturbance . There is strong link between stress and ground level remains far from satisfactory. Till this time, mental illness, but large number of people remain there doesn't appear to be uniformity in national healthy even in life threatening situations . The factors mental health programme and mental health which help in maintenance of homeostasis include legislation of the India. The new Mental Health Care Bill social support, coping etc. There are numerous studies has been cleared by the Union Cabinet on June 14, 2013 Indian Association for Social Psychiatry A9 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 2013, and once approved by the Parliament, will repeal caregivers the Psychiatric Department, Govt. Medical the Mental Health Act 1987. The Mental Health Care Bill College & Education, Sect-32, Chandigarh started Home 2012 makes significant strides over the Mental Health Base Treatment Services. Home Base Treatment Act 1987 and proposes to bring about protection and Services means provision of treatment facilities to the empowerment of persons with mental illness. The psychiatric patients in their home setting. Why was it Ministry of Health and Family Welfare, Government of conceived: To Provide an alternative to hospital India has appointed a Policy Group to prepare a admission, To decrease the stigma attached to hospital National Mental Health Policy and Plan. This is the right admission, To provide service that is accessible, time for pointing towards having greater coherence in available, affordable and responsive which is in all these efforts so that focused attempts to improve agreement with the objectives of national mental mental health care scenario of the nation could be health programme, Effective treatment package in the setting of home and family, To lessen the burden of family members, Reaching the unreached, Facilitate S3 - HOME BASED TREATMENT: A COMMUNITY
early discharge from hospital. How it was planned: In OUTREACH SERVICE FOR ENGAGING THE NON-
order to provide the treatment at home, Home Base Treatment Team was constituted comprising of The conceptual 'Hows' and 'Whys' behind Home Based
Psychiatric Social worker and nursing staff. Two Treatment: BS Chavan
Performa were developed to serve the purpose of HBT The logistics related to implementation of Home
the first was application cum consent form where the Based Treatment: Shikha Tyagi
family/friend/relative writes an application to the HOD asking for interested in availing the services. Along with Sharing of the initial experience using an evidence-
the application, he/she signs the consent form. The based approach: Nitin Gupta
second performa is the HBT assessment performa to be SUMMARY: In view of huge treatment gap, engaging the used by the PSW. The Performa was tested on around 10 patients is one of the objective for mental health patients in the OPD to see whether it will be able to services. In India, the most common treatment set-up serve the purpose. It was also decided that SOFAS will available for patients with mental illnesses is hospital be administered at the first visit and then after an based facilities, which necessitates them having to interval of three months to evaluate the improvement come there for seeking treatment. This approach, in the patient. Criteria (how we fixed) and satisfaction however, faces difficulties for patients who are scale (yet to decide) needs to be added. The HBT service unwilling to come to the hospital due to a myriad of has been proposed for the following category of reasons. Engaging with these non-engagers (or 'difficult patients: Patients with gross personal neglect due to to engage') patients as a model is widely practiced in the mental illness, however patient is unwilling to come for west. However, it has been implemented to a very treatment; Patients with major mental illness who are limited extent in the Indian setting. The Department of staying alone and there is no one to bring them for Psychiatry, GMCH-32, Chandigarh has been gradually treatment; Elderly patients with mental illness who are expanding its Community Outreach Services, under bed ridden and are unable to come to the hospital for which the Home-Based Treatment (HBT) Program has treatment; Non compliant patients with a history of been launched. We shall discuss about the processes multiple relapses and in need of regular medication to and logistics related to the concepts and prevent relapse and hospitalization.
implementation of HBT, and share our experiences S4 - CURRENT PERSPECTIVES ON TOBACCO USE
related to the running of the HBT over a period of 6 months. Introduction: The treatment facilities for the Putting tobacco harm reduction in perspective: Is
psychiatric patients are available in Chandigarh in both there any evidence?: Sonali Jhanjee
public and private sector However, the major difficulty Pharmacological and psychosocial approaches
faced by the families/caregivers arises when the patient tobacco use cessation: "Thus far and the road ahead":
despite psychiatric illness refuses to seek treatment and Prabhu Dayal come to the hospital. Many a times the caregivers Tobacco use in psychiatric disorders: A story of
would approach the Psychiatrist for prescribing Inveterate Smokers?: Yatan Pal Balhara
medicines to their relative without even having seen the patient once. Considering this problem faced by the Tobacco use is a global pandemic. Tobacco dependence 2013 Indian Association for Social Psychiatry A10 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 is a chronic relapsing condition, requires repeated Effect of marriage on family functioning and clinical
interventions and multiple attempts to quit. Strategies outcome in persons with Bipolar Affective Disorder: A
for assisting smoking cessation include behavioural case control study – Nikhil Goel
counseling and pharmacotherapy. Three drugs are Legal perspectives of marriage and mental health in
currently used as first-line pharmacotherapy: nicotine Indian context – Sonia Parial
replacement therapy (NRT), bupropion and varenicline. This symposium covers one of the proposed thrust Compared to placebo, the drug effect varies from RR = areas of research i.e. mental health of special groups 2.27 for varenicline, to 1.69 for bupropion, and 1.60 for such as women who got married after recovery from any form of NRT. Second-line pharmacotherapies psychoses. This symposium will further cover course include nortriptyline and clonidine. A Cochrane and outcome of psychoses following marriage. Thus we systematic review in 2013 for the first time establishes don't have any readymade answer available, whether the efficacy of psychosocial support over and above marriage helps in improvement or otherwise. These pharmacotherapy. Conventional tobacco cessation studies will be able to answer all pertinent questions policies and programs generally present tobacco users related to the field. Rationale: It is a popular belief in with only abstinence oriented treatment measures. general public that marriage is a cure for different forms However, the currently available treatment of nicotine of mental disorders from hysteria to psychosis, but, addiction has limited efficacy. Many tobacco users are contrary to public opinion, professionals feel that unable to achieve cessation with the current marriage can be detrimental to the continue wellbeing approaches and experience the very real and obvious of certain types of mental illness. By these studies we adverse health consequences. A third approach to will be able to outline the role of marriage in preexisting tobacco use cessation, tobacco harm reduction, psychosis. Present knowledge and relevant involves the use of alternative sources of nicotine, bibliography: Fish concluded precipitation of major including medicinal nicotine, modern smokeless mental illness by marriage is a largely culture bound tobacco products (swedish snus), modified phenomenon. Behere and Tiwari concluded it is not conventional cigarettes and e cigarettes to reduce the only the type of illness which is affected by marriage but harm caused by tobacco. The evidence base of it is also important at which stage of illness the person effectiveness of these approaches has possible public got married. Outcomes & Benefits of the study: The health implications. However Tobacco harm study will provide answer whether marriage is a cure for reduction(THR) is a controversial issue with socio- psychoses or otherwise and concerning outcome political overtones and opponents of THR argue that regarding their family functioning.
some aspects of harm reduction interfere with cessation and abstinence of tobacco and might increase initiation of tobacco products. Title: Effect of marriage in female schizophrenia
Further, people with mental health and addictive patient: A pilot study.
disorders (MHADs) have higher rates of cigarette Name of Authors: Prakash B Behere, Akshata N
smoking, and less success in quitting tobacco use compared with the general population giving rise to Speaker: Manik Bhise
increased tobacco-related medical illness in this MHAD population. Discussion regarding scope of this Aims and Objectives: 1. To study the effect of marriage comorbidity, and addressing treatment of tobacco on schizophrenic females in terms of demographic dependence in people with MHAD is important to variables & clinical outcome, family function in both reduce the morbidity and mortality in this population.
groups and marital adjustment in married patients.
S5 – MARRIAGE AND PSYCHOTIC ILLNESS
Study design: It is an Analytical cross sectional study with comparison group in department of psychiatry Introduction to Marriage and Mental Health – Prakash
AVBRH. Cases & comparison: 25 married & single female schizophrenia patients who fulfilled the Effect of marriage in female schizophrenia patient: A
selection criteria as led down in the study over 6 month Pilot study – Akshata Mulmule
period (Jan 2013 to June 2013).
Effect of marriage on male patients with schizophrenia
– Manik Bhise
2013 Indian Association for Social Psychiatry A11 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 Written informed consents & Clearance from are more likely to be less educated, less skilled and more institutional Ethical committee was taken.
likely to lose their jobs. This may affect their choices regarding marriage. Some studies show that stable Scales: A semi-structured proforma to record marriage is a good prognosis factor for schizophrenia. demographic, clinical variables; Brief psychiatric rating Male patients are less likely to be left alone / divorced scale for severity of illness, Family functioning by family by their partners than female patients. Other studies assessment device, Family interaction pattern scale and contradict to this by showing marriage as stressful life marital adjustment rating scale.
event that may lead to more relapse. Treatment Results and conclusion: discontinuation after marriage is less common in males Socio demographic variables of both groups were than females, probably because they stay in same comparable other than occupation. 40% patients were family after marriage. In current symposium we will be staying with husband, 24% cases informed their reviewing literature on these issues.
spouses regarding illness prior marriage, more than 60% got married on their parent's advice & had poor Title: Effect of marriage on family functioning and adjustment. Most patients and relatives were of clinical outcome in persons with Bipolar affective opinion marriage can cure mental illness. Cases with disorder: A Case control study.
children had less separation rates. Mental illness was relatively severe in cases than comparison group; family Name of Authors: Prakash B Behere, Nikhil Goel functioning was similar in both groups. with increasing Aims and objectives: To study the effect of marriage in severity of illness marital adjustment deteriorates with Bipolar affective disorder patients in terms of clinical antagonistic interaction among members.
outcome, family functioning and quality of life.
Methodology: A case control study was conducted in Title: Effect of Marriage on male patients with the Department of Psychiatry at AVBR Hospital. 55 patients each of study and control group were taken. Controls were Bipolar affective disorder patients who Name of Speaker: Manik C. Bhise were never married. Brief Psychiatric Rating Scale Introduction: Schizophrenia affects males and females (BPRS), Family Assessment Device (FAD) and PGI Quality equally. Being a disabling illness with chronic course it of Life (QOL) scale was administered.
affects all spheres of life of person. Marriage being Results and Conclusion: 76% of controls had upto 5 major life time decision studying its impact on illness is years of duration of illness while 52% cases were having of paramount importance.
illness of more than 5 years. 72.7% controls suffered Issues under consideration: Being a disease of young from maximum episodes of mania while only 47% cases age, patients often have to make choice about marriage had mania as their maximum episodes. Mean BPRS after onset of illness. Whether they should get married scores in control and case group was 36.72 and 39.78 or not is first issue. Family's expectations from marriage respectively, which is suggestive of mild to moderately that illness may improve as responsibility comes etc ill(Leucth et al, 2005). However the difference is not need to be seen. Social skills deficits, occupational significant. Similarly mean scores of FAD & QOL in case impairment, avolition etc are some of the issues which group and in control group was different, however the may impair male patients in performing their duties as difference was not significant. With this we can come to husband. Another consideration is sexual impairment a Conclusion that marriage does not influence outcome associated with disease or its treatment. Stability of of illness, quality of life and family functioning in marriage is another issue. These issues assume persons with bipolar affective disorder.
importance in male patients as our society has different expectations from males and females, whether or not one has schizophrenia.
Speaker: Sonia Parial Discussion: Available literature can help us on some of Title: Legal perspectives of marriage and mental health the issues mentioned above. Studies have constantly in Indian context.
revealed deficits in social and occupations functioning Marriage is a 'contractual agreement' which formalizes of patients with schizophrenia. They have less income, and stabilizes the social relationship that comprises the 2013 Indian Association for Social Psychiatry A12 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 family. The contract of marriage needs both physical dementia) continue to exhibit deficits in cognitive, and mental element. It is considered to be a stress for social and vocational areas which interfere in their long some vulnerable people, which may lead to term outcome and rehabilitation into the society. Many development or exacerbation of mental illness. such individuals thus require a comprehensive mental Conditions prevailing in the course of marital life health service package wherein some effective non- determine the continuation of the relationship pharmacological modalities of treatment can be between partners. Desertion, cruelty, adultery, and provided so as to have a net positive outcome in the life mental illness may interfere with the marital life, and it of the patients as well as their caregivers. Also, many may not be possible for the relationship to continue times medicines are helpful only in the acute phase of (Nambi, 2005).
the illness and not very much effective thereafter; this being specially so in patients suffering with There are different laws governing marriage in different schizophrenia. Also, rehabilitation services for people religions. According to Hindu Marriage Act(1955) disabled due to mental illness has, unfortunately, grounds for judicial separation are that the respondent received less focus in the country in comparison to has been incurably of unsound mind or has been those with physical disabilities or mental retardation. suffering continuously or intermittently from mental People with mental illnesses require rehabilitation in disorder of such a kind and such a extent that the the domains of cognitive, social as well as vocational petitioner cannot reasonably expected to leave with skills. The culmination of all these factors together the respondent. Muslim Marriage Act (1939) states that resulted in the commencement of the "Disability a person of unsound mind cannot contract a marriage Assessment, Rehabilitation and Triage (DART)" services and such a marriage if contracted is void. However, if by the Department of Psychiatry, Government Medical the guardian of the person of unsound mind considers College and Hospital-32, Chandigarh. Under DART such marriage to be in his interest and in the interest of services, the following units have been set-up and society and is willing to take up all the monetary operationalized viz. Neuropsychological Rehabilitation obligations of the marriage, then such a marriage can be Unit, Social Skills Training Unit, Vocational Skills Training performed. Marriage can be dissolved by divorce by the and Rehabilitation Unit, and Day Care Centre. The parties without recourse to court and on certain symposium shall outline the vision behind DART, its grounds by recourse to court. A Muslim husband of position statement, objectives and intent, and detail sound mind may divorce his wife without assigning any the repertoire of services. The presenters will aim to cause by pronouncing "TALAQ". A Muslim woman can highlight the scope and role of rehabilitation in modern seek divorce on the ground that her husband has been day psychiatry and make a case for rehabilitation being insane for a period of two years. According to Parsi given credence in management of mental illnesses, and Marriage law (1936) any married person may seek a need for an appropriate shift of focus from biological divorce if the defendant was a unsound mind at the psychiatry onto social psychiatry. time of marriage and has been habitually so up to the date of the suit: provided that the divorce shall not be S7 - RESEARCH ASSOCIATED PRIORITY INNOVATION &
granted on this ground, unless the plaintiff. DEVELOPMENT (RAPID) PROGRAM OF THE IASP
Unsoundness of mind is not a ground for annulment. Setting research priorities for IASP: Pratap Sharan
These acts have not been revised since years. Recent The schematics and pragmatics of setting up the
research data and consensus holds that there may be research database: Ashwani Mishra
serious violation of rights of persons with mental illness in some cases where these acts are applied.
Research Proposal: IASP Multi-centric study on stigma
related to psychosis: Nitin Gupta
S6 - REHABILITATION THROUGH THE DISABILITY
ASSESSMENT REHABILITATION TRIAGE (DART)
Stigma related to psychosis and its correlates:
SERVICE: THE WAY FORWARD!
Preliminary data: Pravin Khairkar
BS Chavan, Subhash Das, Shikha Tyagi, Rushi Following the last year's National Conference of The Indian Association of Social Psychiatry (IASP) in Despite advancement in pharmacological treatment, a Chandigarh, the Association undertook a new research large number of patients with chronic psychiatric initiative. The mission statement was to promote disorders (like schizophrenia, bipolar affective disorder, research of importance to the evolution of social recurrent depression) and organic brain disorders (e.g. 2013 Indian Association for Social Psychiatry A13 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 psychiatry in India through development of research formally structured to meet their specific needs have collaboration. Accordingly objectives were identified, been reported in the literature. The presentation aims and the Executive Committee appointed an IASP to discuss the factors related to lack of initiatives Research Taskforce. In this symposium, we shall outline towards innovative programs and why more residents the remit of the Taskforce and the research vision of the don't take advantage of services that do exist. Further, IASP for its membership along with a brief discussion on efforts aimed towards helping residents at AIIMS would the logistic requirements and support systems entailed be discussed.
in such an initiative. Progress on the initial work by the S9 (CME Symposium) - SUICIDE IN THE NEW
Taskforce and the identified short-term objectives shall be presented.
Epidemiology of Suicide: Changing Scenario: Debjani
S8 - MENTAL HEALTH ISSUES IN MEDICAL STUDENTS
Manju Mehta, Rajesh Sagar, Rachna Bhargava Preventing Suicide in School and College Children:
The mental health of residents in training is a topic of Rajesh Sagar considerable concern. Recent attention to the issue of Determinants of suicide in women with mental illness
patient safety has led to examination of the relationship and their management: Abhishek Pathak, Indira
between residents' stress and compromised clinical performance. In addition, studies suggest that the Suicide in Elderly: Causes and Management: Pankaj
mental distress experienced by medical students could potentially have adverse consequences on academic performance, competency, professionalism and health. S10 - GENDER AND MENTAL HEALTH
The symposium aims to address different issues related Gender Issues and Mental Health: Current Perspective
to mental health among medical residents and share – Rajiv Gupta
the experience of dealing with them at AIIMS.
Is Gender Important for Psychoeducation or
Assessment of Medical residents Psychotherapy – Satabdi Chakraborty
Though there is considerable research on morbidity Gender and Help Seeking Behaviour – Bhupendra
however, review on Indian research shows that despite increase in mortality and morbidity rates, there is Gender and Stigma – Sudha Chaudhury
dearth of systematic assessment of stress and associated factors. At AIIMS, efforts have been made to In 2002, World Health Organisation passed its first screen students who are at high risk. A comprehensive Gender Policy, acknowledging the gender issue as assessment at different levels over the years has helped important on its own. Unfortunately, "gender" is to identify vulnerable group. We intend to discuss increasingly used inappropriately as a substitute for various issues related to assessment.
"sex", particularly in biomedical literature, a tendency which has created confusion. Sex denotes biologically Psychiatric Morbidity determined characteristics, while gender indicates Studies have revealed a high prevalence of culturally- and socially-shaped variations between men psychological distress in medical students, ranging from and women. Gender is related to how we are perceived 21.6% to 56%. Studies have reported an association of and expected to think and act as women and men prolonged psychological distress with lowered medical because of the way society is organized, and not students' self-esteem, anxiety and depression, because of our biological differences. Health services difficulties in solving interpersonal conflicts, sleeping for women have a tendency to focus on their disorders, increased alcohol and drug consumption, reproductive functions, neglecting the issues related to cynicism, decreased attention. Prolonged psychological mental health. A lack of female medical personnel is distress has also been linked with medical student sometimes a barrier for women to utilize healthcare suicide. The psychological issues identified among the services. Poor women find themselves without access students at AIIMS would be discussed.
to healthcare more often than men from the same Intervention Strategies social group, even in rich countries like the United States. In many developing countries including India, Few mental health programs dedicated to residents and women complain about lack of privacy, confidentiality 2013 Indian Association for Social Psychiatry A14 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 and information about options and services available. Cognitive Functioning: A double-edged sword?:
Gender differences in the prevalence of psychiatric Shivanand K disorders are well known fact. But whether this Formulating a Comprehensive Management Plan:
difference is also affect the outcome of psycho- Mamta Sood education or psychotherapy? Stigma is another Management of patients with serious mental illnesses common factor related to psychiatric illness but to what (defined as having nonorganic psychosis with severe extant this variable is related to gender differences. The dysfunction and on treatment for 2 or more years) aim of this symposium is to discuss why gender matters poses a significant challenge to the clinicians. In the in mental health, to explain the relationship of gender recent years, it has been increasingly recognized that and health-seeking behavior and to elucidate gender the approach to management of these patients needs a issues in relation to therapy and stigma, to examine the paradigm shift from emphasis on removal of symptoms gender differences in common mental health problems, to improving overall functioning and quality of life. and to discuss current Indian perspective.
Amongst this population there is a subgroup of patients S11 - PSYCHO-ONCOLOGY: ROLE OF MENTAL HEALTH
who are difficult to treat and continue to have PROFESSIONALS IN CANCER CARE – WHERE DO WE
persistent psychopathology and dysfunction despite receiving adequate treatment for sufficient duration. Over view of Psycho-oncology: What can mental
The failure to improve may be due to various factors health professionals offer?: Soumitra S Datta
related to the patient, family or health care systems. Medication non-adherence, unrecognized negative and Correlates of well-being in women with breast cancer
cognitive symptoms, under-diagnosed physical and in India: Associations with emotional health, cancer
psychiatric co-morbidities are some of the important and treatment related variables : Lopamudra Tripathi
reasons for poor response to treatment. The Suicide in medically patients – A focus on patients with
management of these patients needs comprehensive cancer: O P Singh
evaluation and formulation of a feasible and Background: Being diagnosed to have cancer can be a sustainable treatment plan tailored for individual emotionally difficult time. Right from the beginning patients utilizing available evidence based knowledge. when its doctors break the news of diagnosis to through In the seminar, complexities in the management of the various stages of cancer care there is role of mental patients with difficult to treat serious mental illnesses health professionals. During the treatment phase it will be discussed.
could be more to do with procedural anxieties, body S13 - SUBSTANCE USE DISORDERS: CURRENT
image problems, depression etc. Following cure people SCENARIO AND CHALLENGES IN THE CHANGING
often live in the shadow of fear of recurrence. In the SOCIAL MILIEU
unfortunate circumstances of the cancer progressing to Introduction and overview: Rajiv Gupta
terminal stages, patients benefit from support and helping them to this extremely difficult phase of facing Epidemiology – focus on changing pattern of drug use:
death imminently. It's obvious in today's cancer care, Aniruddha Basu that patients benefit from a combination of Principles of management: acute and chronic
psychological and pharmacological interventions treatment: Madhurima Ghosh
alongside chemotherapy, radiotherapy and surgery. Principles and practice of Psychosocial management:
S12 - COMPLEXITIES IN THE MANAGEMENT OF
Sunila Rathee, Vinay PATIENTS WITH 'DIFFICULT TO TREAT' SERIOUS
The importance of substance use disorders (SUD) are ingrained in the theme of the conference and no The interplay of Medication Monitoring with
discussion of 'mental health in changing social milieu' Treatment Non-adherence: Sivakumar T
can be complete without reference to substance use. Physical Health Comorbidity and its Monitoring: Nitin
India traditionally is a country where different forms of substance producing plantations like tobacco, cannabis and opium have been cultivated and consumed with some religious and social sanction. However, currently Management: Nand Kumar
India is in a very vulnerable geo-political situation due 2013 Indian Association for Social Psychiatry A15 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A9-A16 to its close proximity to the golden triangle and golden not simply a biological change in the brain but a crescent. Along with this, rapid social, economic, biopsychosocial phenomenon. Hence it is important to cultural changes in the country compounded with short understand the emergence of newer substances, newer sighted policies, weak enforcement agencies and weak products of older substances, and newer addictions in legal provisions have made substance use disorders the rapidly changing modern Indian society today. The (SUDs) one of the most burdensome medical four talks in this symposium will try to capture these conditions. Some comprehensive, standardised trends in the sociocultural context among various social epidemiological surveys done recently have been strata. The first speaker will discuss the rise of the focusing on the changing pattern of drug use in the 'alcopop' culture in modern Indian society. The second current society and highlighting the threat of speaker will talk about a silent epidemic of inhalant prescription drugs use and injection drug use leading to abuse as the 'poor man's cocaine'. The third speaker will the HIV epidemic. One way to effectively deal with this highlight the emerging menace of 'club drugs' in the huge problem is to make adequate provision for affluent party circles in modern India. The final speaker treatment. A comprehensive assessment with medical will elucidate the 'unsocial network': how modern and psycho-social needs is key for successful society alienates people and paradoxically draws them management. Every patient who is posing problem to together in a virtual world. self, family or society due to substance use needs to be S15 – ADOLESCENT RESILIENCE
advised to quit followed by proper detoxification, Introduction to the concept of Resilience: Karobi Das
pharmacological treatment and chronic management thereafter. A principle of harm reduction is to be followed wherever complete abstinence is not possible Development: Harpreet Kanwal
and psychosocial interventions like motivation Models of Adolescent Resilience: Sunita Sharma
enhancement, relapse prevention are to be practised. Bolstering Adolesence Resilience: Pathways for
Along with this, rehabilitative measures are to be Future: Jaison Joseph
undertaken to help the substance users to return to the With the changing milieu, the stress & adversity has mainstream. Special treatment provisions are required emerged has one of the intrusive phenomenon for at risk groups like adolescents, females, prisoners percolating into the life of youth today. However, some and patients with psychiatric illnesses. If proper of the youth tend to shatter during adversity, while treatment provisions are made and patients others take adversity as a challenge and produce highly incorporated in standardised treatment protocols then positive adaptational outcomes. In fact, it appears that outcome is good and even comparable to other chronic some individuals who are challenged by adversity medical conditions. The symposium aims to highlight emerge stronger, with greater capacities that they may the contemporary challenges and the concerted efforts not have otherwise. This capacity to bounce back in required on the part of the mental health professionals spite of stress and adversity is labeled as 'Resilience' in including psychologist, social workers with equal psychological taxonomy. It also refers to the process of participation by administration, religious leaders, and overcoming the negative effects of risk exposure, coping successfully and avoiding the negative social service organization to control this scourge of trajectories. Resilience has been a major research theme for developmental theorists for years. Initially, S14 - THE "BRAVE NEW WORLD": MODERN
resilience was studied focusing on the within person ADDICTIONS IN MODERN SOCIETY
factors, however in years, the eco-systemic perspective was also considered in resilience research. Looking at Alakananda Dutt: Old wine in new bottle: the 'alcopop'
the social changes happening at fast face in Indian culture in India.
society there is strong need to enhance the resilience Kaustav Chakraborty: Erasing the mind with 'Eraz-ex'.
skills of adolescents to prepare them for a progressive future. The biggest challenge is to provide the Rajarshi Neogi: Revving up the rave: club drugs in
preventive interventions designed to bolster the resilience. With such background the current Debasish Basu: The Unsocial Network - 'addiction' to
symposium shall focus upon the understanding of psychological resilience, the pathways and trajectories Substance use and addiction patterns are not static but of adolescent development and directions for future in vary with time, culture, and societal trends. Addiction is implementing resilience theory into practice. 2013 Indian Association for Social Psychiatry A16 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A17-A20 W1-ADVOCACY FOR MENTALLY CHALLENGED
penalizing not only the patients, but also their families. Various researches have shown that the stigma of FACILITATORS: RK Brahma, Divya Gopal Mukharjee,
mental illness affects the requirements for care of good quality in mental health especially at the primary care Advocacy for Mentally Challenged: Advocacy means level. Time has come to break the cycle of disadvantage speaking / pleading for or supporting individuals or resulting from stigma to make a priority. An enlightened their cause. In effect I feel very strongly that both of this public working in unison with professional associations meanings of advocacy is a dire necessity or should be can leverage national governments and health care considered as a right for the mentally challenged. We organizations to provide equitable access to treatment are aware of the acts covering the rights of disabled and to develop legislation against discrimination. These people who are physically handicapped. However, efforts may dispel the indelible mark, the stigma caused mental disability are not as visible or audible because by mental illness.
they suffer in silence- within themselves , they are often W2- DISABILITY ASSESSMENT: FIRST STEP TOWARDS
unable to articulate their suffering or needs, in an PSYCHOSOCIAL REHABILITATION
appealing manner – often disjointed and difficult to decipher . This leads to people dismissing them as FACILITATOR: Kamlesh Kumar Sahu
"f¡Nm R¡Nm"- or in other words "mad" – not worth Substantial proportions of person with mental illness listening to or denigrated into subhuman category. We continue to have residual deficits despite best as psychiatrists are expected to be their advocates- fight treatment. Majority of persons with long standing mental illness continue to manifest symptoms, misunderstandings, neglect and even down right impairments or disabilities. Since mental disorders oppression, not just by other fellow - citizens but manifest in social context, disability due to them is institutionalized discrimination by legislation, generally termed as "social disability" (Taly & Murali, corporates and even the state. Where is the humanity, if 2001). Social Disability can manifest in several roles that we cannot standup for the weak, disempowered and a person is expected to perform in the society e.g. self meek – can't be their standard bearer!!! care, interpersonal relationship, family, social and Stigma in urban society: Even amongst well educated occupational. Rehabilitation can be defined as the and middle to higher socioeconomic group of combined and coordinated use of medical, social, individual's misconception and misapprehension educational and vocational measures for training and related to mental illness is quite prevalent. This leads to retraining the individual to the highest possible level of their negative, avoiding and sometimes actively functional ability. It includes all measures aimed at antagonistic behavior towards mentally ill individuals reducing the impact of disabling and handicapping and their families. They object to their presence in their conditions and enabling the disabled and handicapped midst citing reasons like disturbance to their daily to achieve social integration (WHO). Rehabilitation of routine and affecting their children and adversely! disability due to mental illness needs specific modes since social disability has its unique features. It can be Stigma and Myths at Primary Care Level: Stigma, or the managed well in the community with proper medical feeling of being negatively differentiated because of treatment and psychosocial rehabilitation. But always being affected by a particular condition or state, is there is a hitch in assessment of this kind of disability related to negative stereotyping and prejudicial since it has very unique features: It is not visible like attitudes. These in turn, lead to discriminatory practices physical disabilities (e.g. lack of motivation), that deprive the stigmatized person from legally experienced subjectively (e.g. hearing voices when recognized entitlements. In developing countries like alone), fluctuates (e.g. disability differs with duration India, beliefs about the nature of mental conditions and nature of symptoms), recurrent (e.g. disability often enmeshed with religious beliefs and cultural reoccurs with fresh episode of illness) etc. So, there is a determinants, tend to delay needed treatment by 2013 Indian Association for Social Psychiatry A17 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A17-A20 need to have skills of assessment for this area of explanation or hypothesis of how an individual comes disability because with proper and adequate to present with a certain disorder or circumstances at a knowledge the nature of disability any intervention of particular point in time that includes biological, rehabilitation will not be effective. Now social worker is psychological, social, cultural and systemic factors. It is a an integral part in multidisciplinary team in treatment key element in psychiatric evaluations, discharge and rehabilitation of persons with mental illness. Hence summary and prior authorizations for treatment. The it is very much necessary for them to acquire these skills presentation proposes to explore techniques of particularly for new professionals and trainees. This formulating psychiatric cases in an interactive manner.
workshop may be interesting for those courageous W5- ASSESSMENT AND MANAGEMENT STRATEGIES
young professional social workers who want to work in FOR REHABILITATION IN MENTAL ILLNESS USING THE
this field. The entire workshop will be enriched with DART MODEL
practical demonstration of various tools for FACILITATORS: BS Chavan, Subhash Das, Nitin Gupta,
assessment, case illustrations and usage of multimedia.
W3- ASSESSMENT AND MANAGEMENT OF LEARNING
The Department of Psychiatry, Government Medical College and Hospital-32, Chandigarh has been running FACILITATORS: Adarsh Kohli, Manju Mohanty
the "Disability Assessment, Rehabilitation and Triage Learning disorders are characterized by deficits in (DART)" services since December 2012 with the acquiring expected skills in reading, writing, spellings purpose of comprehensive rehabilitation of patients and arithmetic, compared with other children of same with mental illnesses. Under DART services, the age and criteria for intellectual capacity. Prevalence of following units have been set-up and operationalized learning disabilities range from 2-10% in school age viz. Neuropsychological Rehabilitation Unit, Social children. Usually learning disabled are not easily Skills Training Unit, Vocational Skills Training and differentiated from normal population. Learning Rehabilitation Unit, and Day Care Centre. The workshop disabilities if left undetected, result in poor academic shall focus on how to assess the suitability of patients performance, class detention or dropping out of school. for the purpose of rehabilitation, how to undertake a They also often lead to these children losing their self- esteem, withdrawn or aggressive behavior, anxiety, comprehensive management plan using case vignettes depression and at times even anti-social behaviors. and group-work.
Thus identification, assessment and management of IDENTIFIED OBJECTIVES: these children is a challenging task. The aim of this 1. To understand the various concepts linked with course is to impart skills, which would enable the rehabilitation in mental illness.
mental health professionals, parents and teachers to be able to identify learning disabled children and planning 2. To understand the various parameters/ appropriate remedial strategies. The course content will deal with the issues of methods of identification at determining the process of Rehabilitation pre-school, primary school and secondary school level. 3. To be able to evaluate the patient for possible The different methods of academic and behavioral assessments will be discussed. The focus of 4. To be able to determine the pathway of care for management will be on the methods of enhancing rehabilitation of a particular individual.
reading, comprehension, writing, spelling and arithmetic skills. Besides the issues pertaining to 5. To be able to determine the most appropriate associated psychosocial problems will also be taken up.
management strategy (or strategies) as regards rehabilitation of a particular individual.
W4- CASE FORMULATION IN PSYCHIATRY: A HOLISTIC
APPROACH
W6 - COPING WITH DOMESTIC VIOLENCE
FACILITATOR: Anindya Banerjee
FACILITATORS: Indira Sharma, Abhishek Pathak
Case formulation is a core skill in clinical psychiatry, Introduction of the topic followed by case vignettes of which helps in understanding the presenting problem cases. Participants will be divided into groups. Each and guiding individualized treatment. It is a provisional group will be allotted one case vignette. The group will 2013 Indian Association for Social Psychiatry A18 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A17-A20 be discussing possible coping methods for preventing developmental spectrum alone. New disorders are domestic violence. The prospects and consequences of being added to the current spectrum and it is seen that each method will be discussed. Finally one or more childhood is no longer immune to even significant coping method will be chosen. The group will make mental disorders like depression, psychosis, anxiety and their presentation. There will be discussion with the PTSD. The changing nature of social fabric has definitely made a huge contribution to the current pattern of childhood disorders. In this workshop we aim to W7-'HOW'S AND 'WHY'S' FOR FORMULATING A
elucidate the significant social contributors and also COMPREHENSIVE PLAN FOR EVALUATION AND
discuss the possible pathways of prevention and MANAGEMENT OF PATIENTS WITH SEVERE MENTAL
treatment.We have divided the theme under the following subheadings: [1] Childhood Depression and FACILITATORS: Mamta Sood, Nitin Gupta
Social Environment- we discuss the probable In psychiatry practice, about one third to half of the predisposing factors like parental discord, peer patients present with severe mental illnesses (SMIs) pressure, overstimulation, easy access to alcohol and depending upon the setting, notwithstanding the drugs etc. We outline the possible macro and micro- general population prevalence rate of SMIs being 1-2%. environmental ways to manipulate the social milieu and Therefore, it is imperative to understand how to highlight the necessary strategies for prevention and formulate a comprehensive plan for evaluation and treatment including early help-seeking behaviour. [2] management of patients with SMIs in routine clinical Juvenile Delinquency- crime has been steadily practice. The basic premise is that it should be done in increasing in the 15-18 year age group. Although a accordance with available cost-effective, evidence- minor by legal definition it is imperative that these based treatments focusing on the patient as a whole. young criminals are vigorously treated to prevent The diagnosis of SMI can be made based on assessment recidivism. We discuss the current juvenile delinquency of psychopathology but for holistic evaluation, the act, the limitations and ways in which the young patient needs to be assessed in the context of his/her criminals can be helped to lead a more normal life.The familial (environmental) and socio-cultural milieu. The workshop/symposium aims to bring the current impact of psychopathology on functioning of the research in front of the audience. International service patient, disability suffered and physical and psychiatric delivery models will be highlighted to identify the gaps co-morbidities should also be evaluated. In a similar and create innovative pathways for local service way, although the treatment with antipsychotics remain the backbone of management of patients with W9- PSYCHOTHERAPY FOR THE INDIAN SETTING: THE
SMIs, the comprehensive management plan should PROCESS OF ASSESSMENT AND CONDUCT OF
also address the environmental and socio-cultural INDIVIDUAL DYNAMIC PSYCHOTHERAPY
issues (arising out of evaluation) keeping in perspective FACILITATORS: VK Varma (USA), Nitin Gupta
the short term goals of improved psychopathology and treatment of co-morbidities and long term goals of BACKGROUND & NEED: "It is inevitable that cross- improved functioning and reduced disability. In this cultural differences . must be taken into account in workshop, the focus will be on identifying the ascertaining suitability of and in adapting pragmatics of the 'how' and 'why' related to making a psychotherapy for a particular culture (Varma, 1985)". comprehensive plan for evaluation and management of Traditional cultures, like those of South Asia, revolve patients with SMIs.
around primary support groups, like the family. As opposed to West, in the traditional societies of South W8- SECURING THE FUTURE- UNDERSTANDING THE
Asia, all relationships are multi-dimensional, sub IMPACT OF SOCIAL ENVIRONMENTAL CHANGES ON
serving a myriad of functions. The same applies to the CHILDREN'S MENTAL HEALTH
healer-patient relationship, the healer being a friend, FACILITATORS: Sanyogita Nadkarni, Soumitra Dutta
philosopher and guide, a wise person, a village elder, The last decade has seen a worldwide increase in the and a benevolent senior, as also a family member. His prevalence of childhood problems. In India too, there objective is to help in all possible ways, to total growth, has been a significant increase in childhood disorders. development and actualization, and not just in the Moreover, childhood disorders are not limited to narrow confines of the illness. 2013 Indian Association for Social Psychiatry A19 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A17-A20 Adapting psychotherapy for the traditional societies, IDENTIFIED OBJECTIVES :
such as that of India requires taking into account 1. To train mental health professionals in the practice differences in the socio-cultural and religious variables, of individual psychodynamically oriented such as, dependence versus autonomy, psychological sophistication, the introspective and verbal ability, the 2. To discuss the rationale for adapting Western- need for confidentiality, the nature of dyadic model psychotherapy for traditional societies, relationship, the personal responsibility in decision- taking into account socio-cultural variables making, the nature of guilt and shame, and the social distance between the patient and the healer. 3. To discuss the methodology of selection of cases Psychotherapy may accordingly be made more active, and assessment for psychotherapy open and direct, briefer, crisis-oriented, supportive and 4. To discuss the process of psychotherapy; from flexible, with greater activity on the part of the healer, symptoms to conflicts to defense mechanisms to and with the involvement of the larger family and social interpretation to working through matrix. It also needs to be tuned to and blend itself to 5. To illustrate the conduct of psychotherapy, giving the religious belief system. Furthermore, on account of case vignettes and using role-play involving the trained manpower constraints, expertise of professionals of various backgrounds may be utilized.
However, there is no model available for the practice of psychotherapy in India. The facilitators have identified various factors and processes that seem to be the key and extremely helpful in the conduct of psychotherapy in the Indian setting, and would like to share the same with the participants.
2013 Indian Association for Social Psychiatry A20 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 FREE PAPERS (ORAL)
THE ROLE OF A PSYCHIATRIC NURSE IN MANAGING
PHYSICAL HEALTH OF PATIENTS WITH SEVERE AND
National Institute of Behavioural Sciences, P7 CIT Road, ENDURING MENTAL ILLNESS: THE CHANDIGARH
Background: National Institute of Behavioural Sciences
Virtu Chongtham, BS Chavan (NIBS) has been working on for more than two years on Department of Psychiatry, Government Medical College the psychological profile of cancer patients - which is & Hospital-32, Chandigarh barely systematically studied before in this part of our country. Our study reveals that Indian society is In comparison to the general population, patients different than some of the western countries in dealing diagnosed with severe and enduring mental illnesses with cancer patients with possible devastating (SMI) have heightened risk for physical health outcome. Though Indian family and socio-cultural comorbidities (especially cardiovascular & metabolic structure are unique to provide support to the ailing disorders) & malignancies with reduced life expectancy. members of the family, feeling of helplessness also is This is further compounded by the high prevalence of evident leading to psychiatric vulnerability. As the metabolic side effects due to the use of psychotropic united or joint families still persist in areas, the medications (especially antipsychotics) as part of their caregivers are more in numbers and can usually take treatment. Literature points to the under/lack of turns. On the contrary, the community or welfare diagnosis and lack of management thereof thereby services are mostly scanty and unorganized in India. further contributing to high rates of morbidity and Aim: The aim of the present study is to understand how
mortality in this disadvantages population of patients the cancer patients in India identify and acknowledge with SMI. In the west, psychiatric nurses have taken on the family support as well as community support roles and work collaboratively in order to deliver system. Materials & Methods: Total 148 patients (Age
multidisciplinary-based comprehensive care. One of 18-60) having cancer diagnosed within the last one year such roles has been to ensure physical health had been studied. Patients were divided in two age monitoring and/or enabling patients with SMI to access groups (<30 yrs & >30 yrs) and gender wise also The test appropriate care for their physical health. Such batteries used were Duke Health Profile, Locus of initiatives and roles are still not clearly defined or Control, Socio-economic Status Scale, Perceived outlined in the Indian set-up where psychiatric nursing Support Inventory, Bells Adjustment Inventory and is still developing across various fronts, and is gradually Parental Sensitization Index. Results: Subjects who
becoming part of the multi-disciplinary set-up. The scored better significantly in social health and self- Department of Psychiatry, GMCH-32 has been running a esteem areas in Duke Health Profile reflected more community based outreach program for 12 patients satisfactory treatment outcome. Better parental with SMI undergoing respite care. For last 9 months, a sensitization indicated better mental health but social psychiatric nurse has been involved in the care with welfare was not perceived as an important factor for adoption of a comprehensive multidisciplinary treatment availability. Better home and social approach. The presenter will share her experiences and adjustments were reflected in treatment outcome. her integral role as a psychiatric nurse in the delivery of Locus of control was not related to treatment outcome care with special emphasis on the role of a psychiatric in general. Lower age group indicated different nurse in the education, management and monitoring of perceived support and outcome and females reflected physical health issues for patients with SMI.
better social support and adjustment. Conclusion:
SOCIAL SUPPORT AND MENTAL HEALTH PROFILE IN
Studies indicate that both family and community and CANCER PATIENTS: PROSPECTIVE ROLE OF SOME
welfare support are very much needed for oncology FACTORS ON TREATMENT MAINTENANCE
patients in western countries. On the contrary, present Kedar Ranjan Banerjee, Tanmoy Mitra, Jayanti study indicates that in a developing country like India, Bhattacharya, Akash Mahato, Madhumita Das, though family support is highly anticipated by cancer 2013 Indian Association for Social Psychiatry A21 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 patients, social welfare is not regarded as indispensable A STUDY ON INTERNET ADDICTION, DEPRESSION,
mainly due to either unavailability or inaccessibility.
ANXIETY AND STRESS AMONG HIGH SCHOOL
STUDENTS
DISCRIMINATION AND STIGMA AGAINST PATIENTS OF
MENTAL HEALTH AND RELATED PSYCHOSOCIAL
Department of Psychiatric Social Work, LGB Regional Kedar Ranjan Banerjee, Jayanti Bhattacharya, Tanmoy Institute of Mental Health, Tezpur Assam Mitra, Akash Mahato, Madhumita Das, Debabani Background: There have been growing concerns
worldwide for what has been labeled as "internet National Institute of Behavioural Sciences, P7 CIT Road, addiction." Research on internet addiction demonstrated that the greater use of the internet is associated with some social and psychological variables There has been a significant change in last decade in the such as, declines in the size of social circle, depression, area of mental health treatment. But the much needed loneliness, low self-esteem and life satisfaction and low approach in awareness of understanding the mental family functioning. Aim of the study: The present study
health problems is yet to be determined. Aim: To
will investigate the extent of internet addiction in High identify lacunae in our socio-legal infrastructure that school students and to examine the relationships creates a risk for individual with mental disorder and between internet addiction, depression, anxiety, and associated others. Method: Case study. Observation:
stress. Methodology: The present study will be a cross
Tania, a 17 year old suffered a manic episode with sectional survey using stratified random sampling psychotic symptoms following the rigours of her board technique. The participant will be randomly selected exams. She was sexually disinhibited and claimed to be from high school of Tezpur, Assam and in Ranchi, pregnant. Her family believed that she had tainted the Jharkhand. A total of two hundred (Hundred high family's honor and physically chastised her. They school students each from Tezpur and Ranchi) sample believed her male tutor to be the culprit and seriously will be randomly selected in the age range of 16-18 assaulted him despite his pleas of innocence. The family years for the present study. Socio demographic sheet, even contemplated suicide en-masse to escape a life of the online cognition scale (OCS) and the depression shame. They eventually consulted a psychiatrist and anxiety stress scale (DASS) will be administered. Results Tania recovered with treatment. She denied any sexual will be discuss in floor.
liaisons with her tutor. She recalled that she had seen images of nude males on her maternal uncle's laptop HOME BASED PSYCHOSOCIAL REHABILITATION
which had probably influenced her disinhibited SERVICES TO IMPROVE SOCIO-OCCUPATIONAL
sexualized behavior. The family relocated to a different FUNCTIONS AND DISABILITY IN PERSONS WITH
city to escape scrutiny. Tania's maternal uncle denied possession of porn images and insisted that he was Kamlesh Kumar Sahu determined to lead a celibate life. The uncle's insisted Department of Psychiatric Social Work, Institute of that the tutor had several porn films on the latter's Psychiatry, IPGME&R, SSKM Hospital, 7 D.L. Khan Road, laptop. The uncle himself sought psychiatric help for anxiety disorder. Discussion: Who is to blame? For the
stress that caused a 17 years old to become psychotic ?
Aim: To improve socio-occupational functions and
For the atrocities meted out to a psychotic girl and an disability in persons with major mental illness (PWMI). innocent man by the people ignorant of mental health Methods: 70 samples were taken from ongoing
problems ? For the near suicidal decision of a family ? psychosocial services in Department of Psychiatric For a suspected closet homosexual's reluctance to Social Work, Institute of Psychiatry, Kolkata. PWMI come to terms with his own personality? And tendency diagnosed with any major mental illness of either sex to displace blame onto an innocent other ? How may we between 18 – 50 years of age without any comorbidity remedy this ? The relevant points will be discussed. were enrolled with their consent. For psychosocial rehabilitation (PSR) were tailored to meet individuals' needs; components from case management and assertive community treatment were adopted along with social case work techniques. The intervention 2013 Indian Association for Social Psychiatry A22 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 plans were executed through partnership with family depression or less emotional intelligence expressed members of PWMI. Pre and post assessments were more suicidal ideation. There were no significant done using Socio Occupational Functioning Scale and difference in suicidal ideation among male and female. Indian Disability and Assessment Scale and analyzed to Result also indicates that depression, emotional compare the level of socio-occupational functions and intelligence, neurotic and psychotic personality disability. Qualitative measures such as feed back from predisposition contribute significantly to suicidal the service users and their family members and in depth ideations and predicted 30.5% of the variance. interviews and observation were also considered to WHY PSYCHOTHERAPY NEVER PICKED UP IN INDIA?
supplement the quantative one in order to know the clear picture of the outcome. Results: Preliminary
findings were quite exciting when majority of PWMI shown improvement in their socio-occupational Consultant Psychiatrist, Mental Health Care functioning and disability. Conclusions: It is eminently Centre,Burdwan, West Bengal feasible to start a wide spectrum of home based India as a nation has always been interested in matters psychosocial rehabilitation service programmes of mind. In fact volumes of ancient Indian writings are particularly in rural areas. Feasible and sustainable dedicated to the understanding of human mind. Why could be ensured to evolve families as a partner of care.
then psychotherapy, which is a healing art through SUICIDAL IDEATION IN UNDER GRADUATE COLLEGE
talking, never gained popularity in India. Psychiatry that STUDENTS IN KOLKATA: SOME PSYCHOLOGICAL
we practice in India, is completely an imposed western model based discipline. Whatever is medicine and technology based is easy to match. But talk therapy Soma Sahu1*, Sadhan Dasgupta2, Kamlesh Kumar which is completely culture specific cannot be simply copied from other culture. Indian mind is different as is 1Department of Psychology, Bangabasi College, mind of any other culture. First let us forget all western Kolkata; 2Department of Applied Psychology, Calcutta models of talk therapy and build up a model which is University, Kolkata; 3Department of Psychiatric Social typically Indian. Because we train people in alien Work, Institute of Psychiatry, Kolkata models, we do not develop into good therapists barring Aim & Objectives: To study the nature and extent of
few who can adapt. And then you need formal training suicidal ideation and its relationship with personality of psychologists in more number who can take up talk traits, emotional intelligence and level of depression therapy as their career. In India Psychiatrists are so few among college students in Kolkata and to assess the in number that they will never have so much time for predictability of afore said variables for suicidal separates talk therapy sessions. On the other hand ideation. Methodology: Undergraduate students from
whole lot of people who study psychology till 10 colleges from Kolkata having age of 18 years or more universities go wasted serving in some administrative or were selected for the present study with their written clerical job, who could have been jolly well trained into consent. Students with any major mental /physical clinical psychologists serving society as talk therapists. illness and history of major hospitalization in last two Equally important is to have proper licensing authority years were excluded. Students who already attempted who will decide who all can practice talk therapy.
suicide, having family history of suicide attempt or ASSESSMENT OF SOMATIC SYMPTOMS AMONG
suicide were also excluded from the study. 400 (equal SCHOOL GOING CHILDREN: A STUDY FROM NORTH
from both sexes) criteria based sampling method was EAST INDIA
used and assessed cross-sectionally using: Socio- Suman Borah, Arif Ali demographic and Clinical Datasheet, Eysenck Personality Questionnaire (Eysenck and Eysenck, 1975), Department of Psychiatric Social Work, LGB Regional Emotional Intelligence Test (Chadha and Singh, 2001), Institute of Mental Health, Tezpur Assam Adult Suicidal Ideation Questionnaire (Reynolds, 1987) Introduction: Somatic symptoms are commonly
and Beck Depression Inventory - II (Beck et al, 1996). reported among young children. The burden of such Result & Conclusion: Results indicate that students
symptoms on both young children and health services is have either psychoticism or neurotic personality traits substantial. Research indicates that somatic symptoms having more suicidal ideation. Students having more could impose limitations on social function and 2013 Indian Association for Social Psychiatry A23 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 participation in school life. Aim: To assess somatic Questionnaire. Independent correlates were symptoms among school going children. Methodology: determined using logistic regression models. The level The study will be conducted in three English medium of statistical significance was kept at p< .05 for all the high schools under Tezpur Municipal area. The study tests. Results: A total of 2454 adolescents completed
will be a descriptive study using random sampling the study. About 40.9% reported use of any substance technique. The sample included 300 students of class 7 during the past 12 months, mostly alcohol. Family to 10th of Tezpur, Assam. Socio demographic sheet and factors like single-parent households and parental Children's Somatization Inventory (CSI) and The Duke alcohol/substance use were all independently Health Profile (DUKE) will be administered to the associated with substance use. Factors that showed subject's. Results will be discuss on floor significant independent association with any substance use are family factors like living with a single ROLE OF FAMILY FACTORS IN SUBSTANCE USE AMONG
parent/non-parent caregiver; having fewer numbers of ADOLESCENTS ACROSS SEVEN COUNTRIES
siblings, lower maternal education and unemployment, Yatan Pal Singh Balhara1, Olayinka Atilola2,3, Dejan and parental alcohol or substance use. Adolescents of Stevanovic4, Mohamad Avicenna5, Hasan Kandemir6, mothers who drink alcohol were independently Rajna Knez7, Petar Petrov8, Panos Vostanis9 1Department of Psychiatry, All India Institute of Medical alcohol/substance use. Conclusions: The modifiable
Sciences, Ansari Nagar, New Delhi, India; 2Department family related risk factors need to be explored and of Psychiatry, University College Hospital Ibadan, followed by appropriate intervention strategies.
Ibadan Nigeria; 2Department of Behavioural Medicine, COMPARISON OF CAUSES OF DOMESTIC VIOLENCE IN
College of Medicine, Lagos State University, Lagos MARRIED WOMEN WITH MENTAL ILLNESS & PHYSICAL
Nigeria; 4Department of Psychiatry, General Hospital Sombor, Sombor Serbia; 5Faculty of Psychology, State Jyoti Srivastava*, Indira Sharma**, Anuradha Islamic University Syarif Hidayatullah, Jakarta, Indonesia; 6Department of Child and Adolescents psychiatry, Harran University, Sanliurfa, Turkey; Ph.D Scholar, Institute of Medical Sciences, Banaras 7Department of psychiatry, University Hospital Centre Hindu University, Varanasi (IMS, BHU); Department of Rijeka, Croatia; 8Department of Child and Adolescent Psychiatry IMS,BHU; Department of Obtetrics & Psychiatry, University Hospital St. Marina, Varna, Gynaecology. IMS, BHU Bulgaria; 9School of Psychology, Leicester University, Background: Domestic violence against women is the
United Kingdom most pervasive human rights violation in the world Aims and Objectives: To assess role of family related
today. Violation not only causes physical injury, it also risk factors for alcohol/substance use and abuse among undermines the social, economic, psychological, a cohort of school-going adolescents from seven spiritual and emotional well being of the victim, the countries (India, Indonesia, Nigeria, Serbia, Turkey, perpetrator and the society as a whole. However, there Bulgaria and Croatia). Methodology: The study was
is limited data on its cause especially in developing conducted under the auspices of the International Child countries. Objective: To assess the magnitude and
Mental Health Study Group (ICMH-SG), a non-profit pattern of domestic violence in woman. To compare the research-oriented organization of child and causes of domestic violence with mental illness & adolescent's psychiatrists, psychologists, and other physical illness. Material & Methods: The sample of
mental health practitioners from undeveloped and study comprised of 30 women with mental illness and developing countries. The group was formed at the 30 women with physical illness. Mental illness patient occasion of the Excellence in Child Mental Health diagnosed according to with Axis one psychiatric conference held in Istanbul Turkey in November 2011. Disorder DSM IV-TR, who were selected from the Participants were sampled from town/cities in the Psychiatry OPD of the S.S. Hospital, BHU and physical seven countries based on the convenience of the illness patient suffering from mild to moderate physical researchers. Alcohol and substance use, including illness as per ICD 10 (WHO), were be selected from the problematic/hazardous use (abuse), was measured Obstetrics and Gynecology Department of S.S Hospital. using the CRAFFT instrument. Aspects of mental health The patients were assessed on the structured were measured using the Strength and Difficulty questionnaire on Domestic Violence. Results: Domestic
2013 Indian Association for Social Psychiatry A24 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 violence was significantly higher amongst the mental & this knowledge would prevent them from attempting physical illness women of educated up to suicide in future. Conclusions: Most suicide attempters
graduation/post graduation and house maker women. are not aware of the legal status of suicide attempt in The study found out the overall domestic violence in India and majority felt that it may act as a deterrent.
mental & physical illness group was 83.3% & 50%. The NURSING STUDENTS' ATTITUDE TOWARDS SUICIDE
prevalence of verbal violence was 21% in mental illness ATTEMPTERS: A STUDY FROM RURAL PART OF
and 8% in physical illness, economical violence was 17% & 6%, physical violence was 21% and 3% and sexual Naresh Nebhinani1, Mamta2, L Tamphasana3, Achla D violence was 10% in mental illness. The main etiological factors of domestic violence in mental illness were 66.7% of participants unable to perform domestic 1Department of Psychiatry, All India Institute of Medical chores and 33.3% husband has low frustration Science, Jodhpur, Rajasthan; 2Silver Oaks College of tolerance by nature in physical illness which is causing Nursing, Mohali, Punjab; 3 Dr Syamala Reddy College of violence so they were becoming the victim of domestic Nursing, Bangalore; 4 National Institute of Mental violence. It was observed that domestic violence was Health & Neurosciences, Bangalore greater in mental illness as compared to physical illness.
Aims and objectives: Majority of health professionals
EXPLORING AWARENESS ABOUT LEGAL STATUS ON
have unfavorable attitudes towards patients presenting SUICIDE ATTEMPT IN INDIA AMONG SUICIDE
with self-harm, which further compromises their willingness and outcome of care. This study was aimed to assess the nursing students' attitudes toward suicide Aniruddha Mukherjee,1 Shivanand Katttimani,2 attempters. Methodology: Cross-sectional study was
conducted in two nursing colleges of North India. 308 1Department of Psychaitry, B. S. Medical College, nursing students were recruited through total Bankura, West Bengal; 2Department of Psychiatry, enumeration method from May–June 2012. 'Suicide opinion questionnaire' was administered to assess their Aim and Objectives: To assess for presence of
attitudes towards suicide attempters. Descriptive awareness about legal status on suicide attempt in India statistics was employed with SPSS version 14.0 for and collect views on its effect on suicide attempt among Windows. Results: Majority were single females, from
suicide attempters seen in a general hospital setting. urban locality, with the mean age of 20 years. Only Methodology: Medically stabilized suicide attempters
minority had previous exposure to suicide prevention attending Crisis Intervention Clinic of JIPMER (January- programmes and management of such cases. Majority December 2012), were interviewed about their suicide of students agreed for mental illness, disturbed family attempt from legal perspective on four aspects: life, and depression as major push to attempt suicide. Whether they knew about existing legal status of They held favorable attitude for half of the attitudinal suicide attempt before this current suicide attempt? If statement, but they were uncertain for rest half of the not, whether knowing the legal status would have statements. Conclusions: They generally had favorable
prevented this current suicide attempt? And after attitude towards suicide attempters. Their uncertain informing about the legal status to those who were not response highlights the need for enhancing educational aware, were asked further two questions: Will exposure of nursing students and new staff at the knowledge about legal status prevent them from future earliest opportunity, to carve their favorable attitude suicide attempt? Will knowledge about legal status if towards patients presenting with self-harm. made wide spread to everyone, prevent everyone from EFFICACY OF ATTENTION TRAINING FOR CHILDREN
attempting suicide? Results: There were total 129
WITH ADHD
subjects. Mean age was 27 years, 45 % were females, Susmita Halder*, Rima Mukherjee** 78.5 % were from rural area, years spent in education ranged from 0-15, majority belonged to nuclear families *Consultant Clinical Psychologist, Fortis Hospital, and 55.8 % were employed. Nearly half of the subjects Kolkata; **Consultant Psychiatrist, Kolkata were not aware of the legal status of suicide attempt. Attention Deficit Hyperactivity Disorder (ADHD) is one 72.1 % felt that this knowledge would prevent others of the most common neurobehavioral disorders of from attempting suicide. However 55.8 % thought that childhood. Children with ADHD have problems with 2013 Indian Association for Social Psychiatry A25 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 attention span and tend to be very easily distracted. vegetative existence.Homeless persons and families are They specifically have difficulty in paying, and an increasing but marginalized part of societies; they maintaining attention over prolonged periods of time, have diverse and complex needs that have often not along with difficulty in focusing and screening the been addressed by the available services. In order to stimulus presented in their surrounding environment. give, proper care, protection to persons with mental Consequently, their behavior is inattentive, impulsive illness and provide them rehabilitation services, the and hyperactive. Effective intervention may improve state Commissioner for the differently abled has come their attention span over time, which lead them to be out with a novel initiative to estabilise rehabilitation more productive in school and at home. Aim &
homes for the persons with mental illness in various objective: The present study aims to find out the
Districts in Tamil Nadu with the support of NGOs and efficacy of a 12- week attention training program for assistance by the Govt.of Tamil Nadu. Aim: To study
children with ADHD, aged 6- 10 years, to improve and understand the various barriers towards attention span of these children. Methodology: Total 5
reintegrating the persons with mental illness, after children, 3 males, 2 females were selected for the study availing psychosocial rehabilitations training following purposive sampling technique, from Clinics in programmes. Method: Persons with Mental illness got
Kolkata. Before training program, parents completed admitted through rescue and rehabilitation scheme ADHD – SC4 Checklist to assess severity of the problem. since Nov.2010 were taken as the universe for this There was no marked difference in baseline study. A total of 30 persons with mental illness (both assessment. After diagnostic and baseline assessment sex) were selected through simple random sampling including the cognitive functions; training was delivered method. They were assessed for their level of in individual session. Training program included training symptoms before and after by administering a tool on on sustained, selective, alternative, and divided Global Assessment of Functioning (GAF) (Endicott, attention. Participants completed an outcome Fleiss & Cohen, 1976). The data was analyzed by using evaluation after 12 weeks of training program. Results
the appropriate statistical tests. Findings: Various
& Conclusion: Results show there was improvement in
rehabilitation interventions given to the persons with attention and reduction in scores of severity in mental illness have shown in reduction of symptoms. attention scale in post assessment. Present study shows An attempt has been made to list the barriers faced by evidence for the efficacy of attention training for the persons concerned, family members and others children with ADHD to improve attention span.
while reintegrating the Persons with Mental Illness in the society. Further the authors have suggested the BARRIERS IN REINTEGRATING PERSONS WITH MENTAL
remedial measures to overcome the barriers at length ILLNESS, AVAILING REHABILITATION TRAINING AT
in the paper.
STATE RUN REHABILITATION HOME
SELF STIGMA AND SELF ESTEEM AMONG PERSON
Dr.C.Ramasubramanian, M.Kannan, K.Vigneshvaran, WITH SCHIZOPHRENIA ATTENDING PSYCHIATRIC
M.S. Chellamuthu Trust and Research Foundation, Debashree Bora, SP Deuri Department of Psychiatric Social Work, LGB Regional Introduction: Nearly 70 percent of the Mentally Ill
Institute of Mental Health, Tezpur Assam Citizens of this community live in their family. The affected persons are rendered Homeless when their Aim: The study aims to assess and examine self stigma
primary caregivers are no longer alive. So the physical and self esteem among person with schizophrenia absence of a home coincides with the physical attending rehabilitation centre. Methodology: The
phenomenon are taken into the street. Other present study is a cross sectional study. The sample will circumstances which also renders the persons be drawn using purposive sampling from Centre of homeless when the primary caregiver starts ageing and Rehabilitation Science, LGB Regional Institute of Mental their physical energy, to take care of the mentally ill, Health (LGBRIMH), Tezpur, Assam. Sixty persons with deteriorates and sheer physical incapacity to provide diagnosis of schizophrenia (30 person with care often leads these persons continue to live in the schizophrenia attending rehabilitation centre and 30 street with virtually no social support or sense of self person with schizophrenia those who are not attending care or protection and so they deteriorate further into rehabilitation centre) will be included in the study 2013 Indian Association for Social Psychiatry A26 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 .Socio demographic data sheet ,Internalized stigma of effect of substance dependence on the Quality of life of mental illness scale ,self esteem inventory and Brief substance dependence subjects in DDTC , PGIMER, Psychiatry Rating scale (BPRS )will be applied to all Chandigarh. A standardized tool "WHO QOL BREF" was participants. Results: The results will be discussed on
used to collect data. We had taken subjects from DDTC the floor of house.
WARD and OPD. The sample size consisted of 50 subjects. The results of the study revealed that most of STUDY OF PSYCHIATRIC COMORBIDITY AND
the subjects 24(48%) were rating their quality of life as PSYCHOSOCIAL STRESS FACTORS IN PATIENTS
neither poor nor good, 19(38%) were neither satisfied nor dissatisfied with their general health, experienced a Soumya Chatterjee, Maithili Kadam, VP Kale lot of pain 23(46%) that effected their daily work, felt Department of Psychiatry, GRANT MEDICAL COLLEGE & the need of medical treatment 20(40%) for doing their SIR J.J.GROUP OF HOSPITAL, MUMBAI daily living activities, had adequate/sufficient energy for daily life, were satisfied with their sleep 18(36%),19 Aims and Objectives: [1] To study prevalence of
(38%) were satisfied with their ability to perform their psychiatric comorbidity in patients attempting suicide. daily work, 20(40%) were satisfied with their work [2] To assess psychosocial stress factors in those capacity. The psychological health of substance patients. Materials and Methods: 100 consecutive
dependent subjects was as follows most of the subjects patients with alleged history of attempting suicide 16(32%) were enjoying their life in moderate amount, being referred in the Psychiatric Department of a 24(48%) were rating their life to be very meaningful, tertiary care Hospital were selected during March 15(30%) had moderate amount of ability to concentrate –December 2012. Critically ill patients and patients on their work,15 (30%) were very accepting of their without any reliable relatives were exempted from the bodily appearance, 20 (40%) were neither satisfied nor dissatisfied with their abilities, 22(44%) rarely had Assessment was based on a semi-structural Performa negative feelings. Regarding social health of substance including DSM IV –TR, Beck's suicide intent scale, dependent subjects it was seen that 24(48%) were presumptive stressful life events' scale. Results and
satisfied with their personal relationships, 15 (30%) discussion: Majority were found female 66%, single
were satisfied with their sex life, 14 (28%) were very mostly from upper lower socio economic class dissatisfied with support from their friends. The .According to the DSM IV Criteria- 32% were diagnosed environmental health of substance dependent subjects with substance consumption followed by adjustment it was observed that most of the subjects 22(44%) felt disorder (17%), depression (16%) , personality disorder very much safe in their daily life, 27(54%) felt their (16%) and schizophrenia (7%).Mean value of total physical environment was very much healthy, 14(28%) suicide intent was 20.75.Commonly used methods of had moderate amount of money for fulfilment of needs, self-harm were self-poisoning followed by self-cutting. 15(30%) had sufficient availability of information which Mean value of stressful life events in last 1 yr was 2.02 they had need in their daily life, 16(32%) had complete and 6.39 in life time. Conclusion: Parasuicide was found
opportunity for leisure activity, 25(50%) were satisfied among low age group population ( below 30 yrs ) with with their living condition and 23(46%) were satisfied low suicide intent where substance dependence and with access to health services.
personality disorder prevails compare to medium to SHAME & STIGMA OF MENTAL ILLNESS
high suicide intent with more severe psychiatric comorbidity in elder subjects.
AN EXPLORATORY STUDY TO ASSESS THE EFFECT OF
N.I.N.E., PGIMER, Chandigarh SUBSTANCE DEPENDENCE ON THE QUALITY OF LIFE OF
Background: The mental illness is a major cause of
PATIENTS IN DDTC, PGIMER, CHANDIGARH, 2012-2013
disability. The suffering of a person with mental illness is Amandeep Kaur, Amadeep Kaur, Amita, Karobi Das, enormous. However, the shame, stigma and RenuSharma, D Basu* discrimination towards mentally ill further add on to this suffering. This stigma is prevalent in all sections of N.I.N.E. and *Department of Psychiatry, PGIMER, society including the mental health professionals. Aim:
The current study aimed to investigate the attitudes of This exploratory study was conducted to assess the nursing students towards mental illness & associated 2013 Indian Association for Social Psychiatry A27 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 shame and stigma. Methodology: The cross sectional behavior of the child in 80.59 %. Impulsive behavior was approach was used in current study. A total of 87 considered to have a significant impact by parents i.e., nursing students enrolled in Bachelors of Nursing in 79.10%, rrelationships among the parents was Science degree currently in 3rd year of their course affected in 77.61 %, increased fatigue due to care was in were included as study participants using the purposive 77.61%, infrequent injuries were reported to have an sampling technique. The assessment measures were impact on families 62.68%. Conclusions: There is a huge
the socio-demographic profile sheet and a 35 item need for more research into ADHD especially on its standardized scale given by Gilbert to assess attitudes impact on the patient and their families and effective towards mental illness. Results: The findings of the
treatment strategies to manage the same in order to study revealed the attitudes towards mental illness on improve the overall quality of life of these families. following subscales: Attitude towards mental illness in A CASE CONTROL STUDY ON THE QUALITY OF LIFE OF
general, the external shame, the internal shame & the SUBJECTS WITH ALCOHOL AND OPIOID DEPENDENCE
reflected shame, with community as well as family as frame of reference. The highest mean scores were Bichitra Nanda Patra, Siddharth Sarkar, Debashis Basu, obtained in subscale of reflected shame with respect to Surendra K. Mattoo family followed by external shame with respect to community, with the mean scores of 7.6 & 6.6 Drug De-addiction and Treatment Centre, Department respectively. Conclusion: The mental health
of Psychiatry, Postgraduate Institute of Medical professionals are themselves prejudiced and Education and Research (PGIMER), Chandigarh. unconsciously harboring the stigma and discrimination Aims and Objectives: To assess the quality of life in
towards mentally ill, hence, it is recommended to opioid and alcohol dependent subjects attending a reorient the education system in such a way that while tertiary care de-addiction centre in India. learning core psychiatry, the issues like shame and Methodology: Patients were recruited from the
stigma are also effectively dealt with. outpatient clinic of Drug De-addiction and Treatment A STUDY OF IMPACT OF ATTENTION DEFICIT
Center, Department of Psychiatry, PGIMER, Chandigarh. HYPERACTIVITY DISORDER (ADHD) AND ITS
Controls were healthy volunteers. The severity of COMORBIDITIES ON FAMILY
substance dependence was calculated by using Drug Abuse Screening Test, Severity of Alcohol Dependence Suresh Yadav, Vivek Agarwal, Amit Arya, Pawan Kumar Questionnaire. The quality of life (QOL) assessment was done with World Health Organization-QOL – Bref, Hindi King George's Medical University, Lucknow version (WHO-QOL-Bref). Results: There were
Children with attention deficit hyperactivity disorder significant differences in age, employment status and (ADHD) experience difficulties and impairments in marital status between the alcohol dependent, opioid various domains of life including academic difficulties, dependent and control group. There was significant social skills problems, strained family relationships and difference in duration of substance dependence functioning. Aim: To study the impact of ADHD and its
between alcohol and opioid dependent group. There comorbidities on family in the patients attending the were significant differences in total quality of life score outpatient clinic. Methodology: The study sample
and in the domain of physical health, psychological consisted of old and newly registered subjects between health, environment score between the study and the the age group of 06 to 16 years who fulfilled the DSM- control group. Conclusion: There is poorer quality of life
IV-TR criteria for ADHD. The study subjects were in subjects with alcohol and opioid dependence than subjected to a detailed evaluation on the Kiddie- the healthy control groups. Therefore, the aim of Schedule for Affective Disorders and Schizophrenia- treatment of substance use disorder should also focus Present and Lifetime version (K-SADS-PL) for ADHD and on the improvement in quality of life of the subjects comorbid psychiatric disorders. A questionaire for seeking treatment. assessing the impact of ADHD was administered and
results evaluated. Results: Problems at school was most
reported by 92.54 % , worry for the future of the child
was reported by 89.55%, problems in interaction with
relatives in 83.58% and problems in society due to
2013 Indian Association for Social Psychiatry A28 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 A STUDY ON TEMPERAMENTAL TRAITS OF CHILDREN
underprivileged children in India as depicted by Child OF COMMERCIAL SEX WORKER'S
Rights and You (CRY) is disappointing. Although there are many activities focusing on the CSWs, but there are Shahid E *, Som DM**, Mamta S**, Arif A*** not many for their children's. The children need formal *Department of Psychiatric Social Work, RINPAS, Kanke; and non-formal health and life skill education (Pal et al. **Department of Psychiatric Social Work, CIP, Kanke; 2011). It is a need of the hour to draw attention to them ***Assistant Professor, Department of Psychiatric with care and concern. This study is an effort to explore Social Work, LGBRIMH, Assam the needs of the children of CSWs on the basis of their Background: The 1989 United Nations Charter
present health and psychosocial status. Method and
guarantees every child the right of survival, protection, Materials: A community based crossed sectional study
development and participation. But to whom and how was conducted at Sonagachi red light area in the month will the children of commercial sex workers (CSWs) of August and September 2012. Aim of the study was to demand this? Their isolation from society, ignorance assess the anxiety, depression and psychosocial issues and lack of awareness are often the cause of their faced by the children of commercial sex worker. Semi predicaments. The situation of underprivileged structured interview schedule was developed to collect children in India as depicted by Child Rights and You socio demographic details and special focus was given (CRY) is disappointing. Children of CSWs constitute 5.3 to explore to psychosocial issues. Depression and million in number and between 5 and 18 years of age. Anxiety in Youth Scale (DAYS) was used to assess They form 40% of the total population of CSWs in India. depression and anxiety symptom. Result will be
About 80% are found in the five metros, 71% of them discussed during presentation. are illiterate and 500,000 are forced to enter this trade THE COMPARATIVE STUDY BETWEEN THE COGNITIVE
every year. This study is an effort to explore the needs of DEVELOPMENT IN THE PRE SCHOOL IN ANGANWARI
the children of CSWs on the basis of their OF RAJASTHAN VS MAORI PRE SCHOOL STUDENT OF
temperamental traits and psychosocial status. Method
WANGANUI NEW ZEALAND
and Materials: A community based crossed sectional
study was conducted at Sonagachi red light area. Aim of the study was to assess the psychological wellbeing and Consultant NIPCCD, New Delhi behaviour of the children of commercial sex worker. The study was conducted in the anganwari in rajasthan Semi structured interview schedule was developed to were the tribal children were taken in the age group 3-6 collect socio demographic details and special focus was years male and female The children of Wanganui Maori given to explore to psychosocial behaviour, and Child of New Zealand were taken in the age group 3-6 years; Behaviour Checklist (CBCL- Youth Self Report) was used both male and females. The children were given CLCT to assess temperamental traits. Result will be discussed
test. Six areas were tested. They were- conceptual skills, during presentation. information, comprehension ,visual perception ANXIETY, DEPRESSION AND PSYCHOSOCIAL ISSUES OF
memory and object vocabulary. The result shown in CHILDREN OF COMMERCIAL SEX WORKERS
these test in Rajasthan boys and Maori boys showed difference and same was the case with the girls. The full Som DM, Shahid E*, Mamta S3 results will be presented Department of Psychiatric Social Work, CIP, Kanke; TRANQUILIZING STIGMA: IDENTIFYING INDIVIDUAL
Department of Psychiatric Social Work, RINPAS, Kanke INTERVENTIONS FOR EMPOWERING PEOPLE WITH
Background: Every child has the right to a healthy and
happy childhood and to become a complete person. Santosh Loganathan*, R SrinivasaMurthy** Unfortunately an evil spirit of the West Bengal society invites women to live in a "hell hole" where they are *National Institute of Mental Health and Neurosciences generally looked as hapless victims and labeled (NIMHANS), Bangalore; **Association for the Mentally commercial sex workers. Children of the commercial sex workers (CSWs) are at the receiving end of this Aims and Objectives: Stigma associated with mental
scenario and society forces them to inherit the stigma illness is as old as civilization itself and continues to that is attached to the profession of their mother plague the lives of those suffering from mental illness. (Pardeshi G et al. 2006). The situation of The stigma experiences are universal, but need to be 2013 Indian Association for Social Psychiatry A29 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A21-A30 understood within the socio-cultural context. Specific stigma experiences. Results: PWS (People with
interventions targeting the individuals to deal or schizophrenia) described being teased, ridiculed and address the stigmatizing experiences are negligible in being labeled for life. Experiences of status loss, India. This study was undertaken in order to understand discrimination, anticipated discrimination and the the subjective experiences and possible implications for dilemma of whether to conceal ones illness or to reveal anti-stigma interventions for empowering individuals it were also common. Suffering from the label more experiencing stigma. Methodology: We conducted a
than the illness with distressing emotional responses qualitative study using semi-structured interviews was common. Many more unanswered questions that among 200 patients attending urban and rural left individuals clueless were also observed. psychiatry clinics. By using thematic content analysis we Conclusion: It is thus the need of the hour to conceive
identified themes that could possibly have implications and develop an integrated, individualized, tailor-made for anti-stigma interventions targeting individuals with therapy/ therapies for PWS.
2013 Indian Association for Social Psychiatry A30 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 FREE PAPERS (POSTERS)
REDUCING STRESS OF THE CAREGIVERS WITH
change of attitude and its impact on the wellbeing of Aarthi, Karobi Das, LN Yaddanapudi, Ashutosh Aggarwal knowledge about alcoholism and information about National Institute of Nursing Education, PGIMER, usual behaviour elicited by the care-givers of alcohol- dependent patients. Counselling aimed at addressing "In times of stress, the best thing we can do for each the care-giver issues influencing their attitude towards other is to listen with our ears and our hearts and to be alcoholism and clarifying queries if any, using dialectical assured that our questions are just as important as our approach.This study was a one group Pretest- Posttest answers." Keeping this in mind a quasi experimental Study. A sample of 50 alcohol dependent patients was study was conducted on patients' caregivers who were selected using Purposive Sampling technique from Drug admitted in selected ICU's of Nehru Hospital, PGIMER, De-Addiction & Treatment Centre, PGIMER, Chandigarh during the year 2013-14. The objective of Chandigarh. Conceptual framework of the study was the study was to assess the effect of the Psychological based on I-change Model/ Integrated Model by De intervention on the stress level of the caregivers. The Veries (2008). 'Socio-demographic sheet', 'Scale for Modified caregiver strain index and Life event scale ( Attitude towards Drinking and Alcoholism' and 'WHO's Holmes and Rahe, 1967) was used to measure stress of Subjective Well-being Inventory'were employed to the caregivers. 30 subjects were taken under each ascertain the objectives of study. A five days group from selected ICU's. Post test was taken after intervention was given to the study sample in the form implementing psychological intervention using of 'Bibliotherapy with Counseling', consisted of three Modified caregiver strain index. Psychological sessions of 45 min. each on 3 alternate days (i.e. Day 1, 3 intervention which was planned for four consecutive & 5). The results of the study, to reveal whether the days, and conducted within 24 hours of admission of intervention was effective or not will be discussed.
the patient in selected ICU's. The psychological PERCEPTIONS ABOUT ANXIETY, DEPRESSION AND
intervention includes the aspects which will help the SOMATIZATION IN GENERAL MEDICAL SETTINGS: A
caregivers to understand the feelings associated with event and explore the coping methods to reduce stress. A Kuruvillla. KS Jacob Also various alternatives were also discussed with the caregivers. Department of Psychiatry, Christian Medical College,Vellore 'BIBLIOTHERAPY WITH COUNSELLING' – AN
INTERVENTION TO CHANGE ATTITUDE & WELL-BEING
Background: The recognition rates of anxiety and
OF CARE GIVERS OF ALCOHOL DEPENDENT PATIENTS
depression in general medical settings, despite the significant prevalence of such presentations, are low. Rajwinder Kaur, Sandhya Ghai, Debashish Basu Psychiatrists argue that the recognition and National Institute of Nursing Education, PGIMER, management of these conditions by physicians is less than optimal in primary care and general practice. We Although the consumption of alcoholic beverages are did this study to gain insights into physicians' commonly seen in both man's leisure and business perspectives on anxiety, depression and somatization, hours, however, evidence suggests that public attitudes the conceptual models they employ and the practical toward the alcoholic still remain ambivalent and problems they face in managing such patients in fractured. The attitude of care-givers is of particular general medical settings. Methods: Focus group
importance because they deal directly with the discussions (FGDs) were conducted with family and alcoholic, which significantly affect their health as well primary care physicians. The FGDs for physicians were as of alcoholic. The aim of the present study was to tape recorded and transcribed, verbatim. The views of assess the effect of 'Bibliotherapy with Counseling' on psychiatrists working in liaison clinics were also 2013 Indian Association for Social Psychiatry A31 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 ascertained. Results: Family and primary physicians
NEEDS OF PATIENTS WITH SCHIZOPHRENIA
admitted to a high prevalence of patients who present ATTENDING A TERTIARY CARE HOSPITAL
with medically unexplained symptoms. They noted the Hareesh Angothu, Grace Rebekah Samuel, Suja Kurian co-occurrence of psychosocial stress. All physicians Department of Psychiatry, Christian Medical College, working in general medical settings admitted to Vellore, Tamil Nadu. difficulty in separating anxiety, depression and somatic presentations because of milder, less distinct Background: Patients with major mental illness
syndromes and overlapping symptoms. They argued especially schizophrenia have a mixture of needs in that it was difficult to use the current three-category different domains. While some of their needs, mostly division and that a more complex classification would clinical are attended to by the treating team their social be time-consuming and impractical in primary care. and individual needs are usually not addressed . There Conclusion: Psychiatric classifications for use in primary is a dearth on this information from resource poor care should consider the different context and employ countries. Method: Patients (N=85) with ICD 10
physicians' perspectives rather than push specialist diagnosis of Schizophrenia of more than two years and concepts and criteria.
on regular outpatient follow up were evaluated using CANSAS-P for their needs. Sociodemographic and SOCIO-DEMOGRAPHIC PROFILE OF SUICIDAL
clinical details also were collected. Met and unmet ATTEMPTERS ADMITTED TO A RURAL MEDICAL
needs and gender difference in these domains were COLLEGE HOSPITAL OF CENTRAL INDIA
analyzed. Results: Average number of met needs
Dipayan Sarkar, KK Mishra, Praveen Khairkar, Neha among 22 domains assessed using CANSAS-P were in 7domains and unmet needs were in 4 domains with no Department of Psychiatry, MGIMS, Sevagram significant gender difference in both met and unmet needs. Most frequently expressed unmet need was Objectives: Vidharbha region of Maharashtra has
about handling psychological distress due to mental remained in the forefront in the past due to numbers of illness, which was reported by 54% of patients. Domains farmers' suicide reported from this region. At point of like food (100%) and accomadation (96%) were rated as time it reached to an epidemic like proportions. It has met need by most patients. Conclusion: Nearly
been stabilized over the year due to intervention by hundred percent of this group of patients with a various Govt. and Non-Govt. organizations. In spite of diagnosis of Schizophrenia had reported that all their that several cases of attempted suicide has been still basic needs like food and accommodation were met. admitted in this region. Quite a no of them are non- Domains of unmet needs and possible causes and farming related. Keeping that in view we evaluated two interventions are discussed. cases who were admitted in our hospital during a short
period of three months. Methodology: We evaluated
OPTIC NEUROPATHY ASSOCIATED WITH GLUE
the socio- demographic profile, economical condition, SNIFFING: A CASE REPORT
and reason for suicidal attempt for all the cases who Prashant Gupta, Anju Dhawan, Ramandeep Pattanayak, were admitted to our medical college hospital during a Rachna Bhargava, Piyali Mandal short period of 3 months. (June to August 2013) . All the National Drug Dependence Treatment Centre, All India case details were recorded in a structured Performa. Institute of Medical Sciences, New Delhi The collected data was analyzed using suitable
statistical tests. Result: Total 21 numbers of cases were
Objective: The present report aims to illustrate a case of
admitted during this period. Majority of patients were inhalant dependence with associated optic neuropathy. from male gender and in the age group of 20-29 years. Methodology: A 14-year old boy belonging to low
Details of method of attempt used and reason for socioeconomic status, was seen in the out-patient clinic attempt will be discussed during the presentation. of National Drug Dependence Centre, AIIMS, New Delhi Conclusion: As it has been portrayed farming related
and was diagnosed with inhalant dependence (glue suicide is not the main cause of suicide in this region, sniffing) for 2 years and nicotine dependence for 5 years there are several other etiological factors which play a according to ICD-10. Cannabis intermittent use for 4 major role amongst the suicide attempters of this years was reported. Patient also had a history of single region as seen in other parts of the country.
episode GTCS of unknown etiology, prior to the onset of substance use (other than nicotine). A multidisciplinary 2013 Indian Association for Social Psychiatry A32 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 team conducted detailed in-patient clinical evaluation. On physical examination, he was found to have hospitalization, patient functionality, and coping style constricted visual field bilaterally even though there of the family members. Aim: To measure the coping
were no subjective complaints regarding vision. Upon skills of the care givers of patients with schizophrenia further investigation, bilateral optic disc pallor was and bipolar affective disorder and to explore the found. Humphrey visual field testing revealed effectiveness of a psycho-education on coping styles. bilaterally reduced visual fields. Malin's Intelligence Methodology: This study was carried out at the
Scale for Children was administered to assess Psychiatry department of PGIMS Rohtak. Sample size: intellectual functioning. Results & Discussion: A
30 healthy care givers of the schizophrenia and 20 diagnosis of toxic optic neuropathy was made. No other healthy care givers of Bipolar Affective Disorder. All the causes of visual field defects could be found. Patient caregivers were screened on GHQ-12 and were was found to have borderline intelligence. excluded if GHQ score was more than two. Four Consumption of substances was in a same aged peer sessions (over three months) of intervention were group, none of whom were attending schools or provided to healthy care givers. They were assessed on pursuing occupations. Patient was a school dropout Coping Checklist (CCL) at base line and after completion prior to inhalant use due to lack of interest in studies. of intervention. Result: Result has shown that
Symptomatic management & nutrient suppleme- improvement was greater in bipolar affective disorder ntation was done. Psychoeducation regarding impact of as compared to schizophrenia. Three subscales of CCL: inhalant abuse specifically on physical health and problem solving, acceptance and denial improved relapse prevention sessions were held. Occupational significantly in both groups but distraction positive rehabilitation was planned. At 3 month follow-up, improved only in caregivers of patients with bipolar patient is maintaining abstinence and has started affective disorder.
learning hair cutting skills. Conclusion: Literature which
ROLE OF FAMILY ENVIRONMENT IN DEVELOPMENT
is primarily based on adult population is divided on the AND MANAGEMENT OF PSYCHOPATHOLOGY: A CASE
reversibility of inhalant associated optic neuropathy. Follow up of this particular case might provide further insight into the factors associated with the persistence or reversibility of this impairment.
Department of Psychiatry, PGIMS, Rohtak EFFECT OF PSYCHO-EDUCATION OF THE PRIMARY
Family is a unit in which parents and children live CAREGIVERS OF PATIENTS WITH SCHIZOPHRENIA AND
together ( Bhatia & Chada ,1993). Family is a dynamic, BIPOLAR AFFECTIVE DISORDER
self regulatory system comprised of interdependent parts & interact one another in a somewhat predictable Kumar R, Chakraborty S, Singh B, Gupta R manner. Family has undoubtedly the most fundamental Department of Psychiatry, PGIMS, Rohtak influence and have been referred as the " bed rock of Background: Due to deinstitutionalization, the role of
child development" (Brenfenbrenner, 1976, 1986). the family member has become an important factor for Research has consistently demonstrated that problems the treatment and outcome of the illness like within family system are associated with a variety of schizophrenia and bipolar affective disorder. Living with psychological and behavioral problems in children and a severely mentally ill relative means that the family has adolescents (Forehand, 1993; Garmenzy, 1993). The to cope with the unpredictable nature of psychotic quality of parent child attachment, the degree to which symptoms, as well as the social stigma associated with parents offer their children age-appropriate intellectual the disease. The care giver's personality, quality of stimulation and the way in which control and warmth family relationships and degree of social support are are combined & have highly significant effect on considered as the mediating factors which determine children's later psychological adjustment (Darling and his/her coping strategy. Coping is defined as any Steinberg, 1993). Children of depressed, anxious and behavioral or cognitive response made by any family disturbed individuals are significantly more member contingent on a life event. Therefore, coping is maladjusted, depressed and anxious (Billing and Moss, both what a person does and also what that person 1985). Adolescents are more likely to benefit from thinks in response to an event or situation. Psycho- treatment if they and their families accept that there is education can directly address a wide range of issues the problem and are committed to resolve it. With the 2013 Indian Association for Social Psychiatry A33 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 aim to study the effect the role of family environment in families of patients with schizophrenia in comparison to development and management of psychopathology, a bipolar affective disorder.
case study of a young boy of 18 years, who was brought ATTRIBUTION OF LOCUS OF CONTROL AND
by his parents with chief complaints of school refusal, TRAUMATIC LIFE EVENTS IN DEPRESSIVE PATIENTS:
decreased interest in studies with sadness of mood, AN INVESTIGATION IN HOSPITAL PATIENTS
irritability & withdrawal behaviour along with disturbed Kedar Ranjan Banerjee, Tanmoy Mitra, Akash Mahato, sleep and self care from one year for treatment is Jayanti Bhattacharya, Madhumita Das, Debabani presented . For management of present case few psychological test and Family Environment Scale (Moos and Moos, 1974) were administered. After assessment National Institute of Behavioural Sciences, P7 CIT Road, it came to light that family environment is very stressful where conflicts, achievement orientation and control is Introduction: Negative life events are noted to have a
high and cohesion, organization, intellectual, cultural major impact in depressive patients. In fact, it has been and recreational orientation is very low. So, to manage noted that more than 75% patients with major the present case a total of 16 sessions were held with depression report negative life events prior to the young boy and his family members. The patient and depression (Jenaway & Paykel, 1997). Locus of control family member had gained significant improvement in is a personality construct that has been observed to be patient's problems and family conflicts and associated with features of depression and anxiety. The communication patterns from the therapy sessions. relative risk of depression after exposure to negative life Details will be presented during presentation.
events varies from 3 to 10. It can be conceived that FAMILY PATHOLOGY AND SOCIAL SUPPORT IN MAJOR
depression onset is more strongly related to dependent to independent life events. Life events can also be predecessor of anxiety disorder. Personality traits can Sheokand N, Singh B, Chakraborty S, Gupta R be linked to life-event exposure and attribution. The Department of Psychiatry, PGIMS, Rohtak locus of control may play a role in appraisal of life events Background: Family is the most important primary unit
which in turn affect the cognitive and behavioural where every individual finds their self identity. Current approaches of the individuals. Aim: The present study
researches on psychiatric illness have indicated that investigate the link between locus of control, life events family contributes significantly to the development of and negative affectivity in depressive patients. mental disorders. The importance of the role of the Methods: Total 100 (n=100) patients (age group 20-50)
family as a causative factor in the development of were selected from the Salt Lake Government hospital mental disorders is getting more and more established, out door with symptoms of major depression. The test particularly over the past few decades. On the other batteries used were BDI, MADRS, Life events Schedule, hand family is key element from where a person gets Locus of control, and Personality Questionnaire. They his/her social support. From family, an individual gets were given the tests after one week of first visit at the emotional, financial, mental support and is able to cope hospital outdoor. A group of same number of healthy with his/her problems. Aims: The aim of this study is to
subjects was used as control. Results: Previous history
assess the family pathology and social support in the of depression, gender and type of negative events were patients diagnosed with schizophrenia and bipolar found significant (p=0.05) related with negative affective disorder. Method: Total number of patients
affectivity. External locus of control was also observed recruited for this study were sixty. 30 patients were to be significantly (p=0.05) related to the above diagnosed with schizophrenia and 30 were diagnosed construct. The controls indicated no significant with bipolar affected disorder. Sample was collected relations among measures. The appraisal of stressful from the dept. of psychiatry, PGIMS, Rohtak. Socio- events remains obligatory for elevated level of negative demographic datasheet, social support questionnaire affectivity. Conclusion: It can be assumed that
were administered on patient and family pathology personality style and attribution as locus of control has scale was administered on parents. Result: Family
a major role in evaluation of traumatic life experiences. pathology is high in the families of patients diagnosed This in turn can make a subject vulnerable for the with schizophrenia in comparison to bipolar affective occurrence of depression. Personality trait and disorder. Social support was found to be poor in the constitution can be a link between distressing life 2013 Indian Association for Social Psychiatry A34 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 events and resultant depression. The feeling of having formal preschool education and nutrition and health no control over situations or events cause worries education for mothers. The services are provided at the which in turn incite helplessness leading to depression. Anganwadi (literally, courtyard play centre).An Although it is established that negative life events can anganwadi centre usually covers a population of 1000 in precipitate depression, the association is a complex one rural and urban area and 700 in tribal area.The specific and probably operates in both directions. Improper objective of ICDS is, to:Improve the nutritional and appraisal of negative events thus probably form a health status of children in the age group of 0-6 vulnerability construct for onset of depression. years;Provide environmental condition needs for physical; social and psychological development of STRESSFUL LIFE EVENTS AND THEIR ROLE IN
children; Reduce the incidence of low birth weight and OBSESSIVE COMPULSIVE DISORDER
severe malnutrition among children; Enhance Kedar R Banerjee, Akash Mahato, Tanmoy Mitra capabilities of mother to provide proper child care; and National Institute of Behavioural Sciences, Kolkata. Background: Etiology of Obsessive Compulsive
departments to promote child development. ICDS Disorder (OCD) points to neurobiological causes along services through a network of anganwardis. All the with psychological factors. While stressful life events services including preschool education, supplementary increase a person's vulnerability to develop illness, all nutrition and health check –ups are delivered at the people having stressful life events necessarily do not anganwadi by the Anganwadi Worker with the develop OCD. Objective: To investigate the presence
assistance of a helper. Supportive supervision and and impact of stressful and traumatic life events in OCD guidance, aimed at continuous improvement in the patients and compare that with OCD patients without skills, is provided by the supervisor . Measures, helps us such events. Methodology: Patients from National
to understand the overall development of the child.This Institute of Behavioural Sciences and Apollo Gleneagles things depend upon these factors and grop work can set Hospital, Kolkata were recruited for this study (duration these things.The whole community will be benefitted. August 2011 till June 2013). A total of 42 patients diagnosed with OCD (ICD 10, DCR criteria) were divided Physical set up of the anganwadi/play center: into two groups on the basis of presence of stressful and 1) Play centre /anganwari situated in clean and traumatic life events preceding the onset of obsessive compulsive symptoms. A profile of the life events was 2) Availability of safe drinking water source/and made and the groups were compared upon their storage system.
symptom pattern and severity. Standard evaluation procedure included assessment on the Yale Brown 3) Availability of adequate indoor space (adequate Obsessive Compulsive Scale, Medico Psychological =floor space for 30-40 children to sit comfortably, 1 Questionnaire, Life events Scale and the Beck square mats. /child) Depression Inventory. Results and Conclusion:
4) Availability of adequate outdoor space Significant number of OCD patients reported having (adequate=play area for 10-15 children to play at a stressful life event preceding the development of time, 2 square mats/child).
obsessive Compulsive symptoms. Further details of the 5) Utilization of the available space.
results will be provided during presentation. 6) Availability of place for storage for rations.
GROUP WORK PRACTICE OF SOCIAL WORK EFFECTVE
IN CHANGING THE INTEGRATED CHILD DEVELOPMENT
7) Availability of kitchen for cooking PROGRAMES IN INDIA.
8) Availability of toilets in the centre.
B) Functionaries Consultant NIPCCD , New Delhi 1) Age, marital status.
The ICDS is a preventive as well developmental effort; it 2) Educational background.
takes a holistic approach to the child by providing a 3) Experience.
package of services which includes periodic health-check-ups. ,referral and medical services, monitoring of 4) Kind of training.
growth, immunization, supplementary feeding, non- 2013 Indian Association for Social Psychiatry A35 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 5) Adult/child ratio at the centre.
category wise and the Final discussion will be presented at the time of conference.
6) Motivational level of the functionary through perception indicators CAUSAL ATTRIBUTION OF SYMPTOMS AMONG
PRIMARY CAREGIVERS OF PATIENTS WITH DELIRIUM
Abhishek Ghosh, Sandeep Grover, Deepak Ghormode Frequency of contacting beneficiaries Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh Regularity and frequency of the services provided. Background: Unlike the West, in India, family is the key
resource in the care of patients with mental illness. A) Frequency of conducting stories, hymens, outdoor Family not only fulfills the need of the patients but also games, creative activities.
plays a major role in treatment seeking and compliance. B) Variety in programmed planning.
Hence their perception about the causality of the disease affects help seeking. Though the same has been C) Availability and utilization of teaching aids/ play studied for other mental disorders, in delirium this is materials.Skills of the worker still unexplored. Aim: To study the caregivers' belief
A) Planning and conducting pre school education.
about the causes of delirium. Methodology: Three
(Evaluated through observation by trained hundred thirty one consenting primary caregivers staying with the patients during the acute episode of delirium were evaluated for their beliefs about the Health and Nutrition Education.
plausible etiologies of symptoms of delirium. Diagnosis a) Number of formal health and nutrition education of delirium was based on Diagnostic and statistical sessions conducted.
manual- fourth text revision (DSM-IV-TR) criteria for b) Specific message covered.
delirium. Illness attribution was assessed by spontaneous reporting and probing with a checklist c) Methods and techniques used.group work covering physical, stress induced, hygiene related and supernatural causes. Results: On spontaneous
A) Existence of coordination committees at reporting, 50.5% of caregivers attributed delirium to anganwadis workers level.
physical illnesses as a direct cause of delirium. Other attributions included: substance abuse especially Agenais workers skill in eliciting community alcohol (13%), supernatural causes (13.6%), stress (3%) and 1.6% of caregivers attributed the symptoms to poor c) Frequency of holding meeting of coordinating hygiene. The mean number of etiologies reported spontaneously were 1.3 (SD=0.8). On probing, 49.5% d) Active involvement of self help group in the area.
attributed symptoms to one or more supernatural causes. The mean number of etiologies reported on E) Administrative support.
probing were 1.5 (SD=1.6). Conclusions: A significant A) Frequency of the visit of the supervisory staff.
proportion of caregivers attribute the symptoms of B) Kind of help or assistance provided.
delirium to supernatural and other non-organic causes. This may adversely influence further treatment seeking c) Efficiency of introducing corrective action.
and subsequent prognosis. d) Functionaries perception of the support received.
HELP SEEKING BEHAVIOR AND LIFE SATISFACTION
E) Frequency of holding training sessions and AMONG THE SPOUSES OF PERSON WITH BIPOLAR
The above mentioned information will be reported as Swain M, Eqbal S Ali, A Singh AR quantitative indicators, some of these will have to be, CIP, Kanke, RINPAS, Kanke, and LGBRIMH, Assam however, measures of central tendency along with dispersion could be worked out. Rates and ratios may Bipolar disorder is a pathological disturbance of mood, also be required to depict the flow. The disintegration typically characterized by oscillating manic and by nature of project, caste group and beneficiary depressive states (DSM-IV, American Psychiatric 2013 Indian Association for Social Psychiatry A36 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 Association, 1994). Bipolar disorder is characterized by and 6% of girls, who were currently non-users of recurrent episodes of mania and depression, cigarettes, expressed intention to smoke in the future. interspersed with periods of recovery during which 54% of the subjects had family members who smoked. mood would be more or less euthymic; however, such Susceptibility to smoking was higher among boys who recovery is usually not complete as there remains a high had smokers in the family. The findings from the study incidence of occupational, psychological and social have implications for prevention programs for smoking difficulties during their lifetimes (Marneros and among adolescents in general and college students in Goodwin 2005). Due to the chronic nature of the illness the patient adds the substantial burden on care giver's THE COMPARATIVE STUDY OF PSYCHOLOGICAL
which affect their quality of life. However, India is a FUNCTION OF CHILDREN WITH NORMAL AND
country known for the several mixtures of cultures, ABNORMAL CHILDREN WITH HEART SURGERY
which may influence the causative beliefs, and consequently, the help-seeking behaviors of the psychiatric patients as well as the caregivers. Therefore, Consultant NIPCCD, New Delhi there is a need to explore of many overt and covert Background & Methods: The children in age group 0-6
factors acting as hindrance in the help seeking years coming for heart surgery is a great event. It is behaviour of the spouses of bipolar disorder. Aim:-To
necessary with Children who had normal hemoglobin study the relationship between help seeking behavior and weight and height, and compare with low weight and life satisfaction among the spouses of person with and haemoglobin. The samples comprise of normal and bipolar disorder. Methods and Materials:-This study
underweight were taken. The children were matched was a hospital based cross sectional study, carried out at for age and screened for intellectual functioning. central institute of psychiatry, Ranchi. Total 40 spouses Psychological functioning was observed by Teddy bears of person with bipolar disorder was recruited for this picnic and children play therapy. Personal construct study. General help-seeking questionnaire and life were assessed prior to play session; the third play satisfaction scale was applied on spouses. Result:-
session was chosen for comparison of behaviours. Result will be discussed at the time of presentation. Results: Children in heart surgery group as compared to
SUSCEPTIBILITY TO SMOKING AMONG ADOLESCENTS
low weight had greater negative personal constructs. Difference in play behaviours were seen in type of play, LN Suman, K Thennarasu affective, cognitive, narrative aspect of play, and Department of Clinical Psychology & Department of defense utilized. Conclusion: Psychological functioning
Biostatistics, NIMHANS, Bangalore of children with low weight and heart surgery is not India is the world's second highest tobacco growing and disordered, they should be need for better care in the tobacco consuming country. In the 2006 Global Youth children with heart diseases.
Tobacco Survey, it was found that smoking had increased among boys and girls in India. Although the POISONING: A RARE CASE REPORT
health outcomes of smoking are well known, little Satyakam Mohapatra, NM Rath research has been carried out to examine adolescent smoking susceptibility in the Indian context. The aim of Mental Health Institute, SCB Medical College, Cuttack, the present study was to examine smoking susceptibility among a sample of 1000 college students Organophosphate (OP) poisoning is the commonest in Bangalore. The sample consisted of 488 boys and 512 poisoning in India with nearly half of the admissions to girls with a mean age of 17.66 years. The students were the 'emergency' with poisoning being due to these selected from 14 English and Kannada medium compounds . The central nervous system effects of organophosphate intoxication have received less Sociodemographic Data Sheet and Susceptibility to attention in the medical literature than peripheral Smoking Scale (SSS; Pierce, et al, 1998). Written effects. Certain patients displayed vague mental informed consent was obtained from all the changes such as irritability, memory disturbances and participants and assessment was carried out in the dream abnormalities for several months after their college premises. Results revealed that 27% of boys and apparent recovery from organophosphate poisoning. 10% of girls had initiated cigarette smoking. 15% of boys There are also reported cases where there is 2013 Indian Association for Social Psychiatry A37 Indian Journal of Social Psychiatry, 2013, 29 (3-4), A31-A38 development of schizophrenic or depressive symptoms contributory family history or past history. The patient after exposure to organophosphate insecticides. Aim
was treated with tablet olanzapine 10mg per day and and Objectives: To present a case where the patient
the patient improved significantly within 10 days. developed manic episode 15 days after accidental Conclusion: The mechanism of mood changes and
ingestion of organophosphate poison and to review the other psychiatric symptoms is as yet unclear. It may be available literature. Methods: We are presenting a case
the excess acetylcholine merely upsets the balance of of 33-year-old female presented with manic episode transmitter systems active in cortical area or it for last 10 days. On evaluation there was past history of suppresses dopaminergic activity, and resulting accidental ingestion of organophosphate insecticide 15 hypersensitivity of postsynaptic dopaminergic neurons days before the onset of psychiatric symptoms. In the may cause psychiatric symptoms. Although the acute interval period between ingestion of poison and onset muscarinic and nicotinic side-effects are well known of manic episode the patient was asymptomatic. There and easily recognized, very few cases of psychiatric was no history of any substance use. There was no changes are reported.
2013 Indian Association for Social Psychiatry A38

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