Indian Psychiatry

Craving is considered to play an important role in the persistence of drug use and relapse of drug use. Very few studies have looked into the subjective experience of this phenomena. This study attempts to study craving comprehensively as described by the ...

The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Based on purposive sampling technique, ten patients with TBI falling in the age range of 20-40 years and fulfilling the inclusion and exclusion criteria were chosen from All India Institute of Speech and Hearing, Mysuru, India. A quasi-experimental design, i.e., nonequivalent control group design was chosen for the study. Patients were assessed on Luria-Nebraska Neuropsychological Battery for Adults, Cognitive Symptoms Checklist, and Community Integration Questionnaire. Patients in experimental group were given neuropsychological rehabilitation for 6 months. Brainwave-R and Talking Pen were used as rehabilitative tools. Patients with TBI have significant neuropsychological deficits observed in memory, visuo-spatial organization, arithmetic, spelling, writing, fine motor coordination, a...

Wilson's disease is a rare metabolic disorder involving copper metabolism may present with hepatic, neurological and psychiatric manifestations. We present a case of Wilson's disease with behavioral symptoms, which responded to risperidone.

The trail making test (TMT) is a short and convenient estimate of cognitive functions, principally attention and working memory. Like most neuropsychological tests, it is derived from and primarily applicable to English-speaking individuals. Norms for other ethnic minorities may differ significantly. The application of majority or mixed norms to specific ethnic subcultures may introduce systematic bias. To examine the impact of an English test on primarily nonEnglish-speaking individuals, outpatients attending the dermatology department of a large Indian hospital (n = 120) were asked to complete the English version of the TMT. The time taken to complete the TRAILS was unexpectedly long, although all the subjects scored within normal limits on the modified mini mental status examination and a test for general knowledge. Possible reasons for the delayed completion times are discussed below.

SUMMARY Many research findings have shown that the presence of a schizophrenic patient in the family proves very stressful for each individual family member, as well as for the network of family relationships. This paper outlines the proceedings of an innovative one-day program in family psychoeducation. Program content and participant responses are described; the need for the organization of further such programs for the dissemination of information are highlighted.

In a series of original and pathbreaking publications, Jaswant Singh Neki (1925-2015), a leading Indian Sikh scholar and psychiatrist (Sikhnet contributors, 2021; Wikipedia contributors, 2021), proposed the gurū-chelā (master-disciple) relationship to create a new paradigm for the therapeutic relationship,  employing an accessible cultural idiom that Indian patients could understand and identify with (Neki, 1973, 1974, 1975, 1976, 1977, 1978, 1992). Contrasting his new Indian paradigm with the Western patient-therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change-seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, 1997). The gurū-chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki’s paradigm in India (Carstairs, 1980; Parkar, et al., 2001; Sethi & Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), among Indian trainees in the West and in their return to India (Ananth, 1981; Pande, 1968; Surya, 1966) and in Western psychiatric and psychotherapeutic cultures (Di Nicola, 1985a, 1985b, 1997), concluding with a synthesis of Neki’s gurū-chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.

The backdrop of the Indian Independence offers glimpses of many ‘metaphors of madness’. In this article, we explore this through a few instances, starting from 1857, around the time of the First War of Independence, to 1947, when India became an independent nation. Such metaphors have their parallels both in historical as well as in contemporary times, where instances of one man’s imagination becoming another’s concept of irrationality and insanity continue.

Assessment and management of mental disorder among sensory impaired is challenging as there is no clear guideline. Most physicians and psychiatrists are not trained to provide competent care in such patients. This report highlights the issues and challenges that a clinician may encounter in patient with profound hearing loss and speech impairment.

Social Anxiety Disorder (SAD) is a chronic, disabling and treatable disorder with common onset in adolescence. Virtually there are no Indian studies on SAD. The study was conducted to find out frequency, demographic and phenomenological characteristics of SAD, family related risk factors, academic impairment and comorbidity of depression among adolescents. 421 adolescents in one high-school were screened for SAD and depression and associated factors with academic impairment. 54 (12.8%) had SAD. The most common manifestation of SAD was avoiding giving speeches. SAD was equally common among both genders, was associated with difficulty in coping with studies, concern about weight, having less friends, lack of intimacy with parents, and being treated differently from siblings. In conclusion, SAD is a common adolescent disorder, with major depression as a comorbidity and associated with impairment in academic functioning. All adolescents especially with depression consulting medical prof...

Wilson's disease (WD) is a relatively rare disease of copper metabolism. The diagnosis is often missed initially. The presentation is usually neurologic or hepatic, seen in 40% of patients. Psychiatric presentation of WD is reported in only 15% of patients. We present a 32-year-old patient with severe psychiatric manifestations. On examination, he had mild rest and postural tremors and a KF ring was seen. Serum ceruloplasmin was low and 24-hour urinary copper was elevated. The patient responded to penicillamine, lorazepam and quetiapine, and is being followed up.

The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Based on purposive sampling technique, ten patients with TBI falling in the age range of 20-40 years and fulfilling the inclusion and exclusion criteria were chosen from All India Institute of Speech and Hearing, Mysuru, India. A quasi-experimental design, i.e., nonequivalent control group design was chosen for the study. Patients were assessed on Luria-Nebraska Neuropsychological Battery for Adults, Cognitive Symptoms Checklist, and Community Integration Questionnaire. Patients in experimental group were given neuropsychological rehabilitation for 6 months. Brainwave-R and Talking Pen were used as rehabilitative tools. Patients with TBI have significant neuropsychological deficits observed in memory, visuo-spatial organization, arithmetic, spelling, writing, fine motor coordination, a...

There is discrepancy and failure to adhere to current international guidelines for the management of metastatic colorectal cancer (CRC) in hospitals in Greece and Cyprus. The aim of the present document is to provide a consensus on the multidisciplinary management of metastastic CRC, considering both special characteristics of our Healthcare System and international guidelines. Following discussion and online communication among the members of an executive team chosen by the Hellenic Society of Medical Oncology (HeSMO), a consensus for metastastic CRC disease was developed. Statements were subjected to the Delphi methodology on two voting rounds by invited multidisciplinary international experts on CRC. Statements reaching level of agreement by ≥80% were considered as having achieved large consensus, whereas statements reaching 60-80% moderate consensus. One hundred and nine statements were developed. Ninety experts voted for those statements. The median rate of abstain per statemen...

The objective of this paper is to provide a systematic review on the epidemiology of psychiatric disorders in India based on the data published from 1960 to 2009. Extensive search of PubMed, NeuroMed, Indian Journal of Psychiatry website and MEDLARS using search terms “psychiatry” “prevalence”, “community”, and “epidemiology” was done along with the manual search of journals and cross-references. Retrieved articles were systematically selected using specific inclusion and exclusion criteria. Epidemiological studies report prevalence rates for psychiatric disorders varying from 9.5 to 370/1000 population in India. These varying prevalence rates of mental disorders are not only specific to Indian studies but are also seen in international studies. Despite variations in the design of studies, available data from the Indian studies suggests that about 20% of the adult population in the community is affected with one or the other psychiatric disorder. Mental healthcare priorities need to be shifted from psychotic disorders to common mental disorders and from mental hospitals to primary health centers. Increase in invisible mental problems such as suicidal attempts, aggression and violence, widespread use of substances, increasing marital discord and divorce rates emphasize on the need to prioritize and make a paradigm shift in the strategies to promote and provide appropriate mental health services in the community. Future epidemiological research need to focus on the general population from longitudinal prospective involving multi-centers with assessment of disability, co-morbidity, functioning, family burden and quality of life.

The present randomized, double blind, parallel group, controlled, multi-centric trial was designed to evaluate the efficacy and tolerability of escitalopram in comparison with citalopram and sertraline in the treatment of major depressive disorder. Outpatients (N=214) with an ongoing/newly diagnosed ICD-10 major depressive episode and a Hamilton Rating Scale for Depression (HAM-D) score of > 18 were randomly assigned to citalopram, 20-40 mg/day (74 patients), escitalopram, 10-20 mg/day (69 patients) and sertraline, 50-150 mg/day (71 patients), for a 4-week double-blind treatment period, with dosage adjustment (after 2 weeks of treatment) according to the response to treatment. Clinical response was evaluated by the 17 items HAM-D and the Clinical Global Impression (CGI) scales, which were recorded at baseline and at weekly intervals. Tolerability was evaluated by observed/spontaneously reported adverse changes in laboratory parameters (baseline and after 4 weeks). Response rate w...