The fundamentals of Indian personality: An investigation of the big five.

Context: The Big Five model is a well-accepted model of personality but there is scant research on the factor structure of personality from Asian populations. It is unclear whether the Big Five personality model can account for cross-cultural variation in personality structures. Aim: To explore the factor structure of personality by analyzing the Big Five personality factors in a sample from Karnataka, South India. Settings and Design: This was a cross-structural observational study conducted in Udupi and Mangalore. Methods and Material: 400 community participants (200 women) from diverse socio economic backgrounds were recruited for the study and were assessed on either an English or Kannada version of the BFI-2-S. The reliability of the translated version of BFI-2-S was established. Statistical Analysis Used: Exploratory factor analysis using Principal Component Analysis with Varimax Rotation and Kaiser Normalization was carried out. Results: Factor Analysis revealed a four-factor and a five-factor solution that varied distinctly from the original Big Five. None of the identified factors fit into the original five factors. The four-factor solution explained 36.86% of the variance and the five-factor solution explained 41.74%. The five factors were named as - Social Effectiveness, Interpersonal Ability, Altruism, Emotional Instability, and Innovativeness. The translated tool showed good temporal stability. Conclusions: The Five factors identified in the present study differ from the Big Five model or the General Factor of Personality. This raises questions about the cross-cultural validity of the Big Five model as well as highlighting the need to adopt more culturally adaptive methods of assessing personality.

Valproate-Associated Hyperammonemic Encephalopathy: Clinical Correlates and Management Strategies in a Tertiary Care Center.

BACKGROUND: Common adverse effects of valproate include sedation, tremor, gastrointestinal effects, and weight gain. Valproate-associated hyperammonemic encephalopathy (VHE) is an uncommon adverse effect of valproate therapy, which includes symptoms such as tremors, ataxia, seizures, confusion, sedation and coma. We report clinical features and management of 10 cases of VHE in a tertiary care center. METHODS: In a retrospective chart review of case records from January 2018 to June 2021, 10 patients with VHE were identified and included in this case series. The data collected include demographic information, psychiatric diagnosis, comorbidities, liver function tests, serum ammonia and serum valproate levels, dosages and duration of valproate, management of hyperammonemia including dosage variations, discontinuation, adjuvant drugs used, and whether rechallenge was done. RESULTS: The most common indication of starting valproate was bipolar disorder (n = 5). All the patients had more than one physical comorbidity and risk factors for developing hyperammonemia. Seven patients received valproate at a dose higher than 20 mg/kg. The duration of valproate use varied from 1 week to 19 years before developing VHE. Dose reduction or discontinuation and lactulose were the most common management strategies used. All 10 patients improved. Among the 7 patients in whom valproate was discontinued, for 2 patients valproate was reinitiated in inpatient care with careful monitoring and was found to be well tolerated. CONCLUSIONS: This case series highlights the need for a high index of suspicion for VHE as it is frequently associated with a delayed diagnosis and recovery in psychiatric settings. Screening for risk factors and serial monitoring may allow earlier diagnosis and management.

Gender Differences in Clinical Characteristics and Comorbidities in Bipolar Disorder: a Study from South India.

The clinical features and course of bipolar disorder differ between women and men; however, studies are limited in Indian population. The objective of this study was to identify gender differences in patients with bipolar disorder. This was a cross-sectional, hospital-based observational study conducted over a period of 25 months. The sample consisted of 110 males and 90 females with a diagnosis of bipolar disorder according to ICD-10 Diagnostic Criteria for Research. Socio-demographic and clinical details were collected using semi-structured proforma. All patients were evaluated on Mini International Neuropsychiatric Interview Plus, Presumptive Stressful Life Events Scale and Clinical Global Impression. Sample consisted of 55% men and 45% women. The total number of episodes was similar between genders, however, the number of manic episodes (p = 0.004) was significantly more in males and the number of depressive (p = 0.003) and mixed episodes (p = 0.018) were significantly more in females. Majority of males had first episode of mania, whereas, first episode in females were mostly depressive (p < 0.001). Comorbid physical disorders were seen in 61.1% females and 40% males. Bipolar disorder subtype, episode types and number varied across gender. Co-morbid hypothyroidism, migraine, and obesity are seen more often in women and substance use was higher in men.

Ethical and Legal Aspects of Telepsychiatry.

Ethical and legal frameworks are essential components in mental health care, due to inherent nature of illnesses and practice modules. These serve to safeguard rights and privileges of patients and mental health professional. Gradual evolution of technology and its' application in assessments and interventions is making it as an essential part of mental health care delivery. This transition will bring innovative challenges for mental health care delivery in terms of practice, ethical and legal aspects. Existing ethical and legal frameworks are time tested for real time/face to face delivery of mental health care. Ongoing pandemic provided opportunity and necessitated use of technology for delivering health care needs. Newer operational and practice guidelines have emerged for practice of telemedicine in general and telepsychiatry in specific. These are in lines with existing ethical and legal frameworks. However, additional frameworks with specific definitions about what constitutes consultation, assessment methods, prescription modes and contents of prescription, documentation, certification, eligible platforms for telepsychiatry, need to be incorporated and observed. The article addresses these ethical and legal aspects in telepsychiatry practice with the background of existing practice guidelines and rules.

Co-morbidity in Bipolar Disorder: A Retrospective Study.

BACKGROUND: Bipolar disorder is a relatively common, long-term, and disabling psychiatric illness that is associated with high levels of functional impairment, morbidity, mortality, and an increased risk of suicide. Psychiatric co-morbidity in bipolar disorder ranges from 57.3% to 74.3%, whereas medical co-morbidity varies from 2.7-70%. Indian scenario in this aspect is not clear. MATERIALS AND METHODS: The objective was to ascertain the prevalence of physical and psychiatric co-morbidities in patients attending a tertiary care center over a period of 1 year and its relationship with socio-demographic and clinical variables. One hundred and twenty-five case record files were included in the review. OPCRIT software was used for re-establishing the diagnosis of bipolar disorder, which yielded 120 cases. A semi-structured pro-forma, specifically designed for the study, was used to collect the socio-demographic and clinical details. RESULTS: Co-morbid psychiatric disorders were found in 52 (43.3%) of the sample, whereas co-morbid physical illness was present in 77 (64.2%) patients. The most common psychiatric disorder associated was substance use disorder (27.5%), whereas co-morbid cardiovascular disorder was the most frequent physical diagnosis in the sample (20%). DISCUSSION: The prevalence of co-morbid psychiatric disorders in bipolar patients was lower than that reported in western literature. It could be related to retrospective nature of study or reflect true lower prevalence rates. Also, certain disorders such as eating disorders were absent in our sample, and migraine diagnosis was very infrequent.

Bupropion precipitating acute psychosis: a case report.

Bupropion is a norepinephrine dopamine-reuptake inhibitor that has been found to be effective in the treatment of nicotine dependence. Although well tolerated, seizures and psychosis have been described to occur with bupropion as severe adverse effects. We report the precipitation of acute psychosis with bupropion prescribed for smoking cessation in an elderly patient.