'Ego-dystonicity' in homosexuality: An Indian perspective.

BACKGROUND: Homosexual persons are targets of verbal and physical abuse, discrimination and face legal disadvantages in many countries, including India. These external factors could play a role in determining discomfort with their sexuality. AIMS: We ascertained the association between ego-dystonicity of sexual orientation and indices of perceived acceptance, stigma and awareness of possible normative lifestyles. METHODS: Fifty-one self-identified adult homosexual men were assessed using online questionnaires that covered information including their socio-demographic details; a Visual Analog Scale (VAS) that measured their degree of discomfort with their sexuality; Reactions to Homosexuality Scale, Perceived Acceptance Scale, Modified China Men Who Have Sex with Men (MSM) Stigma scale; and trait version of the Positive and Negative Affect Scale. The participants were also asked to provide a written narrative of their experiences which influenced their comfort with their sexuality. RESULTS: Discomfort with sexuality significantly correlated with education, acceptance by friends and family, legal disadvantages, awareness and accessibility to non-heteronormative lifestyles and support systems and trait affect. Only acceptance by friends and awareness showed significance on linear regression. Qualitative analyses revealed external attributions for discomfort. CONCLUSIONS: Modifying external factors, reducing legal restrictions and improving societal acceptance and support systems could reduce 'ego-dystonicity'. 'Ego-dystonicity' as a determinant for psychiatric classification and intervention needs to be reexamined.

Clinical efficacy of Manasamitra Vataka (an Ayurveda medication) on generalized anxiety disorder with comorbid generalized social phobia: a randomized controlled study.

BACKGROUND: Studies on alternative medicines for generalized anxiety disorder (GAD) are few. Manasamitra Vataka (an Ayurveda preparation) is explored for its efficacy in patients with GAD with comorbid generalized social phobia. MATERIALS AND METHODS: Seventy-two (72) patients with GAD with comorbid social phobia meeting DSM IV TR criteria, and who were between the ages of 20 and 55 of either sex, participated in the study. They were randomly divided into three treatment groups: Group 1 (n=24) and Group II (n=24) received Manasamitra Vataka tablets (100 mg twice daily for 30 days). Group II, in addition to Manasamitra Vataka, underwent Shirodhara (therapy involving dripping of medicated oil [Brahmi tail] over the forehead) treatment for the first 7 days. Group III (n=24) received clonazepam 0.75 mg daily in divided dose for 30 days. The assessment of the study was done using the Hamilton Anxiety Rating Scale, Beck Anxiety Inventory, Beck Depression Inventory, Epworth Sleepiness Scale (ESS), World Health Organization Quality of Life BREF, and Clinical Global Impression scales (Improvement and Efficacy). RESULTS: Patients from all the groups showed significant reduction in clinical parameters evaluated. However, improvement in ESS was observed only in Group II. The treatment outcome was comparable between the three groups. CONCLUSIONS: This is the first study conducted on the efficacy of Manasamitra Vataka in anxiety disorders. The results suggest that Manasamitra Vataka is effective in the management GAD with comorbid generalized social phobia. Add-on effect of Shirodhara reduced the daytime sleepiness. Further studies on Manasamitra Vataka need to be carried out to judge its potential as a first-line treatment modality.

White matter abnormalities in children and adolescents with obsessive-compulsive disorder: a diffusion tensor imaging study.

BACKGROUND: There is paucity of data on white matter (WM) abnormalities in juvenile obsessive-compulsive disorder (OCD). This study aimed to identify WM microstructure changes in juvenile OCD. METHODS: Fifteen children and adolescents with OCD and 15 matched healthy controls underwent diffusion tensor imaging using a 3 Tesla (Achieva, Best, The Netherlands) magnetic resonance imaging scanner. Voxelwise analyses were conducted on data processed through tract-based spatial statistics (TBSS). RESULTS: Patients significantly differed from controls in axial as well as radial diffusivities, but not in fractional anisotropy. Patients demonstrated significantly increased axial diffusivity in corpus callosum (genu, body, and splenium), right and left superior longitudinal fasciculi, left inferior longitudinal fasciculus, right and left cingulum, bilateral anterior thalamic radiations, bilateral anterior limb of internal capsule, left posterior limb of the internal capsule, and middle cerebellar peduncle. In addition, significantly increased radial diffusivity was seen in patients in genu of the corpus, right and left superior longitudinal fasciculi, left inferior longitudinal fasciculus, right and left uncinate fasciculi, bilateral anterior thalamic radiation, bilateral inferior fronto-occipital fasciculus, left posterior limb of internal capsule, right superior cerebellar peduncle, middle cerebellar peduncle, and right inferior cerebellar peduncle. CONCLUSIONS: Our findings suggest involvement of multiple WM tracts in juvenile OCD. In addition to the widely proposed hypothesis of orbitofrontal-striato-thalamo-cortical circuitry deficits in the development of OCD, our findings suggest involvement of additional brain regions, possibly parietal cortex, lateral prefrontal cortex, and limbic system. The widespread differences in WM among cases and controls also points to the possibility of underlying myelination changes.

The association between attention-deficit/hyperactivity disorder and early-onset alcohol dependence: A retrospective study.

BACKGROUND: Early onset (EO) alcohol dependence (AD) has been found to represent a subtype of alcoholism with a distinct profile and prognosis compared to late onset (LO) alcohol dependence. Externalizing disorders, especially attention deficit hyperactivity disorder (ADHD) that may continue as attention deficit hyperactivity disorder, residual type (ADD, RT) in adulthood, may increase susceptibility to early-onset AD. AIMS: To examine the relationship between ADHD and ADD, RT symptoms and age at onset of AD in a sample of Indian male patients. 70 male subjects with AD presenting to the De-Addiction Services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, were studied. The study had a retrospective design. MATERIALS AND METHODS: Patients were examined for evidence of past ADHD in childhood and current ADD, RT using structured instruments. Chi-square tests and odds ratios were used to express the relative risk of association of ADHD with early- and late-onset AD. RESULTS: Significantly more EO alcoholics (19/30, 63.3%) had a history of ADHD in childhood compared to LO alcoholics (7/28, 25%, P < 0.05) ADD, RT was also over-represented in EO probands. CONCLUSIONS: The results of this study are consistent with previous research that shows a high incidence of ADHD in early-onset alcoholics. This may have important management implications.

Psychosomatic disorders in developing countries: current issues and future challenges.

PURPOSE OF REVIEW: This paper focuses on understanding of the concept, recent advances, and challenges to be faced in the field of psychosomatic disorders by the developing countries. RECENT FINDINGS: Changing health scenario in developing countries has led to imminent epidemic of noncommunicable diseases along with the unmet agenda of controlling infectious diseases. Psychosomatic medicine has a role to play in curtailing the upcoming epidemic. Research studies on psychosomatic disorders from developing countries are very few. Most of the publications are in nonpsychiatric medical journals covering explorative to intervention studies. Traditional, complementary, and alternative medicines such as ayurveda are already playing their role in the area of psychosomatic disorders in developing countries. SUMMARY: The role and responsibility of the psychiatrist is changing from treating major mental disorders to preventing and treating psychosomatic disorders. In this regard, developing countries have to meet various challenges such as development of manpower, training of medical and paramedical staff, funding resources for clinical practice and research, coordinating with complementary and alternative medicines, and networking with policy makers in combating the imminent epidemic.