A prospective study of suicidal behaviour in Sundarban Delta, West Bengal, India.

BACKGROUND: Deliberate self-harm is a challenging public health issue but there is a paucity of data on non-fatal deliberate self-harm in the literature. We aimed to understand the behaviour of deliberate self-harm, both fatal and nonfatal, in a primary care setting. METHODS: A year-long prospective study of all admitted patients of deliberate self-harm at 13 block primary health centres of the Sundarban region was done to examine the sociodemographic profile and clinical outcome of suicidal behaviour. Data were collected by using an especially devised deliberate self-harm register. Each subject was administered a 20-item case history sheet by trained medical officers and nursing staff. RESULTS: A total of 1614 deliberate self-harm subjects (619 men, 995 women) were admitted during the year, of whom 143 (62 men, 81 women) died. Although women, especially in the younger age groups, constituted the majority of subjects (61.6%), the fatality trend was higher among men than among women (10% v. 8.1%). Poisoning was the commonest (98.4%) method of self-harm, particularly using pesticide. Easy availability of pesticides was a risk factor. Psychosocial stressors, such as conflict with spouse, guardian or in-laws, failed love affairs and economic distress, were the common underlying reasons. The majority of acts of deliberate self-harm (92.6%) were committed inside the home, especially by women. Only a small proportion of subjects had a past or family history of attempt at deliberate self-harm. The overall incidence of fatal and non-fatal deliberate self-harm was 5.98 and 61.51 per 100 000 population, respectively. CONCLUSION: Both fatal and non-fatal pesticide-related deliberate self-harm is a major public health issue in the Sundarban region. An intersectoral approach involving primary health, administration and agriculture may help in developing an effective preventive programme to reduce the morbidity and mortality from deliberate self-harm.

A study on mortality and morbidity pattern of acute childhood poisoning cases admitted in block primary health centres of Sundarban, West Bengal.

A hospital - record based study was conducted in Sundarban of West Bengal to explore the profile of mortality and morbidity pattern of acute accidental poisoning among children. Sundarban is an underdeveloped coastal region of West Bengal. Three years retrospective (1999 - 2001) data of childhood accidental poisoning cases were collected from the indoor admission registers and case history sheets of 11 Block Primary Health Centers (BPHC) of the region. A total of 1056 children with accidental poisoning were admitted during those three years of which 58% were males. Mean age of males was slightly higher than females in all the three years. Organophosphorus pesticide poisoning was the commonest.

Media influenced imitative hanging: a report from West Bengal.

Media influences behaviour, especially of the young children and adolescents in various ways. The present study examined the media coverage of a judicial hanging and its immediate social effect. In a qualitative study the media coverage of a case of a judicial hanging was thoroughly discussed and the media influence, for over a period of ten weeks of the incident, in terms of suicide and copying of hanging among children, was collected and analysed. Eighteen cases were reported as an aftermath of this hanging: 1 suicide and 17 imitative hanging in children with 5 deaths. This report calls for attention that media should be cautious and responsible in presenting the news items that have potential social impact.

Community Psychiatry Clinics at Sundarban: a clinical and cultural experience.

A series of Community Psychiatric Clinics were conducted in different blocks of Sundarban region of West Bengal. One of the primary objectives of this was to collect clinical epidemiological data on psychiatric morbidity in the region. A total of 26 clinics were conducted in Sagar, Kakdwip, Canning and Gosaba block of the Sundarban region during the period from end 1998 to end 2000. A total of 451 psychiatric cases with diagnostic categories (male 239, female 212) and 215 non-psychiatric cases (male 107 and female 108) were seen in these clinics. Diagnostic Interview Schedules (SCID) and Clinical rating scales like Hamilton Depression Rating Scale and Brief Psychiatric Rating Scales were used to ascertain clinical diagnosis quantitatively. Special emphasis was given on common psychiatric disorders.

Koro following cannabis smoking: two case reports.

Koro in the background of drug abuse is quite rare. The present report of Koro during the first experience with cannabis is the only account of its kind in the world Koro literature to date. The nature and extent of this genital depersonalization is discussed.

Studies on solution and solution-cast film of polyaniline colloids prepared in the absence and presence of ultrasonic irradiation.

Spectroscopic and voltammetric features for the solution and solution-cast film of polyaniline (PANI) colloids prepared in the absence and presence of ultrasonic irradiation were examined. Significant differences in the color and absorption spectra between the solution of colloids prepared in the absence and presence of irradiation were observed. Effects of ambient atmosphere on the solution of colloids were also studied. A gradual decay in the absorption at approximately 365 nm was occurred upon ageing the solution in air for the colloid prepared under ultrasonic irradiation. PANI film, cast from its colloidal solution, exhibited excellent electroactivity. The films thus cast were applied to electrode modification to control electrochemical reaction. Clear voltammetric response was observed on the electrode modified with the colloid prepared in the presence of ultrasonic irradiation.

Biomedical potential for symptom choice in Koro.

The distribution of different biomedical sexual factors in relation to Koro in 162 cases in a North Bengal Koro epidemic, has been analysed. Anatomo-sexual factors such as venereal disease and scrotal filaria were found to be significantly commoner in Koro patients. The commonest cited precipitating factor was extramarital intercourse (23.5%).

Puppy pregnancy in humans: a culture-bound disorder in rural West Bengal, India.

BACKGROUND: Delusion of pregnancy in males, though uncommon, has been reported in the literature. Delusion of animal pregnancy in humans is unreported until now, and we are reporting here cases of puppy pregnancy in human beings from a part of rural West Bengal, India. MATERIAL: Studies of six male cases and one female case of delusion of puppy pregnancy after an alleged touch or bite of a dog are presented. DISCUSSION: Detailed phenomenological analysis revealed that there exists a strong cultural belief that dog bite may evolve into a puppy pregnancy even in the human male. Psychiatric status showed that there was a clear association of obsessive-compulsive disorder in two cases, anxiety-phobic locus in one and three showed no other mental symptom except this solitary false belief and preoccupation about the puppy pregnancy. All the cases were from rural areas and their communities endorse this pathogenic event of puppy pregnancy in humans. One case (11-year-old child) exemplified how the social imposition of this cultural belief made him a case that allegedly vomited out an embryo of a dog foetus. CONCLUSION: Although the belief in puppy pregnancy is culturally shared, the cases presented a mix of somatic and psychological complaints and their help-seeking behaviour was marked. These features prompted us to identify this phenomena as a culture-bound disorder which needs proper cultural understanding for its effective management.

Sociocultural context of suicidal behaviour in the sundarban region of India.

The role of mental illness in nonfatal deliberate self-harm (DSH) is controversial, especially in Asian countries. This prospective study examined the role of psychiatric disorders, underlying social and situational problems, and triggers of DSH in a sample of 89 patients hospitalised in primary care hospitals of the Sundarban Delta, India. Data were collected by using a specially designed DSH register, Explanatory Model Interview Catalogue (EMIC), and clinical interview. Psychiatric diagnosis was made following the DSM-IV guidelines. The majority of subjects were young females (74.2%) and married (65.2%). Most of them (69.7%) were uncertain about their "intention to die," and pesticide poisoning was the commonest method (95.5%). Significant male-female differences were found with respect to education level, occupation, and venue of the DSH attempt. Typical stressors were conflict with spouse, guardians, or in-laws, extramarital affairs, chronic physical illness, and failed love affairs. The major depressive disorder (14.6%) was the commonest psychiatric diagnosis followed by adjustment disorder (6.7%); however 60.7% of the cases had no psychiatric illness. Stressful life situations coupled with easy access to lethal pesticides stood as the risk factor. The sociocultural dynamics behind suicidal behaviour and community-specific social stressors merit detailed assessment and timely psychosocial intervention. These findings will be helpful to design community-based mental health clinical services and community action in the region.

Deliberate self-harm prevention in the Sundarbans region need immediate public health attention.

Deliberate self-harm is a major public health problem. This study is aimed to examine the sociodemographic characteristics of both non-fatal and fatal deliberate self-harm cases admitted at the 13 block primary health centres of the Sundarbans region under South 24 Parganas district, West Bengal. Retrospective deliberate self-harm data from the admission registers of 13 block primary health centres was collected for the year 1999. A total of 1850 deliberate self-harm cases (639 males and 1211 females) were admitted at the 13 block primary health centres, of which 159 (60 males, 99 females) were fatal (completed suicide). A higher fatality rate for male than female (9.4% compared to 8.2%) was observed. Women (65.5%), especially of younger age groups constituted the major cases. Poisoning (96.9%) was the commonest method of self-harm. Easy availability of pesticides was a common factor. Marital status and seasonal trend (March-April) had important contribution in self-harm incidents. Planned psychosocial intervention as a part of community mental health programme may help to reduce the deliberate self-harm morbidity and mortality at this primary care level.

Pesticide poisoning in non-fatal deliberate self-harm: A public health issue: Study from Sundarban delta, India.

BACKGROUND: Non-fatal deliberate self-harm (DSH), particularly with pesticides, is a major public health problem in many developing countries of the world. Agriculture is the primary occupation of most people living in the Sundarban region in West Bengal, India. Pesticides are extensively used in agriculture, and these agents are most frequently used in DSH. AIM: This study aimed to identify the nature of methods and agents used in non-fatal DSH attempts in the Sundarban area under South 24 Parganas district of West Bengal. MATERIALS AND METHODS: Detailed demographic and clinical data on DSH cases of 13 Block Primary Health Centres' (BPHCs') admission registers were analyzed. One Focus Group Discussion (FGD) with the Panchayat Samiti of each block (totally 13 FDGs) was conducted to elicit the Samiti members' perception about the problem of pesticide-related DSH or suicide in the region. RESULTS: A total of 5,178 (1,887 male and 3,291 female) subjects were admitted at the BPHCs during the study period from 1999 to 2001. Organophosphorous pesticide poisoning was found to be the most common method (85.1%) in DSH. This emphasizes the importance of developing an urgent poisoning-prevention program with a special focus on improving clinical services, as well as initiating farmers' education programs focusing on safe pesticide practices at the primary-care level.

Culture, ethnicity, and paranoia.

This paper defines concepts of culture, ethnicity, and paranoia. It then explores the relationship between culture and ethnicity and the development of paranoia both in mental health settings and in the wider world. The importance of cultural awareness training while dealing with an ethnic population in any multicultural setting is emphasized. When exploring paranoia, proper exploration of its genesis is essential to distinguish between pathological and nonpathological paranoia.