Comorbidity in patients with Dhat syndrome: a nationwide multicentric study.

INTRODUCTION: There are limited numbers of studies on Dhat syndrome. Major limitations of the existing literature are heterogeneous assessment methods used to describe the comorbidity and small sample size from isolated centers. AIM: To assess comorbidity with a common methodology in patients with Dhat syndrome from multiple centers across India. METHODS: Using a cross-sectional design, this multicentric study involved assessment of 780 male patients, aged more than 16 years, across 15 study centers. MAIN OUTCOME MEASURES: ICD-10 criteria (for evaluation of psychiatric morbidity and sexual dysfunction) RESULTS: About one-third (32.8%) of the cases had no comorbidity. One-fifth (20.5%) of the patients had comorbid depressive disorders and another one-fifth (20.5%) had comorbid neurotic, stress-related and somatoform disorders. Half (51.3%) of the study sample had comorbid sexual dysfunction. When various combinations of comorbidities were evaluated, it was seen that more than one-fourth (28.7%) of the patients had only comorbid sexual dysfunction and one-sixth (15.9%) had only comorbid depressive/anxiety disorders. A little more than one-fifth (22.6%) had comorbidity of both sexual dysfunction and depressive/anxiety disorders. CONCLUSION: Comorbid sexual dysfunction is seen in half of the cases of Dhat syndrome, and it is more common than comorbid depressive and anxiety disorders.

Stress, anxiety, and depression among call handlers employed in international call centers in the national capital region of Delhi.

BACKGROUND: Call handlers employed in call centers repeatedly undergo stress in their day-to-day lives and this can have deleterious effects on their health. OBJECTIVES: The objectives were to study the levels of stress, anxiety, and depression, and their predictors among call handlers employed in international call centers in the National Capital Region (NCR) of Delhi. MATERIALS AND METHODS: A cross-sectional questionnaire-based survey was conducted among 375 call handlers aged 18-39 years. Depression Anxiety Stress Scale- 42 (DASS-42) was used to measure stress, anxiety, and depression along with a pretested sociodemographic questionnaire. Univariate analysis was done to find out the association of stress, anxiety, and depression with various factors. Variables with P < 0.25 were included in multiple logistic regression and three models were developed each for stress, anxiety, and depression. RESULTS: The prevalence of stress, anxiety, and depression among call handlers was 46.7%, 57.1%, and 62.9% respectively. Abnormal sleep quality, prolonged travel time, and lack of relaxation facilities at the office were predictors of stress and depression. The presence of physical ailments, the absence of hobbies, temporary/part-time employment, and traveling long-distance to office were significant predictors of anxiety among call handlers. CONCLUSION: Call handlers face a high burden of stress, anxiety, and depression. Public health specialists need to pay adequate attention to their health problems.

An uncommon case of hypersexual behaviour with frotteurism.

Frotteurism is an aberrant behaviour wherein the person tends to rub or bring about physical contact between his genitals and an unrelated female to derive sexual pleasure. Our report describes an atypical case of hypersexual behaviour presenting in the form of masturbation with features of frotteurism and unipolar depression. The paper discusses the differential diagnosis and management of hypersexual behaviour.

Prevalence of cognitive dysfunction, psychological morbidity and abuse in the community-based elderly population in India.

BACKGROUND: The elderly population in India is expected to grow enormously by 2050 owing to an increase in life expectancy. Community-based data on the prevalence of psychological morbidity, abuse and cognitive dysfunction are scarce. AIMS: To determine the prevalence of cognitive dysfunction, psychological morbidity and abuse in the elderly population in a resettlement colony from East Delhi, India. METHODS: A cross-sectional study was conducted on the elderly population of a resettlement colony, in East Delhi, comprising 5 blocks and 12 subblocks with a total population of 65 000. The study was carried out within 2 months from April to August 2017. The self-reported questionnaires were administered to detect cognitive dysfunction, psychological morbidity, social support and pattern of abuse. RESULTS: The mean age of the study subjects was 70.29 years (53.8% were males, 78.8% were married, 86.9% were Hindus and 75% were living with children). A total of 106 subjects (66.6%) belonged to the lower socioeconomic strata with 120 (75%) living with children. Most of the subjects (70.6%) studied below the primary level of education. As detected on Goldberg General Health Questionnaire-12, 56.9% of the subjects had psychological morbidity. On Dementia Assessment by Rapid Test, 33.1% of subjects were screened positive. The pattern of abuse reported was as follows: emotional abuse (16.9%), physical abuse (7.5%), sexual abuse (1.9%) and social neglect (18.1%). The social support score was found to be 46.22 (12.22). CONCLUSION: The results of this community-based study signify that appropriate steps at the policy level need to be undertaken so that abuse as well as neglect can be prevented. In addition, screening the elderly population helps to detect early cognitive dysfunction, psychological morbidity, abuse victims and individuals with poor support.

Polymorphism in apolipoprotein E among migraineurs and tension-type headache subjects.

Nitric oxide plays an important role in the pathogenesis of migraine as well as tension-type headache. Studies suggest that the expression of molecules involved in the pathogenesis of headache, i.e., nitric oxide and interleukin, is influenced by apolipoprotein E (APOE) and is gene specific. Hence, we hypothesized that APOE polymorphism may be associated with migraine as well as tension-type headache.The study sample comprised of three groups: migraineurs, tension-type headache subjects as well as a healthy control group. A total of 50 subjects in each group were included after screening for the inclusion and exclusion criteria. None of the subjects was a blood relative of any other subject included in the present study. Their venous blood was drawn and stored at -20 degrees C. Genomic DNA extraction was performed with a commercial kit and simple sequence-specific primer PCR was performed to assess the APOE polymorphism. Data were analyzed with the help of SPSS V11.0 for Windows. chi(2) test and logistic regression analysis were run. The results of the study showed that APOE epsilon2 gene increases the risk of migraine as compared to the control group and the tension-type headache group (OR=4.85; 95% CI=1.92-12.72; P<0.001 and OR=2.31; 95% CI=1.08-4.94; P=0.01, respectively). Interestingly, APOE epsilon4 gene was protective against migraine as well as tension-type headache. This study shows that APOE epsilon2 gene increases the risk of migraine, while APOE epsilon4 gene is protective against migraine and tension-type headache. Further research is required to confirm the findings of the present study in a larger sample and to elucidate the role of APOE polymorphism in headache.

Sleep patterns of urban school-going adolescents.

OBJECTIVE: To analyze the variance in sleep habits of adolescents of different high school Grades in urban India. DESIGN: Cross-sectional questionnaire-based study. SETTING: Community based school survey in an urban setting. SUBJECTS: School going adolescents from 9th to 12th Grades. METHODS: A total of 1,920 adolescents aged 12-18 years were included. The questionnaire contained questions related to sleep habits. Each question was explained to the participants and their responses were noted. Outcome parameters were total sleep time in a day, time to go to bed and wake up-time, sleep latency, nocturnal awakenings (duration, frequency per night and nights per week), wake-time after sleep onset, wake time after sleep offset, sleep efficiency, quality of sleep, daytime napping (duration and frequency), and sleepiness during the day. RESULTS: Mean age of the adolescents included in this study was 15.1 years and mean total sleep time was 7.8 hr/day. Adolescents of higher Grades had lesser total sleep time (9th=8 hours; 10th=7.7 hours; 11th=7.9 hours; 12th=7.6 hours; P=0.001), and more frequent nocturnal awakenings (9th=35.9%; 10th=44.7%; 11th=40.3%; 12th=28.3%; P=0.001). Daytime leg pain ( 9th=14.4%; 10th=18.4%; 11th=6.1%; 12th= 21.8%; P=0.01), daytime napping (9th=47.6%; 10th=50.4%; 11th=61.8%; 12th=69.8%; P=0.001), and daytime sleepiness (9th=37.2%; 10th=39.1%; 11th=39.7%; 12th=54.2%; P=0.001) increased progressively among higher Grades. Adolescents in higher Grades were more prone to not follow their weekly schedule on week-ends (P= 0.001). Sleep debt of approximately one hour per day was seen in all adolescents, and progressed with higher Grades. CONCLUSION: Adolescents of higher Grades had lesser sleep time, and frequent awakenings; suffered daytime leg pain, and felt sleepy during the day. These factors suggest increasing sleep deprivation among higher Graders.

25 Hydroxyvitamin D levels, quality of life, and disability in long-standing patients of somatization.

INTRODUCTION: Somatization disorder is a debilitating condition, in which patients have multiple physical complaints with no explained cause and no relief even after consultations. AIM: The present study examined the association of 25-hydroxyvitamin D (25[OH]D) levels, quality of life, disability, and symptom profile in long standing with somatization disorder. METHODS: One-hundred three patients of somatization disorder suffering for ≥2 years, visiting psychiatry outpatient clinic during two consecutive summer season (April to June) of 2015-2016 were recruited. Symptom profile was studied using Patient-Health-Questionnaire (PHQ-15) items (somatic symptoms), PHQ-9 items (depressive symptoms), Generalized Anxiety Disorder-7 (GAD-7) item (anxiety symptoms).quality of life was assessed using the World Health Organization Quality of Life BREF 26 item, and disability measure was World Health Organization Disability Assessment Schedule (WHODAS) 2.0. 25(OH) D levels were estimated using chemiluminescence binding assay. RESULTS: The poor quality of life in somatization disorder was significantly associated with disability, symptom profile using PHQ-15, PHQ-9, and GAD-7. 25(OH)D levels were deficient in 56.31% of the study population. CONCLUSION: The high somatic symptom severity in majority of patients suffering from somatization disorder needs more attention from psychiatrists across cultures so that functional status and quality of life can be improved. Routine estimation of Vitamin D levels and correction of its deficiency may bring about symptomatic relief at an early stage, thereby reducing the morbidity associated with the disorder.

Quality of Life in Patients with Coronary Artery Disease and Panic Disorder: A Comparative Study.

OBJECTIVES: The quality of life (QOL) of patients with coronary artery disease (CAD) is known to be impaired. Non-cardiac chest pain referrals are often under-diagnosed and untreated, and there are hardly any studies comparing the QOL of CAD and panic disorder related (non-cardiac) chest pain referrals (PDRC). METHODS: We assessed the psychiatric morbidity and QOL of patients newly diagnosed with CAD (n = 40) at baseline and six weeks post-treatment and compared their QOL with patients with PDRC (n = 40) and age- and gender-matched healthy controls (n = 57). Psychiatric morbidity in the CAD group was assessed using the General Health Questionnaire (GHQ12) item, Hamilton Anxiety Scores (HAM-A), and Hamilton Depression Scores (HAMD). QOL measures were determined by the World Health Organization QOL questionnaire (brief) and Seattle Angina Questionnaire. The CAD group was treated with anti-ischemic drugs (nitrates, betablockers), antiplatelet drugs (acetylsalicylsalicylic acid), anticoagulants (low molecular weight heparin, clopidogrel), and managed for risk factors. The PDRC group was treated with selective serotonin reuptake inhibitors and anxiolytics. RESULTS: Patients with panic disorder had a worse QOL than those with CAD and healthy controls in the physical domain and psychological domain (PDRC vs. CAD vs. healthy controls, p < 0.001). In the CAD group, smoking was associated with change in angina stability (p = 0.049) whereas other tobacco products were associated with change in angina frequency (p = 0.044). Psychiatric morbidity was present in 40.0% of patients with CAD. In the PDRC group, a significant correlation of HAM-A scores was noted in the physical (p = 0.000), psychological (p = 0.001), social (p = 0.006), and environment (p = 0.001) domains of QOL. Patients with panic disorder had a significant improvement in anxiety scores after treatment compared to baseline (HAM-A scores difference 21.0 [16.5-25.6]; p < 0.001). CONCLUSIONS: Patients in the PDRC group had a worse QOL than those in the CAD and healthy control groups. This highlights the need for careful diagnosis and prompt treatment of panic disorder in these patients to improve their QOL. Additionally, smoking, the use of other tobacco products, and hypercholesterolemia were associated with angina symptoms in patients with CAD.

Health-related quality of life in patients with trachomatous trichiasis or entropion.

PURPOSE: To determine the health-related quality of life in patients with trachomatous trichiasis or entropion, before and after intervention. METHODS: A prospective, case-control, interventional study. Health-related quality of life was evaluated in 60 patients with trachomatous trichiasis or entropion, before and after intervention, and 60 age- and gender-matched controls without trichiasis or entropion, using the WHOQOL-Bref questionnaire. Thirty patients and controls had vision < 6/18, while 30 had vision = 6/18 in the better eye. The WHOQOL-Bref assesses four domains of quality of life: physical health (1), psychological health (2), social relationships (3), and environment (4). Domain scores of patients and controls and of patients before and after intervention were compared using Student's t-test. Patient characteristics were correlated with domain scores using Pearson's correlation. RESULTS: Quality of life was poorer than that of controls in domains 1 and 2 for patients with vision < 6/18 in the better eye (p < 0.001, p = 0.001, respectively), and in domains 1, 2 and 4 for patients with vision = 6/18 (p < 0.001, p < 0.001, p = 0.01, respectively). Scores improved after intervention in all domains except domain 3, even though vision did not improve. CONCLUSIONS: Patients with trachomatous trichiasis or entropion suffer in the physical, psychological and environmental domains of health-related quality of life even when vision is normal. Timely intervention is essential not only to prevent corneal blindness but also to reduce the suffering caused by the non-visual symptoms. Future studies must identify barriers to therapeutic intervention, and attempts should be directed at overcoming them so as to reduce the non-blinding burden of trachoma.

Prevalence of abuse in mentally ill patients visiting outpatient setting in a tertiary care hospital in India.

AIM: In a developing country such as India, the abuse of patients suffering from psychiatric disorders has been underreported. The aim of this study was to detect abuse in chronically ill psychiatric patients visiting a psychiatric outpatient setting in a tertiary care hospital in Delhi, India. MATERIAL AND METHODS: A cross-sectional descriptive written survey was carried out on 406 patients. A self-administered questionnaire for patient abuse was developed in Hindi based on the World Health Organization's Domestic Violence Questionnaire that encompassed questions regarding physical, emotional and sexual abuse. RESULTS: Of the 406 patients, 294 (72%) suffered from abuse, with 64% experiencing emotional abuse, 39% physical abuse and 21% sexual abuse. In chronically ill psychiatric patients, a significant association was found between education and abuse, with most abuse occurring among senior secondary pass outs (i.e. 11-12 years of education) and least among junior high school pass outs (6-8 years of education). A majority (74%) of these patients lived in urban areas (p = .020). A significant association was also found between abuse and the psychiatric diagnosis of the patient, with 53% suffering from depression, 66% anxiety disorder, 81% bipolar disorder, 94% psychotic disorder, 86% obsessive compulsive disorder, 44% sexual disorder and 12% other psychiatric disorders. CONCLUSIONS: There is a need to create awareness in society in order to prevent abuse. Screening for abuse in routine psychiatric practice is of utmost importance so that timely interventions can be given, thereby preventing its deleterious health consequences.

Disseminated neurocysticercosis presenting as acute stress reaction.

Neurocysticercosis is the most common and preventable parasitic infection of the central nervous system, but disseminated cysticercosis is said to be rare. We report a case of a 31-year-old male, who presented with anxiety manifestations temporally associated with stress related to job. After initial clinical improvement, he presented with an incapacitating headache which was diagnosed as disseminated neurocysticercosis after thorough evaluation and investigations. Magnetic resonance imaging of the brain with contrast showed multiple small hyperintense lesions involving bilateral, temporoparietal, occipital, gangliothalamic with ring enhancement. His cysticercosis antibody IgG serum (EIA) was 2.05. The clinical management consisted of antihelminthic and antiepileptic drugs along with stress management.

Meige's syndrome.

Meige's syndrome consists of idiopathic blepharospasm and oromandibular dystonia. The exact etiology is not known and various hypotheses have been proposed for its causation. The hypothesis suggesting dopaminergic and cholinergic hyperactivity is most widely accepted. There is no curative drug for Meige's syndrome although a variety of treatments have been proposed. We report a case which responded to tetrabenazine.

Burden and depression in primary caregivers of persons with visual impairment.

CONTEXT: Caregivers who assist persons with visual impairment often neglect their needs, resulting in burden and depression. Rehabilitation efforts, directed to the disabled, seldom target the caregiver. AIM: To assess burden and depression in persons caring for blind individuals. SETTINGS AND DESIGN: This was a cross-sectional study carried out in the outpatient department of a tertiary-level teaching hospital in New Delhi. MATERIALS AND METHODS: Institutional Ethical Board approval was obtained and written informed consent too was obtained from the participants involved in this study. Persons with best-corrected vision <20/200 in the better eye, and their primary caregivers, were recruited. We recorded demography, other illness/disability, household income, relationship with disabled person, and caregiver burden (Caregiver Burden Scale) and depression (Centre for Epidemiologic Studies Depression Scale). STATISTICAL ANALYSIS: Statistical analysis was carried out using SPSS version 20 (Released 2011. Armonk, NY: IBM Corp.); range, average, and standard deviation were determined for age, burden, and depression. The association between burden and depression was determined using Pearson's correlation; the relationship between degree of disability and caregiver burden and depression was determined using unpaired t-test; using multiple linear regression, factors were found to be statistically significant; significance was taken at P < 0.05. RESULTS: Twenty-seven (53.0%) men and 24 (47.0%) women had visual impairment. Most caregivers (n = 40; 81.6%) were first-degree relatives or a spouse; 32 (65%) had schooling <5 years; and 29 (59%) were unemployed. Depression ranged from 21 to 52 (average 43.2 ± 5.71); it correlated with degree of disability (P = 0.012), household income (r = -0.320; P = 0.025), and burden (r = 0.616; P < 0.001). Burden ranged from 30 to 73 (average 54.5 ± 6.73) and correlated with degree of disability (P = 0.006). On multiple linear regression, burden predicted depression (r = 0.557; P < 0.001). CONCLUSIONS: Caregivers merit community support, financial benefit, interventions to diagnose and treat depression, and training in coping. Centers that provide disability certification could offer counseling.

Phenomenology and beliefs of patients with Dhat syndrome: A nationwide multicentric study.

AIM: To assess the phenomenology and associated beliefs in patients with Dhat syndrome. METHODS: A total of 780 male patients aged more than 16 years were recruited from 15 centers spread across the country and were assessed on Dhat Syndrome Questionnaire. RESULTS: The most commonly reported reasons for passage of Dhat were excessive masturbation (55.1%), sexual dreams (47.3%), excessive sexual desire (42.8%) and consumption of high energy foods (36.7%). The most common situation in which participants experienced passage of Dhat were as 'night falls' (60.1%) and 'while passing stools' (59.5%). The most common consequence due to passage of Dhat was weakness in sexual ability (75.6%). In terms of psychological and somatic symptoms, the common symptoms included bodily weakness (78.2%); feeling tired or having low energy (75.9%); feeling down, depressed, or hopeless (67.9%); and little interest or pleasure in doing things (63.7%). In terms of treatment expectations, about half of the patients (49.1%) expected that energizing medications like vitamins/tonics/tablets were required and more than one-third (38.2%) expected that there was a need for taking energizing injections. CONCLUSION: Present study shows that Dhat syndrome is a distinct clinical entity seen all over India, with its characteristic features.

1. An uncommon case of zoophilia: a case report.

Humans show a wide array of sexual preferences and behaviour. Zoophilia, or bestiality, consists of sexual intercourse by a human being with a lower animal. There is a paucity of literature on zoophilia. We describe a rare case of preferential zoophilia involving multiple animals. The perpetrator developed this habit only during episodes of depression. It is recommended that due to the apparent common occurrence of this condition, questions exploring a topic which appears to be routinely ignored should be included in the psychiatric interview.

Normal pressure hydrocephalus presenting as delusional disorder.

Normal pressure hydrocephalus (NPH) is caused by aqueductal stenosis resulting in syndrome of gait disturbance, cognitive impairment, and urinary incontinence. Late onset psychosis should be evaluated thoroughly to rule out any organic cause. We present the case of a female patient presenting with delusions, gait disturbances, urinary incontinence in her 50s.