Current Issue Volume 12, Number 2 , July-December 2018

EDITORIAL
Gautam Saha

E-learning in Psychiatry: How Effective is it?

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:iv]



In today’s era, the busy clinicians often lack time to pore over thick and lengthy books to look for the information they require. For example, while writing a prescription, they have doubts regarding the safety of a psychotropic drugs in a particular medical condition. They are more likely to Google it using their smartphones rather than reach out for a book in their clinics which may or may not contain the information they require.


ORIGINAL ARTICLE
Prosenjit Ghosh, Jayanta Kurmi

Study of Sociodemographic and Clinical Profile of Admitted Patient Leaving Against Medical Advice from Psychiatry Ward of a Teaching Hospital

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:39-45]



Introduction: Leaving against medical advice (LAMA) meaning a patient choosing to leave the hospital before the treating physician recommends discharge may result into inadequate treatment, relapse and prolonged duration of illness.

Aim and objectives: The aim of this study was to assess the prevalence, reasos for LAMA, sociodemographic variables and clinical profile of such patients.

Materials and methods: Retrospectively data were obtained from indoor register of a Psychiatry department of a teaching hospital for patients opting LAMA, during a period of 18 months from January 2017 up to June 2018. International Classification of Disease (ICD)-10 criteria was used for the diagnosis purpose.

Results: Out of 569 patients admitted during the study period total 60 patients fulfilled the criteria for LAMA. The frequency of LAMA was found to be 10.5%. LAMA was found to be more common in those below age 40 years (85%), in those from non-urban background (75%), who were educated up to high school (71%), who were suffering from neurotic, and psychotic and substance abuse disorders. The commonest reason cited for LAMA was going to faith healer and most of the LAMA occurred within first four days of hospitalization.

Conclusion: Leaving against medical advice (LAMA) is a frequent problem in psychiatric inpatients and is a matter of great concern for the treating doctors.

Keywords: Faith healer, Leaving against medical advice, Substance abuse.

How to cite this article: Ghosh P, Kurmi J. Study of Sociodemographic and Clinical Profile of Admitted Patient Leaving Against Medical Advice from Psychiatry Ward of a Teaching Hospital. Ind J Priv Psychiatry 2018;12(2):39-45.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Gopala S Poduri

Psychiatrists’ Perception of Continuing Medical Education

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:46-49]



Background: The number of continuing medical education (CME) programmes is becoming increasingly more in recent times and there were no formal reported studies among psychiatrists in India.

Objective: To find out psychiatrist’s general opinion about CME.

Materials and methods: Data were collected from a representative sample of psychiatrists in active practice about CMEs attended in the last 5 years using a proforma through email and representative contacts. The general impression about CME and faculty was collected apart from personal data. The opinion regarding CME credit hours for renewal of medical council of India (MCI) registration was obtained by a question. Data were analysed using descriptive statistics and Cronbach’s alpha was computed for reliability, validity and to know the data adequacy of the test to perform

Results: In all responses from 202 participants were analysed. Majority of responders were below 40 years (64%). More than half were in the profession for less than 10 years. Two-fifth conducted CME and nearly a third were office-bearers mostly in city associations. Sixty-six percent attended because of topic while 34% for faculty and 21% for MCI renewal. Thirty-six percent were either partly or fully sponsored by pharmaceutical companies. While 58% participants and 74% faculty found CME favorably, on the unfavourable side the figure were 21% and 51% respectively. More than half (55%) were against the need of CME for renewal of registration.

Conclusion: An unconditional positive regard may be good for psychiatric therapy but the same cannot be said of CME.

Keywords: Acceptance, Continuing medical education, Psychiatrists opinion.

How to cite this article: Poduri GS. Psychiatrists’ Perception of Continuing Medical Education (CME). Ind J Priv Psychiatry 2018;12(2):46-49.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Krishna M Singh, Regina R Khakha, Roshan V Khanande

Antioxidants Used in the Treatment of Various Psychiatric Disorders

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:50-54]



Aim: To review the place of antioxidants in the treatment of psychiatric disorders, and to weigh it against the criticism for such treatments.

Background: Oxidative stress leads to aging, and antioxidant use (naturally available in food and supplementations) is one of the dietary modality for health promotion with major benefits. Antioxidants have also been used in treatment and prevention of many medical disorders. Brain, one organ using oxygen abundantly, and for its high lipid content suffers from oxidative stress. Even postmortem studies of brains of individuals with psychiatric disorders show degenerative changes possibly due to long-term damage by oxidative stress. Hence, the use of antioxidants in treating psychiatric disorders is one of the new areas of research in psychiatry.

Review results: Many agents have been used in the treatment of psychiatric disorders. Gingko biloba, Selegiline, omega-3-triglycerides, vitamin E, and N-acetyl cysteine have been found useful as adjuncts in the treatment of schizophrenia. Similarly, the usefulness of adjunct N-acetyl cysteine and ethyl-eicosapentaenoic acid (EPA) treatment in bipolar depression is reported. omega-3-triglycerides have also been used in the treatment of dementia as an adjunct with mixed results. Ubiquinol has shown promise in treating autism.

Conclusion: The results of adjunct antioxidant treatment in psychiatry have been mixed with at times conflicting results. Much research is required to establish their place as a treatment modality in psychiatry.

Clinical significance: Use of antioxidants in the treatment of psychiatric disorders, at Max, currently, is of adjunct value only; even the cost-effectiveness of such treatments has to weighed against the useful clinical utility.

Keywords: Antioxidants, Gingko biloba, Omega-3-triglycerides, Psychiatry, N-acetyl cysteine.

How to cite this article: Singh KM, Khakha RR, Khanande RV. Antioxidants Used in the Treatment of Various Psychiatric Disorders. Ind J Priv Psychiatry 2018;12(2):50-54.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Seshadri S Chatterjee, Guru S Gowda, Soumitra Das, Adesh K Agrawal

Klein Levin Syndrome and Cavum Verge: A Midline Rarity

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:55-56]



Klein Levin syndrome (KLS) is rare triad of episodic hypersom-nolence, hyperphagia, and hypersexuality. Cavum verge (CV), although, mainly reported as a non-pathological, incidental, neuro-radiological abnormality by itself, may sometimes be associated with behavioral and psychiatric abnormalities. We here present a case of KLS with the magnetic resonance imaging (MRI) finding of Cavum verge. We then discuss the current literature of both the disorders and try to find some heuristic associations, if any, between the two.

Keywords: Cavum verge, Hypersomnia, Klein Levin syndrome.

How to cite this article: Chatterjee SS, Gowda GS, Das S, Agrawal AK. Klein Levin Syndrome and Cavum Verge: A Midline Rarity. Ind J Priv Psychiatry 2018;12(2):55-56.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Subir Bhattacharjee, Sujit Sarkhel

Very Early Onset Mania with Hypersexuality in a 4.5-Year-Old Child: A Case Report

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:57-58]



Bipolar mood disorder (BPD) may manifest as the first episode of mania as early as below 6 years old. There are controversies regarding its diagnoses as because of sharing of symptoms with disruptive mood dysregulation disorder (DMDD), attention deficit hyperactivity disorder (ADHD) and conduct disorder. Hypersexuality was found to be a prominent feature in early-onset bipolar disorder (EOBD). Here is a case report of first episode mania in a child of 4.5 years old with a prominent feature of hypersexuality who responded well with valproate and risperidone.

Keywords: Childhood hypersexuality, Childhood mania, Very early onset mania.

How to cite this article: Bhattacharjee S, Sarkhel S. Very Early Onset Mania with Hypersexuality in a 4.5-Year-Old Child: A Case Report. Ind J Priv Psychiatry 2018;12(2):57-58.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Tanupreet Kaur, Harneet Kaur, Sakshi Gupta, Subhash Das

A Rare Case of Drug-induced Eosinophilia Following Reintroduction of Clozapine

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:59-61]



Clozapine, an atypical antipsychotic agent commonly used for treatment-resistant schizophrenia (TRS) is well known to cause blood dyscrasias among many other common side effects like sedation, sialorrhoea, weight gain and some rare side effects such as eosinophilia. Clozapine-induced eosinophilia though rare has received extensive attention and may preclude its use in the patients who may otherwise be responding well to the treatment. Although there has been evidence in the literature highlighting the rare presentation of eosinophilia in patients receiving clozapine. Here we present a rare case of undif-ferentiated schizophrenia who received clozapine in the past and tolerated it well but developed transient eosinophilia on its re-introduction.

Keywords: Clozapine, Eosinophilia, Schizophrenia.

How to cite this article: Kaur T, Kaur H, Gupta S, Das S. A Rare Case of Drug-induced Eosinophilia Following Reintroduction of Clozapine. Ind J Priv Psychiatry 2018;12(1):59-61.

Source of support: Nil

Conflict of interest: None


CME
Imon Paul

Newer Updates in Psychiatry: Focus on Vortioxetine

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:62-65]



Vortioxetine is the new antidepressant on the block which has been described to have a novel mechanism of action-it directly works on multiple receptors of the neurotransmitter serotonin and it also inhibits serotonin reuptake. It has been shown to have promising antidepressant, antianxiety and pro-cognitive action especially during treatment of major depression. This article gives a brief overview of vortioxetine-its clinical use, pharmacological profile, and safety and tolerability. Most of the studies till date have found vortioxetine to be clinically efficacious, and it also improved the cognitive profile in patients with depression. It has a favorable adverse effect profile- it has been shown to be tolerated well by most subjects in clinical trials where nausea was the most frequently reported side effect, and it also showed the added advantage of comparatively less incidence of unwarranted sexual adverse effects.

Keywords: Adverse events, Major depressive disorder, Vortio-xetine.

How to cite this article: Paul I. Newer Updates in Psychiatry: Focus on Vortioxetine. Ind J Priv Psychiatry 2018;12(2):62-65.

Source of support: Nil

Conflict of interest: None


OBITUARY
Mrugesh Vaishnav

Obituary

[Year:2018] [Month:July-December] [Volumn:12 ] [Number:2] [Pages:27] [Pages No:66]



It takes education and knowledge to become a good psychiatrist and to be clinically sound to become a good and successful medical practitioner. But to be a pioneer and leading frontman in a field which in the 1980s was a stigma is a life time achievement only few would be worthy of acquiring.


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