Abstract

N N De Oration

Improving Outcomes for Psychoses in Resource Constraint Settings: Looking Beyond Pharmacology

Mamta Sood

Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar New Delhi – 110 029, India. E-mail: [email protected]

Psychotic disorders cause significant disability and burden. Majority of persons with psychotic disorders reside in low-middle income countries, for example, as per national mental health survey (2016), there are ~6 million (prevalence - 0.4 %) in India and 75% of them do not receive any treatment. Outcome studies suggest that about one third of patients with psychotic disorders recover fully and about 10% show poor improvement. The former group do not require any intervention after they recover and the latter require long term long stay facilities with specialized care. Rest of about two third of the patients experience multiple relapses and remissions. When they access care, most receive pharmacological treatment that helps only in symptom control. However, psychosocial interventions that are crucial for improving functioning and reducing disability are rarely applied although well designed psychosocial care is available in a few public funded and private setups. Inadequate mental health workforce, fragmented healthcare systems, poor public funded services and benefits are significant barriers. Psychiatry training like other fields of medicine usually is given in the tertiary care centres where focus on medical model combined with large patient loads results in establishing of pharmacological intervention as major model of care neglecting holistic biopsychosocial model. Also, implementing evidence-based pharmacological treatment is not difficult due to availability of a large variety of antipsychotics in the market.

In this context for these two third patients with psychotic disorders for providing holistic care, it is important to use available resources pragmatically. In the psychiatry training, it is important to integrate psychosocial evaluation and management of patients. Most of the patients stay in community with their families who play multiple roles in their care starting from identification of psychopathology and initiating treatment to providing social, financial and emotional support. It is important to make families partners and stakeholders in providing care. Culturally sensitive family intervention taking account of needs and viewpoints of the families can be an important nonpharmacological strategy. Studies suggest that long-term disability can be prevented by intervening early in the course of the psychoses. Families take up caregiving role without any formal training. So, for first episode psychosis, instead of using resource-intensive strategies from high income countries, psychoeducation for short duration can be used. The life expectancy of patients with psychotic disorders, especially with chronic disease is less than that for the general population. Majority of these patients access care from general hospitals, it is important to regularly monitor their physical health. Also, in last decade, a large telenetwork has developed in the country. Digital technology including mobile technology offers hope for providing home-based psychosocial care in low resource settings. In this context, we have designed psychosocial care programme comprising of manuals and mobile apps for both first episode as well as chronic psychotic disorders.

Balint Award

Healing Rejuvenates when Hand Holding is Mutual: A 5 Years Blooming Patient-Therapist Story

Mini Sharma

Department of Psychiatry, RVRS Medical College and Mahatma Gandhi Hospital, Bhilwara, Rajasthan, India.

A Tale of Two Brothers and the Incumbent Prerogative for a Social Ombudsman

Rohit Verma

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

Social support stipulates two imperative components: a structural component comprising of network size and frequency of social interactions, and a functional component with emotional (such as receiving love and empathy) and instrumental (practical help such as monetary gifts or assistance with care) dimensions. In treatment of chronic illnesses, a clinician's role dynamically fluctuates between providing therapeutic care and social support. I present such a case where my role belonged to more of a social ombudsman for the care receivers mitigating their daily lifestyles rather than a clinician providing only pharmacological upkeep. This case taught me the perspective of devoting time to patients and their family members beyond the call for duty from being a mere prescription provider to be more of a social aid to the debilitated family unit.

Keywords: Chronic illness, mental illness, perceived care, social support, therapeutic nihilism

Anil Malhotra Award

Psychosocial Correlates of Recovery Capital in Alcohol and Opioid-Dependent Patients: A Cross-Sectional Comparative Study

Mahadev Singh Sen, Apinderjit Kaur¹, Rakesh Lal¹, Siddharth Sarkar¹

Department of Psychiatry, Institute of Human Behaviour and Allied Sciences, Delhi, ¹Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.

Introduction: All the resources that catalyze this recovery are known as recovery capital. This study aims at finding out the correlates which help increase the recovery capital of an individual and the extent to which it can affect them. Methods: Along with sociodemographic and clinical variables we assessed recovery capital (Assessment of Recovery Capital or ARC Scale), religiosity (Duke University Religion Index), spirituality (Daily Spiritual Experience Scale), Coping (Coping Strategies Inventory –short form), social support (Social Support Questionnaire), subjective happiness (Subjective Happiness Scale) of patients diagnosed with Alcohol dependence syndrome (ADS group) and Opioid dependence syndrome (ODS group) who were currently not having withdrawal symptoms. Results: A total of 111 subjects were screened of which 49 in ODS group and 30 in the ADS group met the selection criteria. The majority of the subjects in both groups were married, belonged to urban areas, practiced Hinduism, and were living in nuclear families. There was a significant difference between the educational status, religion practiced, age of onset of dependence, severity of dependence, and duration of abstinence between the ADS and ODS groups. Better social support (p=0.029), higher emotion-focused coping (p<0.001), and higher engagement (p=0.001) in ADS while pattern of disengagement (p=0.003) was found higher in the ODS group. Other correlates were comparable in both groups. Recovery (ARC) has a moderate correlation with Social Support in both groups (ODS-rho=0.424, p=0.002 and ADS rho=0.695, p<0.001). Also, in ADS group a moderate correlation was seen between Emotion Focused Engagement, Problem Focused Engagement, and coping skills. While in ODS subjects a weak correlation of recovery capital was observed with Organizational Religious Activity and Emotion Focused Engagement, Emotion Focused Disengagement coping skills. Discussion: The results of our study reveal that social support emerged as the important factor common in both the groups which suggests that it should be the key area of psychosocial interventions in both disorders. A focus on enhancing coping styles and increasing other lifestyle factors can help sustain this path for longer.

Keywords: Recovery capital, recovery in substance use disorder, religiosity, social support, spirituality

A Comparative Study of Pattern of Substance Use and Co-Occurring Psychiatric Disorders among Out-Patient Opioid Users across Different Age Groups

Pooja Shakya, Anju Dhawan, Rachna Bhargava, Biswadip Chatterjee

Department of Psychiatry and National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India.

E-mail: [email protected]

Background: The clinical burden of treatment-seeking youth opioid users has increased over time in the world. Understanding the pattern and severity of substance use and its impact in subsequent years has potential clinical implications. Materials and Methods: 90 patients with primary opioid use were assessed and compared on various tools namely Semi-structured Interview Schedule, WHO ASSIST (Alcohol, Smoking and Substance Involvement Screening Test), OTI (Opiate Treatment Index), GAF (Global Assessment and Functioning Scale), MINI (Mini International Neuropsychiatric Interview) and MINI-KID. Two comparisons were done firstly, 30 older adults (25-45 years) versus 60 youth (15-24 years) then youth opioid dependent patients were further studied by comparing 30 adolescents (15-19 years) with 30 emerging adults (20-24 years). Results: In comparison to older adults, the youth opioid users showed faster progression from initiation of substance use to opioid use, lesser duration of opioid use before treatment seeking, greater severity of opioid use and cannabis use, and lesser age of dependence for all the substances, higher scores on poly drug use, risky injection use and criminal behaviour. On comparing adolescents with emerging adults, adolescent have higher inhalant ever use and cannabis dependence but progression from substance use to opioid use was faster in emerging adults along with more involvement in risky sexual behaviour. Psychiatric co-morbidity in opioid dependent patients is more common in younger age groups as compared to older ones. Conclusion: These findings suggested that opioid dependent patients with the early onset substance use are distinct from adult onset substance use and more prone to complications. This study provides insights about this vulnerable population and demands more strenuous measures to address these.

Keywords: Adolescent opioid users, co-occurring psychiatric disorders, opioid dependent, treatment seekers, youth

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of Delhi

Mini Sharma, Dinesh Kataria, Nitin B. Raut, Shiv Prasad, Parvaiz Alam

Department of Psychiatry and Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, India.

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Methods: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age >60 years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34 mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder.

Keywords: Buprenorphine, elderly Indian population, opioid use disorder

JK Trivedi Award

Utilization of Cultural Formulation Interview to Understand the Factors Affecting Treatment Adherence and Help-Seeking in Mood Disorders: A Qualitative Study from Western India

Kartik Singhai, Jitender Aneja¹, Mukesh Swami², Pratibha Gehlawat²

Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, ¹Department of Psychiatry, AIIMS, Bhatinda, Punjab, ²Department of Psychiatry, AIIMS, Jodhpur, Rajasthan, India.

Introduction: Treatment adherence rates amongst patients of affective disorders remain sub-par across the world. Socio-cultural factors affecting the same remain poorly understood. The current study aimed to explore and conceptualise the same. Methodology: The study utilized a qualitative grounded theory study design. The patients who fulfilled the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) criteria of unipolar depression or bipolar affective disorder, and were presently under our treatment for at least three months and currently in remission, aged 18-60 years, and were able to understand Hindi or English, scored less than 6 on the Medication Adherence Rating Scale were included. Furthermore, key care givers were also included in the study. Using purposive sampling and data saturation, a total of 30 participants were recruited. In-depth interviews were conducted using the cultural formulation interview as given in DSM-5 was used as the interview tool. Thematic analysis of data was done using Atlas.ti version 8.4.3. Results: A total of 14 themes (deductive and inductive) emerging from 171 codes were identified. Some of the important inductive themes included: cultural and societal attitude towards illness and treatment seeking; trust, experience and expectations from available health care; faith healing related practices and beliefs. The implicit themes such as cultural understanding of the problem and cultural factors affecting help seeking also showed prudent findings. Conclusion: The study findings demonstrate the various features of the socio-cultural milieu and identity of an individual and family that have an influence on the treatment seeking behavior.

Keywords: Bipolar affective disorder, cultural formulation, depression, interview, qualitative, thematic analysis

Eye Tracking As a Tool for Assessing Social Cognition: A Case Control Study Comparing Patients with Psychosis and Healthy Controls

Ashlyn Tom, Shubham Nanoli, Rohit Verma

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

Eye movement dysfunction is a common abnormality in Schizophrenia and other psychotic disorders. Patients with schizophrenia have impairments in social cognition. Various eye movement paradigms can be used to measure predefined parameters using eye trackers. The current study intends to understand the eye movement characteristics in individuals suffering from psychosis using newer eye tracking instruments with better precision. In this study, we studied 29 individuals meeting the diagnostic criteria for schizophrenia spectrum and other psychotic disorders based on clinical assessment as per DSM-5 along with 29 age and gender matched healthy controls using various eye tracking parameters measured using a Tobii Pro Spectrum device 360. There were significant differences between the groups in the free viewing task. Average duration of fixations was higher whereas the number of fixations and total amplitude of saccades were found to be reduced in the patient group. Peak velocity of first saccade was also seen to be reduced in the patient group. However, there were no abnormalities in the antisaccade, predictive saccade, memory saccade and smooth pursuit tasks. Eye movement parameters was also found to be significantly correlated with the cognitive task measurements. Altered free viewing in patients may lead to the deficits in social cognition. These findings confirm the presence of eye movement abnormalities in psychosis spectrum disorders and the role of cognitive deficits in psychosis.

User Satisfaction and Attitude of Healthcare Professionals towards Patients with Psychiatric Illness at Tertiary Care Teaching Hospital in North India

Kashyapi Garg, S. Nagendran¹

Department of Psychiatry, Sarojini Naidu Medical College, Agra, ¹Department of Psychiatry, Teerthanker Mahaveer Medical College, Moradabad, Uttar Pradesh, India.

Context: User satisfaction in health care is an important measure of quality of services received and can involve both, the patient and their carer. User satisfaction in mental health takes on added importance, as it determines whether the patient is likely to continue to follow-up. Aims: Assess the perceived attitude of healthcare professionals in emergency services attending to the patients with psychiatric illness and patients with non-psychiatric illness and user satisfaction as perceived by the service user. Settings and Design: Study was done in tertiary care teaching hospital in Northern India. Patients attending the emergency department needing a psychiatry referral, those attending for causes other than psychiatric illnesses but referred for a psychiatric evaluation, and/or their carers willing to participate in study and provide written informed consent, were included in the study. Materials and Methods: A semi-structured proforma was applied for recording the socio-demographic details, psychiatric and other relevant medical history of the patient. A Semi-Structured questionnaire about the perceived attitude of healthcare professional, on a 5-point Likert scale, was applied. Statistical Analysis Used: Descriptive statistics for categorical variables was done. Inferential statistics were calculated using Chi-square test. Results: Out of a total 95 respondents, 69 patients were diagnosed with a psychiatric disorder and remaining 26 patients had medical illness or other non-psychiatric disorders. Females were a majority in both groups. Conclusions: Major strengths in this study was the quantitative analysis of health-workers attitude towards patient of psychiatric illness showing user-rated satisfactory attitudes. There was less of a stigmatising and more of a positive impact noted.

Keywords: Attitude towards patients, emergency department, mental health care, user-satisfaction

BB Sethi Award

A Cross Sectional Study of Knowledge and Attitude Regarding ECT and rTMS among General Population and Mental Health Professional Trainees

Rahul Mathur, Anuranjan Vishwakarma, Rohit Verma, Shubham Nanoli, Shyamanand Roy, Srinivas Rajkumar, Rishi Gupta

Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.

Introduction: Electroconvulsive therapy (ECT) and repetitive transcranial magnetic simulation (rTMS) have a proven efficacy and safety in psychiatric disorders. Even a treatment modality with proven efficacy and safety, its acceptability depends on the perception among clients, treatment providers as well as in general population. In this study we have compared knowledge and attitude regarding rTMS and ECT among general population and mental health trainees. Methodology: It is a cross sectional study conducted at a tertiary care centre. In first part of study the knowledge and attitude regarding ECT and rTMS is assessed in general population (N=500) and in the second part same has been done among mental health trainees (N=80). The participants were assessed for their sources of information, knowledge and attitude for the modalities. Results: Among general population, it was seen that 54% of the participants were familiar about ECT as compared to only 4% for rTMS. Only 9% of the participants among general population reported that they received information about ECT from a psychiatrist. About 18% and 15% participants among general population considered ECT as inhumane and cruel respectively and another 25% reported that they will advise their relatives to receive it if recommended by a doctor. The most common source of information among trainees for ECT was media while it was from professionals for rTMS. However, the sources of information didn't significantly affected the knowledge and attitude scores in this group. Conclusion: The majority of participants from general population were unaware about the fundamentals of the ECT and rTMS method, informed consent, indications, effectiveness, and adverse effects. This highlights the need for promoting awareness among general population regarding these treatment modalities. The study also highlights the need for making necessary modifications in the curriculum in medical training so as to improve understanding of the trainees regarding effacious treatment options.

Keywords: Attitude, electroconvulsive therapy, knowledge, mental health trainee, repetitive transcranial magnetic simulation

Early Retention in Services as Predictors of Tobacco Cessation in the Medium Term: A Medical Record Based Longitudinal Tele-Follow-up Study at a Tertiary Care Centre in Eastern India

Aniruddha Basu, Kumari Rina, Aparajita Guin, Rebecca Haokip

Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, West Bengal, India.

Introduction: The aim was to evaluate the outcome of tobacco cessation services. Primary objective was to find the association of early retention in services with tobacco cessation outcomes. Secondarily we tried to find other socio-demographic, clinical and treatment related predictors of tobacco cessation. Methodology: The outcome would be evaluated through a retrospective-prospective design. Retrospective design was record based while the prospective design was done telephonically by calling the patients and enquiring about their status after at least 6 months after the first visit. 'No tobacco usage in last one month' was considered 'abstinent'. Those who 'reduced their usage in last one month' by about 50% were considered to have 'reduced' whereas others who 'continued their usage in same previous manner 'were considered to be 'same' user. Results: Out of 356 patients registered between June 2021 to Fenruary 2022, 81 (22.75%) could not be contacted, 221 (62.08%) had 'reduced usage' after a tele-follow-up of at least 6 months, 50 (14.04%) patients have retained the same usage and 4 patients expired. Of the 221 who reduced usage, 53 were abstinent (14.48%). 'Initial retention in services' was significantly associated with 'reduced usage' (p=0.003) in the tele-follow-up in the medium term that is follow up with median duration of 13 months. With regard to 'abstinence', none could stand the test of significant after correction in the logistic model except 'types of tobacco usage' which predicted a statistically significant effect with a odd's ratio of 3.15 (p=0.001). Discussion: This study reveals important information regarding 'type of tobacco' as predictor of abstinence and 'initial retention' as predictor of 'reduction in tobacco usage'. Such studies need further clarification in future more robust face to face studies with biochemical verification.

Symposia

Symposium 01: Need for Developing Comprehensive Indian Model of Social Case Work, Counselling and Psychotherapy as Contribution to Social Psychiatry in India

V. Sayee Kumar

Counselling and Psychotherapy, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Therapists generally follow Psychoanalysis, Behavioural Models, Client centred therapy, Maslow's Need Hierarchy Theory, etc. for decades. However, they are considered inadequate as they are developed in Western and European cultural conditions. Sigmund Freud developed psychoanalysis in the context of nuclear family and limited the structure of mind with Id, Ego and Super Ego. But Indians' Ego is considered a part of the larger supreme ego with natural and spiritual elements and the individual with such an ego aims to integrate oneself with Universal Self by social, cultural, religious and spiritual means. Some may take specific pathways like yoga or undertake a dedicated work being done not to earn money but to realise oneself. Many scholars and practitioners have observed that psychotherapy, as practiced in the West, might be suitable only for those living in cosmopolitan cities of India and not for majority of the population. Psychiatric Social Workers are very much aware of the impact of socio-cultural elements on health and behaviour through the use of social case work, an individualised therapeutic intervention. Issues like confidentiality and privacy in the Indian context do not even exist in Indian languages and, in the socio-cultural context. Since 1960s there have been attempts to integrate indigenous concepts in the application of psychotherapy and counselling. Some authors like Verma viewed psychotherapy as, the 'interpersonal method of mitigating suffering' and found its roots in the communication of Buddha; he also emphasized the use of concepts of Karma and Dharma in psychotherapy. Neki used the concept of Sahaja. There are some important works from South like Thirukkural known as Tamil Veda, has summarised the human behaviour and conduct in life. Tamil Veda or the Kural by Tiruvalluvar of south India has combined all three pillars of the triage or trivarga such as virtue (aram), wealth (porul) and love (kaman), in one slim book. This south Indian tradition indicates a bonding and common civilizational nature of India. The nastika traditions high light the materialism guiding the human behaviour with objectivity. Apart from these, there are countless traditions in India propounded and propagated by many from different faiths too. The presentation will explore the need to develop a comprehensive model of Indian approaches to plan and practice therapies of case work, counselling and psychotherapy.

Symposium 02: Futuristic Use of Cannabis in India and Across the Globe: Pros and Cons

Gautam Anand, Umang Gupta, Shreya Kataria, Srishti Arora

Department of Psychiatry, MMC&H. E-mail: [email protected]

1. Legal aspects of cannabis use: rules & regulations in India & abroad. Seemingly they very across the globe each country has their rules & regulations to control the use of illicit drug and substances
2. Pros and cons of use of cannabis-this is being disseminated in the form of modak, sweets, grass, drink and joints predominately practicing in the country from where it was disseminated
3. Managing overuse and persistent use of cannabis -it will leave to create lot of complications such as social, psychological & legal despite of its therapeutic uses
4. Since this substance has multiple indignation in treatment as well as special therapeutic indication in palliative care and stage life care compels to restate the laws of form new legislative, regulations to use this substance that is why the increasing demand of threptic uses ant toxification of other substances from more harmful than harmful less use favors legislation.

Symposium 03: Unveiling Mental Health during the COVID-19 Pandemic Through a Biopsychosocial Lens: Theory, Practice and Strategies

Ananya Mahapatra, Prerna Sharma¹, Meenu Anand²

Dr. Baba Saheb Ambedkar Hospital and Medical College, ¹Center of Excellence in Mental Health, IHBAS, ²Department of Social Work, University of Delhi, New Delhi, India. E-mail: [email protected]

The idea of Biopsychosocial Model as a new paradigm for theoretical conception of health and illness was proposed by George Engel in 1977. The biopsychosocial framework was formulated primarily as a counterpoise to the reductionist approach of a medical model of illness which overemphasized the role of biological factors and individual pathology in the causation of illness, without taking into account, the complex interplay and reciprocal relationships of psychological and external socio-cultural factors with internal biological factors (e.g., genetics). Derived from the principles of General Systems Theory, the Biopsychosocial Model highlights the complex interplay of biological, psychological, and social determinants and processes in pathogenesis of illnesses as well as their impact on the recovery and well-being of the patient. Since its emergence in January 2020, the COVID-19 pandemic rapidly snowballed from a global public health emergency to a full-blown humanitarian crisis across nations. Besides the high rates of physical morbidity and mortality, the pandemic has also given rise to a complex set of psychosocial issues emerging from nationwide lockdowns, quarantine, social isolation, economic collapse, changing family and work structure etc, resulting in significant adverse mental health consequences, which is currently viewed as a second pandemic, in itself.

This symposium aims to conceptualize the mental health consequences of the COVID-19 pandemic through the Biopsychosocial Model. It seeks to highlight the theoretical concepts of Biopsychosocial Model from the perspective of the COVID-19 pandemic, how the Biopsychosocial framework can be applied to plan management of mental disorders during the pandemic and its limitations, from an Indian perspective. It is rooted in contextualism, a world view in which any event is interpreted as an ongoing act inseparable from its current and historical context. The shared experience of the crisis by clients as well as the mental health care professionals in the post COVID pandemic world must guide us towards a new direction of conceptualizing mental health and illness. The uniqueness of the paper lies in its amalgamation of proposed strategies towards the prevention of mental disorders and promotion of mental health from a holistic lens.

Symposium 04: “Green Time”, “Blue Time” and “Me Time”: Embracing the Role of Lifestyle Based Mental Health Care in Psychiatry

Virtu Chongtham, Shivangi Mehta, Bandana Bist

E-mail: [email protected]

With the growing burden of mental illness globally (1 in every 8 people, or 970 million people around the globe were living with a mental disorder), it is need of the hour to incorporate new approaches which can be delivered alongside the traditional mental health care. There is an upcoming body of evidence which supports the role of lifestyle factors and efficacy of lifestyle interventions in the prevention and treatment of mental disorders. Hence, lifestyle factors are given importance as modifiable treatment targets.

Aim: The aim of this symposium is to discuss the role of lifestyle psychiatry as a new approach in prevention and treatment of mental disorders.

Introduction to the Topic: Ms. Virtu Chongtham.

Role of lifestyle factors in onset and treatment of mental disorders: Current evidences – Dr Shivangi Mehta.

Other emerging considerations in the field of lifestyle psychiatry – Ms. Virtu Chongtham.

Factors to be considered for adaptation and future scale up for lifestyle psychiatry: Application of lifestyle based mental health care – Dr. Bandana Bist.

Symposium 05: The Role of Internet and Digital Technology in Shaping Mental Health Related Help-Seeking Behaviours in the New Millennium

Swarndeep Singh, Subhash Das, Shubh Mohan Singh¹

Department of Psychiatry, Government Medical College and Hospital, ¹Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India. E-mail: [email protected]

In India, about one in every seven people is suffering from a diagnosable mental disorder, and there is a huge mental health treatment gap ranging between 70% to 92% for different disorders. This is likely due to culmination of various factors like poor mental health literacy, high mental health related stigma, inadequate and unevenly distributed mental health resources. The growing popularity of internet-based information and communication technologies offer ways to overcome these factors hampering mental health related help-seeking.

Internet based digital technologies can be used to provide tele-psychiatry consultation and online counselling to distant patients by mental health experts. Also, it can be used to remotely train non-specialist health professionals for catering to the mental health care needs of the population. The use of mobile mental health apps in promoting positive mental health and alleviating symptoms of psychological distress or disorders like anxiety or depression has been tested with variable success. Apart from providing mental health treatment, internet also acts as repository of mental health related information that could be accessed by general population in an easier and discrete manner. This shall help increase mental health literacy and promote appropriate and timely treatment seeking behaviors.

Through this symposium the speakers would like to discuss the role of internet and digital technology driven strategies in promoting mental health literacy and widening the net mental health services. We would also highlight associated challenges with the use of these newer modalities, and propose ways of addressing some of them in the Indian context.

Topic Wise Speakers of Proposed Symposium:

• Dr Shubh Mohan Singh: The potential of internet and digital technology in bridging the mental health treatment gap
• Dr Swarndeep Singh: The role of worldwide web network in promoting mental health literacy
• Dr Subhash Das: Challenges and the way forward onto the path of digital psychiatry.

Symposium 06: Use of Tramadol Therapeutically for the Treatment of Opioid Dependence: Rationale, Experience and Caveats

Prabhoo Dayal, Siddharth Sarkar, Piyali Mandal, Kirti Sharma

Department of Psychiatry and NDDTC, AIIMS, New Delhi, India.

E-mail: [email protected]

Tramadol is an opioid agonist medication that has been used in the treatment of acute and chronic pain. Tramadol has been utilized in some circumstances in the management of opioid dependence as well due to its ability to cater to the withdrawal symptoms. The medication has the potential to be misused as well, but the effect as an opioid and the consequent abuse potential seems to be lower than some other opioids like morphine. This has been suggested through post marketing surveillance data, though there is a growing concern of abuse of tramadol as well. In certain parts of the world, access to opioids like buprenorphine and methadone has been a challenge. Therein, tramadol can be considered as yet another treatment option for patients with opioid dependence. This symposium would discuss the therapeutic use of tramadol for patients with opioid dependence. The first speaker, Dr. Prabhu Dayal would discuss the applied clinical pharmacology of tramadol and set the rationale for use of tramadol. The context and practicalities of selection of tramadol as a medical option would be discussed. The second and third speakers, Dr. Siddharth Sarkar & Dr Kirti Sharma would discuss some of the retrospective studies which have evaluated the clinical use of tramadol in patients with opioid dependence. This presentation would include studies which have used tramadol for detoxification, as well as for extended detoxification or maintenance. The final speaker, Dr. Piyali Mandal, would discuss the caveats while using tramadol, including the issues of potential diversion. She would also discuss the future avenues of research and the unanswered questions on the use of tramadol in the clinical setting.

Titles of the Speakers:

• Rationale of clinical use of tramadol in opioid dependence: Dr. Prabhoo Dayal
• Experiences of using tramadol for (extended) detoxification of patients with opioid dependence: Dr. Siddharth Sarkar & Dr. Kirti Sharma
• Caveats of using tramadol in patients with opioid dependence: Dr. Piyali Mandal.

Symposium 07: Dual Diagnosis: A View from Clinicians across Different Sites

Siddharth Sarkar, Yatan Pal Singh Balhara, Amit Singh¹, Arpit Parmar²

Department of Psychiatry and NDDTC, AIIMS, New Delhi, ¹Department of Psychiatry, KGMU, Lucknow, Uttar Pradesh, ²Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India. E-mail: [email protected]

Dual diagnosis is a common occurrence in the clinical setting and refers to concurrence of substance use disorders and additional psychiatric illnesses. Referred to by other terminologies as well, presence of two or more disorders sometimes makes the treatment challenging and prognosis guarded. There are differences in approaches to handling dual diagnoses, though often priorities of treatment may run in different directions. Dual diagnosis itself is heterogenous set of permutations and combinations of substance use disorders. Therefore, the features and implications of different combinations may be unique. Nonetheless, a dual diagnosis thinking helps to conceptualize the case better and pay attention to different needs of the patient. In this symposium, we discuss the various facets of dual diagnosis, especially of relevance to Indian setting. The first speaker, Dr. Siddharth Sarkar, would discuss the genesis of Dualdiagnosis India network, an informal network of clinicians interested in the field of dual diagnosis, brought together in a platform. The second speaker, Dr. Yatan Pal Singh Balhara would discuss the different models of dual diagnosis care in India, collated from the participants of these online meetings. The third speaker, Dr. Amit Singh, would reflect upon the process and learning from the monthly case discussions as a part of this endeavour. The fourth speaker, Dr. Arpit Parmar would discuss the future scope of research pursuits in dual diagnosis, especially of issues relevant to India.

Symposium 08: Mental Health Issues in a Disaster Situation

Kshirod K. Mishra, Prashant Mohapatra¹, Samrat Kar²

Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, ¹City Hospital, ²Cuttack, Odisha, India. E-mail: [email protected]

World Health Organisation (WHO) defined disaster as 'a severe disruption, ecological and psychosocial, which greatly exceeds the coping capacity of the affected community'. Developing countries are at high-risk for disaster proneness due to psychosocial challenges like poverty, meagre resources, illiteracy, poor infrastructure, corruption, lack of trained manpower and poor knowledge of disaster mental health. India has faced several natural disasters such as earthquakes, cyclones and tsunamis as well as man-made disasters in the form of terrorism and communal violence. Disasters are known to have substantial effect on both physical and mental health of the affected population. Emotional instability, stress reactions, anxiety, trauma and other psychological symptoms are observed commonly after the disaster and other traumatic experiences. These psychological effects have a massive impact on the concerned individual and also on communities. Psychiatrists can play an important role in assisting individuals and communities to recover from the aftermath of disaster. They bring a unique set of skills and experiences that can be invaluable in minimizing morbidity and facilitating recovery. The importance of psychiatric participation in disaster preparedness is emphasized through this symposium.

Symposium 09: Psychosocial Impact of Migration from India of Youth to Developed Countries

Varghese P. Punnoose, Joice Geo¹, P. M. Jaimon

Government Medical College, Kottayam, ¹Pushpagiri Medical College, Thiruvalla, Kerala, India. E-mail: [email protected]

Human migration is an ancient phenomenon that influences human life and the environment around. Migration from one place to another is for better living conditions, education, employment, etc. Migration has got social as well as psychological underpinnings. It is also a process of people adapting to a new environment involving decision making, making adjustments to the local cultural needs and becoming a part of the new system. Migration is increasing largely at international level and is estimated that 3.1% of the world population are internationally migrated. The concept of migration is wider and can be classified into several types like Internal Migration, External Migration, Immigration, Emigration, Population transfer and so on. There are various push and pull factors for migration as described by Lee and as well as other theories. In India the patterns of migration are changing due to social-cultural, economic, political and legal factors. Migration has definite influence on health, social, economic, cultural, religious and political aspects of human life and among these, impact on the mental health of the migrants is one important area which has to be studied in detail. The impact of migration on the family members of migrants is also an important area to be explored.

This symposium is aimed to discuss regarding these factors in detail.

• Introduction & trends in the new wave of migration: Prof. Varghese P. Punnoose
• Psychosocial impact on parents: Dr Jaimon PM
• Psychological Impact on the migrants: Dr Joice Geo
• Future Trends & Conclusion: Dr Varghese Punnoose.

Symposium 10: Impact of Mental Illness and Addiction on Family and Its Management

G. S. Kaloiya, S. A. Basir¹, Jay Singh Yadav², Prashant Mishra³

National Drug Dependence Treatment Centre, AIIMS, ¹Hamdard and IP University, ³Base Hospital, ITBP, New Delhi, ²Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail: [email protected]

An illness of any sort affects the whole family and not just the suffering one. It shakes the systems and structure of the family along with its functioning. Mental Illness (MI) and addiction in comparison to other physical illnesses have much higher impact on family. Mental illness not only causes distress and crisis among family members but also affects their well-being. Mental illness and addiction force family to change lifestyle, job, role, boundary and take up new roles to survive in the crisis. Family members try to manage the patient with whatever resources they have. These resources drain out quickly and leads to helplessness. They are unable to cope-up with such problems and overcome their sufferings without professional help. Therefore, engaging family members in treatment of the patient not only help in the swift recovery of the patient but also reduces distress among family members. Family members' perception, beliefs, coping etc. get better when they become part of the treatment. Family members response vary towards the affected member and the type of illness as per their position, relation and attachment. In case of addiction parents react differently than the partner and children. Whereas in case of depression, anxiety, etc. the reactions and crisis are different. Issues related to geriatric population affect the family. Family where a member is working in high risk job like military or paramilitary reacts differently. In this symposium, factors related to family with addiction, mental health, geriatric population and paramilitary personnel will be discussed along with their management.

The following topics will be discussed:

1. Impact of addiction on family and its management: GS Kaloiya
2. Impact of mental illness on family and its management: SA Basir
3. Psychosocial issues in geriatrics and its impact on family: JS Yadav
4. Issues and concerns of families of paramilitary personnel: P Mishra.

Symposium 11: Female Sexual Dysfunctions: A Recent Update on Scientific Understandings and Psychological Interventions

Adarsh Tripathi, T. S. S. Rao

E-mail: [email protected]

Sexual dysfunctions are highly prevalent in general population and are often associated with the psychological distress, impairments in interpersonal functioning, quality of life and sexual satisfaction. Prevalence of sexual dysfunctions in females are even higher than the males. The scientific understanding of the female sexual dysfunctions (FSD) is gradually and steadily increasing. Biological, psychological, social, cultural and relational aspects play an intricate, dynamic and complex role in manifestations of sexual dysfunctions in females. Average clinicians are awfully ignorant about the development in the field. This causes difficulty in evaluation, diagnosis, and management of such cases in clinical practice. Due to lack of success in such cases, females in need of intervention for sexual dysfunctions do not seek consultations and suffer in silence.

Evidence based management strategies for female sexual dysfunctions are limited in number. However, there is newer information available that can be useful for clinicians and their clients. Based on neurophysiological, psychological, and other factors, new therapeutic strategies have been tested and found useful.

This symposium aims at updating about newer advances in scientific understanding and treatment strategies in relation to female sexual dysfunctions.

1. Understanding needs, difficulties and challenges of females experiencing sexual difficulties – Prof TSS Rao, Mysore
2. Newer treatment strategies for female sexual dysfunction – Prof Adarsh Tripathi, Lucknow.

Symposium 12: Life Style and Mental Health

World Federation for Mental Health, Indira Sharma, Roy Kallivayalil, Sunil Mittal

E-mail: [email protected]

Background: Unhealthy life style is a major determinant of mental ill-health, and mental and physical morbidity. It is important to understand the same for communities to take steps towards remediation of faulty life styles.

Aim: To present the scientific evidence of various aspects of lifestyle which are detrimental to mental and physical health.

Lay Out of Symposium: Total duration 1 hour.

Introduction: Indira Sharma: 6 minutes.

1. Exercise and mental and physical health: Indira Sharma 13 minutes.
Physical exercise prevents and helps in the treatment of many mental and physical disorders and depressive disorders, obesity, diabetes mellitus essential hypertension, etc. Lack of adequate physical exercise is a risk factor for all causes of death.

2. Diet and mental and physical health: Sunil Mittal: 13 minutes.
Processed food, stored and fast food (e.g. pizza and cheese burger) are being consumed in large amounts, both in urban and rural areas. These foods usually have high fat, salt content, preservatives, colouring agents and emulsifiers. Vacuum-packed foods are infected with Clostridium botulinum. Such foods have been linked to obesity, lack adequate essential vitamins and minerals, and even to malignancy.

3. Social drugs and Health: Roy Abraham Kallivayalil: 13 minutes.
Social drugs such as tobacco (smoked and smokeless) and alcohol are regularly consumed by many people despite existing regulations to control their use, health education, knowledge about harmful effects, and adverse effects on health. Tobacco and alcohol use are major risk factors for a wide range of illnesses including cardiovascular, liver, renal disease, diabetes mellitus and malignancy.

Discussion: 10 minutes.

Delegated participating in the symposium will offer valuable comments.

Concluding Remarks: Dr Sunil Mittal: 2.5 minutes.

Dr Roy Abraham Kallivayalil: 2.5 minutes.

Symposium 13: Development of Panic and Anxiety National Indian Questionnaire

Pratap Sharan, Manoj Sahu¹, H. R. Sowmya², Suprabha Shrivastava, Mahjabin Nayeem

AIIMS, New Delhi, ¹Pt. Jawaharlal Nehru Memorial Medical College, Raipur, Chhattisgarh, ²St John's Medical College Hospital, Bengaluru, Karnataka, India. E-mail: [email protected]

Background: Anxiety disorders are major public health problems. Screening tools have to be developed to detect these disorders effectively at the community level as at least half of these disorders remaining undetected. There is a high degree of cross-cultural variability in the prevalence and presentation of the anxiety disorders. Hence, there is a need to study the phenomenology of anxiety disorders in non-Western cultural contexts and to develop culturally appropriate assessment measures.

Objective: To develop Panic and Anxiety National Indian Questionnaire (PANIQ).

Methods: Draft of the PANIQ questionnaire was developed by items selected from case files, patient interviews, literature review and focus group discussions. The draft PANIQ scale were administered to 2700 (900 each in AIIMS, Delhi, St John's Bengaluru, and Pt JNMMC, Raipur) adults. The PANIQ tool was administered along with socio-demographic variables, Global Mental Health Assessment Tool (GMHAT), Prime MD Patient Health Questionnaire, Panic Disorder Severity Scale, PGI N-2 and Montgomery Asberg Depression Rating Scale and Brief Scale to measure Anxiety. Exploratory factor analysis and Confirmatory factor analysis was conducted for the data reduction and data coherence of the PANIQ Tool.

Results: CFA was conducted on the full data set for panic disorder (PD) and generalized anxiety disorder (GAD) separately. In GAD we looked for replicable factors across the 3 centres (factor congruence of 0.6 in at least 2 centres) across 3-20 EFA solutions. The GAD EFA suggested a 3-domain solution ('Core', 'Cognitive' and 'Somatic'). In PD items, we looked for replicable factors across the 3 centres (factor congruence of 0.5 in at least 2 centres) across 3-20 EFA solutions. The PD EFA suggested a 3-domain solution ('Catastrophization', 'Cognitive', and 'Somatic'). CFA result suggested 10 base facets for a unidimensional GAD model including Core, Cognitive, Worry, Concentration, Work, Performance-social anxiety, and Sleep, Muscle tension, Breathlessness, Heart-chest and Other autonomic. CFA result suggested 9 facets for PD: Catastrophic cognition, Breathlessness, Heart-Chest, Loss of behavior control, Altered mental function, Gastrointestinal, Muscular tension, Sensory overload and Other autonomic.

Conclusion: Result suggested full model with 3 broad factors as core, cognition and somatic in GAD and full model with 3 broad factors as catastrophization, cognitive and somatic in PD.

Presenters:

Pratap Sharan: Introduction.

Manoj Sahu: Methodology.

Sowmya HR, Priya Sreedaran, Ashok MV: Cultural manifestation of anxiety domains in anxiety disorder group.

Suprabha Shrivastava: Exploratory Factor Analysis.

Mahjabin Nayeem: Confirmatory factor analysis.

Symposium 14: Are You What You Eat? Clinical Expressions and Experiences of Eating Habits and Eating Disorders in Children, Adolescents and Young Adults

C. A. Smitha, Vidya Ganapathy, Sheena G. Soman

E-mail: [email protected]

This Symposium brings out a multidimensional clinical discussion of the issues related to eating which we see in day to day Psychiatry practice which ranges from hardcore eating disorders to eating habits related to various psychopathology. The speakers from their expertise and experience in working with youngsters will elaborate on how the mental health issues and eating habits are connected, Psychosocial factors that influence the eating habits and the eating disorders, Common presentations, co-morbidities and The preventive and management aspects.

1. Eating habits, body satisfaction, social standards and mental health of youngsters - Gliding through the tangled hanks.
The social factors that influence the youngsters including peer pressure, media and culture and the manifestation in a pathological way will be the focal point of this section. How the beliefs and misinformation related to food and nutrition affects the thoughts feelings and behaviours of the youth will be discussed. Body dissatisfaction and orthorexia nervosa among the youth will also be explored in this session.
Dr. Smitha C A; Ass. Professor in Psychiatry; Govt. Medical College, Kozhikode.

2. Eating Disorders in Youngsters - Looking through a clinician's lens.
In this section the speaker will be elaborating about the eating disorders that are commonly encountered in the consultation room. The common presentations and the challenges will be discussed in detail.
Dr. Vidya Ganapathy; Consultant Child Psychiatrist, TDH, KEM Hospital, Pune.

3. Tackling the co-morbidities and the complications - Exploring the Feasible Interventions.
In this session the speaker will be discussing the common co-morbidities and anticipated complications of the eating disorders. Management strategies considering the biopsychosocial aspects will also be discussed.
Dr. Sheena G Soman; Consultant Psychiatrist, Govt. Mental Health Centre, Thiruvanathapuram.

Symposium 15: Mental Health Issues and Substance Use among Medical Students

Sandeep Grover, Adarsh Tripathi¹, Siddharth Sarkar²

Department of Psychiatry, PGIMER, Chandigarh, ¹Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, ²Department of Psychiatry and NDDTC, AIIMS, New Delhi, India. E-mail: [email protected]

Medical education has been considered to be a stressful experience. During medical graduation, students are expected to have a wide theoretical knowledge, and gain skills in various domains (like surgical skills, laboratory skills, communication skills etc.) to become a successful professional. Added to that are societal and familial expectations and own desire to excel and become renowned in their field. However, medical students are also humans who may have mental health and substance related issues, as young adults from the general population.

This symposium would discuss the mental health and substance use related concerns among medical students. The symposium would also discuss the barriers to seeking help among the medical students, as despite healthcare being available in close quarters and knowledge of disorders being there, many students do not seek care. The first speaker, Dr. Sandeep Grover would discuss the extent and patterns of mental health issues among medical students. The commonly encountered disorders and their manifestations would be discussed. The second speaker, Adarsh Tripathi, would discuss the barriers to seeking care among medical students. The speaker would discuss the ways in which the barriers to seeking mental health care can be reduced. The third speaker, Dr. Siddharth Sarkar would discuss substance use and behavioral addictions among medical students and the ways it can be addressed.

Symposium 16: Psychiatric Comorbidities and Its Management in Psoriasis

Priyanka Sharma, Anshuman Tiwari¹, A. Q. Jilani², Deepak Sharma³

Department of Psychiatry, G. R. Medical College and JAH, ³Department of Dermatology, G. R. Medical College, Gwalior, Madhya Pradesh, ¹Department of Psychiatry, S. M. M. H Medical College, Saharanpur, ²Department of Psychiatry, Dr. R M L Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. E-mail: [email protected]

Chronic skin disorders have currently been assessed considering not only their physical aspect but also the related psychosocial issues. Psoriasis is relatively common, chronic, inflammatory & hyperproliferative skin disease that affects 1.4 % to 2% of the population. Many people with Psoriasis isolate themselves because of such a deep sense of shame, embarrassment & low self-esteem because of cosmetic disfigurement. It is estimated that at least 10 percent of psoriasis sufferers have a severe form that causes disability & exclusion from a normal life.

All these factors lead to a situation affecting the psychological health of patients of psoriasis. As a matter of fact, psychiatric comorbidities are highly prevalent in patients of psoriasis with depression and anxiety most common disorder. Both psoriasis & psychiatric disorders individually have chronic debilitating course with significant suffering and distress therefore.

Addressing the psychological aspects of dermatological disease may help minimizing frequency of symptom exacerbations in patients of psoriasis. Similarly, management of dermatological symptoms may reduce negative emotional responses such as anxiety & depression that can be secondary to the nature of dermatological symptoms. Liaison between dermatologist & psychiatrist in the treatment of psoriasis would be of great help for such patients.

In our symposia we will talk about the psoriasis, psychiatric comorbidities associated with it and its management.

The symposia will be discussed under the following heading:

1. Introduction about Psoriasis - Dr Deepak Sharma
2. Psychiatric manifestation in patients with Psoriasis - Dr Priyanka Sharma
3. Management of co morbid Psychiatric disorders in Psoriasis - Dr Anshuman Tiwari & Dr A Q Jilani.

Symposium 17: Roles of Psychiatrists in Emergency Medical Services

Ajay Kumar, Aseem Mehra¹, Arti Yadav²

Department of Psychiatry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, ¹Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, ²District Hospital, Barabanki, Uttar Pradesh, India. E-mail: [email protected]

Many patients visiting medical emergencies either require psychiatric interventions primarily or for their comorbid psychiatric condition. The common psychiatric conditions in patients visiting medical emergencies are anxiety, neurosis, somatic complaints, substance use disorder, abnormal behaviour, self-harm, and suicide in India.

A physician can treat physical illness and injuries but is less equipped to deal with the psychiatric crisis. Unaddressed mental health issues often result in disastrous outcomes such as suicide; hence, a psychiatrist has a crucial role in an emergency. Their presence can greatly help detect and manage psychiatric sufferings at the earliest, reducing violence, need for physical restrain, serious substance withdrawal, suicidality, coercive treatment, improving outcomes, and even reducing the overall hospital stay of the patient.

The psychiatrist also trains and empowers other team members of emergency medicine in education on suicidality, use of psychotropics, de-escalation and benefits of avoiding restrains.

Telepsychiatry can also be used effectively in an emergency setting; a quick two-way video can be handy when physical consultation is not feasible, especially in conditions like the COVID-19 pandemic.

There are several backdrops to emergency psychiatry in India, poor orientation, lack of specific guidelines and policies, and most importantly, inadequate focus on training; emergency psychiatry has not been recognised as a speciality until recently in India. Primarily psychiatric emergencies are dealt on-demand basis as an “on-call service”. There is a need to focus on training and developing a dedicated team of a psychiatrist working closely with other members of emergency medicine and in all the GHPUs in the country.

Symposium 18: Working in Community: CAPPS Approach to Make Mental Health and Well-being for All a Global Priority

Purushottam, Vinay, Priti Singh, Sunila

E-mail: [email protected]

1. Mental health & well being: understanding the significance in post-COVID period
2. Community and Preventive Psychiatric Services: The Step Forward
3. Focusing on Mental health & well being with legal perspective
4. Road map to future.

Mental health and well being is holistic view which encompasses psychological, social religious and spiritual balance with a feeling of containment and positive attitude towards life. Mental health and well being is holistic view which encompasses emotional, social religious and spiritual balance with a feeling of containment and positive attitude towards life. Mental health has its significance for an overall growth and progress of an individuals and community.

COVID-19 emerged as global pandemic. Lock down and frightening results of infection had a gross impact on mental health of citizens and is still haunting the psyche and well being. Many mental health issues have been witnessed.

A multidisciplinary team of Community and Preventive Psychiatric Services (CAPPS) was constituted at Institute of Mental Health to look into the mental health services in background of these issue as well as to provide services in accordance with the Chapter VI of MHCA-19.

Focusing on bio psycho social model, the approach to mental health and well being is quite different from medical approach and illness concept. The CAPPS team followed the same. Focus on lifestyle modification which include regulation of sleep wake cycle, diet, exercise, yoga, meditation and pranayama help in restoring the well being and should be incorporated. Thus, the preventive importance of diet and life style modification was continuously discussed with various groups. Mental health of caregivers should also be focused along with the mental well being of mental health professionals,

Investing in self rediscovering old hobbies and spending quality time with family and in groups need to be promoted. All these approaches need moving in the community and with the community for making mental health and well being for all a global priority.

Symposium 19: Traumatic Life Events and Psychopathology in Adolescence and Young Adulthood: Theories, Neurobiology and Pathophysiology, Impacts, Assessment, and Intervention

Ananya Mahapatra, Vandana Choudhary¹,Rishi Gupta², Sujata Sathpathy³

Dr. Baba Saheb Ambedkar Hospital and Medical College, ¹Independent Practitioner, ²Manokalp Clinic, ³Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]

Psychological stress from cumulative traumatic life events in early life has been demonstrated to be associated with an increased prevalence of anxiety, depression, mood, substance use disorders, and emotionally unstable personality disorders in the adolescent population, and severely impact and diminish their quality of life. Several psychological and biological theories have been postulated to determine the pathways that link the response to adverse childhood events with the development of psychopathology in adolescents. However, there is a paucity of research identifying specific profiles or combinations of exposure to forms of adverse childhood events and their impact on adolescent psychopathology. Also, associations between traumatic life events and internalizing psychopathology in adolescents, have been reported to be bi-directional, and often involve a complex interaction between stressors across developmental trajectories.

Objective: The current symposium will highlight the theoretical models that conceptualize the interaction between traumatic life events in early life and the development of psychopathology in adolescents. It will describe the current status of pathophysiology and neurobiological research, to delineate the brain areas and neural networks implicated. It will further detail the impact of trauma on the course and outcome of mental disorders in an adolescent population. Finally, the symposium aims to provide a comprehensive overview of current assessment and intervention strategies with a specific focus on traumatic life events, for the management of adolescent psychiatric disorders.

Symposium 20: Dimensions of Social Psychiatry in COVID-19 Era

G. Prasad Rao, U. C. Garg, N. N. Raju

E-mail: [email protected]

The COVID-19 pandemic is the most serious global threat to public health in this century. The first reports of a cluster of novel coronavirus came in December 2019 in the Wuhan city of Hubei Province in China. Due to the proximity and various links to China, COVID-19 had badly hit Asia early on, along with several Pacific islands countries. During October 2020, the daily new cases in India were at around 80 000, making it the worst hit country in terms of cases. Although all countries faced difficulties due to Covid-19, South Asian countries in particular have had to deal with a more challenging situation due to their large population, weak health facilities, high poverty rates, and low socio-economic conditions. To contain the spread of the virus, South Asian countries, particularly India had imposed stringent lockdowns across the country, which affected the lives and livelihood of the people.

There has been a rise in several psychosocial determinants of mental health across the globe both during and post-COVID pandemic. The economic, social, and physical stressors of pandemic affect the low and middle- income countries population, such as emotional distress due to separation from loved ones, social disruption due to loss of freedom, uncertainty about the advancement of the disease, and the feeling of helplessness. These aspects might lead to dramatic consequence, such as the rise of suicide. Suicidal behaviors were often related to the feeling of anger associated with the stressful condition widely spread among people who lived in the most affected areas. Health-care workers are another segment of population particularly affected by the pandemic stress. Psychosocial care not only may help people cope with stressors but also help communicate public health measures to vulnerable population in a way that is more easily accessible and comprehensible.

Symposium 21: Integrating Perinatal Mental Health Care: Service Delivery Models

Prerna Kukreti, V. Ramesh, Bhavuk Garg

Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Perinatal mental health has significant impact on maternal and neonatal morbidity as well as mortality. But in Asian countries, it is still practiced as isolated models of care than being woven in routine obstetric and neonatal health. This symposium presents magnitude of perinatal mental health problems and innovative solutions to address the same.

Perinatal Mental Health Problems: Burden and public health approaches: Dr Omsai Ramesh V, Professor, Dep of Psychiatry, Lady Hardinge Medical College, Delhi, India.

This section will discuss magnitude of different perinatal mental health problems and concerned existing health programs & policies.

Integrated maternal mental health service: Innovative models across South Asia: Dr Prerna Kukreti, Associate Professor Psychiatry, Lady Hardinge Medical College, Delhi, India.

Despite huge burden of maternal mental health morbidity, service implementation still remains a challenge. This section will focus on innovative models developed by various south Asian countries ranging from screening programs to intervention programs. It will also discuss a stepped care model developed in India, Brief INtervention for Depression in Pregnancy (BIND-P) model.

Capacity Building in Perinatal mental health: Training manpower from reproductive Child health Care setting.

Dr Bhavuk Garg, Associate Professor Psychiatry, Lady Hardinge Medical College, Delhi, India.

This section will focus on how to build capacity for doctors, nursing health care and primary health care providers in obstetrics, pediatrics and other programmatic settings of reproductive Child health Care.

Symposium 22: Smartphones and Elderly: Opportunities, Problem Use and Mental Health Perspective

Sajjadur Rehman, Nitin Raut, Shipra Singh¹

Department of Psychiatry and Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, ¹Department of Psychiatry, PGIMS, Rohtak, Haryana, India. E-mail: [email protected]

Global percentage of elderly smartphone owners and users has increased steadily. Reasons may be varied like smart-phones have become a single gadget to fulfill varied needs like communication, accessing social media, paying bills, entertainment including gaming and other day to day needs like ordering groceries to ordering cabs and so on. However current literature suggests that the link is beyond mere utility in day-to-day activities and has possible mental health dimensions. This Symposium intends to provide insight upon benefits of smartphone usage in elderly, possible problematic use and relationship of smartphones in various mental health aspects in elderly.

Smartphone uses in elderly: Introduction and overview: This section will provide the magnitude and overview of normal smartphone use in elderly: Dr. Sajjadur Rehman.

Smartphone use in elderly: The good and the bad- Mobile phone usage in elderly has its pros and cons. This section will highlight the two aspects in elderly: Dr. Shipra Singh.

Smartphone use in elderly: the mental health perspective- Dr. Nitin Raut.

Smartphone as a technology has huge potential for utilization in area of elderly mental health. This section will briefly discuss the role of this technology in various aspects of elder mental health.

Symposium 23: Medical Student Mental Health: Exploring Systems of Well-being in the New Millennium

Pratap Sharan, Aishwarya Raj, Divyani Khurana, Suprabha Shrivastava

Department of Psychiatry, AIIMS, New Delhi, India. E-mail: [email protected]

Pratap Sharan: Introduction and the need for Student wellness.

Aishwarya Raj: Various facets of wellness, curriculum and curricular restructuring.

Divyani Khurana: Innovations at Student Wellness: Moving beyond the usual.

Suprabha Shrivastava: Way forward and Conclusion.

Medical education is a journey of tremendous changes and developments which are both personal and professional hence posing challenges to maintain the well-being. Plethora of available research has identified stressors such as demanding academic structure, lack of control over one's schedule, sleep deprivation, adjustment difficulties and interpersonal conflict. Another important facet is the course of medical education in the pandemic over the recent years. The past two years during the pandemic saw cancellation of physical clinical postings, to digitization of physical classes thus presenting new set of challenges to the quality of medical education and well-being.

Available systems have focused on reducing distress and enhancing student wellness and many top tier medical schools have utilized many interventions to reduce student distress and enhance student well-being. Students are often asked to maintain hobbies, enhance their social support system, and work towards resilience in order to protect their mental health. It is interesting to know that these systems are varied yet have a similar undertone to what they have been trying to achieve with respect to student well-being.

Though there have been efforts to develop ways to ameliorate the effect of these stressors there is a lot to be yet explored. Wellness initiatives for students require innovation in terms of usability and applicability to increase the range of services and better student engagement. These innovations range from peer support to technology driven approaches.

Through this symposium we are attempting to talk about exploring the available systems of well- being in the new millennium and efforts of Student Wellness Centre, AIIMS, New Delhi towards students' well-being and way forward.

Workshops

Workshop 01: Enhancing Effectiveness of Case Work, Counselling and Psychotherapy Practice by Developing Micro Skills of Listening

V. Sayee Kumar

Counselling and Psychotherapy, Chennai, Tamil Nadu, India.

E-mail: [email protected]

Introduction: Listening is an integral skill for any mental health professional which are must for both assessment and therapeutic procedures. Counselling and Psychotherapy are intended to attend emotional concerns of people in close quarters. When this happens in the clinic it is a challenge for professionals to master the micro skills in listening.

Background and Need: Unlike in physical medicine, mental health practice any other therapeutic intervention, psychotherapy is unique in addressing the most personal concerns of people in close quarters. While good listening is a basic requirement to be a therapist, but it is equally important to refine and develop it as a core competency for a mental health therapist. Due to limited facilities for systematic psychotherapy, counselling and social case work training in India, our graduates in mental health come out either untrained or under-trained in therapy. This is true especially in mastering specialized skills like active listening, advanced empathy and many others. But the demand for such services in India is growing.

Identified Objectives:

1. To sensitise and develop skills of the participants of the therapist's verbal and non-verbal behaviours during therapy
2. To offer a training opportunity to our MH Professionals for some experiential learning
3. To explore various nuances of therapist – patient communication in Indian context.

Methods: So, it is proposed to conduct this exercise with a format which includes a combination of brief guided presentations, lecture, discussion, group interaction, demonstration, role play, evaluation and exercises. A care is taken to make the content and process relevant for Indian setting. At the end there will be a feedback and reflection from the participants. It is an attempt to share the knowledge and build a competency in therapeutic listening of the participants. In a fast-developing country like India, it is very important to ensure required human resource development in the mental health.

Conclusion: So, the best alternative is to offer short term and focused competency building exercise in psychotherapy skills in professional meets. This workshop is best suited for residents, interns and budding professionals in mental health disciplines who will find it useful. Mid and senior level practitioners may find it interesting to update themselves.

Workshop 02: Designing and Conducting Support Groups

Ruksheda Syeda, Wilona Braganza, Kashypi Garg

E-mail: [email protected]

Aims:

1. To orient psychiatrists in understanding the increasing need of support groups for psychiatric disorders for various types of target populations
2. To train psychiatrists to design and structure support groups addressing the different concerns
3. To share tips on the practical logistical & social media aspects of conducting support groups in the Indian context
4. To enhance skills of reaching out to individuals with mental illness and their caregivers.

Outline: Support groups or self-help groups for mental health are one of the most common types of research-based support available. While qualitative research shows positive evidence and quantitative research shows mixed evidence when it comes to showing favourable effects on the symptoms and the social functioning of patients, there is still inadequate effort directed towards researching about and running support groups given the mental health burden and the treatment gap observed in the Indian context. Unfortunately, the processes which impact the recovery processes involvement in self-help groups are not fully understood and hence it stands as one of the major hurdles in being recommended as part of treatment. Researchers and mental health consumer advocates argue that the approach to recovery from mental illness should emphasize not just on the symptoms of the disorder but also on the 'life-context' of these individuals. Hence, recovery should be described not merely as some end-point, but a social-psychological process. These trainer-facilitated but member governed groups provide social support and knowledge by interaction with peers probably experiencing similar symptoms and, in many ways, finding acceptance by their “own”. This important step provides cognitive changes that improve the quality of the stigmatized individual's life. Peer services allow very high levels of acceptance and understanding which no other professional relationship could possibly reciprocate.

The Covid pandemic has been mentally exhausting for majority people and has also exacerbated or worsened a lot of psychiatric disorders. During this time, although psychological help was available, it was remote or difficult for everyone to approach and the need for support groups has surfaced. Considering this need, many poorly directed online support groups have mushroomed.

Unfortunately, in India, there is a paucity of peer support service in providing mental health service to a large extent. Surprisingly, there is no provision of peer support in either government programs like the National Mental Program or the National Health Policy of India considering the fact that it will require a good level of funding and investment.

With this aspect in mind, this workshop would include training psychiatrists to design and conduct well-functioning and professionally supervised support groups. This workshop would include presentations, personal experiences of conducting support groups, oral discussions and group activities to empower psychiatrists to tap into this much needed resource for recovery of patients with mental illness.

Workshop 03: Tips for Writing and Submitting a Research Paper: A Workshop for Young Mental Health Professionals

Nitin Gupta, Hitesh Khurana¹, Siddharth Sarkar²

Gupta Mind Healing and Counselling Centre, Chandigarh, ¹Department of Psychiatry, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, ²Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India. E-mail: [email protected]

Research findings are important to advance the field of mental health and document the incremental progresses made in the sciences. However, research needs to be disseminated to the interested readers to update their knowledge, enhance the scientific discourse and stimulate further research. The process of publication is the means through which scientific evidence is scrutinized (and sometimes harshly), before it becomes a part of the established scientific literature. Many general and speciality journals exist which cater to different audiences, and have different scope. A young researcher needs to be aware of the publication processes so that their contributions reach the desired audience and scholarly discussions. Their hard work of conducting the research may not realize the optimum potential if they are unaware of the publication processes, what is desirable from the point of view of the editors and reviewers, and what goes on in establishing in the research landscape. This workshop will shar the tips for writing and submitting a research paper with younger mental health professionals. The workshop would be conducted by the Editor and Deputy Editors of the Indian Journal of Social Psychiatry, the official journal of the Indian Association for Social Psychiatry. The workshop would discuss what editors are looking for in an article sent to a journal for potential publication, and how to choose a journal for publication. It would also describe the review process and what authors should be mindful about responding to reviewer's comments. The workshop also would discuss about reporting guidelines, publication ethics and plagiarism. The workshop encourages younger mental health professionals to discuss their concerns and questions pertaining to publications in scientific journals.

Free Papers (ORAL)

Free Paper 01: Caregiver Burden in Primary Caregivers of Children with Intellectual Disability Disorder

Abhilakshya Jyoti, Prerana Gupta

Teerthankar Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Intellectual disability is not a single, isolated disorder. It often originates before the age of 18 and is characterised by significant limitations both in intellectual functioning and in adaptive behaviour. In India, around 2% of the population is affected by intellectual disability. Raising a child with a disability has been recognised for some time as a major source of burden and distress in family caregiving. A caregiver is a person who supports and cares for some person diagnosed with chronic or debilitating medical condition. Psychiatric problems have a significant effect on both patients and their caregivers. While much attention has been paid in the literature to parental stress, less attention is paid to caregiver burden, defined as the strain or load borne by a person who cares for a family member with a disability.

Aim and Objectives: To find out the caregiver burden in primary caregivers of children with Intellectual disability disorder.

Materials and Methods: Children coming to the Department of Psychiatry and Department of Paediatrics with a diagnosis of Intellectual Disability Disorder will be taken up for this study. The primary caregiver will be identified. Exclusion as well as inclusion criteria will be applied. Detailed psychiatric interview will be done by the consultant psychiatrist to assess for any active mental disorder. Caregiver burden scale will be applied to the primary caregivers and data will be subjected to statistical analysis.

Results: Will be discussed at the time of presentation.

Free Paper 02: Perception on Anxiety among Adolescents and Mental Health Professionals and Development of Comic Strip

K. Latha, M. R. Pravitha, K. S. Meena, Aruna Rose Mary Kapanee¹, S. K. Chaturvedi

Departments of Mental Health Education and ¹Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India. E-mail: [email protected]

Background: Adolescence is a phase of many physical and psychological developments. This stage is also vulnerable for development of mental illness. Anxiety is one of the most prevalent disorders among adolescents which mostly onsets before puberty. This study aimed to understand the perception on anxiety among adolescents and mental health professionals and develop a comic strip on anxiety.

Methods: It was a qualitative study which involved Focus Group Discussions (FGDs) among mental health professionals and pre-university college students. The FGD data was analysed through direct content analysis according to the predetermined broad themes.

Results: The themes included general awareness, factors responsible, symptoms and coping, management and barriers to seeking professional help. Awareness regarding anxiety was poor among adolescents and they were found to be reluctant to seek professional help in certain situations. The findings from the FGD were incorporated to develop a comic strip on anxiety for adolescents.

Conclusions: Adolescents were not aware about anxiety but they just understood that there was some problem. The barriers for not seeking professional help included lack of support from parents & family, lack of confidentiality and stigma. The comic strip on anxiety was developed with the findings and is expected to reduce stigma, improve awareness and aid in early identification and effective management of anxiety among adolescents.

Free Paper 03: Effectiveness of WHO Toolkit Based Telephonic Smoking Cessation Intervention on Tobacco Use and Level of Motivation among Dependent Smokers with Pulmonary Diseases: A Randomized Control Trial

Santosh Kumar Barik

E-mail: [email protected]

Introduction: People who smoke cigarettes on a regular basis have their airways and lungs affected by tobacco smoke. Smoking causes a variety of respiratory diseases, including asthma, lung cancer, chronic obstructive pulmonary disease (COPD), TB, and a variety of chest infections, as well as gradually lowering smokers' immune. Three out of four smokers who are aware of the negative consequences of smoking want to quit. Telephone services can give proactive and reactive smoking cessation assistance to callers. The goal of this study is to deploy a telephonic interactive smoking cessation intervention to reduce tobacco use and improve motivation to quit among dependent smokers seeking treatment for pulmonary OPD for pulmonary problems.

Methods: The current study was a randomized pre-test post-test control group design; sixty-eight dependent smokers were randomized into experimental (n1 = 34) and control group (n2 = 34) using allocation concealment method. The baseline assessment of socio- demographic, clinical profile, tobacco use were assessed using case intake proforma, nicotine dependence using Fagerstrom test for nicotine dependence (FTND) questionnaire and level of motivation by Readiness to change questionnaire (RCQ). The smokers in experimental group underwent a WHO Toolkit based smoking cessation counselling intervention which was conducted in three sessions of 15-20 minutes duration within a gap of 7 days along with a 4th week of WHO inspired standardised text message and the smokers in control group were given routine treatment as usual. Tobacco use profile and level of motivation were reassessed for both the groups after one month of the initial assessment.

Results: The sample characteristics were comparable between experimental and control group at the baseline. Following the WHO Toolkit based smoking cessation interventions, there was a significant reduction in the daily use of bidi/cigarettes; Greater reduction in the daily use of bidi/ cigarettes was found in the subjects in the experimental group than in the control group. (P < 0.001), (P < 0.001) respectively. There was a significant difference in the two groups based on their post-test tobacco use status (P = 0.02). There was significant difference found in the post-test level of motivation between the two groups (P < 0.001).

Conclusion: Smoking cessation counselling based on the WHO Toolkit assists dependent smokers with pulmonary problems in changing their tobacco use behaviour and increasing their motivation level. In order to improve motivation and change smoking behaviour in smokers, a trained counsellor and ongoing intervention are essential.

Free Paper 04: Perceived Barriers to Disclosing Intimate Partner Violence to Health Professionals

Mysore Narasimha Vranda, Navaneethan Janardhana

Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]

Introduction: Intimate partner violence (IPV) against women is the major public health problem around the globe. Health care providers play a vital role in screening of IPV. When it comes to the disclosure of violence women hardly disclose to the health care professionals. The barriers and challenges in disclosing IPV among the survivors in health care professionals yet to be explored.

Methods: It was qualitative research conducted at a tertiary care psychiatric setting. An in-depths interviews were conducted with twenty-five women with mental illness experiencing IPV to understand perceived barriers to disclosure of IPV among mental health professionals using purposive sampling.

Results: The analysis revealed fear of retaliation from their abusive spouses, lack of confidence in the clinicians, fear of repercussions are the individual level factors for non-disclosure. At the professional's level lack of privacy, and presence of abusive partner and unempathetic attitude of professionals, fear of re-victimization are the factors for the non-disclosure.

Conclusion: The findings of the study highlighted the need for training of mental health professionals to respond to IPV in the clinical setting.

Free Paper 05: A Study on Perceived Experiences, Barriers, and Facilitators in Seeking Treatment among Women with Substance Use Disorders

Adharsa Ajayan, Mysore Narasimha Vranda, Arun Kandasamy¹

Departments of Psychiatric Social Work and ¹Psychiatry, National Institute of Mental Health Neuro Sciences, Bengaluru, Karnataka, India. E-mail: [email protected]

Background: The use of substances has always been considered as a male phenomenon, leading the researchers to conduct studies mostly among the male population. This study on the other hand was conducted among women to understand their perceived experiences, barriers, and facilitators in seeking treatment.

Methods: 20 WwSUDs availing treatment under the De-addiction Centre were recruited using a consecutive sampling. A mixed methodology design adopted to collect the data. Allen Barriers to Treatment Instrument (ABTI), and IDIs were used to collect the data about barriers and facilitators to avail services among WwSUDs.

Results: The findings revealed that a lack of knowledge about the treatment, responsibilities at home, perceived stigma, myths about treatment related aspects are the some of the barriers to seeking treatment. Family support, health concerns, and self-thought as some of the facilitators for seeking treatment.

Conclusion: The study highlighted that psychosocial barriers and facilitators are more than systemic and structural barriers and facilitators indicating the need for gender-specific treatment care for WwSUDs.

Free Paper 06: Study of Factors Leading to Sexual Abstinence and Emergence of Psychosomatic Symptoms in Women of Postpartum Period

Drishti Sharma, Gautam Anand

Department of Psychiatry, Muzaffarnagar Medical College and Hospital, Uttar Pradesh, India. E-mail: [email protected]

Sexual abstinence is practice of refraining from some or all aspects of sexual activity for medical, psychological, legal, social, financial, moral or religious religions. Postpartum abstinence refers to the period of voluntary sexual inactivity after child birth and is mainly a period when nursing or breastfeeding mother is expected to keep away from the husband sexually.

Aim: To study psychosexual factors leading to sexual abstinence and emergence of psychosomatic symptoms in women of postpartum period.

Methods: Randomly selected 50 patients of postpartum period interviewed on structured questionnaire based on Arizona sexual experience scale, relation somatic symptoms checklist, beck depression inventory, general health questionnaire and quality of marriage index.

Results and Conclusions: The obtained data will be finally computed and analysed. Physical changes, psychological consequences and mother and fatherhood responsibilities over priority to children have effect on psychosocial livelihood.

Free Paper 07: Study on the Barriers Preventing Legalization of Cannabis Based on Duration of Use, Emergence and Variation in Clinical Features and Diagnosis in Tertiary Care Hospital, Muzaffarnagar

Harsh Singh, Gautam Anand

Department of Psychiatry, Muzaffarnagar Medical College and Hospital, Uttar Pradesh, India. E-mail: [email protected]

Habitual use of cannabis is the primary barrier for legalization of cannabis. The use of cannabis is prohibited under the NDPS act since 1985. Legalization is one of the ways to limit the use of cannabis.

Aim: Study on the barriers preventing the legalization of cannabis based on Duration of use, emergence and variation in clinical features and diagnosis in tertiary care hospital, Muzaffarnagar.

Methods: Randomly selected 50 patients of cannabis users of variable time period will be selected for the study. The following scales will be applied – (1) Brief Psychiatric Rating Scale (BPRS); (2) Hamilton Anxiety Rating Scale (HAM-A); (3) Severity of Dependence Scale (SDS); and (4) General Health Questionnaire (GHQ).

To find the reason behind the need for legalization.

Opinion poll – Resulted to legalize the cannabis use so as to substitute other substances which are more harmful.

Free Paper 08: Association of Internalizing and Externalizing Behaviours of Children with Screen Time: A Cross-sectional Study

Akul Gupta, Manish Tyagi

Department of Psychiatry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Objectives: While it has been purported that excessive screen time can lead to behavioural problems, it has also been suggested that children with behavioural dysregulation receive more access to screens to manage problematic behaviour. This study examines associations between screen time and externalising and internalising behaviours across childhood to identify the need for psychiatric evaluation.

Methods: Data was collected using google forms distribution among parents of children aged 6-14 years studying in a private school in an urban city and organised age-wise in 4 groups. The self-administrable form comprised of semi-structured proforma to record the demographic data and screen time in hours/day. The externalizing and internalizing behaviours were measured using the Strengths and Difficulties Questionnaire (SDQ) and the cognitive, emotional, and behavioural problems were identified using the Pediatric Symptom Checklist (PSC) via parent/caregiver report. Statistical analysis will be used to assess and establish a temporally stable (i.e. “timevariant”) association.

Results: Results are awaited and will be discussed at the time of presentation.

Conclusions: Conclusions derived from the results after statistical analysis will be discussed at the time of presentation.

Free Paper 09: Assessing Emotional States and Risk of Adjustment Disorder in a Sample Transitioning Back to Office after the COVID-19 Pandemic

Prashant Singh, Manish Tyagi

Department of Psychiatry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Objectives: Due to prolonged lockdown and adoption of work from home model people experienced social isolation, disruption of lifestyle, the stress of relocation and loss of productivity. This study is to investigate the psychological impact of the workforce transitioning back to the office after adapting to the new normal of working from home and reorganizing their lifestyle by measuring their emotional states (depression, anxiety and stress) and identifying individuals at high risk for adjustment disorder.

Methods: Data was collected using google forms distribution among people working from home for at least 2 years duration and transitioning back to the office. The self- reportable form comprised of semi-structured proforma to record the individual demographic data, the 21-item Depression Anxiety Stress Scale (DASS-21) to measure the emotional states and the 8-item Adjustment Disorder – New Module (ADNM-8) to identify core symptoms of Adjustment disorder. Statistical analysis will be used to assess and analyse the collected information and discover an association amongst various domains.

Results: Results are awaited and will be discussed at the time of presentation.

Conclusions: Conclusions derived from the results of statistical analysis will be discussed at the time of presentation.

Free Paper 10: Cross-cultural Adaptation and Psychometric Properties of the Kessler Distress Scale (K10) among Caregivers of Elderly Population in Community Setting

Arif Ali

Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India. E-mail: [email protected]

Background: The Kessler Psychological Distress Scale (K10) has been widely used in general and clinical populations for assessing psychological distress. However, whether it can be used in caregivers of elderly population in community setting and its reliability and validity in culturally diverse groups is unknown.

Objective: To evaluate the psychometric properties of an Assamese version of the Kessler Psychological Distress scale (A-K10) in an elderly population in Assam, India.

Methods: The present study will follow a cross-sectional survey design. For the present study two rural revenue blocks- Tezpur and Biswanath of Sonitpur district of the State of Assam were selected from the study location. A total of 1993 individuals from the general population participated in the study. Assamese version of the Kessler Psychological Distress scale was developed by translation and back-translation by a panel of native speakers of both English and Assamese. The translated instruments were administered to caregivers of elderly person from a community sample. The content validity, construct validity, reliability, internal structure, and external reliability were analyzed using standard statistical methods.

Results: The K10 demonstrated very acceptable reliability and validity in screening psychological distress in caregivers of elderly population. In the present study, Bartlett's Test of Sphericity was found to be significant (P < 0.001). In the present study all the items with high values were well represented in the common factor space and the final commonalities (extracted) was above (P < 0.5). So, all the Kessler Psychological Distress Scale 10 items (K10) were retained. The Kessler Psychological Distress Scale 10 items (K10) factors were identified with Eigen values ranging from 0.110 (1.10%) to 6.86 (68.6%) which explained 100.00 of the total variance. The factor pattern matrix showed that after principal factor analysis, all the items were retained from Kessler Psychological Distress (A-K10) (factor loading was more than 0.40 in all the items). The A-K10 demonstrated strong internal consistency reliability (Cronbach's alpha=0.93). Conclusions-The instrument was found to have acceptable psychometric properties, and is a valid tool that can be used in community settings to screen for psychological distress in caregivers of elderly population.

Free Paper 11: To Study the Effects of Changing Pattern of Education from Offline to Online and Emergence of Mental Issues Secondary to Online Gaming in Adolescents During Peri Pandemic COVID-19 Era

Anirudha Atul Salunke, Gautam Anand

Department of Psychiatry, Muzaffarnagar Medical College and Hospital, Bahadarpur, Uttar Pradesh, India. E-mail: [email protected]

Global Pandemic compelled us to use gadgets and Internet for Educational and other purposes like Social interactions, Reading, playing games, learning new food recipes, tea parties and family get togethers, fun interactions with friends and many other purposes. Gaming has affected most adversely to the adolescent population.

Aim: To study the effects of changing pattern of education from offline to online and emergence of mental issues secondary to online gaming in adolescents during peri pandemic COVID-19 era.

Methods: Randomly selected 50 adolescents of same age group were compared with the normal non-gamers of the same age group and then put on DASS brief 21-item version of DASS Scale, Young Internet Addiction Test, Problematic online gaming questionnaire.

Results and Conclusions: Obtained data indicates marked behavioural changes, increased screen time, disturbed sleep, loss of concentration and over engagement in gaming addiction.

Free Paper 12: Effect of Seasonal Variation in the Occurrence of Delirium in Patients Admitted to Intensive Care Units of a Tertiary Care Centre in North India

Rishabh Chandra, Nirnay Sachdeva, Abbas Mehdi

Department of Psychiatry, Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Delirium is a quite common entity in critically ill patients and known to have several predisposing and precipitating factors. Clinically we have seen a strong relationship between delirium occurrence and season. The observation that the general morbidity of the patients varies according to seasonal factors may suggest the possible existence of seasonal differences regarding delirium.

Aims and Objectives: The aim of current study was to determine the effect of seasonal variation in occurrence of delirium in patients admitted to intensive care units of tertiary care centre.

Materials and Methods: We conducted a prospective study of patients admitted to intensive care units of tertiary care centre in north India, between July 2021 and June 2022. Patients were screened using RASS (Richmond Agitation Sedation Scale) and DOSS (delirium observation screening scale). Confusion Assessment Method Intensive Care Unit (CAM-ICU) was used to assess delirium. The incidence of delirium and LOS were summarised by season and statistically analysed.

Results: Total 720 patients admitted to intensive care units, 158 (21.94%) had delirium, 64 of whom in females (40.5%) and 94 in males (59.5%). Incidence of delirium was more in winter (57%) than in summer (43%).

Conclusion: The study indicates higher rates of occurrence of delirium in the winter than in the summer months. The role of possible underlying favouring or triggering factors deserves further research.

Free Paper 13: Prevalence and Predictors of Mental Health among Undergraduate University Students: A Cross-Sectional Study of Northeast India

Fayaz Ahmad Paul, Indrajeet Banerjee, Arif Ali

Department of Psychiatric Social Work, LGB Regional Institute of Mental Health, Tezpur, Assam, India. E-mail: [email protected]

Background: The college/university years represent a period of increased vulnerability for a wide range of mental health challenges. During this stage of development, prevalent mental problems start to manifest. Depression, anxiety, stress, substance abuse; internet addiction, sleep disturbance, and suicidality are more prevalent among undergraduate university students of northeast India.

Aim and Objectives: This study will assess and identify the prevalence and predictors of mental health among undergraduate university students in northeast India.

Methodology: A cross-sectional descriptive research design study was conducted among undergraduate university students at the Central University of Tezpur, Assam. A total of 200 students aged between 18 to 25 years were recruited for the study. Socio-demographic Datasheet, Mental health Continuum long form (MHC-LF), Alcohol Use Disorders Identification test (AUDIT), Drug Abuse Screening Test (DAST-10), Academic Psychological capital questionnaire (A-PCQ) and Students academic stress scale (SASS) were administered to the respondents. The analysis of data was done with the help of the Statistical Package of Social Sciences version-21. The study was undertaken with the approval of the Scientific Committee and Institute Ethics Committee of LGBRIMH, Tezpur. The participants were clearly explained about the purpose of the study and prior informed consent of all participants was taken before the assessment.

Results: It will be discussed at the time of the presentation.

Conclusion: Clinically significant mental health symptoms are common and persistent among undergraduate university students and can have a negative impact on their academic performance. There is a high rate of multiple stress exposures among the students of northeast India and the high impacts of stress on mental health and suicidality among undergraduate university students. A broad mental health plan of action that includes a whole college/university approach to prevention and targeted early-intervention measures and related research is required. Colleges/university campuses must consider student experiences to mitigate stress during this developmental period.

Free Paper 14: Effect of Positive Mental Health Interventions on the Use of Internet among Teenager College Students in University Campus in Pune City, India during COVID-19 Pandemic Era

Anjalee L. Nagda, Manjiri Datar

Department of Psychiatry, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India.

Introduction: The COVID-19 restrictions led to internet use as a necessity for basic education and communication. However, easy access could make adolescents more prone to behavioral addiction of compulsive internet and social media use, mobile gaming and pornography. It was found in various studies of increased behavioural addiction of compulsive internet use in adolescents and young adults during the pandemic period. The behavioural addictions are predisposing factors for depression, anxiety and sleep disturbances. A study by Fernandes et al reports that compulsive internet use and increased social media use was strongly associated with worries of Covid-19 and depression. A study reported psychosocial factors like family functioning, social support also contributes to the internet addiction in junior college students. There have been few studies in India to find if psychosocial interventions done on large general group of students can be beneficial in improving the wellbeing and decrease in maladaptive behaviours like problematic internet use in the current COVID-19 era.

Aim: To evaluate the effect of positive mental health interventions on the use of Internet among Teenager College students.

Objectives: (1) To determine the effect of positive mental health interventions in the current Covid-19 pandemic era; in 2 sessions on the use of Internet among 2nd year undergraduate students in multidisciplinary Streams. (2) To determine the improvement by subjective report and scores on the scale of Psychological Well-being, perceived stress scale and Generalized Problematic Internet use scale 2. (3) To determine the reduction in scores if any through an evaluation post intervention.

Materials and Methods: Evaluation was done in two multidisciplinary degree colleges, on the second-year students, in the form of a didactic lecture and focused group discussions. The study also consisted of a pre and post evaluation. (1) Initial assessment with basic proforma, sociodemographic details, subjective description of internet use during and after COVID-19 pandemic. (2) Mental health assessment tools used: (a) Ryff Psychological wellbeing scale (b) Perceived stress scale (c) Generalized Problematic Internet use scale 2.

Results and Conclusion: This is an ongoing study and results are awaited. Conclusion will focus on understanding and evaluating reduction in scores if any.

Free Paper 15: Prevalence of Postcoital Dysphoria in Sexually Active Men

Nirnay Sachdeva, Rishabh Chandra, Abbas Mehdi

Department of Psychiatry, Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Postcoital dysphoria (PCD) is characterized by inexplicable feelings of irritability, sadness and/or tearfulness. Previous research has mostly on women's postcoital symptoms, failing to explore postcoital symptoms in male.

Aim: The aim of this study was to estimate the prevalence of postcoital dysphoria in sexually active men from a metro city in north India.

Materials and Methods: A sample of 100 sexually active men were recruited in the study by means of online survey. Detailed socio-demographic and Post sex experience scale (P-SES) was utilised.

Results: Of all the participants in our study, 34% reported at least one of the postcoital symptoms and 28.88% reported experiencing more than one negative emotion after sex in their life time for no apparent reason. Patients experiencing PCD report a sense of regret after intercourse, have a thought which they don't like, feel depressed, feel irritable, feel a sense of loneliness, feel like they should cry, feel a sense of emptiness and feel rejected.

Conclusion: Our study indicates that a good proportion of males experienced PCD. According to the good enough sex model, PCD which occurs intermittently may represent natural variation in the human experience of the resolution phase rather than a sexual dysfunction.

Free Paper 16: Effect of Positive Mental Health Interventions on the Psychological State of Teenager College Students in University Campus in Pune City, India During COVID-19 Pandemic Era

Nityasree Koduri, Manjiri Datar

Department of Psychiatry, Bharati Vidyapeeth Deemed University, Pune, Maharashtra, India.

Introduction: The COVID pandemic and the aftermaths have been a significant stressor for adolescents in terms of adaptation to online education, lack of proximity to peers and support systems, impaired communication, career challenges, familial discord etc. With stressors related to pandemic and change in social dynamics, the general psychological wellbeing of college students who are in their late adolescence have been affected due to uncertainty regarding academic success, future careers, and social life during college, amongst other concerns. The impending loom of Covid-19 wave with uncertainty of education and career can cause intense distress and anxiety in college students. A study reports that quarantine and restriction measures in Covid-19 can be a reason for social isolation leading to loneliness experienced by adolescents. Loneliness can be a predisposition to anxiety and depression. Very few studies were found in literature focusing on the type and extent of intervention, if done will lead to positive outcome if any. Present study thus aims at evaluating the effects of intervention done in the form of positive mental health interventions, and the psychological state of the selected population.

Aim: To evaluate the effect of positive mental health interventions on the psychological state of Teenager College students.

Objectives: (1) To determine the effect of positive mental health interventions in the current COVID-19 pandemic era; in 2 sessions on the psychological state of 2nd year undergraduate students in multidisciplinary Streams; (2) To determine the improvement by subjective report and scores on the scale of Psychological Well-being, perceived stress scale; (3) To determine the reduction in scores if any through an evaluation post intervention.

Materials and Methods: Evaluation was done in two multidisciplinary degree colleges, on the second year students, in the form of a didactic lecture and focused group discussions. The study also consisted of a pre and post evaluation. (1) Initial assessment with basic proforma, sociodemographic details, subjective description of mental health challenges during and after Covid-19 pandemic. (2) Mental health assessment tools used: (a) Ryff Psychological wellbeing scale (b) Perceived stress scale.

Results and Conclusion: This is an ongoing study and results are awaited. Conclusion will focus on understanding and evaluating reduction in scores if any.

Free Paper 17: Gender Dimensions of Parenting Challenges Experienced by Patients with Bipolar Affective Disorder: A Qualitative Study in Odisha, India

E-mail: [email protected]

Background: Parenting is recognized as a great influence on the child's development in major areas such as physical, psychological, emotional, social, and intellectual. For those parents with bipolar disorder, parenting could be perceived as a distressful and even more challenging task due to sudden fluctuations in mood state. There is a dearth of literature in the Indian context exploring parenting challenges experienced by patients suffering from bipolar disorder.

Aim: To explore the parenting challenges experienced by patients with bipolar disorder and their spouses.

Methods: A descriptive phenomenological study was undertaken to explore the parenting challenges experienced by patients with bipolar disorder and their spouses. Nine participants including nine patients with bipolar disorder and nine spouses were purposively sampled till the data saturation was achieved. The inclusion criteria were patients with bipolar disorder who were currently in remission and willing to participate in the study. Data was collected by using a semi-structured In-depth Interview Guide. Thematic analysis was done with MAXQDA software.

Results: Three main themes surfaced after thematic analysis. The first theme emerged “parenting challenges experienced by the patients with bipolar disorder and their spouses” which is explained by parental disengagement, emotional dysregulation, regret, stigmatization, and the spousal perspective. The second theme emerged “parental perception about child development” which is explained in terms of change in their role performance, behavioural adaptation as per parental illness, and emotional dysfunction. The third theme emerged as “interpersonal conflicts and support system” which is explained in chaos between parent-child, familial, marital, and the support system within the social environment.

Conclusion: The core challenge was parental disengagement which is the leading cause of disrupted interpersonal relationships between parents and the reason for regret. Maternal challenges are fear of separation from the children, hospitalization, and non-involvement with children's activities due to lack of energy. While paternal challenges include provoked aggression by confronting the children followed by avoiding interaction with children. Spousal also had to deal with multiple challenges at times, including emotional displacement upon children, depressed mood, and suicidal thoughts. Lacking of co-parenting was significantly recognized by both mother and father with bipolar disorder. Both paternal and maternal illness imposes a change in the role performance of the children as they act like caregivers, providing daily assistance, ensuring medication compliance, and unconditional emotional support to the spouse. Children were considered a vital supportive factor throughout the recovery process. Initially, children were perceived as a triggering factor for parental mania episodic. Still, over the years, when behavioural adaptation and change in their role performance occur, they are perceived as a reason for the recovery.

Free Paper 18: Association of Relationship Problems in Marital Life of Patients with Depressive Disorders

Sahil Goyal, S. Nagendran

Department of Psychiatry, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Depressive disorders are characterized by depressive mood (e.g. sad, irritable, empty) or loss of pleasure accompanied by other cognitive, behavioural, or neurovegetative symptoms that significantly affect the individual's ability to function. In Hindu marriage, custom is sacrosanct, which is why a marriage ceremony is said to be complete only when the customary rites and rituals are fully performed.

Aim: To study the association between relationship problems among married couple and depressive disorders among married couple.

Methods: Married Couple visiting the Psychiatry OPD of TMMC&RC, Moradabad with one of the partners diagnosed as a case of depressive disorder after taking written informed consent and application of inclusion and exclusion criteria, were applied Marital Adjustment Test (MAT) to assess approximate extent of satisfaction and dissatisfaction between spouse and partner.

Results: Pearson correlation analysis revealed negative significant correlation between score of PHQ spouse and MAT spouse i.e. with increase in score of PHQ spouse, there is decrease in score of MAT spouse. Similar relationship was observed for BDI II and MAT Score of patients.

Conclusion: It can be concluded that the patients with depression showed more dissatisfaction in marriage with their spouses and that a similar relationship was observed for the spouses of the patients when MAT was applied to them. However, our study didn't study the factors responsible for such an association between mental incompatibility among married couple and depressive disorders among married couple.

Free Paper 19: Stigma Experienced by Persons Infected with COVID-19: An Exploratory Study

B. P. Nirmala, Pallerla Srikanth

Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India. E-mail: [email protected]

Background: The COVID-19 pandemic had spread throughout the world very rapidly and had enormously impacted all spheres of human life. Person infected with Covid-19 faces issues not only with physical health, but also with their psychological health and the mental health needs were found to be significant. The stigma and discrimination towards the disease was also extended to the near and dear ones of patients infected with Covid-19 as they were labelled, stereotyped, discriminated against and treated inhumanly. The current study is an attempt to explore the stigma experienced by the patients infected with COVID-19.

Methods: The study used exploratory research method to assess the stigma experienced by the patients infected with covid-19. The list of patients infected with Covid-19 was obtained from Department of Health and Family Welfare, Karnataka. The study was conducted in South Bangalore. Patients infected with covid-19 aged between 18 to 60 years were included in the study. Explanatory Model Interview Catalogue scale was used to assess the stigma and an interview guide developed by researchers was used to assess the manifestations of stigma.

Results: One third of the subjects were male (n = 105), studied up to higher secondary (n = 101), married (n = 127), and employed (n = 126), and the mean age of the participants in the study is 39.21 ±11.04 (years). Many of the participants (62%), (n = 93) have reported severe levels of the stigma.

Conclusion: It is evident from the current study findings that patients infected with COVID-19 experienced moderate to severe levels of stigma. The current study has explored the various causes, forms, and consequences of stigma in a small population. Stigma was manifested in family, community, and at workplace, recreational places, and peer groups. Findings of the study brings out how COVID-19 has formalized social relationships, narrowed social network diluting social bonding and intimacy. The study highlights the need adopt a new process of social transformation. It emphasizes the need to carry out qualitative research to explore the livid experience of the persons infected with Covid-19. There is a broad scope to conduct a comparative study on diverse population which will help in understanding the different influences of Covid-19. The plan of action suggests that Non –governmental organization should be involved at various levels, for dissemination of information and building up social and community support for persons infected with Covid-19.

Free Paper 20: Level of Insight and Symptom Dimension in OCD

Tamanna Hooda, Gyanendra Kumar, Sheetal Tripathi

E-mail: [email protected]

Introduction: Obsessive–compulsive disorder (OCD), characterised by obsessions and compulsions, is a clinically heterogeneous condition and this heterogeneity can be explained in terms of symptom dimensions and insight. Several studies have been conducted and findings on OCD dimension and insight correlation are quite ambiguous. So, evaluating insight in different symptom dimensions in OCD is very crucial.

Aim and Objectives: To determine the relation between level of insight and prominent symptom dimensions in obsessive compulsive disorder and to study the relation between level of insight and prominent symptom dimension with severity of symptom in obsessive compulsive disorder.

Materials and Methods:Venue: The study was conducted at the institute of mental health and hospital, Agra. Design: The study is a hospital based cross sectional study. Sampling: 60 OCD patients as per ICD-10 diagnostic criteria were selected through purposive sampling. Tools: Patients diagnosed and assessed using Yale -brown obsessive-compulsive scale (Y-BOCS), dimensional obsessive-compulsive scale (DOCS) and Scale to Assess Unawareness in Mental Disorder (SUMD) and insight grading.

Results: Appropriate statistics will be applied.

Discussion: Result will be discussed at the time of presentation.

Free Paper 21: Status of Sexual Dysfunction in Remitted Bipolar Patients on Lithium

Ravi Chandran, Gyanendra Kumar, Sheetal Tripathi

E-mail: [email protected]

Introduction: Bipolar affective disorder contributes to the total mental disorder DALYs about 4.9% to 9.6%. Bipolar disorder causes unusual shift in sexual and risk-taking behaviours and can be significant character of bipolar disorder. Dissatisfaction in sexual life is usually associated with marital violence, less warmth and relationship problem, breakups-all of which may in turn worsen the patient life, their relationship and drug compliance. Many studies have evaluated the effect of antipsychotic, antidepressant and benzodiazepine on sexual functioning. Data on sexual adverse effect in patient on long term lithium are limited in India.

Aim: The study aimed to evaluate the status of sexual dysfunction in remitted bipolar patient receiving maintenance treatment with lithium.

Methods: Venue – Patient recruited from OPD of institute of mental health and hospital, Agra, India. Design – Cross sectional study. Sample – Total 120 patient diagnosed as Bipolar disorder according to ICD 10, currently stable on lithium. Tools used - Global assessment for functioning scale, YMRS and HAMD for clinically stability and ASEX scale for sexual dysfunction.

Results: Appropriate statistics will be applied.

Discussion: Result will be discussed at the time of presentation.

Free Paper 22: Stigma, Mental Health Issues, and Discrimination Experienced by People with Same-Sex Orientation

T. R. Kanmani

E-mail: [email protected]

Background: The mental health and psychosocial well-being of the same sex are affected by challenging social situations and other factors. The higher prevalence of mental health disorders among gays and lesbians is stigma, prejudice, and discrimination creating a stressful social environment that leads to mental health problems. Therefore, the current study aimed to understand the stigma and discrimination faced by people with same-sex orientation.

Methodology: The study adopted a descriptive research design; the universe of this study is the P.S.S.O.s who access the services from N.G.O.s in Bengaluru working on human sexuality, individual sexual pREFERENCES, and gender identity. The N.G.O.s are working to bring more public acceptance and legal aid and providing assistance on a need basis. Purposive sampling is adopted based on the interaction with N.G.Os, an average of 7 women and further discussion with biostatisticians, the sample size of men of same-sex orientation is set to 14.

Results: The median age of the participants is 28. The support from friends is significantly different in males and females. The support from friends for men with same-sex orientation has a median score of 20 IQR from 16 to 27.3 and for women, it is 28 IQR between 22 and 28. The support from significant others for gay men is 20.5 IQR from 15.3 to 28 and for lesbians, it is 28 IQR between 26 and 28. The result of the screening M.I.N.I tool revealed that one person (4.8%) has depression, one person (4.8%) has suicidality, two participants (9.5%) have social phobia, almost one-fifth of the participants (19%) have post-traumatic stress disorder. Few participants (14%) have alcohol dependence. Almost one-fifth of the participants (19%) have substance use disorder, 2 participants (9.5%) have generalized anxiety disorder and a few participants (14.3%) have an antisocial personality disorder.

Conclusion: The present research studied the sexual stigma faced by PSSOs, perceived social support systems, and mental health conditions because of various stigmatizing, discriminating, and traumatizing experiences. In the future, the research can explore the needs of the PSSO that have to be the focus of Public Health Workers can translate from grassroots to policy level, ensuring the community members' participation.

Free Paper 23: Olanzapine Induced Black Hairy Tongue

Preeti, Parvaiz Alam, Shiv Prasad, Dinesh Kataria

Department of Psychiatry, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Black hairy tongue is a benign disease characterized by elongated filiform lingua papillae, with a carpet-like appearance of the dorsum of the tongue. Initially it was described as a painless benign clinical condition characterized by defective desquamamtion and reactive hypertrophy of the filiform papillae of the dorsum of tongue but the etiology and pathophysiology of black hairy tongue is not fully understood. Although the classical manifestation is black in color, the tongue can also appear in different color such as brown, yellow, green blue, or unpigmented. Prevalence of Black hairy tongue range from 0.6% to 11.3%. Although etiology is not fully understood, Black hairy tongue may be triggered by smoking, excessive coffee or black tea drinking, poor oral hygiene, dry mouth as well as certain drugs. We present here a case of a 23 year old female with Bipolar affective disorder with current episode manic with psychotic symptoms who developed Black hairy tongue following treatment with Olanzapine (second generation antipsychotics) and recovered within 2 month after withdrawal of treatment with olanzapine and on maintaining good oral hygiene gentle scraping or brushing of tongue daily however discoloration did not subside with only proper mouth hygiene and on oral antifungal medication which were tried earlier before withdrawing olanzapine of patient. Awareness about this side effect is important as it would unnecessary investigation and ensure proper management of the patient with this side effect of black hairy tongue.

Free Paper 24: Psychosocial Care for the Children of Mentally Ill Individuals

N. Janardhana

E-mail: [email protected]

Chronic illnesses in parents affect children in the family. These children have a higher risk for developing emotional problems. When the one or both the parents are diagnosed to have mental illness, the risk for child developing emotional and mental health problems increases. An inconsistent, unpredictable family environment, inconsistency parenting, child assuming the role of adult, and taking up domestic responsibilities and caring younger sibling would affect the child's life and its impact spills over to the adult life. The mental health professionals and the development workers working in institutional and community setting should be sensitive, to identify the invisible child carers while providing care to adult person with mental illness. They should extend their patience hearing to understand the young carer's concerns and problems, while caring adults with mental illness. The comprehensive psychosocial intervention starts with identifying the positive elements in the family and the natural strengths of the child, some of the psychosocial interventions will be shared during the presentation.

Free Paper 25: Prevalence of Cyberbullying and Mental Health Issues among Adolescents in Bengaluru

Ranjith Prabhu James, Mysore Narasimaha Vranda, M. Thomas Kishore

E-mail: [email protected]

Background: One of the major public health concerns among adolescents in the world today is cyberbullying. Victims of cyberbullying experience mental health issues. Information technology has been greatly impacted by digital technology. Nevertheless, there is looking at the studies with larger adolescent population on mental health issues of cyberbullying in India.

Aim: The present study aimed to understand the prevalence of cyberbullying and mental health issues among adolescents.

Methods: The study adopted a cross-sectional explorative design. 484 adolescents from schools and colleges belonged to age group of 13-18 years were selected using convenient sampling. Cyberbullying Online Aggression Survey Instruments and Strength and Difficulties Questionnaire used to collect the data.

Results: The results revealed a prevalence rate of 14.5% are only the victims of cyberbullying and 5.8% are the offenders of cyberbullying. Overall scores on SDQ revealed 61% had mental health problems especially in the form of high peer problems (27.2%) and low prosocial social behaviour (18.8%).

Conclusion: The study found that cyber victimization and cyber offending are very common among adolescents. The victims and bullies both displayed signs of emotional and behavioural issues. The findings underlined the need for a whole-school approach in the prevention of cyberbullying using different stakeholders at different levels.

Free Paper 26: Biological Rhythm Disturbances and Psychosocial Functioning in Remitted Bipolar Patients – A Tertiary Care Centre-Based Cross-Sectional Study from South India

Liya Fathin Siraj, A. Nisha

E-mail: [email protected]

Background: Irregular circadian rhythms can lead to onset of mood episodes in vulnerable individuals or may trigger relapses in already diagnosed bipolar patients, may constitute reliable early warning signs of relapse and may present as clinical feature of an episode. Biological rhythm disturbances seem to persist even after remission from bipolar affective disorder (BPAD) and can negatively affect the course and prognosis.

Objectives: To determine the relationship of biological rhythm disturbances with various clinico-socio-demographic variables and psychosocial functioning in remitted bipolar patients.

Methods: This study was conducted in the Psychiatry department of MOSC Medical college, Kolenchery, Kerala between January 2022 to August 2022. Assessment of biological rhythm disturbances using BRIAN (Biological Rhythms Interview of Assessment in Neuropsychiatry) and psychosocial functioning using FAST (Functioning Assessment Short Test) was done in 50 outpatients with ICD-10 diagnosis of BPAD-currently in remission.

Results: 29 (58%) were females. The mean age of the study population was 46.46 ± 11.76 years. The median BRIAN score was 30 (26, 35). 14 (28%) patients had moderate impairment and 5 (10%) had severe impairment of psychosocial functioning even in remission. A weak positive correlation (r_s = 0.207, P = 0.149) between biological rhythm disturbances and psychosocial functioning was found which was not statistically significant.

Conclusion: Biological rhythm disturbances were least impaired in our subjects. No significant relationships were found with clinico-socio-demographic variables or psychosocial functioning in remitted bipolar patients. More studies are needed to establish the factors which ameliorate the biological rhythm disturbances in subgroups of bipolar patients.

Free Paper 27: Treatment Noncompliance, Inter-Episodic Functioning and Associated Factors in Remitted Bipolar Disorder – A Cross Sectional Study from a Tertiary Care Centre in Kerala

Nayana R. Nakul, P. Joseph Varghese

E-mail: [email protected]

Background: Non-compliance is the degree to which a patient does not carry out the clinical recommendations of a treating physician. Compliance is directly related to the prognosis of the illness. Treatment compliance and inter-episodic functioning is associated with clinical outcomes in bipolar affective disorder (BPAD).

Objectives: To study the socio-demographic and clinical factors affecting non-compliance and inter-episodic functioning in remitted BPAD patients.

Methods: This study was conducted in the Psychiatry department of MOSC Medical college, Kolenchery, Kerala between February 2022 to August 2022. Assessment of compliance to medications using MARS (Medication Adherence Rating Scale) and inter-episodic functioning using FAST (Functioning Assessment Short Test) was done in 80 outpatients with ICD-10 diagnosis of BPAD-currently in remission.

Results: Out of the study sample, 42 (52%) were males. The mean age of the study population was 47.08±9.44 years. 17 patients (21.3%) had good inter-episodic functioning while 38 patients (47%) had moderate to severe impairment. Treatment noncompliance was 53% in the study sample. Treatment compliance showed significant association with regular follow-up (p value=0.014) and did not show any association with various socio-demographic variables or inter-episodic functioning.

Conclusion: This study concluded that regular op follow-up can significantly improve the treatment compliance. No significant relationships were found with clinico-socio-demographic variables or inter-episodic functioning in remitted bipolar patients.

Free Paper 28: Not Today Darling! I Have a Headache

R. K. Mahendru

E-mail: [email protected]

Men and women can never understand each other unless they have clear knowledge of their normal sexual functioning sex is beautiful joyful and fun but it must be done with agreement. Masturbatory guilt feelings and myth about penile size often takes away the pleasure of sex. “Not today darling I have a headache” is expressed more frequently by a overburdened husband than by a worried house wife. Work tension, watching TV for long hours, alcohol and interest in other men & women often create sexual problems. Recently a neurology professor at Southern Illinois University reports that sex is one of the best cures for relieving a headache. Especially if the sex takes place within 30 minutes of the onset of the headache. “Hurry up Dear”, a wife may well respond when her husband complains of a headache. Performance anxiety, frank sexual problems monotony and boredom and search for variety and novelty often lead to avoidance of sexual activity. Remedial measures include counseling and sex education. Keep adding little fun in sex and keep surprising the partner some times. Sex being a unique and complex human activity often teaches us to become more humble courageous and confident. Good relationships good communication, an open mind, a youthful heart and a spirit of adventure can make sex with your partner a life long joy.

Free Paper 29: ADHD in Adults with Alcohol Use Disorder

T. Subha, K. Aravind, P. M. Jaimon, Varghese Punnoose

E-mail: [email protected]

Background: Attention deficit hyperactivity disorder has known to be a neurodevelopmental disorder. The individuals with substance use disorder often present into adulthood with predominant symptoms of hyperactivity and inattention. ADHD is a risk factor for alcohol and other illicit drug use and is often unrecognized in adults. The prevalence of adult ADHD ranges from 10.8 to 40.9 in substance use disorder.

Aims: (1) The prevalence of attention deficit hyperactivity disorder in adult patients with alcohol use disorder (ADHD) attending deaddiction treatment in the Department of Psychiatry at Government Medical College, Kottayam; (2) The association between the severity of alcohol use and ADHD and also the association between the sociodemographic variables and ADHD.

Methodology: The subjects who meet the diagnostic criteria for Alcohol Use Disorder as per DSM-5 criteria will be recruited for the study after taking written informed consent. The sociodemographic details will be collected using a specially designed proforma and screening for ADHD will be done by Adult ADHD self-report scale (ASRS-5) and those who are screened positive for ADHD will be assessed by Diagnostic Interview for ADHD in adults (DIVA-5). The alcohol use severity and tobacco use severity will be assessed by alcohol use disorders identification test (AUDIT) and Fagerstrom test for nicotine dependence respectively.

Results: The results will be discussed in detail during the presentation.

Free Paper 30: Many Facts of Spirituality

R. K. Mahendru

E-mail: [email protected]

Spirituality is a complex phenomenon. Every body defines spirituality in his own way. According to some Spirituality is the assimilation of your education, exposure sensitivity, struggle and circumstances. The wisdom of experience, the eye to observe and the desire to learn are spirituality. The body's desire to live a purposeful existence, the soul's cry for freedom, the minds call for silence and the lips usage to smile, are all spirituality. Many people from all walks of life have ability to live in spiritual way. They perceive the needs of other people and express love and compassion in genuine selfless way which only few of us are able to do. “It is said that some kind spiritual life is absolutely essential for proper physical and psychological health.” – Walter.

Studies confirm that the elderly people are generally happier and more satisfied of life if they are more spiritual committed and active. Older people with high morale are more likely to be in good health than those without good moral values. There are amazing recent studies which show that prayers enhance health and promote healing. A US Study published in 2007 says that people who lead a good clean life – those who are conscientious, self-disciplined and scrupulous are less likely to suffer from Alzheimer's disease. The life is a journey full of dreams and the death is going home. There are many ways which can make the journey of life peaceful meaningful and enjoyable: Finding happiness, Loving yourself and others, Enjoying the joy of giving, Accepting the change Having Faith, Forgiveness and letting go the spiritual journey is not about achievement, it is about celebration. Love, light and liberty are the final destination. Happiness is elusive for most people but it is essential for good health. Wealth Status and Beauty “Don't Ensure Happiness” Detachment is most important for happiness once you detach yourself from everything and everybody, you feel happy and you spread happiness. The only thing you radiate is love and the peace sets in. The more we care for the happiness of others, the greater is our own sense of well being. Love is important ingredient of life. Love your neighbour as you love yourself is not just a moral mandate but more of a physiological and psychological mandate. Scientists call love an unconditional positive regard for self & others. But plain and simple, love or compassion is dazzling mixture of caring, inner joy and concern. Faith is what your heart tells you true and when your mind cannot prove it. From battle fields to divorce courts, from hospital beds to play ground the most vital ingredient of resilience is Faith Change is the law of nature, accept change it is unavoidable. Change can lead to crying, sorrow, frustration, anger, resentment tension, anxiety or depression for a while. We also have hope and recover to become stronger as a result of change. Many of the ordinary daily arts practiced at home can be used to deepen and extend our spirituality because they foster contemplation and demand a degree of artfulness. In short, there are many spiritual paths. Whichever is yours, follow it, exemplify it and keep climbing up your own tree of life. Set aside time- even just a minute or two each morning and evening- for spiritual renewal, for your own personal choice of prayers and meditation.

Free Paper 31: Scope of Applying Cinema as a Social Therapeutic Adjunct to Psychiatric Illness

Suddhendu Chakraborty

E-mail: [email protected]

Cinema for long has remained a unique method to portray different forms of mental illness. However, modern researches have been made to make it a tool in the form of 'Cinema Therapy' to promote awareness as well as to reexplore the path to initiate psychotherapy more efficiently. From Kurosawa to Hitchcock Satyajit Ray to Anurag Kashyap, a right take on mental illness onscreen has a tremendous impact on overall social acceptance of the entity and promoting empathy and more sincere adherence to the therapy protocol. Further this attempt tries to explore the positive and negative keys of using cinema as a therapeutic adjunct to mainstream treatment of mental illness.

Free Paper 32: A Comparative Study to Assess the Personality Dimensions, Perceived Stress and Coping of Patients with Psychodermatological Disorder and Comparison Group

J. P. Haripriya, Renju Sussan Baby

E-mail: [email protected]

Background: Psychodermatology are group of skin condition that has an impact on human psychology. There is a dearth of literature studying the psychological aspects of dermatological conditions from India. We report a study comparing the personality dimensions, coping and perceived stress in psychodermatological disorders (Psoriasis, Acne, Urticaria and Eczema) and compared them with comparison group.

Methodology: This is a cross sectional study. After obtaining ethical approval of the instituted and informed consent, a total of 38 adult psychodermatology patients (6 Psoriasis, 14 Acne Vulgaris, 3 Urticaria and 15 Eczema) attending the dermatology OPD were enrolled and age, sex matched comparison group was selected from individuals accompanying patients in different outpatient departments/ volunteers/ employees of the institute. The demographic detail, personality dimensions, perceived stress and coping assessed using a preformed proforma and compared with comparison group.

Results: The median score of adaptive coping in psychodermatological to comparison group was 44 to 35. (p=0.001). The median score of extraversion in psychodermatological to comparison group was three to two (p=0.017). The median score of neuroticism in psychodermatological to comparison group was three to two (P < 0.001). The median perceived stress level in psychodermatological to control was 21 to that 18 (P = 0.022).

Conclusion: The present study revels patients with psychodermatological conditions significantly suffer from lack of adaptive coping and neuroticism significant compared to comparison group. Hence, health workers may focus on counselling of these patients along with the medical support provided for the dermatological condition.

Free Paper 33: A Study of Psychiatric Morbidity in Patients Presented with Attempted Suicide in a Tertiary Care Hospital in Northern India

Akanksha, Ved Prakash Gupta, Suhail Ahmed Azmi

Department of Psychiatry, JNMCH, AMU, Aligarh, Uttar Pradesh, India. E-mail: [email protected]

Background: Suicide is a major public health issue that affects people all around the world. It is responsible for almost one million fatalities per year. Because a past suicidal attempt is the strongest predictor of future suicide, knowing the circumstances that lead to a suicidal attempt might aid in the development of suicide prevention methods. Psychiatric illnesses are one of the most important predictors of attempted suicide.

Objectives: The aim of this study was to look at the psychiatric morbidities that have a role in attempted suicide.

Methods: The present study was conducted in the Department of Psychiatry, Jawahar Lal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh. Suicide attempters referred for psychiatric evaluation from various departments of the hospital during the period December 2018 to November 2019 were evaluated.

Results: Approximately 56.25% (n = 45) patients were found to have concurrent psychiatric illness while remaining 43.75% were without illness.

Conclusion: Most of the subjects in our study had some diagnosable psychiatric illness. Major Depressive Disorder being the most common cause in our study.

Free Paper 34: Bollywood, Women and Substance Use: A Mixed-Method Study

Swati Kedia Gupta, Ravindra Rao, Udit Panda, Snehil Gupta

E-mail: [email protected]

Exposure of substance use through media is associated with early initiation and higher rates of substance use. Movie characters, serve as the super-peers for the masses and affect their learning. However, literature on this is mostly limited to opinion papers or non-systemic qualitative analysis, moreover, data is sparse from India. Moreover, until recently, psychoactive substance use has largely been perceived as a male problem and research has been insensitive to gender variations. However, studies are pointing towards narrowing of this gap over the last couple of decades.

The current study aimed at assessing the extent and pattern of the depiction of alcohol and tobacco in woman as depicted in Bollywood movies, and analysing the trends in their portrayal over three decades. For this purpose, 150 Hindi movies, over, three decades, were systematically chosen and analysed. Results indicated that there have been significant changes in portrayal of substance use in woman over the three decades, along with changes in context and attitude of other people. Implications of the same would be discussed.

Free Paper 35: Assessment of Knowledge, Attitude and Mental Health Literacy among Female Medical Students – A Focus on Women Mental Health

Yogender Malik, Sarita Yadav¹, Rajiv Gupta

Department of Psychiatry, Institute of Mental Health, University of Health Science, Rohtak, ¹Department of Students Welfare, BPS Medical College for Women, Sonepat, Haryana, India.

E-mail: [email protected]

Background: Mental health is a big problem throughout the world commonly affecting the female gender. By increasing mental health literacy might be a modifiable contributing factor in ill mental health of women. The constant efforts to expand this concept leads to promotion of positive mental health literacy, being familiar with mental disorders and treatments. That further would enhance help seeking behavior competency and decreases the stigma against mental illness and their treatment. So this study was planned to assess the knowledge, attitude and mental health literacy among female medical students, might change the concept of mental health in this new millennium.

Objectives: Assessment of knowledge, attitude and mental health literacy among Female medical students – A focus on Women mental health.

Methods: The present study was a part of large cross-sectional study. The target population was Female medical students only studied at BPS medical college for Women Khanpur Kalan belongs to rural areas of Haryana. The study was conducted in liaison with department of Psychiatry, PGIMS Rohtak. The socio-demographic profile collected, then all participants were assessed for Knowledge, attitude and mental health literacy by using adapted Hindi version of the self-administered knowledge, attitude and mental health literacy questionnaire. The subjects who met the inclusion criteria were enrolled and informed written consent was obtained.

Results: The mean age of the entire sample was 20.16 (1.28). 26.2% medical students belonged to rural area and 73.6 % from urban locality. The family history of mental illness was present in around 3% of participants. Rest of results depicted during oral presentation.

Conclusion: The findings of this study might give an insight that there is need to increase mental health literacy for utilization of positive information in ways that promote and sustain good mental health.

Free Paper 36: A Level of Empathy and Spirituality among Medical Undergraduates: A Cross-Sectional Study

N. Gyan Nihal

Department of Psychiatry, Mamata Medical College, Khammam, Telangana, India. E-mail: [email protected]

Introduction: Patients' care with empathy has shown a higher clinical competence with great rapport. It leads to an accurate diagnosis with fewer medical errors. Patients tend to be more satisfied with improved outcomes both psychologically and pharmacologically. Empathy supports medical students to achieve capabilities essential for patient-centered care and in development of affective skill, manners, and personal as well as professional growth.

Aims and Objectives: To assess the level of empathy among medical students and to assess the level of spiritual well-being and its relation with empathy.

Materials and Methods: The cross-sectional study was carried out from January 2022 to March 2022 period post ethics committee approval. A total of 200 medical students were selected for the study, fifty from each year. Jefferson Scale of Physician Empathy Student version (JSPE-S), Toronto Empathy Questionnaire (TEQ), Spiritual Well-Being Scale (SWBS), and Demographic Questionnaire were used for the collection of data.

Results: The mean JSPE-S score was 108.41 (14.19), mean TEQ score was 44.89 (6.26), and mean SWBS was 80.58 (18.89). By JSPE-S, the mean empathy score decreased from the 3rd year and was lower in the final year (P = 0.00002). By TEQ, the empathy score was higher in the 2nd year followed by 3rd and 1st and was lower in the final year (P = 0.002). Females had higher empathy than males (P < 0.002 for JSPE-S and P < 0.00001 for TEQ). There was a significant positive relationship between spiritual well-being score with mean JSPE-S (r = 0.4429, P = 0.0012) and TEQ score (r = 0.5777, P = 0.00001).

Conclusion: Medical students had an average level of empathy and spiritual well-being. Clinical empathy decreased from the 3rd year and was lower in final-year students. Spiritual well-being had a positive significant relationship with empathy. There was a statistically significant association between mean empathy scores with demographic variables such as gender, parental education, habit of doing meditation, permanent residence area, and year of study.

Free Paper 37: Mephentermine Use in Young Adults

Anshumi Bhattacharya, Jyoti Shetty, Manjiri Datar

Bharati Vidyapeeth Medical College and Hospital, Pune, Maharashtra, India. E-mail: [email protected]

Background: Mephentermine is a N-alpha-alpha-trimethylphenethylamine sulphate dehydrate and is used as a vasopressor agent with sympathomimetic action. It acts on monoaminergic synapses and causes release of monoamines (noradrenaline, dopamine and serotonin) in the brain. Since the last decade, there has been increased trends of its misuse in young people for better performance in competitive sports, body building or as a recreational drug. Also, there are no established guidelines and protocol for treatment and there is a lack of awareness regarding its potential for dependence. Our case report includes 2 cases of young adults with mephentermine use in dependence pattern and their management.

Aims and Objectives: The 2 patients and their relatives were interviewed in detail and the pattern of mephentermine use and dependence in them was established. They were started on treatment. Patients were reassessed after treatment was started and improvement was recorded.

Methodology: A detailed clinical interview was done which included details regarding their personal history. General physical examination followed by systemic examination and mental status examination was done. Basic laboratory investigations were done. Substance use and dependence were established using ICD-10 Criteria. Both the patients were started on treatment and serial MSEs were done.

Results: Both the patients were started on medication and advised complete abstinence from substance, antipsychotics and benzodiazepines were started according to the presenting symptoms.

Conclusion: Mephentermine is a substance with high abuse potential. As there are no established FDA guidelines for its treatment, patients were managed based on their presenting symptoms.

Free Paper 38: Characteristics of Patients Attending the Child and Adolescent's Psychiatric Outpatient Clinic of a Tertiary Care Hospital in North India

Nayab Anjum, Zeba Khan, M. Reyazuddin, Malsawmtluangi

Department of Psychiatry, Jawaharlal Nehru Medical College, Aligarh, Uttar Pradesh, India. E-mail: [email protected]

Background: Psychiatric morbidity profile of children and adolescents is very different from that of adults. Failure of early identification and timely intervention of psychiatric disorders adversely affect the development of child to healthy adult.

Objectives: To study the sociodemographic and clinical profile and to statistically estimate the frequency of various psychiatric disorders among the patients who presented to the child and adolescent psychiatric OPD.

Methodology: In this retrospective file review study, all patients attending child and adolescent psychiatry clinic of a tertiary care hospital during the period between 2018-2022 were taken. Semi-structured socio-demographic and clinical profile collection proforma and ICD-10 were used as tool and statistical analysis was done by using SPSS 16.

Results: Chi-square test was used to compare the number of cases reported per year from 2018 to 2022, total number of cases reported were (N=1199), mean cases 239.8 (20%) per year. The highest number of cases were reported in age group 10-15 years 766, mean cases was 153.2 per year and year 2019 highest cases were reported (n=350). Results also indicated that highest number of disorders reported were Intellectual disability 201 (40.2 cases per year), epilepsy 286 (57.2 cases per year), hyperkinetic and conduct disorder 106 (21.2 cases per year), neurotic/anxiety disorder, other headache syndrome and schizophrenia and psychotic disorder were also in significant number per year with Chi-square value of 158.84 which is significant at. 01 level of significance. The highest number of cases were from Hindu community. Disorders were prevalent more among boys than girls and equally distributed in rural and urban areas.

Conclusions: The year wise trends revealed that there is significant shift in frequency of cases and their cumulative proportion in demographics, diagnostic profile and type of treatment methods with significant number of follow up 0 to 4.

Free Paper 39: Mode of Deliberate Self-Harm in Patient Admitted in SRN Hospital Prayagraj

Nand Asare, V. K. Singh, Abhishek Pratap Singh, Anurag Varma

Department of Psychiatry, Motilal Nehru Medical College, Prayagraj, Uttar Pradesh, India. E-mail: [email protected]

Background: Deliberate self-harm (DSH) is a one of the commonest causes of death in the world with a higher rate noted in low and middle income countries. DSH refers to the purpose of self-harm with or without suicidal tendency. In this study we analyzed the mode of deliberate self-harm in admitted patients.

Aims and Objectives: Mode of DSH in patients admitted in SRN Hospital Prayagraj.

Materials and Methods: It was a descriptive study of sociodemographic variables, clinical data was obtained from 90 patients during the course of 1 year who admitted in SRN hospital Prayagraj, with deliberate self-harm attempt. Assessment was done on a detailed proforma for clinical and sociodemographic variables. Following tools were used: Columbia suicidal severity rating scale (C-SSRS); Modified Kuppuswamy scale.

Observation: The study revealed that DSH was generally attempted by younger adults as compared to elderly of which 55% were male patients whereas 45% were females. In this study, the most common mode of DSH was agrochemical poisoning (58) followed by hanging (16), overdose of prescribed medications (5), corrosive poisoning (4), wrist /neck slashing (4), others (3).

Conclusion: Since still a large number of DSH attempts are with agrochemical, political will, and legal changes regarding the sale of poisonous chemicals can lead to a decrease in mortality and morbidity associated it DSH attempts.

Free Paper 40: A Study of Assessment of Anxiety and Depression in Spouses of Patients with Alcohol Dependence

Tushar Jagawat, Deepinder Kaur, Savita Jagawat

Department of Psychiatry, NIMS&R, Jaipur, Rajasthan, India.

E-mail: [email protected]

Introduction/Background: Spouses of patients of Alcohol-Dependence, a key member of such dysfunctional family system, are most vulnerable to have significant psychiatric morbidities such as anxiety disorders, depression etc. A study conducted in India showed 65% of the wives of alcoholics had psychiatric disorders ranging from mood and anxiety disorders to major depressive disorders.

Aims and Objectives: To assess the anxiety and depression in spouses of patients with alcohol dependence.

Materials and Methods: The study was conducted in OPD of psychiatry department of tertiary care medical college and hospital in Rajasthan. On the basis of inclusion and exclusion criteria 130 spouses of patients with alcohol dependence were studied.

Result, Conclusion and Discussion: The diagnosis of Psychiatric morbidity was made according to ICD10. Majority of the subjects have shown mixed anxiety and depression. The interpretation and implication of the results on psychosocial aspects of spouses of patients with alcohol dependence will be discussed during the presentation.

Free Paper 41: Are Doctors Feeling Burnout? Multicenter Cross-Sectional Study on Burnout Syndrome and Its Determinants During the Ongoing Pandemic

Praveen Rikhari, Ashutosh Kumar, Kavita Chawla¹, Arun Mishra², Geetu Singh³, Achyut Kumar Pandey⁴

Departments of Psychiatry and ³Community Medicine, Sarojini Naidu Medical College, Agra, ¹Department of Physiology, Moti Lal Nehru Medical College, Prayagraj, ²Department of Psychiatry, Uttar Pradesh University of Medical Sciences, Etawah, ⁴Department of Psychiatry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India. E-mail: [email protected]

Background: Though the concept of burnout has been around for long, its significance is increasing nowadays owing to the demanding nature of jobs. The latest ICD-11 also provides a detailed description of Burnout syndrome. Physicians are at high risk for experiencing burnout and this becomes especially relevant in the ongoing COVID-19 pandemic.

Objectives: The objective of the study was to determine the risk of burnout among medical faculty and its predictors.

Methods: This was a multicentric cross-sectional study that included medical faculty from four tertiary care government teaching hospitals in north India. A survey was conducted during the current COVID-19 pandemic to assess burnout using a structured online questionnaire based on Burnout Assessment Tool. The questionnaire also included relevant socio-demographic, professional, health, and lifestyle-related details. Descriptive statistics and the Chi-square test were used for statistical analysis.

Results: A total of 244 medical faculty completed the survey. 27.87% were at risk of burnout, out of which 11.89% were at a very high risk of burnout. Dissatisfaction with job and sleep resulted in a higher risk of burnout (P < 0.00001 for both). Regular exercise/yoga reduced the risk of burnout (P = 0.039).

Conclusion: Faculty members are at high risk of burnout, regardless of sociodemographic and work-related factors. Regular physical activity may decrease the risk of burnout.

Free Paper 42: Endoxifen in Patients with Secondary Mood Disorder: A Mini Case Series

Sandeep Kaur Dhillon, Navkiran S. Mahajan, Ranjive Mahajan

Dayanand Medical College and Hospital, Ludhiana, Punjab, India. E-mail: [email protected]

Introduction: The PKC signalling pathway plays an important role in mood disorders. Endoxifen (an active metabolite of Tamoxifen), a new cornerstone in the treatment of bipolar (mania and mixed episodes) is shown to modulate PKC pathway. It is thought that it may also benefit patients of secondary mood disorder though there is not enough literature at present moment for this indication.

Aims and Objectives: To study the effect of Endoxifen in patients with secondary mood disorder.

Materials and Methods: A mini case series of patients (n = 3) presenting to psychiatry department at DMC &H Ludhiana with secondary mood disorder who were either non-responsive to or not tolerating conventional pharmacotherapies (mood stabilizers, typical and atypical antipsychotics were included). They were having manic (n = 2) or mixed (n = 1) episodes. They were given Tab. Endoxifen 8 mg once daily. They were assessed clinically using Young Mania Rating Scale and Hamilton Depression Rating Scale weekly for 4 weeks then fortnightly for 3 months.

Results: All 3 patients showed improvement in mood symptoms within first week. At the end of 2 weeks YMRS score decreased from 23-25 to 13-15 and HAM-D score decreased from 18 to 13. All patients have completed at least 3 months of treatment and is ongoing. Functional Improvement has also been seen in all 3 patients. No adverse events were reported.

Conclusion: Endoxifen may hold promise, not only in bipolar mood disorders but also in secondary mood disorder. There is need for further studies to study more about Endoxifen and its implications.

Free Paper 43: Patterns of Substance Abuse among Bipolar Affective Disorder Patients in a Tertiary Health Care Centre in Central India

Shobhit Mathur, Kshirod Kumar Mishra, Ahmed Mushtaq Reshamvala, Harshal S. Sathe

Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India. E-mail: [email protected]

Background: Substance abuse is highly prevalent in the patients of bipolar affective disorder (BPAD) and it adversely affects the symptoms, treatment and recovery. The magnitude and pattern of substance consumption in BPAD patients living in rural areas is an under-researched subject.

Methodology: A cross-sectional, observational and descriptive study was conducted on the hospital admissions of BPAD at a rural tertiary health care centre. A predesigned and pre-approved proforma was used to collect the demographic and clinical information of the patients and illness severity was assessed using the standardized psychometric scales. The alcohol use disorder identification test (AUDIT), cannabis use disorder identification test (CUDIT) and Fagerstorm Test for Nicotine dependence (FTND) to quantify the abuse of substances.

Results: Seventy-six consecutive admissions of BPAD over one and half year were assessed. The co-morbid substance abuse of at least one substance was present in 58% patients. Smokeless tobacco (52%), followed by alcohol (32.9%) were the most commonly abused substances. Binge drinking was the commonest pattern (68%) for alcohol consumption which was usually done in the evening time (68%) and/or in company of friends or acquaintances (96%). The patients abusing substances had significantly higher severity of BPAD (P = 0.008) and had a poorer treatment adherence (P = 0.07).

Conclusion: Early identification and management of substance abuse in patients having BPAD is an essential measure to improve the therapeutic outcome.

Free Paper 44: Bullying in Adolescents with Dissociative Disorder

Akanksha Shukla, Dinesh Kataria, Om Sai Ramesh, Saurabh

Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Background: Dissociative disorder is a prevalent mental health problem with a prevalence of 1.5 to 15.0 per 1,000 among outpatients. A study on the psychological effects of bullying found hallucinations, dissociation and paranoia were considerably more common among students who reported being bullied. However, there is limited research studying psychosocial factors like bullying in adolescents with dissociative disorder thus we propose this study.

Objective: To assess the pattern of bullying in adolescents with dissociative disorder.

Methodology: Type of study: Hospital-based cross-sectional analytical study. Study period January 2021 to August 2022. Place of study: Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi. Study population: Adolescents aged 10-19 years fulfilling criteria for dissociative disorder according to ICD-10 coming in the Department of Psychiatry and Drug Deaddiction Centre, LHMC. Sample size and sampling technique: A convenient sample of minimum of 40 subjects were recruited. Adolescents aged 10-19 years diagnosed with dissociative disorder coming to the Department of Psychiatry, LHMC, were assessed for recruitment as per selection criteria and recruited consecutively till the desired sample was reached. Appropriate written informed consent and assent was taken from the participants and guardians as per the age. Assessment of the pattern of bullying was done by the Gatehouse Bullying Scale.

Results: Bullying was present in 37% of individuals, frequent bullying reported by 22%. Most commonly bullying by teasing or name-calling was reported. Mean of the GBS scale score was found to 0.30. Presence of bullying and GBS scale score were associated with female gender.

Conclusion: There was a dearth of studies about the proportion of bullying in adolescents with dissociative disorder to compare our findings. In our study bullying was found to be more frequent than in a study among adolescents in the general population (16%). However, due to the wide range of bullying prevalence reported in some studies, we are unable to say if bullying was more in adolescents with dissociative disorder when compared to the general population.

Free Paper 45: Experience of Stress, and Perceived Need for Stress Reduction Intervention among Health Care Professionals in India during COVID-19: A Qualitative Study

Manjusha Mohandas, M. Manjula, Paulomi M. Sudhir, Hemant Bhargav¹, B. S. Nagaraja², T. K. Sreekant³, Sailaxmi Gandhi⁴, Ajay Kumar Sharma

Departments of Clinical Psychology, ¹Integrative Medicine and ⁴Nursing, NIMHANS, ²Bangalore Medical College and Research Institute, ³E-Health Research Center, International Institute of Information Technology, Bengaluru, Karnataka, India.

Background: Adverse effect of any emergency health situation on the mental health of health care professionals is ubiquitous. COVID-19 has necessitated the need for quick and structured intervention for the front-line workers. Negative impact of COVID-19 on mental health is widely discussed, however, structured short-term intervention is rarely delivered. It is imperative that brief intervention to protect the mental health of front-line workers should be made available.

Objective: This study focuses on experiences, challenges and perceived need for stress reduction intervention among health care professionals.

Methods: The sample comprised of health care professionals providing service to persons identified to have COVID-19 as well as those involved in screening, conducting investigations and taking care of persons in quarantine. The HCPs included in the study are medical doctors, nurses, and lab technicians. Purposive sample was used in the study. Consent from HCPs from different parts of the country (N=17) was sought and interviewed in an online mode. Interview transcripts were analysed using thematic analysis.

Results: The major themes emerged were stress related to work environment, the impact of stress: physical, psychological and social' and coping strategies used and the perceived need for brief intervention to deal with stress.

Conclusion: The study highlights the need for a structured short-term crisis intervention program for HCP in any health emergency situation. It is critical that such an intervention should keep the cultural aspects in mind and made freely available in all private and public sectors.

Free Paper 46: Assessment of Sexual Dysfunction in Adult Males with Alcohol Use Disorder

Simran Doria, Dinesh Kataria, Shiv Prasad

Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Background: Alcohol use affects almost every aspect of the human sexual cycle. Sexual dysfunction due to alcohol could be multifactorial in nature and hormonal, neurological and psychological factors may contribute to it. Both clinical and experimental research have reported that sexual dysfunction correlates with quantity, frequency, and duration of alcohol consumption. When taken acutely, modest doses of ethanol can increase the sexual drive but, can also lead to a decrease in erectile capacity in men.

Objectives:Primary Objective: To assess the level of sexual dysfunction in adult male patients with alcohol use disorder. Secondary Objective: To assess the relationship between level of sexual dysfunction with the severity of Alcohol use disorder.

Methods: Type of study: Hospital based cross sectional analytical study. Study period: The proposed study was conducted from January 2021 to June 2022. Place of study: The study was conducted in the Department of Psychiatry and Drug-Deaddiction Centre, Lady Hardinge Medical College and Smt. S. K. Hospital, New Delhi. Study population: Adult male patients fulfilling the criteria for Alcohol Use Disorder according to the DSM-V, coming in the Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College and Smt. Sucheta Kripalani Hospital, New Delhi. Sample size and sampling technique: Considering feasibility and time constraints and taking into account inclusion and exclusion criteria, a convenient sample of 70 was used. Participants fulfilling the inclusion and exclusion criteria, coming to various treatment facilities of LHMC, within the time frame of the study, and meeting inclusion and exclusion criteria were recruited consecutively.

Results: The mean of ASEX Total Score was 15.81 with a standard deviation of 3.64 and the total score ranged from 7 - 24. 34.3% of the participants had Sexual Dysfunction.

Conclusions: There was a weak positive correlation between ASI: Alcohol Status and ASEX total score, and this correlation was statistically significant (rho = 0.26, P = 0.031). This showed that in our study population, more is the severity of Alcohol use, more is the sexual dysfunction.

Free Paper 47: COVID-19 Vaccine Hesitancy in Perinatal Period: Facilitators and Barriers in Persons with Mental Illness

Prerna Kukreti, Ramdas Ransing, Pracheeth Raghuveer, V. Omsai Ramesh, Dinesh Kataria, Shiv Prasad, Manju Puri

Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Background: The Government of India recommends pregnant and lactating women to get vaccinated against the Novel Coronavirus Disease 2019 (COVID-19). However, vaccine hesitancy in this population could adversely affect the uptake of vaccination. Persons with mental illness in peripartum phase is further a vulnerable group. There is an urgent need for assessing extent of vaccine hesitancy in this group and study the various determinants same (e.g., effects on fetuses or infants, concern about interaction with psychotropics) in this population.

Methods: A cross sectional survey using convenience sampling was conducted amongst 40 pregnant or lactating women seeking treatment for mental illness in psychiatry OPD and having intact capacity for healthcare decisions was done from November 2021 to June 2022. Participants were assessed on Oxford COVID-19 vaccine hesitancy scale (OC19-VHS) and participants were classified as hesitant, non-hesitant, and unsure. Other mental health parameters and attitude about vaccination in general was assessed using a semi-structured proforma.

Results: The most of study participants (65%) reported positive views about COVID-19 vaccine in general but significantly lower (39%) participants wanted to take vaccine during pregnancy. Age less than 30 years, presence of severe mental illness, poor follow ups, past pregnancy complication and mild COVID infection in past those with were more commonly associated with low OVHI Scores. Multivariate analysis revealed presence of severe mental illness and poor follow ups as the main predictors.

Conclusion: Persons with mental illness in peripartum phase are a unique vulnerable group, psychiatrist must discuss safety information on COVID-19 vaccines with this group to provide reassurance and facilitate informed pregnancy vaccine decisions.

Free Paper 48: To Study Prevalence of Conduct Symptoms in Children and Adolescents during the Depressive and Anxiety Phase

Parvaiz Alam, Akhilesh Sharma¹, Sandeep Grover¹, Swapnajeet Sahoo¹

Department of Psychiatry, LHMC, New Delhi, ¹Department of Psychiatry, PGIMER, Chandigarh, India. E-mail: [email protected]

Background: Behavioural symptoms are frequently reported in depression and anxiety symptoms in the child and adolescent population. There may be presence of conduct symptoms that make atypical presentation in child and adolescent population.

Objective: To study prevalence of conduct symptoms in children and adolescents during the depressive and anxiety phase.

Methods: Patients aged 6 to 18 years, diagnosed with an episode of major depression and anxiety disorder in the Child and Adolescents outpatient department (OPD). The assessment for conduct symptoms was done using the Child Behaviors Checklist.

Results: A total of 60 CAP population was studied. Around 16.7% (n=10) patients with depressive disorder and 10% (n=6) with an anxiety disorder had conduct symptoms. There was a major presentation seen as: Lack of guilt, breaking rules, fighting, bad friends, lying and cheating, attacking others, stealing and vandalism; as a part of conduct symptoms.

Conclusion: Depression and anxiety are not uncommon in CAP. Conduct disorder is often a presenting symptom in the CAP group which might be a presenting symptom for depression and anxiety in them.

Free Paper 49: To Study the Pattern of Psychiatric Illnesses in the Community of North Western Rajasthan

Mini Sharma, Veerbhan Chanchalani, Priyank Jain, Naveen Kumar Bairwa, Jexy Jacob

E-mail: [email protected]

Background: COVID-19 has affected the mental health of all populations irrespective of gender and age. While, COVID-19 has shunned all resources and services, it continues to affect the physical as well as mental health of all. Its major impact is on the mental health of people.

Aim: To study the pattern of psychiatric illnesses in the community of Northwestern Rajasthan.

Methodology: A retrospective data collection from out-patient department of NMHP outreach services in 5 Tehsils in the Bhilwara district of Rajasthan was analyzed to see the pattern of psychiatric illnesses in the community post- COVID-19. The data was analyzed using SPSS.

Results: A male predominant population was seen where a total of 9536 patients were evaluated. A majority of population had depression, psychosis and anxiety as most prevalent psychiatric illness. While among the substance users opioid use and alcohol use was most common.

Conclusion: Post- COVID-19 pattern of psychiatric illness continues to be as before while opioid use was more prevalent as compared to alcohol use in the community of northwestern Rajasthan.

Free Paper 50: Prevalence of Psychiatric Comorbidities in Patients with Rheumatoid Arthritis and Their Determinants

Ayushi Bisht, Vishal Sinha, Kumar, Ashutosh Kumar

Department of Psychiatry, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India. E-mail: [email protected]

Background: Rheumatoid Arthritis (RA) is a common rheumatological disorder affecting 0.3-1% population. Chronic pain, disability, isolation as the consequence of the disease, poor quality of life, and life long medications may contribute to the development of psychiatric comorbidities.

Objectives: To study psychiatric co-morbidities and their determinants in patients with Rheumatoid Arthritis at Sarojini Naidu Medical College and Hospital, Agra.

Methods: This was a cross-sectional study that included patients of Rheumatoid Arthritis attending rheumatology OPD of SNMC, Agra. A total 111 patients were enrolled over a period of 1 year. All patients were assessed using a sociodemographic proforma, Clinical Disease Activity Index (CDAI) for disease severity, Health Assessment Questionnaire (HAQ-DI) for disability assessment. Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A) were administered in those who were diagnosed as having depression and anxiety.

Results: A total of 111 Rheumatoid Arthritis patients were enrolled in the study. Out of all the patients 36% of patients were diagnosed to have depression, and 40% were diagnosed to have anxiety. High CDAI and high HAQ-DI score were associated with both depression and anxiety (P < 0.05). Other predictors which were associated with depression and anxiety were total duration of illness and use of corticosteroids.

Conclusion: Depression and anxiety are common psychiatric disorders in patients with Rheumatoid Arthritis. Predictors for depression and anxiety in patients were high CDAI, HAQ-DI Scores, total duration of illness and corticosteroid use.

Free Paper 51: Prevalence and Nature of Psychiatric Disorders in Patients of Locally Advanced Head and Neck Cancer

Aayush Kapoor, Ashutosh Kumar, Surabhi Gupta¹, Praveen Rikhari

Departments of Psychiatry and ¹Radiation Oncology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.

E-mail: [email protected]

Background: World-wide, the head and neck cancers form the sixth most common cancer. It is the most common cancer of males in India and the fifth most common in females. In India, the age-adjusted rates among female is the highest. Despite high prevalence and an ever increasing incidence symptoms of psychological distress often go fairly unnoticed in patients of HNC, one of the major reasons for this might be co-occurrence of neuro-vegetative symptoms such as sleep disturbances, loss of appetite and fatigue with that of anxiety and depressive disorders. Furthermore, compared to pain assessments, symptoms of emotional distress are often ignored and less likely to be documented in patients, which further suggests that psychological distress is much less likely to be assessed in comparison to physical distress.

Objectives: The objective of the study was to study the incidence and prevalence of psychiatric comorbidities and the influence of quality of life on the same in HNC cancer.

Methods: Patients attending the radiation oncology OPD with the diagnosis of Locally advanced Head and Neck Cancer and undergoing treatment that fulfil the exclusion and inclusion criteria were included into the study. The patients were first staged as per TNM staging and all patients will undergo mandatory required clinical examination, lab investigations & imaging investigations. The clinical information and data will be collected by interviewing the patient and informant on presentation. All patients after their informed consent will be assessed with Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to screen for mental illness and a diagnosis will be made using the DSM 5. Following this, assessments were done using HAM-A and HAM-D questionnaires in patients who were diagnosed with depressive disorders (Adjustment disorder with depressed mood, Major depressive Disorder etc) and Anxiety Disorders (Adjustment Disorders with anxious Distress and others), at various stages of disease. The quality of life was assessed using the European Organization for Research and Treatment of cancer (EORTC) Quality of Life Questionnaire (QLQ) via a module specific to Head and Neck Cancer (the QLQ- Head and Neck-43).

Results and Conclusion: To be presented alongside in the meet.

Free Paper 52: Suicide Prevention in Young People in Asia: A Review

R. Dhanasekara Pandian, Anish V. Cherian, Arya Thirumeni

Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.

E-mail: [email protected]

Background: The official records of India states that there were one lakh sixty-four thousand suicides in 2022 and nearly sixty thousand of them were young people. This points to the necessity of suicide prevention strategies to be initiated from school level. This paper attempts to determine the existing suicide prevention strategies for young people in Asia.

Methods: The investigators abstracted data from Pubmed, EBSCO and JSTOR. We included studies evaluating or reviewing any preventive intervention that are specified for young people. The studies between the years January, 2000 and December, 2021 are included. This review excluded postvention studies for young people.

Results: Majority of the studies on youth suicides in Asia reported the risk factors, prevalence and the need for comprehensive prevention strategies as compared to the number of studies that assessed preventive or therapeutic intervention for youth. Online psychoeducation for suicide prevention, school and community-based awareness programmes targeting young population are found as most common strategies of suicide prevention used in the Asian Countries.

Conclusion: The results suggest the need for implementation of evidence-based suicide preventive strategies for younger population. This review can give a framework for developing a comprehensive suicide prevention programme for young people.

Free Paper 53: Cognitive Impairment in Adult Onset and Late Onset Depression: A Comparative Study

Sweta Verma, V. K. Singh, Abhishek Pratap Singh, Anurag Varma

Department of Psychiatry, Moti Lal Nehru Medical College, Prayagraj, Uttar Pradesh, India. E-mail: [email protected]

Background: Major depressive disorder (MDD) in older adults or Late-onset depression (LOD), is a prevalent and debilitating psychiatric disorder. Cognitive impairment often coexist in patients of depression. This is particularly evident in LOD when compared to Adult onset depression (AOD). There is considerable heterogeneity in the types, severity, and overall number of cognitive impairments reported in LOD samples and depression severity also contributes to cognitive dysfunction in LOD.

Aims and Objectives: To compare cognitive impairment and severity of MDD between AOD (20-45 years) and LOD (>60 years).

Methodology: A cross- sectional study conducted in an outpatient setting in a tertiary care centre on 117 patients with AOD of age range between 20-45 years, and 117 patients of LOD age >60 years of either gender were included and assessed on Structural Clinical Interview for DSM Disorders-5 (SCID-5) for Major Depressive Disorder, Cognitive impairment was assessed on Hindi-Mental Status Examination (HMSE) and severity of MDD was assessed on Hamilton depression rating scale-21 (HAMD-21).

Results: It was found that the LOD patients had more cognitive impairment in comparison to AOD patients. In LOD 19 out of 117 pts had mild cognitive impairment (MCI) in whom HMSE score came ≤ 23 and 8 out of 117 patients of adult onset had MCI in whom HMSE score came ≤ 23 [19 (16.2%) vs.8 (6.8%)] and p-value <0.0407 which was significant. Severity scores of MDD on HAMD-21 were higher in AOD patients in comparison to LOD pts. [52 (44.4% vs. 44 (41%)], and (P < 0.04) which was significant.

Conclusions: LOD is associated with more cognitive impairment and AOD is associated with greater severity of depressive illness.

Free Paper 54: A Cross Sectional Study from a Tertiary Care Hospital on Prevalence of Anxiety, Depression and Health-Related Quality of Life Among Pulmonary Tuberculosis Patients

Manish Singh¹, Yogi Rana¹, Abhishek Pathak¹, Rohit Pathak²

¹Department of Psychiatry, Hind Institute Of Medical Sciences, Sitapur, ²Department of Respiratory Medicine, Hind Institute Of Medical Sciences, Sitapur, E-mail:[email protected]

Background: Overall prevalence of Tuberculosis remains high and is leading cause of death in India and affects every domain of life. Tuberculosis has been associated with significant burden of psychiatric illnesses. Neglected anxiety and depression in pulmonary tuberculosis patients can affect treatment adherence, prognosis and Quality of Life.

Aims & Objectives: To determine the prevalence of anxiety and depression and its impact on quality of life in patients of pulmonary tuberculosis and to study the relationship between psychiatric morbidity and its clinical correlates.

Material & Methods: This cross sectional study was conducted at a tertiary care hospital among 100 patients of pulmonary tuberculosis attending the OPD of respiratory medicine between Jan 2021 to Jan 2022. To establish the diagnosis of anxiety and depression semi structured pro-forma and ICD-10 criteria were used. To estimate the severity of anxiety and depression, HAM-A and HAM-D scales were used respectively. To assess the quality of life, WHO-QOL BREF scale was used. Data was analysed using Microsoft SPSS 20.00 Version.

Results: Of the pulmonary tuberculosis patients enrolled in this study, a total of 72% had psychiatric morbidity, constituting 42% major depressive disorder and 30% generalised anxiety disorder. Among socio-demographic variables, there was positive statistical association of depression with unemployment, unmarried marital status and Muslim religion. Among clinical variables, medical co-morbidity, sputum positivity, dyspnoea, past history of tuberculosis and substance abuse showed positive association with psychiatric morbidity. TB patients without psychiatric morbidity had better QoL scores in all the health domains (Physical, Psychological, Environmental and Social) and this difference was found to be statistically significant.

Conclusions: Prevalence of anxiety and depression is very high in pulmonary tuberculosis patients. Detailed assessment and management of anxiety and depression and strengthening of consultation-liaison services will improve the treatment adherence, prognosis and quality of life of tuberculosis patients.

FREE PAPERS (POSTER)

Poster 01: Psychosocial Intervention with Bipolar Affective Disorder with Poor Social Support: A Case Report

Chandra Bala, Kamlesh Kumar Sahu, Priti Arun

Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: [email protected]

Background: Bipolar Affective Disorder (BPAD) is a major mental disorder. Various psychosocial issues are associated with its course and outcome. The present case is being shared to demonstrate the psychosocial problems and intervention (PSI).

Assessment: The case presented here is that of a 28 years unmarried female, Post Graduate, lost both the parents, unemployed, belongs to Hindu nuclear family of middle socio-economic status, resident of district Karnal, Haryana referred from Orthopaedic Emergency with complaints of irrelevant talks, over talkativeness, reckless behaviour, increased libido, big talks, use of tobacco and alcohol and also recovering from complications of an old fracture of lower limb. On MSE she has increased psycho motor activity, increased rate, tone and volume of speech, labile affect, thought flow increased, ideas of grandiosity, and flight of ideas. She was diagnosed as BPAD and admitted as an independent patient with no primary and secondary support. A psychosocial formulation was prepared and a plan for psychosocial intervention was made.

Management and Outcome: The patient was provided basic amenities to support her basic needs. The patient used to reside with her two sisters in her parental home in Karnal, Haryana. She alleged that her sisters threw her out of the house due to her behavioural problems during her illness state. She has been wandering around and travelling to hospitals to get herself treated for many months now. The sisters were contacted telephonically who refused to take any responsibility of her and also informed the treating team that she had been disowned by the family. As an unmarried female, suffering from a mental illness she had the right not only to her parental property but also to her late father's pension. To protect her rights legal aid from Haryana State Legal Services Authority was initiated. Despite the repeated reminders no female advocate was provided and in the meantime one of her uncle brought guardianship certificate. Since patient was unwilling to stay in the ward she had to be discharged. However, she was lost to follow up.

Conclusion: The case study demonstrates that outcome of psychosocial intervention in the absence of adequate support system the treatment of BPAD may not always be positive.

Poster 02: Caregiver Burden in Intellectually Disabled Children and Its Association with Personality Profile

Abhilakshya Jyoti, Prerana Gupta

Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Intellectual disability is not a single, isolated disorder. It often originates before the age of 18 and is characterised by significant limitations both in intellectual functioning and in adaptive behaviour. In India, around 2% of the population is affected by intellectual disability. Raising a child with a disability has been recognised for some time as a major source of burden and distress in family caregiving. Psychiatric problems have a significant effect on both patients and their caregivers. While much attention has been paid in the literature to parental stress, less attention is paid to caregiver burden. The individual characteristics of the personality are closely linked to how an individual reacts to the management of resources in the face of problematic life events. Studies from Western countries have found the prevalence of depression among mothers of children with ID to be around 50%. However, Indian studies show the prevalence of depression in mothers of children with ID up to 85%. In another study, 44% of the fathers had psychological distress in the form of anxiety, depression, and somatic complaints. In this study we tried to correlate and access which personalities were more vulnerable to feel more burdened and as a result develop psychiatric comorbidities.

Aims and Objectives: To find out the caregiver burden in primary caregivers of children with Intellectual disability disorder and to associate the level of caregiver burden with the personality profile of the caregivers.

Materials and Methods: Children coming to the Department of Psychiatry with a diagnosis of Intellectual Disability Disorder were taken up for this study. The primary caregiver was identified. Detailed psychiatric interview was done by the consultant psychiatrist to assess for any active mental disorder. Caregiver burden scale was applied to the primary caregivers and their personalities accessed using 16 personality factor scale. To obtain an association between them the data was subjected to statistical analysis.

Results: Results will be discussed at the time of presentation.

Poster 03: A Case Report of Catamenial Epilepsy: A Diagnostic and Therapeutic Challenge

Akul Gupta, S. Nagendran

Department of Psychiatry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Catamenial Epilepsy (CE) is a form of intractable and generally treatment refractory pattern of epileptic disorder with clusters of seizure activity around specific periods of the menstrual cycle due to hormonal fluctuations, i.e. decrease of progesterone levels in the perimenstrual (C1) and Inadequate luteal phase (C3) or rise in estrogen levels in periovulatory phase (C2). There is a paucity of literature addressing this condition from a clinical standpoint, and the literature that does exist is limited to the neurological community. This case report reviews the diagnosis and management of CE in a 45-year-old female who presented to the psychiatry outpatient department with a history of epileptic seizures since 22 years with adjunct post-ictal psychosis since 10 years. She was refractory to antiseizure treatment administered previously by medical practitioners. The patient was admitted to the psychiatry inpatient unit and detailed clinical history revealed a recurrent cyclical pattern of occurrence of generalised epilepsy in the perimenstrual phase (C1). A diagnosis of C1 type CE with post-ictal psychosis was established and treatment was reinitiated with anti-psychotic and anti-seizure drugs along with hormonal therapy. This report aims to enable physicians in identifying CE, understand menstrual physiology optimize treatment regimens and individualize hormonal treatment by considering adjustment and interactions with anti-seizure drugs.

Poster 04: A Case Report of Anorexia Nervosa in an Adolescent Female of Lower Socio-Economic Class

Prashant Singh, S. Nagendran

Department of Psychiatry, Teerthanker Mahaveer Medical College and Research Centre, Teerthanker Mahaveer University, Moradabad, Uttar Pradesh, India. E-mail: [email protected]

Anorexia Nervosa is an eating disorder defined by restriction of energy intake relative to requirements, leading to significantly low body weight. The patient may also have an intense fear of gaining weight with or without a distorted body image or the inability to recognize the seriousness of their significantly low body weight. Models, actors and athletes portray a level of thinness that maturing females identify with increased self-esteem and self-control. The current report is a case of a 17-year-old female, belonging to a lower socio-economic class of a Hindu family currently living in a rural area of western Uttar Pradesh with her family; she was referred to the psychiatry outpatient department by the paediatrics department of our tertiary care centre for complaints of recurrent episodes of vomiting since 15 months. A diagnosis of Anorexia Nervosa was made with a Body Mass Index of 8.7 which was life-threatening. The patient was transferred to the psychiatry in-patient unit and a multi-modal approach to treatment was implemented which included detailed assessment, refeeding, psychopharmacological and cognitive behavioural therapeutic approach. This case report calls for the attention of medical practitioners to be aware of signs and symptoms of eating disorders even in non-traditional patient populations and review the management approach.

Poster 05: Psychiatric Manifestation of Myhre Syndrome: A Case Report

Vasundhara Bhushan, Gyanendra Kumar, Arti Yadav, Sheetal Tripathi

Department of Psychiatry, Institute of Mental Health and Hospital, Agra, Uttar Pradesh, India. E-mail: [email protected]

Background: Myhre syndrome is a rare genetic autosomal dominant connective tissue disorder with multisystem involvement, developmental delay, distinctive skeletal abnormalities in association with mild to moderate intellectual disability and behavioral changes, caused due to heterozygous SMAD4 gene mutation.

Methodology: We recruited a case with molecular confirmed Myhre Syndrome from IMHH, Agra for psychiatric manifestations of Myhre Syndrome. We mentioned history by collecting data from medical reports, clinical examination and investigations. We herein report a case of 17 yrs old female with history of Intrauterine Growth Retardation, developmental delay, specific facial features and skeletal abnormalities, thickened skin and joint limitations. The adolescence is marked by mild intellectual disability and behavioral issues. Thus, we are reporting for the first-time occurrence of psychiatric complaints in this patient.

Results: Myhre Syndrome is a progressive genetic disorder with multi system involvement and psychiatric complaints. Thorough clinical assessment and multidisciplinary approach is required to extend our knowledge on both phenotypic characteristic and genetic basis of behavioral changes in Myhre Syndrome.

Poster 06: A Case Report of Conversion Catatonia

Nayab Anjum, Zeba Khan

Department of Psychiatry, Jawaharlal Nehru Medical College and Hospital, Aligarh, Uttar Pradesh, India. E-mail: [email protected]

Introduction: The catatonia is characterized by marked psychomotor disturbance, was first described by Karl Ludwig Kaulbaum in 1874. In this case report, we present a 19-year-old female patient suffering from a complex case of conversion catatonia who responded to the electroconvulsive therapy.

Case Study: A 19-year-old Indian female had complaints of social withdrawal, decreased speech, decreased oral intake, decreased self-care for past 6 months. Later on, family members brought the patient to emergency department of our tertiary care hospital with complaints of mutism, rigidity in all four limbs, poor oral intake and soiling of clothes from last 2 days. As we suspected it as a case of catatonia, Busch Francis catatonia rating scale was applied, and a score came out to be 18. Lorazepam challenge test was done with Injection lorazepam 2 mg slow iv, and it came out to be positive (patient started blinking, there was increased speech output and decreased rigidity). Patient was now admitted to the psychiatric ward, however after admission patient became significantly more catatonic with mutism, negativism, stupor and posturing. Due to deterioration in patient's nutritional status, ECT was planned. 24 hours before giving ECT, lorazepam was stopped. She received her first ECT on day 7 of admission. Two days after the first ECT, patient showed improvement. On mental status examination, patient explained how she felt prior to entering catatonic state “My mother is ill, my father does not stay at home due to work, I have good relationship with my brother but in lockdown he left home and went to distant place for his job. I felt alone, this upset me. I escaped into silence, like light out.” On inquiring about her mood, she used to say that she was sad, while smiling at the same time and didn't show any concern for her symptoms (la belle indifference). Patient displayed no disturbance in perception, thought form and content. Her affect was appropriate, she had a sense of self and showed no impairment in role functioning. She showed interest in activities and exhibited no impairment in interpersonal functioning. On asking her about future plans after discharge, she said she wanted to remain in hospital as she made friends there and was getting required attention from her family members unlike earlier. Total four cycles of modified ECT were given and patient reached baseline. Tab lorazepam was continued and tab memantine was stopped. Patient was discharged on tab lorazepam 2 mg TDS. Four days later, patient again came to emergency with a catatonic episode and patient was admitted. Patient was given 8 cycles of maintenance ECT and was discharged in improved condition.

Conclusion: Catatonia has only rarely been described as a form of conversion disorder. We present a case in which the patient responded to environmental stress and her own anger by developing an acute catatonic reaction. Patient responded to ECT. ECT may act earlier than drug treatment. Conversion catatonia may be used in psychiatric classification system such as DSM.

Poster 07: Gender Dysphoria Secondary to Delusion: A Case Report

Biplab Konwar, Dhrubajyoti Bhuyan

Department of Psychiatry, Assam Medical College, Dibrugarh, Assam, India. E-mail: [email protected]

Background: Gender dysphoria (GD) is characterized by incongruence between one's identity and gender assigned at birth. People with schizophrenia may experience gender dysphoria as a result of a delusional shift in gender identity or it may develop independently of psychotic symptoms.

Case: Mr x, 25 year male presented with irritability, aggressive behavior, with desire to change his gender. He believed that he was ill treated and everyone blamed him because of his gender and no one blamed females and they were more well treated in his society. He began thinking of becoming a woman and speaking with a feminine voice who sought psychiatric care with the desire to undergo sex reassignment surgery. The man's delusion included the conviction of being of the opposite sex with history of convulsion and bronchial asthma. He was admitted and on detailed evaluation, findings of delusion of reference, commanding auditory hallucination and delusion of persecution was thought be a case of schizophrenia. He was given antipsychotic drug risperidone orally and his symptoms decreased.

Discussion: Usually gender dysphoria present with desire to change gender. So, we should not jump directly to gender dysphoria. In our case it is secondary to delusional belief. There should be detailed psychiatric and psychosocial evaluation before coming to proper diagnosis.

Conclusion: Prompt diagnosis of a primary psychotic illness in patients manifesting transsexual convictions has implications for both the treatment and understanding of the relationship between gender dysphoria and schizophrenia.

Poster 08: Burnout and Suicidal Behaviour among Female Medical Students in a Rural Institution: The Possible Mediating Role of Alcohol Addiction Behavior

Aakanksha Kharb, Sunny Garg

Department of Psychiatry, B.P.S. Government Medical College for Women, Khanpur Kalan, Sonipat, Haryana, India.

E-mail: [email protected]

Background: Burnout is a serious problem that medical students must cope with. Around the world, there is a growing interest in medical students' stress, despair, burnout, and suicide. A strong relationship between burnout and suicidal behaviour has been reported worldwide. However, the mechanism elucidating this psychological distress remains uncertain.

Objectives: The purpose of this study was to assess the prevalence and risk factors for burnout, and to explore the mediating role of alcohol addiction on the relationship between burnout and suicidal behaviour among female medical students.

Methods: A cross-sectional institution-based study was conducted from April to May 2022 on 425 female medical students. The study participants were chosen using a stratified random sampling approach. A self-administered questionnaire was employed to collect data. The study included Maslach Burnout Inventory (MBI), Alcohol Use Disorder Identification Test (AUDIT), and Suicide Behavior Questionnaire-Revised (SBQ-R) to measure burnout, alcohol use disorder, and suicidal behaviour respectively. Chi-squared test for the risk factors and Pearson's correlation test for the relationship between variables, were used. Hayes' PROCESS macro for SPSS was employed to carry out mediation analysis.

Results: Around 34.08%, 35.47%, and 38.23% of respondents were emotionally exhausted (EE), showed high cynicism (CC), and had a low sense of personal accomplishment (PA), respectively. The identified risk factors significantly associated with burnout (27.4%) were relationship issues (P < 0.05), personal history of psychiatric illness (p<0.001), and unsatisfied academic performance (p<0.001). In correlational analysis, PA was significantly negatively associated (r= - 0.205; p<0.001), and EE (r= 0.183; p<0.001) and CC (r= 0.162; p<0.001) were significantly positively associated, with suicidal behaviour. The indirect effect (SE= 0.0134) via alcohol addiction accounted for 24.1% of the total effect (SE= 0.0554) of cynicism (CC) on suicidal behaviour (partially mediated) while it accounted for only 9.1% of the total effect (SE= 0.0554) of emotional exhaustion (EE) on suicidal behaviour.

Conclusion: The results specify the relationship between Cynicism and suicidal behaviour by demonstrating that it is mediated by alcohol addiction using a dimensional measure. These modifiable risk factors can be addressed by psychotherapy to mitigate the risk of suicidal behaviour among the future medical workforce.

Poster 09: Anorexia Nervosa as a Result of Bullying

Atreyee Dutta, Dhrubajyoti Bhuyan

Department of Psychiatry, Assam Medical College and Hospital, Dibrugarh, Assam, India. E-mail: [email protected]

Background: Anorexia nervosa is a chronic eating disorder, primarily affecting adolescent girls and young women characterized by low weight, fear of gaining weight, a strong desire to be thin, and food restriction. It is a syndrome related to a changing culture as recent times have seen rise in its reporting in non-Western countries like India as well. Bullying is often seen as an inevitable part of school life with enduring social and psychological consequences. Here, we report a case of Anorexia Nervosa which resulted from bullying.

Case: A 14-year-old girl had been bullied by her classmates by fat shaming her for around 2 years. During COVID-19 lockdown, she had no extracurricular activities and during attending online classes, her friends had teased her that she has gained a lot of weight. She started restricting her food intake drastically and started exercising vigorously and had lost a significant weight over a period of just 3-4 months with 30 kg weight & BMI of 13.3 kg/m². She was first taken to a general physician from where she was referred to us with lethargy, amenorrhoea, difficult temperament, depressed mood and a preoccupation with body image.

Discussion: According to the National Center for Educational Statistics (2013), 1 in 3 children (27.8%) report being bullied during the school year, with greater frequency among middle school children. Our result confirms an association between bullying and eating disorder (Anorexia nervosa).

Conclusion: Bullying in adolescence predicts eating disorder symptoms so bullying involvement should be a part of risk assessment and treatment planning for children with eating problems with a multi-disciplinary approach in its management.

Poster 10: Psychological Distress among the School Teachers

Renjith R. Pillai, Abhishek Ghosh, Ruchita Shah, Akhilesh Sharma, Kamal Kishore

Department of Psychiatry, Drug De-Addiction and Treatment Center, PGIMER, Chandigarh, India. E-mail: [email protected]

Background: The paper was part of the DST& RE Chandigarh funded project titled, “mental health literacy among school teachers”. The psyche of the teachers could have a direct bearing on the teaching-learning process of the school children. A contented teacher with manageable stress would do better at schools, it is important to know the prevailing situation and hence this study.

Objectives: The researcher intends to present one of the project objectives, which was to determine the level of psychological distress among school teachers in the Union Territory of Chandigarh, India.

Methods: It was an online cross-sectional study participated by 331 teachers from schools falling under the four clusters, namely 16, 17, 18 and 19 of the Education Department, Chandigarh Administration. Tools used for data collection included (a) a socio-demographic data sheet prepared by the researcher and (b) Self Reporting Questionnaire (SRQ-20). After availing necessary permissions, data was collected online using Google Forms. Informed consent was taken from the participants and ethical clearance was given by PGIMER, Chandigarh. Analysis was done using SPSS Software wherein 10 teachers were excluded due to history of psychiatric illness.

Results: A total of 7.2% teachers were reported to be in “case” category. Mild distress was found in 92.8% teachers and another 6.5% were in moderate distress category. Female participants and teachers from nuclear families were found to have a significant distress.

Conclusions: Teachers with higher level of distress should to be provided with mental health services and this component could be incorporated in the school mental health programme. Merits, limitations and implications of the study will be presented.

Poster 11: Akinetic Crises with Pin Point Pupil in Progressive Supranuclear Palsy: A Case Report

Porimita Chutia, Shailendra Mohan Tripathi

Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India. E-mail: [email protected]

Introduction: Akinetic crisis is a Parkinsonian emergency with acute worsening of motor symptoms characterized by nearly complete akinesia and often associated with dysphagia, dysautonomia, hyperthermia and/or increased levels of serum muscle enzymes. It is a life-threatening condition with a death rate of 15% requiring urgent intervention. There is no published literature of akinetic crises in progressive supranuclear palsy (PSP) till date.

Clinical Case: Here we report a sixty years old married Hindu male from rural UP with complete akinesia, dysarthria, dysphagia, dysautonomia and pin point pupil for two days. On detailed evaluation supranuclear vertical gaze palsy, repeated falls backward and axial rigidity along with neuro-radiological findings of 'hummingbird sign' and 'morning glory sign' were found suggestive of probable PSP. He was treated by multiple physicians as a case of idiopathic Parkinsonism for three years without much improvement in symptoms for which they stopped the medications abruptly four days back resulting in akinetic crises. The patient responded well to low dose of Amantadine and Escitalopram combination therapy and intravenous fluids with multivitamin injection.

Discussion: Abrupt stoppage of antiparkinsonian medications notably the dopaminergic and anticholinergic drugs lead to rebound cholinergic excess. The imbalance between cholinergic and dopaminergic neurotransmission in basal ganglia leads to akinetic crises similar to neuroleptic malignant syndrome. Amantadine is a dopaminergic, anticholinergic NMDA receptor antagonist along with selective serotonin re-uptake inhibitor (SSRI) improved the condition via fine tuning of the neurotransmitter pathways. The highlights of this report are PSP patient may also present with akinetic crises, the importance of caregiver education regarding the adverse effect of sudden stoppage of drugs and the role of low dose Amantadine and Escitalopram in treating the condition.

Poster 12: Shared Psychotic Disorder (Folie À Deux): Case Report with Conflicting Symptoms

Mallika Singh, Birva Desai

E-mail: [email protected]

Background: Shared Paranoid illnesses are a relatively uncommon psychiatric ailment characterised by the spread of paranoid delusions from one susceptible individual to one or more nearby others. The two individuals engaged in a folie à deux have a convoluted dependent relationship, yet it is difficult to diagnose the disease.

Case History: Here, we examine a case of folie à deux involving an inducer mother and an inducee son. In the clinical setting outlined, Folie à deux was readily detected; wherein the inducee son's symptoms appeared after the inducer mother's symptoms. In this case, the mother displayed positive symptoms such as persecutory delusions and hallucinations, whereas the son exhibited negative symptoms predominantly with some delusions.

Clinical Implications: Recognizing folie a deux and getting the right help for it is crucial, just as it is for any unusual condition. The importance of time spent apart by the involved individual is crucial to the healing process which is highlighted here.

Poster 13: Sociodemographic Profile and Pattern of Opioid Abuse among Patients Presenting to a De-Addiction Center in Tertiary Care Hospital of Jaipur, Rajasthan

Lovesh Saini, Lalit Batra, Suresh Gupta

Department of Psychiatry, SMS Medical College, Jaipur, Rajasthan, India. E-mail: [email protected]

Background: The substances abuse has become one of the major public health problems of present society and literature on the magnitude of this problem is limited. Recently there has been an increase in the incidence of substance abuse throughout the world. Opioids are the major drugs of potential harm and health consequences with more and more people getting involved in it.

Objective: The present study was undertaken with the objective to find out the epidemiological profile and patterns of opioid abuse among patients presenting to a de-addiction center in Jaipur as proper assessment of the current trends and pattern of opioid abuse can be helpful in more effective intervention of this menace.

Methods: A cross sectional study was conducted at Department of Psychiatry, SMS Medical College & Hospitals, Jaipur. A pretested semi-structured proforma was administered to 100 opioid patients (20-50 years) who presented to deaddiction center for treatment, to find out various sociodemographic variables and pattern of opioid abuse.

Results: All the patients who approached for de-addiction services were males. Nearly half of the patients (48%) coming for treatment were in the age group of 20-30 years. In terms of socio-economic status, the highest proportion of the patients (52%) were coming from the lower class, 34% of the sample was from middle class; and 14% were from the upper class. Majority of the patients (60%) were unmarried and from rural background (62%). Most of the patients (58%) attending the clinic were using opioid since more than two years, whereas 32 % were using it for 1-2 years and 10% for less than a year. Majority of our patients (42%) were using oral route for administration followed by inhalational (28%).

Conclusion: As majority of patients were from young age, a comprehensive preventive program targeting young adults needs to be formulated and strictly implemented. Moreover, proper rehabilitative methods to be adopted to lessen the chances of relapse.

Poster 14: A Study of Psychological Burden in Patients of Polycystic Ovarian Syndrome at Psychiatric Centre, S.M.S. Medical College Jaipur

Bharti Mohanpuria

E-mail: [email protected]

Background and Aim: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. In the past, polycystic ovary syndrome has been looked at primarily as an endocrine disorder. Studies now show that polycystic ovary syndrome is a metabolic, hormonal, and psychosocial disorder and a stigmatizing condition that affects a woman's identity, mental health and quality of life. This aspect has not received adequate attention in India. It is extremely important to holistically treat these patients early on to help them deal with the emotional stress that is often overlooked with PCOS. The present study aims to find out the psychological burden among women suffering with PCOS.

Methods: A cross sectional study was conducted at Department of Psychiatry, SMS Medical College & Hospitals, Jaipur, India during June 2021 to June 2022. 110 females in the reproductive age group (18–45 years) diagnosed with PCOS (as per Rotterdam criteria 2003) and without any pre-existing psychiatric illness were clinically interviewed for psychological disorders. The presence of psychological burden – depression, anxiety and stress – was quantified using Depression, Anxiety and Stress Scale-21 (DASS-21).

Results: Out of 110 PCOS women studied, 75 (68.2%) were found suffering with anxiety, 63 (57.3%) with depression and 58 (52.7%) with stress. Overall, there was increased prevalence of psychological disorders among women with PCOS.

Conclusion: The study indicates that the presence of PCOS is associated with an increased prevalence of stress, depression and anxiety. Meeting the psychological need of the PCOS women will help in improving their quality of life.

Poster 15: Diagnostic and Management Challenges in a Case of Late Onset Bipolar Disorder with Neuroimaging Findings

Pinki Sevda, Pranshu Singh, Swati Choudhary, Preethy Kathiresan, Tanu Gupta

Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. E-mail: [email protected]

Introduction: The onset of bipolar disorder most commonly occurs around 20 years of age. In more than half of the cases, onset is before the age of 20, frequently in late adolescence. In contrast to this, first-onset mania is very rare among elderly people. If the first manic/hypomanic episode occurs >50 years, it is known as Late-onset Bipolar-Disorder. Late Onset BPAD is more frequent in women and occurs with fewer and milder manic symptoms, but with more irritable behaviour. It is also associated with higher frequency of neurological (”organic”) etiologies. So, it is necessary to rule out organicity first. As the literature in this area is sparse, this case report will add to existing literature. Case Summary: A 60-years old married female presented to our OPD with manic symptoms with past history of a depressive episode. From OPD, she was admitted to an inpatient facility to manage acute disturbances caused by her manic symptoms. After detailed assessment, she was started on T. Risperidone 2 mg. Due to existing co-morbidities i.e. hypothyroidism, dyslipidemia, HTN, she was continued on her medications for the same. Due to high prolactin levels (1271 mIU/l), Tab. Risperidone was tapered down and stopped, and Tab Aripiprazole 5 mg was added which was hiked to 15 mg. Sodium Valproate was added as a mood stabilizer and hiked to 1250 mg. Considering the age of onset, MRI Brain was done to rule out organicity which revealed encephalomalacia with gliotic changes in bilateral superior frontal gyrus, mild prominence of sulcal spaces and dilation of bilateral lateral ventricles. A possibility of normal pressure hydrocephalus was kept in the report. After a detailed assessment from the Neurology department, no active intervention was advised from their side. Psychology opinion was taken for neuropsychological assessment in which Moderate to severe deficits were seen in areas of working memory, attention and concentration, delayed recall, verbal retention and visual retention. Patient's mood symptoms improved significantly with medications at the time of discharge. During follow-up, she developed Extrapyramidal symptoms in the form of tremors and bradykinesia and hence, Tab. Aripiprazole was tapered and stopped. In further follow-ups, even though there was improvement in her EPS symptoms, it did not completely resolve. After discussion with neurologist and after a literature review, Valproate was also tapered and stopped as it can also cause EPS symptoms. The patient was started on Tab. Lamotrigine in view of multiple episodes of depression and only one episode of mania and that too, on an antidepressant (SSRI induced switch). However, she developed ulcers in her mouth and rashes in her skin following that, which did not heal even with dermatologist treatment, and hence it was tapered and stopped. Now, the patient is currently off all medications from the psychiatry side, and we are predominantly focusing on non-pharmacological management like activity scheduling, behavioral activation, problem-solving techniques for the stressors in her life. She is in close observation through regular follow-ups and is maintaining well currently.

Conclusion: The case described had both diagnostic and management challenges. As there were significant neuroimaging findings, the organic basis of mood disorder could not be ruled out. Also, as the patient had side effects with all the medications, we are currently focusing only on non-pharmacological intervention. This case adds to the limited literature on late-onset bipolar disorder.

Poster 16: Late-Onset Dissociative Convulsions: A Case Report

Roopsi Kakkar, Preethy Kathiresan

Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India. E-mail: [email protected]

Introduction: Dissociative disorders usually have an onset in younger age group, and the dissociative symptoms reduce in intensity and frequency as person grows older. In the few studies that mentioned about the dissociative disorder in older adults, the symptoms had been usually a continuation of the illness with younger age of onset. Also, dissociative amnesia and dissociative identity disorder are the most commonly reported types among older adults. In this case report, we present a unique case which presented with onset of dissociative convulsions at 51 years of age.

Case Summary: A 51-year-old illiterate and married female, presented with complaints of episodes of unresponsiveness, out of phase movements of all four limbs lasting for 2-3 hours, for last 1.5 years. The episodes had increased to 2-3 times daily for the past 15 days leading to significant socio-occupational dysfunction. On further exploration, we found that symptoms had started after departure of her son to another city and the symptoms increased whenever he left the city after staying for few days at home during holidays. A diagnosis of dissociative neurological symptom disorder, with non-epileptic seizures were made and patient was started on Tab Duloxetine 20 mg. Family members were psycho-educated to cut down secondary gains.

Conclusion: Our case was unique in terms of its onset, and it adds to the rare entity in context of dissociation. Dissociative disorders can occur at any age and clinicians need to remain vigilant to identify and manage dissociative disorders for optimum patient care.

Poster 17: A Study to Assess the Various Personality Traits in Patients Presenting with Epilepsy

Aanchal Singh, Poonam Bharti

Department of Psychiatry, MMIMSR. E-mail: [email protected]

Aim and Objectives: A study to assess the various personality traits in patients presenting with Epilepsy.

Results: The mean age group at which generalized seizure occur is 7.19 years and that of partial seizure is 6.98 years. Majority of the children presented in the age group of 4-8 year the overall male: Female ratio is 1.04:1. Patients with epilepsy had significantly higher dimensional scores on seven DSM-IV PDs, including schizoid, antisocial, histrionic, avoidant, dependent, passive aggressive, and depressed, compared to the control group. They scored considerably higher on the paranoid, schizoid, dissocial, histrionic, anxious, and dependent PD ICD-10 PD features. A considerably higher total dimensional score was discovered in the epilepsy patients for both DSM-IV and ICD-10.

Conclusion: It is generally recognised that mental co-morbidities are connected to epilepsy, and temporal lobe epilepsy is the epilepsy condition with the highest frequency of these psychiatric characteristics. Personality disorders are significantly less treated than other psychiatric diseases.

Poster 18: Student Wellness Program – A Multistage Level Intervention to Identify Psychological Problems among Medical Students

Roy A. Kallivayalil, Sheena Varughese, Derrick Johnson, M. Goutham Kiran, Nibin Wilson

E-mail: [email protected]

Background: India hosts world's largest medical education consortium with an estimated 80,000 medical students graduate as doctors from more than 530 medical colleges in India every year. Medical education is the most sought-after courses in India and at the same time can be stressful for some. To intervene in this matter, Kerala University of Health Sciences, Thrissur have begun Student support and guidance program (SSGP) in all their professional institutions under them. Student Wellness Program (SWP) was conceived at our medical institution to ensure each student who requires help gets timely intervention. There have been many articles in India where statistics of prevalence of mental health disorders as well as suicides are available but very less literature on what measures are being taken so as to prevent or tackle these health problems.

Objectives: To find the prevalence of the most common mental health disorder among students of medical college in the southern state of India.

Methods: Open sessions will be arranged for all MBBS students from first to final year. This will be followed by small group focussed sessions of 10-12 students. After getting written informed consent, students attending the focussed group will be assessed using Patient Health Questionnaire (PHQ)-9 and Depression Anxiety Stress Scale-21 (DASS21). Those screened to have any problems will be further evaluated by consultant psychiatrist and appropriate interventions will be provided.

Results: Data will be analysed and presented.

Poster 19: Personality Traits and Online PREFERENCES as Predictors for Internet Use Disorder

Sonali Aggarwal, Priti Arun, Shivangi Mehta

Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India. E-mail: [email protected]

Background: With recent innovations in technology and easy availability, the internet usage has increased enormously, posing risk of addiction, particularly in college students. Personality traits and the type of online activities greatly influence an individual's risk for addiction.

Aim: This study aimed to evaluate association of personality traits and online activities with internet addiction.

Methods: This cross-sectional study was conducted on college students (18-25 years) pursuing graduation in professional colleges in Chandigarh. Participants lacking proficiency in English language and proficiency in the use of internet were excluded. Participants responded to online questionnaire consisting of Young's internet addiction test, Big Five inventory and BIS/BAS scales. The occurrence and severity of internet addiction were assessed and association with various personality traits as well as type of online activities was analysed.

Results: Out of 481 college students (mean age-20.85+/-1.84 years, male: female-0.9-1), 175 (36.38%) students (male: female–1.13:1) with mean age-20.56+/-1.61 years, were found to have internet addiction (mild-115, moderate-57, severe-3). On comparison between two groups (addiction and no addiction), the differences in use of adult entertainment sites, chat rooms, instant messaging, online gaming, online shopping and recreational surfing were statistically significant. On multivariate logistic regression, use of chat rooms (p value=0.04; OR-1.24), instant messaging (p value=0.01; OR-1.33), online gaming (p value=0.03; OR-1.25) and recreational surfing (p value=0.02; OR-1.25) were found to be independent predictors for internet addiction. We did not find influence of type of online sites on severity of internet addiction. Among the personality traits, the differences in conscientiousness, neuroticism, openness to experience, BIS and BAS drive scores were significantly significant between addiction and no-addiction groups as well as mild vs. moderate-severe groups (except BAS drive). On multivariate logistic regression, neuroticism (p value-0.03; OR-1.06) and openness to experience (p value-0.00; OR-1.09) were found to be positive predictors, for both presence of internet addiction as well as moderate-severe addiction, while conscientiousness (p value-0.00;OR-0.87) was found to be a negative predictor for the same.

Conclusions: In this study, neuroticism and openness to experience were found to be predictors of internet addiction as well as moderate-severe addiction. In addition, use of chat rooms, instant messaging, online gaming and recreational surfing were associated with higher chances of developing internet addiction.

Poster 20: Clozapine Induced Tardive Dyskinesia: A Case Report

Arnav Sharma, Parvaiz Alam, Bhavuk Garg, Dinesh Kataria

Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Background: Tardive dyskinesia is a movement disorder that causes involuntary, repetitive body movements and is currently seen in patients who are on long term treatment with antipsychotics. Compared to first generation anti-psychotic medications, clozapine has not only been reported to be associated with lower incidence of tardive dyskinesia but rather has a beneficial effect on tardive dyskinesia. In the index case we are describing tardive dyskinesia caused by clozapine and review the existing literature linking clozapine with tardive dyskinesia.

Objective: To describe a case of tardive dyskinesia associated with clozapine.

Case History: A 44-year-old female presented with a history suggestive of schizophrenia for 13 years. Patient was maintaining well on Clozapine 200 mg for last 6 years. However, 6 months ago on routine follow up involuntary orofacial movements were observed. Patient didn't report any distress or dysfunction due to these complaints; examination didn't reveal any tremor or rigidity or any other signs of Extra pyramidal side effect. Abnormal Involuntary Movements Scale was applied and gave a score of 6.

Conclusions: Clozapine is an atypical antipsychotic, which binds to both dopamine and serotonin receptors, and it acts as an antagonist at the 5HT2A and D4 receptors. Data linking to clozapine and tardive dyskinesia is mainly available from case reports and series. In reviewing the articles, we found that most patients who developed TD on clozapine were on dose ranging between 300-500 mg/day and were using clozapine for 1.5 months to 10.5 years. Here, in our case TD developed 6 years after use. Although available literature points towards protective role of Clozapine in EPS, our case highlights the need to be cautious while prescribing this drug. We expect our case will contribute to the limited literature on “clozapine-induced TD”.

Poster 21: Akathisia in a Patient on Levosulpiride: A Case Report

Shruti Zunzunwala, Akanksha Shukla, Parvaiz Alam, Shiv Prasad, Dinesh Kataria

Department of Psychiatry and Drug Deaddiction Centre, Lady Hardinge Medical College, New Delhi, India. E-mail: [email protected]

Background: Levosulpiride is usually prescribed as a prokinetic by gastroenterologists. Over the past decade there has been a considerable increase in Levosulpiride prescriptions, especially in Asia and Europe. Akathisia is a distressing adverse reaction which can lead to serious consequences like suicidality. However, it is usually underdiagnosed or misdiagnosed in patients treated with Levosulpiride. There are only few case reports on Levosulpiride-induced akathisia in the literature.

Objective: To describe a case of akathisia associated with Levosulpiride.

Case Report: Mrs. S, a 55-year-old female presented with low mood, decreased interest, decreased activity levels since three months followed by acute onset of restlessness manifested as pacing, rocking and crossing- uncrossing of legs with severe distress since 2.5 months. Patient was evaluated on OPD basis and no history of any psychotropics was revealed. Patient was started on tablet escitalopram 10 mg, with no improvement in symptoms patient started reported suicidal ideations secondary to the distress of restlessness following which patient was admitted. On detailed evaluation history of starting of Levosulpiride in combination with a PPI as a prokinetic prescribed by a gastroenterologist 2 days prior to onset of restlessness was revealed. Levosulpiride was stopped and the patient had complete resolution of restlessness from the next day itself. Rechallenge with single dose of Levosulpiride 75 mg was done on Day 7 of admission after taking informed consent from the patient following which patient developed restlessness after 10 hours of drug administration.

Conclusion: According to the Naranjo Adverse Drug Reaction Scale, the probability of association of this adverse reaction with Levosulpiride was 7 suggestive of probable adverse drug reaction. In this case, the temporal relationship suggests Levosulpiride as the causative molecule. Our patient had akathisia leading to suicidal ideation, which indicates its seriousness. Thus, the recognition of such adverse effect requires a high index of suspicion, early recognition, and prompt management. Patients and their caretakers should be warned of symptoms of akathisia when started on Levosulpiride.

Poster 22: Quality of Life among Spouses of Patients with Alcohol Dependence Syndrome

Tarun Tripathi, Abbas Mehdi

Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India. E-mail: [email protected]

Background: Alcohol use has significant harmful effect to the physical, psychological and social health of individuals, families and communities. Spouse of the patients with alcohol dependence syndrome are the most vulnerable who suffer the consequences of alcoholism and its effects. Very few studies have been done on wives of patients with alcohol dependence syndrome in the Indian settings.

Aims and Objectives: Current study aimed to determine the quality of life in spouses of patients with alcohol dependence syndrome.

Materials and Methods: This is a cross-sectional study conducted in a tertiary care hospital. Study group comprises of 60 wives of men with alcohol dependence syndrome were assessed using WHO QoL Bref and M.I.N.I. Multiple linear regression analysis was used to assess the independent association of alcohol use with QoL.

Results: Mean (SD) age at initiation was 23.4 (8.5) years. Results shows that mean quality of life score of spouses of patients with alcohol dependence syndrome in physical domain (12.50), psychological (10.43), social (6.24) and environmental (11.10) respectively. The Chi-square test shows that there is a highly significant association between QOL scores of subjects and selected variables such as income of family (P ≤ 0.001) and number of children (P ≤ 0.015).

Conclusion: The study results revealed that spouses of patients with alcohol dependence syndrome are having poor quality of life. Hence need to adopt effective interventions to promote the wellbeing of the wives of patients with alcohol dependence syndrome and to improve their quality of life.

Poster 23: Acute Psychosis or Cerebral Malaria: The Imbroglio Answered Amidst Investigation - A Rare Case Series

Yogi Rana, Manish Singh, Abhishek Pathak

Department of Psychiatry, Hind Institute Of Medical Sciences, Sitapur C. E-mail: [email protected]

Despite the fact that malaria is a most common condition and cerebral manifestation of malaria occur in up to one-third of cases, little scientific attention has been focused on the psychic effects of malaria infestation. Cerebral malaria is one of the most common non-traumatic encephalopathies in the developing country. Even though the diagnosis of cerebral malaria can be made relatively easily in majority of cases, atypical presentation can often lead to misdiagnosis or delayed diagnosis. Cerebral malaria is usually secondary to Plasmodium Falciparum infection. Plasmodium Vivax causing cerebral malaria in adult population is very rare. We report 2 cases of an uncommon presentation of Plasmodium Vivax infection in adult patients with fever, headache and altered mental status. Case presentation1 A previously healthy 35-year-old Hindu married male presented to our hospital with fever and headache since 15 days and irritability, aggressive and assaultive behaviour, agitation, disturbed sleep and over talkativeness since 5 days and was diagnosed as having an acute psychotic state. Case presentation2 A previously healthy 25-years-old Hindu married male presented to our hospital with fever and headache since 15 days and irritability, aggressive behaviour, muttering to self, suspiciousness, irrelevant talk, disturbed sleep since 3 days and was also diagnosed as having an acute psychotic state. However, further investigations carried out in our unit (including card test for malaria parasite) were positive for P. Vivax in both patients. They were treated as for cerebral malaria with intravenous Artesunate and discharged from hospital with no neurological deficit. Conclusion As atypical presentation of cerebral malaria can often lead to misdiagnosis, we believe our reports on atypical cases of Plasmodium Vivax will sensitize doctors and health personnel about rare presentations in adults and help in early diagnosis and management to reduce the severity and death toll due to the disease.

Poster 24: Obsessive Compulsive Disorder Related to Medications: A Rare Phenomenology

Vasu Mishra, Pratibha Gehlawat

Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India.

Introduction: Contamination concerns along with washing compulsions is one the most common phenomenology in relation to obsessive compulsive disorder (OCD). Here we present a case of OCD with one of the rarest phenomenology which we could successfully diagnose and manage in our tertiary care setting.

Case Summary: A 39-year-old male presented to the outpatient department with complaints of irritability and anger outbursts. Upon exploration, in the initial years for his anxiety complain he consulted a private psychiatrist where some medications were prescribed (Records N/A). Gradually he started having recurrent thought that medicines he has been prescribed are not effective. He acknowledged the fact that these thoughts are irrational but due to the ongoing anxiety he took consultation from another doctor where again he was prescribed another combination of medication following which he anxiety subsided. Subsequently he began to have such thoughts repetitively wherein he would change medication or combine them in order to make it new for him. According to family members he started remaining absentee from his shop, would even steal money from shops account and would consult another doctor to get another set of given treatment. As per patient although he knew the fact that these thoughts are irrational but he was never able to take prescribed medication for more that 2 days in his illness duration of 10 years. After discussion he was admitted to the inpatient ward for further diagnostic clarification and management. Cap fluoxetine was started and gradually hiked along with exposure and response prevention therapy.

Conclusion: Our case was unique in terms of its presentation, and it adds to the rare phenomenology in context of OCD. Considering the content of obsessions, it was difficult to manage in OPD settings and IPD admission itself started the exposure and response prevention therapy. So, clinicians should remain vigilant and evaluate phenomenology in great detail for better diagnosis and possible treatment outcomes

Poster 25: Pushpagiri Community Mental Health Programs in Central Kerala- A Model for LAMI Countries.

Neethu S Cherian, Haritha S, Soumya P Thomas, Roy A Kallivayalil

Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, 689101, India. E-mail: [email protected]

Founded in 1982, the department of Psychiatry at Pushpagiri Institute of Medical Sciences, Thiruvalla is one of the oldest General Hospital Psychiatry Units in Kerala, India. It is a pioneer in collaborative work in mental health care with Non-Governmental Organisations (NGOs). We are now actively working with Mariasadanam Rehabilitation Center, Pala (Kottayam dist.) and Snehabhavan Rehabilitation Centre Edathuva, Alleppey. 400 and 200 persons respectively, with mental illness are rehabilitated in these two centres. We are also working with the District Mental Health Programme (DMHP) of Pathanamthitta district by extending mental health services through Primary Health Center, Kuttur and Chathenkary Community Health Center for the last 10 years. We make monthly visits to the NGO rehabilitation centres and cater to their different mental health needs. We also observe special days and arrange awareness classes and also encourage their participation in entertainment programs. We promote vocational training programs also. We also take medical students during our visits, which in fact is a great opportunity for them to understand the need for community health care and it also provides a great exposure to the specialty in general. We make monthly visits as part of DMHP on second Tuesdays to Kuttur and third Tuesdays to Chathenkary along with our post graduate residents. These Community Mental Health Programmes have helped us to extend mental health care to communities which would otherwise have been deprived of this. It has received much public acclaim. This can be a model for Low and Middle Income (LAMI) Countries.