Sexual Dysfunction in Women with Depression: A Hospital-Based Cross-sectional Comparative Study.

BACKGROUND: There is a need to explore the sexual functioning of women with depression as one part of sexuality is that it helps in developing an intimate emotional and physical relationship with another person, and this relationship may serve as a buffer against life stresses. Our aim was to study the prevalence and types of sexual dysfunction in depressed women patients and to compare them with non-depressed women. MATERIALS AND METHODS: A total of 270 participants who attended a teaching hospital were selected for the study - 135 cases and 135 controls. Sociodemographic and clinical details were collected. Mini International Neuropsychiatry Interview (M.I.N.I), Hamilton Depression Rating Scale (HAM-D), Arizona Sexual Experiences (ASEX) scale, and Female Sexual Functioning Index (FSFI) scale were used. Sexual dysfunction was assessed in both groups. RESULTS: Among the cases, 47.40% had mild depression, 44.44% had moderate depression, and 8.15% were severely depressed. On the ASEX, 46.66% of the cases had sexual dysfunction, while it was only 8.89% among the controls. The difference in sexual dysfunction among cases and controls was statistically significant. Using the FSFI, 40% of the cases had female sexual dysfunction (FSD), and it was only 11.1% in controls. CONCLUSION: Sexual dysfunction was more common in females with clinical depression than in those without depression. Numerous factors can operate in the causation of FSD. This study underlines the importance of screening females with depression for FSD, for its early diagnosis and management.

Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India.

Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.

Risk Factors for Kidney Stones in Rural Puducherry: Case-Control Study.

INTRODUCTION: Renal stone is a distressing chronic condition which is getting common across the world. The rigorous evidence on multiple risk factors of kidney stone from a single study is limited. AIM: To find out the social and dietary risk factors responsible for the occurrence of kidney stone in a local community in rural Puducherry, India. MATERIALS AND METHODS: It was a hospital-based unmatched case-control study. Based on existing information, a sample of 70 cases and 140 controls was calculated and considered adequate. The exposure information on recent cases was uniformly collected by interview and review of radiologic records and exposure information for controls was collected through interviews. Associations between the occurrence of renal stone as a dependent variable and multiple independent variables such as age, sex, socioeconomic status, type of family, religion, the source of drinking water and dietary practices were studied by using multiple logistic regression analysis. RESULTS: We found associations of occurrence of kidney stone with genetic predisposition (OR:16.98, CI;3.02-95.25), less frequency of urine per day (OR:5.95, CI;1.03-34.19) and dietary habit of eating red meat once a week (OR:32.28, CI; 9.7-143.2) and even once a month (OR:5.20, CI;1.44-18.77). CONCLUSION: The risk of kidney stone was found high among those who had genetic predisposition, less frequency of urination per day and those who consumed red meat once a month or more. Patients and local community should be educated to reduce the red meat consumption and increase the consumption of water and fluid, especially during the hot climates.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses as perceived by their family caregivers and health-care providers.

AIM: To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. MATERIALS AND METHODS: Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). RESULTS: The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need. CONCLUSIONS: According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

Academic stress and depression among adolescents: a cross-sectional study.

OBJECTIVE: To examine the relationship between academic stress and depression among adolescents. METHODS: A cross-sectional study was conducted at higher secondary schools in Tamil Nadu. 1120 adolescents were included in the study after screening by MINI-kid tool. Modified Educatonal Stress Scale for Adolescents was administered to all children. RESULTS: Adolescents who had academic stress were at 2.4 times (95% CI=0.9-2.4) (P<0.001) higher risk of depression than adolescents without academic stress. CONCLUSIONS: Adolescents with severe academic stress need to be identified early as interventions to reduce academic stress is likely to affect the occurrence and severity of depression.

Indian Psychiatric Society multicentric study on assessment of health-care needs of patients with severe mental illnesses.

AIM: To assess the health-care needs of the patients with severe mental disorders. MATERIALS AND METHODS: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). RESULTS: The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. CONCLUSION: About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

Indian Psychiatric Society-World Psychiatric Association - World Health Organization survey on usefulness of International Classification of Diseases-10.

BACKGROUND: World Health Organization (WHO) is in the process of revising the International Classification of Diseases 10 (ICD-10). For increasing the acceptability of the ICD-11, WHO along with World Psychiatric Association (WPA), conducted a survey of psychiatrists around the world, in which 386 psychiatrists from India participated. AIM: To present the findings of "WPA-WHO Global Survey of Psychiatrists' Attitudes toward Mental Disorders Classification" for Indian psychiatrists who participated in the survey as members of Indian Psychiatric Society. METHODOLOGY: The online survey was sent to qualified psychiatrists who are members of Indian Psychiatric Society and are residing in India. RESULTS: Of the 1702 members who were urged to participate in the survey, 386 (22.7%) participated. Most(79%) of the psychiatrists opined that they use formal classificatory systems in their day-to-day clinical practice. ICD-10 was the most commonly (71%) followed classificatory system. Nearly half (48%) felt the need for only 10-30 categories for use in clinical settings and another 44% opined that 31-100 categories are required for use. Most of the participants (85%) suggested that a modified/simpler classificatory system should be designed for primary care practitioners. Similarly, the same number of participants (89%) argued that for maximum utility of a nosological system diagnostic criteria should provide flexible guidance that allows cultural variation and clinical judgement. About 75% opined that the diagnostic system they were using was difficult to apply across cultures. CONCLUSION: Findings of the survey suggest that classificatory systems are routinely used in day-to-day practice by most of the participating psychiatrists in India and most expect that future classificatory system should provide flexible guidance that allows cultural variation and clinical judgement.

IPS multicentric study: Functional somatic symptoms in depression.

BACKGROUND: As a pilot project, Indian Psychiatric Society conducted the first multicentric study involving diverse settings from teaching institutions in public and private sectors and even privately run psychiatric clinics. AIM OF THE STUDY: To study the typology of functional somatic complaints (FSC) in patients with first episode depression. MATERIALS AND METHODS: A total of 741 patients from 16 centers across the country participated in the study. They were assessed on Bradford Somatic Symptom inventory for FSC, Beck Depression Inventory for severity of depression, and Comprehensive Psychopathological Rating Scale- anxiety index (CPRS-AI) for anxiety symptoms. RESULTS: The mean age of the study sample was 38.23 years (SD-11.52). There was equal gender distribution (male - 49.8% vs. females 50.2%). Majority of the patients were married (74.5%), Hindus (57%), and from nuclear family (68.2%). A little over half of the patients were from urban background (52.9%). The mean duration of illness at the time of assessment was 25.55 months. Most of the patients (77%) had more than 10 FSCs, with 39.7% having more than 20 FSCs as assessed on Bradford Somatic Inventory. The more common FSC as assessed on Bradford Somatic Inventory were lack of energy (weakness) much of the time (76.2%), severe headache (74%) and feeling tired when not working (71%), pain in legs (64%), aware of palpitations (59.5%), head feeling heavy (59.4%), aches and pains all over the body (55.5%), mouth or throat getting dry (55.2%), pain or tension in neck and shoulder (54%), head feeling hot or burning (54%), and darkness or mist in front of the eyes (49.1%). The prevalence and typology of FSCs is to a certain extent influenced by the sociodemographic variables and severity of depression. CONCLUSION: Functional somatic symptoms are highly prevalent in Indian depressed patients and hence deserve more attention while diagnosing depression in Indian setting.

IPS multicentric study: Antidepressant prescription patterns.

BACKGROUND: There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression. AIM: To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics. MATERIALS AND METHODS: Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated. RESULTS: Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth (N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients (N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523). CONCLUSION: Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription.

Position statement and guidelines on unmodified electroconvulsive therapy.

BACKGROUND: In modern day psychiatric practice, it is assumed as a matter of fact that when electroconvulsive therapy (ECT) is administered, it will be administered under anesthesia and with succinylcholine (or its equivalent) modification. Yet, as surveys indicate, there is considerable practice of unmodified ECT in developing countries and, to a small extent, in the developed world, as well. MATERIALS AND METHODS: This document examines historical and recent literature on the geographical practice, physiology, efficacy, and adverse effects of unmodified ECT. Particular attention is paid to musculoskeletal risks. RESULTS: Although almost all the research is of poor methodological quality, there is a good reason to accept that unmodified ECT is associated with a wide range of adverse consequences, important among which are musculoskeletal complications, pre-ECT anxiety, and post-ECT confusion. However, it appears from recent data that these risks are not as large as historically portrayed. Possibly explanations are suggested, with seizure modification using parenteral benzodiazepines as a special possibility. CONCLUSIONS: Under exceptional circumstances, if ECT is strongly indicated and seizure modification with succinylcholine is not feasible, unmodified ECT, especially benzodiazepine-modified ECT, may be a viable option. A detailed set of recommendations for such use of unmodified ECT is proposed along with necessary checks and balances. This document has been approved by the Indian Psychatric Society, the Indian Association of Biological Psychiatry, and the Indian Association of Private Psychiatry (which commissioned the preparation of the document).

Training and National deficit of psychiatrists in India - A critical analysis.

India is the second most populous country in the world, with an estimated current population of 1.17 billion. This article aims to estimate the deficit of psychiatrists in India in relation to epidemiological burden of mental illness, propose short-term and long-term strategies to tackle the deficit and emphasize the importance of modifying the curriculum of undergraduate medical education to enable the proposed strategies. With 6.5% prevalence of serious mental disorder, the average national deficit of India is estimated to be 77%. More than one-third of the population has more than 90% deficit of psychiatrists. The authors estimated that the undergraduate medical curriculum devotes only 1.4% of lecture time and 3.8-4.1% of internship time to psychiatry, thereby leaving the general practitioners and the non-psychiatrist specialists unprepared to competently deal with mental illness in their practice. We propose short and long-term strategies to manage this deficit of psychiatrists.