Asian Journal of Psychiatry

Editorial Board

2010-06-01

Long term outcomes in persons with bipolar disorder—Developing versus developed countries

K.N. Roy Chengappa — 2010-06-01

The article by Chopra and colleagues (this issue) describing psychosocial outcomes in a small cohort of persons with Bipolar Disorder (BPD) in rural South India brings to mind both old and new clinical issues associated with this psychiatric disorder. The “old” refers to the Kraepelinian notion that Manic Depressive Illness, unlike Schizophrenia, is a cyclical, episodic mood disorder, with episodes often showing polar opposite phenomenology, and in the main, recovery occurring between episodes, with no cognitive deterioration over time, a view with proponents but also many opponents in recent years.

The utility and benefits of clinical neuropsychology in Asia

S.L. Collinson, M. Lam, C.J. Hayes — 2010-06-01

Abstract: Neuropsychological evaluation is the clinical practice of identifying and measuring impairments in mental functions in the context of a patient's mental strengths and preserved abilities for the purposes of diagnosis, rehabilitation planning, and long-term care. Best practice approaches to the medical management of neurodegenerative, neurological and psychiatric illness have lead to increasing demand for neuropsychological services. The simultaneous challenges of Asias’ increasing adult and rapidly ageing population underscore the need for consideration of the role of neuropsychological services in day-to-day clinical practice. Here, we outline the clinical utility of neuropsychological assessment and indications for its use in general psychiatric practice.

Psycho-social outcomes for persons with bipolar-I disorder: Eight-year follow-up of a rural cohort from south India

Mohit P. Chopra, K.V. Kishore Kumar, Sanjeev Jain, R. Srinivasa Murthy — 2010-06-01

Abstract: Background: Assess psycho-social outcomes in a rural cohort of patients with bipolar-I disorder (BD).Methods: Detailed evaluations were performed using the Longitudinal Interval Follow-up Evaluation (LIFE) assessments of community-based BD patients in southern India. Several subjective and objective outcome measures were examined.Results: Only half the cohort could be described as having a good overall outcome, with persistent difficulties in inter-personal relationships in a substantial proportion of patients. Separation or divorce, or co-morbid alcohol dependence impacted a higher proportion of female patients compared to males.Conclusions: In spite of the small cohort size, this longitudinal study indicates mixed outcomes for BD patients in this setting, with several patients showing enduring psycho-social and global impairments. Even though symptomatic recovery for BD patients might be better in developing countries compared to those observed in developed nations, the notion of better psycho-social outcomes for BD in developing countries needs closer re-examination in larger cohorts.

Differences in the preferred antipsychotics for acute schizophrenia among young psychiatrists in two regions of Japan

2010-06-01

Abstract: Background: Effective emergency intervention for acute schizophrenia is of great concern to psychiatrists. To investigate whether differences in attitudes toward pharmacotherapy exist in the emergency setting, we surveyed two regions of Japan.Methods: The subjects were 100 psychiatrists. The clinical experience of all subjects was not more than 15 years. A questionnaire with a case vignette was sent to them and returned anonymously. Thirty-five out of 42 subjects in Hokkaido and 30 out of 58 subjects in Fukuoka responded.Results: We found a difference in the preferred route of administration of haloperidol, the agent chosen by 46.2% of the respondents. Most psychiatrists in Hokkaido preferred intravenous administration, but none of the Fukuoka psychiatrists chose this route preferring intramuscular administration. The mean dose of haloperidol was significantly higher in Hokkaido (7.29±2.5mg) compared to that in Fukuoka (5.56±1.7mg).Conclusion: The difference in preferred route of administration and dose of haloperidol probably reflects the content of training at each hospital and suggests that early training determines the subsequent clinical custom of each psychiatrist.

No gross abnormality of plasma homocysteine after acute methionine loading in clinically stabilized patients with schizophrenia

2010-06-01

Abstract: Homocysteine is reported to be a risk factor for schizophrenia. The methionine loading test evaluates the summation of a multitude of enzymatic pathways associated with homocysteine metabolism. Using a challenge paradigm, we measured homocysteine levels in 10 chronic schizophrenia patients and five controls at baseline and 3h after 100mg/kg oral methionine. This pilot study failed to detect a gross abnormality of plasma homocysteine level after acute methionine load in patients with schizophrenia. Elevations in plasma homocysteine reported in schizophrenia do not derive from a dynamic abnormality in methionine metabolism in this challenge paradigm.

Mode of transmission of schizophrenia

R. Ponnudurai, J. Jayakar — 2010-06-01

Abstract: Objective: Although the evidences for the phenomenon of “anticipation” and parental “imprinting” have been shown in schizophrenia, they are inconclusive. The purpose of this study was to test these hypotheses by examining three successive generations.Method: 58 schizophrenic patients who had their maternal or paternal parent or grandparent, or both, affected with schizophrenia or related disorders were analyzed. Chi-square test was used to assess the association of the sex of the parent with more than one of the affected proband families. The differences in the age of onset of the illness between the successive three generations was calculated using the t-test.Results: In comparison to mothers’ affected families, a large proportion of the father side affected families had more than one of their offspring affected with the illness. The age of onset in probands was lower in comparison to that of those on the parental side and the difference was more significant when the paternal side was affected. Interestingly, when the age of onset in the grandparents was compared with either of the parental sides of the probands no difference emerged, indicating lack of support from this study for the theory of anticipation. At any rate, the age of onset of probands was significantly lower in comparison to that of the paternal grandfather side. Further, skipping of a generation in the process of transmission was noted in some families.Conclusions: It is hard to ignore our findings that suggest paternal side transmission.

Psychiatric admission in dementia care—Cultural and social factors may determine outcome

Kuruvilla George — 2010-06-01

Abstract: Background: There is a rising tide of the elderly in developed and developing nations and this would mean that there would be a similar increase in the prevalence of dementia. Data from China and India, which are the most populous nations, suggest this trend and that it will be a major social and health problem. The demented elderly will cause a rapid increase in the contribution to the global burden of disease and disability over the next 20 years unless a miracle cure for dementia is found soon. None of the nations are going to be able to keep pace with the medical needs of the elderly, especially the needs of the elderly suffering from dementia. The finite resources we have need to be managed very carefully.Objective: This paper argues that the psychiatric needs of the elderly dementia sufferers can be met without admission to acute inpatient psychiatric units. Apart from a tiny minority, most of the problems can be managed in the community unless they have co-morbid medical problems that need admission to a general medical hospital. The paper argues that most admissions into acute inpatient psychiatric units are mainly for social rather than for psychiatric reasons. Admission might meet the needs of the carer but it is debatable as to whether the needs of dementia sufferers are best met by hospitalisation. On the contrary, we may be doing more harm than good by our interventions. Two examples are given of dementia care in a developed nation and a developing nation. We may be able to learn aspects of dementia care from developing countries.

Prevalence of depression among diabetic patients in an outpatient clinic in Hospital Sik: A rural hospital in Malaysia

Ng Teng Khai — 2010-06-01

The main objective of this investigation is to study the prevalence of depression among diabetic patients visiting the outpatient clinic in Hospital Sik. Sik is one of the many rural districts in Malaysia and the majority of the residents are Malays. They mostly work as farmers or rubber tappers. Diabetic patients with depression were found to be associated with poorer glycemic control and higher mortality. () Thus, screening of diabetic patients for depression is essential as the prevalence of depression is high.

Asian pearls

Nashaat N. Boutros — 2010-06-01

In this issue, we present a translation of one full length paper discussing ways to predict and decrease the incidence of major depressive disorders following major cardiovascular surgeries. The paper demonstrates one of the main goals of the Asian pearls section, which is to provide full details of important works published in languages other than English thus allowing wider accessibility to the work and facilitating the performance of reviews or meta-analyses when a large enough body of work accumulates. By inclusion of works from around the world, this goal is reached faster which is to the benefit of our patient populations.

The effects of a PRECEDE-based educational program on depression, general health, and quality of life of coronary artery bypass grafting patients

2010-06-01

Abstract: Background: Depression is commonly reported as a consequence of coronary artery bypass grafting surgery. It is the most important barrier to proper treatment of cardiac patients, causing failure in accepting the condition, decreasing the motivation in following the therapeutic recommendations, and negatively affecting the patients’ function and quality of life.Objective(s): The objective of this study was to investigate the effects of a PRECEDE-based educational program on depression, general health, and quality of life in coronary artery bypass grafting surgery patients.Methods: The experimental study included 54 post-bypass surgery patients in Isfahan Cardiovascular Research Center. The patients were randomly assigned to intervention and comparison groups (27 patients in each). The data were collected using four questionnaires (Cardiac Depression Scale, General Health Questionnaire-12, SF-36, and a PRCEDE-based questionnaire to measure predisposing, reinforcing, enabling factors, and self-help behaviors). All subjects were pre-tested. The intervention, consisting of nine educational sessions per week (60–90min each) was implemented. The patients were followed for 2 months post-intervention and post-tested at the end of the second month.Results: Following the educational intervention, the mean scores of predisposing factors, enabling factors, reinforcing factors and self-helping behaviors were significantly increased in the intervention group, compared to the comparison group (p<0.001). The mean score for depression in the comparison group (104.5±30.4) and intervention group (112.8±21.9) decreased significantly following educational intervention, but the change was more pronounced in the intervention group compared with the control group (66.2±22 vs. 89.2±27.8). The difference between the two groups on the basis of general health was statistically significant (p<0.0001). Improvements in quality of life on the basis of physical function (p<0.04), role limitations resulting from emotional status (p<0.01), and mental health (p<0.04) were statistically significant.Conclusion: The findings of the study confirmed the effectiveness of an educational program based on the PRECEDE Model on decreasing depression level, improving general health, and increasing quality of life in coronary artery bypass grafting surgery patients.

Delusional procreation syndrome: A psychopathology in procreation of human beings

2010-06-01

Abstract: The content of delusions in delusional syndrome has fascinated psychiatrists from antiquity. Delusions are classified on different principles such as, degree of inexplicability, subverted mental function, degree of independent nosological status, and on thematic content (traditional and logical). Delusions in sequence of procreation in three cases of schizophrenia along related delusions in published literatures are described under the broad rubric of term “delusional procreational syndrome” (DPS) (in the model of delusional misidentification syndrome), based on “logical thematic content” in the sequential phases of procreation. The DPS consists of numbers of delusions such as ‘delusion of having spouse’, ‘delusion of pregnancy’, ‘delusion of delivery (child birth and labour)’, ‘delusion of being parents (paternity/maternity)’ and so on. Authors also reviewed published literatures on these delusions. Though the concept of DPS is fascinating, further studies are needed to validate the concept of DPS.

Breaking bad news—Issues important for psychiatrists

Santosh K. Chaturvedi, Prabha S. Chandra — 2010-06-01

Breaking bad news (BBN) is an important clinical skill for doctors and nurses. Bad news can be defined as any information that drastically alters a patient's view of his/her future for the worse.

Conference Proceedings: 62nd Annual National Conference of Indian Psychiatric Society

Naren P. Rao — 2010-06-01

The 62nd Annual National Conference of Indian Psychiatric Society (ANCIPS) was held at B.M. Birla Science and Technology research center, Jaipur during 17–20 January 2010 with the theme “Preserving mental health through family and culture”.

Corrigendum to “Prevalence of DSM-IV major mental disorders among Korean adults: A 2006 National Epidemiologic Survey (KECA-R)” [Asian Journal of Psychiatry 3 (2010) 26–30]

2010-06-01

The authors regret that in the article the following errors occurred. In the first sentence of ‘4.3. Psychotic disorders’ section, the second ‘KECA study’ should be changed to ‘the Epidemiological Catchment Area (ECA) study’. The KECA study is the nationwide epidemiologic study performed in Korea in 2001, while the ECA study was carried out in the U.S. in the 1980s. In addition, several terms need to be spelled out in this sentence. This sentence should read:

In memoriam – Professor S.M. Channabasavanna (1932–2010)

Anand K. Pandurangi — 2010-06-01

“Achara (conduct) is imperceptible; Not felt except through action; It cannot be grasped if lived without a purpose. Only Basavanna, who is Channasanga's sharana Knows this Achara”.