Asian Journal of Psychiatry - Articles in Press

Factor structure and reliability of the 30-item Sinhala version of General Health Questionnaire (GHQ) - Corrected Proof

Chrishantha Abeysena, Pushpa Jayawardana, Upali Peiris — 2012-05-21

Highlights: ► We found that Sinhala version of the GHQ-30 consisted of five factors. ► Those five factors together accounted for 51.6% of the total variance. ► The Cronbach's alpha coefficient of GHQ-30 was 0.94.Abstract: Objective: To determine the factor structure and the reliability of the Sinhala version of the General Health Questionnaire-30 (GHQ-30).Methods: This was a descriptive study including 368 patients with in the age range of 18–75 years, attending the Out Patient Department (OPD) of Colombo North Teaching Hospital, Ragama, Sri Lanka during the period between June 2009 and September 2010. Sinhala version of GHQ-30 was given to be completed by the participants. Each item of the GHQ was rated on a four-point scale (0-1-2-3). Factor analyses were performed by applying Generalized Least Squares method using oblimin rotation. The internal consistency was assessed by calculating Cronbach's α coefficient.Results: Median age of the study population was 32.5 years (Inter quartile range [IQR]=21 years) and the median GHQ score was 9 (IQR 7). GHQ-30 produced a five factor solution which accounted for 51.6% of the total variance (TV). Factor I (Depression) accounted for 38% of TV, Factor II (Loss of confidence) 5%, Factor III (Insomnia) 4%, Factor IV (Social dysfunction) 2.7% and Factor V (Anxiety) 2%. The Cronbach's alpha coefficients of GHQ-30 was 0.94 indicating satisfactory internal consistency.Conclusions: GHQ-30 comprises five factors/subscales and it displayed adequate reliability for assessment of psychiatric disorders among Sinhala speaking primary care attendees in Sri Lanka.

Affect intensity and negative mood regulation (NMR) expectancies: A preliminary Indian study - Corrected Proof

Seema Mehrotra, Ravikesh Tripathi — 2012-05-21

Highlights: ► The study involved an Indian adult community sample spanning 20–60 years age range. ► Higher positive affect intensity was associated with higher NMR expectancy. ► Affect intensity, NMR expectancy-significant predictors of stress and well being. ► High negative affect intensity with low NMR expectancy-practice implications. ► Need for further research on positive affect intensity and well being relationship.Abstract: Individuals differ in the intensity with which they typically experience affect as well as in their beliefs regarding their ability to alleviate negative mood states. These variables have been implicated in a range of clinical problems. Most studies utilize a single index of affect intensity. The differential correlates of positive and negative affect intensity, their association with negative mood regulation expectancy and their role as predictors of psychological outcomes have been insufficiently explored. This study aimed at exploring the relationship of affect intensity variables with negative mood regulation (NMR) expectancy, their association with age and gender and examining the role of affect intensity and NMR expectancy as predictors of stress and well being in a community sample of Indian adults. The sample consisted of 206 participants aged between 20 and 60 years. Higher age was associated with higher NMR expectancy but lower positive affect intensity. Positive and negative affect intensity showed differential patterns of association with NMR expectancy. Higher negative affect intensity was associated with lower NMR expectancy whereas higher positive affect intensity was associated with higher NMR expectancy. Affect intensity and NMR expectancy variables jointly predicted 30–39% of variance in perceived stress and well being. Implications for further research are discussed.

Religion, spirituality and mental health in the West and the Middle East - Corrected Proof

Harold G. Koenig, Faten Al Zaben, Doaa Ahmed Khalifa — 2012-05-21

Highlights: ► We present similarities and differences in Christian and Muslim belief systems. ► We examine how these similarities and differences may affect religion/spirituality-mental health relationships. ► We review research on religion/spirituality and mental health in largely Western, Christian countries. ► We review research on religion/spirituality and mental health in Middle Eastern, Muslim countries.Abstract: Research on religion, spirituality and mental health has been rapidly accumulating from Western countries and now increasingly from the Middle East. We review here the latest research on this topic from these two areas of the world, one largely Christian and the other largely Muslim, after discussing similarities and differences in these faith traditions. Contrary to popular thought, there is considerable overlap between these religious groups in beliefs, practices of worship, moral beliefs and values, and emphasis on family life (although also some distinct differences). Because of the similarity in belief and practice, it is not surprising that research on mental health and devout religious involvement in both these religious traditions has tended to produce similar results. Religious psychotherapies within these faith traditions have been developed and are now being refined and used in clinical trials to determine if integrating patients’ religious resources into therapy is more or less effective than conventional therapies in relieving the symptoms of depression and anxiety.

Adapting an evidence-based intervention to REACH Forgiveness for different religions and spiritualities - Corrected Proof

Everett L. Worthington, Yin Lin, Man Yee Ho — 2012-05-21

Highlights: ► We selectively review the literature on regarding the REACH Forgiveness intervention. ► We consider literature on practice, research, and theory. ► We focus on ways to adapt the REACH Forgiveness intervention to religions and spiritualities. ► We teach a method of forgiving a transgression that can generalize to being a more forgiving person.Abstract: The REACH Forgiveness intervention has been used in psychoeducational groups, couple and individual counseling and psychotherapy, and workbooks. It has been investigated in over 20 randomized clinical trials (RCTs) worldwide. It has been accommodated to treat Christians and shown to be effective in RCTs. But most research has established it to be effective when not accommodating it to religious or spiritual clientele. In this article, we will claim that it can be accommodated to a variety of religious clients. We describe guidelines about what is essential to the treatment and what might be effectively modified to be acceptable to religious and spiritual clients embracing a variety of beliefs and practices.

Yoga: A spiritual practice with therapeutic value in psychiatry - Corrected Proof

Shivarama Varambally, B.N. Gangadhar — 2012-05-21

Highlights: ► Yoga is a spiritual practice originally meant to help in achieving self-realization. ► Yogic practices have produced neurobiological changes in healthy volunteers. ► Yoga-based practices have shown benefits in many physical and mental disorders. ► Benefits of such spiritual practices for psychiatric patients need consideration.Abstract: Yoga is one of the spiritual practices derived from the orthodox school of Hindu philosophy. The practices were codified by Patanjali under the title of Ashtanga Yoga. Although Yoga was traditionally seen as a practice meant for achieving self-realization, in recent years there has been significant attention given to the effects of yoga practices on physical and mental health. Yoga as a therapy has proven to be effective as a sole or additional intervention in several psychiatric disorders.Conclusions: The literature suggests that yoga can lead to significant symptomatic improvements in psychiatric disorders, along with neurobiological effects which may underlie these changes. This suggests that mental health professionals should be open to the potential benefits of spiritual practices for their patients, either as complementary interventions to modern treatments or as sole treatment in some disorders.

A preliminary study on the influence of glutathione S transferase T1 (GSTT1) as a risk factor for late onset Alzheimer's disease in North Indian population - Corrected Proof

2012-05-11

Highlights: ► Deleted GSTM1 and GSTT1 gene may be the possible risk for Alzheimer's disease (AD). ► Association of GSTM1 and GSTT1 with AD was studied in 50 cases and 100 controls. ► The odds of AD in GSTT− is found to be increased by 2.47 times than GSTT1+. ► Deletion of GSTT1 was found significantly associated with AD (p=0.02*).Abstract: Introduction: Oxidative stress plays key role in pathogenesis of Alzheimer's disease. Glutathione S-transferases (GSTs), a family of phase-II isoenzymes, play a critical role in providing protection against electrophiles and products of oxidative stress. Among different classes of GSTs, GSTM1 (Mu) and GSTT1 (theta) are found to be genetically deleted which results in decreased expression of the concerned enzyme. This study aims at preliminary analysis of the frequency of deletion of GSTM1 and GSTT1 and their association with late-onset Alzheimer's disease.Material and methods: In this study, association of the deletion type polymorphism of GST M1 and T1 as possible risk factors for dementia of Alzheimer's type was studied in 50 patients and 100 controls. Dementia was diagnosed by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria, Mini Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) scale. Genotyping was done by multiplex Polymerase Chain Reaction (PCR). Associations between null genotype of either GSTM1 and GSTT1 or both with Alzheimer's disease were analyzed by Chi-Square test.Results: Deletion of GSTT1 was found significantly associated with Alzheimer's disease (χ2=5.08, p=0.02*).Conclusions: The odds of Alzheimer's disease in null GSTT1 is found to be increased by 2.47 times in comparison to positive GSTT1.

Agonist treatment in opioid use: Advances and controversy - Corrected Proof

Biju Viswanath, Prabhat Chand, Vivek Benegal, Pratima Murthy — 2012-05-07

Highlights: ► We review the pharmacological management of opioid dependence syndrome. ► Agonist maintenance therapy seems to be the first choice in the current setting. ► Buprenorphine has emerged as a first line agonist in view of safety profile. ► Areas of controversy include supervision, affordability and duration of treatment.Abstract: Opioid dependence is a chronic relapsing condition which requires comprehensive care; pharmacological agents form the mainstay of its long term treatment. The two most popular approaches are the harm reduction method using agonists and the complete abstinence method using antagonists. Currently, particularly from the harm minimization perspective and the low feasibility of an abstinence based approach, there is an increasing trend toward agonist treatment. The use of buprenorphine has gained popularity in view of its safety profile and the availability of the buprenorphine–naloxone combination has made it popular as a take-home treatment. This review outlines the pharmacological advances and controversies in this area.

Identification of chromosome abnormalities in screening of a family with manic depression and psoriasis: Predisposition to aneuploidy - Corrected Proof

2012-05-07

Highlights: ► We studied a case of manic-depression (MD), cytogenetically and immunologically. ► We studied a family including father, mother and the son (patient). ► As materials, we used blood and skin fibroblasts of individuals we studied. ► Chromosomal aberrations and immunologic changes were recorded. ► MD is probably caused by the interaction of several mutant genes in the family.Abstract: Cytogenetic analysis is an important stage in understanding the genetic background of manic depression (MD), and may provide a valuable clue to the identification of target loci and successful search for major genes. In order to identify chromosomal regions we aimed to detect the relationships between chromosomal aberrations (CAs) and immunological markers in a family with MD and psoriasis. We used the cell cultivation and conventional G-banding. We found predominantly numerical aberrations. The most common aneuploidy was chromosome 8, followed by chromosome 22, 21, 15, X and Y. However, structural aberrations consisted of duplications, deletions, translocations and breaks, with a focus on: loci on del(1)(q12–q23), del(1)(q21.1–q24), del(1)(q21.1–q23), del(10)(p11.2-pter), der(2)t(2;4)(p25;p12), t(2;22)(p14;p13), t(19;Y)? and dup(10)(q26). The susceptibility genes of MD or psoriasis may be located on these loci. Numerical sex CAs included 4(5.8%) with 45,X, 3(4.3%) with 47,XXY, and 4(5.8%) with structural chromosome X; del(X)(q13); del(X)(p11-pter) del(X)(q21.3) and inv(Y)(q11.2). We also conducted an immunological study. According results of this study, the percentage of CD2+, CD4+ and CD8+ lymphocytes of the father were significantly higher, whereas CD4+ lymphocytes were decreased in the mother, when compared the healthy persons. The percentage of CD4 level of the son was decreased, whereas CD8+ lymphocytes were higher. The CD4/CD8 ratio of the father and the son was found to be significantly high. These results may suggest that MD and psoriasis have a significant impact on both genetic and immunological parameters.

Sleep disturbances with suicidal ideation have resisted for many years: Lessons from a PTSD case - Corrected Proof

Yuichiro Abe — 2012-05-07

Clinically, sleep disturbances are common among individuals with posttraumatic stress disorder (PTSD), which are often resistant to first-line recommended treatment (). Sleep disturbances are a frequent residual complaint even after successful PTSD treatment (). Indeed, although it is suggested that cognitive-behavior therapy (CBT) for PTSD had a favourable impact on sleep, the majority of individuals still suffered from residual sleep difficulties (). As some Holocaust survivors presented, impaired sleep and frequent nightmares had been considerable problems, even 45 years after the liberation ().

Suicidal risk and childhood adversity: A study of Indian college students - Corrected Proof

Saumya Singh, M. Manjula, Mariamma Philip — 2012-05-07

Highlights: ► Physical abuse is the most common form of early trauma, experienced in both male and female college students. ► Affectionless control is the most widely reported style of parental bonding in the sample. ► A moderate degree of association exists between suicidal risk and early exposure to trauma. ► Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting.Abstract: Background: The study was undertaken in response to reported increase in deaths due to suicide and suicidal behaviors in the youth.Aim: The objectives of the study were to assess childhood adversity and suicidal risk and to study the relationship between adverse childhood experiences and suicidal risk, in Indian students.Method: A cross sectional study design was conducted with 436 undergraduate students in the age range of 18–25. Suicidal risk was assessed using Scale for Suicidal Ideation and Beck's Hopelessness Scale. Parental Bonding Instrument and Early Trauma Inventory-Self Report (Short Form) were used to assess adverse childhood experiences.Results: Suicidal risk in terms of suicidal ideation and hopelessness was reported by 15% and 9%, respectively. Physical abuse is the most common form of early trauma, experienced in both males and females. Males experienced significantly more traumatic experiences in all domains. Affectionless control, which is considered as the pathogenic form of parent child bonding, is widely reported. A moderate degree of association exists between suicidal risk and early exposure to trauma. Higher suicidal ideation, hopelessness and trauma are reported in respondents with affectionless parental control and neglectful parenting.Conclusion: The study provides evidence of correlation between suicidal risk and childhood adversity in the Indian setting.

Assessing social support among South Asians: The multidimensional scale of perceived social support - Corrected Proof

Kareen Tonsing, Gregory D. Zimet, Samson Tse — 2012-05-01

Highlights: ► We examine the psychometric properties of the Urdu and Nepali translation of the MSPSS. ► Both MSPSS-N and MSPSS-U were inversely correlated with depressive symptoms. ► Both scales reported good construct validity and high internal reliability.Abstract: The psychometric properties of the Multidimensional Scale of Perceived Social Support (MSPSS) of the Urdu (MSPSS-U) and Nepali (MSPSS-N) versions were investigated among Pakistani (n=148) and Nepalese (n=153) respondents living in Hong Kong. The factor analysis of the MSPSS-N conducted in this study confirmed the three factors of the original MSPSS, namely, Family, Friend, and Significant Others, while only two factors were extracted from the MSPSS-U (i.e., the Family and Friends subscales). With regard to construct validity, both the MSPSS-U and MSPSS-N were inversely correlated with depression, anxiety and stress as assessed by the Depression Anxiety Stress Scale (DASS-21). The internal reliability and construct validity of the MSPSS-U and MSPSS-N were also established and provided support for the validity of both versions as tools for measuring perceived social support among South Asian migrants.

Case of borderline personality disorder in a 23 year old male with history of Klinefelter syndrome - Corrected Proof

Taral R. Sharma, Chintan H. Shah, David W. Hartman — 2012-04-30

We present a report of borderline personality disorder in a patient with Klinefelter syndrome. Mr. Smith (not real name) is a 23 year old Caucasian male, with a past psychiatric history significant for borderline personality disorder and mood disorder, not otherwise specified, who was brought to the emergency room on an emergency custody order. He was receiving no psychotropic medications prior to this encounter. He reported getting stressed out that afternoon after talking to his ex-girlfriend. He also reported that she broke up with him as ‘she had a depressive episode.’ He also reportedly got upset and started making scratches on his left forearm with a plastic knife. He reported that he left the house to talk to his parents.

Association between MTHFR C677T and A1298C, and MTRR A66G polymorphisms and susceptibility to schizophrenia in a Syrian study cohort - Corrected Proof

Bassam Lajin, Amir Alhaj Sakur, Roula Michati, Amal Alachkar — 2012-04-30

Highlights: ► The first association study between the folate/homocysteine metabolic pathway genes and Schizophrenia in a Syrian population. ► The first association study between MTRR A66G polymorphism and Schizophrenia. ► Schizophrenia is associated with MTHFR A1298C and C677T polymorphisms in a Syrian study cohort. ► No association was found between MTRR A66G polymorphism and Schizophrenia in a Syrian study cohort.Abstract: The folate–homocystiene metabolic pathway has been shown to be involved in the susceptibility for developing schizophrenia by several studies. In the present study we investigated the role of three common polymorphisms of the folate–homocysteine metabolic pathway in an Arab population from Syria consisting of 85 schizophrenic patients and 126 healthy controls. The studied polymorphisms included the MTHFR C677T and A1298C, and MTRR A66G, all of which result into amino acid changes, and were previously shown to yield decreased enzymatic activity and alter plasma homocysteine concentration. While MTHFR C677T and A1298C polymorphisms were not previously studied in an Arab population with respect to the susceptibility for developing schizophrenia, the MTRR A66G was not previously investigated in any population around the world. Our results indicated a strong association between MTHFR A1298C and schizophrenia. The variant C allele frequency was significantly higher in the patients group (40% vs 29.4%, OR=1.6, 95% CI (1.06–2.41), p=0.023). A statistically significant association was found for MTHFR 677TT genotype under the recessive model in the male patients subgroup (OR=2.6, 95% CI (1.04–6.5), p=0.036), and MTHFR 677CT genotype under the overdominant model in the total patients group (OR=0.52 95% CI (0.29–0.92), p=0.024). No statistically significant association was found for MTRR A66G polymorphism on an individual basis. However, a borderline association was found for the CC/GG (C677T/A66G) compound genotype (OR=2.24, 95% CI (0.97–5.15), p=0.053). Our results support the hypothesis of association between schizophrenia and folate–homocystiene metabolic pathway genes.

Efficacy of quetiapine in treatment-resistant panic disorder: A case report - Corrected Proof

William Pitchot, Marc Ansseau — 2012-04-05

Highlights: ► Some patients with panic disorder fail to respond to standard treatments. ► Some studies have suggested that atypical antipsychotics in association with an SSRI could be an option for treatment-refractory panic disorder. ► Efficacy of low doses of quetiapine in addition to an antidepressant in a patient suffering from treatment-resistant panic disorder.

Treating a physician patient with psychosis - Corrected Proof

2012-03-29

Highlights: ► The authors present the case of a physician patient with severe psychotic illness. ► The problem of insight in psychosis is reviewed including relevant treatment recommendations. ► Associated medical-legal issues regarding an impaired physician are discussed. ► The practical and ethical dilemmas of caring for a physician patient are explored.Abstract: The authors present a case of a psychotic female patient who is a former graduate of a locally prestigious medical school and has subsequently been diagnosed with schizophrenia. The patient entered treatment in an outpatient clinic following discharge from her 11th hospitalization. This hospitalization was initiated after the patient's physician friend had called the police and notified them that the patient was significantly disorganized to warrant further evaluation. Treatment was characterized by significant transference and counter-transference reactions amongst her clinicians – both treatment-promoting and treatment-interfering – based on her status as a physician. The problem of insight was a significant hurdle in the treatment of the patient as her medical knowledge of mental illness was substantially greater than her insight into her own mental illness.Throughout treatment, a number of medical-legal and ethical issues arose. Initially, the question was raised as to the legality of the actions by the patient's friend—having made a clinical assessment without having a clinical role in the patient's care. As the patient's clinical status improved and she sought to re-enter the medical field as a resident, new medical legal issues surfaced. What were the roles of the patient's treaters in maintaining confidentiality and simultaneously ensuring the safety of patients that the psychotic physician might care for?This case highlights the universality of psychiatric vulnerability. Insight in psychosis as well as the transference and counter-transference issues involved in caring for a psychotic physician are discussed. Additionally, a thorough medical-legal discussion addresses the various complexities of caring for a psychotic physician.

Substance-induced psychotic disorders: 13-Year data from a de-addiction centre and their clinical implications - Corrected Proof

Munish Aggarwal, Anindya Banerjee, Shubh Mohan Singh, S.K. Mattoo, D. Basu — 2012-03-07

Abstract: The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

A study of psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy - Corrected Proof

Harsh Chalana, Jasmine Kaur Sachdeva — 2012-03-05

Highlights: ► We measured psychiatric morbidity during pregnancy. ► High score was found in patients with history of previous abortion. ► It decreases with increase in time gap between current pregnancy and previous abortion. ► Routine screening for psychiatric morbidity is needed in pregnancy.Abstract: Introduction: Pregnancy plays a unique role in the transformation of women towards completeness. For those women who have had a previous unsuccessful outcome, pregnancy may bring a lot of inevitable negative emotions. We studied psychiatric morbidity during second trimester of pregnancy subsequent to abortion in the previous pregnancy.Methods: The study was carried out in Dayanand Medical College and Hospital, Ludhiana, India. A total of 120 patients were divided into 4 groups depending on their pregnancy status. All the groups were compared with each other regarding their psychiatric morbidities, which were measured using various rating scales such as Hamilton Depression rating scale, Hamilton Anxiety Rating Scale, State Trait Anxiety Inventory, Presumptive Stressful Life events Scale, and Brief Psychotic Rating Scale.Results: We found that subjects with history of previous abortion, whether single or more had significantly higher mean depression and anxiety score than primigravida or subjects with history of previous successful pregnancy; depression and anxiety scores decreased with increase in time gap between abortion and current pregnancy. High anxiety was found in 36.67%(11) of females with history of previous abortion. We also found that 36.67%(11) of subjects with previous single abortion and 30%(9) of subjects with previous 2 or more abortions were suffering from depressive episode. None of the female suffered from psychotic disorder.Conclusions: The incidence of depression and anxiety is high in pregnancy after previous abortion and more in subjects who conceive earlier after previous abortion. These results warrant the need for screening all pregnancies for psychiatric morbidity after a previous abortion.

Upcoming conferences - Corrected Proof

R. Thara — 2012-03-05

The fifth International Conference on Schizophrenia (ICONS), organized by the Schizophrenia Research Foundation (SCARF), will be held in Chennai, India between September 21 and 23, 2012. Faculty will include a galaxy of international schizophrenia researchers who will showcase the latest work in the field. ICONS also features awards for young researchers contributing to this exciting field of scientific endeavour. For details, contact Dr. R. Thara, Director, SCARF India.

Applying mobile technologies to mental health service delivery in South Asia - Corrected Proof

Neil Krishan Aggarwal — 2012-02-06

Highlights: ► There is a shortage of mental health professionals in South Asia. ► There is high penetration of mobile phones throughout South Asia. ► Research can elucidate whether mobile phones can be used for mental health applications.Abstract: Mobile phones have increasingly assumed an important role in the treatment of mental disorders in high-income countries. This paper considers such possibilities in the South Asian context. First, a brief review of mobile phone use in mental disorders is provided. Next, data on the market penetration and dissemination of mobile phones in South Asia is presented. Finally, common barriers to treatment for mental disorders in South Asia are evaluated against solutions that could be derived from mobile technologies. Though not without their risks, mobile phones have the potential to increase engagement, treatment, and retention of South Asian patients with mental disorders in unprecedented ways.

A comparison between acupuncture versus zolpidem in the treatment of primary insomnia - Corrected Proof

Jung-Hung Tu, Wei-Ching Chung, Chun-Yuh Yang, Dong-Sheng Tzeng — 2012-01-24

Highlights: ► Acupuncture might be effective as Zolpidem for the treatment of primary insomnia. ► Female, older and higher educational level predict better outcome by acupuncture. ► No difference in follow up study of PSGI score between acupuncture and zolpidem group.Abstract: Background: To determine the relative efficacy of acupuncture and zolpidem in the treatment of primary insomnia, we administered a sleep quality scale to thirty-three patients with primary insomnia randomly chosen to receive one of the two therapies at a psychosomatic clinic.Methods: A study in the psychosomatic clinic at a teaching hospital in southern Taiwan from November 2007 to November 2008. The 19 patients in acupuncture group underwent one acupuncture session a week. The 14 patients in the control group took zolpidem 1# (10mg) every night. Members of both groups returned to our clinic once a week for four weeks. The main outcome measure was the Pittsburgh Sleep Quality Index (PSQI).Results: Both groups were found to have improved significantly. Using generalized estimating equation analysis to test the variance with group and time as factors, we found both groups improved over time at a similar rate (p=0.79). In regression analysis, setting the fourth total PSQI score to zero, the baseline PSQI score was 4.13 (p<0.001), the second score 1.32 (p=0.005), and the third 1.49 (p=0.03); men had a higher PSQI score 1.56 than women (p=0.02); the increasing age of one year would have lower PSQI score 0.08 (p<0.001) and increasing educational level of one year which would decrease PSQI score 0.25 (p=0.007).Conclusions: Acupuncture might be used as an alternative strategy compared to zolpidem for the treatment of primary insomnia.

Successful treatment of atypical depression with amisulpride: A case report - Corrected Proof

2012-01-24

Recent reports support the role of amisulpride in treatment of mood disorders (). Though its antipsychotic effect is due to antagonism at D2 and D3 receptors () its antidepressant property could be due to 5-HT7A antagonism, independent of the dopamine receptor as shown recently (). The efficacy of amisulpride has been documented in schizophrenia with depression (), dysthymia with or without major depression (), and as an add-on agent in the treatment of bipolar affective disorder (). Its role in atypical depression, however, has not been investigated. In this context, we report successful use of amisulpride in a patient with atypical depression.

Problematic internet behaviours among university students in Sri Lanka - Corrected Proof

2012-01-09

Published literature on problematic internet use is mostly from industrialized nations. We attempted to identify the problematic internet behaviours among university students in Sri Lanka. This is the first study to assess this issue in Sri Lanka.