PSYCHIATRIC MORBIDITIES IN TRANSGENDER AND CISGENDER PEOPLE OF MANIPUR, INDIA: A COMPARATIVE STUDY

Objective: Psychiatric morbidities seem to be one of the major concerns among the transgender people. Lack of knowledge and ignorance was associated with growing abuse over these sexual minority groups and makes them vulnerable for mental health morbidity. The objective of this study is to identify and compare the psychiatric morbidities of transgender with the cisgender (persons who contend to remain in the gender assigned at birth) people of Manipur, India. Methods: From September 2015 and December 2016, a cross-sectional study was conducted in the outpatient department (OPD) of Regional Institute of Medical Sciences, Manipur, India. Using a non-probability convenient sampling, the transgenders and comparative group of cisgenders (both N=32) matched for age, literacy, socio economic class were recruited in this study. A standardised survey questionnaire, i.e. Mini‑International Neuropsychiatry Interview‑Plus (MINI-PLUS) scale was employed to assess the presence of psychiatric illnesses like depression, phobia, anxiety and etc.  A descriptive statistic and chi- square test were used to analyse the data. Result: A total of 6.25% of transgenders were found to be suffering from at least one psychiatric diagnosis. Substance abuse was seen in majority of cases, i.e. 59.37%. The life-time alcohol abuse was seen in 84.37%, past history of depression is 46.87%, Generalized Anxiety Disorder (GAD) is 37.5% and PTSD is 9.4% respectively, which were higher when compared to cisgender group. Suicidal risk was also higher in the transgender persons with 37.5% of them have previous suicidal attempts when compared to cisgender population (p = 0.0001). Conclusion: Transgenders were found to be suffering from a higher psychiatric morbidity compared to the cisgender people. High level of suspicion and timely intervention for psychiatric illness should be part of the multidisciplinary care for the transgender persons

CROSS-SECTIONAL STUDY ASSESSING FACTORS ASSOCIATED WITH PERCEIVED DENIAL AMONG POST-MYOCARDIAL INFARCTION SURVIVORS IN A MALAYSIAN CARDIAC HEALTH FACILITY

Objectives: The aim of this study was to determine the factors associated with perceived denial among post-myocardial infarction (post-MI) survivors in Malaysia. Methods: This descriptive-analytical single-hospital cross-sectional study was conducted between July and September 2016 among 201 post-MI survivors aged between 24 and 96 years old at the outpatient cardiac clinic in a Malaysian public hospital. A self-administered questionnaire that consisted of the validated 8-items Verbal Denial of Myocardial Infarction Questionnaire, and items on socio-demographic, health attributes and social support characteristics based on the OSLO-3 Social Support Scale (OSS-3) was utilized. Descriptive, bivariate and multivariate analyses were conducted. Results: The average total score of perceived denial in post-MI survivors was 22.1 (SD ± 6.1) and ranged between 8 and 37. At multivariate level, greater denial score was more prevalent in singles, those with time-to-event of ≤ 1 year, those sustained arrhythmias, those who perceived good health, and those received a lot of other people’s concern. These associations were statistically significant (p<0.05). Conclusion: Perceived denial was significantly associated with socio-demographics, health attributes and social support in post-MI survivors. Early screening is crucial to prompt primary caregivers to initiate potential coping mechanisms for better prognosis and improved quality of life. Â

A Case Report of Ovarian Teratoma Causing Treatment Resistant Schizophrenia

Objective: Ovarian teratoma has been frequently associated with Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis in recent years since the discovery by Dalmao in year 2007. It is postulated that the ovarian teratoma containing nervous tissue express NMDAR subunits that react with patient’s antibodies would worsen patients’ underlying psychosis and impact on treatment response. Method: We reported a case of a 37-year-old lady diagnosed with Treatment Resistant Schizophrenia (TRS) who had poor response to treatment despite multiple trials of antipsychotics, and electroconvulsive therapy. Results: Patient achieved remission following the excision of an ovarian teratoma and had been maintaining well with minimal psychotropic intervention. Conclusion: This case suggests on how ovarian teratoma could affect treatment response in Schizophrenia. Diagnostic reassessment is an important first step in the management of TRS. Â

ECG STUDY IN PATIENTS ON HIGH DOSE ANTIPSYCHOTICS

Objectives: There are many antipsychotic medications that have been shown to be associated with the prolongation of the rate-corrected QT (QTc) interval on the electrocardiogram (ECG). Studies have shown that QTc prolongation is associated with increased risk of arrhythmias and sudden cardiac death. This study aims to identify and study the risk profile of patients on high-dose antipsychotic and to examine the prevalence of rate and rhythm abnormalities, in particular, QTc prolongation. We hope that this study could throw a light on current practice patterns and also could potentially guide us towards safe practice in the future. Methods: We recruited 37 adult outpatients who are on high-dose antipsychotic from the 3 outpatient clinics of the Institute of Mental Health in Singapore. Baseline characteristics risk profiling was performed to identify their pre-existing risk, including checks on Calcium, Potassium and Magnesium levels to rule out confounders. 12 lead ECG was done and reviewed manually by our resident physician. Results: It showed that rate abnormality was detected in 8 patients (22%) and QTc interval prolongation was detected in nearly 12 patients (32.4%) but of those only 3 patients had significantly prolonged QT interval needing the primary treating team to review their psychopharmacology regime. Conclusion: QTc Prolongation was positively linked with a number of cardiovascular risk factors

Use of Twitter as an Emerging Tool for Advocacy of Public Health Issues: A study on Mental Health Issues in Odisha, India.

Suicide and other Mental Health Issues are a neglected preventable disease which needs to be addressed. According to NCRB 2015 , India 133,623 people committed suicide having  Incidence of 10.6/100,000  and in  Odisha state 4,087 people committed suicide with incidence rate of 9.7/ 100,000. Twitter is a free social channel where registered individuals or organizations (I e, users) can share 280-character messages called tweets. Advocacy is an activity by an individual or group which aims to influence decisions within political, economy, social systems and institutions. Objective: Use of twitter as a tool to raise the mental health issues among policy makers, administrators of both state and central government level. Methodology: After creating twitter accounts we have used system approach to address the issues. Various stake holders ( health ministers, secretaries, Govt. officials of health department, Psychiatrists, Psychologists, NGOs, Public Health Specialists, Electronic Media Printed Media etc.) were identified and discussed about suicide and other mental health issues in the form of tweets, retweets, replies. The issues related to Suicide And Mental Health were tweeted, Retweeted  to policy makers. The process was repeated  for one month since 30th July 2018. Out of 98 tweets during one month of duration  majority of them  on first two weeks 38.7% and 33.6%  .Similarly retweets were more in the first week 46.8% followed by 73(32.5%). Replies were more in the 2nd week. Out of total 352 likes on our tweets, retweets and replies majority in 2nd week. Observations: State level-Signing of Memorandum of Understanding between NIMHANS, Bangalore , AIIMS New Delhi and AIIMS Bhubaneswar, Odisha through Central and State Governments. a) A NIMHANS like institute will be set up near Bhubaneswar having a budget of Rs 3000 millions. b) Telemedicine project in AIIMS Bhubaneswar which will be connected to NIMHANS Bangalore- to improve capacity building.2. Helpline number was started from Department of Psychiatry SCB Medical College, Cuttack, Health and welfare department, Odisha has started giving frequent advertisements in various printed Medias to create awareness.  With the interventions at center level, IRDA ordered insurance firms/companies to include “mental illness” in their medical insurance policies adhering to provision of mental health care act 2017

Auditory mismatch negativity in adolescents with dissociative identity disorder

Objective: : Dissociative identity disorder (DID) has connections with childhood trauma, and there might be an attentional deterioration in DID adolescents.  The mismatch negativity (MMN) of the event-related potentials might provide an objective marker of pre-attention (passive or involuntary attention) deficit in these younger patients.  Methods: We therefore trialed MMN in 10 adolescents with DID and 11 age and gender matched healthy volunteers using an auditory frequency deviance paradigm at three midline scalp electrodes.  Their anxiety and depression levels were measured using the self-rating anxiety and depression scales respectively.  Results: The MMN amplitudes at the three electrode sites and N1 amplitudes to deviant stimulus at two sites were higher in patients, both anxiety and depression levels were also more elevated in patients, but the cerebral potentials were not correlated with either anxiety or depression level.  Conclusions: The higher MMN amplitudes in DID indicate more enhanced accuracy in discriminating stimulus change, which might be related to an atypical lack of inhibition on the irrelevant stimuli or increased cortical neuronal activity in the disorder

UNDERLYING PSYCHIATRIC DISORDER AMONG CHILDREN WITH SOMATIC COMPLAINTS PRESENTED AT PEDIATRIC UNIT OF A TERTIARY CARE HOSPITAL IN KARACHI, PAKISTAN

Objective: Children with functional somatic symptoms (FSS) often present with chronic symptoms severe enough to result in decreased quality of life, healthcare seeking behavior and skepticism in general pediatricians due to timely non-diagnosis is a major issue. Neurobiological alterations and adverse psychosocial factors contribute to FSS. This research aims to study the presence of undiagnosed psychiatric disorder and adverse psychosocial factors contributing to somatization. Methods: Retrospective approach was adapted and pre-recorded patient-centered data of five years (2008-2012) of the pediatric ward of Aga Khan University Hospital in Karachi, Pakistan was utilized.  Medical records of patients admitted with complaints of bodily symptoms and diagnosed with a psychiatric disorder were identified and retrieved, manually. Data was entered and analyzed using SPSS v.23. Results: Of 20,608 admissions, 67 (0.63%) of all ward admissions had somatic complaints and after an evaluation, they were diagnosed with a psychiatric or conversion disorder (CD). Most frequent clinical presentations were pseudoseizure (n=15, 22.3%) and headache (n=11, 16.4%). The most common psychiatric diagnoses were Conversion Disorder (CD) (n=38, 56.7%) and Major Depressive Disorder (MDD) (n=10, 14.9%). History of physical/verbal abuse and parental marital discord were significant stressors for CD. 17.9% (n=12) children had suicidal ideation which included 50% (n=5) children with MDD. Conclusion: This retrospective analysis concludes that somatization with underlying undiagnosed psychiatric disorders such as Conversion and Major Depressive disorder are commonly seen in the pediatric general practice. Somatization and comorbid psychiatric disorder roots back to emotional trauma or distress such as physical abuse and parental marital discord

THE DETERMINANTS OF PERINATAL DEPRESSION (PND) IN TEBET MERDEKA, JAKARTA AND SINDANGBARANG, BOGOR INDONESIA

Objective: Depression during pregnancy and post-partum is more prevalent in low-middle-income countries (LIMCs). The studies are scarce in these countries, especially in South-East Asia region. The aim of our study was to identify determinants of depression among post-partum mothers. Methods: This cross-sectional study was conducted in 2016 among 347 subjects living in three areas in Jakarta and Bogor city, Indonesia. A mother who gave birth within 4 to 16 weeks was included in this study. The perinatal depression (PND) and its determinant were assessed using a structured questionnaire and Edinburgh Postnatal Depression Scale (EPDS). Logistic regression with the level of significance of <0.05 were employed to measure the association between variables. Result: PND proportion was lower in suburb's area compared to the urban. Mothers who perceived their health status as poor health were more likely to develop PND compared to those who felt that their health is on the prime level (Odds ratio, OR= 3.81, 95 % confidence interval [CI] = 1.7 -8.22,  p=0.001). Psychological violence was also strongly correlated to PND. PND had a strong association to mother’s perception of her own health. Conclusion: PND has strong association with mother’s perceived health condition. This result supported previous studies, which suggest that physical health affects depression

A COMPARATIVE STUDY OF CLINICAL AND MARITAL CHARACTERISTICS ACCORDING TO NUMBER OF MARRIAGES AND SEX OF INDIVIDUALS WITH BIPOLAR DISORDER

Objective: Bipolar disorder (BD) disrupts functionality in all fields of life. While being married may have  a positive effect on the disease, marriage itself, the most significant factor of social support, is negatively influenced by BD. Our purpose is to determine whether affective symptoms are related to the decision-making processes associated with getting married or divorced, and  to investigate sex differences in these processes in patients with BD. Methods: A total of 113 women and 92 male patients were included in the study. Two semi-structured questionnaires, Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) were used. Analysis was done by dividing the data by two groups for sex and by three groups for  the number of marriages. Results: The number of marriages and divorces occurring during a mood episode was higher among females (p=0.004, p=0.001 respectively).  For those who were not married, the onset age of BD was earliest (p<0.001). Among  those who were married twice or more, they had mixed episodes, used antipsychotics,  were first married at an earliest age, married or divorced during a mood episode, and their divorce rate due to BD was higher (p=0.032, p=0.016, p=0.006, p=<0.001, p<0.001 and p<0.001 respectively). Conclusions: Not marrying or marrying more than once may be associated with negative prognostic factors. Females with BD are more likely to divorce due to BD and remarried. For both sexs, it seems more frequent to decide on marriage during  the manic episode

Prevalence Of Thyroid Dysfunction And Its Relationship With The Severity Of Major Depressive Disorder (MDD)

Objective: The objective of this study is to determine the prevalence of thyroid dysfunction in Major Depressive Disorder and the factors that were associated with the severity of MDD. Methods: A total of 140 major depressive disorder patients researched are subjected for blood sampling to determine the blood thyroid abnormalities. The severity of illness of MDD was determined by the duration of illness, frequency of admission/ suicidal attempts, and the Hamilton rating scale for depression (HAM-D). Results: Thirty-one of the 140 patients had thyroid dysfunction. There was no significant difference in the severity of illness among patients with MDD between thyroid dysfunction and normal function group (p=0.024). Conclusion: Patients with MDD had high prevalence of thyroid dysfunction; however, the former had no correlation with later.Please click PDF below to download the full paper...Â