KC DUBE POSTER AWARD

CAREGIVER BURDEN IN FAMILIES OF PATIENTS WITH DISSOCIATIVE DISORDER: A CROSS SECTIONAL STUDY Principal Author: Kashypi Garg Second Author: Ashutosh Kumar Introduction: Dissociation is a temporary disruption and/or discontinuity in either consciousness, memory, emotion, identity, perception, body representation, motor control or behaviour of a person leading to an impairment in normal functioning of their daily life. Prevalence of dissociative disorders in India ranges from 1.5 to 15.0 per 1,000 for outpatients and 1.5 to 11.6 per 1,000 for inpatients. In India families are the mainstay of caregiving for persons with mental illnesses. Family environment has important role associated with dissociation, dissociative symptoms puts significant burden on family. Aim: The aim of the study was to assess prevalence and level of caregiver burden in patients with dissociative disorder Methodology: Caregivers and their patients meeting the criteria for diagnosis of dissociative disorders according to ICD-10, attending the in-patient or out- patient department of psychiatry and who were willing to give consent for the study, were included in the study. Socio-demographic data and accompanying scales were applied respectively. Results: Out of a total 33 study subjects, majority were females (88%), most common diagnosis was mixed dissociative disorder. The caregiver burden assessed by the Family Burden Interview Scale(FBIS),although there was no significant correlation between the severity of dissociation and financial burden and disruption in family activities, the study showed positive correlation of effect of dissociative symptoms on family leisure (r=.564), on family interaction(r=.359), on physical health of family members (r=.762) and on the mental health of family members (1=.679). Discussion: This study depicts that carers of patients with dissociative disorders carry a significant burden which creates an impact on their physical and mental health. This requires further broad research. The limitation of this study was the small sample size. A CASE OF A 7 YEAR OLD MALE WITH INCIDENTAL FINDING OF CHRONIC MICROVASCULAR ISCHEMIA WITH DISSOCIATIVE AMNESIA Ritu Meena’, Tushar Jagawat?, Alankrita* Department of Psychiatry, NIMSR, Jaipur, Rajasthan, India Presenting author - Ritu Meena Introduction:- IC 10 specifies dissociative Amnesia as loss of memory of usually important recent events not due to organic mental disorder and in DIMS as inability to recall important autobiographical information. Aims and objective:- To assess the clinical profile of 47 vear old male with incidental finding of chronic micro vascular ischemia with diagnosis of dissociative amnesia Case:- A case of 47 year old male who came to psychiatric department NIMSR Jaipur with his son and complains of not recognising his identity/personal information associated with crying episodes and sleep disturbance since 3 days. The patient was referred to neurology department for no identifiable medical causes for acute forgetfulness. MRI was done, reported with chronic microvascular ischemia. Patient was referred back to psychiatry department for no acute reason of forgetfulness, sleep disturbance and crying episode. Mini mental status examination and trail making test were administered All investigations were done and were normal with same MRI finding. Memory and attention loss with emotional lability following psychological stress and trauma. Patients was diagnosed with dissociative Amnesia with chronic microvascular ischemia. Result:- Patient was started on antidepressants, benzodiazepine with dialectical behaviour therapy. Psychoeducation was given to family. His MMS score improved and memory gradually recovered, enabling him in daily activities. Discussion and Conclusion:- Dissociative amnesia is difficult to assess due to overlaped by neurological findings and symptoms. IMPACT OF PERCEIVED STIGMA AND ILLNESS PERCEPTION ON THE QUALITY OF LIFE IN PATIENTS WITH ACNE VULGARIS Dr. Aanushja Suklabaidya Department of Psychiatry, AIIMS, Jodhpur Objectives: Acne vulgaris, a common dermatological ilhess, affects a person’s selfimage, social and work-life negatively, resulting in various psychological issues. The aim of this study was to find the impact of perceived stigma and illness perception on the quality of life in patients with acne vulgaris. Methodology: Cross-sectional study with purposive sampling done Dermatology OPD of a tertiary care centre. Total of 213 participants between 18-25 years enrolled. Grading of acne severity done using the Global Acne Grading System (GAGS). Acne-Specific Quality of Life Questionnaire (Acne-Q0L), Feelings of Stigmatization Questionnaire (FSQ), Brief Illness Perception Questionnaire (BIPQ), Hamilton-Depression Rating Scale (HAM-D), Hamilton-Anxiety Rating Scale (HAM-A) were applied. Results: Moderate acne was the most common grade of acne (55.9%). Psychiatric comorbidity was seen in 37.6% of participants. Rural participants had a poorer Quality of Life (QoL), higher perceived stigma, more threatening perception of illness, and greater anxiety. Patients with Post-Inflammatory Hyperpigmentation (PI) and Scarring had significantly more severe acne, poorer Q0L, higher perceived stigma and more threatening perception of illness, more psychiatric comorbidity, and higher scores on depression and anxiety rating scales with p-value < 0.0001. In multiple linear regression, PIH, Scarring, Stigma, and Illness Perception (IP) were significant predictors of QoL, and IP made the highest variance contribution to the model. Discussion: Patients with higher perceived stigma feel ashamed and guilty about their appearances, and unappealing to others. It increases fear of anticipating rejection and increases secretive behavior. Longer duration and higher severity of illness leads to feeling of helplessness due to lack of control over the symptoms, which leads to a threatening perception of illness resulting in impairment of OoL EFFICACY OF ADJUNCTIVE DEXMEDETOMIDINE IN COMPARISON TO STANDARD TREATMENT IN CASES OF ALCOHOL WITHDRAWAL DELIRIUM Presenter: Dr. Amit Chail (LOM/A01/18) Co-authors: Dr. Harpreet Singh (LF-08037), Dr. Rajiv Kumar Saini (LF-18179), Dr. Mayank Dhiman Address for correspondence: Surg Cdr (Dr) Amit Chail, Dept of Psychiatry, Command Hospital (WC), Chandimandir, Panchkula - 134107, Haryana, India E-mail: [email protected] Mob: 9673994438, Aims and Objectives: To compare the treatment outcomes in patients of Alcohol Withdrawal Delirium (Delirium Tremens, DT) who received adjunctive Dexmedetomidine with those who received standard treatment. Methodology: This retrospective study was conducted in patients with Delirium tremens Alcohol withdrawal delirium, who were admitted from 01 Jan 2021 to 31 Aug 2022. Participants were divided into two groups on the basis whether they received standard treatment alone (SOC group) or adjunctive Dexmedetomidine infusion along with standard care (DEX group). The two Ernups were computed in turns of kunaline dennegmplie and cliniead/ profiles and wreatment olcomes. ResuIts: Total d4 punients were aumnited with Delitun Tremens during the surd period. 30 patients neceived standand agonist detoxification (liont loading and PRN) and supportive care. While 1a received adjunetive Dermedetomidine. Mean baseline CIWA-arscore 10s 23 1 for the Dovnedetonidine (DEX) group and 23 6 for the other (50C) group (o value 0.3). DEX group had better outcomes than SOC group in terms of ICU stay (46.9 vs 52.7 hours: p value- 0.005). total duration of BZD use (10.7 vs 11.5 days, p value= 0.02). Maximum dose of B32D (diazepam equivalent) in first 24 hours (227 vs 203 mg, p value <0.001), mean dose of PRN haloperidol (2.7 vs 5.8 mg, p value= 0.002) and mean maximum RASS score in first tWO days (+2.7 vs +3.2, p value = 0.02). Only 02 patients developed Aspirational pneumonia in SOC group while none in DEX group. Discussion: Dexmedetomidine has unique sedative, sympatholytic and respiratory sparing properties. Our chart review indicates that addition of Dexmedetomidine to standard treatment regimen can improve outcome in cases of Delirium tremens. Conclusion: Dexmedetomidine is an effective and relatively safer adjunct to BZDs in Delirium Trements. ATTITUDE TOWARDS CLOZAPINE USE AMONG PATIENTS: A FACTOR ANALYTIC MODEL Chandrima Naskar, Sandeep Grover Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh Background: Clozapine is considered to be the antipsychotic of choice for patients with Treatment Resistant Schizophrenia (IRS). However, despite its proven efficacy in TRS, a significant number of clinicians feel hesitant to use clozapine because of its side effect profile and need for monitoring. Not much information is available regarding the perception about clozapine among patients who have been receiving clozapine. Objective: This study aimed to evaluate the perception regarding clozapine use amongst patients who were taking it. Methods: 172 consenting patients who have been receiving clozapine for > 1 year were evaluated on a self-designed questionnaire on a 4 point scale (Yes/No/Maybe/Don’t know) toassess various aspects of their experiences about clozapine use. Results: Majority of the participants were male{59%1, and the mean age of the study sample was 32.7 years and a mean duration of clozapine use of 6.5 years. Majority of patients reported improvement in hallucinations [72.9%], delusions[81.9%], sadness[74.1%], anxiety [75.4%], suicidality [81.8%], functioning[78.7%] and behavioral problems [83.9%] with clozapine. About two-third[68.3%] reported improvement in memory and 61.9% reported improvement in their work performance. However, 38-40% of the patients reported to have become duller with the clozapine and experienced increased sleepiness, and only 20% reported of other disabling side effects like lethargy, forgetfulness and decreased attention. About one-fourth[25.8%] of the patients reported distress related to frequent blood testing. After factor analysis, five factors described the different aspects of attitude and experience of clozapine. The 5 factors were named as impact of clozapine on psychopathology and clinical features, attitude towards starting and long term continuation of clozapine, cognitive side effects of clozapine, negative impact of clozapine, and comparison between pre and post-clozapine state. Conclusions: The present study suggests that despite the fear of patient’s distress due to side effects and clinical monitoring of clozapine, patients tend to have an overall positive attitude about using clozapine. CLINICAL PROFILE AND OUTCOME OF PATIENTS RECEIVING CONTINUATION ELECTRO CONVULSIVE THERAPY (C-ECT): A 10 YEAR RETROSPECTIVE STUDY Sanjana Kathiravan, Sandeep Grover. Subho Chakrabarti; Post Graduate Institute of Medical education and Research, Chandigarh, India Background: There is lack of data on use of continuation electroconvulsive therapy (C-ECT) from India. Objectives: This study aimed to evaluate the clinical profile and outcome of patients receiving C-ECT. Methods: The ECT register was used to identifv patients receiving C-ECT (ECT after completion of acute course, to maintain remission or prevent relapse) during the period of 2011 to 2022 Sociodemographic, clinical and treatment outcome details were extracted from their treatment records. Results: 72 C-ECT courses were identified, used in 60 patients. Majority of the patients were male (59.7%), single (47.2%), unemployed (63.9%), belonged to Hindu religion (69.4%), from middle socioeconomic status (90.3%), and from urban background (66.7%). The mean age of the patients at the time of starting ECT was around 40 years. The commonest diagnosis was schizophrenia (72.2%), followed by recurrent depressive disorder (22.2%). The commonest indication was persistent psychotic symptoms poorly responding to multiple antipsychotic trials (mean: 3.2, SD: 1.42), including clozapine. These patients received a mean of 22.58 (SD: 8.05; range 10 to 46) ECTs, with 10.0 (SD:4.83) ECTs for the management of acute phase of illness and 12.57 (SD: 6.20) ECTs as part of continuation treatment. Majority (66.7%) of the patients received 4 (once weekly) C-ECTs in the first month, followed by 3 more in the next month. However, 16 patients received weekly ECTs during the second month too, as symptoms worsened with lowering of frequencies. Ten patients received more than one C-ECT courses. Majority of the patient’s maintained improvement gained during acute phase or showed further improvement with C-ECT along with ongoing pharmacotherapy as rated on appropriate scales. CGI- severity difference before and after C ECTs was 2.94 (SD: 0.88). Conclusions: Continuation ECT is considered in only in small proportion of patients. However, when used, it is effective in maintaining the benefits gained during the acute course of ECT and preventing relapse. SUICIDE ATTEMPTS IN ELDERLY: A GROWING CONCERN WORLDWIDE Dr. Shalini Perugu, Dr. Priya Sreeharan, SN Jayasudha, Dr. Divya Hegde, Dr. Mathew Varghese St John’s Medical College, Bengaluru, Karnataka, India Background: Suicide rates among elderly remain the highest across nations. Epidemiological data predicted a demographic transition with double the number of elders by 2050. Suicide research and prevention initiative were mostly base towards the younger population. Aims/objectives: To determine factors and followup in elderly with a wide Methodology: Data was extracted from records (Total-1361, Elderly-13) of a lurse led service located in a general hospital in Urban Bengaluru from January 2016 to September 2022 using a semi-structured proforma in cluding scale for assessment of lethality and presumptive stressful life events scale (PSES) Results: Majority of elderly were married (93%), completed primary education (40%), unemployed (65%), no past attempt (95%) with 2 chronic medical illnesses and 4 stressful events in the past 1 year. Medication overdose (48%) was common method in context of an altercation or financial stress. Higher percentage of males had addiction problems and past attempt was more in females. 39% had depression.30% followed up with mental health services after the attempt. Discussion: Elderly with suicide attempts presenting to hospital in urban (3.2%) is less than rural (7.9%) setting. Depression was diagnosed for the first time after the suicide attempt in 35%. Depression in elderly is underdiagnosed for various reasons. Unique challenges encountered by elderly like chronic medical illness, financial circumstances, grief, isolation and cognitive impairment makes them vulnerable to depression. Help seeking and follow-up rates after the attempt with mental health services is low and telephonic calls made through this service is an alternate strategy to engage in care. Conclusion: Research shows contact with health professional is made prior to attempt and assessment for psychological distress is often missed. Integrating this into preliminary screening process and training the clinicians helps in primary prevention of suicide in elderly. COMPARISON OF EFFICACY AND SAFETY OF LOW DOSE AMISULPRIDE VERSUS OLANZAPINE-FLUOXETINE COMBINATION IN POST-SCHIZOPHRENIC DEPRESSION: A DOUBLE-BLIND RANDOMISED CONTROLLED TRIAL Dr. Tathagata Biswas, Dr. Biswa Ranjan Mishra, Dr. Rituparna Maiti, Dr. Susanta Kumar Padhy, Dr. Santana Nath, Sahadeb Panigrahi All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India Aims/objectives: To compare the efficacy and safety of low-dose amisulpride versus olanzapine- fluoxetine combination (OFC) in post-schizophrenic depression (PSD). Methodology: A double-blind, active-controlled trial was conducted among sixty patients with PSD over 2-years. The patients were randomised equally to receive either low-dose amisulpride (100 to 300mg/day) or fixed-dose OFC (5/10mg + 20mg). The Calgary Depression Scale for Schizophrenia (CDSS), the Clinical Global Impression -Severity (CGI-S) and –Improvement (CGI-1) scales were measured at baseline, and after eight weeks. The scores were compared within and between the groups and correlated with the changes in the serum BDNF levels across the timelines. Results: The change in the CDSS scores from baseline over eight weeks was significant in both the OFC group (MD: 4.25, 95% CI: 3.93 to 4.5S, p<0.001) and the amisulpride group (MD: 4.36, 95% CI: 4.04 to 4.68, p<0.001). However, the changes were not significant when compared between the groups (MD: -0.11, 95% Cl: -1.38 to 1.45, p=0.878). Similarly, the changes in CGI-S scores and serum BDNF levels were significant in each group; but non-significant when compared between the groups. A negative correlation was found between the changes in the CDSS scores and the serum BDNF levels in each group (OFC: p=-0.123, p-0.035, amisulpride: 0.161, p=0.005). No significant adverse events were noted in either group. Discussion: Low-dose amisulpride, by its preferential antagonism of presynaptic De/D - autoreceptors, exert antidepressant actions with efficacy comparable to OFC in PSD. Amisulpride monotherapy has added benefits of easy dose titrations during any psychotic exacerbation. BDNF is a potential biomarker in patients with maior mental illnesses, including PSD. Conclusion: Low-dose amisulpride can be a potential monotherapy in PSD with a favourable safety profile.

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