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59 Research and Young Psychiatrists: A Survey on Research Experiences and Barriers to Research
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Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
Methods: We assessed three people with diagnosis of schizophrenia. All of them were suffering from hearing voices that discussed them in third person. Treatment with typical and atypical antipsychotics failed to suppress voices. The patients were asked to record the duration and severity of their auditory hallucinations over a baseline period of a week. Three experimental conditions were assessed in random order on alternate weeks, each condition were applied for two hours between 10 a.m and 2 p.m for a week. Ratings were made during the intervention too. The intervention conditions were audiotapes of pure music (classical music), speech and music (Radio Payam in Iran) and a blank tape (control). The portable audiotape cassette players with intra-aural headphones were used. Data were analyzed by SPSS soft ware (version 16) using t-test. Results: The tapes of pure music, music and speech reduced the severity of hallucinations whereas the blank tape had little effect. The hallucinatory episodes lasted for an average of 13.5 min while listening to the pure music and 10.1 min for music and speech tape and 16.1 min for listening to blank tape and 17.9 min when not listening to audiotape (baseline). Duration of hallucination significantly reduced when patients listening to the pure music, music and speech (p < 0.05), but it was not significantly reduced as compared with blank tape (control). Conclusion: This study supports treating persistent auditory hallucination by altering external stimulation. Audiotape therapy may be helpful. Poster session P63. Others 7 Transcallosal Conduction Abnormalities in Subjects at High-risk for Alcohol Dependence: A TMS Study M. Kesavan1 , P.K. Puttaswamy1 , G. Venkatasubramanian1 , P.K. Pal2 , V. Benegal1 . 1 Psychiatry, 2 Neurology, National Institute of Mental Health and Neuro Sciences [NIMHANS], Bangalore, India Introduction: The genetic vulnerability to alcohol dependence [AD] is believed to be inherited as a state of Central Nervous System disinhibition, particularly in individuals with a high family loading of AD and paternal early onset AD. We have previously reported impaired cortical inhibition in these high-risk [HR] subjects. Objective: Corpus callosum [CC] abnormalities have been reported in subjects at HR for AD. Aim: In this study, we investigated transcallosal conduction in individuals at high-risk for alcohol dependence using single-pulse TMS. Methods: HR [n = 31] and LR [n = 27] in the age range of 13–25 years, matched for age, gender and handedness were recruited after informed consent. Following single pulse TMS, electromyogram from the right first dorsal interosseus muscle was used to record the Ipsilateral Silent Period [iSP] at 100% of the stimulator output. 10 trials were obtained for each individual with a 6 second ISI to avoid muscle fatigue. Results: iSP was absent more often in the HR subjects (124 times out of 340 trials) as compared to the LR subjects (63 times out of 300 trials) and this was statistically significant (c2 = 18.4; p < 0.0001). Conclusions: The greater absence of silent periods in our HR group indicates defective conduction across the CC, which could in turn reflect a delay in development/maturation of the CC as compared to the low risk group.
24 Psychiatric Disorders among Children Living in Orphanages – Experience from Kashmir Y.H. Rather. Department of Psychiatry, Government Psychiatry Disease Hospital, Srinagar, India In the conflict torn developing countries, where adoption and foster care are little practised, orphanages remain one of the few means of survival of inumerable orphans. Critical research, however, has potrayed orphanages as a breeding ground for psychopathology. This study was taken up to examine this opinion. An orphanage for girls in Srinagar was surveyed by Psychiatrists, and using DSM IV guidelines screened children were evaluated for psychopathology. Children were in the age group of 5–12 yrs. PTSD was the commonest psychiatric disorders (40.62%), easily attributable to the prevailing mass trauma state of almost two decades. Next commonest diagnoses were MDD (25%) and conversion disorder (12.5%). A high psychopathology in orphanages could be an important guide for policy makers to plan for better rehabilitation and social reintegration of orphans. 26 ADHD Presenting as Recurrent Epistaxis Y. Rather. Department of Psychiatry, Government Psychiatry Disease Hospital, Srinagar, India Epistaxis is an important otorhinilaryngological emergency, which usually has an apparent etiology, frequently local trauma in children. Here we present a case report wherein the epistaxis was recalcitrant, and proved to have a psychiatric disorder as an underlying basis. The child was diagnosed with Attention Deficit/ Hyperactivity Disorder, hyperactive type, which led to trauma to nasal mucosa due to frequent and uncontrolled nose picking. Treatment with a psychotropic drug controlled the patient’s symptoms and led to a remission of epistaxis. 59 Research and Young Psychiatrists: A Survey on Research Experiences and Barriers to Research T. Charernboon, M. Phanasathit. Department of Psychiatry, Thammasat University, Pathumthani, Thailand Objective: The objectives of this survey were to examine involvement in research activities, research training experience and barriers to research among young psychiatrists in Thailand. Method: The study employed cross-sectional descriptive survey. The sample included psychiatrists aged 40 years or under. The questionnaires were created by the researcher team. Results: There were 82 responders (57.7% response rate). Regarding the involvement in research, 58.5% of the sample had been principal investigators and 36.6% had published papers. Concerning the attitude to research, 53.6% expressed their willingness to do further research. Regarding the past training experience, 80.5% indicated that they had undertaken research courses during residency training and 65.8% were satisfied with their thesis process. Among the greatest barriers to conducting research reported were too much workload (85.4%), non-understandable statistical analyses and software (81.7%), lack of research experience (68.3%), no research advisor (62.2%) and shortage of research funds (50%). There were a number of factors affecting research experiences and opportunities: (1) psychiatrists with training from university hospitals were more likely to be involved in research activities than other types, (2) those currently working in university hospitals had a higher rate of published papers, and (3) those who were satisfied with their thesis experience were more willing to do more research. Conclusion: Just over half of the respondents had remained involved in research activities and keen to do more research. Training and working in university hospitals appeared to
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
provide better research experiences and opportunities for young psychiatrists than in other types of institution. 123 The Comparison of Executive Function in Children with Attention Deficit, Hyperactive Children and Normal Children of Arak M. Samadzadeh1 , M. Abbasi2 , B. Shahbazzadegan1 . 1 University of Medical Sciences, 2 University of Mohaghegh Ardabili, Ardebil, Iran The aim of this study was the comparison of executive function in children with attention deficit hyperactivity disorder and normal children of Arak. The study populations were all the children with ADHD (Attention Deficit/Hyperactivity Disorder) aged 9 to 15 years attending junior high school education center for retarded children and junior high school children who did not have any mental health problems. The sample consisted of 40 male children; 20 with ADHD and 20 randomly selected normal children. For collecting data, Raven’s on colored matrices, Connors’ rating scale for ADHD, flowers and hearts test, visual research test and Simon’s test I, II have been used. For data analysis, MANOVA test and Log research questionnaire test have been used. The results showed that there was significant difference between the executive function of the normal and hyperactive children (p < 0.00). There was also significant difference between the inhibitions function and working memory in hyperactive children as compared to normal children. 152 Proposed Management Algorithm for Atypical Neuroleptic Malignant Syndrome and Serotonin Syndrome P. Chandrasekaran. Neurobehavioural Medicine, Penang Adventist Hospital, Georgetown, Malaysia With the increasing co-administration of neuroleptic and antidepressant medications, a spectrum-based concept of approach is suggested in the unlikely event of adverse reactions. Atypical forms of adverse events that do not fulfil the criteria for the diagnosis of Neuroleptic Malignant Syndrome (NMS) have been increasingly reported, as are varied presentations of Serotonin Toxicity; these have been attributed to drug combinations that may pharmacologically block dopamine and stimulate serotonin receptors, with the typical picture of NMS and frank Serotonin Syndromes existing on the ends of both pathophysiological processes. A proposed flowchart to detect to what extent each process contributes to a given presentation and thereafter with suggested management pathway is hereby presented that is flexible and would provide better outcome. It is hoped that this algorithm would aid clinicians faced with diagnostic and therapeutic difficulties to critically appraise their patients with these conditions. 226 Pituitary Tumour Presenting as Psychosis without Neurological Signs A.K. Ghosh, S. Rayapureddy. High Dependency Psychiatric Care Unit, Institute of Mental Health, Singapore, Singapore Background: Pituitary tumours are most commonly associated with signs and symptoms of increased intracranial pressure, visual disturbances and endocrinological changes. Many of them are known to cause cognitive impairments but only few cases had been reported in which the presenting symptoms are primarily psychiatric in nature. Objective: To describe a rare case of acromegaly with pituitary tumour presenting as a psychotic disorder. Method: Single case report. Results: A case of a 35 year-old man with acute psychosis is described. He presented to our psychiatric facility with disorganisation, delusional misidentification, persecutory ideas, grandiosity, perceptual abnormalities and marked fluctuations in
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behaviour and orientation. He did not show any improvement with antipsychotics and had to be augmented with a mood stabilizer. He was noted to have some acromegalic features though there were no neurological signs. Routine blood tests including a thyroid profile only showed raised ESR. A CT and a subsequent MRI scan revealed a large pituitary tumour likely to be a macroadenoma compressing the optic chiasm and extending into left cavernous sinus. The initial blood workup for pituitary tumour showed raised Prolactin and IGF-1. He was transferred to a general hospital for further evaluation and management. After a complete evaluation he was diagnosed with acromegaly with hypogonadism and blunted cortisol response. He was treated with Hydrocortisone, Olanzapine, Benzhexol, Sodium Valproate and Lorazepam while waiting for surgery. Conclusion: The case emphasizes the importance of investigations, especially neuroimaging, in atypical presentations of psychosis which may be first presentation of rare disorders like acromegaly. 242 Exploring the Effects of Perceived Parenting Styles on Outcomes of Body Image Dissatisfaction and Social Anxiety among Young Adults A. Lamont, J. Dickson. Swinburne University of Technology, Melbourne, VIC, Australia Social anxiety disorder (SAD) is an unrelenting disorder with high prevalence rates within the community. Previous literature indicates that parental control and parental care play an important role in the development and maintenance of SAD, while body image dissatisfaction has been found to occur in conjunction with the disorder. The current study aimed to further explore the influence of perceived parenting styles on outcomes of body image dissatisfaction and social anxiety. A series of selfreport measures were completed by 179 participants (119 women; 59 men; 1 unspecified) between the ages of 18 and 29 years of age. Participants were asked to recall both maternal and paternal parenting styles, along with current individual perceptions of body image and symptoms of social anxiety. After controlling for trait anxiety and depression, results indicated that lower levels of perceived parental care predicted outcomes of social interaction anxiety, whereas parental control did not significantly influence social anxiety at all. Furthermore, the fitness evaluation facet of body image was found to partially mediate the relationship between perceived parental care and social interaction anxiety, thus partially supporting the hypothesis of a mediation effect. However, the findings failed to confirm expected differences in maternal and paternal influence on affecting outcomes of social anxiety and body image dissatisfaction. Limitations and implications of the current study are discussed and specific suggestions are made for future research. 243 Screening for Common Perinatal Mental Disorders in Women in the North of Vietnam: A Comparison of Three Psychometric Instruments T.D. Tran1,2 , T. Tran1 , B. La1,3 , D. Lee4 , J. Fisher2 . 1 Research and Training Centre for Community Development, Hanoi, Vietnam; 2 Centre for Women’s Health, Gender and Society, University of Melbourne, Melbourne, VIC, Australia; 3 TUNA Clinic, Hanoi, Vietnam; 4 School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong S.A.R. Background: There is an urgent need for screening tools suitable for use by community based health workers to assist in the identification of people with compromised mental health. The aim of this study was to establish the validity of three widely used psychometric screening instruments in detecting Common Perinatal Mental Disorders (CPMDs) in women in northern Vietnam. Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), General Health
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
Methods: We assessed three people with diagnosis of schizophrenia. All of them were suffering from hearing voices that discussed them in third person. Treatment with typical and atypical antipsychotics failed to suppress voices. The patients were asked to record the duration and severity of their auditory hallucinations over a baseline period of a week. Three experimental conditions were assessed in random order on alternate weeks, each condition were applied for two hours between 10 a.m and 2 p.m for a week. Ratings were made during the intervention too. The intervention conditions were audiotapes of pure music (classical music), speech and music (Radio Payam in Iran) and a blank tape (control). The portable audiotape cassette players with intra-aural headphones were used. Data were analyzed by SPSS soft ware (version 16) using t-test. Results: The tapes of pure music, music and speech reduced the severity of hallucinations whereas the blank tape had little effect. The hallucinatory episodes lasted for an average of 13.5 min while listening to the pure music and 10.1 min for music and speech tape and 16.1 min for listening to blank tape and 17.9 min when not listening to audiotape (baseline). Duration of hallucination significantly reduced when patients listening to the pure music, music and speech (p < 0.05), but it was not significantly reduced as compared with blank tape (control). Conclusion: This study supports treating persistent auditory hallucination by altering external stimulation. Audiotape therapy may be helpful. Poster session P63. Others 7 Transcallosal Conduction Abnormalities in Subjects at High-risk for Alcohol Dependence: A TMS Study M. Kesavan1 , P.K. Puttaswamy1 , G. Venkatasubramanian1 , P.K. Pal2 , V. Benegal1 . 1 Psychiatry, 2 Neurology, National Institute of Mental Health and Neuro Sciences [NIMHANS], Bangalore, India Introduction: The genetic vulnerability to alcohol dependence [AD] is believed to be inherited as a state of Central Nervous System disinhibition, particularly in individuals with a high family loading of AD and paternal early onset AD. We have previously reported impaired cortical inhibition in these high-risk [HR] subjects. Objective: Corpus callosum [CC] abnormalities have been reported in subjects at HR for AD. Aim: In this study, we investigated transcallosal conduction in individuals at high-risk for alcohol dependence using single-pulse TMS. Methods: HR [n = 31] and LR [n = 27] in the age range of 13–25 years, matched for age, gender and handedness were recruited after informed consent. Following single pulse TMS, electromyogram from the right first dorsal interosseus muscle was used to record the Ipsilateral Silent Period [iSP] at 100% of the stimulator output. 10 trials were obtained for each individual with a 6 second ISI to avoid muscle fatigue. Results: iSP was absent more often in the HR subjects (124 times out of 340 trials) as compared to the LR subjects (63 times out of 300 trials) and this was statistically significant (c2 = 18.4; p < 0.0001). Conclusions: The greater absence of silent periods in our HR group indicates defective conduction across the CC, which could in turn reflect a delay in development/maturation of the CC as compared to the low risk group.
24 Psychiatric Disorders among Children Living in Orphanages – Experience from Kashmir Y.H. Rather. Department of Psychiatry, Government Psychiatry Disease Hospital, Srinagar, India In the conflict torn developing countries, where adoption and foster care are little practised, orphanages remain one of the few means of survival of inumerable orphans. Critical research, however, has potrayed orphanages as a breeding ground for psychopathology. This study was taken up to examine this opinion. An orphanage for girls in Srinagar was surveyed by Psychiatrists, and using DSM IV guidelines screened children were evaluated for psychopathology. Children were in the age group of 5–12 yrs. PTSD was the commonest psychiatric disorders (40.62%), easily attributable to the prevailing mass trauma state of almost two decades. Next commonest diagnoses were MDD (25%) and conversion disorder (12.5%). A high psychopathology in orphanages could be an important guide for policy makers to plan for better rehabilitation and social reintegration of orphans. 26 ADHD Presenting as Recurrent Epistaxis Y. Rather. Department of Psychiatry, Government Psychiatry Disease Hospital, Srinagar, India Epistaxis is an important otorhinilaryngological emergency, which usually has an apparent etiology, frequently local trauma in children. Here we present a case report wherein the epistaxis was recalcitrant, and proved to have a psychiatric disorder as an underlying basis. The child was diagnosed with Attention Deficit/ Hyperactivity Disorder, hyperactive type, which led to trauma to nasal mucosa due to frequent and uncontrolled nose picking. Treatment with a psychotropic drug controlled the patient’s symptoms and led to a remission of epistaxis. 59 Research and Young Psychiatrists: A Survey on Research Experiences and Barriers to Research T. Charernboon, M. Phanasathit. Department of Psychiatry, Thammasat University, Pathumthani, Thailand Objective: The objectives of this survey were to examine involvement in research activities, research training experience and barriers to research among young psychiatrists in Thailand. Method: The study employed cross-sectional descriptive survey. The sample included psychiatrists aged 40 years or under. The questionnaires were created by the researcher team. Results: There were 82 responders (57.7% response rate). Regarding the involvement in research, 58.5% of the sample had been principal investigators and 36.6% had published papers. Concerning the attitude to research, 53.6% expressed their willingness to do further research. Regarding the past training experience, 80.5% indicated that they had undertaken research courses during residency training and 65.8% were satisfied with their thesis process. Among the greatest barriers to conducting research reported were too much workload (85.4%), non-understandable statistical analyses and software (81.7%), lack of research experience (68.3%), no research advisor (62.2%) and shortage of research funds (50%). There were a number of factors affecting research experiences and opportunities: (1) psychiatrists with training from university hospitals were more likely to be involved in research activities than other types, (2) those currently working in university hospitals had a higher rate of published papers, and (3) those who were satisfied with their thesis experience were more willing to do more research. Conclusion: Just over half of the respondents had remained involved in research activities and keen to do more research. Training and working in university hospitals appeared to
Poster presentations / Asian Journal of Psychiatry 4S1 (2011) S41–S90
provide better research experiences and opportunities for young psychiatrists than in other types of institution. 123 The Comparison of Executive Function in Children with Attention Deficit, Hyperactive Children and Normal Children of Arak M. Samadzadeh1 , M. Abbasi2 , B. Shahbazzadegan1 . 1 University of Medical Sciences, 2 University of Mohaghegh Ardabili, Ardebil, Iran The aim of this study was the comparison of executive function in children with attention deficit hyperactivity disorder and normal children of Arak. The study populations were all the children with ADHD (Attention Deficit/Hyperactivity Disorder) aged 9 to 15 years attending junior high school education center for retarded children and junior high school children who did not have any mental health problems. The sample consisted of 40 male children; 20 with ADHD and 20 randomly selected normal children. For collecting data, Raven’s on colored matrices, Connors’ rating scale for ADHD, flowers and hearts test, visual research test and Simon’s test I, II have been used. For data analysis, MANOVA test and Log research questionnaire test have been used. The results showed that there was significant difference between the executive function of the normal and hyperactive children (p < 0.00). There was also significant difference between the inhibitions function and working memory in hyperactive children as compared to normal children. 152 Proposed Management Algorithm for Atypical Neuroleptic Malignant Syndrome and Serotonin Syndrome P. Chandrasekaran. Neurobehavioural Medicine, Penang Adventist Hospital, Georgetown, Malaysia With the increasing co-administration of neuroleptic and antidepressant medications, a spectrum-based concept of approach is suggested in the unlikely event of adverse reactions. Atypical forms of adverse events that do not fulfil the criteria for the diagnosis of Neuroleptic Malignant Syndrome (NMS) have been increasingly reported, as are varied presentations of Serotonin Toxicity; these have been attributed to drug combinations that may pharmacologically block dopamine and stimulate serotonin receptors, with the typical picture of NMS and frank Serotonin Syndromes existing on the ends of both pathophysiological processes. A proposed flowchart to detect to what extent each process contributes to a given presentation and thereafter with suggested management pathway is hereby presented that is flexible and would provide better outcome. It is hoped that this algorithm would aid clinicians faced with diagnostic and therapeutic difficulties to critically appraise their patients with these conditions. 226 Pituitary Tumour Presenting as Psychosis without Neurological Signs A.K. Ghosh, S. Rayapureddy. High Dependency Psychiatric Care Unit, Institute of Mental Health, Singapore, Singapore Background: Pituitary tumours are most commonly associated with signs and symptoms of increased intracranial pressure, visual disturbances and endocrinological changes. Many of them are known to cause cognitive impairments but only few cases had been reported in which the presenting symptoms are primarily psychiatric in nature. Objective: To describe a rare case of acromegaly with pituitary tumour presenting as a psychotic disorder. Method: Single case report. Results: A case of a 35 year-old man with acute psychosis is described. He presented to our psychiatric facility with disorganisation, delusional misidentification, persecutory ideas, grandiosity, perceptual abnormalities and marked fluctuations in
S83
behaviour and orientation. He did not show any improvement with antipsychotics and had to be augmented with a mood stabilizer. He was noted to have some acromegalic features though there were no neurological signs. Routine blood tests including a thyroid profile only showed raised ESR. A CT and a subsequent MRI scan revealed a large pituitary tumour likely to be a macroadenoma compressing the optic chiasm and extending into left cavernous sinus. The initial blood workup for pituitary tumour showed raised Prolactin and IGF-1. He was transferred to a general hospital for further evaluation and management. After a complete evaluation he was diagnosed with acromegaly with hypogonadism and blunted cortisol response. He was treated with Hydrocortisone, Olanzapine, Benzhexol, Sodium Valproate and Lorazepam while waiting for surgery. Conclusion: The case emphasizes the importance of investigations, especially neuroimaging, in atypical presentations of psychosis which may be first presentation of rare disorders like acromegaly. 242 Exploring the Effects of Perceived Parenting Styles on Outcomes of Body Image Dissatisfaction and Social Anxiety among Young Adults A. Lamont, J. Dickson. Swinburne University of Technology, Melbourne, VIC, Australia Social anxiety disorder (SAD) is an unrelenting disorder with high prevalence rates within the community. Previous literature indicates that parental control and parental care play an important role in the development and maintenance of SAD, while body image dissatisfaction has been found to occur in conjunction with the disorder. The current study aimed to further explore the influence of perceived parenting styles on outcomes of body image dissatisfaction and social anxiety. A series of selfreport measures were completed by 179 participants (119 women; 59 men; 1 unspecified) between the ages of 18 and 29 years of age. Participants were asked to recall both maternal and paternal parenting styles, along with current individual perceptions of body image and symptoms of social anxiety. After controlling for trait anxiety and depression, results indicated that lower levels of perceived parental care predicted outcomes of social interaction anxiety, whereas parental control did not significantly influence social anxiety at all. Furthermore, the fitness evaluation facet of body image was found to partially mediate the relationship between perceived parental care and social interaction anxiety, thus partially supporting the hypothesis of a mediation effect. However, the findings failed to confirm expected differences in maternal and paternal influence on affecting outcomes of social anxiety and body image dissatisfaction. Limitations and implications of the current study are discussed and specific suggestions are made for future research. 243 Screening for Common Perinatal Mental Disorders in Women in the North of Vietnam: A Comparison of Three Psychometric Instruments T.D. Tran1,2 , T. Tran1 , B. La1,3 , D. Lee4 , J. Fisher2 . 1 Research and Training Centre for Community Development, Hanoi, Vietnam; 2 Centre for Women’s Health, Gender and Society, University of Melbourne, Melbourne, VIC, Australia; 3 TUNA Clinic, Hanoi, Vietnam; 4 School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong S.A.R. Background: There is an urgent need for screening tools suitable for use by community based health workers to assist in the identification of people with compromised mental health. The aim of this study was to establish the validity of three widely used psychometric screening instruments in detecting Common Perinatal Mental Disorders (CPMDs) in women in northern Vietnam. Methods: Translated and culturally verified versions of the Edinburgh Postnatal Depression Scale (EPDS), General Health