Sujit Kar

Gender identity disorder (GID) is a relatively rare psychiatric disorder characterized by desire to be of the opposite sex, cross-dressing, cross – sex roles in fantasy plays, desire to participate in games of opposite sex, preference for playmates of opposite sex and persistent discomfort with the assigned sex leading to significant impairment and distress. These manifestations occur in the absence of physical disorders leading to intersex. Co-morbidities like depression, anxiety disorder and conduct disorder may be associated with GID. Identifying the co-morbidities, addressing the bio-psycho-social attributes of this disorder is an important and key step to management. Presence of co-morbidities makes the diagnosis and management of GID, a challenge. Adverse childhood experiences like sexual abuse may attribute to the gender identity disorder as well as the externalizing and internalizing behaviors of the child in later part of life. In this case report, we highlighted 337 the diagnostic and management issues as well as the adverse childhood experiences that might have attributed to GID and co-morbid psychiatric disorders.

Cognitive deficits are one of the core symptoms of schizophrenia that evolve during the course of schizophrenia, after being originated even before the onset of illness. Existing pharmacological and biological treatment modalities fall short to meet the needs to improve the cognitive symptoms; hence, various cognitive remediation strategies have been adopted to address these deficits. Research evidences suggest that cognitive remediation measures improve the functioning, limit disability bettering the quality of life. The functional outcomes of cognitive remediation in schizophrenia are resultant of neurobiological changes in specific brain areas. Recent years witnessed significant innovations in cognitive remediation strategies in schizophrenia. This comprehensive review highlights the biological correlates of cognitive deficits in schizophrenia and the remedial measures with evidence base.

ABSTRACTSchizophrenia is a severe mental disorder. Cognitive deficits are one of the core features of schizophrenia. Multiple domains of cognition (executive function, attention/vigilance, working memory, verbal fluency, visuospatial skills, processing speed, and social cognition) are affected in patients with schizophrenia. Deficits in cognition led to impairment in the real world functioning. Identifying the cognitive deficits and early intervention is required for better functional outcome. This review focuses on conceptual understanding of cognition with its neurobiological correlates in schizophrenia and its different clinical implications.

Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

Acquired immunodeficiency syndrome (AIDS) is a retroviral infection in the humans and other primates. Lot of development in understanding the virus, it’s life cycle, pathogenesis, opportunistic infections, laboratory investigations for diagnosis and management of AIDS with antiretroviral drugs have taken place over the last few decades. This article attempts to highlight a basic conceptual preview of HIV infection and AIDS. Introduction Acquired immunodeficiency syndrome (AIDS) is the single most important modern day pandemic in our times. The first case of AIDS was described in 1981 [1, 2]. In 1983, the causative virus of AIDS was isolated by Luc Montagnier and his colleagues from a West African patient suffering from generalised lymphadenopathy [3]. They named it Lymphadenopathy Associated Virus (LAV). In 1984, it was established as the etiological agent of AIDS by Robert Gallo and his co-workers when it was named Human T cell Lymphotropic Virus III [3]. Thereafter, on various occ...

Melasma is a hyperpigmented dermatological condition common in females. Drugs such as steroids, cosmetics, and photosensitizing agents are known to cause melasma. We report here a case of an adult male with obsessive-compulsive disorder, receiving clomipramine, who developed melasma.

Catatonia is a syndrome of specific motor abnormalities, closely associated with disorders of mood, thought, and cognition. The principal symptoms of catatonia are mutism, immobility, negativism, posturing, stereotypy, and echo phenomena. Catatonia occurs in various psychiatric illnesses as well as medical disorders like infections of the central nervous system such as encephalitis, autoimmune disorders, cerebrovascular events, systemic metabolic disturbances, and toxic drug states. Catatonia may often mislead the clinician and the patient may be misdiagnosed as primarily suffering from a psychiatric disorder and be treated accordingly. Encephalitis may present with various psychiatric symptoms including catatonic features as its sequel that may sometimes be misunderstood as a primary psychiatric disorder. We highlight a case of a young female in her postpartum period, who presented with initial aggressive behavior and sleep deprivation followed by features of catatonia accompanied with fever. She initially responded well to benzodiazepines; however, her subsequent response was poor. When she was subjected to neuroimaging, it revealed signal intensity alteration in the bilateral basal ganglia and temporal regions suggestive of encephalitis; cerebrospinal fluid (CSF) viral markers examination revealed immunoglobulin M (IgM) positivity for Japanese encephalitis (JE). This case report highlights the diagnostic dilemma and management issues of a case of JE with catatonic symptoms.

It is a known fact that depression is the one of the leading causes of years lived with disability and the fourth leading cause of disability-adjusted life-years worldwide. Depression is often under-recognized among patients of epilepsy due to lack of awareness of depressive symptoms. Due to improper management of depression in epileptic patients, it can interfere with treatment outcomes and hence can impair the quality of life. Undermanaged depression in epilepsy is generally associated with work absenteeism and direct medical costs. Electronic JR_liographic databases like PubMed and Google Scholar were searched using the format “(depression, epilepsy and symptoms)”. Cross-linked searches were made taking the lead from key articles. Recent articles and those exploring the etiological factors & symptomatic presentation of depression were focused upon. The main purpose of this review was to study the causative association between epilepsy and depression and to discuss the varied symp...

Byline: Sujita. Kar, Darpan. Kaur Indian Psychiatric Society (IPS) is a powerful force in world psychiatry. Over the past several decades, it has reached several milestones; the latest of which is the initiation of Travel Fellowship Training for young faculties in psychiatry, within the country. The Committee for Research and Education Foundation and Training of IPS has started this Travel Fellowship Training for young life fellow/life ordinary member psychiatrists of IPS. This educational program focuses in strengthening the clinical skills of young psychiatrists in their areas of interest by undergoing training in any institute, within the country under the guidance of experts of the country. In the year, 2015 – IPS has awarded the travel fellowship to Dr. Darpan Kaur, Assistant Professor, Department of Psychiatry, MGM Medical College, Navi Mumbai, Maharashtra and Dr. Sujita Kumar Kar, Assistant Professor, Department of Psychiatry, King George's Medical University, Lucknow, U.P. IPS has arranged all the logistics for travel (to and fro airfare in economic class), accommodation and facilitation of official processes at the training institute. In this report, Dr. Sujita Kumar Kar and Dr. Darpan Kaur share their experience of their fellowships. Dr. Sujita Kumar Kar had opted for the fellowship training on the “Brain Stimulation Techniques” from 23[sup]rd November 2015 to 5[sup]th December 2015 and Dr. Darpan Kaur had opted for the fellowship training in child and adolescent psychiatry from 1[sup]st to 15[sup]th November 2015. Dr. Sujita Kumar Kar undertook training at the Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru under the mentorship of Prof. B. N. Gangadhar, Prof. Jagadisha Thirthalli, and Dr. Urvakhsh M. Mehta. In the 2 weeks training on “Brain Stimulation Techniques” at the NIMHANS, Bengaluru, the focus was to improve the clinical skills in the newer brain stimulation techniques like – repetitive Transcranial Magnetic Stimulation (rTMS), transcranial Direct Current Stimulation (tDCS), and some unique methods in electroconvulsive therapy (ECT) (especially bi-frontal and electroencephalogram [EEG] monitored ECT). With discussion with the mentors, the following schedule was drawn: *Observing different brain stimulation techniques such as rTMS, tDCS, ECT (especially bi-frontal and EEG monitored ECT) *Hands on training on these techniques *Discussion regarding difficult issues related to these techniques *Reading the resource materials provided *Writing two scientific papers *Making a presentation on a selected topic before completing the training. The trainee directly observed and conducted the hands-on administration of TMS sessions including neuro-navigation assisted rTMS, continuous and intermittent theta burst stimulation, and cerebellar TMS. He had observed tDCS procedure in patients with OCD, alcohol dependence (for anticraving purpose), and persistent auditory hallucination as well as EEG monitored ECT and bi-frontal ECT. Two academic articles are under preparation for publication. He presented a seminar on the topic, “efficacy and predictors of treatment response in rTMS in depression”. At the end of the fellowship, the trainee acquired skills to administer different types of TMS, tDCS, and ECT. He has also acquired knowledge about these brain-stimulation techniques including the potential of setting up similar laboratories elsewhere. He developed the competence of planning research using these techniques. The hospitality and support of the mentors, staff, and residents were unimaginable. Overall, it was a nice and memorable experience of academic, clinical learning which will be helpful in clinical practice, teaching as well as research collaboration. A travel fellowship program of short duration is an excellent opportunity of strong relevance to current generation psychiatrists to build up skills in their area of interest. …

Depression is a common neuropsychiatric condition associated with systemic sclerosis. The association of depression and systemic sclerosis is the result of multiple mechanisms such as autoimmune, significant morbidity due to multi-system involvement, distorted self-image due to disfigurement, chronic disability, and iatrogenic. The prevalence of depression in systemic sclerosis is as high as 65% as found in several clinical studies. Early diagnosis and appropriate intervention of depression in systemic sclerosis through integrated multidisciplinary team approach is more likely to improve the global outcome of illness. Hence, multidisciplinary management approach is highly recommended for the management of depression in systemic sclerosis.

Dhat syndrome is a culture bound syndrome of Indian subcontinent and depression is one of the frequently associated psychiatric co-morbidity with it. We present here the case of an adolescent boy who presented with major depressive disorder with Dhat syndrome who responded significantly to antidepressant and psychosocial intervention in a period of two weeks.

Australian & New Zealand Journal of Psychiatry, 49(12) with organic manic episodes (Gross and Herridge, 1988). We describe a manic illness in a patient in whom a right medial temporal lobe and thalamic arteriovenous malformation was detected. Ms A, a 15-year-old adolescent female, presented with complaints of irritability, over talkativeness, over familiarity and increased physical activity present for the last month. She gave a medical history of insidious progressive onset of left-sided weakness, starting over 4 years earlier. There was no history of fever, headache, head injury, incontinence, seizure episode or any other neurological abnormality. The weakness of the left side of body was permanent. No treatment was sought for it. Two months after onset of this neurological problem, she had experienced a manic episode, which resolved completely with 4 weeks of treatment from a psychiatrist (treatment details were not available). There is no family history of any neuro-psychiatric illness. On neurological examination, there was atrophy and flaccidity of the left upper and lower limbs, power was 2/5, superficial reflexes were diminished, deep tendon reflexes were exaggerated, plantar reflex was extensor on left side. On mental status examination, affect was irritable and grandiose ideas and decreased need for sleep were elicited. All blood tests were normal. Computed tomography (CT) angiography revealed intracranial arteriovenous malformation embedded in right medial temporal lobe and thalamic regions. The patient was started on valproate 300 mg twice daily and lorazepam 2 mg per day. There was significant reduction in manic symptoms after 3 weeks of treatment and complete resolution of affective symptoms after 8 weeks. She was maintained on 600 mg of valproate per day and referred to the department of neurosurgery for evaluation and management of the intracranial arteriovenous malformation. Organic manic disorder should be considered in any manic patient who presents outside the usual age of onset for idiopathic manic-depressive disease, has no family or personal history of affective disturbance or has concomitant neurologic deficit. Lack of acknowledgment of deficits, and the tendency for mania to overshadow other aspects of clinical presentation, may cause neurologic abnormalities to be overlooked and might account for the rarity of reported cases of organic manic disorder associated with cerebrovascular disease.

India is a country of many religions and ancient cultures. Indian culture is largely directed by the Vedic culture since time immemorial. Later Indian culture is influenced by Buddhism, Islam, and Christianity. Indian belief system carries the footprints of these cultures. Every culture describes human behaviors and an interpretation of each human behavior is largely influenced by the core cultural belief system. Sexuality is an important domain which is colored by different cultural colors. Like other cultures, Indian culture believes "semen" as the precious body fluid which needs to be preserved. Most Indian beliefs consider loss of semen as a threat to the individual. Ancient Indian literature present semen loss as a negative health related event. Dhat syndrome (related to semen loss) is a culture-bound syndrome seen in the natives of Indian subcontinent. This article gathers the Indian concepts related to semen loss. It also outlines belief systems behind problems of D...