Kerala Journal of Psychiatry Official Publication of Indian Psychiatric Society (Kerala Branch) Branch of Indian Psychiatric Society (Kerala) en-US Kerala Journal of Psychiatry 0377-0699 Delivering mental health services to the people of Kerala - Need for a balancing act Harish M Tharayil ##submission.copyrightStatement## 2019-10-23 2019-10-23 32 1 A Comparative study of impulsivity, lethality and intent among patients attempting suicide by self-immolation and poisoning <p><strong>Background: </strong>Suicide is one of the top ten leading causes of death in the world as well as India. Poisoning is one of the most common modes of attempting suicide. Self-immolation is a devastating form of suicide attempt. Impulsivity has been demonstrated as an important risk factor for suicide. Lethality and intent were found to be interrelated in previous studies. But a comparative study of impulsivity, lethality and intent between self-immolation and poisoning was not found in a literature search.</p> <p><strong>Objectives:</strong></p> <ol> <li>To compare socio-demographic characteristics, impulsivity, intent and lethality in those who attempt suicide by self-immolation and poisoning.</li> <li>To find the intercorrelations between intent, impulsivity and lethality.</li> </ol> <p><strong>Methods: </strong>A cross-sectional comparative study was done among persons attempting suicide by self-immolation (n=40) and poisoning (n=50). Barratt's impulsivity scale, Smith's LSARS (lethality of suicide attempt rating scale) and Beck's suicide intent scale were used to assess impulsivity, lethality and intent, respectively. Percentages, mean, median and range were used to describe the data. Chi-square test, t-test and Pearson correlation were used for statistical analysis.</p> <p><strong>Results and discussion: </strong>There were significant associations between occupation, family income and socioeconomic status and mode of suicide attempt. Lethality was higher in self-immolation. Lethality and intent were significantly intercorrelated in both groups. Impulsivity and lethality were negatively correlated in the self-immolation group.</p> <p><strong>Conclusion: </strong>Self-immolation is a highly lethal method of attempting suicide. Highly lethal suicide attempts have high intent. Greater the impulsivity, less lethal the attempt is likely to be.</p> <p><strong>&nbsp;</strong></p> Namita Nazeer Harish M Tharayil Varsha Vidyadharan ##submission.copyrightStatement## 2019-09-30 2019-09-30 32 1 Factors influencing Betel quid chewing among indigenous tribal population in Wayanad, Kerala : A qualitative study <p><strong>Background: </strong>Indigenous tribes are at higher risk of substance misuse, including betel quid. Available studies in this area focused on health hazards, while socio-behavioural aspects of betel quid practices are less studied, especially among the tribal population in India.</p> <p><strong>Objectives: </strong>The study was conducted to explore the factors influencing betel quid use among indigenous tribes in Wayanad, Kerala</p> <p><strong>Methods: </strong>Using a purposive sampling method, we selected 12 persons with betel quid use form Paniya and Kattunaicker tribal community at Wayanad. Qualitative in-depth interviews were used for data collection. The thematic analysis was done to understand the key themes and categories.</p> <p><strong>Results</strong>: We identified that betel quid chewing among tribes often initiated in young age, with influence of the home environment, parental, peer and spouse related factors. Key themes that emerged were the trajectory of betel quid use, betel quid intake, dependency, access and availability of betel quid in tribal dominant areas.</p> <p><strong>Conclusion: </strong>As our study result indicated many features of betel quid dependency, community level screening for identifying the potential cases and provision of treatment services might be required. Future studies to assess proper intervention for betel quid chewing can be undertaken.</p> Anvar Sadath Kurian Jose Jiji KM Shibu kumar TM ##submission.copyrightStatement## 2019-10-30 2019-10-30 32 1 Development and Preliminary validation of a screening tool for Specific learning disorder in children <p><strong>Background: </strong>Delay in early diagnosis of Specific learning disorder (SLD) is influenced by various factors, including the lack of simple yet validated tools for assessment.</p> <p><strong>Objective: </strong>We aimed to develop and validate a screening questionnaire in English and Malayalam for SLD in children aged 7-11 years, which can be used easily. This paper deals with the initial development and preliminary validation of the tool, which was subsequently validated in a larger sample and had already been published.</p> <p><strong>Materials and methods:</strong> The tool was validated using a case-control methodology. It was developed after ensuring face and content validity, and suitable modifications were done based on the internal consistency measure and factor analysis results. The tool was applied in children with SLD and two groups of controls. ROC curve analysis was done to find the optimum cut-off, and validity parameters were estimated.</p> <p><strong>Results: </strong>A total of 21 SLD, 42 normal and 37 borderline intelligence children, were studied. The final tool with 26 items had good Cronbach’s alpha (0.95) and area under the curve values (0.96). The tool had good sensitivity (100 %) and specificity (77.2%), i.e., if the score is &lt;10, we can rule out SLD.</p> <p><strong>Conclusions: </strong>We propose a new screening tool for SLD with promising reliability and validity characteristics that need to be evaluated further.</p> <p>&nbsp;</p> Varsha Vidyadharan Harish M Tharayil Biju George ##submission.copyrightStatement## 2019-11-05 2019-11-05 32 1 Incidence of Metabolic Syndrome in patients treated with Clozapine in a tertiary care center in central Kerala <p><strong>Background</strong><strong>:</strong> Clozapine is widely used for the treatment of resistant Schizophrenia (Sz). Metabolic syndrome (MetS) is its recognized side effect. Reports on the side effects of Clozapine are scanty from Kerala. Hence a prospective observational study was conducted.</p> <p><strong>Aim</strong>: The aim of the present study was to find the incidence of Metabolic syndrome in patients with psychosis, after 12 weeks of treatment with clozapine in a tertiary care centre in Kerala.</p> <p><strong>Methods</strong>: Patients diagnosed as Schizophrenia or Delusional disorder based on International Classification of Diseases (ICD)-10 and not meeting the threshold criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and on Clozapine treatment were recruited and followed up for at least 12 weeks. Augmentation, when needed, was limited to Amisulpride, Aripiprazole, and/or Modified Electroconvulsive Therapy (MECT). Bodyweight, waist circumference, blood pressure, fasting blood sugar, and triglycerides levels were measured at the enrolment and after 12 weeks. Seventy-five patients completing follow up for 12 weeks were considered as study subjects. Patients who fulfilled NCEP ATP III criteria at 12 weeks were diagnosed as having MetS.</p> <p><strong>Results</strong>: Study sample of 75 had not met the threshold criteria of NCEP ATP III based MetS diagnosis at the study entry. But among them, 23 met no criteria, 23 met one criterion and 29 met two criteria. Out of 75 patients, 32 (42.7%) developed Metabolic Syndrome at three months. Among 23 who met no criteria at intake, 3 (13%) developed MetS, while it was 9 (39%) in 23 who met 1 criterion and 20 (69%) in 29 who met 2 criteria.</p> <p>The mean Clozapine dose at discharge was 514±148 mg in those who developed MetS while it was 428±164 mg in those who did not. This difference was statistically significant (p&lt;0.05).</p> <p><strong>Conclusion</strong>: Incidence of MetS is high in Clozapine receiving Psychotic patients. The present study showed that in the study population, risk factors have a cumulative effect on the development of this side effect, and the risk is high when the dose of clozapine is higher.</p> Peter K Joseph Praveenlal Kuttichira Saibunnisa K Beevi ##submission.copyrightStatement## 2019-12-01 2019-12-01 32 1 Posterior Circulation Stroke –presenting as Psychotic disorder <p>The prevalence of posterior circulation stroke is less reported compared to anterior circulation stroke, accounting for one fourth of all ischemic strokes. It commonly presents with neurological deficits like visual deficits, vertigo and sensory-motor deficits rather than merely psychiatric symptoms. Nonetheless, there could be comorbid psychiatric symptoms associated with it. A rare presentation of posterior circulation stroke presenting with psychosis as a primary symptom without any neurological deficit is discussed.</p> <p>&nbsp;</p> <p>&nbsp;</p> Dilshana Nafisa K Priya Nayak Safeekh A T ##submission.copyrightStatement## 2019-10-17 2019-10-17 32 1