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BACKGROUND There has been an increased rate of diagnosis of alcohol dependent syndrome (ADS) observed in our psychiatry clinic constituting a major portion of them into inpatients care. Evaluation of psychiatric complaints in patients with alcohol dependant syndrome is challenging at times. Depression has been found to be a common psychological association seen in them. Suicidality and other selfharming behaviour as a co morbidity are also not uncommon. There is dearth of information available on occurrence of alcohol dependent syndrome in psychiatry attendees and pattern of alcohol use especially from this part of north-eastern region of Assam. We wanted to assess the occurrence and pattern of alcohol use disorder amongst patients attending psychiatry unit of a tertiary care centre in upper Assam, estimate its bed occupancy rate, and determine psychiatric comorbidity among them. METHODS A hospital based cross sectional study was conducted among 104 consecutive subjects attending Psychiatry department of Jorhat Medical College, Assam. After thorough examination and informed written consent subjects were administered with alcohol use disorder identification test (AUDIT) and MINI plus. Semi structured socio demographic Proforma was used to collect information on demographic data and different variables. As it was a descriptive study, data collected were organized in frequency tables and analysed using percentage. RESULTS In present study, prevalence of alcohol dependent syndrome in psychiatry set up was 12.68 % and bed occupancy rate of ADS was 13 %. Majority were between the age 28 and 47 years, males, Hindus, married, belonged to nuclear family and hailed from upper lower social class followed by lower middle class. Approximately 18 % of cases had psychiatric co morbidity and majority of them had depression and suicidality. CONCLUSIONS A major number of alcohol dependant patients attended psychiatry OPD and occupied almost half of the beds as inpatients of a tertiary care hospital. Mood disorder was the commonest comorbid condition in these patients. Though the results cannot be generalized, it may definitely reflect the magnitude of alcohol use in this region. Hence forth a psychiatry unit like ours warrant a full-fledged department for treatment of ADS and alcohol related problems and some policy to work for its prevention. KEYWORDS ADS, Occurrence, Bed Occupancy, Psychiatric Co-Morbidity

Background: Disability associated with mental illness is a major contributor to the global burden of disease. The present study looks at some aspects of disability associated with 7 psychiatric disorders: schizophrenia, bipolar affective disorder, anxiety disorders, depression, obsessive-compulsive disorder, dementia, and mental and behavioural disorders due to the use of alcohol. Aims: (i) To evaluate the nature and quantity of disabilities in the study groups; (ii) to compare the degree of disability with the severity of the disorder; (iii) to compare disability among various disorders; and (iv) to study the longitudinal stability of disability in the disease groups. Methods: A total of 228 patients attending the OPD, Department of Psychiatry, Assam Medical College, Dibrugarh, between July 2003 and June 2004, who were diagnosed as per ICD-10 guidelines and SCAN, were included in the study. Severity was assessed by the application of some commonly used rating scales for each specific disorder. The level of disability was assessed by using the Indian Disability Evaluation and Assessment Scale (IDEAS). Patients were followed up at 6 and 12 months. Statistical analysis was done on SPSS version 10. Results: All the 7 disorders under study are associated with significant disability; schizophrenia being maximally disabling. Disability associated with alcohol use disorder and anxiety is comparable to disability on account of OCD. Over a period of 12 months, disability due to depression, alcohol use disorder and anxiety tend to remain significant.

Byline: Kamala. Deka, Neha. Dua, Monali. Kakoty, Rina. Ahmed Sir, Persistent genital arousal disorder (PGAD) or restless genital syndrome results in spontaneous, persistent and uncontrollable genital arousal, with or without orgasm or genital engorgement, unrelated to any feelings of sexual desire.[sup][1],[2] Here, we present a case of a 53-year-old female, who is a widow for 25 years. She came to us with 21/2 years history of increased sexual sensation in the genital area which she could not control, along with headache, dizziness, low mood, disturbed sleep, and crying spells. She had no desire to have sex, but she used to feel warm inside her vagina with pulsations, lubrication, tingling, throbbing response, and sometimes discharge. Initially, it was 15−20 times a day gradually increased to persist throughout the day. She lied on bed whole day crying, clinging herself or folding her body on herself because of the sensations. To get the relief she used to splash water or sometimes put her fingers inside her vagina following that she felt relief for few minutes but again felt the same sexual sensation. She did not have intercourse, neither did she use any artificial objects for pleasure. Her mood was low throughout the day, sleep disturbed, and appetite decreased. She was a widow for 25 years. No major psychosocial stressor was elicited. There was no history of sexual abuse in childhood. She had attained menopause 4 years back. History of earlier treatment with various such as like conjugated estrogen, cabergoline, alprazolam, vertin, cinnarizine, zolpidem, chlordiazepoxide, escitalopram, clonazepam, clomipramine, and etizolaam in adequate dosages for adequate duration did not have any beneficial effect on her. After being admitted she was investigated for sexual dysfunction. There was no local genital pathology and per vaginum examination was normal. Investigations like blood sugar levels, kidney function test, liver function test, thyroid profile, blood and urine routine and urine culture were within normal limit. Follicle-stimulating hormone (FSH) levels were raised, prolactin and estrogen were within normal range for her age. Total testosterone and free testosterone was normal. Her ultrasonography abdomen, transvaginal ultrasound, magnetic resonance imaging brain, computed tomography scan brain did not reveal any abnormality. Our patient was preoccupied with her increased sexual sensations and had feelings of guilt, shame, hopelessness, worthlessness. After workup, she was diagnosed conceptually to be a case of PGAD with depression. She was started on clomipramine 150 mg/day and clonazepam 1.5 mg/day in divided doses. After 2 weeks as we could not hike the dose of clomipramine due to giddiness, fluoxetine 40 mg/day was added and lignocaine gel local application was made 5−6 times a day along with pelvic floor exercises. She reported a marginal decrease in genital sensations as compared to before but was fluctuating. So after consultation with a gynecologist injection leuprolide3.75 mg (antiandrogen) subcutaneous was added to her treatment and advised to be repeated at 1 month interval for 3 months. Few days after 1[sup]st leuprolide injection, she reported a decrease in sexual sensation. The patient continued to improve and her genital sexual sensation significantly subsided at the time of discharge. She has received the 2[sup]nd and 3[sup]rd dose of injection leuprolide on follow-up and continued other medications as such. The patient is maintaining well for over 1[sup]1/2 years now. A patient of PGAD is generally diagnosed as sexual dysfunction not otherwise specified in the official classificatory system. …

Background The exponential increment of various co-morbid disorders among HIV positive individuals includes various medical subspecialties and mental health is one of them. HIV/ AIDS affects mental health by its complex interactions which may be the result of the psychological response to the diagnosis or complex neurobiological interactions. Therefore the current study aims at systematic evaluation of psychiatric morbidity in HIV/AIDS patients.

Clozapine was introduced in European market in 1972 as an effective treatment for schizophrenia without extrapyramidal side effects. Within a short while, the clozapine story virtually came to a halt following detection of life-threatening neutropenia and agranulocytosis. Judicial use of granulocyte colony stimulating factor (GCSF) can be life saving with infrequent side effects in these cases. Here we are presenting a case of clozapine induced agranulocytosis managed with GCSF but had transient but life-threatening thrombocytosis, a very uncommon complication of GCSF therapy. Expression of GCSF receptors on the surface of megakaryocytic lineage is thought to be the cause of this unusual phenomenon.

Aim: To study the clinical presentations and relationship of socio-demographic variables with conversion disorder. Methods: Forty patients admitted to the department of psychiatry, Assam Medical College and Hospital, Dibrugarh, during November 2004 to August 2005 who fulfilled the inclusion criteria of the study were evaluated for socio-demographic variables and clinical presentations on a semi-structured pro forma. Results: Conversion disorder is more common in young adults (57.5%), females (92.5%) and among students belonging to nuclear family of lower socioeconomic status. A majority of the patients had an obvious precipitating factor, of which family-related (40%) and school-related (30%) problems accounted for the major types. Motor symptoms were the predominant presentation (87.5%) with pseudo seizure being the commonest.

An 11-year-old girl presented with a behavioural problem of 2 years' duration, which developed following an attack of viral encephalitis. Her behavioural changes had manifested as conduct disorder and were treated with pharmacotherapy as well as behavioural therapy.