Wednesday, June 5, 2019
Dhat Syndrome: Sexual Behaviour and Psychiatric Comorbidity
Dhat Syndrome familiar Behaviour and Psychiatric ComorbidityOriginal Research ArticleTitle Dhat syndrome and its association with versed behavior and pyschiatric comorbidities in Indian malesSahu R.N, MD ( abnormal psychology), doubt and Professor,Co- AuthorsSharma V K, MD, WHO Fellow (USA), Head and Professor, Department of Medicine Gandhi Medical College, Bhopal, Madhya Pradesh, IndiaAshutosh Kumar, Lecturer, Gandhi Medical College, Bhopal, Madhya Pradesh, IndiaChintan Bavishi, Lecturer, Manipal University, Manipal, Karnataka, IndiaBalaji More, Assistant Professor, Krishna Institute of Medical Sciences, Karad, MaharashtraTitle Dhat syndrome and its association with symptoms, sexual behavior and comorbidities in Indian male long-sufferings AbstractThe Context (Background) Dhat syndrome is often taken as culture bound syndrome of Indian subcontinent. There are many misconceptions which form free-base of symptoms and comorbidities.Aims Dhat syndrome is reported on basis of self d iagnosis. The ingest aims to study associated symptoms, sexual behavior and comorbidities in Indian population.Methods and Material This cross-sectional and case- ascendancy study, was carried with help of trained local anaesthetic interviewers at Department of Psychiatry and Medicine, Gandhi Medical College (GMC), Associated Hamidia Hospital, Bhopal, India. Cases were compared to healthy matched controls. The study was conducted using clinical interview, physical examination and other necessary investigations like urine abstract and microscopy.Results Of the 50 cases and control, each, age group was 21 to 25 years (48%) and education upto12th class (60%). 20% cases reported memorial of Masturbation. Extramarital or premarital sexual contact was found to have little significance on the syndrome. 76% of the patients met DSM-IV Diagnostic Criteria for Anxiety and 56% patients met for Depression. 23 patients (46.3%) were having a co-morbid somatic complains like bodyache, weakness and fatigue. Erectile dysfunction by 34% Premature ejaculation by 8% was reported. In Urine routine compend and microscope no oxalates or phosphates were noned.Conclusions Dhat syndrome is more(prenominal) common among low educated young population. Laboratory evidence of any pathological cause was not found. Contrary to popular belief, it had no direct coefficient of correlation with masturbation and pre and extra marital sexual contact.Key Words Dhat Syndrome, Semen, Sexual behavior, Somatic symptoms, Erectile DysfunctionIntroductionDhat syndrome is a Culture bound syndrome.1 provided it has been menti onenessd in medical history and reported by population worldwide. The culture has profound impact on the mental status of an individual. According to International categorisation of Diseases (ICD) 10 had classified Dhat syndrome had been classified in both neurotic disorder (F48.8) and into culture specific disorder caused by undue concern about the debilitating effects of the passage of semen. The cases are always self reported and they often report a set of symptoms. These vague somatic symptoms are fatigue / embodied weakness, headache, depression3, anxiety, loss of appetite, palpitation / tachycardia, guilt, poor concentration, forgetfulness.2 Due to existing belief it is often associated as a result of masturbation and cosmos sexually active foreign marriage. The comorbidities include erectile dysfunction, premature ejaculation and impotence.Patients reported semen loss in urine or involuntarily outside (spontaneously while sleeping during loosening or while showering) of sexual relations.4 A typical profile of Dhat Syndrome patient either is a young man, unmarried or recently married, less educated, and the one who holds strong traditional beliefs.5This category of disease involves mixed disorders of behavior, beliefs, and emotions which are of uncertain etiology and nosological status and which occur with particular frequency in certain cu ltures. The ethnic belief and pattern associated with Dhat syndrome make it different from delusional disorder. 6, 7Material and MethodsThe study is a case-control cross sectional study, aimed to evaluate the symptoms, beliefs and comorbidities related to Dhat syndrome. The study and control group of 50 each was assessed.The study was conducted at Gandhi Medical College (GMC), Associated Hamidia Hospital, Bhopal, India. Study group of 50 subjects was selected who had Dhat syndrome without any other organic disorder at OPD of Psychiatry Department. The control group of 50 patients was shortlisted from the Medicine Department. They were not diagnosed for Dhat syndrome and were matched with the case group in most aspects. Both groups were interviewed based on a structured interview. inclusion body criteriaCase groupComplain of whitish discharge in the urine and associating it with symptoms and comorbiditiesFulfilled DSM-IV TR criteria apartConsenting to clinical interviewControl group Inpatients who were not suffering from Dhat syndrome though they were suffering from other medical ailmentsMatched in other aspects with the case groupConsenting to clinical interviewExclusion criteria Presence ofgenitourinary disorderTesticular tumorVaricoceleOrganic sexual dysfunctionPelvic inflammatory diseaseEndocrine disordersSpinal cord traumaEthicsinstitutional review board and ethical committee approval was taken from GMC, Bhopal, India. All periodic adverse event reports were reported to them and appropriate guidance was taken.All interviewers were calculated about ethical and legal considerations. All identification information including names, initials and hospital numbers were avoided to keep the patient details in anonymity. Written information swallow after the details of the project were fully explained was obtained from all participants. There were no minors involved and hence no paternal consent involved in this study.Statistics The data was analyzed by using stat istical tests of mean and standard deviation. (P0.005)ResultsDhat syndrome is prevalent in younger age group. Anxiety is most prevalent followed by depression. They are related to sexual symptoms as ejaculatory dysfunction, premature ejaculation and impotence. (Fig. 1) Patients associated Dhat syndrome as a direct result of excessive indulgence in sexual action or masturbation or to nocturnal emissions. (Fig. 2) Dhat syndrome was prevalent in class of lower education, below class 12.Routine biochemical and urine laboratory military rating was conducted for all 100 participants.Other necessary investigations were carried out as per the requirement of the subjects to exclude organicity ( Sonography and Hormone Assay). None of the reports showed presence of oxalates or phosphates. A semen analysis founded out altogether 1 patient had azoospermia and 2 were having oligospermia.Figure 1 Co-morbid conditions associated with patients in study group and control groupFigure 2 Sexual histor y of patients in study group and control groupDiscussionAs a Culture bound syndrome, Dhat syndrome has been discussed for long time. Epidemiology and prevalence is noted in history of medicine all over the world.1, 8 The Dhat syndrome is not limited to Indian subcontinent. The origin of its name had a strong relationship with Indian culture, history and mythology.9, 10Dhat Syndrome forms an important health problem and the magnitude is also very high. In view of this it films a proper attention and sensitization amongst the health care providers for the proper treatment, counseling of these patients and referring them to related specialty. The patient presenting with Dhat syndrome is typically more likely to be recently married of average or low socio-economic status (student, jackstones or farmer by occupation), came from a rural area and belonged to a family with conservative attitudes towards sex.11The exact pathophysiology of Dhat syndrome is not known. The study demonstrated various other symptoms and morbidities being involved along with Dhat syndrome. The prevalence in relatively younger age group can be attributed to hormonal rush.12 Majority of these individuals visited self-claimed sex specialists and traditional combine healers. The contact with these health providers not only strengthen their misconception and false beliefs, but also compel the patients to pay huge cost of investigations and drugs which are not only non-effective but also hazardous. 5Among other studies the relationship between marital status or sexual contact outside marriage and Dhat syndrome is not discussed. This study establish contrary to the popular belief that no such cause-effect relationship exists. Dhat syndrome was most common among illiterate patients and less educated patients. There is a need for patient education and sex education in the eradication of syndrome. 13, 14 The spread of disease in all age groups indicate towards the need of patient education about th e disease in India. In many cases the syndrome is under diagnosed. In general, the deep-rooted misconceptions associated with anatomical and physiological aspects of sexuality are difficult to be correct with general counseling sessions.The further work in this field is required to know Whether Dhat is a Culture bound syndrome only in India? What is the pathophysiology crapper it? Is there any relationship of it with depression, anxiety or other mental health disorder? Whether there is any relationship between puberty and Dhat syndrome. mention We are thankful to all the interviewers who conducted data collection.ReferencesSumathipala A, Siribaddana SH, Bhugra D. Culture-bound syndromes the story of Dhat syndrome. Br J Psychiatry. 2004 184 200-9.Bhatia M.S, Jhanjee A, Kumar P. Culture bound syndromes- a cross-sectional study from India. European Psychiatry. 2011 26448Dhikav V, Aggarwal N, Anand KS. Is Dhat syndrome, a culturally appropriate manifestation of depression? Med Hypothes es. 2007 69 (3) 698.Mehta V, De A, Balachandran C. Dhat syndrome a reappraisal. Indian J Dermatol. 2009 54(1) 89-90.El Hamad I, Scarcella C, Pezzoli MC, Bergamaschi V, Castelli F Migration Health Committee of the International Society of pilgrimage Medicine. Forty meals for a drop of blood. J Travel Med. 2009 16(1) 64-5.Behere PB, Natraj GS. Dhat syndrome the phenomenology of a culture bound sex neurosis of the orient. Indian J Psychiatry. 1984 26(1) 76-8.World Health face (1992) International Statistical Classification of Diseases and Related Health Problems (ICD-10). Geneva WHO.De Silva P, Dissanayake SAW. The use of semen syndrome in Sri Lanka A clinical study. Sex Marital Ther. 1989 4195-204.Malhotra HK, Wig NN. Dhat syndrome a culture-bound sex neurosis of the orient. Arch Sex Behav. 1975 4(5) 519-28.Angst J, Gamma A, Gastpar M, et al. Depression Research in European Society Study. Gender differences in depression. epidemiological findings from the European DEPRES I and II s tudies. Eur Arch Psychiatry Clin Neurosci. 2002 252(5) 201-9.Singh G. Dhat syndrome revisited. April 198527(2)119-122Carroll BJ. Adolescents with depression. JAMA. 2004 Dec 1292(21)2578Tiwari SC, Katiyar M, Sethi BB. Culture and mental disorders. An overview. J Social Psychiatry 1986 2403-25Avasthi A, Jhirwal OP. The concept and epidemiology of Dhat syndrome. J Pak Psychiatry Soc. 2005 2 68.
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