Dhat Syndrome: Sexual Behaviour and Psychiatric Comorbidity

Dhat Syndrome: Sexual Behaviour and Psychiatric Comorbidity Original Research Article Title: Dhat syndrome and its association with sexual behavior and pyschiatric comorbidities in Indian males Sahu R.N, MD (Psychiatry), Head and Professor, Co- Authors: Sharma V K, MD, WHO Fellow (USA), Head and Professor, Department of Medicine Gandhi Medical College, Bhopal, Madhya Pradesh, India Ashutosh Kumar, Lecturer, Gandhi Medical College, Bhopal, Madhya Pradesh, India Chintan Bavishi, Lecturer, Manipal University, Manipal, Karnataka, India Balaji More, Assistant Professor, Krishna Institute of Medical Sciences, Karad, Maharashtra Title: Dhat syndrome and its association with symptoms, sexual behavior and comorbidities in Indian male patients Abstract: The Context (Background): Dhat syndrome is often taken as culture bound syndrome of Indian subcontinent. There are many misconceptions which form base of symptoms and comorbidities. Aims: Dhat syndrome is reported on basis of self diagnosis. The study aims to study associated symptoms, sexual behavior and comorbidities in Indian population. Methods and Material: This cross-sectional and case-control study, was carried with help of trained local 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 analysis 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 history 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 analysis and microscope no oxalates or phosphates were noted. Conclusions: Dhat syndrome is more common among low educated young population. Laboratory evidence of any pathological cause was not found. Contrary to popular belief, it had no direct correlation with masturbation and pre and extra marital sexual contact. Key Words: Dhat Syndrome, Semen, Sexual behavior, Somatic symptoms, Erectile Dysfunction Introduction Dhat syndrome is a Culture bound syndrome.1 But it has been mentioned in medical history and reported by population worldwide. The culture has profound impact on the mental status of an individual. According to International Classification 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 / bodily 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 being sexually active outside marriage. The comorbidities include erectile dysfunction, premature ejaculation and impotence. Patients reported semen loss in urine or involuntarily outside (spontaneously; while sleeping; during defecation; 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.5 This 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 cultures. The cultural belief and pattern associated with Dhat syndrome make it different from delusional disorder. 6, 7 Material and Methods: The 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 criteria: Case group: Complain of whitish discharge in the urine and associating it with symptoms and comorbidities Fulfilled DSM-IV TR criteria apart Consenting to clinical interview Control group: Inpatients who were not suffering from Dhat syndrome though they were suffering from other medical ailments Matched in other aspects with the case group Consenting to clinical interview Exclusion criteria: Presence of Genitourinary disorder Testicular tumor Varicocele Organic sexual dysfunction Pelvic inflammatory disease Endocrine disorders Spinal cord trauma Ethics: Institutional 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 careful 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 consent 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 statistical tests of mean and standard deviation. (P>0.005) Results: Dhat 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 activity 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 evaluation 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 only 1 patient had azoospermia and 2 were having oligospermia. Figure 1: Co-morbid conditions associated with patients in study group and control group Figure 2: Sexual history of patients in study group and control group Discussion As 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, 10 Dhat Syndrome forms an important health problem and the magnitude is also very high. In view of this it needs a proper attention and sensitization amongst the healthcare 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, laborer or farmer by occupation), came from a rural area and belonged to a family with conservative attitudes towards sex.11 The 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 faith 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. 5 Among 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 the 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 behind 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. Acknowledgement: We are thankful to all the interviewers who conducted data collection. References Sumathipala 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; 26:448 Dhikav V, Aggarwal N, Anand KS. Is Dhat syndrome, a culturally appropriate manifestation of depression? Med Hypotheses. 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 Travel 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 Organization (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; 4:195-204. 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 studies. Eur Arch Psychiatry Clin Neurosci. 2002; 252(5): 201-9. Singh G. Dhat syndrome revisited. April 1985;27(2):119-122 Carroll BJ. Adolescents with depression. JAMA. 2004 Dec 1;292(21):2578 Tiwari SC, Katiyar M, Sethi BB. Culture and mental disorders. An overview. J Social Psychiatry 1986; 2:403-25 Avasthi A, Jhirwal OP. The concept and epidemiology of Dhat syndrome. J Pak Psychiatry Soc. 2005; 2: 6–8.

How technology making culturally diverse ideas Essay

  Question: How has technology worked to make the world a smaller place and bring about culturally diverse ideas that help identify opportunities and solve problems? There was a day when high tech communication was a guy on a pony galloping to the next town to deliver a letter. Then there were the days of switchboard operators and party lines, now we have nearly instant communication with anybody in the world right at our fingertips. Communication technology has always served to make the world a smaller place. The recent surge in high tech communications has hastened the process. Maybe the biggest way that technology has made the world smaller is through the internet. The internet or World Wide Web is almost scary when you think about how accessible it has made the places that were once the farthest away. With things like Google earth, you can actually look at just about any place on the globe. Just type in an address or a name of a town and you can instantly see a satellite image of that place, zooming in and you can start to make out the streets and houses. No, the technology doesn’t actually transport you there but by looking at it with your own eyes, you feel like you are there. It’s not just Google earth that help the internet make the world small. It’s the internet in general. The World Wide Web is just that, it is a web that connects every computer in the world. No computers are more than a few links away and you can use the computer to do amazing thing, like see your baby take his first steps, even though you are in a different state. Programs like Youtube.com guarantee that anything captured on camera can be viewed by millions and millions of people, often within seconds or minutes of the event. Web cams also serve to make the world smaller. You can check out webcams anywhere and get up to the minute information about what is going on there. Smart phones are another instance of technology making the world small. The new business -phones are so efficient and so high tech that you  can now do face to face international business from thousands of miles away. If you want to talk with a whole roomful of people in France from the comfort of your bedroom while wearing your pajamas, you can use your smart phone to do just that. If you want another example of how technology has made the world small consider online dating. There was a time that a person had to put on nice clothes and go out into the real world to meet a love interest. Today, you can be â€Å"out there† without ever having to go out. You can meet hundreds of interested singles, see what they look like, and find out about their interests, backgrounds, and values while locked in your room. You can even engage in a virtual relationship by using email or instant messaging. It is possible to get to know a person on a relatively deep level without ever meeting at all. This is a part of the beauty and the freakiness of internet.

Bite Me: A Love Story Chapter 12

12.Alchemy The Chinese herb shop smelled like licorice and dried monkey butt. The Animals were piled into the narrow aisle between counters, trying to hide behind Troy Lee's grandmother and failing spectacularly. Behind a glass case, the shopkeeper looked older and more spooky than Grandma Lee, which none of them thought possible until now. It was like he'd been carved from an apple, then left on the windowsill to dry for a hundred years. The walls of the shop were lined, floor to ceiling, with little drawers of dark wood, each with a small bronze frame and a white card with Chinese characters written on it. The old man stood behind glass cases that held all manner of desiccated plant and animal bits, from whole sea horses and tiny birds, to shark parts and scorpion tails, to odd spiky bits that looked like they'd been flown in from another planet. â€Å"What's that?† Drew asked Troy Lee from under a veil of stringy blond hair. He pointed to a wrinkled black thing. Troy Lee said something in Cantonese to Grandma, who said something to the shopkeeper, who barked something back. â€Å"Bear penis,† said Troy Lee. â€Å"Should we score some?† asked Drew. â€Å"For what?† asked Troy. â€Å"An emergency,† said Drew. â€Å"Sure, okay,† said Troy Lee, then he said something to Grandma in Cantonese. There was an exchange with the shopkeeper, after which Troy said, â€Å"How much do you want? It's fifty bucks a gram.† â€Å"Whoa,† said Barry. â€Å"That's expensive.† â€Å"He says it's the best dried bear penis you can buy,† said Troy Lee. â€Å"Okay,† said Drew. â€Å"A gram.† Troy passed the order through Grandma to the shopkeeper. He snipped a tip off a bear penis, weighed it, and placed it on the pile of herbs in the sheet of paper he had laid on the counter for Drew. Grandma's paper was much larger, and the shopkeeper had been tottering around the shop for half an hour gathering the ingredients. At one point when the old man was up on the top of the ladder at the far back corner of the shop, the Animals had leapt the counter and laced their arms together as a human rescue net, which served only to scare the bejeezus out of the shopkeeper and set Grandma off in a tirade of Cantonese scolding, to which they all responded like dogs, paying her rapt attention and tilting their heads as if they actually had some idea of what the fuck she was talking about. Lately the Animals had been all about saving lives. Most of the time, guys their age would be fairly convinced of their immortality, or at least oblivious of their mortality, but since being murdered by a blue hooker turned vampire, then resurrected as vampires, then restored to living by Foo Dog's genetic alchemy, they had been feeling what they could only describe as Jesusy. â€Å"I'm feeling extra Jesusy,† said Jeff, the tall jock. â€Å"I always feel extra Jesusy,† said Clint, who always did. â€Å"Yeah, extra Jesusy, bitches! Let's go save some mother-fuckers!† Lash had shouted, which had sort of embarrassed everyone a little, since they had been sitting around a table in Starbucks at the time, discussing the attack of the cat cloud and the information they'd exchanged with the two homicide cops. â€Å"It's up to us,† Lash added softly, sort of slinking into his hoody and putting on his shades. Now they watched as the old shopkeeper folded up Grandma Lee's bundle of ingredients and tucked in the paper so it was as tight as a toothpick spliff, then flipped the package over and wrote some Chinese characters on the back with a carpenter's pencil. â€Å"What's it say?† Barry asked Troy Lee. â€Å"It says, ‘vampire cat remedy.'† â€Å"No shit?† â€Å"Yeah. Then there's a bunch of warnings about side effects.† An hour later they were sitting around the Lee kitchen table, waiting for the big twenty-quart soup pot on the stove to come to a boil. Grandma Lee rose from her chair and tottered over to the stove with her package of herbs. Troy Lee joined her, helped her unwrap the package, and held the paper away from the burner as she scooped handfuls of herbs and animal parts into the boiling water. Foul and magical fumes bubbled out of the kettle, like the flatulence of dragons on a demon-only diet. â€Å"This really going to work, Grandma?† Troy Lee asked in Cantonese. â€Å"Oh yeah. We used it when I was a girl in China and some vampire cats invaded the city.† â€Å"And they still have the recipe in a shop down on Stockton Street?† â€Å"It's a good recipe.† She scooped the last of the package into the water. â€Å"How do you use this stuff, anyway?† â€Å"With firecrackers.† â€Å"It's wet, how are you going to use firecrackers?† â€Å"I don't know how, I just like firecrackers.† The Animals covered their noses and started filing out of the kitchen. â€Å"That smells like fermented skunk ass,† said Jeff. Grandma said something in Cantonese, followed by â€Å"My bitches,† pronounced in frighteningly accentless English. â€Å"What? What'd she say?† asked Jeff. â€Å"She says, ‘That's how you know it's a good recipe, gents,'† said Troy Lee. THE EMPEROR A dark basement. A thousand sleeping vampire cats. One formerly human vampire. One huge, shaved vampire-cat hybrid. Five matches left. No way out. A half hour, maybe less, until sundown. The Emperor was not a man to use profanity, but after he assessed his situation and burned his fingers with his fourth to last match, he said, â€Å"Well, this blows.† There was no helping it, sometimes a man, even a brave and noble man, must speak the harsh truth, and his situation, did, indeed, blow. He'd tried everything he could think of to escape the basement, from building a stairway to the window with empty fifty-five-gallon drums, to screaming for help like a man on fire, but even on a platform of oil drums he couldn't find the leverage or the strength to move the Dumpster away from the window. He could hear Bummer and Lazarus whimpering outside in the alley. All the other windows had been bricked up, all the steel fire doors were bolted, and, of course, the elevators and cables were long gone from the shafts (which he'd discovered after an hour prying the doors open with a metal support bar he'd taken off one of the shelves where Tommy Flood lay curled up with the Chet-thing). A dusty spray of twilight filtered down the elevator shaft from somewhere above, and it was by this that the Emperor ascertained that there was no way to climb the shaft, and that now it was dangerously close to sundown, as the light had turned a dim orange color. He would fight, oh yes, he would not go down without a battle, but even the magnificently agile little swordsman had gone down to the attacking pounce of cats. What chance did he stand in the dark with only a metal bar? He'd already checked the empty oil drums for accelerants, hoping he might burn his enemies before they awakened, but he'd had no luck. The barrels had had dry goods or something solid in them, and even so, he wasn't sure how he'd avoid being suffocated by burning cat fumes. Then, in thinking about how he might escape the flames, it occurred to him how he might escape. He made his way back to the storeroom where Chet and Tommy lay, and lit one of his precious matches to get his bearings. Yes, there was still a bolt on the door, and in addition there were enough barrels and shelves to construct a barricade beyond that. The match went out and he felt his way across the room until he touched Tommy's back-cold flesh. He took his ex-friend under the armpits and dragged him off the shelf and across the room, bumping through the door-way as he went. He shoved the body to the side and cringed with the crunch it made, falling onto the immobile bodies of dead cats. Back through dark, feeling around until he found Chet's fur. He felt for what he thought were the front paws, then backed across the room again, the huge shaved vampire cat in tow. Chet was lighter than Tommy had been, but not by much, and the Emperor was winded. He couldn't afford to sit. The ray of light in the elevator shaft had gone deep red. He heard Bummer let out a ruff beyond the window. â€Å"Run, men, away! Go away from this place. I'll find you in the morning. Go!† He never raised his voice to the men, even when they were in peril, and he heard Lazarus whimper at his command, but then the sound of Bummer growling while being dragged away by the scruff of his neck. He would get the message after a block or so. The men were safe. He pulled the metal door shut, then yanked on it until he heard a click. Then spent the second to the last of his matches looking at the simple bolt, and taking a last look around the room, trying to memorize the layout of the barrels and shelves that he would have to move in the dark. As the match burned out, he heard stirring in the room outside. There was a rack of metal shelves to the right of the door. He grabbed them and overturned them in the doorway. Yes, the door opened out, but what could it hurt. The more he put between himself and the vampire cats, the better. He scooped up armloads of the clothing at his feet and tossed them over the shelves, then backed across the room, throwing everything he touched in front of him, as if he were tunneling out the other side. Finally, he crawled up in the heavy shelf where Tommy and Chet had been and crouched, facing the door. He felt for the handle of the kitchen knife that he'd tucked in his belt at the small of his back, drew it, and held it before him. There were distinct cat noises-yowls, hisses, and meows, coming from the room outside. They were awake, up, and moving. There was a tentative scratch at the door, then a whirr of scratching, like someone had turned a power sander on outside, then it stopped as quickly as it had started and all he could hear was his own breathing. No. There was movement. The slight rustle of cloth, then a low, trilling purr. And it was coming from inside the door, he was sure of it. The Emperor clamped the knife in his teeth and lit his last match. The room was as he thought it would be, a pile of debris and barrels, but swirling out from under shelving in front of the door was a layer of mist, moving across the floor toward him, undulating in tiny waves that approximated the sound of a purr.

Crime And The Death Penalty - 1138 Words

As generations pass by, more people are likely changing for the good or the bad. Changing for the bad means that they would start committing crime because they are forced, influenced or potentially to feel they will â€Å"never get caught†. Firstly, crime is an action or activity that is not really illegal, but considered to be wrong. Committing crimes is hurtful to the one committing crime and the victim of the crime. This research paper consists of reasons and a further in cite on juveniles being sentenced to the death penalty. Everyone feels bad for children, because they are posed as innocent. They don’t seem that innocent when they commit a heinous crime. The research will include the factors that relate to juveniles committing crime,†¦show more content†¦Often young children start getting involved in crime which leads to an unsuccessful future, filled with committing offenses and becoming a young offender. A juvenile or young offender is a person who has convicted or is cautioned about a criminal offense. This young offender can be a male or female. ACS Distance Education researches have shown that some factors are likely to increase youths becoming involved in committing offenses. Some of the risk factors which affect the youth to committing crime are parental criminality, poor parental discipline, lack of supervision, family conflicts, school disorganization, low family income, and having the opportunity for crime. Many youth fail in school due to poor academic performance and poor attendance. Sometimes we cannot blame the youth for their behaviors because many come from problems at home such as physical abuse, neglect or abandonment. These are many of the few common factors leading to offenses made by youth. Analyzing areas and districts have allowed us to conclude the least and most crime rates. Shaw and McKay on p.21 show the rates of male juvenile delinquents in Chicago, 1900-1906. The map shows that a high rate of crime commi tted were around the central business districts where there is industry. Also, low rates of crime were shown in city’s periphery where there is a rise in industry. Studies indicate that there is a high increase of crime based on nationality. Delinquents come from