Dhat Syndrome: Sexual Behaviour and Psychiatric Comorbidity

Dhat Syndrome Sexual Behaviour and Psychiatric ComorbidityOriginal Research wordTitle Dhat syndrome and its association with informal behavior and pyschiatric comorbidities in Indian malesSahu R.N, MD ( psychopathology), Head and Professor,Co- AuthorsSharma V K, MD, WHO Fellow (USA), Head and Professor, Department of Medicine Gandhi medical testing 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, awakeual behavior and comorbidities in Indian male patients AbstractThe Context (Background) Dhat syndrome is practic eachy taken as culture bounciness syndrome of Indian subcontinent. There ar m whatever mis sentimentions which form base of symptoms and comorbidities.Aims Dhat syndrome is report on bas is of ego diagnosis. The plain aims to study associated symptoms, sexual behavior and comorbidities in Indian population.Methods and fabric This cross-sectioned and case-control study, was carried with help of trained local inter work outers at Department of Psychiatry and Medicine, Gandhi Medical College (GMC), Associated Hamidia Hospital, Bhopal, India. occurrences were comp atomic number 18d to healthy matched controls. The study was conducted using clinical interview, physical examination and new(prenominal) necessary investigations like urine analysis and microscopy.Results Of the 50 cases and control, severally, climb on radical was 21 to 25 years (48%) and tuition upto12th disunite (60%). 20% cases reported hi bosh of Masturbation. Extramarital or premarital sexual extend to 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 mental picture. 23 patients (46.3%) were having a co-morbid somatic complains like bodyache, impuissance and fatigue. Erectile dysfunction by 34% Premature ejaculation by 8% was reported. In Urine routine analysis and microscope no oxalates or phosphates were noned.Conclusions Dhat syndrome is more common among low educated young population. Laboratory recite of any pathological cause was not found. Contrary to best-selling(predicate) belief, it had no direct correlation with masturbation and pre and extra marital sexual allude. get wind Words Dhat Syndrome, Semen, Sexual behavior, Somatic symptoms, Erectile DysfunctionIntroductionDhat 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 cordial status of an individual. According to International Classification of Diseases (ICD) 10 had assort Dhat syndrome had been classified in both neurotic inconvenience oneself (F48.8) and into culture specific disorder caused b y undue concern about the debilitating effects of the release of seminal fluid. The cases are always self reported and they often report a set of symptoms. These vague somatic symptoms are fatigue / bodily weakness, headache, notion3, anxiety, dismission 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 out-of-door marriage. The comorbidities include erectile dysfunction, premature ejaculation and impotence.Patients reported semen loss in urine or involuntarily outside (spontaneously while quiescency during defecation or while showering) of sexual relations.4 A typical visibility of Dhat Syndrome patient either is a young man, unmarried or late married, less educated, and the one who holds strong traditional beliefs.5This category of sickness involves blend disorders of behavior, beliefs, and emotions which are of uncertain etiology and nosol ogical status and which occur with particular absolute frequency in certain cultures. The cultural belief and pattern associated with Dhat syndrome make it antithetical 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 convention of 50 each was assessed.The study was conducted at Gandhi Medical College (GMC), Associated Hamidia Hospital, Bhopal, India. Study aggroup of 50 subjects was selected who had Dhat syndrome without any new(prenominal) 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 about aspects. Both groups were interviewed based on a structured interview.Inclusion criteriaCase groupComplain of whitish discharge in the urine and associating it with sympt oms and comorbiditiescarry through DSM-IV TR criteria apartConsenting to clinical interviewControl groupInpatients who were not suffering from Dhat syndrome though they were suffering from another(prenominal)(a) medical ailmentsMatched in other aspects with the case groupConsenting to clinical interviewExclusion criteria movement ofGenitourinary disorderTesticular tumorVaricoceleOrganic sexual dysfunctionPelvic inflammatory diseaseEndocrine disordersSpinal cord damageEthicsInstitutional review board and ethical committee approving was taken from GMC, Bhopal, India. totally periodic adverse event reports were reported to them and enamour guidance was taken.All interviewers were careful about ethical and legal considerations. All identification information including abduces, initials and hospital numbers were avoided to keep the patient flesh out in anonymity. Written information consent after the details of the go out were fully explained was obtained from all participants. There were no minors involved and accordingly no paternal consent involved in this study.Statistics The data was canvass by using statistical 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 drill or masturbation or to nocturnal emissions. (Fig. 2) Dhat syndrome was prevalent in class of lower reproduction, below class 12.Routine biochemical and urine research laboratory evaluation was conducted for all 100 participants.Other necessary investigations were carried out as per the requisite 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 groupFigure 2 Sexual history 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 valuable health problem and the magnitude is also very high. In view of this it needs a priggish 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, tar 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 faith healers. The contact with these health providers not only chant their misconception and false beliefs, but also compel the patients to pay huge appeal of investigations and drugs which are not only non-effective but also hazardous. 5Among other studies the relationship amongst 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 uneducated patients and less educated patients. There is a need for patient education and sex education in th e 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 battlefield 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.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. Europe an Psychiatry. 2011 26448Dhikav 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. 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