Socio-Demographic Profile and Self-Injurious Behavior among Patients with Mania at a Tertiary Care Hospital

Background: Mania is a common mood disorder. Mania associated with distractibility, irritability, impulsive behavior, great physical and mental activity. Irritability and impulsive behavior can lead to variable degree of self-injurious behavior. Self-injurious behavior more troublesome to patient and family members, there is a lack of proper research in the field of self-injurious behavior and mania. Objective: To assess the sociodemographic profile of selfinjurious behavior in mania and selfinjurious behavior in relation to severity of mania. Methods: Present study was a hospital based cross sectional study. The study was conducted at a tertiary care psychiatric hospital for a period of 6 months. 40 Patients with bipolar affective disorder with currently Mania with or without psychosis were included in the study. Patients with other psychiatric disorder were excluded from the study. Results: The mean age of study subjects was 29.75+7.012. The overall prevalence of self-injurious behavior among patients with mania was 37.5%. Cutting was seen in 4 males and 4 female patients. Burned with a cigarette and Burned with a lighter was seen only in one male patient. The age of onset of cutting and banged was seen at around 26 years of age. Total duration of mania for cutting was around 14 years and 17 years for head banged. Conclusion: The overall prevalence of self-injurious behavior among patients with mania was 37.5%. This was more in females as compared to males. But the difference is narrow and cannot be statistically significant.

elevated, expansive, or irritable mood lasting for at least 1 week. Mania associated with inflated self-esteem, a decreased need for sleep, distractibility, great physical and mental activity, and over involvement in pleasurable behavior. Those who receive antidepressant are at risk of developing mania and hypomania. But it is not clear whether the antidepressants lead to mania or hypomania. Some percentage of patients who are treated for unipolar depression may have underlying bipolar disorder. 1 Formerly called self-mutilation, self-injury, or self-harm, non-suicidal self-injury (NSSI) is The deliberate and direct alteration or destruction of healthy body tissue without suicidal intent; these behaviors range from skin cutting or burning to eye enucleation or amputation of body parts. 2 Self-mutilation is more commonly associated with patients with bipolar I disorder compared to other psychiatric illnesses. 3 In Greece, out of 63 (78.7%) prisoners who had a diagnosable psychiatric disorder, nine (11.2%) subjects had schizophrenia or bipolar disorder and21 (26.3%) subjects had alcohol dependence. DSH before and during imprisonment was reported by 15% and 2.5% of these 63 prisoners. 4

Aims and objectives of the study
• To assess the clinical profile of self-injurious behavior in mania and self-injurious behavior in relation to severity of mania

MATERIALS AND METHODS
Present study was a hospital based cross sectional study. The study was conducted at a tertiary care psychiatric hospital of Hyderabad which is a 600bedded hospital. The study was conducted for a period of 6 months. 40 Patients with bipolar affective disorder with currently Mania with or without psychosis were included in the study. Patients with mental retardation, personality disorders, other psychiatric disorder, other than those included in the inclusion criteria like Bipolar affective disorder with depression and mixed episode, obsessivecompulsive spectrum disorder were excluded from the study.  6 Deliberate self-harm inventory has 17 questions, this questionnaire asks about many different things that people sometimes do to hurt themselves. Be sure to read each question carefully and respond honestly. Often, people who do these kinds of things to themselves keep it a secret, for a variety of reasons. Honest responses to these questions will provide us with greater understanding and knowledge about these behaviors" and the best way to help people.  100 Majority of the subjects belonged to Hindu religion (28) and 06 were from Muslim religion and 06of the subjects belonged to Christian religion. In the Mania group, 28 (70%) were Hindus, six (15%) were Muslims and six (15%) were Christians.    Table 4 shows majority of the study subjects were married 77.5% (n=31). Were single 20% (n=18), were widower2.5% (n=1) and none were widower and separated/divorced.  Table 5 shows occupational status of the study population. . 42.5% (n = 17) were unskilled, 40% (n = 16) were semiskilled, 2.5% (n = 1) were skilled and shop owners, clerks were 15%(n=06).  Table-6 shows residential status of study population. Majority of the subjects belonged to rural background 67.5% (n=26) compared to urban background 32.5% (n=14). The overall prevalence of self-injurious behavior among patients with mania was 37.5%. This was more in females i.e. 40% as compared to males i.e. 35%. But the difference is narrow and cannot be statistically significant.

arms, or other area(s) of body (without intending to kill yourself) **Carved pictures, designs, or other marks into your skin ***. Banged your head against something, to the extent that you caused a bruise to appear ****Punched yourself or punched another item (i.e., wall, etc.), to the extent that a bruise or cut appeared. [S. N. -Serial number, SIB -Self-injurious behavior, M-Mild, MD-Moderate, SR-Severe, EX-Extreme, T-Total]
Cutting was seen in 4 males and 4 female patients. Among males, this behavior was seen in 3 patients with moderate grade of mania. But in females, this behavior was seen in 3 patients with mild grade of mania. Burned with a cigarette was seen only in one male patient who was having moderate grade of mania. Burned with a lighter was also seen only in one male patient who was having moderate grade of mania. Both these types were not seen in females. Behavior like carved pictures and punched was not seen in the present study group. Banged behavior was seen in one male and four female patients. The age of onset of cutting and banged was seen at around 26 years of age. The number of episodes also ranged between 2-3 for cutting and banged. Mean age at last episode was less in case of cutting and slightly more in case of banged. Total duration of mania for cutting was around 14 years and 17 years for head banged.

DISCUSSION
In the present study 50% males and 50% female were participated, majority of the selfinjurious behavior prevalence higher in females40 %( n=8) than males35 % (n=7) which is agree with Whitlock J et al and Conterio K et al study. 7,8 The mean age of subjects were 29.75(SD 7.012), which agree with Das et al 9 says that the mean age at intentional self-harm of the sample was 29 years (SD -12.11), with a range of 12-76 years. Majority of subjects belongs to upper low socioeconomic status 47.5%, As, this study was conducted in government run tertiary care hospital, most of the patients who seek medical attention were from middle and lower socio-economic status, so naturally patients who came to this type of set up were from middle and lower classes, and this not support with Das et al study says majority of the self-injurious subjects are belongs to middle socioeconomic status (85%) 8  The overall prevalence of self-injurious behavior among patients with mania was 37.5%. This was more in females i.e. 40% as compared to males i.e. 35%. But the difference is narrow and cannot be statistically significant. Cutting was seen in 4 males and 4 female patients. Among males, this behavior was seen in 3 patients with moderate grade of mania. But in females, this behavior was seen in 3 patients with mild grade of mania. Burned with a cigarette was seen only in one male patient who was having moderate grade of mania. Burned with a lighter was also seen only in one male patient who was having moderate grade of mania. Both these types were not seen in females. Behavior like carved pictures and punched was not seen in the present study group. Banged behavior was seen in one male and four female patients. The age of onset of cutting and banged was seen at around 26 years of age. The number of episodes also ranged from 2-3 for cutting and banged. Mean age at last episode was less in case of cutting and slightly more in case of banged. Total duration of mania for cutting was around 14 years and 17 years for head banged.

CONCLUSIONS
The overall prevalence of self-injurious behavior among patients with mania was 37.5%. This was more in females as compared to males. But the difference is narrow and cannot be statistically significant. Cutting was seen in 4 males and 4 female patients. Among males, this behavior was seen in 3 patients with moderate grade of mania. But in females, this behavior was seen in 3 patients with mild grade of mania. Burned with a cigarette was seen only in one male patient who was having moderate grade of mania. Burned with a lighter was also seen only in one male patient who was having moderate grade of mania.