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   Table of Contents - Current issue
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July-December 2017
Volume 26 | Issue 2
Page Nos. 111-244

Online since Tuesday, July 10, 2018

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EDITORIAL  

Misogyny, feminism, and sexual harassment p. 111
Kalpana Srivastava, Suprakash Chaudhury, PS Bhat, Samiksha Sahu
DOI:10.4103/ipj.ipj_32_18  
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REVIEW ARTICLE Top

Bipolar affective disorder and its impact on various aspects of marital relationship p. 114
Sandeep Grover, Ritu Nehra, Anita Thakur
DOI:10.4103/ipj.ipj_15_16  
Bipolar disorder (BD) is a severe mental disorder, which not only has negative consequences on the life of the patient, but also affects the immediate family members. As it often starts early in life, patients who get married often suffer from many negative consequences in their marital life due to the illness. This review focuses on studies which have evaluated marital rates, rate of marital failure, divorce, infertility, and procreation among patients with BD. In addition, this review evaluates the existing literature pertaining to marital adjustment, marital satisfaction, sexual dysfunction, and sexual satisfaction among patients with BD and their partners/spouses. Data suggest that very high proportion of patients with BD get married and marital rates are higher for patients with BD, when compared with those suffering from schizophrenia. In terms of divorce rates, studies suggest that patients with BD have higher rates of divorce. In terms of fertility rates, studies suggest that compared to those without the illness, the fertility rates among patients with BD are lower. In terms of marital adjustment, results are mixed with some studies suggesting poorer marital adjustment among patients and their spouses too. In terms of sexual dysfunction, studies suggest the presence of sexual dysfunction among one-third to half of the patients receiving lithium. To conclude, this review suggests that patients with BD experience multiple negative marital and sexual consequences.
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ORIGINAL ARTICLES Top

Study of prodromal and residual symptoms of depression p. 121
Vishal B Pede, Suyog Vijay Jaiswal, Vishal A Sawant
DOI:10.4103/ipj.ipj_19_18  
Background: The definitive diagnosis of depression calls for fulfillment of certain criteria in terms of symptoms, severity, and duration, but subthreshold cases are not uncommon. These may evolve to become clinically diagnosable depression preceded by prodrome. The current study was conducted to study prodromal and residual symptoms in depression. Materials and Methods: Eighty follow-up patients of depressive episode (F32, International Classification of Diseases-10) in remission defined by Hamilton Depression Rating Scale score <8 were interviewed. A symptom was identified as prodromal if it appeared at any time before the period of onset of symptoms sufficient to fulfill the criteria to make a diagnosis of depressive episode. Clinical Interview for Depression and Related Syndromes was used to identify the presence of symptoms. Statistical analysis was done with McNemar test and Pearson's Chi-square test using SPSS software version 20.0. Results: The mean age of patients was 41.25 (±8.58) years and the sample was predominately female patients (80%). All the eighty patients had at least one prodromal symptom. The mean duration of prodrome was 115 (±64.46) days. Irritability (45%), insomnia (45%), and reduced energy (43.8%) were the most frequent prodromal symptoms. Frequency of irritability was comparable in prodromal and residual phases of depression (P = 0.074) and significantly associated with a positive family history of depression (P = 0.004). Conclusion: Prodrome is present in most cases of depression lasting from weeks to months. Prodrome is frequented by irritability, anxiety, sleep problems, and fatigability. Irritability is associated with genetic loading of depression and likely to present as residual symptom if it is present in prodromal phase.
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Psychology of tobacco use: Are anti-tobacco policies encouraging the use of smokeless tobacco? A cross-sectional study in an industrial township p. 128
Diptarka Karmakar, Amitav Banerjee
DOI:10.4103/ipj.ipj_70_17  
Background: Anti-tobacco policies are focused on curbing smoking. Less attention is given to the use of smokeless tobacco use. This raises the concern whether these policies lead to increased use of smokeless tobacco use. The present study addresses this issue. Materials and Methods: A stratified random sample of 399 participants over 18 years and both genders were part of this cross-sectional study. They included an interview of urban and rural residents by house-to-house survey including outpatients, inpatients, and college students. Information was collected by face-to-face interview on a standard instrument for recording tobacco use. Additional questions were added to elicit switch from smoking to smokeless forms of tobacco. In-depth interviews were also held with some tobacco vendors. Statistical Analysis: Data were summarized in percentages and with mean and standard deviation. Chi-square and two sample t-tests were used to explore associations. Results: Prevalence of smokeless tobacco use was 36.59% (95% confidence interval: 31.97%–41.41%). Smokeless tobacco use was highest in rural community at 60.20% compared to urban community in which it was 40%. Unskilled workers had the highest prevalence of smokeless tobacco use at 48.57% compared to lowest prevalence among professionals (12.50%). Years of schooling was inversely related to both smoking and smokeless tobacco use. Prevalence of smoking at 20.55% was much less than use of smokeless tobacco use. Awareness of adverse health effects and ban in public places were the main reasons for quitting smoking. About 10% of those who quitted smoking took smokeless tobacco. Conclusion: There was a tendency among tobacco users to switch over to smokeless tobacco use due to awareness of health effects and ban on smoking in public places. A much higher prevalence of smokeless tobacco use compared to smoking suggests that the problem of smokeless tobacco use is receiving less attention from policymakers vis-à -vis smoking control policies.
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Frontal lobe executive dysfunction and cerebral perfusion study in alcohol dependence syndrome p. 134
Puneet Khanna, Pookala Shivaram Bhat, J Jacob
DOI:10.4103/ipj.ipj_26_18  
Background: Long-term alcohol use leading to frontal lobe impairment has been a cause of concern for many decades. However, there are very few studies from India of evaluation of frontal lobe executive dysfunction among alcoholics. Hence, this study was undertaken to evaluate the frontal executive dysfunction using Wisconsin Card Sorting Test (WCST) and perfusion deficits by Single-Photon Emission Computerized Tomography (SPECT) among alcohol-dependent patients. Aim: The aim of this study is to evaluate the frontal executive dysfunction using WCST and frontal lobe perfusion deficits by SPECT among alcohol-dependent patients. Materials and Methods: This was a cross-sectional study involving 20 alcohol dependence syndrome patients in a tertiary care center. After ethical clearance and informed consent, all were evaluated using WCST and SPECT. Results: About 45% patients had impairment on WCST, and it was related to the duration of drinking. About 55% showed reduced frontal lobe perfusion on SPECT scan and they had a long duration of drinking compared to controls. Among the patients showing impairment on WCST subscores, more than 50% had reduced frontal lobe perfusion on SPECT. Conclusion: This study not only confirmed the executive function impairment and frontal lobe perfusion deficits in alcohol-dependent patients but also showed a concomitant presence of both in patients with chronic alcohol abuse.
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Quality of life of patients with schizophrenia and chronic obstructive pulmonary disease: An observational study p. 140
Smitha Ramadas, Vyjayanthi Bonanthaya
DOI:10.4103/ipj.ipj_76_16  
Background: Quality of life (QOL) is a novel and holistic parameter in measuring health outcome. Recently, the concept is gaining importance as an outcome measure in illnesses, with a chronic and progressive course. Schizophrenia and chronic obstructive pulmonary disease (COPD) are psychological and physical illnesses, respectively, which share this characteristic. Studies comparing the QOL of psychological and physical illnesses are few. The extant literature did not reveal any studies comparing the QOL of schizophrenia and COPD. Aim: The aim of this study was to compare the QOL of patients with schizophrenia, a chronic psychiatric disorder, and COPD, a chronic physical illness. Materials and Methods: The study was cross-sectional in design. The QOL of thirty patients each with schizophrenia and COPD, from a tertiary care teaching hospital, was assessed using the WHO Quality of Life Assessment-BREF scale. Comparison was done between the two groups. Results: The QOL of patients with schizophrenia was significantly better in the physical domain (Z = 2.75, P = 0.006) and overall perception of life (Z = 3.25, P = 0.001). Overall perception of health was also better in schizophrenia (Z = 1.94, P = 0.052). The social domain was the only one in which COPD patients had a better score than schizophrenic patients, though it was not statistically significant (Z = 0.17, P = 0.86). Conclusion: The QOL of schizophrenic patients is slightly better compared to that of COPD patients. Only in the social domain was the QOL of schizophrenic patients inferior to that of COPD patients. Therefore, in schizophrenic patients, priority interventions to improve the social deficits are important because these determine their QOL vis a vis, a chronic physical illness.
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Quality of life of caregivers of early-onset psychosis and mentally retarded children: A Comparative study Highly accessed article p. 146
Bharat Singh Shekhawat, Supriya Agarwal, Shreyance Jain
DOI:10.4103/ipj.ipj_21_16  
Context: In India, patients with mental illness and mental retardation (MR) are cared by their families. In caregiving, problems such as disturbance of routine, family leisure, family health, and emotional stress can have a negative impact on quality of life (QOL). Aims: The purpose of this study is to assess and compare the QOL of the caregivers of children of early-onset psychosis (EOP) with caregivers of MR children and also to find out the correlation between sociodemographic variables and QOL. Settings and Design: A prospective study was carried out in the outpatient and inpatient unit of a tertiary care center teaching hospital of North India. Materials and Methods: Thirty caregivers each of two groups, i.e., children with EOP and mentally retardation, between the ages of 13 and 18 years with minimum 1 year of illness and fulfilling the inclusion and exclusion criteria, were compared with a well-matched control group. QOL was assessed using the World Health Organization QOL-BREF (Hindi version). Statistical analysis was done using SPSS (version 16.0). Results: QOL was significantly affected in most of its dimensions in the caregivers of both EOP and MR groups in comparison to the control group but more deterioration was noted in caregivers of children with MR. Sociodemographic factors such as domicile, education, family type, and family size were important determinants of QOL. Conclusion: Multiple factors seem to be responsible for poor QOL of caregivers of children with MR and EOP.
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Validation of yoga module for children with intellectual disabilities p. 151
Vishvanath Pise, Balaram Pradhan, Manmath M Gharote
DOI:10.4103/ipj.ipj_80_17  
Background: Children with developmental disabilities generally experience more pain than the normal children due to chronic systemic conditions associated with their disability. Description of pain is generally difficult in children and more so in children with intellectual disabilities (IDs). Yoga has been regarded as a kind of physical activity as well as a pain management strategy. Previous studies have reported the beneficial role of yoga in enhancing physical and psychomotor abilities of IDs; however, a validated yoga module (YM) for IDs is unavailable. The present study is aimed at developing a validated YM for children with IDs. Materials and Methods: The content validity of YM for children with IDs was assessed by a panel of 22 experienced yoga experts. The YM for children with IDs was developed in the form of tailor-made yoga practices that were supported by classical texts and research evidence. A total of 32 practices were included in the YM, and each practice was discussed and rated as (i) not essential, (ii) useful but not essential, and (iii) essential. The content validitity ratiowas calculated using Lawshe's formula. Results: Data analysis showed that out of 32 YM practices, 31 indicated significant content validity (cutoff value: 0.42, as calculated by applying Lawshe's formula for the CVR). Conclusions: The present study suggests that the YM for children with IDs is valid with good content validity. However, future randomized controlled trials must determine the feasibility and efficacy of the developed YM for children with IDs.
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Atypical waveform morphology in schizophrenia-visual evoked potential as a promising endophenotype p. 155
Sneh Babhulkar, Ruchi Kothari, Praveen Khairkar
DOI:10.4103/ipj.ipj_37_17  
Background: Electrophysiological research has provided measures of dysfunction of visual pathway in schizophrenia through the use of visual evoked potential (VEP) as the neurophysiologic tool. Objective: The main objective of this study is to examine the morphology and topography of VEP responses in schizophrenic patients and to explore the potentiality of VEP as an endophenotype. Materials and Methods: The study included 20 patients of schizophrenia who were recruited from the outpatient and inpatient department of psychiatry of a tertiary care rural hospital. The patients were assessed by tools such as Positive and Negative Symptoms Assessment Scale and Clinical Global Impression Scale for Severity. Transient Pattern Reversal VEP recordings were taken using an Evoked Potential Recorder (RMS EMG EP MARK II), and it was a cross-sectional study. Results: The mean age of patients was 45.95 ± 10.14 years in the range of 35–60 years. Qualitative analysis of VEP waveforms in people with schizophrenia was performed. Abnormal waveform morphology was observed in 14/20 (70%) of the study population and all of them were the chronic and severe cases. Six out of 15 (40%) showed lack of differentiation of the evoked complex so that the three waves (negative–positive-negative [NPN] complex) could not be identified. In 5 of 15 (33.33%) VEP records, a distinct altered waveform with extinguished second negative component of NPN complex was obtained. Conclusion: Qualitative morphometric findings of this study in terms of pattern-reversal VEP waveform abnormalities emerged as a tool to provide evidence of relationship for emerging as first potential biomarker for diagnosing schizophrenia.
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A study of psychiatric referrals for fitness for work p. 162
Jaideep Kishore Patil, Ivan Stanley Netto, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_12_18  
Background: There are very few Indian studies regarding the psychiatric evaluation of state government workers referred for psychiatric fitness for work. Aim: This study aimed to examine the reasons for referral, psychiatric diagnosis, and outcome of psychiatric referrals for fitness for work at a tertiary-level referral government hospital. Materials and Methods: The study evaluated consecutive psychiatric referrals at a tertiary-level referral government hospital with their informed consent utilizing a specially prepared pro forma, Kuppuswamy's Socioeconomic Status Scale and the Mini International Neuropsychiatric Interview plus. Psychiatric diagnoses were based on the International Classification of Diseases 10th Edition Diagnostic Criteria for Research. Results: The study included 67 male and 8 female psychiatric referrals with a mean age of 39.5 years. Most of the psychiatric referrals were married (82.6%), Hindu by religion (97.3%), from urban areas (80%), belonged to upper middle class (46.7%), and had rotating shifts or emergency duties (50%). Psychiatric referrals were usually made for a single reason (57%), most commonly absenteeism (84%) followed by undisciplined behavior (38%). A past history of disciplinary action taken against them was given by 56% of the referrals. The most common psychiatric diagnosis was psychoactive substance-use disorder (21.3%) followed by psychotic disorders (20%) and mood disorders (14.7%). No psychopathology was detected in 18.7% of the referrals. Most of the psychiatric referrals (68%) were fit for work, though 22.67% were declared unfit for work (permanent invalidation). Psychiatric referrals with multiple reasons for referrals, longer duration of psychiatric illness (>5 years), and diagnosis of organic mental disorder or psychotic disorder received invalidation (permanent unfitness) on psychiatric grounds. Conclusions: Psychiatric referral for fitness for work is most commonly for absenteeism. The most common psychiatric diagnosis was substance-use disorder followed by psychoses. The majority (68%) were found fit for work after treatment though 22.6% required invalidment from service.
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Multiple roles of working women and psychological well-being p. 171
Sudhinta Sinha
DOI:10.4103/ipj.ipj_70_16  
Background: Today, women's roles are emerging differently with new commitment and career oriented as well as commitment to families. So, this in turn leads to a number of stress and strain among working women. Aims and Objectives: The aim and objective of this study was to elucidate the work–family conflict on psychological well-being experienced by working women and to determine whether social support has beneficial role in the psychological well-being of the working women. Materials and Methods: Eighty-two women working in different professions from dual-earner family and 82 homemakers from traditional single-earner family were included in the study and assessed on the following: (1) Postgraduate Institute (PGI) Health Questionnaire and (2) PGI Social Support Questionnaire (SSQ) for the assessment of well-being and social support, respectively, and data were analyzed. Results: Working women scored lower on PGI Health Questionnaire than homemakers, which was statistically highly significant, indicating that working women had higher psychological well-being than homemakers or nonworking women. On the assessment of PGI and SSQ, scores revealed that women in dual-earner families perceived lower social support as compared to those of single-earner families. Conclusion: Employed women are more satisfied with their life than nonworking women, and the quality of home and work environments determines the impact of employment on the psychological well-being of working women in dual-earner families.
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Neuropsychological deficits in elderly with depression p. 178
Rupesh Ranjan, Richa Priyamvada, Gyanendra Kumar Jha, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_86_14  
Background: Depressed patients are preoccupied with unhappy thoughts which reduce their capacity to focus on attention, memory, and other cognitive performance. Aim: The aim of this study is to assess neuropsychological deficits in elderly depressive and compare it with matched normal controls. Methods: After consideration of inclusion and exclusion criteria, the sample of 30 elderly depressive patients diagnosed on the basis of International Classification of Diseases, Tenth Edition criteria and 30 normal controls were selected. The selection of sample was by purposive sampling from private psychiatric clinic of Bhopal. The age range of sample was 60 years and above. All participants were administered the Geriatric Depression Scale, and the Luria–Nebraska Neuropsychological Battery-1 (LNNB form-1). Results: On the Geriatric Depression Scale, 21 patients were at mild level and nine patients were at severe level of depression. None of the normal controls were depressed. On LNNB form-1, depressive patients showed significant elevation on receptive speech, arithmetic, memory, reading, writing, and expressive speech as compared to normal controls. Conclusion: Older depressive patients showed significantly more neurocognitive deficits as compared to normal controls. It is important that these deficits are identified and addressed for the holistic treatment of late-onset depression.
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Relationships between body mass index and depressive symptoms in patients with obstructive sleep apnea: A study from Northern part of India, Kashmir p. 183
Sheikh Shoib, Javid A Malik, Shariq Masoodi
DOI:10.4103/ipj.ipj_78_16  
Background: Obstructive sleep apnea (OSA) often results in a wide range of psychological symptoms. The relationship of depressive disorders and depressive symptoms with body mass index (BMI) and severity of sleep apnea were the subject of numerous studies; results, however, were inconclusive in the majority of studies. Keeping this in view, we studied the correlates of depressive symptoms in patients with OSA. Relationships between BMI and depressive symptoms in patients with OSA. Methods: We performed polysomnography (PSG) studies of patients that were referred from various subspecialty clinics from July 2011 to August 2013. Ninety-five women and 87 men (total 182) diagnosed with OSA were reviewed for the presence of depressive symptoms and degree of sleepiness using the Epworth Sleepiness Scale (ESS) scores Hamilton Depression Rating Scale (HAM-D). Moreover, Mini-International Neuropsychiatric Interview Scale was applied at the time of PSG. This was followed by application of standard methods of statistical analysis. Results: Our sample included 27 (42.6%) men and 20 (57.4%) women, with a mean age of 58.60 ± 14.75 years. Women (61.6 ± 10.0) had a mean age significantly more (P = 0.011) than that of men (54.0 ± 13.0). BMI has a statistical significant correlation with apnea–hypopnea index (correlation is significant at the 0.05 level [two-tailed]), ESS (correlation is significant at the 0.05 level [two-tailed]), and HAM-D (correlation is significant at the 0.01 level [two-tailed]). Conclusion: Depressive symptoms are more common and more severe in women with OSA than in men. There is definite relationship between BMI and depressive symptoms in patients with OSA. There is no causal relationship between OSA and depressive symptoms in the population studied.
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A study on prevalence and correlates of depression among women living with human immunodeficiency virus/acquired immune deficiency syndrome in North Karnataka p. 188
Shivanand B Hiremath, Mahesh Desai
DOI:10.4103/ipj.ipj_3_16  
Context: Depression is the most prevalent psychiatric condition seen in human immunodeficiency virus (HIV)-positive individuals. Various biological, sociocultural, and economic factors make women more vulnerable to HIV and acquired immune deficiency syndrome (AIDS). Depression affects medication adherence and immunity against HIV thus contribute significantly to disease progression. Aims: The aim is to assess the prevalence, sociodemographic, and clinical correlates of depression among women living with HIV/AIDS. Settings and Design: Antiretroviral therapy (ART) centre attached to government medical college hospital in North Karnataka and cross-sectional design. Materials and Methods: This study was conducted among of 145 women living with HIV/AIDS, depression was assessed using Beck Depression Inventory, and social support was assessed using Lubben Social Network Scale and quality of life (QoL) using the World Health Organization QoL BREF scale. Statistical Analysis Used: Data were analyzed using Statistical Package for the Social Sciences version 20.0. Chi-square test with P value less than 0.05 was taken as statistically significant. Results: Among 145 HIV-positive women, 50 (34.5%) were depressed. Depression was statistically significant in women from rural background. Significant association between depression and risk of social isolation was observed. Scores of all domains of QoL, that is, physical, psychological, social, and environmental were reducing with increase in the severity of depression indicating that QoL was decreasing with increase in severity of depression. Among the four domains, social domain was the most affected. Conclusions: Depression among women living with HIV/AIDS which is underdiagnosed and undertreated. Depression negatively impacts adherence and immunity leading rapid progression of the infection. Therefore, early diagnosis and treatment of depression are essential.
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Structure, process, and impact of a staff support group in an oncology setting in a developing country p. 194
Jayita Kedar Deodhar, Savita Sachin Goswami
DOI:10.4103/ipj.ipj_59_16  
Background: Health-care staff working in oncology setting experience excessive stress, which if unrelieved can lead to burnout. Staff support groups have been found beneficial. Aims: This study aims to evaluate the structure, process, and impact of a staff support group conducted for field workers involved in cancer screening in an urban tertiary cancer center in a developing country. Settings and Design: Retrospective analysis of staff support group conducted in a tertiary care cancer center. Methodology: Prospectively maintained data with structured notes for documenting the process of the support group sessions for the field workers was analyzed. Impact was analyzed through a feedback questionnaire designed for the purpose completed by participants at 4 months, 1, and 2 years following session completion. Statistical Analysis: Descriptive statistics for reporting the overall structure and participants' profile and content analysis for identifying the support group process and themes expressed by the participants were used. Results: Eleven participants attended the support group consisting of 8 structured sessions. The processes identified were planning, implementation, and supervision of the lead therapist conducting the group. Work overload, target completion, feeling demoralized, interpersonal conflicts, and importance of team support were the main issues identified. Cognitive behavioral approaches were learnt for stress management. Eight, nine, and all 11 participants found the support group moderately to very useful at 4 months, 1 year, and 2 years, respectively. Conclusions: The support group followed a planned structure, with good implementation, recording of content and supervision, with both short-term and sustained positive impact.
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Immunological changes in depression p. 201
Sunil Goyal, Kalpana Srivastava, Chaitanya Kodange, Pookala Shivram Bhat
DOI:10.4103/ipj.ipj_22_18  
Background: The role of Immune system in the pathophysiology of depressive disorders is a field of active research, however Indian literature is sparse. The present study was planned to assess the immunological response in depression. Materials and Methods: The study comprised of 100 subjects. There were fifty cases of depression satisfying the ICD-10 criteria with no physical illness and HIV negative status and fifty age and sex matched healthy volunteers. Depression was assessed on HRSD and BDI scales. Assessment of three markers each of cellular immunity (NK cells, CD4, CD8 cells) and humoral immunity (Il-2, IL-6 and CRP) was carried out on both groups and depressed patients were reassessed on all parameters after 08 weeks of treatment with antidepressants (SSRIs or TCAs). Results: NK Cells were significantly higher in the depressed group and CD 8 Cells and CD 4 Cells were higher in the control group (P = 0.001). Depressed group before treatment v/s control group differed significantly in the cell mediated immune markers. IL-2 levels were higher in the control group. The markers of cell mediated immunity i.e., NK cells, CD4, CD8 had increased significantly after treatment (P=< 0.001). The humoral immunity markers (CRP and IL-2) decreased significantly after treatment (P=< 0.001). However IL -6 levels were raised significantly in the subjects after treatment (P=< 0.001). Conclusion: Dysregulation of immune response occurs in depressed patients with changes in both cell mediated and humoral immunity. Further, antidepressant treatment affects the immune status of depressed patients.
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Adverse health effects and unhealthy behaviors among dental undergraduates surfing social networking sites p. 207
Suryakant C Deogade, Sudhanshu Saxena, Prateek Mishra
DOI:10.4103/ipj.ipj_67_15  
Introduction: Little is known about the relationships between adverse health effects and unhealthy behaviors among dental undergraduate students surfing social networking sites (SNSs). Objectives: The aim of this study was to determine the associations between adverse health effects and unhealthy behaviors with social networking usage among dental students. Materials and Methods: A cross-sectional study was conducted in a private university in Madhya Pradesh (India) among 300 dental undergraduate students. A self-administered questionnaire was used. It included questions on sociodemographical data, pattern of social networking use, social relationship, unhealthy behaviors, and health effects. Results: The mean age was 21.5 (±2.3) years. The average daily SNSs surfing hours were 3.5 (±1.8). Significant associations were found between average hours of social networking and the following factors: isolation from family members and society, refusing to answer calls, musculoskeletal pain, headache, and eye irritation (P < 0.001). The average hours spent on social networking were significantly associated with holding urination and defecation while online, surfing SNSs until midnight, and postponing, forgetting, or skipping meals (P < 0.001). Cohen's effect size value between adverse health effect and social networking hours were 0.78, 0.86, 0.82, 0.86, and 0.81 for back pain, shoulder pain, wrist pain, headache, and eye irritation, respectively. The effect size value between health-related behaviors and social networking hours were 0.72, 0.62, 0.72, 0.71, and 0.84 for holding urine, holding defecation, postponing meal, skipping meal, and social networking until midnight, respectively. Gender-wise comparison for social networking hours showed a low practical significance (d = 0.09). Conclusions: The average hours spent on social networking were associated with adverse health effects and unhealthy behaviors among dental undergraduate students, as well as social isolation from the family and society.
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Evaluation of treatment adherence in outpatients with schizophrenia p. 215
Bhushan Chaudhari, Daniel Saldanha, Adnan Kadiani, Roma Shahani
DOI:10.4103/ipj.ipj_24_17  
Background: Treatment nonadherence is a major obstacle in the successful management of schizophrenia. Finding out factors associated with nonadherence and the reasons for nonadherence are important to improve treatment adherence in patients with schizophrenia. This study was conceived to evaluate treatment adherence in patients with schizophrenia and the factors associated with it. Materials and Methods: A cross-sectional study was conducted in 50 consecutive patients with schizophrenia with the help of semi-structured pro forma consisting of sociodemographic details, information regarding illness and treatment history, (PANSS), and Morisky Medication Adherence Scale-8 to assess medication adherence. Nonadherent patients were further assessed for their reasons for nonadherence. Results: Among the patients, 52% were low adherers (nonadherers). Factors associated with nonadherence were younger age of patients, male gender, low household income, higher PANSS score (positive, negative, and total score), lower grades of insight, lack of family history of psychiatric illness, responsibility of taking self-medications, first-generation antipsychotics, and number of drugs in prescription. Major reason for nonadherence given by patients were adverse effects of medications, treatment perceived as ineffective, financial problems, shame and stigma about illness and treatment, regarding treatment unnecessary and difficulty to access health-care facility. Conclusion: Our study established high proportion of nonadherence in patients with schizophrenia and also brought out factors associated and reasons for nonadherence. Adequate psychoeducation of patients and their caretakers as well as psychosocial interventions, strengthening mental health infrastructure, and community mental health services will significantly improve treatment adherence.
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Indian nursing students' attitudes toward mental illness and persons with mental illness p. 223
Vanteemar S Sreeraj, Seema Parija, NA Uvais, Sandhyarani Mohanty, Sudhir Kumar
DOI:10.4103/ipj.ipj_25_16  
Background: Nursing fraternity play a pivotal role in psychiatric services. Negative attitudes toward mental illness have been consistently reported in nursing students. Psychiatric conditions and persons suffering from them may elicit different kinds of attitudinal responses. Objective: The current study aimed at assessing the attitude toward mental illness and also at comparative evaluation of the attitude toward persons with different psychiatric, physical, and social conditions. Materials and Methods: The present study was carried out among conveniently selected nursing students (n = 100) using Attitude Scale for Mental Illness (ASMI) and Attitude to Mental Illness Questionnaire (AMIQ) on their 1st day of psychiatric posting. Results: Higher stereotype (3.1 ± 0.8), benevolence (3.7 ± 0.6), and pessimistic prediction (3.4 ± 0.9) were reported toward mental illness. Negative attitude was noted toward persons with criminal background (4.8 ± 3.7), heroin abuse (3.2 ± 3.6), suicidal depression (1.36 ± 3.6), alcohol use (0.59 ± 4.38), and schizophrenia (0.03 ± 3.2) in the same order, with positive attitude toward diabetic (−4.4 ± 3.9) and religious persons (−5.13 ± 3.6). Significant correlation of ASMI scores was noted mainly with schizophrenia of AMIQ but not with other psychiatric conditions. Conclusion: High negative attitudes in nursing students underline the need for stronger antistigma measures. Differences in attitude toward mental illness in general and specific psychiatric conditions need further systematic evaluation.
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A study of psychiatric comorbidity after traumatic limb amputation: A neglected entity p. 228
Anamika Sahu, Rishab Gupta, Sushma Sagar, Mohit Kumar, Rajesh Sagar
DOI:10.4103/ipj.ipj_80_16  
Background: Amputation following trauma is emerging as a major health burden on the medical services and on the families and the society as well. Loss of limbs causes inability to support self and the family that further leads to various psychiatric disorders in many patients. Therefore, the present study is planned to explore psychiatric comorbidity in patients with amputation following trauma. Materials and Methods: Fifty-nine amputees were recruited by consecutive sampling within 6-month period from amputation clinic of a tertiary care hospital. All participants were interviewed on a semi-structured pro forma of sociodemographic and amputation-related parameters and assessed on psychiatric comorbidity using Mini-International Neuropsychiatric Interview scale. Results: Majority of the patients were male (88.1%) and belonged to younger age group of 16–30 years (71.2%). Approximately, 97% of patients had single-limb amputation (96.6), predominantly right limb (55.9%). Lower limb amputation was noted in 79.7% of participants. Motor vehicle accident was the most common mode of injury followed by railway track injury and others. The most common psychiatric comorbidities in our sample were major depressive disorder (71.2%), suicidality (30.5%), and posttraumatic stress disorder (PTSD) (20.3%). PTSD was positively correlated with phantom sensation (rs = 0.295, P = 0.05) and phantom pain (rs = 0.279, P < 0.05). Conclusion: A substantial proportion of amputees had alarming sign of depression, suicidal ideation, and PTSD. Thus, there is a need to form liaison between surgical treatment providers and psychiatrists and psychologists to manage psychiatric comorbidity in amputees.
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Felt needs for psychological training to enhance performance: Perspectives of youth engaged in competitive sports Highly accessed article p. 233
Sathvik G Udayakumar, Manoj Kumar Sharma, Manjula Munivenkatappa, Paulomi M Sudhir, Seema Mehrotra, Noufal T Hameed
DOI:10.4103/ipj.ipj_8_17  
Background: Individuals undergoing training in competitive sports are required to deal with various challenges such as real and perceived pressures to perform and invest sustained efforts in rigorous training regimens. Global literature indicates successful inclusion of psychological components in the training of sportspersons. It is well recognized that training programs need to be designed keeping in view the local contextual factors as well as felt needs. However, there are very few studies from India that have explored felt needs of individuals training in competitive sports. Aim: The study was conducted to explore felt needs for psychological inputs in youth selected for training in various sports by the Youth Empowerment and Sports Department, Government of Karnataka. Method: The sample composed of 166 youth (males = 98 females = 68), aged between 16 and 21 years, residing in state sports hostels of Bengaluru and Mysuru and undergoing training in competitive sports. A ten-item survey prepared based on the literature review, and a pilot study was used to assess felt needs for training in psychological aspect for performance enhancement. Results: Learning ways to maintain motivation for sports practice despite ups and downs in performance/other obstacles, maintaining self-esteem, managing disappointments, managing anger, and handling stress related to injuries received highest endorsements (75% or more) as strong felt needs in the overall sample. Only a few differences emerged between genders and age groups. Conclusion: The study has implications for integrating psychological training into the routine training of young sportspersons engaged in competitive sports.
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CASE REPORT Top

Neuropsychiatric sequelae of attempted hanging and diagnostic dilemmas p. 239
Jitender Aneja, Satyarth Jangli, Parmanand Kulhara, Manish Bathla
DOI:10.4103/ipj.ipj_46_15  
Suicide is an important cause of death worldwide, and India is not immune to this major health problem. Suicide by hanging is one of the lethal methods widely practiced. However, literature is very sparse as well as old in the context of neuropsychiatric consequences seen in those who survive such attempts. We present a case of a young boy who survived an attempted hanging and was left with neuropsychiatric sequelae in the form of retro/anterograde amnesia, aggression, lability of affect, and impaired memory and visuomotor deficits. The associated diagnostic dilemmas, namely whether to diagnose such patients with Korsakoff's psychosis, organic amnesic syndrome, or major neurocognitive syndrome, are discussed and a brief review of literature of this largely ignored area is also presented.
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LETTER TO EDITOR Top

Internet addiction with coexisting psychiatric diagnosis p. 243
Manoj Kumar Sharma, G Ragesh, Thamil Selvan Palanichamy, Ameer Hamza, Prabha S Chandra, Santosh K Chaturvedi
DOI:10.4103/ipj.ipj_79_14  
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