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   Table of Contents - Current issue
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January-June 2018
Volume 27 | Issue 1
Page Nos. 1-157

Online since Monday, October 15, 2018

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EDITORIALS  

Media and mental health Highly accessed article p. 1
Kalpana Srivastava, Suprakash Chaudhury, PS Bhat, Swaleha Mujawar
DOI:10.4103/ipj.ipj_73_18  
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Clinical medicine to social medicine Highly accessed article p. 6
Antonio Ventriglio, Pookala Shivaram Bhat, Dinesh Bhugra, Kalpana Srivastava
DOI:10.4103/ipj.ipj_68_18  
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REVIEW ARTICLES Top

Antecedents of depression in children and adolescents p. 11
Savita Malhotra, Swapnajeet Sahoo
DOI:10.4103/ipj.ipj_29_17  
Depression in children and adolescents is a growing health problem in the 21st century. There is growing evidence that depression poses a significant risk in the developmental trajectory of children and adolescents. It is important to identify the antecedents of depression in this vulnerable group of individuals so as to develop specific and effective preventable techniques and strategies. In this brief review, we have tried to highlight the specific antecedents of childhood and adolescence depression on which evidence is available in a structured manner. Antecedents identified in childhood and adolescent depression were categorized into biological factors, temperament, cognitive vulnerability, family factors, sociodemographic factors, academic factors, changing social milieu, school factors, and peer group influence along with the emergence of the recentproblem of excessive social networking use. Biological and psychosocial factors are equally important in the development of depression in this age group. Antecedents of childhood and adolescence depression can be targeted both to prevent and intervene depression in this population.
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Challenges and perspectives of child labor p. 17
Amir Radfar, Seyed Ahmad Ahmadi Asgharzadeh, Fernando Quesada, Irina Filip
DOI:10.4103/ipj.ipj_105_14  
Child labor is one of the oldest problems in our society and still an ongoing issue. During the time, child labor evolved from working in agriculture or small handicraft workshops to being forced into work in factories in the urban setting as a result of the industrial revolution. Children were very profitable assets since their pay was very low, were less likely to strike, and were easy to be manipulated. Socioeconomic disparities and lack of access to education are among others contributing to the child labor. Religious and cultural beliefs can be misguiding and concealing in delineating the limits of child labor. Child labor prevents physical, intellectual, and emotional development of children. To date, there is no international agreement to fully enforced child labor. This public health issue demands a multidisciplinary approach from the education of children and their families to development of comprehensive child labor laws and regulations.
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History of psychiatry: An Indian perspective p. 21
Anand Mishra, Thomas Mathai, Daya Ram
DOI:10.4103/ipj.ipj_69_16  
A knowledge of history becomes important in learning the way concepts have evolved and how they are understood in different and conflicting traditions in psychiatry. Modern psychiatry and its history has always been observed through the prism of western science which has its own evolutionary line in which the eastern sciences can't fit and are always at a disadvantage. Especially the colonial bid to prove its legitimacy as a civilizing mission led to representation of European medicine as morally superior to the eastern practices resulting in a biased history. Though in reality, the history of psychiatry is heterogeneous and consists of many different scientific and cultural traditions which vary between populations. hence the Indian concept of “unmada” can't be compared or conformed to “schizophrenia” without addressing its cultural and historical contexts. Many suggest that in case of Indian patients, an understanding of illness through a Vedantic model of psych seems more appealing in comparison to the western constructs, as such an attitude has been transferred over generations. Therefore, a knowledge of history of psychiatry, especially from an Indian perspective becomes important.
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ORIGINAL ARTICLES Top

Knowledge, attitude, and practice among tobacco and alcohol addicts before and after psychological intervention in a de-addiction center at Madhya Pradesh, India p. 27
Rahul Ganavadiya, BR Chandrashekar, Pallavi Singh, Ruchika Gupta, Poonam Tomar Rana, Shubham Jain
DOI:10.4103/ipj.ipj_77_14  
Context: Tobacco and alcohol addiction has emerged as a major public health issue in most of the regions of the world. It has resulted in enormous disability, disease, and death and acquired the dimension of an epidemic. It is estimated that five million preventable deaths occur every year globally, attributable to tobacco use. The number is expected to double by 2020 if death due to tobacco continues to occur at the same rate. Alcohol, on the other hand, contributes to 25% of all deaths in the age group of 20–39 years. The interventions such as supportive pharmacotherapy, nicotine replacement therapy, counseling, behavioral intervention, psychotherapy, and detoxification therapy are being commonly employed in the management of patients with addiction to tobacco and alcohol. Aim: The aim of this study is to compare the knowledge, attitude, and practice (KAP) among tobacco and alcohol addicts before and after psychological intervention in a de-addiction center. Settings and Design: This study was a randomized control trial, focusing on psychological interventions practiced in a de-addiction center, Indore, Madhya Pradesh, India. Materials and Methods: The information on KAP related to tobacco and alcohol was collected at baseline from 83 participants. This was compared with the information collected in the postintervention follow-ups from each participant. Statistical Analysis Used: Statistical tests for parametric analysis were done using one-way ANOVA with Scheffe's post hoc test, RMANOVA with Mauchly's test for sphericity assumption, and Bonferroni test for comparing the main effects. Nonparametric tests included Pearson's Chi-square test, McNemar's Chi-square test, Spearman's rho, and Kruskal–Wallis test. The statistical significance was fixed at 0.05. Results: The mean KAP score for the study population was highest at the first follow-up followed by the second follow-up for both tobacco and alcohol addiction. The least KAP score was observed at the baseline. Conclusions: Although a significant improvement in the mean KAP score was observed at the first follow-up, subsequent follow-up revealed a reduction in the overall KAP score in the present study. This could be attributed to the fact that following their discharge from the de-addiction center, most of the participants reverted back to their deleterious habits.
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Stress levels and its association with self-harm and risk-taking behavior in medical undergraduates p. 41
Preethi Menon, Suprakash Chaudhury, Daniel Saldanha, Samiksha Sahu, Vasdev Singh, Vinayak Pathak
DOI:10.4103/ipj.ipj_31_18  
Background: Medical studies are very challenging. As a result of the demands placed on them, students may be under stress, and this may affect their behavior and performance. Not many Indian studies have delved into this problem. Aim: The aim of the study is to assess the levels of stress and its associated adverse behavioral effects in undergraduate medical students in a tertiary care medical college. Materials and Methods: This cross-sectional, descriptive, and analytical study included medical students from 2nd to 4th year who had given informed consent to participate in the study. Students were assessed with a semi-structured questionnaire, students stress scale (SSS), perceived stress questionnaire, and risk-taking and self-harm (RT and SH) inventory. Results: A total of 405 students (153 males and 252 females) participated in the study. There were no significant differences in the age, perceived family support, religious practices, physical activity, and SSS scores of the male and female students. A significantly higher score was obtained by boys as compared to the girls on the scores of the RT subscale and total score on RT and SH inventory. However, girls obtained significantly higher scores as compared to boys on the perceived stress scale. Among girls, 23.4% reported high stress, 63.5% had moderate stress, and 13.1% reported low stress. Among boys, 11.1% reported high stress, 68.6% had moderate stress, and 20.3% reported low stress. The difference was statistically significant. Conclusions: The majority of Medical undergraduates were under stress; however, the majority perceived themselves to be under moderate stress. Male students had higher scores on RT and SH inventory as compared to females. There is an urgent need to study the causes and devise effective management and preventive measures to avoid the harmful long-term effects of stress on their careers and well-being.
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Somatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder p. 47
Vijaya Kumar, Ajit Avasthi, Sandeep Grover
DOI:10.4103/ipj.ipj_72_17  
Aim: The aim of this study was to study somatosensory amplification, health anxiety (hypochondriasis), and alexithymia among patients with generalized anxiety disorder (GAD) and to evaluate the association of these variables with the severity of GAD. Materials and Methods: Cross-sectional design was employed, and patients were recruited from the outpatient clinic of the psychiatry department of a multispecialty tertiary care medical institute in North India. The patients who were clinically diagnosed to have GAD by the two independent qualified psychiatrists were screened with Mini International Neuropsychiatry Interview to confirm the diagnosis. Forty patients with GAD meeting the inclusion criteria were assessed with GAD-7 scale, somatosensory amplification scale (SSAS), the Whiteley Index (WI) and Toronto alexithymia scale - 20 Hindi version (TAS-H-20). Results: The mean scores of patients with GAD on SSAS, WI, TAS-H-20, and GAD-7 scale were 25.70 (SD-5.84), 7.75 (SD-3.30), 59.77 (SD- 8.63), and 13.37 (SD- 3.58), respectively. Half of the patients with GAD had significant health anxiety as defined by WI score of >7. Around 40% of GAD patients were alexithymic as defined with TAS-H-20 scores of >60. SSAS, WI, TAS-H-20 had a positive correlation with the severity of GAD as measured with GAD-7 scale. Conclusions: GAD patients have significant somatosensory amplification, health anxiety (hypochondriasis), and alexithymia. Accordingly, there is a need to develop effective psychological interventions focused on these factors in GAD.
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Efficacy of inhibitory learning theory-based exposure and response prevention and selective serotonin reuptake inhibitor in obsessive-compulsive disorder management: A treatment comparison p. 53
Narendra Nath Samantaray, Suprakash Chaudhury, Preeti Singh
DOI:10.4103/ipj.ipj_35_18  
Background: The majority of treatment research on obsessive-compulsive disorder (OCD) has focused on emotional processing theory (EPT)-based exposure-based interventions. Despite the outcomes of EPT-based exposure and response prevention (ERP), a sizeable percentage of patients do not respond whereas 50%–60% of those who respond experience at least partial relapse at follow-up assessments. Inhibitory learning theory (ILT) provides a novel foundation for understanding how exposure therapy can be maximized to overcome such deficits but has not been adequately studied and compared to other evidence-based management in OCD. Aim: The aim of this study was to compare ILT-based ERP plus selective serotonin reuptake inhibitor (SSRI) with only SSRI treatment in OCD patients. Materials and Methods: The present study is pretest/posttest control group design with single masking, where participants (n = 32) diagnosed with OCD were randomly assigned into two treatment groups, namely ILT-based ERP plus SSRI and SSRI alone. Yale-Brown obsessive-compulsive scale was primary outcome measure. Intervention was done for 3 months. Thereafter, the participants were followed up for 6 months. Results: ILT-based ERP and SSRI are both effective treatments. There was no significant difference in treatment effects between combined treatments of SSRI plus ILT-based ERP and SSRI alone in immediate post assessment. However, combined treatment of SSRI plus ILT-based ERP had significantly better treatment effects on follow-ups than SSRI alone. Conclusions: SSRI combined with ILT-based strategies to maximize ERP is significantly better than SSRI alone in the treatment of OCD.
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A study on Internet addiction and its relation to psychopathology and self-esteem among college students p. 61
Manish Kumar, Anwesha Mondal
DOI:10.4103/ipj.ipj_61_17  
Background: Internet use is one of the most important tools of our present-day society whose impact is felt on college students such as increased use of Internet. It brings change in mood, an inability to control the amount of time spent with the Internet, withdrawal symptoms when not engaged, a diminishing social life, and adverse work or academic consequences, and it also affects self-esteem of the students. Objective: The main objective of this study is to explore the Internet use and its relation to psychopathology and self-esteem among college students. Methodology: A total of 200 college students were selected from different colleges of Kolkata through random sampling. After selection of the sample, Young's Internet Addiction Scale, Symptom Checklist-90-Revised, and Rosenberg Self-Esteem Scale were used to assess the Internet usage, psychopathology, and self-esteem of the college students. Results: Depression, anxiety, and interpersonal sensitivity were found to be correlated with Internet addiction. Along with that, low self-esteem has been found in students to be associated with possible users of Internet. Conclusion: Internet usage has been found to have a very strong impact on college students, especially in the areas of anxiety and depression, and at times it affected their social life and their relationship with their family.
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Proactive coping style and intentional self-harm: A cross-sectional study p. 67
D Bhattacharyya, M Namdeo, AK Dwivedi
DOI:10.4103/ipj.ipj_2_18  
Background: Coping style adopted by a person has been identified as an important factor in precipitating or preventing an intentional self-harm attempt. While the influence of reactive coping has received lot of research attention, effects of proactive coping on suicidal behavior has not been studied, even though it is known that proactive coping is associated with better mental health. The authors in the current study sought to investigate the relationship of proactive coping style with attempted deliberate self-harm. Materials and Methods: A total of 44 individuals who presented with intentional self-harm were compared with age, sex, marital status, and education-matched healthy controls. Pierce Suicide Intent Scale was used to ascertain suicidal intent, and Proactive Coping Inventory was used to assess proactive coping. Results: There were no significant differences between subjects and controls for proactive coping, preventive coping, emotional support seeking, avoidance coping, and instrumental support seeking. However, participants scored higher in strategic planning (P = 0.027). Conclusions: Proactive coping has no significant relationship with intentional self-harm; however, more studies with better designs are needed to comment conclusively.
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To identify predictors of relapse in cases of alcohol dependence syndrome in relation to life events p. 73
Vinay Singh Chauhan, Shubra Nautiyal, Rajat Garg, Kirti Singh Chauhan
DOI:10.4103/ipj.ipj_27_18  
Background and Objectives: Relapse is a complex and dynamic phenomenon that appears to be determined by biological, psychological, and social factors and an interaction among these. This study examined the association between demographic variables, clinical parameters, and psychosocial factors that predict the vulnerability to relapse in cases of alcohol dependence syndrome. Materials and Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, life events, and dysfunction were carried out among patients with alcohol dependence syndrome (n = 100) who had relapsed and compared with those (n = 100) who had managed to remain abstinent. Results: Patients who had relapsed were found to have significantly more positive family history of substance use, past history of alcohol-related comorbidity, experienced a higher number of undesirable life events, and higher negative mood states and social anxiety and dysfunction in social, vocational, personal, family, and cognitive spheres compared to patients who had remained abstinent. Conclusions: Relapse in alcohol dependents is an interaction of many factors, and multiple layers of assessment may be required to predict relapse. This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It provides the basis for investigating the correlates of relapse in a wide range of behavioral and substance use problems.
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Study on risk factors in adolescents admitted with deliberate self-harm in Tata main hospital, Jamshedpur p. 80
Manoj Kumar Sahoo, Harshita Biswas, Sanjay Kumar Agarwal
DOI:10.4103/ipj.ipj_62_17  
Background: Suicide ranks as the second cause of death worldwide among 15–19 years olds, with at least one lakh adolescents dying by suicide every year. Therefore, research on understanding the dynamics of suicide attempts in adolescents can be used as a means of suicide prevention. Objective: The objective of this study is to understand the psychological, social, and personality factors contributing to deliberate self-harm/suicide attempt in patients of adolescent age group admitted to Tata Main Hospital, Jamshedpur. Materials and Methods: This study was carried out at Tata Main Hospital Jamshedpur. Consecutive suicide attempters up to the age of 19 years referred from medical or surgical wards over a period of 1 year are taken up for study. Data were collected on socio-demographic sheet and specific pro forma to collect various risk factors contributing to this behavior specifically designed for this study. Data were analyzed using descriptive statistics and Chi-square test. Results: Majority of the suicide attempters were females of younger age, lower-middle income status, urban background, and students. Two-third (68%) of the attempter had at least one psychiatric diagnosis. Nearly 75% of the suicide attempts were committed after a precipitating factor. The risk factors associated with suicide attempts in included increased family conflicts, peer-interpersonal problems, perceived humiliations and personality traits. Conclusion: The early identification and treatment of vulnerable populations with risk factors for suicide across the lifespan will help in planning and implementing strategies for prevention.
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25 Hydroxyvitamin D levels, quality of life, and disability in long-standing patients of somatization p. 87
Shruti Srivastava, Manjeet Singh Bhatia, Priyanka Gautam
DOI:10.4103/ipj.ipj_73_17  
Introduction: Somatization disorder is a debilitating condition, in which patients have multiple physical complaints with no explained cause and no relief even after consultations. Aim: The present study examined the association of 25-hydroxyvitamin D (25[OH]D) levels, quality of life, disability, and symptom profile in long standing with somatization disorder. Methods: One-hundred three patients of somatization disorder suffering for ≥2 years, visiting psychiatry outpatient clinic during two consecutive summer season (April to June) of 2015–2016 were recruited. Symptom profile was studied using Patient-Health-Questionnaire (PHQ-15) items (somatic symptoms), PHQ-9 items (depressive symptoms), Generalized Anxiety Disorder-7 (GAD-7) item (anxiety symptoms).quality of life was assessed using the World Health Organization Quality of Life BREF 26 item, and disability measure was World Health Organization Disability Assessment Schedule (WHODAS) 2.0. 25(OH) D levels were estimated using chemiluminescence binding assay. Results: The poor quality of life in somatization disorder was significantly associated with disability, symptom profile using PHQ-15, PHQ-9, and GAD-7. 25(OH)D levels were deficient in 56.31% of the study population. Conclusion: The high somatic symptom severity in majority of patients suffering from somatization disorder needs more attention from psychiatrists across cultures so that functional status and quality of life can be improved. Routine estimation of Vitamin D levels and correction of its deficiency may bring about symptomatic relief at an early stage, thereby reducing the morbidity associated with the disorder.
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A study of association of behavioral problems with scholastic backwardness in urban lower middle-class school children p. 92
Neha Sharma, Ram Chandra Das, Kalpana Srivastava, Rucha Upasani
DOI:10.4103/ipj.ipj_25_18  
Introduction: Scholastic backwardness is a common phenomenon with multifactorial etiology. Behavioral problems are known to occur in children who are scholastically backward (SB). These may be a part of the broad phenomenon, or may exist in cause and effect relationship with scholastic backwardness. Aims: The aim of this study is to study the presence of behavioral problems associated with scholastic backwardness in school-going children in Pune cantonment. Materials and Methods: A total of 300school children aged 8–14 years studying in Class III–IX from two government-aided semi-Marathi schools in Pune cantonment were screened for scholastic backwardness and evaluation of behavioral problems was carried out for positive cases and matched controls. Results: Out of the 28 SB children, behavioral problems were present in 17, giving a prevalence of 60.71%, in comparison with the scholastically normal (SN) group of 50, only 14 of which had behavioral problems, prevalence is 28%. A significant association was found between scholastic backwardness and behavioral problems, which were more prevalent in the SB group compared to matched controls. Conclusions: Behavioral problems are more prevalent among children who are SB when compared to their SN counterparts. Further research is required to assess in detail whether the behavioral problems are comorbid with scholastic backwardness, lead to scholastic backwardness or occur as a consequence of scholastic backwardness.
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Study of quality of life among health workers and psychosocial factors influencing it p. 96
Amit Kumar, Pookala Shivaram Bhat, Sumalatha Ryali
DOI:10.4103/ipj.ipj_41_18  
Background: To cope with the challenges in the health-care delivery system and to guarantee the quality of care rendered and client satisfaction on the care received, it is important to know how satisfied health-care workers are with their quality of life, job and what characteristics influence their quality of life. This study was undertaken in a tertiary care hospital to assess the same using validated questionnaires. Aim: This study aims to study the quality of life among the health workers (doctors and nurses) of a large multispecialty tertiary care hospital and the psychosocial factors influencing it. Materials and Methods: A total of 200 health-care workers with their background demographic data were assessed using quality of life questionnaire and occupational stress inventory. The data compiled were analyzed with appropriate statistical methods. Results: The overall quality of life among the study population was average, and the mean prevalence of occupational stress level was of mild level. There was a correlation between domains of occupational stress and domains of quality of life of health-care workers. Conclusion: Study findings revealed that overall perception of quality of life was average, overall stress level of health-care workers was moderately elevated and majority showed average coping resources.
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Role of personality in tobacco smoking behavior in corporate sector: A cross-sectional study p. 103
Prathamesh S Kulkarni, Shubhangi R Parkar, Natasha Kate, Kaneenica Ninawe, Rimple Limbachiya
DOI:10.4103/ipj.ipj_46_16  
Background: India's corporate sector has grown steadily over the past decade, and it is providing a lot of work opportunities to Indian youth. Around 20% of employees in the corporate sector in India smoke cigarettes. In general, addictive behaviors including smoking are associated with certain personality dimensions. Hence, we conducted a study with the aims to assess the level of nicotine dependence in tobacco smokers (working in corporate sector), study their personality profile, and association of their personality traits with continuing smoking behavior. Materials and Methods: The study proposal along with its intended aims and objectives was cleared by the Institutional Ethical Review Board. It was a cross-sectional study. We used FTND for level of nicotine dependence and NEO FFI 3 for personality profile along with a structured proforma. Results: Most of the clients were of very low to low level of nicotine dependence. As high as 40% of the clients did not even attempt to quit smoking, most common reason for attempt at quitting was health concerns. Major causes of relapse were friends, people at workplace, and nature of work. Clients were high on neuroticism, average on extraversion and openness, and low on agreeableness and conscientiousness. Neuroticism was significantly associated with the level of nicotine dependence. Extraversion and openness were associated with health concerns, while agreeableness and conscientiousness were associated with social factors as a reason to quit. Extraversion and agreeableness were associated with occupational factors and social factors as reasons to relapse. Conclusion: Understanding one's personality would be helpful to identify health-enhancing (which help to attempt at quitting) and health-destructive (which were responsible for relapse) behaviors. This can further help in framing interventions that particularly target these personality traits and behaviors.
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Study of internet addiction in children with attention-deficit hyperactivity disorder and normal control p. 110
Rupesh Enagandula, Shipra Singh, Gaurav W Adgaonkar, Alka A Subramanyam, Ravindra M Kamath
DOI:10.4103/ipj.ipj_47_17  
Background: In the current era, the use of electronic media in the form of Internet has increased exponentially, particularly among children, and has led to their excessive involvement in Internet. In this context, attention-deficit hyperactivity disorder (ADHD) children were found to have increased tendency for this addiction. Aims and Objectives: The aim is to study and compare Internet addiction between ADHD and normal children and the relation of demographic profile to Internet addiction. Materials and Methods: This was a cross-sectional study including 100 children (50 ADHD cases and 50 normal children without any psychiatric illness as controls) between the ages of 8 and 16 years. A semi-structured pro forma for demographic profile and Internet usage using Young's Internet Addiction Test (YIAT) was used. Statistical analysis was done using SPSS 20. Results: Internet addiction among ADHD children was 56% (54% having “probable Internet addiction” and 2% having “definite Internet addiction”). This was statistically significant (P < 0.05) in comparison with normal children where only 12% had Internet addiction (all 12% had “probable Internet addiction”). ADHD children were 9.3 times more prone to the development of Internet addiction as compared to normal (odds ratio – 9.3). Significant increase in average duration of Internet usage in ADHD children with increasing score of YIAT (P < 0.05) was seen. The incidence of Internet addiction was more in male ADHD children as compared to normal (P < 0.05). Conclusions: ADHD children are more prone to Internet addiction as compared to normal children and thus require preventive strategies.
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A novel approach to suicide prevention – Educating when it matters p. 115
Nimisha D Desai, Paragkumar Chavda, Sandeep H Shah, Nilima Shah, Saurabh N Shah, Elavatsala Sharma
DOI:10.4103/ipj.ipj_10_18  
Background: Looking at the burden of suicide, there is a dire need for medical schools to incorporate suicide prevention training. Effective communication helps in early detection and management of suicidal behavior. Medical students can act as a GATEKEEPER if they receive adequate training. Methodology: This was an educational intervention study done at tertiary care teaching hospital to assess the knowledge and attitude of medical students toward depression and suicide and to impart and assess communication skills for suicide prevention in one of the four batches of students in 4th semester. Pretest was conducted to assess knowledge and attitude toward depression and suicide, followed by training using interactive lectures, demonstration of interview, and hands-on training with patients and role-plays. The posttest and objective structured clinical examination (OSCE) were administered for skill assessment. Feedback was taken regarding this intervention. Results: The mean marks of the pre- and post-test were 8.96 (8.3–9.6) and 14.58 (13.8–15.3), respectively, out of 25. The difference was statistically significant (t = 13.24, P ≤ 0.0001) which suggests improvement in knowledge. We found mixed responses in attitude statements showing limited change. Mean obtained marks on OSCE examination out of 66 was 42.7. Among various components of OSCE, students scored high on rapport building. The most useful components of trainings were role-play, OSCE, and interaction with patients as per their feedback. Conclusion: The intervention was found effective in increasing knowledge, changing attitude, and enhancing communication skills of medical students toward suicide prevention. Training of communication skills for suicide prevention in depressed person should be given to every medical student as suggested by feedback.
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Attitude of undergraduate medical students toward psychiatry: A cross-sectional comparative study p. 124
Charan Singh Jilowa, Parth Singh Meena, Mahendra Jain, Gaurav Dhanda, Krishan Kumar Sharma, Anil Kumar Kumawat, Yogesh Dosodiya, Sunil Moond
DOI:10.4103/ipj.ipj_82_17  
Context: Both psychiatry as a specialty and mental illnesses carry a lot of stigmatizing attitudes. Even medical professionals are not immune to prevailing stigma. Psychiatrists are perceived to have less scientific attitude, earn less money, to be less respected, and to have less prestige. Aims: The present study was designed to know the attitude of medical students with different years of exposure to medical education, toward psychiatry as a specialty. Settings and Design: The study was conducted at JLN medical College, Ajmer. The participants were divided into two groups, undergraduate and interns, respectively. It was a cross-sectional descriptive study. Materials and Methods: Self-administered sociodemographic and Attitude Toward Psychiatry-30 items questionnaires were given to the second-year and medical intern and the scores were analyzed using appropriate statistical tools. Statistical Analysis Used: Student's t-test and Chi-square test using SPSS version 21. Results: Nearly 84% of second-year medical students and 52% of interns had positive attitude toward psychiatry (P = 0.001). Only five second-year (5%) and two intern (1.8%) students affirmatively indicated to choose psychiatry as a career choice, while 73% denied choosing psychiatry as a specialty. Conclusions: Second-year medical students showed more positive attitude than the intern group. Increasing negative attitude in higher classes might be due to poor teaching of psychiatry in under graduate training, ridiculous stereotypic comments and remarks by medical teachers and practitioners belonging to other specialty branches.
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Prevalence of excessive internet use and its association with psychological distress among university students in South India p. 131
Nitin Anand, Praveen A Jain, Santosh Prabhu, Christofer Thomas, Aneesh Bhat, PV Prathyusha, Shrinivasa U Bhat, Kimberly Young, Anish V Cherian
DOI:10.4103/ipj.ipj_28_18  
Background: Excessive internet use, psychological distress, and its inter-relationship among university students can impact their academic progress, scholastic competence, career goals, and extracurricular interests. Thus, a need exists to evaluate the addictive internet use among university students. Objectives: This study was set up to examine the internet use behaviors, internet addiction (IA), and its association with psychological distress primarily depression among a large group of university students from South India. Methods: Totally 2776 university students aged 18–21 years; pursuing undergraduate studies from a recognized university in South India participated in the study. The patterns of internet use and socioeducational data were collected through the internet use behaviors and demographic data sheet, IA test (IAT) was utilized to assess IA and psychological distress primarily depressive symptoms were evaluated with Self-Report Questionnaire-20. Results: Among the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild IA, 16.4% (n = 455) for moderate addictive use, and 0.5% (n = 13) for severe IA. IA was higher among university students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on the Internet and had psychological distress. Male gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA. Conclusions: IA was present among a substantial proportion of university students which can inhibit their academic progress and impact their psychological health. Early identification of risk factors of IA can facilitate the effective prevention and timely initiation of treatment strategies for IA and psychological distress among university students.
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A study of relationship between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students p. 141
KV Guruprakash, SG Mehta, Bajpai Atul, Jyoti Prakash, KJ Divinakumar, SA Khan, P Patra
DOI:10.4103/ipj.ipj_20_18  
Introduction: Medical postgraduate student experience considerable stress during their training, which may cause agony to the individual or affect care rendered to the patient. Significant burnout and psychopathology has not been uncommon. Materials and Methods: A study was done to assess the relation between perceived stress, coping pattern, burnout, and general psychopathology among the postgraduate medical students. Results: Perceived stress was associated with higher scores on general psychopathology and burnout. Postgraduate students who displayed positive coping strategies had lesser perceived stress. Females had higher scores on perceived stress and psychopathology. Conclusion: Stress is one of the major growing mental problems among highly educated health professional, and it should not be ignored as it can cause many other health issues.
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CASE REPORTS Top

Unusual cases of succubus: A cultural phenomenon manifesting as part of psychopathology p. 147
Sandeep Grover, Aseem Mehra, Devakshi Dua
DOI:10.4103/ipj.ipj_71_17  
Succubus is also known as demon female lover who approaches males in their dreams to have sex. This is the phenomenon which is rarely described in psychiatric literature. It is more identified as a cultural belief in different religions. We report the two cases diagnosed with schizophrenia, who reported this rare phenomenon of succubus as part of their psychopathology and discuss the phenomenon of succubus.
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Identification and management of “delirious mania:” A rare clinical entity p. 151
Nishtha Chawla, Priyanka Yadav, Raman Deep Pattanayak, Sudhir K Khandelwal
DOI:10.4103/ipj.ipj_22_16  
Little is known about the entity of delirious mania, apart from a few reports. Delirious mania, though a potentially lethal condition, has not found a place in the current classification system. We discuss the approach to the identification and management of delirious mania in a female patient presenting with catatonic and delirious features, with a past history of recurrent mood episodes. However, it must be emphasized that it is likely to be a rare clinical presentation of bipolar disorder and should not be the first diagnostic consideration. As a rule, any patient presenting with delirium or clouded consciousness first warrants a thorough medical workup and other specialty referrals.
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SHORT COMMUNICATION Top

Flibanserin: A controversial drug for female hypoactive sexual desire disorder p. 154
Rashmi Baid, Rakesh Agarwal
DOI:10.4103/ipj.ipj_20_16  
Sexual functioning is an integral part of human life. Female sexual dysfunction (FSD) adversely affects quality of life and general well-being. The Food and Drug Administration recently approved flibanserin, for treatment of female hypoactive sexual desire disorder (HSDD), regarded as the most common FSD, amid great controversy. A novel multifunctional serotonin agonist and antagonist, flibanserin, has been shown to be efficacious in treating HSDD but with a rather tenacious side effect profile. We review this interesting drug in its entirety. Data for the article were collected by reviewing articles on PubMed, the drug (Addyi) website, and related websites on the internet.
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