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   Table of Contents - Current issue
July-December 2019
Volume 28 | Issue 2
Page Nos. 155-324

Online since Friday, August 14, 2020

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Social media and mental health challenges Highly accessed article p. 155
Kalpana Srivastava, Suprakash Chaudhury, Jyoti Prakash, Sana Dhamija
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Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India Highly accessed article p. 160
Sachin Kumar Saxena, Raghu Nandan Mani, Arun Kumar Dwivedi, V S S R Ryali, Anurag Timothy
Background: Students pursuing higher education are subject to high stress levels which could be associated with dysfunctional coping. Maladaptive coping is known to be operative in manifesting as psychopathology as depression, anxiety, suicidal ideation, and substance abuse. This study aimed to elaborate the psychological morbidity among professional undergraduates in general and medical students in particular, its evolution over the years and its psychosocial correlates. Methodology: The study examined medical students (n = 202) and age-matched engineering students (n = 145) belonging to the first and final year for psychological stress and coping, educational stress, domestic and professional concerns, depression, anxiety, and substance abuse. Psychometric scales along with demographic questionnaire were used to assess and quantify stress and psychological morbidity. Results: Medical students had higher levels of stress (psychological and education related) and higher psychological morbidity (depression and anxiety). Stress scores correlated positively with depression and anxiety scores and negatively with substance use score. Psychological stress other than educational stress was noted to be predictors of alcohol use in the sample. Conclusion: Our study elucidates that medical students face higher levels of psychological and education-related stressors and have higher levels of psychological morbidity than students from engineering colleges. Psychoactive substances are used as a form of self-medication to alleviate stress.
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Perception of employees on mental health at a leading botanical garden, India: A qualitative study p. 170
Meena Kolar Sridara Murthy, Bibin V Philip, Sharmitha Krishnamurthy, Anish V Cherian, Santosh Kumar Chaturvedi
Background: The prevalence of mental health issues in India is increasing. The lack of knowledge about mental illnesses and negative beliefs about treatment usually lead to delayed treatment. Mental health literacy is a prerequisite for early recognition and intervention in mental disorders. Aims: The study was undertaken with the aim to explore the awareness of mental health among the employees of the botanical gardens to address this massive issue. Materials and Methods: Two focus group discussions were carried out with five and ten members from two diverse groups of population respectively. Results: The study highlights that the signs and symptoms of mental illness were not well recognized by the participants except few.The study also shows the presence of misconceptions among the sample regarding mental health and the role of mental health professionals. This indicates the need for mental health literacy among the community. Conclusion: The study shows that the knowledge of the employees of the botanical garden regarding mental health was limited. This limited knowledge may be a prominent cause of poor treatment turn up. Therefore a need of systematic sensitization program to increase mental health literacy is highlighted through the study.
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Caregiver burden in children with intellectual disability: Does special school education help? p. 176
Vikhram Ramasubramanian, Ramasubramanian Chellamuthu, R Selvikumari, P Raja Soundara Pandian, R Gopi
Background: Caregivers are playing a vital role in mentally ill patients in India. Families of children with intellectual disability encounter a high degree of stress such as physical, emotional, and financial. Aim: The aim of this study was to compare and evaluate the caregiver burden and depression between the special school-going children and nonschool-going children with intellectual disability. Materials and Methods: The present study was conducted on caregivers of patients with intellectual disability at Radianz Health Care and Research Private Limited, Ahana Hospitals, Akash Special School, and M. S. Chellamuthu Trust and Research Foundation, Madurai. The Zarit Burden Interview scale was utilized to assess the level of burden experienced by the caregivers. The Major Depression Inventory scale was utilized to assess the severity of depression experienced by the caregivers. The Binet Kamat Test of Intelligence was administered by a psychologist to assess the IQ level of the children. Results: Totally 80 caregivers were participated in the study. The mothers of children with intellectual disability suffered from burden and depression when compared to the fathers (P < 0.0001). The parents of nonschool-going children had a higher level of burden and depression as compared to the parents of special school-going children (P < 0.0001). Conclusion: Special school is playing a vital role for children with intellectual disability. It can be reasonably concluded from the study that both the groups face burden and depression. However, the severity of burden and depression is comparatively higher among parents of nonschool-going children.
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Effect size of lithium, carbamazepine, and sodium valproate in child and adolescent bipolar 1 disorder during manic phase: A prospective open-label study p. 185
Rakesh Kumar Singh, Vinod Kumar Sinha, Suprakash Chaudhury
Aim: The aim was to evaluate the “effect size (ES),” tolerability, and acceptability of lithium, carbamazepine, and sodium valproate in the acute phase treatment of pediatric Bipolar 1 disorder patients during manic phase. Materials and Methods: This hospital-based, prospective, open-label study included 67 patients in manic phase of bipolar I disorder, aged 6–17 years, after informed consent by the caregivers. The patients were randomly assigned to the lithium group (n = 30), carbamazepine group (n = 20), and sodium valproate group (n = 17). They were assessed with the Schedule for Affective Disorders for School Age Children's-Present and Life time version administered to the parent and child separately, Conner's Abbreviated Rating Scale, and Cassidy Scale for Manic States (CSMS). Lithium was started in the dose of 30 mg per kg of body weight, carbamazepine in the dose of 10–20 mg/kg/day, and sodium valproate in the dose of 10–20 mg/kg body weight. Antipsychotic (chlorpromazine [CPZ] 100–500 mg per day or haloperidol up to 750 mg of CPZ equivalent) was allowed in the study. Injection haloperidol 10 mg and injection promethazine 50 mg intramuscular were allowed for initial 3–5 days to combat acute agitation. Rescue medication such as injection lorazepam 2–4 mg intramuscular was allowed throughout the study duration. The patients were rated weekly on CSMS, Bipolar Clinical Global Impression, Udvalg for kliniske Undersogelser Side Effect Rating Scale, and side effect checklist for lithium, sodium valproate, and carbamazepine, respectively. The serum level of concerned drug was obtained at weekly intervals and dose hiked, if needed to get target serum level. Results: The response rate was 90% in lithium group, 70% in carbamazepine group, and 88% in sodium valproate group on the basis of ≥33% reduction from baseline CSMS. The effects of change of CSMS over the 6 weeks across the three treatment group were found to be highly statistically significant. Conclusions: In the acute phase treatment of pediatric bipolar 1 disorder patients during manic phase, the ES for lithium was 0.85, for carbamazepine 0.71, and for sodium valproate 0.84. These agents are well tolerated in treating bipolar disorder in children.
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Prevalence of premenstrual dysphoric disorder among school-going adolescent girls p. 198
Madhu Gupta, Devakshi Dua, Harsheen Kaur, Sandeep Grover
Background: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome which has a significant negative impact on the various domains of life of adolescent girls. Aim: The aim of this study was to estimate the prevalence of PMDD in adolescent girls studying in classes 7th–10th and ascertain the level of stress, anxiety, and depression among them. Methodology: A cross-sectional study was conducted in three all-girls schools in Chandigarh (two – government and one – private) after taking necessary permissions. Participants were evaluated on a self-rated questionnaire which included the PMDD scale, Perceived Stress Scale, Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and Patient Health Questionnaire-9. Results: A total of 397 girls participated in the study. The mean age of respondents was 14.34 (standard deviation [SD]: 1.17; range: 11–20) years, with most (44%) studying in class 10th. The mean age of attaining menarche was 12.54 (SD: 0.92; range: 10–15) years. The prevalence of PMDD was found to be 4.8% (n = 19). Majority of the respondents reported moderate levels of perceived stress (62%). A positive correlation was seen between the severity of PMDD, age, levels of perceived stress, severity of depression, and anxiety in the respondents. Conclusion: Nearly 5% of adolescent girls suffer from PMDD, with higher prevalence among those with depression, GAD, and higher perceived stress. Thus, there is a need to screen adolescent females for PMDD at the earliest and institute intervention to minimize its negative impact.
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Assessment of knowledge, attitude, and practices and motivation to quit tobacco habits in relation to age and educational status among male tobacco users visiting a Government Dental College Hospital, India p. 203
JR Sukhabogi, BR Chandrashekar, G Satish Kumar, N Harita
Background: Tobacco use has become an epidemic of modern times. Its use is widespread among young adults and those from lower socioeconomic classes. Objective: The objective is to assess knowledge, attitude, and practices (KAP) and motivation to quit tobacco habits in relation to age and educational status among male tobacco users visiting a Government Dental College Hospital, India. Materials and Methods: This was a questionnaire survey conducted among 199 male adult smokers visiting the Department of Public Health Dentistry in a Government Dental College in India. Quota sampling was used for recruiting the required number of study participants. Information on KAP related to smoking habits was collected using a predesigned structured questionnaire by two trained and calibrated dentists. Knowledge, attitude toward quitting and their self-confidence toward quitting was compared in relation to age and educational status using Chi-square test. Results: A higher percentage of younger adults aged 18–24 years were interested in quitting the habit (100%) compared to those aged 45–64 years (85.2%). Similarly, a higher percentage of young adults have tried quitting the habit (76.9%) compared to their older counterparts (64.8%) (P < 0.05). Knowledge on ill effects of smoking increased with increasing educational attainment (P < 0.001). People with higher educational attainment had observed the warning sign on packaging (73.7%) compared to those with less than primary education (25.9%) and they also reported that the presence of such warning sign motivated them to think about quitting (54.8% vs. 0%) (P < 0.001). Conclusion: Knowledge, positive attitude toward quitting and self-confidence to quit were higher among younger adults and those with secondary education compared to their elder counterparts and those with less than primary education.
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Efficacy of cognitive behavioral therapy with paroxetine and paroxetine only for social anxiety disorder: A behavioral, placebo-controlled study p. 211
Narendranath Samantray, Nilamadhab Kar, Preeti Singh, Sarada Prasanna Swain, Amool Ranjan Singh, Suprakash Chaudhury, Jashobanta Mahapatra
Background: Individually, cognitive behavior therapy (CBT) and paroxetine (PX) are considered as frontline treatments for social anxiety disorder (SAD). However, the possibility of combined interventions of these might be more helpful than either intervention alone has met with mixed reviews. Hence, the goal of the current study was to examine whether combining CBT + PX would be superior to PX alone in the treatment of SAD in various stages of treatment. Methodology: The present study is a single-center, rater-blind, behavioral placebo (Bh. PBO)-controlled study. Sixty-seven participants were prospectively observed in two groups, one receiving CBT + PX and PX + Bh. PBO for 24 weeks. The Social Interaction Anxiety Scale (SIAS) was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage. The SIAS was measured at pre, post (12 weeks), end of booster (24 weeks), and 2-month follow-up (32 weeks) stage. Results: Both treatment groups have significant difference in the mean scores of SIAS in posttreatment, booster, and follow-up stages from their respective mean scores at prestage. Mann–Whitney U-test found no significant differences in the mean scores of SIAS between CBT + PX and PX + Bh. PBO at posttreatment and booster phase, whereas a statistically significance difference (P = 0.03) was found in 2-month follow-up stages. Both treatment groups have large effect size in posttreatment and end of booster phase. At 2-month follow-up stage, a large effect size of 1.11 was found in CBT + PX group as compared to medium size of 0.6 in PX + Bh. PBO group. Conclusions: Combined treatment of CBT + PX provided no advantage over PX + Bh. PBO in acute stages of treatment, but the former have significantly better maintenance of treatment gains in 2-month follow-ups than the latter.
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Prevalence of disability in Chandigarh: Findings of large household screening p. 218
Bir Singh Chavan, Nitasha Sharma, Karuna Singh
Background: The robust and sound national statistics on disability is the cornerstone for empowering the disabled population to have a barrier-free and right-based society for this population. The disability rates in India have marked discrepancies across various surveys. Taking into account the lack of data on disability in Chandigarh in terms of the proportion of disabled not included or counted owing to nonavailability of disability certificate or just lack of awareness as well as lack of data on the degree of utilization of various disability benefits, the present survey was planned. Methodology: The present study aimed at screening all the households of Chandigarh for different forms of disability using a 12-item screening tool. The survey included 254, 436 households with 925,380 population. A total of 8577 persons were screened positive for disability. The prevalence rates for the whole population were extrapolated by further confirming disability in a random sample chosen from screen-positive cases. Results: The estimated prevalence for disability in Chandigarh ranged between 0.83 and 0.86 after generating the confidence intervals. Conclusion: The prevalence rate of disability in Chandigarh is less than the national census data.
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Psychological well-being in medical undergraduates in a rural medical college in South India p. 225
Sreelatha P, Sumana Gundam, P V S S Arun, Sumalatha Ryali
Background: Medical colleges strive to create a learning environment best suitable for undergraduate medical education. In this process, measures taken can affect and influence the medical undergraduate psychological well-being. The demands of medical education lead to a psychological distress far beyond that experienced by the students of other specialties. Aims: The aim of this study is to study the levels of psychological well-being in medical under graduates. Materials and Methods: Using a cross-sectional design, 402 medical students were surveyed using the Ryffs's Psychological Well-being Scale. Results: Low psychological well-being is evident in most of the medical undergraduates with the presence of stressors playing a significant role on psychological well-being with academic stress taking a major role. Conclusion: As depicted from the current study, academic stress plays a role in low psychological well-being of medical students.
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Nomophobia and its relationship with depression, anxiety, and quality of life in adolescents p. 231
Manu Sharma, Amandeep, Devendra Mohan Mathur, Jitendra Jeenger
Background: Nomophobia is a portmanteau for “no mobile phone” and phobia or mobile phone addiction. Nomophobia refers to discomfort, anxiety, nervousness, or anguish caused by being out of contact with a mobile phone. There is a paucity of literature from India on this emerging mental health condition. Objectives: The objectives of this study were to assess the prevalence of nomophobia and its relationship with depression, anxiety, and quality of life among adolescent students. Materials and Methods: A cross-sectional study was carried out in 1386 high school students aged between 14 and 17 years. The Nomophobia Questionnaire (NMP-Q) was used to assess nomophobia. Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), and Short Form-36 (SF-36) were used to measure depression, anxiety, and quality of life, respectively. Results: Out of 1386 adolescents, 569 (41.05%), 303 (21.86%), and 82 (5.1%) have mild, moderate, and severe nomophobia, respectively. There were significantly more males with nomophobia. There was a statistically significant relationship between NMP-Q score and BDI, BAI, and SF-36 scores. A significant positive correlation was observed between NMP-Q score and scores on BDI and BAI and a significant negative correlation between SF-36 score. Conclusion: The results of the study indicate that nomophobia is an emerging mental health condition, especially in male adolescents. Nomophobia is significantly associated with depression, anxiety, and poor quality of life. Multicentric studies are needed to better understand this disorder.
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Is occupation the “driving force” for tobacco consumption? A cross-sectional study to assess prevalence, patterns, and attitude towards tobacco use among long-distance bus drivers and conductors in Western Maharashtra p. 237
G Ayyappa, Renuka Kunte, Arun Kumar Yadav, Dashrath R Basannar
Background: Tobacco use remains a major cause of preventable deaths worldwide. The recent Global Adult Tobacco Survey 2016–2017 has shown the prevalence of tobacco use among Indian population to be 28.6%. In Maharashtra, 35.5% of all adult males either smoke tobacco or use some form of smokeless tobacco. Not much data are available on tobacco use with respect to different occupations in India, though risk of tobacco use is known to be higher among individuals in certain occupations. Methods: This cross-sectional descriptive study was conducted among 190 long-distance bus drivers and conductors of long route buses departing from one of the main bus stations of the State Transport Corporation in Pune city. Data were collected using a pretested, structured questionnaire by interview method. Results: Prevalence of tobacco consumption (TC) among the respondents was 55.8% (95% confidence interval; 48.4–63). Among the tobacco users, 54% reported initiation at age <18 years “peer pressure” and “curiosity” were the main reasons for initiation while “feeling alert” and “feeling mature” were reasons for continued use. A large proportion (74.5%) of the respondents expressed their intention to quit tobacco in the near future. Conclusion: Long-distance bus drivers and conductors showed a high prevalence of TC which may be linked to certain occupation-related factors. Targeted tobacco cessation activities at workplaces may be considered as a strategy for better impact of tobacco control activities in India.
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The relationship between quality of life and social support among nurses: A cross-sectional study p. 242
Fatemeh Shojaei, Maryam Puryaghoob, Malihe Babahaji, Somayye Ghavipanje Rezaei, Samira Jafari
Objective: This research was conducted with the aim of evaluating the quality of life (QoL) and its relationship with social support of nurses. Materials and Methods: This cross-sectional study was performed on 241 nurses working at Zanjan University of Medical Sciences. The instruments used in this study were the Persian SF-36 tool, McCain Marquin Social Interaction Questionnaire, and information on individual and job characteristics. The sampling method was cluster sampling with probability proportional to population size. The information was analyzed using SPSS version 18 and with proportional statistics. Results: Only 31.6% (67) of the nurses had high levels of social support. The average social support was 47/65 ± 93/6. The highest mean score of QoL 67.75 ± 25.023 was related to physical activity and the lowest score mean were related to dimensions of bodily pain (54.59 ±22.727) and role limitations because of physical health problems (59.60 ± 40.261). In the linear regression model with the Enter method, the adjustment of the effects of the variables of the three dimensions of general health, mental health and happiness, and QoL was associated with social support. Conclusion: The majority of nurses have moderate social support and poor QoL for nurses. Therefore, considering the effects of nurse support, it is recommended to perform supportive interventions and plan for more well-being of nurses.
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A cross-sectional study on personality, coping strategies and quality of life of a single child and with siblings among undergraduate health profession students in Tamil Nadu p. 248
Arumuganathan Shanmugavinayagam, Ezhilarasi Panneerselvam, H Gladius Jennifer, Siva Ilango Thangaraju, V Sethumadhavan
Background: Over the years, there is an increase in the prevalence of single-child families due to the declining fertility rate, to improve socioeconomic status, and promotion of family planning policies. Studies from other countries revealed psychological issues in the single child; this study aims to determine the differences in personality, coping strategies, and quality of life (QOL) of single child and one among siblings group among undergraduate health professional students of an educational group in Tamil Nadu. Methods: A cross-sectional study design with universal sampling was used to collect data from 890 consenting undergraduate students. Instruments used were semi-structured pro forma to collect sociodemographic details, Eysenck Personality Inventory (EPI), Coping Strategies Inventory-Short Form, and WHOQOL-BREF. Descriptive statistics of mean, standard deviation, percentages, and independent t-test along with Spearman's correlation tests were used to analyze data and compare groups. Results: A total of 863 study participants' data were included in the analysis. About 8.92% (n = 77) of participants were single child, and >87% were from urban background. About 47% of respondents were from medical. Single female child had higher mean extroversion scores and used problem-focused disengagement strategies than females with siblings. The number of siblings was negatively correlated with the disengagement score. No difference noticed in QOL domains between the groups. Conclusion: This study did not find any significant difference in personality dimensions, coping strategies, and QOL between single child and those with siblings. However, a positive association was observed between extroversion, engagement coping strategies, and QOL.
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Antenatal preparedness for motherhood and its association with antenatal anxiety and depression in first time pregnant women from India p. 255
Shubhangi Sambhaji Dere, Jagdish K Varotariya, Rakesh P Ghildiyal, Sunil A Sharma, Darpan Mohinder Singh Kaur
Background and Aims: Pregnancy is a developmental period demanding special adjustments. Psychologically, pregnancy can be associated with positive preparedness in some and fear of childbirth or doubts of mothering role in others. Anxiety and depression during pregnancy can have negative implications on its outcome. The current study aims to provide insight into factors influencing maternal preparedness for motherhood. Methodology: Hundred first time pregnant women were enrolled after written informed consent and ethical approval. The Pregnancy Experiences Scale-Brief Version was used to study maternal rating of uplifts and hassles experiences specific to pregnancy, indicating affective valence toward the pregnancy. Pregnancy-Related Anxiety Questionnaire (PRAQ-R) helped to identify pregnancy-specific anxiety and depressive symptoms were screened using Whooley's Questions. Data were analyzed using Microsoft Excel 15.30 (170107). Results: The mean age of the women was 23.1 years. More than half of the pregnancies were unplanned, and the mean duration of pregnancy was 6.8 months. The positive experience was reported more than a negative experience. Negative valence increased in the presence of psychosocial stressors. On PRAQ-R, anxiety symptoms were reported by 52% of the patients, especially high on the domain of “fear of giving birth” and increased with trimester. Depressive symptoms were reported by 23% of the women. Conclusion: Advanced gestation, presence of stressors, past psychiatric illness, ANC complications, and the presence of anxiety/depression influence maternal preparedness for motherhood. There is a need of sensitizing the doctors, nurses, health-care workers, and relatives regarding screening, referral of unmet psychological needs of pregnant women to help new mothers to adjust with their motherhood positively.
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Quality of life and disability in males with alcohol dependence syndrome p. 262
Prajakta Patkar, Daniel Saldanha, Suprakash Chaudhury, Ichpreet Singh
Aim: The aim is to study the quality of life (QoL) and disability in persons with alcohol dependence syndrome (ADS). Materials and Methods: This cross-sectional, analytical, case–control study in a tertiary hospital in a suburb of Maharashtra included 100 cases of ADS and equal number of age- and sex-matched healthy controls fulfilling the various inclusion and exclusion criteria. Results: The study revealed that individuals commonly initiate drinking alcohol between 20 and 30 years and first present to the hospital for seeking medical attention in the age group of 30–40 years after 10–12 years of drinking when they are moderately or severely dependent on alcohol. Alcohol dependence is associated with lower educational levels and lower levels of employment. Many have problems in their marital and intimate relations, making it difficult for them to stay in long-term relationships. As a consequence of their frequent aggressive and violent behaviors, they are more commonly involved in legal matters. Having a positive family history of alcohol dependence and familial psychiatric disorders makes them have a higher chance of developing alcohol dependence. As the number of years of drinking increases, so does the dependency level. Conclusion: Alcohol dependence is associated with lower QoL and higher levels of disability levels. The severity of alcohol dependence is inversely proportional to the QoL experienced by them and directly proportional to their disabilities.
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Psychological morbidity in soldiers after spinal cord injury p. 272
T Madhusudan, SP Rathee
Background: Spinal cord injury (SCI) patients usually experience multiple and ongoing, neurological, and other medical problems with significant damage to the social and psychological well-being of themselves and their families. Materials and Methods: Soldiers with SCI transferred to the regional centre after suitable stabilization of their fractures and general physical condition were included in the study. The baseline assessment included a diagnostic interview and review of case notes for a comprehensive, multi-axial diagnosis. The participants were assessed using the Barthel's Index, the Hospital Anxiety and Depression Scale, the General Health Questionnaire, Quality of life (QOL) Index, AFMC stressful life event Scale, and the Social Support Survey with the current defense or coping style also being recorded. Similar assessments were repeated at 1 month, 6 months, and at 1 year after intake. Results: It was noticed that the mean scores on the Hospital Anxiety and Depression Scale were below the cut-off point for diagnosable disorder, or in the mild end of the spectrum. However, the measures of psychological distress and QOL showed significantly high mean scores. Anxiety Scores showed little variation over time initially, and none of the mean differences (t values) reached statistical significance. However, when the scores of intake and those at 6 months are compared, there was a statistically significant improvement. Depression scores, on the other hand, showed a steady improvement with each assessment. General lack of well-being and psychological distress along with poor QOL remained high throughout the period of assessment with little variation over time .These morbidity measures could not be accounted for by variations in stressful life-event scores or by variations in degree of disability. Although the negative correlation between anxiety and depression scores and those on the QOL index approached conventional levels of significance, there was little correlation overall between morbidity measures and the putative modifying variables at any stage of assessment. Conclusions: Although psychological symptoms of depressive and anxious spectrum was virtually universal, psychiatric illness at syndromal intensity warranting a formal psychiatric referral and management was rare in patients with SCI in the 1st year. The general well-being and QOL were expectedly dismal throughout. Expected correlations between the measures of social support and degree of disability with the measures of anxiety, depression, subjective distress, and QOL were not demonstrated .There is a need to look beyond these and explore factors such as lack of information, physical morbidity, quality of social support, and dependence for the activities of daily living to evolve a nuanced approach toward the challenge that these clientele represent.
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Comparison of impact of family stigma on quality of life among caregivers of male inpatients with alcohol and opioid use disorder p. 278
Rohit Garg, Abhishek Gupta, Deepam Kundal
Background: Caregivers of patients with alcohol and opioid use disorder (OUD) have low quality of life (QoL) and suffer from family stigma. However, impact of family stigma on QoL has not been studied in this population. Materials and Methods: One hundred primary caregivers of male inpatients with severe alcohol use disorder (AUD) (n = 47) and OUD (n = 53) as per the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition were enrolled into the cross-sectional, descriptive study.Participants were assessed using sociodemographic and clinical proforma, World Health Organization QoL-BREF Hindi, and Hindi family stigma scale. Kolmogorov–Smirnov tests and Pearson's correlation were used for statistical analysis. Results: Majority of caregivers were females (64%), homemakers (48%), and married (80%). More than 50% of caregivers resided in rural areas and nuclear families. 46%, 30%, and 24% of caregivers were parents, wives, and siblings and children. Males, caregivers between 31 and 45 years of age, and married caregivers had significantly higher QoL. Parents had significantly lower QoL. Caregivers of patients with AUD had significantly lower overall QoL than that of OUD. Wives faced higher discrimination and overall stigma. Overall QoL, satisfaction with physical health, and environment were significantly negatively correlated with discrimination. Total stigma was negatively correlated with satisfaction with environment. Conclusion: Stigma and discrimination have negative impact on QoL of caregivers. Stigma reduction and QoL enhancement should be integral part of psychosocial interventions for caregivers of patients with AUD and OUD.
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Therapeutic and prophylactic role of cognitive enhancers in electroconvulsive therapy-induced cognitive deficits p. 286
Jyoti Prakash, Suprakash Chaudhury, Kaushik Chatterjee, A Kotwal, Kalpana Srivastava, Amitav Saha
Objectives: The objective is to evaluate the pattern of cognitive deficits after electroconvulsive therapy (ECT); to ascertain the role of various psychosocial, illness and treatment-related parameters on cognitive functions after ECT; and to evaluate the effect of donepezil on various cognitive deficits. Materials and Methods: A triple-blind randomized controlled trial was undertaken. Ninety patients undergoing ECT were included into study after due consent and institutional ethical approval. They were randomized into two groups: one using donepezil with ECT and the other using placebo with ECT. Various cognitive parameters were studied before ECT, after a course of ECT and after 4 weeks of last ECT. Findings were assessed in the light of available socialdemographic and clinical parameters and existing literature. Results: ECT was found to be an effective therapeutic modality. Immediate memory worsened over the course of ECT till after 4 weeks of ECT. Augmentation of donepezil was found useful. It sped up the improvement of general memory and working memory during ECT. Conclusion: Donepezil has therapeutic and prophylactic benefit on cognition of patients undergoing ECT over the course of treatment till 4 weeks after the ECT.
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Outcome of a “modified brief intervention” program delivered at work place for a population with hazardous alcohol use p. 294
Sojan Baby, Harpreet Singh, Ranveer Singh, Siddharth Dixit, Amit Chail, Amresh Dubey
Introduction: At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a “modified brief intervention” program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure. Materials and Methods: Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given “modified brief intervention” in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software. Results: No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation. Conclusion: The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.
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Correlates of excessive Pokemon Go playing among medical students p. 301
Mili Ashar, Liz Thaliath, Kimaya Sali, Suprakash Chaudhury, Biswajit L Jagtap, Anand A Patil, Spandana Devabhaktuni
Background: A new virus “Pokémon GO” is infecting Homo sapiens at an exponential rate. The symptoms include swaying your cell phone in air and focusing in blankness, straying into the unknown in search “Pikachu”. In the “Pokedemiological” triad, the host is a medical student, agent is Pokémon GO, and the environment is a chaos of childhood fantasies and peer pressure turning into a vicious cycle of addiction, stress, anxiety, and depression. Aim: The aim was to study the correlates of excessive playing of Pokemon Go in medical students. Materials and Methods: By purposive sampling, fifty MBBS students who were regularly playing Pokémon GO for more than 2 weeks and equal number of age- and sex-matched students who were not playing any computer games were included in this study with their consent. They were assessed with a pro forma asking information about their habit and the depression, anxiety, and stress scale. Statistical analysis was done using t-test, Chi-square test, and Mann–Whitney U-test. Results: Reasons for starting to play Pokemon Go included liking the concept (n = 39), peer pressure (n = 8), and free availability (n = 3). Wandering outside their residence alone until way after dark to play the game was reported by 27 players, and six admitted to stopping in the middle of a road to catch a rare pokemon. Twenty-eight players admitted that the game had adversely affected their behavior. Twenty players play much longer than they originally planned, whereas 22 lost track of time while playing the game. The players were under significantly more stress, anxiety, and depression compared to nonplayers. Conclusion: Regular playing of Pokemon Go results in adverse consequences including exposure to dangerous situations, stress, anxiety, and depression.
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Rate and risk factors of nocturnal enuresis in school going children p. 306
Sunayna Pandey, Harsh J Oza, Hemang Shah, Ganpat K Vankar
Purpose: The purpose is to find out the rate of nocturnal enuresis in school going children (5–12 years) and the risk factors associated with it. Materials and Methods: The parents of children aged between 5 and 12 years studying in two primary schools in Ahmedabad completed a self-administered semi-structured questionnaire comprising of enuresis, sociodemographic profiles, and risk factors. Children with enuresis and those without were compared on demographic characteristics and risk factors using Chi-square and t-test for categorical and quantitative data respectively. The data were analyzed using SPSS version 17. Results: The response rate was 86.54% as 1904 responses were collected out of 2200. The overall rate of nocturnal enuresis was 6.7% (according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition definition of nocturnal enuresis). As the age increased, the rate of nocturnal enuresis declined. A positive family history was seen in 36.6% of children with enuresis. Enuresis was found to be more frequently in lower socioeconomic class. It was a neglected problem, only 20.6% of children received some kind of treatment. Conclusion: The rate of nocturnal enuresis was 6.7% in school going children. Strong correlation was found with family history. Although the rate was high, most of the children with enuresis were not treated.
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Jugaad: An indi-genius problem-solving approach p. 312
Jyoti Prakash, Kaushik Chatterjee, Kalpana Srivastava, Vinay S Chauhan
Jugaad, “an inexpensive innovation to meet an expensive need” has caught the attention of the global industry as a frugal innovative concept worth exploring. Relevant literature was reviewed to understand psychosocial factors related to Jugaad. A conceptual framework was developed based on available evidence. Jugaad is an effective approach aimed at functional problem-solving in a resource-constrained environment. Possible drawbacks need to be kept in mind while utilizing this approach.
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Escitalopram-induced severe akathisia leading to suicide attempt p. 315
Alok Pratap, Sayeed Akhtar, Prakriti Sinha, Ajay Kumar Bakhla
Akathisia, a distressing adverse reaction, is usually underdiagnosed or misdiagnosed in patients, who are treated with selective serotonin reuptake inhibitors (SSRIs). Escitalopram-induced akathisia is rarely reported in the literature. We report a case of severe akathisia leading to a suicide attempt in a 25-year-old male induced by 5 mg of escitalopram, that remitted completely after discontinuation of escitalopram and did not reappear later. Patient and their caretakers should be warned of symptoms of akathisia even when a very low dose of SSRI is prescribed.
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Impact of eclectic cognitive retraining in a case of high-altitude cerebral edema p. 318
Amit Chail, Sojan Baby, Rachit Sharma, Amresh Dubey
Cognitive impairment in cases of high-altitude cerebral edema is a less researched area of neuropsychiatry. Usually, it presents with depressive symptoms and can sway the treatment on the lines of organic depressive disorder and pseudodementia. We report one such case of which presented with depressive symptoms with cognitive dysfunction. The diagnosis was later revised to organic amnesic syndrome. His cognitive deficits improved with the use of cognitive retraining, especially with the use of mobile-based applications.
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Adjunctive dexmedetomidine for treatment of delirium tremens: Case report and brief review p. 321
Amit Chail, Amresh Dubey, Yujal Man Singh, Nikahat Jahan
Alcohol withdrawal delirium (delirium tremens [DT]) is a medical emergency. Gamma-aminobutyric acid type A agonists (benzodiazepines [BZDs]) are the mainstay of treatment. Resistant alcohol withdrawal requires adjunctive medications along with BZDs and supportive care. DT is associated with significant autonomic dysfunction (sympathetic hyperactivity). Dexmedetomidine is a selective a2-adrenergic receptor agonist which reduces sympathetic over-activity and agitation in delirious patients. We present a case of alcohol withdrawal delirium (DT) who responded well to adjunctive dexmedetomidine infusion resulting in reduced sympathetic activity and reduced dose requirement of BZDs.
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