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July-December 2020
Volume 29 | Issue 2
Page Nos. 181-369

Online since Monday, March 15, 2021

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EDITORIAL  

Digital technological interventions in mental health care p. 181
Kalpana Srivastava, Suprakash Chaudhury, Sana Dhamija, Jyoti Prakash, Kaushik Chatterjee
DOI:10.4103/ipj.ipj_32_21  
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REVIEW ARTICLES Top

Role of various lifestyle and behavioral strategies in positive mental health across a preventive to therapeutic continuum p. 185
Jyoti Prakash, K Chatterjee, K Srivastava, VS Chauhan, A Chail
DOI:10.4103/ipj.ipj_126_20  
There is growing interest in lifestyle and behavioral strategies not only in prevention but also in the management of psychiatric morbidity. Available literature in this direction was accessed, and the role of various lifestyle and behavioral factors was explored. There is strong evidence of the role of good sleep, nutritious diet, exercise, social connectedness, enhanced self-esteem, sense of purpose in life, resilience, mindfulness, and environmental mastery in the promotion of mental well-being and prevention and management of psychiatric disorders. There is a significant scope of lifestyle and behavioral intervention in ensuring positive mental health spanning from preventive to therapeutic dimension.
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Influence of Esports on stress: A systematic review Highly accessed article p. 191
Thamilselvan Palanichamy, Manoj Kumar Sharma, Maya Sahu, DM Kanchana
DOI:10.4103/ipj.ipj_195_20  
Esports is an electronic sport known as competitive video gaming, which has seen tremendous growth over the past few years. Unlike traditional sports such as hockey, baseball, and soccer, Esports is an interconnection of multiple platforms, computing, gaming, and media into a sport event. A systematic review was conducted to collate and review all the research studies concerning Esports from a health perspective and analyze various physical and psychological distress regarding Esports. Relevant published papers were identified through the electronic databases Google Scholar, PubMed, and Research Gate. As a result of the systematic research review, seven articles were identified that investigated three major domains (i) Esports and physical issues, (ii) Esports and psychological distress, and (iii) Esports and addiction. The result indicated that Esports excessive play and its competitive nature lead to physical and psychological problems. Physical issues include eye fatigue, blurry vision, low back pain, tension headache, wrist pain, hand pain, and poor posture while gaming. Psychological issues include depression, anxiety, apathy, uncooperative attitude, tense, sleep disturbances, mental distress, aggressive affect and behaviors, distress in social life, and emotional disturbances. The studies also found that long hours of online gaming was associated with the presence of depression, social phobia, obsession–compulsion, interpersonal sensitivity, hostility, phobic anxiety, paranoid ideation, psychoticism attention-deficit hyperactivity disorder, and gaming addiction. This review draws insight into the problematic side of Esports and suggested that future studies must focus on the interventions to deal with the negative impact of Esports.
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Workplace based assessment: A review of available tools and their relevance p. 200
Jyoti Prakash, K Chatterjee, K Srivastava, VS Chauhan, R Sharma
DOI:10.4103/ipj.ipj_225_20  
Workplace-based assessment (WPBA) appears to be a promising tool for more comprehensive assessment of the learners. Relevant literature in this direction was collated and analyzed for its relevance, salience, and merit. Many WPBA tools are being used by various educational institutions which spans across multiple domains and over the entire duration of the workplace learning. It caters to holistic assessment with structured measures, real-time feedback, and continuous professional development. It is being used more for formative assessment and has limited utility in summative assessment as on date. WPBA tools have promising prospect in bringing novelty, objectivity, and holistic approach in assessment.
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ORIGINAL ARTICLES Top

Multimodal psychotherapy in the management of somatization disorder Highly accessed article p. 205
Ranjan Kumar, Masroor Jahan
DOI:10.4103/ipj.ipj_11_17  
Background: Somatization is the presentation of physical symptoms without an objective and identifiable cause, and the condition is among the most common and challenging problems in primary medical care. Several modal of psychotherapy modal is being practiced but effective treatment in rarely delivered. Aim: The aim of this study is to evaluate the efficacy and durability of multimodal psychotherapy in the management of somatization disorder. Materials and Methods: This is a hospital-based study using the pre-post design with control group. Thirty outpatient department patients with somatization disorder were selected and divided into two groups, i.e., intervention group and control group using the purposive sampling method. Intervention group was given 12 sessions of management package, i.e., symptoms monitoring form, scheduling of daily activity, sleep hygiene, diaphragmatic breathing, psycho-social intervention, psychodynamic individual psychotherapy, and cognitive restructuring (approximately 3–4 months). Efficacy and durability were measured by the Bradford somatic inventory, general health questionnaire-28 (GHQ-28), defense mechanism inventory (DMI), and Sack's sentence completion test (SSCT). Results: The results reveal that there are significant differences found among intervention group in comparisons to the control group in the context of somatic complaints (BSI), general health functioning (GHQ-28), life conflict (SSCT), and in defense mechanism (DMI). Significant improvement also found between postintervention and follow-up of the intervention group on different study variables. Conclusion: The present study findings indicate that multimodal psychotherapy program is effective in the Indian context in the management of somatization disorder.
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Severity of violence and quality of life of women with psychiatric disorders as compared to normal controls p. 213
Sapna Kumari, Manisha Kiran, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_33_20  
Background: Despite the fact that violence against women is a significant public health problem, there is a paucity of research into this area, and little is known about the extent to which women with psychiatric disorders are affected. Aim: The aim of the study was to assess and compare the severity of violence and quality of life of women with psychiatric disorders and normal controls. Materials and Methods: Based on purposive sampling technique, a sample consisting of 120 participants was selected from in-patient (female section) and outpatient services of the Ranchi Institute of Neuro-Psychiatry and Allied Sciences and Kanke Area. Both groups were matched on sociodemographic details. Normal controls were screened using General Health Questionnaire-12. The severity of violence against women scale and the revised Conflict Tactics Scale were used to assess the severity of violence, and World Health Organization Quality of Life (WHOQOL)-BREF scale was used for the assessment of the quality of life. Scales were scored as per their test manuals. Results were tabulated and compared using appropriate statistical tests. Results: Women with psychiatric illness as well as normal controls faced various forms of symbolic violence equally. Women with psychiatric disorders faced significantly higher severity of physical assault, sexual coercion, and injury as compared to normal controls. Women with psychiatric disorders had significantly lower scores on WHOQOL BREF compared to normal participants. Conclusion: Women with psychiatric disorders suffered significantly higher severity of both physical and sexual violence and had significantly worse quality of life compared to normal controls.
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Clinical, sociodemographic profile and stressors in patients with conversion disorders: An exploratory study from southern India p. 222
Ravi Bammidi, Lakshmi Prasad Ravipati, M D Abu Bashar, Kota Suresh Kumar
DOI:10.4103/ipj.ipj_100_20  
Background: Patients present with “conversion disorder” as a response to any underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors, resulting in conversion. Further, knowing the sociodemographic and psychological profile of the conversion patient helps in better management. Aim: The aim of the study was to study the clinical presentations, sociodemographic characteristics, and underlying stressors associated with conversion disorder. Materials and Methods: Fifty patients admitted to the Department of Psychiatry, NRI Medical College and Hospital, Guntur, Andhra Pradesh, from January 2013 to December 2014, who fulfilled the inclusion criteria of the study were evaluated for sociodemographic characteristics, clinical presentations, and stressor on a semi-structured pro forma. Results: Majority of the patients with conversion symptoms were children and young adults (74.0%), females (62.0%), students (46.0%), married (54.0%), and those from nuclear families (78.0%) and rural background (62.0%). Socioeconomic status wise, majority (66.0%) of the patients belonged to middle class. Majority of the patients (92.0%) had a recognizable precipitating factor, of which family-related/marital (36.0%) and education/school-related (18.0%) problems accounted for the major types. Purely motor symptoms were the predominant presentation (84.0%) with unresponsiveness/syncopal attack and pseudo seizure being the commonest. Conclusion: Conversion disorders are commonly seen in females, children and young adults, students, and in those belonged to middle class in socioeconomic status and rural areas. They are mostly preceded by identifiable psychosocial stressors.
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Demographic and psychosocial profile of disruptive mood dysregulation disorder in Indian settings p. 228
Samiksha Sahu, Daniel Saldanha, Suprakash Chaudhury, Preethi Menon, Shivaji Marella, Vasdev Singh Kalkat
DOI:10.4103/ipj.ipj_226_20  
Aims: The aim of this study was to assess the demographic and psychosocial profile of the children with and without disruptive mood dysregulation disorder (DMDD) attending psychiatric and pediatric OPD and evaluation of the phenomenology of children diagnosed with DMDD. Materials and Methods: Children of 6–16 years attending the psychiatric outpatient department were screened by self-made peer-reviewed questionnaire and further underwent diagnostic evaluation using DSM 5 diagnostic criteria. Socioeconomic status (SES) was assessed using the Kuppuswamy scale. Affective Reactivity Index (ARI) was used to measure the severity of irritability. Overall behavioral problems were assessed on Conner's parent rating scale and impairment in functioning on the Children's Global Assessment of Functioning Scale. Results: A total of nine subjects were diagnosed with DMDD out of 500. The mean age of children with DMDD was higher than other children. DMDD children had better SES. Multiple psychosocial factors such as broken family, family history of psychiatric illness, and childhood adversities including sexual abuse were found to be a contributory factor. Those diagnosed with DMDD had significant conduct and learning problem along with moderate to severe irritability and a mean CGAS value of 50.66 which implies that children with DMDD had moderate impairment in functioning. Conclusions: DMDD cases have male preponderance, urban background, and belong to upper and middle socioeconomic strata. Conduct problems, academic decline, hyperactivity, impulsivity, and mild degree of impairment in anxiety, along with moderate to severe irritability produce impairment in their overall functioning of these children.
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Prevalence of psychological morbidities and their influential variables among nurses in a designated COVID-19 tertiary care hospital in India: A cross-sectional study p. 237
Sunny Garg, Megha Yadav, Alka Chauhan, Dinesh Verma, Kirti Bansal
DOI:10.4103/ipj.ipj_220_20  
Background: Nurses are the main part of the health workforce, performing their duties as frontline warriors against the novel coronavirus pandemic. Nurses involved in the care of infected (COVID-19) patients, may feel more discomfort physically and experience greater psychological morbidities. Aims and Objectives: The main aim of the study is to evaluate the prevalence of anxiety and stress among nurses in a designated COVID-19 hospital and variables that influence these psychological problems. Methodology: Nurses working in the designated tertiary care hospital were invited to participate in an online cross-sectional survey (dated, September 5–15, 2020). A self-administered questionnaire regarding sociodemographic characteristics, COVID-19-related experiences, perceived threat regarding COVID-19, and two scales (Generalized Anxiety Disorder-7 and Perceived Stress Scale-10) for the assessment of anxiety and stress was applied to nurses. Chi-square test and multiple regression analysis were used to investigate the predictors (risk and protective) of psychological morbidities in nurses. Results: On analysis of 209 participants, it was revealed that 65 (31.1%) participants have anxiety symptoms and 35.40% have moderate to the high level of stress. Being proud of working in this profession was the only protective factor from such psychological morbidities. The identified risk factors for greater anxiety symptoms and moderate-to-high-level stress were, working experience of >10 years (odds ratio [OR] = 3.36), direct involvement in the care of suspected/diagnosed patients (OR = 3.4), feeling worried about being quarantined/isolated (OR = 1.69,) and high risk of being infected at the job (OR = 2.3 for anxiety and OR = 2.1 for moderate-to-high stress). Conclusions: Deteriorating the psychic health of nurses is one of the major outcomes during the COVID-19 pandemic in India which warrants the necessity of providing psychological support to nurses and controlling the risk factors related to these problems. Greater focus should be on the frontline and experienced nurses.
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A sham-controlled trial of repetitive transcranial magnetic stimulation over left dorsolateral prefrontal cortex and its effects on craving in patients with alcohol dependence p. 245
Shashank Raikwar, KJ Divinakumar, Jyoti Prakash, Shahbaaz Ali Khan, KV GuruPrakash, Silvi Batham
DOI:10.4103/ipj.ipj_53_19  
Aim: The aim of this study is to study the effects of repetitive transcranial magnetic stimulation (rTMS) therapy over the left dorsolateral prefrontal cortex (DLPFC) in craving in drug-naive male inpatients of alcohol dependence syndrome. Methods: A single-blind randomized sham-controlled study involving sixty inpatients of alcohol dependence syndrome in a tertiary care center. Following detoxification and consent, the patients were allocated into either active or sham groups for rTMS protocol. Daily sessions of rTMS were administered over the left DLPFC at 120% of motor threshold at high-frequency (10 Hz) stimulation with 4 s train, inter-train interval of 26 s, and a total of twenty trains per session. Alcohol craving questionnaire (ACQ-NOW) was administered thrice for each patient, i.e., before rTMS, on completion of rTMS, and 02 weeks following completion of rTMS. Results: Analysis of variance of scores of ACQ NOW pre rTMS and immediately after and 2 weeks post rTMS did not show significant reduction in craving scores. Conclusion: Administration of ten daily sessions of high-frequency rTMS over the left DLPFC did not have significant effect in reducing craving in patients with alcohol dependence syndrome.
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Impact of COVID-19 pandemic on mental health among Indians: A posttraumatic stress disorder p. 251
Sudha Bala, Harshal Pandve, Rinee Manna, BS Sreelal, Sunil Patel, Tanmay Saxena, Sona G Joy
DOI:10.4103/ipj.ipj_121_20  
Background: Post Traumatic stress disorder usually occurs after a traumatic event and nowadays we are all facing the pandemic – the COVID-19 which has effected our mental health to a great extent. So this study was taken up to assess the risk of Post traumatic stress disorder symptoms using impact of event scale-revised (IES-R), their main stressors and coping measurements. Materials and Methods: A telephonic interview schedule was adopted to fill the online questionnaire among general population of age group 20-55 years covering different states using snow ball technique. Results: depicted 8.2% at risk of post traumatic stress disorder symptoms and 32.5% at risk of suppressed immune system functioning which is presumed to have its effect for the next 10 years. The main stressors of Covid -19 with increased score were worry about economic influences, effect of social media on daily life, lack of social support and poor knowledge. Coping measurements with brief resilient coping scale found 40.5% as low resilient copers who had higher mean scores of IES-R. Conclusions: This needs to be addressed earlier to bring up preventive strategies to ameliorate by including counselling services in the routine health care services of India.
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Exploring cyberchondria and its associations in dental students amid COVID-19 infodemic p. 257
B Shailaja, Vibha Shetty, Suprakash Chaudhury, Murali Thyloth
DOI:10.4103/ipj.ipj_212_20  
Background: Adverse psychological effect of pandemic includes not only increased levels of stress, anxiety, and depression but also cyberchondria - the problematic online health research behavior. It is thought that the distress and uncertainty of pandemic clubbed with information overload and its ambiguity have paved the way for cyberchondria. Students being the vulnerable population, the present study was an effort at understanding cyberchondria in students. Aim: The aim of the study is to assess cyberchondria and its association with depression, anxiety, stress, and quality of life (QOL) in dental students during the pandemic. Materials and Methods: An online questionnaire-based survey was carried out on dental students. The survey tool comprised a semi-structured pro forma, General Health Questionnaire-12, Depression Anxiety and Stress Scale 21, Cyberchondria Severity Scale 15, and European Health Interview Survey QOL 8. Results: The study revealed that 98.7% of the students were affected by one of the constructs of cyberchondria, viz., “excessiveness” (93.7%), followed by “distress” (84.3%) and “reassurance”-seeking behavior (83.7%). Cyberchondria affected girls more than boys and shared robust positive correlation with depression, anxiety, and stress but not QOL. Factors such as stress, anxiety, QOL, and changes in appetite were associated with higher severity of depression. Family financial losses, preexisting psychiatric illness, and media adverse effect shared robust positive associations with severity of depression, anxiety, and stress and an inverse association with QOL. 76.0% of the students expressed excessive worries regarding missing out on clinical exposure, and nearly half of the students were dissatisfied with eLearning. 78.3% of the students experienced changes in sleep; 68.7% had changes in appetite; and 89.0% reported reduction in the level of physical activity. Conclusion: Cyberchondria is affecting the large majority of students. Educational institutions must put efforts to sensitize students about cyberchondria.
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Effect of Internet addiction on marital life p. 268
Sunny Chattopadhyay, Manish Kumar, Om Prakash Singh, Payel Talukdar
DOI:10.4103/ipj.ipj_76_19  
Context: Certain behaviors exceed to an extent such that control becomes difficult and tolerance, dependence, and withdrawal are evident, it is regarded as behavior addiction. Internet addiction is defined as “the forced and excessive use of the Internet and the irritation that occurs when the Internet is deprived.” Internet connects people to the World Wide Web and provides an easy escape for people from their immediate environment and people tend to move away from their intimate relations. Aims: We intend to find the effect of Internet addiction on marital life. Settings and Design: It was a cross-sectional study with purposive sampling from the community. Subjects and Methods: Standardized instruments were used for the assessment of Internet addiction and marital satisfaction. The correlation was estimated and the level of significance was calculated. The marriage quality scale by Shah was used as an instrument for marital satisfaction. Youngs Internet addiction test was used for checking for the presence of Internet addiction. Statistical Analysis Used: The mean, standard deviation, and correlation were estimated and the level of significance calculated. Results: Regular users of the Internet had a relative risk of 52.5% with 1.5% showing severe addiction. Trust, dominance, and dissolution potential did not show a significant correlation. Conclusions: The risk of Internet addiction was high among regular internet users. The level of psychological comorbidity was also high. It affected marital satisfaction adversely. However, trust, dominance, and dissolution potential were least affected. In the case of marital disharmony, Internet addiction needs to be looked at as an etiological factor.
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Association of sociodemographic factors with various domains of alcohol-induced sexual dysfunction – An Indian perspective p. 272
Harpreet Singh Dhillon, Bhupendra Yadav, PS Bhat, Gurpreet Kaur Dhillon, Shibu Sasidharan
DOI:10.4103/ipj.ipj_112_20  
Background: Sexual dysfunction is frequently seen in alcohol-use disorders. The available research on this topic has studied erectile dysfunction and premature ejaculation using nonvalidated scales. This study was undertaken to study the other major domains of sexual dysfunction, namely sexual desire, orgasmic dysfunction and satisfaction, and their association with sociodemographic factors. Materials and Methods: A cross-sectional descriptive study design was used and 78 male patients were recruited. The assessment was conducted using a specially designed intake pro forma, International Index of Erectile Function (IIEF-15) Scale, DSM-5 and International Classification of Disease, 10th revision, diagnostic criteria for research. A correlation between the amount of alcohol consumed and its effect on various domains of sexual dysfunction was also carried out using Pearson's correlation coefficient. Results: The sociodemographic profile was studied in association with the overall (total) IIEF-15 subscale using analysis of variance (ANOVA). Statistically significant differences were observed among age groups, education subgroups, marital disharmony, years of alcohol use, and lifetime alcohol use. Further, since the values of ANOVA were significant, Tukey's post hoc analysis was carried out which showed a statistically significant difference among the groups. Various domains of sexual dysfunction showed a strongly negative correlation for overall IIEF subscale followed by intercourse satisfaction, sexual desire, and orgasmic function with years of alcohol use and lifetime alcohol use. Conclusion: Sexual dysfunction in alcohol dependence patients was significantly associated with a family history of paternal alcohol abuse, lower educational background, increasing age, and marital disharmony. This study also found a strongly negative correlation between various domains of sexual functioning and years of alcohol use/lifetime alcohol use.
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Mobile phone use screening test: Development, validation, and implications for screening excessive mobile use p. 279
Manoj Kumar Sharma, Nitin Anand, Kalpana Srivastava, Rajesh Sagar, P Marimuthu, BN Roopesh, Shilpi Saraswat
DOI:10.4103/ipj.ipj_174_20  
Background: Early identification for the addictive use of smartphones would enable timely intervention to minimize suffering from compromised functioning and associated psychological problems. This study is the first such attempt to develop a test for addictive/excessive use of the mobile phone in the Indian context. The present study aims to develop and validate the mobile phone use screening test (MUST) for the Indian subcontinent. Materials and Methods: Five hundred individuals aged 18–40 years, residing in the South Indian city of Bangalore participated in the study. The sociodemographic datasheet and the newly developed test were administered on these individuals to gather demographic information and patterns of excessive mobile phone use. Results: The developed test has 18-items which use a self-report Likert-type scale format. The test–retest reliability was 0.93 and the Cronbach's alpha was found to be 0.86. The scoring criterion for the overall score was: <30 = mild use; 31–49 = moderate use; and 50 and above = excessive/addictive smartphone use. The scale has four components: craving, loss of control, coping, and consequences. Conclusions: The MUST can be used for the identification of addictive/excessive use of mobile phone among adolescents and young adult groups.
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Trajectory of insight on various dimensions among bipolar disorder in-patients p. 285
Syed Ummar Ibrahim, Vinod Balaji Kalyanasundaram, Shree Aarthi Ramanathan, Sureshkumar Ramasamy
DOI:10.4103/ipj.ipj_22_20  
Background: Insight is awareness of one's symptoms, illness, and need for treatment. In bipolar disorder, insight is better in bipolar depression and nonpsychotic depression when compared with mania and psychotic depression. Insight impacts on medication adherence. In our study, we measured and compared with various clinical parameters of insight. The aim of this study is to assess various dimensions of insight recovery prospectively in bipolar affective disorder patients with treatment and drug compliance. Materials and Methods: Patient's insight was assessed using Mood Disorder Insight Scale (MDIS) at baseline, 1st, 3rd, and 6th months. Their insight was then compared with various sociodemographic profiles and correlated with number of mood episodes, family history of mental illness, and 6-month MDIS scores. Results: Depression patients scored better in insight components (P = 0.001). The good compliance group attributed their symptoms to their illness than the poor compliance group (P = 0.013). The MDIS scores were gradually improving from baseline to 6 months (P ≤ 0.001). There was no relationship between insight and the number of episodes (P = 0.788). Conclusion: Depressive episode patients had better insight during the baseline, which improved during 6 months follow-up compared with manic patients. Among various components of insight, insight on the attribution of symptoms was a predictor of good compliance. Progression of insight was steady and proportionate to the duration of treatment in depressive episode patients.
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Is age just a number: Exploring fear, anxiety, and coping in individuals during COVID-19 p. 293
Sonali Jain, Shweta Jha
DOI:10.4103/ipj.ipj_183_20  
Introduction: The current pandemic coronavirus (COVID-19) is a novel disease with no standardized course of treatment and cure. This novelty, origin, and dispersion of COVID-19 have been reported to cause chaos, anxiety, and fear among the general population. Aim: The present study aimed to explore the correlation between different age groups, in relation to their general coping strategies, fear, and anxiety due to COVID-19. Methodology: The research study employed a total sample of 135 participants. The sample was divided into four age groups: 12–18, 19–25, 26–55, and 56–85. Participants were selected through convenience sampling. General coping strategies employed by these participants were assessed using a brief COPE scale, the COVID-19 fear scale was used to assess fear, and coronavirus anxiety scale was used to screen anxiety. Results: Our results indicated that age has a negative correlation with adaptive coping and positive correlation with problem-focused coping, emotion-focused coping, and fear of COVID-19. The most used coping strategy among the age groups 12–18 and 19–25 age group was adaptive coping; for the 26–55 age group, it was problem-focused coping; and for the age group 56–85, emotion-focused coping was used the most. Conclusion: The findings of the current research could help to make the intervention procedure tailor-made for different age groups, thereby ensuring adherence and relatability to the precautionary directions.
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Anxiety level among government employees admitted to dedicated COVID-19 hospital p. 298
Arun Kumar Yadav, Gaurav Yadav, D Ravi, Ram Sagar, Kalpana Srivastava, Jyoti Yadav, Reema Mukherjee
DOI:10.4103/ipj.ipj_231_20  
Introduction: Patients of COVID-19 patients while in a hospital may have stigma, fear, and guilt among them. However, the data on anxiety among the admitted COVID-19 patients are lacking in India and elsewhere. Hence, the study was conducted among the admitted patient of COVID-19 to describe their anxiety status. Methods: The study was conducted as a cross-sectional study in a designated COVID-19 hospital in Delhi. The data were collected from October 22, 2020, to November 21, 2020. All patients who were admitted to the hospital for more than 72 h were eligible for participation. The data collection was done using a questionnaire. The questionnaire consists of two parts. One part was sociodemographic variables, and the other part was the Anxiety Scale. The anxiety score was collected on the Zung Self-Rating Anxiety Scale. Results: A total of 132 eligible patients were admitted during the period. The questionnaire was answered by 122 (92.4%) patients. All patients were male. The patients' mean age was 33.5 years (standard deviation = 8.9 years), with a range of 21 years–65 years. The mean score of the Zung Self-Rating Scale was 29.5 (7.2), with an interquartile range of 24–33. There were only five patients (4.4%; 95% confidence interval: 1.3%–9.3%) whose scores were 45 or more, indicating mild-to-moderate anxiety. There was no statistically significant association between any sociodemographic variable and Anxiety Rating Scale. Conclusion: The anxiety level in the specialized population was low due to social security. The level of anxiety among health-care workers may be further explored.
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Role of comorbid depressive symptoms on the cognitive deficits in obsessive compulsive disorder p. 302
Anwesha Mondal, Manish Kumar
DOI:10.4103/ipj.ipj_73_19  
Background: Obsessive compulsive disorder (OCD) is a chronic distressing condition that is marked with impairment in daily functioning including social, family, and occupational areas of life. Depression is the most common comorbidity among patients with OCD. The presence of co-occurring depressive symptoms adds to the burden of the OCD. Previous studies with neuropsychological testing reveals a pattern of cognitive deficits among patients with OCD. Few studies have also shown that the cognitive deficits in OCD are mediated by comorbid depressive symptoms. Objective: The objective of this study was to assess whether the comorbid depressive symptoms have any role on the cognitive deficits in OCD. Methodology: Forty patients diagnosed with OCD with an elevated rating in Beck Depression Inventory (BDI) and 20 normal controls were chosen for the study. The forty patients were split according to the severity scores of BDI as per one group consisting of patients with only mild depression and other group consisting of patients with moderate and severe depression. Yale–Brown Obsessive Compulsive Scale has been administered to assess the severity and symptoms of the disorder. Digit Vigilance Test and Triads Test have been administered to assess attention; Comprehensive Trial Making Test (CTMT) and Rey Complex Figure Test have been administered to assess attention, executive function, and memory. Results: OCD patients have significantly performed poor than the normal controls. On further analysis, OCD patients with moderate and severe depressive features have performed poor than the patients with mild depressive features on the tests administered for attention, executive function, and memory. On assessing the role of comorbid depressive features on cognitive deficits, having mild depressive features were not found to be significantly correlated to the cognitive deficits, whereas patients having moderate and severe depressive features were found to be significantly correlated to the cognitive deficits among OCD patients. Conclusion: The findings suggest that the higher level of depressive symptoms is associated with cognitive deficits in OCD patients. It can be suggested that the comorbid moderate-to-severe depressive symptoms play an important role in the cognitive deficits found among the OCD patients.
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The experiential impact of isolation and quarantine on patients during the initial phase of the COVID-19 pandemic in India p. 310
Krishan Kumar, Shweta Jha, Mahendra Prakash Sharma, Rajni Sharma, Shubh Mohan Singh
DOI:10.4103/ipj.ipj_178_20  
Background: Most countries around the world have been affected by the COVID-19 pandemic. Although there are quantitative studies on the effects of the COVID-19 pandemic on health-care professionals and other population groups, there are few studies that have evaluated the experiences of patients in the initial phases of the pandemic. Aim: This study aims to conduct a qualitative study assessing the experiences of the patients in isolation and quarantine in the initial stage of the COVID-19 pandemic. Methodology: The present study was a qualitative study through telephonic interviews with patients in isolation and quarantine due to COVID-19 from April 4 to 12, 2020. Patients in isolation had confirmed COVID-19 and were mandatorily admitted in specially designated COVID hospitals. Patients in quarantine were suspected to have COVID-19 due to symptoms or contact with confirmed patients with COVID-19. Results: The experiences could be classified as having psychological impact, interpersonal impact, social impact, behavioral changes and impact on occupational aspects. The experience was predominantly unpleasant and characterized by anxiety, stigma, ostracization, guilt, and worry about the future. Conclusion: The experiences of the individuals in both the groups emphasize the importance of addressing psychological stressors. It could be concluded that individuals and their families would accordingly benefit from effective interventions to deal with the negative experiences they have been through due to the present pandemic.
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Is psychiatric morbidity in chronic migraine associated with poor outcome: Experience from a tertiary care centrer p. 317
Vikas Mathur, Sirisha Komala, Dhiraj Jhamb, Jyoti Prakash, Manoj Somasekharan
DOI:10.4103/ipj.ipj_187_20  
Introduction: Chronic Migraine is defined as headache occurring on 15 or more days/month for more than 3 months, which, on at least 8 days/month, has the features of migraine headache. This constitutes 10%–15% of all migraine patients in a neurology clinic. Literature on psychological comorbidities of chronic migraine in India is scant and it will improve overall patient care once discerned. Aim: To screen for psychiatric comorbidities in chronic migraine patients. Subjects and Methods: A cross-sectional study was conducted to compare overall psychiatric morbidity of 100 patients of chronic migraine and control group of 100 healthy individuals. Results: Chronic migraine cases had more psychological disturbance in comparison to healthy control (61% vs. 4%). Psychiatric morbidity was more in patients with higher migraine disability assessment score (MIDAS) Scores and frequent relapses. Significant anxiety and depression was seen in women, higher age group and higher MIDAS Values. Conclusions: The prevalence of psychological distress in Chronic migraine was significantly more, implying that they experience more psychological distress than the general population. Identifying these will result in better patient care in addition to standard drugs.
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Quality of life and marital adjustment in spouses of schizophrenia patients p. 323
Samiksha Sahu, Swaleha Mujawar, Dikshita Garg, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_176_20  
Background: With the availability of potent antipsychotics, the prognosis of schizophrenia has improved. As a result, there is increasing interest in assessing the quality of life (QOL) and marital adjustment of patients with schizophrenia. However, there is a paucity of Indian data in this area. Aim: To evaluate and compare the QOL and marital adjustment in spouses of patients with schizophrenia and controls. Materials and Methods: This cross-sectional, hospital-based study comprised of consenting female individuals of the age group of 20–40 years. The study group included 30 spouses of male patients with schizophrenia (according to ICD 10-DCR) and control group included 30 age-matched spouses of male participants without psychiatric disorders. The participants were selected from the psychiatry ward and outpatient department and neighboring areas of the Dr. D. Y. Patil Medical College, Pune, India. Only couples married for at least 5 years were included in the study. Wives with a history of any major psychiatric or major medical disorders were excluded. All the participants were evaluated with a sociodemographic data sheet, the World Health Organization QOL (WHOQOL)-BREF, and the Marital Adjustment Questionnaire. The statistical analysis was done using descriptive frequency, Chi-square, and Mann–Whitney U-test. Results: Wives of patients with schizophrenia had significantly lower scores on psychological, social, and environmental domains of WHOQOL BREF and on sexual adjustment, social adjustment, emotional adjustment, and total score on the marital adjustment questionnaire as compared to the control group. Conclusion: Wives of patients with schizophrenia have lower QOL and marital adjustment compared to controls.
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Rehabilitation needs of patients with schizophrenia attending the general hospital psychiatric unit of a tertiary care hospital in South India p. 329
Priyadersini Moummourtty, Padmavathi Nagarajan, Ravi Philip Rajkumar, Charanya Kaliamoorthy
DOI:10.4103/ipj.ipj_180_20  
Context: Schizophrenia is a major psychiatric illness that is stressful for both patients and their families. Along with clinical improvement with medications, psychosocial rehabilitation is an essential part of treatment to improve functioning and quality of life. Aims: This study aims to assess the rehabilitation needs of patients with schizophrenia and to identify the association of these needs with demographic and clinical variables. Settings and Design: A cross-sectional descriptive design was used. The study was conducted in a general hospital psychiatric unit (GHPU) of a tertiary care teaching hospital. Subjects and Methods: The sample included 770 subjects (385 patients and 385 caregivers). A standardized self-administered questionnaire, the Rehabilitation Needs Assessment Schedule was used to assess the patients' rehabilitation needs. Statistical Analysis Used: Categorical variables were expressed as frequencies and percentages. Continuous variables were expressed in terms of mean with standard deviation or median with an interquartile range. The association between different rehabilitation needs was analyzed using the Chi-square test or Fisher's exact test. Results: The most common requirement was skill training rehabilitation needs (93.8%), followed by psychosocial modification rehabilitation needs (88%) and help for family members (87%). There were significant associations (P < 0.05) between age at onset of illness with employment, current living status with overall needs, and help needed by the family. Conclusion: The study found that 76.9% of the patients required help in at least one rehabilitation domain. The findings of the study have implications in planning and implementing rehabilitation programs.
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CASE REPORTS Top

Digital failure: An emerging reason of anger expression among adolescents p. 335
Manoj Kumar Sharma, Shweta Sunil, BN Roopesh, Preeti M Galagali, Nitin Anand, Pranjali Chakraborty Thakur, Priya Singh, SJ Ajith, Keshava D Murthy
DOI:10.4103/ipj.ipj_81_19  
Network connectivity can often lead to positive as well as negative mood states among regular Internet users. Recently, studies have mainly focused on the impact of Internet abuse/addiction on the various aspects of the individual, in terms of cognitive, emotional, behavioral, and interpersonal domains. However, one of the issues that is not much reported are the issues about what happens to the children who are not able to access the internet due to connectivity issues. Given this, the current article discusses two cases with negative emotional and behavioral manifestations of increased anger and frustration due to reduced Internet connectivity. This can help draw more research and attention to the need for increased cyber-literacy and incorporation of anger management programs into psychological interventions that address Internet Addiction.
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Noonan syndrome with somnambulism: A rare case report p. 339
Samiksha Sahu, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_84_19  
Noonan syndrome is an autosomal dominant, genetic, multisystem disorder with a prevalence of 1 in 1000–2500 live births. Characteristic features of the condition include distinctive myopathic facial features, hypertelorism, short and broad nose, webbed neck, and low set ears. About 10% of the subjects have auditory defects due to sensorineural hearing loss. The patient also has short stature, chest deformity (superior pectus carinatum and inferior pectus excavatum), widely spaced nipples, and delayed puberty. A rare psychiatric manifestation of somnambulism and somniloquy in a case of Noonan syndrome is reported.
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Delusion of pregnancy for 21 years in an elderly woman: A case report and review of literature p. 342
Devakshi Dua, Sandeep Grover
DOI:10.4103/ipj.ipj_62_19  
Delusion of pregnancy (DOP) is a rare phenomenon especially in the elderly, with only 22 cases being reported. In this report, we present a case of a 74-year-old female with DOP and depressive disorder. In this case, a diagnosis of persistent delusional disorder was considered as the DOP persisted even after resolution of depressive symptoms with the use of antidepressants, antipsychotics, and electroconvulsive therapy.
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Linezolid-induced serotonin syndrome p. 345
Anish Shouan, Rajeet Kumar, Vivek Lal, Sandeep Grover
DOI:10.4103/ipj.ipj_37_19  
Linezolid is an oxazolidinone antibiotic, which is a weak, reversible, nonselective monoamine oxidase A and B inhibitor; is known to increase serotonin levels, and has been implicated in the development of serotonin syndrome (SS). There is limited literature on the development of SS with linezolid, when used alone. In this report, we present the case of a 70-year-old female who developed features of SS while being treated with linezolid 600 mg twice daily for pneumonia. The SS in her case was managed with stoppage of linezolid, administration of cyproheptadine, and supportive measures.
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Neuroleptic malignant syndrome associated with the use of injection zuclopenthixol acetate p. 349
Anish Shouan, Ankit Kumar Sinha, Sandeep Grover
DOI:10.4103/ipj.ipj_49_19  
Zuclopenthixol is usually used in parental form to manage acute agitation and psychosis.[1] It has high affinity for dopamine D1 and D2 receptors. There are very few reports of Neuroleptic Malignant Syndrome (NMS) with use of zuclopenthixol monotherapy. In this case report, we present a 35 year old male with alcohol dependence, presented to the emergency with altered sensorium, fever and stiffness of limbs. He had history of receiving Injection Zuclopenthixol acetate 200 mg thrice over 24 hours. Within 12-14 hours of the last injection, patient developed features suggestive of NMS. On investigations he was found to have raised serum creatinine phosphokinase levels (839.9U/L; reference laboratory value: 26 to 308 U/L) and leukocytosis. In view of these features, he was diagnosed with NMS and was started on supportive management to address the dehydration and was given Thiamine 500 mg thrice daily. Additionally he was started on Tab. Bromocriptine 5 mg thrice daily and lorazepam 2 mg/day. With this intervention, his symptoms improved over the period of 1 week and tablet bromocriptine was tapered off, after 1 week of being asymptomatic.
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Self-injurious behavior in epilepsy p. 352
Neelam Rathi, Daniel Saldanha, Suprakash Chaudhury, Swaleha Mujawar
DOI:10.4103/ipj.ipj_94_19  
Self-injurious behavior (SIB) can be described as an act involving self-inflicted destruction of tissue, right away or over a period of time. Patients with epilepsy have to deal with an often chronic and unpredictable disorder leading to adversity in many psychosocial variables such as employment, stigma, and overall quality of life. The above factors contribute toward SIB in these patients. Behavioral problems occurring in people with epilepsy can range from aggressiveness, mood fluctuations to SIB. We report a 23-year-old male, married, educated up to 10th standard, referred from neurology department for psychiatric evaluation. The patient had gone to neurologist with the chief complaints of generalized tonic–clonic convulsions and was hospitalized for breakthrough seizure. There was a history of indulging in episodes of self-SIB since the past 8 months. He responded satisfactorily to adjustment of antiepileptic medication along with fluoxetine and low-dose risperidone. Early identification of such behavior in epilepsy patients should be done so that a holistic management is undertaken leading to better functioning and improved quality of life.
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SHORT COMMUNICATIONS Top

Caring for the COVID warriors: A healthcare's perspective in the challenging times p. 355
Rajiv Kumar Saini, Suprakash Chaudhary, M SVK Raju, Kalpana Srivastava
DOI:10.4103/ipj.ipj_167_20  
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Social media during corona pandemic p. 357
Sana Dhamija, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_123_20  
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COVID-19: Mass exodus of migrant workers in India, are we staring at a mental health crisis? p. 360
Shailaja S Patil, Shivakumar P Chaukimath
DOI:10.4103/ipj.ipj_102_20  
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Economic and psychological impact of COVID-19 lockdown: Strategies to combat the crisis p. 362
Jwalant Chag, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_120_20  
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ERRATUM Top

Erratum: The relationship between quality of life and social support among nurses: A cross-sectional study p. 369

DOI:10.4103/ipj.ipj_39_21  
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