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   Table of Contents - Current issue
January-June 2021
Volume 30 | Issue 1
Page Nos. 1-190

Online since Wednesday, June 30, 2021

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“SHAANT BHIM”: A simple algorithm for management of violent patients p. 1
Jyoti Prakash, Prateek Yadav, Kaushik Chatterjee, Suprakash Chaudhury, Kalpana Srivastava
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Application of pharmacogenomics in psychiatric practice: The road ahead p. 4
Prafull Mohan, YK Gupta, J Prakash
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Nurse with smile: Does it make difference in patients' healing? Highly accessed article p. 6
Kalpana Thakur, Suresh K Sharma
Smiling is a highly significant component of nurses' caring behavior. Nurses have to deal with too many people at workplace and interpersonal relation building is the key secret for quality work and also enhances job satisfaction. A genuine smile given by a nurse can do wonders as it conveys acceptance, builds trust and establishes inter-personal relationship. It also helps nurses to feel better and avoid anxiety or stress burnout in clinical situation. This paper of ours highlights the importance of nurses' smile in patients' recovery and important research literature to support smiling culture among health-care professionals.
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Trends and issues in community mental health programs in India: The Ranchi Institute of Neuropsychiatry and Allied Sciences experience p. 11
Deepak Kumar Giri, Suprakash Chaudhury, Prashanta Kumar Chakraborty
Psychiatric disorders are among the leading causes of disability the world over. With the World Health Organization, spearheading the crusade to incorporate the mental health component into primary health care, developing countries also have accepted the need for community care of patients with psychiatric disorders. Since independence various initiatives by the government has led to a significant change in the place of mental health care as part of the general health care. At the time of independence apart from mental hospitals, there was practically no organized mental health care. Since then General Hospital Psychiatry units and also Psychiatric Nursing homes have started. Currently, mental health issues are actively seen as part of the public agenda in the various forms. The overall effect has been the movement to recognize mental health as an important issue in the community and services to move beyond mental hospital care to care to the community. Majority of population in Jharkhand is residing in rural areas. Due to the lack of proper communications and infrastructure, Ranchi Institute of Neuropsychiatry and Allied Sciences (RINPAS) had started community outreach program way back in 1999. At present, these centers are running in four different areas of the state with great success. RINPAS experience shows that how even with resource constraints, quality services can be provided to unreached population.
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Does application of complexity theory simplify concepts of psychiatry: Analogies and insights p. 18
Jyoti Prakash, K Chatterjee, S Shankar
Scientific curiosity has not been able to explain the cause of psychiatric illness based on primarily biological or social paradigm. Available literatures were explored to understand causality of psychiatric illness from perspective of physics. Theory of complexity and other relevant theories were extrapolated to address these questions. Mental illness appeared to be a complex interplay of reductionism and emergentism, genetic and epigenetics, stress and the vulnerability or the core and the periphery. Mental illness displayed complex interaction between biological trait and environmental state.
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Adult attention-deficit hyperactivity disorder: From clinical reality toward conceptual clarity p. 23
Jyoti Prakash, K Chatterjee, S Guha, K Srivastava, VS Chauhan
There is ambiguity about the clinical picture and concept of attention-deficit hyperactivity disorder (ADHD) in adults. Relevant literature was extracted from various search engines, analyzed, and interpreted. Available literature suggests a significant prevalence of ADHD in the adult population affecting the quality of socio-occupational functioning. Inattentiveness was more commonly present than hyperactivity–impulsivity. Frequent comorbidities with other psychiatric disorders like anxiety disorders and substance use disorders were noted. Pharmacological management and psychotherapy have been found effective in its management. ADHD is a disorder across the lifespan and fairly prevalent among adults. Greater awareness and more research are required for a better understanding of Adult ADHD and its effective management.
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Coping with COVID: Cross-sectional study to assess the psychological impact and coping strategies utilized by Indian internet users during the lockdown of the COVID-19 pandemic p. 29
Virendra Vikram Singh, Priyadarshee Patra, Ankit Singal
Introduction: The sudden and extended lockdown imposed by the government as an attempt to break the transmission chain of COVID disrupted the lives and plans of many. The impact on mental health of people is variable depending on the appraisal of the situation and the resources and coping strategies. Aim and Objectives: The aim of the study was to know the impact on mental health and coping strategies used by internet users dealing with the COVID-19 pandemic and involved difficulties in India. Materials and Methods: The survey was conducted using Google doc application. Tools included Generalized Anxiety Disorder-7 (GAD-7) questionnaire, Patient Health Questionnaire (PHQ), and brief COPE questionnaire. Statistical Analysis: Descriptive statistics were used to assess the sociodemographic characteristics, GAD-7, PHQ-2, and brief COPE scales. The group differences were analyzed using appropriate parametric or nonparametric tests for the quantitative variable and Chi-square/Mc-Nemar's test for categorical variables. The data were analyzed using SPSS software. Results: Three hundred and twenty six responses were analyzed. Nearly 35.3% screened positive for anxiety disorder and 12% for major depression. Respondents who were screened positive for anxiety disorder used active coping, denial, substance use, behavioral disengagement, planning, and self-blame more often than those screened negative. Those screened positive for major depression used all the coping strategies similar to anxiety disorder except for active coping more often than those who screened negative. While females used adaptive coping more frequently than males, respondents those engaged in essential services employed maladaptive coping less often. Conclusions: Acceptance, positive reframing, and positive coping were the most often employed strategies, while denial, self-blame, and substance use were least often employed.
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Assessing caregiving burden among primary caregivers in a medical intensive care unit setup: Cross-sectional study p. 36
Santosh Iranna Ramdurg, Siddanagouda M Biradar, Pallavali Janardhana Reddy
Objective: Caregiver burden in caring patients in intensive care unit (ICU) settings are stressful and challenging place. Caregivers also play very important role in doctor–patient relationship. In India, there is a skewed trend in doctor–patient relationship. Without addressing caregiver's psychological issues, we may not able to deliver good medical services. “Caregiver burden in primary caregivers of patients admitted to medical ICU (MICU) was measured. Methodology: Its cross-section observational study. We collected the information from total of 100 caregivers whose patient got admitted to MICU. We took only one caregiver. We administered socio-demographic data, Zarit Caregiver Burden Interview (ZBI) for assessing burden in caregivers. Results: The mean age of the caregivers was 38 years with 66% males were being primary caregivers and mean age of education was 8.61 years. The mean duration of patient stay in hospital was 4.67 days with range of 4–18 days. Mean duration of illness in patient was 466 days with range of 4 days to 10 years. Mean score caregivers burden as per ZBI was 5.10 with range of 0–25. Thirty-five percentage of caregiver were felt caregiving was the burden. Correlation analysis shows ZBI negative relationship with caregivers' age and education and patients total duration of illness. There was a positive co-relationship with the duration of ICU admission. Conclusion: Higher burden was observed in caregivers and caregivers felt more burden if patients stays longer duration in ICU. More research is needed in this area.
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Role of age at onset in the clinical presentation of bipolar disorder in Indian population p. 41
Ajitabh Soni, Paramjeet Singh, Sunil Kumar, Raghav Shah, Lalit Batra, Manoj Verma
Objective: The objective of this study was to determine any association of age at onset (AAO) with clinical presentation of bipolar disorder (BD) and family history of illness. Materials and Methods: A hospital-based cross-sectional observational study was conducted including 162 patients having a diagnosis of BD current episode manic. Individuals were divided into three subgroups according to AAO, i.e., early-onset BD (EOBD) (AAO ≤21 years), intermediate-onset BD (AAO – 22–34 years), and late-onset BD (AAO ≥35 years). The subgroups were compared on clinical variables; items of the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and Scale for the Assessment of Positive Symptoms (SAPS); and family history of illness. Results: The early-onset group had significantly more episodes per year than the other groups (P < 0.001). The prevalence of family history of mood disorder was also significantly higher in the early-onset group than the other subgroups. AAO was found to be significantly associated with different items of YMRS, HAM-D, and SAPS. The early-onset group had higher rating on irritability, motor activity–energy, sexual interest, depressed mood, delusions, and thought disorders, whereas the late-onset group had higher rating on elevated mood. Conclusion: EOBD can be considered as a specific phenotype of BD, which is more homogenous, severe, and inheritable form of illness.
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Prevalence and health risk score of tobacco and alcohol use by using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test among construction workers in Puducherry, India p. 47
Jaswant Kumar, Ganesh Kumar Saya, Srikanta Kanungo
Background: Construction workers are one of the important neglected occupation groups. The study aimed to assess the prevalence and health risk score of tobacco and alcohol use and its association with sociodemographic factors and self-reported morbidities among construction workers. Materials and Methods: A cross-sectional study was conducted among 400 male construction workers in a tertiary care medical institution in Puducherry, India. A semi-structured questionnaire based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) guidelines for assessment and health risk score of alcohol and tobacco use was used. The association of current tobacco and alcohol use with associated factors was analyzed by univariate analysis. Results: About 371 male construction workers participated. The mean (standard deviation) age of construction workers was 28.28 (9.04) years. The prevalence of current tobacco and alcohol use was 60.1% (223/371) and 47.7% (177/371), respectively. Out of 133 smokers, 60.9% (81) were used only bidi, 27.1% (36) only cigarette, and 12% (16) both bidi and cigarette. Most of the workers (126/151 [83.4%]) used khaini among smokeless tobacco users. The majority (204/241 [84.6%]) of ever smokers and nearly half of alcohol users (103 [49.8%]) had moderate risk based on ASSIST score. Higher current tobacco consumption is associated with higher age group, married, lower education status, unskilled occupation, contractual workers, migrants from other states, more duration of work in construction field, and the presence of self-reported health problems (P < 0.05). Current alcohol consumption is associated with more duration of work in construction field and the presence of self-reported health problems (P < 0.05). Conclusions: Tobacco and alcohol use is high, and health risk due to substance use is also more in construction workers.
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Application of functional analytic psychotherapy to manage schizophrenia p. 55
Usri Sengupta, Amool Ranjan Singh
Introduction: Cognitive behavioral therapy (CBT) and third-wave CBT approaches have been shown to ameliorate symptoms of schizophrenia. However, this study uses the functional analytic psychotherapy which focuses on the environmental causes of behavior which includes the client's present environment as well as his history of past interactions with it, to bring about a change in the client and reduce the symptoms. This therapy has never been used earlier with patients having schizophrenia in India; therefore, it was taken up for this study. Methodology: A pre–post design with control group was used in the present study. Ten patients were taken. Positive and Negative Syndrome Scale for measuring symptoms of schizophrenia, Schizophrenia Quality of Life Scale for assessing quality of life, Coping Response Inventory-Adult form for assessing coping skills, Apathy Evaluation Scale-Clinician Version for assessing apathy, Family Adaptability and Cohesion Evaluation Scale for assessing perceived interpersonal relationship were used for assessment pre- and postintervention. Fifteen sessions were done with each patient within a period of 10 months at the rate of one session per week. Chi-square test, Wilcoxon signed-rank test, and Mann–Whitney U-test were used for the analysis of data. Results: Significant improvements were found in positive symptoms, general psychopathology, approach coping mechanisms, psychosocial and motivation domains in quality of life, and perceived cohesion in family among the patients postintervention. Conclusion: Functional analytic psychotherapy is an effective method for treating patients having schizophrenia with the application of its specifically modified rules for use with patients having psychosis.
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Assessment of quality of life in vitiligo patients attending a tertiary care hospital - A cross sectional study p. 62
Suman Baidya, Pranjal Dey, Rakesh Mohanty
Background: Vitiligo is a common form of localized depigmentation of skin which draws unusual attention to the patient especially when it is in visible areas of the body. The appearance of visible skin lesions and its chronic progression may cause a significant burden on patients' health-related quality of life and psychiatric morbidity may arise as a complication. Aims: An endeavor has been made to find out how the disease influences the quality of life of affected persons. Methodology: This was a hospital based cross sectional study. Clinically diagnosed eighty vitiligo patients were selected from dermatology outpatient department with purposive sampling method and compared them with those of healthy control group. In selected cases Dermatology Life Quality Index (DLQI) questionnaire was used for the assessment of quality of life. Also International classification of mental and behavioral disorders research criteria along with 17-item Hamilton Rating scale of Depression were applied to diagnose the presence of depression. Data were collected and “Chi Square Test” or “Fisher Exact t Test” was used. All analysis were done using SPSS version 20.0. Results: In this study 92.5% of the patients had elevated DLQI scores. We found higher DLQI mean score in vitiligo patients ( 9.68+5.24) compared to (1.36+ 1.37) of control and depression was significantly associated with the impairment of quality of life. Conclusion: Vitiligo patients have significant impairment in their quality of life and more in those who develops depression.
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Coping strategies and social support as moderators of occupational stress and mental health link among police personnel p. 67
Shweta Singh, Bandna Gupta, PC Mishra
Background: The occupation of police personnel is known to be enormously stressful. The occupational stress research shows that coping strategies and social support have a buffering effect on stress and a protective role on mental health. The present research study was set out to investigate the role of coping strategies and social support as moderating factors of the relationship between occupational stress and mental health in police personnel of Uttar Pradesh in terms of their ranking. Methodology: The present cross-sectional study was conducted using standardized questionnaires. The sample comprised a total of 300 male police personnel. Hundred constables, 100 inspectors, and 100 officers were incidentally selected from six districts of Uttar: Lucknow, Varanasi, Meerut, Raebareli, Ghaziabad, and Noida. Results: Study results showed coping strategies and social support to have a moderating effect on the relationship between stress and mental health in inspectors and officers but failed to show such relationship in constables. Conclusion: There is the implication for the training in terms of teaching-specific active and adaptive coping strategies for the management of workplace-related stress and promotion of health and well-being in the police personnel.
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Rorschach inkblot test and psychopathology among patients suffering from schizophrenia: A correlational study p. 74
Anwesha Mondal, Manish Kumar
Background: Rorschach test has been considered a well-known and most widely used projective test for the assessment of personality and diagnostic evaluation in various psychiatric disorders. Schizophrenia is considered to be the major psychiatric illness characterized by gross distortion of reality, the disorganization and fragmentation of perception, thought, emotion, and withdrawal from social interaction. Rorschach provides both specific and general knowledge about the different areas of personality functioning, such as coping style, emotions, managing stress, mediation, ideation, self-perception, and interpersonal relationships along with correlating with the psychopathology of the schizophrenia patients. Aim: The aim of the present study is to assess the relationship between Rorschach response pattern different symptoms in schizophrenia patients. Methodology: After having informed consent, 100 patients of schizophrenia group were included as per the International Classification of Diseases 10th Revision Diagnostic Criteria for Research (ICD-10 DCR) criteria. Information about sociodemographic data and clinical details was collected using the sociodemographic and clinical data sheet from the drawn sample. For the assessment of symptoms of schizophrenia patients, Scale for the Assessment of Positive Symptom and Scale for the Assessment of Negative Symptom have been used. After that Rorschach test was administered individually to all the participants to assess the personality structure of each schizophrenia patients. Results: The results showed that there is a significant positive and negative correlation among positive, negative schizophrenia symptoms, and different Rorschach variables. Conclusion: Schizophrenia patients having positive and negative symptoms would be giving Rorschach variables indicative of moderate level of cognitive distortions, poorly controlled and disorganized affect, less conventional form of responses, poor perception and loss with reality, poor interpersonal relationships, presence of anxiety, and aggression.
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Alarming rates of psychological problems among caregivers of pediatric kidney patients admitted during the COVID-19 pandemic lockdown p. 84
Rajni Sharma, Krishan Kumar, Rakesh Pilania, Lesa Dawman, Navpreet Kaur, Rahul Sharma, Karalanglin Tiewsoh
Introduction: Caregivers of children with comorbidities suffer from various psychological problems. We envisage more such complications during this COVID-19 pandemic. Methodology: A cross-sectional study to assess psychological issues in caregivers of children with kidney diseases, admitted during lockdown period in India was done. Psychological tools including Peritraumatic Distress Inventory (PDI), Insomnia Severity Index, Depression Anxiety Stress Scale (DASS II), Positive and Negative Affect Schedule (PANAS) and a new “COVID Stress Survey Questionnaire” were used. Standard statistical analysis using SPSS Statistic 23 (IBM SPSS Statistics, New York, United States) was done. Results: Forty-seven caregivers (33 mothers; 14 fathers) were included. Of these, 33 (70.2%) experienced psychological distress. On PANAS, 45 (95.7%) scored below cut off on a positive affect and 42 (89.4%) scored above cut off on a negative effect. The DASS II score revealed that 38 (80.9%) reported mild stress, 23 (48.9%) severe anxiety, and 37 (78.7%) had moderate depression. Upper middle socioeconomic status caregivers reported more insomnia. Further, parents of children with acute kidney injury (AKI) or prolonged hospital stay scored higher on subjective distress and aversive feelings. Conclusion: We observed an alarming level of distress, insomnia, and anxiety among caregivers, more so in upper middle socioeconomic status, children with AKI and prolonged hospital stay. We suggest due counseling should be done.
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The prevalence of depression among the elderly people living in rural Wardha p. 90
Sourav Goswami, Pradeep R Deshmukh
Background: Depression is the most common psychiatric disorder among elderly population in India, which generally remains undiagnosed and undertreated. Exact burden of depression among the elderly population in rural India was not known. Aim: This study was conducted to determine the prevalence of depression among the elderly population in rural population of Wardha, Maharashtra. Materials and Methods: This is a cross-sectional study carried out among the elderly (≥60 years) population of both sexes residing in the field practice area of the department of community medicine. Geriatric depression scale was used for screening depression among the study population. Data collection was completed within 2 months using convenience sampling. Ethical approval was taken before beginning the study. Magnitude was expressed in percentage along with its 95% confidence interval (CI). Univariate and multivariate logistic regressions were done. Odds ratio and 95% CI were used to express association. Results: Magnitude of depression among the elderly population was found to be 41.7% (95% CI: 36.1–47.4). In this study, we found the following factors to have positively contributed towards depression among elderly population in rural Wardha: female sex, widowed, separated, divorced, decreased decision-making capability, abused, or being suffering from chronic illnesses. Conclusion: Our study showed the prevalence of mild depression to be 26.72% and that of severe depression to be 15.17% among the elderly study participants.
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A community-based study of prevalence and functional status of major depressive disorder in an industrial area p. 96
Daniel Saldanha, Swaleha Mujawar, Suprakash Chaudhury, Amitav Banerjee
Background: Depression is a significant public health issue that needs to be taken care of, as it poses a great economic burden on the society at large. Early identification and treatment of the patients will reduce mental morbidity and disability. Aim: The aim is to study the prevalence and functional status of subjects with major depressive disorder in the community. Materials and Methods: After identification of the sample population, the sociodemographic details were recorded. Subsequently, assessment was carried out by General Health Questionnaire (GHQ), Patient Health Questionnaire-9 (PHQ-9), Functional Status Questionnaire (FSQ), and Mini Mental State examination (MMSE). Results: A total of 2000 subjects were screened using the GHQ and PHQ and 544 subjects were selected. These 544 subjects were further assessed with FSQ and MMSE. Out of the 544 subjects, 65.1% had a GHQ score of <14, 22.1% had a score between 15 and 19, and 12.9% had a score of >20. The PHQ-9 score was found to be <5 in 28.9% subjects, 5–14 in 64.3% subjects, and >14 in 6.8% subjects. Majority of the sample population was in the warning zone according to the FSQ. The MMSE scores were ≥23 in 86% and ≤22 in 14% of the patients. Over 65% of the subjects were relatively mentally healthy. Out of the remaining 35%, 22% of the subjects required screening for psychiatric disorders and 13% of them did require active psychiatric intervention. Conclusions: It would be beneficial to the community if a database is created regarding the psychiatric disorders such as depression prevalent in the community and their functional status so that the effective measures can be implemented to minimize the suffering by providing effective psychiatric care at the earliest and follow them up in the long run.
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Absence of undergraduate medical students from psychiatric training: A study from central India p. 102
Kshirod Kumar Mishra, Alka T Rawekar, Ahmed Mushtaq Reshamvala
Background: Psychiatric problem is as common as among the 25% of the general population and 15% patients attending specialty clinic. Majority of the cases are dealt by primary care physician at the first contact, but there is only 2 weeks of clinical posting and 20 h of theory classes during MBBS course. Earlier studies have reported low attendance during the posting and theory classes. There are few studies on this aspect. On this background, the present study was planned. Methodology: One hundred 8th semester students of MBBS from two medical colleges (Group A government aided college and Group B from Private college under autonomous university) from the same locality of Central Maharashtra were selected for the study after due approval by the Institutional Ethical Committee. Questionnaire was prepared by the psychiatric faculty of both institutes and administered to the individual students. The data were analyzed using suitable statistical methods (Chi-square test and t-test). Results: Only 27% of the students in Group A attended 25%–30% of clinical posting, whereas none of them attended a single theory class. While in Group B, 1/3rd of students attended 30%–40% of clinical posting and 20%–25% of theory class. No separate examination in the subject (88%–94%) and adjustment of attendance in the other major subjects (64–86%) were cited as main reasons for nonattendance among the majority of the students in both the groups. Conclusion: Strict adherence to the attendance by the institutional authority, increase in the training hours and separate examination in the subject at undergraduate level may help in improving the attendance and change in attitude of the students toward psychiatry.
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Behavior of general population toward mentally ill persons in digital India: Where are we? p. 106
Abhishek Bharti, Harpreet Singh, Deepak Singh, Vipin Kumar
Background: We aimed to find out the overall reported and intended behavior of the general population of India toward mentally ill persons. Materials and Methods: Participants were included in an online survey using a nonprobability snowball sampling technique. After taking informed consent, sociodemographic details were recorded, and the “Reported and Intended Behaviour Scale” was administered. Results: Out of 818 responses, 684 responses were eligible for study after exclusion. The mean age (standard deviation) of the study population was 31.01 (7.79) years. Maximum participants reported that they did not live (76.6%), did not work (75.7%), did not live nearby (66.4 %), or have not had a close friend (79.8%) with mental health problems. However, most individuals neither agreed nor disagreed to live (48.5%), work (38%), and live nearby (42.7%) a mentally ill person, but maximum individuals strongly agreed to continue a relationship with a friend having mental health problems (34.5%). There were 77.5% males and 32.2% healthcare workers. Regarding intended behavior, there was a significant difference between healthcare workers and persons other than these as well as between males and females. Participants who had previous interaction with the mentally ill person were more willing to interact with the same. Conclusion: Most people do not intend to have stigmatized behavior toward mentally ill persons. Healthcare workers and males have less negative social reactions toward mentally ill persons in different domains of life. However, there is still a need to intensify awareness about mental health.
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A study to understand the pattern of hyponatremia in patients using selective serotonin reuptake inhibitors and serotonin dopamine antagonists p. 113
Love Kumar Tomar, Priyadarshee Patra, Ankur Nigam
Introduction: Hyponatremia can be a common but often overlooked side effects of psychotropics drugs. Most patients with drug-induced hyponatremia are asymptomatic and diagnosis is made incidentally following routine blood tests. Objectives: The aim of the study was to understand the pattern of hyponatremia in patients using selective serotonin reuptake inhibitors (SSRI) and serotonin dopamine antagonists (SDA). Materials and Methods: All inpatients and outpatients who were diagnosed with International Classification of Diseases-10 psychiatric disorders and undergoing treatment with SSRI, SDA, or combination of both for the same, were included in the study after simple random sampling, subject to inclusion and exclusion criteria. Statistical Analysis Used: Categorical variables were observed as numbers and percentages. Continuous variables were evaluated as mean ± standard deviation. A Chi-square test was done to find the association between categorical variables. SPSS (IBM) version 21 was used for data analysis. Results: In 150 patients, we found hyponatremia in 17 patients (11.33%). About 66–75 age group patients had maximum found cases of hyponatremia (66.66%). About 20.31% of females found hyponatremia. Among SSRIs, 16% of individuals had hyponatremia whereas among SDA it was 6%. Patients who were taking both SSRIs and SDA total prevalence of hyponatremia was 12%. Conclusions: Older age groups and females had higher chances of hyponatremia while taking SSRIs and SDAs. Among SSRIs, escitalopram had maximum percentage of hyponatremia, whereas fluvoxamine had minimum. Among SDAs, risperidone had maximum percentage, whereas quetiapine had minimum percentage of hyponatremia. Patients who were taking both fluoxetine + olanzapine or fluoxetine + risperidone had higher percentage of hyponatremia.
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Perceived stigma among the patients of coronavirus disease-19 admitted at a dedicated COVID-19 hospital in Northern India: A cross-sectional study p. 118
Arun Kumar Yadav, Vishal Mangal, Ravi Devarakonda, Kalpana Srivastava
Background: Coronavirus disease-related stigma started early in the pandemic with multiple media reports highlighting the discriminatory practices toward the health-care workers, patients, and survivors. Materials and Methods: A cross-sectional study was conducted in a designated COVID -19 hospital in Delhi from 22 October 20 to 21 November 20. All patients admitted to the hospital for more than 72 h were eligible for participation in the study. Anyone without a mobile phone and not able to read was excluded from the study. The data were collected using a pretested, prevalidated questionnaire. Results: One hundred and twenty-two (92.4%) patients answered the questionnaire. All patients were male. A total of 54 (44.26%: 95% confidence interval [CI] 35.3–53.5) COVID-19 patients blamed themselves for getting the infection, compared to 68 (55.74% 95% CI: 46.5–64.7) patients who believed that acquiring the disease was not their fault. There was a statistically significant association between feeling ashamed and blaming themselves for COVID-19 (P = 0.046). A total of 19 (15.6%) have reported that they have been told that getting COVID-19 is your fault. Conclusion: The stigma related to COVID -19 needs to be tackled with multipronged strategy. In India, it is not a routine to assess mental health; however, the current pandemic has brought forward the importance of stigma and other related issues during the pandemic.
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Postexposure psychological sequelae in frontline health workers to COVID-19 in Andhra Pradesh, India p. 123
Keya Das, V S S. R. Ryali, R Bhavyasree, C Madhu Sekhar
Introduction: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 has engulfed the globe since December 2019. Healthcare workers remain at the forefront of this battle, and like prior pandemics face mental health challenges along with physical risks. We aimed to study the perceived stress and possible posttraumatic stress in the frontline workers exposed to active COVID-19 duties in the state of Andhra Pradesh, India. Methodology: A special voluntary, anonymous, survey-based Google questionnaire was designed with mandatory consent form and queries to clarify inclusion exclusion criteria. Tools included valid, reliable self-administered scales, namely General Health Questionnaire 12, Perceived Stress Scale and Impact of Events Scales-Revised. A purposive sampling method was adopted, by posting the survey questionnaire on WhatsApp groups of doctors, interns, and nurses working on active COVID-19 duty in Andhra Pradesh. Results: About 69.7% of the frontline workers recorded higher perceived stress and definitive posttraumatic stress disorder (PTSD) was found in 34.8%, with psychological distress recorded in 53%. Conclusion: The higher levels of perceived stress discovered in the vast majority with definitive PTSD features in a third of the sample indicates the need for provision of mental health support proactively among frontline workers on active COVID-19 duty.
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A study of emotional states in candidates undergoing the diagnostic process for COVID-19 p. 131
Sanjana Kathiravan, Kirtan Rana, Meha Verma, Krishan Kumar, Ritin Mohindra, Shubh Mohan Singh
Background: Waiting for results is often associated with a state of anxiety and restlessness. The current study is intended to study the emotional state of people waiting for their results after undergoing COVID-19 testing. Methods: A descriptive study was done among 140 participants enrolled by simple random technique over a period of 1 month in May 2020. The participants who gave sample for COVID-19 were assessed for their emotional state at two stages – after giving sample and during the waiting period before telling results to them. A self-designed questionnaire focusing on the demographics and emotional state was submitted by the participants distributed to them as Google Forms. Wilcoxon signed-rank test and McNemar test were used to compare the statistical change in emotions over a period of time. Results: Around 63.6% and 68.8% of the participants had neutral emotional state after giving sample and before announcement of results, respectively. The mean score of agreement with decision to test was 9 ± 1.6 and discomfort related to testing was 4.6 ± 2.6 on Likert scale of 1–10. A statistically significant difference (P = 0.01) was observed in mean response for “something can be done to help” after giving sample (1.6 ± 0.4) and before announcement of results (1.8 ± 0.3). Conclusions: Patients undergoing testing for COVID-19 undergo psychological turmoil and use various coping methods. Patients endorsed various suggestions including quicker generation of results, environmental changes and counselling services to help them cope better. Incorporating these suggestions may improve the diagnostic process in patients with COVID-19.
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Effect of four weeks of integrated yoga intervention on perceived stress and sleep quality among female nursing professionals working at a tertiary care hospital: A pilot study p. 136
Niranjan Parajuli, Balaram Pradhan, Mansingh Jat
Background: Studies have reported that significant nursing professionals experience tremendous stress which often affects their sleep quality leading to poor well-being. Yoga being a mind body intervention reported to improve sleep quality and reduce stress. Aim: The present pilot study was designed to assess the effect of yoga on perceived stress and sleep quality of the female nursing professionals working at tertiary care hospital. Materials and Methods: Thirty-three apparently healthy nursing staffs in the age range of 30–60 years (mean age 40.60 ± 10.26) were recruited as participants of the study, from a tertiary care hospital in Delhi. Participants were administered perceived stress scale (PSS) and Pittsburgh sleep quality index (PSQI) before and after the yoga intervention. Participants received 4 week of yoga intervention for 45 min/day for 5 days a week. Results: There was a significant reduction on the postscores of PSS (t = 5.86, P < 0.0001, paired t-test) and PSQI (z = −4.38, P < 0.0001, Wilcoxon signed-ranks test) in comparison to prescores. After the yoga intervention, perceived stress reduced by 27.01% and the sleep quality improved by 38.68%. Conclusion: The finding of the study suggests effectiveness of yoga in reduction of the perceived stress and improvement of the quality of sleep of the nursing professional. However, the present findings need to be confirmed with further studies with larger sample size and robust research design.
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Impact of mindfulness-based therapy on psychological characteristics of juveniles in conflict with law in India p. 141
Maria Madiha, Deoshree Akhouri
Background: According to National Crime Records Bureau, India, there has been a significant increase in criminal activities among juvenile over the past 3 years, especially in Uttar Pradesh in comparison to other Northern States. Various management strategies have been undertaken for such adolescents. However, there is a lack of management strategies in the Indian context for juvenile in conflict with law. Thus, this research work aims to see the effect of mindfulness-based therapy (MBT) on juveniles in conflict with law and not in conflict with law. Aim: The aim of the study was to see the effect of MBT on juveniles in conflict with law and not in conflict with law; to assess and compare the effect of MBT on their temperament, aggression, emotional quotient, and social quotient; and to see the effect of MBT on their level of mindfulness. Methodology: A total 25 adolescents of 13–19 years of age, both genders, literate and illiterate belonging from rural and urban population were included for the study. Among these, 17 juveniles in conflict with law were taken from District Child Protection Unit and eight juveniles not in conflict with law were taken from general adolescent population. After explaining the purpose of the study and attaining the consent from guardians, assessment was done using different psychological tools. MBT was used for the management. The pre-postresearch design was used. Results and Conclusion: Results obtained in this study are suggestive of that MBT is a fruitful management technique for juveniles in conflict with law serving in observation homes as well as for juveniles not in conflict with law.
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Multiple cross-sectional assessments of empathy in medical undergraduate students p. 147
Ramadugu Shashikumar, Kruti Agarwal, Aiman Mohammad, Chatterjee Kaushik
Introduction: Empathy a cognitive phenomenon, with affective and behavioral components; helps improve clinical competence. It varies depending on physicians' gender and specialty. While some western studies reported significant fall in empathy levels when they progressed from non-clinical to clinical training years, Asian studies including Indian had varied results. We hypothesize that empathy will decrease among medical undergraduates over four years while they progress from non- clinical to clinical rotations and that female medical students and those opting for clinical specialties will have higher empathy than male medical students and those opting for non clinical specialty. Methodology: This study was carried out in a medical college from the year 2012 to 2015. Each year at the beginning of academic session all students were asked to complete Jefferson's -Scale for Physician's Empathy (JSPE student) student version. Over next three years similar assessments were repeated for all batches. The results were tabulated and analyzed using EpiInfo7 software. Results: Over four years 481, 416, 412 and 354 medical students in 1st, 2nd, 3rd and 4th year respectively from seven different batches were evaluated. Choice of specialty differed significantly in each year different batches. The empathy score had no relation to gender or choice of specialty. Empathy declines from first year onwards till third year but is not statistically significant. Conclusion: In this large multiple sample cross sectional study, it is evident empathy drops from 1st to 3rd year therefore there is an urgent need to evaluate why empathy falls.
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Critical appraisal of journal article by psychiatry PG residents using a new module: Impact analysis p. 153
Pookala Shivaram Bhat, Amit Chail, Kalpana Srivastava
Background: A gap exists from evidence-based medicine (EBM) to clinical practice and there is a felt need to bridge this. Critical appraisal of scientific articles during Journal club by postgraduate (PG) residents will help them to understand and apply the scientific evidence into best clinical practice. Hence, a new module of critical appraisal of journal articles was used for Psychiatry Residents in a Medical College and its impact was assessed. Materials and Methods: Nine psychiatry PG residents from three academic batches participated in the study after informed consent and Institutional ethical committee clearance. They were trained in the Colorado Psychiatry EBM Examination Test module. Subsequently, three consecutive journal article presentations of them were assessed under seven Subtests of the module. Results: There was gradual increase in the assessment scores of all PG residents with each journal article presentation. They also expressed satisfaction of the assessment method and felt confident of applying the principles of critical appraisal in their clinical practice in future. Conclusion: This study evaluated the impact of a new module of critical appraisal of journal article by psychiatry PG residents. It was found to be acceptable by residents and improved their competency to apply literature-based EBM into their clinical practice. It is recommended for further multicentric evaluation on a larger sample.
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Social cognition in siblings of patients with bipolar disorders p. 157
Swati Choudhary, BN Subodh, Sandeep Grover
Background: Identifying people at risk of developing bipolar disorder (BD) using endophenotypes is of recent interest. Few studies on social cognition in first-degree relatives of patients with BD have shown inconsistent findings. This study aimed to evaluate the social cognitive deficits (SCD) and its correlates among siblings of patients with BD. Methodology: In this cross-sectional study, patients of BD (n = 32), their siblings (n = 32), and healthy control (HC) subjects (n = 38) matched for age, gender, and education were evaluated on social cognition rating tools in Indian setting and neurocognitive tests (color trail test, Wisconsin card sorting test [WCST], and Hopkin's verbal learning test [HVLT]). Results: When the siblings of patients with BD were compared with patients with BD and the HCs, siblings (mean 0.6 [standard deviation [SD]: 0.2]) performed worse than the HCs (mean 0.9 [SD: 0.1]) (P ≤ 0.001) on the Faux pas composite index. Compared to HCs, siblings performed worse on all the subtests of HVLT (Trial delayed) (P < 0.001) and WCST (total correct, total errors, and conceptual responses) (P < 0.001). Conclusion: Presence of elevated level of SCD among siblings, especially the Faux pas composite index in comparison to HCs, imply that these are stable traits, which are more often present in the patients and at risk individuals. This implies that SCD can be considered as another important endophenotype for BD.
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Psychiatric morbidity in patients with idiopathic Parkinson's disease: A cross-sectional study p. 165
Santhosh Kumar, Ajit Avasthi, Manish Modi, Sandeep Grover
Objective: To evaluate the prevalence of psychiatric comorbidities in patients with idiopathic Parkinson's disease (IPD). Methodology: Two hundred and thirty-nine patients with IPD were evaluated on Mini-International Neuropsychiatric Interview PLUS (MINI-PLUS). In addition, patients found to have depression as per the MINI-PLUS were evaluated on Beck Depression Inventory. Results: One hundred and thirty-five (56.5%) patients had a current psychiatric diagnosis and 59.8% had a lifetime psychiatric diagnosis. As per MINI-PLUS, about two-fifth (39.7%) of patients had suicidality. In 18.8% of patients, suicidality was present in the absence of axis-I psychiatric diagnosis. Among the various psychiatric disorders, the most common disorders included depressive disorders (current: 17.5%; lifetime: 23.8%), anxiety disorders (current: 17.5%; lifetime: 17.5%), and psychotic disorders (current: 11.3%; lifetime: 11.7%). Conclusions: More than half of the patients with Parkinson's disease have psychiatric disorders. High prevalence of psychiatric morbidity calls for close liaison between the neurologist and the psychiatric disorders.
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Coping with the aftermath of COVID: Industrial resurgence, mental health, and resilience p. 175
Kaushik Chatterjee, Ankit Dangi, Jyoti Prakash, Kalpana Srivastava, Vinay Chauhan, Prateek Yadav
COVID-19 pandemic has affected billions of people worldwide. Economies world over have suffered slowdown with a direct impact on industry. The vulnerable industrial worker has suffered both financially and mentally. As the pandemic has begun to slow down, the industry has started showing signs of growth and economy appears to be coming back on track. Financial losses may be recovered in time, but the mental health impact of pandemic is likely to be long-lasting. In the aftermath of COVID-19, mental health needs of vulnerable sections of societies need to be addressed. An attempt has been made to understand the mental health impact of COVID-19 pandemic on industrial workers. Preventive and promotive measures for positive mental health of industrial workers are discussed with a focus on resilience-building.
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Management of obsessive–compulsive disorder with virtual reality-based exposure p. 179
Devakshi Dua, Gopika Jagota, Sandeep Grover
Little information is available about use of virtual reality exposure for management of obsessive compulsive disorder (OCD). We present a patient with OCD, who presented with significant dysfunction related to his OC symptoms and was managed with virtual reality based exposure therapy. A 27-year-old male, presented with a history suggestive of OCD for last 8 years. His symptoms were characterized by obsessive images of known people, leading to significant anxiety and distress. To get rid of his anxiety and distress, he would repeat the acts at hand, multiple times till these images would subside or till he would be able to replace these images by desirable images. These symptoms led to marked socio-occupational dysfunction. The treatment history was suggestive of minimal response to adequate trials of multiple selective serotonin reuptake inhibitors and he was on capsule fluoxetine 80 mg/day at the time of presentation. Exposure and Response therapy was tried in the past by using imaginal exposure, but this was unsuccessful, as the patient would avoid imagining the anxiety-provoking images. Hence, he was exposed to the anxiety provoking images by using virtual reality which involved presenting him with videos containing pictures of known and unknown people arranged randomly, along with the anxiety-provoking images. Over a period of 2 months, 60 sessions of ERP were carried out and the whole hierarchy was completed. This case demonstrates that virtual reality can be used in behaviour therapy for OCD, by using virtual reality techniques, and there is a need to develop software and programs for assessment and management of OCD.
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Seeing the National Education Policy 2020 through the lens of early child development p. 182
G Fatima Shirly Anitha, Udayakumar Narasimhan
Globally there is a revolution in science with digitalisation and artificial intelligence. A country's investment in education is crucial to manage the knowledge economy. Early childhood education is the foundation for future academic success and life skills. India's third National Educational Policy emphasises on improving the quality of early learning. This curriculum aligns with the basic theories and stages of early child development, which if effectively implemented leads to holistic development and learning.
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The impact of working in a COVID hospital on sexual functioning in male nurses: A study from North India p. 187
Mahendra Kumar, Ritin Mohindra, Khina Sharma, Roop Kishor Soni, Kirtan Rana, Shubh Mohan Singh
Introduction: The COVID-19 pandemic has spread to almost all the countries and regions in the world. The fear of getting infected while serving COVID patients and the stress due to separation from family during the quarantine period may impact over sexual functioning of healthcare workers (HCWs). Methodology: The study protocol was approved by the institutional ethics committee. This was a nonfunded, cross-sectional, observational study. All participants provided written informed consent. This study was carried out in a multispecialty tertiary teaching hospital in North India. The participants were drawn from married and living with partner male nurses. Sexual functioning was assessed using the changes in sexual functioning questionnaire short-form (CSFQ-14). Results: The study found that the prevalence of global sexual dysfunction was significantly higher in male nurses who had completed their rotations in the COVID hospital when compared to those who had not. There were no statistically significant differences between the groups on sociodemographic profiles and the profile of their spouses. Discussion: HCWs working in COVID situations are known to suffer from stress, depression, and anxiety. This may impact the sexual functioning of the HCWs, especially when they have been in an infectious environment and the marital dyad may have doubts of the transmission of the infection. Conclusion: Male nurses who have worked in a COVID care setting are likely to report higher levels of sexual dysfunction
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