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   2020| January-June  | Volume 29 | Issue 1  
    Online since November 7, 2020

 
 
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INVITED EDITORIAL
Industrial impact of COVID-19 pandemic: Mental health perspective
Jyoti Prakash, Kaushik Chatterjee, Kalpana Srivastava
January-June 2020, 29(1):9-11
DOI:10.4103/ipj.ipj_39_20  
  3,414 156 -
EDITORIAL
Mental health aspects of pandemics with special reference to COVID-19
Kalpana Srivastava, Suprakash Chaudhry, Sowmya AV, Jyoti Prakash
January-June 2020, 29(1):1-8
DOI:10.4103/ipj.ipj_64_20  
  1,763 51 -
REVIEW ARTICLES
Psychological management of mental health concerns related to COVID-19: A review of guidelines and recommendations
Narendra Nath Samantaray, Romalin Pattanaik, Kalpana Srivastava, Preeti Singh
January-June 2020, 29(1):12-21
DOI:10.4103/ipj.ipj_81_20  
Many publications have delineated strategies for mental health care to respond to psychological concerns and ramifications related to coronavirus disease 2019 (COVID-19). The current review aims to encapsulate existing guidelines and recommendations of psychological management for mental health care for the general population, health-care professionals, children, and elderly populations, applied to a pandemic in particular reference to COVID-19. The literature on psychological care of such repercussions of COVID-19 was retrieved via a search in PubMed and Google database. Of 91 retrieved initial articles, only 18 were selected for final analysis, which was divided into two categories: (a) guidelines by government/public health bodies (n = 11) and (b) publications in peer-reviewed journals (n = 7). The recommendations can be summed but not limited to psychoeducation from a reliable source, normalization of stress, behavioral activation, scheduling of activities with a bespoke blending of recreational and daily chores, supportive care, staying digitally connected, relaxation techniques, ensuring rest, rotating shifts and short breaks during working hours, curtailing media consumption, fostering community resilience, seeking and sharing support from colleagues/supervisors, avoidance of abusing psychoactive substances, online consultation of mental health professionals on need, and participatory communication in a developmentally appropriate way with children. In the absence of observational and controlled studies on psychological management during pandemic times, we recommend such research soon.
  1,454 29 -
SHORT COMMUNICATION
Coronavirus disease 2019 and the inevitable increase in screen time among Indian children: Is going digital the way forward?
G Fatima Shirly Anitha, Udayakumar Narasimhan
January-June 2020, 29(1):171-175
DOI:10.4103/ipj.ipj_131_20  
The world is facing an unprecedented crisis due to the Coronavirus disease catastrophe. The pandemic has been ravaging for the past six months claiming human lives, causing financial loss, and job insecurity. Children are susceptible to the psychosocial aspects of this pandemic. Being locked indoors there is exorbitant media exposure among children. The debate of digital media technology is now challenged by the pandemic. Digital technology is a boon during this crisis being a platform for both education and recreation. In the background of this inadvertent increases screen exposure we discuss the various health concerns and the need to balance media appropriately to carry it forward during this crisis which shows no sign of waning.
  1,326 41 -
ORIGINAL ARTICLES
COVID-19 pandemic and its aftermath: Knowledge, attitude, behavior, and mental health-care needs of medical undergraduates
Shailaja B, Hemendra Singh, Suprakash Chaudhury, Murali Thyloth
January-June 2020, 29(1):51-60
DOI:10.4103/ipj.ipj_117_20  
Background: The undeniable impact of the COVID-19 pandemic on the educational sector has left the students perplexed and uncertain. Infection-related fears, inevitable loneliness, disturbed routine making way for adverse lifestyle habits, stressors such as financial crisis faced by their families, and many more further accentuate their vulnerability to mental health issues. Aim: The aim was to assess the knowledge, attitude, and behavior of medical undergraduate students about the COVID-19 outbreak, and to assess their stress, anxiety, depression, and quality of life (QOL). The study also explored the correlation between the knowledge, attitude, and behavior of the medical undergraduate students about the pandemic and their mental health issues. Materials and Methods: An online questionnaire-based survey was carried out on medical undergraduate students. The survey tool comprised a semi-structured proforma; General Health Questionnaire-12 items; Depression, Anxiety, and Stress scale-21 items; and European Health Interview Survey-Quality of Life-8 items. Results: Nearly 61.8% of the students seemed well read and had good knowledge about the medical aspects of the pressing issue of COVID-19, and majority of the students had adaptive attitudes and behaviors toward the pandemic. Almost 23.2% of the students had depression, 20.7% had anxiety, and 13.0% had stress ranging from mild to extremely severe. Nearly 75.1% of the students experienced changes in appetite and 53.6% had changes in appetite. Nearly half of the students expressed excessive worries regarding studies. The mean score of QOL of students was 3.9 ± 0.6. Students with adaptive attitudes and behavior experienced relatively less severe depression, anxiety, and stress compared to their counterparts. Conclusion: A significant portion of the medical undergraduates are experiencing mental health issues and study related concerns due to the adversity brought by the pandemic. The concerned educational bodies and institutes must take up necessary steps to mitigate the adverse effects of the pandemic on students.
  616 20 -
Measuring addiction to internet gaming among Indian medical students: Development and preliminary psychometric properties of a new scale
Saurav Basu, Pragya Sharma, Ruchir Rustagi, Ragini Sharma, Nandini Sharma
January-June 2020, 29(1):33-37
DOI:10.4103/ipj.ipj_114_20  
Background: Internet gaming disorder (IGD) is emerging as an important source of behavioral addiction in young people globally. Objective: The aim of this study was to assess addiction to internet gaming in medical students using a self designed research instrument. Materials and Methods: We conducted a cross-sectional study and enrolled 264 male and 160 female MBBS students (n = 424) in Delhi, India. The study instruments included: a 2-item Internet gaming screening questionnaire (IGSQ), a 14-item self-designed Internet gaming addiction scale (IGAS) to measure addiction-like behavior associated with multiplayer Internet gaming, and the Pittsburgh Sleep Quality Index to measure sleep quality. Results: After preliminary screening, 91 male and 6 female participants were found to be multiplayer Internet gamers, and were further assessed using the 14-item IGAS. The Cronbach's alpha of the IGAS was 0.879. Principal component analysis revealed a three-component IGAS structure based on eigenvalue cutoff (>1), loading score >0.4, and inspection of the scree-plot that explained 66.71% of the total variance. The IGAS score and the average weekly gaming time of the participants showed a moderate positive correlation (r = 0.45, P < 0.001). Only 17 (4.0%) participants reported agreement/strong agreement across ≥5 domains of addiction. The mean (standard deviation) IGAS score was significantly higher in the participants reporting poor sleep quality (PQSI > 6) (P = 0.047). Conclusion: IGD has low prevalence among medical students, and the problem is negligible among female students. The 14-item IGAS, in conjunction with the 2-item IGSQ, are reliable and valid tools for the assessment of IGD.
  470 21 -
Effectiveness of cognitive behavioral therapy on social anxiety disorder: A comparative study
Nirupama Behera, Narendra Nath Samantaray, Nilamadhab Kar, Mihir Ranjan Nayak, Supraksh Chaudhury
January-June 2020, 29(1):76-81
DOI:10.4103/ipj.ipj_2_20  
Background: Both cognitive behavior therapy (CBT) and paroxetine (PX) are the preferred treatments for social anxiety disorder (SAD). However, in literature, there have been divided opinions for the efficacy of the combination of these treatments. This study intended to evaluate whether the combination of CBT and PX would be superior to monotherapy of PX in the treatment of SAD. Methods: This was a single centre, rater-blind, non randomised study which included 40 consenting adult participants who received CBT+PX or PX only. The Liebowitz Social Anxiety Scale, Social Interaction Anxiety Scale, and Brief Fear of Negative Evaluation scale (BFNE) were assessed at baseline (0 weeks), immediate posttreatment (16–18 weeks for CBT + PX and 16–20 weeks for PX only), and at follow-ups 2 months after posttreatment. Results: Both the treatment groups have a statistically significant difference in mean scores in all outcome measures in posttreatment and follow-up stages compared with pretreatment scores. However, CBT + PX has a better treatment and maintenance gain as compared to PX alone in the posttreatment and follow-up stages. Conclusions: In SAD management, combinations of CBT + PX are superior to PX alone, and the treatment gains are also better maintained in former than latter.
  410 17 -
SHORT COMMUNICATION
Psychological impact of COVID-19 pandemic on health care professionals and workers
MD Abu Bashar, Ravi Bammidi
January-June 2020, 29(1):176-179
DOI:10.4103/ipj.ipj_99_20  
The outbreak of a novel coronavirus starting from December 2019 and reaching pandemic proportions has raised concerns as to the ability of the current protective measures and the health-care system to handle such a threat. Health-care workers may experience considerable psychological distress as a result of the coronavirus disease-19 pandemic due to providing direct patient care, vicarious trauma, quarantine, or self-isolation.
  371 24 -
ORIGINAL ARTICLES
Development of the Indian scale of the fear of COVID-19
Neha Sayeed, Sneha Patel, Sneha Das
January-June 2020, 29(1):47-50
DOI:10.4103/ipj.ipj_90_20  
Background: The first human case of COVID-19, the disease caused by the novel coronavirus causing COVID-19, subsequently named SARS-CoV-2 was reported by the officials in Wuhan City, China, in December 2019. In India, on January 31, 2020, the first case of COVID-19 was reported. Materials and Methods: The Indian scale of fear related to COVID-19 (ISF-C19) Scale was developed in Hindi and was rated by two raters. Then, it was applied on twenty individuals (ten males and ten females) as a pilot study. The study had been conducted in Eastern India, in the state of Jharkhand. ISF-C19 was completed by 118 participants (females – 75; males – 43), aged 18 years or older from the community, and the subjective well-being was assessed. The psychometric properties of this instrument were investigated. Safety measures (i.e., mask, maintaining distance, gloves, and sanitizers) were taken throughout the data collection period. Results: Findings suggested that this scale has adequate sampling, adequate interitem reliability coefficient, and higher overall scores on the ISF-C19 indicated more severe fear related to COVID-19. Conclusion: In light of the current scenario of the emerging cases in India, there is an urgent need to develop a scale related to COVID-19 as there is no published Indian standardized scale before this recent outbreak of pandemic. Considering the current scenario, this scale is useful to assess the fear related to COVID-19.
  340 38 -
Psychosocial profile of male perpetrators of domestic violence: A population-based study
Adnan Kadiani, Suprakash Chaudhury, Daniel Saldanha, Neha Pande, Preethi Menon
January-June 2020, 29(1):134-148
DOI:10.4103/ipj.ipj_78_18  
Background: Domestic violence can result from societal, community, and relationship factors pertaining to both the perpetrator and the victims. The male perpetrators of domestic violence have rarely been the subjects of a study. Aim: To understand the factors influencing a man's risk in perpetrating domestic violence in a community setting. Materials and Methods: This observational, exploratory study was conducted on 50 male perpetrators of domestic violence in an urban slum. A semi-structured questionnaire which incorporated Adverse Childhood Experience International Questionnaire, Alcohol Use Disorders Identification Test, Hamilton Rating Scale for Anxiety, and Becks Inventory for Depression was used for assessment. Results: All the respondents reported both verbal and physical violence with 26% reporting complicated physical violence. Alcohol dependence was diagnosed in 77% of respondents. Twenty-four percent had depression and 34% had anxiety. The mean number of ACEs suffered by the respondents was 4 and the range was 0–8. Substance abuse in the family (86%) and witnessing verbal/psychological abuse (82%) were the most common ACE found. Complicated domestic violence was statistically significantly associated with the presence of alcohol dependence, witnessing complicated physical abuse between the parents and parents separated due to death or divorce. Certain adversities, namely verbal punishment, physical punishment, bullying, community violence, caretaker of sibling, and household work, were strongly associated with abusers who suffered from psychiatric comorbidities. Conclusion: The presence and severity of alcohol dependence and the number of childhood adversities are strongly associated with complicated type of domestic violence. Those who were victims of a large number of ACEs also suffered from anxiety, depression, and alcohol dependence.
  339 20 -
Sexual dysfunction in alcohol-dependent men and its correlation with marital satisfaction in spouses: A hospital-based cross-sectional study
Jitendra Rohilla, Guarav Dhanda, Parth Singh Meena, Charan Singh Jilowa, Pinki Tak, Mahendra Jain
January-June 2020, 29(1):82-87
DOI:10.4103/ipj.ipj_5_20  
Background: Chronic use of alcohol affects almost every organ system of the body, including male sexual functions. There are only a few Indian studies, which have assessed sexual functions in alcohol-dependent (AD) men and many of them have limitations. This study was aimed to assess sexual functions and marital satisfaction among AD individuals compared to matched controls. Subjects and Methods: A cross-sectional descriptive study was carried out on 70 AD men (study group) and an equal number of matched controls and their spouses in the Department of psychiatry of Jawahar Lal Nehru Medical College, Ajmer. Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised, and Severity of Alcohol Dependence Questionnaire (SADQ) were used to assess withdrawal state and severity of alcohol dependence in the AD group. Marital Adjustment Test (MAT) and Arizona Sexual Experience Scale (ASEX) were used in both study and control groups to assess marital satisfaction and various aspects of sexual functioning. Results: More than half of the men (58.6%) with alcohol dependence were found to have sexual dysfunction compared to only one-fifth in the control group (18.5%). The most commonly affected sexual functions were the ability to get and keep erection (70%) and arousal (62.8%). There was a large negative correlation of MAT scores in the AD group with the SADQ, rho (ρ) = −0.68, and sexual dysfunction (ASEX), rho (ρ) = −0.57. However, the duration of alcohol use did not have any significant association with marital satisfaction. Conclusions: This study showed that participants with AD were more likely to have sexual dysfunction and lower level of marital satisfaction in their spouses. This effect was not because of acute intoxication of alcohol or withdrawal symptoms. We need further research to ascertain whether sexual dysfunction and marital dissatisfaction is a result of alcohol dependence or its reinforcer or both.
  317 22 -
Workplace violence against doctors in a tertiary care hospital
Sandeep Grover, Nobel Dalton, Ajit Avasthi
January-June 2020, 29(1):38-46
DOI:10.4103/ipj.ipj_79_20  
Aim: This study aimed to evaluate the magnitude and factors associated with violence against doctors. Materials and Methods: An online survey of doctors working in a tertiary care hospital in India was done by using the modified version of the workplace violence (WPV) in the Health Sector Questionnaire, developed by the World Health Organization. Results: Out of the 353 participants, 193 doctors (54.6%) reported being exposed to violence at their workplace in the past 6 months. Participants from the medical branches (57.8%), senior residents (60.3%), and those who were posted in emergency services (79.4%) and night duty (56.1%) reported more violence. The most common type of WPV was verbal abuse (91.2%), and the perpetrators were relatives of the patients (51.7%). The possible perceived reasons for WPV were patient overload (69.7%), prolonged duty hours and excessive workload (69.7%), and long waiting periods for patients/caregivers (66.9%). The majority of the participants considered that recruiting an adequate number of professional and paraprofessional staff (75.6%) can lead to a reduction in WPV. Conclusions: The present study suggests that more than half of the doctors working in a tertiary care hospital in India face WPV. There is a lack of specific redressal mechanism to address WPV. Accordingly, there is a need to develop a mechanism for reporting of WPV and to implement preventive strategies at the individual level and at the system level. There is need for strengthening and implementing laws and making new policies to reduce WPV.
  315 20 -
Depression and anxiety associated with functional bowel disorders and its impact on quality of life: A cross-sectional study
Sukanto Sarkar, Sunayana Choudhury, Sivaprakash Balasundaram, SajeethManikanda Prabu Balasubramanian
January-June 2020, 29(1):68-75
DOI:10.4103/ipj.ipj_59_18  
Background: Functional bowel disorder (FBD) is conceptualized as a “biopsychosocial disorder.” Psychological factors are important moderators of symptom severity and persistence, treatment seeking and response to treatment. We investigated psychological factors and quality of life (QOL) in patients with FBD. Methods: Seventy patients visiting the department of medical gastroenterology diagnosed as FBD were included in the study. Severity of FBD was rated with FBD Severity Index. The Depression, Anxiety, and Stress Scale was applied and patients were divided into two groups, i.e., with moderate stress (Group A) and with severe stress (Group B). QOL in both the groups was assessed by WHOQOL-BREF Scale. Chi-square, t-test was done to compare the groups. Regression analysis was done to find predictors of poor QOL. P<0.05 was taken as significant. Results: Patients of Group B had a longer duration of illness and had higher prevalence of depressive disorder (P = 0.03) in comparison to patients in Group A, who had higher prevalence of anxiety disorders (P = 0.06). Severity of FBD was positively correlated with depression (r = 0.8; P = 0.02). Physical and psychological QOL was significantly impaired in Group B patients having depression (P = 0.02; P = 0.03). Regression analysis showed a positive trend for presence of depressive disorder (P = 0.05), anxiety disorder (P = 0.08) and severity of FBD (P = 0.09) as predictors of poor QOL. Conclusion: In our study, the high prevalence of stress, anxiety and depression in patients with FBD indicates the need for routine screening of such symptoms along with a collaborative and holistic treatment approach. Several etiological perspectives explaining the complex gut–brain interaction are also provided.
  313 9 -
Factors predicting the presence of depression in obstructive sleep apnea
Sheikh Shoib, Soumitra Das
January-June 2020, 29(1):29-32
DOI:10.4103/ipj.ipj_38_18  
Background: Obstructive sleep apnea (OSA) is a sleep-related breathing disorder and is associated with a myriad of neurocognitive dysfunctions and cardiac and metabolic diseases. Several studies have shown the relation of depressive symptom in patients with OSA. Keeping this in view, we planned to study various factors predicting the presence of depression in OSA. Aim: The aim of the study was to study various factors predicting the presence of depression in OSA. Methods: We performed polysomnography (PSG) studies on patients that were referred from various subspecialty clinics from July 2011 to August 2013. Psychiatric diagnosis was done using the Mini International Neuropsychiatric Interview (plus) scale. This was followed by the application of the Hamilton Depression Rating Scale. Standard methods of statistical analysis were used for data analysis. All statistical analyses were performed using SPSS software version 11.0 (SPSS, Chicago, Illinois, USA) and tests of statistical significance were two-sided and differences were taken as significant when P-value was less than 0.05. Results: Of 182 patients who underwent PSG, 47 were suffering from depression with a mean age of 58.60 years. Age, gender, snoring, body mass index, hypertension, witnessed apnea, nocturia, disturbed sleep, and daytime sleepiness were significantly correlated with depression. Diabetes and cardiovascular disease were also significantly correlated, but the correlation was statistically significant at the 0.05 level. Conclusion: This study demonstrates a significant overlap between sleep apnea and depression. Health specialists need more information about screening for patients with OSA to ensure proper diagnosis and treatment of those with the condition.
  304 15 -
CASE REPORTS
Application of mindfulness on stress, anxiety, and well-being in an adolescent student: A case study
Anand Kumar, Amool Ranjan Singh, Masroor Jahan
January-June 2020, 29(1):165-170
DOI:10.4103/ipj.ipj_75_17  
Background: Stress and anxiety are the major problems students face in their lives and specifically in their academic life, which, in turn, has a significant negative impact on their academic performance. There are different approaches to deal with stress and anxiety, for example, cognitive behavioral therapy and relaxation techniques. Objective: The present study was conducted to evaluate the applicability of mindfulness on stress, anxiety, and psychological well-being in an adolescent student. Methods: In this study, single-case study design was used. The Pediatric Symptoms Checklist, Youth Self-Report, Institute of Personality and Ability Testing Anxiety Scale, and Checklist of Psychological Well-Being were administered on ten adolescent students. After the initial assessment, one participant was selected who was having significant level of stress, anxiety, and poor psychological well-being. Further detailed assessment was done using the Raven Standard Progressive Matrices, Parents' Observation Checklist, Teachers' Observation Checklist, and Students' Self-Observation Checklist. The student underwent 24 sessions of mindfulness training with a frequency of three sessions in a week. After completion of sessions, post assessment was done. He was re-assessed after 3 months. Results: After completion of mindfulness training, improvement was observed in stress, anxiety, well-being, and other variables, and the improvement was maintained till follow-up. Conclusion: Mindfulness training has the potential in effectively reducing stress and anxiety and increasing a sense of well-being, but the major barrier is getting fixated with an idea of what's the right way to do mindfulness and feel it.
  293 10 -
ORIGINAL ARTICLES
Impact of a community-based mental health awareness program on changing attitudes of the general population toward mental health in Gujarat, India – A study of 711 respondents
Sandip H Shah, Lennox E Byer, Raghu K Appasani, Neil Krishan Aggarwal
January-June 2020, 29(1):97-104
DOI:10.4103/ipj.ipj_24_19  
Context: In India, there is a large mental illness treatment gap, especially in rural areas. Contributors to this problem include stigma and a general lack of mental health knowledge. The State Health Department of Gujarat, India, released a video tool, in 2003, with the goal being to educate the community on topics related to mental health. Aims: The aim of this study was to evaluate the ability of the government-developed video tool to improve attitudes toward mental health in rural Gujarat. Settings and Design: Eight hundred and sixty-five individuals, in 17 villages in Gujarat, agreed to attend a mental health awareness workshop that used the government-developed video tool. One workshop was held in each village. A structured questionnaire evaluating attitudes was administered to the participants before and after the workshop. Subjects and Methods: government-developed video tool, standardized questionnaire for attitude evaluation. Statistical Analysis Used: A McNemar's test was used to evaluate the difference between pre- and post-scores. Results: A total of 711 participants completed the pre- and post-questionnaire. Attitudes related to psychosis, suicidal ideation, postpartum depression, learning disability, general mental illness, and perceptions of dangerousness showed significantly favorable improvement (P <.005). Attitudes related to substance abuse worsened (P < 0.005). Conclusions: Results suggest that a government-developed video tool can successfully improve short-term attitudes. Attitudes toward substance abuse may require a different approach than attitudes toward other types of mental illness.
  289 8 -
Prevalence of childhood depression in school going adolescents in an urban Indian school
Dhiraj Raja, Harpreet Singh, Amit Chail, Ankit Dangi
January-June 2020, 29(1):88-92
DOI:10.4103/ipj.ipj_71_20  
Background: Understanding the prevalence of a psychiatric disorder among children is essential for formulating sound public health policy. Aim: This study is aimed to estimate the prevalence of depression in urban school-going adolescents and its association with age, sex, and birth order. Materials and Methods: A total of 500 participants in the age group 12–16 years from a working-class community, studying in an urban school, were selected for the study. The children with a score greater than or equal to 19 on the CDI scale were taken for the second phase, and diagnosis of depression was confirmed by a psychiatric consultant through a clinical interview. In clinically diagnosed cases, all help was rendered, including follow-up. Results: The prevalence of clinical depression among school-going children of age group 12–16 years was 8.4%. There was no significant gender difference in the prevalence of clinical depression. Significantly, more children had clinical depression in the age group of 14–16 years than in the 12–14 years of age group. Depressive symptoms were more among children with first birth order. Conclusions: These results show that depression is common in school going urban adolescents in India and highlight the need for screening school-age children for depression so that early intervention can be provided.
  263 18 -
CASE REPORTS
Pathways of migration from gaming to gambling
Nisha John, Manoj Kumar Sharma, Nitin Anand, Sailaxmi Gandhi, Pranjali Chakraborty Thakur, Maya Sahu, Ishita Mondal, Priya Singh, N Suma, Ashwini Tadpatrikar, Shikha Ahuja, SJ Ajith, Keshava D Murthy, Hemant Kumar Gupta
January-June 2020, 29(1):159-161
DOI:10.4103/ipj.ipj_45_20  
Gaming and gambling have been studied in terms of similarity of its manifestations. There is a dearth of empirical-based evidence for the exploration of pathways to understand the shift from gaming to gambling. A 23-year-old male from a nuclear family was assessed using clinical interview for the pathways for shifting from gaming to gambling. The pathways were personality predispositions, maladaptive coping, interpersonal distress, peer pressure, variable reward anticipation, addiction characteristics in the form of craving, loss of control and use despite having consequences. These findings suggest that there is a need to create awareness among young adults about these potential causes related to transition from gaming to gambling.
  263 17 -
ORIGINAL ARTICLES
Disability in clinically stable patients of schizophrenia
Mahaprakash Sharma, Anil Nischal, Anuradha Nischal, Manu Agarwal, Bandna Gupta, Sujit Kumar Kar, Erika Pahuja
January-June 2020, 29(1):61-67
DOI:10.4103/ipj.ipj_82_20  
Purpose: Disability associated with schizophrenia affects every aspect of life. In India, persons with schizophrenia are eligible for disability benefits. Only a handful of patients are aware and able to avail the benefits. We intended to assess disability in clinically stable patients of schizophrenia as even though they are stable but are disabled and may benefit from disability benefits and rehabilitation. Methods: Sixty-two clinically stable patients of schizophrenia were assessed on the Mini-International Neuropsychiatric Interview, Positive and Negative Syndrome Scale (PANSS), and Schizophrenia Cognition Rating Scale. Disability was assessed on the Indian Disability Evaluation and Assessment Scale (IDEAS). Results: Nearly one-fourth of the “stable patients” had moderate-to-severe disability (22.6% – moderate and 1.6% – severe), i.e., certifiable disability as per IDEAS. Disability had a significant correlation with all three domains of PANSS as well as total PANSS score. The correlation was stronger with negative than with positive symptom scores. Disability also strongly correlated with cognitive impairment. “Work,” “communication and understanding,” and “interpersonal relationship” domains of IDEAS had a strong correlation with cognitive impairment. Conclusion: Nearly 25% of the stable patients had certifiable disability. The “work” domain of IDEAS was most affected. It demonstrates that the rehabilitation of this population may contribute to reducing disability.
  254 14 -
Quality of life, adjustment, and associative comorbid conditions in children diagnosed with attention deficit hyperactivity disorder: A comparative study
Krishan Kumar, Rajni Sharma, Aseem Mehra, Lokesh Saini, Ruchita Shah, Akhilesh Sharma
January-June 2020, 29(1):123-129
DOI:10.4103/ipj.ipj_119_20  
Introduction: Attention deficit hyperactivity disorder (ADHD) is a common pediatric, neurodevelopmental disorder, with serious impacts on lives of those suffering from it. ADHD is known to be associated with social and emotional difficulties, poor self-regulation, aggression, reduced empathy, inability to regulate socially desirable behavior along with conflicts within family, and increased conflict with peers and several associated comorbid conditions. Aim: The study aims at exploring quality of life (QOL) and adjustment along with associated comorbid conditions in children diagnosed with ADHD in comparison with normal children. Methods: A total sample of 60 children including 30 children diagnosed with ADHD and 30 normal children were selected and assessed using Vanderbilt ADHD Parent rating scale Childhood Psychopathology Measurement Schedule, KINDL QOL: Parent Questionnaire and Pre-Adolescent adjustment Scale to assess level of ADHD, comorbid psychopathologies, their QOL and adjustment respectively. Results: Overall results have indicated that parents reported lesser symptom and pathology in comparisons to teachers for ADHD. Those diagnosed with ADHD had positive and significant comorbidities associated of; low intelligence with behavioral problems and high levels of conduct problems, anxiety, depression, psychotic tendencies, physical illness with emotional problems and somatization in comparison to normal and thus a poor adjusted life, with significant report of poor self-esteem and peer relations and QOL. Conclusion: The results of the present study has clearly stated that severe burden has been perceived by ADHD children, with a poor perceived QOL, several adjustment issues, and sufferance of one or other comorbidity. Thus, the study could help understand and emphasize the need of holistic treatment comprising medicinal and therapeutic methods, including intervention for parents, focusing exclusively on enhancing and curbing these factors.
  240 18 -
Neuropsychological dysfunctions among chronic schizophrenia patients, alcohol dependence cases, and normal subjects: A comparative study
Vidhata Dixit, Santosh Kumar, Suprakash Chaudhury
January-June 2020, 29(1):105-122
DOI:10.4103/ipj.ipj_70_20  
Aim: The aim of this study is to assess the neuropsychological profiles of chronic schizophrenia and alcohol-dependent subjects. Materials and Methods: This hospital-based cross-sectional study included 30 chronic schizophrenia patients, 30 alcohol-dependent patients and 30-matched normal controls. Demographic and clinical data were collected on a self-designed pro forma. Positive and Negative Syndrome Scale (PANSS) and Severity of Alcohol Dependence Questionnaire (SADQ-C) were administered to chronic schizophrenia and alcohol-dependent patients, respectively. The AIIMS Comprehensive Neuropsychological Battery in Hindi (Adult Form) was used to assess neuropsychological dysfunctions. Results: Neuropsychological dysfunctions were found in 83.3% of chronic schizophrenia patients, 36.7% alcohol dependents and none of the normal subjects. In comparison to normal subjects, schizophrenia patients had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, memory, and intellectual processes. A significant positive correlation was found between the PANSS total score and T scores of most of the clinical scales except motor and visual scales; the PANSS general psychopathology score and T scores of most of the clinical scales except motor visual and pathognomonic scales; the PANSS negative score and T scores of most of the clinical scales except visual scale; and the PANSS positive score and T scores of receptive speech, arithmetic, and memory scales. In comparison to normal subjects, the alcohol dependents had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, and memory. A significant positive correlation was found between the SADQ total scale and T scores of clinical scales such as expressive speech, writing, arithmetic, intellectual processes, left hemisphere, and total battery scales. Conclusions: Neuropsychological dysfunction was significantly more common and severe in chronic schizophrenia patients than in alcohol-dependent patients. In comparison to alcohol dependents, the chronic schizophrenia patients had more dysfunctions in neuropsychological-domains such as tactile, arithmetic, memory, and intellectual processes.
  228 20 -
CASE REPORTS
Neuroleptic malignant syndrome associated with the use of injection zuclopenthixol acetate
Anish Shouan, Ankit Kumar Sinha, Sandeep Grover
January-June 2020, 29(1):162-164
DOI:10.4103/ipj.ipj_54_19  
Zuclopenthixol is available in two parenteral formulation,i.e., in the form of acetate and decanoate. It has high affinity for dopamine D1 and D2 receptors. There is limited literature of association of neuroleptic malignant syndrome with the use of zuclopenthixol monotherapy. These case reports have mostly implicated zuclopenthixol decanoate, and also zuclopenthixol acetate. In this report, we present a case of neuroleptic malignant syndrome associated with use of zuclopenthixol acetate.
  227 15 -
ORIGINAL ARTICLES
Maternal stress in neonatal intensive care unit very often overlooked by health professionals
Nidhi Kumar, Achinta KR Mallick
January-June 2020, 29(1):130-133
DOI:10.4103/ipj.ipj_88_19  
Context: Admission of a neonate in a neonatal intensive care unit (NICU) can be very stressful for the mother, which often remains unattended by health-care professionals. Early identification of maternal stress, environmental stressors, and providing remediation will prove instrumental in providing a holistic family-based patient care. Aims: The aim of the study was to analyze the stress levels among mothers whose babies were admitted to NICU. Settings and Design: This was a cross-sectional question-based observational study conducted in the pediatric department of a peripheral hospital in Pune, Maharashtra. Subjects and Methods: This was a cross-sectional, observational, hospital-based study. Maternal stress level was assessed using the Parental Stressor Scale: NICU (PSS: NICU) questionnaire among 73 mothers. Stress score was quantified using Likert scale as low (1–2.9), moderate (3–3.9), and high (4–5), respectively. Statistical Analysis Used: Simple descriptive statistics method with frequency, percentage, mean, and standard deviation was used as applicable. Results: NICU environment is moderate to highly stressful for mothers. The mean score for each domain of PSS: NICU was as follows: sights and sounds, 2.60 (±0.43); looks and behavior, 3.47 (±0.31); and parental role alteration, 3.94 (±0.24), respectively. Maternal stress level remained high irrespective of age at delivery, educational level, occupation, mode of delivery, and number of living children. Conclusions: Mothers of NICU-admitted babies are under significant stress, which needs to be identified early along with care of the sick neonate, so as to give a holistic care to the family.
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REVIEW ARTICLES
Conceptual issues in mood disorder: An update
Sandeep Motichand, Daya Ram
January-June 2020, 29(1):22-28
DOI:10.4103/ipj.ipj_37_15  
The concept of mood disorders dates back to eternity. This long history of the emotions and their disorders has a fascinating journey. As with any history concerned with disease concepts, the conceptual history of mood disorders must be scrutinized through close attention to nosological texts in tracing how categories were created how they evolved over the time. This article covers the evolution of the concept of mood disorders and its journey from the Hippocratic era to the Kraepelin's dichotomization between dementia praecox (schizophrenia) and manic-depressive insanity (bipolar and unipolar disorders) and its culmination into the contemporary classifications of mood disorders. It also addresses the problem of boundaries between the different mood disorders in terms of their conceptualization and classification. The shortcomings of the classificatory systems and the current progress in the nosology have also been discussed.
  221 12 -
ORIGINAL ARTICLES
Factors influencing suicidal attempt among the agrarian community of central Maharashtra
Kshirod Kumar Mishra, Joge Vivek Prabhakar
January-June 2020, 29(1):93-96
DOI:10.4103/ipj.ipj_84_20  
Introduction: Attempted suicides occur 8–20 times more frequently than completed suicides. Attempted suicides are just the tip of the iceberg of the completed suicides, now a universal phenomenon. Several factors such as financial constraints, altercation among family members, and easy availability of pesticides have been attributed as the common factors for attempted suicide among the rural population. Materials and Methods: On this background, we evaluated all the cases of attempted suicide admitted to our rural medical college during a period of 1 year. Details of sociodemographic profile, mode of attempt, and reason for the attempt were evaluated. All the cases were administered Beck's Depression Inventory. Factors influencing suicidal attempts among farmers and nonfarmers were analyzed using suitable statistical methods. Results: Out of a total of 117 cases of attempted suicide, only 21% of the cases were farmers. Majority of them were males and were married. The main mode of attempt was poisoning. The common psychiatric diagnosis was adjustment disorder followed by depressive disorder. Conclusion: Although the study was conducted in a rural setup from an agrarian background, the majority of the cases were of nonfarmer. The most common mode of suicidal attempt among farmers as well as nonfarmers was pesticide ingestion owing to its easy availability among the agrarian population. Although the most common reason for attempt among the nonfarmer population was interpersonal problems, indebtedness still remains the most common reason for farmers. Attention of policymakers is drawn toward two important aspects: policy on the sale of usual pesticides and policy for the farmers to overcome loss in farming.
  196 11 -
CONTEMPORARY ISSUE
Available videoconferencing freeware and medical education
Amit Chail, Kaushik Chatterjee, Vinay Singh Chauhan, Jyoti Prakash
January-June 2020, 29(1):155-158
DOI:10.4103/ipj.ipj_122_20  
Background: Traditionally medical education involves classroom teaching, small group discussions and bed-side clinics. These have become difficult to conduct in times of the COVID-19 pandemic. Video-conferencing software and apps provide pragmatic alternatives for medical education in this scenario. However, the apps are not designed specifically for medical education. In this background, we aimed to review available video-conferencing freeware (platforms/apps) for their suitability in imparting post-graduate medical education. Methodology: Software and apps were searched on Android and iOS platforms. Freeware were selected based on pre-defined criteria. They were evaluated for features supporting post-graduate medical education like participant numbers, time limit, user comfort and security features. Results: Our search yielded 118 video conferencing software and apps. Of these, 07 free apps met the initial inclusion and exclusion criteria. 'Say Namaste' was included post-hoc. Most apps allowed adequate numbers of participants and were comfortable for users. Only two apps had end-to-end encryption. Conclusion: Video-conferencing freeware can serve as a viable alternative for some aspects of medical teaching. Provision of certain additional features would make these apps more effective for post-graduate medical education.
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ORIGINAL ARTICLES
Auditory sensation with affective agnosia: A prevalence of alexithymia among tinnitus patients
Ajay Kumar Bakhla, Meenakshi Dayal, Rajni Bala, Ashit Toppo
January-June 2020, 29(1):149-154
DOI:10.4103/ipj.ipj_40_18  
Objectives: The aim of the present study was to determine the prevalence and association of alexithymia, depression, and anxiety in patients affected by tinnitus. Methods: The study was conducted among the patients referred for audiometric evaluation for tinnitus. They were further evaluated with the Hospital Anxiety and Depression Scale, the Tinnitus Handicap Inventory, and the Toronto Alexithymia Scale. Analysis was done for prevalence and the sample was categorized as high and low tinnitus handicap subgroups, and mean scores of alexithymia, anxiety, and depression were compared. Results: A total of 70 patients (55.7% – male and 44.3% – female) with a mean age of 33.17 ± 12.24 years were finally analyzed. The severity of tinnitus was most severe (34.3%), followed by moderate (20%), catastrophic (18.6%), mild (17.1%), and slight (10%). The prevalence of alexithymia, anxiety, and depression among patients of tinnitus was found to be 65.7%, 37.1%, and 20%, respectively. The high tinnitus handicap group showed higher scoring on total alexithymia score, anxiety, and depression and higher scoring with describing emotion and identification of emotion, but there was no difference for the subscale of externally oriented thinking. Conclusions: The study found a prevalence of alexithymia, anxiety, and depression as 65.7%, 37.1%, and 20%, respectively, among patients of tinnitus, and problem of describing and identification of emotion are associated with higher tinnitus handicap.
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