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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 23 | Issue 2
Page Nos. 75-138

Online since Thursday, November 14, 2019

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EDITORIALS  

A new beginning! p. 75
Sandeep Grover
DOI:10.4103/jmhhb.jmhhb_46_19  
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Physician burnout: Are we taking care of ourselves enough! p. 76
Sandeep Grover
DOI:10.4103/jmhhb.jmhhb_45_19  
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REVIEW ARTICLE Top

Physician burnout: A review Highly accessed article p. 78
Sandeep Grover, Himani Adarsh, Chandrima Naskar, Natarajan Varadharajan
DOI:10.4103/jmhhb.jmhhb_47_19  
The concept of Physician Burnout emerged in the 1960s. Over the last six decades or so, it has been recognized as a worldwide phenomenon. This brief review presents the evolution of the concept, risk factors, epidemiology, clinical manifestations, assessment, prevention, and management of physician burnout. Available data suggest that different theoretical models have been proposed and evaluated to understand the emergence of burnout at the workplace. The risk factors for the development of burnout can be understood as personal and organizational factors and interaction of these factors, determine the final experience of burnout. The incidence of burnout among medical professionals is generally reported to be higher than other professionals, and high rates of burnout are seen across all the stages of medical career, i.e., medical students, interns, postgraduates, and practicing physicians. There are some data to suggest rising trend in the prevalence of burnout among physicians. The common signs and symptoms of burnout include anger, irritability, impatience, increased absenteeism, decreased productivity, and decreased quality of care. However, many authors have categorized the symptoms into different stage models. Burnout among physicians is associated with multitude of negative consequences for the physicians, and patients, and the health-care system. Available data suggest that it is important to recognize burnout at the earliest and use preventive strategies for emergence of the same. At present, there are no clear-cut guidelines for the management of burnout, but some of the individual-level interventions, which are thought to be helpful for burnout, include cognitive-behavioral techniques, meditation and relaxation techniques, development of interpersonal skills, and development of knowledge and work-related skills. In addition to this, various interventions carried out at the level of organization and the physician–organization interface have also been proposed to address physician burnout.
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ORIGINAL ARTICLES Top

Psychopathology and emotional deficits among patients with psychogenic nonepileptic seizures: A comparative study Highly accessed article p. 86
Anand Thaman, Naina Sharma, Rajeev Gupta
DOI:10.4103/jmhhb.jmhhb_35_18  
Introduction: Psychogenic nonepileptic seizures (PNESs) are a neuropsychiatric condition involving involuntary episodes of movements, sensation, perception and behaviour which otherwise resemble epileptic seizures (ESs) but without any electrical discharges of brain cortices. High psychiatric comorbidity is found in PNES which may precipitate or perpetuate this condition. Moreover, disruption in emotional processing is attributed as the cause of its onset. Objectives: This study aimed to evaluate the broad psychopathological index and overall symptom distress along with emotional processing deficits as compared to epilepsy and control group. Materials and Methods: The study consisted of three groups, i.e., PNES (n = 37), ES (n = 30), and healthy control group (n = 37). Brief Symptom Inventory measuring nine dimensions of psychiatric symptoms and overall distress was applied for evaluating psychopathological profile of three groups. Emotional processing scale-25 was used to measure emotional processing deficits in five areas. Results: PNES group had higher number of females, higher symptoms of psychopathology, and increased overall symptom distress as compared to ES and control group. Similarly, PNES group showed more deficits while processing their emotions in all areas. Conclusion: Understanding psychopathology and emotional processing deficits in PNES provides clinicians a clearer picture and ready reference for devising biological and psychosocial interventions in these patients.
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Depression and suicidal ideation among young persons in Benin City, Edo State: An assessment of prevalence and risk factors Highly accessed article p. 93
Esohe Olivia Ogboghodo, Eseosasere Osadiaye, Tracy Omosun-Fadal
DOI:10.4103/jmhhb.jmhhb_13_19  
Background: Globally, more than 300 million people of all ages suffer from depression. It is a serious mental health problem that has as one of its ripple effects, suicidal ideations, which may lead to suicide attempts or suicide. Suicide accounts for an estimated 6% of all deaths among young people. Depression and suicide result from a complex interaction of social, psychological, and biological factors. This study was carried out to assess the prevalence and risk factors of depression and suicidal ideation among young persons in Benin City, Edo State, Nigeria. Methods: This was a descriptive cross-sectional study among young persons in Benin City, Edo State, Nigeria. A multistaged sampling technique was used to select respondents. Data were collected using pretested structured self-administered questionnaire which was adapted from the Patient Health Questionnaire 9. Data analysis was by IBM SPSS version 22.0, and the level of significance was set at P < 0.05. Results: A total of 504 respondents were participated in this study. The prevalence of depression and suicidal ideation among the respondents was 223 (44.2%) and 75 (14.9%), respectively. Significant determinants of prevalence of depression were presence of social factors (P < 0.001), medical factors (P = 0.005), and economic factors (P = 0.005). Respondents, who were depressed, were also more likely to have suicidal ideations (P < 0.001, confidence interval = 0.233–0.645). Conclusion: Over two-fifths of the respondents were depressed and less than a tenth had suicidal ideations. It is very pertinent for the government and medical personnel to put in synergistic efforts to ensure that depression among young persons is promptly addressed.
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Molestation of the Bengali Hijras of India: Case of hiatus between social support and mental depression p. 99
Sibsankar Mal
DOI:10.4103/jmhhb.jmhhb_18_19  
Background: The Hijra community has evolved to form a unique subculture within the Indian society. They are particularly vulnerable to adverse mental health outcomes, such as depression. They are socially excluded and deprived from social well-being. Objectives: This study examined mental health outcomes, androgyny-related molestation, perceived social support, and predictors of depression among Bengali Hijras of India. Methodology: An exploratory cum descriptive research design with a nonprobability purposive sampling was adopted including the Center for Epidemiological Studies Depression Scale and the Multidimensional Scale of Perceived Social Support to assess depression. Results: Overall, 80% of Hijras reported at least one instance of molestation; around 69% approved depressive omens. Social support emerged as the most significant predictor of depressive syndromes (P < 0.05), whereby Bengali Hijras experiencing higher levels of overall perceived social support tended to approve lower levels of depressive syndromes. Discussion: Contrary to expectations, molestation did not reach statistical significance as an independent risk factor of depression (P = 0.058), whereas some other Hijra-specific predictors were found to be statistically significantly associated with depressive symptoms (P < 0.05). The pervasiveness of molestation, depression, and suicidal attempts represents a major health concern and highlights the necessity to facilitate prosperity-sensitive, health-care dispensation. Conclusion: The study suggests that perceptions of social support among Bengali Hijras have very important implications upon one's likelihood of experiencing depressive symptoms. Therefore, this study may support the implementation of programs or actions to improve the mental health of Bengali Hijras.
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Comorbidities among children with intellectual disability presenting for disability certification at a tertiary care center and assessment of burden in mothers of these children p. 108
Pikakshi , Kamal Kumar Verma, Shri Gopal Goyal, Anju Thakral, Girish Chandra Baniya
DOI:10.4103/jmhhb.jmhhb_5_19  
Background: Intellectual disability (ID) (ICD-11) is defined as impairment in general mental abilities as well as social adaptability of the individual. It is associated with many physical and behavioral comorbidities as well as sleep problems which contribute to the disability. Living and caring for the person with ID is burdensome. Aims and Objectives: To assess physical, behavioral and sleep problems among children with ID and also assess burden in mothers of these children. Materials and Methods: This was a cross-sectional observational study carried out in tertiary care teaching hospital. Children approaching for disability certification were assessed clinically. Assessment of IQ (Intelligence quotient) and SQ (Social quotient) was done using Seguin form board and Vineland social maturity scale (VSMS) respectively and Diagnosis was made on the basis of ICD-11. Those fitting into the diagnosis of ID and fulfilling the screening criteria were taken into the study along with their mothers. Comorbidities were assessed and burden in the mothers who are the main caregivers was assessed on Zarit burden scale. Results: 72% of the children were males. The mean age of the children was 11.15 yrs. The mean IQ and SQ of children in our study were 43.88 and 45.28 respectively. IQ and SQ were found to be positively correlated. 44% of children were having mild, 36% were moderate, 6% were severe while 14% belonged to the category of profound intellectual disability. Among behavioural problems hyperactivity was the most common problem present in 48% of the children. Sleep problems were also prevalent among these children, bedtime problems being the most common (22%). Majority of mothers of these children reported burden (90%). Conclusion: Children with ID had significant co-morbidities and sleep problems which need to be addressed separately. Higher level of ID is associated with increased severity of burden; it being the maximum in the caregivers of childs with severe to profound ID. Adequate measures to address issues related to caregiver will be very helpful to relieve stress and finally improve care of intellectually disabled children.
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Impact of having a child with special needs on the psychosocial well-being of the parents: A cross-sectional study p. 115
Aditi S Jambekar, Manasi S Padhyegurjar, Shekhar B Padhyegurjar, Sadhana P Joshi, Pushpa Shahri
DOI:10.4103/jmhhb.jmhhb_24_18  
Context: Parenthood is one of the most demanding and a major milestone in the life of a couple. The task becomes more complicated if the newborn is a special child with different abilities. Parents suffer from unprecedented stress in the process of child-rearing. Efforts need to be made in understanding the problems faced by the parents and measures such as counseling services need to be made available to help them cope up with the issues. Aims: The aims of this study are (1) to evaluate the impact of having a child with special needs on the psychological, emotional, and social lives of the parents and (2) to assess the perceived need of parents for counseling services. Settings and Design: The design of the study was cross sectional with purposive sampling involving parents of special children who were being treated at two different centers at a suburb of a metro city. Subjects and Methods: Personal interviews were conducted by the researcher in local language. Statistical Analysis Used: The analysis was carried out using Microsoft Excel. Proportions were calculated, and Z-test of difference between two proportions was applied. Results: Dependency (76%), poor communication (50%), behavioral problems (68%), financial constraints (74%), stress and worry (94%), and reduced social life (60%) were some of the problems faced by affected parents. Special children were well accepted by society in general. Acceptance of the affected child by siblings was significantly less than parents (Z = 6.67, P < 0.01). There was a great (96%) perceived need for counseling services though hardly any parents (4%) have ever approached a counselor. Conclusions: Parents of children with special needs face multiple difficulties in day-to-day life. There was a perceived need for counseling services which if made available will help parents to cope up. Family and friends can be more effectively used as resource persons. Support groups of parents will be of help.
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Sexual functions and marital adjustment among persons with alcohol use disorder p. 120
Navneet Kaur, Manoj Kumar Bajaj, Ajeet Sidana
DOI:10.4103/jmhhb.jmhhb_29_18  
Background: Relationship between sexual functioning and marital adjustment has been widely studied; further, the alcohol use has been found to be an important factor in the marital adjustment, but these variables are not much researched together. Aim: The aim of the study is to examine the sexual functions and marital adjustment among persons with alcohol use disorder. Setting and Design: The current study was carried out at the department of psychiatry in a tertiary care hospital of North India, which followed the cross-sectional, single-assessment exploratory study design. Materials and Methods: A total number of 50 male patients with alcohol use disorder and their spouses from the de-addiction clinic of the outpatient services of the department of psychiatry were recruited. Patients who were in the age range of 25–50 years, married for at least 1 year, and came in contact for the first time for treatment for alcohol use disorder were included. Patients having diagnosable comorbid major psychiatric disorder which requires immediate pharmacological treatment, having any medical or neurological comorbid illness that can lead to sexual dysfunction, and/or on any medication which is known for affecting sexual functioning and severe withdrawal or intoxicated at the time of assessment were excluded from the study. Patients were assessed using Diagnostic and Statistical Manual of Mental Disorders-5 Diagnostic Criteria for sexual dysfunctions and severity of alcohol dependence questionnaire for assessing the severity of alcohol dependence, while participants and their spouses were assessed on marital adjustment questionnaire for measuring marital adjustment among them. Results and Conclusion: Fifty-four percent of the patients with alcohol use disorder had sexual dysfunctions. The prevalence of premature ejaculation was the most, followed by decline in sexual desire or hypoactive sexual disorder and then erectile dysfunction; majority of them had more than one sexual dysfunction. No significant difference was found in the marital adjustment between the couples with and without sexual dysfunctions. There was no correlation between marital adjustment and alcohol dependence severity found in the present study.
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Depression, suicidal risk, and its relation to coping in Indian school-going adolescents p. 125
M Manjula, BN Roopesh, Maraimma Philip, Anupama Ravishankar
DOI:10.4103/jmhhb.jmhhb_11_19  
Aims and Objectives: The study aimed at examining the prevalence of depression, suicidal risk in school going adolescents and to understand the stressors, coping methods used in relation to severity of depression and socio-demographic variables. Materials and Methods: Stratified Random sampling was used to select the 7 schools (8-10 grades) and 10 pre-university colleges (11 and 12 grades) from South Bangalore. Sample comprised of 1428 adolescents. Assessment tools used included Beck depression inventory, Checklist for stress, coping and suicidal behaviours, Suicidal probability scale, and Adolescent coping orientation to problems experienced inventory. Results: About 30% of the sample had moderate to severe depression, 3% reported suicidal behaviours and 0.7% had moderate to severe suicide risk. Older adolescents and girls had higher severity of depression. Suicidal risk was higher in males. Younger adolescents used more emotion focused coping strategies. Those with suicidal behaviours had higher scores on depression, hopelessness, suicidal ideation, and risk. Suicidal probability was predicted by scores on BDI, and methods of coping used. Conclusion: The study implicates need for preventive interventions in school setting in keeping with the sociodemographic and family factors and developmental needs of adolescents.
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LETTERS TO EDITOR Top

Can abrupt discontinuation of clozapine lead to seizure? p. 135
Ajeet Sidana
DOI:10.4103/jmhhb.jmhhb_37_18  
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Role of tramadol as an augmenting agent in treatment-resistant depression p. 137
Leezu Bhusri, Manish Bathla, Parul Gupta, Angad Harshbir Singh
DOI:10.4103/jmhhb.jmhhb_6_19  
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