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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 23 | Issue 1
Page Nos. 1-73

Online since Friday, November 2, 2018

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FROM THE EDITORíS DESK  

A Farewell Note and Gratitude p. 1
Rajesh Sagar
DOI:10.4103/0971-8990.244925  
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EDITORIAL Top

Domestic violence and mental health Highly accessed article p. 2
Rajesh Sagar, Gagan Hans
DOI:10.4103/0971-8990.244924  
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PRESIDENTIAL ADDRESS Top

Community psychiatry in India: Where we stand? p. 4
Ajeet Sidana
DOI:10.4103/jmhhb.jmhhb_63_17  
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DR. BUCKSHEY AWARD PAPER Top

Does prenatal maternal stress affect the outcome of pregnancy? A prospective study from North India p. 12
Jitender Aneja, Bir Singh Chavan, Jasmin Garg, Anju Huria, Poonam Goel
DOI:10.4103/jmhhb.jmhhb_55_17  
Background: The impact of prenatal maternal stress on the outcomes of pregnancy has been investigated previously but with contradictory findings. Only few studies have evaluated the association of pregnancy-specific anxiety with preterm birth (PTB) and low birth weight (LBW). In addition, minimal research in this aspect is available from low- and middle-income countries. Aim: The study investigated the association of anxiety (in general and pregnancy-specific), depression, and stress with the outcomes of pregnancy in terms of PTB and LBW. Materials and Methods: It was a prospective study in which 110 antenatal mothers in the first to third trimester of pregnancy were evaluated on perceived stress scale-14, pregnancy-related anxiety scale, state trait anxiety inventory, and Beck depression inventory. The participants underwent single assessment on these tools, and the outcomes of pregnancy were retrieved either from medical records or through telephonic enquiry. Results: The presence of pregnancy-specific anxiety, perceived stress, and depression did not affect the outcome of pregnancy. However, participants with trait anxiety were at higher risk of delivering a preterm baby (odds ratio = 4.08; confidence interval = 0.79–20.91) although the effect was small. None of the sociodemographic or obstetrical clinical variables associated with the outcomes of pregnancy. Conclusion: Although stress and anxiety were quite prevalent in our cohort, it did not impact the outcomes of pregnancy.
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DR. AK KALA AWARD PAPER Top

The clinical, personality, and genetic correlates of binge drinking: A controlled association study from India p. 19
Abhishek Ghosh, Savita Malhotra, Debasish Basu, Madhu Khullar
DOI:10.4103/jmhhb.jmhhb_35_17  
Background and Objectives: Reasonable amount of literature has been accumulated over the years to indicate that the binge drinkers might be different from the group which does not have any history of binging. Only a handful of research demonstrated genetic predisposition for binging. Materials and Methods: This was a clinic-based association study with a case–control design. Two hundred and ten alcohol dependence cases were recruited. Binge drinking was diagnosed using Semi-structured Assessment for Genetics of Alcoholism-II-. Structured instruments were used for the assessment of impulsivity, and novelty seeking traits. single nucleotide polymorphism genotyping was done using Taqmann assay by real-time quantitative polymerase chain reaction (q-PCR) using Taqman assay (ABI 7500) fast real-time PCR system. Results: Comparison of clinical characteristics revealed an earlier age of onset of alcohol use and dependence, significantly more number of accidental injuries, emotional problems, and history of delirium tremens among the binge drinking group. The mean score in the extravagance subscale, overall novelty seeking scale, subscales of nonplanning, and attentional impulsiveness were significantly more among the binge drinkers. With regard to the candidate gene polymorphism (rs25531), short (S) allele of serotonin transporter was observed to be associated with the binge drinking group. Conclusion: Association of impulsiveness and novelty seeking is a new and important finding, indicating the role of personality traits to increase the vulnerability toward binge drinking. The association with the S allele, although is a replication of previous results, is nevertheless important as our study is from a different ethnic population.
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ORIGINAL ARTICLES Top

A study of burden of anorexia nervosa in India - 2016 p. 25
Anusa Arunachalam Mohandoss
DOI:10.4103/jmhhb.jmhhb_60_17  
Introduction: The emergence of Anorexia Nervosa (AN) in India been sporadically reported and till date, no epidemiological study has been reported. Global Burden of Disease Study 2016 (GBD 2016) offers a unique opportunity to study the AN as well as to estimate its burden quantification. Materials and Methods: Using the GBD 2016 approach and accounting for gender, age, and disability weight were accounted to calculate the disability-adjusted life years (DALYs). Results: As accounted in the model, the prevalence rate of AN for males was 10/100,000, whereas for females, it was 37.2 and combined gender burden was 22.3/100,000. A loss of 73782.7 DALYs was estimated. An estimated 55 deaths due to AN was observed. Most of the burden of the AN was borne by females in the age of 15–19 years than others with a male:female ratio of 1:4. The prevalence rate was observed to increase from 1990 to 2016. Discussion: Within the confines of the current mathematical modeling and secondary data analysis, the Indian burden of AN is significant, particularly among young females. AN is least studied mental illness in India. With increasing distorted body image perception and “western” style living, eating disorder in reported to increasingly prevalent among Indians. Mental health professions need to include AN for screening at the community level. Nonavailability of specific literature and parameters to quantify disability. Conclusion: A mathematical estimate of the AN in India is presented with its implication using a secondary data approach. In wake of rapid changes in society, the mental health community should realize that India shall not be immune to AN in the present and future.
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A study of treatment-seeking behavior in psychiatric patients at a tertiary care hospital in Delhi p. 33
Dinesh Kataria, RC Jiloha, MS Bhatia, Sneha Sharma
DOI:10.4103/jmhhb.jmhhb_46_17  
Background and Aims: Patients with mental disorders often do not seek professional help for a multitude of reasons. These issues need to be highlighted and addressed. This cross-sectional study aims to collect and to analyze treatment-seeking behavior in psychiatric patients. Subjects and Methods: Five hundred patients presenting to psychiatry Outpatient Department of a tertiary hospital in Delhi, were recruited after obtaining written informed consent. Patients were diagnosed based on the International Classification of Disease-10 criteria, and sociodemographic details were collected. Treatment-seeking behavior schedule was applied. Results: Patients between 18 and 35 years of age constituted around 60% of the total treatment-seeking patients and only 2% were above the age of 65 years. More than 60% of the sample belonged to an urban, middle socioeconomic background from nuclear families. Depression and anxiety disorders were the most common psychiatric morbidities followed by psychotic disorders and substance use disorders. Up to half of the sample had sought treatment before coming for consultation. Of these 55% visited nonpsychiatric doctors, 30% of psychiatrists and others consulted faith healers, alternate medicine, and psychologists before visiting our facility. Easy accessibility, faith, and good reputation were the reasons for going to a doctor while belief in the supernatural causation of mental illness was the major reason for seeing a faith healer. Mostly, a family member had given information about our facility. Previous ineffective treatment and cost concerns regarding medications were the predominant reasons to visit after prior visits elsewhere. Conclusion: Factors determining treatment-seeking behavior can help address problems and delay in early identification and optimal management of mental disorders.
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Adolescent girls in romantic relationship under child protection system – Issues and concerns: A study from India p. 38
B Manjula, N Janardhana, Bergai Parthsarathy Nirmala
DOI:10.4103/jmhhb.jmhhb_26_18  
Background: Existing literature shows the developmental significance of romantic relationships during adolescence and its influence on mental health and emotional well-being of adolescents. However, in recent years, this phenomenon has begun to receive more research attention in the Indian context. In India, many adolescent girls engage in risk-taking behaviors such as running away from home, child marriage, unsafe sexual relationships and teenage pregnancy, and consequently come into contact with child protection units. Methods: Adopting a retrospective exploratory research design, this study is a case report analysis of the psychosocial issues at individual level and family level in romantic relationship of adolescent girls who engaged in such risk-taking behaviors and were institutionalized in a State Children's Home in urban India. Results: In the present study, the mean age of the participants was 16.34 years with the range of 14–18 years. About 60% of the participants were in high school. Majority of them hailed from nuclear family with lower socioeconomic status and belonged to Hindu Religion. Psychosocial issues among adolescents and parents before and after risk-taking behaviors are varied and interlinked. Majority of the issues are related to the social norms and have significant impact on adolescents and their parents. Conclusion: Implications for future research, and for designing interventions for adolescents and their families, based on a mental health and development perspective, are highlighted. There is a need for enhancing skills among adolescent girls and for family interventions to enhance parent–children relationships to deal effectively with issues in the context of adolescent romantic relationships.
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Ending up in prison healthy and getting out mentally ill: Prevalence and risk factors of psychiatric illnesses among jail inmates at the Kondengui Central Prison (Yaoundé-Cameroon) p. 43
Eric Clement Lele Nkoagne, H Blaise Nguendo Yongsi
DOI:10.4103/jmhhb.jmhhb_20_18  
Background: Mental disorders are a matter of great concern worldwide. The situation is particularly challenging in the developing countries given the substandard detention conditions of prisoners. This appears to be an obstacle to achieve the triple economic, social, and security goals of prisons of this 21st century. Objectives: This study aims at determining the prevalence and risk factors associated with mental disorders among inmates in Cameroon. Subjects and Setting: The study focuses on 230 convicted and unconvicted inmates being held at the Central Correctional Prison of Kondengui in Yaoundé. Materials and Methods: A cross-sectional study of a random sample was conducted to assess psychiatric disorders using a Mini-International Neuropsychiatric Interview. The Chi-square test was used to determine associations at the 5% significance level, and magnitude of association was estimated using the odds ratio and its 95% confidence interval. Results: Of the 230 inmates, 80 (34.8%) were diagnosed as suffering from a mental illness, and identified disorders were related to psychotic disorders (66.67%) to mood disorders (54.29%), borderline personality (38.57%), and suicidal thoughts (24.29%). Risk factors associated with those mental disorders were mostly environmental (the general prison environment), sociological and individual (regimes governing daily life inside prison). Conclusion: Mental disorders are common among inmates. Extrapolation of our results suggests that inmates in Cameroon need transfer to hospital for specialized psychiatric treatment and services and that environmental condition of detention must be improved.
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Behavioral problems and temperamental characteristics among children in alcoholic families p. 52
Ottilingam Somasundaram Ravindran, K Hima, S Natarajan, R Sathianathan
DOI:10.4103/jmhhb.jmhhb_2_18  
Background: Children of alcoholics (COAs) are at high risk for behavioral problems and temperamental difficulties. Aim: The aim of this study was to compare the behavioral problems and temperamental characteristics in children of persons with and without alcoholism. Materials and Methods: Using a case–control design, 60 children (30 in the study group and 30 controls) were evaluated for their behavioral problems, aggression, and temperamental characteristics. Tools used were: Child Behavior Checklist, Aggression Questionnaire, and the Malhotra's Temperament Schedule. Results: The COAs were found to be more aggressive, manifesting more behavioral problems and temperamental difficulties than the controls. Conclusion: Children in families with an alcohol-dependent father are at increased risk for problem behaviors with a difficult temperament.
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Alexithymia governing neurosis: A comparative study between patients and caregivers p. 57
Apala Aggarwal, Deeksha Kalra, Dinesh Kataria, Rohit Verma
DOI:10.4103/jmhhb.jmhhb_58_17  
Context: Individuals with neurotic disorders are believed to have alexithymia, which not only acts as a substrate for neurosis but also poses difficulties in delivering psychotherapeutic intervention to these patients. Aims: This study aims to study and compare alexithymia among patients of neurosis and their caregivers. Settings and Design: This descriptive cross-sectional study was carried out at the Department of Psychiatry of a Tertiary Government Hospital in Delhi. Materials and Methods: Fifty consecutive patients of neurosis (as per ICD-10) and their caregivers were assessed using Hindi versions of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Toronto alexithymia scale (TAS-20) after taking written informed consent. Statistical Analysis: Data were analyzed using descriptive statistics, independent t-test, ANOVA, and multiple linear correlation. Results: The mean age of patient and caregiver groups was comparable (35.86 ± 10.6 and 36.04 ± 10.6 years) with no significant difference on socio-demographic parameters. The patient group had significantly higher scores of total TAS and also on parameters of difficulty identifying feelings, difficulty describing feelings and externally oriented thinking (P < 0.000). Total PHQ-9 and GAD-7 scores were significantly correlated to TAS scores (total and 3 domains) in both groups. Females scored higher than males (P = 0.022, PC = 0.324) and age showed negative correlation (P = 0.036, PC = −0.297) with total TAS scores in the patient group. Conclusion: The study shows that alexithymia is more common in patients with neurosis as compared to their caregivers. Besides, it is closely related to neurotic traits in the caregivers who scored high on PHQ-9 and GAD-7 despite being free of a diagnosable illness.
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BRIEF COMMUNICATION Top

Help-seeking behavior and pathways to care among patients seeking treatment at a private psychiatric hospital in North India p. 63
Dhanesh Kumar Gupta, Roop Sidana, Mitesh Behari, Kamal K Verma, Mahendra Singh Bhadoriya
DOI:10.4103/jmhhb.jmhhb_49_17  
Background: There are no studies on pathways to psychiatric care in patients seeking help at private psychiatric hospitals in India. Aim: This study aims to study help-seeking behavior and pathways to care among patients-seeking treatment at a private psychiatric hospital in North India. Subjects and Methods: Fifty newly registered patients were assessed for their help-seeking behavior and pathways to care before seeking the current consultation. Descriptive analysis was performed. Results: Most of the patients sought help either as self-referral or on advice of their relatives, friends, and other patients. Eighty percent of patients had seen a care provider within 1 month of onset of their symptoms. Forty-eight percent patients approached a psychiatrist while 34% approached a faith healer or unqualified local practitioner as their first care provider. Conclusion: Patients with mental illnesses vary in their help-seeking behavior with regard to their choice of first care provider, time to reach a psychiatrist, and number of care providers sought for their mental health problems.
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CASE REPORT Top

Dermatitis artefacta (factitious dermatitis) responding to high-dose sertraline p. 67
Vinayak Koparde, Shivakumar Patil, Sandeep Patil
DOI:10.4103/jmhhb.jmhhb_45_17  
Dermatitis artefacta (factitious dermatitis) is a prototypical psychodermatological condition. This condition though not uncommon its management involves complete psychiatric evaluation and treatment. It is commonly seen in patients with underlying psychological conflicts. There are no systematic studies to assess the efficacy of medicines for this condition. However, reports of improvement with selective serotonin reuptake inhibitors and atypical antipsychotics are present. Here, we report a case of dermatitis artefacta responding to high dose of sertraline.
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INSPIRATIONS FROM HISTORY Top

Chronobiology: Discovery of the molecular mechanisms of circadian rhythm p. 69
Pooja Shakya, Shyama Nand Roy, Raman Deep
DOI:10.4103/jmhhb.jmhhb_33_18  
Advances in the field chronobiology have potential implications for physical as well as mental health and human behavior. Several paradigm-shifting discoveries established key mechanistic principles for the biological clock. We trace the origins and key discoveries that helped to advance the field of chronobiology and a ground-breaking work recently recognized by Nobel prize. The foundational work by Hall, Rosbash and Young led them to Nobel prize in physiology or medicine (2017) for discoveries pertaining to molecular basis of circadian rhythm.
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LETTERS TO EDITOR Top

Lamotrigine-associated breakthrough hypomania p. 72
Ajeet Sidana
DOI:10.4103/jmhhb.jmhhb_56_17  
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Workplace violence in health care p. 73
Indranil Ghosh, Dimple A Shah, Bibhukalyani Das, Dipendra K Pradhan
DOI:10.4103/jmhhb.jmhhb_59_17  
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