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   Table of Contents - Current issue
July-December 2019
Volume 24 | Issue 2
Page Nos. 63-153

Online since Wednesday, July 22, 2020

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Focus on youth mental health: The need of the hour p. 63
Swapnajeet Sahoo, Sandeep Grover
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Internet and psychopathology: A complex paradigm p. 66
Yatan Pal Singh Balhara, Swarndeep Singh
Psychopathology refers to the scientific exploration of abnormal mental states. The advent of internet has changed the way human beings experience their life and the world around them. There is hardly any aspect of the modern living experience that has remained uninfluenced from internet. The same is true for the field of psychopathology as well. The unprecedented pace of digital revolution with ever increasing utilization of internet-based technologies for different purposes, apart from providing a world of exciting opportunities, has also been associated with several negative consequences. This relatively newer addition to the human living experience is also reflected in the inclusion of newer diagnostic categories in the current diagnostic system (thereby meaning addition of new psychopathology). It has also impacted the experience, manifestation, and communication of psychopathology that existed for years even before advent of the Internet. The current article offers a description of the various clinically relevant human behavioral manifestations that are shaped by our exposure to the Internet and related technology. It also proposes a scheme for categorizing these clinically relevant human behavioral manifestations. This categorization is expected to have clinical and research implications going ahead.
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A review of scales of perceived parenting style p. 73
Sukanya Rajan, Janardhana Navaneetham, P Marriamma, D Muralidhar
Background: Research in the field of parenting has grown in the recent decade. Parenting style scales are used to measure the perception of parenting style either from the child's viewpoint or parent's viewpoint. The previous review of scales affirms the parenting style scales in the western context. The current review examines the scales available to measure the same from a young adult's perspective and throws light on the need to have a scale which can bring out cultural aspect. Methodology: Searches of PubMed, EBSCO, PROQUEST, and Google Scholar to identify scales that focus on the perception of parenting styles and find publications that assess their criterion-related validity. Results: Almost 10 numbers of instruments assessing parenting style among the young adults were located. Searches identified 10 scales and the publication that assesses the validity. The evident approach to item generation was available literature, focus group discussion, and interviews prominently on the foundation of Baumarind's theory of parenting style. Findings raise methodological concerns, which inform recommendation for future development. Conclusion: Scales perceiving parenting styles have been developed in the western context and validated for Indian context, hence there is a need for developing indigenous scales suiting our collectivistic culture.
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Effectiveness of melatonin in the management of delirium: A retrospective study p. 78
Sandeep Grover, Devakshi Dua, Swapnajeet Sahoo, Subho Chakrabarti, Ajit Avasthi
Background: Melatonin, a naturally occurring endogenous hormone, primarily secreted by the pineal gland plays a key role in managing multiple bodily functions which are affected among patients with delirium. In view of the same, exogenous melatonin has been evaluated in the prevention and management of delirium. Compared to the data on role of melatonin in prevention of delirium, data on the management of delirium are limited. Aim: To evaluate the effectiveness of melatonin in patients with delirium and to compare the same with haloperidol and quetiapine. Materials and Methods: Using retrospective study design, data of patients diagnosed with delirium as per the Diagnostic and Statistical Manual, 5th Revision criteria, and rated on Delirium Rating Scale-Revised 98 version at the baseline and 6 consecutive days. Results: The study included 108 patients, of whom 34 were on melatonin, 31 were on quetiapine, and 43 were on haloperidol. Findings of the present study show that melatonin is as effective as haloperidol and quetiapine in the management of delirium. Patients required 1.5–6 mg/day of melatonin, administered during the evening time. Melatonin was mostly used in patients who had prolonged QTc interval, which precluded the use of antipsychotics. Conclusion: The present study suggests that melatonin may be another pharmacological treatment option for the management of delirium, especially among patients with prolonged QTc interval.
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Effects of psychological capital and self-esteem on emotional and behavioral problems among adolescents p. 85
Nilesh Maruti Gujar, Arif Ali
Background: Psychological capital (PsyCap) and self-esteem can potentially affect mental health among adolescents and can be used effectively to cope with stress. Aim and Objectives: The purpose of this study was to evaluate the association between PsyCap, self-esteem, emotional, and behavioral problems and to determine the extent to which PsyCap and self-esteem predict the variability in the emotional and behavioral problems of school-going adolescents. Methodology: The present study was cross-sectional, and schools were selected using purposive sampling technique. A total of 387 samples were included based on the Krejcie and Morgan method to determine the sample size. Sociodemographic datasheet, PsyCap Questionnaire, Rosenberg Self-Esteem Scale, and Strengths and Difficulties Questionnaire (self-report) were administered. Results: The prevalence of emotional and behavioral problems was found to be 21.6% (abnormal level), and self-esteem had a negative correlation with emotional and behavioral problems (r = −0.208 P < 0.01) and a positive correlation with PsyCap (r = 0.409; P < 0.01). Self-esteem was found to be a significant predictor for emotional and behavioral problems. Conclusion: Emotional and behavioral problems of the adolescent population are closely related to self-esteem and PsyCap. Building PsyCap and self-esteem can strengthen the mental health of adolescents.
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Burnout in medical professionals working in a tertiary care hospital: A re-analysis of the data p. 91
Sandeep Grover, Swapnajeet Sahoo, Ashish Bhalla, Ajit Avasthi
Background: Burnout is highly prevalent among medical professionals. The three dimensions of burnout, i.e., emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) often co-exist and have been found to negatively affecting professionalism. Objectives: To evaluate the prevalence of burnout in terms of three dimensions of Maslach burnout inventory (MBI) and to explore the correlates of the same among the doctors. Methodology: An online survey questionnaire was circulated among the medical professionals (residents and senior consultants/faculty) of a tertiary care hospital of North India to evaluate burnout, depression, stress, and internet addiction (IA). Results: The survey included data of 445 responders, of whom 376 (84.5%) were resident doctors and 69 (15.5%) were faculty members in the institute. Based on the suggested cutoffs, 79.1% of the participants (n = 352) reported moderate-to-high level of EE, 59.55% of the participants reported experiencing moderate-to-high level of DP, and 7.0% of the participants (n = 31) reported of having low PA. Burnout in any one dimension of MBI was seen in 30.6% (n = 136), in two dimensions in 50.6% (n = 225), and in all the three dimensions in 10.8% (n = 48). Highest level of EE and DP and low PA were reported by participants from the specialty of pediatrics, and this was followed by internal medicine. Participants with high EE and high DP were significantly younger, were more often females, and had significantly higher average number of working hours per week. All the three domains of burnout were associated with the presence of depression and perceived stress and significantly higher scores on Young IA scale. Linear regression analysis suggested that for all the three dimensions of burnout, perceived stress score was the variable, which explained the maximum variance. Conclusions: Burnout is highly prevalent among medical professionals, especially in the domain of EE, and this is followed by DP. Younger age, female gender, and longer working hours/week are significantly associated with EE and DP and with low PA. Perceived stress is one of the important predictors of burnout in medical professionals.
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Use of self-help manual for the management of obsessive–compulsive disorder: Effectiveness in Indian context p. 104
Sneh Kapoor, Manju Mehta, Rajesh Sagar
Background: The past few decades have seen great strides in the field of psychotherapy. With the advancement in technology, alternative modes of therapy dissemination such as computers, telemental health, and manuals are being explored. Obsessive–compulsive disorder (OCD) has increasingly come under the purview of these modes, particularly for the delivery of self-directed exposure and response prevention. The current study explores the effectiveness of self-help manuals (SHMs) in the management of OCD. Methods: The study employed a pre- and post-experimental design. Participants were randomly assigned to one of the three conditions (independent variable) – Therapist-directed Intervention, SHM, and Control Group. Outcome measures used (Dependent Variables) were symptom severity scores as assessed on Yale–Brown Obsessive Compulsive Scale (Y-BOCS). Sixty participants between the ages of 15–45 years were screened and assigned to one of the three conditions. The therapist-directed group received exposure and response prevention (ERP) delivered by the therapist in weekly sessions, while self-help group received the manual with progress updates on a fortnightly basis, and control group received only pharmacotherapy. Outcome assessment was conducted postintervention at 15 weeks. Results: Both therapist-directed as well as SHM groups showed significant improvement from pre- to post-intervention while was not seen for the control group. No significant difference was seen in improvements for the groups using therapist-directed or SHM approach; however, both showed significantly greater improvement on Y-BOCS scores as compared to controls. Conclusion: SHMs produce improvements comparable to that of traditional therapist-directed approaches. The findings raise important implications for the use of manuals as adjuncts or independent therapy models.
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Cognitive functions in alcohol use and cannabis use disorder: A cross-sectional study p. 113
Ottilingam Somasundaram Ravindran, G Nandini, Natarajan Shanmugasundaram, V Vivian Kapil
Background and Aim: Alcohol and cannabis misuse have an impact on neurocognition. This cross-sectional study evaluated the neuropsychological performance of individuals with alcohol dependence and cannabis dependence with concomitant alcohol use. Materials and Methods: We recruited individuals with alcohol dependence (n = 21) and cannabis dependence with concomitant alcohol use (n = 17) and age being 18–60 years as per the International Classification of Diseases-10th revision criteria. Convenience sampling was done. All the participants were evaluated by a comprehensive neuropsychological battery. Comparisons involving neuropsychological measures were performed using Mann–Whitney U-test. Results: Participants with cannabis dependence with co-occurring alcohol use showed significantly poorer performance than the participants with alcohol dependence on tasks assessing processing speed, working memory, verbal learning and memory, visuospatial ability, and language skills Conclusions: Participants with cannabis dependence with co-occurring alcohol use exhibited poorer cognitive performance on several neuropsychological measures than the participants with alcohol dependence. Age, duration, and early age of cannabis use initiation have no links with cognitive performance in the cannabis + alcohol group.
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Rethinking medical school curriculum: An exploratory study of medical student mental health in a nontraditional program p. 120
Lindsey N Teal, Krucial K Styslinger, Steven H Kelder, Freya Spielberg
Context: Medical student mental health has been studied extensively, yet little is known about students in nontraditional medical school programs. Aims: The goal of this study was to assess the frequency of symptoms of mental illness in the first, second, and third class at a new, nontraditional medical school. Settings and Design: An exploratory self-reported study was conducted in students enrolled at recently opened University of Texas at Austin Dell Medical School (n = 147) in April 2019. Methods: The Patient Health Questionnaire-9 was selected as the outcome measure for the study which includes subscales for depression, thoughts of suicidal ideation or self-harm, anxiety, and posttraumatic stress disorder (PTSD). Qualitative interview data were collected to better understand perceived barriers to engaging with university mental health services. Statistical Analysis Used: Descriptive statistics was used for the univariate analysis with Chi-square, and logistic regression models were used for the bivariate analysis. Results: One hundred and twenty of the 187 students responded to the survey, and the response rate was 81.6%. Overall, 16 (13.3%) of medical students were screened positive for depression, 14 (11.7%) for anxiety, and 4 (3.4%) for PTSD. There were 7 (5.8%) of students who reported suicidal ideation or thoughts of self-harm. The second year students reported higher rates of mental health illnesses when compared to other classes. Common barriers to using mental health services were lack of time (n = 52, 63.4%) and stigma (n = 13, 15.9%). The response rate for the quantitative and qualitative data was 120 (81.6%) and 82 (68.3%), respectively. Conclusions: Attending a nontraditional medical school program may contribute to a low prevalence of anxiety (11.7%). Since the 2nd year clinical medical students had the highest rates of mental illness and reported lack of time as the largest barrier, interventions should focus on providing flexible timing of mental health services.
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Short-term changes in the mental health of recently enrolled university students p. 126
Rubi Abigail Cruz-Sanchez, Luis Enrique Ferrer-Juárez, Martha Edith Reyes-Garduño, María José Gil-Trejo, Sergio Manuel Sánchez-Moguel, Sofía González-Salinas
Background: There are no studies that evaluate whether briefly after beginning of university studies, emotional changes, sleeping alterations, or disordered eating habits take place. Aim: To evaluate whether depression, anxiety, stress, sleep quality, and eating behaviors change 1 month after the beginning of medical school. Methods: We applied an online version of the scales Depression, Anxiety, and Stress Scale-21, Pittsburgh Quality Index, and Eating Attitudes Test-26 to recently enrolled medical students in their 1st week of classes and 1 month after. A total of 17 students completed both tests; their mean age was 18.4 years. Results: Sleep quality decreased 1 month after starting undergraduate studies, while no significant changes occurred in the level of depression, anxiety, stress, or eating behaviors. Importantly, waist circumference increased 1 month after starting classes. A correlation analysis showed that poor sleep quality in Test 2 was positively related to depression, anxiety, and stress also in Test 2. By multivariate linear regression, we found that sleep quality was only statistically related to depression scores. We found no statistical relationship between eating behaviors and the emotional state of the students. Conclusion: We provide evidence in favor of a relationship of emotional alterations and sleep quality while did not find an association of these variables with eating behaviors. We conclude that briefly after enrollment at medical school, sleep quality is mainly affected and this may later lead to emotional alterations.
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Arsenic contamination in groundwater causing impaired memory and intelligence in school children of Simri village of Buxar district of Bihar p. 132
Arun Kumar, Md Samiur Rahman, Ranjit Kumar, Mohammad Ali, Pintoo Kumar Niraj, Abhinav Srivastava, Sushil Kumar Singh, Ashok Kumar Ghosh
Background: Over the last few decades there has been increased health related issues due to arsenic poisoning worldwide. In India, in state of Bihar, 18 districts are affected from arsenic poisoning causing various health related problems in the exposed population. Arsenic poisoning in Buxar district of Bihar in the recent times has been identified as one of arsenic hotspot of Bihar due to serious health related problems including cancer. Aims and Objectives: The present study aims to find out that whether arsenic contamination in groundwater causes impaired memory and intelligence in school children of Simri village of Buxar district of Bihar or not? Materials and Methods: In the present study, water samples were collected from three hand pumps, which were utilized by the school children for drinking purpose since last ten years. Hair samples of 65 students enrolled in this school were also collected for the analysis of arsenic concentration and its correlation with the drinking water arsenic was done. The same students were interviewed for neuro-behavioural and memory tests for which various methods were utilized like continuous performance test (CPT), symbol digit test (SDT), pattern memory test (PMT) and switching attention behavior (SAB). Results: The study revealed high arsenic concentration in the water and hair samples. The correlation between high arsenic concentration in water and hair denotes high degree of exposure. Their neuro-behavioural analysis reflected very alarming observations like impaired intelligence memory pattern along with the inattention, loss of concentration and alertness. The highest arsenic concentration in drinking water observed was 857 μg/L while in the children hair sample the maximum value was 12.609 mg/Kg. Conclusion: The present study thus concludes that arsenic poisoning is causing changes in the neuro-behavioural activities in school children of Simri village. Therefore, a specific strategy is urgently required to control the present problem.
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Coping among caregivers of patients suffering from bipolar affective disorder p. 139
Abdul Majid Gania, Harmanjeet Kaur, Ajaz Ahmad Suhaff, Sandeep Grover, Abdul Wahid Khan, Sajid Mohammad Wani
Introduction: Burden caused by bipolar affective disorder (BPAD) upon families and caregivers is a matter of increasing clinical concern. Stressors are coped with based on how significant they are for those involved. Coping means trying to overcome that which is causing stress and may refocus the significance associated with the difficulties, guide the individual's life, and keep him/her physically, psychologically, and socially healthy. Aims and Objectives: The aim and objective of the study was to explore ways of coping by caregivers of patients suffering from BPAD. Materials and Methods: The sample comprised 100 caregivers of 100 patients either outpatients or inpatients at the Department of Psychiatry, SKIMS, Bemina, Srinagar, diagnosed with BPAD using International Classification of Diseases, tenth revision. Results: Majority of caregivers were from the age group of 40–49 years, males, married, and with no formal education. In our study, majority of caregivers were from the age group of 40–49 years, males, unmarried, and with no formal education. Majority of caregivers had been providing care to the patients for the duration of 1–5 years. Majority of caregivers were spouses of the patients. The most common method of coping was consulting doctors, talking to friends/family, and seeking practical help. Majority of caregivers used avoidance, seeking social support, and problem-focused strategies. Collusion strategy was also frequently used. Coercion strategy was used less frequently. Conclusions: Majority of caregivers used avoidance, seeking social support, and problem-focused strategies. Collusion strategy was also frequently used. Coercion strategy was used less frequently. We need to better understand caregivers' views and personal perceptions of the stresses and demands arising from caring for someone with bipolar affective disorder. Family interventions are needed to increase the coping ability of caregivers of the patients.
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Consultation-liaison psychiatry in newly established general hospital psychiatry unit: Scope and suggestions p. 144
Himanshu Gupta, Deeksha Elwadhi, Zara Ahmed, Ram Chander Jiloha
Background: Consultation-liaison (C-L) psychiatry is the subspecialty of psychiatry dealing with mental health disorders in nonpsychiatric settings. The ubiquity of mental health problems has increased the need for such a service to exist in general hospital psychiatric units, as many psychiatric patients report to a different specialty of medicine for the first time. This study aims to evaluate the utilization of psychiatry C-L services by nonpsychiatric inpatient units in a general hospital psychiatry unit taking into consideration the paucity of data for understanding the trends and improving service provision in the future. Materials and Methods: A retrospective chart review of all inpatient referrals received by the psychiatry department from July 2015 to February 2017 was conducted. The sociodemographic profile, source of referral, reason for referral, and psychiatric diagnosis using the International Statistical Classification of Diseases-10 were analyzed using descriptive statistical methods. Results: A total of 605 patients were referred, which comprised 0.86% of total indoor admissions. Maximum number of consultations was sought from internal medicine. “Unexplained physical symptoms” was the most common reason for referral (35%). Consequently, neurotic, stress-related, and somatoform disorder (25.5%) was the most common psychiatric diagnosis followed by mood disorder (19.8%). Conclusion: Poor and variable referral rate from various departments highlights the increasing need to sensitize all clinicians regarding psychiatric comorbidity. There is a need to explore factors that would result in increasing referral rates and making psychiatric consultation services effective and efficient.
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Reasons for playing online games among females: A case report based evidence p. 148
Manoj Kumar Sharma, Nitin Anand, N Suma, Pranjali Chakraborty Thakur, Maya Sahu, Nisha John, Ashwini Tadpatrikar, Priya Singh, SJ Ajith, Ankita Biswas, R Archana, Akash Vishwakarma, Keshava D Murthy
The online gaming has not been a well -researched area among females. The female gamers also have a preference for violent games. A 17-year-old female pursuing secondary education, belonging to a single child nuclear family presented with complaints of playing online games, increased expression of anger, decline in academics, and decreased social interaction. The case demonstrated that feeling of achievement, escapism, distraction, and developing social ties were the predominant motives to play games among females. The case also reflected the issues of emotional dyscontrol which were secondary to the nonavailability of opportunity to play. The case implies for enhancing understanding the process issues of gaming behaviors among females, cross-cultural knowledge, as well as for screening and formulating preventive strategies.
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Refeeding syndrome in catatonic schizophrenia p. 151
Supriya Agarwal, Rakesh Kumar Biswas, Abhishek Gupta, Sandeep Choudhary
Refeeding syndrome is an uncommon but potentially fatal condition. It occurs in a patient who consumes a large amount of calories over a brief period of time after a sustained period of starvation. This syndrome is characterized by a high risk of cardiovascular collapse secondary to electrolyte imbalance if left untreated or if there is a delay in the management. Psychiatric patients with a diagnosis of schizophrenia or severe depression are known to refuse food for a prolonged period of time, thus creating a malnourished or starved metabolic state. The purpose of this article is to bring an acute awareness and sensitize the fellow psychiatrists about refeeding syndrome, a likely fatal possibility in a starved or malnourished patient on refeeding. Prompt recognition and management in collaboration with medical colleagues can save the life of these patients.
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