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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 24 | Issue 1
Page Nos. 1-62

Online since Thursday, June 4, 2020

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EDITORIAL  

Family-based interventions for substance use disorders must look at the local needs and service delivery p. 1
Siddharth Sarkar, Gauri Shanker Kaloiya
DOI:10.4103/jmhhb.jmhhb_53_19  
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REVIEW ARTICLE Top

Insulin resistance and depression: Relationship and treatment implications p. 4
Vijender Singh, Bhavuk Garg
DOI:10.4103/jmhhb.jmhhb_55_19  
Insulin resistance has been associated with depressive symptoms and depressive syndrome. Studies have attempted to assess the relationship between metabolic syndrome and depression and more specifically insulin resistance and depression. Studies have also been carried out to assess the direction of this relationship. This brief review is purported to present and discuss the currently available literature evidence about relationship of insulin resistance with depression and the treatment implications of this relationship. The presence of insulin resistance in an individual is positively associated with increased depressive symptoms and the presence of depressive symptoms is found to be associated with insulin resistance. However, a causal relationship could not be established. Prospective study designs can help to enhance our knowledge in finding a causal relationship. Intervention studies that will further help in treatment decisions are required.
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DR.BUCKSHEY AWARD PAPER Top

Pathways to care and reasons for treatment-seeking behavior in patients with opioid dependence syndrome: An exploratory study p. 8
Sai Prashant Bansal, Ajeet Sidana, Shivangi Mehta
DOI:10.4103/jmhhb.jmhhb_40_18  
Background: Magnitude of the menace of opioid dependence syndrome (ODS) is ever escalating especially in Northern India. However, no studies have been attempted to study the pathways to care and reasons for treatment-seeking behavior in patients with ODS. Aim: This study aims to investigate the pathways to care and reasons for treatment seeking in patients with ODS attending the community outreach clinic and de-addiction outpatient department (OPD) of a tertiary care teaching hospital. Materials and Methods: In a cross-sectional, exploratory study, a total of 40 patients diagnosed with ODS as per International Classification of Diseases-10 criteria who visited the psychiatry OPD and community outreach clinic were included. In addition to the sociodemographic and clinical variables, semi-structured questionnaires were developed by the Department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, India, for this study. These were first used in a pilot study and then used for the assessment of reasons for seeking treatment and pathways to care from a particular setting that is either community outreach clinic or OPD. Results: Index study found out that 25% ODS patients attended OPD directly for the first time ever in their life for treatment and 55% attended community outreach clinic run by the Department of Psychiatry, GMCH, Chandigarh, India. For 30% and 35% of the individuals attending OPD and Community outreach clinic, respectively, the first point of contact ever in life since the first use of opioid was any other tertiary care center. Alternative medicine practitioners were consulted by about 20% of the patients seeking help for the first time from OPD and none amongst those attending community outreach clinic. Referral rate was also very low in OPD attending sample (20%) while absolute zero in the community sample. Whereas among reasons for seeking treatment, increasing drug cost was the most cited reason by OPD attending patients and ill-health effects by community clinic attending patients (35% each) in personal reasons, while family-related reasons were poor interpersonal relationships with family members in OPD treatment-seeking patients (45%) and family property dispute in community clinic attending patients (35%). Conclusion: It can be concluded from the study that <50% of patients with substance use disorders visit the psychiatrist for treatment on the first contact. It means that a large number of patients go to different places/people/services for advice/treatment. However, the cost of the drug was one of the main reasons for treatment-seeking behavior in this population. Community clinic attending patients are more aware about the treatment facility available in the vicinity of their dwelling place, thereby preferring a place nearby to their home for treatment.
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DR.AK KALA AWARD PAPER Top

Comparison of efficacy and tolerability of escitalopram and venlafaxine in treatment-naïve patients with unipolar nonpsychotic depression: Is there a need to revisit the prescription patterns? p. 15
Harneet Kaur, Ajeet Sidana, Thiyam Kiran Singh
DOI:10.4103/jmhhb.jmhhb_21_19  
Background: Depression is a common mental illness for which guidelines recommend selective serotonin reuptake inhibitors as the first-line treatment. As per the Sequenced Treatment Alternatives to Relieve Depression trial, the first antidepressant needs to be chosen carefully so that the number of treatment changes and therefore treatment resistance can be reduced. This study compared the efficacy and tolerability of escitalopram and venlafaxine, in treatment-naïve patients with first-episode, nonpsychotic unipolar depression. Methodology: In this prospective, randomized, open-label study, 77 patients with the International Classification of Disease-10 Diagnostic Criteria for Research diagnosis of depression were inducted and randomly assigned using a computer-generated random table to receive either escitalopram (10–20 mg/day) or venlafaxine (75–225 mg/day) in therapeutic range for a period of 12 weeks. The assessments included the Hamilton Depression Rating Scale (HDRS) and physical investigations at baseline and weeks 2, 6, and 12. A total of 60 patients completed the study and were included in the final analysis. Results: Thirty patients in each group (n = 60) enrolled with comparable baseline assessment except significantly higher HDRS in the venlafaxine group (29.87 ± 10.58) compared to escitalopram group (21.80 ± 4.41). At 12 weeks, the reduction in HDRS was significantly early and higher in the venlafaxine group (26.3 ± 9.7) than the escitalopram group (21.3 ± 4.2). Common adverse effects in the venlafaxine group included Gastrointestinal (GI) activation and vivid dreams which were seen till 2 weeks; the escitalopram group included sexual dysfunction which lasted till the end of the study. Conclusions: Both the molecules lead to significant reduction in HDRS scores across assessment. However, venlafaxine demonstrated superior efficacy and transient adverse effects compared to escitalopram, despite having higher HDRS scores at baseline. The results of the current study indicate that serotonin–norepinephrine reuptake inhibitors such as venlafaxine should be prescribed more often in routine clinical practice.
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ORIGINAL ARTICLES Top

Predictors of inpatient completion of detoxification in patients with substance use disorders p. 23
Ajeet Sidana, Raveena Saroye, Abhinav Agrawal
DOI:10.4103/jmhhb.jmhhb_62_19  
Background: Despite the availability of adequate indoor treatment facility for patients with substance use disorders (SUDs), a substantial number of patients do not undergo complete detoxification process. Incomplete detoxification leads to premature termination of treatment and relapse. Aims and Objectives: To see the association of various sociodemographic and clinical variables with completion of detoxification in hospitalized patients with SUDs. Materials and Methods: Case record files of patients with SUDs as per ICD-10, who were admitted in the de-addiction ward of a tertiary care teaching hospital of North India from January 1, 2019, to August 31, 2019, were retrieved and analyzed for various sociodemographic and clinical variables. Results: A total of 85 patients with SUDs were admitted during an 8-month period; majority of the patients were male with a mean age of 32 years, middle economic status, and from Punjab. Major substances of abuse were opioid (43.5%), followed by alcohol (37.6%) and nicotine and cannabis (5.9%). The most common route of administration was oral, followed by injecting, chasing, and smoking. Overall, 32 patients completed the detoxification during hospitalization. Age of the patient, withdrawal severity, and duration of stay in the ward are good predictors of completion of detoxification. Conclusion: It can be concluded from the study that older patients, increased severity of withdrawals, and longer duration of stay are good predictors of successful detoxification.
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Disability among patients with mental illness in Jimma Town, Southwest Ethiopia, 2017, community based crosssectional study p. 27
Liyew Agenagnew, Almaz Mamaru, Hailemariam Hailesilassie, Birhanie Mekuriaw, Badiru Dawud, Eba Abdisa, Daniel Tolosa, Mubarak Abera, Matiwos Soboka, Habtamu Kerebih, Eyerusalem Yeshigeta, Elias Tesfaye
DOI:10.4103/jmhhb.jmhhb_42_19  
Background: Disability is a limitation in performing socially defined roles and tasks expected within a social, cultural and physical environment. Despite it is a focus of concern in mental health care, the score of disability among mentally ill patients and its determinant factors were not studied in Jimma town, Southwest, Ethiopia. Therefore, this study aimed to assess the disability of patients with mental illness in Jimma town, Southwest Ethiopia, 2017. Materials and Methods: A community-based cross-sectional study, with case tracing method, was conducted from April 20 to June 24/2017 among 304 patients in Jimma University Teaching Hospital. Data were collected through face-to-face interviews using the World Health Organization Disability Assessment Schedule 2.0 with 12 items. The collected data were analyzed by bivariate and multivariate linear regression analysis method using Statistical Package for the Social Sciences version 20. Results: Out of 300 respondents, a majority had the diagnosis of schizophrenia 96 (32%) followed by 73 (24.3%) major depressive disorder. The median score of disability of the respondents was 11.1 within the ranges from 0 to 100). Over one-third of the respondents (39.3%, n = 118) reported no difficulty in any activity and only 5% (n = 15) reported an extreme difficulty or not able to do any activity for the past 30 days. While having a job negatively associated with disability (unstandardized B − 0.075, P = 0.007) and not attending school (unstandardized B 0.113, P = 0.020), number of admission (unstandardized B 0. 022, P = 0.033), and stigma (unstandardized B 0.008,P < 0.001) positively associated with disability score. Conclusions: The median score of disability of the respondents was 11.1 (within the ranges from 0 to 100), and most of the patients had no disability. Occupational status, educational status, number of admissions, and stigma were independent predictors of disability among mentally ill patients.
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Social and clinical correlates of stimulant use disorder (mephedrone) in a tertiary mental health setting in Mumbai: A pilot exploratory study p. 36
DU Bharath, Poornima S Rao, Vinayak Pandurang Kale, Sunil Kumar Panigrahi, Murali Krishna, Steven Jones, Sumanth Mallikarjuna Majgi
DOI:10.4103/jmhhb.jmhhb_40_19  
Introduction: Increasing mephedrone use is a major public health concern in India. There are limited data on sociodemographic determinants and psychiatric comorbidity associated with stimulant use disorder (mephedrone) (SUD-M) from India. Aim: The primary objective of this study was to report the clinical and social correlates of SUD-M among those presenting to specialist mental health services in Mumbai, India. Methods: Patients with SUD-M were recruited from a clinical setting. Standardized culturally validated assessments were carried out to obtain information about sociodemographics and mental health: comorbid psychopathology Brief Psychiatric Rating Scale, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and Minnesota Multiphasic Personality Inventory-2 for personality traits and a clinical assessment for diagnosis of mental disorder using DSM-5. Results: SUD-M was more common among young men from the low socioeconomic position. The most common reasons for choosing mephedrone over other substances were better high from the drug and peer pressure. There were no associations between sociodemographic factors with the severity of SUD-M. Around 40% of the patients with SUD-M had psychiatric comorbidity. Psychotic disorders and anxiety symptoms were most common. Family history of substance use, comorbid substance use, and comorbid psychiatric disorders were directly related to the severity of SUD-M. Conclusions: This was a cross-sectional study with a relatively smaller sample size of self-nominating participants limiting the generalizability of findings to a wider population. Therapeutic implication of this finding is that prompt attention and treatment of the comorbid psychiatric disorder is essential while treating patients with SUD-M. Further population-based studies are recommended for a better understanding of the burden of SUD-M.
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Exploring the association between risky sexual behaviors and substance use among Jimma university students, Ethiopia p. 44
Yonas Tesfaye, Liyew Agenagnew
DOI:10.4103/jmhhb.jmhhb_54_19  
Background: Youths in colleges have special and complex needs, with extremely high rates of sexual behaviors, mental health problems, and drug misuse. Despite this, the causal relations remain to be elucidated. Objective: The aim of this study was to assess the association between risky sexual behaviors (RSBs) and substance use among Jimma University students, Ethiopia, 2016. Materials and Methods: A quantitative cross-sectional study was conducted among 700 sampled students. Participants were drawn using a multistage stratified random sampling technique. Data were collected using a pretested, self-administered questionnaire. Alcohol use disorder identification test tool was used to assess alcohol use and for RSBs, and Khat uses questionnaires that were developed after an extensive review of the literature. Data were entered into Epi-data data management software and exported to SPSS version 20 for statistical analysis. Multivariable logistic regression was used for analysis and Variables at P < 0.05, and a 95% confidence level was used to declare statistical association. Results: The prevalence of RSB among students was found 30.2%. The odds of RSB were nearly three times higher among those who had probable alcohol use disorder than their counterpart (adjusted odds ratio [AOR] 2.9, 95% confidence interval [CI]: 1.4–6.1); similarly, the odds of RSB were nearly three times higher among those who had to chew Khat 2–4 times a month than never chewed counterpart (AOR 2.8, 95% CI: 1.1–7.7). Conclusion: The prevalence of RSB and substance use among Jimma University students was high and positively associated.
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A cross-sectional survey of social media anxiety among students of university of Nigeria p. 51
Deborah Oyine Aluh, Thelma Chukwuobasi, Adaobi Uchenna Mosanya
DOI:10.4103/jmhhb.jmhhb_64_19  
Background: Social media anxiety has been on the rise globally. There is sparse literature on the association between social media and anxiety. Most of the available data originate from high-income countries. This is the first attempt to assess social media anxiety among undergraduate students in an African country. Materials and Methods: We employed a cross-sectional and descriptive method for this study. The Social Anxiety Scale for Social Media Users was the data collection tool used to assess the levels of social media anxiety among undergraduate students of the University of Nigeria. Data were analyzed with SPSS Version 20.0. Both inferential and descriptive statistics were used. Results: A total of 228 out of the 380 questionnaires distributed were filled and returned (60% response rate). Social media usage was highest for WhatsApp (4.4 ± 0.902). The mean social media anxiety score was 68.75 ± 12.35. The prevalence was higher in females (69.00 ± 12.59) than males (68.42 ± 12.06), but the difference had no statistical significance (t = −0.356, P = 0.864). There was a negative nonsignificant association between social media usage and social media anxiety (r = −0.051, P = 0.4450). Conclusion: There was no significant association between social media usage and social media anxiety among the students surveyed. Longitudinal studies are necessary to investigate whether social media use is a causal risk factor for anxiety symptoms and anxiety-related disorders.
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CASE REPORTS Top

Disulfiram-induced psychosis at a therapeutic dose and in clear sensorium: Two case demonstrations p. 57
Abhishek Ghosh, Debasish Basu, C Pradeep, BN Subodh
DOI:10.4103/jmhhb.jmhhb_1_19  
The literature on disulfiram induced psychosis showed, it was either associated with delirium or preceded by a prescription of a higher dose. We report two cases of psychosis in clear sensorium developing in individuals with alcohol dependence without any familial loading following a short duration of a therapeutic dose of disulfiram. Before the onset of psychosis, the patients were abstinent from alcohol for about a month, which made substance-induced psychosis unlikely. Psychosis resolved following discontinuation of disulfiram. Hence, the diagnosis of disulfiram-induced psychosis was considered. A plausible mechanism of such association has been discussed. Disulfiram-induced psychosis though unusual could be disruptive and severe. Close surveillance following disulfiram is important for early identification and management of such condition.
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Memantine as an augmentation therapy in obsessive–Compulsive disorder p. 60
Parul Gupta, Shazia Anjum, Leezu Bhusri, Angad Harshbir Singh
DOI:10.4103/jmhhb.jmhhb_20_19  
Obsessive Compulsive Disorders a mental illness, which is long lasting and the person has recurrent thoughts or mental images and compulsive acts, which the person is unable to resist. SSRI and TCA are primarily used drugs for obsessive-compulsive disorder (OCD), but in few patients these lead to less response and some other augmenting drugs have to be added along with them. A role for glutamatergic dysfunction in the pathophysiology of OCD has been found. We report 2 cases with a diagnosis of OCD where the patients did not show good response on YBOCS with SSRI and other adjunctive drugs like venlafaxine, resperidone in adequate dose and duration. When memantine was added (20 mg) the patient showed improvement on YBOCS where score reduced within the 6 weeks of augmentation.
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