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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 25 | Issue 2
Page Nos. 71-159

Online since Tuesday, February 23, 2021

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EDITORIAL  

Etiquettes of practicing telepsychiatry p. 71
Sandeep Grover
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REVIEW ARTICLE Top

Cyberpsychiatric disorders: An overview of assessment and management p. 76
Sandeep Grover, Anish Shouan
DOI:10.4103/0971-8990.309968  
The advent of computers and the Internet has resulted in both positive and negative changes in day-to-day human life. These “negative changes” include physical problems such as back pain to visual problems, as well as psychological problems such as prolonged Internet use. These negative changes in the human life, as a result of excess of Internet use, are understood as “cyberpsychiatric disorders,” which are defined as the co-occurrence of excessive Internet use and current psychiatric nosology. Some of the well-known conditions include problematic Internet use (PIU), online gambling disorder, Internet gaming disorder (IGD), cyberchondria, cyber suicide, cybersexual addiction, cyberbullying/cyberstalking, and online compulsive buying. However, current nosological systems have not recognized these conditions. This article reviews the current understanding about various cyberpsychiatric conditions, their assessment, and management. Current evidence suggests that, although some of these constructs are poorly defined, some constructs such as PIU, IGD, and cyberbullying have been researched more than the other constructs. In terms of prevention and management of these disorders, mental health professionals have a big role to play. At present, very few treatment models have been evaluated and have been found to be effective. With the passage of time and digitalization of the modern age, there will be an upsurge in the number of patients suffering from these ailments and the mental health professionals must be prepared to address these issues.
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ORIGINAL ARTICLES Top

I Would Just Want to Leave this World”: Women's experiences of domestic violence in Northern Namibia p. 93
Belinda L Selebano, John D Matthews
DOI:10.4103/jmhhb.jmhhb_31_20  
Background: Domestic violence (DV) is a traumatic experience that is influenced by a complex interplay of intrinsic and extrinsic factors and which exists worldwide. Namibia, located in Southwest Africa, is no exception to this as local media continuously report incidences of physical and sexual violence committed against women throughout the country. Materials and Methods: Using a qualitative design, twelve (N=12) female participants who experienced first-hand the effects of DV provided extensive insights into this phenomenon and its causal factors and offered suggestions as to what can be done to address this issue. Results: The results from this inquiry detail the physical and mental health implications of abuse and the challenges and barriers that participants experienced during the help seeking process. Conclusions: These findings contribute to knowledge enhancement and awareness raising which are essential for policy development and establishing inclusive practices related to DV. Furthermore, the study endeavours to assist helping professionals, such as social workers, psychologists, counsellors, and psychiatrists in their assessment and support of individuals who experience traumatic violence in their intimate relationships.
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Prevalence and risk factors of alcohol consumption behavior among late adolescents: Evidence from Puducherry, India p. 100
L Raja Lourde, Prakash Babu Kodali
DOI:10.4103/jmhhb.jmhhb_83_20  
Introduction: Alcohol is a psychoactive substance with dependence-producing properties. Adolescents account for a quarter of current drinkers in the world. Early initiation of alcohol use is one of the most important predictors of future physical and social health. Materials and Methods: A cross-sectional descriptive study among a sample of 210 adolescent males (aged 18–19 years), was conducted to identify the prevalence of alcohol consumption and the factors associated with it. The data were statistically analyzed using frequencies, percentages, Chi-square tests of independence and binary logistic regression. Results: About 62.3% (n = 131) of the respondents have consumed alcohol and 54.3% (n = 114) were current drinkers. Alcohol consumption was significantly associated with monthly pocket money (N = 210, χ2 = 17.834, df = 5), parents-consuming alcohol (N = 210, χ2 = 6.926, df = 1), friends-consuming alcohol (N = 210, χ2 = 24.549, df = 1), smoking status (N = 210, χ2 = 54.189, df = 1), and awareness about health effects of alcohol (N = 210, χ2 = 193.482, df = 2). Social influences of “friends-consuming alcohol” and “parents-consuming alcohol” were strongly associated with alcohol consumption among adolescents with odds ratio (OR) of 4.048 (95% confidence interval [CI] = 1.485–11.032) and 2.172 (95% CI = 1.076–4.386), respectively. In addition, it was also observed that smoking status and high monthly pocket money of INR 8000–12000 was strongly associated with alcohol consumption status with OR of 15.161 (95% CI = 5.076–45.286) and 25.660 (95% CI = 1.323–498.489), respectively. Conclusion: The study highlights the possible role of the individual, economic and social dimensions in the initiation of alcohol consumption among adolescents. The alcohol prevention interventions should be delivered through a multi-pronged approach focusing on these dimensions to be more effective.
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Understanding of mental health-related stigma among people in urban Kolkata p. 106
Soumyadeep Dey, Bhaswati Ganguli, Gunjan C Khemka, Sarbani Das Roy, Laboni Roy, Arupkumar Chakrabartty, Kazi Monjur Ali, Abhijit Dey
DOI:10.4103/jmhhb.jmhhb_39_20  
Background: Mental health-care settings are not equipped to address holistic care. . Being a program manager, one needs to have good understanding about different barriers of access to mental healthcare services. Poor awareness and stigma attached to mental health are two important barriers of a community-based mental healthcare intervention. There is a dearth of studies that provide information about this. The present study reflects the same. Objective: The objective of this study was to assess people's knowledge about mental health and perceived stigma and to identify factors that influence them. Methods: The study was conducted under two types of intervention wards – one with urban mental health program (UMHP) and another one with homeless people with mental illness (HPMI). There was a comparison ward with no intervention. Information was collected from 272 respondents through multistage random sampling method from general community. Analysis was done using profile characters of participants as independent variables and knowledge, attitude, and practice (KAP) score and stigma score as dependent variables. Results: The mean KAP score is 25.5 (range: 13–32). It implies 65.3% cumulative KAP level on mental health. Around 29.9% of people believe that going to a psychiatrist means that a person has mental illness. KAP and stigma scores are influenced by the type of ward but not by any other profile characters. KAP score is higher in UMHP and HPMI wards than the comparison ward. Conclusion: The intervention wards have more KAP score than comparison ward implying the effectiveness of community-based mental health interventions. This calls for replication of similar interventions for wider spread of knowledge on mental health among general population.
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Incidence, prevalence, risk factors and outcome of delirium in the intensive care unit of a tertiary care hospital p. 113
Samta Goyal, Anupam Shrivastva, Gurpreet Singh, Sandeep Kumar Goyal, Deepshikha Kamra, Sandeep Kaur, Maninder Kaur, Lovepreet Kaur
DOI:10.4103/jmhhb.jmhhb_52_20  
Context: Delirium is an acute fluctuating disorder. Impairment in attention and awareness is considered a core symptom. Data from the west suggests that up to 80% of ventilated patients have delirium. Aims: The aim of this study was to evaluate the incidence, prevalence, risk factors, and outcome of delirium in the intensive care unit (ICU) of a tertiary care hospital. Settings and Design: The study was carried out in various ICUs of a multidisciplinary tertiary care hospital after approval from the Institutional Ethics Committee. Written informed consent was obtained from the patients or family members of the patients before enrolling in the study. Subjects and Methods: Consecutive patients aged 16 years or more admitted to the ICUs were recruited for the study. Patients with bilateral deafness and blindness, neurosurgical and neurological cases, and patients or relatives refusing consent were excluded. All the patients were assessed between 9 am and 5 pm daily on the Richmond Agitation and Sedation Scale (RASS) to assess the level of sedation and agitation. The patients found to be arousable (−3 to + 4) were screened using the Confusion Assessment Method for ICU (CAM-ICU) for the presence of delirium. Those patients who screened positive for delirium on CAM-ICU were further assessed by the psychiatrist for the diagnosis of delirium as per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision ( DSM-IV-TR) diagnostic criteria. All the enrolled patients were administered an etiological checklist specifically designed for the study. The patients were followed until the point of discharge from ICU or death. Statistical Analysis Used: Data analysis was performed using Epidata Analysis version 2.2.2 and Epilnfo 3.5.4 software. Results: Out of 109 patients, 18 (16.5%) patients had delirium within 24 h of admission in ICU, and 36 (33%) developed delirium after 24 h of ICU stay. Conclusions: Thus a total of 49.5% of patients developed delirium during ICU stay. History of delirium in the past, the use of invasive ventilation, and hypocalcemia were significantly more in delirious patients as compared to nondelirious patients. The mean stay of delirious patients in ICU was significantly more. Restraints were used more in delirious patients, and the difference was statistically significant.
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Anxiety related to COVID-19 infection: An online survey among the general public in India p. 118
Sandeep Grover, Swapnajeet Sahoo, Aseem Mehra, Ritu Nehra
DOI:10.4103/jmhhb.jmhhb_141_20  
Background: There are widespread anxiety and fear related to contracting COVID-19 infection in the general public ever since the outbreak of COVID-19, which had now increased to a great extent due to the ever-rising number of positive cases and mortality rates associated with COVID-19. Aim: The present study aimed to evaluate the anxiety related to contracting COVID-19 infection in the public. Methodology: An online survey was conducted using the SurveyMonkey® platform-generated link in which a COVID-19 anxiety-specific questionnaire was used to assess anxiety and worry related to contracting COVID-19. A total of 462 responses were analyzed. About one-sixth (18.8%) of the responders reported anxiety in at least one domain and worry in at least one domain related to contracting COVID-19 infection. While 42.2% of the responders had anxiety in at least one domain, highest being in the domain of anxiety related to behaviors of others, about one-fourth of the responders (26.6%) expressed worry in at least one domain, more in the domain of worry related to family members going out to buy something or for work. Males and people of younger age group had significantly greater anxiety score, and those with a chronic physical illness had significantly greater worry score. Conclusion: The present study suggests that there is a heightened level of anxiety in the society due to COVID-19 and about 18.8% of the people may be having anxiety severe enough to require clinical attention. However, the survey findings should be interpreted well with regard to its limitations being circulated in few social media platforms and, therefore, may not be generalized to the entire country.
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COVID-19 and mental health through the eyes of Indian newspapers p. 128
Deepali Gul, Gulbahar Singh Sidhu
DOI:10.4103/jmhhb.jmhhb_63_20  
Context: COVID-19 poses challenges to both physical and mental health of the patients, their loved ones, the health-care providers, and the people at large. It has been pointed out that the prime reason behind this is the bombardment of information ranging from accurate to exaggerated to grossly incorrect by the media. Aims: We aimed to assess the nature and extent of the coverage pertaining to mental health and COVID 19 in the print media. Subjects and Methods: In our prospective study, all print items related to the mental health aspects of COVID-19 published in a national daily, The Hindu and a regional daily, The Tribune were included. Results: A low percentage of the total print items related to COVID-19 pertained to the mental health aspects in both newspapers. Most of the print items appeared on the inner pages. Anxiety was the most common mental health problem mentioned, followed by depression and fear for one's own safety. Yoga, meditation, other forms of physical exercise, contacting helplines, and talking to people were the most commonly suggested ways to manage mental health problems. The opinion of a mental health professional was sought in only 13.33% of the print items in The Tribune, whereas the corresponding figure for The Hindu was 65%. Conclusions: We found that the coverage was less extensive as compared to the reported prevalence of mental health problems associated with COVID-19. Our findings underscore the need for more exhaustive and widespread reporting of mental health problems associated with the pandemic.
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The prevalence of internet addiction among school-going adolescents: A comparative assessment as per two screening criteria p. 133
Deeksha Grover, Jaison Joseph
DOI:10.4103/jmhhb.jmhhb_114_20  
Background: The Internet is an integral part of modern life, and for the vast majority of Internet users, its benefits far outweigh the adverse consequences secondary to excessive use. There is a wide variation of the prevalence of Internet addiction worldwide and scanty evidence on its magnitude among school-going adolescents. Aim: In this study, we evaluated the self-reported Internet addiction measures in the high school children (14–16 years) attending selected schools of Rohtak. Materials and Methods: This cross-sectional study compared the Internet addiction as per the Young Diagnostic Questionnaire (YDQ) and Internet Addiction Test (IAT) from a consecutive sample of 400 students. We explored the relationship of IA as per these criteria and sociodemographic and Internet use profiles in this population. Results: The prevalence of severe Internet addiction ranged from 4.2% to 4.8% depending on the IAT (cutoff score of 80) and YDQ (cutoff score of >5) measurements, respectively. There was a good concordance between the two criteria for determining the level of Internet addiction (r = 0.848, k = 0.805, P < 0.001). Conclusion: The findings of the present study suggest that there is a good level of concordance between IAT and YDQ. When time is a limitation, YDQ (8 items) can be considered for screening Internet addiction in this setting.
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Telemedicine for mental health during COVID-19: Need and accessibility by patients of community outreach clinics p. 138
Ajeet Sidana, Abhay Raj Singh, Jaswinder Kaur
DOI:10.4103/jmhhb.jmhhb_136_20  
Background: In the unprecedented times of the COVID-19 pandemic, majority of the outpatient departments have been closed including psychiatry community outreach clinics (COCs). The only way to reach out to these patients has been the newly evolved telemedicine services. Aim and Objectives: The aim of the study is to study the need and accessibility of telemedicine services among patients of COCs. Methodology: The case record files of patients who got them registered in the COCs during January to March 2020 were taken out and sociodemographic, clinical, and contact details were retrieved. A 12-item questionnaire was prepared to know the current status of these patients and information about need and accessibility of telemedicine service for mental health over phone. Results: A total of 78 patients were interviewed. Mean age of the respondents was 43.90 years. The most common clinical diagnoses were neurotic, stress-related, and somatoform disorders followed by substance use disorders, mood disorders, and schizophrenia, including other psychotic disorders. About two-third of the respondents reported that their condition worsened over a period of 4 months after closure of COCs, while one-fourth patients could not purchase medicines due to nonrenewal of prescription. Only 2.4% of the respondents were aware about the existing telemedicine services in the hospital and 100% of the respondents agreed to consult telemedicine services after imparting the information and scope of telemedicine services. Conclusion: Sudden closure of COCs led to worsening of mental health status of already registered patients in the clinics. There were poor knowledge and accessibility of telemedicine service by the respondents. Information, education, and communication about telemedicine services increase the feasibility, acceptability, and accessibility of services.
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BRIEF COMMUNICATION Top

Three tier mental health-care service delivery during COVID-19 pandemic in India p. 143
Apurvakumar Pandya, Somen Saha, Priya Kotwani, Vaibhav Patwardhan
DOI:10.4103/jmhhb.jmhhb_70_20  
The world is concerned about managing COVID-19 pandemic and its consequences. The COVID-19 has not only affected physical health and the economy but impacted the mental health of people globally. It has created a parallel epidemic of psychological distress. Experts envision a gigantic influx of patients needing mental health care, with needs far greater than the nation's existing public health systems can deal with. This paper discusses Indian scenario of mental health issues fueled by COVID-19 pandemic and strategies to address mental health emergency by adopting unconventional sustainable measures and formally integrating mental health into public health preparedness and emergency response plans of the country.
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CASE REPORTS Top

COVID-19 as a “nightmare” for persons with obsessive-compulsive disorder: A case report from India p. 146
Swapnajeet Sahoo, Seema Bharadwaj, Aseem Mehra, Sandeep Grover
DOI:10.4103/jmhhb.jmhhb_69_20  
The impact of coronavirus disease 2019 (COVID-19) on patients with psychiatric illnesses has also been worrisome for psychiatrists. Most of the mental health organizations have mentioned that of all the psychiatric disorders, COVID-19 could worsen the symptoms of people with preexisting obsessive-compulsive disorder (OCD). Fear of contamination with germs is one of the most common intrusive obsessive thoughts with subsequent ritualistic and compulsive handwashing in patients with OCD. The current guidelines and the only safety strategy employed for infection control is frequent hand hygiene. In this regard, there is every possibility that those with preexisting OCD can have worsening of symptomatology, or many individuals can develop new-onset obsessive-compulsive symptoms that need to be addressed and appropriately evaluated. We report an individual with OCD on treatment who relapsed following the outbreak of the COVID-19 pandemic. This case would help to raise awareness among mental health professionals to have a different approach to patients with OCD during the ongoing pandemic.
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Olanzapine-induced choreoathetoid movements in a young patient of schizophrenia p. 149
Amey Y Angane, Aditya R Anvekar, Geetanjali S Ghorpade, Vishnu B Unnithan
DOI:10.4103/jmhhb.jmhhb_120_20  
Atypical antipsychotics like olanzapine are used in the management of schizophrenia due to their lower propensity to cause extrapyramidal symptoms. Yet, few case reports have suggested that olanzapine may cause tardive dystonia, dyskinesia, and oculogyric crisis. However, olanzapine has been never reported to induce nonrhythmic choreoathetoid movements in an adolescent patient within short periods of consumption. Here, we report a novel case of choreoathetoid movements with history of olanzapine consumption for 2 years. The patient presented with involuntary bilateral movements affecting her entire body for the past 4 months, and a diagnosis of olanzapine-induced choreoathetoid movements was made after excluding other neurological and inherited causes by performing necessary investigations. After olanzapine was tapered and stopped, the patient improved and has been subsequently maintained on clozapine. Thus, constant monitoring for movement disorders is needed, particularly in patients with risk factors, even with atypical antipsychotics like olanzapine, and this must play a vital role in management.
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A case report on acute and transient psychotic disorder due to coronavirus disease 2019 quarantine p. 152
Parveen Kumar, Deepak Sachinand Tiwari, Vishal Kanyhialal Patel, Disha Alkeshbhai Vasavada
DOI:10.4103/jmhhb.jmhhb_138_20  
Unexpected situation of coronavirus disease-2019 pandemic could increase the incidence of mental health problems such as psychotic disorders and other mental health problems. Psychotic disorders can occur as a result of quarantine social isolation. Herewith, we present a case of 30-year-old male with onset of brief psychotic disorder after quarantine. The patient was treated with risperidone and had rapid improvement. Quarantine leads to stress and social isolation in individuals, which can result in psychosis. There is a need of early detection and intervention services to improve the outcome of psychosis due to quarantine.
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Diagnostic dilemma and management difficulties in a case of chronic mania p. 155
Tushar Kanta Panda, Vijay Saini, Pankaj Mahal, Tanu Gupta, Naresh Nebhinani
DOI:10.4103/jmhhb.jmhhb_148_20  
Chronic mania has been defined as the presence of manic symptoms more than 2 years without remission. These patients have poor outcomes, severe impairment in functioning, and diagnostic and management difficulties. There are few cases with chronic mania reported in the Indian literature. We aim to present a case of chronic mania with challenges in diagnosis and management.
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LETTER TO EDITOR Top

The changed psychiatric teaching landscape in the times of COVID-19 p. 158
Siddharth Sarkar, Nileswar Das
DOI:10.4103/jmhhb.jmhhb_87_20  
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