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   Table of Contents - Current issue
July-December 2018
Volume 2 | Issue 2
Page Nos. 73-164

Online since Friday, November 30, 2018

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Consultation liaison with nephrology Highly accessed article p. 73
Neena S Sawant
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Challenges for young people and mental health in today's changing world p. 76
Rajesh Dhume
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Diagnostic perspective in psychogenic nonepileptic seizures: An overview p. 80
Priyesh Kumar Singh, Tara Singh, Vijay Nath Mishra, Rameshwar Nath Chaurasia, Trayambak Tiwari, Indramani Lal Singh, Anchal Singh
Psychogenic nonepileptic seizures (PNESs) are the episodes altered movement, sensation, or experience similar to epilepsy but caused by psychological process and not associated with abnormal discharges in the neurons. Diagnosing PNES is extremely a tough work for a neurologist because of its psychological etiology and somatic manifestation. The patients with PNES are frequently misdiagnosed for epilepsy and exposed to antiepileptic drugs for several years which risk their life and put unnecessary economic burden on them. Majorly, while diagnosing PNES, the neurologist has to rule out several neurological and psychological disorders. PNES multiple etiologies and lack of quantifiable biomarkers make its diagnosis more difficult and inaccurate. Although the gold standard measure to diagnosis PNES is video-encephalography, it is always not available for the assessment and is too costly. Therefore, neurologists go for other diagnostic procedures to distinguish PNES from epilepsy. Psychological assessment of the patients; semiological and historical details of the patients; postictal observation; and provocation techniques such as saline injection, verbal suggestion, moist swab application, tuning fork application, and compressed temple region are being used in a substantial way to diagnose PNES. Besides, these neuroimaging techniques such as electroencephalography and magnetic resonance imaging and chemical biomarker such as serum prolactin are also being measured to be sure for PNES diagnosis. Further, it must be understood that above assessment procedures are not independent but are complementary to each other, and hence, PNES etiology is still going through elucidation process. Therefore, diagnosing PNES is a cumbersome task. However, if diagnosis of PNES is made with joint efforts of neurologist, psychologist, and psychiatrist, although usually not practiced, only then one can arrive at a definite conclusion.
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Family therapy in India p. 88
Anuradha Vishwas Sovani
Origins of family therapy are traced, acknowledging that this is in fact a group of therapeutic approaches. An overview of work done at major mental health centers in India is followed by an attempt at outlining key differences in Indian vis-a-vis Western approaches to family therapy, addressing some of the unique problems that are encountered in our country. Traditional systems of arranged marriage and a joint family, in vitro fertilization interventions and the family pressures to have a baby, the impact of work on family life and the onslaught of social media and family migrations across the globe are some of the issues outlined. Major approaches to family therapy are selected, and their key features are highlighted. Specifically, Minuchin's structural family therapy and Virginia Satir's conjoint family therapy are described. Touching very briefly on Milton Erickson's strategic family therapy, the article moves on to White and Epston's narrative family therapy; and each approach is described vis-a-vis its strengths when applied to an Indian family setup. The article ends on preventive, promotive, and rehabilitative approaches espoused by the author as also by many therapists in India. Behavioral family interventions by Sanders are outlined as is the positive parenting program and its Indian avatar in Palakshaala. Preventive approaches such as functional family therapy by Sexton and Alexander are described. Rehabilitative work with patients and caregivers is outlined, citing examples. The article ends by highlighting some recent changes in the social fabric that seem to be deeply affecting family structures.
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Research progress in the understanding and implications of stigma related to mental health p. 93
Amresh Shrivastava, Avinash De Sousa, Pragya Lodha
Stigma is neither new nor an isolated condition for people suffering from mental as well as physical disorders. It is regrettable that scientists, researcher, philosophers, and community leaders have been silent for a long time in recognizing and dealing with it. However, during the past 20–30 years, significant progress has taken place in stigma research, the world over including India. From research done in India, there is clear evidence that: stigma is not merely a social condition. Convergence of social, mental, and physical disorders around stigma has far-reaching consequences on risk and health outcomes. The present paper looks at the position of stigma in mental health from an Indian perspective. The research done on stigma in India is reviewed, and certain recommendation for the management and eradication of stigma are elucidated. Stigma in specific conditions such as schizophrenia, substance abuse, and child sexual abuse are also addressed. The WHO guidelines and Mayo clinic guidelines to eradicate are used as a basis to be applicable to the Indian scenario. We examine how a life of an individual is affected with stigma, how mental health advancement has changed or not changed negative impact of stigma on patients and finally how stigma is measured and minimized, mainly for work done in India.
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Is there a protective model against suicide? p. 101
Mona Srivastava, Pradeep Yadav
Background: Suicide is a major concern to medical professionals because of the association of social, personal, occupational domains, and a dearth of effective interventions especially so in our set up. Aims: The aim of this study is to compare and correlate different factors influencing suicide attempts and draw a model regarding their role in suicidal behavior. Materials and Methods: A total of 80 consecutive suicide attempters were recruited in the study, in which the correlation analysis was performed between presumptive life events scale, social support scale and coping style questionnaire and partial regression analysis among eight factors influencing suicidal behavior. Results: Correlation between social support and coping mechanism showed a significant positive correlation between four components. Correlation between total life events and coping questionnaire, positive significant correlation was found in six set of factors and correlation between total life events and social support total 15 set of factors were having significant correlation only one of them is positively correlated. A linear regression model was drawn most influencing factor was psychiatric illness and least is perceived support. Conclusion: Suicide attempts are influenced by many factors some are protective, and some are risk factors. This analysis shows that not individually but many factors are correlated with each other significantly so that they can give additional risk or protection. Therefore, a common model set can be drawn to minimize risk factors and maximize protective factors to implement suicide prevention strategies. These steps can contribute in decreasing the morbidity of suicide significantly and also the burden associated with it.
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A profile of occupational stress in nurses p. 109
Aditi Prasad Chaudhari, Kaustubh Mazumdar, Yogesh Mohanlal Motwani, Divya Ramadas
Background: Occupational stress is common in nurses. Stress can impact the health of the nurses leading to somatic complaints. Aims and Objectives: (1) To determine the extent and causes of occupational stress among nurses at Bhabha Atomic Research Centre Hospital. (2) To compare the stress levels among nurses depending on their years of experience. (3) To study any correlation between stress levels and the extent of somatic complaints. Materials and Methods: Ninety-seven staff nurses without any preexisting psychiatric illness were evaluated for occupational stress using the Expanded Nursing Stress Scale. The extent of somatization was measured using the Patient Health Questionnaire – 15, in a cross-sectional study. Cronbach's alpha, analysis of variance, and Spearman's correlation co-efficient test were applied to the data. Results: An internal consistency of 0.945 was noted using Cronbach's alpha. 51.5% nurses experienced mild, 34% experienced moderate, and 2.10% experienced severe stress. Conflicts with supervisors, patients, and their families and workload were the main causes of occupational stress while discrimination was the least affected domain. Nurses with 6–10 years of experience had maximum stress. The stress levels correlated with the extent of somatic complaints. Conclusions: Occupational stress is prevalent in nurses. It may be higher in nurses with lesser experience and it can be associated with somatic complaints.
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Depression and anxiety in patients with chronic kidney disease undergoing hemodialysis p. 115
Vinod Kumar, Vikash Khandelia, Ankita Garg
Introduction: Chronic kidney disease (CKD) is a global health problem with a high economic burden on the health-care system. Considering the chronic nature of disease patients undergoing hemodialysis are at risk of developing psychiatric disorders. In this study, we aimed to evaluate the incidence of depression and anxiety in CKD patients undergoing hemodialysis. Methods: This was a prospective, cross-sectional, observational study conducted between June 2016 and September 2017. Patients of either sex having CKD and undergoing hemodialysis were included in the study. Sociodemographic and depression and anxiety related details were collected. Results: A total 150 patients were enrolled in this study, of which 92 (61.3%) patients had depression and 42 (28%) had anxiety. Overall, depression was higher in males, but the difference was not significant; similarly, the anxiety was higher in males, but the difference was statistically significant (P = 0.050). Majority of patients with depression were aged more than 80 years; however, anxiety was more common in patients aged between 40 and 60 years. A total of 59.4% of depressive patients were Hindus, and 27.3% of anxiety patients were Hindus. The correlation between depression and marriage was significant; however, the relationship was not significant between anxiety and marriage. Among patients with depression 55.9% of patients were illiterate, and among patients with anxiety, 25.4% were illiterate. Conclusions: This study provides extensive information on the relationship between depression or anxiety and sociodemographics features among patients with CKD undergoing hemodialysis.
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Psychosocial effects of halitosis among young adults p. 120
Shravani G Deolia, Mariya Ali, Shriya Bhatia, Sourav Sen
Background: One of the greatest and oldest taboos in our society is halitosis which is considered as a common dental condition and is suffered by many individuals around the world and dentists are usually the ones they turn to for their first professional help. Aim: This study aims to understand the psychological and the social effects of halitosis among young adults and to correlate their psychosocial effects with different level of halitosis. Materials and Methods: A cross-sectional descriptive study was performed on participants (n = 200; range 18–25 years) using a self-administered closed-ended questionnaire to detect the psychological and social effects of halitosis on individuals, and severity of their halitosis was checked using a device, FitScan® Breath Checker (Tanita Incorporation). A parallel was drawn between their psychosocial effects and severity of halitosis. Results: There were 94 (47%) males and 106 (53%) females used in this study. The age group used was 18–25 years and the younger age group showed a higher incidence of halitosis in relation to the older age group. About 44 (22%) patients out of the 200 gave a score of 0-Happy face on the device FitScan indicating that they were suffering from pseudohalitosis and not true halitosis. Both genders showed not much of difference with respect to the psychological impact of halitosis, however, social impact was seen more in females. Conclusion: This study revealed that pseudohalitosis is common among individuals and it restricts one's caliber. The social effects of halitosis are seen greatly in females, however, the psychological impact of halitosis is seen almost equally in both the genders.
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Psychiatric morbidity in intensive care unit patients p. 125
Mona Nongmeikapam, Mohan Reddy, Ruth Sneha Chandrakumar, Jagadish Singandahalli Narayan
Background: Numerous studies have established a higher incidence of psychiatric disorders among general hospital inpatients. Hence we explored if patients in the Intensive Care Units have more psychiatric morbidity due to their longer stay, more critical health conditions, and other stressors. Materials and Methods: A total of 100 patients in the MICU were interviewed using the Symptom Checklist Revised (SCL-90-R) once they got stabilized and just before they were transferred to a step-down ward. Results: Nearly 52% of the participants had no psychiatric morbidity. 36% had mild and 12% had moderate psychiatric morbidity as per the SCL-90-R Scale. There was no participant with severe psychiatric morbidity. Factors such as age, gender, educational level, or duration of stay had no significant influence on the outcome. Among the psychiatric manifestations, interpersonal sensitivity and somatization were found to be the most prevalent symptoms at 60.3% and 59.1%, respectively. Conclusion: Psychiatric morbidity is high among patients in Intensive Care Units, and severity of presentation may also be more than that in general medical patients. Identifying them early and prompt intervention may be necessary to reduce the cost, the duration, and the suffering of the patients.
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Insights into psychosocial problems of primary caretakers of patients with schizophrenia in India p. 130
Sharmishtha S Deshpande, Shweta Dewani, Sufiyan Niyaz Sirkhot, Dhanashree Veerkar
Context: Schizophrenia affects 1%–1.5% of the population of the world. The illness commonly affects young population disturbing and disrupting the patient as well as his family. Research has demonstrated increased physical and mental health morbidities among these caretakers. Aims: The aim of this study was to explore various stresses and social problems faced by caretakers due to patient's schizophrenia. Settings and Design: A qualitative study of the distress experienced by primary caretaker of schizophrenia patients was undertaken at a tertiary hospital in an urban Indian setting. Methods: Relatives of 30 patients were assessed for their physical, psychological, and social problems. Their narratives of distress caused by patients' illness were recorded as verbatim and analyzed qualitatively manually. Statistical Analysis: Manual qualitative and quantitative analysis. Results: Caretaker was a parent in 72.3% of the cases. Distress due to blaming by relatives for not bringing up the child carefully was reportedly experienced by most parents, especially the mothers. Local cultural setting plays a huge influence in these highly personal and sensitive concerns. Social stigma, anxiety about illness, anger, and resentment were commonly reported. Conclusions: These insights into suffering of the caretakers of people suffering from schizophrenia in current local setting need to be considered and addressed as essential part of the management of Schizophrenia.
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Sound walk guide: A transition tool for autism spectrum disorder p. 135
Alicia P L. Boam, Alka S Ahuja
Objective: The objective of this study was to design and create a ”Sound walk Guide” for children with autism spectrum disorder (ASD) transitioning between primary and secondary education. Methods: A literature review was conducted on transition tools used for children with ASD. This informed the development of a sound walk guide based on a sound walk audio tool. Results and Discussion: The literature review highlighted the sensory difficulties faced by children with autism during transition. It described some of the transition tools used in ASD from online training programs to virtual reality tools. However, there was little literature on specific tools for primary to secondary school transition. This informed the development of a user-friendly sound walk guide which was developed along with children and professionals in education and health.
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Autopilot, criminal responsibility, and diversion: A case series p. 139
Ajaykumar Vishwasrao Pawar
Intent or mens rea and the Act or actus reus are essential components of a crime and absence of one can lead to complete acquittal of the defendant. I report two cases where there are broad similarities in the nature of the mental disorder, but the intent was lacking in one of the cases. The interplay between symptoms of mental illness, presence of intent, and other relevant factors can lead to differing outcomes when the cases go to the court. An opinion from a psychiatrist is valuable in such cases and indeed written and/or oral evidence from a psychiatrist is required under the mental health act in the UK before certain decision can be taken in the court.
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Nonresponsive responder! –Somatic symptoms presenting as refractory depression with response to electroconvulsive therapy p. 144
Suhas Chandran, M Kishor, Shreemit Maheshwari, Supriya Mathur, TS Sathyanarayana Rao
Depression is a condition that can present with varied signs and symptoms. Physical pain, although not stated as a symptom of depression according to the official psychiatric classification systems of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases, 10th revision, is also frequently reported by patients with depression. Physical symptoms, common in major depression may lead to chronic pain, often complicating treatment and is generally accompanied by a significant level of dysfunction. A multi-pronged approach often becomes necessary in such patients. They are amenable to numerous strategies including cognitive behavioral therapy (CBT), pharmacotherapy and in some resistant cases electroconvulsive therapy (ECT) also becomes an effective treatment approach. The use of ECT becomes even more pertinent in patients who fail to achieve remission despite being treated with CBT and various pharmacological regimens. We hereby report a case of a 61-year-old man with depression, presenting with pain abdomen as a part of recurrent depressive disorder who eventually responded to the use of ECT as a therapeutic modality. The potential role of the dose of the anesthetic agent influencing the efficacy of the ECT has also been highlighted.
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A rare case report of alektorophobia in an adult male p. 147
Suvarna Jyothi Kantipudi, Navina Suresh, R Sathianathan
Alektorophobia is a term specific to fear of chickens/hens. It is a type of ornithophobia (fear of birds) which comes under specific phobia, animal type. Alektorophobia is derived from the Greek word ”Alektor” which means ”rooster” and ”phobos” meaning ”fear.” Specific phobia is a type of anxiety disorder and is relatively common in females, children, and adolescents. Although specific phobias are common type of anxiety disorder, alektorophobia is a rare entity. In our case report, we discuss a 32-year-old gentleman with a specific phobia for cocks and hens, who presented with significant distress and socio-occupational dysfunction. He was successfully treated with a combination of pharmacological agent selective serotonin reuptake inhibitors and nonpharmacological strategies (systematic desensitization) and remained symptom-free even after 9-month follow-up. This is the first case of alektorophobia reported in adult male to the best of our knowledge. This case emphasizes the need for understanding the role of psychological processes in the development of phobia and role of nonpharmacological strategies in the management.
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Capgras syndrome, diarrhoea, and hyponatremia p. 150
Devesh Sharma, Anchal Sharma, Ramesh Kumar, Sudhir Sharma
We present a case of a 56-year-old male who developed Capgras syndrome following hyponatremia consequent to dehydration. He was a previously healthy male who eventually developed secondary systematized delusions due to misidentification syndrome. This case highlights the need for evaluating the role of toxic/medical etiology in the causation of this syndrome that is more often encountered in schizophrenia.
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Depot preparation in schizophrenia: Indian outlook p. 152
Mohit Shah, Disha Parikh, Sagar Karia
Schizophrenia is a mostly chronic mental disorder, and symptomatic relapse is frequently observed. It is often associated with social and/or occupational decline that can be difficult to reverse. Most patients with the illness need long-term pharmacological treatment and antipsychotic drugs represent the mainstay of clinical care. Long-acting injectable antipsychotics are an important alternative to oral medication, particularly advantageous in the context of compliance management.
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Case report guidelines and informed consent p. 158
Ritambhara Y Mehta
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The art of sexual history taking and barriers faced by residents p. 160
Rashmi V Singh
It is a well-established fact that sexual health has a very strong influence on emotional as well as physical well-being. Hence, it is imperative that effort is taken to acquire information about sex-related issues in patients' lives. Substantial amount of literature is available stating the importance of a good sexual history. Negligence on the part of residents by avoiding adequate sexual history can lead to important problems going untouched. This article aims to give some insights into what exactly are the obstacles faced by residents in taking a good sexual history. It will help the residents to develop an unbiased attitude and be more facilitating while taking sexual history. This can go a long way to make the patients feel more encouraged and comfortable in sharing not only their sexual complaints but also their attitudes and beliefs regarding sex.
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Brain teasers: Psychiatry and allied sciences quiz p. 163
Devavrat Harshe
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