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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 3 | Issue 1
Page Nos. 1-78

Online since Friday, May 24, 2019

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EDITORIAL  

Delusional parasitosis revisited p. 1
Neena S Sawant
DOI:10.4103/aip.aip_25_19  
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GUEST EDITORIAL Top

Adolescent mental health: Issues, challenges, and solutions p. 4
Naresh Nebhinani, Shreyance Jain
DOI:10.4103/aip.aip_24_19  
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REVIEW ARTICLES Top

Psychological issues in pediatric organ transplantation p. 8
Dinesh Saroj, Sagar Karia, Avinash De Sousa
DOI:10.4103/aip.aip_54_18  
Pediatric organ transplantation (POT) has shown enormous development in the past few decades, and the number of POT has increased exponentially. While the various medical issues in pediatric transplantation have been discussed, there is a dearth of literature on the psychological issues surrounding POT. The present review aims at providing an overview on various psychological issues that surround POT. Literature search using search engines was carried out, and review papers and original research articles were analyzed. The overall role of the psychiatrist in the POT setup is discussed and issues such as depression and anxiety that may occur in children and their parents is elaborated. The neurocognitive changes that may occur in POT are also discussed and the need for regular monitoring is stressed. Special population such as developmental disabilities and human immunodeficiency virus infection in the organ transplant setting and specific issues related to them are discussed. The role of a child and adolescent psychiatrist as an invaluable asset to any POT team is discussed and deliberated. Multiple psychological facets that may be encountered while dealing with children and adolescents undergoing organ transplantation are discussed.
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Prevention of dementia in elderly population: A comprehensive review of literature Highly accessed article p. 14
Jamaan M Al-Zahrani
DOI:10.4103/aip.aip_60_18  
Background and Aims: Dementia is the loss of cognitive functioning – remembering, thinking, and reasoning – and behavioral capabilities to such a degree that it interferes with an individual's daily living activities. The objective of this paper is to summarize current knowledge on the most promising interventions for preventing cognitive decline. Methods: Electronic databases were searched using PubMed/Medline and Google Scholar to retrieve relevant research papers conducted in Saudi Arabia and internationally. Keywords included “dementia,” “prevention strategies,” “aging,” “aged,” “Elderly population.” Articles published in the English language and published between 2000 and 2018 were included in the study. Analysis: Overall, limited evidence exists to support the cause-effect association between the progression/development of dementia and preventative strategies. Studies to date provide the most promising strategies for dementia prevention that includes healthy diet, social engagement, physical activity, cognitive activity, and vascular risk factor control. Conclusion: Dementia is a disease more commonly observed in old people. Studies in the future will determine the risk factor modification and its implications in controlled trials with specific emphasis on whether some simultaneous interventions may either have a multiplicative or additive effect.
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ORIGINAL ARTICLES Top

A study of psychiatric morbidity and substance use pattern among the adolescents attending department of psychiatry of a tertiary hospital in Northeastern India p. 19
Udayan Majumder, Senjam Gojendra, Ningombam Heramani, Rajkumar Lenin Singh
DOI:10.4103/aip.aip_36_18  
Context: This hospital-based study attempts to explore the morbidity load of categorized mental disorders along with the pattern of substance use in the adolescent group of people presenting to a tertiary hospital of Manipur, India. Aims: This study aims to document sociodemographic profiles, psychiatric morbidity, and substance use pattern among the adolescents attending the Department of Psychiatry of a tertiary hospital of Manipur, India. Settings and Design: This study was a cross-sectional, hospital-based study. Subjects and Methods: This cross-sectional study included 474 consecutive adolescent patients (10–19 years) attending both outpatient department and inpatient department of the Department of Psychiatry of a Tertiary Hospital of Manipur, India, were enrolled during the study. Diagnoses were made according to the ICD-10. Statistical Analysis: The statistical software, namely SPSS 22.0 and R environment ver. 3.2.2 were used for the analysis of the data. Results: Almost 68.4% were within 16–19 years, 51.3% lived with their families, 56.1% were male, 62% of them were Hindus, and majority of them were from urban background (54.4%). Neurotic, stress-related, and somatoform disorders were the highest (41.4%), followed by psychotropic substance use in 21.3%, mood disorders in 14.8%, schizophrenia and delusional disorder in 12.2%, behavioral and emotional disorder in 9.3%, and disorders of adult personality and behavior (F60-69) in 0.4%. The most common categorical psychiatric diagnosis in males due to psychotropic substance use (37.2%) while neurotic, stress-related, and somatoform disorders (61.1%) were the most common categorical diagnosis in females. Conclusions: Very few studies have been conducted to reflect the scenario and pattern of psychiatric morbidities in the state of Manipur. We hope this study will be helpful in reflecting the psychiatric morbidity load in the adolescent group for helping them with early diagnosis and intervention.
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Bipolarity and temperament in depression: Making the right diagnosis p. 23
Abhijeet Soni, Suyog Vijay Jaiswal, Vishal A Sawant, Deoraj Sinha
DOI:10.4103/aip.aip_40_18  
Background: Diagnosis of bipolar disorder is often missed clinically in cases presenting in depression, and temperament is an important clue to correct it. We, therefore, studied cases diagnosed as depression to see the evidence of undiagnosed bipolar disorder as well as temperament. Materials and Methods: Patients of a depressive episode (ICD-10, F32), between 18 and 60 years of age and within mild or normal range on Hamilton Depression Rating Scale at the time of interview were included in this study. The patients were diagnosed retrospectively using mini-international neuropsychiatric interview (MINI) mania hypomania scale to look for missed diagnoses of mania or hypomania episodes. Bipolar spectrum diagnostic scale (BSDS) was used to evaluate bipolar spectrum, and temperament assessment scale and Temperament Evaluation of Memphis, Pisa and San Diego Auto questionnaire (TEMPS-A) was used to assess affective temperament of participants. Chi-square test was used to compare the cases. Results: Out of 100 patients, 35 cases were diagnosed with hypomania and two cases with mania. BSDS was positive in 16% cases whereas it was positive in 9% cases with past episodes of hypomania and 1% case of mania. On TEMPS-A, 12% of cases had depressive or dysthymic temperament, 37% of cases had cyclothymic temperament, 21% of cases had hyperthymic temperament, and 5% of cases had irritable temperament. Cases with irritable or dysthymic temperament had no evidence of bipolar disorder on MINI and were statistically significant (P < 0.001). Limitations: Consecutive sampling, cross-sectional design, retrospective diagnosis. Conclusion: The misdiagnosis of Bipolar II disorder and bipolar spectrum disorder can happen as depression. Temperament can help assert evidence for bipolar disorder in cases presenting as depression and using standardized tools like MINI can help correct diagnosis and management.
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Life events and quality of life in patients of Cushing's disease p. 28
Neena Sawant, Akanksha Sharma, Nalini Shah
DOI:10.4103/aip.aip_49_18  
Background: Cushing's disease (CD) is a rare endocrine disorder associated with increased serum levels of cortisol secreted due to an underlying tumour in pituitary. Stressful life events are known to aggravate CD and affect coping with the illness. Quality of life (QoL) may also be impaired due to physical changes, limitations in activity and emotional problems despite treatment of CD. Hence, we undertook this research to study the life events and QoL in patients of CD. Methods: Thirty-five patients of CD were enrolled from the endocrine outpatient department after written informed consent and institutional ethics approval. A pro forma for demographic variables and details of CD was administered with the Holmes and Rahe stressful life events scale Social Readjustment Rating Scale (SRRS) and short-form 36 (SF-36) health survey for general QoL and well-being. Results: Twenty-nine (82.5%) patients had low scores (<150) on SRRS 5 (14.28%) patients had scores in the medium range, whereas only 1 (2.86%) patient had a higher score. Thus, life events were not significant to aggravate the disease in our sample. A poor QoL was reflected in all 35 (100%) patients indicating severely impaired QoL on both mental and physical components. All the subdomains of SF-36, namely physical functioning, role limitation due to physical health and emotional health, energy/fatigue, emotional well-being, social functioning, pain and general health were affected. Conclusions: Life events experienced were not significant to worsen the underlying illness, but an impaired QoL in all spheres of functioning was evident. Liaison with the endocrinologist would also work towards improving the issues of body image disturbances and self-esteem for better prognosis for the patient.
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Cognitive impairment in euthymia- A comparative study of clinical and treatment variables between bipolar affective disorder patients and normal controls at a tertiary care centre in Kerala p. 32
Megha Alathukattil Pradip, K Saibunnisa Beevi, Praveenlal Kuttichira, James T Antony
DOI:10.4103/aip.aip_50_18  
Objective: Several studies have described cognitive impairments in euthymic state of bipolar patients. However, limited studies have established clearly the correlation between clinical variables and cognitive functions, the effect of mood stabilizers on the cognitive performance of euthymic bipolar patients and there are few studies reported from South India. This study aims to assess the cognitive impairments in euthymic state of bipolar patients when compared with normal healthy comparison group and to determine the clinical factors increasing the risk of cognitive impairment in such patients. Materials and Methods: Fifty bipolar patients in the euthymic state confirmed through Young Mania Rating Scale ≤ 6 and Hamilton Depression Rating Scale ≤8 were compared with healthy comparison group on tests for assessing set shifting, verbal learning and memory, attention, short-term memory, and verbal fluency. The clinical variables – age of onset, number of episodes, and duration of illness – were assessed to determine whether it influenced the neurocognitive functions. Results: Euthymic bipolar patients performed worse than the comparison group in the areas of executive functions, verbal learning and memory, attention, short-term memory, and verbal fluency. The duration of illness and frequency of episodes significantly correlated with the neurocognitive deficits. The age of onset and mood stabilizers prescribed also influenced the cognitive functions in these patients. Conclusion: Cognitive impairments are found in bipolar affective disorder patients even in euthymic state. The duration of illness, number of episodes, age of onset, and medications affected the cognitive functions. This calls for prompt and effective management of the bipolar patients.
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Prevalence of mental health status in adolescent school children of Kohima District, Nagaland p. 39
Kelhouletuo Keyho, Nilesh Maruti Gujar, Arif Ali
DOI:10.4103/aip.aip_52_18  
Background: Adolescents suffer from psychosocial problems at one time or the other during their development phase and they are highly vulnerable to develop psychiatric disorders. The aim of the study was to see the mental health status of school-going adolescents in Kohima district, Nagaland. Methods: The researcher used a cross-sectional study as the design. In the present study, field setting was private and government schools of Kohima district, Nagaland. The population sample consisted of school-going adolescents' age between 13 and 19 years from private and government schools in Kohima. Random sampling technique was used for the selection of schools. On the basis of which three schools were selected, the selected schools were taken consent from the school authority. Total enumeration method was used for data collection. A total of 702 students were recruited for the study. Adolescents, as well as parental consent, were undertaken. The study was undertaken with the approval of the Scientific Committee and the Ethical Committee of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health. Socio-demographic data sheet and the Strengths and Difficulties Questionnaire were used. Results: The prevalence of mental health status on the basis of the total difficulties score was found to be 17.2% at the abnormal level whereas 28.8% was at the borderline level. The study results also revealed that in adolescent population, emotional problem was present in 17.1%, hyperactivity in 16.1%, conduct problem in 15.2%, peer problem in 5.6%, and prosocial behavior in 5.1%. Conclusions: Mental health problems are highly prevalent among the adolescent population in India. Early identification, treatment, and promotion of mental health services are required.
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Prevalence of common psychological morbidities among youth and their association with tobacco and/or alcohol use: A cross-sectional study from a village in Central India p. 43
Shambhavi Chowdhary, Kshitija Palhade, Kartik Ingole, Shruti Atram, Eashwar Tupat, Sanghe Doma, Abhishek V Raut
DOI:10.4103/aip.aip_2_19  
Context: Youth is a period of major physical and psychological changes. During this vulnerable phase, many individuals develop an inclination toward addiction. Objectives: The objectives of this study are to assess the prevalence of common psychological morbidities among the youth and its association with addiction. Study Design: The community-based cross-sectional study was conducted among individuals in the age group of 15–24 years. Methodology: A sample size of 102 individuals was estimated assuming 50% prevalence, 95% confidence level, and a nonresponse rate of 10%. One hundred and five individuals were offered participation, of which 97 individuals gave consent and were included in the study. The Global Mental Health Assessment Tool–Primary Care version was used for determining the prevalence and severity of common psychological morbidities. Data regarding tobacco and/or alcohol use were collected using the World Health Organization-Alcohol, Smoking, and Substance Involvement Screening Test. Descriptive analysis was performed using frequency and percentage. Association was found out using the odds ratio with 95% confidence intervals. Results: One-third of respondents have consumed tobacco in their lifetime, whereas 13.4% of respondents are alcohol consumers. Among psychological morbidities, anxiety had the highest prevalence (42.3%). Tobacco consumers had greater odds of developing all the eight psychological morbidities, and significant association was found with depression. Alcohol consumers showed greater odds of developing seven common psychological morbidities. Combined tobacco and alcohol users have greater odds of developing six of the eight common psychological morbidities and had a significant association with depression. Conclusions: There is a wide prevalence of addiction and psychological morbidities among rural youth. The high prevalence of addiction and its significant association with depression compels us to consider paying greater attention to these two factors as a whole.
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BRIEF RESEARCH ARTICLE Top

A study of psychiatric morbidities in recovering intensive care unit patients p. 50
Pranjalee N Bhagat, Shilpa Amit Adarkar
DOI:10.4103/aip.aip_33_18  
Background: Patients recovering from Intensive Care Unit (ICU) admission may develop cognitive and psychological symptoms. With the improvement in medical facilities, survival rate of these patients has increased. With increase in survival rate, cognizance of cognitive and psychological symptoms has increased. There is compelling evidence that psychiatric illnesses such as depression impair functional status in patients with chronic medical illnesses. Identification and treatment of these symptoms in an early stage will lead to enhanced recovery and hence improvement in quality of life. Aims: This study commits to sociodemographic profile and assessment of cognitive and psychological symptoms in recovering ICU patients. Materials and Methods: After Institutional Review Board permission, 50 patients recovering from ICU were enrolled to study cognitive symptoms using Mini-Mental Status Examination. Psychological symptoms were assessed using Hospital Anxiety Depression Scale. Sociodemographic profile of these patients was also studied. Results: Of 50 patients, 22% suffered from mild to severe cognitive impairment. 22% had borderline symptoms to symptoms amounting to cases of anxiety. 36% patients had borderline symptoms to symptoms amounting to cases of depression. Conclusions: In our study, we found that ICU stay can lead to cognitive impairment in patients. ICU stay can also lead to psychological symptoms such as anxiety and depression.
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Clinical presentation of delusion of parasitosis in a tertiary care center p. 55
Hemang Manaharbhai Shah, Mahemubin Lahori, Prakash Mehta
DOI:10.4103/aip.aip_55_18  
Background: Delusional parasitosis is a relatively uncommon psychiatric condition. Owing to its low prevalence there is limited research in this area. The present cross sectional study was conducted to study clinical presentation, belief and response of patients of delusion of parasitosis in a general hospital over a period of January 2017 to September 2017. Methods and Materials: 40 new patients who presented to psychiatry OPD with primary complaint of crawling sensation under skin were enrolled. Results: The delusion of parasitosis was seen more in females and those who were illiterate. The symptom was localized to the face or scalp. Dermatologist was the physician of contact for 59% of the patients. Comorbid depression and anxiety were also seen. Conclusion: The symptom of parasitosis was not uncommon but liaison with dermatologist is necessary for early diagnosis and management.
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CASE REPORTS Top

Kleine-levin syndrome: A rare case and review p. 58
Falguni B Patel, Parlin M Dadhaniya, Manasvi V Jariwala, Bhaveshkumar M Lakdawala
DOI:10.4103/aip.aip_48_18  
Kleine–Levin syndrome (KLS), also known as sleeping beauty syndrome, is a rare disorder with unknown etiology. The syndrome is characterized by hypersomnolence and may be associated with hypersexuality, hyperphagia and cognitive or mood changes. Fever, head trauma and stress may be the precipitating factors. The case here is a 15-year-old male patient who presented with excessive sleepiness, hypersexual behavior, excessive food intake and mood changes. These symptoms started after becoming afebrile from high-grade fever. Multiple investigations done were within normal limits. He did not respond to valproate, olanzapine and lorazepam. Spontaneous remission and reemergence of symptoms after 2 weeks were noted. By clinical history, normal investigations and exclusion of other mental and medical disorders, he was diagnosed to have KLS. Reviewing literature, lithium therapy was found to be beneficial in KLS. Hence, lithium was given in this patient to which he responded well.
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Phenytoin toxicity secondary to friend's advice!! p. 60
Jisha Myalil Lucca, Kishore M, Shruthi S
DOI:10.4103/aip.aip_63_18  
It is very common that antiepileptic prescription in substance induced seizure, however Phenytoin abuse is very rare. We report a case of 25 year old man with a known diagnosis of polysubstance abuse. After a road traffic accident and hospitalization, the patient reduced the use of various substances he used and eventualy lead to withdrawal seizures and started with Phenytoin 100 mg twice daily. As influenced by friend's advice he increased phenytoin dose and developed clinical symptoms of phenytoin toxicity.
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COMMENTARY Top

Snakes and their relevance to psychiatry p. 63
Anil Kakunje, Ramesh Ammati, Prakash Tolar, Sowmya Puthran, Mohammad Swaroop
DOI:10.4103/aip.aip_46_18  
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LETTERS TO EDITOR Top

Violence against Doctors: A psychological perspective p. 67
Parthasarathy Ramamurthy, Pradeep Thilakan
DOI:10.4103/aip.aip_43_18  
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Suicide and mental illnesses: Bridging the existing gaps p. 68
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/aip.aip_57_18  
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Writing effective discussion contributes to literature and improves research quality: Saving the scientific communication p. 70
Tarun Verma
DOI:10.4103/aip.aip_18_19  
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PG CORNER Top

Understanding biofeedback and its use in psychiatry p. 71
Swati Balkrishna Shelke, Rashmi V Singh
DOI:10.4103/aip.aip_13_19  
Biofeedback is a technique which demonstrates the mind–body connection. It is training through which patients learn to exert voluntary control on involuntary body processes. Biofeedback can be helpful in the management of a wide variety of medical and psychiatric disorders. Among these are the anxiety-depression spectrum, psychosomatic disorders, chronic pain syndromes, as well as sleep disorders. Biofeedback is a good choice as main treatment and adjunct treatment in indicated disorders, if the patient prefers or when other treatment modalities are unsuccessful or contraindicated. The management of somatoform disorders is often a challenging task. Pharmacotherapy may not be effective or suitable in certain patients or situations, requiring different modes of interventions. In such cases, biofeedback can be effectively used. We, in this article, will review relevant research on the efficacy, mechanism of action, biofeedback training, planning of sessions, and clinical recommendations.
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BOOK REVIEW Top

People watching: An Apt guide to human body language and behavior p. 74
Govardhan Belaguli
DOI:10.4103/aip.aip_53_18  
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IMAGES IN PSYCHIATRY Top

The face of the giant panda: Demystified p. 77
Soniya Patankar, Shilpa Sankhe, Abhishek Bairy
DOI:10.4103/aip.aip_27_19  
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