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   Table of Contents - Current issue
July-December 2019
Volume 3 | Issue 2
Page Nos. 79-187

Online since Wednesday, December 18, 2019

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Poverty and its effect on neurobiology – What do we know? p. 79
Avinash De Sousa
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Presidential address at the annual conference of IPSWZB, Navi Mumbai, 2019 developing the psychiatrist as a leader p. 82
Deepak S Rathod
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New psychoactive substances: An emerging epidemic p. 86
Kranti Kadam
New psychoactive substances (NPSs) are growing at an alarming rate causing a threat to the public health. They are available online or in head shops and come with variety of street names across the cities, states, and countries. NPSs are prepared in the laboratories either by tweaking or altering the chemical structure of existing substances such as cannabis and ecstasy. They are cheap, easy to obtain, and difficult to be detected by traditional drug screening methods. It has become very challenging to detect them within the clinical settings because of the fast rate of their availability and their constant changing structure. Their purity as well as pharmacology and toxic effects are still not known. These drugs cause major life-threatening complications, which is worrisome. The legal status of these drugs is ambiguous. The laws are complex, changing, are not well defined to control or regulate their use which is a major setback. As many clinicians are unaware of the existence of such drugs, the identification and management of withdrawal syndrome and overdose become difficult. There is a need to create awareness regarding the risks and the health hazards caused by these novel substances as well as to develop and design new prevention approaches that are able to attract the attention of the young population.
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Testosterone and schizophrenia: A clinical review p. 92
Pragya Lodha, Sagar Karia
The relationship between testosterone and psychiatric disorders has been a long-standing one. The sex difference in schizophrenia has triggered to better understand the role that testosterone plays in the unfolding and clinical presentation of this psychotic disorder. DHEA and testosterone are found to influence dopaminergic, glutamatergic and GABAergic neurotransmission systems that are believed to play a role in the pathophysiology of schizophrenia. The onset of schizophrenia in males, most frequently encountered during adolescence, is also characterized by an increase in testosterone levels. Some studies have also observed lower testosterone levels in adult males with schizophrenia (or psychosis) compared to healthy controls.
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Impact of educational intervention on common beliefs about sex among adolescent health sciences students p. 97
Nishant Ohri, Amandeep Gill, Ganpat Vankar, Aditi Patel, Aditya Dubey
Background: A majority of educational programs place emphasis on sexually transmitted diseases, abortion, and contraception but ignore the broader questions of sexual experience, anatomy, and cultural myths. The aim of the present study was to explore the impact of our intervention on these ignored domains. To ascertain the sex-related knowledge of students and note gender-wise differences. To explore which domains were affected least by educational intervention and which the most. Methods: Nine lectures were delivered to a total of 488 students. They filled the Knowledge Subscale Derogatis' Inventory (21 items; dichotomous) before and 2 h after the lectures, responses were anonymously collected in a ballot box. The lecture was of an hour and followed by 20 min of Q/A sessions. Emphasis was placed on sexual response cycle, interpersonal relationships, sexual fantasies, and prevalent myths. Results: There were 450 respondents pretest, and 414 in the posttest. In both groups, girls were in majority (69.6% and 73.9%). The mean knowledge scores of both groups were 7.88 (sd3.26) and 15.70 (sd3.42). The difference was significant (P < 0.0001). Boys had significantly higher scores than girls at pretest (t = 9.274; P < 0.0001), but at posttest a greater improvement in scores of girls, mitigating the initial difference (t = 0.339; P = 0.734). Statistically significant improvement was found in every item. Yet, significant gender-related differences persisted in a few items. Conclusions: Poor knowledge regarding sex among adolescent students in apparent is the study. Girls have a significantly lesser knowledge. The lectures mitigated the difference in knowledge between both the genders. Human sexuality training programs in India must include the domains of a knowledge deficit.
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Effectiveness of smoking cessation program using nicotine chewing gums and transdermal nicotine patches among patients with schizophrenia in Chennai City: An interventional study p. 105
R Dharshanram, Kiran Iyer, B Arthi, PD Madankumar
Background: Schizophrenia (SCH) is a common illness with lifetime risk of approximately one in 100 people. The most likely age of onset for men is the mid–20s, while for women, it is in the early 30s. Schizophrenic patients have higher rates of nicotine dependence. This study aims to compare the effectiveness of smoking cessation program using nicotine chewing gums and transdermal nicotine patches (TNPs) among schizophrenic patients in Chennai city. Methods: Participants were required to have a diagnosis of SCH in maintenance stage, who met diagnostic and statistical manual mental disorder-IV for SCH, to be at least 18 years old. The study participants were divided into two groups: Group A (10 participants) and Group B (10 participants). Nicotine chewing gums were administered to Group A participants, and TNPs were administered to Group B participants. Results: Among 20 participants, all the study participants were male with a mean age of 45.20 years. In this study, significant reduction on carbon monoxide level (mean difference – 3.2 ± 0.78) and number of cigarettes (mean difference – 4.11 ± 0.55) were noted on TNP trial (P < 0.64), and the significant difference on nicotine dependence was seen between groups (Group A and Group B) (P = 0.00). Conclusion: Even though the results of our study showed reduction in smoking, but not smoking cessation, still, a better understanding of the factors that lead to successful smoking cessation outcomes in smokers with SCH and other psychiatric disorders may lead to improvement in treatment plan.
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Electroencephalogram abnormalities in borderline personality disorder p. 110
S Shankar, C Selvaraj, S Sivakumar
Background: Borderline personality disorder (BPD) shows aberrant behavior, which is associated with difficulties in emotions and processing. Seizure-like activity has been invoked as underlying factors in BPD. However, the occurrence and significance of electroencephalogram (EEG) abnormalities in BPD received little attention. The aim of this study was to assess the EEG abnormalities in BPD and to compare with healthy controls. Methods: Sixty consecutive BPD patients attending the psychiatry unit and 60 healthy controls were selected for the study. All were subjected for EEG assessment and appropriate statistical analysis was done. Results: There was no significance in sociodemographic profile between cases and controls. Thirty-one percent of cases had EEG abnormalities and only 3.3% of the controls had EEG abnormalities. 19 of the 60 patients had EEG abnormalities of which 2 (10.5%) had mild , 6 (31.5%) moderate, and 11 (57.8%) had severe category of BPD. Predominantly, sharp waves and spike waves were seen in severe type and nonspecific waves (slowing) in mild and moderate types. Conclusion: EEG abnormalities were significantly higher in BPD than healthy population. However, the electrophysiological investigation of BPD is limited, and no longitudinal studies have been attempted so far. Longitudinal studies are particularly useful to reveal the electrophysiological aberrations in BPD.
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Perception of burden by caregivers of patients with schizophrenia in relation to symptom profile p. 116
Bharathi Gunjahalli, PM Chougule
Background: Schizophrenia begins early in life causing significant long-lasting impairments. The caregivers face physical, psychological, and economic difficulties in taking care of them. The current study was undertaken to study the influence of symptomatology, duration of illness, and treatment compliance of patients with schizophrenia on caregivers' burden. Methods: This study was hospital based, clinical, instrument rated, and cross sectional. Eighty-five patients and their caregivers who satisfied the selection criteria were interviewed. Information regarding sociodemographic details, patients' illness, present psychopathology, and relatives' burden were collected. Scale for Assessment of Negative Symptoms and Scale for Assessment of Positive Symptoms for (patients) and Burden Assessment Schedule for caregivers was used in the study. Descriptive and inferential statistical analysis was used. Results: The present study found that positive symptoms caused greater burden when compared to negative symptoms. Burden increased with increasing severity of negative symptoms. Although no significant influence of duration of illness and compliance to treatment was seen on caregivers' perception of burden, differential effect of the burden was observed for the above variables. Conclusions: Adequate treatment of symptoms benefits both patients and their caregivers. There is need for proper education of the patient and the caregivers about the need for continued treatment. The current study corroborates the importance of adequate treatment of positive symptoms as well as negative symptoms and the need to address caregiving by the family members for the well-being of both.
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Association between personality factors and early employment of mothers in medical undergraduates p. 124
Shubham Ratnawat, Abhijeet D Faye, Sushil Gawande, Rahul Tadke, Vivek Kirpekar, Sudhir Bhave
Background: Personality of an individual can be influenced by a variety of factors, including parenting and mother–child interactions in childhood. Reduced time spent with mother due to early employment of mother can affect the personality development in a positive or negative way. Personality, in turn, can influence academic performance, learning, and coping in Bachelor of Medicine, Bachelor of Surgery (MBBS) students. This study aims at exploring the association of mother's employment in the initial period of life and personality traits in MBBS students. Methods: This was a cross-sectional study conducted in a tertiary care center. Consecutively selected 200 MBBS students of all the academic years were interviewed using a semi-structured pro forma and big five inventory scale. Data were statistically analyzed using mean, standard deviation, Chi-square test, and other tests. A P < 0.05 was considered statistically significant. Results: Mothers of 21% of the students worked during pregnancy, and mothers of 33% of the students started working within the first 6 months of delivery. Significantly, high score of extraversion, agreeableness, and openness was found in students whose mothers started working within the first 6 months of delivery. No significant correlation was found between early employment of mother and scores of neuroticism and conscientiousness. Neuroticism score was higher in final MBBS students, students living away from home, and those staying in nuclear families. Conclusion: Early employment in mother was associated with high extraversion, agreeableness, and openness in MBBS students.
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Lack of association between religiosity/spirituality and mental well being among medical students and interns p. 137
Tabitha Gheevarghese, Parthasarathy Ramamurthy, Manikandan Mani, Pradeep Thilakan
Background: High subjective well-being causes better health and longevity. Religiosity has been shown to be positively associated with subjective well-being of medical students. The composition and content of religion is different in India, and hence the role of religiosity and spirituality on mental well-being of Indian medical students requires exploration. The present study was conducted to assess the relationship of religiosity and spirituality with mental well-being among medical students and interns. Methods: Warwick–Edinburgh Mental Well-Being Scale (WEMWBS), Centrality of Religiosity Scale (CRS), and Intrinsic Spirituality Scale (ISS) were administered to medical students at a private medical college in South India. The association of religiosity and spirituality with mental well-being was analyzed using Pearson's correlation analysis. Results: There was no correlation between WEMWBS and CRS scores. Similarly, there was no correlation of WEMWBS score with ISS score. Among Christian and Muslim medical students, there was a significant correlation between WEMWBS and ISS scores. No such correlation was found among Hindu medical students. Conclusion: Overall, there was no association of mental well-being with religiosity and spirituality among medical students. However, there were significant differences in this association among students with different religious affiliations. Among Christian and Muslim medical students, there was a positive association of mental well-being with spirituality but not with religiosity. No such association was found among Hindu medical students.
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Psychological distress in survivors of farmers' suicides in drought prone Aurangabad and Jalna Districts of Marathwada region in Maharashtra, India p. 143
Manik Changoji Bhise, Arun Vishwambhar Marwale, Ashish Chandrakantrao Mohide, Shraddha Shivaji Jadhav, Gaurav Pradeep Murambikar
Background: Survivors of suicide experience psychological distress for years after suicide. In India, farmers' suicide survivors are special group, with unique set of stressors. There are very few studies examining this group in India. The objective was to assess psychological distress and its correlates in survivors of farmers' suicides. Methods: This was a cross-sectional study from two districts of Marathwada region of Maharashtra. A predesigned and pretested semi-structured questionnaire to assess sociodemographic variables was used. Self-reporting questionnaire-20 was administered to evaluate psychological distress in 93 survivors of farmers' suicides. Standard descriptive statistics (percentages, means, and Chi-square test) were used. Results: Female-to-male ratio was 2.8:1. Majority (76%) survivors were young adults and 97.8% were from rural area. Most survivors assessed in study were spouse (68.8%) followed by parents (9.6%), siblings (2.2%), progeny, and others (19.35%) of suicide victims. Of all survivors, 75% were doing farming, while rest had other sources of income in addition to farming. Out of 93 survivors, 81.7% of survivors were experiencing significant psychological distress. Twenty-eight percent survivors themselves had thought of ending their life during 1 month prior to assessment. Most commonly, distress was expressed through somatic symptoms and depressed mood. There was no significant correlation of psychological distress with age, sex, occupation, and place of residence of survivors. There was no significant correlation between psychological distress and relationship of survivor with suicide victim. Conclusions: Survivors of farmers' suicides are suffering from significant psychological distress. Suicide ideation was present in significant number of them. The current situation needs urgent psychological intervention to alleviate their suffering.
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A study of factors affecting help-seeking behavior in major depressive disorder p. 148
Srinivasa Kartik Valipay, Minakshi Nimesh Parikh, Maitri Desai, Bakarali T Nathametha
Background: Major depressive disorder (MDD) is among the most common mental disorders. Apart from the high prevalence, depression has been found to contribute to a high degree of impairment in functioning, equalling or exceeding that associated with debilitating medical conditions. Despite this, research shows a large treatment gap and demonstrable benefits on addressing this gap. Hence, it becomes important to study the factors affecting help-seeking behaviors among patients with MDD. Our study aims to assess these factors. Methods: It was a cross-sectional study conducted on 100 consecutive consenting patients of MDD in the department of psychiatry of a tertiary care hospital. The instruments used were semi-structured pro forma for sociodemographic details, Big Five Inventory-10 Scale for personality traits, K10 rating scale for psychological distress, and Depression Stigma Scale to assess the stigma faced. Results: In our study, we found (a) sociodemographic factors such as higher family income, joint family type, and rural locality to be statistically significantly associated with late help seeking and (b) patient-related factors of higher levels of perceived stigma to be statistically significantly associated with late help-seeking behavior. Conclusions: Factors such as family type, stigma, and living in a rural area were significantly associated with late help seeking. Psychoeducation of family members and increased awareness and access to mental health-care professionals may help address these issues. Studying factors affecting help seeking on a larger scale may help with policy formulation in future.
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A cross sectional study of cognitive impairment in patients of alcohol use disorder attending a tertiary health care center in Central India p. 155
Ajinkya Sureshrao Ghogare, Ashish Vilas Saboo
Background: Alcohol use disorders (AUDs) have been prevalent among all societies and across the country. In India, the prevalence of AUD in 2010 as reported by the World Health Organization was 2.6% and 1.7% had reported heavy episodic drinking. AUD in India is especially important to watch out for because of consumption of country liquor and high rates of alcohol use in rural population. The aim of the study was to find the relation between AUD and cognitive impairment. Methods: The present study was carried out in the department of psychiatry of a tertiary health-care center and the data were collected from diagnosed cases of AUD. The sociodemographic profile and clinical variables were recorded in specific case report form prepared for this clinical study using Mini-Mental State Examination, Brief Cognitive Rating Scale (BCRS), and Bender Visual–Motor Gestalt Test Second Edition (BG II). Results: Of the 100 patients studied, most were young between the age groups of 18 and 30 (44.0%) years, followed by 31–40 years (40.0%), and 16.0% were above 40 years of age. Most of the patients had a history of alcohol use <10 years (43.0%) and 11–20 years (40.0%), whereas only 17% had it for over 20 years. Sociodemographic parameters such as age, marital status, family type, and residence and alcohol use parameters such as duration, pattern, type, severity, family history, and onset of alcohol use were significantly associated with the measures of cognitive function, i.e., Mini Mental State Examination (MMSE), BCRS, and BG II. Conclusions: Longer duration of alcohol use, severity of AUD, daily drinking, heavy drinking, country liquor consumption started early in age, and family history of alcoholism influence the cognitive dysfunction in patients of AUD.
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The impact of stress, stigmatization, and psychological morbidity on the quality of life in psoriasis p. 161
Nilima Kumari Mahapatro, Harshavardhan Sampath, Anil Mishra
Background: Psoriasis is a chronic and disabling dermatological disorder. The quality of life (QoL) in psoriasis is determined not only by clinical factors such as the type and extent of lesions but also by important psychosocial variables such as stressful live events, stigmatization, and psychological morbidity. Aims and Objectives: To assess the clinical and psychosocial determinants of QoL in psoriasis. Methodology: Using a cross-sectional, hospital-based study design, outpatients with psoriasis were administered the psoriasis disability index, psoriasis severity (simplified psoriasis index), psoriasis life stress inventory (PLSI), 6-item stigmatization scale, and 12-item general health questionnaire (GHQ-12). Results: The sample consisted of 39 psoriasis patients with a mean age of 41.77 years (standard deviation 13.15). Psoriasis vulgaris was the most common variant. Multiple regression analysis showed that among the clinical and psychosocial variables, only psychological morbidity (GHQ-12) significantly predicted psoriasis QoL (β = 0.314, t = 2.05, P < 0.049). Conclusion: Psychological factors are pivotal in determining QoL in psoriasis and need to be routinely assessed in dermatological settings.
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Correlation of perceived parenting patterns on the personality traits of medical students p. 165
Parul Sharma, Arun Kumar Tandon
Introduction: Parents are children's primary nurturers, and the responsibility of proper guidance of their children falls on their shoulders. Each parent, however, differs in the way they interact with their children. Do these interactions correlate, in any way, with the way the personality traits that their children develop, when they grow up, is the question that has been tried to answer in this study. Methodology: The study was conducted on 100 MBBS students of the 4th year of MMMC and H Kumarhatti, Solan, Himachal Pradesh, India. Two self-administered questionnaires were administered to the students: (1) International Personality Disorder Examination (IPDE)- ICD 10 was used to screen for the personality traits of students and (2) the Perceptions of Parents Scale to assess the students' retrospective perception of their parents' methods of parenting. Result: MAS and FAS were found to be significantly negatively correlated with paranoid trait among students;MW was significantly negatively correlated with paranoid trait among students; and FI,FASand FW were significantly negatively correlated with borderline trait, and FI was significantly negatively correlated with dependant traits. Conclusion: Parenting style of both parents as seen in the study, does show correlation with development of some personality traits of their wards.
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Hyponatremia misdiagnosed as depression p. 168
Neena S Sawant, Shubhangi R Parkar, Karishma Rupani, Himanshi Bansal, Suraj Singh
Serotonin reuptake inhibitors, antiepileptics, and antipsychotics are frequently used drugs by psychiatrists for various psychiatric illness which have hyponatremia as a side effect. The symptoms of hyponatremia include lethargy, weakness, headache, and irritability with neuropsychiatric complications such as seizures and confusion. Symptoms of hyponatremia usually occur when serum sodium concentration falls below 130 mEq/L. We report two cases which presented with depressive symptoms but were found to have persistent low serum sodium levels. The depressive features further improved on sodium correction. Both patients were on drugs which caused hyponatremia, a commonly occurring side effect of many medications which often goes undiagnosed. The cases highlight the importance and need for regular evaluation and monitoring.
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Clozapine-induced massive hematemesis: A rare case report Highly accessed article p. 171
Javed Ather Siddiqui, Shazia Farheen Qureshi, Yousef Bin Ahmed Shawosh
Clozapine (CLZ) is a drug of choice for the treatment of resistant schizophrenia. It is always blamed probably due to its life-threatening side effects, such as agranulocytosis, constipation, cardiomyopathies, and rarely hematemesis. We report the case of a 65-year-old patient diagnosed with resistant schizophrenia and treated with CLZ later he developed sudden massive hematemesis. The aim of our case report is to describe the rarely seen and potentially life-threatening side effect related to CLZ. Physician, particularly psychiatrists and medical specialists, should not ignore, be aware, and alert or always need to be watchful to the fatality of CLZ-induced hematemesis in the management of psychiatric disorders and should take appropriate therapeutic measures in such a case.
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Hypnotherapy in the treatment of conversion disorder blindness and deafness type p. 173
Chirag Ashok Kundalia, C Agila, Kalpesh V Chandrani
Conversion disorder is characterized by the loss of one or several neurological functions, with no apparent organic cause. In such cases, vision may be compromised in up to 5% of the patients in ophthalmologic emergencies. Hypnosis is a suggestion technique that has been used for years in the treatment of conversion disorder with positive results. Reported here is the case of a patient with conversion disorder, blindness, and deafness type whose evolution was satisfactory after one session of hypnotherapy.
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Musical obsessions: Successful treatment with low dose of escitalopram p. 176
Aneesh Alexander, Parthasarathy Ramamurthy, Pradeep Thilakan
Musical obsessions include repeated intrusive musical tunes, lyrics, or songs. In this report, two patients who presented with isolated musical obsessions and responded well to low dose of escitalopram (10 mg/day) are described. Musical obsessions have to be differentiated from musical hallucinations and palinacousis. Attention to psychopathology and associated clinical features are important in differentiating these conditions. Our case studies add to the limited knowledge of this uncommon condition.
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Antiepileptic drug-induced Stevens–Johnson syndrome: Which one to stop or continue? p. 178
Dipsa Digant Shastri, Falguni Ankur Chaudhari, Parag Suresh Shah, Jignesh Vaishnani
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The mental health attributes of recurrent metallic foreign body insertion to scalp in a young woman p. 180
Jai Singh, Sujita Kumar Kar, Chhitij Srivastava
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Cycloplegic eye drop-induced delirium in a child p. 182
Amit Shivaji Mane, Amey Yeshwant Angane
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Handling delirium on call p. 184
Sachin Mahajan
Delirium is a common cause of disturbed behavior in medically ill people and is often undetected and poorly managed. It is a condition at the interface of medicine and psychiatry that is all too often owned by neither. Despite its clinical importance, delirium is often not detected, or is misdiagnosed as or other psychiatric illness.Hence, identification of risk factors, education of professional carers, and a systematic approach to management can improve the outcome of the syndrome. This article is for psychiatry postgraduate students to understand various aspects of delirium, bedside assessment with management of the patient with a focus on etiology , predisposing factors ,pathogenesis & different types of presentation in clinical practice.
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