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   Table of Contents - Current issue
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September-October 2020
Volume 62 | Issue 5
Page Nos. 457-614

Online since Saturday, October 10, 2020

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EDITORIAL  

The need for routine psychiatric assessment of COVID-19 survivors Highly accessed article p. 457
Om Prakash Singh
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1169_20  
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GUEST EDITORIAL Top

Building resilience in the COVID-19 era: Three paths in the Bhagavad Gita Highly accessed article p. 459
Matcheri S Keshavan
DOI:10.4103/psychiatry.IndianJPsychiatry_829_20  
The COVID-19 pandemic has emerged as a major stressor of a global scale, affecting all aspects of our lives, and is likely to contribute to a surge of mental ill health. Ancient Hindu scriptures, notably the Bhagavad Gita, have a wealth of insights that can help approaches to build psychological resilience for individuals at risk, those affected, as well as for caregivers. The path of knowledge (Jnana yoga) promotes accurate awareness of nature of the self, and can help reframe our thinking from an “I” to a “we mode,” much needed for collectively mitigating the spread of the coronavirus. The path of action (Karma yoga) teaches the art of selfless action, providing caregivers and frontline health-care providers a framework to continue efforts in the face of uncertain consequences. Finally, the path of meditation (Raja yoga) offers a multipronged approach to healthy lifestyle and mindful meditation, which may improve resilience to the illness and its severe consequences. While more work is needed to empirically examine the potential value of each of these approaches in modern psychotherapy, the principles herein may already help individuals facing and providing care for the COVID-19 pandemic.
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REVIEW ARTICLE (INVITED) Top

A systematic review of personality temperament models related to somatoform disorder with main focus on meta-analysis of Cloninger's theory components p. 462
Farzin Rezaei, Azad Hemmati, Khaled Rahmani, Saeid Komasi
DOI:10.4103/psychiatry.IndianJPsychiatry_345_20  
The systematic review aims to identify four personality temperament models related to somatoform disorder with the main focus on the meta-analysis of temperaments and characters in Cloninger's theory. The literature search was performed on PubMed (Medline), Scopus, Web of Science, Cochrane, and ProQuest for all articles published in English from January 1990 to April 2019. Due to heterogeneity, pooled estimates of the standard mean difference between cases and controls were calculated using the random-effects model. Based on our inclusion criteria, 14 studies were identified, 7 of which were included in the meta-analysis. The results show that there is a significant difference between cases and controls with regard to harm avoidance (HA) (z = 5.322, P < 0.001), self-directedness (z = −4.719, P < 0.001), and self-transcendence (z = 2.848, P = 0.004). Compared to controls, HA and self-transcendence were higher and self-directedness was lower in cases. With regard to other subscales, there was no difference between the two groups (P > 0.05). The publication bias was not seen (P > 0.05 for Egger statistics). Up to now, very few studies have been focused on the relationship between personality temperament models and somatoform disorder. Among the components of the Cloninger's model, the poor self-directedness along with the abnormally high self-transcendence and HA is the personality component related to the somatoform disorder. Thus, Cloninger's model may potentially draw a personality profile for vulnerability to somatoform disorder. Given the limited number of studies available, future studies may challenge the results of the present study.
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TILAK VENKOBA RAO ORATION AWARD 2020 Top

The social neuroscience of psychosis: From neurobiology to neurotherapeutics p. 470
Urvakhsh Meherwan Mehta
DOI:10.4103/psychiatry.IndianJPsychiatry_550_20  
Psychotic disorders form the core of severe mental illnesses and contribute to substantial disability and health-care costs worldwide. A growing research framework to understand and treat psychotic symptoms using a transdiagnostic paradigm is the social brain perspective of psychoses. The theme of my oration is to highlight how the growing knowledge of evolutionarily preserved social brain networks can help integrate social contextual, psychological, and neurobiological aspects of the genesis of psychotic symptoms and use that knowledge in a translational manner to identify potential therapeutic avenues that extend beyond conventional treatments. The concepts and empirical study of social cognition, social brain (e.g., mirror neuron system), social behaviors (e.g., symptoms and real-world functioning) are illustrated. These give insights into potential newer therapies with brain stimulation, oxytocin, and yoga.
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ACCELERATED RESEARCH Top

Information overload regarding COVID-19: Adaptation and validation of the cancer information overload scale Highly accessed article p. 481
Sujit Sarkhel, Ajay Kumar Bakhla, Samir Kumar Praharaj, Malay Kumar Ghosal
DOI:10.4103/psychiatry.IndianJPsychiatry_974_20  
Background: Access to excessive information from multiple sources relating to COVID-19 in a short span of time can have detrimental effects on individuals. Aim: The study aims to validate Corona Information Overload Scale (CoIOS) by adaptation of Cancer Information Overload scale (CIOS) on English speaking Indian citizens. Materials and Methods: An online survey was carried out using Google Form on 300 individuals out of whom 183 responded. The CoIOS was to be filled up. It was an 8 item Likert type scale with responses ranging from “strongly agree” to “strongly disagree.” Results: Principal components analysis showed two components with an initial eigenvalue > unity (3.38 and 1.09), with 42.33% and 13.64% of variance, respectively, making a total of 55.97% variance. The composite reliability value was also found to be 0.789 and 0.815 for factors I and II, respectively, convergent validity and discriminant validity calculation also affirmed good construct reliability. Conclusion: CoIOS appears to be a valid and reliable scale for measuring health information overload in relation to COVID-19. However, it has a two factor component, namely “excessiveness of information” and “rejection of information.”
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Impact of COVID-19 pandemic and lockdown on the state of mental health services in the private sector in India p. 488
Sandeep Grover, Aseem Mehra, Swapnajeet Sahoo, Ajit Avasthi, Adarsh Tripathi, Avinash D'Souza, Gautam Saha, A Jagadhisha, Mahesh Gowda, Mrugesh Vaishnav, Omprakash Singh, PK Dalal, Parmod Kumar
DOI:10.4103/psychiatry.IndianJPsychiatry_568_20  
Background: No information is available about the impact of lockdown and COVID-19 pandemic on the mental health services in the private practice in India. Aim: The current study is aimed to assess the impact of the COVID-19 pandemic and lockdown on the state of Mental Health Services in the Private Sector in India. Materials and Methods: An online survey was carried out using the Survey Monkey platform during the period of 1st to 15th May 2020 among the members of the Indian Psychiatric Society. Results: Three hundred and ninety six responses were analysed. There was a reduction in revenue generation by about 70%. All kinds of services, including outpatient services, inpatient services, psychotherapy services, consultation-liaison, and electroconvulsive therapy (ECT) services, were severely affected. One-third of the participants were using the teleservices during the pandemic. The most common problem faced in running the services included modifying the psychological treatment to maintain social distancing, and managing the staff. Besides providing clinical care to the patients, the majority of the mental health professionals reported that they were involved in increasing awareness about the mental health consequences of pandemic and the lockdown and addressing myths related to the spread of infection. Conclusion: The pandemic and the lockdown have markedly impacted mental health services in the private sector. ECT services, inpatient services, psychotherapy services and outpatient services are the most affected. However, the COVID-19 pandemic and lockdown have led to the expansion of teleconsultation services.
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ORIGINAL ARTICLES Top

Evaluation of sympathetic sudomotor responses to auditory stimuli in children with autism spectrum disorders p. 494
Remya Bharath, Shailaja S Moodithaya, Harsha Halahalli, Shrinivasa Bhat Undaru, Suchetha Kumari Nallilu, Amrit M Mirajkar
DOI:10.4103/psychiatry.IndianJPsychiatry_573_19  
Aim and Objective: Autism spectrum disorder (ASD) being a complex neurological and developmental disorder is also associated with autonomic nervous system dysfunction. Sudomotor nerve function is one highly sensitive index of sympathetic cholinergic activity and can be evaluated by measuring sympathetic skin response (SSR) to various stimuli. Studies reporting SSR to auditory stimulus among ASDs are limited and to the extent of our knowledge not assessed in the Indian scenario. The objective of the study was to assess and compare sympathetic sudomotor activity by evaluating SSR to auditory stimuli in children with and without ASDs. Materials and Methods: A total of eighty individuals were enrolled in the study, including forty children with ASD and forty typically developing (TD) children. SSR to auditory stimulus was assessed using a digitized data acquisition unit in a soundproof room, maintained at 23°C. SSR indices such as latent period (s), amplitude (mv), and habituation were analyzed and compared using appropriate statistical tests between the groups. P < 0.05 was considered statistically significant. Results: Habituation for SSR was statistically significantly lower (P < 0.001) in children with ASD (0.43 [0.21, 0.61]) compared to TD children (0.78 [0.65, 0.95]). Latent period was also statistically significantly higher in children with ASD (1.67 [1.37, 2.02]) compared to TD children (1.41 [1.2, 1.72]). However, there was no significant difference in amplitude values between the groups. Conclusions: Children with ASDs exhibited slower habituation of SSR to auditory stimuli compared to healthy controls. This slower habituation process might be due to the persistent predominant state of sympathetic nerves, which, in turn, contributes to the atypical emotional and behavioral traits prevailing in ASDs.
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Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study p. 501
Snehil Gupta, Gayatri Bhatia, Siddharth Sarkar, Biswadip Chatterjee, Yatan Pal Singh Balhara, Anju Dhawan
DOI:10.4103/psychiatry.IndianJPsychiatry_705_19  
Background: Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment. Methods: This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals. Results: About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status. Conclusion: Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.
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Prevalence and correlates of body dissatisfaction and disordered eating patterns in Indian youth: The role of media p. 509
Soumya Singh, Padmaja Gadiraju
DOI:10.4103/psychiatry.IndianJPsychiatry_737_19  
Background: The current study aimed to assess how media internalization and pressure are associated with body mass index (BMI), disordered eating, and body image dissatisfaction in Indian adults and whether there exist gender differences within these variables. The study also aimed to examine whether BMI and media internalization and pressure predict body dissatisfaction and disordered eating. Materials and Methods: The study utilized self-report measures that were administered to 262 men and women between the ages of 18–25 years (M = 21.64). Results: The results indicated that BMI was significantly correlated with internalization athlete, body shape dissatisfaction, and disordered eating, but not internalization general or media pressure. Internalization general, internalization athlete, media pressure as well as body shape dissatisfaction, and disordered eating were found to be positively correlated. Men and women did not significantly differ on any variable, but internalization athlete. Overweight and obese men and women were found to be significantly more dissatisfied than underweight and normal-weight men and women; however, the difference was not significant for overweight and obese males and normal-weight and overweight females. In addition, media influence and BMI significantly predicted body dissatisfaction and disordered eating. Conclusions: The present study contributes to a novel understanding of body image concerns and risk for clinical eating disorders in Indian youth and potential implications for future research.
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Prevalence and risk factors associated with substance use in children: A questionnaire-based survey in two cities of Uttar Pradesh, India p. 517
Raj Narain, Sarita Sardana, Sanjay Gupta
DOI:10.4103/psychiatry.IndianJPsychiatry_595_19  
Background: There is a sharp increase of substance use, particularly tobacco and alcohol, among schoolchildren. Aims: A study was undertaken to assess the prevalence, age of initiation, and determinants for the uptake of tobacco and alcohol habits among ever-user students. Settings and Design: This was a cross-sectional study conducted among school students. Materials and Methods: Information on alcohol and tobacco use, age at initiation, peer influence, reason of initiation, etc., was collected from students of class 7th–12th (ages: 11–19 years) studying in schools of Noida and Ghaziabad cities, through a pretested self-administered questionnaire through multistage sampling design. Univariate analysis was done to assess the significance of various determinants. Results: “Ever use of substance” (alcohol or tobacco) was found in 14.3% students and was 1.2 times more among boys in comparison to girls (P < 0.05). About 29.5% of these students initiated the habit before 11 years of age and its prevalence was significantly more among boys from government schools as compared to private schools. The habits were 2.2, 3.8, and 4.6 fold higher among students if the father, mother, siblings, or friends also used substances. Substance use was less frequent among children of white-collared father and more educated parents. One-third of students up took the habit to make friends. Conclusion: The rising prevalence of substance use among students is a threat to the society. Introducing a “substance use prevention policy” in schools to educate students about various adverse effects and refusal skills may help curb this menace.
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The difference in sleep, depression, anxiety, and Internet addiction between Korean adolescents with different circadian preference p. 524
Jun-Soo Chung, Eunhye Choi, Ah Reum Lee, Shin-Young Kim, Kina Lee, Bung-Nyun Kim, Subin Park, Kyu-In Jung, Seung-Yup Lee, Min-Hyeon Park
DOI:10.4103/psychiatry.IndianJPsychiatry_254_19  
Objectives: Compared to adults, adolescents tend to prefer evening times developmentally. The orientation toward evening times is associated with behavioral and emotional problems. Thus, this study examined the association of circadian preference with sleep-related variables, depression, anxiety, and Internet addiction in Korean adolescents. Materials and Methods: Participants completed the questionnaires measuring sleep pattern, sleep problem, depression, anxiety, and Internet addiction. Results: Among 765 students (age range: 13–17 years), 211 students (Nmale= 134) were allocated into morning types (MT) and 258 adolescents (Nmale= 147) were allocated into evening types (ET) based on scores of the Morningness–Eveningness Scale. Adolescents without circadian preference (N = 296) were defined as neither type (NT). ET, compared to MT and NT, woke up later in the weekend, showed delays in bedtimes, and spent shorter time sleeping. They also reported a higher level of daytime sleepiness, insomnia, and depression than NT. However, the group difference in wake time on school days was not significant, and adolescents showed mild insomnia regardless of their circadian preference. Although smartphone using time in the weekend was significantly different between groups, group difference in Internet addiction was significant only when gender was adjusted. Conclusion: Circadian preference was associated with sleep patterns and sleep problems in Korean adolescents. ET showed significantly different sleep patterns compared to MT and NT. ET not only reported a higher level of daytime sleepiness and insomnia but also more depressive symptoms compared to NT. These findings suggest that the uniqueness of adolescence and environmental factors seemed to influence the association of circadian preference with mental problem.
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Prevalence and correlates of bullying perpetration and victimization among school-going adolescents in Chandigarh, North India p. 531
Monica Rana, Madhu Gupta, Prahbhjot Malhi, Sandeep Grover, Manmeet Kaur
DOI:10.4103/psychiatry.IndianJPsychiatry_444_19  
Objectives: Bullying among adolescents is one of the important but neglected health concerns, especially in low- and middle-income countries. The objective of this study was to estimate the prevalence and correlates of bullying among Indian adolescents. Study Design: This was a cross-sectional study. Materials and Methods: The prevalence of self-reported involvement in any kind of bullying was assessed among sixth to tenth class students (n = 667, mean age 13 years), across government (n = 359) and private (n = 308) schools using Olweus Bully-Victim Questionnaire in Chandigarh, a North Indian union territory. Self-esteem and emotional and behavioral difficulties of the participants were measured by using standard Rosenberg Self Esteem Scale and Strengths and Difficulties Questionnaire, respectively. Multinomial logistic regression was done to determine the predictors of bullying. Results: Prevalence of any kind of bullying was 25.6% (16% victimization, 5.2% perpetration, and 4.3% being bully-victim). Verbal bullying was the most common (55.1%), followed by physical (32.7%) and relational (25.2%) bullying. The prevalence of cyberbullying was 2.7%. Around 44% of students reported that adults in school never did anything to stop bullying. Bully-victims had the highest mean difficulty score (16.07). Significant predictors of bullying were being male (odds ratio [OR] = 2.5 [1.5–4.2], P < 0.001); studying in government school (OR = 0.63 [0.41–0.99], P = 0.048); having abnormal emotions (OR = 2.24 [1.1–4.7], P = 0.035); and poor peer relations (OR = 2.77 [1.44–5.35], P = 0.002). Conclusions: One in four adolescents experience some form of bullying in schools in a North Indian city. Bullying perpetration and victimization is associated with gender, type of school, and abnormal difficulties (emotional and behavioral problems).
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Beneficial aspects of autism stemming from enhanced visuospatial skills: Result from a comparative study in India p. 540
Soumen Karmakar, Sharmila Sarkar
DOI:10.4103/psychiatry.IndianJPsychiatry_667_19  
Background: Autism spectrum disorder (ASD) is a relatively common neurodevelopmental disorder characterized by impairments in social interaction and communication, associated with restrictive and repetitive behaviors, interests, and activities. However, there are various positive character traits among individuals suffering from ASD – they are generally honest, decisive, and nonjudgmental. They are also reported to have excellent attention to details, which have been ascribed to their enhanced visual search skills. Aim: Our study was undertaken to assess these visuospatial perception skills among children with autism and compare the results with that of typically developing (TD) children in the Indian population. Materials and Methods: A total of 47 children with ASD and 47 age-, gender-, and education-matched TD children were assessed using tests for disjunctive and conjunction search, real-world visual search, and visual working memory. Results: Children with ASD performed significantly better than the TD children in tests for visual search and were comparable in the test for visual working memory. Conclusion: Our study showed that children with autism have enhanced visual skills, and this quality can be honed further and be utilized in jobs that require good observation skills and attention to details.
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Social cognition in patients with first episode of psychosis in remission p. 544
Mahadev Singh Sen, Ritu Nehra, Sandeep Grover
DOI:10.4103/psychiatry.IndianJPsychiatry_342_19  
Aim: The present study aimed to compare the social cognition (SC) deficits in patients with first-episode psychosis (FEP) and healthy controls and evaluate the association of SC deficits with socio-occupational functioning, insight, quality of life, and stigma. Methods: This study included 30 patients with FEP in remission phase and 26 healthy controls matched for age, gender, education, and intelligent quotient. SC was assessed on the domains of theory of mind (ToM), social perception, and attributional bias. Results: Compared to healthy controls, patients with FEP had significantly higher deficits in the domains of second-order ToM (unpaired t = 4.447, P < 0.001) and Faux Pas Composite Index (unpaired t = 2.824, P = 0.007). In the correlation analysis, higher age of patients with FEP was significantly associated with more externalizing bias (Pearson's correlation coefficient = 0.38, P = 0.039) and those with lower level of education had more social cognitive deficits in the domains of Faux Pas Composite Index (Pearson's correlation coefficient = 0.43, P = 0.018), Social Perception Index (Pearson's correlation coefficient = 0.38, P = 0.04), and Nonsocial Perception Index (Pearson's correlation coefficient = 0.5, P = 0.005). Duration of untreated psychosis was associated with higher deficits in the first-order ToM (Pearson's correlation coefficient = −0.38, P = 0.04) and Externalizing Bias Index (Pearson's correlation coefficient = −0.49, P = 0.006). Longer duration of treatment was associated with higher impairment in first-order ToM index (Pearson's correlation coefficient = −0.42, P = 0.02). General psychopathology and total Positive and Negative Syndrome Scale total score correlated significantly with externalizing bias, with a higher level of psychopathology associated with more severe deficits in this domain. There was no correlation of SC with the quality of life, cognitive insight, and stigma (except for occasional correlation of stereotype endorsement and externalizing bias). Conclusion: The present study suggests that compared to healthy controls, patients with FEP have impairment in the domains of second-order ToM and Faux Pas Composite Index. However, social cognitive deficits have only a few correlations with various psychosocial outcomes of FEP.
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BRIEF RESEARCH COMMUNICATIONS Top

Association between depression, anxiety and quality of life among patients with diabetes mellitus and/or hypertension in a tertiary care railway hospital in India: A cross-sectional study p. 555
Rajeev Ranjan, Santanu Nath, Siddharth Sarkar
DOI:10.4103/psychiatry.IndianJPsychiatry_794_19  
Introduction: Comorbid depression and anxiety have been found to be highly present in patients suffering from chronic physical illnesses such as diabetes mellitus (DM) and hypertension (HTN). These comorbid psychiatric conditions further reduce the quality of life (QOL) in the sufferers. The present study aimed to assess the association between depression, anxiety, and QOL among patients with DM and/or HTN. Materials and Methods: This cross-sectional study was carried out in the outpatient setting of the medicine department of the tertiary care referral hospital of East Central Indian Railways. One hundred and twenty-three individuals of DM and/or HTN of more than 1-month duration were assessed for depression, anxiety, and QOL using the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization QOL Brief (WHOQOL-BREF) version scale. Results: The mean age of the sample (53.7% had HTN, 12.2% had diabetes, and 34.1% had both HTN and diabetes) which comprised 87% males was 50.20 (±6.0) years. The mean HADS (anxiety and depression) scores were 3.6 for both (range 0–14). Nearly 10.6% and 17.1% of the samples had scores above the cutoff for HADS anxiety and depression subscales. The WHOQOL-BREF scores were highest for the environmental domain and were lower for psychological, physical, and social domains. The HADS anxiety and depressive scores correlated significantly negatively with the WHOQOL-BREF physical and psychological domains. Female gender and the presence of an additional medical illness were significantly associated with higher HADS depression scores. Conclusion: Fair proportion of patients with HTN and/or diabetes has been affected with higher anxiety and depressive scores, which predicted a poor QOL. This calls for early identification of these mental health issues in sufferers of depression and HTN, which will facilitate an early holistic management.
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Mentalizing self and others: A controlled study investigating the relationship between alexithymia and theory of mind in major depressive disorder p. 559
Onur Durmaz, Hayriye Baykan
DOI:10.4103/psychiatry.IndianJPsychiatry_554_19  
Background: Theory of mind (ToM) and alexithymia have been reported to relate with depression in recent studies. However, data regarding the role of alexithymia and ToM in depression remain uncertain. Aim: The aim of the current study was to determine the levels of alexithymia and ToM abilities as well as their relationship with each other and clinical features in major depressive disorder (MDD). Materials and Methods: Patients diagnosed with MDD and healthy controls were undergone sociodemographic data, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale (TAS-20), and reading the mind in the eyes test (RMET) to determine the depression, anxiety, alexithymia, and ToM abilities. Results: Depression, anxiety, and alexithymia levels were higher, while ToM abilities were found to be decreased in MDD patients relative to controls. A positive correlation was observed between depression levels and alexithymia levels in terms of difficulty in identifying feelings subscale and total scores of TAS-20 (P = 0.006, P = 0.036, respectively), while a positive correlation was also observed between anxiety levels and alexithymia levels in terms of difficulty in describing feelings subscale scores of TAS-20 (P = 0.02) in depressed group. No correlation was found between depression, anxiety levels, and RMET accuracy scores. Conclusion: Our results suggest alexithymia and impaired ToM abilities might be prominent but prone to be distinct clinical constructs in MDD patients.
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Depression prevalence, its psychosocial and clinical predictors, in diabetes mellitus patients attending two health institutions of north India catering rural population p. 566
Jyoti Gupta, Dheeraj Kapoor, Vivek Sood, Sukhjit Singh, Neeraj Sharma, Pankaj Kanwar
DOI:10.4103/psychiatry.IndianJPsychiatry_172_19  
Background: Diabetes mellitus (DM) poses a greater risk of depression and a poor quality of life (QoL). There is a limited data regarding relationship of depression to QoL in patients from rural health care settings of North India. Aim: To know the prevalence and predictors of depression in patients of DM among various sociodemographic, clinical and QoL variables. Settings and Design: This cross-sectional study was conducted in two hospitals of North India mostly catering rural population from 2014 to 2018. Materials and Methods: Sociodemographic and clinical data of DM patients was collected. They were applied Hindi translation of QoL Instrument for Indian Diabetes Patients and Patient Health Questionnaire-9. Analyses were done by Statistical Package for Social Sciences (Version 17.0, USA). Results: Among 300 patients, 25.6% had clinical depression. Illiteracy, the affect on general, emotional/mental health and role limitation by diabetes predicted risk of depression. Conclusion: Education of patients regarding self-management in DM to assure good health should be emphasised.
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Transcranial direct current stimulation for refractory auditory hallucinations in schizophrenia: Acute and 16-week outcomes p. 572
Pattath Narayanan Suresh Kumar, Arun Gopala Krishnan, Rohith Suresh, Chittaranjan Andrade
DOI:10.4103/psychiatry.IndianJPsychiatry_182_19  
Background: Transcranial direct current stimulation (tDCS) has demonstrated efficacy against antipsychotic-refractory auditory verbal hallucinations (AVH) in schizophrenia. The duration of persistence of benefit is not well characterized. Materials and Methods: Thirty-one adults with schizophrenia and medication-refractory AVH were treated with 2–3 mA tDCS in 30 min sessions, twice a day, 6 days a week, for 2–4 weeks. The anode was sited over F3 and the cathode midway between T3 and P3 in the 10–20 EEG system. Patients were assessed until a 4-month study endpoint using two auditory hallucination rating scales and the Positive and Negative Syndrome Scale (PANSS-N). Results: Auditory hallucinations were moderately reduced by tDCS with 25%–29% improvement evident by the end of the 2nd week and another 10% improvement between week 2 and 4 months. There was no loss of benefit at the end of the 4-month study. There was also a small (11%) but statistically significant improvement in PANSS-N scores. Conclusions: Although this study is limited by the nonblind, uncontrolled design, the results suggest that tDCS, as delivered, holds promise for treating refractory AVH in schizophrenia; the benefits persist beyond the short term.
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Assessment of lithium-related knowledge and attitudes among patients with bipolar disorder on long-term lithium maintenance treatment p. 577
Saurabh Kumar, Swarndeep Singh, Pankaj Mahal, Anuranjan Vishwakarma, Raman Deep
DOI:10.4103/psychiatry.IndianJPsychiatry_339_19  
Background: Gaps in lithium-related knowledge among bipolar disorder (BD) patients on lithium prophylaxis may pose safety concerns and could adversely influence attitudes to lithium. Objective: To assess the lithium-related knowledge and attitudes among patients with BD. Materials and Methods: This was a cross-sectional, observational study assessing euthymic, adult outpatients with BD on lithium prophylaxis (≥1 year) using a semi-structured pro forma, lithium questionnaire for knowledge, lithium attitude questionnaire (LAQ), and medication adherence rating scale (MARS). Results: Descriptive analysis revealed several deficits in knowledge, including lack of critical safety information or need for periodic blood tests. Lower knowledge group had significantly more negative attitudes. Favorable attitude toward lithium (lower LAQ score) was significantly associated with the number of psychiatric follow-ups in the last year and MARS score. Conclusion: There were critical deficits in lithium-related knowledge among the patients. Lower lithium knowledge was associated with negative lithium attitudes. Educative interventions should be delivered periodically to regular lithium users.
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Electroconvulsive therapy during the COVID-19 pandemic p. 582
Sandeep Grover, Preeti Sinha, Swapnajeet Sahoo, Shyamsundar Arumugham, Sachin Baliga, Subho Chakrabarti, Jagadisha Thirthalli
DOI:10.4103/psychiatry.IndianJPsychiatry_335_20  
The COVID-19 pandemic has forced substantial changes in the practice of psychiatry, including that of electroconvulsive therapy (ECT). There is higher risk of transmission of the SARS-CoV-2 virus during ECT unless due care is taken. However, in many cases, ECT cannot be avoided. In this paper, we discuss various measures that may be adapted to reduce the risk of transmission of the virus during ECT. We also suggest certain modifications to the practice of ECT in order to achieve a balance between risks and benefits of the procedure during the pandemic.
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Menstrual psychosis: A not so forgotten reality p. 585
Rajashree Ray, Imon Paul
DOI:10.4103/psychiatry.IndianJPsychiatry_883_20  
Menstrual psychosis is a rare entity, reported mostly as case studies in the medical literature. It presents with an acute onset of psychotic symptoms lasting for a short duration in a previously normal patient and occurring in rhythm with her menstrual cycle. It is usually associated with complete recovery in between episodes. This case series elaborates three case studies which have met the modern classification of this disorder and responded adequately to treatment. Reporting this series will help us to recognize and explore the role of hormonal changes related to the menstrual cycle on the mental health of women.
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Biofeedback intervention during the pregnancy for the treatment of anxiety disorder: A case report and review of literature p. 588
Aseem Mehra, Sandeep Grover
DOI:10.4103/psychiatry.IndianJPsychiatry_144_20  
Anxiety disorder during pregnancy has an adverse effect on the fetal, Obst, and neonatal outcomes. There is controversy about the use of psychotropic during pregnancy. The effective, safest, and easy to administer, nonpharmacological intervention is the unmet need. Biofeedback therapy is an acceptable and effective therapy for anxiety symptoms during pregnancy. We report a case of a young pregnant presented with anxiety symptoms in the first trimester along with recurrent panic attacks. The patient was managed with Biofeedback therapy, without any prenatal or postnatal complication. Future studies are required to understand the efficacy and effectiveness of biofeedback therapy.
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COVID-19: Survey of doctors p. 591
Nitasha Sharma, Abha Bang Soni, Chittaranjan Andrade
DOI:10.4103/psychiatry.IndianJPsychiatry_980_20  
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Psychological impact of COVID-19 lockdown: An online survey from India: Few concerns p. 591
Avinash Shukla
DOI:10.4103/psychiatry.IndianJPsychiatry_1012_20  
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Comment on psychological impact of COVID-19 lockdown: An online survey from India p. 593
Gurvinder Pal Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_995_20  
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Accelerated research for COVID-19: Methodological ruminations for internet-based research p. 594
Anindya Das
DOI:10.4103/psychiatry.IndianJPsychiatry_1035_20  
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Comments on psychological impact of COVID-19 lockdown: An online survey from India p. 595
Sandeep Grover, Swapnajeet Sahoo, Aseem Mehra, Ajit Avasthi, Adarsh Tripathi, Alka Subramanyan, Amrit Pattojoshi, G Prasad Rao, Gautam Saha, KK Mishra, Kaustav Chakraborty, Naren P Rao, Mrugesh Vaishnav, Om Prakash Singh, PK Dalal, Rakesh K Chadda, Ravi Gupta, Shiv Gautam, Siddharth Sarkar, TS Sathyanarayana Rao, Vinay Kumar, YC Janardran Reddy
DOI:10.4103/psychiatry.IndianJPsychiatry_1086_20  
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Recurrent, progressive ventricular tachycardia after electroconvulsive therapy p. 596
Nikhil Avula, Devavrat Harshe, Gurudas Harshe
DOI:10.4103/psychiatry.IndianJPsychiatry_836_20  
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Association of recurrent ventricular tachycardia with electroconvulsive therapy p. 598
Sandeep Grover, Shivali Aggarwal
DOI:10.4103/psychiatry.IndianJPsychiatry_901_20  
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Acute stress reaction related to use of personal protective equipment in health-care workers p. 599
Devakshi Dua, Raj Laxmi, Aseem Mehra, Swapnajeet Sahoo, Sandeep Grover
DOI:10.4103/psychiatry.IndianJPsychiatry_409_20  
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Comments on, “need to develop 'interventional psychiatry' as a subspecialty in India” p. 600
Mukesh Samani
DOI:10.4103/psychiatry.IndianJPsychiatry_242_20  
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Let's build the psychological immunity to fight against COVID-19 p. 601
Tanu Gupta, Naresh Nebhinani
DOI:10.4103/psychiatry.IndianJPsychiatry_420_20  
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Educational concerns of children with disabilities during COVID-19 pandemic Highly accessed article p. 603
Hemangi Narayan Narvekar
DOI:10.4103/psychiatry.IndianJPsychiatry_585_20  
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Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak? p. 604
Abhishek Ghosh, Kshitiz Sharma, Tathagata Mahintamani, Sabaresh Pandiyan, Fazl-e Roub, Sandeep Grover
DOI:10.4103/psychiatry.IndianJPsychiatry_447_20  
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Coronavirus disease 2019 pandemic: Ethical concerns for the treatment of individuals with substance use disorders in India p. 606
Tathagata Mahintamani, Abhishek Ghosh
DOI:10.4103/psychiatry.IndianJPsychiatry_376_20  
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Online group cognitive behavioral therapy for panic buying: Understanding the usefulness in COVID-19 context p. 607
Sujita Kumar Kar, Vikas Menon, S M Yasir Arafat
DOI:10.4103/psychiatry.IndianJPsychiatry_610_20  
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COVID-19 pandemic and implications for graduate medical training p. 609
Vikas Menon, Susanta Kumar Padhy, Kumari Rina
DOI:10.4103/psychiatry.IndianJPsychiatry_570_20  
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Stigma-discrimination: Significant collateral damage of COVID-19 p. 610
Carlos Arturo Cassiani-Miranda, Adalberto Campo-Arias
DOI:10.4103/psychiatry.IndianJPsychiatry_506_20  
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Regulating e-pharmacies: Whose job is it anyway? p. 612
Amit Chail, Harpreet Singh, Ankit Dangi
DOI:10.4103/psychiatry.IndianJPsychiatry_40_20  
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Psychotherapy belongs to whom? p. 613
Siddeswara Bargur Linganna, Kattimani Shivanand
DOI:10.4103/psychiatry.IndianJPsychiatry_798_20  
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