Indian Journal of PsychiatryIndian Journal of Psychiatry
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   Table of Contents - Current issue
September-October 2021
Volume 63 | Issue 5
Page Nos. 415-519

Online since Tuesday, October 12, 2021

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Comprehensive Mental Health Action Plan 2013–2030: We must rise to the challenge Highly accessed article p. 415
Om Prakash Singh
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Cognitive and affective empathy in men with alcohol dependence: Relation with clinical profile, abstinence, and motivation Highly accessed article p. 418
Hrishikesh Bipin Nachane, Gomati V Nadadgalli, Maithili S Umate
Background: Empathy plays a role not only in pathophysiology but also in planning management strategies for alcohol dependence; however, few studies have looked into it. No data are available regarding the variation of empathy with abstinence and motivation. Assessment based on cognitive and affective dimensions of empathy is needed. Aim: This study aimed to assess cognitive and affective empathy in men with alcohol dependence and compared it with normal controls. Association of empathy with disease-specific variables, motivation, and abstinence was also done. Methods: This was a cross-sectional observational study conducted in the outpatient department of a tertiary care center. Sixty men with alcohol dependence and 60 healthy controls were recruited and assessed using the Basic Empathy Scale for cognitive and affective empathy. The University of Rhode Island Change Assessment Scale was used to assess motivation. Other variables were assessed using a semi-structured pro forma. Comparative analysis was done using unpaired t-test and one-way ANOVA. Correlation was done using Pearson's correlation test. Results: Cases with alcohol dependence showed lower levels of cognitive, affective, and total empathy as compared to controls. Affective and total empathy were higher in abstinent men. Empathy varied across various stages of motivation, with a significant difference seen between precontemplation and action stages. Empathy correlated negatively with number of relapses and positively with family history of addiction. Conclusions: Empathy (both cognitive and affective) is significantly reduced in alcohol dependence. Higher empathy correlates with lesser relapses. Abstinence and progression in motivation cycle is associated with remission in empathic deficits.
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Cluster analysis of risky behaviors among the youth in Western Iran: Determining correlates and comparing clusters based on severity of disability and attitude toward mental health help-seeking p. 424
Habibolah Khazaie, Farid Najafi, Behrooz Hamzeh, Azita Chehri, Afarin Rahimi-Movaghar, Masoumeh Amin-Esmaeili, Mehdi Moradi-Nazar, Sepideh Khazaie, Ali Zakiei, Saeed Kamasi, Yahya Pasdar
Background and Aims: The objectives of the study were (i) cluster analysis of risky behaviors; (ii) determining correlates; and (iii) comparing clusters with regard to the attitude toward mental health help seeking. Methods: The current cross-sectional study is a part of the first phase of the Persian Youth Cohort. From October 2014 to January 2017, 2990 individuals from Ravansar City in western Iran completed structured interviews and national and international standard questionnaires. The obtained data were analyzed using two-stage cluster analysis, multinomial logistic regression analysis, and Chi-square test. Results: This model provided three distinct clusters: (i) low-risk group with mild distress, (ii) high-risk group with high distress, and (iii) violent group with medium distress. Some sociodemographic and lifetime psychiatric disorders were the correlates of unhealthy clusters (P < 0.05). Compared to the reference cluster, a higher number of members in unhealthy clusters were suffering from medium to severe disability. Nevertheless, the participants in these clusters were less inclined to mental health help seeking. Conclusions: More than half of the youth were suffering from suicidal and violent behaviors. Since high-risk participants are less inclined to mental health help seeking, the health policymakers can successfully utilize the results in planning general health programs.
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Utility of special drive campaign on substance use disorders in hard-to-reach communities in the fast urbanizing town of Solan, India p. 433
Ajay Kumar Singh, Kushel Verma, Sumit Chawla, Vaishali Sharma, Prerna Gupta
Aims: Special drive campaigns on substance use disorders (SUDs) in India are usually organized in educational institutes, non-governmental organizations, or few selected localities. Hard to reach communities of construction, prison, and industrial sites quite often remain uncovered. Materials and Methods: During a month-long special drive in 2019, under a cross-sectional study, we reached these communities of Solan town through awareness camps and incorporated standardized screening tools for evaluating morbidity patterns of SUDs. Results: Statistically significant relationship existed between 360 participants (90.8% males, 9.2% females; mean age of 33 years) and their educational levels with χ2 (1, n = 360) =130.59, P = 0.000. Fagerstrom's scale inferred very high nicotine dependence in 10.6%, 7.9%, and 2.4% of prisoners, industrial workers, and laborers, respectively. Whereas, Fagerstrom scale for smokeless tobacco revealed 31% of significant dependence potential amongst laborers. Alcohol use disorder identification test revealed 28 persons with harmful alcohol dependence. Drug abuse screening test revealed 13.6% of prisoners having moderate level drug abuse potential. The Kruskal–Wallis test showed a statistically significant difference, in levels and potential of substance use in construction, prison, and industrial sites. Conclusion: The study proved the utility of special drives in evaluating SUDs morbidity patterns in hard-to-reach communities.
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Concordance of assessment of insight by different measures in obsessive-compulsive disorder: An outpatient-based study from India p. 439
Sandeep Grover, Abhishek Ghosh, Natasha Kate, Siddharth Sarkar, Subho Chakrabarti, Ajit Avasthi
Aims: This study aimed to examine the (a) prevalence of various levels of insight among patients with obsessive-compulsive disorder (OCD) and (b) correlation of insight specifier (Diagnostic and Statistical Manual [DSM]-5) and other established measures of insight in OCD. Methods: One hundred and twenty-five outpatients with a diagnosis of OCD were assessed by Brown Assessment of Beliefs Scale (BABS) and DSM-IV's insight specifier. The insight specifier of DSM-5 was determined by item one (“conviction”) of BABS. Dimensional Yale-Brown Obsessive-Compulsive Severity Scale was used to assess the frequency and severity of dimensional obsessive-compulsive (OC) symptoms. Results: The mean age of the participants was 31.2 (±11) years. Seventy-seven (61.6%) of the participants were men. There was a high correlation (r = 0.73) between the insight specifiers of DSM-5 and DSM-IV. Insight categories of DSM-5 had modest correlations with BABS total score and BABS-based insight categories. Significant associations were observed between the level of insight and comorbid psychotic illness, hoarding and symmetry dimensions of OC symptoms, severity of depressive, and OC symptoms. The first two associations were consistent across group comparisons (insight-groups based on DSM-IV and BABS) and correlation (with total BABS score). Conclusions: Majority of the patients with OCD have good insight and application of different tools influence the assessment of insight in OCD. The DSM-5 insight specifier has strong and significant correlation with the DSM-IV's insight classification and categorization of insight by BABS.
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An instrument for visual cue associated craving of HEroin (IV-CACHE): A preliminary functional neuroimaging-based study of validity and reliability p. 448
Shantanu Shukla, Abhishek Ghosh, Chirag Kamal Ahuja, Debasish Basu, Bharath Holla
Background: Craving is the subjective experience of desire for specific drugs. Lack of reliability and untested construct validity are limiting factors for the existing questionnaires to assess craving. Aim: The aim of the study was to design and test the validity and reliability of an instrument to assess visual cue-induced craving for heroin dependence. Materials and Methods: In the first stage of the study, a set of forty images (twenty each of heroin and neutral cues-) were captured and validated by expert consensus. Thirty male participants with heroin dependence rated their cue-induced craving on a six-point Likert scale while viewing this image-set. In the next stage, putative construct validity was examined using a pilot cue-reactivity functional magnetic resonance imaging paradigm with ten additional heroin-dependent patients. Results: Cronbach's alpha for the instrument for visual cue-associated craving of HEroin (IV-CACHE) was 0.9, suggestive of high internal consistency. There were modest and significant correlations of IV-CACHE with the drug desire questionnaire (r = 0.43), and obsessive-compulsive drug use scale (r = 0.37), supporting concurrent validity. Patients with heroin dependence exhibited cue reactivity in the left fusiform area, right lingual gyrus, right precuneus region, right inferior frontal, inferior temporal gyri, and middle occipital gyri. The activated brain areas were largely aligned to the underlying neurobiological substrates of craving but might also have depicted nondrug-specific factors (aberrant face processing and attentional bias). Conclusion: The present cue-task is a promising tool for the examination of cue-related craving for heroin in the Indian setting.
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Serum nitric oxide levels are depleted in depressed patients treated with electroconvulsive therapy p. 456
Murat İlhan Atagun, Ozge Canbek Atay, Ozlem D Balaban, Derya Ipekcioglu, Baris Alpugan, Suat Yalcin, Almila Senat, Nesrin Karamustafalioglu, Mehmet C Ilnem, Ozcan Erel
Background: Nitric oxide (NO) is an endogenous substance which has several endocrine functions and may act as neurotransmitter in the brain. High levels of NO may provoke nitrosative stress. Aim: It was aimed to examine serum levels of NO in patients with depressive episodes who were treated with electroconvulsive therapy (ECT) in this study. Methods: The design was a case–control, follow-up study. Patients with depressive episodes (n = 23) and a healthy control group (n = 21) were enrolled. Three serum samples were obtained from the patient group (before ECT, after first and seventh sessions). NO, nitrite, and nitrate levels were examined. Statistical Analysis: Differences between groups were examined with t-test or Mann–Whitney U-test. Longitudinal data were evaluated with Panel Regression Analysis and Kruskal–Wallis Test. Results: Serum levels of NO and nitrite decreased significantly after the seventh session of ECT administration compared to the baseline and first session. Nitrate levels did not differ between the assessments. Conclusions: Reduction of the serum NO and nitrite levels might be a contributing factor for hypertension during the sessions. These findings are reflect the circulating NO levels. Further studies may dissect NO physiology in the brain in mental disorders and potential external effects.
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Training nonspecialists in clinical evaluation for telepsychiatry using videoconferencing: A feasibility and effectiveness study p. 462
Savita Malhotra, Subho Chakrabarti, Aarzoo Gupta, Kanupriya Sharma, Minali Sharma
Aims: Videoconferencing-based telepsychiatry has been used successfully for the assessment and management of psychiatric disorders. However, training mental health professionals through videoconferencing has seldom been attempted. Online decision support systems for diagnosing psychiatric disorders had been developed earlier at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, as a part of a project for delivering telepsychiatric services to remote areas. The feasibility of videoconferencing for training nonspecialist staff in the use of the online tool to diagnose psychiatric disorders was examined. The effectiveness of training was evaluated using ratings of diagnostic agreement between trainees and trainers and estimations of training costs. Methods: The Skype platform was used for videoconferences (VCs). Broadband internet connections had bandwidths of 4 mbps and speeds of 512 kbps. A total of 62 training sessions were conducted by the PGIMER team for remote-site teams using role-play techniques and actual patient interviews. Results: Videoconferencing-based training was considered to be convenient, satisfactory, and useful by all the participants. Diagnostic agreement between trainees and trainers was 89%–100%. Such training also appeared to be cost-effective. The main problems encountered were poor connectivity and poor audiovisual quality of the VCs. Conclusions: Videoconferencing can be feasible and effective for training nonspecialists to diagnose psychiatric disorders.
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Hunger, fear, and isolation – A qualitative analysis of media reports of COVID-19-related suicides in India p. 467
Madhumitha Balaji, Vikram Patel
Background: India's suicide rates are among the highest in the world and may increase further as a consequence of COVID-19. There is a need to examine which pandemic related stressors may be contributing to suicide, in order to inform the deployment of suicide prevention strategies, for the current as well as future pandemics. Aim: To understand pandemic related stressors contributing to suicide in India. Methods: We identified and conducted a thematic analysis of Internet media reports of COVID-19 related suicides in India between February 1, 2020 (2 days after the first COVID-19 case), and May 31, 2020, (the end of phase four of the nationwide lockdown). Results: Ten pandemic stressors spanning both disease and lockdown-related factors were identified in 291 suicides. Economic hardship was present in a third; other notable stressors were: fear of the virus; isolation; desperation to be connected with loved ones or return home; and craving for alcohol. Men and young people seemed particularly vulnerable to these stressors. Conclusions: COVID-19 related suicides appear to be precipitated by social and economic adversities, mainly associated with containment strategies. These findings need to be confirmed by national suicide data. Suicide prevention strategies should mitigate the impact of recognized stressors in the long term, target high-risk individuals, and offer mental health care alongside containment strategies.
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Antisuicidal efficacy of ketamine infusion in suicidal patients of depressive disorder p. 483
Umesh Pathak, Sunil Kumar Ahuja, Rajeev Dwivedi, Nimisha Mishra, Pradeep Kumar, Dheerendra Kumar Mishra, Rajesh Singh
Background: The efficacy of ketamine in the rapid alleviation of depressive and suicidal symptoms has been observed over the past few years around the globe. Exploration of rapid antisuicidal efficacy of ketamine in Indian subpopulation can be a good preventive pharmacological option for unprecedented rise in suicides in India. Aim: To assess efficacy of ketamine infusions on suicidal patients of depressive disorder. Severity of depression and suicidality were quantified daily over 1 week. Materials and Methods: This was a randomized control study, comprised sixty patients of age group 18–60 years, with a diagnosis of depressive episode, having the Modified Scale for Suicidal Ideations (MSSI) score >20 with exclusion of severe medical or surgical illness, pregnancy, and breast-feeding females. Patient were assigned to ketamine and normal saline group. Three infusions were given over 1 week on day 0, day 2, and day 4. Assessments were made at baseline using the 17-item Hamilton Depression Rating Scale (HAM-D17) and MSSI, for depression and suicidality, respectively. Assessments were repeated at 6 h after first infusion and then every day for 1 week. Results: There were significant reductions in HAM-D17 score and MSSI score within 6 h of the first dose in the ketamine group as compared to the normal saline group. Significant sustained improvement was seen on further days till 1 week in the ketamine group as compared to the normal saline group. Conclusion: Ketamine might be a reasonable choice to fulfil the efficacy gap created by the delayed antisuicidal onset of standard treatments.
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Psychosocial health and its associated factors among Men who have sex with Men in India: A cross-sectional studyS p. 490
B Thirunavukkarasu, Jyoti Khandekar, Mamta Parasha, Balraj Dhiman, Kartikey Yadav
Background and Aim: MSM in India experience complex and multiple psychosocial challenges. The current study was conducted with an aim to assess the magnitude and predictors of psychosocial health-related problems including MSM registered in targeted intervention centers in Delhi. Methods: A cross-sectional study was conducted among 235 MSMs. Burden of psychosocial health issues among MSM including depression, anxiety, substance abuse, and partner violence was assessed using semistructured questionnaire. Chi-square test was used to study the association of sociodemographic characteristics and psychosocial issues among the study participants. Results: The prevalence of depression, anxiety, substance abuse, and partner violence was 45.1%, 37.8%, 27.6%, and 8%, respectively. Age (<24 years), education up to middle school, and being single had significant association with depression. Being sex worker as occupation had a significant association with anxiety and intimate partner violence. Conclusions: The study reveals a significant burden of psychosocial problems and throws light toward broadening the spectrum of health assessment among this vulnerable group.
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Audit of requests for disability certification of adults received at a tertiary care general hospital psychiatry unit p. 495
Mahadev Singh Sen, Raman Deep, Vanaja Nair, Rakesh Kumar Chadda
Background: Persons with disability (PwD) are entitled to certain benefits from the State on grounds of being disabled. With the recent enactment of the Rights of PwD Act, 2016, and increased efforts to provide assistance to persons with certifiable disabilities, data pertaining to disability requests can be useful to understand the way in which services are utilized. Materials and Methods: This study is an audit of the disability certificates issued to all subjects with age ≥18 years between 2016 and 2019 at a tertiary care general hospital psychiatry unit, and discusses the pattern and profile of the certificates. Results: A total of 356 patients were issued disability certificates (2016–2019). The mean age of the subjects was 32.8 (±11.2) years and about 30% of them were females. Intellectual disability (58.3%) was the most common diagnosis, followed by schizophrenia and related disorders (31%), while all other disorders constituted a smaller proportion (11%) of the sample. About 60% of the subjects had moderate disability, 37.4% had severe disability, and 1.7% had profound disability. Conclusion: A large majority of the certificates were issued to subjects with intellectual disability. Patients with severe mental illnesses are probably not accessing the disability benefits optimally. This audit also points to under-representation of women as well as an overall underutilization of services by individuals with mental disability.
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Did psychopathology in Indian psychiatric patients change following the COVID-19 pandemic? p. 500
Prakash B Behere, AP Behere, D Chowdhury
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Clinical Research Center for Neuromodulation in Psychiatry: A Multi-Center Initiative to Advance Interventional Psychiatry in India p. 503
Ganesan Venkatasubramanian, Urvakhsh Meherwan Mehta, Nishant Goyal, Samir Kumar Praharaj, Shreekantiah Umesh, Kesavan Muralidharan, Jagadisha Thirthalli
This manuscript introduces a unique program titled “Clinical Research Center (CRC) for Neuromodulation in Psychiatry” supported by the prestigious CRC/Public Health Research Center Grant of the DBT Wellcome Trust India Alliance. This multi-institutional research program will be led by NIMHANS (Bengaluru) in collaboration with the Central Institute of Psychiatry (Ranchi), and Kasturba Medical College (Manipal). The goal of this CRC is in alignment with the editorial titled “Need to Develop “Interventional Psychiatry” as a subspecialty in India” published in the January 2020 issue of the Indian Journal of Psychiatry. The translational research studies and the training programs envisaged through this center will facilitate the development of cost-effective, advanced interventional psychiatry tailored to resource-limited Indian clinical settings and similar other countries as well.
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Medical Council of India regulations for entry into graduate medical courses: Unfair barriers for persons with disability due to mental illness p. 506
Hareesh Angothu, Prabhu Jadhav, Deepak Jayarajan, Sivakumar Thanapal, Krishna Prasad Muliyala
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Brief psychotic disorder during COVID-19 pandemic: A case series p. 508
Esra Aydin Sunbul, Emine Cengiz Cavusoglu, Huseyin Gulec
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Comment on “Changes in sleep pattern and sleep quality during COVID-19 lockdown” p. 511
Amal Joseph Jolly
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Developmental coordination disorder and its impact on health-related quality of life in school children p. 512
Sujatha Baskaran, Jagatheesan Alagesan, DV Lal, A Brite Saghaya Rayna
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Angioedema induced by valproic acid p. 514
Sevler Yildiz, Asli Kazgan
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Off-label use of ivermectin for COVID-19: Are there any neuropsychiatric effects to be aware of? p. 516
Marcelo G O'Higgins, Juan I Barrios, José D Almirón-Santacruz, João M Castaldelli-Maia, Antonio Ventriglio, Julio C Torales
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Chronic psychiatric illness masquerading as bipolar disorder in a family secondary to familial systemic lupus erythematosus with limbic encephalitis p. 517
Sandhya Manorenj, Reshma Sultana Shaik
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