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   Table of Contents - Current issue
Coverpage
July-August 2021
Volume 63 | Issue 4
Page Nos. 315-413

Online since Saturday, August 7, 2021

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EDITORIAL  

Mental health in diverse India: Need for advocacy p. 315
Om Prakash Singh
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_635_21  
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AWARD PAPER: D.L.N. MURTHY RAO ORATION Top

History and mystery of Dhat syndrome: A critical look at the current understanding and future directions p. 317
TS Sathyanarayana Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_791_20  
Sexual health, an essential component of individual's health, is influenced by many complex issues including sexual behavior, attitudes, societal, and cultural factors on the one hand and while on the other hand, biological aspects, genetic predisposition, and associated mental and physical illnesses. Sexual health is a neglected area, even though it influences mortality, morbidity, and disability. Dhat syndrome (DS), the term coined by Dr. N. N. Wig, has been at the forefront of advancements in understanding and misunderstanding. The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as “a culturally determined idiom of distress.” It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India. The research in India has ranged from the study of a few cases in the past to recent national multicentric studies concerning phenomenology and beliefs of patients. The epidemiological studies have ranged from being hospital-based to population-based studies in rural and urban settings. There are studies on the management of individual cases by resolving sexual myths, relaxation exercises, supportive psychotherapy, anxiolytics, and antidepressants to broader and deeper research concerning cognitive behavior therapy. The presentation looks into DS as a model case highlighting the importance of exploring sexual health concerns in the Indian population in general and in particular need to reconsider DS in the light of the newly available literature. It makes a fervent appeal for the inclusion of DS in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manuals which can pave the way for a better understanding and management of DS and sexual problems.
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REVIEW ARTICLES Top

A systematic review of Indian studies on sexual dysfunction in patients with substance use disorders p. 326
Siddharth Sarkar, Nishtha Chawla, Ashlyn Tom, Prabhat Mani Pandit, Mahadev Singh Sen
DOI:10.4103/psychiatry.IndianJPsychiatry_716_20  
Background and Aims: Sexual dysfunction is often associated with substance use disorders. This study aimed to synthesize Indian literature on sexual dysfunction among patients with substance use disorders. Materials and Methods: Electronic search engines were used to identify studies of the last 20 years that reported sexual dysfunction with different substance use disorders. Information was extracted using a predefined template. Quality appraisal of the included studies was carried out using Joanna Briggs Institute checklist. Results: Twenty-seven relevant papers were identified that pertained to 24 distinct studies. Most of them were in patients with alcohol dependence, and fewer were in patients with opioid dependence. The study designs were primarily single-group cross-sectional, though many case–control, cross-sectional studies were also identified. The proportion of participants with sexual dysfunction ranged from 22.2% to 76% for studies related to alcohol dependence and 40% to 90% for studies pertaining to opioid dependence. Varied types of sexual dysfunctions were identified, including poor satisfaction, lack of desire, premature ejaculation, and erectile dysfunction. Efforts to address bias and confounders were not reported in most studies. Conclusion: Sexual dysfunction affects a substantial proportion of patients with substance use disorders. Clinicians can make an effort to ascertain and address sexual dysfunction in their routine clinical practice while dealing with patients with substance use disorders.
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Mental health outcomes among health-care workers dealing with COVID-19/severe acute respiratory syndrome coronavirus 2 pandemic: A systematic review and meta-analysis p. 335
Abhijit Dutta, Avinash Sharma, Rodrigo Torres-Castro, Hariom Pachori, SukhDev Mishra
DOI:10.4103/psychiatry.IndianJPsychiatry_1029_20  
Introduction: The psychological impact of COVID-19 on health-care workers (HCWs) has received attention from researchers to understand the extent of the effects of the ongoing pandemic on this population. The aim of this systematic review and meta-analysis was to synthesize the currently available literature on the topic to determine the prevalence of mental health problems in HCWs. Materials and Methods: We conducted a systematic review and meta-analysis, searching PubMed, PsycINFO, Scopus, and Cochrane Library databases for articles published from December 2019 to August 15, 2020. We identified studies reporting the prevalence of any mental health condition in HCWs involved directly or indirectly in providing services during the COVID-19 pandemic. The prevalence proportion for individual outcome was extracted as an estimate of interest. We performed random-effects meta-analyses evaluated using Q statistic, I2 statistic, subgroup analyses, and sensitivity analyses and assessed study quality. This review was done in adherence to the Reporting Items for Systematic Reviews and Meta-Analysis and Meta-analysis of Observational Studies in Epidemiology guidelines. The study protocol was registered prospectively at PROSPERO (CRD42020182005). Results: We identified 1958 studies, of which 33 studies including 39703 participants (with a median = 393; range = 88–14825) were finally included for analysis. The estimated overall prevalence were as follows: depression 32.4% (95% confidence interval [CI]: 25.9–39.3, I2 = 99%), anxiety 32.5% (95% CI: 26.4–39.0, I2 = 99%), insomnia or sleep disturbance 36.6% (95% CI: 36.6–48.3, I2 = 99%), and stress 37.7% (95% CI: 24.0–52.3, I2 = 100%). Conclusion: HCWs who are dealing with the COVID-19 pandemic have a significant prevalence of depression, anxiety, insomnia and poor sleep quality, and stress. The health-care workforce needs to practice self-care now more than ever, while health-care managers and policymakers need to factor in the mental health consequences of COVID-19 on their workforce.
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ORIGINAL ARTICLES Top

Obsessive belief and emotional appraisal correlates of symptom dimensions and impairment in obsessive–compulsive disorder p. 348
Reema Sinha, Pooja Mahour, Eesha Sharma, Urvakhsh M Mehta, Manu Agarwal
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1194_20  
Background: Obsessive–compulsive disorder (OCD) is a heterogeneous and debilitating illness. Symptom dimensions of OCD lend homogeneous avenues for research. Variations in one's appraisal of thoughts and emotions can influence symptom dimensions and impairment. However, little is known about the combined influence of these appraisals in OCD. A clear understanding of these relationships has putative treatment implications. Aim: The aim of the study is to examine the associations among obsessive beliefs, emotional appraisals, and OCD symptom dimensions in adults. Materials and Methods: We examined 50 drug-naïve/drug-free adults with active OCD. Symptom dimensions and impairment were assessed using the Dimensional Yale–Brown Obsessive–Compulsive Severity Scale. Obsessive beliefs and emotional appraisals were studied using the Obsessive Beliefs Questionnaire-44 and Perception of Threat from Emotion Questionnaire. Results: Tobit regression analysis showed the differential association of obsessive beliefs and symptom dimensions – perfectionism/certainty associated with contamination and responsibility/threat estimation associated with aggressive obsessions. Impairment was associated with dimensional symptom severities and with the perception of threat from anger. This association remained even after controlling for depression severity and obsessive beliefs. Conclusions: OCD symptom dimensions are heterogeneous in underlying obsessive beliefs. Emotional appraisals contribute significantly to impairment alongside symptom severity. Emotion-focused interventions must be included in the psychotherapeutic interventions for OCD.
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Predictors of retention in the treatment for opioid dependence: A prospective, observational study from India p. 355
Anish Shouan, Abhishek Ghosh, Shubh Mohan Singh, Debasish Basu, Surendra Kumar Mattoo
DOI:10.4103/psychiatry.IndianJPsychiatry_448_20  
Background: Literature on a longitudinal study of the determinants of treatment retention for patients with opioid dependence is limited. Aim: To find out patient- and treatment-related (buprenorphine-naloxone-assisted treatment [BNX treatment] versus naltrexone treatment) predictors for retention in maintenance treatment. Materials and Methods: A total of 100 participants with opioid dependence were recruited by convenience sampling. The primary outcome was treatment retention – 3 months and 6 months postentry into maintenance treatment. Multiple assessments were done for the severity of opioid dependence and withdrawal, high-risk behavior, quality of life, and recovery capital – baseline and 3 and 6 months. The secondary outcome was to assess the change observed in the above-listed variables. Results and Conclusions: Bivariate analysis across retained and the dropout groups brought out significant differences for some (type of opioids and route of administration) but not for other (age, employment, and education) patient-related factors. Multivariate analysis, adjusting for the type of maintenance treatment, rendered these associations statistically insignificant. BNX-based treatment (compared to naltrexone maintenance) was the most significant predictor of treatment retention both at the end of 3 months and 6 months. Even after controlling for the severity of opioid dependence and withdrawal, type and route of opioid use, and high-risk behavior, patients on BNX were eleven times (14 times at the end of 6 months) more likely to be retained in the treatment. BNX group had significant improvements in the domains of recovery capital, quality of life, addiction severity, and severity of opioid dependence. There is a need to scale up the BNX-assisted treatment program in India and elsewhere.
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Sexual dysfunction in clinically stable patients with bipolar disorder receiving valproate p. 366
Sandeep Grover, Abbas Mehdi, Ajay Kumar, Subho Chakrabarti, Ajit Avasthi
DOI:10.4103/psychiatry.IndianJPsychiatry_205_20  
Aim: This study evaluated the prevalence of sexual dysfunction in patients with bipolar disorder, while receiving valproate monotherapy. Materials and Methods: Sixty-three clinically stable patients with bipolar disorder were evaluated on the Arizona sexual experience scale (ASEX), Udvalg for Kliniske Undersogelser (UKU) other side effect subscale and brief adherence rating scale. Results: The mean age of the study sample was 38.84 (standard deviation: 12.49) years. About three-fourth of the participants were male (76.2%). About one-fourth (28.6%) were found to have sexual dysfunction as per the ASEX. In terms of dysfunction in specific domain of sexual functioning, depending on the cut-off used, problem with sexual desire varied from 13.33% to 35.41% among males and 6.66%–46.66% in females. Erectile dysfunction was seen in 13.33%–31.25% of males and difficulty in vaginal lubrication was reported by 13.33%–26.66% of females. When those with and without sexual dysfunction as per the ASEX were compared, it was seen that those with sexual dysfunction had significantly longer duration of illness, higher prevalence of abnormal blood pressure and higher mean scores on the UKU other side effect subscale. Both the groups did not differ on other clinical variables. Conclusion: A significant proportion of patients receiving valproate experience sexual dysfunction. Higher prevalence of sexual dysfunction was associated with longer duration of illness, higher prevalence of abnormal blood pressure, and higher mean scores on UKU other side effect subscale.
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Relapse in opioid dependence: Role of psychosocial factors p. 372
Kailash Sureshkumar, Pranab Kumar Dalal, Shabeeba Z Kailash, Vidyendaran Rudhran
DOI:10.4103/psychiatry.IndianJPsychiatry_383_20  
Background: Although our understanding about neurobiology of opioid dependence and availability of pharmacological treatment has gone a long way in the last few decades, psychosocial interventions play a pivotal role in the prevention of relapse owing to reasons such as less treatment-seeking behavior and poor penetrance of opioid substitution treatment. There are many studies assessing psychosocial factors in alcohol and nicotine dependence, yet the availability of such studies for opioid dependence is sparse. This study aimed at evaluating the association of relapse in opioid dependence with various psychosocial factors. Materials and Methods: This was a cross-sectional study with two groups of opioid dependence patients: In abstinence (N = 28) and relapse (N = 33). Psychosocial variables such as high-risk situations, coping behavior, stressful life events, self-efficacy, and social support were assessed in the two groups and analyzed for the association with opioid relapse. Results: This study reports that more high risk situations (odds ratio [OR] =1.58; 95% confidence interval [CI] =1.22–2.03; P = 0.017), especially negative mood state and undesirable stressful life events (OR = 2.08; 95% CI = 1.28–3.37; P = 0.05) were significantly associated with higher odds of relapse in patients of opioid dependence. Further, higher self-efficacy (OR = 0.92; 95% CI = 0.87–0.96; P = 0.017) was significantly associated with lower odds of relapse. Conclusion: Psychosocial factors such as high risk situations, undesirable stressful life events, and self-efficacy were significantly associated with relapse in opioid dependence. Hence, practice of a holistic, multimodal, and individualized treatment plan addressing these factors might help in reducing the relapse rates in them.
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An analysis of neurocognitive dysfunction in brain tumors p. 377
Pravin Borde, Gautam Dutta, Hukum Singh, Daljit Singh, Anita Jagetia, Arvind Kumar Srivastava, Rohit Bharti, Anand Prakash, Anil Kumar
DOI:10.4103/psychiatry.IndianJPsychiatry_942_20  
Background: Neurocognitive dysfunction is an important issue in patients with frontal lobe lesions. These patients who may be in good neurological status may succumb to neurocognitive dysfunction, affecting their daily living and hampering the quality of life. This study aims to correlate pre- and post-operative neurocognitive dysfunction in patients with frontal lobe lesions. Materials and Methods: A prospective analysis of 50 patients of newly-diagnosed frontal lobe tumors of any grade deemed suitable for surgical resection was carried out. All patients underwent neurocognitive testing using frontal assessment battery (FAB), mini mental state examination, and verbal learning and memory test pre- and post-operatively. Results: In this study, 22 patients had right frontal lobe lesion, whereas in 24 patients, it was located in the left frontal lobe, and 4 patients had bilateral lesions. Only 12 patients were found to be in good FAB score preoperatively, and all of them had symptom duration of less than 3 months. 1-week postsurgery, 26 patients achieved a good score, which increased to 44 at 3rd month. Patients who had psychological dysfunction for more than 3 months had average-to-bad preoperative FAB scores, while at 3rd month postoperatively, only six patients were in average score and none in bad score. Conclusion: Frontal lobe lesion should be kept in mind in patients with neurocognitive dysfunction. FAB is a simple bedside test that should be included in routine neurological examination in daily neurosurgical practice to assess long-term functional outcome in patients with frontal lobe lesions.
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Knowledge, attitudes, and practices about COVID-19 among Kashmiri population: A cross-sectional study p. 383
Bushra Syed Imtiyaz, Chahat Jamwal, Arshad Hussain, Fazle Roub, Rabbanie Tariq, Imran Qayoom, Juvaria Syed, Mahvish Renzu
DOI:10.4103/psychiatry.IndianJPsychiatry_408_20  
Background: Nations across the globe are investing enormous resources to contain the coronavirus disease 2019 (COVID-19) pandemic. Assessing community knowledge and behavior could help in designing effective health-care policies tailored to the need of target population. Aims: We aimed to assess the knowledge, attitudes, and practices (KAP) about COVID-19 among Kashmiri population and to determine the association of KAP scores with the sociodemographic variables. Settings and Design: This was a cross-sectional study conducted via various online platforms. Materials and Methods: A structured questionnaire was formulated which was divided into three scoring sections assessing KAP about COVID-19 and a nonscoring section assessing individual reactions. A link to the survey was disseminated through social media platforms. A total of 1051 individuals participated. Statistical Analysis: Descriptive statistics were used for assessing the demographic characteristics of participants. Inferential statistics (Mann–Whitney U-test and Kruskal–Wallis test) were used for comparison. Results: Majority of the participants belonged to the age group of 20–39 years (75.4%), were unmarried (66.6%), were from urban background (54.9%), and had education of above high school (96.3%). In general, scores suggested that participants possessed adequate knowledge (mean ± standard deviation: 10.07 ± 1.134), had good attitudes (11.85 ± 1.42), and followed good practices (12.26 ± 1.42) regarding COVID-19. However, we found the correlations between KAP scores to be weak. Conclusions: A knowledge–praxis gap was highlighted in the studied population which was especially true for the vulnerable age group of > 60 years. The findings call for attention of health-care policymakers to design need-based, locally adaptable, and practicable interventional strategies for target population.
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BRIEF RESEARCH COMMUNICATIONS Top

Celebrity drug use reporting in Indian media and its impact on drug-related online search behavior: An infodemiology study p. 391
Swarndeep Singh, Gayatri Bhatia, Pawan Sharma, Arpit Parmar
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1329_20  
Aim: We aimed to examine and interpret the changes in internet search volumes for keywords representing different drug use-related themes before and after the drug use started being discussed in the Indian news media during recent celebrity drug trials. Materials and Methods: Data were extracted using Google Trends framework in health-related research. Search keywords were prepared under four broad themes: General interest in cannabis use, drug use being a criminal/unlawful act, help seeking for cannabis use, and help-seeking for drug-related problems. The mean relative search volume was analyzed and compared pre- and post-media discussion about celebrity drug use using SPSS V23.0. Results: A significant increase was noted in online search interest for keywords related to themes of general interest in cannabis use and drug use being a criminal/unlawful act once the media discussion on the celebrity drug use started. However, no corresponding increase was noted in online search interest for themes of help seeking for drug-related problems in general and cannabis use in particular. Conclusion: Media discussions on celebrity drug use may impact the online search behavior of the general public adversely. There is an need to develop and adhere to drug use reporting guidelines by media professionals.
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A study of thyroid profile in patients suffering from the first episode of mania: A cross-sectional study p. 395
Manish Kumar Goyal, Kuldeep Singh Yadav, Ram Kumar Solanki
DOI:10.4103/psychiatry.IndianJPsychiatry_33_20  
Background: Thyroid function is commonly considered in the assessment of mood disorders. Reports of thyroid dysregulation in patients with mania are associated with several confounding factors. To eliminate confounding factors, studies of first-episode mania are desirable. This study tried to find out any relationship between thyroid disorders and mania. Aim: The aim of this study is to assess and compare the thyroid profile between first-episode mania and healthy controls and to ascertain the correlation between severity and duration of the manic episode with FT3, FT4, and thyroid-stimulating hormone (TSH) levels. Materials and Methods: This was a cross-sectional study conducted in the psychiatry department of a tertiary care hospital. Forty consecutive drug-naïve patients with first-episode mania, diagnosed according to the International Classification of Disease-10 (study group), were matched with 40 healthy controls (control group). Both the groups were compared on the basis of thyroid profile and thyroid levels were correlated with duration and severity of illness in the study group. Results: Nearly 7.5% of cases in the study group had hyperthyroidism, whereas 5% had subclinical hyperthyroidism. In contrast, normal controls showed 5% and 10% prevalence of hypothyroidism and subclinical hypothyroidism, respectively. A statistically significant lower level of TSH was observed in the study group (P < 0.001), whereas the mean serum levels of FT3 and FT4 were higher in the study group, but the difference was statistically nonsignificant. No significant correlation of thyroid hormones level with duration and severity of illness was noted. Conclusion: Our findings highlight a higher prevalence of hyperthyroidism in patients with mania and suggest the role of thyroid hormones in mania.
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LETTERS TO EDITOR Top

Mephentermine abuse – A case report p. 400
Parijat Roy, Bhumika Shah, Sagar Karia, Avinash Desousa, Nilesh Shah
DOI:10.4103/psychiatry.IndianJPsychiatry_934_20  
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Mania associated with overdose of nevirapine in an adolescent: A case report p. 401
V Venkatesh Raju, Aaqib Zaffar Banday, Pandiarajan Vignesh, Sandeep Grover
DOI:10.4103/0019-5545.323389  
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Early-onset anorexia nervosa with psychotic symptoms: A case report p. 403
Ragini Bheemireddy, Shanti Mohan Kethawath, Srilakshmi Pingali, Umashankar Molanguri
DOI:10.4103/psychiatry.IndianJPsychiatry_446_20  
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Fluoxetine-induced liver injury and skin reaction: A case report p. 405
Abhijeet Soni, Astik Mane
DOI:10.4103/psychiatry.IndianJPsychiatry_320_20  
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Risk-mitigation measures in a tertiary care psychiatric hospital during COVID-19 pandemic p. 406
Guru S Gowda, Sundarnag Ganjekar, Damodharan Dinakaran, Sharad Philip, Nellai K Chithra, Deepa Purushothaman, Vishukumar Hallikere Shankarappa, TS Jaisoorya, Palanimuthu T Sivakumar, Shashidhara Harihara Nagabhusana, Veena Kumari Singh, Muralidharan Kesavan, V Bhadrinarayan, Pratima Murthy, Bangalore N Gangadhar
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_20_21  
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Is gender dysphoria a mental illness? The problem of overdiagnosis and medicalization in psychiatry p. 408
Manik Inder Singh Sethi, Sivabalan Elangovan
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_233_21  
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Response to letter to the editor “Psychotherapy belongs to whom?” p. 410
Nithya Poornima Murugappan, Poornima Bhola
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1361_20  
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Olanzapine-induced acute generalized exanthematous pustulosis: A case report p. 411
Jitender Jakhar, Rozy Badyal, Sundiep Kumar, Shiv Prasad
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_194_21  
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