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2017| July-September | Volume 59 | Issue 3
Online since
October 6, 2017
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VIEWPOINT
Treatment of substance use disorders through the government health facilities: Developments in the “Drug De-addiction Programme” of Ministry of Health and Family Welfare, Government of India
Anju Dhawan, Ravindra Rao, Atul Ambekar, Amal Pusp, Rajat Ray
July-September 2017, 59(3):380-384
DOI
:10.4103/psychiatry.IndianJPsychiatry_19_17
PMID
:29085101
Substance use disorder (SUD) is a major problem worldwide, including in India, and contributes significantly to morbidity and mortality. The Ministry of Social Justice and Empowerment, Government of India, addresses the prevention and rehabilitation aspect of substance use through the establishment of “rehabilitation centers” run by nongovernmental organizations. The Drug De-addiction Programme (DDAP) was initiated in 1988 under the Ministry of Health and Family Welfare, Government of India, and was mandated with provision of treatment for SUDs. Through the DDAP, de-addiction centers (DACs) have been established in government hospitals by providing a one-time financial grant by the central government, with the recurring expenses to be borne by the state governments. In addition, some premier institutions as well as DACs from Northeastern region are provided annual recurring grants for their functioning. Capacity building has been a major focus area of DDAP in which nonspecialist medical officers working in government hospitals have been trained, and various training materials have been developed. Another major area of work is the development of “drug abuse monitoring system” to track the pattern of drug use and profile among individuals seeking treatment in the DACs. Monitoring and evaluation exercises carried out show that the existing model of inpatient treatment and of shared responsibility between central and state governments is partially successful. The establishment of drug treatment clinics on pilot basis with a focus on outpatient treatment and direct support from the DDAP for staff as well as for medicines is showing encouraging results.
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ORIGINAL ARTICLES
Pattern and prevalence of substance use and dependence in the Union Territory of Chandigarh: Results of a rapid assessment survey
Ajit Avasthi, Debasish Basu, BN Subodh, Pramod K Gupta, Nidhi Malhotra, Poonam Rani, Sunil Sharma
July-September 2017, 59(3):284-292
DOI
:10.4103/psychiatry.IndianJPsychiatry_327_16
PMID
:29085086
Background:
Substance misuse is a matter of major public health concern in India. House-to-house survey, though an appealing method to generate population-level estimates, has limitations for estimating prevalence rates of use of illicit and rare substances.
Materials and Methods:
In this rapid assessment survey (RAS), respondent-driven sampling was used to recruit substance-using individuals from the field. Size of the substance-using population was estimated using the “benchmark-multiplier” method. This figure was then projected to the entire population of the Union Territory (U.T) of Chandigarh. Focused group discussions were used to study the perceptions and views of the substance users regarding various aspects of substance use.
Results:
Prevalence of any substance dependence in the U.T of Chandigarh was estimated to be 4.65%. Dependence rates on opioids, cannabinoids, and sedative hypnotics were found to be 1.53%, 0.52%, and 0.015%, respectively. Prevalence of injectable opioids was calculated to be 0.91%. Injectable buprenorphine was the most commonly used opioid, followed by bhukhi/doda/opium and heroin. A huge gap was found between the prevalence rates of substance-using population and those seeking treatment.
Conclusion:
RAS can be a useful method to determine the prevalence of illicit and rare substances. Our survey shows that the use of substance including that of opioids is highly prevalent in the U.T of Chandigarh. The findings of this survey can have implications for policymaking.
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Risk factors for the development of delirium in alcohol dependence syndrome: Clinical and neurobiological implications
Sukanto Sarkar, Sunayana Choudhury, Gem Ezhumalai, Janet Konthoujam
July-September 2017, 59(3):300-305
DOI
:10.4103/psychiatry.IndianJPsychiatry_67_17
PMID
:29085088
Introduction:
Alcohol withdrawal delirium (AWD) or delirium tremens (DT) is associated with severe complications and high mortality. Prospectively identifying patients with increased risk of developing DT would have important preventive and therapeutic implications. Thus, the present study aimed to identify clinical risk factors predicting the development of DT.
Materials and Methods:
The study was a cross-sectional quasi-experimental one with equivalent control group, conducted at a tertiary hospital from August 2014 to May 2015. Forty adult male inpatients, diagnosed with DT, were compared with forty age- and sex-matched inpatients in alcohol withdrawal state without delirium. Assessments were done using confusion assessment method, Clinical Institute Withdrawal Assessment of Alcohol Scale, and Mini–Mental Status Examination. For group comparisons, Pearson's Chi-square test and independent sample
t
-test were used; logistic regression was applied to identify predictors followed by receiver operating characteristic curve analysis.
Results:
Heavy drinking (
P
= 0.005; odds ratio [OR]: 1.17, confidence interval [CI]: 1.05–1.31), continuous pattern of drinking (
P
= 0.027; OR: 4.67, CI: 1.19–18.33), past history of delirium (
P
= 0.009; OR: 552.8, CI: 4.88–625.7), alcohol-induced psychosis (
P
= 0.002; OR: 74.6, CI: 4.68–1190), and presence of cognitive deficits (
P
= 0.044; OR: 12.5, CI: 1.07–147.3) emerged as strong predictors of AWD.
Conclusion:
The risk factors found can be easily evaluated in a clinical setting for physicians to readily identify patients at risk for developing DT and plan intensive therapies for them. At a neurobiological level, patients with preexisting brain neurotransmitter disturbances are at greater risk for developing DT.
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Comparative outcome in patients with delirium tremens receiving care in emergency services only versus those receiving comprehensive inpatient care
Sojan Baby, Pratima Murthy, K Thennarasu, Prabhat K Chand, Biju Viswanath
July-September 2017, 59(3):293-299
DOI
:10.4103/psychiatry.IndianJPsychiatry_260_17
PMID
:29085087
Background:
Delirium tremens (DT) is a medical emergency. Many cases are treated and discharged from emergency services (ES), after complete or partial resolution of delirium. Few receive comprehensive inpatient addiction treatment (CIAT) after the initial emergency management.
Objective:
The objective of this study was to compare 6-month outcomes of treatment in alcohol-dependence syndrome (ADS) patients presenting with DT receiving either only emergency care or emergency care along with CIAT.
Materials and Methods:
In this prospective observational study, all patients of ADS presenting in DT over a 1-year period were followed up for 6 months. Patients who received care only in the emergency services (ES) (111) were compared with patients who received ES followed by CIAT (90). Primary followup measure was regular followup (RFU) at outpatient department, and patients not presenting for RFU received telephonic followup (TFU). Alcohol use status was monitored at 6 months, as per Feuerlein and Küfner criteria.
Results:
Patients who received both ES and CIAT had better RFU compared to patients treated in the ES alone at 6 months (71/90 vs. 17/111, respectively,
P
< 0.005). CIAT also resulted in better combined follow-up (RFU and TFU) (85/90 vs. 60/111, respectively,
P
< 0.005). Compared to ES treatment group alone, ES plus CIAT group had fewer relapses (41/85 vs. 42/60, respectively,
P
< 0.05). The most common reason for direct discharge from ES was nonavailability of beds for inpatient treatment.
Conclusions:
Merely emergency treatment of ADS patients presenting with DT does not provide satisfactory treatment outcome with respect to alcohol use. ES treatment followed by CIAT ensures better outcome in the form of fewer relapses and better follow up.
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GUEST EDITORIAL
Cannabis: Does it have a medicinal value?
Aniruddh P Behere, Prakash B Behere, TS Sathyanarayana Rao
July-September 2017, 59(3):262-263
DOI
:10.4103/psychiatry.IndianJPsychiatry_208_17
PMID
:29085083
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3,130
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EDITORIAL
A possible role for ketamine in suicide prevention in emergency and mainstream psychiatry
TS Sathyanarayana Rao, Chittaranjan Andrade
July-September 2017, 59(3):259-261
DOI
:10.4103/psychiatry.IndianJPsychiatry_345_17
PMID
:29085082
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3,039
637
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ORIGINAL ARTICLES
The use and effectiveness of pro re nata psychotropic medications in children and adolescents: A systematic review
Kenneth Asogwa, Jerome Okudo, Joel Idowu
July-September 2017, 59(3):264-274
DOI
:10.4103/psychiatry.IndianJPsychiatry_34_17
PMID
:29085084
Background:
Published studies have not demonstrated the benefits of the practice of psychotropic PRN administration.
Aim:
The goal of this study is to perform a systematic review on pro re nata (PRN) psychotropic medications administration in children and adolescents and examine the safety and effectiveness of this practice in child and adolescent psychiatric care units.
Settings and Design:
This is a systematic review.
Materials and Methods:
Several databases were searched till date. One hundred and sixty-five titles and abstracts were found and a total of 14 studies, for which most were retrospective, met the absolute criteria. The patients studied were children, adolescents and patients that presented to the emergency room or admitted as inpatient.
Results:
Indications for admission included aggression and agitation for all the studies. Most the medications used include haloperidol, olanzapine, diazepam, and risperidone. Commonly reported adverse effects following the administration of the PRN medications were sleepiness, acute dystonia, and drowsiness. The effectiveness of PRN medications, which was reported in four of reviewed studies, ranged from 30% to 50%.
Conclusion:
Different effectiveness/outcome measures were used for all the studies; therefore, we could not generalize effectiveness across all the studies. Findings of the reviewed articles show the imperativeness of more research to evaluate the safety and effectiveness of PRN medications among child and adolescent populations.
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3,049
517
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Attitude toward psychiatrists and psychiatric medication: A survey from five metropolitan cities in India
Aron Zieger, Aditya Mungee, Georg Schomerus, Thi Minh Tam Ta, Aino Weyers, Kerem Böge, Michael Dettling, Malek Bajbouj, Ulrike von Lersner, Matthias C Angermeyer, Abhinav Tandon, Eric Hahn
July-September 2017, 59(3):341-346
DOI
:10.4103/psychiatry.IndianJPsychiatry_190_17
PMID
:29085094
Background:
Stigmatization and overall scarcity of psychiatrists and other mental health-care professionals remain a huge public health challenge in low- and middle-income countries, more specifically in India. Most patients seek help from faith healers, and awareness about psychiatrists and treatment methods is often lacking. Our study aims to explore public attitudes toward psychiatrists and psychiatric medication in five Indian metropolitan cities and to identify factors that could influence these attitudes.
Materials and Methods:
Explorative surveys in the context of public attitudes toward psychiatrists and psychiatric medication were conducted using five convenience samples from the general population in Chennai (
n
= 166), Kolkata (
n
= 158), Hyderabad (
n
= 139), Lucknow (
n
= 183), and Mumbai (
n
= 278). We used a quota sample with respect to age, gender, and religion using the census data from India as a reference.
Results:
Mean scores indicate that attitudes toward psychiatrists and psychiatric medication are overall negative in urban India. Negative attitudes toward psychiatrists were associated with lower age, lower education, and strong religious beliefs. Negative attitudes toward psychotropic medication were associated with lower age, male gender, lower education, and religion.
Conclusion:
In line with the National Mental Health Policy of India, our results support the perception that stigma is widespread. Innovative public health strategies are needed to improve the image of psychiatrists and psychiatric treatment in society and ultimately fill the treatment gap in mental health.
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ART AND PSYCHIATRY
Nurture the nature
Lakshmi Sravanti
July-September 2017, 59(3):385-385
DOI
:10.4103/psychiatry.IndianJPsychiatry_341_17
PMID
:29085102
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LITERARY PSYCHIATRY
Alvars
of South India: A psychiatric scanner
Ottilingam Somasundaram, Tejus Murthy
July-September 2017, 59(3):375-379
DOI
:10.4103/psychiatry.IndianJPsychiatry_383_16
PMID
:29085100
Vaishnavism
, the other important Hindu tradition besides
Saivism
, gained importance by the
Bhakti
movement sprouting from the Tamil land in the 7
th
–9
th
centuries Common Era and spreading all over the subcontinent, and as preached by the
Alvars
, which is discussed along with the evolution of the Godhead of Lord Vishnu is briefly mentioned. The maternal care of the divine child Sri Krishna by
Yashodha
as described by the
Alvar
,
Perialvar,
is summarized. The mysticism of
Nammalvar
and the religious experiences of other two
Alvars
,
Kulasekarar
and
Andal,
are sketched in this study.
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155
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ORIGINAL ARTICLES
A cross-sectional comparative study on the assessment of quality of life in psychiatric patients under remission treated with monotherapy and polypharmacy
Benson Koshy, CM Gopal Das, Yogananda Rajashekarachar, DR Bharathi, Shashank S Hosur
July-September 2017, 59(3):333-340
DOI
:10.4103/psychiatry.IndianJPsychiatry_126_16
PMID
:29085093
Context:
The concept of quality of life (QoL) is becoming an important measure of the impact of psychiatric disorders. It is natural that once patient achieves remission, QoL would improve, but very few studies are conducted under this phase. This study compares the differences in QoL in remitted patients with monotherapy and polypharmacy.
Aims:
The aim of this study is to compare the QoL between psychiatric patients in remission treated with monotherapy and polypharmacy.
Settings and Design:
It is a questionnaire based cross-sectional comparative study.
Materials and Methods:
This study included outpatients under remission who come for follow-up in psychiatric department. Semi-structured data collection form was used. Remission was confirmed using suitable scales, and QoL was assessed using the World Health Organization quality of life-Brief (WHOQOL-BREF) scale. Clinical Global Impression (CGI) and Global Assessment of Functioning (GAF) were applied to understand the overall improvement and functioning levels.
Results:
Out of the total 100 patients enrolled in the study, fifty patients were on monotherapy and fifty patients on polypharmacy. The cost of medication was comparatively high for polypharmacy (Rs. 3568.92 [±348.54]) than monotherapy (Rs. 1936.56 [±252.07]). The QoL in physical, psychological, and social domains was significantly high in patients on polypharmacy rather than monotherapy when assessed using the WHOQOL-BREF scale. Ninety-six percent of monotherapy patients had CGI scores between 1.5 and 2.4 while 74% of polypharmacy patients had scores between 1.0 and 1.5. Ninety-six percent of monotherapy patients had <80 GAF scores while 92% of polypharmacy patients had >80.
Conclusions:
Patients treated with polypharmacy had better QoL and also clinical improvement and functioning levels were superior.
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2,620
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Special educators' knowledge and training on autism in Karnataka: A cross-sectional study
Shivani Tiwari, Joyce John
July-September 2017, 59(3):359-365
DOI
:10.4103/psychiatry.IndianJPsychiatry_133_17
PMID
:29085097
Context:
In the wake of increasing prevalence of autism globally, with a substantial change in understanding of the disorder, it is essential to update knowledge of the healthcare professionals involved in the intervention of children with autism. Special educators are important team members in the rehabilitation of children with autism. There are only a few studies addressing knowledge and training of special educators in the rehabilitation of children with autism, particularly in the Indian context.
Aim:
The present study investigated knowledge and training on autism among special educators in a southern state of India, Karnataka.
Settings and Design:
A descriptive cross-sectional study design was adopted for this study.
Materials and Methods:
Data were collected from 47 special educators, who answered questions related to general knowledge, knowledge of educational programming, knowledge about classroom behaviors, and professional development needs regarding autism.
Statistical Analysis:
Statistical analysis of the data was performed using Statistical Package for Social Sciences (version 16).
Results:
Results of the study indicated that special educators had an overall reduced level of understanding about autism and poor knowledge on educational programming and classroom behaviors in children with autism. Further, their knowledge regarding autism varied with educational qualification and years of work experience.
Conclusions:
Findings of the study, thus, emphasize the need for increasing awareness by providing knowledge and training to special educators working with children with autism in India.
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259
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Attitudes toward the mentally ill among community health-related personnel in South Korea
Wook Jung, Eunkyung Choi, Jaehak Yu, Doo-Heum Park, Seung-Ho Ryu, Jee Hyun Ha
July-September 2017, 59(3):328-332
DOI
:10.4103/psychiatry.IndianJPsychiatry_58_16
PMID
:29085092
Background and Aims:
Prejudice and negative attitudes toward mental illness are major obstacles in the rehabilitation and functional recovery of patients. The objective of this study was to evaluate the attitudes of health-related personnel toward mentally ill patients in a local urban community in South Korea.
Materials and Methods:
In total, 401 participants (men, 132; women, 269; mean age, 37.3 ± 9.5 years) were recruited. The participants were health-related personnel in a district of Seoul, who were recruited from three different workplaces: a local administration office, a public health center, and a community welfare center. Sociodemographic data were gathered, and the community attitudes toward the mentally ill (CAMI) inventory were administered. Comparisons of the CAMI subscales were conducted among participants using statistical analysis.
Results:
Community welfare center workers showed more authoritarianism and social restriction and less community mental health ideology than the other two groups. Among the demographic variables, a shorter working career, higher education, female gender, and younger age were also related to a more negative attitude toward mentally ill patients.
Conclusion:
Community health-related personnel who have contact with patients with mental illness should be encouraged to have a fair, hospitable, and open-minded attitude. It is advisable for these workers to receive interventions such as regular educational programs early in their careers.
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Substance use and dependence in the Union Territory of Chandigarh: Results of a household survey using a multistage stratified random sample
Ajit Avasthi, Debasish Basu, BN Subodh, Pramod K Gupta, Nidhi Malhotra, Poonam Rani, Sunil Sharma
July-September 2017, 59(3):275-283
DOI
:10.4103/psychiatry.IndianJPsychiatry_326_16
PMID
:29085085
Background:
Substance misuse is a global health and social problem with major adverse consequences. A number of regional studies on prevalence of substance use and dependence have been carried out in India; but methodologically robust data from Chandigarh are sparse.
Methodology:
A house-to-house survey was carried out to estimate the prevalence of substance use and dependence in an adequate multistage-stratified random sample in the Union Territory (UT) of Chandigarh, using standardized instruments and predefined measures. Two thousand individuals (1000 each from urban and rural sites) from 743 households were interviewed.
Results:
Lifetime use of any substance was reported in 21.26% households (8.01% of all respondents; 13.6% males and 1.01% females). Current use was reported in 6.55% of respondents. Prevalence rates of both lifetime and annual/current substance dependence were 2.96% (4.74% for males and 0.72% for females). Alcohol (6.72%) was the most common substance to be ever used by respondents, followed by tobacco (3.34%), opioids (0.17%), and hypnotics (0.04%). Lifetime dependence rates were found to be 1.76%, 2.28%, 0.04% and 0.17% for alcohol, tobacco, hypnotics, and opioids, respectively. None reported the use of cannabinoids, inhalants, or stimulants. Substance users were more likely to be married, employed, and in higher income group as compared to those who never used substance. Only 3.78% substance users had ever sought treatment for the same.
Conclusion:
Substance use is prevalent in the UT of Chandigarh, with a higher prevalence in males. Substance users hardly ever seek treatment for substance use. This highlights the need of awareness and community-level services for the treatment of substance use disorders.
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2,457
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Identification and treatment of Nepal 2015 earthquake survivors with posttraumatic stress disorder by nonspecialist volunteers: An exploratory cross-sectional study
Arun Jha, Suraj Shakya, Yinyin Zang, Nishita Pathak, Prabhat Kiran Pradhan, Khem Raj Bhatta, Sabitri Sthapit, Shanta Niraula, Rajesh Nehete
July-September 2017, 59(3):320-327
DOI
:10.4103/psychiatry.IndianJPsychiatry_236_16
PMID
:29085091
Context:
In April 2015, a major earthquake struck northern regions of Nepal affecting one-third of the population, and many suffered mental health problems.
Aims:
This study aimed to conduct a preliminary investigation of prevalence and feasibility of brief therapy for posttraumatic stress disorder (PTSD) among earthquake survivors.
Settings and Design:
This is an exploratory cross-sectional study of prevalence and feasibility of brief trauma-focused therapy for PTSD among survivors 3 and 11 months after the earthquake in affected areas near Kathmandu.
Methodology:
A team of local nonspecialist mental health volunteers was trained to identify survivors with PTSD using the PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) (cutoff score 38). They were trained to deliver either shortened versions of narrative exposure therapy (NET)-revised or group-based control-focused behavioral treatment (CFBT).
Results:
Altogether, 333 survivors were surveyed (130 in July 2015 and 203 in March 2016) with PCL-5 as the screening instrument, using the cutoff score of 38 or more for diagnosing PTSD. A PTSD prevalence of 33% was noted in 2015 and 28.5% in 2016. This drop of 4.5% prevalence in the intervening 8 months suggests that a significant number of survivors are still suffering from PTSD. Most participants were female, aged 40 or above, married, and poorly educated. Compared to the brief (four sessions) individual NET-revised, a group-based CFBT was found more acceptable and affordable.
Conclusions:
PTSD is common following earthquake trauma, and if untreated, survivors continue to suffer for a long time. Management of PTSD should be included in future disaster management plans.
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276
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Association of chronic disease prevalence and quality of life with suicide-related ideation and suicide attempt among Korean adults
Pankaj Joshi, Han-Byol Song, Sang-Ah Lee
July-September 2017, 59(3):352-358
DOI
:10.4103/psychiatry.IndianJPsychiatry_282_16
PMID
:29085096
Aims:
The aim of this study is to find the association of chronic disease prevalence (CDP) with suicide-related ideation (SI) and suicide attempt (SA) and to determine the combined effect of CDP and quality of life (QoL) with SI or SA.
Design:
This was a cross-sectional study.
Materials and Methods:
The data were collected from the nationally representative Korea National Health and Nutrition Examination Survey IV and V (2007–2012). For the analysis, a total of 35,075 adult participants were selected as the final sample, which included 5773 participants with SI and 331 with SA.
Statistical Analysis:
Multiple logistic regression models were used to examine the odds ratio after adjusting for age, sex, marital status, education, occupation, and household income.
Results and Conclusion:
SI was positively associated with selected CDP, such as cardiovascular disease (CVD), stroke, ischemic heart disease (IHD), cancer, diabetes, renal failure, and depression, except hypertension. Subjects with CVD, IHD, renal failure, and depression were found likely to have increased odds for SA as compared to non-SA controls. Lower QoL strongly affected SI and SA. Furthermore, the likelihood of SI increased for depressed and cancer subjects who had low QoL in comparison to subjects with high QoL and without chronic disease. Similarly, statistically, significant interaction was observed between lower QoL and depression in relation to SA compared to non-SA controls. These data suggest that suicide-related behavior could be predicted by the prevalence of chronic disease and low QoL.
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2,316
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Psychological adaptation of Indian expeditioners during prolonged residence in Antarctica
Sudhir K Khandelwal, Abhijeet Bhatia, Ashwani K Mishra
July-September 2017, 59(3):313-319
DOI
:10.4103/psychiatry.IndianJPsychiatry_296_16
PMID
:29085090
Background:
In view of the growing human activities in Antarctica and increasing exposure of humans to prolonged isolation under extreme conditions, such as space travel and deep sea diving, it is necessary to study the psychological adaptation to such an environment. The current study aimed to assess the psychological adaptation of Indian expeditioners to prolonged residence in Antarctica.
Materials and Methods:
Twenty-four winter team members of 27
th
Indian Scientific Expedition to Antarctica were administered seven instruments 5 times during the expedition. The instruments measured cognition and memory, general psychological health and tobacco, and alcohol consumption.
Results:
Alcohol consumption was maximum during the initial days of arrival on the continent and decreased thereafter, with another spike during the peak of the winter season. Externalized psychological reactions peaked during the midwinter period. Anxiety and insomnia peaked during the coldest period whereas depressive symptoms did not change throughout the expedition. Cognition was at its worst during the final phase of Antarctic residence. No significant change was noted in the third quarter of wintering.
Conclusion:
Each phase of Antarctic residence could be equated with a particular stage in psychological adaptation. There was no third quarter phenomenon.
[ABSTRACT]
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2,405
207
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Partial mediator role of physical abuse on the relationship between attention-deficit/hyperactivity disorder symptoms and severity of dissociative experiences in a sample of inpatients with alcohol use disorder
Cuneyt Evren, Gokhan Umut, Muge Bozkurt, Yesim Can, Bilge Evren, Ruken Agachanli
July-September 2017, 59(3):306-312
DOI
:10.4103/psychiatry.IndianJPsychiatry_366_16
PMID
:29085089
Aim:
This study aimed to evaluate the relationship of attention-deficit/hyperactivity disorder (ADHD) symptoms with dissociative experiences, and the mediator role of childhood traumas on this relationship, while controlling the effect of depression in alcohol use disorder (AUD).
Settings and Design:
It was a hospital-based, cross-sectional study.
Materials and Methods:
One hundred and ninety inpatients with AUD were evaluated with the Beck Depression Inventory, the Adult ADHD Self-Report Scale (ASRS), Childhood Trauma Qestionnaire, and Dissociative Experiences Scale (DES).
Statistical Analysis:
One-way ANOVA, Chi-squared test, and hierarchical linear regression model were performed.
Results:
The ratio of those who receive 10 points or less from DES was 26.8%, those who receive points between 11 and 30 was 45.3%, and those who receive more than 30 points was 27.9%. The latter group that was considered as a group with high risk of dissociative disorder had higher scores from depression, childhood trauma, and ADHD scores than the other groups. Rate of those with high probability of ADHD was higher among this group. ASRS total score and inattentive subscale scores were moderately (
r
= 0.552 and
r
= 0.547, respectively) and hyperactive/impulsive subscale was mildly (
r
= 0.430) correlated with DES score. Severity of ADHD was related with the severity of dissociative symptoms, and physical abuse had partial mediator effect on this relationship, even after controlling the depressive symptoms.
Conclusions:
These findings demonstrate that the presence of severe IN symptoms is an important factor related with dissociative tendency in AUD population with a history of physical abuse.
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2,252
214
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A comparison of dexmedetomidine with propofol versus esmolol with propofol to attenuate the hemodynamic stress responses after electroconvulsive therapy
Radhe Sharan, Neeru Bala, Joginder Pal Attri, Keerty Garg
July-September 2017, 59(3):366-369
DOI
:10.4103/psychiatry.IndianJPsychiatry_373_16
PMID
:29085098
Background:
Modified electroconvulsive therapy (ECT) under anesthesia is an important modality in the treatment of severe, persistent depression; bipolar disorder and schizophrenia; especially in cases resistant to pharmacologic therapy.
Aim:
The aim of the present study is to compare the effects of dexmedetomidine and esmolol on patients' hemodynamics, motor seizure duration, and recovery times following ECT.
Materials and Methods:
Ninety cases aged between 18 and 50 years of the American Society of Anesthesiologists grade I and II; were randomly divided into three groups of 30 each. Group A received normal saline (placebo), Group B received dexmedetomidine 1 μg/kg, and Group C received esmolol 1 mg/kg; followed by induction with propofol 1 mg/kg and muscle relaxation with succinylcholine 0.75 mg/kg. Hemodynamic parameters at baseline, after study drug infusion, after induction, and after ECT application were recorded at different time intervals. The motor seizure duration using arm isolation method and recovery times using postanesthesia discharge scoring system were noted.
Results:
The maximum increase in hemodynamic parameters was seen following the ECT current application. Post-ECT rise in mean arterial blood pressure and heart rate in dexmedetomidine group was significantly less as compared to esmolol and control group at 2, 4, 6, and 8 min using unpaired
t
-test. There was no significant difference in motor seizure activity duration, emergence, and recovery times among the three groups.
Conclusions:
Both dexmedetomidine and esmolol attenuate the hyperdynamic response to ECT without affecting the seizure duration, but dexmedetomidine has a more favorable response in view of stable vitals, smooth emergence and no adverse effect on recovery duration.
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2,165
267
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LETTERS TO EDITOR
Farmers' suicide and agrarian crisis: Social policy and public mental health
Anindya Das
July-September 2017, 59(3):398-399
DOI
:10.4103/psychiatry.IndianJPsychiatry_138_17
PMID
:29085112
[FULL TEXT]
[PDF]
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[EPub]
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2,203
201
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Significant improvement of posttraumatic stress disorder and psychotic symptoms after inpatient Eye Movement Desensitization and Reprocessing treatment: A case report with 6-month follow-up
Leonhard Kratzer, Peter Heinz, Rebecca Schennach
July-September 2017, 59(3):389-390
DOI
:10.4103/psychiatry.IndianJPsychiatry_318_16
PMID
:29085105
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2,204
189
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ORIGINAL ARTICLES
Quality of sleep and well-being of health workers in Najran, Saudi Arabia
O Ogunsemi Olawale, O Afe Taiwo, Almohandes Hesham
July-September 2017, 59(3):347-351
DOI
:10.4103/psychiatry.IndianJPsychiatry_241_16
PMID
:29085095
Background:
Health care involves taking care of other peoples' lives. Professionals in the field of health care are expected to be at their best all the time because mistakes or errors could be costly and sometimes irreversible.
Aim:
This study assessed the quality of sleep and well-being of health workers in Najran city, Saudi Arabia.
Materials and Methods:
It was a cross-sectional study done among health workers from different hospitals within the kingdom of Najran, Saudi Arabia. The subjects were administered questionnaire that contained sections on demographic and clinical characteristics, sleep quality, and section relating to well-being.
Results:
One hundred and twenty-three health workers comprising 29 (23.6%) males and 94 (76.4%) females participated in this study. The majority of the workers 74 (60.2%) were nurses; a quarter were doctors while the remaining 13.6% accounted for other categories of health workers such as the pharmacist and laboratory technicians. Fifty-two (42.3%) of the workers were poor sleepers. Significantly (
χ
2
= 23.98,
P
= 0.000), majority of the subjects that were poor sleepers (84.6%) compared with the 42.3% of the good sleepers rated the last 12 months of their profession as a bit stressful or quite a bit stressful. Similarly, 46.2% of the workers that were poor sleepers significantly (
χ
2
= 24.69,
P
= 0.000) rated their ability to handle unexpected and difficult problems in their life as fair or poor compared with 14.1% of the good sleepers
Conclusion:
Health workers expressed some level of stress in their professional life, and a good proportion of the subjects were poor sleepers. There is, therefore, the need to establish a program within the health-care organization to address social, physical, and psychological well-being at work.
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2,108
247
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LETTERS TO EDITOR
Doctors interested in alternative learning: JSS DIAL - An innovative facility by the doctors for the doctors!!
M Kishor, Nayanabai Shabadi, Abhimanyu Chandak, VG Manjunath, HS Kiran, TS Sathyanarayana Rao
July-September 2017, 59(3):403-404
DOI
:10.4103/psychiatry.IndianJPsychiatry_243_17
PMID
:29085117
[FULL TEXT]
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[PubMed]
1,971
132
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From compliance to adherence: Changing views, changing concepts
Abhishek Ghosh, Satish Suhas, Chintan Solanki, Malay Dave, Harish M Tharayil, Dinakaran Damodharan, Chittaranjan Andrade
July-September 2017, 59(3):399-400
DOI
:10.4103/psychiatry.IndianJPsychiatry_281_17
PMID
:29085113
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1,850
163
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Lithium-induced polyuria and amiloride: Key issues and considerations
Raman Deep Pattanayak, Pallavi Rajhans, Pooja Shakya, Namita Gautam, SK Khandelwal
July-September 2017, 59(3):391-392
DOI
:10.4103/psychiatry.IndianJPsychiatry_168_17
PMID
:29085107
[FULL TEXT]
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[EPub]
[PubMed]
1,823
179
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ORIGINAL ARTICLES
Effectiveness of dexmedetomidine as premedication prior to electroconvulsive therapy, a Randomized controlled cross over study
Deepa Sannakki, Naina Parag Dalvi, Shilpa Sannakki, Devangi P Parikh, Sanchita K Garg, Bharati Tendolkar
July-September 2017, 59(3):370-374
DOI
:10.4103/psychiatry.IndianJPsychiatry_33_17
PMID
:29085099
Background:
This study evaluated the effect of dexmedetomidine on the acute hyperdynamic response, duration of seizure activity, and recovery profile in patients undergoing electroconvulsive therapy (ECT).
Aims:
To study the effectiveness of dexmedetomidine 1 μg/kg intravenous in ECT in terms of attenuation of the hyperdynamic response, seizures duration, and sedation.
Design:
This was a prospective, randomized, double-blinded, crossover study.
Materials and Methods:
Thirty patients were included in the study and were treated as both cases and controls. The study drug was given 10 min before induction of anesthesia. Vital parameters and recovery scores were recorded.
Results:
In Group D, heart rates at 3
rd
and 5
th
min after electric stimulus (T6 and T7, respectively) were 94.5 ± 20.1 and 90.4 ± 12.8/min as compared to 111.9 ± 15.5 and 109.0 ± 13.7 in Group N, respectively (
P
< 0.0001). The systolic blood pressure in Group D and Group N were 116.53 ± 26.09 and 138.03 ± 19.32 at T6, respectively (
P
< 0.001). Diastolic blood pressure and mean arterial pressure were significantly reduced after induction and electric stimulus in Group D. The seizures duration was similar in both groups. Modified Aldrete's Score and Richmond Agitation-Sedation Score were prolonged in Group D.
Conclusion:
Dexmedetomidine, before the induction of anesthesia, prevents the acute hyperdynamic responses to ECT without altering the seizures duration. However, patients may have delayed recovery and delayed discharge.
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1,769
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LETTERS TO EDITOR
IPS travel fellowship in perinatal psychiatry
Shubhangi S Dere
July-September 2017, 59(3):402-403
DOI
:10.4103/psychiatry.IndianJPsychiatry_9_17
PMID
:29085116
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1,817
134
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Clozapine-associated Pisa syndrome: A rare type of tardive dystonia
Pattath Narayanan Suresh Kumar, Arun Gopalakrishnan
July-September 2017, 59(3):390-391
DOI
:10.4103/psychiatry.IndianJPsychiatry_308_16
PMID
:29085106
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1,724
197
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Pharmacovigilance in drugs used in the treatment of drug dependence
Anusha Thota, Prasad Thota, Vivekanandan Kalaiselvan, Siddharth Sarkar, Gyanendra Nath Singh
July-September 2017, 59(3):393-395
DOI
:10.4103/psychiatry.IndianJPsychiatry_268_16
PMID
:29085108
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1,752
132
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Nonconvulsive status epilepticus and central paralysis after modified electroconvulsive therapy in a schizophrenic patient
Peng Deng, Xiahong Wang, Jingjing Sui, Jianyue Pang, Qian Liu, Hengfen Li
July-September 2017, 59(3):387-388
DOI
:10.4103/psychiatry.IndianJPsychiatry_301_16
PMID
:29085104
[FULL TEXT]
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1,651
110
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Questionable usefulness of the everyday abilities scale of India to screen for dementia
Swapnajeet Sahoo, Sutanaya Pal, Avisha Mahla, Satish Suhas, Ekta Franscina Pinto, Chittaranjan Andrade
July-September 2017, 59(3):395-396
DOI
:10.4103/psychiatry.IndianJPsychiatry_130_17
PMID
:29085109
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1,588
116
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The importance of using a valid method to assess medication compliance in psychosis
Abha Thakurdesai, Vikas Menon, Bhavesh Lakdawala, Abha Bang Soni, K Krishnamurthy, Chittaranjan Andrade
July-September 2017, 59(3):400-401
DOI
:10.4103/psychiatry.IndianJPsychiatry_282_17
PMID
:29085114
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1,569
129
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Hallucination and priapism associated with methylphenidate usage: Two case reports
Erman Esnafoglu, Esra Yancar Demir
July-September 2017, 59(3):386-387
DOI
:10.4103/psychiatry.IndianJPsychiatry_273_16
PMID
:29085103
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1,524
162
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Bringing worldly experiences back home for the progress of youngsters like me!
Supriya Agarwal
July-September 2017, 59(3):397-398
DOI
:10.4103/psychiatry.IndianJPsychiatry_131_17
PMID
:29085111
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1,578
97
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Response to questionable usefulness of the everyday abilities scale of India to screen for dementia
Sunil Kumar Raina, Vishav Chander, Sujeet Raina, Dinesh Kumar
July-September 2017, 59(3):396-397
DOI
:10.4103/psychiatry.IndianJPsychiatry_184_17
PMID
:29085110
[FULL TEXT]
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1,537
100
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Treatment compliance and noncompliance in psychosis: Methodological issues
Ekta Franscina Pinto, Swapnajeet Sahoo, Deepanjali Deshmukh, Naresh Vadlamani, Isha Dhingra, Sagar Karia, Chittaranjan Andrade
July-September 2017, 59(3):401-402
DOI
:10.4103/psychiatry.IndianJPsychiatry_343_17
PMID
:29085115
[FULL TEXT]
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1,444
127
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© 2006 - Indian Journal Psychiatry | Published by Wolters Kluwer -
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th
April, 2007