Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2020| May-June  | Volume 62 | Issue 3  
    Online since May 15, 2020

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Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study
Kaustav Chakraborty, Moumita Chatterjee
May-June 2020, 62(3):266-272
Background: COVID-19 pandemic poses a unique medical challenge to the humanity in recent times. The psychological impact of the pandemic itself and the lockdown in particular is likely to be huge. Aim: To assess the psychological impact of COVID-19 pandemic on general population in West Bengal. Materials and Methods: It was an online survey which was conducted using Google Forms with link sent using WhatsApp. A 38-item self-designed questionnaire was used for the study. The survey questionnaire would take around 5–7 min to complete. Total 507 responses were received by the stipulated time. Results: Near about five-seventh (71.8%) and one-fifth (24.7%) of the respondents felt more worried and depressed, respectively, in the past 2 weeks. Half of the respondents (52.1%) were preoccupied with the idea of contracting COVID-19 and one-fifth (21.1%) of the respondents were repeatedly thinking of getting themselves tested for the presence of COVID-19 despite having no symptoms. Majority (69.6%) of the respondents were worried about the financial loss they were incurring during the period of lockdown. One-fourth (25.6%) and one-third (30.8%) of the respondents found that COVID-19 pandemic had threatened their existence and they found it difficult to adjust to the new routine during 21-day lockdown period, respectively. Conclusion: The index survey suggested that worry and sleep disturbances were common among the respondents in the past 2 weeks. The pandemic threatened the existence of the respondents to a great extent and affected their mental status negatively.
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Attitude, practice, behavior, and mental health impact of COVID-19 on doctors
Seshadri Sekhar Chatterjee, Ranjan Bhattacharyya, Sumita Bhattacharyya, Sukanya Gupta, Soumitra Das, Bejoy Bikram Banerjee
May-June 2020, 62(3):257-265
Background: COVID-19, like every other pandemic, has imposed an unprecedented threat to doctors' physical and mental health. Literature in this area is sparse. The present study has been done to explore the knowledge, attitude, and behavior of doctors regarding this pandemic and how it influences their depression, anxiety, and stress level. Materials and Methods: This online survey has been done for 10 days. Data were collected on background characteristics, knowledge, attitude, and behavior of the respondents in a semi-structured pro forma, and psychiatric morbidity was measured by the Depression, Anxiety, and Stress Scale-21. A total of 152 complete responses have been received. The data were assessed using SPSS software. Results: Out of 152 study participants, 34.9% were depressed and 39.5% and 32.9% were having anxiety and stress, respectively. Significant predictors for psychiatric morbidities were experience in health sector, duty hours, use of protective measures, and altruistic coping. Multivariable logistic regression showed most of the factors to be significantly associated with depression, anxiety, and stress level. Discussion: Doctors who were working during COVID pandemic have a high prevalence of psychiatric morbidity. Age and having multiple comorbidities are significant predictive factors. Adequate protective measures should be warranted. Altruistic coping and a sense of greater goal are significant among the doctor community, in this pressing time. The doctors are pushing themselves to the best of their capacity and also protecting their patients' best interest. A large-scale, multicentric study will probably give a larger picture and will guide us for better service planning and delivery.
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COVID-19 pandemic-related anxiety in teenagers
Swapnajeet Sahoo, Seema Rani, Ruchita Shah, Ajay Pal Singh, Aseem Mehra, Sandeep Grover
May-June 2020, 62(3):328-330
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Mental health of migrant laborers in COVID-19 pandemic and lockdown: Challenges ahead
OP Singh
May-June 2020, 62(3):233-234
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Changing scenario of addiction psychiatry: Challenges and opportunities
PK Dalal
May-June 2020, 62(3):235-241
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COVID-19 and lockdown: Delayed effects on health
Chittaranjan Andrade
May-June 2020, 62(3):247-249
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A narrative review of suicide and suicidal behavior in medical students
Cameron Watson, Antonio Ventriglio, Dinesh Bhugra
May-June 2020, 62(3):250-256
Studies across different countries have consistently demonstrated high rates of several psychiatric disorders among medical students. These findings, in turn, may be correlated with the higher than expected rate of suicide in student doctors. We aimed to provide a narrative review of the literature concerning suicidality in medical students worldwide. A narrative review is not a systematic review. Using Pub Med, we identified articles including our defined search terms: ((suicide) OR self-harm) (attempted suicide, deliberate self-harm AND medical students) OR future doctors. Particular credence was given to review articles and original research conducted this decade. We find that medical student suicide is likely related to a number of social and environmental factors. Structural systems in medical schools may play a role, for example, curricula, accommodation, social support, and academic pressures. Interpersonal factors that may be implicated include social isolation, the competitive nature of learning, and being away from home at an early age. There may also be endemic factors unique to medical training, which may contribute to higher rates of depression and suicidality; these include simulation training, working with cadavers, and witnessing trauma throughout placements. The socio-cultural environment, for example, the role of ragging, expectations from teachers, and patients, may place extra pressure on vulnerable individuals. Rates have been shown to be higher among females, which raises further discussion on the nature of gender roles and gender role expectations within medicine. As the medical workforce of the future, today's students require a considerable emotional and financial investment. It is, therefore, crucial that educators and supervisors understand the needs of this student body while delivering the essential skills to be a doctor in a sensitive nonstigmatizing manner.
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Mental health of migrants
Meryam Schouler-Ocak, Marianne C Kastrup, Mrugesh Vaishnav, Afzal Javed
May-June 2020, 62(3):242-246
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Opioid substitution therapy with buprenorphine-naloxone during COVID-19 outbreak in India: Sharing our experience and interim standard operating procedure
Debasish Basu, Abhishek Ghosh, BN Subodh, SK Mattoo
May-June 2020, 62(3):322-326
Coronavirus disease 2019 (COVID-19) has been declared as a pandemic by the World Health Organization on March 11, 2020. It has affected most countries of the world, including India. Both the disease and the unavoidable national response to it have posed unique challenges to our health-care system. A particular vulnerable group of patients is those with opioid dependence maintained on opioid substitution therapy (OST). These patients are pharmacologically dependent on the OST medication (buprenorphine, buprenorphine-naloxone combination [BNX], and methadone) for their healthy functioning and recovery. COVID-19 outbreak, lock-down, and difficult access to medical care, all are likely to induce stress and withdrawal, which is a potential risk for relapse among individuals with opioid dependence, who are anyway more vulnerable due to social, housing, living, and medical conditions. In this context, it is essential to re-strategize the existing OST services to adapt to the challenging circumstances. In this communication, we share our experience and formulate interim standard operating procedures (SOPs) for running a hospital-based OST service utilizing take-home BNX. The challenges, principles to meet the challenges, and interim SOPs are shared as being currently practiced in our center. Individual institutes, agencies, hospitals, and clinics running OST service with BNX can adapt these SOPs according to their characteristics, needs, demand, and resources; so long as, the basic principles are adhered to.
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Alcohol-related self-harm due to COVID-19 pandemic: Might be an emerging crisis in the near future: A case report
Seema Rani, Swapnajeet Sahoo, Shaheena Parveen, Aseem Mehra, BN Subodh, Sandeep Grover
May-June 2020, 62(3):333-335
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Prevalence and clinical correlates of residual symptoms in remitted patients with bipolar disorder: An exploratory study
Sandeep Grover, Subho Chakrabarti, Swapnajeet Sahoo
May-June 2020, 62(3):295-305
Objective: This cross-sectional study aimed to evaluate the prevalence and factors associated with residual symptoms (both depressive and manic) in subjects with bipolar disorder (BD). Materials and Methods: A total of 844 subjects diagnosed BD with an illness of 2 years' duration and minimum of two lifetime episodes and in clinical remission were evaluated for residual symptoms using Hamilton Depression Rating Scale (HAM-D) and Young Mania Rating Scale (YMRS). Based on the severity of residual symptoms, the study groups were divided into four groups. Results: Sixty-nine percent of the subjects had residual depressive symptoms (i.e., HAM-D score in the range of 1–7) and 59% had residual manic symptoms (i.e., YMRS score in the range of 1–7). The most common residual depressive symptom was psychic anxiety (34%) followed by impaired insight (29%). The most common manic symptom was poor insight (31%) followed by sleep disturbances (25%). Subjects with both sets of residual symptoms had onset of BD at a relatively young age, when compared to those with only residual depressive symptoms. Presence of any comorbid physical illness and substance abuse disorder was significantly higher in those with both sets of residual symptoms. Conclusions: The present study suggests that a substantial proportion of patients with BD have residual symptoms of both types. Comorbid physical illness and substance use were associated with residual symptoms. Identification and management of residual symptoms are highly essential to improve the overall outcome of patients with BD.
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Nonadherence in bipolar disorder patients: A 14-year retrospective study
Dinesh Narayanan, Arya Jith, Rahul Bansal
May-June 2020, 62(3):290-294
Background: Bipolar disorder is a disabling psychiatric disorder. The existing literature suggests about 41% of patients to be nonadherent. Nonadherence leads to relapses, delay in recovery besides higher inpatient care cost as well as higher global cost of the disease. Nonadherence in bipolar affective disorder (BPAD) is a complex phenomenon, its critical determinants are yet to be identified with certainty. Aims: This study aims to assess the prevalence of nonadherence in BPAD and to delineate the factors associated with it. Methods: Medical records were reviewed in this study from 2005 to 2019 at a medical college in Kerala. Patients who were diagnosed with BPAD according to International Classification of Diseases 10 and who were needing or opting for prophylaxis were included. Patients who were not taking medications for at least 1 week were termed as nonadherent. We included 150 participants in our study. Results: To test the statistical significance of the association of categorical variables between H/O of adherence and nonadherence, Chi-square test was used. In the sample, 82.7% had at least 1 week of history of noncompliance in the past. The most common reason was poor understanding of illness by the family (56%) followed by a negative aspect of the patient toward the drug (20%). Conclusion: Therefore, this study concludes that though majority of the patients have a history of nonadherence of at least 1 week on long-term follow-up, it was seen that majority of the patients were more than 80% adherent to medications.
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Relationship between life skills, repetitive negative thinking, family function, and life satisfaction in attempted suicide
Dushad Ram, Amulya Koneru, Basawanna Gowdappa
May-June 2020, 62(3):283-289
Background: Impaired life skills, family dysfunction, negative thinking and low life satisfaction may predispose to suicidal behavior. There is paucity of study that examined these variables in suicide attempt. Aims: This study was conducted to know the levels and the relationships of these variables in attempted suicide. Settings and Design: Hospital-based cross-sectional. Materials and Methods: In this hospital-based cross-sectional study, 328 participants with a history of attempted suicide were assessed using socio-demographic and clinical pro forma, life skills profile (LSP), perseverative thinking questionnaire (PTQ), satisfaction with life scale (SLS), and family assessment device (FAD) after obtaining informed consent. Statistical Analysis: Descriptive statistics, Mann–Whitney U and Kruskal–Wallis-H test and regression analysis. Results: Results revealed a mean scores on PTQ, LSP, SLS, and FAD to be 29.93 (standard deviation [SD] =13.5), 21.32 (SD = 13.5), 15.71 (SD = 6.8), and 26.46 (SD = 4.57), respectively. In linear regression analysis (R2 = 0.815, df = 3, F = 475.715, P = 0.001), LSP score had a statistically significant positive association with PTQ score (beta = 0.861, t = 32.76, P = 0.001) and FAD score (beta = 0.068, t = 2.79, P = 0.0046); while negative association with SLS score (beta = −0.078, t = −2.92, P = 0.004). Conclusions: The study findings suggest of impaired life skills, life dissatisfaction, impaired family function, and elevated repetitive negative thinking pattern in attempted suicide. Better life skills have a positive association with higher life satisfaction, family function, and low repetitive thinking and thus seem to have a protective effect against suicidal behavior in the population.
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Problems in using WhatsApp groups for survey research
Shahul Ameen, Samir Kumar Praharaj
May-June 2020, 62(3):327-328
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Recurrent mass hysteria in schoolchildren in Western Nepal
Reet Poudel, Tapas Kumar Aich, Krishma Bhandary, Dipendra Thapa, Rajesh Giri
May-June 2020, 62(3):316-319
Aim: The aim was to study the clinical presentation and factors contributing to “recurrent mass hysteria” among rural schoolgoing children. Materials and Methods: A visit to a school in a remote hilly district of Puythan, Nepal, was carried out to assess students experiencing mass dissociative/conversion symptoms over a short period of time. There was a second incidence of “mass hysteria” on the day of visit. Regular follow-up of these students was done telephonically for the next 1 year. Results: The total number of child victim of “mass hysteria” was 47, with majority of them being girl students. Historically, at least two more attacks of “mass hysteria” were noted in the schoolchildren in the preceding years. Follow-up study revealed no further attacks of similar “mass attacks” over the following 1 year. Conclusion: Supporting, assuring, counseling, and educating these children, their parents and teachers and conducting public awareness programs are the mainstay of treatment of mass hysteria.
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Artificial intelligence-based classification of schizophrenia: A high density electroencephalographic and support vector machine study
Sai Krishna Tikka, Bikesh Kumar Singh, S Haque Nizamie, Shobit Garg, Sunandan Mandal, Kavita Thakur, Lokesh Kumar Singh
May-June 2020, 62(3):273-282
Background: Interview-based schizophrenia (SCZ) diagnostic methods are not completely valid. Moreover, SCZ-the disease entity is very heterogeneous. Supervised-Machine-Learning (sML) application of Artificial-Intelligence holds a tremendous promise in solving these issues. Aims: To sML-based discriminating validity of resting-state electroencephalographic (EEG) quantitative features in classifying SCZ from healthy and, positive (PS) and negative symptom (NS) subgroups, using a high-density recording. Settings and Design: Data collected at a tertiary care mental-health institute using a cross-sectional study design and analyzed at a premier Engineering Institute. Materials and Methods: Data of 38-SCZ patients and 20-healthy controls were retrieved. The positive-negative subgroup classification was done using Positive and Negative Syndrome Scale operational-criteria. EEG was recorded using 256-channel high-density equipment. Eight priori regions-of-interest were selected. Six-level wavelet decomposition and Kernel-Support Vector Machine (SVM) method were used for feature extraction and data classification. Statistical Analysis: Mann–Whitney test was used for comparison of machine learning-features. Accuracy, sensitivity, specificity, and area under receiver operating characteristics-curve were measured as discriminatory indices of classifications. Results: Accuracy of classifying SCZ from healthy and PS from NS SCZ, were 78.95% and 89.29%, respectively. While beta and gamma frequency related features most accurately classified SCZ from healthy controls, delta and theta frequency related features most accurately classified positive from negative SCZ. Inferior frontal gyrus features most accurately contributed to both the classificatory instances. Conclusions: SVM-based classification and sub-classification of SCZ using EEG data is optimal and might help in improving the “validity” and reducing the “heterogeneity” in the diagnosis of SCZ. These results might only be generalized to acute and moderately ill male SCZ patients.
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Coronavirus disease 2019 pandemic: Time to optimize the potential of telepsychiatric aftercare clinic to ensure the continuity of care
Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math
May-June 2020, 62(3):320-321
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Factor structure and internal consistency of Oriya version of Edinburgh Postnatal Depression Scale
Late Krishna Priyambada, Ajay Kumar Bakhla, Amrit Pattojoshi
May-June 2020, 62(3):312-315
Background: “Edinburgh Postnatal Depression Scale” (EPDS) is a widely used screening instrument for assessing peripartal depression. To utilize it for Oriya-speaking population, we translated the scale and studied its internal consistency and factor structure. Materials and Methods: Consenting Oriya-speaking pregnant women attending antenatal checkup during second or third trimester were administered the translated EPDS. Internal consistency analysis (Cronbach's alpha and item-total correlation) and exploratory factor analysis (principal component analysis) with varimax rotation were carried out to identify factor structure. Results: The Cronbach's alpha coefficient for the scale was found to be 0.81, whereas principal component analysis revealed a three-factor solution that accounted for 87.61% of the total variance. The factors included “cognitive depression,” “somatic depression,” and “anxiety factor,” with a percentage of variance being 41.18%, 28.09%, and 18.33%, respectively. Conclusion: The translated Oriya EPDS is a reliable scale with adequate internal consistency and three-dimensional factor structures.
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Assessment of quality of sleep and its association with body mass index among medical consultants working in a medical college in northern India
Manish Bathla, Anshu Goyal, Shazia Anjum, Leezu Bhusri, Angad Harshbir Singh, Parul Gupta
May-June 2020, 62(3):306-311
Background: Medical specialist/consultants are exposed to various factors such as long duty hours, call duties, academics, meetings and regulation of departmental work which has adversely affected their sleep quality. Objective: To assess sleep quality and association of body mass index with quality of sleep among medical consultants working in medical college. Method and Tool: This is a cross-sectional study and was done by convenient sampling technique. Pittsburg Sleep Quality Index (PSQI) was used as the assessment tool which categorizes sleep as good or poor according to the score. Chi-square test was applied to establish an association with the variables. Results: A total of 67 responses were obtained, of which 28 showed good sleep on PSQI. Among consultants having good quality sleep, the majority were females (n=18); aged above 40 years (n=17). No relationship was seen with BMI and chronic disease. Consultants spending more than 85% of the time in bed sleeping (p < 0.006) and those going to bed before 10.30 pm (p < 0.026) had good sleep quality. Conclusion: Good quality of sleep was observed in females, people above 40 years and those who don't have any chronic disease, though this association of sleep quality with the factors was not significant. Going to bed early (before 10:30 pm) had a positive effect on sleep quality (p < 0.026). In general, poor sleep quality was seen among medical consultants.
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The psychology behind response of people in wake of the COVID-19 pandemic in India
Pritha Roy
May-June 2020, 62(3):330-331
  1,187 345 -
Rare tumor – insulinoma mimicking dissociative disorder
Supriya Agarwal, Kaveri Saxena, Abhinav Dhami
May-June 2020, 62(3):331-332
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Temple-healing in South India
Rajiv Radhakrishnan
May-June 2020, 62(3):335-336
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