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   2021| January-February  | Volume 63 | Issue 1  
    Online since February 15, 2021

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Mental Health Matters: Celebrating 1st foundation day of Indian psychiatric society
Savita Malhotra, Koushik Sinha Deb, Pronob Kumar Dalal
January-February 2021, 63(1):1-4
  2,362 166 -
Qualitative research methods in psychiatry in India: Landscaping the terrain
Pranab Mahapatra, Krushna Chandra Sahoo, Pritam Jitendriya, Mousumi Samal, Sanghamitra Pati
January-February 2021, 63(1):5-14
Background: Qualitative research methods (QRMs) bear a critical role in psychiatry as they explore the phenomenology of psychiatric illness and its sociocultural dimensions. However, there is limited evidence regarding its use in psychiatric research in India. Aim: This study, under the aegis of mapping qualitative health research in India initiative, attempted to landscape the use of QRMs in psychiatry and elicited expert opinion on its potential, perceived quality, and scope for improvement. Materials and Methods: We reviewed studies using qualitative methodology published in the Indian Journal of Psychiatry (IJP) and the abstracts presented at the Annual Conference of the Indian Psychiatric Society (ANCIPS) between 2010 and 2019. Titles and abstracts were screened and shortlisted; full-text articles were checked to identify the relevant ones. In addition, ten experts comprising psychiatry journal reviewers, editors, and conference scientific committee members were interviewed to elicit their views and suggestions. Results: Out of 356 papers published in IJP between 2010 and 2019, only 12 papers used QRMs: five qualitative and seven mixed methods. Out of 2297 abstracts published between 2010 and 2019 in ANCIPS, only 28 had used QRMs, consisting of 20 qualitative and eight mixed methods. The findings reveal that qualitative research is still an understudied domain in Indian psychiatry with a substantial need for rigor and quality. Conclusions: To catalyze the use of qualitative research in Indian psychiatry, continuing medical education programs through workshops or webinar mode need to be imparted. These trainings should aim at building skills on qualitative study design, data collection, analysis, and writing.
  2,006 319 -
Addiction-like behavior associated with social media usage in undergraduate students of a government medical college in Delhi, India
Saurav Basu, Ragini Sharma, Pragya Sharma, Nandini Sharma
January-February 2021, 63(1):35-40
Background: Excessive use of social media is increasingly being recognized as a source of technological addiction in young people globally. Objective: The aim of this study is to assess social media addiction in medical students using a self-designed questionnaire. Materials and Methods: We collected data from undergraduate medical students (MBBS) in Delhi, India using a self-administered 20-item social media addiction questionnaire (SMAQ) to measure addiction-like behavior, and the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. Results: We enrolled 264 (62.3%) male and 160 (37.7%) female participants of mean (standard deviation) age 19.83 (1.6) years. The Cronbach's alpha of the SMAQ was 0.879. A principal component analysis revealed a 4-component SMAQ structure based on eigenvalue cutoff (>1), loading score >0.3, and inspection of the Scree-plot that explained 54.7% of the total variance. We observed strong loadings of impaired control items on Component 1, decreased alternate pleasure items on Component 2, intense desire items on Component 3, and harmful use items on Component 4. The mean SMAQ score was significantly higher in the students reporting poor sleep quality and older students. Conclusion: The SMAQ has acceptable psychometric properties, with higher scores associated with sleep deprivation. A majority of students were unable to reduce their time spent on social media despite wanting to do so, signifying the presence of tolerance and impaired control.
  1,540 251 -
Telemedicine practice guidelines of India, 2020: Implications and challenges
Damodharan Dinakaran, Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math
January-February 2021, 63(1):97-101
Telemedicine Guidelines of India, 2020 promises to pave a road map for regularization and diversification of teleconsultation services across the country. This guideline is the need of the hour, especially during the current coronavirus disease pandemic. All modes of communications (text, audio, video, etc.) between the service provider and user are included in the broad rubric of the guidelines. Scope, inclusions, exclusions, and restrictions are clearly specified in the guideline. Medications are grouped and listed for the specific type of consultation, and restricted drugs are notified. This guideline especially helps mitigate the gaps in legislation and reduces the uncertainty while providing a practical, safe, and cost-effective framework to improve healthcare service delivery in this article; the authors discuss the implications of this new guideline and the challenges during the implementation of teleconsultation services across the country.
  1,169 143 -
Development and validation of Vellore Inventory of Life Skills among people with severe mental illness
Meghana C Chandran, Febin Saji, Reema Samuel, KS Jacob
January-February 2021, 63(1):15-27
Background and Aim: Rehabilitation for people with severe mental illness is incomplete without life skills assessment and intervention. The aim of the study was develop a culturally specific performance-based measure assessing life skills of patients with severe mental illness. Materials and Methods: The items for the Vellore Inventory of Life Skills (VILS) were drawn after consultation with a reference group and from existing standardized scales. The items were categorized into two sections with six components each, which was further hierarchically arranged into activities at either basic, intermediate, or advanced level. One hundred consecutive clients between 18 and 60 years of age who provided written informed consent were assessed on the Comprehensive Evaluation of Basic Living Skills (CEBLS) and the VILS to evaluate convergent validity and inter-rater reliability. The General Health Questionnaire (GHQ-12) was used to evaluate divergent validity. The assessments were repeated after a week to evaluate test–retest reliability. Results: The scale had good inter-rater reliability 0.938 (95% confidence interval [CI] 0.887–0.967) and test–retest reliability 0.907 (95% CI 0.865–0.937). The correlation between total score of VILS and CEBLS (Pearson's correlation coefficient [PCC] = 0.611; P = 0.001) suggested moderate convergent validity. The correlation between total score of VILS and GHQ-12 (PCC = −0.260; P = 0.105) implied good divergent validity. Conclusion: Preliminary data suggest that the VILS is clinically useful for the Indian population.
  1,017 195 -
Does academic streams influence alcohol use in colleges?
Priya G Menon, Abel Thamby, KP Jayaprakashan, Anjana Rani, B Sivasankaran Nair, K Thennarasu, TS Jaisoorya
January-February 2021, 63(1):28-34
Background: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. Aims: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. Settings and Design: This is a cross-sectional survey conducted among college students. Materials and Methods: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. Statiscal Analysis: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. Results: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing “other” stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. Conclusion: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.
  934 231 -
Validation of revised reading the mind in the eyes test in the Indian (Bengali) population: A preliminary study
Madhushree Chakrabarty, Gargi Dasgupta, Rudraprasad Acharya, Seshadri Sekhar Chatterjee, Prathama Guha, Matthew K Belmonte, Kaberi Bhattacharya
January-February 2021, 63(1):74-79
Background: Social cognition deficits are common in clinical populations but there is a dearth of standardized social cognition assessment tools in India. Theory of mind (ToM) is an important aspect of social cognition which is often assessed with the revised reading the mind in eyes test (RMET-R). However, we do not have a statistically validated version of the test for the Indian population. Aim: This study aims to assess the acceptability, reliability, and validity of the Bengali version of the RMET-R. Materials and Methods: We administered the RMET-R to 23 patients with chronic schizophrenia (SCZ), 22 patients with bipolar disorder, and 104 healthy controls (HCs) to evaluate the reliability and validity of the instrument in the Indian (Bengali) population. Results: We obtained moderate internal consistency (Cronbach's alpha = 0.6) and test-retest reliability (intraclass correlation coefficient = 0.64, P < 0.001). Positive correlations were found between RMET-R and Wechsler picture arrangement (r = 0.60, P < 0.001), picture completion (r = 0.54, P < 0.001), and comprehension subtests (r = 0.48, P < 0.001). Patients with SCZ (M = 49.7, standard deviation [SD] = 16.5) scored significantly lower than HCs (M = 68.9, SD = 13.8) (P = 0.008; Cohen's d = 1.3) on the RMET-R. Thus this tool could discriminate patients who are reported to have Theory of Mind deficits from healthy controls. Conclusion: The Bengali version of the RMET-R is a reliable and valid tool for assessing first-order ToM insofar as the original RMET-R measures this construct.
  1,060 94 -
Adverse effects and short-term developmental outcomes of infants exposed to atypical antipsychotics during breastfeeding
Santosh Kumar Sinha, M Thomas Kishore, Harish Thippeswamy, John Vijay Sagar Kommu, Prabha S Chandra
January-February 2021, 63(1):52-57
Background: Postpartum period in women is vulnerable to the occurrence and exacerbation of psychiatric disorders. Mothers with postpartum psychosis or bipolar disorder need treatment with psychotropic medications, especially atypical antipsychotics. However, many mothers and families will have reservations about the use of psychotropics during the perinatal period, particularly during breastfeeding because of its presumed side effects and adverse developmental outcomes of the child. Since there are limited data in this area, the present study aimed to examine the adverse effects, if any, and the short-term developmental outcome of infants exposed to atypical antipsychotics during breastfeeding. Methods: The study involved infants of postpartum women (n = 28) who were admitted in the mother and baby inpatient psychiatry unit of a tertiary care center in India. The medication side effects were checked every alternate day for 1–2 weeks using a checklist based on common side effects that infants may experience due to lactation exposure of atypical antipsychotics. Developmental assessments of the infants were done using the Developmental Assessment Scales for Indian Infants and through anthropometric measurements such as weight, length, head circumference, and chest circumference in follow-up when they came as an outpatient after 1–3 month interval. Results: The occurrence of adverse side effects was quite low (17.85%). The main side effects directly attributable to atypical antipsychotics were constipation and sedation. Of the 17 infants who attended follow-up, 52.9% (n = 9) showed some form of developmental delay at the time of the first follow-up. However, low birth weight, higher maternal age (>35 years), and exposure to medications (quetiapine and phenytoin) during pregnancy may be confounding risk factors. Conclusions: The acute adverse effects of atypical antipsychotics such as sedation and constipation in the infant through breast milk were seen in less than a fourth of the sample. Developmental delay was noted in a proportion of infants; however, this may be due to other risk factors.
  940 198 -
Parenting skills of patients with chronic schizophrenia
Anjumoni Rabha, Susanta Kumar Padhy, Sandeep Grover
January-February 2021, 63(1):58-65
Aim of the Study: This study aims to evaluate the parenting skills of patients with schizophrenia as perceived by themselves and their children and compare the same with a matched healthy control group of parents and their children. Materials and Methods: Fifty-one patients with schizophrenia and their 51 children were assessed on the Alabama Parenting Scale. A healthy control group of 51 parents and their children were also assessed for parenting. Results: The mean age of parents with schizophrenia was 45.23 years. Compared to the parents in the healthy control group, patients with schizophrenia reported deficits in the domains of positive involvement, positive parenting; more often report poor monitoring/supervision, and inconsistent discipline. When the children of patients with schizophrenia and children of healthy parents were compared, children of healthy control parents reported higher positive involvement, positive parenting; and lower corporal punishment and inconsistent discipline. Except for few associations, parenting was not affected by demographic and clinical profile of the patients with schizophrenia. Conclusion: The present study suggests that patients with schizophrenia have deficits in parenting and there is a need to improve the parenting skills of the patients with schizophrenia.
  872 143 -
Factors associated with dropout from treatment: An exploratory study
Sandeep Grover, Sridhar Mallnaik, Subho Chakrabarti, Aseem Mehra
January-February 2021, 63(1):41-51
Aim: To evaluate the factors associated with treatment dropout among patients attending the psychiatric outpatient services. Materials and Methods: Seventy-two patients who dropped out from treatment were contacted and they were compared with 200 regular attendees for sociodemographic and clinical variables, medication adherence, treatment satisfaction, attitude toward medication, insight, and therapeutic alliance. Results: Compared to “regular attendees,” those who dropped out from treatment were significantly older, were more likely to be married, had higher age of onset, had longer duration of illness, received less supervision for medication at home, higher proportion of them continued to remain symptomatic, had more negative attitude toward medications, had poorer insight, were poorly complaint with medication, were less satisfied with the treatment provided, and had poor quality of therapeutic alliance. Conclusion: This study suggests that dropout from treatment can be avoided by addressing issues of negative attitude toward medications, improving satisfaction with the treatment contact and enhancing therapeutic alliance.
  738 140 -
Angioedema in a patient with COVID-19 who received depot olanzapine pamoate: Diagnostic dilemma posed
Rajeev Ranjan, Santanu Nath, Chayan Kanti Manna, Gabby Sethi, Pankaj Kumar
January-February 2021, 63(1):115-116
  707 46 -
Dissociative experiences and health anxiety in panic disorder
Sujoy Ray, Rajashree Ray, Neha Singh, Imon Paul
January-February 2021, 63(1):70-73
Background: Dissociative experiences and health anxiety are frequently encountered in anxiety disorders and contribute to the burden of illness. Aim: The aim was to assess and compare dissociative experiences and level of health anxiety in patients with panic disorder and normal individuals. Materials and Methods: We recruited forty eligible patients with panic disorder and forty healthy volunteers without any psychiatric diagnoses. Health anxiety was evaluated by the Short Health Anxiety Inventory and dissociative symptoms were assessed by the Dissociative Experiences Scale (DES). Results: Dissociative experiences were more frequently reported by patients with panic disorder compared to normal controls, but overall mean DES scores were lower in both groups compared to previous literature. A high level of health anxiety was also seen in panic disorder compared to normal individuals. Conclusion: Health anxiety and dissociative experiences, especially depersonalization-derealization, are commonly encountered in panic disorder and should be actively explored to understand how they influence psychopathology and treatment outcome.
  668 74 -
Lunatic asylums: A business of profit during the colonial empire in India
RC Jiloha
January-February 2021, 63(1):84-87
The knowledge about “maladies of the mind” was in the early stages of development and far from being considered as medical conditions till the mid-19th century. Around this period, the British began to establish “Native-Only” lunatic asylums in India, particularly in the Bengal Presidency of their colonial empire. These institutions were primarily meant to provide custodial care and to rehabilitate those creating nuisance, particularly the wanderers and vagrants. However, these facilities turned into forced labor houses producing goods for the British Empire in the name of treatment. As traders, the British amassed India's wealth in several ways, and the establishment of lunatic asylums for the natives was one of the profit-making businesses. Undercover of Victorian morality, the reports of medical treatment had evolved into profit margin data. This article explores some of the obscure facts of British colonial rule in regards to mental health.
  586 88 -
School mental health program in India: Need to shift from a piecemeal approach to a long-term comprehensive approach with strong intersectoral coordination
Devvarta Kumar
January-February 2021, 63(1):91-96
School mental health program (SMHP) has been recognized worldwide as key to improve the mental health and wellbeing of school going children. Unfortunately, in India, SMHP is badly neglected. There is no comprehensive SMHP that covers all school children (from rural and urban areas) across the country. A few sporadic activities that occur are praiseworthy; however, they lack a long-term approach. Major reasons for such neglect of SMHP in India could be lack of a steering body, poor intersectoral coordination, and minimal stakeholders' involvement. India, as any other country, needs to implement countrywide SMHP on the model of mental health promotion, prevention, and early intervention (PPEI). This paper outlines the deplorable state of SMHP in India and the needed steps to implement an effective countrywide SMHP on the PPEI model.
  582 75 -
Video consultations from tele aftercare clinic: An early experience from an Indian geriatric psychiatry service
Shiva Shanker Reddy Mukku, Narayana Manjunatha, Channaveerachari Naveen Kumar, Palanimuthu T Sivakumar, Suresh Bada Math
January-February 2021, 63(1):102-103
  593 49 -
Gandhian thought and mental health – A critique
Smriti Mahajan, Suman Mahajan
January-February 2021, 63(1):88-90
The entire gamut of psychiatric literature heavily references notions derived from western impressions. For many concepts, however, one need not go that far. The roots for various concepts, when examined closely, can be found in Gandhian thought and philosophy. Apart from his precious kernels in the fields of diet, sanitation and exercise; there are concepts in psychology, mental well-being and psychotherapy which seem like allusions to Gandhian principles. Nevertheless, to state that all his ideas hold true would be overzealous. His concepts of sexuality would not find favour with the modern mental health professional. The trick probably would be to see Gandhi in a more human light rather than the superhuman divinity that has been associated with him. This would allow us to better incorporate his principles in everyday life of regular individuals.
  560 78 -
Susceptibility of clinically depressed patients to COVID-19: Is there a link?
Abhishek Das, Ankit Halder, Rajendra S Patil, Devavrat G Harshe
January-February 2021, 63(1):112-113
  548 49 -
Memory changes following adjuvant temporo-parietal repetitive transcranial magnetic stimulation in schizophrenia
Preeti Gupta, Anamika Sahu, Surjit Prasad, Vinod Kumar Sinha, Ajay Kumar Bakhla
January-February 2021, 63(1):66-69
Objective: The use of repetitive transcranial magnetic stimulation (rTMS) in schizophrenia has shown improvement as well as deficits in memory. Though most studies had focused on dorsolateral prefrontal cortex only, but impact of rTMS on cognitive functions remain inconclusive. The need of the study is to assess the impact of rTMS on memory in schizophrenia. Materials and Methods: Forty right-handed male patients with schizophrenia were included by purposive sampling and rated on Positive and Negative Syndrome Scale (PANSS) before starting the rTMS treatment with the experimental group. Low frequency 1 Hz rTMS including 1200 stimulations were given over temporo-parietal cortex for 20 min as add on to medications. At the end of 10 session treatment (5 days a week for 2 weeks), the patients were re-evaluated. Results: A total of 39 patients (20 for experimental group and 19 for control group) with mean age of 29.70 ± 9.05 and 31.26 ± 7.78 years, respectively, shows significant difference to pre- and post-treatment mean PANSS score in positive, negative and general psychopathology domains. The pre- and post-treatment mean Postgraduate Institute Memory Scale Scores with multivariate repeated measures analysis of variance revealed significant improvements in all memory domains (P < 0.01) except remote memory in both experimental and control groups. Conclusion: RTMS in combination with antipsychotics has shown improvement in psychopathology in patients of schizophrenia without any deterioration of memory.
  534 60 -
An adolescent with anorexia nervosa presenting with catatonia
Ram Kumar Solanki, Shashi Kant Khanna, Gunjan Solanki, Kuldeep Singh Yadav, Rishika Agarwal, Manish Kumar Goyal
January-February 2021, 63(1):116-117
  534 56 -
Sociodemographic and clinical profile of drug treatment seekers attending the State Psychiatric Hospital and Drug De.addiction Center at Agartala, Tripura
Udayan Majumder, Joysree Das, Swapan Chandra Barman, Jyotirmoy Ghosh, Bimal Krishna Bhowmic
January-February 2021, 63(1):80-83
Background: Substance use disorders have become a widespread public health problem, especially in the northeastern states, and limited studies have been undertaken to reflect the picture of the same. Aims: The aim of the study was to study the sociodemographic and clinical profile of drug treatment seekers attending a State Psychiatric Hospital and De-addiction Center of Northeastern India. Materials and Methods: It was a cross-sectional hospital-based study conducted from October 2018 to August 2019. Two hundred and ten consecutive treatment-seeking patients, fulfilling inclusion and exclusion criteria and diagnosed with the International Classification of Diseases version 10 for substance dependence, were included in the study. Results: Most common abused drug was opioids (42.9%), followed by alcohol (14.3%), whereas 29.0% were people who inject drugs. Peer pressure in 55.2% and curiosity in 32.9% were reported to be the most common causes for initiating substances. Hepatitis C was the most common (52.4%) comorbidity related to intravenous drug users. Conclusions: Results of the current study will definitely encourage further large-scale community-level studies to assess the prevalence of substance abuse in the state as well as in drug policymaking.
  522 64 -
Medical school stressors – What about the health of our students?
Reem Salman, Neha Sadik
January-February 2021, 63(1):113-114
  532 45 -
Miller Fischer syndrome? A harbinger of obsessive compulsive disorder - A case report
P Liji, Keya Das
January-February 2021, 63(1):109-110
  507 49 -
Ganser syndrome: Intricacy in diagnosis and management
Ajeet Sidana, Sumeesha Jaswal
January-February 2021, 63(1):103-104
  476 64 -
Craniopharyngioma mimicking bipolar disorder with rapidly progressive functional decline
Chian-Feng Huang, Chen-Yu Kuo, Shin-Chiao Tien
January-February 2021, 63(1):104-106
  490 44 -
Chronic subdural hematoma presenting as reversible Parkinson-like symptoms and bladder and bowel dysfunction in a patient with schizophrenia
Esira Sampath Wijamunige, Vajira Indika Dharmawardene
January-February 2021, 63(1):110-112
  422 39 -
Disulfiram-induced seizure in a patient with alcohol dependence syndrome
Manoj Kumar Sahoo, Harshita Biswas
January-February 2021, 63(1):107-109
  218 46 -
Sociocultural barriers in management of gender dysphoria: A case report
Milan Nathvani, Vijay Kumar Saini, Pratibha Gehlawat
January-February 2021, 63(1):106-107
  180 60 -