Indian Journal of PsychiatryIndian Journal of Psychiatry
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   2021| May-June  | Volume 63 | Issue 3  
    Online since June 17, 2021

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Suicide among Indian doctors
M Kishor, Suhas Chandran, HR Vinay, Dushad Ram
May-June 2021, 63(3):279-284
Background: India has one of the largest numbers of doctors in the world. It is estimated that more than 1 million doctors are in India. Every year more than 80,000 medical students graduate as doctors from 529 medical colleges in India. Medical profession is considered as more stressful, but mental health is still a subject of taboo in medical profession in Indian context. Doctors have higher suicide risk, 2.5 times more than the general population. In the United Kingdom, 430 doctors committed suicide between the years 2011 and 2015. Even though suicide among doctors is reported in Indian media, there is hardly any scientific study that has looked into the suicide among Indian doctors because of many hurdles in the collection of information. Materials and Methods: All the Indian newspaper that are published in English and are available in the online platform were scrutinized on doctors suicide report from the year 2016 March to 2019 March. Results: Thirty suicides were reported between 2016 March and 2019 March, out of which 18 were female and 12 male. More than 80% were younger than 40 years. Twenty-two were from medical education institutions. Seventeen were from south India and 13 from North India. Eight were MBBS students and ten were postgraduate students. Among subspecialties, six doctors were from Anesthesia. Seventeen used hanging as a method for suicide, eight used medications, and five jumped from building to end life. Nineteen of suicide reports about doctors mentioned that they were depressed. Conclusion: Suicide among Indian doctors is concern. Majority are young undergraduate and postgraduate medical students. Female doctors were more than male doctors. Most doctors were reported to be depressed and used lethal method such as hanging and medications.
  5 2,183 189
Psychological distress among survivors of moderate-to-critical COVID-19 illness: A multicentric prospective cross-sectional study
Javaria Imran, Prashant Nasa, Leny Alexander, Surjya Upadhyay, Veena Alanduru
May-June 2021, 63(3):285-289
Purpose: Coronavirus disease-2019 (COVID-19) is predicted to have long-term sequelae on the physical and mental health of survivors. We aim to calculate the prevalence of psychological distress in moderate-to-critical survivors of COVID-19. Materials and Methods: The patients discharged from the hospital after moderate-to-critical COVID-19 were interviewed using e-mail at 30 and 60 days for anxiety, depression, and posttraumatic stress disorder (PTSD) using Generalized Anxiety Disorder-7, Patient Health Questionnaire-9, and PTSD Check List-5 questionnaire, respectively. Results: In 103 patients (96% were immigrant workers), the prevalence rate of clinically significant anxiety, depression, and PTSD was 21.4%, 12.7%, and 8.7% at day 30 and 9.5%, 7.1%, and 4.7% at day 60, respectively. There was significantly higher anxiety in patients of Indian nationality and depression with preexisting chronic illness. Conclusion: There is a high prevalence rate of clinically significant psychological distress among COVID-19 survivors, and we propose a formal psychiatric assessment and long-term follow-up.
  4 2,370 236
COVID-19 and manifest psychological morbidity: A case series
Parmod Kumar, Shubham Kamal, Shubhangi Tuli, Nitin Gupta
May-June 2021, 63(3):294-296
The COVID-19 pandemic in India has been reported to be associated with numerous major mental health issues globally; the most common is – stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear. This case series presents three different cases, wherein the COVID-19 pandemic resulted not only in deterioration of previous symptoms experienced by patients (obsessive–compulsive disorder and depression) but also led to the development of new symptoms specifically related to coronavirus (Psychosis). Authors highlight the need to develop preventive strategies for vulnerable groups and try to understand the etiopathogenesis of illnesses so developing, in order to identify support systems and management strategies during the pandemicrelated crisis.
  4 2,376 182
Evaluation of Psychological Impact of COVID-19 on Health-Care Workers
Sandeep Grover, Aseem Mehra, Swapnajeet Sahoo, Ajit Avasthi, TS Sathyanarayana Rao, Mrugesh Vaishnav, PK Dalal, Gautam Saha, Om Prakash Singh, Kaustav Chakraborty, YC Janardran Reddy, Naren P Rao, Adarsh Tripathi, Rakesh K Chadda, KK Mishra, G Prasad Rao, Vinay Kumar, Shiv Gautam, Siddharth Sarkar, Vijay Krishnan, Alka Subramanyam
May-June 2021, 63(3):222-227
Aim: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. Materials and Methods: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). Results: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (<30 years). Higher prevalence of depression and anxiety disorder was seen in younger (<30 years) age group, being a doctor (compared to paramedics). In addition, higher prevalence of depression was seen in those who were directly involved in the care of patients with COVID-19 infection. Conclusion: About half of the HCWs are suffering from psychiatric morbidity, specifically anxiety, in the wake of the COVID-19 pandemic. There is a need to assess all the HCWs for psychiatric morbidity and provide them with psychological support.
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Is there a case for inclusion of medicines used to manage alcohol use disorder in the World Health Organization Model List of Essential Medicines?
Yatan Pal Singh Balhara, Jatin Tarwani
May-June 2021, 63(3):297-298
  2 1,762 72
Short-term outcome of mothers with severe mental illness admitted to a mother baby unit
Vishwas Yadawad, Sundarnag Ganjekar, Harish Thippeswamy, Prabha S Chandra, Geetha Desai
May-June 2021, 63(3):245-249
Background: Mother baby psychiatry units (MBUs) are the expected standard of inpatient care internationally for postpartum mothers with severe mental illness (SMI) and favorable outcomes for mother infant dyads have been reported from these services. However, there are very few such units in low- and middle-income countries. The current study aimed to assess the short-term outcome of mothers in SMI admitted to an MBU in India. Materials and Methods: Mother infant dyads admitted over a year in the MBU were assessed in detail at admission, discharge, and at 3 months. Tools used included the Brief Psychiatric Rating Scale (BPRS), Young's Mania Rating Scale, Edinburgh Postnatal Depression Scale, and Clinical Global Impression. Mother infant interaction was assessed using the NIMHANS maternal behavior scale. Results: The mean age of the 43 mothers admitted in this period was 27.3 ± 6.2 years. For 27 (62.8%) mothers, this was a first episode of psychosis. Affective disorders and acute psychotic disorders were the most common diagnoses. The average duration of stay in the MBU was 25 days. While all mothers showed significant improvement at discharge, mothers with a first episode in the postpartum had higher BPRS scores (Ws = 309.5, P = 0.02) as compared to the others. At 3 months following discharge, all mothers sustained the improvement achieved. Discussion: Mothers with SMI admitted to an MBU showed significant clinical and dyadic improvement at discharge which was sustained at 3 months. However, the lack of a control group limits the generalizability of the current findings. Conclusion: The study highlighted a favorable short-term outcome among mothers with SMI admitted to a MBU facility.
  2 2,030 161
Comparison of religiosity and spirituality in patients of depression with and without suicidal attempts
Devakshi Dua, Susanta Padhy, Sandeep Grover
May-June 2021, 63(3):258-269
Aim: This study is aimed to compare the religiosity and spirituality of patients with first-episode depression with suicidal ideation and those with recent suicidal attempts. Additional aim was compare the religiosity and spirituality of patients with first-episode depression with healthy controls. Methods: Patients of first episode depression with suicidal ideation and healthy controls were assessed by Centrality of Religiosity Scale (CRS), Duke University Religion Index (DUREL), Brief Religious coping scale (R-COPE), and Spiritual Attitude Inventory (SAI). Results: Patients with depression were divided into two groups based on the presence (n = 53) or absence (n = 62) of suicidal attempts in the previous 14 days. Both the patients with and without suicide attempts were matched for depression severity. Both the patient groups did not differ in terms of religiosity and spirituality as assessed using CRS and SAI. Both depression groups had lower scores on religiosity as compared to healthy controls as assessed on CRS. The two groups also had a lower score on the “sense of hope” which is a part of SAI, when compared to healthy controls. Compared to patients without suicide attempts (i.e., ideators group) and healthy controls, subjects with suicide attempts more often used negative religious coping. Total numbers of lifetime suicide attempts in the attempt group were associated with the ideology domain of the CRS. Conclusion: Compared with healthy controls, patients with depression have lower levels of religiosity and spirituality. In the presence of comparable severity of depression, higher use of negative religious coping is associated with suicide attempts.
  2 2,354 235
Catatonia associated with seizures due to parietal cavernoma
Aditya Somani, Ashish Sharma, Nitin Goyal, Manish Gulia
May-June 2021, 63(3):309-311
  1 1,838 85
Risperidone-induced thrombocytopenia in a case of psychosis and neuroendocrine tumor: A case report
Sachin Kumar Saxena, Arun Kumar Dwivedi, Anurag Timothy, Raghunandan Mani, Surender Sharma, Sumit Sharma, Sweta Ratna
May-June 2021, 63(3):311-312
  1 1,742 84
Alcohol consumption during pregnancy among tribal women in India: Need for a concerted action
Pranab Mahapatra, Sanghamitra Pati, Krushna Chandra Sahoo
May-June 2021, 63(3):312-313
  1 1,836 94
Partially empty sella with generalized epileptiform discharges presented as manic episode in an elderly female: A case with diagnostic dilemma – Causation or coincidence?
Nileswar Das, Kritika Agarwal, Shiv Prashad
May-June 2021, 63(3):298-300
  1 1,796 74
Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state
Deeksha Arora, C Xavier Belsiyal, Vikram Singh Rawat
May-June 2021, 63(3):250-257
Background: Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected. Aim: The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs. Materials and Methods: An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann–Whitney, Kruskal–Wallis, and binary logistic regression). Results: The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92–3.06), loss of valuables (OR = 2.62; 95% CI = 0.78–9.04), self-blame (OR = 6.06; 95% CI = 1.15–31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89–46.85) acted as determinants in the occurrence of PTSD and depression. Conclusion: A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.
  1 2,252 170
Development of psychiatry curriculum as a major subject during MBBS in India
Vishal Dhiman, Vijay Krishnan, Aniruddha Basu, Anindya Das, Jitendra Rohilla, Vikram Singh Rawat, Anil Nishchal, Malay Dave, Ram Kumar Solanki, Sreeja Sahadevan, Arghya Pal, Shobit Garg, Sai Krishna Tikka, Mohan Dhyani, Priyaranjan Avinash, Manoj Gupta, Ravi Kant, Ravi Gupta
May-June 2021, 63(3):290-293
  1 2,428 102
Perceived stress, marital satisfaction, and sexual satisfaction in spouses of males having bipolar disorder with and without alcohol use disorder: A cross-sectional study
Sanchari Mukhopadhyay, Sneha Sharma, Apala Aggarwal, Dinesh Kataria
May-June 2021, 63(3):270-273
Background: Bipolar affective disorder (BPAD) and alcohol use disorder (AUD) are frequently comorbid and affect the social, occupational, and personal domains of patients and their spouses. Aim: This cross-sectional study was conducted to assess and compare the levels of stress, marital satisfaction, and sexual satisfaction between the spouses of males with BPAD + AUD and of those without AUD. Materials and Methods: Spouses of 100 males with diagnosed BPAD, currently in remission, including fifty patients having comorbid AUD, were recruited as participants. Participants were assessed with Perceived Stress Scale-10, Dyadic Adjustment Scale, and Sexuality Scale. Statistical Analysis: Descriptive statistics, Chi-square, t-test, analysis of variance, and correlation on SPSS were used for statistical analysis. Results: More stress (59%), poorer marital (53%) and sexual satisfaction (89%) were found in the majority participants, with significantly higher stress in the group with husbands having both BPAD + AUD (P < 0.01). Duration of cohabitation had a direct, and education and family income had inverse relations with stress. Conclusions: BPAD worsens stress, marital satisfaction, and sexual satisfaction in the study participants, the stress increasing further with comorbid AUD. Education, family income, and duration of cohabitation have a significant bearing on stress.
  - 2,058 152
Prescription patterns and medication adherence in preadolescent children with attention deficit hyperactivity disorder
Ajita S Nayak, Hrishikesh Bipin Nachane, Prerna Keshari, Shubhangi R Parkar, Kumar Hemant Saurabh, Manan Arora
May-June 2021, 63(3):274-278
Background: Nonadherence in attention deficit hyperactivity disorder (ADHD) can be as high as 80%, yet studies on adherence to medications in preadolescent children are few. Recent Indian trends in prescription patterns are lacking. Aim: The present study assesses prescription patterns and adherence to medications in preadolescent children with ADHD. Materials and Methods: Fifty children aged 5–12 years with ADHD, who were on medications for at least 6 months, were enrolled. Their sociodemographic factors and prescription details were noted. Vanderbilt ADHD Diagnostic Parents Rating Scale and Compliance Rating Scale were administered. Results: Sixty-two percent of the children had good compliance, whereas 38% showed reluctance. Adherence was better in children with shorter duration of illness, lesser severity, absence of side effects, and stimulant prescription. Non–stimulant-based combination (40%) was more common compared to stimulants (28%), with atomoxetine and risperidone being the most commonly prescribed medications. Conclusions: Adherence to medications in preadolescent children with ADHD is good. Associated factors and implications are discussed.
  - 1,901 124
Grief management in COVID-19: Indian context
Om Prakash Singh
May-June 2021, 63(3):211-211
  - 3,164 319
Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program
Rajani Parthasarathy, Naveen Kumar Channaveerachari, Narayana Manjunatha, Kamaldeep Sadh, Rakesh Chander Kalaivanan, Guru S Gowda, Vinay Basvaraju, Shashidhara Nagabhushana Harihara, Girish N Rao, Suresh Bada Math, Jagadisha Thirthalli
May-June 2021, 63(3):212-214
  - 3,321 195
“My son's reputation tainted:” Primary empty sella syndrome masking as psychosis
Shikha Jha, Rajeev Ranjan, Chayan Kanti Manna
May-June 2021, 63(3):301-302
  - 1,810 88
Psychosis as acute presentation in Hashimoto's thyroiditis
Rohit Gondwal, Priya Ranjan Avinash, Arghya Pal, Sagar Modi
May-June 2021, 63(3):302-304
  - 2,169 101
Cyclical vomiting and clinician's dilemma
Seshadri Sekhar Chatterjee, Sayantanava Mitra
May-June 2021, 63(3):304-306
  - 1,718 73
Tardive laryngeal dystonia with risperidone – A case report
Stephen Amarjeet Jiwanmall, Rajesh Gopalakrishnan, Anju Kuruvilla
May-June 2021, 63(3):306-307
  - 1,926 104
Challenges faced by community-level workers in delivering mental health services for a rural community in South India
Vijaya Raghavan, A Kulandesu, S Karthick, S Senthilkumar, T Gunaselvi, Kotteswara Rao, Sujit John, R Thara
May-June 2021, 63(3):307-308
  - 1,574 75
Psychiatry as a major subject in undergraduate training: A step in the right direction
Suravi Patra, Binod Kumar Patro, Arpit Parmar
May-June 2021, 63(3):313-314
  - 1,528 93
Does religiosity in persons with schizophrenia influence medication adherence
Davuluri Triveni, Sandeep Grover, Subho Chakrabarti
May-June 2021, 63(3):228-232
Background: Little information is available regarding the effect of religiosity and spirituality on medication adherence in patients with schizophrenia. Aim: This study aimed to evaluate the association of medication adherence with different aspects of religiosity and spirituality in patients with schizophrenia. Materials and Methods: One hundred patients with schizophrenia were evaluated on religiousness measure scale and Duke Religion Index (DUREL); Brief Religious Coping Scale (Brief RCOPE); World Health Organization Quality of Life Spirituality, Religiosity, and Personal Beliefs (WHOQoL-SRPB); and Brief Adherence Rating Scale (BARS). Results: A higher level of religiosity as assessed by the religiousness measure scale, private religious activities and intrinsic religiosity as per DUREL, positive religious coping, and all the domains of WHOQOL-SRPB was associated with better medication compliance as assessed by the percentage of doses of medications consumed in the last 1 month as evaluated by using BARS. Conclusion: The present study suggests that a higher level of religiosity and spirituality were associated with better medication compliance.
  - 2,798 344
Externalizing psychopathology and cognitive functions in patients with early- and late-onset alcohol dependence
Anamika Das, Sujita Kumar Kar, Pronob Kumar Dalal, Pawan Kumar Gupta
May-June 2021, 63(3):233-239
Background: Alcohol use disorder is attributing to a significant health-care burden worldwide. Early-onset alcohol dependence is associated with more adverse outcomes than those with late-onset alcohol dependence. Comorbid externalizing disorders and cognitive deficits may be associated with the negative outcomes in early-onset alcohol dependence. This study aims at exploring the externalizing psychopathology and cognitive performance in early-onset alcohol dependence versus late-onset alcohol dependence. Materials and Methods: This is a cross-sectional study carried out on patients attending the psychiatry unit of a tertiary care center of north India after obtaining approval from the institutional ethics committee. A total of 57 patients with alcohol dependence enrolled in the study, after screening a total of 112 patients. Patients were evaluated for the externalizing psychopathology (using SSAGA intravenous [IV]) and cognitive performance (using Wisconsin Card Sorting Test [WCST] and continuous performance test [CPT]). Comparison of sociodemographic, clinical variables as well as externalizing psychopathology and cognitive performance was done between early-onset and late-onset alcohol dependence. Results: Comparison between early-onset and late-onset alcohol dependence revealed that the score of individual externalizing psychopathologies and the total externalizing psychopathology score on SSAGA IV in the early-onset group are significantly higher than late-onset alcohol dependence. Similarly, there is a significant difference in the executive functions (on WCST) between the two groups (early onset < late onset). On CPT, there are significantly more errors of omission in the early-onset group in comparison to their late-onset counterparts. Conclusion: Early-onset alcohol dependence is associated with more externalizing psychopathology and more cognitive dysfunction than late-onset alcohol dependence.
  - 2,362 209
Influence of catechol-O-methyltransferase enzyme gene polymorphism on alcohol and tobacco consumption in North Indian treatment seeking population
Rizwana Quraishi, Jaydeep Sharma, Raka Jain, Atul Ambekar
May-June 2021, 63(3):240-244
Background: The co-occurrence of alcohol and tobacco dependence is frequently witnessed in treatment settings. It is a challenge for clinicians to treat such patients due to their powerful biological association. Aim: The study is aimed to assess the relationship of Catechol-O-methyltransferase (COMT) Val158Met polymorphism with substance intake among individuals who are dependent on both alcohol and tobacco. Materials and Methods: A cross-sectional study involving patients coming to the outpatient department was planned. Brief information on their sociodemographic and substance use profile was recorded. Genotyping of COMT Val158Met was carried out using established polymerase chain reaction-restriction fragment length polymorphism method. The COMT genotyping was classified based on the presence or absence of Met allele using the dominant model. Descriptive statistics, Chi-square test, Mann–Whitney test, and Binary logistic regression analysis were performed to analyze the data. Results: The study included 104 alcohol and nicotine co-dependent subjects. More than eighty percent of the participants were educated above secondary level, married, and employed. The allele frequencies of met and Val were found to be 0.23 and 0.77, respectively. Forty percent of the participants reported tobacco-related health problems. The odds of consuming alcohol and nicotine were four times high among Met allele carriers. While the Fagerström test for nicotine dependence and heaviness of smoking index scores were up to four and eight times higher among met allele (odds ratio 4.3 and 8.9, respectively). Conclusion: Patients carrying Met allele are reported to consume higher amounts of alcohol and tobacco and were likely to score high among measures of nicotine dependence. Thus met allele carriers needs additional attention for a successful treatment outcome.
  - 2,018 147
A journey through psychiatry – A personal perspective
R Ponnudurai
May-June 2021, 63(3):215-221
  - 2,207 141