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   Table of Contents - Current issue
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September-October 2019
Volume 61 | Issue 5
Page Nos. 429-545

Online since Tuesday, September 3, 2019

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EDITORIAL  

Neglect and abandonment of persons with dementia in India: Urgent need for residential and day-care facilities Highly accessed article p. 429
Om Prakash Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_507_19  
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ORIGINAL ARTICLES Top

Patterns and predictors of self-harm in patients with substance-use disorder Highly accessed article p. 431
Rishi Gupta, Shubham Narnoli, Nileshwar Das, Siddharth Sarkar, Yatan Pal Singh Balhara
DOI:10.4103/psychiatry.IndianJPsychiatry_578_18  
Background: Suicide is a growing health concern and causes significant health burden. Patients with substance use disorders represent an especially vulnerable population in terms of self-harm. Data on risk factors for self-harm in substance-using population in the Indian context are limited. We aimed to determine the patterns and sociodemographic/clinical predictors of self-harm in patients with substance use disorders. Materials and Methods: We assessed 300 male patients on Deliberate Self-Harm Inventory to assess the patterns of self-harm. We performed mediation analysis to determine whether clinical variables acted via sociodemographic variables in their effect on self-harm. Results: The occurrence rate of self-harm was 32.7%. It was significantly associated with a younger age, being unmarried/separated, unemployed, history of injecting drug use, high-risk sexual behavior, and cannabis use disorders. Conclusion: Self-harm is an important consideration among patients with substance use disorders, and needs to be addressed by the clinicians involved in the care of such patients.
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Profile of students referred for the assessment of scholastic backwardness at a tertiary care center p. 439
Smitha Ramadas, Vimy V Vijayan
DOI:10.4103/psychiatry.IndianJPsychiatry_443_18  
Background: Scholastic backwardness (SB) is a challenging problem affecting school-going children. Students seeking evaluation and certification of SB, especially in class nine and ten are on a rising trend in Kerala, the most literate state in India. However, there is a paucity of research regarding this. Objectives: The objectives of this study are to determine the clinical, sociodemographic, and academic profile of students referred with “difficulty in academics” in the psychiatry department of a government teaching hospital in Kerala. Materials and Methods: A retrospective chart review of students aged 6–16 years, referred to clinical psychologist for the structured assessment of SB, after evaluation by psychiatrists, over 1 year was done. Results: Overall, 207 students were assessed. Children aged 13–16 years were the majority (61.4%). Most of them were males (61.4%) and from rural background (81.6%). Majority (60%) was from high school and 22% of students were in class 10. Previous assessments for SB were done only in 20% of high school students. About 97% belonged to state syllabus, 90% were in Malayalam medium, and 93.3% were referred by teachers. The principal diagnosis was “slow learners” (34.8%) followed by intellectual disability (28%). About 11.6% had specific learning disorder (SLD), 15.5% had other neurodevelopmental, behavioral, and emotional disorders/problems, and 10% had no diagnosis. Conclusion: Varying degrees of intellectual impairment was the main cause of SB; majority was in high school and was never evaluated for SB. There was over-representation of class 10 students for first-ever assessment. Students with SB were identified and referred late for professional services. Those with SLD and nil diagnosis were similar in number probably reflecting an attempt to pass board exams by availing the benefits of certification. Designing curriculum and assessment to suit the differing intellectual levels of students are, therefore, recommended.
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Depressive symptoms and the risk of arthritis: A survival analysis using data from the osteoarthritis initiative p. 444
Vishal Vennu, Harsh Misra, Asha Misra
DOI:10.4103/psychiatry.IndianJPsychiatry_241_18  
Background: Some studies investigated the association between depressive symptoms and arthritis; however, no longitudinal studies have documented the relationship between developing depressive symptoms and the risk of arthritis. Therefore, this study evaluated whether the development of depressive symptoms was associated with an elevated risk of arthritis. Materials and Methods: A survival analysis using Cox regression models was applied to osteoarthritis initiative data obtained over 6 years from adults (n = 3,662) aged ≥45 years at baseline. Developing depressive symptoms was defined using the 20-item Center for Epidemiologic Studies Depression scale (cutoff 16 points) between baseline and 1 year. Arthritis was defined answering “yes” to the following self-reported question: “Did the doctor say you developed arthritis since the last clinic visit about 1 year ago?” over the 6-year follow-up period. Results: The hazard ratios for developing arthritis were 3.51 (95% confidence interval [CI] = 2.32–5.29) and 2.03 (95% CI = 1.45–2.85) for men and women, respectively, as compared to those who did not develop depressive symptoms. There was a significantly (χ2 = 73.672, P < 0.0001) lower survival probability at each time point throughout the study among men and women who developed depressive symptoms. Conclusion: In both men and women, developing depressive symptoms increased the risk of arthritis, and the survival probability decreased at each time point.
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Perspectives, attitude, and practice of lithium prescription among psychiatrists in India p. 451
Sucharita Mandal, Spoorthy Sai Mamidipalli, Bhaskar Mukherjee, Suchandra K Hari Hara
DOI:10.4103/psychiatry.IndianJPsychiatry_451_18  
Introduction: Lithium “the magic pill” past its discovery remained the respite for patients with bipolar disorders for decades. The prescriptions of lithium were replaced by other drugs because of the cumbersome monitoring, adverse effect profile, narrow therapeutic index, and frequent comorbidities in patients. The objectives of this study were to understand the knowledge, attitude, and practice of lithium by a subset of psychiatrists in India, which will help us understand the theory–practice gap and for devising strategies to bridge the existing gap. Materials and Methods: The current study was an online survey which included 103 psychiatrists from India of either gender and any age group. Predesigned questionnaire about the knowledge, attitude, and practice of lithium use was circulated for 1 month (March 2018). We received 135 responses (31% response rate), of which 32 were incomplete. Hence, the total sample of psychiatrists included in the study was 103. Results: The results suggest that most practitioners included in the survey had knowledge about the effects, adverse effects, and the monitoring protocols and were comfortable in using lithium in patients on outpatient basis. Despite being aware of the indications, the psychiatrists were skeptical in starting lithium due to multitude of perceived barriers such as comorbidities, patient's low adherence to blood monitoring, and adverse effects. Conclusions: Clinicians should be well aware of the adverse effects, monitoring protocols, which will help them to use lithium in a more appropriate manner.
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Predictors of caregiver burden after stroke in Nigeria: Effect on psychosocial well-being p. 457
Osunwale Dahunsi Oni, Andrew Toyin Olagunju, Christopher Izehinosen Okpataku, Adebayo Rasheed Erinfolami, Joseph Dada Adeyemi
DOI:10.4103/psychiatry.IndianJPsychiatry_395_18  
Background: Family caregivers (CGs) are critical to the care and recovery of stroke survivors (SSs), particularly in the community. However, little is known about their psychosocial well-being, especially in developing countries. In this study, we assessed CG burden, psychiatric morbidity, quality of life (QoL), and predictors of burden. Materials and Methods: We recruited 150 dyads of CGs/SSs from two outpatient clinics in Nigeria. Data were collected through sociodemographic/clinical questionnaire, the Zarit caregiver burden interview, the World Health Organization QoL-BREF, and the Mini-International Neuropsychiatric Interview. Disability in SSs was graded with the Modified Rankin Scale. Results: Compared to CGs who were mostly females (86.7%) with a mean age of 42.8 (±12.6) years, SSs were older with a mean age of 61.6 (±12.5) years and were mainly males (62.7%). The mean CG burden score was 31.6 (±10.5) and eight in 10 CGs, 124 (82.7%) reported moderate-to-severe burden scores. Mental disorders in the form of depression and/or anxiety disorders were diagnosed in 26 (17.3%) CGs. Significant predictors of high-burden scores (P < 0.05) were incontinence in SSs, psychological symptoms in SS, worse poststroke disability, and performance of more CG tasks (B = 8.3, 4.5, 3.9, and 3.5, respectively). CGs QoL scores correlated negatively with burden scores, with medium-to-large effect sizes (r = −0.4–−0.6) across QoL spheres. Conclusion: In this study, psychosocial burden in CGs was indexed by various determinants and impacted QoL negatively. Given the integral role of CGs to the care of SSs in the community, mental health services, psychosocial support programs, and stratification based on known vulnerability factors seems viable options for intervention, assessment, and planning.
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Beliefs about voices and their relation to severity of psychosis in chronic schizophrenia patients p. 465
Nishtha Chawla, Raman Deep, Sudhir Kumar Khandelwal, Ajay Garg
DOI:10.4103/psychiatry.IndianJPsychiatry_573_18  
Background: Auditory hallucinations may persist in a subset of chronic psychotic patients in spite of treatment. It is important to understand the personal meaning and significance of voices in these patients. In spite of its relevance, only a limited literature is available. Aim: This exploratory study aimed to assess the beliefs regarding voices in treatment-seeking patients with chronic schizophrenia having persistent auditory verbal hallucinations (AVHs) and assess their relation to the severity of psychosis. Materials and Methods: We recruited thirty adult patients with chronic schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with both lifetime and current significant AVHs (≥50% days/month). Co-occurring psychiatric disorders were ruled out using the Mini International Neuropsychiatric Interview-7.0.0. Patients were assessed using a semi-structured proforma, Beliefs about Voices Questionnaire-Revised (BAVQ-R), Psychotic Symptom Rating Scale (PSYRATS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression-Schizophrenia (CGI-SCH)-severity. Results: The median age of the patients was 32 years (interquartile range [IQR]: 23.8–40.5). The median duration of illness and treatment was 7 years (IQR: 3.4–15.0) and 3 years (IQR: 1.9–10.5), respectively. Higher BAVQ-R scores were found on “malevolence,” “omnipotence,” and “emotional and behavioral resistance.” These beliefs had a significant positive correlation with PSYRATS hallucination subscale, but not with the severity of psychosis (SAPS, SANS, and CGI-SCH). The sample had lower scores for “benevolence” and “engagement” subscales of BAV-Q. Conclusion: Overall, the study sample believed AVH to be more malicious and omnipotent rather than benevolent, and resisted the voices, engaging only minimally with them. These beliefs were not related to the severity of psychosis, but were related to the severity of hallucinations. Assessing the beliefs regarding AVH in larger, diverse samples may help to plan behavioral interventions.
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Dependence on smokeless tobacco and willingness to quit among patients of a tertiary care hospital of Bhavnagar, Western India p. 472
Pathik M Patel, Mihir Prafulbhai Rupani, Aditya N Gajera
DOI:10.4103/psychiatry.IndianJPsychiatry_87_18  
Background: There is a paucity of data on smokeless tobacco (SLT) use in Bhavnagar city of western India. This research attempts to find out the dependence and willingness to quit SLT use. Materials and Methods: This was a hospital-based cross-sectional study conducted in a tertiary care government hospital on a calculated sample size of 258 SLT users in the year 2017. The patients were recruited from ear-nose-throat (ENT) and dental outpatient department (OPD). The tobacco dependence was assessed using “Fagerstrom Test for Nicotine Dependence-SLT” and willingness to quit was assessed on a Likert scale of 1–10. Results: Among the 258 SLT users, 20% were highly dependent on SLT and 61% had low willingness to quit tobacco. “Mawa” was the most common (60%) chewed form of tobacco. Illiterate patients were three times more likely and patients whose occupation required traveling were 2.4 times more likely to develop high dependence for SLT than their counterparts. Patients living in the joint family were 2.7 times more likely to develop high dependence than patients living in a nuclear family. Conclusion: There is a need for the introduction of tobacco cessation interventions in ENT and dental OPD of tertiary care hospitals of western India.
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Efficacy of ketamine therapy in the treatment of depression p. 480
Suprio Mandal, Vinod Kumar Sinha, Nishant Goyal
DOI:10.4103/psychiatry.IndianJPsychiatry_484_18  
Background: Severe depressive disorder is among most debilitating condition. Conventional pharmacotherapy usually takes several weeks (usually 4–12 weeks) to improve symptoms. Ketamine is an N–methyl-D aspartate receptor antagonist having rapid action on depressive symptoms. Objectives: The effect of subanesthetic dose of ketamine was assessed on depressive and anxiety symptoms. Illness severity and improvement were assessed after treatment with ketamine. Materials and Methods: Twenty-five drug-free/naïve patients of the male sex, with severe depression having no previous history of psychotic disorder, head injury, organic disorder, cardiological problem, or substance abuse were admitted for the study. Assessments were made at baseline and injection ketamine hydrochloride was given at a subanesthetic dose of 0.5 mg/kg intravenous bolus after preparation. Assessments were repeated 1 h after the first dose. Six doses were given over 2 weeks and assessments were repeated. Final assessments were made after 1 month of the last dose. Results: There was a significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine. Significant improvement at 1st h of the first dose was seen in depression and anxiety and not for illness severity. There were transient adverse effects observed in some patients which subsided within 1 h. Conclusion: Ketamine has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.
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The extent and nature of coverage of mental health issues in printed media in India p. 486
Blessy Mohandass, Manpreet Kaur, Harpreet Kaur
DOI:10.4103/psychiatry.IndianJPsychiatry_75_19  
Context: The term media on a whole pertain to the main method of mass communication. The chief aim of the media is communication, with the objective of educating, informing, and entertaining the audience. It is unknown how accurately the media reports the topics related to mental health issues. Aims: The aim of this study is to explore the extent and nature of coverage of mental health issues in printed media. Settings and Design: Data collection for the present study was conducted at the Library Gian Sagar College of Nursing, Ram Nagar, District Patiala, Punjab, in January 2017. A quantitative research approach with exploratory research design was adopted to explore the extent and nature of coverage of mental health issues in printed media. Subjects and Methods: By purposive sampling technique, 923 printed media from which a sample of 839 articles was drawn, i.e., N = 839 (N1for newspapers, N1= 827 and N2for magazines, N2= 12) with the help of search terms which consisted of 32 general and diagnostic terms covering the full range of mental disorders. Statistical Analysis Used: Descriptive statistics were used. Results: One hundred and ninety-three (23%) articles on mental health issues appeared in the city/region section. Two hundred and one (32%) articles in newspapers did not mention the author. The most common theme of articles in newspapers was suicide 169 (25%) followed by substance abuse 209 (20%). The neutral description was used by 589 (71%) of all articles. Conclusions: Majority of the articles appeared in the city/region section with neutral/nature.
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A cross-sectional study on the prevalence of anxiety among school students in Teliamura municipality area of Tripura p. 491
Kaushik Nag, Bivek Ghosh, Anjan Datta, Nabarun Karmakar, Partha Bhattacharjee
DOI:10.4103/psychiatry.IndianJPsychiatry_415_18  
Background: Anxiety in adolescence has been a serious problem nowadays. It is seen that anxiety among students cause many harms to their mental and physical health affecting their career. Objective: The objective of this study is to know about the burden of anxiety among school students and to find out the association of different grades of anxiety with sociodemographic characteristics and any other factors. Materials and Methods: In a cross-sectional study, 400 school students of Class IX–XII, from four schools of Teliamura Municipality area of Tripura were included during May 2016–June 2016. Required sample from each school was selected by proportion probability sampling. Then, students were selected using systematic random sampling technique until the sample size from each school was reached. Beck anxiety inventory was used to assess the different grades of anxiety among students. Results: Most of the students were suffering from mild anxiety (49.4%) followed by moderate anxiety (43.3%) and severe anxiety (7.3%). The mean anxiety score of the school students was 16.90 ± 9.02. Female students (10.9%) had more severe anxiety compared to male students (3.8%) and this difference of different grades of anxiety with gender was statistically significant. The association of different grades of anxiety with a history of stressful events in the past 6 months was found to be statistically significant. Conclusion: Anxiety was present in each age group and females were suffering more with severe anxiety. Future research on academic anxiety should be done to combat against this problem of anxiety among school students.
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Posttraumatic stress disorder and psychosocial difficulties among children living in a conflict area of the Southeastern Anatolia region of Turkey p. 496
Murat Eyuboglu, Damla Eyuboglu, Birgul Sahin, Esra Fidan
DOI:10.4103/psychiatry.IndianJPsychiatry_165_18  
Background: Traumatic events and armed conflicts can lead to many mental disorders, especially posttraumatic stress disorder (PTSD), in children. We investigated the PTSD symptoms, psychosocial difficulties, general health levels of the parents, and direct and indirect effects of trauma on psychological outcomes. Materials and Methods: A total of 482 children were included in the study. Two hundred and eight of those children were from Derik district, where street fights, curfews, and conflict have been experienced, and 274 of those children were from Yeşilli district, where no conflicts have been observed despite being in the same province. All children filled out the child posttraumatic stress disorder reaction index, the strengths and difficulties questionnaire (SDQ), and parents filled out the General Health Questionnaire-12 (GHQ). Results: All children showed moderate PTSD symptoms; however, no significant difference was observed between the two groups. In the exposed group, children, who had to leave their homes for a while due to conflicts, had worse PTSD symptoms, higher SDQ difficulty scores, and parents' GHQ scores. It was determined that being a female having high maternal GHQ scores and leaving home due to the conflicts significantly increase the risk of occurrence of trauma symptoms. Conclusion: Our findings suggest that children are susceptible to the direct and indirect effects of trauma. It is crucial for intervention programs to be developed for the detection, prevention, and treatment of PTSD symptoms to be applied to all children, regardless of exposure type, in areas affected by conflict.
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A prospective observational study on psychotropic drug use in non psychiatric wards p. 503
Jisha Myalil Lucca, Ankam Vamsi, Shilia Jacob Kurian, Smruti Ebi
DOI:10.4103/psychiatry.IndianJPsychiatry_28_18  
Background: Psychotropic medications are the first line for the management of psychiatric illnesses; in addition, they are also being used in an off-labeled manner. Inappropriate prescribing of psychotropic medications either can cause serious harm or may be of no benefit to the patients. However, there is a dearth of information on the pattern of psychotropic drug use in the nonpsychiatry wards. Aim: The aim of this study is to assess the use of psychotropic drugs in general medicine and surgical wards of a teaching hospital. Materials and Methods: An observational study was conducted in the general medicine and surgical wards of a university teaching hospital over 6 months. Patients admitted to the medicine and surgical ward were observed for a prescription of psychotropic medications. Once they were prescribed with a psychotropic medication, the patients were included in the study and were followed until discharge. All the necessary information such as dose, route, class of psychotropic and prescriber's status were documented and analyzed. Results: A total of 322 patients were prescribed with 452 psychotropic medications. The average number of psychotropic per patient was 1.40 ± 0.76 (range: 1–4). The rate of psychotropic medications prescription in the nonpsychiatric ward is 10.73%. Alcohol dependence syndrome (n = 90 [26.71%]) and pain (n = 43 [43.87%]) were the observed psychiatric and nonpsychiatric indications. The frequently prescribed psychotropic classes were benzodiazepines (n = 165 [36.50%]) and antidepressants (n = 144 [31.86%]). Nonpsychiatrists (n = 250 [55.3%]) were the common prescribers and benzodiazepines (n = 124 [27.43%]) were the preferred class for nonpsychiatrist, whereas psychiatrist prescribed different class of psychotropic drugs. Conclusion: This study emphasizes that nonpsychiatrist irrespective of their specialty prescribed psychotropic medication for psychiatric and nonpsychiatric indications.
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Relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients: A sample of Turkey p. 508
Gulay Tasdemir Yigitoglu, Gulseren Keskin
DOI:10.4103/psychiatry.IndianJPsychiatry_285_17  
Background: Dysfunctional beliefs are believed to have an effect on substance abuse. Drug-addicted individuals experience difficulties with coping in stressful situations and therefore, start reusing these drugs. Aim: This study was conducted to determine the relationship between dysfunctional beliefs and stress coping methods in drug-addicted patients. Materials and Methods: The population of this descriptive and cross-sectional research study comprised 51 patients who were admitted to the Alcohol and Drug Addiction Treatment Center of a state hospital, diagnosed with drug addiction, and consented to participate in our study. The data were collected by using the Sociodemographic Information Form, the Dysfunctional Attitude Scale (DAS), and the Coping Assessment Questionnaire (COPE). The data obtained were evaluated by percentage, correlation, one-way analysis of variance, Mann–Whitney U-test, and Kruskal–Wallis test. Results: The average COPE score of the drug-addicted patients was found to be 171.60 ± 23.35. The average DAS score of the drug-addicted patients was determined to be 161.66 ± 36.94. A statistically significant difference was found between the DAS and COPE scores of the patients (P < 0.05). Conclusions: It can be concluded that these patients have dysfunctional beliefs and exhibit emotion-focused coping attitudes. More comparative studies investigating the dysfunctional beliefs of alcohol- and drug-addicted people and coping methods should be conducted.
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BRIEF RESEARCH COMMUNICATIONS Top

Mirror finger patterns of apparent monozygotic twins and sib pairs with Schizophrenia p. 520
R Ponnudurai, I Shajahan, A Rani, J Jayakar
DOI:10.4103/psychiatry.IndianJPsychiatry_476_18  
Background: Although mirror images are noted in some twins, no such reports are available for twins and subjects with schizophrenia. Aim: The study was to assess the occurrence of mirror image finger patterns in apparent monozygotic twins with schizophrenia. Another objective was to elucidate these characteristics among sib pairs with schizophrenia for comparison with those of the twins. Materials and Methods: Eight apparent monozygotic twin pairs and eight sib pairs with schizophrenia were investigated. The frequency of identical patterns in the right side finger of one twin and the corresponding left side finger of the other twin was assessed, and similarly on other sides. Similar assessment was made in sib pairs with schizophrenia and normal sib pairs. Results: The left middle finger pattern of one of the twin pair was found to be the mirror image of the right middle finger of the other twin in all the twin pairs studied and so was in seven of the sib pairs with schizophrenia. These mirror images of sib pairs with schizophrenia was more than those of normal sib pairs. This difference was accentuated with significantly more of these patterns in the twins in comparison to those among normal sib pairs. Notably, no difference emerged between the sib pairs with schizophrenia and the twins in any of their finger pairs. Conclusion: Mirror images that are probably due to factors like abnormal genotypes and L- DNA, appear to be promising tools to study the etiology of schizophrenia.
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Prevalence and determinants of posttraumatic stress in adolescents following an earthquake p. 526
Marthoenis Marthoenis, Andri Nirwana, Liza Fathiariani
DOI:10.4103/psychiatry.IndianJPsychiatry_35_19  
Context: The 2016 Aceh earthquake causes a significant mental health impact in adolescents. However, the prevalence and determinants have never been reported. Aims: The study aimed to estimate the prevalence rate and determinants of posttraumatic stress symptoms in adolescents following an earthquake. Settings and Design: This cross-sectional study was conducted in Pidie Jaya district approximately 6 months following the earthquake. Materials and Methods: The Trauma Screening Questionnaire (TSQ) was distributed to adolescents living around the earthquake-affected area. Statistical Analysis: The Chi-square test and binomial logistic regression were performed using GNU PSPP statistical software. Results: The prevalence of posttraumatic stress disorder (PTSD) was 47%, and the mean score of TSQ was 5.11 (standard deviation = 2.3). The presence of PTSD was associated with gender and age (P = 0.001). Logistic regression analysis confirmed that gender, being injured, witnessing someone injured, feeling stressed after the earthquake, and feeling scared of staying inside a building following the earthquake were independently and significantly associated with PTSD (P = 0.001). Conclusion: The prevalence of PTSD at 6 months following an earthquake is relatively high, and many factors are associated with the presence of PTSD.
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Paranoia in patients with gender dysphoria: A clinical exploration p. 529
Sagar Karia, Alpa Alure, Tejesvi Dave, Nilesh Shah, Avinash De Sousa
DOI:10.4103/psychiatry.IndianJPsychiatry_433_18  
Background: Gender identity disorder (GID) is a distressing disorder characterized by a persistent unhappiness with one's own gender and a desire to be of the opposite gender as well as seeking sex reassignment surgery for the same. The aim of the study was to assess the Minnesota Multiphasic Personality Inventory (MMPI) profiles in patients with GID and compare with healthy normal population and also examine differences in the profiles based on original gender of the patients. Materials and Methods: A total of 56 patients with GID that fulfilled the Diagnostic and Statistical Manual of Mental Disorders 5 criteria for the same were participants of the study, and there were 54 control participants. They were administered the MMPI, and the scores across various scales were statistically analyzed. Results: It was seen that apart from masculinity feminity (Mf) scale, other scales such as Paranoia (Pa, P < 0.01), Schizophrenia (Sc, P = 0.01), and Psychopathic deviate (Pd, P < 0.01) were also elevated in many patients. Male patients seeking surgery to become female showed higher scores on Pa and Sc scales than female patients. On detailed inquiry, it was found that there was no evidence of psychosis clinically, and in fact, their paranoia was reality based. Conclusion: MMPI profiles in patients with GID needs to interpreted with caution and clinicians must keep in mind that elevated Pa and Sc scales on the MMPI in these patients need not indicate a psychotic profile.
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CASE REPORT Top

Deep brain stimulation of ventral internal capsule for refractory obsessive–compulsive disorder p. 532
Alok Gupta, Sumant Khanna, Rahul Jain
DOI:10.4103/psychiatry.IndianJPsychiatry_222_16  
The main objective of this study is to assess the effectiveness of deep brain stimulation (DBS) of the ventral striatum (VS) of the anterior limb of internal capsule for patients suffering from refractory obsessive–compulsive disorder (OCD) and to compare its result with traditional anterior capsulotomy. The present study consisted of two patients subjected to stimulation of ventral capsule (VC)/VS region of internal capsule for refractory OCD. Leads were implanted on both sides stereotactically using fused images of magnetic resonance imaging and computed tomography scan brain and connected to pulse generator (Medtronic). Outcome of both the patients was measured by Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), and Mini-Mental Status Examination. The first case was followed for 4 years and 6 months, while the second case was followed for 2 years and 6 months. Both the patients responded very well to stimulation with reduction of Y-BOCS from 38 to 12 (68.42% improvement) in the first patient and 38 to 10 (78.68% improvement) in the second patient after 1 year. BDI also improved in both the patients with no significant change in mental state. No adverse effect was seen in any of the patient. The beneficial effect of DBS persisted in both the patients till follow-up and was much superior to the beneficial effect of anterior capsulotomy. We conclude that DBS of VC/VS complex is very safe and effective in refractory OCD and shows considerable promise for the future. The result of two treated patients was much better as compared to lesioning (anterior capsulotomy) and the beneficial effect persisted for long time.
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LETTERS TO EDITOR Top

A case of neurocysticercosis: Neuropsychiatric manifestations, course, and treatment p. 537
Rossetos Gournellis, Kalliopi Tournikioti, Matilda A Papathanasiou, Anna Karavia, Athanasios Douzenis, Ioannis Michopoulos
DOI:10.4103/psychiatry.IndianJPsychiatry_466_18  
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Placebo in psychotherapy of childhood depression p. 539
Tarun Verma
DOI:10.4103/psychiatry.IndianJPsychiatry_561_18  
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Children with strabismus: Is there psychological impact on mothers? p. 540
Syed Usman Bin Mahmood, Sidra Zafar, Azhar Hussain, Zafar Iqbal
DOI:10.4103/psychiatry.IndianJPsychiatry_67_18  
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Compulsive sexual behavior in depressed women p. 541
Shaily Mina
DOI:10.4103/psychiatry.IndianJPsychiatry_137_18  
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Long-term intentional Datura use and its consequences p. 543
Shalini Singh, Devika Kosana, Rakesh Lal
DOI:10.4103/psychiatry.IndianJPsychiatry_276_18  
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Pediatric moyamoya disease presenting as attention deficit hyperactivity disorder: Time to pay attention p. 544
Suravi Patra, Ashis Patnaik
DOI:10.4103/psychiatry.IndianJPsychiatry_403_18  
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