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   Table of Contents - Current issue
Coverpage
March-April 2020
Volume 62 | Issue 2
Page Nos. 111-229

Online since Tuesday, March 17, 2020

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EDITORIAL  

Substance use in India – Policy implications p. 111
Om Prakash Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_207_20  
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GUEST EDITORIAL Top

Gender differences: The new challenge for the next years p. 112
Florence Thibaut, Venu Gopal Jhanwar
DOI:10.4103/psychiatry.IndianJPsychiatry_75_20  
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REVIEW ARTICLE Top

Suicide among doctors: A narrative review Highly accessed article p. 114
Antonio Ventriglio, Cameron Watson, Dinesh Bhugra
DOI:10.4103/psychiatry.IndianJPsychiatry_767_19  
Doctors across the world work in stressful conditions, often making life or death decisions under considerable pressure. With changes in patient and societal expectations, these pressures continue to rise. For several decades, it has been illustrated that rates of psychiatric disorders, especially suicide, are considerably higher in doctors than the general population. We performed a comprehensive literature search of suicide in doctors. Using defined terms (suicide, self-harm, doctors, physicians, residents) in PubMed, we identified pertinent articles for review. We find that suicide in doctors is influenced by exposure to the physical and emotional distress endemic to the profession. These experiences may be compounded by emotional giving to the brink of exhaustion; a lack of positive feedback; alongside workplace isolation and poor support networks. Moreover, risks may be magnified by impacts outside of work; long hours, strained family relationships, poor work–life balance, as well as system and organizational politics. Despite this, doctors persistently avoid seeking help because of stigma against mental illnesses, stigma against themselves, and growing concerns that disclosure may impact their medical license. In many cases, doctors choose to self-medicate with prescription medications, alcohol, and a range of other substances. It is important that health services respond promptly, adequately, and sensibly to the needs of doctors in distress. Organizations including regulators have a moral responsibility to care for the wellbeing of its staff. A proactive approach to well-being, through training, and support will not only benefit doctors but also the patients who utilize their services each day.
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ORIGINAL ARTICLES Top

Development and validation of Vellore Assessment of Social Performance among clients with chronic mental illness p. 121
S Thamaraiselvi, A Priyadarshini, Namrata Arisalya, Reema Samuel, KS Jacob
DOI:10.4103/psychiatry.IndianJPsychiatry_510_19  
Background: Social skills deficits are hallmark symptoms of chronic mental illness. The absence of a culturally sensitive instrument to measure social skills in the Indian population demands the need to develop and standardize such instruments. Aim: The aim of this study was to develop and validate a context-specific, culturally relevant, and performance-based assessment scale for social performance. Materials and Methods: An expert committee of mental health professionals reviewed existing literature, identified standardized scales, examined items for cultural relevance, and identified possible issues for measurement. The items were categorized into 5 domains with a 7-point scale. The instrument was initially piloted on 10 participants, then among 101 consecutive clients with chronic mental illness between 18 and 60 years of age who provided written informed consent. They were assessed by two therapists to evaluate inter-rater reliability and test–retest reliability. They were also assessed on the Social Interaction and Communication Skills Checklist (SICSC) to evaluate convergent validity and on the 12-item General Health Questionnaire (GHQ-12) to assess divergent validity. Standard statistical tests were used to study its characteristics. Results: The scale had good inter-rater reliability (0.941; 95% confidence interval [CI]: 0.914, 0.960) and test–retest reliability (0.928; 95% CI: 0.810, 0.965). The correlation between total score of Vellore Assessment of Social Performance (VASP) and SICSC (Pearson's correlation coefficient = 0.696; P = 0.001) suggested moderate convergent validity. The correlation between total score of VASP and GHQ-12 (Pearson's correlation coefficient = −0.046; P = 0.648) implied good divergent validity. Conclusion: VASP seems to be a promising scale to assess social performance in people with mental illness.
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Neurocognitive and clinical correlates of insight in schizophrenia p. 131
Dhanya Raveendranathan, Jessie Joseph, Tanya Machado, Ashok Mysore
DOI:10.4103/psychiatry.IndianJPsychiatry_238_19  
Background: Schizophrenia is a heterogeneous disorder characterized by various symptom dimensions and neurocognitive deficits. Impairment of insight is a core clinical symptom of the disorder. There has been an increasing focus on neurocognition and insight in schizophrenia; although, many studies fail to control for premorbid cognitive status. Materials and Methods: Schizophrenia patients (n = 60) selected for adequate background education were recruited from outpatient services of a tertiary care hospital and community care homes in Southern India. These patients were comprehensively assessed using a neurocognitive battery. Clinical assessments were done using the Positive and Negative Syndrome Scale (PANSS) and Schedule for the Assessment of Insight-expanded version (SAI-E). Partial correlation was performed to examine the relationship of insight with clinical and neurocognitive measures. Statistical significance was set at P = 0.004 (Bonferroni correction for 12 tests of association). Linear regression analysis was performed to examine the predictors of insight. Results: The mean PANSS positive, negative, general psychopathology, and total scores were 14.2 ± 4.9, 17.4 ± 5.0, 34.3 ± 6.8, and 65.8 ± 13.9, respectively. Mean insight score (SAI-E) was 8.5 ± 2.9. In partial correlation done after controlling for IQ, significant negative correlations were observed between insight score and the Wisconsin Card Sorting Test (WCST) total errors (P = 0.001), WCST perseverative errors (P < 0.001). Insight scores had negative correlations with PANSS negative (P < 0.002) and total scores (P < 0.002). WCST perseverative errors were the primary predictor of insight in the regression analysis. Conclusion: Insight has a strong relationship with executive functioning in schizophrenia. This could indicate shared neurobiological substrates for insight and executive functioning.
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Impact of brief psychosocial intervention on key relatives of patients with schizophrenia: A randomized controlled trial p. 137
Rajneesh Kumar, Anil Nischal, Pronob Kumar Dalal, Sannidhya Varma, Manu Agarwal, Adarsh Tripathi, Sujita Kumar Kar, Bandna Gupta
DOI:10.4103/psychiatry.IndianJPsychiatry_138_19  
Background: Caregivers of patients with schizophrenia often experience high burden of care and have deterioration in the quality of their life. This study attempted to assess the efficacy of a brief psychosocial intervention (BPI) on the burden of care and quality of life (QOL) of key relatives of patients with schizophrenia and its subsequent effect on QOL of their patients (if any). Methods: A total of 66 patients and their key relatives were included in the study. Patients were assessed for psychopathology (by applying Positive and Negative Syndrome Scale and World Health Organization QOL scale [WHOQOL-BREF]) and relatives were assessed on Burden Assessment Schedule and WHOQOL scale (WHOQOL-100). Thirty-three patients and their key relatives were randomly allocated to BPI group and nonspecific control intervention group. Results: There was a statistically significant reduction in burden of care (P = 0.004) and improvement in QOL of relatives (P = 0.024) as well as in QOL scores of patients (P = 0.0028) in the BPI group. Conclusion: BPI is associated with a significant improvement in QOL as well as burden of care of key relatives of patients with schizophrenia, which, in turn, results in improvement in QOL of their patients.
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An exploratory study of cannabis use pattern and treatment seeking in patients attending an addiction treatment facility p. 145
Siddharth Sarkar, Arpit Parmar, Amit Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_132_19  
Background and Aims: Although cannabis is the most common illicit substance of use in India, it is often not the presenting complaint of patients with substance use disorders. The present study aimed to understand the profile of cannabis use disorders among patients at a substance abuse treatment facility in an Indian tertiary care center. Materials and Methods: This was a cross-sectional interview-based study which assessed adult patients with substance use disorders who had a history of cannabis use in the recent past. Participants were evaluated for cannabis use disorder as per the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) and cannabis dependence as per the International Classification of Diseases, 10th revision (ICD-10). They were assessed for cannabis withdrawal, and treatment-seeking behavior about cannabis use was explored. Results: Among the 100 male participants in the study, the use of smoked form (charas, ganja, sulfa) was more common than oral form (bhang). Fifty-eight patients fulfilled the ICD-10 criteria of dependence, whereas 74 patients fulfilled the DSM-5 criteria of cannabis use disorder. Tolerance, craving, and withdrawal were the most common clinical features. Only 7 patients ever sought help for quitting cannabis, whereas 28 patients thought that generally treatment is required for quitting cannabis. Conclusion: More cannabis users seem to fulfill a diagnosis of cannabis use disorder as per DSM5 than cannabis dependence as per ICD-10. Treatment seeking for cannabis use disorders seems to be low among the substance using patients. Clinicians need to focus on cannabis use as well when they treat patients with substance use disorders.
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The pattern of alcohol use and its relationship with consequences among problem alcohol users: A community-based cross-sectional study from India p. 152
Snehil Gupta, Rakesh Lal, Atul Ambekar, Ashwani Kumar Mishra, Ravindra Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_194_19  
Background: Pattern of drinking has a strong bearing on alcohol-related negative consequences. Very few studies from India have assessed this relationship using any standardized instrument. Aim: The current study aims to assess the relationship between pattern of alcohol use and negative consequences among problem alcohol users using a standardized instrument. Materials and Methods: This cross-sectional, observational study using snowball sampling technique was conducted among 75 participants in an urban slum of a metropolitan city of India. Screening of the participants was done by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST). Alcohol use details and alcohol-related adverse consequences were obtained by a semi-structured questionnaire and Drinker Inventory of Consequences (DrInC) inventory, respectively. Descriptive statistics, Chi-square test, and logistic regression test were used to analyze the data. Results: There was a significant association between high total DrInC score and ≥3 subscale scores with employment status, percentage of total family income spent on alcohol, source of income to procure alcohol, amount of alcohol, morning drinking, alcohol use for relaxation, and drinking throughout the day (Chi-square test). Age ≤35 years, current unemployment/part-time employment state, spending ≥25% of total family income on alcohol, family history, and drinking throughout the day were more likely to have high total DrInC score and ≥2 subscale scores (logistic regression analysis). Conclusion: A large proportion of the participants were suffering significantly from alcohol-related consequences but still were not receiving any treatment. It emphasizes the need for more epidemiological studies in this area for its treatment and policy-level implication.
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Portrayal of alcohol in Bollywood movies: A mixed methods study Highly accessed article p. 159
Ravindra Rao, Udit Panda, Swati Kedia Gupta, Atul Ambekar, Snehil Gupta, Alok Agrawal
DOI:10.4103/psychiatry.IndianJPsychiatry_294_19  
Introduction: Exposure to alcohol in popular movies during adolescence is associated with higher rates of alcohol use. We aimed to assess the extent and pattern of depiction of alcohol in Bollywood movies, and to analyze the trends in portrayal of alcohol over three decades selected for the study. Materials and Methods: We selected the top five grossing movies for each year of the three decades selected (1961–1970; 1981–1990; and 2001–2010). Content analysis was conducted for each scene depicting alcohol in the movie. We compared quantitative variables across the three decades to assess for any changes in the portrayal of alcohol and performed qualitative content analysis for the text description of the context, in which alcohol was depicted in each movie. Results: Of the total 150 movies analyzed, 135 (90%) movies contained at least one scene depicting alcohol. Alcohol scenes comprised 7% of the total movie time. Majority of the scenes (92.2%, n = 976) showed the substance (alcohol) itself. Spirits were the most common alcohol beverages depicted (75.1%, n = 733). Only 7.9% of scenes (n = 84) depicted alcohol brands. About 67% (n = 709) of scenes showed characters consuming alcohol or appeared intoxicated. Most scenes portrayed hero (n = 253, 35.7%) consuming alcohol. Female characters were depicted in 7.5% (n = 53) alcohol scenes. The third decade (2001–2010) had the least proportion of scenes depicting Spirits and the highest proportion of scenes depicting beer and wine. Decade three also had the most proportion of scenes set in clubs, bars, discotheques or restaurants, scenes with characters of “positive” shade depicting alcohol use, and the scenes portraying heroine with alcohol use. Conclusion: There is an increasing trend toward alcohol depiction by positive characters for fun and relaxation, and toward depiction of low-concentration alcohol such as beer in recent decades. The impact of changing trend of alcohol depiction on the Indian viewers, especially young audience, needs further study.
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Depression and diabetes: An experience from Kashmir p. 167
Arshad Hussain, Zaid Ahmad Wani, Hamidullah Shah, Abdul Hamid Zargar, Mushtaq Ahmad Margoob, Waseem Qureshi
DOI:10.4103/psychiatry.IndianJPsychiatry_46_19  
Background: Diabetes mellitus is a common chronic metabolic disorder characterized by hyperglycemia. Minimal attention has been paid toward the relationship between diabetes and depression in developing countries such as India, despite a number of studies in developed countries, exploring casual pathway between the two highly prevalent conditions. The aim of this study was to estimate the prevalence and severity of depression among patients of diabetes attending the endocrinology department of a tertiary care hospital of Kashmir. Methodology: A total of 527 patients having diabetes of ≥6 months with age ranging from 18 years to 60 years were screened for major depressive disorder (MDD) using Diagnostic and Statistical Manual IV-based criteria. Severity of depression was assessed by the Montgomery–Asberg Depression Rating Scale. Results: Depression was present in 39.65% of patients. Depression was more prevalent in the age group of 29–38 years, in females as compared to males, among literates and government employees. Prevalence of depression among Type 1 diabetic patients was 60%, while as in case of Type 2, it was 37.75%. Depressed patients had higher fasting blood glucose levels as compared to nondepressed diabetic patients. Conclusion: MDD is inordinately high among adult diabetic patients, and majority of the depressive patients have moderate intensity of MDD.
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Age, preoperative higher serum cortisol levels, and lower serum acetylcholine levels predict delirium after percutaneous coronary intervention in acute coronary syndrome patients accompanied with renal dysfunction p. 172
Jing Ru Ma, Meng Meng Fan, Zhan Sheng Wang
DOI:10.4103/psychiatry.IndianJPsychiatry_37_19  
Background: The objective of the study is to investigate the incidence and risk factors of delirium after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients accompanied with renal dysfunction. Materials and Methods: This was a prospective and cohort study, performed in a medical center from July 2014 to June 2017, which enrolled ACS patients accompanied with renal dysfunction who were treated with PCI. Univariate analysis and binary logistic regression analysis was used to determine the incidence and risk factors of delirium. Results: Data were analyzed from 119 patients. The 7-day incidence of delirium after PCI in ACS patients accompanied with renal dysfunction was 15.97% (n = 19/119). The binary logistic regression analysis results indicate that age (odd ratio [OR] 1.463; 95% confidence interval [CI] 1.070–2.001; P = 0.017), preoperative higher serum cortisol (COR) (OR 1.025; 95% CI 1.002–1.048; P = 0.030), and lower serum acetylcholine (Ach) (OR 0.965; 95% CI 0.937–0.993; P = 0.016) were significant differences in delirium and nondelirium groups. Conclusions: Age, preoperative higher serum COR levels, and lower serum Ach levels were independent risk factors for delirium after PCI in ACS patients accompanied with renal dysfunction.
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Subjective cognitive complaints and its relation to objective cognitive performance, clinical profile, clinical insight, and social functioning in patients of schizophrenia: A cross-sectional study p. 178
Sachin Pradeep Baliga, Ravindra M Kamath, Jahnavi S Kedare
DOI:10.4103/psychiatry.IndianJPsychiatry_639_19  
Context: Neurocognitive deficits are well documented in schizophrenia. Neurocognitive insight (NI), described as awareness of neurocognitive deficits, has not been evaluated in the Indian context. Its relation to clinical profile and social functioning also remains unexplored. Aims: The aim of this study was to evaluate the subjective cognitive complaints (SCCs) and their relation to objective cognitive performance, clinical profile, clinical insight, and social functioning in patients of schizophrenia. Settings and Design: This was a cross-sectional study at the outpatient department of a tertiary care teaching hospital. Materials and Methods: One hundred individuals with schizophrenia were evaluated using Positive and Negative Syndrome Scale, Subjective Scale To Investigate Cognition in Schizophrenia, abbreviated version of Scale to Assess Unawareness in Mental Disorders, and Schizophrenia Research Foundation–Social Functioning Index. Cognitive performance was assessed using (1) Digit Span Test (attention) from Wechsler Adult Intelligence Scale, 3rd edition and (2) Passages Test (explicit memory), (3) Verbal n-back Test (working memory), and (4) Stroop Test (executive functioning) from the National Institute of Mental Health and Neuro Sciences Battery. Statistical Analysis: Statistical analysis was done using descriptive statistics, nonparametric tests, and Pearson's coefficient of correlation. Results: Participants showed impairment in all cognitive domains. Except for working memory, there was no correlation between SCC and objective performance for other cognitive domains correspondingly, implying poor NI. Severity of psychosis and clinical insight did not have any correlation with SCC. Higher SCC correlated with poorer social functioning, especially in “occupational” and “other social roles” domains. Conclusions: Individuals with schizophrenia have poor NI. This is independent of severity of psychosis or clinical insight into illness. Socio-occupational functioning and depression should be actively enquired into when patients present with SCC.
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Association between insight and internalized stigma and other clinical factors among patients with depression: A cross-sectional study p. 186
Luke Sy-Cherng Woon, Siew Im Khoo, Azlin Baharudin, Marhani Midin
DOI:10.4103/psychiatry.IndianJPsychiatry_612_19  
Background: Insight influences treatment adherence among patients with depression. These patients also experience considerable social and self-stigma. The relationship between insight and internalized stigma has been extensively studied among patients with schizophrenia but not patients with depression. Aim: This study aimed to determine the relationship between the level of insight in illness and internalized stigma among patients with depression and to identify the clinical factors associated with impaired insight. Materials and Methods: A cross-sectional survey was conducted among adult psychiatric outpatients with depressive disorders at a teaching hospital in Kuala Lumpur for 10 months. Sociodemographic and illness-related data were gathered. Two questionnaires, Mood Disorder Insight Scale (MDIS) and Internalized Stigma of Mental Illness Scale (ISMI), were administered. Results: Ninety-nine respondents participated in the study (female: 63.6%; Malay: 41.4%; mean age: 46.4 years). The median duration of illness was 6.0 years. More respondents were taking combination therapy (59.6%). There was a statistically significant correlation between ISMI and MDIS scores (rs = 0.339, P = 0.001). On bivariate analyses, intact insight was associated with non-Malay race, combination therapy, higher average ISMI scores and subscores for alienation, stereotype endorsement, discrimination experience, and social withdrawal. Combination therapy, higher scores for alienation, and social withdrawal subscales were associated with a greater likelihood for intact insight in logistic regression model. Conclusions: Significant association exists between insight and internalized stigma in patients with depression. Interventions to reduce the impact of internalized stigma while improving patients' insight are required.
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BRIEF RESEARCH COMMUNICATIONS Top

The incidence of prolonged post-electroconvulsive therapy delirium: A retrospective study p. 193
Sandeep Grover, Ajay Kumar, Subho Chakrabarti, Ajit Avasthi
DOI:10.4103/psychiatry.IndianJPsychiatry_553_19  
Objective: The objective of the study was to assess the incidence and determinants of electroconvulsive therapy (ECT)-induced delirium. Materials and Methods: Using a retrospective study design, data of 488 patients undergoing modified ECT were evaluated for the development of new-onset prolonged delirium. Demographic and clinical parameters of patients who developed delirium and those who did not develop delirium were compared. Results: 5.7% of the patients developed prolonged post-ECT delirium. The use of quetiapine in higher doses and the lack of use of antidepressants while receiving ECT were associated with the development of prolonged post-ECT delirium. None of the other clinical and ECT-related parameters emerged as a significant factor associated with the development of prolonged post-ECT delirium. Conclusions: A small proportion of patients undergoing ECT develop post-ECT prolonged delirium.
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Reducing stress among medical students: A qualitative study of students' perspectives p. 198
Siddharth Sarkar, Vikas Menon, Santosh Kumar
DOI:10.4103/psychiatry.IndianJPsychiatry_354_19  
Background: Qualitative studies on students' perspectives about stress in medical education are sparse but nonetheless potentially relevant. Aim: The aim of the study was to assess the proportion of students who considered medical education to be excessively stressful and to elicit students' perspectives about ways to reduce stress in medical education. Materials and Methods: All medical undergraduate students of the college were asked about various aspects of stress in medical training using a self-rated questionnaire. Qualitative answers about the ways of reducing stress were also obtained using the questionnaire. Results: Medical education was considered to be excessively stressful by 265 (55.1%) students. The most common themes expressed for reducing the stress of medical education included those of “less frequent exams,” “more spare time,” and “slowing the pace of study or reducing syllabuses.” Conclusion: Majority of students considered medical training to be stressful and curricular overload is an important reason for the same.
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VIEWPOINT Top

Rehabilitation of long-stay patients in state mental hospitals: Role for social welfare sector p. 202
Thanapal Sivakumar, Jagadisha Thirthalli, Bangalore N Gangadhar
DOI:10.4103/psychiatry.IndianJPsychiatry_332_19  
Barriers to discharge long-stay patients with mental illness (PWMI) are complex and involve social factors. Recent legislations emphasize community living and creation of facilities by Government for PWMI without social support. The Honorable Supreme Court has dealt with the need for setting up rehabilitation homes for long-stay PWMI who do not require hospitalization. In such cases, nominated representative from social welfare sector needs to be involved in discharge planning. The social welfare sector needs to play a bigger role in the rehabilitation of long-stay PWMI.
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UG EDUCATION Top

Competency-based medical curriculum: Psychiatry, training of faculty, and Indian Psychiatric Society p. 207
M Kishor, Ravi Gupta, MV Ashok, Mohan Isaac, Rakesh K Chaddha, Om Prakash Singh, Henal Shah, Anil Nishchal, Malay Dave, HR Vinay Kumar, Anindya Das, Jitendra Kumar Rohilla, PK Singh, Pankaj Kumar, Mukesh Swami, RK Solanki, Sreeja Sahadevan, Aragya Pal, Rajat Ray, Shobit Garg, Sai Krishna Tikka, Mohan Dyanin, Priyaranjan Avinash, Vishal Dhiman, Aniruddha Basu, Vikram Singh Rawat, Vijay Krishnan, Vikas Menon, Suhas Chandran, Naresh Nebhinani
DOI:10.4103/psychiatry.IndianJPsychiatry_81_20  
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CASE REPORTS Top

Assessment of tripartite headache in a case of depression with partial empty sella syndrome p. 209
Roshan F Sutar
DOI:10.4103/psychiatry.IndianJPsychiatry_269_19  
Headache is multifactorial and can be classified as primary and secondary. It is a common notion for a treating clinician to oversee other causes of headache once the diagnosis of one type of headache has been made. Association of multiple types of headache together in a single patient is not uncommon, but often missed due to busy outpatient setting. The repeated visits of such patient for the treatment of headache can increase the burden on health-care utilization, especially in lower-middle-income countries like India. Patience, documentations, openness to dual pathology, and educating patient play an instrumental role in the assessment of headache.
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Stereotypical linear purpura of the upper limbs: A report of three cases of a rare psychocutaneous disorder and review of the literature p. 212
Sharmila Sarkar, Sudip Kumar Ghosh, Abheek Sil
DOI:10.4103/psychiatry.IndianJPsychiatry_356_19  
Mechanically induced purpura with its varied clinical presentations may often pose a great diagnostic challenge to the treating physician. In this report, we seek to familiarize clinicians with a relatively new and rarely diagnosed psychocutaneous disorder, stereotypical linear mechanically induced purpura of the upper limbs, which we had the chance to detect in three teenage girls from Eastern India. A review of the PubMed and Medline database reveals a paucity of information on this subject, especially in the English language literature. Only a handful of reports have been described worldwide till date. However, it is probably hitherto unreported from India.
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LETTERS TO EDITOR Top

Primary hypoparathyroidism: Rare neuropsychiatric presentation of manic symptoms, myopathy, and seizures p. 217
Pooja Patnaik Kuppili, Mukesh Kumar Swami
DOI:10.4103/psychiatry.IndianJPsychiatry_328_19  
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Art therapy based on painting therapy on the improvement of autistic children's social interactions in Iran p. 218
Zeinab Jalambadani
DOI:10.4103/psychiatry.IndianJPsychiatry_215_18  
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A case of delusional parasitosis presented as shared psychotic disorder treated successfully with aripiprazole p. 219
Derya Canli
DOI:10.4103/psychiatry.IndianJPsychiatry_285_19  
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A case of two culture-bound syndromes (Koro and Dhat syndrome) coexisting with obsessive–compulsive disorder p. 221
Sayanti Ghosh, Arabinda Narayan Chowdhury
DOI:10.4103/psychiatry.IndianJPsychiatry_298_19  
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Recurrent ventricular tachycardia during the electroconvulsive therapy procedure: A case report p. 222
Sandeep Grover, Shivali Aggarwal
DOI:10.4103/psychiatry.IndianJPsychiatry_412_19  
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Comments on “Relative efficacy of N-Acetylcystiene and Baclofen in cannabis dependence - A retrospective study with telephonic follow-up” p. 224
Swathy Sheela Sudevan, G Aparna, Harish M Tharayil
DOI:10.4103/psychiatry.IndianJPsychiatry_479_19  
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Trajectory of liver function tests during the initial alcohol detoxification period: A preliminary analysis p. 225
Shanti Mohan Kethawath, Raka Jain, Anju Dhawan, Siddharth Sarkar
DOI:10.4103/psychiatry.IndianJPsychiatry_439_19  
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Comments on “perspectives, attitude, and practice of lithium prescription among psychiatrists in India” p. 227
Guru S Gowda, Arun Enara, Sachin Nagendrappa
DOI:10.4103/psychiatry.IndianJPsychiatry_615_19  
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Response to letter to the editor: Perspectives, attitude and practice of lithium prescription among psychiatrists in India p. 228
Sucharita Mandal, Spoorthy Sai Mamidipalli, Bhaskar Mukherjee, K Hari Hara Suchandra
DOI:10.4103/psychiatry.IndianJPsychiatry_675_19  
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