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   Table of Contents - Current issue
July-August 2020
Volume 62 | Issue 4
Page Nos. 337-455

Online since Monday, July 27, 2020

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Aftermath of celebrity suicide – Media coverage and role of psychiatrists p. 337
OP Singh
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Does electroconvulsive therapy cause brain damage: An update p. 339
Amal Joseph Jolly, Shubh Mohan Singh
Electroconvulsive therapy (ECT) is an effective modality of treatment for a variety of psychiatric disorders. However, it has always been accused of being a coercive, unethical, and dangerous modality of treatment. The dangerousness of ECT has been mainly attributed to its claimed ability to cause brain damage. This narrative review aims to provide an update of the evidence with regard to whether the practice of ECT is associated with damage to the brain. An accepted definition of brain damage remains elusive. There are also ethical and technical problems in designing studies that look at this question specifically. Thus, even though there are newer technological tools and innovations, any review attempting to answer this question would have to take recourse to indirect methods. These include structural, functional, and metabolic neuroimaging; body fluid biochemical marker studies; and follow-up studies of cognitive impairment and incidence of dementia in people who have received ECT among others. The review of literature and present evidence suggests that ECT has a demonstrable impact on the structure and function of the brain. However, there is a lack of evidence at present to suggest that ECT causes brain damage.
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Psychological impact of COVID-19 lockdown: An online survey from India Highly accessed article p. 354
Sandeep Grover, Swapnajeet Sahoo, Aseem Mehra, Ajit Avasthi, Adarsh Tripathi, Alka Subramanyan, Amrit Pattojoshi, G Prasad Rao, Gautam Saha, KK Mishra, Kaustav Chakraborty, Naren P Rao, Mrugesh Vaishnav, Om Prakash Singh, PK Dalal, Rakesh K Chadda, Ravi Gupta, Shiv Gautam, Siddharth Sarkar, TS Sathyanarayana Rao, Vinay Kumar, YC Janardran Reddy
Background: The COVID-19 pandemic has led to a complete shut-down of the entire world and almost all the countries are presently in a “lockdown” mode. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, the impact of the same on mental health is not well known. Aim: This study aimed to evaluate the psychological impact of lockdown due to COVID-19 pandemic on the general public with an objective to assess the prevalence of depression, anxiety, perceived stress, well-being, and other psychological issues. Materials and Methods: It was an online survey conducted under the aegis of the Indian Psychiatry Society. Using the Survey Monkey platform, a survey link was circulated using the Whatsapp. The survey questionnaire included perceived stress scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Warwick-Edinburgh Mental Well-being Scale to assess perceived stress, anxiety, depression, and mental well-being, respectively. The survey link was circulated starting from April 6, 2020 and was closed on April 24, 2020. Results: During the survey, a total of 1871 responses were collected, of which 1685 (90.05%) responses were analyzed. About two-fifth (38.2%) had anxiety and 10.5% of the participants had depression. Overall, 40.5% of the participants had either anxiety or depression. Moderate level of stress was reported by about three-fourth (74.1%) of the participants and 71.7% reported poor well-being. Conclusions: The present survey suggests that more than two-fifths of the people are experiencing common mental disorders, due to lockdown and the prevailing COVID-19 pandemic. This finding suggests that there is a need for expanding mental health services to everyone in the society during this pandemic situation.
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State of mental health services in various training centers in India during the lockdown and COVID-19 pandemic p. 363
Sandeep Grover, Aseem Mehra, Swapnajeet Sahoo, Ajit Avasthi, Adarsh Tripathi, Avinash D'Souza, Gautam Saha, A Jagadhisha, Mahesh Gowda, Mrugesh Vaishnav, Omprakash Singh, PK Dalal, Parmod Kumar
Background: There is some information from different developed coutries that mental health services have been badly affected by the COVID-19 pandemic. Little information is available from India. Aim: The aim of this study was to evaluate the impact of lockdown and COVID-19 pandemic on mental health services in India's various training centers. Materials and Methods: In an online survey, information was collected from various training centers of India through E-mail or WhatsApp. Results: Responses were received from 109 institutes. The majority of the responses were received from state-funded government medical colleges and private medical colleges. Since the lockdown and COVID-19 pandemic, brain stimulation treatments have completed stopped. Other, most affected services included electroconvulsive therapy, inpatient services, outpatient services, and psychotherapy services. However, there was an expansion of teleconsultations services because of the lockdown and the COVID-19 pandemic. In three-fourth of the centers mental health services were being provided to the patients with COVID-19 infection. In most of the institutes, mental health professionals were involved at different levels in the COVID-19 responsibilities. These included providing helpline services to the general public, screening people in quarantine for mental health issues, providing clinical care to COVID-19 patients, screening health care workers (HCWs) for mental health issues, and training the HCWs. Conclusion: COVID-19 pandemic and lockdown have led to the collapse of regular mental health services. The present study also shows that mental health professionals are playing a significant role in addressing the prevailing psychiatric morbidity, specifically related to the COVID-19 related issues, and taking care of the HCWs.
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Changes in sleep pattern and sleep quality during COVID-19 lockdown Highly accessed article p. 370
Ravi Gupta, Sandeep Grover, Aniruddha Basu, Vijay Krishnan, Adarsh Tripathi, Alka Subramanyam, Anil Nischal, Arshad Hussain, Aseem Mehra, Atul Ambekar, Gautam Saha, Kshirod Kumar Mishra, Manish Bathla, Mukesh Jagiwala, Narayana Manjunatha, Naresh Nebhinani, Navendu Gaur, Niraj Kumar, Pronob Kumar Dalal, Pankaj Kumar, Purav Kumar Midha, Ritu Daga, Sai Krishna Tikka, Samir Kumar Praharaj, Sandeep Kumar Goyal, Shweta Kanchan, Siddharth Sarkar, Sourav Das, Sujit Sarkhel, Susanta Kumar Padhy, Swapnajeet Sahoo, TS Satyanarayana Rao, Vaibhav Dubey, Vikas Menon, Vishal Chhabra, Vivekanand Lahan, Ajit Avasthi
Introduction: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted “lockdowns” which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. Materials and Methods: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. Results: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. Conclusions: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.
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Confirmatory factor analysis of the depression, anxiety, and stress scale among Indian adults p. 379
Manoj Kumar Sharma, David John Hallford, Nitin Anand
Background: The Depression, Anxiety, and Stress Scale (DASS) is a widely used measure of negative emotional states. While the DASS is increasingly used in mental health research in India, to date no study has examined the factor structure among Indian adults. Methods: A large community sample of English-speaking Indian adults completed the DASS 21-item version, and confirmatory factor analyses were conducted. Results: The results indicated a good fit for a three factor (depression, anxiety, and stress) and a one-factor model (general psychological distress). There was no substantial difference between the fit of the models, and the DASS subscales were very strongly correlated with one another (r ≥ .80). Conclusion: The findings from this sample suggest that the DASS-21 items appear to assess general psychological distress, with little evidence that the items assess three distinct subscales.
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Integrated intervention program for alcoholism improves impulsiveness and disadvantageous reward processing/risk-taking p. 384
Rajesh Kumar, Keshav J Kumar, Vivek Benegal, Bangalore N Roopesh, Girikematha S Ravi
Background: Impulsivity and aberrant reward processing are the core features of substance use disorders, including alcoholism. The present study examined the effects of an Integrated Intervention Program for Alcoholism (IIPA) on impulsiveness and disadvantageous reward processing/risk-taking in persons with alcoholism. Materials and Methods: The study adopted age- and education-matched (±1 year) randomized control design with the pre-post comparison. The sample comprised 50 persons with alcoholism. They were allotted randomly into two groups, the intervention (IIPA) group and treatment as usual (TAU) group (n = 25 in each). Participants were assessed at pre-intervention on impulsivity (Barratt's Impulsiveness Scale) and decision-making task, which reflects reward processing deficits (modified Iowa gambling task [mIGT]). The TAU group received usual treatment for alcoholism (i.e., pharmacotherapy; three sessions in a week group therapy on relapse prevention and six sessions in week yoga) for 18 days. The intervention group received IIPA along with usual treatment (except yoga). Outcome assessment was repeated after 18 days of intervention. Results: Both groups were comparable at pre-intervention (baseline). However, the intervention (IIPA) group showed a significant reduction in impulsivity and selection from disadvantageous decks on mIGT at post-intervention, while the TAU group had no significant change. Conclusion: The findings suggest that IIPA could improve impulsivity and disadvantageous reward processing/risk-taking in persons with alcoholism. These are core features of substance use disorders and could pose a high chance for relapse after treatment. Further studies may examine improving these characteristics with IIPA and its impact on treatment outcomes such as relapse rate and maintaining sobriety.
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Which factors may differentiate lifetime suicide attempters from ideators in obsessive–compulsive disorder patients? p. 392
Cagdas Oyku Memis, Bilge Dogan, Doga Sevincok, Tolga Tunagur, Seda Derici Memis, Levent Sevincok
Background: The causes underlying suicidal behaviour in patients with obsessive-compulsive (OCD) are not fully understood. Aim: In this study, we examined whether lifetime suicide attempt (SA), and suicide ideation (SI) was associated with affective temperaments, impulsivity, childhood traumatic events or separation anxiety. Methods: We compared OCD patients with lifetime SA (Group 1; n=25), lifetime suicide ideation (SI) (Group 2; n=62), and without lifetime SI and SA (Group 3; n=73) through Beck Scale for Suicidal Ideation (BSSI), Childhood Trauma Questionnaire Questionnaire (CTQ-SF), Separation Anxiety Symptom Inventory (SASI), Baratt Impulsiveness Scale (BIS-11), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), and Beck Depression Inventory (BDI). Results: Post hoc tests showed that educational level was significantly lower in Group 1 than in both Group 2 and 3. Childhood abuse were significantly higher in attempters than ideators, and non-suicidal patients. The depressive, cyclothymic, and anxious temperaments were significantly higher in attempters and ideators compared to control subjects. The aggressive obsessions (p=0.002), childhood abuse history (p=0.009), lifetime major depression (p=0.017), and lower educational levels (p=0.006) strongly predicted the increased risk of lifetime SA, compared to non-suicidal patients. Childhood abuse (p=0.022) was the most significant predictor of lifetime SA in OCD. Conclusion: We suggested that childhood abuse history emerged as the most significant variable that distinguished lifetime attempters from only ideators in OCD patients.
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Network and pathway enrichment analysis of Attention Deficit/Hyperactivity Disorder candidate genes p. 400
Pratichi Singh
Background: Attention deficit/hyperactivity disorder (ADHD) is a well-known multigenic neurodevelopment disorder. It is a psychiatric disease which mainly affects the children and adolescence. Globally, 3%–5% of children are suffering from this mental disorder. Aims and Objectives: This disease is characterized by hyperactivity, impulsiveness and inattentiveness. Suffering individuals are also observed with sleep related problems. Though, its polygenic, to study the complexity of these genes, we used a purely network approach. Firstly, we collected all the candidate genes involved in ADHD through a literature survey. Materials and Methods: We investigated these genes using STRING 10 and Cytoscape v 3.3.0 for protein protein interaction network. Accordingly, we attempted to identify the hub genes based on definite parameters like betweenness centrality, clustering coefficient and node degree using Network analyzer. Likewise, the key transcriptional regulators were acknowledged by means of MatInspector program. Finally, the enrichment analysis was executed using ClueGO. Results: As a result, dopamine receptor D2, brain derived neurotrophic factor, HTRF1A, and dopamine receptor D4 were recognized as hub genes among the reported ADHD genes. While, 17 transcription factors (TFs) were conveyed as the key TFs for these hub genes. Conclusion: Functional enrichment analysis revealed regulation of dopamine and behavioral fear response pathways. These pathways have been assumed to play a central role in the ADHD within the selected candidate genes.
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Burnout in medical students of a tertiary care Indian medical center: How much protection does resilience confer? p. 407
Shaurya Pharasi, Suravi Patra
Context: Medical profession continues to grapple with burnout; even medical students are not spared of this self-destructive psychological experience. Attempts are being made to control and contain burnout in medical students by the medical fraternity. Aims: We intend to study the prevalence and determinants of burnout in medical students in a tertiary medical center and also to study the relationship of resilience with the experience of burnout. Settings and Design: This was a cross-sectional anonymous survey method. Materials and Methods: Randomized stratified sampling method was used wherein roll numbers of MBBS students belonging to four different semesters were chosen using randomization software. Based on prevailing prevalence of burnout, sample size calculation was done, and 196 completed questionnaires were included in analysis. The Maslach Burnout Inventory (MBI) and the Resilience Scale for Adults (RSA) were used. Two-dimensional approach toward diagnosing burnout was used. Statistical Analysis: Association tests were carried out to analyze the association between means, and Spearman's rho was used to assess the correlation of MBI subscales with RSA subscales. We also used binary logistic regression to assess the relationship of burnout with resilience. Results: The prevalence of burnout was 16.84%, and high scores on depersonalization (DP) subscale were seen in males. Personal accomplishment (PA) scores were lower in the fifth and seventh semesters. A statistically significant correlation was observed between MBI and RSA subscales. Binary regression analysis revealed higher resilience scores were significantly associated with decreased likelihood of burnout in emotional exhaustion (odds ratio [OR] = 0.95; 95% confidence interval [CI] = 0.93-0.97), DP (OR = 0.95; 95% CI = 0.93–0.98), and PA (OR = 0.91; 95% CI = 0.84–0.98). Conclusions: Burnout prevalence in our sample lies at the lower range of global prevalence rates. Resilience is protective from burnout.
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Genetic association of the human GAP43 gene with schizophrenia in a Northeast Chinese Han population p. 413
Zhilin Luan, Wenhua Ming, Xiaoxiao Huo, Jingwei Yu, Bing Wang, Yang Sun
Background: GAP43, a membrane phosphoprotein with high expression level in the developing brains, plays an important role in higher integrative functions of the brain. Materials and Methods: To explore the association of GAP43 with schizophrenia, 11 single-nucleotide polymorphisms (SNPs) were examined in a Northeast Chinese Han sample set consisting of 741 schizophrenia patients and 1330 healthy controls. Results: The results showed that three SNPs were associated with schizophrenia (rs2028248, rs6790048, and rs2164930). Haplotype analysis also revealed a significant association of a strong linkage disequilibrium block (rs2164930-rs11926976-rs16823991) with schizophrenia. Conclusion: The current findings suggested that the human GAP43 gene may be a susceptibility gene for schizophrenia.
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Sexuality, sexual well being, and intimacy during COVID-19 pandemic: An advocacy perspective Highly accessed article p. 418
Debanjan Banerjee, T S Sathyanarayana Rao
The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS)-CoV-2, has emerged as a global public health threat. The implications are much beyond just health crisis, and it has long-lasting psychosocial and economic implications. Although the psychological offshoots such as depression, anxiety, posttraumatic stress, and sleep disturbances are being studied in-depth, there is a dearth of literature on the sexual well-being and sexual practices during this pandemic. Considering the physical distancing; travel restrictions; the high human–human transmission rate; misinformation and uncertainty about the sexual routes of transmission for SARS-CoV-2; and fear about intimacy, sexuality, and safe sexual practices have increased significantly. This is more prominent in newly settled or distanced couples and the frontline health workers, with increased risk exposure to the virus. For them, guilt and distress associated with sexual relationships might increase primary psychiatric and sexual disorders. This, in turn, impacts relationships and emotional bonding in couples and affects healthy coping during the pandemic crisis. Although sexual abstinence is the safest practice to prevent transmission, it is not practically feasible in all cases. Risk reduction counseling, sex with quarantined partners, and digital sex are other options that are worth exploring. There are additional concerns of digital safety, unhealthy use of technology, cyber-crimes, and online extortion. Keeping this in the background, this advocacy article glances through the effects of past outbreaks on sexuality, reviews the current recommendations, and proposes methods and approaches for sexual well-being during the COVID-19 pandemic, which is vital for overall public health.
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School-based substance use disorder prevention in India: A brief appraisal p. 427
Amrit Pattojoshi, Sai Krishna Tikka
Substance use among Indian school children is a rising concern. Awareness across Indian schools and mental health professions regarding school-based prevention programs for substance use is limited. Describing the globally recommended evidence-based school-based prevention programs, this commentary highlights their need, availability, feasibility, and cultural relevance in Indian context.
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Psychiatry postgraduate examinations for 2020 in the middle of COVID19 crisis: Suggestions from Indian teachers of psychiatry p. 431
M Kishor, Henal Shah, Suhas Chandran, Ashok V Mysore, Ajay Kumar, Vikas Menon, HR Vinay, Mohan Isaac, OP Singh
The COVID19 pandemic is an unprecedented disaster. In India, the spread of COVID19 infection and the subsequent lockdown coincided with a crucial period of the annual examination in almost all educational institutions. The pandemic has created hurdles in the conduct of examination due to many reasons, some of which are spread of infection and associated safety issues, lack of public transport for patients as well as the postgraduates in outstation and examiners, and lack of workforce due to round-the-clock service for rendering health services leading to difficulty in arranging logistics at the examination center. Currently, there are no guidelines or policies on how examinations need to be carried out during such a pandemic. Hence, there is an urgent need to look at solutions within the profession for the completion of examination. Teachers of psychiatry play an important role in the national mental health services. Their expertise can be valuable for finding solutions that work. This article has compiled suggestions from Indian teachers of psychiatry.
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A rare case report of Lilliputian and Brobdingnagian hallucinations in a case of pemphigus vulgaris p. 435
Roshan Sutar, Suman Patra, Faisal Siddiqui, Sanjeet Diwan, Abin Rajan
Pemphigus vulgaris is an autoimmune disorder characterized by intraepithelial, blistering lesions affecting the skin and mucous membrane. Psychiatric manifestations of pemphigus vulgaris are generally described secondary to steroid and immunosuppressant therapy though recent studies highlight independent association of pemphigus with psychotic disorders. We describe a unique development of Lilliputian hallucinations, their transformation into Brobdingnagian hallucinations on treatment with steroids and gradual resolution back to Lilliputian status on treatment with risperidone. Earlier Lilliputian hallucinations have been described in a case of Charles Bonnet syndrome, Balint syndrome, alcohol withdrawal delirium, head injury and dementia. This unique phenomenon carries it significance in the literature from psychopathological perspective.
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Not what it seems to be: Depression versus periodic limb movement disorder p. 437
Ravi Gupta, Kaustuv Kundu, Khwaja Khayyam, Lokesh Kumar Saini
Sleep disorders often disturb sleep. Daytime symptoms of disturb sleep mimic that of depression, somatoform disorder, fibromyalgia and chronic fatigue syndrome. We are presenting a case of depression who was not responding to antidepressant therapy. Based on clinical history, diagnosis was changed to chronic fatigue syndrome and in view of prominent sleep disturbances, polysomnography was done. Based on sleep study data, diagnosis of periodic limb movement disorder was made and he was started on ropinirole, that improved his symptoms.
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More evidence and attention are needed to clarify the correlation between moyamoya disease and attention deficit hyperactivity disorder p. 440
Jin Yu, Jibo Zhang, Jincao Chen
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Neurobiology of attention deficit hyperactivity disorder in moya moya disease p. 441
Patra Suravi, Patnaik Ashis
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Comparison of efficacy of ketamine versus thiopentone-assisted modified electroconvulsive therapy in major depression p. 442
Amit Jagtiani, Hitesh Khurana, Naveen Malhotra
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Comments on “Perspectives, attitude, and practice of lithium prescription among psychiatrists in India” p. 443
Kumar Thamaraiselvan Santhosh, Hallikere S Vishukumar
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National guidelines for media reporting of suicide p. 444
Smitha Ramadas, Praveenlal Kuttichira, Chittaranjan Andrade
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Comment on “Attitude, practice, behavior, and mental health impact of COVID-19 on doctors” p. 445
Aditya Somani, Ajay Kumar
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Authors' responses to the comments on “Attitude, practice, behavior, and mental health impact of COVID-19 on doctors” p. 446
Seshadri Sekhar Chatterjee, Ranjan Bhattacharyya, Sumita Bhattacharyya, Sukanya Gupta, Soumitra Das, Bejoy Bikram Banerjee
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Comments on “Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study” p. 447
Sourav Khanra, Nishant Goyal, Christoday Raja Jayant Khess
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Reply to the comments on “Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study” p. 448
Kaustav Chakraborty, Moumita Chatterjee
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Clinical features and suicidal behavior in major depression with comorbid attention-deficit hyperactivity disorder p. 449
Vikas Menon, Deepika Biyyala, Moushumi Purkayastha Mukherjee
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Mental Healthcare Act, 2017, and addiction treatment p. 450
Abhijit Nadkarni, Urvita Bhatia, Richard Velleman, Ravindra Agrawal, Soumitra Pathare
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Coping strategies used by postnatal mothers with perceived stress p. 451
Jagadeeswari Jayaseelan, M Prathap Mohan
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Personality characteristics of online gamers p. 453
Manoj Kumar Sharma, Nitin Anand, Keshava D Murthy
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”A tale of tail”: A case of lizard tail abuse p. 454
Soumitra Das, Seshadri Sekhar Chatterjee, Sayantanava Mitra
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