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   2018| January-March  | Volume 60 | Issue 1  
    Online since April 12, 2018

 
 
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LETTERS TO EDITOR
Decriminalization of suicide as per Section 115 of Mental Health Care Act 2017
V Sneha, Shivappa Madhusudhan, N Rudra Prashanth, Hongally Chandrashekar
January-March 2018, 60(1):147-148
DOI:10.4103/psychiatry.IndianJPsychiatry_335_17  PMID:29736081
  4,518 255 -
ORIGINAL ARTICLES
Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India
Kerem Boge, Aron Zieger, Aditya Mungee, Abhinav Tandon, Lukas Marian Fuchs, Georg Schomerus, Thi Minh Tam Ta, Michael Dettling, Malek Bajbouj, Matthias Angermeyer, Eric Hahn
January-March 2018, 60(1):24-31
DOI:10.4103/psychiatry.IndianJPsychiatry_406_17  PMID:29736059
Background: India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors. Materials and Methods: Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis. Results: Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts. Conclusion: Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.
  2,612 374 -
EDITORIAL
Cyberbullying: A virtual offense with real consequences
TS Sathyanarayana Rao, Deepali Bansal, Suhas Chandran
January-March 2018, 60(1):3-5
DOI:10.4103/psychiatry.IndianJPsychiatry_147_18  PMID:29736055
  2,235 503 -
ORIGINAL ARTICLES
General Health Questionnaire-12 reliability, factor structure, and external validity among older adults in India
Min Qin, Athina Vlachantoni, Maria Evandrou, Jane Falkingham
January-March 2018, 60(1):56-59
DOI:10.4103/psychiatry.IndianJPsychiatry_112_17  PMID:29736063
Aims: The purpose of this study is to analyze the internal consistency, factor structure, and external validity of the 12-item General Health Questionnaire (GHQ-12) among older adults in India. Settings and Design: This study analyzes data collected as part of the UNFPA "Building Knowledge Base on Ageing in India (BKPAI)" project. The BKPAI Survey was conducted in 2011 in seven major demographically advanced states of India – Himachal Pradesh, Punjab, West Bengal, Odisha, Maharashtra, Kerala, and Tamil Nadu. Materials and Methods: A community-based representative sample of 9692 respondents aged 60 and above from seven Indian states was employed. The GHQ-12 questionnaire was administered. Statistical Analysis: The Cronbach's alpha was calculated to analyze internal consistency. Factor analysis was applied to explore the factor structure of GHQ-12, and then correlation coefficients were calculated to examine the external validity of the measurement. Results: The Cronbach's alpha of the GHQ-12 is 0.9. Factor analysis reveals two significant components which accounted for 59% of the variance. The correlation between the overall score of GHQ-12 and the subjective well-being inventory (SUBI) is 0.58. Conclusions: The GHQ-12 shows adequate reliability among the older population in India.
  2,068 217 -
Mix headache: A valid clinical entity?
Tapas Kumar Aich, Uttam Gupta, Sandip Subedi
January-March 2018, 60(1):78-83
DOI:10.4103/psychiatry.IndianJPsychiatry_349_17  PMID:29736067
Background: Chronic daily headache (CDH) patients respond better with a combination of anti-migraine and anti-stress medications, irrespective of clinical diagnosis of chronic migraine (CM) or chronic tension-type headache (CTTH). Hypothesis: "CDH: Mix headache" type is a valid clinical entity. Materials and Methods: A total of 70 participants fulfilling the diagnosis of "primary CDH," aged between 15 and 55 years were taken up for the present study. All these patients were subdivided into either CM or CTTH, based on the predominance of symptom profiles in these patients, in confirmation with the International Headache Society guidelines (International Classification of Headache Disorders-2, 2004). Schedules for clinical assessment in neuropsychiatry (SCAN) were applied to these patients to collect information about any mental or behavioral symptoms present at the time of the study. Psychiatric comorbidity was confirmed according to the International Classification of Diseases (ICD)-10. Results: Forty-eight (68.6%) patients could be differentiated into CM and rest 22 (31.4%) patients were given a diagnosis of CTTH. SCAN and ICD-10 diagnosis revealed the presence of comorbid anxiety and depressive illness in 47 (67.2%) patients. Thirty-four of them belonged to CM (MH) group and the rest 13 had CTTH. Discussion: We propose that these 47 (67.2%) patients of CDH form our special category of "CDH - mix headache" subtype. Thus, 14 (20%) patients constitute "CDH - migraine" subtype and rest 9 (12.8%) patients have a diagnosis of "CDH - tension headache" subtype. Conclusion: Findings of the present study validate the concept of "mix headache" and explains the clinical observation that chronic daily headache (CDH) patients responds better with a combination of anti-migraine and anti-stress medications.
  2,098 164 -
A preliminary study of association of genetic variants with early response to olanzapine in schizophrenia
Anmol Singh, Ram Pratap Beniwal, Prachi Kukshal, Triptish Bhatia, BK Thelma, Smita N Deshpande
January-March 2018, 60(1):10-16
DOI:10.4103/psychiatry.IndianJPsychiatry_104_18  PMID:29736057
Background: Treatment response can be predicted in schizophrenia by DNA information in the drug metabolism pathways. This study aimed to examine clinical characteristics and genetic determinant (s) of early response to olanzapine treatment in schizophrenia using specified drug metabolizing genes. Materials and Methods: Consenting participants (n = 33) suffering from schizophrenia were diagnosed on Diagnostic Interview for Genetic Studies. Oral olanzapine was administered in an incremental dose up to 10 mg (2 weeks) and 20 mg (6 weeks). All participants were tested on Positive and Negative Syndrome Scale, Clinical Global Impressions, and Global Assessment of Functioning at 0, 2, and 6 weeks. Side effects were also evaluated. After 2 weeks, 11 (33.33%) fulfilled criteria for early response, whereas 17 (51.52%) responded at 6 weeks. We investigated the contribution of clinical factors and five polymorphisms (rs2740574, rs2470890, rs762551, rs3892097, and rs1065852) in predicting response to olanzapine at 2 and 6 weeks of treatment with a standard dose. Results: Severity of positive symptoms at baseline was associated with response at 2 weeks (P = 0.01) while higher scores on Scale for the Assessment of Negative Symptoms (SANS) at baseline was associated with response at both 2 (P = 0.04) and 6 weeks (P = 0.03). None of the five single nucleotide polymorphisms (SNPs) selected were significantly associated with response to olanzapine. Conclusions: Olanzapine is an effective and safe drug. Positive and Negative Syndrome Scale positive score and SANS score were variably associated with response at 2 and/or 6 weeks. Replicate studies with bigger sample size are warranted for conclusive results in the Indian population for genetic association.
  1,703 538 -
Prevalence and correlates of sexual dysfunction in male patients with alcohol dependence syndrome: A cross-sectional study
Deepak Koyilerian Prabhakaran, A Nisha, P Joseph Varghese
January-March 2018, 60(1):71-77
DOI:10.4103/psychiatry.IndianJPsychiatry_42_17  PMID:29736066
Background: Contrary to the popular belief concerning the aphrodisiac effects of alcohol, there exists scientific evidence which conclude on sexual dysfunction caused by chronic alcohol use. There is a dearth of studies from India. Aim: The aim is to estimate the prevalence and correlates of sexual dysfunction in alcohol-dependent patients and to explore the association between sexual dysfunction and various alcohol-related variables. Materials and Methods: The study employed a cross-sectional descriptive design and recruited 84 male patients admitted for de-addiction in a tertiary care center. The evaluation was conducted using a specially designed intake proforma and tools such as Severity of Alcohol Dependence Questionnaire, Arizona Sexual Experience Scale, and International Classification of Disease, 10th revision, diagnostic criteria for research. Results: Thirty-seven percent of the patients had sexual dysfunction – the most common type being erectile dysfunction (25%), followed by dysfunction in satisfying orgasm (20%) and premature ejaculation (15.5%). Sexual dysfunction was significantly associated with the duration of alcohol dependence, amount of alcohol consumed per day, and severity of alcohol dependence. Conclusions: Sexual dysfunction is common in male patients with alcohol dependence. The study highlights the detrimental effects of alcohol on sexual function and this information can be utilized in motivational interviewing of patients with alcohol dependence syndrome.
  1,787 366 -
GUEST EDITORIAL
The enigma of demonetization and the unexplored consequences
Arun Enara, Mahesh R Gowda
January-March 2018, 60(1):6-9
DOI:10.4103/psychiatry.IndianJPsychiatry_196_17  PMID:29736056
  1,773 366 -
ORIGINAL ARTICLES
Alcohol harm to adolescents from others' drinking: A study from Kerala, India
TS Jaisoorya, KV Beena, GS Ravi, K Thennarasu, Vivek Benegal
January-March 2018, 60(1):90-96
DOI:10.4103/psychiatry.IndianJPsychiatry_186_17  PMID:29736069
Context: There is scarce data on the prevalence of harm to adolescents from others' use of alcohol from India. Aims: The aim is to study the prevalence of harm to school students from others' alcohol use in the district of Ernakulam, Kerala and examines its psychosocial correlates among victims. Settings and Design: This was a cross-sectional survey of 7560 students of the age range of 12–19 years from 73 schools. Materials and Methods: Harm consequent to others' drinking was assessed using a brief version of the World Health Organization–Thai Health Questionnaire on Harm to Others from Drinking. Standardized instruments were used to assess other measures. Statistical Analysis: The prevalence of various harms was determined. Mixed-effect logistic regression was used to explore the sociodemographic, academic, and psychological factors associated with various types of harms and odds ratios reported. Results: Harm due to others' alcohol use was reported by 44.5%, frequent harm by 15.7%, psychological harm by 43.3%, physical harm by 9.7%, property harm by 2.9%, and financial harm by 15.4%. Boys reported greater harm than girls. Girls experienced relatively greater harm within the family and boys outside the family. Being older, having a part-time job and urban residence increased the odds of harm. Adolescents reporting harm had higher odds of substance use, psychological distress, suicidality, sexual abuse, and attention-deficit/hyperactivity disorder symptom-counts. Conclusion: The high prevalence of harm from others alcohol use to adolescents with multiple negative impacts underscore the urgent need for public health measures to reduce social costs of alcohol use.
  1,857 245 -
Prevalence of mental disorders in Punjab: Findings from National Mental Health Survey
BS Chavan, Subhash Das, Rohit Garg, Sonia Puri, Aravind A Banavaram
January-March 2018, 60(1):121-126
DOI:10.4103/psychiatry.IndianJPsychiatry_221_17  PMID:29736074
Background: Knowledge of the prevalence of mental disorders is essential for setting up services and allocation of resources. Existing studies suffer from methodological problems which limit their utility and generalizability. There was a long felt need to conduct a scientifically robust study in different regions of India to have national prevalence rates. Aims: This study aims to estimate the prevalence of mental disorders in a representative population of Punjab as a part of the National Mental Health Survey. Settings and Design: Community-based survey carried out in rural and urban areas of Punjab using multistage, stratified, random cluster sampling technique and random selection was based on Probability Proportion to Size. Materials and Methods: The survey was conducted in 60 clusters of 4 districts (Faridkot, Ludhiana, Moga, and Patiala) of Punjab. Mini-International Neuropsychiatric Interview adult version 6.0 for mental morbidity, case definition for generalized tonic–clonic seizure, an expansion of the Fagerström Nicotine Dependence Scale for tobacco use and screener for intellectual disability were used. Appropriate statistical methods were applied. Results: A total of 2895 respondents aged >18 years from 719 households were interviewed. The prevalence of lifetime and current mental morbidity was 17.94% and 13.42%, respectively. Higher prevalence of mental morbidity was found among persons aged >60 years and those belonging to lower income group and rural population. Conclusions: The prevalence of mental morbidity is high in the population. The findings give a clear picture of magnitude of the problem and will help policy planners to tackle the situation which looks grave and warrants immediate intervention.
  1,833 218 -
Understanding masked depression: A Clinical scenario
Prasad Shetty, Akshata Mane, Sourabh Fulmali, Ganesh Uchit
January-March 2018, 60(1):97-102
DOI:10.4103/psychiatry.IndianJPsychiatry_272_17  PMID:29736070
Background: Masked depression is often misdiagnosed due to the predominance of somatic symptoms and is further complicated by lack of awareness among doctors. Aim: The present survey was conducted to gather the views of psychiatrists and nonpsychiatrists regarding presentation and management aspects of masked depression. This may help in unmasking this condition and facilitate early identification and appropriate management of patients presenting with this condition. Materials and Methods: This questionnaire-based survey was conducted as an interview through computer-aided telephonic interview among 300 doctors (150 psychiatrists and 150 nonpsychiatrists) across India. Results: Both psychiatrists and nonpsychiatrists reported a high prevalence of somatic symptoms among patients with masked depression. Nonpsychiatrists (44%) more often than psychiatrists (20%) noted chronic pain in the majority of patients with masked depression. Psychiatrists (31%) more often than nonpsychiatrists (9%) noted lack of concentration in the majority of patients with masked depression. Sexual dysfunction among young patients and noncompliance to therapy for chronic illness were considered as potential predictors of masked depression. There was a general agreement among psychiatrists and nonpsychiatrists that medical liaising is beneficial for the management of patients with masked depression. Conclusion: Both psychiatrists and nonpsychiatrists agree that somatic symptoms are commonly encountered in patients with masked depression. However, these somatic symptoms are often interpreted as physical illness rather than as an entity of depression which creates an unmet need in terms of managing masked depression, especially by nonpsychiatrists.
  1,753 293 -
LETTERS TO EDITOR
Depression, anxiety and stress among pregnant women: A community-based study
Adity Priya, Sanjay Chaturvedi, Sanjiv Kumar Bhasin, Manjeet Singh Bhatia, Gita Radhakrishnan
January-March 2018, 60(1):151-152
DOI:10.4103/psychiatry.IndianJPsychiatry_230_17  PMID:29736084
  1,686 280 -
ORIGINAL ARTICLES
Impact of neuropsychological rehabilitation on activities of daily living and community reintegration of patients with traumatic brain injury
Amrita Kanchan, Amool Ranjan Singh, Nawab Akhtar Khan, Masroor Jahan, Rajesh Raman, TS Sathyanarayana Rao
January-March 2018, 60(1):38-48
DOI:10.4103/psychiatry.IndianJPsychiatry_118_17  PMID:29736061
Objectives: The present study was targeted to observe the impact of neuropsychological rehabilitation on activities of daily living (ADL) and community reintegration of patients with traumatic brain injury (TBI). Settings and Participants: Based on purposive sampling technique, ten patients with TBI falling in the age range of 20–40 years and fulfilling the inclusion and exclusion criteria were chosen from All India Institute of Speech and Hearing, Mysuru, India. Design: A quasi-experimental design, i.e., nonequivalent control group design was chosen for the study. Materials and Methods: Patients were assessed on Luria–Nebraska Neuropsychological Battery for Adults, Cognitive Symptoms Checklist, and Community Integration Questionnaire. Patients in experimental group were given neuropsychological rehabilitation for 6 months. Brainwave-R and Talking Pen were used as rehabilitative tools. Results: Patients with TBI have significant neuropsychological deficits observed in memory, visuo-spatial organization, arithmetic, spelling, writing, fine motor coordination, and executive functioning. Neuropsychological deficits have a major impact on ADL and community reintegration. Neuropsychological rehabilitation is effective in rehabilitating neuropsychological deficits, which in turn leads to improvement in ADL and community reintegration. Conclusion: Neuropsychological rehabilitation should be one of the major goals in rehabilitation procedures for patients with TBI in order to bring overall improvement in them.
  1,617 247 -
Improvement in neurocognitive functions and serum brain-derived neurotrophic factor levels in patients with depression treated with antidepressants and yoga
Naveen Gowrapura Halappa, Jagadisha Thirthalli, Shivarama Varambally, Mukund Rao, Rita Christopher, Gangadhar B Nanjundaiah
January-March 2018, 60(1):32-37
DOI:10.4103/psychiatry.IndianJPsychiatry_154_17  PMID:29736060
Context and Aims: Impairment in cognition is well-known in patients with major depressive disorder. This study examined the effect of yoga therapy with or without antidepressants and antidepressants alone on certain neuropsychological functions in patients with depression. Correlation between changes in neuropsychological test performance and serum brain-derived neurotrophic factor (BDNF) levels was also explored. Materials and Methods: Antidepressant-naïve/antidepressant-free outpatients with depression received antidepressant medication alone (n = 23) or yoga therapy with (n = 26) or without (n = 16) antidepressants. Depression was assessed using the Hamilton Depression Rating Scale. Neuropsychological tests included digit-span forward and backward, Rey Auditory Verbal Learning Test, and Trail Making Tests (TMT-A and B). These tests were administered before and 3 months after the treatment in patients, and once in healthy comparison subjects (n = 19). Statistical Analysis: Baseline differences were analyzed using independent sample t-test, Chi-square, and one-way ANOVA. Paired t-test was used to analyze the change from baseline to follow-up. Pearson's correlation was used to explore the association of change between 2 variables. Results: Patients had impaired performance on most neuropsychological tests. After 3 months, there was significant improvement – patients' performance was comparable to that of healthy controls on majority of the tests. Significant inverse correlation was observed between increase in BDNF levels and improvement in TMT "A" duration in Yoga-alone group (r = −0.647; P = 0.009). Conclusions: To conclude that, Yoga therapy, alone or in combination with medications, is associated with improved neuropsychological functions and neuroplastic effects in patients with depression.
  1,506 313 -
BRIEF RESEARCH COMMUNICATIONS
A study on association of iron deficiency with attention deficit hyperactivity disorder in a tertiary care center
Kamirul Islam, Soutrik Seth, Suman Saha, Atanu Roy, Rajib Das, Asok Kumar Datta
January-March 2018, 60(1):131-134
DOI:10.4103/psychiatry.IndianJPsychiatry_197_17  PMID:29736076
Background: Iron is important for brain development and cognitive function. Iron deficiency may cause alteration of neurotransmitters and may be manifested by different central nervous system disorders including attention deficit hyperactivity disorder (ADHD). Aims: As studies are scarce in the Indian context, we had undertaken this study to find out the association between iron deficiency and ADHD. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: Hematological parameters indicating iron status (hemoglobin [Hb], ferritin, Iron, total iron binding capacity [TIBC], mean corpuscular volume [MCV], and mean corpuscular Hb [MCH]) were measured among 119 ADHD patients selected by complete enumeration method and 119 controls. Statistical Analysis: Shapiro–Wilk test, Mann–Whitney U-test, Spearman's correlation, and binary logistic regression were used. P < 0.01 was taken as statistically significant. Results: Hb, iron, ferritin, MCV, and MCH were lower among cases and negatively correlated to ADHD, while reverse is true for TIBC and ADHD. Iron deficiency anemia makes one 3.82 times more prone for ADHD. Conclusion: Iron deficiency was associated with ADHD.
  1,469 298 -
EDITOR SPEAKS
Fond Reminiscenes and doting expectations......
TS Sathyanarayana Rao
January-March 2018, 60(1):1-2
DOI:10.4103/psychiatry.IndianJPsychiatry_146_18  PMID:29736054
  1,326 325 -
ORIGINAL ARTICLES
Psychiatric comorbidities in acute coronary syndromes: Six-month follow-up study
D Ramya Shruthi, S Sunil Kumar, Nagaraj Desai, Rajesh Raman, TS Sathyanarayana Rao
January-March 2018, 60(1):60-64
DOI:10.4103/psychiatry.IndianJPsychiatry_94_18  PMID:29736064
Introduction: Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India. Materials and Methods: The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis. Results: The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up. Conclusion: Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.
  1,321 279 -
BRIEF RESEARCH COMMUNICATIONS
A pilot study of MD (psychiatry) theses-based research
Shrikant Srivastava, Vivek Agarwal, Alka Subramanyam, Mona Srivastava, TS Sathyanarayana Rao, G Prasad Rao, Hitesh Khurana, Archana Singh
January-March 2018, 60(1):127-130
DOI:10.4103/psychiatry.IndianJPsychiatry_161_17  PMID:29736075
Introduction: Undertaking a research project is mandatory for MD Psychiatry trainees. The present study was undertaken to assess the type of research activity being undertaken as part of MD Psychiatry dissertation, and its contribution to national and international literature. Materials and Methods: Three medical colleges supplied the data about the topic, names of the supervisor and the candidate, collaboration, funding accrued, and publication details of MD-based research carried out between years 2000 and 2010 inclusive; 95 records were collected for the final analysis. The details of the publications provided were cross-checked on the internet, which would have taken care of missed publications as well. Results: Most studies were single-point assessment clinical studies. Only 2 studies had been funded, 11 had collaboration with other departments within the same institute, and 5 had inter-institute collaborations. Majority of the studies were not published. Only 30 were published as full paper and 9 as abstracts. Of these 30 full publications, only 3 were published in journals having JCI impact factor values (1.4, 1.3, and 1.4, respectively). Conclusions: The main finding of this pilot study was that MD-based research has low contribution to the national and international literature, and those articles which are published are in low impact journals. Suggestions for modifying this state of affairs are discussed.
  1,417 153 -
ORIGINAL ARTICLES
Effects of electrical stimulus composition on cardiac electrophysiology in a rodent model of electroconvulsive therapy
Nagendra Madan Singh, TN Sathyaprabha, Jagadisha Thirthalli, Chittaranjan Andrade
January-March 2018, 60(1):17-23
DOI:10.4103/psychiatry.IndianJPsychiatry_88_18  PMID:29736058
Background: No electroconvulsive therapy (ECT) study on humans or in animal models has so far examined whether differently composed electrical stimuli exert different cardiac electrophysiological effects at constant electrical dose. The subject is important because cardiac electrophysiological changes may provide indirect information about ECT seizure quality as modulated by stimulus composition. Materials and Methods: Adult female Wistar rats (n = 20/group) received fixed, moderately suprathreshold (18 mC) electrical stimuli. This stimulus in each of eight groups was formed by varying pulse amplitude, pulse width, pulse frequency, and stimulus duration. The electrocardiogram was recorded, and time and frequency domain variables were examined in 30 s epochs in preictal (30 s before electroconvulsive shock [ECS]), early postictal (starting 15 s after stimulation), and late postictal (5 h after ECS) periods. Alpha for statistical significance was set at P < 0.01 to adjust for multiple hypothesis testing. Results: Cardiac electrophysiological indices in the eight groups did not differ significantly at baseline. At both early and late postictal time points, almost no analysis yielded statistically significant differences between groups for four time domain variables, including heart rate and standard deviation of R-R intervals, and for six frequency domain variables, including low-frequency power, high-frequency power, and total power. Conclusions: Cardiac electrophysiological measures may not be helpful to identify differences in seizure quality that are driven by differences in the composition of electrical stimuli at constant, moderately suprathreshold electrical dose. The generalization of this conclusion to threshold electrical doses and to human contexts requires a study.
  1,350 217 -
Resilience in Wives of persons with Alcoholism: An Indian exploration
Pradeep R Johnson, Carl Britto, Kevin Jude Sudevan, Ashish Bosco, Priya Sreedaran, Mysore V Ashok
January-March 2018, 60(1):84-89
DOI:10.4103/psychiatry.IndianJPsychiatry_271_14  PMID:29736068
Context: Mental health has currently shifted focus from "deficit" to strength-based approaches such as Resilience. Coping styles and personality factors have been well studied in Wives of persons with Alcoholism (WopA) but not Resilience. Alcohol dependence in spouse is seen as an adversity. Aims: To evaluate Resilience in the WopA and explore its relationship with marital quality and clinical variables of Alcohol Dependence in their husbands. Settings and Design: A cross-sectional study in a tertiary care hospital in Bangalore, Karnataka. Subjects and Methods: WopA (n=34) between 25–55 years, were assessed for Resilience using Resilience Scale for Adults (RSA), while marital quality was assessed using Marital Quality Scale (MQS). The Severity of Alcohol Dependence, Age of onset of Initiation, Age of onset of Problem Drinking, and Age of onset of Dependence were evaluated in their husbands. Statistical Analysis: Independent sample t-test, Chi-square test, and Pearson's correlation were used. Results: Majority of the WopA (82%) scored low on the RSA. Low Resilience (LR) WopA scored significantly lower on all factors of RSA except the perception of future; in comparison to High Resilience (HR) WopA. Additionally, the LR WopA reported significantly poorer marital quality. Conclusions: Most WopA had low Resilience. LR WopA also had significantly poor marital quality. These findings need to be studied further in a larger population with culturally appropriate scales. The low scoring Resilience factors amongst WopA may be utilized in strength-based psychotherapeutic approaches. There is a need to improve the understanding of Resilience and its assessment in this population.
  1,319 242 -
CASE REPORTS
Galactorrhea with antidepressants: A case series
Navratan Suthar, Vrinda Pareek, Naresh Nebhinani, Deep Kunwar Suman
January-March 2018, 60(1):145-146
DOI:10.4103/psychiatry.IndianJPsychiatry_317_17  PMID:29736080
Galactorrhoea is a rare but distressing, and often embarrassing adverse effects of selective serotonin reuptake inhibitors (SSRIs) treatment. Here we report three cases that developed galactorrhoea with combination of SSRIs or combination of SSRI and SNRI/TCA and also review the literature of galactorrhoea with SSRIs.
  1,253 199 -
ORIGINAL ARTICLES
Dropout rates and factors associated with dropout from treatment among elderly patients attending the outpatient services of a tertiary care hospital
Sandeep Grover, Devakshi Dua, Subho Chakrabarti, Ajit Avasthi
January-March 2018, 60(1):49-55
DOI:10.4103/psychiatry.IndianJPsychiatry_410_17  PMID:29736062
Aim: This study aimed to evaluate the dropout rates from treatment and associated factors among elderly patients attending a tertiary care psychiatry outpatient facility. Materials and Methods: Data of 1422 patients aged ≥60 years, attending the walk-in clinic were evaluated. Results: Out of 1422 patients, 406 (28.55%) belonged to the "dropout" group. In the dropout group, the age of patients was significantly higher than the followed-up group, and a higher proportion of patients were >70 years old. Significantly lower proportion of patients with diagnosis of depressive disorders belonged to the "dropout" group and significantly higher proportion of patients with "other" diagnoses belonged to the "dropped out" group. In patients with depressive disorders, a higher proportion of the patients in the "dropout" group were Hindu by religion (68.7% vs. 58.7%; χ2 = 4.26; P = 0.03). In patients with bipolar disorder, patients in the "dropout" group had significantly higher income (Rs. 13,323 [standard deviation [SD] = 16,769] vs. 5681 [SD = 9422]; t-test value: 2–25; P = 0.028) and lesser proportion of patients were of the male gender (63.15 vs. 86.95%; Mann–Whitney U value = 257.5; P = 0.039). In the group of other diagnoses, a higher proportion of patients in the "dropout" group were currently single (32.3% vs. 18.7%; χ2 = 4.12; P = 0.042), from rural locality (63.1% vs. 46.72%; χ2 = 4.33; P = 0.037) and were not prescribed medications (40% vs. 22.4%; χ2 = 6.05; P = 0.04). Conclusion: Dropout from treatment among elderly patients is associated with higher age, not being prescribed medications, and diagnosis other than the affective disorders, psychotic disorders, and the cognitive disorders.
  1,108 149 -
LETTERS TO EDITOR
The princess of polka dots: Using art as a medium to cope with hallucinations
KV Suma, Suhas Chandran, TS Sathyanarayana Rao
January-March 2018, 60(1):156-158
DOI:10.4103/psychiatry.IndianJPsychiatry_149_18  PMID:29736088
  1,037 166 -
ORIGINAL ARTICLES
Effect of moderate learning style–teaching mode mismatch on academic performance among 2nd year medical students in Pakistan
Muhammad Hamza, Inam-Ul-Haq , Sidra Hamid, Maha Nadir, Nadir Mehmood
January-March 2018, 60(1):109-113
DOI:10.4103/psychiatry.IndianJPsychiatry_194_17  PMID:29736072
Introduction: The vagueness surrounding ≴learning style–teaching mode mismatch≵ makes its effects uncertain. This study tried to tackle that controversy by comparing and assessing the effect of different learning styles on performance in physiology examination when teaching mode was somewhat different than learning preferences of the 2nd year medical students. Methods: A total of 102 2nd year medical students participated in this study. Honey and Mumford learning style questionnaire was used to categorize the participants into one of the four learning styles (activist, reflector, theorist, and pragmatist). Many teaching modes were used in the medical college. The first professional theory and practical physiology scores of these 102 students of University of Health Sciences were obtained online. Learning styles were compared with physiology scores and age using one-way analysis of variance and post hoc statistical analysis and between males and females by using Chi-square test. Results: Pragmatists had the lowest total physiology score (P < 0.001), while theorists had the highest total physiology scores (P < 0.001). Activists and reflectors had scores in between pragmatists and theorists, and there was no statistical difference between these two styles of learning (P = 0.9). No student scored below 60%. Conclusion: This study demonstrated that the effect of moderate teaching–learning mismatch is different for different learners. Theorists excelled as they had the highest physiology score, while pragmatists lagged in comparison. Reflectors and activists performed better than pragmatists but were worse than theorists. Despite this, none of the students scored below 60%. This shows that a moderate learning style–teaching mode mismatch is not harmful for learning.
  1,075 126 -
Effectiveness of a new low-cost psychosocial rehabilitative model to reduce burden of disease among persons with severe mental illness: An interventional follow-up study
Roy Abraham Kallivayalil, Sanu Sudhakar
January-March 2018, 60(1):65-70
DOI:10.4103/psychiatry.IndianJPsychiatry_85_17  PMID:29736065
Context: Mental health disorders are an important factor contributing to the global burden to disease. Less than 1% of the health budgets in 62% of developing nations and 16% of developed nations are spent on mental health services. The availability of mental health rehabilitative services remains minimal. Aims: This study aims to find the effectiveness of a new low-cost psychosocial rehabilitation model. Setting and Design: The study was conducted at a rehabilitation center. An interventional follow-up study was designed. Materials and Methods: A new low-cost psychosocial rehabilitative model was employed for 6 months for persons residing at a rehabilitation center. The World Health Organization Quality of Life (WHOQOL-BREF) instrument, WHO Disability Assessment Schedule (WHODAS) 2.0, and WHO (Five) Well-Being Index would be scored before and after the intervention. Statistical Analysis: The differences between the scores were analyzed using paired t-test or Wilcoxon signed rank test, whichever is applicable. P < 0.05 was taken as statistically significant. Results: Sample size was 110. 29.1% were rehabilitated and 68.2% remained at the rehabilitation center at 6 months. The pre- and post-test scores using the new model showed improvement in the scores. The mean scores for WHO-BREF, WHO-5 score, WHODAS-2 score were 73.2, 51.14, and 20.34, respectively. On follow-up, the scores improved to 82.6, 67.09, and 15.96, respectively. Conclusions: The low-cost psychosocial rehabilitative model was found to be effective. This could serve as a model not only for other similar centers in India and but also for other low- and middle-income group countries.
  965 187 -
Assessing the extent of utilization of biopsychosocial model in doctor–patient interaction in public sector hospitals of a developing country
Maha Nadir, Muhammad Hamza, Nadir Mehmood
January-March 2018, 60(1):103-108
DOI:10.4103/psychiatry.IndianJPsychiatry_153_17  PMID:29736071
Background: Biopsychosocial (BPS) model has been a mainstay in the ideal practice of modern medicine. It is attributed to improve patient care, compliance, and satisfaction and to reduce doctor–patient conflict. The study aimed to understand the importance given to BPS model while conducting routine doctor–patient interactions in public sector hospitals of a developing country where health resources are limited. The study was conducted in Rawalpindi, Pakistan. Materials and Methods: The study design is qualitative. Structured interviews were conducted from 44 patients from surgical and medical units of Benazir Bhutto Hospital and Holy Family Hospital. The questions were formulated based on patient-centered interviewing methods by reviewing the literature on BPS model. The analysis was done thematically using the software NVivo 11 for qualitative data. Results: The study revealed four emerging themes: (1) Lack of doctor–patient rapport. (2) Utilization of a paternalistic approach during treatment. (3) Utilization of a reductionist biomedical approach during treatment. (4) Patients' concern with their improvement in health and doctor's demeanor. Conclusion: The study highlights the fact that BPS is not given considerable importance while taking routine medical history. This process remains doctor centered and paternalistic. However, patients are more concerned with their improvement in health rather than whether or not they are being provided informational care. Sequential studies will have to be conducted to determine whether this significantly affects patient care and compliance and whether BPS is a workable model in the healthcare system in the third world.
  1,028 122 -
MISCELLANY
The Lord Buddha destigmatizes mental illness
Ottilingam Somasundaram, Tejus Murthy
January-March 2018, 60(1):135-137
DOI:10.4103/psychiatry.IndianJPsychiatry_293_17  PMID:29736077
The authors describe the encounter of Lord Buddha with a greatly mentally disturbed woman named as Patacara (literally in Pali: "the shameless" or "the naked" woman). His reception of her in spite of the dislike of the listeners of his discourse, his explanation of her difficulties, and consolation are mentioned. Her elevation as one of the great Bhikkunis as "The One with Discipline of the Mind" is an outstanding example of destigmatization of mental illness.
  978 159 -
CASE REPORTS
Nonpharmacological methods in managing patients with dementia in a tertiary care hospital
Nisha Mani Pandey, Shailendra Mohan Tripathi, Bhupendra Singh, Sarvada Chandra Tiwari
January-March 2018, 60(1):141-144
DOI:10.4103/psychiatry.IndianJPsychiatry_365_17  PMID:29736079
Management of dementia is very crucial. Nonpharmacological methods (NPM) are well appreciated and encouraged to be used as first-line treatment for managing elderly patients with dementia (PwD). The present case reports aimed to share the strategies of NPM for managing PwD. NPM requires a structured blueprint to record, follow-up, and monitor the outcomes. A structured proforma has been developed in the department. After getting all the basic information from the patient, needed assessments are being done by the concerned team member to identify and rate the level of severity of the problem, and specific NPM strategies are being provided. Concerted efforts give positive results; knowledge and understanding about the illness help the caregiver in managing the patient. No negative impact has been reported; NPM is a cost-effective approach and therefore should be studied on a larger level to provide evidence from India and prove its efficacy.
  943 130 -
Deep brain stimulation of anteromedial globus pallidus internus for severe Tourette syndrome
Paresh K Doshi, Raghvendra Ramdasi, Smita Thorve
January-March 2018, 60(1):138-140
DOI:10.4103/psychiatry.IndianJPsychiatry_53_18  PMID:29736078
Tourette syndrome (TS) is a complex disorder characterized by tics and is associated with behavioral problems. Although its intensity decreases in adolescence and adult life, in some cases it continues to remain severe and refractory to medical treatment. Deep brain stimulation has been offered as a treatment option in such cases. We report two cases of TS treated with of anteromedial globus pallidum internus. Both the cases had good postoperative control of tics and associated obsessive–compulsive behavior.
  886 126 -
ORIGINAL ARTICLES
A study of neuropsychological profile of human immunodeficiency virus-positive children and adolescents on antiretroviral therapy
Vasantmeghna S Murthy, Ajita S Nayak, Minal K Joshi, Kaneenica Ninawe
January-March 2018, 60(1):114-120
DOI:10.4103/psychiatry.IndianJPsychiatry_200_17  PMID:29736073
Aims: The aim is to study the neuropsychological and functional profile of children and adolescents with human immunodeficiency virus (HIV) infection on antiretroviral therapy (ART) and the association between the neuropsychological status and medical illness variables, treatment variables, and functional status in the cases of the sample and compare with normal controls. Materials and Methods: Forty-two HIV-positive children and adolescents on ART were evaluated and compared with 40 matched controls not known to be HIV-positive. The tools used were the Wechsler Intelligence Scale for Children-III R for neuropsychological evaluation, the Brief Impairment Scale to assess functional impairment, and a semi-structured questionnaire to obtain other relevant details. Results: There were significant differences between the verbal, performance intelligence quotients (IQs), global IQ score, and several individual subtests between cases and controls. The HIV group was also found to have a significant functional impairment. Conclusion: Our findings show that HIV infection is associated with significant cognitive and functional impairment. The role of ART in these impairments requires further study. Such understanding can help to introduce wholesome and relatively safer management strategies for youngsters with HIV infection and improve their quality of life.
  849 124 -
LETTERS TO EDITOR
Kinesiophobia after complex regional pain syndrome type one in a case of stroke hemiplegia and effect of cognitive behavior therapy
Damayanti Sethy, Surjeet Sahoo
January-March 2018, 60(1):152-154
DOI:10.4103/psychiatry.IndianJPsychiatry_201_17  PMID:29736085
  849 115 -
Dyke-Davidoff-Masson syndrome presenting with bipolar I mania with psychosis
Pooja Kumari, Harim Mohsin, Maju Mathew Koola
January-March 2018, 60(1):149-151
DOI:10.4103/psychiatry.IndianJPsychiatry_229_17  PMID:29736083
  830 127 -
Hair loss due to methylphenidate use: A case study
Oznur Bilac, Meryem Özlem Kütük, Cemal Bilaç
January-March 2018, 60(1):159-160
DOI:10.4103/psychiatry.IndianJPsychiatry_156_16  PMID:29736089
  752 92 -
BOOK REVIEW
Textbook of Child and Adolescent Psychiatry
V Ashok Mysore
January-March 2018, 60(1):161-162
DOI:10.4103/psychiatry.IndianJPsychiatry_122_18  
  617 146 -
LETTERS TO EDITOR
Antidepressant compliance in a rural setting: Response
TS Sathyanarayana Rao, Chittaranjan Andrade
January-March 2018, 60(1):148-149
DOI:10.4103/psychiatry.IndianJPsychiatry_138_18  PMID:29736082
  650 74 -
Response to issues concerning the article “Treatment compliance and noncompliance in psychoses”
K Nagaraja Rao
January-March 2018, 60(1):154-155
DOI:10.4103/psychiatry.IndianJPsychiatry_163_18  PMID:29736086
  600 63 -
Wisconsin card sorting test performance impairment in schizophrenia: Flaws in a report
Pravesh Parekh, Avinash Shukla, Migita Michael Dcruz, Satish Suhas, Chittaranjan Andrade
January-March 2018, 60(1):155-156
DOI:10.4103/psychiatry.IndianJPsychiatry_31_18  PMID:29736087
  601 58 -