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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 7 | Issue 1
Page Nos. 1-76

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EDITORIAL  

Empathy in clinical practice p. 1
Sai Krishna Puli
DOI:10.4103/tjp.tjp_26_21  
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REVIEW ARTICLE Top

Advance directives for euthanasia in India: Role of psychiatrist p. 3
Bhogaraju Anand
DOI:10.4103/tjp.tjp_19_21  
This review article starts by defining Good death, Euthanasia, and Advance Directives (ADs). Most of the religions in India do not support self-annihilation although exceptions are made in cases of “Samadhi” by saints. Indian law permits the donation of organs in brain dead patients, while Euthanasia is viewed as a criminal act. The case of Aruna Shanbaug and a plea for Euthanasia resulted in the Honorable Apex court of India permitting passive euthanasia and also issued ADs. It is now for the parliament to debate and enact. The role of a psychiatrist at present appears limited in the context of Euthanasia and Advanced Directives, but in future, importance might increase with psychiatric comorbidities being higher in incurable conditions and suffering. Literature from foreign countries shows that patients with mental illness have also undergone Euthanasia which is of grave concern.
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ORIGINAL ARTICLES Top

Depression, anxiety, and stress among domestic migrants during COVID-19 pandemic in Hyderabad p. 10
Lakshmi Keerthana Thatavarthi, Vijay Kumar Modala, Phanikanth Kondaparthi
DOI:10.4103/tjp.tjp_22_21  
Context: In the current pandemic, migrants face specific stressors like separation from family, un-sanitized housing, overcrowded conditions, financial instability resulting in poor coping strategies and making them more prone to mental illness. It is crucial to address their psychological needs and contribute to the literature. Aim: The study was done to assess depression, anxiety, and stress in domestic migrants along with domestic migration stress and COVID 19-related anxiety. Materials and Methods: It was a cross-sectional study conducted in Hyderabad, Telangana among 70 individuals who have migrated from their home states, chosen after obtaining informed consent. Domestic migration stress questionnaire to evaluate migration stress, depression anxiety stress scale-21 to evaluate depression, anxiety and stress, and the corona anxiety scale to evaluate anxiety-related to pandemic were used. Data were analyzed using the statistical package for the Social Science Version 25.0. Results: The study population was screened and was found to experience symptoms of severe depression (mean 21.43), severe anxiety (mean = 16.80), and moderate stress (20.43). They had considerable domestic migration stress (mean = 41.03) and COVID related anxiety (mean = 9.78). Domestic migration stress and COVID anxiety together had significantly impact on depression, anxiety, and stress. COVID anxiety alone affected depression and anxiety significantly. Domestic migration stress alone when analyzed had impact on the stress experienced. Conclusion: Depression, anxiety, and stress symptoms among the domestic migrant population are very prevalent currently. The mental health of migrants should be made a priority and active awareness programs and screening should be done. Further large-scale studies with adequate funding from the government and appreciable concern from the mental healthcare providers should be done.
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A cross-sectional study of intimate partner violence, adverse childhood experiences, and psychiatric morbidity in females with mental illness at a tertiary hospital p. 16
Sanchita Gour, Sireesha S Rao
DOI:10.4103/tjp.tjp_21_21  
Background: Intimate partner violence (IPV) has an adverse effect on the mental health of women. Sparse literature is available on IPV in women with mental illness. Aims and Objectives: This study was carried out to assess the proportion of IPV, its correlation with sociodemographic factors, and its association with adverse childhood experiences. Materials and Methods: The study was cross-sectional. Convenient sampling technique was used to collect the sample. Remitted female patients were assessed on the Abuse Assessment screen and Adverse Childhood Experiences Scale. Semi-structured intake pro forma was used to enter sociodemographic details and diagnosis (as per International classification of diseases-10). Data were analyzed using SPSS V.22. Results: Proportion of IPV among female study subjects were found to be 67.14%. IPV was found to be more among subjects who were unmarried, single, divorced, those who had borderline, histrionic traits, and those whose partners were dependent on alcohol. IPV showed a positive correlation with adverse childhood experiences. Study subjects who showed more ACE showed a positive correlation with a family history of substance abuse, suicide attempts, and histrionic and borderline personality traits Conclusion: IPV was high among patients with mental illness. Risk is high if the partner has alcohol dependence syndrome. Marriage was found to be protective against IPV. Prevention and intervention programs and marital counseling should be directed toward the assessment and treatment of IPV among females with psychiatric disorders.
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Procrastination and self-compassion in individuals with anxiety disorders p. 22
Pratishtha Petwal, Paulomi Matam Sudhir, Seema Mehrotra
DOI:10.4103/tjp.tjp_20_21  
Background and Aim: Literature on procrastination suggests that it is related to varied negative outcomes in the nonclinical population; however, there is a paucity of studies examining procrastination in the clinical population. We examined procrastination and self-compassion in persons with anxiety disorders. Methods: Forty-nine individuals diagnosed with an anxiety disorder, between 18 and 50 years of age, were recruited from a tertiary care center. Participants were assessed using the Decisional Procrastination Scale, the Adult Inventory of Procrastination, the Self-Compassion Scale, the Overall Anxiety Severity and Impairment Scale, and the Beck Depression Inventory-II. Results: Results indicated that individuals with anxiety disorders reported elevated procrastination and low self-compassion. Self-compassion and decisional procrastination were significantly negatively correlated. The subjective distress due to procrastination reported by the participants was significantly positively correlated with decisional procrastination. Self-compassion and anxiety severity were found to be negatively correlated. Self-compassion was a significant predictor of decisional procrastination and anxiety severity. Conclusion: The findings of the present study highlight the significance of assessing procrastination in anxiety disorders and indicate that self-compassion-based interventions may be helpful in alleviating anxiety symptoms and in reducing decisional procrastination.
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Health-related quality of life and psychological well-being in chronic obstructive pulmonary diseases p. 29
Shinjini Samajdar, Susmita Halder
DOI:10.4103/tjp.tjp_18_21  
Background: Chronic obstructive pulmonary disease (COPD) is a persistent inflammatory lung disease which is characterized by progressive and partially reversible symptoms. The incidence rate of COPD is accelerating and becoming remarkable among worldwide population. Increasing recognition of psychological comorbidities among patients with COPD is more likely to be seen than non-COPD patients. Impairment in physiological functioning and restricted lifestyle leads to higher rate of mental health deterioration. Understanding the spectrum of negative consequences related to the psychological and social functioning of the patients with COPD has been underrecognized, and deficits are mostly untreated. Due to deleterious effects of COPD on physical functioning, decline in quality of life (QOL) has been acknowledged. Aim: The aim of the study is to compare the health-related QOL (HRQL) and psychological well-being between COPD patients and normal controls. Methods: In the present study, sixty individuals, thirty individuals diagnosed with COPD and 30 normal controls were taken of both genders, with the age range of 50–70 years. Measures were taken on the basis of psychological well-being and HRQOL. Results: Results suggest that individuals with COPD differed significantly in subjective psychological well-being and HRQOL in comparison with normal controls. Conclusion: In conclusion, COPD affects patients overall psychological well-being and QOL adversely, and requirement of comprehensive psychosocial management is recommended.
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Clinico-etiological profiles in patients with delirium in intensive care unit setting p. 35
Indukuri Suchaitri Reddy, Pavan Kumar Kulkarni, Preeti Gudlavallety, Pragathi Gollepally, Gopinath Sriperumbudur
DOI:10.4103/tjp.tjp_14_21  
Background: Delirium is a neuropsychiatric disorder with a prevalence ranging from 16% to 53.6% in India. Although delirium is characterized as a unitary syndrome, not all symptoms follow the same trajectory over the course. Hence, there is a necessity for a larger number of studies to understand these phenomenological and etiological profiles across different regions in India. Aim: To study the clinico-etiological variables and phenomenological profile in delirium in the intensive care unit (ICU) setting. Materials and Methods: A longitudinal prospective study was conducted in a tertiary care hospital including all consecutive delirium patients who referred to the psychiatry department from ICU. All the participants' socioeconomic data were obtained and were administered. Charlson comorbidity index, Neelon and Champagne confusion scale, Richmond agitation sedation scale, delirium etiology checklist, delirium revised scale, revised-98, descriptive statistics, and ANOVA were used for statistical analysis. Results: Out of 51 study population, the mean age was 57.82 ± 17.19 years, with male preponderance and belonging to lower-middle and upper-lower class. 70.58% of the patients were found to have moderate–severe delirium. Majority of the referral population are from general medicine and of hyperactive delirium. There is no association established with the number of drugs and comorbidities with delirium severity. Metabolic disturbances are most common; sleep–wake cycle disturbance has the highest score and also the most common feature in delirium severity. Conclusion: Majority of the cases who were referred are male in moderate–severe stage and hyperactive delirium. As the detection of cases is challenging in the ICU settings, better understanding of the underlined etiological and phenomenological profiles may aid in easy identification of delirium cases at early stages.
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Mental health problems during COVID-19 outbreak in social health-care workers in Karimnagar p. 42
Shiva Kumar Rachakatla, Kishan Porandla, P Sai Krishna, N D Sanjay Kumar, Vishnu Vardhan Mavillapalli, Sphurti Pusukuri, Ayesha Sultana
DOI:10.4103/tjp.tjp_10_21  
Introduction: The COVID-19 outbreak has created unpredictable stress physically and mentally in all sections of population. There is no exception for health-care workers being in frontline during this crisis period. Due to the virus rapid transmission and the pattern of clinical presentation, uncertainty, is created in the form of health emergency all over. There is a need to address mental health issues during this pandemic outbreak of COVID-19 in those who are in frontline. Subjects and Methods: It is an observational cross-sectional study performed in social health-care workers (accredited social health activist [ASHA]) to know the psychological disturbances during COVID-19 outbreak. This study has been done in primary health centers located in and around Karimnagar City, Telangana. The scale used to perform this study is Depression, Anxiety, and Stress Scale of 21 questions. Results: Out of 181 ASHA workers interviewed, majority of ASHA workers were at normal emotional states of depression (81.8%) and stress (91.2%), but about half (91, 50.3%) of them had moderate level of anxiety and 16 (9%) had severe anxiety level. Only 12 (6.6%) and 4 (2.2%) had moderate depression level, and stress level, respectively. Out of 91 ASHA workers who had moderate level of anxiety, only one had moderate level of depression and out of 16 who had severe level of anxiety, all of them had normal level of depression and stress. Conclusion: Frontline health care workers experience psychological disturbances during pandemics like COVID-19 to a certain degree. Administrators should be aware that the mental health support of health care workers is an important part of the COVID- 19 response. Educational interventions, to ensure understanding and use of infectious control measures. Psychological support, like counselling services and development of support systems among colleagues.
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A cross-sectional survey of psychosocial effects of COVID-19 on doctors working in a tertiary care hospital p. 47
Sushmitha Kota, Shankar Kumar, Anvitha Kayarpady, Archana Gopal, NR Prashanth
DOI:10.4103/tjp.tjp_6_21  
Background: The novel coronavirus disease (COVID-19) outbreak has made great psychological impact on the medical fraternity. Concerns such as fear of infection and inadequate PPE can lead to psychological distress impairing functioning. Aims: The aim of the study was to assess psychosocial effects among doctors working with COVID-19 patients and to study the association of these concerns with psychological distress. Settings and Design: It was a cross-sectional study conducted among 150 doctors in a tertiary care hospital treating COVID-19 patients for a period of 2 months. Materials and Methods: A pro forma containing sociodemographic details, concerns regarding COVID-19 and perceived needs that could reduce stress among the doctors, Depression Anxiety and Stress Scale 21 was sent using Google Forms to consenting doctors. Data were entered on SPSSv20. Data were analyzed using Chi-square test to compare concerns, univariate and multivariate logistic regression was done to predict stress using concerns. Results: Out of 150 doctors, 53 (35.33%) were male and 97 (52.67%) were female. The main concerns were fear of infecting colleagues and family members (55.33%), not getting adequate support from the management (47.33%), fear of infecting themselves (22%), and fear of death (22.66%). Working as a team (76.67%), provision of adequate PPE (63.33%), positive attitude of colleagues (62.67%), recognition of work by the management (58.67%), provision of adequate training (56.67%), and family support (53.33%) were the main perceived needs of the doctors which could reduce stress. Those with “high stress” significantly had greater helplessness, loneliness, and feeling avoided by people and fear of death due to COVID-19 (P: 0.05, 0.001, 0.002, and 0.01, respectively). Conclusions: The chief concerns among doctors working in COVID hospitals were regarding safety (infecting family members) and stigma and discrimination by the society. Factors which they perceived would reduce stress were working in a team, social support, and provision of safety measures by administration/management.
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A qualitative study regarding stress and coping in frontline postgraduate trainee doctors working at a COVID hospital p. 54
Ivan Stanley Netto, Niteen Abhivant, Kunal Shewale, Nirali Muchala
DOI:10.4103/tjp.tjp_4_21  
Context: There are few studies regarding stress and coping in postgraduate trainee doctors (PGTDs) working with COVID-19 patients during the first phase of the COVID-19 pandemic in the Indian setting. Aims: This qualitative study examines the causes of stress, the stress experience, and the coping methods in PGTDs working with COVID-19 patients. Setting: This study was conducted at a tertiary referral hospital with an attached medical college and a COVID-19 hospital in India. Materials and Methods: This qualitative study used in-depth audio interviews with PGTDs. Statistical Analysis: Content analysis was used to identify direct and latent themes. Results: Thematic saturation was achieved with 13 participants. The major themes were related to the causes of stress, the stress experiences, and the coping with stress in PGTDs while working with COVID-19 patients. Conclusions: There are various causes of stress reported by PGTDs while doing their COVID duties. The stress was due to external and internal stressors. Most experience some degree of stress while working in COVID-19 wards. This was more during their first duties, but subsequent ones are less stressful. Most use healthy coping mechanisms to cope with the stress. The advice they have for other COVID-19 HCWs has also been reported. Implications: This will be useful to plan suitable interventions, training, research, and policy for PGTDs working with COVID-19 patients in the Indian setting.
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BRIEF RESEARCH COMMUNICATION Top

Opioid dependence growing concern: A profile of a tertiary care hospital in North India p. 61
Sunila Rathee, Vinay Kumar, Bhupendra Singh, Rajiv Gupta
DOI:10.4103/tjp.tjp_1_21  
Background: It is well-known that opioids are one of the world's most challenging substances which are growing rapidly. India too has a considerable problem of opioid use. State Drug Dependence and Treatment Center, Rohtak is only center in Haryana proving treatment with opioid substitution therapy. Aim: The present study was aimed to draw a profile of the patients attending this treatment facility. Methods: It was a retrospective secondary data-based study for the year 2018–2019. All the data records were reviewed and tabulated for the interpretation. Results: The present study found that maximum (46%) of the participants were from the age group of 20–29, almost males married and unmarried both were seeking treatment, 70% of them were educated at least up to secondary slandered but maximum (42%) were unemployed. Age of initiation was vary from 10 to 29 years and 74.2% were reported addiction of heroin. Chasing was the most popular method of consumption followed by oral and intravenous. Support from family was reflected in the referrals, and it can be considered as good for the better outcome and reduction of relapse. Conclusion: Opioid use is growing among adult males that need immediate attention of care.
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CASE REPORTS Top

Nonparaneoplastic anti-N-methyl-D-aspartate receptor encephalitis with subclinical hyperthyroidism associated with thyroid antibodies p. 66
Sukeerthi Busi, Pavan Kumar Kadiyala, N Pushparaju
DOI:10.4103/tjp.tjp_15_21  
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is an autoimmune disorder with neuropsychiatric symptoms. It is most often misdiagnosed initially as a primary psychiatric disorder. Young women in the background of ovarian teratomas, viral infections are most commonly impacted. Recently, the coexistence of anti-thyroid antibodies with anti-NMDAR antibodies in nonparaneoplastic anti-NMDAR encephalitis has come to light. A 32-year-old married female presented with sudden onset of disruptive and ritualistic behavior, decreased need for sleep, preceded by spikes of high-grade fever, chills, and rigor. Later, she developed episodes of catatonia alternating with spontaneous speech associated with shouting and crying spells. Blood investigations (except for hyperthyroidism and anti-thyroid antibodies), brain imaging, electroencephalogram, and cerebrospinal fluid (CSF) analysis were normal. She was treated with lorazepam (to a maximum of 16 mg), antipsychotics, antidepressants, anticonvulsants, dopaminergic, and steroid drugs with no significant improvement. CSF analysis was repeated for the encephalitis panel and revealed anti-NMDAR encephalitis. The patient was started with intravenous immunoglobulin for 5 days which led to significant clinical improvement. Screening for encephalitis is considered necessary in patients with altered behavior, not responding to symptomatic psychotropic and neurological treatments.
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Sodium valproate-induced necrotizing pancreatitis in a patient with bipolar mania p. 70
Sripathi Santhosh Goud, Vishal Indla
DOI:10.4103/tjp.tjp_13_21  
Bipolar disorder is a chronic complex disorder that requires lifelong maintenance treatment. Sodium valproate is an effective first-line drug for bipolar mania. Adverse effects associated with valproate are typically benign, but there are serious adverse effects that are less frequently seen. Acute pancreatitis is a very rare side effect seen with valproate use with a high mortality rate. We report the case of a 24-year-old male patient with bipolar mania who developed acute necrotizing pancreatitis with sodium valproate.
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THE STALWARTS Top

Dr. Vidya Sagar (1909–1978) p. 72
S Uma Maheswari
DOI:10.4103/tjp.tjp_11_21  
Dr. Hoch, Consultant, WHO, on his visit to Mental Hospital, Amritsar, in November 1964 said, “You have here at Amritsar a sea of nectar of human kindness and also a Dr. Vidya Sagar, a sea of wisdom. May they never dry up.” He was talking about Dr. Vidya Sagar Diwan, a legendary figure in Psychiatry. Dr. Vidya Sagar was a pioneer in community psychiatry, showing how modern psychiatry can be adapted to local conditions. During the horrific times of partition, when a huge number of patients with mental illness were sent to Amritsar and kept in army barracks, Dr. Vidya Sagar's devotion to the service of these patients was phenomenal. Community Psychiatry has come a long way in India. The building blocks were laid by Dr. Vidya Sagar, in 1950, by constructing tents and involving family members in the treatment of persons with mental illness in Amritsar.
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Professor Julian Paul Leff p. 74
Hamza Hussain
DOI:10.4103/tjp.tjp_5_21  
Professor Julian Paul Leff was trained at University College Hospital and Maudsley hospital, he was emeritus professor at Institute of Psychiatry. He had 38 years of research experience with medical research council. He developed psychosocial interventions involving intensive group and individual work with families instead of treating patient alone. He was the pioneer in cultural psychiatry and conducted cross cultural studies demonstrating the association between high expressed emotions and relapse of psychosis in different cultures. With more than 150 researches, review articles, more than 10 books authored, co-authored and edited, he left treasury behind him and physically parted from us on February 23, 2021, surrounded by his family members.
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