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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 8 | Issue 2
Page Nos. 57-129

Online since Friday, December 16, 2022

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EDITORIAL  

Reviewers the backbone of a journal p. 57
Sai Krishna Puli
DOI:10.4103/tjp.tjp_49_22  
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PRESIDENTIAL ADDRESS Top

“Psychiatry and Psychiatrist: An everlasting endeavoring journey” – My Journey p. 59
V George Reddy
DOI:10.4103/tjp.tjp_51_22  
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REVIEW ARTICLE Top

A public health approach to suicide prevention in the Indian setting p. 63
Roy Abraham Kallivayalil, Bettina Sara Mathew
DOI:10.4103/tjp.tjp_45_22  
Suicide prevention should be one of the top global priorities. A public health approach is the one which is likely to produce the best results. Suicide prevention cannot be achieved in isolation – addressing the social determinants of health and mental health is integral to this. Identifying collaborators, situation analysis, assessing the availability of resources, advocacy, gaining commitment of the political leadership, and tackling stigma are integral components. Suicide prevention should be aimed at all levels – primary, secondary, and tertiary. Increasing awareness, identification of risk and protective factors, training of primary care physicians and other health personnel, helplines, restriction of the means, responsible media reporting, and multisectoral collaboration are important strategies.
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ORIGINAL ARTICLES Top

Profile of male forensic ward patients in the state of Telangana, South India, and the challenges faced p. 68
Anitha Rayirala, Umashankar Molanguri, Nagalakshmi Thupkar, Ravikishore Sadula
DOI:10.4103/tjp.tjp_22_22  
Background: Clinical profiling helps to identify the common psychiatric problems that would result in psychiatric referrals and admissions and helps to develop protocols to counteract common psychiatric problems. Aim: The study aims to identify the profile of forensic ward patients in terms of sociodemographic, clinical, and criminal profiles; evaluate the challenges faced while treating them; and to come up with certain recommendations to the concerned prison authorities to how to deal with them. Materials and Methods: Retrospective chart reviews of 90 male forensic ward inpatients were done and the details as per the semi-structured intake pro forma were taken, and the data were analyzed using descriptive statistical methods. Results: Majority of the patients were single, uneducated, unemployed, and belonged to low socioeconomic status. Referral letters from the concerned prison medical officer were absent in half of the cases. Majority of the patients had personality disorders as the main diagnosis, and antisocial personality disorder was seen in majority (34.4%), followed by substance disorders (32.2%), psychosis (30%), and mood disorders (22.2%). 12.2% of convicted murder individuals diagnosed as schizophrenia. Most common crime committed by the individuals with Anti-social personality disorder was theft (15.6%). Conclusion: In many patients, the information about the reasons for referral and behavioral observation reports was lacking. This lack of information makes it difficult for the psychiatrist to accurately diagnose and treat. Sensitization and creating awareness of prison authorities are of paramount importance to deal with these challenges.
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Effectiveness of family-focused psycho-education on expressed emotions among caregivers of persons with bipolar affective disorder: An interventional study p. 74
K Ashalata, Sateesh Rangarao Koujalgi
DOI:10.4103/tjp.tjp_4_22  
Background: Expressed emotion (EE) is a significant characteristic of the family milieu that has been found to predict symptom relapse in bipolar affective disorder (BPAD). The need for family-focused psychosocial intervention in BPAD suitable to our culture is poorly understood. Therefore, this study was designed to discover the effectiveness of Barcelona family-focused group psycho-education on EE in BPAD. Aim: The aim of the present study is to assess the effectiveness of family-focused psycho-education on EE among caregivers of patients with BPAD. Materials and Methods: The interventional study included forty primary caregivers of patients diagnosed with BPAD. Caregivers were randomly allocated into five groups of eight each. BPAD was diagnosed by using the International Classification of Diseases-10, Classification of Mental and Behavioral Disorders, and Diagnostic Criteria for Research. The researcher had used the purposive sampling technique. Assessed EE by administering Family Attitude Scale (FAS) at pre- and postinterventional phases, family-focused group psycho-education module of Barcelona was adopted as an interventional method. Results: Totally 23 (57.5%) male and 17 (50.75%) female caregiver respondents participated in the study. The mean value of the overall pretest FAS score of total respondents was 94.33, critical comments = 43.75, hostility actions = 29.98, and distancing = 28.53. With EE dimensions, a greater difference in pre-intervention mean of 94.33±8.48 and a post-intervention value of 37.28±13.07 could be observed (t = 25.20, P = 0.001 and P< 0.05, respectively). Conclusion: Barcelona family-based psycho-educational intervention model is effective in reducing higher EE in families of patients with BPAD.
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A cross-sectional and comparative study of burnout among medical students of urban government medical college p. 81
Hamza Hussain, Sireesha Srinivasa Rao
DOI:10.4103/tjp.tjp_43_22  
Background: Burnout syndromes are becoming more prevalent in medical students of late due to multiple reasons that can negatively impact their lives and academic performances. Aims and Objectives: This study aims to estimate and compare the prevalence of burnout across first- and final-year medical students and assess sociodemographic factors associated with it. Materials and Methods: A cross-sectional study on 375 students of a government medical college was carried out through an online questionnaire based on the Copenhagen Burnout inventory (personal domain). The data were analyzed using SPSS version 26. Results: The prevalence of burnout among the first year was 40% and the final year was 54%. Burnout was more prevalent among female gender, and in students who did not have any hobbies or were uncomfortable seeking support from teachers and parents. Conclusions: To reduce these effects, focus must be on reducing stress, the inclusion of sports, and improving resiliency and the study environment.
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Mental health of the frontline nurses during the COVID-19 pandemic and its association with working conditions and personality traits p. 88
Archana Vinnakota, Nayanika Tummala, Anusha Nemani, Srikrishna Nukala, Sachin Reddy Kasarla, Srikar N Gandham
DOI:10.4103/tjp.tjp_41_22  
Background: During the COVID-19 pandemic, hospital nurses are involved in the direct patient care despite high infection rate. During earlier pandemics, health-care personnel reported significant levels of stress, worry, and depression. The pandemic has adverse outcomes not only on the individual's well-being but also on the patient care and health-care system. Aim: The aim of this study was to estimate the prevalence of stress, anxiety, and depression among nurses working in COVID-19 treating hospitals and its association with the hospital working conditions and the personality traits. Methodology: A cross-sectional study was conducted among 218 nurses working in the COVID-19 hospitals. Data were collected using study tools which include the semi-structured sociodemographic questionnaire, hospital working conditions, Perceived Stress Scale, Generalized Anxiety Disorder-7 Scale, PHQ-9 Depression Scale, and Ten-item Personality Inventory (TIPI). Results: In the current study, the prevalence of perceived stress, anxiety, and depression among nurses was found to be 88.1%, 50.9%, and 28.9%, respectively. Majority of the nurses with higher number of patients to be attended in the hospital were found to have statistically significant high-stress scores. The nurses with higher stress scores were found to have higher mean values of extraversion and openness to experiences traits on the TIPI Scale. Conclusion: The nurses working in COVID-19 hospitals were found to have a high prevalence of stress, anxiety, and depression. The study showed that there is a significant influence of hospital working conditions along with the individual's personality traits on the mental health of nurses.
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Disturbed eating attitudes among male and female undergraduate medical students at a tertiary center, Telangana p. 95
Mohammad Sohel, Mallepalli Pramod Kumar Reddy, Nikitha Chowdary Chandra
DOI:10.4103/tjp.tjp_15_22  
Introduction: Eating attitude can simply be defined as the beliefs, thoughts, feelings, and behaviors toward food, whereas disturbed eating approach is defined as an eating behavior that does not permit the diagnosis of an eating disorder. Problematic eating attempts in both male and female populations have now become a global debate. In research, body mass and weight concerns, dissatisfaction with one's current appearance, depression anxiety, stress, and social pressures have all been found as common facilitating variables of problematic eating habits among college students. Aims and Objectives: The aim of this study is to assess the disturbed eating attitude among male and female medical undergraduates from a tertiary medical center, Telangana. Materials and Methods: This was a questionnaire-based, cross-sectional study. The duration of the study was from January to June 2021. Eating Attitude Test based on 26 items (EAT-26) was adapted to Google Forms and circulated among undergraduate medical students from a tertiary hospital center, Telangana. Results: Male and female medical students were compared in terms of their disturbed eating attitudes in this study. The EAT was used to determine whether or not a person's eating habits were disturbed. The t-test was used to conduct the statistical analysis, which revealed that male students have a more disturbed eating attitude than female students. This shows that disturbed eating behaviors are no longer limited to women but are now impacting men as well. To prevent its spread, educational institutions should monitor the dangers that have occurred in their pupils and encourage them to adopt good eating habits. Conclusion: Thus, it can be concluded from the result of the current study that male undergraduates are more prone toward disturbed eating habits than female undergraduates. The findings of this study can assist guidance counselors, general public, students, parents, and academic institutions in dealing with eating disorders, particularly in preventing it from the severity level.
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Betrayal trauma, dissociative experiences, and posttrauma cognitions among women in a state shelter home p. 100
Chaitra Nagaraj Kumble, LN Suman
DOI:10.4103/tjp.tjp_25_22  
Context: There is a long history of interpersonal trauma in women, and the risk factors and mental health consequences have been well studied. Betrayal trauma (BT) theory by Freyd talks about the specific kind of trauma perpetrated by someone close to the victim, which may lead to increased dissociative responses. Recent research extends the theory to explain the role of posttrauma appraisals playing a mediating role in the development of psychopathological responses. Aim: The aim of this study was to explore trauma history, BT, and dissociative experiences among women in a Government Reception Centre. Setting: The sample included 30 women from the Reception Centre, Bangalore. Subjects and Methods: Data were obtained using a Sociodemographic Data Sheet, Brief BT Survey (revised), the Dissociative Experiences Scale, Posttrauma Cognitions Inventory and a visual analog scale for assessing psychological distress. Statistical Analysis Used: Descriptive statistics and nonparametric inferential statistics were used for quantitative analysis. Results: All the women in the sample had experienced BT directly or as witnesses. There was no significant difference in dissociation between high- and low-BT groups. The presence of negative cognitions toward oneself was associated with increased dissociative experiences. Negative cognitions toward self and depersonalization experiences were higher in the group with severe physical trauma than the group without. Conclusion: The article highlights the high prevalence of betrayal trauma, and risk for trauma-related psychopathology and revictimization that go unassessed in government shelter homes, while reiterating the need for a trauma-informed care approach to intervention.
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CASE REPORTS Top

Perceived difficulties of the family member of a survivor of rape with multiple disabilities in accessing care and support p. 107
Mysore Narasimha Vranda, Channaveerachari Naveen Kumar, Moorkath Febna, Thirumoorthy Ammapattian, Sahana Supriya Shiri
DOI:10.4103/tjp.tjp_39_22  
Gender-based violence against women and girls is a major public health issue. Women with multiple disabilities are more vulnerable to experience sexual violence due to pre-existing vulnerability factors than non-disabled. In this case report, we are present a case report of perceived challenges and difficulties experienced by the family member of a 26 years old survivor of sexual assault with multiple disabilities in availing health and psychosocial services in the community.
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Paranoid psychosis presentation in normal pressure hydrocephalus p. 110
Tapal Renu Mounika, Harshitha Veeramachaneni, Ananda Reddy Endreddy, VV Seshamma
DOI:10.4103/tjp.tjp_26_22  
Normal pressure hydrocephalus (NPH) is caused by aqueductal stenosis, where excessive cerebrospinal fluid (CSF) accumulates in the ventricles of the brain. It is characterized by the triad of gait disturbance, cognitive impairment, and urinary incontinence. Late-onset psychosis should be evaluated thoroughly to rule out any organic cause. We present the case of a male patient presenting with delusions, hallucinations, gait disturbances, and urinary incontinence in his late 60s.
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Psychosis following COVID-19 vaccination p. 113
Javangula Swetha Krishna, Veeramachaneni Harshitha, Ananda Reddy Endreddy, V Venkata Seshamma
DOI:10.4103/tjp.tjp_28_22  
COVID-19 infection has caused a lot of pain and suffering to date, but it is still showing catastrophic effects on humanity even after developing and effectively using the COVID vaccines for the containment of the virus. With the prevailing pandemic, there are new problems arising postvaccination in people, especially the neuropsychiatric manifestations. The present case report is of a 46-year-old single mother who completed graduation and working as a primary school teacher brought to our outpatient department with complaints of muttering to herself, decreased sleep and appetite, hearing the voice of her husband who died 15 years back, and being fearful after 3 days of receiving the second dose of Covishield vaccine. She got prescribed tablet risperidone 2 mg (bd) and tablet clonazepam 0.5 mg at night. In the absence of any other causative explanations, a temporal association is that the presentation could have been triggered as a result of complications relating to COVID-19 vaccination.
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Repurposed oral tapentadol as an intravenous drug of abuse in opioid dependence p. 116
Arshiya Fathima, Minhaj Zafar Nasirabadi, Arifuddin Ahmed, Mazher Ali
DOI:10.4103/tjp.tjp_48_22  
We present to you a case series of a group of individuals who presented to us with a history of intravenous drug abuse of repurposed oral tapentadol. Tapentadol is a synthetic benzenoid with a dual mode of action, as an agonist for the μ-opioid receptor and a norepinephrine reuptake inhibitor, with potential anti-nociceptive activity. The prevalence of current opioid use in India is reported to be 4% in males and 0.2% in females. Limited availability and difficulty in procuring the recommended drugs for detoxification and maintenance therapy in opioid dependence give reasons to consider treatment alternatives for the same. This case series aims to address the need and effectiveness of evidence-based treatment in opioid dependence.
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Neuropsychological impairments in a young-onset Marchiafava–Bignami disease with alcohol-dependence syndrome p. 120
Sravanthi Penubarthi, Raghunath Miryala, Vishwak Reddy Vatte, Srinivas Kandrakonda
DOI:10.4103/tjp.tjp_31_22  
The neuropsychological aspects of Marchiafava–Bignami disease (MBD) have not been reported in detail in the medical literature, despite various reports mentioning that chronic alcoholism is the most common etiology for the same. The condition is predominant in men around the fourth to sixth decades with a mean age of 45 years. To the best of our knowledge, we report a case of early onset of MBD in a 32-year-old man diagnosed with alcohol-dependence syndrome, who presented with cognitive impairment, behavioral issues, and gait abnormalities after a period of loss of consciousness of around 4 days. Along with symptomatic treatment, the patient was given thiamine supplementation, parenteral for a week, followed by oral thiamine. There was a slow improvement in his cognitive symptoms, while the rest of the symptoms improved within a month of starting medications.
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STALWARTS Top

Dr. Thara Rangaswamy p. 124
G Madhu Vamsi
DOI:10.4103/tjp.tjp_21_22  
Dr. Thara is a one of the pioneer women psychiatrists in India. Along with Sarada Menon and S Rajakumar, she cofounded an nongovernmental organization, called Schizophrenia Research Foundation (SCARF), based in Chennai, India. She is currently the Vice Chairman of SCARF, which was previously held by Dr. Sarada Menon. She is a researcher in schizophrenia and community mental health. She is the editor of the book-Emergencies in Psychiatry in low- and middle-income countries. Her Madras Longitudinal Study which has followed up persons with first episode schizophrenia for 35 years and is one of its kinds in the world. She pioneered the use of mobile telepsychiatry to deliver high quality care for schizophrenia in resource-less rural communities. In 2022, she received the Nari Shakti Puraskar, the highest civilian award for women, for creating awareness for mental disorders.
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LETTER TO EDITOR Top

Women widowed in the COVID-19 – The victims of invisible virus p. 127
Mysore Narasimha Vranda, Radhakrishnan Vasanthra Cicil
DOI:10.4103/tjp.tjp_19_22  
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