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   Table of Contents - Current issue
July-December 2021
Volume 7 | Issue 2
Page Nos. 77-150

Online since Wednesday, January 12, 2022

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Prescription errors: How to overcome? p. 77
Sai Krishna Puli
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Newer addictions in children and adolescents p. 79
Rama Subba Reddy
New forms of digital/social media include Applications (Apps), Multiplayer Video Games, YouTube Videos, Or Video Blogs (Vlogs), WhatsApp, Twitter, Snapchat, Instagram, Telegram. Research evidence suggests that these newer media offer both benefits and risks to the health of children and teenagers. In a survey done on parents by family foundation in 2011, 52% of children 0–8 years of age had access to a mobile device (although only 38% had ever used once). By 2013, this access had increased to 75% between 0 and 8-year olds. In addiction cycle, there are three stages: Binge/intoxication, Withdrawal/negative affect, Preoccupation/anticipation. Majority of us spend much of our time online, especially now during the era of COVID-19 to stay connected to others and keep ourselves entertained during social distancing. As with most disorders, there is not always a clear cause of Internet addiction. However, there are likely multiple factors that contribute to the development of this disorder, some of which are rooted in nature and others that are rooted in nurture. Other newer addictions are pathological gambling, internet gaming disorder, online porn addiction, online shopping addiction, social networking addiction causes biological as well as psychological problems. Manage screen use, Meaningful screen use, Model healthy screen use, Monitor for problematic screen use at any age. To promote health and wellness in children and adolescents maintain adequate physical activity, healthy nutrition, good sleep hygiene, and a nurturing social environment.
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Neurobiological correlates of burnout p. 87
Durva Balkrishna Sail, Avinash De Sousa
Introduction: Maslach defined burnout syndrome first time as a syndrome involving (i) exhaustion, (ii) “depersonalization” – lack of empathy for or detachment from service recipients, and (iii) a reduced sense of professional accomplishment. Burnout leads to changes in autonomic system, immune and endocrine system. The aim of this paper was therefore to provide an overview of the literature on clinically significant burnout and their potential neurobiological and physiological correlates. Methods: All English articles published between till October 2021 were searched in PubMed, Science-Direct, Medline, GoogleScholar, using the keywords, burnout, hypothalamic-pituitary-adrenal-axis, cortisol, stress, neurobiology, neurogenesis, BDNF, immune, biological, sympathetic, parasympathetic, autonomic nervous system, endocrine, metabolic, cognition, sleep, and neuroimaging in various combinations. The full text of relevant articles was obtained and their reference lists were reviewed for additional studies. Results: Burnout leads to alteration in autonomic, endocrine and immune system marked by deranged levels of various hormones and immune markers. It is also reflected as neuroimaging changes in various brain structures and may manifest as cognitive changes. Accelerated aging, increased risk of cardiovascular diseases and type II diabetes mellitus, increased allosteric load are some other manifestations of burnout that needs clinical attention. Conclusion: Future research with more homogeneous clinical samples, prospective experimental designs and challenge tests will help to delineating the underlying biological mechanisms of burnout. This will help to point to potential treatment targets.
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Prevalence and profile of adult attention deficit hyperactive disorder in alcohol use disorder: An explorative study p. 94
Naveen Kumar Dhagudu, Mayurnath Reddy, Omesh Kumar
Objectives: To assess the prevalence of adult attention deficit hyperactive disorder (ADHD) in alcohol use disorder. To explore the attitude towards treatment of ADHD comorbidity among the people with alcohol use disorders. To explore the clinical profile of comorbid adult ADHD in alcohol use disorder. Background: Adult attention deficit hyperactive disorder (ADHD) often under-diagnosed and under-treated among the people with alcohol use disorder (AUD). This current study was intended to assess the prevalence of adult ADHD in treatment-seeking patients with AUDs and its clinical predictors' profile and to explore the attitude of the individuals with adult ADHD toward its treatment. Methodology: This was a cross-sectional study conducted in 200 consecutive treatment-seeking in and outpatient subjects with AUD. Participants were assessed their sociodemographic and clinical predictor profile details along with, questionnaires such as Maudsley Addiction Profile, Mini International Neuropsychiatric Interview 5.0, adult ADHD Rating Scale, and Clinical Institute of Alcohol Withdrawal-Ar Scale. Those positive for adult ADHD (ADHD+) were compared with those negative (ADHD−) on various clinical variables. Furthermore, the attitude toward treatment for ADHD among the ADHD+ subjects was assessed. Results: Thirty-six participants (18%) screened positive and confirmed for adult ADHD. Less than one-fourth (n = 6, 16.7%) of participants were willing for any treatment, and majority (n = 16, 50%) were not sure to get the same. Participants with adult ADHD in AUD presented with earlier age of onset of alcohol use, more severity of alcohol use profile, and more. Conclusions: About 18% prevalence of adult ADHD in treatment-seeking AUD highlighting the importance of its recognition. Furthermore, there is utmost need to sensitize about the treatment modalities for ADHD in participants with AUD to reduce the adverse outcomes of the same.
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Assessment of mental capacity in psychiatric inpatients p. 101
Isha Ahluwalia, Najamus Saquib Siddiqui, Sandeep Kondepi, K Chandrasekhar
Background: As per the Mental Health Care Act (MHCA) 2017, the construct of mental capacity assessment aims to define an individual's ability to make autonomous decisions. It provides a legal framework for mental health professionals to assess a person's ability to make treatment-related decisions. The present study aims to assess the mental capacity in psychiatric inpatients and various capacity variables affected in patients with psychosis. Objective: The objective of this study is to assess mental capacity in a psychiatric inpatient facility. Materials and Methods: It is a cross-sectional, observational study of 48 patients admitted to the psychiatric inpatient facility. MacArthur Competence Assessment Tool for Treatment interview was used to assess the capacity of participants. Data were analyzed using MS Excel version 2007. Results: Out of 48 patients, we found that 41 (85.41%) patients were lacking mental capacity. Patients who scored poorly in the domain of “understand” also had poor performance on the rest of the domains, while those who had better understanding performed relatively well in other domains. Conclusions: Under the MHCA 2017, mental capacity assessment has been included in alignment with UNCRPD 2006, to safeguard the interests of patients and help in effective policy-making. It is, therefore, important to incorporate mental capacity assessment in clinical practice to protect the rights of patients.
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A comparative study on neurological soft signs in patients suffering from schizophrenia, their first-degree relatives and healthy control p. 105
Durva Balkrishna Sail, Sneh Babhulkar, Nitesh H Mishra, Krishna Kadam, Prasanna Vinayak Phutane, Akash Kumar Nema, Pooja Dubey
Introduction: Neurological soft signs (NSS) can be defined as a group of minor nonlocalizable neurological abnormalities, including simple motor coordination, complex motor sequencing, and sensory integration dysfunctions. Research has postulated complex etiopathogenesis of schizophrenia which is amalgamation of various genetic, biological, and psychosocial factors. This study provides us opportunity to endorse the neurodevelopmental hypothesis in schizophrenia. Aim: The aim of this study is to study and compare NSS in patients suffering from schizophrenia, first-degree relatives and healthy controls. Methods: A cross-sectional, observational, noninterventional, single time assessment, and hospital-based study was carried out on 60 patients, 60 first-degree relatives, and 60 healthy controls. Evaluation was done using the Positive and Negative Syndrome Scale and the Cambridge Neurological Inventory (Part 2). Results were obtained, tabulated, and analyzed. Results: We observed that patients with schizophrenia had more NSS than healthy control as well as their first-degree relatives. Similarly, first-degree relatives of patients with schizophrenia had more NSS than healthy control. The most common soft sign in patients as well as relatives was Oseretsky test. Most of the patients performed poorly on tests for motor coordination and sensory integration so did their first-degree relatives. Conclusion: NSS can be potential endophenotype for patients suffering from schizophrenia. Patients with schizophrenia had more NSS than healthy control as well as their first-degree relatives. Similarly, first-degree relatives of patients with schizophrenia had more NSS than healthy control. This suggests a role of common genetic and/or environmental factors in the pathogenesis of these abnormalities in the two groups. This is in with support neurodevelopmental hypothesis of schizophrenia.
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Stressful life events on coping mechanism among Women with dissociative disorder p. 109
Indira Bhowmick, Ilora Barik Sil, Upendra Singh, Pradip Kumar Saha
Background: Dissociative disorder in adults is caused by traumatic life events. Various cultural backgrounds specify the multiple types of stressful or undesirable life events. Dissociative phenomena have a pervasive relationship with traumatic stress derived from any negative life event. The inability to cope with the stressors disrupted their behaviors or daily functioning beside that any traumatic life events considered a triggering factor of their mental illness. The interrelation between these two variables; coping mechanism and life event determine the treatment outcome, relapse rate, and prognosis of the dissociative disorder. Aim: The aim of this study is to compare the coping strategies and stressful life events between person with dissociative disorder and normal control group. Materials and Methods: Seventy respondents (35 of dissociative disorders and 35 of general population) were reviewed, and the two groups were compared with respect to their sociodemographic profile, life events, and coping mechanisms. Results: Respondents with dissociative disorders have experienced a higher number of stressful life events with dysfunctional coping mechanism. Conclusion: Stressful life events lead to develop dysfunctional coping pattern in the persons with dissociative disorder.
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Prevalence and correlates of metabolic syndrome among psychiatric inpatients at a tertiary care center p. 114
Natasha Celia Saldanha, Sivaprakash Balasundaram, Sukanto Sarkar, Mohamed Hanifah
Background: Metabolic syndrome (MetS) is a complex illness with interconnected physiological, clinical, and metabolic factors. MetS is more prevalent in patients with mental illness than in the general population and contributes to greater morbidity and mortality. Thus we, studied the prevalence and correlates of MetS in psychiatric inpatients. Materials and Methods: The study is an observational cross-sectional study conducted at a tertiary care center. All consecutive patients (n = 185) admitted to the department of Psychiatry were enrolled after informed consent. Sociodemographic data, clinical data, and treatment details were collected. The WHO Global Physical Activity Questionnaire was administered to assess the level of physical activity; MetS was diagnosed as per the International Diabetes Federation criteria. Results: The prevalence of MetS was 22.7% among the study participants. The prevalence of MetS was significantly associated with higher age, urban domicile status, and middle and upper socioeconomic classes. Clinical characteristics such as longer duration of illness, comorbid substance use disorders, and treatment regimens with only antipsychotics medications were associated with higher likelihood of MetS. There was a higher prevalence of MetS among subjects with lower level of physical activity. Conclusion: One-fourth of the psychiatric inpatients had MetS. Guidelines specific to the Indian context need to be developed for the screening and monitoring of psychiatric patients with reference to MetS. Promotion of physical well-being and physical activity among patients with mental disorders is likely to contribute to a better overall outcome.
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Stress and anxiety among medical interns and doctors deputed in COVID duties: A cross-sectional study p. 122
N Gyan Nihal, Prashanth Challuri, Mallepalli Pramod Kumar Reddy, Ravulapati Sateesh Babu
Background: In addition to the psychological aspects of the outbreak in the society, doctors and medical interns are subjected to additional stress due to direct involvement in the treatment of patients and increased risk of infection, fear of transmission to their closed ones, feeling stigmatized and rejected, and working under extreme pressure. On the flip side, physical and emotional burnout over time is caused by the increasing number of cases and disease-related fatalities, work overload for an extended period of time, and lack of Personal Protective Equipment (PPE). Stress and anxiety should also be focused among medical interns and doctors. Aims and Objectives: The aim of this study is to assess stress and anxiety among medical interns and doctors posted in COVID-19 duties. Materials and Methods: This cross-sectional study consisted a sample size of 373 participants comprised of doctors and medical interns posted in COVID duties across India. The samples were drawn using the convenience sampling method. Perceived stress scale-10 and generalized anxiety disorder– 7 scale were the tools used to collect the data for this study. Results: Majority of the sample were under moderate stress (62.47%) and mild anxiety (34.58%). The mean score of stress and anxiety in the study was 21.14 (standard deviation [SD] = 7.452) and 8.44 (SD = 5.550), respectively, and found to be statistically significant. Conclusions: Our study confirms that medical interns and doctors face moderate stress and mild anxiety while attending COVID duties and treating COVID-positive patients. The mental well-being of doctors and medical interns should be protected while fighting with a disaster that has a major impact on society globally.
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A follow-up study to evaluate psychological impact among patients admitted for COVID-19 treatment to a tertiary care hospital p. 128
Abdul Salaam Mohammed, Raj Kiran Donthu, Sankar Reddy Tamanampudi Pratap, Ramya Krishna Kurma
Introduction: Coronavirus disease 19 (COVID-19) is a pandemic caused by a novel virus. It is associated with higher infectivity and mortality, which has led to a rise in psychological problems. This study is an attempt to assess and compare the psychological impact among patients admitted with COVID-19 infection during and after hospital stay. Materials and Methods: The study was an observational follow-up study involving patients diagnosed and admitted to a tertiary care COVID-19 designated center using reverse transcription-polymerase chain reaction test result. They were assessed once during the hospital stay and again within 15 days of discharge. Along with the socio-demographic details, they were administered a depression, anxiety, and stress (DASS-21) scale. The data were analyzed using the R language. Results: A total of 154 participants were assessed twice on the DASS-21 scale. Participants expressed significant financial problems and fear of COVID-19 both during admission and after discharge. There was a significant reduction in DASS-21 scores of DASS-21 after discharge. Scores were more reduced among those below 25 years; females; unmarried; higher education; employed; joint family setting and those without children. Conclusions: In the current study, the psychological impact is reduced after successfully being treated for COVID-19 infection. There is a need to focus on early and continuous psychological interventions to patients along with the COVID-19 specific treatments.
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Posttraumatic stress symptoms in health-care workers treating COVID-19 crisis: A cross-sectional descriptive study p. 134
Gangasani Saketh Reddy, B Praveen Kumar, Sheethal Puttala, Gireesh Kumar Miryala
Background: Severe acute respiratory syndrome (SARS-COVID 19) pandemic had much impact on both physical and psychological aspects. In order to assess the posttraumatic stress disorder (PTSD) symptoms among the health-care workers (HCWs), the study has been made. Methodology: A cross-sectional study was conducted among 96 HCWs. The sociodemographic characteristics such as age, gender, department, and designation were collected using a standardized questionnaire. Posttraumatic stress symptoms were assessed using a self-administered PTSD checklist. Results: The mean severity score of PTSD symptoms was 38.5 (12.9). There was a positive correlation between age and the severity score assessed using the PTSD checklist. There was also significant difference between the departments and total score with the P = 0.02. Conclusion: It denotes that the HCWs were in moderate level of stress in the pandemic. It also shows that, among postgraduate students as their years of experience increased, PTSD score also increased.
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Pattern of psychiatric presentation of patients coming to the emergency unit of psychiatry department of a tertiary care teaching hospital in West Bengal p. 138
Saheli Dey, Soumi Ghosh, Arijit Mondal, Amit Bhattarcharya
Background: Psychiatric emergencies are characterized by acute conditions of disturbances of affect or mood, behavior, and thoughts, which, if not managed with immediate therapeutic intervention, can cause great harm to the patient and surroundings. In most of the institutions, due to lack of emergency psychiatric units, these are managed by general hospital emergency units, which is the reason for underreporting of psychiatric cases in developing countries like India. Aim: The aim is to study the pattern of psychiatric presentation of the patients coming to the psychiatric emergency unit of a tertiary care teaching hospital in West Bengal. Methods: This prospective, longitudinal, hospital-based study was conducted for a period of 3 months on patients attending the psychiatric emergency unit of a tertiary care teaching hospital in West Bengal. Clinical details of the patient, source and reason for referral, and presenting complaints were recorded and analyzed. Results: Out of 200 patients attending the psychiatric emergency unit, most were female aged between 21 and 40 years. The three most prevalent presenting complaints among subjects were abnormal behavior with somatic complaints, excitement, and violent behavior followed by substance use. The foremost reason for a referral from other departments was either due to the absence of any physical illness or no abnormalities detected in the investigations conducted. Conclusions: The results from the study could help in gaining knowledge regarding emergency psychiatric conditions, increase in preparedness for their rapid management, and improvement of emergency psychiatry services to meet the mental healthcare demands in our country.
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Steroids use in COVID-19 saves the lungs but can precipitate psychosis: A case series from a tertiary care center in Andhra Pradesh p. 145
Aakanksha Brahmdeo Singh, Sripathi Santhosh Goud, Vishal Indla
Steroid-induced psychiatric adverse effects are not uncommon with an average incidence of 27.6%. The symptoms can range from mild anxiety to severe psychosis. An increase in the use of corticosteroids to treat severe acute respiratory syndrome-coronavirus-2 has been observed which resulted in more patients presenting with steroid psychosis. Herein, we report two case vignettes, presenting with steroid-induced psychosis after recovery from a recent infection of coronavirus disease-2019.
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Dr. Ajitha Chakraborty: The first practicing Indian female psychiatrist (October 31, 1926–May 08, 2015) p. 148
Manasa Prabhakar
Dr. Ajitha Chakraborty, popularly called Ajithadi by her students and juniors who remember her as outspoken, nonconformist, and perfectionist, was born in preindependent India on October 31, 1926. She graduated in medicine from Medical College, Bengal, then went on to get her DPM and MRCP, FRCP from England, and came back to India in 1960 after almost a decade. She was the first qualified and practicing female psychiatrist in India. She was the first lady president of IPS. She was a pioneer in the social and cultural psychiatry research, admired, and appreciated by the first-line researchers of the world in cultural psychiatry like H B M Murphy, Raymond Prince, etc. At the 5th World Congress of Psychiatry in Mexico City in 1971, she voiced her concerns that there were no sessions chaired by women and received widespread support. The Lancet requested her to write an invited article on “Culture, Colonialism and Psychiatry” in 1991. She also wrote an autobiography named, “My Life As A Psychiatrist: Memoirs And Essays”.
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