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   Table of Contents - Current issue
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July-December 2022
Volume 31 | Issue 2
Page Nos. 181-386

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EDITORIAL  

Nanopsychiatry: Is it a big thing in small size? p. 181
Jyoti Prakash, Suprakash Chaudhury, Kaushik Chatterjee, Kalpana Srivastava
DOI:10.4103/ipj.ipj_157_22  
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REVIEW ARTICLES Top

Ethical and legal issues concerning COVID 19 vaccinations in persons with mental illness in India p. 183
Sharad Philip, Satish Suhas, P Lakshmi Nirisha, Praveen Pandey, Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math
DOI:10.4103/ipj.ipj_228_21  
Mental healthcare in India faces severe challenges amid the ongoing pandemic. India runs the largest vaccination drive globally, including booster doses to rapidly vaccinate its population of over a billion. As persons with mental illness are at greater risk of adverse outcomes from COVID 19, they need prioritized access and administration of these vaccines. This manuscript examines the current legislation and identifies how the legal and ethical frameworks can prioritize COVID 19 vaccinations for persons with mental illness in India through a review of the various legislations of India concerning persons with mental illness and judicial judgments concerning the pandemic and vaccination. Subsequently, we discuss ethical and legal challenges associated with vaccination in this vulnerable population and possible solutions. Based on the current review, the authors recommend the guidelines for capacity assessment for vaccination decisions and discuss existing legal frameworks relevant to the vaccination of persons with mental illness.
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A camp approach of community psychiatry in India: Past, present, and the future p. 191
K Rakesh Chander, Sydney Moirangthem, Rahul Patley, Sharad Philip, Prateek Varshney, Vinay Basavaraju, Rajani Parthasarathy, P V Mohan Krishna, Narayana Manjunatha, Naveen Kumar Channaveerachari, Suresh Bada Math
DOI:10.4103/ipj.ipj_195_21  
Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.
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Where, when, and to whom gaming motives may be harmful? A systematic review p. 197
Senthil Amudhan, Manoj Kumar Sharma, Kalpana Srivastava, Nitin Anand, Akash Vishwakarma, Karunanidhi Azhagannan
DOI:10.4103/ipj.ipj_154_21  
The alarming growth in online gaming activities in recent years calls for an understanding of the determinants of gaming behaviors among adolescents and young adults. A systematic review was conducted to collate and review all the research studies concerning the understanding of the gaming motives. Relevant published articles were identified through the electronic search from PubMed, Medline, PsycInfo, Sciencedirect, and APA databases. The review identified four major topics of gaming motives, namely gaming behavior, gaming usage pattern, gaming demographics, and associated psychopathology. The review highlighted the role of motives in gaming use and psychopathology. The age of the player was associated with the expression of these motives. Further insights were drawn into the role of motive in the recreational and problematic use of gaming. The study findings emphasize the need to develop adequate interventions to prevent the occurrence of psychological impairments that would result from potentially problematic video gaming.
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ORIGINAL ARTICLES Top

Behavioural and Emotional difficulties in School children during COVID 19 pandemic using narrowband dimensions of SDQ: Online survey from North? East India p. 207
Subhashish Nath, Vijay Gogoi, Siddeswara Bargur Linganna, Jita Baruah, Bikram Sutradhar
DOI:10.4103/ipj.ipj_130_21  
Background: Containment strategies such as lockdown during coronavirus disease 2019 (COVID-19) pandemic have forced home confinement of many children. Data on psychological difficulties in children during lockdown are scarce from this part of the country. Aim: The aim of the study is to describe the burden and pattern of behavioral and emotional problems of schoolchildren during COVID-19 lockdown in a small town from Northeastern India. Materials and Methods: Caregivers of children (4–17 years old) attending English medium schools of the town were invited to participate in the study. A descriptive cross-sectional online survey using purposive nonprobability sampling was conducted between August and September 2020. Strengths and Difficulties Questionnaire (SDQ) was used to measure behavioral and emotional difficulties of children. Responses were based on child's behaviors over the last 6 months which coincided with the ongoing lockdown period in the region. Results: A total of 304 responses were received, among which 242 were considered for analysis. The parent-reported SDQ showed 23.1% of children having emotional or behavioral problems during the COVID-19 lockdown. Peer problems (43.4%) were the most common, followed by conduct problems (25.6%), emotional problems (23.1%), and hyperactivity (11.1%). Type of family (nuclear/joint/extended) was significantly associated with total difficulties (χ2 = 6.608, P = 0.03), conduct problems (χ2 = 8.492, P = 0.01), and hyperactivity (χ2 = 5.908, P = 0.05). Socioeconomic status of the family was associated with hyperactivity (χ2 = 8.755, P = 0.01). Conclusion: Significant number of children have behavioral and emotional difficulties during COVID-19 lockdown period.
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Prevalence of adult ADHD in patients with substance use disorder in North East India p. 214
Biswajeet Samal, Gojendra Senjam, Jayaprakash Russell Ravan, Heramani Singh Ningombam, Rama Chandra Das, Sudipta Kumar Das
DOI:10.4103/ipj.ipj_250_21  
Background: Attention deficit and hyperactive disorder (ADHD) often co-exist with substance use disorders (SUD) both in adolescents and adults. Untreated ADHD can lead to multiple relapses, sociooccupational dysfunction and may worsen the outcome of SUD. ADHD is often underdiagnosed in the adult population. Therefore, the present study was intended to determine the types, patterns, and factors related to drug dependence among different age groups and to estimate the prevalence of adult ADHD in SUD patients in North East India. Materials and Methods: This is a cross-sectional hospital-based study carried out in patients diagnosed with SUD as per the Diagnostic and Statistical Manual Disorders, 5th Edition. Adult ADHD Self-Report Scale (v1.1) Symptom Checklist was applied to screen for symptoms of adult ADHD in the patients. Results: In the age group of 18–29 years, 82.7% of patients were diagnosed with opioid use disorder (OUD), while 63.9% of the subjects in the age group of 30–49 years patients suffered from Alcohol Use Disorder (AUD). All patients of age 50 years and above were AUD. Our study showed that 24.3% of the total study population had the presence of adult ADHD. Symptoms of Adult ADHD were found in a higher proportion among OUD (28.7%) in comparison to OUD (11.5%). Conclusion: The association of adult ADHD with OUD has been around three times than the AUD group. Hence young people (18–29 years) diagnosed with OUD need to be screened for adult ADHD and should be treated for the same for better abstinence and to prevent complications.
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Assessment of lethality and its clinical correlates in suicide attempters with mood disorders p. 221
Nishtha Chawla, Raman Deep, Snehil Gupta, Anuranjan Vishwakarma, Mahadev S Sen
DOI:10.4103/ipj.ipj_251_21  
Background: Relatively limited literature is available on lethality assessment for suicide attempts in affective disorders from the Indian subcontinent. Aims: To assess the lethality and its clinical correlates in lifetime suicide attempters with mood disorders. Methods: A total of 100 lifetime suicide attempters, aged ≥18 years, with a DSM-5 diagnosis of bipolar disorder (BD) or major depressive disorder—recurrent (MDD-R) were recruited. Current euthymia was ascertained (Hamilton Depression Rating Scale (HAM-D) ≤7; Young Mania Rating Scale (YMRS) ≤4). Assessments were conducted using clinical pro forma, Risk–Rescue Rating Scale (RRRS), Columbia Suicide Severity Rating Scale (C-SSRS) and Barratt's Impulsiveness Scale (BIS). Results: Average age of the sample was 36.32 ± 11.76 years (48% males, 52% females). The mean duration of affective illness was 10.59 ± 8.32 years. Risk–rescue scores for lethality were significantly higher in males (vs females), bipolar disorder (vs unipolar), multiple attempters (vs single) and planned (vs unplanned) attempters. Risk–rescue score also showed a significant positive correlation with lifetime total and depressive episodes, and intensity of ideations, and a significant negative correlation with BIS—attention impulsiveness. Regression analysis [F (3,96) = 12.196, P < 0.001, adjusted R2 = 0.253] found that lifetime lithium prescription, intensity of suicidal ideations and attention impulsiveness explained 25.3% variance in lethality. Conclusion: Absence of lifetime lithium, higher intensity of suicidal ideations and lower attentional impulsiveness predicted higher lethality of suicide attempts. Lethality of suicide attempts was found to be associated with a multitude of clinical factors, notably male gender, bipolarity, multiple attempts, planned attempts and number of total and depressive episodes. Assessment of lethality and its correlates can help to plan strategies towards risk prevention in mood disorders.
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Prevalence and effect of cyberchondria on academic performance among undergraduate dental students: An institutional based study p. 228
Siva Kumar Patanapu, Chilukuri Sai Sreeja, Nagarani Veeraboina, Kandadi Vasavi Reddy, Sreenivas Voruganti, Patlola Anusha
DOI:10.4103/ipj.ipj_272_21  
Background: Cyberchondria has been used to describe an increase in anxiety about one's health status as a result of excessive online searches. These online health research studies were associated with a small but reliable increase in depression and anxiety which may decrease concentration of a student on academics. Methods: The questionnaire was distributed among 302 undergraduate dental students (second year, third year, fourth year, and interns) of Kamineni Institute of Dental Sciences and Hospital. The survey tool comprised Cyberchondria Severity Scale–Short form (CSS-15) questionnaire and percentage of marks obtained in the previous University examination. Statistically significance was set at P < 0.05. Results: A significant difference was observed for subscale Compulsion (p = 0.05*), Distress (p = 0.001*) with a higher mean score among 24-26 years old dental students. Females had significant higher mean score subscales Distress (4.63 ± 2.93; P = 0.02*) and Reassurance (5.99 ± 2.90; P = 0.001*) than males. Regarding overall CSS, significant higher mean scores were observed among the students who scored less than 65% (7.90 ± 2.01) in their last year university academic examination (0.000*). Conclusion: Scheduling educational programs and strengthening easily accessible health services for the students has a particular importance in solving the health problems of young people.
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Pragmatic issues and prescribing patterns in bipolar disorder: A mental health professional's survey p. 235
Shobit Garg, Nishant Goyal, Sai Krishna Tikka, Preeti Mishra
DOI:10.4103/ipj.ipj_22_21  
Background: There is substantial treatment gap between the suggested guidelines and pragmatic clinical practice for psychotropic usage in bipolar disorder (BD) due to the lack of naturalistic studies and not taking into account the transcultural differences and diverse background. We intend to study this treatment gap and elucidate the preference of psychotropics and prescription patterns, critical clinical issues faced and related pragmatics in BD by conducting the mental health professionals survey. Methodology: After focused discussions, Canadian Network for Mood and Anxiety Treatments guidelines being the primary anchor, a 46-item online survey questionnaire was prepared. With 25.4% response rate, 127 psychiatrists were evaluated using Survey Monkey® electronic platform on the demographics, predominant polarity; usage of antipsychotics, antidepressants, and electroconvulsive therapy, psychotropic's preference (monotherapy vs. polytherapy) in the acute and maintenance phase of BD. Results: Majority of the participants were males (70.9%) and placed in government institute or medical colleges. Majority agreed that child and adolescent and old age bipolar probands are not routinely seen but subthreshold BD cases are frequent; did not prefer mood stabilizer in pregnancy (61.4%) and antidepressants, preferred polytherapy in acute but monotherapy in maintenance phase (after 3rd episode), seldom preferred ECT as an option (more in suicidality), agreed to a subset of BD being refractory and neuroprogressive. Conclusion: This study elucidates the importance of treatment preferences, prescribing patterns and pragmatic issues faced by the clinicians. These patterns if studied longitudinally in a systematic manner would help in modifying the potential treatment strategies and reduce treatment gap.
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Comparative change in P300 indices following antidepressant treatment in patients with major depressive disorder p. 243
Santosh L Wakode, Sandip Meghnad Hulke, Roshan Sutar, Avinash E Thakare
DOI:10.4103/ipj.ipj_214_21  
Context: Cognitive disturbance is seen in patients with major depressive disorder (MDD). Event-related potential can assist in measuring the neurocognition, and P300 is the most commonly used noninvasive electrophysiological parameter for measuring cognition. Aims: The aim of this study is to assess the baseline P300 parameters, Hamilton Rating Scale for Depression (HAM-D), and Montgomery–Asberg Depression Rating Scale (MADRS) scores and compare them with their levels after 3 months of antidepressant therapy. Settings and Design: a longitudinal study was done on total 24 diagnosed cases of major depression who underwent P300, HAM-D, and MADRS assessment in the gap of 3 months before and after starting antidepressant therapy. Subjects and Methods: Newly diagnosed cases of MDD patients were assessed using HAM-D and MADRS for severity rating. P300 assessment was also carried out with auditory oddball paradigm using Nihon Kohden NCV-SMG-EP system. The assessments were repeated after 3 months of antidepressant treatment. Statistical Analysis Used: The Wilcoxon test was used to compare mean values of P300 parameters, HAM-D, and MADRS score. Spearman correlation analysis was done to study the association between various parameters of P300 and HAM-D and MADRS score before and after treatment of 3 months of antidepressant therapy. Results: Significant difference is shown in various parameters P300 except for A11-P300 amplitude and A31-P300 amplitude. A significant difference was shown in HAM-D and MADRS scores. No significant correlation was seen between other P300 parameters and HAM-D and MADRS scale before as well as after antidepressant therapy. Conclusions: P300 may be used as an index to evaluate the response to antidepressant treatment in patients with MDD.
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The appraisal-distress relationship of auditory hallucinations in patients with schizophrenia: The moderating role of metacognitive beliefs p. 248
Amrita Choudhary, Jay Kumar Ranjan, Hari Shanker Asthana, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_248_21  
Background: Appraisal of hallucinatory voices plays a significant role in anxiety and depression among patients with auditory hallucinations. Metacognitive beliefs are also associated with psychological distress in schizophrenia patients. However, there is a dearth of literature exploring the role of metacognitive beliefs on the appraisal-distress relationship, specifically, the overemphasis laid on the need to maintain consistency among thoughts and avoid cognitive dissonance. Aim: The aim of the study is to study the role of metacognitive beliefs on the appraisal-distress relationship. Materials and Methods: A total of 126 schizophrenia patients with auditory hallucinations were selected through purposive sampling technique. The participants were assessed on Hindi version of beliefs about voices questionnaire-revised (BAVQ-R), hospital anxiety and depression scale, metacognition questionnaire-short, and modified (MCQ-SAM). Results: Correlation analysis indicated significant relationship between the dimensions of BAVQ-R (i.e., benevolence, malevolence, and omnipotence) and MCQ-SAM (i.e., cognitive self-consciousness, positive beliefs about worry, importance of consistency of thoughts, and beliefs about normal experience of unwanted thoughts), depression and anxiety. Hierarchical regression analysis indicated that benevolence, malevolence, and importance of consistency of thoughts were predictors of anxiety; malevolence, importance of consistency of thoughts and positive beliefs about worry were predictors of depression. Results of moderation analysis indicated that malevolent beliefs about voices predict the intensity of distress among clinical voice-hearers, and importance of consistency of thoughts plays a moderating role in this appraisal-distress relationship. Conclusion: In schizophrenia patients with auditory hallucinations, the appraisal-distress relationship is strengthened when the need to maintain cognitive consistency is over-emphasized.
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Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome p. 255
Kalpana Srivastava, Jyoti Prakash, Pookala Shivaram Bhat, Kaushik Chatterjee, Suprakash Chaudhury, Vinay Chauhan
DOI:10.4103/ipj.ipj_267_21  
Background: Treatment of alcohol dependence is a major challenge due to frequent relapses. Cognitive-behavioral therapy (CBT) has been reported to be useful in the treatment of alcohol dependence. Aim: This study aims to evaluate the effect of CBT module in management of Alcohol Dependence and compare it with treatment as usual (TAU). Materials and Methods: All newly diagnosed alcohol dependence patients during the study period meeting the exclusion and inclusion criteria were included in the study. Patients with a head injury, HIV seropositive status, or any other organic brain disorder and comorbid psychiatric disorders were excluded. The study included 226 patients with alcohol dependence randomly assigned to intervention group (n = 116) and TAU group (n = 110). Demographic and clinical data were recorded and Severity of Alcohol Dependence Questionnaire was applied. Relapse was taken as an outcome variable. Both TAU group and experimental group were followed on standard protocol of treatment. Results: The data were analyzed and relative risk (RR) was calculated. Findings revealed the study group receiving CBT had a better outcome and relapse rate was also significantly low in the experimental group as compared to the TAU group. Conclusion: The RR of relapse is lower in patients of alcohol dependence on CBT within 6 months and within 1 year as compared to cases on TAU. It is recommended that CBT be used as an adjunct to treatment in alcohol dependence cases.
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A cross-sectional survey of sleep patterns and quality and its association with psychological symptoms among doctors working in a COVID-19 care facility p. 262
Sushmitha Kota, Shankar Kumar, Archana Gopal, Prashanth Nagabhushan Rudra, K Anvitha
DOI:10.4103/ipj.ipj_142_21  
Context: The coronavirus disease 2019 (COVID-19) outbreak has led to several psychological symptoms among frontline doctors of which sleep disturbances are common. Stress due to isolation and disease-related factors are known to be associated with sleep disturbances. Aim: The aim of this study is to establish the prevalence of poor sleep and its association with psychological symptoms among doctors working in COVID-19 tertiary hospital. Settings and Design: A cross-sectional online survey was conducted among 150 doctors who were treating COVID-19 patients. Materials and Methods: The survey contained a semi-structured questionnaire including sociodemographic details, Depression Anxiety Stress Scale 21, and Pittsburgh Sleep Quality Index scale. Analysis was done using the SPSS v20. Results: Of 150 doctors, we found 67 (44.67%) and 83 (55.33%) doctors were poor sleepers and good sleepers, respectively. Those who were married (P = 0.001), had higher working hours per month (P = 0.001), the presence of family history of psychiatric illness (P = 0.008), and history of substance use (P = 0.007) were associated with poor sleep. Furthermore, poor sleep was associated with higher stress (P = 0.001), anxiety (P = 0.001), and depression (P = 0.001). A multiple logistic regression revealed that family history of psychiatric illness (odds ratio [OR]-5.44, P = 0.01) and the presence of substance use (OR-7.77, P = 0.01) predicted poor sleep. Conclusion: Sleep pattern abnormalities were present in 45% of the frontline COVID-19 doctors studied. Family history of psychiatric illness and substance use was associated with higher chances of having poor sleep. It is important to recognize and manage sleep abnormalities as these could be initial signs of a psychiatric disorder or manifestations of underlying stress, especially in the vulnerable population.
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Comparison of cognition and alexithymia in patients of schizophrenia with and without comorbid alcohol use: A cross-sectional exploratory study p. 267
D Abhijeet Faye, Rahul Tadke, Sushil Gawande, H Sudhir Bhave, Vivek Chintaman Kirpekar, Anirban Chatterjee, Yashika Nathani, Deepika Singh
DOI:10.4103/ipj.ipj_155_21  
Background: Cognitive impairment and alexithymia are commonly associated with schizophrenia and alcohol use disorder independently. Both can lead to poor prognosis and recovery. In patients with dual diagnosis, this association can be more prevalent and severe. Materials and Methods: A total of 75 participants were grouped into two (35 each): Group A, a Schizophrenia group and Group B with comorbid alcohol use. Sociodemographic factors, clinical profile, cognitive functions, and alexithymia were compared between the two groups using semi-structured pro forma, Positive and Negative Syndrome Scale, Alcohol Use Disorders Identification Test (AUDIT), Montreal Cognitive Assessment (MoCA) Scale, Toronto Alexithymia Scale (TAS-20) (subcategorized into three subscales (1) “Difficulty describing feelings” (DDF), (2) “Difficulty identifying feeling” (DIF), and (3) “Externally-Oriented Thinking” and Brief Psychiatric Rating Scale. Statistical analysis was performed using the Chi-square tests and t-tests as applicable. P < 0.05 was considered statistically significant. Results: The mean age of the participants was 33.61 (standard deviation [SD]-8.11), mean duration of schizophrenia was 70.8 months (SD-47.5) and mean duration of alcohol consumption was 9.10 years (SD-7.7). MoCA score was significantly lower (mean-21.80, SD-2.98) and TAS total score was significantly higher in Group B (Mean-67.31, SD-8.10). DDF (Mean-19.28, SD-4.02) and DIF scores (Mean-22.86, SD-4.66) were significantly higher in alcohol group compared to nonalcohol group. Furthermore, MoCA score was significantly impaired and TAS total, DDF and DIF scores were significantly higher in participants with AUDIT score >8 (P < 0.05). Lower score on MoCA correlated with the higher score of alexithymia. Conclusion: Cognitive dysfunction and alexithymia were significantly more in patients of schizophrenia with comorbid alcohol use and positively correlated with the severity of alcohol use disorder.
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Development and psychometric testing of the Knowledge, Attitude, and Practice Questionnaire to assess knowledge, attitude, and practices regarding COVID-19 among patients attending COVID screening outpatient department in a tertiary care hospital in North India p. 276
Nidhi Chauhan, Ravi Rohilla, Deepak Aggarwal, Sumeesha Jaswal, Abhayraj Singh, Priti Arun
DOI:10.4103/ipj.ipj_177_21  
Background: COVID-19 pandemic has hit the world leading to major disruptions globally. Due to its highly contagious nature and associated mortality, a wide array of emotional and behavioral reactions were seen which indirectly reflected the knowledge, attitudes, and practices (KAP) of individuals. Understanding the KAP of individuals is fundamental when it comes to decreasing future COVID cases. Aim: The study aimed to develop a Knowledge, Attitude, and Practice Questionnaire regarding COVID-19 (COVID-KAPQ) among patients attending screening outpatient department (OPD) in a tertiary care hospital in North India and evaluate its psychometric properties. Materials and Methods: The study procedure consisted of step-wise procedure starting with item generation, expert evaluation for categorization of items into domains of KAP and testing for psychometric properties. The items were generated and evaluated by the Delphi method based on 8 experts. Reliability and validity were assessed using data from 200 patients attending COVID screening OPD. Content validity was evaluated using content validity index (CVI); construct validity was examined using exploratory factor analysis and Cronbach's alpha coefficient was computed for internal consistency. Results: The final COVID-KAPQ consisted of three domains and 29 items. Cronbach's alpha coefficient for the entire questionnaire was 0.734, 0.710 for knowledge domain, 0.614 for attitudes domain, and 0.759 for practice domain. CVI ranged from 0.86 to 1. Five factors each for knowledge and attitudes domain and two factors for practice domain were extracted by principal factor analysis and varimax rotation, with a cumulative contribution of 70.19%, 71.54%, and 66.77% variance in KAP domain. Conclusions: A questionnaire COVID-KAPQ (KAP regarding COVID-19) was developed. Psychometric testing indicated that it had adequate validity and reliability for use in COVID research in the general population. This questionnaire might help the public health researchers to map the level of KAP in the population and plan awareness and prevention strategies accordingly.
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Clinical correlates of regional gray matter volumes in schizophrenia: A structural magnetic resonance imaging study p. 282
Shailaja B , Archana Javadekar, Suprakash Chaudhury, Daniel Saldanha
DOI:10.4103/ipj.ipj_104_21  
Objectives: The objective of this study is to investigate the correlation between the regional gray matter volumes and length of Para Cingulate Sulcus (PCS) with the clinical profile of patients with schizophrenia. Materials and Methods: In this hospital-based, cross-sectional study, thirty consecutive in-patients diagnosed with schizophrenia and equal number of healthy volunteers matched for age- and sex- were recruited as controls. Detailed clinical assessment and magnetic resonance imaging (MRI) of the brain were carried out within 2 days for controls and within 2 weeks of hospitalization for patients. The Positive and Negative Syndrome Scale and Montreal Cognitive Assessment were applied to schizophrenia patients to assess symptoms and cognitive function, respectively. Results: Schizophrenia patients had significant volume deficit in bilateral amygdalae, bilateral superior temporal gyri, anterior cingulate cortex and bilateral hippocampi, along with a highly significant reduction in the length of right PCS. Schizophrenia patients with the duration of untreated psychosis (DUP) of 6–12 months showed a significantly greater volume of the right superior temporal gyrus (STG). First-episode schizophrenia patients had a significant reduction in the length of the left PCS. The volume of bilateral superior temporal gyri in schizophrenia patients showed a significant direct correlation with positive symptoms and an inverse correlation with negative symptoms. Conclusion: Schizophrenia patients have significant volume deficit in some brain regions. DUP of 6–12 months is associated with significantly greater volume of the right STG. First-episode schizophrenia patients have a significant reduction in the length of the left PCS. In schizophrenia patients, the volume of bilateral superior temporal gyri showed a significant direct correlation with the positive symptoms and an inverse correlation with the negative symptoms.
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Happiness and its determinants among nursing students p. 293
T K Ajesh Kumar, Deepika Cecil Khakha, Poonam Joshi, Smita Das, KJ Manu
DOI:10.4103/ipj.ipj_127_21  
Background: Being happy in life is very essential to be healthy, which is important for nursing students to grow and adapt well in their professional life. Aim: The aim of this study is to assess the level of happiness and identify the determinants of happiness among nursing students. Materials and Methods: Three hundred and forty-two undergraduate nursing students College of Nursing, All India Institutes of Medicals Sciences, New Delhi, India, enrolled in the study by convenience sampling. Data were collected through demographic information sheets and oxford happiness questionnaires. Frequencies, percentages, mean, standard deviation, Chi-square test, and multiple linear regression were used to analyze the data. Results: The mean happiness score of nursing students was 3.96 ± 0.59 on a scale of 6. The percentage distribution showed that 43.2% of the students responded “not particularly happy,” and 42.1% were “rather happy.” The current year of study, the number of close friends, stress experienced in the past 6 months, and engagement in physical activities contributed 53% of the variance in the happiness score of nursing students (P < 0.001). Further, monthly family income (P = 0.018) and choice of course (P = 0.003) had a significant association with their happiness score. Conclusion: Nursing students had a moderate level of happiness. The study suggests that there is a need to develop strategies to enhance happiness among nursing students in alignment with the identified factors. Educators need to develop a holistic curriculum giving equal importance to academic competencies and personal flourishment.
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Self-stigma, hope for future, and recovery: An exploratory study of men with early-onset substance use disorder p. 299
Tanya Anand, Arun Kandasamy, LN Suman
DOI:10.4103/ipj.ipj_52_21  
Context: The internalizing of experience of stigma among patients with substance use disorders (SUDs) can be debilitating to recovery. Individual factors such as self-regulation and abstinence self-efficacy can impact confidence in recovery and hope for future. Aims: The aim of the study was to explore relationship among self-stigma, self-regulation, self-efficacy, optimism, and confidence in recovery of patients with early-onset SUDs. Settings and Design: The study was carried out on a sample of 40 male patients with SUDs. The study had a single group exploratory design. Materials and Methods: The Self-Regulation Questionnaire, Drug Taking Confidence Questionnaire, Substance Abuse Self Stigma Scale, Revised Generalized Expectancy of Success (GES), and visual analog scale for craving were the measures used in the study. Statistical Analysis: Pearson and spearman's correlation coefficient were used to test associations between the variables. Multiple regression models were drawn to examine predictors of generalized expectancy of success and confidence in recovery. Results: Self-regulation, generalized expectancy of success (optimism), and confidence in recovery were found to be significantly correlated with self-stigma dimensions. The multiple regression model revealed self-regulation and self-devaluation as significant predictors of optimism (GES), whereas abstinence self-efficacy and values disengagement dimension of self-stigma predicted patients' confidence in recovery. Conclusions: Poor regulatory capacities along with internalized feelings of shame, guilt, and devaluation may lead to lower levels of optimism and poorer expectancies of success from future. Patient's self-efficacy in terms of abstaining from use behaviors and disengagement from pursuing life goals can lead to lower levels of confidence in recovery from SUDs and have implications for treatment seeking.
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Psychiatric morbidity in family members of alcohol dependence patients p. 306
Rahul Singh, Ekram Goyal, Suprakash Chaudhury, Alka Puria, Santosh Kumar, Ajay Kumar
DOI:10.4103/ipj.ipj_179_20  
Background: There is a paucity of Indian studies assessing psychiatric morbidity among family members of subjects with alcohol use disorder. Aim: To study psychiatric morbidity in wives/life partners and children of alcohol-dependent patients. Materials and Methods: Fifty consecutive index patients diagnosed to be alcohol dependent according to the International Classification of Diseases-10 classification of mental and behavioral disorders diagnostic criterion for research reporting to psychiatry department were taken. The study was conducted on family members of alcohol-dependent patients who were enrolled in the study as subjects. These included both their children and spouses and they were evaluated for any psychopathology using M. I. N. I. AND M. I. N. I.-KID scales. Results: Out of 50 spouses and 67 children enrolled in the study group. Sixty-eight percent had psychiatric morbidity in spouses which include 34% had major depressive episodes. Spouses living in the nuclear family and illiterate had more psychiatric morbidity. Total psychiatric morbidity in children above 18 years was 56.25%, maximum being in alcohol and substance dependence. Total psychiatric morbidity in children between 6 years and 18 years was 31.37%, maximum being in generalized anxiety disorder (11.76%). Conclusion: Spouses of subjects with alcohol dependence have a high prevalence of psychiatric morbidity. Spouses living in the nuclear family had a more major depressive episode and generalized anxiety disorder. Psychiatric morbidity was more in illiterate spouses. Psychiatric morbidity was also high in children. Female children between 6 years and 18 years had more generalized anxiety disorder than males.
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Quality of life and its sociodemographic determinants in breast cancer patients p. 313
Surbhi , Himanshu Gupta, Gurmeet Kaur Brar, Vineet Jalota
DOI:10.4103/ipj.ipj_6_21  
Background: Breast cancer is the most common cancer in women worldwide. As the outcome of any cancer treatment is not only dependent on disease-free interval but also on the quality of life (QOL) of the survivor. Hence, this study was conducted to evaluate QOL of breast cancer patients and sociodemographic factors affecting QOL of patients. Subjects and Methods: A cross-sectional study was conducted among 50 breast cancer patients and 50 controls, which fulfilled the selection criteria. The sociodemographic profile and QOL using the World Health Organization QOL-BREF were analyzed using the descriptive statistical methods. Results: All the QOL indicators were statistically significantly (P = 0.0001) lower among breast cancer patients. QOL indicators were statistically significantly (P < 0.01) lower in young age. Not much difference was observed according to religion and these were significantly (P < 0.05) higher among the homemakers. There was no significant difference in all the QOL indicators according to the marital status of the cases. However, these were significantly (P < 0.05) higher among rural cases compared with urban one. The QOL indicators were statistically significantly (P < 0.05) higher among the cases living in joint families than nuclear. No difference was observed among different socioeconomic status. Conclusion: QOL was significantly lower among the breast cancer patients. Age, occupational status, type of family, and locality were the significant factors that affect the QOL of breast cancer patients. Hence, psychological and social support can play an important role in improving QOL of cancer patient.
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Psychiatric comorbidity and quality of life in patients with bipolar disorder p. 318
Gunja Sengupta, Shivananda Jena
DOI:10.4103/ipj.ipj_24_21  
Background: Psychiatric comorbidity in patients with bipolar disorder (BD) has been associated with an earlier onset, rapid cycling, worsening severity and outcome, and increased suicidality. Patients with BD have been reported to have poor quality of life (QOL) even during remission. Aims and Objectives: Estimate the prevalence of psychiatric comorbidity and assess the QOL in patients with BD, and find the associated sociodemographic and clinical variables. Materials and Methods: This cross-sectional study was done in a general hospital psychiatric unit on 100 patients (both inpatients and outpatients) with DSM-IV-TR BD in partial or complete remission. Patients were assessed using a semi-structured pro forma, Mini International Neuropsychiatric Interview 6.0 - Hindi version, Hamilton Rating Scale for Depression or Young Mania Rating Scale and World Health Organization QOL instrument, short-form (WHOQOL-BREF), Hindi Version. Results: Sixty-one percent of the sample had at least one psychiatric comorbidity, and the commonest comorbid disorders were substance use disorders (SUD) (30%) and anxiety disorders (AD) (28%). Male gender was identified as a predictor for comorbidity in BD. The mean QOL-BREF score was 85.96 ± 14.35. Poor QOL was associated with older age at onset of comorbidity, multiple comorbidities, mixed episodes, rapid cycling, partial remission, and increased severity of depression while patients with current hypomanic symptoms were found to have better QOL. BD with comorbidity had worse QOL than those without comorbidity.Conclusion: The majority of patients with BD had at least one comorbidity. SUD were the most common comorbid disorders. QOL, already poor in BD patients, was poorer in cases with comorbidity.
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Development and training of mental health professionals in providing psychological intervention and support for women survivors of intimate partner violence – A pre–post evaluation study p. 325
Mysore Narasimha Vranda, Channaveerachari Naveen Kumar, Navaneetham Janardhana
DOI:10.4103/ipj.ipj_164_21  
Context: Health care providers play a significant role as they are the first contact for seeking help for intimate partner violence (IPV) survivors. Aims: This research aimed toward developing a comprehensive culturally appropriate intervention package for the mental health professionals (MHPs) to provide psychological intervention and support for women survivors of IPV and test the training impact on the level of attitude, knowledge, and preparedness to respond to IPV disclosure among MHPs. Settings and Design: A single group, pre–post intervention study, was conducted at Tertiary Mental Health Hospital in the Southern part of India, Bengaluru. Materials and Methods: A total of 30 MHPs were recruited for the study using purposive sampling. MHP Attitude, Knowledge, Preparedness to Manage IPV (MAP–IPV) questionnaire was used to collect the data. Statistical Analysis Used: Descriptive statistics were used to assess the sociodemographic characteristics of the participants. The pre–post evaluation was analyzed using the independent “t” test by comparing the means scores of the MAP–IPV questionnaire. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) – 20 version of the software. Results: The results revealed a lack of attitude, knowledge preparedness, and available resources materials among MHPs in addressing IPV cases. Pre–post evaluation showed statistically significant improvement in attitude, knowledge, and preparedness to identify and respond to IPV disclosure among MHPs after the intervention program. Conclusion: The comprehensive IPV intervention package effectively brings gain in attitude, knowledge, and preparedness among MHPs in addressing survivors of IPV. Practice guidelines and clear referral pathways following IPV disclosure need to be implemented to support the gains made through the training.
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Drug abuse in North Kashmir – An experience from a drug de-addiction center p. 331
Ashish Kumar Goyal, Ravi Nimonkar, Vishal Chopra, Pardal Maninder Pal Singh
DOI:10.4103/ipj.ipj_252_21  
Background: The history of substance abuse is as old as mankind itself. Easy transit of drugs across the state of Jammu and Kashmir is facilitated due to its geographical location. Materials and Methods: A descriptive study was carried out among individuals with substance use disorders in a de-addiction center in Northern Kashmir from August 2017 to July 2018. The study sample included all patients with substance use disorders attending the de-addiction center. Inclusion criteria: Individuals using substances attending the de-addiction center where the study was carried out were included in the study. Exclusion criteria: Individuals using substances attending the de-addiction center and not willing to participate were excluded from the study. A semi-structured pretested questionnaire was utilized as the study tool. Excel sheet and SPSS version 23 were used for data analysis. Ethical approval was obtained from the institutional ethical committee. Results: The mean (SD) age of patients was 29.58 years (8.8) ranging from 10 to 62 years and all were males. The commonest age of onset for substance use was between 11 and 20 years (56%). Nicotine abuse was the most common substance in our study. Peer pressure (52.8%) was the most common reason for drug dependence, followed by relief from negative symptoms on abstinence (29.6%). Conclusion: There is a worrying trend of the early age of initiation into substance use disorders. Since more youth are becoming engaged in substance use, it is important to evolve and apply preventive, curative, and rehabilitative strategies before it is too late.
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Quality of online news media reports of child sexual abuse in India p. 336
Swarndeep Singh, Romil Saini, Rajesh Sagar
DOI:10.4103/ipj.ipj_238_21  
Background: Media plays an important role in creating awareness and shaping public opinion about child sexual abuse (CSA). Research suggests that sensible media reportage on CSA is important for positive impacts of media. However, most of the studies assessing the quality of CSA news reports are from western countries. Aim: To systematically assess the pattern of online news media reportage of CSA in India. Methodology: A total of 149 news reports on the topic of CSA in India, published online over a one-year period were analyzed. Framing of CSA and other news media characteristics were evaluated. Results: Framing of CSA was episodic in majority of news reports, with criminal-justice system-related details about individual cases mentioned in about 90% reports. Further, more than two-third news reports did not mention possible causes or reasons of CSA, and possible steps that people could take to prevent CSA. About one-fifth of news reports provided statistics, research findings, or correct information to dispel myths or wrong public stereotypes about CSA. Inclusion of child helpline or contact information of any child welfare/support services was missing in most of the news reports. Conclusion: This is the first study to systematically assess the quality of news media reports on CSA in India. It provides valuable baseline information about existing media practices and helps in identifying areas for further improvement of media reporting on CSA. There is a need to conduct regular workshops with media professionals to provide them adequate training and support for improving media reporting of CSA.
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CASE SERIES Top

Delusion of pregnancy: Conception in brain p. 341
Madhubrata Ray, Sanjay Kumar, Alok Sinha, Rohith R Pisharody
DOI:10.4103/ipj.ipj_166_21  
Delusional disorders are common psychiatric disorders, but a delusion of pregnancy is a rare condition. Four cases that presented at a single tertiary care psychiatry center with delusion of pregnancy as a part of different psychological disorders are illustrated here. These cases were seen over a period of 6 months and had varied presentations and associated psychopathologies. Three of the four patients showed rapid recovery to treatment, but one patient was lost to follow-up. The heterogeneity in the presentation, sociodemographic profile of the patients and even in the symptom profile and response to treatment in this condition is highlighted and discussed in this case series.
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The devil molested me: A case series of incubus syndrome from North India p. 346
Robin Victor, Priyaranjan Avinash, Rupali Rohatagi, Arvinder Singh Aulakh
DOI:10.4103/ipj.ipj_207_21  
Incubus syndrome is a disorder typically seen in females where she reports that a male demon lies upon her and engages in sexual activity with her. While the concept of incubus is typically based on Western folklore a limited number of case reports are present on this topic more from India. There is a diverse opinion among the authors related to this disorder where some link this to psychotic disorders while some to sleep disorders. Here we report a case series of females who were suffering from psychotic disorder and over time developed incubus syndrome. We also the role of cultural factors and superstition in the formation of these disorders and the role of antipsychotic medication and modified electroconvulsive therapy in its treatment.
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SHORT COMMUNICATIONS Top

Paternal depression: “The silent pandemic” p. 350
Harpreet Singh Dhillon, Shibu Sasidharan, Gurpreet Kaur Dhillon, M Babitha
DOI:10.4103/ipj.ipj_236_20  
Maternal mental health during and after pregnancy is a well researched entity. However, father's mental health during the same period and even while raising the children has not been given due consideration. Recent studies have tried to explore the prevalence, risk factors, symptoms and implications of paternal depression on the children, marriage and the whole family. In this short communication, we aim to bring to the fore the recommendations for prevention and management of paternal depression.
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The pattern of inpatient psychiatry admissions at a general hospital psychiatry unit in South India: A retrospective study Highly accessed article p. 354
Padmavathi Nagarajan, Ravi Philip Rajkumar, KT Harichandrakumar, Natarajan Varadharajan
DOI:10.4103/ipj.ipj_138_21  
Background: Mental illnesses are becoming a major health issue across the world. The availability of inpatient facilities for mentally ill patients is very much limited in developing countries such as India. Aim: This study was aimed to explore the pattern of psychiatric admissions at a general hospital psychiatry unit (GHPU) in South India. Methodology: The study was conducted at a multispecialty tertiary care hospital in South India. A retrospective, chart-based study design was adopted to achieve the objectives. All inpatient case records available from the department of psychiatry, the medical records department, and the electronic hospital information system of the institute were reviewed between April 2006 and March 2016. Results: A total of 3082 patients were admitted as psychiatry inpatients during the 10-year study period, representing an average of 308.2 admissions per calendar year. The majority of inpatients were male (n = 1824; 59.2%). Concerning diagnostic categories, mood disorders were accounted for 33.6% of admissions, followed by psychotic disorders (26.4%) and substance use disorders (19.3%), respectively. The median length of hospital stay was 14 days (range 0–163 days). A statistically significant seasonality pattern was noticed for mood disorders (December to February) and anxiety and neurotic disorders (August to October). Conclusion: It is obvious that treatment-seeking attitude among individuals with mental illnesses is increasing and the awareness regarding treatment aspects is also increasing among the general public. Hence, there is a need to improve the existing resources to facilitate intensive management for better treatment outcomes and this, in turn, will enhance the quality of life of mentally ill individuals.
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Affective symptoms as a predictor of internet addiction among young adults Highly accessed article p. 359
Nitin Anand, Manoj K Sharma, Palaniappan Marimuthu, Ravish Huchegowda, Pranjali C Thakur, Akash Vishwakarma, Ashwini Tadpatrikar, Ishita Mondal, Azhagannan KM , Vikas S Rawat
DOI:10.4103/ipj.ipj_175_21  
Objectives: Mental health difficulties have been found to be associated with internet addiction, which makes it a multifaceted problem. The current study aimed to examine the relationship between internet addiction and affective states (depression, anxiety, and stress). Material and Methods: The study sample consisted of 731 individuals (403 males and 328 females) ranging in age from 18 to 25 years. We used an observational survey design to study participants with an internet addiction test and depression, anxiety, and stress scale. Results: The mean age ± standard deviation of the sample was 22.58 ± 2.80 years. Stress and depression were found to play a major role in internet addiction in the regression analysis. Conclusions: The study supports the association between internet use and stress and depression. The findings imply the need for early identification and intervention of affective states in the context of unhealthy internet use.
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Role of meditation in resilience and hope among students Highly accessed article p. 364
Abha Singh, Ritu Modi
DOI:10.4103/ipj.ipj_183_21  
Context: Rising stress levels for students in the current era due to challenges such as competition and pressure to succeed are a cause for concern. Resilience and hope are two powerful weapons in the fight against these stress-related issues. Aim: The study's objective was to explore the role of goal meditation on resilience and hope among students. Materials and Methods: The study participants comprised college students aged 22–24 years from Kanpur, U.P., India. The purposive sampling method was used to draw samples. A pre‒post study design was used to test the role of meditation in resilience and hope, for which post data were collected 6 months after the imposition of intervention. Statistical Analysis: The Wilcoxon signed-rank test was employed to analyze data. Results: Results indicated that resilience and hope increased in pre-and post-int ervention measures, and there is a positive relationship between resilience and hope. Conclusion: Based on these results, it was inferred that goal meditation effectively enhances resilience and hope among students.
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Effect of yoga on children with autism spectrum disorder in special schools Highly accessed article p. 367
Sindhu Shanker, Balaram Pradhan
DOI:10.4103/ipj.ipj_212_21  
Introduction: Yoga as a holistic mind-body intervention is increasingly evaluated for the management of various autism symptoms in children with autism spectrum disorder (ASD). Methodology: Forty-three children with ASD from 4 special schools were randomized into two groups, yoga group: 23 children and control group: 20 children. The yoga group received 12 weeks of yoga intervention in special schools. Results: Significant improvement in the yoga group was noted in the overall autism severity (P < 0.001) as reported by the parents in comparison to the control group. Conclusion: The findings of the study show that yoga can have a positive impact on the symptomatology of autism.
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Adding pre-emptive anticholinergics to antipsychotics: Is it justified? Highly accessed article p. 370
Kaushik Chatterjee, Ankit Dangi, Rachit Sharma, Prateek Yadav, Vinay Singh Chauhan, Jyoti Prakash
DOI:10.4103/ipj.ipj_269_21  
Anti-psychotics are the mainstay of treatment for Schizophrenia and psychotic disorders. Historically, anticholinergics have been prescribed to prevent or treat extrapyramidal side effects (EPS) associated with first-generation antipsychotics (FGAs). Even though newer antipsychotics are associated with markedly lower rates of EPS, concurrent anticholinergic use remains high. Use of these medications has potential for long-term side effects, worsening of EPS and poor adherence. We have briefly discussed the limited association between second-generation antipsychotics (SGAs) and EPS, the efficacy of anticholinergics for different types of EPS, and summarized various national and international guidelines on the subject. In conclusion, there is no evidence for prophylactic use of anticholinergics with antipsychotics. Clinicians need to guard against this tendency to be unduly cautious.
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LETTERS TO EDITOR Top

Comments on “Absence of undergraduate medical students from psychiatric training: A study from central India” p. 374
Anusha Prabhakarane, Himanshu Sharma, Dinesh Kumar, Dinesh Valvi, Jagdish Varma
DOI:10.4103/ipj.ipj_187_21  
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Cognitive behavioral therapy-based approach for management of persistent hallucinations in treatment-resistant schizophrenia p. 376
Abhinav Agrawal, Raman Deep Kaur, Ajeet Sidana
DOI:10.4103/ipj.ipj_137_21  
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Low serum lipid levels as predictors of future suicide attempt in Parkinson's disease p. 378
Fulvio Alexandre Scorza, Antonio-Carlos Guimaraes De Almeida, Carla Alessandra Scorza, Josef Finsterer
DOI:10.4103/ipj.ipj_197_21  
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Nymphomania with intellectual disability p. 380
Mini Sharma, Manoj Kumar, Sneha Gupta
DOI:10.4103/ipj.ipj_151_21  
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A case of restless legs Syndrome – Ill-ness or ill-spirit? p. 382
Neha Sharma
DOI:10.4103/ipj.ipj_213_20  
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Sir Michael Rutter: Pioneer, legend, and father of modern child psychiatry p. 384
Sheikh Shoib, Mohd Faizan Siddiqui, Sheikh Mohd Saleem, Miyuru Chandradasa
DOI:10.4103/ipj.ipj_244_21  
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