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   Table of Contents - Current issue
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July-December 2021
Volume 30 | Issue 2
Page Nos. 191-366

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EDITORIAL  

Digital phenotyping in psychiatry: When mental health goes binary p. 191
Jyoti Prakash, Suprakash Chaudhury, Kaushik Chatterjee
DOI:10.4103/ipj.ipj_223_21  
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REVIEW ARTICLES Top

Well-being and burnout in medical students p. 193
Dinesh Bhugra, Andrew Molodynski, Antonio Ventriglio
DOI:10.4103/ipj.ipj_224_21  
There is no doubt that practice of medicine is an extremely stressful profession. Not surprisingly, training and education in medicine also creates a degree of pressure. In the past 50 years, more attention is being paid to the mental health and well-being of doctors. However, recently focus has shifted to the mental health and well-being of medical students. A series of studies have shown that the rates of mental ill-health among doctors and medical students are exceptionally high and appear to be getting worse. In studies across 12 countries with over 3600 responses, it has been shown that rates of burnout among medical students vary and have been reported to be over 90% of respondents in Hong Kong. Explanations for these high rates vary according to cultural factors which include parental expectations, financial and housing problems, and relationship difficulties. It is crucial that institutions make every effort at looking after the mental health needs of medical students and their medical staff.
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First-episode psychosis: How long does it last? A review of evolution and trajectory p. 198
Jyoti Prakash, K Chatterjee, K Srivastava, VS Chauhan
DOI:10.4103/ipj.ipj_38_21  
Study of first-episode psychosis (FEP), an episode of psychotic nature which manifests for the first time in an individual in the longitudinal continuum of his/her illness, has been study matter of research interest in recent years. A comprehensive review of the literature will help us understand the evolution and trajectory of this concept better. A literature review of available articles addressing the concept, phenomenology, evolution, identification, course, and outcome of FEP was done; the same was subsequently divided into broad topics for better clarity and analyzed. FEP constituted a clinical psychotic phenomenon with underlying significant heterogeneity in diagnosis, stability, course, and outcome. The study has attempted to view FEP both as horizontal spectrum across various diagnoses and longitudinally ranging from asymptomatic individual with unknown risk status to attenuated psychosis to multiple relapses/unremitting illness. Many risk and protective factors have been brought out with varying certainty ranging bio-psycho-social spectrum. Efforts have been made to calculate polygenic risk score based on genes involvement/sharing between various psychotic spectrum disorders; as well as biomarker panels to identify people at risk. FEP may prove to be an important concept to understand psychosis in general; without putting things into the diagnostic rubric. It may help understand multiple risk and protective factors for the course and outcome of psychotic illness and may clear the cloud to sharpen the evidence toward commonality and distinctiveness between various psychotic diagnoses in vogue for more comprehensive concept.
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Psychometric properties of Fagerstrom Test of Nicotine Dependence: A systematic review p. 207
Manoj Kumar Sharma, LN Suman, Kalpana Srivastava, N Suma, Akash Vishwakarma
DOI:10.4103/ipj.ipj_51_21  
The Fagerstrom test for nicotine dependence (FTND) is a widely used test for assessing physical nicotine dependence. However, there is a need to assess the psychometric properties of FTND to assess its role in treatment outcome studies. The aim of the present investigation was to review the psychometric properties of the FTND. A broad systematic literature search was performed from Pubmed and PsycINFO from 2000 to 2019. The publication language was limited to English. Two review authors performed the study selection and extracted the data. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Rayyan software used to screen relevant studies. A total of 1471 articles retrieved from the search, of which 33 studies fulfilled the inclusion criteria. Eleven studies related to testing the reliability of the FTND were analyzed. Twenty-five studies evaluated the Cronbach alpha of the test. Analysis of the studies revealed the questionable psychometric qualities of the adapted versions of the test across different cultures and ethnicity. It also suggested that it may not tap the appropriate constructs that would predict smoking patterns in light smokers, e-cigarette smokers, and smokeless tobacco users. Thus, further research must focus on improving the psychometric properties of FTND to enhance the measurement of nicotine dependence.
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ORIGINAL ARTICLES Top

Effectiveness of gatekeepers' training for suicide prevention program among medical professionals and medical undergraduate students of a medical college from Western India p. 217
Rutvin Patel, Ritambhara Mehta, Kamlesh Dave, Pradhyuman Chaudhary
DOI:10.4103/ipj.ipj_31_21  
Introduction: Suicide risk among Indigenous populations is a multifaceted phenomenon, influenced by biological, psychological, and social factors at the individual level, as well as cultural, political, and economic issues at the family and community level. The global prevalence of depression among medical students was recently estimated to be 28.0 % according to a meta-analysis of 77 studies. In the field of suicide prevention, the term gatekeeper refers to “individuals in a community who have face-to-face contact with large numbers of community members as part of their usual routine.” They may be trained to “identify persons at risk of suicide and refer them to treatment or supporting services as appropriate”. In our study we aimed to improved attitude and knowledge in gatekeeper to improve detection and referral of individuals who are at risk of suicide. Methods and Material: We adapted an evidence-based gatekeeper training into a two-hour, multi-modal and interactive event for medical professional and undergraduate students. Then we evaluated the intervention compared to free-recall knowledge and attitudes questions were examined before and after participation in a student and faculty gatekeeper training program. Focus groups with students enriched interpretation of quantitative results. Statistical analysis used: Knowledge, attitudes, and skills of both students and teachers were analyzed by Mann–Whitney U-test. Comparison of knowledge, attitudes, and skills between both groups was analyzed by Wilcoxon signed-rank test. Results: Undergraduate students developed more positive attitude for suicidal behavior where faculties developed more confident in their skill after training sessions. Conclusion: brief gatekeeper training found effective in improving knowledge about suicide. Also, increasing participants' accuracy to identify warning signs, risk factors and protective factors about suicide.
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Awareness among parents of individuals with intellectual disability about sexual health education p. 224
Ravinder Saini, Wasim Ahmad, Nazli
DOI:10.4103/ipj.ipj_74_21  
Background: Most of the parents have no idea that how and when they should educate about sexual health to their typically growing children. It is important for parents to educate their children with intellectual disability about sexual health. The risk of sexual exploitation and abuse is very high in individuals with intellectual disability. Objective: The present study was conducted to find out the awareness among the parents of individuals with intellectual disability about sexual health education. Materials and Methods: Subjects for the present study were the parents of individuals with intellectual disability studying at government rehabilitation institute for intellectual disabilities, chandigarh (n = 100). The present study is a cross-sectional study and subjects were selected by making use of random sampling technique. A Rating scale on “Awareness on sexual health education for parents of intellectually challenged children” developed by Lakshmi and Navya, (2014) was used. Results: The results revealed that there is a significant difference in knowledge, attitude, and practice among the parents of individuals with intellectual disability about sexual health education. The significant difference with respect to the gender on awareness about sexual health education (knowledge, attitude, and practice) among the parents of individuals with intellectual disability was found. No significant difference with respect to family type on awareness about sexual health education was found. Conclusion: Parents who live in rural locality have responded greater on the knowledge and practice than those who live in urban locality. However, parents living in urban locality have scored more on attitude over the parents who live in rural locality.
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Nomophobia: A rising concern among Indian students Highly accessed article p. 230
Ravi Kumar, Supriya Kumari, Puja Bharti, Divyam Sharma
DOI:10.4103/ipj.ipj_134_21  
Background: Nomophobia is defined as “the fear of being without a mobile phone or unable to use it.” Nowadays, it is considered a modern age phobia. It is to be considered as a form of behavioral addiction. Aim: This study aims to determine the level of nomophobia in the Indian population aged between 15 and 35 years. Materials and Methods: A personalized questionnaire was designed in the Google Forms and distributed among the targeted audience. The questionnaire contained three parts: consent letter, sociodemographic details, and nomophobia questionnaire. A total of 2061 valid responses were analyzed in SPSS software. Results: Out of 2061, 52.9% of the respondents were male and 47.1% were female. 92.2% of the respondents were between 18 and 24 years of age group. Moreover, 79.1% of the respondents are undergraduate or pursuing their graduation. 35.5% of the respondents were from metropolitan city, 38.8% were from an urban city, and 12.15% were from a semiurban city, while the rest 13.6% were from rural areas. 74.8% of the respondents were moderate nomophobic, 18.9% were severe nomophobic, and 6.3% were mild nomophobic. Conclusion: In this study, we observed that nomophobia is moderate to severe and that our “physical, mental, and social health” has a major concern.
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Prevalence of diabetes distress and its relationship with self-management in patients with type 2 diabetes mellitus p. 234
Suravi Patra, Binod Kumar Patro, Susanta Kumar Padhy, Jogamaya Mantri
DOI:10.4103/ipj.ipj_60_19  
Context: Diabetes distress (DD) in India has been studied mainly in the context of depression. Little is known about DD, its determinants, distribution, and its impact. Aims: This study aims to estimate the prevalence of DD and identify its socio-demographic and clinical determinants in type 2 diabetes mellitus patients. To assess the relationship of DD with self-management in nondepressed type 2 diabetes mellitus. Settings and Design: A cross-sectional descriptive study in noncommunicable disease clinic of a tertiary care medical center. Subjects and Methods: DD Scale was used to assess DD in 200 patients with type 2 diabetes mellitus. Diabetes Self-Management Questionnaire was used to evaluate self-management behavior. Patient Health Questionnaire 9 was used to exclude depression. Statistical Analysis Used: Sample size calculation was done as per prevailing prevalence estimates. SPSS 20.0 was used for statistical analysis. ANOVA and Independent t-tests were done to compare between groups means. Hierarchical multiple regression analysis was done, keeping self-management as a dependent variable and socio-demographic, clinical variables, and DD as independent variables. Results: The prevalence of DD was 42% in our sample. The duration of diabetes showed that a significant association with DD. DD was significantly and negatively associated with all four domains of self-management, while statistical significance was reached in three domains: dietary control (β = −0.378, P < 0.01); glucose management (β = −0.181, P < 0.01); and healthcare use (β = −0.244, P < 0.01). Conclusions: DD is widespread in our patients and harms self-management. There is a need to address DD to improve disease-specific outcomes.
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Development and psychometric evaluation of COVID-19 psychological burden scale for Indian health care workers p. 240
Viswa Chaitanya Chandu, Krishna Prasad Lingamaneni, Venkat Ramana Reddy Baddam, Srinivas Pachava, Yamuna Marella, Vikram Simha Bommireddy
DOI:10.4103/ipj.ipj_71_21  
Background: It is beyond doubt that the health care systems across the globe have been experiencing burdens of unprecedented magnitude in the coronavirus disease (COVID-19) era. However, no psychometric tools were validated in India to assess the impact of COVID-19 on the psychological well-being exclusively among health care workers, given their obvious risk for exposure. Objectives: This study was conducted to develop the first of its kind psychometric tool that measures the psychological burden posed by COVID-19 on Indian health care workers. Materials and Methods: One hundred and sixty-nine health care workers attending COVID-19 duties in four different states of India took part in the study. The initial scale designed was tested for face and content validity. Exploratory factor analysis using direct oblimin rotation with Kaiser normalization was employed to determine the factor structure. Differential item functioning (DIF) analysis with ordinal regression based on the type of COVID-19 facility at which the participant is serving, educational background was done for identification of item bias. Results: COVID-19 Psychological Burden Scale for Indian Health Care Workers (CPBS-IHCW), with 17 items loaded on four components, demonstrated good internal consistency reliability (Cronbach's Alpha 0.873). DIF revealed no item bias based on type of facility and educational background. Significant differences in CPBS-IHCW scores were noted between health care workers serving at different COVID-19 facilities and belonging to different educational backgrounds. Conclusion: CPBS-IHCW is a 17-item, rapidly administrable scale, demonstrating good internal consistency reliability, and temporal stability, which can be used in the assessment of psychological burden among health care professionals catering to the needs of the COVID-19 affected.
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Correlation of neurocognitive deficits with positive and negative symptoms in schizophrenia p. 249
Richa Priyamvada, Rupesh Ranjan, Gyanendra Kumar Jha, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_44_20  
Background: Patients with schizophrenia manifests a broad array of cognitive impairments, including impaired performance on measures reflecting attention, information processing, executive functions, memory, and language capabilities. Aim: This study aims to assess neurocognitive deficits and their correlation with positive and negative symptoms in patients with schizophrenia. Materials and Methods: Sample was collected from private clinic of Jabalpur, Bhopal, and Patna. Selection of sample was purposive sampling. The sample size consists of 60 diagnosed cases of schizophrenia on the basis of (International Classification of Diseases-10 [ICD-10] Diagnostic Criteria for Research criteria) and 30 normal controls. Annet's Hand Preference Battery was used to screen handedness and only right-handed male were included in this study. After screening according to inclusion and exclusion criteria, 60 diagnosed (ICD-10 criteria) schizophrenia patients were selected which was further divided into two groups on the basis of positive and negative syndrome scale, i.e. schizophrenia with positive and negative symptoms. Thirty matched normal controls having scores <2 scores on General Health Questionnaire-12 were selected for the study. After filling of sociodemographic details Luria-Nebraska Neuropsychological Battery (LNNB-I) was administered on both schizophrenia group and normal control. Results: Cognitive functions are severely impaired in schizophrenia compared to normal control and within schizophrenia groups negative schizophrenia had poor performance on LNNB-I than positive schizophrenia. Regarding the correlation of neurocognitive deficits, both schizophrenia groups were correlated but negative symptoms of schizophrenia were strongly correlated with neurocognitive deficits. Conclusion: Cognitive functions are severely impaired in schizophrenia as compared to normal control and within schizophrenia groups, negative schizophrenia had poor performance on LNNB-I than positive schizophrenia. Regarding the correlation of neurocognitive deficits, both schizophrenias groups were correlated but negative symptoms of schizophrenia were strongly correlated with neurocognitive deficits.
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Efficacy and durability of cognitive behavior therapy in managing hallucination in patients with schizophrenia p. 255
Priyanka Shukla, Debasish Padhi, KS Sengar, Abha Singh, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_94_20  
Background: The cognitive behavior therapy (CBT) approach to psychosis is a relatively recent development and focuses directly on the core psychotic symptoms of hallucinations and delusions. Aim: The aim of this study is to assess the efficacy of cognitive behavior therapy in managing hallucination in patients with schizophrenia and to evaluate the generalizability and durability of the therapeutic gains. Materials and Methods: In this confirmatory pre–post assessment study, based on the purposive sampling technique, a sample consisting of 40 (20 for experimental and the other 20 for control group) patients having schizophrenia with core symptoms of hallucination and delusions under treatment as usual were selected and matched on the sociodemographic and clinical variables. For the clinical variables, the Psychotic Symptom Rating Scale and Scale for the Assessment of Positive Symptoms were used. After baseline assessment, the cognitive behavioral program was tailored on the experimental group and patients of both the group were reassessed after the completion of treatment. Follow-up data to see the durability of program were taken from all the patients of experimental and control groups. Results: Cognitive behavior therapy was found to be effective for the treatment of auditory hallucination in schizophrenia. The therapeutic gains in all study variables were found to be maintained or further improving at follow-up which proves that cognitive behavior therapy is durable. Conclusion: Cognitive behavior therapy in conjunction with pharmacotherapy was found to be more effective in improving clinical symptoms of schizophrenia and global functioning compared to pharmacotherapy alone.
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Association of digital media exposure and addiction with child development and behavior: A cross-sectional study p. 265
Fatima Shirly Anitha, Udayakumar Narasimhan, Abhinayaa Janakiraman, Nivetha Janakarajan, Priyadharshini Tamilselvan
DOI:10.4103/ipj.ipj_157_20  
Background: Media exposure which was traditionally restricted only to television has now broadened to include various handheld devices and constant internet access. Although high quality educational and interactive screen time is beneficial, excessive addiction and early introduction of such media use has various deleterious consequences. Aim: To estimate the exposure of media among Indian children and its influence on early child development and behaviour. Settings and Design: A tertiary care hospital based cross-sectional study. Materials and Methods: We included 613 children between 18 months and 12 years who visited the paediatric out-patient department for a well or a sick visit. Their media exposure was extensively analysed along with Problematic Media Use Measure Short Form (PMUM-SF). They were screened for behaviour problems using the Child Behaviour Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) accordingly. Those under five years were also subjected to a screening using Ages and Stages Questionnaire (ASQ3). Results: The most common gadget used was television followed immediately by smartphones. The average daily screen time was 2.11 hours, Mean+SD=2.11+1.53, 95% CI 2.11+ 0.12 , found in (40.1%) of the study population .The prevalence of screen addiction was 28.1%, majority being boys..Increased screen time and media addiction were significantly associated with concerns in communication, problem-solving and personal-social domains, as well as conduct, hyperactivity and pervasive developmental disorder (PDD) problems. Conclusion: We conclude that media exposure among children should be enquired as a routine. This helps to curtail unhealthy digital media practices at the earliest to ensure a digital safe environment for children.
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Parental experiences of telerehabilitation for children with special needs: An exploratory survey p. 272
Noufal Thadathukunnel Hameed, Sisira Chalapurath Satheesan, Jameela Padmalayam Santhamma
DOI:10.4103/ipj.ipj_235_20  
Context: The COVID-19 pandemic's emergence necessitated that clinic/hospital-based rehabilitation is replaced or substituted by other modes. Using telecommunication devices was found a convenient alternative. Aims: Present study explored the telerehabilitation experiences of the parents of children with developmental disabilities (CDD). Settings and Design: The study was conducted among the service users of a not-for-profit NGO located in Kerala. Parents of children with one or more developmental disabilities formed the population of the present study. The present study was a cross-sectional exploratory survey. Subjects and Methods: A total of 205 parents took part in the study using a brief open-ended survey. The majority of the participants were females (65%). Statistical Analysis Used: The sociodemographic data were analyzed using frequency and percentage. The qualitative data were analyzed using thematic analysis. Results: Overall, the study found that parents experienced more challenges in telerehabilitation compared to face-to-face interventions. Perceived challenges included externalizing problems, reduced effectiveness, logistical issues, multiple disabilities, and the child's lack of interest in gadgets. Perceived advantages included the child's liking for the device and increased availability of time. Conclusion: In short, the study throws light on the various challenges experienced by parents in implementing telerehabilitation for their CDD. The findings strongly recommend fine-tuning telerehabilitation programs to meet these challenges to provide optimal care to our children with special needs.
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Female Dhat syndrome in primary care setting p. 278
Aseem Mehra, Soundappan Kathirvel, Shalini Gainder, Ajit Avasthi, Sandeep Grover
DOI:10.4103/ipj.ipj_76_20  
Aim: The study aimed to evaluate the females presenting with the complaint of nonpathological vaginal discharge to a general gynecology outpatient service in a rural community clinic from the perspective of female Dhat syndrome. Methodology: Sixty-nine females considered to have nonpathological vaginal discharge after detailed gynecological evaluation, including required investigations, attending a rural community clinic were assessed for their belief about the vaginal discharge. The study subjects were also evaluated on the proposed criteria of female Dhat syndrome by using a semi-structured interview. Results: The mean age of onset of vaginal discharge was 36.1 (standard deviation - 8.5) years. Most of the females considered the loss of vaginal fluid as loss of a vital fluid from the body. Consumption of warm foods and drinks (75.8%) was the most common reason reported for vaginal discharge followed by eating unbalanced food/inappropriate food (73.5%). A majorty of the subjects considered vaginal discharge responsible for bodily weakness (87.0%), backache (71.0%) and stomache (66.7%). About two-third of the participants considered the taking energizing medications like vitamins/tonics/tablets and treatment from a gynecologist the treatment for vaginal discharge. Conclusions: Significant proportion of females with non-pathological vaginal discharge have a belief that they are losing a vital fluid of the body. The subject attributes their symptoms to factors such as consumption of warm foods and drinks, and eating unbalanced food/inappropriate food. Accordingly, assessment and management of women with Dhat syndrome require addressing these important issues.
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Prevalence of risk for obstructive sleep apnea in patients with bipolar disorder p. 285
Natarajan Varadharajan, Sandeep Grover
DOI:10.4103/ipj.ipj_91_19  
Aim: To evaluate the prevalence of risk for obstructive sleep apnea (OSA) among patients with bipolar disorder (BD). Methodology: Eighty-seven patients with BD and 50 matched controls were assessed by using the Berlin questionnaire. Results: One-fifth of the patients with BD was found to be at high risk for OSA, compared to the 6% prevalence in the control group. Patients in high risk for OSA were more often females, had significantly higher body mass index, high waist circumference, and comorbid physical illnesses. In terms of pharmacotherapy, there was association of use of antipsychotics with higher risk of OSA at the trend level (p=0.052). Conclusion: The prevalence of high risk for OSA is significantly higher among patients with BD and higher prevalence is related to obesity and comorbid physical illnesses.
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Depression and anxiety in parents of children and adolescents with intellectual disability p. 291
Rachit Sharma, Harpreet Singh, Mangal Murti, Kaushik Chatterjee, Jaspreet Singh Rakkar
DOI:10.4103/ipj.ipj_216_20  
Background: Parents of Intellectual Disabled (ID) children and adolescents are subjected to higher caregiver burden which is associated with Depression and Anxiety. There are very few studies which have assessed these morbidities in an industrial population. Aims and Objectives: The aim of this study was to explore the prevalence of Depression and Anxiety and its psychosocial correlates among these parents. Materials and Methods: The study was a Cross-sectional observational study, conducted at the Psychiatry unit of a tertiary care multi-specialty hospital in Maharashtra. It examined 99 parents (99 fathers and 98 mothers) of 99 children and adolescents (up to 18 yrs of age) with Intellectual Disability for Depression and Anxiety. Assessment was done using Hospital Anxiety and Depression Scale (HADS). Results: 94% of mothers and 66.7% of fathers were found to have either anxiety or depressive symptoms, or both. Among mothers, 91.8% had scores suggestive of anxiety, 66.3% for depression and 64.3% for both anxiety and depression. Among fathers 57.6% had had scores suggestive of anxiety, 35.4% for depression and 26.3% for both. The association was significant between HADS Depression sub-scores of parents and child's ID severity, diagnosis of Down's syndrome and lack of family support (P-value <0.05). In addition significant association was also found between father's anxiety and depression scores and age of father and medical co-morbidities in the child (P-value <0.05). Conclusion: Significantly high proportions of parents were found to have anxiety /depressive symptoms or both. These symptoms appear to be associated with severity of ID and lack of family support and were significantly more in the primary care giver (mothers).
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Evaluation of burden felt by caregivers of patients with schizophrenia and bipolar disorder p. 299
Kajal Jitendrakumar Tanna
DOI:10.4103/ipj.ipj_28_21  
Background: It can be a difficult task to provide care to the patients living with mental health issues, especially with chronic diseases such as schizophrenia and bipolar disorder where the patient loses touch with reality. Aim: The current study was aimed to assess the of burden of care that caregivers feel while giving care to the patients of schizophrenia and bipolar disorder and to compare the difference in burden between these two conditions. The study also evaluated the factors affecting the caregiver's burden. Settings and Design: This was a cross-sectional interview-based study conducted at the psychiatry department of a tertiary care hospital in Gujarat among caregivers of schizophrenia and bipolar disorder. Subjects and Methods: Each caregiver was given the Zarit-Burden Interview scale in vernacular language and asked to rate each statement from 0 to 4 where 0: never, 1: rarely, 2: sometimes, 3: quite frequently, and 4: nearly always. The final score was calculated and interpreted as: 0–21 – little or no burden, 41–60 – moderate to severe burden, and 61–88 – severe burden. Statistical Analysis: Data of the burden score were expressed as mean and standard deviation and compared using unpaired t-test. Pearson's correlation coefficient was used for correlation between burden score and variables such as age, years of education, and duration of illness. The analysis was done using GraphPad version 3.0 and Microsoft Excel 2016. Results: A total of 210 caregivers reported the interview scale completely, of which 105 caregivers belonged to schizophrenia group and 105 were related to bipolar disorder. Average of burden score was 64.89 ± 15.7 and 59.11 ± 17.8 (maximum score: 88) in schizophrenia and bipolar group, respectively, and difference between the group was statistically significant. In both the groups, it was found that, with increase in the age of patients, caregiver's burden significantly increased. Conclusion: Caregivers of schizophrenia and bipolar disorder patients feel a considerable burden of care with more burden felt by the caregivers of schizophrenia. The more vulnerable to burden are females, elderly, low-income groups, and patients in whom longer duration of care is required. The caregivers should receive an adequate support for maintaining their own mental health. they should be provided support for maintaining their mental health. Particularly, vulnerable are females, elderly, low-income groups, and longer duration of care. They should be provided with adequate support.
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A pilot study on effect of adjunctive transcranial direct current stimulation on symptom domains of depression in patients with depressive disorder p. 305
Shipra Singh, Amit K Meena, Gautam Sharma, Smita N Deshpande
DOI:10.4103/ipj.ipj_38_20  
Background: Depression is a highly prevalent condition and includes clusters of symptoms, namely, depressive cognition, anxiety, and visceral symptoms. Depressive symptoms often respond sub-optimally to pharmacotherapy. Adjunctive transcranial direct current stimulation (tDCS), a noninvasive brain stimulation modality, may improve depressive symptomatology. Aim: The aim of this study was to study the effect of tDCS as an augmentation strategy in depression and its various symptom domains. Materials and Methods: It is a prospective interventional study. Patients diagnosed with depressive disorder (based on International Classification of Disease- 10 criteria, diagnosed by treating psychiatrist), aged 18-70 years, who showed inadequate improvement on antidepressant selective serotonin reuptake inhibitors, were recruited after informed consent. Each participant was administered 20 sessions of tDCS over 2 weeks, each session of 20 min, with anode placement at left dorsolateral prefrontal cortex and cathode at right supraorbital region. Hamilton Rating Scale for Depression (HAM-D) was administered pre- and post-intervention to assess the change in symptoms. Results: Of a total of 35 participants, the mean score on HAM-D prior to and postintervention was 19.97 (standard deviation [SD] = 3.519) and 13.17 (SD = 3.365), respectively. The difference was statistically highly significant (P = 0.000) on paired t-test. All symptom domains of HAM-D, identified using the Cole and Motivala model (Cole et al., 2004), also showed significant reduction from pre-tDCS to post-tDCS scores (P = 0.000). Conclusion: Positive effect of tDCS on depressive symptoms, its tolerability and safety profile, and affordability makes it an effective therapeutic strategy in augmenting antidepressants in patients with depression. However, longer period studies with larger sample size may yield more generalizable results.
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Cognitive dysfunction in first-episode schizophrenia and its correlation with negative symptoms and insight Highly accessed article p. 310
Pookala Shivaram Bhat, Jitin Raj, Kaushik Chatterjee, Kalpana Srivastava
DOI:10.4103/ipj.ipj_107_20  
Background: Cognitive dysfunction in schizophrenia is a well-known feature and can adversely affect the patient participation in treatment and rehabilitation. Studies have shown its relationship to the severity of negative symptoms and level of insight also. Not many Indian studies are available on this in first-episode schizophrenia, and hence, this study was undertaken. Materials and Methods: Eight-five cases of first-episode schizophrenia fulfilling inclusion criteria were included in the study after ethical clearance, informed consent, and stabilization of acute symptoms. All were assessed using psychosocial pro forma, Addenbrooke's Cognitive Examination-III Scale, positive and negative syndrome scale, and schedule for the assessment of insight. Data analysis was done using Statistical Package for Social Sciences Version 20:0. Results: Cognitive dysfunction was seen in 40% of patients. Maximum dysfunction was in the memory domain followed by fluency domain and language domain was relatively well preserved. A significant negative correlation was observed between cognitive function and negative symptoms, but a significant positive correlation was seen with insight. Conclusion: Cognitive dysfunction is present in a significant proportion of schizophrenia in the first episode itself. Early assessment will facilitate appropriate interventions directed at insight and cognitive rehabilitation.
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Comparison of personality profile of prison criminals in the Yasooj Central Penitentiary and noncriminals based on 16 personality factors Highly accessed article p. 316
Mahnaz Moghanloo
DOI:10.4103/ipj.ipj_115_20  
Aims: The study was conducted to examine the personality profile of prisoners in the Yasooj Central Penitentiary (YCP) according to Cattell's 16 Personality Factors (PFs) Model. Settings and Design: In doing so, 50 prisoners were selected from among all 20–35-year-old male prisoners at YCP. Moreover, 50 people were selected from the nonprison community to match with the prisoner group. Subjects and Methods: In a causal–comparative study, both groups were matched and were evaluated using two questionnaires: demographic information and Cattell's 16-PF questionnaires. Statistical Analysis Used: The statistical method used to predict the distinguishing personality traits of the two groups, prisoners and nonprisoners, was discriminant analysis. Results: The results indicated that from among Cattell's 16 factors, only 7 factors in the two groups were discriminant and predicting crime: Conservative, sober, expedient, self-control, imaginative, reserved, and tough mindedness. Conclusions: According to the results, 16 main factors of personality have the ability to predict crime.
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Personality and mental health factors associated with performance at university level: A study of business administration students p. 323
Namita Rath, Shreyan Kar, Nilamadhab Kar
DOI:10.4103/ipj.ipj_34_21  
Background: Performance of students at university level may be influenced by various factors. Aim: In a sample of business administration students, we explored personality, mental health, and life style factors associated with high and low achievers based on their examination grades (Grade A and higher vs. Grade B and lower). Methods: We studied personality factors using big five inventory (BFI)-10, anxiety through generalized anxiety disorder-7 screening scale, and depression by patient health questionnaire-9 scale. In open-ended questionnaires, stress, relationship, and drug uses were enquired about. Results: Considerable proportions of students had anxiety (33%) and depression (41%) at moderate-to-severe level; however, they were not different in the two groups. Higher examination grades were associated significantly with higher scores on conscientiousness factor of BFI-10 and female gender. There was no difference in self-reported stress or substance use between the two groups. Conclusions: While conscientiousness was associated with better performance, mental health factors were comparable between higher and lower grades in examination. The results highlight the need for further research on personality and modifiable factors such as stress, anxiety, and depression and to evaluate effectiveness of interventional approaches on academic performance.
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A comparison of personality traits, learning style, and perceived stress among surgical and nonsurgical residents in a tertiary care hospital in India p. 329
Rahul Bansal, Kathleen Anne Mathew, Arya Jith, Dinesh Narayanan
DOI:10.4103/ipj.ipj_93_21  
Introduction: It is often perceived that the presence of a distinct surgical personality plays an important role in predicting success in their surgical career. This study compares the personality profiles, perceived stress, and learning styles of surgical and nonsurgical residents. Aim: The aim of this study is to examine the differences in personality traits, learning style preferences, and perceived stress among surgical and nonsurgical residents. Setting and Design: A cross-sectional study was conducted comparing surgical and non-surgical residents in a tertiary care teaching hospital. Materials and Methods: The 50-item International Personality Item Pool Big- Five Factor Marker questionnaire was used to score 5 personality domains. The 24-item Learning Style Inventory Questionnaire was used to determine the preferential learning styles (visual, auditory, or tactile). The Perceived Stress Scale was administered to assess the perception of stress in the residents. Statistical Analysis: t-test and chi-square test were done for statistical analysis. Results: A statistically significant difference was found in learning style preferences with visual (14.78 ± 3.73 vs. 7.4 ± 2.25) and kinesthetic styles being (13.84 ± 4.37 vs. 6.96 ± 1.47) preferred by surgical residents whereas auditory style was preferred by nonsurgical residents (P < 0.05). Surgical residents scored higher in extraversion (P = 0.00), conscientiousness (P = 0.00), and openness to experience (P = 0.00) which was statistically significant. Nonsurgical residents were found to have a higher perception of stress which was statistically significant (13.40 ± 7.10 vs. 21.12 ± 7.52) (P = 0.01). Conclusion: The significant trait variance supports the concept of surgical personality.
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Association between emotional and behavioral problems and perceived parenting in attention deficit hyperactivity disorder: An exploratory study p. 335
Preeti Jacob, Bikram Kumar Dutta, M Thomas Kishore, Urvakhsh M Mehta, Mariamma Philip
DOI:10.4103/ipj.ipj_106_21  
Background: Parent–child relationship difficulties are seen in families of children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD), and they may contribute to long-term negative outcomes. Aim: Our aim was to examine perceived parenting and its correlation with emotional and behavioral problems in children and adolescents with a diagnosis of ADHD. Materials and Methods: This was a cross-sectional study involving 38 children and adolescents, between 8 and 16 years of age, diagnosed to have ADHD. Parents rated the children and adolescents on the Strengths and Difficulties Questionnaire (SDQ), whereas children/adolescents rated parents on the Alabama Parenting Questionnaire (APQ). Results: The study population primarily consisted of males (86.8%), between 8 and 12 years (68%), and belonged to urban families (82%). Warm, attentive, and engaged parenting behaviors which were subsumed under the domain of parental involvement in the APQ were associated with fewer total problem behaviors as well as specifically lower conduct and peer problems on the SDQ. Similarly, parents who used positive disciplining strategies as per the APQ had fewer total behavioral problems as well as specifically lower emotional problems on the SDQ. Children with comorbid oppositional defiant disorder reported lesser mean scores in all domains of parenting and significantly in the domains of parental involvement and positive parenting as per the APQ. Conclusions: Parental involvement and positive parenting were significantly associated with fewer emotional and behavioral problems in children and adolescents diagnosed with ADHD. This has direct implications for clinical practice. Further studies are needed to adapt parenting strategies to the Indian context.
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Impact of breathing and relaxation training (Sudarshan Kriya) on cases of alcohol dependence syndrome p. 341
Prateek Yadav, Kaushik Chatterjee, Jyoti Prakash, Neha Salhotra, Vinay Singh Chauhan, Kalpana Srivastava
DOI:10.4103/ipj.ipj_117_21  
Background: Alcohol abuse is a public health problem and the course of alcohol dependence syndrome (ADS) is known for its relapsing nature. Additional interventions with empirical evidence are worthy of consideration. Breathing and Relaxation Training, like Sudarshan Kriya (SK) is recommended for stress management, and have been shown to positively affect outcomes in stress-related disorders. The aim of this study was to assess the effect of an intervention of Breathing and Relaxation Training, on drinking behavior in patients of ADS. Methodology: Eighty in-patients diagnosed with ADS were included after obtaining informed consent, in this prospective study and were randomized into two groups. They were administered Alcohol Use Disorder Identification Test (AUDIT) at admission and 6-months after discharge. The Study group (n = 40) underwent a 6-day intervention of Breathing and relaxation Training (SK) apart from the standard therapy. “WHO-5 Well-Being Index” was administered before and after the training. The Control group was exposed to the standard therapy for ADS. A follow-up on a monthly basis and finally at 6-month interval was done to assess alcohol consumption status. Results: Socio-demographically both the groups were comparable. The breathing and relaxation training (study) group had a significant rise in “WHO-5 Well-Being Index” (P < 0.001). There was a significant reduction in AUDIT scores after 6 months in both groups. AUDIT scores were significantly lower in the study group (11.20 ± 2.81) than the control group (15.30 ± 4.05) after 6 months (P < 0.001). The study group also reported fewer days of drinking (P = 0.004) and reduced overall drinking in the intervening period (P < 0.001). Conclusion: The addition of Breathing and Relaxation Training (SK) in the management of ADS provided additional therapeutic benefits in the form of fewer days of drinking and reduced total alcohol consumption.
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Stress, anxiety, depression, and resilience in cancer patients on radiotherapy p. 346
Mrudula Mungase, Suprakash Chaudhury, Anand A Patil, Biswajit Jagtap, Vandana Jain
DOI:10.4103/ipj.ipj_78_20  
Background: The diagnosis of cancer may cause extreme disruption in the life of an individual because in the minds of most people the disease is associated with extreme pain, suffering, and death. Aim: This study aimed to assess stress, anxiety, depression, and resilience among cancer patients undergoing treatment with radiotherapy. Materials and Methods: Consecutive cancer patients taking radiotherapy treatment from a tertiary care hospital were included in the study with their written informed consent. Subjects suffering from comorbid medical or psychiatric disorders were excluded from the study. Demographic and clinical details of the patients were recorded on a specially prepared pro forma. Depression Anxiety and Stress Scale (DASS) and Abbreviated Connor–Davidson Resilience Scale were administered. Scoring of the scales was carried out as per the test manual. The data were tabulated and analyzed using the SPSS software. Results: The study sample included 100 patients (38 male and 62 females) with a confirmed diagnosis of cancer receiving radiotherapy. Based on the scores obtained on the DASS, depression was present in 24 patients, anxiety was significantly high in 25 patients, while stress was significantly high in five patients. Male patients undergoing radiotherapy had significantly higher scores on resilience and significantly lower scores on depression anxiety and stress compared to female patients. In patients undergoing radiotherapy, stress, anxiety, and depression were significantly negatively correlated while resilience. Anxiety, gender, and resilience were found to be significant predictors of depression based on multiple regression analysis. Conclusion: Cancer patients undergoing radiotherapy suffer from depression, anxiety, and stress which are negatively correlated with resilience. Resilience is significantly higher in males, while anxiety, depression, and stress are significantly higher in females. In addition to therapy aimed at reducing depressive and anxiety symptoms, psychiatric management should also aim to increase the resilience of these patients.
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CASE REPORT Top

“Ghost on the coast”: Persistent hallucinations through the prism of cultural concepts of distress p. 353
Hesitha Abeysundera, Hemant Khanna
DOI:10.4103/ipj.ipj_103_21  
There is minimal literature and case reports on cultural concepts of distress, especially on ghost sickness. The aim of this article is to educate clinicians to culture-bound syndromes/cultural concepts of distress when assessing people from culturally and linguistically diverse backgrounds. This case report describes an elderly male of Papua New Guinea who presented with psychotic symptoms, shaped by the cultural concept of distress from experiencing loss. This paper describes the importance of utilizing of cultural liaison officers to provide culturally-informed care and before diagnosing a patient with the culture concept of distress, every effort should be made to thoroughly investigate to exclude an organic cause for the presentation.
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CASE SERIES Top

Weaved around COVID-19: Case series of coronavirus thematic delusions p. 356
B Shailaja, B Adarsh, Suprakash Chaudhury
DOI:10.4103/ipj.ipj_138_20  
Stressful situations such as the COVID-19 pandemic can serve as a niche for developing pathological mental state or influence the symptomatology of patients with psychiatric disorders. Here, we present four such cases. Three cases highlight the onset of psychosis precipitated by the immense stress posed by the pandemic. In the last case, psychopathology of a patient with preexisting mental illness getting influenced by the pandemic is highlighted. In all the four cases, it is interesting to note that delusional work is weaved around the COVID-19.
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SHORT COMMUNICATION Top

Development of mental health services in Kashmir p. 361
Sheikh Shoib, S M Yasir Arafat, Sheikh Mohd Saleem
DOI:10.4103/ipj.ipj_4_21  
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LETTERS TO EDITOR Top

COVID-19 in India: Vulnerable migrant population and an added menace of substance abuse p. 364
Rishi Sharma, Renu Bisht, Sai Krishna Tikka, Ashish Ramesh Bhute, Binaya Kumar Bastia
DOI:10.4103/ipj.ipj_168_20  
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The foreseen scenario of dental profession in India during and after coronavirus disease-2019 Highly accessed article p. 366
Thorakkal Shamim
DOI:10.4103/ipj.ipj_75_20  
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