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   Table of Contents - Current issue
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January-June 2022
Volume 31 | Issue 1
Page Nos. 1-180

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EDITORIAL  

Do food and nutrition have therapeutic value for disorders of mood and conation? p. 1
Jyoti Prakash, Suprakash Chaudhury, Kaushik Chatterjee, Sanjeev Kumar
DOI:10.4103/ipj.ipj_68_22  
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REVIEW ARTICLE Top

Depression, anxiety, and quality of life after percuataneous coronary interventions p. 6
Rajiv Kumar Saini, Suprakash Chaudhury, Navreet Singh, DS Chadha, Rajneesh Kapoor
DOI:10.4103/ipj.ipj_126_21  
Coronary artery disease (CAD) is the leading cause of morbidity and mortality in the world. However, some fascinating advances in the field of cardiology have not only added years to people's life but life to years as well. Percutaneous coronary intervention (PCI), commonly known as coronary angioplasty is a nonsurgical procedure used to treat stenotic coronary arteries. In recent years, PCI has become the preferred modality of treatment for occluded coronary arteries. However, there has been growing interest in the quality of life (QOL) issues for those who undergo such procedures. Depression, anxiety, vital exhaustion, hostility, anger, and acute mental stress have been evaluated as risk factors for the development and progression of CAD. Further, they also have strong bearing toward recovery from an acute coronary event. The current article discusses the role of depression, anxiety, and QOL of patients undergoing PCI.
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ORIGINAL ARTICLES Top

Personality and achievement: A follow-up study p. 19
Rani Srivastva, Alka Sabharwal, Alka Agrawal, Anita , Himanshu Vershney, Yashaswini Srivastava
DOI:10.4103/ipj.ipj_57_21  
Background: The health and well-being of medical students along with their successful progression is an important concern for society. Studies across the world demonstrated a high prevalence of psychiatric morbidity and low self-esteem among medical students requires immediate attention and effective management. Aim: To compare the symptoms of depression, anxiety, and stress between the groups who have cleared all papers in the first attempt with those who have got supplementary at least in one paper during their MBBS course. Materials and Methods: Raven's Progressive Matrices Scale, Eysenck personality Questionnaire, Sinha's Anxiety Scale, Stress Reaction Check (SRC) List, and 16-Personality Factors questionnaires were used along with performance score was recorded for the objective of the study. Results: Nonparametric tests, Mann–Whitney and Wilcoxon are used and found that RSPM scores and EPQ Lie-scale scores are statistically different as the P < 0.05. Overall performance and psychological problems association are found out using Spearman's correlation test and it is found that Factor C and Tough poise under 16 PF are significantly correlated. Conclusions: The study concluded that there is a significant difference between the abstract reasoning between the two groups of students measured by RSPM. When the students are compared by taking gender as grouping variable the study concluded psychosis, lie scale value is significantly different in the two groups and the mean value is higher in the female group. It is also concluded that the stress level measured by SRC is significantly different and the mean value is higher in the female group. Furthermore, the global factors Tough poise and independence are found to be significantly different in two groups with 16 PF questionnaire.
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Effect of sertraline and fluvoxamine on quality of life in patients with obsessive–compulsive disorder: A 12-week interventional study p. 26
Jasmine Brar, Ajeet Sidana, Nidhi Chauhan, Manoj Kumar Bajaj
DOI:10.4103/ipj.ipj_133_21  
Background: Obsessive–compulsive disorder (OCD) is associated with poor quality of life (QoL) and functionality. Treatment leads to improvement in QoL and better functioning. Aim: To assess the effect of treatment with SSRIs on QoL and disability in first-episode, drug-naïve patients with OCD. Materials and Methods: Fifty first-episode, drug-naïve patients with a diagnosis of OCD according to the Diagnostic and Statistical Manual 5 were assessed for severity of illness (Y-BOCS), World Health Organization QoL (WHO-QoL Bref), and disability (WHODAS 2.0) at baseline and at 12 weeks after receiving treatment with either sertraline or fluvoxamine. Results: The scores for QoL were low and for disability were high at baseline, and the scores for WHO-QoL-Bref and WHODAS 2.0 improved significantly after 12 weeks of treatment compared to baseline. This improvement correlated with reduction in the illness severity scores on Yale-Brown Obsessive–Compulsive Scale. The responders to treatment had better QoL and lower disability compared to nonresponders. Conclusion: There is an impairment in QoL and disability in first-episode, drug-naïve patients with OCD, and QoL improves and disability decreases with adequate treatment with SSRIs, and this improvement correlates with improvement in the illness severity.
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Positive mental health on Indian track: A complex twist of occupational stress and coping p. 31
Satish A Ambhore, Satishchandra Kumar
DOI:10.4103/ipj.ipj_136_21  
Background: The present research aimed to propose a positive mental health model in relation to occupational stress and coping styles among train drivers of Indian railways. Methods: Sample (N = 300) in the age group of 21–59 years, with 40 years of mean age, and the job experience ranged from 3 to 40 years with a mean of 15 years was undertaken through purposive sampling technique. The sample also had a proper representation of the sociodemographic background. The survey-based research design with an empirical approach was used in the present study. Results: The structural equation model revealed the positive mental health of train drivers negatively associated with the experience of occupational stress. Their flourishing state has supported the positive effect of problem-focused coping and the negative effect of social support. However, this relationship with work stress was absent. Through moderation effect, problem-focused coping style strengthens the inverse association between occupational stress and positive mental health. This effect was equivalent across all living areas and income groups at the model as well as the path levels. Conclusions: This study revealed that train drivers who engaged in problem-focused coping could better handle organizational role stress and benefit from improved mental well-being. Therefore, many failures in the railway caused by human error emphasize the importance of this preventive strategy.
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Scholastic performance and ambitions in retropositive and vulnerable pediatric patients: A prospective study p. 38
Neerja Saraswat, Prateek Yadav, Ankit Singal
DOI:10.4103/ipj.ipj_174_21  
Introduction: It is widely recognized that HIV epidemic has a negative impact on retropositive pediatric patients. However, at present, the school performance and ambitions in retropositive and vulnerable pediatric patients from India are lacking. Aims: The aim of this study was to analyze the possible association between scholastic performance and ambitions in retropositive and vulnerable status in pediatric patients. Materials and Methods: Case–control study was conducted over a period of 2 years. Forty-two retropositive, vulnerable, and equal age- and gender-matched controls between the age of 6 and 16 years were included. All children or parents were enquired about performance, attendance, grades in last academic year, and their ambitions in life. The data were collected in a prevalidated questionnaire and analyzed using SPSS Version 20. Results: A total 42 children between the age of 6 and 16 years were included. Twenty-seven (64.3%) were males and 15 (35.7%) females. Eleven (26.2%) were retropositive, 27 (64.3%) had one infected parent, and 4 (9.5%) patients had both the parents retropositive. Twelve (28.5%) cases failed their previous academic years compared to 1 (2.3%) control. Only 2 (4.7%) had attendance more than 90% in cases as compared to 18 (42.8%) among controls. Twenty-one (50%) attributed feeling of isolation as a cause of poor academic performance, while none of the controls did the same. There was a significant association between poor grades and poor attendance at school and retropositive (P < 0.001). The odds ratio of feeling of isolation was 1.62. Conclusion: Retropositive and vulnerable status significantly affect the academic performance and ambitions in these children.
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Barriers to treatment of alcohol and tobacco use disorders in industrial workers p. 43
Ankur Sachdeva, Enub Ali, Jai Mehar Singh
DOI:10.4103/ipj.ipj_99_21  
Background: Substance use disorders (SUDs) are common among industrial workers and often lead to higher absenteeism and lower productivity. Multiple factors may be responsible for hindering the treatment of SUDs among industrial workers. Objective: The study was planned to assess the barriers to treatment of SUDs among workers employed in organized industries and factories. Materials and Methods: We conducted a cross-sectional study done at a tertiary care hospital associated with medical college in Delhi NCR. A total of 200 participants presenting to medicine outpatient department for the treatment of illnesses other than SUDs were selected by systematic random sampling. Participants consenting for inclusion and fulfilling the Diagnostic and Statistical Manual of Psychiatric Disorders, 5th edition criteria for substance dependence were assessed using barriers to treatment inventory and Mini-International Neuropsychiatric Interview 7.0.2. Results: The most commonly reported barriers to seeking treatment were time conflict (99.5%), followed by the absence of problem (80.5%), fear of treatment (68%), and negative social factors (49%). The absence of problem as a major barrier was reported significantly more in younger male participants, whereas fear of treatment was reported more in younger and unmarried females. Privacy concerns showed significant association with older females whereas negative social support was associated with married urban males. Alcohol dependence was observed to be significantly more in barriers such as admission difficulty, poor treatment availability, privacy concern absence of problem, and poor treatment availability and admission difficulty as a barrier was observed to be more in mild severity of illness. Conclusion: Educating employees through company wellness programs, Employee Assistance Program, and Work/Life programs to educate them about the harmful effect of substance use and various treatment availability options. Efforts should be made to reduce stigma in the workplaces, making necessary amendments so as to allow workers to have sufficient time for proper rehabilitative services and to ensure the patient about the privacy and confidentiality of the illness and treatment.
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Identifying entrustable professional activities for postgraduation in psychiatry: What should a psychiatrist be able to do? p. 49
Vinay Singh Chauhan, Kaushik Chatterjee, Jyoti Prakash, Yujal Man Singh, Ankit Dangi, Amresh Dubey, Amit Chail, Rachit Sharma
DOI:10.4103/ipj.ipj_124_21  
Background: Competency-based medical education (CBME) has been the mandate by regulatory bodies of medical education in India, and implementation is an evolving process. This study aimed to identify and propose a set of entrustable professional activities (EPAs) for a master's degree in psychiatry. An attempt has been made to present it in the form of a portfolio. Methodology: Faculty experts in psychiatry went through phases of review to select appropriate EPAs for postgraduate residents from divergent thinking to development of portfolio. Results: One hundred and sixty-seven EPAs were identified and are presented. These were divided according to expertise required. Of these, 54% were considered vital, 30% essential, and 16% desirable. Conclusion: It is envisaged that the use of EPAs and portfolios will be instrumental in implementation and success of CBME in psychiatry. It is expected that medical universities will incorporate them in their curricula. It is also expected that data will be generated to identify challenges, which shall guide future refinement of the EPAs.
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Psychiatric morbidity among human immunodeficiency virus test seekers attending the integrated counseling and testing center facility of a tertiary care hospital in South India p. 56
Srinivasan Chelladurai, Padmavathi Nagarajan, Vikas Menon, Rakesh Singh
DOI:10.4103/ipj.ipj_43_21  
Background: Testing for human immunodeficiency virus (HIV) infection has become a mandatory and routine regimen for various reasons. Literature suggests that the level of psychiatric morbidity is high among HIV-infected individuals. However, often psychiatric problems are undetected and untreated among these people and this is possible by the simple measure of screening when these people contact a health-care facility such as an integrated counseling and testing center (ICTC). The paucity of published data in this arena necessitates exploring the facts related to this issue. Hence, this study was aimed to identify the psychiatric morbidity among people undergoing HIV testing by a screening method. Methods: A cross-sectional, descriptive study was carried out among 384 individuals, those who were undergoing HIV testing at an ICTC facility of a tertiary care hospital in South India. They were assessed for psychiatric morbidity by a structured clinical diagnostic interview using mini international neuropsychiatric interview. Those people who were identified as having psychiatric problem were referred to psychiatric clinic for further management. Results: The mean age of the patients was 40 (±13.27) years and the males (n = 254, 66.1%) predominated than the females (n = 130, 33.9%). Psychiatric illness was identified in many patients (n = 91, 24%) including major depressive disorder (n = 64, 16.7%), suicidal ideas (n = 31, 8%), panic disorder (n = 26, 6.8%), and substance abuse (n = 15, 3.9%). Conclusion: The findings imply the need to integrate screening and referral services for the people undergoing HIV testing. Early screening of psychiatric morbidity among individuals utilizing the ICTC facility may help identify and treat the illness at an early stage.
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Prevalence of mental health disorders among health-care providers of COVID-19 positive and suspected cases p. 61
Subhash Das, Dasari Harish, Shikha Tyagi, Ravi Rohilla, Ira Domun, Apoorva Garg, Mallikarjun A Pandargiri, Shaminder Singh
DOI:10.4103/ipj.ipj_229_20  
Background: Health-care providers (HCP) engaged in demanding work like being involved in the care of COVID-19 positive and suspected cases are likely to have a lot of stress, anxiety, depression, and other mental health issues. It will be noteworthy to have an idea about the magnitude of the mental health problems in them to formulate effective intervention strategies for their well-being. Aims and Objectives: The aim of this study is to determine whether frontline HCP engaged in the treatment and care of COVID-19 positive and suspect cases experienced increased mental health problems. Methodology: Two hundred and fifty-one frontline HCPs engaged in COVID-19 duty and 97 nonfrontline (controls) HCP were assessed and compared using tools like General Health Questionnaire 12, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. Appropriate statistical tools such as analysis of variance and Chi-square were used. Results: Frontline HCP who were directly involved in COVID-19 duty had a higher proportion (28.3%) of psychological morbidities as compared to 19.6% among controls; HCP-frontline had significantly 2.17 times chances of having psychological distress compared to HCP controls. Among, HCP-frontline 13.1% had clinical depression, whereas in the HCP control, this was 6.2%. Further, 20.3% of HCP frontline and 10.3% of HCP control had clinical anxiety, and the difference between the two groups was statistically significant (P = 0.0011). Conclusion: Frontline HCPs working in demanding work such as COVID-19 patient care are susceptible to psychological distress, anxiety, and depression which warrant urgent attention.
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A comparative study of the effect of electroconvulsive therapy and transcranial direct current stimulation in the treatment of persons suffering from treatment-resistant depression p. 68
Vikhram Ramasubramanian, S Mathumathi, Gopi Rajendhiran, P Bijulakshmi, M Kannan
DOI:10.4103/ipj.ipj_217_20  
Background: About 20%–30% of persons with major depression are said to have treatment-resistant depression (TRD) when they do not respond to antidepressants. These people continue to suffer in life and have poor quality of life. Although electroconvulsive therapy (ECT) is the most successful option in treating TRD, many people refuse ECT due to various reasons (stigma, the cost involved, and medical complications). Various studies combine treatment options such as psychotherapy, repetitive trans magnetic stimulation, ketamine, and transcranial direct current stimulation (tDCS) in an attempt to reduce symptoms for those people suffering from TRD. This study aims to compare the effectiveness of ECT and tDCS in TRD. Subjects and Methods: A total of 90 persons suffering from TRD were selected for the study. 46 persons received 6 ECTs and 44 persons received 10 sessions of tDCS. Treatment response was measured using baseline and postassessment scores of Hamilton depression rating scale and clinical global impression. The scores were used to determine the effectiveness of ECT in comparison to tDCS in TRD. Statistical Analysis: The mean ± standard deviation was analyzed and paired t-test was used to find the significance of treatment outcome in a group at a 95% confidence interval. Results: ECT was found to be more effective than tDCS in the reduction of depressive symptoms. tDCS showed a significant reduction in depressive symptoms (P < 0.001). ECT has yet again been proven to be effective in the treatment of TRD. Conclusion and Discussion: tDCS is effective in reducing depressive symptoms in persons suffering from TRD. However, ECT is superior in decreasing depressive symptoms in TRD when compared to tDCS.
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Prevalence and characteristics of eating disorders among college students of a nonmetro city of Gujarat p. 74
Chintan Madhusudan Raval, Renish Bhupendrabhai Bhatt, Deepak S Tiwari, Bharat N Panchal
DOI:10.4103/ipj.ipj_28_20  
Context: There is a relative paucity of prevalence data about eating disorders (EDs) in India among young population. Aims: We aimed to estimate the prevalence and characteristics of EDs and abnormal eating behaviors among college students of a nonmetro city of Gujarat. Setting and Design: A cross-sectional survey was done among five colleges of a nonmetro city in Gujarat from February to September 2019. Subjects and Methods: Total 790 college students were assessed using a semi-structured format, Eating Attitudes Test-26, and Bulimic Investigatory Test Edinburgh followed by structured clinical interview as per DSM-5 criteria for EDs. Statistical Analysis: Outcomes were expressed in frequency, proportion, mean, and standard deviation. P values were calculated by Pearson Chi-square test or Fisher's exact test to determine the significance of the result. Results: The prevalence of abnormal eating behaviors was 25.2% (n = 199). Anorexia nervosa (AN) was not detected. The prevalence of bulimia nervosa (BN) was 0.2% and other specified feeding or eating disorder (OSFED) was 0.6%. “Being aware of calorie content” (53.7%) and “preoccupation with desire of thinness” (46.3%) were commonly found. “Impulse to vomit after meals” (2.5%) was least common. Lower body mass index was found among subjects with abnormal eating behavior. None of the subjects had amenorrhea. Conclusions: The prevalence of disordered eating behaviors, BN, and OSFED was 25.2%, 0.2%, and 0.6%, respectively. AN was not detected. OSFED was the most common ED and the characteristic “body image disturbance” was the most common symptom.
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Comorbidities of male patients with sexual dysfunction in a psychiatry clinic: A study on industrial employees p. 81
Jnanamay Das, Shailly Yadav
DOI:10.4103/ipj.ipj_116_20  
Background: Previous studies assessed the association of sexual dysfunction (SD) in cases of specific organic and psychiatric disorders separately as risk factors of SD, but the extent of association of various disorders in cases of SD was rarely evaluated. This study was conducted to assess almost all types of comorbidities to find out their effects on SD in male patients and to make complete diagnoses. Materials and Methods: All male patients aged between 18 and 60 years reporting with sexual problems to the psychiatry outpatient department were evaluated with Arizona sexual experiences scale (ASEX) for males. Their assessment included detailed medical and psychiatric history including medicine intake, physical and mental status examination. Relevant biochemical investigations were done including sex hormone assessment. Results: Among 104 males diagnosed as cases of SD according to the ASEX scale in 1 year period only 75 patients completed all the biochemical and hormonal assessments. It was observed that 38.67% were diagnosed as SD without any comorbidity, 25.33% had biochemical or hormonal or physical comorbidities, 21.33% had psychiatric comorbidities and 14.67% had psychiatric as well as biochemical or hormonal or physical comorbidities (n = 75). The severity of SD was higher in the patients with comorbidity and the age of the patients predicted its severity. Conclusion: All cases of SD should be assessed in detail for physical, biochemical, hormonal, and psychiatric comorbidities to treat them holistically. Psychiatrists should play a key role in assessing, diagnosing, treating, and referring them to the appropriate treatment provider.
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Efficacy of family psychoeducation on drug compliance, self-esteem and caregivers' burden among selected psychiatric inpatients from a tertiary care centre, North India p. 89
Kureel Bhawana, Xavier Belsiyal Chellappan, Jitender Rohilla
DOI:10.4103/ipj.ipj_190_20  
Background: Lack of awareness has alarmingly raised the proportion of drug noncompliance among psychiatric patients, which are proven worrisome not only to the patients but also to their caregivers. An individually tailored family psychoeducation will address the issue by enhancing the knowledge among patients and their caregivers. Aim: The aim of this study is to assess the efficacy of family psychoeducation on drug compliance, self-esteem, and caregiver's burden among psychotic and mood disorder patients in a selected tertiary care center, Uttarakhand, India. Methods: A quasi-experimental study was performed among 120 participants using total enumerative sampling in a general hospital psychiatric ward. Data were collected from patients and caregivers using the Medication Adherence Rating Scale, Rosenberg Self-esteem Scale, and Zarit burden interview-22. The outcome measures were evaluated in the 2 and 4th weeks, and data were analyzed using the descriptive (frequency, percentage) and inferential statistics (Friedman analysis of variance, Wilcoxon signed-rank test) using the SPSS software version 23.0. Results: The present study showed that almost 30% of patients were noncompliant with their drug regime (mean ± standard deviation, 4.23 ± 1.57), and a majority (63.33%) of them presented with a low level of self-esteem. Furthermore, 71.7% and 13.3% of caregivers experienced a moderate and severe burden. An increase in drug compliance (35%) and self-esteem (31%) and a decrease in caregivers' burden (13%) were observed after the administration of family psychoeducation (P = 0.00). Conclusion: There is a great need to provide family psychoeducation on a routine basis in general hospitals. Patients with higher self-esteem will ultimately show improved social and occupational functionality resulting in satisfactory treatment compliance and decreased caregivers' burden.
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A study of family-related factors associated with scholastic backwardness in urban lower middle class school children p. 98
Neha Sharma, Rama Chandra Das, Kalpana Srivastava, Rucha Upasani
DOI:10.4103/ipj.ipj_36_20  
Introduction: Causes of scholastic backwardness in a child may be internal or external. The external factors include the factors related to the family the child is living in, and these factors are usually under-estimated in assessing contribution to scholastic backwardness. Aims: The aim of this study is to study the family factors associated with scholastic backwardness in school-going children in Pune Cantonment. Materials and Methods: Three hundred school children aged 8–14 years studying in Class III to IX from two government aided semi-Marathi Schools in Pune Cantonment were screened for scholastic backwardness, and evaluation of family-related factors was carried out for positive cases and matched controls. Results: Significant association was found between scholastic backwardness and such family factors as maternal education, chronic illness in the family members, and family problems such as domestic violence and substance abuse (P < 0.05). Conclusions: The family a child lives in plays an important role in determining the scholastic performance of a child. Adverse impact on the child's performance can be made by such variables as low maternal education, chronic illness in one or more family members, and poor family environment. Management strategies and policies aimed at correcting these preventable cause would ensure that they are identified and remedied at an early stage to ensure optimum scholastic performance by children.
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Association between parental psychiatric illness and psychological well-being of their children Highly accessed article p. 104
Shaily Mina, Rupam Dhiman, Abhilasha Yadav, Kuldip Kumar
DOI:10.4103/ipj.ipj_155_20  
Background: Children and adolescents are the pillars of a healthy society. Researches have explored significantly higher rate of psychopathology in children whose parents (either) have psychiatric illness in comparison to the general community (25%–50% v/s. 20%). Parental psychiatric illness (PPI) has significant long-term consequences on child's development-general health, cognitive stimulation, social, emotional, and behavioral maturity. Objectives: The objective of this study is to assess the cognitive, emotional, and behavioral problems of children of parents with psychiatric illness. Methodology: The present cross-sectional study attempted to evaluate the factors linked with the PPI and overall child's development. Two hundred and six parents with psychiatric illness (>1-year duration) were included in the research. Results: A total of 206 families (either mother/father) and their children 353 in number (<18 years) were included in the study. Slightly higher percentage of mother as participant was observed (56.8% v/s. 43.2%). In 80% of the families, mother was the primary caregiver of the children. Marital discord was prevalent in these families (17.9% reported by mother v/s. 31.5% reported by father). Conclusion: Early identification of the soft indicators of the children of PPI should be identified along with the treatment of their parents. Schools should be oriented to initiative an early assessment by the evaluation of the children with psychiatrist/psychologist.
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Anxiety among doctors during COVID-19 pandemic in a tertiary care center in India p. 113
Anupam Singh Yadav, Ashutosh Kumar
DOI:10.4103/ipj.ipj_200_20  
Background and Objectives: The ongoing pandemic of COVID-19 has a severe impact on the health-care system worldwide bringing doctors under immense pressure to work under stressful conditions. The main objective of this study was to assess anxiety among doctors and to understand the perceived causes of anxiety. Methodology: Questionnaires were made available to all willing doctors of SN Medical College, Agra; King George's Medical University, Lucknow, and GSVM Medical College, Kanpur, between May 12, 2020, and June 20, 2020 (during nationwide lockdown). The questionnaire consists of three main sections: details about respondents' working status, questions regarding respondents' reasons for concern, and Becks' Anxiety Inventory (BAI) scale. Results: Two hundred and fifty responses were received from about 599 doctors presented with the questionnaire. About 32% of the respondents have already done duties in COVID facilities and the rest are awaiting deployment at those facilities. Forty-two percent reported concern regarding transmitting the illness to close ones/loved ones/family members to be a cause of anxiety and 40% were worried about the quality of protective gear closely followed by examination-related worries. About 28.8% of the respondents scored >7 on BAI with 62.5% of these (18% of total respondents) reporting “moderate” levels of anxiety. Conclusions: Our findings underline the fact that pandemics such as COVID-19 cause significant levels of anxiety among doctors. The levels of anxiety differed for age, sex, and specialty. The perceived causes were the risk of transmitting to loved ones and concerns regarding protective gear. These outcomes highlight the need for early interventions to address anxiety and to provide support for doctors during such crises.
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Spirituality as intrinsic motivational factor and health related quality of life among hospitalized male patients practicing Hinduism in India p. 120
Suhasini Reddy Nandika, K Nagalakshmi
DOI:10.4103/ipj.ipj_222_20  
Introduction: Intrinsic motivation denotes doing an activity for itself and deriving pleasure and satisfaction from involvement. Intrinsic spirituality as the most important motive or driving factor in a person's life has a significant influence on the perception of one's own physical and psychological health, social relationships, and environmental health. Aim: The study aims to investigate the influence of intrinsic spirituality as a motivational factor on the dimensions of health-related quality of life (HRQoL) among hospitalized patients. Materials and Methods: Three hundred and sixty-seven patients admitted to a tertiary hospital were selected by stratified random sampling from different medical and surgical wards. Patients comprised Hindu male patients, mean age 36 (standard deviation = 13.2) years suffering from either medical or surgical disorders of minor-to-moderate intensity. Measures of Intrinsic Spirituality Scale and WHOQOL-BREF were administered to assess their intrinsic spirituality and the four dimensions of HRQoL, namely physical and psychological health, social relationships, and environmental quality of life. Data of 325 patients (42 participants eliminated in data cleaning process) were analyzed using SPSS version 25 for Pearson's correlation, and regression analysis. Results: Higher scores on intrinsic spirituality were found to be positively impact overall quality of life and general health (r = 0.169, P = 0.002; ß =0.180, P = 0.001), psychological health (r = 0.149, P = 0.007; ß =0.151, P = 0.006), social relationships (r = 0.123, P = 0.026; ß =0.133, P = 0.016), and environmental health perception (r = 0.211, P = 0.000; ß =0.22, P = 0.000) and were not significantly correlated with physical health perception (r = 0.091, P = 0.10; ß =0.093, P = 0.094). Conclusion: Spiritual motivation significantly predicts better psychological, social, and environmental health perception among hospitalized male Hindu patients. Realistic perception with respect to physical health is also reflected in this study.
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Frequency of psychiatric comorbid symptoms in bipolar disorder patients in remission p. 126
Aarshie Koul, A Siddharth Shetty
DOI:10.4103/ipj.ipj_233_20  
Introduction: Psychiatric comorbidity has been detected in one-third of bipolar patients. The illness itself may be a precipitating factor for developing substance use and anxiety disorders. Comorbid anxiety disorders with bipolar disorder (BD) are associated with decreased chances of recovery, poorer role functioning, and quality of life, and greater likelihood of suicide attempts. Hence, identifying comorbid symptoms in remitting patients has important preventive and therapeutic implications. Aims: The aim of the study was to estimate the frequency of psychiatric comorbid symptoms in patients of bipolar affective disorder in remission and to identify its relationship with sociodemographic variables. Methodology: This is a cross-sectional study conducted in Father Muller Medical College and Hospital, Mangalore (April 2019–July 2019), which included 90 patients aged 18–50 years with BD, manic, or depressive episodes in remission for 8 weeks who were evaluated using mini international neuropsychiatric interview plus, Hamilton rating scale for depression, and young mania rating scale. Sociodemographic details were assessed by a semi-structured pro forma. The data were analyzed using frequency, Chi-square test, and t-test. Results: Most common psychiatry comorbid symptoms seen in BD were found to be drug dependence/abuse (n = 31), second most common being alcohol dependence/abuse (n = 21), followed by suicidality (n = 8), antisocial personality, social phobia, panic disorder, and agoraphobia. Significance was found for suicidality, agoraphobia, and social phobia if the last episode was depressive and for suicidality if index episode was depressive and if age of onset was >40 years. Conclusion: Psychiatric comorbidities in BD may worsen the course and prognosis of the disorder and hence, clinicians must maintain a high index of suspicion for them. Furthermore, comorbidities may need to be identified and appropriate interventions employed to prevent iatrogenic complications.
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Evaluation of relationship between stress and periodontal disease in different professional college students p. 135
Lakshmi Kanth Kolaparthy, Bharathi Kota, Yamuna Marella, Radhika Kondraganti, Gopinath Cheni, Ravindranath Dhulipalla
DOI:10.4103/ipj.ipj_234_20  
Background: To evaluate the association between stress and periodontitis in different professional college students. Subjects and Methods: The study was conducted in 360 professional college students which includes Medical, Dental, Pharmacy, Nursing, Engineering, and Chartered Accountancy. From each group, 60 students were included in the study. Self-reported Depression, Anxiety, and Stress Scale questionnaire was given to all the students and clinical examination was conducted in all the participants to assess the Oral hygiene index - simplified (OHI-S), clinical attachment level (CAL), and Gingival Index Simplified (GI-S). Statistical Analysis: Statistics was performed using the ANOVA test, post hoc test, and Pearson correlation test to compare the psychological parameter of stress with periodontal parameters among six groups of students. P <0.05 was considered to be statistically significant. Results: Group I showed higher mean stress scores (10.78 ± 0.76) compared to other groups. The mean OHI-S (1.61 ± 0.15), mean CAL (3.68 ± 0.79), and mean GI-S (1.43 ± 0.15) scores also increased with elevated stress levels among medical students. Followed by Group VI and Group II showed almost similar results. Conclusion: The present study showed strong association between stress and periodontal disease and have an adverse effect over oral hygiene factors among the students.
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Students' perceptions on newly designed foundation course at MBBS entry level: A mixed-method study p. 141
Kavita R Bhatnagar, Aroma Oberoi
DOI:10.4103/ipj.ipj_67_20  
Background: Selection of students to medical colleges is based on merit of candidate at written entrance examination which does not take care of nonscholastic abilities of the students. Medicine is a profession that requires not only mastery of large body of knowledge and clinical skills but also high standards of professionalism and appropriate attitudes. Methodology: A 1-month long foundation course was conducted for the fresh students admitted to MBBS course at Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, India. Seventy-four students had joined the course. The course was planned, arranged, and executed by the department of Medical Education Unit. It included six modules. Retrospective pre- and postevaluation was done for knowledge, skill, and attitude. Wilcoxon signed-rank test was used for all pair-wise comparisons. Participants also completed a questionnaire (Likert scale and some open-ended items) about educational quality of sessions and utility of the course. Descriptive statistics and qualitative methods were used for data analysis. Results and Conclusion: Response rate was 100%. Students perceived foundation course as an excellent opportunity to acquire basic knowledge, attitude, and skills required for subsequent phases in MBBS course. This Foundation Course enhanced their orientation to the curriculum and campus, boosted confidence to cope up with the challenging syllabus, helped them develop time and stress management skills, and also sensitized them to achieve the highest standards of morale required to ensure ethical practice.
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A cross-sectional study to assess the caregiver burden and the quality of life of caregivers of the patients suffering with psychiatric illness p. 151
Parul Gupta, Poonam Bharti, Manish Bathla, Angad Harshbir Singh, Leezu Bhusri
DOI:10.4103/ipj.ipj_228_20  
Background: The impairment due to the psychiatric disorders makes the sufferer unable to become independent, therefore require long term support and care by their relatives. About 32% of years lived with disability (YLD) and about 13% of disability adjusted life-years (DALYs) is found in mental illness. Aims and Objectives: The aims were to study the socio-demographic profile, the caregiver burden and quality of life of the caregivers of the patients with different psychiatric illness. Also, to compare the burden and quality of life among caregivers of different psychiatric groups. Materials and Methods: It is a cross sectional study in which 120 caregivers of patients with psychiatric illnesses were included; divided into four groups (30 each): Anxiety, psychotic, mood and substance use disorders. After the consent, Zarit burden interview, socio demographic profile and quality of life -10 scales were used to assess the objectives. Results: The results revealed that maximum caregivers were males, and spouses in relation with the patient. Most of them were married and educated. Maximum had mild to moderate level of burden (49.1%), followed by moderate to severe level of burden in about 22.5% caregivers. Significant association was seen with the burden level. But no significant association was seen with the quality of life. Conclusion: Caregivers of the psychiatric patients have to suffer a lot and may land up into the psychiatric symptoms themselves.
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CASE REPORTS Top

Aripiprazole-induced obsessive–compulsive symptoms p. 158
Dilshana Nafisa, Anil Kakunje
DOI:10.4103/ipj.ipj_182_20  
Aripiprazole is a novel antipsychotic with a unique pharmacological profile as a dopamine partial agonist.It is indicated for treatment of schizophrenia and bipolar disorder. This new antipsychotic has low rate of extrapyramidal side effects, metabolic changes and no significant adverse effect on serum prolactin concentration. In addition,it is not associated with significant weight gain like other atypical antipsychotics. As a reason, when other antipsychotics cause these adverse events, it's not uncommon to switch to Aripiprazole.Obsessive compulsive symptoms have been untoward sequel of a few second-generation antipsychotics. Among the second generation antipsychotics Clozapine, Olanzapine, and Risperidone are the most prominent agents associated with these sequelae, according to case reports. More recently, a handful of case reports indicated development of Obsessive-compulsive symptoms with Aripiprazole. We report a case that exhibited similar unexpected adverse effects after administration of Aripiprazole. Keywords: Aripiprazole, Second generation antipsychotics, Obsessive-compulsive symptoms (OCS).
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Hashimoto's encephalopathy with psychiatric presentation p. 162
Apala Singh, Linkan Verma
DOI:10.4103/ipj.ipj_61_20  
Hashimoto's encephalopathy is an uncommon neuropsychiatric syndrome with varied clinical presentations. It presents as an encephalopathy without central nervous system infection or tumor. Mostly observed ones are seizures, cognitive impairment, movement disorders, altered sensorium, and behavioral and psychotic symptoms. Treatment with steroids and immunosuppressants has led to excellent remission rates. Here, we report a case of a 55-year-old male who presented predominantly with psychiatric symptoms and rapidly progressing dementia. The patient was managed by intravenous steroids and low-dose oral risperidone. Prompt investigations and diagnoses helped in treating the condition. This case highlights that timely diagnosis can lead to an excellent prognosis in this condition.
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Benzodiazepine withdrawal catatonia: Two cases from a tertiary care center in Eastern India p. 165
Uttam Majumder, Avik K Layek
DOI:10.4103/ipj.ipj_265_21  
Catatonia is a diagnostic entity of a neuropsychiatric cluster of symptoms that can occur in a number of different psychiatric, neurologic, and metabolic disorders. Benzodiazepines remain the mainstay of the treatment of catatonia through their possible effect on the gamma-aminobutyric acid (GABA) receptor modulation in the central nervous system (CNS). Rarely, patients have been seen to manifest catatonic symptoms when they face sudden withdrawal from long-term benzodiazepine treatment. Here, we have presented two such cases of different clinical profiles where following benzodiazepine withdrawal, sudden catatonic symptoms emerged that responded quickly on re-administration of benzodiazepines.
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SHORT COMMUNICATIONS Top

Older adult life in COVID-19 pandemic: Focus on social isolation, loneliness, and minimization of risks p. 168
Priyaranjan Maral, Deepa Punetha
DOI:10.4103/ipj.ipj_219_20  
At the moment of worldwide lockdown with the outbreak of coronavirus disease 2019 (COVID-19), older adult life bangs up with lots of changes such as stagnation in life, abuses, or violence (e.g., physical, emotional, sexual, and neglect). Older adults are feeling and experiencing more deprivation of social connectedness in a self-isolating environment. When there is a need for solidarity worldwide, COVID-19 is escalating stigmatization and discrimination against older adult populations. For this reason, we are particularly interested/accentuated more on the isolation life and loneliness lifestyles of older adults residing inside the four walls of their houses. In addition, emphasis is also given on different approaches of 4 R's such as reinoculate, remove, restore, and resilience for minimization of impact of COVID-19 among older adults. However, the cultural differences and societal values also played a major role in minimization of mental health challenges and illnesses during lockdown in Western and Eastern societies. The “We-ness” of collectivistic culture of Eastern societies brings more “Wellness” for older adult mental health. On the other hand, the “I-ness” of individualistic culture of Western societies brings only “Illness” for the older adult population. Still, many countries are facing a second or third wave of COVID-19, which are worsening the situation more for the older adult population. With aging and social isolation in pandemic, older adults' well-being can be restored by developing healthy habits, involvement in religious activities, adopting natural healing techniques, and positive thinking toward the life.
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Lifetime child sexual abuse assessed at age 18: A survey of college students from Kerala, India p. 172
Aditi Singh, Anjana Rani, Priya G Menon, B Sivasankaran Nair, K Thennarasu, TS Jaisoorya
DOI:10.4103/ipj.ipj_201_20  
Estimates of child sexual abuse (CSA) during adolescence may undercount exposure and retrospective recollection in adulthood may be prone to recall bias. Thus, a more accurate and CSA may be possible if the question is examined in a large sample of 18 years old. This study examined the prevalence and psychosocial correlates of CSA among college-going 18 years olds. This is a cross-sectional survey of college students. 1424 students from 58 colleges selected by cluster random sampling completed a self-administered questionnaire incorporating standardized instruments. Prevalence rates were calculated. Chi-square test was used to compare categorical variables and binary logistic regression analysis was used to examine the correlates of CSA. CSA was reported by 13.2% and significantly more common among males compared to females (18.4% vs. 10.4%, P < 0.05). In the full model of binary logistic regression analysis, students who reported sexual abuse were significantly more likely to report psychological distress and suicidal thoughts. The finding was replicated even when male and female students were analyzed separately. To conclude, CSA is common among college students. With an increasing number of young people enrolling in colleges in India, timely interventions on campuses are important to reduce the psychological morbidity in this population.
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LETTER TO EDITOR Top

Demographic and clinical profile of women receiving inpatient treatment at a deaddiction unit of a psychiatric hospital in India: Five years' observation p. 177
Sourav Khanra, Ujjwal Singh, Sanjay Kumar Munda, Basudeb Das
DOI:10.4103/ipj.ipj_84_21  
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