Indian Journal of Private Psychiatry

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Volume 16, Number 2, July-December 2022

EDITORIAL

Mahesh Gowda, Khushboo Dewani

The National Medical Council Regulations: The Road Ahead

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:3] [Pages No:53 - 55]

   DOI: 10.5005/jp-journals-10067-0124  |  Open Access |  How to cite  | 

ORIGINAL RESEARCH

Akshay Chordia, Sagar Karia, Nilesh Shah, Avinash De Sousa

A Study of Safety and Efficacy of Methylphenidate in Children and Adolescents: An Observational Clinical Study

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:5] [Pages No:56 - 60]

Keywords: Appetite, Attention deficit hyperactivity disorder, Methylphenidate, Weight

   DOI: 10.5005/jp-journals-10067-0115  |  Open Access |  How to cite  | 

Abstract

Background: Attention deficit and hyperactivity disorder (ADHD) leads to various problems like academic underachievement, interpersonal relationship problems, and low self-esteem. Medications like methylphenidate (MPH) used for its treatment have decreased appetite and weight loss as the main side effects. There is scarce literature that throws light on the prevalence or severity of these particular side effects in patients with ADHD. Aims and objectives: So this study was conducted to assess the safety and efficacy of MPH in children and adolescents diagnosed with ADHD. Materials and methods: Patients of age-group 5–17 years who were diagnosed with ADHD were included in the study after taking informed consent of their parents. Semistructured pro forma was used to collect demographic and phenomenological details. Conners rating scale was used to assess ADHD severity. Methylphenidate was started for treating ADHD and patients were followed up at 1 and 3 months and change in Conners scale and side effects including appetite changes were asked for on follow-ups. Also, height and weight were measured on all visits. Results: One-hundred and seven patients with a mean age of 9.61 years were enrolled; of which, 79% of them were males. Seventy-three percent of them had a combined type of ADHD. The mean dose of MPH increased on subsequent follow-ups. Forty percent of them experience a decrease in their appetite at 1 month but only 18% of them had appetite issues at 3 months. There were no statistically significant changes in the height and weight of the patients on follow-ups. Conclusion: MPH is a very well-tolerated treatment for ADHD and not many side effects are observed in children taking it. Appetite reduction is seen for the initial treatment period which can be managed by giving MPH after heavy breakfast and meals.

ORIGINAL RESEARCH

HN Pratibha, S Sourabh, Sushmitha Kota, Shankar Kumar

A Cross-sectional Study of Psychological Distress, Coping Strategies, Concerns, and Perceived Needs among Nurses Working in a Dedicated COVID-19 Center

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:6] [Pages No:61 - 66]

Keywords: Anxiety, Depression, Nurses, Psychological

   DOI: 10.5005/jp-journals-10067-0117  |  Open Access |  How to cite  | 

Abstract

Context: Nurses presented with highest levels of occupational stress and resulting distress when compared to other healthcare workers, which could be due to nurses spending more time than doctors with patients with frequent rotations of duties and direct contact of the nurses with the patients. Most studies have focused on psychological distress among nurses in the coronavirus disease-2019 (COVID-19) pandemic. We in addition wanted to explore their concerns, factors which could possibly mitigate their distress in addition to studying coping strategies used by them and its association with psychological distress which was the aim of the present study. Settings and design: It was a cross-sectional study using convenient sampling where snowballing technique was used to contact 100 frontline nurses working for a dedicated COVID-19 care center. Materials and methods: The study tools included were socio-demographic questionnaire, Depression Anxiety Stress Scale 21 (DASS 21), Brief COPE scale, and a list of concerns and perceived needs which could mitigate distress which was sent using google forms to participants after obtaining informed consent from each participant. Statistical analysis used: Descriptive data were tabulated using percentages. Statistical analysis was conducted using Chi-square test for categorical variables, t-test for continuous variables, and Spearman correlation for correlations. Results: Our study had 100 participants, of which 43 (43%) were males and 57 (57%) were females. Majority of them were married (60%) and living with family (77%). The predominant concern was death due to COVID-19 infection. Nurses in the study reported that factors such as family support, working as a team and positive attitudes of colleagues, recognition of work by management could possibly help in mitigating distress. Those with high stress had significantly higher fear of death due to COVID-19 infection (p = 0.001). We found a significant association between high emotion focused and avoidant type of coping with higher stress (p = 0.0001) and high problem-focused coping with lower stress (p = 0.0013). Conclusion: The results of the present study highlight the need to better understand psychological distress and coping strategies among nurses providing care to COVID-19 patients. Administration should establish a system to support nurses and monitor their psychological health.

Original Article

Sneha S Raju, Darpan Kaur, Shubhangi S Dere, Rakesh Ghildiyal

Profile of Psychiatric Disorders among COVID-19 Patients Admitted at COVID-designated Medical College and Hospital

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:5] [Pages No:67 - 71]

Keywords: COVID-19, Profile, Psychiatric disorders

   DOI: 10.5005/jp-journals-10067-0105  |  Open Access |  How to cite  | 

Abstract

Introduction: There is sparse literature on psychiatric disorders among Coronavirus (COVID-19) disease patients at tertiary health care centers. Aims and objectives: To study the profile of psychiatric disorders among COVID-19 disease patients admitted at COVID-designated medical college and hospital and to assess demographic factors like age, sex, referring units, psychiatric diagnosis, and psychiatric intervention. Materials and methods: A retrospective study was conducted among patients admitted for COVID-19 disease referred to psychiatry department for consultation liaison psychiatry services from April 2020 to November 2020 (First wave) in COVID-designated medical college and hospital fulfilling the inclusion and exclusion criteria. Case records of adult patients admitted at COVID-designated hospital with reference for psychiatry were eligible for the study. Case records with incomplete data were excluded from the study. A predesigned data collection form was used to assess demographic factors such as age, sex, referring units, psychiatric diagnosis, and psychiatric intervention. Institutional Ethics Committee (IEC) clearance was obtained. The data were tabulated in Excel sheet and analyzed with descriptive tests. Results: A sample size of 121 referrals was assessed; out of which, 4 patients’ records were incomplete and not diagnosed with psychiatric disorders nor psychological problems and were nil active from psychiatry. Hence, their records were excluded from the study. In the final analysis, 117 case records were included. We found that 76 (64.96%) were males and 41 (35.04%) were females; the mean age of the sample was 47.4 years; 62.39% were confirmed cases of COVID-19 disease, whereas 37.61% were probable cases of COVID-19 disease. The maximum number of referrals were received in the month of July (36.75%). The referrals were received mostly from COVID isolation wards (53.85%) followed by COVID high dependency unit (23.93%) and COVID intensive care unit (22.22%). The commonest psychiatric disorders among the referred patients were adjustment disorder (34.62%) followed by organic delirium (26.92%). Escitalopram was the most medication prescribed followed by clonazepam. Conclusion: We conclude that psychiatric disorders were found to be prevalent in patients with COVID-19 disease admitted at COVID-designated medical college and hospital and had a distinct profile with relevant clinical and research implications as per our study setting.

Original Article

Shahul Ameen

A Website on Mental Healthcare Act, 2017: Usage Analysis of Its First 2.5 Years

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:6] [Pages No:72 - 77]

Keywords: Google Analytics, Mental health website, Mental Healthcare Act, 2017, Usage analysis

   DOI: 10.5005/jp-journals-10067-0118  |  Open Access |  How to cite  | 

Abstract

Background and aims: Websites are valuable tools to share information with countless persons in a cost-effective manner. No previous study has assessed the performance of a website meant for Indian mental health professionals (MHPs). This study aimed to analyze the usage data of a website on the Mental Healthcare Act (MHCA), 2017, for the 2.5 years since its launch (August 2018–February 2021). Methods: Information on the number and location of visitors, devices and browsers they used, bounce rate, number and duration of sessions, pageviews, traffic sources, search engine keywords that brought visitors, and the most popular pages was collected using Google Analytics (GA). Results: Out of the total 11,936 sessions, 34.66% were from returning visitors, 2,124 lasted >3 minutes, 226 lasted >30 minutes, and 90.34% were from India. Of the visitors, 49.6% came directly, 45.3% were from search engines, 51.06% used desktops, 45.92% used mobile phones, and 70.79% used Google Chrome. Bounce rate was 58.93%. Most keywords that brought visitors from search engines and the most popular pages were about admission and discharge procedures and the related forms. Conclusions: The website received an adequate amount of quality traffic. It probably helped Indian MHPs understand the admission and discharge procedures the Act dictated and also provided them the related forms. Professional organizations, institutions, and departments should create websites, on focused topics, for Indian MHPs. They should ensure that the sites are compatible with mobile phones and diverse browsers. GA can be used to garner useful insights.

Original Article

Ankit Halder, Navna Panchami Ravindran, Devavrat Harshe, Sneha Harshe, Gurudas Harshe, Avinanda Biswas, Dhakshana Pushpanathan, Abhishek Shewale, Sucharita Patra, Aditya Nair

Course of Sexual Dysfunction in Different Domains among Hypertensive Patients: A Longitudinal Study in a Tier 2 City in India

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:7] [Pages No:78 - 84]

Keywords: Course, Hypertension, Sexual dysfunction

   DOI: 10.5005/jp-journals-10067-0120  |  Open Access |  How to cite  | 

Abstract

Introduction: A greater risk of sexual dysfunction (SDys) is found in hypertensive individuals. The study aimed to chronicle the course of dysfunction in different domains of male and female sexual function in patients of essential hypertension and correlate the findings with different patient characteristics. Materials and methods: The study was conducted in a semi-urban outpatient department setting, in Kolhapur city, consisting of 360 patients of essential hypertension on antihypertensive therapy for at least 2 years fulfilling the criteria of the study protocol in General medicine OPD of DY Patil Hospital and Research Institute. Detailed clinical history, examination, and laboratory investigations were carried out. Clinical data were collected using standard questionnaires. Demographics and clinical data were analyzed in R-studio software (v.1.2.5001). Result: Of the 180 males, 46.11% (n = 83), and of 180 females, 38.89% (n = 70) had dysfunction in at least one domain. Among the 83 males with dysfunction, erectile dysfunction (Edys) was the commonest (100%) and lack of intercourse satisfaction (49%) was the least. Among the 70 females with dysfunction, lack of sexual desire was the commonest (78%) and lack of lubrication (46%) was the least. Age, antihypertensive drug type, and duration of antihypertensive treatment were significantly associated with dysfunction (p <0.005). Sexual dysfunction improved in all the 25 males and 23 females who took treatment for it in the form of drugs and psychotherapy. Conclusion: Sexual dysfunctions are more prevalent in hypertensive individuals. It should be aggressively screened, avoided, and treated since it is a sign of increased cardiovascular risk that also reduces the quality of life.

BRIEF RESEARCH COMMUNICATION

Sashi B Gupta, S Preeti, Suganya PP Krishna Pillai, M Subramanyam, Garapati N Sowmya, M Chandrashekar

Post-COVID–Long COVID—What More?

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:85 - 86]

Keywords: Coping strategies, Lockdown, Long COVID-19 syndrome

   DOI: 10.5005/jp-journals-10067-0114  |  Open Access |  How to cite  | 

Abstract

Coronavirus disease-2019 (COVID-19) has influenced our lives in all possible ways and continues to morph it. The impact has been on social, economic, occupational, educational, and not only on health, as is usually the case with a virus. The mental health is impacted severely by the long COVID-19. The guidelines to manage such a long-term impact shall be helpful, failing which healthcare workers and the people would be helpless.

BRIEF RESEARCH COMMUNICATION

Anil Kumar Agarwal, Shrikant Srivastava

A Naturalistic Study of Obsessive-compulsive Disorder: A Retrospective Chart Review

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:4] [Pages No:87 - 90]

Keywords: Comorbidity, Counseling skills, Developing practice, Improving psychiatric practice, India, In-patients, Obsessive-compulsive disorder

   DOI: 10.5005/jp-journals-10067-0122  |  Open Access |  How to cite  | 

Abstract

The electronic case records were retrieved for patients with a primary diagnosis of obsessive-compulsive disorder (OCD), and who had visited the clinic during a specified period (n = 125). The mean and standard deviation (SD) of the age of the patients were 36 ± 13.5 years, the duration of illness was 8.6 ± 7.3 years, and the follow-up period was 45.5 ± 41.9 months. The age of onset of the illness was in the late 20s. Comorbid diagnosis with OCD was seen in 41% cases–bipolar disorder (BD) 28% and schizophrenia = 13%. A family history of a psychiatric illness was present in nearly one-third of the cases. Subjectively, outcome of “Normal” or “Better” was seen in 41% cases of pure OCD, 19% of OCD + BD, and 5% in OCD + schizophrenia. Clinical presentations of cases are also discussed. The patient's behavior in attending the clinic showed that initially the patients visit the clinic more frequently when the illness is severe, but later they come for consultation whenever there were some problems, but they continue taking medicines.

CASE REPORT

Sashi Bhushan Gupta, Suganya Ponnaiah Pillai Krishna Pillai, Mahesh Gowda, S Preeti, Sanjiv Chamraj, M Chandrashekar

Neuropsychiatric Presentation of Systemic Lupus Erythematosus—When to Attribute: A Case Report

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:91 - 92]

Keywords: NP syndromes, Psychosis, SLE

   DOI: 10.5005/jp-journals-10067-0097  |  Open Access |  How to cite  | 

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune disease with the involvement of various systems. Neuropsychiatric symptoms of SLE (NPSLE) are nonspecific. The attribution of NP symptoms is difficult. We report a case with NP symptoms followed up for more than 20 years which tested positive for SLE. Introduction: SLE is a chronic autoimmune disease that is known to affect different organs in the body.1 The diagnostic criteria of the disease have evolved over time, and the prevalence of the illness has also gradually increased. Nervous system involvement is common and can manifest as neurological or NP symptoms. The American College of Rheumatology has set definitions for 19 NP syndromes [12 central nervous system (CNS) and 7 peripheral nervous system (PNS)] deemed to occur in SLE, which is widely used in clinical practice and for research.1 These NP syndromes are classified into frequent, common, infrequent, and rare based on the frequency of the symptoms.2 None of the NP syndromes is specific for SLE; however, one-third of the NP syndromes are related to SLE autoimmunity.2 Determination and attribution of NP syndromes to SLE in patients is a challenging but critical step in treatment.2 Among psychiatric syndromes, mood disorder and anxiety have been found to be frequent compared with psychosis, which is infrequent.3

CASE REPORT

Leena Dhake, Sagar Karia, Nilesh Shah, Avinash Desousa

A Probable Case of Sexsomnia

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:93 - 94]

Keywords: Clonazepam, Escitalopram, Parasomnia, Sexsomnia, Sexual behavior

   DOI: 10.5005/jp-journals-10067-0109  |  Open Access |  How to cite  | 

Abstract

Sexsomnia is a rare parasomnia that has been included a psychiatric disorder in Diagnostic and Statistical Manual-5 (DSM-5). Here we present the case of a 25-year-old male who presented with abnormal sexual behavior in sleep. There was no epileptic tendency noted, no other psychiatric comorbidity and no organic cause was determinable. The patient responded to clonazepam.

CASE REPORT

Ankit Halder, Navna Panchami, Gurudas Harshe

Escitalopram Associated with Priapism: A Rare Case Report

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:95 - 96]

Keywords: Escitalopram, Priapism, Rare

   DOI: 10.5005/jp-journals-10067-0123  |  Open Access |  How to cite  | 

Abstract

Priapism is a pathologic condition characterized by the penile erection that persists beyond or is unrelated to sexual stimulation. A 35-year-old male patient presented to the Surgery Emergency Unit with a painful erection for the past 15 hours. This was his third episode in the past 2 months. The last 2 episodes being for 5–6 hours each within intervals of 3 weeks. The patient was diagnosed to be in major depression 6 months back and was placed on escitalopram 10 mg for the first 2 months and then was raised to 20 mg once daily dose. Priapism episodes started 4 months following an increase in dosing. Escitalopram was cross-tapered to nortriptyline over a 1 month. In subsequent follow-up visits for 3 months, the patient experienced no further such episodes. Selective serotonin reuptake inhibitors (SSRIs), mostly escitalopram, are frequently prescribed nowadays for their better tolerability profile. So, while prescribing such medications, psychoeducation of the patients regarding such side effects and meticulous monitoring of the same can be lifesaving many a time.

LETTER TO THE EDITOR

Niva Jacob, Sashi B Gupta, Suganya PPK Pillai, M Chandrashekar, S Preeti

A Peep into the Society through a Kitchen

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:2] [Pages No:97 - 98]

Keywords: Gender roles, Marital rape, Marriage, Menstrual myths, Movie review, Patriarchal society

   DOI: 10.5005/jp-journals-10067-0119  |  Open Access |  How to cite  | 

Abstract

Most females in our society are having a difficult married life but not many of them are having the privilege or courage to walk out of it or stand up for their rights, as they are uneducated or helpless due to financial dependence or even the societal pressure. After a period of sustained silence, they might end up having depression or other mental health issues or even end their lives. Some believe it is the right thing to do and enjoy it by blindly following it. Some suppress their emotions and dreams and passively live their life and go unrecognized. Some stand up for their rights and might even break their marriages. Some lucky females get to be married as well as live a life without such issues due to progressively thinking husbands and families where marriage is considered a partnership instead of ownership, where both partners accept egalitarian roles. The patriarchal ideas existing in the society and the magico-religious beliefs existing around menstruation are also addressed.

How WE DO IT

Raviteja Innamuri, Sharad Philip, Jayant Mahadevan, Pratikchya Tulachan, Naga VSS Gorthi, Amit Singh, Guru S Gowda, Harita Mathur, Rajesh Shrestha, Shreeram Upadhyaya, Lochana NP Samarasinghe, Rajitha D Marcellin, Samindi T Samarawickrama, Shanali I Mallawaarachchi, Yasodha M Rohanachandra

Effective Oral Presentations: The Steps to Making an Impact on the Podium

[Year:2022] [Month:July-December] [Volume:16] [Number:2] [Pages:4] [Pages No:99 - 102]

Keywords: Early Career Psychiatrist, Early Career Psychiatrist Leadership and Professional Skills Workshop, Effective oral presentation, Preparing a presentation

   DOI: 10.5005/jp-journals-10067-0112  |  Open Access |  How to cite  | 

Abstract

There is convincing evidence to support that the skills to deliver an effective oral presentation are essential tools for a successful career. These skills are yet not part of the official academic curriculum across many Asian countries. This invariably affects young researchers who are seeking to build confidence through these presentations. The authors examined the relevant literature sources for recommendations and guidelines to prepare an effective oral presentation and have added insights and learnings gleaned during the “Early Career Psychiatrist Leadership and Professional Skills Workshop.” Key takeaways—An effective oral presentation does not begin with making a PowerPoint presentation but identifying the key message and building a mental structure of the presentation in a spoken style. Any rule of making a presentation is only valid if it assists in delivering this key message. Having slides is not mandatory and one has to examine whether the slides of the presentation complement or are distracting the audience from the presentation. Similarly, statistics can be presented outside of tables in many compelling ways. It is prudent to cautiously explore and experiment with the guidelines and learnings listed here to suit the early career psychiatrist (ECP) style. We believe that these gleanings can benefit other medical professionals with relevant modifications.

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