Indian Journal of Private Psychiatry

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Volume 16, Number 1, January-June 2022

EDITORIAL

Mahesh R Gowda

Psychedelics Road Ahead: Are We Ready?

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:2] [Pages No:1 - 2]

Keywords: LSD, MDMA, Psilocybin, Psychedelics, Psychoactive drug

   DOI: 10.5005/jp-journals-10067-0113  |  Open Access |  How to cite  | 

Abstract

Psychedelics are classed as a schedule I substance under the Controlled Substances Act of 1970 because of the potential for mind-changing effects. In vulnerable people, unsupervised use has the potential to lead to suicide. However, the management of end-of-life anxiety, severe resistant depression, resistant obsessive–compulsive disorder, and substance abuse is met with a high failure rate. The preliminary study on psychedelics has yielded promising results, prompting the Food and Drug Administration (FDA) to classify them as a breakthrough medicine. More phase 3 research, funded by pharmaceutical company, are in the works. Similar studies should be funded by national institutes and government bodies to ensure unbiased results, as the findings of such studies may need legislative changes.

ORIGINAL RESEARCH

Manjula Simiyon, Swetha Joju, Pradeep Thilakan, Manikandan Mani

How Lengthy and Tortuous is the Pathway to Psychiatric Care among Patients Visiting a Tertiary Care Hospital in South India? A Cross-sectional Study

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:7] [Pages No:3 - 9]

Keywords: Duration of untreated illness, India, Pathway, Traditional healers

   DOI: 10.5005/jp-journals-10067-0106  |  Open Access |  How to cite  | 

Abstract

Background: Mental illnesses (MI) are commonly linked with a higher burden of disease. A large number of patients with mental illnesses do not present to the mental health services directly rather they adopt a pathway that is usually prolonged and tortuous. By the time they reach the mental health services the illness becomes chronic and the resources are exhausted. It is all the more relevant in countries like India where traditional healing practices are easily accessible in contrary to mental health services. Aims and objectives: The aims and objectives of this study were to measure the number of encounters patients with psychiatric illnesses had before meeting a mental health professional and the duration of untreated illness (DUI). Materials and methods: In this cross-sectional questionnaire-based study, we interviewed 150 patients and their caregivers visiting the outpatient services of a tertiary care teaching hospital in South India. Results: The median time taken for any help, from traditional healers, general hospitals, or a mental health practitioner was 12 months (IQR 2–47.25). The median DUI was 18 months (IQR 2.75–60), and the median total duration of illness was 24 months (IQR 4–87). The mean number of encounters was 2.7 (SD ± 1.77). As the first point of contact, 12% had met a traditional healer and 40% had met a psychiatrist. Friends and relatives in 80% of the patients initiated help-seeking. In multivariate analysis, age, male gender, and lower educational status were significant predictors for a longer duration of illness. Conclusion: Patients in India continue to take a long and tortuous pathway to psychiatric care that goes through many encounters.

ORIGINAL RESEARCH

Ume Hani, Kasthuri Pandiyan

Psychiatric Morbidity among Transgender Population: A Study in a Rural Area of Bengaluru

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:4] [Pages No:10 - 13]

Keywords: Gender dysphoria, Psychiatric morbidity, Transgender

   DOI: 10.5005/jp-journals-10067-0108  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To study the psychiatric morbidity among transgender population. Materials and methods: A cross-sectional study was done using convenience sampling. Sixty consenting transgenders, fulfilling criteria for gender dysphoria based on DSM-5 criteria, were included. The study was done for a period of 18 months. Tools used: For assessing the sociodemographic profile, semi-structured pro forma was used, and for assessing psychiatric morbidities, Mini International Neuropsychiatric Interview (MINI)-plus scale was used. Results: Among 60 participants, 36 (76.6%) had psychiatric morbidity, of which 16 (26.7%) had substance-use disorder, 10 (16.7%) among them had alcohol dependence, and 6 (10%) had nonalcoholic substance-use disorders, such as cannabis, benzodiazepines, and cocaine. Ten (16.7%) participants qualified for the diagnosis of depressive disorder among which six (10%) had mild depression and four (6.7%) had moderate depression. Dysthymia was present in four (6.6%) individuals. Eleven (18.3%) participants had adjustment disorder. Three (5%) of them had anxiety disorder and two (3.3%) had insomnia. Conclusion: Substance use and depression were found to be the most common psychiatric disorders among this population followed by adjustment disorders. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention are needed to prevent or treat their psychiatric comorbidities. Clinical significance: The study highlights that there are various psychiatric morbidities prevalent among transgender population, mainly due to the various life adversities they face, which points toward encouraging and creating awareness toward the need for reducing discrimination and accepting the transgender persons in the families, friends, and the community groups which will help them in mainstreaming, achieve welfare, and reduce their psychosocial problems. The findings of this study may help to inform the development of appropriately targeted and tailored mental health interventions and resilience-building programs for transgender population.

Original Article

Amrita Chakraborti, Suvajit Pal

What does not Kill You Makes You Stronger: An Online Survey into Healthcare Providers’ Mental Health during Corona Pandemic

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:11] [Pages No:14 - 24]

Keywords: COVID-19, Healthcare provider, Psychiatry morbidity, Serious mental illness

   DOI: 10.5005/jp-journals-10067-0095  |  Open Access |  How to cite  | 

Abstract

Context: Novel corona virus poses a profound and interminable threat to humanity. Healthcare providers (HCPs)’ assigned responsibility to combat the disease from frontline put them in mortal danger takes a toll on their mental health. Aim and objective: To identify HCP\'s unmet mental health needs. Settings and design: A cross-sectional, online mental health survey was conducted during Unlock 1.0, June, 2020, among doctors and nursing staffs working in a South Bengal health district. Materials and methods: Tools used were an online semistructured questionnaire, Depression, Anxiety and Stress Scale—21 Items, Insomnia Severity Index, and Brief Resilience Scale. Statistical analysis: Descriptive statistics, Chi-square, independent t-test, ANOVA, and Pearson and Spearman\'s correlation were done by SPSS-16. Results: Among 78 respondents, 74% are doctors, 56% males, and 80% aged between 21 and 50 years, married, having children, living with family, and working in tertiary Govt institute. About 62% had preexisting medical comorbidities, 50% had clinical insomnia, 28% opted for a psychiatric evaluation, but only half of them actually volunteered. Mean score for insomnia, depression, anxiety, stress, and resilience was 7.82, 5.72, 7.64, 4.13, and 20.27, respectively. “Fear of getting infected and infecting others” dominated 33% HCP\'s concern regarding COVID-19. Presence of medical and mental comorbidity, place of living, exposure, household duty, and exercise made significant difference to insomnia, stress, anxiety, and depression (p <0.05). One-fourth of population reported increase in sleep and had significant association with stress and depression (p <0.05). Conclusions: High unmet mental health needs of HCPs are evident in increased burden of sleep dysfunction, medical morbidity, and reluctance to disclose about psychological issues. Clarification needed on reported hypersomnia and effect of lockdown activities on mental health.

RESEARCH ARTICLE

Subodh Kumar, Divye Kartikey, Jayeeta Biswas

Status of Perceived Stress and Quality of Life in Adults during COVID-19 Pandemic

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:4] [Pages No:25 - 28]

Keywords: Adults, COVID-19, Pandemic, Perceived stress, Quality of life

   DOI: 10.5005/jp-journals-10067-0102  |  Open Access |  How to cite  | 

Abstract

Background: The deadly second wave of coronavirus disease-2019 (COVID-19) pandemic swept through the whole of India during the month of April–May 2021. Restrictions like lockdowns and social distancing impacted the normal functioning of life. It is in this backdrop that we need to understand the perceived stress and quality of life among people. Aim and objective: The aim and objective of this study was to evaluate and study the relationship between perceived stress and quality of life among adults living in Delhi NCR, during the second wave of the COVID-19 pandemic. Materials and methods: A 10-item perceived stress scale (PSS-10) was used to assess perceived stress among adults. The 26-item World Health Organization Quality of Life Brief Version (WHOQOL-BREF) was used to assess the quality of life. The data were collected online and analyzed using statistical methods, like independent samples t-test and Spearman\'s rank correlation. Results: The study found no significant difference in the perceived stress between males and females (p >0.05). There was no significant difference in various domains of quality of life, like physical health, psychological health, social relationships, and environmental health between males and females (p >0.05). Also, the overall quality of life had a significant negative correlation (p <0.01) with perceived stress. Conclusion: Better outcomes on the parameters of physical health, psychological health, social relationships, and environmental health among the participants helped them to keep perceived stress at low-to-moderate levels and achieve a better quality of life.

BRIEF RESEARCH COMMUNICATION

Dileep K Maurya, Pradeep Kumar, Mona Srivastava

Adverse Childhood Experiences and Substance Abuse in Young Adults: A Correlational Study

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:5] [Pages No:29 - 33]

Keywords: ACE-IQ, DAQ, GHQ-12, Sociodemographic characters

   DOI: 10.5005/jp-journals-10067-0110  |  Open Access |  How to cite  | 

Abstract

Background: Adverse childhood experiences (ACEs) have been strongly associated with development and prevalence of substance abuse throughout the lifespan. This study provides information regarding different ACEs and its contribution toward substance abuse, which in turn would optimize a better psychosocial intervention during childhood. Objective: This was a cross-sectional comparative study comparing various ACEs in young adults to find out the pattern and extent of substance use in young adults. Methods: Sixty participants in both case and control group were taken and were given GHQ-12, DAQ, ACE-IQ CPS% SDS and applied using SPSS software. Result: In cases mean score of GHQ-12, DAQ, and ACE-IQ 9.05, 150.6, and 3.53 while in control 0.600, 55.8, and 0.850, respectively. Most common ACE in cases is community violence at 81.7% followed by alcohol and drug abuser in households at 78.3%. Prevalence of substance uses tobacco 85%, alcohol intake 86.7%, cannabis abuse 20%, opioid 18.3%, and sedative 11.7%. Discussion: Our study showed that among all substances alcohol and tobacco were the commonest substances of abuse and the findings point to a picture of prevalence of adverse experiences in early life in relation to various sociodemographic factors among adult substance users. Conclusion: The present study showed that children with history of exposure to multiple adversity should be given high priority for early identification and relief to maintain the quality of their lives and to help develop as healthy productive citizens.

CASE REPORT

M Subramanyam, Sanjiv Chamraj, Khushboo Dewani, Preeti Srinivasa

Atypical Psychiatric Manifestation of Primary Wilson's Disease: A Case Report

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:4] [Pages No:34 - 37]

Keywords: Bipolar affective disorder, Extrapyramidal side effects, Irritability, Rigidity, Tremors

   DOI: 10.5005/jp-journals-10067-0096  |  Open Access |  How to cite  | 

Abstract

Background: Wilson\'s disease (WD) is an autosomal recessive disorder of copper metabolism. It is associated with ATP7B gene mutations, present on chromosome 13. It is primarily a liver disease, but presentation varies according to copper deposition in various organs. The diagnosis depends on clinical features, Kayser–Fleischer rings, biochemical parameters, radiological findings, liver biopsy, and gene analysis. Case: We report an atypical presentation of WD, where the patient presented with only psychiatric manifestations with two episodes of mania with duration of 3 years to evolve from psychiatric manifestations to neurological and hepatic manifestations of WD. Conclusion: A high index of suspicion is required, and early recognition of atypical presentation and initiation of the treatment can prevent a catastrophic outcome.

CASE REPORT

Fakirappa B Ganiger, Somashekhar Bijjal, Jitendra D Mugali

Psychiatric Manifestations in COVID-19 Patients Presenting to a Tertiary Care Center: A Case Series

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Catatonia, COVID-19, Delirium, Depressive episode, Mania, Psychosis

   DOI: 10.5005/jp-journals-10067-0101  |  Open Access |  How to cite  | 

Abstract

Coronavirus disease-2019 (COVID-19) pandemic has emerged as a public health emergency and has led to economic, occupational, and social disruption. Along with physical illness, it is also associated with disruption of mental health. In this case series, we have presented six different case reports of persons with COVID-19 illness, who presented to or were referred to the psychiatric assessment. These include panic disorder, mania, depressive episode, acute psychosis, delirium, and organic catatonia.

CASE REPORT

Namitha Das, Sandhya Cherkil, Thoduka Rajan John

A Rare Presentation of Anorexia Nervosa as Cardiac Failure in an Adolescent Girl

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:2] [Pages No:42 - 43]

Keywords: Adolescent girl, Anorexia nervosa, Cardiac failure, Depression

   DOI: 10.5005/jp-journals-10067-0103  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of the study was to highlight the systemic life-threatening manifestations of anorexia nervosa (AN). Background: AN is a psychiatric disorder commonly seen among young females with significant systemic manifestations and the highest mortality among psychiatric disorders. Description: We present the case of an athletic adolescent girl (after obtaining written consent for publication from her father) presenting to the emergency department in shock with cardiac failure. She also had hypoalbuminemia and multiple electrolyte disturbances like hyponatremia, hypokalemia, hypocalcemia, and hypophosphatemia. She underwent extensive evaluation including coronary angiogram and other appropriate tests to rule out malabsorption syndrome. In the absence of organic causes, and as she gave a history of deliberate food restriction, she underwent a psychiatric evaluation. She was found to be a perfectionist with obsessive personality traits. She started to restrict her diet due to fear of gaining weight as she got bullied by her peers in the new school. There was a significant weight loss of almost 14 kg over a period of 6 months. Additionally, she had depressive symptoms like decreased mood, anhedonia, and lack of energy and initiative, concentration difficulties, and an apparent academic decline. Conclusion: She met the criteria for the diagnosis of AN—restrictive type severe, comorbid with major depressive disorder, and was started on combined psychotherapy and pharmacotherapy with fluoxetine leading to a dramatic clinical improvement. Clinical significance: The case highlights the life-threatening complications of AN and the role of timely psychiatric interventions in managing these patients.

CASE REPORT

Rohit P Deshmukh, Astik B Mane, Shachi Singh

PANDAS in an Adult?: A Case Report

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:2] [Pages No:44 - 45]

Keywords: Anxiety, Compulsive behavior, Obsessive–compulsive disorder, Reading, Young adult

   DOI: 10.5005/jp-journals-10067-0104  |  Open Access |  How to cite  | 

Abstract

Introduction: A spectrum of neurobehavioral disorder that includes obsessive–compulsive disorder (OCD) occurs in association with streptococcal infection is called as pediatric autoimmune neuropsychiatric disorder associated with streptococcal infection (PANDAS).1 Role of autoimmune mechanism in the etiology of OCD and Tourette\'s syndrome in the patient subgroup with early onset has been reported in several reports.2 The temporal association between neuropsychiatric symptom exacerbations and streptococcal infections was the major distinguishing feature of the PANDAS subgroup. Case: A 22-year-old male, presented to the psychiatric outpatient department (OPD) with complaints of recurrent thoughts and images of dirt present on a holy book with compulsive action of cleaning the holy book repeatedly in order to relieve anxiety. Around 4 days prior to these complaints, the patient had an episode of high-grade fever associated with chills, sore throat, cough, and cold. In view of the early onset of obsessive symptoms with sudden exacerbations, and the past history of streptococcal throat infection, the possibility of PANDAS was considered. Yale–Brown obsessive compulsive disorder rating scale revealed a score of 26. He was examined by a physician, advised blood investigations, and was started on antibiotic, antipyretic along with cough syrup and antacid. We started him on tablet clonazepam 0.5 mg HS and SOS to reduce the anxiety-related symptoms associated with his presenting complaints. On examination, the patient was very fidgety and would keep crossing-uncrossing his legs; otherwise, his systemic examination was unremarkable. Hemoglobin (13.5 g/dL), TLC (5700/mm3), and ESR (05 mm in the first hour), blood sugars, renal function test (RFT), and liver function test (LFT) were within normal limits. In view of recent past history of sore throat, antistreptolysin O (ASO) titers were advised and found to be high (>200 Todd units). He followed up after 7 days with complete remission. When the patient was followed up at 12 months and 18 months, he did not had any such episode. Discussion: The coexistence of streptococcal infection and repetitive thoughts leads to the concept that there can be an autoimmune reaction—a cross-reaction between streptococcal and brain antigen. It has been suggested that in OCD following an infection, the antibodies to the bacteria may make their way to the healthy brain and attack the basal ganglia, which disrupts normal brain activity and triggers OCD. We report a case in order to suggest that we should be alert while assessing OCD in young patients, as it might be secondary to streptococcal infection. This has therapeutic implications. Trials of immunomodulator therapy can be given as suggested in a few kinds of literature. Although still experimental, it may have potential for the future, especially in those not responding to conventional treatment. Conclusion: This report might suggest that PANDAS-like syndrome may occur in adults also. We should be cautious of this syndrome during treatment.

CASE REPORT

Sarthak Kamath, Shankar Kumar, Shreekara Adiga

Suicide Attempt by Toothbrush Consumption in a Polysubstance-dependent Person

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:2] [Pages No:46 - 47]

Keywords: Polysubstance dependence, Suicide, Toothbrushes

   DOI: 10.5005/jp-journals-10067-0107  |  Open Access |  How to cite  | 

Abstract

Aim: To report a case of suicidal attempt by toothbrush consumption in a polysubstance-dependent person. Background: Substance dependence is a common psychiatric illness. Tobacco and alcohol are the most commonly abused drugs. Polysubstance dependence has the highest prevalence in 18–29-year-old people at 13%. Suicide is one of the most dangerous consequences and is more than ten times the rate in the general population. Case description: We present a case of a 19-year-old unemployed male patient from Bengaluru who is dependent on tobacco, cannabis, and cocaine with heroin use in a harmful use pattern. He attempted on life by consuming four toothbrushes for which surgical intervention was done and they were removed successfully. In addition, he had substance-induced psychosis and possibility of antisocial personality disorder. We applied the alcohol, smoking and substance involvement screening test (ASSIST) scale, which showed a moderate risk of a health problem with tobacco, cannabis, and cocaine. Conclusion: This is a unique method of a suicide attempt by consuming four toothbrushes in a substance-dependent person. Clinical implications: Polysubstance dependence is frequently complicated by suicide attempts. Our case report shows that even apparently harmless objects like toothbrushes could be used to attempt on life. Hence, it is imperative to keep such patients with suicidal risk under 24-hour supervision to prevent complications.

LETTER TO THE EDITOR

Sunil KG Patil, Mahesh R Gowda, Somashekhar Bijjal, Rajani Parthasarathy, Khushboo Dewani

Trained Professional and Service Opportunity Gap in India in the Field of Mental Health: The Enigma

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:2] [Pages No:48 - 49]

Keywords: Mental health field, Professional, Service opportunity gap

   DOI: 10.5005/jp-journals-10067-0094  |  Open Access |  How to cite  | 

VIEWPOINT

UC Samudyatha, Pakha Tesia, Sonali Tesia, M Subramanyam

Roadmap to Integrate National Telemental Health Program and MHCA: Signboards that cannot be Ignored

[Year:2022] [Month:January-June] [Volume:16] [Number:1] [Pages:3] [Pages No:50 - 52]

Keywords: COVID-19, eHealth, Telepsychiatry, Mental Healthcare Act

   DOI: 10.5005/jp-journals-10067-0111  |  Open Access |  How to cite  | 

Abstract

The Union Budget 2022 was remarkable for its landmark mention of Mental Health. It is expected that the National Telemental Health Program would bridge the gap between the scattered human resources and needs in the country. The policy decision is welcome to the medical community in general since we can easily fathom the advantages. However, we must focus on how the new venture can be made sustainable and patient centric.

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