Indian Journal of Private Psychiatry

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Volume 14, Number 1, January-June 2020

Original Article

Anil K Agarwal

Depression in Clinical Practice: A Retrospective Case Record Analysis

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Depression, Natural history, Psychiatric clinic

PDF  |  DOI: 10.5005/jp-journals-10067-0049  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The aim of this study is to study the natural course of depression in a private clinic setting. Materials and methods: The records of all patients suffering from depression excluding bipolar and schizoaffective disorders diagnosed according to DSM IV were scrutinized from November 1, 2017, to October 31, 2018. Observations: A total of 702 patients were diagnosed as suffering from depression. Nearly 13% had a change in diagnosis of bipolar disorder or obsessive-compulsive disorder (OCD) and other conditions. Nearly 80 patients\' records were not adequate, and therefore, only 528 patients were taken for detailed study. All these patients were analyzed for various clinical details. Many patients suffering from depression require a change of diagnosis mainly to bipolar disorder and OCD. Depression is generally a chronic recurring illness, but the pattern of recurrences is variable. More men seek treatment, while depression is more common in females. Similarly, more young people seek treatment while depression is more common in the elderly. The number of chronic patients increased with age. Most patients came to the clinic only when they were feeling worse and discontinue treatment as soon as they get better. Resistant depression requires reevaluation of diagnosis and reassessment of psychosocial factors.

Original Article

Mohmmed K Chisty, Ganesh Kini, Anil Kakunje, Ravichandra Karkal, Perla Mohammed Ali Nishad

Types of Psychiatric Presentation to Emergency Room of a Tertiary Care Center: A Record-based Retrospective Study

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:3] [Pages No:6 - 8]

Keywords: Emergency psychiatry, Emergency room presentation, Register-based study

PDF  |  DOI: 10.5005/jp-journals-10067-0051  |  Open Access |  How to cite  | 

Abstract

Background: Emergency psychiatry is a developing subspecialty, and emergency rooms (ERs) are the major entry point for people with mental illness. Emergency room psychiatrists work under circumstances of uncertainty and time limitations. The knowledge of various ER psychiatric presentations helps us to make tailor-made intervention. Aim and objective: The aim of the study was to examine the various clinical presentations of psychiatric patients brought to the ER. Materials and methods: It is a register-based study, and patients who attended the ER of Yenepoya Medical College Hospital (YMCH) constituted the study sample. Results: A total of 134 patients attended the ER of YMCH during the study period. The highest number of patients who were bought to the emergency was of bipolar affective disorder (BPAD) followed by patients with depression, and the least presentation was for obsessive-compulsive disorder (OCD) and dissociative disorders. Conclusions: The nature of the emergency with which patients sought emergency services in India is varied.

Original Article

Harish Kulkarni

Episodic, Event-triggered Staring Compulsion: An Unusual Form of Obsessive-compulsive Disorder

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:2] [Pages No:9 - 10]

Keywords: Keywords: Compulsive behavior, Obsessive-compulsive disorder, Reading, Young adult

PDF  |  DOI: 10.5005/jp-journals-10067-0053  |  Open Access |  How to cite  | 

Abstract

Obsessive-compulsive disorder (OCD) has varied presentations. An OCD with predominant mental compulsion is rare. A case presented here is of a 21-year-old male patient with staring episodes. He got the urge to stare at uninteresting and insignificant visual cues while reading. Symptoms appeared only while reading academic books and during his examinations. Symptoms caused him significant distress and dysfunction; hence, he was unable to read for the examinations. His unsuccessful attempts to overcome the act of staring made him more anxious. Other differential diagnoses like impulse control disorder, attention deficit hyperactivity disorder, mania, and generalized anxiety disorder were ruled out and diagnosis of OCD was made. The patient was treated with selective serotonin reuptake inhibitors: paroxetine 25 mg and later fluoxetine up to 60 mg with propranolol and clonazepam initially. Significant improvement was noted on follow-ups, which maintained even after medications were withdrawn.

Original Article

Sreelatha Pasupuleti, Mulinti Suresh Kumar

Comparison of Body Image Dissatisfaction in Postpartum Mothers after Normal and Cesarean Delivery

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:5] [Pages No:11 - 15]

Keywords: Body image, Body perception, Mode of delivery, Postpartum

PDF  |  DOI: 10.5005/jp-journals-10067-0056  |  Open Access |  How to cite  | 

Abstract

Background: Body image disturbances are not limited to young women but occur across all age-groups. Postpartum mothers particularly are more vulnerable to dissatisfaction in body image. Settings and design: This is a cross-sectional observational hospital-based study set in a rural tertiary care center. Materials and methods: Postpartum mothers were approached after their delivery and those who consented were enrolled in the study. Body image dissatisfaction was assessed using the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS) along with Marital Adjustment Test and Socio-cultural Attitudes toward Appearance Questionnaire-3 (SATAQ-3). Self-designed questionnaire to obtain the sociodemographic and clinical variables of the patients was also incorporated. Results: The modified bradykinesia rating scale subscales of appearance evaluation and appearance orientation show less body dissatisfaction in cesarean section postpartum mothers. Body image dissatisfaction was not significantly associated with either the marital satisfaction or the sociocultural influences, including the media as measured by SATAQ-3. Conclusion: The current study contributes to the existing literature of body image disturbances in postpartum mothers. It also highlights the comparison of body image dissatisfaction in cesarean section and normal delivery in the background of existent scant literature in this area of research.

Original Article

Parveen Kumar, Vishal K Patel, Deepak S Tiwari, Nirav B Chanpa, Disha A Vasavada

Impact of Education on Change in Attitude toward Persons with Disabilities among Undergraduate Medical Students

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:4] [Pages No:16 - 19]

Keywords: Disability, Education, Medical students

PDF  |  DOI: 10.5005/jp-journals-10067-0057  |  Open Access |  How to cite  | 

Abstract

Background: Negative attitudes and behaviors toward a person with disability are found among general public and healthcare professionals. Both person disabilities and their caregivers within India are subject to multiple deprivations and limited opportunities in several dimensions of their lives. Aims and objectives: To explore the attitude, behavior, and impact of education in changing attitudes toward persons with disabilities among undergraduate medical students. Materials and methods: A cross-sectional, interventional study was carried out about the effects of education on changing attitude toward persons with disabilities in freshly admitted first-year medical students as a part of the foundation course of Medical Council of India using Multidimensional Attitudes Scale toward Persons with Disabilities (MAS). Results: Female participants have a better attitude toward a person with disabilities than male participants. A negative correlation was observed between age and affect (r = −0.600), cognition (r = −0.552), and behavior (r = −0.689) component scores; also, negative correlation was observed between income and affect (r = −0.175, p = 0.008) and behavior (r = −0.268, p < 0.001) component scores of multidimensional scale. Conclusion: Male participants, younger age, and lower family income of participants were associated with more negative attitudes toward a person with disabilities, and education had a significant impact on developing positive attitude and behavior toward person with disabilities. By training, medical students can bring in a big leap of change in healthcare delivery.

RESEARCH ARTICLE

Megha Rathi, Chhavi Tewary, Prathama G Chaudhuri

Cognitive Processes in Adolescents with Borderline Personality Traits and Its Relation to Temperament and Comorbid Psychopathology

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:6] [Pages No:20 - 25]

Keywords: Character, Cognitive errors, Comorbid psychopathology, Coping strategies, Emerging borderline personality, Expressed concerns, Temperament

PDF  |  DOI: 10.5005/jp-journals-10067-0050  |  Open Access |  How to cite  | 

Abstract

Aims: This study aims to assess the differences and relationship between temperament, character, cognitive errors, coping strategies, and psychopathology in adolescents with and without borderline personality traits. Materials and method: One hundred adolescents from urban upper-middle-class families were included in this cross-sectional, randomized comparative study. The clinical population was selected from a multispecialty mental health clinic, whereas the control group was taken from the community through matching techniques. Millon Adolescent Clinical Inventory (MACI), Temperament and Character Inventory (TCI), Cognitive Error Questionnaire, and Coping Strategies Inventory were administered. Mann–Whitney U test was done along with Spearman\'s rank difference correlation. Result: The clinical group had high novelty seeking, harm avoidance, and low persistence. In terms of expressed concerns and psychopathology, the clinical group has high identity diffusion, family discord, childhood abuse, anxious affect impulsivity, and depression. Furthermore, it has a higher use of cognitive errors along with maladaptive coping strategies. There is a negative correlation between cognitive errors and maladaptive coping along with persistence and suicidal tendency. Conclusion: Clinical groups have temperament difficulties, more psychopathology, and higher usage of cognitive error and maladaptive coping strategies. Clinical significance: The current study aims to assess the psychological factors contributing to the development of borderline personality organization, which would facilitate early and effective psychological intervention. Recognition of risk factors would lead to diagnosis at the early stage of symptoms, improving prognosis.

RESEARCH ARTICLE

Rajmohan Velayudhan, Suni M Saraswathy

Neuropsychological Functions in Short- and Long-term Alcohol Abstinence

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:4] [Pages No:26 - 29]

Keywords: Abstinence, Alcohol dependence, Executive dysfunction, Immediate recall

PDF  |  DOI: 10.5005/jp-journals-10067-0054  |  Open Access |  How to cite  | 

Abstract

Background: Evidence suggests significant impairment across multiple cognitive functions and remains stable during the first few months of abstinence from alcohol and abates by one year. Methodology: The study was conducted in a tertiary care teaching hospital on 20 alcohol-dependent patients each in the short- (STA) and long-term abstinence (LTA) group. Both the groups compared were age and sex matched. The Mini International Neuropsychiatric Interview (MINI) screening was used to diagnose alcohol dependence. The following neuropsychological tests were done to assess the case and control groups: Trail making test, verbal working memory: N-back test, Rey\'s auditory verbal learning test. Parametric and nonparametric test were used to analyze the data based on the criterion. Results: There was no significant difference between STA and LTA groups in mean time taken to complete the task in Trail A and Trail B (t = 1.16, p = 0.25 and t = 0.72, p = 0.48). There is no significant difference between two groups in working memory functions in verbal 2-back and 1-back errors or hits. There is a significant difference between long-term and short-term alcohol abstinent groups in immediate recall (t = −2.189, p = 0.03). There is no significant difference between two groups in other trials of learning and memory tasks. Conclusion: The result of this study shows that there is no significant difference between short-term and long-term abstinent groups in attention, working memory task, verbal learning, and memory task. Longer duration of abstinence is required for the improvement in neuropsychological deficits due to alcohol use.

RESEARCH ARTICLE

Bhupendra Singh, Priti Singh, Upendra Singh, Purushottam Jangid, Rajiv Gupta

Students’ Perceived Stress and Internet Addiction during the Lockdown in India

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:5] [Pages No:30 - 34]

Keywords: Internet addiction, Lockdown, Perceived stress

PDF  |  DOI: 10.5005/jp-journals-10067-0055  |  Open Access |  How to cite  | 

Abstract

Background: Internet use expanses from day-to-day necessities to morbid levels. More emphasis is now being given to online services during this current pandemic situation. Internet use is acting as double-edged sword. This study was aimed to know the perceived stress and Internet addiction among the students pursuing professional courses during the lockdown of corona pandemic in India. Aim: The aim was to assess the perceived stress and Internet addiction during the lockdown among professional students. Methodology: A cross-sectional study for students perusing professional courses of different streams through an online survey was carried. During the lockdown, a Google form was created for students with proper information about the questionnaire with the request for participating in the research. Survey contained a total of 38 questions. After taking informed consent, sociodemographic proforma, perceived stress scale, and Internet Addiction Test were applied. Result: A total of 297 students from various professional courses participated in the study. A total of 62.2% of them were reported that their time for Internet use has increased significantly. Maximum (84%) participants reported high level of perceived stress and 62% of them were using Internet up to a moderate level of addiction. Positive correlation was present between perceived stress and Internet addiction. Conclusion: Lockdown restrictions increased the perceived stress and vulnerability of Internet addiction among the students.

RESEARCH ARTICLE

Darpan Kaur, Rishab Verma, Shaunak Ajinkya, Rakesh Ghildiyal

Patterns of Consultation-liaison Psychiatry among Inpatients at a Tertiary Care Hospital

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:6] [Pages No:35 - 40]

Keywords: Consultation-liaison psychiatry, Inpatients, Patterns, Referral, Tertiary care hospital

PDF  |  DOI: 10.5005/jp-journals-10067-0052  |  Open Access |  How to cite  | 

Abstract

Background: There is sparse literature on the profile of consultation–liaison psychiatry (CLP) across tertiary institutions in developing countries like India. Aims: To assess specific patterns of referrals to psychiatry, psychiatric diagnosis, and interventions among inpatients admitted at a tertiary care hospital and to explore demographic and correlation factors. Materials and methods: An observational type of cross-sectional study was conducted assessing consecutive inpatients fulfilling the inclusion and exclusion criteria referred to the Psychiatry Department for Consultation-liaison Psychiatry. Institutional Ethics Committee (IEC) clearance was obtained. A structured predesigned data collection form was used to assess relevant variables, and analysis was done comprising frequency analysis, mean, percentage, chi-square test, analysis of variance (ANOVA), and multiple logistic regressions. Results: We analyzed a convenient sample profile of 100 referrals. The mean age of the sample was 40.95 years (SD = 18.05) with 70% males. Eighty-one percent were from rural areas with 19% from urban areas. The mean days of referral were 2.27 days (SD = 3.155). The medicine department contributed to maximum referrals (60%). Common reasons for referral were substance use (23%) and self-harm (20%). The most common psychiatric diagnosis was alcohol dependence (24%). The dual diagnosis was observed in 10% of patients. Correlational regression analysis found that alcohol dependence was significantly seen in males, while depression and adjustment disorders were seen in females. Fifty-eight percent received oral psychiatric medications, while 42% received only psychotherapy. Seventy-six percent of patients/caregivers were not adequately communicated by the referring team about specific reasons for reference to psychiatry. Conclusion: Our study has relevant implications for research and clinical care across CLP.

CASE REPORT

Shorouq Motwani, Krishnapriya Murlimanohar, Sagar Karia, Nilesh Shah, Avinash De Sousa

Psychogenic Grunting: A Case Report

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:2] [Pages No:41 - 42]

Keywords: Conversion disorder, Grunting, Psychogenic grunting, Somatoform disorder

PDF  |  DOI: 10.5005/jp-journals-10067-0047  |  Open Access |  How to cite  | 

Abstract

Grunting may be a symptom that may be seen as a part of somatoform, conversion, and tic disorders. The symptom is distressing to both the patient and relatives around the patient. We present herewith the case of a 14-year-old adolescent girl who was referred to our outpatient department with psychogenic grunting and responded well to medications.

CASE REPORT

Parijat Roy, Sagar Karia, Avinash De Sousa, Nilesh Shah

Olanzapine-induced Rabbit Syndrome: A Case Report

[Year:2020] [Month:January-June] [Volume:14] [Number:1] [Pages:2] [Pages No:43 - 44]

Keywords: Antipsychotics, Olanzapine, Rabbit syndrome

PDF  |  DOI: 10.5005/jp-journals-10067-0048  |  Open Access |  How to cite  | 

Abstract

Rabbit syndrome is an antipsychotic-induced movement disorder associated with long-term exposure of typical antipsychotics and rarely atypical psychotics. We report the case of a 56-year-old female patient who was suffering from a bipolar mood disorder and was well maintained on olanzapine 10 mg per day. She developed rabbit syndrome 1 year after the initiation of the drug.

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