Indian Journal of Private Psychiatry

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2020 | July-December | Volume 14 | Issue 2

EDITORIAL

Is there a Need for “Comfortable Treatment Options” as an Alternative to “Community Treatment Order” in the Light of MHCA–2017?

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:2] [Pages No:45 - 46]

Keywords: Community treatment order, Mental healthcare Act, 2017, Serious mental illness

   DOI: 10.5005/jp-journals-10067-0070  |  Open Access |  How to cite  | 

Abstract

There is a need for introducing community treatment order (CTO) like legal measures by amendments in Mental healthcare Act (MHCA), 2017. In the future, there would be a need for well-designed studies of patients with severe mental illness with CTO options that look into outcome parameters like illness control, functionality, violence, self-harm, suicide, criminality, legal issue, and disability-adjusted life years. In addition, studies on caregivers’ perspective and their quality of life, economics, and rehospitalization would shed more light on the utility of CTO in India. Envisioning similar provisions of leave of absence as a prerequisite to symptomatic person with mental illness who do not want to get admitted can be pathbreaking.

INVITED ARTICLE

Anil Kakunje

Lunar Effect or Transylvania Effect: The Moon and Mind Connection

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:4] [Pages No:47 - 50]

Keywords: Effect, Lunar, Lunatic, Moon, Transylvania

   DOI: 10.5005/jp-journals-10067-0063  |  Open Access |  How to cite  | 

Abstract

The connection between the moon and human behavior has been there for centuries. The word ‘lunatic’ comes from the Latin word “Luna” meaning moon. The belief of moon influences mind is not only among the general public but also strong among health professionals. The lunar effect (i.e., lunacy increases during certain phases of the moon) is the connection between the lunar cycle and human behavior, and “Transylvania effect” is for those who discard the idea as a fancy thinking. Research evidence has not completely resolved the debate. Mental health providers should be aware of the beliefs revolving around moon and the mind. They should ensure that they are acquainted with the scientific evidence for and against such beliefs.

Original Article

Lubna Mohammedrafik Nerli, Viral Ratanprakash Shah, Deepak Sachidanand Tiwari, Vishal Kanaiyalal Patel, Disha Alkeshbhai Vasavada, Rangdon Dor Sangma

Evaluation of Knowledge and Attitude toward LGBT Community, and the Effect of Education on Knowledge and Attitude in Medical Undergraduates

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:6] [Pages No:51 - 56]

Keywords: Attitude, Doctors, Knowledge, LGBT community, Religion, Undergraduates

   DOI: 10.5005/jp-journals-10067-0060  |  Open Access |  How to cite  | 

Abstract

Background: The people of the LGBT (lesbian, gay, bisexual, and transgender) community are underprivileged in healthcare settings. Knowledge and awareness about LGBT among the medical undergraduates would eventually fulfill the gap of healthcare services. Aim: It is to evaluate the knowledge and attitude toward the LGBT community and the effect of education on knowledge and attitude. Methods: This was a cross-sectional, interventional study of first-year medical students over a period of three days. The “Survey on California State University, Northridge (CSUN) attitude towards LGBT” was used as a survey tool. Statistical test: Descriptive statistics and the Chi-square test were used for the analysis of data. Results: Out of 51 students, 32 (62.74%) were raised in a religious household. The results also showed that as compared to males, females were more religious in terms of frequency of visiting religious places and practicing religious preaching. The majority percentage of students disagrees with the traditional gender roles without any significant gender differences. It was also found that as compared to females, more percentage of males are uncomfortable in interacting with LGBT people. The results show that the students have better knowledge about LGBT people; however, the change from “neutral” and “agreement” to “disagreement” is not much significant. The students have a positive attitude toward the LGBT people, but there is no significant change in the attitude postintervention. Conclusion: This study concludes that though there is positive knowledge and attitude toward LGBT people among medical undergraduates, they are not comfortable in interacting with them.

Original Article

Mansi Vora

Efficacy and Tolerability of Vortioxetine in Patients with Major Depressive Disorder: A Clinical Perspective from 33 Indian Cases

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:5] [Pages No:57 - 61]

Keywords: Antidepressant, Cognitive functions, Major depressive disorder, Prescription review, Selective serotonin reuptake inhibitor, Vortioxetine

   DOI: 10.5005/jp-journals-10067-0061  |  Open Access |  How to cite  | 

Abstract

Aim: Limited data are available concerning the tolerability and efficacy of vortioxetine in Indian depressive patients. This retrospective prescription review analysis provides clinical experience of vortioxetine in patients with major depressive disorder (MDD) and high ratings of anxiety (anxious depression). Materials and methods: This prescription data review was carried out at Westcoast Institute of Neuroscience, India. Data were extracted from prescription of all the patients suffering from depression and other psychiatric disorders who were treated with vortioxetine (Brintellix) from February 1, 2019, to May 31, 2020. Results: Thirty-three prescription records were reviewed during the study. Vortioxetine improved depressive and psychological symptoms with minimum adverse effects. Vortioxetine showed good tolerability in majority of patients who were still receiving vortioxetine monotherapy by the end of the therapy. Mental Status Examination (MSE) revealed that the patients treated with vortioxetine demonstrated better orientation, reactiveness, and attentiveness. Conclusion: This retrospective prescription review analysis demonstrated the effectiveness, and tolerability of vortioxetine in Indian MDD patients with depressive and anxiety symptoms.

Original Article

Anand Thaman, Naina Sharma

Differences in Cognitive Profile of Psychogenic Nonepileptic and Epileptic Seizure Patients

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:6] [Pages No:62 - 67]

Keywords: Executive cognitive functioning deficits, Neuropsychological profile, Psychogenic non-epileptic seizures

   DOI: 10.5005/jp-journals-10067-0062  |  Open Access |  How to cite  | 

Abstract

Psychogenic non-epileptic seizures (PNES) are the episodes of involuntary movements, altered consciousness, sensations, and perceptions, which otherwise look similar to epileptic seizures (ES), but without any abnormal electrical activities in brain areas. PNES is generally considered psychological in origin; however, latest theoretical models suggest the mediation of cognitive-emotional vulnerabilities in these patients. Cognitive deficits especially in executive domains have been reported in previous studies, but findings are largely equivocal. The present study attempted to evaluate the comparative profile of two seizure groups along with the healthy control. Selected tests from NIMHANS neuropsychological battery were applied to measure the executive cognitive domains. Results of study found common (response inhibition/flexibility) as well as different (attention, verbal category fluency, and visual working memory) cognitive performances of two seizure groups. These findings confirmed the genuineness of cognitive deficits in PNES patients and urge the mental health professionals to consider these vulnerabilities while making interventional strategies.

Original Article

Benugopal Mohapatra, Neloy Sinha, Avijit Mondal, Partha Mukherjee, Moumita Chatterjee

Prevalence of Psychiatric Comorbidities in Patients with Psoriasis: A Cross-sectional Study from a Tertiary Care Hospital in Eastern India

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:7] [Pages No:68 - 74]

Keywords: Anxiety, Depression, Psoriasis, Psychiatric comorbidities

   DOI: 10.5005/jp-journals-10067-0064  |  Open Access |  How to cite  | 

Abstract

Background: Psoriasis has been known to be associated with various psychiatric comorbidities like depression, anxiety, adjustment disorder, persistent stress, and impaired sexual and marital life. Aim: The aim of this study was to find out the prevalence of psychiatric comorbidities in patients with psoriasis. Methods: One hundred and forty-nine consecutive patients with psoriasis fulfilling the inclusion criteria got examined by a senior consultant dermatologist. Sociodemographic and clinical pro forma were filled in. Following informed consent, the patients were assessed for severity of the condition by Psoriasis Area and Severity Index score and were screened for the presence of psychiatric comorbidities by a validated Bengali version of the screening tool Self-Reporting Questionnaire 20 (SRQ 20). Subjects were administrated in succession with Bengali version of Self-Reporting BDI (Beck Depression Inventory) (already validated), Hamilton Anxiety Scale, and SKINDEX 61 (interviewer-rated) for evaluating the depression, anxiety, and psychiatric morbidities under the guidance of a consultant psychiatrist. Results: In index study, a majority of the subjects (98%) had a mild degree of anxiety symptoms. In BDI, the majority of the subjects had minimal depression, whereas near about two-fifths of the subjects had mild to severe depression. As per SRQ assessment of psychopathology, the majority of subjects (57.71%) had psychiatric disorder. Around two-thirds male and half of the female subjects, respectively, were SRQ positive. On SKINDEX-61, the majority of the subjects responded affirmatively in a decreasing order of frequency in the following domains: embarrassment, discomfort, fear, anger, physical limitation, depression, and cognitive impairment. Severity of psoriasis had a significant positive correlation with depression severity grades and the presence or absence of psychopathology. The index study also revealed that the number of body sites involved in psoriasis had a significant positive correlation with depression severity. Conclusion: Psoriasis was associated with significant psychiatric comorbidities, and those need to be addressed.

Original Article

Ashfaq A Dangroo, Kamlesh K Sahu, Priti Arun

Psychosocial Interventions in Persons with Schizophrenia: A Protocol for Intervention Studies

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:5] [Pages No:75 - 79]

Keywords: Psychosocial, Psychosocial interventions, Schizophrenia

   DOI: 10.5005/jp-journals-10067-0065  |  Open Access |  How to cite  | 

Abstract

Background: Schizophrenia is a severe and chronic illness that is often the most difficult to manage, which has health and economic consequences for patients, families, and communities. Psychosocial interventions aim to change psychological, social, physiological, and functional outcomes by utilizing psychological or behavioral actions. Methods: We hypothesize that psychosocial intervention offered to patients with schizophrenia to predict the outcomes of intervention. The research design of the study was a prospective intervention study in which intervention was given to patients at the outpatient department of the Department of Psychiatry, Government Medical College and Hospital, Chandigarh. Fifteen persons with schizophrenia (F20.0–20.9) as per the International Classification of Diseases-10 were consecutively included in this study. The intervention was done in eight sessions around 1 hour in each session on a weekly basis in 2 months. Expected outcomes: This study is expected to predict the outcomes of the intervention and also helps the department to make interventions appropriate. These sessions along with pharmacological treatment improve the level of functioning and quality of life. Significance: Psychosocial therapies that are added to antipsychotic medications that have been empirically validated target one or more deficit areas, such as positive and negative symptoms, cognitive impairments, and poor social functioning. Trial registration: Clinical Trial Registry India CTRI/2021/01/030487. Registered on January 15, 2021.

Original Article

Parveen Kumar, Rangdon Dor Sangma, Lubna Mohammedrafik Nerli, Disha Alkeshbhai Vasavada, Krishna Manharbhai Mayani, Deepak Sachidanand Tiwari

Knowledge, Attitude, and Beliefs Regarding Convalescent Plasma Donation among COVID-19-recovered Patients at a Tertiary Care Center in India

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:5] [Pages No:80 - 84]

Keywords: Attitude, Blood products, COVID-19, Knowledge, Plasma, SARS-CoV-2

   DOI: 10.5005/jp-journals-10067-0068  |  Open Access |  How to cite  | 

Abstract

Background: Convalescent plasma is gathered from a possible human source of specific antibodies. Convalescent plasma is released as an “off-label” therapy for novel coronavirus 2019 (COVID-19). Amid the national shortage of this blood product, it is critically important that those who have recovered from COVID-19 donate plasma. Aim: The current study aimed to assess the knowledge and attitude of COVID-19 recovered patients toward convalescent plasma donation. Method: A cross-sectional study was carried out among patients discharged after recovery from COVID-19 at a tertiary care center from August 2020 to December 2020. Participants were approached 30 to 45 days after discharge from the hospital and requested to complete a semi-structured pro forma containing the following sections: (1) Demographic details; (2) Knowledge about Convalescent Plasma Questionnaire; (3) Attitude toward Convalescent Plasma Questionnaire; and (4) Reasons for not donating plasma. Following this, education was given to participants about plasma donation. Result: A total of 400 participants were included in the study of age 18 to 60 years, out of them 42.75% donated plasma and 57.25% did not donate. Participants have good knowledge about their blood group, the requirement of blood group matching for plasma donation, and the use of convalescent plasma therapy. Plasma donors have a more positive attitude toward donation. Among non-donors, 47.8% of participants were unaware, while 42% did not know about fitness for plasma donation. Non-donors have the misbelief that plasma donation temporarily weakened the individual and those who donate plasma can contract a disease. Slight negative correlation between “knowledge” and “attitude” toward plasma donation’ scores on the “Pearson correlation test” (r = 0−0.142, p = 0.005). Conclusion: Donors have a more positive attitude toward plasma donation. The idea of voluntary plasma donation can be intensively promoted by improving knowledge and awareness through education and specific campaigns.

REVIEW ARTICLE

Ravindra Neelakanthappa Munoli

Psychodermatology: An Overview of History, Concept, Classification, and Current Status

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:7] [Pages No:85 - 91]

Keywords: Classification in psychodermatology, Definition of psychodermatology, History of psychodermatology, Psychodermatology, Psychodermatology clinic, Psychodermatology in India, Stress and psychodermatology

   DOI: 10.5005/jp-journals-10067-0067  |  Open Access |  How to cite  | 

Abstract

Psychodermatology is an evolving discipline of medicine with an interface of dermatology and psychiatry. Current psychodermatology relies on understanding that biological, psychological, and social factors play roles in the disease etiopathogenesis. These interactions can be seen over the entire disease course. Recent research addressed the embryological and physiological connections between skin and nervous system, which get reflected in many dermatoses. Various classifications have evolved to understand psychodermatological disorders but there is lack of consensus on definition and classification. Though various models of clinics have shaped up, a holistic approach by liaison between psychiatrist, dermatologist, and psychologist will be ideal to address these. Current review addresses history and evolution of psychodermatology, defines psychodermatology, discusses classification, and explores pathophysiological aspects.

BRIEF RESEARCH COMMUNICATION

Sagar Karia, Ruksheda Syeda, Avinash De Sousa

A “Real-World” Chart Review Study of Monotherapy and Adjunctive Vortioxetine in Clinical Practice

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:3] [Pages No:92 - 94]

Keywords: Cognition, Depression, Side effects, Vortioxetine

   DOI: 10.5005/jp-journals-10067-0059  |  Open Access |  How to cite  | 

Abstract

Background: Vortioxetine is a novel antidepressant drug that proved effective in the treatment of major depressive disorder (MDD) and anxiety disorder. It is a unique antidepressant having a multimodal serotonergic mechanism of action and also has important effects on other neurotransmitters implicated in the neurobiology of depression. Keeping in mind the sparse literature on vortioxetine from India, this real-world chart review was conducted to assess its utility and effectiveness. Materials and methods: This is a multicentric retrospective chart analysis of all patients who were prescribed vortioxetine in outpatient psychiatric clinics set in urban areas. Patients prescribed the drug between January 1, 2019, and December 31, 2019, were included in the study. The chart review included details regarding the reason for starting vortioxetine, dosage, side effects observed, duration, and adjunctive medications that the patient had. Descriptive statistics were used in the analysis and the data were presented. Results: The chart review had data of 131 patients. Of these, 85 patients are still maintained on vortioxetine. Majority of the subjects suffered from a MDD. Other indications for the use of vortioxetine included anxiety disorders, obsessive-compulsive disorders, and borderline personality disorder. Only 12 patients suffered side effects which were minor. Majority of the patients reported good improvement with the drug and cost of the drug was a major deterrent to continuing long-term treatment with the drug. Conclusions: Vortioxetine was found to be efficacious with minimal side effects. It may improve cognition in depression and has a lower incidence of treatment-emergent sexual dysfunction. Further data from diverse patient populations are needed before we comment on its effectiveness and safety.

LETTER TO THE EDITOR

Sashi bhushan Kumar Gupta, Mahesh Gowda, Chandrashekar Muthylappa

Left Behind: Surviving Suicide Loss

[Year:2020] [Month:July-December] [Volume:14] [Number:2] [Pages:2] [Pages No:95 - 96]

   DOI: 10.5005/jp-journals-10067-0066  |  Open Access |  How to cite  | 

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