Indian Journal of Private Psychiatry

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2021 | July-December | Volume 15 | Issue 2

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EDITORIAL

On the Quest to Bestow Autonomy have We Conferred Poor Prognosis?

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:2] [Pages No:55 - 56]

Keywords: Covert medication, Prognosis, Proxy consultation, Treatment adherence

   DOI: 10.5005/jp-journals-10067-0099  |  Open Access |  How to cite  | 

276

EXPERT VIEW/REVIEW PAPER

Preeti Sinha, Nishant Goyal, Radhika Kelkar, Vidya Kote Lingappayya

Application of Brain Stimulation Techniques during Pregnancy

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:5] [Pages No:57 - 61]

Keywords: Depression, Electroconvulsive therapy, Mental disorders, Pregnancy, Transcranial magnetic stimulation.

   DOI: 10.5005/jp-journals-10067-0087  |  Open Access |  How to cite  | 

Abstract

Pregnancy is associated with an increased vulnerability to developing psychiatric illnesses that, if left untreated, pose the risk of negative consequences for the mother and the fetus. At the same time, there is a risk of teratogenicity and other possible interference with fetal development associated with pharmacotherapy. Taking into account all these factors, brain stimulation techniques are emerging as reasonable alternatives for the treatment of psychiatric disorders during pregnancy. Here, electroconvulsive therapy (ECT) has the advantage of better evidence of efficacy and faster response. The adverse effects associated with ECT specifically for mother and fetus during pregnancy can be mitigated with proper precautions, monitoring, and multidisciplinary care. Repeated transcranial magnetic stimulation (rTMS) is also emerging to be effective and safe during pregnancy, although the evidence is currently more related to its applicability in depression. This article describes various aspects of ECT and rTMS with the aim of improving their utility as treatment modalities for psychiatric disorders during pregnancy. The other brain stimulation modalities are not much explored for psychiatric disorders during pregnancy and hence are described briefly.

315

ORIGINAL RESEARCH

Darshankumar Dharaiya, Kamlesh Dave, Pradhyuman Chaudhary

Effect of Stress Coping on Burnout: A Prospective Study with First-year Postgraduate Medical Students

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:7] [Pages No:62 - 68]

Keywords: Burnout, Coping strategies, First-year resident, Perceived stress

   DOI: 10.5005/jp-journals-10067-0092  |  Open Access |  How to cite  | 

Abstract

Background: Many studies have recognized that the first postgraduate year (PGY-1) of residency training is the most stressful. Failing to cope with the stress will have a negative impact on their work performance and the quality of patient care. Aims and objectives: To investigate stress and burnout in PGY-1 residents and to explore the relationship between stress, coping strategies, and burnout. Methods: Fifty-four PGY-1 residents completed the Perceived Stress Scale, the Copenhagen Burnout Inventory and Coping Inventory at baseline and after 6-month follow-up. The association among stress, burnout, and coping strategies was examined by paired t-test. Results: PGY-1 resident students had an increase in the level of perceived stress, level of personal burnout, work-related burnout, and patient-related burnout from baseline to 6-month follow-up (p >0.05). In male resident doctors, only work-related burnout increased significantly with the duration of residency, while in females, a significant increase in the level of personal, work-related and patient-related burnout was observed. Conclusion: The present study revealed high levels of stress that are predictor of burnout, which increases with the duration of the residency program.

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ORIGINAL RESEARCH

Mrugesh Vaishnav, Sandeep Grover, Gautam Saha, Parth Vaishnav, Gundugurti Prasad Rao, Ajit Avasthi

Neuropsychiatric Issues in Persons with COVID-19 Infection: An Online Survey from India

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:12] [Pages No:69 - 80]

Keywords: Anxiety, COVID-19, Depression, Fear, Neuropsychiatric issues, Resilience

   DOI: 10.5005/jp-journals-10067-0098  |  Open Access |  How to cite  | 

Abstract

Background: Multiple surveys across the globe during the first wave of the pandemic suggested an increase in the prevalence of various psychiatric disorders like depression, anxiety disorder, and insomnia in the general population, patients with acute coronavirus disease-2019 (COVID-19) infection, and in the post-COVID-19 infection patients. However, the data on psychological morbidity during the post-COVID-19 infection phase is limited barring a few small sample size studies. In this background, this study aimed to evaluate the prevalence of neuropsychiatric issues in persons who had suffered from COVID-19 infection and compare the same with persons who did not suffer from COVID-19 infection, but witnessed the same in one of their relatives. Materials and methods: In this cross-sectional web-based study, 1172 adult participants, aged 18–75 years, who had either suffered and recovered from COVID-19 infection or those who did not develop COVID-19 infection but witnessed the infection in a family member completed the PHQ-9, GAD-7 scale, fear of COVID-19 Scale (FCV-19S), brief resilient coping scale (BRCS), brief resilience scale (BRS), and a 19-item self-designed questionnaire to evaluate neuropsychiatric issues and coping mechanisms. Results: In terms of psychiatric morbidity, about one-fourth of those who developed COVID-19 had depression and that of higher severity significantly more than those who did not develop COVID-19 themselves. Similarly, about one-fourth of the persons who developed COVID-19 infection also had anxiety disorder and higher proportion of them had more severe anxiety, which was significantly higher than those who did not develop COVID-19 themselves. Compared to those who did not develop COVID-19 infection themselves, a higher proportion of those who developed COVID-19 demonstrated intense recollection or flashbacks of illness, trying to avoid memories, thoughts, or feelings related to the stressful experience, brain operating slowly, forgetfulness, persistent headache, new-onset seizures, and higher level of resilient coping. Conclusion: There is an urgent need to focus on the mental health consequences of COVID-19 infection and to provide multidisciplinary care to people who have gone through the COVID-19 infection to prevent and manage the post-COVID or long-COVID symptoms.

312

Original Article

Shiji Pazhampallial Jose, Supriya Hegde, Neetha Kamath

Recognition of a Person with Alcohol Dependence: A Community-based Survey

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:6] [Pages No:81 - 86]

Keywords: Alcohol dependence, Alcohol use, Prevalence

   DOI: 10.5005/jp-journals-10067-0085  |  Open Access |  How to cite  | 

Abstract

Aims: The aim of the study was to identify the alcohol dependents in selected communities. Methods: Community-based descriptive survey was conducted. A total of 330 men who are residing in selected communities of Dakshina Kannada, were selected using the purposive sampling technique. The Alcohol Use Disorders Identification Test (AUDIT) tool was used to gather the data. Descriptive and inferential statistics were used to analyze the data. Results: Majority (279) of men were categorized as alcohol dependents and about 51 were nonalcohol dependents out of 330 men based on AUDIT score. There was a significant association between AUDIT scores and demographic variables like family support. Conclusion: Nowadays alcohol use is becoming the major public health concern as it affects not only the victim but also the entire family, which destroys the family life. So steps should be initiated to stop alcohol use.

227

Original Article

Archana Gopal, Anvitha Kayarpady, Prashanth Nagabhushan Rudra

Sexual Functioning and Its Association with Psychological Symptoms among Doctors Working in a COVID-19 Care Facility: A Cross-sectional Survey

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:5] [Pages No:87 - 91]

Keywords: Anxiety, COVID-19, Depression, Healthcare workers, Sexual dysfunction

   DOI: 10.5005/jp-journals-10067-0082  |  Open Access |  How to cite  | 

Abstract

Background: Psychological symptoms which are common among frontline healthcare workers (HCWs) can be devastating and can affect sexual functioning of this population. Aims: The article was to assess sexual functioning among the frontline doctors and to study the association between sexual functioning and psychological symptoms. Materials and methods: It was a cross-sectional survey conducted among 150 doctors treating COVID-19 patients in a tertiary care teaching hospital. The survey tools included a sociodemographic questionnaire, Depression, Anxiety, and Stress Scale-21 (DASS-21), and Changes in Sexual Functioning Questionnaire (CSFQ) which was sent using a Google Forms link to all participants after informed consent. Chi-square test, t-test, Pearson correlation, and multivariate logistic regression were used. p <0.05 was considered statistically significant. Results: Sexual dysfunction was present in 21 (31.62%) males and 65 (65%) females. Both males and females with severe stress had lower global sexual functioning scores (p = 0.02, 0.02). Those with severe stress had reduced sexual frequency, sexual pleasure, and sexual excitement. Global sexual dysfunction was predicted by age >25 years in males, working hours >100/month, and severe stress in both males and females. Conclusion: Sexual dysfunction was common in both male and female frontline doctors. Presence of stress, higher age, and greater working hours were associated with poor sexual functioning with decreased sexual desire, sexual pleasure, and sexual arousal.

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Original Article

Swarna Hemamalini Mohan Sundaram, Ganesh Kini Kota, Rohan D Mendonsa, Ravichandra Karkal, Anil Kakunje, Varikara Veetil Mohan Chandran

Psychotic Mania and Nonpsychotic Mania: A Comparative, Cross-sectional Study

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:4] [Pages No:92 - 95]

Keywords: Age of onset, Bipolar disorder, Nonpsychotic mania, Psychotic mania

   DOI: 10.5005/jp-journals-10067-0084  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: Though mania is considered a mood disorder and presents with elevated/irritable mood, increased goal-directed activity, pressure of speech, and flight of ideas, they can also manifest with psychotic symptoms including Schneiderian first-rank symptoms. The present study was undertaken to compare and study any differences between psychotic mania and nonpsychotic mania groups. Materials and methods: We compared the sociodemographic and clinical variables between 30 psychotic and 30 nonpsychotic mania patients, i.e., a total of 60 patients. After obtaining ethical clearance from the Institutional Ethics Committee, we used the Mini International Neuropsychiatric Interview to conduct structured diagnostic interview and the Young's Mania Rating Scale (YMRS) to assess the severity of mania. Results: Young's Mania Rating Scale scores (Mann–Whitney U = 785.5; p <0.05) and duration of hospital stay (Mann–Whitney U = 587.0; p = 0.04) were significantly different between the two groups. During correlation analysis, negative correlation between age of onset and number of episodes of psychotic mania (p = –0.477; p = 0.008) was seen. A moderate association between duration of hospitalization and YMRS scores (p = 0.331; p = 0.010) was also observed. Conclusion: Psychotic mania tends to be more severe and needs longer duration of stay in hospital compared to nonpsychotic mania. The negative correlation between age of onset and the number of episodes of psychotic mania highlights the need for specialized early interventions to treat such cases to alter the course of the disorder and improve the socio-occupational impairment.

315

BRIEF RESEARCH COMMUNICATION

Telepsychiatry in India: Personal Observations

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:2] [Pages No:96 - 97]

Keywords: India, Obsevations, Present and future, Teleconsultation

   DOI: 10.5005/jp-journals-10067-0089  |  Open Access |  How to cite  | 

Abstract

Telepsychiatry in India has been widely used by many psychiatrists to provide much-needed help to patients during the COVID pandemic. Neither the patients nor the clinicians were prepared for the process. This author practiced during this period and used some innovative methods. The observations are made for three periods. Normal consultations during corona pandemic, when only teleconsultations were allowed, and during a period when both types of consultations were available. During the pandemic, when normal consultations were provided very few (164) patients came for consultation. When only teleconsultation was provided, 335 patients were consulted in nearly a similar duration. This clearly shows that as soon as a safe method of consultation was available the numbers jumped to double indicating that many patients could not consult as a safe consultation method was not available. When both types of consultations were available the number doubled to 748 indicating that many patients were not comfortable with teleconsultation. Most patients did not follow all directions asked for teleconsultations but submitted important information. Very few new patients opted for teleconsultations. Telepsychiatry is an exciting prospect for the future, it will open new avenues of consultation and prevention. We must make it more efficient and patient-friendly, and a continuous effort should be made to refine the process.

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CASE REPORT

Sunil KG Patil, Ume Hani, Shivakumar Thandavamurthy

Atypical Presentation of COVID-19 in a Patient with Polysubstance Use and Retroviral Positive Status

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:3] [Pages No:98 - 100]

Keywords: Atypical presentation, COVID-19, Drug overdose, Pandemic

   DOI: 10.5005/jp-journals-10067-0083  |  Open Access |  How to cite  | 

Abstract

Aim: To know the uncommon presentations of coronavirus disease 2019 (COVID-19) in patients with psychiatric illness for early diagnosis. Background: The COVID-19 pandemic has been associated with multiple mental health issues. A recent survey by the Indian Psychiatric Society also highlighted the presence of stress, anxiety, depression, insomnia, fear, and cognitive defects in patients with COVID-19. The occurrence of COVID-19 in people with the psychiatric illness may present with various challenges right from diagnosis to treatment. Case description: A 41-year-old male with a history of multiple substance use, in dependence pattern for alcohol, opioids, benzodiazepines, Cannabis, and tobacco, since the past 20 years presented with a history of generalized fatigue for 1 day and drowsiness since morning. The patient was on antiretroviral treatment since 4 years. The patient had a history of multiple attempts of deliberate self-harm (DSH) of impulsive type and a history of an overdose of prescribed medicines (quetiapine and nitrazepam) as well. In view of the history of DSH, drug overdose was suspected in the absence of the history of reuse of substances. However, the real-time polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and a minimal improvement happened on drug overdose-related treatment. Conclusion: These patients pose a challenge in the prevention and control of COVID-19 spread. It also hinders the diagnosis and effective management leading to further complications. Among patients with polysubstance use and also among immunocompromised populations, the presence of atypical symptoms should raise a suspicion of COVID-19 and screening protocols should be revaluated. Clinical significance: A comprehensive understanding of the atypical symptoms should be helpful in identifying and effectively managing COVID-19. This also emphasizes the use of appropriate protection during clinical contact with every patient keeping in mind the risk of infection.

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CASE REPORT

Sreelatha Pasupuleti, Bhavya Sree Rayachoti

Obsessive Jealousy Masquerading as Delusional Disorder

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:2] [Pages No:101 - 102]

Keywords: Delusional jealousy, Forensic psychiatry, India, Mental health, Morbid jealousy, Obsessive-compulsive disorder

   DOI: 10.5005/jp-journals-10067-0088  |  Open Access |  How to cite  | 

Abstract

Jealousy and morbid jealousy are the phenomena commonly encountered by psychiatrists. Its significance extends beyond the clinical characteristics and treatment to forensic aspects as well. This jealousy results in behaviors designed to prevent partner infidelity and to retain their romantic partners. These retention behaviors can be both nonviolent and violent and differ in males and females. Morbid jealousy is a symptom with different psychopathological presentations resulting in distinct psychiatric diagnosis and treatment. Obsessive jealousy in particular needs special consideration as it goes unrecognized or more often be mistaken for delusional jealousy. In contrast to delusional jealousy which expresses itself with the strong degree of conviction of partner's infidelity, obsessive jealousy presents as recurring, unpleasant, undesired, unwanted, and irrational thoughts of their partner's infidelity. In obsessive jealousy, the individual suffers from a possibility of unfaithfulness which can be sexual and emotional with resultant monitoring behaviors.

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CASE REPORT

Ume Hani, Shivakumar Thandavamurthy

Alcohol Use Disorder and COVID-19: A Case Series

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:3] [Pages No:103 - 105]

Keywords: Alcohol dependence, COVID-19, Substance abuse

   DOI: 10.5005/jp-journals-10067-0091  |  Open Access |  How to cite  | 

Abstract

Aim: The following case series aims to highlight and put forth the various outcomes of alcohol use disorders (AUDs) and coronavirus disease-2019 (COVID-19). Background: The hazardous and well-established relation of how alcohol damages every functional component of the human body, plays a vital role in understanding the enormously severe effects it can have with a comorbid infection especially COVID-19. Tagged along come the various degrees of complications ranging from mild to severe, the latter being the most common. Case descriptions: This case series presents three cases with AUDs succumbing to COVID-19 infection eventually having unfavorable outcomes. Conclusion: Patients with AUDs are not only prone to acquire COVID-19 infection, the chances of having complications are not unlikely. Clinical significance: A better understanding of AUD and COVID-19 including the etiopathogenesis, should be emphasized on and management plans for better outcomes should be put forth. Establishing protocols and being vigilant of what to expect in such cases serves of utmost value.

265

LETTER TO THE EDITOR

Chandrashekar Muthyalappa, Santhosh Madhukar Nambiar

Joji: A Play of Authoritarian Parenting

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:2] [Pages No:106 - 107]

Keywords: Authoritarian parenting, Joji, Movie

   DOI: 10.5005/jp-journals-10067-0090  |  Open Access |  How to cite  | 

Abstract

Joji is a 2021 Indian Malayalam-language black crime drama film directed by Dileesh Pothan and written by Syam Pushkaran. Based on William Shakespeare's Macbeth, this movie is about an upper middle class Christian family in the high ranges of Kerala during the coronavirus disease 2019 pandemic. This movie portrays a father being authoritative leading to internalizing and externalizing behaviors like aggressiveness, defiance, poor-coping skills, self-harm, and submissiveness in his children.

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VIEWPOINT

Raveesh Bevinahalli Nanjegowda, Ravindra Neelakantappa Munoli

Rama—The Epitome of Indian Ethics: Relevance to Modern Mental Health

[Year:2021] [Month:July-December] [Volume:15] [Number:2] [Pages:4] [Pages No:108 - 111]

Keywords: Indian ethics, Mental health, Rama, Ramayana

   DOI: 10.5005/jp-journals-10067-0093  |  Open Access |  How to cite  | 

Abstract

India is known for its ancient traditions. From time immemorial, various faiths have flourished here. Ethics has its origin in its theology and philosophical thinking. Ethics is the core of all these multiple faith systems from the roots of Vedas, Upanishad's, and epics. The people's moral code is an indicator of their social and spiritual ways of life developed from these roots. They teach the true essence of human life is to live amidst worldly joy and sorrows. The epic Ramayana differentiates the term human value from social value. Ramayana means the journey of Rama. Though the central theme of the Ramayana revolves around the victory of good over evil, it is the righteousness and patience/tolerance of Rama in circumstances of adversity and felicity which colors the epic. Rama sacrificed all his pleasures for the welfare of his subjects upholding the true dharma. Translators have failed to find an exact equivalent English word for dharma. It is often said to be a duty and does not equate with religion. The three goals of human life as per Indian culture are artha (prosperity), kāma (desire), and dharma (righteous living); the fourth, which is the most important and ultimate goal of life, is moksha. The two essential aspects of Indian culture by which life goals are achieved are values and holism. Values refer to moral, spiritual, and ethical values, and holism means oneness or unity. Many dynasties, kings, and kingdoms ruled India. But Rama is considered the “Purushottama” or “Maryada Purusha” for his uncompromising and untiring binding with the core Indian values and ethics. This paper tries to reveal these much-needed ethical values in modern human life where such ethics are eroding.

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