Indian Journal of Private Psychiatry

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2023 | January-June | Volume 17 | Issue 1

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EDITORIAL

Prosenjit Ghosh

Burden of Mental Health: Present Status and Road Ahead

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:3] [Pages No:1 - 3]

Keywords: Burden of mental health, Depressive disorder, Mental health, National Mental Health Programme, Sigma, Suicide, Sustainable development, Unemployment

   DOI: 10.5005/jp-journals-10067-0132  |  Open Access |  How to cite  | 

371

Original Article

Ridhima Bhatia, Ragul Ganesh, Yudhyavir Singh, Nishant Patel, Shailender Kumar, Richa Aggarwal, Anjan Trikha

Coping Strategies among Healthcare Workers Directly Involved in Coronavirus Disease-2019 Care in a Tertiary Care Hospital in India

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:6] [Pages No:4 - 9]

Keywords: Adaptive, Coronavirus disease-2019, Maladaptive, Mental health, Stress, Young doctors

   DOI: 10.5005/jp-journals-10067-0126  |  Open Access |  How to cite  | 

Abstract

Background: The pandemic of coronavirus disease-2019 (COVID-19) has put healthcare workers (HCWs) under the immense pressure of providing care to a large number of patients with the risk of getting infected. This has resulted in the rise of severe mental health issues in them and coping with such deep stress needs certain strategies. Aim: A study was used to evaluate the coping techniques adopted by the HCWs to deal with COVID-19-related stress. Methods: A 28-item Brief-coping orientation to problems experienced (COPE) questionnaire-based cross-sectional survey was used with the HCWs directly involved in the care of COVID-19 patients in September 2020 during the peak of the first COVID-19 wave and coping strategies were analyzed as continuous variables. Result: A total of 221 HCWs completed the questionnaire of which 166 (75%) were doctors. The mean scores for adaptive strategies and maladaptive strategies were 41.56 (9.04) and 21.41 (5.6), respectively. The most employed coping strategy was acceptance (6.35 ± 1.6) and the least was substance abuse (2.33 ± 0.9). Conclusion: Of all the coping strategies, adaptive strategies were the most employed. However, females and young ones employed maladaptive strategies, indicating the need for necessary attention in them.

815

Original Article

Anvitha Kayarpady, S Sourabh, Prashanth Nagabhushan Rudra, Shankar Kumar

A Comparative Study of Childhood Abuse in Depressed Female Patients and Patient Attendees in a Medicine Ward of a Tertiary Care Hospital

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:4] [Pages No:10 - 13]

Keywords: Adverse childhood experiences, Depression, Emotional abuse, Female

   DOI: 10.5005/jp-journals-10067-0125  |  Open Access |  How to cite  | 

Abstract

Background and aims: Adults with childhood abuse have high prevalence of psychiatric disorders out of which depressive disorder is most commonly reported. In addition, a dose–response relationship is reported to exist between childhood abuse and chronic depression. This study was conducted to estimate the proportion of depressed female patients having childhood abuse and to correlate between severity of childhood abuse and severity of depression. Materials and methods: In total, 30 cases and 30 comparison groups between 18 and 65 years of age were included after informed consent, where cases included females with major depressive disorder and comparison group included attendees of patients admitted in general medicine ward of the same hospital in this cross-sectional analytical study. For cases, those with organic mood disorder, substance-induced mood disorders, and patients with severe medical illness were excluded, whereas for comparison group, those with current or past history of any psychiatric disorders and severe medical illness were excluded. Study tools included sociodemographic questionnaire, MINI plus to screen for any psychiatric illness, Hamilton Depression Rating Scale (HDRS) to assess the severity of depressive disorder, and Childhood Trauma Questionnaire-Short Form (CTQ-SF) was used to screen for childhood trauma. Data were entered and analyzed in Microsoft Excel. Results: Prevalence of childhood abuse in our study was higher in cases (60%) than comparison group (43%) but statistically was not found to be significant. Comorbid medical illness among cases was higher (37.7%) than the comparison group (3.3%) in our study (p < 0.003). History of psychiatric illness in parents was significantly higher among cases than comparison group (p = 0.01). Total trauma scores were significantly higher in cases than comparison group (p = 0.009). A prevalence of emotional abuse was significantly higher in cases (40%) than in the comparison group (13%). Positive correlation was found between CTQ scores and the severity of depression in our study (p = 0.002). Conclusion: There is high prevalence of childhood abuse among depressed female patients compared with healthy comparison group. Severity of childhood abuse was positively correlated with severity of depression. It is thus important to recognize childhood abuse in female patients with depression, which necessitates management with psychotherapy in addition to pharmacotherapy for depression.

342

Original Article

Leo Malandain, Florence Thibaut

Is there Any Relevance for the Use of Cyamemazine in the Treatment of Schizophrenia?

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:6] [Pages No:14 - 19]

Keywords: Antipsychotic treatment, Anxiety, Cyamemazine, Schizophrenia

   DOI: 10.5005/jp-journals-10067-0128  |  Open Access |  How to cite  | 

Abstract

Introduction: Cyamemazine is widely used in the treatment of schizophrenia despite a potential risk of QT interval prolongation on electrocardiogram and weak evidence for its antipsychotic efficacy. The aim of our study was to compare the level of anxiety and the co-prescription of benzodiazepines and hypnotics in schizophrenic patients who received cyamemazine (alone or in association with other antipsychotics) with those who did not receive cyamemazine. Materials and methods: A total of 1,859 patients were enrolled according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for schizophrenia. We collected their medication prescriptions and assessment scale scores and compared patients receiving antipsychotic mono or polytherapy with or without cyamemazine at inclusion, 6-, and 12-months. As a comparison, we will use the same outcome measures in patients receiving loxapine or levomepromazine rather than cyamemazine. Results: Brief psychiatric rating score (BPRS) scale anxiety subscores of patients under monotherapy of cyamemezine at inclusion was lower than for other antipsychotic medications but the patients received higher doses of anxiolytics. No differences in psychotropic drug use or anxiety subscores were observed between patients on antipsychotic polytherapy whether cyamemazine was used or not at inclusion, 6-, and 12-months. Patients under antipsychotic polytherapy including cyamemazine had better Global Assessment of Functioning (GAF) scores than patients under polytherapy excluding cyamemazine. Comparison of cyamemazine, loxapine, and levomepromazine groups showed no statistically significant differences in co-prescription of psychotropic drug use or anxiety subscores at inclusion, 6-, and 12-months of follow-up, respectively. Conclusion: Our study does not find any evidence to recommend the use of cyamemazine in the anxiolytic or antipsychotic treatment in patients suffering from schizophrenia.

571

Original Article

Gopala S Poduri

An Analysis of Telugu Suicides by Gender

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:6] [Pages No:20 - 25]

Keywords: Andhra Pradesh, Bifurcation, Gender, Sex ratio, Suicide rate, Telangana

   DOI: 10.5005/jp-journals-10067-0131  |  Open Access |  How to cite  | 

Abstract

Background: Gender differences are getting progressively narrowed in all fields. Aim: Evaluate the Telugu suicides to find out if any gender differences are there in various parameters in Telugu states. Methods: Suicide data from the national portal were analyzed to find out gender differences in cause, education, income, method, profession, rate, and social status, for the period 1967–2021 before bifurcation (1967–2013) and after bifurcation (2014–2021). Further, differences between the two states were analyzed separately. Simple basic statistics and Wilcoxon signed-rank test were used to compare parameters. Results: There were a total of 471,285 Telugu suicides in the 56-year period of 1966–2021. Sex ratio (male/female) was 2.55. The lowest no. of suicides was recorded in 1980 (1,905) and the highest in 2021 (18,238). Female suicides recorded a reduction after bifurcation to an average of 29.1%. There was a marginal reduction in suicide after bifurcation due to reduced female suicides. The predominance of male suicides over women was maintained all through the recorded period. This continued even when the state was bifurcated. The contribution of Telugu suicides to total suicides was 9.8%. In most of the parameters studied, there were differences between the sexes. Telangana persistently recorded a higher rate. Conclusions: Further in-depth analysis is required to correlate with other associated parameters to identify sex-specific factors for suicide.

449

Original Article

Kaustav Chakraborty, Moumita Chatterjee, Rajarshi Neogi, Ranjan Bhattacharyya, Munish Agarwal, Soumya Chatterjee, Gautam Saha

Neuropsychiatric Manifestations of COVID-19: An Online Survey

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:8] [Pages No:26 - 33]

Keywords: Coronavirus disease, Neuropsychiatric, Psychiatric, Symptoms

   DOI: 10.5005/jp-journals-10067-0136  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease-2019 (COVID-19) is known to cause neuropsychiatric sequelae. However, there is dearth of data regarding the same from this subcontinent. Aim and objectives: To determine the prevalence of neuropsychiatric symptoms among patients who recovered from COVID-19 illness. Materials and methods: It was an online survey that was conducted by using Google form with link sent by using WhatsApp to subjects who suffered and recovered from COVID-19 illness. The online survey was done through a 71-item self-designed questionnaire. It took around 10 minutes to complete the questionnaire. In total, 250 responses were received. Results: A typical subject was male (63.2%), healthcare provider (33.6%), Hindu (96.4%) by religion, and from urban background (74%). Nearly about two-fifths (43.2%) and one-fifth (20.8%) of the subjects had comorbid physical and psychiatric disorders, respectively. Majority of the subjects had COVID-19 illness in the past 1 month. Nearly about one-sixth (17.6%) of the subjects lost somebody in their family due to COVID-19. Majority (59.2%) of the subjects experienced persistent fatigue after recovering from COVID-19. Nearly about one-third of the subjects experienced persistent low mood (34.8%), sleep difficulty (38.8%), anxiety symptoms (39.6%), irritability (34.4%), difficulty in concentrating (39.6%), and forgetfulness (30.8%). Nearly about one-sixth of the subjects had panic attacks (18.4%), flashback of illness (16%), obsessive–compulsive symptoms (18.8%), and sexual difficulty (16%) after recovering from COVID-19. Nearly half of the subjects became more preoccupied about bodily symptoms (45.6%), became more anxious on reading COVID-19-related news (45.2%), and hence avoided the same (49.6%). Nearly about one-fifth of the subjects had persistent loss of smell (25.6%), taste (20.4%), and brain fog (26.4%). A miniscule proportion of the subjects had new-onset headache (15.2%), giddiness (12%), and tremor of hands (9.6%). Conclusion: The index survey suggested that neuropsychiatric symptoms are quite prevalent after recovering from COVID-19 illness.

450

Original Article

Ajay Prakash, S Sourabh, Prashanth Nagabhushan Rudra, Shankar Kumar, Shalu Elizabeth Abraham

Metabolic Syndrome in Patients with Depression: A Cross-sectional Comparative Study

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:6] [Pages No:34 - 39]

Keywords: Antidepressant, Depression, Metabolic syndrome, Waist circumference

   DOI: 10.5005/jp-journals-10067-0129  |  Open Access |  How to cite  | 

Abstract

Background: Depression is a leading cause of disability worldwide and is also known to be comorbid with a number of medical and psychiatric illnesses. Metabolic syndrome (MS) that is now emerging as a common lifestyle illness is found to be twofold greater in patients with depression. Often, antidepressants have been considered to be the reason for this possible link, however, research from the West suggests that a direct link is plausible. There is a scarcity of literature supporting these data from the East. In this study, we have attempted to assess the prevalence of MS in depressive patients, and to determine the probable risk factors contributing to the association. Materials and methods: Sixty consecutive patients that fulfilled the inclusion criteria were recruited from a tertiary care center in India. Sociodemographic and clinical data were obtained using a semistructured pro forma. Depressive disorder was diagnosed using International classification of diseases-10 (ICD-10), and severity was measured using Hamilton rating scale for depression (HAM-D). The weight, height, waist circumference (WC), systolic and diastolic blood pressure (BP), as well as fasting lipids and glucose were measured. Metabolic syndrome was diagnosed based on National Cholesterol Education Program/Adult Treatment Panel (NCEP ATP-III) criteria (2005 revision). The descriptive and inferential statistics were done using statistical package for social sciences (SPSS) 16. Results and conclusion: The overall prevalence of MS among depressed patients was 35%. The prevalence among “drug-naive” patients was 30%, whereas among “on-drug” patients was 40%. The most common abnormal MS components were WC (53.33%), systolic BP (SBP) (53.3%), and high-density lipoprotein (HDL) (53.3%). Age of the patient was the only sociodemographic factor that showed significant correlation with components of MS like fasting blood sugar (FBS) and SBP. Age of onset of depression among MS cases had a negative correlation with WC. Among the MS components, the distribution of diastolic BP (DBP) and triglycerides (TG) was statistically different among the “drug-naive” and “on-drug” groups. Thus, in view of significant number of depressed patients being at risk of developing MS, it would be necessary to keep a regular check on metabolic parameters in this group of patients.

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Original Article

Prathama G Chaudhuri, Megha Rathi, Aparna Sharma, Yoshita Agarwal

Emotional Distress and Coping Strategies in COVID-19 Pandemic across Different Stages of Life: An Eriksonian Perspective

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:5] [Pages No:40 - 44]

Keywords: Anxiety, Coping styles, Coronavirus disease-2019, Depression, Mental health

   DOI: 10.5005/jp-journals-10067-0130  |  Open Access |  How to cite  | 

Abstract

Background: The early part of 2020 saw countries across the world take various measures to mitigate the effects of the coronavirus pandemic and impose restrictions on the movement of people. In a developing economy like India, the effects of a lockdown on the life and livelihood of people are huge, and reports are unequivocal about the psychological impact it is having on the mental health of individuals. Objectives: This study examined how the imposed lockdown affected the emotional states of individuals across age-groups and the various coping styles adopted to deal with the overwhelming uncertainty, anxiety, and lack of productivity. Materials and methods: This study was carried out in early 2020, comprising 600 men and women from metropolitan cities in India belonging to the age-group of 20–89 years, hailing from upper or upper-middle income backgrounds with a minimum education level of higher secondary. The tools used were Beck Depression Inventory II, State-Trait Anxiety Inventory (STAI) Form Y, and Coping strategies inventory. Multivariate analysis of variances (MANOVA) was used for statistical computation. Results: Results indicated that young adults displayed intense depression and anxiety relative to other age-groups. Men had significantly more anxiety and depression across all age-groups. People across different age-groups displayed different coping styles. Problem solving and cognitive restructuring were dominant coping styles in early and middle adulthood. Seeking social support was found to be highest in young adulthood. Expressed emotions and social withdrawal were more prominent coping styles in late adulthood. Conclusion: The results indicate significant psychological distress in all age-groups during pandemic with young adults being affected the most. Coping strategies differed across different stages of the life cycle. The findings may facilitate the formulation of effective intervention across different age-groups, both during and after the pandemic.

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CASE REPORT

Jitendriya Biswal, Antara Kunwar

Nail Hyperpigmentation Following Valproic Acid Use: A Rare Case Report

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:2] [Pages No:45 - 46]

Keywords: Hyperpigmentation, Nail, Valproic acid

   DOI: 10.5005/jp-journals-10067-0137  |  Open Access |  How to cite  | 

Abstract

Aim and background: Valproic acid (N-dipropylacetic acid) is a widely accepted anticonvulsant. Apart from its use in seizure treatment, it is also prescribed for various psychiatric disorders like bipolar disorder. The common side effects include gastrointestinal distress, tremors, weight gain, transient alopecia, exanthemas, and low platelets. Very few cases have been reported of nail and nail bed hyperpigmentation. We aim to report and highlight a case of hyperpigmentation of fingernails and toenails of both the upper limb and lower limb following use of valproic acid. Case description: A 22-year-old male presented with acute manic symptoms characterized by overtalkativeness, tall claims, being irritable, and aggression. He was hospitalized in view of being unmanageable at home. All the baseline investigations were within the normal range. The patient tested negative for HIV, hepatitis, and syphilis. Oral second generation antipsychotic, tablet riseperidone (4 mg/day) and valproic acid (1gm/day) was prescribed. The patient showed significant improvement with the above treatment and was discharged after 20 days of hospitalization. During the first follow-up, after a period of 4 weeks following discharge, tablet risperidone was gradually tapered-off in view of improvement of symptoms. On the second follow-up after 2-months duration, he reported a “brownish-yellow discoloration of all finer nails and toenails”. The patient had no other systemic disease and denied any other concomitant drug use or misuse. The potassium hydroxide (KOH) study was negative for any fungal infection, and the histopathological report was negative for any pigment incontinence melanophages/increased melanocytes. Discontinuation of valproic acid for about a month resulted in the clearing of brownish-yellow pigmentation. Conclusion: Valproic acid rarely causes nail and nail bed discoloration due to deposition of a drug (drug metabolite) or deposition of iron following blood vessel damage. These proinflammatory changes can be reversed if identified earlier with subsequent stoppage of valproic acid. Clinical significance: To provide prompt management, both general practitioners and specialists must be aware that medications may cause hyperpigmentation.

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CASE REPORT

Kamal Nath, Subho Panja

An Adolescent with Incapacitating Tics

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:2] [Pages No:47 - 48]

Keywords: Brain imaging, Obsessive–compulsive disorder, Pediatric autoimmune neuropsychiatric disorder is associated with streptococcal infections, Streptococcal infection, Sudden onset

   DOI: 10.5005/jp-journals-10067-0133  |  Open Access |  How to cite  | 

Abstract

Introduction: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), also known as a pediatric acute-onset neuropsychiatric syndrome (PANS), are the sudden development of mainly obsessive–compulsive disorder (OCD) symptoms, tics, or other symptoms among children and adolescents. Case description: This case is about a male of age 15 years with a history of fever 3 years back, after which symptoms such as abnormal sounds and body movements gradually started, which were involuntary. After many trials with different antipsychotics, the patient started responding but symptoms persist along with anxiety and irritability at times. Conclusion: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections occur in about 1 in 1,000 children, which is a rare disorder and is difficult to diagnose. The treatment is challenging as a suitable antipsychotic has to be picked in terms of efficacy and dosing.

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CASE REPORT

Debdutta Nayak, Kamal Nath

Delirious Mania in a Case with Multiple Demyelinating Foci

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:2] [Pages No:49 - 50]

Keywords: Bells mania, Delirious mania, Demyelination, Psychosis

   DOI: 10.5005/jp-journals-10067-0135  |  Open Access |  How to cite  | 

Abstract

Introduction: A serious but underdiagnosed neuropsychiatric illness called delirious mania is described by the sudden onset of delirium, mania, and psychosis. Demyelination is the term used to describe the loss of myelin while axons are largely preserved. Depending on the site of insult, various neuropsychiatric manifestations may appear. We are discussing a case that was presented initially as mania but after a proper evaluation it was found to be a case of delirious mania along with multiple demyelinating foci in brain imaging, which had an impact on the presentation of this case. Case description: This is a case of 19-year-old man presented with complaints of talkativeness, tall claims, increasingly bizarre, and disorganized behavior with intermittent restlessness for the last 2 months. After a few trials with psychotropics, the patient started showing improvement with a combination of mood stabilizers and antipsychotics. Conclusion: Recent reports suggest that delirious mania may constitute up to 15% of all acute mania cases. When delirious mania is unrecognized or improperly treated, it can progress rapidly in severity and can become life-threatening. Like in our case, patients presenting with manic symptoms should also be properly evaluated for other underlying pathology which may have a significant impact on patient's well-being.

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LETTER TO EDITOR

Prerna Maheshwari, Preeti Srinivas

Feasibility of Academics Including Practice Following Postgraduation

[Year:2023] [Month:January-June] [Volume:17] [Number:1] [Pages:2] [Pages No:51 - 52]

Keywords: Academic, Continuing medical education, Private practice

   DOI: 10.5005/jp-journals-10067-0134  |  Open Access |  How to cite  | 

Abstract

Following postgraduation, continuing to engage in gaining academic knowledge often posits a challenge for medical professionals, especially those in private practice. Nevertheless, keeping up-to-date with ongoing research, new findings, and perspectives regarding psychopathology and medical management often widens the horizon in which one is operating. Private practitioners in every medical field have opportunities to continue refreshing their academic knowledge in the least time-consuming manner while balancing their clinician roles. Being an academician and clinician does not have to be exclusive to each other and furthering knowledge will only lead to better evidence along with experiential-based clinical care and satisfying patient outcomes.

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