Indian Journal of Private Psychiatry

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2023 | July-December | Volume 17 | Issue 2

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EDITORIAL

Ishita Bhattacharya, Avinash Desousa, Prosenjit Ghosh

Ethical Issues in Psychotherapy with Suicidal Clients

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:53 - 54]

Keywords: Autonomy, Ethical, Psychotherapy, Suicidal

   DOI: 10.5005/jp-journals-10067-0152  |  Open Access |  How to cite  | 

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Original Article

Gopala S Poduri

Telugu Suicides: Before and after Bifurcation of State

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:4] [Pages No:55 - 58]

Keywords: Andhra Pradesh, Before and after bifurcation, Combined Andhra, Suicide rate, Telangana, Telugu state

   DOI: 10.5005/jp-journals-10067-0138  |  Open Access |  How to cite  | 

Abstract

Background: Apart from being the first linguistic-based state, Telugu states are important states in more than one way in the Indian union. There were no reports from the Telugu states about suicides before and after the bifurcation. Aim: To analyze suicides in Telugu states for the period 1966–2021 and to find the effect of bifurcation on the considered criteria. Materials and methods: Information relating to suicides was accessed from National Crime Records Bureau on Accidental Deaths and Suicides in India. The data obtained relate to number of suicides, rate, cause, education, income, marital status/social status, mode/means, and profession for the years 19662013 for the combined Andhra Pradesh (AP) and 20142021 for Andhra and Telangana states, separately and combined. Wilcoxon signed-rank test was used to compare criteria before bifurcation (20062013) and after bifurcation (20142021) by combining AP and Telangana states and differences between the two states. Results: Telugu state contributed 9.4% and 10.8% toward national suicides before and after bifurcation, respectively. There were no differences in the criteria studied before and after bifurcation, except in rate. Telangana recorded a higher rate compared with its’ counterpart. Andhra recorded lesser illiterates and higher poisoning. Conclusion: Improving education and health facilities and providing better earnings will reduce suicides. Telangana needs to adopt drastic measures to reduce the rate.

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Original Article

Javed A Siddiqui, Shazia Farheen Qureshi, Abdullah Alzahrani

The Association between Hyponatremia and Psychotropic: An Observational Study in Chronic Forensic Rehabilitation Ward at Mental Health Hospital, Taif, Saudi Arabia

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:5] [Pages No:59 - 63]

Keywords: Antidepressant, Antipsychotic, Hyponatremia, Mood stabilizer

   DOI: 10.5005/jp-journals-10067-0139  |  Open Access |  How to cite  | 

Abstract

Background: Hyponatremia is the most common electrolyte imbalance experienced in psychiatric clinical practice, both in hospital and outpatient settings, in patients taking psychotropic medications. It is a multifactorial clinical condition characterized by a plasma sodium level of less than 130 millimoles per liter. In psychiatric patients, this is mostly ignored and untreated, which can lead to increased mortality.1 Aims and objectives: The main objectives of this study are: • To evaluate the socio-demographic profile. • To evaluate the severity of hyponatremia in patients using psychotropic. • To evaluate the association between hyponatremia and psychotropic. Materials and methods: This was an observational study performed in the forensic psychiatric rehabilitation wards of the Mental Health Hospital, Taif, Saudi Arabia. Study participants were patients admitted to the inpatient ward (n = 73) between 2018 and 2022. Descriptive statistical analysis was explored and presented as categorical variables such as frequencies and percentages. We also explored the relationship between hyponatremia and psychotropics. Results: An observational study was conducted over a period of 5 years. The majority of patients (34.48%) were in the age group of 46 to 55 years, and the total number of hyponatremia patients was (n = 29; 39.72%). The maximum number of patients was 44.82% with mild hyponatremia (130–134 mmol/L), 37.93% with moderate (125–130 mmol/L), and 17.24% with severe hyponatremia (<120 mmol/L). Hyponatremia was found in 4.10% of antidepressant patients, 20.54% of patients on antipsychotics, and 9.58% of patients on mood stabilizers. Conclusions: In our study, hyponatremia was most prevalent among patients between 45 and 55 years of age. Haloperidol was the most likely antipsychotic to cause hyponatremia. Among atypical antipsychotics, aripiprazole was most commonly associated with hyponatremia, followed by risperidone and amisulpride, whereas quetiapine had a minimal number. Among mood stabilizers, valproic acid was associated with hyponatremia, whereas lithium and carbamazepine were less likely to be associated.

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Original Article

Robin Victor, Rohit Gondwal, Priyaranjan Avinash, Kiran Bhat

Psychiatric Implication of Deficiency of Vitamin B 12 and Vitamin D: A Cross-sectional Study from North India

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:4] [Pages No:64 - 67]

Keywords: Mental disorders, Psychiatric disorders, Vitamin B12, Vitamin B12 deficiency, Vitamin D, Vitamin D deficiency

   DOI: 10.5005/jp-journals-10067-0149  |  Open Access |  How to cite  | 

Abstract

Background: Both vitamin B12 and vitamin D are closely correlated with various neurological and psychiatric disorders. These vitamins might have an etiological and prognostic value across a variety of psychiatric illnesses, especially depressive disorder, anxiety disorder, substance use disorder, schizophrenia, dementia, schizophrenia, and so on. Objective: To explore about the deficiency of vitamin D and vitamin B12 in patients presenting to the psychiatry OPD and admitted in indoor wards and explore its relation with various psychiatric disorders. Materials and methods: In our cross-sectional, observational study, data were taken out retrospectively from the psychiatry and biochemistry record system of patients who had visited psychiatry OPD and IPD in the last 6 months and had undergone vitamin B12 and vitamin D investigations. Results: About 168 subjects were included in the study, of which 96 had undergone vitamin B12 level and 72 underwent vitamin D investigations. The mean of vitamin B12 was 314.02 ± 420.28 and the mean of vitamin D was 72.5 ± 62 in the study sample. Vitamin B12 deficiency was majorly found in patients suffering from anxiety disorder (29.8%) followed by depressive disorder (19.1%) and substance use disorder (17%), while vitamin D deficiency was mainly present in cases with an anxiety disorder (29.7%) followed by depressive disorder (13.5%). An equal number of cases with substance use disorder, schizophrenia, and somatic symptom disorder had the vitamin D deficiency. Conclusion: Early recognition of the deficiency and prompt management would surely affect the course of various psychiatric morbidities.

886

Original Article

Subodh Kumar

Prevalence of Nomophobia and Analysis of Its Contributing Factors among Higher Education Students

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:6] [Pages No:68 - 73]

Keywords: Anxiety, College students, Higher education, Nomophobia, Smartphone addiction

   DOI: 10.5005/jp-journals-10067-0150  |  Open Access |  How to cite  | 

Abstract

This study aimed to assess nomophobia (NMP), a condition of fear of being without a mobile phone, among college students who are the main users of mobile phones. It is observed that students try to explore the features and applications of a new invention and feel the need to stay connected with their peers constantly, leading to addiction. Data from 200 college students were collected using Nomophobia Questionnaire (NMP-Q). This study showed that 12% of the participants had a mild level of NMP, 48% had a moderate level of NMP, and 40% had severe NMP. The male participants had comparatively higher NMP than female participants; postgraduate (PG) students had comparatively higher NMP than undergraduate (UG) students; Medical students had higher NMP; and other Science students had the lowest NMP. t-test revealed no significant difference in NMP between male and female participants (t = 1.33, p > 0.05). However, there was a significant difference in NMP between UG and PG students (t = –2.667, p < 0.01). Analysis of variance test revealed no significant difference in NMP among Arts, Engineering, Medical, and Science students (F = 0.187, p >0.05). Pearson's correlation coefficient of age and NMP showed a strong significant positive relationship between age and NMP of the students (r = 0.227, p < 0.01). These findings suggest that there is a need for innovative solutions to address the mental health challenges faced by college students due to excessive smartphone use. Educators, mental health professionals, and policymakers can use these findings to develop effective interventions and programs to address NMP and its impact on mental health.

368

Original Article

Nirmalya Mukherjee, Gargi Mondal, Sashi B Gupta

COVID-19-related Psychosocial Information: Findings from a Public Online Search Engine

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:4] [Pages No:74 - 77]

Keywords: COVID-19, Mental health, Pandemic, Psychological issues, Social support, Search engine

   DOI: 10.5005/jp-journals-10067-0148  |  Open Access |  How to cite  | 

Abstract

Purpose: There is an emotional and psychosocial impact of the COVID-19 pandemic. We planned to find the responses provided by online search engine to an Internet user when searching for psychosocial issues related to COVID-19 pandemic. Methodology: Key terms “COVID-19” and “COVID-19 PSYCHOSOCIAL” were searched on Google search. Responses from the first five pages were considered. About 62 relevant articles were found. Results: Articles were grouped into news article, journal article, and resource article. The article describes the impact of COVID-19 and coping methods. Few provided helpline numbers and online resources like textual and audiovisual information on home-based well-being methods as well as guidance for individual care. Conclusion: Media channels, scientific community, and various government and nongovernment organizations published various articles catering to the psychosocial and mental health needs of general public, risk groups, and professionals. In the future, the acceptance, knowledge dissemination, and impact of these articles on people's attitude and practice during the pandemic situation shall be looked into. There is a need for standard guidelines for publishing public information on online public forums.

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REVIEW ARTICLE

Shorouq Motwani, Anita Hukumchand, Sagar Karia, Sushma Sonavane, Avinash Desousa

Sexual Dysfunction with Antidepressants: A Clinical Review

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:5] [Pages No:78 - 82]

Keywords: Antidepressants, Erectile dysfunction, Libido, Psychotropics, Sexual dysfunction

   DOI: 10.5005/jp-journals-10067-0143  |  Open Access |  How to cite  | 

Abstract

Sexual dysfunction is an important unwanted phenomenon of psychotropic medications. This is often underreported and not given due importance, which can often lead to impaired quality of life and less-than-optimal medication compliance. All types of psychotropic medications are linked to sexual side effects. As the underlying mental disorder improves, some of the sexual issues abate, but treatment-related sexual adverse effects may persist over time and are unfortunately underrecognized by clinicians and scarcely investigated in clinical trials. When it comes to sexual dysfunction due to psychiatric disorders, there are two important things to understand. First, any mental illness can cause sexual dysfunction, and second, severer the underlying psychiatric disorder, severer is the sexual dysfunction (in both frequency and severity). Even though patients may be suffering from mental illnesses of variable severity, it is important for them to have a normal and enjoyable sex life. The reported incidence of sexual dysfunction found with antidepressant medication varies considerably between different studies, making it difficult to estimate the exact incidence or prevalence. The sexual problems encompass a range of sexual disorders and include decreased sexual desire, decreased sexual excitement, diminished or delayed orgasm, and erection or delayed ejaculation problems. Patients with sexual disorders usually also have anxiety disorder and vice versa; also, women with sexual dysfunction are more prone to anxiety and depression compared with others. This happens because sex steroids and the various neurotransmitters modulate both sexual function and mood. The mechanism by which psychotropic medications affect the sexual cycle is through the interaction between medications and the various above-mentioned neurotransmitters. Physicians should monitor their patients for antidepressant-induced sexual adverse effects, as these may affect compliance with therapy and the ultimate treatment success. Sexual function should be actively assessed at regular intervals. Management of antidepressant-induced sexual dysfunction requires an individualized approach.

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REVIEW ARTICLE

Jyotika

A Systematic Review Article Determining the Prevalence and Causal Association of Chronic Lupus Patients Developing Obsessive Compulsive Disorder

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:8] [Pages No:83 - 90]

Keywords: Neuroimaging, Neuropsychiatric, Obsessive compulsive disorder, Systemic lupus erythematous

   DOI: 10.5005/jp-journals-10067-0146  |  Open Access |  How to cite  | 

Abstract

Introduction: The incidence of neuropsychiatric lupus ranges from 25% to 75% with obsessive–compulsive disorder (OCD) being a common manifestation. The cardinal correlation and pathophysiological mechanism of OCD in chronic lupus patients is still under research. The objective of this article is to determine the prevalence and causal association of a chronic lupus patient developing OCD in its course of disease. Materials and methods: Human studies, randomized control trials, non-randomized control trials, cohort series, and cohort studies were included. This search resulted in 940 published, peer reviewed scientific articles as of March 2018. There was a repetition of the articles but yet the total was above 800 articles which were individually reviewed, thoroughly analyzed, and exquisitely interpreted. Results: The brain regions and cortico-striatal-thalamic-cortical (CSTC) circuits dysfunction with abnormalities of serotonin (5-HT), glutamate, and dopamine neurotransmitters in OCD were determined. The proposed pathophysiological hypotheses of activation of autoimmunity and inflammatory mechanism with predominant role of antibodies like anti-RP antibody, N-methyl-d-aspartate receptor antibodies, anti-phospholipid antibodies etc. and also increased proinflammatory cytokines like interleukin (IL)-6, IL-8 etc., were shown with probable heterogeneous neurological origin. This hypothesis was further strengthened by evidentiary support of neuroimaging modalities like brain magnetic resonance imaging (MRI), resting functional MRI, voxel-based morphometry, diffusion-tensor imaging, quantitative susceptibility mapping etc., which even though has provided mixed inferential data, there is consistent and repeated demonstration of structural abnormalities in basal ganglia and CSTC circuits. Conclusion: The evaluation and treatment approach would be different for the patients with only OCD and the one harboring OCD with underlying lupus. In the future, more studies involving neuroimaging and pathophysiology are recommended with similar prospects for better advancement.

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CASE REPORT

Javed A Siddiqui, Shazia F Qureshi, Yousef BA Shawosh

Risperidone-induced Premature Ventricular Complexes in Psychosis: A Case Report

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:4] [Pages No:91 - 94]

Keywords: Antipsychotic agents, Arrhythmia, Cardiac, Risperidone

   DOI: 10.5005/jp-journals-10067-0116  |  Open Access |  How to cite  | 

Abstract

Atypical antipsychotics are known to cause cardiovascular side effects, such as prolonging the QTc interval due to blockade of the potassium repolarization channels, and hence they predispose to ventricular arrhythmias, like premature ventricular complexes (PVCs). Here, we report a case of a male schizophrenic patient who is complaining of palpitations and feeling clinically as well as symptomatically troublesome PVCs associated with risperidone. We consider that PVCs may have been generated by risperidone, with his stressful mental condition, and subsided after withholding it.

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CASE REPORT

Ashmeet Singh, Jasleen Kaur Bhalla

Catatonia in Young Male with Cerebral Palsy and Intellectual Disability: A Case Report

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:4] [Pages No:95 - 98]

Keywords: Catatonia, Cerebral palsy, Intellectual disability, Periventricular leukomalacia, Quality of life

   DOI: 10.5005/jp-journals-10067-0127  |  Open Access |  How to cite  | 

Abstract

Aim: To consider the possibility of an organic cause vs mental health-related cause in a young patient of cerebral palsy presenting with catatonic features. Background: The catatonic symptoms in a young patient with cerebral palsy and intellectual disability can either be a sequelae of the preexisting organicity or has an independent organic or psychological cause. One of the organic causes is the white matter loss in the brain parenchyma-like periventricular leukomalacia (PVL) due to perinatal hypoxic insult that leads to cerebral palsy and consequent intellectual disability. Case description: We present the case report of a 20-year-old male who presented with acute onset of catatonic symptoms in the absence of any preexisting psychiatric disorder. His general physical examination manifested spastic diplegia, mutism, negativism, posturing, and staring gaze without any other focal neurological deficits. The routine blood investigations were within normal limits, whereas the MRI brain was suggestive of PVL with white matter loss and thinning of corpus callosum. The neurology consults suggested conservative management for the same, and the patient was managed with Lorazepam and Olanzapine, following which his catatonic symptoms started improving. During his hospital stay, intellectual quotient was assessed that revealed moderate level of intellectual disability. Conclusion: It is difficult to absolutely ascertain whether the organicity had direct influence on the patients presenting psychiatric symptoms or not. However, due to the neuropsychological changes, one cannot exclude the possibility that the sequelae of PVL or intellectual disability might have played a role in this case. Clinical significance: This raises considerable problems when it comes to choosing a therapeutic strategy for such a patient like whether the medical intervention alone or along with assistive therapies for the damaged white matter and intellectual disability would change the course, prognosis, and the outcome of the psychiatric symptoms or whether the psychopharmacological intervention would be sufficient for a better outcome and quality of life of the patient.

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CASE REPORT

Jubilee Evangeline Darnei, Surajit Kumar Sen

Transient Focal Lesion of Corpus Callosum in Epilepsy: A Case Report

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:99 - 100]

Keywords: Antiepileptic drugs, Carbamazepine, Cytotoxic lesion, Splenium

   DOI: 10.5005/jp-journals-10067-0141  |  Open Access |  How to cite  | 

Abstract

Introduction: Lesions of the splenium of the corpus callosum (SCC) are nowadays seen in a wide variety of medical conditions due to the increasing usage of magnetic resonance imaging (MRI). These lesions can be either reversible or irreversible depending on the etiology. However, in cases of epilepsy, they are called transient as they have been observed to resolve spontaneously after a period of time and this transient nature can be detected in its distinguishing features on MRI that differentiates it from other medical conditions. Case proper: The case is about a 22-year-old male previously diagnosed with Generalized tonic-clonic seizure for the last 15 years who presented to casualty with irritability and aggressive behavior. On further evaluation, it was revealed that he had been taking antiepileptic drugs (AEDs) for the last 7 months and had suddenly stopped them. Magnetic resonance imaging revealed a transient focal cytotoxic lesion in the corpus callosum. Later both psychotic behavior and seizures were controlled and MRI during follow-up showed resolution of the focal lesion. Conclusion: The classical findings in this patient with a history of epilepsy with sudden antiepileptic stoppage followed by behavioral symptoms along with an MRI showing a transient focal lesion in the corpus callosum of splenium with spontaneous resolution on follow-up are indicative of a favorable prognosis, which can be used to differentiate it from other medical conditions where splenial lesions are also found.

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CASE REPORT

Dhrubajyoti Bhuyan, Biplab Konwar

Gender Dysphoria Secondary to Delusion: A Case Report

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:101 - 102]

Keywords: Gender roles, Schizophrenia, Sex assignment surgery

   DOI: 10.5005/jp-journals-10067-0140  |  Open Access |  How to cite  | 

Abstract

Gender dysphoria (GD) may appear in individuals with schizophrenia either as the consequence of a delusional change in gender identity or it may appear separately from psychotic symptoms. Differentiating between these scenarios is not only a difficult task from a diagnostic standpoint, but it also has an impact on treatment choices. People with GD should undergo detailed psychiatric and psychosocial evaluation as unnecessary hormone replacement therapy and sex reassignment surgery could be avoided in cases where it is secondary to a primary psychiatric illness. When both illnesses co-occur, it is imperative to analyze the occurrence and progression of each symptom, their consistency (across time), the patient's feedback, and their reaction to antipsychotic medication.

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LETTER TO THE EDITOR

Debdutta Nayak, Subho Panja, Himabrata Das

Shortcomings of the Mental Health Care Act 2017 in Indian Context

[Year:2023] [Month:July-December] [Volume:17] [Number:2] [Pages:2] [Pages No:103 - 104]

   DOI: 10.5005/jp-journals-10067-0147  |  Open Access |  How to cite  | 

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