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   Table of Contents - Current issue
Coverpage
January-June 2021
Volume 26 | Issue 1
Page Nos. 1-87

Online since Friday, July 30, 2021

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EDITORIAL  

The interaction of COVID-19 pandemic and schizophrenia p. 1
Sandeep Grover
DOI:10.4103/jmhhb.jmhhb_133_21  
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REVIEW ARTICLE Top

Prevalence and diagnostic tools predictability of common mental disorders among Indian children and adolescent population: A systematic review and meta-analysis p. 5
G Radhika, R Sankar, R Rajendran
DOI:10.4103/jmhhb.jmhhb_127_20  
The objective of this systematic review was to examine the pooled prevalence of common mental disorder (CMD) and to evaluate the predictability of screening instruments to detect CMD in the children and adolescent population in India. Data sources included the MEDLINE, PubMed, PyschEXTRA, and PyschINFO up to 2020, with additional studies identified from a search of reference lists to examine the diagnostic utility of tools carried out in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, PRISMA within parentheses after the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines (PRISMA). Only studies involving children and adolescents with an independent measure of depression and anxiety in India were included. Random effects meta-analyses were employed to calculate a pooled estimate of depression prevalence. Twenty studies met all inclusion and exclusion criteria for the systematic review. The analysis showed that several tools were used in different regions of the nation to measure CMD such as the beck depression inventory (BDI), Children's Depression Rating Scale-Revised (CDRS-R), and Depression Anxiety Stress Scale. The pooled prevalence of depression was 19% (95% confidence interval (CI) = 12.57–27.12), 15% (95% CI = 4.67–30.90) for anxiety, and 11% (95% CI = 4.37–19.77) for any depressive disorder. In terms of BDI had the highest sensitivity (61%) while CDRS-R had the highest specificity (75%). Given the high heterogeneity of the studies, there is insufficient evidence that any tool accurately screens for CMD and likely to underestimate the true prevalence.
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HISTORY Top

History of Indian psychiatric society-north zone p. 17
Sandeep Goyal, Abdul Majid Gani, Sandeep Grover, Bharat Singh Shekhawat, Rajiv Gupta, Rakesh Kumar Chadda, Ajit Avasthi
DOI:10.4103/jmhhb.jmhhb_139_21  
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ORIGINAL ARTICLES Top

COVID-19 outbreak: Impact on psychological well-being of the health-care workers of a designated COVID-19 hospital p. 20
Vishalkumar Kanaiyalal Patel, Sunayna Pandey, Arpit Madhusudanbhai Jani, Deepak Sachidanand Tiwari, Falguni Babubhai Patel, Rajendra Kumar Amritlal Thakrar
DOI:10.4103/jmhhb.jmhhb_179_20  
Context: COVID-19 outbreak has had a huge impact on health-care facilities, and challenges of health-care providers would compromise their physical and mental well-being during this epidemic. Aims: This study aimed to find out stress, anxiety, insomnia, and depression among the health-care workers during COVID-19 outbreak. Settings and Design: This was a 3-month, cross-sectional, observational, single-center study of health-care workers of designated COVID-19 hospital. Subjects and Methods: Study objectives were explained to health-care workers, and written consent was obtained. Participants were approached in their department as per their convenience and requested to fill the pro forma. Depression, Anxiety, and Stress Scale-21 and Insomnia Severity Index were used to detect psychological issues in the form of stress, anxiety, insomnia, and depression. Statistical Analysis: Descriptive statistics and Chi-square test were used for analysis of variables in the study. Results: Overall 27.41% and 29.18% of the health-care workers reported stress and anxiety symptoms, respectively, while 18.78% reported clinically significant insomnia and depression. Among them, being female, married, elderly, presence of medical illness, frontline workers, frequently watching COVID news, and excessive fear of COVID emerged as statistically significant variables associated with stress, anxiety, insomnia, and depression. Conclusions: Health-care workers experienced many mental health issues while performing duties during COVID-19 outbreak. Such issues are alarming and need to be addressed with appropriate health-care policy.
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Effect of nurse-led screening linked brief psycho-education for improving adherence to antipsychotic medications among clients with mental illness: A quasi-experimental study p. 28
Hemlata Ghatwal, Jaison Joseph, Purushottam Jangid
DOI:10.4103/jmhhb.jmhhb_175_20  
Background: Despite the significant improvements in pharmacotherapy, nonadherence to antipsychotic medication is consistently reported in the literature. Many studies evaluated the side effects of antipsychotic medications but there is scanty evidence regarding screening linked intervention. Aim: The study investigated the effect of nurse-led screening linked brief psycho-education in improving adherence to antipsychotic medication among treatment-seeking clients with mental illness. Materials and Methods: This study is a quasi-experimental study in which a total of 80 subjects were consecutively recruited as per the sampling criteria. The side effect of antipsychotic medication was measured using the Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU-SERS). A trained nurse delivered a 30-minute individual-based screening linked brief psychoeducation for the management of side effects as per the standard module. The outcome measures were changes in adherence to medication measured as per the medication adherence rating scale (MARS-5©Professor Rob Horne) during a 1-month follow-up. Results: Anxiety (40%), reduced duration of sleep (40%), reduced salivation (36%) were the most common moderate-to-severe side effects as per UKU-SERS. Overall, the study observed a significant improvement of self-reported medication adherence in the intervention group as compared to the control group during the 1-month follow-up (F = 46.49; P < 0.001). Conclusion: The nurse-led screening linked brief psychoeducation may be an effective strategy for improving adherence to antipsychotic medication in this setting. More studies should be conducted in similar settings for an evidence base to advocate the role of the nurse as a brief intervention therapist in the routine mental health care setting.
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Technology-based psychosocial management for psychological distress due to stigma associated with COVID-19: A case study from North Karnataka p. 36
Kannappa V Shetty, Suruchi Sonkar, Mahesh Mahadevaiah
DOI:10.4103/jmhhb.jmhhb_225_20  
COVID-19 is associated with a significant distress and stigma. Due to the nature of the disease, it is difficult to conduct counseling and therapy without taking significant precautions such as wearing a complete personal protective equipment kit which impedes with rapport and dampens the speech which is quite essential for therapy. Herewith, we present a case where we used technology-based interventions, course, and outcome. Although the results of this case study cannot be generalized, few factors clearly stand out in the treatment of psychological distress among COVID-19-positive clients – psychoeducation, supportive therapy components of Cognitive Behavioral Therapy (CBT), and management of expressed emotion may play a key role in dealing with rural population. Family interventions were used to facilitate healthy family communication pattern (using technology) toward healthier involvement, connectedness aid client's recovery in the aftermath and acceptance of COVID-19 diagnosis. Intervention should also equip and empower client and family to deal with stigma and helplessness through clarifying misconceptions, providing knowledge, and enhancing agency or mastery over circumstances. These can serve as guidelines during treatment of psychological distress among COVID-19-positive clients and their families.
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Profile of patients seen in the emergency setting: A retrospective study involving data of 5563 patients p. 40
Sandeep Grover, Devakshi Dua, Swapnajeet Sahoo, Subho Chakrabarti
DOI:10.4103/jmhhb.jmhhb_18_21  
Background: There are limited numbers of studies from India, which have evaluated the demographic and clinical profile of patients seen in the emergency setting. Aim: This retrospective study aimed to evaluate the profile of the patients, seen in the emergency setting by a psychiatry team. Methodology: The psychiatry emergency register was reviewed for the data for 6 calendar years (2014–2019), for the demographic and clinical profile. Results: 5563 patients were evaluated by the emergency psychiatry team during the period of 6 years, with the number of patients seen in each calendar year varying from 693 to 1057. The mean age of the patients availing psychiatry emergency services was 38.35 years (standard deviation: 16.65), with a significant proportion (13.1%–16.7%) of them in the elderly age group. Majority of the patients were male (64.6%) and were seen initially by the medicine and allied branches (87.8%). The most common diagnosis was delirium, and this was followed by affective disorders. Substantial proportions of the patients had substance use disorders (18.5%) and self-harm (9.8%). Nearly four-fifths of the patients were managed with psychotropic medications, and nearly one-fifth were treated with psychotherapeutic interventions, while more than half underwent investigations. Conclusion: The present study suggests that delirium, followed by affective disorders, substance use disorders, and intentional self-harm are the most common psychiatric diagnoses, among patients seen in the emergency setting. These findings can have important implications for organizing the psychiatric services in the emergency setting and for training.
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A study of mental health status in relatives of COVID-19 inpatients in a tertiary care hospital p. 49
Minakshi Nimesh Parikh, Kartik Srinivasa Valipay, Mehul Brahmbhatt, Pragna Sorani, Vrunda Ashok Patel, Kesha Khetani, Nirav Patel, Harvee Shah, Aatman Nimesh Parikh
DOI:10.4103/jmhhb.jmhhb_184_20  
Introduction: The global scale of COVID-19 has been enormous, with the disease affecting 20 million people worldwide and resulting in 751,154 deaths by August 14, 2020. An increase in mental health problems is expected with an event of such scale, given past experience with epidemics such as severe acute respiratory syndrome and Ebola, among various vulnerable populations. One such population may be the family members of patients affected with COVID-19. Methods: This was a cross-sectional study. Five hundred and forty-one relatives of patients admitted in the COVID-19 wing of a tertiary care hospital were studied. Sociodemographic details were recorded and a Gujarati version of General Health Questionnaire-28 (GHQ-28) was applied. A total score of ≥4 on GHQ-28 was considered indicative of “caseness” or psychiatric morbidity and the population was divided into two groups based on whether the score was <4 or ≥4. The groups were analyzed for any differences with respect to variables like age, gender. Conclusion: 5.17% of the study population had a GHQ-28 total score of ≥4 indicative of “psychiatric morbidity.” The most common symptoms were fatigue, stress, sleep disturbance, and anxiety. Male gender and advanced age were statistically significantly more likely to have a GHQ-28 total score ≥4.
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Evaluation of association of impairment of attention with other symptoms of delirium p. 54
Sandeep Grover, Aseem Mehra, Subho Chakrabarti, Swapnajeet Sahoo, Ajit Avasthi
DOI:10.4103/jmhhb.jmhhb_44_21  
Aim: To evaluate the association of impairment of attention with other symptoms of delirium. Methodology: Eighty-six patients with delirium as per the Diagnostic and Statistical Manual, 5th Revision seen in the consultation-liaison psychiatry setup of a tertiary care hospital were cross-sectionally assessed on the short informant questionnaire on cognitive decline in the elderly (Retrospective), montreal cognitive assessment (MoCA), and delirium rating scale revised-98 (DRS-R98) version. Results: The mean age of the study participants was 46.6 (standard deviation [SD] – 16.4) years. All the patients had impairment in attention with the altered sleepwake cycle, acute onset of illness, with the fluctuating course and underlying physical disease. In terms of severity, the severity score was the highest for the item of sleep-wake cycle disturbances, followed by motor agitation. The mean noncognitive symptoms domain of the DRS-R98 domain were more than the mean score of the cognitive symptom domain of DRS-R98. The mean total score on MoCA was 11.9 (SD: 7.5). Higher attention impairment was associated with more severe noncognitive and cognitive symptoms and higher delirium severity as assessed by DRS-R98. Higher severity of attention deficit was also associated with higher impairment in other domains of cognition of MoCA. Cognitive symptoms, as evaluated by DRS-R98, had more significant correlations with various domains of MoCA except for language and abstraction. Conclusion: Attention deficits are the core symptom of delirium and have a significant impact on other cognitive and noncognitive symptoms of delirium.
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Views of medical students about online classes started during the COVID-19 pandemic: An online exploratory survey from India p. 62
Sandeep Grover, Sandeep Kumar Goyal, Swapnajeet Sahoo, Samta Goyal, Aseem Mehra
DOI:10.4103/jmhhb.jmhhb_43_21  
Aim of the Study: To evaluate the views of medical students about online classes started in view of COVID-19 pandemic. Methodology: An online survey was conducted using Survey monkey platform®. A survey link which was sent through the WhatsApp platform® to the MBBS/BDS students across the country. The survey questionnaire evaluated the views about the various aspects of the online classes. Results: A total of 1059 students completed the survey, of which 1033 entries were analyzed. The participants' mean age was 20.8 years with nearly equal male-to-female ratio, majority being MBBS students who were taking part in online classes mostly from home (95.4%), by using smart phones (85%). When asked to compare the experience of online classes with regular in-person classes, a majority of the participants reported having poor attention and concentration, poor retention of knowledge, poor learning of theoretical aspects of subject, poor learning of practical aspects of the subject, poor questions/answers sessions, and only 38.9% and 10.6% rated online theory and online practical classes as 'good' or 'very good,' respectively. The most common advantages of online classes reported by the students were that they do not have to travel (69%) and do not have to dress up (69.9%), while the most commonly reported disadvantages included poor learning of practical aspects (75%), followed by strain on eyes (73.4%) and difficulties with internet connectivity (64.8%). A small proportion of students 'occasionally' or more often indulged in surfing Internet, Chatting on WhatsApp/Telegram/FB Messenger, and using Social Media (Facebook, Instagram, We Chat, Snap Chat, and Telegram) while attending online classes. Conclusions: This study suggests that although various colleges are running online classes, as a substitute for the regular in person classes in view of the need for social distancing, these classes are not well received by the students and are possibly does not fulfilling the desired needs of the students. Further, the present study suggests that students still prefer in-person classes.
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Gaming pattern, prevalence of problematic gaming, and perceived stress level among the Indian medical graduate p. 68
Parveen Kumar, Vishal Kanaiyalal Patel, Deepak Sachidanand Tiwari, Disha Alkeshbhai Vasavada, Renish Bhupendraderbhai Bhatt, Nirav Bhupendraderbhai Chanpa
DOI:10.4103/jmhhb.jmhhb_116_20  
Background: Problematic gaming use is prevalent among the adolescents and young adults. The awareness of problematic gaming as a behavioral addiction is low in the community. Aims: This study was aimed to find the prevalence of problematic gaming, gaming pattern, and perceived stress level among Indian medical graduates. Methods: A total of 922 undergraduate medical students participated in this cross-sectional study. Demographic details, different gaming variables, “internet gaming disorder scale short form (IGDS9),” and “Perceived stress scale” were filled by participants using the Google form. Results: Out of 595 students, 8.71% reported problematic gaming use. Positive correlation was observed between Internet gaming disorder score and perceived stress score (r = 0.446, P < 0.001). Male participants, younger age group, first year medical students, and participants playing more hours per day were associated with higher score on IGDS (P < 0.001). Positive correlation was observed between the duration of game play (in years) with IGDS score (r = 0.359, P < 0.001). Action games playing participants had higher score on Gaming Disorder Scale followed by simulation games playing participants (P = 0.001). Conclusion: Problematic gaming use is prevalent behavioral addiction among the medical students. Students with problematic gaming reported a high level of stress. Education and interactive workshop of problematic gaming should be conducted as a part of foundation course in the medical education.
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BRIEF COMMUNICATION Top

Eating disorders research in India: A bibliometric assessment of publications output during 2000–2019 p. 74
Sandeep Grover, BM Gupta
DOI:10.4103/jmhhb.jmhhb_145_20  
Aim: The paper examines quantitative and qualitative dimensions of India's research output on Eating Disorders. Methodology: Scopus database was searched for the publications on eating Disorder from India during the years 2000 to 2019, and then the articles were screened to select the relevant articles. Results: The study included 132 publications. India's cumulative research in this area registered 328% absolute growth and averaged 6.87 citations per paper. The distribution of output by type of research revealed that anorexia nervosa and pica (31.82% and 28.79% share) contributed the largest shares of publications on eating disorders during 2000–2019. All India Institute of Medical Sciences, New Delhi; National Institute of Mental Health and Neurosciences, Bengaluru; and Postgraduate Institute of Medical Education and Research, Chandigarh, lead the country as the most productive organizations (with 14, 11, and 7 papers each). Indian Journal of Psychological Medicine and Indian Journal of Pediatrics formed the most common journals publishing research on eating disorder, with largest contribution of 9 papers each. Conclusion: There is meager research on eating disorders from India.
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CASE REPORT Top

A holistic psychotherapeutic approach for the management of obsessive-compulsive disorder with poor insight p. 78
Ritu Raj Gogoi, B Surchandra Sharma
DOI:10.4103/jmhhb.jmhhb_56_20  
An individual with obsessive-compulsive disorder (OCD) and poor insight has a significant impact on the person, thinking clearly about his obsessive thought and compulsive behavior. Cognitive-behavior therapy is an evidence-based therapy for the treatment of OCD patients. However, the need felt to incorporate other therapeutic approaches such as supportive, mindfulness-based therapy to treat OCD. This case study tried to discuss the efficacy of a holistic intervention approach in an individual with OCD who had poor insight. The result showed that the holistic approach decreased distress, intrusive thought and reassurance-seeking behavior and improved his insight. At the end of the psychotherapy session, the Y-BOCS score decreased to 15.
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LETTERS TO EDITOR Top

Binge gaming and COVID-19: A looming crisis p. 83
Subhasmita Mahapatra, Manoj Kumar Sharma, Senthil Amudhan, Nitin Anand
DOI:10.4103/jmhhb.jmhhb_26_21  
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Smoking cessation in COVID-19: A silver lining to the cloud p. 85
Siddharth Raj Yadav, Rohit Kumar, Pranav Ish, Nitesh Gupta
DOI:10.4103/jmhhb.jmhhb_204_20  
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