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   Table of Contents - Current issue
July-December 2021
Volume 26 | Issue 2
Page Nos. 89-175

Online since Wednesday, February 2, 2022

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Demoralization: Implications in practice of medicine p. 89
Sandeep Grover
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Knowledge about and attitude toward electroconvulsive therapy among those who agree and those who refuse electroconvulsive therapy treatment p. 92
Sandeep Grover, Natarajan Varadharajan, Subho Chakrabarti
Background: Electroconvulsive therapy (ECT) is although one of the most effective treatments in psychiatry, and many a times patients refuse the same. Although, there is information about the knowledge about and attitude towards ECT among people who receive the same, little is known about these among those who refuse ECT. Aim: This study attempted to assess and compare the knowledge about and attitude toward ECT in patients with severe mental illness who accepted and refused ECT. Methodology: 68 patients divided into 3 groups (readily accepted; accepted, with initial reluctance; refused) based on the readiness for ECT were evaluated using ECT knowledge and attitude questionnaire. The higher proportion of those who refused had poor knowledge about the frequency of ECT sessions, investigations required before ECT and believed that ECT can be given against patient and family members' consent. Higher proportion of those who initially refused but later agreed believed that ECT can be given without the patient or family members'consent and it is given only to those patients who are unlikely to improve when compared to those who agreed ECT. Compared to those who agreed spontaneously, higher proportion of the participants in other two groups believed that ECT is not useful in the treatment of psychiatric disorders and they lacked knowledge about headache being a side effect of ECT. In terms of attitude toward ECT, higher proportion of those who refused ECT (n = 24; 89%) had a negative attitude in terms of not recommending the same for their relatives and were reluctant to receive ECT themselves. Conclusions: The results highlight that negative perception toward ECT in patients who refuse to receive ECT. Thus, it is essential to convey adequate information about ECT to enhance their understanding and acceptance.
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Stress, mental health, and resilience during the COVID-19 pandemic lockdown: Preliminary findings of an online survey in India Highly accessed article p. 100
BR Sahithya, Rithvik S Kashyap, BN Roopesh
Background: The recent COVID-19 pandemic has induced a considerable degree of fear, worry, and concern in the population at large. Drastic changes in daily lives as a result of lockdown may expose individuals to high stress levels, which might make them vulnerable to mental health issues. It is important to identify and understand these difficulties, which can help mental health professionals and policy makers address these issues. Aim: The present study aimed to screen mental health problems and to gain insight into resilience among Indians during the COVID-19 pandemic lockdown. Materials and Methods: The study was cross sectional, using online survey method. Sociodemographic datasheet, a self-designed questionnaire, Patient Health Questionnaire and Brief Resilience Scale were entered into Google Form, and was sent using E-mails and WhatsApp to the personal contacts of the investigators. The link was also posted in social media groups. The participants were requested to complete the survey and then forward the link to their contacts. Inclusion criteria laid for the study included English speaking males and females, 18 years or older, and living in India. A total of 348 individuals filled in the forms, of which 327 were complete and included for analysis. Results: Fifty percent of the participants surveyed had symptoms of common mental disorders. Thirty-three percent had elevated scores needing diagnostic evaluation for somatoform disorder, 33% for generalized anxiety disorder, and 35% for depression. 8% reported developing interpersonal difficulties with family members, 17% reported financial stress, 23.5% were worried about job loss, and 35% found the lockdown very stressful. Elevated scores on patient health questionnaire-somatic, anxiety, and depressive symptoms were associated with financial stressors, worries about job loss, and lockdown stress. Ten percent of the participants indicated a need to talk to psychologist, and 40% were not aware of tele counselling facilities. Higher resilience was associated with lower odds of developing psychiatric symptoms. Conclusion: The results offer preliminary data-based insight into the impact of the lockdown, and are suggestive of increased stress and mental health liabilities. Fostering resilience may be critical to prevent or reduce mental health problems in general population during the pandemic.
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Empathy assessment among medical doctors working at the university college hospital Ibadan, Nigeria p. 109
Abimbola Margaret Obimakinde, Uyiose Odebambe Iyoke, Morohunmubo Jesusemenaga Ibiyo, Oluwatosin Ann Emmanuel, Ogooluwatan Faithful Odefemi, Adejumoke Hephzibah Abiodun
Background: Empathy is the competence of a physician to understand the patient's situation, perspective and feelings and to act on that understanding in a helpful therapeutic way. Empathy is the backbone of patient-physician communication in clinical care, it can be innate, learnt or acquired in the course of the medical career. This study, evaluated empathy and its correlates among medical doctors working in the University College Hospital, Ibadan, Nigeria. Methods: This was a cross-sectional study of 188 interns, resident and specialist doctors working at the University Hospital College, Ibadan in March-May 2018. Consecutive consenting doctors were given a self-administered questionnaire that collected information on sociodemography, work and empathy using the 20-items Jefferson Scale of Physician Empathy. Data were analyzed using the SPSS version 23 and statistical significance was set at P < 0.05. Results: The majority of the respondents were male (60.1%), between 30 and 39 years (60.6%) old, married (60.6%) and Christians (91.5%). Many worked in the Internal Medicine Department (38.3%), were Senior-Resident doctors (41.0%) and of Yoruba (82.4%) ethnicity. Senior-Residents doctors ([120.2 ± 15.4]; P = 0.009) and Consultants ([117.8 ± 21.4]; P = 0.009) had highest empathy scores. Doctors who are raised in lower social status families, lacked ability in taking patient's perspective ([56.2 ± 12.2]; P = 0.046). Doctors in surgical-related specialities had lower empathy scores, those in medical-related specialities, especially Psychiatrists (127.1 ± 10.1) and Family Physicians (125.8 ± 7.9) had the highest scores (P = 0.034). Doctors who had never learnt about empathy had the lowest score in perspective-taking ([50.5 ± 30.4]; P = 0.041). Duration of practice and work-hours respectively correlated positively ([rs = 0.174]; P = 0.018) and negatively ([rs = −0.206]; P = 0.005) with empathy scores. Conclusions: Medical doctors possessed varying levels of empathy relative to their sociodemographic characteristics, the speciality of choice and level of expertise. Exposure to teachings on empathy and work-related challenges underscores empathic skills.
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Comparison of demographic profile and psychological problems related to coronavirus disease 2019 outbreak among the general public (18 years and above) in a Northern State of India: A web-based cross-sectional survey p. 117
Jaison Joseph, Bharat Pareek, Sandeep Grover, Sunita Sharma, Biji P Varkey, Tamanna Sehrawat, Sarita Kumari, Seema Parjapat, Sapna Saini
Background: The psychological impact of the general public during a pandemic is complex and incompletely understood. There is a dearth of studies reporting the psychological problems in the general public during the coronavirus disease 2019 (COVID-19) crisis in India, including a comparison as per demographic profile. Materials and Methods: An online survey was conducted from April 17, to May 1, 2020 using the principles of the snowball recruiting technique. The psychological problems of the potential study subjects were evaluated using the Hindi version of the Patient Health Questionnaire-4 (PHQ-4) scale. There were a total of 1826 responses, out of which 391 were excluded from the analysis. Results: The mean age of the subjects was 41.95 years (Median = 50, SD = 19.05, range: 18–86 years) and around 45% of respondents were with an age range of 18–39 years. The mean and standard deviation of the PHQ-4 was 1.81 (2.34), and the overall prevalence of psychological problems was 30% as per the cutoff of PHQ-4. The estimates of anxiety and depression among study subjects were 11% (158/1435) and 16.1% (232/1435), respectively. Younger age, female gender, unmarried, and rural residential status were significantly associated with increased psychological problems in this setting. Conclusion: The psychological response to the COVID-19 varies with sociodemographic status, and about one-third of the people reported having psychological problems in the early phase of the COVID-19 pandemic in this setting. There is a need to expand the mental health services to each stratum of the society with a focus to provide personalized care as per the sociodemographic profile.
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Perceived stress and coping skills in the newly joined medical undergraduate students: An exploratory study from Eastern India p. 122
Swapnajeet Sahoo, Pravash Ranjan Mishra, Shree Mishra, Manisha Kar, Susanta Kumar Padhy
Objectives: To assess the perceived stress and to evaluate the sources of stress, the prevalence of psychological morbidity (if any) and different coping strategies among the newly joined 1st-semester medical undergraduate students. Methodology: A cross-sectional exploratory study was conducted on all the newly joined 1st-year medical students (who had entered 3 months back) at a tertiary care medical college and teaching hospital in Eastern India. Perceived stress and depressive symptoms were assessed on the Perceived Stress Scale-10 (PSS-10) and Patient Health Questionnaire-9 (PHQ-9). A self-designed questionnaire was used to evaluate different premedical entry-level preparation issues and ongoing psychosocial and academic-related stressors. Coping was evaluated on the Ways of Coping Checklist. Results: Ninety-five first-semester medical undergraduate students (mean age − 18.34 ± 0.95 years) who had joined the Institute 3 months back participated in the study. The mean PSS score was 21.56 ± 3.97 and about 85.3% and 11.6% of the students reported moderate and high degrees of stress. Depressive symptoms were reported by 36.8% (PHQ-9 cut-off ≥10). During medical preparation (as rated on a Likert scale of 0–10), the mean rated stress level was 6.84 ± 2.05. Almost half of the students reported facing problems adjusting to the new place and environment (48.4%), facing language problems (11.6%), and unfavorable hostel facilities (10.5%). Under academic stressors – more than half of the students perceived the vastness of academic curriculum as a major stressor as “often” (53.7%) followed by fear of failure in exams (35.8%). Students followed both negative coping strategies (such as escape avoidance coping, distancing, and confrontive coping) and positive coping strategies (self-controlling, seeking social support, planful problem-solving, and positive appraisal). Significant association of depressive symptom score was found with self-controlling (P - 0.012) and seeking social support (P = 0.015) type of coping. Conclusion: A substantial proportion of undergraduate medical students have moderate to high stress at the entry level (just within the months of joining medical curriculum) and about one-third (36.8%) had depressive symptoms. Most of the students reported of using escape–avoidant type of coping while dealing with the ongoing stressors. More focus on improving resilience and positive adaptive coping skills in the initial formative years of medical education to prevent psychological morbidities and burnout in future years of medical education.
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Gender-based shame-focused attitude of general public toward mental illness: Evidence from Jharkhand, India p. 132
Ravi Shankar Kumar, Abhijit Pathak
Objective: The present study aimed to examine the attitude of the general public toward the mental illness in Jharkhand. Material and Methods: A community-based cross-sectional study with a sample size of 240 consisting of a male (163) and female (77) of the general population was done. The study was conducted in the urban and rural areas of Hazaribagh district based on a simple random sample technique. To collect data, Attitude Toward Mental Health Problem (ATMHP) was used. The sociodemographic profile has been calculated with descriptive statistics, and Mann–Whitney U-test has been used to find the significant differences in attitude score. Results: Males and females are both having positive attitude attitudes toward mental illness. Females are having a more positive attitude than males since the mean score is lower in all the four domains of ATMHP (9.39 ± 7.03 > 7.51 ± 5.87, 13.36 ± 9.87 > 9.67 ± 9.30, 5.52 ± 4.97 > 4.35 ± 4.59, 7.82 ± 6.34 > 5.53 ± 4.83, 6.41 ± 4.96 > 4.57 ± 4.46). However, a significant difference has not been found in two domains of ATMHP at 0.05 significant statistical levels. After controlling the co-variates through multinomial logistic regression, males showed 3.7 times odds of developing shame than female toward family member and statistically significant differences were found at less than P value 0.05 levels. Conclusions: People have started to comprehend and empathize with the patient and the family of the mentally ill, and they do not feel shame in admitting, seeking help, and reaching family to help.
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A study to assess the level of burnout and its determinants among medical practitioners working in a tertiary care center in South India p. 139
G Ananda Krishna, Chandra Sekhar Chittooru, Sravana Deepthi Chittem, Surendra Babu Darivemula, Niharika Bheemisetty
Background: Burnout is defined as a feeling of hopelessness and inability in carrying out one's job effectively. Burnout in the life of medical practitioners is a term used to describe a psychological state, which appears after a long period of exposure to psychosocial risk factors such as high patient load, long working hours, and unreasonable demands from patients. The objective was to study the prevalence of burnout among medical practitioners and factors associated with burnout. Methodology: The study was a descriptive cross-sectional study conducted among medical practitioners of tertiary care hospital with a sample of 102. The study was conducted using the Maslach Burnout Inventory with additional questions on demographic factors, work experience, hours of work, and specialty. Data were entered in MS Excel 2007 and analyzed with IBM SPSS statistics 21 version. Results: Out of 102 subjects, 26 (25.5%) members were suffering from burnout in any one of the three dimensions. In the emotional exhaustion, 15 (14.7%) were experiencing high scores, 14 (13.7%) members, and 73 (71.6%) members were experiencing moderate and low scores, respectively. However, in the depersonalization dimension, just 1 (1%) member was experiencing high score, whereas 11 (10.8%) members and 90 (88.2%) members were experiencing moderate and low scores, respectively. In the personal accomplishment dimension, 16 (15.7%) members were experiencing high scores, whereas 13 (12.7%) members and 73 (71.6%) members were experiencing moderate and low scores, respectively. Conclusions: Burnout exists among medical practitioners, and measures should be taken to identify causes and take remedial actions.
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Psychiatric morbidity and its impact on quality of life in patients with epilepsy: A cross-sectional study p. 144
Yogender Kumar Malik, Surender Kumar Mattoo, Parampreet Singh Kharbanda, Sandeep Grover
Aim: The aim of this study is to evaluate the prevalence psychiatric comorbidities by using a structured diagnostic instrument and it impact on quality of life among patients with idiopathic epilepsy. Methodology: Using a cross-sectional study design, 120 patients with idiopathic epilepsy were assessed for psychiatric morbidity by using MiniInternational Psychiatric Interview-PLUS version for psychiatric morbidity and Quality of life in Epilepsy-31 scale. In addition, all the patients were also assessed on Beck Depression Inventory-II and generalized anxiety disorder-7 (GAD-7) to rate the severity of depressive and anxiety symptoms, respectively. Results: The present study showed that the prevalence of current and lifetime psychiatric diagnosis as per Mini International Neuropsychiatric Interview-PLUS is 68.3% and 75%, respectively. Among various psychiatric disorders, depressive disorders were the most common (54.16%), followed by GAD (8.3%). In terms of severity of depressive symptoms, 10.8% patients had mild depression, 25.8% moderate depression, and 14.2% had severe depression. On GAD-7, 28.3% were found to have mild, 15% had moderate and 15.8% had severe anxiety. Psychiatric morbidity both current and lifetime was associated with poorer quality of life in all the domains. Conclusion: Psychiatric morbidity is highly prevalent in patients with epilepsy and it has significant negative impact on the quality of life. These findings suggest that there is a need for close liaison between the psychiatrist and the neurologist to address psychiatric issues among patients with epilepsy.
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Depression, Anxiety, and Stress among Indian Youth during the COVID-19 Lockdown A Cross-Sectional Survey p. 153
Ruchi Vaidya, Santhosh Kumar Kaza, Pallavi Gupta, Stevan M Weine, Shalini Chandrashekar Nooyi, Nayanjeet Chaudhury
Purpose: The psychological effects of the unprecedented global emergency due to COVID-19 are a significant concern worldwide. The present study aims to investigate the prevalence of stress, anxiety, and depression among Indian youth during the COVID-19 lockdown. Methods: A cross-sectional survey was conducted online across India during the COVID-19 lockdown. A total of 1641 Indian youth between the ages of 15–24 years across 23 states and 3 union territories were analyzed for their mental health status. Depression, anxiety, and stress (DAS) levels of the Indian youth were measured using DAS scale 21. The study was approved by the Institutional Review Board (IRB Reference number: DRP/EFP 530/2020: 08/06/2020). Results: Moderate to higher levels of depression and anxiety were observed among 45% and 49% of Indian youth, respectively, during the COVID-19 lockdown. DAS was significantly higher among youth preparing for competitive examinations, those who had an acquaintance infected with COVID-19 and those who perceived COVID-19 as a risky infection (P < 0.01). School-going students showed significantly lower levels of depression and stress compared to college-going students (P < 0.01). Conclusion: The high levels of DAS during the COVID-19 pandemic indicate a significant mental health burden among Indian youth. These findings indicate the need for a multisectoral approach to cope with stresses and to improve psychological well-being among youth during the pandemic.
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Esport: Is it a sport or clinical entity? p. 161
Pranjali Chakraborty Thakur, Manoj Kumar Sharma, John Vijay Sagar Kommu, Nitin Anand
Esports is being seen as equivalent to sport. Subsequent to diagnostics started treating gaming as mental health condition or a research category. The need is being felt to explore the mental health perspective of Esports. Thus, for people who are engaged in Esports, there is a possibility that they may develop certain physical or mental health concerns if the gaming pattern is problematic. It implies the need for research to identify the status of their clinical condition or a career option as a sport player.
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Handbook of consultation liaison psychiatry in India, first edition p. 164
Devakshi Dua
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Effect of guided imagery as an adjunct to pulmonary rehabilitation on anxiety, quality of life, and quality of sleep in a post COVID-19 patient via telerehabilitation p. 166
Priyanka Jayesh Shah, Siddhi Vijay Ghodge
The COVID-19 outbreak caused by the novel severe acute respiratory syndrome coronavirus 2 was declared as a global pandemic by the World Health Organization. Patients infected with the disease have to be kept in social isolation in order to limit the spread of infection. This in turn led to anxiety and fear among the general public post isolation related to spread of infection. Furthermore, it was observed that many of them suffered from disturbed sleep which in turn affected the quality of life (QOL) of the patients post COVID-19 infection. The following case report concluded of a positive effect of guided imagery (GI) as an adjunct to pulmonary rehabilitation on anxiety, QOL, and quality of sleep in a post COVID-19 patient via telerehabilitation.
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An exploratory case study on the use of rational emotive behavior therapy for treatment of illness anxiety p. 169
J Nandini
Illness anxiety disorder is characterized by preoccupation with having or developing a serious illness accompanied by maladaptive safety or avoidance behavior that impairs the persons everyday functioning. It deteriorates the quality of life of the individual. Cognitive behavior therapy is often a good treatment choice. Here, I present the efficacy of rational emotive behavior therapy in addressing the irrational beliefs of the client and its effectiveness in alleviating behavioral and cognitive symptoms of illness anxiety.
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Electroconvulsive therapy for somatic symptom disorder with comorbid depression p. 173
Ajeet Sidana, Abhinav Agrawal, Apoorva Garg
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Two more cases of pregabalin dependence: The pandora's box is open and needs serious attention p. 174
Abhishek Ghosh, Sambhu Prasad, Aniruddha Basu, Debasish Basu
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