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   Table of Contents - Current issue
January-June 2022
Volume 27 | Issue 1
Page Nos. 1-70

Online since Saturday, August 13, 2022

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Managing medical comorbidities in clinical practice: Should psychiatrists do more for their patients? p. 1
Sandeep Grover
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Systematic review: Rates and determinants of relapse to alcohol: A systematic review of Indian studies p. 8
Siddharth Sarkar, Ashlyn Tom, Sauvik Das, Balaji Bharadwaj, Abhishek Ghosh
Background and Aims: Relapse is a major clinical concern in alcohol use disorders. The magnitude of the problem, poor access and availability of treatment, and changing social milieu placed India in a challenging position. This was a systematic review of Indian studies on rates and determinants of relapse to alcohol. Methods: Systematic search (January 1980–May 2020) was carried out on PubMed and Google Scholar to select studies that presented either rates or predictors (or both) to alcohol. Relapse was broadly defined based on the characterization in the included articles. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard for reporting systematic reviews. Results: Thirty-six studies were selected for the qualitative synthesis from the 68 studies. In the pooled sample of 2481 participants, the relapse rate ranged from 3.4% to 90%. The study duration varied from 1 to 36 months. Results suggested that the rates were overall higher in the observational than interventional studies and in studies from states with community prevalence of alcohol use >15% than in those <10%. There was significant heterogeneity among studies. Risk factors of relapse identified were demographic (e.g., younger age), psychological (e.g., craving), situational (e.g., peer influence), stressful life situations (e.g., financial problems), and family history of alcohol use. Conclusion: Relapse is likely in a substantial proportion of participants. Addressing the risk factors might help in delaying relapse. Future studies could concentrate on inclusive study design and robust methodology, to examine and understand the rates and risk factors of relapse.
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Parenting styles and mental health of adolescents: A cross-sectional study in South India Highly accessed article p. 19
Christy Vijay, Kavita Peter Gonsalves, Naveen Ramesh
Background: Environmental factors determine the behavior of children, and children, in turn, depend on their parents or caregivers to provide them with safe and holistic physical and social environment. Baumrind's classified parenting style into four types: Authoritarian, Authoritative, Permissive, and Uninvolved. Objective: The objective is to determine the perceived parenting styles and its association with stress among adolescents. Methodology: This cross-sectional study involved adolescents between the ages of 13 and 19 years studying in Government Secondary Schools located in two villages of rural Karnataka, South India. Parenting styles were assessed by parenting styles and dimensions questionnaire (PSDQ) short version, and stress was measured using the Perceived Stress Scale. Results: Among the 445 adolescents who participated in this study, 228 (51.2%) were male and 217 (48.8%) were female. Based on the mean PSDQ score, authoritarian parenting style (53.07%) was the most prevalent type, followed closely by the authoritative (52.16%) style. Boys from all age groups felt their parents adopted permissive style and girls of all age groups felt their parents had an authoritative style. The prevalence of moderate and mild stress was more among boys and girls, respectively. Parenting style did not change with substance use among parents. Permissive parenting styles for boys and authoritarian parenting style for girls were associated with higher stress. Conclusion: According to adolescents, their parents adopted authoritarian parenting style; permissive style among boys, and authoritative style among girls, and this was associated with high-stress levels.
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Premenstrual syndrome among college students and its relation to their study activities p. 24
Pallavi Talukdar, Nurnahar Ahmed, Subhra Sarkar
Aim: The study was conducted to assess Premenstrual Syndrome (PMS) among college students and its relation to their study activities in a selected college. Methods: Nonexperimental Quantitative research approach was used in the present study. Data were collected from 229 female students studying degree courses in a selected college of Tezpur. The college for the study was selected by purposive sampling and the participants were selected with the systematic random sampling method. A sociodemographic pro forma and self-structured questionnaires were used to collect the data. Results: The data analyses were performed using SPSS version 20. Descriptive analyses showed that 21% of the female students had irregular menstrual cycles and 12.2% had heavy menstrual flow. Among the participants, 45.9% of the female students had menstruation-related problems. Use of substance, family history of menstruation-related problems, regularity of menstrual cycles, menstruation flow, presence of any menstrual problems were found to be associated with PMS. In the present study, PMS was found to be positively correlated with impact on study activities (r = 0.542 and P = 0.000). Conclusion: At the end of the study, the investigators found that PMS is an important issue which is affecting the study behavior or habit of the female degree students.
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A clinical study of internet gaming disorder in adolescents with psychiatric disorders p. 29
Praveen Sachan, Amit Arya, Shweta Singh, Pawan Kumar Gupta, Vivek Agarwal, Vishal Gupta
Objectives: The severity of different internet gaming disorder (IGD) symptoms criteria has not been explored much. The study describes the phenomenology of IGD in adolescents with comorbid psychiatric disorders attending child and adolescent psychiatry outpatient department (OPD). Materials and Methods: A total of 46 adolescents aged 13–16 years, who have attended child and adolescent psychiatry OPD, of a tertiary care teaching hospital for psychiatric disorders, with a history of gaming and who fulfilled criteria as per the fifth edition of Diagnostic and Statistical Manual (DSM-5) for IGD have been included. All the adolescents have then assessed using semi-structured pro forma, internet gaming disorder scale (IGDS), and K-SADS-PL. Results: In the study sample, the most common IGDS criterion was “conflict” and the least common criterion was “tolerance.” The IGDS mean score of “conflict” was the highest while of “displacement” was the least. “Escape” and “deception” were significantly higher for females. “Displacement” was significantly higher for urban domicile and online mode of gaming. “Persistence” was significantly higher for those who were gaming on personal devices and playing Massively Multiplayer Online Role-Playing Games (MMORPGs). Psychiatric disorders associated with IGD were ODD (46.66%), dissociative disorder (24.44%), attention-deficit hyperactivity disorder (ADHD, 17.77%), and depressive disorder (11.11%). Phenomenology of IGD was comparable across all psychiatric comorbidities, except subjects with dissociative disorders, who had significantly higher scores for “escape” than for ADHD and depression. Furthermore, subjects with ODD had significantly higher scores for “displacement” than the subjects with dissociative disorder in terms of IGDS scores. Conclusion: Significant differences in the severity of DSM-5-IGD symptoms criteria are found in terms of gender, domicile, gaming genre (MMORPGs), accessibility of smartphones, online/offline modes of gaming, and the associated psychiatric comorbidity.
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Sociodemographic predictors of perceived expressed emotions and self-esteem in persons with obsessive-compulsive disorder p. 35
Lokesh Kumar Ranjan, Nilesh Maruti Gujar, Pramod Ramlakhan Gupta
Background: The attitude and emotions of the family member toward persons with obsessive-compulsive disorder (OCD) have a negative effect on perceived experiences of expressed emotion and self-esteem. It is crucial to observe expressed emotion and self-esteem for better treatment outcomes in OCD. Aim: The aim of this study is to assess the sociodemographic predictors of perceived expressed emotion and self-esteem in persons with OCD. Materials and Methods: The present cross-sectional comparative study conducted among persons with OCD on treatment from the outpatient department of the Central India Institute of Mental Health and Neuro Sciences (CIIMHANS), Dewada, Chhattisgarh, India, and normal controls from neighboring areas (Dewada and Kopedih) of the CIIMHANS. A total of 150 persons with OCD and 150 normal controls were selected purposefully. The sociodemographic datasheet, clinical datasheet, family emotional involvement and criticism scale, and Rosenberg self-esteem scale were used for the comparative assessment. Results: Self-esteem was found to have a significant negative correlation with occupation and a positive correlation with family income. Expressed emotion (EE) showed a significant negative correlation with gender, family type, family income, and self-esteem. On the regression analysis, sociodemographic variables including gender, education, occupation, and family income were found to be significant predictors of EE, whereas occupation was found to be a significant predictor of self-esteem. Conclusion: The present study corroborates that sociodemographic factors are associated and had a predictive role in negative experiences of EEs and unfavorable self-esteem in persons with OCD.
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Prevalence of delirium and predictors of longer intensive care unit stay: A prospective analysis of 207 mechanical ventilated patients p. 41
Rajesh Kumar, Hoineiting Rebecca Haokip, Tamanna , Mukesh Bairwa
Introduction: The incidence of delirium varies in literature across the globe. Delirium is reported as one of the leading causes of increased length of hospital stay and mortality among intensive care unit (ICU) patients. This study aims to determine the prevalence and independent predictors of longer ICU stay among mechanically ventilated patients admitted into a medical ICU. Methods: In this prospective investigation, 207 consecutive patients admitted to the medical ICU beyond 72 h of mechanical ventilation at a tertiary care hospital between September 2020 and July 2021 were screened for delirium. ICU nurses assessed sedation and delirium status of patients after 72 h of mechanical ventilation using the Richmond Agitation Sedation Scale and Confusion Assessment Method for ICU. A multiple linear regression model was used to identify the predictors of more extended hospital stay, and the KaplanMeier curve was used to study time-to-event analysis. Results: Findings reveal that 161 (77.8%) patients develop delirium after 72 h of mechanical ventilation in the medical ICU. Patients who experienced delirium were advanced in age (mean ± standard deviation [SD]: 51.50 ± 14.97 vs. 37.39 ± 8.31 years, P ≤ 0.001), and more critically ill (mean ± SD: 15.84 ± 4.94 vs. 6.93 ± 2.07, P ≤ .001) and have multiple organs dysfunctions (mean ± SD: 12.56 ± 3.45 vs. 5.17 ± 1.83, P ≤ 0.001) at the time of admission compared to nondelirious patients. Patients who developed delirium significantly reported a higher oxygen flow (mean ± SD: 7.38 ± 1.08 vs. 6.30 ± 1.43 L/min, P = 0.001), a long duration of ICU stay (mean ± SD: 11.61 ± 1.71 vs. 9.24 ± 1.69 days, P ≤ 0.001), longer days on mechanical ventilation (mean ± SD: 8.44 ± 1.57 vs. 6.22 ± 1.46 days, P < 0.001) and shows higher in-hospital mortality (P = 0.003). Acute Physiology and Chronic Health Evaluation-II (odds ratio [OR]: 0.068 95% CI: 0.027–0.019, P < 0.001) and SOFA (OR: 0.132, 95% CI: 0.075–0.189, P = 0.001) reported independent predictors of ICU stay after 72 h of ICU admission. Conclusions: Delirium was reported in more than two-thirds of patients after 72 h of mechanical ventilation. The severity of illness and multiple organ dysfunctions reported independent predictors for longer days of ICU stay.
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Comprehensive mental health facets and their correlates amid “The New Normal” pandemic: How do adolescents differ from adults? p. 48
Shweta Singh, Pawan Kumar Gupta, Rakesh Kumar Tripathi, Manjistha Datta, Nisha Mani Pandey, Saakshi Batra, Pooja Mahour, Amit Arya, Adarsh Tripathi, Bandna Gupta, Manu Agarwal, Anil Nischal, Vivek Agarwal, PK Dalal
Objective: The present study aimed to compare the comprehensive mental health facets of adolescents with the adults. Materials and Methods: A cross-sectional design with 1,027 participants (456 adolescents; 347 young and 224 middle age adults). The Comprehensive Diagnostic and Statistical Manual-5 self-rated Level 1 cross-cutting symptom measure, perceived stress scale, and brief COPE were used. Chi-square test of independence and spearman rank correlational analysis was performed. Results: 33.77% of adolescents, 25.65% of young adults, and 17.41% of middle-aged adults reported that their symptoms started during the pandemic. Adolescents reported higher depression, anxiety, suicidal ideations, anger, and somatic complaints. Significantly higher adolescent females (39.9%) were found to have sleep disturbances than their male counterparts (25.5%). The correlational analysis showed that most mental health domains, except substance use, showed moderate-to-low correlations with the “impact of COVID-19.” Conclusion: This study observed that adolescents to be more clinically vulnerable in the domains of depression, anxiety, suicidal ideations, anger, and somatic complaints. Middle-aged adults should further be seen as a clinically vulnerable population for substance use during the new normal. This research indicates the need for further extensive research on assessment and management. Also, it provides a comprehensive analysis for clinical decision-making and policy development to combat the mental health problems in the backdrop of the COVID-19 pandemic.
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Eating behavior and stress levels among college students p. 60
Mitravinda Aneesh, Rinnu Roy
Background: Eating behavior of college students is very dynamic. College students tend to have erratic eating patterns because of long study hours in college, high workload, and lack of time. Aim: The purpose of the study was to assess the eating behavior and the stress level they experience. Materials and Methods: A cross-sectional study was conducted on 237 college-going students aged 18–24 years selected via convenience sampling. Information regarding age, sex, household income, place of stay, and self-reported weight and height was collected via an online survey. Three-Factor Eating Questionnaire was used to assess eating behavior and Perceived Stress Scale was used to assess stress levels. Results: Two-third of the students had normal body mass index (BMI). Majority of the participants (81.4%) had moderate stress levels. We found that uncontrolled eating (UE) (45%) was the most predominant eating behavior among college students. Linear regression analysis indicated that male gender and perceived stress predicted UE and emotional eating behavior, respectively. On the other hand, female gender and BMI predicted cognitive restraint eating behavior. Conclusion: Our study found that distinct eating behaviors are prevalent during the college years itself. Deep-rooted eating behaviors can make way for health risks in the near future. Hence, it is imperative to educate the college students about food and nutrition and also teach healthy stress management strategies.
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Interplay between traditional healing and modern psychiatry resulting in timely diagnosis of autoimmune encephalitis: A case report from a low- and middle-income country setting p. 65
Bushra S Imtiyaz, Chahat Jamwal, Mushtaq Ahmad Margoob, Hadiqa Maryam, Sandeep Grover
There is poor coordination between mental health professionals and traditional healers. This often leads to mismanagement of patients with various mental disorders, which can sometimes result in a fatal outcome. It is often suggested that there is a need to improve the coordination between mental health professionals and traditional healers. In this report, we present the case of a young girl whose family initially consulted a traditional healer for her condition and was then referred to appropriate mental health facilities. This coordination resulted in the timely diagnosis of autoimmune encephalitis.
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Resilience building to combat COVID-19 stress in adolescents p. 68
Swapnajeet Sahoo, Amog Shahane, Satish Shahane
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