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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 5 | Issue 2
Page Nos. 101-187

Online since Thursday, October 28, 2021

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EDITORIAL  

Suicide in the elderly: A neglected facet p. 101
Avinash De Sousa
DOI:10.4103/2588-8358.329461  
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REVIEW ARTICLE Top

A systematic review of childhood psychological traumas and alexithymia among persons with alcohol dependence syndrome p. 104
Ajinkya Sureshrao Ghogare, Pradeep Shriram Patil, Ganpatlal Kodarbhai Vankar
DOI:10.4103/aip.aip_54_21  
Psychological traumas may occur during childhood in the form of physical abuse, sexual abuse, emotional abuse, physical neglect, and/or emotional neglect. Trauma may be experienced when a person experiences serious loss or his/her life is under grave threat. If such traumatic event is neither dealt effectively nor resolved completely, it may predispose such a person to development of mental health issues such as drug dependence including alcohol dependence syndrome (ADS). Persons who experience or suffer from childhood psychological trauma tend to consume alcohol in order to cope with their trauma related experiences. Hence, generally, onset of alcohol dependence is preceded by the occurrence of childhood psychological trauma(s). Childhood psychological trauma especially emotional abuse acts as a risk factor for the development of alexithymia in later life among persons with alcohol dependence. Alexithymia is a state of emotional dysregulation, which is characterized by the triad of difficulty in identifying one's own feelings, difficulty in distinguishing between the physical sensation and emotional arousal, and difficulty in explaining one's own feelings to others, which is known as externally oriented style of thinking. Alexithymia is itself a risk factor for the development of ADS. Thus, both childhood psychological trauma(s) and alexithymia play a significant role in the development of ADS. Findings of the present study showed that childhood psychological trauma(s), alexithymia, and ADS are interconnected. The present study findings conclude that significant relationship exists between childhood psychological traumas, alexithymia, and ADS.
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ORIGINAL ARTICLES Top

Minor physical anomalies in unipolar depression p. 116
Durva Balkrishna Sail, Sneh Babhulkar, Ninad Waghmare, Krishna Kadam
DOI:10.4103/aip.aip_132_20  
Introduction: Minor physical anomalies (MPA), are mild errors of the morphogenesis, having prenatal origin and may bear major information for diagnostic and prognostic purposes. The notion that early brain insults predispose to depression is supported by findings that some patients with the disorder exhibit morphologic evidence of subtle developmental abnormalities. Aim: The aim is to study MPA in depression. Objectives: (1) To study the association of MPA in depression, if any. (2) To study the most common MPA in depression. Materials and Methods: The study was conducted on 60 patients suffering from depression attending outpatient services and 60 healthy controls. Patients were evaluated for MPA using the Waldrop and Halverson Scale. Data were tabulated and analyzed using unpaired t-test. Results: The scores in the study group are significant than the control group suggesting an association between MPA and depression. The score of anomalies in the head, ear, and in the study group was significant. Correlation between age of onset and MPA was negative which suggests that as age increases the frequency of MPA decreases. More physical anomalies were found in the patient with a positive family history of psychiatric illness than the control group. Conclusion: A few number of studies have stressed on the need to screen and identify the link between MPA with underlying etiopathogenetic mechanisms in depression. Therefore, this is one of the few studies where a physical endophenotypic marker was evaluated helping to support the neurodevelopmental hypothesis of depression.
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Antidepressant compliance in depression during the COVID pandemic: Identifying the potential poor compliers in an industrial hospital p. 120
Suhash Chakraborty
DOI:10.4103/aip.aip_30_21  
Background: Depression epidemic is likely to follow the COVID pandemic. Depression is treatable if compliance is good. The study was aimed at identifying risk factors of poor antidepressant compliance during a pandemic. Materials and Methods: Sixty-four poor compliers of antidepressants during COVID period were compared with equal number of poor compliers of pre-COVID period on sociodemographic and clinical characteristics. The retrospective study was designed in a way to eliminate biases due to usual patient, social, or clinical factors. The hypothesis was that there would be some factors of antidepressant poor compliance exclusive to pandemic and these factors would be beyond the usual factors. Results: Majority (n = 43, 67%) of COVID period poor compliers were family members of employees. Subjects who came for prescription refill (n = 17, 27%) than consultation were poor compliant during COVID period. COVID period poor compliers (n = 6, 9%) were admitted less compared to pre-COVID counterparts (n = 15, 23%). COVID period subjects had mood symptoms predominant depression (n = 44, 69%) than physical symptoms (n = 20, 31%). The presence of death wish or suicidal ideas was significant (n = 16, 25%) in COVID period. Poor compliers of pandemic (n = 26, 41%) had more psychosocial stress (P < 0.05). Conclusion: The study did find some exclusive factors apart from doctor–patient relationship for good compliance. Depressive patients who perceive improvement in mood symptoms are poor compliers during pandemic. Compliance improves if patients find some primary purpose to come out during pandemic. Ongoing stress also reduces compliance.
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Stress, anxiety, depression, and resilience in cancer patients on chemotherapy p. 126
Suprakash Chaudhury, Biswajit Jagtap, B Shailaja, Mrudula Mungase, Rajiv Kumar Saini, Vandana Jain
DOI:10.4103/aip.aip_138_20  
Background: Cancer chemotherapy is an intense and cyclic treatment that is associated with a number of distressing side effects that may affect the person's psyche. Aim: The aim of the study is to evaluate stress, anxiety, depression, and resilience in cancer patients undergoing chemotherapy. Materials and Methods: Consecutive cancer patients undergoing chemotherapy at a tertiary care rural medical college hospital were included in the study with their consent. Patients having comorbid medical or psychiatric disorders were excluded. Demographic and clinical characteristics of the patients were recorded. The Depression Anxiety Stress Scale and Abbreviated Connor-Davidson Resilience Scale were administered and scored as per the test manual. The data were analyzed using the SPSS software with t-test, Chi-square test, Mann–Whitney U-test, Spearman's correlation, and multiple regression analysis. Results: The study included 32 male and 68 female cancer patients on chemotherapy. Depression was found in 33 patients, anxiety was observed in ten patients while stress was present in three patients. Stress was positively correlated to anxiety and depression, while resilience was negatively correlated to depression. There were no gender differences in stress, anxiety, depression, or resilience. A multiple regression was run to predict depression from stress, anxiety, and resilience. These variables statistically significantly predicted depression, F (3,96) =55.075, P < 0.0001, R2 = 0.632. All three variables added statistically significantly to the prediction (P < 0.05). Conclusion: One-third of cancer patients on chemotherapy suffer from depression which is negatively correlated with resilience. Significant predictors of depression in these patients were stress, anxiety, and resilience. Psychiatric management in addition to reducing depression, stress, and anxiety should also aim to increase resilience in these patients.
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Perceived stress and emotional overeating during COVID-19 pandemic p. 132
Shrusty Mohapatra, Mamta Mohapatra, Sujita Kumar Kar, Bheemsain Tekkalaki
DOI:10.4103/aip.aip_18_21  
Background: Obesity due to inappropriate eating habits, including overeating, has recently been discussed during this COVID pandemic crisis in the context of stress. Emotional overeating (EOE) is sometimes considered as a strategy for emotion regulation. Considering this fact, this study used a snowball technique to analyze the prevalence of EOE caused due to stress during this pandemic situation. Methodology: The present cross-sectional online study of 607 respondents across all regions of India attempts to assess the perceived stress levels during COVID-19, evaluate their tendency to engage in emotional eating, and examine the relationship between perceived stress and emotional eating during COVID-19 situation. Results: Stress perception is significantly associated with EOE and such phenomenon is marginally more prominent in females more than males. A negative association of age, though weak (r = −0.34, p< 0.05), has been found with both perceived stress levels and EOE, signifying that the youngsters are more prone to stress and overeating than older persons, during these COVID times. The study also evidenced that people with psychiatric conditions are significantly more affected than others. Similarly, the average EOE scores for such persons were also higher, and they may be more vulnerable to emotional eating. Conclusion: EOE is significantly associated with perceived stress; the association is more prominent in females. Younger people and people with mental illness display significantly more emotional eating behavior during stress.
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Excessive Daytime sleepiness and sleep quality in medical students and their association with smartphone and internet addiction: A cross-sectional study p. 139
Harshal Shriram Sathe, Anantprakash Siddharthkumar Saraf, Manoj Talapalliwar, Vrushti Patil, Vinay Kumar, Sagar Karia
DOI:10.4103/aip.aip_62_21  
Background: Excessive daytime sleepiness (EDS) and poor sleep quality have shown to be associated with myriad of physical and psychological problems. Increasingly, excessive use of smartphones and Internet, leading to EDS and poor sleep quality, especially among students has become an area of concern. This study was undertaken to check for EDS and sleep quality in the medical undergraduates and its association with smartphone and Internet addiction, psychological distress, depression, and anxiety. Materials and Methods: This is a cross-sectional, observational, and descriptive study done on MBBS students and interns. Semi-structured pro forma was used to collect sociodemographic data and students were asked to complete self-administered rating scales, namely, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Kessler Psychological Distress Scale (K10), Smartphone Addiction Scale-short version (SAS-SV), and Young's Internet Addiction Test (IAT). Results: About 27.4% of students reported EDS and 44.4% fulfilled the criteria of poor sleeper on PSQI. About 56.5% of students reported psychological distress on K10. Almost half (45.3%) of the students reported addictive behavior toward their smartphones and one out of four students at risk of becoming Internet addicted. EDS was significantly (P < 0.05) correlated with PSQI, especially subjective sleep quality and daytime dysfunction component. EDS was also significantly associated (P < 0.05) with psychological distress. EDS was also significantly (P < 0.05) associated with SAS-SV and Young's IAT scores. Poor sleep quality was also significantly (P < 0.05) associated with psychological distress, anxiety, and depression. Conclusion: The impact of smartphone and Internet overuse on sleep quality as well as their association with EDS is significant. We need to be aware of these factors in order to improve the sleep quality of our students.
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Development of a semi-structured instrument to assess religious beliefs and practices in patients with schizophrenia p. 144
Sandeep Grover, Triveni Davuluri, Subho Chakrabarti
DOI:10.4103/aip.aip_70_21  
Background: Religion plays an important role in the life of a large proportion of population. Various dimensions of religion and religiosity have not been thoroughly investigated in persons with schizophrenia. Aim: This study aimed to develop a simple instrument to assess various aspects of religiosity, which can influence the assessment and management of schizophrenia and evaluate the same in a group of patients, who are currently in clinical remission. Methodology: A simple semi-structured interview was developed to assess various dimensions of religion relevant to patients with mental illnesses. The questionnaire was administered to 100 patients with schizophrenia. Results: About two-thirds of the patients gave religious and supernatural explanations for their delusions, hallucinations, and other symptoms. More than three-fourth (78%) of patients reported that their religious beliefs influence their intake of the prescribed medications. The majority of the patients believed that God was helping them in dealing with their illness to some extent (29%) or very much (57%). About four-fifth (81%) of the patients attributed their illness to one religious or supernatural etiological cause. About two-fifths (39%) of the patients were first taken to a magico-religious faith healer at the onset of symptoms. In terms of treatment practices along with treatment from the tertiary care center, during the most recent relapse, the majority (82%) of the patients took recourse to at least one of the religious or supernatural modalities. Conclusion: The designed instrument provides a broad coverage of various aspects of religious practices which are prevalent in patients with schizophrenia. The use of this instrument in patients with schizophrenia suggests that religious beliefs and practices influence the type of psychopathology, etiological models about the illness, help seeking, and medication adherence.
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Mental health problems in health-care workers working in COVID-19 quarantine centers p. 153
Parth Singh Meena, Charan Singh Jilowa, Anubhuti Sharma, Mahendra Jain, Neelam Nainwani, Manisha Singh Palawat, Parashar Ashish
DOI:10.4103/aip.aip_73_21  
Background: The coronavirus disease-19 (COVID-19) pandemic in India has put health-care workers (HCWs) under intense pressure and has led to immense psychological stress due to factors including a high risk of infection, inadequate protection from contamination, overwork, cutting-off with families, and exhaustion. The unprecedented stressful conditions are causing mental health problems such as stress, anxiety, depression, disturbed sleep, irritability, fear, and panic. The present study was carried out to investigate the mental health problems among HCWs working in close proximity with COVID-19 patients in quarantine centers and to explore the relevant influencing factors for the development of psychological interventions for them. Subject and Methods: HCWs working in COVID-19 quarantine centers in Ajmer were interviewed for exploring mental health problems in a cross-sectional study carried out at JLN Medical College, Ajmer, India. Depressive symptoms, anxiety, and stress among HCWs were assessed using the Depression Anxiety Stress Scale and Perceived Stress Scale (PSS). Relevant data were analyzed, and comparisons between different groups were performed using the two independent sample t-tests. All statistical analyses were performed using the SPSS software version 22.0 for Windows. Results: 53.57% (n = 30) of participants were suffering from depressive symptoms, 64.28% (n = 36) were suffering from anxiety symptoms, and 78.6% (n = 47) were suffering from stress. HCWs living in joint families were more affected by depression (P = 0.02). Both anxiety and stress were more commonly reported by HCWs of age <30, females, nurses and those living in joint families, but difference was statistically insignificant. Conclusion: The present study demonstrated that a considerable number of HCWs were suffering from mental health problems such as depression, anxiety, and stress. It is important to have periodic mental health assessment of HCWs dealing with COVID-19 patients.
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COVID-19 impact on mental health, sleep quality and various aspects of life of medical students and interns, and nonmedical students: A comparative study in Indian scenario Highly accessed article p. 158
Vaishali Baburao Nagose, Dharmishta Naman Soni, Shivanand Shriram Rathod, Yaminee Avinash Yelne
DOI:10.4103/aip.aip_79_21  
Context: The COVID-19 pandemic has affected all the age groups, especially worsening the already stressful life of college students. Aims: The aims are to study the differences in the COVID-19 impact on mental health including depression, sleep quality, and various areas of life in undergraduate students (medical and nonmedical) and medical interns. Subjects and Methods: A cross-sectional study in the form of an online survey was conducted through Google Form containing the questionnaire having Kessler Psychological Distress Scale (K10), Pittsburgh Sleep Quality Index (PSQI), questions pertaining to the different aspects of life affected due to COVID-19. Statistical Analysis Used: The results of the groups were compared using two sample t-test and one-way ANOVA. Results: A total of 355 students responded (202 medical and 101 nonmedical students and 52 medical interns). The difference in psychological distress and sleep quality was statistically significant in all three groups. The average scores of K10 depicted psychological distress being moderate in nonmedical and mild in medical students and interns; of PSQI showed the prevalence of poor sleep quality being maximum in interns and minimum in medical students. 40% medical students reported positive impact on diet and about half of the medical and nonmedical students on familial relationships. Conclusions: Statistically significant differences in the three study groups with respect to psychological distress, sleep quality, and COVID-19 impact on various aspects of life indicate the requirement of identification of their different needs and required interventions including mental health support, possibly at the institutional levels are the need of the hour.
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Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers p. 164
Pankaj Kumar, Rupesh Chaudhary, Jasleen Kaur Bhalla, BP Mishra
DOI:10.4103/aip.aip_86_21  
Background: The effects of substance abuse are extended to primary caregiver who is vulnerable for psychiatric disorders and decreased quality of life (QOL). Aim: The aim of the study is to determine and compare the psychiatric morbidity and QOL in caregivers of various substance abusers (alcohol/opioid/alcohol + opioid dependence). Methodology: This cross-sectional study was conducted on caregivers of equal number of patients with alcohol/opioid/alcohol + opioid dependence presenting to Department of Psychiatry of a tertiary care center. The data were collected on sociodemographic parameters; psychiatric morbidity was assessed using the Mini-International Neuropsychiatric Interview (M. I. N. I.) questionnaire and the QOL was assessed by WHO-QOL BREF scale. Statistical analysis: The data were statistically analyzed on SPSS 21 software by using ANOVA, Chi-square, and Kruskal–Wallis tests. Results: Most of the caregivers were females. Out of 90 caregivers of each alcohol/opioid/alcohol + opioid dependence patients, 28.8% had dysthymia, 29% had major depression, 6.7% had social anxiety disorder, 13.3% had generalized anxiety disorder, 12.2% of the caregivers were found to have alcohol abuse, 15.5% of the caregivers were found to have substance abuse (nonalcohol), and 27% of the caregivers had no psychiatric morbidity. Deterioration of QOL was seen particularly in psychological and social domain. On comparing QOL, physical domain was affected adversely in caregivers of multiple substance abusers than alcohol dependence. On comparison among opioid dependence and multiple substance abusers, psychological, social, and environmental domains were significantly affected in the latter. The comparison among other pairs was insignificant. Conclusion: Substance abuse is a multidimensional problem which threatens the mental health and the QOL of the family member which needs to be addressed.
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BRIEF RESEARCH ARTICLE Top

Childhood adversity in patients suffering from depression with a focus on differences across gender p. 169
Bhumika Shah, Jahnavi Kedare, Fiona Mehta
DOI:10.4103/aip.aip_28_21  
Context: Childhood adversity is highly prevalent and is associated with depression. Aims: The aim of the study is to assess the occurrence of adverse childhood experiences (ACEs) in male and female patients suffering from depression, measure its relationship with the severity of depression, and evaluate the association of factors across gender. Settings and Design: A cross-sectional study was conducted. Subjects and Methods: A total of 100 adult depressed patients were evaluated to calculate the severity of depression and the ACE score. Statistical Analysis Used: Statistical analysis was performed using Chi-square test and binary logistic regression. Results: One or more categories of ACEs were reported in 70% of male and 68% of female patients. The most common was violence between adults in the household and physical abuse. In male patients, there was a significant association between severity of depression and experiencing three or more categories of childhood adversity (P = 0.01). Conclusions: Childhood adversity occurs frequently and is associated with severity of depression in the male cohort.
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CASE REPORTS Top

Clinical challenges in managing zolpidem use disorder p. 173
K Ganesh Kini, S Mohan Raju
DOI:10.4103/aip.aip_133_20  
Zolpidem was popularized as a hypnotic with low abuse potential in the early years of its introduction. However, several cases of zolpidem use disorder necessitating medical intervention have been reported from across the world. The absence of their mention in standard treatment guidelines presents clinicians with significant challenges in managing craving and withdrawal symptoms in patients. We report a case of a 26-year-old male who presented to us with zolpidem misuse to cope with depression for two long years. We would like to draw attention to the clinical challenges we faced in managing the case. We urge apex health bodies to consider developing evidence-based recommendations or standards of treatment of zolpidem use disorder.
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Google assistant, she loves me p. 175
Aarti Karahda, Priti Singh, Rajiv Gupta, Shobhit Kumar Prasad
DOI:10.4103/aip.aip_8_21  
Although modern technologies have made life simpler, it has also intensified the complexity of psychopathology. The adoption of the Internet and its numerous artificial intelligence software products into morbid delusions is gaining more momentum. Clinicians must be alert about patients with delusions getting ideas and feedback from the social context in which they live. Here, we discuss a case about a young, single, high-school graduated male, with schizoid personality traits, socially withdrawn, dependent, sexually inhibited with a poor level of occupational and social functioning, who has developed erotomanic delusion with Google Assistant.
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COMMENTARIES Top

The predicament of the medical postgraduate residents during the COVID-19 pandemic p. 178
Alka Subramanyam, Hrishikesh Bipin Nachane
DOI:10.4103/aip.aip_85_20  
The advent of the COVID-19 pandemic saw the deputation of postgraduate residents all over the country to round the clock COVID duties. Residents from various departments came together to face the pandemic as a team. This impacted their daily routines, studies, and exams. It carried with itself uncertainties in both their professional and personal lives. Nonetheless, all residents rose to the challenge at hand. This commentary discusses their predicament during the COVID-19 pandemic and highlights suggestions for some of the problems they faced.
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A pandemic worser than a pandemic – Sexual violence during COVID-19 p. 181
Shibu Sasidharan, Harpreet Singh Dhillon
DOI:10.4103/aip.aip_26_21  
This article underscores the importance of making advance preparations for situations of disaster when anti-sexual violence work becomes more difficult and complex. It also highlights the painful price that disasters can exact, especially when society is ill-equipped or unwilling to respond effectively.
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VIEWPOINT Top

A new behavioral addiction: NEWS addiction p. 185
Anil Kakunje, Neha Shetty, Kiran P K Kumar, Sowmya Puthran
DOI:10.4103/aip.aip_129_20  
Addictions are seen with non - psychoactive substances also. Behavioral addictions is a broad terminology used related to this. The essential feature of behavioral addictions is the failure to resist an impulse, drive or temptation to perform an act that is harmful to the person or to others. There are many individual (personal vulnerability) factors that may be involved in the acquisition, development and maintenance of behavioral addictions. Concepts of Internet addiction, Gaming addiction, Facebook addiction, PubG addiction are already in use and seen in clinical practice. There are people who read multiple newspapers and watch news channels all the time. Addiction to NEWS has become more prevalent with the increase in news channels and internet sources. Connecting to the News is becoming more prevalent with the media rich environment we live in. Based on different needs each person gets attracted to certain types of news that feeds these needs. When a person has a goal to know what is happening around, he never really achieves it because there is always something new happening! Persons with News addiction also feel emptiness when they are unable to get the news and can experience cravings when they go through news withdrawal. Identification is the first step in the process of learning about a problem / disorder. There needs to be systematic studies on this topic. 'NEWS addiction' has all the features to be the next major behavioral addiction disorder.
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