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   Table of Contents - Current issue
Coverpage
January-March 2022
Volume 6 | Issue 1
Page Nos. 1-111

Online since Friday, April 29, 2022

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EDITORIAL  

Domestic violence against men: A lesser explored phenomenon p. 1
Avinash De Sousa
DOI:10.4103/aip.aip_48_22  
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REVIEW ARTICLES Top

A clinical review of enuresis and its associated psychiatric comorbidities p. 4
Rachana Pole, Ganpatlal Kodarbhai Vankar, Ajinkya Sureshrao Ghogare
DOI:10.4103/aip.aip_102_21  
Enuresis is a common childhood condition treated by pediatricians and psychiatrists. Enuresis is also commonly referred as bedwetting. It is more prevalent among boys than girls. Enuresis is an involuntary voiding of urine continuing after an anticipated age of control in the absence of any organic abnormality. This review summarizes the current knowledge about epidemiology, diagnosis, etiological factors, psychiatric comorbidities, and behavioral (enuresis alarm and star charts) as well as pharmacological (desmopressin and imipramine) management of enuresis. It is important to understand the epidemiology, etiology, behavioral as well as pharmacological management, and screening for psychiatric comorbidities for the better outcome among the children with enuresis. Enuresis can be stressful physically as well as mentally for both child and parents. Many times, parents of children with enuresis either do not show willingness or hesitate to report the bedwetting behavior of their children due to perceived stigma related to enuresis. Hence, there is a paucity of data in this field that the detailed evaluation of the prevalence, causative factors, and risk factors is needed and of great value to understand the psychiatric comorbidities associated with enuresis for the better outcome. Psychological support and motivation are needed for both children and their parents for improving their treatment-seeking behavior and for an effective management of enuresis.
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Differential profile of three overlap psychiatric diagnoses using temperament and character model: A systematic review and meta-analysis of avoidant personality disorder, schizoid personality disorder, and social anxiety disorder p. 15
Azad Hemmati, Farzin Rezaei, Khaled Rahmani, Narges Shams-Alizadeh, Omran Davarinejad, Maryam Shirzadi, Saeid Komasi
DOI:10.4103/aip.aip_148_21  
Some psychiatric disorders are mostly overlapping and measures for facilitating differential profiles play a key role in the identification of a disease, course, prognosis, and management. This systematic review and meta-analysis aimed to (i) explore the association between the components of temperament and character model and three overlap psychiatric diagnoses including avoidant personality disorder (APD), schizoid personality disorder (SPD), and social anxiety disorder (SAD) and (ii) provide differential profiles for each of these disorders. The literature search was performed on 7 international scientific databases for all articles published in English, January 1990-June 2019. The pooled effect sizes were obtained using the correlation coefficients or the standardized mean differences between cases with SAD and healthy controls by the random-effects method. Fifteen correlational studies for APD and SPD and eight case–control studies for SAD met the criteria for entering meta-analysis. All three disorders were positively associated with harm avoidance (HA) and negatively associated with novelty seeking (NS), self-directedness (SD), and cooperativeness. APD and SPD were also negatively associated with reward dependence (RD). The differential profiles are as follows: NS (APD < SAD), HA (APD > SPD, SAD), RD (SPD < APD < SAD), SD (APD < SPD, SAD), cooperativeness (APD, SPD < SAD), and self-transcendence (ST: APD > SPD, SAD). It seems that HA, SD, and cooperativeness are the common core of these three diagnostic categories. More extreme tendencies in NS and RD, along with ST with a lower possibility, are the main traits in the differential profiles.
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ORIGINAL ARTICLES Top

A cross-sectional online survey of an impact of COVID-19 lockdown on smartphone addiction and nomophobia among undergraduate health sciences students of a rural tertiary health-care center from Maharashtra, India Highly accessed article p. 27
Ajinkya Sureshrao Ghogare, Swapnil Arun Aloney, Ganpatlal Kodarbhai Vankar, Ashish Wasudeorao Bele, Pradeep Shriram Patil, Ranjit S Ambad
DOI:10.4103/aip.aip_38_21  
Introduction: Increased use of smartphones can lead to smartphone addiction and “no-mobile-phone-phobia” known as nomophobia. During an ongoing coronavirus disease 2019 (COVID-19) lockdown, to tackle an issue of boredom, many people including undergraduate health sciences students (HSSs) are using smartphones, leading to an increased risk of smartphone addiction and nomophobia. During lockdown, many universities have shifted the mode of learning to e-classes by using an internet-based technology on smartphones, which may contribute to increased exposure to smartphones, leading to an increased risk of smartphone addiction among students. Objective: To assess an impact of COVID-19 lockdown on smartphone addiction and severity of nomophobia among UG HSSs. Materials and Methods: The present study was conducted at a rural tertiary health-care center in Maharashtra state of India with a sample size of 412. Smartphone Addiction Scale–Short Version was used to assess smartphone addiction and Nomophobia Questionnaire was used to assess nomophobia. Results: Majority (69.7%) reported inability to concentrate on studies at home due to increased use of smartphone during the COVID-19 lockdown. Boredom (32.8%) was the most bothering thing during lockdown, and to tackle it, 55.8% reported of using smartphone. 97.6% had nomophobia and 45.1% had smartphone addiction. There was increase in the prevalence of smartphone addiction and nomophobia during the COVID-19 lockdown as compared to the prevalence from studies which were conducted in the pre-COVID-19 lockdown period. Conclusion: Appropriate measures should be taken by health sciences universities and authorities to address an issue of smartphone addiction and nomophobia so that students can concentrate on their studies at home during the COVID-19 lockdown.
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Psychological correlates of disability among patients with chronic low back pain p. 38
Aditi P Chaudhari, S Anukarthika, Kaustubh Mazumdar
DOI:10.4103/aip.aip_55_21  
Background: Chronic low back pain (cLBP) is pain that lasts for more than 3 months after the first acute episode of back pain. There is evidence that psychological factors are involved in the response to pain and hence the development of disability. There are very few Indian studies on the subject. This study was conducted to study the prevalence of psychiatric morbidity in patients with cLBP, to study the fear avoidance and pain catastrophizing in these patients, and to determine if these factors impact disability due to cLBP. Methodology: One hundred consecutive patients of cLBP, aged 18 to 60 years, with no previous psychiatric illness were assessed for depression, anxiety, and somatization using the Patient Health Questionnaire-9 (PHQ), Generalized Anxiety Disorder -7, and PHQ -15, respectively. Fear-avoidance beliefs and pain catastrophizing were assessed with the Fear Avoidance Beliefs Questionnaire and Pain Catastrophizing Scale, respectively. The Roland-Morris Disability Questionnaire was used to assess the disability. The data were pooled and statistically analyzed using Pearson's Correlation test and multiple regression analysis. Results: The prevalence of anxiety, depression, and somatization was 28%, 38%, and 34%, respectively. Fear-avoidance beliefs related to work and physical activity were high among 60% and 26%, respectively. Pain catastrophizing was high among 8% of patients. 32% patients had high disability. Disability correlated significantly with depression, somatization, and fear avoidance (work and physical activity) but following multiple regression analysis, fear-avoidance related to physical activity was the only predictor of disability. Conclusions: Disability assessment must be an integral part of the management of cLBP, and patients with high disability may be screened for psychiatric morbidity and fear-avoidance beliefs. The role of targeted interventions for these factors could then be explored.
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Telecounseling and guided relaxation for addressing patient, student, and health-care worker distress: An experience p. 44
Saloni Naik, Anusha Prabhakaran, Ankur Mahida, Suman P Singh, Himanshu Sharma, Jagdish Varma
DOI:10.4103/aip.aip_104_21  
Introduction: In the face of the coronavirus disease 2019 (COVID-19) pandemic, the leadership of the institute felt a need for mental health interventions among patients admitted in COVID-19 isolation, university students, and health-care workers engaged in COVID-19 care. This article aims to share our experience in providing these services. Methodology: COVID-19 inpatients were telephonically counseled. Counseling protocol was based on national guidelines. Students of the university were assessed for emotional problems using a symptom checklist and Kessler 10-item Distress Scale. Subsequently, the faculty assigned as mentors were trained in providing telephonic psychological first aid (PFA) to the students. Psychosocial help was offered to health-care workers through daily guided relaxation sessions. Results: Forty-two of 69 COVID-19 inpatients were telephonically contacted. New-onset mental health problems were found in 40%. Half of the COVID-19 confirmed patients and half of the females had a higher prevalence of mental health problems. On the symptom checklist, 330 students were responded. Worry about the future, contagion, and boredom were reported by the majority of students. On the Kessler 10-item Distress Scale, 272 students were responded. Thirty-seven percent had likely mental disorders (22 males and 79 females). Twenty-two students contacted psychiatrists through mentors and were provided teleconsultation. Eighty health-care workers attended guided relaxation sessions. Twenty-nine responded on the feedback form. Most respondents felt guided relaxation was useful in reducing stress, with strongly agree (n = 12) and agree (n = 14) responses. Conclusions: Emotional problems were significantly prevalent among students and COVID-19 patients. Training faculty in PFA can help address students in distress. Guided relaxation may help frontline workers manage stress.
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Anxiety, knowledge, attitude, and preventive practices toward COVID-19 among patients with psychiatric illness – A comparative study from South India p. 49
Preethy Raghuraman, Manjula Simiyon, Vishnu Vardhan Rudravaram, Manikandan Mani, Pradeep Thilakan
DOI:10.4103/aip.aip_137_21  
Background: Coronavirus disease 2019 (COVID-19) pandemic has induced serious threats to people's mental health. There are increasing concerns about anxiety linked with COVID-19. There are very few studies conducted to understand the needs of the mentally ill during this pandemic. Aim: The study aimed to assess and compare the anxiety, knowledge, attitude, and preventive practices related to COVID-19 among people with and without psychiatric illnesses. Materials and Methods: A cross-sectional analytical study was conducted among patients with psychiatric illnesses and their caregivers in the psychiatry department of a tertiary hospital. All consenting adults with a diagnosed psychiatric illness and scoring < 3 in the Clinical Global Impression-Severity scale were included in the case group. All consenting adult caregivers who accompany the patients were included in the reference group. Coronavirus Anxiety Scale and Knowledge, Attitude, and Preventive Practices towards COVID-19 Questionnaire were administered. Data were analyzed using IBM SPSS (19.0 version). Results: Less than 10% of the participants in both the groups had COVID-related anxiety. 98.3% of the participants in both the groups knew that isolation and treatment of COVID-19-affected individuals can prevent the spread of the virus. Avoidance of handshaking (case – 85% and reference – 81.7%) and going out of home unnecessarily (case – 83.3% and reference – 81.7%) were the predominant preventive practices in both the groups. Only, the attitude had a statistically significant difference between both the groups (P < 0.05). Conclusion: Patients with psychiatric illness had fair knowledge, and they followed preventive practices toward COVID-19 that are comparable with healthy individuals. There were discrepancies between their knowledge and preventive practices.
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How coronavirus disease 2019 is affecting the mental health of postpartum women: A cross-sectional study p. 57
Santosh Iranna Ramdurg, Subhashchandra R Mudanur, Sanjeevkumar Bentoor, Rajashri Yaliwal, Shreedevi Kori, Lata Varma
DOI:10.4103/aip.aip_117_21  
Aims: We aimed to study the prevalence of mental health problems in postpartum women during coronavirus disease 2019 (COVID-19) pandemic and to evaluate various parameters affecting it. Methods: Data were collected from May 15, 2020, to October 15, 2020, and during this period, 311 postpartum women were enrolled in the study. Sociodemographic data and obstetric-related information and Depression, Anxiety, and Stress Scale-21 were administered. Data were analyzed for the prevalence of depression, anxiety, and stress among postpartum women and various factors that affect mental health. Results: Postpartum women showed a higher prevalence of depression (38%), anxiety (42%), and stress (21%). It was more in rural background women, single mother, having 4–5 children, and from higher socioeconomic (lower socioeconomic status) background. Conclusion: This study assessed the prevalence of mental health problems in postpartum women and highlighted the high prevalence rates of anxiety, depression, and stress among this population.
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Psychological impact of COVID-19 on female health professionals p. 63
Priya Bansal, Supriya Agarwal
DOI:10.4103/aip.aip_63_21  
Background: The World Health Organization in January 2020 declared an outbreak of novel coronavirus disease, COVID-19, an international public health emergency. The suddenness of this calamity with no end in sight caused a great deal of stress, anxiety, and depression throughout the world. Aim: The aim of this study was to assess the psychological impact during the developing COVID-19 situation among female health professionals. Methods: This was an observation-based cross-sectional study conducted for a total of 3-month duration between August and October 2020. A structured questionnaire to assess the psychological impact was sent via the (email) electronic mail system, and responses were obtained from 343 female doctors. Results: The mean ± standard deviation values for age were found to be 39 ± 8 years. Insomnia, stress, and anxiety were seen in a majority of the respondents. Conclusions: The present study has shown severe psychological impact associated with the pandemic on female health-care workers and highlights the major factors associated.
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Impact of Covid-19 pandemic on quality of life in persons with alcohol use disorder - A cross-sectional study p. 67
Sindhu Ponnusamy, Suvarna Jyothi Kantipudi
DOI:10.4103/aip.aip_94_21  
Introduction: Alcohol use disorder has a chronic relapsing course. Various biological, psychological, environmental, and psychosocial factors play a major role in maintaining abstinence and determining relapse in patients. The COVID-19 pandemic has caused significant changes in every person's life. It is important to assess how this situation has determined alcohol use in the patients who had utilized deaddiction services in the past. Aim: The aim of this study is to assess the pattern of alcohol use, perceived stress, and quality of life (QOL) during COVID-19 in patients who had utilized deaddiction services for alcohol use disorder in the preceding 1 year. Materials and Methods: A cross-sectional design was employed in the study. After obtaining consent, telephonic interviewing of patients who had utilized deaddiction services during January–December 2019 was done, and questionnaires including sociodemographic details, Severity of Alcohol Dependence Questionnaire, Brief Substance Craving Scale, Perceived Stress Scale-10, and WHOQOL-BREF scale were administered to assess the pattern of alcohol use, stress levels, and QOL. Comparisons were carried out on different variables using SPSS version 20. Results: A total of 122 patients were inducted into the study. About 70.5% of the relapsed individuals belonged to joint families. There was a significant association between the poor QOL and relapse status of the individuals. High levels of stress were reported among the individuals who have relapsed compared to nonrelapsed individuals. Conclusion: High rates of relapse and higher stress levels were found in our study. This study has helped us to understand the pattern of alcohol use in individuals during this pandemic. It is important to address the factors contributing to relapse in individuals so as to focus on developing and implementing feasible and accessible interventions to help the individuals.
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Knowledge and attitude of nurses toward delirium p. 73
Sandeep Grover, Aseem Mehra, Neha Sharma, Swapnajeet Sahoo, Devakshi Dua
DOI:10.4103/aip.aip_134_21  
Aim: This cross-sectional study aimed to evaluate the attitude, practice, and knowledge among the nurses about the delirium in a tertiary care hospital. Materials and Methods: The study included 138 nurses working in a tertiary care multispecialty hospital in North India. The knowledge and attitude toward delirium were assessed by using a self-designed questionnaire (33 questions), of which 26 items specifically evaluated the knowledge and attitude toward various aspects of delirium. Results: The majority of the participants were females (83.3%), had done graduation (92.8%) in nursing, were junior nursing staff, and were directly in contact with the patient's care. The study shows that the majority of the nurses have poor knowledge about the etiology, prevalence, symptoms, and not aware of the screen procedure and instruments for delirium. Further, they lacked knowledge about the pharmacological and nonpharmacological management of delirium. A majority (83.3%) of the nurses opined that the psychiatry ward is the best place to manage patients with delirium. The majority of the nurses routinely did not screen their patients with delirium and did not know the screening instruments (84.4%) available for delirium. A majority (92.8%) of the nurses opined that they were never trained specifically to assess and manage delirium, and 98.6% expressed willingness for training. Conclusion: This study suggests that nurses working in intensive care unit and emergency settings in a tertiary care hospital in India have poor knowledge, negative attitudes, and poor practices about delirium.
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Depression anxiety and stress in patients visiting medicine outpatient department of tertiary care hospital during COVID pandemic p. 82
Zain , Manjiri Chaitanya Datar, Jyoti Vittaldas Shetty
DOI:10.4103/aip.aip_7_21  
Background: Coronavirus disease 2019 is a unique pandemic that has struck all the nations. Extraordinary crisis warrants extraordinary response like severe lockdown. The study aims to assess the prevalence of depression, anxiety, and stress, in general, and around corona, in particular, in people with medical comorbidity. Setting and Design: This is a cross-sectional study that was carried out in outpatient department setting of a tertiary care hospital from July 2020 to September 2020. Aims and Objectives: The study aimed to assess the prevalence of depression, anxiety, and stress, in general, and anxiety around corona, in particular, and the correlation with sociodemographic profile and comorbid medical illness. Materials and Methods: Fifty patients with various medical comorbidities were assessed using depression anxiety and stress scale and corona anxiety scale (CAS) and a specially designed pro forma. Statistical Analysis: The collected data were coded and entered in Microsoft Excel sheet. The data were analyzed using Statistical Packages for the Social Sciences version 20.0 software. The results are presented in a tabular and graphical format. For quantitative data, mean, standard deviation, median, etc., were calculated. For qualitative data, various frequency, rates, ratio, and percentage were calculated. Results: A statistically significant relationship was found between education and anxiety (P = 0.027) and between medical comorbidity and depression. Conclusion: In our study, medical comorbidities are associated with depressive cognition. Surprisingly, no significant anxiety on CAS could be found.
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Mental health problems in health-care workers of tertiary level COVID-19 care centers in Central India p. 86
Sudhir Laludeo Mahajan, Anantprakash Siddharthkumar Saraf, Harshal Shriram Sathe, Kshirod Kumar Mishra, Sally John, Ahmed Mushtaq Reshamvala
DOI:10.4103/aip.aip_103_21  
Background: The health-care workers (HCWs) who are overburdened during the COVID-19 pandemic are at increased risk of developing psychological disorders. Aim: The aim of this study was to assess the magnitude of psychological problems such as depression, anxiety, and fear of COVID-19 among the HCWs and to study their correlates. Material and Methods: The study is an online multicentric cross-sectional survey of mental health problems in the HCWs of three tertiary level COVID care centers in Central India. HCWs were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Fear of COVID-19 Scale. Results: Out of 467 HCWs assessed, 25.5% of the participants had depression (defined by PHQ-9 score of more than 5), whereas anxiety was present in 24.4% of the study subjects (defined by GAD-7 score of more than 5). Forty-six percent of the participants had medium-to-high levels of fear of COVID-19. Female gender, working in the nonclinical department, direct involvement in care of COVID-19 patients, perceived worsening of physical health status following the pandemic outbreak, and past history of psychiatric problem were the factors significantly associated with presence of depression as well as anxiety. Age of the participant had a positive correlation with fear of COVID-19 and a negative correlation with depression and anxiety levels. Conclusion: HCWs serving in COVID hospitals are vulnerable to develop mental health problems and appropriate screening measures and interventions should be designed so as to preserve mental health of this vital task force.
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A cross-sectional study on internet addiction disorder and its association with sleep quality in young adults p. 95
Nikhilesh Andhi, Aamer Nawaz Syed, Ayesha Saffura
DOI:10.4103/aip.aip_107_21  
Background: India is estimated to have 650 million Internet users in the country by 2023, with such explosive numbers internet addiction is emerging to be a major concern within the nation, particularly among youngsters. Aim:To study internet addiction disorder and its association with sleep quality in young adults. Methods And Materials: A cross-sectional study was conducted enrolling a total of 310 participants. Internet addiction and sleep quality were assessed in these participants using Young's Internet Addiction Scale and Pittsburgh Sleep Quality Index, respectively. Result: Out of 310 participants, a total of 140 (45.1%) study participants were found to have an Internet addiction. Consequently,268 (87%) participants showed poor sleep quality. A further outcome of the study implicated Internet addiction influenced job performance (60%), individual's productivity (70.9%), and symptoms such as difficulty in breathing, long pauses between breaths, loud snoring, legs twitching, or jerking, and episodes of disorientation or confusion while asleep. Conclusion: The study results suggest a significant association between sleep quality and Internet addiction and that poor sleep quality is mediated by internet addiction and potentially keeping individuals at risk of developing obstructive sleep apnoea, insomnia, restless legs syndrome, periodic limb movement disorder, depression, anxiety, etc., which upon worsening might lead to the wide variety of cardiovascular diseases, neurological, and psychiatric disorders.
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CASE REPORTS Top

Managing a COVID-Positive health-care worker with recent suicide attempt through telepsychiatry Highly accessed article p. 99
Chandrima Naskar, Sandeep Grover, Swapnajeet Sahoo, Aseem Mehra
DOI:10.4103/aip.aip_4_21  
COVID-19 pandemic has emerged as a major problem for the health-care workers (HCWs). Many HCWs are facing adverse psychological outcomes, during the COVID pandemic. HCWs are not only expected to carry out duties in COVID areas but are also expected to stay in isolation during the period of quarantine. Various models have been proposed to address the psychological issues in HCWs using telepsychiatry. However, there are no clear-cut guidelines, for managing people with suicidal behavior. In this report we present a HCW, diagnosed with recurrent depressive disorder, current episode severe depression without psychotic symptoms, who attempted self-harm and was shortly diagnosed with COVID-19 infection leading her to getting admitted in the COVID-19 ward. She was managed with supportive psychotherapy during her COVID ward stay through telepsychiatry. We discuss the challenges faced and how these were handled.
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Role of serotonin receptor antagonist cyproheptadine in treatment-resistant akathisia Highly accessed article p. 102
Vishnupriya Veeraraghavan, Krishnan Srinivasan
DOI:10.4103/aip.aip_97_20  
Akathisia is a term used for motor restlessness along with subjective feelings of tension and discomfort. It requires both subjective and objective aspects, and these behaviors are attributed to the inner feelings of tension. It is due to antipsychotic drug exposure. Treatment involves lowering the dosage of the antipsychotic medications, adding propranolol, benzodiazepines like diazepam or clonazepam, clonidine, or mirtazapine. Here, we present a case of akathisia which we found novel as the patient did not respond to the forementioned conventional methods and developed adverse effects but responded only to cyproheptadine syrup.
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CASE SERIES Top

The complex interaction between religion conversion, technology, and psychopathology p. 105
Nidhi Chauhan, Abhinav Agrawal, Ramandeep Kaur, Sumeesha Jaswal
DOI:10.4103/aip.aip_21_21  
Religion is an abstract concept encompassing specific set of organized beliefs and practices, usually shared by a community or group, whereas spirituality is more of an individual practice dealing with having a sense of peace and purpose. Religion and psychiatric illness too share a complex relationship and intent for religious conversions pose a diagnostic dilemma in many cases. This relationship is further being influenced by easy access to social media and excessive smartphone use in the contemporary world. Here, we discuss two cases of young males who presented to us with intense desire to change their religion (interest generated after watching YouTube videos and listening to speeches on the smartphone), consequently leading to interpersonal problems and psychopathology. The management approach highlights the need to identify the intent and knowledge for religious change, differentiate individual preferences from that of the family/society, avoiding misdiagnosis and focusing on symptom resolution and improving functionality.
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VIEWPOINT Top

Fatherhood and depression: Sound the alarms! p. 108
Harpreet Singh Dhillon, Shibu Sasidharan, Gurpreet Kaur Dhillon, Babitha Manalikuzhiyil
DOI:10.4103/aip.aip_145_20  
Maternal mental health during and after pregnancy is a well researched entity. However, father's mental health during the same period and even while raising the children has not been given due consideration. Recent studies have tried to explore the paternal depression and its impact on the children, marriage and the whole family. In this short communication, we aim to bring to the fore the risk factors, impact and recommendations to address the issue of paternal depression.
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LETTER TO EDITOR Top

Use of bupropion and topiramate in management of tianeptine abuse in a young male with dysthymia p. 111
Kritika Chawla, Sujita Kumar Kar
DOI:10.4103/aip.aip_131_21  
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