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   Table of Contents - Current issue
Coverpage
April-June 2022
Volume 6 | Issue 2
Page Nos. 113-197

Online since Friday, August 19, 2022

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EDITORIAL  

Geriatric substance use: Challenges for practice p. 113
Avinash De Sousa
DOI:10.4103/aip.aip_127_22  
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PRESIDENTIAL ADDRESS Top

Presidential address: Mind–Body medicine p. 117
Arun Marwale
DOI:10.4103/aip.aip_17_22  
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REVIEW ARTICLES Top

Parental risk factors in schizophrenia: The apple does not fall far from the tree p. 122
Ziske Maritska, Bintang Arroyantri Prananjaya, Nita Parisa, Puji Rizki Suryani, Friska Anggraini, Safa Nabila Putri, Jesica Putri Salim, Mohammad Hilal Atthariq Ramadhan
DOI:10.4103/aip.aip_150_21  
Despite its common prevalence, the etiology of schizophrenia is still elusive. Some studies suggest the involvement of several neurotransmitters, while some point out the role of genetics and environmental factors in the development of schizophrenia. Among varied proposed risk factors, several parental characteristics might constitute the risk factors for schizophrenia. Parental age, migration, and parental socioeconomic status are some of the suggested risk factors related to the development of schizophrenia in the offspring. This review aims to briefly discuss the three parental risk factors concerning the incidence of schizophrenia in the offspring.
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Background of suicide amidst COVID-19 pandemic in India: A review of published literature p. 125
L Manoj Kumar, Rinu J George, Manikantan Mohanan
DOI:10.4103/aip.aip_23_22  
Background and Objectives: Globally, suicide is a pertinent public health crisis that affects almost all nations cross-culturally. Suicide is one of the leading causes of death in many countries, even before the COVID-19 pandemic hit worldwide. India, a nation developing rapidly, is also not free from the leashes of suicide deaths. COVID-19 augmented the rate of suicide due to multifaceted determinants. Adequate empirical evidence about data on suicide is also scarce. Materials and Methods: This review synthesizes determinants, available demographic correlates, and reported rates of suicide published in the Indian context. The authors conducted a thorough literature search to find published English free full-text scientific articles related to suicide during the COVID-19 pandemic in the Indian context. Databases relied on for literature were PubMed, Google scholar, and PLOS one databases using comprehensive search strategies to avail the maximum number of studies. Results: Ten out of 76 studies available in the initial search were analyzed thoroughly for ruling out determinants, rates, and sociodemographic correlates of suicide. Fear of COVID-19 infection, financial crisis, mental breakdown, and job loss are cardinal reasons attributed for suicide, and male suicides are more prevalent in this arena. Interpretation and Conclusions: Findings portray factors such as fear of COVID-19 diagnosis, apprehension to become infected, financial crisis, loss of job, and isolation are some of the significant determinants quoted out. The study points out the need for multifaceted policies in preventing this public health crisis.
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ORIGINAL ARTICLES Top

Problematic smart phone use in medical undergraduates in a Tertiary Teaching Hospital in South India during COVID lockdown p. 130
P Sreeelatha, M Suresh Kumar
DOI:10.4103/aip.aip_33_21  
Background: The COVID-19 pandemic has influenced all spheres of existence. Medical education, especially undergraduates, had to cope with the changing trends in the delivery of teaching modules. This has substantially influenced smart phone usage in medical students. Aims: The aim of the study is to evaluate the impact of COVID-19 lockdown on smart phone usage in medical students Materials and Methods: Using a cross-sectional online survey design, 556 medical undergraduates in a teaching hospital were included and assessed using questionnaires to measure problematic smart phone use/addiction. Results: Majority of the medical students scored high on problematic mobile phone use questionnaire short version-dependent subscale and SMARTPHONE ADDICTION SCALE-SHORT VERSION scales used to assess smart phone usage. Significant increase in the smart phone use during COVID lockdown was observed when compared to smart phone use before lockdown. Conclusion: COVID-19 pandemic with resulted in nationwide lockdown affected the smart phone usage in medical students. Problematic smart phone use and smart phone addiction is prevalent in medical undergraduates. Smart phone use for recreational use exceeds the smart phone use for academic achievement.
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Comorbid depression and anxiety in patients of epilepsy p. 137
Geetanjali Gupta, Raghav Kesri, Suchita Goyal, Sagar Karia
DOI:10.4103/aip.aip_97_21  
Introduction: Epilepsy is a common chronic noncommunicable neurological disorder in which brain function is impaired. Epilepsy patients are more prone to comorbidities such as depression, anxiety, psychosis, personality disorders, hypo-sexuality, migraines, and other behavioral disorders. Comorbid depression and anxiety are more common in people with epilepsy than in the general population. Comorbid psychiatric illness in epilepsy has multifactorial etiology, including epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy, and any associated brain dysfunction and/or damage. Hence, this study was conducted to check the association of comorbid depression and anxiety with the sociodemographic factors and disease-associated factors in patients with epilepsy. Aim: To study the occurrence of depression and anxiety in patients with epilepsy and their relationship with sociodemographic and disease-associated factors. Materials and Methods: This was a single-centered cross-sectional study, in which 96 patients participated. To assess the severity of depression and anxiety, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were used, respectively. Results: Out of 96 patients, comorbid depression was seen in 35 (36.45%) and anxiety in 28 (29.16%) patients. Conclusions: The present study points out that depression is more prevalent than anxiety in patients with epilepsy and its severity is more if onset age is earlier and duration of illness is more.
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Perceived stress and insomnia among medical residents in South India: A cross-sectional study p. 142
M Anupama, Harish Kulkarni, Vinyas Nisarga, Sushravya
DOI:10.4103/aip.aip_140_21  
Background: The ever-expanding medical knowledge, longer work schedule and the work atmosphere ridden with litigations make the medical education a stressful phase. Stress in resident doctors goes unattended many a times. Residents also face difficulty in sleep owing to their heavy work and erratic routine. Insomnia is noted to be a common accompaniment of stress. In this background, the present study is aimed to estimate the prevalence of stress levels and the presence of insomnia among resident doctors and to assess the association between them along with their socio-demographic correlates. Methodology: Resident doctors working in three different hospitals attached to a medical college were approached; consenting participants were administered Sociodemographic pro forma, Perceived Stress Scale, and Bergen's Insomnia scale. Statistical analysis was done using SPSS software. Results: A total of 251 residents participated in the study, of which majority were females, Hindu, from an urban background, unmarried and used no psychoactive substance. Of all the residents 80% reported to be stressed and 62% had insomnia. Bergen's Insomnia scores had moderate correlation with Perceived stress scores (r = 0.453, P < 0.001). Female and sleep-deprived residents had higher stress. Residents in clinical branches and residents with long work hours had significant insomnia than their counterparts. On logistic regression analysis, duration of work hours and problem adjusting to the current place of residence significantly predicted insomnia. Conclusion: Most residents reported to be having stress and the stressed individuals had associated insomnia. Given the serious health effects of stress, there is a need to detect it early. Insomnia could be viewed as an early and soft indicator of underlying stress.
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Gaming addiction in children and adolescents with attention-deficit hyperactivity disorder and disruptive behavior disorders p. 149
Lavkush Verma, Vivek Agarwal, Amit Arya, Pawan Kumar Gupta, Pooja Mahour
DOI:10.4103/aip.aip_77_21  
Context: There is a dearth of studies on the risk of gaming addiction (GA) in children and adolescents with disruptive behavior disorders (DBDs) and its comorbidity with attention-deficit hyperactivity disorder (ADHD). Methods: Seventy participants aged 6–16 years diagnosed with ADHD and DBD were included in this cross-sectional, observational study and compared with 40 healthy controls. They were assessed for clinical details of gadget type, duration of use, and purpose on a semi-structured questionnaire. The intensity of video gaming was assessed using Game Addiction Scale (GAS). Behavioral symptoms were assessed on Child Behavior Checklist (CBCL). Descriptive statistics with t-test, analysis of variance, and Pearson's correlational analysis were used as applicable. Results: Use of gadgets for video games for ≥ 4 hours was found to be significantly higher (P = 0.001) in cases (61.5%) than in controls (10%). Most of the cases used Internet for communication (69.4%) and entertainment (58.3%). A significantly higher number of cases (37.1%) fulfilled criteria for video game addiction and the numbers were significantly higher in ADHD + DBD groups as compared to only ADHD or only DBD group. Children with GA had significantly higher scores in all domains of CBCL as compared to those without GA. The GAS score had a significant positive correlation with aggressive behavior, social problems, rule breaking, and attention problem domains of CBCL. Conclusions: GA was significantly higher in ADHD and/or DBD than normal children and adolescents. Comorbidity of ADHD and DBD further increases the risk of GA. Therefore, children with these disorders should be screened routinely for GA.
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The silent toll of second COVID-19 wave: A dass-21 questionnaire survey among health-care workers at a Tertiary-Care Public Hospital, Mumbai p. 155
Faisal Khan, Vishal Dewalwar, Parijat Roy, Heena Merchant, Suroopa Das, Avinash Desousa
DOI:10.4103/aip.aip_61_22  
Background: The uncontrolled spread of the COVID-19 disease in India's second wave post-February 2021, put to task the public health system across the nation. This, in turn, exhausted our health-care workforce both physically and mentally. To establish the prevalence of psychological symptoms and guide the action plan in place, the present study was undertaken among COVID-19 health-care workers (HCWs) at tertiary-care public hospital, Mumbai. Materials and Methods: The present cross-sectional study was conducted after due institutional ethical clearance among 212 HCWs engaged in the management of COVID-19 patients during the second wave. A Google Form® was created in English, Hindi, and Marathi languages for self-administration. Data were collected under three domains; informed consent, sociodemographic and workplace-related details, and DASS-21 Questionnaire scores. This was further subjected to statistical analysis using SPSS® software. Results: This study included 90 (42.5%) doctors, 91 (42.9%) nurses, and 31 (14.6%) other categories of HCWs. Depression was prevalent in 44.3% HCWs, while 43.9% and 36.3% of the HCWs were affected by anxiety and stress, respectively. Younger population, female gender, and doctors were associated (P < 0.05) with an increased likelihood of either of the prevalent psychological symptoms. Other significantly associated (P < 0.05) factors included COVID-19 vaccination status of the HCW, history of COVID-19 infection, infected colleague at workplace, workplace housing facilities and commute, number of dependents on the HCW and hospitalized family member or close friend. Conclusion: The COVID-19 HCWs were found to be under considerable psychological strain. In essence, screening, identifying, and effectively targeting HCWs for psychological interventions is needed to protect and strengthen the health-care system.
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Irony comprehension in schizophrenia: Development, content validity and “Known-Groups” validity of an Indian, comic-based, computerized task p. 164
Trisha Walia, Sayli Agashe, Deyashini Lahiri Tikka, Daya Ram, Basudeb Das, Sai Krishna Tikka
DOI:10.4103/aip.aip_89_22  
Introduction: Irony comprehension (IC) has been described as a schizophrenia (SCZ) disease marker. High variability exists in the measurement of IC. We aimed to assess content and “known-groups” validity of an Indian, comic-based, computerized-IC task. Methods: A 15-story IC task was prepared. Content validity of the IC task stimuli was assessed by experts in mental health. Performance on the IC task was compared between 15 SCZ patients and 15 healthy controls (HC). Known-groups validity was assessed using discriminant function analysis. Results: Content validity of the IC task was optimum. Lower number of correct responses and longer reaction times for irony stimuli were seen in SCZ patients, compared to HC. Both these measures showed 100% accuracy in discriminating SCZ from HC, therefore, implying excellent “known-groups” validity. Conclusion: The newly designed IC task has good psychometric properties, in terms of content and “known-groups” validity.
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Incidence of psychiatric illness among COVID-19-positive individuals with and without loss of smell or taste symptoms in a Tertiary Care Hospital in South India – A prospective cohort study p. 169
S Shankar, M Mohamed Ilyas Rahamathulla
DOI:10.4103/aip.aip_39_22  
Background: COVID infection is known to cause acute and long-term neuropsychiatric presentations. Coronavirus infections are known to have neuroinvasive potential with consequent neuropsychiatric manifestations. Materials and Methods: The study was conducted in a tertiary care hospital, and COVID-19-positive individuals were grouped based on the presence or absence of loss of smell (anosmia) or taste symptoms (ageusia). Group 1 without smell or taste disturbance, and Group 2 with smell or taste disturbance. Both groups were followed up for 6 months to assess the new onset of psychiatric illness. Results: The onset of new psychiatric illness was present in 8 out of 30 (26.66%) cases in group 2 when compared with 2 out of 30 (6.66%) cases in Group 1, with a relative risk of 4 (95% confidence interval 0.9247–17.3023). In 10 cases, the pattern of psychiatric illness was depression (16.66%), anxiety (6.6%), posttraumatic stress disorder (3.33%), acute psychosis (3.33%), and acute stress disorder (3.33%). Both groups were compared in terms of socio-demographic profile, inflammatory markers, and computed tomography severity score, and no significant difference was noted between the two. A relative risk of 4 indicates that COVID-19-infected individuals who lose their sense of smell or taste are more likely to develop new-onset psychiatric illness. Conclusion: Impact of COVID-19 on the central nervous system is very evident, and loss of smell or taste symptoms could be an early marker. Early recognition and prompt treatment with immunotherapy or newer therapies will prevent the emergence of psychiatric disturbance and its disability.
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CASE SERIES Top

A case series of study of childhood psychological trauma and alexithymia among persons with alcohol dependence syndrome attending inpatient de-addiction facility from Central Rural India Highly accessed article p. 176
Ajinkya Sureshrao Ghogare, Pradeep Shriram Patil, Ganpatlal Kodarbhai Vankar
DOI:10.4103/aip.aip_37_21  
Psychological trauma occurs when a person suffers from serious threat or loss to his/her life. Childhood psychological trauma can be of various forms such as physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect. Such adverse childhood experiences, if not effectively dealt or resolved, may lead to the development of drug dependence including alcohol dependence syndrome (ADS) in adult life. In many cases, development of ADS is preceded by the occurrence of childhood psychological trauma(s). Such a person with a history of childhood psychological traumas may consume alcohol to cope with his/her trauma-related distress. Alexithymia is a state characterized by a triad of difficulty in identifying one's own feelings, difficulty in differentiating between physical sensations and emotional arousal, and difficulty in explaining one's own feelings to others. Alexithymia has a role in the development of drug dependence including ADS. The number of childhood psychological trauma among persons with ADS was associated with alexithymia in adulthood. Childhood psychological traumas, mainly emotional abuse, might act as a predisposing factor for the development of alexithymia in persons suffering from ADS. This case series presented clinical picture of two individuals with ADS in which both childhood psychological trauma(s) and alexithymia were assessed by using standard and psychometrically valid psychological tools such as Childhood Trauma Questionnaire and Toronto Alexithymia Scale-20 item, respectively. This case series is unique because the assessment of childhood psychological trauma(s) and alexithymia is neglected area in Indian psychiatric research field and detailed ample of literature is not available at present in which the relationship between childhood psychological traumas, alexithymia, and ADS has been assessed. In the present case series, first individual with ADS had clinically significant alexithymia, severe emotional abuse, severe emotional neglect, moderate physical abuse, and moderate physical neglect, while second individual with ADS had no alexithymia but he had moderate-level emotional neglect and mild levels of emotional abuse, physical abuse, and physical neglect.
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CASE REPORTS Top

Clozapine-induced hypertension p. 181
Vrushti Bharat Patil, Kshirod Kumar Mishra, Sally John, Ahmed Mushtaq Reshamvala
DOI:10.4103/aip.aip_99_21  
Clozapine, a second-generation antipsychotic, is known to have a significant effect on the cardiovascular system, especially on blood pressure. Previous reports show about 4% incidence of clozapine-induced hypertension. However, there are very few cases reported in females. We report a case of clozapine-induced hypertension in a 30-year-old female diagnosed with schizophrenia. When she showed no response to two antipsychotics, clozapine was started. Within a few days, she developed hypertension, not manageable with simultaneous use of antihypertensive medication. Her blood pressure returned to normal after stopping clozapine. Hence, it is important to take appropriate measures to check for rare side effects like hypertension in patients receiving clozapine and to evaluate for all other possible causes.
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Lurasidone-induced tardive dyskinesia p. 184
Shreyas Shrikant Pendharkar, Shilpa Avinash Telgote
DOI:10.4103/aip.aip_91_20  
Lurasidone is a novel atypical antipsychotic with additional antidepressant and pro-cognitive properties. The drug has shown good efficacy in treatment of schizophrenia as well as bipolar disorder. It is currently used as monotherapy as well as adjunctive therapy with Lithium or valproate, due to its lower propensity of cardiometabolic side effects and endocrinological adverse effects. Extra pyramidal side effects and akathisia with lurasidone therapy are reported in a minority of patients, but very few instances of tardive dyskinesia with lurasidone therapy are reported so far.
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Blurring the boundaries of organic and functional psychosis p. 186
Debolina Chowdhury, Mamidipalli Sai Spoorthy, Swaroopa Vasant LungePatil, Parul Gupta
DOI:10.4103/aip.aip_58_22  
Organic and non-organic illnesses may present with uncommon symptoms. In some cases, the presenting atypical symptoms make a prompt and accurate diagnosis difficult. Accordingly, unequivocal psychotic and affective symptoms also require adequate evaluation before determining the diagnosis and management. Here we present a case whose presenting symptoms strongly suggested an organic etiology, namely autoimmune psychosis, but failed to be diagnosed as such through laboratory tests and didn't respond to appropriate treatment. Re-evaluation of the case revealed significant past psychiatric history, suggesting functional psychosis but the patient did not respond to anti-psychotic medications either. This case therefore highlights the importance of complete unbiased work-up for all psychoses.
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LETTERS TO EDITOR Top

Incorporating health information technology/information communication technology into prevention and treatment of mental health disorders p. 189
Shweta Kapote, Srikanth Pallerla
DOI:10.4103/aip.aip_21_22  
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History is rewritten-defeated the disability p. 191
Pallerla Srikanth
DOI:10.4103/aip.aip_144_21  
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Can Indians be receptive toward single-session therapy p. 193
Jasmine Joseph, Srikanth Pallerla
DOI:10.4103/aip.aip_102_22  
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An account from the other side of the table p. 195
Sumit Roy Chowdhury
DOI:10.4103/aip.aip_95_22  
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PG CORNER Top

A chunk of coal p. 196
Shradha Khatri
DOI:10.4103/aip.aip_70_22  
Introduction: In December 2019, an outbreak of pneumonia of unknown origin was reported in Wuhan, Hubei Province, China and the World Health Organization declared it as a pandemic on 12 March 2020. The pandemic had devastating repercussions in form of human lives, economy and mental health. Method: This article brings in light the experiences, expectations and coping mechanisms of the author during raging 30-days duty in a 250 bedded isolated Covid-19 pneumonia ward. Results: While the world stagnated in the walls of their residence, the health care workers, donning the badge of “Duty to serve”, faced a real-time war against the pandemic with sidelines of stigma, discrimination and mental trauma, in their stride with their heads held high. Conclusions: The article focuses on helpless, frustrating yet intriguing journey through the experiences encountered in midst of the second wave of the pandemic, ending with a sense of humility, gratitude, resilience and post-traumatic growth.
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