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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 6 | Issue 4
Page Nos. 301-400

Online since Monday, January 30, 2023

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EDITORIAL  

Gender identity and gender identity disorder: Issues for clinical practice p. 301
Pooja Vora, Avinash De Sousa
DOI:10.4103/aip.aip_2_23  
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REVIEW ARTICLE Top

Association between markers of oxidative stress and cognitive functioning in schizophrenia p. 304
Vikas Menon, Ilambaridhi Balasubramanian, Ravi Philip Rajkumar
DOI:10.4103/aip.aip_174_22  
High levels of oxidative stress have been implicated in the pathogenesis of schizophrenia. Our objectives were to review the association between oxidative stress markers and neurocognitive functioning in schizophrenia. Electronic search of MEDLINE, ProQuest, Scopus, and Google Scholar databases was carried out in September 2022 to identify relevant English language articles. Articles identified were grouped under the following themes: comparison of oxidative stress or antioxidant biomarkers between patients with schizophrenia and general population, association between biomarkers of oxidative stress and cognitive dysfunction in schizophrenia, and clinical trials evaluating the effect of antioxidant compounds on cognitive functioning in schizophrenia. We reviewed 36 eligible papers: 30 observational studies and 6 intervention trials. Marked heterogeneity was noted in patient population, oxidative stress markers examined, and cognitive measures. Majority (83.3%) of the observational studies were cross-sectional in design; half of them (50%) were conducted on chronic, stable, medicated patients. Most of the observational studies showed increased levels of oxidative stress biomarkers and decreased antioxidant activity in schizophrenia compared to controls. A significant positive association was noted between markers of antioxidant activity and cognitive performance in this group. Treatment trials of antioxidant agents showed positive but inconsistent evidence for benefits on cognitive measures and clinical symptomatology in schizophrenia. Our findings are broadly consistent with the redox imbalance hypothesis in schizophrenia. The significant associations noted between antioxidant markers and cognitive functioning may have key neurobiological and therapeutic implications.
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ORIGINAL ARTICLES Top

Impact of online teaching on mental health and quality of life among medical teachers during COVID-19 pandemic - A cross-sectional study p. 320
Ramesh Kumar Tilwani, Ankit Awasthi, Madhurima Maheshwari, Khemlata Tilwani, Aman Deep
DOI:10.4103/aip.aip_139_21  
Background: Stress is the physiological and psychological response to internal or external stressors. The COVID 19 outbreak caused a sudden shutdown of conventionally designed medical teaching and new digital e-learning methods emerged which invariably affected the psychology of medical teachers. Aims and Objective: To study the impact of the COVID-19 pandemic and distance teaching on the psychological status of medical teachers. Materials and Methods: A total of 322 medical teachers were included in the study; an online survey was conducted through a social media platform between April and May 2021. The online consent was obtained from all the participants. Participants were asked to complete a modified validated Google Form questionnaire with perceived stress scale (PSS-10) which is a classic stress assessment instrument. Results: The PSS-10 score was significantly high in the medical teachers who were using digital online e-learning methods first time during this COVID 19 pandemic lockdown. Male teachers reported more stress as compared to female teachers. Conclusion: Higher perceived stress among medical teachers during the COVID-19 pandemic should be acknowledged and strategies to mitigate it should be recommended. Proper counseling services should be available to support the mental health and well-being of faculty.
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Common mental disorders and its associated factors among thalassemic patients p. 328
Mubashir Zafar
DOI:10.4103/aip.aip_44_22  
Background: Thalassemia is a common genetic disorder among Asian population. The objective of this study is to determine the common mental disorders among thalassemic patients. Methods: A cross-sectional study conducted in different thalassemic centers across Pakistan. A total 250 study participants were selected through multistage stratified sampling technique. A structured and validated questionnaires was used. Chi-square test used to determine the relationship between sociodemographic characteristics with mental disorders. Results: Among study participants, 16%, 20%, and 5% suffered from severe anxiety, depression, and psychosis disorder, respectively. Those patients living without parents had more likely associated with depression, anxiety and psychosis disorders. these patients also had more frequent need to blood transfusion. Conclusion: Prevalence of common mental disorders highest among thalassemic patients. There is need to screening of mental disorders among the thalassmic patients and they referred to psychiatry clinic for early management.
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Knowledge and attitudes of parents, teachers, and doctors regarding screen overuse and its addiction in children, adolescents, and young adults: A survey focusing towards possible solutions p. 332
Shirish Ravichandra Rao, Prashant Harish Saraf, Shilpa Amit Adarkar, Gayatri Sachin Inamdar, Pauras Pritam Mhatre, Vidushi Chandrabhan Gupta, Amey Abhijit Ambike, Keval Tushar Dedhia, Shreeya Kuldeepsing Raul
DOI:10.4103/aip.aip_1_22  
Background: Media and technology have become an integral part of today's life. Internet addiction, video gaming, binge-watching, social media use, and hence the overall screen time is rising. There are physical, psychological, and social adverse consequences of screen overuse. Objective: The objective is to assess the knowledge and attitudes of the study participants and to present solutions for screen addiction. Subjects and Methods: A structured questionnaire was developed content validity ratio (CVR >0.65). It was sent via email to more than 500 participants and also on more than 70 WhatsApp groups. It was an online cross-sectional study where 800 participants were recruited using convenience and snowball sampling. Microsoft Excel 2019 and SPSS version 26 were used to obtain and analyze data. P value was determined by using the Chi-square test. Results: Knowledge of screen use guidelines and health concerns was highest in doctors followed by teachers and least in parents (P 0.001). 95% of doctors believed any kind of screen overuse should be classified as an addiction. For preventing screen addiction, the role of parents was voted to be most important (49% participants) and for overcoming screen addiction, the role of the person himself was voted to be most important (48% participants). Conclusion: The level of knowledge in our study population regarding screen use guidelines was moderate to low. The attitude of parents for tackling their child's screen use was found to be appropriate. The multi-stakeholder approach should be considered for tackling screen addiction.
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Profile of patients attending telepsychiatry unit and its usability and satisfaction during pandemic in South India - A retrospective study p. 339
Vishnupriya Veeraraghavan, Krishnan Srinivasan
DOI:10.4103/aip.aip_152_21  
Background: The COVID-19 pandemic is an unexpected event that has led to a drastic shift in the practice of medicine around the world. Currently, not many studies are available in India regarding the role of telepsychiatry and no study has been done to assess the usability and satisfaction scores of patients who undergo a telepsychiatric consultation. Aim: The aim of the study is to find the profile of patients attending the telepsychiatry Unit and its usability and satisfaction during the pandemic in South India. Setting and Design: The study was conducted on patients attending telepsychiatric consultation from a period of March 25, 2020, to September 2020. Materials and Methods: A retrospective chart analysis of patients attending telepsychiatry consultation from March 25, 2020, to September 2020 was made. Patients who underwent video consultation were asked to fill out the telehealth usability questionnaire scale through Google Forms. The usability of the telehealth system was assessed using a Likert Scale and scoring was done. Statistical Analysis: Descriptive statistics were used to characterize the study population. Statistical significance was set at P < 0.05. The design and findings of this study were written in accordance with SQUIRE 2.0 guidelines. Results: Twenty-two percent of the study population had consultation for more than fourtimes. Around 78% of the study population had online consultation for less than four times. More than 74% of the study population had video consultation and 26% of the study population had audio consultation. The total average Telehealth Usability Questionaire score was 5.3. The usefulness score summary was found to have a low score of 5.2 ± 0.6, whereas the satisfaction scale summary was found to have the highest score of 5.3 + 0.9. Conclusion: Profile of patients who attend a telepsychiatry unit during the crisis and their satisfaction helped us to know the pros and cons of online consultation and the ways to improve telemedicine in regard to psychiatric patient care. Our study shows that majority are satisfied with telepsychiatric consultation.
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Implication of online-based brief psychotherapy in anxiety spectrum disorder during COVID-19 pandemic p. 345
Susmita Halder, Akash Kumar Mahato, Shinjini Samajdar
DOI:10.4103/aip.aip_38_22  
Background: The rapid, ongoing and progressive nature of corona virus pandemic situation is representing global public health disquiet. The uneasiness, apprehension or worry regarding the current circumstances is leading to mental health concern and the quality of life and functioning are being affected and leading to mental health problems. Excessive worry and tension could elevate negative emotions and consternation regarding necessities of daily life, preventive and control measures, life and health threats are the risk factors of aggravation of somatic symptoms. Supportive psychotherapy is an evidenced based therapeutic measure to manage negative emotions and feelings. Aims and Objectives: The present study aimed to explore the application of brief online based brief psychotherapy in the pandemic situation to intervene symptoms of anxiety, somatic concern, and associated negative emotions in daily life. Method: It is a case series of 5 adults with anxiety and somatic symptoms, aggravated in post COVID19 situation therapeutically intervened through brief online based brief psychotherapy. Results: Significant changes in symptom pattern and severity suggest positive indications of online brief therapy for anxiety and related symptoms in pandemic situation.
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Study of the severity of depression and quality of life in adults with HIV/Acquired Immunodeficiency Syndrome at antiretroviral therapy center in western Maharashtra p. 349
Rajkiran A Salunkhe, Pawan V Khot, Krutika Ainapur, Vishal Ganpati Patil
DOI:10.4103/aip.aip_138_22  
Introduction: The universal access to antiretroviral therapy (ART) has caused a significant reduction in morbidity and mortality in HIV-infected individuals. Depression is one of the most prevalent psychiatric diagnoses seen in HIV-positive individuals, which has a significant impact on health-care utilization, adherence to ART, and quality of life (QOL). Hence, this study was planned to study the depression severity and health-related QOL in HIV-positive individuals. Aim: The aim was to study the severity of depression and QOL in adults with HIV/acquired immunodeficiency syndrome (AIDS). Methods: This was a cross-sectional study conducted at the regional ART center of a tertiary care hospital where 90 adult patients with HIV/AIDS in the age group of 18–60 years fulfilling DSM V criteria for depression were interviewed. A semistructured questionnaire was applied to obtain sociodemographic data. Quick Inventory of Depressive Symptomatology and QOL Scale (WHO QOL-HIV BREF) were used to assess the severity of depression and QOL in patients. Results: Of 90 patients, 40% had severe depression and 60% had mild-to-moderate depression. The severity of depression had a significant correlation with duration of HIV illness, duration of depressive symptoms, and socioeconomic status. The low QOL mean score was observed in all domains of QOL questionnaire. There was a significant correlation between the severity of disease and QOL. No correlation was found between CD4 count and QOL or severity of depression. Conclusions: Early diagnosis and treatment of depression in HIV may help improve the QOL of patients. CD4 cell count alone may be inadequate criteria for the prediction of mental health status and QOL.
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Social media fatigue during the lockdown phase of the COVID-19 pandemic p. 355
Pragya Lodha, Anoushka Thakkar, Ankita Gupta, Raghu Appasani, Emmanuel Essien, Alexander Audu
DOI:10.4103/aip.aip_15_22  
Background: The coronavirus pandemic has led to deleterious effects on health, physical, and mental. The pandemic, onset since the end of 2019, has negatively impacted individuals across all sociodemographic variables. The widespread pandemic pushed global governments to enforce sanitizing, masking, and maintaining physical distancing. This lockdown meant that everyone was restricted at home, pushing academic, and work activities to take virtual means. Furthermore, this implicated excessive screen use due to increased virtual means of working. Methodology: The present study investigates social media fatigue (SMF) and the psychological effect of the same among participants of India and Nigeria. The study deploys 299 participants (males and females) for the same. Results: The findings from the study indicate that though SMF exists, it is not a prominent effect seen, considering that social media use helped people emotionally connect to their loved ones. Conclusion: This study provides data on SMF in participants from India and Nigeria during the lockdown period of the pandemic, an area of research that has not been looked into much. The study builds a scope for further research to delve into the impact of SMF at a global level, studying it with more robust statistical methods.
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Impact of COVID-19 on mental health of health-care providers in Maharashtra: A cross-sectional study p. 362
Maya Vikas Kshirsagar, Saneeka Rajesh Vaidya, Madhura Dhananjay Ashturkar
DOI:10.4103/aip.aip_93_22  
Background: As COVID-19 is spreading rapidly, it is emotionally challenging for everyone. It has been observed that health-care workers come to play a major role and give their efforts to a greater extent in such situations. The studies have reported adverse psychological reactions to the 2003 severe acute respiratory syndrome outbreak among health-care workers. Hence, the study was planned to assess depression, anxiety, and stress among health-care professionals during the corona pandemic. Materials and Methods: A cross-sectional, observational study was carried out on health-care professionals working in the state of Maharashtra who were involved in the management of COVID-19 patients. Institutional ethical permission was taken before the study. The questionnaire was created to collect the data which having background information and the Depression, Anxiety, and Stress Scale-21. Data were entered into Microsoft Excel sheets and appropriate statistical analysis was done. Results: A total of 200 participants were included in the study. It was observed in our study that 51% of participants had depression, 38% had stress, and 49% had anxiety. Depression, anxiety, and stress were more among female health-care professionals than male professionals and it was statistically significant. It was found in our study that depression, anxiety, and stress were more in urban professionals than in rural health-care professionals, and the difference was statistically significant. Conclusion: As our study demonstrated a higher burden of depression, stress, and anxiety, early screening of health-care professionals and implementation of psychological interventions are essential for protecting and maintaining the functionality of the health-care system.
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BRIEF RESEARCH ARTICLES Top

Perceived advantages and disadvantages of work from home in IT professionals p. 366
Om Limaye, Sagar Karia, Nandlal Prajapati, Nilesh Shah, Avinash Desousa
DOI:10.4103/aip.aip_29_22  
Background: Work from home (WFH) was faced with new challenges for many of them. Aims and Objectives: The aim is to investigate IT professional's experiences of WFH during the pandemic and to identify the main factors of advantages and disadvantages of WFH. Materials and Methods: An online survey was conducted among IT professionals by sending Google forms to them wherein demographic, professional details were collected and questions regarding advantages and disadvantages of WFH were asked. Results: 61.4% of individuals were males and 38.6% were females with mean age of 29.82 ± 4.25 years. The main advantages of WFH were flexible work timings and reduction in traveling time and costs by employees. Disadvantages perceived were mainly extending working hours and loss of professional and personal life balance. Conclusions: This survey suggests that WFH is advantage to employees and it can be enhanced for increasing productivity by overcoming the disadvantages to a maximal extent possible.
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Impact of COVID-19 pandemic on treatment seeking in opioid users: A retrospective comparative study p. 370
Mini Sharma, Dinesh Kataria, Nitin B Raut, Om Sai Ramesh, Sajjadur Rehman, BK Gracy
DOI:10.4103/aip.aip_11_22  
Background: The planet has been hit by the novel coronavirus since December 2019, which has not only affected the day-to-day activities but has also affected the health-seeking approach of the general population. The reports from the National Institute on Drug Abuse survey hint toward a rise in opioid use in the states. Even in India, the utilization of health services, especially the outpatient department (OPD) and opioid substitution clinics have been affected due to the impact of COVID-19 and subsequent national and regional lockdowns. The Indian studies reflect upon the experience and measures to continue the treatment facilities in substance users, yet none are available to reflect upon the impact of COVID-19 on the pattern of opioid use or functionality of OPD services. Objective: The objective of this study is to study the impact of COVID-19 pandemic on treatment seeking among opioid users from OPD-based opioid treatment centers: a retrospective study. Methodology: A retrospective study was done in an OPD-based opioid treatment center of a tertiary care hospital to analyze the impact of COVID-19 on treatment-seeking opioid users by comparing the data of pre-COVID-19 (April 2019–March 2020) and during COVID-19 (April 2020–March 2021) OPD visits by opioid users. The OPD visits data were collected, including the number of visits, the total number of buprenorphine tablets dispensed, and the dose of buprenorphine consumed per month. The data collected were further analyzed for the descriptive and analytic statistics using the SPSS software version 23.0. Results: During the pre-COVID-19 (April 2019–March 2020) duration, there were a total of 1104 (average 92/month) OPD visits and 4818 (Average 401/month) buprenorphine tablets were dispensed; whereas during the COVID-19 year (April 2020–March 2021), it was 980 (average 81.66/month) visits and 5174 (431/month) tablets. The results were further compared using the paired t-test, which was found to be statistically significant for the number of tablets dispensed, whereas not statistically significant for the number of OPD visits and doses. Conclusion: Although the COVID-19 pandemic has affected the feasibility to seek treatment in opioid users, it has not significantly affected OPD visits for opioid treatment at our center. Although the policy changes such as Indian Psychiatry Society (IPS) interim guidelines for opioid substitution therapy have been beneficial to facilitate the harm reduction and treatment-seeking attitude and have not affected the treatment seeking as expected due to lockdown and transportation which have been a hurdle. Further regulations on opioid treatment OPD, Tele-consultation services and mobile mental health services may be helpful to ensure continuity of treatment and harm reduction among the opioid users.
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Expressed emotion among families of individuals with alcohol dependence syndrome: A pilot study p. 374
Kannappa V Shetty, Sanjeev Kumar Manikappa, Shreyaa Murthy, Jagadish Anjanappa, Vikram Singh Rawat
DOI:10.4103/aip.aip_14_22  
Background: Alcohol dependence syndrome (ADS) is a progressive condition stemming from severe alcohol use, where the person becomes increasingly reliant on alcohol, loses control over its use and will have to increase the quantity of consumption to get the same effect, making it extremely difficult to stop. This affects various aspects of a person's life such as the physical health, financial, interpersonal, social, and ethical life. It also induces negative behaviors such as aggressiveness, risk-taking attitudes such as drunken driving, legal issues, and withdrawal from the responsibilities at work and household. Even if the person decides to stop, various stressors might make them fall back into the same habit. Criticality, hostility, and emotional overinvolvement of the family members toward the patients of ADS, commonly referred to as expressed emotion (EE), are some of the major causes for relapse Materials and Methods: The sample comprised 31 subjects, who were selected convenience sampling. The data were collected at a private tertiary care neuropsychiatry hospital, Bengaluru. Ethics approval and informed consent were taken. Family Emotional Involvement and Criticism Scale and sociodemographic schedule were used. Results: The perceived criticism was found to be higher (24.6 ± 1.94) than emotional overinvolvement (18 ± 4.48) among ADS caregivers, and the total score of the EE revealed that there was higher score (42.06 ± 5.2) than the average score of the scale. Conclusion: The study highlights the need for addressing EE in the families of patients with ADS and to plan for comprehensive psychosocial interventions.
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Prevalence of substance use and assessment of sleep quality, stress, and anxiety in police personnel in the pandemic p. 378
Ashika B George, Jyoti V Shetty
DOI:10.4103/aip.aip_127_21  
Background: COVID-19 pandemic has thrown everyone into crisis mode. Lockdowns have affected police personnel, especially as they were working on the ground level. Our study aims to assess the prevalence of substance use and assess the stress, anxiety, and sleep quality among police personnel during the COVID-19 pandemic. Design: This design was a cross-sectional study, July–September 2020. Setting: This study was conducted at Bharati Vidyapeeth Police Station. Materials and Methods: One hundred police personnel were selected at random and interviewed. The Perceived Stress Scale and Symptoms of Stress Scale, the Coronavirus Anxiety Scale, Alcohol, Smoking, and Substance Involvement Screening, and the Pittsburgh Sleep Quality Index were used. Statistical Analysis: The collected data were coded and entered in Microsoft Excel sheet, were analyzed using inferential and descriptive analysis as mean, standard deviation, t-test, and Chi-square by Statistical Packages for the Social Sciences version 20.0 software. Results: The stress assessed using the SPSS and inferential and descriptive analysis came out to be as follows: 1% with high stress, 33% with moderate stress, and 66% experiencing low stress. The prevalence of CRA was found to be 8%. A total of 31% were found to have some sleep issues. A total of 44% of the police personnel were found to use some substance, with the prevalence of alcohol being 32% and nicotine being 22%. There was no significant association found between anxiety, stress, and sleep quality with substance use in the study. There was no significant relationship found between sociodemographic profile and scores on the scales used.
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CASE REPORTS Top

Nocturnal frontal lobe epilepsy presenting as sleepwalking episodes and restless leg syndrome-like symptoms p. 384
Arya Jith, Kathleen Anne Mathew, Kudrat Jain
DOI:10.4103/aip.aip_154_21  
Nocturnal frontal lobe epilepsy (NFLE) is characterized by seizures with complex motor behaviors arising mainly during sleep. Varied clinical presentations and nonspecific electroencephalogram findings make it difficult to distinguish NFLE from other nocturnal paroxysmal events such as nonrapid eye movement (NREM) parasomnias and restless leg syndrome (RLS). Here, we present a case of NFLE, which had a complex clinical presentation resembling features suggestive of RLS and NREM parasomnia and posed a diagnostic challenge. Initiation of carbamazepine as the anti-epileptic led to rapid resolution of symptoms.
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Secondary delusion of pregnancy in an antipsychotic Naïve patient Highly accessed article p. 387
Parul Gupta, Mamidipalli Sai Spoorthy, Pradeep Shriram Patil
DOI:10.4103/aip.aip_113_21  
Delusion of pregnancy is relatively rare phenomenon encountered in psychiatric patients but is reported frequently in developing countries. It can be associated with both psychiatric and neurological disorders. We are reporting a case of delusion of pregnancy that developed in a drug-naïve young woman secondary to auditory hallucination with normal body mass index with no neurological cause due to paranoid schizophrenia. Till date, only seven such cases were reported where auditory hallucinations were reported along with the belief in pregnancy. It should be differentiated from pseudocyesis/pseudopregnancy/simulated pregnancy/Couvade syndrome. Workup should include the identification of the psychosocial/cultural factors leading to the development of this phenomenon, although pharmacological treatment remains the mainstay of the treatment.
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Use of haloperidol in amiodarone induced delirium Highly accessed article p. 390
Rachit Sharma, Ranveer Singh, Markanday Sharma
DOI:10.4103/aip.aip_72_21  
Amiodarone, a versatile Class III antiarrhythmic drug, is considered one of the most effective agents in counteracting supraventricular and ventricular tachyarrhythmia. Delirium related to amiodarone therapy is infrequently associated with amiodarone. Although the prevalence of this disorder is extremely low, it is worthy of note the time-dependent relationship between the onset of therapy and the beginning of psychiatric symptoms. We report the case of an older woman who was diagnosed with a case of decompensated dilated cardiomyopathy with atrial fibrillation. She developed delirium after treatment with amiodarone. It also highlights the use of antipsychotic, despite continuous use of amiodarone.
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VIEWPOINT Top

Premenstrual syndrome and premenstrual dysphoric disorder: A review of their history with an eye on future p. 393
Sayanti Paul, Arghya Pal
DOI:10.4103/aip.aip_16_22  
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are two very closely related disorders that are seen in the overlapping territories of gynecology and mental health. Grossly, both these disorders are characterized by psychiatric and somatic symptoms that become prominent during the luteal phase of the menstrual cycle and cause significant impairment in the activities of daily living and usually spontaneously resolve shortly after the completion of the menstrual cycle. Researchers worldwide have been bemused by the simultaneous existence of these two diagnostic entities. The popular belief has been that the diagnostic entity of PMS has been mainly endorsed by the various gynecological societies worldwide, contrary to PMDD, which is a relatively newer diagnostic entity created by the American Psychiatric Association during the publication of the Diagnostic and Statistical Manual of Mental Disorders. The current article intends to trace the incredible journey of these entities from its inception to their current form and its utility in the current scenario and propose future implications.
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LETTERS TO EDITOR Top

The eternal flame: Impressing on stigma against transgender population – A mental health perspective from a Tier 2 Indian City p. 398
Navna Panchami Ravindran, Ankit Halder, Roma Dilip Shahani
DOI:10.4103/aip.aip_163_22  
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Time to focus on acid attack survivors p. 400
Unmana Dutta, Anu Teotia, Navin Kumar
DOI:10.4103/aip.aip_180_22  
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