Indian Journal of Psychological Medicine
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   Table of Contents - Current issue
Coverpage
November-December 2018
Volume 40 | Issue 6
Page Nos. 503-602

Online since Friday, November 9, 2018

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GUEST EDITORIALS  

Primary (Mental) health care and the national mental health program p. 503
Anindya Das
DOI:10.4103/IJPSYM.IJPSYM_337_18  
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Mental health implications of elder abuse and domestic violence p. 507
Pankajakshan Vijayanthi Indu
DOI:10.4103/IJPSYM.IJPSYM_438_18  
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REVIEW ARTICLES Top

National mental health programme–optimism and caution: A narrative review p. 509
Snehil Gupta, Rajesh Sagar
DOI:10.4103/IJPSYM.IJPSYM_191_18  
India was one of the major World Health Organization (WHO) member countries to launch its National Mental Health Programme (NMHP) in 1982 in accordance with WHO's recommendations to deliver mental health services to the people under the framework of general health care system in the community. NMHP underwent major strategic revisions over its course, starting from setting a district as the unit for program planning and implementation under the District Mental Health Program (DMHP) to incorporating it with the National Rural Health Mission (NRHM) for effectively scaling up the program. The program also underwent evaluations by government bodies and independent agencies and was reviewed by many researchers. The program has been partly successful in terms of enhancing its reach to community, improving service delivery, and getting increased budgetary allocation, but at the same time, its impact was limited by financial and human resource constraints, lack of community participation, ineffective training, poor NGO/private partnership, and lack of a robust monitoring and evaluation (M and E) system. The latest National Mental Health Policy and the incorporation of its objectives have given a new impetus to the ongoing NMHP, however, its implementation needs to be monitored and the impact is yet to be evaluated. We attempted to review the available literature pertaining to NMHP and DMHP to highlight the determinants of its outcome, with special emphasis on on-going programs and to provide some important future directions.
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Comorbidity of personality disorder among substance use disorder patients: A narrative review p. 517
Arpit Parmar, Gaurishanker Kaloiya
DOI:10.4103/IJPSYM.IJPSYM_164_18  
Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.
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ORIGINAL ARTICLES Top

Prevalence and predictors of abuse in elderly patients with depression at a tertiary care centre in Saurashtra, India p. 528
VK Patel, DS Tiwari, VR Shah, MG Patel, HH Raja, DS Patel
DOI:10.4103/IJPSYM.IJPSYM_18_18  
Context: Elder abuse has devastating consequences such as poor quality of life, psychological distress and loss of property and security. Abuse of elderly patients with depression has not been adequately researched in India. Aims: To explore the prevalence and predictors of abuse and its relation to various sociodemographic variables in elderly patients with depression. Settings and Design: A cross-sectional, observational study carried out at a tertiary care centre in Jamnagar. Methods and Materials: In all, 100 elderly patients with depression, attending Out Patient Department of Psychiatry at Shree M. P. Shah Government Medical College and Guru Gobind Singh Hospital, Jamnagar, were selected using simple random sampling by lottery method. Actual Abuse Tool and Elder Abuse Suspicion Index were used to detect abuse. Geriatric Depression Scale was used to assess depression, and Mini Mental State Examination was used to rule out dementia. Statistical Analysis: Descriptive statistics, Chi-square test, and binary logistic regression were used. Results: The prevalence of abuse was 24%. Among those who had experienced abuse, 50% had experienced psychological abuse, 17% had experienced neglect, 8% had experienced exploitation and 4% had experienced physical abuse. About 54% of patients with severe depression had experienced abuse. Daughters-in-law (54%) and sons (42%) were the most common perpetrators. Illiteracy and severe depression were found to be the predictors of abuse. Conclusion: Prevalence of abuse in elderly patients with depression is high. Severe depression and illiteracy are important predictors of experiencing abuse.
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Study of domestic violence among currently married females of Haryana, India p. 534
Anuradha Nadda, Jagbir S Malik, Ravi Rohilla, Savita Chahal, Vinod Chayal, Varun Arora
DOI:10.4103/IJPSYM.IJPSYM_62_18  
Background: No nation is untouched by domestic violence, and it is well-known that domestic violence has serious impact on women's health and well-being. The present study aimed to assess the prevalence and characteristics of domestic violence and injuries owing to domestic violence among currently married women. Materials and Methods: This was a community-based, cross-sectional study conducted in the rural and urban areas of Haryana. In total, 880 currently married females of the reproductive age group were interviewed using the Women's Questionnaire (used in National Family Health Survey-3) which is according to the Modified Conflict Tactics Scale. Results: Totally, 37% of the females had ever experienced domestic violence and 28.9% currently experienced domestic violence. All types of violence (except sexual violence) were significantly more common in the rural area than the urban area. Injuries owing to domestic violence were reported by more than half (55.4%) of the women. Among spousal violence, emotional violence was the most common type of violence followed by physical violence. Only 0.1% and 4.5% of females had ever initiated physical and emotional violence respectively, against their husbands, and in rest of the cases, it was the husband who initiated violence. Conclusion: Awareness regarding domestic violence needs to be made, and law enforcement regarding it needs to be made stringent. Rehabilitation of victims of domestic/spousal violence should also be considered on priority.
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Intimate partner violence and psychiatric comorbidity in infertile women - A cross-sectional hospital based study p. 540
Swapna Bondade, Rupa S Iyengar, BK Shivakumar, KN Karthik
DOI:10.4103/IJPSYM.IJPSYM_158_18  
Background and Aim: In Asian countries, child bearing is a social obligation. Experience of infertility profoundly affects the personal well-being of women. Women with infertility are at a higher risk of anxiety, depression, and Intimate partner violence (IPV). In this background the present study was carried out to determine IPV and psychiatric comorbidity in women with infertility. Methods: Hundred consecutive women with primary infertility in the age group of 18 years to 45 years were included in the study. Psychiatric diagnosis was made according to DSM-5. Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D) were used to assess the severity of the anxiety and depressive symptoms. IPV was assessed using WHO violence against women instrument. Results: The mean age of the 100 women was 26.73 ± 4.23 years, duration of marriage was 7.11 ± 4.177 years and duration of infertility treatment in years was 5.56 ± 3.89. The prevalence of IPV among patients was 50% and psychiatric comorbidity was 46%. When we compared the women who experienced IPV and who did not, the prevalence of anxiety disorder and depressive disorder was high among IPV group. Anxiety, depressive scores in HAM A, HAM D were higher in IPV group compared to the other group and was statistically significant. Conclusion: A significant number of women who had infertility reported IPV. This emphasizes the importance of screening for IPV in these women. It is observed that women with IPV had higher psychiatric comorbidity and may require psychotherapeutic intervention.
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Trait impulsivity in alcohol-naïve offspring at high risk for alcoholism Highly accessed article p. 547
Rajesh Kumar, Keshav J Kumar, Vivek Benegal
DOI:10.4103/IJPSYM.IJPSYM_92_18  
Background: Impulsivity is considered to be a vulnerability marker for substance use disorders, including alcoholism, in offspring with familial alcoholism. However, it is not adequately explored whether different age groups offspring at high risk for alcoholism differ in their impulsivity. The present study examined trait impulsivity in offspring at high risk for alcoholism, and further examined impulsivity by categorizing these offspring into different age groups. The study also examined the association between impulsivity and age, and the association of executive functions with age and education. Materials and Methods: Sample consisted of alcohol-naïve offspring at high (n = 34) and low (n = 34) risk for alcoholism. Participants were matched on age (±1 year), education (±1 year), and gender. The measures included were: Mini-international neuropsychiatric interview, family interview for genetic studies, sociodemographic data sheet, Annett's handedness questionnaire, Barratt's Impulsiveness Scale-version 11, and tests assessing executive functions. Results: Offspring at high risk for alcoholism demonstrated significantly high impulsivity. Furthermore, offspring at high risk were categorized into three subgroups with age. Results showed no significant difference between the subgroups with respect to impulsivity. Correlation analysis revealed no significant association between impulsivity and age. However, executive functions (concept formation, working memory, and safe decision-making) showed significant positive association, while perseveration and risky decision-making showed a negative association with age and education in both the groups. Conclusion: The present study demonstrates high impulsivity trait in offspring at high risk for alcoholism. The high impulsivity could pose a risk for addiction and may require preventive intervention.
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Quality of life and its relationship with perceived stigma among opioid use disorder patients: An exploratory study p. 556
Swarndeep Singh, Saurabh Kumar, Siddharth Sarkar, Yatan Pal Singh Balhara
DOI:10.4103/IJPSYM.IJPSYM_171_18  
Background: In view of recent global opioid epidemic and scarcity of literature assessing the quality of life (QoL) and stigma among opioid use disorder (OUD) patients, this study aimed to assess the overall QoL and examine its relationship with perceived stigma among them. Materials and Methods: This cross-sectional study assessed patients with OUD at a tertiary care centre. QoL was assessed using the World Health Organization Quality of Life-brief version, whereas perceived stigma was measured using the Perceived Stigma of Substance Abuse Scale (PSAS). Results: Among 168 patients with OUD, all the four domain-wise scores of physical health (r = 0.79, P < 0.01), psychological health (r = 0.87, P < 0.01), social relationships (r = 0.78, P < 0.01) and environment (r = 0.80, P < 0.01) QoL correlated significantly with average score, with maximum impairment noted in the social domain. The mean PSAS score was 21.19 ± 2.99, with perceived stigma found to be significantly associated with impairments in the physical (β = –0.28, P < 0.01), psychological (β = –0.27, P < 0.01) and environment (β = –0.21, P < 0.01) domains of QoL. Furthermore, being employed was significantly associated with impairment in the social domain of QoL (β = –0.17, P = 0.02). Conclusion: OUD similarly affects all the four domains of QoL, with a higher level of perceived stigma associated with significantly poorer QoL in the physical, psychological and environment domains. However, future studies assessing different forms of stigma and QoL among patients with OUD are needed to confirm and better characterise the findings of this study.
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ECT in the postpartum period: A retrospective case series from a tertiary health care center in India p. 562
Sandeep Grover, Swapnajeet Sahoo, Subho Chakrabarti, Debashish Basu, Shubh M Singh, Ajit Avasthi
DOI:10.4103/IJPSYM.IJPSYM_105_18  
Objective: To evaluate the clinical profile and effectiveness of ECT in females with postpartum onset psychiatric syndromes or worsening of psychiatric disorder during the postpartum period. Materials and Methods: A retrospective chart review was carried out to identify females who had received ECT during their postpartum period from January2004 to April 2017. Results: During the study period, 13 females in their postpartum period received ECT, which accounted for 2.24% of the total females (n = 578) who had received ECT and 1% of total patients who were administered ECT during this period. The most common clinical diagnosis was postpartum depression (n = 7; 53.86%). Three (23.1%) patients were diagnosed with bipolar disorder and had experienced a relapse during the postpartum period. Two (15.4%) patients were diagnosed with schizophrenia and 1 (7.7%) patient was diagnosed with postpartum psychosis/acute and transient psychotic disorder. ECT was considered as a treatment of choice in 9 (69.2%) patients. All the patients with depression or mania achieved clinical remission, and patients with psychotic disorders also had significant reduction in their symptoms. Cognitive complaints were reported by 4 (30.8%) patients, and aches and pains after ECT were reported by 7 (53.8%). Conclusion: ECT is a safe and effective treatment option in postpartum onset psychiatric syndromes or patients experiencing relapse or exacerbation of severe mental disorders during the postpartum period and is associated with a very good response rate with minimal or no complications.
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BRIEF COMMUNICATION Top

An Indian, comic-based, online-EEG paradigm for theory of mind: An exploratory, pilot study on schizophrenia patients p. 568
Sayli Agashe, Trisha Walia, Deyashini L Tikka, Basudeb Das, Daya Ram, Sai K Tikka
DOI:10.4103/IJPSYM.IJPSYM_238_18  
Background: False-belief (FB) tasks are used to assess the theory of mind (ToM) functioning, which has been found to be impaired in schizophrenia. FB task stimuli used so far in neuroimaging studies in schizophrenia have been sentence-based ones. We aimed to validate an Indian, colour-comic based FB task by using an online-electroencephalogram (EEG) paradigm discriminating schizophrenia patients and healthy controls. Materials and Methods: Fifteen schizophrenia patients and 15 healthy controls performed online FB task during a 256-channel-EEG recording. 'Content' and 'known-groups' validity were examined using offline behavioural measures. Evoked gamma spectral-power in four regions of interest (ROIs) was compared between groups. Social functioning was also assessed. Results: Strength of classifying the groups was significant for both the number of correct responses and the reaction-times on the FB tasks. Social functioning was found to be poorer in patients. On the comparative analysis of evoked gamma spectral-power in the ROIs, very small effect size and observed power were noted. Conclusion: 'Content' and 'known-groups' validity of the culturally undermined comic-based FB task are good. Our findings reiterate that ToM functioning is impaired in schizophrenia. Our results were inconclusive in inferring whether evoked gamma spectral-power could be used as a neural validator for poor ToM functioning.
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CASE REPORTS Top

Is menstrual psychosis a forgotten entity? p. 574
Ashvini Vengadavaradan, Gopinath Sathyanarayanan, Pooja Patnaik Kuppili, Balaji Bharadwaj
DOI:10.4103/IJPSYM.IJPSYM_205_18  
The connection between menstruation and psychosis has been recognized since the 18th Century. However, there are few case reports available in modern times describing about 30 patients with this condition. The psychosis may occur in the premenstrual phase in some patients and in others it begins with the onset of menses. Polymorphic psychosis is the commonly described clinical picture in these patients with an admixture of mood symptoms and psychotic symptoms. We describe a 42-year old lady who developed psychotic symptoms with the onset of her menses. The patient had irritability and aggression, persecutory ideas, hallucinatory behavior, increased religiosity, formal thought disorder, disorganized behavior and poor self-care lasting for about 20 days after which she will spontaneously remit for about 10 days till the onset of her next menses. These symptoms began about 13 years after her last childbirth and were present in this cyclical manner for the last seven years. She was admitted in view of gross disorganization and was treated with 4 mg per day of risperidone. She did not develop symptoms with onset of her next menstrual period and was discharged. She maintained well on the prophylaxis for a period of three months. After that, she discontinued medications and had a relapse of symptoms lasting the first two weeks of her menstrual cycle and remained well for about two weeks thereafter. Hormonal assays did not reveal abnormal levels of gonadal hormones. We discuss the association between menstrual cycles and the potential association of psychosis with estrogen levels. Various conditions that lead to fluctuation in estrogen levels, such as menopause, postpartum period as well as post-oopherectomy period have been described to lead to a risk for psychotic symptoms. Similarly, the cyclical changes in estrogen levels during the course of a menstrual cycle leads to psychosis in some women.
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Lithium-induced thyroiditis in a patient having bipolar affective disorder - A rare case report p. 577
Praveen Arathil, Kotchuthressia Mathew, Dinesh Narayanan
DOI:10.4103/IJPSYM.IJPSYM_403_17  
A 22-year-old female, previously diagnosed with bipolar affective disorder on lithium therapy, presented to us with manic symptoms. The blood investigations revealed elevated thyroxine and thyroid peroxidase antibodies and reduced thyroid-stimulating hormone with poor tapping function of thyroid on technetium thyroid scintigraphy indicating lithium-induced thyroiditis.
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Depression with chronic inflammatory demyelinating polyneuropathy p. 580
Arun Marwale, Manaswi Gautam, Gaurav Murambikar, Manik Bhise, Anand Soni
DOI:10.4103/0253-7176.234798  
Depression and chronic inflammatory demyelinating polyneuropathy (CIDP) both are chronic illness of different etiopathology and are usually not looked for together while screening a patient. However, both have got a long incubation period as well as have an overlapping symptom profile. Rarely, cases reported in literature talk both together. Here, we report a rare case with depression complicated by CIDP managed together to improve outcome of depression.
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LETTERS TO EDITOR Top

Internet phobia: A case report p. 584
Virupakshappa Irappa Bagewadi, Soumitra Das
DOI:10.4103/IJPSYM.IJPSYM_460_17  
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Are the therapeutic qualities of cannabis reinforcing its abuse? A case report p. 585
Manjula Simiyon, Pradeep Thilakan
DOI:10.4103/IJPSYM.IJPSYM_87_18  
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Comments on “How do our patients respond to the concept of psychiatric advance directives? An exploratory study from India” p. 587
Vinutha Ramesh, Aditya Somani
DOI:10.4103/IJPSYM.IJPSYM_352_18  
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Authors' response to the comments on “How do our patients respond to the concept of psychiatric advance directives? An exploratory study from India” p. 588
Bheemsain Tekkalaki, Veerappa Y Patil, Sandeep Patil, Sameeran S Chate, Ramling Dhabale, Nanasaheb M Patil
DOI:10.4103/IJPSYM.IJPSYM_402_18  
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Internal, external, and ecological validity in the context of studies on advance directives p. 589
Venkata L Narasimha, Sagar Karia, Chittaranjan Andrade
DOI:10.4103/IJPSYM.IJPSYM_365_18  
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Comments on “Specific learning disabilities: Issues that remain unanswered” p. 590
Varsha Vidyadharan, MT Harish
DOI:10.4103/IJPSYM.IJPSYM_384_18  
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Authors' response to the comments on “Specific learning disabilities: Issues that remain unanswered” p. 591
Adarsh Kohli, Samita Sharma, Susanta Kumar Padhy
DOI:10.4103/IJPSYM.IJPSYM_389_18  
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Comments on “Prenatal depression and infant health: The importance of inadequately measured, unmeasured and unknown confounds” p. 592
Tarun Verma
DOI:10.4103/IJPSYM.IJPSYM_306_18  
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Author's response to comments on “Prenatal depression and infant health: The importance of inadequately measured, unmeasured and unknown confounds” p. 594
Chittaranjan Andrade
DOI:10.4103/IJPSYM.IJPSYM_411_18  
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Comments on “A study of magnitude and psychological correlates of smartphone use in medical students: A pilot study with a novel telemetric approach” p. 596
Sidharth Arya, Venkata Lakshmi Narasimha
DOI:10.4103/IJPSYM.IJPSYM_385_18  
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Authors' response to comments on “A study of magnitude and psychological correlates of smartphone use in medical students: A pilot study with a novel telemetric approach” p. 597
Saras Prasad, Devavrat Harshe, Navneet Kaur, Sudha Jangannavar, Aishwarya Srivastava, Unnati Achanta, Samra Khan, Gurudas Harshe
DOI:10.4103/IJPSYM.IJPSYM_431_18  
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Comments on “Screening for mental health disorders among pregnant women availing antenatal care at a government maternity hospital in Bengaluru city” p. 598
Jayant Mahadevan, Bheemsain Tekkalaki, Venkata Lakshmi Narasimha, Ramdas Ransing, Chittaranjan Andrade
DOI:10.4103/IJPSYM.IJPSYM_354_18  
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LEARNING CURVE Top

How to read a research paper: An exercise using a study on continuation vs. discontinuation of antidepressants during pregnancy p. 600
Chittaranjan Andrade
DOI:10.4103/IJPSYM.IJPSYM_424_18  
The ability to critically read a research paper is a skill that all postgraduate students and academicians require because the findings of a study must be interpreted in the context of its strengths and limitations. This article summarizes a recent study on continuation vs. discontinuation of antidepressants during pregnancy; preterm birth and low-birth weight were the outcomes of interest. The strengths and limitations of the study are considered, as are the best and worst case scenarios related to antidepressant use during pregnancy. It is hoped that this exercise will increase the reader's awareness of statistical and methodological issues that emerge when a study is critically examined.
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ERRATUM Top

Erratum: Two-year follow-up of isolated epileptiform discharges in autism: An endophenotypic biomarker? p. 602

DOI:10.4103/0253-7176.245092  
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