Indian Journal of Psychological Medicine
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   Table of Contents - Current issue
Coverpage
March-April 2020
Volume 42 | Issue 2
Page Nos. 105-206

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GUEST EDITORIAL  

Are specialist treatment services needed for doctors with mental health problems? p. 105
Sanju George, Sandip Deshpande, Roy A Kallivayalil
DOI:10.4103/IJPSYM.IJPSYM_313_19  
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REVIEW ARTICLE Top

Prevalence and factors associated with burnout among healthcare professionals in India: A systematic review and meta-analysis p. 108
Vartika Kesarwani, Zeeshan Gulam Husaain, Jaiben George
DOI:10.4103/IJPSYM.IJPSYM_387_19  
Background: With increasing workload and dismal working conditions, healthcare professionals (HCPs) in India often suffer from burnout. Understanding the extent of these problems and the contributing factors is necessary to build a healthy workforce capable of serving the society. The purpose of this study was to systematically review and analyze: 1) the prevalence of burnout among HCPs in India and 2) the factors associated with burnout in this population. Methods: A systematic search of MEDLINE and EMBASE, from the inception of these databases to October 2019, was conducted using keywords. The search results were screened to identify studies evaluating burnout among HCPs in India using a standard burnout tool. Using a random effect model, the pooled prevalence of burnout was estimated using Maslach Burnout Inventory (MBI) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Risk factors for burnout were assessed qualitatively. Results: A total of 15 studies assessing burnout in 3845 Indian HCPs were identified. The pooled prevalence of burnout was 24% in the EE domain, 27% in the DP domain, and 23% in the PA domain. Younger age, female gender, unmarried status, and difficult working conditions were associated with increased risk of burnout. Conclusion: Burnout is highly prevalent among Indian HCPs, with close to one-fourth of them suffering from burnout. A number of personal and professional factors are associated with burnout, and these should be considered while developing solutions to tackle burnout.
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ORIGINAL ARTICLES Top

Pattern and correlates of depression among medical students: An 18-month follow-up study p. 116
Shabna Mohammed, Harish Tharayil, Soumya Gopakumar, Christina George
DOI:10.4103/IJPSYM.IJPSYM_28_19  
Background: Medical students are subjected to various challenges, which are possibly etiological in the onset and persistence of depression. There is inadequate research on the longitudinal pattern and correlates of the emotional health of medical students in India. We aim to delineate the longitudinal pattern of depression among medical students and the factors predictive of depression. Methods: An 18-month follow-up design with 350 students (2012 intake) from two medical colleges in Kerala, India, was employed. A semistructured questionnaire and the Patient Health Questionnaire 9 were administered 2, 8, and 18 months into the course. Results: Depression was present in 42.80%, 36.20%, and 42.50% of the students at the three assessments. Variables significantly associated with depression on univariate analysis were the course not being of the student's choice at the first assessment; having an unemployed parent (mother) at the second assessment; alcohol use and male gender at the third assessment. On multivariate analysis, male gender (OR = 1.95[1.11–3.41]) and the presence of depression at 2 months (OR = 2.30[1.31–4.05]) and 8 months (OR = 2.48[1.39–4.44]) were predictive of depression at 18 months. Conclusions: The high rates of depression and the pattern of high rates early in the course among the medical students contrasts with that reported from other countries. Early depression and male gender were predictive of depression later in the course. The implications of this are to be taken into consideration when undergraduate intervention programs are planned.
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Prevalence and correlates of burnout among undergraduate medical students – A cross-sectional survey p. 122
K Vidhukumar, Majida Hamza
DOI:10.4103/IJPSYM.IJPSYM_192_19  
Background: Burnout among medical students is important for its prevalence, consequences, and modifiable risk factors. Although there are studies on the topic across the globe, Indian studies are few in number. A prevalence estimate of burnout and its determinants among Indian medical graduates will keep us informed about the emotional and motivational factors hindering their professional growth. Methods: From a total of 500 students spanning 5 professional years, data could be collected from 375 students. The study used a questionnaire primarily consisting of “personal burnout” domain of the Copenhagen Burnout Inventory (CBI), which is a validated instrument to assess the burnout at a cutoff score of 50. The questionnaire also included a set of potential personal correlates of burnout. In addition to summary statistics, both univariate and multivariate analyses were used for discerning the relationship of these correlates with burnout. Results: The prevalence of burnout among medical students in the college under study was 48.5% (95% confidence interval 43.4–53.7). The proportions of moderate, higher, and severe burnout were 44.8%, 3.2%, and 0.5% respectively. Univariate and multivariate analyses revealed that female gender and perceived stress were associated with burnout. Choosing medicine by one's own choice and maintaining hobbies and interests were associated with less chance for burnout. Conclusion: Burnout is a prevalent phenomenon among medical students. There are modifiable risk factors for burnout and addressing them will help in training a medical student with high motivation and professionalism.
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Problematic internet use, mental health, and sleep quality among medical students: A path-analytic model p. 128
Mohammad Reza Shadzi, Alireza Salehi, Hossein Molavi Vardanjani
DOI:10.4103/IJPSYM.IJPSYM_238_19  
Background: There is a close association between problematic Internet use (PIU), sleep quality, and mental health problems. To evaluate which mental health problem is more associated with coexistence of both PIU and poor sleep quality, we hypothesized a model in which PIU influences sleep quality directly and also through the mediation of three different mental health problems. Methods: A total of 402 medical students completed the Persian versions of the Internet Addiction Test, 21-item Depression Anxiety Stress Scale, and Pittsburgh Sleep Quality Index. A maximum likelihood structural equation model was used to assess the hypothesis. For assessment of the indirect effects, bootstrapping was conducted. Results: PIU predicted poor sleep quality through indirect pathways by the mediation of mental health problems (P < 0.001). Poor sleep quality were associated with depressive symptoms (P < 0.001), anxiety (P = 0.035), and stress (P < 0.001); however, the direct pathways from stress and anxiety to poor sleep quality were not statistically significant (P > 0.05). Conclusion: Findings extend our previous knowledge about the interrelationships between PIU, sleep disturbances, and mental health problems by unveiling the key role of depressive symptoms.
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Non-scholastic qualities and their association with social media usage among medical students in Puducherry, India p. 136
Sahla Sathar, S Ganesh Kumar, Srikanta Kanungo
DOI:10.4103/IJPSYM.IJPSYM_197_19  
Background: Non-scholastic qualities, namely personal characteristics, interpersonal activities, and communication skills, are needed for the effective functioning of a medical professional. The study aimed to assess non-scholastic qualities and their association with social media usage among medical students. Methods: This is a descriptive, cross-sectional study in a tertiary care medical institution in Puducherry, coastal south India. The non-scholastic qualities were assessed by standard questionnaire and categorised as low, moderate and high qualities. Social media usage was assessed by SONTUS (Social Networking Time Use Scale) and the participants were categorised as low, average, high, and extremely high users. Multiple logistic regression analysis was done. Results: Out of 270 medical students, 63% belonged to the moderate non-scholastic quality category. About 36% of the students had high non-scholastic quality. Most of the students were extremely high users of social media (60%). About 48% (47/98) of students with high non-scholastic qualities had extremely high social media usage, while 67% (115/172) of students with low and moderate non-scholastic qualities had extremely high social media usage, and both the associations were statistically significant (P = 0.003). Those with a high level of social media usage had 2.27 times (95% CI: 1.239-4.166) higher non-scholastic qualities compared to extremely high social media usage. Conclusions: The majority had moderate non-scholastic qualities and extremely high use of social media.
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Sleep quality and daytime sleepiness among the clinicians working in a tertiary care center in Sikkim, India p. 141
Rishav Dey, Sanjiba Dutta, Samrat Singh Bhandari
DOI:10.4103/IJPSYM.IJPSYM_439_18  
Background: Doctors in India have increased workload and are at risk for poor sleep and excessive daytime sleepiness which have not been explored much. Methods: One hundred doctors selected by convenience sampling from different departments of the hospital were assessed cross-sectionally. Physical parameters which were assessed included height, weight, blood pressure, and diabetes status. Other variables assessed included durations of duty hours and social media usage. Sleep quality and daytime sleepiness were assessed with the Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS), respectively. Results: Mean age of the participants was 35.3 years with a SD of 6.21. In all, 42% were female. The overall prevalence of poor quality of sleep was 28.3%. Among the participants, junior and senior residents were the most affected; 45% of the junior residents were having a poor quality of sleep. Daytime sleepiness was significantly more common among the junior residents as compared with doctors of other designations (P =0.02). The mean duration of duty hours was highest for the junior residents. Male participants were more likely to be obese and to have systemic hypertension. No significant difference was found for social media usage among different designations or gender. Conclusion: Poor sleep quality and excessive daytime sleepiness are highly prevalent among the doctors, especially those who are lower in the hierarchy. Interventions for physical and psychological morbidity among the doctors and strict implementation of guidelines governing duty hours and call schedule of junior physicians are recommended.
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Emotion recognition, emotion awareness, metacognition, and social functioning in persons with schizophrenia p. 147
Radhika Kolavarambath, Paulomi M Sudhir, PV Prathyusha, Jagadisha Thirthalli
DOI:10.4103/IJPSYM.IJPSYM_149_19  
Background: Emotion processing has received significant research attention in persons with schizophrenia. However, some aspects of this construct, such as emotion awareness, are less researched. In addition, there is limited work on metacognitive awareness and social functioning in persons with schizophrenia. Methods: Our sample comprised of 27 participants with schizophrenia- and 26 nonclinical controls. The clinical group was assessed on Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Tool for Recognition of Emotions in Neuropsychiatric Disorders, Toronto Alexithymia Scale, Metacognitive Assessment Scale, self-reflectiveness subscale of Beck's Cognitive Insight Scale, Scale S and Scale U subscales of the Metacognitive Assessment Scale, and Groningen's Social Dysfunction Scale. Results and Conclusion: Participants with schizophrenia had greater deficits in emotion recognition than nonclinical controls (P = 0.05, df = 51). There was no significant correlation between emotion recognition and metacognition in the clinical group. The presence of negative symptoms was significantly associated with social functioning in persons with schizophrenia.
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Neurocognitive profile in Indian individuals genetically at risk of schizophrenia p. 155
Sunny Chattopadhyay, Nanasaheb M Patil, Raghavendra B Nayak, Sameeran S Chate, Om P Singh
DOI:10.4103/IJPSYM.IJPSYM_243_19  
Background: Cognitive deficits have been noted in patients of schizophrenia in remission, as well as in first-degree relatives. This study aims to evaluate the neurocognitive performance in unaffected first-degree relatives of patients of schizophrenia in comparison with healthy controls, as well as patients of schizophrenia in remission. Methods: It was a 1-year case-control study by purposive sampling. Patients with a diagnosis of schizophrenia, first-degree relatives of patients of schizophrenia, and controls from nongenetic relatives of patients were recruited as per inclusion and exclusion criteria. Samples were matched for age and educational status. The General Health Questionnaire 28 (GHQ-28) screened them and they were checked for remission by Positive and Negative Syndrome Scale (PANSS) and then subjected to various instruments for assessment of neurocognition, standardized for the Indian population. To remove the effect of symptoms as confounding factors, PANSS score of <3 for each individual item was set as the criterion for remission. Intelligence quotient (IQ) was screened in all participants to exclude mental retardation. Statistical analysis used was the analysis of variance (ANOVA) with post hoc Fisher's least significant difference (LSD). Results: Significant neurocognitive impairments were detected in the patients and first-degree relatives when compared with the control subjects. The most common impairment in the patient group was in speed of processing, and among unaffected first-degree relatives, it was in the working memory. Conclusion: Indian individuals genetically at risk of schizophrenia showed significant neurocognitive impairments in all domains compared with controls.
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Olanzapine pamoate use for schizophrenia: Retrospective records based study from a tertiary care hospital p. 162
Sandeep Grover, Himanshu Singla, Subho Chakrabarti, Ajit Avasthi
DOI:10.4103/IJPSYM.IJPSYM_269_19  
Background: Little is known from India about the experience of using olanzapine long-acting antipsychotic injectables (LAI). In this background, this study aimed to evaluate the clinical profile of patients suffering from schizophrenia who were prescribed olanzapine LAI and to evaluate the usefulness and acceptability of olanzapine LAI among these patients. Methods: In this retrospective study, data of all the patients with schizophrenia receiving olanzapine pamoate, was extracted. Results: 40 patients (males-55%; mean [SD] age- 36.2 (12) years; mean duration of illness (SD) prior to depot-143.3 (115.9) months) were included in the study. Olanzapine LAI was invariably prescribed in patients with a past history of non-compliance. Data was available for a mean (SD) follow-up duration of 17 (10.8) months. The most frequently used dose of olanzapine LAI used was 300 mg every two weeks (55%). This was followed by 405 mg every four weeks in (32.5%). Mean Clinical Global Impression (CGI) Severity score prior to starting of olanzapine LAI was 5.8 (0.7), which reduced to 2.7 (1.1) at the time of last follow-up or the last use of olanzapine LAI, and this was a statistically significant improvement (paired t-test value = 16.41; P < 0.001). Only one (2.5%) patient experienced Post injection Delirium/Sedation Syndrome during the study period. Only one patient was hospitalized after starting depot olanzapine. Conclusion: Olanzapine LAI is mostly used in patients with a history of non-compliance. Olanzapine LAI is associated with a significant reduction in the severity of illness.
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Suffering in silence: Stories of Indian women with chronic mental illness and sexual coercion p. 168
Akanksha Rani, Fahim Ul Hassan
DOI:10.4103/IJPSYM.IJPSYM_296_19  
Background: Patriarchy exposes women to various forms of discrimination and oppression. Women are more often blamed for mental illness, which can result in social isolation and stigma. Method: Case Study. Results: Psycho-social intervention aided in empowering women by giving them voices to speak as well as by utilizing their strengths and available community resources to develop a sense of self-efficacy, coping strategies, and support system. Conclusion: Women with chronic mental illness have unique needs and challenges. Mentally ill women face sexual coercion in childhood or adulthood. The factors related to help-seeking in the context of abuse were family reactions, social support, and stigma. Our findings highlight the need to conduct risk assessments and provide community-based and coordinated services during follow-up visits.
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Relationship between the level of motivation and personality disorder in patients with opioid dependence syndrome p. 175
Manu Sharma, Sankalp Doda, Devendra Mohan Mathur, Jitendra Jeenger
DOI:10.4103/IJPSYM.IJPSYM_217_19  
Background: The relationship between the level of motivation and personality disorder (PD) in patients with opioid dependence syndrome is understudied. Method: A cross-sectional study was conducted on consecutively selected 100 adult inpatients with opioid dependence syndrome. All participants were assessed on ICD-10-AM Symptom Checklist for Mental Disorders, University of Rhode Island Change Assessment (URICA), Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES 8D), International Personality Disorder Examination (IPDE), and Severity of Opioid Dependence Questionnaire (SODQ). Results: Most patients expressed the level of motivation at contemplation level, medium level of recognition for the need for change, and high levels of ambivalence and taking steps for change. PD was diagnosed in 40% of the patients. The most common PD identified was dissocial, followed by an emotionally unstable personality disorder-impulsive type. There was no statistically significant difference in URICA, SOCRATES 8D, or SODQ scores in opioid-dependent patients with and without PDs. Patients with severe opioid dependence reported higher readiness to change. Conclusion: Most of the patients with opioid dependence syndrome presenting for treatment are at the contemplation level of motivation. More than one-third of patients with opioid dependence syndrome have PD. A diagnosis of comorbid PD is unrelated to the level of motivation in patients with opioid dependence syndrome. Further multicentric research on personality and PD in a diverse sociocultural population with opioid use disorders is needed.
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Effectiveness of a structured training module on different learning domains among yuva parivarthakas under yuva spandana program p. 182
S Pradeep Banandur, Gautham M Sukumar, Mutharaju Arelingaiah, Lavanya Garady, Jyoti M Koujageri, Sateesh L Sajjanar, Basavaraj Hadapad, MS Ramesh, Gururaj Gopalkrishna
DOI:10.4103/IJPSYM.IJPSYM_144_19  
Background: Yuva Spandana (YS) is a youth mental health promotion program implemented across all 30 districts of Karnataka. Yuva Parivarthakas (YPs - youth change agents) are trained to provide mental health promotion services to any “youth with issues” through Yuva Spandana Kendras (guidance centers) situated within district stadiums across Karnataka. Aim of the study was to evaluate the change (comparing before and after training) in different learning domains (cognitive – knowledge, affective – attitude, and psychomotor – practice) among trainees (YPs) attending YS training. Methods: Quasiexperimental study design was utilized for this study. A semistructured interview schedule was developed and used before and after the training. Data were analyzed by descriptive statistics. The difference in change of mean score was assessed using the paired t-test. The shift in the proportion of trainees post-training in the three domains was assessed using McNemar's test. Results: The mean (±SD) age of trainees was 27.5 ± 3.3 years. Majority of them were males (63.8%), had completed bachelor's degree (53.4%), and were residing in rural Karnataka (77.7%). The knowledge and attitude scores significantly improved (P < 0.001) post-training, without significant improvement in practical skills. Conclusion: It is recommended that future training programs need to be focused on creating opportunities to YPs in order to increase their practical skills to work with youth having issues.
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VIEWPOINT Top

Psychiatry's future: Biology, psychology, legislation, and “the fierce urgency of Now p. 189
Brendan D Kelly
DOI:10.4103/IJPSYM.IJPSYM_492_19  
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PRACTICAL PSYCHOTHERAPY Top

Clinical hypnotherapy in grief resolution - A case report p. 193
Aarzoo Gupta, Ajeet Sidana
DOI:10.4103/IJPSYM.IJPSYM_476_19  
Grief is one's reaction to any loss, and the coping mechanisms during grief either deplete or become maladaptive. One of the common ways to cope with grief is alcohol or substance intake. The course and resolution of grief vary depending upon many factors. Hypnotherapy has been useful and effective in addressing grief reactions as well as associated manifestation, such as sleep problems, depressive features, or post-traumatic stress disorder. It might be a good choice of treatment while dealing with patients having underlying issues or maladaptive coping mechanisms. This is a single case study design hypothesized to indicate maladaptive coping of increased alcohol consumption to deal with the death of a young son. The case had been treated as alcohol dependent syndrome with multiple hospitalizations without addressing underlying grief. The treatment approach was changed, and grief was addressed using hypnotherapy. Clinical hypnotherapy helped address grief and facilitated the index case to accept the loss. This resulted in minimizing hospitalizations, abstinence and improved day-to-day functioning along with the use of adaptive mechanisms to cope with the loss. Clinical hypnotherapy is an effective intervention to deal with underlying conflicts or issues that may not be addressed directly in a therapy setting.
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LETTERS TO EDITOR Top

Gender Differences in Auditory P300 Event.Related Potential in Indian Population p. 198
NA Uvais, S Haque Nizamie, Basudeb Das, Mohammad Z. U H. Katshu, VS Sreeraj
DOI:10.4103/IJPSYM.IJPSYM_329_19  
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Relationship between matrix metalloproteinase-9 and lifetime history of suicidal behavior in remitted patients with bipolar I disorder: A Cross-Sectional Pilot Study p. 200
Vigneshvar Chandrasekaran, Karthick Subramanian, Shivanand Kattimani, Hanumanthappa Nandheesha, Siddharth Sarkar, Venkatalakshmi Penchilaiya
DOI:10.4103/IJPSYM.IJPSYM_320_19  
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COMMENTS ON PUBLISHED ARTICLE Top

Comments on “nomophobia: A mixed-methods study on prevalence, associated factors, and perception among college students in Puducherry, India” p. 203
Arghya Pal, Arvinder P S. Aulakh
DOI:10.4103/IJPSYM.IJPSYM_15_20  
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LEARNING CURVE Top

Reverse causation, physical inactivity, and dementia p. 205
Chittaranjan Andrade
DOI:10.4103/IJPSYM.IJPSYM_45_20  
One variable may influence another as cause and effect. However, in situations in which a cause-effect relationship is scientifically plausible, reverse causation may also be possible. As an example, physical inactivity may predispose to dementia through cardiometabolic and other mechanisms. However, physical inactivity may also be a result of an ongoing dementia prodrome in which patients are physically slowed down during the years preceding the dementia diagnosis. This article examines reverse causation and how it was studied in a recent individual participant data meta-analysis of physical inactivity as a risk factor for dementia. This article also shows that other interpretations are possible when a finding suggests reverse causation.
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