Indian Journal of Psychological Medicine
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   Table of Contents - Current issue
July-August 2019
Volume 41 | Issue 4
Page Nos. 303-402

Online since Monday, July 15, 2019

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Beyond research reporting guidelines: How can the quality of published research be enhanced? Highly accessed article p. 303
Vikas Menon
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Women with mental illness – An overview of sociocultural factors influencing family rejection and subsequent institutionalization in India p. 306
Febna Moorkath, Mysore Narasimha Vranda, Channaveerachari Naveenkumar
Background: Family abandonment and rejection resulting in homelessness are detrimental to women diagnosed with mental illness in India. A majority of the literature related to homelessness holds a western background, and women's homelessness in relation to mental illness is relatively unexplored in the Indian context. This review was conducted to understand the sociocultural factors influencing family rejection and to synthesize the living situation of institutionalized women with mental illness in India. Methods: Literature search in electronic databases (PubMed, Google Scholar), carried out using appropriate keywords, and a manual search in the library catalog. Results: As per the selection criteria, 19 reports, including original research articles and conceptual papers, were included and reviewed. Conclusion: There is a shortage of methodologically sound research in understanding the connection of mental illness–women homelessness–and the institutionalization scenario. This review highlights the necessity of shifting focus from institutionalization to innovative psychiatric rehabilitation strategies using the Mental Healthcare Act, 2017.
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Eating disorders: An overview of Indian research Highly accessed article p. 311
Sivapriya Vaidyanathan, Pooja Patnaik Kuppili, Vikas Menon
There has been sporadic research on eating disorders in India, with no published attempt to collate and summarize the literature landscape. Hence, the present narrative review aims to summarize Indian work related to eating disorders, discern current trends, and highlight gaps in research that will provide directions for future work in the area. Electronic search using the MEDLINE, Google Scholar, and PsycINFO databases was done to identify relevant peer-reviewed English language articles, in October 2018, using combinations of the following medical subject headings or free text terms: “eating disorders,” “anorexia nervosa,” “bulimia,” “treatment,” “epidemiology,” “co-morbidity,” “management,” “medications,” “behavioral intervention,” and “psychosocial intervention.” The data extracted from studies included details such as author names, year, from which of the states in India the work originated, type of intervention (for interventional studies), comparator (if any), and major outcomes. There is increasing research focused on eating disorders from India over the last decade, but it continues to be an under-researched area as evidenced by the relative paucity of original research. The cultural differences between east and west have contributed to variations in the presentation as well as challenges in the diagnosis. Hence, there is a need for the development of culturally sensitive instruments for diagnosis, as well as generating locally relevant epidemiological data about eating disorders from community and hospital settings.
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Fear of childbirth among pregnant women availing antenatal services in a maternity hospital in rural Karnataka p. 318
Avita Rose Johnson, Melvin G Kumar, Rosy Jacob, Maria Arul Jessie, Fabiyola Mary, Twinkle Agrawal, Vijaya Raman
Background: Pregnancy, though joyful, may be a time of fear and anxiety. Twenty percent of pregnant women in developed nations report a fear of childbirth, and 6%–10% describe a severe fear that is crippling. This could lead to adverse maternal and fetal outcomes. Data on fear of childbirth among pregnant women are lacking in India and would help in incorporating measures to enhance routine antenatal care. Methodology: With the objective of documenting fear of childbirth and associated factors, a cross-sectional study was conducted in rural Karnataka among women availing antenatal care services, using a face-validated 30 item questionnaire developed by the authors which was then scored to determine fear of childbirth. Results: Of 388 women studied, 45.4% (176) had a fear of childbirth. The commonest fears documented were: not feeling confident about childbirth, being afraid or tense about the process of childbirth, fear of labor pains, and fear of cesarean section. Teenage pregnancy, nulliparity, primigravida status, and having no living child were significantly associated with fear of childbirth. Conclusion: Overall, 45.4% (176) of women had a fear of childbirth. It is important to identify and address the various fears of childbirth that women may have, as revealed by this study, with a view to providing information and reassurance to the mother, with the aim of improved maternal and fetal outcomes.
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Knowledge, attitude, and practice regarding contraception among women with schizophrenia: An observational study from South India p. 323
Bhuvaneshwari Sethuraman, Arun Rachana, Suja Kurian
Background: Women with schizophrenia have needs beyond their mental health needs, such as those arising out of their gender, sexual, and reproductive functions. Very little is known about the knowledge, attitude, and practice regarding contraception among women with schizophrenia from India. Materials and Methods: Study among women with schizophrenia (in reproductive age group, having at least one living child, and currently staying with husband) from south India explored their knowledge, attitude, and practice of contraception. Adhering to observational design and ethical principles, data were collected using a semi-structured questionnaire. Modified National Family Health Survey-3 questionnaire and Positive and Negative Symptom Scale of Schizophrenia were also used. Results: Ninety-six women with schizophrenia participated. The mean age was 33.5 years [standard deviation (SD): 6.8 years], and the mean age of onset of schizophrenia was 29.2 years (SD: 6.2 years). Although nearly 90% had knowledge on at least one method of contraception, the mean total number of methods known was mere two. Out of 65 women who were practising contraception, 86.2% adopted female sterilization. The common reasons for not using contraception were wish for another child/son, lack of awareness, and fear of side effects. Unmet need for family planning was 14%. Informed choice of contraception was below 3%. There was statistically significant association between those who were currently using contraception and variables such as age 31 years and above, undifferentiated subtype of schizophrenia, and greater severity of schizophrenia. Conclusion: Although the majority had some knowledge about contraception, decision-making largely rested with others, and informed choice regarding contraception was poor. These could pose an obstetric risk on women with schizophrenia. Sociocultural and illness-related factors influencing contraception need to be explored.
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Gender variability of perceived stress and negative inferential feedback in depression p. 331
Ajita S Nayak, Shubhangi R Parkar, Hrishikesh B Nachane, Bijal A Sangoi, Rashmi G Shinde
Background: The role of negative inferential feedback and perceived stress in hopelessness depression is known. However, studies on their gender variability are lacking. The difference in various domains of negative inferential feedback and its impact on cognitive hopelessness, depression, and outcome of psychotherapy between men and women has been hypothesized. Aims: This study analyzed the difference in stress levels and hopelessness in the form of negative inferential feedback in depressed men and women. Methodology: In all, 35 men and 35 women suffering from depression were recruited. They were first assessed on the Hamilton's Depression Rating Scale, and their sociodemographical details were recorded. They were then administered the Perceived Stress Scale (PSS) and the Adaptive Inferential Feedback Questionnaire. Results: Perceived stress in depressed women showed a positive correlation with negative inferential feedback (r = 0.39, P = 0.04). Levels of depression were comparable in the two genders. Comparison between the two genders showed no difference in proportion across the levels of severity of depression (χ2 = 5.44, P = 0.14). Depressed women rated higher stress, mainly in the helplessness domain of the PSS (P = 0.04). Women were shown to have more negative inferential feedback and attribute their hopelessness to more stable and global causes when compared with men (P = 0.04). Conclusion: Depressed women perceive more stress and receive more negative feedback, than men, to negative life events. Women attribute their hopelessness to more stable and global causes when compared with men.
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The level and sources of stress in mothers of infants admitted in neonatal intensive care unit p. 338
Jagdish R Varma, Somashekhar M Nimbalkar, Dipen Patel, Ajay G Phatak
Background: Hospitalization of a new-born child is stressful for parents. This study was done to determine the level and sources of stress in mothers of infants admitted in Neonatal Intensive Care Unit (NICU) and variance in stress by infant and maternal characteristics. Materials and Methods: Parental Stressor Scale for NICU was used as the primary outcome measure. Maternal socio-demography, maternal and infant characteristics such as gravidity, number of prenatal visits, perceived support from family members, perceived level of discomfort that the baby underwent, pregnancy and delivery complications, gestational age, sex, birth weight, length of NICU stay and ventilator support, and neonatal morbidity were also collected from maternal and infant hospital records. Results: Amongst these rural and poorly educated mothers, the appearance of the baby, sights and sounds of NICU environment were major sources of stress. Higher maternal stress was found to be associated with poor family support during pregnancy, mothers' perception of the baby's discomfort, lower birth weight of the baby, baby on ventilator, post-partum depression, and moderate to severe anxiety symptoms. Mothers who had higher levels of education and those with pregnancy complications were more stressed. Conclusions: Before designing remediation programs for parents, local demography and the predominant NICU stressors need to be kept in mind. Possibility of screening at-risk mothers by questioning them about perception of baby's discomfort needs to be evaluated further.
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Training and clinical impact of cognitive behaviour therapy workshops in a teaching hospital in North India p. 343
Arun Kumar Gupta, Eesha Sharma, Sujita Kumar Kar, Adarsh Tripathi, Thomas Reeves, Renuka Arjundas, Pronob Kumar Dalal
Background: Cognitive behaviour therapy (CBT) is an empirically supported psychotherapy with applications across psychiatric disorders. The demand for nonpharmacological interventions is increasing in the developing world. Unfortunately, existing resources are unable to cater to treatment and training needs. Methods: The aim of the current paper is to provide a description of the format of a series of CBT training workshops and their clinical impact in a psychiatric tertiary care center in north India. Over a period of nine years, nine training workshops were conducted. CBT concepts and skills sets were inculcated in faculty and student participants, using teaching strategies based on adult learning techniques. Results: The workshops resulted in a tremendous increase in the number of patients taken up for CBT. While therapeutic and training outcomes were not systematically assessed, the naturalistic outcomes (60 out of 85 patients completed therapy; improvement reported by >90% of the completers) are encouraging and showcase capacity building by means of CBT training in these workshops. Conclusions: CBT training workshops are an effective way to impart CBT skills and, therefore, to build CBT expertise in a resource-poor setting.
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Knowledge and attitudes toward sexual health and common sexual practices among college students – A survey from Vellore, Tamil Nadu, India p. 348
Arnab Mukherjee, Rajesh Gopalakrishnan, Packirisamy Thangadurai, Anju Kuruvilla, KS Jacob
Background: Indian society is considered to have conservative attitudes regarding sex and is ambivalent about the concept of sex education. Previous reports suggest that a considerable proportion of Indian youth have inadequate sexual knowledge and hold a variety of sexual misconceptions. Methodological flaws limit the generalizability of some earlier studies. Aims: This study assessed knowledge and attitude toward sexual health and common sexual practices among college students in Tamil Nadu. Methodology: A total of 952 students from seven randomly selected colleges in Vellore district of Tamil Nadu participated in the survey. The survey questionnaire contained 51 questions on knowledge and attitude toward sexual health and common sexual practices and incorporated items from standardized questionnaires and additional questions suggested by a multidisciplinary group who work in the field. Results: Two hundred seventy-five students among those who completed the survey were women. Higher knowledge scores were associated with older age, male gender, being from a rural background, pursuing non-science streams, and being in postgraduate courses. Nonconservative attitudes were associated with older age, male gender, enrollment in non-science disciplines, discomfort with the family environment, and a religious family background. Conclusions: Sexual knowledge is inadequate and sexual misconceptions were widely prevalent in the population studied. School-based comprehensive sex education programs, which have been demonstrated to be effective in improving sexual health, could be used to deal with these lacunae in sexual health knowledge and attitudes.
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The effectiveness of a brief psychological intervention for patients with diabetes-related distress p. 357
Dhanya Raveendranathan, Jismy George, Nandhini Lakshmana Perumal, Ashok Mysore
Background: Diabetes-related distress (DRD) is the negative emotional and psychological reaction to living with diabetes mellitus (DM). DRD has been reported to affect glycemic control and self-management practices adversely. Limited research is available on the effectiveness of psychological interventions for DRD. We aimed to study the effectiveness of a brief psychological intervention for patients with DRD. Methods: The findings of a targeted brief psychological intervention conducted for patients with DRD, as a part of psycho-endocrinology liaison services in a general hospital, are reported. Details regarding the assessment and intervention given were collected from the patients' records. Forty-one patients with DRD diagnosed using Diabetes Distress Scale (DDS) were given the single session intervention consisting of brief diabetes education focusing on physical activity and medication adherence, relaxation techniques, and illness-specific problem-solving strategies. Effectiveness was assessed using change in Clinical Global Impression-Severity (CGI-S), patient-rated visual analog scale, brief physical activity questionnaire, and medication adherence at baseline and 2-month follow-up. Results: Analysis using Wilcoxon signed rank test found a significant change in the follow-up scores on all the assessment scales. Conclusions: The study highlights the benefits of brief intervention for reducing DRD, thus reducing the emotional burden of living with DM.
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Correlation of cognitive resilience, cognitive flexibility and impulsivity in attempted suicide p. 362
Dushad Ram, Suhas Chandran, Aarsha Sadar, Basavana Gowdappa
Context: Impaired cognitive flexibility and resilience and increased impulsivity are presumed to underlie an attempt of suicide. There is, however, a paucity of research examining their relationship in those who attempted suicide. Aims: To know the correlation of cognitive flexibility and resilience and impulsivity in attempted suicide. Materials and Methods: Two hundred seventy subjects with suicide attempt (s) were assessed with sociodemographic and clinical proforma, cognitive flexibility scale (CFS), cognitive resilience scale (CRS), and Barratt impulsiveness scale (BIS-15). Statistical Analysis Used: Descriptive statistics, linear regression model. Results: Mean scores on CFS, CRS, and BIS-15 were 44.93 (SD ± 2.50), 4.49 (SD ± 0.25), and 36.13(SD ± 2.13), respectively. On linear regression analysis, BIS-15 nonplanning had statistically significant negative correlation with CFS and CRS scores, and BIS-15 attention had a positive correlation with CFS and CRS scores. CFS and CRS scores were positively correlated. Conclusions: In attempted suicide, cognitive flexibility and resilience are interrelated positively and inversely associated with impulsivity (nonplanning and inattention).
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Deficits in theory of mind and emotional awareness in somatoform disorders p. 368
Abel Thamby, Geetha Desai, Urvakhsh Meherwan Mehta, Santosh K Chaturvedi
Introduction: Emotions develop from a less differentiated to a highly differentiated level, and their arrest at a lower level is hypothesized to result in somatization. The present study aimed at investigating the Theory of Mind and emotional awareness in patients with somatoform disorders. Materials and Methods: Twenty patients with somatoform disorders, along with 20 healthy controls matched for age, sex, and education, were recruited after obtaining informed consent. Assessments included semi-structured proforma for sociodemographic and clinical details; Scale for Assessment of Somatic Symptoms (SASS) for somatic symptoms; and Patients Health Questionnaire (PHQ) to assess somatic symptoms, depression, and anxiety. Emotional awareness was measured using the Levels of Emotional Awareness Scale (LEAS), in which the participants had to provide descriptions of feelings of self and the other person in 20 imaginary situations. The responses were scored using a standardized manual. The Theory of Mind was measured using the Social Cognition Rating Tool in Indian Settings (SOCRATIS). Results: The two groups did not differ on any demographic parameters. Patients with somatoform disorders scored significantly lower on emotional awareness (t = −3.74; P < 0.001) and the Theory of Mind (t = −3.56; P < 0.001). The above differences remained significant even after controlling for comorbid depressive and anxiety symptoms. Conclusion: Patients with somatoform disorders are likely to have Theory of Mind and emotional awareness deficits independent of mood states. Future studies are needed to assess whether these deficits are trait- or state-dependent and whether they are cause or effect.
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Self-reported anger: Vulnerability for risky behaviors in two-wheeler riding young men p. 375
Rajesh Kumar, Paulomi M Sudhir, Rajeev J Michael, Manoj K Sharma, Neelima Chakrabarty, Seema Mehrotra
Objectives: Aggressive driving and road accidents are major concerns in the public health sector. This study aimed to explore risk to aggressive and risky behaviors on the road in two-wheeler riding young men. Methods: The study comprised 433 young male two-wheeler riders from an urban city of India. A two-wheeler riding survey that captured subjective perception of difficulty in managing anger in general, easy provocability to anger, and aggressive and risky behaviors on the road, and Negative Mood Regulation (NMR) scale were administered. Results: Of the 433 participants, 83 (19%) reported experiencing problematic anger in general, whereas 175 (40.42%) did not endorse experiencing problematic anger. Based on this, two groups were formed, namely, problematic anger-present group and problematic anger-absent group. The problematic anger-present group reported high score on easy provocability to anger, difficulty in controlling anger, specific motives related to riding fast than usual, and severity of aggressive responses to frustrating situations while riding, and low score on NMR scale. Statistical analysis revealed a significant difference between the groups. Conclusion: This study highlights the relevance of assessing subjective perception of problematic anger in two-wheeler riding young men. This has implications for designing interventions for enhancing road safety.
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Revisiting postgraduate (PG) psychiatry training in India p. 380
Anil Kakunje, Varghese P Punnoose, Kannan P Ponnusamy, Ashok V Mysore, Sharon Joe Daniel
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Planning statistical analysis: Wrong and right approaches explained using an entertaining example from everyday life p. 388
Chittaranjan Andrade, Nilesh B Shah
Inferential statistical tests are used to examine hypotheses in research data but can also be applied to information in everyday life. Using data from a cricket tournament as an example, this article describes a plausible but wrong plan of analysis and explains what a correct method of analysis might be. Testing a hypothesis that was set after visual inspection of data or indiscriminate analysis can both result in false-positive conclusions. Making incorrect assumptions in statistical tests will also result in incorrect conclusions. Statistics is not merely about crunching numbers. It is also about knowing how to plan and execute the analysis.
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A case of frontotemporal dementia presenting as nicotine dependence and carbohydrate craving p. 391
Preethi V Reddy, Lavanya Anuroop, Veda Shetageri, Raghavendra K Kumar, Ganeshan Gopalakrishnan
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Dysmorphic delusion and olanzapine-induced postpartum dermatosis in a case of schizophrenia p. 393
Roshan Sutar, Sundarnag Ganjekar
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Euprolactinemic galactorrhea with paroxetine: Exploring the missing link p. 395
Shree Mishra, Santanu Nath, Biswa Ranjan Mishra, Jigyansa Ipsita Pattnaik
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Meningomyelocele on exposure to clozapine during perinatal period p. 398
Prakruthi Narayanaswamy, KS Shaji, TP Sumesh
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Comorbid bipolar disorder and benign joint hyper mobility syndrome (BJHS): More than a mere coincidence? p. 399
NA Uvais, VS Sreeraj
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