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   Table of Contents - Current issue
November-December 2019
Volume 41 | Issue 6
Page Nos. 503-601

Online since Monday, November 11, 2019

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Translation or development of a rating scale: Plenty of Science, a Bit of Art p. 503
Vikas Menon, Samir Kumar Praharaj
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A focus group study of Indian psychiatrists' views on electroconvulsive therapy under India's mental healthcare act 2017: 'The ground reality is different' p. 507
Richard M Duffy, Gautam Gulati, Vasudeo Paralikar, Niket Kasar, Nishant Goyal, Avinash Desousa, Brendan D Kelly
Background: India's Mental Healthcare Act, 2017 (MHCA) greatly restricts the use of electroconvulsive therapy (ECT) in minors and bans unmodified ECT. Indian psychiatrists have raised concerns that these measures may deprive certain patients of life-saving treatment. This study describes the perspectives of Indian psychiatrists on how ECT is dealt with in the legislation. Methods: We conducted nine focus groups in three Indian states. We explored the positive and negative implications of the MHCA and discussed its implementation, especially in relation to ECT. Results: Many of the themes and concerns commonly discussed in relation to ECT in other jurisdictions are readily apparent among Indian psychiatrists, although perspectives on specific issues remain heterogeneous. The one area of near-universal agreement is Indian psychiatrists' affirmation of the effectiveness of ECT. We identified three main areas of current concern: the MHCA's ban on unmodified ECT, ECT in minors, and ECT in the acute phase. Two broad additional themes also emerged: resource limitations and the impact of nonmedical models of mental health. We identified a need for greater education about the MHCA among all stakeholders. Conclusion: Core concerns about ECT in India's new legislation relate, in part, to medical decisions apparently being taken out of the hands of psychiatrists and change being driven by theoretical perspectives that do not reflect “ground realities.” Although the MHCA offers significant opportunities, failure to resource its ambitious changes will greatly limit the use of ECT in India.
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Factors associated with alcohol misuse among indigenous tribal men in Wayanad: A qualitative study p. 516
Anvar Sadath, Kurian Jose, Shibukumar Theertamkara Meethal, Jiji Kavanakudi Mathai, Aswati Paroor Venugopal, Neethumol Xavier
Background: Disproportionate level of alcohol misuse is reported among indigenous people all over the world. A few available studies from India also support higher alcohol misuse among tribal men, but the reason for it is largely unexplored. Thus, we explored the factors associated with alcohol misuse among indigenous tribal men in Wayanad, Kerala. Methods: Using a qualitative phenomenological method and purposive sampling techniques, we recruited seven tribal men with a history of alcohol misuse and 28 tribal promoters from the identified tribal colonies in Wayanad, Kerala, India. Data collection was done with a combination of focus group discussions and in-depth interviews. Thematic analysis was applied to the data for identifying core themes. Results: We identified the important trajectories of alcohol consumption among tribal men. They initiated alcohol misuse at a younger age due to parental influence, home environment, and peer pressure. Alcohol misuse associated with their traditional rituals and practices, exploitation of landlords, occupational factors, and saving habits. It caused a substantial burden to their spouses and children. Conclusion: Alcohol consumption often initiated in their young age was associated with socio-cultural rituals, practices, and exploitation.
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Prevalence of adult ADHD co-morbidity in alcohol use disorders in a general hospital setup p. 523
Somashekar Reddy Lohit, Girish Nanjundappa Babu, Shilpi Sharma, Suprita Rao, Beesanahalli Shanmukhappa Sachin, Abhay Vishwas Matkar
Background: Attention deficit hyperactive disorder (ADHD) symptoms persisting into adulthood can influence the course and outcome of alcohol use disorders (AUDs). A cross-sectional study was conducted to assess the prevalence of adult ADHD in patients admitted with AUDs in a general hospital setup. Methods: In this study, 100 consecutive inpatients with alcohol use disorder (AUD) were evaluated for the diagnosis of ADHD. Patients with AUD were assessed with Severity of Alcohol Dependence Questionnaire, Clinical Institute Withdrawal Assessment for Alcohol and Adult ADHD Self Report Scale. Among the subjects who screened positive for adult ADHD on ASRS, diagnosis of adult ADHD was confirmed using the DSM 5 diagnostic interview. Epi-Info Version 7.2 was used for data entry and analysis. Mann Whitney test and Chi-square test (or Fisher's Exact test) were used for statistical analysis. Results: Twenty-one subjects screened positive for adult ADHD. Among them, 19 subjects had a confirmative diagnosis of adult ADHD. Patients with adult ADHD comorbid with AUDs showed accelerated progression towards dependence, and early relapses. Conclusions: In all, 19% of treatment-seeking inpatients with AUDs have co-morbid adult ADHD. Regular screening of AUD patients for adult ADHD and addressing the psychopathology may improve the treatment outcome.
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Use of filter paper to measure alcohol biomarkers among opioid-dependent patients on agonist maintenance treatment: A community-based study p. 529
Rizwana Quraishi, Mohit Varshney, Amit Singh, Dharamveer Singh, Mukesh Kumar, Ravindra Rao, Raka Jain, Atul Ambekar
Background: Harmful Alcohol use is frequent among opioid dependents patients undergoing agonist maintenance treatment. The objective assessment of harmful alcohol use can be done using laboratory measures of serum biomarkers. For community-based patients, there is often a requirement of an alternative method due to lack of onsite laboratory services. The aim of the study was to examine filter paper as a matrix to measure serum biomarkers of harmful alcohol use. Methods: The initial phase involved standardization of the filter-paper-based assay. Conditions were optimised for extraction and estimation of alcohol biomarkers (Aspartate Aminotransferase; AST, Alanine Aminotransferase; ALT, Gamma Glutamyl transferase; GGT and Carbohydrate Deficient Transferrin; CDT) from the filter paper. For clinical validation, serum samples were collected from community clinics. Biomarker levels obtained from both the methods were correlated using linear regression analysis. Limits of agreement between the two methods was estimated using the Intraclass Correlation Coefficient (ICC). Results: The extraction of enzymes (AST, ALT and GGT) from filter paper was carried out using the substrate buffer available with the reagent kit (Randox, UK). CDT was readily extracted from filter paper using deionised water. Serum biomarker levels measured from samples collected from community clinics correlated well with filter paper extracted levels (ICC 0.97-0.99). More than 90% of alcohol biomarker levels were recovered from the filter paper matrix using this method. Conclusion: Filter paper has the potential to be used as a matrix to objectively measure alcohol biomarkers among opioid-dependent patients from community settings lacking onsite laboratory facilities.
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Drug use among teenagers and young adults in Bhutan p. 535
Kinley Wangdi, Tshering Jamtsho
Background: Use, possession, and illegal transactions of controlled substances have increased in recent years in Bhutan. This study aimed to determine the national prevalence of ever drug use and identify its associated factors amongst teenagers and young adults. Methods: This study was conducted using data from the National Health Survey 2012 of Bhutan. The outcome variable of interest was ever drug use in teenagers and young adults. The questionnaire was developed following the WHO STEPwise approach to surveillance of non-communicable diseases (STEP). Univariate and multivariate logistic regression were performed to identify correlates of ever drug use. Results: The prevalence of ever drug use among teenagers and young adults was 3.2% (n = 672). The factors associated with ever drug use were: being men; being single; being in age group of 18-24 years; having a primary school, high school, monastic, university, or diploma education; being technicians or salespersons; feeling always lonely; having ever consumed alcohol, and having ever smoked. Conclusion: Compared to the other countries in the WHO South-east Asia region, the prevalence of ever drug use in Bhutan is low. Use of other substances, including smoking and alcohol use, was associated with ever drug use. For greater effect, drug use prevention strategies should include prevention of smoking and alcohol use.
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Nomophobia: A mixed-methods study on prevalence, associated factors, and perception among college students in Puducherry, India p. 541
G Jilisha, J Venkatachalam, Vikas Menon, Jeby Jose Olickal
Background: As more people are utilizing smartphones, nomophobia is also on the rise. Several Indian studies have revealed nomophobia among young adults. The severity of nomophobia and related behaviors is underrated and often go unnoticed in India. Methods: The sociodemographic characteristics, smartphone usage pattern, and perceived ill-health related to smartphone usage of the participants were obtained using a semistructured questionnaire. Twenty-item Nomophobia questionnaire was used to assess nomophobia. In-depth interviews were conducted among students with moderate and severe nomophobia scores. Results: Among the 774 participants, 23.5% had severe nomophobia scores. Older age, male gender, duration and frequency of smartphone usage, use for social networking, checking without reason, and checking smartphone after waking up in the morning were significantly associated with nomophobia. The in-depth interview showed attributes of addiction among the students, like dependency and compulsive behavior. Students also experienced anxiety and frustration when they had to part with their smartphones. Conclusion: A sizable minority of the students had signs of severe nomophobia, distinct patterns of usage, and misperceptions regarding health and their usage pattern.
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Prevalence and correlates of excessive smartphone use among medical students: A cross-sectional study p. 549
Surabhi P Dharmadhikari, Sneha D Harshe, Poorva P Bhide
Background: Increasing smartphone use has led to the introduction of smartphone addiction as a behavioral addiction with detrimental effects on health. This phenomenon has not been widely studied in the Indian context. This study assessed the rate of smartphone addiction in a sample of medical students, with a focus on its correlation with sleep quality and stress levels. Methods: A cross-sectional study was conducted between November 2016 and January 2017 in 195 medical students. Their smartphone use, level of smartphone addiction, sleep quality, and perceived stress levels were measured using the Smartphone Addiction Scale-Short Version (SAS-SV), the Pittsburgh Sleep Quality Index (PSQI), and the Perceived Stress Scale (PSS-10), respectively. Results: Of the 195 students, 90 (46.15%) had smartphone addiction as per the scale. A self-reported feeling of having smartphone addiction, use of the smartphone right before sleeping, PSS scores, and PSQI scores were found to be significantly associated with the SAS-SV scores. Significant positive correlations were observed between the SAS-SV and PSS-10 scores, and the SAS-SV and PSQI scores. Conclusions: There is a high magnitude of smartphone addiction in medical students of a college in Western Maharashtra. The significant association of this addiction with poorer sleep quality and higher perceived stress is a cause for concern. The high self-awareness among students about having smartphone addiction is promising. However, further studies are required to determine whether this self-awareness leads to treatment seeking. Further studies are required to explore our finding of the association of smartphone addiction with using the smartphone before sleeping.
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Translation and adaptation into hindi of Central religiosity Scale, Brief Religious Coping Scale (Brief RCOPE), and Duke University Religion Index (DUREL) p. 556
Sandeep Grover, Devakshi Dua
Background: Religion/religiosity plays an important role in the lives of most Indians. However, there are lack of validated instruments in regional languages to assess the various dimensions of religiosity in the Indian population. This limits evaluation of religion/religiosity and comparison of Indian data with western research for health-related issues. Methods: The CRS, BRCOPE, and DUREL scales were translated into Hindi by using the standard translation-back-translation methodology as specified by the World Health Organization. Initially, the Hindi version of each scale was completed by 132 participants, and the second time, participants completed either the Hindi or the English version of the scales after 3–7 days. Data were evaluated for cross-language equivalence, test–retest reliability, internal consistency, and split half reliability. Results: The Hindi version of CRS, DUREL, and RCOPE had good cross-language equivalence with the English version for all the items and dimensions in all three scales, which was highly significant (P < 0.001). The test–retest reliability was also high for all three scales (Cohen's Kappa value >0.67 for various items and subscales P < 0.001). Cronbach's alpha for the Hindi version of the scales was 0.95, 0.76, and 0.89 for CRS, DUREL, and BRCOPE, respectively. The Spearman–Brown coefficient was 0.89, 0.70, and 0.43 for CRS, DUREL, and BRCOPE, respectively. Conclusion: The Hindi version of CRS, DUREL, and BRCOPE has good cross-language equivalence, internal consistency, split-half reliability, and test–retest reliability. It is expected that availability of these validated versions will provide impetus to research evaluating the association of clinical parameters and religiosity.
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Development of Comprehensive Satisfaction Index (ComSI) and its association with WHOQOL-BREF p. 562
Bhupendra Singh, Nisha Mani Pandey, Betsy Mehrotra, Anamika Srivastava, Alok Kumar Chowdhury, SC Tiwari
Background: Comprehensive satisfaction in life may be considered as a significant contributor to health for everyone, including the aging population (individuals aged 45 years and above). For understanding the comprehensive satisfaction, an assessment measure with various psychometric properties may be useful. During a longitudinal study of aging and geriatric mental health, a 26-item tool was developed in Hindi for the assessment of satisfaction. This article aimed to analyze the items of Comprehensive Satisfaction Index (ComSI) applying Varimax rotation and to find out its association with World Health Organization Quality of Life Brief (WHOQOL-BREF). Methods: Data of 260 subjects were extracted from the longitudinal study to analyze the psychometric properties of the tool named as Comprehensive Satisfaction Index and its association with various domains of WHOQOL-BREF. Varimax rotation was applied after computing Kaiser–Meyer–Olkin and Bartlett's test of sphericity. Furthermore, the association between various components of ComSI and various domains of WHOQOL-BREF was explored. Results: Of the total 26 items of the tool, item no. 17 was excluded due to its –ve/ <0.31 value. A total of three components were generated with >1 eigenvalues; maximum items were loaded in component 1 (19) followed by components 2 (4) and 3 (2). Each of these factors has been significantly correlated with each other. Furthermore, these components also were compared with various domains of WHOQOL-BREF, and positive correlation was obtained for most of them. Conclusion: There is a positive association between ComSI and WHOQOL-BREF. This tool will help in identifying the satisfaction level of the aging subjects promptly and efficiently, which would further help in making strategies for interventions.
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Development of a scale of positive temperament in Indian context p. 569
Jyotika Bedi, Tarun Verma
Background: Available tests of temperament measure the traits of different categories (like reward dependence, emotionality) with a large number of items. These tests do not deal specifically with traits of positive temperament (emotionality), and most scales measure negative emotionality as a counterpart of positive emotionality. The current study reports the development of a new scale of positive temperament, with fewer items and applicable in the Indian context. Methods: Items were developed with help from available scales of positive temperament, which led to the selection of 36 items from six different constructs. The data were collected in two stages for exploratory and confirmatory factor analysis of the scale. Stage one and two consisted of 278 and 338 participants, respectively, in the age group of 18–80 years, from both the genders and different professions. Data was collected online through the Qualtrics survey website. The participants responded on a 5-point Likert scale from 0–4 indicating how often they behave in a particular way as asked by the item. The test was reconducted on a subsample of 98 participants after 4 weeks to measure test-retest reliability. Convergent validity was also established using strengths and difficulties questionnaire and neuroticism scale, and divergent validity was found with age. Results: Exploratory factor analysis revealed four factors: optimism, perseverance, self-contentment, and adaptability. Confirmatory factor analysis later revealed that the 4-factor model fits best with the data, having comparative fit index (CFI) of 0.96 and root mean square error of approximation (RMSEA) of 0.063. The internal consistency estimates of the four factors ranged from 0.72 to 0.91, indicating a stable structure of scales. The final scale is of 28 items, with seven items in each factor. The test-retest reliability coefficients ranged from 0.79–0.96. Two second-order factors were also identified. Conclusions: The positive temperament inventory is a four-factor, 28-item validated inventory with a stable set of items, having specific applicability in measuring positive temperament and fewer items for ease of use in different situations. This is the first scale of its kind in the Indian context and holds a promising future in the area of personality and clinical research.
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Dialectical behavior therapy in emotion dysregulation - Report of two cases p. 578
Aarzoo Gupta, Archana Kashyap, Ajeet Sidana
Emotion dysregulation is the inability to control and modulate one's affective state, and it might be associated with mental disorders. The development of secure attachment with significant others, in early childhood, has been theorized to be essential to the development of emotional regulation. Disruption of the formation of secure internal representations may, therefore, substantially compromise the acquisition of emotional-regulation capacities in childhood and lead to social maladjustment in later life. It is a pre-post case study design of two adolescents who presented with acts of self-harm and history indicating a provisional diagnosis of personality disorder. However, an in-depth assessment revealed emotional dysregulation. The model of Dialectical Behavior therapy (DBT) recommended for non-clinical populations was delivered in 12-16 sessions, resulting in a positive outcome that sustained for 12-24 months follow-up, improving interpersonal effectiveness. The role of DBT as an early intervention in emotional dysregulation is highlighted, as it enhances social adjustment by altering the attribution style.
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Biopsychosocial model in contemporary psychiatry: Current validity and future prospects p. 582
Adarsh Tripathi, Anamika Das, Sujita K Kar
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Opioid substitution treatment using buprenorphine for management of dependence on natural opioids: Case series p. 586
Preethy Kathiresan, Atul Ambekar, Siddharth Sarkar
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Dystonia after shooting street heroin: An underreported matter of concern p. 588
Abhishek Ghosh, Raghav Shah, Chandrima Naskar, Sambhu Prasad, Nidhi Sharma
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Acute dystonia following opioid withdrawal: An uncommon presentation p. 591
Santanu Nath, Biswa R Mishra, Shree Mishra, Jigyansa I Pattnaik
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Tramadol-related adverse drug reactions at an addiction psychiatry setting: A cross-sectional analysis p. 593
Naveen Kumar Dhagudu, Anusha Erravalli, Siddharth Sarkar, Rakesh Kumar Chadda
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Substance use related emergencies in a tertiary care general hospital setting: Observations and discussion p. 595
Tamonud Modak, Swarndeep Singh, Saurabh Kumar, Raman Deep
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Comments on “correlation of cognitive resilience, cognitive flexibility and impulsivity in attempted suicide” p. 598
Tarun Verma
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Need for and practical interpretations of the person-year construct in neuropsychiatric research p. 600
Chittaranjan Andrade
In observational studies, groups of interest may be carved out of predictors of interest. Thus, for example, if cardiovascular (CVS) health at age 50 years is the predictor of interest for dementia as the long-term outcome, groups of interest could comprise persons with poor, intermediate, and optimal CVS health at age 50. These groups would almost certainly be unbalanced in terms of sample size and duration of follow-up when incident dementia is assessed. The present article is a companion to the previous article in this column; it explains why the duration of follow-up needs to be factored into the sample size in each group, making person-years rather than persons as the unit for risk assessment. Next, this article explains how to reverse calculate an estimate of the number needed to treat (NNT) statistic in such situations. Finally, this article explains why the NNT so estimated is an approximation and not a true estimate of the NNT in the population.
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