Indian Journal of Psychological Medicine
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   2019| September-October  | Volume 41 | Issue 5  
    Online since September 5, 2019

 
 
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REVIEW ARTICLE
Suicide prevention strategies for general hospital and psychiatric inpatients: A narrative review
Karthick Navin, Pooja Patnaik Kuppili, Vikas Menon, Shivanand Kattimani
September-October 2019, 41(5):403-412
DOI:10.4103/IJPSYM.IJPSYM_169_19  PMID:31548762
Background: In-patient (IP) suicides contribute a small but significant proportion of overall suicides. Despite this, suicide prevention strategies focusing on the general hospital IP population remain relatively underresearched. This paper is intended to provide an overview of various proposed suicide prevention approaches in the general hospital, including psychiatric IP, settings, and their evidence base. Methodology: Electronic searches of MEDLINE through PubMed, ScienceDirect, and Google Scholar databases were performed to identify potentially relevant articles from inception till January 2019. The generated abstracts were systematically screened for their eligibility to be included in the review. Included articles were grouped under five broad themes: environmental modification, staff education, pharmacotherapy, psychotherapy, and brain stimulation. Data extraction was done using a structured proforma. Results: Environmental modifications and educating the health care professionals appear to be the most promising strategies to reduce suicide-related mortality among IPs. Among pharmacological methods, ketamine has shown initial promise in reducing suicidal ideations. Follow-up data are lacking for most of the described methods. Limited but positive evidence exists for cognitive therapies focusing on the immediate postadmission period and brain stimulation techniques, and it warrants further replication. Conclusion: There is a striking paucity of original research on IP suicide prevention. Given the ethical and methodological issues in carrying out studies with IP suicide as the primary outcome, there is a need to focus on intermediate suicide outcome measures, such as knowledge, attitude, and skills among staff handlers of suicidal patients.
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ORIGINAL ARTICLES
Perspectives about Illness, Attitudes, and Caregiving Experiences among Siblings of Persons with Schizophrenia: A Qualitative Analysis
Anekal C Amaresha, Ganesan Venkatasubramanian, Daliboina Muralidhar
September-October 2019, 41(5):413-419
DOI:10.4103/IJPSYM.IJPSYM_318_19  PMID:31548763
Background: Siblings of persons diagnosed with schizophrenia (SPS) are one among the major sources of support for persons with schizophrenia. There is a dearth of psychosocial literature on SPS in India. This qualitative study explored the perspectives about the illness, attitudes, and caregiving experiences of SPS. Materials and Methods: Qualitative audio-recorded interviews were conducted with 15 SPS, purposively selected from a tertiary mental health hospital of Southern India. A general inductive approach was adopted to analyze the qualitative data. Results: Four broad themes were identified from qualitative data analysis. (1) SPS described several explanatory models of mental illness in terms of causal attributions and treatment care. (2) They had expressed emotion toward their ill siblings, such as criticality, hostility, and emotional over-involvement. (3) They experienced objective and subjective burden while caring for their ill sibling. In spite of all these, (4) they were part of their ill siblings' care in terms of ensuring regular follow-ups and drug adherence and supported their livelihood. They coped up with adaptive as well as maladaptive strategies. Conclusion: SPS provide significant support to their affected siblings. However, they do have non-biomedical models of mental illness and negative attitudes toward patients and experience burden. Hence, psychosocial interventions may help SPS while caregiving for their affected siblings.
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Mobile phones as a medium of mental health care service delivery: Perspectives and barriers among patients with severe mental illness
Gopika Sreejith, Vikas Menon
September-October 2019, 41(5):428-433
DOI:10.4103/IJPSYM.IJPSYM_333_18  PMID:31548765
Background: The use of mobile phone technology to support various components of health care delivery (often referred to as mHealth) is on the rise. Little systematic information, however, is available on user felt needs and barriers to mHealth approaches among people with severe mental illness (SMI). Our objectives were to elicit user needs, preferences, and barriers to using mobile phones for health care service delivery among people with SMI. Materials and Methods: A cross-sectional study was carried out among 75 subjects with SMI between August 2017 and October 2017. All patients had a minimum illness duration of two years or more and a Global Assessment of Functioning score of less than 70. Information on user perspectives was elicited using a 10-item structured questionnaire, to assess mobile phone usage patterns, felt needs, barriers, and preferences, developed for use in patients with SMI. Results: Majority of the patients reported using mobile phones and were favorably disposed to mHealth approaches. Voice calls (n = 47, 62.7%) were the most preferred mode of service delivery. The most preferred service frequency was twice-weekly (n = 31, 41.3%), followed by once-weekly (n = 22, 29.3%). Majority (n = 47, 62.7%) reported no barriers to mobile phone usage, whereas 14 (18.6%) perceived a lack of necessity of mobile phones as a service delivery medium. Reminders about medication and appointments through mobile phones (n = 35, 46.6%) were the most felt needs, followed by crisis helplines (n = 27, 36.0%) and information about mental health services (n = 22, 29.3%). Conclusion: These findings support the use of mHealth approaches in resource-constrained settings and provide specific inputs to refine the modalities of mHealth service delivery.
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VIEWPOINTS
Towards a dementia-friendly India
C T Sudhir Kumar, Sanju George, Roy Abraham Kallivayalil
September-October 2019, 41(5):476-481
DOI:10.4103/IJPSYM.IJPSYM_25_19  PMID:31548773
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ORIGINAL ARTICLES
Quality of life in Schizophrenia: What is important for persons with Schizophrenia in India?
Sumit Durgoji, Krishna Prasad Muliyala, Deepak Jayarajan, Santosh Kumar Chaturvedi
September-October 2019, 41(5):420-427
DOI:10.4103/IJPSYM.IJPSYM_71_19  PMID:31548764
Background: Quality of life (QOL) is a multidimensional construct and is increasingly recognized as an important outcome measure. Schizophrenia runs a chronic course and is a disabling mental disorder. Assessment of QOL using currently available scales for schizophrenia may not be culturally relevant. Methods: In phase one, patients with schizophrenia using psychiatric rehabilitation services, caregivers, and mental health professionals were interviewed qualitatively to identify factors that are important for QOL of patients. In phase two, 40 patients with schizophrenia were recruited consecutively from the outpatient department and asked to rate the importance/relevance of the above items for QOL on a Likert scale. Results: Themes that emerged were work, family's understanding about illness, stigma, financial issues, social life, social standing, religion and spirituality, medications, physical health, mental health and symptoms, recreation and leisure, and independent living. Work and family's understanding of illness were considered as moderately or very important by all patients in phase two. Conclusions: Work is very important for all patients with schizophrenia for their QOL. The themes derived from this study could guide the development of a scale for QOL that is relevant to the Indian context.
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Marital problems among partners of patients with bipolar affective disorder
Parakkal Drisya, Kavungathodi Bindumol, TK Saleem, Dayal Narayan
September-October 2019, 41(5):448-454
DOI:10.4103/IJPSYM.IJPSYM_409_18  PMID:31548768
Background: Partners of patients with bipolar affective disorder (BPAD) have problems with their marital life. Identification of these problems is important to develop strategies to solve them for improving quality of life. Aims: To identify marital distress and problem areas in their marital life among the partners of patients with BPAD. Materials and Methods: A cross-sectional descriptive design was used to collect data from 125 participants, 59 males and 66 females, who were partners of patients with BPAD. The study was done in outpatient clinics of Community Mental Health Clinics of District Mental Health Program. Tools used for data collection included a semi-structured interview schedule to collect socio-personal data of partners of patients with BPAD and clinical data of the patient, Couple Satisfaction Index (CSI), and Problem Areas Questionnaire (PAQ). Purposive sampling technique was used. Results: Majority of the participants (male - 55.9%, female -54.5%) expressed marital distress on CSI. Handling family finances and career/job decisions were the most problematic areas for male participants, whereas household tasks, handling finances, and career/job decisions were the most problematic areas for female participants. Conclusion: A significant proportion of spouses of BPAD patients have marital distress in important areas of life, with a potential for long-term consequences in their lives.
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Stigma and its correlates among caregivers of patients with bipolar disorder
Sandeep Grover, Jitender Aneja, Nandita Hazari, Subho Chakrabarti, Ajit Avasthi
September-October 2019, 41(5):455-461
DOI:10.4103/IJPSYM.IJPSYM_24_19  PMID:31548769
Background: Stigma associated with mental illness is multifaceted, and it extends to even those who take care of the afflicted persons. Research shows that stigma has maximal impact on patients who have schizophrenia and their caregivers, but information pertaining to caregivers of patients with bipolar disorder is minimal. Accordingly, this study aimed to evaluate stigma and its correlates among caregivers of patients with bipolar disorder. Methodology: This cross-sectional study conducted at a tertiary care hospital purposively enrolled 103 caregivers of patients with bipolar disorder-I. The caregivers were assessed on the stigma scale for caregivers of people with mental illness (CPMI) and the Explanatory Model Interview Catalogue (EMIC) stigma scale. Results: The majority of caregivers attributed the illness of the patient to stress (54.4%), chemical imbalance (48.5%), or heredity (29.1%), while nearly one-fourth believed it to be the will of God. The mean weighted scores on various domains of CPMI were comparable [affective domain = 2.24 (standard deviation (SD) = 0.51); cognitive domain = 2.25 (SD = 0.54) and behavioral domain = 2.23 (SD = 0.55)]. The mean score on EMIC was 28.00 (SD = 14.57). Caregivers with low income reported higher stigma in affective and cognitive domains. Also, lesser time spent with the patient correlated with higher stigma in the affective domain. Furthermore, poor functioning of the patient was associated with high caregiver stigma in cognitive and behavioral domains. Conclusion: Caregivers of patients with bipolar disorder experience significant affiliate and courtesy stigma, and higher stigma is associated with lower income of the caregivers and lesser time spent in caregiving.
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Perception about marriage among caregivers of patients with schizophrenia and bipolar disorder
Pramod Kumar, Nitasha Sharma, Sandhya Ghai, Sandeep Grover
September-October 2019, 41(5):440-447
DOI:10.4103/IJPSYM.IJPSYM_18_19  PMID:31548767
Background: Marriage has a complex relationship with mental illness. The marriage of a person with mental illness (PMI) is a controversial issue with varied opinions. There is a dearth of studies exploring perception about marriage among caregivers of patients with severe mental disorders. Materials and Methods: Thirty caregivers were interviewed in depth using a semi-structured interview schedule. Quantitative data were analyzed using MS Excel, while qualitative data were interpreted based on Colaizzi's framework. Results: About half (53%) of the caregivers believed that PMI should marry, and 46% of caregivers believed that marriage could worsen the mental illness of their patient. The qualitative analysis showed that factors that affect the decision among caregivers to get their mentally ill wards married include shovelling off the stigma of keeping the unmarried ward at home and to have somebody to take care of the unmarried ward after their death. Many caregivers believe that marriage and/or sexual intercourse can be a cure/treatment for various mental disorders. Conclusion: Caregivers of patients with severe mental illness have many misconceptions about the association of marriage and outcome of mental illnesses.
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Sexual dysfunction in drug-naïve or drug-free male patients with psychosis: Prevalence and risk factors
Dhananjayan Ravichandran, Rajesh Gopalakrishnan, Anju Kuruvilla, KS Jacob
September-October 2019, 41(5):434-439
DOI:10.4103/IJPSYM.IJPSYM_1_19  PMID:31548766
Background: There is a growing body of literature on the high prevalence of sexual dysfunction in patients with psychotic disorders. However, most studies have focused on medication-related sexual side effects. Material and Methods: Consecutive males with a diagnosis of acute psychosis or schizophrenia who were either drug-naïve or drug-free for six months were recruited to the study after obtaining informed consent. Sociodemographic and clinical data, psychopathology (using Positive and Negative Syndrome Scale), and sexual functioning (using The International Index of Erectile Functioning and DSM-IV TR criteria) were assessed. Bivariate and multivariate statistics were obtained. Results: One hundred males were recruited. The overall prevalence of sexual dysfunction by DSM IV-TR criteria in this population was 17%. The factors that were associated with sexual dysfunction were older age and later age of onset of illness. The rate was higher on excluding those who said that they were not sexually active (25%). Conclusions: Sexual dysfunction may be found in patients with psychotic disorders even prior to commencing antipsychotic medications. It is possible that this is contributed to by several factors including the disease process. Assessment of sexual function in these patients will help in early identification and appropriate management.
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Change in attitude among nursing undergraduate students following one-month exposure in a mental healthcare setting
Naveen Grover, Sayma Jameel, Vishal Dhiman
September-October 2019, 41(5):462-465
DOI:10.4103/IJPSYM.IJPSYM_342_18  PMID:31548770
Background: Attitude of treating professionals plays an important role in the treatment of mental illnesses. Nursing professionals are an important part of the mental health care team. As a part of their nursing coursework, nursing students are posted in a mental health setting. It is important to assess the impact of such postings on their attitudes. Materials and Methods: A total of 235 undergraduate nursing students posted in a mental healthcare setting for one month participated in the study. Their attitude towards mental illness and psychiatry was assessed before and after the posting, using Personal data sheet, Attitude Scale of Mental Illness (ASMI), and Attitude towards Psychiatry Scale (ATP). Results: At pre-assessment, the nursing students had a negative attitude on all dimensions of ASMI except benevolence, and positive attitude on all the six domains of ATP. At post-assessment, attitude improved significantly on pessimistic prediction dimension of ASMI, and they were able to maintain their positive attitude on ATP. Conclusions: One-month posting had a weak positive impact on attitude towards mental illness and no detrimental impact on attitude towards psychiatry. There is a need for better efforts to increase the impact of training on attitude towards mental illness.
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LETTERS TO EDITOR
Clozapine-related constipation: A retrospective study
Sandeep Grover, Swapnajeet Sahoo, Nandita Hazari
September-October 2019, 41(5):485-487
DOI:10.4103/IJPSYM.IJPSYM_467_18  PMID:31548775
  302 29 -
LEARNING CURVE
Ultraprocessed food and cardiovascular risk: Estimating the number needed to harm in an unfamiliar situation
Chittaranjan Andrade
September-October 2019, 41(5):501-502
DOI:10.4103/IJPSYM.IJPSYM_340_19  PMID:31548782
The Number Needed to Harm (NNH) statistic is a measure of effect size. It is defined as the number of patients who need to be treated for one additional patient to experience an adverse outcome. The NNH is conventionally calculated in the context of a randomized controlled trial. This article explains how the NNH can be estimated and understood for a lifestyle behavior in the context of an observational study in which the outcome was described using an uncommon unit. The lifestyle behavior, here, was the intake of ultraprocessed food and the outcome was stated as the number of events per 1000 person-years. The NNH can be estimated from the data provided, expressed in different ways, and converted into a form that is relevant to clinical practice.
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LETTERS TO EDITOR
Central pontine/extrapontine myelinolysis presenting with manic and catatonic symptoms
Vaibhav Patil, Rishab Gupta, Sukhjeet Singh, Ankur Goyal, Koushik Sinha Deb
September-October 2019, 41(5):491-493
DOI:10.4103/IJPSYM.IJPSYM_58_19  PMID:31548777
  205 16 -
Steroid-responsive encephalopathy as a semblance of neuroleptic malignant syndrome in a patient with schizophrenia
Jitender Aneja, Pankaj Mahal, Gautam Sudhakar, Samhita Panda, Sarbesh Tiwari
September-October 2019, 41(5):487-491
DOI:10.4103/IJPSYM.IJPSYM_307_19  PMID:31548776
  193 10 -
Income Generation programs and real-world functioning of persons with schizophrenia: Experience from the thirthahalli cohort
Shyam Ravilla, Krishna Prasad Muliyala, Naveen Kumar Channaveerachari, Kudumallige K Suresha, Arunachala Udupi, Jagadisha Thirthalli
September-October 2019, 41(5):482-485
DOI:10.4103/IJPSYM.IJPSYM_151_19  PMID:31548774
  188 15 -
VIEWPOINTS
Role of integrated and multidisciplinary approach in combating metabolic syndrome in patients with severe mental illness
Pooja Patnaik Kuppili, Naresh Nebhinani
September-October 2019, 41(5):466-471
DOI:10.4103/IJPSYM.IJPSYM_48_19  PMID:31548771
  174 17 -
LETTERS TO EDITOR
Imaging in psychogenic nonepileptic seizures: An observational study
Rajeswari Aghoram, Pradeep P Nair
September-October 2019, 41(5):494-496
DOI:10.4103/IJPSYM.IJPSYM_487_18  PMID:31548778
  167 11 -
VIEWPOINTS
Facilitating aadhaar and voting for long-stay patients: Experience from a tertiary care center
Thanapal Sivakumar, Joseph Wilson James
September-October 2019, 41(5):472-475
DOI:10.4103/IJPSYM.IJPSYM_235_19  PMID:31548772
  160 18 -
COMMENTS ON PUBLISHED ARTICLES
Comments on “Adaptation and validation of parental behavioral scale for children with autism spectrum disorders to Kannada”
Gurvinder Pal Singh, Bheemsain Tekkalaki, Chittaranjan Andrade
September-October 2019, 41(5):498-499
DOI:10.4103/IJPSYM.IJPSYM_338_19  PMID:31548780
  154 22 -
Comments on “Factors associated with treatment adherence in children with attention deficit hyperactivity disorder”
Chittaranjan Andrade, Devavrat Harshe
September-October 2019, 41(5):497-498
DOI:10.4103/IJPSYM.IJPSYM_276_19  PMID:31548779
  158 7 -
Authors' responses to the comments on “Adaptation and validation of parental behavioral scale for children with autism spectrum disorders to Kannada”
Karukayil Sivadas Gayathri, Shivani Tiwari
September-October 2019, 41(5):499-500
DOI:10.4103/IJPSYM.IJPSYM_357_19  PMID:31548781
  127 9 -
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