Open Journal of Psychiatry & Allied Sciences, Formerly DYSPHRENIA

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/172149

Editor-in-Chief: Shyamanta Das
ISSN: 2394-2053 (Print); 2394-2061 (Online)

Frequency: Half-yearly

Language: English

Open Access Peer-reviewed journal

Web site: https://www.ojpas.org/

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Now showing 1 - 20 of 49

Intra-psychic disarray of gender identity and sexual orientation: in the process of coming out as transsexual
(Academy Publisher, 2020-06) Das, B S; Ghosh, S.
The present paper takes a step towards understanding the confusion that a transgender individual undergoes, while coming in terms with one抯 gender identity. Here, we will be presenting a case study with few anecdotes to put forward concepts of negotiation, self-understanding, and disclosure. We will refer to the individual as 慼im� as the person identifies himself as a male and is in the process of transition. Here, we have introduced the coming out process as a one-way and two-way process.
Metabolic syndrome among patients taking second generation antipsychotics: does obstructive sleep apnoea and sleep quality play any role?
(Academy Publisher, 2020-06) Rohatgi, R; Avinash, P R.
Background: Metabolic syndrome (MetS) is common among patients who have been exposed to second generation antipsychotics (SGA). Obstructive sleep apnoea (OSA) and sleep quality may also contribute to MetS. Aims: To study the contribution of sleep quality and OSA on the development of MetS in patients taking SGA. Methods: Total 60 patients taking SGA for more than three months were taken for the study. It was an observational, cross-sectional study. The diagnosis of OSA was done using Hindi translation of Berlin questionnaire. Hindi version of the Pittsburg Sleep Quality Index was used to assess the sleep quality. MetS was diagnosed using Adult Treatment Panel III criteria. Results: Forty two subjects did not have MetS, out of which 35 had low risk of OSA and seven had high risk of OSA, while 18 subjects had MetS of which nine each had high and low risk of OSA. The results were highly significant with a p-value of 0.007 (p?0.05). Subjects without MetS (n=42) comprised four good sleepers and 38 poor sleepers. Subjects with MetS (n=18) comprised of one good sleeper and 17 poor sleepers. The results were non-significant with a p-value of 0.525 (p?0.05). The high risk of OSA had around seven times higher likelihood of contribution to MetS. Conclusions: Sleep quality did not play a significant role in increasing the likelihood of MetS and OSA increased the likelihood of MetS in subjects exposed to SGA by seven times.
揈xtant of the living dead� a case report on Cotard抯 syndrome and its treatment aspects from a tertiary care hospital in India
(Academy Publisher, 2020-06) Das, K; Liji, P; Ryali, VSSR.
Cotard抯 syndrome has always borne a historical construct, being linked to pure psychosis, affective disorders as well as organic disorders like Parkinson抯, temporal lobe epilepsy, migraine, and cerebral infarction. Emphasis has remained on the psychopathology, involving beliefs of negation, damnation, guilt, and denouncing of body organs. Treatment aspects has been focused on less frequently; moreover, sparsely from India. We present a case of bipolar affective disorder, current episode severe depression with psychotic symptoms (Cotard抯 syndrome) with special focus on treatment.
Internet addiction as a comorbid condition among users with mild intellectual disability
(Academy Publisher, 2020-06) Sharma, M K; Leeshma, B K; Prasad, K; Hamza, M A; Tadpatrikar, A; Thakur, P C; Singh, P.
Background: Internet use provides the user with intellectual disability an opportunity for socialisation, entertainment, and knowledge. User with mild intellectual disability use internet more frequently during free time as well as for entertainment. The present case study is on the use of internet among users with mild intellectual disability. The users approached for management of addictive behaviour. Material and methods: Clinical interview, the Internet Addiction Test, the Problematic Online Gaming Questionnaire, and the Pornography Addiction Screening Tool were administered in individual setting. Results: The users found to have addictive use of internet, pornography, and game. It was associated with disturbance in their life style. Conclusions: It has implications for screening the addictive use of technology and their management among users with mild intellectual disability.
Acute olanzapine toxicity in a toddler
(Academy Publisher, 2020-06) Singh, H; Amarnath, Boggaram, S; Krishna, Murthy, M; R, ATK.
Olanzapine is an antipsychotic medication, which is approved for treatment of psychiatric illnesses among various age groups of psychiatric patients. Accidental consumption of olanzapine is uncommon among the paediatric age group. We report a case of accidental consumption of 15 tablets of olanzapine (5 mg each) in a two-year-old boy. It is important that clinicians are made aware of these reports of an overdose of olanzapine.
Low incidence of metabolic syndrome in patients taking atypical antipsychotic in Eastern India
(Academy Publisher, 2020-06) Dash, S S; Ravan, J R; Thakur, B; Pasumarthy, S; Kumar, S; Das, S K; Chowdary, P C.
Background: Atypical antipsychotics, widely used in many psychiatric diseases, are known to cause metabolic syndrome (MetS). But, there is sparse of prospective study to see the effect of atypical antipsychotics causing MetS in drug na飗e or drug free patients among the Indian population. This study aimed to determine the incidence of MetS and change in individual risk factor for MetS in schizophrenia and mood disorder patients after three months of receiving atypical antipsychotics. Method: Sixty patients of schizophrenia (n=40) and mood disorders (n=20) were screened at the baseline and all of them were prospectively followed up for the occurrence of MetS after three months. Results: By applying the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP III) modified criteria for Asian, the incidence of MetS was found to be 11.66%. When analysing the individual risk factor for MetS, the mean value from baseline to follow-up was weight (in kg) 58.55�.03 to 59.80�.24 (p<0.001), waist circumference (cm) 80.52�33 to 81.43�42 (p<0.001), systolic blood pressure (mm/Hg) 113.93�28 to 117.53�.89 (p<0.001), diastolic blood pressure (mm/Hg) 74.80�31 to 78.32�79 (p<0.001), fasting blood glucose (mg/dl) 86.23�.02 to 91.35�.04 (p<0.001), triglyceride (mg/dl) 97.32�.41 to 101.25�.38 (p<0.001), high-density lipoproteins (HDL) (mg/dl) 48.07�98 to 48.05�57 (p=0.951). Conclusion: Our study suggests that incidence of MetS in Indian population was 11.66% after three months of using atypical antipsychotic drugs in patients with schizophrenia or mood disorder. The change in mean value in the individual risk factor for MetS was statistically significant. Long-term follow-up studies are required to identify the real burden of MetS after using atypical antipsychotic drugs.
Diagnostic dilemma of cognitive decline in a young female: considering congenital rubella, depressive disorder, and moyamoya disease
(Academy Publisher, 2020-06) Victor, R; Saxena, V; Raghuvanshi, S; Gupta, R.
We report a case of a 20-year-old young female patient from North India presenting with headache, decline in scholastic performance, irritability, and low mood, and having a history of hemiparesis, who had rubella infection in her antenatal period, who was investigated and diagnosed as persistent depressive disorder (PDD) with left-sided hemiparesis in remission with moyamoya disease (MMD) based on history, examination, and relevant investigation (magnetic resonance imaging [MRI] brain/magnetic resonance [MR] angiogram). We highlight the difficulties we faced in attributing whether the cognitive decline was due to congenital rubella, PDD, MMD, or a combination of any of these three diagnoses.
Psychosis associated with anti-N-methyl-d-aspartate receptor encephalitis
(Academy Publisher, 2020-06) Bhaumik, U; Singh, H.
Aim: Anti-N-methyl D-aspartate (NMDA) receptor encephalitis is commonly seen in women with various neuropsychiatric symptoms. Here we report a case of psychosis associated with anti-NMDA receptor encephalitis. Case description: A 22-year-old woman was admitted with acute onset fever, generalised tonic-clonic seizures, reduced speech output, and delusion of persecution for one week. She was found positive for anti-NMDA receptor antibodies and anti-thyroid peroxidase antibodies. Her psychotic symptoms improved with antipsychotics, immuno-modulators, and steroids within two months. Conclusion: A possibility of anti-NMDA receptor encephalitis should be kept in mind in young women presenting with psychotic symptoms. It is ideal to liaise with neurologist to screen all such cases with suspicion of autoimmune encephalitis visiting a psychiatry clinic.
Stigma and discrimination in patients suffering with schizophrenia and depression: a comparative study
(Academy Publisher, 2020-06) Nukala, S; Singisetti, S; Chilukuri, S; Vinnakota, A; Nambaru, L R.
Introduction: Stigma remains a powerful negative attribute in social relationships of people with mental illness. Historically, stigma towards people with schizophrenia or depression has differed. Persons with schizophrenia are seen as violent and dangerous, whereas people with depression are seen as more accountable for their illness. Studies comparing stigma in these two illnesses in a systematic manner are far and few. Aim: To study and compare the levels of stigma and discrimination in persons suffering from schizophrenia and depressive disorder. Material and methods: A cross-sectional study was carried out with 30 patients each of schizophrenia and major depressive disorder attending the outpatient department of psychiatry at a tertiary care hospital in Andhra Pradesh, India. Diagnosis was made as part of routine clinical assessment and confirmed using the fifth edition of the American Psychiatric Association抯 Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria. After obtaining informed consent these patients were subjected to a semi-structured proforma wherein their demographic profiles and additional clinical history was recorded. The main study tool, the discrimination and stigma scale (DISC) was used in all patients. Results: The mean DISC score was found to be significantly higher in schizophrenia patients than depression patients, i.e. p<0.05, indicating higher stigma and discrimination in patients with schizophrenia, compared to those with major depression. Conclusion: For people with mental illnesses, stigma and discrimination adds to the distress and suffering, and hinders their recovery. This plays a greater role in patients with schizophrenia than those with depression.
Parenting styles, temperament, and anxiety in children: preliminary findings in the Indian population
(Academy Publisher, 2020-06) BR, S; Raman, V.
Background: Anxiety disorders are the most frequent mental disorders in children, and contribute to development of secondary complications such as later risks of anxiety disorders, major depression, substance dependence, suicidal behaviour, and other adverse developmental outcomes. Childhood anxiety has been associated with various environmental factors including parenting styles. Temperament influences the way children interact with their parents, and how parents respond to them. Materials and methods: The present pilot study was designed to examine the association between parenting styles, temperament, and child抯 anxiety. A total of 12 children, six in Clinical Group (CG) and six in Healthy Control Group (HG) were recruited. CG consisted of children who met the DSM-IV-TR diagnostic criteria for anxiety disorders. HG consisted of healthy children matched on age and gender. Results: Anxiety in children was positively associated with father抯 authoritarian and permissive parenting style, and negatively associated with mother抯 authoritative parenting style. Anxiety in children was also negatively associated with temperament dimensions sociability and emotionality, and positively associated with distractibility. There were also significant associations between temperament dimensions and parenting styles, specifically permissive parenting style was negatively associated with sociability and emotionality. Conclusions: The effect of parenting styles in Indian context did not differ from those of West as the study finds both authoritarian and permissive parenting style to be associated with child anxiety. Temperament dimensions were also associated with parenting style and child outcome. This study emphasises the importance of examining dyadic parent-child relationships, and demonstrates that father抯 parenting style also has a significant effect on the child, and having authoritative mother may be a protective factor against anxiety.
Effect of socio-cultural factors in therapeutic intervention
(Academy Publisher, 2020-06) Nair, V S; Moorkath, F; Vranda, M N.
Comorbidity and presence of family dysfunction in personality disorders, namely borderline personality disorder have been found commonly with bipolar affective disorder clients. Dialectic behaviour therapy (DBT) though has shown efficacy in treatment of such conditions, at times due to the socio-cultural differences of the models adopted from the western concept, there is a felt difficulty in the formulation of the therapeutic model making it necessary to collaborate with other models for smoother formulation and improvement in the overall functioning in the clients. A 21-year-old female of bipolar affective disorder with emotionally unstable personality disorder traits was referred to a psychiatric social worker for assessment and plan of intervention inclusive of DBT and family-focused therapy (FFT). Twenty sessions, each lasting for one hour were conducted with the client and family, each on an inpatient basis to (1) Assess and grade the problems in hierarchy, (2) Understand the socio-cultural constructs in sessions, (3) Teach DBT concepts and relaxation techniques to ameliorate stress and help her to improve the relationship and dynamics with her family through FFT. At the time of discharge, the client had improved nearly 30%, and the client and family were more confident in facing social situations, emotional dysregulation, interpersonal issues, distress tolerance goals which has been explained in the context of the socio-cultural factors focusing on alliance, institutions, expectations, and cultural adaptation involved in therapy and the involvement it had in the therapeutic process.
Adaptation of cognitive behaviour therapy in childhood obsessive-compulsive disorder: a case study
(Academy Publisher, 2020-06) Chakraborty, S; Halder, S.
Cognitive behaviour therapy (CBT) has been proved to be one of the most well-researched and effective therapy. It has been found effective in many clinical conditions in children and adolescents as well. Application of therapeutic processes gets complicated by the facts that childhood and adolescent problems do not come in neat packages and tend to overlap and/or coexist. For instance, there is much overlap among clinical problems like anxiety, depression, behavioural problems, and between reading and writing difficulties, and attention and hyperactivity. Many behavioural and emotional disturbances in children are also associated with specific medical conditions. The relationship between physical and/or medical conditions and emotional and behavioural disorders in children and adolescent has been documented in various studies. This demands attention to the therapeutic intervention to the childhood problems with greater monitoring and modulation. Use of CBT in childhood and adolescent problems for efficiency and convenience may be grouped into externalising and internalising disorders, and the management techniques may be formulated and tailored to meet the two opposing dimensions. In this case study, index client was an eight years old girl who presented with compulsive behaviour along with anxiety and fear, and the application of CBT techniques, its adaptability and efficacy in this case of obsessive-compulsive disorder (OCD), with specific phobia would be discussed.
Loneliness, social anxiety, social support, and internet addiction among postgraduate college students
(Academy Publisher, 2020-06) Singh, A; Khess, C R J; K, J M; Ali, A; Gujar, N M.
Background: There is little evidence that loneliness, social anxiety, and social support can cause excessive use of internet addiction in college students. The present study is just an attempt to show a relationship between loneliness, social anxiety, social support, and internet addiction among college students. Methodology: Cross-sectional study design was used to select sample from four departments (History, Philosophy, Hindi, and English) of Ranchi University using simple random sampling. A total of 100 students were included and informed consents were taken for further assessment. Sociodemographic datasheet, the revised UCLA (University of California, Los Angeles) Loneliness Scale, the Social Interaction Anxiety Scale (SIAS), the Multidimensional Scale for Perceived Social Support (MSPSS), and the Internet Addiction Test (IAT) were administered. Study was undertaken with the permission of scientific and ethics committee of Central Institute of Psychiatry, Ranchi. Data was analysed by using Statistical Package for the Social Sciences (SPSS) version 23.0. Results: High level of loneliness (92%), social anxiety in 21%, social phobia in 22%, and severe internet addiction was present in 15% of the respondents. Loneliness has a significant positive correlation with social anxiety (r=0.285, p<0.01). In regression analysis, social anxiety, perceived social support, and internet addiction contributed significantly to the prediction of loneliness among college students [F(3,96)=4.492, p=0.005] accounting at 1.23% variance. Social anxiety strongly contributes to the variance on the loneliness (Beta=0.358, t=3.389, p=0.001). Conclusion: Social anxiety has a significant relationship with loneliness and act as prominent predictors for loneliness. Prevalence of internet addiction was high among college going students.
Physical illnesses among psychiatric inpatients in a tertiary care setup
(Academy Publisher, 2020-06) Uday, B; Niranjan, V.
Background: Rates of undiagnosed and untreated medical illnesses are higher in individuals with severe mental illness, compared to the general population. These comorbid medical illnesses result in poorer outcomes, greater severity of symptoms, increased incidence of non-compliance, increased length of stay, increased mortality and healthcare costs. There is a paucity of literature concerning the prevalence of physical illnesses in psychiatric patients from India. Objective: To study the nature and prevalence of physical illnesses in psychiatry inpatients in a tertiary care psychiatry setup. Materials and methods: Consecutively admitted inpatients from the psychiatry ward of a tertiary care centre were recruited for study for six months duration. Detailed general physical examination, systemic examination, and various laboratory investigations were done. Referrals were sought from the respective medical or surgical departments for evaluation. Diagnosis of physical illnesses was validated by the consultant physician. The data were compiled on semi-structured proforma and analysed by using descriptive statistical methods. Results: Seventy per cent patients were found to have associated physical illnesses. Metabolic disorders were present among 28.9% patients followed by endocrinal (25.6%), haematological (18.3%), gastrointestinal (15%), cardiovascular (12.2%), neurological (9.4%), and stomatognathic disorders (8.3%). Conclusion: Index study reports a high prevalence of medical comorbidity in the psychiatric inpatients. There is an urgent need for further research and sensitisation of mental health professionals about recognising the medical comorbidities and their prompt treatment via liaison with physicians and other medical staff.
Clozapine prescribing patterns in hospitalised patients in everyday clinical practice
(Academy Publisher, 2020-12) Karli?i?, I S; Staševi?, M; ?or?evi?, V; Dutina, A.
Aim: Clozapine is the gold standard for treatment-resistant schizophrenia. Despite clear recommendations for use, under-use and excessive delay in the use of clozapine are an ongoing findings in the literature. The aim of this study was to analyse the clozapine prescribing patterns in hospitalised patients in everyday clinical practice in Serbia. Methods: This cross-sectional study was conducted in Clinic for Mental Disorders “'Dr Laza Lazarevi?”' in Belgrade and included a sample of 238 patients, discharged from hospital treatment during 2018. Demographic, data on the clinical characteristics of the subjects, dosage and combination of clozapine with other psychopharmacs were collected retrospectively, from the patients’ medical records. Descriptive and statistical hypothesis testing methods were used to analyse the primary data. Results: The incidence of clozapine administration was 23.5%. Clozapine was introduced into therapy after average treatment duration of 7.2 years and prior administration of three different antipsychotics. 68.1% of patients were treated with dual antipsychotic therapy prior to clozapine administration. In 53.8% of patients, clozapine was prescribed as antipsychotic monotherapy, while only eight per cent were not prescribed adjuvant therapy. The most commonly used antipsychotic in combination with clozapine was haloperidol (34.9%), while the most prescribed non-antipsychotic adjuvant drug was valproate (66%). Benzodiazepines were prescribed in 55.9% of subjects. In most subjects, the dose of clozapine was less than the standard dose. Conclusion: Clozapine is prescribed less frequently than expected and is often used in an irrational manner. Additional research is needed to advance its application in everyday clinical practice.
Neuropsychiatric manifestations in multiple sclerosis: clinical case report and review of literature
(Academy Publisher, 2020-12) Kumari, M; Singh, H; Keerthi, G D U; Mudigubba, M K.
Background: Multiple sclerosis (MS) is a neurological disability affecting young and middle-aged adults. Neuropsychiatric manifestations in the background of multiple sclerosis had been reported as a sporadic occurrence. Case description: Here, we report the case of a 57-year-old man who developed neuropsychiatric manifestations during the course of MS. Discussion: In our case, the presence of MS might be a possible reason for the neuropsychiatric manifestations. However, not many case reports have previously acknowledged wherein a patient developed neuropsychiatric symptoms secondary to multiple sclerosis. Conclusion: Hence, this case stresses the need for future studies assessing the relationship between multiple sclerosis and psychosis.
Postpartum depression and associated risk factors: a descriptive study in tertiary care teaching hospital
(Academy Publisher, 2020-12) Baishya, M; Das, B.
Background: Postpartum depression is a mood disorder that can affect women after childbirth which may cause feeling of extreme sadness, anxiety, and exhaustion that may lead to hamper of daily care activities for themselves and others. Aim: To determine presence of depression and associated risk factors among postnatal mothers. Methods and material: Fifty postnatal mothers, aged between 18-44 years were selected from the Department of Obstetrics and Gynaecology, Gauhati Medical College Hospital (GMCH), Guwahati, Assam, India. The presence of postpartum depression and maternal bonding with baby were assessed by using the Edinburgh Postnatal Depression Scale (EPDS) and the Postpartum Bonding Instrument. Results: The prevalence of postpartum depression among mothers was 26%. Prevalence was found higher among the Muslim postnatal mothers. ‘Confidence and anxiety’ and ‘aggression to baby’ were found more significant which adversely affected bonding with their babies. Conclusions: Postpartum depression was found in a high number of mothers and it adversely affected bonding to their babies.
The cacophony of emotions in a mental health professional from the isolation ward during coronavirus disease 2019 (COVID-19) pandemic
(Academy Publisher, 2020-12) Hazarika, Mythili.
This commentary is on the narrative of the thoughts of a first-line healthcare worker, and the psychological overview of the same while working in isolation ward and being in quarantine during coronavirus disease 2019 (COVID-19) pandemic.
COVID-19: saving the saviours should be our priority – is India in the right direction?
(Academy Publisher, 2020-12) Singh, J; Singhal, S.
This commentary draws attention to the need of taking care of the physical and mental health of the healthcare workers while treating patients with COVID-19.
A study on prevalence of psychiatric morbidity and substance abuse among prisoners
(Academy Publisher, 2020-12) Tirumani, S R; Vennam, B S V; Seepana, R.
Background: Studying the psychiatric morbidity among prisoners is important to plan the correctional measures and to understand many related factors. Aim and objectives: 1. To determine the sociodemographic profile. 2. To assess the prevalence of psychiatric morbidity and substance abuse among prisoners. Methodology: It was an observational study. Two hundred prisoners were included in to the study randomly. Study instrument were the Mini-International Neuropsychiatric Interview (M.I.N.I.)-Plus and personality disorders according to the American Psychiatric Association’s text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Results: Mean age of prisoners was 36.45±11.2 years. Most of the sentenced prisoners were Hindu, males, illiterates, and from rural area. Majority (83%) belonged to lower socioeconomic status. 33.5% had a history of substance abuse before entering into prison. Majority of them (83.5%) were diagnosed with psychiatric illness. Predominant type found was mood disorder. Conclusions: High psychiatric morbidity was revealed in the study and there should be screening programme at the point of entry to reveal the undiagnosed psychiatric illness. Training of prison staff is needed to respond and support the prisoners with psychiatric illness.

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