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

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.
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.
Assessing burden and its determinants in caregivers of chronic kidney disease patients undergoing haemodialysis
(Academy Publisher, 2021-12) Joseph, SJ; Bhandari, SS; Dutta, S; Khatri, D; Upadhyay, A.
Background: Caregivers face a lot of adversities while supporting their near ones undergoing haemodialysis, and their burden is often ignored by health professionals. The paucity of research in the Indian context has kept their needs out of sight. Aim: To explore the level of burden in the caregivers of patients with chronic kidney disease (CKD) undergoing haemodialysis and to assess whether patient related variable affects the burden. Methods: Fifty-one patients and their caregivers from two dialysis units in Sikkim, India, were assessed cross-sectionally. The Zarit Caregiver Burden Scale (ZCBS) was administered to measure the caregiver burden. The Patient Health Questionnaire-9 (PHQ-9) and the Charlson’s Comorbidity Index (CCI) assessed the patient’s depression and medical comorbidities, respectively. Descriptive analysis was done for the sociodemographic and clinical variables. Chi-square test was used to find the association between the categorical data. Kruskal-Wallis tested the association between categorical and quantitative variables. Results: Mean age of patient was 46.13 (±13.15) years and that of the caregiver was 44.78 (±12.14) years. 68.6% of caregivers had mild to severe levels of caregiver burden. Caregivers who were unemployed and educated till secondary school were more likely to report caregiver burden. Female gender, older caregivers, and caregivers attending patients with a longer history of haemodialysis reported a more severe burden. Conclusion: The level of burden in caregivers of CKD patients is significant and is affected by various factors, which, in turn, also affects patient’s wellbeing. Further research in this area is needed in our country for better management of patients and policymaking.
A brief summary of human molecular genetic techniques for clinical psychiatrists
(Academy Publisher, 2021-06) Rai, CB; Mukhopadhyay, A; Deshpande, SN; Thelma, BK.
Concerted and systematic efforts to understand genetics of human health and disease over the preceding 60 odd years have witnessed remarkable progress. The incremental gains through this journey were enabled by chromosomal analysis, recombinant deoxyribonucleic acid (DNA) techniques, notable discovery of single nucleotide polymorphisms following the Human Genome Project, consequent genome-wide variant-based studies, and now whole genome sequencing with ultimate diagnostic potential. Of note, success in prediction and prevention of chromosomal and single gene disorders comprising ~six to eight per cent each of all genetic disorders have been unprecedented but uncovering genetics of common complex disorders conferring ~60% of the genetic disease burden continues to pose a challenge and await new analytical paradigms - a mix of reductionist and organismal biology together with artificial intelligence and machine learning approaches being the current trend. A brief account of this path of progress in medical genetics and genomic insights along with limitations, to achieve the overarching goals of predictive, preventive, personalised, and participatory medicine is presented in this article.
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.
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.
A comparative study on sociodemographic and clinical profile of patients undergoing admission and readmission in a mental health institute
(Academy Publisher, 2021-12) Das, S; Mehta, S; Baruah, A; Sah, D.
Aims: Psychiatric patients have a high rate of readmission. So, we need to understand what kind of patients are more likely to be readmitted, to predict the clinical and social factors that place them at risk, and to identify potential limitations in existing healthcare delivery systems. Objective of the study was to find out and compare sociodemographic and clinical profiles of patients getting first admission and readmission. Methods: It was a retrospective, record-based observational study from computerised database of the institute and the case record files of patients for one year. Variables like age, sex, religion, marital status, locality, education, occupation, and diagnosis were studied. Analysis was done by chi-square test using the Statistical Package for the Social Sciences (SPSS) version 16.0. Results: The total number of admissions during this period was 876, among which 463 had been admitted previously in the institute and 60 had been admitted more than once in the time period. Among new admissions and readmissions, majority were unemployed, unmarried, Hindu males, 16-30 years of age, and had schizophrenia and related spectrum diagnosis (F20-F29). No significant difference in readmission rates were found for sex, marital status, religion, educational status, or locality. Readmission rates among housewives were seen less than expected. There were significant differences among different diagnoses in terms of readmission (p<0.001), with F30-F39 showing more than expected readmissions and F10-F19 showing more than expected first admission with less than expected readmissions. Conclusions: Current study reviews the scenario of mental healthcare utilisation. Decreased readmission rates of women and of patients with substance abuse disorders warrants further community-based research.
Comparison of attitudes toward psychiatry among undergraduate and postgraduate medical students
(Academy Publisher, 2021-06) Ghosh, P; Doley, M; Dutta, N; Bhattacharya, A.
Introduction: Attitudes toward psychiatry among medical students will have a great impact on future of expanding psychiatry and breaking barriers at multiple levels. Aims: To assess and compare the attitudes of undergraduate (UG) and postgraduate (PG) medical students toward psychiatry and assess association between sociodemographic variables and attitudes toward mental illness. Methods: A cross-sectional study conducted in a tertiary health care centre, total of 100 (50 UG and 50 PG) medical students were recruited in the study. A standardised questionnaire, Attitudes Toward Psychiatry-30 items (ATP-30) and semi-structured proforma for sociodemographic details were given to study subjects to fill up. Statistical analysis: Both quantitative and qualitative measures of data were calculated. Statistical significance was kept at p-value of <0.05, using Fisher’s exact test and Chi-square test. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 21. Results: The overall ATP-30 score responses were positive (>90) in both males (88%) and females (62%). More number of positive responses were seen in both UG (68%) and PG (84%) medical students compared to only some negative responses in UG (22%) and PG (16%). This difference is significant at p-value <0.05. There is a significant difference (p-value <0.05) in attitudes among UG and PG students in item number four revealing 32% PGs wish was to be psychiatrist. Majority of the UGs and PGs agreed that UG psychiatric training is valuable. Conclusion: We have found overall good attitudes toward psychiatry in the study population but conflicting interest in taking psychiatry as career choice.
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 cross-sectional study of attitude towards psychiatry among undergraduate medical students
(Academy Publisher, 2021-06) BK, Shiva, Kumar; B, Neeraj, Raj; HR, Vinay.
Background: Psychiatric disorders are common, affecting millions of population worldwide. Patients with psychiatric disorders, psychiatrists as professionals, and psychiatry as a subject are seen in negative attitudes. Prejudices and negative attitudes exist among medical professionals as well. Aims: This study aims to know the attitude of undergraduate medical students towards psychiatry and compare the attitude among students with or without exposure to clinical psychiatry postings. Materials and methods: This is a descriptive, cross-sectional study conducted at a medical college, Karnataka, South India. Undergraduate students belonging to all phases and consenting for the study were the participants. They were considered into two groups, students not exposed to psychiatry clinical posting and students exposed to psychiatry clinical postings, respectively. Apart from collecting sociodemographic details, a self-administered Attitude Towards Psychiatry?30 items questionnaire was used and t-test, chi-square/Fisher’s exact test were used for statistical analyses. Result: The sample consisted of 484 students, of which 52.3% vs 47.7% of students were not exposed to psychiatry vs exposed to psychiatry clinical postings respectively. Overall students reported having a positive attitude towards psychiatry. We found 96.1% of students with clinical exposure to psychiatry have a better attitude compared to 86.9% of students not exposed to psychiatry clinical postings. Conclusion: A positive attitude towards psychiatry is necessary for better care of patients as well as to reduce stigma regarding mental illness. As clinical exposure improves the positive attitude, there is always a scope for improvements in the form of better psychiatry training at the undergraduate level.
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.
Disability and socio-occupational functioning in persons with schizophrenia
(Academy Publisher, 2020-12) Mahanta, P; Deuri, S P; Banerjee, I.
Background: Schizophrenia is a chronic mental illness which severely affects the functioning of individuals in their daily life. Functional disability in chronic illness is one of the major concerns for mental health professionals. The study aims to assess the disability of persons with schizophrenia and its relationship with age of onset, total duration of illness, and socio-occupational functioning. Methods and materials: The present study is a descriptive cross-sectional study. Sixty persons with schizophrenia were selected using simple random sampling from the outpatient department (OPD). Written informed consent was taken from the participants who fulfilled the inclusion and exclusion criteria. Clarifications were made regarding the basic purpose of the study before administration of tools. The study was undertaken with the permission of the Scientific Advisory and Institute Ethics committees. Sociodemographic datasheet, the revised Kuppuswamy scale, the Brief Psychiatric Rating Scale (BPRS), the Indian Disability Evaluation and Assessment Scale (IDEAS), and the Social Occupational Functioning Scale (SOFS) were administered. Collected data were analysed using the software (Statistical Package for the Social Sciences [SPSS] 25.0) using the statistical methods of mean, standard deviation, frequency, percentage, and Pearson correlation. Results: The findings showed that most of the respondents (71.7%) were having moderate level of disability and moderate impairment (40%) in socio-occupational functioning. The global score of disability has a significant positive correlation with total duration of illness (r=0.255, p<0.05) and negative correlation with age of onset of illness (r=-0.075), and there is significant positive correlation (r=0.829, p<0.01) between socio-occupational functioning and global disability. Conclusion: Disability has an impact on socio-occupational functioning in persons with schizophrenia. A higher level of disability can lead to higher level of impairment.
Dyadic adjustment and marital communication of persons with depression
(Academy Publisher, 2021-12) Kannekanti, P; Bhattacharjee, D; Ram, D; Pachori, H.
Background: One of the most important relationships between a man and a woman is marriage. Marriage is a social union as well as a legal contract between people that creates kinship. It is a primary institution of society. Marriage involves an emotional and legal commitment that is quite important in any adult life and even same in the persons with depression. Faulty marital relationship not only affects the couples but it inflicts longitudinal negative impact upon the entire family system and individual members of families. Methodology: The present study aims to compare the pattern of dyadic adjustment and marital communication between married individuals with depression and married healthy controls. Cross-sectional study design was used. Purposive sampling technique was used to collect the data for the study. The study group comprised of 30 married individuals with depression, whereas the other group consisted of 30 married healthy controls. Both the groups were examined on sociodemographic datasheet, the Dyadic Adjustment Scale (DAS), and the Marital Communication Inventory (MCI). Result: It was found that there were significant differences in the dyadic adjustment and marital communication of persons with depression compared to healthy controls, and there was no significant difference between males and females of depression patients in dyadic adjustment and marital communication. Conclusion: There is need to involve the spouse in the treatment process, and couple-based interventions will help for better marital adjustment and communication with depression patients compared to the healthy controls.
Economic hardships during pandemics and its impact on mental health: a narrative review with special focus on the COVID-19 pandemic
(Academy Publisher, 2021-12) Patchaikannu, G.
Economic crisis during pandemics has an obviously significant impact on the mental health of people. The uncertainty of economic conditions leaves people uncertain about their future, and, would trigger mental health conditions like stress, depression, anxiety, substance use, and also, re-emergence of pre-existing mental health issues. The coronavirus disease 2019 (COVID-19) pandemic has created job losses in various sectors and, the rise in unemployment will be an unavoidable consequence. Literature has pointed out to the causal relationship between unemployment and depression. Suicidal behaviour during the economic crisis is a significant psychological issue. Poor financial conditions could also affect children’s mental health due to disruption in the availability of nutrition and essential commodities, mental health issues in parents, and poor quality of parenting. The increase in alcohol consumption and the grey-market of alcohol noted in the time of COVID-19 pandemic are of utmost concern. Active labour market programmes are the need of the hour due to the rising unemployment rate. Family support programmes and debt relief programmes could help vulnerable families, and, prevent mental health issues in vulnerable groups, including the child and adolescent age groups. Strict control over the grey-market of alcohol, and, an increase in alcohol prices via government agencies would help prevent alcohol-related problems which are indirectly related to economic burden. Teleconsultation services would further help to manage those affected by the economic crisis and psychological issues.
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.
Exploration of life events and perceived stress in female patients admitted in the psychiatry department of a tertiary care hospital
(Academy Publisher, 2020-12) Borgohain, L; Bhuyan, D; Chandel, S.
Background: Research in past four decades show that recent life events do contribute to the onset of psychiatric illness but exact relationship between stress and psychiatric illness is still unclear and studies on life events are relatively less in North Eastern region of India. Aim: To examine the nature of life events, perceived stress, their association with various psychiatric illness and impact on duration of hospital stay in admitted female patients. Method: It is a cross-sectional study on 100 female patients admitted in psychiatry ward in Assam Medical College & Hospital, Dibrugarh, Assam, India, over a period of one year. Life events were examined using the Presumptive Stressful Life Events Scale (PSLES) and perceived stress was assessed by 14-item questionnaire, the Perceived Stress Scale (PSS). Result: Four most common stressful life events were financial problem/loss, death of a close family member, excessive alcohol use, and illness of a family member. Patients of schizophrenia perceived more stress than mood disorder followed by conversion disorder. Similarly, duration of hospitalisation was also higher in patients with higher perceived stress. Conclusion: The results of current research suggest that higher levels of perceived stress and negative life events are encountered in patients with schizophrenia. Life events in manic patients are usually related to social life while in depressive patients, role of loss is found more important like bereavement, loss of job.
An exploration of psychological distress and stigma in frontline workers amidst COVID-19 from Andhra Pradesh, India
(Academy Publisher, 2021-12) Das, K; R, Bhavya Sree; C, Madhu Sekhar.
Background: Time has evidenced the impact of various pandemics on the human race, and specifically the impact on the healthcare workforce assigned to the forefront. The coronavirus disease 2019 (COVID-19) brought in similar challenges across the globe, and also nationally. Mental health-related distress endured during these trying times in special forces remains an area of interest, but additionally we saw the reports of stigmatisation of healthcare workers working in COVID-19 areas. We aimed to explore the psychological distress and stigma faced by frontline workers in Andhra Pradesh, India. Materials and methods: Data was collected via specially designed Google survey forms, with a consent form and valid tools attached, namely the General Health Questionnaire-12 and a semi-structured questionnaire exploring stigma. Total of 321 nurses, interns, postgraduate trainees, and consultants working in COVID-19 were included in the study. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20 with descriptive (percentage, mean, and standard deviation) and inferential (chi-square and Fisher’s exact tests) statistics. Results: Young, unmarried males who have done COVID-19 duties for seven days, majority serving in screening areas and having experienced COVID-19-like symptoms formed the larger sample. Younger age, unmarried, females, nursing staff were significantly found to have distress. Prevalence of stigma was noted with significant association of distress with anxiety over testing, discrimination for working in a COVID-19 centre, being afraid to reveal COVID-19-like symptoms, being disliked for living among family and friends post-quarantine. Conclusion: Majority were less than 30 years, unmarried, female who had significant association between psychological distress. Stigma was reported with association to psychological distress.
His Master Voice
(Academy Publisher, 2021-12) Das, Himabrata.
In this free-flowing conversation with the Open Journal of Psychiatry & Allied Sciences (OJPAS®), the stalwart Dr. HR Phookun speaks about how the ongoing pandemic is changing the world we live in and the major challenges for mental health professionals arising out of this crisis. He also discusses his experience of taking online classes and predicts a larger role that technology will play in the delivery of mental health services.
Iatrogenic skin popper: tramadol dependence in a patient with no previous substance history
(Academy Publisher, 2021-12) Aggarwal, S; Kumar, K; Kumar, A; Sharma, S; Nayar, N; Upadhyay, K.
Tramadol, a synthetic codeine analogue having a weak ? receptor agonist action has been widely used for relief of mild to moderate pain. Most commonly, tramadol addiction or abuse is reported among doctors or people with previous history of drug abuse. However, rare cases of tramadol dependence have been described in patients without prior substance abuse history. We are describing one such case of a 35-year-old male who presented with history of using injection tramadol regularly for three years where there was no prior history of drug abuse but who was prescribed tramadol for medical reason. The frequency of one ampule of tramadol increased from once in two to three days to almost daily up to 12-14 ampules/day. The management was a serious challenge. We admitted the patient for inpatient detoxification. He required tramadol injections to manage his withdrawal symptoms, along with lorazepam and clonidine which were gradually tapered over a period of 14 days. This case highlights that tramadol dependence though very rare but still can happen in a patient without substance abuse history. Also, the physician should be aware of the abuse potential of tramadol and should keep in mind short and judicious prescription, and educating the person regarding the risk of abuse can help to minimise this debilitating and sometimes fatal addiction.
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.

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