Neglect and abandonment of persons with dementia in India: Urgent need for residential and day-care facilities Om Prakash Singh Indian Journal of Psychiatry 2019 61(5):429-430

Patterns and predictors of self-harm in patients with substance-use disorder Rishi Gupta, Shubham Narnoli, Nileshwar Das, Siddharth Sarkar, Yatan Pal Singh Balhara Indian Journal of Psychiatry 2019 61(5):431-438 Background: Suicide is a growing health concern and causes significant health burden. Patients with substance use disorders represent an especially vulnerable population in terms of self-harm. Data on risk factors for self-harm in substance-using population in the Indian context are limited. We aimed to determine the patterns and sociodemographic/clinical predictors of self-harm in patients with substance use disorders. Materials and Methods: We assessed 300 male patients on Deliberate Self-Harm Inventory to assess the patterns of self-harm. We performed mediation analysis to determine whether clinical variables acted via sociodemographic variables in their effect on self-harm. Results: The occurrence rate of self-harm was 32.7%. It was significantly associated with a younger age, being unmarried/separated, unemployed, history of injecting drug use, high-risk sexual behavior, and cannabis use disorders. Conclusion: Self-harm is an important consideration among patients with substance use disorders, and needs to be addressed by the clinicians involved in the care of such patients.

Profile of students referred for the assessment of scholastic backwardness at a tertiary care center Smitha Ramadas, Vimy V Vijayan Indian Journal of Psychiatry 2019 61(5):439-443 Background: Scholastic backwardness (SB) is a challenging problem affecting school-going children. Students seeking evaluation and certification of SB, especially in class nine and ten are on a rising trend in Kerala, the most literate state in India. However, there is a paucity of research regarding this. Objectives: The objectives of this study are to determine the clinical, sociodemographic, and academic profile of students referred with “difficulty in academics” in the psychiatry department of a government teaching hospital in Kerala. Materials and Methods: A retrospective chart review of students aged 6–16 years, referred to clinical psychologist for the structured assessment of SB, after evaluation by psychiatrists, over 1 year was done. Results: Overall, 207 students were assessed. Children aged 13–16 years were the majority (61.4%). Most of them were males (61.4%) and from rural background (81.6%). Majority (60%) was from high school and 22% of students were in class 10. Previous assessments for SB were done only in 20% of high school students. About 97% belonged to state syllabus, 90% were in Malayalam medium, and 93.3% were referred by teachers. The principal diagnosis was “slow learners” (34.8%) followed by intellectual disability (28%). About 11.6% had specific learning disorder (SLD), 15.5% had other neurodevelopmental, behavioral, and emotional disorders/problems, and 10% had no diagnosis. Conclusion: Varying degrees of intellectual impairment was the main cause of SB; majority was in high school and was never evaluated for SB. There was over-representation of class 10 students for first-ever assessment. Students with SB were identified and referred late for professional services. Those with SLD and nil diagnosis were similar in number probably reflecting an attempt to pass board exams by availing the benefits of certification. Designing curriculum and assessment to suit the differing intellectual levels of students are, therefore, recommended.

Depressive symptoms and the risk of arthritis: A survival analysis using data from the osteoarthritis initiative Vishal Vennu, Harsh Misra, Asha Misra Indian Journal of Psychiatry 2019 61(5):444-450 Background: Some studies investigated the association between depressive symptoms and arthritis; however, no longitudinal studies have documented the relationship between developing depressive symptoms and the risk of arthritis. Therefore, this study evaluated whether the development of depressive symptoms was associated with an elevated risk of arthritis. Materials and Methods: A survival analysis using Cox regression models was applied to osteoarthritis initiative data obtained over 6 years from adults (n = 3,662) aged ≥45 years at baseline. Developing depressive symptoms was defined using the 20-item Center for Epidemiologic Studies Depression scale (cutoff 16 points) between baseline and 1 year. Arthritis was defined answering “yes” to the following self-reported question: “Did the doctor say you developed arthritis since the last clinic visit about 1 year ago?” over the 6-year follow-up period. Results: The hazard ratios for developing arthritis were 3.51 (95% confidence interval [CI] = 2.32–5.29) and 2.03 (95% CI = 1.45–2.85) for men and women, respectively, as compared to those who did not develop depressive symptoms. There was a significantly (χ2 = 73.672, P < 0.0001) lower survival probability at each time point throughout the study among men and women who developed depressive symptoms. Conclusion: In both men and women, developing depressive symptoms increased the risk of arthritis, and the survival probability decreased at each time point.

Perspectives, attitude, and practice of lithium prescription among psychiatrists in India Sucharita Mandal, Spoorthy Sai Mamidipalli, Bhaskar Mukherjee, Suchandra K Hari Hara Indian Journal of Psychiatry 2019 61(5):451-456 Introduction: Lithium “the magic pill” past its discovery remained the respite for patients with bipolar disorders for decades. The prescriptions of lithium were replaced by other drugs because of the cumbersome monitoring, adverse effect profile, narrow therapeutic index, and frequent comorbidities in patients. The objectives of this study were to understand the knowledge, attitude, and practice of lithium by a subset of psychiatrists in India, which will help us understand the theory–practice gap and for devising strategies to bridge the existing gap. Materials and Methods: The current study was an online survey which included 103 psychiatrists from India of either gender and any age group. Predesigned questionnaire about the knowledge, attitude, and practice of lithium use was circulated for 1 month (March 2018). We received 135 responses (31% response rate), of which 32 were incomplete. Hence, the total sample of psychiatrists included in the study was 103. Results: The results suggest that most practitioners included in the survey had knowledge about the effects, adverse effects, and the monitoring protocols and were comfortable in using lithium in patients on outpatient basis. Despite being aware of the indications, the psychiatrists were skeptical in starting lithium due to multitude of perceived barriers such as comorbidities, patient's low adherence to blood monitoring, and adverse effects. Conclusions: Clinicians should be well aware of the adverse effects, monitoring protocols, which will help them to use lithium in a more appropriate manner.

Predictors of caregiver burden after stroke in Nigeria: Effect on psychosocial well-being Osunwale Dahunsi Oni, Andrew Toyin Olagunju, Christopher Izehinosen Okpataku, Adebayo Rasheed Erinfolami, Joseph Dada Adeyemi Indian Journal of Psychiatry 2019 61(5):457-464 Background: Family caregivers (CGs) are critical to the care and recovery of stroke survivors (SSs), particularly in the community. However, little is known about their psychosocial well-being, especially in developing countries. In this study, we assessed CG burden, psychiatric morbidity, quality of life (QoL), and predictors of burden. Materials and Methods: We recruited 150 dyads of CGs/SSs from two outpatient clinics in Nigeria. Data were collected through sociodemographic/clinical questionnaire, the Zarit caregiver burden interview, the World Health Organization QoL-BREF, and the Mini-International Neuropsychiatric Interview. Disability in SSs was graded with the Modified Rankin Scale. Results: Compared to CGs who were mostly females (86.7%) with a mean age of 42.8 (±12.6) years, SSs were older with a mean age of 61.6 (±12.5) years and were mainly males (62.7%). The mean CG burden score was 31.6 (±10.5) and eight in 10 CGs, 124 (82.7%) reported moderate-to-severe burden scores. Mental disorders in the form of depression and/or anxiety disorders were diagnosed in 26 (17.3%) CGs. Significant predictors of high-burden scores (P < 0.05) were incontinence in SSs, psychological symptoms in SS, worse poststroke disability, and performance of more CG tasks (B = 8.3, 4.5, 3.9, and 3.5, respectively). CGs QoL scores correlated negatively with burden scores, with medium-to-large effect sizes (r = −0.4–−0.6) across QoL spheres. Conclusion: In this study, psychosocial burden in CGs was indexed by various determinants and impacted QoL negatively. Given the integral role of CGs to the care of SSs in the community, mental health services, psychosocial support programs, and stratification based on known vulnerability factors seems viable options for intervention, assessment, and planning.

Beliefs about voices and their relation to severity of psychosis in chronic schizophrenia patients Nishtha Chawla, Raman Deep, Sudhir Kumar Khandelwal, Ajay Garg Indian Journal of Psychiatry 2019 61(5):465-471 Background: Auditory hallucinations may persist in a subset of chronic psychotic patients in spite of treatment. It is important to understand the personal meaning and significance of voices in these patients. In spite of its relevance, only a limited literature is available. Aim: This exploratory study aimed to assess the beliefs regarding voices in treatment-seeking patients with chronic schizophrenia having persistent auditory verbal hallucinations (AVHs) and assess their relation to the severity of psychosis. Materials and Methods: We recruited thirty adult patients with chronic schizophrenia as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition with both lifetime and current significant AVHs (≥50% days/month). Co-occurring psychiatric disorders were ruled out using the Mini International Neuropsychiatric Interview-7.0.0. Patients were assessed using a semi-structured proforma, Beliefs about Voices Questionnaire-Revised (BAVQ-R), Psychotic Symptom Rating Scale (PSYRATS), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Clinical Global Impression-Schizophrenia (CGI-SCH)-severity. Results: The median age of the patients was 32 years (interquartile range [IQR]: 23.8–40.5). The median duration of illness and treatment was 7 years (IQR: 3.4–15.0) and 3 years (IQR: 1.9–10.5), respectively. Higher BAVQ-R scores were found on “malevolence,” “omnipotence,” and “emotional and behavioral resistance.” These beliefs had a significant positive correlation with PSYRATS hallucination subscale, but not with the severity of psychosis (SAPS, SANS, and CGI-SCH). The sample had lower scores for “benevolence” and “engagement” subscales of BAV-Q. Conclusion: Overall, the study sample believed AVH to be more malicious and omnipotent rather than benevolent, and resisted the voices, engaging only minimally with them. These beliefs were not related to the severity of psychosis, but were related to the severity of hallucinations. Assessing the beliefs regarding AVH in larger, diverse samples may help to plan behavioral interventions.

Dependence on smokeless tobacco and willingness to quit among patients of a tertiary care hospital of Bhavnagar, Western India Pathik M Patel, Mihir Prafulbhai Rupani, Aditya N Gajera Indian Journal of Psychiatry 2019 61(5):472-479 Background: There is a paucity of data on smokeless tobacco (SLT) use in Bhavnagar city of western India. This research attempts to find out the dependence and willingness to quit SLT use. Materials and Methods: This was a hospital-based cross-sectional study conducted in a tertiary care government hospital on a calculated sample size of 258 SLT users in the year 2017. The patients were recruited from ear-nose-throat (ENT) and dental outpatient department (OPD). The tobacco dependence was assessed using “Fagerstrom Test for Nicotine Dependence-SLT” and willingness to quit was assessed on a Likert scale of 1–10. Results: Among the 258 SLT users, 20% were highly dependent on SLT and 61% had low willingness to quit tobacco. “Mawa” was the most common (60%) chewed form of tobacco. Illiterate patients were three times more likely and patients whose occupation required traveling were 2.4 times more likely to develop high dependence for SLT than their counterparts. Patients living in the joint family were 2.7 times more likely to develop high dependence than patients living in a nuclear family. Conclusion: There is a need for the introduction of tobacco cessation interventions in ENT and dental OPD of tertiary care hospitals of western India.

Efficacy of ketamine therapy in the treatment of depression Suprio Mandal, Vinod Kumar Sinha, Nishant Goyal Indian Journal of Psychiatry 2019 61(5):480-485 Background: Severe depressive disorder is among most debilitating condition. Conventional pharmacotherapy usually takes several weeks (usually 4–12 weeks) to improve symptoms. Ketamine is an N–methyl-D aspartate receptor antagonist having rapid action on depressive symptoms. Objectives: The effect of subanesthetic dose of ketamine was assessed on depressive and anxiety symptoms. Illness severity and improvement were assessed after treatment with ketamine. Materials and Methods: Twenty-five drug-free/naïve patients of the male sex, with severe depression having no previous history of psychotic disorder, head injury, organic disorder, cardiological problem, or substance abuse were admitted for the study. Assessments were made at baseline and injection ketamine hydrochloride was given at a subanesthetic dose of 0.5 mg/kg intravenous bolus after preparation. Assessments were repeated 1 h after the first dose. Six doses were given over 2 weeks and assessments were repeated. Final assessments were made after 1 month of the last dose. Results: There was a significant improvement in depression, anxiety, and the severity of illness after 2 weeks and 1 month of the last dose of ketamine. Significant improvement at 1st h of the first dose was seen in depression and anxiety and not for illness severity. There were transient adverse effects observed in some patients which subsided within 1 h. Conclusion: Ketamine has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.

The extent and nature of coverage of mental health issues in printed media in India Blessy Mohandass, Manpreet Kaur, Harpreet Kaur Indian Journal of Psychiatry 2019 61(5):486-490 Context: The term media on a whole pertain to the main method of mass communication. The chief aim of the media is communication, with the objective of educating, informing, and entertaining the audience. It is unknown how accurately the media reports the topics related to mental health issues. Aims: The aim of this study is to explore the extent and nature of coverage of mental health issues in printed media. Settings and Design: Data collection for the present study was conducted at the Library Gian Sagar College of Nursing, Ram Nagar, District Patiala, Punjab, in January 2017. A quantitative research approach with exploratory research design was adopted to explore the extent and nature of coverage of mental health issues in printed media. Subjects and Methods: By purposive sampling technique, 923 printed media from which a sample of 839 articles was drawn, i.e., N = 839 (N1for newspapers, N1= 827 and N2for magazines, N2= 12) with the help of search terms which consisted of 32 general and diagnostic terms covering the full range of mental disorders. Statistical Analysis Used: Descriptive statistics were used. Results: One hundred and ninety-three (23%) articles on mental health issues appeared in the city/region section. Two hundred and one (32%) articles in newspapers did not mention the author. The most common theme of articles in newspapers was suicide 169 (25%) followed by substance abuse 209 (20%). The neutral description was used by 589 (71%) of all articles. Conclusions: Majority of the articles appeared in the city/region section with neutral/nature.