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   Table of Contents - Current issue
Coverpage
October-December 2022
Volume 38 | Issue 4
Page Nos. 309-428

Online since Friday, November 18, 2022

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EDITORIAL  

Challenging times, changing focus, and social psychiatry p. 309
R Srinivasa Murthy, Nitin Gupta
DOI:10.4103/ijsp.ijsp_225_22  
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PRESIDENTIAL ADDRESS Top

COVID-19 through a cultural lens p. 312
Pratap Sharan
DOI:10.4103/ijsp.ijsp_227_22  
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PERSPECTIVE Top

Schizophrenia, Recovery, and Culture: The Need for an Indian Perspective p. 318
Srinivasan Tirupati, Ramachandran Padmavati
DOI:10.4103/ijsp.ijsp_178_21  
Recovery is a concept that defined a positive and empowering experience for people with Schizophrenia. Recovery is an innately personal phenomenon, but the cultural environment can influence the recovery process. The concept of recovery originated in the West. The Eastern cultures differ in various aspects from the Western cultures. Application of the Western model of recovery in an Eastern culture like India without considering the cultural differences would be misplaced. This paper discusses two cultural factors in Indian life, namely, the family and the doctrines of Karma and Fate, that can impact recovery from Schizophrenia. Understanding the impact of culture on schizophrenia recovery should also consider cultural variations between individuals and over time. Principles and practice of Recovery-oriented mental health care in India should consider the unique local cultural environment.
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VIEWPOINT Top

Social rhythm disruption, psychosocial stressors, and the COVID-19 pandemic: Possible role of interpersonal and social rhythm therapy Highly accessed article p. 325
Chehak Gidwani, Kritika Chaudhary, Debanjan Banerjee
DOI:10.4103/ijsp.ijsp_370_20  
Besides public health, life and living themselves have been constantly adapting to rapid changes, due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. New norms such as working from home, global lockdown, travel restrictions, lack of “social touch,” increased digitalization, and rising misinformation have disrupted the “social structure” and led to evolving role transitions in daily living. Added to that are the grief and bereavement due to fatalities of the pandemic. Besides the immense impact on psychosocial health and the “funneling” effect on interpersonal relationships, the rapidly changing routines throughout the last few months due to the outbreak have challenged the biological clock, social rhythm, and sleep-wake structure. These vital parameters form the zeitgebers responsible for tuning the body and physiological responses, disrupting which can lead to biopsychosocial dysfunction, and thus increasing the risk of psychiatric disorders. Most of the psychosocial offshoots of the pandemic have been mediated by “daily schedule disruption” of the society and sleep-wake disturbances. Interpersonal and social rhythm therapy (IPSRT), originally proposed by Frank, has the capacity to target sleep-wake cycles, alertness, energy, and appetite, with evidence-based efficacy in mood disorders. In this article, we discuss this structural disruption caused by COVID-19 in social and interpersonal domains and the possible role of IPSRT in mitigating these effects by stabilizing the circadian rhythms for better emotional health as well as psychosocial well-being.
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ORIGINAL ARTICLES Top

Epidemiological Determinants of Depression and Its Associated Coping Mechanisms among College Students Confined during COVID-19 Lockdown: A Cross-Sectional e-Survey in North India p. 333
Sunny Garg, Alka Chauhan, Sanjeet Singh, Kirti Bansal
DOI:10.4103/ijsp.ijsp_2_21  
Background: Subject of interest is the status of mental health of college students around the globe as they are undergoing a lot of mental stress and depression during the pandemic lockdown. Aims and Objectives: The aim of this survey is to evaluate the prevalence of depression, its determinants, and association with coping mechanisms among college students during the COVID-19 pandemic lockdown. Methodology: A cross-sectional, questionnaire-based e-survey among college students in North India using Snowball sampling technique was done. A total of 920 responses (calculated sample size) were collected for a period of 25 days from 6th to 30th October 2020. A questionnaire regarding sociodemographic characteristics, COVID-19-related experiences along with Patient Health Questionnaire-9 (PHQ-9), and Carver Brief-coping orientation to the problem experienced-28 was adapted to Google Forms and distributed to college students. Chi-square test, independent t-test, Pearson's correlation, and hierarchical multiple regression analysis were used to investigate the determinants of depression and its association with coping mechanisms. Results: On analysis of 884 qualified participants, it was revealed that 402 (45.5%) participants have depressive symptoms ranging from moderate to severe level. The mean score of PHQ-9 was 9.82 ± 6.61. Nearly 85% thought that they were lagging behind in studies. The main determinants of depression in this study were age group of 21–24 years thought of lagging behind in studies and family members/friends/relatives diagnosed with COVID-19. Adaptive coping mechanisms (emotional support, religion, and humor) were significantly associated with lower depressive symptoms and maladaptive coping mechanisms (self-distraction, denial, behavioral disengagement, and venting) were significantly associated with higher depressive symptoms among students. Conclusions: This survey revealed multiple determinants of depression, mainly including academic worries among college students. The college staff should provide a well-structured pedagogical framework to encourage them and alleviate the unpleasant psychological effects of pandemic on students.
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A 1-Year Study on the Usage of Psychiatry Helpline Number – 9108919025 p. 342
Janisar Javed, Anil Kakunje
DOI:10.4103/ijsp.ijsp_40_21  
Background: To facilitate contact with mental health professionals (MHP), mental health centers are implementing early intervention programs with innovative strategies such as 24 h helpline services. The aim of the present study is to describe the usage of the 24 h psychiatry helpline number – 9108919025. Materials and Methods: This is a 1-year retrospective study which was conducted after the Institutional Ethical Committee clearance from May 14, 2019, to May 13, 2020, about the usage and utility of a free psychiatry helpline which is run by the department of psychiatry of a tertiary care teaching hospital. The helpline is available 24 h a day and 7 days a week, with trained MHP receiving the calls. The helpline caters to any emergencies related to emotional, psychological issues, and psychiatric illness. Results: The majority of the callers were males (57.2%) compared to female callers (42.8%). The common reason for approaching the helpline was psychosocial issues (46.3%) followed by inquiries related to psychiatric services (37.4%) and drug prescriptions (14.2%). Stress (52.1%) was the most common psychosocial issue faced by the callers followed by depression (11.7%) and interpersonal relationship conflicts (9.5%). Students with stress issues (41%) were the most common age group which approached the helpline followed by adults with work-related stress issues (26%). Conclusion: In Indian scenarios, where mental health services are spread unequally, helplines are a faster efficient, cost-effective, easy, stigma free system for helping people with mental illness, educating the public, and for information dissemination about psychiatric disorders.
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Effect of motivational enhancement therapy and behavioral couple therapy in subjects of alcohol dependence syndrome: A comparative study p. 346
Saurav Kumar, Mona Srivastava, Manushi Srivastava, Jai Singh Yadav, Shiv Prakash
DOI:10.4103/ijsp.ijsp_443_20  
Background: Alcohol dependence is a wide and extending social and physical problem in the world. It affects a person at the individual, family, and society levels. The aim is to study and compare the influence of motivational enhancement therapy (MET) and behavioral couple therapy on the level of motivation in a person with alcohol dependence. Methodology: Pre- and post-test with control group design was used. A total number of 60 subjects were selected using a purposive sampling method. The sample comprised twenty subjects in the behavioral couple therapy treatment as usual (Behavioral couple therapy BCT + TAU) group, twenty subjects in the control (TAU) group, and twenty subjects in the (MET + TAU) group, respectively. The subjects recruited were in the age range of 21–60 years, educated up to primary level and above, with no comorbid psychiatric, neurological disorder, physical problem, multiple substance use coming to outpatient department and inpatient department Department of Psychiatry IMS, BHU, Varanasi, and wife having age above 18 years, married for at least 1 year, educated up to primary level and above. Tools: sociodemographic datasheets, alcohol use disorder identification test, general health questionnaire-12, and stages of change readiness and treatment eagerness scale were utilized. Results: Psychotherapeutic intervention such as MET and behavioral couple therapy plays an effective role in raising motivation to change in alcohol-dependent person to quit alcohol, which is indicated by the significant rise in motivation for the change of alcohol-dependent person's recognition (F = 4.42, P < 0.05) and taking steps (F==3.78, P < 0.05). Conclusion: The present study suggests that combining pharmacological treatment with appropriate psychosocial therapies give fruitful result in the form of a desire to quit alcohol dependence.
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Motivations of drinking or abstaining from alcohol: A cross-sectional study among 2nd-year undergraduate students p. 351
Manjiri Chaitanya Datar, Jyoti Vittaldas Shetty, Bharat Kumar Manchharam Mali
DOI:10.4103/ijsp.ijsp_458_20  
Background: Alcohol consumption at young age can lead to various negative medical and social consequences for college students. There are various motivations for students to consume alcohol. Few studies have been done to find out the motivations of students who prefer to stay abstinent from alcohol. Understanding the motivations of drinking and abstinence would help designing various preventive therapeutic programs for alcohol abstinence. Objectives: The objectives of the study were as follows: (1) to find the most prominent motivations for alcohol consumption and abstinence in students, (2) to compare the motivations for alcohol consumption and abstinence according to gender, and (3) to compare the motivations of students who did not ever consume alcohol with students who are abstinent for 6 months. Methodology: This was a cross-sectional study. Second-year undergraduate students of medical, engineering, and fine arts colleges who consented for the study were asked to fill pro forma about the pattern of alcohol consumption revealing the details of only age and gender. Depending on response about the last consumption of alcohol, the students were asked to fill either four-factor motivational model questionnaire for those who had consumed alcohol in the past 6 months or motivation for abstaining from alcohol questionnaire for students who had never consumed alcohol or were completely abstinent for the past 6 months. Descriptive and inferential statistical analysis using two independent sample tests was used. Results: Out of total sample of 224 students from the 3 colleges, 80 students who reported to have consumed alcohol in the past 6 months filled the four-factor motivational model questionnaire. One hundred and forty-four students who did not ever consume alcohol or were abstinent from the past 6 months filled the motivation for abstaining from alcohol questionnaire. Social and enhancement motives were most common in students consuming alcohol. Male students had more enhancement motivation than females. Among motivations to stay abstinent, fear of negative consequences of alcohol, indifference, and family constraints were the most common motives. Male students had significant fear of negative consequences and family constraints than female students. Fear of negative consequences, dispositional risk, and family constraints were significant motivations in students having alcohol abstinence for 6 months than those students who had never consumed alcohol. Conclusion: Positive motivations for alcohol consumption are predominant in college students. Knowledge of adverse consequences and family constraints play an important role in deterring students from alcohol consumption.
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Knowledge, attitude, and practice among parents about sex education of their children with intellectual disability p. 357
Wasim Ahmad, Nazli , BS Chavan
DOI:10.4103/ijsp.ijsp_297_20  
Background: Awareness among parents having children with intellectual disabilities has been a major concern for the last many decades. Despite several policies and plans of the government somehow, the desired awareness among the parents has not yet been created. Objective: The objective of this study was conducted to find out the knowledge, attitude, and practice (KAP) toward sex education among parents having children with intellectual disability. Materials and Methods: One hundred and thirty parents of children with intellectual disability (irrespective of severity) using a random sampling technique were selected. To assess the KAP of parents scale named Awareness on Sexual Education for Parents of Intellectually Challenged Children developed by Lakshmi and Navya (2014) and published by National Psychological Corporation, Agra, India, was used. Results: The result reveals no significant difference in the KAP, respectively, among parents w.r.t. their gender. Significant difference in the knowledge (t = 3.58) and attitude (t = 2.82) was noticed w.r.t. education. In the KAP, respectively, a significant difference (t = 2.95; t = 2.22 and t = 3.06) was found among parents toward sex education w.r.t. their income. The overall awareness (KAP) w.r.t. education (t = 3.62) and income (t = 3.82) reveals significant difference but not w.r.t. gender. The analysis reveals a significant positive correlation of knowledge with attitude (r = 0.453), knowledge with practice (r = 0.233), and attitude with practice (r = 0.252). Conclusion: Based on the findings, the study concludes that gender has no role to play in imparting sex education to children with intellectual disability. However, education and income may contribute significantly to the awareness among parents of children with intellectual disability.
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Magnitude and determinants of behavioral and psychological symptoms in dementia patients visiting a geriatric psychiatry clinic in a rural medical college p. 362
Kshirod Kumar Mishra, Ahmed Mushtaq Reshamvala, Harshal Shriram Sathe
DOI:10.4103/ijsp.ijsp_262_21  
Background: The proportion of elderly people in the Indian population is increasing, thereby making dementia a major public health concern. The behavioral and psychological symptoms of dementia (BPSD) are deleterious to the illness course in dementia. The characteristics and sociodemographic and clinical correlates of BPSD is an understudied area. Materials and Methods: This was a retrospective cross-sectional observational descriptive study conducted in a public hospital. Hospital records of 97 dementia patients who visited the geriatric clinic in the time span of 20 months were analyzed using appropriate descriptive and inferential statistics. Results: The mean age of the patients was 69.9 ± 8.50 years, majority being males (72%). Sleep disturbance (75.3%), changes in psychomotor activity (55.7%), and irritability (45.3%) were the most common behavioral and psychological symptoms associated with dementia. Apathy was seen in 39% of patients, whereas the proportion of patients with depression and anxiety was 26% and 35%, respectively. Psychotic symptoms such as delusions and hallucinations were seen in approximately 24% and 15.5% of patients, respectively. The psychotic symptoms showed a significant association with lower levels of education, whereas apathy was negatively associated with age. Females had a higher likelihood of having psychotic symptoms as compared to males. Conclusion: In the present study, the frequency and association of neuropsychiatric symptoms with demographic variables have been described in dementia patients visiting a public hospital in rural India. Among BPSD, sleep and motor disturbances were most frequent whereas agitation/aggression was least frequent. The age, education level, and gender differences noted in the individual symptoms need to be confirmed in further studies with better design.
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BRIEF COMMUNICATION Top

Factors influencing substance use among transgender individuals in India: Knowledge gap and way forward p. 369
Karthick Subramanian, Muthuraman Kavya
DOI:10.4103/ijsp.ijsp_126_21  
Background: Due to various psychological and psychosocial factors, transgender (TG) individuals suffer from psychiatric disorders including substance use disorders (SUDs). Although factors influencing mental illness and stigma in TG persons have been identified, the literature is scarce regarding the factors influencing substance abuse among the TG population. The present review identifies the burden and risk factors for substance use among TG individuals in India. Methods: An electronic search of databases such as MEDLINE, ProQuest, and Google Scholar yielded 11 relevant Indian research articles. The factors moderating substance abuse among TG persons were reviewed. Results: Studies reveal that alcohol and tobacco use disorders are the most common SUDs among TG persons in India, apart from illicit drug use. Depressive symptoms, anxiety, unemployment, and discrimination in various spheres of life were associated with elevated substance use among TG individuals. Not being married, higher income, often out with family and friends, having more sexual partners, and interpersonal violence with partner predicted harmful and illicit patterns of substance use. Conclusion: Various demographics, sexual relationship characteristics, and psychosocial factors tend to influence substance abuse patterns. Future studies are needed to explore the influence of various physical, psychosexual, psychological, and psychosocial factors on the substance use patterns among TG persons in India.
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MOVIE REVIEW Top

Parasitic…”: Revisiting 'Domestic help' during the indian lockdown through a cinematic lens p. 373
Debanjan Banerjee
DOI:10.4103/ijsp.ijsp_438_20  
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ABSTRACT Top

Abstract p. 379

DOI:10.4103/0971-9962.361372  
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