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   Table of Contents - Current issue
Coverpage
July-December 2022
Volume 23 | Issue 2
Page Nos. 79-148

Online since Monday, December 26, 2022

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EDITORIAL  

Dr DS Raju oration award-andhra pradesh psychiatry conference 2021-2022 p. 79
Gorrela Venkata RamanaRao
DOI:10.4103/amh.amh_61_22  
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ORIGINAL ARTICLES Top

Correlation of neurological soft signs with neuropsychological performance in persons with schizophrenia: A cross-sectional study from North-Eastern India p. 85
BS Sachin, Kangkan Pathak, Priyaranjan Avinash, Vrinda Saxena, Robin Victor
DOI:10.4103/amh.amh_159_21  
Background: Neurological soft signs (NSS) are subtle motor and sensory deficits that are frequently found in various psychiatric disorders including schizophrenia. NSS in schizophrenia are frequently associated with impairment in cognitive abilities and deterioration in neuropsychological performance (NP). Objective: We aimed to study the correlation between NSS and NP in persons with schizophrenia. Methods: Sixty individuals of whom thirty had schizophrenia according to the International Classification of Diseases 10th Revision and the rest thirty were matched controls were selected based on inclusion and exclusion criteria. Demographic and clinical details were obtained and tests for the assessment of NSS and neuropsychological assessment were administered. Comparison based on scores obtained in these scales was made in both the groups. Results: NSS were present in 100% of patients with schizophrenia and in 16.6% of controls in the control group. There was a statistically significant difference between the two groups in neuropsychological assessment. In Group 1, NSS showed a significant negative correlation with Tower of London, Stroop Color-Word Test, Digit Vigilance Test, and Digit Symbol Substitution Test. However, there was no correlation between NP and NSS in Group 2. Conclusion: NSS were more in persons with schizophrenia compared to healthy normal controls. Furthermore, there is a negative correlation between NSS and NP in persons with schizophrenia, which is differing from the control group. We may conclude that the presence of NSS predicts the poor NP, and also contributes to poor cognitive abilities of persons with schizophrenia.
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A cross-sectional study of frequency, type, and lethality of deliberate self-harm in bipolar affective disorder patients presenting to tertiary care center p. 90
Fakirappa Basavaraj Ganiger, Somashekhar Bijjal, AT Safeekh, Manisha Sharma
DOI:10.4103/amh.amh_135_21  
Introduction: Deliberate self-harm (DSH) is one of the leading causes of death and a major public health problem worldwide. According to the World Health Organization, DSH has increased by 60% over the past 50 years, of which 90% of victims had a psychiatric disorder. Aims and Objectives: The aim is to analyze the frequency, type, and lethality of DSH in bipolar affective disorder (BPAD) patients. Materials and Methods: This study included 150 patients diagnosed to have BPAD. Specially designed sociodemographic pro forma was used to record basic profile. DSH inventory was administered on BPAD patients who presented with DSH to analyze the type and lethality. Diagnosis of BPAD was made according to the International Classification of Diseases, tenth revision. Data were recorded, compiled, and analyzed using frequency and percentage with the IBM SPSS Statistics for Windows, Version 24.0. Results: The frequency of DSH was found to be 33%, out of which 38 (35%) patients had manic episode and 11 (30%) patients had depressive episode. The most common type of DSH was found to be cutting self with sharp or blunt objects and consumption of poison with frequency of 12 (24.5%) each. The second most common DSH was banging head, which was present in (11) 22.4% of patients. Conclusion: BPAD is associated with increased risk of DSH compared to the general population. The most common type of DSH was cutting self with sharp objects followed by consumption of poison. Patients who presented with DSH in depressive episode and severe mania had more lethal modes of DSH.
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Lower serum ferritin levels and higher inattentiveness in attention deficit hyperactivity disorder in a case–control study p. 95
Bhogaraju Anand, Chemarthi Venkata Sireesha
DOI:10.4103/amh.amh_19_22  
Introduction: Attention deficit hyperactivity disorder (ADHD) has hyperactivity, impulsivity, and inattentiveness. Brain iron stores influence dopamine synthesis and behavior. Serum ferritin is a marker for iron stores. Few studies are there on serum ferritin levels in ADHD, and the results showed either way as low or equal to controls. Contradictory results were observed in two published Indian studies, hence the need for the study. Aims and Objectives: The objectives of this study were to compare serum ferritin and hematological indexes between children with ADHD and normal controls and also to compare ADHD subscales in two of ADHD groups divided on a cutoff serum value of below 15 ng/ml (World Health Organization criteria). Materials and Methods: Children with ADHD without comorbidities were compared with controls at a child and adolescent psychiatry unit, Hyderabad, India, after ethics committee approval. The assessments included Conners' Parent Rating Scale (CPRS)-Revised (S), serum ferritin, and hematological indexes. Results: Two-three children with ADHD and 38 normal children as controls participated. The mean (standard deviation [SD]) of serum ferritin levels in the ADHD group 28.26 (16.46) and controls 23.06 (18.88) was not statistically significant. Significantly higher mean values (14.60) on cognitive/inattention subscale was noticed In below (15 ng/ml) serum ferritin level group compared to the mean (11.50) in above (15 ng/ml) serum ferritin group. Negative nonsignificant correlation (r = −0.366) between cognitive-inattention subscale of ADHD and serum ferritin levels was noticed. Conclusions: Iron-deficiency state showed higher inattentiveness on CPRS subscale than noniron-deficiency state. There is a weak negative correlation between serum ferritin and inattentiveness.
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Psychometric properties of Kessler's Psychological Distress Scale (K10) in cancer patients p. 101
Manish Namdeo Thakre, Harshal Shriram Sathe, Manoj Rajanna Talapalliwar
DOI:10.4103/amh.amh_104_21  
Context: Kessler's Psychological Distress Scale (K10) is a self-rated, easy-to-apply scale to measure psychological distress. The suitability of its use in treatment-seeking cancer patients in the clinical setup has not been studied. Aims: The aim was to assess the psychometric properties and associations of K10 with sociodemographic and clinical variables and depression levels in the cancer patients visiting the hospital. Settings and Design: The research was a cross-sectional, observational, descriptive study conducted in the oncology outpatient department of a public hospital. Materials and Methods: The data were collected from 155 cancer patients using semi-structured pro forma for sociodemographic and illness-related information. K10 and Patient Health Questionnaire-9 were used to quantify psychological distress and depression. Statistical Analysis Used: The factor structure of Kessler's 10-item scale was assessed by confirmatory factor analysis, and Cronbach's alpha was calculated as a measure of internal consistency. Given the nonnormal distribution of quantitative data, nonparametric tests were used to analyze the association of K10 scores with sociodemographic and clinical variables and depression scores. Results: The K10 showed good internal consistency (Cronbach's alpha = 0.914) in the cancer patients. In confirmatory factor analysis using structural equation modeling, the single-factor and two-factor models could not adequately fit across goodness-of-fit indices. There was a significant association between the levels of psychological distress and depression in cancer patients. Conclusion: K10, in its current form, is a reliable instrument to measure psychological distress. However, a need-based modification of the existing scale is required in treatment-seeking cancer patients.
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Correlation of factors associated with marital satisfaction-A cross-sectional study from an urban place in Andhra Pradesh p. 107
Sripathi Santhosh Goud, Adavi Swayntika, Vishal Indla, Naga Saritha Kolli
DOI:10.4103/amh.amh_146_21  
Context: Marriage is an age-old tradition that has become an essential custom for the survival and evolution of human beings. Marital satisfaction is the most essential aspect of a marriage. It is an important psychological construct affecting individual and relational well-being. Multiple factors affect marital satisfaction, and research related to these factors is scarce in India. Aims: We aimed to study the association between various sociodemographic factors, attachment styles, sexual satisfaction, and marital satisfaction. Materials and Methods: It was a cross-sectional, correlational study done on 80 subjects who were selected by purposive sampling method. A semi-structured pro forma was used to collect sociodemographic data. ENRICH (Evaluation and Nurturing Relationship Issues, Communication, and Happiness Marital Satisfaction scale was used to assess marital satisfaction. Index of Sexual Satisfaction was used for rating sexual satisfaction. A relationship questionnaire was used to measure the adult attachment style. Descriptive and inferential statistical analyses were done to find the relation between different study variables. Results: Among sociodemographic variables, gender (P = 0.03), ongoing conflicts (P < 0.001), and the attachment style of the subjects (P < 0.001) had shown a statistically significant relationship with marital satisfaction. Problems in the area of sexual satisfaction had a negative correlation with marital satisfaction (r = −663, P < 0.001). Conclusions: Although marital satisfaction is culturally dependent, attachment styles, ongoing conflicts in one's relationship, and sexual satisfaction are some of the common factors associated with marital satisfaction across cultures.
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Impact of COVID-19 on death anxiety in patients with anxiety spectrum disorders: A case–control study p. 113
Sampurna Chakraborty, Prakriti Sinha, Alok Pratap, Basudeb Das, Vikas Kumar
DOI:10.4103/amh.amh_2_22  
Background: COVID-19 pandemic has exacerbated symptoms in existing diagnosed cases of anxiety. Its impact on people with mental illness is expected to be significant, leading to an increase in relapse rates and expectedly inducing or exacerbating death anxiety. Aims & Objectives: This study aimed to assess the impact of Covid 19 fear on general anxiety and wellbeing and death anxiety and compare people with anxiety spectrum disorders on perceived fear, autonomic anxiety symptoms, and death anxiety with those without these disorders. Materials & Methods: We recruited 36 participants with anxiety spectrum disorder (generalized anxiety disorder (n=6), obsessive-compulsive disorder (n=17), panic disorder (n=5) and mixed anxiety and depression (n=8) and 36 individuals free from any psychiatric illness. Tools used include General Health Questionnaire, Fear of COVID-19 Scale, Perceived Stress Scale, Beck Anxiety Inventory and Multidimensional Fear of Death Scale. Results: A statistically significant correlation was noted between many variables in both the study groups. The regression analysis showed a significant difference in general well-being and anxiety & death anxiety in the clinical group. Study outcomes indicated that the current pandemic has triggered significant fear and anxiety in anxiety patients and among healthy controls and has triggered significant death anxiety in the clinical and healthy control group. Conclusion: The study showed that fear of covid-19 is a predictive factor for stress, death anxiety, and general well-being. These findings may be helpful to plan preventive measures, tailored intervention focusing on death anxiety and relapse plans effectively.
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Disability associated with premenstrual dysphoric disorder: A prospective study p. 118
Anusha Nemani, S. V. R. Naga Pavan Kumar Kampalli, Nooka Raju Nadukuru
DOI:10.4103/amh.amh_110_22  
Introduction: Premenstrual dysphoric disorder (PMDD), a severe form of premenstrual syndrome (PMS), is a of emotional, behavioral, and physical symptoms that cause severe functional impairment. This prospective, observational study was performed on students to assess the prevalence, the factors associated with PMS and PMDD, and the functional impairment caused by PMDD in various aspects of life. Methodology: The present study was conducted on 224 consenting college students who attained menarche using standardized instruments such as the Daily Record of Severity of Problems, the Carolina Premenstrual Assessment Scoring System, and the Sheehan Disability Scale. Results: The prevalence of PMS and PMDD was 19.64% and 4.46%, respectively. disability scores and functional impairment in the study were comparable to other major mental illnesses. Conclusion: This study therefore emphasizes the need for identification and prompt management of PMS and PMDD so as to improve the quality of life.
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Stigma among COVID-19 patients in South India-A cross-sectional study p. 123
Kannappa V Shetty, Anekal C Amaresha, Urmila Bamney, Ravi Philip Rajkumar, Prerna Srivastava, G Mahesh
DOI:10.4103/amh.amh_189_21  
Background: COVID-19 has a significant biopsychosocial impact on the lives of people who are infected, with the stigma associated with the illness being one of the major issues. However, the level of stigma based on demographics, gender differences, hospital-based or home-based care is yet to be explored. Hence, this study aimed to infer the level of stigma between these groups in the urban district of south India. Materials and Methods: This cross-sectional study recruited 50 participants who were recently infected with COVID-19 and were receiving either hospital or home-based care. The stigma was assessed using a standardized questionnaire which has four domains. MannWhitney U test was conducted to analyze the data. Results: Median age is 54 years and the majority of the participants are male (74%). The mean score of enacted stigma subscale was 4.48, disclosure fear was 2.34, internalized stigma was 2.82, perceived externalized stigma was 7.32 and the total stigma mean score was 17. The perceived externalized stigma subscale was higher in males (7.57 ± 5.96) when compared to females 6.62 ± 5.53. Total stigma scores were higher for males 17.2 ± 10.1 when compared to females 16.2 ± 10.5. The total stigma score was more (17 ± 10.3) among home isolated COVID patients as compared to hospitalized patients (16.9 ± 10.2). Conclusion: Increased levels of stigma among COVID-19 patients have various important psychosocial implications. This study highlights the need for larger prospective cohort studies to further understand stigma in the context of COVID-19.
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Quantitative electroencephalography – A promising biomarker in children with attention deficit/hyperactivity disorder p. 129
Mini Sharma, Manoj Kumar, Suman Kushwaha, Deepak Kumar
DOI:10.4103/amh.amh_24_22  
Background: Attention-deficit/hyperactivity disorder (ADHD) is marked by inattention, hyperactivity, and impulsivity. Experimental studies have reported increased theta activity and reduced beta activity on electroencephalography (EEG), although theta wave tends to appear during meditative, drowsy, hypnotic, or sleeping states. Aims: We aimed to study EEG changes in children with significant severity of ADHD. Settings and Design: A cross-sectional study was designed for the children with ADHD presenting to the Child and Adolescent Psychiatry Outpatient Department (OPD) of IHBAS. Methodology: A total of 33 ADHD children in the age group of 5–12 years attending OPD were included in the study after qualifying the inclusion and exclusion criteria for the study. DSM-5 criteria were used to make the diagnosis of ADHD and severity was assessed using Conners' Rating Scale-Revised Parent short version. The children with more than 50% score on the Conners Scale were included in the study. The quantification of the recorded EEG was done using Fast Fourier Transformation by New Natus NeuroWorks computer software. Statistical Analysis: The data were analyzed using SPSS version 23.0. Results: Around 3/4th of participants in the study showed elevated theta: beta ratio results on qEEG. Conclusions: Although ADHD is marked by inattention, hyperactivity, and impulsivity, children with ADHD showed marked elevated theta: beta ratio indicating raised slow-wave changes in cortical activity, thus concluding quantitative EEG as a promising biomarker in children with ADHD.
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BRIEF REPORT Top

Anxiety, Depression and Barriers to Mental Health Services among patients with Neurological disorders: Brief report from a tertiary care centre in South India p. 133
Raviteja Innamuri, Arnab Mukherjee, Bhuvaneshwari Sethuraman, Arun Rachana, Vivek Mathew
DOI:10.4103/amh.amh_177_21  
There is high prevalence of psychological distress in patients diagnosed with neurological disorders. A cross-sectional study was done among inpatients from the department of neurology in a tertiary care centre in South India to assess prevalence of anxiety, depression, and barriers to mental health-care utilization. Anxiety and depression were estimated using the Hospital Anxiety and Depression Scale (HADS). There is a high prevalence of psychological distress among the study participants. Proactive inquiry and screening of distress by the treating team may help identify psychological distress. Patients are more conforming and open to treating doctor. Barriers to mental health-care utilization included stigma, patient perception regarding treating doctor's attitude, patients' perception regarding distress, and doctor's perception regarding patient distress. There is a need for measures to alleviate stigma.
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CASE REPORTS Top

Lithium-induced bilateral flapping tremors (asterixis) in geriatric mania p. 139
Ranganath R Kulkarni, Swapna A Pandurangi, Raghavendra C Patil, NS Divyashree
DOI:10.4103/amh.amh_200_21  
Asterixis (flapping tremors) is a movement disorder due to cortical or subcortical pathology that usually indicates serious underlying disease processes such as encephalopathy secondary to severe hepatic dysfunction, metabolic derangements, toxic agents, or serious adverse drug events. Mood stabilizers such as valproate and carbamazepine with or without concomitant administration of antipsychotics such as clozapine and risperidone have been implicated to induce asterixis. Lithium, a first-line mood stabilizer drug for geriatric mania, with its unique profile of side-effects due to narrow therapeutic window, is very rarely implicated to induce asterixis, especially when used as a monotherapy. We report a case of lithium-induced asterixis, ataxia, acute cognitive impairment, and altered sensorium in an elderly male with first-episode of mania, both during toxic and therapeutic serum levels of lithium. This case highlights the association between asterixis, ataxia, delirium, and lithium, substantiating the dictum “start low and go slow” in geriatric psychopharmacology.
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A chronic alcoholic with central pontine myelinolysis: Victim of double hit p. 141
Sreekarthik Pratapa, Mamidipalli Sai Spoorthy, Parul Gupta
DOI:10.4103/amh.amh_100_21  
Central pontine myelinolysis (CPM), is a potentially fatal neurological disorder identified by demyelination at the bottom of the pons. Osmotic stress, endothelial dysfunction, blood–brain barrier damage, and rapid correction of hyponatremia believed to be the main causes. Chronic alcoholism may influence the CPM. We report a case of chronic alcoholism and normonatremia, who presented with sudden onset of drowsiness and quadriparesis, after sudden abstinence from alcohol who was eventually diagnosed with CPM. Evidence of elevated serum ammonia level indicated encephalopathy. Our case emphasizes that CPM can manifest in patients with chronic alcoholism. CPM must be distinguished from the natural course of alcohol withdrawal delirium and Wernicke's encephalopathy, which necessitates clinical astuteness and a high level of suspicion on the part of the physician.
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Neuroleptic-induced tardive dystonia in young patients suffering from psychosis p. 144
Amey Yeshwant Angane, Aditya R Anvekar, Prerna K Keshari, Vishnu B Unnithan
DOI:10.4103/amh.amh_10_22  
Tardive dystonia is one of the extrapyramidal syndromes that start after long-term use of dopamine receptor antagonists. Tardive dystonia is underdiagnosed and often misdiagnosed; some of the treatment possibilities are hardly known among psychiatrists and are notorious for being resistant to treatment. Here, we present a set of two cases who had come with neuroleptic-induced tardive dystonia, initially given oral tetrabenazine and injectable botulinum toxin, but they did not respond. They got better after treatment with the combination of oral baclofen and electroconvulsive therapy (ECT). ECT is thought to prevent the super sensitization of postsynaptic dopamine receptors that contribute to the development of tardive states. Baclofen is a presynaptic gamma-aminobutyric acid receptor agonist primarily used to treat spasticity. Both may have acted synergistically to treat the dystonia. Tardive dystonia needs to be ruled out in patients with a history of long-term antipsychotic medication use. Consultant liaison with psychiatrists will be of paramount importance in the timely management of these cases. The combination of ECT and baclofen may be an effective choice for patients of schizophrenia with tardive dystonia developed in the course of neuroleptic treatment. However, further controlled studies are needed to develop and refine the guidelines for managing it.
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LETTERS TO EDITOR Top

Bridging the gap by strengthening the MHGAP: Integrating mental health care into primary health care in Nigeria p. 148
Abolaji Paul Adekeye
DOI:10.4103/amh.amh_34_22  
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