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   Table of Contents - Current issue
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January-June 2022
Volume 23 | Issue 1
Page Nos. 1-76

Online since Thursday, May 19, 2022

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ORIGINAL ARTICLES  

Prevalence of sexual dysfunction in the patients suffering from depression: A cross-sectional study p. 1
Prosenjit Ghosh, Gulshan Narula, Anweshan Ghosh
DOI:10.4103/amh.amh_23_21  
Background: A significant number of patients suffering from depression experience various sexual dysfunctions like decreased sexual interest, erectile disorders, premature ejaculation and anorgasmia. The evaluation of the prevalence of sexual dysfunction in depression is complicated by the fact that both medications as well as the depressive state itself may affect sexual desire and arousal. This study aimed to assess the prevalence of sexual dysfunction in cases of depression, and to check the correlation of severity of depression with severity of sexual dysfunction. Methods: This study was a cross-sectional non-interventional hospital based study. Diagnosis of depressive disorder was made according to ICD-10. The severity of depression was assessed using Beck Depression Inventory (BDI-II) and the severity of sexual dysfunction was assessed using Arizona Sexual Experience scale (ASEX). The data obtained was analysed using SPSS Version 23. Results: A total of 100 depressed patients diagnosed as per the International Classification of diseases 10 criteria were recruited after their informed consent. Majority of the participants were young lower middle class female; most of the participants were married (50%), homemakers by profession (34%), belonging to a semiurban area (43%). 50% of them (n=50) reported having sexual dysfunction. The mean BDI-II total score was 17.08±4.206. The mean ASEX total score was 28.28±11.312. The BDI-II score was found to be significantly correlated with the ASEX total score (r=0.686, p<0.001). Conclusion: A significant correlation was found between severity of depression and severity of sexual dysfunction.
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A pilot open-label study of oral acetazolamide for sodium valproate-associated weight gain in bipolar affective disorder p. 7
Mathews Joseph Panicker, Anil Kakunje, Vishwajit L Nimgaonkar, Smita Deshpande, Triptish Bhatia, Shashwath Sathyanath
DOI:10.4103/amh.amh_61_21  
Background: Bipolar affective disorder (BD) is a chronic recurrent disorder having a definite link with metabolic abnormalities, including obesity, dyslipidemia, and insulin resistance. Drugs approved for the treatment of BD include sodium valproate but have weight gain as a metabolic side effect. An increase in weight is one of the common reasons for discontinuation of mood stabilizers. There is a need for a weight loss agent which will not increase mood symptoms in bipolar disorder. This study looks at the effect of acetazolamide on weight when combined with sodium valproate in patients diagnosed with BD in remission. Materials and Methods: This pilot quasi-experimental open-label 8-week follow-up study was conducted in a tertiary care teaching hospital following clearance from the institutional ethics committee. Thirteen outpatients with BD who reported weight gain on sodium valproate monotherapy received oral acetazolamide 500 mg/day. A specialized pro forma was used to record demographic and physical data with side effects. Results: The mean baseline weight was 70.15 ± 8.75 kg and the mean baseline body mass index was 25.09 ± 2.61. The mean sodium valproate dose of the study population was 692 mg/day. Ten of 11 individuals who completed the study showed some reduction in weight and nine showed a slight decrease in abdominal girths. Conclusion: There was a nonsignificant decrease in weight and abdominal circumferences at the end of 8 weeks, however, since it is a small pilot study, we need more evidence.
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Wounded healers? Exploring body image perceptions and the need for psychosocial intervention among undergraduate medical students p. 12
Miriam Archana Simon, Chhaya Akshay Divecha, Hassan Tayyab, Alhassan Ali Asaad
DOI:10.4103/amh.amh_14_21  
Background: Body image issues are on the rise and affect people of all ages. It is one of the top-ranked issues of concern for young people. The present study aims to explore the body image perceptions and concerns of medical students, in particular their body esteem. Materials and Methods: The present study was conducted among the medical students at the College of Medicine and Health Sciences, National University of Science and Technology, Sultanate of Oman. Students across the 6 years in the medical program were invited to be part of the study. Self-report of body mass index and body weight satisfaction were obtained. Participants were also required to complete items corresponding to the Appearance and Attribution sub-scales of the Body Esteem Scale for Adolescents and Adults. Results: Results from 351 participants indicate that medical students in Oman experience low body esteem, especially related to the self-perception of their appearance and evaluations of others. Bodyweight dissatisfaction and behavioral attempts to change weight, though associated, are not very strong predictors for body esteem. Conclusions: Results indicate that psychosocial and cultural factors may play a major contributory role in body image perceptions. Exposure to medical training that instills knowledge and awareness of body composition, eating habits and eating disorders does not seem to positively impact higher body esteem in students. It is recommended that awareness modules and psychoeducation sessions focusing on body image issues be planned and initiated for medical students in Oman.
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A cross-sectional study on domestic violence, marital satisfaction, and quality of life among partners of patients with alcohol use disorder p. 18
Divija Bunga, Rajshekhar Bipeta, Umashankar Molanguri
DOI:10.4103/amh.amh_77_21  
Introduction: Alcohol use disorders (AUDs) have adverse effects on physical and psychosocial health and results in marital problems with reduced quality of life in partners. Aims and Objectives: The aims and objectives of the study are to investigate the relationship between domestic violence (DV), marital satisfaction, and well-being in partners of AUD patients. Materials and Methods: This was a cross-sectional study on patients with AUD and their partners. We administered the Severity of Alcohol Dependence Questionnaire to the participants and DV questionnaire, marital satisfaction scale, coping questionnaire, and the World Health Organization (WHO-5) well-being index scales to the partners. Statistical Analysis Used: Descriptive statistics were depicted using frequency tables, and linear regression analysis was performed. Results: DV was reported by 36.98% of the partners, and the marital satisfaction rate was 62.58%. The WHO-5 well-being was 33.88%, engaged coping was 38.60%, tolerant coping was 23.60%, withdrawal coping being 6.18%, and total coping was 72.76%. The severity of alcohol dependence syndrome (ADS) negatively correlated with well-being (r = 0.24) and marital satisfaction (r = 0.17). Furthermore, DV showed a negative correlation with the marital satisfaction (r = 0.32; P = 0.02) and well-being (r = 0.50; P = 0.0001) with statistical significance. Conclusions: The majority of the partners experienced DV, marital dissatisfaction, and poor well-being.
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Assessment of social functioning, quality of life, and social support in persons with schizophrenia: A gender difference p. 23
Shrishti Dahuja, Upendra Singh, Ram Pratap Beniwal
DOI:10.4103/amh.amh_81_21  
Context: The outcome of schizophrenia (SZ) is impaired psychosocial functioning and poor quality of life (QOL) which is associated with burdens and societal expenditure to the caregivers. Aims: This study was aimed to access the difference in social occupational functioning, QOL, and social support between male and female patients with SZ. Settings and Design: This is a cross-sectional observational study conducted on persons with SZ visiting the psychiatry outpatient department in a tertiary care teaching institute. Materials and Methods: The sample consisted of N = 200 persons with SZ (International Classification of Diseases-10) aged 21–45 years of both genders. The assessment of socio-occupational functioning, QOL, and social support with administering the Social Occupational Functioning Scale (SOFS), World Health Organization Quality of Life-BREF Scale, and PGI Social Support questionnaire. Statistical Analysis: A Chi-square test was applied for discrete variables and a t-test for continuous variables. An independent sample t-test was used to assess differences between the males and females. Results: Overall, males were more educated than females. Occupationally, there was a significant difference between males and females (P = 0.000). A significant difference (P = 0.000) was found between males and females on total socio-occupational functioning and social support (P = 0.000). The difference between males and females on QOL was observed on perceived physical health (P = 0.000) and psychological health (P = 0.039). Conclusions: This study confirms that there is a definite gender difference in SZ on psychosocial and QOL. Males were physically, psychologically healthier and had better socio-occupational functions as well as strong social support compared to females.
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Empowering the caregivers of persons with schizophrenia – A psychosocial approach p. 30
Kannappa V Shetty, Navaneetham Janardhana, Suresh Bada Math, P Marimuthu, Ravi Philip Rajkumar
DOI:10.4103/amh.amh_67_21  
Background: Caregivers are generally the main support system for people with schizophrenia in India. Materials and Methods: The study aimed to evaluate the efficacy of psychosocial intervention (PSI) of knowledge about schizophrenia among the caregivers of persons with schizophrenia (PWS). Eighty caregivers of PWS were categorized into two groups: one group received routine care and the other group received additional PSI. The PSI program consisted of ten sessions with separate methodology and techniques. The Knowledge about Schizophrenia Interview, Mini-International Neuropsychiatric Interview 6.0, and sociodemographic interview schedule were used. Results: There was a significant change in pre- and postscores of the intervention group (PSI) on caregivers' knowledge (t = ‒16.64; P = 0.000) about schizophrenia. Conclusion: Study results indicate that caregivers in the experimental group (PSI) were having better knowledge about the illness than those in the control group (treatment as usual). PSI intervention was found to be effective in increasing caregivers' scientific knowledge on the illness.
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Study on perception towards psychiatry among nursing students in a tertiary care hospital p. 35
Kakarla V. M. Sailahari, R V. R. Abhinaya, KV Ramireddy
DOI:10.4103/amh.amh_114_21  
Introduction: Nursing fraternity plays a pivotal role in psychiatric services. Psychiatric conditions and persons suffering from them may elicit the different kinds of attitudinal responses. While there are multiple factors leading to an individual's decision to specialize in psychiatry, the individual's perceptions and attitudes toward psychiatry tend to play an essential role Aim: The current study aimed at assessing the attitude toward psychiatry among nursing students at a tertiary care hospital. Design: Cross-sectional study. Materials and Methods: One hundred and thirty-seven nursing students from Tertiary care teaching hospital were recruited the study and administered attitudes assessed using Attitudes toward Psychiatry-18 Scale. Statistical Analysis: Data were analyzed using the SPSS statistics version 23. Results: Majority of respondents showed favorable attitudes toward 14 items and unfavorable attitudes in remaining 4 items. Only 29.9% participants expressed their willingness to specialize in psychiatric nursing. Conclusions: A study found majority of students having favorable attitudes toward psychiatry. More can be done in the present education and training curriculum to develop empathetic attitudes toward people with mental illness, as it will affect the way these prospective nursing students deliver care toward their patients.
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Anxiety and depression among elderly tribal population of H.D. Kote, Mysuru, India: Prevalence and factors associated with it p. 40
KV Sindhu, Smitha Malenahalli Chandrashekarappa, Mohankumar Thambad, Prakash Boralingiah, Arun Gopi, MR Narayan Murthy
DOI:10.4103/amh.amh_103_21  
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Community perceptions with regard to mental illness in urban, rural, and tribal areas in Mysuru p. 47
Saurish Hegde, Smitha Malenahalli Chandrashekarappa, Shabeena Akbar, MR Narayana Murthy
DOI:10.4103/amh.amh_107_21  
Background: Mental illness is multifactorial in its occurrence varying from place to place, thereby listing different opinions among communities. Religious, cultural beliefs play an important role in the perception of mental illness. This study aims to understand the community perceptions of urban, rural, and tribal areas and associate with sociodemographic factors. Aims: (1) To explore the knowledge, attitude, cultural beliefs, and practices with regard to mental illness among urban, rural, and tribal population of Mysuru. (2) To compare the knowledge, attitude, cultural beliefs, and practices with regard to mental illness among urban, rural and tribal population of Mysuru. Materials and Methods: Study design: It was a cross-sectional study conducted between January 2021 and March 2021 in urban (n = 100), Rural (n = 100), and Tribal (n = 100) field practise areas in Mysuru district among participants aged >18 years. A semi-structured questionnaire regarding their attitude, beliefs, and understanding about mental illness was drafted, and data were obtained from participants after taking their informed consent. Ethical clearance was obtained from the institute. Statistics: Chi-square analysis was done to see the association between sociodemographic variables and perceptions. Results: Participants held different opinions across three different zones. A significant association was seen between their age, place, education, occupation, and type of family with their perception about mental illness. Conclusion: We can conclude that age, place, education, and occupation play an important role in the varied perception regarding mental illness. Continuous and focused interventions have to be done among the community for a positive acceptance and reducing stigma toward mental illness.
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Correlation between Clinical Dementia Rating and brain neuroimaging metrics of Alzheimer's disease: An observational study from a tertiary care institute of Eastern India p. 56
Sumit Chakraborty, Santanu Mandal, Sourav Kundu, Arkaprabha Sau
DOI:10.4103/amh.amh_87_21  
Context: Dementia is an already established major clinical health problem globally as well as in India. Neuroimaging, particularly magnetic resonance imaging (MRI), has an established role to support a clinical diagnosis of Alzheimer's disease (AD) by identifying certain brain atrophy patterns. Aims: The aim of this study was to assess clinico-radiological utility of neuroimaging biomarkers of AD. Settings and Design: This was an observational study with cross-sectional design with 36 patients of AD in a tertiary care hospital in Eastern India. Materials and Methods: Patients with AD in the age group of 55–90 years were subjected to MRI brain examination as per protocol at the Department of Radiodiagnosis, IPGMER and SSKM Hospital, Kolkata. The GCA (Global Cortical Atrophy) score, mesial temporal atrophy (MTA) score, Fazekas grading score, and Koedam score were determined and these MRI parameters were correlated statistically with Clinical Dementia Rating (CDR) score for further analysis. Statistical Analysis Used: IBM SPSS Statistics Version 20 was used as a statistical tool, and Spearman's rho coefficient was used as statistical test for correlation, and P < 0.05 was considered as statistically significant. Results: Average hippocampal volumes showed a significant negative correlation with CDR depicting a clinical deterioration, can be used as probable marker of brain atrophy. This is reinforced by the findings of significant positive correlations of CDR with GCA, MTA, and Koedam's score. Conclusions: It is proposed that global cortical atrophy, MTA, and Koedam score can be used as a basic screening imaging biomarker of AD in the population with dementia.
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Medical and psychological comorbidity among COVID patients during the first wave in Dharwad District of South India: A cross-sectional study p. 62
Kannappa V Shetty, Mahesh Desai, Ashish Srivastava, P Marimuthu, Sanjeev Kumar Manikappa, Urmila Bamney
DOI:10.4103/amh.amh_136_21  
Background: The COVID-19 is a viral communicable disease and the World Health Organization declared it as a public health emergency of international concern. This pandemic has challenged the entire world including India's health-care system and resources. It is a devastating recurrence in people with underlying health issues or comorbidities, eventually resulting in mortality. Comorbidities including both medical and psychological disorders among COVID patients have a large amount of impact on the individual's mental health as well as functioning. Materials and Methods: The study comprised 800 hospitalized COVID-19 patients during the first wave from North Karnataka region in India. The data were collected using a structured interview schedule through hospital telephones. The ethical approval was obtained from the Institute Research Ethics Committee. Results: The mean age of the hospitalized COVID patients was 41.02 ± 15.21, and the mean age of comorbidity was 47.69 ± 14.84. Following medical comorbidities such as diabetes (9.3%), hypertension (9.3%), cancer (1.8%), diabetes + hypertension (2.1%), and asthma (0.9%) and psychological comorbidities such as anxiety (3.8%) and depression (3.3%) were found among the hospitalized COVID patients during the first wave. Conclusions: It can be observed that comorbidity may increase the risk of death among COVID patients who were hospitalized and appropriate medical and psychological interventions can be provided for various co comorbidities at the earliest to prevent further defuncting and distress caused by the pandemic.
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REVIEW ARTICLE Top

Pharmacological management of behavioral and psychological symptoms of dementia: Brief review p. 67
Shobit Garg, Deepak Goel, Sai Tikka Krishna
DOI:10.4103/amh.amh_12_21  
Behavioral and psychological symptoms of dementia (BPSD) are the main reason for medical attention in dementia patients. Most of the time caregivers get attentive toward dementia only after BPSD. The patient's quality of life is dependent on severity and burden of psychological symptoms. Most common BPSD manifestations are agitation/aggression, depression, psychosis, and social disinhibition. We are presenting the current biological understanding and brief review of pharmacological treatment of BPSD. The current review is based on PUBMED search with the following key words “Neuro-cognitive Disorders” AND “BPSD” AND “Pharmacological Treatment,” “Antipsychotics,” “Antidepressants,” “Mood Stabilizers,” “Benzodiazepines,” “Cognitive Enhancer,” “Antihypertensive.” We have selected all reviews, systemic reviews, meta-analysis, and randomized trials on pharmacotherapy in BPSD from 2002 to 2021. Brief review on BPSD will help to fill the knowledge gap of clinical decision on pharmacotherapy in BPSD patients. It is not a systemic review but only brief view point or commentary/summary on evidence-based pharmacotherapy in BPSD.
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CASE REPORTS Top

Stupor resolving into rapidly deteriorating locked-in syndrome: Early magnetic resonance imaging brain in diagnosis p. 72
Bhogaraju Anand
DOI:10.4103/amh.amh_43_21  
Locked-in syndrome (LiS) is a rare condition characterized by quadriplegia, lower cranial nerve paralysis, and mutism with preservation of consciousness, vertical gaze, and upper eyelid movement. Here, we present a case that had initial mild neurological symptoms, stupor, fully conscious state, and computed tomography-brain showing old cerebral infarcts. There was a rapid deterioration of the condition into LiS and magnetic resonance imaging (MRI) brain showing infarcts bilaterally in the cerebellum, pons, midbrain, and thalami and finally leading to death. Relevant studies for discussion are presented. This case highlights the importance of MRI brain at the earliest even for cases with initial mild neurological symptoms and stupor to make an early diagnosis.
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A case report on escitalopram-induced galactorrhea with euprolactinemia p. 74
Saikiran Pasupula, Rajeshwari Pasupula, DV Satyamurthy G, Saka Meghana
DOI:10.4103/amh.amh_83_21  
Galactorrhea is defined as the spontaneous flow of a milky or colorless fluid-like discharge from the nipple. The condition occurs most often in women but can also develop in men and children. Galactorrhea is more common with antipsychotics when compared to antidepressants. Limited literature is available regarding escitalopram-induced galactorrhea on which the current case report focuses. The current study advances the earlier studies in presenting galactorrhea with normal prolactin levels. The following case report depicts the development of galactorrhea by the use of escitalopram at a low dose when compared to other studies.
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