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   Table of Contents - Current issue
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January-June 2021
Volume 22 | Issue 1
Page Nos. 1-83

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EDITORIAL  

Impact of COVID-19 pandemic on child and adolescent mental health p. 1
John Vijay Sagar Kommu
DOI:10.4103/amh.amh_62_21  
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ORIGINAL ARTICLES Top

A cross-sectional study of psychological distress in patients hospitalized for COVID-19 p. 4
Srilakshmi Pingali, Ajay Kumar Joopaka, Pradeep Sharma Telkapalli, Molanguri Umashankar
DOI:10.4103/AMH.AMH_66_20  
Introduction: The novel coronavirus disease-19 (COVID-19) which started in China has now spread across the world. Many measures to contain the pandemic are being employed like hospitalization of patients tested positive, quarantine of contacts, and social distancing. The consequent social isolation and the uncertainty of the disease has led to psychological distress. Aims and Objectives: The aim was to study the psychological distress and its associated factors in patients hospitalized for COVID-19. Materials and Methods: A cross-sectional study was done in a designated COVID center where patients tested positive were admitted from all over the state. A total of 222 hospitalized COVID-19 patients were screened using the Patient Health Questionnaire-4 and those who screened positive had their diagnosis confirmed by using the International Classification of Disease 10 criteria. Results: A total of 222 patients were screened of which 22.1% showed distress, 12.6% showed mild distress, and 9.5% moderate distress. Depression criteria were met by 5.5% and 3.2% had generalized anxiety disorder. Factors significantly associated with distress were deaths in the family and duration of hospitalization, whereas family members affected with COVID-19 were inversely related to psychological distress. Conclusion: Having a number of family members affected and simultaneously admitted in the same hospital seems to have acted as a buffer against psychological distress. However, deaths in the family due to COVID-19 and long duration of hospitalization were found to be factors associated with psychological distress. Efforts should be made to treat not only the physical health but also address the psychological distress in patients hospitalized for COVID-19.
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Depression and behavior problems among children residing at welfare hostels and orphanages p. 10
Sai Kiran Pasupula, Madhavi Kodali, Therissa Benerji, Krishna Mohan Parvathaneni
DOI:10.4103/AMH.AMH_52_20  
Context: Childhood-onset of depression is often associated with childhood family adversity, parental neglect, and problematic peer relationships. Emotional and behavioral problems and high rates of depression were more common in orphans when compared to nonorphan. Aim: The aim was to study and compare the depression and behavioral problems among children residing at welfare hostels and orphanages. Materials and Methods: This study is a cross-sectional and descriptive study. Three welfare hostels and four orphanages run by nongovernment organizations were approached, and children between the ages of six and fourteen were recruited. Children residing at home were taken as controls. Children's Depression Rating Scale and Rutter's Behavior Scale for Children were applied to assess depression and behavioral problems, respectively. Statistical Analysis Used: Statistical analysis was done using Epi Info software. Results: Depression is found to a greater extent among children in the orphanages' group than in the welfare group. Rutter's score ≥9 was observed in 15%, 8.3%, and 5% of children in the welfare hostels' group, orphanages' group, and controls' group, respectively. Conclusions: The prevalence of depression is found to be more among orphanage children, followed by children residing at welfare hostels compared to the control group. Behavior problems are more among children residing at welfare hostels than children residing at orphanages.
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Knowledge, awareness, and attitude of health professions student's towards end-of-life patient care p. 15
Aga Syed Sameer, Muhammad Anwar Khan
DOI:10.4103/AMH.AMH_59_20  
Objectives: Provision of ethical medical care is the totem pole of the health-care system and to make appropriate decisions while providing the end-of-life (EOL) care is essential for all physicians. The aim of this study was to assess the knowledge, awareness, and attitude of health professions students (HPSs) about the bioethics of EOL medical care. Methodology: This cross-sectional study was carried out in all colleges of our University for Health Sciences, Jeddah Campus from September 2019 to December 2019. A predesigned and validated questionnaire about end of life patient care was adopted to achieve the purpose of the study. Results: A total of 522 students responded to this survey, of them, 290 (55.6%) were male, while 232 (44.4%) were female with a ratio of 1:1.25. Also, 226 (43.3%) of the respondents were from College of Medicine (COM), 142 (27.2%) from College of Health Professions (COSHP), 86 (16.5%) from College of Applied Medical Sciences (CAMS), and 68 (13.0%) from College of Nursing (CON). 44.9% of the males and 52.6% of females had a disagreement with the statement that patient has the right to end his or her own life of which 24.8% of COM, 27.9% of CAMS, 35.3% of CON, and 26.85% of COSHP strongly disagreed (P < 0.001). Additionally, most of the HPSs agreed to that terminally ill patients can die peacefully at home of which 69.9% were of COM, 46.5% of CAMS, 41.2% of CON, and 46.5% of COSHP students (P < 0.001). The analysis of data showed that COM and CON students' bioethical knowledge and awareness about EOL care was higher than that of CAMS and COSHP. Conclusions: The awareness about the bioethical concepts of EOL care was good among the HPSs of KSAU-HS, however this study identifies a need of introducing the bioethical concepts of palliative care in the curriculum.
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A prospective study of major depressive disorder among COVID 19 survivors at a tertiary care hospital p. 23
Kajalpreet Kaur, Vishal Kanaiyalal Patel, Parveen Kumar, Disha Alkeshbhai Vasavada, Lubna Mohammedrafik Nerli, Deepak Sachidanand Tiwari
DOI:10.4103/AMH.AMH_72_20  
Background: The COVID-19 pandemic has impacted physical health, wellbeing, and mental health, which has a disastrous effect on the health system. Among disorders emerging in the aftermath of a disaster, depression is the second most common. Aim: The current study was aimed to estimate the prevalence of major depressive disorder (MDD) at two-time points in individuals who have been hospitalized for the treatment of COVID 19. Materials and Methods: A prospective study was carried out from May 2020 to October 2020 at a tertiary care center among patients discharged after recovery from novel coronavirus (COVID 19). A diagnostic clinical interview was conducted to diagnose MDD, and its severity in patients who had recovered from COVID 19 using “Patient Health Questionnaire (PHQ-9)” at the time of discharge and 1 month after their discharge from the hospital. Statistical Analysis: Descriptive statistics and Chi-square test were used for the analysis, P < 0.05 was considered statistically significant. Results: A total of 440 participants participated in the study. Out of them, 30.90% of participants met the criteria for MDD at the time of discharge and 19.5% at 1 month post-discharge. Participants who stayed for more than 14 days, were admitted to intensive care unit (ICU) and those with co-morbid medical illness had a higher prevalence of MDD. Conclusion: High prevalence of MDD was observed at the time of discharge among hospitalized participants. Longer duration of hospital stay and admission in ICU is associated with more unpleasant events, subsequently resulting in higher rates of morbidity, such as depression.
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Attitude towards COVID-19 vaccine among the general public in south India: A cross sectional study p. 28
Ganga Raju Godasi, Raj Kiran Donthu, Abdul Salaam Mohammed, Ravi Sankar Pasam, Sri Lakshmi Tiruveedhula
DOI:10.4103/amh.amh_33_21  
Introduction: Coronavirus disease-19 (COVID-19) is a novel infection that sets off a pandemic in a short period. Research has been going on to develop safe and effective vaccines and around 150 are in the process of development. In India, two vaccines have been given emergency approval. There has been a rise in hesitancy toward vaccination not only in India but also worldwide. Materials and Methodology: The study included 697 participants who were not vaccinated. The study questionnaire was administered through online Google Forms and included informed consent, sociodemographic details, questions related to COVID-19 infection and vaccine, and vaccine attitude examination (VAX) scale. Results: Among the 697 participants, 216 (31%) were not willing to get vaccinated. Those with prevailing mental (P = 0.011) or physical health (P < 0.001) problems were of negative opinion toward vaccination because of unforeseen complications. Participants with lower education (P = 0.041), skilled to semi-skilled job (P = 0.028), and joint family (P = 0.006) opined that vaccination was more of commercial profiteering for manufacturing companies. Participants who were married (P = 0.010) and living in a joint family (P = 0.009) setting were more inclined toward a preference for natural immunity. Conclusion: The study highlights that 69% of participants were willing to take the COVID-19 vaccine. Various measures can be taken by different stakeholders to improve the positive attitude. As medical professions, we can improve the positive attitude by actively taking the vaccine and educating the local people about the benefits.
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Study on suicidal intent and its relationship with psychiatric morbidity in cases of deliberate self-harm p. 36
Shalaka S Pawar, Prasad K Tagad, Nitin D Bhoge, Alka V Pawar
DOI:10.4103/AMH.AMH_65_20  
Background: Mental disorders are among the strongest predictors of suicide attempts. However, little is known regarding which disorders that is uniquely associated with suicidal behavior because of high levels of psychiatric co-morbidity. The present study was planned to undertake on suicidal intent in such deliberate self-harm patients. Aims: The aim is to determine the suicidal intent and to assess the relationship with psychiatric morbidity in patients of deliberate self-harm Settings: Patients of deliberate self-harm. Design: Cross-sectional study. Materials and Methods: The sample consisted of 50 patients of deliberate self-harm admitted during study period of 6 months in appropriate in-patient unit for observation and necessary intervention, who fulfils inclusion criteria. A semi structured pro forma was used for collection of socio-demographic data, case history and Beck's Suicide intent scale was used which is designed to assess the severity of intention to die associated with an episode of deliberate self-harm. Statistical Analysis Used: Descriptive statistics such as mean, standard deviation, and percentage was used to present the data. To assess the relationship between the suicidal intent and psychiatric morbidity, Chi-square test was used. A P < 0.05 were considered significant. Data analysis was performed using software SPSS v20.0. Results: Self poisoning (80%) was found to be the most common method employed in deliberate self-harm. 74% of the deliberate self-harm attempts were impulsive in nature. Altercation with the spouse (30%) was the most common precipitating factor. Psychiatric morbidity was found to be associated with suicidal intent (P = 0.0068). Conclusions: In conclusion, even with low intent to harm self we have to be careful while examining the patients of psychiatric morbidity. They are at risk of attempting harm to self. We cannot ignore the patients just on the basis of low intent to harm self.
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Proportion of subjects remaining abstinent following alcohol de-addiction treatment and factors associated with abstinence - A 3 months prospective cohort study p. 43
Ariya Nair, Praveen Arathil, Dinesan Narayanan
DOI:10.4103/AMH.AMH_49_20  
Aims: The aim is to study prevalence of abstinence rates for 3 months follow-up in individuals of alcohol dependence undergoing de-addiction treatment. Also to assess for possible co-relation between sociodemographic, clinical, personality, cognitive functioning and laboratory variables of relapsed and abstinent individuals. Subjects and Methods: Eighty-six individuals who were admitted for alcohol deaddiction treatment were taken for the study after taking consent. Sociodemographic and clinical variables were assessed using a pro forma. The Mini-International Neuropsychiatric Interview was administered to rule out other disorders. Clinical Institute Withdrawal Assessment of Alcohol, revised scale to assess the severity of withdrawal. Personality was assessed using 16PF. The Tower of London (ToL) test was used to assess executive function. Individuals were followed up after discharge till 3 months from the admission date to assess for the maintenance of abstinence. Results: Out of 86 individuals, only 24 individuals maintained abstinence at 3 months. About 72.08% of those who had previous deaddiction treatment did not maintain abstinence or were lost to follow-up. Duration of hospitalization was significantly more in abstinent individuals (15.63 ± 6.31, P = 0.001). On 16PF individuals who did not maintain abstinence had higher perfectionism scores (5.97 ± 1.9, P = 0.027) similarly on the ToL test they had lower scores on the total number of problems solved on the minimum number of moves (7.02 ± 1.76, P = 0.001). Conclusion: There is the low rate of abstinence among individuals having undergone deaddiction treatment at the end of 3 months. Modifying treatment for individuals who have past relapses, personality disturbances, and avoiding early discharge may help in increasing the abstinence rate.
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Defeat and entrapment in the pathogenesis of suicidal behavior p. 51
Srikrishna Nukala, Srinivas Singisetti, Archana Vinnakota, Shvetha Chilikuri, Abhilash Garapati, Vidya Sanapala, Laxman Nambaru
DOI:10.4103/AMH.AMH_50_20  
Introduction: Human behavior is very complex and driven by different motivations. At times, we find a deviant escape behavior in some situations, characterized by streaks of self-destruction or “suicidal behavior.” Defeat and entrapment have been hypothesized as central to this behavior. Aim: We aimed to study the relationship between defeat, entrapment, suicidal ideation, and suicidal attempt. Materials and Methods: This study was a cross-sectional study of fifty patients who attempted suicide and survived the attempt. When medically fit for psychological assessment, they were approached in a person in the hospital psychiatric ward. These patients were subjected to a detailed psychiatric interview, and any psychiatric illness in the patients was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V criteria. They were assessed on the defeat and entrapment scales by Gilbert and Allan. The Modified Scale for Suicidal Ideation by Ivan W. Miller was used to determine the presence or absence of suicidal ideation and severity of suicidal ideation. Results: The presence of a current depressive disorder diagnosis and planning of attempt had a significant association with higher scores on internal entrapment, total entrapment, defeat, and suicidal ideation scales. The scores on defeat, internal entrapment, total entrapment, and suicidal ideation scales correlated positively and highly significantly. Conclusion: Entrapment and defeat are identified as important in the pathogenesis of depression and self-harm. Arrested escape and flight appear as motivation for suicidal behavior.
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Assessment of quality of life and psychiatric morbidity in patients undergoing hemodialysis at a tertiary care center p. 57
Ananda Reddy Endreddy, Lakshmi Rajesh Chennareddy, Subahani Shaik
DOI:10.4103/AMH.AMH_60_20  
Background: Hemodialysis is a procedure performed in persons who suffer from acute/chronic renal failure or who have end-stage renal disease. Due to disabilities caused by renal disease and the continuous requirement of dialysis, it is frequently associated with comorbid psychiatric disorders, which in turn adversely affects the quality of life (QOL) of patients. Aims and Objectives: Our study was conducted with the objectives of estimating the proportion of psychiatric comorbidities and the QOL among the patients who were on hemodialysis. Materials and Methods: A cross-sectional study was done on a total of fifty consecutive patients undergoing dialysis in the hemodialysis unit, Department of Nephrology, Narayana Medical College and Hospital. A semi-structured questionnaire was used to obtain the sociodemographic details, history including details of illness, dialysis, and medical comorbidities. The presence of psychiatric comorbidities was assessed using Mini-International Neuropsychiatric Interview. The WHOQOL-BREF Scale was used to assess the QOL and the Modified Kuppuswamy Socioeconomic Scale was used to assess the socioeconomic status. Results: Psychiatric comorbidities were observed in 80% of the patients undergoing hemodialysis. Among the psychiatric comorbidities, major depressive disorder was found in 54%, dysthymia in 14%, and generalized anxiety disorder in 12% of the patients. History of diabetes was found in 80% of the patients and history of hypertension was found in all the patients in the study. Among the patients, a significant association was observed between the psychiatric comorbidities and the score in all the four domains of the WHOQOL-BREF Scale. Conclusions: Our study concludes that the majority of the patients were found to have psychiatric comorbidities. On the WHOQOL-BREF Scale, all the four domains in QOL were significantly associated with psychiatric morbidity.
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Study of relationship between serum creatine phosphokinase levels with severity of alcohol withdrawal p. 63
Rani Malik, Harpreet Singh Dhillon, Vinod Kumar Sahu, Shibu Sasidharan, Gurpreet Kaur Dhillon
DOI:10.4103/AMH.AMH_4_21  
Background: Alcohol withdrawal syndrome is a potentially life-threatening condition with severe complications such as withdrawal seizures and delirium tremens. A valid and reliable biomarker for predicting the severity of alcohol withdrawal can be instrumental in individualizing effective therapy at the earliest. Methodology: This was an observational study done on 120 patients to study the relationship between serum creatine phosphokinase (CPK) levels with severity of alcohol withdrawal. The assessment for the severity of alcohol withdrawal was done with Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) scale and an association was studied between the serum CPK levels and the severity of alcohol withdrawal. The data was analyzed using Chi-square test and Kruskal–Wallis tests. Results: The severity of alcohol withdrawal as per the CIWA was 26.66% mild, 55% moderate, and 18.33% severe. The mean serum CPK level for mild withdrawal was 126.93 IU/L, moderate withdrawal was 303.66 IU/L, and for severe withdrawal was 780.81 IU/L. A statistically significant association was obtained indicating that patients with higher CIWA-Ar scores are likely to have a higher level of serum CPK levels. Conclusion: Serum CPK levels were significantly associated with severity of alcohol withdrawal and can possibly serve as a candidate biomarker.
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A cross-sectional study of psychological distress among doctors' spouses during COVID-19 p. 68
Sripathi Santhosh Goud, Vishal Indla, Manjiri Deshpande, Indla Ramasubba Reddy
DOI:10.4103/amh.amh_51_21  
Introduction: Coronavirus disease 2019 (COVID-19) infection and subsequent lockdown restrictions brought drastic changes in the lives of the people. Doctors' community led the fight against COVID-19 as frontline warriors leaving their families at home for prolonged periods. The psychological issues among the family members, particularly spouses of doctors, are significantly high and need special attention. Aims: We aimed to assess the level of psychological distress among doctors' spouses and the possible relationship between different variables and the level of the distress. Materials and Methods: The study was conducted in online mode using chain-referral sampling method. Sample size was 120 and comprises doctors' spouses who were not related to medical field. Those who were working in medical field or having any past psychological illness were excluded from the study. A semi-structured pro forma was used to collect the basic demographic details, and Kessler's Psychological Distress Scale (K10) was used to rate psychological distress. Results: 72.5% of the study population had reported psychological distress, and half of these participants reported severe psychological distress. Age was the single variable that had significance (P < 0.1), whereas other variables did not show statistically significant values. Conclusion: Psychological distress is much higher compared to the general population in the spouses of the doctors. In long run, this may result in psychological illnesses such as depression and anxiety disorders. As a special group, these require targeted interventions and care for the prevention of severe mental health problems.
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REVIEW ARTICLE Top

Yoga therapy in psychiatry: Myths and misconceptions p. 74
Rama Reddy Karri, Ananda Balayogi Bhavanani, Meena Ramanathan, Vijaya Gopal Mopidevi
DOI:10.4103/amh.amh_64_21  
Yoga is a philosophy, a science, and an art, the value of which is underrecognized. Many myths and misconceptions are prevailing among the common people as well as mental health professionals, resulting in an underutilization of this effective tool that has the potential for health promotion and disease prevention. It has been established to be an effective adjunct in treating many psychiatric and psychosomatic problems. Scientific, evidence.based data are accumulating from global research institutions. Salutogenesis or wellness concept with a holistic approach is the hallmark of the yoga. This article is a review attempting to dispel some of the popular myths and misconceptions.
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CASE SERIES Top

Effectiveness of buprenorphine in detoxification and naltrexone in relapse prevention of tramadol-dependent patients: A case series p. 80
Vijaya Chandra Reddy Avula
DOI:10.4103/amh.amh_39_21  
Tramadol hydrochloride is a centrally acting synthetic analgesic drug. Its analgesic properties are weak agonist at mu- and kappa-opioid receptors, blockade of reuptake serotonin (5-HT), and norepinephrine at synaptic cleft inhibiting pain transmission. This case series is about the treatment of nine patients who were dependent on tramadol. All patients satisfied criteria for opioid dependency International Classification of Diseases, 10th Revision diagnostic criteria. WHO treatment guidelines for opioid detoxification using Buprenorphine and relapse prevention using oral naltrexone were followed. Detoxification with buprenorphine did not alleviate all withdrawal symptoms. Craving toward tramadol and the cost of naltrexone was a reason to relapse in patients. Cost and failure to address craving lead to noncompliance with naltrexone. Partial agonists like buprenorphine and long-acting agonist like methadone should be used to detoxify and prevent relapse in patients dependent on tramadol.
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