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   Table of Contents - Current issue
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January-March 2020
Volume 36 | Issue 1
Page Nos. 1-92

Online since Tuesday, March 17, 2020

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GUEST EDITORIAL: FROM THE OUTGOING EDITORíS DESK  

Indian Journal of Social Psychiatry – The show must go on! p. 1
Debasish Basu
DOI:10.4103/ijsp.ijsp_25_20  
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EDITORIAL Top

Social unrest and its impact on mental health p. 3
Rachna Bhargava, Nitin Gupta
DOI:10.4103/ijsp.ijsp_27_20  
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AWARD PAPER: BALINT AWARD PAPER Top

Healing the healer – A 10-Year journey of supporting a medical student with bipolar disorder p. 5
Koushik Sinha Deb
DOI:10.4103/ijsp.ijsp_20_20  
Mental disorders are increasingly becoming a significant issue among medical students, consequent to rapid societal changes and increase in life stress. Yet, help seeking for mental health problems in medical students is universally poor. Attitudinal factors, stigma, and systemic barriers prevent early detection of such problems and often push students to self-harm and suicide. The fear of losing the capacity and license to practice often prevents students to come forward for treatment. Here, we discuss the various issues of a similar case from India and deliberate on the possible solutions to help such students in need.
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AWARD PAPER: DR GC BORAL AWARD PAPER Top

Relationship of stigma with burden and coping among caregivers of patients with severe mental disorders p. 11
Aseem Mehra, Ajay Kumar, Sandeep Grover, Subho Chakrabarti, Ajit Avasthi
DOI:10.4103/ijsp.ijsp_123_19  
Aim: This study aimed to evaluate the association of stigma with the caregiver burden and coping. Methodology: One hundred and sixteen adult caregivers of persons with severe mental illness were evaluated on the Stigma Scale for Caregivers of People with Mental Illness (CPMI), Family Burden Interview (FBI) Schedule, and Family Coping Questionnaire. Results: In terms of stigma, the mean total score was highest for the affective component followed by behavioral and least for the cognitive component of CPMI. On FBI, the highest burden was reported for the financial burden followed by disruption of routine family activities, disruption of family leisure activities, disruption of family interaction, the effect on the physical health of others, and effect on the mental health of others. The most common coping strategy used by the caregivers was gathering information followed by positive communication and patient's social involvement. A higher level of stigma in all the domains was associated with a significantly higher burden in all the domains of the objective burden, except for effect on physical and mental health on others. Higher use of copings such as positive communication and social interests was associated with higher stigma in all the domains except for lack of significant association between positive communication and cognitive domain of stigma. Higher use of resignation as a coping mechanism was associated with a higher stigma in the cognitive domain of CPMI. Conclusion: This study shows that a higher level of stigma among caregivers of patients with severe mental disorder is associated with higher objective caregiver burden and higher use of coping mechanisms such as positive communication and social interest. Accordingly, it can be said that any effort to mitigate the caregiver burden needs to take stigma into account.
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AWARD PAPER: DR JK TRIVEDI AWARD PAPER Top

Effect of caregiver group therapy on caregiver burden and neuropsychiatric symptoms in patients with dementia p. 19
Osheen Saxena, Thiyam Kiran Singh, Subhash Das
DOI:10.4103/ijsp.ijsp_17_20  
Background: Dementia is a disease characterized by brain atrophy, leading to cognitive decline. The clinical picture includes the presence of neuropsychiatric symptoms (NPSs), which can increase the caregiver burden. The present research was aimed at studying the effect of group therapy intervention with caregivers of patients with dementia on caregiver burden and NPSs of patients. The study was prospective, interventional, and exploratory. Materials and Methods: The study included 30 primary caregivers of geriatric patients (aged 60 and above) with dementia. The caregivers were divided into two groups of 15, in which one group received routine treatment and the other group received group therapy in addition to routine treatment. The patients in both groups were assessed on Neuropsychiatric Inventory Questionnaire, Everyday Abilities Scale for India, and Hindi Mental State Examination, and the caregivers of both groups were assessed on Zarit Burden Interview before and after the intervention. Statistical Analysis Used: Independent t-test was used to compare the age between two groups and Chi-square test to compare other sociodemographic variables between groups. Paired samples t-test was used for within-group comparison, and Mann–Whitney U-test was used between-group comparison. Results: There was significant improvement in NPSs of the patients and caregiver burden after intervention in the combined group. However, there was greater improvement in NPS of patients and caregiver burden in the group that received group therapy. Conclusions: Group therapy in caregivers of the patients with dementia is effective in improving the NPSs of patients, as well as in reducing caregiver burden.
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AWARD PAPER: DR BB SETHI AWARD PAPER Top

Assessment of sexual behavior among patients seeking treatment for opioid dependence and their knowledge and attitude about high-risk sexual behavior: A cross-sectional observational study p. 29
Nishtha Chawla, Suraj Verma, Siddharth Sarkar, Atul Ambekar
DOI:10.4103/ijsp.ijsp_7_20  
Aims: The primary aim of the current study was to assess the sexual history and behavior among treatment-naïve male patients of heroin dependence presenting to outpatient services; their knowledge and attitude about high-risk sexual behavior; and their sexual quality of life. Methods: A cross-sectional exploratory study was done on treatment-naïve patients of heroin dependence, recruited by purposive sampling method. They were assessed using a semi-structured pro forma that explored sociodemographic and clinical details, including details on injecting behavior, sexual history and behavior, perceived impact of heroin on sexual functioning, and knowledge and attitude toward high-risk sexual behavior; Human Immunodeficiency Virus (HIV) Knowledge Questionnaire-18; and Sexual Quality of Life Questionnaire-Male. Results: Fifty-three married patients with a diagnosis of opioid dependence were included in the study. The mean age of the sample was 31.4 years, with a mean age of heroin initiation being 22.5 years and 39.6% having a history of injecting drug use. About 40% of the sample reported to have engaged in sex with a commercial sex worker or a casual partner, of which many reported that such encounters were unprotected. Almost all of the participants reported sex under intoxication in the last month. Prolonging of the duration of erection and ejaculation was reported by a large majority of participants, while many reported heroin intake to increase libido and sexual pleasure. HIV and sexual quality of life were generally poor. Injecting drug use was associated with significantly greater number of partners, having history of casual partner sex, unprotected sex with casual partner, and poorer sexual quality of life. Conclusion: Risky sexual behaviors are common (including few having coercion/assault) among patients with opioid dependence syndrome. Knowledge regarding high-risk sexual behavior and HIV is poor, which should be a focus of treatment strategies. Injecting drug use is associated with more risky sex and poorer sexual quality of life.
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ABSTRACT Top

Pending Abstracts of NCIASP-Bhubaneswar 2019 p. 37

DOI:10.4103/ijsp.ijsp_5_20  
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ORIGINAL ARTICLES Top

The legacy of blood and glory: Unearthing the social panorama of honor killings p. 47
Lipika Malik, Vikas Punia
DOI:10.4103/ijsp.ijsp_16_18  
Context: The concept of honor killing is very interesting yet complex to explore. Such killings are out rightly condemned by the society, yet supported by the family. Such unique characteristics and increasingly alarmingly rates of honor killings calls for attention in this area. Aims: The objectives of the present study were to explore honor killings from the perspective of social identity (SI) theory. In addition, it also aims to investigate into the development and alternatives to honor killing. Settings and Design: In order to fulfill the objectives of the study, a village from the state of Haryana was selected for the study. A qualitative study was designed. Subjects and Methods: A sample of 3 participants residing in the village were taken as sample. Purposive sampling was done. A semi structured interview schedule based on components of SI theory (SIT) was devised. Statistical Analysis Used: Thematic analysis was done. Results: Three themes were generated from the data which were social comparison, positive distinctiveness, and attachment to SI. Conclusions: Psychological insights into the process of honor killings can be of prime importance as it can provide new pathways into the understanding and prevention of such killings. However, honor killings is a highly complex phenomenon, hence cannot be understood by SIT alone, therefore there are still unexplored areas of honor killings which still need to be investigated.
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Effects of social games as therapeutic tool on psychological well-being among physically disabled horticulture trainees: Person-centered therapeutic approach p. 54
Babita Gupta
DOI:10.4103/ijsp.ijsp_68_18  
Background: Horticulture therapy has been used to promote physical health, mental health, and psychological well-being where trained professional person could be a medium through which certain clinically defined goal can be achieved. Aim: The aim was to study the effects of social games as therapeutic tool based on person-centered approach on psychological well-being among physically disabled horticulture trainees. Settings and Design: One-group pretest–posttest design was done. Self-prepared psychological well-being checklist was used. Social games as therapeutic tool was done based on person-centered approach by Carl Roger. Subject and Methods: The sample consisted of thirty unmarried mild-to-moderate physically disabled horticulture trainees at Horticulture Centre, Bangalore city, India. Participants were in the age range of 16–30 years, from low socioeconomic status, hailing from rural background, and educated between VI and XII Std/level were selected for the study.Statistical Analysis Used: t-test was done. Results: The present study found a significant difference in the scores of psychological well-being checklist after intervention among physically disabled horticulture trainees. Postintervention results revealed improved reciprocal interaction, positive thinking, motivation, regularity for the horticulture course, and reduced anxiety.Conclusions: It can be concluded that social games-based person-centered therapeutic tool on psychological well-being among physically disabled horticulture trainees is effective.
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Depression, anxiety, and stress among Indian urban affluent adults p. 60
Shraddha Chauhan, Bani Tamber Aeri
DOI:10.4103/ijsp.ijsp_115_18  
Introduction: Mental health disorders now have a major share in the global burden of diseases. Regular screening of populations is crucial for timely detection and prevention. A lot of attention has been rendered to the assessment of depression, anxiety, and stress using Depression Anxiety and Stress Scale-21 (DASS-21) among school- or college-going population. However, assessments among adults are limited. Methodology: Urban, affluent, 30–45-year-old apparently healthy adults (n = 218; both males and females) were enrolled from preventive health check programs of private hospitals in the National Capital Region, Delhi, India. The DASS-21 item questionnaire was administered as a part of cross-sectional data collection after obtaining written informed consent. Scores were computed as per the DASS-21 manual, and their correlations with probable demographic, dietary, lifestyle, anthropometric, and biophysical factors were explored. Results: Mild to moderate levels of depression anxiety and stress were observed among 22.1%, 23% and 15.2% respectively and severe or extremely severe levels were observed among 5.1%, 8.7% and 7.3% participants respectively. No meaningful correlations were observed with demographic, dietary, lifestyle, anthropometric, and biophysical factors in this population. Conclusion: The incidence of these factors in an apparently healthy and productive population highlights the importance of regular screening for timely detection and designing clinical preventive strategies. Also, further research is needed to ascertain if the DASS scores have any probable relationship with demographic dietary, lifestyle, anthropometric and biophysical factors such as those assessed in this study.
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Influence of music on sensorimotor coordination and concentration among drivers in an Indian city p. 64
Neelima Chakrabarty, Guneet Singh Assi, Kumar Sumit, Kamini Gupta, PC Haritha
DOI:10.4103/ijsp.ijsp_94_18  
Background: Music is a popular pastime and an essential part of our lives that has the power to change one's state of mind. The melody, lyrics, and rhythm combine together to create creative symphonies that can either fill one with energy, enthusiasm, and positivity, or take one to melancholic mood. Music is known for its positive influence and therapeutic qualities but at times it can be distracting as well especially when your other faculties are engaged in doing other work. Driving is one such activity where music, though a joy to listen to, can prove disastrous through distractions. Materials and Methods: This study with the help of Vienna Test System examines the psychological impact of different genre of music on a driver's driving abilities and possible reaction and response amidst exposure to multiple stimuli, which could be correct, omitted, or delayed. The sample included 16 individuals who were drivers. The sample was classified into two groups of equal numbers with one named “young” comprised of people up to the age of 30 years while the other named “old,” were more than 45 years old. The participants were asked to undertake driving test, “with” and “without” the music. Using the Vienna Tests System, acoustic and visual stimuli using soft classical, hard rock, and jazz music were used during the driving test. Results: A two-way mixed analysis of variance test and differences by t-test examined the relationship of age and impact of music on individual's reaction time (RT) and number of correct, omitted, or delayed responses, which was found significant. Conclusion: The participants under the group of “with music” clearly resulted in better performance showing lower RT, compared to the situation where no music was played.
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A cross-sectional study of internalized stigma in euthymic patients of bipolar disorder across its predominant polarity p. 73
Arghya Pal
DOI:10.4103/ijsp.ijsp_7_19  
Introduction: Patients with bipolar affective disorder (BPAD), when classified according to their predominant polarity (PP), tend to show differences in their clinical correlates. Patients with BPAD show significant internalized stigma. The current study was conducted to investigate the differences in internalized stigma between various PP in BPAD. Methods: Seventy-five euthymic patients with BPAD were recruited and classified into their PP using appropriate criteria (two-thirds predominance). They were compared on the scores of the Stigma Scale (SS), Rosenberg Self-Esteem Scale (RSES), Participation Scale, and World Health Organization Quality of Life-BREF version – Hindi (QOL-BREF). Results: No significant differences were observed among the various PP on the total scores of SS. Patients with manic PP (MPP) and indeterminate PP (IPP) showed more difficulty in disclosure compared to depressive PP (DPP). In MPP and DPP, years of completed education, self-esteem, participation, and QOL were correlated to discrimination, but no such trend could be observed for IPP. Conclusion: Internalized stigma in individual PP is different from the attributes that affect BPAD as a whole. Although the groups did not differ in terms of internalized stigma, patients with DPP faced higher difficulty and disclosure. Subtle trends emerged which should be kept in mind while forming antistigma measures. Small sample size, purposive sampling, and cross-sectional design were the major limitations of this study.
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Severity of disability in persons with schizophrenia and its sociodemographic and illness correlates p. 80
Bibin Vengathanath Philip, Anish V Cherian, Ravi Girikematha Shankar, Prakashi Rajaram
DOI:10.4103/ijsp.ijsp_3_19  
Background: Disability is a major public health issue across a person's lifespan. Schizophrenia is a chronic mental disorder that causes considerable disability in a person's functioning. It has major setback on the person's life which drastically affects various areas of life. The current study aimed to investigate the severity of disability in persons with schizophrenia and to see its relationship with sociodemographic and clinical characteristics. Materials and Methods: Sixty persons who met the criteria for schizophrenia as per the International Classification of Diseases-10 were recruited from Psychiatry Outpatient Department, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India. The sample was assessed using the sociodemographic data sheet, Positive and Negative Syndrome Scale, and World Health Organization-Disability Assessment Schedule-II. Results: The overall disability level seemed to be moderate, but severe disability was noted in the areas of social participation and interpersonal relationship. Conclusion: Primarily, the study would help to bring about better comprehensive treatment, including rehabilitative plans to reduce the burden of disability while improving the functioning level of the persons with schizophrenia.
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BRIEF COMMUNICATION Top

Effectiveness of brief executive functions-based cognitive remediation in inpatient males with schizophrenia p. 87
Soni Jaiswal, Priya Saxena, Diptarup Chowdhury, Priyadarshee Abhishek
DOI:10.4103/ijsp.ijsp_23_19  
Context: Executive functions deficit is one of the hallmark impairments seen in persons with schizophrenia and is also linked with their functional outcome. Aims: The present study was designed to assess the effect of targeted cognitive remediation (CR) on executive functions and psychopathology in persons with schizophrenia. Settings and Design: This was a preliminary intervention study based on quasi-experimental design. Subjects and Methods: A CR module targeting executive functions was designed. Six persons with schizophrenia who underwent 4 weeks of individual executive functions-based CR were compared with matched control treatment as usual (TAU) group on Wisconsin Card Sorting Test (WCST), Mini-Mental State Examination (MMSE), and Positive and Negative Syndrome Scale (PANSS). Statistical Analysis Used: Between-group comparisons were made through Mann–Whitney U-test. Within-group pre-post analysis was made through Wilcoxon signed-rank test. Results: Post-1-month comparison on PANSS subscales, MMSE and WCST non-perseverative error showed insignificant group differences. However, participants in the intervention group committed significantly less perseverative error and completed more category sets on WCST in comparison to TAU. Conclusions: One-month CR targeting executive functions was found to be effective in improving cognitive flexibility. Despite a small sample, findings emphasize the need for including CR in the regular management of persons with schizophrenia.
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LETTER TO EDITOR Top

WhatsApp as a modality of expression of delusional misinterpretation p. 91
Manoj Kumar Sharma, Santosh K Chaturvedi
DOI:10.4103/ijsp.ijsp_118_18  
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