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   Table of Contents - Current issue
Coverpage
April-June 2020
Volume 36 | Issue 2
Page Nos. 93-167

Online since Saturday, June 27, 2020

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FROM THE EDITORS DESK  

Indian journal of social psychiatry – The show will go on! p. 93
Nitin Gupta
DOI:10.4103/ijsp.ijsp_163_20  
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EDITORIAL Top

Telepsychiatry – A step into the future p. 95
Abhijit R Rozatkar, Vipul Singh
DOI:10.4103/ijsp.ijsp_124_20  
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PERSPECTIVE Top

Occupational mental health services for medical professionals: Relevance in the Indian context p. 98
Sanju George, Nitin Gupta
DOI:10.4103/ijsp.ijsp_123_20  
Medical practitioners are often reluctant to acknowledge and seek timely help for their own mental health problems. If things are to improve, both medical professionals and policy makers alike need to “wake up.” In this article, we first look at why doctors (including medical students) are susceptible to mental health problems and why they are reluctant help seekers, and then discuss how an occupational mental health service for doctors can work in hospital settings. We focus on the need for occupational mental health services in medical settings in India and how they can be translated from theory into practice.
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REVIEW ARTICLE Top

Social cognition: Concept, evaluation, and application in psychiatry p. 102
Kartik Singhai, Pooja Patnaik Kuppili, Jitender Aneja
DOI:10.4103/ijsp.ijsp_84_19  
Social cognition (SC) serves an interface between psychology and cognitive neuroscience and its conceptualization has evolved over years. SC broadly refers to a process of encoding and decoding the social information, i.e., how a person thinks about himself/herself and others in his/her social world. The refinement of various constructs of SC as well as the assessment tools has contributed to its better understanding and application in psychiatry. At present, major research groups in this field have agreed on that emotion perception, social perception, theory of mind, and attributional style to be the key domains of SC. A marked growth of evidence for the deficits in SC in various psychiatric disorders has led to the development of a plethora of evaluation tools. Although it has been largely studied in schizophrenia and autism spectrum disorders, lately, an increasing number of researches have been conducted in other psychiatric as well as neurological disorders. Consequent to the evidence of deficits in various domains of SC in psychiatric disorders, a number of targeted interventions have been devised. This article provides an overview of the evolution of concept, definition, and domains of SC, its evaluation, and application in psychiatry.
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ORIGINAL ARTICLES Top

Perspectives on advance directives in psychiatric practice: A qualitative study from Kerala, India p. 114
Chikku Mathew, Deenu Chacko, PV Indu, K Vidhukumar
DOI:10.4103/ijsp.ijsp_26_19  
Context: Advance directive (AD) is being used in psychiatric care in developed countries for the last two decades. Although the AD is bound to offer patient autonomy and beneficence, evidence for its effectiveness and feasibility are limited. By the enactment of the Mental Health Care Act, 2017, India is going to implement AD. Aims: This study aimed to find perspectives on AD in psychiatric practice by different stakeholders in Kerala, India. Subjects and Methods: A qualitative study using focus group discussion and in-depth interview was done among mental health service users such as patients and carers, providers such as psychiatrists, clinical psychologists and psychiatric social workers, and advocates. Transcribed information was coded by R package for Qualitative Data Analysis, a free software. Results: The predominant themes identified were freedom of choice, issues of documentation, suitability in a crisis, apprehension about future care, mental capacity at the time of making the AD, issues about nominated representative, limitations in the exercise of treatment options by doctors, and the possibility of defensive practice in psychiatry. Half of the patients supported the AD, whereas the other half did not. Advocates agreed that patients should be given the freedom to choose and hence supported the AD. Some mental health service providers favored AD, whereas others were apprehensive. Conclusions: Although ADs help patients in preserving their autonomy, many uncertainties, practical issues, and legal issues are to be tackled for its effective implementation.
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Suicide announcement on social media in Nigeria p. 119
Musa Usman Umar, Aishatu Yushau Armiya'u, Tukur Muhammad Ali
DOI:10.4103/ijsp.ijsp_27_19  
Background: Suicidal behaviors are recently being documented on social media and the Internet. Online social media such as Facebook represent a new dimension for global information transfer. Suicidal behaviors and their consequence on social media are yet to be evaluated in professional articles. This article seeks to discuss the potential effects of suicidal behaviors on Facebook and to bring forth the need for awareness among health-care professionals and the general public. Methodology: We present ten cases of suicidal announcement on social media platforms and discuss the challenges associated with social media announcement of suicide. Results: In the ten cases we presented, there were warning signs of suicide posted by the individuals on their Facebook walls, but help was not provided on time or after the incident with resultant completion of suicide. In some of the cases, there was an attempt to alert some friends on the suicidal ideation, but most friends thought that the statement was not related to suicide. While in others, caring and empathic support with quick intervention from friends and family led to the rescue of the suicidal individuals. Limitation: The mental health status of the individual before they showed warning signs of suicide was not known, and therefore it was not possible to assess their mental states. Other reports have shown that not all individuals with suicidal signs will proceed to attempt suicide or complete the suicide. Conclusion: Suicide announcement through social media is being recognized as probably a unique form of suicidal behavior which has the potential for prevention of suicide through early identification of high-risk individuals. Suicide knowledge and attitude and less stigmatization toward mental illness may help in encouraging help-seeking behavior and the general populations' understanding of suicidal warning signs while operationalizing methods of assisting such individuals.
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Quality of life among patients with depression: Impact of self-stigma p. 125
Rohit Garg, Harneet Kaur
DOI:10.4103/ijsp.ijsp_32_19  
Background: Health-related quality of life (QoL) is an important aspect in the recovery of mental illness. There is ample research evidence that evaluates the reduced QoL and stigma in the various mental illnesses, but there has been paucity of the literature exploring the impact of self-stigma and its correlation with QoL in patients with depression. Aim of the Study: This study aims to find the impact of self-stigma on QoL of patients with depression and also find the correlates of QoL. Methods: A total sample of 150 patients was recruited from the outpatient department of psychiatry of a tertiary care medical college and hospital in North India in August and September, 2018. The patients recruited were in symptomatic remission and were assessed on Hindi versions of WHOQOL Bref and self-stigma scale. Results: After the statistical analysis, it was revealed that majority of the sample were young (47.33%), urban (54%), females (57.33%) who were married (52%), and living in joint families (59.33%). Most affected domain of QoL was satisfaction with psychological health with score 39.62 ± 10.29 and the least affected was satisfaction with environment with score 58.23 ± 14.90. Significant correlation was found between the sociodemographic factors, self-stigma, and QoL. Younger patients had a better QoL on psychological domain. Female patients had a better overall QoL (Q1) and better satisfaction with psychological health and satisfaction with environment. Conclusion: Depression has a significant correlation with the deterioration in QoL of patients. The burden of self-stigma further significantly deteriorates the QoL of patients with depression.
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Body image dissatisfaction in young Indian Men: Prevalence, psychosocial correlates, and the impact of sociocultural pressure p. 130
Geeta Soohinda, Harshavardhan Sampath, Divyanti Mishra, Sanjiba Dutta
DOI:10.4103/ijsp.ijsp_28_19  
Background: Body image dissatisfaction (BID) is the negative perception of the weight and shape of one's body. It is a prominent risk factor for conditions ranging from eating disorders, body dysmorphic disorder, depression, anxiety, and substance use disorders. BID evolves from a complex interaction between psychological (personality, self-esteem), physical (body mass index), and cultural factors (social expectations and media messages). Once restricted to adolescent Caucasian females, BID has been increasing among men in developing Asian cultures. This study aimed to address the scarcity of research on BID and its correlates among young Indian men. Materials and Methods: A cross-sectional, quantitative, observational, questionnaire-based research design was chosen to address the objectives in a sample of male college students aged 18–25 years. The body shape questionnaire (BSQ-8c), sociocultural attitudes toward appearance questionnaire-4, Rosenberg's self-esteem scale and the mini-International personality item pool (MINI-IPIP) personality scale were used to measure BID, sociocultural pressures, self-esteem, and personality traits, respectively. Results: Of the 511 males, 34.44% (n = 176) had moderate to marked BID. Underweight men had greater BID than those who were obese. However, the differences in BSQ-8c scores across various BMI categories were not statistically significant (Kruskal–Wallis H = 6.07, df = 3, P = 0.108). BID significantly correlated with levels of neuroticism (rs = 0.093, P = 0.0360). Sociocultural pressure from the family, peers, and media significantly correlated with the internalization of thin and muscular body image ideals (all P < 0.001, highly significant). Conclusion: BID is a significant concern among young Indian men, especially those with high levels of neuroticism. This is compounded by the internalization of social pressures from the family, peers, and media.
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Dhat syndrome and its perceived impact on psychological well-being p. 136
Jyoti Das, Siddharth Dutt
DOI:10.4103/ijsp.ijsp_22_19  
Background: Dhat syndrome is a culture-bound syndrome originating in the Indian subcontinent, primarily among men characterized by the fear of loss of semen. Objective: The article discusses the perceived impact of Dhat syndrome on the overall psychological well-being of the individual. Method: Four patients from hospitals in Kolkata, West Bengal, were screened using MINI and then interviewed using semi-structured interview to assess presenting concerns, interventions, psychological well-being, attitude toward sex and masturbation, and their sociodemographic details. The data were then categorized based on the dimensions of the questionnaire, which was then analyzed individually and separately based on the dimensions. The differences and commonalities between the dimensions as conveyed by the participants were then reported. Results: The analysis showed that the participants reported lower levels of psychological well-being based on the categories of Seligman's PERMA model and attributed it to the symptoms experienced by them. They traced the beginning of the hindrances to achieving optimal well-being to the onset of symptoms. Conclusion: This article proposes the incorporation of integrative therapeutic interventions and advocacy of sex education to address the psychological well-being over the current symptom reduction interventions used.
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Psychometric properties of the hindi version of beliefs about voices questionnaire-revised p. 141
Amrita Choudhary, Jay Kumar Ranjan, HS Asthana
DOI:10.4103/ijsp.ijsp_91_19  
Background: The cognitive model of auditory hallucinations posits that the beliefs or appraisal of the voices plays an important role in the determination of consequent reactions. These beliefs are explored effectively through “Beliefs About Voices Questionnaire-Revised (BAVQ-R).” However, Hindi adaptation and psychometric evaluation of this tool are yet to be done. Hence, the present study aimed at translating the BAVQ-R in Hindi language and assessing the psychometric properties of the same. Methodology: The original version was translated in Hindi language using translation–back-translation method. This translated version of BAVQ-R was then administered to 51 schizophrenia patients with a history of active auditory hallucinations. All the participants were selected from Central India Institute of Mental Health and Neuro Sciences, Rajnandgaon (Chhattisgarh), using purposive sampling technique. Initially, the informed consent was taken from the patients, followed by the administration of the Hindi version of BAVQ-R and Psychotic Symptom Rating Scale (PSYRATS). Finally, the psychometric properties, e.g., internal consistency reliability, divergent validity, and convergent validity were calculated. Results: The internal consistency reliability was within the range of 0.6–0.94, as indicated by Cronbach's alpha. The divergent validity was high as malevolent voices and engagement feelings and behavior towards the voices were negatively correlated (r = −0.56, P < 0.01), and benevolent voices significantly negatively correlated with resistance feeling and behavior towards the voices (r = −0.74, P < 0.01). Convergent validity was measured by correlating the subscales of BAVQ-R with the dimensions of PSYRATS. Pearson's correlation indicated significant associations between the dimensions of the two scales. Conclusion: The Hindi version of BAVQ-R has good psychometric properties. The tool has good internal consistency along with high divergent and convergent validity.
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A clinical study on risk behaviors and seroprevalence of HIV, hepatitis B, and hepatitis C among injection drug users on opioid substitution therapy: An observational study p. 146
Shabir Ahmad Dar, Bilal Ahmad Bhat, Aaliya Khanam, Shazia Kousar
DOI:10.4103/ijsp.ijsp_70_19  
Introduction: Hepatitis B virus (HBV), hepatitis C virus (HCV), and HIV infection among IDUs is an emerging trend. Opioid substitution therapy (OST) is an evidence-based treatment for opiate-dependent clients that replaces illicit drug use with medically prescribed, orally administered opiates such as buprenorphine. The objective of this study was to determine the sociodemographic variables; seroprevalence of HIV, hepatitis B, and hepatitis C; associated risk behaviors; comorbid substance use pattern; and psychiatric comorbidity among injection drug users (IDUs). Methods: A total of 57 IDUs aged between 18 and 60 years who attended the OST center during 4 months period of a government medical college in North India were included in the study. Results: All of the IDUs were males with a mean age of 26.55 ± 7.26 years. The mean dose of buprenorphine used for the substitution was 6.24 ± 2.4/day at the start of the therapy. Most of the patients were unemployed, with a maximum of them studied up to high school level. The most common substance abuse among IDU users was tobacco 47 (82.46%), followed by Cannabis 23 (40.35%). High-risk behavior found among OST clients was sharing needles (29.82%), unprotected sexual intercourse (12.28%), and sexual intercourse with multiple partners (3.51%). HCV testing showed positive among 9 (15.78%) clients. Conclusion: Oral substitution with buprenorphine is an effective harm reduction strategy for preventing HCV, HBV, and HIV among IDUs. Buprenorphine is a safe compound, with minimal side effects and minimal chances of overdoses.
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Children with intellectual disability, impact on caregivers: A cross-sectional study p. 151
Divija Bunga, Hrishikesh Giriprasad Manchala, Nikhil Ravindranath, Uma Shankar
DOI:10.4103/ijsp.ijsp_81_19  
Background: In India, the magnitude of the problem of intellectual disability (ID) hardly needs any exaggeration. In India, the prevalence varies from 0.63% to 7.14%. Depending on the severity of the ID, children tend to be proportionately dependent on their parents. Aim: The aim is to know the disability impact and the type of impact of having an ID child on the parents. Materials and Methods: Hundred parents of ID children attending the outpatient department (OPD) services either for treatment for behavioral issues or rehabilitation services to child psychiatry OPD of tertiary care hospital. The level of ID is assessed using developmental screening test and the International Classification of Diseases-10. The disability impact on parents is assessed using the modified National Institute of Mentally Handicapped Disability Impact Scale (DIS). Results: 56.63% of parents have disability impact as related to the physical care of the child, financial problems (58.87%), loss of support from relatives and inlaws, and maintaining social relations with friends and neighbors due to social restriction (36.75%) domains of DIS. As the severity of ID increased, disability impact concerning physical care is also increased along with specific negative thoughts. Majority of parents (71.72%) did not feel any kind of embarrassment because of the ID child. 67.3% of the parents had a positive impact like improved tolerance and patience. Conclusions: The current study gives the heartening finding that most of the parents of the selected intellectually disabled children viewed that they have a more positive impact of 67.3% which implies that every family with a disabled child will not have a negative impact nor it is a bad fate or misfortune. In many families, it can have a positive impact like increased Self Efficacy, parental and family general satisfaction with life which helps the parents to provide necessary care and support and handle the situation more gracefully.
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Availability of mental health services at the primary care level in northern part of Nigeria: Service providers' and users' perspectives p. 157
Emmanuel Ejembi Anyebe, Victor O Olisah, Saleh Ngaski Garba, Hassan Hassan Murtala, Fatima Balarabe
DOI:10.4103/ijsp.ijsp_52_19  
Background/Objectives: Community-based mental health services (MHSs) should target 70% of the rural population, the end users of primary health-care (PHC) services. In this study, the views of the service users and providers were explored to determine the level of MHSs available at their PHC care centers in three selected states in northern part of Nigeria. Materials and Methods: Concurrent quantitative and qualitative data (using mixed-methods research) were collected from a sample of 249 participants through a survey questionnaire and focus group discussions. The sets of data were analyzed using SPSS 23.0 and thematic clustering; these were triangulated to determine the availability of the MHSs. Results: PHC service providers and users reported that PHC centers lacked any formal MHSs, and only a few personal efforts by service providers were mentioned. The service users could not attest to even these unofficial services. Conclusion: Primary MHSs remain conspicuously absent at community level in the study areas. Both service providers and users attest to the near-complete scarcity despite their willingness to provide and use the services, respectively, if and when formal arrangements can be made. Recommendations: Stakeholders' attention is once again drawn to a neglected component of the PHC to promote mental health and prevent community mental health problems characteristic of many communities.
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BRIEF COMMUNICATION Top

Pattern and trends of substance use at a tertiary care hospital in Puducherry p. 163
Ashvini Vengadavaradan, Pooja Patnaik Kuppili, Balaji Bharadwaj
DOI:10.4103/ijsp.ijsp_47_19  
Background: Substance use disorders are a major contributor to the global burden of disease. Since there is a paucity of data on trends and patterns of substance use in Southern India and their locoregional variations across India, we have attempted this study to explore the same. Methods: A retrospective chart-based study was done, of all the outpatients and inpatients who had availed services at a tertiary care hospital in Southern India, for a 5-year period from November 2013 to October 2018. The age, gender, diagnosis, prevalence, and trends of different substance use in our study population were recorded and examined. Results: Both outpatients and inpatients had alcohol as the most common substance of dependence. Among outpatients, all substances studied showed an increasing trend of use in contrary to the specific increase in cannabis dependence among inpatients. Only 0.2% of the population studied was female. Conclusion: Since there are differences in trends and patterns of substance use in northern and southern parts of India, there is a need for studies focusing on the psychosocial, cultural, and legal reasons that could explain the same. Future studies are required to focus on community prevalence and use among females of various substances.
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LETTER TO EDITOR Top

Sustaining optimal mental health and well-being of employees at workplace in Indian settings p. 166
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/ijsp.ijsp_29_19  
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