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   Table of Contents - Current issue
October 2020
Volume 36 | Issue 5 (Supplement)
Page Nos. 1-190

Online since Friday, October 2, 2020

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From “normal” to “new normal” and from “social isolation” to “social bubbles”: The impact of COVID-19 Highly accessed article p. 1
Nitin Gupta
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“Holidays” in people who are addicted to lotteries: A window of treatment opportunity provided by the COVID-19 lockdown p. 6
Sanju George
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Being positive about COVID-19 p. 7
Hitesh Khurana
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Patient support services for COVID-19 patients p. 9
Abhijit R Rozatkar
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Impact of COVID-19 on addiction treatment services p. 11
Siddharth Sarkar
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Reflections for the young Indian minds p. 12
Rachna Bhargava
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The “Idiot Box”: A useful coping strategy in COVID-19 times p. 14
Subhash Das
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Morbidity among healthcare workers and the “Grief Model”: Findings from a survey p. 15
Vipul Singh
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Impact of COVID-19 on day-care centers for persons with psychiatric disability p. 16
Thanapal Sivakumar
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Psychosocial rehabilitation: Pre-COVID, during COVID, and Post-COVID era p. 18
Shikha Tyagi
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COVID-19 pandemic: Some observations and a few recommendations p. 19
Indira Sharma
The COVID-19 pandemic has emerged as a major challenge for India. There has been a widespread response from different sectors. This article seeks to make pertinent observations on the responses to the pandemic in light of implications for the mental health of the community and give concrete suggestions regarding the same. The main observations include: a “global COVID mass hysteria” is fast spreading, an unbalanced presentation of the pandemic highlighting the negative more than the positive aspects; COVID stress is accounted for by other factors as well; cultural aspect of COVID, the nothing to do syndrome; limitations of webinars/online classes; need for simple coping strategies; causes of domestic violence during COVID lockdown; right to privacy of being COVID positive is not absolute, has to be balanced; emergence of morbidities during lockdown, new and old, physical and mental; attention to COVID-19 is resulting in less attention to non-COVID cases; and the major problems of persons with mental illness, especially those with severe mental illness and substance use disorders. The recommendations are balanced education on COVID-19; a pragmatic model of coping, which includes a healthy lifestyle, positive cognitions, and instrumental help to the needy; periodic review of strategies; early detection and treatment of mental illness; re-calibration of health services; continuous supply of medication to persons with mental illness on maintenance therapy; and simple home-based de-addiction.
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COVID-19 pandemic and emotional health: Social psychiatry perspective Highly accessed article p. 24
R Srinivasa Murthy
The COVID-19 pandemic is a challenge to humanity. It is not only a health crisis but also a social crisis. As in the case of past pandemics, life, as we know, is unlikely to be the same after we come out of the pandemic. There will be changes at the level of individuals, families, communities, states, nations, international relationships, and the way all of us will deal with a range of human and environmental situations. Disasters are always associated with increased rates of emotional health needs from distress to specific disorders, such as posttraumatic stress disorder, and the vulnerabilities are associated with the way society is organized. Past experiences have shown psychosocial interventions, ranging from self-care, psychological first aid, school interventions, counseling, social support and formal psychiatric care can minimize the emotional health impact of disasters. These activities can be initiated by individuals, paraprofessionals, and professionals. In addition, there is an important role for social–economic interventions such as provision of food, healthcare, shelter, protection from harm, and relocation/rehabilitation. Spiritual resources are an important part of coping with the pandemic. An emerging area of disaster psychiatry is the possibility of posttraumatic growth and facilitating of community resilience. There is sufficient evidence, from the past, of major societal level changes, following pandemics, in healthcare, education, welfare, governance, and citizen–government relationships along with relationships across countries. The psychosocial interventions, with survivors of disasters, should be to promote mental health and prevent mental disorders and care of persons with mental disorders involving the individuals, families, communities, and the government. The pandemic also offers opportunities for understanding and addressing of the risk factors for mental health and factors contributing to resilience of individuals and communities. The current pandemic presents challenges and opportunities for the Indian Association for Social Psychiatry.
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Battling COVID-19: The unbound mutant p. 43
Savita Malhotra
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The stigma story of COVID-19 in India p. 46
Astha , Vinay Kumar
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Need to move – Discussion to action p. 49
Suresh Bada Math
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Rebuilding emotional health through individual and family efforts p. 53
Adarsh Kohli
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Understanding of emotional health of migrants, with special focus on social factors p. 55
BS Chavan
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Training mental health professionals for COVID-19 pandemic and beyond p. 58
Jagadisha Thirthalli, Rahul Patley, Channaveerachari Naveen Kumar
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Intersectoral activities in the time of COVID-19 p. 61
Rajesh Sagar, Mahadev Singh Sen
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Debating the process, impact, and handling of social and health determinants of the COVID-19 pandemic Highly accessed article p. 64
Sudhir K Khandelwal
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“Unheard voices of the pandemic”: Psychosocial vulnerabilities of the Indian migrant population during COVID-19 crisis p. 84
Debanjan Banerjee, TS Sathyanarayana Rao
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Patients with preexisting mental illness and other vulnerable groups in the COVID-19 pandemic p. 87
Rakesh Kumar Chadda
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Utilization of primary health-care infrastructure in tackling COVID-19 p. 89
Roy Abraham Kallivayalil, Arun Enara
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Civil society and volunteerism in the COVID-19 pandemic p. 91
Gautam Saha
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Sophie's choice: The costs of the COVID-19 pandemic versus the costs of its “treatment” p. 93
Debasish Basu
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The pandemic and social psychiatry p. 95
Alok Sarin, Sanjeev Jain
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The impact of social inequities on mental ill-health: The banyan response p. 98
Rachel Mathew, Preetha Krishnadas, Smriti Vallath, Vanitha Rajesh, Joske G.F. Bunders, Lakshmi Ravikanth, Vandana Gopikumar
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The 'othering' in pandemics: Prejudice and orientalism in COVID-19 p. 102
Debanjan Banerjee, Roy Abraham Kallivayalil, TS Sathyanarayana Rao
Pandemics are not just medical phenomena. They affect the society at large, having long-lasting psycho-social implications. Throughout history, they have led to stigmatization, prejudice, “othering,” and blame. This amplifies hate and socioeconomic divisions, and the effect outlasts the outbreak itself by years to come. Traditionally, humankind has always fared better to deal with the pathogen causing the outbreak, rather than the resultant stigma and prejudice. In the pursue of biological cures for the infection, this vital social implication is unfortunately neglected. The coronavirus disease 2019 (COVID-19) has emerged as a global public health threat. As international borders are sealed, economies slashed, and billions quarantined at their homes in an attempt to contain the spread of infection, history repeats itself in the prevalent marginalization, blame, and stigma that are more contagious than the virus itself. This commentary traces back through the past to look at examples of orientalism and colonialism in pandemics and the resultant stigma, and also to highlight global perspectives of the prevalent prejudice in this current outbreak of COVID-19.
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Social vaccine for the ongoing COVID-19 pandemic! p. 107
R Srinivasa Murthy, Nitin Gupta
The COVID-19 pandemic has affected humanity across the world. Mankind and scientists are working around the clock in desperation to finding effective solutions to control and eradicate the virus and develop measures to boost the immunity of the population through an effective vaccine; all of these are likely to take time. Nevertheless, one important aspect that has come to the forefront of the pandemic is the importance of social factors at all levels, and the responses, to the pandemic; which has been referred by many professionals to as “social vaccine.” This perspective discusses its effectiveness, underlying concepts, lessons learnt, and critiques the related issue of “social distancing.” We conclude with the assertion that “the fuller use of social resources and positive outcome of the pandemic could be an important contribution from India.”
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Social and psychological consequences of “Quarantine”: A systematic review and application to India p. 112
Pratap Sharan, Pallavi Rajhans
Background: Quarantine has been used as a public health measure to contain the spread of communicable diseases. Its use in the current COVID-19 pandemic is based on experience from the past while handling other coronavirus infections. Objectives: The aim of this study is to synthesize the available literature focusing on the psychological and social consequences of quarantine. Materials and Methods: PubMed search for original research articles published in peer-reviewed journals in the English language was done. Studies focusing on psychological or social impact on quarantine were included. In view of the current pandemic being caused by coronavirus, studies were limited to the outbreak causing coronavirus diseases. Results: Psychological problems most commonly reported were anxiety, depression, acute, and posttraumatic stress disorder. Various other emotional problems, loneliness, anger, frustration, and psychosomatic problems were also reported. Quarantined individuals experience stigma and isolation. The literature on the purpose of quarantine, and referral pathways to obtain help and care seemed lacking. Literature from India and other low- and middle-income countries was scarce. Conclusion: There is a need to address the psychosocial issues emerging from the experience of quarantine. Mental health workers can play an important role in managing them, but it would require collaboration and good organizational support. More studies from developing countries can be planned in future.
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Domestic violence during the COVID-19 pandemic: Lessons to be learned p. 120
Tharun R Krishnan, Siti Halimatul Saadiah Hassan, Veena A Satyanarayana, Prabha S Chandra
Pandemics such as the ongoing SARS-CoV-2 (COVID-19) have a significant impact on individuals, families, and countries alike. People have to deal with the consequences of the infection as well as the precautionary measures taken to contain the infection such as isolation, social distancing, and restriction on movements. Domestic violence (DV) is a gender-based violence that happens at homes and usually involves the spouse or partner or other family members. Due to the current pandemic and the ensuing lockdown, DV has posed a major challenge for frontline mental health professionals. The UN Women has reported increased rates of violence against women and children during the COVID-19 pandemic. However, it is difficult to measure the point prevalence due to restrictions, both in accessing help and in reporting. Women have reported difficulty in help seeking, while professionals have reported difficulties in assessment, service delivery, and in linking women to appropriate services. This article explores the possible mechanisms behind DV during COVID-19, its manifestations, difficulties in providing help during this pandemic, and recommendations for health professionals and mental health service providers. It also discusses the challenges in data gathering and research and provides recommendations for various stakeholders to address DV in future pandemics.
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Social analysis of the governmental-based health measures: A critique p. 126
Rajiv Gupta, Sidharth Arya
Governments across the globe have responded to the COVID-19 pandemic by imposing restrictions of various magnitudes on citizen activities. The Indian government imposed one of the strictest lockdown among all nations. The lockdown initially meant for 3 weeks has been extended thrice for a total duration of about 10 weeks. During this period, there has been closure of nonessential services. While the government did take certain proactive steps, however much remains to be desired at the ground level. This unprecedented move and other precautionary steps to control the pandemic unearthed numerous psychosocial consequences; however, for this particular paper, we will focus on social challenges such as migration, poverty and hunger, social disconnection, homelessness, and increased screen time arising as a result of government-based measures. Government policies for health-care workers have been only partially successful as there had been numerous incidents of struggles expressed from different corners of the country. Further stigma related to pandemic has had a serious impact on control measures. It remains unclear whether the social changes occurring to combat the crisis are transient or will create a totally transformed society. The true extent of the devastation due to the pandemic will only be clear in the near future.
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Psychology of misinformation and the media: Insights from the COVID-19 pandemic Highly accessed article p. 131
Debanjan Banerjee, TS Sathyanarayana Rao
The coronavirus disease 2019 (COVID-19) pandemic has emerged as a significant and global public health crisis. Besides the rising number of cases and fatalities, the outbreak has also affected economies, employment, and policies alike. As billions are being isolated at their homes to contain the infection, the uncertainty gives rise to mass hysteria and panic. Amid this, there has been a hidden epidemic of “information” that makes COVID-19 stand out as a “digital infodemic” from the earlier outbreaks. Misinformation and fake news are invariable accompaniments to this “information pollution” which can add to the anxiety, fear, uncertainty, and agitation and lead to faulty treatments, noncompliance to precautionary measures, prejudice, and stigma. Research shows that distress and panic during pandemics can propagate and promote misinformation in various ways along with increased digital screen time and unhealthy use of technology. In that context, media is considered to be a “double-edged sword” and can either add to the misinformation burden or aid in the awareness and health communication during such a biological crisis. Lessons from past outbreaks portray media, especially social media, as a useful tool to promote health literacy and control the outbreak. This article looks at the impact of information during COVID-19, the psychology behind spread of misinformation, and finally, a balanced view of the role of media in such disasters, proposing ways for its healthy integration into public and social health.
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Epidemiological mapping and public mental health skills in preventing community spread of COVID-19 infection: A psychiatrist's perspective p. 138
BS Chavan
After the report of the first case of COVID-19 in November 2019 from Hubei province of China, the disease took a pandemic form in a short span of 4 months, and the World Health Organization declared it as a pandemic on March 11, 2020. In India, the first case of COVID 19 was detected in Kerala on January 30, 2020, and by March 15, 2020, there were 107 cases. Fearing further spread, India declared complete lockdown from 24th March, 2020 initially for 21 days and it was further extended from time to time. The early curfew and lockdown by India has been successful in slowing the spread of infection. The other initiatives by the Government of India, namely closing the national and international airports, halting of public transport, screening of passengers coming from abroad, ramping up of testing facility, enforcing of social distancing, and wearing of masks, further reduced the rate of spread of COVID-19 infection. The most crucial component of the intervention by the institutions was tracking, testing, and treatment. For epidemiological mapping and contact tracing, the role of a mental health professional (MHP) as the leader is important during the early stages of prevention of COVID-19 infection. The MHPs are better equipped in contact tracing because of their skill in taking in-depth history, focusing on nonverbal cues during the session, early detection of denial of information, and they are better equipped in rapport building than their colleagues from other medical disciplines.
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Strategic mental health psychosocial responses in times of COVID-19 in India p. 143
Achal Bhagat
The magnitude of the mental health problems and the treatment gap has been an unaddressed concern in the Indian public health system. With the arrival of the COVID-19 pandemic, India is at the brink of a mental health crisis. An overburdened health system will have to cater not just to the existing mental health needs, but also to the added psychosocial adversities arising due to the COVID-19 pandemic. The following article aims to describe the mental health needs of the nation at a time of an infectious epidemic. It further outlines the modalities and the process of service delivery using cross-sectoral, multi-tiered, transdisciplinary human resources, and technological interventions.
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Embracing uncertainty during COVID-19 times: Psychiatry training, research, and practices in an institute p. 151
Santosh K Chaturvedi, Naveen Manohar Pai, Niharika Singh, Aishwariya Jha
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Organizing inpatient services in a general hospital in times of COVID-19 p. 154
Mamta Sood, Bichitra Nanda Patra, Raman Deep, Lalitha Kalyansundaram, Sunita Dua, S Vijay
COVID-19 is an unprecedented event and has affected patients with psychiatric disorders in multiple ways. Patients in inpatient settings are at high risk of exposure of getting COVID-19 infection. We reviewed the literature on the inpatient psychiatric facilities and measures regarding how to address COVID-19 in these settings. We then provide an experiential narrative of the strategies and improvisations to meet the challenges of COVID-19 so as to continue the inpatient services at a large public funded medical school and hospital in North India. Literature suggested that it is important to restrict hospitalization, expedite discharges, prohibit visit of the attendants, minimize group activities, provide psychological assistance, multidisciplinary teams to provide care, to tackle issue of stigma, have adequate means for practicing preventive measures, creating facility for isolation and have clear guidelines for diagnostic testing. The psychiatry ward in our hospital was designated non-COVID ward and substantial beds were reserved for surgical trauma patients. For organizing inpatient services, we created a multidisciplinary team. Some of the measures were institute-mandated, while others were intra-departmental measures to protect staff as well as patients in the psychiatry ward. It can be concluded that COVID-19 pandemic is still an evolving situation. The measures to prevent exposure to COVID-19 infection in the inpatient facilities continues to evolve as and when fresh challenges emerge.
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Telepsychiatry and COVID-19: A new dawn for digital psychiatry? p. 162
Subodh Dave, Seri Abraham, Parmod Kumar, Anilkumar S Pillai, Sridevi Sira Mahalingappa
Psychiatrists all over the world are being presented with the unique challenge of continuing to deliver mental health care during, and after the first wave of the COVID-19 pandemic. Telepsychiatry has emerged as a potential solution to this challenge, especially when physical distancing has become the norm in social discourse. India, with its vast rural population and technological prowess, has been one of the early adopters of telepsychiatry. However, given the reach of mobile telephony in India, its usage is not as widespread as anticipated. In the post COVID-19 world, the rapid and broad adoption of telepsychiatry could offer a potential solution to bridge the gap between the availability and need for mental health professionals and interventions. Evidence suggests that telepsychiatry is at least as effective as face-to-face consultations in improving mental health outcomes. There is emerging literature on the remote assessment of patients in various settings globally and from India. This article aims to help clinicians translate this evidence into action in their clinical practice by providing practice guidance on conducting comprehensive telepsychiatry assessments. It also sheds light on the challenges and opportunities encountered with telepsychiatry in the Indian setting.
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Community mental health services in India: The pandemic and beyond p. 168
T Manoj Kumar
Both popular and professional narratives during the COVID pandemic have focused on the perceived mental health needs of the population. Anxiety and distress have figured high in the list of mental health problems anticipated either during the crisis or in the aftermath. Some of this has been based on previous experience of disasters, but the current pandemic is unique in that there are no modern-day comparable equivalents. A number of cross sectional studies, many from China, have reported high levels of symptoms, particularly anxiety. However, the interpretation of these is difficult as it is not clear if the reported high scores on questionnaires translate into the presence of diagnosable mental disorders. By focusing on the population effects of the pandemic, we are in danger of neglecting the needs of the existing severely mentally ill. It is also becoming increasingly clear that the pandemic could continue for months or years. Existing mental health services have been badly affected by the ongoing lockdown. Considering that the treatment gap is already wide in India and resources stretched in meeting the existing needs, we cannot afford to lose the gains we have made in meeting the needs of people with severe mental disorders. This paper describes, in the light of an example from Kerala, how we can adapt to the changed circumstances without care being significantly compromised. It could also be that these changes forced on us now, could actually make the delivery of mental healthcare even better in future. The COVID challenge also provides opportunities for reform.
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Psychotherapy during Corona crisis p. 174
Kishore Chandiramani
The corona infection is peaking in India, and we have seen a surge in mental health problems; sadly the mental health peak is yet to come. The populations hit hardest are the front-line staff, children, elderly, people who live alone, individuals with comorbid health conditions, socially and financially deprived groups, and those who are vulnerable to suffering domestic violence. Alcohol- and drug-dependent individuals have also reported a worsening in their mental health and suicides that could have been prevented have occurred. The financial desperation in society has increased the risk of crime rates. The lockdown has made it difficult for people to use their habitual coping strategies, and access help from their own social and spiritual support systems and the mental health services. This article in intended to help psychotherapists make sense of the unique nature of the corona related psychological problems and to learn new ways of dealing with them.
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The “Good, Bad, and Ugly:” Challenges for the health-care professionals in wake of the COVID-19 pandemic p. 181
Swati Kedia Gupta, Sudhir Khandelwal
Health care has been considered as among the most coveted and noble of all professions. However, the last decade has seen increasing incidents of violence against health-care professionals. The world, currently, faces an unprecedented emergency in the form of COVID-19 and health-care workers are at the frontline, saving lives and exposing themselves to the deadly virus and yet face the stigma of spreading the virus. The public perception has ranged from lauding the efforts of medical staff to unprovoked or unnecessary violence towards them. The current overview aims to understand the challenges faced by the health-care professionals specifically during the pandemic and how it has impacted perception of public and government.
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Together: The healing power of human connection in a sometimes lonely world p. 187
Nitin Gupta
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Pale rider: the spanish flu of 1918 and how it changed the world Highly accessed article p. 189
R Srinivasa Murthy
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