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  Citation statistics : Table of Contents
   2018| January-March  | Volume 34 | Issue 1  
    Online since March 29, 2018

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Internalized stigma experienced by patients with first-episode depression: A study from a tertiary care center
Swapnajeet Sahoo, Sandeep Grover, Rama Malhotra, Ajit Avasthi
January-March 2018, 34(1):21-29
Background: Although there is abundant literature on stigma and its correlates in patients with severe mental illnesses such as schizophrenia and bipolar disorder, data on stigma experienced by patients with first-episode depression (FED) are limited. Aims and Objectives: To estimate internalized stigma perceived by patients with FED and to assess the relationship of stigma with sociodemographic and clinical variables. Methodology: This cross-sectional study included 107 patients with FED with duration of illness of at least 1 month, currently not meeting the criteria of syndromal depression (as assessed on Hamilton depression rating scale score ≤ 7). These patients were assessed on Internalized Stigma of Mental Illness Scale (ISMIS) for internalized stigma and Participation Scale for restriction of activities. Results: About two-fifths of patients (41.1%) reported stigma as per the total ISMIS score. In terms of various domains of stigma, stereotype endorsement (54.2%) was reported by the highest proportion of patients and this was followed by alienation (47.7%) and discrimination experience (38.3%). About half of the study sample (49.5%) reported restriction in participation with one-third of the sample reporting having severe or extreme restriction. Younger age, longer duration of depressive episode, and presence of comorbid physical illness were found to be strongly associated with higher level of stigma. Higher level of participation restriction was associated with higher level of stigma in the domains of alienation (P ≤ 0.001) and social withdrawal (P ≤ 0.004). Conclusions: The present study suggests that internalized stigma/self-stigma is highly prevalent among patients with FED. Accordingly, there is a need to develop stigma mitigation programs addressing these patients at the earliest to improve their treatment outcome.
  5 2,488 274
The hijras of India: A marginal community with paradox sexual identity
Sibsankar Mal
January-March 2018, 34(1):79-85
Transgender people in India, commonly known as the Hijras, who claim to be neither male nor female, are socially excluded in Indian society. The uniqueness of Hijras lies not only in their existence beyond social structure but also in Indian society's historical acceptance of that position. This study aims to understand the sociocultural exclusion of Hijras, depending on their gender identity disorder and their paradox sexual appearance. An exploratory cum descriptive research design with a nonrandom purposive sampling including the snowball technique was adopted, to collect information from 51 Hijras at Kharagpur town from the state of West Bengal, India. The study shows that although Hijras have a sort of sanctioned and visible place in Hindu society, but in the contemporary Indian context, it is the gender nonconformity of the Hijra that has a major impact besides lack of a gender recognition, sexual expression, employment, decent housing, subsidized health-care services, and as well as the violence they suffer, especially when they choose to take up formal works. Therefore, Hijras are controversial and minacious community in Indian society and their existence disrupts essential ideas about sex or gender. They need to be recognized as having a space on society's gender continuum. Vertical interventions of rights are greatly needed to address the unique needs of this marginalized group and recognizing them as equal citizens of India.
  3 69,585 1,593
Effect of teacher's training on enhancing self-determination among individuals with intellectual disability
Wasim Ahmad, AT Thressiakutty
January-March 2018, 34(1):16-20
Background: During the past two decades, self-determination has emerged as an important concept in education, progress, and services delivery for persons with disabilities. Objective: This study attempted to find out the effect of teacher's training on enhancing self-determination among individuals with intellectual disability (IID) with respect to gender and age. Sample: IID (n = 50) were intervened by the trained special educators. Design: Single group pre- and post-test design has been used. Tool: Self Determination Scale for Adults with Mental Retardation was utilized for collection of data. Results: The data collected was analyzed using the statistical techniques such as t-test, ANCOVA, and post hoc Tukey test. The results show that the training has a remarkable impact on self-determination among IID. Conclusion: The findings have shown that there is a significant effect of teacher's training on enhancing self-determination among IID.
  1 1,993 228
What scares patients to get admitted in a psychiatry ward? An exploratory study
Sushmita Bhattacharya, Bir Singh Chavan
January-March 2018, 34(1):86-89
Background: There has been very little focus on understanding the experiences of people suffering from mental illness during their treatment in the outpatient and inpatient treatment facilities. Majority of the decisions regarding their treatment are taken by the mental health professionals in consultation with the caregivers, and the patient remains a passive recipient of the services. It is commonly seen that patients refuse admission in the psychiatry ward even when clinical needs warrant admission. Aim: The aim of the current study was to explore the perception of patients regarding admission in the psychiatry ward and the fears associated with indoor treatment facility. Methodology: A semistructured interview schedule was administered to 110 patients undergoing treatment from outpatient services to study their attitude toward treatment in psychiatry ward. Results: A large number of patients perceived psychiatry ward as a hostile place with unfriendly atmosphere and dark and unsupportive environment. However, the patients who had been admitted in the past found it less scary and appreciated good and friendly behavior of the staff in the ward. Conclusion: Negative perception of inpatient treatment and psychiatry wards is still highly prevalent among the patients. With growing focus on reducing stigma about psychiatric illnesses, dispelling the myths related to treatment in wards is the need of the hour.
  1 1,808 140
Mental disorder and disability: A cross-sectional study of disability variance in severe mental disorders
Anvar Sadath, Shibu Kumar, Suja Mathew
January-March 2018, 34(1):52-56
Background: Severe mental disorders are associated with long-standing functional impairment and disability. The degree of disability varies with diagnosis. However, limited evidence are available on the association of psychiatric diagnosis and disability, especially from community settings in India. Methods: We examined the association of psychiatric diagnosis and disability in 711 persons suffering from severe mental illness. The patients were recruited from 12 community psychiatry outreach clinics at Wayanad District, South India. The Indian Disability Evaluation and Assessment Scale was administered to measure disability. ANOVA was applied to examine the extent of disability variance in diagnosis. Results: Disability varied significantly with diagnosis (F = 3.866; P = 0.000). Persons with schizophrenia experienced higher disability than bipolar affective disorder and depressive disorder. However, the disability was found nonsignificant in other diagnosis groups. Conclusion: The result implies the need for illness-specific programs and rehabilitative measures for persons with disability.
  1 3,071 297
Role of perceived family environment in the pathogenesis of schizophrenia
Roshan Lal Dewangan, Promila Singh, Tanmay Mahapatra, Sanchita Mahapatra
January-March 2018, 34(1):69-78
Background: Family plays an important role in mental health of its member, thus its contribution can also be discerned in pathogenesis. Maintenance and relapse of several mental illnesses have been also attributed to the family environment (FE). This study explores FE as perceived by schizophrenia patients. Methodology: A case–control study was conducted in Chhattisgarh, India, to measure the association of perceived FE with schizophrenia. Between February 2014 and January 2015, 100 paranoid schizophrenia patients and 100 neighborhood-based healthy (based on 28-item General Health Questionnaire) controls were recruited. Minimum school-educated individuals aged 20–35 years were eligible if they/their caregivers provided consent. Interpersonal relationships and FE were assessed by an interviewer-administered 69-item FE scale. Results: The odds of suffering from schizophrenia increased with age, decreased with education, income, and found to be less among married. Schizophrenia risk was negatively associated with mean scores for cohesion, acceptance/caring, active-recreational orientation, and organization. Negative symptoms of schizophrenia were less pronounced among patients belonging to joint families. Conclusion: Thus, to minimize the burden and morbidity associated with schizophrenia, interventions to improve FE by minimizing conflict and improving cohesion, acceptance/caring, active-recreational orientation, and organization, and specifically targeting older, less-educated, poor, and married individuals in nuclear families seemed necessary.
  1 2,460 251
Concerned parents, belligerent adolescent: Providing support to distressed parents
Siddharth Sarkar
January-March 2018, 34(1):11-15
Societal changes have brought about transformation in the family dynamics in India. The youth of today is exposed to a wide variety of influences, and their tendency toward experimentation makes them vulnerable to get into unpleasant situations. Adding to that, issues related to use and abuse of substances sometimes bring them into contact with mental health professionals. Parents come with high expectations that the treatment provider would provide “treatment” that would miraculously mend the ways of the belligerent adolescent. The treatment provider may find himself or herself sandwiched between a poorly motivated, somewhat deviant adolescent and concerned parents who press for a lasting solution. The progression of therapeutic encounters presents certain challenges to the mental health professional. In this case discussion, I would like to present few issues and challenges and put forth some reflections about an adolescent with substance use and behavioral problems brought by family members. Over time, the stance of the therapist changed from attempting to “reform” the adolescent to providing support to the distressed parents. At the same time, the potential ways of dealing with such a situation are explored further.
  - 1,652 193
Disability among patients with opioid use disorders and its relationship with stigma toward substance use
Saurabh Kumar, Swarndeep Singh, Siddharth Sarkar, Yatan Pal Singh Balhara
January-March 2018, 34(1):30-36
Background: From a medical model perspective of substance use disorders (SUDs), opioid use disorders are associated with some degree of disability. This study aimed to assess the disability among patients with opioid use disorders (OUDs) and its relationship with internalized stigma. Methodology: This cross-sectional study assessed patients with SUDs at a tertiary care center. Disability among patients with OUDs was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS) while stigma was measured using Internalized Stigma of Mental Illness Scale (ISMIS). Results: Among 168 patients with OUD, the disability was greatest in the domain of work followed by interpersonal activities. About 48.2% and 3.0% of the participants had moderate and severe disability according to IDEAS. Disability (IDEAS) scores had a robust correlation with the stigma (ISMIS) scores (r = 0.453, P < 0.01). Multiple regression analysis found that internalized stigma (ISMIS score) was an independent predictor of disability among patients with OUDs (β =0.42, P < 0.01). Conclusions: From a medical perspective, OUDs are associated with considerable disability which has significant correlation with internalized stigma. Designing interventions which can target internalized stigma among patients with OUD may help in reducing the disability associated with it.
  - 1,651 155
Profiling the initial 1st Year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”
Subhash Das, Nitin Gupta, Anadrika Debbarma, Manoj Kumar Bajaj
January-March 2018, 34(1):37-47
Background: Increase in life expectancy of Indians will require revamping the health-care infrastructure for the elderly. In India, either there are not too many specialized geriatric mental health services available across the country or those that are available have problems of resources and quality. With this perspective, the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, developed the Geriatric Mental Health Clinic (GMHC) for the elderly residing in and around Chandigarh. The aim of the study was to study the initial 1-year cohort and assess their satisfaction levels as well as to see whether their functioning improves with the intervention so provided. Materials and Methods: Using the “service evaluation framework,” the patients and caregivers who attended the GMHC over a period of 1 year were evaluated using tools such as Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, World Health Organization quality of life-BREF (WHO-QoL-BREF)-Hindi version, and Patient Satisfaction Scale (PAT-SAT). In addition, sociodemographic and clinical profile data of the service users were compiled. Results: A total of 105 cases formed the cohort under study, wherein 70% had functional psychiatric illness and almost more than half of the cases had comorbid physical illness, hypertension being the most common. GAF score of 45.42 and WHO-QoL-BREF score of 78.7 at the time of follow-up suggested that there was “slight impairment in socio-occupational functioning” and “poor QoL,” respectively. However, GAF and HMSE scores were significantly decreased in those with organicity. Overall service users reported good service-cum-clinician satisfaction scores on PAT-SAT; there was also significant reduction of EASI score from that of baseline, suggesting improvement in functioning. Conclusions: Findings show that the newly started GMHC, even though in its incipient stage, is attracting patients of all diagnostic categories, from expected catchment areas, is being able to deliver interventions which are bringing about clinical and functional improvement, and service users are not reporting dissatisfaction.
  - 1,505 130
Mental health services in disaster-affected population in low-resource settings
Rakesh Kumar Chadda
January-March 2018, 34(1):7-10
The paper discusses planning mental health services in disaster-affected population in low-resource settings. Disasters, both natural and artificial, are not uncommon in the modern world. Mental health problems are common in a disaster-affected population. Disaster often traumatizes and devastates the affected population badly, also damaging the available resources. Planning mental health services include assessing the needs, accessibility of the area, available resources and their mobilization, and coordination with the local authorities and policymakers. Mental health professionals need to take a prompt initiative and leadership role. The author discusses his own experience in planning such a service in Kashmir in November 2005 following a massive earthquake which affected the state on October 8, 2005. Role of the National Disaster Management Authority of India in the management of disasters is also briefly discussed.
  - 2,265 228
Can social psychiatry bridge the sociopolitical divide between brain disease and free will models of addictions?
Abhishek Ghosh, Debasish Basu
January-March 2018, 34(1):1-3
  - 1,684 229
Erratum: Abstracts of the XXII World Congress of the World Association of Social Psychiatry (WASP) at New Delhi, India from 30thNovember 2016 to 4thDecember 2016

January-March 2018, 34(1):94-94
  - 959 98
A case of sporadic koro from Kerala
AP Megha, James T Antony, K Saibunnisa Beevi, Geomy G Chakkalakkudy, Praveenlal Kuttichira
January-March 2018, 34(1):90-91
  - 1,393 133
Mindfulness integrated cognitive behavior therapy in bipolar disorder in remission: A case study
Seema P Nambiar, M Manjula, Shyam Sundar Arumugham
January-March 2018, 34(1):92-93
  - 1,484 184
Assessment of level of empathy among nursing students during internship
Sukhpal Kaur, Sushma Saini, Indarjit Waia
January-March 2018, 34(1):57-61
Background and Objective: Empathy is one of the therapeutic communication techniques for providing comfort to the client. It is an important component of meaningful interpersonal relationship. Internship is the period of tremendous changes, both personally and professionally. The current study was undertaken to assess the level of empathy among the nursing students during their internship. Methodology: The study was descriptive in nature. It was carried out at a nursing college of a North Indian city. Forty-six nursing interns participated in the study. Jefferson Scale of Empathy was administered three times to the students during the internship, i.e., at the beginning, at 6 months, and at the completion of internship. Results: Mean age ± standard deviation of the participants was 21.43 ± 0.91 with the range of 20–23 years. There was an increase in the number of participants with high level of empathy from the 23.9% at the beginning to 29.6% at the midway and 28.3% at the end of internship, but the increase was not statistically significant (P > 0.01). The mean empathy score, in the beginning, was 50.76 ± 4.2 with the range of 43–60. At the midway of the internship, the score was 52.13 ± 4.62 with the range of 40–60. However, at the end of internship the score was 52.41 ± 4.48 with the range of 40–60. There was no significant change in the empathy score throughout the internship (F = 1.816, P = 0.167). It may be because of the saturation level of empathy among the students of senior most class. Hence, future research may study empathy level among all the 4 years of training separately rather than only interns.
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Picture versus words: A comparison of pictorial and verbal informed assent formats
Siddharth Dutt, Bangalore N Roopesh
January-March 2018, 34(1):62-68
Background for the Study: Informed consent is a process of obtaining permission from the participant to participate in research. Involving children in a research requires them to give their “assent” for participation. Informed assent is obtained from children even after their guardians have given consent for participation. Studies have shown that children have difficulty understanding the key elements of research process such as right to withdraw from the study or the meaning of “harm” involved in the research process. Further, the studies have also propounded that using child-friendly methods such as using pictures and simple language would facilitate children's understanding. Objectives: In this study, pictorial and verbal assent formats were compared find out which format is suitable for children's understanding of informed assent with respect to research. Methods: A sample of 389 school going children and adolescents of both the gender, ranging from 7 to 16 years were considered for the study. The sample was randomly divided into two groups, where for one group (n = 197), pictorial assent format was administered and another group (n = 192), verbal assent format was administered. The pictorial assent format was developed for the study by the corresponding author. Results and Conclusions: Analysis revealed that there was a significant level of interaction between gender and the two assent formats. Males were able to understand pictorial assent format better compared to the females, whereas females were able to understand verbal assent format better than the males, when age and education were considered as covariates. Further, it was found that as age increases there is better understanding of research processes in both the formats. Hence, while the process of obtaining assent for participation in research, age of child must be considered and with respect to gender differences males tend to prefer pictorial formats whereas females tend to prefer verbal formats.
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Effect of yoga on positive–Negative affect and self-esteem on tribal male adolescents- A randomized control study
Rema Mohan, Sony Kumari
January-March 2018, 34(1):48-51
Aim: Effect of yoga on positive–negative affectivity and self-esteem in tribal adolescents. Material and Methods: This is a pilot randomized control study. Several chits were made in which the name of all the available students was written. The youngest boy from the group selected 30 chits for yoga group and the remaining students were included in the control group. The yoga group included 30 male adolescents between the age of 10 years and 18 years (M = 14.4, SD = 3.51). Control group included 25 male adolescents between the age of 10 years and 18 years (M = 13.3, SD = 1.90). PANAS-C and Rosenberg self-esteem scales were used to measure the positive–negative affectivity and self-esteem, respectively. Data was collected before and after interventions. Results: Study shows significant increase in positive affect (P = 0.008) and negative affect (P = 0.047) in experimental group as compared to control group's positive affect (P = 0.468) and negative affect (P = 0.156). Self-esteem in experimental group slightly reduced (P = 0.927). Similarly, self-esteem in control group reduced (P = 0.019). Conclusion: Study suggests that two weeks of yoga practice has a significant impact on positive-negative affect in tribal adolescents.
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Cultural diversity and mental health
Rajiv Gupta
January-March 2018, 34(1):4-6
  - 1,965 248