Delusional parasitosis: A case series

Delusional parasitosis (DP) is an infrequent psychotic illness, where the patient has a false but firm belief that his body is infested with parasites. It can be primary or secondary. Usually, these patients consult nonpsychiatric specialties from where they are referred to psychiatry. The presentation of DP varies among patients, although it typically manifests as a crawling and pinpricking sensation. Hallucinations are commonly seen. Antipsychotics show good remission of symptoms. A series of seven cases of DP have been described, and the condition is briefly discussed.

Biopsychosocial correlates of emotional problems in women during pregnancy and postpartum period

Background

Transition to motherhood is associated with several emotional problems that can have long-term consequences on the mother and baby.

Aim

To examine the association of various biomedical and cultural factors with the new onset of emotional problems during pregnancy and postpartum period.

Materials and Methods

This prospective longitudinal study included 300 pregnant women interviewed in the third trimester.

Results

The prevalence of emotional problems in the study group was 31.58%. The prevalence of anxiety disorder NOS and mixed anxiety and depressive disorder in the last trimester of pregnancy in our study was 4% and 1.33%, respectively, and 0.67% and 1.33%, respectively, at 4 days postpartum. At 6 weeks postpartum, the prevalence of anxiety disorder NOS was 1.33%, generalized anxiety disorder was 0.67%, and major depression was 1.33. The prevalence of postpartum blues in our study was 25.33%.

Conclusion

There was a significant association between psychiatric disorders during and postpartum period and the following factors: higher parity, increased maternal age, low hemoglobin levels, cesarean section, planned pregnancy, and extended family. Postpartum blues was associated with higher parity and low blood pressure.

The effect of the COVID-19 pandemic and lockdown on the psychosocial health of medical students

Background

The COVID-19 pandemic had many psychological adverse effects due to fear and panic of infection. However social distancing and lockdown restrictions imposed to curb the spread of infection had an impact on the social life of people. The effects of this on the psychosocial health of the population were less explored area.

Aim

To study the effect of the COVID-19 pandemic and lockdown on the psychosocial health of medical students.

Materials and Methods

A cross-sectional observational study was conducted on medical students with the help of an online Google Form administering a questionnaire consisting of sociodemographic information; Coronavirus Social Distance Attitudes Scale and Attitude toward lockdown measure to assess favorable or opposing attitudes of participants toward social distancing and lockdown; Bergen Social Relationship Scale, Evaluation of Social System scale and Social Support Questionnaire to measure quality of social relations and social support satisfaction; and three item loneliness scale to evaluate feeling of loneliness.

Results

The loneliness levels in participants were high (mean = 6.74 ± 0.79). There was a gender difference in the variables measured. Male students showed a favorable attitude toward social distancing (Positive social distance attitude scale P < 0.001, negative social distance attitude scale P < 0.001) and a better quality of social relations (Bergen Social relationship P < 0.001, evaluation of social system P < 0.001, SSQN P < 0.001, SSQS P < 0.001). However, male students scored more for loneliness as compared to females during the lockdown period (P < 0.001).

Conclusion

The loneliness levels were high in medical students during the COVID-19 pandemic and lockdown and even higher in males who were considered a non-vulnerable group. So the balanced approach between preventive restriction measures and the social connectedness of the population is advised for making social distancing policies in the future.

Mental health concerns of interns posted in COVID-19-affected regions of Maharashtra

Background

Healthcare providers faced the challenge of managing coronavirus disease 2019 (COVID-19)-infected patients. At the onset of the spread of the coronavirus infection across the globe, awareness of the treatment modalities was poor. Interns were relatively new to treating patients as they had just started their clinical postings in February or March 2020. Working in the COVID-19 wards with the sudden influx of a large number of patients, treating them with ever-changing guidelines did cause increased physical and mental stress. Thus, to understand the impact of coronavirus infection on interns this study was conducted.

Materials and Methods

An online survey was conducted among interns of various medical colleges of Nagpur, Mumbai, Pune, and Miraj using Google Forms. Participation was anonymous and voluntary. Responses were accepted for 1 week from March 27, 2020, till April 3, 2020. Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder 7 Scale (GAD-7) (9) were used to assess anxiety and depression.

Result

Our study showed that 36.3% of the interns who were posted for COVID-19 duty had depression, whereas 34% had anxiety symptoms. Anxiety and depression were comparable in interns posted for COVID-19 duty and those posted in other clinical departments. Young age, female gender, and perceived risk of contracting COVID-19 were the predictors for anxiety and depression.

Conclusion

There was a high level of anxiety and depression among interns working in hospitals during the COVID-19 pandemic irrespective of whether they were posted for COVID-19 duty or not. Reporting such information is important to plan further management of mental health needs.

Assessment of supernatural attitude toward mental health among tribal and non-tribal populations

Background

In India, only about 10% of persons with psychiatric illnesses receive evidence-based treatments. Stigma, mistrust in allopathic medicine, allegiance toward faith healers, cultural and traditional practices, and beliefs are some of the major hindrances to the treatment of mentally ill patients.

Aim

To assess supernatural attitudes toward mental health among tribal and non-tribal populations.

Materials and Methods

A total of 100 subjects were included in the study after informed consent, 50 of whom were tribal and 50 non-tribal. All were required to fill a self-constructed proforma, the Supernatural Attitude Questionnaire (SAQ), and the Attitudes Toward Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF). The scales were scored, compiled, and statistically analyzed.

Results

The tribal and non-tribal subjects were well-matched on socio-demographic variables. The score of SAQ was significantly higher in the tribal group as compared to the non-tribal group. On the ATSPPH-SF, the scores of the two groups were not significant.

Conclusion

Even though the tribal populations of India hold a higher supernatural attitude toward mental illnesses as compared to the non-tribal populations, their treatment-seeking attitude remains unaffected.

Translation and psychometrics of the Bengali adaptation of Coronavirus Anxiety Scale

Background

The Coronavirus Anxiety Scale (CAS) was developed in April 2020 as an instrument to gauge the symptoms of stress and anxiety occurring secondary to the COVID-19 pandemic. It was constructed using the English language due to which its application to a multi-linguistic country like India became a hindrance.

Aim

To establish psychometric validity and reliability of the Bengali translation of CAS.

Materials and Methods

Experts well-versed in the English and Bengali languages translated CAS from English to Bengali. This was followed by further correction by forward and backward translation processes until a version with high accuracy and low redundancy was procured. The original scale was applied to 91 volunteers, and the translated version was applied to the same group after 14 days.

Results

The mean scores of the original version and the translated version showed a significant correlation. The Bengali version of CAS had high internal consistency, significant concurrent validity, and acceptable split-half reliability. It was hence deemed easily understandable and capable of measuring anxiety due to COVID-19 similar to the original scale.

Conclusion

The Bengali translation of the CAS can be accurately used to assess symptoms of anxiety and stress with high reliability and validity in those who are able to read the Bengali language.

Sexual dysfunction in men with alcohol dependence

Background

Prolonged and excessive use of alcohol can affect the sexual function. The occurrence of sexual dysfunction has adverse psychological and interpersonal consequences.

Aim

To assess the occurrence and correlates of sexual dysfunction in individuals suffering from alcohol dependence.

Materials and Methods

Seventy male subjects hospitalized in a tertiary care hospital for treatment of alcohol dependence syndrome with simple withdrawal symptoms were included in the study with their informed consent. Their sexual function was evaluated utilizing a 14-item changes in sexual functioning questionnaire.

Results

According to the findings of the current study, sexual dysfunction is quite prevalent in alcohol-dependent people (75.7%). Erectile dysfunction was the most common disorder, followed by diminished sexual desire and early ejaculation.

Conclusion

Alcohol-dependence patients have a high prevalence of sexual dysfunctions. In routine clinical practice, this may be overlooked. Clinicians must be made aware of the frequent occurrence of sexual disorders in alcohol dependence patients.

Quality of online media reports of suicide and attempted suicide in India

Background

News media reporting of suicide may influence the masses toward or against suicidal behavior. So, responsible reporting by news media is important to protect vulnerable people from the deleterious effects of media reporting. World Health Organization has issued guidelines for media reporting of suicide in this regard. We planned this research to evaluate the quality of online news media reports of suicide and attempted suicides in India.

Material and Methods

We assessed a total of 210 news reports about suicide and attempted suicides (70 English, 70 Malayalam, and 70 Hindi) to evaluate the reporting of harmful and protective characteristics in news according to the World Health Organization guidelines for reporting suicide in media.

Results

We found all three language media reported almost all potentially harmful characteristics with gender (100%), location/site of suicide in the headline (97.61%), precipitating life events (95.24%), mentioning term 'Suicide' in the headline (98.10%), monocausal explanation for suicidality (90.95%), suicide method in the headline (90.95%), an accompanying photo (92.38%), and suicide method (93.81%) being reported with highest frequency. Potentially protective characteristics were not included in most news reports with poor focus on awareness information. Vernacular language media were poor as compared to English news media about the quality of reporting suicide.

Conclusion

We found poor adherence to reporting guidelines by online news media for reporting of suicide with poor coverage of educative and awareness information for the general public. It underlines the need for improving awareness among media professionals about responsible reporting of suicide.

Attitudes toward the use of facemasks during the COVID-19 pandemic in the Indian community

Background

The use of face masks by all community members for the prevention of COVID-19 infection is considered one of the most effective strategies. However, the use of masks by community members was influenced by many factors which affected its efficacy as a preventive measure.

Aim

To evaluate the attitudes toward the use of masks during the COVID-19 pandemic in the Indian community.

Materials and Methods

We did an online survey with the help of a questionnaire which included information about demographic data, awareness and attitudes about COVID-19 infection and its preventive measures, and attitudes towards mask use in particular.

Results

Participants had a positive attitude towards mask use. However, there were certain reasons for not using masks some of which were gender specific.

Conclusion

People had good awareness and attitude towards mask use. However, some gender differences in perception of masks used in various settings should be addressed for future awareness and education of the community about mask use.

Childhood trauma and bipolar affective disorder: Is there a linkage?

Bipolar affective disorder (BPAD) is a major psychiatric illness impairing the quality of life. The etiology of BPAD is influenced by different factors possibly related to gene-environment interactions. Approximately 30% to 50% of individuals with BPAD have experienced some traumatic event in childhood. Serious adverse experiences that children may suffer early in life are often described as childhood trauma (CT). It includes physical, emotional, and sexual abuse and physical and emotional neglect. CT is linked with an elevated risk of developing BPAD. Childhood adversities play a role in modulating the early onset of illness, increased number of depressive episodes, increased suicide attempts, and other clinical severity of BPAD. Hospital-based studies comprising heterogeneous populations had researched the specific role of each trauma subtype as a predisposing factor for BPAD. Identifying and addressing CT through early intervention methods may prevent the future development of chronic disorders like BPAD. This review article is an attempt to explore and highlight the existing literature regarding the association of different subtypes of CT with BPAD.

Impact of clinical rotational posting on attitude toward psychiatry of undergraduate medical students in Malaysia

Background

Almost all over the world, psychiatry training of undergraduate medical students has been criticized to be deficient in imparting required knowledge and improving the perception of students towards psychiatry and psychiatric treatment. Considering the large mental health need gap in the community, it is essential to improve undergraduate students' attitude toward psychiatry.

Aim

Hence, this study was planned to study the impact of psychiatry clinical posting on attitude toward psychiatry of undergraduate medical students.

Materials and Methods

Undergraduate medical students undergoing psychiatry posting were assessed on the first and last day of clinical posting with the help of semi-structured proforma consisting of sociodemographic information, favored future career choice, the relevance of psychiatry to their future careers, the usefulness of particular knowledge and skills, the value of knowledge of psychiatric specialties and the utility of different settings for learning psychiatry.

Results

After their clinical posting, students had a more positive attitude towards the usefulness of psychiatry knowledge in future general practice and the usefulness of psychiatry knowledge from undergraduate training in the future. Knowledge of alcohol withdrawal management, detection and management of delirium, and Mental Health Acts were perceived more essential in the future. Also, specialties such as deaddiction and child and adolescent psychiatry were felt more useful in future practice. After posting, students perceived that psychiatry can also be learned at medical and surgical wards as well as during home visits. However, despite some positive changes in attitude toward psychiatry, there was no significant change in choosing psychiatry as a career by the students after posting.

Conclusion

Undergraduate psychiatry training during clinical posting was able to make some positive changes in the knowledge and attitude of students. However, still, there were lacunae in some areas of concern. Preference of psychiatry as a branch of specialization was not increased after posting. This indicates the need for better reforms in psychiatry education at the undergraduate level to improve the perception of undergraduate students about psychiatry.

Evidence-based cognitive retraining in elderly depressives

Background

Aging is a normal biological process, and its dynamic changes are beyond the control of human beings. The role of depression, fear, and anxiety in old age is preoccupied with unhappy thoughts, and loneliness leads to early deterioration in their cognitive performance which makes it difficult to perform daily activities and hence affects their quality of life.

Aim

The present study was done to assess the effectiveness of cognitive retraining in elderly depressives and its effect on their quality of life.

Materials and Methods

The study was done on a sample of 20 depressive elderly patients with an age range above 60 years diagnosed with ICD-10 criteria. The study was pre- and post-intervention, and the sampling method was purposive. Firstly to screen handedness, Annet's hand preference battery was used, to assess the depression in elderly, the geriatric depression scale was done, and for attention and memory, Digit Span Test (WAIS-R) and Wechsler Memory Scale (WMS) were administered, respectively. WHO-QOL BREF was done to know the quality of life of the patient. After preassessment, cognitive retraining tasks were introduced to the patients. A total of 15 sessions were taken within three months of follow-up and after that to evaluate the efficacy of an outcome of the cognitive retraining, post-assessment was done.

Results

Improvement was noticed in elderly depressive patients in the area of cognitive domain, i.e., attention, recognition, shifting, fixedness, recall, and planning which showed improvement in quality of life and daily activities.

Conclusion

In the remediation of cognitive deficits, cognitive retraining plays a very important role, and it helps the elderly population to live their life healthily and hence enhance their coping skills.

Psychiatric Symptoms and Fatigue in COVID-19 Survivors

INTRODUCTION

Psychiatric symptoms and fatigue are common after the coronavirus disease 2019 (COVID-19) illness. The cause of these symptoms is direct neuronal injury and indirect injury with immune-mediated inflammation. In addition, social factors also affect mental health.

OBJECTIVE

We aim to compare psychiatric symptoms and fatigue between COVID-19 survivors and healthy controls.

MATERIAL AND METHODS

We prospectively evaluated 100 COVID-19 survivors for anxiety, depression, positive affect, and behavior control using the Mental Health Inventory (MHI). Fatigue is assessed using the Modified Fatigue Impact Scale (MFIS) score. We compared them with 100 healthy controls.

RESULTS

There was a significant statistical difference between the MHI score and individual components of MHI. Overall, MHI scores in cases and controls were 79.41 and 93.31, respectively, with a P value of less than 0.0001. Computed scores for anxiety, depression, behavior control, and positive affect of COVID-19 survivors showed statistically significant differences as compared to healthy controls. There was a weak association between hospital stay duration and poor MHI scores. Fatigue was significantly worse in COVID-19 survivors, with a mean score of 6.93 in cases and 5.35 in controls, with a P value of 0.0001. This was a cross-sectional study evaluating psychiatric symptom scores, but not establishing the diagnosis. It is suggested that appropriate treatment and counseling for these symptoms should be done.

CONCLUSIONS

Psychiatric symptoms and fatigue were significantly more common in COVID-19 patients after recovery from acute illness. It is a major contributing cause of morbidity other than organic complications of COVID-19 and requires attention in management.

Reliability and psychometric validity of the Marathi adaptation of coronavirus anxiety scale

Background

The coronavirus anxiety scale (CAS) was developed and validated in 2020 as a psychometrically suitable measure of anxiety incurred by the coronavirus disease of 2019 pandemic. Since it is available only in the English language, it cannot be used in the general population, most of whom are not English speaking.

Aim

The aim of this study is to determine the validity and the reliability of the Marathi adaptation of CAS.

Materials and Method

CAS was translated by bilingual experts, followed by forward and backward translation processes and pilot study. Final version was used. Eighty volunteers, who are versed in both English and Marathi languages, were included. The original English version of the scale was first applied, followed by the Marathi translation, after a hiatus of 14 days.

Result

Mean score of the original English version was 2.950 (±2.773) and that of the Marathi version was 2.775 (±2.778), showing significant correlation (.001 level) with Kendall's tau-b of 0.830. The Marathi version of CAS has a high degree of internal consistency as demonstrated by a Cronbach's alpha of 0.809. The scale has significant concurrent validity and acceptable split-half reliability. A principal components analysis with varimax rotation was performed on the CAS responses of the participants, which yielded one factors with an eigenvalue greater than one, representing 58.51% of the total variance. CAS was found to be easily understandable and capable of adequately evaluating and measuring various aspects of corona anxiety.

Conclusion

The Marathi adaptation of CAS is a valid and reliable instrument to assess anxiety due to coronavirus in the Marathi-speaking population of India.

Prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs: A cross-sectional study

Background

In patients undergoing surgical procedures, preoperative period is one of the most worrying periods. There are only few studies which revealed that increased preoperative anxiety is associated with increased requirements of doses of anesthetic agents.

Aim

The aim of this study is to assess the prevalence of preoperative anxiety in patients posted for surgical procedures and its relation to the doses of anesthetic drugs.

Materials and Methods

This is a cross-sectional, analytical study done between January 2021 and April 2021. A total of 100 patients undergoing surgery have given consent to participate in the study by filling self-designed questionnaire, Amsterdam Preoperative Anxiety and Information Scale (APAIS). Data analysis was done by SPSS version 24 using appropriate statistical tests.

Results

Preoperative anxiety was noted in 21% of the patients who were undergoing surgery. The association between preoperative anxiety and need for increase in the doses of anesthetic agents during intraoperative period was found to be statistically significant (P < 0.004).

Conclusion

A significant number of patients required increased amounts of anesthetic drugs to reduce anxiety during intraoperative period. Therefore, appropriate methods have to be introduced to address the concerns of patients undergoing surgery and thereby reducing anxiety.

Motivation for solitude, COVID-19-related anxiety and resilience among Indian medical students

Background

Recent reports indicate that self-isolation because of coronavirus disease 2019 (COVID-19)-related lockdowns had significant influence on mental health of medical students.

Aim

To understand the relationship between two different motivations for solitude - self-determined versus non-self-determined with medical students' COVID-19-related anxiety and psychological resilience during their self-isolation because of COVID-19-related lockdowns.

Materials and Methods

After the approval of the Institutional Ethics Committee, this online survey was done on undergraduate Indian medical students during the COVID-19 pandemic. Expressing consent at the beginning of the online form, enabled the students to proceed to the next section comprising their sociodemographic details and clinical details. The last section of the form comprised the Motivation for Solitude Scale-Short Form, the COVID-19 Anxiety Scale, and the Connor-Davidson Resilience Scale-Abbreviated.

Results

282 out of 286 students of either sex gave their consent and completed the given form. Both self-determined and non-self-determined motivations for solitude were higher in female medical students. The self-determined motivation for solitude was directly related to all students' resilience. A past history of psychiatric illness was directly associated with the non-self-determined motivation for solitude of the students. The non-self-directed motivation for solitude of female students was indirectly related to their resilience. The COVID-19-related anxiety was not related to either type of motivation for solitude as well as the resilience of the medical students.

Conclusion

Indian female medical students are more motivated for solitude, be it self-determined or non-self-determined, than their male counterparts. The student's resilience has a direct relationship with students' self-determined motivation. The COVID-19-related anxiety among the medical students is not related to their motivations for solitude or resilience.

Cannabis use and its relationship with bipolar disorder: A systematic review and meta-analysis

Cannabis use has been stated as a causal risk factor for the occurrence of schizophrenia and other psychotic disorders. There is a dearth of literature stating the association of cannabis with bipolar disorder. This review aimed to find the repercussion of cannabis use on the onset of the first episode of bipolar disorder and the worsening of the symptoms in pre-existing illness. A thorough systematic review of the existing literature was carried out using the PRISMA guidelines. PubMed, Medline, EMBASE, SCOPUS, and Google-scholar databases were searched for studies fitting our study's inclusion and exclusion criteria. A total of 25 studies were included in the systematic review and out of these 25 studies, five prospective studies met the inclusion criteria for the primary outcome meta-analysis. A total sample of 13,624 individuals was included in these five studies. A fixed effect model was used in the meta-analysis of these five studies and it revealed an association between cannabis and bipolar disorder with an effect size of 2.63 (95% CI: 1.95-3.53) (heterogeneity: chi² = 3.01, df = 3 (P = 0.39); I² = 0%). Our findings propose that cannabis use may precipitate or worsen bipolar disorder. This highlights the importance of the detrimental effect of cannabis use on bipolar disorder and the need to discourage cannabis use in the youth culture. High-quality prospective studies are required to delineate the effect of cannabis use on bipolar disorder.

Stress, postpartum depression, and anxiety in mothers of neonates admitted in the NICU: A cross-sectional hospital-based study

Background

Mothers of neonates admitted to a neonatal intensive care unit (NICU) experience heightened distress, anxiety, depression, and trauma symptoms. Despite their prevalence, these conditions are generally neither recognized nor treated due to the constraints of time and concerns about the social acceptability of screening.

Aim

To study stress, postpartum depression, and anxiety in mothers of neonates admitted to the NICU.

Materials and Methods

One hundred forty consecutive mothers having preterm and low birth weight neonates in the NICU were taken for the study as cases and an equal number of mothers of full-term neonates matched for age and socioeconomic status (SES), were recruited as controls with their informed consent. Subjects were assessed with the Acute Stress Disorder Scale (ASDS), Post-Traumatic Stress Disorder (PTSD) Symptom Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), and Perinatal Anxiety Screening Scale (PASS).

Results

Mothers of preterm neonates in NICU had significantly higher scores on the ASDS, PSS, EPDS, and PASS compared to controls. There was a significant association of ASDS and PSS scores with younger age, higher education, middle SES, joint family, urban residence, unplanned pregnancy, and male child. There was a significant association of the EPDS scores with lower SES, low education, unemployment, and male child. There was a significant association of the PASS scores with younger age, lower SES, and cesarean section.

Conclusion

Mothers of preterm neonates admitted to the NICU compared to controls have significantly higher levels of stress, anxiety, and depression.

Gender and sexual orientation of undergraduate medical students in India: A cross-sectional study

Background

Although the potential for alternate conceptions of gender roles and sexual orientations are diverse, it is by-and-large not well tolerated. This study explores the self-reported gender-roles and sexual orientations of Indian undergraduate medical students.

Aim

To study self-reported gender role and sexual orientation of undergraduate medical students in India.

Method

One hundred twenty volunteers were included in the study consisting of 60 males and 60 females. A questionnaire comprising of a sociodemographic proforma, Bem Sex-Role Inventory (BSRI), and Epstein Sexual Orientation Inventory (ESOI) were given to each participant. The scales were scored, tabulated, and statistically analyzed.

Results

The BSRI revealed that femininity was predominant in both female and male participants, at 68.33% and 55%, respectively. The ESOI revealed that females had significantly higher opposite-sex attraction than males. Though males had higher same-sex attraction than females, the difference was not statistically significant. Females also had a significantly higher sexual orientation range and a mean sexual orientation. Sexual drive was significantly higher in males. Significantly more females supported homosexuality and bisexuality as compared to males.

Conclusion

This study helps establish that gender roles can be non-conforming. It helps ascertain that while heterosexual orientation predominates, alternate sexual orientations also exist. It paves the way for future studies and explorations to alleviate public misconceptions.

Selecting a thesis topic: A postgraduate's dilemma

It is said that well begun is half done. Choosing a thesis topic and submitting a research protocol is an essential step in the life cycle of a postgraduate resident. National Medical Commission of India mandates that all postgraduate trainees must submit at least one original research work (dissertation), one oral paper, one poster, and one publication to be eligible for final year examination. It is the duty of the faculty to ensure that trainees take active interest and submit their theses on time. However, their journey is often marred by multiple challenges and hurdles. The literature was searched from year 2000 onwards till 2011 using Pubmed, ResearchGate, MEDLINE, and the Education Resources Information Centre databases with terms related to residency training, selecting thesis topic, challenges or hurdles, and conversion of thesis into journal article. Existing literature on the subject matter is sparse. Current article advocates promotion of ethical and original research during postgraduation and proposes a checklist for residents before submission of their proposals.

Internet addiction and its effects on psychological wellbeing: A community-based study

Background

The internet has become an essential part of life, and it has both beneficial and detrimental effects. There is a plethora of evidence relating to the effect of internet addiction on psychological health. There is also an unmet need to lay the foundation for the differences in usage and the effects on mental health in regard to the use of the internet for rural and urban students.

Materials and Methods

The present study was conducted on 200 adolescent subjects belonging to the urban and rural areas around the city of Varanasi to establish the pattern of use of the internet as well as its psychological implications. The participants were evaluated upon the Internet Addiction Test (IAT) and General Health Questionnaire-12 (GHQ-12), and information pertaining to socio-demographics as well as accessory information related to internet usage were captured through semi-structured proforma.

Results

The results indicated no significant differences in the pattern of internet usage (mean IAT score) as well as psychological health (mean GHQ-12) between urban and rural youth. There was a significant positive association between the overall severity of internet use with poor psychological health (GHQ-12 score). There was a significant difference in the overall mean age as well as the mean age of onset of internet use between both groups (rural versus urban). This study highlighted an important issue of the digital divide based on gender-wise differences in the pattern in the overall sample.

Conclusion

This study highlighted the important differences in the pattern of internet use among the rural and urban populations with its clinical implication being a need to educate the youth regarding the healthy use of technology.

Gender differences in burden of care and coping strategies among caregivers of schizophrenia patients

Background

Caregivers of patients with schizophrenia have a considerable burden of care and develop different coping strategies to deal with the caregiving burden.

Aim

The aim of this article is to assess gender differences in the burden of care and coping strategies used among caregivers of clinically stable patients with schizophrenia.

Methods

In this cross-sectional study, a total of 57 caregivers (33 males and 24 females) of the patients with schizophrenia attending a psychiatric outpatient setting were included by purposive sampling. The caregivers were assessed with the Burden Assessment Schedule 20 items (BAS-20) and Brief Approach/Avoidance Coping Questionnaire (BACQ) to assess the burden of care and coping strategies, respectively.

Results

Average BAS-20 score was comparable between the male and female caregivers. If the patient was a spouse, the male caregivers had a significantly higher burden of the marital relationship than the female caregivers. On the BACQ, the socio-emotional approach subscale was significantly higher in female caregivers. The avoidance-oriented coping score and socio-emotional avoidance subscale were significantly higher in male caregivers. A significant positive correlation was found between BAS-20 score and avoidance-oriented coping scores in all caregivers except the females where a significant negative correlation was found between BAS score and socio-emotional avoidance type of coping.

Conclusion

There are no gender differences in the burden of care in caregivers of clinically stable patients with schizophrenia except the male caregivers have a higher burden in the domain of marital relationship. The socio-emotional approach type of coping is higher in females while the socio-emotional avoidance type of coping is lower in male caregivers.

Psychiatric morbidity in family members of alcohol dependence patients

BACKGROUND

There is a paucity of Indian studies assessing psychiatric morbidity among family members of subjects with alcohol use disorder.

AIM

To study psychiatric morbidity in wives/life partners and children of alcohol-dependent patients.

MATERIALS AND METHODS

Fifty consecutive index patients diagnosed to be alcohol dependent according to the International Classification of Diseases-10 classification of mental and behavioral disorders diagnostic criterion for research reporting to psychiatry department were taken. The study was conducted on family members of alcohol-dependent patients who were enrolled in the study as subjects. These included both their children and spouses and they were evaluated for any psychopathology using M. I. N. I. AND M. I. N. I.-KID scales.

RESULTS

Out of 50 spouses and 67 children enrolled in the study group. Sixty-eight percent had psychiatric morbidity in spouses which include 34% had major depressive episodes. Spouses living in the nuclear family and illiterate had more psychiatric morbidity. Total psychiatric morbidity in children above 18 years was 56.25%, maximum being in alcohol and substance dependence. Total psychiatric morbidity in children between 6 years and 18 years was 31.37%, maximum being in generalized anxiety disorder (11.76%).

CONCLUSION

Spouses of subjects with alcohol dependence have a high prevalence of psychiatric morbidity. Spouses living in the nuclear family had a more major depressive episode and generalized anxiety disorder. Psychiatric morbidity was more in illiterate spouses. Psychiatric morbidity was also high in children. Female children between 6 years and 18 years had more generalized anxiety disorder than males.

Cognitive behavior therapy as an adjuvant in management of alcohol dependence syndrome

BACKGROUND

Treatment of alcohol dependence is a major challenge due to frequent relapses. Cognitive-behavioral therapy (CBT) has been reported to be useful in the treatment of alcohol dependence.

AIM

This study aims to evaluate the effect of CBT module in management of Alcohol Dependence and compare it with treatment as usual (TAU).

MATERIALS AND METHODS

All newly diagnosed alcohol dependence patients during the study period meeting the exclusion and inclusion criteria were included in the study. Patients with a head injury, HIV seropositive status, or any other organic brain disorder and comorbid psychiatric disorders were excluded. The study included 226 patients with alcohol dependence randomly assigned to intervention group (n = 116) and TAU group (n = 110). Demographic and clinical data were recorded and Severity of Alcohol Dependence Questionnaire was applied. Relapse was taken as an outcome variable. Both TAU group and experimental group were followed on standard protocol of treatment.

RESULTS

The data were analyzed and relative risk (RR) was calculated. Findings revealed the study group receiving CBT had a better outcome and relapse rate was also significantly low in the experimental group as compared to the TAU group.

CONCLUSION

The RR of relapse is lower in patients of alcohol dependence on CBT within 6 months and within 1 year as compared to cases on TAU. It is recommended that CBT be used as an adjunct to treatment in alcohol dependence cases.

Clinical correlates of regional gray matter volumes in schizophrenia: A structural magnetic resonance imaging study

OBJECTIVES

The objective of this study is to investigate the correlation between the regional gray matter volumes and length of Para Cingulate Sulcus (PCS) with the clinical profile of patients with schizophrenia.

MATERIALS AND METHODS

In this hospital-based, cross-sectional study, thirty consecutive in-patients diagnosed with schizophrenia and equal number of healthy volunteers matched for age- and sex- were recruited as controls. Detailed clinical assessment and magnetic resonance imaging (MRI) of the brain were carried out within 2 days for controls and within 2 weeks of hospitalization for patients. The Positive and Negative Syndrome Scale and Montreal Cognitive Assessment were applied to schizophrenia patients to assess symptoms and cognitive function, respectively.

RESULTS

Schizophrenia patients had significant volume deficit in bilateral amygdalae, bilateral superior temporal gyri, anterior cingulate cortex and bilateral hippocampi, along with a highly significant reduction in the length of right PCS. Schizophrenia patients with the duration of untreated psychosis (DUP) of 6-12 months showed a significantly greater volume of the right superior temporal gyrus (STG). First-episode schizophrenia patients had a significant reduction in the length of the left PCS. The volume of bilateral superior temporal gyri in schizophrenia patients showed a significant direct correlation with positive symptoms and an inverse correlation with negative symptoms.

CONCLUSION

Schizophrenia patients have significant volume deficit in some brain regions. DUP of 6-12 months is associated with significantly greater volume of the right STG. First-episode schizophrenia patients have a significant reduction in the length of the left PCS. In schizophrenia patients, the volume of bilateral superior temporal gyri showed a significant direct correlation with the positive symptoms and an inverse correlation with the negative symptoms.

The appraisal-distress relationship of auditory hallucinations in patients with schizophrenia: The moderating role of metacognitive beliefs

BACKGROUND

Appraisal of hallucinatory voices plays a significant role in anxiety and depression among patients with auditory hallucinations. Metacognitive beliefs are also associated with psychological distress in schizophrenia patients. However, there is a dearth of literature exploring the role of metacognitive beliefs on the appraisal-distress relationship, specifically, the overemphasis laid on the need to maintain consistency among thoughts and avoid cognitive dissonance.

AIM

The aim of the study is to study the role of metacognitive beliefs on the appraisal-distress relationship.

MATERIALS AND METHODS

A total of 126 schizophrenia patients with auditory hallucinations were selected through purposive sampling technique. The participants were assessed on Hindi version of beliefs about voices questionnaire-revised (BAVQ-R), hospital anxiety and depression scale, metacognition questionnaire-short, and modified (MCQ-SAM).

RESULTS

Correlation analysis indicated significant relationship between the dimensions of BAVQ-R (i.e., benevolence, malevolence, and omnipotence) and MCQ-SAM (i.e., cognitive self-consciousness, positive beliefs about worry, importance of consistency of thoughts, and beliefs about normal experience of unwanted thoughts), depression and anxiety. Hierarchical regression analysis indicated that benevolence, malevolence, and importance of consistency of thoughts were predictors of anxiety; malevolence, importance of consistency of thoughts and positive beliefs about worry were predictors of depression. Results of moderation analysis indicated that malevolent beliefs about voices predict the intensity of distress among clinical voice-hearers, and importance of consistency of thoughts plays a moderating role in this appraisal-distress relationship.

CONCLUSION

In schizophrenia patients with auditory hallucinations, the appraisal-distress relationship is strengthened when the need to maintain cognitive consistency is over-emphasized.

Cyberchondria During the COVID-19 Pandemic

Many factors govern the behavior pertaining to anxiety regarding health – it may be stressors, triggers, adverse situations faced by people. Since the outbreak of the COVID-19 virus, health-related anxiety has been widespread. December 2019 saw the occurrence of a form of pneumonia, not known at that time, from the Wuhan region of China to rapidly proceed into a worldwide pandemic and lockdown. This disrupted normal life across the globe and affected social and economic functioning. Cyberchondria has been one of the coping strategies seen during this time, pertaining to online health-related searches which offer answers and relief as seen at the surface but also bringing a plethora of mental health challenges. The authors in this chapter try to simplify what exactly cyberchondria is and how has it affected the lives of the worldwide population during the COVID-19 crisis, the biggest pandemic of recent times. The origin, development, and prevalence of the concept, along with coping, treatment, and prevention of the condition are discussed.