Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp <p>Official&nbsp; Journal of the Branch of Indian Psychiatric Society (Kerala)</p> en-US kumarv68@gmail.com (Dr. K Vidhukumar) Mon, 30 Sep 2019 00:00:00 +0000 OJS 3.2.0.3 http://blogs.law.harvard.edu/tech/rss 60 Delivering mental health services to the people of Kerala - Need for a balancing act http://kjponline.com/index.php/kjp/article/view/175 Harish M Tharayil Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/175 Wed, 23 Oct 2019 00:00:00 +0000 Research designs- an Overview http://kjponline.com/index.php/kjp/article/view/179 <p>A research design is a systematic plan to study a scientific problem. The research problem determines the type of design. Research designs can be qualitative or quantitative; the latter can be experimental (interventional) and non-experimental (observational). Observational studies are further classified into descriptive (such as case reports, case series and cross-sectional studies) and analytical studies (like case-control and cohort studies). Experimental studies compare experimental groups exposed to different treatments or interventions. All these are briefly discussed along with systematic reviews, meta-analysis, qualitative research, basic sciences research, translational and implementation research.</p> Pankajakshan Vijayanthi Indu, K Vidhukumar Copyright (c) 2020 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/179 Thu, 02 Jan 2020 00:00:00 +0000 A Comparative study of impulsivity, lethality and intent among patients attempting suicide by self-immolation and poisoning http://kjponline.com/index.php/kjp/article/view/165 <p><strong>Background: </strong>Suicide is one of the top ten leading causes of death in the world as well as India. Poisoning is one of the most common modes of attempting suicide. Self-immolation is a devastating form of suicide attempt. Impulsivity has been demonstrated as an important risk factor for suicide. Lethality and intent were found to be interrelated in previous studies. But a comparative study of impulsivity, lethality and intent between self-immolation and poisoning was not found in a literature search.</p> <p><strong>Objectives:</strong></p> <ol> <li>To compare socio-demographic characteristics, impulsivity, intent and lethality in those who attempt suicide by self-immolation and poisoning.</li> <li>To find the intercorrelations between intent, impulsivity and lethality.</li> </ol> <p><strong>Methods: </strong>A cross-sectional comparative study was done among persons attempting suicide by self-immolation (n=40) and poisoning (n=50). Barratt's impulsivity scale, Smith's LSARS (lethality of suicide attempt rating scale) and Beck's suicide intent scale were used to assess impulsivity, lethality and intent, respectively. Percentages, mean, median and range were used to describe the data. Chi-square test, t-test and Pearson correlation were used for statistical analysis.</p> <p><strong>Results and discussion: </strong>There were significant associations between occupation, family income and socioeconomic status and mode of suicide attempt. Lethality was higher in self-immolation. Lethality and intent were significantly intercorrelated in both groups. Impulsivity and lethality were negatively correlated in the self-immolation group.</p> <p><strong>Conclusion: </strong>Self-immolation is a highly lethal method of attempting suicide. Highly lethal suicide attempts have high intent. Greater the impulsivity, less lethal the attempt is likely to be.</p> <p><strong>&nbsp;</strong></p> Namita Nazeer, Harish M Tharayil, Varsha Vidyadharan Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/165 Mon, 30 Sep 2019 00:00:00 +0000 Factors influencing Betel quid chewing among indigenous tribal population in Wayanad, Kerala : A qualitative study http://kjponline.com/index.php/kjp/article/view/173 <p><strong>Background: </strong>Indigenous tribes are at higher risk of substance misuse, including betel quid. Available studies in this area focused on health hazards, while socio-behavioural aspects of betel quid practices are less studied, especially among the tribal population in India.</p> <p><strong>Objectives: </strong>The study was conducted to explore the factors influencing betel quid use among indigenous tribes in Wayanad, Kerala</p> <p><strong>Methods: </strong>Using a purposive sampling method, we selected 12 persons with betel quid use form Paniya and Kattunaicker tribal community at Wayanad. Qualitative in-depth interviews were used for data collection. The thematic analysis was done to understand the key themes and categories.</p> <p><strong>Results</strong>: We identified that betel quid chewing among tribes often initiated in young age, with influence of the home environment, parental, peer and spouse related factors. Key themes that emerged were the trajectory of betel quid use, betel quid intake, dependency, access and availability of betel quid in tribal dominant areas.</p> <p><strong>Conclusion: </strong>As our study result indicated many features of betel quid dependency, community level screening for identifying the potential cases and provision of treatment services might be required. Future studies to assess proper intervention for betel quid chewing can be undertaken.</p> Anvar Sadath, Kurian Jose, Jiji KM, Shibu kumar TM Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/173 Wed, 30 Oct 2019 00:00:00 +0000 Development and Preliminary validation of a screening tool for Specific learning disorder in children http://kjponline.com/index.php/kjp/article/view/176 <p><strong>Background: </strong>Delay in early diagnosis of Specific learning disorder (SLD) is influenced by various factors, including the lack of simple yet validated tools for assessment.</p> <p><strong>Objective: </strong>We aimed to develop and validate a screening questionnaire in English and Malayalam for SLD in children aged 7-11 years, which can be used easily. This paper deals with the initial development and preliminary validation of the tool, which was subsequently validated in a larger sample and had already been published.</p> <p><strong>Materials and methods:</strong> The tool was validated using a case-control methodology. It was developed after ensuring face and content validity, and suitable modifications were done based on the internal consistency measure and factor analysis results. The tool was applied in children with SLD and two groups of controls. ROC curve analysis was done to find the optimum cut-off, and validity parameters were estimated.</p> <p><strong>Results: </strong>A total of 21 SLD, 42 normal and 37 borderline intelligence children, were studied. The final tool with 26 items had good Cronbach’s alpha (0.95) and area under the curve values (0.96). The tool had good sensitivity (100 %) and specificity (77.2%), i.e., if the score is &lt;10, we can rule out SLD.</p> <p><strong>Conclusions: </strong>We propose a new screening tool for SLD with promising reliability and validity characteristics that need to be evaluated further.</p> <p>&nbsp;</p> Varsha Vidyadharan, Harish M Tharayil, Biju George Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/176 Tue, 05 Nov 2019 00:00:00 +0000 Incidence of Metabolic Syndrome in patients treated with Clozapine in a tertiary care center in central Kerala http://kjponline.com/index.php/kjp/article/view/169 <p><strong>Background</strong><strong>:</strong> Clozapine is widely used for the treatment of resistant Schizophrenia (Sz). Metabolic syndrome (MetS) is its recognized side effect. Reports on the side effects of Clozapine are scanty from Kerala. Hence a prospective observational study was conducted.</p> <p><strong>Aim</strong>: The aim of the present study was to find the incidence of Metabolic syndrome in patients with psychosis, after 12 weeks of treatment with clozapine in a tertiary care centre in Kerala.</p> <p><strong>Methods</strong>: Patients diagnosed as Schizophrenia or Delusional disorder based on International Classification of Diseases (ICD)-10 and not meeting the threshold criteria for MetS according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and on Clozapine treatment were recruited and followed up for at least 12 weeks. Augmentation, when needed, was limited to Amisulpride, Aripiprazole, and/or Modified Electroconvulsive Therapy (MECT). Bodyweight, waist circumference, blood pressure, fasting blood sugar, and triglycerides levels were measured at the enrolment and after 12 weeks. Seventy-five patients completing follow up for 12 weeks were considered as study subjects. Patients who fulfilled NCEP ATP III criteria at 12 weeks were diagnosed as having MetS.</p> <p><strong>Results</strong>: Study sample of 75 had not met the threshold criteria of NCEP ATP III based MetS diagnosis at the study entry. But among them, 23 met no criteria, 23 met one criterion and 29 met two criteria. Out of 75 patients, 32 (42.7%) developed Metabolic Syndrome at three months. Among 23 who met no criteria at intake, 3 (13%) developed MetS, while it was 9 (39%) in 23 who met 1 criterion and 20 (69%) in 29 who met 2 criteria.</p> <p>The mean Clozapine dose at discharge was 514±148 mg in those who developed MetS while it was 428±164 mg in those who did not. This difference was statistically significant (p&lt;0.05).</p> <p><strong>Conclusion</strong>: Incidence of MetS is high in Clozapine receiving Psychotic patients. The present study showed that in the study population, risk factors have a cumulative effect on the development of this side effect, and the risk is high when the dose of clozapine is higher.</p> Peter K Joseph, Praveenlal Kuttichira, Saibunnisa K Beevi Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/169 Sun, 01 Dec 2019 00:00:00 +0000 First episode depression in women- a study of clinical characteristics through the female reproductive stages in a rural tertiary care center in Kerala http://kjponline.com/index.php/kjp/article/view/178 <p><strong>Background:</strong> The lifetime prevalence of major depressive disorders is 10-25% for women and 5-12% for men. Women are more prone to develop depressive episode from the period of menarche to the perimenopausal period. Relatively little research has been done on this. <strong>Materials and methods:</strong> Female patients between the ages of 12 years to 55 years presenting in the outpatient department with first episode depressive symptoms are selected (ICD 10) and the number of patients presenting in different stages of the reproductive cycle – perimenarche, pregnancy, post-partum, post abortion and perimenopausal are noted. Age at onset, severity of the illness, positive family history, presence of somatic and hypochondriac symptoms, and suicidal intent (Beck suicidal intent scale, Hamilton rating scale for depression) were noted. <strong>Results and discussion</strong>: Out of the total 120 patients, 53 were in the perimenopause state, 23 in the perimenarche, 5 in pregnancy, 14 in the post-partum, and 7 as post abortion. The mean age of onset of depressive disorders is 36.7 years (SD- 13.67). The severity of the depressive episode is significantly higher towards the younger age group (&lt;30years) and number of patients presenting with somatic symptoms are much higher towards the older age group (41-55years). There is no significant difference in presence of positive family history, hypochondriasis and suicidal intent among various age groups. <strong>Conclusion: </strong>Perimenopausal and perimenarche periods show higher prevalence of depressive disorders during female reproductive cycle. Biological changes in reproductive cycle can cause increase prevalence of depression in women.</p> Joice Geo, Jismi B Krishnan, Mareen Benjamin, Roy Abraham Kallivayalil Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/178 Fri, 27 Dec 2019 00:00:00 +0000 Promoting recovery through peer provided interventions -Rajah Experience http://kjponline.com/index.php/kjp/article/view/172 <p>Peer provided interventions are considered to be an additional approach to treatment as usual for mental illness. The word ‘peer’ stands for the goal of persona empowerment, education and recreation. Peer provided interventions improves the quality of life and increases the prognosis of mental illness. Rajah Rehabilitation Centre has been started to coordinate peer provided interventions to schizophrenia and bipolar affective disorder since 2016 to provide the opportunity to get more help than from a one-to-one therapeutic session.</p> <p><br><br></p> Kavitha M A, Nechiyilthody Pfizer Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/172 Thu, 26 Dec 2019 00:00:00 +0000 Posterior Circulation Stroke –presenting as Psychotic disorder http://kjponline.com/index.php/kjp/article/view/162 <p>The prevalence of posterior circulation stroke is less reported compared to anterior circulation stroke, accounting for one fourth of all ischemic strokes. It commonly presents with neurological deficits like visual deficits, vertigo and sensory-motor deficits rather than merely psychiatric symptoms. Nonetheless, there could be comorbid psychiatric symptoms associated with it. A rare presentation of posterior circulation stroke presenting with psychosis as a primary symptom without any neurological deficit is discussed.</p> <p>&nbsp;</p> <p>&nbsp;</p> Dilshana Nafisa, K Priya Nayak, Safeekh A T Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/162 Thu, 17 Oct 2019 00:00:00 +0000 Changing trends of suicides in Kerala and solutions http://kjponline.com/index.php/kjp/article/view/177 <p>Suicidal behaviour with consequent fatal outcome has become a significant public health problem in India. On average, 9,000 people per year commit suicide in Kerala. Despite the enormity of the problem, there are only a few methodologically sound studies in this area. Currently available data show that suicidal phenomena, which occur in Kerala, are different from western society in a number of ways. Second and third decade seems to be the most susceptible age for Kerala suicides. The predominance of males in suicide reported from western countries is not so significant in Kerala. In Kerala, more than 70% of suicide victims are married. Though emotional disorders play an essential role in suicides, social factors also have an important role in Kerala suicides. Hanging and insecticide poisoning appear to be the favourite methods in Kerala. These observations have high relevance in planning suitable and meaningful suicide prevention strategies in our state. Mental health professionals in Kerala have an important responsibility to develop and implement effective suicide prevention programmes.</p> Sureshkumar Pattath Narayanan Copyright (c) 2019 Kerala Journal of Psychiatry http://kjponline.com/index.php/kjp/article/view/177 Fri, 20 Dec 2019 00:00:00 +0000