Kerala Journal of Psychiatry 2022-01-09T21:57:58+0530 Dr. K Vidhukumar Open Journal Systems <p>Official&nbsp; Journal of the Branch of Indian Psychiatric Society (Kerala)</p> Cohort studies 2022-01-09T21:57:58+0530 Pankajakshan Vijayanthi Indu Karunakaran Vidhukumar <p>Cohort studies are observational analytical studies and are placed just below randomized controlled trials in the hierarchy of scientific evidence. They are also called longitudinal studies and can be prospective, retrospective or ambidirectional. In cohort studies, groups (cohorts) that are identical in every aspect other than the exposure are followed up for the outcome. Critical components of a cohort study are the definition of the objective/s, choice of the study population and comparison group, measurement of exposures and outcomes, follow-up, analysis and interpretation. Assembling cohorts, accurate measurement of exposure and outcome, and addressing dropout are the main design imperatives in cohort studies. The advantages and disadvantages of cohort studies and an overview of analysis are also presented.</p> 2021-12-31T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Prevalence of premenstrual dysphoric disorder among high school girls of Gadag district, Karnataka, india- a school-based cross-sectional study 2021-07-22T22:48:12+0530 Nitin O Pattanashetty Jitendra Mugali Niharika HS <p><strong>Background:</strong> Premenstrual dysphoric disorder (PMDD) has consequences on behaviour, cognitive abilities, mental health status, academic performance, and overall quality of life. The study examined the prevalence of premenstrual dysphoric disorder (PMDD) among high school going girls of Gadag. <strong>Methods:</strong> A school-based cross-sectional study was conducted among 900 high school going girls aged 12-16 years from government and private schools of Gadag district. The data was collected using a pre-tested semi-structured questionnaire. The proforma included socio-demographic profile and symptoms related to PMDD. A detailed history was obtained from parents and teachers. Data were analysed using coGuide software, V.1.03 and the <em>p-</em>value was set at &lt; 0.05. <strong>Results: </strong>In the present study, the prevalence of PMDD was 4.89%. Out of 900 girls, 650(70%) were studying in 9<sup>th</sup> and 10<sup>th</sup> standard. Forty-four students were diagnosed with PMDD, out of which 14 (4.32%) were aged 14years, 17 (4.89%) were in 9<sup>th</sup> St, 30 (4.3%) belonged to English medium, and the majority, 39 (10.1%), were Hindus. Hindu religion was found to be significantly associated with PMDD (P-value of &lt;0.001). No significant difference in PMDD was seen with age (p-value 0.325), the standard of studying (P-value of 0.948), and medium of instruction (P-value of 0.123). <strong>Conclusion:</strong> The magnitude of PMDD, according to this study, is 4.89%, and the menstrual health of young schoolgirls, particularly those in the age group 12 to 16 years, needs significant public health attention.</p> 2021-09-04T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Does psychiatric comorbidity influences quality of life and disability among subjects with refractory focal epilepsy- a comparative cross-sectional study 2021-08-03T23:45:16+0530 Vishnu Vipin Praveeen Arathil <p><strong>Background: </strong>Refractory focal epilepsy is a disorder associated with a significant impact on quality of life and disability. Having comorbid psychiatric disorders among these subjects has been well documented. Recently studies have looked at how this impacts the quality of life and disability, but they are few in number. <strong>Methodology: </strong>Subjects were taken from the epilepsy clinic whom neurologist diagnosed as having refractory focal epilepsy. MINI International Neuropsychiatric Interview (MINI) was used to identify psychiatric comorbidity. Two groups of 25 subjects were made based on whether they had or did not have psychiatric comorbidities and further assessed with the World Health Organization Quality of Life (WHOQOL)-BREF for quality of life and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for disability. <strong>Results: </strong>Analysis of the two groups showed quality of life score lesser in the group with psychiatric comorbidities, which was significant (p&lt;0.001). Similarly, the disability score was higher in the group with psychiatric comorbidities, which was significant (p&lt;0.001). <strong> </strong>The quality of life was lowest in major depressive disorder (60.80±8.47) and disability was highest in psychosis (105.33±1.53). <strong>Conclusion: </strong>Psychiatric comorbidities in subjects with refractory focal epilepsy significantly impact the quality of life and disability. It is essential to have a good team approach, and liaison between neurology and psychiatry for early detection and treatment of such symptoms will decrease healthcare costs and improve quality of life.</p> 2021-09-07T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Risk of eating disorders and its association with body image concerns, depression, anxiety and stress among medical students in a college in Kerala 2021-06-16T06:24:03+0530 Chitra Tomy Anju Lakshmi V Kathleen Anne Mathew Arya Jith <p><strong>Background: </strong>Eating disorders are one of the most under-recognised psychiatric conditions which can lead to considerable morbidity. With their high workloads, academic pressure, and peer influence, medical students may be more likely to develop eating disorders. This study aimed to assess the prevalence of eating disorders among medical students in a college in Kerala. It was also planned to find its association with body shape concerns, depression, anxiety and stress. <strong>Methods:</strong> A cross-sectional study was conducted among 472 undergraduate medical students and interns at a medical college in Kerala. Socio-demographic proforma, Eating Attitudes Test-26 (EAT-26), Body Shape Questionnaire-8C (vBSQ-8C), Depression, Anxiety and Stress Scale-21(DASS-21)-were administered after obtaining informed written consent. Statistical analysis was done using the chi-square test and Pearson correlation. <strong>Results:</strong> The prevalence of risk of eating disorders among medical students was 19.1%. Depression, anxiety and stress were significantly associated with the risk of eating disorders (p=0.034, p=0.001 and p=0.001, respectively). A positive correlation was found between the risk of eating disorders, body shape concerns and body mass index (p=0.001). <strong>Conclusion: </strong>A considerable risk of eating disorders was noted among medical students in Kerala. Body shape concerns and symptoms suggestive of depression, anxiety, and stress showed a significant association with the risk of eating disorders. Increased awareness and early identification can help institute timely interventions.</p> 2021-09-18T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Depressive symptoms in alcohol dependence- a cross-sectional study 2021-08-20T17:06:27+0530 Puneet Mathur Nabanita Sengupta Rahul Bhargava <p><strong>Background: </strong>Patients with alcohol dependence often suffer from comorbid psychiatric illnesses like depression which may influence treatment and outcomes. Sociodemographic factors may potentially influence depressive symptoms in patients with alcohol dependence. <strong>Aims: </strong>To study the prevalence of depressive symptoms in patients with alcohol dependence and to identify sociodemographic factors affecting this association. <strong>Methods</strong>: Patients with alcohol dependence above 18 years of age were included. The diagnosis was made by ICD-10 diagnostic criteria. The severity of alcohol dependence was rated with the severity of the alcohol dependence questionnaire (SADQ) and depression with the Hamilton depression rating scale (HAM-D). Sociodemographic data were recorded in each patient. Statistical analysis was done using independent t-tests, Chi-square tests, one-way analysis of variance (ANOVA) and Pearson’s correlation analysis. <strong>Results</strong>: The mean SADQ Score was 21.5±8.6 (range, 9-48). The severity of alcohol dependence was mild in 15(25%), moderate in 40(66.7%) and severe in 5(8.3%), respectively. The mean Hamilton depression rating scale score was 7.8±3.9(range, 3-17). The prevalence of depression in our study was 38.3%. Out of these, 17(28.3%) had mild and 6 (10%) had moderate depression. There was a positive and significant correlation between SADQ scores and depression scores (Pearson’s correlation coefficient, r=0.494, P=0.001). Patients who were unemployed (ANOVA, P=0.046, separated (ANOVA, P=0.002), and joint family (ANOVA, P=0.039) had significantly higher depression scores.<strong>Conclusion</strong>: In conclusion, sociodemographic factors like unemployment, marital separation and living in joint families may significantly influence the association between alcohol dependence and depression.</p> 2021-10-15T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Phenomenology of delirium in decompensated liver disease patients-a prospective observational study 2021-07-22T11:01:12+0530 B Lakshmi Dorai G Raghuthaman <p><strong>Background: </strong>Decompensated liver disease (DCLD) is associated with various cognitive changes. The present study aimed to estimate the prevalence, phenomenology, and course of delirium in decompensated liver disease patients. <strong>Methods</strong>: This prospective observational study was done on 111 patients admitted to the gastroenterology department with the diagnosis of DCLD. Richmond Agitation Sedation Scale (RASS) and confusion assessment method (CAM) were used to detect delirium for the first five consecutive days. Patients detected to be having delirium were administered a delirium rating scale (DRS) for the next seven days to evaluate the features of delirium. Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. For normally distributed quantitative parameters, the mean values were compared using an independent sample t-test. Categorical outcomes were compared between study groups using the chi-square test. coGuide version V.1.0 was used for statistical analysis. <strong>Results: </strong>The prevalence of delirium among patients with DCLD was 34 (30.63%). All delirious patients continued to have delirium symptoms for the initial three days. Six patients remitted as early as the fourth day of DRS assessment, while nine patients continued to have delirium symptoms even by the seventh day of evaluation. <strong>Conclusion: </strong>Nearly one-third of patients with DCLD presented with delirium. They presented with insomnia, cognitive deficits, motor retardation, and minimal psychotic symptoms. Many patients completely recovered from delirium within a week, but a few had delirium up to the seventh day.</p> 2021-10-28T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Anxiety, depression and quality of life in breast cancer patients undergoing chemotherapy in a tertiary care centre- a cross-sectional study 2021-08-19T06:19:31+0530 Nimmy Susan Abraham Roy Abraham Kallivayalil <p><strong>Background: </strong>Breast cancer is the commonest cancer among women worldwide. The diagnosis and treatment of breast cancer are strongly associated with anxiety and depression, which negatively affects the patient's quality of life (QOL). We aimed to study the prevalence of anxiety and depression in breast cancer patients undergoing chemotherapy and their quality of life. <strong>Methods: </strong>This cross-sectional study included 30 women aged 18-65 years diagnosed with breast cancer and undergoing chemotherapy in a tertiary care centre in Kerala, India. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). QOL and its domains were assessed using the WHOQOL?BREF. <strong>Results: </strong>The mean age of women in the study was 53.57±7.33 years. Of the 30 patients, the prevalence of anxiety and depression was 16.7% and 20.0%, respectively. The severity of anxiety was mild, and among patients with depression, 3.3% had moderate depression. In the domains of QOL, the physical domain score was minimal, while the domain of the social relation had a maximum score. The physical domain of QOL was significantly associated with chemotherapy-related hair loss and mouth sores, psychological domain with a family history of psychiatric illness, chemotherapy-related nausea/vomiting and mouth sores. Occupation and total monthly income were associated with the environment domain and postsurgical status with the social relations domain. <strong>Conclusion:</strong> Anxiety and depression were found in breast cancer patients undergoing chemotherapy, and the overall QOL was not affected by anxiety or depression.</p> 2021-10-31T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Comparison of socio-demographic and clinical factors between “unipolar mania” and bipolar affective disorder 2021-09-12T08:27:51+0530 S Amithabh Ganesh Kini Anil Kakunje <p><strong>Background:</strong> Bipolar Affective Disorder is defined as an affective or mood illness characterised by distinct episodes of elevated mood and sad mood. However, many patients report recurrent episodes of mania but no depressive episodes usually termed as Unipolar Mania. Our study aimed to identify Unipolar Mania among patients diagnosed with Bipolar Affective Disorder and assess any difference in the clinical and socio-demographic profile between the two groups. <strong>Material and methods</strong>: This cross-sectional observational study was conducted between April 2020 and March 2021 at the outpatient clinic of a tertiary care medical college hospital. Patients aged &gt;18 years and diagnosed with Bipolar Affective Disorder as per ICD-10 criteria constituted the study population. Patients with a history of any medical illness that may significantly influence CNS function or structure as judged by clinical evidence were excluded. <strong>Results:</strong> A total of 52 patients were included in the present study after obtaining informed consent, 26 patients each in both groups. The mean age of patients in the Unipolar Mania (UM) group was 38.77±12.42 yrs, and Bipolar Affective Disorder (BPAD) group was 41.15±12.47yrs. The younger age of onset was noted among UM group (25.62±5.31) compared to the BPAD group (28.69±6.29). Psychotic symptoms in the first episode, suicidal attempts, comorbid anxiety disorder, substance use disorder and medical illness were more common among the BPAD group. In contrast, the seasonality was more common among UM group. There was no significant difference between the two groups regarding the number of episodes, the number of psychotic episodes, and mood-congruent psychotic episodes. The Childhood Trauma Questionnaire score was almost similar in both groups. <strong>Conclusion:</strong> There were no significant differences between the Unipolar Mania (UM) group and Bipolar Affective Disorder (BPAD) group regarding clinical and socio-demographic variables. Unipolar mania, perhaps, is not a distinct nosological disorder. Unipolar mania could be considered a course specifier similar to how rapid cycling, seasonality, and peripartum onset mood disorders are considered rather than a separate nosological entity.</p> 2021-11-12T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Prevalence of internet addiction and its relationship with disordered eating among medical college students in south India: a cross-sectional study 2021-07-22T11:04:41+0530 B Lakshmi Dorai Sanila Sara Alex C Pradeep <p><strong>Background: </strong>The easy availability of various gadgets with the provision of faster internet at affordable prices has exponentially increased internet usage in the past few years. This study aimed to estimate the prevalence of internet addiction and describe its association with disordered eating in medical college students. <strong>Methods: </strong>This cross-sectional study was conducted on 300 medical college students in south India. After obtaining ethical clearance and informed consent, students were given a questionnaire containing sociodemographic variables, Young's Internet Addiction Test (IAT), and Eating Attitudes Test questionnaires (EAT). Descriptive analysis was carried out by mean and standard deviation for quantitative variables, frequency, and proportion for categorical variables. Categorical outcomes were compared between study groups using the chi-square test. Univariate binary logistic regression analysis was performed to test the association between the variables. <strong>Results: </strong>The prevalence of internet addiction was 46.7% in this study. Disordered eating was found to be 12.3% in medical students. Internet addiction was observed to be more in the younger age group. (P &lt;0.001) A significant association was obtained between internet addiction and disordered eating. (P &lt;0.05). <strong>Conclusion: </strong>Nearly half of the medical students in this study were addicted to the internet, and disordered eating was also high among medical students. A closer look into the aspects like internet addiction and eating disorders is required, as these may silently impact the life and productivity of the budding doctors.</p> 2021-12-07T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Neuropsychiatric manifestations in COVID-19 patients with mucormycosis presenting to tertiary care center- cross-sectional study 2021-10-11T11:31:39+0530 Fakirappa Ganiger Jitendra Mugali Somashekhar Bijjal R Ashitha B Anirudh <p><strong>Background: </strong>Corona Virus Disease 2019 (COVID-19) pandemic has caused disruption of mental health along with physical illness, and it is associated with social and occupational impairment. Co-morbid mucormycosis in COVID-19 has added to the severity of psychiatric symptoms. <strong>Objectives: </strong>Primary objective was to assess neuropsychiatric manifestations in COVID-19 patients with mucormycosis. The secondary objective was to assess concerns for psychiatric symptoms. <strong>Materials and Methods: </strong>A cross-sectional study was done on COVID-19 patients with mucormycosis. A consecutive sampling method was adopted, and 70 COVID-19 patients with mucormycosis were recruited to the present study. Mini International Neuropsychiatry Interview Plus (M.I.N.I. Plus) was used to screen psychiatric symptoms, and the diagnosis was made as per the International Classification of Diseases tenth revision (ICD-10). Beck depression inventory (B.D.I.), Hamilton scale for assessment of anxiety (HAM-A) and Beck suicide inventory (B.S.I.) were used to assess the severity of symptoms. R<strong>esults: </strong>Prevalence of neuropsychiatric manifestations in the present study was 64.28%, among which 28.8% had Major depressive episodes, 40% had anxiety, 11% had substance use disorder, and 20% had delirium. The major concern for symptoms was found to be the uncertainty of outcome, which was present in 29% of patients, followed by fear of death (25%), postoperative complications (19%), lack of knowledge (3%) and 22% of patients had multiple concerns. <strong>Conclusion: </strong>Prevalence of neuropsychiatric disorders is higher in COVID-19 patients with Mucormycosis. Psychiatric screening should be considered in these patients to decrease morbidity and improve outcome and quality of life.</p> <p><strong>Keywords: </strong>COVID-19, MINI-Plus, Major depressive episode, Anxiety, Mucormycosis<strong>.</strong></p> 2021-12-31T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Factors affecting cognitive functioning in individuals with bipolar disorder in euthymic phase 2021-08-19T06:16:58+0530 Mareen Benjamin Roy Abraham Kallivayalil <p><strong>Background</strong>: Neurocognitive studies during the euthymic phase of bipolar disorder have shown persistent cognitive deficits in 32% of patients. There is limited evidence in the Indian literature regarding this area. Neurocognitive impairment can significantly affect the overall functional recovery of these individuals. Understanding potential factors contributing to neurocognitive impairment in bipolar disorder is essential to develop prevention strategies and effective treatments. <strong>M</strong><strong>ethods</strong>: A total of 50 patients with bipolar disorder currently in euthymic phase for the last three months with a minimum duration of illness of two years and current Young Mania Rating Scale&lt;11 and Hamilton Depression Rating Scale &lt;8 currently on medications were administered various cognitive tests namely digit span test forward and backward, digit symbol substitution test and Trail making test A and B. The study was completed within a period of 6 months after getting approval from the institutional ethics committee. <strong>Results</strong>: Patients with bipolar disorder, in remission, have cognitive impairment in attention, memory and executive functioning. More than 50% of the patients could perform digit span test forward more than five digits, and in the case of the digit span test backwards, more than 50% of patients could perform only less than or equal to three digits. In the Trail Making tests A and B, 66% of the patients could perform within &lt;/=78seconds, and 62% could perform within &lt;/=273 seconds, respectively. Only 4% of the patients could complete 49 squares in the Digit symbol substitution test. <strong>Conclusion</strong>: Findings of the current study shows evidence of cognitive impairment in euthymic bipolar patients.</p> 2021-12-31T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Meta-analysis as a research design – Steps demystified for novice medical researchers 2021-08-12T22:05:08+0530 Manoj Kumar L <p>Meta-analysis is a study design that assesses previous research quantitatively and arrives at a conclusion for a research question; that outcome or conclusion is considered strong enough to be kept in an apex position in the hierarchy of evidence. Meta-analysis is found to be a hurdle for most novice researchers due to complex statistical procedures and the availability of unbiased published literature globally. The lack of accurate theoretical background also adds to the aforementioned complexity. This paper tries to portray a simple, practical outline about meta-analysis, justification for using this design, other essential aspects concerned and methods to be used. Literature relevant to the topic published within ten years in prominent journals and websites has been reviewed thoroughly while writing this paper. Keywords used for literature search were; ‘Meta-analysis’, ‘systematic review’, ‘Meta-analysis research design’ and ‘Meta-analysis framework’. The search was carried out after applying appropriate Boolean operators. Thoroughly and rigorously conducted meta-analysis is valid and has the potential of decision making in evidence-based medicine practice as it provides a more precise and cumulative estimate of the effect of a treatment/intervention, risk factor for a disease and or efficacy of drugs. The necessity to inculcate results or findings from numerous research studies makes it clear that meta-analysis as a research design is desirable in the field of medicine.</p> 2021-10-13T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Mobile addiction-an emerging epidemic 2021-11-05T10:20:58+0530 M P Radhakrishnan 2021-11-10T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry Discuss your findings well 2021-12-29T22:18:02+0530 Samir Kumar Praharaj Shahul Ameen <p>NA</p> 2021-12-31T00:00:00+0530 Copyright (c) 2021 Kerala Journal of Psychiatry