Kerala Journal of Psychiatry

When the Body Feels Foreign: A Case of Body Ownership disturbance in Brief Psychotic Disorder

2025-01-22T10:00:44+0530

Deficits in the sense of self are well-documented in psychotic disorders, but evidence regarding disturbances in body ownership remains inconclusive. This case report presents a rare and severe instance of body ownership disturbance in a young woman, marked by delusions of estrangement from her body, multiple self-harm attempts, social withdrawal, and profound functional decline. Although she received antipsychotic treatment, cultural factors impeded treatment adherence. The case underscores the diagnostic challenges associated with such disturbances and highlights the critical role of social and cultural influences on illness perception and care-seeking behavior. It emphasizes the need for greater clinical awareness of body ownership disturbances in psychotic disorders, further research into their phenomenology, and the development of culturally sensitive interventions to enhance treatment outcomes.

Kallmann Syndrome and Depression: A Case Report

2025-04-07T06:05:29+0530

Kallmann syndrome is a genetic condition that causes low testosterone levels and anosmia. It can also be linked to mood disorders such as depression. This case report describes an 18-year-old male with Kallmann syndrome who experienced low mood, fatigue, irritability, and sleep disturbances. He was receiving testosterone therapy and was started on Escitalopram and Clonazepam for depression. His symptoms initially improved, but after stopping both testosterone and antidepressants, his depression returned. Restarting Escitalopram led to symptom improvement. This case highlights the need for regular psychiatric evaluation in patients with Kallmann syndrome, as stopping treatment can lead to a relapse of depressive symptoms. Early recognition and proper management can improve patient well-being.

Epilepsy Versus Psychotic Depression in an Adolescent: A Case Report

2025-02-19T09:38:20+0530

Epilepsy has often been linked with multiple psychiatric symptoms. Psychotic symptoms are often seen in pre-ictal, interictal, and post-ictal periods. Differentiating between neurological and psychiatric disorders in adolescents poses significant diagnostic challenges due to overlapping clinical features. We present the case of a 15-year-old boy who exhibited depressive symptoms, seizures, and psychotic symptoms, raising concerns both for epilepsy and psychotic depression. This led to an interplay between the symptoms of these two disorders. While treating one condition often complicates the other, such cases require efficient multidisciplinary care between neurology and psychiatry. This case highlights the complexity of diagnosis considerations in adolescent neuropsychiatry and underscores the importance of interdisciplinary collaborations for accurate diagnosis and management.

Hyperhomocysteinemia in a Patient with Schizophrenia – A Case Report

2025-05-14T06:55:50+0530

Hyperhomocysteinemia is a common metabolic disorder that is associated with mental disorders. Treatment with vitamin supplements was found to be beneficial in reducing elevated homocysteine levels. An 18-year-old male, presenting with a 1 ½ years history of schizophrenia, had elevated serum homocysteine. The elevated homocysteine level reached normal with vitamin supplements, and schizophrenic symptoms subsided with a relatively low dose of antipsychotics. Correcting metabolic errors such as hyperhomocysteinemia can result in significant improvement of associated psychotic symptoms.

Mental Health Awareness Campaigns: Experiment with Exhibition and Public Participatory Training

2025-03-26T06:05:20+0530

A multifaceted approach to mental health education is needed to mould the public's perception of mental disorders. The campaign aimed at the accurate portrayal of mental health issues, particularly in the context of media representation and public understanding. The demonstration of modified Electroconvulsive Therapy (ECT) on a human replica sparked significant interest among visitors, facilitating discussions about shock therapy and its misconceptions. A dedicated module on substance use served as a platform to discuss the harmful effects of drugs and alcohol, mainly targeting adolescents and young adults. The evolution of mental health care over the past 250 years was presented through interactive biographical slides, fostering a deeper understanding of the historical context and the importance of positive mental health practices. The need to refrain from harmful stereotypes and misrepresentations in media, which can shape societal views, often portraying individuals with mental disorders as violent or unpredictable, was highlighted. The creation of a makeshift mini-theater for public awareness video shows and individual sessions conducted by trained volunteers was an effective strategy for engaging the community in mental health discussions. These initiatives aimed to educate stakeholders on the importance of accurate mental health representations and the detrimental effects of stigma. There is a necessity for comprehensive mental health education that addresses misconceptions, promotes positive behaviors, and encourages open dialogue within the community.

Parenting in the Digital Era

2025-07-15T10:35:54+0530

Parenting is one of the significant challenges that every human being faces in their lifetime. There have been several fundamental changes in the lifestyle of children and adolescents in the twenty-first century compared to those of a previous generation. In today’s digital era, everything has become super fast to such an extent that you need to click your mobile a couple of times to get a sure ticket for a movie or to order your choicest delicacy, which would invariably be delivered straight to your doorstep. The time gap between the genesis of a desire and its realisation has dwindled to a few minutes or even a few seconds. The parent needs to be mindful of their children's digital behavior and ensure that they can guide them about healthy and unhealthy choices in digital encounters. Parents should be well-versed in the online friends of their kids and the nature and quality of the interaction their kids are having with them. Ensuring healthy screen time, which is age-appropriate, is another vital issue that should be considered seriously. According to the American Academy of Pediatrics' recommendation, children under 2 years of age should not have any screen time. Children between 3 and 5 years old may be permitted one hour of screen time daily, which does not need to be continuous. Parents should ensure that this screen time does not consist exclusively of cartoons or fast-moving visuals. The parent should understand that it is more important to allow the child to play and explore novel aspects of their life rather than restricting their freedom within the four walls of tuition centres, thereby ruining any chance for psychosocial development. Studies from various parts of the world have shown that physical inactivity, apart from increasing the chance for metabolic lifestyle-induced disorders, also paves the way for behavioral addiction, including online gaming disorders as well as substance use disorders in the future. As a parent, it is your primary responsibility to listen non-judgmentally to your child's concerns. Most importantly, it is not about moral policing your child, but about empowering them to differentiate between healthy and unhealthy choices in life, which defines the parent in you.

Proportion of Depression Among Pregnant Women Seeking Antenatal Care at a Primary Health Center in South India

2025-05-12T16:03:02+0530

Background: Depression in the antenatal period can have serious repercussions for both the mother and child. There is a paucity of community studies in the area of antenatal depression in the state of Kerala. This study was carried out to find out the prevalence of antenatal depression and to explore the correlates of depressive symptoms with social and clinical variables in antenatal women attending a primary health center in Pangappara, Thiruvananthapuram.

Methods: A community-based cross-sectional study was carried out among 175 antenatal women attending antenatal clinics at the primary health center Pangappara, under the medical college health unit area, Thiruvananthapuram. Socio-demographic and clinical details were recorded using a pretested semi-structured questionnaire. Antenatal women were assessed using the Edinburgh Postnatal Depression Scale questionnaire to detect depressive symptoms. The data collected was analyzed using SPSS version 22. Pearson's Chi-square test and Fisher’s exact test were used for the comparison of categorical variables between groups.

Results: The prevalence of depressive symptoms according to EPDS was found to be 18.85%. Past history of psychiatric illness and history suggestive of premenstrual syndrome were found to have a statistically significant association with depressive symptoms on binary logistic regression analysis (p<0.005).

Conclusion: The proportion of antenatal depression was found to be relatively high. Clinical factors like a history suggestive of premenstrual syndrome and a past history of psychiatric illness were found to be significant risk factors for antenatal depression.

Psychosocial Problems Among Healthcare Workers in a Tertiary Care Centre During the COVID-19 Pandemic - A Qualitative Study

2025-07-11T08:39:32+0530

Background: The COVID-19 pandemic has affected the mental health of healthcare workers (HCWs) engaged in fighting the pandemic, as reported by many quantitative studies. Only a few qualitative studies, mostly conducted online, have explored the psychosocial problems faced by them, especially the residents. This study was done to have an in-depth understanding of psychosocial problems experienced by the HCWs engaged in delivering care to COVID-19 cases in a tertiary care centre.

Methods: A qualitative study was undertaken, comprising 11 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs) with various stakeholders, chosen purposively to ensure representativeness, after obtaining informed consent. Transcriptions of the recorded IDIs and FGDs and translation to English were done. Free-listing, domain identification, coding, and identification of categories and themes were undertaken. A conceptual model was developed. Triangulation of methods and data was ensured.

Results: Physical, emotional, behavioral, interpersonal, and interdepartmental problems, worries, apprehensions, social issues, deficiencies, and occupational impairments were the identified themes. Almost all the participants reported emotional problems like anxiety, fear, depression, anger outbursts, etc. All stakeholders experienced physical problems, primarily related to the use of personal protective equipment, and were overwhelmed by the workload and deficiencies in various domains. Social stigma, discrimination, and ostracization were experienced mostly by the nurses, nursing assistants, and attenders. Deficiencies in their academic training were a major concern for the residents.

Conclusion: Various psychosocial problems were common among HCWs engaged in delivering care to COVID-19 patients. The inadequacies of the system and the attitude of the community contributed to these issues.

Clinical Profile of Patients Attending the MACT Board In A Tertiary Care Centre In Kerala – A Cross-Sectional Study

2025-03-28T06:48:38+0530

Background: Following a motor vehicle accident, individuals may seek compensation for their disabilities through legal channels, which involves attending the Motor Accidents Claim Tribunal (MACT) board. Understanding the clinical profile of these patients and the types of disabilities they sustain can be crucial.

Aim: To assess the clinical profile of patients attending the MACT board of a tertiary care centre in Kerala.

Methods: A record-based cross-sectional study was conducted on the patients referred to a tertiary care center for the disability assessment by MACT for a period of one year. The relevant data were entered in a pre-designed proforma for the study, and descriptive statistics were computed.

Results: Among the 248 patients who attended the board, the mean age of the patients was 44.2 years, and the majority were males. Fractures were most common type of injury followed by Traumatic Brain Injury (TBI), subdural haemorrhage was the most common type of TBI, and frontal lobe was the most commonly involved lobe., 196 (79.03%) were found as disabled, locomotor 156 (80%) being the most common type of disability. TBI was seen in 90 (36.4%); among them, 19 (9.7%) had a psychiatric disability, with the work domain of the Indian Disability and Evaluation Scale being the most affected.

Conclusion: The study brings forth the clinical profile of patients attending the Motor Accident Claim Tribunal Board. A large majority of patients attending the board were found to be disabled, and many had to wait for more than five years for disability assessment. This highlights the need for more centres for disability assessment for these patients, as well as the need for awareness regarding rehabilitation and more rehabilitation facilities for these patients.

Psychological Outcomes Among COVID-19-Infected and Non-infected Healthcare Workers from a Tertiary Care Center in North India: A Cross-sectional Comparative Study.

2025-05-05T06:38:05+0530

Background: Numerous studies have examined the psychological impact of COVID-19 within the Indian context. However, there is limited evidence comparing psychological distress among healthcare workers, both with and without a history of COVID-19 infection, from a tertiary care center in North India. This study seeks to identify psychological distress in healthcare workers from a tertiary care hospital in North India, with comparisons between those who had contracted COVID-19 and those who had not.

Materials and Methods: The present study used a cross-sectional comparative design, selecting participants based on their past RTPCR-confirmed COVID-19 infection status. Psychological distress was assessed using three standardized screening instruments: patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder scale (GAD-7), and the impact of event scale–revised (IES-R).

Results: The mean age of the participants was 35.59 ± 8.6 years, with the majority being female (74%), married (80%), and working as nurses (62.6%). The overall prevalence of depression, anxiety, and post-traumatic symptoms related to COVID-19 among the participants was 25.7%, 13.5%, and 8.8%, respectively. These psychological symptoms were more frequently reported among those who had been infected with COVID-19 than among those who had not. Logistic regression analysis indicated that individuals with a history of COVID-19 infection were twice as likely to experience depressive symptoms, anxiety symptoms, and post-traumatic stress compared to those without such a history.

Conclusion: The study found that 11–27% of healthcare workers experienced psychological morbidities during the COVID-19 pandemic. These findings emphasize the importance of ongoing psychological assessment and support for healthcare workers in similar pandemic situations.

Perceived Social Support Among People with Lived Experience of Serious Mental Illness in Remission and Their Disability: A Cross-Sectional Study

2025-05-21T06:36:18+0530

Background: Disability associated with mental illness is a major contributor to the global burden of disease. There are only limited studies assessing perceived social support and disability among patients who are in remission. This study helps us understand whether the perceived social support among people with lived experience (PWLE) is associated with disability. Aim: To determine the association between perceived social support and disability among people with lived experience of serious mental illness. Material and Methods: This cross-sectional analytic study was conducted over 6 months among 125 patients diagnosed with Schizophrenia spectrum disorders, Depressive disorders, and Bipolar and related disorders who are in complete or partial remission according to DSM-5 criteria. Socio-demographic data was collected using a semi-structured proforma. Multidimensional Scale of Perceived Social Support (MSPSS), and World Health Organization Disability Assessment Schedule 2.0. (WHODAS II) were used to study perceived social support and disability. An association between perceived social support and disability among people with lived experience of serious mental illness was done using the Chi-square test. Results: Among 125 patients, 13.6% perceived high social support, 48% perceived moderate social support, and 38.4% perceived low social support. The majority of the PWLE of serious mental illness in remission had no disability The majority of the PWLE of serious mental illness in remission had no disability. Conclusion: This study shows that there is no significant association between disability and perceived social support. There may be other factors that determine disability among people with lived experience of serious mental illness.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee.

A Comparative Study of Clinical Characteristics, Course of Illness, Substance Use Pattern and Quality Of Life between Patients with Bipolar and Unipolar Depression

2025-05-29T11:07:40+0530

Background: Distinguishing between unipolar and bipolar depression is critical for effective management. This study aims to compare the clinical characteristics, illness trajectory, substance use patterns, and quality of life in patients with unipolar and bipolar depression.

Methods: A cross-sectional study including 140 patients diagnosed with unipolar or bipolar depression per DSM-5 criteriawas conducted. Participants were evaluated using the Hamilton Depression Rating Scale (HDRS), Brief Psychiatric Rating Scale (BPRS), WHO Quality of Life-BREF (WHOQOL-BREF), Alcohol Use Disorders Identification Test (AUDIT), and the Fagerstrom Test for Nicotine Dependence. Socio-demographic and clinical data were analysed using descriptive and inferential statistics.

Results: Patients with Bipolar Depression (BD) had significantly higher symptom severity, with mean HDRS scores of 21.59 (SD = 5.05) compared to 17.64 (SD = 4.43) in Unipolar Depression (UD) (p < 0.001), and BPRS scores of 44.10 (SD = 7.99) vs. 37.91 (SD = 8.55), respectively (p < 0.001). Psychotic symptoms were more common in the BD group (64.3%) compared to the UD group (34.3%) (p< 0.001). Regarding the course of illness, BD patients had an earlier age of onset (mean = 25.61 years, SD = 7.31) than UD patients (mean = 36.23 years, SD = 8.04; p < 0.001), a greater number of depressive episodes (p < 0.001), longer average duration of episodes (p = 0.009), and more frequent hospitalizations (p < 0.001). In terms of quality of life, psychological domain scores were significantly lower in the BD group (mean = 41.63, SD = 13.47) compared to the UD group (mean = 48.71, SD = 13.34; p = 0.004).

Conclusion: Bipolar depression presents with greater severity, recurrence, and psychotic symptoms, impacting overall psychological well-being.

Community Attitude towards Mental Illness- 12 Item Questionnaire (CAMI-12) - Malayalam Version

2025-05-29T10:49:40+0530

The 12- item Community Attitude towards Mental Illness (CAMI-12) scale was derived from the original Community Attitudes toward the Mental Illness (CAMI) scale developed by Taylor and Dear in 1981. The questionnaire consisted of Forty attitudinal statement about mental illness. CAMI was used to measure community attitudes towards people with mental illness, with participants saying how much they agreed or disagreed with each statement on a 5-point Linkert scale.¹The 12 CAMI statements were phrased in both positive and negative directions. These 12 items were grouped into the two subscales: Prejudice and Exclusion (PE) and Tolerance and Support (TS) with 6 questions in each subscale.²Positive views were expressed by agreement with ‘Tolerance and Support’ items and disagreement with ‘Prejudice and Exclusion’ items. The degree of a respondent’s agreement or disagreement was rated on a 5-point Likert Scale which was scored as follows: 0 for ‘disagree strongly’, 25 for ‘disagree slightly’, 50 for ‘neither agree nor disagree’, 75 for ‘agree slightly’ to 100 for ‘agree strongly’. Negative statements were scored in reverse so that in each case, a higher score represented a more positive attitude. There was also a sixth option of ‘Don’t know’ and but were excluded from the calculation of the mean score.² Mean score of positive statements and negative statements were calculated. Total stigma score was also calculated. The 25^th percentile of the total stigma scores are calculated. The participants with total score more than the 25^th percentile are having low stigma and those caregivers whose total score less than the 25^thpercentile have high stigma.

The initial translation of the questionnaire to Malayalam was done by two independent translators whose mother tongue was Malayalam. One translator was given sufficient information to understand the purpose of CAMI-12, while the other was blinded. The two translations were then contrasted with each other. The translations were then back translated to English by another translator whose mother tongue was Malayalam, but had previous experience in translation and was fluent in both spoken and written English. This was done as the service of a translator whose mother tongue was English couldn’t be obtained. The back translator was also blinded to the concept of CAMI-12. A panel constituting principal investigator, the translators, and expert with vast experience in Psychiatry decided on the final version.

The Malayalam version of CAMI-12 total score had a high internal consistency with Cronbach’s alpha value of 0.90. The internal consistency of the Malayalam version of the two subscales with Tolerance and Support (TS) and Prejudice and Exclusion (PE) were excellent with Cronbach’s alpha value of 0.89 and 0.90 respectively.³

The test- retest Reliability of the CAMI-12 Malayalam version was assessed with re-administration after 4 weeks. The intraclass correlation of the total score was 0.89 and for the subscales TS and PE were 0.88 and 0.91.³

Moonlight Over the History of Psychiatry In Kerala

2025-06-19T09:02:04+0530

This is a review of a fascinating and eminently readable book by Dr. K.A. Kumar, one of my teachers in psychiatry, who is well-known to the psychiatric fraternity in India. The book is titled “Novum Nilavum, which I am translating as Sufferings and Moonshine.

Dr. Kumar has dedicated this book to his parents: his mother, who taught him the basics of kindness and caring, and his father, who instilled in him a sense of justice and duty. After this, there is a brief preface by him and a concise introduction by the famous Malayalam writer, Paul Zacharia. The book has twelve chapters and ends with an afterword by the author himself.

Dr. Kumar offers a firsthand account of the mental health care scenario in the most literate state of the country. It is a gratifying experience for the reader to go through this well-written book. This book is a welcome addition to the very sparse list of books on the history of Psychiatry and mental health in Kerala. Reading it will be a delight to mental health professionals, and lay readers will also find the book engaging.

Book: Novum Nilavum (Sufferings and Moonshines); Memoirs of a Psychiatrist

Language: Malayalam

Author: Professor K A Kumar

Publisher: Chintha Publishers, Thiruvananthapuram, February 2025

Distributed by: Deshabhimani Book House, Thiruvananthapuram

The book is available on Amazon.com [Link]

Navigating Parenting in the Digital World

2025-07-18T05:59:41+0530

Aim, Research Questions, Objectives, and Hypotheses- Which One and How to Write in a Manuscript?

2025-07-06T23:11:24+0530

A well-defined research framework is fundamental to conducting effective and impactful studies. This article explores the distinct yet interconnected roles of key research components: the aim, objectives, research questions, and hypothesis. The aim outlines the broad purpose of a study, while objectives delineate the measurable steps necessary to achieve the aim. Research questions specify the inquiries that guide the investigation. A hypothesis provides a testable prediction based on an assumption. Clarifying these elements is crucial for designing a coherent and focused research plan. By distinguishing and articulating each component, researchers can improve the clarity, direction, and overall quality of their studies.