Kerala Journal of Psychiatry <p>Official&nbsp; Journal of the Branch of Indian Psychiatric Society (Kerala)</p> Branch of Indian Psychiatric Society (Kerala) en-US Kerala Journal of Psychiatry 0377-0699 Disability assessment in Traumatic Brain Injury – Issues and controversies <p>This viewpoint article discusses the issues and difficulties that psychiatrists face when seeing patients with traumatic brain injury. Lack of proper instruments for assessment, lack of clarity on who is the medical authority for certification, confounding effects of comorbidities, etc. are discussed.</p> Harish M Tharayil Varsha Vidyadharan Copyright (c) 2022 Harish M Tharayil, Varsha Vidyadharan (Author) 2022-12-11 2022-12-11 35 2 98 104 10.30834/KJP.35.2.2022.351 The journal – the journey thus far and ahead Pankajakshan Vijayanthi Indu Copyright (c) 2023 Pankajakshan Vijayanthi Indu (Author) 2023-02-20 2023-02-20 35 2 83 84 10.30834/KJP.35.2.2023.383 Mentally ill patients and the nation’s criminal justice system James T Antony Copyright (c) 2023 James T Antony (Author) 2023-02-07 2023-02-07 35 2 88 97 10.30834/KJP.35.2.2023.377 Psychiatric practice in Kerala: Current scenario and future directions. (Presidential address). Alfred V Samuel Copyright (c) 2022 Alfred Samuel (Author) 2022-12-28 2022-12-28 35 2 85 87 10.30834/KJP.35.2.2022.369 Writing ‘acknowledgements’ in manuscripts: More than gratitude! <p>In scientific manuscripts, authorship is based on substantial contributions to the research; all other contributions are acknowledged. Acknowledgements may be for intellectual inputs, financial or technical support, sharing data or other materials, and help in manuscript writing. Any non-scientific contribution need not be acknowledged. The acknowledgement should be a simple statement without embellishments and specific regarding the contributions. Writing appropriate acknowledgements in manuscripts gives due credit to the contributors.</p> Samir Kumar Praharaj Shahul Ameen Copyright (c) 2023 Samir Kumar Praharaj, Shahul Ameen (Author) 2023-02-03 2023-02-03 35 2 152 154 10.30834/KJP.35.2.2023.372 Experimental studies: Randomized controlled trials – Part I <p>Experimental research design involves experiments where experimental groups are created, exposed to specific interventions and specific outcomes studied. Randomized controlled trials (RCTs) are true-experimental studies and the most accurate and powerful among experimental study designs. In RCTs, participants are randomly allocated to receive one of several interventions, and the effects of these interventions are studied regarding particular outcomes. The different types of RCTs are discussed.</p> Pankajakshan Vijayanthi Indu Karunakaran Vidhukumar Copyright (c) 2023 Pankajakshan Vijayanthi Indu, Karunakaran Vidhukumar (Author) 2023-02-20 2023-02-20 35 2 155 158 10.30834/KJP.35.2.2023.384 The Arts and Psychiatry The Artist Copyright (c) 2023 The Artist (Author) 2023-02-12 2023-02-12 35 2 159 159 10.30834/KJP.35.2.2023.379 Coercion experience of patients with mental illness in a tertiary care hospital in Kerala <p><strong>Background:</strong> Coercion is a negative experience that interferes with the basic freedom and rights of patients with mental illness. The present study focuses on understanding the experience of coercion in patients with mental illness during their admission to a tertiary care hospital. <strong>Objectives:</strong> The study aims to assess the coercion experience of patients with mental illness who are undergoing treatment from a teaching hospital in a northern district of Kerala. The study also looked into the relationship between coercion experience and socio-demographic variables. <strong>Methods:</strong> A semi-structured interview schedule to assess socio-demographic variables and MacArthur Admission Experience Survey to assess the coercion experience of patients with mental illness were used in this study. The study sample included 84 patients with mental illness who had admission experience in the last two years. <strong>Results:</strong> Findings of the study revealed that 36.9% of patients with mental illness experienced high coercion and another 29.8% reported a moderate level of coercion. Affective reactions to hospitalization showed confusion (48.80%) and sadness (40.48%). A significant negative correlation was established between coercion experience and age, drug compliance and age of onset of illness. There was no significant relationship between coercion experience and sex, marital status, religion, socio-economic status, educational status, occupational status, diagnosis category, place of residence and regularity of treatment. <strong>Conclusion:</strong> A significant proportion of patients report coercive experiences during their admission for psychiatric treatment. Coercion is a negative experience that adversely affects the outcome. The study is attempting to highlight whether there is a need to lessen coercion</p> Anagha Unnikrishnan T K Saleem C A Smitha Copyright (c) 2023 Anagha Unnikrishnan, T K Saleem, C A Smitha (Author) 2023-02-14 2023-02-14 35 2 105 111 10.30834/KJP.35.2.2023.342 Effect of online customized psychiatry teaching on the perceptions about psychiatry among undergraduate medical students: a randomized controlled study <p><strong>Background:</strong> Student-centered innovative teaching methods are needed to increase interest in and improve perceptions about the field of Psychiatry. We aimed to assess the effect of online customized psychiatry learning on perceptions about Psychiatry among undergraduate medical students. <strong>Materials and methods:</strong> Between June to August 2021, we carried out a randomized controlled trial among second-year medical students of a teaching cum tertiary health care institution in South India. Participants (n=36) were randomized into the intervention (n=18) or control group (n=18). The intervention group received online customized psychiatry teaching in addition to the regular curriculum teaching while the control group received only regular curriculum teaching. The outcome measure studied was perceptions about Psychiatry, assessed using a structured questionnaire that was applied before and after the intervention. <strong>Results:</strong> Usable responses were obtained from 32 participants (Mean age=22.3 years, standard deviation=0.8; 50% females). At the end of the study, there was no significant difference in the scores between the groups on either the Images of Psychiatry subscale (t=1.36, p=0.18) or the Efficacy of Psychiatry subscale (t=1.56, p=0.11). However, in a within-group analysis, scores on the Images of Psychiatry subscale improved significantly in the intervention group (t= -3.65, p=0.002) but not in the control group (t= -1.18, p = 0.258). Likewise, scores on the Efficacy of Psychiatry subscale improved significantly in the intervention group (t = -3.06, p=0.008) but not in the control group (t= -0.81, p=0.432). <strong>Conclusion:</strong> Online customized psychiatry teaching did not improve perceptions about Psychiatry compared to regular curriculum teaching.</p> Nimmy Chandran Vikas Menon Copyright (c) 2023 Nimmy Chandran, Vikas Menon (Author) 2023-01-16 2023-01-16 35 2 112 121 10.30834/KJP.35.2.2023.313 Perception of doctors and patients regarding telepsychiatry services during the COVID-19 pandemic: Experience from the state of Kerala, India <p><strong>Introduction: </strong>The present article aims to describe the experience of organizing a telepsychiatry program to ensure continuity of care during the COVID-19 pandemic from the doctors’ as well as the patients’ perspectives. <strong>Methods: </strong>We initiated a synchronous telepsychiatry program for continuity of care using a Government-sponsored online platform with facilities for consulting a psychiatrist and e-prescription. Three months later we conducted a Video Focus Group discussion (VFGD) among the doctors involved in the program and telephonic interviews with randomly selected patients and caretakers to evaluate the merits and demerits of the program and to elicit suggestions for improvement. <strong>Results: </strong>The online services were availed by 120 patients (55% males) with the majority in the 19-60 years age group; 47.5% of them were availing psychiatry consultation for the first time. Overall, depression and anxiety were the common diagnoses. Both doctors and patients felt that online services are feasible and acceptable, ensure adequate privacy and provide the opportunity to avail of mental health services without stigma. <strong>Conclusions: </strong>Telepsychiatry has the potential to develop into an alternate model of mental health service delivery and it is more advantageous to women, the elderly, and those with travel difficulties. Mental health support to people in prisons, government residential facilities, and geographically isolated areas through online platforms is a feasible and cost-effective option. Definite legal and ethical guidelines on telepsychiatry should be formulated with facilities for training for professionals. Online platforms should be more user-friendly and tailor-made to provide psychotherapy and counseling services in addition to pharmacotherapy.</p> <p> </p> K Ravindren Rajith P Ashokkumar P K Anish Amith Gangadharan P M Neeny Padinharath Krishnakumar Jobin Tom Copyright (c) 2023 K Ravindren Rajith, P Ashokkumar, P K Anish, Amith Gangadharan, P M Neeny, Padinharath Krishnakumar, Jobin Tom (Author) 2023-01-29 2023-01-29 35 2 122 130 10.30834/KJP.35.2.2023.333 Factors influencing relapse in patients with schizophrenia <p><strong>Introduction: </strong>Relapse is a major factor for disability and poor quality of life in patients with schizophrenia. Several factors contribute to the relapse of symptoms in schizophrenia. Studying the modifiable factors helps in planning relapse prevention strategies. <strong>Aims:</strong> The study aimed to assess the factors influencing relapse among patients with schizophrenia. The study focused on selected modifiable factors such as stressful life events, perceived stress, expressed emotion, drug compliance and perceived stigma. <strong>Methods:</strong> A comparative design was used for this study. Tools used for data collection included a semi-structured interview schedule, Life Change Index Scale, Perceived Stress Scale, Medication Adherence Rating Scale, Family Emotional Involvement and Criticism Scale and STIG-9 questionnaire. Purposive sampling technique was used. The sample consisted of two groups of patients with schizophrenia, 50 patients in relapse and another group of 50 patients in remission. <strong>Results: </strong>The two groups were comparable in terms of socio-demographic and clinical variables, except for history of substance use. The mean (Standard deviation) scores of stressful life events were higher for the relapse group [159.82 (53.87)] compared to controls [114.42 (30.98), p &lt; 0.001]; so also, for perceived stress [12.40 (3.54) and 7.26 (2.93), p &lt; 0.0001)]; expressed emotion [27.36 (6.19) and 17.24 (5.64), p &lt; 0.001)]; poor drug compliance [3.78 (1.94) and 7.60 (1.67), p &lt; 0.001], perceived stigma [14.46 (3.53) and 12.38 (3.28), p = 0.003]. <strong>Conclusion: </strong>Knowledge of factors that contribute to relapse in schizophrenia will help mental health service providers to improve the standards of care. Interventions in schizophrenia should specifically target relapse prevention and improved quality of life.</p> P Nabeel T K Saleem A M Ashfaq-U-Rahman Copyright (c) 2021 Kerala Journal of Psychiatry 2023-01-31 2023-01-31 35 2 131 138 10.30834/KJP.35.2.2023.294 Mental health consequences of isolation – a mixed-methods study from a tertiary COVID care setting <p><strong>Background: </strong>Isolation of infected people is one of the strategies adopted to contain the spread of the COVID-19 pandemic. Understanding people’s mental health issues in hospital isolation is important because many are likely to develop psychological problems that need early intervention. Through this study, investigators aimed to assess the experiences and perceptions of people who had undergone hospital isolation for COVID-19 as well as the proportion of patients with symptoms of anxiety and depression and the factors associated with them. <strong>Methods: </strong>A mixed-methods study was conducted in a tertiary COVID care setting among inpatients of the COVID-19 isolation ward. A quantitative study was done among 75 inpatients. Symptoms of anxiety and depression were assessed using Hospital Anxiety and Depression scale. The data obtained were analyzed using R software. In-depth interviews (IDI) and focus group discussions (FGD) were the research methods used. Free listing, coding and creating coding categories of the transcribed and translated information were done using the R package for Qualitative Data Analysis (RQDA). <strong>Results: </strong>22.67% of study participants had scores suggesting anxiety and 24% had depression. 14.67% had both. There was a significant association between marital status and levels of anxiety or depression (?²=7.86, <em>df</em>=3, p=0.04). The predominant themes that emerged from the qualitative study were psychological effects of isolation, positive coping, stigmatisation, fear of transmitting disease, concerns about the future, need for information, the necessity of isolation and the need for recreation. <strong>Conclusions: </strong>Isolation has both social and psychological impact. The study highlights the potential areas of impact which could help one to plan appropriate interventions. The need for providing adequate information about the details of isolation and efforts to alleviate stigma is also evident from the study.</p> Mithila George Priya Govindankutty Menon K Vidhukumar Copyright (c) 2023 Mithila George, Priya Govindankutty Menon, K Vidhukumar (Author) 2023-02-09 2023-02-09 35 2 139 147 10.30834/KJP.35.2.2023.371 Mephentermine abuse for stamina, resulting in mania - a case report <p>Mephentermine is an amphetamine-like drug used to treat hypotension. There have been case reports of mephentermine abuse in India, some associated with psychosis. This is the first to be associated with mania and the first reported from Kerala. We report the case of an adult male with a three-month history of irritable mood, increased energy and various other manic symptoms. Interview revealed three years history of intravenous mephentermine use for athletic enhancement that evolved to a dependence pattern. Higher mental function evaluation revealed deficits in concentration and recent memory. He was started on a combination of antipsychotic and mood stabilizer; psychoeducation was also initiated. Mania went into remission over three weeks but dependence continued, and the patient was then lost to follow-up. We expect this case report to increase awareness among both clinicians and the public and to start an investigation into the prevalence of this problem in at-risk populations.</p> Pranav V Nair Bindhya Babu Zoheb Raj Sushil Kakkan Copyright (c) 2023 Pranav V Nair, Bindhya Babu, Zoheb Raj, Sushil Kakkan (Author) 2023-01-03 2023-01-03 35 2 148 151 10.30834/KJP.35.2.2023.361