Kerala Journal of Psychiatry

Prevalence of perceived stress among higher secondary school students in an educational district of South Kerala

Raj Keerthi — 2024-09-11

Background: Adolescence is a period when one’s mental resilience builds up. Also, it is a period when one may develop mental health problems, stress being one of the causes. Schools become a medium for early detection of those suffering from such issues and a platform for providing preventive measurements. Hence, this study aimed to assess the prevalence of perceived stress among students in higher secondary schools of the Thiruvananthapuram educational district, Kerala. Also, this study attempted to find the association between various socio-demographic factors and perceived stress. Methods: This was a community-based, cross-sectional study conducted using stratified cluster sampling in 539 adolescents of 48 different classes from eight higher secondary schools (four government, two private-aided, and two private-unaided) over one year from August 2018, using the Perceived Stress Scale-10. Informed consent and assent were obtained as required from the participants. A Chi-square analysis was performed to assess statistical significance. Odds Ratio and confidence intervals were calculated to estimate the strength of association. Logistic regression analysis was done to determine the risk factors. The correlation of academic performance with perceived stress was assessed using the Spearman-Rank test. Results: Significant levels of stress were observed in 34.1% of the participants, and 8.7% of those with significant stress had severe perceived stress. The levels of perceived stress were high among those who performed better academically and there was a positive correlation between both. Age and stream of their study were the factors that showed an association with the stress levels experienced by the students. Conclusion: Adolescents undergo immense stress, academics being an unavoidable stressor. Contrary to expectations, higher stress levels were observed in students who performed better. Employment of stress reduction programs in schools ought to be considered a priority.

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

C M Naina — 2024-05-08

Background: There is a steady increase in the number of suicide deaths throughout the life span, particularly among youth compared with other age groups. The youth are naturally vulnerable to mental health problems, especially during their adolescent years. Our study aimed to estimate the proportion of youth with high suicidal intent and to assess the association of socio-demographic and clinical factors, including stressful life events, with suicidal intent in youth with intentional self-harm (ISH). Methods: This cross-sectional, descriptive study was done at the Department of Psychiatry, Government Medical College, Thrissur, Kerala, from December 2019 to May 2021 after getting approval from the Institutional Ethics Committee. The study sample consisted of 97 consecutive inpatients aged 15 to 24 years with ISH referred from various departments to the Psychiatry Department, who satisfied the inclusion and exclusion criteria. All the participants were enrolled after getting written informed consent/assent from the guardian and/or the patient. The suicide intent was assessed using Beck’s Suicide Intent scale. A specially designed proforma was used to assess the socio-demographic details and precipitating factors. The stressful life events were assessed using the Presumptive Stressful Life Events Scale. Results: 18.5% of youth with ISH had high suicidal intent. Past history of suicide attempts (p = 0.03) and life events (p = 0.002) were significantly associated with high suicidal intent. Conclusions: Past history of suicide attempts had a significant association with high suicide intent. Early recognition and correction of the risk factors can help to prevent further suicide attempts.

Prevalence of postpartum depression among mothers attending immunization clinic in a primary health centre: A cross-sectional study

Neethu Varma P — 2024-09-08

Background: Postpartum depression (PPD) is one of the common psychopathologies that can have devastating effects on the mother, child, and family. Studies of PPD in primary care settings are sparse. The objectives of this study were to estimate the prevalence of PPD among mothers attending immunization clinics in a primary healthcare setting and to assess the association between PPD and various clinical and socio-demographic variables. Methods: A cross-sectional study of 223 postnatal mothers aged 18-40 years was conducted at the Immunization Clinic of an Integrated Family Health Center in Kerala. Sociodemographic and clinical data was collected using a semi-structured, interviewer-administered questionnaire. The presence of PPD was assessed by using the Malayalam version of the Edinburgh Postnatal Depression Rating Scale (EPDS). The association of PPD with various socio-demographic and clinical variables was evaluated. Analysis was done using SPSS version 24. Variables associated with PPD at the univariate level were further included in a multivariate regression analysis to identify the risk factors for PPD. Results: The prevalence of PPD was found to be 13.9%. The younger age of the mother, poor social support, nuclear type of family, delivery by Cesarean section (CS), and early postpartum duration had a strong association with and were independent predictors of PPD. The sex of the baby had no association with PPD. Conclusion: PPD was found in a significant number of mothers. Considering the high prevalence in community settings, PPD should be viewed as a disorder of public health significance, and routine screening of PPD is needed for early intervention.

Effect of mirtazapine on weight and metabolic profile among psychiatric patients: A prospective, observational study from South India

Salma Nazim — 2024-08-27

Background: Treatment with mirtazapine is reported to cause weight gain and adverse metabolic profile in several populations. Limited information is available regarding the metabolic adverse effects of mirtazapine in the Indian population. This study aims to compare the weight and metabolic profile of patients on mirtazapine at baseline and after six months of treatment in a tertiary care Indian setting. Methodology: This hospital-based, observational study was conducted in a tertiary care teaching institute in South India. Forty patients prescribed mirtazapine for various psychiatric disorders were included. Weight, body mass index, lipid profile, blood sugar, and HbA1c values were compared at baseline and after six months of treatment. Descriptive statistics used included mean and standard deviation (SD). Results: Statistically significant increase in mean weight (0.97 kg, SD - 2.2; p = 0.008), mean BMI, mean HbA1C (0.1, SD - 0.21; p = 0.007), and mean total cholesterol (6.6 mg/dl, SD - 13.5; p = 0.005) was observed after six months of treatment with mirtazapine. Conclusion: The study demonstrates the importance of close monitoring of patients who are started on mirtazapine to identify and treat metabolic deregulation promptly. Long-term, controlled studies in larger samples are needed to arrive at meaningful conclusions.

Prevalence of panic disorder among patients with non-cardiac chest pain attending cardiology outpatient department in a tertiary care centre in Kerala – A cross-sectional study

Nisha Radhakrishna Pillai — 2024-09-06

Background: Non-cardiac chest pain, a term that serves as a broad canvas, has a multitude of potential causes in which panic disorder emerges as a prevailing cause. The recognition and accurate diagnosis of panic disorder among patients with non-cardiac chest pain is important. Hence a study was conducted to understand the prevalence of panic disorder among patients with non-cardiac chest pain in a tertiary care center in Kerala. Methods: A hospital-based, cross-sectional study was done among 118 patients who were diagnosed with non-cardiac chest pain by a cardiologist. The study was conducted in the cardiology OPD in a tertiary care center in Kerala. Mini-International Neuropsychiatric Interview Panic disorder – Version 6.0.0 (M.I.N.I.) was used to diagnose panic disorder among these patients. Results: It was found that panic disorder was present in 39.8% (95% Confidence Interval - 30.9-49.3%). Conclusion: The prevalence of panic disorder in patients diagnosed with non-cardiac chest pain was 39.8%. Consultation liaison treatment using pharmacotherapy and/or psychotherapy with the help of a psychiatrist may benefit such patients.

Time to share unpaid domestic labor! Prevalence of depressive symptoms among working women

Mary Ajithra — 2024-07-22

Background: The prevalence of depression is higher among women compared to men. The prevalence of depression is higher among married working women compared to married working men. Studies estimating the prevalence of depression among working women and quantitatively evaluating household work about depression in Kerala, India, are limited. The primary objective of the study was to estimate the prevalence of depressive symptoms among working women residing in the field area of Medical College Health Unit – Pangappara, Thiruvananthapuram. The secondary objective was to study factors associated with depressive symptoms among the study population. Methods: The study design was a cross-sectional study for which 110 participants were selected using two-stage cluster sampling. The data was obtained over the phone due to the then-ongoing COVID-19 pandemic. The data was analyzed with SPSS Version 26. Results: The prevalence of depressive symptoms among the study population was 14.5%, with a PHQ-9 score greater than or equal to five. The prevalence of depressive symptoms with a PHQ-9 score greater than or equal to ten was 4.5%. The prevalence of depressive symptoms was significantly higher among working women who had no one to help with household chores and childcare. Conclusion: The study quantifies the duration of unpaid domestic labor done by working women in addition to paid jobs. These unpaid domestic chores are often not shared by their husbands. The study signifies the need for gender equality and the sharing of domestic work and child care by male partners.

Bipolar affective disorder in a patient with neurosarcoidosis – A case report

Arun Joy — 2024-04-10

Background: Sarcoidosis is a rare clinical condition that can involve the central nervous system. 20% of cases of neurosarcoidosis (NS) can have psychiatric manifestations. Here, we highlight a case of bipolar affective disorder (BPAD) for 25 years with NS. Case report: A 50-year-old woman presented with progressive sensorineural hearing loss from 15 years of age and BPAD for 25 years. She developed generalized tonic clonic seizure and catatonia while on sodium valproate, leading to a detailed medical evaluation. Neuroimaging showed leptomeningeal enhancements, atherosclerosis, and stenosis of the internal carotid artery. Her serum angiotensin-converting enzyme level was elevated, and chest X-ray showed parenchymal lesions. She was diagnosed with neurosarcoidosis. Her condition improved with steroids and mycophenolate mofetil. BPAD was treated with sodium valproate. Discussion: Rare medical conditions like NS can present as psychiatric disorders. Poor response and vulnerability to adverse effects of psychotropics warrant a detailed clinical evaluation for organic etiology.

Desperate measures of involuntary deaddiction: A case report of acute disulfiram poisoning

Nanma Livingstone — 2024-08-05

Disulfiram is an effective deterrent drug for alcohol use in patients who have undergone detoxification and who are motivated to remain abstinent. Disulfiram poisoning is not common; only a few cases have been reported in the literature. Although most patients tolerate disulfiram well, severe toxic side effects have also been reported including hepatitis, encephalopathy, psychosis, optic neuropathy, and peripheral neuropathy. This is a case report of disulfiram toxicity in a 30-year-old man who developed mental status changes, pruritic rashes, and blurred vision after being given one gram of disulfiram per day covertly. He was managed conservatively and the symptoms subsided gradually. This case report highlights the importance of creating awareness about the dangers of covert administration of medications for alcohol use.

Alzheimer's day reflections

T M Raghuram — 2024-07-02

The hefty price of good intention: ‘Thoppumpady incident’

Girija Sathiaseelan Ramkumar — 2024-08-15

Navigating mental health: A review of Dr. James T Antony’s vision for Indian Psychiatry

Krishnan Sivasubramoney — 2024-08-25

Sample size estimation in research: Necessity or compromise?

Samir Kumar Praharaj — 2024-08-30

An adequately powered sample is essential for accurate parameter estimation and meaningful significance testing. It is important to balance sample size with practical considerations such as cost and feasibility. Sample size calculation is guided by key factors such as effect size, variability, power, and significance levels. While complex formulas and software aid precision, practical rules of thumb and strategies can also be used effectively. Transparent documentation of the rationale and methods used for sample size calculation is vital for ensuring reproducibility.

Farmers’ suicide in India: "Sociological disaster or unrecognized psychopathology"

Sureshkumar Pattath Narayanan — 2024-08-31

Though agricultural farming is considered a peaceful and healthy industry, it has a high rate of mortality, especially suicide. Farmer suicides account for 11.2% of all suicides in India. This is an increase of 5.7% when compared with 2020 figures. In 2022, many states reported drought conditions and untimely incessant rainfall, leading to a high suicide rate. Unrestrained imports and changes in tariff regimes brought in by the liberal economic reforms have led to a drastic drop in agricultural prices, identified as reasons by social scientists for farmer suicides. The rising cost of cotton cultivation and pesticide costs are pointed out as reasons for suicide among cotton farmers. Mental health and psychosocial aspects are largely ignored in the discussion of farmer suicides. Psychological autopsy studies on farmers’ suicides have reported significant psychiatric morbidity among victims. We should look for the possibility of a treatable psychiatric illness behind every farmer’s suicide to identify and treat these conditions, and this will make a significant "medical breakthrough" in the fight against suicide.