Kerala Journal of Psychiatry

Reliability and validity of Malayalam version of 12-item Community Attitude Towards Mental Illness (CAMI-12) questionnaire

Meera Sujathan — 2023-11-05

Background: Community attitude toward mental illness (CAMI) is an important determinant in the management of people with psychiatric disorders. Stigma interferes with diagnosis, treatment, and rehabilitation of all mental disorders. Even though studies have been done to evaluate knowledge, attitude, and behaviors toward psychiatric patients, no tools are available in the local language, Malayalam, for assessing CAMI. A validated and reliable Malayalam tool is an essential prerequisite for assessing the level of stigma in the local population. The objectives of our study were to assess the reliability and validity of the Malayalam version of the 12-item Community Attitude towards Mental Illness (CAMI-12) Questionnaire and to estimate the proportion of caregivers of patients with MI having a high level of stigma as per CAMI-12. Methods: This observational study was done in Government Medical College, Kottayam, from June 2021 to December 2021, after getting the approval of the Institutional Ethics Committee. Written informed consent was obtained from the participants before recruiting them for the study. One hundred and twenty caregivers of patients with mental illness were recruited by consecutive sampling, and they completed the Malayalam version of CAMI-12 at baseline and after four weeks. Internal consistency was assessed using Cronbach’s alpha. Results: The Malayalam version of CAMI-12 total score and the subscales for Tolerance and Support (TS) and Prejudice and Exclusion (PE) had a high internal consistency with Cronbach’s alpha values of 0.90, 0.89 and 0.90, respectively. Conclusions: Our study demonstrated good reliability and validity for the Malayalam version of CAMI-12. The proportion of caregivers with a high level of stigma was found to be 28.3% (95% Confidence Interval [95% CI] = 20.2-36.4%).

Caregiver burden in alcohol dependence syndrome and its sociodemographic correlates: A cross-sectional study from South India

Jithin T Joseph — 2023-11-08

Background: Caring for people with severe mental and medical illness adversely affects their natural caregivers, which is measured as caregiver burden (CGB). Even though many studies have investigated CGB in chronic medical and mental illnesses, such studies are minimal in substance use disorders with a chronic course, relapses and remissions. The current study intended to investigate the extent of CGB among caregivers of alcohol dependence syndrome (ADS) patients and how different sociodemographic and clinical variables affect CGB. Methods: We conducted a cross-sectional study in a tertiary psychiatry hospital among those who were admitted for the treatment of alcohol dependence. One hundred patients and their caregivers were included in the study. Data was collected using a semi-structured questionnaire, the severity of dependence assessed using the Severity of Alcohol Dependence Questionnaire (SADQ) and the burden using the Burden Assessment Schedule. Data were analysed using SPSS software, and relevant statistical tests were used. Results: All our patients were male, educated and married. Most of the patients started alcohol use before the age of 20 years, had been using alcohol for more than 10 years, 91% had a history of deaddiction treatment, and 80% were using nicotine. Most caregivers were females, either the spouse or parent, from low socioeconomic status, nuclear families, from a rural background. Most were educated but didn't have jobs and stayed with the patient for more than 10 years. Our study found that 93% of the caregivers experienced moderate to severe burden, and 73% of the patients had severe alcohol dependence. The caregiver being illiterate, unemployed, and not having a permanent residence were significantly associated with a high caregiver burden, and the caregiver being male with a low burden. Patients being illiterate, unemployed, and having more than two previous admissions were the factors associated with a severe burden. Logistic regression analysis found caregiver gender and education, patient employment and number of admissions to be predictors of severe burden. Conclusions: There is a high burden among caregivers of alcohol dependent patients. Caregiver gender and education, patient employment and number of admissions were the predictors of severe burden.

Risk of violence in severely mentally ill and the psychiatric morbidity among their caregivers

Aysha Zabin Madathil — 2023-12-16

Background: Violence in psychiatric patients is a major concern to both public and mental health professionals. Risk of violence (ROV) in patients can cause a high degree of psychological stress on caregivers that may predispose them to various psychological problems. Aim: To estimate the ROV in patients with severe mental illness and to estimate the relationship between the ROV among severely mentally ill and the psychiatric morbidity in their primary caregivers. Methods: A cross-sectional study was conducted at a tertiary care center involving 308 patient subjects and their caregivers. Socio-demographic data were collected using a proforma, and caregivers were diagnosed based on the International Classification of Diseases-10 using Mini International Neuropsychiatric Interview (MINI)-Plus. ROV was assessed using Historical Clinical Risk Management (HCR)-20, Version 3. Statistical analysis was done using the Chi-square test for association and odds ratio and its 95% confidence interval for the strength of association. Results: High ROV was found in 32.5% of the severely mentally ill. Caregivers reported a high rate of psychiatric disorders (44.8%), of which 71.7% were mood disorders. A significant association was found between ROV in patients and psychiatric morbidity in their caregivers (p = 0.001). Conclusion: ROV is high among the severely mentally ill. There is a high rate of psychiatric morbidity among caregivers of patients with a high ROV. There is a significant association between psychiatric morbidity in caregivers and ROV in patients.

Psychiatric morbidity among prisoners in South India: A cross-sectional study

S Shiney — 2023-12-30

Introduction: Everyone has a fundamental right to enjoy the best possible level of physical and mental health, irrespective of race or gender. The incarcerated are taken away from their friends and relatives, regardless of their mental state. There is a high prevalence of mental illness among male and female prisoners, as per various studies. The aim of the study is to assess the prevalence of psychiatric morbidity among prisoners without a past history of psychiatric illnesses, to determine the association of socio-demographic factors, and to assess the prevalence of various psychiatric disorders in this population. Methods: A cross-sectional study was conducted on 200 male prisoners by simple random sampling. The assessment was done using a self-prepared socio-demographic proforma and Mini International Neuropsychiatric Interview. Result: The prevalence of any psychiatric morbidity was observed to be 86%, and the most commonly seen morbidity was substance use disorder (81%), followed by adjustment disorders (20%), and 96% had a low risk for suicide. There was almost equal representation of age groups: 74% of prisoners were married or widowed, 90% belonged to rural residences, 75% of the participants had secondary education or below, almost 95% were below poverty line, and 92% were employed previously. Conclusion: In our study, we found that the most common reason for imprisonment was murder and other causes like abkari, family law related, as well as political issues. Almost 12% and 18% reported crime in the family and crime by peers. The most commonly seen morbidity was substance use disorder (81%), followed by adjustment disorders (20%). Around 96% had a low risk for suicide.

Cognitive dysfunction and its correlates in male inpatients with alcohol dependence: A comparative cross-sectional study

Kizhakke Ppattuthodi Rajula — 2024-01-07

Background: Alcohol is the most widely used psychoactive substance worldwide. More than 50% of alcohol dependent subjects can have alterations in cognitive functions. Cognitive dysfunction interferes with treatment and increases the risk of relapse in alcohol dependence; hence, its identification has potential therapeutic implications. We compared the cognitive dysfunction in alcohol dependent inpatients with controls. Methods: This hospital-based cross-sectional comparative study was conducted in a tertiary center in South India. The study population consisted of 76 consenting male psychiatry inpatients of the age group 18-65 years with alcohol dependence who did not have delirium, while 76 caregivers who accompanied patients to the hospital and were not dependent on alcohol were the controls. The severity of alcohol dependence in the study group was assessed using the Short Alcohol Dependence Data Questionnaire (SADD), and the cognitive functions of both groups were evaluated by the Montreal Cognitive Assessment (MoCA). Results: The prevalence of cognitive impairment was higher in the study group than in controls (96.1% vs. 36.8%, p = 0.001). Conclusion: There is a significantly greater cognitive impairment in those with alcohol dependence compared to those without. Evaluating alcohol dependent patients for cognitive impairment can have important therapeutic and prognostic implications.

MHCA-2017: Changing knowledge into practice – Need of the hour (Presidential Address).

K P Jayaprakashan — 2023-12-18

Affective symptoms in an individual with central pontine myelinolysis – A case report

C Haritha Babu — 2023-12-21

Background: Central pontine myelinolysis is characterized by damage to regions of the brain, the most common site being pontine white matter tracts, following a rapid correction of metabolic disturbances such as hyponatremia. Case report: A female aged 34 years presented with gastritis. Baseline investigations did not suggest an infective picture. Her serum sodium levels were noted as 101 meq/l at admission. Corrective measures were carried out, and serum sodium levels increased to 133 meq/l in 3 days. Within three days, she developed manic symptoms. MRI of the Brain confirmed both central and extrapontine myelinolysis. She was treated with mood stabilizers and antipsychotics and was discharged in two weeks with complete remission of symptoms. Discussion: Neuropsychiatric symptoms developing in the background of rapid correction of serum sodium levels have been reported in a few studies previously. Focus on the brain areas involved may provide insight regarding the etiopathogenesis of these symptoms.

Spontaneous pneumothorax in a cannabis dependent person – A case report

M Aswathy — 2023-12-03

Cannabis is a common drug of abuse. There have been only a few studies on the various effects of cannabis on the respiratory system. So here we highlight a case of spontaneous pneumothorax in a patient with cannabis dependence.

Management of alcohol withdrawal state in a patient with respiratory depression

Arathy Nathan — 2023-12-03

Alcohol withdrawal state is generally managed using benzodiazepines. In various studies, it was found that anticonvulsants, including oxcarbazepine, are as effective as benzodiazepines in managing alcohol withdrawal state. This case report highlights the efficacy of oxcarbazepine in acute alcohol withdrawal state where benzodiazepines were contraindicated due to respiratory depression. We report the case of managing alcohol withdrawal state in a 50-year-old male with respiratory depression.

The Re-examination

Prathibha S Manjeeram — 2023-12-26

Holism is central to psychiatric practice

James T Antony — 2024-01-25

Psychiatry in Kerala has come a long way from its humble beginnings. But, in the olden days, psychiatry practice used to be different; it was more holistic. Now, the focus is more on biological insights and novel technologies. As psychiatrists, we have to remain holistic in our clinical approach and manage our patients with a biopsychosocial perspective.

Lithium memoirs

K A Kumar — 2024-01-26

Letters commenting on published articles: Last but not the least

Samir Kumar Praharaj — 2024-01-30

As a part of the post-publication peer review, readers can send comment letters to a journal on the articles it has published. Such letters critically comment on the content of the related article. They allow the readers to see the messages of the article in the context of the criticisms, give the authors of the concerned article an opportunity to clarify their stand, help initiate scientific dialogues, and, with consequent corrections or retractions, even help perfect the scientific literature. Comment letters should be relevant, scientifically foolproof, short, focused, straightforward, balanced, and polite.

Retraction of “Psychosomatic problems in caregivers of patients with major mental illnesses.”

P V Indu — 2024-02-24