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 Comments on the editorial on the Rights of Persons with Disabilities (RPWD) Act 2016 and Psychiatric Care. Hareesh Angothu Copyright (c) 2020 Kerala Journal of Psychiatry 2020-06-11 2020-06-11 33 1 76 79 10.30834/KJP.33.1.2020.191 A case report of Lithium induced Dariers disease <p>Lithium has been used frequently in the management of Affective disorders since six decades and known to cause dermatological adverse events in the form of Acne, exacerbation of Psoriasis etc..Here we report another dermatological manifestation of Lithium therapy, induction of Dariers disease.</p> Dinesh Kumar MK Aswathi T V Shima K Copyright (c) 2020 Kerala Journal of Psychiatry 2020-02-21 2020-02-21 33 1 52 55 10.30834/KJP.33.1.2020.181 Anti NMDA encephalitis presenting with mixed psychiatric symptoms - case report <p>Anti NMDA receptor encephalitis is an autoimmune reaction against neuronal cell surface antigens. The prevalence of this condition is about 0.6 per lakh. Here, we present the case of an 18-year-old female, who presented with seizures along with both dissociative and psychotic symptoms. Later, she turned out to be a case of Anti-NMDA receptor encephalitis. Anti NMDA receptor encephalitis presents with behavioural, cognitive, psychiatric and neurological symptoms progressing to coma and death if untreated. The patient did not show improvement with first-line therapy like IVIG. Hence, the second-line agent, Rituximab, had to be used. She needed three anti-epileptic drugs for seizure control. There is evidence that delay in treatment can adversely affect the prognosis. There should be increased awareness among psychiatrists and other relevant medical professionals about this under-diagnosed disorder.</p> <p>&nbsp;</p> Swathy Sheela Sudevan Gayatri Rajan Arathi J S Varsha Vidyadharan Harish M Tharayil Copyright (c) 2020 Kerala Journal of Psychiatry 2020-05-16 2020-05-16 33 1 56 59 10.30834/KJP.33.1.2020.190 Psychotropic medications and metabolic side effects in common genetic syndromes with intellectual disability-case report <p>Multi-systemic genetic disorders are strongly associated with psychiatric illness and may require psychotropics for their management. The choice of psychotropics is primarily determined by medical comorbidities and adverse effects. A careful assessment of behavioural phenotype and metabolic monitoring for children on psychotropics should be followed to avoid adverse consequences. Hence, the need for monitoring of metabolic syndrome during routine clinical evaluation and the use of aripiprazole which demonstrated a good response with minimal adverse effects are highlighted with a description of cases of children with intellectual disability and neurodevelopmental genetic syndromes like Down Syndrome and Prader-Willi syndrome.</p> Charanya Kaliamoorthy Moushumi Purkayastha Mukherjee Manul Das Nivedhitha Selvakumar Preeti Kandasamy Copyright (c) 2020 Kerala Journal of Psychiatry 2020-06-22 2020-06-22 33 1 60 63 10.30834/KJP.33.1.2020.193 A case report of dacrystic seizures presenting with psychosis <p>Dacrystic seizures present with sudden bursts of crying and often manifest with comorbid psychiatric symptoms. Here, we present the case of a 27-year-old female with an 11-year history of stereotyped patterns of crying spells, associated with fearfulness, suspicions, hallucinatory behaviour, recurrent suicidal gestures and impairment in functioning. She was treated mostly with antipsychotics, antidepressants and mood stabilizers (for a brief period) irregularly, without adequate improvement. She presented with catatonia, hypokalemia and aspiration pneumonia, following default of medications for one month. With appropriate treatment, her physical condition became stable, when short-lasting bouts of recurrent crying spells were observed, followed by confused behaviour and sleep, along with delusions and hallucinations. Her EEG showed epileptiform discharges; brain imaging was normal. She showed good response to anticonvulsants along with antipsychotics. Such unusual presentations of epilepsy and comorbid psychiatric symptoms warrant a high index of suspicion, for proper diagnosis and management.</p> Aysha Zabin M Madathil Anithakumari Ayirolimeethal Pankajakshan Vijayanthi Indu Copyright (c) 2020 Kerala Journal of Psychiatry 2020-07-01 2020-07-01 33 1 64 68 10.30834/KJP.33.1.2020.199 The Rights of Persons with Disabilities Act 2016 and Psychiatric Care Thomas John Copyright (c) 2020 Kerala Journal of Psychiatry 2020-02-13 2020-02-13 33 1 1 4 10.30834/KJP.33.1.2020.183 When breath becomes air <p>NIL</p> P M A Nishad Ravichandra Karkal Anil Kakunje Mohan Chandran VV Copyright (c) 2020 Kerala Journal of Psychiatry 2020-02-13 2020-02-13 33 1 85 87 10.30834/KJP.33.1.2020.184 How to choose a research topic? Samir Kumar Praharaj Shahul Ameen Copyright (c) 2020 Kerala Journal of Psychiatry 2020-04-15 2020-04-15 33 1 80 84 10.30834/KJP.33.1.2020.188 Impact of COVID-19 Lockdown on Lifestyle and Psychosocial Stress - An Online Survey <p><strong>Background</strong>: In addition to the socioeconomic problems, COVID-19 related lockdown may have profound mental health consequences. <strong>Aims and Objectives</strong>: The objectives were to assess the influence of lockdown on lifestyle, psychosocial stresses and experienced quality of life (QOL). The study also assesses the association of the socio-demographic variables with lifestyle, psychosocial stress and QOL. Methodology: An online survey on the lifestyle changes, psychosocial stress and QOL were conducted using a validated questionnaire via the Google forms platform. The data collected were analysed using parametric and nonparametric tests. Results: The study included 263 respondents. The fear of developing COVID-19 was reported by 67.7%, 31.2% experienced weight gain, internet use was increased in 66.9%, and alcoholism and smoking decreased by 83.3% and 58.8% respectively. Lockdown upset 48.3% moderately, and 36.1% experienced anxiety, 23.4% feared job loss and 51.3% had financial worries. 91.1% of the study population reported fair to good QOL. Females showed significantly more religiosity, (?<sup>2= </sup>7.81; p= 0.02) did lesser exercise, (?<sup>2= </sup>10.9; p= 0.023) and had poor mood. (t=2.68; p=0.009) Older people were less afraid of COVID-19 infection and were less upset by the lockdown. The urban population were more fearful of COVID-19 and were more upset by the lockdown. Conclusion: Lockdown had a major effect on lifestyle and increased psychosocial stress, but people still experienced a fair QOL during this period.</p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> Divya R Nair Velayudhan Rajmohan Raghuram TM Copyright (c) 2020 Kerala Journal of Psychiatry 2020-06-21 2020-06-21 33 1 5 15 10.30834/KJP.33.1.2020.194 Consultation Liaison Psychiatry - Diagnostic concordance between referring physician and psychiatrist <p><strong>Background</strong>: Consultation – liaison psychiatry (CLP) provides expert advice and act as a liaison. There is a high prevalence of psychiatric comorbidities among patients of other specialities, yet the referral rates are low, probably due to inadequate psychiatric awareness which can be assessed from the diagnostic concordance.</p> <p><strong>Objective: </strong>To assess diagnostic concordance between the psychiatrist and referring doctor.</p> <p><strong>Materials and</strong> <strong>Methods: </strong>This is a cross-sectional record-based study of all inpatients referred to CLP. Data was collected from CLP registry.</p> <p><strong>Results: </strong>Most of the referrals were from General Medicine. The most common reason for referral was alcohol use disorders and common diagnoses made by referring physicians were alcohol use disorders, delirium and mood disorders, similar to the psychiatrist’s diagnoses; however, deliberate self harm (DSH), a common diagnosis made by the referring doctor, constituted only 4.2% of psychiatrist’s diagnoses. There was complete diagnostic concordance for 40.9%; perfect agreement was found for DSH and alcohol use disorders, substantial agreement for delirium and moderate agreement for mood disorders. The agreement was low for DSH with comorbid depression, other substance use disorders and organic mental disorders.</p> <p><strong>Conclusion: </strong>The diagnostic concordance for common mental health problems is low, according to the present study. CLP needs to extend its educational function towards other specialities and it should be an active component of undergraduate psychiatric training.</p> <p><strong>Keywords</strong>: Consultation Liaison Psychiatry, Diagnostic concordance</p> <p> </p> Reji Keerthy P S Sivin P Soumya Varughese Sheena Geo Joice Vijayan Vijayalal Roy Abraham Kallivayalil Copyright (c) 2020 Kerala Journal of Psychiatry 2020-02-21 2020-02-21 33 1 16 26 10.30834/KJP.33.1.2020.182 Effect of a Stress Reduction Programme on Academic Stress and Coping Skills of First Year Medical Students <p><strong>Background</strong>: Medical students, especially in the first year of their college life, are under stress. <strong>Materials and Methods</strong>: Study was conducted on 100 first year medical students. The students were given a semi-structured questionnaire to collect sociodemographic data; they were subsequently administered the Academic Stress Scale and the Adjustment Style Inventory. Then a Structured Stress management session was conducted for them, and they were made to practice many stress coping skills for three weeks, following which the questionnaires were re-administered and data collected. The data were analysed with the chi-square test, independent-sample t-test, paired t-test and Pearson’s correlation.</p> <p><strong>Results</strong>: The academic stress and coping scores showed no difference among both sexes. The academic stress score showed a negative correlation with coping scale (p= 0.019). There was a significant reduction in the academic stress score post-intervention (p&lt;0.001). The scores of adjustment styles also showed a significant improvement, and there was a significant improvement in the total adjustment style score and negative coping score post-intervention (p&lt;0.001). The positive coping score, however, did not show a significant change.</p> <p><strong>Conclusion</strong>: Stress management programmes are effective in reducing academic stress and adjustment styles. The students tend to reduce negative coping skills and better manage stress, post-intervention.</p> <p class="western" align="justify"><span lang="en-IN">&nbsp;</span></p> Ajith Premnath Sheela Sivan Rajmohan Velayudhan Suni MS Raghuram TM Copyright (c) 2020 Kerala Journal of Psychiatry 2020-04-11 2020-04-11 33 1 27 33 10.30834/KJP.33.1.2020.187 A cross sectional study on Psychological aspects and Quality of Life of Nursing Students <p><strong>Background:</strong> With the increase in students pursuing nursing education in India, studies report one in four students suffer from stress related disorders like anxiety and depression. While many studies focus on the stressors and associated external factors, this study was designed to assess dimensions of personality, types of coping and potential impact on quality of life.</p> <p><strong>Methodology:</strong> A cross sectional survey was conducted with universal sampling of 161 consenting nursing students. Semi structured proforma, Eysenck Personality Inventory (EPI), Coping Strategies Inventory- short form (CSI-SF) and WHOQOL – BREF were used for data collection. Statistical analysis was done using SPSS version 20. Descriptive statistics of mean (sd) and percentages and inferential statistics of Independent t-test, ANOVA and Pearson’s correlation analysis were used.</p> <p><strong>Results:</strong> 161 out of 184 study participants were included in the analysis. 93.2% of participants were females and more than 60% were from rural background. Neuroticism scores were significantly higher among first and second year student. Problem focused disengagement and emotion focused disengagement scores were significantly higher among first and fourth year students respectively. Third year students scored high across psychological, social and environmental domains of quality of life.</p> <p><strong>Conclusion:</strong> Neuroticism as a trait negatively impacts the student’s coping strategies and quality of life. Early understanding of individual’s personality will help to implement measures to strengthen their coping strategies in dealing with stressors and improve quality of life.</p> Arumuganathan S Sumithra Devi S Usaid S Ezhilarasi P Baby E Siva Ilango T Copyright (c) 2020 Kerala Journal of Psychiatry 2020-05-12 2020-05-12 33 1 34 41 10.30834/KJP.33.1.2020.189 Delay and treatment factors of psychiatric treatment among patients seeking faith healers <p><strong>Background</strong>: Belief in faith healers, lack of awareness and stigma of mental illness have placed obstacles in timely identification and treatment of mental illness. This study assessed the factors influencing individuals with mental illness to seek faith healers. It was also planned to study the delay caused due to faith healers in starting psychiatric treatment.</p> <p><strong>Methods</strong>: Cross-sectional study of 100 consecutive patients who had visited a faith healer at least once and attending the outpatient clinic of the department of psychiatry was done using a semi-structured questionnaire.</p> <p><strong>Results</strong>: Fear of psychiatric medication (46%), stigma of psychiatric illness (44%) and beliefs in myths (43%) were the main reasons for avoiding psychiatric treatment. There was a significant delay in psychiatric treatment initiation when comparing people who first visit faith healers to those who first visited psychiatrists (28.2 months vs 14.5 months, p=0.002). Post-visit to psychiatrist, 57% prefer to continue with the psychiatrist, and 34% would visit both, and only 5% would prefer faith healer.</p> <p><strong>Conclusions</strong>: Myths and stigma regarding psychiatric illness are prevalent, and mental health education can improve the scenario.</p> Asha Jalal Ajith Premnath Suni MS Rajmohan Velayudhan Manoj Kumar G Raghuram TM Copyright (c) 2020 Kerala Journal of Psychiatry 2020-05-12 2020-05-12 33 1 42 51 10.30834/KJP.33.1.2020.186 Kerala Psychiatry, yesterday and today: recollections and reflections <p>During the 35th annual conference of Kerala State branch of Indian Psychiatric Society (SIPSCON 2019), conducted in Thrissur, a group activity was designed, titled ‘Voices from the floor: group activity on contemporary psychiatric issues in Kerala’. In this academic program, the participants were given the centre stage. It was designed as a group activity where all the delegates were divided into small groups to give their experiential account and reflection related to mental health care in Kerala. The topic of discussion and exploration in each group were chosen from either one of the broad perspectives of clinician, academician or mental health activist.</p> <p>&nbsp;This narrative is based on the introductory remarks made in the workshop, co-authored by all the authors and presented by the third author. From this activity, the outcome expected was to discover a treasure of information which could pave the way for further exploration and action plans. No consensus was aimed at. These could shape the future of Kerala mental health scenario.</p> Smitha Ramadas Girish Menon Praveenlal Kuttichira Copyright (c) 2020 Kerala Journal of Psychiatry 2020-03-19 2020-03-19 33 1 69 75 10.30834/KJP.33.1.2020.185 Case report and case series <p>Case reports/series are the basic types of descriptive epidemiologic studies. The distinction between case reports and case series on the one hand, and case series and descriptive/analytic epidemiologic studies, on the other hand, is not sharp. History of medicine has demonstrated how case reports/series had generated or furthered medical knowledge in many situations. External validity and novelty are the key advantages of these studies. They act as ‘screening studies’ for deductive epidemiological research. Case reports/series are fraught with biases and lack of strength of evidence to inform clinical decision making. To generate evidence-based information, authors of case reports/series should give attention to the guidelines for maintaining of methodological rigour.</p> <p>&nbsp;</p> <p>&nbsp;</p> Pankajakshan Vijayanthi Indu Karunakaran Pillai Vidhukumar Copyright (c) 2020 Kerala Journal of Psychiatry 2020-05-23 2020-05-23 33 1 88 92 10.30834/KJP.33.1.2020.197