Kerala Journal of Psychiatry

Work Stress And Suicide Among Medical Professionals: Time To Act

Mohan Sundaram — 2024-10-08

Painting by A Patient

Anonymous — 2024-10-08

Painting submitted via treating psychiatrist. Both wish to remain anonymous.

Access painting in the HTML format

Attitude Among Medical Graduates Towards Mental Illness And Psychiatry As A Field Of Specialization: A Cross-Sectional Study

Mohammed Sheikh Irfan — 2024-12-04

ABSTRACT

Background: In India, where the burden of mental disorders is substantial, the shortage of trained psychiatrists is alarming; psychiatry remains one of the least chosen specialties among medical graduates. This study assesses medical graduates' attitudes toward psychiatry and mental illness. The study also aims to identify critical barriers that deter students from choosing psychiatry as a career, focusing on gender-based differences in attitudes.

Materials and Methods: A cross-sectional survey was conducted among medical graduates using the Attitude Towards Psychiatry-30 (ATP-30) scale. Data were analyzed using independent t-tests.

Results: Both male and female participants demonstrated positive attitudes toward psychiatric patients and the significance of psychiatric illness. However, significant gender differences were observed in critical areas, with females more likely to question psychiatry’s scientific rigor (p = 0.025) and job satisfaction in psychiatry (p=0.008). Despite positive overall attitudes toward psychiatry, only 26% of participants expressed an interest in pursuing psychiatry as a career, with females showing a higher reluctance, though not statistically significant (p =0.708).

Conclusion: While medical graduates generally hold favorable attitudes toward psychiatry, gender differences in perceptions regarding the scientific rigor of psychiatry and concerns about job satisfaction act as barriers.

Funding: Self Funded

Conflict of Interest: None

Complex Relationship between Social Networking Sites Use, Mental Health, and Well-being: A Cross-sectional Study

Merin Poulose — 2024-12-27

Background: Social Networking Systems (SNS) are web-based services integral to global communication and social interaction. This study explores predictors of smartphone addiction, the role of motivation and psychosocial well-being, and the prevalence and predictive role of anxiety and depression in smartphone addiction.

Materials and Methods: This survey-based study used Google Forms to collect data through a predesigned questionnaire and other standardized scales. It was conducted over five days and shared through various SNS platforms.

Results: 78.69% identified themselves as netizens and 38.5% met the criteria for smartphone addiction, which was used as a window to assess SNS use. The psychological well-being scale scores were higher in participants without smartphone addiction. Higher scores in personal growth (p=0.001), environmental mastery (p=0.02), and self-acceptance (p=0.002) were significantly associated with lower smartphone addiction. Personal growth subscale and Behavioural Inhibition System Scores were statistically significant predictors for smartphone addiction. A significant association was found between depression levels and smartphone addiction.

Conclusion: Individuals struggling with psychosocial well-being, low self-acceptance, lack of control over their environment, and inadequate coping skills for personal growth are likely to use SNS as a refuge. Depression needs to be ruled out while exploring smartphone addiction.

Conflict of Interest: None

Source/s of Research Funds: Self

Codependency And Personality Characteristics Of Caregivers Of Patients With Alcohol Dependence Syndrome: A Cross-Sectional Study

Alka Baby — 2024-12-10

Background

Alcohol dependence syndrome (ADS) is one of the most well-known issues in the public domain; it affects not only the patient but also those in their immediate vicinity, including family members. Family members may eventually become codependent, which throws off the dynamics within the family. Recognizing and rectifying this issue will, in turn, improve their coping strategies and enhance their quality of life. This study analyses the codependency and personality traits of caregivers of ADS patients and evaluates the association between these two variables.

Methods

This cross-sectional study was conducted in the Psychiatry department of a tertiary care facility in Kerala, India. For this study, 92 male ADS patients' caregivers were evaluated. The International Personality Disorder Examination (IPDE) and the Spann-Fischer Codependency Scale (SFCS) assessed caregivers' personality traits and codependency. The collected data was examined, and the Fisher’s Exact test was used to determine the statistical significance.

Results

The SFCS ratings of 92 caregivers of ADS patients showed that 57.61% had low, 29.35% had moderate, and 13.04% had severe codependency. An IPDE personality examination revealed that 29.3% of caregivers had anxious characteristics, and 30.4% had dependent personality traits. A p-value of <0.001 indicated a statistically significant association between codependency and personality traits.

Conclusion

In this study, a statistically significant association between codependency and personality traits among caregivers of ADS patients was observed.

Funding: Self funded

Conflict of Interest: None

Factors Influencing Relapse Among Alcohol Dependent Patients - A Mixed Method Study

Chikku Mathew — 2024-12-12

Background

Alcohol use disorders are chronic, and relapses occur due to neurobiological and psychosocial factors. This study was conducted to elicit the prevalence of psychiatric co-morbidities, severity of dependence, craving, and level of motivation in alcohol-dependent subjects who have relapsed and to elicit factors resulting in relapse using a mixed method.

Method

Eighty-two alcohol dependence syndrome patients (ADS) with a history of relapse were recruited after obtaining consent. A mixed method-concurrent parallel design was adopted. Mini-International neuropsychiatric interview (M.I.N.I), Penn Alcohol Craving Scale (PACS), Severity of Alcohol Dependence Questionnaire (SADQ), and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) questionnaires were administered. Six in-depth interviews (IDI) and 5 focus group discussions (FGD) were conducted, and the data from the two phases were analyzed.

Results

The mean age of the participants was 44.45 years. 53.7 % had co-morbid tobacco use, 43.9 % had borderline personality disorder and 47.6% had mild dependency. 41.5 % had only moderate levels of motivation to quit. A significant association was obtained between the severity of dependence and craving (p= 0.016). Qualitative data identified 1) Drinking Motives, 2) Self-perception, 3) Misconceptions related to alcohol use, and 4) Social factors leading to relapse.

Conclusion

The study shows that co-morbid tobacco use and the presence of borderline personality disorders were higher in patients with relapse and that severe dependence was associated with higher craving. Motives related to usage, self-perception about alcohol use, misconceptions related to alcohol use, and social factors also led to relapse.

Funding: Self funded

Conflict of Interest: None

Depression, Anxiety, and Stress among the LGBTQIA+ Population in Northern Kerala: A Cross-sectional Study

Linda L Lawrence — 2024-12-31

Background: LGBTQIA+ are a minority exposed to discrimination, stigma, and unfavorable legislation. They face difficulty in accessing appropriate healthcare interventions, which makes them more prone to psychological dysfunction. However, currently, there is a dearth of research in this area. Hence, this study aimed to estimate the prevalence of depression, anxiety, and stress among the LGBTQIA+ population in Northern Kerala. Also, this study attempted to find the association between sociodemographic profile and severity of anxiety, depression, and stress. Materials and Methods: Depressive symptoms, anxiety symptoms, and stress levels were evaluated in 78 participants from a health awareness camp for the LGBTQIA+ community using the PHQ-9 questionnaire, GAD-7 scale, and Perceived Stress Scale. Statistical analysis was conducted using SPSS version 20.0. Results: The majority of the participants experienced minimal to mild anxiety (70.5%) and depressive (47.5%) symptoms. Moderate level of stress was reported by 84.6% of participants. Association between anxiety symptoms and sociodemographic variables like biological sex and gender identity were found to be statistically significant (chi-square=14.986, p value=0.005 and chi-square=12.816, p value=0.046). Depressive symptoms had a significant association with gender identity (chi-square=18.132, p value=0.034), and stress had an association with socioeconomic status, which was found to be statistically significant. (chi-square=15.846, p value=0.003). Conclusion: The burden afforded by anxiety, depression, and stress on the lives of the LGBTQIA+ community warrants early detection and psychiatric intervention. In light of a dearth of studies, further research in this area is the need of the hour.

Recurrent Treatment Emergent Delirium in A Case Of Bipolar Disorder With Primary Adrenal Insufficiency- A Case Report

Lakshmipriya PM — 2024-11-01

Background: Addison’s disease (AD) is associated with a range of neuropsychiatric symptoms, including mood disorders. Treatment-emergent delirium in patients with AD and comorbid bipolar affective disorder (BPAD) is rare. Case Report: A 45-year-old male with a 25-year history of episodic psychiatric illness developed increased talkativeness, overfamiliarity, and decreased need for sleep after medication discontinuation. Upon readmission, he was treated with lithium, quetiapine, and sodium valproate, subsequently developing delirium and hyponatremia. Sodium valproate was discontinued, and low-dose antipsychotics were introduced alongside lithium adjustments. He responded well, with delirium resolving and manic symptoms managed effectively. Discussion: This case underscores the need for careful monitoring of electrolyte levels in patients with AD on psychotropic medications to prevent treatment-emergent delirium.

Zolpidem Withdrawal Symptoms in Schizophrenia – A Case Report

Anusree Nilavarayath — 2024-11-15

Background: Substance abuse and dependence are common psychiatric co-morbidities in schizophrenia. Many cases of withdrawal symptoms with high doses of zolpidem dependence were reported in mood or anxiety disorders. Here, we present a case of zolpidem withdrawal in a schizophrenia patient.

Case report: A 51-year-old male diagnosed with paranoid schizophrenia presented with restlessness, headache, threatening violence, and craving for zolpidem within about two hours of stopping the drug. Zolpidem was prescribed for insomnia. He developed dependence and experienced withdrawal symptoms even with a one-hour delay in getting zolpidem. It was successfully treated with 1mg of clonazepam.

Discussion: Schizophrenic patients often abuse zolpidem, leading to dependence and withdrawal when prescribed for insomnia. Severe withdrawal symptoms can occur with a lower dose of zolpidem. Zolpidem withdrawal can be treated with benzodiazepines like clonazepam.

Propofol Induced Seizure like Phenomenon During Modified Electroconvulsive Therapy

Divya R Nair — 2024-12-18

Background: Propofol is an intravenous anesthetic that is said to have anticonvulsant properties. This is a case report of the propofol-induced seizure-like phenomenon (SLP) during modified (MECT).

Case Report: A 24-year-old female with severe depression without psychotic symptoms and borderline personality disorder underwent six sessions of MECT. During the earlier session of MECT using thiopentone as an anesthetic, a prolonged seizure occurred, indicating a low seizure threshold. Then, it was changed to propofol. When propofol was given as an induction agent, even before giving ECT, the patient developed seizure-like involuntary jerking movements. EEG and MRI were done after the fourth session and were found normal.

Discussion: This case report highlights that even though propofol has anticonvulsant activity, few cases of SLP during procedures have been reported. Propofol-induced SLP during MECT is the first of its kind.

Conflict of Interest: Rajmohan Velayudhan: The article was submitted on 30 July 2024. On 12 August, the author became editor-in-chief of the Journal. Adhering to COPE Guidelines, the previous editor and section editor processed and decided on the article. The current editor-in-chief was not involved in any processing or decision-making phase.

The other authors have no conflict of interest.

Self-compassion Among Psychiatrists - A Brief Narrative Review

Krishnan Sivasubramoney — 2024-12-14

Self-compassion is treating oneself with kindness, recognizing shared humanity, and holding painful thoughts and feelings in balanced awareness. It is particularly beneficial for psychiatrists who face highly stressful environments. Self-compassion can serve as a protective factor against burnout, emotional exhaustion, and compassion fatigue. It is associated with increased emotional resilience and a greater sense of well-being.

The culture within medical and psychiatric fields often emphasizes perfectionism, which can make it difficult for psychiatrists to practice self-compassion. Mindfulness practices can be integral to developing self-compassion. Healthcare institutions can play a crucial role in fostering an environment conducive to self-compassion by providing mental health support, creating peer support groups, and promoting a culture that values self-care and work-life balance.

Individual psychiatrists can adopt personal practices to enhance self-compassion. Self-compassion can also positively impact patient care by fostering empathy, patience, and understanding and encouraging patients to adopt similar attitudes toward themselves.

Experiments with OCD: A Review of Dr. P.J. Saju's Journey through OCD and CBT

Jaseela PT — 2024-12-21

"People are not disturbed by things, but by the view they take of them" – Epictetus.

The quote above aptly highlights the profound influence of thoughts on life. This theme resonates throughout Dr. P.J. Saju's Malayalam book Ente OCD Sathyanweshana Pareekshanangal. (translated as OCD- My Experiments with Truth) The author aims to improve understanding and awareness of obsessive-compulsive disorder (OCD) among readers, and the book successfully fulfills this purpose. It underscores that OCD extends beyond the stereotypical notions of excessive washing or cleaning, delving into its complexities. The book serves as an easy-to-use self-help guide for anyone who desires to use cognitive behavior therapy (CBT) to overcome OCD.

The book is available on Amazon.com [Link]

Reporting of ‘Ethical Considerations’ in Research Papers: The Essentials

Samir Kumar Praharaj — 2024-12-28

Ethical considerations are a fundamental component of research manuscripts. Standard practices involve documenting written informed consent, ethics committee approval, and trial registration. When mentioning ethics committee or trial registry details, include the name, approval number, and date. Providing clear and comprehensive documentation of ethical considerations fosters transparency and enhances trust in the research process among editors, reviewers, and readers.

Preserving the ‘Right to Play’- Stories of Lost Playgrounds

Rachna George — 2024-12-25

Play, an essential element of childhood, is characterized by freedom, creativity, and spontaneity, offering children a self-directed space for exploration, inquiry, and enjoyment. Beyond recreation, play fosters cognitive, emotional, and social development through theoretical underpinnings like Piaget’s cognitive development theory, Vygotsky’s sociocultural approach, and Freud’s psychodynamic lens.

Developmentally, play evolves through stages, from solitary to cooperative interactions, as described by Mildred Parten. Ethological studies reveal that play contributes to social hierarchies and adaptive skills even in the animal kingdom. However, modern urbanization, digital entertainment, and structured activities have eroded unstructured outdoor play opportunities. Legislative efforts, such as the UNCRC’s Article 31, affirm children’s right to play, yet implementation varies globally. Case studies from Wales, India, and Scandinavia highlight innovative solutions to reclaim play, including mobile play hubs, community-driven spaces, and play-centric policies.

Play’s role extends beyond individual development to shaping societal values. Structural and policy changes, such as inclusive urban planning and international advocacy, combined with attitudinal shifts that prioritize unstructured play, are imperative. Recognizing play as a fundamental right is essential to nurturing creativity, critical thinking, and well-being, ensuring children grow into well-rounded individuals.

Play and its Salience in Children

John Vijay Sagar Kommu — 2024-12-31

Play ensures the holistic development of a child across all developmental domains, provides valuable learning opportunities, enables children to practice and strengthen their skill repertoire, and provides a sense of agency to children. Play is an important medium to initiate and maintain peer relationships. Play allows children to express their feelings and allows them to work with unacceptable feelings. Article 31 of the United Nations Rights of the Child mentions that play is the right of all children. This editorial focuses on the importance of play in the life of childern.