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 Hypomanic episode following COVID - 19 Pneumonia - case report <p>Coronavirus disease-2019 (COVID-19), an acute respiratory infection caused by severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2), was declared a pandemic in early 2020. Although the virus primarily affects respiratory and gastrointestinal systems, it is neurotropic and has neuropsychiatric complications. The most common neuropsychiatric manifestations seen in COVID-19 infection include delirium, depression, anxiety and post-traumatic stress disorder; very few cases of mania have been reported. Here, we report two cases –an elderly male and a middle-aged female – without a past history of psychiatric illness, presenting with hypomanic episodes following COVID-19 infection. Their blood investigations were normal, and neuroimaging revealed chronic and age-related changes only. As they showed a good response to mood stabilizer, further evaluation including the CSF study was deferred. Psychiatric symptoms could have been the outcome of an interaction of the psychosocial stressors associated with the pandemic on the brain, which was made vulnerable by the COVID-19 infection. </p> Kuruthikadavath Kurussithodi Hridya Surendran Kalambattumadathil Surabhi Pankajakshan Vijayanthi Indu Copyright (c) 2021 Kerala Journal of Psychiatry 2022-03-18 2022-03-18 35 1 64 67 10.30834/KJP.35.1.2022.281 Colpocephaly with seizure disorder in an adult- report of a rare case <p>Colpocephaly is a congenital abnormality in the ventricular system of the brain. It is a rare anatomic finding in the brain characterized by occipital horns that are disproportionately enlarged compared to other parts of the lateral ventricles. The radiological diagnosis is usually made in the perinatal period and early childhood. The patient usually suffers from mental retardation, seizures and delayed motor milestones in early childhood and presents other congenital anomalies like meningomyelocele. Adult cases of colpocephaly have rarely been reported. This case report describes a case of a 21 year old man who presented with epileptic seizures occurring for the last three years. Nothing significant was found on the physical and mental state examination. His EEG was unremarkable. His CT Scan revealed Colpocephaly with dysgenetic corpus callosum with intracerebral lipoma. The patient was put on antiepileptics and his epileptic seizures resolved. </p> <p> </p> Prinka Arora Kumar Mahesh Copyright (c) 2022 Prinka arora, Mahesh Kumar (Author) 2022-03-03 2022-03-03 35 1 68 69 10.30834/KJP.35.1.2022.304 Early onset schizophrenia with an underlying epileptiform disorder-a case report <p>We report the case of a 15 year old girl presenting with negative symptoms of schizophrenia, with an underlying epileptiform disorder that was masked. Though many cases of epilepsy who subsequently develop a psychotic disorder have been well documented, only a few cases of primary psychotic disorder with epilepsy have been described. This case report highlights the overlap between both these disorders and the need for a clinician to be cognizant of both.</p> Mariyam Salim Sreya Jithin George Anilkumar T.V Arun B Nair Copyright (c) 2022 Mariyam Salim Sreya, Jithin George, Anilkumar T.V, Arun B Nair (Author) 2022-04-13 2022-04-13 35 1 70 73 10.30834/KJP.35.1.2022.308 Choosing an appropriate title for your manuscript Samir Kumar Praharaj Shahul Ameen Copyright (c) 2022 Samir Kumar Praharaj, Shahul Ameen (Author) 2022-08-02 2022-08-02 35 1 74 77 10.30834/KJP.35.1.2022.343 Use of Effect Size in medical research: A brief primer on its why and how L Manoj Kumar Jayan Stephen Rinu George GL Harikrishna PS Anisha Copyright (c) 2022 L Manoj Kumar, Stephen Jayan , George Rinu , GL Harikrishna, PS Anisha (Author) 2022-05-22 2022-05-22 35 1 78 82 10.30834/KJP.35.1.2022.322 Gender differences in bipolar disorder- a cross-sectional study in central Kerala <p><strong>Introduction</strong>: There is a need for better recognition of the nature and course of bipolar disorder among both genders as it may improve the quality of care. The objective of the study was to identify gender differences in sociodemographic characteristics and illness characteristics among patients with bipolar disorder presenting to a tertiary care centre. <strong>Methods</strong>: This was a cross-sectional descriptive study comparing 50 males and 50 females with a diagnosis of bipolar disorder, current episode manic according to DSM 5 criteria. The sociodemographic and illness-related data were collected from a reliable informant, and the Young Mania Rating Scale (YMRS) was applied. <strong>Results</strong>: The total number of episodes was similar between genders; however, the number of depressive episodes (p&lt;0.000) was more in females. The majority of males had the first episode of mania, whereas the first episode in females was mostly depressive (p=0.009). Comorbid medical illnesses especially, hypothyroidism and obesity, were seen more often in women and substance use was higher in men. <strong>Conclusion</strong>: It was found that women often had depressive episodes, whereas a manic picture was commonly seen in men. Endocrine and metabolic abnormalities were more often seen in women with bipolar disorder, while substance abuse was prevalent among men. A substantial difference was noticed in the course, polarity and severity of illness between the genders. This knowledge may provide better insight into adequate treatment strategies for improving the quality of life in persons with Bipolar disorder.</p> Bettina Sara Mathew Soumya P Thomas Roy Abraham Kallivayalil Copyright (c) 2021 Bettina Sara Mathew, Soumya P Thomas, Roy Abraham Kallivayalil (Author) 2022-01-25 2022-01-25 35 1 1 8 10.30834/KJP.35.1.2022.288 Intimate partner violence and its association with common mental disorders among spouses of men with alcohol dependence syndrome attending tertiary care hospital <p><strong>Background: </strong>Intimate Partner Violence (IPV) among spouses have been associated with increased common mental disorders (CMDs) and poor quality of life in women. But this relationship has not received adequate research attention. <strong>Aim: </strong>To study the prevalence of IPV and CMDs and their interrelationship among spouses of people with ADS. <strong>Methods: </strong>A cross-sectional study was done on 65 spouses (participants) of people with ADS admitted to the inpatient de-addiction services. The participants were administered with Demographic and Health Survey Tool, Domestic Violence Module (DVM) to assess the IPV. Alcohol Use Disorder Identification Test (AUDIT) was applied to note the pattern of alcoholism. Participants were administered with Self Reporting Questionnaire-20 (SRQ-20). Those who had a score of 6 and above on the SRQ-20 were administered with specific modules of MINI. International Neuropsychiatric Interview PLUS to obtain a specific diagnosis of CMD. <strong>Results: </strong>IPV was present either in the form of emotional, physical or sexual violence (84.6%). Physical (72.3%) and emotional violence (66.2%) was noted to be the most commonly experienced violence, followed by sexual violence (30.8%). On backwards linear regression analysis, emotional violence was found to be a significant predictor variable for CMDs (p &lt;0.05), and the Chi-square test showed a significant association of CMDs with emotional violence ( p = 0.009 ). <strong>Conclusion</strong>: The results emphasize the need to develop and integrate psycho-social interventions in the routine de-addiction programmes, focusing on the mental well-being of spouses of people with ADS. Conventionally, de-addiction programmes focus more on the patient, and less emphasis is given to the mental health needs of the spouses. This study highlights that CMDs and IPVs are prevalent in spouses of patients with ADS. Hence, such interventions can aid in the early diagnosis and management of CMDs.</p> Deepthi Vijay Hudge Aneesh S Bhat Anish V Cherian Satheesh Rao Francis N P Monteiro Copyright (c) 2022 Kerala Journal of Psychiatry 2022-01-20 2022-01-20 35 1 9 15 10.30834/KJP.35.1.2022.299 Prevalence and characteristics of Thyroid dysfunction in patients with Depressive Disorders presenting to Tertiary care center- A cross-sectional study <p><strong>Background: </strong>Thyroid dysfunctions, hypothyroidism and hyperthyroidism, can lead to mood disorders like depression and mania. Conversely, depressive disorders are associated with subtle variations in thyroid hormone levels. <strong>Objectives: </strong>The objective of the study was to examine the prevalence and characteristics of thyroid dysfunction in patients with Depressive disorders. <strong>Methodology: </strong>A cross-sectional study was conducted on patients diagnosed with depressive disorders who presented to outpatient and inpatient setting in the psychiatry department. Consecutive sampling method was used till the calculated sample size of 82 patients was reached. Diagnosis of depressive disorder was done as per the International Classification of Diseases, 10<sup>th</sup> revision (ICD-10). Hamilton depression rating scale (HAM-D) was administered to assess the severity of depressive symptoms. Thyroid Dysfunction was diagnosed based on the morning (8 AM) serum levels of T3, T4 and TSH levels. Data analysis was done using statistical package for the social sciences (version 24), and results were presented as mean and percentages. <strong>Results: </strong>Among 82 patients with depression, the prevalence of thyroid dysfunction was 15% (12), and subclinical hypothyroidism was the most common type with prevalence of 11% (9), followed by hypothyroidism. There was no significant association between the severity of depressive episode and the type of thyroid dysfunction (x<sup>2</sup>-14.208, df-9, <em>p</em>-.115). <strong>Conclusion: </strong>Prevalence of thyroid dysfunction is higher in depressive disorders. Regular monitoring of Thyroid functions tests should be considered during follow up to prevent relapse of symptoms.</p> Fakirappa Ganiger A T Safeekh Somashekhar Bijjal Manisha Sharma Copyright (c) 2022 Dr Fakirappa B Ganiger, Dr Safeekh AT, Dr Somashekhar Bijjal, Dr Manisha Sharma (Author) 2022-04-19 2022-04-19 35 1 16 20 10.30834/KJP.35.1.2022.301 Severity of Alcohol Dependence Syndrome and its Socio-demographic and Clinical Correlates - A Cross Sectional Study <p><strong>Background</strong>: In Kerala, according to National Family Health Survey 4, 37.5% of males and 1.6% of females use alcohol. Even though the physical and mental health morbidity of alcohol dependence is well-known, studies are less. The study assessed the severity of alcohol dependence and its different socio-demographic and clinical correlates. <strong>Materials and Methods: </strong>A hospital-based cross-sectional study was conducted among alcohol dependence syndrome patients. Total sample size 100 was achieved by consecutive sampling. Data was collected using a semi-structured proforma, which included severity of alcohol use using severity of alcohol dependence questionnaire (SADQ). Chi-square test and logistic regression analysis were done to find the relationship between variables. <strong>Results</strong>: All the participants were males. The majority were between 30-60 years, from a rural background (64%), belonged to low socioeconomic (85%) nuclear families (65%). The majority of the participants had started using alcohol before 20 years of age (85%), were using alcohol for more than ten years (97%), had comorbid nicotine use (80%), at least one previous admission (91%) and a positive family history of alcohol use (72%). All the participants in the study had moderate to severe ADS. On comparing different variables with the severity of ADS, age of onset, the number of previous admissions and comorbid nicotine use were significant. Logistic regression analysis found the age of onset (p-value 0.019) and nicotine use (p-value 0.002) as the predictors of severity of ADS. <strong>Conclusion</strong>: Study points to the need for early intervention programs targeting the high-risk population and the need for addressing nicotine use among persons with ADS.</p> T Joseph Jithin V R Aniji V Arun Mathew J Valamparampil Copyright (c) 2022 Kerala Journal of Psychiatry 2022-01-30 2022-01-30 35 1 21 29 10.30834/KJP.35.1.2022.305 Prevalence and determinants of anxiety and depression among individuals admitted with covid-19 infection in a tertiary level hospital <p><strong>Background: </strong>The COVID 19 pandemic is associated with mental health concerns such as anxiety and depression at multiple levels and has recently been postulated to be linked to the long COVID syndrome. <strong>Objectives: </strong>To determine the prevalence and factors associated with depression and anxiety in individuals admitted with COVID-19 infection. <strong>Methods: </strong>154 individuals admitted with COVID-19 infection were screened for depression and anxiety employing PHQ9 and GAD 7, respectively. Trained interns did the screening on consecutively admitted patients. <strong>Results:</strong> The proportion of depression and anxiety was 26.6%(n=41) and 20.1%(n=31), respectively. Moderate and above symptoms were present in 3.9% of the individuals(n=6) on both scales. Older age (t=2.124, p=.035), lower educational status (t=3.725, p=0.000), a family member losing their job during the pandemic (t=1.91, p=0.05), presence of fever (t=2.069, p=0.040), oxygen therapy (t=2.19, p=0.030) and treatment with hydroxychloroquine (t=2.122, p=0.035) were found to be significantly associated with high depression scores. Being less educated (t=3.594,p=0.000), admission under non-paying status (t=2.209, p=0.029), a family member losing their job during the COVID pandemic (t=1.946, p=0.05), presence of non-productive cough (t=1.940, p=0.05), fatigue (t=2.418, p=0.017)), myalgia (t=2.015, p=0.046), having Diabetes Mellitus (t=2.151, p=0.033) and requiring oxygen therapy (t=2.030, p=0.040) were significant risk factors for higher anxiety scores. <strong>Conclusions: </strong>The feasibility of screening for depression and anxiety by non-mental health professionals in poorly technology-enabled moderately ill inpatient populations within LAMIC settings have been demonstrated. Psychosocial disadvantage and indicators of relatively severe covid infection seem to be risk factors for depression and anxiety. A system for screening for these disorders employing feasible strategies should ideally be incorporated to mitigate both short term and long-term negative consequences of this pandemic, particularly in inpatient populations, who are already subject to various vulnerabilities.</p> Christina George Sreejith Cheruvilakam Anu Franco Dyuthi Neeraj Sam Tom Stephen P S Shiburaj Copyright (c) 2022 Christina George, Sreejith Cheruvilakam, Anu Franco, Dyuthi Neeraj, Sam Tom Stephen, P S Shiburaj (Author) 2022-02-14 2022-02-14 35 1 30 38 10.30834/KJP.35.1.2022.306 Attitude towards suicide among junior residents- A cross-sectional study <p><strong>Background</strong>: Suicide as a public health problem is gaining importance due to the COVID pandemic. After a suicide attempt, a patient is examined at emergency services by duty doctor. After that, a right attitude is essential to prepare the patient for psychiatry referral or give mental health intervention by themselves. Suicide among doctors is also relatively high. Faulty attitude could prevent them from seeking help when faced with a suicide risk situation. Junior residents (JRs) are the first point of contact with patients in medical colleges. Their attitude to suicide is not studied in Kerala, where the suicide rate is high. Therefore, we decided to study the attitude towards suicide among junior residents. <strong>Methods:</strong> Attitude to suicide among 2<sup>nd</sup> and 3<sup>rd</sup> year JRs was assessed by Eskin's Attitude towards Suicide questionnaire, and comparisons were done by Mann Whitney and Kruskal Wallis tests. <strong>Results</strong>: Suicide was less acceptable for the residents (88%), and they were more favouring to ‘communicating their problems' (89%). Suicide as a sign of mental illness was not considered by 49%, and 17% were uncertain. Females favoured open discussion of suicide (p=0.038). Those of Muslim religious affiliation had a restrictive attitude to suicide (p=0.001) and believed in punishment after suicide (p=0.001). No difference in attitude was observed between the year of study and between clinical and nonclinical specialities. <strong>Conclusion</strong>: Professional experience that the study population has had, has not influenced their attitudes in desirable ways. Therefore, training in suicide prevention needs to be imparted to all JRs because they function as gatekeepers towards suicide prevention.</p> T N Nitin Murali Smitha Ramadas Copyright (c) 2022 T N Nitin Murali, Smitha Ramadas (Author) 2022-02-24 2022-02-24 35 1 39 46 10.30834/KJP.35.1.2022.310 Effect of adjunctive music listening in schizophrenia – a randomized controlled trial <p><strong>Background: </strong>Music-based interventions are currently being researched for their effectiveness in schizophrenia. Very few studies have been done in the acute phase. Further, there is a dearth of published Indian research in this context. <strong>Methods: </strong>A prospective, randomized, controlled, single-blind study was done in a tertiary psychiatric hospital in South India from October-2015 to March-2016. Immediately after admission, consenting adult patients with schizophrenia were randomly assigned to two groups. Over four weeks, Group-A(N=51) received 20 sessions of music-listening as an add-on to standard care, and Group-B(N=53) received standard care alone. Reduction in Positive and Negative Syndrome Scale (PANSS) scores and the drug dosage requirements for both groups were compared. Statistical analysis was done using two-way repeated-measures ANOVA for PANSS score reduction and Mann-Whitney U for drug dosage comparison. <strong>Results: </strong>We observed a greater decrease in PANSS scores in Group-A than Group B, but this difference did not reach significance (p&gt;0.05 for all three subscales and total score). Group-A required lesser risperidone-equivalent doses than Group-B, but this was not significant (p=0.27). However, Group-A required significantly lesser diazepam equivalent (p=0.003) and trihexyphenidyl (p=0.007) doses than Group-B. <strong>Conclusions</strong>: The above findings suggest a possible additional benefit of adding music listening to standard care for the acute phase management of schizophrenia and reducing drug dosage requirements. Music-based interventions for schizophrenia warrant further research, especially in the Indian context and wider application in clinical practice.</p> A Jeyan Nair V Indu B Sivaprakash K Banipreet Copyright (c) 2022 A Jeyan , Nair V Indu, B Sivaprakash, K Banipreet (Author) 2022-03-01 2022-03-01 35 1 47 53 10.30834/KJP.35.1.2022.316 Prevalence of generalized anxiety disorder in COVID-19 patients admitted in a tertiary care hospital in South India: A cross-sectional study <p><strong>Background</strong>: SARS-CoV-2 virus can affect the lungs and other organs of our body, including the brain. Studies from various parts of the world have started reporting a high prevalence of anxiety disorder in COVID-19 patients. This study aims to estimate the prevalence of generalized anxiety disorder in patients admitted with COVID-19 infection in a tertiary care medical college in South India. <strong>Methods</strong>: All COVID positive patients admitted to a tertiary care medical college during the study period were evaluated by a psychiatrist, and diagnosis was made based on ICD-10. GAD-7scale was used to assess the severity of anxiety disorder. <strong>Results</strong>: Hundred and eighty-four COVID-19 patients were studied. Generalized anxiety disorder was detected in 34.8% of the patients. <strong>Conclusions</strong>: Generalized anxiety disorder is highly prevalent in COVID-19 patients. Proper screening and treating generalized anxiety disorder in them will help in the care of these patients.</p> Lakshmi KP Subhash Chandra Kudrat Jain Bindu Menon Copyright (c) 2022 Lakshmi KP, Subhash Chandra, Kudrat Jain, Bindu Menon (Author) 2022-05-11 2022-05-11 35 1 54 57 10.30834/KJP.35.1.2022.321 Socio-demographic profile and challenges faced by the transgender community in Kollam district, Kerala-a clinic-based cross-sectional study <p><strong>Background</strong>: Gender presentations and social categories vary across cultures, and many terms are used to describe individuals who live between or outside a male-female binary. Transgender is a term used to describe a person whose gender identity or gender expression differs from their biological sex. They face much discrimination that denies them equal access to key social goods, such as employment, health care, education, and housing. They are also marginalized in society, making them one of the vulnerable groups at risk of becoming socially excluded. We aimed to look into the socio-demographic profile and challenges faced by transgender and whether there is a change in the attitude of the people of Kerala towards them. <strong>Methods</strong>: From transgender people registered under Suraksha Clinic in Kollam, 100 subjects were taken up for the study. A semi-structured questionnaire in the local language was used to collect information. <strong>Results:</strong> 57% of transgender people had a high school education, and only 4% completed higher education. Initially, 62% faced hesitance from their families in acknowledging their transgender identity, and 20% were rejected from their family. However, 40% of the family members have now accepted them as transgender because of changes in laws and reduced stigma in the community. In their parental home, 46% were discriminated compared to the other siblings. Transgender faced discrimination from the health sector as well. It was found that 52% were satisfied with the health support system of the country, while 28% were not satisfied. <strong>Conclusions</strong>: Transgender people face many problems in their daily life. Most transgender people believe that legal measures, support from transgender organizations, and social awareness programmes could help them fetch more social acceptance.</p> Jomon Joy Vincy Nelson Copyright (c) 2022 Jomon Joy, Vincy Nelson (Author) 2022-05-22 2022-05-22 35 1 58 63 10.30834/KJP.35.1.2022.327