Kerala Journal of Psychiatry

The Weight Beneath the White Coat: Professional Stress, Help-Seeking Barriers, and the Hidden Grief of Doctors

Arun Kishore NR, Shaji KS, Jimmy Mathew (Author) — Mon, 15 Sep 2025 00:00:00 +0530

Doctors face disproportionately high rates of stress, burnout, and suicide compared to the general population. Yet, paradoxically, help-seeking among doctors remains exceptionally low. This article explores the systemic, cultural, and psychological barriers that prevent doctors from accessing support. Drawing on clinical experience, sociocultural analysis, and reflections from the field, we argue that medical culture and professional identity shape a unique and often isolating experience of stress. We call for institutional reforms and early educational interventions to normalise vulnerability, promote wellbeing, and support doctors in their dual identities as caregivers and human beings.

Alcohol Use Disorders in Males who have Survived a Suicidal Attempt- A Cross-Sectional Study

Arathy Nathan A, Lekshmy Gupthan, Jaimon Plathottathil Michael (Author) — Tue, 04 Nov 2025 00:00:00 +0530

Background: Alcohol use disorders could be a major risk factor for suicidal behaviour. Our study aimed to find out the proportion of adults with Alcohol Use Disorder (AUD) in males who have survived a suicidal attempt and to find out the association of AUD and alcohol use-related factors with high suicidal intent.

Methods: This cross-sectional study of 230 consecutive male inpatients of age 18-70 years admitted with non-fatal suicidal attempt in consultation liaison psychiatry used a specifically designed proforma to get the socio-demographic, suicide, and alcohol use-related variables. The suicide intent was assessed using Beck’s Suicide Intent scale. The Alcohol Use Disorders Identification Test (AUDIT) was used to identify AUD. The severity of Alcohol Dependence Questionnaire (SADQ) was used to assess the severity of AUD.

Results: 43.9 % of adult males with non-fatal suicidal attempt had AUD, and 15.2% had high suicidal intent, 63 (62.4%) had used alcohol on the day of the attempt, and 40 (39.6%) of them used alcohol before the attempt to facilitate the suicidal attempt. Of the patients with moderate or low suicidal intent, 75 (38.5%) had AUD, and 26 (74.3%) with high suicidal intent had AUD, which was found to be significant. (chi-square = 15.46, p = 0.001). Severity of alcohol dependence had a significant association with high suicidal intent (chi-square=4.46, p=0.03). Logistic regression after adjusting for confounders showed that AUD [Odds ratio= 4.18 (1.78-9.79); p=0.001] and severity of AUD [Odds ratio= 3.33 (1.33-8.30); p=0.01] remained significant risk factors for adult suicide attempts.

Conclusions: AUD was found to be significantly associated with high suicidal intent among adult males who have survived a suicidal attempt. Early recognition of risk factors for suicide, including alcohol use disorders and various alcohol use-related factors, helps in preventing suicides.

Proportion of Psychotic Features in Patients With Major Depression and Their Relationship With Depression Severity: A Cross-Sectional Study

Amrutha C Madhu, Ashfaq U Rahman AM, Uvais NA, Chitra Dilip (Author) — Wed, 19 Nov 2025 00:00:00 +0530

Background: Psychotic features like delusions and hallucinations occur in a clinically meaningful subset of depressive episodes. While Western estimates place the prevalence of psychosis in depression at 15–30%, Indian data are limited. ICD-10 ties psychosis to severe depression, whereas DSM-5 decouples psychosis from severity, and ICD-11 introduces moderate depression with psychotic features. Contemporary, India-specific evidence is needed to inform classification and care.

Methods: This cross-sectional study at a tertiary care center evaluated 170 consecutive adult persons with depression (including major depressive episodes in bipolar I/II) who were diagnosed per DSM-5 using SCID-5. Depression and psychosis severity were assessed with the Hamilton Depression Rating Scale (HAM-D) and the Brief Psychiatric Rating Scale (BPRS), respectively. The data were analyzed using ANOVA, the chi-square test, and Pearson's correlation.

Results: Overall, 24.7% (42/170) had psychotic features. Prevalence rose with depression severity: 0% in mild, 8.6% (7/81) in moderate, and 47.9% (35/73) in severe depression, which was significant. (p=0.01) Mean BPRS scores increased across severity strata with significant between-group differences. (F=55.79, p<0.001) HAM-D scores correlated positively with BPRS scores(r= 0.77, p<0.001), indicating that higher depressive severity was associated with greater psychosis severity.

Conclusion: Psychotic features occur in approximately one-quarter of persons with major depression and are not confined to severe episodes, with a notable proportion present in moderate depression. The graded increase in both prevalence and severity of psychosis with depressive severity supports DSM-5’s delinking and aligns with ICD-11’s category of moderate depression with psychotic features. These findings underscore the need for routine psychosis screening across all depression severities

Coping Strategies and Psychological Wellbeing Among Undergraduate Students Affected by Cyberbullying: A Cross-Sectional Study

Sun, 30 Nov 2025 00:00:00 +0530

Background: Cyberbullying is an emerging concern among undergraduate students, potentially affecting their mental health and academic life. Understanding how students cope with such experiences is crucial for designing effective support systems. This study aimed to identify coping strategies employed by undergraduate students experiencing cyberbullying and to examine the association between these strategies and psychological well-being.

Methods: A cross-sectional study was conducted among 744 undergraduate students selected through multistage random sampling from colleges in Khammam city, Telangana, South India. Data were collected using validated instruments: The Cyberbullying and Cybervictimization Questionnaire, the Coping with Cyberbullying Questionnaire, and the Psychological Wellbeing Scale. Descriptive statistics summarized participant characteristics, and Chi-square tests assessed associations between cyberbullying status and psychological well-being subscales.

Results: Among the participants, 40.3% reported being victims of cyberbullying and 25.5% admitted to perpetrating it; 32.3% were both victims and perpetrators. Technical coping strategies such as blocking or reporting perpetrators (mean = 20.52) and seeking close support from friends and family (mean = 17.94) were most frequently used, whereas retaliation was least common (mean = 15.03). No significant associations were found between experiences of cyberbullying or cybervictimization and any psychological well-being subscales (p > 0.05).

Conclusion: Undergraduate students predominantly adopt practical coping strategies, notably technical measures and social support, when facing cyberbullying. The absence of a significant link between cyberbullying experiences and overall psychological well-being suggests that other factors, such as pre-existing mental health and social support, may play a more pivotal role. Strengthening institutional support systems and promoting healthy coping mechanisms remain essential to address the psychosocial impact of cyberbullying.

Proportion of Sexual Dysfunction in Patients with Alcohol Dependence Syndrome in a Tertiary Care Hospital: A Cross-sectional Study

Thu, 11 Dec 2025 00:00:00 +0530

Background: A fulfilling sexual life is vital for emotional intimacy, self-esteem, and overall well-being. However, alcohol dependence poses significant challenges to sexual health, often leading to various dysfunctions that adversely affect quality of life. Understanding the prevalence and pattern of these dysfunctions among alcohol-dependent males is essential for comprehensive clinical management and intervention.

Methods: This cross-sectional study aimed to evaluate the prevalence of sexual dysfunction and its association with the severity of alcohol dependence among 80 adult male participants diagnosed with Alcohol Dependence Syndrome. The Severity of Alcohol Dependence Questionnaire (SADQ) and the Arizona Sexual Experience Scale (ASEX) were administered. Statistical analyses, including Chi-square tests, ANOVA, and descriptive statistics, were performed using SPSS.

Results: The mean age of participants was 39 years [38.96 ± 4.77]. A majority (55%) resided in rural areas, 21% had received formal education, and most belonged to low socioeconomic backgrounds; 88% were married. Based on SADQ scores, 65% demonstrated severe alcohol dependence, 26.25% moderate, and 8.75% mild, with a mean score of 32.96. Overall, 70% of participants experienced sexual dysfunction. The most common issues included low sexual drive (51.2%), difficulty achieving orgasm (50%), erection difficulty (46.25%), difficulty in arousal (43.75%), and orgasmic dissatisfaction (32.5%). Multiple sexual dysfunctions were frequently observed in a single patient, and a highly significant association was found between the severity of alcohol dependence and each type of sexual dysfunction.

Conclusion: The high prevalence of sexual dysfunction among alcohol-dependent males underscores the need for routine sexual health screening and integrated therapeutic approaches within de-addiction programs. Addressing sexual dysfunction as a comorbid concern may enhance motivation for recovery and improve overall psychosocial functioning.

Proportion of Post-partum Depression and Anxiety Symptoms among Women in a Tertiary Care Setting - A Cross-sectional Study

Gulshan Hooda, Jaison Joseph, Rajeshwari Devi (Author) — Thu, 18 Dec 2025 00:00:00 +0530

Background: Postpartum depression (PPD) and anxiety are mental health problems in females, and many factors predispose the occurrence of this illness. The study assessed the prevalence of postpartum depression and anxiety among postnatal mothers.

Materials and Methods: A hospital-based cross-sectional study was conducted among 200 women admitted to a tertiary care hospital in North India between March 2023 and April 2023. The Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire-4 4 (Anxiety) were used to estimate the post-partum depression and anxiety, respectively.

Results: The mean age of the study subjects was 26.41 (SD = 5.292), and most of them belonged to rural backgrounds (64%). The prevalence of postpartum depression and anxiety was 30.5% (EPDS score of 10 and above) and 24% (PHQ score of 3 and above), respectively. Younger age (less than 35 years), rural background, low family income, complications during pregnancy, and low birth weight of the child were significantly associated with post-partum depression and anxiety in this setting (p <0.05).

Conclusion: The findings of the present study revealed that nearly 20%-30% of study subjects had postpartum psychological distress in this setting. Depression is often not diagnosed during postpartum, which emphasizes the need for similar screening practices in obstetrical and primary care.

Sensory Deprivation or Postictal Vulnerability? Psychosis Following Phenytoin-Induced Toxic Epidermal Necrolysis – A Case Report

Sthuthi Shireen, Aiswarya R Kamath, Bindu Menon (Author) — Thu, 11 Dec 2025 00:00:00 +0530

Background: Acute cutaneous and mucosal manifestations of drug-induced toxic epidermal necrolysis are well recognized. Ocular complications lead to visual impairment and sensory deprivation and may predispose to psychosis.

Case Report: A 59-year-old woman with epilepsy, previously stable on anti-seizure medications, in whom phenytoin was introduced for breakthrough seizures. Following this, she developed toxic epidermal necrolysis (TEN), resulting in bilateral vision loss and subsequently full-blown psychosis. While she had shown mild irritability earlier, it was only after the seizure and abrupt sensory deprivation that she developed vivid hallucinations, delusions, and poor insight. The clear temporal sequence highlights the role of both postictal vulnerability and sensory deprivation in precipitating organic psychosis.

Conclusion: This case emphasizes the need to evaluate organic causes when elderly patients present with new-onset psychotic symptoms.

Neurosyphilis: Diagnostic Challenges and Public Health Relevance – A Case Report

Thu, 25 Dec 2025 00:00:00 +0530

Background: Syphilis, caused by Treponema pallidum, remains a diagnostic challenge due to its varied clinical manifestations. Neurosyphilis, a late-stage complication, can mimic psychiatric disorders and lead to misdiagnosis.

Case Report: A middle-aged woman presented with progressive cognitive decline, personality changes, and psychotic symptoms. She was initially mistaken for a primary psychiatric illness. Serological testing confirmed neurosyphilis, and treatment with intravenous penicillin resulted in marked improvement in neuropsychiatric features. This case emphasizes the importance of considering syphilis in atypical psychiatric presentations, particularly given its global resurgence.

Conclusion: Early recognition and timely therapy are essential to prevent irreversible neurological damage, underscoring the need for heightened clinical vigilance and routine screening in at-risk populations.

Letter to the editor in response to "The Weight Beneath the White Coat: Professional Stress, Help-Seeking Barriers, and the Hidden Grief of Doctors"

Fraser Walker, Graham Walker (Author) — Sat, 15 Nov 2025 00:00:00 +0530

We write as psychiatry trainees working in Scotland in response to Kishore, Shaji & Mathew’s thought-provoking piece titled ‘The Weight Beneath the White Coat: Professional Stress, Help-Seeking Barriers, and the Hidden Grief of Doctors’. The article effectively draws attention to the significant issue of burnout within the medical profession, which we agree is largely unspoken and warrants greater scrutiny. We write to reflect on some of the points raised from the perspective of current psychiatry trainees.

Response to the "Letter to the Editor response to The Weight Beneath the White Coat: Professional Stress, Help-Seeking Barriers, and the Hidden Grief of Doctors"

Arun Kishore NR, Shaji KS, Jimmy Mathew (Author) — Sat, 15 Nov 2025 00:00:00 +0530

We agree that supervision, when well organised and practised, could address several of the issues we raised in the paper. We would also like to point out that supervision that is unhelpful or absent could have adverse consequences on stress and help-seeking behaviours in doctors. At times, the focus of supervision is on the normative aspects to the neglect of its formative and restorative functions. Indeed, the concept of clinical supervision is often lacking in medical training in India.

We agree that Balint groups and other reflective spaces can significantly help reduce professional stress. Like the authors, we hope that faculty and trainees in other specialties will also recognise the importance of initiatives that help lower stress levels and promote the well-being of doctors.

Cognitive Behavior Therapy for Obsessive-Compulsive Disorder with Co-Morbid Personality Disorder: A Case Series

Susmita Halder, Arpita Roy Choudhury (Author) — Sun, 21 Dec 2025 00:00:00 +0530

Background – There have been contrasting results regarding the influence of co-morbid personality disorder (PD) on cognitive behaviour therapy (CBT) outcomes for anxiety disorders. This case series examines the efficacy and challenges of CBT for patients with obsessive-compulsive disorder (OCD) and comorbid PD.

Case Series: For the present case series, three individuals with the diagnosis of OCD were selected. They also presented with comorbid obsessive compulsive PD (OCPD), anxious avoidant PD, and dependent PD, respectively, as assessed by the ICD-10 International Personality Disorder Examination (IPDE). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered to assess the severity of OCD in the patients. They underwent a variable number of CBT sessions.

Results: Pre- and post-intervention analyses showed reductions in Y-BOCS scores across the baseline, 2-month, and 4-month follow-ups, along with improvements in functioning, as evidenced by patient and informant feedback pre- and post-intervention. However, the patient with co-morbid OCPD had a fluctuating course of treatment outcome, and his poorer motivation and preoccupation with details interfered with the course of therapy.

Conclusion: CBT treatment plans of such groups of patients should be individualized to address the issues posed by comorbidity.

Strengthening of the Association Through Networking

Anoop Vincent (Author) — Tue, 06 Jan 2026 00:00:00 +0530

The theme of the year is “Strengthening of association through networking.”

Through increasing the number of life fellows and LOM in our IPS Kerala State branch.
The membership drive will be continued in full strength with my team.
I want to associate with IMA, IAP, other governmental agencies, and NGOs to build awareness of mental health and its relevance for early detection of cases.
We want to conduct a workshop for our young psychiatrists on prospects here in India and Kerala, as well as abroad.
We will put pressure on NMC to make Psychiatry a single theory paper and a small case during the medical practical.

How to Select and Report the Appropriate Study Design

Samir Kumar Praharaj, Shahul Ameen (Author) — Sat, 10 Jan 2026 00:00:00 +0530

A clear understanding of study designs is essential for planning research and critically evaluating evidence. The choice of design depends on the research question, with multiple designs often suitable for a single question. Misapplication or misreporting of study designs can threaten validity and mislead readers. This manuscript provides an overview of common quantitative study designs, including observational and experimental studies. Common reporting errors include omitting the study design, incorrect labelling, inappropriate causal claims, failure to identify confounders, and omitting details of randomisation and allocation concealment.

Good Research Begins in the Days of Postgraduate Training!

Sujit Sarkhel (Author) — Sun, 18 Jan 2026 00:00:00 +0530