Kerala Journal of Psychiatry <p>Official&nbsp; Journal of the Branch of Indian Psychiatric Society (Kerala)</p> en-US (Dr. K Vidhukumar) (X) Sat, 07 Aug 2021 22:58:07 +0530 OJS 60 Prevalence of major depressive disorder among wives of men with alcohol use disorder-a cross-sectional study from a tertiary care hospital <p><strong>Background: </strong>Alcohol Use Disorder is highly prevalent in India. Alcohol acts as a continuous stressor, with several stressfull consequences on the wife. Literature suggests an association between alcohol use in the husband and depression in the wife. <strong>Objectives: </strong>The primary objective was to assess the prevalence of Major Depressive Disorder(MDD) among wives of men with Alcohol Use Disorder attending the Psychiatry Department in a tertiary care centre. The secondary objective was to assess the association of various sociodemographic and clinical variables with depressive disorder in the wives. <strong>Methods: </strong>A cross-sectional study was done on wives of men diagnosed with Alcohol Use Disorder while attending the outpatient clinic or inpatient treatment at the Psychiatry Department. Consecutive sampling was done till the calculated sample size of 133 was reached. PHQ 9 was administered to the wives to assess Depressive Disorder with a cutoff score of 10. Statistical analysis was done using the Chi-square test. Odds Ratio and confidence intervals were calculated to determine the strength of associations. <strong>Results: </strong>Prevalence of Major Depressive Disorder in the study population was found to be 27.8%. A significant association was found between the severity of Alcohol Use Disorder and depression in wives (OR=4.01,95%CI=1.4411.22, p&lt;0.01). Morning drinking among husbands was significantly associated with depression in wives(OR=4.32,95%CI=1.32-19.56, p=0.04). <strong>Conclusion: </strong>Prevalence of Major Depressive Disorder among wives of men with Alcohol Use Disorder was high. Depressive disorder in wives significantly correlated with the severity of Alcohol Use Disorder and the husbands' morning drinking. Hence wives of men with Alcohol Use Disorder should be routinely screened for depression, and necessary interventions should be given promptly.</p> Vijunath Thilakan, Krishnan Sivasubramoney, Mili Babu (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Sun, 25 Apr 2021 00:00:00 +0530 Delinquent behaviour and emotional intelligence among inmates of juvenile homes in Kerala, India <p><strong>Background: </strong>Delinquent behaviour represents a wide variety of law and norm violating behaviours by children. In India, statistics show that there is an increase in the rates of crimes committed by children. <strong>Methods: </strong>The sample of the study consisted of 100 adolescents from juvenile homes. Personal data sheet, Delinquent behaviour checklist, and Mangal Emotional Intelligence Inventory were the study tools. Mann-Whitney U test was carried out to find the association between delinquent behaviour and emotional intelligence among the inmates of juvenile homes. <strong>Results</strong>: Delinquent behaviour is found in 38% of children living in Juvenile homes. No significant difference is found between boys and girls in delinquent behaviour and emotional intelligence. A negative association is found between delinquent behaviour and emotional intelligence in the inmates of juvenile homes. <strong>Conclusion: </strong>Delinquent behaviour is found to be high among inmates of juvenile homes. A significant association was found between delinquent behaviour and emotional intelligence. Both nature and nurture are important in the development of emotional intelligence. Opportunities and training for the development and improvement of psychological faculties like emotional intelligence may impact the prevention and management of delinquent behaviour among children.</p> Ganga G Kaimal, K. Vidhukumar, M S Razeena Padmam (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Sat, 30 Jan 2021 00:00:00 +0530 Attitude towards drug adherence in inpatients with bipolar affective disorder: a cross-sectional study <p><strong>Background and Objectives: </strong>Bipolar Affective Disorder is the sixth leading cause of disability-adjusted life years in individuals aged 15-44 years. Among the patients with Bipolar Disorder, about 60% are at least partially non-adherent to medications. This study attempted to study attitude towards drug adherence in inpatients with bipolar affective disorder. <strong>Materials and Methods: </strong>Consecutive patients, between 18 to 60 years of age, diagnosed with Bipolar Affective Disorder, undergoing inpatient treatment over a two-month period, were recruited. Their attitude towards drug adherence was assessed using a 30-item version of the Drug Attitude Inventory (DAI). <strong>Results: </strong>Subjects in this study had good medication adherence (DAI= 3.12± 7.09), indicating these patients tended to report favourable views towards their psychiatric medications. <strong>Conclusion:</strong> Assessment of attitude towards non-adherence in this population showed good medication adherence and a positive response to treatment.</p> Anina Elizabeth Selvin, Sreeja Sreekumar, Joseph Varghese P (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Sat, 01 May 2021 00:00:00 +0530 The profile of subclinical hypothyroidism in subjects with premenstrual dysphoric disorder – A pilot study <p><strong>Background</strong>: Psychiatric disorders are usually found to be associated with thyroid dysfunction. Although thyroid dysfunction's relevance to psychiatric disorders is recognized, few studies have estimated the prevalence of subclinical hypothyroidism in subjects with the premenstrual dysphoric disorder in the Indian population. <strong>Method</strong>: A hospital-based cross-sectional study conducted in a tertiary care centre in central Kerala, enrolled 70 subjects diagnosed with Premenstrual Dysphoric Disorder (PMDD) who presented to the psychiatry and gynaecology Out Patient Departments (OPD). Sociodemographic and clinical data were collected followed by administration of PMDD rating scale. Mini International Psychiatric Interview was done to rule out other psychiatric disorders. TSH was done for all subjects after two months during follow up. <strong>Results</strong>: 63.33 % of subjects with PMDD were found to have thyroid dysfunction. A significant association was established between PMDD score and subclinical hypothyroidism. <strong>Conclusion</strong>: Subclinical hypothyroidism is common in premenstrual disorder and is closely associated with the same.</p> Parvathy S, Anoop Vincent, Ashok Antony (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 15 Feb 2021 00:00:00 +0530 Interactive workshop on writing and publishing research: reflections and lessons learned <p>Publishing research is an essential skill for health professionals. In India, few training programs are specifically aimed to improve scientific writing. We developed a two-day interactive training workshop to address the need of the researchers. Methods such as targeted Facebook advertising and sending emails to available collections of addresses were used to inform potential participants from diverse disciplines about the program. There were 48 participants from 15 disciplines. Half of them were females, and half were from Psychiatry. We reflected on the content and experience of the workshop and have summarized the lessons learned from it. The participants perceived the workshop to be useful and found the experience satisfying.</p> Shahul Ameen, Samir Kumar Praharaj (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 31 May 2021 00:00:00 +0530 Prevalence of delirium among older adults in a tertiary care referral hospital in Kerala <p><strong>Background:</strong> Delirium is a common neuropsychiatric condition in older adults in medical and surgical settings. It is important to identify cognitive impairment in the elderly population early in their stay at the hospital to reduce morbidity and mortality. The literature on the prevalence of delirium in the elderly population shows that the occurrence of delirium is associated with patient factors and clinical settings. Delirium may affect the outcome of the primary medical condition in addition to the occurrence of poor compliance to treatment and long-term psychological sequela. <strong>Aim: </strong>The study aims to identify the prevalence of clinical delirium among patients at the age of 60 years or above, admitted in medical and surgical units of Government Medical College Hospital, Kozhikode, Kerala. The study also looked into the related factors and management aspects of the condition. <strong>Methods: </strong>A cross-sectional observational method was used in a sample of 300 older adult patients who were selected using a census approach from medical and surgical inpatient units of the hospital. Clinical and personal details were collected in addition to the assessment of the participants with the Confusion Assessment Method (CAM) and Nursing Delirium Screening Scale(Nu-DESC). <strong>Results: </strong>Findings of the study revealed the prevalence of delirium in older adult patients at 16%. The study also shows a significant association between the prevalence of delirium and selected clinical variables and area of admission. <strong>Conclusion: </strong>Early identification and prompt medical and psychiatric care, and environmental manipulation will reduce the development of complications in older adults.</p> Anjana BTV, T K Saleem, K Ramesh (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Sun, 21 Mar 2021 00:00:00 +0530 A cross-sectional study of depression among death row convicts from a south Indian state <p><strong>Background:</strong> Convicts punished with death sentences are reported to show a higher vulnerability for depression than the general population and other convicts. Previous studies have looked at the prevalence of depression in convicts; however, no studies from India have examined depression specifically among death row convicts. The present study aims to assess the prevalence of depression among death row convicts. <strong>Methods:</strong> This is a cross-sectional study conducted among 28 death row convicts from a South Indian State, using a semi-structured questionnaire and Beck's Depression Inventory-II. After obtaining necessary permission from the government and prison authorities to interview the convicts, two visits were made to Central Prison, Belgaum. Descriptive statistics were used to measure the frequencies and percentage.<strong> Results:</strong> Most convicts in this study were aged between 30 and 60 years (68.96%) and predominantly male (93.10%). The majority of the convicts had either mild or no depression, while the rest had moderate to severe depression (57.15% vs 42.85%). Depression was significantly higher during the initial phase of the conviction (57.13%). There was an inverse trend of depression (57.13%, ? 6 years vs 42.85%, &gt; 6 years) with the duration of stay in prison. <strong>Conclusions:</strong> Depression is prevalent among death row convicts. More systematic observation and analyses are needed from both the legal and medical fraternity to look at the death sentence and its impact on mental health.</p> Virupaksha Shanmugam Harave, Bidare Sastry Nandakumar, Devarayadurga Venkateshamurthy Guruprasad (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Wed, 05 May 2021 00:00:00 +0530 Mental Health Problems among Medical Students during COVID-19 Lockdown: A Cross- Sectional Study <p><strong>Background</strong>: COVID-19, which originated in China, became a pandemic affecting more than 180 countries. By April 2020, India had announced lockdown in an attempt to control the spread of the virus. Lack of social interaction and apprehension about the studies had created emotional disturbances among medical students. <strong>Methods</strong>: The study was done in a medical college situated in Central Travancore, Kerala, between 2020 April 20 to May 31. Depression Anxiety Stress Scale (DASS) and Impact Event Scale-Revised (IES-R) were administered in Google forms to the MBBS batch WhatsApp groups. <strong>Results</strong>: Out of 320 responses from medical students, 239 were females, and 82 were male students. 56% of male students and 54% of female students have mild to severe depressive symptoms, 58% of male students and 54% of female students have symptoms of anxiety, and 63% of male students and 50% of female students experienced mild to severe stress.68% of males and 62% of females have higher Impact events scale.<strong> Conclusion</strong>: There is a high prevalence of anxiety and depression among medical students during the COVID lockdown period. There is a significant difference between genders in scores of anxiety, stress and impact of events. This shows the need for resilience training among medical students.</p> Joice Geo, Sivin P Sam, Roy Abraham Kallivayalil (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Wed, 28 Apr 2021 00:00:00 +0530 Visits to a Malayalam website on mental health: Analysis of Seven Years' Data <h2><strong>Background</strong>: Online articles are an important opportunity for educating the public on mental health topics. No previous study has examined the performance of a mental health website with content in an Indian language. <strong>Methods</strong>: Data on user acquisition and behaviour were obtained through Google Analytics for the first seven years (February 2014 – February 2021) of a Malayalam website that features 93 articles on mental health. Major Google Analytics variables assessed were the numbers of new and returning visitors, bounce rate, number and duration of sessions, pageviews, and unique pageviews. Relevant variables were compared for the first and seventh years. <strong>Results</strong>: In the seven years, there were 82,137 sessions, of which 21.81% were from returning visitors, 64.03% were from India, and 35.54% were from the state of Kerala, India. The mean session duration was 2 minutes 18 seconds. User engagement dropped over the study period. While in the first year, 77.20% of the visitors accessed the website from desktops, in the seventh year, 72.03% used mobile phones. Though social media was the major source of visitors (36.26%), the proportion of visitors has declined. Over the study period, the specific social media sites that send the most traffic and the browsers the visitors predominantly use have changed. Most keywords that brought users from search engines were about love and sex. The most popular articles were also about love and sex. <strong>Conclusion</strong>: Periodic and long-term monitoring using Google Analytics can provide insights that owners of mental health websites can exploit to attract more visitors and improve user engagement. Older websites may need optimization to utilize the growing visits from mobile phones.</h2> Shahul Ameen (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 24 May 2021 00:00:00 +0530 CASPR2 positive autoimmune encephalitis presenting as delirium in an alcohol dependent patient: a diagnostic dilemma <p>Delirium, a major psychiatric emergency commonly encountered in alcohol withdrawal state, can have various aetiologies. Here we present a case of protracted delirium in an alcohol dependent patient, which on detailed neurological workup was diagnosed to be autoimmune encephalitis with CASPR2 (contactin-associated protein-like 2) antibodies. Subsequent treatment with immunotherapy and steroids lead to the resolution of symptoms.</p> <p align="justify"><span style="font-family: Times New Roman, serif;"><span style="font-size: medium;"><span lang="en-IN"> </span></span></span></p> Arya Jith, Kathleen Anne Mathew, Dinesh Narayanan, Sheen Maria Jacob (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 07 Jun 2021 00:00:00 +0530 Hypermotor seizure presenting with unusual psychiatric symptoms - a case report <p>We report a case of hypermotor seizure activity. The patient presented behavioural changes with previous reports of normal electroencephalogram (EEG). A prolonged video EEG of this patient showed rare epileptic abnormalities over the left frontocentral region, which ruled out a conversion disorder diagnosis. Management using Antiepileptics proved beneficial in this case.</p> Jith Arya , Narayanan Dinesh , V Neelima (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Wed, 06 Jan 2021 00:00:00 +0530 Hidden in the Rash - Alcoholic Pellagra Encephalopathy <p>Pellagra Encephalopathy is a recognised medical condition due to niacin deficiency. Patients with alcohol dependence invariably have vitamin deficiencies, including niacin. Pellagra Encephalopathy can be challenging to diagnose alongside withdrawal delirium. Diarrhoea, skin rashes, memory and attention deficits, paraesthesia and proximal muscle weakness were noted in four patients diagnosed with delirium tremens. Atypical features such as cognitive and neurological deficits were understood as the presentation of pellagra encephalopathy. The presence of neuro-cognitive symptoms in addition to typical dermatological presentation guided consideration of pellagra encephalopathy comorbid with delirium due to alcohol withdrawal. Subtle neurological symptoms indicative of pellagra encephalopathy may be overlooked in patients with delirium.</p> M D Praveen Das, Sheena Varughese, Mithun S Acharya, Chandrashekar B Huded (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Tue, 23 Mar 2021 00:00:00 +0530 Stevens-Johnson Syndrome while on lamotrigine and NSAID:A case report <p>Stevens-Johnson syndrome is a severe immune-mediated cutaneous reaction occurring due to exposure to certain drugs. Lamotrigine is an FDA approved drug used in the treatment of bipolar depression. When it is given concomitantly with sodium valproate, the risk of developing Stevens-Johnson syndrome increases. Here we present the report of a patient with bipolar depression who developed serious skin rashes while on lamotrigine and NSAID prescribed by a local doctor, who recovered after timely management. This case highlights the importance of following proper dosing, drug escalation regimen and managing drug interactions during lamotrigine therapy.</p> Madhavi Bhat, Anil Kakunje, Rajesh Mithur, M Manjunath Shenoy, K A Mashood, Sowmya Puthran, Anjana Joy (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 15 Mar 2021 00:00:00 +0530 Subcortical band heterotopia and pachygyria with cognitive deterioration in an elderly patient <p>Subcortical band heterotopia and pachygyria are rare conditions characterized by ectopic neuronal migration, leading to the appearance of "continuous double cortex appearance" and loss of normal convolutions of the cortex, respectively on neuroimaging. They usually present in childhood with disorders of muscle tone, craniofacial dysmorphism, refractory seizures, intellectual disability and feeding disturbances. Patients with such presentations have lowered life expectancy, but many mild cases survive till adulthood. Here we report subcortical band heterotopia and pachygyria – an incidental finding – in the case of an elderly lady with intellectual disability and seizure disorder, who presented with recent onset of cognitive decline and behavioural symptoms.</p> Surendran Kalambattumadathil Surabhi, Anithakumari Ayirolimeethal, Pankajakshan Vijayanthi Indu (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Sun, 06 Jun 2021 00:00:00 +0530 A case report of manic episode following SARS-CoV-2 infection <p>The novel coronavirus infection has been associated with various neuropsychiatric sequelae, including manic episodes, but only a few cases have been described in the literature. Here we present a case of a manic episode in an individual following COVID-19 infection, probably linked to the virus. This case report highlights the need to identify and assess various neuropsychiatric manifestations of COVID-19 and the need for further research on its manifestations, biological mechanisms, and long-term sequelae.</p> Mithun Devasia, Anil Prabhakaran, S Rithwik (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Thu, 27 May 2021 00:00:00 +0530 Darier's disease and Schizophrenia- A case report <p>Darier's disease is a rare autosomal dominant genodermatosis. There is a specific mutation in the ATP2A2 gene on chromosome 12q. Several neuropsychiatric manifestations have been described in association with Darier's disease. Most reports have come from western populations, with limited reports of Darier's disease and its neuropsychiatric associations among Asian people, although the demographic and clinical profiles are comparable. We present a case of 38 year old female from Kerala with Darier's disease presenting with schizophrenia spectrum disorder. Her first degree relatives have schizophrenia-like psychosis and dermatological manifestations suggestive of Darier's disease.</p> Rahul Thovarayi, V Nair Indu, Babu Kiran (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Wed, 30 Jun 2021 00:00:00 +0530 Case-Control Studies <p>Case-control studies (CSS) are observational analytic studies done often in instances of rare cases or outcomes.&nbsp; In a case-control study, clearly defined cases and controls arising from the same population is compared for well-measured exposures. The ease of conduct of the study in terms of resources makes CSS popular. However, since the direction of the study is retrospective, selection and measurement biases are potential threats to the validity of conclusions from CSS. Moreover, CSS gives not give a direct estimate of the risk. Another issue with the CSS study is confounding.&nbsp; How these validity issues could be addressed are also discussed.</p> Pankajakshan Vijayanthi Indu, Karunakaran Vidhukumar (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Tue, 03 Aug 2021 00:00:00 +0530 Writing the methods section in a manuscript Samir Kumar Praharaj, Shahul Ameen (Author) Copyright (c) 2021 Kerala Journal of Psychiatry Mon, 07 Jun 2021 00:00:00 +0530