Kerala Journal of Psychiatry <p>Official&nbsp; Journal of the Branch of Indian Psychiatric Society (Kerala)</p> en-US (Dr. K Vidhukumar) (X) Thu, 31 Dec 2020 12:52:51 +0530 OJS 60 Descriptive studies <p>Descriptive studies are observational studies which range from the case and case series report to extensive epidemiological studies. The essential features of the descriptive studies are its cross-sectional nature. From an epidemiological perspective, there are two types of descriptive studies; prevalence studies and ecological studies. In prevalence studies, the focus is on describing disease and exposure variables with reference to person, place and time on an individual level. They help to assess the disease and sometimes the exposure burden. Sequentially conducted descriptive studies can give time trends. Case-control analysis of descriptive studies can help identify an association, which could be tested by true analytical studies like case-control and cohort studies. The essential validity threats to descriptive studies are selection bias and information bias. Using appropriate random sampling methods, taking steps to prevent response failure and administering validated questionnaires for data collection are the measures to circumvent them. Cross-sectional designs are also used to validate diagnostic tests and research instruments, staging of illnesses and deriving normative values.</p> Pankajakshan Vijayanthi Indu, Karunakaran Pillai Vidhukumar Copyright (c) 2020 Kerala Journal of Psychiatry Thu, 31 Dec 2020 00:00:00 +0530 Still Alice:A journey through the looking glass of Alzheimer’s disease Joel Philip, Vinu Cherian Copyright (c) 2020 Kerala Journal of Psychiatry Mon, 14 Sep 2020 00:00:00 +0530 Willingness and psychological preparedness to attend to COVID-19 patients among healthcare workers in a tertiary care private hospital in Kerala - A mixed method study <p><strong>Background: </strong>The COVID-19 pandemic has made an unprecedented psychological impact on healthcare workers. The objective of this study was to appraise the willingness, attitudes and psychological preparedness of the frontline healthcare workers to respond to the COVID-19 pandemic. <strong>Methodology</strong><u>:</u> This was a mixed-method study combining a web-based cross-sectional survey, focus group discussions and semi-structured interviews. The cross-sectional survey covered 202 healthcare workers, and the qualitative assessment was done on 16 frontline healthcare workers. <strong>Results</strong>: The willingness to respond to the pandemic was found to be significantly higher among doctors and nurses compared to medical interns. Among demographic factors increasing age and female gender were the key factors in determining willingness and positive emotional response. While anxiety was the most common emotional response, the fear of infecting family members was found to be the most common risk perceived in qualitative analysis. The study highlights the altruistic attitude of frontline health workers to be the most important contributing factor for psychological preparedness. <strong>Conclusion</strong><u>: </u>This study outlines the fact that willingness to respond in a pandemic is an innate response in healthcare workers. Considering the risks, workload and socioeconomic stressors, proactive psychosocial support should be given to frontline healthcare workers by the institutions, governments, and society.</p> Neethi Valsan, Ronnie Thomas, Praveenlal Kuttichira, Chithra Valsan, Anita James Copyright (c) 2020 Kerala Journal of Psychiatry Sun, 27 Sep 2020 00:00:00 +0530 Emotional intelligence, perceived stress, and internet use behaviour among undergraduate medical students - a cross sectional study <p><strong>Aim:</strong> To find the pattern and characteristics of Problematic internet use and to determine the relationship between Internet Addiction, Perceived stress and Emotional Intelligence among medical students.</p> <p><strong>Materials and methods:</strong></p> <p>In this cross-sectional study, using convenience sampling, 368 study participants were selected from the undergraduate medical students of a medical college in North Kerala. After getting written informed consent, socio-demographic data sheet, Internet Addiction Test (IAT), Schutte Self Report Emotional Intelligence Test (SSEIT) and Perceived Stress Scale (PSS) were filled up by the participants. Completed responses were scored and analyzed using SPSS 18.0.</p> <p><strong>Results:</strong> Problematic internet use among the participants was 65.7%. In the sample, 42.9% had mild internet addiction, and 22.8% had moderate internet addiction. There was a positive correlation between scores of IAT and PSS and a negative correlation between scores of IAT and SSEIT. A pattern of increased levels of perceived stress and decreased levels of emotional intelligence was noticed with increasing levels of internet addiction scores.</p> <p><strong>Conclusion: </strong>Young medical students were found to have mild and moderate levels of internet addiction and were high in perceived stress. Those with an addiction pattern of internet use also showed lower levels of emotional intelligence. It is crucial to identify those with lower levels of emotional intelligence and intervene effectively for stress management to reduce the internet overuse and emotional sequelae of it.</p> R S Parvathy, CA Smitha Copyright (c) 2020 Kerala Journal of Psychiatry Tue, 21 Jul 2020 00:00:00 +0530 Postpartum depression and its association with social support: a cross sectional study at a maternity hospital in Kerala. <p><strong>Background</strong>: Childbirth is associated with significant physiological changes as well as challenges related to psychiatric disorders. Postpartum depression (PPD) is one such condition associated with high levels of morbidity and mortality. Screening postpartum women for early identification of depression and its prompt treatment should be a crucial component of postnatal health care. Assessment of prevalence and correlates of postpartum depression hence becomes important. <strong>Methods</strong>: Cross-sectional assessment of mothers (n=250) during postnatal visits to the family planning clinics between four weeks and one year of delivery, using Edinburg Postpartum Depression Scale (EPDS), Social Support Questionnaire and a structured questionnaire for the assessment of psychosocial risk factors was carried out in a tertiary care postgraduate teaching hospital of north Kerala. Multivariate Regression Analysis was used to identify the risk factors for PPD. <strong>Results</strong>: 27.6% had postpartum depression (score of <u>&gt;</u>11 in EPDS), and 18.4% had suicidal ideation. Factors associated with the presence of PPD included alcohol use of husband, marital discord, lack of family support and lack of physical help during the postnatal period. Difficulties during labour, the gender of the baby or postnatal complications did not have a significant association with PPD. Though there was a negative correlation between Social Support Scale (SSS) total score and EPDS score, it was not statistically significant. (Pearson’s co-relation coefficient= -0.084, p= 0.186). <strong>Conclusion</strong>: Prevalence of depression in postnatal women is very high. Modifiable psychosocial factors have a close association with PPD, and these are opportunities for intervention as well. Considering the morbidity and mortality linked to untreated PPD, screening of postnatal women and routine provision of therapeutic services to them is suggested.</p> Santhosh Kuriakose, Vinaychandran S  , K T P Dayal Narayan, Mini CH Copyright (c) 2020 Kerala Journal of Psychiatry Sat, 25 Jul 2020 00:00:00 +0530 Self inflicted upper limb injuries in a tertiary care rural Plastic Surgery unit - A psychiatric evaluation <p><strong>Background:</strong> Deliberate self-harm patients (DSH) with upper limb injuries are commonly admitted in the plastic surgery units. Psychiatric comorbidities are risk factors for these patients with self-inflicted injuries. A multidisciplinary team approach is needed.</p> <p><strong>Methods</strong>: Patients who presented with self-inflicted upper limb injuries in the plastic surgery department were referred for psychiatric liaison services. Socio-demographic data, mode of injury, plastic surgical procedures, and psychiatry diagnosis were noted.</p> <p><strong>Results and discussion</strong>: Out of 48 patients, 20 (41.6%) belong to the 21-30 age group, 30 (62.5%) were males. 43 (89.6%) patients needed major plastic surgery procedures. The major psychiatric comorbidities were depressive disorder (27.1%), adjustment disorder (16.6%), alcohol dependence syndrome (14.6%), and bipolar mood disorder (12.5%). High psychiatric morbidity among self-inflicted hand injuries suggests the need for a multidisciplinary approach and long term follow-up.</p> <p><strong>Conclusion:</strong> Psychiatric liaison services are important in the treatment of self-inflicted upper limb injuries.</p> Joice Geo, Cyril Joseph, Chintu Sabu George, Roy Abraham Kallivayalil Copyright (c) 2020 Kerala Journal of Psychiatry Sun, 02 Aug 2020 00:00:00 +0530 Self-reported Emotional Experience Among Police Personnel Before and After Attending a Mindfulness Based Intervention (Mindful Life Management-MLM)-an Observational Study <p><strong>Background</strong>: Stress has been proven to be hazardous, resulting in significant physical, emotional, social and cognitive disturbances which are unpleasant. Police officers have elevated rates of cardiovascular diseases, sleep disorders, anxiety disorders, depression and PRSD. Kerala Police has implemented several programs for management of stress among its members. Mindfulness-Based Interventions (MBIs) have been shown to enhance emotional intelligence, reduce negative emotions and health outcomes in police officers. <strong>Objective</strong>: The objective of the current study is to study the effectiveness of an MBI in reducing the negative emotions among police officers</p> <p><strong>Methods</strong>: The present study is an observational study which attempts to assess and compare the subjectively reported emotion and Mindfulness level among police personnel before and six weeks after attending the Mindful Life Management (MLM) workshop. <strong>Results</strong>: Results of the present study suggests a statistically significant association between subjective emotional experience and the MBIs. Five Facet Mindfulness Questionnaire (FFMQ) scores also were found to be significant statistically. FFMQ scores before and after the MLM workshop were found to be statistically significant. <strong>Conclusion</strong>: Results of the present study points to the fact that MLM can be thought of as a method of intervention to manage emotional turmoil among police personnel of our state. The relationship between the change in emotion and change in FFMQ score has to be further explored with adequate sample size. This ongoing study comparing the stress and emotional levels of the police force in the State of Kerala before and after MLM course will help to strengthen further the effects of MBIs in recognizing their emotional state.</p> Sivasubramoney Krishnan, Kothandaraman Lekshmy, Prabhakaran Anil, Bharathadas Sandhya, Kumari Jayageetha Copyright (c) 2020 Kerala Journal of Psychiatry Sat, 31 Oct 2020 00:00:00 +0530 Association of tobacco smoking with bipolar affective disorder- a comparative cross-sectional study at a tertiary care centre in south India <p><strong>Background</strong>: Smokers with psychiatric disorders, most notably those with serious mental illness and substance use disorders tend to present with more severe nicotine dependence and nicotine withdrawal than smokers without these illnesses. The following study aims to explore the correlation of smoking with bipolar affective disorder</p> <p><strong>Setting and design</strong>: The comparative cross-sectional study was done in Amrita Institute of Medical Sciences &amp; Research Centre, Kochi, a 1,450-bed hospital for a period of 2 years.</p> <p><strong>Methods and materials</strong>: Seventy subjects with Bipolar affective Disorder who were in remission for at least two months and Seventy subjects who were relatives of paediatric outpatients were included in the study and control group, respectively. Clinical variables were assessed, and Hamilton depression rating scale, Young mania rating scale and Fagerstorm nicotine rating scale were administered to the subjects.</p> <p><strong>Results:</strong> In this study, 52.9% of subjects with bipolar disorder were found to be smokers, and 51.4% of the normal population were smokers. No significant association was observed between bipolar affective disorder, and smoking tobacco, however, a significant correlation was found between smoking status and the total number of episodes of the disorder, psychotic episodes and suicide attempts.</p> <p><strong>Conclusion</strong>: There appears to be a relationship between smoking tobacco and certain clinical features of bipolar affective disorder. It is possibly a bidirectional relation between these two disorders. </p> Parvathy Radhakrishnan, Praveeen Arathil, Dinesh Narayanan Copyright (c) 2020 Kerala Journal of Psychiatry Sat, 31 Oct 2020 00:00:00 +0530 Pathways to care and duration of untreated illness in patients attending a state psychiatric hospital <p><strong>Background: </strong>In India, due to various factors, mentally ill often turn to a variety of carers for treatment. It results in a longer duration of untreated illness (DUI) with poor long term prognosis. Studies on pathways to care, seek to find out predictors of mentally ill person’s help-seeking behaviour. There is a dearth of literature in this subject in Kerala setting. <strong>Methods: </strong>Cross<strong>-</strong>sectional study was conducted on 250 consecutive first-time outpatients. The diagnosis was made according to DSM 5. A pilot-tested, semi-structured proforma was used for socio-demographic details and Encounter form by WHO for pathways to care. The analysis was done using Epi Info software. <strong>Results and discussion: </strong>Four gateways to care identified: Psychiatrist- 71.2%, faith healers – 14.8%, non-psychiatrist modern medicine doctors- 9.2%, alternate systems of medicine- 4.8%. Median DUI was seven months. Faith healers as first carers were more in BPL compared to APL families (p=0.004). Substance use disorders had longer median DUI than psychotic and anxiety disorders and mental retardation. Major neurocognitive disorder had more delays than the schizophrenia spectrum and other psychotic disorders and mental retardation (p=0.000<strong>)</strong>. Among first carers, longer DUI was with faith healers and alternate systems of medicine when compared to psychiatrists. (p=0.000<strong>).</strong> Those from higher socioeconomic status and a diagnosis of substance use disorder more often have a psychiatrist as the first carer. Being male was associated with lengthier pathways. <strong>Conclusion</strong>: Faith healers &amp; alternate systems of medicine practitioners form the first portal of psychiatric care for a small yet significant proportion of the patients. Reduction in DUI in case of psychiatric disorders needs attention to this aspect also.</p> G Sukesh, V Indu Nair Copyright (c) 2020 Kerala Journal of Psychiatry Mon, 30 Nov 2020 00:00:00 +0530 Prevalence and factors associated with post-traumatic stress disorder among flood-affected adults in a panchayat in Ernakulam district in Kerala <p>Floods affected the state of Kerala following unusually heavy rainfall during the monsoon season in August 2018. Post-Traumatic Stress Disorder (PTSD) is the most common and debilitating psychological disorder among victims of floods or any other massive disaster. This study aimed to determine the prevalence and the factors associated with Post-Traumatic Stress Disorder (PTSD) among flood-affected adults in a panchayat in Kerala. In light of the looming threat of climate change, and with Kerala being especially prone to recurring floods due to its geographical location, there is an urgent need to assess the impact of floods on the psychological wellbeing of the residents of the state. To the best of our knowledge, this is the first study to investigate the occurrence of PTSD among the residents of Kerala following exposure to floods. <strong>Methods: </strong>This was a cross-sectional study undertaken in 100 households in a flood-affected community in Kerala. The PTSD Checklist for DSM-5 (PCL-5) was administered to diagnose PTSD. The intensity of flood exposure was measured using a checklist of ten factors.</p> <p><strong>Results: </strong>The prevalence of PTSD was 22%. Loss of a relative, physical injury, and affliction with a physical illness were significantly associated with PTSD. A higher intensity of flood exposure was associated with a greater prevalence of PTSD. <strong>Conclusion: </strong>Our study demonstrates the high prevalence of PTSD following floods in Kerala and the need to conduct post-disaster mental health screening. It highlights those factors that may predict the occurrence of PTSD in the affected population. Recommendations are also put forward to mitigate the psychological impact of floods on the inhabitants of the state in the coming years.</p> Vinu Cherian, Joel Philip, Alexander John Copyright (c) 2020 Kerala Journal of Psychiatry Sun, 06 Dec 2020 00:00:00 +0530 Change in attitude towards suicide with current undergraduate training in psychiatry: a cross-sectional study <p><strong>Background</strong>: Teachers in the field of psychiatry has the responsibility to impart changes in students' attitude towards important areas of the subject. Suicide is the psychiatric emergency that a primary care practitioner is most likely to encounter in day to day practice. In this cross-sectional study, we looked into the change in the attitude of an undergraduate student towards suicide with his/her training in psychiatry with the present undergraduate curriculum. <strong>Materials and Methods</strong>: We recruited undergraduate medical students doing their MBBS course from a medical college of South India. Their responses to Eskin's Attitudes towards Suicide Scale (E-ATSS) and Eskin's Social Reactions to Suicidal Persons Scale (E-SRSPS) were collected. The students were divided into groups of students completed undergraduate training in Psychiatry and those who are yet to get exposed to it. Responses in E-ATSS and E-SRSPS from both groups were compared. <strong>Results</strong>: The overall attitude of students towards suicide and suicidal person were favourable compared to many previous studies. There was a significant difference in the factor ' suicide as a sign of mental illness' when responses from both groups were compared. 2.72±1.11 in the exposed group compared to 3.16±1.11 of unexposed group. p-value&lt;0.001). Also, there was a significant difference in responses to the disapproval of suicidal disclosure. 2.83±0.65 in the exposed group and 2.67±0.67 in the unexposed group. (p-value - 0.01). <strong>Conclusion</strong>: The current undergraduate medical curriculum by Medical Council of India is successful in bringing attitude change in some important domains of the subject of suicide. Domains remain under-covered by the curriculum should be looked into in the future curriculum revisions.</p> V G Vinuprasad, N R Sharadha, Mehmet Eskin Copyright (c) 2020 Kerala Journal of Psychiatry Sat, 12 Dec 2020 00:00:00 +0530 Post Stroke Depression and Lesion Location: A Hospital based cross sectional study <p><strong>Introduction</strong>: Depression is seen in about 40% of patients with stroke and is a common neuropsychiatric consequence. Post-stroke depression (PSD) can be related to the site and side of infarct and psychological stressors. There are conflicting results in this area of research and dearth of studies from India. Thus the study aims to assess the prevalence of PSD in stroke patients and the relation between site and side of stroke with PSD. <strong>Methodology</strong>: A cross-sectional study was done among 40 stroke patients recruited by consecutive non-random sampling in Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla. A semi-structured proforma was used to collect the socio-demographic, illness-related and neuroimaging details. Hamilton depression rating scale was used to assess the severity of depression. SPSS 20.0 was used for statistical analysis. <strong>Results:</strong> 64% of the patients with left-sided lesion had PSD, whereas only 20% had PSD among the right-sided group which was significant with a p-value of 0.005.PSD was seen in 64% (N=9) of patients with subcortical lesions which were significantly high (p=0.006) when compared to 14% (N=2) of the patients with PSD among the cortical group. <strong>Conclusion:</strong> This study showed a high prevalence of PSD and its correlation with left-sided cortical and subcortical lesions. Eliciting the relationship between the lesion and depressive symptoms may help shed light on the neurobiology of depressive disorders.</p> Sivin P Sam, Joice Geo, G I Lekshmi, Roy Abraham Kallivayalil Copyright (c) 2020 Kerala Journal of Psychiatry Thu, 24 Dec 2020 00:00:00 +0530 Your mental health - your responsibility (Presidential address) Thomas John Copyright (c) 2020 Kerala Journal of Psychiatry Mon, 19 Oct 2020 00:00:00 +0530 “Werther effect” – Media, a potential preventive tool for suicidal behaviour <p>Suicide, with all its psychosocial impacts, is a major public health problem and needs prompt preventive approaches considering its increasing magnitude. In this era of the internet, people started to rely more on data available at their fingertips than the print media. And this is the time to apply the knowledge we had gained of print media reporting on suicide (its limitations and possibilities) to online media. This article tries to bring attention to some of the recommendations for media reporting on suicide and the need for researches based on the online media platform.</p> Soumya P Thomas, Sheena Varughese, RA Kallivayalil Copyright (c) 2020 Kerala Journal of Psychiatry Mon, 17 Aug 2020 00:00:00 +0530 Borderline intelligence, disability provisions and fuzzy borders <p>The diagnosis and boundaries of borderline intellectual functioning (BIF) lack clarity. The nosological status in DSM 5 and ICD 10 and 11 are also dubious. The provision of 'borderline disability' of 25 % for the category of Intellectual Disability, in the RPWD (Rights of persons with disability) act, falls below the benchmark disability criteria. The Kerala State commissioner for persons with disabilities categorises those with IQ between 70 and 84, as 'borderline intelligent' and provides the benefits of scribe/interpreter to them. Can the psychiatrist certify an entity which does not exist in the current classificatory systems? The author tries to highlight the fallacies in the implementation of disability provisions in Kerala for students with BIF and provides alternative solutions vis a vis the disability plea.</p> Smitha Ramadas Copyright (c) 2020 Kerala Journal of Psychiatry Mon, 03 Aug 2020 00:00:00 +0530 Writing the introduction section in a manuscript Samir Kumar Praharaj, Shahul Ameen Copyright (c) 2020 Kerala Journal of Psychiatry Tue, 01 Dec 2020 00:00:00 +0530 A case report of Folie à deux with delusion of pregnancy <p>Pseudocyesis is common, whereas delusion of pregnancy is a rare psychopathology. The shared delusion of pregnancy is even rarer. We present a case from a tribal community where a wife shares her husband's delusion. It highlights the role of biopsychosocial determinants in forming psychopathology. It also reflects the need for strengthening community psychiatry approach.</p> Poulose Merin, Krishnan Hareesh Copyright (c) 2020 Kerala Journal of Psychiatry Sun, 27 Dec 2020 00:00:00 +0530 Impact of COVID-19 pandemic on people with alcohol use disorder in Kerala– An observation from Thrissur district <p>The novel coronavirus pandemic had caused the closure of beverage outlets in Kerala in late March 2020. There were a few suicides in the immediate period, which were highlighted in the media attributing to non-availability of alcohol. An observational study of patients admitted at the De-addiction Centre, NEST and Jubilee Mission Medical College and Research Institute was done. We recorded our observations from the closure of the beverage outlets until two weeks after. Though the government anticipated at least 100 patients, we encountered only 17. Those admitted were brought in delirium, with seizures or injuries sustained during delirium. The possible reasons behind this disparity are discussed which included the sale of illicit liquor or use of home-made preparations. The current situation arose due to a lack of planning and sudden closure of beverage outlets without warning being issued to mental health professionals. Opinions regarding steps to be taken for similar situations in the future are posited.</p> Chithira Thomas, Girish Menon, Praveenlal kuttichira Copyright (c) 2020 Kerala Journal of Psychiatry Wed, 30 Sep 2020 00:00:00 +0530