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   Table of Contents - Current issue
Coverpage
January-June 2020
Volume 21 | Issue 1
Page Nos. 1-58

Online since Friday, July 3, 2020

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EDITORIAL  

Autonomy and advance directives in psychiatry patients in India – Mental Healthcare Act 2017 perspective p. 1
Vijaya Chandra Reddy Avula
DOI:10.4103/AMH.AMH_24_20  
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ORIGINAL ARTICLES Top

A comparative study on metabolic syndrome in patients with schizophrenia treated using first-generation and second-generation antipsychotics Highly accessed article p. 4
Dinesh Panati, TP Sudhakar, Puthalapattu Swetha, Vinay Kumar Sayeli
DOI:10.4103/AMH.AMH_4_20  
Introduction: The prevalence of metabolic syndrome is more in patients with schizophrenia receiving first- and second-generation antipsychotics. Aim and Objectives: The aim is to study the prevalence of metabolic syndrome in patients with schizophrenia treated with first-generation and second-generation antipsychotics and to compare the prevalence between two generations. Materials and Methods: The study sample was obtained from the patients attending the outpatient clinic or admitted to the inpatient unit of the department of psychiatry at tertiary care unit. Patients with schizophrenia, 50 each on treatment with first- and second-generation antipsychotics for a minimum of 4 months were measured for fasting blood glucose, blood triglycerides, high-density lipoprotein, blood pressure, and waist circumference. Adult treatment panel diagnostic guidelines were used to diagnose metabolic syndrome. Results: The prevalence of metabolic syndrome in first-generation group was (18%) and second-generation group was (40%). Comparison of the prevalence between the two groups showed Mann–Whitney value of −2.412*, which was statistically significant at P < 0.05. There was significant difference found in the chlorpromazine equivalent dosage of antipsychotics at P < 0.001. It signifies that though the second-generation group had received lesser amount of antipsychotic dose when compared to first-generation group, the prevalence of metabolic syndrome was more in the second-generation antipsychotic group. Conclusion: Metabolic syndrome is seen in both the group of patients taking antipsychotics. In line with previous studies, our study also found that the prevalence of metabolic syndrome is more in patients taking second-generation antipsychotics.
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Emotional intelligence among medical undergraduates, interns, postgraduates, and medical practitioners p. 12
Lakshmi Shodhana Kasam, Raghuram Macharapu, Vishnu Gade, Pramod K R. Mallepalli, Ravulapati Sateesh Babu, S Manjula
DOI:10.4103/AMH.AMH_16_19  
Introduction: Emotional intelligence (EI) impacts many different aspects of daily life, such as the way one behaves and interacts with others. Empathy, one of the five elements of EI, is considered to be the most important psychosocial factor of inpatient care. An assessment of EI and empathy would help health-care professionals give better patient-centered care. Aims and Objectives: This study aims to assess the various components of EI among medical students and professionals and study its relation with personal and social factors. Materials and Methods: This is a cross-sectional study conducted with a sample that consists of 200 participants in Mamata Medical College, Khammam and Pratima Medical College, Karimnagar, Telangana during a period of 6 months (2018). A semi-structured pro forma is used to collect sociodemographic profile and the emotional quotient self-assessment checklist by Sterrett is used to measure EI and empathy. Results: There is a significant negative correlation between work hours and empathy, individuals with lesser work hours scored higher on empathy and social competence. There is also a significant negative correlation between motivation and sleep hours, individuals with more number of sleep hours scored lesser on motivation. Those who exercised scored higher on self-awareness and social competence as compared to those who never exercised. Individuals with a greater number of friends in the workplace scored significantly higher in confidence and motivation. Conclusion: The current study supports that good work relations, empathy, and exercise have a positive correlation with various domains of EI.
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A cross-sectional study of the barriers for seeking mental health care among medical undergraduates p. 16
Lakshmi Shodhana Kasam, Raghuram Macharapu, Vishnu Gade, Pramod K R. Mallepalli, Ravulapati Sateesh Babu, S Manjula
DOI:10.4103/AMH.AMH_17_19  
Aims and Objectives: The aim and objective of this study are to study the major barriers to seeking mental health care among medical undergraduates and to understand the correlation between barriers and demographic factors. Materials and Methods: This was a cross-sectional study that was conducted with a sample that consists of 100 participants in Mamata Medical College, Khammam and Pratima Medical college, Telangana, India, during the period of 6 months (2019). A semi-structured pro forma was used to collect the sociodemographic details, and the Barriers to Access to Care Evaluation Scale was used to assess the reasons for not seeking mental health services. Results: This study found that 26% of the participants did not seek any kind of mental health care despite needing it. The analysis revealed that stigmatizing beliefs, difficulty in sharing one's concerns, preference for self-reliance, and difficulty in accessing help were the prominent barrier themes among responders. Conclusions: This study highlights the vast discrepancy in the number of individuals in need of mental health care and the actual number of people seeking it. The present findings indicate that interventions are required to improve mental health literacy and knowledge of local services.
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Prescribing practice of long-acting injectable antipsychotics p. 21
Jisha M Lucca, Ghada AlSumain, Maryam Almousa, Rehab Alkhalifa
DOI:10.4103/AMH.AMH_1_20  
Introduction: Nonadherence to treatment is one of the main problems that prevent treatment outcomes in schizophrenia. Long-acting injectable antipsychotic (LAIA) simplifies the treatment process and improves the adherence and health-related outcomes. The prescription pattern of antipsychotics in psychiatric and nonpsychiatric wards is well studied. Whereas the patterns of long-acting injectable (LAI) are not yet documented. Hence, this study was aimed to assess the pattern and prescription of LAI in a university hospital in Saudi Arabia. Materials and Methods: This single-centered, retrospective study was conducted in a university teaching hospital in Khobar city over a period of 6 months. Patients of all ages and either gender with a psychiatric diagnosis or received at least a single depot injection over a period of 1 year were included in the study. Results: A total of 101 patients were included in the study; a male predominance was observed in (64%) our study patients. One half of the study patients have a long history (10 years and more) of psychiatric problems. Of the total 313 medications, 176 (55.7%) and 137 (43.3%) were psychotropic and nonpsychotropic medications, respectively. Zuclopenthixol (n = 48) and haloperidol (n = 10) were the commonly prescribed first-generation LAIAs, whereas risperidone (40) was the only one second-generation LAIA preferred in the study site. Befere the Initiation of LAIA ,majority (67%)of the patients received a trial of antipsychotices orally. Conclusion: The study delivers the evidence of LAIA utilization in a psychiatric unit of a tertiary care teaching hospital in Saudi Arabia. LAIAs were the choice not solitary for schizophrenic-like ailments. The utilization pattern is similar to both-generation LAIs. More studies are required to focus the safety and efficacy concerns of LAIA.
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Assessment of brain dominance and its correlation with academic achievement among medical students: A cross-sectional study p. 25
Vedalaveni Chowdappa Suresh, Chandraprakash Poornima, Kumar Krishna Anjana, Ipsita Debata
DOI:10.4103/AMH.AMH_3_20  
Background: Each individual will have a unique way of perceiving, processing, and retrieving information provided, which could have an impact on one's performance. Medical education is undergoing reformation in terms of focusing on skill-based learning. Hence, understanding the pattern of brain dominance could influence the teaching and learning styles. Aims: The aim of this study is to assess brain dominance and its correlation with academic achievement among medical students. Settings and Design: A cross-sectional study was conducted in a recently opened medical college in South India. Materials and Methods: The study sample consists of two batches of medical students of 150 each, of which 245 students consented to participate in the study. Sociodemographic pro forma, alert scale of cognitive style and first-year MBBS final examination results were used. Statistical Analysis: Results were interpreted in the form of frequencies, Chi-square test, and Spearman's correlation test. Results: Of the study group, 60% were female students (n = 147) and 40% were male students (n = 98). Left brain, bilateral, and right brain dominance was seen in 37.55%, 33.06%, and 29.39% of the population, respectively. The r- value was correlated with brain dominance and academic achievement; however, it did not differ significantly at 0.05 level and was found to have a negligible relationship between the two. Conclusion: Female students were predominantly left side brain dominant. Brain dominance and academic achievement did not show any correlation. The importance is attributed to implementing the different teaching methods/styles, as it is believed to influence and promote better learning among medical students.
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A study of cognitive dysfunctions in chronic smokers p. 30
Shaik Ekramulla, Ramya Keerthi Paradesi, Nageswara Rao Nallapaneni
DOI:10.4103/AMH.AMH_11_20  
Background: Cognition is defined as the mental processes of perception, memory, and information processing. Cigarette smoking could contribute to cognitive impairment through atherosclerotic and hemodynamic processes. Aims and Objectives: The aims and objectives were to study the cognitive dysfunctions in chronic smokers and to compare cognitive dysfunctions in chronic smokers with nonsmokers who are matched for age, sex, and socioeconomic status. Settings and Design: This is a cross-sectional study conducted using purposive sampling on participants recruited from the Outpatient Department of Psychiatry, Narayana Medical College and Hospital. Materials and Methods: The study was conducted on a sample of sixty patients. Out of this, thirty participants who are current smokers were taken as cases and the other thirty participants who are the attenders of the patients who never smoked cigarette were taken as controls. Informed consent was taken from the cases and controls. Brief Cognitive Rating Scales (BCRSs), digit symbol substitution test (DSST), and Trial-Making Test-A and B were used to assess the cognitive functions, and Fagerstrom Test for Nicotine Dependence (FTND) was used to confirm the diagnosis of nicotine dependence. Statistical Analysis Used: To test the association between the groups, Chi-square test was used. To test the mean difference between the groups, Student's t-test and ANOVA were used. To test the correlation between the scores, Spearman's rank correlation was used. Results: Smokers when compared to nonsmokers took longer time in the completion of both trail-making tests A and B and gave less correct responses on DSST. Significant impairment in all the five axes of BCRS was observed. Comparison was statistically significant between FTND score, the trail-making tests A and B, BCRS, except axis-ii. Conclusions: The higher the nicotine dependence, the greater is the chronicity of cigarette smoking, which has significant cognitive dysfunction.
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Perceptions of partner drinking problems, regulation strategies, and relationship outcomes p. 39
Vivek Kumar Rachakatla, CH Prashanth, Pramod Kumar R. Mallepalli, Ravulapati Sateesh Babu, Pavani Narukurthi, Manjula Sakamudi
DOI:10.4103/AMH.AMH_10_20  
Introduction: Alcohol use can have negative effects on the relationships, especially if the partner's drinking is perceived to be problematic. Interpersonal perceptions and associations between partners' perceptions of one another have important implications for the individuals comprising a relationship. Aims and Objectives: The objective of this study was to assess the perceptions of partner drinking problems, regulation strategies, and relationship outcomes. Materials and Methods: This cross-sectional study consisted a sample size of 100 participants who are admitted for alcohol de-addiction in Mamata General Hospital, Khammam, Telangana, India. The samples were drawn using a convenience sampling method. Thinking about your partner's drinking (TPD) questionnaire and partner management strategies (PMS) questionnaire were the tools used to collect the data for this study. Results: The results of the study were analyzed and evaluated using the mean, standard deviation and by obtaining the Pearson's correlation principle. The mean was obtained separately for PMS and TPD. Standard deviation (6.473, 5.268) was obtained from the values of the mean. P value was obtained (significance <0.0001). Conclusions: The study determines the ideology of the Indian married couples and their perception toward the partner's drinking problem and their regulating attempts. Certain items from the questionnaire were not implacable in the study group such as pouring out drinks and suggesting alternatives to alcohol use. The results also strongly established that the compatibility of the partners to take up the additional burden of the families due to the partner's negligence and they feel embarrassed to get into the public and family gatherings because of the partner's uncontrolled behavior because of alcohol intake.
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Impact of stressful life events in mood disorders p. 43
Ooha Susmita Biddala, Rayapureddy Satya Krishna Kumar, P Krishna Mohan, Savithri Bhavaraju
DOI:10.4103/AMH.AMH_12_20  
Background: Life events are defined as discrete experiences that disrupt an individual's usual activities, causing a substantial change and readjustment, such as marriage, physical illness or death in the family. A temporal relationship has been established between such stressful life events and the onset and severity of psychiatric illness in many studies. Aims: To assess the impact of stressful life events in patients with mood disorders. Materials and Methods: 70 patients with an established diagnosis of an affective disorder according to ICD-10 were sampled via consecutive sampling. Sociodemographic proforma and HAM-D or YMRS were applied as relevant to rate the severity of illness. Presumptive stressful life events scale (PSLES) was applied to assess for the number and score of stressful life events during the patient's lifetime and the past one year. Results: Stressful life events were found to have a significant contribution to the illness in the context of the socio-demographic background of the subjects. Significant correlation was also seen between severity of illness and stress scores from PSLES with events occurring over lifetime, desirable events and impersonal events eliciting a more severe illness. Conclusion: Life events can behave as acute and ongoing stressors during the course of an illness. Establishing their impact and addressing coping mechanisms should be done to make for a comprehensive management of any patient diagnosed with a mood disorder.
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What explains the wide variation in the prevalence of benchmark disability in the state of Andhra Pradesh? p. 50
Hareesh Angothu, Chandra Banu Gupta Paritala, Vijaychandra Reddy Avula, Nageswara Rao Nallapaneni
DOI:10.4103/AMH.AMH_21_20  
Introduction: Population-based enumeration of persons with disability (PWD) is vital for the allocation of resources to provide social welfare measures, toward PWD inclusion, and for the improvement of their quality of life. Wide variations exist between different estimations of PWD across studies conducted by various agencies such as the Census Board of India, World Health Organization and World Bank. Irrespective of Population based estimations, In India, people certified as having 40% or above disability described as “BenchMark Disability”(BMD), are only eligible for social welfare measures like disability pension, job reservations intended for persons with disability. Objectives: This study was carried out to understand if populations-based estimation of disability prevalence is equivalent to the prevalence of BMD or not. Methodology: Data on the number of persons with BMD, published by the Social welfare department of Andhra Pradesh at online portal called SADAREM is compared to population-based estimation of number of PWD in Andhra Pradesh through census board estimation. Results: As per census 2011, about 1,265,167 (2.5%) persons among the general population were estimated to have one or other disability in Andhra Pradesh State. The data published by the Social Welfare Department of AP state indicates a lower estimate, that by April 2020, there are only 957,412 (1.8%) persons among the general population had one or another BMD. In this article, the possible reasons for such variation are discussed as such variation may have significant policy level implications.
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CASE REPORT Top

An unusual presentation of neurocysticercosis as psychosis with tics p. 55
Krishna Kumar Anjana, Vedalaveni Chowdappa Suresh, Chandraprakash Poornima, Hithelmane Sreeramaiah Madhuvan
DOI:10.4103/AMH.AMH_6_20  
Neurocysticercosis (NCC) is an infection caused by the larval stage of the parasite, Taenia solium. Seizures, psychosis, Parkinsonism, and other movement disorders have been described in the literature pertaining to NCC; however, no reports were available on tics. A young female presented to the outpatient department with headache, psychotic symptoms, and tics for a duration of 15–20 days. On examination, she was noted to have fluctuating orientation and was hypervigilant. She also presented with irrelevant speech, ideational perseveration, paranoid ideation, visual/auditory hallucinations, and motor/vocal tics. Following a detailed evaluation with investigations such as magnetic resonance imaging of the brain and ELISA, a diagnosis of NCC with psychosis and tics was made. She was treated with mannitol, steroids, albendazole, and antipsychotics. Psychosis and tics improved within 1 week of treatment. This case highlights an uncommon presentation of NCC as well as the significance of a high index of suspicion and the need for a careful workup to catch these cases.
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