Industrial Psychiatry

Violence: The scourge of Indian industry Kalpana Srivastava, Suprakash Chaudhury, PS Bhat, Jyoti Prakash Industrial Psychiatry Journal 2018 27(2):159-162

Pharmacotherapy for relapse prevention of alcohol use disorder in the Indian setting: A systematic review Balaji Bharadwaj, Nivedhitha Selvakumar, Pooja Patnaik Kuppili Industrial Psychiatry Journal 2018 27(2):163-171 Alcohol use disorders (AUDs) is an important public health concern as estimates of the prevalence of AUD range at 4%–6% in the Indian population. Currently, there is limited literature on the pharmacotherapeutic interventions for AUD in the Indian setting. It is imperative to identify the possible variations in their effects from Western studies, and hence the current review was attempted to perform a comprehensive evaluation and critical appraisal of the methodology of the evidence on pharmacological strategies of relapse prevention of AUD in the Indian setting. A total of 18 studies were included in the review. Disulfiram was the most common pharmacological agent to be studied. The initial literature before 2000 focused primarily on disulfiram, whereas the studies in the next decade compared it to acamprosate and naltrexone and emerging interest in anticraving agents such as baclofen and topiramate had been noted over the past few years. No studies were available on newer agents such as ondansetron, selective serotonin reuptake inhibitors or formulations such as depot and implants. Deterrent agents were found to be better when compared to anticraving agents in terms of abstinence and relapse, whereas the latter were more effective for control of craving. Among the pharmacological agents studied, the greatest evidence exists for disulfiram for relapse prevention which could be due to affordability of disulfiram and social support in the Indian context. The chief methodological limitations include the lack of randomized trials and objective measures for assessing abstinence.

Transcranial magnetic stimulation: A review of its evolution and current applications Amit Chail, Rajiv Kumar Saini, PS Bhat, Kalpana Srivastava, Vinay Chauhan Industrial Psychiatry Journal 2018 27(2):172-180 Repetitive transcranial magnetic stimulation (rTMS) is a recently developed noninvasive brain stimulation method for the treatment of psychiatric and neurological disorders. Although, its exact mechanism of action is still not clear, current evidence points toward its role in causing long-term inhibition and excitation of neurons in certain brain areas. As evidence steadily grows in favor of rTMS as a therapeutic tool; there is a need to develop standardized protocols for its administration. There have been no reports of any serious side effects with rTMS, though its use is restricted in those having magnetic implants or recent adverse neurological or cardiac event. Of all the psychiatric indications of rTMS, the evidence is most robust for treatment of refractory unipolar depression. This paper reviews contemporary literature highlighting the evolution of rTMS as a diagnostic and therapeutic tool, especially in the management of treatment-resistant depression.

Executive function in patients with schizophrenia based on socio-occupational impairment: A cross-sectional study Delnaz Palsetia, K Chandrasekhar, MS Reddy, Avinash De Sousa, Sagar Karia Industrial Psychiatry Journal 2018 27(2):181-189 Background: Executive dysfunction deficit is the functionally most important cognitive deficit noted in schizophrenia. There is a dearth of Indian literature on the subject. The current study aimed at studying these executive functions in patients with schizophrenia in remission. Methodology: Sixty outpatients with a diagnosis of schizophrenia as per international classification of diseases-10 criteria; in remission as measured by Positive and Negative Syndrome Scale scores were divided into two groups using the personal and social performance scale. The patients with and without socio-occupational impairment formed the two groups. All patients were administered the Wisconsin Card Sorting Test (WCST), Stroop test, Color Trails Test 1 and 2, Phonemic Fluency (Controlled Oral Word Association Test), and category fluency (animal names test) tests and the tower of London test to ascertain deficits in executive functions. The data obtained were subjected to statistical analysis. Results: The two groups were well matched. The group with socio-occupational impairment showed a lesser number of categories completed (P = 0.001), more perseverative errors (P = 0.001), and greater percentage of the same (P = 0.001) on the WCST. Statistically significant differences between both groups were observed for scores on phonemic fluency (P = 0.012) and category fluency (P = 0.049) tests as well as the Tower of London test (P = 0.021). They also showed differences on the Stroop test and Color Trail tests, but this was not statistically significant. Conclusions: Performance on executive function tests is significantly correlated with functional outcome. It is important that future studies explore the role of these tests as a marker of socio-occupational impairment in schizophrenia.

Gender difference in affect of job applicants on completion of projective test battery for personality assessment in armed forces Durlabh Singh Kowal, Manish Kumar Dadhwal Industrial Psychiatry Journal 2018 27(2):190-196 Background: Every test, whether academic or non-academic, induces an 'affect' in subjects and completion of it also produces an affect, may it be positive or negative. The projective tests are peculiar in their nature for the purpose of personality assessment and may also have a temporary or everlasting impact on the respondent's affect at the conscious level. This paper tries to investigate the affect of job applicants in armed forces on completion of projective tests. Studies have shown that women are perceived to express emotions more than men but that there were little differences in the perception of men and women's emotional experience. Aim: The aim of the study was to examine gender difference in the affect of 275 job applicants (110 male and 65 female) after completing the battery of projective tests for personality assessment in armed forces. Materials and Methods: PANAS has been used for determining the positive affect (PA), which reflects the pleasurable engagement and subjective experience of happiness whereas the negative affect (NA) subscale measures the level of subjective distress and unpleased engagement. Results: Female's average score (4.66) was greater than male (4.45) score on the 'attentive' dimension of positive affect. This difference was significant t (273) = - 2.08, P < 0.05. Male's average score (4.47) was greater than female (4.24) score on the 'active' dimension of positive affect. Conclusion: This difference was significant t (273) = 2.14, P < 0.05. Among the dimensions of the negative affect, none of them have significant difference between male and female.

Prevalence of psychiatric morbidity among parents of children with intellectual disability Nandkisor K Tak, Brajesh Kumar Mahawer, Chandra Shekhar Sushil, Rashmi Sanadhya Industrial Psychiatry Journal 2018 27(2):197-200 Background: Intellectual disability is a permanent disabling condition, and caregivers are more vulnerable to develop mental illness. There is little data in developing countries, such as India, concerning about psychological issues in caregivers of intellectually disabled children. Objective: The objective of this study was to find the prevalence of psychiatric morbidity and correlation between sociodemographic factors and psychiatric morbidity in parents of children with intellectual disability. Materials and Methods: This study was carried out among 60 parents of children with intellectual disability at the outpatient Department of Psychiatry, Tertiary Care Centre, India. Parents, who fulfill the inclusion and exclusion criteria of the study, were interviewed by using semi-structured pro forma, International Disease Classification-10 criteria for mental illness, Beck Depression Inventory and Hamilton Anxiety Rating Scale, Brief Psychiatric Rating Scale, and Alcohol Use Disorder Identification Test. Results: The prevalence of depressive disorder was 28.33%, anxiety disorder was 18.33%, and other psychiatric disorders was 8.33% (psychotic disorder 3.33%, insomnia 1.66%, and alcohol use disorder 3.33%) and total psychiatric morbidity was about 55% in parents of children with intellectual disability. Conclusion: The study shows high psychiatric morbidity in parents of children with intellectual disability, and psychiatric screening should be considered among parents of children with intellectual disability.

Study of memory changes after electroconvulsive therapy Rajendran Akambadiyar, Pookala Shivaram Bhat, Jyoti Prakash Industrial Psychiatry Journal 2018 27(2):201-205 Background: Electroconvulsive therapy (ECT) is said to have few adverse effects and among them, cognitive impairment is the most significant side effect limiting its use. However, recent studies have suggested it to be due to illness rather than due to ECT, hence a need to study the memory changes following ECT. Aim: This study aimed to assess the memory changes following ECT and subsequent recovery in the short period of 4 weeks. Materials and Methods: Fifty consecutive first-episode cases of depression requiring ECT and scoring at least 27 on initial Mini–Mental State Examination were studied using Becks Depression Inventory and Wechsler Memory Scale III-Indian adaptation at baseline, after six ECTs, and 4 weeks after last ECT. Findings were analyzed using appropriate statistical methods. Results: Memory improved significantly after a course of six ECTs and further 4 weeks after the last ECT. Depression scores had dramatically reduced after a course of six ECTs. Significant correlation was found between baseline depression scores and baseline general (delayed) memory scores. Conclusions: The memory changes seen after ECT were likely to be mediated by changes in depression. Probably, ECT had no deleterious effects on memory or its negative effects were more than balanced by the changes due to improvement of depression.

Psychiatric comorbidity in patients undergoing hemodialysis Ekram Goyal, Suprakash Chaudhury, D Saldanha Industrial Psychiatry Journal 2018 27(2):206-212 Background: Patients undergoing hemodialysis are under considerable physical and mental stress. Few studies indicate an increase of psychiatric morbidity in them. Aim: The aim is to study the prevalence of psychiatric comorbidity in patients undergoing hemodialysis. Materials and Methods: A total of 49 consecutive patients of chronic kidney disease undergoing hemodialysis were included in the study with their consent. The Institute Ethics Committee clearance was obtained before the start of the study. The psychiatric interview was conducted only after the dialysis procedure was over. Patients were assessed using the Schedule for Clinical Assessment in Neuropsychiatry and Hamilton rating scale for depression. Results: A total of 49 patients in the age range of 15–64 years were included in the study. Majority of the sample was males (75.5%). Out of the patients enrolled in the study group, 45% had psychiatric comorbidity which included depression (26%), adjustment disorder (12.2%), generalized anxiety disorder (2%), mixed anxiety and depression (2%), and mental and behavioral disorders due to harmful use of alcohol (2%) indicating that patients undergoing hemodialysis is more likely to have mood disorder than other psychiatric disorders. Conclusion: Patients with recent-onset dialysis are more prone to psychiatric illnesses as it has a chronic debilitating course with poor outcome leading to major lifestyle changes with occupational disturbance and consequent financial implication.

Burnout and coping strategies among residents of a private medical college in South India: A cross-sectional study P Sreelatha, Liji Premlal, V S. S. R. Ryali Industrial Psychiatry Journal 2018 27(2):213-218 Background: Burnout is evident in various professions increasingly so in the health-care field, where doctors are involved with direct interactions with dependent patients. Burnout is evident even in residents due to working in demanding and testing conditions which has a negative influence not only on their profession, but also patient care. Aims: (1) To measure the levels of burnout among the residents and (2) to assess the relationship between severity of burnout and coping strategies. Settings and Design: It is cross-sectional observational study set in a private medical college with residency program. Materials and Methods: Online self-administered questionnaire was sent to all residents, out of these, 100 residents consented and completely filled the questionnaires and were included in the analysis with a response rate of 55.6%. The questionnaire consisted of sociodemographic variables, Maslach Burnout Inventory, and Brief COPE. Results: Residents who reported burnout as high in two dimensions of emotional exhaustion and depersonalization are 31.82%. The 2nd year residents scored high on burnout measures when compared to 1st and 3rd year residents. It was observed that as the degree of emotional exhaustion and depersonalization increased from low to high, the frequency of the maladaptive coping strategies also increased. Conclusion: Based on these findings it can be concluded that burnout is frequent in residents. Further research is essential to identify the factors that contribute to burnout in residents.

Caregivers' perspectives on disclosure, care, and treatment among pediatric HIV/AIDS patients in South India: A qualitative study Sonali Sarkar, Kalaiselvi Selvaraj, Sriram Krishnamurthy, Abyramy Balasundaram, Subitha Lakshminarayanan Industrial Psychiatry Journal 2018 27(2):219-225 Background: Rollout of antiretroviral therapy (ART) has helped to achieve the increased life span among pediatric HIV patients. The psychosocial aspects of parents or caregivers can affect the treatment adherence in children and the disease outcome. Aims and Objectives: This study aims at understanding the perspectives on disclosure of HIV status, stigma, antiretroviral treatment, and compliance among caregivers of children attending ART clinic in South India and to explore the barriers to treatment-seeking behavior. Materials and Methods: This facility-based qualitative study was carried out among caregivers of pediatric HIV patients <15 years of age. In-depth interview was conducted on caregivers after informed consent in the absence of the child, focusing on stigma, disclosure of HIV status to children, adherence, and coping strategies followed by the parents. The complete interviews were transcribed in English, and content analysis was done to identify the emergence of codes. Interview was conducted among mothers of affected child. The disease status of the children was known only to the parents and not to the children themselves (excepting one) or siblings. Parents intended to keep it confidential for the affected children as long as possible. Nevertheless, to maintain adherence and to prevent disclosure of HIV status, mothers traveled to this ART center from very far places, medical records were hidden, and tablets were removed from the strips and said to be medicines for energy and protection. Conclusion: Mothers of HIV-positive children faced many difficulties to prevent the disclosure of the diagnosis from the affected children and others, which is not very conducive to adherence to the ART regimen. Effective disclosure strategies to manage this emotionally vulnerable group are an urgent need.