Indian Journal of Psychological Medicine最新文献

Background: Death by suicide among young people is a growing issue worldwide. Every year, 46000 children (10-19 years old) take their lives. Lack of social support is one of the causes of suicide in young people. This narrative review aims to highlight the impact of teachers' support in the prevention of death by suicide among young people.

Methods: A literature search was conducted in Scopus, PubMed, Embase, and Web of Science to find out the relevant studies using the keywords and synonyms of "social support," "young," "suicide," and "teacher." The original articles published in indexed and peer-reviewed English language journals in the last 10 years (2014-2023) were included in this review. The included articles were focused on teachers' support in terms of the prevention of suicide among young people.

Results: After screening the title-abstract and full-text articles, the review findings revealed that support from teachers has a positive impact on the prevention of suicide among young people. Young people who have higher teachers' support show lower suicidal behaviors. Hence, teachers' support acts as a protective factor against suicide in young people.

Conclusion: The review concludes that teachers' support has shown a positive impact on reducing suicidal behaviors among young people. Teachers are important sources of support in understanding suicidal behaviors in young people. Holistic support from each one of us is the enormous need to reduce the number of suicides. Studies have recommended that teachers' support should be the focus of intervention, for example, school-based psychoeducation on young people's suicide.

Introduction: Exposure to sexually explicit media influences the sexual knowledge, attitudes, and behavior of youth, so studying this among medical students is of utmost importance.

Aim: To study sexual knowledge, attitudes, behaviors, and sources of influence among medical students.

Methodology: A descriptive, cross-sectional, analytical, web-based study was conducted to assess sexual knowledge, attitudes, behaviors, and sources influencing sexuality in medical students via Google Forms. The form consisted of three parts: the first part was an information sheet and consent form, the second part included the participant's sociodemographic data and the third part related to two study tools, the Sexual Knowledge and Attitude Questionnaire-II (SKAQ-II) and the sexual behavior and sources of influence scale.

Result: A total of 300/950 (31.5%) medical students responded to the Google questionnaire. Their mean age was 20.43 ± 1.87 years (range: 18-26 years). The mean score for sexual knowledge and attitude was 24.35 ± 4.93 and 23.79 ± 4.87, respectively, which suggested that they had good sexual knowledge and liberal attitudes toward sexuality with female preponderance. As student's academic year progresses, their sexual knowledge improves. There was a significant strong positive correlation between sexual attitude and knowledge with a Pearson correlation of r = 0.95, P = 0.004, which means the higher the knowledge, the better the attitude. Medical student's engagement in sexual behaviors with self- and others was at age 18.45 years. The internet was the major source for getting information related to sexual behaviors for them, but they relied on doctors and friends for guidance.

Conclusion: Medical students had adequate sexual knowledge, which was the reason for their liberal attitude toward sexuality. Their major source of sexual knowledge was the internet, although they confided in doctors for sexual doubts.

Background: Physician grief, as defined by Kenneth Doka as disenfranchised grief, refers to "the grief that individuals experience when they incur a loss that is not openly acknowledged, publicly mourned, or socially supported." The experience of patient deaths on the emotional health of young doctors is unknown. The after-effects like stress, anxiety, burnout, depression, and others indirectly have a potential impact on decision-making and patient care. The study aims to shed light on this underexplored dimension and advocate for appropriate training and support to promote physician well-being.

Methods: A qualitative study with a phenomenological approach was used to help explore the lived experience of trainee doctors confronted with patient deaths. The data collection was done through focused group discussions (FGDs) with three groups of trainee doctors. A semi-structured interview guide was framed and focused on their experiences of initial reactions, coping, reflections, and unmet needs among participants. Each interview was manually coded, organized into subthemes, and further into larger themes. All authors agreed upon themes and subthemes.

Results: The findings are elaborated with necessary quotes taken from the transcripts of the FGDs. The main themes identified were (a) Losing a patient's emotions behind the screen, (b) Psychological and Environmental battles, and (c) Identifying lacunae and expressing unmet needs.

Conclusion: The study findings were corroborated by concepts of disenfranchised grief, iatrogenic distress, emotionally unavailable doctors, and poor coping abilities. It also advocates for protocols and proactive measures to support interns and resident doctors.

Background: The brain-derived neurotrophic factor (BDNF) has an important role in the growth of neurons and synaptic transmission. The BDNF gene Val66Met polymorphism (G/A) is associated with depression, but findings have not been consistently replicated. This study adopts a case-control design with an aim to investigate the association of Val66Met polymorphism and peripheral BDNF (serum) levels in patients of major depressive disorder (MDD) and healthy individuals (controls).

Materials and method: This study adopts an observational, case-control design with a total of 174 participants. Cases (n = 87) were currently depressed, having Diagnostic and Statistical Manual of Mental Disorders (DSM-5) MDD, without psychiatric comorbidity. Controls (n = 87) comprised healthy individuals with no family history of psychiatric illness. The cases were evaluated using the NIMH-Life Chart Method, Hamilton Depression Rating Scale (HAM-D), Clinically Useful Depression Outcome Scale (CUDOS), and Clinical Global Impression (CGI). TaqMan assay was used for genotyping, and serum BDNF was measured using Enzyme-linked immunosorbent assay (ELISA).

Results: The case mean age was 35.32 ± 11.69 years (52% females) and comparable to controls. Allelic distribution was 33% (Met), and genotypic distribution was 17% (Met/Met), 32% (Val/Met), and 51% (Val/Val) for cases. The genotypic distribution did not differ across study groups. Serum BDNF was significantly lower in MDD cases as compared to controls (p < .001). The serum BDNF levels were comparable across the genotypic groups among cases.

Conclusion: The Val66Met polymorphism has not been associated with a risk for MDD and, interestingly, did not influence the BDNF levels (serum). Significantly low BDNF levels were found in MDD cases. The study findings show that factors other than Val66Met gene polymorphism have a role in modulating serum BDNF levels.

Background: Children in conflict with law (CICL) is an emerging issue in the contemporary world. Children between the ages of 12 years and 18 years are the most productive age group, but some children may develop behaviors that are undesirable to society by violating laws. The mental health and associated psychosocial factors of such children are lacking in India. It is of utmost importance to understand the mental health aspects of CICL for their rehabilitation, reintegration, and a better society for tomorrow.

Aim: This study aimed to compare the psychosocial factors such as psychological adjustment, level of substance abuse, aggression, sensation seeking, self-esteem, and perceived parenting style between CICL and non-CICL.

Methods: After obtaining the Institute's Ethics Committee approval (Letter No. IEC/CIP/2020-2021/1207, dated March 22, 2022), 70 CICL were selected from Ranchi district of Jharkhand. To compare, 55 non-CICL were selected with the same gender within the age range of 12-18 years, using a cross-sectional comparative survey research design. A semistructured interview schedule was used to assess the basic demographic and legal history of the children. The Strength and Difficulty Questionnaire, Adolescent Alcohol and Drug Involvement Scale, Buss and Perry Aggression Questionnaire, Arnett Inventory of Sensation Seeking, Rosenberg Self-Esteem Scale, and Parental Style Index were used to compare the psychosocial factors between CICL and non-CICL.

Results: The Pearson chi-square test indicated that CICL participants were significantly (P = .001) more likely to be from urban areas, have a history of school dropout and truancy, and come from broken families compared with non-CICL participants. The Mann-Whitney U test & indicated significant differences between CICL and non-CICL in the years of education (P = .001) for both children and their parents. The Mann-Whitney U test found that CICL participants showed significantly higher levels (P = .001) in emotional problems, internalizing attributes, prosocial behavior, level of alcohol/drug involvement, self-esteem, and strictness compared with non-CICL.

Conclusion: These findings have significant implications for the field of juvenile justice, highlighting the need for targeted interventions and support systems. Prevention, promotional mental health aspects, and comprehensive rehabilitation plans are crucial for the successful social integration of CICL.

The conventional and standard pharmacological approaches in the management of bipolar disorders include mood stabilizers and second-generation antipsychotics. However, renal problems owing to the gold standard mood stabilizer, lithium, is three times that of the general population. As bipolar I disorder (BPD I) is associated with overactive protein kinase C (PKC) intracellular signaling, a novel approach in the management of acute mania/mixed affective states of bipolar disorder includes the use of PKC inhibitors, such as Tamoxifen and its derivative metabolite molecule, Endoxifen. Our objective is to report two cases of bipolar disorder that presented in acute manic episodes, with preexisting renal disease, and safe use of Endoxifen as an adjunct/monotherapy for rapid control of symptoms. According to our study, Endoxifen can be used as an anti-manic agent, either as monotherapy or as an adjunct, in patients with renal disease. It can also be used as an effective cover therapy for bipolar disorder patients requiring steroids for the treatment of renal pathology, though long-term studies are needed to assess the long-term safety and efficacy.

Background: The current sensory assessment measures for autism spectrum disorder (ASD) have issues related to cultural and clinical applicability, which makes them difficult to apply in the Indian context consistently. The current study aimed to explore locally relevant themes for sensory reactivity in children with ASD.

Methods: This exploratory phenomenological qualitative study was carried out on 15 parents of children with ASD visiting the child guidance clinic. An in-depth interview (IDI) guide was prepared on the conceptual framework based on Dunn, as well as, Miller's models, which was then further refined based upon the inputs from the experts (psychiatrists, child psychologists, speech-language pathologists, and occupational therapists) working with children with ASD. IDIs were conducted with parents of children with ASD. The data was recorded in audio and video format. It was transcribed and translated from Hindi to English. Coding was done manually, and themes were extracted.

Results: The findings identified four superordinate themes: sensory hyperreactivity, sensory hyporeactivity, sensory seeking, and socio-emotional response.

Conclusion: The lived experience of parents aids in identifying and describing dimensions of sensory reactivity in children with ASD. It will help further in developing a valid and reliable instrument for the assessment of sensory reactivity in children with ASD.

Background: Caregivers play an important role in children's development. Therefore, they need to recognize the learning difficulties that their children face and support them to ensure learning gains and prevent secondary complications. Nevertheless, supporting a child with a learning disability can be challenging for caregivers in many ways.¹ This study investigated caregivers' knowledge of dyslexia, their challenges when raising children with dyslexia, and the support they seek to raise such children.

Methods: Ten individual in-depth interviews (IDIs) and four focus group discussions (FGDs) were conducted among 30 caregivers in Sri Lanka. Initial codes were generated using open coding from the transcripts, leading to sub-themes and themes.

Results: Thematic analysis revealed a lack of knowledge of dyslexia-type difficulties among caregivers and in society, giving rise to misconceptions, leading to labeling and abuse of children. Caregivers feel emotionally pressured, helpless, stressed, and depressed in bringing up children with dyslexia, creating family disputes. Further, as a family, they have a sense of rejection and discrimination from school and society. Caregivers receive insufficient support from the education and health sectors due to multiple complexities such as myths, misbeliefs, inadequate knowledge and skills, unavailability of resources, and inaccessibility to services.

Conclusions: Caregivers and families of children with learning disabilities demand more attention to improve their mental health and family harmony, which in turn improves children's educational and health status. Sri Lankan health, educational, and social services should be optimized to reach the families of children with dyslexia-type difficulties.

Background: Alcohol use disorder (AUD) causes significant morbidity and mortality. Prescription of AUD pharmacotherapies remains low. Attitudes toward AUD pharmacotherapies influence their prescription rates. We conducted an online survey to assess how attitudes modulate the association between knowledge and prescription rates for four commonly used AUD medications among Indian clinicians.

Methods: An online survey was sent nationwide to Indian physicians between February and April 2023 to assess knowledge, attitudes, and practices of various AUD medications. An a priori model was defined to indicate the relationship between study variables. Bootstrapped correlation analysis was conducted to determine confidence intervals of the correlation coefficients between knowledge, attitudes, and prescription practices. Additional subgroup analysis was conducted for faculty and private psychiatrists to assess if they prescribed differently.

Results: A total of 387 physicians responded to the survey. Bootstrapped correlation analysis indicated that safety and acceptability played a moderated prescription rates for acamprosate and naltrexone while they mediating role among faculty. For Disulfiram, perceived efficacy had a mediating effect, especially among private psychiatrists. Among faculty, perceived safety negatively mediated Disulfiram prescriptions. There was no indirect effect of attitudes on the association between knowledge and prescription practices for Baclofen.

Conclusion: The role of attitudes varied across medications. For acamprosate and naltrexone, perceived safety and acceptability significantly moderated prescription rates. For Disulfiram, perceived efficacy played a significant mediating effect. Attitudes did not influence Baclofen prescriptions as a whole, but acceptability significantly mediated prescriptions for private psychiatrists. This might indicate that physicians prescribe Baclofen as an ineluctable option.