This version of BIP! Finder aims to ease the exploration of COVID-19-related literature by enabling ranking articles based on various impact metrics.
Last Update: 18 - 01 - 2023 (628506 entries)
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| Title | Venue | Year | Impact | Source | |
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| 1051 | E-Poster abstract Pattern of serum lithium levels in consecutive samples over a five year period at a tertiary care center in India BACKGROUND: In spite of prevalent use of lithium therapy in clinical settings, there is not much published literature on lithium levels in Indian patient samples AIM: The study aimed to describe the pattern and trend of serum lithium level in consecutive serum lithium estimations between January 2015 and December 2019. It did not include 2020-2021 due to frequent COVID-19 related service disruptions in this period. METHODS: This was a retrospective review of lithium laboratory records for consecutive samples received over a five year period at Department of Psychiatry, AIIMS, New Delhi. RESULTS: A total of 4,376 samples were received over five year period (mean age: 34.98±13.06 years; 62% males; out-patient: 87.4%). One-third (36.3%) samples had serum lithium levels <0.60 mEq/L and a small percentage (3.6%) were in toxic range. Further analysis was restricted to out-patient samples within therapeutic range (0.6-1.2 mEq/L) (N=2,278). One-way between-groups ANOVA (Feb-April, May-July, Aug-Oct, Nov-Jan) was significant (F=3.021; df=3; p=0.029), with LSD post-hoc showing a small but statistically significant difference in mean lithium levels of Aug-Oct compared to Nov-Jan (p=0.007) and Feb-April (p=0.015). Further, serum lithium level was positively correlated to age (p=0.019), serum potassium (p=0.002), and inversely correlated to serum sodium (p<0.001). CONCLUSION: Those with older age and lower sodium levels appear to have higher lithium levels, concordant with existing literature. Serum lithium levels showed a slight but significant elevation in Aug-Oct compared to Nov-Jan and Feb-April. This finding can be explored further with respect to weather variables including temperature and humidity for same period. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1052 | Lorazepam:- A 'boon' for catatonic patients, concomitantly having: Covid-19 infection: A rare case report BACKGROUND: - ”Catatonia” is characterized by alterations in motor, behavioral, and vocal signs occurring in the context of medical, neurologic, & psychiatric disorders. While considering medical etiology, renal failure has been described as one of the factors. It may result in seizures & catatonia. Furthermore, renal failure even though rare has also been implicated in the causation. AIM: - We aim to report a rare case describing multiple etiologies (Renal failure, Seizure, Covid-19) & treatment in a patient with catatonia. RESULT/CASE REPORT: - The patient had Covid-19 infection with concomitant renal insufficiency with uremia. He developed an episode of seizure on 3(rd) day of admission and subsequently developed catatonic symptoms in the post-ictal phase. He did not respond to anticonvulsive treatment but did so with Lorazepam. DISCUSSION: - A variety of conditions can produce catatonia. It is less widely recognized that this state may be caused by seizures; which in turn can also be due to renal failure. Catatonia occurring in the wake of seizures generally responds to the anticonvulsive medication. Even though rare and anecdotal, catatonia has been reported in a few cases reports in patients suffering from Covid-19 infection & it can occur in both the para & post-infectious states. CONCLUSION: - We also want to highlight that lorazepam proved to be an effective and safe choice for the treatment of catatonic symptoms & eventually led to the improvement in the symptomatology of Covid-19. Therefore, we also propose further studies for the treatment of such patients. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1053 | Myths, Facts and Information in COVID Pandemic awaiting the third wave BACKGROUND (CURRENT SCENARIO): Evidently, SARS-II due to COVID-19 is a problem increasing at a geometric progression affecting human civilization at large. Unfortunately there is no cure hence we are left to mercy of preventive and social medicine measures. These models of preventive and social medicine measures are dependent on available information. OBJECTIVE (RESEARCH QUESTION): To assess the level of awareness about prevention of transmission of COVID-19 illness in community. METHODOLOGY: Cases were chosen by purposive sampling as per criteria. After screening and rating, assessment of the level of awareness about prevention of transmission of COVID-19 illness was done by structured questionnaire. The samples shall be collected from community around Burdwan Medical College and Hospital. RESULT: 1. Demographic characteristics(n=110) showed predominance of female subjects, mainly residing in urban area with majority educated upto higher secondary. 2. Source of information was news paper, followed by news app and television. 3. Majority were worried and had a close person who was affected by COVID. 4.Absence of information was evident as in a scale with maximum score of 23 mean score was 15 and median 12.5. CONCLUSION: The accelerating rate of new case load of COVID-19 point to a gap in knowledge, attitude and practices. Hence, a deficit in knowledge is evident. Enhancement of public awareness of COVID appropriate behavior is needed for prevention of pandemic. Abstract INTRODUCTION: Death due to cardiovascular disease is one of the leading causes of mortality in persons with severe mental disorder. There is dearth of information on cardiovascular risk profile of persons with SMD.This study is done to examine the documentation of cardiovascular disease (CVD) risk profile among patients who had cardiac event during inpatient admission in a tertiary care centre. METHODS: An audit of electronic medical records for documentation of CVD risk factors of smoking, alcohol use, obesity, elevated glucose levels, elevated blood pressure was done. RESULTS: 18 among 1260 in patients with Severe mental disorders had cardiac event during 2-year study period. Nearly half of them were smokers and had alcohol use disorder. Majority of them have diabetes and hypertension. There was no documentation of history of hyperlipidemia or family history of cardiometabolic risk factors in the medical records. Out of 18 who had cardiac event, 13 had elevated FBS, 10 had elevated BP, 10 had BMI>25, 9 had high HBA1C, 17 had deranged lipid profile when evaluated during hospital stay. Though some of the patients were on treatment for diabetes, hypertension and dyslipidemia, these parameters were deranged in most of them suggesting either poor compliance to medications or inadequate management. CONCLUSION: This study has shown that there are inadequacies in cardiovascular risk assessment and documentation in persons with severe mental disorders. Although the sample may not be representative of persons with severe mental disorders, major disparities in risk factor evaluation were found- particularly in hospitalised patients. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1054 | A comparative study about knowledge, perceptions and practices between healthcare workers and patients with covid-19 infection admitted in a tertiary care hospital,regarding the use of mask to prevent COVID-19 infection BACKGROUND: COVID-19,a respiratory illness caused by coronavirus. The virus primarily spreads between people through Respiratory droplets.The primary precautionary measures for infection prevention include:Hand & face hygiene.We are conducting a study to know the knowledge, perceptions and practices of medical professionals (Faculties, Residents Doctors of Clinical and Non-clinical specialties) regarding the use of masks to prevent COVID-19 infection AIMS AND OBJECTIVES: To assess and compare the knowledge, perceptions and practices between healthcare workers and patients with covid-19 infection,regarding the use of mask to prevent COVID-19 infection METHODS: Study was conducted from march-june,2021.The study covered 174 health professionals(Faculties and resident doctors of Clinical and non-clinical specialties) and 203 patients with Covid-19 infection,working and admitted respectively at ELMCH,Lucknow.Data was collected using a pre-tested self-administered and designed questionnaire adopted from different studies after getting consent from the study participants. RESULTS: Majority of the HCWs were PG residents(80.2%) and from clinical branches.The doctors from psychiatry had the best knowledge followed by radiology.In PERCEPTION,majority subjects chose N95 as the most effective mask and face shield as an ideal adjunct to it.In PRACTICES,majority of subjects chose to use N95 mask in both hospital and home settings and would sometimes use an adjunct CONCLUSION: Despite good knowledge the govt. and society as a whole need to improve the sensitisation of the population on how to use masks and other precautionary measures to prevent covid-19 | Indian J Psychiatry | 2022 | CORD-19 | |
| 1055 | Study Of Pattern Of Neuropsychiatric Manifestations Among Post-Covid Patients BACKGROUND: COVID-19 pandemic has plagued the world for the past two years. Inflammatory response to SARS CoV 2 virus, social isolation due to quarantine and lock down, loss of loved ones to COVID-19, financial constraints, fear associated with morbidity and mortality of COVID-19 infection are risk factors for developing neuropsychiatric symptoms in patients who have recovered from COVID-19 infection. AIM & OBJECTIVE: To assess the socio-demographic profile neuropsychiatric manifestations in Post-COVID patients. MATERIALS AND METHODS: Cross-sectional study conducted in Ramaiah Hospital from June 2020 to June 2021. All Patients who have tested negative after infection by COVID 19 and referred by the treating physician from Post-COVID clinic were recruited. Data pertaining to socio-demographic details, family history of COVID infection and death due to same was recorded. Psychiatric diagnosis was made using International Classification of Disease – 10 (ICD-10). RESULTS: Forty patients were recruited for the study. Most of them were male (N=23, 57.5%), age between 30-45 years (N=14, 35.0%), married (N=31, 77.5%), employed (N=25, 62.5%), and urban population (N=39, 97.5%). Most of the participants had family history of COVID-19 (N=23, 57.5%), did not have death in family due to COVID-19 (N=33, 82.5%) and did not suffer from pre-existing psychiatric illness (N=33, 82.5%). The most common psychiatric diagnosis was Panic Disorder (N=13, 32.5%) followed by Depression (N=12, 30.0%). CONCLUSION: Mental health professionals should prepare to manage the mental health pandemic that is co-occurring with COVID-19 pandemic and is likely to continue beyond the COVID-19 infection pandemic. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1056 | Assessment of Change in Severity of Stress, Anxiety and Depression in Covid-19 Patients During Hospital Stay-A Cross-sectional Study BACKGROUND: – COVID 19 illness is associated with psychological impairments. Whether this impairment is due to illness itself or inpatient stay also contributes to it needs to be ascertained. Present study was done to assess the change in severity of stress, depression and anxiety in COVID-19 patients on the day of hospital admission and on the day of discharge and its association with clinical variables. METHODS: – A cross sectional study design with sample of 104 patients admitted in the COVID wards. Socio-demographic and COVID related clinical variables and laboratory parameters were recorded. The severity of stress (PSS scale), anxiety (HAM-A scale) and depression (HAM-D scale) was assessed on the day of hospital admission & on the day of discharge. Association between change in severity of these and other variables was assessed. RESULTS: Significant increase in severity of stress, anxiety and depression was found during indoor stay of Covid-19 patients. Severity increased despite improvement in physical status of subjects. There was no significant association of increased severity of stress, anxiety, depression with demographic variables and laboratory parameters. CONCLUSION: – There was a significant increase in level of stress, anxiety and depression during the inpatient stay despite improvement in clinical symptoms, with minimal association with demographic and clinical variables. INTRODUCTION: Since the beginning of COVID 19 pandemic, issues related to mental health has been highlighted repeatedly. Apparently fear of the consequences of this deadly disease has led to increase in stress, anxiety and depression in COVID hospitalized patients.[(1)]The psychosocial stressors are not only limited to those who were infected but are also exacerbated in the un-infected individuals.[(2)] Various factors that may be responsible for this include the direct effect of virus in central nervous system, the neuropsychiatric effects of inflammatory markers, the psychological impact of contact isolation and the stigma of getting infected, and disrupted social functions associated with serious illness.[(4)] Few studies from other countries have shown that most of the hospitalized COVID 19 patients report increased symptoms of anxiety and depression during their inpatient stay. This was significantly associated with occupation status, level of education and severity of Covid-19 illness. [(2, 3)] However, most of published research available on psychological impact of COVID 19 had focussed more on healthcare workers [(11,12,25)] and general public or outpatient setting. [(13)]To our knowledge, there is no literature from India that had assessed change in severity of stress, anxiety and depression in COVID 19 and its associated variables during their hospital stay as indoor patients in Covid-19 Ward. The primary objective of present study was to assess the change in severity of stress, anxiety and depression in COVID-19 patients on the day of admission and on the day of discharge. Secondary objective was to find any association between the change in severity of stress, anxiety and depression with socio-demographic and Covid 19 related clinical variables. METHODS STUDY SETTING: –COVID inpatient ward in a tertiary care medical college. STUDY DESIGN: –A cross-sectional study design with assessment of subjects at two points- 1(st) on the day of admission and 2(nd) on the day of discharge. SAMPLE SIZE: –All the subjects admitted to COVID wards over two months period between 25(th) May 2021 and 24(th) July 2021 were approached for their willingness to participate in the study. We could recruit total 104 subjects who met eligibility criteria and gave informed consent. ELIGIBILITY CRITERIA -: Inclusion criteria – 1. Patients above 18 years of age with positive COVID RT-PCR report. 2. Patients admitted to Covid-19 ward in the tertiary care hospital. Exclusion criteria – the following patients were excluded: 1. Only Rapid Antigen Test positive 2. Only HRCT suggestive of atypical pneumonia 3. Pre-existing psychiatric illness and substance abuse except nicotine 4. Non-invasive ventilation support or medically unstable 5. Persons with impaired capacity ETHICAL ASPECTS –: As per institution’s policy for research on human subjects approval from the Scientific Advisory Committee (SAC) and then from Ethics Committee for Research on Human Subjects (ECRHS) of the institute was obtained. Written informed consent was obtained from all the participants and they were explained about their right to leave the study at any point of time without any impact on their ongoing treatment for Covid-19 illness. No additional financial burden was put on the subjects by participation in study. ASSESSMENTS: – Subject’s socio-demographic and clinical information was recorded anonymously in a pre-designed and pilot tested format. Information included sex, age, marital status, employment status, education, income of head of family and details of primary care giver. The socio-economic status was classified using Kuppuswamy scale. We also recorded clinical variables related to COVID-19 illness like Heart Rate, temperature, Blood pressure, respiratory rate, Oxygen saturation (SPO2) on the day of admission and on the day of discharge to assess clinical improvement in Covid-19 illness. Severity of stress, Depression and anxiety were also assessed at same two time points. Level of stress was assessed using perceived stress scale (PSS) which classifies stress level into Mild stress (0-13), Moderate stress (14-26), Severe stress (27-40). [(4,5)] The severity of anxiety was assessed using Hamilton Anxiety rating scale (HAM-A). Total score obtained can be classified into No anxiety (0-7), mild anxiety (8-14), moderate anxiety (15-23), severe anxiety (>24). [(6)] Severity of depression was assessed using Hamilton Depression rating scale (HAM-D). Total score obtained classifies severity of depression as no depression (0-7) mild depression (8-16), moderate depression (17-23), severe depression (>24). [(7)] Both these scales are already validated to estimate the change in severity of anxiety and depression over a period in time.[(8)] Laboratory investigations like d-dimer, ferritin, Lactate Dehydrogenase, Erythrocyte Sedimentation Rate, C-Reactive Protein were recorded only once during the inpatient stay. STATISTICAL ANALYSIS -: The collected data was analysed using SPSS (Statistical Software for social Sciences) software version 25. Initially descriptive statistics was carried out for the variables using appropriate measures of central tendency. Association between the severity of stress, anxiety and depression with socio-demographic and clinical variables was done using the Wilcoxon Signed Ranks Test and spearman’s correlation. Significance was set with 95% confidence level and p value < 0.05 was taken as significant. RESULTS: Majority of the patients were male (63.4%) with male to female ratio of 1.7. Maximum patients were in the age group of 31-40 years (35.5%) followed by 51 - 60 years (27.8%) and 41-50 years (24.2%). Most were from the rural area (79%), belonging to Hindu religion (95.2%) and had education up to middle school (34.6%). The participants were at clerk level (41.3%), married (85.6%), had full time job (79%). As per Kuppuswamy scale, the subjects could be classified as upper middle (10%), lower middle (67%), upper lower (23%) and none belonged to upper and lower class.Spouse (67%) were the most common caregivers. Average IPD stay in covid-19 ward was 8.23 (2.9). Table-1 shows change in severity of stress, anxiety, depression and clinical variables measured at two cross sections. It is evident that more number of patients experienced higher levels of stress, anxiety and depression at the time of discharge despite being sent to their homes to stay with their family members. Change in stress level, anxiety and depression and the Covid -19 related clinical variables from day of admission to on day of discharge is stated in Table-2. Compared to the assessment on the day of admission, there was significant increase in the level of stress, anxiety and depression on the day of discharge, despite favourable improvement in physical condition as indicated by covid-19 related clinical variables (temperature, pulse rate, blood pressure and oxygen saturation) as listed in the table. This indicates that it’s not the clinical severity of Covid-19 illness itself that causes psychological distress, but inpatient stay and factors associated with it, may also lead to psychological distress in patients admitted to Covid-19 wards. Table-3 demonstrates association between demographic variables, laboratory parameters with change in levels of stress, anxiety and depression during hospital stay. Among the demographic variables, there is a weak negative but significant association between perceived stress and level of education. There is no significant association with other demographic and pathological variables.When considering the increase in the level of anxiety during hospital stay, there is a weak negative but significant association with total stay and level of education. While, there is weak positive but significant association between increased level of anxiety and income, d-dimer levels. There is no significant association with other demographic and pathological variables. For change in level of depression there is a weak negative but significant association between total stay and SGOT levels. There is no significant association with other demographic and pathological variables. DISCUSSION: Findings of present study reveal that as compared to day of admission, many more subjects with covid-19 illness experienced significantly higher level of stress, anxiety and depression at the time of discharge. This is happening despite clinical improvement in these subjects. For demographic variables, in line with previously published studies, a higher proportion of patients in our study were in the age group of 31 – 60 years, more than half were male, belonged to rural region, had some education,and majority were doing clerical jobs or any part time jobs,and belonged to lower middle class.[(1,2)] A recent study conducted to assess the level of stress anxiety and depressions during hospitalization reported similar demographic profile with majority participants being male, married and had good level of education and were employed.[(1)] Few studies which were of cross sectional nature suggested high levels of anxiety as a form of psychological stress, especially following the isolation to seek treatment of COVID 19 infection. [(2, 9)] Our study had assessed these at two points and the level of stress, anxiety and depression was found to be more on the day of the discharge from hospital than on day of admission. In contrast to this, a study from Israel found that the level of anxiety and depression decreased one month following hospitalization. [(15)] Some studies included the past psychiatric illness and substance use as a variable, but we excluded the subjects with pre-existing or past psychiatric illness from our study to avoid confounding effect. [(1,2)] Authors in an Italian study evaluated COVID 19 patients in the emergency department and then screened for psychopathology approximately 1 month after initial emergency department evaluation. It was found that 56% of patients screened positive in at least one psychiatric domain. Approximately 31% screened positive for depression, 42% for anxiety, and 28% for obsessive-compulsive symptoms. [(10)] In our study there was no association between interaction with care giver and severity of stress, anxiety and depression, however few studies also found that isolation and lack of support from care givers and relatives was the key factor for anxiety and depression where less social supports led to more anxiety and depressive symptoms and more depression was found in caregivers. [(3,15,21)] A study conducted in Wuhan China, the prevalence rate of depression and anxiety was found to be 21% and 16.4% respectively. [(14)] Few other studies also reported psychological distress after hospital discharge. [(17, 18, 23)] In our study severity of stress, anxiety and depression is not strongly associated with demographic and social variables, may be due to strong social support and intact family bonding in Indian settings. Depression was also found in quarantined patients. The family support & social interaction was alleviating factor. [(24)] This differs from findings of studies from other countries which reported that lack of social support for patients with COVID-19 being associated with depression and socioeconomic status bearing major impact on severity of depression. [(18,19,20)] Present study was unique from our country to assess the change in the severity level of stress, anxiety and depression during hospital stay in indoor patients of Covid-19 illness. Findings of our study highlight need for inclusion of psychological screening and appropriate management of all patients admitted to Covid-19 ward. Similar recommendations had been made by other authors. Cognitive Behavioural Therapy was found to be effective in reducing psychological distress in patients. [(22)] Among our subjects, all those with significant levels of anxiety and depression were provided treatment at the time of discharge itself. They were informed to be on regular follow in psychiatry OPD after discharge from the ward. After completion of study and preliminary analysis of data, to reduce the stress of admitted patients, we conducted stress management sessions in COVID wards itself as an initiative of our department. STRENGTHS AND LIMITATIONS: The major strength is this is the first study in India which has assessed the change in levels of stress, anxiety and depression during the inpatient [IPD] stay of COVID 19 patients and initiated appropriate management for same. The results of the study should be interpreted with the limitations of it being a single centre study with assessment of only inpatients and cross-sectional design of the study. CONCLUSIONS: There was a significant increase in level of stress, anxiety and depression during the inpatient stay of COVID 19 patients despite improvement in fever and respiratory distress. This change was associated with level of their income and some lab parameters. However, majority of the demographic and clinical variables had no significant impact on increased level of stress, anxiety and depression. Findings highlight the need for appropriate intervention for their psychological health as an essential part of care in COVID wards. CONFLICTS OF INTEREST: None REFERENCES: 1. Zandifar, A., Badrfam, R., YazdaniS., et al. Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. J Diabetes MetabDisord2020;19:1431–1438. 2. Parker C, Shalev D, Hsu I, et al. Depression, Anxiety, and Acute Stress Disorder Among Patients Hospitalized With COVID-19: A Prospective Cohort Study. J Acad Consult Liaison Psychiatry2021;62(2):211-219. 3. Kong X, Zheng K, Tang M, Kong F, Zhou J, Diao L, et al. Prevalence and factors associated with depression and anxiety of hospitalized patients with COVID-19. MedRxiv 2020 Jan 1. 4. Leung DY, Lam T-h, Chan SS. Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke. BMC Public Health2010;10(1):513. 5. Perceived Stress Scale. https://das.nh.gov/wellness/docs/ percieved%20stress%20scale.pdf. State of new Hampshire employee Assistance program [23 12 2014].Available from: https:// das.nh.gov/wellness/docs/percieved%20stress%20scale.pdf; 6. Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying HAM-A cutoffs for mild, moderate, and severe generalized anxiety disorder. International Journal of Methods in Psychiatric Research. 2010 Dec;19(4):223-32. 7. Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Severity classification on the Hamilton depression rating scale. Journal of affective disorders. 2013 Sep 5;150(2):384-8. 8. Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. JAffective disord1988;14(1):61-8. 9. Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive muscle relaxation on anxiety and sleep quality in patients with COVID-19. Complementary therapies in clinical practice 20201;39:1;01132. 10. Mazza MG, De Lorenzo R, Conte C, et al. Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors. Brain BehavImmun 2020; 89:594–600; 11. Dai Y, Hu G, Xiong H, et al. Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. bioRxiv 2020. 12. Zhu Z, Xu S, Wang H, et al. COVID-19 in Wuhan Immediate Psychological Impact on 5062 Health Workers. bioRxiv 2020. 13. Wang C, Pan R, Wan X, et al. Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 CoronavirusDisease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health 2020;17. 14. Chen Y, Huang X, Zhang C, An Y, Liang Y, Yang Y, Liu Z. Prevalence and predictors of posttraumatic stress disorder, depression and anxiety among hospitalized patients with coronavirus disease 2019 in China. BMC psychiatry. 2021 Dec;21(1):1-8. 15. Dorman-Ilan S, Hertz-Palmor N, Brand-Gothelf A, Hasson- Ohayon I, Matalon N, Gross R, Chen W, Abramovich A, Afek A, Ziv A, Kreiss Y. Anxiety and depression symptoms in COVID-19 isolated patients and in their relatives. Frontiers in psychiatry. 2020 Oct 14;11:1042. 16. Matalon N, Dorman-Ilan S, Hasson-Ohayon I, Hertz-Palmor N, Shani S, Basel D, Gross R, Chen W, Abramovich A, Afek A, Ziv A. Trajectories of post-traumatic stress symptoms, anxiety, and depression in hospitalized COVID-19 patients: A onemonth follow-up. Journal of Psychosomatic Research. 2021 Apr 1;143:110399. 17. Prakash J, Dangi A, Chaterjee K, Yadav P, Srivastava K, Chauhan VS. Assessment of depression, anxiety and stress in COVID-19 infected individuals and their families. medical journal armed forces india. 2021 Jul 1;77:S424-9. 18. Beck K, Vincent A, Becker C, et al. Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study. PLoS One. 2021;16(5):e0250590. 19. Faber M, Ghisletta A, Schmidheiny K. A lockdown index to assess the economic impact of the coronavirus. Swiss J Econ Stat. 2020;156(1):11. 20. Li Z, Ge J, Feng J, et al. Less Social Support for Patients with COVID-19: Comparison with the Experience of Nurses. Front Psychiatry. 2021;12:554435. 21. Gallagher S, Wetherell MA. Risk of depression in family caregivers: unintended consequence of COVID-19. BJPsych Open. 2020;6(6):e119. 22. Li J, Li X, Jiang J, Xu X, Wu J, Xu Y, Lin X, Hall J, Xu H, Xu J, Xu X. The effect of cognitive behavioral therapy on depression, anxiety, and stress in patients with COVID-19: a randomized controlled trial. Frontiers in psychiatry. 2020;11. 23. Samrah SM, Al-Mistarehi AH, Aleshawi AJ, Khasawneh AG, Momany SM, Momany BS, Za'nouneh FJ, Keelani T, Alshorman A, Khassawneh BY. Depression and coping among covid-19- infected individuals after 10 days of mandatory in-hospital quarantine, irbid, jordan. Psychology Research and Behavior Management. 2020;13:823. 24. Zhu Z, Xu S, Wang H, Liu Z, Wu J, Li G, Miao J, Zhang C, Yang Y, Sun W, Zhu S. COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinicalMedicine. 2020 Jul 1;24:100443. 25. Sun N, Wei L, Wang H, Wang X, Gao M, Hu X, Shi S. Qualitative study of the psychological experience of COVID-19 patients during hospitalization. Journal of Affective Disorders. 2021 Jan 1;278:15-22. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1057 | Free paper 1.Dr Posina Srishti Dravid 2. Dr Vuthandam Tanmayee 3. Dr Vijay Raj Pratheek Patlolla Nomophobic behavior and assessment of insomnia in private medical college students during covid pandemic : Observational study INTRODUCTION: The term Nomophobia or no mobile Phone phobia is used to describe a psychological condition when people have a fear of being detached from mobile phone connectivity. Insomnia is described as difficulty in falling asleep or difficulty in staying asleep. As the covid-19 pandemic has made vast changes in day-to-day life, with more time available at hand to use smart gadgets and livelihood turning digital(meetings and classes over video calls and shopping for basic necessities online). Smart phone usage has become alarmingly high, so has insomnia and nomophobic behaviour associated with its absence. AIMS: To understand impact of mobile phone leading to nomophobia and insomnia in undergraduate medical students and its association with current covid-19 pandemic. METHODS: An online cross-sectional study was done to collect socio-demographic and clinical characteristics using validated tools from 24th June 2021-30th August 2021 at SVS Medical College and Hospital, Telangana. NMPQ & ISI were used in study to assess nomophobic behavior and insomnia. RESULTS: A total of 180 undergraduate medical students were recruited in the study and sociodemographic data, NMPQ, ISI scores have been collected. The data will be analyzed using appropriate statical tools and results will be complied. CONCLUSIONS: Covid-19 is found to increase usage of smart gadgets leading to Nomobhobia and insomnia. Understanding the burden can improve mental well-being and healthcare system. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1058 | Effects Of Lockdown On Sleep Pattern In The General Population During Covid-19 Pandemic BACKGROUND AND AIM: COVID-19 Pandemic hit India in January 2020. In order to curb the spread of the virus, a nationwide lockdown was instated on March 24(th). The lockdown has had an adverse psychological impact on the general population. Sleep is essential because of its many benefits for mental and physical health. Lack of sleep can impair both mental and physical functioning like decision making, mood changes, anxiety symptoms, jeopardize immune response, increase accidents and increase medical expenditures. The current study was aimed at assessing the sleep patterns during the pandemic in the general public. MATERIAL AND METHOD: This was a cross sectional, observational descriptive survey study conducted through social media platforms. Socio demographic data such age, gender, marital status, etc along with sleep schedules, working routine was assessed using a semi structured proforma. Insomnia Severity Index (ISI) and Patient Health Questionnaire- 4 (PHQ-4) were tools used to assess insomnia; depression and anxiety respectively. RESULT: A total of 124 subjects were included in the study. Sleep patterns revealed a delay in routine bed times, with a reduction in sleep quality and increase in total sleep duration. Moderate to severe insomnia was seen in 9% of patients and 29% had subthreshold insomnia. Anxiety was found in 19% and 22% had depressive symptoms. CONCLUSION: Lockdown due to the COVID 19 pandemic was associated with changes in sleep pattern, quantity and quality of night-time sleep and had also led to manifestation of emotional symptoms in the general population. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1059 | Tele-mental Healthcare as the "New Normal": Revisiting the Nuances The COVID-19 pandemic has seen a significant rise in the demand for mental health services. Technology advancement and pandemic restrictions have revolutionised the mental health field with mental health professionals adapting and shifting towards online platforms. Recent research suggests that online therapy can be as effective as in-person therapy for various mental health conditions. Online psychotherapy isn’t a new practice, rather it has been used during pre-covid times with caution. Several studies have proven the effectiveness of telemental health indicating that both clients and providers who use telehealth generally view it favourably. Online psychotherapy and telemedicine could be more approachable, convenient while increasing access to out-of-state professionals. Online therapy and tele-consultation have its strengths as well as challenges including flexibility in scheduling, convenience, saving time from commuting to and from appointments, enhancing vulnerability and disclosure. However, it has its own set of challenges and ethical concerns, particularly revolving around privacy and confidentiality in the digital space. This symposium will highlight the strengths and challenges of telemental health based on empirical researches and personal experiences of psychotherapists and psychiatrists. With increasing onus over the providers, it becomes important to discuss and address the new demands. It will enable the mental health practitioners to be more equipped and competent to continue offering telehealth as demand for mental health services grows, particularly services offered virtually. Finally, the symposium glances at the future of tele mental healthcare in the light of the recent guidelines and what it possibly holds for service providers. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1060 | Comparative study of coping, anxiety and resilience in doctors caring and not-caring for COVID-19 patients BACKGROUND: Doctors are more vulnerable to the negative effects of the COVID 19 pandemic than the general population due to direct contact with patients causing an increase in levels of anxiety and compromising resilience by isolation and risk to family members. This study aims to explore the anxiety, resilience, and coping among health care professionals. AIM: To compare the coping strategies, anxiety, and resilience in doctors caring and not caring for COVID 19 patients. METHODS: A cross-sectional study was carried out in a tertiary care center from September 2020 to September 2021. A written informed consent was obtained for participation in the study from all doctors recruited for the study after explaining the purpose and design of the study. By purposive sampling a total of 100 doctors were recruited in the study after fulfilling the inclusion and exclusion criteria. RESULTS: The mean Coronavirus Anxiety Scale (CAS), Brief COPE, Connor – Davidson Resilience Scale scores in doctors treating COVID 19 patients was significantly more than the respective scores for doctors not treating COVID 19. CONCLUSION: The doctors treating COVID 19 patients had more anxiety as compared to doctors not treating COVID 19 patients, whereas doctors not treating COVID 19 patients had better coping and resilience as compared to doctors treating COVID19 patients. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1061 | COVID-19 Aftermath: A Cross-Sectional Study Of Quality Of Life In Patients Visiting Post Covid OPD Of Tertiary Healthcare Centre BACKGROUND: COVID had a huge impact on quality of life of patients after being infected from the virus. Is this impact independent or influenced by comorbid psychopathology, is a matter of research and discussion? AIMS: To study of quality of life in patients visiting post COVID OPD and influence of psychiatric comorbidities and various factors on it. DESIGN AND METHODOLOGY: The study is a cross sectional observational study done in Post COVID Out Patient Department of Tertiary Health Care Centre. After ethical clearance, 300 participants (male and female) falling in the age group of 18-65 years, who had suffered from COVID-19 infection were included. Information was recorded in semi structured proformas and WHOQOL-Brief was used to assess quality of life and SCL-90 was utilized to screen psychiatric symptoms. STATISTICS: Data was analyzed with the help of SPSS-22 software. Chi square test for nominal data, Unpaired t- test for ordinal data and Annova test for interval data was applied to obtain a p value (p<0.05 was considered statistically significant). RESULTS: Quality of life in patients post COVID 19 infection was found to be negatively correlated with SCL-90 score and correlation was found to be statistically significant (p<0.05). CONCLUSION: COVID-19 not only affected patients while they were infected, but impacted quality of life even after the remission and the developed psychopathology has an underpinning. Thus, as a psychiatrist we have a greater responsibility than ever to reduce the impact post COVID pandemic and prevent a “latent pandemic”, of mental illnesses. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1062 | SYMPOSIUM TOPIC: COVID and Mental Health: The Challenge and aftermath Abstract Department of psychiatry, Armed Forces Medical College (AFMC), Pune was involved since beginning in addressing the issues of mental health due to the COVID-19 pandemic and conducting research. The department collaborated with various agencies including government of India (GOI) in their outreach activities. Col Jyoti Prakash, Professor Psychiatry, AFMC, Pune had an honour of running a Defence Research Development Organisation (DRDO) made COVID hospital in Bihar. Office of Principal Scientific Advisor to GOI, had selected our department to collaborate with C-DAC (Centre for development of advanced computing) & NIMHANS towards creation of ‘National Digital Wellness Program’ delivered over smart phones- MANAS - Mental health And Normalcy Augmentation System for YoungISTAN - Young Indians: Smart, Talented & Natural. Project MANAS is in progress. The department conducted research on mental health impact on general population, Healthcare workers, COVID patients and their families. Last but not the least, we have managed mental health issues including grief arising during the pandemic. This symposium aims to highlight myriad mental health challenges of COVID 19 and aftermath. The symposium will cover COVID-19 mental health impact, administrative role, shades of grief and positive mental health by four speakers. Speaker 1 - COVID and anxiety: Col VS Chauhan, Professor of Psychiatry, AFMC, Pune. Speaker 2 - Challenges of running a COVID hospital : Col Jyoti Prakash, Professor Psychiatry, AFMC, Pune. Speaker 3 - Many shades of Grief: Col Rajiv Saini, Senior Advisor in Psychiatry, Military Hospital, Pathankot. Speaker 4 - Positive mental health: Surg Cmde Kaushik Chatterjee, Professor & HoD Psychiatry, AFMC, Pune. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1063 | A Cross sectional Study correlating wellness and anxiety in Covid-19 pandemic BACKGROUND: An outbreak of a new coronavirus pneumonia occurred in December 2019 in Wuhan, China. According to a study, during this pandemic, the prevalence rate of depression was at 50.7%, generalized anxiety was at 44.7%, and insomnia 36.1%. Study from Spain, concluded that psychological well-being is key for confronting COVID-19 and preventing mental disorders and coping with emotions. Thus, the extent to which wellbeing makes a difference in anxiety towards COVID-19 has not been explored so far, as per our knowledge. AIMS: 1. To assess the prevalence of corona virus anxiety and wellbeing in Covid-19 pandemic; 2. To assess the relation between corona virus anxiety and wellbeing in COVID-19 patients and general population. METHOD: There is total 345 patients, 54 were COVID positive and 291 COVID negative, were assessed after taking informed consent, 2 scales were used, the HERO wellness scale and Corona virus anxiety scale. RESULTS: 1. Significant difference of mean CAS scale scores between COVID positive and negative. 2. Significant difference of mean HERO scale scores between male and female but not in CAS scale. 3. CAS scale score was found to have significantly negative correlation with happy, enthusiastic, resilient and mental wellbeing but not with optimism. CONCLUSION: There is a significant negative correlation between wellbeing and anxiety during the covid 19 pandemic. Thus, there is a need of research in this aspect, to analyze the effect of betterment of wellbeing as a prophylactic measure against anxiety, especially during the pandemic. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1064 | COVID-19 pandemic Effects and after effects on people with Neurodevelopmental Disorders and their Families COVID-19 has disrupted everyday life worldwide and is the first disease event since the 1918 H1N1 Spanish influenza (flu) pandemic. The extensive damage wreaked by historical pandemics on health, economy, and society was a function of pathogen characteristics and lack of public health resources. In particular this pandemic has worsened neurodevelopmental disorders ADHD, ASD,IDD with an increase in MH, Psychosocial consequences in children and parents.Many of the NDDs are illnesses of life span and require multiple supportive, life enhancing interventions.COVID Pandemic increased phobias,anxiety,clinginess, distraction, irritability, depression, mood lability, impaired social interaction, sleep disturbances, low self-esteem, substance use disorder, and suicide. In India,USA and around the globe Parents and caregivers are experiencing much turmoil. They are increasingly burdened by the changing nature of caring for their children and other family members. May cause caregivers to experience intense distress, anxiety, loneliness, agitation,depression, social withdrawal and other challenging behaviors. There is evidence that there is a higher risk for those residing in residential group homes.Parents are finding themselves simultaneously expected to play the role of parent, special education teacher, and individual aide, all the while having to provide care for other children in the home and juggle work-from-home. children with NDD and families need evaluations, treatments and supports by professionals, as the ongoing pandemic can exacerbate the current challenges and provide ways of handling, coping.Also focus on identification of long-term control strategies that balance consideration of health in at risk populations, societal behavior, and economic impact. ANCIPS 2022 | Indian J Psychiatry | 2022 | CORD-19 | |
| 1065 | Mental healthcare delivery for patients hospitalized with COVID-19. Presenting/ proposing author's contact details: - The COVID-19 pandemic has stretched the healthcare system its limits, largely remaining a puzzle with no definitive treatment and ever emerging variants. The overwhelming psychological stress on such patients (observed devastation, concerns about deterioration, physical isolation, social discriminations) and the CNS effects of SARS-CoV-2 infection together may lead to various psychiatric symptoms like insomnia, depressive mood, anxiety, aggressive outbursts and even suicidal ideations. Literature suggests that up to 35% have depressive symptoms, 28% have anxiety and 20% may have impaired consciousness and confusion which is linked with severe progression of disease. Persons with mental illnesses are at a higher risk of contracting viral infections because of a myriad of factors, such as a chronically dysregulated innate immune system, cognitive and higher motor functioning, and sometimes deficient personal hygiene. The recommendations and necessary social isolation can limit the continuation of tailored care, support and treatment for these patients. The situation worsens when these patients develop COVID-19 and require hospitalization for management, away from familiar caregivers and receive care through the barriers of personal protective equipment (PPE). All patients admitted at our hospital were screened for need of mental healthcare telephonically and received counselling, with in person consultation provided as required on a case-to-case basis for further management. The experience sharing of COVID-19 recovered health care professionals via audio announcement system was initiated to boost the morale of patients. All the patients were managed within COVID-19 isolation protocols. The current evidence, unique experience, novel approach at screening and support, learnings and future directions for mental healthcare delivery in a dedicated COVID-19 hospital (DCH) will be discussed. 1. Conceptual overview and mental healthcare delivery in a DCH: Jaiswal SV. 2. Psychiatric symptoms in COVID-19 & case discussion: Jyrwa S. COVID-19 in patients with mental illness & case di | Indian J Psychiatry | 2022 | CORD-19 | |
| 1066 | Depression, Anxiety and Stress in pregnant females who tested positive for COVID-19- a Cross-sectional study from South Kashmir India BACKGROUND: It is evident that the Novel Coronavirus Diseases pandemic inevitably resulted in increased stress and anxiety in the general population. Pregnancy is a challenging period, and COVID-19 has added risk to women pregnant during the pandemic. AIM: The present study was aimed to assess the emotional difficulties in pregnant females who tested positive for COVID-19. The current study estimated the prevalence of depression, anxiety, and stress among 63 pregnant ladies who tested positive for COVID-19. MATERIAL AND METHODS: The patients were interviewed in the outpatient department of the child and maternity clinic 2weeks after the infection. The interview scale used was DASS-21. The data was analysed using Chi-square and Fisher’s exact test. RESULTS: We found the mean age of participants was 33.5±7.4. We found that 38.1% of the females were having positive bad obstetric history. The Prevalence of depression, anxiety and stress were 33.32%, 50.83%, and 60.3% respectively. In correlation analysis, notably bad obstetric history and working females were significant independent factors for higher levels of depression, anxiety and stress. The depression was also found more in literate females and in third trimester. CONCLUSION: The study indicates high levels of emotional difficulties in pregnant females who tested positive for COVID-19. This calls for extra measures to promote the mental health and resilience of pregnant females, especially during a crises situation. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1067 | Workshop Title: Understanding and accepting the "New Normal" in Children and Adolescents AIM: 1. To revisit “normalcy” as we understood. 2. To understand digital natives and their norms. 3. To explore the impact of the pandemic on the above. OUTLINE: The pandemic was a challenging time for everyone which had an effect on everyday life of multiple individuals. However, the trajectory of the psychological, social and cultural development of the developing minds took a completely different turn. The additional screen use was somewhat inevitable because everything right from personal life to education turned online but on the same hand the prevalence of problematic screentime including social media and gaming increased exponentially. (1) Youth with anxiety, depression, psychotic illness and neurodevelopmental disorders were especially vulnerable to worsening or re-emergence of their symptoms in the times of changing uncertainties. (2) Along with contact restrictions and isolation, there was increased report of parental mental illness, domestic violence and child maltreatment which had a direct effect on the development of the children’s minds. (3) Although there is lack of significant evidence, increased incidence of cases of gender dysphoria and confused sexuality has been noticed due to decreased social exploration and increased exposure to online content in this regard. There are a myriad of changes which has happened in the past two decades because of advent of technology which are both positive and negative, but this Pandemic has amplified both. This workshop will consist of presentations, oral discussions and group activities to understand these changing trends in the development of young minds during the pandemic. REFERENCES: 1. Paschke, Kerstin, Maria Isabella Austermann, Kathrin Simon-Kutscher, and Rainer Thomasius. “Adolescent gaming and social media usage before and during the COVID-19 pandemic.” Sucht (2021). 2. Becker, Stephen P., and Alice M. Gregory. “Editorial Perspective: Perils and promise for child and adolescent sleep and associated psychopathology during the COVID-19 pandemic.” (2020): 757-759. 3. Fegert, Jörg M., Benedetto Vitiello, Paul L. Plener, and Vera Clemens. “Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality.” Child and adolescent psychiatry and mental health 14 (2020): 1-11. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1068 | Impact of COVID-19 on sleep quality of Healthcare professionals BACKGROUND: The outbreak of the 2019 novel coronavirus disease (COVID-19) not only caused particularly large public health problems, but also caused great psychological distress, especially for medical staff. Sleep problems, such as poor sleep quality, are common in the health care profession due to high level of work-related stress. Poor sleep quality could result in serious health consequences, such as hypertension, exhaustion, burnout, and depression. OBJECTIVES: To examine the sleep quality of healthcare professionals during the COVID-19 pandemic and its correlation with the socio-demographic data METHODS: A cross sectional study was conducted using online Google forms. It included demographic data like age, gender, hours of covid duty and Pittsburgh sleep quality index (PSQI) questionnaire among healthcare professionals of tertiary care covid hospital and the responses were recorded. Data was analysed using Microsoft office and SPSS trial version 25. The mean, frequencies, correlations and significance were assessed. RESULTS: Total of 189 healthcare professionals responded to the study. The mean age of the participants was 25.05yrs and 64% were females. 71.4% of the respondents were postgraduates. Pittsburgh sleep quality index with cut off score of >5 have showed that 65% of the participants were having poor sleep quality. There was a significant correlation between Pittsburgh sleep quality index and duty hours. CONCLUSION: Poor sleep quality among healthcare workers could impair their cognitive abilities and their clinical decision-making. Therefore, looking after the mental health of healthcare professionals during the COVID-19 pandemic is necessary. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1069 | Psychological intervention in Pandemic Related Pregnancy Stress among women pregnant during COVID-19: An Experience from South Kashmir, India BACKGROUND AND OBJECTIVES: Pregnancy the most challenging period of women’s lives were greatly hit by the Coronavirus pandemic and lockdown implemented to curtail the spread of infection in the community has also affected antenatal care. The present study was aimed to find out the effectiveness of mental health education programmes in pandemic related pregnancy stress among women pregnant during COVID-19. MATERIAL AND METHODS: A combination of descriptive and experimental research design was used. The stress related to COVID 19 was measured using the Pandemic-Related Pregnancy Stress Scale (PREPS) in 123 pregnant females. The compact mental health education intervention programme specially designed for COVID-19 was administered in the experimental group of 61 pregnant females. The stress levels were compared with 61 pregnant females of the control group who were not exposed to the mental health education programme. The results were compared and evaluated for the effectiveness of mental health education programmes in combating the stress during this pandemic. The programme was reintroduced during the second COVID-19 wave and results were accordingly analysed. RESULTS: From the study, we found there exists a significant difference in the COVID 19 pandemic related pregnancy stress between control and experimental groups. The mean scores of PREPS preparedness of the experimental group before and after the intervention was 3.36±0.89 and 1.25±0.81 respectively. A t-value of 12.38 was found which is statistically significant at a CI of 95% (1.77 to 2.44). Similarly, the mean score of PREPS infection of experimental group before and after the intervention was 3.36±0.91 and 1.28±0.71 and for PREPS positive appraisal of the experimental group before and after the intervention was 1.27±0.90 and 3.34±11.58 respectively The t-value of 11.58 was found which is statistically significant at CI of 95% (-2,42 to -1.71). However, in control the mean scores for PREPS subscales before and after were almost the same (3.34±0.71 and 3.34±0.71, 4.04±0.91 and 3.94±0.80, 2.27±0.90 and 2.01±0.80). The t-values were statistically insignificant. Therefore from the results, we conclude that in both the experimental and control group the PREPS subscale scores were higher before intervention and reduced to significant levels after intervention in the experimental group however, there was no significant change in stress levels in the control group who were not exposed to the intervention programme. There was also a significant improvement in positive appraisal in pregnant females who received mental health education. Similar results were found during the second COVID-19 wave. CONCLUSION: Pandemic related pregnancy stress had increased and can be of unfavourable consequences regarding mother and infants health. Therefore, early intervention to improve self-care and motivate women to approach the self in a way that entails inculcating and exercising things that inevitably enhance physical and mental health. At the same time refraining from the contrary thereby dispensing with professional medical help will eventually improve the overall mental health of pregnant females. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1070 | Neuro-Psychiatric Outcomes in Covid-19 Recovered Patients BACKGROUND: Viral infections of respiratory affects Central Nervous system (CNS), precipitating a spectrum of psychiatric and neurological disorders. Some patients with COVID-19 develop various CNS abnormalities with serious long term consequences. AIM: To study neuro-psychiatric manifestations in post COVID-19 RT-PCR positive patients. MATERIALS AND METHODS: 100 consecutive patients of all age groups were taken as cases who were COVID-19 RT-PCR positive, in a duration of 12 months. The neurological symptoms, MRI findings and CSF findings of the cases were recorded. Subjects were assessed with scales Mini Mental State Examination (MMSE), Mental Health Inventory (MHI), Modified Fatigue Impact Scale -5- Item Version (MFIS-5). RESULTS: On MHI scale, 28.6% of the cases were diagnosed as Depression and 16.32% of the cases were diagnosed as Anxiety. On MFIS-5 scale, 14.9% of the cases were found to have sleep disorders and Fatigue. Positive MRI Brain findings were present in 1.2% cases. No neuro- psychiatric manifestations were found in 38.98% cases after recovery from COVID. CONCLUSION: In the COVID-19 pandemic, the psychiatric manifestations are common and neurological findings are also found in some cases. Attention to neuropsychiatric consequences of COVID-19 might help in early identification and better management. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1071 | Influence of Covid-19 pandemic on Psychiatric presentation: A Case Series BACKGROUND: The Covid-19 pandemic has had a significant impact on people’s lives globally. It has affected not only physical health but also the mental well-being of the population. The pandemic itself and the subsequent lockdown brought various socio-economic hardships and stressors. These environmental and psychological factors played a central role in shaping novel psychopathological presentations. AIMS: These case series aim to elucidate the role of the covid 19 pandemic in influencing the psychopathological presentation and development of psychiatric illness. METHODS: Three cases uniquely impacted by the Covid 19 pandemic were identified, and structured clinical assessments were carried out. Case 1 shows how societal fears and perceptions centering around the covid 19 pandemic impacted and crept into psychopathology. Case 2 highlights the role of covid related lockdown and fear of contracting illness resulting in sensory deprivation, which lead to the emergence of psychotic symptoms in an elderly male. Case 3 depicts the onset of obsessive fear of contamination & contracting Covid infection and subsequent compulsions associated with other obsessions. RESULTS: An understanding of the proximal and distal factors and environmental factors shaping psychopathology is vital. Early identification of these factors and prompt treatment leads to good recovery and beneficial results despite prevailing uncertainty about the pandemic CONCLUSION: Above case series highlights the need to have better understanding of the various factors that affect the presentation of psychiatric illness, and further qualitative studies are warranted. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1072 | Assessment of motivation for solitude, covid-19 related anxiety and resilience among medical students BACKGROUND: Covid-19 related lockdowns and restrictions have generated mixed reactions in people. For some, it is a time of agony, anxiety and despair but for others, it has brought the opportunity to spend time alone. People utilize aloneness with different motivations (self-determined versus not self-determined motivations for solitude) and this can determine one’s unique way to deal with life events. This study was designed to assess these motivations for solitude among medical students of a tertiary care centre and to find their relationship with Covid-19 related anxiety and resilience among these students. MATERIALS AND METHODS: This was an analytical cross-sectional study where more than 300 medical students (age above 17, of either gender, from 1(st) year to final year of MBBS) of a tertiary care institute of Eastern India were enrolled after obtaining informed consent. The study was passed by the Institute’s Ethical Committee. Motivation for Solitude Scale – Short Form, COVID-19 Anxiety Scale, Connor-Davidson Resilience Scale-Abbreviated (CD-RISC2) were the principal tools to be applied. RESULTS: The collected data is under being entered and will be analysed using the appropriate statistical tests. The obtained results and their discussion will be shared during the presentation. CONCLUSION: The outcome of the study, in terms of different motivations for solitude, is expected to influence the policymaking in assessments as well as psychosocial interventions for vulnerable students during a loneliness crisis like the Covid-19 pandemic. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1073 | A study on Mental Health assessment among the Resident Doctors, House Surgeons, during the coronavirus Disease-2019 pandemic INTRODUCTION: Mental health issues among medical students are well recognized worldwide, with medical education accounting for one the most stressful of learning environments. Medical students are more anxious and depressed than their peers, and the prevalence of various mental health problems is on the rise.[(1,2)]With an ever increasingly competitive climate, mental morbidity and stress are seen to increase along with the years of training.[(3)] While the factors such as heavy workload and concerns about the examinations may even be essential for all-round development, they result in burnout, lack of sleep, and have an adverse effect on academic performance.[(4,5)] Physician and medical student suicides have become alarmingly common in the present day. Much priority is not afforded to the mental health of health-care personnel, despite growing evidence of untreated mental disorders in this group.[(4)] Mental health issues among medical students are also often unreported owing to stigma due to several factors, such as, fear of being evaluated poorly by faculty members, diminished respect from peers, or being perceived as unable to handle responsibilities.[(6)] A higher incidence of substance abuse is also noted in medical students, and these habits are usually new and persist throughout adulthood.[(7)] As future health-care providers, medical students require early attention and support systems for their well-being during medical school. The severe acute respiratory syndrome coronavirus-2 pandemic has had far reaching psychosocial effects globally.[(8,9)] In March 2020, the government of India announced a nationwide lockdown, as an essential and effective measure for breaking the coronavirus disease 2019 (COVID-19) transmission cycle. The psychosocial effects of the pandemic as well as the lockdown, such as depression, anxiety, and panic have taken a toll on the entire population and medical professionals, resident doctors and House surgeon have been no exception. The pandemic marked an end to normal day-to-day life. Uncertainty and uneasiness have pervaded in the medical student community, who have now not been exposed to classroom or clinical experience for almost 3 months due to the lockdown restrictions. Ambiguity about the future, especially in relation to examinations, curriculum, promotion to the next semester, commencement of internship, competitive examinations, and finding employment, is likely to aggravate any preexisting mental health problems in the medical student, adding to the feelings of anxiety, and self-doubt. This study assesses the mental health of medical health professionals, residents and house surgeons during the COVID-19 pandemic by employing a general health questionnaire (GHQ). The prevalence of mental health issues is estimated, and associations between mental health status and other demographic variables are also studied. METHODOLOGY: This was a cross-sectional study conceptualized and designed at a tertiary-care teaching hospital in Khammam,Telangana. Sample size was calculated taking prevalence value = 50%, precision = 4%, α = 0.05, and 95% confidence interval, and the minimum required sample size was 60. This study included a sample of 105 medical resident doctors and house surgeons at Mamata Medical college, Khammam, Telangana. The GHQ-28 was adapted to GoogleForms® and administered to the medical professionals at Mamata medical college. The survey was circulated extensively across Mamata medical college, and the responses were collected for a period of 1 month from april 30, 2021 to july 5, 2021. Informed consent was obtained along with the survey responses, and confidentiality issues were explained to all the respondents of the survey. Surveys with incomplete responses were excluded. The questionnaire is divided into four parts by the factor analysis. Questions (Q) 1 to Q7 are for somatic symptoms, Q8 to Q14 are for anxiety/insomnia, Q15 to Q21 are for social dysfunction, and Q22 to Q28 are for depression. Hence, a somatic symptoms score, anxiety/insomnia score, social dysfunction score, depression score, and total GHQ score are calculated. Each of the four subscores and the total score were treated as continuous measures and analyzed for association with other variables. A Likert scale ranging from 0 to 3, signifying “not at all,” “no more than usual,” “rather more than usual,” and “much more than usual” was employed for the GHQ-28. The total score hence ranged from 0 to 84. The GHQ-28 has been translated and validated in over 38 different languages since its introduction, and this study utilized the English version. We used a cutoff score of >23 to define an abnormal GHQ score. The Cronbach’s alpha of reliability for the GHQ-28 has been reported to vary from 0.78 to 0.95.[(10,11)] STATISTICAL ANALYSIS: Sciences, Version 20 (IBM Corp., SPSS statistics for windows, Armonk, NY, USA)[(12)] for Windows (version 21) and Microsoft Excel 2010. Categorical variables were analyzed with the Chisquare test. Statistical significance levels for all analyses were set at the P = 0.05. RESULTS: This study included 105 medical professionals including House surgeons and Resident doctors practicing in different clinical departments, working at Mamata Medical college, khammam,Telangana. Mean age for the study sample is 25.28years, there were 43 male and 62 female at total of 105 medical professionals out of which 17 were male House surgeons and 35 female house surgeons, 26 were male residents and 27 female residents. In this study 70 participants have scored >23 GHQ score. Females were shown to have higher GHQ score >23 than the male participants. A correlation coefficient was computed to assess the relationship between GHQ 28 score with the male and female residents and house surgeon. But statistically insignificant p value was emerged that is 0.57, as the p value is taken as <0.05, Chi square statistics with Yates correction is 0.0138, p value is 0.71 which is not significant at p<0.05. The questionnaire is divided into four parts by the factor analysis. Questions (Q) 1 to Q7 are for somatic symptoms, Q8 to Q14 are for anxiety/insomnia, Q15 to Q21 are for social dysfunction, and Q22 to Q28 are for depression. These individual scores were compared among the male and female participants out of whom p value was not significant for Somatic, Social dysfunction and Depression. But p value was significant for Anxiety when compared among the male and female participants which signifies that females were more prone to anxiety than male participants, as the female participants scored GHQ score of >23 more than male participants. The two-tailed P value equals 0.0122 By conventional criteria, this difference is considered to be statistically significant for Anxiety among the male and female participants. DISCUSSION: This study assessed psychological morbidity among Medical health professionals during the COVID-19 pandemic, and several findings have emerged. A staggering 60 % of participants had an abnormal GHQ score, which was higher than the prevalence rates reported by other authors in similar studies in India and worldwide.[(13,-15)] Medical training-related distress is a well-known phenomenon and goes hand in hand with the difficulty and the challenges of the profession. In them present day, competition in the field of medicine is at an all-time high, and failure to contend against over 100,000s of others carries a steep cost. The realization that the pandemic is here to stay has set in, with most of the participants believing that the pandemic will continue to affect them for 6 months or more. This study found that almost one-thirds of participants felt, particularly uneasy and uncertain about their careers and future on account of this pandemic, and these participants were twice as likely to score higher on the GHQ questionnaire. This study also saw females being two times as likely to have mental health issues. Females may tend to show the higher levels of psychological distress due to a decreased sense of coherence and less social support, as hypothesized and described in other studies.[(13,16)] This study has revealed that An emphasis on early intervention and an open culture that permits the expression of personal grievances and struggles is of paramount importance. A learning environment that punishes a student for underperformance is counterproductive and not conducive to personal improvement. On the other hand, the medical profession is one that demands intense resilience and patience, and it is through friendly guidance from faculty that this goal becomes achievable for a medical student. The inclusion of mentorship programs between faculty and students and mandatory appointment of trained counsellors in medical schools is a step in the right direction. The role of yoga, meditation, and mindfulness has also been studied extensively as a means to reduce the stress and anxiety.[(17,18)] Widespread application of these modalities for the psychological well-being of medical students could prove promising and are the need of the hour if we want the health of our future generations in capable hands. CONCLUSION: Mental health issues are very common among medical professionals, which may be aggravated now during the COVID-19 pandemic. The factors such as uncertainty caused by pandemic, female sex were associated with greater mental health issues. Even disregarding the pandemic as a stressor, guidance and counselling, and intervention at the individual, group and community levels are still essential for the all-round development of medical professionals. Further studies utilizing various tools to assess mental health may be warranted. LIMITATIONS: This study was an open survey of medical professionals at Mamata Medical College, Khammam, and thus a systematic approach to sampling was followed. The GHQ-28 was merely a single tool used in this study to assess mental health and may not accurately depict the complete picture. While uncertainty due to the COVID-19 pandemic was strongly associated with mental health problems in this study, it cannot be determined what proportion of these problems was pre-existing, to arrive at a causeeffect relationship between the pandemic and mental health problems. REFERENCES: 1. Hope V, Henderson M. Medical student depression, anxiety and distress outside North America: A systematic review. Med Educ 2014;48:963-79. 2. Ghodasara SL, Davidson MA, Reich MS, Savoie CV, Rodgers SM. Assessing student mental health at the Vanderbilt University School of Medicine. Acad Med 2011;86:116-21. 3. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 2006;81:354-73. 4. Center C, Davis M, Detre T, Ford DE, Hansbrough W, Hendin H, et al. Confronting depression and suicide in physicians: A consensus statement. JAMA 2003;289:3161-6. 5. Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia 2004;59:207-11. 6. Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA 2010;304:1181-90. 7. Newbury-Birch D, Walshaw D, Kamali F. Drink and drugs: From medical students to doctors. Drug Alcohol Depend 2001;64:265-70. 8. Odriozola-González P, Planchuelo-Gómez Á, Irurtia MJ, de Luis- García R. Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res 2020;290:113108. 9. Hiremath P, Suhas Kowshik CS, Manjunath M, Shettar M. COVID 19: Impact of lock-down on mental health and tips to overcome. Asian J Psychiatr 2020;51:102088. 10 Jackson C. The general health questionnaire. Occup Med 2007;57:59. 11. Farahangiz S, Mohebpour F, Salehi A. Assessment of mental health among Iranian medical students: A cross-sectional study. Int J Health Sci (Qassim) 2016;10:49-55. 12. Nie, Norman H., Dale H. Bent, and C. Hadlai Hull. ““SPSS: Statistical package for the social sciences.” 1975:249; 13. Jafari N, Loghmani A, Montazeri A. Mental health of medical students in different levels of training. Int J Prev Med 2012;3:S107-12. 14. Aktekin M, Karaman T, Senol YY, Erdem S, Erengin H, Akaydin M. Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey. Med Educ 2001;35:12-7. 15. Sreeramareddy CT, Shankar PR, Binu VS, Mukhopadhyay C, Ray B, Menezes RG. Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BMC Med Educ 2007;7:26. 16. Bíró E, Balajti I, Adány R, Kósa K. Determinants of mental wellbeing in medical students. Soc Psychiatry Psychiatr Epidemiol 2010;45:253-8. 17. Malathi A, Damodaran A. Stress due to exams in medical studentsrole of yoga. Indian J Physiol Pharmacol 1999;43:218-24. 19. Woodyard C. Exploring the therapeutic effects of yoga and its ability to increase quality of life. Int J Yoga 2011;4:49-54. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1074 | Symposium Title: Addiction treatment services during COVID-19 pandemic- Experience from a Community Drug Treatment Clinic in Delhi, India Opioid use disorders are one of the most serious global health problems. According to the latest national survey, current use of any opioid was 2.1% and an estimated 8.5 Lakh people who inject drugs (PWID) are in India. Opioid Agonist Treatment (OAT) is the most effective evidence-based strategy for management of opioid use disorders. In India, OAT is provided in government hospitals and through community-based OAT clinics. The covid-19 pandemic and nation-wide lockdown have adversely impacted OAT services delivery in the country. The National Drug Dependence Treatment Centre (NDDTC) runs a community drug treatment clinic in an urban impoverished area of East Delhi and provides low-threshold, free-of-cost OAT services for patients residing in the clinic’s vicinity. The clinic responded to the COVID-19 pandemic challenge and continued OAT throughout the pandemic by making substantial changes in its operations. This symposium shares the experience of NDDTC in running community-based OAT services using Clinical Workflow Automation based digital platform, teleconsultations, and various strategies adapted to deliver uninterrupted services during this unprecedented time. The feasibility, perceived satisfaction and retention rates of the patients receiving the tele medication assisted treatment offered is assessed among 100 patients will also be discussed. The various operational challenges faced and lessons learned during delivery of OAT services would also be discussed. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1075 | Impact of Aggression on Quality of Life in Healthy Adults during COVID-19 Pandemic- An Online Survey from Kashmir, India BACKGROUND AND OBJECTIVES: Aggression is a most common symptom shared by various mental disorders but is often neglected when not associated with overt signs and symptoms of psychiatric illnesses. When in excess aggression can prove destructive and results in social maladjustment. Aggression is considered to be a normal reaction of humans and can be provoked by any type of stressful situation like COVID-19. During COVID-19 Pandemic, and lockdown implemented to curtail the spread of infection, people were restricted to their houses. Prolonged stay at home, financial problems, closure of schools and recreational parks increased frustration in all. The present study was aimed to investigate the levels of aggression and its impact on the quality of life (QoL) of healthy adults during times of Pandemic. MATERIAL AND METHODS: To examine the hypothesis, an online survey was conducted during the lockdown period of the COVID-19 Pandemic April to August 2020. A Google form of 65 questions (9 questions asking about socio-demographic variables, 29 questions enquiring about aggression and 27 questions about quality of life) was created with a starting question asking for consent to participate in the survey. The hypothesis of the study was mentioned at the top of the survey page. The inclusion criteria for the participants were age between 18 to 55 years with minimum qualification of high school so that they can easily understand the questionnaire without any history of psychiatric illness or use of psychotropic medication for the same at the time of survey or in past. The Google form was shared on social media to reach the maximum number of participants. After fulfilling the inclusion criteria, the participants filled the questions about sociodemographic variables, the Buss-Perry aggression questionnaire and the WHO-BREF Quality of life questionnaire. STATISTICAL ANALYSIS: The data were entered in SPSS.21 a software package of a comprehensive system for analysing data. The descriptive statistics, average mean score and standard deviation of different variables have been calculated followed by the t-test and ANOVA to check the significance. The multiple regression analysis was performed to find the correlation across subscales of aggression and quality of life. RESULTS: A total of 192 healthy adults voluntarily participated in the online survey. The average age of the participants was 32.03±6.09 years. Out of 192, 60.41% (n=116) were males and 39.58% (n=76) were females, 51.56% (n=99) were married and 48.43% (n=93) were unmarried. The majority 85.41% (n=164) of the participants were graduates and postgraduates. The total aggression score was found more in males than females with a mean of 77.78±20.35, 71.0±20.26. The males also scored higher in physical and verbal aggression. Physical aggression was found more in the married group with a Mean±SD of 20.68±8.4. The participants from urban backgrounds scored higher in Anger (20.68±8.4), verbal (15.55±4.7) and total aggression (77.98±20.35) than rural group (18.30±7.1, 13.55±3.8, 71.00±20.26, respectively) and the difference was statistically significant (S=.036, .003, .021, respectively). The psychological quality of life was found less in joint families with a Mean±SD of 19.10±2.9 than nuclear families (20.38±3.0) and the difference was statistically significant (S=.004). the social quality of life was found less in the unmarried group with a Mean±SD of 10.10±1.9. From this study, a positive and significant correlation between subscales of aggression and subscales of quality of life was found. The results also showed a negative and significant correlation between the aggression scale and the quality of life scale. CONCLUSION: According to this study, the physical and verbal aggression levels were found to be more prevalent than hostility and anger. It was revealed that as the level of aggression increases, all the subscales of quality of life were negatively affected. More impact was found on psychological and social quality of life which indicates COVID-19 had a direct impact on psychosocial wellbeing of people. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1076 | A study on Mental Health assessment among the Resident Doctors, House Surgeons, during the coronavirus Disease-2019 pandemic A study on Mental Health assessment among the Resident doctors, House surgeons during the Corona virus Disease-2019 pandemic in Mamata Medical College INTRODUCTION: Medical students and health care professional are more anxious and depressed than their peers, and the prevalence of various mental health problems is on the raise. The corona virus disease 2019 (COVID-2019) pandemic has had far-reaching psychosocial consequences on the medical professionals. AIMS AND OBJECTIVES: The aim of this study is to assess the mental status of Resident doctors and House surgeons at Mamata medical college during COVID -19 Pandemic and lockdown. MATERIALS AND METHODS: A questionnaire-based, cross-sectional study. General health questionnaire with 28 items (GHQ-28) was adapted to GoogleForms and circulated among healthcare professionals from MamataMedical College, Khammam. RESULTS: This study included 105 medical professionals including House surgeons and Resident doctors practicing in different clinical departments, working at Mamata Medical college, khammam,Telangana. Mean age for the study sample is 25.28years, there were 43 male and 62 female at total of 105 medical professionals out of which 17 were male House surgeons and 35 female house surgeons, 26 were male residents and 27 female residents. In this study 70 participants have scored >23 GHQ score. Females were shown to have higher GHQ score >23 than the male participants CONCLUSION: Mental health issues are very common among medical professionals, which may be aggravated now during the COVID-19 pandemic. The factors such as uncertainty caused by pandemic, female sex were associated with greater mental health issues. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1077 | Psychological impact of COVID-19 on healthcare professionals and general population in India- A Cross-sectional Study CONTEXT-: COVID 19 pandemic is having a psychological impact not only on the frontline healthcare worker but also on the general population. The comparative data on psychological impact of COVID 19 pandemic on healthcare professional and general population is limited. AIM: To assess the psychological impact of COVID-19 pandemic on healthcare worker and general populations in India and to find the difference between the two groups. MATERIAL AND METHODS: Sample comprised of 840 participants according to inclusion/exclusion criteria. The participants were given the online survey after applying The Checklist for Reporting Results of Internet E-Survey (CHERRIES). The survey link (Google Forms) was sent to each participant via Email and WhatsApp. E- Survey comprised of a semi-structured sociodemographic details, medical history proforma and Depression Anxiety Stress Scales-21 (DASS-21). Each participants were contacted for any queries and to maintain the validity of the scales used. STATISTICAL ANALYSIS USED: To analyze the differences in psychological impact, mean score of depression, anxiety and stress between the two groups were compared using the Independent Samples Mann-Whitney U test. The chi-squared test was used to analyze the differences in categorical variables between the two groups. Statistical analysis was performed Microsoft Excel. RESULTS: The significant difference was found between the two groups i.e. the healthcare professionals and general population in the prevalence of stress (P=0.033) with level higher among the healthcare workers. The healthcare professionals, who were involved in direct care of covid 19 patients were found to have significantly higher level of stress( P= 0.006 ) and anxiety (P=0.002) than those who were not directly involved. CONCLUSION: Study reveals that the prevalence of depression, anxiety and stress was not significantly different among the healthcare workers and general population. Significant difference was found in prevalence of anxiety and stress in healthcare workers involved in the care of Covid-19 patients and the healthcare professionals not involved. Psychological intervention may be considered for the healthcare professionals involved covid-19 patients. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1078 | Health anxiety in patients presenting to Psychiatry outpatient department of a Tertiary care hospital during COVID-19 pandemic BACKGROUND: Corona virus disease-2019(covid-19) pandemic has had a huge impact on mental health of individuals across the world. Many studies assessed the psychological impact of the pandemic across various demographic groups. Present study attempted to assess health anxiety in patients presenting to psychiatry outpatient department during the pandemic. AIM: To study health anxiety during covid-19 pandemic among patients presenting to psychiatry outpatient department of a tertiary care hospital METHODS: A cross-sectional study was conducted between May and August2021 in the psychiatric out-patient department of medical college hospital after approval from institutional ethics committee. A semi-structured proforma with covid-19 related questions and Short Health Anxiety inventory (SHAI) were applied after obtaining written informed consent from participants. RESULTS: Mean health-anxiety score of the participants was 24.5±8.7. 60% of the study participants never tested positive for covid and recorded higher health anxiety scores. 35% of them delayed their visit to the outpatient department due to fear of contacting covid. CONCLUSIONS: It is important to identify health anxiety and its effects on patients during a pandemic and address issues such as delay in seeking first consultation and follow-up due to fear of contacting infection and apply this knowledge to future pandemics. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1079 | Organic Personality Disorder Following Mixed Sars-Cov-2 And Herpes Simplex Viral Encephalitis We describe a 30-year-old functionally active male, who had sudden onset of fever, sever headache, altered sensorium followed by neck rigidity for 3 days duration. Nasopharyngeal swab for covid 19 was taken suspecting covid 19 encephalitis which turned out to be positive. CT brain revealed a hypodense lesion in the left anterior temporal lobe. CSF analysis showed lymphocytosis and elevated protein. RT-PCR of CSF detected HSV DNA. Patient was treated in an intensive care unit with intravenous antiviral drugs and was given oxygen support for hypoxemia. HIV was seronegative. After 2 weeks, there was significant alteration of the habitual pattern of premorbid behavior. Patient was brought to the psychiatric OPD with complaints of altered emotional behavior characterized by emotional lability, unprovoked aggression, reduced ability to persevere with goal directed activities and significant cognitive impairment. On MSE, patient has perseveration of speech, labile affect with no thought or perceptual disturbances. Combined infection of COVID 19 and HSV encephalitis is a rare entity, posing a dilemma of possible causative factor for the neuropsychiatric manifestation. Neuropsychiatric manifestations of HSV encephalitis include personality/behavioral change, seizures and cognitive impairment. No such recognized syndromes have been identified with covid 19 encephalitis except for delirium, depressive and anxiety states and post-traumatic stress disorder. The possible pathophysiology behind covid 19 encephalitis causing neuropsychiatric manifestation is immune/antibody mediated mechanism. Hence in this case, the contribution of SARS-CoV-2 causing such neuropsychiatric manifestation cannot be ruled out. REFERENCES: 1. A first case of meningitis/encephalitis associated with SARS-Coronavirus2 Takeshi Moriguchi 1, Norikazu Harii 2, Junko Goto 3, Daiki Harada 3, Hisanori Sugawara 3, Junichi Takamino 3, Masateru Ueno 3, Hiroki Sakata 3, Kengo Kondo 3, Natsuhiko Myose 3, Atsuhito Nakao 4, Masayuki Takeda 5, Hirotaka Haro 6, Osamu Inoue 7, Katsue Suzuki-Inoue 8, Kayo Kubokawa 9, Shinji Ogihara 10, Tomoyuki Sasaki 8, Hiroyuki Kinouchi 11, Hiroyuki Kojin 12, Masami Ito 12, Hiroshi Onishi 13, Tatsuya Shimizu 13, Yu Sasaki 13, Nobuyuki Enomoto 14, Hiroshi Ishihara 15, Shiomi Furuya 12, Tomoko Yamamoto 12, Shinji Shimada 16; 2. Postviral autoimmune encephalitis: manifestations in children and adults Harald Prüss 1. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1080 | A Comparative Survey on Burnout and Resilience in Frontline workers afflicted by COVID-19 vs Non-afflicted, in the Second wave, in Andhra Pradesh, India.: Abstract for free paper presentation BACKGROUND: The Covid-19 pandemic is of an international scale with the number of people working on frontlines in healthcare positions has been of a scale never witnessed before. The wellbeing and emotional resilience of healthcare professionals are key components of continued delivery of healthcare services during the pandemic. Although, researchers have estimated burnout and resilience among health care workers, they didn’t study in health care workers who were infected with covid. Nor was the group compared to uninfected health care workers. AIMS: To compare these two groups to gain insights into how the infection will affect the already wounded morale of the health care workers in the light of continued onslaught in form of subsequent waves. METHODS: : This cross sectional study was conducted for 1 month, after obtaining the ethics clearance. Purposive sampling was used to include doctors, interns & nurses involved in Covid 19 duties in Andhra Pradesh during the second wave. A specially prepared anonymous, voluntary, online, valid, reliable self-administered google form was used. Brief resilience scale and Copenhagen Burnout inventory, used to asses resilience and burnout respectively, along with socio demographic data. The data was analysed using by Chi - square test, Fischer - exact test for significance of association. RESULTS: The sample consisted of 249 respondents, of which, majority (n=134; 45.4%) were between the ages 18-24 yrs, and most of them, interns (n=146; 58.6%). As per the two groups, 27.7%(n=69) of subjects have been afflicted by Covid 19 during second wave. CONCLUSION: The mean resilience for those afflicted by COVID 19 and Non-afflicted was 2.9 and 3.2 respectively and mean work-related burnout was 60.7 and 54.6 respectively, indicating a difference in attitudes and outlook towards the work. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1081 | Abstract for Symposium COVID-19 and suicides in India: Where do we stand? Introduction(1) The Corona Virus Disease 2019 (COVID-19) has ignited many debates and has undoubtedly shaken up the core foundations of the health-care system worldwide. There has been plenty of evidence that pandemic and the effects of lockdown have Studies have resulted in elevated levels of psychological symptoms such as depression, anxiety, phobia, trauma, etc. Concerning the COVID-19 outbreak (since late January 2020 in India), the first case that was reported in India is stated to be due to fear of being infected with COVID-19. Similarly, COVID-19 suicide occurrences were reported as of fear of infection, economic crisis and social boycott in Bangladesh and Pakistan, from the neighbouring countries of India. Though the report of the National Crime Record Bureau (NCRB) was released as last as October’21 this year, many of the incidents were reported by press and over social media platforms. The NCRB Statistics - 2020(2) A total of 1,53,052 suicides were reported in the country during 2020 showing an increase of 10.0% in comparison to 2019 & the rate of suicides has increased by 8.7% during 2020 over 2019. Majority of suicides were reported in Maharashtra (13.0%) followed by Tamil Nadu (11.0%), Madhya Pradesh (9.5%), West Bengal (8.6%) & Karnataka (8.0%). These 5 States together accounted for 50.1% of the total suicides reported in the country. Family Problems (33.6%) & Illness (18.0%)’ were the major causes of suicides. Drug Abuse/Addiction (6.0%), Marriage Related Issues(5.0%), Love Affairs (4.4%), Bankruptcy or Indebtedness (3.4%), Unemployment (2.3%), Failure in Examination (1.4%) & Poverty (1.2%) were other causes. Daily wage earners accounted for the maximum percentage (24.6%). Hanging’ (57.8%), consuming ‘Poison’ (25.0%), ‘Drowning’ (5.2%) and ‘Fire/Self Immolation’ (3.0%) were the prominent means/mode. Beyond the NCRB Statistics(3) The NCRB report has some significant limitations. NCRB underestimates suicide rates due to under- reporting of cases & this data is usually made available after a significant delay of between 12 and 24 months. Furthermore, NCRB releases summary annual data rather than weekly or monthly data to analyse trends (Important during COVID19). NCRB does not keep any record of attempted suicides as well. Analysis of media reports reveals that the rates of suicide and attempted suicide between 24 March to 3 May 2020 compared to the same dates in 2019 showed a 67.7% increase in reported suicides and attempted suicides during the lockdown. More suicides & attempted suicides were by older employed men. Suicides increased in 2020 in states which traditionally have low suicide rates such as Bihar, Uttar Pradesh, Rajasthan, Haryana, and Chandigarh (also economically less developed & inadequate health infrastructure). There were 39 alcohol-related suicides & 7 attempted suicides as compared to no such suicide/ attempted suicide cases in 2019. Conclusion(3) The possibility that the pandemic may have increased the risk of suicide as reflected from the media reports has been attested by the recently released NCRB data. However, both the reports are an underestimate of the true figures. The pandemic however has now provided an opportunity for cross- sectoral collaboration for suicide prevention rather than restricting suicide prevention to the health sector Symposium Proposal: Digital Phenotyping in Mental Health This symposium explores the emerging field of digital phenotyping in mental health. Despite developments, psychiatry heavily relies on patients’ interviews and self-reporting to match the diagnostic criteria of the ICD or DSM and is still handicapped by the lack of objective measurements for diagnosis and management. Smartphones and wearables, which have emerged as new tools for health investigation, generate many digital fingerprints that provide insights into human behavior. They collect data in naturalistic settings in-situ, leveraging the lived experiences of patients and no longer confined to clinics or research laboratories. However, such technology with revolutionary potential is also associated with challenges and controversies. Various legal, ethical, and security issues concern digital phenotyping in mental health. The first presentation by Vijay Gogoi of LGBRIMH sets the scene for what follows(1). He discusses the advent and concept of using digital devices and the Internet of Things (IoT) for personal sensing in the context of mental health. Terminologies like computational behavioral analysis, personal sensing, continuous measurement are being applied in similar research approaches. Hence, some researchers also view digital phenotyping as a variant of deep phenotyping, closely aligned with the goals of precision medicine and a new tool for the National Institute of Mental Health’s Research Domain Criteria. Dhrubajyoti Chetia of LGBRIMH then discusses the various research trends in mental health using digital devices(2). The features studied as behavioral markers for social context, stress, sleep, mood, and clinical disorders like depression, schizophrenia, and bipolar disorder will be discussed. Changes in location and activity patterns, keyboard interaction dynamics, voice modulation, social communication logs are used to predict depressive and manic states. Proactive screening in online environments and automatic natural language processing of social media posts have been used successfully to identify individuals with evidence of psychological distress. Signals from smartphones and clinical measurements may provide a safety net for patients at risk of self-harm or suicide. The challenges and limitations of using digital technology are highlighted by Sajjadur Rehman of Lady Hardinge Medical College(3). Results are not comparable across studies because of varying data collection techniques and research designs. As most research is currently being carried out in small samples as proof of concept studies, replicating the same in a large population is a challenge. Variability from geographical location, characteristics of people, data types, environments, etc., is a barrier. With rapid technological advancements, and people changing their usage, machine learning algorithms are bound to become inaccurate. Finally, as health care professionals, the ethical and security concerns were discussed by Kunal Deb of LGBRIMH(4). Accountability for safety and efficacy, usually assessed by government agencies, is still not well developed for digital health technologies. Strict data privacy and protection regulations also need to be in place. The use of various data streams may assist the third party in re-identifying individuals without their knowledge, with the potential impacts of mental health diagnosis and predictions on employment, insurance, litigation, and other contexts. 1.Vijay Gogoi, Associate Professor, Psychiatry, LGBRIMH, Tezpur, Assam; 2.Dhrubajyoti Chetia, Associate Professor, LGBRIMH, Tezpur Assam. 3.Sajjadur Rehman, Assistant Professor, Psychiatry, Lady Hardinge Medical College, Delhi; 4.Kunal Deb, Assistant Professor, Psychiatry, LGBRIMH, Tezpur, Assam. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1082 | Impact of COVID-19 Pandemic on Availability and Utilization Of Mental Health Services: Findings of a Multi-Centric Study AIMS: To explore the availability, access and utilization of mental health services during COVID-19 pandemic restrictions (1(st) wave) in patients registered at psychiatry facilities across India and to assess difficulties faced by caregivers of these patients. METHODOLOGY: It was a multi-centric study carried at 4 centres across India, providing mental health services. It used convenience sampling method, wherein we recruited a total of 500 subjects from all centres over a period of 6 months using predefined inclusion and exclusion criteria. A semi structured performa to explore the availability, access and utilization of mental health services and difficulties faced by caregivers during COVID-19 pandemic. RESULTS: Of the 500 subjects recruited, 54.6 % were males, 80.4% were Hindus and 56% were from rural areas. The subjects reported that 75.3% had problems accessing the mental health services, owing to closure of OPD services (83.2%), non-availability of doctors (63.5%), poor availability of transport (61.9%). It was reported that 16.3% changed their psychiatrist and had to contact GPs (16.5%), their illness worsened in 66.1% of the cases, 68.8% faced difficulties in availing psychotropic medications. The caregivers of these subjects reported that 80.3% of them faced difficulties during lockdown which was attributed to non-availability of doctors (67.5%) and medication (33.6%). DISCUSSION: This sub-sample of registered OPD patients at 4 treatment facilities across India, showed that three fourth of subjects had problems accessing OPD, which was largely due to closure of routine OPDs and non-availability of doctors as well as transport facilities due to pan India lockdown. One sixth of patients had to change their psychiatrist and resort to GPs for consultation. In two third of cases the symptoms worsened and around same numbers did not get psychotropic medications during lockdown. Three fourth of caregivers of patients reported difficulties due to non-availability of doctors and medications. CONCLUSIONS: COVID-19 pandemic related restrictions affected the availability, access and utilisation of mental health services negatively and lot of difficulties were also faced by caregivers of these patients. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1083 | Opioid Assisted Medical Treatment (OAMT) in India: History, current status, evidence of its effectiveness and future directions Opioids are one of the most common illicit substances used globally as well as in India. Opioid Agonist Maintenance Treatment (OAMT) is the most evidence-based long-term treatment for patients with opioid dependence syndrome. Buprenorphine is the most commonly used opioid medication for OAMT in India, while methadone and slow-release oral morphine are used less commonly. Buprenorphine was introduced in India around three decades back, and since then, many Indian studies have confirmed its effectiveness as OAMT in the Indian opioid-using population. The significant expansion of OAMT in India occurred when it became a part of the National AIDS Control Programme as an HIV prevention strategy. Since then, there has been a gradual expansion of OAMT under the National AIDS Control Programme. However, the provision of OAMT under this programme is limited to only people who inject drugs (PWID), thus leaving out the majority of opioid users in India. The Drug De-addiction Programme (currently renamed as National Program for Tobacco Control and Drug Addiction Treatment) under the Ministry of Health and Family Welfare (MoHFW) provides OAMT through its Drug Treatment Clinics (DTCs) in government hospitals across the country. The number of such DTCs is limited. More recently, the Ministry of Social Justice and Empowerment (MSJE) has approved a scheme of Addiction Treatment Facility (ATF) under which OAMT shall be available in Government hospitals at district level. The symposium will cover many of these issues and challenges. Presenter 1 will give a background of OAMT and will focus on its effectiveness in the Indian population. Presenter 2 will talk about the history and current status of OAMT under the National AIDS Control Organization. Presenter 3 will cover the history and current status of OAMT under MoHFW and MSJE. Presenter 4 will discuss the significant changes in the OAMT programs during the COVID-19 pandemic and the impact. Presenter 5 will discuss the major issues faced during the expansion of OAMT in India during the last three decades and the future directions in the various Indian settings. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1084 | Are the Collaborative Video Consultations module in Diploma in Primary Care Psychiatry helpful INTRODUCTION: The ‘Diploma in Primary Care Psychiatry’ (DPCP) is a 1-year, module-based, digitally-driven, hybrid format, distance education training program conducted by Tele-Medicine Centre, Department of Psychiatry at National Institute of Mental Health and Neurosciences, Bengaluru for in-service MBBS doctors [Primary Care Doctors (PCDs)] of various states. This course can catalyze India’s National Mental Health Program for the capacity building of PCDs. We discuss the outcome of “Collaborative Video Consultation” (CVC) modules that mimics real-time expert guidance for the DPCP course conducted for MBBS in-service doctors of Bihar, India. METHODOLOGY: In one year, we supervised 217 CVCs. We examined the diagnostic concurrence between PCDs and tele-psychiatrists, reviewed the CVCs, and generated learning themes. RESULTS: Among the total sample (n=217), 64 (29.9%) patients had Severe Mental Disorders, 73(32.8%) had Common Mental Disorders, and 36(14.7%) had substance use disorders. The diagnostic concurrence was 83%, with a kappa agreement of 0.77 (p<0.001). Learning themes that emerged ranged from diagnostic clarification to enhancement of clinical skills. DISCUSSION: It is the first study to evaluate the impact of the CVC module. The 83% diagnostic concordance reflects on the overall effectiveness of the training modules. The learning themes that emerged were quite diverse and involved various aspects of psychiatric care. Hence, this training model in a post-COVID world is a feasible and scalable option for training primary care doctors in India, leading to a reduced treatment gap and global burden of disease. INTRODUCTION: Primary healthcare provides universally accessible ‘essential healthcare’ to individuals and families in the community. In India, the prevalence of psychiatric disorders in the National Mental Health Survey from a representative adult population was 10.6%(1), and the treatment gap is more than 70% for all psychiatric disorders. Psychiatric disorders are major contributors to the global health burden(1). To address this, empowering Primary Care Doctors (PCDs) in identifying, assessing, and managing first-line psychiatric illness in a primary care setting is the feasible strategy given the country’s inadequate psychiatrist to patient ratio. The concept of comprehensive primary healthcare services has been highlighted by the Bhore committee(2) and demonstrated to be feasible through the landmark Bellary model(3). However, with a population of 1.4 billion, India needs more novel methods to implement and sustain community psychiatry services through District Mental Health Program (DMHP). After the Mental Health care Act (MHCA) 2017(4), mental health services delivery in the community and deinstitutionalization have become a legal mandate in India. Since 2015 there has been a paradigm shift in the district mental health program delivery in Bihar state(5) through an innovative, collaborative model between NIMHANS, National Health Mission (NHM) state health society, Bihar. The DMHP program has successfully trained several health care providers from Bihar Doctors and nurses from Bihar over the last three years. In 2017-18, eleven district medical officers were trained to initiate DMHP services.(6) Despite this, there was a need to better prepare the primary doctors in psychiatry to provide mental healthcare services, especially given the lack of formal Psychiatric training beyond two weeks in undergraduate in most medical colleges. PCD training in mental health care involves several logistic challenges such as inadequate undergraduate training in psychiatry, time constraints in learning due to their hectic clinical work, lack of adequate human resources, and failure of multiple capacity-building programs through traditional classroom training. To overcome these challenges, Diploma in Primary Psychiatry (DPCP), a 1-year modular-based digitally-driven hybrid training program, was conceptualized by the Telemedicine Centre, Department of Psychiatry at National Institute of Mental Health and Neurosciences) (NIMHANS) Bengaluru for DMHP capacity building. This course can be the catalyst to further mobilize India’s National Mental Health Program for the capacity building of PCDs. DPCP program was designed to cater to PCDs training in psychiatry with minimal disruption to their clinical duties with the incentive of career enhancement through an additional diploma degree. This program was initiated first with PCDs of Uttarakhand in collaboration with the State Government. The Uttarakhand DPCP program was reasonably effective and paved the way to conceptualizing other telemedicine-based innovative approaches to mental health capacity enhancement(7). This study discusses the outcome of one of the modules, the Collaborative Video Consultation Module (CVC) (on-the-job supervised training by a board-certified psychiatrist) of the DPCP program for in-service MBBS doctors from Bihar. To evaluate the outcome of this training program, this paper focuses on assessing PCD’s ability to diagnose psychiatric disorders and their perception of learnings from the CVC module. METHODOLOGY: This paper was based on findings from the DPCP program conducted for in-service MBBS doctors of Bihar from February 2020 to March 2021. The overview of the program has been explained in brief below. So far, Telemedicine Centre, NIMHANS, Bengaluru, awarded DPCP to 20 in-service MBBS doctors of Uttarakhand. It follows the hybrid model of training with initial brief (5 days) onsite training at a tertiary care psychiatry department (NIMHANS), which has classroom sessions, consultation-based training (real-time observations of psychiatric assessments of patients and management), and also visit a DMHP center to understand the working of DMHP. This brief onsite module followed by everything digital modules aiming for direct skill transfer using adult learning principles (andragogy)(8). The details about different modules of DPCP are described elsewhere(9)(https://pubmed.ncbi.nlm.nih.gov/32361210/) (https://pubmed.ncbi.nlm.nih.gov/30166682/). In continuation with the collaboration and to enable the provision of DMHP services across all districts of Bihar, primary care doctors from 19 districts of Bihar and 3 Prisons were enrolled in a one-year DPCP program. The curriculum for DPCP is Clinical Schedules of Primary Care Psychiatry version 2.2(CSP), which has a validated screening procedure and a heuristic point of care manual designed for PCDs(10). The 22 PCDs came to NIMHANS from 17(th) February 2020 to 22(nd) February 2020. In this module, PCDs were trained in psychiatric history-taking and mental state examination through clinical demonstration and onsite classes. In-Person consultation-based training in the outpatient clinic was conducted at First contact and follow-up outpatient services of the Department of Psychiatry, NIMHANS, Bengaluru. All PCDs underwent didactic teaching sessions in Common mental disorders (CMDs), teaching sessions on specialized topics such as Emergency psychiatry, Geriatric Psychiatry, Child and Adolescent Psychiatry, Forensic and legal aspects of psychiatry, along with a visit to DMHP services at Chikkaballapur district, about 70 km from Bangalore, Karnataka. They also received orientation on Tele- On-Consultation-Training sessions and made them familiarised with the digital modules of DPCP and the telemedicine platforms. On returning to their workplace- District hospital settings, Digital Modules were initiated. This paper focuses on findings from the collaborative video consultation (CVC) module conducted throughout the course, especially after Tele on-consultation training module. CVC module Format: In the CVC module, instant video consultation is sought by trainee PCDs from tele-psychiatrist, which is a real-time second opinion from a board-certified psychiatrist. The Tele-psychiatrist was available to the PCDs during working hours and occasionally for emergency cases, anytime for discussion/advice. PCDs choose to discuss their selected patients to decide the best treatment for them or any difficulty in diagnosis. Some of these patients were also seen in follow-ups up to 6 months whenever these patients visit these doctors (one of the criteria of formative assessment of DPCP course). Soon after CVC, a tele-psychiatrist enters all clinical data in a specially designed proforma containing learning points and whether PCD felt skill enhancement or not from each CVC. Diagnosis of the patient population is made as per clinical schedules of primary care psychiatry. Whenever clinical presentation is not allowing CSP diagnoses, ICD-10 CDDG diagnosis is considered. PCDs discussed several cases ranging from children, adolescents with mental health issues to elderly individuals with psychiatric complaints. PCDs were also actively involved in providing care to psychiatry patients who could not follow up with their treating psychiatrists during the 1(st) wave of the COVID 19 pandemic and travel restrictions during the lockdown. They also discussed patients presenting to emergencies with psychiatric disorders. The PCDs were motivated and actively involved in helping patients who needed psychiatry care, including counseling patients in isolation centers. Diagnostic concurrence was evaluated from similarities/differences in PCD and tele-psychiatrist diagnosis. The authors screened all the data entered in the CVC, and pre-defined learning themes were generated. The learning themes were finalized after agreement by all the authors. Data were analyzed using SPSS version 27.0(11). RESULTS: In the past year, 217 CVCs were conducted for 15 PCDs as a part of the CVC module. The socio-demographic of these 217 cases are as follows (Table 2) The mean age of the clinical sample was 34 years (S. D – 15.75). The gender distribution of the sample has shown that males were more than females. Table 3 shows the psychiatric diagnosis made by the psychiatrist of the total sample. 64 (29.9%) of the patients had SMD (Severe Mental Disorders), 73 (32.8%) had CMD (Common Mental Disorders), and 36 (14.7%) had substance use disorders. Table 5 shows the diagnostic concurrence between PCD doctors and Tele-psychiatrists on the psychiatric diagnosis. Among diagnostic discordance, the distribution of psychiatric diagnosis was analyzed and presented below. (Table 6) shows the descriptive analysis of the pre-defined learning themes obtained from PCD doctors at the end of each discussion. DISCUSSION: The study results demonstrate that PCDs could accurately diagnose psychiatric disorders with statistically significant (kappa value: 0.78) diagnostic concordance between PCDs diagnosis and tele-psychiatrist diagnoses. The learning acquired during CVCs demonstrated by the learning themes ranged from understanding psychopathology, arriving at a diagnosis, and planning treatment. The maximum number of CVCs who conducted the learning theme was the enhancement of their advanced clinical skills. Of the 217 CVCs, the PCDs prescribed both pharmacological and also non-pharmacological management (counseling) in a maximum number of patients (n=190, 87.6%) Assessing the effectiveness of a training program is essential; effectiveness is measured in several parameters such as knowledge attitude and practices of the trainee health workers through structured questionnaires, assessing patient outcomes, and evaluating the skill acquired(12) . Collaborative Video Consultations (CVC) module is an instant video consultations module with trainer tele-psychiatrist on selected general patients, wherein, Tele-OCT module focused on imbibing basic clinical skills for identification and management of commonly presenting psychiatric illness in a PCD among consecutive general practice patients. At the same time, CVCs (which can be equated to second opinion through video consultations) are PCD-driven modules that focus on enhancing their skills obtained in the Tele-OCT module (13). In CVC, the initial screening of the patient is done by PCDs and reaches out to tele-psychiatrist in case of any clarification/difficulty for these selected patients. It is the first study to evaluate the impact of the CVC module. Since PCDs would have completed a minimum of one session of Tele-OCT before CVCs, it is expected that PCDs have been trained already in rapid screening and management of psychiatric disorders. Of the total CVC consultations, 83% had diagnostic concordance with kappa agreement of 0.78 which means to say that PCDs were able to diagnose most of the cases which reflect on the overall effectiveness of the DPCP program, in particular, the Tele-OCT module pointing towards achieving adequate competency to provide mental health care which is essential for assessing the impact of any medical training program(14). The CVC module helped PCDs to sustain confidence secondary to real time positive feedback experience. This has also been proved in an earlier study on the impact of the overall effectiveness of training programs for PCDs in Bihar(15). Gask L et al. (1998), in the pre-digital era, had discussed the application of video feedback (playing of recorded videos of patient consultations) of training in mental health skills to address areas requiring improvement(16), CVC which can be considered as an innovative digital module enables to provide real-time confidence maintaining feedback to the PCDs; thus the discordance of 17% also can be taken on a positive note as PCDs were able to identify their areas of error/doubts and bring it to discussion with tele-psychiatrist. On assessing the descriptive of learning themes, it has been shown that PCDs perceive skill enhancement in 35.5% of case discussions. This is in line with the objectives of CVCs, as basic training would have been done in previous modules, and CVCs essentially result in skill enhancement in the assessment, diagnosis, and management of psychiatric cases. CVCs allowed the Tele psychiatrists to observe and help the PCDs to refine and help PCDs gain new skills, the importance of knowledge transfer and case-based reader acceptance, which has been demonstrated in a study by Fleury, MJ et al. 2012 wherein they studied qualitative aspects of training of general practitioner in psychiatry(17). Learning themes also reflected 7.4% of learning happened in special population management. PCDs need to be aware of psychiatric issues in special populations such as the elderly and pregnant women to facilitate appropriate and timely referrals and emergency management. Other learning themes such as handling complex cases, referral red flags, and atypical case presentations will likely help PCDs identify patients requiring specialist management. Some learning themes such as screening for psychiatric illness, diagnosis, and pharmacological management also reflect building upon their learned skills through Tele-OCT and getting practiced at CVC discussions. The documenting of the learning points enabled the tele-psychiatrist to assess the areas wherein PCD would require more handholding. The traditional classroom training focuses on knowledge transfer, whereas the CVC focuses on skill transfer using a bottom-up approach, in line with the adult learning principles. Though the training aimed to provide essential DMHP services, additional skills were also imbibed, as demonstrated by the various learning themes discussed in our study results. The CVC module also enabled the PCDs to collaboratively engage with the tele-psychiatrist, which would, in turn, will allow them to provide collaborative care under DMHP and be team leaders. In the absence of psychiatrists and difficulty to access the limited specialty psychiatric services, training of PCDs in psychiatry is vital; the CVC module is probably preliminary evidence that without such training, many individuals with mental health issues would remain undiagnosed and untreated and continue to be in the “functional treatment gap” among primary care attendees(3). The learning and the training would serve the purpose of task sharing and task shifting in mental health, which is an effective strategy to address the treatment gap under the current scenario. Strengths & Limitations: 1. This study is the first study to evaluate the effectiveness of the CVC module of the DPCP program by assessing the diagnostic concurrence. 2. This study also involves a qualitative component of assessing learning themes, through which it assesses PCD’s perception about CVC discussions. 3. This study also shows the feasibility of providing instant video consultations to all PCDs amidst the Covid pandemic. 4. Follow-up data were not available, which is an essential limitation of this study. The authors are planning to incorporate it in future studies. CONCLUSION: In this study, we have discussed the implication of CVC on the training of PCDs and their skills. The study demonstrates the positive impact of the CVC on the training of PCDs in primary care psychiatry. Capacity-building training programs should employ training modules such as the CVC for effective training and better patient care. Such modules may be used not just to PCDs but to other cadres of the health care workforce. The symptomatic and functional outcomes of CVC-treated patients have to be studied in the future. The cost-effectiveness and impact on service provision need to be studied in the future. Further, there is also a need to assess and compare the various training formats in primary care psychiatry and its impact. FUNDING: The Training Program was funded by the State Health Society,Government of Bihar ACKNOWLEDGEMENTS: The researchers would like to thank the Doctors, Nurses who took up the training and were selflessly strived for ensuring best patient care. The Authors thank patients and families for their cooperation. We thank the NIMHANS Administration for their support in conducting the training program. We would like to express our gratitude to the Government of Bihar Administrators without whose efforts and collaboration this program would not have been possible. REFERENCES: (Endnotes) 1. Sagar R, Dandona R, Gururaj G, Dhaliwal RS, Singh A, Ferrari A, Dua T, Ganguli A, Varghese M, Chakma JK, Kumar GA. The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. The Lancet Psychiatry. 2020 Feb 1;7(2):148-61. 2. Duggal R. Bhore Committee (1946) and its relevance today. 3. Van Ginneken N, Jain S, Patel V, Berridge V. The development of mental health services within primary care in India: learning from oral history. International journal of mental health systems. 2014 Dec;8(1):1-4. 4. Mental Health Care act 2017. 5. Mantri G. Many Indian states have less than 10 psychiatrists: These govt figures tell a shocking story. The News Minute. 6. Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatric Quarterly. 2021 Sep 12:1-2 7. Pahuja E, Kumar TS, Uzzafar F, Manjunatha N, Kumar CN, Gupta R, Math SB. An impact of a digitally driven primary care psychiatry program on the integration of psychiatric care in the general practice of primary care doctors. Indian Journal of Psychiatry. 2020 Nov;62(6):690. 8. Knowles M. Andragogy: An emerging technology for adult learning. London, UK. 1996. 9. Pahuja E, Santosh KT, Harshitha N, Manjunatha N, Gupta R, Kumar CN, Math SB, Chandra PS. Diploma in primary care psychiatry: An innovative digitally driven course for primary care doctors to integrate psychiatry in their general practice. Asian journal of psychiatry. 2020 Apr 23;52:102129-. 10. Kulkarni K, Adarsha AM, Parthasarathy R, Philip M, Shashidhara HN, Vinay B, Manjunatha N, Kumar CN, Math SB, Thirthalli J. Concurrent validity and interrater reliability of the “clinical schedules for primary care psychiatry”. Journal of neurosciences in rural practice. 2019 Jul;10(03):483-8. 11. Nie NH, Bent DH, Hull CH. SPSS: Statistical package for the social sciences. New York: McGraw-Hill; 1975. 12. Caulfield A, Vatansever D, Lambert G, et al WHO guidance on mental health training: a systematic review of the progress for nonspecialist health workers BMJ Open 2019;9:e024059. doi: 10.1136/ bmjopen-2018-024059 13. Pahuja E, Kumar S, Kumar A, Uzzafar F, Sarkar S, Manjunatha N, Balhara YP, Kumar CN, Math SB. Collaborative video consultations from tertiary care based telepsychiatrist to a remote primary care doctor to manage opioid substitution therapy clinic. Journal of Neurosciences in Rural Practice. 2020 Jul;11(03):498- 501. 14. Andrzej Wojtczak (2002) Glossary of medical education terms: Part 1, Medical Teacher, 24:2, 216- 219, DOI: 10.1080/01421590220120722 15. Malathesh BC, Bairy BK, Kumar CN, Nirisha PL, Gajera GV, Pandey P, Manjunatha N, Ganesh A, Mehrotra K, Bhaskarapillai B, Gunasekaran DM. Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India. Psychiatric Quarterly. 2021 Sep 12:1-2. 16. Linda Gask and Richard Morriss (1999). Training general practitioners in mental health skills. Epidemiologia ePsichiatria Sociale, 8, pp 79-84 doi:10.1017/S1121189X00007570 17. Fleury, MJ., Imboua, A., Aubé, D. et al. General practitioners' management of mental disorders: A rewarding practice with considerable obstacles. BMC Fam Pract 13, 19 (2012). https://doi. org/10.1186/1471-2296-13-19 | Indian J Psychiatry | 2022 | CORD-19 | |
| 1085 | IMPACT OF COVID-19 PANDEMIC IN PATIENTS WITH PRE-EXISTING MENTAL ILLNESS VISITING OUTPATIENT DEPARTMENT OF TERTIARY Healthcare CENTRE- A CROSS SECTIONAL OBSERVATIONAL STUDY BACKGROUND -: COVID-19 pandemic has had a negative impact on mental health. While there has been extensive work on the effect of pandemic on the mental health of the general population, studies on the impact of pandemic on people with mental illness are limited. AIMS-: The study aimed to ascertain Psychological impact of COVID-19 pandemic in patients with pre-existing mental illness and its correlation with clinical, socio-demographical factors. METHODOLOGY –: 100 participants aged 18-65 years, who visited Psychiatry OPD, were included. The psychological impact due to life stress was assessed using the Impact of Event Scale. Current Psycho-pathology was assessed by DASS-21 scale. The perceived loneliness and social isolation were assessed by De Jong Gierveld Loneliness Scale. RESULTS-: Out of 100 participants, 55% reported to have faced difficulties during pandemic, 64% reported worsening of mental illness, 40% faced difficulty in accessing medications, resulting in non-compliance. 61% managed to visit hospital during pandemic, while 35% could not access consultation services. Only 4% sought teleconsultation. Psychological impact of COVID was found to be positively correlated with the perceived loneliness and social isolation during quarantine(r=11.619, p=0.01). DISCUSSION-: These results depict a significant impact of COVID-19 pandemic on mental health patients with psychiatric illness that is exacerbated by social isolation. Quarantine and social distancing lead to elevated levels of loneliness and social isolation, which in turn produce repercussions on mental health. Also family dynamics and difficulty to access mental health care, appear to play a significant role. CONCLUSION-: These results highlight a significant impact of COVID-19 pandemic on mental health of psychiatric patients and elucidates prominent association with demographic factors and the difficulty to access mental health care. There is need to strengthen telepsychiatry services in recent times. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1086 | Professional Fulfillment and Burnout among Resident Doctors during second wave of COVID-19 pandemic RESULTS: • 152 residents participated in study; • 75 Males and 77 Females, Mean age - 29.6 years; • 67 (44.1%) married, 37 (24.3%) have children; • 71 (46.7%) stay with family; • 22.4% residents have some chronic illness; • 22.4% have family member with chronic illness; • Family members of 49.6% participants were Covid positive, 9.2% lost someone in close family; • 72 (47.4%) residents tested Covid positive, mostly during 2(nd) wave; • 94.7% were immunized with at least one dose; • 82.2% got adequate PPE during 2(nd) wave; • 68.4% believed significantly affected psychologically; • 11.8% sought psychological help; • 84.2% had Covid duty; • 43.4% worked in Covid only hospital; • 82.9% treated Covid patients directly; • 71.1 % continued seeing own specialty patients; • 54.6% participated in academics; • 84.9% Junior and 15.1% Senior residents; • Residents more likely to feel professionally fulfilled (PF); • Males, OR 2.6 (1.1 – 6.0); • Have children, OR 2.4 (1.0 – 5.6); • Residents more likely to have Burnout; • Who believe that pandemic significantly affected them psychologically, OR 3.4 (1.5 – 7.3); • With history of mental illness, OR 3.2 (1.0 – 9.8); • Residents less likely to have Burnout; • Living with family OR 0.5 (0.3 – 0.9); • Those participating in academics had higher PF scores p=0.04. DISCUSSION & CONCLUSION: • Low professional fulfilment among residents(2) • Burnout rates similar to previous studies(3,4) • The role of gender, children and family found in this study similar to previous studies(3) REFERENCES: 1. Trockel, M., Bohman, B., Lesure, et al (2018). Acad Psychiatry, (42), 11– 24; 2. Zhang, J.Q., Dong, J., Pardo, J. et al. (2021) Ann Surg Oncol 28, 6051– 6057; 3. IsHak WW, Lederer S, Carla Ros M er al (2009) J Grad Med Educ 1 December; 1 (2): 236–242; 4. Treluyer, L., Tourneux, P. (2021) Eur J Pediatr 180, 627–633. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1087 | Abstract for Paper Presentation:-: Title: Observational study of change in pattern of alcoholism amongst junior residents in a tertiary care hospital in India due to post COVID stress in comparison with pre-pandemic era BACKGROUND: Studies have shown higher alcohol consumption amongst doctors in period of psychological stress. Psychological stress including pandemic related stress may lead to problem drinking. A major brunt of this unprecedented situation of COVID 19 is faced by frontline physicians who are doing COVID 19 related duties relentlessly, leading to psychological distress among them. There is lack of study on the possible effects of COVID related stress and prevalence in alcoholism among junior doctors in India. AIMS: This prospective observational study conducted in a tertiary care hospital in India assesses whether there is any change in pattern of alcohol use during COVID pandemic among frontline junior residents and is there any relation of this change in alcohol use with perceived stress associated with COVID. METHODS: Junior residents who have fulfilled inclusion criteria and given informed consent are asked to fill online Google form on their alcohol use using WHO AUDIT (alcohol use disorder identification test) questionnaire. Their COVID related perceived stress is assessed using PSS-10-C scale. RESULTS: Among 60 junior residents assessed till now, AUDIT scores before and after pandemic were compared using chi square test with p value of 0.003 , indicating there is significant change in alcohol use levels between pre and post pandemic era. CONCLUSION: In this ongoing study, alcohol use is expected to increase significantly between the pre and post COVID era. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1088 | Professional Fulfillment and Burnout among Resident Doctors during Second Wave of COVID-19 Pandemic BACKGROUND: • Generally high level of burnout due to stress in resident doctors; • COVID pandemic resulted in disruption of everyday functioning of everyone including resident doctors; • Special COVID duties, increased work hours, PPE use and availability and disrupted academic calendar; • Likely to cause burnout among resident doctors and affect professional satisfaction. AIM: To study burnout and professional satisfaction among resident doctors in India during second wave of COVID pandemic METHODS: A pan India online cross-sectional study among resident doctors using Google forms Approval from Institutional Ethics Committee Semi structured proforma to asses demographics Stanford Professional Fulfilment Index for Professional Fulfilment and Burnout(1) | Indian J Psychiatry | 2022 | CORD-19 | |
| 1089 | Depression and Anxiety in inpatients of dedicated COVID-19 Hospital BACKGROUND: COVID-19 is a RNA virus predominantly involving lungs causing mild to severe respiratory illness. Psychiatric disorders are much common in COVID 19 pandemic including depression 33% prevalence and anxiety 28% prevalence in general population((1)). The interactions between immune systems and neurotransmitters((2)), neurotrophism((3)) and psychological stressors((4)) emerged as a mechanisms underpinning mood disorders, psychosis. However no studies are done in Indian population in estimating burden of Anxiety and depression in inpatients of dedicated COVID-19 hospital. AIMS: 1. To estimate the burden of depression and anxiety in COVID 19 positive patients in a tertiary hospital. 2. To evaluate its relationship with inflammatory markers. METHODS: Patients were screened during tele-couselling after taking verbal consent using GAD7 and PHQ-9 questionnaire to assess anxiety and depression. Patients were examined in the wards; those patients who fulfill diagnostic criteria for depression and anxiety according to ICD-10 were included. Routine inflammatory markers sent during admission were noted, patients are followed up during course of hospital stay, and treatment response was noted. RESULTS: Prevalence of depression is 13.6% and anxiety 17.8% in hospitalized patients with moderate to severe COVID 19 infection. Females suffered more for both anxiety and depression. Positively correlated with inflammatory markers especially serum LDH and baseline systemic immune inflammatory index (SII) which reflects immune response and systemic inflammation to infection. CONCLUSION: Programs should be designed to reduce the stress in general population in collaboration with mental health professionals. 1. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res. 2020 Sep;291:113190. doi: 10.1016/j.psychres.2020.113190. Epub 2020 Jun 7. PMID: 32563745; PMCID: PMC7276119. 2. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, Melloni EMT, Furlan R, Ciceri F, Rovere-Querini P; COVID-19 BioB Outpatient Clinic Study group, Benedetti F. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020 Oct;89:594-600. doi: 10.1016/j.bbi.2020.07.037. Epub 2020 Jul 30. PMID: 32738287; PMCID: PMC7390748. 3. Rogers J, Chesney E, Oliver D, Pollak T, McGuire P, Fusar-Poli P et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. The Lancet Psychiatry. 2020;7(7):611-627. 4. Choi EPH, Hui BPH, Wan EYF. Depression and Anxiety in Hong Kong during COVID-19. Int J Environ Res Public Health. 2020 May 25;17(10):3740. doi: 10.3390/ijerph17103740. PMID: 32466251; PMCID: PMC7277420. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1090 | Phenomology of delirium in patients with COVID-19 infection BACKGROUND: In patients with COVID-19, delirium may be presented as direct central nervous system invasion, activation of CNS inflammatory mediators, a secondary effect of other organ system failure, prolonged mechanical ventilation time, or environmental factors, including social isolation. AIM: To study the phenomenology of delirium in patients of COVID infection admitted in Intensive care unit of level 3 COVID hospital. METHODS: Forty five patients were included in this study all of whom were diagnosed COVID 19 infection and were admitted in ICU. They had been referred to the psychiatry department for assessment of delirium, and those who screened positive for the same were evaluated by applying delirium assessment instruments, such as the Confusion Assessment Method for the ICU (CAM-ICU), delirium rating scale-R-98 (DRS-R-98) and Richmond agitation sedation scale(RASS). RESULTS: The disturbance in sleep wake cycle(93.3%) was the most frequent and most severely affected symptoms of delirium and delusion(11.1%) was least common symptom of delirium. CONCLUSION: Delirium appears to be a sequele of events in patients with COVID 19.Although these constellation of symptoms do raise a question about whether the delirium seen in COVID-19 indicates simply a severe systemic illness or whether COVID 19 uniquely target subcortical structures. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1091 | A Cross-Sectional Study on The Correlation between Psychological Distress and Eating Behaviours of Young Adults During the Covid-19 Pandemic BACKGROUND: Since the onset of COVID-19 pandemic, an increasing level of anxiety, depression and stress are being reported along with a dramatic shift in daily routine, living and eating patterns of young individuals. AIMS: The study aimed to explore the associations between the psychosocial impact of the COVID 19 pandemic in India, depressive symptomatology, anxiety/stress levels and disordered eating behaviours among adults aged between 18-35years. METHODS: This was a community based, cross sectional study conducted during August 2021. An online survey was circulated, wherein 110 adults participated. Questions about socio-demographic, lifestyle and eating behaviours were asked. Coronavirus Impact Scale (CIS), Depression, Anxiety, Stress Scale (DASS-21) and Three Factor Eating Questionnaire Revised 18-item version (TFEQ-R18) were used. Pearson’s correlation analysis was used. RESULTS: A total of 101 valid responses were used for statistical analysis. 51% respondents reported mild change in daily routine while 49% reported stress and discord in their families due to the pandemic. Almost 10% of the respondents reported features suggestive of moderate depression and anxiety, while 1.9% reported bingeing on food almost every day in the past month. A positive association was observed between the scores of coronavirus impact scale and that of depression (r=0.366, p=0.000), anxiety (r=0.402, p=0.000), stress (r=0.416, p= 0.000) and uncontrolled eating (r=0.198, r=0.047). CONCLUSION: The COVID-19 pandemic has led to increasing psychological distress and also disordered eating patterns, particularly of bingeing types. Thus, screening of this age group for psychiatric disorders becomes important in order to formulate future targeted interventions. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1092 | Covid-19 Vaccine Hesitancy for Children in Parents: A Cross-Sectional Survey Among Healthcare Professionals in India AIMS AND OBJECTIVES: COVID Vaccine has been recently approved for children less than 18 years in India. Health care providers are consistently cited as the most important resource for vaccine information by ‘Vaccine Hesitant Parents ’VHPs, and provider recommendation for vaccination is crucial for improving vaccine uptake. So the study aims to assess in Healthcare professionals, the Prevalence of parental COVID-19 vaccine hesitancy and their knowledge, attitude, beliefs and perception towards paediatric COVID-19 vaccine. MATERIALS AND METHODS-: A cross-sectional study was conducted, using a Snowball Sampling Technique, through a self- designed web-based questionnaire among the Health-care Professionals having children less than 18 years of age across India after taking Ethics Approval. RESULTS: Prevalence of Hesitancy among health care professionals regarding pediatric COVID-19 vaccine is 3.3%. Significant correlation was seen between those who wanted to vaccinate their children and the ones who had taken vaccine themselves (p=0.00). The most important source of information was internet and social media (34.3%). About 90% of the participants were aware about the vaccine and knew about its side effects and contraindications. Majority of the people believed in usefulness of vaccine in preventing infection (p=0.008) and in reducing severity (p= 0.009). 90% of the people understood importance of vaccine and feel it is a need for community at large (p=0.00). DISCUSSION-: There is a reduction in hesitancy for Pediatric COVID-19 vaccine as compared to adult vaccine among HCWs as shown in other studies which shows increased trust and positive attitude and beliefs towards vaccine. CONCLUSION-: The prevalence of Vaccine Hesitancy was found to be 3.3%. Majority of the participants had positive beliefs and attitude towards pediatric COVID-19 Vaccine, thus can contribute towards Acceptance in community at large. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1093 | Referral pattern to Department Of Psychiatry during covid period in a covid 19 nodal center-A Descriptive study AIM: To study referral pattern to department of psychiatry during covid period in a covid-19 nodal centre. MATERIALS AND METHODS: STUDY TYPE – Descriptive study STUDY PERIOD – 6 months ( may 2020 to October 2020 ) All the individuals referred to department of psychiatry were covid positive. Reasons for referrals are documented and Psychiatric diagnosis was determined using ICD – 10 criteria. Those with depression were prescribed with SSRI’s, patients diagnosed with psychosis were given antipsychotics, symptomatic treatment given to patients with organic delirium. RESULTS: Out of 137 referrals 25.54% were diagnosed with Alcohol dependence syndrome with withdrawal symptoms, 21.89% were diagnosed with organic delirium, 18.24% were with psychosis, 5.83% are with depression, 1.45% were with acute stress reaction, 1.45% with deliberate self harm behaviour, 16.05% were with no disorder, 10.21% were with other disorders. CONCLUSION : During covid period the most common referral to department of psychiatry was altered behaviour and the most common psychiatric diagnosis was alcohol use disorder with withdrawal state. The majority of the patients were males (88). | Indian J Psychiatry | 2022 | CORD-19 | |
| 1094 | Role of meditation and yoga in treating Stress,Anxiety &Depression Many experts believes this undoubtedly that Panic is dangerous than pandemic. Fear, stress, anxiety, depression and obsession out of continuous panic state of mind would be more dangerous than the infection caused by covid19 corona virus during pandemic because if one member of a family is infected by infection than all other members of same family were found to be suffering from the stress and fear of being infected next. This situation give a clue that numbers of people having fear and panic of infection is more than sufferer of actual pandemic due to covid infection.During years 2019,2020,2021 pandemic and post covid pandemic periods , there were sudden raising pattern is seen in the psychological disorder noted worldwide as per the panelists of different organization and private research analysts. It has shaken every one from individual to institutes .Sudden application of break in the modern life style and prolong home bounded situation exacerbated the mental health issue beyond the expectation of experts. Pandemic has hampered the life style of all age group specially children ,adolescents and young who are captivated at home . Prolong sitting front of computer for school from home,work from home , different on line courses from home . This forced home living situation creating many psychological disorder among different age group .This is why application of yoga and mediation has raised in treatment of psychological disorder . Modern psychiatry is still far away from the application of ancient knowledge of yoga ,meditation and holistic understanding of human psychological nature its constitution and disorders . Therapeutic approach of meditation and yoga is only at surface level and need to be explored up to deep .Lack of deep knowledge and ignorance of same is the reason for that modern psychiatry is unable to provide the holistic approach for treating psychological disorder in comprehensive away . It has been got evident that yoga and meditation has helped many people who were kept in their houses for long time to stay healthy and to create mental well-being too .In this scientific paper application of knowledge,skill,approach,perception ,hidden intellect from ancient books on yoga sutra and meditation is done for treating different psychological disorders .Many experts either lack the idea or ignore to accept about different approaches written for treating differ psychological disorders in many books like swami Vivekananda translation of patanjali yoga sutra that’s written by by maharishi Patanjali 600bc , the Veda,the Upnishad ,The Bhagwat Gita and many more ancient books and ancient philosophy of yoga and meditation .By application of these skill , knowledge and perception and holistic approach towards the cessation of mental waves that common in mental disorder. As the modern age is the age of psychological disorders. Hence the holistic approach towards the study of human mind, its nature and disorders is the crucial need of the day. Efforts for this are going on in eastern as well as western countries. In western countries modern psychology developed as the branch of natural sciences is also trying to find out the solution for the problem at its own level. However due to its materialistic prejudices and single sided vision towards the human mind and nature it is unable to reach at the root cause of the problem and adopt the holistic approach for its therapy. Abstract for ANCIP2022 -BY DR.SANTOSH KUMAR PANDIT, Email-Panditsant79@gmail.com Mobile-7980309435. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1095 | Psychiatry Morbidity in Covid 19 Patients in A Tertiary Care Hospital-A Telepsychiatric Interview INTRODUCTION: COVID 19 possess a serious threat to the physical as well as the mental health.COVID 19 has negatively affected mental health and increased the incidence of psychological crisis.Historically, telepsychiatry has experienced a substantial evolutionary period with the expansion of the internet.The development of telepsychiatry will likely be viewed in the future in terms of the eras of before,during,and after COVID 19. AIM: To study the psychiatric morbidity in COVID affected patients through telepsychiatry. MATERIALS AND METHODS: This was a retrospective chart review of data collected from April 2020 to June 2021 through audio only telephone calls.The COVID positive and suspect COVID patients admitted in different wards and Intensive care unit at Kilpauk Medical College Hospital,Chennai were included in the study.All the patients were given Patient Health Questionnaire(PHQ-9) and Generalized Anxiety Disorder(GAD-7) by trained investigators.Appropriate statistical analysis done and results are obtained. The Results will be discusssed at the time of presentation. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1096 | Coping with continuing pandemic: Role of Social Psychiatry Proposal from the World Association of Social Psychiatry (WASP) Covid-19 pandemic has been an unprecedented crisis seen by the humanity in the last two years with a magnitude no less than the two world wars. Globally, more than 260 million cases have been reported and more than 5 million deaths have been attributed to Covid-19 till the end of November 2021. Despite introduction of the vaccine nearly a year ago, though there has been a big hope of controlling the pandemic, there have been repeated rises in infections due to the mutations in virus, like the coming of Delta, Delta plus and Omicron variants, which are increasingly infectious. There have already been two waves of the pandemic with the second wave being very lethal in India. The pandemic had both direct as well as indirect effects on mental health of the population across allover the world. Many countries had to resort to lockdowns to control the spread of infection, which had serious economic consequences, adding to the mental and social distress. Other infection control measures like quarantine and social isolation, and inability of the persons with existing mental illnesses to access treatment further added to the problem. Introduction of vaccine brought some hope, but it has been a great challenge to cover such a huge population with vaccine alongwith dealing with vaccine hesitancy. This symposium being proposed by the World Association of Social Psychiatry. The symposium will assess the current situation with focus on psychosocial aspects, social psychiatry approach used to deal with the mental health issues, challenges ahead and the lessons learnt to deal with any future challenges of similar nature. Chair: Rachid Bennegadi, President, WASP; Gautam Saha, President, IPS Proposer: Rakesh K Chadda Current situation - Roy Abraham Kallivayalil Social psychiatry approach - Debasish Basu Challenges ahead- Ramarao Gogineni Lessons learnt - Rakesh K Chadda | Indian J Psychiatry | 2022 | CORD-19 | |
| 1097 | When Life Meets Livelihood: Impact of Financial Stress on Psychological Wellbeing of Business Entrepreneurs and Salaried Individuals and the way Forward with Brief Structured Psychotherapy CONTEXT: The COVID-19 pandemic and the ensuing lockdown are affecting business entrepreneurs and service sector individuals emotionally and financially. AIMS: To assess financial stress and its impact on quality of life (QOL) and overall stress amongst business entrepreneurs and service employees. To explore the protective effects of existential thinking and positive coping styles and compare the efficacy of Acceptance and Commitment Therapy (ACT) and Cognitive Behaviour Therapy (CBT). SETTINGS AND DESIGN: 1000 businessmen and service employees between 18-60 years were included in this cross sectional, randomized group design comparative study. METHODS AND MATERIALS: Covid 19 Fear Scale, Perceived Stress Scale, Financial Stress Scale, WHO QOL Scale, Brief Cope, Existential Concern Questionnaire, Existential thinking Scale were administered. Forty people from each group were randomly allocated to weekly group sessions of ACT or CBT. STATISTICAL ANALYSIS: ANOVA, ANCOVA, Independent sample and paired t tests, Hierarchical correlation. RESULT: Financial stress was higher in businessmen. QOL was higher among serviceholders. Financial stress had positive association with Covid fear, low per capita income, avoidance coping. QOL had negative association with perceived stress, existential concerns. ACT was more effective than CBT. CONCLUSION: There is significant difference in financial stress and QOL between businessmen and serviceholders. Psychotherapy is an effective intervention. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1098 | The Use of Telepsychiatry during COVID-19: A Cross-sectional Study on Demographic and Clinical Profile of Those who Sought Help by Using this Facility AIM: We aimed to study the demographic and clinical profile of patients who sought teleconsultation for psychiatric disorders from august 2020 to January 2021. MATERIALS & METHODS: In this cross-sectional descriptive study, data was retrieved from the telepsychiatry services and was analyzed to examine the demographic and clinical parameters of patients. RESULTS: Atotal of 3444 teleconsultations were sought with a mean age of 37.78 ± 15.08. About 80% of the patients were in the age group of 20-60 years. Females outnumbered males with 1938 (56.3%) females and 1538 (43.7%) males. Mood disorders were the most frequent diagnosis with Major Depressive Disorder in 1572 (45.6%) and Bipolar Disorder in 636 (18.5%). Co-morbidity was present in 234 (6.8%) of the study group. The mean psychotropics prescribed were 1.95 ± 0.84. One, two, three and four psychotropics were prescribed in 918 (26.7%), 1470 (42.7%), 900 (26.1%) and 42 (1.2%) respectively. Those aged < 20 years or ≥ 60 years prescribed psychotropics at lower rates in comparison to the 20-60 years age group. Female patients had a significantly higher rate of psychotropic prescription than male patients. Three or four psychotropics were prescribed to those with co-morbidity at a significantly higher rate. CONCLUSION: Demographic and clinical profile of patients seeking treatment through telepsychiatry was found to be comparable with face-to-face outpatient consultations. CLINICAL SIGNIFICANCE: With the development of clinical, operational, legal, and ethical guidelines for telepsychiatry practice, the systematic application of Information and Communication Technologies to the practice of mental healthcare is being rapidly adopted. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1099 | Neuropsychiatric Aspects of COVID-19 BACKGROUND: COVID-19 pandemic has led to widespread psychosocial distress. In addition to pandemic associated psychological distress, there is increasing evidence to suggest direct effects of the COVID- 19 virus itself and the subsequent host immunologic response on Central Nervous System manifesting in the form of wide range of neuropsychiatric complications in both acute and post recovery phase. NEUROPSYCHIATRIC MANIFESTATIONS: The data available from similar epidemics of SARS and MERS CoV, revealed common neuropsychiatric manifestations including (a) Neurological: Headache, Impaired sensorium ranging from mild drowsiness to delirium and coma, dysfunction of olfaction and taste sensation, seizures, encephalitis, encephalopathy, Guillain-Barre syndrome (GBS), acute cerebrovascular events, narcolepsy and other neuromuscular and demyelinating processes (b) Psychiatric: Depressed mood, anxiety, impaired memory and insomnia in acute phase and even in post-illness stage, depressed mood, insomnia, anxiety, irritability, memory impairment, fatigue, traumatic memories and sleep disorder were frequently reported. A diverse group of presentations, increasingly referred to as “long Covid,” is also being described in patients who reported with wide variety of symptoms including disabling fatigue and cognitive difficulties, persisting for many months after acute infection. PSYCHONEUROIMMUNOLOGY OF COVID-19: Though exact neurotropism of SARS-CoV-2 is unknown , the present available data based on laboratory studies on SARS-CoV-2 and research on its taxonomically similar coronaviruses such as SARS-COV and MERS-COV suggest its potential to enter the CNS via angiotensin converting enzyme 2 receptors. Other mechanisms causing CNS dysfunction include cytokine driven inflammatory responses and wider systemic effects such as endotheliopathy, breakdown of the blood-brain barrier, and clotting abnormalities. Additional mechanisms for neuropsychiatric disorders include autoimmunity and psychological trauma of life threatening illness and pandemic related socioeconomic stressors. The relative contributions of these mechanisms to neuropsychiatric sequelae remain largely unknown. ROLE OF PSYCHIATRIST: Psychiatrist has an important role in not only managing concerns, fears, and misconceptions at the local community and broader public level but also in early identification, prevention, and treatment of COVID-19 related neuropsychiatric manifestations, and hence should be an integral part of COVID-19 treating team. MANAGEMENT: The management of neuropsychiatric complications of COVID requires a multidisciplinary team input due to the multisystemic nature of the illness, particularly in severe cases. Adopting bio-psychosocial strategies and judicious use of psychotropic medications is essential for better results. CONCLUSION: Covid-19 is likely to have important neuropsychiatric effects in both the short and longer term. Although the mechanisms to neuropsychiatric complications is still under study, the better understanding will not only augment screening of at-risk individuals but also help in prevention and management of these neuropsychiatric complications. | Indian J Psychiatry | 2022 | CORD-19 | |
| 1100 | Psychiatric co morbidity in patients being treated for COVID-19: A cross-sectional study in India BACKGROUND: COVID-19 pandemic has become one of the central health crises of a generation and has affected people of all nations, continents, races, and socioeconomic groups. No matter how much resources are put aside, the patient are vulnerable to develop psychological and sleep problems due to covid as there is no specific management for covid 19 infection. There could be multiple causes of mental health issues in COVID-19 , ranging from stigma, hospitalization, uncertainty about prognosis, media created fear, lack of social/family support, loneliness, and even feeling of not having last right/rituals after death. AIM: To determine mental health issues among patients being treated for COVID-19 infection. METHODS : A random sample of COVID 19 in Era medical college was examined using a cross-sectional design(n=200).Depression was measured using the Patient Health Questionnaire(PHQ-9).Anxiety was assessed using the Beck Anxiety Inventory(BAI).Sleep was evaluated using the Insomnia Severity Index(ISI). RESULTS: 31% of patients were having moderate anxiety symptoms.20% reported of mild depression whereas 62.5% had subthreshold insomnia. CONCLUSION: COVID-19 has devastating effects within the short time and cause increase in mental health problems in Covid 19 patients. We should learn from this experience that in future, in such exigencies, the mental health services should be geared up to adapt to the emerging situation. | Indian J Psychiatry | 2022 | CORD-19 |
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