Eating behaviours, social media usage, and its association: A cross-sectional study in Indian medical undergraduates.

Background: Despite increasing incidence, there is little data on abnormal eating behaviours or disorders in Indian youth, especially medical students. Additionally, little literature exists measuring the association of social media use with abnormal eating behaviours. Aim: To assess the prevalence of abnormal eating behaviours amongst medical students, social media usage, and any association of social media usage with eating behaviours. Materials and Methods: An online cross-sectional questionnaire-based study was conducted with 272 participants at a medical college, and two scales: the Three-Factor Eating Questionnaire-Revised 21items (TFEQ-R21) and the Scale of Effects of social media on Eating Behaviour (SESMEB) were used. Results: 22% of the participants reported abnormal eating behaviours. A significant difference in the effect of social media on eating behaviour according to the year of study [f = 3.08, P = 0.02] was seen with the final years having the lowest and the first years having the highest SESMEB scores. Students using more than 4 social media platforms had a higher SESMEB score [t = -2.02, P < 0.04]. A positive correlation was seen between TFEQ domains such as uncontrolled eating [r = 0.38, P = 0.01], emotional eating [r = 0.30, P = 0.01], and TFEQ total score [r = 0.40, P = 0.01] with SESMEB scores. Conclusion: This study finds a significant correlation between increased social media usage and developing abnormal eating behaviours in medical students. It highlights the need for the creation of policies regulating social media use with eating behaviours in mind.

A study on impostor phenomenon, personality, and self-esteem of medical undergraduates and interns.

Introduction: Impostor phenomenon (IP) is a psychological experience where an individual considers their achievements to be fraudulent. IP in medical professionals is of paramount importance since it affects their self-confidence and communication skills. It has been associated with burnouts, low self-esteem, and neuroticism. Aim: This research aimed to study the prevalence of IP, personality traits, and self-esteem and to look at gender differences in medical undergraduate students and interns of an urban medical college along with the correlation of IP with personality traits and self-esteem in them. Methodology: An online survey via Google Groups was conducted among MBBS students and interns of a medical college after informed consent and ethics approval were received. Four hundred sixteen participants completed the survey questionnaire which included demographic variables along with the the Clance Impostor Phenomenon Scale, the Big Five Inventory, and the Rosenberg Self-Esteem Scale. Results: IP was found in 236 (56.7%) students and interns. Personality domain mean scores were extraversion (26.4 ± 5.12), agreeableness (33.5 ± 5.4), conscientiousness (29.9 ± 5.7), neuroticism (21.6 ± 5.7), and openness (35.1 ± 4.9). The self-esteem mean score was 18.37 ± 6.14; only 16.11% had high self-esteem. Interns and first-year MBBS students scored higher on IP and low on self-esteem among all groups. Significant gender differences were seen in females on agreeableness, conscientiousness, and neuroticism as compared to the males. IP negatively correlated with self-esteem, extraversion, agreeableness, and conscientiousness and positively with neuroticism. Conclusion: This study throws some light on the IP experiences of medical undergraduates which have not been extensively researched in India.

Online teaching, learning, and health outcomes: Impact on medical undergraduate students.

Background: Online education has become a norm since the pandemic and it was a complete change for the medical curriculum. Many students missed patient interaction, which was a crucial part of their learning. Aim: This study was designed to know the perceptions of online teaching of both the non-competency-based medical education (non-CBME) and competency-based medical education (CBME) curriculum during the coronavirus disease 2019 (COVID-19) pandemic, learning outcomes, and health-related problems due to online teaching-learning in medical undergraduates. Materials and Methods: It was an online survey done after ethics approval. The survey questionnaire was sent to all medical undergraduates via email or WhatsApp and responses were recorded after informed consent. The total number of students who completed the survey was 346. Results: 66% of students found that online classes were not as enjoyable as offline. 66% found them time-saving with learning at their own pace. 85% felt they learned no clinical skills, and 80.6% said there was a lack of practical demonstrations. 71% experienced digital fatigue, 62% missed learning in a group, and 73% felt the poor motivation to study. Only 30% and 18.7% were confident enough to take a history or do an examination of the patient, respectively, after online clinics. 33% were confident to appear for university theory and only 11% for practical exams. The health problems faced due to online teaching included somatic complaints, sleep disturbances anxiety, and depressive symptoms in 40% of students. Conclusions: The students were dissatisfied with online teaching. Learning outcomes were affected, as they were not confident to appear for university exams. Hence, though teaching happened during the pandemic, the online education imparted revealed lacunae and health effects.

Depression, body image and quality of life in acne scars.

Background: Acne scars commonly occur in almost 95% of adolescents having acne. Depression and the psychosocial impact of acne have been studied by previous researchers but there are few studies on acne scar patients. Objectives: To study the prevalence of depression, body image, and quality of life in patients with acne scars and the correlation of depression with body image and quality of life. Material and Methods: Around 81 patients above 18 years of age clinically diagnosed as having different grades of acne by a dermatologist were assessed for depression using Becks Depression Inventory, Body image concern inventory, and Dermatology Life Quality Index and included in the study after being informed consent. Results: The mean duration of acne was 6.03 ± 2.9 years, and acne scar was 2.88 ± 1.2 years. Nearly 93% of our sample had an equal preponderance of Grade 1 and Grade 2 acne scars. 31 (38.27%) patients had clinical depression with a total mean BDI score of 16.8 ± 9.7. 15 (18.5%) and 7 (8.6%) patients had moderate and severe depression respectively. Only 5 (6.17%) patients reported significant body image disturbances. All patients reported a very large effect on the quality of life due to flaws in facial appearance leading to feelings of embarrassment and impairment in sexual activities. Depression was significantly associated with grade 1 and 2 scars, body image disturbances, and quality of life. Conclusions: There is a high prevalence of depression in patients with acne scarring which needs to be detected and treated. Liaison with a psychiatrist would improve the outcome.

A rare case of acrogeria, Gottron type with borderline personality disorder.

Acrogeria is a rare disorder that is characterized by premature aging of the distal extremities. It was first described by Gottron in 1941. Only about 50 cases have yet been reported worldwide. It is diagnosed clinically, and patients have a normal life expectancy. The disorder is seen from birth and could have an autosomal dominant or recessive inheritance. The classic features include a characteristic pinched face, thin lips, fine hair, skeletal defects, and thin, taut parchment-like skin of the extremities. We describe a case of Acrogeria, Gottron type, who also had a borderline personality disorder. However, there is very little information on the prevalence of psychopathology in patients having syndromes of premature aging.

Management of Psychiatric Disorders in Patients with Endocrine Disorders.

The neuropsychiatric symptoms and disorders among endocrine disorders are discussed in the context of current global and local epidemiological data. Neuropsychiatric symptoms, clinical differentials in hypothyroidism, hyperthyroidism, and parathyroid disorders, and relevant management protocols are described. HPT axis and its interaction with psychotropic usage are mentioned. Stress diathesis, depression, anxiety disorders, and severe mental illnesses and their respective association with diabetes, the relevant mechanisms, and management protocols are stated. The metabolic syndrome, its definition, and its relationship to psychotropic usage are laid out. Moreso, best clinical practices for scenarios such as hyperprolactinemia and psychiatric illnesses, and steroid-induced psychosis are mentioned.

How Common are Depressive-Anxiety States, Body Image Concerns and Low Self-Esteem in Patients of PCOS?

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age with increased incidence of emotional disturbances and other psychopathology. We undertook this research to study the prevalence and severity of depression and anxiety as well as understand body image disturbances and self-esteem of the women of PCOS. We studied the relationship of depressive symptoms with self-esteem and body image disturbances. METHOD: A total of 105 patients diagnosed as PCOS were recruited from gynecology OPD after informed consent and ethics approval. A proforma along with Beck's Depression Inventory, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Body Image Concern Inventory and Rosenberg' s Self-Esteem Scale were administered to patients for further assessment. RESULTS: In total, 54 (51.43%) patients of PCOS had depression on BDI, 12( 11.43%) patients had body image disturbances an d 23 (21.90%) patients had a low self-esteem. A total of 21 patients( 20%) had mild and moderate depression while 5% had severe depression. Majority 53 (50.48%) of our patients had mild anxiety whereas severe to extreme anxiety was seen in about 31% of patients. Body image disturbances were seen in only 12(11.43%) patients and low self-esteem was present in 23 patients. No statistically significant correlation of depression was seen with body image or self-esteem. CONCLUSIONS: The results of this study indicate that there is a high prevalence of depression and anxiety in patients of PCOS than body image concerns and low self-esteem. Prognosis for patients would improve by liaison between gynecologist and psychiatrist.

A Retrospective Analysis of Psychiatric Presurgical Evaluation of Children and Adolescents Evaluated for Epilepsy Surgery in a Comprehensive Epilepsy Care Unit of Mumbai.

Background Epilepsy being one of the most prevalent neurological diseases in children is associated with psychopathology and academic concerns. Epilepsy surgery is considered for refractory epilepsy at some centers in India and hence this study was undertaken to find out prevalence and type of psychopathology in children and adolescents with refractory epilepsy before epilepsy surgery. Methods All data were analyzed from the records of patients undergoing preepilepsy surgery protocol workup in comprehensive center of epilepsy care at a general municipal hospital in Mumbai. A record of 150 children and adolescents in the age group of 3 to 18 years over a period of 10 years was taken and all details of demographics, epilepsy, and psychopathology were recorded. Results The mean age for our sample was 11.4 ± 3.4 years and a male preponderance was seen. Majority (80%) of the children were pursuing education. The duration of seizure disorder was approximately 4.41 + 2.36 years and complex partial seizures were seen commonly in 50% of the children. Both magnetic resonance imaging (MRI) and video electroencephalography (VEEG) findings revealed right sided lateralization followed by left in majority of the patients. Psychopathology was seen in 70 (46%) patients with mental retardation, hyperkinetic disorders affecting attention and activity and oppositional defiant disorder, and unspecified mental disorder due to underlying brain damage being the type of International Classification of Disease-10th Revision (ICD-10) disorders seen. Patients with psychopathology showed a left-sided predominance on their MRI and VEEG findings for laterality of the epileptogenic focus as compared with right side. Conclusion Refractory seizures and associated psychopathology impact family life, friendships, and academics and worsen prognosis and quality of life. Screening for psychopathology in children with epilepsy would therefore lead to better outcomes especially prior to epilepsy surgery.

Clinical manifestations and cultural correlates of psychogenic nonepileptic seizure symptoms: An Indian perspective.

Introduction: Patients with psychogenic nonepileptic seizures (PNES) tend to have more frequent and disabling seizures than those which true epilepsy and are often misdiagnosed as epilepsy due to lack of clear diagnostic criteria and variations in clinical semiology. This study was an attempt to improve the understanding and type of clinical manifestations seen in patients of PNES and the cultural beliefs regarding their symptoms. Materials and Methods: In this cross-sectional observational study, 71 patients diagnosed with PNES by neurologists on the basis of their clinical presentation and a two hours normal VEEG recording were enrolled in the study after ethics approval. The clinical manifestations of PNES were recorded in detail along with details of various cultural attributions of the patients to the symptoms which were recorded in open- and closed-ended questions. Results: Clinical manifestations included verbal unresponsiveness (74%), whole body rigidity (72%), upper limb (55%) and lower limb movements (39%), vocalizations and head movements in less than 25%, and automatisms in only 6 patients. Pelvic thrusting as a manifestation was seen in only one patient. Thirty-eight patients attributed their symptoms to being possessed by God/ghost/evil spirit; nine to black magic being done on them; twenty-four patients did not relate symptoms to religious beliefs. Sixty-two patients had visited faith healers. Conclusions: This study is the first of its kind which looks at various clinical presentations of PNES patients in order to assess if there is any cultural basis for the symptoms.

Gender Issues in the Care of Elderly: A Narrative Review.

Aging is an inevitable physiological process. A significant increase has been noted in the elderly population over the years. Aging population face challenges with physical health conditions, but also mental health problems. Care of the elderly is influenced by health conditions, health services, as well socio cultural factors. Gender plays an important role in the aging process with significant differences noted in the aging process, variations in health conditions as well care received. The current review addresses the role of gender in the aging process and its influence in the prevalence, clinical presentation and course of various mental and physical health conditions in the elderly. The review identifies gaps in understanding the gender perspectives related to long-term elderly care, legal and financial issues. The review emphasizes the necessity to address the gender perspective in aging to adequately meet the health demands of the elderly.

Psychiatric Sequelae and COVID Experiences of Post COVID -19 Recovered Resident Doctors and Interns of a Tertiary General Hospital in Mumbai.

Background: The wide and profound psychological impact of the COVID pandemic on people has been demonstrated by several studies. A survey from the Indian Medical Association (IMA) showed that at least 500 doctors have been infected across Maharashtra, with Mumbai doctors making it to the top of the list. The most infected are the resident doctors working in government hospitals. A few doctors also have lost their lives while working in this pandemic. The delicate balance between duty, altruism and fear for oneself and others often causes conflict and feelings of helplessness and dissonance in many health care personnel with a fear to resume back the duty, especially after being a COVID victim. There have been hardly any studies yet, related to understanding the emotional and general well being of COVID-19 positive health care workers who have recovered and resumed their duties. Aims and Objectives: To study in post COVID-19 recovered resident doctors and interns the presence of anxiety and depressive symptoms, sleep changes, general well-being, perceptions of their COVID experience and association of general wellbeing with anxiety, depression and sleep changes. Methods: The study was conducted after institutional ethics committee permission and online informed consent from the participants which included medical interns and resident doctors of our institute. A Google form with questions and scales pertaining to the aims of the study (Patient Health Questionnaire, Zung Self Rating Anxiety Scale, Warwick Edinburgh Mental Well Being Scale and Insomnia Symptom Questionnaire) was sent on the Google link to the 150 interns and resident doctors via whatsapp who had recovered from COVID 19 infection. Their details were taken from hospital database with Dean permission. Results: 79 responded to the link with the mean duration of COVID infection being 16.1 ± 8.59 days. 64 participants were hospitalized and 18 participants had lung parenchymal involvement. 28 participants had depressive symptoms on the patient health questionnaire. Only 4 participants experienced anxiety as per Zung self rating anxiety scale. 69 participants had greater well being with scores higher than 40 on the Warwick Edinburgh mental well being scale. 8 participants had sleep related issues affecting their work. A negative correlation of general well being was seen with depression, anxiety and insomnia which was highly significant. The most distressing of COVID experiences were being isolated in a room, transmitting disease to near and dear ones and possibility of a serious complication. Re infection, workload followed by use of PPE was the major concern.Many described their COVID experience as boring, depressing with feelings of loneliness. Conclusions: Our study is the first of its kind to evaluate the psychiatric sequelae and COVID experiences of post COVID-19 recovered resident doctors and interns. Psychosocial and institutional support will definitely help in improving the post COVID sequelae in the resident doctors and interns.

Dissociation, Stressors, and Coping in Patients of Psychogenic Nonepileptic Seizures.

BACKGROUND: Psychogenic nonepileptic seizures (PNES) commonly present both to neurologists and psychiatrists and include a wide range of psychopathology. In order to understand the demographics, dissociative experiences, stressful life events, abuse, and coping in these patients, this study was undertaken. METHODS: This was a cross-sectional, observational study. A total of 71 patients of PNES, referred from neurology, were assessed on Dissociative Experience Scale (DES), Scale For Trauma and Abuse, Presumptive Stressful Life Events Scale (PSLES), and Ways of Coping Questionnaire to ascertain the dissociative experiences; the prevalence of trauma, abuse, and stressful life events, and the coping mechanisms. RESULTS: Females predominated, with the duration of PNES up to 2 years. The mean ± SD total DES score was 38.14 ± 14.1, indicating high dissociation. On the PSLES, for the stressful life events in the last one year, the mean score was 98.28 ± 87.1. Marital and family conflicts and death were reported more. History of childhood or adult physical and sexual abuse was less reported. History of head trauma was present in 13 patients. Emotion-focused coping was used more than problem-solving strategies. CONCLUSIONS: Very few Indian studies have looked into these nuances. This study has helped in improving the understanding of the various risk factors of PNES and the coping strategies, and in sensitizing psychiatrists and neurologists to enquire into trauma and abuse of these patients.

Gender Differences in Depression, Coping, Stigma, and Quality of Life in Patients of Vitiligo.

Though vitiligo is one of the psychodermatological disorders which do not cause direct physical impairment, it is cosmetically disfiguring leading to serious psychological problems in daily life. We undertook this research to study patients of vitiligo the prevalence of depression, coping, stigma, and quality of life and comparison of the same in both genders. Patients diagnosed clinically as having vitiligo by consultant dermatologist were enrolled after informed consent and ethics approval. 156 patients were screened, of which 100 satisfying criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of Beck's depression inventory, participation scale, dermatology life quality index, and adjustment to chronic skin diseases questionnaire. Depression prevalence was 63.64% in females and 42.86% in males (p<0.0457); the total mean BDI scores were significant with females having higher scores than males (p<0.0083). No significant differences were seen on participation scale though 52% females felt stigmatized as compared to 45% males (p <0.5779). While almost 97% of our patients had impaired quality of life there was no significant difference in both genders on the total score (p<0.3547). Females had significantly higher faulty coping style than males with significant differences on all domains and total scores (p< 0.0094). There was a strong association of depression with faulty coping and stigma (p< 0.0001) in both genders. Also association of stigma with quality of life showed highly significant findings in both genders (p< 0.0001) on all the domains of DLQI. This study helps in early identification of psychological problems in vitiligo patients and planning their future course of management, hence improving the prognosis and quality of life.

A prospective study on sexual dysfunctions in depressed males and the response to treatment.

BACKGROUND: Sexual dysfunctions are common in depression but are often underreported and the misconceptions about sexual functioning are highly prevalent. Medications used to treat depression can also cause impairments in sexual functioning. Hence, we decided to study the prevalence and types of problems in sexual functioning, sexual myths, and misconceptions in depressed males and compare it with the general population, along with the changes in depression and sexual functioning after treatment with escitalopram. MATERIALS AND METHODS: A total of 56 depressed males diagnosed as per the International Classification of Diseases 10 criteria and 60 males from the general population were recruited after their informed consent. Beck Depression Inventory, the Arizona Sexual Experiences Scale, the International Index of Erectile Functioning, and a questionnaire to assess myths and misconceptions were used for assessment. The patient group was treated with escitalopram and all the above scales were re-administered after 6 weeks. RESULTS: Most of the patients had mild-to-moderate grades of depression. Sexual dysfunctions were seen in 62.5% of the patient group. Significant differences were seen with decreased sexual desire, orgasmic problems, and overall dissatisfaction in the patient group. Depression was found to be significantly associated with sexual functioning. Myths about masturbation and penile size and shape were higher in the depressed population. After treatment with escitalopram, there was an improvement in depression and satisfaction with intercourse and overall sexual life. CONCLUSIONS: Mental health-care professionals, must inquire regarding sexual functioning sensitively, ensure that they psycho-educate those with misconceptions, and be watchful for changes in sexual functioning when they prescribe antidepressants.

A Study on Psychiatric Disorders, Body Image Disturbances, and Self-Esteem in Patients of Cushing's Disease.

BACKGROUND: Cushing's disease (CD) is a rare endocrine disorder associated with increased serum levels of cortisol secreted due to an underlying tumour in pituitary. Psychiatric disturbances like depression, psychosis, mania along with body image disturbances are seen in patients of CD. Hence, we undertook this research to find the prevalence and type of psychiatric disorders, body image disturbances, and self-esteem in patients of CD. MATERIALS AND METHODS: Thirty-five patients diagnosed as CD as per the standard criteria by the endocrinologist were recruited after informed consent and ethics approval. Proforma with demographic details, Structured Clinical Interview for DSM-IV, Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale, and Body Image Concern Inventory were used for assessment of the aims. RESULTS: 65% patients had psychopathology with 21% patients having major depressive disorder, 62% patients had mild, and 28% had moderate depression on BDI. 50% patients had body image disturbances and 60% had low self-esteem. Depression was found to have a negative correlation with self-esteem and positive correlation with body image disturbances. CONCLUSION: A high prevalence of psychopathology is seen in patients of CD which may often go undetected. Liaison with the endocrinologist would also work towards improving the issues of body image disturbances and self-esteem for better prognosis for the patient.

Memory outcomes in mesial temporal lobe epilepsy surgery.

INTRODUCTION: Decline in verbal memory after dominant mesial temporal lobe surgery is a concern. Outcomes primarily reported by group data analysis do not address issues of practice effects and measurement errors and also do not provide information about individual meaningful change after surgery. Reliable Change Indices (RCI's) are regarded to be robust statistical methods for reporting individual change and have not been hitherto derived in patient populations in India. AIM: Report memory outcomes for patients after surgery using group data as well as RCI score analyses using RCI scores derived in a control patient population. METHOD: Retrospective data analysis of 106 selected patients who underwent Anterior Temporal Lobectomy (ATL) surgery. RCI scores derived from a control group of 44 non-operated patients. Outcomes based on score shifts on the various measures of two verbal and visual memory tests. RESULTS: Group mean score analysis revealed no significant shifts in verbal or visual memory scores after left ATL, but significant improvements in verbal memory after right ATL. RCI score analysis revealed decline and improvements in a small percentage of patients for both left and right ATL groups. Percentage of patients showing decline was much less than reported in western literature although percentage improved was comparable. DISCUSSION: Differences in decline percentage may be due to RCI scores and clinical characteristics of our sample (impaired pre-operative functioning, majority seizure free post surgery, moderate hippocampal sclerosis, early onset, long duration of seizures). CONCLUSION: Group analyses mask individual change. Therefore, to report memory outcomes and counsel patients about relative risk-benefits of surgery, RCI scores derived from our patient populations should be used.

Is psychiatric assessment essential for better epilepsy surgery outcomes?

Epilepsy surgery is one of the most accepted and beneficial treatment for resistant epilepsies. However there is some variability in the comprehensive epilepsy care programs offered globally. Many centers do not do a psychiatric assessment unless required. It is now evident from a large body of research that epilepsy is associated with psychiatric morbidity which is also seen in patients considered for epilepsy surgery. There is also evidence to state that the risk for worsening or de novo psychiatric disorders is often seen post surgery. This calls for a comprehensive psychiatric assessment of all patients enrolled for the epilepsy surgery program to be evaluated pre and post surgically to minimize the risk of post surgical psychological disturbances and/or poor quality of life. Efficacious treatment of psychiatric disorders in those having psychiatric morbidity contributes to improved patient wellbeing, seizure freedom and better quality of life. Hence there is a need for most centers globally to include regular psychiatric assessment of epilepsy surgery patients as a protocol.

Delusional parasitosis with folie à deux: A case series.

Delusional parasitosis (DP) is characterized by single hypochondriacal delusion in which patient feels he/she is infested with insects. The authors present a case series of three cases of DP with shared psychotic disorder (folie à deux) in which one individual developed a delusional belief in the context of a close relationship with another person or people who already had an established delusional idea. All patients of DP were assessed in the outpatient department of Psychiatry of a tertiary care hospital. Diagnosis of DP was made on detail clinical history and supporting clinical findings. All our primary cases had DP and the accompanying relatives of our patients had folie à deux as they shared the belief of parasite infestation which was firm and persisted despite evidence to the contrary. The primary cases of delusional parasitosis responded well to oral risperidone. The intensity of the belief in the secondary person also reduced with improvement in the symptoms of the patients.