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 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.

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.

Neuroleptic malignant syndrome in cycloserine-induced psychosis.

A 33-year-old multidrug-resistant tuberculosis female patient diagnosed as cycloserine-induced psychosis developed several neuroleptic side effects such as extrapyramidal reaction, neuroleptic malignant syndrome, and drug-induced parkinsonism while she was being treated with initially haloperidol and then olanzapine over a period of 2 months. Patient's antipsychotic medications were withdrawn, and treatment with bromocriptine showed prompt recovery. The multiple neurological adverse effects which the patient developed had implications on the management of the complications as well as her illness.

A study of depression and quality of life in patients of lichen planus.

The precise cause of lichen planus is unknown, but the disease seems to be immunologically mediated. It is a psychocutaneous disorder. Due to scarcity of Indian studies in this field, we decided to study in patients of lichen planus the prevalence of depression and quality of life with comparison of the same in both the genders. Patients diagnosed as having lichen planus by consultant dermatologist were enrolled after informed consent and ethics approval. 45 patients were screened, of which 35 who satisfied the criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of dermatology life quality index and Beck's depression inventory. While 25% were depressed with females being more affected than males, quality of life was impaired in more than 90% patients. Impairment was maximum due to symptoms and illness feelings, disturbed daily activities, or work and time consumption in treatment. There was a strong association between depression and impairment in quality of life in both the genders. This study helps in early identification of psychological problems in lichen planus patients and in planning their future course of management, hence reducing the lack of productivity and improving the prognosis and quality of life.

Psychiatric morbidity in refractory mesial temporal lobe epilepsy before and after epilepsy surgery

Background & Objective: Psychiatric disorders constitute a large part of illness burden in patients with refractory epilepsy. A careful presurgical psychiatric assessment is now an integral part of evaluation in most centers performing surgeries for refractory epilepsy. This study was undertaken to determine the prevalence of psychiatric disorders and outcome of the psychopathology in patients of refractory mesial temporal lobe epilepsy (mTLE) before and after epilepsy surgery. Method: Forty eight patients diagnosed as having refractory mTLE by the Neurologists were included in the study. The patients were assessed using the Brief Psychiatric Rating Scale (BPRS), Beck’s Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) before surgery as well as in the second and sixth month of postoperative period. Results: More than half of the patients (54%) had psychopathology. Depressive disorders were more common. Lateralisation of focus in MTS and psychopathology in the patient revealed equal right and left preponderance. No significant difference was found on BPRS, BDI and HDRS scales at 2 and 6 months follow up post epilepsy surgery in patients having psychopathology. Conclusions: Patients had a favourable outcome after surgery as regards to their psychopathology as well as the seizures.

Understanding family functioning and social support in unremitting schizophrenia: A study in India.

CONTEXT: This study aimed to clarify the difference in the perception of family functioning and social support by the schizophrenic patients and their principal caretakers, and whether the social support is related to healthy family functioning. SETTING AND DESIGN: The study was set in the psychiatric outpatient department of a tertiary care hospital and data was collected by means of a semi-structured interview. MATERIALS AND METHODS: Fifty unremitting schizophrenics diagnosed by diagnostic and statistical manual (DSM)-IV criteria and their family members were interviewed. Family functioning was assessed by the family assessment device (FAD) and the social support was assessed by the multidimensional scale of perceived social support (MSPSS). STATISTICAL ANALYSIS: Group differences were analyzed using unpaired 't' test for comparison of FAD and MSPSS means and subscale scores. Pearson's correlation coefficient was used to find the direction and magnitude of association between the various dimensions (subscales) of FAD and the social support from family. RESULTS: Schizophrenic patients had more difficulty on problem solving as compared to their relatives, while no significant differences were noted on the other dimensions of FAD in the two groups. Also, schizophrenics perceived more social support from friends than from their families. All the dimensions of the family functioning correlated to the social support perceived from the family in the schizophrenic patients. CONCLUSIONS: Our study highlights the need to study the issues of perception of family functioning and social support so as to improve the prognosis in a disabling disorder like schizophrenia. Providing better social support and understanding the family functioning will result in strengthening the family as a unit, so as to provide better care to the patient.

Isolated sleep paralysis.

Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months.