Disenfranchised grief and Covid-19: How do we make it less painful?

The devastating effects of death due to Covid-19 on the bereaved are not adequately addressed. The grief associated with death during the Covid-19 pandemic is disenfranchised and complicated and has significant repercussions on the bereaved. The lockdown, social distancing norms, isolation due to disease or quarantine and infectivity of the disease, place restrictions on the traditional mourning practices. Misconceptions also play a role. Dignity and ethics are frequently breached, perhaps inadvertently. This can lead to serious mental and physical health consequences. We explore the complexities and suggest measures for acknowledging the grief and making it less painful. Pragmatic suggestions to avoid emotional distancing and to uphold the dignity and rights of the deceased and the bereaved are highlighted with examples which can be emulated.

Profile of students referred for the assessment of scholastic backwardness at a tertiary care center.

BACKGROUND: Scholastic backwardness (SB) is a challenging problem affecting school-going children. Students seeking evaluation and certification of SB, especially in class nine and ten are on a rising trend in Kerala, the most literate state in India. However, there is a paucity of research regarding this. OBJECTIVES: The objectives of this study are to determine the clinical, sociodemographic, and academic profile of students referred with "difficulty in academics" in the psychiatry department of a government teaching hospital in Kerala. MATERIALS AND METHODS: A retrospective chart review of students aged 6-16 years, referred to clinical psychologist for the structured assessment of SB, after evaluation by psychiatrists, over 1 year was done. RESULTS: Overall, 207 students were assessed. Children aged 13-16 years were the majority (61.4%). Most of them were males (61.4%) and from rural background (81.6%). Majority (60%) was from high school and 22% of students were in class 10. Previous assessments for SB were done only in 20% of high school students. About 97% belonged to state syllabus, 90% were in Malayalam medium, and 93.3% were referred by teachers. The principal diagnosis was "slow learners" (34.8%) followed by intellectual disability (28%). About 11.6% had specific learning disorder (SLD), 15.5% had other neurodevelopmental, behavioral, and emotional disorders/problems, and 10% had no diagnosis. CONCLUSION: Varying degrees of intellectual impairment was the main cause of SB; majority was in high school and was never evaluated for SB. There was over-representation of class 10 students for first-ever assessment. Students with SB were identified and referred late for professional services. Those with SLD and nil diagnosis were similar in number probably reflecting an attempt to pass board exams by availing the benefits of certification. Designing curriculum and assessment to suit the differing intellectual levels of students are, therefore, recommended.

Quality of life of patients with schizophrenia and chronic obstructive pulmonary disease: An observational study.

BACKGROUND: Quality of life (QOL) is a novel and holistic parameter in measuring health outcome. Recently, the concept is gaining importance as an outcome measure in illnesses, with a chronic and progressive course. Schizophrenia and chronic obstructive pulmonary disease (COPD) are psychological and physical illnesses, respectively, which share this characteristic. Studies comparing the QOL of psychological and physical illnesses are few. The extant literature did not reveal any studies comparing the QOL of schizophrenia and COPD. AIM: The aim of this study was to compare the QOL of patients with schizophrenia, a chronic psychiatric disorder, and COPD, a chronic physical illness. MATERIALS AND METHODS: The study was cross-sectional in design. The QOL of thirty patients each with schizophrenia and COPD, from a tertiary care teaching hospital, was assessed using the WHO Quality of Life Assessment-BREF scale. Comparison was done between the two groups. RESULTS: The QOL of patients with schizophrenia was significantly better in the physical domain (Z = 2.75, P = 0.006) and overall perception of life (Z = 3.25, P = 0.001). Overall perception of health was also better in schizophrenia (Z = 1.94, P = 0.052). The social domain was the only one in which COPD patients had a better score than schizophrenic patients, though it was not statistically significant (Z = 0.17, P = 0.86). CONCLUSION: The QOL of schizophrenic patients is slightly better compared to that of COPD patients. Only in the social domain was the QOL of schizophrenic patients inferior to that of COPD patients. Therefore, in schizophrenic patients, priority interventions to improve the social deficits are important because these determine their QOL vis a vis, a chronic physical illness.

The development of a guideline and its impact on the media reporting of suicide.

CONTEXT: A causal association between media reporting of suicides and the subsequent actual suicides has been observed. There are no studies from India regarding media reporting of suicide. This study examines whether educating media professionals about responsible reporting of suicides can change the quality of reporting. AIMS: To study the impact of a guideline on the reporting style of suicides by journalists. SETTINGS AND DESIGN: Newspaper reports in the local language examined by psychiatrists. MATERIALS AND METHODS: The Department of Psychiatry of a Teaching Hospital conducted a workshop for journalists, with the collaboration of media and mental health professionals and came out with a guideline about responsible reporting of suicide. Using this, a proforma was designed for assessing newspaper reports of suicides. All the suicide reports in the leading newspapers in Kerala were analyzed for one year prior to the workshop, the immediate next year, the second year, and six years later, using the 15 item proforma and whether each report was concordant or discordant to each item in the proforma was noted. RESULTS: The total concordant responses were 43.7% in the year prior to the workshop, 45.2% during the first year following the workshop, 46.2% in the next year, and 45.7% after six years. When the trend of each item was examined, the concordance rates were increasing in each item, except two. There was no statistical significance. CONCLUSIONS: A workshop for journalists could bring about positive changes in the media reporting of suicides. The changes persisted over the years, although they did not reach statistical significance.

A study of an antipsychotic prescription pattern of patients with schizophrenia in a developing country.

BACKGROUND: Though there are several recommended guidelines for treating schizophrenia, in routine clinical practice, these are not followed. AIM: To conduct an audit of the prescription pattern of antipsychotic drugs in patients with schizophrenia, in a tertiary care centre in India, during a period of 1 year and compare it with Maudsley guidelines and Clinical practice guidelines for Psychiatrists in India (IPS guidelines). MATERIALS AND METHODS: Data were collected from the case records, compiled, and analyzed. The concordance or discordance with Maudsley and IPS guidelines were studied. RESULTS: The demographic variables of the patients and the prescription pattern of drugs were analyzed. The correlations between supramaximal and sub-threshold dosage of drugs to the gender, age, duration of illness, and combination of drugs were examined. CONCLUSIONS: Polypharmacy of antipsychotics is common. 31% of patients were on combination of typical and atypical antipsychotics. 4% of patients were receiving supramaximal dose of antipsychotics and all of them were on combination (P =<0.03, x(2)). 24% of patients were on sub-threshold doses. 83% were not on anticholinergic drugs.