Background: India is a country of several diversities and cultures, which may influence the help-seeking behavior of mentally ill patients and families. Only a few Indian studies have focused on help seeking, especially for severe mental disorders. Objective: The study aimed to describe and compare the help-seeking behaviors among caregivers of psychotic patients visiting psychiatric clinics at two distinct cities of India. Materials and Methods: This was a cross-sectional exploratory study of key caregivers (N=50) of patients with a DSM-IV TR diagnosis of schizophrenia and other psychotic disorders, visiting psychiatric out-patient departments of VIMHANS, New Delhi, and CIMS, Bilaspur, Chhattisgarh. After due informed consent was taken, a semi-structured proforma was administered for socio-demographic profile, illness details, causative beliefs, and information on help seeking. Results: Supernatural forces were held responsible by 40% of the Bilaspur sample in contrast to 8% in New Delhi sample. Faith-healers were initial contacts for 56% and 64% of sample, respectively, at New Delhi and Bilaspur. Faith-healers followed by a psychiatrist formed the commonest pathway of care at both centers (32% and 36%, respectively). The sample at New Delhi spent significantly more money (median: $4000 vs. $10) and traveled greater distances (median: 35 km vs. 10 km) for faith-healers during the course of illness. Two-thirds of sample in New Delhi and one-third at Bilaspur were aware of the nearby psychiatrist at the time of initial help seeking; however, only 28% and 12%, respectively, chose psychiatrist as an initial contact. The New Delhi sample reported a fear of medication adverse effects and stigma as perceived disadvantages of psychiatric help. The median time lost at both the centers was 1 month, with a maximum of 8.4 years in New Delhi and 4.9 years in Bilaspur. Of the total, 16% caregivers at New Delhi and 32% at Bilaspur center reported an intention to continue with faith-healing practices alongside psychiatric care. Conclusion: In spite of differing causal attributions, the patients and families across these cities may not be as different when it comes to behaviors related to help seeking for mental illness. Future large-scale studies across various regions of India may help in determining sociocultural and regional patterns of help seeking in greater detail.

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Background: Adequate sexual expression is an essential part of many human relationships, and may enhance quality of life and provide a sense of physical, psychological, and social well-being. Epidemiological and clinical studies show that depression is associated with impairments of sexual function and satisfaction, even in untreated patients. Most antidepressant drugs have adverse effects on sexual function, but accurate identification of the incidence of treatment-emergent dysfunction has proved troublesome. However, few investigators have reported the base rate for disturbances in sexual desire, arousal, and orgasm or ejaculation in patients with major depressive disorder (MDD) prior to antidepressant treatment. The purpose of this study is to define the frequency of sexual dysfunction (SD) in 60 patients with MDD and examine the relationship between SD and quality of life enjoyment and satisfaction variables. Materials and Methods: A consecutive series of 24 male and 36 female MDD patients diagnosed by SCID-DSM IV assessment completed a series of psychometric measures including a Sexual Function Questionnaire-Arizona Sexual Experience Scale (ASEX) which asked about change in sexual interest and function as well as quality of life of life enjoyment using QLESQ-SF. Results: Over 33.33% of men and 42% of women reported decreased sexual interest. Reduced levels of arousal were more common in both men and women (8-22%) than ejaculatory or orgasm difficulties (11-16%). In women, SDs were more than males. Quality of life was more impaired in sample with SDs than those without dysfunction showing significant impact of SD on quality of life. Limitation and Conclusion: Although limited by a relatively small sample of drug-free patients with MDD, and by the absence of a non-depressed comparison sample, these results emphasize the importance of factors beyond specific drug effects in the assessment of SD in drug naive-depressed patients.

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We describe the clinical presentation of a 25-year-old female patient who presented in dermatology with recurrent episodes of painful ecchymotic bruising over the anterior aspect of both arms and face. On enquiry, these episodes were precipitated by emotional stress and were preceded with a history of fall from the stairs. The patient also had multiple stressors in her day-to-day life and symptoms of depression. A diagnosis of mild depressive disorder without somatic complaints and Gardner Diamond syndrome was made. The patient was started on antidepressants, which not only improved her mood symptoms but also caused a remission of her painful bruises.

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We report here a case that presented as mania followed by depression and mild cognitive impairment, which was misinterpreted and treated as a depressive episode of bipolar disorder and planned for electroconvulsive therapy, but was ultimately found to have cryptococcal meningitis and HIV-associated neurocognitive symptoms.

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Modafinil is a stimulant drug widely used to promote wakefulness in a variety of psychiatric and neurological conditions. Modafinil-induced severe dermatologic reactions are uncommon but serious side effects. We report a patient who developed fixed drug eruption after exposure to a single dose of tablet modafinil. On assessment using the Naranjo scale, the score was five, which made us conclude that modafinil was the "probable" cause of the patient's adverse drug event. This case report highlights the need to be alert toward the emergence of dermatologic side effects among patients taking modafinil.

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Background: The differences in digit ratio are proposed to arise due to differential effects of sex steroids on the growth of finger bones. In this study, we sought to examine the sex differences and the influence of family history of psychosis on digit ratio in patients with schizophrenia compared to matched healthy controls (HCs). Materials and Methods: Digit ratio (2D: 4D) was examined for a large sample of schizophrenia patients (n=200) and HC (n=177) to evaluate the potential effects of family history. Results: The right hand 2D: 4D digit ratio was lesser in schizophrenia patients compared to HC (0.97±0.05 vs 0.98±0.04, t=2.2, P=0.02). There was a significant difference in the right hand 2D: 4D digit ratio of female patients with schizophrenia when compared to female HCs (0.96±0.05 vs 0.98±0.03, t=2.1, P=0.03) while males showed no such difference on either hands. On the contrary, family history‑positive males showed a significantly greater digit ratio for the left hand (FH present (0.99±0.04) vs HC (0.97±0.04), t=2.15, P=0.03), while there was no difference between family history‑positive females and HC. Conclusion: Overall, in patients, reversal of expected "directionality" in digit ratio was observed in our study with greater left 2D: 4D in male patients having a family history of schizophrenia being a novel finding. Reversal of sexual dimorphism has been linked to the pathogenesis of schizophrenia. It is possible that such reversal might have a putative genetic basis, perhaps only in men with schizophrenia.

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Aim: To assess the P300 latency and amplitude in recently diagnosed human immunodeficiency virus (HIV)-positive patients and compare the same with a healthy control group. Further an attempt was made to study the correlation between P300 amplitude and latency (in milliseconds) with neurocognitive functions. Materials and Methods: Thirty newly diagnosed HIV-positive patients who on self report did not have any cognitive dysfunction were recruited. The patients were evaluated for P300 evoked response using the odd-ball paradigm, MMSE and a comprehensive neuropsychological battery. The P300 latencies were compared with 30 normal control subjects. Results: The mean P300 latency (in milliseconds) of the HIV-positive subjects was significantly more than the healthy control group. The mean amplitude of HIV group was significantly less than the normal control group. On MMSE, 7 HIV-positive subjects had mild cognitive impairment (MMSE total score 20-23), six patients had minimal cognitive impairment (MMSE total score 24-27) and 17 patients had no cognitive impairment (MMSE total score >27). On neuropsychological test battery only three (10%) of HIV-positive subjects had cognitive dysfunction. There was negative correlation between P300 latency (in milliseconds) and MMSE total score and performance on Koh's Block subtest. Conclusion: P300 may be a reliable indicator of cognitive impairments in HIV patients.

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Intelligence is assessed for ruling out mental retardation and to find out the relative cognitive strengths in autism. Of special interest is to know the nature of intelligence and cognition in high functioning autism. But very little is known how the assessments are carried given the deficits in communication, socialization in autism. This cross-sectional study aims to describe the nature of intelligence and cognition in a child with HFA and drawing implications for assessment in the Indian setting. Results indicate that there is no evidence for superior crystallized intelligence in HFA, though a jagged profile could be expected both across and within cognitive domains.

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A 22-year-old woman who was on sertraline 50 mg oral tablets once daily for 2 years for treatment of major depression took 30 such tablets (1500 mg) in a fit of rage, with a suicidal intent. She presented to the Emergency Department of a Tertiary Care Hospital with tachycardia, tachypnea, hypertension, tremors, agitation, confusion, vomiting, and hyperthermia. The patient was admitted and treated symptomatically, and sertraline therapy was discontinued. The unwanted effects subsided within 48 h and she recovered uneventfully within 72 h. This case report describes an unsuccessful attempt of suicide with sertraline overdose in a patient on long-term sertraline therapy and underlines the importance of close monitoring of such patients.

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While tobacco use occurs in many forms all over the world, there is little information on cross-tobacco use. Authors report an unusual case of tobacco use in the form of chewing beedies which are normally smoked (cross-tobacco use). A 22-year-old single female, diagnosed with schizophrenia for the last 6 years, started chewing beedies from the age of 15 years and was using it in a dependent pattern since 7 years. After 3 years of treatment for her schizophrenia, patient's family pressured her to seek tobacco cessation treatment. Initial treatment with nicotine gum replacement and behavioral counseling did not prove useful. Subsequently she was treated with bupropion 300 mg/day and able to successfully abstain. Cross-tobacco use is relatively rare, and merits further study, especially in the mentally ill population.

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Iloperidone, a piperidinyl-benzisoxazole derivative, is structurally related to risperidone and approved for treatment in acute stage of schizophrenia. Iloperidone is usually considered as a prolactin sparing atypical antipsychotic thereby offering treatment advantage. We aim to present the first reported case of iloperidone-induced hyperprolactinemic galactorrhea in a middle-aged female. A middle-aged female with the diagnosis of paranoid schizophrenia was treated with iloperidone up to a dosage of 8 mg/day. Three months after starting the medicine, patient developed galactorrhea for which no other medical cause could be ascertained except for increased prolactin level. Iloperidone was stopped and aripiprazole was initiated with which galactorrhea subsided and prolactin level returned to normal. Index case report amply demonstrates that Iloperidone can cause hyperprolactinemic galactorrhea even at low dosage and after considerable period into the treatment.

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Man has always yearned for a higher sense of belonging in life. Since ancient ages, human beings have tried to examine and evaluate the relationship between spirituality, religion and medicine. The interface of spirituality, quality of life and mental health is fascinating and sublime. Religion and spirituality play an essential role in the care giving of patients with terminal illnesses and chronic medical conditions. Patient's needs, desires and perspectives on religion and spirituality should be addressed in standard clinical care. Ongoing research in medical education and curriculum design points towards the inclusion of competence, communication and training in spirituality. There are structured and reliable instruments available for assessing the relationship between spirituality, religion and health in research settings. Intervention based scientific studies in the arena of spirituality and modern medicine are needed. Further research should be directed towards making modern medicine more holistic.

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Background: The reduction in fertility level, reinforced by steady increase in the life expectancy has produced fundamental changes in the age structure of the population, which in turn leads to the aging population. Objectives: To know the psycho-social problems of the elderly in urban population of Mysore; to determine the extent of functional impairment among the elderly and to know the psychological distress of the elderly using GHQ score. Materials and Methods: This community-based cross-sectional study was carried out at the field practice area of Urban Health Center , JSS Medical College, Mysore . The study population comprises of all geriatric population aged 60 years or above who were residing in the study area for atleast one year. 526 study subjects were recruited for the study. Data collection was done from May 2011 to December 2011 using a preformed semi-structured schedule. Data was entered into Microsoft Excel and statistical analysis is carried out using SPSS-17 version. Results: 162 out of 207 elderly men (78.3%) were more functional than 240 out of 319 aged women (75.2%). Severe functional impairment was almost same in both gender (4%) while moderate imparement was noted slightly more among aged women. The functional score was significantly higher for young old, for literates, for middle class and for employed. Anxiety and insomnia were found in 3.4% of the aged (males 2.4% and females 4.1%) followed by somatic symptoms 2.9%, social dysfunction 1.5% and severe depression 1.1%. All psychological distress were found more among elderly women. The prevalence of mental illnesses were found to be significantly higher for age more than 75 years. Conclusions: Awareness among the elderly population should be created for regular medical check-ups to ensure prevention and early detection of the chronic diseases. There is a need to have geriatric wards having specialized professionals with psychiatric and medical social workers along with subsidized health care services.

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Context: Alcohol abuse is a known risk factor for suicide. Alcohol increases aggression and impulsivity, which are strongly related to suicidal behavior. Sociocultural factors influence both alcohol use and suicide rates. Studies, conducted in one population, are not applicable to other and the results cannot be generalized. Aims: The aim was to study the putative role of alcohol in suicide cases in the rural Indian population by analysis of various sociodemographic variables. Settings and Design: This was a cross-sectional study in conducted in a tertiary medical college. Materials and Methods: Two hundred consecutive patients who survived a suicide attempt were evaluated by a psychiatrist. The data were recorded for sociodemographic variables, psychiatric disorders, suicide intent, lethality of the suicide attempt, and history of alcohol intake prior to the suicide attempt. Using alcohol intake prior to the suicide attempt as a determining dimension, various sociodemographic variables were analyzed for their statistical significance and the role of alcohol in suicide cases was assessed. Results: Seventeen percent suicide attempt survivors had a history of alcohol intake prior to the suicide attempt. Fifteen percent had a history of alcohol use disorder. Alcohol use affected the suicide rate in the male population in the late twenties to mid-thirties age group, illiterate and people with high school education, semiskilled workers, shop owners, and student population. Alcohol dependence, bipolar II disorder, intermittent explosive disorder, and dysthymic disorder had higher rate of suicide attempt with the use of alcohol prior to the suicide attempt. Alcohol users attempted a more lethal suicide attempt and were found to have problems with primary support group and occupational problem as precipitating stressor for suicide attempt. Conclusions: Alcohol use increases the suicide rate, in the specific rural Indian population.

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Objectives: This cross-sectional study examined psychiatric co-morbidity and work and social adjustment after a natural disaster among survivors who were extricated from under the rubble. Materials and Methods: Individuals (N=40) belonging to district Muzaffarabad, a severely earthquake affected area on 8 ^th October 2005, were interviewed. The examination included the MINI International Neuropsychiatric Interview for DSM-IV Axis I disorders, Work and Social Adjustment Scale, and questions covering background characteristics and disaster exposure. Results: The most prevalent disorders were posttaumatic stress disorder (32.5%), major depressive disorder (17.5%), dysthymia (15.0%), agoraphobia (25.0%), and panic disorder (20.0%). Moreover, 77% of the respondents have been diagnosed with at least one psychiatric disorder. Work and soical adjustment was found to have an inverse relationship with the psychiatric co-morbidity. Conclusion: Small sample size and lack of comparison group from non-earthquake struck areas may limit the generalizability of the psychatric disorders. Psychiatric disorders other than PTSD, especially depressive and anxiety disorders, are of clinical importance when considering long-term mental health effect of disasters.

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Background: Emotional intelligence has a major role in mental health and life skills training, and could be viewed as a bridge relating to emotional intelligence and mental health. Aim: The present study is aimed at determining the effect of life skills training on the emotional intelligence among the first year students of Mazandaran University of Medical Sciences. Materials and Methods: In this experimental study, the subjects were selected by random sampling and allocated into two groups: Case group (n=20) and control group (n=19); they matched for gender, experience of stressful life events in the past six months, level of interest in the field of study, and level of emotional intelligence. The two groups responded to Bar-on Emotional Quotient Inventory before starting the experiment. Subsequently, the case group underwent life skills training. After the training, Bar-on Emotional Quotient Inventory was responded by the case and control groups again. The data was analyzed using descriptive statistics including Chi-square test, paired and independent t-tests, using SPSS software version 15. Results and Conclusion: In the case group, the scores of emotional intelligence after life skills training were significantly improved (t=11.703 df=19 P=0.001), while no significant difference was observed in the control group (t=0.683 df =18 P=0.503). By performing programs such as life skills training, the levels of emotional intelligence of the students could be increased, which itself could lead to academic success, reduced substance abuse, and increased stress tolerance in the students.

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Background: All kinds of drugs are available over the counter in Bangladesh. Aim: The objective of this study was to investigate the over the counter use of self medicated drugs for primary and adjunct therapy in psychiatric diseases among medical and nonmedical students. Materials and Methods: 101 medical students and 186 nonmedical students were found, who used at least one of the nine drugs (believed as antipsychotics among nonmedical people) under survey within 6 months prior to survey date. The nine drugs used for survey were domperidone, sertraline, amitriptyline, midazolam, diazepam, prochlorperazine bromazepam, flupentixol-melitracen, and clonazepam. Statistical Analysis: Snowball sampling method was used. The symptoms, diseases, etc. of the students and the length of therapies they had followed for the respective drugs were noted. Results: Among nonmedical students, several cases were found where drugs were being self medicated in wrong indications, for example, use of flupentixol melitracen and domperidone to treat headache. Conclusion: The nonmedical students chose the fast acting drugs having the strongest effects for self medication.

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Background: Dropping out of school is a worldwide phenomenon with drastic mental health consequences for children, families and society. Aim and Materials & Methods: This study examines school dropouts in one district in Kerala with an emphasis on looking at multiple reasons for the problem. Results: The most common "reason" was various Physical disorders (80, 21.8%) followed by Mental Retardation (77, 20.9%). Child labour (Employment) came last (30, 8.1%) as a "reason" while financial issues constituted 50 (13.6%). Family issues accounted for 63 (17.1%) and School-related issues 68 (18.5%). Conclusion: This study highlights the need to examine a space of reasons for this phenomenon with active involvement and coordination of multiple agencies to examine and support getting children back to school and prevent dropouts.

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Background: Worldwide, the stigma and discrimination impede HIV-AIDS programs across the continuum of prevention to care. We studied stigma and related issues in HIV-positive subjects. Materials and Methods: At a tertiary care hospital in North India, we studied 100 HIV-positive outpatients not receiving antiretroviral therapy. The subjects self-administered 'Tanzania Stigma Indicator and Community Endline-Individual Questionnaire'. Psychiatric morbidity was screened with General Health Questionnaire (GHQ-I2 Hindi) and diagnosed with Structured Clinical Interview for DSM-IV (SCID). Results: A typical subject was middle aged (25-44 years, 77%), school non-completer (63%), village dweller (61%), and male (59%). Only 35 subjects could differentiate between HIV and AIDS, and only 24 were aware of antiretroviral therapy. Unprotected sex, sharing injections, and blood transfusions were reported spontaneously as possible sources of transmission by 56-79% subjects each. About 80% of subjects reported no fear in touching HIV-positive subjects or their objects. Avoiding injections, being faithful to uninfected partner, avoiding blood transfusions, using condoms, and avoiding sharing razors/blades were reported spontaneously as HIV preventive measures by 40 to 26 subjects each. Half of the subjects blamed self for contracting HIV. Only 38 subjects reported others behaving differently with HIV-positive subjects. HIV status disclosure was reported by 98 subjects (73 to family or relatives). Urban subjects reported higher primary stigma and shame or blame. Psychiatric disorders, present in 45 subjects, showed no association with stigma items. Conclusions: The subjects had a limited knowledge, especially of treatment aspects. Stigma showed no association with psychiatric disorders. The study reflects a strong need for public health measures to enhance awareness and knowledge about HIV/AIDS.

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Background: Compassion fatigue is a broad term comprising of two components - burnout and secondary traumatic stress. The current study is aimed at identifying 'burnout' and 'compassion fatigue' among clinicians involved in care of individuals suffering from medical illness. Materials and Methods: A total of 60 clinicians were included in the study. A semi-structured questionnaire was administered to gather information related to personal, professional, anthropometric, and metabolic profile of the study participants. Professional Quality of Life Scale (ProQoL Version V) was used to assess burnout, compassion satisfaction and secondary traumatic stress. Analysis was carried out using the SPSS version 19.0. Results: The mean age of clinicians was 46.68±11.06 (range 26-67 years). Burnout score was significantly higher in those involved in diabetology practice. Similarly, compassion satisfaction score was greater among those with greater years of practice as well as among those in private practice. Clinicians who reported a poor working condition, as opposed to good, had more burnout and less compassion satisfaction. Conclusion: The current study suggests that it is important to find out ways of decreasing burnout and compassion fatigue among clinicians.

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Major mental disorders such as schizophrenia and affective disorders are highly disabling illnesses. The cultural factors that influence the diagnosis and treatment of these disorders are of paramount clinical significance. We attempted to critically review the cultural factors in relation to the epidemiology, phenomenology, treatment, and outcome of major mental disorders from an Indian perspective, and tried to compare these with the cultural factors identified in major international studies. The clinical expression of major mental disorders was noted to vary across cultures in the review. In addition, the outcome of major mental disorders is reported to be better in developing nations than in the developed countries. Transcultural variations are also noted to exist in pharmacokinetics, pharmacodynamics, traditional healing practices, and psychotherapeutic approaches. The role of cultural factors in severe mental illnesses needs adequate attention from mental health professionals. Continued research on the cultural aspects is required to understand the interplay of all social, cultural, and biological factors. It is important to consider other cultural, traditional, and folk methods for understanding and management of mental illnesses.

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