Dhat syndrome is a culture-bound syndrome of South-East Asia, common in young men. However, similar entity has also been described in female patients who attribute their symptoms to nonpathological or physiological vaginal discharge. The current diagnostic system for psychiatric illnesses does not encompass Dhat syndrome in females, and so these group of patients receive alternative diagnoses such as somatoform disorder or depression. As a result of which the focus of unique Dhat syndrome-centered management gets weakened, affecting the clinical outcome. This case study focuses on the diagnostic dilemmas related to Dhat syndrome in females and pitfalls in the current diagnostic system.

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Background: Urinary Ethyl glucuronide (EtG) and Ethyl sulfate (EtS) are established markers of alcohol conumption. Measurement of these markers in serum offers certain advantages. This outpatient department based study evaluated performance of serum Ethyl glucuronide (EtG) and Ethyl sulphate (EtS) as biomarkers of recent alcohol consumption in alcohol dependent subjects. It also evaluated effect of alcohol dose and time since consumption on serum EtG and EtS concentration. Methods: Information regarding alcohol intake was collected using Time line follow back calendar method from 152 subjects. Blood samples were collected to determine serum EtG and EtS concentration. Results: The results revealed that serum EtG (at a threshold of 45 ng/mL) could detect recent moderate to heavy alcohol consumption with 85 percent sensitivity and 89 percent specificity. The results also show that simultaneous measurement of EtS does not increase test accuracy. We found that dose of alcohol and time since alcohol consumption explain 68 and 62 percent variance in serum EtG and EtS levels. Conclusion: EtG testing in blood was found useful as a way to detect recent drinking. This sensitive and specific short-term biomarker provides valuable information about recent alcohol consumption.

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Medically unexplained symptoms (MUS) commonly present across the board in medical specialties and are often challenging to treat. Our objective was to assess the efficacy for cognitive-behavior therapy (CBT) in MUS. Electronic search of databases was carried out for published controlled trials in English language peer-reviewed journals from inception till August 2016. Effect sizes for the trials were computed using standardized mean difference, and I² test was used to assess sample heterogeneity. Pooled mean effect sizes were derived using a random-effects model. Critical appraisal of studies was done using the Cochrane risk of bias assessment tool. A total of 11 trials involving 1235 subjects were included in the study. Ten trials used standard CBT techniques while one studied the efficacy of mindfulness-based CBT technique. The control arms were treatment as usual in five trials, augmented care in four and waitlisted controls in two trials. The pooled mean effect size for CBT was 0.388 (range 0.055–0.806, 95% confidence intervals 0.316–0.461). The I² value was 0 using a random effects model indicating low heterogeneity among studies. Risk of bias was noted in many included studies. Egger plot intercept indicated potential publication bias. CBT was superior to the waiting list, treatment as usual or enhanced usual care with moderate effect sizes in the treatment of MUS. These findings are impacted by the limited number of studies in this area and questionable methodological rigor of included studies.

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Background: Technology use has shown an impact of users' lifestyle. The use has been attributed to psychosocial reasons. This usage manifests as excessive to addictive use of technology. There is a need to explore its addictive potential on large sample study as well as its association with psychosocial variables. It is one of its kind study on wider age group. The present work assessed the magnitude, burden, and sociodemographic correlates of technology addiction in an urban community. Materials and Methods: A total of 2755 individuals (1392 males and 1363 females) in the age group of 18–65 years were approached for screening internet addiction and mobile overuse, using house-to-house survey methodology. Results: The survey indicated the presence of addiction for 1.3% for internet (2% males and 0.6% females) and mobile phone overuse (4.1%–2.5% males and 1.5% females). It was more common among males. Significant differences were observed in relation to family status for internet and mobile phone use more commonly among single/nuclear families. Technology addictions were found to be more common among single families and lesser in nuclear and joint families. Mobile phone users had psychiatric distress in comparison to users with internet addiction. The study showed negative correlation of age, years of marriage, and numbers of family members with internet addiction and mobile overuse. Conclusions: It has implication for raising awareness about addictive potential of technology and its impact on one's lifestyle.

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Background: To find any association between family structure and rates of hospitalization as an indicator for behavior problems in children. Methods: Retrospective chart review of 154 patients who were admitted to the preadolescent unit at Lincoln Prairie Behavioral Health Center between July and December 2012. Results: We found that only 11% of children came from intact families living with biological parents while 89% had some kind of disruption in their family structure. Two-third of the children in the study population had been exposed to trauma with physical abuse seen in 36% of cases. Seventy-one percent had reported either a parent or a sibling with a psychiatric disorder. Children coming from biologically family were less likely to have been exposed to trauma. Children coming from single/divorced families were less likely to have been exposed to sexual abuse but more likely to have a diagnosis of attention deficit hyperactivity disorder (ADHD) compared to other types of families. Strong association was found between exposure to trauma and certain diagnoses in respect to hospitalization. ADHD predicted a 4 times likelihood of having more than one previous hospitalization, with mood disorder, oppositional defiant disorder, and physical abuse increasing the risk by more than twice. Conclusions: Significant differences in family structure were demonstrated in our study of children being admitted to inpatient psychiatric hospitalization. The presence of trauma and family psychiatric history predicted higher rates of readmission. Our study highlighted the role of psychosocial factors, namely, family structure and its adverse effects on the mental well-being of children.

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Background: The number of Internet users in India crossed 205 million in October 2013. Excessive internet use has been attributed to socio-occupational dysfunction, and this study is targeting the junior doctors on whom not many studies have been done till date. Objective: The objective of this study was to analyze the proportion of junior doctors with internet addiction and whether there is any relation between increased internet use and psychological distress, assessed using General Health Questionnaire (GHQ). Materials and Methods: One hundred postgraduate students and house surgeons were requested to fill out the specially prepared pro forma, Internet Addiction Test Questionnaire and GHQ, and the data were analyzed. P < 0.05 was considered statistically significant. Results: Among the 100 study participants, 13% were found to have moderate addiction and none were in severe addiction range. Internet addiction was more common among those from urban areas (P = 0.011). A significant association was found between GHQ score and internet addiction test score (P = 0.031). Conclusion: The Internet is a double-edged social revolution. Further studies are required to delineate the specific effects on human behavior.

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Background: Tobacco related diseases is largely preventable and can stop pre-mature death. According to World Health Organization (WHO), the prevalence rate of smoking is 28.6% (40% among males and 18.2% among females).^[1] Beedismoking and tobacco chewing are the commonest forms of tobacco habits in India, and strongly associated with oral cancer in India.^[2] There are methods to estimation of severity of tobacco dependency, of them FTND is identified. The score for FTND is used for cigarette smoking, but we do not know the FTND score of ST users and Beedi smokers in India. Therefore, keeping the study in plan, we aim a systemic review with the following objective. Objectives: 1. To pursue a review of published researches on interrelations between Beedi smoking and FTND score. 2. To pursue a review of published researches on interrelations between consumption of ST and FTND score. Materials and Methods: A systematic search of published papers were examined from three different electronic databases namely Pubmed, Cochrane library, and ProQuest . The inclusion criteria and exclusion criteria was set based on commonality of the studies which was looked through the objectives. Total of four papers of its category were found, and those met the criteria for inclusion factors. Results: Seventy-one articles were screened initially and forty-three articles were excluded and twenty-eight articles were screened, out of which twenty articles were excluded based on inclusion criteria. The abstracts of remaining eight articles were reviewed and four were removed because of duplication of the data. Finally, four articles were included for review after three stages of screening. Review results revealed that out of four selected reviews, one research study finding was interrelated with FTND score and Beedi and ST users. This study results also revealed that there is not a set of research carried out on FTND score for Beedi smokers and ST users.

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Background: Sleep problems, especially in the adolescent stage of development, may be associated with excessive daytime sleepiness, impaired neurocognitive function, and a host of others leading to suboptimal performance. Objectives: To determine the pattern of sleep problems in school-going adolescents based on the bedtime problems; excessive daytime sleepiness; awakenings during the night and problems falling back asleep; regularity and duration of sleep; sleep-disordered breathing (BEARS) sleep screening algorithm. Materials and Methods: This is a cross-sectional descriptive study involving 353 secondary school-going adolescents in Kano metropolis. Subjects were selected for the study using multistage sampling technique. The study lasted from March 2015 to July 2015. Sleep problems were screened for using the BEARS sleep screening algorithm. Tables were used to present the qualitative data. The various BEARS sleep patterns were assessed, and comparison between stages of adolescence was done using Chi-square test (and Fisher's exact test where necessary). A significant association was considered at P < 0.05. Results: Of the 353 adolescents studied, 61.8% were males while 38.2% were females with male, female ratio of 1.6:1. Early, middle, and late adolescents constituted 13.9%, 39.9%, 46.2% respectively. BEARS sleep screening revealed awakenings during the night (34.6%) as the most common sleep-related problem reported, and this was followed by excessive daytime sleepiness (21.0%). Age-group dependent sleep duration was 7.19 ± 1.26, 7.13 ± 1.13, 7.16 ± 1.28, with P > 0.05. Although 62.9% of all the adolescents watched TV/play video games until 1 h before going to bed and this was highest in late adolescence, it was not statistically significantly associated with any of the sleep problems. Conclusion: Both the quality and quantity of sleep in Nigerian adolescents in Kano is suboptimal. Adolescent and sleep medicine should receive more attention in our environment.

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Background: It has been proposed that increased physiological responses (i.e., cardiovascular reactivity) to a stressor or stressors may increase the risk of developing cardiovascular disease (CVD) including increased blood pressure (BP) or hypertension. However, many prospective studies have examined the hemodynamic reactions to laboratory stress tests and CVD in Western countries and only a few studies have examined with varying durations of follow-up in the same sample studies. In addition, still relatively little is known about cardiovascular reactivity in Asian populations. Therefore, the aim of this study was to examine whether cardiovascular responses to psychological stressors remained a significant predictor of 40-month follow-up among initially normotensive participants in Thailand, Asia. Materials and Methods: Hemodynamic parameter was measured at rest, during, and after mental arithmetic, a speech task, and a cold pressor task. Ninety-five healthy normotensive male and female participants were reevaluated BP at 40 months later. Results: Regression analyses indicated that after adjustment for baseline BP, initial age, sex, body mass index, and family history of CVD, heightened systolic BP (SBP) responses to mental arithmetic was associated with increased future SBP (ΔR² = 0.04, P = 0.023). Conclusions: Therefore, these findings suggest that cardiovascular reactivity remains a prediction of future BP and may play a role in the development of hypertension and CVD.

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Background: Cognitive impairments are among the most important adverse effects of electroconvulsive therapy (ECT). Although much is known about them in patients with depression, there is very little information about these in persons with schizophrenia. Methods: In this study, we examined the persistence of cognitive impairments in a subsample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing the therapeutic and cognitive efficacy of bifrontal ECT (BFECT; n = 23) and bitemporal ECT (BTECT; n = 29) electrode placements. Total scores on Hindi Mental State Examination, processing speed, working memory, and verbal fluency were assessed in these patients at two points: first, at the end of their respective ECT course and at the follow-up (mean [standard deviation] = 98.7 [38.3] days). The course of cognitive impairments was assessed in all patients (n = 49) as a single group. Further, BFECT and BTECT patients were also compared with one another. Results: ECT-induced acute cognitive impairments in patients with schizophrenia had normalized by the end of 3 months' follow-up post-ECT. All the tested parameters in the realm of Hindi Mental Status Examination, speed of processing, sequencing, spatial and working memory and verbal fluency showed recovery. Further, across all tests, BFECT and BTECT ultimately had similar scores at the follow-up though BFECT performed relatively better with regards to the acute effects. In fact, worst performing BTECT group caught up to recover to comparable levels of performance by the end of follow-up. Conclusions: In patients with schizophrenia, most of acute ECT-induced cognitive impairments recover by the end of 3 months' post-ECT. Further, different electrode placements do not seem to make any difference regarding ultimate recovery of cognitive deficits. Future prospective studies are needed that could address the limitations of this study.

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Aim: This study aimed to evaluate the prevalence of physical comorbidities among elderly patients with depression attending psychiatric services and the secondary aim of the study was to evaluate the influence of physical comorbidities on symptom profile of depression. Methodology: 140 patients with a diagnosis of depression as per the International Classification of Diseases-10 criteria were evaluated on Geriatric Depression Scale (GDS) and a physical comorbidity checklist. Results: More than two-third (72.1%) of the patients had at least one physical illness. Out of those with physical comorbidity, more than half (57 out of 101) had at least 2 physical illnesses. The most commonly involved systems were cardiovascular system (n = 68; 48.6%), followed by endocrinological system (27.1%) and ophthalmological system (26.4%). Most common physical comorbidity was hypertension (47.14%), followed by cataract (25.7%) and diabetes mellitus (25%). The presence of any physical comorbidity, presence of hypertension or presence of diabetes mellitus did not influence the manifestations of depression as assessed by GDS-30. Conclusion: Elderly patients with depression have high rates of physical comorbidities. Clinicians managing elderly patients with depression must get their patient thoroughly evaluated for the presence of various physical comorbidities.

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Children and adolescents often present to physicians and pediatricians with a range of medically unexplained symptoms, most common being headache, abdominal, and bone pains. These symptoms can be a manifestation of underlying depressive, anxiety or somatoform disorders, and sometimes the only symptom. Hence, it is important to recognize and manage these symptoms. Atypical facial pain (AFP) or atypical trigeminal neuralgia that has variably been described to be of psychological origin is considered to be rare in children. We describe the case of a 13-year-old adolescent girl who presented with AFP, who was finally diagnosed to have a somatoform disorder. We discuss the characteristics of AFP in the index case that justify the diagnosis. We also attempt to describe psychosocial factors related to such a presentation.

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Cyclical vomiting syndrome (CVS) is an idiopathic functional disorder characterized by recurrent episodes of nausea and vomiting separated by symptom-free intervals. Even though initially described in children, it is seen in all age groups. Exact etiology is not known. Various physical, infectious, and psychosocial stressors have been implicated for CVS. High incidence of psychiatric comorbidities such as panic attacks, anxiety disorder, and depression is seen in CVS. Most children outgrow CVS with time though some may transition to migraine or continue to have CVS as adults. Frequent misdiagnosis, delay in diagnosis, or inadequate treatment often lead to years of recurrent vomiting. This case report highlights the importance of the management of CVS by a multidisciplinary team including a psychiatrist in addressing the various physical and psychological factors effectively and that would result in faster and prolonged recovery.

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Objective: The objective of this study is to examine the impact of vary doses of buprenorphine on anxiety symptoms in opioid-dependent inpatients over a 7 days period, using a randomized controlled trial design. Design: Patients were randomized to three groups. Patients and Methods: Fourteen men who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for both opioid use disorder and generalized anxiety disorder and were seeking for treatment. Intervention: Patients obtain dosages of 32 mg or 64 mg or 96 mg of buprenorphine as a single dose only and were treated in a psychiatric inpatient unit. Of 14 subjects; 5 (35.7%) obtained 32 mg, 4 (28.6%) obtained 64 mg, and 5 (35.7%) obtained 96 mg of buprenorphine. Measurements: Administering daily Hamilton Anxiety Rating Scale and interview. Results: All the patients ended the 7-day treatment time. The results showed a significant reduction in anxiety symptoms within each of the three groups (P = 0.00), but no difference in outcome between the groups (P = 0.605). Conclusions: The outcome suggests a single high dose of buprenorphine can supply a speedy, safe, simple, and suitable means of anxiety treatment. The single high dose of buprenorphine could be a novel mechanism medication that provides a rapid and sustained improvement for generalized anxiety disorder in opioid dependent patients. Placebo-controlled trials of longer duration are needed to evaluate ability, safety, and psychological and physiological influence of extended exposure to this medication.

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Background: Anger is seen as comorbid condition in psychiatric conditions. It has an impact on one's quality of life. It leads to variation in the treatment outcome. The present study is going to explore the relationship of anger with treatment outcome among alcohol users after 1 year of treatment. The data for the present study were taken from the project work on correlates of anger among alcohol users, funded by center for addiction medicine, NIMHANS, Bengaluru, Karnataka, India. Materials and Methods: A total of 100 males (50 alcohol-dependent and 50 abstainers) in the age range of 20–45 years with a primary diagnosis of alcohol dependence were taken for the study. They were administered a semi-structured interview schedule to obtain information about sociodemographic details, information about alcohol use, its relationship with anger and its effects on anger control and the State-Trait Anger Expression Inventory. Results: 68% of the dependent and abstainers perceived anger as negative emotion and 76% in control perceived it as negative. The presence of significant difference was seen for relapsers group in relation to trait anger and state anger. The group who remained abstinent from the intake to follow-up differs significantly from the dependent group in relation to state anger and anger control out. Mean score was higher on trait anger for the dependent group. Conclusions: It has implication for anger management intervention/matching of treatment with users attributes and helping the users to develop the behavioral repertoires to manage anger.

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A 22-year-old male diagnosed with bipolar affective disorder presented to us with a 3^rd episode mania resistant to both olanzapine and haloperidol as well as electroconvulsive therapy. He, however, responded to chlorpromazine (CPZ) which was also effective as a mood stabilizer. The patient had a relapse of his illness when CPZ was stopped and responded again when it was started. The case demonstrates that CPZ may have a role in as both an anti-manic agent and for the maintenance for bipolar disorders. The possible underlying mechanism for this role is also discussed.

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Background: It is reported that persons with high Lie score (L score) of a personality test are aggressively self-confident and are also related to depression or schizophrenia In this study, we examined the characteristics of patients with high L scores on the Maudsley Personality Inventory (MPI) and examined the significance of the L score. Materials and Methods: We collected the data of 10789 subjects and examined the relationship between L score or the number of characteristic biased persons and the parameters of age, sex, education level, occupation, and degree of pain. Furthermore, we examined the changes in extraversion–introversion (E score), neuroticism (N score), and L scores at approximately 1 year after surgery in 1711 patients who underwent surgery at our university hospital or affiliated hospitals. Results: L score was significantly higher among persons with a high degree of pain, and ratio of the characteristic biased persons in L score was significantly high among persons in their 40s to 60s, healthcare professionals and those with a high degree of pain. Moreover, L score scarcely changed between before and after surgery when compared with E score and N score. Conclusion: L score is not greatly influenced by an individual's state of mind or situation at different times, and may indicate the personality traits proper to the person. It is shown that L score may indicate the personality trait characteristics of persons who want to make themselves look good in the eyes of other.

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Kleine-Levin syndrome (KLS) is a rare disorder characterized by episodic hypersomnia along with cognitive and behavioral disturbances (i.e., hyperphagia and hypersexuality). It is commonly seen in a young male. Not much is known about its long-term management; however, many reports suggest the usefulness of anticonvulsants and lithium for the same. We hereby report a case of childhood KLS from India who was successfully treated with low-dose lithium and discuss the relevant literature.

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Introduction: The purpose of this research is genealogy examination of three generation of bipolar mood disorder Type I patients. Methods: Patients selected using Poisson sampling method from 100 patients with bipolar mood disorder Type I, referring to a psychiatric center of Amir Kabir Hospital of Arak, Iran. Examine issues such as physical ailments, psychological review of living and deceased family members of each patient, drawn family pedigree using pedigree chart, check the relationship of the different pattern of the autosomal dominant and recessive disease, sex-linked dominant and recessive and linked to Y chromosome have been performed on patients. Different methods used in this study are pedigree chart and young mania rating scale and SPSS and Pearson's correlation test for analyzing the data collected. Results: Among the studied inheritance patterns, the most common inheritance pattern was autosomal recessive. There was a significant relationship between age, number of generation, and inheritance patterns with physical ailments in families of patients with bipolar mood disorder (P < 0.05), but there was no significant association with mental illness (P > 0.05). Furthermore, there was a significant relation between generation and skin, gastrointestinal, ovarian, lung, coronary heart disease, diabetes mellitus, hypertension, Cerebrovascular accident (CVA), hyperlipidemia, cardiomyopathy, hypothyroidism, and kidney disease in patients with bipolar affective disorder Type I (P < 0.05). Conclusion: The results showed that autosomal recessive was the most pattern of inheritance and there is a significant relationship between generation and some physical disorders in patients with bipolar mood disorder Type I.

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Very early-onset schizophrenia (defined as an onset of psychosis before 13 years of age) is a rare and severe form of the disorder which is clinically and neurobiologically continuous with the adult-onset disorder. It is rarely reported <12 years of age in Indian literature. Here, we present a 15-year-old boy who developed psychosis at 9 years of age and during illness developed tic disorder.

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Aims: This study aimed to evaluate the patterns of platelet counts during the course of alcohol withdrawal and its relationship if any with liver enzymes. Methodology: Forty consecutive patients, with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition, Text Revision criteria, willing for a 10-day inpatient detoxification program and presenting within 12 h of the last consumption of alcohol were recruited in the study. Details about the diagnosis and alcohol consumption patterns were assessed with a detailed psychiatric interview. After admission, routine investigations (complete blood counts [CBCs] and liver function tests) were sent and records were kept. CBC was sent for platelet counts on the 2^nd, 4^th, 6^th, 8^th, and the 10^th day of alcohol withdrawal. Results: Nearly 40% of the patients developed delirium tremens (DT group) and rest had an uncomplicated alcohol withdrawal (ND group). Platelet counts at baseline and all the 4 days of collection were significantly lower in DT group than the ND group. Platelet counts increased gradually from baseline till 10^th day of alcohol withdrawal, mean increase in platelet counts being 88.61 ± 11.60% (median: 61.11%, range [23.41–391.23%]). Platelet counts in 63% of the patients showed a drop on the 4^th day of withdrawal before rising till the 10^th day of alcohol withdrawal. Platelet counts were not affected by liver enzymes or other alcohol consumption patterns. Conclusions: Transient thrombocytopenia and reverse thrombocytosis during alcohol withdrawal are associated with an initial drop in platelet counts. The synchrony between the drop and the onset of DT needs to be evaluated.

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Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Treatment usually consists of serotonergic medications along with exposure therapies. Danger ideation reduction therapy (DIRT) is an alternative therapy predominantly for washing compulsions and focuses on reduction of danger ideations. DIRT was tried on Ms. S. with a history of OCD for 15 years and improvement was noticed on Yale–Brown Obsessive Compulsive Scale, Padua Inventory, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale after 15 sessions of DIRT though she was not fully symptom-free. Thus, DIRT was found to improve OCD symptoms and improved her insight into illness.

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Abrupt normalization of hyperthyroid state with antithyroid drugs is reported to precipitate psychosis. We report the development of acute psychosis in a 20-year-old woman, following 30 days use of tablet carbimazole 10 mg for hyperthyroidism due to the multinodular goiter. At the time of presentation, she was euthyroid with a resolution of hyperthyroid status both clinically and biochemically. After 20 days treatment with tablet olanzapine 10 mg/day and stoppage of carbimazole, psychotic symptoms remitted completely and she has since remained in a euthyroid state and free from psychotic symptoms. This case highlights the development of psychosis in individuals, following rapid restoration to normal serum thyroid hormone levels in hyperthyroid individuals with carbimazole.

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Introduction: Substance abuse is known public health problem in the world. Felt need of treatment and barriers in seeking treatment are important for successful treatment of addictions. Therefore, this study was designed to understand the pattern (type) of substance abuse among residents of urban slum and to study the felt need and barriers for the treatment of substance abuse among substance abusers in urban slum areas of the central India. Materials and Methods: A community-based cross-sectional study was conducted in slum area in central India. Results: The smokeless tobacco (92.5%) and alcohol (70.35%) were the most common substances used in the study population. More than half (60.4%) of study participants were felt the need of de-addiction but in reality very few approached for treatment for their addiction. The most common barriers were unawareness about place of availability of treatment, absence of any health problem and the confidence of handling their own drug problem, and dependency on substance. Conclusions: There was huge gap in the felt need and actual treatment-seeking practice due to treatment barriers in the treatment of substance abuse.

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Introduction: Studies have reported that females who drop out prematurely from inpatient treatment have poor treatment outcome. However, literature from India is limited in this regard. Methods: We reviewed case records of female patients admitted with opioid use disorder at NDDTC, Ghaziabad between January 1, 2008 and December 31, 2012 to study the predictors of inpatient treatment completion among female patients with opioid use disorder in relation to their sociodemographic and clinical profile. Results: Over the 5 years, 72 female patients were admitted with opioid dependence. During the study period, out of 72 patients, 44 (61.1%) were inpatient treatment completers and 28 (38.9%) were noncompleters. Mean length of ward stay was 5.1 ± 3.8 days and 16.2 ± 11.8 days for inpatient treatment noncompleters and completers, respectively, the difference being statistically significant (t = 4.845, P < 0.001). The multivariable analysis (adjusted for selected demographic characteristics as marital status, education, and employment) revealed that most women taking drug for relief from pain, having medical morbidity, and onset of opioids at age 25 years or more had a significantly greater likelihood for being treatment completers. Conclusion: Certain factors can help in identification of women opioid users who are at risk of leaving the treatment.

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A 9-year-old girl presented with 2-month history of continuous coughing; despite detailed evaluation, no organic cause was found. Considering the provisional diagnosis of a psychogenic cough, she was advised for psychiatry consultation. After a psychological assessment, she was found to have comorbid anxiety (Screen for Child Anxiety Related Disorders score- 25) along with punitive parenting and sibling rivalry issues. She was initially treated with parental psychoeducation, play therapy, and behavior therapy. Since she did not show expected progress with the treatment, low-dose escitalopram was started along with the ongoing therapy, considering her anxiety. There was a significant improvement in her symptoms in 1-month follow-up. She maintained improvement during further follow-ups. This case illustrates the need to identify and treat comorbid psychiatric issues in the management of a psychogenic cough.

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The two terms, pseudocyesis and delusion of pregnancy, were frequently used for pseudopregnancy. Delusion of pregnancy is a special form of hypochondriacal/somatic delusion reported in various psychiatric and organic disorders. The origin of the delusion of pregnancy in schizophrenia has often been explained by psycho-analytic interpretations attributing wish fulfilling, protective role to false beliefs, and mother establishes an undisturbed union with her fetus during pregnancy, which eliminate loneliness and helplessness. The current case is a 49-year-old married female with an illness of total duration of 10 years. Initial symptoms were delusion of infidelity and persecution and 2^nd and 3^rd person auditory hallucination; however, the patient started reporting around 2 years back that she was pregnant and there were three female children inside her abdominal cavity rather than in uterus. She was firm on this belief and was not convinced by family members even giving evidence contrary to her belief like showing ultrasonography report. She firmly believed that these are gift of God, and they are special children who would be delivered through special procedure. Blood investigation revealed raised prolactin level, blood sugar and ultra sonography suggestive of cholelithisis. Patient's psychiatric symptoms including delusion of pregnancy were significantly improved with treatment, and medical and surgical comorbidities were managed with appropriate consultations.

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Background and Objectives: Assessment of cotinine, a metabolite of nicotine in body fluids, is an important approach for validating the self-report among tobacco users. Adaptation of assays on dried urine spots (DUSs) has advantages of ease of collection, transportation, minimal invasiveness, and requirement of small volume. The aim of the present study was to develop an efficient method for testing cotinine in DUSs and evaluating its clinical applicability. Methods: This involved optimization of conditions for detection, recovery, and stability of cotinine from dried urine, spotted on filter paper. Enzyme-linked immunosorbent assay was used for screening, whereas confirmation was done by gas chromatography. For clinical applicability, urine samples of tobacco users were tested. Results and Interpretation: Water was found to be a suitable extracting solvent as compared to carbonate-bicarbonate buffer (pH 9.2) and saline. Screening was achieved by two punches taken from a 20 μl (diameter 1.3 cm) spotted urine samples, and confirmation was achieved by five complete circles each of 20 μl sample volume. The recovery was found to be 97% in water. Limit of detection for the method was found to be 100 ng/ml. No signs of significant degradation were found under all storage conditions. All the urine samples of tobacco users were found to be positive by a conventional method as well as DUSs, and the method proved to be efficient. Conclusions: DUS samples are a useful alternative for biological monitoring of recent nicotine use, especially in developing countries where sample logistics could be an important concern.

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Objectives: The objective of this study was to develop a structured curriculum for a group-based parenting program for parents/caregivers of children or adolescents treated in the inpatient child and adolescent mental health unit of a national health institute. Methods: Data from group session reports of 3 years of conducting group-based parenting programs in the same setting were analyzed and prominent themes of discussions were shortlisted before finally arriving at a six-session group parenting program module. Results: A six-session intervention module was designed by psychiatric social workers experienced in group work. The content followed combination of various theoretical approaches and methodologies ultimately aiming in improving the overall knowledge and understanding of parents or caregivers on various child and adolescent mental health issues, and enhancing their skills and competence in dealing with various emotional and behavioral problems in children. Conclusion: Group-based parenting programs are found to be effective in improving the over psychosocial health of parents and the emotional and behavioral problems of children and adolescents as a result of better parenting. Development and standardization of culture appropriate group intervention curriculums would help in the development of this cost effective method as a medium of change.

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Adverse cutaneous reactions are known to occur with psychotropic medications, which may lead to poor drug compliance. As compared to other group of psychotropics, there is relatively scarce literature on olanzapine-induced skin eruptions. We present a case of a 39-year-old man diagnosed with first episode mania and alcohol dependence syndrome who was started on tablet olanzapine which leads to fixed drug eruptions. Exhaustive investigations were done, all of which came out within normal limits. A diagnosis of fixed drug eruptions was made by the dermatologist. The skin eruptions subsided after stopping olanzapine. It has, thus, been emphasized that clinicians should be aware of the potential cutaneous eruptions associated with olanzapine. Early detection of the same would lead to timely management and hence better compliance with the psychotropic treatment.

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Various brain areas in both cortical as well as subcortical locations are involved in pathological laughter. Pathological laughter may be seen as a prodromal symptom or acute manifestation or late sequel of stroke. Various other neuropsychiatric conditions attribute to stroke. It is often difficult to ascertain the cause of pathological laughter in the presence of multiple brain pathologies. Here, we highlight a case of a 55-year-old female, who had multiple episodes of stroke and subdural hematoma, presented with pathological laughter and other behavioral abnormalities.

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True and psychogenic nonepileptic seizures (PNES) go hand in hand. One colors the picture of other. Although it is thought that children carry lower risk for PNES than adults, this may represent the under-diagnosis of this condition in childhood due to few studies on this specific topic. Again, true seizure can be misdiagnosed by dramatic and varied manifestations appearing as psychological phenomena. We report a case of a 9-year-old boy presenting with sudden onset, short lasting, off and on different “melodramatic” episodic behavioral problems with La-Belle' indifference without loss of consciousness, appearing to be of psychogenic origin but finally ended with a diagnosis of temporal lobe epilepsy and responded dramatically with antiepileptics. The goal of this case report is to alert the reader to be cautious about rarer presentations of epilepsy and see each case holistically which may be misguided as PNES.

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Subacute sclerosing panencephalitis (SSPE) is a rare slowly progressing neurological illness. Although patients with SSPE initially present with symptoms such as myoclonic jerks, cognitive decline, and personality/behavioral changes usually, rarely pure psychiatric symptoms (e.g., mania, psychosis, and catatonia) have also been reported during the initial course of the illness. We report an unusual case of an adolescent with SSPE presenting with prominent positive psychotic and catatonic symptoms with the absence of classical symptoms of SSPE in initial course of illness and further discussed the relevant literature.

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