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Aim and Objectives: Although inclusive education of children with intellectual disability is currently an accepted practice, it is often challenged by negative attitude of schoolteachers. We undertook two surveillance studies aimed at Study A - identifying knowledge and teachers' attitudes towards children with intellectual disability and practices of inclusive education in a semi-urban school of South India. Study B -Determining the effect of educational intervention towards attitudes on inclusive education. Method: Knowledge, Attitude and Practice surveillance questionnaires (KAP and ATPD) were given to ninety-six consenting schoolteachers in Study A and twenty schoolteachers in Study B and analyzed. Results: In Study A, the overall attitude mean indicated a favorable attitude towards the children with intellectual disability. The mean overall attitude score was 77.1 (SD: 9.58), with a normal distribution. Forty to fifty percent were aware of intellectual disability and attributed them to biological causes. Ninety-two percent agreed on the need for education and stepwise training for a child with an intellectual disability. In real-life practice, results of classroom management were inaccurate. In Study B, knowledge, attitudes and practices towards inclusive education improved with educational intervention with a positive change of 7.19% on the ATDP scale. Conclusion: These findings suggest a generally positive attitude towards intellectual disability and inclusive education. Comprehensive training programs improve knowledge and attitudes towards inclusive education.

Background: Medical interns have 2 weeks compulsory internship in psychiatry. Aim: We tried to explore their learning and views about psychiatry during these 2 weeks. To document verbatim their account about the knowledge gained and their experiences during the psychiatry internship posting and derive prominent themes. Methods: Focus group discussion was conducted at the end of the posting using a semistructured questionnaire for seven consecutive batches of interns posted in psychiatry. To enhance trustworthiness, we utilized member checking, data triangulation, and peer debriefing. Their routine during posting, competencies, expectations from the posting, and frustrations were the main points discussed. The interns willingly participated and discussed their views about psychiatry posting. Results: They were aware of psychiatry as an important medical discipline and had a fair degree of knowledge about it. Most of them found the posting useful. The interns had not attained the required competencies in handling emergencies and use of psychiatric drugs. Conclusion: Involvement of senior faculty and formative assessments will be necessary in the training of medical interns. This can ensure that they gain the required competencies. [ABSTRACT FROM AUTHOR]

Background: Clozapine has well-documented inter-ethnic variations in pharmacokinetics. There is a paucity of data about clozapine use and associated adverse events such as seizures, obsessive compulsive symptoms, neutropenia, and agranulocytosis, from India. Methods: This retrospective cohort study followed up 228 patients initiated on clozapine in a tertiary care referral center in India for an average of 10 years. We calculated incidence rates of new-onset seizures, new-onset obsessive compulsive symptoms, agranulocytosis, and neutropenia. We collected data on doses of clozapine used and serum assays and calculated concentration-to-dose (C/D) ratios. We also collected relevant clinical details about clozapine-induced seizures. Results: In the sample, 16.8% had new-onset seizures, 12.3% had new-onset OC symptoms, 2.7% had neutropenia, and 0.9% had agranulocytosis. The mean C/D ratio was 2.09 (SD = 1.8). Almost half (46.3%) of available serum assays were in the supra-therapeutic range. Seizures were associated with a higher clozapine dose at one year (OR = 1.003; 95%CI = 1.000–1.006; P value = 0.045) and the presence of positive psychotic symptoms at one year (OR = 4.214; 95%CI = 1.894–9.373; P < 0.001). Conclusion: Compared to existing literature, Indians have a higher rate of clozapine- related seizures and need lower doses to reach therapeutic serum levels. [ABSTRACT FROM AUTHOR]

There is high prevalence of psychological distress in patients diagnosed with neurological disorders. A cross-sectional study was done among inpatients from the department of neurology in a tertiary care centre in South India to assess prevalence of anxiety, depression, and barriers to mental health-care utilization. Anxiety and depression were estimated using the Hospital Anxiety and Depression Scale (HADS). There is a high prevalence of psychological distress among the study participants. Proactive inquiry and screening of distress by the treating team may help identify psychological distress. Patients are more conforming and open to treating doctor. Barriers to mental health-care utilization included stigma, patient perception regarding treating doctor's attitude, patients' perception regarding distress, and doctor's perception regarding patient distress. There is a need for measures to alleviate stigma. [ABSTRACT FROM AUTHOR]

Some of the biggest challenges in clinical practice remain in understanding all aspects that affect the person presenting in ill-health. One of the challenges is in explaining medical concepts to patients. Analogies can be an effective tool of the therapeutic armamentarium. This article elucidates a theory of analogies, principles of effective analogies in clinical practice, steps in discussing analogies, examples, and implications in clinical practice. [ABSTRACT FROM AUTHOR]

A 48-year-old man who is a known case of bipolar disorder was maintaining well on a combination of carbamazepine and quetiapine for 3 years until he developed fever, severe leucopenia and lymphadenopathy, along with significant loss of weight and appetite. A thorough investigation revealed Kikuchi’s disease as a likely histological diagnosis. Carbamazepine was discontinued and quetiapine was titrated for the management of psychiatric symptoms. The patient gradually made good recovery following discontinuation of carbamazepine and the diagnosis of drug-induced myelosuppression was retained. Clinicians need to be aware of the adverse effects of medications being used for long-term prophylaxis and other possible conditions that may change the course of drug effects [ABSTRACT FROM AUTHOR]

Objective To compare the efficacy and safety of 2% ketoconazole soap in treatment of tinea versicolor (TV) and to compare it with stat 400mg dose of ketoconazole. Methods Patients of TV confirmed by potassium hydroxide (KOH) mount were divided by block randomization into 2 groups. Group 1 received 400mg of oral ketoconazole single dose and a non-medicated soap for daily bath. Group 2 received 2% ketoconazole soap for daily bath. The lather from the soap while bathing was to be left on the skin for 3 minutes. Patients were assessed at the end one month and KOH repeated from index lesion. Results Twelve patients out of 25 completed the study, 6 in each group. Four patients (66%) were mycologically cured in group 1 while two patients (34%) were mycologically cured in group 2. All these patients were compliant with the usage of soap. Conclusion Ketoconazole soap is at best an adjunct in the treatment of TV. It might however be useful in the prophylactic management of patients with chronic TV as bathing is almost a daily routine in most patients especially in tropics. Further studies are required in this aspect. [ABSTRACT FROM AUTHOR]