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Background: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. Aim: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. Materials and Methods: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). Results: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (

This study aimed to evaluate the prevalence of unipolar mania (UM) in a group of patients of bipolar disorder (BD). Additionally, effort was made to evaluate the demographic, clinical and treatment related factors, which distinguish subjects of UM from BD.Seven hundred and seventy-three patients with BD, of at least 10 years duration, recruited from 14 General Hospital Units of tertiary care centers from India were evaluated for UM.The prevalence of UM, varied from 5.4% to 20.3%, depending on the definition used. With the most stringent definition of ≥4 episodes of mania and at least 5 years of follow-up, the prevalence of UM was 5.4%. Compared to patients of BD, who have episodes other than mania too, those with UM had lower proportion of patients with lifetime history of suicide attempts, spent less time in the episodes in their lifetime and had lower severity of residual depressive and manic symptoms. Further, compared to those with episodes other than mania too, those with UM had higher number of manic episodes per year of illness, had higher proportion of patients who had more than five episodes in the lifetime and had higher proportion of those with at least one episode with psychotic symptoms in the lifetime.The present study suggests that a small proportion of patients with BD have UM course and this runs a different clinical course compared to that seen in patients with traditionally recognized as BD.

To evaluate the risk factors associated with lifetime suicide attempts in bipolar disorder (BD) patients.773 BD patients with a duration of illness of at least ten years, currently in clinical remission, were evaluated for suicidal attempts in their lifetime. Those with and without lifetime suicide attempt(s) were compared for various demographic and clinical risk factors.242 (31.3%) patients had a history of at least one lifetime suicide attempt. Compared to those without lifetime suicide attempts, those with suicidal attempts were less educated, were more often females, spent more time in episodes, and had a significantly more number of total episodes (in the lifetime, first five years of illness, and per year of illness), had significantly more number of total depressive episodes (in the lifetime, first five years of illness, and per year of illness), spent more time in depressive episodes, had more severe depressive episodes, more often had depression as the first episode in the lifetime, spent more time in mania/hypomania/mixed episodes, had higher residual depressive and manic symptoms, more often had rapid cycling affective disorder pattern in the lifetime, use of cannabis in dependence pattern, had poorer insight into their illness and had a higher level of disability (especially in three out of the four domains of Indian disability evaluation assessment scale).About one-third of the patients with BD have at least one-lifetime suicidal attempt, and those with suicide attempts usually have a poorer course of illness.

Introduction: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted “lockdowns” which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. Materials and Methods: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. Results: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. Conclusions: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

Dissociative disorders as described by ICD 10 include a range of disorders and combine what are conversion disorders (assumed under somatoform disorders in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and the cluster of dissociative disorders. The mutual idea shared by these disorders is a partial or complete loss of usual integration between memories, cognizance of identity, and immediate sensations and voluntary control of body movements. Conversion occurs when there are clinical symptoms representing alteration of functioning of motor or sensory systems and which do not follow a pattern of a known neurological or medical disease. Dissociation is a mechanism that allows the mind to compartmentalize certain memories or thoughts from normal consciousness. These split-off mental contents are available and may return to consciousness either by an event or spontaneously. Broadly, dissociative disorders may be viewed as shown in Table 1. Table 1 Types of dissociative disorders

Background:Rising population of elder people and associated rise in health problems, frailty and disabilities have significant socioeconomic and health care implications. Mental health related disability contributes significantly in the global disability statistics and is an important health and quality of life indicator. Assessment of disabilities in elderly is essential part of routine evaluation, further it also helps the clinicians in identifying current functional status and choosing and monitoring therapeutic interventions and need for social welfare schemes.Methods:In order to understand the process of disability assessment in geriatric psychiatry and to gather information about social welfare schemes a literature review in Google Scholar and PubMed electronic database, and website of various ministries under Government of India was done, using developed key search terms for articles published up to February 2021. The identified eligible articles were reviewed for ideas and concepts, which were then integrated and categorized under broader themes. Finally, the broad categories were discussed briefly based on the above framework.Results:Review findings are summarized under the following headings: concept of ageing and disability, assessment of disability, process of certification, and social welfare schemes.Conclusions:The process of disability assessment comprises of comprehensive clinical evaluation, use of standardized rating instruments and disability certification wherever warranted or asked for. It is now being acknowledged worldwide by provisions of various social welfare benefits, that living with disability and increased care needs should be an integral part of definition of successful ageing.

Aim of the Study: This study aimed to evaluate the prevalence and risk factors for suicidal ideations (SIs) and suicidal attempts (SAs) among elderly patients with depression, seeking treatment in psychiatric setups. Methodology: The study sample comprised 488 elderly patients (age ≥60 years) with depression recruited across eight centers. These patients were evaluated on the Columbia Suicide Severity Rating Scale, Geriatric Depression Scale-30, Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-15 Scale, UCLA Loneliness Scale, Revised Social Connectedness Scale, and Montreal Cognitive Assessment Scale. Results: “Wish to die” was present in one-fifth (21.7%) and about one-fourth (26.6%) of the study samples at the time of assessment and in the lifetime, respectively. Overall, one-fourth (25.8%; n = 126) of the participants had SIs at the time of assessment and two-fifths (41.5%; n = 203) had SIs in the lifetime. Overall, about one-tenth (9.2%) of the participants made an SA just before assessment and one-sixth (16.6%) had at least one SA in the lifetime. Compared to those with no SIs in the lifetime, those with current and lifetime SIs had lower age of onset and longer duration of illness, less often had a comorbid physical illness, more often had recurrent depressive disorder, had significantly higher anxiety as assessed on GAD-7 scale, and had significantly higher prevalence of loneliness and significantly higher prevalence of cognitive deficits. When those with any current and lifetime SAs and those with no lifetime SAs were compared, those with SAs had longer duration of current treatment and more often had comorbid physical illness and significantly higher cognitive deficits. Conclusions: The present study suggests that about one-fourth (25.8%) of the elderly with depression have SIs at the time of assessment and about two-fifths (41.5%) have lifetime SIs. About one-sixth of the elderly patients with depression make at least one SA in the lifetime and about one-tenth attempt suicide in recent past. In terms of risk factors for SIs and SAs, the present study suggests that the presence of comorbid anxiety, loneliness, and cognitive deficits possibly predispose the elderly to suicidal behaviors.

Aim: To evaluate the prescription pattern of patients with BD, currently in clinical remission. Additional aim of the study was tocompare the prescription pattern across different study centres. Methodology:Prescription of 773 patients, currently in clinical remission, recruited from the outpatient setting of 14 General Hospital Tertiary Care Units of tertiary care centres in the country were evaluated. Results Almost all (98.1%) participants were on medications at the time of assessment. In terms of conventional mood stabilizers, those receiving valproate (44.2%), out-numbered those receiving lithium (38.9%). A small proportion (7.4%) was receiving a combination of both valproate and lithium. About two-third (62.5%) were receiving at least one antipsychotic medication, with olanzapine (31.7%) being the most commonly prescribed antipsychotic, followed by quetiapine (11.1%), and risperidone (9.6%). About one-third (34.4%) of the participants were receiving antidepressants, with sertraline (22.6%) forming bulk of the prescription. Less than half (43.9%) of the participants were also receiving a benzodiazepine medication at the time of assessment, with chlordiazepoxide (18%) being the most common agent, followed by clonazepam (14.5%). There was variation in the prescription patterns across different centres, in terms of monotherapy, polypharmacy, use of preferred conventional mood stabilizers, use of various antipsychotics and antidepressants. Conclusion: Besides conventional mood stabilizers, about two-third of patients with bipolar disorder received concomitant antipsychotics, one-third received concomitant antidepressants and less than half received benzodiazepines.

Objective To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India. Methods The management of pregnant women with COVID-19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID-19 hospital in India. Results Using a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory-confirmed COVID-19. A sustainable model is established for providing services to pregnant women with COVID-19 in Mumbai Metropolitan Region, India. Conclusion With limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID-19 settings. This COVID-19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID-19. The model established in the present study can be replicated in other low- and middle-income countries.

Objectives This multicentric study from India aimed to evaluate the long term course and outcome of bipolar disorder (BD). Method Seven hundred and seventy-three participants diagnosed with BD, attending 14 outpatient clinic centers across the country, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the long term course of BD. Results The mean age of onset of the first episode of illness of the study sample was 26.3 (8.54) years, and mean duration of illness at the time of assessment was 233.05 (94.55) months. In terms of the total number of lifetime episodes, the mean number of manic episodes (mean: 3.68; SD: 4.75) exceeded the mean number of depressive episodes (mean: 3.36; SD: 5.51). The mean numbers of total lifetime episodes were 8.58 (10.6%). When the number of episodes per year was computed, the mean number of manic episodes per year exceeded that of the mean number of depressive episodes. Compared to females, a higher proportion of males had a history of comorbid substance dependence. Limitations The course was assessed retrospectively and the study was limited to participants attending the outpatient clinics. Conclusions The course of BD in India differs from that described from developed countries in the form of a number of manic episodes exceeding the depressive episodes.

To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD).A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability.About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate.About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.

India is currently home to 104 million elder, which comprise about 8.6% of the population of the country. This is only projected to increase to 20% by the year 2050. Among all elder in India, one in ten resides in Maharashtra. In addition, majority of the oldest old (above 80 years) reside in the state of Maharashtra. All these make it very important for the Government of Maharashtra to have a plan for elder care, besides the existing national policies. Ideal geriatric care services should be accessible, goal oriented, comprehensive, and accountable. Further, they should be integrated in the community for basic needs and also deliver specialty care. Maharashtra lacks in training, infrastructure, awareness of present schemes and policies, and implementation and execution of the National Programme for Health Care for the Elderly. Considering that we house the largest number of elder individuals in the country, it is time the state government took measures to implement urgent changes for elder care.

Introduction: Undertaking a research project is mandatory for MD Psychiatry trainees. The present study was undertaken to assess the type of research activity being undertaken as part of MD Psychiatry dissertation, and its contribution to national and international literature. Materials and Methods: Three medical colleges supplied the data about the topic, names of the supervisor and the candidate, collaboration, funding accrued, and publication details of MD-based research carried out between years 2000 and 2010 inclusive; 95 records were collected for the final analysis. The details of the publications provided were cross-checked on the internet, which would have taken care of missed publications as well. Results: Most studies were single-point assessment clinical studies. Only 2 studies had been funded, 11 had collaboration with other departments within the same institute, and 5 had inter-institute collaborations. Majority of the studies were not published. Only 30 were published as full paper and 9 as abstracts. Of these 30 full publications, only 3 were published in journals having JCI impact factor values (1.4, 1.3, and 1.4, respectively). Conclusions: The main finding of this pilot study was that MD-based research has low contribution to the national and international literature, and those articles which are published are in low impact journals. Suggestions for modifying this state of affairs are discussed.

Background: In the current era, the use of electronic media in the form of Internet has increased exponentially, particularly among children, and has led to their excessive involvement in Internet. In this context, attention-deficit hyperactivity disorder (ADHD) children were found to have increased tendency for this addiction. Aims and Objectives: The aim is to study and compare Internet addiction between ADHD and normal children and the relation of demographic profile to Internet addiction. Materials and Methods: This was a cross-sectional study including 100 children (50 ADHD cases and 50 normal children without any psychiatric illness as controls) between the ages of 8 and 16 years. A semi-structured pro forma for demographic profile and Internet usage using Young's Internet Addiction Test (YIAT) was used. Statistical analysis was done using SPSS 20. Results: Internet addiction among ADHD children was 56% (54% having “probable Internet addiction” and 2% having “definite Internet addiction”). This was statistically significant (P < 0.05) in comparison with normal children where only 12% had Internet addiction (all 12% had “probable Internet addiction”). ADHD children were 9.3 times more prone to the development of Internet addiction as compared to normal (odds ratio – 9.3). Significant increase in average duration of Internet usage in ADHD children with increasing score of YIAT (P < 0.05) was seen. The incidence of Internet addiction was more in male ADHD children as compared to normal (P < 0.05). Conclusions: ADHD children are more prone to Internet addiction as compared to normal children and thus require preventive strategies.

Aim To explore the prevalence of residual symptoms (both depressive and manic) and their correlates in subjects with bipolar disorder in clinical remission. Methodology This multicentric cross-sectional study included patients in clinical remission recruited across the 14 centers. The patients were evaluated on the Hamilton Depression Rating Scale (HDRS) and Young Mania Rating Scale (YMRS) for the prevalence of residual symptoms. A score of ≤7 on both scales defined the presence of residual symptoms. Results Four-fifth (79.8%) of the participants had residual symptoms, with 130 (16.8%) having only residual depressive symptoms, 74 (9.6%) having only residual manic symptoms, and 413 (53.4%) having both depressive and manic residual symptoms, on HDRS and YMRS. The residual symptoms were related to the polarity of the most recent episode and the lifetime predominant polarity. Higher numbers of lifetime depressive episodes are associated with higher residual depressive symptoms, and higher numbers of lifetime manic episodes are associated with higher chances of having residual manic symptoms. Conclusions A large proportion of patients with bipolar disorder have residual symptoms during the remission phase. Clinicians need to make efforts to identify and address the same to improve the treatment outcome.

Aim This cross-sectional study aimed to assess the predominant polarity (PP) in patients with bipolar disorder (BD) and the factors associated with PP. Methodology For this study, 773 participants with at least 10 years of illness, were recruited from 14 centres, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the course of illness and PP was determined by both Barcelona proposal and the Harvard Index. Results According to Barcelona proposal for PP, 20.6% of the patients belonged to depressive PP, 45.8% belonged to manic PP and 33.6% belonged to indeterminate polarity. According to Harvard index of PP, 31.6% of the patients belonged to depressive PP, 56.1% belonged to manic polarity and 12.3% of the patients could not be categorized into any of these categories and hence, were considered to have indeterminate polarity. Those with depressive PP were more often having BD-II, had later age of onset, spent more time in episodes, had higher residual depressive symptoms, had lower residual manic symptoms, more often had depression as the first lifetime episode, and less often had at least one psychotic episode. Conclusion In the Indian subcontinent, although the prevalence of PP is influenced by the definition used, the most common PP is that of mania.

Drug-resistant epileptic encephalopathy such as Dravet syndrome presents with autistic symptoms. Three cases with autism spectrum disorder with comorbid Dravet syndrome were assessed. All the cases presented with onset of seizures before a year and with autistic features. The patients responded to a combination of antiepileptic drugs (AEDs), resulting in reduced frequency of seizures and behavioral issues. Contrary to the belief that both epilepsy and use of AEDs have adverse impact on the cognition of children with an early onset of epilepsy, we found improvement in the symptoms of our patients who presented with autism and epilepsy. Primary treatment approaches such as occupational therapy, special education, speech therapy, and behavioral therapy; effective diagnosis of comorbidities such as epilepsy; and aggressive treatment might help with behavioral improvement. Early diagnosis followed by treatment with AEDs can improve seizures, electroencephalography abnormalities, and behavioral problems.

These guidelines have been framed after an amalgamation of expert guidelines across the globe, and existing practices in India, as outlined by experts in the field. Due to the lack of systematic research in the field of autism in India, the evidence of the said practices is not documented, which becomes a limitation of these guidelines. The good part is that India has an indigenous tool for assessment, which has been recommended by the Government of India, which we have attached as an Appendix 1. Autism has till date always been viewed as an illness from the medical model, and hunt for a “cure” has been the norm. With the increase in awareness and available therapies, the focus shifted to disability and inclusion. However, as more autistic individuals express themselves and their needs, the focus now has shifted from the medical model to the social model of neurodiversity, thereby implying that autism is actually a variant of normal human development and human diversity. The next decade will probably see how best the two paradigms can be aligned to destigmatize and integrate autistic individuals into society at large. Keeping the above in mind, the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) shifted from grouping the disorders as separate diagnoses under the umbrella of pervasive developmental disorders (PDDs) to conceptualizing them as all members of the broader category of known as autism spectrum disorder (ASD). The number of core domain deficits was reduced to two (social communication and repetitive behavior). ASD would now be diagnosed when a patient demonstrated at least three symptoms in the domain of social communication and at least two symptoms of restricted interests/repetitive behaviors; including an added behavior of hyper-or hypo-reactivity to sensory input or unusual interests in sensory aspects of the environment [Table 1]. Table 1 Diagnostic and statistical manual of mental disorders -IV-TR versus diagnostic and statistical manual of mental disorders - 5

The advent of the COVID-19 pandemic saw the deputation of postgraduate residents all over the country to round the clock COVID duties. Residents from various departments came together to face the pandemic as a team. This impacted their daily routines, studies, and exams. It carried with itself uncertainties in both their professional and personal lives. Nonetheless, all residents rose to the challenge at hand. This commentary discusses their predicament during the COVID-19 pandemic and highlights suggestions for some of the problems they faced.

Background: Psychiatric co-morbidity along with other disease and treatment related factors including treatment modality (i.e. insulin versus oral agents) affect the quality of life of diabetic patients significantly. The aim and objectives of the study was to study psychiatric morbidity and quality of life and relationship between these factors in patients of type-2 diabetes being treated with insulin versus oral hypoglycemics. Methods: A cross sectional study with patients of type-2 diabetes 50 each taking insulin and oral hypoglycemics was carried out in the endocrinology outpatient department and wards of the tertiary teaching municipal medical institute in Mumbai. Subjects were assessed using QOLID (quality of life instrument for Indian diabetic patients) and SCL-90R (symptoms checklist 90 revised). Software used was SPSS-19. Data was analyzed using Pearson’s bivariate correlation and unpaired t-test according to applicability. Results: 76% of subjects on insulin while 82% on oral hypoglycemics had satisfactory quality of life. There was no statistically significant difference in the two groups on quality of life. (t= -1.130, p=0.261). 46% of patients on insulin and 40% on oral hypoglycemics had significant psychopathology. Highest scores were found on depression, somatization and obsessive compulsive symptoms in both groups; however there was no significant difference in the two groups on either global score or the subscales of SCL-90R. Increase in psychopathology was associated with decrease in quality of life (negative correlation) in diabetics as a whole (R= -0.748, p=0.000) as well as on all subscales. Female gender was associated with better quality of life while male gender, age, duration of illness, blood glucose levels and presence of associated complications with poor QOL. Conclusion: Treatment modality does not seem to affect quality of life or psychopathology in diabetic patients and increased psychopathology is associated with poor quality life in them.

Background: Families of children with disabilities otherwise experience higher stress; and relation between parenting styles and coping of children is well known. Parental factors and family functioning may play a role in shaping the child, especially having issues like SLD. The objective is to study was coping strategies of children with SLD, parenting styles of their parents, their family functioning and relation of these with each other.Methods: It is a cross-sectional study undertaken after Institutional Ethics Committee approval, parent’s consent and child’s assent. Participants were 100 consecutive children, diagnosed with SLD, 9-13 years of age. Tools used were: Semi-structured proforma, Parenting Practices Questionnaire, Family Assessment Device and Children’s Coping Strategies Checklist Revision 1.Results: Authoritarian parenting style was significantly was associated with less use of ‘active’ and ‘support seeking’; and increased use of ‘distraction’ and ‘avoidance’ strategies. High scores on Authoritative style was associated with ‘active’ and ‘support seeking’ strategies. Avoidance coping strategy was associated with poor (high scores) and active coping strategies with higher (low scores) on problem solving, communication, and general family functioning.Conclusions: Parenting practices and family functioning can be pivotal in determining child’s attitude and coping. Assessment of this can be routinely included in child evaluation.

Background: Biological approaches tend to treat love as a brain generated physiological process like hunger or thirst. On the other hand, psychologists have created many descriptive theories of love in an effort to understand the full range of experience and behaviours associated with love. One of the most prominent and interesting models is the John Alan Lee’s theory called “love styles”. According to him, there are six love styles, named: eros, ludus, storge, pragmatic, maniac, and agape. Aims and objectives: This study aimed to assess the love styles of young adults and assess its relationship with their personality traits. Materials and methods: A total of 120 young adults were taken as the sample using purposive sampling technique. Socio-demographic profile, relationship status, and attitude towards sex were assessed through semi-structured questionnaire. Love Attitude Scale was applied and clinical assessment of personality traits was done using the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) after taking their informed consent. Data was pooled and statistical analysis was done, using analysis of variance (ANOVA) and chi-square tests. Results: The most preferred love style in the study population was eros, while the least preferred was ludus. Extramarital relationship and premarital sex was positively associated with ludus love style. Subjects with borderline and narcissistic personality traits scored significantly high on the ludus love styles. Conclusion: Love styles differ between the two sexes and also changes with their age. Personality trait influences the love style of a person.

Background: Elderly patients presenting with cognitive and depressive symptoms often create a diagnostic challenge between depression and the dementing process. Various screening and diagnostic instruments have been developed for differentiating the two, one of which is Addenbrooke's cognitive examination (ACE). However, results have not been consistent across various studies, and not much data is available in the Indian context. Aims and Objectives: To study cognition in elderly patients presenting with both cognitive and depressive symptoms at the baseline and at 3 months follow-up after starting antidepressants, and to compare the two profiles. Materials and Methods: It was a follow-up study with 70 participants who had presented with both depressive and cognitive symptoms. Tablet escitalopram was given and ACE was performed at the baseline and at 3 months after starting antidepressants. Improvement on ACE was present in 37 participants and absent in 33 participants. The cognitive profile of these two groups was subjected to statistical analysis. Wilcoxon signed-rank test was used to study the difference between the full and domain ACE scores between the preintervention phase and postintervention phase within each group. Results: There is a significant difference between preintervention and postintervention full ACE scores and different domain scores in the depression group unlike in the MCI group. Conclusion: Diagnostic tools such as ACE can be utilized for differentiating mood disorder with an actual dementing process. It also reveals the need for periodic assessments of such patients.

Background: Stigma is very common among caregivers of patients with severe mental disorder; however, there is lack of national level data from India. Aim: To assess affiliate stigma and its correlates among caregivers of patients with severe mental disorders. Method: For this, caregivers of patients with schizophrenia ( N = 707), bipolar disorder ( N = 344) and recurrent depressive disorder ( N = 352) were assessed on Stigma scale for Caregivers of People with Mental Illness and General Health Questionnaire. Results: Caregivers of patients with schizophrenia reported significantly higher stigma than patients with bipolar disorder and recurrent depressive disorder. Caregiver of patients with bipolar disorder reported significantly greater stigma than the caregivers of patients with recurrent depressive disorder. Higher caregiver stigma in all the diagnostic groups was associated with higher psychological morbidity in caregivers. Higher stigma in caregivers of schizophrenia was seen when the patient had younger age of onset and longer duration of treatment. In the bipolar disorder group, higher stigma in caregivers was seen when patient had higher residual manic symptoms. Conclusion: This study suggests that caregivers of patients with schizophrenia experience higher stigma than the caregivers of patients with bipolar disorder and recurrent depressive disorder. Higher stigma is associated with higher psychological morbidity in the caregivers. Therefore, the clinicians managing patients with severe mental disorders must focus on stigma and psychological distress among the caregivers and plan intervention strategies to reduce stigma.