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BackgroundThe aim of the current study was to explore the effect of gender, age at onset, and duration on the long-term course of schizophrenia.MethodsTwenty-nine centers from 25 countries representing all continents participated in the study that included 2358 patients aged 37.21 ± 11.87 years with a DSM-IV or DSM-5 diagnosis of schizophrenia; the Positive and Negative Syndrome Scale as well as relevant clinicodemographic data were gathered. Analysis of variance and analysis of covariance were used, and the methodology corrected for the presence of potentially confounding effects.ResultsThere was a 3-year later age at onset for females (P P P P = .001). No significant effects were found concerning duration of illness.DiscussionOur results confirmed a later onset and a possibly more benign course and outcome in females. Age at onset manifested a single peak in both genders, and surprisingly, earlier onset was related to a slower progression of the illness. No effect of duration has been detected. These results are partially in accord with the literature, but they also differ as a consequence of the different starting point of our methodology (a novel staging model), which in our opinion precluded the impact of confounding effects. Future research should focus on the therapeutic policy and implications of these results in more representative samples.

Telepsychiatry and telepsychotherapy are new treatment modalities that have been used more than ever during the COVID-19 pandemic. There are many challenges that are faced with the use of this modality for both patients and psychiatrists alike. There are critical issues faced with regard to the development of rapport, managing the entire teleconsultation set up, privacy and issues related to fees, issues related to prescribing and monitoring, and issues while handling emergencies. The challenges faced are discussed and some solutions if possible are laid out.

The main purpose of this review is to elucidate the interplay of various factors in the relationship between suicide and schizophrenia. Suicide and schizophrenia have been interlinked as a symptom, factor in recovery and prognosis, outcome measure and response to psychotic symptoms in patients with schizophrenia. Many biomarkers have been identified in relation to the two phenomena. The analysis of the papers of the last 5 years (2015–2019) and till date has revealed studies looking at outcomes in relation to suicide, biological markers to determine the protection from and occurrence of suicide in schizophrenia and demographic factors that play a role in the occurrence of suicide in patients with schizophrenia. Suicide is a common occurrence in patients with schizophrenia and must be studied further in diverse populations of the disorder to help determine exact relationships between these two variables that will aid in clinical recovery, better outcome and improve prognosis.

BackgroundThe aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.MethodsTwenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.ResultsThe results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.ConclusionsThe current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

Stigma is neither new nor an isolated condition for people suffering from mental as well as physical disorders. It is regrettable that scientists, researcher, philosophers, and community leaders have been silent for a long time in recognizing and dealing with it. However, during the past 20–30 years, significant progress has taken place in stigma research, the world over including India. From research done in India, there is clear evidence that: stigma is not merely a social condition. Convergence of social, mental, and physical disorders around stigma has far-reaching consequences on risk and health outcomes. The present paper looks at the position of stigma in mental health from an Indian perspective. The research done on stigma in India is reviewed, and certain recommendation for the management and eradication of stigma are elucidated. Stigma in specific conditions such as schizophrenia, substance abuse, and child sexual abuse are also addressed. The WHO guidelines and Mayo clinic guidelines to eradicate are used as a basis to be applicable to the Indian scenario. We examine how a life of an individual is affected with stigma, how mental health advancement has changed or not changed negative impact of stigma on patients and finally how stigma is measured and minimized, mainly for work done in India.

Schizophrenia is a complex disorder and there are many intricate facets to its management. And the present chapter discusses how. While schizophrenia remains a complex disorder, it may serve as a learning curve for personal therapeutic and professional growth of a psychiatrist. The nature of the disorder, variances in its presentations, the varied symptom profiles and course, as well as prognosis all serve to complicate its management and outcome. The conundrum of poor insight coupled with the presence of negative symptoms that may be non-amenable to routine treatments makes recovery difficult. The role of medications while defined puts on the treating doctor the task of finding the right combination that would work for a patient while having minimal side effects and maximal improvement. Psychotherapy for schizophrenia has not yet been defined well, and there is a need for this approach combined with medical management. Difficulty in the psychotherapeutic management of schizophrenia is discussed. It is also very difficult for psychiatrists to keep abreast of the latest developments in neurobiology and genetics and translating the same into clinical practice. Research is moving at a fast pace and one cannot keep up to date with a busy clinical practice. The effect of treatment settings, religion, and myths is also laid out, with a final touch on the vagaries of the doctor–patient relationship in schizophrenia. Thus, schizophrenia as a disorder is a learning curve for most psychiatrists, and this curve moves as one grows in experience.

Mental illness is fraught with stigma worldwide. The current chapter looks at stigma as a factor in recovery from mental illness, especially schizophrenia. The chapter outlines the concept of stigma and the types of stigma that may plague patients with schizophrenia and mental illness. The various aspects of stigma in India and the West and factors such as age, social support, duration of illness, marriage, and gender that affect stigma and recovery are outlined. Certain studies of importance are discussed. The various methods and scales used to measure stigma are also discussed along with special reference for stigma as a factor in recovery from schizophrenia. Anti-stigma interventions that have been successful in schizophrenia are outlined, and factors that determine successful elimination of stigma are elaborated.

This chapter is a clinical overview of resilience as a measure of outcome and recovery in schizophrenia. The chapter starts with an elucidation of the concept of resilience as applied in psychiatry. The basic neurobiology of resilience and resilience as a psychobiological construct for the pathogenesis of psychiatric disorders is discussed. This is followed by a discussion of specific factors in the neurobiology and genetics of mechanisms that enhance resilience and also play a role in the recovery from schizophrenia. Studies in the realm of schizophrenia and resilience (both long term and short term) and neuroimaging data are discussed, and certain points of relevance from a clinical perspective for resilience and recovery from schizophrenia are discussed.

Understanding of the psychopathology of various psychiatric disorders is evolving, with newer avenues of research enlightening us from genetics, epigenetics, functional neurobiology, neural circuits, hormones and social/environmental determinants. We are now aware that neurobiological factors are contributing to the development of psychiatric illnesses coupled with their interaction with psychosocial factors. Resilience is defined as the ability to bounce back after an adversity or life event that was traumatic and life-changing. It is a factor that is a unique psychopathological construct as it is a biopsychosocial factor which determines an individual's response to an illness and recovery from the same. Resilience is a human capacity to adapt swiftly and successfully to stress and to revert to a positive state. There has been now a paradigm shift in the understanding of resilience with respect to stress risk vulnerability and such dimensions of psychopathology. Resilience is a factor that must be evaluated in every patient and that shall help us determine the outcome of psychiatric disorders and will also be a determinant in the occurrence of relapses. Early identification of vulnerable patients shall lead to the implementation of resilience-based interventions in these populations and shall prevent against future occurrence of these disorders. In this chapter, we posit the construct of resilience as a psychopathological construct for mental disorders.

Human beings possess the power to resist an adverse situation and this unique characteristic is one of the basic instinct to survive. Individual capacity to deal with insurmountable adversities is a matter of great astonishment. Often physical capacity fails but drive and conviction to survive in difficult situations persist and remains source of strength. In language of understanding it is referred to an internal capacity to fight. A number of people refer to this as ‘resilience’. There are about seventy definitions of the term resilience. The Oxford dictionary defines it as ‘the capacity to recover quickly from difficulties and toughness’. Considering most of the references to tern resilience it appears to be ‘human capacity to deal with adverse situations and quickly bounce back to normalcy’.

Child sexual abuse (CSA) is an important public health problem with long-standing neurobiological, developmental, and psychiatric abnormalities. The present review analyzes the long-term effects of CSA from a developmental, psychiatric morbidity, neurochemical and neurobiological perspective and then tries to posit a developmental neurobiological trajectory from CSA to the genesis of psychopathology in later life. The role of various neurotransmitters such as serotonin and dopamine affected by CSA are discussed. Serotonin abnormalities have been reported in various studies among participants exposed to CSA. Structures such as the prefrontal cortex, superior temporal gyrus, corpus callosum, parietal lobes, hippocampus, and cerebellum all demonstrate volumetric and structural changes in response to the trauma of CSA. Neurocognitive studies demonstrate memory and spatial awareness as well as decrements in general cognitive performance and memory when compared to normal individuals. The hypothalamic-pituitary-adrenal axis has also been implicated in CSA, and there is an alteration in corticotropin-releasing hormone response due to the continuous cumulative trauma of CSA. This paper also reviews a section on the role of genetic and epigenetic factors in the development of psychiatric disorders as a result of exposure to episodes of CSA where studies have demonstrated changes in DNA methylation in response to CSA. This review tries to hypothesize a developmental trajectory framework which is individual for every case where exposure to CSA may lead to psychopathology and psychiatric morbidity later in life. Rapid and emerging fields such as developmental traumatology in relation to CSA are also discussed.

Recovery rates and relapse in schizophrenia is ever increasing despite advances in treatments that are available. Schizophrenia is a disorder that has its fair share of disability and distress related to physical and medical comorbidity that occurs. There is a need for non medical interventions in schizophrenia that focus on wellness with the aim of enhancing the overall quality of life of both the patients and their caregivers. Wellness based interventions shall focus on cultivating a positive mindset, enhancing optimism and resilience and building strengths for better self esteem and confidence in combating the stress and turmoil associated with schizophrenia. This shall aid better recovery and shall enhance the quality of life of patients in the years to come.

Attenuated psychosis syndromes (APS) is a common condition that has been recognized in clinical settings in India. The following chapter addresses various issues in APS as seen in Indian clinical practice and the various ways in which these cases present. There are many common clinical scenarios that may lead to identification of the condition in India. Culturally sensitive factors that may serve as deterrents from seeking help and treatment are discussed, and the role of faith healers in the management of these patients is elaborated. The various types of treatment facilities available in India and methods commonly used in treatment are discussed. Personal-, social-, cultural-, and treatment-related factors that promote resolution or prevent development of APS in India are addressed. Assessment procedures for clinical evaluation and diagnosis of the condition are discussed along with components of psychoeducation that can be carried out with caregivers. Various treatment methods adopted and the course and prognosis of APS are presented from an Indian perspective.

M.B. is supported by a NHMRC Senior Principal Research Fellowship (APP1059660 and APP1156072). All authors contributed equally., Fountoulakis, K.N., Dragioti, E., Theofilidis, A.T., Wikilund, T., Atmatzidis, X., Nimatoudis, I., Thys, E., Wampers, M., Hranov, L., Hristova, T., Aptalidis, D., Milev, R., Iftene, F., Spaniel, F., Knytl, P., Furstova, P., From, T., Karlsson, H., Walta, M., Salokangas, R.K.R., Azorin, J.-M., Bouniard, J., Montant, J., Juckel, G., Haussleiter, I.S., Douzenis, A., Michopoulos, I., Ferentinos, P., Smyrnis, N., Mantonakis, L., Nemes, Z., Gonda, X., Vajda, D., Juhasz, A., Shrivastava, A., Waddington, J., Pompili, M., Comparelli, A., Corigliano, V., Rancans, E., Navickas, A., Hilbig, J., Bukelskis, L., Injac Stevovic, L., Vodopic, S., Esan, O., Oladele, O., Osunbote, C., Rybakowski, J.Κ., Wojciak, P., Domowicz, K., Figueira, M.L., Linhares, L., Crawford, J., Panfil, A.-L., Smirnova, D., Izmailova, O., Lecic-Tosevski, D., Temmingh, H., Howells, F., Bobes, J., Garcia-Portilla, M.P., García-Alvarez, L., Erzin, G., Karadaǧ, H., De Sousa, A., Bendre, A., Hoschl, C., Bredicean, C., Papava, I., Vukovic, O., Pejuskovic, B., Russell, V., Athanasiadis, L., Konsta, A., Stein, D., Berk, M., Dean, O., Tandon, R., Kasper, S., De Hert, M.

Understanding of the psychopathology of various psychiatric disorders is evolving, with newer avenues of research enlightening us from genetics, epigenetics, functional neurobiology, neural circuits, hormones and social/environmental determinants. We are now aware that neurobiological factors are contributing to the development of psychiatric illnesses coupled with their interaction with psychosocial factors. Resilience is defined as the ability to bounce back after an adversity or life event that was traumatic and life-changing. It is a factor that is a unique psychopathological construct as it is a biopsychosocial factor which determines an individual's response to an illness and recovery from the same. Resilience is a human capacity to adapt swiftly and successfully to stress and to revert to a positive state. There has been now a paradigm shift in the understanding of resilience with respect to stress risk vulnerability and such dimensions of psychopathology. Resilience is a factor that must be evaluated in every patient and that shall help us determine the outcome of psychiatric disorders and will also be a determinant in the occurrence of relapses. Early identification of vulnerable patients shall lead to the implementation of resilience-based interventions in these populations and shall prevent against future occurrence of these disorders. In this chapter, we posit the construct of resilience as a psychopathological construct for mental disorders.

Resilience is defined as the ability to bounce back from trauma and stressful situations. Resilience has many psychosocial and biological variables that play a role in its genesis and development. The present chapter looks at the psychoneuroendocrinological basis of resilience and looks at various hormones that play a role in the genesis, development and maintenance of resilience.

This chapter looks at the interrelationship between economic recession and mental health. The world has been fraught with many economic recessions, and this chapter provides an overview of various effects that economic recession may have on mental health at an individual, family, and epidemiological level. Various economic recessions that have affected humanity across the world are outlined. Suicide, depression, and various mental health problems resulting from an economic recession are discussed. There is also a discussion of management strategies for the same at an individual, group, and policy level. There is also a need for mental health services to be easily available at the time of economic recessions to reduce that negative outcomes that may ensue due to the same.

Background: Low levels of cholesterol have been described in suicide behavior including among those individuals who have an increased tendency for impulsivity. Violent suicide attempters show significantly lower cholesterol levels than nonviolent suicide attempters. The suicide rate is particularly high in the prodromal and early phase of schizophrenia. It is unclear if there is a psychopathological relationship between early psychosis, suicide, and cholesterol levels. The present study examines levels of cholesterol and suicide behavior in a cohort of early psychosis. Methodology: Sixty admitted patients with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of nonaffective schizophrenia spectrum disorder (early psychosis) were assessed in a naturalistic cross-sectional, cohort study. Psychopathology was assessed with the Positive and Negative Symptom Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale, and Scale for Impact of Suicidality–Management, Assessment and Planning of Care (SIS-MAP). Serum levels of cholesterol were estimated in the cohort as well. The findings were analyzed for a clinical correlation of cholesterol levels, suicidal attempters, and psychopathology. Results: Out of 60 patients, 13 patients had a suicide attempt in the recent past. No serum cholesterol abnormality (3.7 ± 1.2 mmol/L) was observed in patients as a group and those with low suicidality (SIS-MAP 33; serum cholesterol: 3.5 ± 1.4 mmol/L). Females with moderate suicidality showed statistically significant lower cholesterol levels than males (P = 0.047). Conclusions: The study suggests lower levels of cholesterol in patients of psychosis with severe suicidal thoughts and depression in early psychosis. More research is required in this field to determine the neurochemistry of suicide behavior in psychosis and its significance in the prediction of suicidal behavior.

Child sexual abuse (CSA) is a hidden and under-reported problem in psychiatry. CSA has been studied in various epidemiological data based studies and has been found to be a significant risk factor for the development of psychiatric illness in later life. Depression, suicide and suicidal attempts as well as self-injurious behaviour have all been reported to be significantly greater in patients than have been exposed to CSA versus those who have not been exposed to the same. There are studies that demonstrate higher rates of substance abuse, body image disturbances, eating disorders and cluster B personality traits in patients that have been exposed to CSA. The paper looks at the available data on lifetime occurrence of psychiatric disorders in patients that have been exposed to CSA. The various mechanisms by which CSA exposure can lead to psychiatric disorders in adulthood are discussed and the need for identification, assessment and clinically evaluating the presence of CSA in patients in routine clinical practice is highlighted.

There has been a revolutionary advance in the treatment and management of schizophrenia from a clinical aspect yet the social and functional outcomes remain poor. Cognitive function is impaired in schizophrenia and shows various domains of dysfunction like verbal memory, processing speed and working memory. It is also known to be a factor associated with poor outcome in schizophrenia. Resilience is a new concept psychobiological concept which is defined as individual’s ability to adapt swiftly to adverse life events and bounces back to normalcy. Resilience has genetic, neurobiological, neurochemical and psychological underpinnings. It is the ability to effectively deal with psychosocial stressors and appears to be one of the many factors associated with favourable outcomes in schizophrenia. Besides several neurobiological abnormalities associated with resilience, neucognitive functions are of particular interest. Persistent psychosocial stressors also lead to significant neurobiological changes which may be synergetic to poor outcome due to cognitive changes. Though there has been extensive research in the field of cognitive function in schizophrenia, the trajectory of its pathway of poor outcome remains undetermined. Resilience being a protective factor may be one of the psychobiological functions which modulate the effect of neurocognition on the outcome of schizophrenia. There has been some success with interventions aimed at improving cognitive function in schizophrenia whether pharmacological or non pharmacological. In this paper, we discuss a hypothesis that resilience may be a “linkage” between cognition and outcome. There is a need for interventions aimed at increasing resilience in patients with schizophrenia and we hypothesize giving evidence that this may in turn improve outcome and neurocognitive functioning in schizophrenia.

Background : Suicide is a global health problem which is highly underreported and under treated. Though suicide intervention helplines have been studied the pattern of utilization of a suicide helplines by those referred to the facility has not been studied. Methodology : In the present study we have studied the pattern of utilization of a helpline in a community mental health clinic in the city of Mumbai. The study sample was patients who called the helpline and later attended the out patient facility of the clinic. Data was collected in semi-structured format and statistically analyzed using computer software. Results : 15149 calls were received by the helpline. Of the 1391 patients reporting suicidal ideation (59.42%) only 718 opted for psychiatric evaluation. 18.3% of patients with suicidal ideas had a past suicidal attempt while 82.6% had a psychiatric diagnosis. Majority of patients were belonging to psychotic and mood disorder categories. Financial and educational stressors were reported as the main stressors leading to suicidal ideas. Conclusions : A helpline offers definite advantage for patients with suicidal ideation to access mental health services. A helpline is an economical service that serves as a contact point to bring more people at an early stage to mental health care facilities.

Current understanding of mental disorders is based upon “biopsychosocial model”. Research also suggests what biological changes take place in a particular disorder as well as nature of risk which arises from psychological, social and environmental conditions. However it remains unclear how these psychosocial and environmental risk factors interact with biological factors which lead to clinical syndromes. This paper examines interrelationship of psychosocial and environmental risk and biological changes observed in mental disorders and tries to identify the possibility of a pathway of the psychopathology of psychiatric disorders. The review aims to demonstrate that significant advances in the fields of psychosocial, cultural, anthropological and neurobiological research provide novel insights into the etiology of mental disorders. There are neurochemical, functional and structural neurobiological, neurocognitive, immunological findings and findings from gene-environment interaction that appears promising. However these findings are in an isolated manner. Comprehensive studies examining major biological changes together in relation to psychosocial risk factors are lacking. Every individual reacts differently to the same environmental risk while there tends to be similarities in individual outcome in response to such stressors. The findings though robust independently, remain very preliminary to suggest a sequential trajectory for developing a clear pathway for pathogenesis. It is currently unclear whether there is a differential psychopathological impact of psychosocial stressors in different cultures despite the extensive variability both between and within major social groups and societies. Further research investigating modifiable and non-modifiable risk factors in context of prevailing socio-economic conditions is urgently needed to plan effective interventions.

Objective: To determine if there is a significant rise in serum prolactin (PRL) in acute psychosis related to disease process and weather there is a significant gender difference in the level of PRL and its correlation psychopathology. Procedure: Naturalistic study involved 60 consenting outpatients and inpatients in a tertiary psychiatric setting. Patient base was comprised of men (n = 30) and women (n = 30) with 83% in the age range of 21 - 40 years old. All subjects had confirmed first episode diagnosis set forth by the Diagnostic and Statistical Manual of Mental Disorders. Patients were drug free and drug naive. Standardization for control was done using 15 control PRL samples obtained from healthy individuals. Methodology involved assessment by radioimmunoassay, the Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale at day 1, 3 weeks and again at 6 weeks. All patients were treated with atypical antipsychotic drugs. Results: Serum PRL was elevated on baseline in 75% of first episode psychosis schizophrenia, yet found to have a negative correlation to psychopathology at base week 3 and week 6 samples. Conclusions: Elevated serum PRL is not a potential indicator of acute schizophrenia. Levels are higher in females than in males, yet females respond better to treatment at a lower dose than males.

Cannabis is a known risk factor for schizophrenia, although the exact neurobiological process through which the effects on psychosis occur is not well-understood. In this review, we attempt to develop and discuss a possible pathway for the development of psychosis. We examine the neurobiological changes due to cannabis to see if these changes are similar to those seen in schizophrenic patients the findings show similarities; however, these mere similarities cannot establish a 'cause-effect' relationship as a number of people with similar changes do not develop schizophrenia. Therefore, the 'transition-to-psychosis' due to cannabis, despite being a strong risk factor, remains uncertain based upon neurobiological changes. It appears that other multiple factors might be involved in these processes which are beyond neurobiological factors. Major advances have been made in understanding the underpinning of marijuana dependence, and the role of the cannabinoid system, which is a major area for targeting medications to treat marijuana withdrawal and dependence, as well as other addictions is of now, it is clear that some of the similarities in the neurobiology of cannabis and schizophrenia may indicate a mechanism for the development of psychosis, but its trajectories are undetermined.

Disulfiram remains a viable option as a treatment for alcohol dependence and has been shown in recent studies to be successful in treating patients with alcohol dependence in a manner that is superior to both naltrexone and acamprosate. It is also useful in dual diagnosis patients and those with co-morbid cocaine and alcohol dependence. Although disulfiram’s mechanism of action in alcohol dependence was long thought to be its effects as a psychological deterrent, more recent studies have uncovered potential anticraving effects as well. Recent reviews exhort to the importance of supervised disulfiram therapy in highlighting many of the potential and unique benefits of disulfiram. The present article will review the major clinical trials of disulfiram spanning nearly 60 years. It also discusses the usage of disulfiram across diverse populations along with monitoring for compliance and various adverse effects that may be encountered. The paper also reviews certain studies on long acting disulfiram therapy, recent comparative trials of disulfiram and its use in alcohol dependence. The review concludes with the role of disulfiram in the present day and long-term pharmacotherapy of alcohol dependence along with future research needs in this area.

Although the Kraepelinian classification paradigm is widely used, observations of overlapping boundaries among the symptoms associated with bipolar disorder and schizophrenia are beginning to challenge this dichotomy. The objective of this research was to explore the symptoms of individuals diagnosed with schizophrenia and with bipolar mood disorder in order to determine the frequency of symptom overlap. One hundred patients of a psychiatry ward were divided into two main groups based on their diagnosis—schizophrenia or bipolar mood disorder. Chi-square analyses were used to determine whether the symptoms measured in this study differed between individuals diagnosed with schizophrenia and those diagnosed with bipolar mood disorder. The results suggest that both positive/manic symptoms and negative/depressive symptoms are present in individuals diagnosed with schizophrenia and with bipolar mood disorder and, consequently, they do not present a reliable means of differentiating between these two groups. These findings have many implications for the ways in which mental illness is conceptualized and classified. Treatment efforts and interventions may be enhanced if a more dimensional approach to diagnosing mental illness is utilized.

Understanding of psychopathology of mental disorder is evolving, particularly with availability of newer insight from the field of genetics, epigenetics, social, and environmental pathology. It is now becoming clear how biological factors are contributing to development of an illness in the face of a number of psychosocial factors. Resilience is a psychobiological factor which determines individual's response to adverse life events. Resilience is a human capacity to adapt swiftly and successfully to stressful/traumatic events and manage to revert to a positive state. It is fundamental for growth of positive psychology which deals with satisfaction, adaptability, contentment, and optimism in people's life. Of late, there has been a paradigm shift in the understanding of resilience in context of stress risk vulnerability dimension. It is a neurobiological construct with significant neurobehavioral and emotional features which plays important role in deconstructing mechanism of biopsychosocial model of mental disorders. Resilience is a protective factor against development of mental disorder and a risk factor for a number of clinical conditions, e.g. suicide. Available information from scientific studies points out that resilience is modifiable factor which opens up avenues for a number of newer psychosocial as well as biological therapies. Early identification of vulnerable candidates and effectiveness of resilience-based intervention may offer more clarity in possibility of prevention. Future research may be crucial for preventive psychiatry. In this study, we aim to examine whether resilience is a psychopathological construct for mental disorder.

Many studies have confirmed that the risk of suicide in patients with first-episode psychosis (FEP) is high, and high rates of premature mortality, particularly from suicide, may occur in the early phases of schizophrenia. However, suicide rates are difficult to measure in FEP patients, even in carefully defined samples, and there is relatively little specific information about the risk of suicide at illness onset or retrospectively concerning the untreated psychotic period. This selected review of the literature investigates suicidal behaviour with particular regard to severe suicidality (plans and attempts) and risk factors associated with suicide in FEP patients. A search was performed to identify all papers and book chapters during the period 1965-2010, and approximately 100 studies met the inclusion criteria. Most of evidence suggests that risk of suicidal behaviour is relatively high in FEP patients. The research reports highlight the need for universal, comprehensive, public mental health interventions aimed, not only toward early detection, but also toward the rapid engagement in treatment of people with psychoses. These interventions should include an adequate assessment of suicidal behaviour in patients with FEP, and an examination of the efficacy of specific components of the interventions.

One negative outcome associated with schizophrenia is a deterioration of cognitive functioning. Little is known about what happens to cognitive abilities in the years following a diagnosis of first-episode schizophrenia. This study assessed the cognitive functioning of 61 individuals with first-episode schizophrenia who showed significant clinical improvement (Clinical Global Improvement rating of much or very much improved) after 10 years of treatment, comparing their cognitive functioning at the time of the initial diagnosis and at 10-year follow-up. Our results indicated deterioration in some cognitive abilities at baseline with further decline in this area found after 10 years. Visuomotor integration, working memory, and executive functioning deteriorated in the 10 years of treatment following diagnosis, and many individuals who were classified as much or very much improved still demonstrated abnormal cognitive functioning. These findings suggest the need for greater focus on cognitive functioning in treatment for schizophrenia.

Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.

Byline: Amresh. Shrivastava, Megan. Johnston, Ming. Tsuang This review considers the effects of cannabis on cognitive functioning, in both short and long term. Although the general impression supported by many studies is that cannabis causes cognitive decline, particularly with long-term usage, some research suggests that this may not be the case. Nevertheless, certain specific neuropsychological parameters have been found to be affected. Most commonly and consistently reported are response time, prolongation of word viewing time, basic oculomotor deficit, residual verbal memory and executive functioning. The pathways to cognitive dysfunction are given particular focus, including the role of the central nervous system (CNS) cannabinoid system. Finally, the psychiatric effects of cannabis are considered in light of the idea that cognitive function may be the common denominator in the association between cannabis and psychotic disorders. Effect of Cannabis on Cognition Cannabis is one of the most commonly abused illicit drugs. The World Health Organization [sup][1] reports that almost 3% of the world's adult population abuses cannabis, with many more individuals reporting less frequent use. Adolescents in particular consume high levels of cannabis, starting generally between 12 and 16 years of age. This is an important factor from a psychiatric and developmental point of view. [sup][2] Cannabis use is of important consideration in light of its recognized acute and long-term health effects. [sup][1],[3] Active compounds of cannabis, called cannabidols, have 64 active isomers, each having different effects on human health and behavior. Only one metabolite, tetrahydrocannabinol (THC), is reported to be an active metabolite responsive for its effects. [sup][4] Studies show that it induces both psychical and physical dependencies, [sup][5] but the perception of withdrawal is weak on account of its slow elimination. [sup][6] There is a widely held belief that cannabis is inert to the brain, [sup][7] and although the psychological consequences are quite evident, the population at large seems unconvinced. There is much debate about the nature of cannabis dependence, as it is considered non-addicting due to the absence of a withdrawal state. This presumption has also been proved wrong. [sup][6] The general impression supported by many studies is that cannabis causes cognitive decline, particularly with long-term usage. Majority of studies have suggested a significant cognitive decline in cannabis abusers compared to non-abusers and healthy controls. [sup][8],[9],[10] A report by Bartholomew et al. [sup][11] suggested that cannabis use has a detrimental effect on prospective memory ability in young adults but users may not be aware of these deficits. Cannabis is known to produce substantial acute effects on human cognition and visuomotor skills. Many recent studies additionally revealed rather long-lasting effects on basic oculomotor control, especially after chronic use. [sup][12] Even so, it is still unknown to what extent these deficits play a role in everyday tasks that strongly rely on an efficient saccade system, such as reading. Cannabis has a negative impact on cognition; however, the current body of research literature does not provide evidence of significant, long-term effects due to cannabis use. Several acute effects are noted and some are suggestive of negative mental health consequences. [sup][13] Evidence from both animal and human studies suggests that the severity of the effects of cannabis use on cognitive development is dependent on the age when cannabis use begins. [sup][14] One possible explanation is that those who begin cannabis use early in adolescence are more likely to become heavily dependent. It is plausible that chronic cannabis abuse will then interfere with educational and vocational training. From a more biological perspective, however, use of cannabis during critical developmental periods in the still maturing brain may induce persistent alterations in brain structure and brain function. …

Purpose of review Schizophrenia is a complex neurobehavioral disorder for which there are many promising new treatments. There is, however, a discrepancy in outcome measure reports when they are obtained from patients, relatives, caregivers, or professionals, making it difficult to determine the level of recovery. This lack of agreement may result from limitations of the measurement tools themselves, which are not comprehensive and may be measuring different aspects of outcome. Alternatively, it could be that the conceptual understanding of outcome and recovery require development. Recent findings For various reasons, patients assessed as ‘recovered’ remain excluded from mainstream society. We are of the opinion that present outcome measures do not capture real-life situations. We propose that the concept of recovery be carefully defined and the gold standard of outcome should incorporate social and clinical parameters. We attempt to redefine recovery. Patients who have shown clinical improvement do not necessarily do well in everyday situations even though there is obvious clinical improvement. Therefore, it has been repeatedly argued that a consensus of recovery should be determined and that routine clinical practice should then adapt to the agreed criteria. Summary We argue that the outcome measures should be multidimensional and consist of at least two parameters: clinical remission and social outcome.

Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.

Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology.

Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. Historically, there have been changes and three major reforms are needed, namely attempt to facilitate discharge and placing patients back into the family, introducing teaching and research in mental hospitals, and accountability to civil rights as per the requirements of the National Human Rights Commission. In this review, we explore the brief history of mental hospitals in India and examine the reforms in the clinical, administrative, and psychosocial areas of these hospitals and progress in teaching and research. We finally summarize and conclude the necessity and the relevance of mental hospitals in India akin to modern psychiatric practice. We believe that mental hospitals have an important and perhaps a central role in mental health services in India. Its modernization to address issues of long-term stay, burden on caregivers, stigma, research and teaching including undergraduate and postgraduate training, new curriculum, and training for nonpsychiatric professionals and primary care physicians are necessary components of the role of mental hospitals and responsibilities of both government and nongovernmental sectors. Last but not the least, it is obligatory for mental hospitals to ensure that evidence-based treatments are implemented and that the standard of care and respect of civil and human rights of the patients and families are provided while involving the people's participation in its functioning.

This study aimed at validating the domains of suicidality assessed by the Scale for Impact of Suicidality-Management, Assessment and Planning of Care (SIS-MAP) and creating a brief screener based on the full scale. A total of 50 individuals with suicidal ideation were given the SIS-MAP interview. Support was found for these domains of suicide risk; in particular, the subscales of ideation and protective factors for suicide risk were highly reliable. For each domain of suicidality, items most predictive of total risk index scores were selected to create a brief screener aimed at expediting the assessment process. The screener was reliable, predicted overall suicide risk index scores, and approached significance in predicting subsequent suicide attempts.

Background: Prevalence of negative symptoms in the early phase of schizophrenia remains uncertain. Ne- gative symptoms are the primary cause of long term disability and poor functional outcome. The purpose of this study is to examine the presence of negative symptoms in patients with fist episode psychosis in schizophrenia who were hospitalized. Methods: Nega- tive symptoms were measured in 72 patients present- ing with FEP using the scale for assessment of nega- tive symptoms (SANS) and ascertained diagnosis us- ing DSM-IV. Prevalence of SANS items and sub- scales were examined for both schizophrenia and bi- polar disorder. Results: This study shows that a sig- nificant number of patients with first episode schizo- phrenia had negative symptoms 66 (87.5%). All five subtypes of negative symptoms were present in 47% of patients suggesting primary negative symptoms, and about 40% have secondary negative symptoms. Independently, each subtype of negative symptoms was seen in 48% - 76% of patients. The most preva- lent negative symptom in first-episode schizophrenia was found to be blunting (72%). 46% of patients had significant level of depression, overall psychopa- thology was severe and level of functioning was poor. We found that 45.8% patients were prescribed anti- cholinergic medications which indicated that at least 45% subjects had extra-pyramidal symptoms (EPS). Conclusion: Primary negative symptoms are preva-lent in about half of First episode Psychosis (FEP) schizophrenia patients. These findings have implica- tions for identification, early treatment, and reduced treatment resistance for negative symptoms in order to increase social and clinical outcome of schizo- phrenia. Further research is required in this area. Keywords: Negative Symptoms; First Episode Psychosis; Schizophrenia; Symptomatology

Cannabis has been implicated as a risk factor for the development of schizophrenia, but the exact biological mechanisms remain unclear. In this review, we attempt to understand the neurobiological pathways that link cannabis use to schizophrenia. This has been an area of great debate; despite similarities between cannabis users and schizophrenia patients, the evidence is not sufficient to establish cause-and-effect. There have been advances in the understanding of the mechanisms of cannabis dependence as well as the role of the cannabinoid system in the development of psychosis and schizophrenia. The neurobiological mechanisms associated with the development of psychosis and effects from cannabis use may be similar but remain elusive. In order to better understand these associations, this paper will show common neurobiological and neuroanatomical changes as well as common cognitive dysfunction in cannabis users and patients of schizophrenia. We conclude that epidemiologic evidence highlights potential causal links; however, neurobiological evidence for causality remains weak.