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Background & objectives: Limited data are available on prescription patterns of the antidepressants from India. We studied antidepressants' prescription pattern from five geographically distant tertiary psychiatric care centers of the India. Method: In this cross-sectional study, all patients who attended outpatients department or were admitted in the psychiatry wards at Lucknow, Chandigarh, Tiruvalla, Mumbai and Guwahati on a fixed day, who were using or had been prescribed antidepressant medications, were included. The data were collected on a unified research protocol. Results: A total of 312 patients were included. Mean age was 39±14.28 yr and 149 (47.76%) were females, 277 (87.5%) were outpatients. Among the patients receiving antidepressants, 150 (48.1%) were of diagnoses other than depression. Diabetes mellitus 18 (5.78%) was the most common co-morbid medical illness. A total of 194 (62.2%) patients were using selective serotonin reuptake inhibitors (SSRIs) with escitalopram 114 (36.53%) being the most common antidepressant used. Overall, 272 (87.18%) patients were using newer antidepressants. Thirty (9.62%) were prescribed more than one antidepressant; 159 (50.96%) patients were prescribed hypnotic or sedative medications with clonazepam being the most common (n=116; 37.18%). Interpretation & conclusions: About half of the patients with diagnoses other than depression were prescribed antidepressants. SSRIs were the most common group and escitalopram was the most common medication used. Concomitant use of two antidepressants was infrequent. Hypnotic and sedatives were frequently prescribed along with antidepressants.

Homeless mentally ill (HMI) persons are a highly vulnerable and socially disadvantaged population, deprived of even the basic minimal human rights. Data on HMI in India is scarce. This retrospective chart review aimed to evaluate socio-demographic, socio-cultural and clinical profile of HMI patients, and to study reasons of homelessness and outcome related variables in these patients. One hundred and forty homeless persons were admitted to the department of psychiatry of a north Indian medical university from February 2005 to July 2011. Of these, one hundred and twenty-seven (90.7%) had psychiatric illness and six had only intellectual disabilities. The majority of HMI persons were illiterate/minimally literate, adult, male, and from low socioeconomic and rural backgrounds. Most of the patients (55.7%) had more than one psychiatric diagnosis. HMI had considerably high rates of co-morbid substance abuse (44.3%), intellectual disabilities (38.6%) and physical problems (75.4%). Most (84.3%) were mentally ill before leaving home and 54.3% left home themselves due to the illness. Most HMI responded to the treatment. After treatment of mental illness, it was possible to reintegrate about 70% of the patients into their families. Families were willing to accept and support them. Untreated/inadequately treated mental illness was the most common reason for homelessness. Easily accessible treatment and rehabilitation facilities at low cost can improve the plight of such patients. Further research in this area is required.

The documented efficacy and long-term benefit of antidepressants in patients with recurrent forms of severe anxiety or depressive disorders support their use in those individuals with these disorders, who experience suicidal thoughts or behavior. In general, it is assumed that antidepressants are beneficial for all symptoms of depression, including suicidality. However, some evidence suggests that Selective Serotonin Reuptake Inhibitors [SSRIs] may cause worsening of suicidal ideas in vulnerable patients. Systematic reviews and pooled analysis of experimental, observational, and epidemiological studies have investigated the use of SSRIs and their association with suicidality. Taking account of the methodological limitations of these studies, the current evidence fails to provide a clear relationship between their use and risk of suicidality in adults. However, in children and adolescents, there appears to be a bit of increased risk of suicidal ideations and attempts, but not of completed suicides. This risk can be anticipated and managed clinically. Clinicians are, therefore, advised to maintain a close follow-up during the initial treatment periods and remain vigilant of this risk. This advisory, however, should not deter clinicians from the use of effective dosages of antidepressants for a sufficient period of time, in every age group of patients, when clinically needed, and if found suitable otherwise.

Benzodiazepines are commonly prescribed to patients with schizophrenia in many countries, but as little is known about such treatment in Asia, we evaluated their adjunctive use for 6761 in-patients diagnosed with schizophrenia in nine Asian countries using a cross-sectional study design in 2001, 2004 and 2008. Multivariate logistic regression and multivariate linear regression analyses were performed to assess predictors of benzodiazepine use and dose, respectively. Overall, 54% of the patients received adjunctive benzodiazepines at an average daily dose equivalent to 30.3 mg diazepam, with minor changes over the years sampled. Benzodiazepine use was highest in Taiwan and Japan, lowest in Thailand and China, and was associated with fewer years ill, presence of delusions (OR 1.24), hallucinations (OR 1.22), disorganized speech (OR 1.17), social or occupational dysfunction (OR 1.16), and use of mood stabilizers (OR 3.15), antiparkinsonian (OR 1.79) or antidepressant drugs (OR 1.33), and lower doses of antipsychotics (all p=0.016 to

Introduction. It has recently been observed that some cognitive deficits in bipolar disorders persist even after the subsidence of active symptoms. The authors aim to study the cognitive functioning of patients with bipolar disorder, currently in euthymia and compare them with normal healthy controls. Methods. Fifteen patients having bipolar-I disorder and currently in euthymia were compared with fifteen age- and education-matched controlled subjects. Cognitive assessments were done using three computer-based tests, i.e., Wisconsin's Card Sorting Test (WCST), Spatial Working Memory Test (SWMT), and Continuous Performance Test (CPT). Results. Euthymic bipolar patients showed significant deficits in executive functions. Subtle deficits were present in attention and working memory that were not statistically significant. Conclusions. Executive deficits may be trait markers in bipolar disorder and may have clinical implications in patient rehabilitation.

Background Current classifications of Mental Disorders are centered on Westernized concepts and constructs. “Cross-cultural sensitivity” emphasizes culturally-appropriate translations of symptoms and questions, assuming that concepts and constructs are applicable. Methods Groups and individual psychiatrists from various cultures from Asia, Latin America, North Africa and Eastern Europe prepared descriptions of main symptoms and complaints of treatment-seeking women in their cultures, which are interpreted by clinicians as a manifestation of a clinically-relevant dysphoric disorder. They also transliterated the expressions of DSM IV criteria of main dysphoric disorders in their cultures. Results In many non-western cultures the symptoms and constructs that are interpreted and treated as dysphoric disorders are mostly somatic and are different from the Western-centered DSM or ICD systems. In many cases the DSM and ICD criteria of depression and anxieties are not even acknowledged by patients. Limitations The descriptive approach reported here is a preliminary step which involved local but Westernized clinicians-investigators following a biomedical thinking. It should be followed by a more systematic–comprehensive surveys in each culture. Conclusions Westernized concepts and constructs of mental order and disorders are not necessarily universally applicable. Culturally-sensitive phenomena, treatments and treatment responses may be diversified. Attempts at their cross-cultural harmonization should take into consideration complex interactional multi-dimensional processes.

This study compared the effects of atypical antipsychotics (risperidone or quetiapine) with placebo and with each other in recently exacerbated patients with schizophrenia requiring hospitalization.This international, randomized, double-blind study included a 2-week monotherapy phase followed by a 4-week additive therapy phase. Recently exacerbated patients with schizophrenia or schizoaffective disorder (DSM-IV) were randomized (2:2:1) to risperidone (n = 153), quetiapine (n = 156), or placebo (n = 73). Target doses were 4 or 6 mg/day of risperidone and 400 or 600 mg/day of quetiapine by day 5, with the ability to increase to 600 or 800 mg/day of quetiapine on day 8. The main outcome measures were the total Positive and Negative Syndrome Scale (PANSS) and need for additional psychotropic medications.Monotherapy Phase: The combined atypical antipsychotic group (n = 308) reached borderline superiority to placebo (n = 71) at the 2-week endpoint on mean change in total PANSS score (-24.1 +/- 1.2 and -20.2 +/- 2.0, respectively; p = 0.067). The change in the atypical group was driven by the improvement with risperidone (-27.7 +/- 1.5 vs. -20.2 +/- 2.0 with placebo, p0.01; and vs. -20.5 +/- 1.5 with quetiapine, p0.01); the improvement with quetiapine was similar to placebo, p = 0.879. Results were similar on other efficacy endpoints. Additive Therapy Phase: Additional psychotropics were prescribed to fewer (p0.01) risperidone (36%) than quetiapine (53%) or placebo patients (59%). The overall discontinuation rate was 18%, 26%, and 38%, respectively. Risperidone, compared with placebo, was associated with more parkinsonism, akathisia, plasma prolactin changes, and weight gain; while quetiapine was associated with more somnolence, sedation, dizziness, constipation, tachycardia, thyroid dysregulation, and weight gain.While the combined atypical antipsychotic group did not experience greater improvements than the placebo group, risperidone, but not quetiapine, was significantly superior in all measured domains to placebo in the management of recently exacerbated hospitalized patients with schizophrenia or schizoaffective disorder, with no unexpected tolerability findings.

The development of the Diagnostic and Statistical Manual-5 (DSM-5) has been an exhaustive and elaborate exercise involving the review of DSM-IV categories, identifying new evidence and ideas, field testing, and revising issues in order that it is based on the best available evidence. This report of the Task Force of the Indian Psychiatric Society examines the current draft of the DSM-5 and discusses the implications from an Indian perspective. It highlights the issues related to the use of universal categories applied across diverse cultures. It reiterates the evidence for mental disorders commonly seen in India. It emphasizes the need for caution when clinical categories useful to specialists are employed in the contexts of primary care and in community settings. While the DSM-5 is essentially for the membership of the American Psychiatric Association, its impact will be felt far beyond the boundaries of psychiatry and that of the United States of America. However, its atheoretical approach, despite its pretensions, pushes a purely biomedical agenda to the exclusion of other approaches to mental health and illness. Nevertheless, the DSM-5 should serve a gate-keeping function, which intends to set minimum standards. It is work in progress and will continue to evolve with the generation of new evidence. For the DSM-5 to be relevant and useful across the cultures and countries, it needs to be broad-based and consider social and cultural contexts, issues, and phenomena. The convergence and compatibility with International Classification of Diseases-11 is a worthy goal. While the phenomenal effort of the DSM-5 revision is commendable, psychiatry should continue to strive for a more holistic understanding of mental health, illness, and disease.

BACKGROUND: Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. RESULTS: Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. CONCLUSIONS: Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries. The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health / Fogarty International Center (R03 TW006481-01). The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the Robert Wood Johnson Foundation (RWJF; Grant 044708)

To assess the prevalence of major depressive disorder and subsyndromal depression in patients with first episode of myocardial infarction (MI) and to compare the socio-demographic, clinical and coronary risk factors in patients with and without depression.Patients of acute MI (n = 101) attending OPD at 4 to 6 weeks after the index event were the subjects. Diagnoses of Major Depressive Disorder were established according to Diagnostic and Statistical Manual for Mental Disorders fourth edition Test Revision (DSN-IV-TR) criteria. Schedule for Affective Disorder and Schizophrenia changed version modified for Bipolar disorder (SADS-CB) was applied to detect cases with depressive symptoms not amounting to major depressive disorder (sub-syndromal). It was a single point cross sectional study.No depressive symptoms (Group-A) were found in 56 patients (55.4%). Major Depressive Disorder (Group-B) was found in 24 patients (23.8%) and subsyndromal symptoms (Group-C) in 21 patients (20.8%). Sociodemographic and clinical variables were similar amongst three groups except, more patients in Group-C were from nuclear family (p = 0.01) and were educated (p = 0.03). More patients in Group-B had hypertension (p = 0.001), diabetes (p = 0.03) or were overweight (p = 0.02) as compared to Group-A. Similarly higher number of Group-C patients had hypertension (p = 0.04), diabetes (p = 0.01) and were current smokers (p = 0.01) as compared to Group-A.Unrecognized and untreated major depressive disorder and sub-syndromal symptoms were frequent in patients of MI. Established coronary factors were more commonly present in these groups as compared to no depressive symptom group. This emphasizes the need for routine screening for depression in post MI phase in our population.

SUMMARY 50 chronic cannabis users were studied for their physical, mental, cognitive and socio-economic aspects of health. They were given W.M.S., Bhatia Battery of intelligence and B.G.T. It was observed that only 12% provided clue for suspecting cognitive deficiency. No social breakdown phenomenon was observed in the sample. Also, no significant physical illness was detected in the subjects.

SUMMARY Forty six key relatives of 'Schizophrenic Patients' who were hospitalised in Department of Psychiatry, K. G's, Medical College, Lucknow were administered ‘Attitude Questionnaire’ which covered five variables : Number of critical comments about someone else in the home ; Hostility; Dissatisfaction; Warmth and Emotional Involvement. Forty one key relatives of ‘Disturbed Family's Patients’ matched for sex and residence, were assessed on similar parameters. There was significant difference only in the area of ‘Dissatisfaction’.

SUMMARY Out of 692 patients registered in the lithium clinic, King George's Medical College, Lucknow, 122 patients suffering from affective disorders, receiving lithium for at least 6 months continuously, having had at least 5 serum lithium estimations done and having been evaluated at least once in 6 months while on follow-up, were analysed with a view to study the relapses. About one-third patients suffered no relapse while on lithium. The study revealed that longer the duration of lithium treatment lesser were the frequency, number, intensity and duration of manic/depressive relapses. Majority of patients were maintained on the lower side (0.5-0.8 mEq/L) of the usually recommended therapeutic range (0.6-1.2 mEq/L) for lithium prophylaxis. Commonly observed side effects include fine tremors, muscular weakness, polyuria, polydipsia and constipation. All the side effects were easily managed and none had a fatal sides-effect. A reappraisal in the light of existing literature of lithium prophylaxis on manic depressive psychosis is done.

SUMMARY Immunoglobulins G, M and A were estimated in serum and cerebrospinal fluid (CSF) of 30 schizophrenics, 20 neurological controls and 20 surgical controls. Significant increased levels of serum Ig A and M were detected in schizophrenics. An association was observed between increasing levels of serum IgA and IgM with the duration of disease and the number of episodes. CSF IgG/TP% was also significantly increased with the severity of the disease. On the basis of viral aetiology of schizophrenia it can be concluded that the increase in immunoglobulins synthesis might be due to the persistent antigenic stimulation.

SUMMARY Platelet MAO activity of 30 male drug free chronic schizophrenics (RDC), 30 male first degree relative of these patients and31 age matched male healthy controls was studied. Analysis of variance revealed that no significant differences existed between the three groups. There was high correlation between the enzyme activily of probands and first degree relatives. Presence or absence of auditory hallucinations, or paranoid features did not affect the enzyme activity significantly.

SUMMARY Thirty patients of affective disorder who were on lithium for a year and thirty patients on antidepressant were studied in detail for renal functions. Our observation is that lithium therapy does not lead to any deterioration in kidney functions. The results are discussed.

SUMMARY The study was carried out in 25 mentally retarded children and compared with equal number of normal children. They were subjected to detailed psychiatric evaluation and dental examination. The dental anomalies were corroborated with cephalometric analysis of lateral cephalograms. It was concluded that all mentally retarded children had some dental abnormality in them in form of dental malocclusion, wide inter dental spaces, absence of teeth etc. We suggest early dental management for such patients for reinforcing their neuromuscular coordination modifying the mastication power, swallowing, speech, stomatognathic function and above all their facial profile for better social acceptance.

SUMMMARY Present study suggest that changes in response to the post dexamethasone plasma cortisol levels in the patients of major depression receiveing anti depressants (Imipramine and Amitryptyline) might represent a laboratory marker of clinical progress. We estimated post dexamethasone plasma cortisol levels weekly in thirty hospitalized patients during pro-treatment, post-treatment and drug free post-treatment wash out period. In most of the cases normalization of the post dexamethasone cortisol levels coincided with clinical improvement and failure to normalize was often associated with poorer clinical recovery. No significant difference was observed in the treatment response between imipramine and amitryptyline based on post dexamethasone plasma cortisol levels.

SUMMARY Sixty patients of endogenous depression and thirty normal controls were studied to find out the relationship of post dexamethasone plasma Cortisol levels (PDPC) and clinical improvement of endogenous depression inpatients treated with electroconvulsive therapy and imipramine. The PDPC levels in both the group of patients showed significant decrease with clinical improvement (Pre and post treatment PDPC values of ECT group was 20.7 ug/dl and 13.6 ug/dl while it was 17.9 ug/dl and 12.7 ug/dl respectively for the Imipramine group). A significant correlation was also found between PDPC and severity of illness (p< 0.001) in the both groups which indicates that PDPC levels is independent of treatment modality used.

SUMMARY Relationship of neurosis and sexual behaviour has been a matter of dispute till date. In the present study sexual behaviour of 40 married neurotics and 22 matched healthy control males was studied. Sexual behaviour of neurotics was similar to control subjects before the commencement of neurotic illness. But after the onset of the neurotic illness subjects showed significant decrease in frequency of coitus, sexual satisfaction and sexual adequacy in comparison to their pre illness behaviour as well as from healthy controls.

A very high prevalence of psychiatric morbidity among the persons attempting or committing suicide has been observed by several investigators (Barraclough et al, 1974; Beck et al, 1990; Drake et al, 1985). In a study of attempted suicide Morgan et al. (1975) reported neurotic depression in 52%, personality disorder in 29% functional psychosis in 12% and alcohol addiction in 10%. Silver et al. (1971) found 80% of the attempters having depressive features. Likewise, Barracloughf1974) found 93% of the suicide being mentally ill, depression accounting for 70%.

The study assessed the lifetime prevalence of comorbidity in forty three DSM III-R opioid and alcohol dependent patients. A total lifetime prevalence rate of 60.5% was found. The results are discussed axis wise and compared with previous relevant studies. There was no significant difference in comorbidity between the opioid and alcohol Dependent groups. Comorbidity on both Axis I and II were high, but there was no significant difference in the presence of Axis I disorders between patients with and without personality disorders. The paper also reports upon the temporal relationships amongst the co-occurring psychiatric disorders.

Twenty-five subjects were studied who had undergone amputation 6 months to 2 years prior to the time of assessment. The sample was divided into sick (those having psychiatric illness) and non-sick (those without any psychiatric illness) groups, and then compared for various life events following the amputation. It was seen that those who were labelled as psychiatrically sick had more work impairment, change in job, socioeconomic difficulties and social avoidance. The latter two factors were also significantly more in right upper limb amputees than the left upper limb amputees; no such difference existed between the upper and lower limb amputees.

Psychiatric sequelae present after 6 months to 2 years following amputation were studied in a group of 25 subjects. The subjects were screened on SCID, HRSD and HARS. The most common diagnoses were depressive disorder NOS (20.6%) and major depressive disorder (10.3%). Patients having right sided amputation were more psychiatrically ill than those with loss of a left limb. Phantom limb was seen in about two-thirds of the total sample-more in the sick group (about 88%) than in the non-sick group (about 55%). Pain in the phantom limb was seen more in the sick group, but telescopy and movement were more frequently complained of by subjects of the non-sick group.

Several studies have reported decreased platelet 5-HT uptake in patients of major depression. The present study was undertaken with the aim to study the active platelet 5-HT uptake in depressed patients and effect of treatment with imipramine/ECT on platelet 5-HT uptake in these patients. 30 patients of major depression and equal number of age and sex-matched controls were included in the study. The depressives received imipramine (N=15) or ECT (N=15). Pretreatment active platelet 5-HT uptake was lower in depressives. Treatment with imipramine resulted in significant decrease in 5-HT uptake while with ECT there was significant increase. The serotonergic mechanisms are discussed.

Several studies suggest that a low cholesterol concentration is associated with depression. The authors sought to determine whether an association exists between serum lipid concentrations and depression. 28 drug-naive patients of major depression diagnosed according to DSMlll- R criteria were included in the study and severity of depression was measured on Hamilton Rating Scale for Depression. Suicidal intent was assessed on Suicidal Intent Questionnaire. 28 normal healthy controls were selected and matched for age, sex and body-mass index with the depressives. Serum lipid estimations were done in each subject after 12 hours overnight fasting. The main finding of the study is that total serum cholesterol, serum triglycerides and serum LDL cholesterol are decreased while serum HDL cholesterol is increased in depression and these changes were more marked in depressed subjects with definite suicidal intent. On regression analysis, total serum cholesterol was the most important predictive variable of the severity of depression.

Practical difficulties associated with assessment of central parameters necessitates the development of peripheral markers of suicidal risk. Recent research suggest that serum lipid profile may be a useful indicator of suicidal behaviour. Serum lipid profiles of forty suicide attempters were compared with forty age, sex and BMI matched controls. Total serum cholesterol, serum Triglyceride, LDL levels and HDL levels were found to be lower in suicide attempters but were not statistically significant. Statistically significant negative con-elation was seen between risk-rescue score and above mentioned parameters. No statitically significant difference was observed when various diagnostic break-up groups of patients were compared.

P300 event related potential was recorded in 115 healthy controls with a mean age of35.9±14.81 years and a male : female ratio of 72 : 43. There was significant difference in the P300 latency in < 40 years as compared to ≥ 40 years group (p< 0.001). There was no significant difference between males and females. There was a strong positive correlation between age and P300 latency (p< 0.001). The regression equation for P300 latency was Y=287.9+1.492x with an SEE of 20.2 (where Y is the P300 latency in ms, x is the age in years, SEE is the standard error of estimate). There was a negative correlation between age and P300 amplitude which was significant in ≥ 40 years age group while in > 40 years age group it was not significant.