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Background: Depression is one of the most common mental illnesses found across all ages, genders and socioeconomic status. It has significant health, psychosocial, and economic impact. It is worse than many chronic medical diseases and has a negative effect on quality of life which persists even after remission. Objectives: The aim of this research was to study the relationship of major depressive disorder with quality of life and stressful life events in adults. Materials and Methods: This was a cross-sectional study wherein purposive sampling method was employed. Patients from psychiatry outpatient department who fulfilled the criteria for major depressive disorder and belonging to the age range of 18–75 years were shortlisted and requested to participate in the study. After taking informed consent, data on quality of life, enjoyment and satisfaction, stressful life events and severity of depression were gathered using questionnaires and a semi structured interview. Results: Severity of depression was found to be negatively correlated with quality of life, enjoyment and satisfaction P = 0.001 level of significance. There were no significant correlations between severity of depression and stressful life events. Pearson’s Chi-square indicated that the severity of depression has a significant association with highest educational qualification, occupation, marital status, and socioeconomic status. Conclusion: Measuring and keeping track of quality of life through self-report levels is important in improving depressive disorders and should be integral part of management. Other steps comprise of starting early treatment, ensuring treatment adherence, reducing severity, and reducing relapse. Psychosocial interventions should also be taken into consideration.

Objectives: Old age is often perceived as a stressful phase of life, as it is associated with multiple physical and often ignored, mental health issues. Life satisfaction (LS) is an individual’s perception regarding life circumstances. Indian literature lacks enough data regarding depression and LS in the elderly; hence, the study was done in patients attending the geriatric outpatient department (OPD), with the following objectives: (a) to study depression (b) to study LS (c) to study the association between the two. Materials and Methods: Sixty-six patients from geriatric OPD in a tertiary care center were selected. The Geriatric Depression Scale and Satisfaction with Life Scale were applied to them after excluding patients with acute medical and psychiatric conditions. Institutional ethics committee approval was obtained, and informed consent was obtained from the participants. Results: More than one-third of our participants (37.9%) were found to be depressed, and 27.3% were found to be less satisfied with life. A significant association (P < 0.001) was found between depression and LS among the participants. Conclusions: Early identification and treatment of depression in the elderly is important as it can enhance LS at this stage of life. This can prevent psychiatric morbidity and consequences such as despair and suicide. Hence, screening for depression in all elderly and early intervention can go a long way in keeping the elderly happy and healthy.

Background: Comorbidity in obsessive–compulsive disorder (OCD) is known, especially alcohol use disorders (AUDs) in OCD. Data are lacking regarding the prevalence, the obsessions and compulsions in people with OCD with comorbid alcohol use. Aims and Objectives: The aim was to study the prevalence of AUDs in people with OCD. The primary objective was to study the prevalence of AUDs in 100 people with OCD. Secondary objective was to study the clinical characteristics, obsessions, and compulsions of people with OCD and comorbid alcohol use. Settings and Designs: The study design was a cross-sectional study. Materials and Methods: 100 patients of Asha Hospital diagnosed with OCD were screened and included in the study after a written informed consent. YBOCS checklist and scoring were done. People satisfying the criteria for AUD were further assessed with SADQ questionnaire. SPSS software was used for statistical analysis. Results and Conclusions: The lifetime prevalence of substance use disorders was found 18%. Point prevalence of any substance use was 13%, out of which 7% had AUDs. 2% had a dependence pattern and 5% had an abuse pattern. When comparing people with alcohol versus non-alcohol use, there was a significant difference in the proportion of males in the alcohol group (P = 0.0011). Nicotine was used in higher proportion in the alcohol group (P = 0.0001). Alcohol users were not regular with medications (P = 0.01). Miscellaneous obsessions are more common in them (P = 0.002). Alcohol users had a higher proportion of nil compulsions (P = 0.057) implying that obsessions were more prominent than compulsions in them. Mean scores of OCD in both groups were around moderate severity, with no significant difference between the two.

Introduction: Caregiving encompasses various challenges and adversities, with resilience playing a crucial role in navigating these hurdles. However, resilience is influenced by individual characteristics, prompting an examination of how demographic variables impact resilience and caregiver burden among caregivers of cancer patients in India. Aim: To investigate the relationship between demographic variables and resilience, as well as caregiver burden, among caregivers of cancer patients in India. Materials and Methods: In this cross-sectional study, a clinical sample of 125 caregivers {males (46.4%) and females (53.6%)} from Indraprastha Apollo Hospital, New Delhi, India was assessed. Resilience was measured using the Connor-Davidson Resilience Scale (CD-RISC), while caregiver burden was evaluated using The Burden Assessment Schedule (BAS). Various demographic factors, including gender, age, qualification, socio-economic status, loss of work, number of children, travel for treatment, duration of treatment, type of illness, and employment status, were examined. T-tests and Analysis of Variance (ANOVA) were utilised for data analysis. Results: The predominance was of female caregivers, comprising 67 (53.6%) individuals, primarily falling within the age bracket of 30-40 years demographic variables significantly influenced resilience levels among caregivers (p-value ranged from 0.001 to 0.86). However, caregiver burden was not significantly impacted by demographics overall (p-value ranged from 0.24 to 0.98), although certain sub-domains were affected. Notably, male caregivers demonstrated higher levels of resilience compared to females (T=9.88, p=0.001), with postgraduate qualifications correlating with increased resilience (mean: 17.02) and lower caregiver burden (mean: 81.53). Additionally, age did not significantly affect the results (effect size ranged from 0.10 to 0.86). Conclusion: The study underscores the importance of tailored support strategies for caregivers, particularly focusing on enhancing resilience among female caregivers and addressing specific burden dimensions affected by demographic factors of socio-economic status and qualification. Overall, resilience was affected by gender, socio-economic status, number of children, travel, duration of treatment, and employment significantly, but caregiver burden was not significantly affected by any demographic variable.

Background: Reaction time is a measure of how fast an organism can react to a certain stimulus. As such, it is a measure of an individual’s performance and the function of sensory-motor connection. While there are studies evaluating the differences in reaction time with gender and psychiatric illness as independent variables, data are lacking when considering them together. Aims: The aim of the study is to study the gender differences in reaction time in patients suffering from psychiatric illness. Settings and Design: The study involves an observational, longitudinal comparative study in the psychiatric outpatient department (OPD) of a tertiary care facility. Materials and Methods: After institutional ethics approval, 100 patients on psychotropic medications attending psychiatry OPD were included in the study along with at least 100 relatives who were not on psychotropic medications, serving as control. Required data were collected using semi-structured pro forma. The reaction time of patients and the control group was assessed using an application on the mobile phone available online as – the “Human Benchmark test.” Data obtained were entered in the MS Excel sheet and analyzed using the computerized software and a P ≤ 0.05 was considered statistically significant. Results: In the group of patients, the males showed delayed reaction time as compared to females, while in the control group, males performed better than the female population in reaction time tests. The highest reaction time was found to be in the substance use disorder group of patients at all points of testing, followed by that of patients with schizophrenia. Conclusions: Gender did not significantly affect the reaction time in both patient and control groups.

Elderly transgender mental health has been a neglected facet of mental health for many years. The current article reviews the global and local challenges faced when catering to elderly transgender mental health. These include trauma and stigma that may be faced when seeking mental health services, in addition to the stigma of belonging to the transgender community. There are many barriers in access to health-care services that have been highlighted, and there are factors such as social discrimination, victimization, hate crime, and domestic violence that add to the barriers. Lack of proper clinics that cater to their needs, improper coverage in health-care insurance, and lack of coverage of sex-change operations also add to the existing burden. Workplace issues and their impact on mental health along with stigma and workplace discrimination are also discussed. The review tries to give an overview of the issues faced, so that clinicians treating these populations are appraised of the same.

The anabolic androgenic steroids (AAS) are a family of hormones that includes the natural hormone testosterone, together with numerous synthetic testosterone analogs. When taken in higher doses and combined with exercise and proper nutrition, AAS cause users to gain muscle mass and lose body fat, even beyond naturally attainable limits. AAS have been used by competitive athletes since long but there has been an increase in its use in general population into a widespread form of substance misuse in the last few years. Here, we report the case of a 32-year-old male with AAS dependence, natural as well as synthetic, since last 10 years presenting to the outpatient department with insomnia and depressive features.

Introduction: Alcohol dependence is an increasing and pervasive problem. Alcohol Withdrawal Syndrome (AWS) is a cluster of symptoms that occur in alcohol-dependent individuals after cessation or reduction of alcohol consumption. However, studies on the clinicoepidemiological profile of patients with AWS and treatment patterns in India are scarce. Aim: To assess the treatment patterns during hospitalisation and after discharge in Indian patients with AWS. Materials and Methods: A retrospective observational study was conducted using data from 1000 patients with AWS who were admitted to nine addiction centres across India. Data from medical charts from the previous five years were collected over six months, from January to June 2022. The study included patients of either sex, aged ≥18 years at the time of data collection, who had been hospitalised for AWS symptoms and had ≥3 months of documented follow-ups. The primary endpoints of the study were the most commonly used medications and their dose titrations in the treatment of AWS, as well as the duration of treatment in the hospital and post-discharge. Key secondary endpoints included the socio-demographic profile of patients, common comorbidities, common signs and symptoms, the association between prescription patterns of Benzodiazepines (BZDs) and liver enzyme levels, and the average duration of hospital stay. Continuous variables were summarised as mean and Standard Deviation (SD), while categorical variables were summarised as frequency and percentages. Levels of serum Aspartate Aminotransferase (AST), Alanine Transaminase (ALT), γ-Glutamyl Transferase (GGT), and bilirubin were recorded from the source data, if available, and the association with the use of chlordiazepoxide and lorazepam was analysed using the Chi-square test. Results: The mean±SD age of the 1000 enrolled patients was 41.4±9.6 years, with the majority (n=997; 99.7%) being males. BZDs were the mainstay pharmacotherapy, with lorazepam (n=686; 68.6%) and chlordiazepoxide (n=482; 48.2%) being the two most commonly prescribed BZDs during hospitalisation. During post-discharge treatment, 57.0% (n/N=74/130) of patients received lorazepam, while 52.0% (n/N=67/130) received chlordiazepoxide. Frequently used drug regimens during hospitalisation included fixed doses of chlordiazepoxide {25 mg twice a day (BID:143/482; 29.7%), 20 mg thrice a day (TID:103/482; 21.4%), or 25mg TID (87/482; 18.0%)}, or lorazepam {2 mg TID (188/686; 27.4%), 2 mg BID (183/686; 26.7%), or 2 mg once a day (OD;175/686; 25.5%)}. Commonly observed signs and symptoms included tremors (n=567; 56.7%), irritability (n=539; 53.9%), and agitation (n=500; 50.0%). Depression (n=182; 18.2%) and anxiety (n=136; 13.6%) were the most commonly reported co-morbidities. Among the patients, only 13.4% (86/641) had an AST/ALT ratio >2, and 12.9% (44/340) had AST and GGT levels >2× Upper Limit of Normal (ULN). There was no significant difference in these patients between those receiving and not receiving chlordiazepoxide (p>0.05). The mean±SD duration of hospitalisation was 23.1±18.97 days, while the mean±SD duration of treatment during hospitalisation and post-discharge was 22.3±16.36 days and 71.6±52.3 days, respectively. Conclusion: The two most commonly prescribed drugs during hospitalisation and post-discharge were the BZDs, lorazepam and chlordiazepoxide. Fixed-dose regimens of chlordiazepoxide at 25 mg BID or TID, or 20 mg TID, and lorazepam at 2 mg TID, BID, or OD were frequently used during hospitalisation.

Mauriac syndrome is a rare complication of poorly controlled type 1 diabetes mellitus and is characterized by hepatomegaly with altered liver enzymes, delayed puberty, growth retardation, and cushingoid features, seen in children. Being a chronic condition, warranting frequent hospitalization, and invasive testing and management, one should always look out for the possibility of comorbid depression, enabling timely diagnosis and treatment. Here, we report the case of 14-year-old male with Mauriac Syndrome having comorbid major depressive disorder being well maintained on escitalopram.

Confusional arousal, classified under parasomnias, is a condition in which patients exhibit wakeful behaviors while still apparently asleep. It may be associated with shouting or sleepwalking and usually lasts for a few minutes to several hours. Patients tend to have no memory of the occurrence of such episodes. We report two cases of confusional arousals, the first, a 15-year-old boy suffering from autism spectrum disorder, and the second, a 10-year-old boy, with no other significant history.

Background: There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle. Aim: This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India. Method: A retrospective case file study was conducted across several centers in India. Results: Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer’s disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions. Conclusions: Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.

Background: Patients with suicide attempts usually present to the emergency department of hospitals, and the attitude of nursing staff and medical personnel plays a major role in their recovery. There is a negative perception and stigma associated with suicide among the public and hospital staff. This study aimed to assess the attitudes and perceptions toward suicide and suicide attempters among 2nd and 3rd year nursing students at a government hospital in Mumbai, India. Methodology: One hundred and eighty-eight nursing students studying in the 2nd and 3rd year of their courses were administered the suicide stigma scale, attitudes to suicide prevention scale and the exposure to suicidal behavior scale. The data were analyzed using descriptive statistics. Results: Sixty-eight (36%) of respondents agreed that those who attempt/commit suicide/take their life (lose their life to suicide) are pathetic while 35% believed that these persons were shallow and 44% of nursing students reported them to be immoral. Seventy six (40%) agreed that if someone is serious about committing suicide, they do not tell anyone about it. Eighty-nine (47%) of the respondents knew someone who made a suicide attempt and 108 (57%) of the students knew someone who had attempted suicide. Majority of the sample found seeking help from mental health professionals to be useful, important, and empowering. Conclusion: Further studies are needed to generalize the findings of this survey and to determine the methods of incorporating suicide assessment and management as an integral part of the nursing curriculum.

Aim: The study was aimed at calculating the levels of stress, anxiety, and depression among medical and health-care workers working in hospitals that catered to COVID-19 patients. Methodology: A total of 471 healthcare and medical personnel filled up an online socio-demographic pro forma and answered the Depression, Anxiety, and Stress scale. The data were analyzed using descriptive statistics and Chi-square test where appropriate. Results: The sample consisted of medical personnel and nurses. Majority were married and male. The levels of anxiety and stress were reported to be higher in males while depression was reported higher in females. Being unmarried and not having children were factors that showed higher depression levels while no socio-demographic factors showed a trend with anxiety and stress. Conclusion: Depression, anxiety, and stress are common in medical personnel and health-care workers working in the COVID-19 pandemic. Sound mental health interventions for these workers and large studies in specific populations are needed to corroborate these findings.

Background: Treatment-resistant schizophrenia (TRS) is one of the most disabling forms of schizophrenia. The Indian population being different in its sociodemographic factors, clinical profiles, and family structures, the experience of the efficacy of clozapine here is insufficient. Aim: The aim of the study is to explore the efficacy of clozapine in TRS over 3 months of drug use. Materials and Methods: It was an open-label interventional 12-week follow-up study, with 30 consenting adults with TRS determined as per modified Conley and Kelly's criteria of treatment resistance. The patient's sociodemographic and clinical details were recorded. Oral clozapine was initiated with gradual up-titration after preclozapine workup. The Positive and Negative Syndrome Scale (PANSS) score was assessed at baseline and reviewed at 4 weekly intervals. Results: By the end of 12 weeks, on an average dose of 494 ± 113.83 mg/day, 36.67% of patients reported 25%–50% improvement in PANSS score. The maximum improvement was seen in the positive symptoms subscale followed by the general and negative symptoms subscale. Conclusion: This study enlightens the dosage differences and efficacy of clozapine in the management of TRS in the Indian population.

Background: Attention deficit and hyperactivity disorder (ADHD) leads to various problems like academic underachievement, interpersonal relationship problems, and low self-esteem. Medications like methylphenidate (MPH) used for its treatment have decreased appetite and weight loss as the main side effects. There is scarce literature that throws light on the prevalence or severity of these particular side effects in patients with ADHD. Aims and objectives: So this study was conducted to assess the safety and efficacy of MPH in children and adolescents diagnosed with ADHD. Materials and methods: Patients of age-group 5–17 years who were diagnosed with ADHD were included in the study after taking informed consent of their parents. Semistructured pro forma was used to collect demographic and phenomenological details. Conners rating scale was used to assess ADHD severity. Methylphenidate was started for treating ADHD and patients were followed up at 1 and 3 months and change in Conners scale and side effects including appetite changes were asked for on follow-ups. Also, height and weight were measured on all visits. Results: One-hundred and seven patients with a mean age of 9.61 years were enrolled; of which, 79% of them were males. Seventy-three percent of them had a combined type of ADHD. The mean dose of MPH increased on subsequent follow-ups. Forty percent of them experience a decrease in their appetite at 1 month but only 18% of them had appetite issues at 3 months. There were no statistically significant changes in the height and weight of the patients on follow-ups. Conclusion: MPH is a very well-tolerated treatment for ADHD and not many side effects are observed in children taking it. Appetite reduction is seen for the initial treatment period which can be managed by giving MPH after heavy breakfast and meals.

Background: Electroconvulsive therapy (ECT) has shown to have efficacy and safety in treating psychiatric disorders. Studies have shown psychiatrists harboring negative attitudes about its use. The aim of the study was to assess the attitudes of psychiatrists toward practice and use of ECT and stigma associated with it. Methodology: A self-designed questionnaire was mailed electronically. Participants were asked to rate their attitudes and experience of using ECT in practice, concerns faced during prescribing ECTs, and possible solutions for destigmatization of ECTs. Results: We received 483 valid responses. Majority had positive attitudes toward the current use of ECT. Practicing in a metropolitan city, working in multiple clinics, having a family history of psychiatric illness, and having a member of the family treated with ECTs were associated with significantly more positive attitude and less concern about ECT. Poor socio-occupational strata, poor financial status, poor educational status, diagnosis of psychosis, and history of suicidal illness were associated with better acceptance of ECT by patients and caregivers. Improving undergraduate education in psychiatry and ECT and organizing interactions between patients advised ECT and patients improved with ECT were felt as effective solutions to counter ECT-related stigma by most number of psychiatrists. Conclusions: Psychiatrists in India have positive attitudes toward ECT yet have major concerns about caregiver reactions and patient dropouts while prescribing ECT. Practice location and prior exposure to psychiatric illness and ECT affect attitudes toward ECT. Psychiatrists suggested multiple strategies to reduce stigma associated with ECTs, changing the name of ECT to a nonstigmatizing was one of them.

Introduction: Epilepsy is a common chronic noncommunicable neurological disorder in which brain function is impaired. Epilepsy patients are more prone to comorbidities such as depression, anxiety, psychosis, personality disorders, hypo-sexuality, migraines, and other behavioral disorders. Comorbid depression and anxiety are more common in people with epilepsy than in the general population. Comorbid psychiatric illness in epilepsy has multifactorial etiology, including epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy, and any associated brain dysfunction and/or damage. Hence, this study was conducted to check the association of comorbid depression and anxiety with the sociodemographic factors and disease-associated factors in patients with epilepsy. Aim: To study the occurrence of depression and anxiety in patients with epilepsy and their relationship with sociodemographic and disease-associated factors. Materials and Methods: This was a single-centered cross-sectional study, in which 96 patients participated. To assess the severity of depression and anxiety, the Hamilton Depression Scale (HAM-D) and the Hamilton Anxiety Scale (HAM-A) were used, respectively. Results: Out of 96 patients, comorbid depression was seen in 35 (36.45%) and anxiety in 28 (29.16%) patients. Conclusions: The present study points out that depression is more prevalent than anxiety in patients with epilepsy and its severity is more if onset age is earlier and duration of illness is more.

Background: Compared to other professions, nurses experience the greatest degree of job stress. Persistent stress is harmful to physical and mental health resulting in apathy, sleep disturbance, frequent absence from work, drug abuse, feelings of inadequacy, physical and nutritional problems, increased health-care cost, and loss of job satisfaction. Hence, this study was done to find the prevalence of occupational stress and its effect on mental health of nurses working in a tertiary care center. Materials and Methods: This was a cross-sectional study conducted among staff nurses after approval from the Institutional Ethics Committee. Sociodemographic data along with their occupational history was collected in a semistructured pro forma. The Professional Life Stress Scale by David Fontanna (PLSS) was used for evaluating occupational stress, and the Mental Health Questionnaire was prepared for evaluating mental health issues. Results: One hundred and eighty-seven nurses were included in the study, with a mean age being around 40 years and mean duration of service being around 18 years. About 45% of them had stress as per DFPS and departments in which they were working did not affect the stress levels. 8.5% of them had elevated paranoia scores and 7.4% had high depressive scores. DFPS had no significant correlation with age of staff nurses and years of experience but had a significant correlation with scores of all domains of mental health. Conclusions: It is concluded from the present study that professional stress has a great impact on health of staff nurses. There is a need for hospital management to develop appropriate intervention programs to reduce workload, make regular shift schedules, and provide positive reinforcements for nurses to reduce anxiety, stress, and depression.

Background: Work from home (WFH) was faced with new challenges for many of them. Aims and Objectives: The aim is to investigate IT professional's experiences of WFH during the pandemic and to identify the main factors of advantages and disadvantages of WFH. Materials and Methods: An online survey was conducted among IT professionals by sending Google forms to them wherein demographic, professional details were collected and questions regarding advantages and disadvantages of WFH were asked. Results: 61.4% of individuals were males and 38.6% were females with mean age of 29.82 ± 4.25 years. The main advantages of WFH were flexible work timings and reduction in traveling time and costs by employees. Disadvantages perceived were mainly extending working hours and loss of professional and personal life balance. Conclusions: This survey suggests that WFH is advantage to employees and it can be enhanced for increasing productivity by overcoming the disadvantages to a maximal extent possible.

Exergames is a new arena of mental health intervention in the elderly. The present article is a clinical review on various areas where exergaming has been used to enhance mental health in the elderly. The review looks at the use of exergames in dementia, geriatric depression, as a tool for movement and to improve memory and cognition. The role of exergames in improving intellectual function, instability and falls in the elderly is also discussed. The role of exergames to improve fragility is mentioned. The review looks at the advantages and disadvantages of exergames in the elderly and the limitations of various studies done so far from a clinical and scientific rigor standpoint. The future research needs are also discussed. Exergames is a mental health intervention area in geriatric mental health that will be used more in the years to come.

Background: TikTok is a mobile application that had become very popular among youth in college and adults alike. Many people have used TikTok as an alternate form of social media and share videos from there on different social media platforms. This study was aimed as survey to ascertain the knowledge, attitudes, and practices toward TikTok as an application. Methodology: A semi-structured questionnaire was prepared to consist of questions regarding demographic details, knowledge regarding TikTok, frequency of usage of TikTok, attitudes toward its use and suggestions for change required in it. The questionnaire was circulated among students through e-mails and Whatsapp. The form was distributed three times in all within a gap of 7 days. The data collected were subjected to descriptive statistical analysis and percentages. Results: Seven hundred students in all were mailed and received the questionnaire. We received 583 responses, of which 81 responses being incomplete were removed, and the final analysis was done with 502 responses. Three hundred and three (60.4%) participants felt that it could be used for entertainment and only 11 (2.2%) mentioned education or awareness. Two hundred and seventy-two (54.2%) participants felt that TikTok use could be a media for boosting self-esteem and self-image. Conclusion: Further studies in detail about various facets of TikTok need to be studied in diverse population to generalize our findings and know how this application has influenced the youth in various sectors.

Chronic sleep deprivation is an important predisposing factor causing delirium. Here, we present the case of a 38-year-old male who presented with altered mental status and behavioral change following chronic sleep deprivation. There was no epileptic activity, no other psychiatric diseases or comorbidity, and no organic cause was determinable. The patient was discharged with counseling without any medications.

If all chronic conditions causing disability of any degree in childhood are included, the prevalence of disability is remarkably high. Studies on families with handicapped children have indicated that both parents often experience psychological disorders such as anxiety and depression. Handicapped children too suffer from psychological illnesses. Hence, the present study was undertaken. The study aims to look at the sociodemographic profile and psychopathology of mentally and physically handicapped children and their parents and to compare it with that of nonhandicapped children. Materials and Methods: The sample consisted of 90 children of both sexes. Sixty of these were handicapped-30 physically and 30 mentally. Thirty children were nonhandicapped. A semi-structured proforma, IQ tests, and Childhood Psychopathology Measurement schedule (CPMS) were used for assessment. Chi-square test and Paired “t”-test were used in the analysis. Results: It was observed that a greater number of handicapped children belonged to the higher score groups as compared to the nonhandicapped group. Significantly higher incidence of morbidity was observed in the handicapped children as compared to nonhandicapped children. Fathers and mothers of handicapped children had higher degree of psychopathology as compared to those of nonhandicapped children. Mothers' psychopathology had a significant effect on the severity of CPMS scoring in physically handicapped children. Conclusion: Handicapped children showed more severe psychopathology as compared to nonhandicapped. Mothers of handicapped children had higher psychiatric morbidity as compared to those of nonhandicapped children. Psychopathology of mother significantly affected the psychopathology of children.

Eating disorders (EDs) are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes toward weight, body shape, and eating play a key role in the origin and maintenance of EDs. As EDs are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed in this review.

Background: The dopamine active transporter (DAT) gene has been implicated in various psychiatric disorders such as attention-deficit hyperactivity disorder and externalizing behaviors. Studies on the methylation loci of DAT and Internet addiction (IA) are sparse. The study aimed to look at the association between various methylation loci of the DAT gene and IA, impulsivity, and other related variables. Methodology: Thirty-two youths with 10/10 genotype of DAT gene were administered the IA Test, Barratt's Impulsivity Scale (BIS), and Adult Self-Report Scale and using buccal swab methylation loci 1–7 of DAT gene were assessed. The data were analyzed by a correlation between various variables and a multiple regression analysis. Results: It was noted that the met5 allele (r = 0.844, P < 0.01) and met7 allele (r = 0.517, P = 0.01) correlated with DAT MEDIA scores. The total scores on the BIS and Internet Addiction Scale (IAS) also showed a positive correlation (r = 0.641, P = 0.01). Positive correlations were also noted between the scores on IAS and rule-breaking behavior as well as withdrawn behavior. Similar positive correlations were found between total scores on the BIS and rule-breaking behavior, withdrawn behavior, and intrusive behavior. Conclusions: Further studies in larger samples are needed to draw conclusions on the relationship between DAT gene methylation loci and IA or impulsivity.

Background: Cerebroprotein hydrolysate (cerebrolysin) is a nootropic and neurotrophic drug used widely in the management of various forms of dementia, stroke and head injury. A number of case series and anecdotal case reports on its efficacy exist. This study is a retrospective chart review of 34 patients with dementia treated at a tertiary general hospital psychiatry department that were given oral cerebroprotein as add on to their existing treatment for dementia. Methodology: 34 patients were administered twice daily oral cerebroprotein 90 mg tablets for 90 consecutive days. The cognitive assessment was done before the first injection and after the last dose using the Adenbrook's Cognitive Examination-Revised (ACER) and the Mini Mental Status Examination (MMSE). Results: Changes on cognitive assessment were minimal and no major improvements were seen though isolated areas of improvement were reported by many patients. The scores on the ACER and MMSE remained in the dementia range though improvement in scores were noted. None of the patients experienced any major side effects with the drug. Conclusions: Oral cerebroprotein is a useful agent in the management of dementia and must be tried as an add-on to regular dementia treatment. Larger studies in prospective cohorts with further stringent assessments warrant exploration.

Sexsomnia is a rare parasomnia that has been included a psychiatric disorder in Diagnostic and Statistical Manual-5 (DSM-5). Here we present the case of a 25-year-old male who presented with abnormal sexual behavior in sleep. There was no epileptic tendency noted, no other psychiatric comorbidity and no organic cause was determinable. The patient responded to clonazepam.

Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by pain stiffness and swelling in the joints with long standing effects on quality of life and is complicated by the presence of medical and psychiatric comorbidity. The current study was aimed at comparing the psychopathology, quality of life and life satisfaction between patients with RA and healthy controls. Methodology: There were two groups in the study – a study group with RA patients (n=97) and control group with their first-degree relatives (n=93). A semi-structured proforma collected data related to socio-demographic variables and RA. The groups were assessed using the Mini International Neuropsychiatric Interview, WHO Quality of Life scale brief version and Satisfaction with Life Scale. The scores were statistically analyzed and presented. Results: The mean age of the sample was 44.94 ± 13.02 years (range 18-82 years) and that of the control group was 23.02 ± 8.41 years (range 18-55 years). The mean duration of illness of the group was 7.2 ± 16.9 years (range 1-40 years). Major depression was the commonest disorder seen in 73.1% (n=73) patients with RA. Generalized anxiety disorder, panic disorder and suicidal feelings were also detected. The RA group had significantly lower QOL scores in the psychological and environmental domains of QOL Life satisfaction scores were also significantly lower in the RA group (p=0.0001) when compared to controls. Conclusion: Patients with RA have significant psychopathology that warrants attention and this affects their quality of life and life satisfaction. Further longitudinal studies in this area to gain clinical and epidemiological Indian data are warranted.

Pediatric organ transplantation (POT) has shown enormous development in the past few decades, and the number of POT has increased exponentially. While the various medical issues in pediatric transplantation have been discussed, there is a dearth of literature on the psychological issues surrounding POT. The present review aims at providing an overview on various psychological issues that surround POT. Literature search using search engines was carried out, and review papers and original research articles were analyzed. The overall role of the psychiatrist in the POT setup is discussed and issues such as depression and anxiety that may occur in children and their parents is elaborated. The neurocognitive changes that may occur in POT are also discussed and the need for regular monitoring is stressed. Special population such as developmental disabilities and human immunodeficiency virus infection in the organ transplant setting and specific issues related to them are discussed. The role of a child and adolescent psychiatrist as an invaluable asset to any POT team is discussed and deliberated. Multiple psychological facets that may be encountered while dealing with children and adolescents undergoing organ transplantation are discussed.

The relationship between testosterone and psychiatric disorders has been a long-standing one. The sex difference in schizophrenia has triggered to better understand the role that testosterone plays in the unfolding and clinical presentation of this psychotic disorder. DHEA and testosterone are found to influence dopaminergic, glutamatergic and GABAergic neurotransmission systems that are believed to play a role in the pathophysiology of schizophrenia. The onset of schizophrenia in males, most frequently encountered during adolescence, is also characterized by an increase in testosterone levels. Some studies have also observed lower testosterone levels in adult males with schizophrenia (or psychosis) compared to healthy controls.

Paranoid pseudocommunities may at times be a resistant and interesting symptom in patients with schizophrenia. A paranoid pseudocommunity is defined as an imaginary group of real persons or imagined persons believed in delusions to be conspiring against a paranoid individual. Herein, we report the case of a 61-year-old male with untreated schizophrenia for 36 years with auditory hallucinations constituting voices of twenty different people that were a part of a reciprocal paranoid pseudocommunity, and we explore the symptom phenomenologically and clinically.

Dementia as a diagnosis at any age is a clinical challenge in psychiatric practice. In recent research reports there have been many case series and anecdotal case reports of dementia with an onset below the age of 45 years. In this case report, we present the case of a 23 year old female that presented with psychotic features initially and on clinical examination and imaging was diagnosed as young onset frontotemporal dementia.

Schizophrenia is a mostly chronic mental disorder, and symptomatic relapse is frequently observed. It is often associated with social and/or occupational decline that can be difficult to reverse. Most patients with the illness need long-term pharmacological treatment and antipsychotic drugs represent the mainstay of clinical care. Long-acting injectable antipsychotics are an important alternative to oral medication, particularly advantageous in the context of compliance management.

Skin reactions have been reported with various antipsychotic drugs in scientific literature. It is important that clinicians be watchful of skin reactions in the elderly with antipsychotic medication, which can be an uncommon occurrence. It has been documented that the elderly are more prone to skin reactions with various forms of medication. We herewith report a case of skin reaction with risperidone in an elderly female patient.

Introduction: Hoarding behaviour is a common symptom seen in patients with Obsessive Compulsive Disorder (OCD). The phenomenology and prevalence of hoarding in OCD have been under studied in India and the phenomenon is less explored on routine clinical examination. Aim: To study the prevalence and phenomenology of hoarding as a symptom in patients with OCD and tried to elucidate some differences between OCD patients with and without hoarding symptoms. Materials and Methods: A total of 50 patients with OCD and 50 relatives of psychiatric patients were the subjects for the study. The OCD group was administered the Yale Brown Obsessive Compulsive Scale (YBOCS), the Hoarding Rating Scale and the Clutter Image Rating Scale. The 50 cases of OCD were further divided on the presence and absence of hoarding as a symptom into 2 groups and the scores on the scales used were statistically analysed using descriptive statistics like frequency and percentages, chi-square test and unpaired t-test. Results: The mean duration of illness was 8.01±5.17 years and the mean age of onset of the illness was 27.28±7.11 years for all patients with OCD. OCD patients with hoarding had a shorter total duration of illness than those without hoarding. Newspapers and scrap were hoarded the most with sentimental reasons along with importance of goods were cited as reasons for the behaviour. The two groups showed significant differences on compulsive sub scale of the YBOCS and no differences were noted in the other scales used. Conclusion: Patients having OCD with hoarding as one of the symptoms may differ from those not having hoarding. However larger studies across diverse groups are needed to corroborate these findings.

Introduction: Medical undergraduate courses and medical students have less emphasis on animal research and the various ethical issues surrounding animal research. Animal research plays a vital role in basic medical research and yet undergraduate students know very little about the same. Aim: To assess the attitude and knowledge of medical undergraduate students towards animal research in general. Materials and Methods: A total of 152 undergraduate medical students in the final year of their medical studies from two medical colleges (one from Mumbai and one from Kolhapur) were administered a semi-structured questionnaire on attitude and knowledge towards animal research. The questionnaire was validated by three senior researchers and was specially designed for the study. The data were collected and analysed using frequency and percentages. Results: Only 66(43.42%) students had visited an animal house/animal laboratory in their medical training and 114 (75%) of them had actual experience of handling animals mainly in the form of dissection studies on rats, frogs and guinea pigs. Only 21(13.8%) were aware of ethical guidelines regarding animal research and 23 (15.1%) strongly agreed that ethical aspects of animal research needed stringent regulation in India. Conclusion: Animal research awareness is scarce in undergraduate medical students and there is a need to incorporate animal research awareness from a medical science point of view in their curriculum to help them develop an understanding of animal research and its ethical dimensions.

Background: Gender identity disorder (GID) is a distressing disorder characterized by a persistent unhappiness with one's own sex and a desire to be of the opposite sex as well as seeking sex reassignment surgery for the same. The aim of the study was to assess the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles in patients with GID and examine differences in the profiles based on original gender of the patients. Methodology: Twenty-seven patients with GID that fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria for the same were participants of the study. They were administered the MMPI-2 and the scores across various scales were statistically analyzed. Before analysis, the sample was divided into groups according to gender, i.e., male-to-female and female-to-male patients who were requesting sex reassignment surgery. Results: No significant elevation of scores on any of the scales was noted in keeping with the fact that patients with GID usually demonstrate minimal psychopathology. All patients showed elevation on at least one subscale other than the masculinity-femininity subscale. No differences across gender were noted indicating that gender was probably not a determinant of psychopathology in GID. Conclusions: MMPI-2 profiles in patients with GID failed to reveal major psychopathology though the MMPI still remains a useful tool in the assessment of this population.

Olfactory reference syndrome (ORS) is a distressing clinical condition characterized by the belief that one's body emits a foul odor which disturbs others though others are unable to perceive the same. The disorder is characterized also by delusions of reference and olfactory hallucinations which may be present. The disorder usually shows a multifaceted picture and may mimic depression, somatoform disorders, obsessive–compulsive disorder, hypochondriasis and at times delusional disorder or schizophrenia. We present here a case of ORS that presented with delusions and suicidal ideation and responded well to a course of electroconvulsive therapy.

Alopecia universalis is characterized by total loss of hair from all over the body such as the scalp, eyebrows, and limbs. Alopecia areata has been known to coexist with psychiatric disorders such as anxiety disorders and depression, although reports with schizophrenia are rare. We present, herewith, a case of alopecia universalis seen to coexist with schizophrenia– a rare clinical picture.

Dandy Walker Syndrome (DWS) is a congenital malformation with brain abnormalities, intellectual disabilities, epilepsy and visible structural changes in particular brain structures. We present here a case of psychosis in an 18-year-old male with DWS, epilepsy and intellectual disability. The purpose of this paper is to discuss the clinically relevant issues, psychopharmacological issues, neuropsychiatric manifestations and consultation liaison issues involved.

Skin rashes have been reported after the start of various antipsychotic drugs in the scientific literature. It is important that psychiatrists be aware of antipsychotic-induced skin reactions in patients on antipsychotic medication which can be an uncommon yet possible occurrence. Patients with psychiatric problems may be prone to skin reactions and may not report the same as they may not be aware of the same. We herewith report a case of skin reaction with Olanzapine in a patient with schizophrenia.

Ofloxacin is a commonly used fluoroquinolone antibiotic in adults as well as children. It is generally safe and well tolerated though rare neurological and psychiatric adverse reactions have been reported with Ofloxacin. We report a case of a 6 years old child who developed hallucinations after being started on Ofloxacin and which resolved on discontinuation of the drug.

Background: “Bhukki” (poppy husk) consumption amongst truck drivers and many professions is a common and often culturally sanctioned form of substance abuse noted in India. There was a sudden surge of these patients undergoing withdrawal of opium due to a police crackdown on illegal smuggling of opium. Objectives: This study was a retrospective chart analysis to study the trend and socio-demographic profile in these patients. Materials and Methods: Study involved analysis of all outpatient department papers of patients presenting with history of crude opium consumption attending the psychiatry outpatient clinic during the period from June 2014 to September 2014. For the purpose of analysis truck drivers and non truck drivers were analyzed separately. Results: The total number of patients analyzed were 265 (264 males & 1 female). The age ranged from 19 to 85 years. About 44% were using only Bhukki, 25% Afeem and 30% both. 67% had no other comorbid substance use. There was statistically significant difference in mean age (p = 0.027) and education status (p = 0.001) amongst truck driver and non- truck driver groups. Conclusion: The study emphasizes the need to look into the socio-cultural aspects of opium addiction in India.

Introduction: Excessive Daytime Sleepiness (EDS) and sleep problems are common in patients with schizophrenia. The symptom of EDS in schizophrenia can be attributed to various causes including neurobiological changes, sleep disorders, medication or as a symptom of schizophrenia itself. EDS as a symptom in schizophrenia has been understudied. Aim: To assess the prevalence of EDS and to the study the same in patients with first episode and chronic schizophrenia. Materials and Methods: In this cross-sectional study 100 patients suffering from schizophrenia as per International Classification of Diseases (ICD-10) criteria were evaluated for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and EDS using the Epworth Sleepiness Scale (ESS). The severity of illness was assessed by Positive and Negative Symptom Scale for Schizophrenia (PANSS) while cognition was assessed using the Frontal Assessment Battery (FAB) and the Trail Making Test A and B. The data was statistically analysed. Results: A total of 100 patients (72 male and 28 female) aged 18 to 64years (mean age 30.63 years) were studied. Poor sleep quality (PSQI > 6) was exhibited by 83% of patients. Excessive daytime sleepiness (ESS > 7) was found in 32% of patients. There was no statistically significant difference in various parameters according to the age, duration of illness or gender. However, first episode patients differed in having better sleep quality than patients with chronic schizophrenia (p=0.0002). Cognition was not affected by sleep quality. Conclusion: A high prevalence of sleepiness and poor sleep quality was noted in the entire sample but it did not have any correlation with age and gender. It also did not affect the cognitive test scores. Further research in this area is warranted.

Obsessive compulsive symptoms have been reported in frontal lobe tumours and basal ganglia lesions. We report herewith a case of an adolescent who had a vermian cystic mass for which he underwent excision surgery. Three months postsurgery family members noticed that he started with repeated hand washing and abnormal walking pattern. Also, he developed bedwetting in sleep at night. He was given clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and Nocturnal enuresis following a cerebellar mass removal which improved with fluoxetine and impiramine respectively.