Search

Abstract This study aims to identify the optimal parameters for regulated metal deposition (RMD) and flux-cored arc welding (FCAW) processes when joining 316LN stainless steel. The objective was to determine the optimal settings for current (A), voltage (V), and gas flow rate (GFR, L/min) to achieve the desired weld bead characteristics, including bead width (BW), bead height (BH), depth of penetration (DOP), and heat-affected zone (HAZ). A Box–Behnken design based on response surface methodology was employed for the bead-on-plate trials. Mathematical models were developed from the experimental data and validated through analysis of variance and residual analysis, with R-squared values confirming model accuracy. The heat transfer search (HTS) algorithm was used for both single objective and multiobjective optimization. For RMD, optimal results were achieved with a BW of 9.95 mm, BH of 4.39 mm, DOP of 2.26 mm, and HAZ of 0.29 mm, at 130 A, 18 V, and 20 L/min GFR. For FCAW, optimal values were a BW of 11.45 mm, BH of 3.59 mm, DOP of 2.15 mm, and HAZ of 0.40 mm, at 210 A, 24 V, and 10 L/min GFR. The Pareto solutions offered a most suitable choice of the optimal configuration, balancing the desired BW, BH, DOP, and HAZ values. The effectiveness of the HTS algorithm is demonstrated by the minimal differences between predicted and measured values, highlighting its high accuracy in optimizing 316LN stainless steel welding parameters.

Background: Postpartum depression (PPD) is a serious concern with multifactorial etiology. Association between prenatal anxiety, pain, and depression has been theorized. Aim: In this randomized controlled trial, we studied the effect of pain relief by combined spinal epidural (CSE) and other factors influencing PPD. Methods: After thorough assessment and obtaining prenatal baseline parameters, parturients were randomly assigned to group 1 (CSE) and group 2 (control) (n = 31 each). Group 1 received 0.5 ml of 0.5% hyperbaric bupivacaine with 12.5 mcg of fentanyl intrathecally and 6 ml of 0.1% levobupivacaine with 2 mcg/ml fentanyl programmed intermittent epidural bolus every 60 min and patient-controlled epidural analgesia (PCEA) bolus of the same drug with a lockout interval of 15 min. Group 2 underwent normal vaginal delivery without neuraxial analgesia. Patients in both the groups were assessed for PPD using Edinburgh Postnatal Depression Scale (EPDS) at day 3 and 6 weeks postpartum. Results: The EPDS score at 6 weeks postpartum was significantly lower in group 1 than in group 2 (P < 0.05). The pain score assessed using visual analog scale was significantly lesser in group 1 than in group 2 (P < 0.001). Multivariate linear regression analysis showed that prenatal anxiety, greater pain interference scores, and perceived stress were major determinants of PPD. Conclusion: CSE analgesia using PCEA pump with PIEB facility in laboring parturients resulted in lesser EPDS scores and hence lesser postpartum depression. Effective pain control may be an important component to prevent PPD.

Background: Bipolar affective disorders are dimensional illnesses in which patients experience, during the long-term course of illness, fluctuating levels of severity of manic and depressive symptoms interspersed with symptom-free periods. It is a highly exhausting and relapsing psychiatric disorder associated with significant morbidity and comorbidity. The World Health Organization Disability Assessment Schedule (WHODAS) is an International Classification of Functioning-based multidimensional instrument that was developed for measuring disability. Aim and Objective: The present study aimed to check the correlation and inter-rater agreement amongst the patient, caregiver, and clinician-administered version of the WHODAS 2.0 among persons with bipolar affective disorder. Materials and Methods: The study was cross-sectional in nature. Thirty samples of patients with bipolar affective disorder as per ICD-10 criteria were selected using a consecutive sampling technique. Patients above 18 years of age with a total duration of illness of at least more than 2 years were included and used self, proxy, and interviewer-administered versions of WHODAS 2.0. Results: The total score of WHODAS 2.0 shows that the interclass correlation coefficient between the patient and caregiver, caregiver and clinician, and patient and clinician was 0.655 (0.469–0.802), 0.599 (0.395–0.767), and 0.722 (0.586–0.820), respectively, indicative of moderate reliability. Caregivers showed a higher mean in cognition, 3.73 (3.13); mobility, 2.63 (1.73); and self-care, 0.867 (1.25), than other raters. Clinicians showed a higher mean (standard deviation) in getting along with people, 4.13 (1.69); life activities of the household, 5.46 (2.67); and participation in society, 10.70 (2.56), than other raters. Conclusion: People suffering from bipolar affective disorder are prone to disability albeit in the mild-to-moderate variety. The findings show that there was moderate reliability between the patient and caregiver, caregiver and clinician, and patient and clinician among the patient rated, caregiver rated on the overscore of WHODAS 2.0.

Background: Management of dementia involves a multidisciplinary approach which also requires active participation from family members and caregivers. Thus, having easy access to information about dementia care is pertinent. Internet-based information is an emerging method for the same. Aim: To perform a comparative assessment of patient-oriented online information available on treatment of dementia over web pages in English and Hindi language. Methods: Observational study was conducted online through a general internet search engine (www.google.com). Web pages containing patient-oriented online information on treatment of dementia in English and Hindi were reviewed to assess their content and quality, esthetics, and interactivity. Appropriate descriptive and inferential statistics were conducted using the Statistical Package for the Social Sciences. Results: A total of 70 web pages met the eligibility criteria. Content quality assessed using the DISCERN score was significantly higher for English web pages compared to Hindi web pages (P < 0.01). About 72.4% (21/29) of English and only 9.8% (4/41) of Hindi web pages had a total DISCERN score of 40 or above, indicating good quality. For esthetics, the median score for English pages was significantly higher than for Hindi web pages (P < 0.01). The web pages with Health On Net (HON) certification had significantly better content quality. Conclusion: Our study revealed a scarcity of good quality online information about dementia and its treatment, especially in the Hindi language. English language websites showed better content quality than Hindi websites. HON Code label might be used as an indicator of better content quality for online resources informing on dementia treatment by lay people.

Background and Aims: There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design: Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods: Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results: The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions: Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Objective. Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review. Materials and Methods. Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline. Results. The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies. Conclusion. There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.

Introduction: COVID-19, is a highly contagious disease caused by Novel Corona Virus SARS-Cov-2. After initial infection, most patients recover completely, but in some patients, symptoms may persist for variable duration. This study was planned to evaluate different persistent symptoms of long COVID among the people of Northern India, who had asymptomatic or mild disease during active infection stage. Methods: A cross sectional study was done in Chandigarh, India, during August 2021 to June 2022. A total of 647 recovered COVID-19 patients, who had suffered of COVID almost ≥3 months back were included in the study. A self-designed questionnaire was developed for the survey. Participants were followed up till 3 months. Results: Out of 647 subjects enrolled, 27.5% had some post-COVID symptoms. Among symptomatic, 55.1% were males and 44.9% were females. Post-COVID headache was significantly more common in females. Sleep disturbances and history of pain and pressure that spreads to arms were significantly more common among non-smokers. Sleep disturbances and change of appetite were significantly more common among non-alcohol users. Chest discomfort and change of appetite were found to be significantly more common among non-hypertensive subjects. Symptoms of chest discomfort, sleep disturbances, anxiety, feeling of sadness on daily basis and forgetfulness was significantly more common among subjects without underlying heart disease, while weakness among patients with underlying lung disease. Poor concentration was found to be significantly more common among patients without underlying lung disease and that in the age group 26-50 years, followed by 51-75 years and 76-100 years. Conclusion: This study attempted to assess the prevalence of post COVID complications among the asymptomatic and mild COVID patients. From the clinical point of view, physicians should be aware of the symptoms, signs, and biomarkers present in patients previously affected by COVID-19 to promptly assess, identify and halt long COVID-19 progression, minimize the risk of chronic effects and to re-establish pre-COVID-19 health.

Background: There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients. Method: An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered. Result: 68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group. Conclusions: There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning.

The regulated Metal Deposition (RMD™) process is a variant of the gas metal arc welding process (GMAW), which was developed to effectively control the metal transfer in the short-circuiting mode. The process is fundamentally a modified short-circuit GMAW process wherein a uniform droplet deposition, making it easier for the welder to control the puddle and hence achieve an enhanced quality of welded joints. In the present study, the RMD technique has been established for the low alloy steel grade 2.25 Cr - 1.0 Mo particularly for depositing the root pass on a 10 mm thick joint. In addition to this, the RMD technique is attempted with metal-cored wires to enhance the deposition rates and hence productivity. The joint fill-up is further attempted with the GMAW technique using metal-cored wires and analysed. The weldments were subjected to post-weld heat treatment followed by mechanical and metallurgical characterization. Mechanical characterization such as tensile properties, impact properties, bend test as well as all weld tensile properties of the weld joint was evaluated and found to be acceptable. The ductile to brittle transition temperature (DBTT) testing was carried out by breaking series of impact specimen till negative temperatures. The DBTT temperature for the weld joint was found well below −30 °C which indicated the strength and soundness of the welded joint. Optical microscopy and scanning electron microscopy was carried out for and favourable results were achieved in microanalysis. The study proposes the use of metal-cored wires for potential applications in the welding of high thickness joints for enhancing the overall productivity.

Abstract Background The elderly are a vulnerable section of the population who are prone to physical, mental, social, and economic deprivation. The effect of COVID-19 had a worldwide impact on all age groups, with a particularly higher mortality and morbidity rate among the elderly population. The present study was undertaken to know about the psychological morbidity in the geriatric population during the period of the COVID-19 pandemic. The study was cross-sectional and was done through a telephonic survey. Eligible elderly subjects were contacted telephonically, and the Geriatric Anxiety Scale and the Geriatric Depression Scale were administered. To evaluate the functional ability of elderly subjects, the Everyday Abilities Scale for India (EASI) scale was administered. For the telephonic survey, verbal consent was sought. Results A total of 92 elderly subjects were included. Male outnumbered the females with a ratio of 1.8:1. Spouse and children were primary caregivers in 83.7% of the subjects. 90.2% were married, and 66.3% had earned a graduate/professional level of education. Chronic illness was present in 50% of subjects. The most common co-morbidities were hypertension (27.2%) and diabetes (21.7%). The proportion of elderly with anxiety and depression was 8.7% and 15.2% respectively. Conclusion The elderly showed lower levels of anxiety and depression. Higher resilience among the elderly and good family support may be the reasons for such an unexpected finding. However, more studies are required to validate the findings of the current study.

We describe a case of late-onset periodic catatonia with atypical course in an elderly male with onset at the age of 70 years with brief episodes of sudden agitation lasting for a few hours of the day, followed by immobility, mutism, ambitendency, withdrawal, and urinary incontinence for the next few days. Four such episodes with complete recovery over the next few days and no residual behavioral symptoms lasting for several years (up to 7 years) without any long-term prophylactic psychotropic use. During the fourth such episode, the patient presented to our facility with a similar abrupt onset of symptoms. All biochemical investigations and neuroimaging findings were found to be noncontributory. On clinical examination, a diagnosis of periodic catatonia was suspected, which was later confirmed by immediate response to the intravenous diazepam challenge given under vitals monitoring in a high-dependency unit setting.

Treatment gap in mental health is vast and continues to remain a grim reality. Amongst community mental health care, one approach available is home based care (HBC). However, HBC services are almost lacking in India. Nevertheless, the limited evidence points towards a successful utility of HBC till date. In this article, the Chandigarh experience of HBC is presented and discussed in detail in order to demonstrate its utility and effectiveness. Lastly, recommendations are provided for the future of HBC.

Background: Dementia is a disease characterized by brain atrophy, leading to cognitive decline. The clinical picture includes the presence of neuropsychiatric symptoms (NPSs), which can increase the caregiver burden. The present research was aimed at studying the effect of group therapy intervention with caregivers of patients with dementia on caregiver burden and NPSs of patients. The study was prospective, interventional, and exploratory. Materials and Methods: The study included 30 primary caregivers of geriatric patients (aged 60 and above) with dementia. The caregivers were divided into two groups of 15, in which one group received routine treatment and the other group received group therapy in addition to routine treatment. The patients in both groups were assessed on Neuropsychiatric Inventory Questionnaire, Everyday Abilities Scale for India, and Hindi Mental State Examination, and the caregivers of both groups were assessed on Zarit Burden Interview before and after the intervention. Statistical Analysis Used: Independent t-test was used to compare the age between two groups and Chi-square test to compare other sociodemographic variables between groups. Paired samples t-test was used for within-group comparison, and Mann–Whitney U-test was used between-group comparison. Results: There was significant improvement in NPSs of the patients and caregiver burden after intervention in the combined group. However, there was greater improvement in NPS of patients and caregiver burden in the group that received group therapy. Conclusions: Group therapy in caregivers of the patients with dementia is effective in improving the NPSs of patients, as well as in reducing caregiver burden.

Background: Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed. Materials and Methods: Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD. Results: Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86–43.55; P = 0.001). Conclusion: CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.

Background: Naltrexone is effective in the treatment of opioid dependence syndrome (ODS) as it prevents relapse. To effectively design a cost-effective treatment modality for ODS using naltrexone as low as 25 mg is something which is worth exploring. Aim: To study the effectiveness of 25 mg naltrexone and 50 mg naltrexone in patients with ODS. Materials and methods: Case record files of patients of ODS admitted in psychiatry ward from January 2015 to September 2017 were retrieved and analysed after applying coding plan. Results: A total of 79 patients with ODS were admitted during this period. Patients were divided into three groups- group one received 25 mg naltrexone per day, group two: 50 mg naltrexone, and group three: non-naltrexone. Cumulative abstinence duration (CAD) in group one was 48 days, group two was 52 days, and group three was 23 days. At follow-up, there was no relationship between abstinence status and dose of naltrexone prescribed and amount of opioid use. Conclusion: Naltrexone is effective in reduction of craving and there was no significant difference between the different dosages of naltrexone, i.e. 25 mg and 50 mg per day.

Background: Increase in life expectancy of Indians will require revamping the health-care infrastructure for the elderly. In India, either there are not too many specialized geriatric mental health services available across the country or those that are available have problems of resources and quality. With this perspective, the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, developed the Geriatric Mental Health Clinic (GMHC) for the elderly residing in and around Chandigarh. The aim of the study was to study the initial 1-year cohort and assess their satisfaction levels as well as to see whether their functioning improves with the intervention so provided. Materials and Methods: Using the “service evaluation framework,” the patients and caregivers who attended the GMHC over a period of 1 year were evaluated using tools such as Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, World Health Organization quality of life-BREF (WHO-QoL-BREF)-Hindi version, and Patient Satisfaction Scale (PAT-SAT). In addition, sociodemographic and clinical profile data of the service users were compiled. Results: A total of 105 cases formed the cohort under study, wherein 70% had functional psychiatric illness and almost more than half of the cases had comorbid physical illness, hypertension being the most common. GAF score of 45.42 and WHO-QoL-BREF score of 78.7 at the time of follow-up suggested that there was “slight impairment in socio-occupational functioning” and “poor QoL,” respectively. However, GAF and HMSE scores were significantly decreased in those with organicity. Overall service users reported good service-cum-clinician satisfaction scores on PAT-SAT; there was also significant reduction of EASI score from that of baseline, suggesting improvement in functioning. Conclusions: Findings show that the newly started GMHC, even though in its incipient stage, is attracting patients of all diagnostic categories, from expected catchment areas, is being able to deliver interventions which are bringing about clinical and functional improvement, and service users are not reporting dissatisfaction.

Background: A substantial proportion of euthymic bipolar disorder patients have neuropsychological impairment which can have a significant impact on the overall functional recovery. Materials and Methods: A total of 60 bipolar disorder patients, currently in euthymic phase for the last 3 months with minimum duration of illness 2 years and current Young Mania Rating Scale

As psychiatry made a steady progress in India, organizations such as the Indian Psychiatric Society and Indian Association for Social Psychiatry (IASP) also grew in strength. These organizations played a crucial role in facilitating research and promoting academic interest in the field of mental health in India. It was felt that there is a great need to have a look into the sociocultural factors and their role in the phenomenology, course, and outcome in mental health problems, especially in the Indian context, with its rich and diverse sociocultural milieu. It was also well acknowledged that the treatment of mental disorders involved a multidisciplinary approach and nonpharmacological management was at least as important as medications. These factors fostered the birth of IASP (in January 1984), which was a distinct organization with different mental health professionals (psychiatrists, psychologists, psychiatric social workers, and psychiatric nurses) that sought to focus on social issues in psychiatry. Over a period IASP was able to create a niche for itself not only in India but globally as well; hosting of World Congress of Social Psychiatry, the prestigious academic event of World Association of Social Psychiatry in 2016 further strengthened IASP's position in the international forum. Nevertheless, IASP did have to struggle from time to time and circumvent around challenging issues. This narrative gives a bird's eye view (as seen by BS Chavan, former Secretary General of IASP) of how IASP evolved over time and how it traversed hurdles to become what it is today.

ObjectivesThe National Mental Health Survey (NMHS) of India was undertaken with the objectives of (1) estimating the prevalence and patterns of various mental disorders in representative Indian population and (2) identifying the treatment gap, healthcare utilisation, disabilities and impact of mental disorders. This paper highlights findings pertaining to depressive disorders (DD) from the NMHS.DesignMultisite population-based cross-sectional study. Subjects were selected by multistage stratified random cluster sampling technique with random selection based on probability proportionate to size at each stage.SettingConducted across 12 states in India (representing varied cultural and geographical diversity), employing uniform, standardised and robust methodology.ParticipantsA total of 34 802 adults (>18 years) were interviewed.Main outcome measurePrevalence of depressive disorders (ICD-10 DCR) diagnosed using Mini International Neuropsychiatric Interview V.6.0.ResultsThe weighted prevalence of lifetime and current DD was 5.25% (95% CI: 5.21% to 5.29%, n=34 802) and 2.68% (95% CI: 2.65% to 2.71%, n=34 802), respectively. Prevalence was highest in the 40–59 age groups (3.6%, n=10 302), among females (3.0%, n=18 217) and those residing in cities with population >1 million (5.2%, n=4244). Age, gender, place of residence, education and household income were found to be significantly associated with current DD. Nearly two-thirds of individuals with DD reported disability of varying severity, and the treatment gap for depression in the study population was 79.1%. On an average, households spent INR1500/month (~US$ 23.0/month) towards care of persons affected with DD.ConclusionAround 23 million adults would need care for DD in India at any given time. Since productive population is affected most, DD entails considerable socioeconomic impact at individual and family levels. This is a clarion call for all the concerned stakeholders to scale up services under National Mental Health Programme in India along with integrating care for DD with other ongoing national health programmes.

Objectives: To compare the efficacy and tolerability of clozapine and quetiapine in patients with treatment-resistant schizophrenia (TRS). Patients and Methods: In this prospective, randomized, open label study of 14 weeks, 53 patients with schizophrenia diagnosed as per ICD-10 and fulfilling the modified version of Conley and Kelly's criteria of TRS were randomly assigned to receive clozapine or quetiapine as per a computer-generated random table. After 2-weeks of dose-titration phase, doses were fixed at minimum therapeutic dose and subsequently adjusted according to the clinical improvement. All patients received dosage of respective drug in therapeutic range. 13 patients were lost to follow up. Treatment efficacy and side effects were evaluated with standardized rating scales. Results: Clozapine group (reduction in total score: mean=14.45, SD=10.39) had significantly greater reductions (P=0.004; CI=3.541-17.059) in the Positive and Negative Syndrome Scale (PANSS) total score, PANSS positive subscale and PANSS general psychopathology subscale at 14 weeks in comparison to the quetiapine group (reduction in total score: mean=4.15, SD=10.71). Significant reduction in PANSS negative subscale was seen with both drugs but no significant difference was present between the two drugs. At 14 weeks, 30% patients in clozapine group and 15% patients in quetiapine group showed response. Clozapine led to significantly greater side effects (P< 0.001, CI=2.241-6.059) on Glassgow Antipsychotic Side-effect Scale (GASS) than quetiapine. Conclusions: Clozapine was found to be more efficacious than quetiapine in patients with TRS but was associated with greater side effects. Both the drugs were found to be equally effective in reducing the negative symptoms.

Background: Lack of awareness about mental illness prevents patients from getting appropriate mental health care. This is more so in places where there is dearth of adequate mental health professionals. These factors highlight the importance of conducting research to assess public knowledge and attitudes toward mental illness. Hence, the aim of the present study was to assess the prevailing concept of depression in the community. Methods: Two villages in the periphery of Chandigarh were selected and local “Panchayat” of the villages were told to select the local members in the community who were regarded as socially responsible. A total of 48 members were selected and a workshop was conducted by the experts in mental health and the cohort was asked about prevailing concept of depression in the local community. The whole workshop was videotaped and the verbatim of the same was recorded. Results: It was found that majority had beliefs that depression is caused by stressful circumstances or substance use and the depressed individual has decreased interaction, fights and sleeps less. It was also noted that the prevalence was perceived to be low. The first treatment preferences were religious/faith healers or the local practitioners. Reasons for treatment gap were cited as ignorance and misguidance in the community. Conclusions: It was interpreted that depression is mainly linked with stressful events and symptoms being behavioural only. The understanding of somatic and biological symptoms was lacking along with the endogenous risk factors and its causes. Treatment gap exists at the grass root level and reasons such as ignorance and misguidance emerged during the discussion with the community leaders.

Understanding the burden and pattern of mental disorders as well as mapping the existing resources for delivery of mental health services in India, has been a felt need over decades. Recognizing this necessity, the Ministry of Health and Family Welfare, Government of India, commissioned the National Mental Health Survey (NMHS) in the year 2014-15. The NMHS aimed to estimate the prevalence and burden of mental health disorders in India and identify current treatment gaps, existing patterns of health-care seeking, service utilization patterns, along with an understanding of the impact and disability due to these disorders. This paper describes the design, steps and the methodology adopted for phase 1 of the NMHS conducted in India. The NMHS phase 1 covered a representative population of 39,532 from 12 states across 6 regions of India, namely, the states of Punjab and Uttar Pradesh (North); Tamil Nadu and Kerala (South); Jharkhand and West Bengal (East); Rajasthan and Gujarat (West); Madhya Pradesh and Chhattisgarh (Central) and Assam and Manipur (North East). The NMHS of India (2015-16) is a unique representative survey which adopted a uniform and standardized methodology which sought to overcome limitations of previous surveys. It employed a multi-stage, stratified, random cluster sampling technique, with random selection of clusters based on Probability Proportionate to Size. It was expected that the findings from the NMHS 2015-16 would reveal the burden of mental disorders, the magnitude of the treatment gap, existing challenges and prevailing barriers in the mental-health delivery systems in the country at a single point in time. It is hoped that the results of NMHS will provide the evidence to strengthen and implement mental health policies and programs in the near future and provide the rationale to enhance investment in mental health care in India. It is also hoped that the NMHS will provide a framework for conducting similar population based surveys on mental health and other public health problems in low and middle-income countries.

Objective: Few studies have investigated the reasons for alcohol initiation and continuation. The present study examined reasons for trying alcohol for the first time and its subsequent use. Furthermore, the study attempted to discover the possible predictors that make an individual vulnerable to alcohol use. Methodology: A total of 280 first-year college students from six different colleges were contacted. Using the method of equal probability, every third subject from each class was selected. All the selected subjects were interviewed and administered semi-structured questionnaire for gathering information regarding their experience with alcohol. Results: In our study, experimentation and peer pressure were found to be the main reasons for both alcohol use and its re-use. The first time drinkers differed a lot from those with multiple users in terms of reasons for trying alcohol, the effect of alcohol, family history of alcohol use, and self-view about alcohol use. The results depicted that the gender, educational stream, and family history of alcohol use are the factors that make an individual vulnerable to alcohol use. Conclusion: First-year of college is a unique transitional period. First-year students with high levels of sensation seeking may be especially at high-risk to begin or escalate heavy drinking. Studying the nature of alcohol initiation may not only be helpful in planning awareness programs but also in preventing underage drinking and alcohol abuse.

Background: Depression is common among diabetes, and is associated with poor outcomes. However, the data on this important relationship are limited from India. Objective: The aim was to estimate the prevalence of depression in patients with diabetes and to determine the association of depression with age, sex, and other related parameters. Materials and Methods: The study was cross-sectional carried out in endocrinology clinic of tertiary care hospital in North India. Cases were patients with type 2 diabetes mellitus (T2DM) above 30 years of age. Depression was assessed using the patient health questionairre-9 (PHQ-9). The relationship with sociodemographic profile, duration of diabetes, hypertension and microvascular complications was also analyzed. Results: Seventy-three subjects (57.5% females) with mean age 50.8 ± 9.2 years were evaluated. The prevalence of depression was 41%. Severe depression (PHQ score ≥15) was present in 3 (4%) subjects, moderate depression (PHQ score ≥10) in 7 (10%) subjects, and mild depression was present in 20 (27%) of subjects. Depression was significantly more prevalent in rural subjects (57%) when compared to urban ones (31%, P = 0.049). Depression increased with presence of microvascular complications, fasting plasma glucose, hypertension, but the differences were not statistically significant. Conclusions: Our study demonstrates higher prevalence of depression in patients with type 2 diabetes. Apart from being belonging to the rural area, no other factor was significantly associated with depression. Therefore, depression should be assessed in each and every patient, irrespective of other factors.