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Aim: This study aimed to evaluate the prevalence of obstructive sleep apnea (OSA) and its correlates among schizophrenia spectrum disorder patients receiving clozapine. Methods: For this, 200 schizophrenia spectrum disorder patients receiving clozapine for at least one year were assessed on the Berlin Sleep Questionnaire for OSA. Results: Around one-sixth of the study sample (16.5%) had a high risk for OSA at a body mass index (BMI) cut-off of 30 kg/m2. When a BMI cut-off of 25 kg/m2 was used, the prevalence of OSA was 36%. A high risk for OSA is associated with a higher prevalence of depression, a higher number of psychiatric comorbidities, diabetes mellitus, a higher mean total chlorpromazine equivalent dose, a higher number of total medications, poorer quality of life in some of the domains, and scored high for all domains and the total score of UKU. Conclusion: To conclude, this study suggests that a high risk of OSA is associated with the presence of depression, a higher number of psychiatric comorbidities, diabetes mellitus, use of higher total chlorpromazine equivalent dose, the total number of medications, poorer quality of life, and a higher prevalence of other side effects.

Background: Little information is available on response to electroconvulsive therapy (ECT) in patients with bipolar disorder (BD) from India. Aim: This exploratory study aims to evaluate and compare the sociodemographic and clinical profiles, treatment outcomes of BD patients with depression and mania/mixed episode who received ECT and to evaluate the predictors of response to ECT. Results: Data of 278 BD patients who received 325 ECT courses were extracted from the ECT register. The number courses of ECT for bipolar depression (n = 202) exceeded those for mania/mixed episodes (n = 123). In terms of response to ECT, >75% response was achieved in 63.3% cases and >50% response was seen in about 90% of the patients. No significant difference was seen in response to ECTs between bipolar depression and mania/mixed episodes. Conclusion: The present study suggests that about two-thirds of the BD patients show more than 75% response to ECT, and more than 90% of the BD patients show more than 50% response to ECT.

Background: There is limited data on the prevalence, symptom profile, and etiology of catatonia among the elderly. Aim: This study aimed to evaluate the prevalence, symptom profile, and primary etiology of catatonia among elderly patients (≥60 years) admitted to an indoor acute care psychiatric unit of a general hospital setting. Methodology: For this retrospective study, the inpatient psychiatry registry of the department for the period of January 2016 and June 2023 was screened to identify elderly patients (aged ≥60 years). The treatment records of these patients were screened for the presence of catatonia. The symptom profile of those with catatonia as per the rating on the Bush Francis Catatonia Rating Scale (BFCRS) and the psychiatric diagnosis made as per the International Classification of Diseases, Tenth Revision was extracted and compared with those without catatonia. Results: Out of the 298 elderly patients admitted to the inpatient unit during the study period, 33 (11.1%) had catatonia at the time of admission. As per BFCRS, the most common catatonic symptoms were mutism (100%), followed by staring (93.9%), immobility (84.8%) and rigidity (84.8%), posturing/catalepsy (69.7%), negativism (66.7%), withdrawal (60.6%), and autonomic abnormality (42.2%). No significant difference was noted among those with and without catatonia in terms of sociodemographic variables. In terms of the etiology of catatonia, in the majority of the patients, catatonia is associated with affective disorder (unipolar > bipolar disorder) (28 out of the 33 patients), followed by dementia (n = 3) and psychotic disorder (n = 2). In terms of management, compared to those without catatonia, those with catatonia more often received benzodiazepines and electroconvulsive therapy. Conclusion: About one-tenth of the elderly admitted to the acute psychiatry inpatient units have catatonia, most of them have retarded catatonia, and the majority of the catatonia among the elderly is associated with affective disorders.

Aim: The present study aimed to compare the clinical profile, indications for electroconvulsive therapy (ECT), effectiveness of ECT, and complications associated with the use of ECT among elderly and adult patients. Methodology: Using a retrospective study design, data from patients with a diagnosis of unipolar depression, who received ECT between January 2013 and March 2023 was extracted. Based on the age at the time of receiving ECT, the study sample was divided into adult (age

Background: There is limited data on use of electroconvulsive therapy (ECT) for management of psychiatric disorders during the postpartum period from India. Aim: We aimed to assess the demographic and clinical profile of patients receiving ECT during the postpartum period for various psychiatric disorders using a retrospective study design. Methods: ECT register of the department was reviewed for the period of January 2019 to December 2023 to identify the patients who received ECT during the postpartum period. The treatment records of these patients were evaluated to extract the demographic and clinical profile. Results: During the study period, 10 patients received ECT during the postpartum period. The mean age of the study sample was 27 (standard deviation [SD]: 2.9) years. Majority of the patients were inpatients (70%) at the time of receiving ECT. Five patients were diagnosed with first-episode depression with postpartum onset, and two patients had postpartum-onset psychotic disorder. One patient was diagnosed with recurrent depressive episode and one with bipolar disorder, current episode mania with psychotic symptom, at the time of receiving ECT. The mean number of ECTs during the ECT course was 6.7 (SD: 3.09). Nine out of the 10 patients showed good response to ECT. Conclusion: Although ECT is less frequently used for management of postpartum psychiatric disorders, its use is associated with significant clinical improvement.

Background: Despite clozapine being the gold standard for treating patients suffering from treatment-resistant schizophrenia, the experience and attitude of patients receiving clozapine for a long duration and their caregivers have not been evaluated, especially in India and other low-middle-income countries. Also, no standardized scale has been validated for such assessment. Objective: This study aimed to evaluate the perception regarding clozapine among patients and their caregivers. We also attempted to evaluate the factor structure of the scale for such assessment. Methods: A total of 172 consenting patients who have been receiving clozapine for ≥1 year and their caregivers were evaluated on self-designed questionnaires (patient and caregiver versions containing 44 and 47 items, respectively) to assess various aspects of their experiences about clozapine use. Results: A majority (70–80%) of patients and caregivers reported improvement in psychotic symptoms, mood symptoms, and overall functioning with starting of clozapine. However, about 40% of the patients reported cognitive side effects, and 20–25% reported disabling side effects like lethargy, forgetfulness and decreased attention, and distress related to blood testing after starting of clozapine. Factor analysis of the questionnaires yielded five- and seven-factor models for the experience and attitude of the patients and the caregivers, respectively. The positive experiences were associated clinical and functional improvement, lower disability, and improvement in functioning as well as the self-reported perceived improvement by the patient and caregiver. Conclusion: This study suggests that patients tend to have an overall positive experience and attitude about using clozapine. The caregivers also report the beneficial effect on the caregiving. A good level of agreement was seen between the experience of patients, caregivers, and clinician-rated improvement in the psychopathology and functioning.

Background: There is a lack of data on the use of continuation electroconvulsive therapy (C-ECT) from India. Objectives: This study aimed to evaluate the clinical profile and outcome of patients receiving C-ECT. Materials and Methods: The ECT register was used to identify patients receiving C-ECT (ECT after completion of an acute course, to maintain remission or prevent relapse) from 2011 to July 2022. Socio-demographic, clinical, and treatment outcome details were extracted from their treatment records. Results: A total of 72 C-ECT courses were identified that were used in 60 patients. Out of all the patients receiving ECT, only 3.25% of patients receive C-ECT. The majority of the patients were male (60%). The mean age of the patients at the time of starting ECT was around 39 years. The most common diagnosis was schizophrenia (73.3%), followed by recurrent depressive disorder (21.6%). The most common indication was persistent psychotic symptoms poorly responding to multiple antipsychotic trials of 3.09 (SD: 1.39), including clozapine. These patients received a mean of 22.58 (SD: 8.05; range: 10 to 46) ECTs, with 10.0 (SD: 4.83) ECTs for the management of the acute phase of illness and 12.57 (SD: 6.20) ECTs as part of continuation treatment. The majority (61.1%) of the patients received four (once weekly) C-ECTs in the first month, followed by three more in the next month. However, 16 patients received weekly ECTs during the second month too, as symptoms worsened with the lowering of frequencies. Twelve patients received more than one C-ECT course. The majority of the patients maintained the improvement gained during the acute phase or showed further improvement with C-ECT along with ongoing pharmacotherapy as rated on appropriate scales. The Clinical Global Impressions-Severity (CGI-S) difference before and after C-ECTs was 2.94 (SD: 0.88). Conclusions: C-ECT is considered in only in a small proportion of patients. However, when used, it is effective in maintaining the benefits gained during the acute course of ECT and preventing relapse.

Background and Aim: The present study aimed to assess the treatment dropout rates, reasons for treatment dropout, and clozapine discontinuation rate among patients attending a tertiary care center in North India. Materials and Methods: Clozapine data bank was used to identify patients on clozapine, and their treatment records were reviewed for the period Jan 2020–March 2020. Patients who did not follow-up at least once in the last 6 months were considered to have dropped out and were contacted telephonically to understand the reasons for dropout. Treatment records of those following up regularly were reviewed to check if clozapine was discontinued and if so, the reason for the same was evaluated. Results: Out of 671 patients on clozapine, 495 (73.8%) were still on regular follow-up and the remaining 176 (26.2%) had dropped out of treatment. Out of the 176 patients who had dropped out of treatment, 84 could be contacted. Common reasons for dropout were long distance from the hospital (n = 27), long waiting time for consultation (n = 8), no benefit with treatment (n = 17), side effects with medication (n = 10), moving away to another place (n = 6), refusal by the patient to follow-up (n = 7), patient improved and so did not feel the need to continue treatment (n = 7), and other reasons (n = 37). Conclusion: About one-fourth of patients who had started treatment with clozapine dropped out from the treatment. The most common reasons for dropout from treatment included long distance from the hospital and no benefit from treatment.

Background: The rates of medication non-adherence among Indian patients with schizophrenia are high, and its detection poses problems. Comparisons of suitable measures to detect medication non-adherence in schizophrenia from Indian outpatient settings are scarce. Aim: This study compared simple and inexpensive methods of detecting medication non-adherence in schizophrenia among outpatients from a tertiary-care center in North India. Materials and Method: A longitudinal comparison of two self-reports, the Morisky Medication Adherence Questionnaire and the Drug Attitude Inventory-10, clinicians' ratings employing the Compliance Rating Scale, and clinic-based pill counts was conducted among 70 outpatients with schizophrenia. The rates and detection of medication non-adherence, associations with determinants of treatment non-adherence, and agreement between measures were examined at intake and after six months of follow-up (n = 53). Results: The self-reports had greater ability to detect medication adherence (specificity 41–65%; positive predictive values 25–51%; negative likelihood ratios 0.86–1.14) and moderate ability to detect medication non-adherence (sensitivity 27–65%; negative predictive values 49–69%; positive likelihood ratios 0.78–1.10). They yielded higher medication non-adherence rates, detected changes in medication non-adherence over time, and were associated with the other measures and the well-known correlates of medication non-adherence. Clinicians' ratings and pill counts had high sensitivity (56–90%) but low specificity (35–49%) to detect medication non-adherence. Conclusion: Self-reports are comparatively better screening options for detecting medication non-adherence among Indian outpatients with schizophrenia. However, the sequential use of different measures could lead to better recognition of medication non-adherence.

Background: Many developed countries have switched from conventional outpatient psychiatric services to tele mental health-based alternatives because of the COVID-19 pandemic. However, similar transitions might be difficult for countries like India because of a shortage of necessary resources. Therefore, the feasibility and acceptability of converting to a home-based tele mental health (HB-TMH) service during the pandemic were examined in an Indian hospital. Materials and Methods: A new and expanded version of an HB-TMH service was operated for all outpatients following the onset of the pandemic. Feasibility outcomes included operational viability, service utilization, service engagement, the need for additional in-person services, and the frequency of adverse events. Patients' and clinicians' satisfaction with different aspects of the service were evaluated using Likert-style questionnaires to ascertain acceptability. The outcomes during the prepandemic and pandemic phases were also compared. Results: The switch to HB-TMH services took 6 weeks during the pandemic. Patient numbers increased greatly following this transition. Attendance improved, the requirement for in-person services was low, and no serious adverse events were reported. However, patients' satisfaction levels were relatively low during the pandemic. Clinicians were more satisfied than the patients with HB-TMH treatment during the pandemic. Differences between them were less marked but still present before the pandemic. Pre- and postpandemic comparisons revealed that both patients and clinicians were more satisfied with all aspects of HB-TMH care before the pandemic than during it. Conclusions: Though conversion to HB-TMH services was feasible during the pandemic, such services need to be improved to enhance patient acceptability.

Background: Electroconvulsive therapy (ECT) is although one of the most effective treatments in psychiatry, and many a times patients refuse the same. Although, there is information about the knowledge about and attitude towards ECT among people who receive the same, little is known about these among those who refuse ECT. Aim: This study attempted to assess and compare the knowledge about and attitude toward ECT in patients with severe mental illness who accepted and refused ECT. Methodology: 68 patients divided into 3 groups (readily accepted; accepted, with initial reluctance; refused) based on the readiness for ECT were evaluated using ECT knowledge and attitude questionnaire. The higher proportion of those who refused had poor knowledge about the frequency of ECT sessions, investigations required before ECT and believed that ECT can be given against patient and family members' consent. Higher proportion of those who initially refused but later agreed believed that ECT can be given without the patient or family members'consent and it is given only to those patients who are unlikely to improve when compared to those who agreed ECT. Compared to those who agreed spontaneously, higher proportion of the participants in other two groups believed that ECT is not useful in the treatment of psychiatric disorders and they lacked knowledge about headache being a side effect of ECT. In terms of attitude toward ECT, higher proportion of those who refused ECT (n = 24; 89%) had a negative attitude in terms of not recommending the same for their relatives and were reluctant to receive ECT themselves. Conclusions: The results highlight that negative perception toward ECT in patients who refuse to receive ECT. Thus, it is essential to convey adequate information about ECT to enhance their understanding and acceptance.

Background: There are limited numbers of studies from India, which have evaluated the demographic and clinical profile of patients seen in the emergency setting. Aim: This retrospective study aimed to evaluate the profile of the patients, seen in the emergency setting by a psychiatry team. Methodology: The psychiatry emergency register was reviewed for the data for 6 calendar years (2014–2019), for the demographic and clinical profile. Results: 5563 patients were evaluated by the emergency psychiatry team during the period of 6 years, with the number of patients seen in each calendar year varying from 693 to 1057. The mean age of the patients availing psychiatry emergency services was 38.35 years (standard deviation: 16.65), with a significant proportion (13.1%–16.7%) of them in the elderly age group. Majority of the patients were male (64.6%) and were seen initially by the medicine and allied branches (87.8%). The most common diagnosis was delirium, and this was followed by affective disorders. Substantial proportions of the patients had substance use disorders (18.5%) and self-harm (9.8%). Nearly four-fifths of the patients were managed with psychotropic medications, and nearly one-fifth were treated with psychotherapeutic interventions, while more than half underwent investigations. Conclusion: The present study suggests that delirium, followed by affective disorders, substance use disorders, and intentional self-harm are the most common psychiatric diagnoses, among patients seen in the emergency setting. These findings can have important implications for organizing the psychiatric services in the emergency setting and for training.

Although there is a rapid increase in the elderly population in India, there is a lack of geriatric mental health services across the country. In India, although the postgraduation psychiatry program is available across many centers, little attention is paid to the subspecialty of geriatric psychiatry during the postgraduation training. There are very few courses (in the form of doctorate of medicine and fellowship programs) available in the subspecialty of geriatric psychiatry in the country. In this background, this paper focuses on the experience of establishing a geriatric clinic in a postgraduation psychiatry department and the impact of the same on patient care, research, and training in the area of geriatric psychiatry. The patient care data suggest that with the establishment of the geriatric clinic, there is an increase in the number of elderly patients admitted to the inpatient setting and those receiving electroconvulsive therapy. Further, there is an increase in the research in the area of geriatric psychiatry.

Aim: To assess the prevalence of metabolic syndrome (MetS) in elderly patients with depressive disorder. Methodology: By using retrospective study design, the treatment records of all the elderly patients (aged ≥60 years) diagnosed with depressive disorders diagnosed as per the International Classification of Diseases, 10th Revision, were reviewed and data of patients for fasting blood glucose levels, lipid profile, and anthropometry (height, weight, waist circumference, and blood pressure [BP]) were extracted. The diagnosis of MetS was made as per the consensus criteria. Results: Data of 93 patients were included in the study. The mean age of the study participants was 65.65 (standard deviation [SD]: 5.61) years and the mean number of years of education was 8.33 (SD: 6.65) years. The mean duration of illness was 70.93 (SD: 107.39) months, with the mean duration of the current episode at the time of collection of data as 5.38 (SD: 3.54) months. More than half (57%) of the patients fulfilled the criteria for MetS. Besides more than half of the patients fulfilling the criteria for MetS, about one-tenth (9.7%) fulfilled one criterion, and one-third (32.3%) fulfilled 2 criteria for the MetS. The most common criteria of MetS which was fulfilled included abnormal waist circumference, followed by raised blood pressure, abnormal triglyceride levels, and abnormal high-density lipoprotein. Fasting blood glucose level was the least common abnormality. The presence of MetS was associated with a higher level of education, higher income, and presence of physical comorbidity. Conclusions: Considering that more than half of elderly patients with depressive illness also suffer from MetS, it is important to monitor elderly with depression for MetS, to reduce the risk of future cardiovascular morbidity and mortality.

Aim: To evaluate the association of impairment of attention with other symptoms of delirium. Methodology: Eighty-six patients with delirium as per the Diagnostic and Statistical Manual, 5th Revision seen in the consultation-liaison psychiatry setup of a tertiary care hospital were cross-sectionally assessed on the short informant questionnaire on cognitive decline in the elderly (Retrospective), montreal cognitive assessment (MoCA), and delirium rating scale revised-98 (DRS-R98) version. Results: The mean age of the study participants was 46.6 (standard deviation [SD] – 16.4) years. All the patients had impairment in attention with the altered sleepwake cycle, acute onset of illness, with the fluctuating course and underlying physical disease. In terms of severity, the severity score was the highest for the item of sleep-wake cycle disturbances, followed by motor agitation. The mean noncognitive symptoms domain of the DRS-R98 domain were more than the mean score of the cognitive symptom domain of DRS-R98. The mean total score on MoCA was 11.9 (SD: 7.5). Higher attention impairment was associated with more severe noncognitive and cognitive symptoms and higher delirium severity as assessed by DRS-R98. Higher severity of attention deficit was also associated with higher impairment in other domains of cognition of MoCA. Cognitive symptoms, as evaluated by DRS-R98, had more significant correlations with various domains of MoCA except for language and abstraction. Conclusion: Attention deficits are the core symptom of delirium and have a significant impact on other cognitive and noncognitive symptoms of delirium.

Background: Little is known from India about the experience of using olanzapine long-acting antipsychotic injectables (LAI). In this background, this study aimed to evaluate the clinical profile of patients suffering from schizophrenia who were prescribed olanzapine LAI and to evaluate the usefulness and acceptability of olanzapine LAI among these patients. Methods: In this retrospective study, data of all the patients with schizophrenia receiving olanzapine pamoate, was extracted. Results: 40 patients (males-55%; mean [SD] age- 36.2 (12) years; mean duration of illness (SD) prior to depot-143.3 (115.9) months) were included in the study. Olanzapine LAI was invariably prescribed in patients with a past history of non-compliance. Data was available for a mean (SD) follow-up duration of 17 (10.8) months. The most frequently used dose of olanzapine LAI used was 300 mg every two weeks (55%). This was followed by 405 mg every four weeks in (32.5%). Mean Clinical Global Impression (CGI) Severity score prior to starting of olanzapine LAI was 5.8 (0.7), which reduced to 2.7 (1.1) at the time of last follow-up or the last use of olanzapine LAI, and this was a statistically significant improvement (paired t-test value = 16.41; P < 0.001). Only one (2.5%) patient experienced Post injection Delirium/Sedation Syndrome during the study period. Only one patient was hospitalized after starting depot olanzapine. Conclusion: Olanzapine LAI is mostly used in patients with a history of non-compliance. Olanzapine LAI is associated with a significant reduction in the severity of illness.

Aim: This study aimed to evaluate the association of stigma with the caregiver burden and coping. Methodology: One hundred and sixteen adult caregivers of persons with severe mental illness were evaluated on the Stigma Scale for Caregivers of People with Mental Illness (CPMI), Family Burden Interview (FBI) Schedule, and Family Coping Questionnaire. Results: In terms of stigma, the mean total score was highest for the affective component followed by behavioral and least for the cognitive component of CPMI. On FBI, the highest burden was reported for the financial burden followed by disruption of routine family activities, disruption of family leisure activities, disruption of family interaction, the effect on the physical health of others, and effect on the mental health of others. The most common coping strategy used by the caregivers was gathering information followed by positive communication and patient's social involvement. A higher level of stigma in all the domains was associated with a significantly higher burden in all the domains of the objective burden, except for effect on physical and mental health on others. Higher use of copings such as positive communication and social interests was associated with higher stigma in all the domains except for lack of significant association between positive communication and cognitive domain of stigma. Higher use of resignation as a coping mechanism was associated with a higher stigma in the cognitive domain of CPMI. Conclusion: This study shows that a higher level of stigma among caregivers of patients with severe mental disorder is associated with higher objective caregiver burden and higher use of coping mechanisms such as positive communication and social interest. Accordingly, it can be said that any effort to mitigate the caregiver burden needs to take stigma into account.

Objectives To investigate whether delirium motor subtypes differ in terms of phenomenology and contributory aetiology.Design Cross-sectional study.Setting International study incorporating data from Ireland and India across palliative care, old age liaison psychiatry and general adult liaison psychiatry settings.Participants 1757 patients diagnosed with delirium using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM IV).Primary and secondary outcome measures Hyperactive, mixed and hypoactive delirium subtypes were identified using the abbreviated version of the Delirium Motor Subtype Scale. Phenomenology was assessed using the Delirium Rating Scale Revised. Contributory aetiologies were assessed using the Delirium Aetiology Checklist (DEC), with a score >2 indicating that the aetiology was likely or definitely contributory.Results Hypoactive delirium was associated with dementia, cerebrovascular and systemic infection aetiologies (p

Aim: This study assessed the various aspects of marital functioning among the spouses of patients with schizophrenia and recurrent depressive disorder (RDD). Methodology: Spouses were assessed on Dyadic Adjustment Scale (DAS), Marital Forgiveness Scale, Quality Marriage Index, New Sexual Satisfaction Scale, and Arizona Sexual Experience Questionnaire. Results: Compared to the spouses of patients with RDD, spouses of patients with schizophrenia reported poor marital adjustment (in the consensus and satisfaction domains of DAS), lower quality of marriage, and significantly lower sexual satisfaction. Spouses did not differ significantly on account of marital forgiveness and prevalence of sexual dysfunction. Higher age of onset of schizophrenia in the patients was associated with better quality of marriage as assessed by using quality of marriage scale, better consensus, and satisfaction as per the DAS. Higher residual psychopathology and poor socio-occupational functioning in patients with schizophrenia were associated with poor marital adjustment and sexual satisfaction. Conclusion: To conclude, the present study depicts that the spouses of patients with schizophrenia have poorer marital adjustment and sexual satisfaction, in comparison to the spouses of patients with RDD.

Background: This study aimed to evaluate the clinical profile of adolescents aged up to 19 years who had received electroconvulsive therapy (ECT). Methods: A retrospective chart review was carried out to identify adolescents aged up to 19 years who had received ECT during the period 2012–2018. Details regarding their sociodemographic and clinical variables and ECT data were extracted from the records. Results: During the study period, a total of 51 adolescents received ECT, and complete records of 50 patients were available for analysis. 4.04% (51 out of 1260) of the patients who received ECT were aged up to 19 years. There was a decreasing trend of use of ECT over the years. The most common diagnosis was schizophrenia (42%), and this was followed by bipolar disorder (22%) and unipolar depression (20%). The mean number of ECTs administered per patient was 8.84 (SD: 5.34; range: 1–21). On the various rating scales, the percentage improvement in patients with psychotic disorders was 77.4%. For patients with depression, the percentage improvement was 77.2%, and that for mania was 80.3%. The percentage improvement in organic catatonia was 64.6%. The number of patients achieving ≥50% response ranged from 87.5% to 100%, and when the response was defined as ≥75% improvement, the proportion of patients varied from 50% to 76.9%. The majority of patients with depression (72.7%) and mania (77.8%) achieved remission. Immediate complications associated with the use of ECT included acute blood pressure changes (18%). Conclusion: ECT is effective and safe in adolescents with severe mental disorders. The clinician should not hesitate and delay the use of ECT in adolescents who require it.

Reports on behavioral interventions for the treatment of Tourette’s disorder (TD) from India are limited. This patient series describes the usefulness and feasibility of conducting behavioral interventions for patients with TD from an Indian general hospital psychiatric unit. Behavioral treatments in these seven consecutively treated adult/adolescent patients with TD included all components of habit reversal treatment, comprehensive behavioral intervention for tics, and exposure with response prevention in some patients. Patients were predominantly male, with adolescent-onset severe TD, typical features and psychiatric comorbidities, and poor response to multiple medications prior to the institution of behavior therapy. In addition to long delays in diagnosis, none of the patients or their caregivers had been informed by the doctors they had consulted earlier about TD or the need for behavioral treatments before attending our center. Institution of behavioral treatments along with medications led to a 75% reduction in the severity of tics and reduction in comorbid symptoms. Patients and caregivers also reported similar rates of improvement as well as reductions in subjective distress and caregiver burden. Five patients have been followed up for seven months to seven years; apart from one patient, all others have had only minor exacerbations of tics during this period. This limited experience suggests that behavior therapies for TD can be successfully implemented in low-resource, non-specialized Indian settings. They are effective, and gains from such treatment are usually enduring.

Aim: To evaluate the marital profile, family size, fertility rates, and perception about various aspects of marriage among the couples, with one of the partner having schizophrenia and compare the same with a group of couples, with one of the partner having recurrent depressive disorder (RDD). Methodology: A total of 76 married patients with schizophrenia and 58 married patients with RDD were evaluated by using a semistructured interview, which covered information about the duration of marriage, number of children, different aspects of marital and sexual life like perception about marriage, mental illness, sexual compatibility, and other variables. Results: A significantly higher proportion of patients with schizophrenia had onset of illness prior to marriage, when compared to the patients with RDD. There was no significant difference between the 2 groups in terms of mean number of children, number of spontaneous abortions, and medical termination of pregnancies. The mean numbers of postnatal deaths were significantly higher in the group in which one of the partners was diagnosed with schizophrenia. Compared to spouses of patients with RDD, higher proportion of the spouses of patients with schizophrenia reported sexual incompatibility since the beginning of the marriage and lack of full satisfaction with sexual life. Compared to patients with RDD, higher proportion of patients with schizophrenia were worried about their children developing mental illness and believed that people with mental illness should not marry. Conclusion: To conclude, this study demonstrates that compared to the spouses of patients with RDD, spouses of patients with schizophrenia have higher negative perception about the marriage.

Background: Melatonin, a naturally occurring endogenous hormone, primarily secreted by the pineal gland plays a key role in managing multiple bodily functions which are affected among patients with delirium. In view of the same, exogenous melatonin has been evaluated in the prevention and management of delirium. Compared to the data on role of melatonin in prevention of delirium, data on the management of delirium are limited. Aim: To evaluate the effectiveness of melatonin in patients with delirium and to compare the same with haloperidol and quetiapine. Materials and Methods: Using retrospective study design, data of patients diagnosed with delirium as per the Diagnostic and Statistical Manual, 5th Revision criteria, and rated on Delirium Rating Scale-Revised 98 version at the baseline and 6 consecutive days. Results: The study included 108 patients, of whom 34 were on melatonin, 31 were on quetiapine, and 43 were on haloperidol. Findings of the present study show that melatonin is as effective as haloperidol and quetiapine in the management of delirium. Patients required 1.5–6 mg/day of melatonin, administered during the evening time. Melatonin was mostly used in patients who had prolonged QTc interval, which precluded the use of antipsychotics. Conclusion: The present study suggests that melatonin may be another pharmacological treatment option for the management of delirium, especially among patients with prolonged QTc interval.

Background: Attitude toward psychotropic medications influences medication adherence. Although there are some data on attitude toward psychotropics among the adult patients, there is a lack of data on attitude of elderly patients toward psychotropic medications. Aim: The study aimed to evaluate the attitude of elderly patients toward psychotropic medications and compare the same with adult patients. Materials and Methodology: Attitude toward psychotropic medications of 102 elderly patients and 499 adult patients diagnosed with affective or psychotic disorders were compared using self-report attitude toward psychotropic medications questionnaire. Results: Compared to adult participants, higher proportion of elderly patients considered psychotropic medications to be the most effective way to treat mental illness and believed that psychotropics are a better option for treatment of mental illnesses than alternative treatments. Compared to adults, significantly lower proportion of the elderly believed that psychotropics do not cure but can lead to substantial improvement. In terms of negative attitude toward psychotropic medications, compared to adult participants, significantly higher proportion of the elderly believed that psychotropics are unnatural and poisonous substances which are harmful; psychotropics are just sedatives, which only calm down the patients; in long-run psychotropics worsen the illness; psychotropics can make the body unnaturally hot or cold; are expensive; make the subjects weak and enervated, and it is always better to take less than the prescribed dose of these medications. Compared to adults, elderly patients had significantly higher negative attitude subscale score. Conclusion: Compared to adult patients with affective and psychotic disorders, elderly patients have more negative attitude toward psychotropic medications. Hence, clinicians managing elderly patients should always evaluate the negative attitudes of the elderly toward psychotropic medications and try to address the same, to improve the medication adherence and outcome.

Background: Stigma associated with mental illness is multifaceted, and it extends to even those who take care of the afflicted persons. Research shows that stigma has maximal impact on patients who have schizophrenia and their caregivers, but information pertaining to caregivers of patients with bipolar disorder is minimal. Accordingly, this study aimed to evaluate stigma and its correlates among caregivers of patients with bipolar disorder. Methodology: This cross-sectional study conducted at a tertiary care hospital purposively enrolled 103 caregivers of patients with bipolar disorder-I. The caregivers were assessed on the stigma scale for caregivers of people with mental illness (CPMI) and the Explanatory Model Interview Catalogue (EMIC) stigma scale. Results: The majority of caregivers attributed the illness of the patient to stress (54.4%), chemical imbalance (48.5%), or heredity (29.1%), while nearly one-fourth believed it to be the will of God. The mean weighted scores on various domains of CPMI were comparable [affective domain = 2.24 (standard deviation (SD) = 0.51); cognitive domain = 2.25 (SD = 0.54) and behavioral domain = 2.23 (SD = 0.55)]. The mean score on EMIC was 28.00 (SD = 14.57). Caregivers with low income reported higher stigma in affective and cognitive domains. Also, lesser time spent with the patient correlated with higher stigma in the affective domain. Furthermore, poor functioning of the patient was associated with high caregiver stigma in cognitive and behavioral domains. Conclusion: Caregivers of patients with bipolar disorder experience significant affiliate and courtesy stigma, and higher stigma is associated with lower income of the caregivers and lesser time spent in caregiving.

Objective: To evaluate the clinical profile and effectiveness of ECT in females with postpartum onset psychiatric syndromes or worsening of psychiatric disorder during the postpartum period. Materials and Methods: A retrospective chart review was carried out to identify females who had received ECT during their postpartum period from January2004 to April 2017. Results: During the study period, 13 females in their postpartum period received ECT, which accounted for 2.24% of the total females (n = 578) who had received ECT and 1% of total patients who were administered ECT during this period. The most common clinical diagnosis was postpartum depression (n = 7; 53.86%). Three (23.1%) patients were diagnosed with bipolar disorder and had experienced a relapse during the postpartum period. Two (15.4%) patients were diagnosed with schizophrenia and 1 (7.7%) patient was diagnosed with postpartum psychosis/acute and transient psychotic disorder. ECT was considered as a treatment of choice in 9 (69.2%) patients. All the patients with depression or mania achieved clinical remission, and patients with psychotic disorders also had significant reduction in their symptoms. Cognitive complaints were reported by 4 (30.8%) patients, and aches and pains after ECT were reported by 7 (53.8%). Conclusion: ECT is a safe and effective treatment option in postpartum onset psychiatric syndromes or patients experiencing relapse or exacerbation of severe mental disorders during the postpartum period and is associated with a very good response rate with minimal or no complications.

Background: The use of antidepressants among elderly is associated with dreaded side effect of hyponatremia. However, there is limited information about specific risk factors associated with developing hyponatremia in elderly. Aim of the Study: The aim of this study was to evaluate the clinical risk factors for the development of hyponatremia among elderly patients started on antidepressant medications. Methodology: Using retrospective study design, patients who developed hyponatremia (n = 35) and those who did not develop hyponatremia (n = 43) with use of antidepressants, were matched on sociodemographic parameters and were compared for various parameters such as physical illness, other medications, and dose and type of antidepressant drug. Results: Higher proportion of those who developed hyponatremia had history of comorbid hypertension, were receiving antihypertensive agents, and were receiving 2 antihypoglycemic agents concomitantly. Majority of the patients who developed hyponatremia were receiving mirtazapine, followed by sertraline and venlafaxine. There was no association of hyponatremia with concomitant use of psychotropics, presence of other physical illnesses, comorbid dementia, and comorbid substance use. Conclusion: Antidepressant-associated hyponatremia is more commonly seen in patients with comorbid hypertension, those receiving any antihypertensive agent and those on more than one hypoglycemic agent.

The revision of diagnostic requirements for mood disorders in the forthcoming International Classification of Diseases-11 (ICD-11) classification was governed by the same principles that applied to the rest of the draft. Precedence was given to clinical utility and universal applicability of the classification. Other guiding principles included ensuring scientific validity of the revision and harmonizing it with the Diagnostic and Statistical Manual of Mental Disorders-5. These fundamentals led to considerable reorganization, restructuring, and expansion of the contents of the revision including the section on mood disorders. The mood disorders section now follows a much simpler format than the ICD-10 and is expected to be easier to use. Its simplicity, notwithstanding descriptions of individual diagnostic categories in the revision are more elaborate and precise and in consonance with the current state of knowledge regarding the different mood disorders included in the section. The draft guidelines are undergoing comprehensive field testing on a very large scale across many countries including a majority from the developing world. Results up to now have been encouraging in terms of user acceptability, clinical utility, and global and cross-cultural relevance. However, one has to await the results of further testing and actual use of the final version of the ICD-11 by all stakeholders to determine if the revision indeed meets the high standards it has set for itself.

Background: Adherence to medical treatment is a major challenge. A significant proportion of patient's dropout of treatment after the initial visit. Little is known about the reasons for such high dropouts. Aim: This study aimed to evaluate the dropout rates and reasons for dropout from treatment among elderly patients with depression attending a tertiary care psychiatry outpatient facility. Methodology: One hundred and forty consecutive new patients aged 60 years or more, attending the psychiatry walk-in clinic, diagnosed with depressive disorders were assessed at baseline and then contacted at 6 months and 1 year to evaluate the follow-up status and reasons for dropout of treatment. Results: Out of the 140 participants, 132 could be contacted after initial registration with the clinic. About two-fifths (n = 58; 41.4%) never return back to the clinic after the first visit. By 6 months and 1 year, 105 (75%) and 126 (90%) patients had dropped out of treatment. When the reason for dropout of those who dropped out “very early (i.e., never returned back)” were evaluated, the most common reason for dropout was “no relief” of symptoms, and this was closely followed by complete relief of symptoms. Among those who followed up at least once, but had dropped out at 6 months, the most common reason for dropout was complete relief of symptoms, and this was closely followed by “no relief” and “worsening of illness” being the other common reasons of dropout. Among those who dropped out after 6 months, the most common reason for dropout was complete relief of symptoms. None of the demographic variable emerged as a predictor of dropout at any time point. Few clinical variables were associated with dropout of treatment. Conclusion: Very high proportion of elderly patients with depression dropout of treatment prematurely. Providing proper information to the patients at each visit can help in reducing the treatment dropout rates.

Background: Electroconvulsive therapy (ECT) is an important modality of treatment for various psychiatric disorders in all age groups. The trends of use of ECT in the elderly population have not been studied despite wide variation in the utilization of this treatment modality. Aim: This study aimed to evaluate the trends in use of ECT in geriatric patients at a tertiary care center over a period of 9 years. Methodology: Data were extracted from the departmental registry for the period of 2008–2016 to evaluate the total number of new patients attending the psychiatric services, total number of new elderly (i.e., ≥60 years) patients attending the psychiatric services, total number of inpatients, total number of elderly inpatients, total number of patients who received ECT, and total number of elderly patients who received ECT. Results: During the period of 2008–2016, elderly formed from 4.6% to 19.11% of the total number of patients who received ECT. There was an upward trend in the proportion of elderly patients receiving ECT, with a nearly 10-fold rise in absolute number and doubling of the percentage of elderly patients among those receiving ECT. Over the years, there was an increase in use of ECT among elderly inpatients and use of ECT as an outpatient treatment for elderly. Conclusion: Over the years, there has been increase in the absolute number as well as proportion of elderly patients receiving ECT. There is a significant increase in the use of ECT among elderly at the outpatient basis.

Since the 1990s, there has been a tremendous upsurge in research on early intervention in psychotic disorders. The neurodevelopmental hypothesis enabled the development of clinical staging models of schizophrenia, which in turn demonstrated that early intervention is possible before the onset of psychosis. Such intervention relied on early detection using prodromal vulnerability indicators and on targeted and stage-specific treatments. Initial efforts were focused on reducing the duration of untreated psychosis to improve outcome. As these efforts were not always successful, research moved on to the examination of prodromes and high-risk states. The “at-risk mental state” strategy based on principles of indicated prevention consisted of the “ultra-high risk” and the “basic symptoms” approaches. A large body of evidence indicated that about 30% of the patients who met criteria for either approach went on to develop full-blown psychosis in the next 2–3 years. Several early psychosis detection programs have been set up worldwide, and controlled trials have shown efficacy of early intervention in first-episode psychosis as well as prodromal or at-risk states. However, several issues regarding identifying and managing such patients still need to be sorted out before prevention of severe mental disorders becomes a reality.

Aim: This study aimed to evaluate the prevalence of physical comorbidities among elderly patients with depression attending psychiatric services and the secondary aim of the study was to evaluate the influence of physical comorbidities on symptom profile of depression. Methodology: 140 patients with a diagnosis of depression as per the International Classification of Diseases-10 criteria were evaluated on Geriatric Depression Scale (GDS) and a physical comorbidity checklist. Results: More than two-third (72.1%) of the patients had at least one physical illness. Out of those with physical comorbidity, more than half (57 out of 101) had at least 2 physical illnesses. The most commonly involved systems were cardiovascular system (n = 68; 48.6%), followed by endocrinological system (27.1%) and ophthalmological system (26.4%). Most common physical comorbidity was hypertension (47.14%), followed by cataract (25.7%) and diabetes mellitus (25%). The presence of any physical comorbidity, presence of hypertension or presence of diabetes mellitus did not influence the manifestations of depression as assessed by GDS-30. Conclusion: Elderly patients with depression have high rates of physical comorbidities. Clinicians managing elderly patients with depression must get their patient thoroughly evaluated for the presence of various physical comorbidities.

Aim of the Study: This study aimed to evaluate the symptom profile, including somatic symptoms among elderly patients with first episode depression using the Geriatric depression scale (GDS-30) and Patient Health Questionnaire-15 (PHQ-15) items version scale. Additional aims were to carry out the factor analysis of symptoms reported on GDS-30 and PHQ-15 among elderly. Methodology: Seventy-nine elderly patients (age ≥60 years) were evaluated on GDS-30 item Hindi version and Hindi version of the PHQ-15. Results: As per GDS-30, the most common symptom noted among elderly was “dropped many of your activities and interests” (91.1%), mind not as clear as it used (88.6%), feeling that life is empty (86.1%), bothered by thoughts you cannot get out of your head (86.1%) and hard to get started on new projects (86.1%), prefer to avoid social gatherings (86.1%). All patients reported at least one somatic complaint as per PHQ-15. The most common somatic symptoms were trouble sleeping (97.5%), feeling tired or having little energy (96.2%), feeling that the heart is racing (52.9%), constipation, loose bowels, or diarrhea (49.6%), shortness of breath (46.8%), nausea, gas or indigestion (45.6%), pain in the arms, legs, or joints (43.3%), and back pain (41.8%). The prevalence of somatic symptoms was not influenced to a large extent by the demographic variables, clinical variables and presence or absence of physical comorbidity. However, the severity of somatic symptoms correlated positively with GDS-30 score. Factor analysis of Hindi version of GDS-30 yielded a four-factor solution, which was similar to many studies across the world. The addition of items of PHQ-15 items of factor analysis still yielded a four-factor solution. Factor 1 of combined GDS-30 and PHQ-15 items included items only from GDS-30 and Factor 3 and 4 included items only from PHQ-15. There was some overlap of items on Factor 2. Conclusion: The present study suggests that GDS-30 does not tap all the symptoms of depression among elderly in the Indian context. Further, the present study shows that GDS-30 is not a one-dimensional scale. Accordingly, the symptom evaluation among elderly depressed patient should go beyond GDS-30.

Aim: To evaluate the sociodemographic, clinical, and treatment characteristics profile of late-onset (LO) bipolar affective disorder (BPAD) (onset ≥50 years) and compare the patients with LO BPAD with early age of onset (10–25 years) and intermediate age of onset (26–40 years) BPAD for the demographic features, illness characteristics, and treatment characteristics. Methodology: In this retrospective study, data (demographic features, clinical characteristics, and treatment characteristics) of 115 patients with LO BPAD (onset ≥50 years) were extracted and were compared with 93 patients with intermediate-onset (IO) (26–40 years) and 130 patients with early-onset (EO) (10–25 years) BPAD groups. Results: Patients with LO BPAD differ from EO and IO BPAD in having higher rates of family history of mental disorders, higher rates of comorbid psychiatric disorders (especially substance use disorders) and physical illnesses, higher rates of suicidal ideations, lower rates of suicidal attempts, higher rates of Type-II BPAD, lower prevalence of psychotic symptoms during the episodes, shorter interepisodic duration, higher use of combination of mood stabilizers and antidepressants, lower preference of lithium, higher preference for valproate, and lower use of benzodiazepines. In addition, patients with LO BPAD differed from those with EO BPAD in having higher rates of having a depressive-manic illness pattern, longer duration of depressive episodes, and lower number of manic episodes. Patients with LO BPAD differed significantly from IO BPAD in having lower number of episodes and more often use of antipsychotic monotherapy during the acute phase. Conclusions: LO BPAD differs from IO and EO BPAD on several of the clinical characteristics. Treatment preferences by the clinicians for LO BPAD also differ from EO and IO BPAD.

Objectives: This study aimed to evaluate the prescription pattern of inpatients admitted in the psychiatric unit of a tertiary care hospital at the time of discharge from the inpatient setting. Material and Methods: In this retrospective chart review data of 496 patients admitted in the psychiatric unit of a tertiary care hospital in northern India diagnosed with an International Classification of Diseases-10 diagnosis of psychotic, affective and neurotic disorder were extracted and analyzed. Results: In all diagnostic groups, olanzapine was the most commonly prescribed antipsychotic followed by risperidone. Very few patients (8.8%) received typical antipsychotics. Venlafaxine was the most commonly prescribed antidepressant; other frequently prescribed antidepressants were fluoxetine, amitriptyline, and sertraline. Among the mood stabilizers, prescription of valproate exceeded that of lithium. In all the groups, more than half of the patients were prescribed benzodiazepines, clonazepam being the most commonly prescribed agent, followed by lorazepam. The mean numbers of psychotropic medications were highest in the bipolar disorder group. Very few patients received the combination of drugs belonging to the same class i.e.,, receiving two antidepressants or two antipsychotics. Conclusion: Olanzapine, venlafaxine, valproate and clonazepam are the most commonly prescribed antipsychotic, antidepressants, mood stabilizers and benzodiazepines, respectively.

Families of Indian patients with mental illnesses have always been involved in their care. Such involvement arises both from choice as well as the compulsion of being a part of an inadequately resourced mental health system. Regardless, families have had to pay a heavy price for undertaking the task of providing care. An extensive body of Indian research on caregiver burden in a number of mental illnesses shows that providing care for a relative with mental illness is associated with considerable distress and burden for the family caregiver. However, much of this research has not made the shift from the somewhat outmoded concept of caregiver burden to the currently prevalent practice of considering the caregiving experience in its totality. Moreover, most of the research is not driven by contemporary theories of caregiving such as the stress coping model. Indian psychiatry has also had a long tradition of supporting family caregivers while they provide care for their ill members. Nevertheless, the Indian evidence for the efficacy of formal family-based interventions remains inadequate and lacks methodological precision. Finally, day-to-day practice in clinical settings does not seem to have made use of the ample body of research evidence in this area to help families in distress. Despite all these problems, progress is being made in the area of family caregiving for mental illness in India. Despite all these problems, slow but steady progress is being made in the area of family caregiving for mental illness in India. It can be hoped that some day in the near future, this progress would translate into mental health professionals forging a true partnership with families providing care for those with mental illnesses.

Introduction: Data on effect of clozapine on metabolic syndrome in adolescent patients with psychosis are limited. This study aimed to evaluate the prevalence and incidence of metabolic syndrome in children and adolescents with psychotic disorders prior to clozapine and while receiving clozapine. Secondary aims were to study the effectiveness and side effect profile of clozapine. Materials and Methods: Thirteen child and adolescent patients were evaluated at baseline, 3 months, and a follow-up beyond 6 months. Assessments were made for metabolic profile, effectiveness by positive and negative syndrome scale (PANSS), and side effects. Results: Prior to starting of clozapine, the prevalence of metabolic syndrome was 23%. After 3 months on clozapine, 38.5% (5/13) patients fulfilled criteria of metabolic syndrome and further on follow-up beyond 6 months (with last observation carried forward) 46.2% (6/13) had developed metabolic syndrome. There was a significant reduction in PANSS scores at 3 months and follow-up more so in those who developed metabolic syndrome at 3 months. Among the other side effects, hypersalivation was the most common side effect (100%) followed by sedation (69%). Conclusion: Half the prevalence of metabolic syndrome in adolescents on clozapine can be attributed to other factors prior to starting of clozapine, and another half can be attributed to clozapine. Clozapine is effective in an adolescent population.

Telepsychiatry, the use of information and communication technologies to provide psychiatric services from a distance, has matured as a mode of service delivery and has expanded its reach since its inception. Telepsychiatry promotes equality of access to high-quality specialized care for underserved users. It enables, empowers and brings about high levels of satisfaction among users. Telepsychiatry can deliver a broad array of clinical services and support several other nonclinical activities. Accumulated evidence demonstrates that clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among patients of all ages, ethnicities, cultures, and diagnostic groups across diverse clinical settings. However, negative attitudes, concerns about the quality of the evidence, doubts about cost-effectiveness, technological vagaries, uncertainty regarding the doctor–patient alliance, and a number of legal, ethical and regulatory hurdles continue to hinder the widespread implementation of telepsychiatric services. A particularly disappointing aspect has been the lack of development of telepsychiatric services in developing countries, where they are required the most because of the large mental-health gap in care with the more traditional forms of services. Problems of costs, lack of infrastructure and connectivity, shortage of trained personnel, sociocultural differences, limited data on effectiveness, and lack of institutional support are the principal challenges to the wider adoption of telepsychiatry in these resource-constrained countries. It is evident that much more effort by all stakeholders, innovative solutions, and hybrid models of care are required before telepsychiatry is able to fulfil its true potential and bring about the promised change in mental health outcomes in the developing world.

Background: A diagnostic tool designed as part of a telepsychiatry application for diagnosis and management of child and adolescent psychiatric disorders in India was developed considering the paucity of trained child psychiatrists and mental health professionals in India. Materials and Methods: The diagnostic tool consisted of screening and 10 th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) criteria-based diagnostic algorithms for 18 psychiatric disorders seen in childhood and adolescence. Accuracy of diagnoses and feasibility of use of the tool was examined by comparing it with detailed semi-structured clinical evaluations by a qualified psychiatrist with 50 psychiatric patients (children and adolescents). Statistical Analysis: Descriptive analyses and paired t-tests were conducted to compare the mean number of diagnosis generated by the two interviews. Sensitivity, specificity, positive and negative predictive values were computed for the screening and the diagnostic sub-modules of the tool, compared to the clinical diagnoses. Kappa coefficients were computed to assess agreement between the diagnoses generated by the diagnostic sub-module and the clinical diagnoses. Results: The screening sub-module had high sensitivity, high specificity and negative predictive values for all disorders. For the diagnostic sub-module, there was moderate (kappa-0.4-0.6) to substantial agreement (kappa > 0.6) for all the disorders, (except psychosis) and high sensitivity (barring a few disorders) and specificity for almost all the disorders. Positive predictive values were found to be acceptable to high for most disorders, with consistently high negative predictive values. Conclusion: The new tool was found to be comprehensive, reasonably short and feasible. Results showed acceptable level of accuracy in diagnosis generated by the tool.

Objective: The objective of this study was to evaluate the socio-demographic and the clinical profile of children and adolescents presenting with Intentional self-harm. Materials and Methods: Records of all children and adolescents (≤19 years) seen by the consultation liaison (CL) services during the period of 2000-2012 were screened. Patients with a diagnosis of intentional self-harm (at the time of assessment) were taken up for this study. Data was extracted from the records, to study the socio-demographic and clinical profile. Results: During the study period, 101 patients aged ≤19 years and diagnosed with intentional self-harm at the time of admission were evaluated by the psychiatry CL services in various emergency and medical surgical wards. In the study population, females (N = 61; 60.4%) outnumbered males. The age of the patients ranged from 12 to 19 with a median and mean of 17.0 years (standard deviation-1.6 years; interquartile range 16-18 years). Children and adolescent with self harm were more commonly females, from nuclear families, middle socio-economic status and Hindu by religion. The common method of self-harm in adolescents is by ingestion of insecticides (65%) and the self-harm behavior was often precipitated by interpersonal problems in the family context. About one-fifth of the patients have psychiatric morbidity. Conclusion: Findings suggest that the most common method of intentional self-harm in children and adolescents is consumption of insecticides and precipitated by interpersonal problems in the family context.

Aim: To compare the symptom profile of patients with delirium without preexisting cognitive deficits and those experiencing delirium in the background of preexisting cognitive deficits. Materials and Methods: A total of 107 patients aged ≥60 years with diagnosis of delirium as per the Diagnostic and Statistical Manual, IV text revision criteria were evaluated on Short Informant Questionnaire on Cognitive Decline in the Elderly (Short IQCODE), Delirium Rating Scale Revised 98 version (DRS-R98), amended delirium motor symptom scale, and delirium etiology checklist and risk factor checklist. On the basis of short IQCODE score, the study sample was divided into those with (≥3.5) and without cognitive deficits and were compared for the symptom profile, motor subtype, risk factors, and etiologies. Results: Based on the short IQCODE scores, the patients were divided into those with (≥3.5) and without cognitive deficits (

Coping is understood as the process of managing external or internal demands that are considered as taxing or exceeding the resources of the person. There is no formal classification of coping strategies, and these are understood as adaptive versus maladaptive and problem focuses versus emotion-focused. Understanding the commonly used coping strategies in a particular group of subjects can provide valuable insights for designing interventions to reduce the stress. In this review, we look at the literature which is available with regards to the coping strategies used by the caregivers of patients with schizophrenia. Findings suggest that caregivers of patients with schizophrenia use mixed type of coping mechanisms to deal with the stress of caregiving. The coping strategies are shown to have association with variables such as caregiver burden, caregiving experience, expressed emotions, social support, psychological morbidity in the caregivers, quality of life of caregivers and psychopathology in patients. One of the major limitations of the literature is that there is a lot of variability in the assessment instruments used across different studies to assess coping.

Religion and spirituality exert a significant role in the lives of many individuals, including people with schizophrenia. However, the contribution of religion and spirituality to various domains (psychopathology, explanatory models, treatment seeking, treatment adherence, outcome, etc.) has not received much attention. In this article, we review the exiting data with regards to the relationship of religion, spirituality, and various domains in patients with schizophrenia. Available evidence suggests that for some patients, religion instills hope, purpose, and meaning in their lives, whereas for others, it induces spiritual despair. Patients with schizophrenia also exhibit religious delusions and hallucinations. Further, there is some evidence to suggest that religion influences the level of psychopathology. Religion and religious practices also influence social integration, risk of suicide attempts, and substance use. Religion and spirituality also serves as an effective method of coping with the illness. Religion also influences the treatment compliance and outcome in patients with schizophrenia.

Objective: Knowledge and attitude regarding electroconvulsive therapy (ECT) is one of the important parameters for acceptance of ECT as a safe and effective treatment option. Several factors shape the knowledge and attitude of general people such as previous experience of ECT, sources of their information about ECT and prevailing myths about ECT. The present study attempted to examine the knowledge and attitude concerning ECT among patients with psychiatric disorders and their relatives. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using the Bengali version of the ECT knowledge and attitude questionnaires, between 100 clinically stable patients with mental illnesses and their healthy relatives. Results: Majority of the patients and relatives were unaware of the basic facts about ECT. Relatives were somewhat better informed and more positive about ECT than patients, but the differences between the two groups were not significant. Previous experience of ECT did not have any major impact in knowledge and attitude in both patients and relative groups. Patients obtained information, mostly from media (44%), doctors (23%), and from personal experiences (13%). On the other hand, relatives obtained information almost equally from media (26%), doctors (27%), and experience of friends or relatives (28%). No significant difference was observed in knowledge and attitude in patients who had obtained their facts from doctors (n=23) and from other sources (n=77). Among relatives, those who had obtained their information from doctors (n=27) were better informed than those who had obtained so from other sources (n=73). Conclusions: Since patients and relatives have poor knowledge and negative attitude toward ECT, medical professionals should impart proper information about ECT to patients and relatives to increase the acceptability of this treatment.

Background: Electroconvulsive therapy (ECT) is quite often used in elderly patients with severe mental disorders. One of the important factors which determine the acceptance of ECT among patients is the knowledge and attitude toward ECT. Aim: The present study attempted to assess the knowledge about and attitude toward ECT among elderly patients with severe mental disorders who had never received ECT. Materials and Methods: Knowledge and attitudes regarding ECT were assessed using ECT knowledge and attitude questionnaires, among 102 clinically stable elderly patients with severe mental disorders. Results: Majority (n = 62; 60.8%) of the patients obtained information mostly from "general word of mouth" or media (n = 23; 22.6%). None of the patients had full knowledge about ECT. Majority of the patients were not aware of the basic facts about ECT. Except for the fact that ECT involves use of electric current and can be given by a doctor, more than two-third of the patients were unaware of the basic facts about the procedure of ECT. Less than half of the patients were aware of the need for informed consent. Knowledge about indications, efficacy, and side effects of ECT was also very poor. In terms of attitude toward ECT, on most (15 out of 16) of the items, positive attitudes toward ECT were found in less than half of the patients (8.8-44.1%). In addition, significant proportions of patients were uncertain about their attitudes to ECT (35.3-66.7%) or had a negative attitude toward ECT (4.9-32.4%). There was significant positive correlation between the total knowledge and attitude score, suggesting that higher knowledge was associated with more positive attitude and vice versa. There was no relationship of total knowledge and total attitude score with demographic and clinical variables. Conclusions: Elderly patients with severe mental disorders have poor knowledge, and a significant proportion of them have a negative attitude toward ECT. Accordingly, it is important that medical professionals should impart proper information about ECT to elderly patients to increase the acceptability of ECT in this age group who more often respond well to ECT.

Background: Despite a large body of evidence, the issue of differences in adherence and continuation of treatment with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs) in schizophrenia remains unresolved. This study compared adherence and continuation of treatment between patients on SGAs and FGAs and examined the influence of several socio-demographic and clinical variables on adherence in the two antipsychotic groups. Materials and Methods: Two groups, one of 40 patients with schizophrenia on SGAs and the other with 30 patients on FGAs, were compared on clinician-rated and patient-rated measures of adherence over 6 months; a 3-month period prior to intake and a 3-month follow-up period. Mean scores on these measures and the proportion of adherent/non-adherent patients was estimated for both groups. Results: The two groups did not differ in the 3-month period prior to intake. Over the subsequent 3 months of follow-up, a-fifth of the patients on FGAs became non-adherent, while about 10% of those on SGAs became more adherent. These differences in continuation rates resulted in patients on SGAs being rated as significantly more adherent at the end of this 3-month follow-up period and over the entire 6 months of the study. Differences in adherence and continuation rates between the two groups were primarily driven by the differences between olanzapine and the FGAs. Supervision of treatment by relatives emerged as the only consistent determinant of adherence, but explained only 8% of the variance. Conclusions: Patients on certain SGAs, notably olanzapine, are more likely to continue with their treatment that those on FGAs.

Background: Given the paucity of research in this area, this study attempted to assess attitudes toward antipsychotic medications and its correlates among patients with schizophrenia, either on first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs) medications. Materials and Methods: Structured assessments of attitudes to antipsychotics, psychopathology, insight and side-effects were carried out in 120 patients with DSM-IV schizophrenia; 89 of these were on SGAs and 31 on FGAs. Results: Patients had predominantly positive attitudes toward antipsychotics. Severity of side-effects was the principal correlate of attitudes, explaining 19.5% of the variance, followed by greater insight (4.2% of the variance). Other factors such as younger age, male gender, employment, higher family income, urban residence and lower symptom-severity explained only a negligible proportion of the variance (0.2%) in attitudes. Patients on SGAs had more positive views of their medications than those on FGAs. They felt more normal on their medications, believed that their thoughts were clearer on medications, felt that good things about their medications outweighed the bad and believed that their medications helped them from falling ill again. In addition, they did not feel as tired and sluggish on their medications and did not believe that medications were unnatural or controlled their bodies. Conclusions: Positive attitudes toward antipsychotics were common among patients with schizophrenia. Attitudes were principally determined by severity of side-effects and insight levels. Patients on SGAs had better attitudes, possibly because of less severe side-effects and greater insight among them. The importance of exploring patients′ attitudes toward their antipsychotics is highlighted by this study.

Background: The prevalence of metabolic syndrome (MS) is found to be higher in patients with depression than in the general population. As there is lack of data from India, this study aimed to assess the prevalence of MS in patients with depression who had never been treated with antidepressants for their depressive disorder and compare the same with a matched group of healthy controls. Materials and Methods: Forty-three drug-naïve patients with depressive disorders and 43 age- and gender-matched healthy controls were assessed for the prevalence of MS as per the consensus definition. Results: The prevalence of MS in patients with depression was 37.2% and was significantly higher than that seen in the healthy controls (16.3%). Increased waist circumference was the most common abnormality in both the study groups. Compared to healthy controls, a significantly higher proportion of patients with depression had abnormal waist circumference, systolic blood pressure, or high blood pressure. Besides 16 patients with depressive disorders having MS, another 53.5% of patients fulfilled one or two criteria of MS. None of the sociodemographic variables was associated with development of MS in patients with depression. Conclusions: Slightly more than one-third of depressed patients who are drug-naïve have MS and this prevalence rate is significantly higher than in healthy controls.

To review the data with respect to prevalence of metabolic syndrome (MetS) and its correlates in schizophrenia. For this review, electronic search engines PUBMED, Sciencedirect, and Google Scholar were used. Available data suggests that most of the studies have been of cross-sectional design. Prevalence rates of MetS have varied from 11% to 69% in medicated patients, and 4-26% in drug naive patients in cross-sectional evaluations. Longitudinal studies have shown the prevalence rates to range from 0% to 14% at the baseline in drug naive patients, which increase to as high as 52.4% by 3 months of antipsychotic medication treatment. The prevalence rates of MetS in patients with schizophrenia are much higher than that seen in general population or healthy controls. Though there is no causal association with any demographic or clinical variables, the risk increases with increase in age. Among antipsychotics, there seems to be an association between MetS and atypical antipsychotics like clozapine and olanzapine. Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage, however, these is some evidence to suggest an association of MetS with adiponectin levels, hematological indices, methylenetetrahydrofolate reductase (MTHFR) and Alpha-1A adrenergic receptor (ADRA1A) gene. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.