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Background: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. Aim: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. Materials and Methods: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). Results: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (

Assigning motives or reasons to situations and actions have been the basic premise of human existence. Attributing cause to an action makes it logical and easier to comprehend. In social psychology, attribution is the process through which individuals explain the causes of behavior and events. Various theories and models have been proposed to explain this concept, starting from the early works of Fritz Heider in the early 20th century and further advances by Harold Kelley and Bernard Weiner. Attributional concepts can be used in a wide arena of behavioral science ranging from mental health stigma-related interventions to consumerism, corporate and jury psychology, and finally, attributional bias in psychosis and learned helplessness in depression. Attribution theories are viewed as the relevant concepts in the exploration and explanation of a wide repertoire of psychopathologies, especially for culture bound syndromes. Research into the translational use of attributional theories has declined in the recent years, the models being criticized for being mechanistic and reductionistic in approach. Nevertheless, the role of “attributions” in social psychology remains equally important today to explore the various facets of human behavior and reactions. The article explores the relevance of attributions in the fields of psychosocial health. It discusses various theoretical perspectives and frameworks premised on attributional models and narrates the understanding as well as the applications of the relevant theories in the realms of stigma research and consumerism. The criticism and implications in mental health are highlighted thereafter.

Pandemics are not just medical phenomena. They affect the society at large, having long-lasting psycho-social implications. Throughout history, they have led to stigmatization, prejudice, “othering,” and blame. This amplifies hate and socioeconomic divisions, and the effect outlasts the outbreak itself by years to come. Traditionally, humankind has always fared better to deal with the pathogen causing the outbreak, rather than the resultant stigma and prejudice. In the pursue of biological cures for the infection, this vital social implication is unfortunately neglected. The coronavirus disease 2019 (COVID-19) has emerged as a global public health threat. As international borders are sealed, economies slashed, and billions quarantined at their homes in an attempt to contain the spread of infection, history repeats itself in the prevalent marginalization, blame, and stigma that are more contagious than the virus itself. This commentary traces back through the past to look at examples of orientalism and colonialism in pandemics and the resultant stigma, and also to highlight global perspectives of the prevalent prejudice in this current outbreak of COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has emerged as a significant and global public health crisis. Besides the rising number of cases and fatalities, the outbreak has also affected economies, employment, and policies alike. As billions are being isolated at their homes to contain the infection, the uncertainty gives rise to mass hysteria and panic. Amid this, there has been a hidden epidemic of “information” that makes COVID-19 stand out as a “digital infodemic” from the earlier outbreaks. Misinformation and fake news are invariable accompaniments to this “information pollution” which can add to the anxiety, fear, uncertainty, and agitation and lead to faulty treatments, noncompliance to precautionary measures, prejudice, and stigma. Research shows that distress and panic during pandemics can propagate and promote misinformation in various ways along with increased digital screen time and unhealthy use of technology. In that context, media is considered to be a “double-edged sword” and can either add to the misinformation burden or aid in the awareness and health communication during such a biological crisis. Lessons from past outbreaks portray media, especially social media, as a useful tool to promote health literacy and control the outbreak. This article looks at the impact of information during COVID-19, the psychology behind spread of misinformation, and finally, a balanced view of the role of media in such disasters, proposing ways for its healthy integration into public and social health.

Background: India has one of the largest health-care systems in the world, and caregivers play an important role in assisting the patients in seeking services, supporting the patient during treatment and also in recovery, as there is a culturally determined emphasis on kinship obligations, with families playing a prominent role in all decisions regarding treatment. The burden this places on the caregiver can undermine their physical, psychological, and functional health. There is a paucity of studies examining caregiver burden in relation to type caregivers (formal or informal) and type of wards (general or special). Our study aims to explore whether their burden and coping differ in relation to the type of ward services. Aims: The aim of the study was (i) to compare the burden among caregivers of general ward patients with that of special ward patients and (ii) to study the satisfaction of hospital services by caregivers in general ward versus special wards. Methods: Sixty caregivers each of general ward and special ward patients were assessed. The caregiver burden scale was utilized to appraise burden, and their coping was evaluated with the revised caregiver efficacy scale. Results:Caregiver burden was more for special wards compared to general wards. Caregiver self-efficacy was more among the primary caregivers of general ward patients. Conclusions:Caregiver burden and self-efficacy play an important role in satisfaction with the service quality of the health-care organization. Education about various aspects of caregiving and early identification of burden areas should be done to allow optimal management strategies tailored for the individual patient and caregiver.

Background: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) are common conditions causing significant impairment in various domains of life. Both the conditions are associated with physical, emotional, and behavioral symptoms. There is dearth of studies regarding symptomatology and severity of the condition in Indian college students. Aim: Aim of this study is to categorize and rank the symptoms and severity of PMDD in college students in India. Materials and methods: A cross-sectional survey was conducted in various colleges of Mysuru. A total of 600 girls were approached over a period of 1 year. Confidentiality was assured and written informed consent was taken. Girls with irregular periods and those who had an absence of menstruation since last 3 consecutive menstrual cycles were excluded. A total of 571 filled up forms were taken for analysis. Data was analyzed using SPSS 22 version software. Chi-square test was used as the test of significance for qualitative data. Results: The mean age of participants was 21.12 ± 2.6 years. Majority of the subjects were unmarried and were from urban background. The prevalence of PMS/PMDD was 46.1%, out of which 10.2% met the criteria for PMDD. Physical symptoms (91.4%) were the most commonly reported symptom domain in the PMDD category, followed by anger or irritability (84.5%). Almost half of the subjects with no or mild PMS had reported physical symptoms. The least reported symptom was insomnia. PMDD group had reported maximum impairment in the domain of relationship with family members (77.6%), followed by home responsibilities and relationship with coworkers. Conclusion: This study suggests that the prevalence of clinically relevant PMS/PMDD is higher than widely cited estimates and is a cause of concern for health care authorities in India. Physical complaints are the most commonly reported among all the symptoms in all groups. There is a need to actively assess for premenstrual symptoms in young women for comprehensive treatment and good outcome.

The Coronavirus disease 2019 (COVID-19) pandemic has been a global unprecedented health threat. Besides the myriad of effects on public health, the psychosocial implications of the outbreak have been far-fetched. Though the increased prevalence of psychiatric disorders, reduced access to care and social vulnerabilities have been highlighted in literature, the immense impact on sexuality and psychosexual health tends to be silent. The World Health Organization (WHO) defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.” Sexual practices and intimacy have been influenced by more ways than one, namely fear of infection, ambiguity about viral spread, misinformation, physical distancing, travel restrictions, intimate partner violence and deprivation of ‘social touch’. The frontline workers, socio-economically impoverished groups, age and sexual minorities are especially affected. Sexual and reproductive rights are compromised due to reduced help-seeking, panic and stigma related to the outbreak. Psychological resilience helps one navigate through stressful situations and assumes a special importance during the ongoing crisis. This chapter reviews the multi-faceted intersections between sexual health and resilience, highlights the possible roles of pandemic-related uncertainty and advocates for certain guidelines to promote and preserve healthy expressions of sexuality for coping during COVID-19.

Background: The Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. Certain factors like age, an immunocompromised state, and social impoverishment, etc. can add to health vulnerabilities during this pandemic. One such group is older transgender adults, who often bear a combination of these risks. As the world is aging fast, their numbers have also been increasing. With this in mind, this study explores the lived experiences and psychosocial challenges of older transgender adults during the COVID-19 pandemic in India.Methods: A qualitative approach was used. Ten individuals with “transgender” identity above the age of 60 were recruited with consent through purposive sampling. In-depth interviews were conducted on the telephone using a pre-designed interview schedule. They were recorded, translated, and transcribed verbatim. Hasse's adaptation of Colaizzi's phenomenological method was used for analysis. Independent coding and respondent validation were used to ensure the rigor of data.Results: The super-arching categories (with themes) were marginalization (“second” priority, stigma, social disconnection), the dual burden of “age” and “gender” (ageism, othering, and psychosexual difficulties), and multi-faceted survival threats (physical, emotional, financial) during the pandemic. Social rituals, spirituality, hope, and acceptance of “gender dissonance” emerged as the main coping factors, whereas their unmet needs were social inclusion, awareness related to COVID-19, mental health care, and audience to their distress.Conclusion: The elderly gender minorities are at increased emotional and social risks during the ongoing pandemic, and their voices are mostly unheard. The need for policy implementation and community awareness about their social welfare is vital to improving their health and well-being.

Highlights • Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. • Number of suicidal deaths during times of COVID-19 is rising though data is limited. • Pandemics lead to several risk factors for suicidality like isolation, loneliness, economic fallout, domestic abuse, stigma and fear. • Biological vulnerabilities (family history of suicide, substance use, etc.) and psychosocial risks (migration, old age, low socio-economic class, etc.) amplify the suicidal risks of pandemics. • Stress and immune reaction to infections like COVID-19 are hypothesized as possible linking pathways to suicidal risk. • Suicide-prevention is discussed as an integral part of public health response to pandemics., The Coronavirus disease 2019 (COVID-19) has emerged as a new global health threat. By increasing the risk of isolation, fear, stigma, abuse and economic fallout, COVID-19 has led to increase in risk of psychiatric disorders, chronic trauma and stress, which eventually increase suicidality and suicidal behavior. There is limited data on association of pandemics and suicides. Cases of suicides have been rising since COVID-19 first emerged in China. The association between suicides and pandemics can possibly be explained through various models like Durkheim's theory, Joiner's interpersonal theory, social stress theory, biological theories, etc. The frontline workers, elderly, migrants, homeless, socio-economically impoverished classes as well as those with pre-existing mental disorders, substance abuse and family history of suicides are at higher risk. Suicides are preventable and need early detection, awareness and socio-culturally tailored interventions. This narrative review draws global perspectives on the association of suicidality and pandemics, the theories and risk factors related to same based on the available evidence. It also hypothesizes neuroimmunity and immune based risk factors as possible links between the psychosocial vulnerabilities and suicide during outbreaks like COVID-19. Proposed strategies of suicide-prevention, as an integral part of public health response to the pandemic are subsequently discussed.

Highlights • COVID-19 has emerged as a global health threat. • The surprised and catastrophic human response to pandemics have been termed as ‘social absurdity’. • The article draws parallelism between the current outbreak and Camus’s La Peste (The Plague), 1947 in terms of ‘social absurdity’. • Existential and positive psychology principles are proposed to re-shape the psychosocial chaos., COVID-19 has emerged as a global health threat. The catastrophic reaction to a pandemic in spite of knowing the deadly outcomes, has been referred to as the 'social absurdity’. Such reaction creates a negativistic outlook with regard to the infection, thus contributing to chaos and preventing containment. In this article, the current pandemic of COVID-19 is revisited through the lens of Camus' ‘La Peste, 1947′. The philosophical roots of social ‘absurdity’ during a pandemic are critically discussed in the context of death anxiety. Subsequently, ways of reshaping it are highlighted, borrowing from the theories of existentialism and positive psychology.

Background Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. The South-Asian (SA) countries have witnessed both the initial brunt of the outbreak as well as the ongoing rise of cases. Their unique challenges in relation to mental health during the pandemic are worth exploring. Materials and methods A systematic review was conducted for all the original studies on the impact of COVID-19 and lockdown on psychological health/well-being in the SA countries of the World Psychiatric Association Zone 16. PubMed, Google Scholar, PSYCHINFO, EMBASE, and SCOPUS were searched till June 2020. Studies conducted in the age group of 18-60 years with a minimum sample size of 10, and statistically significant results were included. Results Thirteen studies were included in the review. They showed increase prevalence in nonpsychotic depression, preanxiety, somatic concerns, alcohol-related disorders, and insomnia in the general population. Psychological symptoms correlated more with physical complaints of fatigue and pain in older adults and were directly related to social media use, misinformation, xenophobia, and social distancing. Frontline workers reported guilt, stigma, anxiety, and poor sleep quality, which were related to the lack of availability of adequate personal protective equipment, increased workload, and discrimination. One study validated the Coronavirus anxiety scale in the Indian population while another explored gaming as a double-edged sword during the lockdown in adolescents. Another study from Bangladesh explored psychosexual health during lockdown. Most studies were cross-sectional online surveys, used screening tools and had limited accessibility. Conclusion The ongoing COVID-19 crisis and its impact serve as an important period for adequate mental healthcare, promotion, research, and holistic biopsychosocial management of psychiatric disorders, especially in vulnerable groups. Mental healthcare and research strategies during the pandemic and preparedness for postpandemic aftermath are advocated subsequently.

Sexual health, an essential component of individual's health, is influenced by many complex issues including sexual behavior, attitudes, societal, and cultural factors on the one hand and while on the other hand, biological aspects, genetic predisposition, and associated mental and physical illnesses. Sexual health is a neglected area, even though it influences mortality, morbidity, and disability. Dhat syndrome (DS), the term coined by Dr. N. N. Wig, has been at the forefront of advancements in understanding and misunderstanding. The concept of DS is still evolving being treated as a culture-bound syndrome in the past to a syndrome of depression and treated as "a culturally determined idiom of distress." It is bound with myths, fallacies, prejudices, secrecy, exaggeration, and value-laden judgments. Although it has been reported from many countries, much of the literature has emanated from Asia, that too mainly from India. The research in India has ranged from the study of a few cases in the past to recent national multicentric studies concerning phenomenology and beliefs of patients. The epidemiological studies have ranged from being hospital-based to population-based studies in rural and urban settings. There are studies on the management of individual cases by resolving sexual myths, relaxation exercises, supportive psychotherapy, anxiolytics, and antidepressants to broader and deeper research concerning cognitive behavior therapy. The presentation looks into DS as a model case highlighting the importance of exploring sexual health concerns in the Indian population in general and in particular need to reconsider DS in the light of the newly available literature. It makes a fervent appeal for the inclusion of DS in the mainstream diagnostic categories in the upcoming revisions of the diagnostic manuals which can pave the way for a better understanding and management of DS and sexual problems.

Sexuality in dementia is infrequently addressed. Dementia is characterized by a progressive deterioration in all domains of functioning, including loss of sexual function. However, the diagnosis of dementia does not mean an immediate or complete cessation of sexuality in the person, or a loss of the ability to consent to sexual activity with a partner. A discussion of sexuality in dementia occurs infrequently in clinical care for several reasons. These include (a) a discomfort in discussing sexuality in older adults, (b) the fear of causing social or cultural offense, and (c) the assumption that the cessation of the reproductive period implies the end of sexual life in older adults. There is also a tendency to focus on the preservation of cognition and independence, with relative neglect of the need for physical and emotional intimacy or quality of life. Patients with dementia are more likely to be sexually active than not. The most common change is a lack or loss or sexual desire. Inappropriate sexual behaviors occur in a minority of patients (28%) and can be usually managed with behavioral measures, with the use of pharmacotherapy for symptomatic management in refractory cases. Other clinical and ethical concerns in dementia include the capacity to consent to sexual intimacy, the formation of new relationships, sexuality in long-term residential facilities, and vulnerability to sexual abuse. Dementia care guidelines recommend a low threshold of suspicion for abuse, with a focus on patient safety. These must, however, be counterweighed by respect for patient autonomy and wishes.

Introduction: Pornography is the term given for non-relational sex without any requirements for relational intimacy. It has appeared in all cultures and civilizations over centuries. Research into the area of addictive sexual behaviors on the Internet incorporates the various constructs surrounding compulsive sexual behavior. Pornography and society: Excess viewing of pornography has been said to be associated with psychiatric comorbidities such as anxiety and depression, and even sexual dysfunction. Individuals with pornography addiction have lower degrees of social integration, increase in conduct problems, higher levels of delinquent behavior, higher incidence of depressive symptoms, and decreased emotional bonding with caregivers. Pornography is an expression of fantasies and is said to have the potential to rewire pleasure centers of the brain and alter structures and function. Conclusion: Pornography can bring about significant changes in the brain similar to what can be seen in drug addictions. Owing to the boom of technology and easy access to such material, it is imperative to provide specifically designed pornography addiction education programs to educate students about the adverse effects of pornography.

Introduction: Sexual health issues are highly prevalent but are underdiagnosed and underrecognized in day-to-day clinical practice. The lack of awareness of the specific health care needs of the patients with sexual dysfunctions and resource limitations might be certain reasons why many hospitals are not been equipped with the sexual health care units. There is paucity of specialized psychosexual health care services across the country. Trained interdisciplinary team with prepared environment in sexual medicine is the need of the hour. We started this psychosexual medicine unit with an emphasis on sexual wellness to deliver comprehensive sexual health care which will be a primary care linkage to patients presenting with symptoms of sexual disorders, so also treatment emergent sexual dysfunction in psychiatry and other medical and surgical branches.Aim: To portray the methods, opportunities, and challenges that we experienced in establishing a specialty psychosexual medicine facility as a different unit in a private university-based medical college and hospital in Mysuru, India.Methods: This triweekly psychosexual medicine unit is situated in the Outpatient Division of Psychiatry and is staffed with a multidisciplinary group of health care professionals. Structured survey tools and proforma are utilized to assess all patients. Case conclusions are made according to International Classification of Diseases, Tenth Revision, symptomatic/clinical explanations and diagnostic recommendations, and furthermore Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) when required. Patient care included interventions in the form of psychotherapy and pharmacotherapy.Results: It is possible to set up a functional psychosexual medicine facility as a different unit with a trained interdisciplinary group of professionals. Patient-centered approach is vital in our care plan and management. Postgraduate students and internees posted in psychiatry division have been undertaking rotations respectively as per their duty rota. There is also a robust academic program that includes once-weekly seminars pertaining to topics of psychosexual health and monthly journal club gatherings interchanging with seminars on sexual health and well-being appraisal devices.Conclusion: By investing on improving infrastructure and available human resources, the specialty psychosexual medicine unit was established. The psychosexual medicine unit not only gave chances for a more comprehensive assessment of individuals with sexual disorders but also improved training and education for residents with focused interdisciplinary research in the field of sexual medicine. It portrays a versatile model that can be replicated in settings of similar type.

Functional gastrointestinal disorders (FGIDs) are chronic, recurrent, frequently debilitating disorders with no identifiable underlying pathology. They occur due to a complex interplay between biological, psychological, and social factors and are some of the most common conditions encountered in general clinical practice as well as the specialist gastroenterological clinic. The top-down regulation of visceral sensations plays an important role in the pathophysiology of the disease, i.e., the central processing of emotions and stressors altering the sensory and motor components of the gut, which increases hypersensitivity and therefore symptom severity. In addition, the core personality traits of the individual play their part in the way symptoms are perceived, further providing proof for the long-prevailing belief that the gut and emotions are linked, the so-called “gut feeling.” The current diagnostic criteria for FGIDs are entirely based on subjective symptoms, challenging in itself due to the varied presentations, and further complicated by the current unavailability of objective laboratory tests which could confirm its presence in the symptomatic individual. The various treatment modalities include psychotherapies ranging from cognitive behavioral therapy to mindfulness, along with appropriate pharmacotherapy to treat physical and psychiatric comorbidities. Addressing all these underlying causes, in addition to weighing in the genetic makeup of the individual, is necessary for delineating accurate prognosis, reducing attending health-care costs, and improving overall outcome of the individual.

Addiction is the term employed not only for excess consumption of substances, but also for problem behaviours like eating disorders, pathological gambling, computer addiction and pathological preoccupation with video games and sexual acts. No clear diagnostic criterion has been established with validity for behavioral addictions. Sexual addiction, including addiction to pornography is not included as a separate entity because of a lack of strong empirical evidence in this area. Different scales can be used for assessment of sexual addiction. Since there is an absence of established diagnostic criteria, the significance of validity of these scales is doubted. Several of the questions in these scales do not yield information about whether the diagnostic criteria are met or not. Pharmacotherapy, together with psychotherapy proves to have a better outcome in such patients as it helps to synthesize the role of developmental antecedents, reduce current anxiety, depression, guilt and to improve social adjustment.

Introduction: Undertaking a research project is mandatory for MD Psychiatry trainees. The present study was undertaken to assess the type of research activity being undertaken as part of MD Psychiatry dissertation, and its contribution to national and international literature. Materials and Methods: Three medical colleges supplied the data about the topic, names of the supervisor and the candidate, collaboration, funding accrued, and publication details of MD-based research carried out between years 2000 and 2010 inclusive; 95 records were collected for the final analysis. The details of the publications provided were cross-checked on the internet, which would have taken care of missed publications as well. Results: Most studies were single-point assessment clinical studies. Only 2 studies had been funded, 11 had collaboration with other departments within the same institute, and 5 had inter-institute collaborations. Majority of the studies were not published. Only 30 were published as full paper and 9 as abstracts. Of these 30 full publications, only 3 were published in journals having JCI impact factor values (1.4, 1.3, and 1.4, respectively). Conclusions: The main finding of this pilot study was that MD-based research has low contribution to the national and international literature, and those articles which are published are in low impact journals. Suggestions for modifying this state of affairs are discussed.

Although sexuality has a long history in the Indian literature, it is not discussed openly due to various reasons. Although sexual medicine has seen a reasonable growth in the last 70 years, somehow, psychological factors associated with the development of various sexual dysfunctions have not received due importance. Cultural factors which contribute to development and persistence of sexual disorders have not been evaluated properly. In terms of training, there is a wide variation across different centers in this country. There are very few indigenously designed instruments for the assessment of sexual disorders and there is limited data on well-evaluated indigenously designed interventions for the management of various sexual disorders. There is a need to homogenize the training and liaise with other specialists working in this area. Centers with well-developed services for sexual disorders need to start observerships and postdoctoral fellowship programs to train the interested clinicians. There is a need for multicentric studies to generate national-level data.

Schizophrenia is a complex, disabling mental illness with an early onset and chronic course. The course of the illness as well as the prognosis is further complicated by the presence of psychiatric and physical comorbidities. Patients with schizophrenia have a reduced life expectancy, and suicide alone is responsible for a significant proportion of this increased mortality. Substance use disorders also significantly add to the morbidity, along with anxiety and depressive disorders which are commonly seen in this population. They also have a much higher incidence of type 2 diabetes mellitus, cardiovascular disease, and pulmonary disease compared to that of the general population. Some of these disorders may predate the schizophrenia onset, and some may emerge post the onset. The social withdrawal and cognitive deficits associated with the condition could hinder early detection and clinical management of comorbidities; therefore, it is imperative that the mental health team remains vigilant in screening these patients for potentially preventable coexisting disorders. In this chapter, we review the evidence regarding the psychiatric and physical comorbidities in patients with schizophrenia, including possible etiological models, management guidelines, and strategies in reducing barriers to health care in patients with schizophrenia.

Schizophrenia is a chronic psychiatric disorder characterised by change in a person’s perception, thoughts, behaviour, and cognitive functions. The illness has a chronic course which causes significant disturbance in various aspects of a person’s life including social, occupational, and functional aspects. The effective management of schizophrenia has to be a combined approach including both pharmacotherapy and psychosocial interventions which have to be tailor-made considering the symptomatology and the phase of illness so that the patient and the family get the maximum benefits. Psycho-education is an integral part of the acute as well as long-term management of schizophrenia. Psycho-education improves the level of understanding of people about schizophrenia and ensures active participation of both the patients and their caregivers in the treatment.

Insulinoma is a functional endocrine tumor of the pancreas that secretes insulin. Insulinoma comprises 25% of the pancreatic endocrine tumors. Patients may have heterogeneous presentation of symptoms varying from mild autonomic symptoms to severe hypoglycemic episodes. Sometimes, insulinoma may present with neuropsychiatric symptoms which can be mistaken for seizure disorder or dissociative disorder. Careful evaluation of the patient with such symptoms is advised to avoid delay in diagnosis of Insulinoma. Here, we are reporting a case who presented with episodic confusional state of 7 years’ duration that was misdiagnosed as refractory seizures. On further evaluation and monitoring, he was diagnosed with insulinoma, the details of which are elaborated in this case report.

There is a substantial increase in the total geriatric population worldwide. This change in demography calls for a greater, deeper, and thorough understanding of elderly and age-related issues. Even though sexuality is a basic and vital driving force, human sexuality, especially elderly sexuality, is frequently misunderstood. Many myths and misconceptions regarding elderly sexuality exist which need attention. Contrary to the popular belief, studies reveal that sexual life continues to be an important aspect in later life and is often viewed by elderly as an expression of love, passion, affection, admiration, and loyalty. Various factors play a role in elderly sexuality including that of bio-psycho-social factors, changes in the body, presence of comorbid conditions along with sexual disorders. Sexual disorders, if present, should be treated and addressed adequately.

Introduction: Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality worldwide. Patients with coronary artery disease (CAD) have more than twofold risk of sexual dysfunction compared with age-matched healthy persons. Coronary artery bypass graft (CABG) surgery benefits in CAD populations are well established. Erectile dysfunction (ED) in men and arousal difficulties in women are highly prevalent in CAD, yet it is frequently under-recognized and under-diagnosed in clinical practice. A further study on the relation between CABG and sexual functioning is not much explored, hence the need for the study. Materials and Method: It is a cross-sectional study conducted in JSS Hospital, Mysuru, Karnataka. A total of 54 consecutive patients who have undergone CABG were considered. Informed and written consent was taken. After stabilization and thorough checkup by the attending cardiologist, interview was conducted. The patients were assessed on a structured and validated pro forma, for males International Index for Erectile Function (IIEF) and for females Female Sexual Function Index (FSFI) were used. ANOVA and Student’s t test, statistical software SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0, and R environment ver.2.11.1 were used for statistical analysis. Results: Of the 54 study subjects, in males, 69.4% had mild to moderate ED, 52.8% had mild orgasmic dysfunction, 44.4% had moderate desire dysfunction, 50% had mild to moderate dysfunction of intercourse satisfaction, and 44.4% had mild to moderate and moderate dysfunction in overall satisfaction. In females, one or the other forms of sexual dysfunction were present in all the female study subjects; among them, 66.7% had arousal difficulties, 44.4% had lubrication, orgasm, and satisfaction problems and pain difficulties. Conclusion: The results obtained in this study showed an increased prevalence rate of sexual dysfunction in patients who have undergone CABG. Hence addressing the concerned issues during the stay in the hospital is necessary for the better outcomes.

Introduction: In 2007, Ministry of Women and Child Welfare, supported by United Nations Children's Fund, save the children and Prayas conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse; among them, the number of boys abused was 52.94%. Aim: The aim of this study was to explore the barriers for seeking psychiatric help by qualitative analysis of stake holders of male victims of child abuse. Materials and Methods: All the statements made by the stakeholders regarding psychiatric assessment and treatment were recorded in each referral made to the psychiatrist. Semistructured interviews and in-depth interviews were conducted to explore the topic of understanding the need for psychiatric treatment to the victims. Results: Collaborative child response unit, a multidisciplinary team, to tackle child sexual abuse in a general hospital received three referrals of male child abuse among the 27 referrals in 20 months. The main theme of the barrier that was generated by interviewing the stakeholders of male child victims of abuse was the misconception of superiority of a male victim due to gender (patriarchy) an expectation that he will outgrow the experience. In-depth interviews of three cases of homosexual abuse explored the theme. Conclusion: Patriarchy is oppressing male children and acts as a barrier to seek psychiatric help in collaborative child response unit.

Depression is a condition that can present with varied signs and symptoms. Physical pain, although not stated as a symptom of depression according to the official psychiatric classification systems of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases, 10th revision, is also frequently reported by patients with depression. Physical symptoms, common in major depression may lead to chronic pain, often complicating treatment and is generally accompanied by a significant level of dysfunction. A multi-pronged approach often becomes necessary in such patients. They are amenable to numerous strategies including cognitive behavioral therapy (CBT), pharmacotherapy and in some resistant cases electroconvulsive therapy (ECT) also becomes an effective treatment approach. The use of ECT becomes even more pertinent in patients who fail to achieve remission despite being treated with CBT and various pharmacological regimens. We hereby report a case of a 61-year-old man with depression, presenting with pain abdomen as a part of recurrent depressive disorder who eventually responded to the use of ECT as a therapeutic modality. The potential role of the dose of the anesthetic agent influencing the efficacy of the ECT has also been highlighted.

Background:Humans are neurobiologically wired for touch receptivity. Social touch is a common and mutual way of expressing affection, care, and intimacy. From an evolutionary perspective, affiliati...

Aim: This study aimed to evaluate the impact of lockdown on sexual functioning in India. In addition, impact of lockdown on relationship with the partner and mental health was evaluated. Materials and Methods: An online survey was conducted using changes in sexual functioning questionnaire, Patient Health Questionnaire-4, and a self-designed questionnaire. Results: The mean age of the participants was 41.5 (standard deviation: 11.2; range: 22–77; median: 39.5) years, with the majority being males 385 (85.6%). The participants reported that lockdown led to reduction in the frequency of sexual intercourse and also touching the partner (fondling, caressing, touching, or kissing) when not indulging in sexual intercourse. Majority of the participants reported improvement in the overall relationship, communication with the partner, and interpersonal conflicts. About two-fifths of the participants reported engaging in sexual intercourse more than twice a week or more. About one-fifth screened positive for psychiatric morbidity, with 14.2% screened positive for anxiety, 14.8% screened positive for depression and 8.7% screened positive for both. In both genders, presence of depression and anxiety were associated with lower sexual functioning in all the domains. Conclusion: Lockdown led to a reduction in the frequency of sexual intercourse, and reduction in the frequency of intimacy in the form of fondling, caressing, touching, or kissing partner when not doing sexual intercourse. However, lockdown led to the improvement in overall relationship and communication with the partners and a reduction in interpersonal conflicts.

The word malingering derives from the Latin word “Malum” that means bad or harmful, and in this context refers to the bad intent of the offender’s actions. It is regarded as fraud and may lead to charges of perjury or criminal fraud. In a clinical setting, various presentations include imitation of pain, insistence on the presence of bleeding, alleging the presence of PTSD-like symptoms, hallucinations, and/or delusions offering a psychosis like picture. “Psychosis” is a term that covers a wide range of clinical presentations making it attractive to malingerers, since inconsistent symptoms may be seen as simply atypical. Such presentations also often lead to a diagnostic dilemma as clinicians tend to group malingering along with factitious disorder and dissociative disorders. Establishing that a patient has a conscious primary motive behind feigning the illness is a key distinction between malingering and those other disorders. We hereby report a case of a 36-year-old male presenting with hallucinatory behavior, auditory hallucinations, delusions, dysphoria, before his marriage date which on detailed evaluation elucidated several inconsistencies between the reported and observed- symptoms, level of function and psychological test results.

Background: Eating disorders (ED), once known to be a rarity are now commonplace all over the world. However, studies on ED in the Indian population are still very rare to come across. Aim: We made an attempt to study the prevalence of ED in the student population of Mysore, South India. Materials and Methods: A total of 1600 students aged 15–25 years and residing in Mysore were surveyed using two standardized questionnaires. Among the 417 students who scored higher in the questionnaires, 35 students were recruited as participants. Another 35 students with low scores were considered controls. A series of anthropometric measurements were conducted along with the establishment of a register on their well-being and family history. Hemoglobin (Hb) content was measured using a Hb test kit from Beacon Diagnostics Pvt., Ltd., India. Statistical analyses were performed using SPSS version 14.01 software utilizing analysis of variance tool. Results: It was found that 26.06% of participants were prone to ED due to their abnormal eating attitudes. We also observed significant differences between the controls and participants in relation to various parameters such as weight, waist and hip circumferences, body mass index, basal metabolic rate, fat percentage. Hb content was normal in both controls and participants. The establishment of the register also revealed that the onset of menstruation differed significantly between the controls and participants. Conclusions: We arrived at the conclusion that ED are definitely prevailing among the students of Karnataka and have a profound effect on the mental and physical health of the students with eating discrepancies.

In this chapter of the WPA Section on Psychiatry and Human Sexuality are presented two interesting articles on sexual dysfunctions, a crucial clinical concern in Sexology – one deals with female sexuality and its dimensions and the other on the adequate and efficient treatments offered in these days. One other concerns the important matter of sexual violence.

Introduction: Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India. Materials and Methods: The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis. Results: The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up. Conclusion: Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.