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   Table of Contents - Current issue
Coverpage
November-December 2019
Volume 61 | Issue 6
Page Nos. 547-666

Online since Tuesday, November 5, 2019

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EDITORIAL  

Recovery in schizophrenia: Nihilism must give way to optimism Highly accessed article p. 547
Om Prakash Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_613_19  
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GUEST EDITORIAL Top

Media Matters in suicide – Indian guidelines on suicide reporting Highly accessed article p. 549
Lakshmi Vijayakumar
DOI:10.4103/psychiatry.IndianJPsychiatry_606_19  
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PRESIDENTIAL ADDRESS Top

Sex, love, and relationships: My journey of 40 years Highly accessed article p. 552
Mrugesh Vaishnav
DOI:10.4103/psychiatry.IndianJPsychiatry_619_19  
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ORIGINAL ARTICLES Top

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India Highly accessed article p. 564
Eesha Sharma, Adarsh Tripathi, Sandeep Grover, Ajit Avasthi, Amitava Dan, Chhitij Srivastava, Nishant Goyal, SM Manohari, Janardhan Reddy
DOI:10.4103/psychiatry.IndianJPsychiatry_128_19  
Context: Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents. Aims: To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD. Setting and Design: This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India. Materials and Methods: Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children's Depression Rating Scale, and Family Interview for Genetic Studies. Results: The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years. Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms. CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness. Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample. Conclusions: This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.
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Factor structure and validity of Type D personality scale among Indian (Tamil-speaking) patients with acute myocardial infarction p. 572
Vikas Menon, Anoop G Pillai, Santhosh Satheesh, Charanya Kaliamoorthy, Siddharth Sarkar
DOI:10.4103/psychiatry.IndianJPsychiatry_27_19  
Background: Type D personality has been linked to negative outcomes following acute myocardial infarction (AMI). Our objective was to determine the factor structure, reliability, and validity of the Type D personality construct among people with AMI in the Indian clinical setting. Materials and Methods: In a cross-sectional study conducted between August 2016 and July 2017, 200 consecutive patients with AMI admitted to a tertiary care center completed the Tamil version of the Type D scale-14 (DS-14). The Eysenck Personality Questionnaire Revised-Short Form (EPQR-S) was also administered to check the convergent/divergent validity. Results: The prevalence of Type D personality was 24%. Results of the principal components analysis revealed a four-factor solution for the Tamil version of the DS-14 which explained more than 75% of the variability. Strong convergent validity with the neuroticism subscale of EPQR-S (r = 0.84, P < 0.001) and divergent validity with the extraversion subscale (r = −0.75, P < 0.001) was noted. The two subscales of the Type D scale, negative affectivity and social inhibition (SI), demonstrated good reliability (Cronbach's alpha of 0.85 and 0.76, respectively). Dropping item no 14 from the DS-14 led to significant increase in internal consistency (Cronbach's alpha 0.81) for the SI subconstruct. Conclusion: Among an Indian Tamil-speaking clinical sample of patients with AMI, Type D is a valid construct and can be assessed using the regional version of the DS-14 which showed a four-factor structure and good psychometric properties. Item no. 14 of the DS-14 scale may need modification for the Indian setting.
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Prevalence and pattern of problematic internet use among engineering students from different colleges in India p. 578
Saurabh Kumar, Swarndeep Singh, Krishnamurti Singh, Srinivas Rajkumar, Yatan Pal Singh Balhara
DOI:10.4103/psychiatry.IndianJPsychiatry_85_19  
Introduction: The college students are prone to use internet in a manner that could negatively affect several aspects of their life. The present study is one of the largest studies to be undertaken in India, aimed at understanding the existing pattern of internet use and estimating the prevalence of problematic internet use (PIU) among college students. Materials and Methods: The Generalized Problematic Internet Use Scale 2 (GPIUS-2) was used to assess the PIU. Multiple linear regression analysis was conducted to ascertain the relationship between GPIUS-2 total score and demographic and internet use-related variables. Results: Of 3973 respondents from 23 engineering colleges located in the different parts of the country, about one-fourth (25.4%) had GPIUS-2 scores suggestive of PIU. Among the variables studied, older age, greater time spent online per day, and use of internet mainly for social networking were associated with greater GPIUS-2 scores, indicating higher risk for PIU. Students who used internet mainly for academic activities and during evening hours of the day were less likely to have PIU. Conclusion: This study suggests PIU among engineering college students in India is an important public health concern. There is a need to create awareness among students, emerging adults, parents, and concerned authorities about the harms associated with PIU. Furthermore, there is a need to implement preventive strategies for inculcating pattern of safe and healthy internet usage among them. In addition, there is a need to develop public health policies for prevention and treatment of PIU and conduct further research to enhance our understanding about the same.
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Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder p. 584
Cuneyt Evren, Elvan Cicikci, Gokhan Umut, Bilge Evren, Kubra Durmus
DOI:10.4103/psychiatry.IndianJPsychiatry_318_18  
Introduction: Patients with alcohol use disorder (AUD) use immature defense styles, and AUD is related with adult attention-deficit hyperactivity disorder (ADHD). Harm avoidance (HA) is related with both AUD and particularly inattentiveness (IN) dimension of ADHD. Aim: The aim of the present study was to evaluate the relationship of defense styles with probable ADHD and severity of ADHD symptoms while controlling the effect of HA among male inpatients with AUD. Settings and Design: The present study with cross-sectional design was conducted at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery in Istanbul. Statistical Analysis: Chi-square test, independent samples t-test, multiple logistic and linear regression analyses, and multivariate analysis of covariance (MANCOVA) were used. Materials and Methods: Participants (n = 151) were evaluated with the Adult ADHD Self-Report Scale, the Defense Style Questionnaire, and the HA Dimension of the Temperament and Character Inventory. Results: HA (particularly HA-1 [anticipatory worry and pessimism]) and immature defense style (particularly acting out) predicted the presence of probable ADHD. In linear regression analysis, HA (particularly HA-1 and HA-4 [fatigability and asthenia]), high immature (particularly acting out), and low mature defense styles predicted the severity of ADHD symptoms. In MANCOVA, immature defense style predicted both the IN and the hyperactivity/impulsivity (HI) dimensions of ADHD, whereas HA and IN dimension and low mature defense style predicted HI dimension. Conclusions: These findings suggest that immature defense style (i.e., acting out) is related with both the presence of probable ADHD and severity of ADHD symptoms, together with HA, which must be taken into account while treating patients with ADHD among male populations with AUD.
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Effect of adjunct yoga therapy in depressive disorders: Findings from a randomized controlled study p. 592
Suriya Kumar, Eswaran Subramaniam, Ananda Balayogi Bhavanani, Sukanto Sarkar, Sivaprakash Balasundaram
DOI:10.4103/psychiatry.IndianJPsychiatry_173_19  
Background: Depression causes significant burden both to the individual and to society, and its treatment by antidepressants has various disadvantages. There is preliminary evidence that adds on yoga therapy improves depression by impacting the neurotransmitters involved in the regulation of mood, motivation, and pleasure. Our study aimed to find the effect of adjunctive yoga therapy on outcome of depression and comorbid anxiety. Materials and Methods: A randomized controlled study involving patients with major depressive disorder (n &#61; 80) were allocated to two groups, one received standard therapy (antidepressants and counseling) and the other received adjunct yoga therapy along with standard therapy. Ratings of depression and anxiety were done using Montgomery–Asberg Depression Rating Scale and Hospital Anxiety and Depression Scale at baseline, 10th and 30th day. Clinical Global Impression (CGI) Scale was applied at baseline and 30th day to view the severity of illness and clinical improvement. Results: By the 30th day, individuals in the yoga group had significantly lower scores of depression, anxiety, and CGI scores, in comparison to the control group. The individuals in the yoga group had a significant fall in depression scores and significant clinical improvement, compared to the control group, from baseline to 30th day and 10th to 30th day. In addition, the individuals in the yoga group had a significant fall in anxiety scores from baseline to 10th day. Conclusion: Anxiety starts to improve with short-term yoga sessions, while long-term yoga therapy is likely to be beneficial in the treatment of depression.
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Chronotypes and its association with psychological morbidity and childhood parasomnias p. 598
Ng Syiao Wei, Samir Kumar Praharaj
DOI:10.4103/psychiatry.IndianJPsychiatry_208_19  
Background: The relationship between chronotypes and sleeping problems is not clear. The objective of the study was to identify the relative occurrence of chronotypes among college students and to explore adult psychological morbidity and childhood sleeping problems across chronotypes. Materials and Methods: One hundred and fifty undergraduate medical students were assigned into different chronotypes by Morningness–Eveningness Questionnaire and they were further assessed using Self-Reporting Questionnaire, Parasomnia Questionnaire (adapted from the Adult Sleep Disorders Questionnaire), and Pittsburgh Sleep Quality Index. Results: Intermediate chronotype was the most common, seen in 87 (58%) students, followed by evening type in 34 (22.7%). Evening types have more difficulties in making a decision, becoming exhausted more easily and feeling worthless than other chronotypes. Evening-oriented students showed a significantly higher frequency of initial insomnia and poorer overall sleep quality than the other groups. The current bedwetting was more in evening types; there was no difference in any other current and childhood parasomnias. Conclusions: Evening chronotypes had greater difficulty in decision-making, and they were more vulnerable to feel worthless. No significant association was found between childhood parasomnias and chronotypes except persistent bedwetting during adulthood in evening types.
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Characteristics and correlates of poststroke depression: An Indian study p. 605
Amlan Kusum Jana, Suddhendu Chakraborty, Samir Kumar Praharaj
DOI:10.4103/psychiatry.IndianJPsychiatry_421_19  
Background: Post stroke depression adversely affects long term outcome of stroke and increases mortality risk. Few studies have looked into the comprehensive picture of post stroke depression in past. Aim: The current study aimed to look into the phenomenology, characteristic features and various correlates of post stroke depression. Method: 142 consecutive stroke patients aged 60 years or above, fulfilling the inclusion criteria were assessed. Sociodemographic and clinical data were gathered using a specially designed pro-forma. Depression, apathy and psychosis were assessed by Post stroke depression rating scale, Apathy Evaluation Scale, and Brief Psychiatric Rating Scale respectively. Groups (with or without major depression) were compared using Mann-Whitney U, chi square or Fisher's exact test. One way ANOVA was conducted to see the relations of lesion location and laterality with various clinical parameters. Kaplan-Meier survival analysis was done to see the time to develop depression. The effect sizes were reported as r and partial eta squared. Results: Guilt was significantly higher (p<.05) with lesions in parietal lobe and remaining of middle cerebral artery territory. Catastrophic reaction (p<.05) and emotional dyscontrol (p<.05) were higher for diffuse lesions, periventricular lesions and lesions in frontal/occipital lobe. BPRS score, but not apathy, had a significant positive correlation with depression (Pearson's r=.692). Mean time to develop depression after stroke was 28.34 (95% CI 22.37 to 34.31) months. Conclusions: Post stroke depression consists of various clinically important sub-components whose occurrence varies with different lesion locations. Post stroke depression is discriminable from apathy but is related to psychosis.
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Evaluation of clinical and suicidal behavior characteristics among urban, Turkish middle-age depressive patients with comorbid attention deficit hyperactivity disorder p. 612
Dursun Hakan Delibas, Esin Erdogan, Seref Gulseren
DOI:10.4103/psychiatry.IndianJPsychiatry_448_18  
Background: In the presence of attention deficit hyperactivity disorder (ADHD) together with additional psychiatric diseases, the treatment process and prognosis of both ADHD and psychiatric comorbidity are adversely affected. Aims: The aim of this study is to compare the characteristics concerning suicidal behavior of the patients diagnosed with major depressive disorder either having (ADHD+) or not having (ADHD) adult ADHD comorbidity and their responses to depression treatment. Materials and Methods: Ninety-six inpatients were included in the study. Sociodemographic data form, the Hamilton Depression Rating Scale (HDRS), the Wender Utah Rating Scale (WURS), the Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale, and the Personal and Social Performance Scale (PSP) were applied to the cases. Results: HDRS scores were found to be significantly high (P < 0.000) in the ADHD+ group during admission and discharge. However, there was no difference found in terms of PSP scores (P = 0.46) during discharge. In the ADHD+ group, the depressive episode started at an earlier age (P < 0.011). The idea of suicide (P < 0.018) and suicidal attempts (P < 0.022) was found to be higher in this group compared to the ADHD group. ADHD+ patients had more suicidal attempts requiring more medical intervention (P < 0.001). Conclusion: Depression starts at an early age in individuals with comorbid ADHD diagnosis, and the progress of the depression treatment changes negatively. This patient group is at greater risk in terms of suicidal behavior. Therefore, it should be considered by the clinicians that ADHD can associate with depression while making the follow-up plans for the cases diagnosed with depression.
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A comparative study of temperamental, behavioral, and cognitive changes in thalassemia major, thalassemia minor, and normal population p. 618
Ranjan Bhattacharyya, Kaustav Chakraborty, Arya Sen, Rajarshi Neogi, Sumita Bhattacharyya
DOI:10.4103/psychiatry.IndianJPsychiatry_459_18  
Background: Temperament in children and adolescents acts as a trait marker which can predict behavioral abnormalities. There was no systemic study in India which has compared the temperamental, behavioral and cognitive changes associated with this hemoglobinopathy among thalassemia major (TM) group. Materials and Methods: The specific objectives of this study were to find the clinicodemographic profile of individuals and parents, the behavioral, temperamental profile of children of beta TM and correlation of temperamental profile with number of blood transfusions, cognitive profile of children having beta TM, minor and age-matched control children and adolescents. Results: Child and adolescents having TM have more temperamental and behavioral problems (P < 0.001) and have more psychopathology in comparison to Tm group. Descriptive statistics of the groups and group comparison (ANOVA) shows statistically significant difference in Temperament Measurement Schedule (TMS) total, CPMS total, TMT A, TMT B, and Children's Depression Rating Scale (CDRS) scales (P = 0.000). Descriptive statistics and group comparison (Chi-square test) show significance in number of blood transfusions not with other parameters (P < 0.001). Comparison between TM (Case) and Tm (Control) (t-test) shows significance with only TMS total and CPMS scales, not in other scales. The correlation matrix showed significant correlation in-between all the parameters (blood transfusion, TMS, CPMS, TMT A, TMT B, and CDRS). Discussion: Those who have been diagnosed as TM have more behavioral and cognitive problems than their comparators. Youngsters receiving more blood transfusions due to their ailments scored higher in childhood depression rating scale. Conclusion: The temperamental, behavioural and cognitive profile are key determinants of both internalizing and externalizing symptoms and management plan can be guided accordingly as reflected in this study.
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Insomnia and depression: How much is the overlap? p. 623
Robin Victor, Sherry Garg, Ravi Gupta
DOI:10.4103/psychiatry.IndianJPsychiatry_461_18  
Background: Previous literature considers insomnia as one of the features, predictor, and also as a residual symptom of depression. However, chronic insomnia and major depressive disorder (MDD) have overlapping features making differentiation between two difficult. Materials and Methods: Forty subjects in each of the three categories-MDD, insomnia (I) and combined diagnoses (MDD-I) were recruited in this study after excluding potential confounders. Diagnosis of MDD was made following Diagnostic and Statistical Manual 5 edition (DSM-5), while the International Classification of sleep disorders 3 edition criteria of insomnia were used for diagnosing insomnia. The severity of insomnia and depression was assessed using the Insomnia Severity Index (ISI) and Patient Health Questionnaire-9 (PHQ-9), respectively. Fatigue was assessed using the Fatigue Severity Scale (FSS), which was translated in Hindi for this study. All subjects were also asked regarding effect of good sleep at night on daytime symptoms, especially on mood. Results: Subjects in MDD group were younger than the other two. Insomnia group was significantly different from the other two groups on most of the measures according to the DSM-5 criteria for MDD. MDD group had lesser frequencies of initial insomnia, middle insomnia, dissatisfaction with sleep and overall distress during the day. MDD-I group had a higher prevalence of daytime sleepiness and hyperactivity/impulsivity. PHQ-9 score was the lowest in the insomnia group. Despite statistically significantly different, ISI score was clinically comparable. The severity of fatigue was comparable across three groups. Contrary to the MDD group, subjects in insomnia and MDD-I group reported significant improvement in daytime symptoms after a good sleep for even one night. Conclusion: There is considerable overlap of symptoms between insomnia and MDD. Subjects having insomnia report significant improvement in daytime and mood symptoms after good sleep, contrary to subjects with MDD.
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Investigating spontaneous brain activity in bipolar disorder: A resting-state functional magnetic resonance imaging study p. 630
Rashmin Mansukh Achalia, Arpitha Jacob, Garimaa Achalia, Abhijit Sable, Ganesan Venkatasubramanian, Naren P Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_391_19  
Background: Despite several neuroimaging studies in the past few years, the exact pathophysiology responsible for the development of bipolar disorder (BD) is still not completely known. Importantly, to the best of our knowledge, no study from India has examined resting state (RS) connectivity abnormalities in BD using regional homogeneity (ReHo). Hence, we examined spontaneous brain activity in patients with BD using RS functional magnetic resonance imaging (RS-fMRI). Aim: The aim of the study is to examine the spontaneous brain activity in patients with BD-I using ReHo approach and RS-fMRI compared to age- and gender-matched healthy control (HC). Materials and Methods: A total of 20 patients with BD and 20 age-, gender-, and education-matched HCs participated in the study. The fMRI data were obtained using 1.5T scanner. RS-fMRI abnormalities were analyzed using ReHo method. Results: Compared to healthy adults, significantly increased ReHo in the BD group was found in the right precuneus, right insula, right supramarginal gyrus, left superior frontal gyrus, right inferior frontal gyrus, right precentral gyrus, and right paracentral lobule. No region had significantly lower ReHo values in BD patients compared to controls. Conclusion: These results suggested that abnormal local synchronization of spontaneous brain activity is present in the frontoparietoinsular region which may be related to the pathophysiology of BD.
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BRIEF RESEARCH COMMUNICATION Top

Taluk Mental Health Program: The new kid on the block? p. 635
Narayana Manjunatha, Channaveerachari Naveen Kumar, Kalaivanan Rakesh Chander, Kamaldeep Sadh, Guru S Gowda, B Vinay, HN Shashidhara, Rajani Parthasarathy, Girish N Rao, Suresh Bada Math, Jagadisha Thirthalli
DOI:10.4103/psychiatry.IndianJPsychiatry_343_19  
This article highlights the platform and framework for the new public mental health initiative, the Taluk Mental Health Program (TMHP), rolled out by the Government of India, as part of the expansion of the District Mental Health Program. In this initial phase, TMHP has been approved for ten taluks of Karnataka state. In the authors' collective opinion, few of the initiatives in the country could be considered as foundations for conceptualizing the TMHP (a) research programs and projects in the community, (b) community intervention programs running in two taluks of Karnataka since the past one and a half decade (Thirthahalli and Turuvekere taluks of Karnataka), and the (c) Primary Care Psychiatry Program of National Institute of Mental Health and Neurosciences. The article briefly describes the above initiatives and ends with further suggestions to scale up TMHP.
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VIEW POINT Top

Does the Lancet Medical Journal Legitimize Terrorism? p. 640
Bevinahalli Nanjegowda Raveesh, Mudraje Prasad Ganesh, Bhat Satish
DOI:10.4103/psychiatry.IndianJPsychiatry_493_19  
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CME Top

Case presentation in academic psychiatry: The clinical applications, purposes, and structure of formulation and summary p. 644
Narayana Manjunatha
DOI:10.4103/psychiatry.IndianJPsychiatry_165_10  
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LETTERS TO EDITOR Top

Postpartum psychosis in Sturge–Weber syndrome: A case report p. 649
Anantprakash Siddharthkumar Saraf, Sneh S Babhulkar, Vivek P Joge
DOI:10.4103/psychiatry.IndianJPsychiatry_560_18  
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Commentary on “Gulati P, Chavan BS, Sidana A. Comparative efficacy of baclofen and lorazepam in the treatment of alcohol withdrawal syndrome. Indian J Psychiatry. 2019;61:60-4” p. 650
Parvesh Batra, Anirudh Bhushan, Neha Dhiman
DOI:10.4103/psychiatry.IndianJPsychiatry_63_19  
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Authors' reply to commentary on “Gulati P, Chavan BS, Sidana A. Comparative efficacy of baclofen and lorazepam in the treatment of alcohol withdrawal syndrome” p. 652
Prannay Gulati, Bir Singh Chavan, Ajeet Sidana
DOI:10.4103/psychiatry.IndianJPsychiatry_325_19  
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Successful administration of electroconvulsive therapy in a patient with treatment-resistant schizophrenia and coexisting myasthenia gravis p. 653
Vanteemar S Sreeraj, Sudhir Venkataramaiah, Aditya Sunka, Sriganesh Kamath, Naren P Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_215_19  
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Tramadol withdrawal psychosis p. 655
Ajeet Sidana, Ira Domun, Prinka Arora
DOI:10.4103/psychiatry.IndianJPsychiatry_11_19  
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Quetiapine-induced behavioral disorder during sleep p. 656
NA Uvais, Naseem Palakkuzhiyil, TP Mohammed
DOI:10.4103/psychiatry.IndianJPsychiatry_545_18  
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Commentary on “high-risk behavior in patients with alcohol dependence” p. 657
Samir Kumar Praharaj
DOI:10.4103/psychiatry.IndianJPsychiatry_209_19  
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Factors influencing treatment outcome in bipolar disorder p. 658
Karthick Subramanian, Natasha Celia Saldanha
DOI:10.4103/psychiatry.IndianJPsychiatry_57_19  
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Delirium associated with discontinuation of sertraline in an elderly p. 660
Subhash Das, Mitesh Kumar, Alisha Sahotra
DOI:10.4103/psychiatry.IndianJPsychiatry_102_18  
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Commentary on: Parental care seeking pathway and challenges for autistic spectrum disorder p. 661
Avni Gupta, Sujata Sethi, Hitesh Khurana, Ashish Kumar Malik
DOI:10.4103/psychiatry.IndianJPsychiatry_210_19  
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Authors' response to commentary on: Parental care seeking pathway and challenges for autistic spectrum disorder p. 662
Pranab Mahapatra, Abhimanyu Singh Chauhan, Sanghamitra Pati
DOI:10.4103/psychiatry.IndianJPsychiatry_291_19  
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Successful application of add-on high-definition transcranial direct current stimulation in a schizophrenic patient with comorbid alopecia universalis p. 663
Rujuta Parlikar, Sowmya Selvaraj, Lakshmi Shiva, Vanteemar S Sreeraj, Ganesan Venkatasubramanian, Prabha S Chandra
DOI:10.4103/psychiatry.IndianJPsychiatry_90_19  
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A rare case of Huntington's disease presenting with treatment-resistant psychosis p. 665
Kartik Singhai, Pooja Patnaik Kuppili, Pratibha Gehlawat
DOI:10.4103/psychiatry.IndianJPsychiatry_111_19  
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