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   Table of Contents - Current issue
Coverpage
October-December 2017
Volume 59 | Issue 4
Page Nos. 405-528

Online since Thursday, January 18, 2018

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EDITORIAL  

Biotin supplements and laboratory test results in neuropsychiatric practice and research p. 405
TS Sathyanarayana Rao, Rita Christopher, Chittaranjan Andrade
DOI:10.4103/psychiatry.IndianJPsychiatry_454_17  
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GUEST EDITORIAL Top

A magna carta in psychosocial rehabilitation: The long road traveled p. 407
VK Radhakrishnan, K Roy Abraham
DOI:10.4103/psychiatry.IndianJPsychiatry_206_17  
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REVIEW ARTICLE (INVITED) Top

Rebuilding the brain with psychotherapy p. 411
Savita Malhotra, Swapnajeet Sahoo
DOI:10.4103/0019-5545.217299  
Brain has been the most fascinating and mysterious organ of the human body. Researchers have tried to explore into each and every function of different parts of the human brain linking it up with various mental and neural processes, some of which are phylogenetically shared and many are unshared. It has been hypothesized that brain is built during development and can be rebuilt during psychotherapy. Recent research in neuroscience of socioemotional cognition, developmental neuroscience, coupled with advances in investigative techniques of brain functions has provided tremendous opportunities for the study of brain and the mind. In this article, in the initial part, we have tried to explain the developmental processes involved in building of the human brain and what changes occur when an individual develops a psychiatric disorder. Later on, we have tried to postulate from different researches available that how psychotherapy can bring about a change in the neural mechanisms of the brain producing long-lasting effects. Several changes in the neural architecture of the brain occur during the process of psychotherapy. Further, we would like to elaborate on the hypothesis based on available literature that if psychiatric disorders can debuild the brain, then psychotherapy can help in rebuilding it again.
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ORIGINAL ARTICLES Top

Religiosity among patients with schizophrenia: An exploratory study p. 420
Davuluri Triveni, Sandeep Grover, Subho Chakrabarti
DOI:10.4103/psychiatry.IndianJPsychiatry_17_17  
Aim: This study aimed to compare the religiosity and religious coping of patients with schizophrenia with a healthy control group and to assess the correlation between the level of religiosity and religious coping with residual psychopathology, level of functioning, and quality of life (QOL). Methodology: Patients of schizophrenia were assessed on religiousness measure scale, duke religion index (DUREL), brief religious coping scale (RCOPE), positive and negative symptom scale, and World Health Organization QOL-BREF version. Results: Of the 100 patients of schizophrenia, 99% reported that they believed in God. About 60% of patients attended religious places either once a week or more and 56% of patients indulged in private religious activity at least once a day. Two-third of the participants had high intrinsic religiosity score. The mean score of positive religious coping (PRC) subscale was 14.56 and that for negative religious coping (NRC) subscale was 8.31. No significant difference was noted in the various domains of religious measure scale, DUREL, and PRC between patients with schizophrenia and healthy controls. However, compared to healthy controls, patients more often used NRC. Various aspects of religiosity (except for negative RCOPE score) correlated negatively with residual psychopathology and positively with functioning and QOL. Conclusion: Findings of this study suggest that high proportions of patients with schizophrenia are religious and this is similar to healthy controls in the community. Higher level of religiosity and more frequent use of religious coping are associated with lower level of psychopathology and better QOL.
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How patients' characteristics influence the use of coercive measures p. 429
Tomasz Pawlowski, Piotr Baranowski
DOI:10.4103/psychiatry.IndianJPsychiatry_100_17  
Background: Coercive measures are applied in psychiatry as a last resort to control self- and hetero-aggressive behaviors in situations where all other possible strategies have failed. For ethical and clinical reasons, the number of instances of coercion should be reduced as far as possible. Aim: The aim of the study was to identify sociodemographic and clinical characteristics of patients that were associated with coercion during hospital treatment. Materials and Methods: The study has a descriptive, longitudinal design, based on a 1 year prospective observation of patients admitted to a psychiatric hospital consisting of six inpatient psychiatric wards with a total of 236 beds. Results: In the 12-month period covered by the study, 1476 people (778 men and 698 women) were treated in the hospital; 226 of them (15%) were subjected to coercion on a total of 405 occasions. The most frequently implemented form of direct coercion was mechanical restraint. The following factors involved in the use of direct coercion were identified: Male gender, young age, mental disorders resulting from the abuse of psychoactive drugs, involuntary admission to the hospital and the use of direct coercion in the past. Conclusion: Assessments of patients' sociodemographic and clinical characteristics can help clinicians recognize patients who are particularly at risk of being subjected to coercive measures.
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The investigation of the relationship between probability of suicide and reasons for living in psychiatric inpatients Highly accessed article p. 435
Reyhan Eskiyurt, Birgul Ozkan
DOI:10.4103/psychiatry.IndianJPsychiatry_31_17  
Aim: This study was carried out to determine the reasons of the suicide probability and reasons for living of the inpatients hospitalized at the psychiatry clinic and to analyze the relationship between them. Materials and Methods: The sample of the study consisted of 192 patients who were hospitalized in psychiatric clinics between February and May 2016 and who agreed to participate in the study. In collecting data, personal information form, suicide probability scale (SPS), reasons for living inventory (RFL), and Beck's depression inventory (BDI) were used. Stepwise regression method was used to determine the factors that predict suicide probability. Results: In the study, as a result of analyses made, the median score on the SPS was found 76.0, the median score on the RFL was found 137.0, the median score on the BDI of the patients was found 13.5, and it was found that patients with a high probability of suicide had less reasons for living and that their depression levels were very high. As a result of stepwise regression analysis, it was determined that suicidal ideation, reasons for living, maltreatment, education level, age, and income status were the predictors of suicide probability (F = 61.125; P < 0.001). Discussion: It was found that the patients who hospitalized in the psychiatric clinic have high suicide probability and the reasons of living are strong predictors of suicide probability in accordance with the literature.
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Posttraumatic growth and its correlates in primary caregivers of schizophrenic patients p. 442
Ozlem Devrim Balaban, Menekse Sila Yazar, Erkan Aydin, Ruken Agachanli, Huseyin Yumrukcal
DOI:10.4103/psychiatry.IndianJPsychiatry_18_17  
Context: The concept of posttraumatic growth (PTG) is important to focus on positive outcomes of a challenging process like caregiving. Aims: The aim of the present study is to investigate the factors inclusively considered to be related to PTG in primary caregivers of schizophrenic patients. Settings and Design: This cross-sectional study was conducted with caregivers of patients with schizophrenia between January 2013 and February 2014 at a mental health hospital. Materials and Methods: The study was carried out on 109 schizophrenic patients followed up at Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, and 109 family members who are the primary caregivers of the patients. All caregivers were evaluated with Posttraumatic Growth Inventory, Multidimensional Scale of Perceived Social Support, Ways of Coping Inventory, and the Basic Personality Traits Inventory and Religious Orientation Scale. Statistical Analysis: Kruskal–Wallis and Mann–Whitney U-test were used in quantitative analysis of data. Spearman's correlation analysis was used in the determination of correlation between variables. Linear regression analysis was used in the determination of predictors of PTG. Results: Optimistic and problem-focused coping, perceived social support (total and all three - family, friends, significant others - domains), personality traits such as extraversion, conscientiousness, and openness to experience, and religiousness were found to be related with PTG. Religiousness, perceived social support, and openness to experience were independent predictors of PTG. Conclusions: Interventions to caregivers of schizophrenic patients on the domains of social support and coping strategies may contribute to caring process in a positive change.
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Comparison of efficacy of haloperidol and olanzapine in the treatment of delirium p. 451
Rajan Jain, Priti Arun, Ajeet Sidana, Atul Sachdev
DOI:10.4103/psychiatry.IndianJPsychiatry_59_17  
Objective: Till date, typical antipsychotic haloperidol is the treatment of choice for delirium. But, due to higher side effects with haloperidol, newer atypical antipsychotics (e.g., olanzapine) are increasingly being used in the treatment of delirious patients. The aim of the current research was to study the efficacy and tolerability of haloperidol and olanzapine in the treatment of delirium. Materials and Methods: This was an open-label, randomized controlled study carried out in a tertiary care hospital at Chandigarh, India. A total of 100 patients admitted in medicine, surgery, and orthopedic wards and diagnosed as having delirium on Confusion Assessment Method scale were included in the study. Patients were given either haloperidol (1–4 mg/day either orally or by nasogastric tube) or olanzapine (2.5–10 mg/day either orally or by nasogastric tube). Severity of delirium and pattern of symptom improvement were assessed by Memorial Delirium Assessment Scale (MDAS). Extrapyramidal side effects were assessed by Simpson–Angus Scale. Results: There was an improvement in delirium severity in both groups with treatment. Mean daily dose of haloperidol and olanzapine used per patient was 2.10 and 5.49 mg, respectively, and the mean duration of treatment in olanzapine group and haloperidol group was 3.57 days and 3.37 days, respectively. There was no significant difference in the mean duration of treatment in both groups. At the end of study period, the MDAS scores in olanzapine and haloperidol groups were 8.43 and 8.00, respectively, and the difference was not significant statistically with P = 0.765. Five patients experienced drug-related mild side effects. Conclusion: Low-dose haloperidol and olanzapine were equally efficacious and well tolerated in delirium.
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Intervention for phantom limb pain: A randomized single crossover study of mirror therapy p. 457
Shashikumar Ramadugu, Satish C Nagabushnam, Nagendra Katuwal, Kaushik Chatterjee
DOI:10.4103/psychiatry.IndianJPsychiatry_259_16  
Introduction: Mirror therapy suggested to help relieve phantom limb pain (PLP) by resolving the visual- proprioceptive dissociation in the brain, but studies so far either had shorter follow-up or smaller sample size. Materials and Methods: In this randomized single crossover trial, 64 amputees with PLP in the age group of 15–75 years of age were distributed into test and control groups by simple randomization method. Of these 28 in control and 32 in test groups, respectively, completed the 4 weeks of mirror therapy and 12 weeks of follow-up assessments. A standardized set of exercises for 15 min/day for 4 and 8 weeks in test and control groups (in the first 4 weeks, the mirror was covered), respectively, was administered under supervision of one of the authors. All were assessed using the visual analog scale and Short-Form McGill Pain Questionnaire on day 0 and at 4, 8, and 12 weeks after therapy. In control group for the initial 4 weeks, the mirror was covered. The assessing author was blinded to the group to which the participants belonged. Results: Significant reduction in PLP was noted in the test group at 4 weeks compared to the control group (P < 0.0001). Significant reduction was seen in control group also after the switchover and sustained for 12 weeks in both. No harm was reported. Conclusion: Mirror therapy is effective in relieving the intensity, duration, frequency, and overall PLP, and improvement is maintained up to 12 weeks' posttherapy.
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Psychiatric morbidity among female commercial sex workers p. 465
Marboh Goretti Iaisuklang, Arif Ali
DOI:10.4103/psychiatry.IndianJPsychiatry_147_16  
Context: Psychological distress is higher in women working in sex industry. The various psycho social issues are associated with female commercial sex workers (FCSWs). The host of psychosocial vulnerabilities including, childhood sexual abuse, exposure to childhood physical abuse, poverty, interpersonal violence in adulthood, sexually transmitted diseases, and substance use, forms a fertile ground for psychiatric morbidity. Aim: This study aims to assess the psychiatric morbidity among FCSWs in Shillong, India. Materials and Methods: In the present study, 100 FCSWs were selected. For the recruitment of sample, simple random sampling procedure was followed; sociodemographic data sheet and the Mini International Neuropsychiatric Interview were administered. Results: In the study, it was found that 9% of the respondents reported having major depressive episode (current), 25% of the respondents reported major depressive episode (past), 3% were having major depressive episode with melancholic features (current), 21% of the respondents reported posttraumatic stress disorder (PTSD), 8% of the respondents reported to have alcohol dependence, 3% of the respondents reported to have nonalcohol psychoactive substance use disorder, 8% of the respondents were found to have generalized anxiety disorder, and 9% of the respondents were found to have antisocial personality disorder. Conclusions: There is a prevalence of mental health problems in the FCSW. Assessment of the psychiatric morbidity in FCSW is significant in developing health policy and interventions to reduce their impact on their well-being. It is the immediate need that the governmental and nongovernmental agencies, mental health professionals, and workers in this area need to be sensitized to the issue of mental health status of the commercial sex workers.
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Early stages of Alzheimer's disease are alarming signs in injury deaths caused by traffic accidents in elderly people (≥60 years of age): A neuropathological study p. 471
Printha Wijesinghe, Catherine Gorrie, SK Shankar, Yasha T Chickabasaviah, Dhammika Amaratunga, Sanjayah Hulathduwa, K Sunil Kumara, Kamani Samarasinghe, Yoo-Hun Suh, HW M. Steinbusch, K Ranil D. De Silva
DOI:10.4103/psychiatry.IndianJPsychiatry_102_16  
Background: There is little information available in the literature concerning the contribution of dementia in injury deaths in elderly people (≥60 years). Aim: This study was intended to investigate the extent of dementia-related pathologies in the brains of elderly people who died in traffic accidents or by suicide and to compare our findings with age- and sex-matched natural deaths in an elderly population. Materials and Methods: Autopsy-derived human brain samples from nine injury death victims (5 suicide and 4 traffic accidents) and nine age- and sex-matched natural death victims were screened for neurodegenerative and cerebrovascular pathologies using histopathological and immunohistochemical techniques. For the analysis, Statistical Package for the Social Sciences (SPSS) version 16.0 was used. Results: There was a greater likelihood for Alzheimer's disease (AD)-related changes in the elders who succumbed to traffic accidents (1 out of 4) compared to age- and sex-matched suicides (0 out of 5) or natural deaths (0 out of 9) as assessed by the National Institute on Aging – Alzheimer's Association guidelines. Actual burden of both neurofibrillary tangles (NFTs) and (SPs) was comparatively higher in the brains of traffic accidents, and the mean NFT counts were significantly higher in the region of entorhinal cortex (P < 0.05). However, associations obtained for other dementia-related pathologies were not statistically important. Conclusion: Our findings suggest that early Alzheimer stages may be a contributing factor to injury deaths caused by traffic accidents in elderly people whereas suicidal brain neuropathologies resembled natural deaths.
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Serum cholesterol and Suicide in first episode psychosis: A preliminary study p. 478
Amresh Shrivastava, Megan Johnston, Robbie Campbell, Avinash De Sousa, Nilesh Shah
DOI:10.4103/psychiatry.IndianJPsychiatry_185_17  
Background: Low levels of cholesterol have been described in suicide behavior including among those individuals who have an increased tendency for impulsivity. Violent suicide attempters show significantly lower cholesterol levels than nonviolent suicide attempters. The suicide rate is particularly high in the prodromal and early phase of schizophrenia. It is unclear if there is a psychopathological relationship between early psychosis, suicide, and cholesterol levels. The present study examines levels of cholesterol and suicide behavior in a cohort of early psychosis. Methodology: Sixty admitted patients with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis of nonaffective schizophrenia spectrum disorder (early psychosis) were assessed in a naturalistic cross-sectional, cohort study. Psychopathology was assessed with the Positive and Negative Symptom Scale for Schizophrenia (PANSS), Hamilton Depression Rating Scale, and Scale for Impact of Suicidality–Management, Assessment and Planning of Care (SIS-MAP). Serum levels of cholesterol were estimated in the cohort as well. The findings were analyzed for a clinical correlation of cholesterol levels, suicidal attempters, and psychopathology. Results: Out of 60 patients, 13 patients had a suicide attempt in the recent past. No serum cholesterol abnormality (3.7 ± 1.2 mmol/L) was observed in patients as a group and those with low suicidality (SIS-MAP <17, serum cholesterol: 4.1 ± 1.3 mmol/L). However, low levels of cholesterol were observed in a subgroup with severe suicidality (SIS-MAP >33; serum cholesterol: 3.5 ± 1.4 mmol/L). Females with moderate suicidality showed statistically significant lower cholesterol levels than males (P = 0.047). Conclusions: The study suggests lower levels of cholesterol in patients of psychosis with severe suicidal thoughts and depression in early psychosis. More research is required in this field to determine the neurochemistry of suicide behavior in psychosis and its significance in the prediction of suicidal behavior.
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No genetic association between A118G polymorphism of μ-opioid receptor gene and schizophrenia and bipolar disorders p. 483
Shaghayegh Yazdani, Vahid Salimi, Mohammad Reza Eshraghian, Mohammad Shayestehpour, Alireza Pourtalebi-Firoozabadi, Bizhan Romani, Azadeh Shadab, Mohammad Reza Aghasadeghi, Jila Yavarian
DOI:10.4103/psychiatry.IndianJPsychiatry_53_17  
Background: Schizophrenia (SZ) and bipolar disorder (BD) are chronic and multifactorial psychiatric disorders that might be affected by different genes in combination with environmental factors. There is evidence of association between polymorphisms of μ-opioid receptor gene (OPRM1) with these disorders. Objectives: The aim of this study was to investigate the genetic association between OPRM1 A118G SNP in SZ and BD patients in comparison with healthy controls (HCs). Materials and Methods: One single-nucleotide polymorphism in OPRM1 was genotyped using TaqMan real-time PCR assay in 203 SZ and BD patients and 389 HCs. Results: There was no statistically significant difference in genotypic and allelic frequencies of OPRM1 A118G SNP between HCs and SZ/BD patients. Conclusions: To find the underlying genetic factors associated with these complex disorders, further studies need to be conducted using larger sample size, different genetic populations, and different gene variations.
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CASE REPORTS Top

Use of modified bilateral electroconvulsive therapy during pregnancy: A case series Highly accessed article p. 487
Sandeep Grover, Pooja Sikka, Shiv Sajan Saini, Neeru Sahni, Subho Chakrabarti, Devakshi Dua, Anisha Aggarwal, Anita Thakur, Shallu Dhiman, Amal Jolly, Swapnajeet Sahoo, Aseem Mehra, Aditya Somani
DOI:10.4103/psychiatry.IndianJPsychiatry_50_17  
There is limited literature on the use of electroconvulsive therapy (ECT) during pregnancy. ECT is considered as a treatment of last resort during pregnancy. In this case series, we present the data of five patients who were administered ECT during pregnancy. The use of ECT required multidisciplinary approach involving psychiatrist, gynecologist, anesthetist and neonatologist. Two patients received ECT during the second trimester and three patients received ECT during the third trimester. In all the patients, ECT was administered by placing the patients in the left lateral position, glycopyrrolate was used for premedication, thiopentone was used for induction, and succinylcholine was used for muscle relaxation. Patients who were administered ECT close to the full-term were given injection betamethasone 12 mg intramuscularly on two consecutive days before starting of first ECT to promote fetal lung maturity. In all the five cases, no adverse maternal and fetal outcomes were encountered except for possible precipitation of labor in one case.
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Electroconvulsive therapy for medication-refractory depression in a patient with ruptured intracranial dermoid cyst, meningioma, and neurofibromatosis p. 493
Priyanka Thukral-Mahajan, Nilesh Shah, Gurvinder Kalra, Chittaranjan Andrade
DOI:10.4103/psychiatry.IndianJPsychiatry_216_17  
Electroconvulsive therapy (ECT) is considered relatively contraindicated in patients with intracranial space-occupying lesions. A 53-year-old male presented with a 5-year history of medication-refractory major depressive disorder. Brain imaging findings suggested the presence of a ruptured dermoid cyst in the transverse sinus and a calcified meningioma in the temporal lobe sulcal space. There was no evidence of mass effect. Neurofibromatosis was the only other clinical condition present. The patient had no clinical neurological deficits. Since the depression was severe and he was suicidal, ECT was advised. There was a substantial improvement after four bilateral and then eight right unilateral brief-pulse ECTs administered on alternate days, thrice weekly. There were no complications associated with ECT. The treatment gains were maintained with maintenance antidepressant medication at a 1-year follow-up. This is probably the first reported case of the use of ECT in a medication-refractory, severely depressed patient with a ruptured intracranial dermoid cyst and with a calcifying meningioma. The results testify to the safety of ECT even in high-risk patients.
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Prolonged wahnstimmung (delusional mood) without development of a psychotic illness in a 50-year-old male p. 496
Benjamin A Stone, Peter Lepping
DOI:10.4103/psychiatry.IndianJPsychiatry_59_16  
Delusional mood, or Wahnstimmung, is a prodromal feature of an impending psychotic illness. In this case, the patient reports experiencing this sensation persistently since early childhood. This case suggests that Wahnstimmung may persist for years without developing into full psychosis. This is the first reported case of prolonged and persistent delusional mood in literature. It should be of interest to psychiatry professionals looking to investigate the prodromal phase of psychosis. This case is regarding a 50-year-old, Caucasian male. He presented to clinic with a feeling of excitement. Despite being referred for suicidal ideation, he described himself as “the happiest guy that I know. I wake up every morning feeling excited.” This original case should highlight the possibility of this phenomenon in other patients. Ultimately, an understanding of why patients may not progress to full psychotic illness may improve our understanding of protective factors in psychotic illnesses.
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Oculogyric crisis with atypical antipsychotics: A case series p. 499
Naresh Nebhinani, Navratan Suthar
DOI:10.4103/psychiatry.IndianJPsychiatry_211_17  
Oculogyric crisis (OGC) is an acute dystonic reaction, commonly seen with the administration of typical antipsychotics, and rarely reported with atypical antipsychotics. Here, we report five cases of oculogyric crisis, developed after administration of atypical antipsychotics. The first case developed OGC on quetiapine 800 mg/day and the second case on olanzapine 20 mg/day. Both the patients did not improve on adding anticholinergic agents and finally stabilized by switching to clozapine. The third case developed OGC on amisulpride 400 mg and lurasidone 40 mg/day and improved by reducing amisulpride dose to 200 mg and stopping lurasidone. The fourth case developed OGC on aripiprazole 30 mg/day and improved by dose reduction. The fifth case developed OGC on amisulpride 400 mg/day and improved by switching to risperidone and anticholinergic combination. Oculogyric crisis is a potential side effect of antipsychotic medications (mostly with typical and rarely with atypical) and generally respond to oral anticholinergics, but in some cases, dose reduction or discontinuation of antipsychotic agent and switching to safer alternatives or clozapine is required.
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BRIEF RESEARCH COMMUNICATION Top

Stress among medical students: A cross-sectional study from a North Indian Medical University p. 502
Kabir Garg, Manu Agarwal, Pronob Kumar Dalal
DOI:10.4103/psychiatry.IndianJPsychiatry_239_17  
Aims: The aim is to study stress among medical students and the relationship of stress to the year of study and gender. Materials and Methods: A single-point, cross-sectional, observational study of students of a medical university in North India divided on the basis of the semester of their course. The study was done using the higher education stress inventory. Results: A total of 251 students were included in the study. Worry about future endurance and capacity was rated the highest by the final year students while faculty shortcomings and insufficient feedback were rated highest by the 2nd-year students and financial concerns the highest by the 1st-year students. Males rated financial concerns higher than females. Discussion: The study would provide insight to the university authorities to make remedies based on the expectations and feedback of the students. Conclusion: the current study shows that stress amongst medical students is a dynamic process as the reasons of stress vary depending on the stage of curriculum. The college/ university administration can mitigate this by taking appropriate steps as needed
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CME Top

Understanding the schizophrenia prodrome p. 505
Manju George, Shreemit Maheshwari, Suhas Chandran, J Shivananda Manohar, TS Sathyanarayana Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_464_17  
Schizophrenia is a neurodevelopmental disorder and its course is said to have an onset much before the presentation with psychotic symptoms. Even though the concept of prodrome in schizophrenia has been accepted, there is still an existence of a diagnostic dilemma. Various imaging studies and biomarkers have also been studied for confirmation of this diagnosis. The critical period of intervention when identified clarifies the doubts about faster and better outcomes.
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VIEW POINT Top

Primary prevention in psychiatry in general hospitals in South Asia p. 510
Mamta Sood, Rakesh Kumar Chadda, Roy Abraham Kallivayalil
DOI:10.4103/psychiatry.IndianJPsychiatry_180_17  
The focus of primary prevention is on reducing the disease incidence. Primary prevention in mental health has been given minimal priority in low-resource settings with no significant investments. General hospitals are one of the main providers of mental health services in South Asia. This paper focuses on primary prevention activities, which can be undertaken in a general hospital in South Asia with abysmally low-mental health resources. For implementing primary prevention in psychiatry, a general hospital may be conceptualized as a population unit, located in a well-populated area with easy accessibility where different kinds of communities, for example, students and resident doctors, consultants, patients and their caregivers, and paramedical, nursing, administrative and other supportive staff, coexist and have varied functions. All the functional components of the general hospital psychiatric units (GHPUs) offer scope for introducing primary preventive psychiatry services. Psychiatrists in GHPUs can lead efforts for primary prevention in mental health in the hospital by employing strategies in the framework of universal, selective, and indicated prevention. The preventive strategies could be targeted at the patients visiting the hospital for various health services and their caregivers, employees, and the trainees. Similar principles can be employed in teaching and training.
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ART AND PSYCHIATRY Top

Goodness of fit p. 515
Lakshmi Sravanti
DOI:10.4103/psychiatry.IndianJPsychiatry_423_17  
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LETTERS TO EDITOR Top

Feedback of students to aligned teaching -learning and assessment Highly accessed article p. 516
Sandeep Kumar Goyal, Naveen Kumar, Dinesh Badyal, Ankit Kainth, Tejinder Singh
DOI:10.4103/psychiatry.IndianJPsychiatry_12_17  
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Postinjection delirium/sedation syndrome with long-acting olanzapine pamoate in a middle-aged female p. 517
Apoorva Upadhyay, Samrat Singh Bhandari, Vatsala Sharma, Shyamanta Das
DOI:10.4103/psychiatry.IndianJPsychiatry_44_17  
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Antidepressant compliance in a rural setting p. 519
Abha Thakurdesai, Sagar Karia, Suhas Satish, Devavrat Harshe, Adarsh Tripathi
DOI:10.4103/psychiatry.IndianJPsychiatry_318_17  
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Major depressive disorder comorbid severe hydrocephalus caused by Arnold–Chiari malformation p. 520
Ali Kandeger, Hasan Ali Guler, Umran Egilmez, Ozkan Guler
DOI:10.4103/psychiatry.IndianJPsychiatry_225_17  
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Does exposure to a seclusion and restraint event during clerkship influence medical student's attitudes toward psychiatry? p. 521
Shabnam Sood, Devna Rastogi, Gilbert Ramos, Napatkamon Ayutyanont
DOI:10.4103/psychiatry.IndianJPsychiatry_261_17  
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Tourette's syndrome and schizophrenia: About a case report p. 523
Hentati Salma, Sellami Rim, Abida Imen, Masmoudi Jaweher
DOI:10.4103/psychiatry.IndianJPsychiatry_210_17  
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Age as a variable: Continuous or categorical? p. 524
Chittaranjan Andrade
DOI:10.4103/psychiatry.IndianJPsychiatry_354_17  
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An innovative concept book guide for MBBS students p. 525
Suhas Chandran, M Kishor, Smriti Bhargava, Rohan Jayaram, Ramaswamy Sundararajan, Preethi Prabhu, TS Sathyanarayana Rao
DOI:10.4103/psychiatry.IndianJPsychiatry_419_17  
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One year of innovative services: Library for patients and their caregivers in the psychiatry ward p. 526
Manju George, M Kishor, TS Sathyanarayana Rao, Anupama Hegde, DA Kusumavathi, P Leeshma
DOI:10.4103/psychiatry.IndianJPsychiatry_424_17  
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ERRATUM Top

Erratum: Cannabis: Does it have a medicinal value? p. 528

DOI:10.4103/0019-5545.223488  
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