The study of cannabis use and psychopathology remains an interesting area from both academic and pragmatic perspectives. This article provides an update on the progress made in this area over the past decade or so. Psychopathology and psychiatric syndromes associated with cannabis use that have received research attention in recent years include cannabis withdrawal, cannabis and psychotic disorders (especially schizophrenia), depression, anxiety, and cognitive impairment. Status of a specific cannabis withdrawal syndrome and a specific 'cannabis psychosis' remains controversial. Current evidence indicates that there is a clinically significant association between cannabis use disorders and psychotic syndromes, depression, anxiety and possibly mild cognitive impairment. However, the nature of this association is often not clear. Several hypothesis related to the cannabis-schizophrenia association are examined. Cannabis use might be casually related to the later development of schizophrenia in an indirect way in a few heavy users, but more commonly, its use may precipitate disorders in persons who are vulnerable to developing psychosis and worsen the course of the disorder.

In the USA, suicide ranked as the third leading cause of death for adolescents in 1999. Non-fatal suicidal behaviours are suicidal thought, specific suicidal plan and suicide attempt. Prospective studies have emphasized the high subsequent suicide rates in clinically presenting suicide attempters. This study was planned to critically review the existing international literature on this area, and compare, if possible, with the Indian data. Both electronic and manual search for published and unpublished works was done for the review of this area. Both international and Indian studies on prevalence, risk factors, management, and prevention of non-fatal suicidal behaviours in adolescents were collected, analysed and reviewed. The study concludes that professionals, like general practitioners, paediatricians, school teachers, school counselors, need to be trained in identifying non-fatal suicidal behaviours in adolescents, and know when to refer them to a mental health professional or mental health service for thorough assessment and effective management. Timely and efficient management of non-fatal suicidal behaviors can prevent future suicidal attempts and completed suicide in most of this highly vulnerable population. Indian studies are very few and without robust study design. Systematic studies in India on this important topic are required.

Risperidone and olanzapine in treatment of psychiatric patients can provoke a plethora of tardive dyskinesias which pose problems for them. This clinical problem requires the urgent attention of mental health professionals. Hence a comprehensive research of Medline and related literature was undertaken from 1996 till August 2004. The published twenty two cases of risperidone (N=12) or olanzapine (N=10) induced tardive dyskinesia were critically reviewed and an attempt is being made to clarify the various issues associated with them. In these reports majority of patients were in younger age group, females and the interval until onset of tardive dyskinesia after initiation of risperidone or olanzapine was within one year. In eight reported cases of risperidone induced and three cases of olanzapine induced tardive dyskinesia, TD disappears either by stopping the drug or switching to other atypical antipsychotic drug. In seven cases of risperidone induced and three cases of olanzapine induced tardive dyskinesia, there was previous exposure to conventional antipsychotic drugs. It is concluded that induction of tardive dyskinesia by these medications is insufficiently documented in these reports but in some cases evidence is suggestive of the role of these drugs in development of tardive dyskinesia. There is no generally accepted treatment for tardive dyskinesia, thus long term studies with risperidone and olanzapine are needed in future to ascertain their tardive dyskinesia liability. Mental health professionals must remain vigilant about onset of tardive dyskinesia with these medications.

This paper reports the findings obtained from an epidemiological study conducted on the Totos-a sub-Himalayan tribe who were at the verge of extinct in early 70's in the state of W.B. The place in which they live is not easily accessible to the outsiders. The present study investigated socio-demographical aspects and the level of psychiatric morbidity within the Toto community. The study had been conducted on the total population of 1021 as available in the study period of 6 weeks. A socio-demographic profile on the tribal community had been drawn. The findings showed that proportion for male and female were close to each other, though, interestingly children below 15 years of age had accounted for almost half of the entire population. The socio-demographic profile that included other bio-social and social cultural factor were also discussed. Psychiatric morbidity was investigated within the Toto community. The results showed about 50 per thousand of the Toto population were psychiatrically morbid – with females being more affected than that of males. The rate of variation of different psychiatric disorder had been studied and the obtained findings indicated that the Totos mostly suffer from depression though other disorders were also found of very low rate compared to that of depression. The findings of psychiatric morbidity had been discussed with each of the socio-demographic factors after proper statistical analysis.

The present randomized, double blind, parallel group, controlled, multi-centric trial was designed to evaluate the efficacy and tolerability of escitalopram in comparison with citalopram and sertraline in the treatment of major depressive disorder. Outpatients (N=214) with an ongoing/newly diagnosed ICD-10 major depressive episode and a Hamilton Rating Scale for Depression (HAM-D) score of > 18 were randomly assigned to citalopram, 20– 40 mg/day (74 patients), escitalopram, 10– 20 mg/day (69 patients) and sertraline, 50-150 mg/day (71 patients), for a 4-week double-blind treatment period, with dosage adjustment (after 2 weeks of treatment) according to the response to treatment. Clinical response was evaluated by the 17 items HAM-D and the Clinical Global Impression (CGI) scales, which were recorded at baseline and at weekly intervals. Tolerability was evaluated by observed/spontaneously reported adverse changes in laboratory parameters (baseline and after 4 weeks). Response rate was defined as a decrease in HAM-D score by 50% from baseline and remission rate was defined as a HAM-D score of < 8. Response rate at the end of two week were 58% for escitalopram (10mg/day), 49% for citalopram (20mg/day) and 52% for sertraline (50-100mg/day). Response rate at the end of four week were 90% for escitalopram (10-20mg/day), 86% for citalopram (20-40mg/day) and 97% for sertraline (100-150mg/day). The Remission rates at the end of four weeks were 74% for escitalopram, 65% for citalopram and 77% for sertraline. Adverse experiences were reported by 45% of patients in escitalopram group, 58% patients in citalopram and 56% patients in the sertraline group. Additionally, there were lesser dropouts and lesser requirement for dose escalation in escitalopram than in citalopram and sertraline group. In conclusion Escitalopram, the Senantiomer of the citalopram is a safe and effective antidepressant in the Indian population. It has potentially superior efficacy than citalopram and a comparable efficacy to sertraline with fewer side effects than both citalopram and sertraline.

Physical traits and features, i.e., body build, colour of eye etc. are often utilized in making diagnosis of psychiatric and physical disorders. A study was carried out to investigate the relationship between baldness and mood disorders on psychiatric out patients, Department of Psychiatry, King George's Medical University, Lucknow, and their available first degree relatives. In this study, 371 psychiatric patients and their first degree relatives were assessed and evaluated. 56.6% male bald patients were found to be suffering from mood disorders. In comparison to male patients of other psychiatric disorders, the relationship between baldness and mood disorders was found to be statistically significant (P<0.001). Though higher percentage of female patients with mood disorders (10.9%) were observed to have baldness in comparison to a single patient with other psychiatric disorder (1.1%), the studied sample of bald female patients was too small to provide meaningful leads. When baldness was studied in selected group of first degree relatives of the index male patients, baldness was observed to be significantly more common in the first degree relatives of mood disorder patients than the first degree relatives of other psychiatric disorder patients. Baldness is being designated as "Sarvada Sign".

This study was conducted in a general psychiatric unit of a zonal hospital of armed forces. 50 consecutive individuals, referred for psychiatric evaluation and sent back with diagnosis of Psychiatric Investigation NAD from 01 Jan. 1998 to 31 Dec. 1999, constituting 21.4% of total 234 first psychiatric referrals were included with an aim to study the sociodemographic and service profile of these individuals. Majority of them were other ranks from army, married, with mean age of 31.9 years and service 11.6 years Medical officers and military units referred individuals almost equally. Majority of them had earned unsatisfactory unit reports. The reasons for referral as perceived by individuals were most frequently unit-related problems followed by health related and domestic problems. It was also found that while units referred individuals when perceived to be undisciplined, medical officers referred individuals with concurrent physical disease or personal problems. The implications of these findings are discussed in the paper.

Demographic aging will soon lead to a sudden increase in the number of older people with dementia and depression in India. We need to develop services to meet the mental health needs of the aged in the population. Geriatric Psychiatry section of IPS has initiated a process of consultations to address this emerging public health issue. Health professionals involved in the care of older people with mental health problems took part in focus group discussions Their opinion and suggestions regarding development of psychogeriatric services and research were gathered. Urgent action is needed to improve the existing low levels of public awareness about mental health problems of older people. Home based care needs to be supported through formal services in the community. If sensitised properly clinicians, can be more effective in managing depression and dementia at primary care level. Research initiatives can be facilitated by networking of researchers and active efforts at dissemination of important research findings. Community health workers could be trained to identify and provide help to older people with mental health problems and their carers. Community outreach programmes for elderly could be particularly relevant in the rural areas where as development of clinic based psycho-geriatric services may be feasible in urban settings. Good research can influence and shape policies which in turn can result in better mental health care for older people.

Personality disorder cases exhibit varieties of abnormal sexual behaviours. The present case is exemplifying how the perception of semen loss is associated with repeated deliberate self-harm attempts.

A chronic and arrested hydrocephalus, presenting with prominent behavioral problems in a patient with treated Congenital Hydrocephalus and a Ventriculo-Peritonial Shunt in situ for twenty seven years. A case report, which signifies neuro-psychiatric liaison.

A male patient with homosexual obsession in obsessive compulsive disorder shows a better outcome following a combination of pharmacotherapy and psychotherapy. This case report emphasizes the importance of combination therapy in obsessive compulsive disorder with abnormal sexual impulses and behavior.