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Background: The diagnosis of breast cancer encompasses not only physical, but also social and psychological implications because of the importance of the breast in a woman's body image, sexuality and motherhood. Women may experience a range of concerns and fears including physical appearance and disfigurement, the uncertainty about recurrence and the fear of death. There are no Indian studies on this subject. Aim: This study explores the various concerns of mastectomized and lumpectomized (breast conserved) patients, determines the coping mechanisms employed and the resolution of concerns. The levels of anxiety and depression in both groups were also studied. Methods: Seventy-five patients with breast carcinoma (50 mastectomized and 25 lumpectomized) were evaluated. The concern and coping checklist of Devlen was used. The severity of anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). Results: Body image or disfigurement was a concern only in the mastectomized group. Concerns were equally resolved between the two groups except for sexual role and performance, wherein the concern was resolved to a lesser extent in the mastectomized group. Coping strategies employed were effective in the resolution of concerns except for sexual role and performance, and recurrence or relapse. No statistically significant difference was found in the depression and anxiety levels of the two groups. Conclusion: Concern regarding sexual role and performance was resolved to a lesser extent in the mastectomized group. Specific psychological intervention is necessary to enhance coping strategies with regard to concerns of body image, and sexual role and performance.

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Background: Tobacco and alcohol use are serious health problems. Studies focusing on problems associated with tobacco and alcohol use in the elderly are limited. Aim: To find out the prevalence of tobacco and alcohol use among rural elderly population. Methods: This cross-sectional study was conducted in the intensive field practice area of the Comprehensive Rural Health Services Project in Ballabgarh in Faridabad, Haryana, a rural field practice area of the Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi. The sample was selected using stratified random cluster sampling. The participants were ?60 years of age at the time of interview. Data on tobacco and alcohol use pattern of 1117 elderly were collected during the interview. Results: The prevalence of smoking was 71.8% in men (n=490) and 41.4% in women (n=497). Among men smokers, 41.5% were light smokers (:-5 beedis/day), 42.9% were moderate smokers (6-20 beedis/day) and 15.6% were heavy smokers (>20 beedis/day). Among women smokers, 71.8% were light smokers, 23.8% were moderate smokers and 4.4% were heavy smokers. Regular alcohol intake was seen in 16.3% of the men compared with 0.8% of the women. Conclusion: The finding of a high prevalence of smoking and alcohol consumption among men in this rural population of India is of serious concern and therefore needs remedial measures.

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Background: Family education programme (FEP) for families of persons with schizophrenia is practised in several centres as a part of patient- and family-related services. Aim: This paper describes two models of FEP conducted at the Schizophrenia Research Foundation (SCARF), Chennai. Methods: The first programme was a part of a research study and was structured utilizing standard evaluation instruments. The second was flexible and tailored to the needs of the family members. Results: After the first programme, the psychopathology of patients and the burden of caregiving on primary caregivers did not show any significant difference but there was a significant gain in caregivers' knowledge with information and experience sharing. Most families seemed to prefer the second programme, which recorded better attendance and participation. Conclusion: Informal educational sessions with periodic 'across-the-table' re-inforcers may be more effective and practical in the Indian setting.

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Hallopeau, a French dermatologist, coined the term trichotillomania (TM) to describe alopecia (baldness) caused by self-traction of the hair, but the term now encompasses the entire syndrome of pathological hair­pulling. It is a disorder of impulse control. The authors present three (adult and child) cases of TM managed successfully using a combination of pharmacotherapy and a package of behaviour therapy. Some psychopathological aspects of the disorder are also discussed.

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Background: There is a high risk of suicidal attempt in patients with depression. This risk varies according to the sociodemographic status and clinical presentation. Aim: To assess the prevalence of suicidal ideation and attempt in patients with major depressive disorder, and to find the correlation between the two. Methods: Sixty patients with major depressive disorder having suicidal ideation were recruited in the study. Of these, 10 had a history of suicidal attempt made in the past or current episode. Sociodemographic details were evaluated and the Hamilton Rating Scale for Depression (HAM-D) was administered. Results: Analysis of the data showed that the incidence of suicidal attempt was 16.6% in patients with suicidal ideation. Statistically, a higher risk of suicidal attempt was found in individuals <30 years of age. Single men, married women and students were more likely to attempt suicide; higher education was also a vulnerability factor. Attempters scored significantly higher in severity of suicidal ideation, agitation and paranoid symptoms whereas among non-attempters, hypochondriasis and general somatic symptoms were more often present. Conclusion: All patients expressing suicidal ideation do not attempt suicide. Young patients with depression, especially unmarried men, married women and students, having severe suicidal ideation with agitation or paranoid symptoms are more likely to attempt suicide.

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Background: Psychiatric disorders are common in alcoholics and such patients have a poorer prognosis. Aim: To determine the prevalence of psychiatric co-morbidity among alcohol-dependent subjects and to compare the prevalence of specific psychiatric disorders between them and a control group. Methods: The study assessed the prevalence of psychiatric co-morbidity in 100 alcohol-dependent subjects and 100 controls. A semi-structured proforma was used to record the sociodemographic variables and the history of alcohol abuse. Statistical analysis was done using the chi-square test. Results: The prevalence rate of psychiatric co-morbidity in alcohol-dependent subjects and controls was found to be 92% and 12%, respectively. The most common disorders were depression, antisocial personality disorder (ASPD) and phobia. There was a significant difference in the prevalence of psychiatric co-morbidity between alcohol-dependent subjects and controls. Conclusion: The findings indicate the need for an active consultation service for better insight into the prevention, treatment and outcome of alcohol dependence.

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Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months.

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Dermatitis artefacta, also known as factitious dermatitis, is a condition in which cutaneous lesions are self ­inflicted and are the result or manifestation of some psychological conflicts. This report presents the case of a 20-year-old man, whose initial presentation resembled a dermatological disorder. Psychological and personality factors as well as issues in the management are discussed.

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Background: Common mental disorders, especially depression, are likely to increase as a result of globalization and industrialization and it is likely that the resultant burden of care will increase proportionately. Women have a higher prevalence of depression and also carry the burden of caring for the affected individuals. Aim: To study the psychological symptoms with possible common mental disorders in a primary care setting. Methods: One hundred two women of Tamil ethnicity were approached to take part in answering the Self­Report Questionnaire (SRQ). The mean age of cases and non-cases were 39 years and 33 years, respectively. Results: Nearly three-fifths scored above the cut-off point. Age, physical illness and chronic pain were found to be important factors in the genesis of depression in particular. Conclusion: These findings have major implications for any preventative or intervention strategies.

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The case of an 18-year-old girl with skin-picking is reported. The patient used to pick at healthy skin and small skin lesions, leading to ulceration, hyperpigmentation and disfigurement. She recovered almost fully with fluoxetine. The implications of diagnosis and the need for early treatment are discussed.

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Background: The importance of early relationship with parents has been stressed by most personality theorists. Deprivation of the nurturing influence can lead to an adverse impact. Aim: To study the effect of early parental loss in the development of adult psychiatric disorder. Methods: A total of 289 soldiers suffering from assorted ICD-10 identified psychiatric disorders were studied to ascertain parental losses during their developmental period. The findings were compared with those of 127 patients drawn from general medical wards. Results: A higher percentage of psychiatric patients had lost their parents before the age of 18 years compared with medical patients (21.5% vs. 8.7%). The difference, which was highly significant, was due to bipolar disorder to some extent and alcohol dependence syndrome to a larger extent. Loss of the father appears to be more significant than loss of the mother. Parental loss is found to be not a significant factor in depression and neurotic disorders. There is no excess of maternal loss in cases of depression. Conclusion: This study indicates that parental loss is a significant factor in the future development of psychiatric disorders. It does not appear to be an important factor in the development of neurotic disorders. The aspect requires comprehensive evaluation.

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