Incidence of farmers ending their lives in Vidarbha region had hit epidemic proportions recently. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step. Suicide in farmers is public health problem and we suggested some immediate and serious interventions to prevent suicide.

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Aim: The present study was done to understand the changing trends in substance dependence across decades. Settings and Design: It is a retrospective study done in Department of Psychiatry in a Teaching Hospital setting. The data of patients who attended the OPD for substance dependence during the months January to December in the years 1985 & 1986, 1995 & 1996 and 2005 & 2006 were collected and analysed. Materials and Methods: A total of 839 new patients with substance dependence identified according to International Classification of Diseases (ICD) (n = 839) was analysed in the present report. Study variables taken into account are alcohol dependence, polysubstance dependence which also includes alcohol, age, sex, age of initiation of substance use, duration of use, and comorbidity. Statistical Analysis: Z -test, Chi-square test, mean, percentages, standard deviation. Results: Substance dependence constituted 5.32% in 1985 and 1986, 5.02% in 1995 and 1996, and 4.05% in 2005 and 2006 of the newly registered total psychiatric patients. The variation in incidence figures across the years is statistically not significant ( P > 0.05). Among the substance dependents 2% in 1985 & 1986, 1% in 1995 & 1996 and 1% in 2005 & 2006 were females. Majority of the patients were alcohol dependent (87.2% in 1985 and 1986, 89.4% in 1995 and 1996, and 79.6% in 2005 and 2006). Polysubstance dependence showed an increasing trend and it was statistically significant. Comparison of the years 1985 and 1986 with 2005 and 2006 gives Z = 2.4, P < 0.05 (statistically significant). Comparison of the years 1995 and 1996 with 2005 and 2006 gives Z = 3, P < 0.01 (significant statistically). Number of people getting initiated to substance use in early age ( viz . 10-19 years) showed an increasing trend. People with positive family history of substance dependence started using substances early in life. (Chi-square value: 164.7, P < 0.0001, significant statistically). In polysubstance dependence comorbidity was more ( Z = 4.1, P < 0.001, significant statistically). Conclusions: Incidence of substance dependence remained the same across the two decades. But incidence of polysubstance dependence is increasing over the years. People start using substances earlier and are becoming dependent earlier in their lives in the present decade. Polysubstance dependence is correlated with greater comorbidity. Early recognition of comorbidity and its management is essential for better prognosis. Substance dependence is exclusively a male diagnosis in our population.

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Early intervention (EI) programs in schizophrenia and other psychoses are aimed at early detection (ED) of the disease; prevent conversion to manifested psychosis and phase-specific treatment to reduce development of chronic disabilities. EI strategies include targeting people at "high risk" for developing schizophrenia, intervening in prodromal phase of schizophrenia, and reducing the "duration of untreated psychosis" (DUP). Services are delivered by a specialized team and are usually resource intensive. Several strategies like treatment with antipsychotics, family interventions, and cognitive behavior therapy have been tried with modest success in prodromal patients. Significant ethical reservations exist regarding exposing prodromal patients to the stigma of labeling as "high risk for schizophrenia" and side effects of psychotropics in the absence of clear evidence of efficacy in favor of ED, intervention by specialist teams, and phase-specific interventions in prodrome of psychosis. More research is warranted to demonstrate the risk-benefit and cost-benefit of such interventions before these can be routinely recommended.

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The ancient Indian concepts and paradigms relating to mental health are holistic and cover aspects that have been neglected by the modern mental health literature. The latter can borrow, study, and incorporate them in their text books to advantage. The current trend in mental health research is heavily biased in favour of biological aspects of psychological phenomena neglecting the basic entity, the mind. Correction of this partisan tilt is urgently needed.

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Though considered rare in the developed countries, pseudocyesis is fairly common in gynecological practices in Africa. Using a case report and an overview of the literature, this paper posits that the elucidation of the psychosocial and cultural contexts within which a given patient lives can provide a basis for the empathic understanding of the reasons for the development of pseudocyesis. The case underscores the contributions of extreme poverty, relationship instability, and recurrent partner abuse in the enactment of pseudocyesis within a culture that treasures children for economic survival and generational continuity. The awareness of this cultural dimension is considered relevant to effective clinical care.

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Background: There are very few studies reporting inhalant abuse/dependence from India. Materials and Methods: Consecutive treatment seeking inhalant abuse cases ( n = 21) were studied for the sociodemographic and clinical profile by using a semi-structured interview schedule. Results: A typical case profile was: unmarried male (100%), mean age 19 years, government school background (76%), unemployed (43%) or student (38%), urban nuclear family (86%), middle socioeconomic status (76%), and poor social support (62%); inhalant dependence (81%), inhalants being the only substance of abuse (33%) and of first or second preference (76%). Duration of inhalant use ranged 6-60 (mean 16) months. All subjects abused typewriter erasing fluid by sniffing (67%), huffing (19%) or bagging (14%). Initiation was out of curiosity (62%), under peer pressure (24%), or as a substitute (14%). Craving was more common (90%) than withdrawal (57%). Almost half of the cases (48%) had a family history for substance dependence. All cases were impaired, more so in family and educational/occupational domains. Conclusions: The results depict that easy availability, cheap price, faster onset of action, and a regular high makes inhalant a substance of abuse especially among the urban youth.

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Context : Despite of there being a pressing need to gauge impulsivity scores, there is no behavioral instrument in India to assess the impulsivity in adolescents. No earlier studies have been done in India to access impulsivity in adolescents. Even in western countries, no study has been done in rural setting to access impulsivity, although segment of rural population is small in western nations with major population residing in urban areas. Aims : To translate BIS-11A into Hindi from English in a culturally sensitive manner and to do preliminary study in rural and urban areas. Settings and Design : First translation of BIS-11 (as it is meant for adults) and cultural substitution resulted in Hindi adult version. Adolescent version was derived from adult version by replacing adult activities with adolescent activities. Materials and Methods: BIS-11 English version was translated into Hindi and a back translation was made. As BIS-11 was developed for adults, answering some of the questions poses challenges for adolescents, so to be used with adolescents, questions that do not fit into adolescent age group were substituted keeping in view the activities of adolescents. Besides, questions that were not suitable as per the Indian culture were modified. Initially, these changes were made hypothetically by discussion among the authors and later a group of 48 school students were interviewed about the questions. Based on the interviews of students a final version was prepared. Translation, back translation, cultural substitution -hypothetically, and in school by discussion were carried out. The questionnaire was given to 120 urban high school students (in Jaipur, northern India) and 50 rural students (at Kanota, 25 km from Jaipur, northern India) and the scores were calculated as per the scoring method provided with original BIS-11. Statistical Analysis : T -test (two-tailed, two sample unequal variance, i.e., type 3) was used. Results : T -test (two-tailed, two sample unequal variance, i.e., type 3) found no significant difference between impulsivity scores of adolescents of urban and rural areas t 0.05(2)1 = 0.57, / t / < t 0.05(2)1, P > 0.05, P = 12.706. There were no gender related differences either. Conclusions : As impulsivity can lead to suicide and is implicated for substance abuse in disorders like Schizophrenia, it is important that culturally sensitive impulsivity studies are done in India on a large scale keeping in view the large size of population. Standardization of the BIS11-A Hindi version is being taken up. The work on Hindi version also generates necessity for other tasks if BIS-11(Hindi version) is to be used widely. Work on psychometric properties of Hindi version of BIS-11 A is being taken up. There is a need to devise a quick way to calculate impulsivity scores keeping in view the large population of India (1 billion out of which at least 33% is Hindi speaking, Census Survey of India, 2001). Besides, BIS-11A needs to be developed for other regional languages in India as there is a high-linguistic diversity in India.

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Context: Disorders of unexplained fatigue are researched globally and debated prominently concerning their biomedical and psychiatric comorbidity. Such studies are needed in India. Aims: To identify biomedical markers and psychiatric morbidity of disorders of severe unexplained fatigue or weakness with disability, designated neurasthenia spectrum disorders (NSDs). To compare biomedical markers of patients with controls. To study correlation between biomedical markers and psychiatric morbidity. Settings: Four specialty outpatient clinics of Psychiatry, Medicine, Dermatology, and Ayurved of an urban general hospital. Design: Case-control study for biomedical markers. Diagnostic interviews for assessment of psychiatric morbidity. Materials and Methods: Patients (N = 352) were recruited using screening criteria and Structured Clinical Interview for DSM-IV screening module. They were compared with controls (N = 38) for relevant biomedical markers. Psychiatric morbidity was assessed with SCID-I interviews, Hamilton scales, and Symptom Check List-90 (SCL-90). Correlations between a nutritional index and axis I morbidity were studied. Statistical Analyses: Frequencies and means of biomedical markers and psychiatric diagnoses were compared and associations assessed with regression analysis. Results: Corrected arm muscle area (CAMA) was significantly lower among patients ( P < 0.001), but not anemia. Anxiety (73.0%) and somatoform (61.4%) disorders, especially nonspecific diagnoses, were more frequent than depressive disorders (55.4%). Generally, Hamilton and SCL scores were lowest in Ayurved clinic, and highest in Psychiatry clinic. Presence of Generalized Anxiety Disorder (GAD) and adjustment disorders correlated with low nutritional index. Conclusions: Malnutrition or de-conditioning that may explain weakness need to be considered in the management of NSDs in India, particularly with comorbid GAD or adjustment disorders. Weakness and anxiety, rather than fatigue and depression, are distinct features of Indian patients. SCL may be more useful than categorical diagnoses in NSDs. NSDs are an independent entity with nonspecific psychiatric comorbidity. Cross clinic differences among patients with similar complaints highlight need for idiographic studies.

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Aim: The study set out to explore the perceptions and knowledge of drug use of the Bangladeshi origin population in Leicester through local Mosques and community and resource centers for recruiting subjects. Setting and Design: A triangulated methodology was used for this research. A review of all available literature was carried out to establish if there was evidence of a drug problem among the Bangladeshis in the UK along with questionnaires and interviews. Materials and Methods: A triangulated methodology was used for this research. A review of all available literature was carried out along with questionnaires as well as semi-structured interviews using self-designed questionnaires. Results and Conclusions: Only 66 questionnaires (16.5%) were returned (46 males and 20 females). These and qualitative exploratory interviews with a small number of community leaders confirmed that drug-related problems exist among the Bangladeshi community, especially in the younger age group and are recognized as such but help seeking is often problematic. An understanding of the perceptions of the Bangladeshi population is useful in developing culturally appropriate services for this group.

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One of the important adverse effects of valproate is delirium due to hyperammonemia. In this case report series, we are reporting three cases with interesting and different types of clinical presentation on valproate monotherapy. Valproate-induced delirium may be mistaken for psychosis or worsening of mania leading to improper diagnosis and poor management. We found that there was an elevated level of plasma ammonia in our cases during the delirious state and which decreased when valproate was discontinued. In our cases the serum valproate levels, liver function tests, electroencephalogram, and imaging studies were normal, which were deranged in the previous case reports. We are the first to rechallenge valproate in one of the cases, to prove that valproate caused the hyperammonemia. We suggest that plasma ammonia levels should be monitored routinely in all cases of altered mental status and receiving valproate therapy.

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