Background: There has been an explosive growth of internet use not only in India but also worldwide in the last decade. There is a growing concern about whether this is excessive and, if so, whether it amounts to an addiction. Aim: To study the prevalence of internet addiction and associated existing psychopathology in adolescent age group. Materials and Methods: A cross-sectional study sample comprising of 987 students of various faculties across the city of Mumbai was conducted after obtaining Institutional Ethics Committee approval and permission from the concerned colleges. Students were assessed with a specially constructed semi-structured proforma and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions. Dukes Health Profile was used to study physical and psychosocial quality of life of students. Subjects were classified into moderate users, possible addicts, and addicts for comparison. Results: Of the 987 adolescents who took part in the study, 681 (68.9%) were female and 306 (31.1%) were males. The mean age of adolescents was 16.82 years. Of the total, about 74.5% were moderate (average) users. Using Young's original criteria, 0.7% were found to be addicts. Those with excessive use internet had high scores on anxiety, depression, and anxiety depression. Conclusions: In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction and be vigilant about psychopathology.

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Schizophrenia is a disorder with variable outcome and the ability to predict the outcome has important clinical utility. Neurological soft signs (NSS) and dorsolateral prefrontal cortex volumes have been described as trait markers for schizophrenia and their relation to long-term outcome in schizophrenia has not been well studied. The aim of this study was to examine the correlation between baseline dorsolateral prefrontal lobe (DLPFL) volume and NSS scores to clinical and functional outcome variables in a cohort of schizophrenia patients who were anti-psychotic naïve at baseline. Fourteen anti-psychotic naive schizophrenia patients whose baseline magnetic resonance imaging scans, NSS scores and positive and negative signs and symptoms scale (PANSS) scores (assessed in drug naïve state) were available were reevaluated after a mean follow-up period of 74.2±24.2 months. The clinical outcome variables measured was PANSS. The social and functional outcome was assessed comprehensively by the socio occupational functioning scale and the Strauss Carpenter outcome scale. The DLPFL, volume was measured from the baseline scans using the region of interest method. Statistical analysis was done using the paired samples t-test and the Pearson's correlation co-efficient. The results showed that smaller left DLPFL volume and greater primitive reflexes at baseline predicted greater negative symptoms and poorer functional outcome on follow-up. This study also demonstrates the clinical utility of NSS as a simple bedside tool in assessing schizophrenia patients.

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Background: Human rights violations among the people with mental illness were not an uncommon occurrence. The present study was aimed to compare persons with psychiatric illness and their caregivers' perceptions regarding the human rights status of people with mental illness in the community. Materials and Methods: A descriptive design was carried out among randomly selected asymptomatic psychiatric patients and their caregivers (N=200) at a tertiary care center. Data was collected through face-to-face interview, using a structured questionnaire. Data was analyzed and interpreted using descriptive and inferential statistics. Results: Our findings revealed that the caregivers than psychiatric patients perceived negatively to the statements i.e., 'Receiving equal information and encouragement about career opportunities' (χ²=10.779, P<0.029), 'Opposing discriminatory actions, slurs' (χ²=9.472, P<0.050) 'Resolving the conflicts with people with mental illness through nonviolent ways' (χ²=27.091, P<0.000), 'Responding to the complaints of harassment or discrimination against the people with mental illness' (χ²=18.697, P<0.001), 'Encouraged to continue their education' (χ²=13.029, P<0.023) 'Exploitation by the community members' (χ²=18.653, P<0.001) and working under fair conditions (χ²=13.470, P<0.009). Conclusion: The study suggests that there is an urgent need to take necessary steps to protect, promote, and fulfill human rights of people with mental illness through providing care, educating the community, and strengthening the legislations.

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It takes about 2 weeks for the onset of antidepressant action of drugs while electroconvulsive therapy though faster, is a cumbersome procedure requiring an anaesthetist and at least a minor operation theatre. Recent studies have shown that Ketamine, when given to severely depressed patients in the dose of 0.5 mg/kg as a slow intravenous infusion over 40 minutes, brought about acute relief from depression and amelioration of suicidal risk within a few hours. The improvement, however, was transient and lasted for up to a week but could be sustained by further weekly or biweekly injections. As the dose of ketamine administered was found to be safe, it was now tried in the intramuscular route in two severely depressed patients with similar rapid improvement. The cases are reported here which pave way for an easier mode of treating acute depression.

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Background, Setting and Design: The chronicity, distress, high rates of comorbidity and varying degree of non response to treatment in Obsessive Compulsive Disorder (OCD) may contribute to suicidal behavior. There is relatively little information on suicidal behavior in OCD subjects. Our study design is Single point non-invasive, cross sectional, clinical study of new and follow up cases. Materials and Methods: Assessment of Suicidal Behavior in patients of OCD attending the adult Psychiatry O.P.D. of Chatrapati Shahuji Maharaj Medical University (CSMMU) U.P. Lucknow using (DSM-IV) criteria for diagnosis of Obsessive Compulsive Disorder, Structured Clinical Interview for DSM-IV Axis-I disorders, Yale Brown Obsessive Compulsive Rating Scale, Scale for Suicidal Ideation (SSI), Beck's Hopelessness Scale (BHS). Statistical Analysis: Mean standard deviation and t test for independent samples, Pearson's correlation coefficient. Results: Statistically significant differences were seen in the SSI score between the "Clinical" and "Sub-Clinical cases" with Clinical group having higher scores. Value of correlation coefficient between YBOCS score and SSI and BHS score is positive and statistically significant ( P<0.01). Conclusion: "Clinical" group of patients had significantly higher scores of suicidal ideation measured by Scale of Suicidal Ideation (SSI). There was a significantly positive correlation between disease severity (YBOCS Score) and degree of suicidal ideation (SIS Score).

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Stigma and discrimination continue to be a reality in the lives of people suffering from mental illness, particularly schizophrenia, and prove to be one of the greatest barriers to regaining a normal lifestyle and health. Research advances have defined stigma and assessed its implications and have even examined intervention strategies for dealing with stigma. We are of the opinion that stigma is a potential clinical risk factor. It delays treatment seeking, worsens course and outcome, reduces compliance, and increases the risk of relapse; causing further disability, discrimination, and isolation even in persons who have accessed mental health services. The delay in treatment due to stigma causes potential complications like suicide, violence, harm to others, and deterioration in capacity to look after one's physical health. These are preventable clinical complications. In order to deal with the impact of stigma on an individual basis, it needs to be (i) assessed during routine clinical examination, (ii) assessed for quantification in order to obtain measurable objective deliverables, and (iii) examined if treatment can reduce stigma and its impact on individuals. New and innovative anti-stigma programs are required that are clinically driven in order to see the change in life of an individual by removing potential risks. The basic requirement for dealing with an individual's stigma perception/experience is its proper assessment for origin and impact in both a qualitative and quantitative manner. We further argue that quantification would allow for regular assessment and offer more effective intervention for patients. It will also be helpful in identifying modifiable social factors to enhance quality of care planning for management in hospitals and communities. The objective of quantification is to facilitate developing an approach to bring the assessment of stigma into clinical work and formulating customized strategies to deal with stigma at the patient level. It would be expected that the assessment of stigma would become a part of routine clinical assessment to identify barriers to outcome. This article discusses the need for quantification of patients' experiences of mental illness stigma.

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Background: Mood stabilizers are drugs used to steady/balance the mood, and are also used to manage symptoms of aggression and impulsivity. There is disparity in prescription pattern across the globe. Aim: The aim of this study was to observe prescription pattern of mood stabilizers for the treatment of bipolar disorder with or without psychotic symptoms. Materials and Methods: A sample of 100 adult patients was selected to participate in the study. First 5 patients of bipolar disorder with or without psychotic symptoms from twenty out-patient departments of various consultant psychiatrists of Department of Psychiatry (C.S.M. Medical University, Lucknow) were included in the sample. A written informed consent was obtained and survey method was adopted to conduct the study. Results and Conclusion: Lithium was found to be the most frequently prescribed mood stabilizer, sodium valproate ranked second while carbamazepine was least frequently prescribed.

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Background: The adult population often suffers from a number of physical and mental problems. This study was conducted to determine the proportion of mental illnesses in adult population visiting the outpatient departments at Dr. TMA Pai Rotary Hospital, Karkala and to study the socio-demographic correlates of psychiatric disorders. Materials and Methods: A cross-sectional study was conducted during March 2004 among 193 adult individuals of 18 years and above at Dr. TMA Pai Rotary Hospital, Karkala, Karnataka. Data was analyzed by the statistical package for social sciences version 10.0 for windows and results were expressed in terms of proportions and their 95% confidence intervals (CI). Chi-square test, multiple logistic regression with adjusted odds ratio and its 95% CI. Results: The proportion of psychiatric disorders in adult population was determined to be 39.9%. Proportion of psychiatric morbidity among males and females were 36.2 and 42.2%, respectively. Conclusion: This study revealed that socio-demographic correlates like age group of 50 years and above, unemployed or housewives, living alone, and a history of psychiatric illness in the family were independently associated with psychiatric disorders in adult population.

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Compulsive sexual behavior consists of sexual obsessions and compulsions that are recurrent, distressing, and interfere with daily functioning. It has been called hypersexual disorder in the upcoming diagnostic and statistical manual 5 ^th edition. Though hypersexuality is commonly seen in mania, it can also be seen in depression and anxiety disorders. This case report describes a case that presented with depression and had underlying compulsive sexual behavior in the form of frottage.

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Objectives: It remains unclear how augmenting anti-psychotic medications with anti-depressants impacts primary positive and negative symptoms of schizophrenia. In this study, we used data collected from a randomized trial comparing citalopram to placebo for management of subsyndromal depression (SSD) in schizophrenia and schizoaffective disorder, to assess the effects of antidepressant augmentation on positive and negative symptoms. Materials and Methods: Participants in this study conducted at the University of California, San Diego and the University of Cincinnati, were persons with schizophrenia or schizoaffective disorder aged 40 or older and who met study criteria for SSD. Patients were randomly assigned to flexible-dose treatment with citalopram or placebo augmentation of their current anti-psychotic medication. Analysis of covariance was used to compare changes in positive and negative syndrome scale (PANSS) scores between treatment groups. We also assessed mediating effects of improvement in depression and moderating effects of multiple factors on positive and negative symptoms. Results: There was significant improvement in PANSS negative symptoms scores in the citalopram group, which was partially mediated by improvement in depressive symptoms. There was no effect on PANSS positive scores. Conclusions: In patients with schizophrenia/schizoaffective disorder, treating depressive symptoms with citalopram appears to carry the added benefit of improving negative symptoms.

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Abstract 0Background: Neuropsychiatric impairments play a significant role throughout the course of cognitive decline. Many psychological and behavioral symptoms are present in patients of mild cognitive impairment (MCI) similar to that seen in individuals with dementia. Aims and Objectives: To study the relevance of neuropsychiatric symptoms of MCI and the impact it has on caregivers of these patients. Materials and Methods: This cross-sectional study was done on 90 patients (30 MCI, 30 dementia and 30 controls) above the age of 50 years. The scales used were Hindi-Mental Status Examination, Global deterioration scale and Neuropsychiatric inventory (NPI). Statistical analysis was done using SPSS 16 software. Results: 73.33% (22) of the subjects in MCI group, 90% (27) of subjects in dementia group and 53.33% (16) of subjects having normal cognition had neuropsychiatric complaints. 73.33% (22) relatives of subjects in the MCI group, 90% (27) relatives of subjects in dementia group and 46.67% (14) relatives of subjects in the normal group (i.e. control group) experienced some distress. The differences in the mean NPI severity, frequency, distress and total scores of the three groups were statistically significant. Severity and frequency of neuropsychiatric symptoms significantly predicted the caregiver's distress. Conclusions: Neuropsychiatric symptoms increase both in frequency and severity with increasing cognitive decline, and they cause distress both to the patient as well as the caregiver; and hence their early recognition is a must. The NPI appears to be a useful tool in that regard.

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Psychogenic purpura, also known as Gardner-Diamond syndrome, is a rare, distinctive, localized cutaneous reaction pattern mostly affecting psychologically disturbed adult women. Repeated crops of tender, ill-defined ecchymotic lesions on the extremities and external bleeding from other sites characterize the condition. We report here a case of psychogenic purpura because of the rarity of the condition and to emphasize the importance of consideration of this entity during evaluation of a patient with recurrent ecchymoses. Early diagnosis of this condition will not only minimize the cost of the medical evaluation but will also benefit the patient.

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Background: Ocular problems are common in mentally retarded children. Due to population growth these problems are increasing. Prevalence rate is variable from region to region. Data on ocular problems in mentally retarded school children is lacking in this region. Aim: The aim of the present study was to identify the ocular disorders in children with mental retardation attending special schools in a district and to study their relationship with the degree of retardation. Materials and Methods: A total of 241 mentally retarded school children in the age group of 6-16 years attending special schools for the mentally retarded children in a district in central India were examined by a team of ophthalmologist, psychiatrist, and a resident in ophthalmology department of a medical college. Complete ocular examination was done. Ocular problems were identified and categorized according to the intelligent quotient. Results: One hundred and twenty four children (51.45%) had ocular problems. Strabismus (10.37%) and refractive error (20.75%) were the common ocular problems seen in this study. An association was found between the severity of mental retardation and ocular problems ( P<0.005). However, no association was seen between the severity of mental retardation and strabismus and refractive error. Conclusion: A high prevalence of ocular problems was seen in mentally retarded school children. Children with mental retardation should undergo annual ophthalmological check up. Early detection and correction of ocular problems will prevent visual impairment in future.

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Context: Previous studies have suggested subtle anatomical brain differences between patients with schizophrenia and healthy control subjects. However, the results are inconsistent and there is no study investigating the various subtypes of this mental disorder separately. Aim: This study was conducted to compare the rate of absence of adhesio interthalamica (AI), a midline brain structure, between 3 subtypes of schizophrenia (paranoid, undifferentiated, and residual) and healthy control group, using magnetic resonance imaging (MRI). Materials and Methods: A total of 29 schizophrenia patients (21 men, 8 women) of three subtypes (paranoid, undifferentiated, and residual) were compared with 29 age- and gender-matched healthy controls. All subjects underwent 3-D brain MRI of full coronal series, 1.5-mm slices without interslice gaps. If the grey matter band connecting the thalami could not be identified on two or more coronal adjacent slices, the AI was considered as absent. The results were statistically analyzed. Results: The incidence rate of AI absence in patients with heterogenous subtypes of schizophrenia was was similar to control group, even when patients and controls of each gender were compared separately ( P>0.05). In residual subtype, patients showed a significant priority in AI absence in comparison with the control group ( P=0.041), which was not seen in paranoid and undifferentiated subtypes ( P>0.05). Conclusion: Residual subtype of schizophrenia is associated with higher rate of AI absence in this study. Subsequent studies are required to determine if the absence of AI is a cause of residual schizophrenia or an effect.

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A 27-year old lady presented to our department with multiple erosive lesions over extremities, which had a very bizarre pattern and was only over accessible parts of body. A thorough history was taken and a diagnosis of dermatitis artefacta was made. We present this interesting case for its rarity and future reference.

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Context: Alcohol dependence can lead to autonomic neuropathy resulting in increased cardiac morbidity and mortality. This has previously been evaluated using heart-rate variability. Aims: We compared sleep heart-rate variability of alcohol-dependent patients with that of healthy controls in this study. Settings and Design: This study was conducted at NIMHANS, Bangalore. A case control study design was adopted. Materials and Methods: Sleep heart-rate variability of 20 male alcohol-dependent inpatients was recorded on the 5 ^th day after detoxification. Sleep heart-rate variability was also recorded in 18 age- and gender-matched healthy controls. Statistical Analysis: The groups were compared using t-test for continuous variables and Chi-squared test for discrete variables. Results: Both time and frequency domain measures were significantly lower in the patients as compared to the controls, indicating decreased HRV in alcohol-dependent individuals. Conclusions: Decreased HRV in alcohol dependence indicates potential autonomic neuropathy.

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This article describes clinical pitfalls in our concepts of what it means for an illness, diagnosis, or evaluation and treatment methods to say that they have been "tested". This articles begins with the problems encountered in newborn testing for Krabbe Disease of the nervous system in New York State over the last few years as an example of a test that did not live up to its promise to help the society. Next, the article gives 3 examples of testing in psychiatry, 1. Psychological testing to make treatment decisions in children with depression, 2. Patient's and parents who have been told, or believe, that they have Asperger's disorder, and 3. The conclusions made about the efficacy of cognitive behavioral therapy based on clinical studies. The article's conclusion sums up these examples as reasons why we need to have a more practical and scientific approach to our understanding and implementation of tests used in our field.

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Background: There has been insufficient and contradictory research to date on the impacts of caring for a child with cleft lip/palate. Therefore this pilot study sought to investigate the mental health and quality of life of primary caregivers of children with cleft lip/palate. Materials and Methods: Seventy-nine primary caregivers of children with cleft lip/palate awaiting a surgical procedure in India completed questionnaires to measure their mental health, quality of life, and demographic variables. Results: The results indicated that half of the sample suffered from poor mental health and a reduced quality of life. Overall perceptions of quality of life were significantly associated with the age of the child requiring care and the contact hours per day spent with the child. Conclusion: It is apparent that caregivers for this population do suffer from a reduced quality of life and poorer mental health. This is especially relevant for older caregivers and those with greater caring responsibilities.

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Background: Diagnostic accuracy of Hot Water Epilepsy (HWE) on history alone was observed to be less satisfactory by the first author while managing such patients psychologically. To confirm this observation this pilot study was planned. Materials and Methods: Symptoms as reported by the patient was confirmed by the two authors in the wards by giving them Hot Water Head Bath. Following this they were subjected to behavioral Psychotherapeutic treatment to relieve them from their distressful symptoms. Results and Conlusion: Confirmed the hypothesis and it was concluded that by witnessing the symptoms of HWE by the treating doctor would improve the outcome of any treatment.

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Background: In animal models, stress and depression are associated with excitatory changes in the amygdala; this aberrant neuroplasticity may represent increased fear learning, explaining the anxiety, fear, and related symptoms that characterize clinical depression. Materials and Methods: In a pilot investigation, we treated adult, male, Wistar rats with sham electroconvulsive shocks (ECS; n=3), low-dose ECS (10 mC; n=3), and high-dose ECS (60 mC; n=3). The rats were sacrificed 1 month after the last of 6 once-daily ECS and, after dissection, sections of the basolateral amygdala were examined using transmission electron microscopy under low (×11,000) and high (×30,000) magnification. Results: In each group, 4 fields were examined under low magnification and 6 fields under high magnification. The number of excitatory synapses and the ratio of excitatory to inhibitory synapses were both numerically lower with ECS than with sham ECS, and the effect was stronger in the high-dose ECS group (statistical analyses were not performed because this was a pilot study). Conclusions: By reducing the number of excitatory synapses and the ratio of excitatory to inhibitory synapses, ECT (especially high-dose ECT) may reduce stress-induced excitatory changes in the amygdala. These changes may help explain a part of the benefits observed with ECT in conditions such as depression and post-traumatic stress disorder.

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Typical and atypical antipsychotic drugs are known to block potassium repolarization channels, prolong the QTc interval, and thereby predispose to ventricular tachyarrhythmias. We report a young male schizophrenic patient who experienced clinically significant and symptomatically distressing ventricular premature contractions (VPCs) in close temporal relation with iloperidone (8-16 mg/day) treatment; there had been no VPCs with prior exposure to risperidone, trihexyphenidyl, and olanzapine, nor with subsequent exposure to asenapine. We hypothesize that the VPCs may have been triggered by an alpha 2c receptor blockade-mediated cardiostimulatory action associated with iloperidone.

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Background: The uniqueness of mindset of an individual makes psychiatric practice interesting, sensitive, and at times subjective. The practice in setup of an organization makes the situation more complex in view of administrative regulations, existing work culture, and issues like confidentiality, etc., Dilemmas are often faced while balancing loyalty between an organization and the patients, values of the therapist and the patient, and different dimension of justice coming from different cultural backgrounds of the patients and the treating doctors. A lot of mental work needs to be put in by the practitioner to consistently adhere to medical ethics and professional approach for taking key decisions despite of contradictory external forces from within and without. Aims: I thought of sharing my experiences especially in setup of an organization with my colleagues so that the decision-taking process becomes somewhat easy and balancing for them. Settings and Design: I have to try to interpret my clinical experiences gathered while working with my patients from the Department of Atomic Energy as well as from my private practice. Conclusion: The need of psycho education to self and others from time to time never ceases simply to make the practice more objective, justified, and graceful.

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