The prevalence of substance use disorders is on an upsurge in the Indian population. Unfortunately, they remain one of the most under reported and undertreated medical conditions. Stigma, in its various forms, can act as a barrier to treatment, reduce willingness of policy-makers to allot resources, and that of health-care providers, to effectively screen and treat. This makes it difficult and challenging for the recovery and reintegration of the patients into mainstream healthcare. In the Indian context, it becomes all the more difficult because of factors such as low literacy, prevalent socio-cultural beliefs, and lack of stringent law enforcement. We intend to highlight the problem of stigma in substance use and its consequences along with the amenable solutions in future.

Management strategies in Alzheimer's disease (AD) are challenging and limited in several aspects. Repetitive transcranial magnetic stimulation (rTMS), being a noninvasive brain stimulation method, has recently been studied in the management of AD. The literature available is different on several aspects such as patient enrollment, site of stimulation, outcome measures, and follow-up. We present a narrative review highlighting important aspects of rTMS in AD. We searched the databases of Google Scholar and PubMed using the search terms: rTMS and Alzheimer's disease; rTMS and cognition; rTMS and dementia; and brain stimulation and Alzheimer's disease. Original research, case reports and series, other narrative reviews, systematic reviews, and meta-analyses were included, and studies where only abstracts were available were excluded. Majority of the studies present a modest benefit of rTMS in mild–moderate AD and some in normal aging and mild cognitive impairment. Improvement is marked in high-frequency rTMS as compared to low frequency. The favorite site of stimulation appears to be the dorsolateral prefrontal cortex (DLPFC). Studies chiefly assessed cognitive function, while sparingly involving other areas of impairment such as psychopathology and global functioning. Improvement in cognition is mainly in the weeks ensuring rTMS, and studies assessing improvement in a long-term follow-up are needed. There appears to be minimal to no side effects reported in most studies. Future implications of rTMS in AD are suggested.

Context: Children with specific learning disorders (SLD) are often observed with neurological soft signs (NSS) and adjunctive emotional/behavioral symptoms. Aims: This study attempts to quantify both NSS and subclinical psychiatric comorbidities in known SLD cases. Statistically relevant data, if generated, would provide clinicians with a clearer picture and further a more well-rounded treatment plan. Settings and Design: The study was observational, cross-sectional, and quantitative, conducted in learning disability clinic attached to a child psychiatry outpatient department in a public-sector tertiary-care teaching hospital in urban India. One hundred and sixty children of age 7–18 years fitting inclusion criteria were enrolled after appropriate consent/assent. Subjects and Methods: A sociodemographic data pro forma, and two scales, the child behavior checklist and Physical and Neurological Examination for Subtle Signs – Revised (PANESS-R), were used. A single-setting interview was conducted, data collected and statistically analyzed. Statistical Analysis: It was done by a qualified statistician using SPSS-16 software. Results: 36.25% had “total” psychopathology, 41.875% “internalizing problem,” and 30% “externalizing problem,” which were associated with poor interpersonal relations, more physical discipline, and “overflow” component of NSS. On PANESS-R, repetitive speed of movement was the most common. More NSS were found in younger age groups, boys and in association with perinatal maternal age of below 20 and above 30 years. Countering previous findings, right-handed children had high incidence of mixed handedness. Conclusions: We recommend routine screening for NSS and psychopathology in SLD children as these may complicate treatment outcome with secondary psychological/neurodevelopmental issues. Prompt detection and appropriate management might redress them more holistically.

Context: The explosive growth of the internet in the last decade has had a huge impact on psychological research in understanding its role in communication and interpersonal behavior. There has been increased interest in the addictive potential of the internet and the effect this can have on psychological well-being. Aims: To study the prevalence of pathological internet use (PIU) and the correlation between PIU and big five personality traits among first-year MBBS students. Settings and Design: The present study with cross-sectional design was conducted in one of the government medical colleges of Gujarat. Subjects and Methods: First-year MBBS students (n = 226) newly admitted in Government medical college, Surat in the year 2018–2019 were enrolled in the study. The internet use pattern was assessed using PIU scale, and the evaluation of their personality traits was done using The Big 5 Inventory. Statistical Analysis Used: Statistical analysis was done by Chi-square test and independent samples t-test. Results and Conclusions: Results showed that prevalence of PIU among first-year MBBS students was high (68.28%). Students who did not take MBBS by their own choice and were living in hostel had more PIU, whereas it was almost equal in both the genders and family type. PIU was found less in students with conscientiousness and openness personality traits and high in students with neuroticism personality trait (P < 0.05). PIU is predictable by measuring the personality characteristics of the students.

Context: Despite the proved effectiveness of electroconvulsive therapy (ECT) in the treatment of many psychiatric emergencies and disorders, ECT continues to be an intervention that attracts controversies. There are limited literature on attitude and knowledge of nursing students toward ECT from India. Aims: The aim was to explore the impact before and after Brief ECT Orientation Module on the knowledge and attitudes toward ECT among nursing students. Study Design: Pre- and post-study design. Subjects and Methods: Nursing students who had completed their psychiatric rotation were assessed using knowledge and attitude questionnaire before and after exposure to 1 h lecture, video representing the ECT procedure, and live demonstration of ECT. Informed consent was obtained from students who agreed to participate in the study. Statistical Analysis Used: Data analysis was done using SPSS version 17.0 SPSS Inc., Chicago, Ill., USA. The impact of Brief ECT Orientation Module on knowledge and attitude of nursing students was assessed by comparing the baseline score on the study questionnaire with the post module scores using student paired sample t-test and Chi-square test. Level of statistical significance was kept at P < 0.05 for all the tests. Results: Majority of the students had average knowledge about the effectiveness, mechanism of action, indications, consent, and side effects of ECT. There was a significant improvement seen toward all domains of the questionnaires post ECT module. Conclusions: Findings of the current study suggest that Brief ECT Orientation Module is effective in improving the knowledge and attitude of nursing students toward ECT.

Background: Stress is a common factor among college students who are subjected to different kind of stressors. The psychological effects of stress, anxiety, and depression, often referred to as “negative emotions,” lead many students down a path of hardship, and it may lead to potentially unfavorable outcomes. Objectives: The objective of this study was to estimate the prevalence of stress, anxiety, and depression and to find out the sources of stressor and coping strategies to deal with stress and their correlation with Depression, Anxiety and Stress Scale (DASS) scores among Engineering students. Materials and Methods: This cross-sectional survey was conducted among 150 students of Bapurao Deshmukh Engineering College from Sevagram, district Wardha, Maharashtra, India. All the students were assessed through semi-structured pro forma, DASS, coping inventory for stressful situation, and sources of academic stress among the students for data collection. Results: The prevalence of stress, anxiety, and depression was found to be 29.3%, 78%, and 59.3%, respectively. The most common source of stressor was academic factors, and coping strategy was task-oriented adopted by the students to deal with their stress. The significant correlations were reported between stress score and gender, satisfaction with academic performance, regularity of attendance; between anxiety score and satisfaction with academic performance; and between depression score and addiction other than smoking. Furthermore, stress and depression were significantly correlated with emotion-oriented strategy. Furthermore, DASS scores were correlated with all sources of stressors. Conclusion: Students are susceptible to different stressors during a study period; hence, there is a need to address these issues to decrease the burden and increase performance.

Background: Schizophrenia is a chronic disorder, and one-third of patients with schizophrenia can develop treatment resistance. Factors such as male gender, early age of onset, positive family history, and low level of social functioning are associated with refractoriness to treatment. However, very few Indian studies have tried to establish the predictors of outcome for schizophrenia. Aims: The aim of the study was to identify the subtypes of treatment-resistant schizophrenia (TRS) and its relation with sociodemographic profile, illness-related variables, and cognitive insight. Materials and Methods: The study was conducted after permission from the institutional review board. Fifty consecutive patients of TRS (treated with two antipsychotics from different classes with adequate doses for 6 weeks each and currently satisfying the Diagnostic and Statistical Manual of Mental Disorders 4^th Edition, Text Revision criteria for schizophrenia) were included in the study. Patients were administered a semi-structured questionnaire to obtain details about sociodemographic status, and the Positive and Negative Syndrome Scale was administered to identify the subtypes of schizophrenia. Becks Cognitive Insight Scale was used to assess cognitive insight. Results: Almost half of the sample (46%) belonged to the positive subtype followed by negative subtype. There was a statistically significant difference in the age of onset, educational qualification, and suicidal ideation between the positive and negative subtypes. There was a significant association of cognitive insight between TRS subtypes, and it suggested that patients with positive subtype had poorer insight than those with negative subtype. Conclusions: It is important to identify the subtype of schizophrenia and the risk factors for treatment resistance. Early recognition and intervention with respect to these risk factors can improve the long-term course of TRS.

Background: Vitiligo is one of the most common dermatological illnesses with localized depigmentation leading to cosmetic impairment. This also causes impairment of physical, psychological, social functioning of individual which in turn leads to psychiatric morbidities such as anxiety and depression. Aims and Objective: The present hospital based study was carried out to evaluate the presence of depression in patients of vitiligo patients in their different socio demographic variables. In addition, attempts were made to measure the severity of depression in those patients. Material and Methods: This was a hospital based cross-sectional study. Eighty patients of vitiligo with lesions in the exposed body parts were enrolled for the study after their informed consent with purposive sampling method from the Department of Dermatology, in a tertiary care hospital in north eastern part of India and compared them with those of healthy control. Those patients were evaluated by using ICD-10 research criteria and 17 item Hamilton rating scale of depression to diagnose and grade the degree of depression. Data were collected and “Chi Square Test” or “Fisher Exact t Test” was used. Mean value and standard deviation were calculated. All analysis were done using SPSS version 20.0. Results: Co morbidity of depression was significantly higher in vitiligo group (23.75%) in comparison to control group (6.25%). Among the depressed patients 68.43% had mild depression and 31.57% had moderate depression. Depression was inversely proportional to the years of education. Conclusions: These findings indicate the need of early recognition of depression among these patients and their early intervention, which will improve the primary disease process positively.

Background: Gaming addiction (GA) is a recent diagnosis in problematic or pathological video game users. This study is aimed to examine the correlation of gaming characteristics and personality traits in GA. Subjects and Methods: This was a cross-sectional, observational study of 225 intern doctors posted to the Department of Psychiatry over a period of 12 months. GA Scale-short version was used to screen for GA. Clinical interview using the Diagnostic and Statistical Manual of Mental Disorder-5 research diagnostic criteria for Internet Gaming Disorder was used to diagnose GA. Neuroticism and extraversion of the Eysenck Personality Questionnaire, Arnett Inventory of Sensation Seeking, Buss Perry Aggression Questionnaire, and State Self-Esteem scale were used for assessment of personality factors. Descriptive statistics, independent t-test, Chi-square test, multiple logistic regression, and multiple linear regressions were used for the analysis of data. Results: Around three-fourth or more interns played online games, spent money on gaming, and playing for 5 years or more had GA. Nearly 70% of addicted interns were using multiple gadgets and 91.42% were playing games in other than leisure time also. Statistically, a significant association was found between GA and gaming variables. Neuroticism, aggression, and sensation-seeking had positive and significant associations while self-esteem and extraversion had negative and significant associations with GA. Conclusions: GA is prevalent among intern doctors with certain gaming characteristics. It is associated with a high level of neuroticism, aggression, and sensation seeking and low level of extraversion, and self-esteem

Background: Medical students experience high-stress levels that can impact on their learning and future care provision. Increased stress can precipitate episodes of anxiety and depression. Furtermore, it is one of the contributing factors of student suicide. As individual's vulnerability plays a major role, this study aims to understand the personality, coping strategies, and quality of life (QoL) of undergraduate medical students in a private medical college in South India. Materials and Methods: A cross-sectional study design with universal sampling was used to collect data from 411 undergraduate students. Instruments used were semi-structured proforma to collect socio-demographic details, Eysenck Personality Inventory (EPI), Coping Strategies Inventory-short form, and World Health Organization QoL-BREF. Statistical analysis was performed using SPSS version 20. Mean, standard deviation, percentages, Independent t-test, one-way ANOVA, and Pearson's correlation were used to describe and analyze the data. Results: Four hundred and three study participants were included in the analysis. About 53.3% of participants were female and >95% were from an urban background. Male students scored more on extroversion while females scored high on neuroticism. Female students applied engagement coping strategies than males. Interns used problem-focused disengagement strategies compared to other students. Females scored significantly higher in social and environmental domains of QOL, and within years of the study, 1^st-year students scored low on physical domain, while 2^nd-year students scored high on social and Interns on the environmental domain. Conclusion: Significant differences found in the personality, coping strategies and QoL across gender and within years of study. The findings will help to understand the student's vulnerability early and strengthen them to deal with stressors effectively.

Context: The rapidly expanding field of psychopharmacology is challenging the traditional concepts of treatment and constantly seeking new drugs to treat psychiatric disorders. There is a sparse work on the utilization of psychotropic drugs in indoor patients. Hence, the present study was planned to add to the existing knowledge of the utilization of psychotropic drugs. Aims: The aims of were to study the drug utilization of psychotropic drugs in the indoor patients of psychiatry department and to evaluate it according to the World Health Organization core drug use prescribing indicators. Settings and Design: This was an observational study in indoor patients of psychiatry department in a medical college. Materials and Methods: In this study, patients of all age groups diagnosed with psychiatric disorder admitted to the psychiatry department were included. The data were collected from 300 prescriptions over 6 months. Data were analyzed using descriptive statistics. Results: In 300 prescriptions, 61.98% were psychotropic drugs and average number of drugs per prescription was five. The percentage of drugs prescribed by generic name and from the essential drug list was 52.93% and 60.9%, respectively. The most common diagnosis was schizophrenia (55.6%), followed by mood disorders (26.6%). The most commonly prescribed drugs for schizophrenia, bipolar disorders, and depression were olanzapine (71.85%), sodium valproate (71.4%), and escitalopram (51.6%), respectively. Conclusion: Most of the drugs were used in accordance with standard guidelines given by the Indian Psychiatric Society. The percentage of drugs prescribed by generic names and from the National List of Essential Medicines (NLEM) needs to be increased. Olanzapine, which is not included in NLEM, was commonly prescribed psychotropic drug

Context: With relatively high transmission rate and fatal potential, the COVID-19 pandemic is responsible for widespread fear and psychological distress all over the world, including India. Aim: Assessment of these problems in the general population is the first step to address this problem. Settings and Design: We did an online survey using snowball sampling strategy through various social media communication platforms. Materials and Methods: Semi-structured format was used to collect sociodemographic data and COVID-19-related information. The Kessler's Psychological Distress Scale (K10) and the Fear of COVID-19 Scale were used for assessment psychological distress and fear, respectively. Results: A total of 530 study respondents had adequate participation from all socioeconomic strata, diverse educational and professional backgrounds, and from all parts of the country. Majority of the participants were from red zone districts of lockdown (72.8%) and considered the imposed lockdown as essential (98.7%), although many of them reported negative impact on their psychological state (38.9%). A substantial number (38%) of people reported psychological distress significantly (P < 0.05) associated with females, unmarried, students, lower socioeconomic status (SES), caretakers of COVID-19 patients, poor perceived physical health, and higher score on the Fear of COVID-19 Scale. Female participants and those belonging to lower SES and a red zone district also reported significantly (P < 0.05) higher degree of fear of COVID-19. Despite this, only about 10.9% of the respondents sought help through telephonic or online counseling and most (91.4%) of them found it helpful. Conclusions: The impact of COVID-19 pandemic on psychological health is catastrophic. Planned measures at local as well as national level are essential to avert this crisis.

Background: Children of alcoholics (COAs), particularly experience life uniquely in the families of alcoholic parents. They are more likely than others to suffer from various physical, emotional, and mental health problems. Aims: The aim of this study is to estimate the prevalence of psychiatric morbidity among the children of alcohol-dependent patients attending our tertiary health care center, and further determine the association between clinical-sociodemographic background and psychiatric morbidities among these children. Methods: It was a cross-sectional study consisting of 100 COAs. Data collections tools used were: Pro forma for sociodemographic details, the Kiddie – Schedule for Affective Disorders and Schizophrenia for school-aged children (6–18 years) Present and Lifetime version (K-SADS PL), Learning Disability Checklist and Wechsler's Intelligence Scale for Children. The data were entered using statistical software Epi-Info (version 3.7.2.1) software package, analyzed using the SPSS software version 24.0. Results: About 60% of COAs assessed had the presence of psychiatric morbidity, with anxiety spectrum and depressive disorders being the most commonly associated diagnosis. It was noted that female gender had a positive association with anxiety spectrum disorders. Further, a history of child abuse had a positive association with evidence of psychiatric morbidity in these children. In addition, family history of antisocial personality traits had a significant association with conduct disorder in COAs. Conclusions: To conclude, psychiatric morbidities were identified in about 60% of children whose fathers were alcohol dependent. These COA's commonly manifested with two major psychiatric morbidities, namely anxiety and depression. Nearly 1/10^th of these children were noted to have substance use as well.

Context: Vitamin B12 also known as cobalamin is water-soluble vitamin which is required for cell metabolism in the body and its deficiency leads to various neuropsychiatric disorders including depression, schizophrenia, and anxiety disorders. Aims: To find out the prevalence of Vitamin B12 deficiency in admitted psychiatric patients and associated clinical features, hematological findings, and risk factors. Settings and Design: It was a cross-sectional, observational study. Subjects and Methods: One hundred and fifty consecutive psychiatric patients admitted in the psychiatry ward of a tertiary care hospital were enrolled in the study population. After taking written informed consent, blood sample was collected for each participant, which is otherwise also a routine investigation for all indoor patients. Sociodemographic data of the patients were collected by a semi-structured interview. Data pertaining to clinical and laboratory presentation and risk factors were also collected. Statistical Analysis Used: Analysis was done using Student's t-test, Chi-square test, and Fisher's exact test. Results: The prevalence of Vitamin B12 deficiency in indoor psychiatric patients was 33.33%. The prevalence of depression was high among these patients (36%). It is more prevalent in males (64%) and in rural population (50%). Hematological changes in peripheral smear in the form of macrocytes (10%), macroovalocytes, and target cells (12%) were common findings. Clinical symptoms such as hyperpigmentation of knuckles (24%), memory loss 16%), fatigue (70%), and tingling numbness (34%) were associated with B12 deficiency. Conclusions: The prevalence of Vitamin B12 deficiency in the study population is reasonably high. More than half of the patients with B12 deficiency were suffering from mood disorders.

Background: Mental illnesses have been largely neglected in India due to poor knowledge about various categories of psychiatric disorders. While stigma and discrimination toward people with mental illness is an important barrier to mental health services utilization, timely diagnosis, and treatment, the stigmatizing attitude toward mental illness starts developing at a younger age around 5 years and continuously evolves through adulthood. Aims: The current study aimed to explore the knowledge about mental illness-related disorder, stigma toward mentally ill persons, and help-seeking behavior toward mental illness. Methodology: A total of 3478 students from 9^th to 12^th class rural school participated in the study. Mental health knowledge of students was assessed using the “Mental Health Knowledge Questionnaire,” and attitude toward persons with mental illness was assessed using the “California Assessment of Stigma Change Scale.” Results: It was observed in our study that in students with higher mental health knowledge about mental illness, students with higher education level, older students, and students with family members affected by mental illness and grossly in females, there were overall fewer stigmas toward mental illness and this group overall believed in possibility of empowerment of mentally ill people. A negative correlation was observed among attribution score with mental health knowledge (r = −0.151) and empowerment score (r = −0.151). Conclusion: The study suggests poor knowledge and understanding about mental illness and has stigmatizing attitude toward persons with mental illness. Students were pessimistic about empowerment and recovery potential of mentally ill persons and also had a negative view toward willingness for treatment.

Background: COVID-19 pandemic has resulted in heightened stress, anxiety, and depression in doctors. This research was undertaken during the lockdown period in Mumbai to study the differences in perceptions of the various concerns related to the pandemic, viz., concerns related to area of residence, workplace, personal, and educational and stress faced by the 3 groups of health-care workers, medical interns, resident doctors, and medical teachers, during the pandemic. Materials and Methods: 1011 residents participated in this online cross-sectional survey after informed consent and ethics approval and 494 completed the survey via a Google Form sent on the WhatsApp groups. Results: Significant differences were noted with interns and residents staying in COVID hotspots, sealed homes, being ostracized, and having difficulty in procuring food as compared to the teachers. Workplace concerns significantly revealed that 90% interns and residents had training before duty, wore personal protective equipment, had difficulty in donning, doffing, were uncomfortable, anxious about being dehydrated, and used frequent sanitizer as compared to teachers. Interns and residents were also significantly anxious about not following social distancing, being preoccupied about the same, and having sleep problems as compared to teachers. They also were concerned about financial issues, travel plans, exams, and missing skill training as compared to teachers. Conclusion: It highlights the difficulties faced by the participants during the lockdown and its impact on their emotional well-being.

The new coronavirus has had a multifaceted impact on humans and has affected nearly everyone, some more than the other. The elderly is one such population, which has been hit in various ways. They are a vulnerable group of being the frequent victim of the infection and also getting succumbed to it. In addition, the mental health issues posed by the effect of this pandemic and the measures adopted to curb its spread have taken a toll and probably would continue long after this is over. In the scenario, with respect to geriatric mental health, emphasis may be made on individual and societal responsibilities rather than solely depending on the specialized mental health-care services. This article observes the vulnerabilities and mental health issues of the elderly in relation to this pandemic and possible measures at various levels.

The biopsychosocial model (BPSM) has been the foundation of psychiatric practice since it was first conceived four decades ago. However, recent advances in technology have led mental health professionals, as a fraternity, to turn to a purely biomedical model of disease, and remedy. We trace the lineage of the BPSM, examine its validity in today's scenario, and argue for the urgent need to reintegrate this model in current and future practice.

The COVID-19 pandemic has emerged as one of the major global health crises of recent times. It has posed adverse consequences for people with mental illnesses with its potential to infect patients with existing psychiatric disorders on psychotropic drugs and additionally, spawning psychiatric symptoms in patients infected with COVID-19. To add to the miseries, there have been a multitude of experimental treatments in the form of antivirals, immune-modulators, corticosteroids, etc., which can have serious interactions with psychotropic drugs. In this review, we intend to provide recommendations for pharmacotherapy to address the neuropsychiatric morbidity in COVID-19 patients.

Paranoid pseudocommunities may at times be a resistant and interesting symptom in patients with schizophrenia. A paranoid pseudocommunity is defined as an imaginary group of real persons or imagined persons believed in delusions to be conspiring against a paranoid individual. Herein, we report the case of a 61-year-old male with untreated schizophrenia for 36 years with auditory hallucinations constituting voices of twenty different people that were a part of a reciprocal paranoid pseudocommunity, and we explore the symptom phenomenologically and clinically.

Hypothyroidism has been associated with mood disorders, sometimes with acute psychosis, hence this report. A 45-year-old married female, working as a daily-wage laborer, was brought with marked irritability, suspiciousness, wandering about, decreased sleep, appetite, and personal care for the past 1½ years. She had attempted suicide three times in the initial 6 months of illness. She had an asthenic body type; dry, hairless skin; hoarse voice; and nonpitting pedal edema. Deep tendon reflexes were delayed. High thyroid-stimulating hormone levels and positive anti-thyroid peroxidase antibody led to the diagnosis of severe hypothyroidism. Based on her psychiatric evaluation, a diagnosis of organic schizophrenia-like disorder (myxedema madness) was made. She was managed with olanzapine and haloperidol along with thyroxine supplement. The patient improved significantly following thyroxine supplementation and modified electroconvulsive therapy sessions. Herewith, we present this unique case of myxedema madness with suicidal attempts for its uniqueness and rarity.