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Antipsychotic agents are effective in schizophrenia by alleviating positive and negative symptoms, but also have the potential for inducing sexual dysfunction by causing hyperprolactinemia. This may have a negative impact on treatment compliance. Risperidone is associated with a high rate of sexual dysfunction compared to olanzapine, clozapine, quetiapine, and aripiprazole. However, the partial dopaminergic agonism of aripiprazole at D₂receptor may explain why its use does not usually cause this side effect and may even revert it when added to another antipsychotic. We present here two cases of schizophrenia, who were treated with risperidone, and complained of sexual dysfunction during follow-up. After the addition of aripiprazole and reducing the dose of risperidone, this side effect reverted without a negative impact on treatment adherence or therapeutic efficacy.

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Schizophrenia is a mostly chronic mental disorder, and symptomatic relapse is frequently observed. It is often associated with social and/or occupational decline that can be difficult to reverse. Most patients with the illness need long-term pharmacological treatment and antipsychotic drugs represent the mainstay of clinical care. Long-acting injectable antipsychotics are an important alternative to oral medication, particularly advantageous in the context of compliance management.

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Eating disorders (EDs) are disabling, deadly, and costly mental disorders that considerably impair physical health and disrupt psychosocial functioning. Disturbed attitudes toward weight, body shape, and eating play a key role in the origin and maintenance of EDs. As EDs are under-researched, there is a great deal of uncertainty as to their pathophysiology, treatment, and management. Future challenges, emerging treatments, and outstanding research questions are addressed in this review.

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Specific learning disability (SLD) is a common and invisible yet highly impactful disability. There have been many changes in the field of SLD. These range from changing concepts, introduction of newer diagnostic systems, presentation of the Rights of Persons with Disability Act, of 2016, an increasing awareness in parents, teachers, and public, filing of legal case, and the Honorable High Court issuing orders regarding this disability. All these happenings require reflecting and implementing new strategies. This will not only to benefit all the concerned people but also make the process of diagnosis and intervention streamlined. In the past, Maharashtra has been a forerunner in granting help to these children. Keeping this in mind, it seemed necessary to look at the current scenario of SLD in our state and suggest a way forward.

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Background: Postpartum depression (PPD) is a depressive disorder, also known as postnatal depression. Despite responsiveness to treatment and serious consequences if untreated, PPD often remains unrecognized. This study aims to study the prevalence of PPD and to correlate risk factors associated with it. Materials and Methods: It was a cross-sectional study in Departments of OBGY, Pediatrics, and Psychiatry in a tertiary care hospital. Two hundred and fifty consecutive women, 1–6 weeks postpartum attending the above departments, were included after written informed consent. A specially designed semi-structured pro forma was used for correlation of various risk factors. Edinburgh Postnatal Depression Scale was used for diagnosing PPD. Results: In our study, we found that 20.4% of the women evaluated suffered from PPD. Significant risk factors for PPD included age below 30 years, financial dependence, positive family history of psychiatric illness and PPD, previous girl child, unwanted pregnancy, pressure to have a male child, and complications during pregnancy and delivery. Domestic violence, substance abuse in husband, and relationship issues also increased the risk. Conclusion: Considerable prevalence of PPD is found across various cultures. Prevention of risk factors is useful in primary prevention of PPD. In the future, our study can be used for screening females with high risk for developing PPD so that more intense interventions can be applied.

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Background: Occupational stress is common in nurses. Stress can impact the health of the nurses leading to somatic complaints. Aims and Objectives: (1) To determine the extent and causes of occupational stress among nurses at Bhabha Atomic Research Centre Hospital. (2) To compare the stress levels among nurses depending on their years of experience. (3) To study any correlation between stress levels and the extent of somatic complaints. Materials and Methods: Ninety-seven staff nurses without any preexisting psychiatric illness were evaluated for occupational stress using the Expanded Nursing Stress Scale. The extent of somatization was measured using the Patient Health Questionnaire – 15, in a cross-sectional study. Cronbach's alpha, analysis of variance, and Spearman's correlation co-efficient test were applied to the data. Results: An internal consistency of 0.945 was noted using Cronbach's alpha. 51.5% nurses experienced mild, 34% experienced moderate, and 2.10% experienced severe stress. Conflicts with supervisors, patients, and their families and workload were the main causes of occupational stress while discrimination was the least affected domain. Nurses with 6–10 years of experience had maximum stress. The stress levels correlated with the extent of somatic complaints. Conclusions: Occupational stress is prevalent in nurses. It may be higher in nurses with lesser experience and it can be associated with somatic complaints.

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Origins of family therapy are traced, acknowledging that this is in fact a group of therapeutic approaches. An overview of work done at major mental health centers in India is followed by an attempt at outlining key differences in Indian vis-a-vis Western approaches to family therapy, addressing some of the unique problems that are encountered in our country. Traditional systems of arranged marriage and a joint family, in vitro fertilization interventions and the family pressures to have a baby, the impact of work on family life and the onslaught of social media and family migrations across the globe are some of the issues outlined. Major approaches to family therapy are selected, and their key features are highlighted. Specifically, Minuchin's structural family therapy and Virginia Satir's conjoint family therapy are described. Touching very briefly on Milton Erickson's strategic family therapy, the article moves on to White and Epston's narrative family therapy; and each approach is described vis-a-vis its strengths when applied to an Indian family setup. The article ends on preventive, promotive, and rehabilitative approaches espoused by the author as also by many therapists in India. Behavioral family interventions by Sanders are outlined as is the positive parenting program and its Indian avatar in Palakshaala. Preventive approaches such as functional family therapy by Sexton and Alexander are described. Rehabilitative work with patients and caregivers is outlined, citing examples. The article ends by highlighting some recent changes in the social fabric that seem to be deeply affecting family structures.

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The relationship between testosterone and psychiatric disorders has been a long-standing one. The sex difference in schizophrenia has triggered to better understand the role that testosterone plays in the unfolding and clinical presentation of this psychotic disorder. DHEA and testosterone are found to influence dopaminergic, glutamatergic and GABAergic neurotransmission systems that are believed to play a role in the pathophysiology of schizophrenia. The onset of schizophrenia in males, most frequently encountered during adolescence, is also characterized by an increase in testosterone levels. Some studies have also observed lower testosterone levels in adult males with schizophrenia (or psychosis) compared to healthy controls.

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New psychoactive substances (NPSs) are growing at an alarming rate causing a threat to the public health. They are available online or in head shops and come with variety of street names across the cities, states, and countries. NPSs are prepared in the laboratories either by tweaking or altering the chemical structure of existing substances such as cannabis and ecstasy. They are cheap, easy to obtain, and difficult to be detected by traditional drug screening methods. It has become very challenging to detect them within the clinical settings because of the fast rate of their availability and their constant changing structure. Their purity as well as pharmacology and toxic effects are still not known. These drugs cause major life-threatening complications, which is worrisome. The legal status of these drugs is ambiguous. The laws are complex, changing, are not well defined to control or regulate their use which is a major setback. As many clinicians are unaware of the existence of such drugs, the identification and management of withdrawal syndrome and overdose become difficult. There is a need to create awareness regarding the risks and the health hazards caused by these novel substances as well as to develop and design new prevention approaches that are able to attract the attention of the young population.

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Serotonin reuptake inhibitors, antiepileptics, and antipsychotics are frequently used drugs by psychiatrists for various psychiatric illness which have hyponatremia as a side effect. The symptoms of hyponatremia include lethargy, weakness, headache, and irritability with neuropsychiatric complications such as seizures and confusion. Symptoms of hyponatremia usually occur when serum sodium concentration falls below 130 mEq/L. We report two cases which presented with depressive symptoms but were found to have persistent low serum sodium levels. The depressive features further improved on sodium correction. Both patients were on drugs which caused hyponatremia, a commonly occurring side effect of many medications which often goes undiagnosed. The cases highlight the importance and need for regular evaluation and monitoring.

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The nonspecific concept of “madness” has been there for thousands of years. In antiquity, people thought of “madness” in terms of divine punishment or demonic possession. It was only during early Renaissance that people took this phenomenon seriously and termed it as an illness. It is due to the efforts of a cluster of scientists and psychiatrists that has led to unraveling of schizophrenia as a mental illness characterised by delusions and hallucinations. As postgraduates, it is important to know how the mystery unfolded and how it has overcome infinite obstacles. This article throws light on how we can learn from history and not deceive ourselves when we selectively take evidence from the past to justify our beliefs. The knowledge of history helps us to understand the disease itself as well as help us understand the chronology of the events leading to the evolution of the enigmatic disorder and its elusive treatment strategies.

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Introduction: Chronic kidney disease (CKD) is a global health problem with a high economic burden on the health-care system. Considering the chronic nature of disease patients undergoing hemodialysis are at risk of developing psychiatric disorders. In this study, we aimed to evaluate the incidence of depression and anxiety in CKD patients undergoing hemodialysis. Methods: This was a prospective, cross-sectional, observational study conducted between June 2016 and September 2017. Patients of either sex having CKD and undergoing hemodialysis were included in the study. Sociodemographic and depression and anxiety related details were collected. Results: A total 150 patients were enrolled in this study, of which 92 (61.3%) patients had depression and 42 (28%) had anxiety. Overall, depression was higher in males, but the difference was not significant; similarly, the anxiety was higher in males, but the difference was statistically significant (P = 0.050). Majority of patients with depression were aged more than 80 years; however, anxiety was more common in patients aged between 40 and 60 years. A total of 59.4% of depressive patients were Hindus, and 27.3% of anxiety patients were Hindus. The correlation between depression and marriage was significant; however, the relationship was not significant between anxiety and marriage. Among patients with depression 55.9% of patients were illiterate, and among patients with anxiety, 25.4% were illiterate. Conclusions: This study provides extensive information on the relationship between depression or anxiety and sociodemographics features among patients with CKD undergoing hemodialysis.

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Positive mental health is, and should continue to be the basis of all the mental health policies of any country. The scarcity of well-documented school mental health (SMH) activities and the data for the region of Maharashtra is the main rationale behind this review article. After reviewing some important studies related to SMH in India, the SMH data at Child Guidance Centre of Yashwantrao Chavan Memorial Hospital in Maharashtra, will be used to discuss and propose a guideline for further SMH activities in Maharashtra. SMH program is the best way to cater to the current and future demand of mental health services and to improve overall child and adolescent mental health.

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Background: There has been a significant surge in the usage of smartphones, Internet, social media platforms, and also the growing concern about the impact of Internet, gaming, and social media addiction (SMA) on mental health in the community since the last decade. Aim: This study is aimed to know the pattern of social media use and social anxiety (SA) among medical undergraduates with SMA. Materials and Methods: This was a 12-month cross-sectional, observational study of 640 medical undergraduates. Social media disorder scale was used to detect SMA and Liebowitz social anxiety scale was used to detect SA. Descriptive statistics, independent t-test, and Chi-square test were used for the analysis of data. Results: According to our findings, 11.04% of the participants had SMA. More than 60% of the participants with SMA spent 2 h or more time on social media in a day. About 29.41% of students with SMA spent more money compared to 11.86% of nonaddicted ones. About 47.05% of students with SMA reported fear of missing out (FoMO) as compared to 34.12% of nonaddicted students. Participants with SMA reported a significantly higher level (P < 0.05) of SA (SA score 67.63) compared to social media nonaddicts (SA score 49.43). Conclusion: Medical undergraduates with SMA spent more time and money on Internet, reported FoMO, frequently checked notifications, and reported regular substance use. They also had high SA; vice versa is also true.

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Background: Adolescents suffer from psychosocial problems at one time or the other during their development phase and they are highly vulnerable to develop psychiatric disorders. The aim of the study was to see the mental health status of school-going adolescents in Kohima district, Nagaland. Methods: The researcher used a cross-sectional study as the design. In the present study, field setting was private and government schools of Kohima district, Nagaland. The population sample consisted of school-going adolescents' age between 13 and 19 years from private and government schools in Kohima. Random sampling technique was used for the selection of schools. On the basis of which three schools were selected, the selected schools were taken consent from the school authority. Total enumeration method was used for data collection. A total of 702 students were recruited for the study. Adolescents, as well as parental consent, were undertaken. The study was undertaken with the approval of the Scientific Committee and the Ethical Committee of Lokopriya Gopinath Bordoloi Regional Institute of Mental Health. Socio-demographic data sheet and the Strengths and Difficulties Questionnaire were used. Results: The prevalence of mental health status on the basis of the total difficulties score was found to be 17.2% at the abnormal level whereas 28.8% was at the borderline level. The study results also revealed that in adolescent population, emotional problem was present in 17.1%, hyperactivity in 16.1%, conduct problem in 15.2%, peer problem in 5.6%, and prosocial behavior in 5.1%. Conclusions: Mental health problems are highly prevalent among the adolescent population in India. Early identification, treatment, and promotion of mental health services are required.

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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

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Tardive dyskinesia (TD) is a condition where we have a limited understanding of the cause and of management. The delayed-onset movements can occur due to prolonged exposure to dopamine receptor-blocking agents (DRBAs). They can be physically disabling and lead to ridicule and stigmatization. TD also interferes with treatment adherence. The increased trend of prescriptions for off-label use of various DRBAs, especially antipsychotics, has increased the risk of TD. No currently available antipsychotic is free of the risk of TD, though the atypicals have a lower risk. The Abnormal Involuntary Movements Scale is the most widely used and recommended tool for the assessment and monitoring of TD. Varied treatment strategies have been tried including cessation of the DRBA, switch to a lower potency antipsychotic, and concomitant use of other medications such as clonazepam and Vitamin E. Most of these strategies have minimal evidence. The recent US Food and Drug Administration approval of two VMAT2 inhibitors, deutetrabenazine and valbenazine, for the treatment of TD has brought some relief to these patients. Cost may be a limiting factor in their use. Nonpharmacological treatment such as deep-brain stimulation, botulinum toxin, and electroconvulsive therapy is to be used only in intractable/incapacitating movements. Despite these newer options, the best strategy in the management of TD continues to be prevention. Judicious use of antipsychotics, regular monitoring of patients on DRBAs, and early diagnosis and intervention are strategies that significantly reduce the development of TD and improve the quality of life of patients.

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This review tracks the development of Herbert Rosenfeld's (1910–1986) work on the psychoanalytic concept, narcissism. The author conceptualizes the scope of this work in Darwinian terms to emphasize the extraordinarily fertile theoretical and clinical material produced by Rosenfeld, which is linked in the text to several other contemporary Kleinian psychoanalysts. The beginning of his lifelong work is examined as “Origins,” the development itself as “Evolution” and at the end of his life, the shifts in his theoretical stance is looked at as “Metamorphosis.” Clinical material is used to illustrate the core concept of narcissism as a defence against separateness.

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Clozapine (CLZ) is a drug of choice for the treatment of resistant schizophrenia. It is always blamed probably due to its life-threatening side effects, such as agranulocytosis, constipation, cardiomyopathies, and rarely hematemesis. We report the case of a 65-year-old patient diagnosed with resistant schizophrenia and treated with CLZ later he developed sudden massive hematemesis. The aim of our case report is to describe the rarely seen and potentially life-threatening side effect related to CLZ. Physician, particularly psychiatrists and medical specialists, should not ignore, be aware, and alert or always need to be watchful to the fatality of CLZ-induced hematemesis in the management of psychiatric disorders and should take appropriate therapeutic measures in such a case.

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Background and Aims: Dementia is the loss of cognitive functioning – remembering, thinking, and reasoning – and behavioral capabilities to such a degree that it interferes with an individual's daily living activities. The objective of this paper is to summarize current knowledge on the most promising interventions for preventing cognitive decline. Methods: Electronic databases were searched using PubMed/Medline and Google Scholar to retrieve relevant research papers conducted in Saudi Arabia and internationally. Keywords included “dementia,” “prevention strategies,” “aging,” “aged,” “Elderly population.” Articles published in the English language and published between 2000 and 2018 were included in the study. Analysis: Overall, limited evidence exists to support the cause-effect association between the progression/development of dementia and preventative strategies. Studies to date provide the most promising strategies for dementia prevention that includes healthy diet, social engagement, physical activity, cognitive activity, and vascular risk factor control. Conclusion: Dementia is a disease more commonly observed in old people. Studies in the future will determine the risk factor modification and its implications in controlled trials with specific emphasis on whether some simultaneous interventions may either have a multiplicative or additive effect.

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