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Aim: Psychiatric morbidities seem to be one of the biggest hurdles in the stigmatized people of transgender. Lack of knowledge and ignorance with ever-growing abuse over this population make them vulnerable for mental instability. This study is an attempt to identify and access the psychiatric morbidities of gender dysphoric people of Imphal, Manipur. Materials and Methods: Using DSM-5 all qualified, consenting gender dysphoric people were assessed for psychiatric morbidities using Mini-International Neuropsychiatry Interview-Plus scale at Imphal, Manipur, and the results were compared using Chi-square test. Results: Substance use disorders were found in the majority of them. Twenty (62.5%) of them had current alcohol abuse, and 10 (31.2%) of them were dependent of alcohol. Fifteen (46.8%) of them were abusing other nonalcoholic psychotropic drugs. Twelve (37.5%) were suffering from generalized anxiety disorder (GAD) followed by 10 (31.2%) with current depressive disorder. Past suicidal attempts were found among 10 (31.2%) of them with 14 (41.2%) out of them for having current suicidal risk. Six (18.7%) of them were having dysthymia, 2 (6.2%) had panic disorder, 3 (9.4%) had agoraphobia and posttraumatic stress disorder, respectively, 8 (25%) suffered from social phobia, and 1 (3.2%) from specific phobia for spiders. Conclusions: This study found high prevalence of comorbid psychiatric disorders of which alcohol use disorder was the prominent one. Other psychiatric disorders such as GAD, depression, and suicidal risk were also found to be higher among these people. As this population is at higher risk of developing other psychiatric problems, regular screening and timely intervention is needed to prevent or treat psychiatric comorbidities.

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Fluvoxamine is one of the commonly used selective serotonin reuptake inhibitors (SSRIs) as a first-line treatment for obsessive-compulsive disorder (OCD). Galactorrhea is a rarely observed adverse effect of SSRIs occurring through complex interactions between serotonergic and dopaminergic systems of brain. We report a case of fluvoxamine-induced reversible euprolactinemic galactorrhea in a 39-year-old woman after initiation of fluvoxamine for OCD. The patient's galactorrhea resolved on discontinuation of fluvoxamine.

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Cognitive impairments in mental disorders are common, poorly recognized, and largely unaddressed despite their significant impact on daily life functioning. Today, the treatment of psychiatric disorders goes beyond only symptom management and emphasizes optimizing functional abilities. Cognitive Rehabilitation or Cognitive Remediation(CR) is the nonpharmacological intervention that has received attention over the last few decades and is steadily emerging as a potentially strong tool to manage cognitive issues that impact functional outcomes. A large body of research has studied role of CR in schizophrenia populations, and the role in other disorders is now being explored. This review looks at the various studies from across the globe and in India to understand the types of programs, their theoretical underpinnings, imaging data, and efficacy of CR. There is considerable heterogeneity across studies in terms of methods, materials, and approaches, and it is challenging to identify the key active ingredients that ensure success. Overall, the meta-analysis studies have identified strategy coaching by an expert therapist and use of CR in conjunction with psychosocial and vocational programs as important factors to ensure best results. Despite promising results in enhancing cognition across most studies, generalization and transfer of this improvement to real-life functioning still remains elusive. Other moderators that can possibly influence outcomes such as motivation factors, therapist-patient relationship, personal goals of the patient and families, and the socioeconomic milieu of the patient need to be studied more extensively in the future studies to develop a comprehensive model of cognitive rehabilitation.

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Background: The risk of lead exposure for mental illness and its burden on Indian children, as a society, is not studied till date. This study aims to present the same as well as to compare the risk and burden between 1990 and 2015. Materials and Methods: Using India-specific, Global Burden of Disease 2015 data health metrics-disability-adjusted life years (DALYs), we estimated the burden of mental illness and exposure to lead as a risk factor for the same. Descriptive estimates of prevalence and DALY for mental illness and risk of lead exposure are presented for various age groups of Indian children (0–14 years) of either gender. Results: In 2015, 26,450,345 Indian children were affected with mental illness contributing to DALYs of 2,453,344. In 2015, 162,492.1 DALYs were lost to mental illness due to risk factors and 130,429 lost DALYs due to risk attributed to lead exposure. The risk rate attribution and the difference of burden in 1990–2015 are presented. Years of life lost due to lead exposure for mental illness is high as compared to all attributed risks. Lead was identified as risk factor for intellectual disability among children. Conclusions: Lead continues to pose a significant overall health risk and specifically for mental illness. The estimated burden of mental illness and extent of association of risk indicate the urgent need of clear policies to reduce lead from our immediate environment.

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Context: Attitudes of paramedical and medical professionals to psychiatric illnesses are important for referral and use of mental health facilities by general people. Knowledge of psychiatric disorders and experience of working with psychiatric patients may be responsible for positive attitudes. Aims: The aim was to assess attitude toward different mental illnesses among different paramedical professionals and to know the impact of education and work experience on attitudes toward mental illnesses. Subjects and Methods: Study sample was nursing staff, nursing students, and junior doctors from tertiary care hospital and students of clinical psychology from a private deaddiction center. The study design was cross-sectional. Attitude to Mental Illness Questionnaire was used with modifications and addition of demographic details. Experience of working with psychiatric patients and attending mental health primary care (MHPC) program also were included for the evaluation of attitudes. Results: Attitudes toward drug abuse, depression, alcohol abuse, and schizophrenia were more negative while toward anxiety spectrum disorders, conversion, and dissociative disorders were more positive. Subjects with experience of working with psychiatric patients and experience of MHPC program showed more positive attitudes. Conclusions: There is need of, developing program containing knowledge of mental health, implementing practical experience of working with psychiatric patients in the curriculum of paramedical and medical profession and restructuring present curriculum to develop positive attitudes to mental illnesses for benefit of community.

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Olfactory reference syndrome (ORS) is a distressing clinical condition characterized by the belief that one's body emits a foul odor which disturbs others though others are unable to perceive the same. The disorder is characterized also by delusions of reference and olfactory hallucinations which may be present. The disorder usually shows a multifaceted picture and may mimic depression, somatoform disorders, obsessive–compulsive disorder, hypochondriasis and at times delusional disorder or schizophrenia. We present here a case of ORS that presented with delusions and suicidal ideation and responded well to a course of electroconvulsive therapy.

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Alopecia universalis is characterized by total loss of hair from all over the body such as the scalp, eyebrows, and limbs. Alopecia areata has been known to coexist with psychiatric disorders such as anxiety disorders and depression, although reports with schizophrenia are rare. We present, herewith, a case of alopecia universalis seen to coexist with schizophrenia– a rare clinical picture.

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Background: Phantom pains with no painful lesion, war wounds which are painless, and spiritual practices such as fire walking are examples of painful stimuli and pleasurable experience. Why frontal leukotomy reduces pain and not parietal lobe are questions indicating it is not the sensations that hurts. Aim and Settings: The aim of the study was to discuss the course of illness of a series of exceptional patients. Patients and Methods: Exceptional patients who astonishingly handled their pain and healed themselves are described.  The first patient, a woodcutter, carried his bowel in a bag for 4 months, the second patient had a large fungating tumor in breast, the third patient repaired his palatal cleft with paper and lived several years, and two swamijis who dissociated themselves from their malignancy. Results and Conclusions: The quality of life of these patients was excellent in spite of serious disorders which indicates “The doctor” within is the most powerful and cheapest healer.

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Context: Stress during pregnancy manifests as mood disorders and anxiety disorders. Recently, many studies have reported cognitive disturbances in pregnancy after subjective interviews as well as objective evaluation. Aims: The aim of the study was to assess pregnancy-specific distress and perceived cognitive functions in an urban sample of pregnant women. Methodology: Sixty working pregnant women, educated up to standard 12^th or above, were evaluated cross-sectionally with pregnancy upscale-downscale scale and cognitive failure questionnaire. Results: Women identified events related to the infant's looks and appearances as most uplifting, whereas physical symptoms and consequences of pregnancy as most distressing. Women reported tasks involving recent and working memory to be most impaired, whereas tasks involving procedural memory, spatial memory, and long-term memory were least affected. Severity of hassles perceived by pregnant women was identified as the predictor of perceived cognitive decline in pregnancy. Conclusions: Events in a normal pregnancy can be perceived as either uplifting or distressing. Perceived distress affects the perception of one's own cognitive performance.

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Background: Mood disorders like inter-ictal depressive symptoms and inter-ictal major depressive episodes are the most frequent psychiatric co-morbidity seen in temporal lobe epilepsies with left hippocampal sclerosis than generalized epilepsies. Despite the clinical significance of depression, it often goes unrecognized and hence untreated in this population. These patients may tend to minimize their complaints to avoid further stigmatization of their illness. This study was undertaken to the prevalence and severity of depressive symptoms in patients with complex partial and generalized seizures, association of depression with the duration of illness and correlation of depression with right or left sided focus in complex partial seizures. Methods: 30 patients each of complex partial and generalized seizure disorder were enrolled to study depressive symptoms with the help of the Beck's Depression inventory a 21 item measure of depressive symptoms. A proforma was prepared to study the various demographic variables, details of seizure disorder &MRI findings. Results: As per the Beck's Depression inventory 26% of complex partial seizure patients and 40% of generalized seizure disorder patients had depressive symptoms which was not statistically significant. 20% and 63% of complex partial seizure patients and 30% and 40% of generalized seizure patients had moderate and mild severity of depression respectively. No significant association between left sided temporal lobe scleroses for depressive symptoms was seen. No correlation was seen of duration of illness with depressive symptoms in both the groups. Conclusions: A high prevalence of depressive symptoms in the generalized seizure group as compared to complex partial seizure group patients emphasizes the fact that the psychiatric morbidity is multi-factorial involving neurobiological as well as psychosocial issues which need to be addressed.

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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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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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Valbenazine is the first drug approved by the US Food and Drug Administration for the treatment of adults with tardive dyskinesia (TD) on April 11, 2017. It acts as a reversible inhibitor of vesicular monoamine transporter 2. It is available orally with a starting dose of 40 mg once daily which can be increased after 1 week to the recommended dose of 80 mg. Clinical trials showed positive outcomes in Abnormal Involuntary Movement Scale and Clinical Global Impression - Global Improvement of TD score with respect to placebo. Valbenazine has an acceptable safety and tolerability profile, the most common side effect observed is somnolence. However, long-term study is lacking, and more data are required to establish its full benefits and concomitant risks which can be missed in the recent trials.

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