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Historically, diversity in human sexuality, such as same-sex attraction (or the older term, ‘homosexuality’), was steeped in psychopathology, but is now accepted as a healthy variation of the human experience. This chapter aims to explore this evolving area through a review of its history in psychiatry to present-day best practice suggestions for clinicians. Commonly used terminology in the field will be reviewed, and the current research to understand the aetiology, prevalence, and cultural factors associated with sexual diversity as worldwide phenomenon will be explored. Changes in diagnostic nomenclature and the underpinning influences in these processes will be discussed. Finally, commonly co-occurring mental health issues and current best practice guidelines to support this cohort clinically will be presented.

The burden of disease related to mental disorders across the world is substantial. However, there remains inequality between funding for clinical and research activities between physical illness and mental illness in almost all countries.One way of reducing this inequality is to ensure that mental health policies reflect this. We were interested in looking at the policies of members of Commonwealth.We decided to survey 52 member countries of the Commonwealth to explore whether mental health policies existed and whether there was equity between physical and mental health services funding. Using World Health Organization (WHO) data sets and other sources when indicated, we looked at the existence and contents of mental health policies.We found that less than half of the countries had a mental health policy. Deinstitutionalization was not seen as a priority in many countries and there was no equity between physical and mental health funding. Although integration between physical and mental health care was recommended in many countries, there was a clear gap.It is apparent that there is still a long way to go in terms of equity between physical and mental health in terms of funding in member states of the Commonwealth. These findings confirm earlier observations of discrimination against people with mental illness. We suggest that there must be mechanisms in place to facilitate and support change wherever required.

Background\ud \ud This Commission addresses several priority areas for psychiatry over the next decade, and into the 21st century. These represent challenges and opportunities for the profession to sustain and develop itself to secure the best possible future for the millions of people worldwide who will face life with mental illness.\ud \ud \ud Part 1: The patient and treatment\ud \ud Who will psychiatrists help? The patient population of the future will reflect general demographic shifts towards older, more urban, and migrant populations. While technical advances such as the development of biomarkers will potentially alter diagnosis and treatment, and digital technology will facilitate assessment of remote populations, the human elements of practice such as cultural sensitivity and the ability to form a strong therapeutic alliance with the patient will remain central.\ud \ud \ud Part 2: Psychiatry and health-care systems\ud \ud Delivering mental health services to those who need them will require reform of the traditional structure of services. Few existing models have evidence of clinical effectiveness and acceptability to service users. Services of the future should consider stepped care, increased use of multidisciplinary teamwork, more of a public health approach, and the integration of mental and physical health care. These services will need to fit into the cultural and economic framework of a diverse range of settings in high-income, low-income, and middle-income countries.\ud \ud \ud Part 3: Psychiatry and society\ud \ud Increased emphasis on social interventions and engagement with societal expectations might be an important area for psychiatry's development. This could encompass advocacy for the rights of individuals living with mental illnesses, political involvement concerning the social risk factors for mental illness, and, on a smaller scale, work with families and local social networks and communities. Psychiatrists should therefore possess communication skills and knowledge of the social sciences as well as the basic biological sciences.\ud \ud \ud Part 4: The future of mental health law\ud \ud Mental health law worldwide tends to be based on concerns about risk rather than the protection of the rights of individuals experiencing mental illness. The United Nations Convention on the Rights of Persons with Disabilities, which states that compulsion based in whole or in part on mental disability is discriminatory, is a landmark document that should inform the future formulation and reform of mental health laws. An evidence-based approach needs to be taken: mental health legislation should mandate mental health training for all health professionals; ensure access to good-quality care; and cover wider societal issues, particularly access to housing, resources, and employment. All governments should include a mental health impact assessment when drafting relevant legislation.\ud \ud \ud Part 5: Digital psychiatry—enhancing the future of mental health\ud \ud Digital technology might offer psychiatry the potential for radical change in terms of service delivery and the development of new treatments. However, it also carries the risk of commercialised, unproven treatments entering the medical marketplace with detrimental effect. Novel research methods, transparency standards, clinical evidence, and care delivery models must be created in collaboration with a wide range of stakeholders. Psychiatrists need to remain up to date and educated in the evolving digital world.\ud \ud \ud Part 6: Training the psychiatrist of the future\ud \ud Rapid scientific advance and evolving models of health-care delivery have broad implications for future psychiatry training. The psychiatrist of the future must not only be armed with the latest medical knowledge and clinical skills but also be prepared to adapt to a changing landscape. Training programmes in an age in which knowledge of facts is less important than how new knowledge is accessed and deployed must refocus from the simple delivery of information towards acquisition of skills in lifelong learning and quality improvement.\ud \ud \ud Conclusion\ud \ud Psychiatry faces major challenges. The therapeutic relationship remains paramount, and psychiatrists will need to acquire the necessary communication skills and cultural awareness to work optimally as patient demographics change. Psychiatrists must work with key stakeholders, including policy makers and patients, to help to plan and deliver the best services possible. The contract between psychiatry and society needs to be reviewed and renegotiated on a regular basis. Mental health law should be reformed on the basis of evidence and the rights of the individual. Psychiatry should embrace the possibilities offered by digital technology, and take an active role in ensuring research and care delivery in this area is ethically sound and evidence based. Psychiatry training must reflect these multiple pressures and demands by focusing on lifelong learning rather than simply knowledge delivery.

More than 50% of world’s population lives in the cities that are bustling with possibilities. Growth in these cities is mainly associated with the change in their demographic and geographical situations. Globalization has contributed further to movement of people and resources creating tensions and overpopulation in some parts and reduction in others. It is inevitable that overpopulation and urbanization leading to overcrowding have been shown to have negative consequences on people’s physical and mental health. Numerous efforts have been made through governmental policies and non-governmental organization (NGO) involvement in order to promote healthy cities between policymakers, healthcare professionals, and community members.

A person’s living environment can have substantial impact on his/her mental health due to a range of factors related to the environment. It has often been argued that urban settings are a hotpot of sociocultural evolutions that attract individuals from the gender and sexual minority (GSM) groups. This has led to migration from rural to urban areas and also from one urban area to another urban area. Various push and pull factors in both the rural and urban areas help GSM individuals decide in which direction to move. While rural areas present with challenges such as social isolation within a homophobic/transphobic environment, urban areas also have their own unique set of challenges for the GSM population. In this chapter, we focus on various factors in both rural and urban settings that impact on the mental health of GSM population.

Grain hardness (texture) in barley is a commercially important trait, associated with water-uptake during the steeping phase of malting, quantified by measuring endosperm hardness. Hordoindolines are seed proteins of barley, related to the wheat puroindoline proteins. The Hordoindoline genes Hina, Hinb-1 and Hinb-2 are orthologs of wheat Pin genes. The information on contributions of Hin genes to barley grain hardness is limited and somewhat ambiguous. Hence this study aimed to investigate the genetic diversity of Hin genes in 12 Australian barley cultivars and 14 landraces originating from geographic centers of diversity. The grain hardness was determined by the Single Kernel Characterisation System (SKCS) and ranged between 24.2–78.5 SKCS units for cultivars and 48.7–94.4 SKCS units for landraces. Hin gene amplifications and DNA sequencing indicated notable genetic diversity, with seven Hina, six Hinb-1 alleles and eight Hinb-2 alleles detected. Some of the SNPs led to substitutions at the potentially functionally important tryptophan rich domain and certain basic and hydrophobic residues in the putative proteins. A novel Hinb-1 allele with an insertion at nucleotide position 210, leading to a frame-shift mutation, was discovered in landrace L400211 from Ethiopia that had a high SKCS hardness value, indicating harder grain. The study suggests that Hin gene variations may contribute to barley grain hardness, and selection of certain alleles may be useful for breeding for varying barley grain textures.

Human sexuality plays a major role in an individual's existence and functioning. In addition, rightly or wrongly sexuality often defines people and also affects social attitudes. These attitudes, if negative, can contribute to stigma and prevent people from help seeking if they are suffering from mental health problems. Recent changes in policy towards same-sex relationships have been positive in many countries including the UK and the USA, whereas in others such as Russia and Uganda attitudes have become more negative and punitive. Sexual activity is seen as having both pleasurable and procreational functions which contribute to society's attitudes to homosexual behaviour. Inevitably, individual responses to their own sexuality and sexual behaviour will be influenced by social attitudes. To ensure that those with various sexual variations can access psychiatric services without discrimination, various levels of interventions are needed. Here we discuss different levels of intervention and organizational change that may make it possible. Social organization and institutional organization of services need to be sensitive, especially as rates of many mental disorders are high in individuals who may be sexually variant. Those providing services need to understand their own negative attitudes as well as prejudices to ensure that services are emotionally accessible.

Hijras are a community in the Indian subcontinent that is well known for a number of reasons and rituals. The hijra community is heterogeneous and has been known in the historical context for millennia, forming a key part of rituals in Hindu culture, celebrating marriages and child birth. Hijras have been physically attacked and have been the focus of fun (ridicule). They have been portrayed both negatively and positively in literature and in Hindi films—which reach a significant audience not only in India but also among the Indian diaspora—involving hijras as comic figures and as caring maternal figures. In this paper we discuss the heterogeneity of such portrayals, illustrating various types with scenes from Hindi films. Social and cultural contexts and understanding of the context is important in understanding sexualities.

For more than a century, films have played a crucial role in shaping our social, political and cultural psyche by portraying a range of psychosocial issues through some interesting story lines and characters. Many of these stories have made a lasting impact on our collective conscious, often entertaining and educating us in the process. The authors of this chapter focus on the portrayal of mental illness and therapy in some selected films and how these shape our perception as a society and more importantly as health-care professionals. The chapter also briefly provides some guidance on how we as responsible health-care professionals and health advocates can influence film portrayals of mental illness and therapy.

Disulfiram remains a viable option as a treatment for alcohol dependence and has been shown in recent studies to be successful in treating patients with alcohol dependence in a manner that is superior to both naltrexone and acamprosate. It is also useful in dual diagnosis patients and those with co-morbid cocaine and alcohol dependence. Although disulfiram’s mechanism of action in alcohol dependence was long thought to be its effects as a psychological deterrent, more recent studies have uncovered potential anticraving effects as well. Recent reviews exhort to the importance of supervised disulfiram therapy in highlighting many of the potential and unique benefits of disulfiram. The present article will review the major clinical trials of disulfiram spanning nearly 60 years. It also discusses the usage of disulfiram across diverse populations along with monitoring for compliance and various adverse effects that may be encountered. The paper also reviews certain studies on long acting disulfiram therapy, recent comparative trials of disulfiram and its use in alcohol dependence. The review concludes with the role of disulfiram in the present day and long-term pharmacotherapy of alcohol dependence along with future research needs in this area.

The Indian hijra community encompasses persons with a variety of gender identities and sexual orientations, forming a culturally unique gender group. Although these communities have existed for ages within Indian society, hijras have been stigmatized and marginalized to a large extent. Such stigmatization may compromise the mental health of hijras possibly giving rise to various mental health issues. The sociocultural aspects of hijras have frequently been the subjects of research by anthropologists and sociologists, but there is a dearth of data regarding mental health problems in them. This study aims to understand the cultural, psychiatric, and sexuality aspects of hijras in the city of Mumbai, focusing on the prevalence of gender identity disorder and psychiatric disorders (if any) in them, their self-esteem, and their sexual practices.

Hypersexuality is characterized by repetitive and intense preoccupation with sexual thoughts, urges, and behaviors that lead to clinically significant distress or impairment in socio-occupational functioning of the affected individual. Although hypersexuality is commonly associated with mania, interestingly studies have reported hypersexuality in persons suffering from depression and anxiety disorders. This study assessed the presence of hypersexual disorder (HD) and type of hypersexual behavior in diagnosed cases of mood and anxiety disorder. Ninety-three patients having mood and anxiety disorders were assessed once for hypersexuality at any time in their life using the Hypersexual Disorder Screening Inventory (HDSI) and Hypersexual Disorder: Current Assessment Scale (HD: CAS). On HDSI, 25% of patients having a mood and/or anxiety disorder screened positive for HD. The most common sexual behavior in these patients was consensual sex with adults. Those screening positive for HD were assessed for their mos...

The divorce rate in India is increasing. In some cases, divorce could result from psychopathology in one of the partners or in other cases may lead to major psychopathology. Therefore it is important to identify problems in marital adjustments. This study aims to find probable reasons for divorce, how people cope with it and whether any psychopathology is associated with it. A total of 100 respondents undergoing divorce were selected after obtaining their consent and interviewed using a semi-structured pro-forma, the Dyadic Adjustment Scale, the Mechanisms of Coping Scale and the Symptom Checklist-90-R. Around 57% of divorce cases in our study were filed by women, 31% by men and 12% by mutual understanding. The primary reason for divorce in our respondents was interpersonal problems (34%). Marital adjustment was poor in 91.6% respondents, with a minimum score for dyadic cohesion and affectional expression. Fatalism, expressive action and problem solving were the commonly used coping methods. In all, 64% h...

Electroconvulsive therapy (ECT) is considered relatively contraindicated in patients with intracranial space-occupying lesions. A 53-year-old male presented with a 5-year history of medication-refractory major depressive disorder. Brain imaging findings suggested the presence of a ruptured dermoid cyst in the transverse sinus and a calcified meningioma in the temporal lobe sulcal space. There was no evidence of mass effect. Neurofibromatosis was the only other clinical condition present. The patient had no clinical neurological deficits. Since the depression was severe and he was suicidal, ECT was advised. There was a substantial improvement after four bilateral and then eight right unilateral brief-pulse ECTs administered on alternate days, thrice weekly. There were no complications associated with ECT. The treatment gains were maintained with maintenance antidepressant medication at a 1-year follow-up. This is probably the first reported case of the use of ECT in a medication-refractory, severely depressed patient with a ruptured intracranial dermoid cyst and with a calcifying meningioma. The results testify to the safety of ECT even in high-risk patients.

Cinema is mainly produced for entertainment of the masses. With newer technology making film clips more available, teachers are increasingly turning their attention to films in training health care students. Transgenderism is one such area in sexuality training that can be taught using films. Transgender individuals face various phase-of-life issues and other life crises that include coming out, family pressures, discrimination, sexual abuse, and end of life. Various curricula in mental health or sexuality training may lack training about transgender issues that are often sidelined, more focus being given to sexual dysfunctions and lesbian, gay, and bisexual issues. As mental health care professionals-in-the-making, trainees need to understand issues surrounding transgenderism in a manner to which they can easily relate. This is important especially considering the fact that they may deal with such clients in their practice. Films serve this purpose by portraying these issues in an understandable...

Sikhism has millions of followers in India and among the Indian diaspora. As a religion it is relatively young but carries with it unique perspectives which are often not well known. The holy book of Sikhism, Guru Granth Sahib, is not only the last Guru, but also remained a key text for this religion. Using descriptions of the religion and its followers we attempt to understand the context of spirituality within this religion and attempt to apply it to clinical settings. We explored various texts to understand the notions of spirituality and ethics and directions for living one's life. We studied both the Gurumukhi version as well as the English translation of the Sikh holy text. In the context of history of the Sikhs, various descriptions related to mental well being were identified. In this paper we describe the history, development and the core values of the religion and we also review their role on psychiatric and mental health settings for managing Sikh patients. Guru Granth Sahib offers a very useful insight into what is understood by the term equivalent to depression and its phenomenology. The notions of dukh (loosely translated as pain, but can also mean sadness or suffering) and maya (illusion) and their role in daily living are also discussed. In this paper these descriptions are explored further and their importance explained.

Over the past 50 years, schizophrenia as a disorder has been widely studied across cultures throughout the world. There are differences not only in the symptoms and presentation but also in outcome and prognosis. Various authors have tried to explore and explain such variation but the reasons for this are not always clear. In this paper, we review some of the cultural aspects of schizophrenia.

Indian society has been tolerant of diverse sexual identities and sexual behaviors as is evident from its mythologies and ancient scripts like the Kamasutra. The transgendered hijra community has evolved to form a unique subculture within Indian society, existing alongside the ubiquitous heterosexual family. This subculture has been clandestine about its customs and lifestyle, but the scene is changing. Although awareness about HIV-AIDS issues in this community is increasing both among the community members and the health professionals, the same cannot be said about mental health issues. This article highlights some of the important aspects of their lives such as their social structure and attaining of Nirvan (emasculation, not to be confused with nirvana) that may be important for the mental health professionals working with such individuals and highlights the dearth of research data regarding the same.

Public mental health incorporates a number of strategies from mental well-being promotion to primary prevention and other forms of prevention. There is considerable evidence in the literature to suggest that early interventions and public education can work well for reducing psychiatric morbidity and resulting burden of disease. Educational strategies need to focus on individual, societal and environmental aspects. Targeted interventions at individuals will also need to focus on the whole population. A nested approach with the individual at the heart of it surrounded by family surrounded by society at large is the most suitable way to approach this. This Guidance should be read along with the European Psychiatric Association (EPA) Guidance on Prevention. Those at risk of developing psychiatric disorders also require adequate interventions as well as those who may have already developed illness. However, on the model of triage, mental health and well-being promotion need to be prioritized to ensure that, with the limited resources available, these activities do not get forgotten. One possibility is to have separate programmes for addressing concerns of a particular population group, another that is relevant for the broader general population. Mental health promotion as a concept is important and this will allow prevention of some psychiatric disorders and, by improving coping strategies, is likely to reduce the burden and stress induced by mental illness.

Purpose of review To understand pathways into healthcare people of minority ethnic groups use and if these differ from those of the majority. Recent findings The current literature shows that some forms of treatment are seen as less stigmatizing and more acceptable. The treatment expectations also dictate choice of healthcare providers. Summary Black and ethnic minority patients may have different explanatory models, which will influence the way they seek help and the sources of help available to them. There are also clear ethnic variations in prevalence of different psychiatric disorders and thus in accessing mental healthcare services. Engaging patients into therapeutic adherence is crucial in the context of their expectations and explanatory models.

Sex is an integral part of the basic needs of an individual. However, Asian populations have had a conservative attitude towards discussing and expressing their sexual concerns to the clinician. Consequently, very limited research on sexuality-related issues has been done on these populations. Many of the biological and socio-cultural factors are different for Asians and Asian migrants to the West, when compared to the native Western population, and this requires dedicated research. The DSM-5 ( Diagnostic and Statistical Manual of Mental Disorders 5th Edition ) has made the classification of sexual dysfunctions gender-specific and has introduced the concepts of ‘gender dysphoria’ and ‘paraphilic disorders’ (distinct from paraphilias); it has removed subtypes based on sexual orientation. These changes will have a definite impact on our understanding of sexual dysfunctions and related disorders in the Asian populations.

The whole world is currently witnessing a pace of globalization and urbanization that is affecting every aspect of mankind, including sexuality. The relation between migration and sexuality can be considered bidirectional. Migrants bring along with them to the host regions their beliefs, attitudes and sexualities. These sexual cultures intersect with those of the host region and result in a set of newer ‘evolved sexualities’. Factors like anonymity, independence, stress, opportunities, accessibility and affordability are important in this phenomenon. The current scenario of globalization may ultimately lead to an amalgamation of various sexualities, giving birth to a uniform sexuality throughout. During the whole process, the migrants’ ethnicity, religion and sexual lifestyles are important things to be understood. Heteronormative models of sexuality are not rigid, but fluid and vulnerable to forces such as migration. The article highlights the areas of intersection of migration, sexuality, religion and/o...

Hindi cinema production from India is the largest in the world. Cinema reflects the society which it portrays, and in turn influences social attitudes. Hindi cinema, often known as Bollywood, demonstrates deep roots in society. In the last decade homosexual behaviour was legalized by the Delhi High Court but subsequently deemed illegal by the Supreme Court. These changes reflect changes in social attitudes. In this paper we highlight social attitudes to homosexuality - both male and female - in the context of portrayal in Hindi cinema. Historically, cultural and social values and the attitudes towards sexuality in India have been sex positive, but over the past 200 years under the British colonial rule they became very negative and indeed punitive towards homosexuality and homosexual men and women in line with prevalent Victorian attitudes to sex and sexual activity. Various descriptions and sexual identities have been identified and described in the literature. In this paper we describe a small selection of films from Hindi cinema which depict homosexuality. These portrayals have been largely negative. We describe the possible reasons for this and the potential impact these portrayals may have on audiences.

Indian history is one of the most ancient in the world; replete with many wars, teachings and religious beginnings. Hinduism is one of India‟s most prominent religions with the Bhagavad Gita being one of its most significant scriptures. Many authors have postulated that different psychotherapeutic methods have been used and described in Bhagavad Gita. In this article, we have explored regarding descriptions of the possible use of hypnotherapy in this holy text.

Introduction: Sexual dysfunction can occur due to biological problems, relationship problems, lack of proper sexual knowledge or a combination of these. India is often known as the land of Kamasutra. But as far as sexuality research is concerned, there is a paucity of relevant data from India. In view of this, we conducted a study to assess the psychosocial profile of males presenting with sexual dysfunction to psychiatry out-patient department of a tertiary medical hospital. Materials and Methods: Hundred consecutive male patients presenting with sexual dysfunction were screened using Arizona Sexual Experiences Scale for clinical sexual dysfunction and after obtaining their informed consent were included in this study. They were assessed using a semi-structured proforma, Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition, Text Revision criteria, Mini-International Neuropsychiatric Interview, and Dyadic Adjustment Scale. Results: Majority of our respondents were in the 18-30 years age group and were married. The main source of sex knowledge for 69% of them was peer group. Age of onset of masturbation was 11-13 years for 43% of them. Premature ejaculation was the most common sexual dysfunction seen in the respondents. Marital discord was seen in significantly lesser number of respondents (32.35%) as also major depressive disorder that was seen in only 16%. Discussion: Premature ejaculation was the most common sexual dysfunction in our sample. Despite the sexual dysfunction, marital discord and depression were seen less commonly in our respondents.

Disulfiram is an aversive agent used as an alcohol deterrent in the treatment of alcohol dependence. Disulfiram causes many side effects including catatonia. We present a case report of catatonia that developed when disulfiram was administered to a patient without his knowledge.

Psychiatry as a discipline is often perceived as ‘different’ by other medical professionals as much as by a common man. This perception of ‘difference’ may give rise to stigma both towards mental illness and to mental health professionals. Mental health professionals are thus both recipients of stigma and agents who can de-stigmatize psychiatry. A psychiatry movie club approach can be a very useful learning experience to understand various aspects of this stigmatization process. This paper presents a brief account of such an endeavour in which the film Gothika (2003) was used to help psychiatry trainees talk about their experiences with stigma towards mental illness as well as their profession.

Psychiatry as a discipline is the most complex medical specialty and is affected very strongly by cultural and social factors which also determine what is normal and what is abnormal. Cultures decide where help is sought from and how services are developed and delivered. Ethical practice of psychiatry is critical in ensuring that patients and their families have confidence in what is being offered. It is helpful to understand spiritual aspects of an individual’s functioning and their family’s perspectives regarding spiritual understanding of mental illness. In clinical practice this clearly means that clinicians must take into account spiritual aspects in etiology and management of mental disorders. Ethical practice is at the core of the practice of medicine and within the context of changing patient expectations of the therapeutic encounters it is helpful that clinicians and policy makers are aware of complex needs that patients have to ensure that services provided are accessible and acceptable. In this chapter we highlight various issues that clinicians may take into account when dealing with patients.

Streptococcal infections in children rarely lead to neuropsychiatric manifestations referred to as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections. The common sequelae include tics, Tourette's syndrome or obsessive-compulsive disorder. Rare presentations may include separation anxiety disorder, body dysmorphic disorder and attention deficit hyperactivity disorder. We present a case of a 10-year-old child that presented primarily with abrupt onset of separation anxiety without any other neuropsychiatric manifestations such as tics or obsessive-compulsive symptoms. Streptococcal infections may present with varied neuropsychiatric manifestations in the pediatric age group and one needs to be more vigilant in cases that have an abrupt onset and unusual presentation. A high index of suspicion is important to diagnose such cases and provide them with a timely treatment.

Pediatric obesity is a major health problem and has reached epidemiological proportions today. The present paper reviews major psychological issues in pediatric obesity from a developmental perspective. Research and literature has shown that a number of developmental, family, maternal and child factors are responsible in the genesis of pediatric obesity. Family food habits, early developmental lifestyle of the child, parenting, early family relationships and harmony all contribute towards the growth and development of a child. The present review focuses on the role of developmental psychological factors in the pathogenesis of pediatric obesity and highlights the developmental factors that must be kept in mind when evaluating a case of pediatric obesity.

Psychiatric polypharmacy refers to the prescription of two or more psychiatric medications concurrently to a patient. It can be categorised as same-class, multi-class, adjunctive, augmentation and total polypharmacy. Despite advances in psychopharmacology and a better understanding of the principles of therapeutics, its practice is increasing rapidly. The prevalence of polypharmacy in psychiatry varies between 13%-90%. There are various clinical and pharmaco-economic factors associated with it. Dealing with polypharmacy requires an understanding of its associated factors. Education, guidelines and algorithms for the appropriate management of various conditions are effective ways to avoid irrational polypharmacy.

After the Delhi High Court judgment on reading down Section 377 Indian penal code, many individuals of alternate sexuality are wanting to come out to themselves and significant others in their lives. In this process, they often turn to psychiatrists seeking help. However the past of this specialty wherein homosexuality and other sexualities were considered a disease still haunts it with anecdotal reports of reorienting treatments continuing in certain parts of the country. While it is important to not continue with this unethical practice, at the same time, it is also important to be supportive to the issues that this and various other marginalized sexualities in our country face. This viewpoint is an attempt to reiterate certain steps that are to be followed by psychiatrists who find themselves in such clinical consultations.

Background: Sexual function and activity in old age have been inadequately studied world over. It is important to know that aging processes are not confined to persons beyond the age of 60 years; many changes in elderly have their antecedents in the middle age. Aims: This study sought to determine the patterns of sexual activity and function in individuals over 50 years of age. It also sought to discuss barriers such as chronic illness that may interfere with sexual function. Materials and Methods: We conducted a study of subjects above the age of 50 years in various outpatient departments (OPDs) of a teaching municipal hospital in Mumbai, by interviewing 60 individuals who attended the OPDs, after taking their informed consent. Socio-demographic and other information on their sexual function and activities were obtained. Data was analyzed using statistical package for social sciences v15. Results: 72% individuals below 60 were sexually active, while only 57% above 60 were active. Others had become completely abstinent at some time in their lives. Statistical analysis revealed significant gender, health and educational status based differences in the sample. Conclusion: Our study showed significant presence of sexual desire, activity and function even after the age of 50 years; a decline by the age of 60 and above was a finding that reflected more in women. Chronic illness did affect sexual function and desire.

For decades, films across the world have entertained people and affected their attitudes regarding certain issues and conditions. Documentary films have been used by governments in different parts of the world to educate the general public and promote health and prevent the spread of disease as part of public health programs. Psychiatry as a branch of medicine like the rest of medicine continues to develop. With an increasing awareness among the general population and popularity of films showing various aspects of mental illnesses on the rise, educators and teachers are turning their attention to using films for education of medical students and psychiatric trainees. Although films may be stereotypical and prejudiced, they can be used successfully in teaching psychiatry trainees. In this paper, development of a movie club and its use are described and suggestions made to improve the use of films in this process.

India and UK have had a long history together, since the times of the British Raj. Most of what Indian psychiatry is today, finds its roots in ancient Indian texts and medicine systems as much as it is influenced by the European system. Psychiatric research in India is growing. It is being influenced by research in the UK and Europe and is influencing them at the same time. In addition to the sharing of ideas and the know-how, there has also been a good amount of sharing of mental health professionals and research samples in the form of immigrants from India to the UK. The Indian mental health professionals based in UK have done a good amount of research with a focus on these Indian immigrants, giving an insight into cross-cultural aspects of some major psychiatric disorders. This article discusses the impact that research in these countries has had on each other and the contributions that have resulted from it.

Films are produced with the aim of entertaining people, but recently there has been increasing use of films to educate medical trainees about various disorders, symptoms of these disorders, patient-therapist interactions, and various other medical and psychiatric issues. Discussions in academic circles have moved from criticism of negative portrayals of mental illness in earlier films to their use in teaching sessions. Films can be used either in full length or clip format to conduct training modules. Use of the film Stigmata to train residents about diagnostic dilemmas and taking a diagnostic approach to patients is discussed.

Psychiatric training curricula these days are heavily biased towards neurobiology which tends to reduce the understanding of psychiatry trainees about psychosocial issues that their patients may face. Psychiatry trainees can get a clearer picture of psychosocial issues when they see a good film on it. A psychiatry movie club is a novel and interesting method that diverts from the didactic methods of teaching. This method was used with an objective to sensitize psychiatry trainees about male homosexuality. A movie club on male homosexuality was organized using a set of 5 films combined with various other teaching strategies to sensitize and teach psychiatry trainees about male homosexuality. Pre- and post-movie club attitudes towards male homosexuality were measured using Attitudes Towards Gay Men Scale (ATG). The participants were followed up 1-year later to see if this change was sustained over time. Participants attending the movie club reported a positive change in their understanding of and attitudes towards male homosexuality. A 1-year follow up through emails showed that the effect sustained over time. Movie clubs can be an effective method to teach psychosocial issues surrounding male homosexuality in psychiatric curricula.

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.

Interpersonal violence whether it is sexual or nonsexual, remains a major problem in large parts of the world. Sexual violence against children and women brings with it long-term sequelae, both psychiatrically and socially. Apart from sexual gratification itself, sexual violence against women is often a result of unequal power equations both real and perceived between men and women and is also strongly influenced by cultural factors and values. Within sociocentric and ego-centric cultures, the roles and representations of genders, and attitudes toward sexual violence differ. Cultures which are described as feminist, provide equal power to both men and women. Sexual violence is likely to occur more commonly in cultures that foster beliefs of perceived male superiority and social and cultural inferiority of women. Although culture is an important factor to understand sexual violence in its entirety, we need to look at, as well as beyond cultural structures, their strengths and weaknesses.