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Background: Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by pain stiffness and swelling in the joints with long standing effects on quality of life and is complicated by the presence of medical and psychiatric comorbidity. The current study was aimed at comparing the psychopathology, quality of life and life satisfaction between patients with RA and healthy controls. Methodology: There were two groups in the study – a study group with RA patients (n=97) and control group with their first-degree relatives (n=93). A semi-structured proforma collected data related to socio-demographic variables and RA. The groups were assessed using the Mini International Neuropsychiatric Interview, WHO Quality of Life scale brief version and Satisfaction with Life Scale. The scores were statistically analyzed and presented. Results: The mean age of the sample was 44.94 ± 13.02 years (range 18-82 years) and that of the control group was 23.02 ± 8.41 years (range 18-55 years). The mean duration of illness of the group was 7.2 ± 16.9 years (range 1-40 years). Major depression was the commonest disorder seen in 73.1% (n=73) patients with RA. Generalized anxiety disorder, panic disorder and suicidal feelings were also detected. The RA group had significantly lower QOL scores in the psychological and environmental domains of QOL Life satisfaction scores were also significantly lower in the RA group (p=0.0001) when compared to controls. Conclusion: Patients with RA have significant psychopathology that warrants attention and this affects their quality of life and life satisfaction. Further longitudinal studies in this area to gain clinical and epidemiological Indian data are warranted. Keywords: Rheumatoid arthritis, Depression, Psychopathology, Quality of life, Life satisfaction.

Background: Cerebroprotein hydrolysate (cerebrolysin) is a nootropic and neurotrophic drug used widely in the management of various forms of dementia, stroke and head injury. A number of case series and anecdotal case reports on its efficacy exist. This study is a retrospective chart review of 34 patients with dementia treated at a tertiary general hospital psychiatry department that were given oral cerebroprotein as add on to their existing treatment for dementia. Methodology: 34 patients were administered twice daily oral cerebroprotein 90 mg tablets for 90 consecutive days. The cognitive assessment was done before the first injection and after the last dose using the Adenbrook's Cognitive Examination-Revised (ACER) and the Mini Mental Status Examination (MMSE). Results: Changes on cognitive assessment were minimal and no major improvements were seen though isolated areas of improvement were reported by many patients. The scores on the ACER and MMSE remained in the dementia range though improvement in scores were noted. None of the patients experienced any major side effects with the drug. Conclusions: Oral cerebroprotein is a useful agent in the management of dementia and must be tried as an add-on to regular dementia treatment. Larger studies in prospective cohorts with further stringent assessments warrant exploration.

Patients diagnosed with cancer often suffer from chronic pain. Management of pain is essential to improve the quality of life of patients. When the standard methods for pain management fail, novel techniques can be implemented. Ketamine is a dissociative anesthetic agent which acts by reducing the central sensitization to pain. We report the case of a patient suffering from intractable pain as a result of Stage IV-C supraglottic laryngeal malignancy that responded well to intravenous ketamine.

Skin rashes have been reported after the start of various antipsychotic drugs in the scientific literature. It is important that psychiatrists be aware of antipsychotic-induced skin reactions in patients on antipsychotic medication which can be an uncommon yet possible occurrence. Patients with psychiatric problems may be prone to skin reactions and may not report the same as they may not be aware of the same. We herewith report a case of skin reaction with Olanzapine in a patient with schizophrenia. Keywords: Schizophrenia, Skin rash, Skin reaction, Antipsychotics, Olanzapine.

Ofloxacin is a commonly used fluoroquinolone antibiotic in adults as well as children. It is generally safe and well tolerated though rare neurological and psychiatric adverse reactions have been reported with Ofloxacin. We report a case of a 6 years old child who developed hallucinations after being started on Ofloxacin and which resolved on discontinuation of the drug. Keywords: Ofloxacin, Hallucination, Fluoroquinolones.

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.

Skin reactions have been reported with various antipsychotic drugs in scientific literature. It is important that clinicians be watchful of skin reactions in the elderly with antipsychotic medication, which can be an uncommon occurrence. It has been documented that the elderly are more prone to skin reactions with various forms of medication. We herewith report a case of skin reaction with risperidone in an elderly female patient.

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.

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.

Background: Early intervention programs for psychosis are gateways for suicide prevention. These programs offer an excellent opportunity for prevention due to easy access, early identification, and provisions for continuity of care. These programs have been found effective in reducing rates of suicide after discharge to communities. The objective of this study was to examine suicide risk level among early psychosis patients admitted with and without previous suicide attempts. We hypothesized that all patients admitted with early psychosis would be at high risk of suicide, regardless of a previous suicide attempt. Methodology: Suicide risk was compared between patients admitted with a suicide attempt (n = 30) and patients admitted without a suicide attempt (n = 30). The primary outcome measure of interest was suicide risk which was measured with the Scale for Impact of Suicidality–Management, Assessment and Planning of Care clinical interview. All patients met DSM-IV TR criteria for schizophrenia. Psychopathology was assessed using the Brief Psychiatric Rating Scale and level of depression was assessed using the Hamilton Depression Rating Scale. The data were statistically analyzed. Results: Patients admitted with a previous attempt (mean = 29.5, standard deviation [SD] =12.0) did not differ significantly in suicide risk from those admitted without a previous attempt (mean = 27.5, SD = 12.5), (t[58] =0.63, P = 0.53). Patients admitted without a suicide attempt scored higher in depressive symptoms (t[58] =10.62, P< 0.001) than that of admitted with a suicide attempt. There were no significant differences between patients admitted with and without suicide attempts on any comorbidity, other than a trend toward a higher prevalence of personality disorder in patients with no suicide attempt. Attempters and nonattempters did not differ on any demographic variables either. Conclusions: Of those admitted without a previous suicide attempt, our findings suggest that it is critical that all patients discharged from an acute psychiatric unit must receive comprehensive community care. The identification of risk, and subsequent intervention for suicidal and self-harm behaviors, should be a central part of treatment for all mental disorders.

Antipsychotic drugs are widely used in the management of schizophrenia in the elderly. Extrapyramidal reactions to these drugs and tardive dyskinesia are a dreaded side effect of these drugs that may be seen in the elderly. We present herewith, a case of probable respiratory dyskinesia, a rare but important variant of tardive dyskinesia seen in an elderly patient with schizophrenia after the sudden stoppage of antipsychotic medication.

Compulsive masturbation is a type of paraphilia related disorder in which a person engages in masturbatory behavior to such an extent that it causes socio-occupational dysfunction. The psychiatric co-morbidities associated with it include mood and anxiety disorders, substance use disorders, etc. Here, we report a case of a patient with the delusional disorder having compulsive masturbation.

Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease, which tends to be progressive, causing weakness of the structures in the brain stem that controls eye movements. PSP falls under the rubric of Parkinsonism plus syndromes that are a group of heterogeneous degenerative neurological disorders that differ from the classical idiopathic Parkinson′s disease. PSP is often underreported, making it important for clinicians to be aware of this disorder. Here we report a case of PSP, which presented primarily with speech disturbances and recurrent falls due to postural instability. On investigating, the magnetic resonance imaging (MRI) revealed a classical sign diagnostic of PSP.

Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years) had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26%) showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

The family is an integral part of one's life. It is very essential that every individual employed or unemployed invests time therein. The family is a source of support and growth for an individual, and the lack of family support or loneliness may be a causative factor in the genesis of psychiatric disorders, especially depression. In India, family plays a paramount role when it comes to mental health of the individual. Tips on how one should invest time in one's family along with the role of a family in one's personal and social structure are discussed.

Background: Cerebroprotein hydrolysate (Cerebrolysin) is a pharmacological and neurotrophic agent that has been used widely in the management of various forms of dementia. Purpose: The present paper presents a retrospective chart review of 25 patients with dementia visiting a tertiary general hospital psychiatry unit who received cerebroprotein hydrolysate as an add on treatment for dementia. Materials and Methods: Twenty-five patients were administered 20 doses of cerebroprotein hydrolysate intravenously at a dose of 60 mg in 250 ml normal saline over 1-2 h after a test dose on 20 consecutive days. The cognitive assessment was done before the first injection and after the last dose using the Adenbrook′s Cognitive Examination-Revised (ACER) and the Mini Mental Status Examination (MMSE). Results: There was significant improvement in scores on the ACER and MMSE, although the final scores remained in the dementia range. None of the patients experienced any major side effects. Conclusions: Cerebroprotein thus is a useful pharmacological option in the management of dementia and warrants further study and exploration.

Background: Clozapine has been used widely in the management of treatment-resistant schizophrenia. The present study aims at determining whether pre-treatment electroencephalography (EEG) abnormalities would serve as a marker for response to clozapine treatment. Subjects and Methods: This was a cross-sectional study done in a tertiary care center in Mumbai where patients diagnosed with schizophrenia using DSM-IV criteria and resistant schizophrenia using Kane criteria were assessed using EEG prior to starting clozapine treatment. They were rated for symptomatic improvement using the Positive and Negative Syndrome Scale (PANSS) along with Clinical Global Improvement for Severity (CGI-S). The results were statistically analysed and presented. Results: 55 out of the 80 patients in the study showed baseline EEG abnormalities. The mean duration of illness in the patients were 2.65 years. Slow wave and background EEG abnormalities were common in pre-treatment EEG. 36.4% patients in the study showed clinical response. Patients with negative symptoms and baseline EEG abnormalities showed better response. Conclusions: The study was circumscribed and had many limitations due to a small sample size. The relation between pre-treatment EEG abnormalities and clozapine response could not be statistically correlated and it could not be ascertained to be a marker for response to clozapine therapy.

Background: There are very few studies from India which have evaluated the prescription pattern for antidepressants by psychiatrists for treatment of depression. Aim: To study the psychotropic prescription patterns of patients with first episode depression from diverse settings including teaching institutions in public and private sectors and even privately run psychiatric clinics. Materials and Methods: Prescription data of 706 patients with first episode depression, who participated in the IPS multicentric study, were evaluated. Results: Escitalopram was the most commonly prescribed antidepressant, comprising 40% of the total prescriptions. This was followed by sertraline (17.6%) and fluoxetine (16.3%). In total, selective serotonin reuptake inhibitors (SSRIs) formed 79.2% of all the prescriptions. Tricyclic antidepressants formed a small part (15.15%) of total prescriptions, with imipramine being the most commonly used tricyclic antidepressant. Serotonin-norepinephrine reuptake inhibitors (venlafaxine, desvenlafaxine and duloxetine) were prescribed to 11.3% of patients with equal share of venlafaxine and duloxetine. About one-sixth ( N=104; 14.7%) of the patients were prescribed more than one antidepressant. Nearly three-fourth of the patients ( N=523; 74.1%) were prescribed a benzodiazepine, with clonazepam being the most preferred agent, prescribed to nearly half of the participants (49%) and formed nearly two-third of the total benzodiazepine prescriptions (346 out of 523). Conclusion: Escitalopram is the most commonly prescribed antidepressant and SSRIs are the most commonly prescribed class of antidepressants. Poly pharmacy in the form of concomitant use of two antidepressants is practiced infrequently. However, benzodiazepines are used quite frequently as the co-prescription.

This report describes a case of an 18-month-old child who was treated for primary insomnia with Zolpidem. To the best of our knowledge, the published literature is devoid of any information on use of Zolpidem in infants and children.