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Background: Unrecognized bipolar spectrum disorder under cover diagnosis of major depression disorder leads to wrong medications (antidepressants in absence of mood stabilizer), which may switch to mania. Aim and Objectives: A study was to identify unrecognized bipolar disorder in patients of major depressive disorder taking antidepressants. Materials and Methods: This is an observational and cross-sectional study of 150 patients previously diagnosed as major depressive disorder taking antidepressants from tertiary care hospital. Patients were assessed by proforma containing demographic details, Questionnaire of mood disorder questionnaire (MDQ), and Hamilton depression rating scale (HAMD) followed by clinical interview according to DSM-5 to confirm diagnosis. Statistical analysis was done. Results: We found 6.67% depression patients screened positive on MDQ for bipolar disorder and diagnosis is confirmed by interview according to DSM-5. MDQ positive patients have early age of onset of depression(P=0.0109), long duration of depression(P=0.0478), presence of previous suicide attempt(P=0.0130), and family history of bipolar disorder(P=0.0361). No statistically significant difference was observed between mean HAMD score and severity of depression between MDQ positive and negative group. Conclusion: Among patients prescribed antidepressants for depression, there is a substantial proportion with unrecognized bipolar disorder and most of them had never received diagnosis of bipolar disorder. When seeing patients with depression disorder, clinicians should review the life history for screening of unrecognized bipolar disorder by looking for early age onset of depressive episode and long lifetime duration of depression, previous suicide attempt, and family history of bipolar disorder.

Objective: Social anxiety disorder (SAD), (also known as social phobia), is characterized by intense fear of social interaction and often associated with social avoidance and impairments. There is high risk for depression, substance use disorder, and suicide among them. Subjects and Methods: It is an observational, cross-sectional, single centered, questionnaire-based study assessing the frequency of SAD and depression and their possible association with quality of life among 290 consenting medical undergraduate students. Social Phobia Inventory (SPIN), Beck's Depression Inventory (BDI II), and the World Health Organization Quality of Life assessment scale (WHOQOL-BREF) were used to screen and assess severity of SAD, depression, and quality of life, respectively. The statistical analysis of proportions was done by Chi-square test, while the scores of SPIN, BDI II, and WHOQOL-BREF was compared using Mann–Whitney test or Kruskal–Wallis test followed by Dunn posttest multiple comparison, using GraphPad InStat version 3.06. Results: Frequency of SAD is 11.37%, and depression is 8.96%. Females are more likely to experience SAD. Participants with SAD are more likely to experience depression (P < 0.0001) and have poor quality of life (P = 0.01). Participants with depression have higher SPIN score (P < 0.0001) and poor quality of life (P < 0.0001). Females are more likely to experience social fear (P = 0.02). Participants staying away from their family are more likely to experience social anxiety in comparison to their peers (P = 0.01). Severity of depression is correlated with severity of social anxiety (Spearman r = 0.4423 [0.3416–0.5329], P < 0.0001). Conclusion: Participants with SAD are more likely to experience depressive symptoms and have poor quality of life and vice versa.

BackgroundCaregivers play a pivotal role in providing care for mentally ill patients. Increase in caregiver burden can make them vulnerable to mental illness themselves.AimsWe assessed the severity of burden of care and its association with depression, anxiety and quality of life among caregivers of patients with alcohol use disorder (AUD) and schizophrenia.MethodsThis was an observational, cross-sectional, single-centred study of 50 consecutive caregivers of patients with AUD and schizophrenia. Participants were recruited from the psychiatry outpatient department of a tertiary care hospital between January and June 2017. The caregivers were further assessed by demographic details, Hospital Anxiety Depression Scale for assessment of depression and anxiety, Zarit Burden Interview for assessment of caregiver burden and WHO Quality Of Life-BREF for assessment of quality of life. Statistical data were analysed using GraphPad InStat V.3.06 (California). Multiple linear regression analysis was applied to identify the predictors of caregiver burden.ResultsBurden of care experienced by caregivers of patients with AUD is as high as that of caregivers of patients with schizophrenia (U=1142.5, p=0.46). Caregivers experiencing high burden of care are likely to have symptoms of anxiety (U=22, pConclusionOur study suggests that caregivers of patients with AUD experience burden of care as high as that of caregivers of patients with schizophrenia. Caregivers with high burden of care are more likely to have depression, anxiety and poor quality of life.Trial registration numberCTRI/2017/03/008224.

BackgroundA major public health problem around the world today is mental illness. Although there are several studies on the topic, it is rarely conducted in the context like the current study.AimsThis study aims to find out the attitudes of medical students towards psychiatry and mental illness as a clinical medicine major and evaluate the effects of clinical posting on their attitudes towards psychiatry and mental illness.MethodsThis is a longitudinal study of 6 months’ duration conducted with students in their fifth semester of medical college in Western India during the academic year of 2016–2017. The participants were assessed by pro forma containing demographic details, and the questionnaires—Attitude Towards Psychiatry-30 items (ATP-30) scale and Mental Illness Clinician’s Attitude (MICA) scale, which were presented to the students at the beginning and at the end of their psychiatry clinical posting. The statistical analysis was done with GraphPad, InStat V.3.06. A p value ResultsThe students’ attitudes towards psychiatry were neutral at the beginning of the psychiatry clinical posting, and improved significantly at the end of the posting on both scales: ATP-30 (p=0.002) and MICA (p=0.048). The students became more positive towards the subject and mental illness in general, negative attitudes also reduced but the change was not statistically significant (p=0.058). We found significant improvement in students’ thinking towards being a psychiatrist in the future post-term (p=0.0002). The changes in attitude in terms of gender were equivocal, with an increase in positive attitude and reduction in negative attitude post-term in both sexes.ConclusionPsychiatry clinical posting aids in cultivating positive attitude towards psychiatry and mental illness and reduces the stigma associated with the students of this major and psychiatric patients.

Background: The side effects of Internet overuse have been emerging progressively causing the emergence of a problem that is defined as internet addiction or problematic internet use. It also disrupts the sleep wake cycle so adversely affecting quality of sleep. This study is a preliminary step toward understanding the effect of internet addiction on sleep quality among medical college students in India.Methods: This was an observational, cross-sectional, single-centred, and self-assessable. Questionnaire based study administrated among 525 consenting medical students. The participants were assessed by proforma containing demographic details, variables related with internet use, questionnaires of IAT (Internet Addiction Test for Internet Use) and PSQI (Pittsburgh Sleep Quality Index for Sleep quality. Statistical data were analysed by Graph Pad InStat version 3.06 using Chi–square test and Mann-Whitney test.Results: There were 9.3% of all participants were considered problematic internet users with frequency of internet addiction 0.9%. Participants with problematic internet use are likely to have poor sleep quality (p

Background: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) characterized by mood changes, anxiety, and somatic symptoms experienced during the specific time of menstrual cycle. Prevalence data of PMS and PMDD is sparse among college girls in India. Aims: The aim of this study is to study the prevalence of PMS and PMDD among college students of Bhavnagar (Gujarat), its associated demographic and menstrual factors, to rank common symptoms and compare premenstrual symptom screening tool (PSST) with Structured Clinical Interview for DSM-IV-TR defined PMDD (SCID-PMDD) for sensitivity and specificity. Materials and Methods: A cross-sectional survey was done in five colleges of Bhavnagar. Of 529 subjects approached, 489 college girls were finally analyzed for sociodemographic data, menstrual history, and PSST. SCID-PMDD was applied among those who were positive on PSST and 20% of those who were negative. The data were analyzed using OpenEpi Version 2. Chi-square test was done for qualitative variables and analysis of variance for quantitative variables. Sensitivity, specificity, and predictive values were calculated for PSST. Results: The prevalence of PMS was 18.4%. Moderate to severe PMS was 14.7% and PMDD was 3.7% according to DSM IV-TR and 91% according to International Classification of Diseases, 10th edition criteria. The symptoms commonly reported were “fatigue/lack of energy,” “decrease interest in work,” and “anger/irritability.” The most common functional impairment item was “school/work efficiency and productivity.” PSST has 90.9% sensitivity, 57.01% specificity, and 97.01% predictive value of negative test. Conclusion: Prevalence of PMS among college students is similar to other studies from Asia. PSST is a useful screening tool for PMS, and it should be confirmed by more specific tool as by SCID-PMDD. Routine screening with PSST can identify college girls who can improve with treatment.

Neuroleptic malignant syndrome is an acute, life-threatening medical complication caused by antipsychotics. It is commonly seen with typical antipsychotics and very rare with atypicals. Cases have been reported with quetiapine also, but this case is of special interest because it occurred in patient who was stable on maintenance quetiapine 200 mg/day for last 5 years.

Objectives: To study the experiences of stigma and discrimination among Schizophrenia and bipolar mood disorder (BMD) patients and to find if any difference in them is present. Materials and Methods: 50 patients diagnosed as BMD and Schizophrenia and in remission for at least 3 months were interviewed by a semi-structured scale. The verbatim was then analyzed qualitatively. Results: Eighty-six percent (86%) patients experienced stigma. Schizophrenia and BMD patients did not differ in their experiences of stigma proving that the tag of mental illness was stigmatizing enough and had no relation to the duration or intensity of illness. The major themes emerging out of the qualitative analysis showed that most of the patients experienced stigmatizing experiences at home with family members which included shame and ridicule, belittlement of opinion. At work place, inability to hide illness lead to change of job or been considered inept to carry out responsibility. Sixty percent (60%) believed that stigma could not be eradicated. On ways to combat stigma, most patients believed that adequate rehabilitation and an assertive attitude on the part of patients was most likely to work. Conclusions: Despite having longer remissions and a milder course than Schizophrenia, BMD patients experienced as much stigma as Schizophrenia patients.