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Abstract Background The purpose of the present study was to evaluate the use of a free online continuing education (CE) course that sought to address barriers of capability by training dental team members in the specific recommendations of the American Dental Association (ADA)-endorsed adult guideline for the pharmacologic management of acute dental pain, shared decision-making, and the adoption of the guideline into practice. Methods In 2022 and 2023, dentists completed an online, asynchronous CE course on the guideline-concordant pharmacologic management of acute dental pain. They completed 11-item knowledge tests before and after completing the course. Total scores on the pre- and post-tests were compared using a t-test. Results The mean score increased from 7.68 (SD = 1.08) on the pretest to 8.79 (SD = 1.35) on the post-test (t (4468) = -27.34, p

Congenital segmental absence of bowel muscle layer which is also known as Segmental absence of intestinal musculature (SAIM) is rare cause of obstruction in neonates and exceedingly rare in adults. We present 35 years old male with right iliac fossa (RIF) pain since 7 daysandnot passing stool since 3 days, was operated with suspicion of intestinal tuberculosis (TB). Our case shows two rare anomalies, SAIM and duplication in single patient which makes itunique. Histopathologically it was diagnosed as Congenital segmental absence of bowel muscle layer with duplication of bowel wall.

Background: Reaction time is a measure of how fast an organism can react to a certain stimulus. As such, it is a measure of an individual’s performance and the function of sensory-motor connection. While there are studies evaluating the differences in reaction time with gender and psychiatric illness as independent variables, data are lacking when considering them together. Aims: The aim of the study is to study the gender differences in reaction time in patients suffering from psychiatric illness. Settings and Design: The study involves an observational, longitudinal comparative study in the psychiatric outpatient department (OPD) of a tertiary care facility. Materials and Methods: After institutional ethics approval, 100 patients on psychotropic medications attending psychiatry OPD were included in the study along with at least 100 relatives who were not on psychotropic medications, serving as control. Required data were collected using semi-structured pro forma. The reaction time of patients and the control group was assessed using an application on the mobile phone available online as – the “Human Benchmark test.” Data obtained were entered in the MS Excel sheet and analyzed using the computerized software and a P ≤ 0.05 was considered statistically significant. Results: In the group of patients, the males showed delayed reaction time as compared to females, while in the control group, males performed better than the female population in reaction time tests. The highest reaction time was found to be in the substance use disorder group of patients at all points of testing, followed by that of patients with schizophrenia. Conclusions: Gender did not significantly affect the reaction time in both patient and control groups.

Mauriac syndrome is a rare complication of poorly controlled type 1 diabetes mellitus and is characterized by hepatomegaly with altered liver enzymes, delayed puberty, growth retardation, and cushingoid features, seen in children. Being a chronic condition, warranting frequent hospitalization, and invasive testing and management, one should always look out for the possibility of comorbid depression, enabling timely diagnosis and treatment. Here, we report the case of 14-year-old male with Mauriac Syndrome having comorbid major depressive disorder being well maintained on escitalopram.

Confusional arousal, classified under parasomnias, is a condition in which patients exhibit wakeful behaviors while still apparently asleep. It may be associated with shouting or sleepwalking and usually lasts for a few minutes to several hours. Patients tend to have no memory of the occurrence of such episodes. We report two cases of confusional arousals, the first, a 15-year-old boy suffering from autism spectrum disorder, and the second, a 10-year-old boy, with no other significant history.

Introduction: Alcohol dependence is an increasing and pervasive problem. Alcohol Withdrawal Syndrome (AWS) is a cluster of symptoms that occur in alcohol-dependent individuals after cessation or reduction of alcohol consumption. However, studies on the clinicoepidemiological profile of patients with AWS and treatment patterns in India are scarce. Aim: To assess the treatment patterns during hospitalisation and after discharge in Indian patients with AWS. Materials and Methods: A retrospective observational study was conducted using data from 1000 patients with AWS who were admitted to nine addiction centres across India. Data from medical charts from the previous five years were collected over six months, from January to June 2022. The study included patients of either sex, aged ≥18 years at the time of data collection, who had been hospitalised for AWS symptoms and had ≥3 months of documented follow-ups. The primary endpoints of the study were the most commonly used medications and their dose titrations in the treatment of AWS, as well as the duration of treatment in the hospital and post-discharge. Key secondary endpoints included the socio-demographic profile of patients, common comorbidities, common signs and symptoms, the association between prescription patterns of Benzodiazepines (BZDs) and liver enzyme levels, and the average duration of hospital stay. Continuous variables were summarised as mean and Standard Deviation (SD), while categorical variables were summarised as frequency and percentages. Levels of serum Aspartate Aminotransferase (AST), Alanine Transaminase (ALT), γ-Glutamyl Transferase (GGT), and bilirubin were recorded from the source data, if available, and the association with the use of chlordiazepoxide and lorazepam was analysed using the Chi-square test. Results: The mean±SD age of the 1000 enrolled patients was 41.4±9.6 years, with the majority (n=997; 99.7%) being males. BZDs were the mainstay pharmacotherapy, with lorazepam (n=686; 68.6%) and chlordiazepoxide (n=482; 48.2%) being the two most commonly prescribed BZDs during hospitalisation. During post-discharge treatment, 57.0% (n/N=74/130) of patients received lorazepam, while 52.0% (n/N=67/130) received chlordiazepoxide. Frequently used drug regimens during hospitalisation included fixed doses of chlordiazepoxide {25 mg twice a day (BID:143/482; 29.7%), 20 mg thrice a day (TID:103/482; 21.4%), or 25mg TID (87/482; 18.0%)}, or lorazepam {2 mg TID (188/686; 27.4%), 2 mg BID (183/686; 26.7%), or 2 mg once a day (OD;175/686; 25.5%)}. Commonly observed signs and symptoms included tremors (n=567; 56.7%), irritability (n=539; 53.9%), and agitation (n=500; 50.0%). Depression (n=182; 18.2%) and anxiety (n=136; 13.6%) were the most commonly reported co-morbidities. Among the patients, only 13.4% (86/641) had an AST/ALT ratio >2, and 12.9% (44/340) had AST and GGT levels >2× Upper Limit of Normal (ULN). There was no significant difference in these patients between those receiving and not receiving chlordiazepoxide (p>0.05). The mean±SD duration of hospitalisation was 23.1±18.97 days, while the mean±SD duration of treatment during hospitalisation and post-discharge was 22.3±16.36 days and 71.6±52.3 days, respectively. Conclusion: The two most commonly prescribed drugs during hospitalisation and post-discharge were the BZDs, lorazepam and chlordiazepoxide. Fixed-dose regimens of chlordiazepoxide at 25 mg BID or TID, or 20 mg TID, and lorazepam at 2 mg TID, BID, or OD were frequently used during hospitalisation.

Background: Patients with suicide attempts usually present to the emergency department of hospitals, and the attitude of nursing staff and medical personnel plays a major role in their recovery. There is a negative perception and stigma associated with suicide among the public and hospital staff. This study aimed to assess the attitudes and perceptions toward suicide and suicide attempters among 2nd and 3rd year nursing students at a government hospital in Mumbai, India. Methodology: One hundred and eighty-eight nursing students studying in the 2nd and 3rd year of their courses were administered the suicide stigma scale, attitudes to suicide prevention scale and the exposure to suicidal behavior scale. The data were analyzed using descriptive statistics. Results: Sixty-eight (36%) of respondents agreed that those who attempt/commit suicide/take their life (lose their life to suicide) are pathetic while 35% believed that these persons were shallow and 44% of nursing students reported them to be immoral. Seventy six (40%) agreed that if someone is serious about committing suicide, they do not tell anyone about it. Eighty-nine (47%) of the respondents knew someone who made a suicide attempt and 108 (57%) of the students knew someone who had attempted suicide. Majority of the sample found seeking help from mental health professionals to be useful, important, and empowering. Conclusion: Further studies are needed to generalize the findings of this survey and to determine the methods of incorporating suicide assessment and management as an integral part of the nursing curriculum.

Background: Work from home (WFH) was faced with new challenges for many of them. Aims and Objectives: The aim is to investigate IT professional's experiences of WFH during the pandemic and to identify the main factors of advantages and disadvantages of WFH. Materials and Methods: An online survey was conducted among IT professionals by sending Google forms to them wherein demographic, professional details were collected and questions regarding advantages and disadvantages of WFH were asked. Results: 61.4% of individuals were males and 38.6% were females with mean age of 29.82 ± 4.25 years. The main advantages of WFH were flexible work timings and reduction in traveling time and costs by employees. Disadvantages perceived were mainly extending working hours and loss of professional and personal life balance. Conclusions: This survey suggests that WFH is advantage to employees and it can be enhanced for increasing productivity by overcoming the disadvantages to a maximal extent possible.

Background: Compared to other professions, nurses experience the greatest degree of job stress. Persistent stress is harmful to physical and mental health resulting in apathy, sleep disturbance, frequent absence from work, drug abuse, feelings of inadequacy, physical and nutritional problems, increased health-care cost, and loss of job satisfaction. Hence, this study was done to find the prevalence of occupational stress and its effect on mental health of nurses working in a tertiary care center. Materials and Methods: This was a cross-sectional study conducted among staff nurses after approval from the Institutional Ethics Committee. Sociodemographic data along with their occupational history was collected in a semistructured pro forma. The Professional Life Stress Scale by David Fontanna (PLSS) was used for evaluating occupational stress, and the Mental Health Questionnaire was prepared for evaluating mental health issues. Results: One hundred and eighty-seven nurses were included in the study, with a mean age being around 40 years and mean duration of service being around 18 years. About 45% of them had stress as per DFPS and departments in which they were working did not affect the stress levels. 8.5% of them had elevated paranoia scores and 7.4% had high depressive scores. DFPS had no significant correlation with age of staff nurses and years of experience but had a significant correlation with scores of all domains of mental health. Conclusions: It is concluded from the present study that professional stress has a great impact on health of staff nurses. There is a need for hospital management to develop appropriate intervention programs to reduce workload, make regular shift schedules, and provide positive reinforcements for nurses to reduce anxiety, stress, and depression.

Background: Electroconvulsive therapy (ECT) has shown to have efficacy and safety in treating psychiatric disorders. Studies have shown psychiatrists harboring negative attitudes about its use. The aim of the study was to assess the attitudes of psychiatrists toward practice and use of ECT and stigma associated with it. Methodology: A self-designed questionnaire was mailed electronically. Participants were asked to rate their attitudes and experience of using ECT in practice, concerns faced during prescribing ECTs, and possible solutions for destigmatization of ECTs. Results: We received 483 valid responses. Majority had positive attitudes toward the current use of ECT. Practicing in a metropolitan city, working in multiple clinics, having a family history of psychiatric illness, and having a member of the family treated with ECTs were associated with significantly more positive attitude and less concern about ECT. Poor socio-occupational strata, poor financial status, poor educational status, diagnosis of psychosis, and history of suicidal illness were associated with better acceptance of ECT by patients and caregivers. Improving undergraduate education in psychiatry and ECT and organizing interactions between patients advised ECT and patients improved with ECT were felt as effective solutions to counter ECT-related stigma by most number of psychiatrists. Conclusions: Psychiatrists in India have positive attitudes toward ECT yet have major concerns about caregiver reactions and patient dropouts while prescribing ECT. Practice location and prior exposure to psychiatric illness and ECT affect attitudes toward ECT. Psychiatrists suggested multiple strategies to reduce stigma associated with ECTs, changing the name of ECT to a nonstigmatizing was one of them.

Background: TikTok is a mobile application that had become very popular among youth in college and adults alike. Many people have used TikTok as an alternate form of social media and share videos from there on different social media platforms. This study was aimed as survey to ascertain the knowledge, attitudes, and practices toward TikTok as an application. Methodology: A semi-structured questionnaire was prepared to consist of questions regarding demographic details, knowledge regarding TikTok, frequency of usage of TikTok, attitudes toward its use and suggestions for change required in it. The questionnaire was circulated among students through e-mails and Whatsapp. The form was distributed three times in all within a gap of 7 days. The data collected were subjected to descriptive statistical analysis and percentages. Results: Seven hundred students in all were mailed and received the questionnaire. We received 583 responses, of which 81 responses being incomplete were removed, and the final analysis was done with 502 responses. Three hundred and three (60.4%) participants felt that it could be used for entertainment and only 11 (2.2%) mentioned education or awareness. Two hundred and seventy-two (54.2%) participants felt that TikTok use could be a media for boosting self-esteem and self-image. Conclusion: Further studies in detail about various facets of TikTok need to be studied in diverse population to generalize our findings and know how this application has influenced the youth in various sectors.

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.

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.

Introduction: There is a growing need for BRCA1/BRCA2 mutation frequencies among hereditary breast and ovarian carcinoma (HBOC) cases, specifically determined on the grounds of personal and family history profiles in the Indian population. The current study was intended to identify BRCA1/2 mutation frequency and spectrum in Indian women fulfilling the National Comprehensive Cancer Network criteria. Methods: One hundred and sixty unrelated women were screened for germline variations in BRCA1 and BRCA2 genes by sequencing. The variants were classified as pathogenic or benign on the basis of American College of Medical Genetics (ACMG) guidelines. Results: Of 160 women screened for BRCA mutations, 51 (31.9%) carried a pathogenic variant in BRCA1 (n = 36) or BRCA2 (n = 15) gene. An increased frequency of mutation was seen in women with a personal history of breast or ovarian cancer (34.5%) in comparison to unaffected family members (25%). A spectrum of 34 different pathogenic variants (20 in BRCA1 and 14 in BRCA2) was identified in 51 cases. This included a novel variant c.3683_3684dup in BRCA1 which was categorized as a pathogenic variant. The variant c.68_69delAG in BRCA1 was identified in 12/51 positive cases and appears to be the hotspot mutation in the Indian population. In addition, 11 different missense variants were identified in 10 of the study participants and were categorized as variants of unknown clinical significance (VUS) based on the ACMG guidelines. Of these, three of the variants (c.389A>C in BRCA1 and c.3179G>A and c.10124G>T in BRCA2) were unreported in the published literature. Conclusion: The prevalence of pathogenic variants in the Indian HBOC cohort is high and is similar to other Indian studies. The spectrum of BRCA variants is also diverse, and it is very important to correctly classify them as pathogenic, VUS, or benign. We reinforce the importance of complete BRCA gene screening in the index case, followed by genetic counseling and targeted mutation analysis in other at-risk family members.

Dementia as a diagnosis at any age is a clinical challenge in psychiatric practice. In recent research reports there have been many case series and anecdotal case reports of dementia with an onset below the age of 45 years. In this case report, we present the case of a 23 year old female that presented with psychotic features initially and on clinical examination and imaging was diagnosed as young onset frontotemporal dementia.

Paranoid pseudocommunities may at times be a resistant and interesting symptom in patients with schizophrenia. A paranoid pseudocommunity is defined as an imaginary group of real persons or imagined persons believed in delusions to be conspiring against a paranoid individual. Herein, we report the case of a 61-year-old male with untreated schizophrenia for 36 years with auditory hallucinations constituting voices of twenty different people that were a part of a reciprocal paranoid pseudocommunity, and we explore the symptom phenomenologically and clinically.

CONTEXT: Hemoglobinopathies constitute the world's most common genetically inherited red blood cell disorder. Screening and accurate identification of hemoglobin (Hb) variants have become increasingly important in antenatal diagnosis and prevention of Hb disorders. AIM: The aim of this study was to screen and identify Hb fractions prevalent in the Central Reference Laboratory of India. MATERIALS AND METHODS: A total of 65,779 cases were screened for hemoglobinopathies on the bio-rad variant high-performance liquid chromatography (HPLC) system by beta-thalassemia short program. The retention times, proportion of the hemoglobin (%) and the peak characteristics for all hemoglobin fractions were recorded. Molecular analysis of the beta-globin gene was carried out by DNA sequencing on eight cases. RESULTS: Total number of abnormal Hb fractions on cation exchange-HPLC (CE-HPLC) was seen in 12,131 (18.44%) cases. Beta-thalassemia trait was the predominant genetic Hb disorder accounting for 7377 cases (11.21%) of the total cases. This was followed by sickle cell trait (2.01%), sickle cell disease (1.59%), beta-thalassemia syndrome (0.80%), HbE trait (0.79%), and borderline HbA2 (0.51%). Molecular characterization of eight rare cases of hemoglobin variants by beta-globin gene sequencing identified three cases of Hb Beth Israel, two cases of Hb Hofu trait, and one case each of Hb J Cambridge, Hb Mizunami, and Hb Sherwood Forest. CONCLUSION: Superior resolution, rapid assay time, and accurate quantification make CE-HPLC suitable for the routine investigation of hemoglobinopathies.

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.

Aims: This study aimed to evaluate the patterns of platelet counts during the course of alcohol withdrawal and its relationship if any with liver enzymes. Methodology: Forty consecutive patients, with alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders-fourth edition, Text Revision criteria, willing for a 10-day inpatient detoxification program and presenting within 12 h of the last consumption of alcohol were recruited in the study. Details about the diagnosis and alcohol consumption patterns were assessed with a detailed psychiatric interview. After admission, routine investigations (complete blood counts [CBCs] and liver function tests) were sent and records were kept. CBC was sent for platelet counts on the 2nd, 4th, 6th, 8th, and the 10th day of alcohol withdrawal. Results: Nearly 40% of the patients developed delirium tremens (DT group) and rest had an uncomplicated alcohol withdrawal (ND group). Platelet counts at baseline and all the 4 days of collection were significantly lower in DT group than the ND group. Platelet counts increased gradually from baseline till 10th day of alcohol withdrawal, mean increase in platelet counts being 88.61 ± 11.60% (median: 61.11%, range [23.41–391.23%]). Platelet counts in 63% of the patients showed a drop on the 4th day of withdrawal before rising till the 10th day of alcohol withdrawal. Platelet counts were not affected by liver enzymes or other alcohol consumption patterns. Conclusions: Transient thrombocytopenia and reverse thrombocytosis during alcohol withdrawal are associated with an initial drop in platelet counts. The synchrony between the drop and the onset of DT needs to be evaluated.

Introduction: Hoarding behaviour is a common symptom seen in patients with Obsessive Compulsive Disorder (OCD). The phenomenology and prevalence of hoarding in OCD have been under studied in India and the phenomenon is less explored on routine clinical examination. Aim: To study the prevalence and phenomenology of hoarding as a symptom in patients with OCD and tried to elucidate some differences between OCD patients with and without hoarding symptoms. Materials and Methods: A total of 50 patients with OCD and 50 relatives of psychiatric patients were the subjects for the study. The OCD group was administered the Yale Brown Obsessive Compulsive Scale (YBOCS), the Hoarding Rating Scale and the Clutter Image Rating Scale. The 50 cases of OCD were further divided on the presence and absence of hoarding as a symptom into 2 groups and the scores on the scales used were statistically analysed using descriptive statistics like frequency and percentages, chi-square test and unpaired t-test. Results: The mean duration of illness was 8.01±5.17 years and the mean age of onset of the illness was 27.28±7.11 years for all patients with OCD. OCD patients with hoarding had a shorter total duration of illness than those without hoarding. Newspapers and scrap were hoarded the most with sentimental reasons along with importance of goods were cited as reasons for the behaviour. The two groups showed significant differences on compulsive sub scale of the YBOCS and no differences were noted in the other scales used. Conclusion: Patients having OCD with hoarding as one of the symptoms may differ from those not having hoarding. However larger studies across diverse groups are needed to corroborate these findings.

Background: Gender identity disorder (GID) is a distressing disorder characterized by a persistent unhappiness with one's own sex and a desire to be of the opposite sex as well as seeking sex reassignment surgery for the same. The aim of the study was to assess the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles in patients with GID and examine differences in the profiles based on original gender of the patients. Methodology: Twenty-seven patients with GID that fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision criteria for the same were participants of the study. They were administered the MMPI-2 and the scores across various scales were statistically analyzed. Before analysis, the sample was divided into groups according to gender, i.e., male-to-female and female-to-male patients who were requesting sex reassignment surgery. Results: No significant elevation of scores on any of the scales was noted in keeping with the fact that patients with GID usually demonstrate minimal psychopathology. All patients showed elevation on at least one subscale other than the masculinity-femininity subscale. No differences across gender were noted indicating that gender was probably not a determinant of psychopathology in GID. Conclusions: MMPI-2 profiles in patients with GID failed to reveal major psychopathology though the MMPI still remains a useful tool in the assessment of this population.

Background: Smartphones have become a necessary evil in our lives. Selfies have become the newest technological fad to take over the youth, due to the wide and easy availability of mobile phones. There is paucity of scientific data on selfies in general, and from our country in particular. This study aimed to analyze the attitudes toward selfie taking, body image acceptance, and narcissism personality traits among an urban school-going population in Mumbai. Materials and Methods: Two hundred and fifty-two students of 11th standard, belonging to an urban Mumbai school, were interviewed in a single centric cross-sectional study. Scales used were - attitude towards selfie-taking questionnaire, body image acceptance, and action questionnaire (BIAAQ) and Narcissistic Personality Inventory (NPI). Statistical Analysis Used: Scores obtained were computed using basic descriptive statistics as well as computerized statistical software. Results: Of the 230 completely filled questionnaires, 54% were males. About 42.6% reported that they regularly clicked selfies of themselves. No gender difference was noticed. On an average, 18.1% girls and 15.2% boys clicked more than 4 selfies/day. The gender difference was statistically not significant (P = 0.5273). Difference in mean BIAAQ between the two genders was noticed to be statistically significant, whereas the NPI scores difference was insignificant. Conclusions: This study is a pioneering/novel/innovative work in the field of selfies. It gives us an insight into the youth's viewpoint towards selfies, which was positive in the majority of the population. A worrisome aspect is the higher body image dissatisfaction among girls. Behavioral addictions such as selfies need more focused research in the future.

Introduction: A growing empirical literature has examined insomnia symptoms as a possible risk factor for a range of suicidal behavior. Not much literature is available in normal adolescent population. Aims: The aim is to find insomnia prevalence, studying various dream factors, and suicidality prevalence among students of various courses. To check if there is a relation between insomnia and suicidal behavior and dreams, particularly nightmares and suicide. Materials and Methods: A total of 400 students of various courses were assessed using Insomnia Severity Index and The Mannheim Dream Questionnaire and Suicide Behaviour Questionnaire. Results: Insomnia was present in 11%, 23%, 19%, and 19% and suicide behavior in 16%, 17%, 12%, and 22%, respectively, in medical, commerce, engineering, and arts students. Statistically significant correlation was found between suicide and insomnia severity and various dream factors. Conclusions: Insomnia and dreams had relation with suicidality in normal adolescent population.

Various drugs have been used in the management of behavioral and psychotic symptoms including aggression and agitation in dementia. However, the risk of side effects and sedation limits the use of higher doses of many agents. Electroconvulsive therapy (ECT) has been used in the management of behavioral symptoms related to dementia although sparingly and rare. We report the case of a 75.year.old male patient with moderate Alzheimer's dementia and severe agitated behavior and aggression which failed to respond to pharmacological treatment and whom we treated using seven ECT sessions with success. Significant clinical improvement was noted and no cognitive decline or worsening of the dementia in any form was reported. The patient was followed up 6 months post the ECT sessions. This case report demonstrates the safety and efficacy ECT use patients with Alzheimer's dementia when behavioral problems and aggression or agitation fail to respond to medications.

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.

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.

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.

Background: Alopecia areata (AA) and psoriasis are associated with various psychiatric comorbidities. Both greatly affect the quality of life (QOL) of patients and psychiatric comorbidities can further worsen it. Thus there is need to recognise psychiatric comorbidities and treat them in these patients. Aims: To determine the psychiatric morbidity and the QOL in these patients to study the factors affecting them. Methodology: 50 patients each of psoriasis and AA were included. 50 people accompanying these patients served as control group. They were diagnosed for psychiatric disorders by clinical interview. Scales used were severity of alopecia tool for AA, psoriasis area and severity index for psoriasis, WHO-QOL scale, Hamilton Rating Scale for anxiety and depression. Results: 22% and 38% patients in AA and psoriasis group respectively suffered from psychiatric disorder, depression was present in 18% and 24% of patients and 4% and 12% had anxiety disorders in respective groups. The control group had only 6% of psychiatric comorbidities. QOL scores had negative correlation with Hamilton-A, Hamilton-D and severity of psoriasis scores and they were statistically significant but not with severity of AA. Conclusion: Thus AA and psoriasis patients had more prevalence of psychiatric comorbidities and it had bearing on their QOL.

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.

Background: Schizophrenia is a chronic psychiatric disorder which has a profound effect on the patient′s life course. Marriage has been shown to be both protective and detrimental to the course of recovery in schizophrenia. The study was planned to elucidate the factors that influenced marriage and the sustainability of marriage in patients with schizophrenia. Materials and Methods: The study sample was 101 patients with schizophrenia that attended the outpatient department of tertiary general hospital. Informed consent was taken and data collected from the patients and/or relatives on a special semi-structured pro forma. The data collected were subjected to appropriate statistical analysis after further subdividing the sample into subgroups. Results: About 69.3% of the total samples were married while 30.7% were unmarried. A significantly greater number of patients who were educated were unmarried (P = 0.026). Age of onset of illness below 25 years (P = 0.002) was a significant factor in those who were unmarried. When marital outcomes were considered, it was noted that greater male patients had stable marriages though not statistically significant, whereas earlier age of onset of illness was a significant factor that resulted in poor marital outcome (t = 2.96, df = 68, P = 0.0021). Conclusions: The effect of marriage on schizophrenia and factors that may influence marital sustainability in patients with schizophrenia need further study and are multipronged. Larger studies in this area of research are warranted.

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.

Dandy Walker Syndrome (DWS) is a congenital malformation with brain abnormalities, intellectual disabilities, epilepsy and visible structural changes in particular brain structures. We present here a case of psychosis in an 18-year-old male with DWS, epilepsy and intellectual disability. The purpose of this paper is to discuss the clinically relevant issues, psychopharmacological issues, neuropsychiatric manifestations and consultation liaison issues involved.

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.

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.

Introduction: Excessive Daytime Sleepiness (EDS) and sleep problems are common in patients with schizophrenia. The symptom of EDS in schizophrenia can be attributed to various causes including neurobiological changes, sleep disorders, medication or as a symptom of schizophrenia itself. EDS as a symptom in schizophrenia has been understudied. Aim: To assess the prevalence of EDS and to the study the same in patients with first episode and chronic schizophrenia. Materials and Methods: In this cross-sectional study 100 patients suffering from schizophrenia as per International Classification of Diseases (ICD-10) criteria were evaluated for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and EDS using the Epworth Sleepiness Scale (ESS). The severity of illness was assessed by Positive and Negative Symptom Scale for Schizophrenia (PANSS) while cognition was assessed using the Frontal Assessment Battery (FAB) and the Trail Making Test A and B. The data was statistically analysed. Results: A total of 100 patients (72 male and 28 female) aged 18 to 64years (mean age 30.63 years) were studied. Poor sleep quality (PSQI > 6) was exhibited by 83% of patients. Excessive daytime sleepiness (ESS > 7) was found in 32% of patients. There was no statistically significant difference in various parameters according to the age, duration of illness or gender. However, first episode patients differed in having better sleep quality than patients with chronic schizophrenia (p=0.0002). Cognition was not affected by sleep quality. Conclusion: A high prevalence of sleepiness and poor sleep quality was noted in the entire sample but it did not have any correlation with age and gender. It also did not affect the cognitive test scores. Further research in this area is warranted.

Obsessive compulsive symptoms have been reported in frontal lobe tumours and basal ganglia lesions. We report herewith a case of an adolescent who had a vermian cystic mass for which he underwent excision surgery. Three months postsurgery family members noticed that he started with repeated hand washing and abnormal walking pattern. Also, he developed bedwetting in sleep at night. He was given clinical diagnosis of Obsessive-Compulsive Disorder (OCD) and Nocturnal enuresis following a cerebellar mass removal which improved with fluoxetine and impiramine respectively.

Background: Internet addiction is a common emerging problem amongst adolescents and students worldwide. The present research aimed at determining the prevalence of internet addiction and its correlation to psychopathology in school going adolescents in Mumbai. Methods: 603 adolescents studying in 8th-10th standard were administered a semi structured preformed, Young’s Internet Addiction Test and Depression Anxiety Stress scale. 555 questionnaires were included in the final analysis using descriptive statistics and correlation by Spearman’s method. Results: The prevalence of internet addiction was noted to be 3.96% in boys and 1.62% of girls. Over 15% of the total sample showed overuse of internet but below internet addiction criteria. Stress scores were significantly correlated with the internet use patterns in both sexes. Majority students used the internet at home while over 50% of the sample had their own mobile phone or laptop or both. The main use of the internet in either sex was for social networking. Conclusions: The present study demonstrates that internet addiction is present in school going adolescents in Mumbai. Further studies across larger populations are needed to consolidate these findings.

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.

Amresh Shrivastava1, Megan E Johnston2, Nilesh Shah3, Marco Innamorati4, Larry Stitt5, Meghana Thakar3, David Lester6, Maurizio Pompili4,71Silver Mind Hospital and Mental Health Foundation of India, Mumbai, India; 2Department of Psychology, University of Toronto, Toronto, ON, Canada; 3Lokmanya Tilak Municipal General Hospital, University of Mumbai, India; 4Department of Neurosciences, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 5Department of Biostatistics, The University of Western Ontario, London, ON, Canada; 6The Richard Stockton College of New Jersey, Pomona, NJ, USA; 7McLean Hospital, Harvard Medical School, Boston, MA, USABackground: Suicide is a major problem in schizophrenia, estimated to affect 9%–13% of patients. About 25% of schizophrenic patients make at least one suicide attempt in their lifetime. Current outcome measures do not address this problem, even though it affects quality of life and patient safety. The aim of this study was to assess suicidality in long-term clinically improved schizophrenia patients who were treated in a nongovernmental psychiatric treatment centre in Mumbai, India.Method: Participants were 61 patients out of 200 consecutive hospitalized first-episode patients with schizophrenia diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders who were much improved on the Clinical Global Impression Scale-Improvement (CGI-I) scale at the endpoint of a 10-year follow-up. Clinical assessment tools included the Positive and Negative Syndrome Scale for Schizophrenia, CGI-I, Global Assessment of Functioning, and suicidality.Results: Many of the patients, although clinically improved, experienced emerging suicidality during the 10-year follow-up period. All of the patients reported significant suicidality (ie, suicide attempts, suicidal crises, or suicidal ideation) at the end of the study, whereas only 83% had reported previous significant suicidality at baseline. No sociodemographic and clinical variables at baseline were predictive of suicidal status at the end of the 10-year follow-up.Conclusion: Schizophrenia is a complex neurobehavioral disorder that appears to be closely associated with suicidal behavior. Adequate assessment and management of suicidality needs to be a continual process, even in patients who respond well to treatment.Keywords: schizophrenia, suicide risk, prevention

Aim: The paediatric surgical pathology specimens manifest a wide spectrum of morphological and histological features. The present work has been undertaken to know the prevalence and to describe the profile of paediatric surgical pathology specimens from western India as seen in Ahmedabad, India from 2008 to 2010. Materials and Methods: We reviewed 140 paediatric surgical specimens, 118 specimens rendered definitive diagnosis were included for the analysis. Cases were divided in two groups, one of developmental and congenital conditions and another of acquired lesions. Results: This study included 118 patients of which 79.3 % were male and 20.7 % were female. Age range of the patients was one day to twelve years. Children of one month to one year age group (infants) were the most vulnerable (31.3% cases). Group of developmental and congenital conditions consisted of 45.7% cases where as 55.3 % cases were of acquired lesions. Gastrointestinal tract was most frequently affected organ (43.2%) followed by head and neck region (14.4%) and testis (7.6%). Hirschsprung’s disease (HD) cases (6.7%) were commonest among the group of developmental and congenital conditions followed by juvenile polyps of colon (5%), Meckel's diverticulum of small intestine (5%) and neural tube defect (5%). In acquired lesions, Appendicitis was the most frequent lesion (21.2%) followed by haemorrhagic infarct of testis due to torsion (5%) and intussuception of intestine (5%). Malignant cases were (4.2%) and the most common cancer was yolk sac tumour. Conclusion: Paediatric surgical specimens, unlike adults, represent significant number of developmental and congenital conditions in addition to acquired lesions; accounting for wide spectrum of morphological and histological features. Study provides insight into the trends of paediatric surgical lesions in the western region of India.

Hallucinations are considered as core symptoms of psychosis by both International Classification of Diseases-10 (ICD-10) and Diagnostic and Statistical Manual for the Classification of Psychiatric Disorders - 4 th edition text revised (DSM-IV TR). The most common types of hallucinations in patients with schizophrenia are auditory in nature followed by visual hallucinations. Few patients with schizophrenia have persisting auditory hallucinations despite all other features of schizophrenia having being improved. Here, we report two cases where tiapride was useful as an add-on drug for treating persistent auditory hallucinations.