This editorial is the outcome of my clinical, academic and research experience. With due respect to all stake holders, I wish to point out that mental health research has neglected this important aspect; namely, unqualified and untrained people administering and interpreting various rating scales and other assessment instruments. In this paper, I discuss why this issue is so important, and suggest what authorities, especially journal editors could do.

Clozapine is currently the most effective drug to manage treatment resistant form of schizophrenia. It has a unique safety profile different from other antipsychotic drugs. Its use requires close monitoring and management, sometimes for the life time of its use. This adds to the cost of treatment and also negatively influences utilisation of the drug by psychiatrists. This article discusses alternatives to make clozapine use less costly while maintaining its safety, effectiveness and improve its utilisation.

Military psychiatry is a branch of psychiatry that is concerned with the mental health of soldiers and their families in war and peace time. It emerged as a special field of importance after World War I. With changing combat scenarios, peace keeping operations and terrorism modern soldier is obliged to confront and endure wide ranging demands for adjustment; with battle fronts becoming diffuse and coming closer to home unarmed civilians are sucked into war like situations. Military psychiatrists as well as their civilian counter parts need to be aware of the essentials of the mental health consequences of military operations of various kinds and related situations.

Astrology is an ancient system which was said to be predictive of human nature, character and health, it has a very significant history and at times it gives an idea that it is nearly scientific, but, rigorous experiments with the available scientific methodologies of present times. The history of astrology, ancient significance, dictions and contradictions are discussed in the presented paper.

Background: Depression is a common psychiatric disorder. It is a global health problem and a public health concern. There is a need to explore and conceptualize a workable and comprehensive model that facilitates the treatment and prevention of depression in the community. The ecological model that has been used in several health issues may be viewed as an option. Objective: This paper aims to propose an ecological model for depression; the model can describe a comprehensive approach in treating and rehabilitating people with depression. Discussion: Application of a community model in psychiatry was first recorded by Lambo. However, application of the ecological model in treatment, rehabilitation, and prevention of depression has not been recorded. We review and discuss the application of this model in this setting. Conclusion: This ecological approach may be a useful approach in treating and rehabilitating individuals with depression in the community. This may require some degree of community sensitization, empowerment and mental health advocacy.

Confidentiality about the identity and details of the patient with some exceptions is the obligation of the treating doctor. Patients expect the clinician to maintain secrecy about them. There can be various reasons for patients demanding their records and psychiatrist's refusal of the same. With the increased number of institutions to safe-guard various sections of the society or individual rights, the question of disclosing the details of the patient to them on demand will be an emerging issue in the future.

Background: Despite its long history for treating bipolar disorder, lithium use has declined recently due to concerns about its long-term side effects, mainly on the kidneys. Objective: This report provides a summary of the recent findings on this issue. Discussion: Possible intermediate factors in causing kidney damage include: frequent lithium toxicity, prolonged use, nephrogenic diabetes insipidus, and presence of concurrent morbidities known to affect the kidneys. Conclusion: Although data have accumulated about safety of short-term lithium use, the literature on the longterm effects on the kidneys is plagued by poor quality, differing methodology, and small sample size, making it very difficult to approach this issue with confidence.

Background: Attention-deficit/hyperactivity disorder (ADHD) is generally accepted as having a strong genetic basis but environmental influences have also been reported as contributing factors. Among the environmental influences, maternal smoking, pregnancy, labour/delivery and neonatal complications (PLDNC) and disturbed family situations have been implicated most. Aims: To study the pattern and extent of familial and environmental risk factors in children with ADHD attending a tertiary general hospital in India. Methods: The study was conducted in the child guidance clinic (CGC) of Kolkata, India from January 2012 to August 2013. The sample was screened by applying child symptom inventory -4-parent version to all the children of age five to twelve years attending the CGC. Children with IQ< 50 were excluded by Binet Kamat test. The final sample was selected by DSM-IVTR criteria. The parents of the final sample were finally interviewed with a semi-structured proforma to find out the familial and environmental risk factors among them. Results: The final sample was 84 ADHD cases out of total 339 children attending the CGC. Of them, 5.95% had diagnosed cases of ADHD among their siblings and cousins, while nearly 20% had alcohol dependence and bipolarity among parents. There was no maternal substance abuse, but disturbed family situations were found in 32.14% of children with ADHD, mostly contributed by parental mental illnesses. PLDNC were also quite common (nearly 30%) among these children, but no regular exposure to food additives. Conclusions: The extent of ADHD in our CGC (25%) though similar with other studies, the pattern of risk factors are different. There is complex interaction of familial (parental externalizing disorders) and other environmental factors (family situations, antenatal care). The role of inadequate maternal and child health care delivery system is also evident.

Background: Irritable Bowel syndrome (IBS) is a common gastroenterological problem with symptoms causing a significant impact on the quality of life of patients. Psychopathology is associated in most of the cases affecting its overall prognosis. Life stressors influence significantly; either by precipitating or causing exacerbation of symptoms. IBS patients exhibit high levels of neuroticism and introversion. Dietary factors also play a role in IBS .Only few Indian studies reported these aspects in IBS. Aims: To identify the sociodemographic, dietary factors, psychopathology, life events and personality factors in irritable bowel syndrome (IBS) in the Indian context. Methods: Patients having IBS were selected for the study by purposive sampling. Normal controls without bowel symptoms were randomly selected from the population. After taking informed consent; sociodemographic data, diet details and illness details were obtained from all subjects. All the subjects were given a 30 item General Health Questionnaire (GHQ); Hamilton Anxiety Rating Scale (HARS); Hamilton Depression Rating Scale (HDRS); Eysenck Personality Inventory (EPI) and Presumptive Stressful Life Events Scale (PSLE). Parametric and non-parametric tests of comparison were employed in analysis of the data and results were interpreted. Results: IBS group scored significantly more than controls on GHQ scores, HDRS scores, Psychic and Somatic sub scores of HARS and PSLE mean stress scores. There was higher neuroticism score, especially in female patients. Family conflict; illness of family member; financial problems and change in sleeping habits were the frequently reported undesirable life event and going on a pleasure trip was the desirable event reported as stressor in these patients. Dietary sensitivities were significantly higher in patient group. Conclusions: We observed higher psychopathology scores consistent with earlier studies. In addition to undesirable stressors, going on a pilgrimage was the only desirable stressor associated with symptom exacerbation which was not reported earlier. Food sensitivities were significantly higher in IBS patients consistent with earlier studies.

Background: The last decade had witnessed an unprecedented growth in social networking sites. To some it seems a boon when it comes to belongingness, while, to others it is a cause of concern because of many psychological issues related to them. Aims: This study was designed to find whether the facebook variables are associated to narcissism and loneliness. Also, age and gender differences are studied with respect to narcissism, loneliness and facebook variables. Methods: A cross-sectional, questionnaire based online survey was carried out on facebook users who, reported questions regarding their demographics, use of facebook and completed NPI-16 and a three-item loneliness scale. Results: Facebook users (N=107), aged 18 to 45 years voluntary participated and completed the survey. Results found that facebook profile features (self rating of profile picture, status updates and number of photos) predicted Narcissism while status updates, number of friends and time predicted loneliness. Also age and gender brought significant differences among facebook users on the scores of narcissism, loneliness and facebook variables. Conclusion: Narcissism and loneliness are found to be associated with facebook variables after controlling age and gender. It may be concluded that facebook might be serving as a platform to narcissists where they can present idealized images of themselves. Also indulging in certain facebook activities might be helping the users to elevate their loneliness. Also differences in narcissism, loneliness and facebook variables are accounted to age and gender.

Background: Schizophrenia being a debilitating illness leads to deterioration in occupational, interpersonal and self supporting abilities. This can pose numerous psychosocial difficulties for patients as well as family members who care for their loved ones resulting in burden of care. Due to the chronic stress of caring for these patients many caregivers develop psychiatric symptoms. Aims: This study was undertaken to assess the burden perceived by caregivers of schizophrenia patients, impact of socio-demographic and patient variables on perceived burden as well as the presence of psychological distress in the caregivers. Methods: 54 patients diagnosed as having schizophrenia as per the DSM IV TR with a duration of illness of two years or more and their caregivers were evaluated using the appropriate psychometric instruments to measure burden, anxiety and depression in caregivers. Results: Our study showed that overall burden perceived was 22.2% with no significant difference between the caregivers of either sex and burden perceived by the caregivers of the sample studied also had a significant impact on their anxiety and depression. Conclusion: Care-givers of schizophrenia patients experience burden as well as psychological distress secondary to caring for a relative with a chronic mental illness.

Background: Stress, anxiety and pathological personality traits are the risk factors implicated in the development of coronary heart disease (CHD). Aims: The purpose of this study to investigate the relation of stress, anxiety and type-A behaviour in the development of CHD. Methods: A sample of 81 CHD patients was selected from coronary care unit (CCU). A matched sample of 81 normal (controls) was selected after the medical checkups by the clinician who labelled them as ‘normal’ as they were not suffering from any disease. The two groups were assessed for the presence of stress, anxiety and type-A behaviour. Results: Significant differences exist between CHD patients and Non-CHD individuals on stress, anxiety and type-A behaviour. The CHD patients scored more on stress, anxiety and type –A behaviour. Conclusion: There is a contribution of stress, anxiety and type-A behaviour in the development of CHD.

Background: Age six to twelve years is a very critical stage in a child's life when the child develops a sense of inferiority or confidence depending on the nurturing and the milieu he is brought up. Many children belonging to disadvantaged families do not get proper education and care to enable their complete development. In this study, we aimed to examine the importance of education institutions that cater to disadvantaged children and their role in cultivating identity and confidence in children. Aims: To study if there is any difference in the adjustment between I standard and III standard students enrolled in a school that provides free holistic education for the children growing up in the slums of an urban city. Methods: Our study sample consisted of eighteen students each from I and III standards from a school for disadvantaged children from an urban city. Preadolescent adjustment scale (PAAS) was administered and the scores were noted and subjected to statistical analysis. Results: There was a significantly higher general, school and peer scores on PAAS suggesting better adjustment in the students of III standard than I standard students, but no change was observed in teacher scores of PAAS. Conclusion: The programs and tutelage given by the school is ameliorating student's attitude towards education and making them more adjusted and comfortable with going to school. This is critical in bringing the slums of India forward and decreasing the gap between the rich and the poor.

Background: Chronic mental illnesses can impact the life of the partners who care for the patients. Aims: The present study examined the quality of life (QOL) of respondents who were giving care to their spouses with schizophrenia. It also aimed to explore gender and age related differences in various dimensions of their QOL. Methods: The respondents (n=304) were so selected that for half of them wives were diagnosed with schizophrenia (hence, the husbands were the caregivers), while for the other half, husbands were diagnosed with schizophrenia (hence, the wives were the caregivers). The type of study is cross sectional. Results: QOL was assessed through four domains of well-being, satisfaction of basic needs, self-care activities and marital happiness. Data analysis using basic statistics and 2x4 ANOVA supported the first hypothesis that predicted gender difference in the QOL. Male caregivers of wives with schizophrenia were found to report higher wellbeing (Mean=37.75 and 33.28), greater satisfaction of basic needs (Mean=45.37 and 38.98) than female caregivers. Results failed to support the second hypothesis that predicted better QOL for younger respondents. The main effect of age was significant with respect to only one out of the four domains of QOL - satisfaction of basic needs. Respondents in the two middle age groups (36-45, 46-55) reported greater satisfaction of basic needs (M=42.17 – 43.76) than those in the younger and the older age groups (25-35, 56-65) (M=41.32 and 41.45 respectively). Conclusion: Chronic illness of a spouse in the marital dyad may be one factor confounding the complications, particularly if the partner giving care to an ill spouse is a woman.

Background: The reasons for an adolescent to start smoking are mainly psychological. A proper assessment of these factors can help us reduce the prevalence of smoking among youth and save them from both its short term and long term harmful effects. Aims: To study the prevalence of tobacco usage through cigarette and hookah smoking in the age group of 17-22 years and find out the factors mainly responsible for the prevalence. Methods: A Cross sectional community based study was conducted among students of different colleges (inter and degree) of Hyderabad of the age group 17-22 years using a predesigned and pretested questionnaire. Results: Different psychological reasons such as to manage stress, to look stylish etc and misconceptions like hookah smoking is less harmful than cigarette smoking were responsible for the prevalent smoking habit among the individuals. Conclusions: There is no single way to prevent youth smoking. A proper understanding of the responsible factors will help promote smoking prevention programs. The nature of the social influence may well change with age. Close friends may exert different types of influences at different ages, and smoking may take on different roles in establishing and maintaining friendships at different ages or for different youth. Understanding the role that smoking plays in the interactions of youth and how this role might vary or change with age is an area that is ripe for research.

Background: Olanzapine is an atypical antipsychotic widely prescribed in schizophrenia patients because of its better tolerability. Clinical picture due to olanzapine over dosage can be confusing in the emergency department. Also often the patient would be drowsy to provide adequate information regarding the method of self harm attempt. Case description: We are reporting a case of olanzapine over dosage which presented to the emergency department with pin point pupils, lacrimation, and hypotension and semi conscious state. Discussion: Organophosphorous poison consumption is one of the common methods of suicide in rural south Indian setting which presents with miosis, respiratory depression and unconsciousness. Pontine hemorrhage is one more condition apart from opiod intoxication which presents with pin point pupils and altered mental status. Conclusion: We attributed olanzapine over dosage as the cause of pin point pupils, lacrimation and drowsiness in our case as other causes were excluded.

Background: Delirium is a common disorder, and can occur in children and adults. It is short lasting, with duration ranging from hours to days. However, prolonged delirium can occur in people with brain damage. Hypoxic ischemic encephalopathy (HIE) is a condition that occurs when the entire brain is deprived of adequate oxygen supply. HIE results in neurological injury and long term dysfunction. Outcome of HIE ranges from significant changes in personality, impairment in memory, cognition and attention, to coma and vegetative states. Only a quarter of patients survive to be discharged from hospital. There are very few case reports of prolonged delirium secondary to HIE following hanging. Case description: A 27 year old Asian man with alcohol dependence syndrome developed prolonged delirium (more than two months) following HIE subsequent to hanging. Discussion: Prolonged delirium has been reported in 1/3^rd cases of delirium. Risk factors for prolonged delirium are increasing age, severe delirium, increasing number of medical conditions. Prolonged delirium was found to be associated with poor functional outcome and increased mortality. Conclusion: Our case report highlights the importance of early detection and management of prolonged delirium.

Background: Phenomenology, the study of subjective experiences, is a valuable diagnostic tool. All experiences reported by patients may not readily fit into classically described phenomenological terms, even when diagnosis may be obvious due to other symptoms. Research into case studies with rare, indefinable phenomenology will definitely enrich n the understanding ability of abnormal human experiences and help us develop cognitive constructs. Case description: Here, we report case reports of two patients who voiced experiences that, by passed typical phenomenological labelling. Discussion: This case report provides food for productive thought and debate among clinicians.

Skinner was the most influential American psychologist, behaviourist, author, inventor, and social philosopher. He is regarded as father of operant conditioning. He is famous for his research on schedules of reinforcement by using animals in Skinner box.