Background: Eating Disorders (ED) were largely thought of as a western phenomenon; however studies have shown that these disorders exist in India. The exact incidence & prevalence of ED is not known in India. We present data from a 10 year retrospective chart review from a tertiary care child and adolescent psychiatry centre in India. Methodology: A 10 year (March 2002-March 2012) retrospective chart review of children and adolescents (up to 16 years) who had attended the child and adolescent psychiatry outpatient services at our centre and diagnosed to have Eating Disorders according to ICD-10 were included in the study. Results: The 10 year prevalence rate of eating disorders was 0.063%. Eating disorders was more common in females (83.3 %)( n=10) in this sample. The female to male ratio was 5:1. The mean age at presentation was 14.42 years (SD 1.08). 83.3% had a co-morbid psychiatric disorder with obsessive-compulsive disorder and depression being the most common. Conclusion: The prevalence of eating disorders was low, however further epidemiological studies are required to ascertain community prevalence of eating disorders. The rates of psychiatric comorbidity including suicidality are high. Therefore, both eating disorders and comorbid psychiatric disorders require a thorough evaluation and holistic management.

Background: There is a growing interest in the study of obsessive compulsive disorder (OCD) in patients with bipolar affective disorder (BD). However, very few studies compared BD with OCD (BD+ OCD) and BD without OCD (pure BD). Aims: We studied the prevalence of OCD in BD patients and compared the socio-demographic and clinical features of BD patients with and without OCD. Methodology: This was a cross-sectional inpatient study on 112 treatment seeking BD patients. The symptoms were rated on Young's Mania Rating Scale, Hamilton Depression Rating Scale and Yale-Brown Obsessive Compulsive Scale. Results: The prevalence of OCD in our sample of BD patients was 33.03%. There was a statistically significant difference between the BD-OCD and BD+OCD groups as regards age (P=0.000), education (P=0.023) and socioeconomic status (P = 0.000). Also, the mean age of onset of first mood episode (P=0.002), harmful use / dependence on substance (P=0.002), suicidal attempts (P = 0.009), past history of treatment (P=0.000) and hospitalizations (P=0.000) and family history of OCD (p=0.000) reached statistical significance. Conclusion: The existing evidence suggests the presence of a specific subset of BD patients characterised by OCD comorbidity that may need different therapeutic strategies. There is a need for follow-up treatment studies to assess how these BD patients progress compared to those without OCD.

Background: Psychiatric stressors and morbidity can be both cause and effect of myocardial infarction. Various life events acting as psychological stressors can precipitate acute myocardial infarction. Acute MI can lead to plethora of psychiatric morbidities, including various degrees of depression and anxiety. Studies from India are scarce on the subject. Aims and objectives: To assess the occurrence of stressful life events and level of psychiatric morbidity (anxiety and depression) in the post myocardial infarction period among myocardial infarction patients and to compare them with a randomly selected non-myocardial infarction control group. Methods: The study was an analytical cross sectional study, conducted in a tertiary care teaching hospital. The study subjects consisted of 50 patients with present acute MI episode, 50 post MI subjects after 6 months of MI episode and 50 healthy controls. Presumptive Stressful Life Event Scale (PSLES) was used to assess stressful life events, DSM-IV TR Diagnostic criteria and Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were used to assess the severity of depression/anxiety. Results: The proportion of people with 2 or more stressors was higher in MI group, compared to non MI group (82% Vs 60%). The proportion of moderate and severe depression was 34% and 10% in post MI group, where as it was 2% and 0% in control group. The proportion of subjects with anxiety was higher among post MI group, compared to controls. The proportion of moderate and severe anxiety was 12% and 24% in post MI group, where as none of the subjects in control group had anxiety. Conclusions: There is a strong association between stressful life events, depression, anxiety and Myocardial infarction.

Background: Comorbidity is common in psychiatric disorders, and schizophrenia (SZ) is no exception. Anxiety disorders (AD) are frequently reported; however different rates are reported across different cultures. Aims: To study the prevalence of ADs in Indian SZ patients, and to compare SZ patients with and without ADs. Methodology: One hundred SZ patients with a mean age of 33.22 (+ 2.12) years, were assessed for comorbid ADs, and rated on various illness severity instruments, such as PANSS and HAM-A. Results: The prevalence of ADs in our sample of SZ patients was 63%, while 48% had more than one AD. The most common comorbidity was social anxiety disorder (24%) followed by obsessive-compulsive disorder (17%). This comorbidity was independent of PANSS severity ratings. Conclusion: The prevalence of ADs in SZ is high. The clinicians should be aware of this high comorbidity and treat them appropriately as ADs may worsen the prognosis of SZ.

Background: Medication non compliance is a common and difficult problem in the treatment of chronic disorders in general and psychiatric disorders in particular. This results in relapses, exacerbations, recurrences and frequent hospitalizations. It affects the quality of life of patients and increases the caregiver burden of the family members. Among various factors which affect non compliance patients attitude to drugs is one potentially modifiable aspect which is attracting attention in patient care. Aims: To study the attitude of patients with schizophrenia and bipolar affective disorder towards drugs and modify any negative attitudes about the drugs. Methodology: Apart from the sociodemographic variables, Drug attitude inventory (DAI) was used to assess the attitude of patients and WHO- Quality of Life (WHO-QOL) was used to assess quality of life of study group patients both at the baseline and during the follow-up. Results: In the bipolar group, 80% of the participants achieved good compliance status from the baseline of 17.8% and in the schizophrenia group 82.2% achieved good compliance compared to 20% at baseline. Their quality of life also improved in all domains. Conclusion: Carefully planned medication counseling to patients and family members and appropriate corrections in the medication appears to show great change in compliance. A little effort put in by treating team can change the quality of life of many patients with psychiatric disorders.

Aims: To assess the attitude of MBBS students toward concept and practice of Psychiatry between first year and final year MBBS students who attended clinical Psychiatry posting. Methodology: A cross-sectional analytical study was carried out. Attitude was measured with 30 item attitude to psychiatry (ATP-30) questionnaire. Results: Attitude toward psychiatry was found to be better in groups of medical students who attended 2 weeks clinical rotation in Psychiatry. However, the same reached statistical significance in only 36.7 % of the questions. Conclusion: Clinical rotation in psychiatry in undergraduate has a favorable effect on attitude of medical students toward concept and practice of psychiatry. Better curriculum and more hours in psychiatry may yield better gain.

Background: Emotion Regulation therapy (ERT) is an integrative therapy for anxiety disorders. ERT focuses on treating the emotion regulation difficulties found to be common underlying etiological factors across anxiety disorders. Case description: The present case report describes application of Emotion Regulation Therapy (ERT) in a client of social anxiety disorder (SAD) with comorbid depression and anxious avoidant personality disorder (AAPD). Rationale for using ERT in SAD, ERT case conceptualization and therapy process are explained. Client received 16 weekly sessions of ERT. Nature and severity of social anxiety, emotion regulation difficulties, depression, general anxiety and clinical global functioning were assessed at pre intervention, post, one month and three months after the intervention. Conclusion: There was improvement on all the outcome measures with the gains maintained over six month period. Results of the study with reference to the implications of using ERT are discussed.

Background: The relationship between eating disorders and schizophrenia is not clear. In most of the cases where foreign body ingestion was observed in patients with schizophrenia, often some relation to their auditory hallucinations was observed. In some it may be due to their delusional beliefs. Case description: We report a case of 38 year old man who presented with pain abdomen to the emergency department. Initial evaluation and physical examination suggested probable intestinal obstruction. Radiographic imaging suggested multiple metal objects in the stomach. Total of 39 objects including rods, screws, pens, wooden sticks, tooth brush, disposable syringes and distilled water bottles were removed from his stomach by surgery. Patient also gave a history of eating cockroaches and lizards. Detailed history obtained from patient and other sources revealed that patient is having schizophrenia for more than ten year duration and he never was treated for this.

Margaret Schonberger Mahler, a Hungarian psychoanalyst, was born in a Jewish family. Her main interest was in normal childhood development, but she spent much of her time with psychiatric children and how they arrive at the “self”. Mahler developed the Separation-Individuation theory of child development, as well as the concept of object constancy. Present paper presents a brief overview of her life and contributions.

“Sexual Violence Against Women” has been a burning topic in the print and electronic media in the last decade and it has become a topic of concern for people living in contemporary India as it poses several mental health issues in all classes of people. Sexual violence against women is a serious and prevalent problem worldwide, in all religions and social classes. WHO reports, overall 35% of women worldwide are experiencing either physical and/or sexual intimate partner violence or non-partner sexual violence. Several studies have shown that sexual violence is more widespread in societies where women's rights are lacking and are neglected (Koenig et al, 2006:132; Kimua et al, 2012:773). It is not only a fundamental violation against human rights but it also damages physical and psychological well-being of individuals and families. The physical damage can lead to unwanted pregnancy and sexually transmitted diseases such as HIV/AIDS; mentally, it can further lead to post-traumatic stress disorder and depression (WHO, 2010:3; Johnsson-Latham, 2010:3).

Background: Obsessive-compulsive disorder (OCD) is typically treated with exposure and response prevention (ERP). However, many patients may not respond satisfactorily to classical ERP. This study is an attempt to evaluate the efficacy of Mindfulness Integrated Cognitive Therapy (MICT) in the treatment of OCD. Methodology: In this study, 10 participants with OCD underwent outpatient MICT. They were assessed on measures of OCD, anxiety, depression, quality of life, mindfulness, quality of life. An independent rater assessed the participants on symptom severity of OCD. Results: Following MICT, the 10 participants showed reduction in symptoms of OCD, anxiety and depression and increase in mindfulness, psychological flexibility and quality of life.

Background: This study examines the short term course and outcome of children and adolescents diagnosed to have Attention Deficit Hyperactivity Disorder (ADHD) and treated from an out-patient service of a tertiary care centre in India Methodology: 63 children were diagnosed to have ADHD of whom 39 children were available at 6 months for a face- to –face follow up. The tools used were MINIKID, Vineland Social Maturity Scale, Attention Deficit Hyperactivity Disorder-Rating Scale –IV (ADHD-RS), Children's Global Assessment Scale (CGAS) and Clinical Global Impressions Scale. Results: The clinic prevalence of ADHD was 10.5%. ADHD- combined was the most common subtype (92.1%). At the end of 6 months, 84.6% continued to fulfill criteria for ADHD. The mean baseline ADHD-RS and CGAS scores significantly improved over the period of follow up. Severity of illness at baseline and presence of oppositional defiant disorder predicted poorer outcome at 6 months. Conclusion: ADHD is a stable disorder. Severity of symptoms and functionality significantly improved in children and adolescents with treatment as usual in the clinic setting. Oppositional defiant disorder and severe forms of the illness require particular attention during management.

Background: Neuropsychological impairment is another common complication of coronary artery bypass graft (CABG) surgery, and the incidence of these deficits ranges from 25% - 80%. Emotional states such as depression and anxiety can influence neuro-psychological test performance. Postoperative cognitive dysfunction has been linked to the presence of delirium and occurs transiently in the majority of cardiac surgical patients. Coping is perceived as a cognitive approach, and the coping strategy is a product of the individual's appraisal. Aims: To assess the neuro cognitive performance and coping styles among patients undergoing coronary artery bypass graft (CABG) surgery. The tools used in this study were Addenbrook's Cognitive Performance Scale and Briefs Coping Inventory. Results: The average of 95 (96%) of patients had mild cognitive impairment and only 4 (4%) had normal cognitive performance preoperatively. 80 (80.8%) were shown mild cognitive impairment and only 19 (19.1%) were shown normal cognitive performance post operatively. 52 (52.5%) of the patients with coronary bypass graft surgery used moderate adaptive coping styles, 40 (40.4%) were used maladaptive coping styles and 7 (7.1%) of patients used adaptive coping styles preoperatively. 30(30.3%) of the patients showed maladaptive coping styles, 55(55.5%) of the patients showed moderate adaptive coping styles, and only 14 (14.1%) showed adaptive coping styles postoperatively. There was statistically significant association between the coping styles of CABG patients with their comorbid conditions ( P=0.042 at P=0.05 level) and there was no statistically significant association with other demographic variables. Conclusion: The present study indicated that patients with mild cognitive impairment could be at risk for sustained feelings of depression after surgery. Most of the patients need psychological support and understanding of the procedure and life style modifications after surgery.

Background: The elderly age group comprises a particularly vulnerable group as they often have multiple co-existing medical and psychological problems. Depression is the commonest psychiatric illness in the elderly and various factors unique to old age play a role in the occurrence of depression. Aims: To study the role of socio demographic factors associated with depression in medically ill geriatric population, and study the role of disability, social support, stress full life events as factors for depression in medically ill geriatric population. Methodology: A cross sectional study was carried out in geriatric patients attending Mamata general hospital, Khammam. Study sample was 105 and they were assed using the following tools: 1) Semi structured schedule 2) MMSE 3) GDS 4) HRDS 5) MDPSS 6) PSLES 7) IADL Results: The prevalence of geriatric depression in our study was 40.95%. Our study found statistical significant difference between unemployment (P=0.001) and depression in medically ill geriatric patients. Socio-demographics with prevalence of depression, no difference between gender, locality, marital status, education, family and depression in geriatric patients. There is a significance (p=0.0001) between perceived social support and depression. Conclusion: Depression is more prevalent in geriatric population. Unemployment, perceived social support and stressful life events plays significant role in causing psychiatric morbidity in geriatric population.

Background: Globally there is an increase in elderly population. Psychiatric morbidity is also increasing in elderly owing to increased longevity and changing social circumstances. Aims: To study the prevalence of psychiatric disorders in rural geriatric population living in an old age home and in the community. Methodology: Mini Mental Status Examination, Geriatric Depression Scale, Patient Health Questionnaire and Brief Psychiatric Rating Scale were used to screen for psychiatric disorders. Hamilton Rating Scale for Depression was used to quantify depression. SPSS 20 was used for statistical analysis. Results: Psychiatric disorders were more prevalent in individuals aged > 80 years(72%). Predominant psychiatric diagnoses were depression, dementia, somatic complaints, alcohol dependence, panic attacks and GAD. Presence of dementia was associated with increased age. Depression was associated with Low education status, female sex, involuntary admission in old age home, presence of physical illness and visual impairment. Individuals in old age home had lesser prevalence of psychiatric disorders than those in community. Conclusion: The overall prevalence of psychiatric morbidity was 59.2%. Psychiatric morbidity was less in old age home population owing to better availability of care, less number of social stressors etc. The study highlights the importance of delivery of structured care facilities in elderly population.

Background: Both work and family are central to one's life but these roles do not always readily reconcile, in particular when workers are faced with major stressors in the work place and long working hours, such as in police service. Balancing work and family life has become an increasing challenge for police personnel. Aims: 1) To study the Work – Family conflict, Organizational and Operational stress in Police personnel of Visakhapatnam region and the relationship between them. 2) To study the work-family conflict and occupational stress in relation to sociodemographic variables. Methods: The study sample consisted of 141 police personnel. The socio-demographic data was individually collected from them. Netemeyer et al (1996) work-family conflict was used to measure Work-Family conflict. A scale developed by Netemeyer et al (1996) was applied to measure family-work conflict. The Police Stress Questionnaire ([PSQ], McCreary&Thompson, 2006) was used for assessing psychological stress. Results: The stress is influenced by the amount of conflict experienced between the role requirements of work and home.

Attention deficit hyperactivity disorder (ADHD) is a psychiatric disorder of neurodevelopmental type characterized by inattentiveness, hyperactivity and impulsiveness. Batten disease is said to be the commonest form among neuronal ceroidlipofuscinoses (NCL). Though it is rare, it begins in childhood as fatal neurodegenerative disorder. We are presenting a rare case suffering from a combination of these two disorders and the management was a challenging task

Background: CBT for psychosis (CBTp) has received significant research attention as an effective approach for treatment resistant psychotic symptoms. However its application to clinical practice can be challenging and may need modifications to suit client needs. Case description: Mr. J, a 45 year old single male, diagnosed with paranoid schizophrenia was referred for the management of persistent auditory hallucinations and associated beliefs and distress. Client was maintaining well since 15 years however symptoms had exacerbated since six months. Assessments were carried out using behavioural analysis, Beliefs About Voices Questionnaire. A cross sectional formulation incorporating beliefs and coping strategies were adopted. Results: CBTp was carried out on an outpatient basis over 15 sessions over one month. At termination, there was significant improvement in frequency of vices, intensity of voices and conviction of beliefs that was maintained at follow up at seven months. Conclusions: In clinical practice it is feasible to modify strategies and techniques within CBTp to address symptoms, when ideal conditions to carry out therapy are not present.

Carl Gustav Jung was a Swiss born psychiatrist, psychoanalyst, journalist, inventor, a prolific writer and the founder of analytical psychology. His work has been influential not only in psychiatry but also in anthropology, archaeology, literature, philosophy, and religious studies. He considered the concept of individuation to be the main task of human development and is best known for some of the psychological concepts like synchronicity, archetypal phenomena, the collective unconscious, the psychological complex, and extraversion and introversion.