Background: Individuals with eveningness chronotype may be at a higher risk for developing unhealthy lifestyle and cardiovascular risk factors. Screening with traditional biomarkers may not help in detecting children and young adults with such a risk. There is paucity of literature studying novel biomarkers such as Apo B/ApoA1 ratio and highly sensitive C reactive protein (hs CRP) in predicting cardiometabolic risk in this population. Objectives: To study the prevalence of eveningness chronotype in attention-deficit/hyperactivity disorder (ADHD) and to know its association with metabolic risk factors that predict cardiometabolic consequences. Materials and Methods: This cross-sectional study consisted of thirty consenting adolescents and young adults who were on treatment for ADHD. Sociodemographic details were collected and the Morningness-eveningness questionnaire, alcohol use disorders identification test, HIV risk-taking behavior scale-sexual behavior subsection were used to determine eveningness, alcohol use, and risky sexual behavior, respectively. Body mass index (BMI) was measured. Blood investigations high-density lipoprotein, low-density lipoprotein, total cholesterol, triglycerides, Apo B/A1 ratio, lipoprotein A, and hsCRP were sent. Results: The prevalence of eveningness in our study participants was 30% (n = 9). Risky sexual behavior was more among those with eveningness (P = 0.03). Those with eveningness had significantly earlier sexual experience (P = 0.05). Alcohol use was also significantly more in those with eveningness (P = 0.02). There was no significant difference in traditional markers such as BMI, lipid profile for cardiometabolic risk among study participants with or without eveningness. However, Apo B/A1 ratio was significantly more in those with eveningness (P = 0.01). Conclusion: Eveningness chronotype is common in ADHD which could indicate risk for future cardiometabolic consequences in addition to behavioral issues. There is a need for large-scale cohort studies studying cardiometabolic risk and the clinical utility of novel biomarkers such as ApoB/ApoA1 in this population.

Introduction: Psychiatric illnesses such as bipolar affective disorder, major depressive disorder, schizophrenia, and dementia can cause significant burden to patient as well as family members. About 14% of the global burden of disease is attributed to neuropsychiatric disorders. Half of the patients with psychiatric illness reported disability in all three domains of work, social, and family life. Aims: (1) To study if caring for patients with major psychiatric illness will lead to significant caregiver's burden. (2) To find the association between caregiver's burden and psychiatric morbidity among the caregivers. Materials and Methods: It is a cross-sectional study conducted at a tertiary care teaching hospital after obtaining institutional ethical clearance. One hundred caregivers of outpatients diagnosed with major psychiatric illness including schizophrenia, bipolar affective disorder, dementia, and major depressive disorder for a period not <2 years were included in the study. The data were using recorded by means of Mini-International Neuropsychiatric Interview and burden assessment schedule. Results: Caregivers of patients with major depressive disorder experienced significantly less burden than those with bipolar disorder or schizophrenia. Spouses of patients experienced significantly more burden compared to other family members providing care. The study also revealed that caregivers caring for patients with longer duration of illness were found to have higher chance of experiencing moderate or severe levels of burden and that, as the age of the carers increased, they were more likely to experience higher levels of burden and caregivers with lower per-capita income experienced severe burden (P = 0.022). It was observed that several carers had psychiatric morbidities with Generalized Anxiety Disorder (56.9%, n = 45) being most commonly reported. This was followed by Major Depressive episode, current at 22.5% (n = 40) and dysthymia at 17.4% (n = 31). Conclusion: Caring for patients with major psychiatric illness leads to significant caregivers' burden. It can also lead to psychiatric morbidities among the caregivers.

Background: COVID-19 pandemic can significantly affect the mental health of doctors as they stand in the front line of this crisis. The psychiatric consequences, in part, can be due to the stress the doctors are subjected to due to their close involvement in the treatment of infected patients. Some of the other reasons are related to the fear of transmission to their families and concerns about the health of self and family, stigmatization, and rejection. Aims: To assess the levels of depression, anxiety, and stress among doctors working in district COVID hospital, note the possible association of life events with the mental health of the doctors during the current situation and address the coping styles they have sought to endure the current crisis. Materials and Methods: An online survey is conducted to assess the psychological responses of doctors during the COVID-19 outbreak. It consisted of four subsections covering (1) sociodemographic data and information on individuals' working conditions, (2) Depression Anxiety and Stress Scale-21, (3) presumptive stressful life events scale, (4) Brief-COPE. Statistical Analysis Used: Statistical analysis was done using SPSS version 25. Results: Of the 353 participants, 80 had symptoms of depression, 151 anxiety, and 74 stress. Significant levels of depression were found among doctors involved in the direct care of patients with COVID-19 compared to those not involved in direct care. Undesirable events were found to be greater in number than desirable events. Concerning coping strategies, we found the more frequent use of adaptive coping strategies compared with maladaptive coping strategies among respondents. Conclusion: COVID-19 pandemic has a sizeable psychological impact on the mental health of doctors involved in direct and indirect care of patients with COVID-19.

Background: Health-care workers around the world are extending support to contain the COVID-19 pandemic. This unprecedented situation has put the health-care system under tremendous pressure. One of the underrepresented and under addressed area is that of psychological stress experienced by doctors in this time of crisis. Aim: The aim of the study was to evaluate for the symptoms of depression, anxiety, and stress among resident doctors working at a COVID-19 tertiary care center and the factors associated with their mental health status. Materials and Methods: An online cross-sectional survey of resident doctors was conducted over a 10-day period from June 1 to 10, 2020, through e-mail using a 2-part questionnaire – 1^st part included information about sociodemographic profile and factors affecting the mental status and the 2^nd included questions from the Depression, Anxiety, Stress Scale-21 (DASS-21). The scoring cutoffs for the presence of depression, anxiety, and stress symptoms were >9, 7, and 14, respectively. The responses were analyzed using SPSS version 22.0 (IBM) with P value as significant below 0.05 and all tests were two tailed. Results: Four hundred and thirty six out of 620 residents completed the survey yielding a response rate of 70.3%. A considerable proportion had symptoms of depression 132 (30.3%), anxiety 179 (41.1%), and stress 102 (23.4%). Females, first-line workers, those with a past history, and family history of mental illness had statistically significant higher scores on all three subscales of DASS-21. The number of working hours showed a significant positive correlation with symptoms of anxiety (r = 0.138, P = 0.004) and stress (r = 0.108, P = 0.024). Conclusion: One-third of respondents reported experiencing negative emotional states currently, indicating pandemic's psychological impact on frontline health workers. There is a need for mental health interventions targeting frontline health workers who are a crucial workforce in lower middle economy like India and promote their overall mental well-being.

Background: Existing literature around pandemics suggests that preventive measures during lockdown have an adverse impact on psychological well-being across different demographic groups. In particular, parents' stress is somewhat complex and influenced by the demands of looking after children, homeschooling, and an increase in domestic chores and needs exploration and timely attention. Aims: The aim is to study the psychological impact of the COVID-19 pandemic and various associated factors on parents. Settings and Design: This was a cross-sectional study done online using Google Forms sent to WhatsApp groups in an urban setting in Andhra Pradesh, on a purposive sampling basis. Materials and Methods: A purposive sampling approach using a survey questionnaire through WhatsApp produced data from 159 parents who completed the Depression, Anxiety and Stress Scale (DASS-21) short version and the Parental Stress Scale (PSS). Results and Conclusions: Criteria for severe stress on the DASS-21 were met in 47% of parents. Severe anxiety and depression were noted in 39% and 40% of the sampled parents, respectively. Mean parental stress scale score significantly correlated with the depression, anxiety, and stress subscales of the DASS-21. These findings indicate that pandemics and subsequent disease-containment responses such as lockdown may create a condition that parents may find overwhelming and one that could have a negative impact on parents and children. Pandemic planning must address these needs within the disease-containment measures.

Context: To prevent domestic violence against women, it is critical to identify men's attitudes toward violence itself. Aims: This study aimed to examine the relationship between the experience of childhood trauma and attitudes toward violence in male nursing students. Methods: This study included 276 male nursing students. Data were collected using a descriptive information form, the Childhood Trauma Questionnaire Short Form (CTQ-SF) and the Attitudes toward Violence Scale (ATVS). Results: Participants' mean age was 21.61 ± 2.01, 47.5% of them experienced violence, and 31.2% witnessed it. They had low levels of childhood trauma and negative attitudes toward violence. There was a weak-positive relationship between their ATVS mean scores and the mean emotional abuse, physical abuse, and sexual abuse subscale scores (CTQ-SF) (P < 0.05). Conclusions: Nursing training programs should include courses on violence and its perception in society to increase awareness. Because childhood trauma negatively affects the violence perception, there should be support programs provided to students who have experienced it.

Background: Sleep disturbances are commonly seen in mental illnesses such as schizophrenia, bipolar affective disorder, depression, anxiety, and substance use disorders. Even though psychiatric symptoms are treated, sleep disturbances remain to be persisting in some groups of patients. Persistent sleep disturbances could lead to relapse of the disorder per se or could lead to cognitive dysfunction or impairment. Depending on the severity of insomnia, cognitive impairment can vary among remitted patients. Methodology: A total of 200 patients suffering from mental illnesses such as schizophrenia and bipolar affective disorder under remission are taken for the study. After obtaining the sociodemographic profile of the patients, insomnia severity is calculated using the Insomnia Severity Index (ISI) scale and cognitive impairment is assessed using the Montreal Cognitive Assessment (MoCA). ISI scores are compared ith MoCA scores and cognitive impairment is assessed in those patients using statistical analysis. Results: The mean age as found to be 32.08, the mean ISI score is 20.55, and the mean MoCA score is 23.15. ISI score as negatively correlated to MoCA score and age. MoCA score as positively correlated to age. Conclusions: Cognitive impairment, as observed on MoCA score, as more hen the insomnia severity is high and also ith increasing age. Correcting the underlying insomnia in remitted patients is very important in preventing cognitive impairment.

Background: This study aimed to estimate the prevalence and correlates of insomnia symptoms among older adults in India. Methods: The study included 72,262 individuals (45 years and older) from the cross-sectional 2017 to 2018 Longitudinal Ageing Study in India Wave 1. Results: The prevalence of insomnia symptoms was 12.7%, 13.2% among women and 11.9% among men. In the adjusted logistic regression analysis, food insecurity (adjusted odds ratio [AOR]: 1.41, 95% confidence interval [CI]: 1.25–1.59), feeling alone (AOR: 1.64, 95% CI: 1.46–1.83), having 3–5 discrimination experiences (AOR: 1.53, 95% CI: 1.32–1.78), having two or more chronic conditions (AOR: 1.65, 95% CI: 1.46–1.86), high functional disability (AOR: 1.80, 95% CI: 1.63–1.99), poor distant vision (AOR: 1.32, 95% CI: 1.17–1.49), poor near vision (AOR: 1.19, 95% CI: 1.07–1.33), edentulism (lost all teeth) (AOR: 1.28, 95% CI: 1.06–1.55), underweight (AOR: 1.11, 95% CI: 1.00–1.23), and pain (AOR: 1.71, 95% CI: 1.54–1.89) were positively associated with insomnia symptoms. High subjective socioeconomic status (AOR: 0.85, 95% CI: 0.76–0.96), urban residence (AOR: 0.90, 95% CI: 0.81–0.99), and medium social network (AOR: 0.87, 95% CI: 0.79–0.96) were negatively associated with insomnia symptoms. Conclusions: More than one in ten older adults in India had insomnia symptoms and several associated factors were identified.

Background: It is common among medical students to incorrectly believe that they have contracted certain diseases they have recently studied. This belief can be seen in the form of health anxiety and investigating health-related information via the Internet. Cyberchondria denotes repeated online searches for health-related information that are associated with increasing levels of health anxiety. Aims: We aimed to study the prevalence and severity of cyberchondria among medical students and its correlation with sociodemographic and clinical data. Materials and Methods: A cross-sectional study was conducted on 400 consented medical students using online Google Forms. The form included demographic and clinical details and the Cyberchondria Severity Scale-15 (CSS-15) questionnaire. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. The k-means clustering was done for grouping the participants. Spearman correlation and linear regression were done for analyzing the data. Results: The mean age of the participants was 19.28 ± 1.75 years. Females constituted 54.3% of the sample. About 24.5% of the students had previously diagnosed (medical/surgical/psychiatric) illness. The mean score of the CSS was 30.86 ± 9.44. Three clusters with 28%, 66%, and 6% of the students represented the CSS cluster center scores of 19.22 (mild), 34.10 (moderate), and 49.63 (severe), respectively. There was a significant positive correlation between total CSS score and previously diagnosed illness (r = 0.233, P = 0.000) and negative correlation with age (r = −0.151, P = 0.003) and year of study (r = −0.254, P = 0.000). Conclusion: The increasing prevalence of cyberchondria is an example of how digital technology may play an important role in facilitating the development of psychopathology.

Background: The Internet has pervaded our daily lives and is well known to lead to addictive behaviors. Internet addiction (IA) and its influence on quality of sleep have not gained much attention from researchers in India. Aims: We aimed to study the rates of IA and its association with quality of sleep in medical undergraduates. Settings and Design: It was a cross-sectional study evaluating 158 final-year medical undergraduate students at a university in southern India. Materials and Methods: The Internet Addiction Test (IAT) and the Pittsburgh Sleep Quality Index (PSQI) were applied on consenting participants after recruitment using purposive sampling. Statistical Analysis Used: Independent samples t-test was done to evaluate the association of gender with sleep quality. Analysis of variance was done to compare sleep quality in various degrees of IA. Pearson's bivariate correlation was done to see the relationship between the severity of IA and the global sleep quality. Results: More than half of the participants, i.e. 90 (57.0%), had IA, with 2 (1.3%) having severe IA. The rates of IA were similar in both genders. Forty (25.3%) participants were having poor sleep quality as measured by global PSQI cutoff score >5. Participants with moderate-to-severe IA had significantly poor sleep quality compared to participants with mild IA (P = 0.042^*). A positive correlation was seen between IAT scores and global PSQI scores (P = 0.012^*). Conclusions: IA is prevalent in medical undergraduates and has a negative impact on quality of sleep. Severity of IA predicts global sleep quality in the participants.

Web-based survey emerged as an important research methodology in the past two decades, its use further increasing during the COVID-19 pandemic. Need for quick data collection and information processing during coronavirus outbreak and stringent conditions of social distancing and lockdown significantly affected research culture. Several researchers turning toward safer, rapid, and reliable research methodology and adopting web-based surveys as a research tool, it is pertinent to be mindful of various technical and ethical aspects, effective use, and limitations of web-based surveys to uphold the standard of research work.

Frontotemporal dementia (FTD) is a neurodegenerative disorder characterized by progressive degeneration of the frontal and temporal lobes which typically presents with cognitive symptoms. Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder characterized by progressive degeneration of upper and lower motor neurons, leading to symptoms of motor weakness. We present a case of behavioral variant of FTD with ALS. The patient presented with changes in his behavior followed by impaired memory and progressive weakness of bilateral upper limbs. Patient eventually developed difficulty swallowing and recognizing faces too. The case highlights the association between FTD and ALS.

Wilson's disease is an uncommon genetic disorder, in which abnormal copper accumulation occurs in various parts of the body. Approximately 30% of patients debut with neuropsychiatric symptoms posing a diagnostic challenge in the initial phase. In this report, we present a case of a middle-aged woman with Wilson's disease who initially developed neurological symptoms such as shaking of hands and jerky movements of the head and later developed psychotic symptoms. We discuss the unique features of our case. Most patients with Wilson's disease develop psychiatric symptoms at some stage. The index case presented with psychosis, which is less commonly described compared to other psychiatric manifestations in patients with Wilson's disease. Currently, there are no treatment guidelines for the management of the same.

Galactorrhea is a very distressing symptom, especially for unmarried females, and medication-induced galactorrhea is a common etiological factor. Among psychotropics, antipsychotic-induced galactorrhea is commonly reported. However, there is dearth of literature regarding antidepressant-induced galactorrhea. There have been few case reports of galactorrhea induced by the use of selective serotonin reuptake inhibitors such as escitalopram and sertraline. Fluvoxamine is one of the routine first-line medications prescribed for obsessive–compulsive disorder (OCD). However, reports about fluvoxamine-induced galactorrhea have been scant. We report two cases of OCD who developed galactorrhea on treatment with fluvoxamine. One patient had hyperprolactinemia while other had euprolactinemic galactorrhea. In both cases, galactorrhea reversed on stopping of fluvoxamine. The complex interaction of serotonin and dopamine in the pathophysiology of hyperprolactinemia is discussed.

Carbamazepine has been well documented to be associated with Steven–Johnson Syndrome (SJS). The newer anti-epileptic oxcarbazepine has not been demonstrated to be associated with this rare side effect except in some case reports. We present a case of SJS caused due to use of oxcarbazepine in a patient of schizophrenia.