Unlike my other editorials published in AP J Psychol Med, the views expressed in this editorial are not completely my own; hence, most of the information is in quotes. I tried to summarize the published literature related to editorial independence. The sole aim is to make all the stakeholders aware of the concept of ‘editorial independence’. The societies have the duty to create an atmosphere where editors feel secure. With humility I would say, to my knowledge this is the only published article on ‘editorial independence’ from India, and possibly other neighbouring countries. Let me sincerely say, this is not a grandiose expression. I stand to be corrected.

Medicine and its practice have a responsibility not to cause harm. Ethical values lie at the heart of clinical practice. Ethical values are even more important in psychiatry –a medical discipline where its practitioners have been handed responsibility for detaining and treating patients against their will. This responsibility needs to be taken seriously and utilised within the context of clinical practice and ethical values. Various organisations have developed codes of ethical practice and it is vital that practitioners are aware of these. These codes include respect for patients and standards of clinical practice. The basis of these codes is reliant on the concepts of principlism which includes respect for autonomy, beneficience, justice and nonmaleficence. These also impact on human rights and influence outcomes. Ethics must form a part of the curricula at all levels.

Despite the introduction of new antipsychotics and improved access to Clozapine over the last 50 or so years, the clinical outcome for people with schizophreniform illnesses has shown little demonstrable improvement. Over the same period of time, a range of evidence based psychological interventions have been developed. Health services research suggest that only a small proportion of people with serious mental illness receive these evidence based psychological interventions. This editorial will focus on reviewing the psychological and psychosocial interventions that have been developed for psychosis and consider what mental health services may need to do to improve the symptomatic and functional outcome for their patients with schizophrenia.

Medicine is one of the oldest professions and has certain professional imperatives and rules. Training of medical professionals is prolonged and often intense and also expensive. It is strongly influenced by cultural values and context and social needs. Over one hundred years ago Abe Flexner reviewed the medical school training in the USA and made some clear recommendations. We believe that some of these observations have a key role to play in medical education at the present time in India. In this brief editorial we raise some of the pertinent factors.

Background: There are many techniques being followed in marital or couples therapy for the resolution of marital discord. In the particular module of Conjoint collaborative therapy where joint sessions with the couple run concurrently with individual sessions for each partner, an additional issue crops up which may influence the outcome independently of the marital therapy: resolution of individual psychopathology may have beneficial effects in strengthening the marriage, but may also have the opposite effect. Individual ego strengthening may disturb the homeostasis which has kept the dysfunctional marriage together. Objective: To study individual ego strengthening as a dynamic factor that influences the course and outcome of marital therapy. Discussion: It may be that many marriages which are held together because of the pressures from without rather than the desire from within may find the dynamics changed by therapy. If the individual sessions are going well, it may be that the benefits there may outpace those in the joint sessions or the progress in the relationship. Conclusion: With the resolution of individual crisis, one or both partners may no longer be willing to carry the relationship forward and a separation is the result. The individual may benefit from the ego strengthening, but it proves deleterious for the relationship. This paper explores the dynamics that may be involved in this event.

Background: Emotions are generic and central to most of the theories and therapies in psychology as well as an important criterion in the psychopathology of various psychiatric disorders. Though the terminology and techniques are varied, every school of therapy attempts to address emotions. Recently there is an increased focus on addressing emotions in psychotherapy. Objective: This paper aims to trace the significance given to emotions in psychological theories and therapies as well as to understand and evaluate the current status of therapeutic interventions addressing emotions. Discussion: There is obvious increase in the importance given to addressing and assessing of emotions. Emotions have become the focus of therapy and an important outcome variable in many recent therapies. However, there is still a lack of systematic assessment methods, measures as well as specific therapeutic components to address emotions. There is also lack of clarity in the terminologies used to refer to ‘emotions’. Finally, the processes and therapeutic factors leading to better emotional regulation are in their nascence and needs systematic exploration. Conclusion: Certain processes such as experiencing deep affect in therapy, depth of processing, reflection on emotions, understanding roots of emotions and using positive emotions to deal with negative emotions are seen to result in positive change. However, there is need for uniform use of terminologies, quantitative and qualitative assessment and methodologies and theoretically grounded therapeutic components to address ‘emotions’ in psychotherapy.

Background: Foreign body aspiration is a common life threatening emergency, but, largely a preventable problem. The object aspirated depends on various factors, such as age, sex, occupation, geographical area, socio-cultural factors, economic status, and nutritional habits. In recent years some traditional/social habits and fashion trends of using headscarf/ hijab pins have become a discrete category of foreign body aspiration in young Muslim/Islam girls wearing headscarves. Objective: To highlight the increasing number of cases coming to clinical attention with headscarf pin aspiration. India having a growing population which is young and fashion oriented, the awareness of this problem needs to improve. Discussion: In recent times young adolescent Muslim girls use multiple matching small headscarf pins to fix the hijab as a fashion trend. Adolescent girls and adults tend to hold the headscarf pin between their lips while wearing the headscarves using their two hands to secure the veil. Lack of concentration or activities such as laughter, talking, and coughing predisposes them to aspiration, especially in young teenage groups where they lack experience in such manoeuvres. Conclusion: Accidental foreign body aspiration to a large extent is a preventable problem and more so in the case of headscarf pin. Appropriate interventions need to be planned as more young population is getting involved.

Background: The risk faced by elderly people living in Great Britain of accidentally harming themselves by taking potentially lethal mixtures of medicines is high which was found in the survey of 695 people aged between 78 and 86 years old, living in 24 sheltered housing complexes in Scotland. Aim: To find out the profile of patients attending an inner city hospital after taking overdose which would in turn help understanding of the reasoning for overdose. Method: The socio-demographic profile of adults attending the inner city hospital in the United Kingdom was recorded and studied for over dose. It was a retrospective study with recordings from the medical case notes during admission in January 2008 – January 2009 who were brought to the accident and emergency department. Results: Average age of 48.67 years with more number of males (n=17) compared to females (n=13), predominantly White British (76.7%) individuals attempted overdose. Out of the sample studied 86% were found to be deliberate overdose, intent to die was recorded to be present in 63.3%. Multiple reasons for overdose were predominant (40%) which includes relationship difficulties, pain, debts, feeling low / depressed, argument, bereavement and stress. Types of medication for overdose, recording made in medical notes regarding overdose has also been studied. Conclusion: There is a significant psychiatric morbidity among patients who overdose and appropriate psychiatric liaison services are needed to manage patients. Further studies focusing on the patterns of overdose, timing, medication prescriptions and age of patients are necessary to further explore the understanding of overdose.

Background: There is continuous change in the demographic structure with aged people growing rapidly in proportion to the younger ones. Understanding quality of life of aged is important. The Kashmir region in northern state of India has witnessed a lot of disturbance, leading forced migration. The young adults who had experienced a great stress while fleeing from their homeland are now mostly falling within the aged category of the population. Their in-depth assessment of quality of life is necessary as this group of aged people has already borne great trauma and are still not properly settled. The findings from the current study may be utilized for developing tailored interventions for the aged migrant people. Aim: This research is an attempt to study gender differences in quality of life among aged Kashmiri migrants residing in Jammu. Methods: Using the simple random sampling data was collected from 280 aged Kashmiri migrants residing in Jammu since 1990. The mean age for the entire sample was 68.49 years. WHOQOL-BREF was used to assess quality of life. Data were collected individually with the help of research assistants proficient in speaking Kashmiri. Results: Results of t test show there are differences in physical health, psychological health, and social relationships of male and female aged Kashmiri migrants. The male aged Kashmiri migrants were better on these domains of quality of life. There was no difference between the two on environmental health. Conclusion: The study revealed that the aged Kashmiri Migrant women need more attention so that their quality of life is enhanced.

Background: There are few studies of depression in Indian population which have looked at depression comprehensively covering various facets in a sample population. The objective of the current study was to recognize the clinical features and comorbidities of depression among inpatients in a tertiary care centre. Method: This was an observational study in which 50 patients admitted with ICD-10 diagnosis of depression were assessed for clinical symptomatology and comorbidity. Results: The mean number of somatic symptoms was 11.44 (SD 6.66), and the mean number of stressful life events over lifetime and in past 1 year were 8.02 (SD 3.8) and 1.44 (SD 1.18), respectively. One fifth of the sample (20%) had personality disorder; among them, mixed personality disorder (12%) was the most common diagnosis. Most of the patients had suicidal ideation (62%) and 26% had attempted suicide during their lifetime. Majority (60%) had atleast one psychiatric comorbidity; the most common being anxiety disorder (46%). Physical comorbidity was present in 54% of the patients; the common diagnoses were hypertension (18%), diabetes mellitus (14%) and ischaemic heart disease (12%). Conclusion: The current study found somatic symptoms and suicide ideation to be frequent in the sample. Also, comorbid conditions including personality disorders are frequent in patients with depression.

Background: Female sterilization a popular contraceptive procedure that results in loss of reproductive function whereas hysterectomy, the surgical removal of uterus results in loss of both reproductive and menstrual function. These are important events in women that are found to be contributing for psychological problems as these are related with feminine identity. Though the usual age at operation is different for both the groups, the concerns are same like feminine identity and sexual life. Aim: To compare and study the psychological problems in terms of depression and anxiety and sexual problems in women who have undergone female sterilization and hysterectomy and also to find out whether these procedures affect quality of life; and, also to study whether better information education communication (IEC) activities, round the clock medical services and careful selection of cases have impact on outcome of these procedures. Methods: A cross sectional epidemiological Study conducted in urban slums by administering semi structured questionnaire and instruments like Hospital Anxiety and Depression scale(HADS), World Health Organization Quality of Life-BREF scale (WHOQOL-BREF). Results: Though the hysterectomy group showed slightly higher mean scores in terms of anxiety and depression but they are not statistically significant. Quality of life was good in all domains in both groups where as sexual problems are slightly more in hysterectomy group. Conclusion: Thus the knowledge about procedure, round the clock medical facility, careful selection, pre procedural distress has impact on outcome.

Background: ADHD is a heterogeneous disorder with a prevalence ranging from 4- 7%.It is associated with comorbidities like oppositional defiant disorder, conduct disorder, mood disorders, anxiety disorders, learning disability to name a few. The rate of comorbidities has ranged from 60 to 100 % in various studies. The most common comorbid disorder has been found to be oppositional defiant disorder. Combined type of ADHD was found to be the subtype associated with most comorbidity. Studies have differed in their findings regarding the influence of gender on comorbidities in ADHD. Aims: To study the rates of various comorbidities in ADHD and differences in comorbidities according to subtype of ADHD and gender. Methods: Our current study was conducted in an outpatient child psychiatry clinic. The records of children who were diagnosed as ADHD were analyzed to understand whether our data reflected the findings of international and other Indian studies. The data was analyzed with regard to the rates of various comorbidities, the difference in comorbidities according to subtype of ADHD and gender. Results: We found the overall rate of comorbidities to be 52.9%.The most common comorbidity was oppositional defiant disorder followed by anxiety disorders. The overall rate of comorbidities did not differ significantly according to gender and subtype. However when individual comorbidities were analyzed oppositional defiant disorder was significantly more in combined type, Anxiety disorders were more in inattentive type and Depression was significantly more in females. Conclusions: As a child with ADHD and comorbidities suffers from multiple handicaps it is essential to study the comorbidities in detail both crosssectionally and longitudinally to understand and treat the illness better. Considering the multiple comorbidities a child with ADHD can present with clinical management should be individualized.

Background: Schizophrenia is one of the most devastating mental illnesses known to mankind. Apart from the classical psychotic symptoms of the illness, depressive symptoms and suicidal ideation also contribute to the morbidity and mortality in schizophrenia. Adequate knowledge about these symptoms and their risk factors may help the clinicians for the better treatment of the patients. Aims: To study the prevalence of depressive symptomatology and suicidal ideation in patients with schizophrenia. Methods: The study subjects were assessed using a semi-structured proforma consisting of socio-demographic details, Positive And Negative Syndrome Scale (PANSS) for symptoms of schizophrenia, Calgary Depression Scale for Schizophrenia (CDSS) for evaluation of depression and Columbia Suicidal Severity Rating scale (C-SSRS) to assess suicidal behaviour. Results: About one third of the patients with schizophrenia were depressed and about one fourth had suicidal ideation. The risk of developing depression was more in subjects from urban areas and with increasing age of the patients. Both depression and suicidal ideation correlated positively with high positive symptom score and general psychopathology score of PANSS. Conclusion: Depressive symptoms and suicidal ideation are frequent in patients with schizophrenia and they need adequate assessment and management for recovery and normal functioning.

Background: Mental health problems are on the rise in young population because of multiple sources of stress and pressure to excel in the competitive environment, especially depression, substance use disorders and suicide in developing countries. Aims: To assess neuro-psychiatric profile of university students attending psychiatry OPD of a tertiary care centre. Method: All the university students who attended psychiatry OPD were assessed for Neuro-psychiatric problems using DSM-IV TR criteria for psychiatric/behavioural problems and Harrison's principles of internal medicine criteria for Neurological problems. Results: The common diagnoses were depression 63(19.3%), tension headache 40(12.3%) anxiety disorder NOS 38(11.7%), dhat syndrome 34(10.4%), obsessive compulsive disorder 29(8.9%), migraine 28(8.6%), conversion disorder 14(4.3%), primary insomnia 11(3.4%), schizophrenia 7(2.1%), mania 6(1.8%), seizure disorder 6(1.8%), generalised anxiety disorder 6(1.8%), substance use disorder 5(1.5%). Conclusion: This study gives us an insight into the mental health of university students.

Background: At times, there is even a need for community involuntary treatment which may help in reducing the hospital admissions of patients with mentally illness. In India, there are very few State run psychiatric hospitals where patients get admitted and treated under section 20 of MHA 1987. There should be provisions for treating mentally ill in the community, if needed involuntarily. Detention of mentally ill for treatment during the time of florid psychosis is not a permanent solution for mental illness treatment. With the existing medicines these illnesses cannot be cured but can be controlled. So it leaves us with the option of using such detention only when no other method to treat is practicable. Such detention should best in the interest of the patient and the community. Aims: This study was an attempt to explore the practical problems in reintegrating the mentally ill back in to the community after their involuntary admission in comparison with the voluntary admission. Methods: This is a cross sectional study and data was collected from the medical records of 113 patients who were admitted in this hospital during the period of January 2010 to June 2010. Nearly 470 voluntary patients' records were analysed during the above said period but by randomization they were limited to nearly 113 to equate with the involuntary admission. Results: Median duration of total hospitalization period in involuntary admission group of patients is 108 days with a minimum of 15 days and maximum of 460 days of admission. Median duration of involuntary stay at hospital is 91 days in some patients in whose reception orders there was a clear mention of what should be done after their treatment and recovery. In comparison to this group median duration of involuntary stay in others is 113 days as there was no clear mention in their reception orders about what should be done after their treatment and recovery. Conclusion: Most of the hospitals do not have any community social worker who can liaise with the family members to address their fears and to facilitate their early reintegration back in to home. There is a need for a review board consisting judiciary and medical personnel which can revoke the reception order at any point of time to minimize through duration of involuntary hospitalization in closed wards.

Background: Traumatic brain injury (TBI) has been found to increase the incidence of psychiatric illness such as depression and generalized anxiety disorder. Aims: To study the incidence of Psychiatric illness in individuals with TBI and in those with orthopaedic injury without evidence of TBI and to correlate the psychiatric illness in TBI with radiological findings. Methods: The study adopted a two group comparison cross sectional methodology. The study group comprised of 50 adult patients with TBI and control group of 50 adult patients with orthopaedic injury without TBI. The tools used were Socio-demographic Sheet (SDS), Mini International Neuropsychiatric Interview (MINI 6.0). Results: The overall incidence of psychiatric illness after TBI is significantly higher than those individuals with orthopaedic injury without TBI (22% vs. 8%). Also, presence of radiological abnormality in CT scan increases the incidence of psychiatric illness. Injury to right hemisphere, especially frontal lobe, increases the chances of major depression and injury to the left hemisphere, especially parietal lobe, increases the chances of generalised anxiety disorder. Conclusion: Presence of radiological abnormality and cerebral laterality were found to be associated with the development of psychiatric disorder after TBI.

Background: The exact magnitude and phase of sexual function affected remains to be elucidated for most psychotropic drugs. So far little research has been done into sexual dysfunctions that develop during the use of antipsychotics. Most clinically used psychotropics cause sexual side-effects, but the nature, severity and frequency of these effects have not been systematically studied in Indian patients. Aim: To evaluate the frequency of sexual dysfunction and its impact on treatment adherence in patients with mental illness treated with various psychotropics under routine clinical conditions. Methods: We assessed the participants' sexual functioning using Psychotropic-Related Sexual Dysfunction (PRSexDQ) is a brief and relatively nonintrusive questionnaire that has shown adequate psychometric properties in patients with mental disorder. Results: It was found that the rate of sexual dysfunction in the study group varied across the scale. However, sexual dysfunction was highest in the Antipsychotic group compared to others. Among the various domains of sexual dysfunction, decreased libido was the most common sexual dysfunction in all groups. On the PRSexDQ, all patients had sexual dysfunction on more than 1 domain (n = 20) out of 45 subjects which is higher in anti-psychotic group compared to the antidepressant group. Conclusions: In order to keep patients symptomatically stable and to help alleviate these side effects, clinicians should alter the treatment strategy, possibly by switching medications, to encourage adherence to the medication as well as optimize patients' outcomes. Our results show that sexual dysfunction is very common in patients receiving long-term treatment with antipsychotics, and it is associated with a great impact in a substantial proportion of patients.

Background: Traumatic Brain Injury (TBI) is a risk factor for epilepsy. Several studies have been conducted to estimate the incidence of epilepsy after TBI. Similarly cognitive impairment is a common consequence of TBI and a substantial source of disability. Aims: To study the incidence of epilepsy and cognitive impairment following TBI and correlate the findings with radiological abnormalities. Method: The study was conducted on 50 consecutive patients with TBI based on the assessment of clinical history for epilepsy and MMSE for cognitive impairment. Results: The incidence of epilepsy after TBI was found to be 40% in our study. It was increased to 50% among the individuals with radiological abnormality on CT scan brain following TBI. Cognitive impairment was found to be highest in individuals with frontal lobe injury (mean MMSE score – 24.13) followed by temporal lobe injury (mean MMSE score – 25.25) and parietal lobe injury (mean MMSE score 26.28). Individuals with no radiologically detectable injury had least cognitive impairment (mean MMSE score - 27.97) Moreover, cognitive impairment was more in individuals with higher number of days in hospital and greater psychological distress. Conclusion: Severity of TBI and presence of radiological abnormality influence new onset epilepsy after TBI. Similarly, injury to frontal lobe and higher number of days in hospital influence cognitive impairment after TBI.

Background: Schizophrenia is a major psychiatric illness comprising thought, perception, emotion, movement, and behaviour. Pharmacotherapy plays an important role in managing this disorder, comprising mostly typical and atypical antipsychotics. Treatment with antipsychotics can cause metabolic side effects leading to medical disorders among the patients suffering from schizophrenia. Aims: To study the effects on glucose and lipid metabolism with the use of atypical and typical antipsychotics in the treatment of schizophrenia. Methods: The present study is a 12 weeks open label prospective study of antipsychotic drugs olanzapine, risperidone and haloperidol in patients with schizophrenia. 80 patients having diagnosis of schizophrenia according to ICD-10 are assigned to treatment with olanzapine (N=20), risperidone (N=20) and haloperidol (N=40). Assessment for analysis include weight, body mass index(BMI), fasting blood glucose(FBS), postprandial blood glucose (PPBS) at baseline and at 4th week ,8th week and 12th week. Lipid profile is assessed at baseline and 12^th week. Results: Out of 80 subjects, only 65 patients completed the study; there are 15 dropouts. At the end of 12 weeks in haloperidol group, there is a mean increase of 3.2 mg/dl in FBS and 2.71 mg/dl PPBS and mean decrease of 2.76 mg/dl in serum cholesterol levels. In olanzapine group there is a mean increase of 6.3 mg/dl in FBS and 3.7 mg/dl in PPBS and mean increase of 7.8 mg/dl in serum cholesterol. In risperidone group, there is mean increase of 2.3 mg/dl in FBS and 2.8 mg/dl in PPBS and mean increase of 0.98 mg/dl in serum cholesterol. Conclusions: Metabolic side effects are more with atypical antipsychotics. Regular blood monitoring of metabolic parameters should be strictly implemented. Consideration should be given for prescribing drugs like metformin for antipsychotic induced weight gain along with dietary management and lifestyle change if deemed necessary.

Background: In spite of having average or above average intelligence, emergence of poor academic performance can be catastrophic, both to the children and their families. Aim: To find out the etiological factors behind the scholastic backwardness which are prevailing in different sexes and in different socio-economic background of the children attending normal school. Method: 125 children of both sexes in the age range of 12 to 16 years were taken for this study. They were brought to rule out the suspected causes of mental retardation. Assessment were done on the measures of the class teacher rating on the functioning of the child in the school including general activity in the class, relationship with students and teachers, academic functioning, play and extracurricular activities. Qualitative analysis of the data was done. Results: Result revealed that intelligence is not the single criteria that determine the academic performance of students. Several cognitive and non – cognitive factors which are found within the child and outside of the child i.e. family, school and society are solely responsible to determine the scholastic performance of the students.

Background: Fahr's syndrome (or Fahr's disease) is a rare idiopathic degenerative disorder, characterized by bilateral symmetrical intracranial calcification and manifested as movement disorders, dementia and other behavioural disturbances. Case description: A 50-year-old male with long standing seizure disorder with intact motor and cognitive function presented with behavioural disturbances. Brain CT showed symmetrical calcification in cerebral hemispheres involving caudate nucleus, internal capsule, adjoining area and cerebellum. The history, clinical and radiological features and exclusion of other possibilities in our case point towards this uncommon disorder. Discussion: A substantial number of patients with Fahr's disease present with behavioural disturbances. Usually late onset Fahr's disease with behavioural disturbances is accompanied by cognitive and motor abnormalities. However, in our case no such neurocognitive abnormalities were found along with the behavioural disturbances in the form of psychosis inspite of widespread intracranial calcification. Conclusion: Psychosis may be the sole presentation in a case of late onset Fahr's disease.

Background: Trichotillomania is a psychological condition that involves strong urge to pull one's hair. Trichophagia is disorder of eating of hair. Bezoar is collection of undigested material such as hair, drugs and plastic or combinations. Rapunzel syndrome is a rare type of trichobezoar, which has mass of hair lodged in stomach extending up to ileum. In majority, diagnosis is made very late, at a stage where surgery is the only option. Case description: A 9 year old girl was brought with complaints of loss of hair on scalp since 8 months, decreased appetite, and constipation, weight loss since 5 months and vomiting since 2 weeks. Patient had paediatric consultations without much benefit; patient was referred to dermatologist and paediatric surgeon. Ultrasound showed mass in abdomen. Patient was operated to find a mass extending from stomach to terminal ileum. Patient was referred to a Psychiatrist and diagnosis of Trichotillomania was made. Discussion: Trichobezoar is common in young females, often with an underlying psychiatric disorder, they present late due to the low index of suspicion. As this condition is a rarity in paediatric age group and very little progress to Rapunzel syndrome, this paper discusses about the systemic team management of the above individual. Conclusion: High index of suspicion is needed to diagnose this condition in paediatric age group.

Sergei Sergeievich Korsakov was the first great Russian neuropsychiatrist of the 19th century and published numerous works in neuropathology, psychiatry, and forensic medicine. Apart from his studies on alcoholic psychosis, he introduced the concept of paranoia and formulated his theory of ‘dysnoia’ and wrote an excellent textbook on psychiatry. He actively participated in promoting the rights of the mentally ill. He was a scientist, psychiatrist, thinker and humanist.