Ivan Pavlov was a renowned physiologist, psychologist and physician from Russia. His experimentation on digestive system of dogs and his observation of involuntary reflexes had made him a Nobel laureate. He is known for his research in classical conditioning and behavioural modification.

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Background: Alcoholism is a chronic relapsing disorder. Alcohol dependence is characterized by a prolonged course of alcohol-related problems and a persistent vulnerability to relapse. Even though there is an improvement in multiple domains of life after alcohol treatment, the risk of relapse remains high following treatment. This study was under taken for better understanding of the causes for relapse and improve outcome for individuals with alcohol dependence. Aims To assess the reasons for relapse in alcohol dependent patients. Methods The present study was conducted on patients with alcohol dependence in the inpatient psychiatric ward. The study sample was collected from 190 in-patients with Alcohol Dependence Syndrome (ADS) using a semi structured interview containing socio demographic variables and the reasons for relapse. The diagnosis of ADS in patients was made according to ICD-10 criteria. Results Craving was noted as most common cause for relapse in alcohol dependent patients. Conclusion There is significant association between age at first drink, age at dependence, duration of dependence, other Co-morbid diagnosis of patients and relapse.

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Background: A number of hypotheses and theories about schizophrenia have tried to explain the disease in various dimensions. Past scientif ic research demonstrated the relevance of nutrients in mental health. Neurodevelopmental and transmethylation theories suggest the role of nutritional factors (vitamins) and genetic factors in the development of the disease. Vitamins and minerals are involved in one or more biochemical pathways and/or physiological actions which influence the function of the human brain. Vitamin deficiencies leading to oxidative damage, methylation deficits, affecting brain developmental mechanisms and neuro-degeneration may explain well some of the symptoms seen in schizophrenia. Methods: Pubmed and Medline search, Scopus, journal and textbook articles have been accessed for the review of literature on Vitamin deficiencies in Schizophrenia. Results: Several nutritional epidemiological studies have provided evidence on the role of vitamins in schizophrenia either in the causation of the illness or as an adjunct in the treatment. Conclusions: This review provides an overview of the role of vitamins in schizophrenia.

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Background: Family care-giving for persons with mental illness has been associated with reduced quality of life and high levels of burden. Most studies on care-giving focused on burden of caregivers in schizophrenia and to some extent on bipolar affective disorders. Aim: The current study examined perceived burden and its influence on the Quality of Life in caregivers of persons suffering from severe and persistent psychiatric illness. Methods: Care givers of persons suffering from mental illness of three groups viz., Schizophrenia (35subjects), Affective Disorder (36subjects), and Mental Retardation (32subjects) attending the outpatient department of a psychiatry hospital were assessed on Zarit Burden interview and World health organization Quality of Life -Bref (WHOQOL-Bref). Care receiver's functional ability was associated with care giver's perception of burden. Results: Care givers of Schizophrenia group reported higher burden than care givers of Affective Disorder followed by Mental Retardation. Overall, care givers reported high burden and significantly reduced Quality of Life in the domains of physical health, social relationships and environment. In particular, Schizophrenia group of caregivers reported higher levels of burden and reduced quality of life in psychological and environmental domains Conclusions: The findings from this study suggest that caregivers need social support and family intervention programmes to cope with the burden of care-giving and enhance better quality of life.

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Background: Obsessive-compulsive disorder (OCD) is a common co-morbid condition in schizophrenia. The clinical implications of this co-morbidity are uncertain. Schizo-obsessive patients were more likely to have paranoid symptoms and first-rank symptoms of schizophrenia. Case description: We present a case of 27 yr old man who initially presented with symptoms suggestive of schizophrenia not responding to treatment and who finally responded to addition of paroxetine to antipsychotics. Discussion: Comorbidity of Schizophrenia and OCD though prevalent is not often diagnosed. The question of whether or not OCD has a deleterious effect on the outcome of schizophrenia has been often asked but never conclusively answered. Conclusion: The clinical issues in this case study highlights the importance of identification and treatment of OCD in schizophrenia. A detailed history is merited in patients especially those not responding adequately to conventional treatment

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Background: Mental health is not a priority area for policy makers even today. Objective: The objective of the present review is to sensitize policy makers regarding the importance of investing in mental health. Appraising the policy makers about the costs of mental illness and the negative economic consequences of poor investment in mental health on the society are the aims. Methodology: A review of various studies on the above subject was done using Google Scholar and PubMed. Results: Most of the studies are from World Health Organization (WHO). There is paucity of studies from the developing world. The costs of mental illnesses are high. The indirect costs are much higher than direct costs. Mental illnesses impact not only the individuals but also the family and society at large. Conclusions: The indirect costs of mental illnesses are much higher than the direct costs i.e. the negative economic consequences of not treating the mental illness is much higher than the costs of treatment as concluded by the World Economic Forum. Mental health and socio-economic development appear to go hand in hand. Investing in mental health is therefore investing for development.

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This is one among a series of editorials related to ethics in publication. The present editorial deals with a key issue of the declaration of conflicts of interest (COI), which all stake holders, especially authors should be aware of. Such issues are now mandatory ethical requirements and not just for name sake. Broadly speaking, COI comes into existence when someone's position may be influenced by his vested interests. World Association of Medical Editors (WAME) says ‘journals have a responsibility to raise awareness and educate the research community about COI.’

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Background: Reports in the last decade have shown that healthcare students face a high degree of stress. Cumulative stress leads to depression and suicidal behaviour in some of them. Aims: This study was designed to identify levels of perceived stress amongst medical and dental students in a private institution of South India. Methods: A cross-sectional, questionnaire-based survey carried out on the first year undergraduate medical and dental students. Perceived stress was assessed using the Perceived Stress Scale. The students were given a questionnaire to be completed by them individually during January-February 2011. Results: A total of 234 students (144 medical and 90 dental students) were studied. The mean PSS score was 16.74(SD 5.99) for medical students and 18.23(SD 5.52) for dental students. While girls perceived greater stress amongst medical students, boys perceived greater stress amongst dental students though the difference did not reach statistical significance. Univariate analysis as well as Pearson's correlations identified interpersonal problems with their friends as well as their course load as the most significant stressors amongst the students. Conclusion: Levels of perceived stress are high in medical students and even higher in dental students. The most common sources of stress were related to academic and psychosocial concerns. Such students blamed reasons such as their course overload, pressure from teachers as well as parents, and problems related to their interpersonal issues.

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Background: Although the term “zycloiden psychosen” was first used by Karl Kleist in 1926 to group together disorders, which had presented with sudden onset, brief episodic course, polymorphous psychotic symptoms and good inter-episode recovery, its origin can be traced back to 1880s. Despite its existence in the community, for so long, the diagnosis of cycloid psychosis is only seldom made, making it a unique disorder. Hence, there seems to be lack of awareness of this rare entity even among the psychiatrists. Case description: A middle-aged woman with abrupt onset of recurrent brief episodes of psychotic symptoms, and complete inter-episode recovery, was admitted with history of alleged consumption of poison in a state of confusion. During psychotic episodes, motility disturbances were predominant. The current episode lasted for about two weeks. Discussion: This case doesn't satisfy the criteria for schizophrenia or affective illness. Although ICD-10 describes ‘acute polymorphic psychotic disorder’ (F23.0, F23.1) it requires the presence of typical schizophrenic symptoms for its diagnosis and is usually not recurrent. The closest this case resembles is cycloid psychosis, meeting three of four Perris criteria. Conclusion: The diagnosis of such unusual cases of psychosis predicts the prognosis and helps in assessment and management of future episodes.

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Background: Body mapping is a creative therapeutic tool that brings together bodily experience and visual artistic expression. Initially, it was used by health and safety for detecting unspoken injuries in workforce, musicians to improve posture and coordination while decreasing injury. Its effectiveness in improving communication was exploited by allied health bodies for talking about sensitive sexual health issues and improve health awareness in Uganda, Kenya, India and Thailand. The technique involves patients to represent psychosomatic symptoms, body images, aches and pains, onto a chart (body map) using colours, pictures, symbols and words to represent various experiences. This is akin to a psychological enquiry where the clinician exploits the exercise to develop an understanding of the patient's psychopathology as well as foster a relationship. Case description: The author reports a case of middle aged man of Afro Caribbean origin with psychotic illness who was successfully treated by utilizing the concepts of body-mind mapping. This paper highlights the benefits of using body mapping in psychiatric practice by way of improved communication between patient and therapist to explore psychosomatic as well as builds therapeutic relationship. Discussion: Body mapping has been used by therapists in diverse areas like eating disorder, trauma etc. It helps to externalise somatic-emotional experience, to make meaning through the creative process of symbolization. This technique may be useful in cases of the chronic illnesses to aid engagement, compliance and insight. The wide prevalence of psychosomatic complaints across the world indicates the necessity for alternative models of interactive communication other than a language based psychiatric interview in all situations. Conclusion: Body mapping can be a useful clinical communication tool. When used appropriately, it has the potential to improve insight and compliance in psychiatric patients.

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Background: In our clinical practice, in patients who went into clinical remission from their psychotic episodes, we found variability in recall pattern of events and experiences occurring during psychotic states. Aims: The present study aimed to find out the deficits in autobiographical memory regarding the events and experiences which occurred during psychotic states in clinically remitted acute and transient psychotic disorder (ATPD) patients. Method: Consecutive patients (20), who went into clinical remission within a period of three months of onset of their first ATPD episodes, along with their informants (20), who were selected as per specific inclusion and exclusion criteria, were interviewed within a period of two months of clinical remission of their psychotic episodes. The interviews were based on a list which included items regarding different events and experiences restricted to the period of patients' illness and their recall abilities were compared. Results: Catatonic features, features suggestive of dis-inhibition, impairment of personal care, manic features and biological function impairment were the items which patients found difficult to recall. Conclusion: The study showed that the patients had autobiographical memory deficits regarding their catatonic features, dis-inhibitions, personal care and biological function impairments and manic symptoms after their clinical remission, which has clinical and management implications. However the study was limited by the small sample size and naturalistic design.

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Background: The economic costs and proportion of disease burden attributable to mental, emotional and behavioural disorders (MEBs) is enormous. This emphasizes on the need for treating the MEBs. Choosing the most cost effective intervention is the key aspect in planning mental health services. Objective: The aim of the present article is to review the studies on cost-effective interventions for MEBs. Methodology: A review of various studies on the above subject was done using Google Scholar and PubMed. Results: Most of these studies are from developed countries. Many of them are conducted by World Health Organization (WHO). There is paucity of data on cost-effectiveness of interventions in the developing world. There are cost-effective interventions available for most of the MEBs. Conclusions: There are cost-effective interventions for MEBs. The available cost-effective strategies need to be incorporated with necessary modifications to tailor to the local needs. Proper planning is crucial for successful approach to mental health. Prevention is the most cost-effective strategy.

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All depressive patients do not look similar. They differ from each other in terms of varying presentation of depression, other associated psychiatric features and personal characteristics. There is lack of evidence in terms of clinical trials and comparative studies to propose different treatment choice for different subtypes. However, in today's endeavour towards person centred health care services, we need to recognize and respect the uniqueness of presentation of every depressed patient from all perspective. Once we recognize it, our next duty is to provide a customized, holistic and cost effective care to that individual for not only improvement of his symptoms but also enhancement of his quality of life.

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