Background: Psychogenic vomiting syndrome is a disorder of unknown aetiology and pathogenesis. This condition characterized by recurrent vomiting has been less studied and researched. The major challenges with this condition are that availing of psychiatric services is least thought of and the guidelines for treatment of this condition are not clear, leading to a lot of dilemma on the part of the clinician due to lack of awareness of the psychological etiological factors and in turn increasing the burden on the patient and family. Case description: A middle aged Asian woman with a diagnosis of psychogenic vomiting was successfully managed with psycho-education, supportive psychotherapy and behaviour interventions. Discussion: The exact aetiopathogenesis of psychogenic vomiting is still not known, and clear treatment guidelines are still not established. The same challenge was faced by the clinicians in the above case too. Conclusion: There is a need for further research and training for general practitioners in identifying and managing psychogenic vomiting, and also a need for consensus diagnostic and treatment guidelines.

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Erikson was a psychoanalyst, who contributed much to ego psychology. His compelling work on personality theory based on psychosocial development and crisis occurring in periods that extended across the entire life cycle has cross cultural and universal applications.

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Background: Persons with major mental illness (such as schizophrenia) may commit crime under the influence of psychopathology. Case description: A 35 year old man (accused) killed his mother (victim). An autopsy of victim's body revealed the cause of death as ‘due to fatal injuries to the brain and neck structures.” With the support of circumstantial evidence and post-mortem report of victim, the inquest officer presented the accused in the court. On receipt of judicial reception order he was subsequently referred to the psychiatrist. The accused was diagnosed as suffering from paranoid schizophrenia and it was found that under the influence of psychosis he committed the crime. The psychotic symptoms were present before the manifestation of violent behaviour, in the form of delusions, hallucinations, and disorganized behaviour. With treatment his psychotic symptoms improved. Discussion: This case illustrates the profile of a person with major mental illness who was never treated, from a forensic perspective. Not all patients are violent; but, the risk is high. Conclusions: Early psychiatric intervention in the form of identification and management may go long way in prevention of violence committed by few patients with major mental illness. There is a need to understand the motivational factors for such violent acts which may help in effective prevention.

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Background: Most tertiary hospitals in India carry out liaison work with various departments like neurology, organ transplant, intensive care units and cosmetic surgery. Mental disorders affecting older people admitted to general hospitals is poorly detected and managed in many general hospitals in India and elsewhere. Aim: To evaluate the service of an old age psychiatric liaison team working in a general hospital and reviewing the parallels which could be drawn with respect to Indian perspective. Method: The study model is based on the cross sectional assessment and service evaluation of a psychiatric liaison team (PLT) for older adults working in conjunction with general hospital. Parallels are drawn to compare and contrast the liaison service model in India and the United Kingdom (UK). Results: A total of 143 patients out of 174 were screened by the PLT; 29.3% were males and 70.6% were females and just more than 60% were above the age of 80 years. Around 32.2% of patients were between the age group of 66-80 years. Most referrals (71.3%) to the PLT were from nursing staff of general hospital belonging to varying seniority. Around 30.8% of the patients referred to PLT have a previous diagnosis of psychiatric illness. Diagnosis of dementia was the commonest (17.4%), followed by depression which was 4.2%, Mild Cognitive Impairment (MCI) was present in 2.8% of patients, 2% have diagnosis of vascular dementia. A survey of non-psychiatry clinicians showed a substantial proportion of doctors underestimate the psychiatric morbidity especially about unexplained physical symptoms and specific depressive symptoms. Conclusion: Psychiatry as a specialty has been neglected at all levels in India and service development has been scanty. The inception of the concept of liaison psychiatry in India has been almost an ancient one but it has not raised the standards of care to any significant level.

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Background: Street children are vulnerable to various psychological disturbances. Assessment of these can help in identifying areas of intervention, which can prevent further damage caused to their life. Aim: To study the demographic profile, street activities, reasons leading them to street life, psychiatric morbidity and substance abuse pattern of street children. Method: This study was conducted in the age group of 5 to 15 years staying in a shelter home run by a local organization. Results: Majority of the boys had left their homes after 10 years of age, and belonged to dysfunctional families. Majority had substance abuse pattern. Many of them showed low self-confidence, low frustration tolerance, poor attention span and difficulty in communication. Conclusions: Proper understanding of risk factors which drive children to street may help reduce the number of such children. Also, early identification of psychological disturbances in such children, timely intervention and enriched environment may prevent further damage to their future.

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Background: The stigma attached to mental illness and the mentally ill is a universal phenomenon and a major barrier to the provision of mental health services. Stigmatising attitude among doctors themselves can result in compromised patient care. Aims: To study the Perception & Attitude towards Mental Health among Post Graduate students of various specialities and House Surgeons. Methods: Cross sectional study involving post graduate students of various descriptive specialities and house surgeons at Meenakshi Medical College and Research Institute, Kancheepuram, Tamil Nadu, India. A modified version of Attitude towards psychiatry-30 (ATP-30) Questionnaire was used for the study. Statistical Analysis was done using the software, Graph Instapad with which Chi Square test with Yates correction was done. Results: The attitude of majority among postgraduate students and house surgeons in Meenakshi Medical college and research institute was positive (70.7%). Males (71.2%) had slightly more positive attitude than females (70.2%). House surgeons (80.4%) had more positive attitude than postgraduate students (64.6%).Non clinical post graduate students (81.8%) had more positive attitude than post graduate students of medical (53.7%) and surgical (68.8%) specialties. Participants posted in psychiatry posting prior to this study had slightly more positive attitude (72.5%) than those who did not (69.8%).Unmarried participants had more positive (73.4%) attitude than married participants (63.9%). Participants from urban background had more positive attitudes (81.2%) than with rural background (41.2%). Conclusion: There is need to create awareness among the non-psychiatry post graduate students about mental health and also introduce mental health education in rural areas.

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The ultimate purpose of research is ‘advancement of knowledge’. All other motives should be secondary. However, that does not seem to be the practice. There are various forms of ‘publication frauds’, one such form is duplicate/redundant publications. According to Committee On Publication Ethics (COPE), issues related to authorship and duplicate publication are the most common types of ethical problems. Duplicate publication occurs when there is partial or complete duplication of data from the same piece of work without proper declaration. The practice was always there, and is on the rise. This editorial is written with an intention to increase awareness regarding this important issue.

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Background: In our day to day work, especially in government hospitals we come across involuntary admissions where it is difficult to discharge them. Aim: To study the 1)socio demographic factors, 2)symptom profile during admission, 3)referral mode, 4) previous admissions, 5)diagnosis, and 6)co morbidity; of the patients admitted in the open and closed wards of a tertiary level psychiatry hospital. Methods: Collecting the information on socio-demographic profile, presentation, diagnosis and management details of the patients from the case sheets in a semi structured proforma. The data so collected is analyzed statistically to determine any significance. Results: Involuntary (closed ward) admissions were determined by various factors, such as education, marital status, caste, economic status, family structure, social support, referral mode, first consultation, duration of untreated illness, substance abuse and symptom profile. Conclusions: Involuntary admission in India is determined by factors which are not similar to other countries. Policies should be made based on large scale Indian studies.

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Adolescents in India form a major proportion of the population. This age group encounters many stressful events which are more specific to this age group like need to perform in exams, compete for various professional courses, broken love affairs etc. Besides this is the age group for onset of major psychiatric disorders. All these factors make this population very vulnerable to suicidal behaviours. However, there is limited data with regard to suicidal behaviour in this population from India. There is an urgent need to study the various factors associated with suicidal behaviour and how suicidal behaviour can be prevented in this age group.

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Background: Mutism is a common accompaniment of catatonic schizophrenia. It responds to treatment with benzodiazepines and electro convulsive therapy. However mutism can also occur in non catatonic schizophrenia. There are very few reports of the same in literature and most show resistance to conventional treatment. The present case report deals with one such case and the challenges it poses. Case description: A young Asian man, with a diagnosis of paranoid schizophrenia presented with long standing mutism in the absence of any other catatonic features. A trial of various antipsychotics and also electroconvulsive therapy failed to show any improvement in mutism. He ultimately responded to amisulpride 800 mg/day. Discussion: Mutism though is most widely reported in catatonic schizophrenia, can also be seen in non catatonic schizophrenia. It shows poor response to conventional treatment. Conclusion: Mutism is a challenging symptom which may persist after the resolution of other psychotic symptoms and continue to hinder the patient's social, occupational and personal life.

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Background: Pellagra, called the disease of 4D'S- dermatitis, diarrhoea, dementia and death, is seen in patients of chronic alcohol dependence, mal absorption syndrome, and psychiatric illnesses like schizophrenia. Mostly a clinical diagnosis, its treatment includes balanced diet and niacin supplementation. There are hardly any case reports about pellagra in schizophrenia patients. Case description: A young Asian woman with complaints of abusing and assaulting, talking to self since three years and loose motions since fifteen days presented to psychiatric outpatient department with signs of dehydration, sharply defined symmetrical, desquamating rash in the neck area and in the sun exposed parts of forearms and legs with mental status examination findings of muttering to self, impaired recent and immediate memory and inability to do simple calculations. Patient showed significant improvement with supportive therapy, antipsychotics, niacin supplementation and balanced diet. Discussion: Pellagra can be seen in psychiatric illnesses like alcohol dependence syndrome, eating disorders and schizophrenia. It occurs along with other vitamin deficiencies which improve with medication and balanced diet. Conclusions: Early identification of vitamin deficiency along with proper education to patients and family regarding the need of balanced diet and adequate vitamin supplementation will prevent further complications. Thus, pellagra seen in schizophrenia patients requires medication and balanced diet.

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Background: Patients with severe mental illness have higher cardiovascular mortality and shortened life span; this is at least partly attributed to medications although lifestyle plays a significant part. Aim: To identify the role of lifestyle factors in contributing to weight gain and metabolic disturbances. Method: We used a cross-sectional approach to measure physical health indices (Blood Pressure, Waist Circumference, Weight and BMI), laboratory indices (fasting sugar and lipid profile) and lifestyle measures using International Physical Activity Questionnaire-IV (IPAQ-IV) and a locally developed questionnaire to identify dietary patterns. Results: We had a total of 45 patients; nearly half of our sample had metabolic syndrome and high Framingham Risk Score. 51% of our sample had high fast-food frequency and 40% used sugared drinks on a daily basis. High fast-food consumption, sugared drink use and low physical activity were significantly associated with obesity, which in turn was significantly associated with risk of metabolic syndrome. Conclusions: It is important to monitor for metabolic parameters and also to identify the lifestyle factors in patients maintained on second generation antipsychotics that increases the risk for weight gain and metabolic syndrome.

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