Background: Medical School is challenging as medical students have to confront varied stressors such as academic pressures, work over load, and issues pertaining to professional competence. Stress can be more during the final year of study as students have to deal with pressure of graduating and making career decisions. Efficient coping protects students against stress. Gender differences may exist in stress and coping. Aims: The present study aimed to examine stress, coping and gender differences in final year medical students. Prediction of stress by coping was also examined. Methods: This cross-sectional study consisted of 117 final year medical students from a medical college in coastal Karnataka. Professional Student Stress Survey to measure stress and Carver's Brief COPE to measure coping were administered. Results: An almost similar amount of mild and moderate degree of stress was experienced by majority of the sample. Academic performance and professional identity issues caused greater stress. Among the major coping approaches, problem coping was used more by the group. The coping subtypes frequently used were planning, active coping, acceptance, and self-distraction. There were no gender differences in stress. With regard to coping, females used more emotional coping strategies, specifically, self-blame and seeking emotional support. Venting, an emotional coping strategy repeatedly emerged as a positive predictor of overall stress and various stress domains. Avoidant coping also positively predicted over all stress and stress in two stress domains. Positive re-framing negatively predicted stress and religion positively predicted stress in two stress domains respectively. Conclusion: The findings point towards the crucial need for stress management programs in medical school. Though students used problem coping frequently, the evident role of maladaptive coping in increasing stress warrants the need for coping skills training. Research on effectiveness of such programs in India needs to be improved.

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Background: Bullying involves repeated and over time targeted intimidation or humiliation. The bully can resort to a number of aggressive behaviours to make the target or victim feel powerless. However, bullying entails more than aggression: a power imbalance exists between the bully and the target. Bullying takes place among young children as well as adults in a variety of settings, but most of the research focuses on children and youth in schools. Aim: To evaluate temperament and character in victims of school bullying in comparison with a control group using the Junior Temperament and Character Inventory. Method: 41 victims of school bullying and 40 control group participants between the ages of 8 and 17 years studying in English medium schools in South Delhi were included in the study. Participants were excluded if participants were younger than 8 years, could not read English and parental consent was not obtained. Illinois Bully Scale and the Junior Temperament and Character Inventory was administered to the participants. Results: According to child and parent data, victims of school bullying had lower scores on self-directedness, cooperativeness, reward dependence and persistence compared with control group and significantly higher scores on novelty seeking and harm avoidance. According to parent data only, victims of school bullying significantly differed from a control group on self-transcendence with higher fantasy scores and lower spirituality scores. Conclusion: Victims of school bullying have a different temperament and character profile compared to control group. Hence, up to a certain age there is still a potential for changing some temperamental characteristics, and consequently timely interventions could prevent the onset of victimization or minimize the severity of clinical outcomes in school children.

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Background: Crime is a complex psychological, sociological and situational behaviour. Personality theories provide possible insights into the psychological aspects of crime. The primary assumption behind the personality theories is that crime and delinquency are related to the presence of some personality traits. Aims: To assess the personality dimensions of offenders, mentally ill offenders and to compare them with normal control population. Methods: A semi-structured interview consisting of Socio-demographic details, Eysenck Personality Questionnaire (EPQ) and Barratt Impulsiveness Scale (BIS-11) were used to assess the personality of offenders, mentally ill offenders and normal population. Results: Offenders with and without mental illness did not differ in their personality, but both the groups differed significantly with the personality of general population. The offenders were more impulsive compared to normal population in general and offenders with mental illness were scoring high on total BIS-11 score and on non-planning impulsivity score compared to normal offenders. Conclusion: Personality traits can predict the person's vulnerability to commit an offence.

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Background: Post Stroke depression (PSD) is considered as a frequent neuropsychiatric consequence of stroke. Approximately one third of stroke survivors experience major depression. This condition can have adverse effects on cognitive function, functional recovery and survival. Aim: The current study examined prevalence of depression in post stroke survivors, its relation with site of lesion, laterality and. sociodemographic factors. Method: After obtaining consent, selected sample of post stroke survivors were diagnosed as post stroke depression based on ICD10 diagnostic criteria. Depression was quantified using HDRS and MADRS before discharge, at the end of first month and three months. Socio demographic profile was obtained. Statistical analysis was done using SPSS. Results: 32 patients of mean age (46.25yrs) and post stroke duration (2 weeks – 3 months) were included in the study. Twenty of thirty two post stroke survivors( 62.5%) met the criteria for depression at the time of discharge i.e. 2 weeks post stroke period, prevalence of PSD was 19 (59.37%) during 2^nd assessment and 13(48.15%) during 3^rd assessment. PSD was significantly associated with right sided lesions (p value = 0.013). In patients with left sided lesion, it is most commonly seen with sub cortical (p value = 0.003). Middle age was significantly associated with PSD (p value = 0.03). Female sex was associated with PSD in left sided lesions (p value = 0.02). No significant difference was found between first, second and third assessment of HAMD, MADRSS scores in depressed patients. No change in depression scores was found in both left and right sides at all assessments. Conclusion: This study emphasizes the need for early detection of depression in post stroke survivors. PSD is related to laterality of lesion, middle aged group and female sex. PSD is maintained at 3 months follow up. These results highlight the need to investigate, diagnose and treat post stroke depression.

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Background: Non-compliance to treatment, especially medication is an important area of concern in psychiatry as it contributes to relapse and re-hospitalization of the patients. One of the ways to improve drug compliance is to know crucial factors responsible for poor drug compliance so that proper management strategies may be planned to improve patients' drug compliance. Aims: To find out the reasons for drug non-compliance and its association with socio demographic variables and psychiatric diagnosis. Methods: The study was conducted on patients attending psychiatry outpatient department for duration of seven months to evaluate the reasons for treatment non-compliance, using a questionnaire designed for the purpose. Results: In our study, it was observed that 63.75% of subjects were compliant and 36.25% were non-compliant. A significant association was found between non-compliance and age group more than 46 years, female gender, low socio economic class, low education rate. Non-compliance was highest among patients with schizophrenia (45.16%) and the main reason for drug non-compliance identified in the present study was a lack of knowledge about the nature of illness. Conclusion: The result of the study concludes that the major reason for non-compliance was lack of knowledge about the illness reflecting the importance of psycho education.

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Background: Autism Spectrum Disorder (ASD) is a part of Neurodevelopmental disorder. There is still research going on the causes of ASD and how to treat it. Current pharmacological treatment fails to completely cure the primary symptoms and can have marked adverse effects in children with ASD. There are non-pharmacological modes of treatment of autism which includes dietary modification. They are likely to be beneficial to some individuals with ASD and generally have a low risk of adverse effects. Objective: To review various studies on the above subject using Google Scholar and Pub Med. Discussion: Several studies have provided evidence about non-conventional treatment including dietary interventions for ASD. Conclusions: This review provides an overview on the role of dietary modifications, nutritional and vitamin supplementation in the patients with ASD.

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Background: Delusional disorder is on a spectrum between more severe psychosis and overvalued ideas. Rates of psychiatric co morbidity in patients with delusional disorder have been found to be high, with affective disorders being the most common co morbid entity. Growing literature has revitalized the efforts to understand, define, characterize and treat this disorder. However, despite these, more studies are needed to clarify the role of mood disturbances in delusional disorder to provide for a better therapeutic approach. Aims: To study the prevalence, socio demographic profile and co morbid depression in delusional disorder patients. Methods: All patients diagnosed as delusional disorder in the last 3 years and attending the psychiatry outpatient department of a general teaching hospital were included. Semi-structured proforma specifically designed for the study was administered to collect socio-demographic data and illness related information. Results: In our study, 53 (1.88%) met the criteria of delusional disorder. Co morbid depression was seen in 17 (32.08%) of these patients. Conclusion: Delusional disorder is a unique entity with considerable psychiatric co morbidity especially depression.

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Mental health issues and its respective domains have been at back burner ever since independence of India. The national policy on mental health was focused on states effort. In the last decade the work done by voluntary sector and NGOs has done significant work across the country. Community care program is the innovative approach that has helped the different stake holders in dealing with mental health and mental illness. The article highlights the stages of development and the major shift in approach in the last few years. The main idea is to develop a view point on community's participation in the field of psychiatric work.

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Background: Possession disorders are commonly reported, especially from third world countries, like India, Far East, African and South American countries. Despite the various fast paced technological advances, possession disorder is still prevalent in various rural pockets of India. As an extension of the ongoing WHO ECA study in the department an attempt was made to look at the presentation and prevalence of this rather culturally variable and versatile disorder. Aims: To study the prevalence of ICD-10-RDC diagnosable possession disorder in the revenue district of Chittoor, India. Methods: Probability sampling design (probability proportional to Size) was employed in this study, which was based on the guidelines adopted in the ongoing WHO Longitudinal Epidemiological study on mental disorders in the department of psychiatry, SVRR Hospital, Tirupati, India. After an inquiry method utilizing the key informants in the locality the cases were identified. Then the subjects and the families were interviewed using ICD-10 RDC criteria for diagnosing Possession disorder. Prevalence rates were calculated as per the data available and an attempt was made to compare the data available in the department. Results: 364 cases were diagnosed based on the methodology of inquiry of key personnel in the community. A prevalence rate of 0.048 % that is 48 per 100,000 populations is identified. But S.V.R.R.Government General Hospital Psychiatry unit being the only tertiary care facility in this area, should have treated 200 cases in a district having five million populations. During the same period census showed only four case of possession disorder out of fifty five conversion disorder patients which was a small fraction. The reason for the above finding could be that many of these cases were utilizing alternate medical or socio cultural interventions. Conclusion: Prevalence of possession disorder is still high in the rural areas and public need proper education regarding the nature and management of possession disorder.

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Background: History taking in psychiatry is perhaps the only method by which it is possible to reach a diagnosis. This requires initial training and constant practice and attempts to hone one's skills that makes one a good clinician Objective: This paper describes different approaches involved in psychiatric history taking. Discussion: A well recorded history of the patient going into the nuances of the evolution of illness and its dynamics facilitates diagnosis and paves way for psychological therapies. Conclusion: The importance of history taking in psychiatry is highlighted. Constant practice of good history taking is helpful to a clinician during his practice and a post graduate student to create a good impression in his clinical examinations.

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Training to use rating instruments is crucial for robust outcomes, both in clinical practice of psychiatry and also in research. Shortfalls in the use of same by non-mental health professionals and minimally trained mental health professionals can seriously implicate clinical outcomes and validity of research.

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Background: Somatisation, the tendency to seek treatment for medically unexplained physical complaints is frequently associated with depression and is more frequently seen in Indian context. Aim: This study is aimed to assess the prevalence of somatisation symptoms among various subgroups of Indian patients with depression and the sociodemographic factors associated with depression. Methods: This is a cross sectional study of 262 patients, who were categorized into three sub groups of as per ICD 10.All the subjects were administrated MADRS and BSI to study severity of depression and nature of somatisation. Results: Female subjects exhibited a higher prevalence of somatisation than male subjects. Similarly married, illiterate, low socio-economic and rural background subjects showed high prevalence of somatisation. Subjects with diagnosis of dysthymia exhibited high prevalence of somatisation (56.42%) followed by mixed anxiety depression (51.08%) and depression with somatic symptoms (48.55%). Conclusion: Somatisation is common in depression. The tendency to perceive and report physical complaints are influenced by various socio demographic factors including gender difference.

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Background: Caregivers of patients with schizophrenia are subjected to a lot of burden due the stigma in the society, lack of support from the government and society, which leads to a lot of financial psychological and social burden on the caregivers. Aims: To study the burden of care on caregivers of patients with schizophrenia and various factors affecting the burden. Methods: This was a cross-sectional study on schizophrenia patients and their caregivers. Caregiver burden was assessed by Interview Schedule (Pai and Kapur, 1981). Results: The burden of care was high in both subjective and objective scales and factors like female sex middle age and severity of illness had effect on extent of burden. Conclusion: The various risk factors for burden must be identified and measures must be taken in terms of support to the caregivers who are at risk to face more burden.

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This editorial aims to draw attention of journal editors and policy makers to a very pertinent question related to publishing. The mandatory requirement of ethics committee (EC) approval is a much needed regulation in light of serious human rights violations in past. However, it may not be always feasible for researchers to comply with this requirement. There is a need to develop some guidelines as to how such instances should be dealt with. This is not a regressive approach. The AP J Psychol Med is very much aware and concerned about the protection of the rights of study participants, and endorses the publication requirements of various organizations.

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Background: Recovery orientation to psychiatric illness views that the patient is more than a sum of his symptoms. There is a great paucity of studies on recovery in schizophrenia in India. Aim: With this goal in mind this study was undertaken to study (1) the socio demographic profile of the sample and their relation with stages of recovery of schizophrenia, (2) the relationship between socio-occupational functioning and stages of recovery and to assess the relationship between stages of recovery and symptomatology. Methods: Study was conducted in Psychiatric outpatient department in general teaching hospital, on patients diagnosed as chronic schizophrenia. Semi-structured proforma, Positive and Negative Syndrome Scale (PANSS), Stages of Recovery Instrument (STORI) and Social and Occupational Functioning Scale (SOFAS) were used. In our study, 37 patients with a diagnosis of schizophrenia were included. Results: This study did not find any significant correlation between demographical variables and the stages of recovery. Stage of moratorium of STORI had significant positive correlation with all subscales of PANSS while stages of awareness, preparation and rebuilding and growth of STORI had significant negative correlation with all subscales of PANSS. Stage of preparation and growth had significant positive correlation with SOFAS while stage of moratorium had significant negative correlation with SOFAS. Thus each stage of recovery in schizophrenia had significant correlation with the level of functioning in our study. Conclusion: This clearly indicates that there is a significant relationship between psychopathological symptoms and the person's ability to pursue the path of recovery.

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Background: Erectile dysfunction (ED) is a very distressing condition that not only has a negative impact on the man's sexual ability but also has damaging repercussions on the couple's quality of life. ED leads to depression, anxiety and loss of self-esteem and can contribute to marital breakdowns. Men are reluctant to seek help for fear of not being taken seriously or out of embarrassment and become isolated within their relationship, which may lose all aspects of intimate contact. Objective: In this article, we are reviewing the approach to a patient with ED in the present context. Discussion: All men with ED should undergo a full medical assessment in a stepwise manner. Conclusion: A stepwise approach in the assessment of ED helps clinician to arrive at a proper diagnosis, which in turn may lead to better management. The teatment for ED is readily available and highly effective, yet is underutilized.

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Background: There has been a change in socio familial scenario over a period of time in India. The elderly are being displaced from a combined family to the old age homes. There is a need to assess the psychiatric morbidity in these settings to frame policies for future. Aims and objectives: To compare socio demographic factors and psychiatric morbidity in elderly living in old age homes and community. Methodology: 50 subjects from each of old age homes and community were administered Geriatric Mental Status Questionnaire after taking informed consent. The socio demographic factors and psychiatric morbidity of the two groups were analyzed statistically. Results: Statistically significant differences were found between the two groups in socio demographic factors like age, educational status, socio economic status, marital status, having no male children and having employed children. Anxiety, moderate depression, obsessions and alcohol use were found to be higher in the community group where as mild depression; cognitive impairment and somatic dysfunction were found to be higher in old age homes, but statistically not significant, except for alcohol use. Conclusion: Elderly people in old age homes and community differed in socio demographic factors but not much in psychiatric morbidity.

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Background: Wellbeing of several segments of population has been documented but information of working women's well-being still is scarce. Indian working women have to deal with psycho-social and cultural barriers and facilitators that impact their well –being. Aims: The present study is focused on the subjective component across professional groups. Methods: One hundred working females from five different professions were selected as they were interested to participate in this study. The professions included executives, teachers, administrators, doctors and engineers. Tools: Life Orientation Questionnaire (LOQ) developed by Sahoo was used to measure subjects' happiness. Results: The dependent measures included overall life satisfaction, satisfaction with general area of life functioning, positive affect experience and negative affect experience. It was shown that doctors and teachers experience maximum happiness whereas administrators experience the least. Engineers and executives were placed in intermediate position. Discussion: The study considers professional setting as a “mini culture”. It is believed that profession has its own norms, expectations and corresponding value systems. Accordingly the happiness in different professional areas may be expressed differently. Conclusion: It was shown that doctors and teachers experience maximum happiness whereas administrators experience the least. Engineers and executives were placed in intermediate position.

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Introduction: The General Medical Council (GMC) provides information regarding sharing information with patients under Good Medical Practice for health care professionals and suggests that medication and treatment side effects must be explained appropriately. Method: To achieve the aim of this study all Consultants, Specialist Registrars (SpRs), Staff Grades / Associate Specialists (SASGs), Senior House Officers (SHOs) and Foundation doctors were sent postal / e-mail questionnaire to inform regarding side effects information they provide to patients. Results: 110 postal / e-mail questionnaires were sent out for doctors to respond about the information they provide regarding the serious and or common side effects of medication. The investigators received 52 (47.3%) responses which included 25 Consultants, 1 SpR, 4 SASGs, 18 SHOs and 4 Foundation doctors. Clozapine and Lithium stand out to be medications for which most doctors would always provide information about common side effects. It was interesting to note that the common side effect information of anti psychotic medications is provided by less than 60% of doctors. In our study we found that 68% of Consultants tend to always provide information about common side effects and 71% of them always provide information about serious side effects of medications. Due to small number of staff grades and SpRs we cannot comment on comparison but 57% and 67% of SHOs provide information about common and serious side effect of medications respectively. Conclusion: Doctors provide more information to the patients if the medication is Clozapine or Lithium but not for Benzodiazepines. Medication adherence could be increased if the patients are well aware of what to expect when they are on medications. Doctors provide information but are poor in documenting the same and our hypothesis is accepted.

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Background: The incidence of suicides has been on gradual rise during the past two decades, especially in developing countries. In rural population, which is mostly dependent on agriculture, the incidence of suicides would be different because of the socio demographic profile and also the variety of stressors that these individuals are exposed to. Aims: To study the incidence of suicides in the past five years, assess the relationship between socio-demographic variables and the number of these suicides and to assess the methods adopted by them. Methods: This is a retrospective study and the data regarding suicides from the past five years was collected from the health care professionals of the respective villages and various other sources like the village heads, revenue employees etc. Each family was visited and the details regarding the socio-demographic profile and the methods adopted were evaluated. The data was analyzed using SPSS 16.0 version. Frequency analysis, percentage analysis, mean and standard deviation, chi-square test were used for statistical analysis. Results: There was a gradual increase in suicidal deaths in the past five years. Suicides were proportionately more in the age group of 15-30years, in males, who were married and unemployed. The most common method adopted for committing suicide was pesticide consumption. Conclusion: This study reflects the need for mental health interventions for the vulnerable populations and also emphasizes the necessity of safer methods to store pesticides for a reduction in the incidence of suicides.

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Background: Epidermoid tumours are rare intracranial benign cystic lesions accounting for 0.2–1.8% of all intracranial tumours. Case description: We present a case of intracranial epidermoid cyst involving right temporal lobe with psychosis showing resolution of symptoms after resection of tumour. Discussion: Literature regarding this is sparse. We discuss the rarity of a right sided epidermoid tumour in temporal lobe with psychotic manifestations. Conclusion: We conclude that organic etiology should always be kept in mind while treating psychosis.

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There are few new drugs for psychiatric disorders, and many pharmaceutical companies have withdrawn from neuroscience research. Pharmaceutical companies are therefore reducing their involvement with psychiatry, which includes a reduction in organizing and funding educational activities. This editorial looks at how psychiatrists of the future will update their knowledge and learn about new treatments, concluding that there may well be an overall reduction in the amount and quality of continuing education available for psychiatrists working in clinical practice. There may be difficulties learning about the safe and effective use of new treatments such as neurostimulation therapies. Psychiatrists will need to be more proactive in seeking education, make better use of online resources, and demand more of hospitals, universities and professional colleges.

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Background: Aaron Beck is one of the pioneers in the field of psychiatry and a contemporary psychiatrist who played a seminal role in the development of ‘cognitive behaviour therapy’ for depression. He is regarded as ‘father of cognitive therapy’ and contributed his research on psychotherapy, psychopathology, study of suicide and various rating scales.

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Background: Children of parents with schizophrenia are reported to be vulnerable to various kinds of psychological and psychosocial problems. Stigma is one of the significant psychosocial impacts often studied in patients with schizophrenia. However the experiences of stigma and psychological well being of the healthy adult children of the parents with schizophrenia is less explored. Aims: To study the perceived stigma and psychological well being of the adult children of parents having schizophrenia and to assess the relationship between perceived stigma and psychological well being. Methods: The study adopted a two group comparison cross sectional methodology. The study group comprised of 30 adult children of parents with schizophrenia and control group consisted of 30 individuals without the history of any mental illness in the parents. The tools used were Sociodemographic Data Sheet (SDS), the stigma items of Explanatory Model Interview Catalogue (EMIC) and Psychological Well Being scale (PWB). Results: More than 50% of the participants in study group experienced stigma. Perceived stigma was positively correlated with current psychopathology of the parents. Active psychopathology in parents turned out to be a significant predictor of the stigma. The control group had better psychological well being compared to the study group. Conclusion: Even in the absence of any diagnosable psychological problems, children of patients with schizophrenia experience stigma and they have poor psychological well being compared to children of parents without psychiatric illness.

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Use of rating scales is an integral part of psychiatric practice and research. However, training for use of scales appropriately is not available. Due to lack of proper training, especially in the hands of non-mental health professionals, rating scalesare used at face value and as a substitute for clinical interview. There is a need to increase the awareness about proper use of rating scales. Additionally appropriate training must be obtained prior to use of rating scales.

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Background: Hypomelanosis of Ito is a neurocutaineous disease commonly associated with seizure and mental retardation. Case description: In this case report, we have found a unique coexistence of Hypomelanosis of Ito and Juvenile Myoclonic Epilepsy with normal intelligence. Discussion: The occurances of two genetically linked disease entities in a single individual arouse a possibility of some common genetic factors. Conclusion: The Juvenile myoclonic Epilepsy with normal intelligence can be a presenting feature in Hypomelanosis of ito.

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Background: Deprived child is a child who is not receiving proper parental care; this includes a child who is not getting proper food, is not going to school, or is not receiving proper medical care; a child who has been illegally adopted; a child who has been abandoned; a child who does not have a parent or guardian. Delinquent children are those who have been adjudicated by a judicial officer of a juvenile court as having committed a delinquent act. Aims: The present study is aimed at looking into certain dimensions which have an impact on the lives of deprived and delinquent children, and to study the factors which plague their behaviours and adjustments. Methods: The sample of 240 which included 120 Delinquent children and 120 deprived children of age 15 to 16 was drawn from the observation home. The literacy level of subjects was upto class VIIIth. The adapted version of Eysenck's (1970) M.P.I. by Jalota and Kapoor (1975), Gough's (1954) “Social Responsibility Scale adapted to Indian situation by Kaur (1982) and Sinha Anxiety Scale (1976) was administered. Results: In deprived children, there is a significant positive correlation between ‘neuroticism and anxiety’ and ‘extraversion and social responsibility’. Conclusion: There is a need for mental health professionals to address these issues while dealing with such children.

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Background: Managing treatment resistant depression has been a confounding problem for psychiatrists in clinical practice. Glutamate receptor agents are being tried as the next line of antidepressants for the future. Case Description: We describe herewith a case of treatment resistant depression that received ECT with ketamine anaesthesia and showed improvement in a course of 7 ECTs. Discussion: The improvement the patient showed was remarkable and demonstrates the efficacy of ketamine in the management of depression where most drugs have not benefited the patient. Conclusion: The role of ketamine in ECT anaesthesia in the management of patients with depression needs to be explored further.

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