Background: Among all the intellectual processes of the human brain, attention is probably the most important cognitive function to be assessed during the mental status examination. Many theories have been proposed for its understanding. It is important to combine this knowledge to understand the role of attention in various psychiatric disorders. Methods: The PubMed, Google and Cochrane Library were searched. Articles were searched using the keywords of “attention” AND biology”, “attention” AND “Hypothesis”, “attention” AND “chemistry”, “attention” AND “process”, “attention” AND “mechanism”, “attention AND anatomy, “attention” AND “neuroanatomy”, “attention” AND “physiology”, “attention” AND “classification”. Discussion: The concept of attention has undergone a huge change along with an improvement in our understanding of anatomy and physiology of the brain. From the earlier postulate of ‘everybody knows what is attention’ there has been a shift to the current conceptualisation that attention is a “phenomena” which is one of the most important and complex cognitive functions of the brain. Several concepts about attention have held their ground and have been corroborated by scientific experiments and imaging techniques. Others have either fallen through or have been modified drastically. All this has led to a better understanding of the processes involved in attention, its disorders and their implications in psychiatric illnesses. Conclusion: Attention as a vital cognitive function influences all other cognitive processes in the mental well-being. It is classified as per the process, the stimuli-their nature and its recovery. Different chemicals, structures and neural mechanisms are involved. It influences general states like memory, confusion, neglect and also psychiatric disorders of which attentiondeficit hyperactivity disorder is the prototype.

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Background: Children with special needs are those who have physical, emotional or learning difficulties. Historically society has always discriminated and never recognised their rights. Pioneers in the field worked and proved that specialised techniques can be used to teach the children with special needs. Objective: The current paper explains the concept of special education and how it is different from general education system. It describes about the various acts and policies which led to the development in the field of education for children with disabilities. Discussion: Initially there were special schools to teach the children with special needs. But then the work started towards integrating these children into regular schools. Then finally government came up with the policy of inclusive education. This progression was due to the shift in the model of disability i.e. from medical model to social model of disability. The people started recognising the drawbacks of segregation and integrated system of education. Methods: Conclusion: In moving towards inclusion, there are several barriers which need to be addressed. Government need to create awareness programs in sensitizing the people about education for children with special needs.

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Background: Literature regarding the sociodemographic profile and illness variables in bipolar affective disorder is sparse in Indian context and hence this study was taken up. Aims: To assess the sociodemographic profile and illness factors in the BPAD patients of the study sample. Methods: This is a cross sectional study of BPAD patients in psychiatric hospital. Fifty patients attending private psychiatric hospital outpatient and inpatient section giving a voluntary written consent and fulfilling inclusion and exclusion criteria were included in the study. The patients were diagnosed as having Bipolar Affective Disorder as per the DSM-IV-TR criteria and the diagnosis confirmed by M.I.N.I (Mini International Neuropsychiatric Interview). A semi structured sociodemographic proforma and clinical profile sheet was administered and the data analysed. Results: Bipolar disorder affected both the genders with slightly higher occurrence in females, majority of them were from the age group of 39-48, illiterate, married, belonged to low socioeconomic class and rural background. Same numbers of manic and depressive episodes were noted. The age of onset in this study was more among 18-28 yr, most of them took treatment for 1-5 years, and majority were on sodium valproate and were regularly adherent to the drug. Conclusion: Sociodemographic and clinical factors associated with BPAD vary in the present scenario. Community based and long-term follow-up studies are needed for better knowledge on the variables associated with bipolar disorder from developing country setting.

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Background: Catatonia is a neuropsychiatric syndrome most commonly characterized by mutism, stupor, refusal to eator drink, posturing, and excitement or hypo kinesis. The concept of catatonia was first described by Karl Kahlbaum in1874. Although the introduction of antipsychotics has reduced the incidence of catatonia, it is still not uncommon and itsdetection rate can be significantly improved by using a standardized rating scale. The prevalence of catatonia is unknown.Catatonia is likely underdiagnosed by psychiatrists and other physicians. It has been reported that the use of amantadinein patients of catatonia, who do not respond to lorazepam has shown effective results because of its N-methyl-D-aspartate receptor (NMDA) antagonistic property. There is a dearth of studies documenting the usefulness of amantadinein catatonia. Case description: Mr. A, a 25 year old male person presented to the psychiatric with the chief complaints of decreasedinteraction with others, poor personal care, appearing sad and bemused, staying aloof, having low appetite and maintainingmundane posters for prolonged time since seven to eight days. The patient was diagnosed as having catatonic schizophreniaas per the International Classification of Diseases Research and Diagnostic Criteria 10^th revision (ICD-10 RDC). BuschFrancis Catatonia Rating Scale was applied to assess the severity of catatonia symptoms. The initial score on day one wastwenty one. Patient who was unresponsive to inj. lorazepam in the dosage of 8-12mg/day by day eight had shown asignificant improvement on adding amantadine 20mg/day by 12^th day. Discussion: Amantadine has N-methyl-D-aspartate receptor (NDMA) receptor antagonist activity, in addition to dopamineagonist activity and its potential efficacy in catatonia may be due to the blockade of hyperglutaminergic excitotoxicity toneurons and decreasing the free radical formation. Conclusion:

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Background: Postpartum mood disorders range in severity from the early maternity blues to postpartum psychosis, a serious state affecting less than 1% of mothers. An estimated 10-15% of new mothers are affected by mild postnatal depression, usually manifesting within the first three months after birth. The strongest antenatal predictors of postnatal depression are depression during pregnancy, anxiety during pregnancy, stressful recent life events, lack of social support, a previous history of depression, and low self-esteem. Aims: To study the prevalence and severity of postnatal depression. Methods: Semi-structured socio-demographic and clinical data sheet was used to record the particulars of the patients. Edinburgh Postnatal Depression Scale (EDPS) was used for the screening purpose, later the clinical diagnosis is established as per the ‘International Classification of Diseases Research and Diagnostic Criteria’. Hamilton depression rating scale (HAM-D) was used to assess the severity of depressive episode. The findings were analysed using SPSS-16. Results: The prevalence of depression in the current study is sixty percent. The mean age of the population is 26.5 ±5.09 years. Most women in the present sample were primipara. Constitution of domestic violence to the severity of depression is found to be significant. Conclusion: Significant depression levels were found in younger age group and in population with a family income of less than 10,000 rupees per month. Depression was significantly more prevalent in those with marital duration less than five years and those who are primigravida. Most of the mothers having female child were depressed which is incommensurable with those who gave birth to male child.

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Background: Mental disorders are an important public health issue that leaves an enormous burden on healthcare services in modern day societies. In India one in four patients attending primary care clinics has a mental disorder. The World Health Organization (WHO) states caregiver burden as the “the emotional, physical, financial demands and responsibilities of an individual's illness that are placed on the family members, friends or other individuals involved with the individual outside the health care system.” The intensity of caregiver burden in psychiatry is mainly influenced by the duration, frequency of hospitalizations and relapse of the illness. Aims: To asses and compare the care giver burden among various psychiatric conditions. Methods: The presumptive diagnosis of the patients was made as per the International Classification of Diseases Research and Diagnostic Criteria; tenth revision (ICD-10 RDC). Family Burden Interview Schedule (FBIS) was used to assess the burden in the care givers. The resultant data was statistically analyzed employing SPSS 16th version. Results: Severe burden is found in the younger age groups. Burden is more experienced in males than in females. Severe burden is seen in chronic conditions. Conclusion: Excessive burden in family domains like family routine, family leisure, family interaction is felt by family members of dementia patients followed by alcohol dependence syndrome, mania and schizophrenia.

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Background: Family caregivers experience significant burden in taking care of their patients with schizophrenia. As caregiver burden might vary over the course of schizophrenia, research on its predictors is needed. Aims: The aim of the study was to determine the association of the disability of patients with chronic schizophrenia and their caregivers' burden. Methods: Sixty patients and their caregiver dyads admitted to an in-patient facility of Institute of mental health, Hyderabad were interviewed. Caregiver's burden was assessed using burden assessment schedule (BAS). Patient's disability was assessed with World health organization disability assessment schedule (WHODAS 2.0). Results: The mean disability by WHODAS in our sample was 87.85 denoting mild disability and caregiver burden score showed a mean value of 81.75 indicating severe burden. The correlation of total severity of disability of chronic schizophrenia with caregiver burden had a correlation co-efficient(R) of 0.57 indicating moderate correlation. Conclusion: Caregivers of chronic schizophrenia patients experience enormous burden and are at risk for mental disorders. The severity of this burden is related to the severity of disability and different domains of disability are affected differently. Our study there by adds to the available evidence and points to the need for clinicians to reduce disability by improving rehabilitation services so that caregiver burden is reduced.

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Background: Aims: To assess the change in quality of life and its correlation with psychopathology among patients with schizophrenia having acute exacerbation. Methods: The study was conducted among patients admitted in the hospital for acute exacerbation of schizophrenia. The subject was assessed with PANSS (for symptom severity), WHO QoL Bref (for quality of life). Then at end of three months after first assessment the PANSS, WHO QoL Bref were re-administered. Paired t tests for changes in severity of symptoms and Pearsons correlation of statistics was used to assess relation between symptom severity and quality of life. Results: 40 patients were enrolled into the study, 3 did not complete the study. The PANSS positive subcategory score showed maximum change (mean=12.054, t=14.214, p<0.01). The WHO QoL Bref social relation showed maximum change (mean=27.405, t=8.347, p<0.01). Change in PANSS score correlation with endpoint QoL scores showed negative subcategory had positive correlation to social relations score (r=0.365, p=0.026) and affective subcategory had negative correlation to psychological domain (r=0.670, p<0.01). Conclusion: Improvement in quality of life in subjects having schizophrenia appears to be significantly related to depressive and anxiety symptoms which can be a part of the disorder.

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Background: Depression is most common among psychiatric disorders and with well documented impact on diabetes mellitus outcome. Aims: To assess psychosocial profile and prevalence of depression in subjects with complicated and uncomplicated diabetes mellitus. Methods: This is a cross sectional study of 80 subjects, categorized into two subgroups of diabetes and were administrated ICD 10 criteria for depression after taking informed consent. The sociodemographic profile and psychiatric morbidity of the two groups were analyzed statistically. Results: Statistically significant differences were found between the two groups in sociodemographic factors like age, marital, educational, socioeconomic, employment status and living situations. All the symptom variables of depression with exception of decreased appetite had shown ‘p‘ value of 0.001 which was highly significant suggesting significant presence of depression and meeting criteria for depression in complicated group when compared with uncomplicated group. The prevalence of depression was found to be 72.5% in complicated group and 15% in uncomplicated group. Conclusion: Depression is common co morbidity in diabetes mellitus. The determinants of psychosocial demographic factors influence the outcome of diabetes mellitus.

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Background: Catatonia is a disorder of varying aetiology characterised by psychomotor disturbance, mutism, negativism, catalepsy, echo phenomenon. Schizophrenia accounts for 10-15% of cases. Atypical antipsychotics are used in treatment resistant cases, of which aripiprazole has a unique D2 partial agonism as mechanism of action. Case description: We present to you a case of catatonic schizophrenia in a 40 year old male that did not respond to optimal does of risperidone, olanzapine, haloperidol, trifluoperazine, amisulpiride, clozapine and ECTs but showed dramatic improvement to Aripiprazole at 20 mg/day. Discussion: Even though the mechanism underlying its action in this case is unclear, we suspect it's the D2 partial agonism characteristic of Aripiprazole that worked where rest all antipsychotics failed. Conclusion: We suggest further study is required regarding efficacy of aripiprazole in treatment refractory catatonic schizophrenia.

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Background: Major depressive disorder is very usual in patients experiencing a history of myocardial infarction (MI). Raising level of Troponin I could be a tool to predict the severity of post myocardial infarction depressive disorder. Aims: The purpose of this work was to test the relationships between levels of Troponin I and severity of post MI depression. Methods: The study was conducted on patients of acute MI (n=100) attending cardiology OPD of Assam Medical College and Hospital, Dibrugarh, Assam in 6- 8 weeks after the index event. Screening was done by The Primary Care Evaluation of Mental Disorders and diagnoses of Major Depressive Disorder were established according to the Diagnostic and Statistical Manual for Mental Disorders fourth edition Test Revision criteria. Severity of the depression was assessed by Beck Depression Inventory. Laboratory reports of serum levels of Troponin I were noted from the medical records of the patients. Statistical tests like the student to test and Pearson correlation were used for analysis. Results: Severity indicators of MI like raising Troponin I has significant association (t test = 3.66, p = 0.0006) and positive correlation (r = 0.797, p= 0.003) with severity of post MI depression. Conclusion: Rising Troponin I levels are associated with increased risk of depression following the myocardial infarction. So it can be utilized to foresee future chances of depression after an attack of myocardial infarction.

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Background: Alois Alzheimer is a Bavarian born German psychiatrist who is considered as the “Father of Neuropathology” was the first to describe the main neuro pathologic characteristics of the peculiar disease in the brain of a woman showing progressive dementia .Alzheimer observed degenerating neurons with neuro fibrillary tangles and senile plaques.

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Background: Possession disorder is common in our country though it receives little attention from mental health care systems, possibly due to the cultural complexity of understanding pathological trance syndromes, its diagnosis and treatment. Aims: To study the attitude and knowledge of the key persons in a population of rural south Indian community towards possession disorder and to study the associations of the various sociodemographic variables of the key persons with their attitude towards possession disorder. Methods: This sample was selected from the revenue district of Chittoor, Andhra Pradesh. Probability sampling design was employed in this study. Sampling was done only in rural areas using probability proportional to size (PPS). Stratification is done to reduce sampling error which allows sub group of interest to be included in the sample. About 253 primary sampling units were selected randomly by a software program. The available key persons were personally contacted by the authors and interviewed using a structured questionnaire prepared for the present study and appropriate statistical tests were done to know the correlation with attitude with the key persons. Results: The total 306 key persons constituted of sarpanches, village leaders, health workers and teachers. Among the key persons majority were sarpanches and village leaders. The possession disorders as a psychiatric disorder was opined by 39.1% of sarpanches and almost equal number of sarpanches felt the influence of spirits and ghosts. Whereas the teachers showed better attitude, opting for psychiatric disorders (81.1%) and only 11.1 % opted for the influence of spirits and ghosts. Key persons with level of education being higher from intermediate and above could say it as psychiatric disorder. Highest number of people reported spirits and ghosts are from the 10th class education and below. People who opined it to be suffering due to the influence of spirits and ghosts thought that only traditional healing can benefit for relief of symptoms. In our study, age and sex do not have bearing on the attitude towards possession disorder or on the preferred mode of treatment. Conclusion: As possession disorder is commonly seen in rural areas, proper education of these “key persons” is necessary regarding the nature and management of disorder for developing a positive attitude towards mental health in the community.

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Background: As per the reports depression will become the major leading cause of disability. Treatment with antidepressants is suboptimal in most of the cases. Studies have shown that Omega 3 fatty acids might play a role in suppression of depression. Objective: This present review summarizes the role of Omega 3 fatty acids in depression and their efficacy profile. Discussion: As per the reports of World Health Organization, depression will become second leading cause of disability worldwide by 2020. Response to treatment with antidepressants is suboptimal in most of the individuals with depression. From so many years, use of Omega 3 fatty acids, as add on therapy has been research of interest, but till now, no standard decision made on their use in depression. The present review summarizes the role of omega 3 fatty acids in reducing depression, previous clinical studies that evaluated the beneficial effects omega 3fatty acids in prevention and treatment of depressive disorder. Conclusion: By reviewing the previous clinical studies and epidemiological findings, we conclude treatment with omega 3 fatty acids, as an adjuvant to antidepressant medication, may effectively reduce the depressive symptoms.

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Background: Since indicated programs target only specific group of participants, they have been criticised for greater social stigma and peer rejection for adolescents. However, there is dearth of empirical research of this assumption, next to none in the Indian context. Aims: The current study examined the perceived stigma and satisfaction reported by adolescents participating in an indicated program to reduce elevated depressive symptoms. Methods: Grade 8, 9, and 11 students (n=65) of an English-medium school of Bangalore participated in the intervention. This being an indicated program, steps were taken to address stigma and mask the nature of the student selection process. An anonymous feedback form was developed and administered to adolescents who participated in the intervention program. Results: Low to nil perceived stigmatisation was found, with adolescents reporting that they were not embarrassed to do the program. The satisfaction with the program was rated to be moderate to high. Conclusion: The current study makes a preliminary dent in the unquestionable certainty that indicated programs would be unpopular with participants due to their high levels of stigma. It points to the need for further evaluation of this issue in providing a balanced consideration of the value of indicated programs.

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Background: An inverse relationship is observed between schizophrenia and rheumatoid arthritis (RA). Case description: A 33 years old male patient's case history is discussed for an unusual co-occurrence of schizophrenia and rheumatoid arthritis. Discussion: Susceptibility genes for major histocompatibility complex are shared by schizophrenia and RA. Platelet activating factor and glutamate systems are said to be involved for the association. Prolonged institutionalization of schizophrenia patients is proposed to confer a protection against RA. Conclusion: The short duration of stay in our patient deserved reporting.

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