Background: Lorazepam (Ativan) and Chlordiazepoxide (Librium) are both popular treatments for alcohol-withdrawal syndrome. Nevertheless, there is little literature directly comparing the two drugs Aim: To compare the efficacy of Lorazepam and Chlordiazepoxide in the treatment of patients experiencing symptoms of acute alcohol withdrawal. Methodology: Sixty consecutive consenting male inpatients in a state of moderately severe, uncomplicated alcohol withdrawal at screening, based on the inclusion criteria, were randomized to receive either Lorazepam (8 mg/day) or Chlordiazepoxide (200 mg/day) with dosing down-titrated to zero in a fixed-dose schedule across 8 treatment days. Severity of alcohol dependence was measured using Severity of Alcohol Dependence Questionnaire (SADQ). The initial withdrawal assessment and subsequent progress of withdrawal were assessed using Clinical Institute Assessment for Alcohol-revised (CIWA-Ar). The rate of withdrawal and total duration of withdrawal were compared among the two groups. Results: The severity of alcohol dependence, assessed using the SADQ (LOR=23.33 ± 10.57, CDZ=23.43 ± 7.64) indicated moderate alcohol dependence for both the groups. Lorazepam and Chlordiazepoxide showed similar efficacy in reducing symptoms of alcohol withdrawal as assessed using the revised Clinical Institute Withdrawal Assessment for Alcohol scale (CIWA-Ar) across 8 treatment days. No difficulties in drug discontinuation were observed with either drug. Conclusion: With the treatment schedule used in this study, Lorazepam is as effective as the more traditional drug Chlordiazepoxide in the treatment of uncomplicated alcohol withdrawal. Higher doses of Lorazepam than those formerly used may be necessary during alcohol withdrawal

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Delirium is a state of impairment in the level of consciousness, cognition, psychomotor activity, sleep-wake cycle and emotions. It is one of the most common neuropsychiatric complication in terminally ill cancer patients. People with Chronic Lymphocytic Leukaemia (CLL) are usually asymptomatic, and presenting to psychiatry outpatient as delirium is a rare scenario. Through our extensive literature search, delirium in CLL was noted only when hematopoietic stem cell transplant was initiated, although we did not get any data on CLL presenting as delirium. We are hereby describing the case of a 65 year old male who presented with delirium as the initial manifestation of CLL. He was started on chlorambucil and prednisolone with conservative management of delirium and was found to be doing well on follow up. This case illustrates the need for thorough evaluation and treatment of the underlying cause for delirium.

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Background: A growing number of research studies suggest that mindfulness-based interventions are effective for a wide range of mental and physical health problems in adults. However, little is known about the effects of such interventions on adolescents, and even lesser in normal population. Aim: This pilot study tested the feasibility, acceptability and usefulness of mindfulness based intervention in improving the cognitive functions of early adolescents (aged 10-14 years). Methodology: 20 adolescents participated in the study- ten in experimental group, and ten who were matched on age and intelligence with those selected for intervention, in the control group. The training comprised of ten sessions of 45 minutes each, on a weekly basis. Pre and post intervention assessments were conducted for cognitive functions. Results: Results of the study are encouraging and provide preliminary data on effects of mindfulness training on cognitive functions- sustained attention, focussed attention, phonemic fluency, verbal working memory, and verbal memory. t test(independent as well as paired) show statistically significant improvement in cognitive functions between the two groups, and within the experimental group. Conclusion: High retention rate, high attendance and positive feedback indicate that the training is feasible and acceptable. Further research is needed to test the efficacy of the intervention with a larger sample.

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Background: The quality and quantity of referral letters is particularly important as they are central to the process of case allocation. Additionally the timing and nature of the psychiatrist response is primarily determined by the referral letter. Aim: To study the appropriateness and quality of psychiatric referrals presented in the referral document to the psychiatricservice at a tertiary care referral centreduring one year. Method: The referral letters of all patients referred from other departments to the psychiatric service of PGIMER Dr R.M.L. Hospital on Mondays during one year were studied. The diagnosis in the referral letter was compared to the International Classification of Diseases, 10th edition, and to the final diagnosis in the case notes for agreement. Results: Among the whole sample of 75 referrals there were 42 males (56%) and 32 (42.7%) females and 1 (1.3%) missing data. Analysis of the referral letters showed that Diagnosis was clearly indicated in only 6 and that was of delirium. Symptomswere mentioned in 55 (73.3%) and not mentioned in 20 (26.7%) of the referral letters. Symptoms were adequately mentioned in 31 (56.4%) and inadequately in 24 (43.6%)letters. Conclusion: There is poor quality of referral letters and obvious poor response rate of psychiatrists. This is an indication for urgent need for intensive training to physicians advising them to include particular items of information in future referrals.

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Background: There is increased prevalence of suicidal rates in our country. Despite impulsivity as an important component of suicidal behaviour, there are few empirical studies evaluating the role of impulsivity in suicidal behaviour. Aims: This study is aimed to assess the role of impulsivity predicting severity of suicidal intent in attempted suicidal patients at general hospital setting. Methods: Consecutive 50 cases of attempted suicide referred to Department of Psychiatry, SVRRGG Hospital, Tirupati from various departments were recruited for the study over a period of 3 months. The subjects were assessed using semi structured pro-forma covering socio-demographic and clinical characteristics of patients followed by Barratt's Impulsivity scale and Beck's suicidal intent scale. Results: We found significant association between Barratt impulsivity scale score and Beck's suicide intent scale score. Attentional impulsivity is significant predictor of high suicidal intent. Conclusion: Impulsivity has a significant role in predicting severity of suicidal intent in subjects who attempted..

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Capgras syndrome is one of the delusional misidentification syndrome characterized by a strong belief that his or her relative/family member or close friend has been replaced by an imposter who has a close resemblance to the original. This is a case of Capgras Syndrome in a 37-year-old male that did not respond to optimal dose of risperidone, olanzapine, haloperidol or trifluoperazine, but show Eddramatic improvement to the combination of Olanzapine 30 mg/day with amisulpride 600mg. We suggest further study is required regarding the efficacy of olanzapine andamisulpride combinationin Capgras Syndrome.

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Background: The incidence of Obsessive Compulsive Symptoms (OCS) in schizophrenic patients ranges between 30% and 59%. Interest in this area has been revived recently because of increased recognition of higher than expected comorbidity rates and observations of the emergence or exacerbations of obsessive compulsive symptoms during treatment of psychosis with the atypical antipsychotics. The literature based on the prevalence & clinical correlates of schizophrenia along with obsessive compulsive symptoms are found to be lesser in India, relatively in south India. Thereby this study is focussed on determining the prevalence & correlates of schizophrenia and obsessive compulsive symptoms in a south Indian population. Methodology: The study sample was recruited from Department of psychiatry SRM Medical College Hospital & Research Centre, Kattankulathur, Tamilnadu, India. The sample size was 100 schizophrenic subjects who fulfilled the inclusion and exclusion criteria. After obtaining the written informed consent, various scales and assessments of the schizophrenia patients were done. Results: Most of the schizophrenia patients in the study population were females. Most of the schizophrenia patients in the study population belonged to lower socio economic status. Schizophrenia patients with OC symptoms had aggressive, contamination, pathological doubt and sexual obsessions. These patients had checking, cleaning and repeating ritual compulsions.The prevalence of obsessive compulsive symptoms among the schizophrenia patients in this study were 6% (N=6). Conclusion: Among the study population, the schizophrenia patients with OC symptoms had lower level of functioning than those without OC symptoms.

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Authorship in a manuscript has become important with the Medical Council of India making publication of papers mandatoryfor promotions. They have further said that the first author and corresponding author only will be considered for promotions.This article talks of the different types of authorship, and also whom to consider as an author.

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Background: Despite the potential psychosocial risks associated with having a chronic illness, a limited number of empirical studies have examined the prevalence of mental health problems in children with HIV. Aims: To study the psychosocial profile and psychopathology in children with HIV & AIDS. Methodology: The study was carried out at PediatricAnti RetroviralTherapy centre and OP block of Niloufer Hospital, tertiary hospital at Hyderabad. Three groups of each 30 children were selected by purposive sampling namely children with HIV staying with parents, children with HIV staying in foster homes and children without HIV staying in foster homes reporting for minor health ailments.Informed consent was taken from caregivers. Sociodemographic data and details pertaining to HIV were obtained from each followed by administration of CPMSscale. Results were compiled and subjected to statistical evaluation. Results: Socio demographic factors such as lower level of paternal education, lower maternal education, death of father and death of mother were significantly associated with HIV infected children. Compared to Non HIV children, HIV children had higher total CPMS score and higher scores in CPMS factors of anxiety, low intelligence with behavior problems, special symptoms, physical illness with emotional problems and high scores of conduct disorder. Conclusion: HIV infected children suffer from both internalizing and externalizing behavioural problems.Key words: Socio-demographic factors, psychopathology, HIV children, behavioural problems.

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A 17 year aged adolescent female from lower socioeconomic status, presented to the OPD with complaints of excessive water intake. The diagnosis was confirmed as Psychogenic polydipsia (PPD) associated with behavioural problems like conduct disorder, with disinhibited behaviour. During the episode of polydipsia, no signs of severe water intoxication was observed. The ICD 10 diagnosis of Conduct disorder, adolescent-onset type (F 91.2) or unsocialized conduct disorder and Borderline intellectual functioning (R 41.83) was made. Her phenotypic features suggested and karyotyping proved the index case to be Turner's syndrome (45 XO).The behavioural manifestations including truancy, risk taking behaviours and frequent stealing and lying fits her in the ICD 10 diagnosis of Conduct disorder of Adolescent onset.

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Background: Epilepsy is a neurological condition in which recurrent seizures take place due to abnormal, excessive neural activity in the brain. This leads toinvoluntary change in the body movement or function. Studies have shown that seizures affect sensation, attention behavior and memory of an individual. Memory problems are very common and distressing to the patients. It is a matter of great concern as it affects their day to day functioning. The higher the frequency of seizures and/or the prolonged duration higher the dysfunction affecting quality of life of the individual. Aim: The study aimed at understanding memory dysfunction associated with primary generalized epilepsy. Methodology: The sample was selected using purposive sampling (N=30). Patients with primary generalized epilepsy were assessed on PGI memory scale (N=15) and were compared with control group (N=15). Results: The results revealed significant dysfunction of attention, concentration, and verbal retention in patients of primary generalized epilepsy. Remote memory and recognition on the other hand was found to be unaffected. Conclusion: The present study concludes that attention and concentration and short term memory is affected in patients withprimary generalized epilepsy.

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Background: Unravellingthe cause of abdominal pain from a psychosocial perspective is ever dynamic, and assessment of psychopathology is crucial. We have several research studies that have enumerated on various causal factors related to abdominal pain in children, predominantly from the western population. However, in a diverse country like India, there is a clear paucity of research evidence in the area of pediatric abdominal pain, especially from a psychosocial perspective. Aim: The present investigation was carried out with the aim of studying the psychosocial factors associated with abdominal pain in pediatric cases in the Indian setting and any gender differences in perceiving the stressors were explored. Methodology: Thirty children in early to late childhood, having abdominal pain with the age group of 5 – 12 years were examinedin this exploratorystudy. Children attending the pediatric and child guidance outpatient clinics who presented with recurrent abdominal pain with no known medical cause were included in the study. Clinical interviews were conducted using Parent's Interview schedule and Kuppuswamy's Socioeconomic Status Scale. Analysis: A statistical package SPSS was used for theanalysis.Descriptive statistics such as mean, standard deviation, chi-square and t test were calculated. Results: Profiling the psychosocial factors revealed that thecommonly associated stressors were abnormal qualities of upbringing, interpersonal stress related to school and abnormal intra-familial relationship. These factors form the vicious cycle in the relapse, accentuating and maintaining clinically significant features. Genderdifferences were found in perceiving the stressors that may indicate the cultural difference in parenting based on the given gender. Children from lower Socio Economic Status were foundto be having more of abnormal immediate environment compared to high or middleclass children. Conclusion: The current findingscontribute to understanding of multifactorial causes which necessarily underpins the psychosocial causes and warrants comprehensive multi-disciplinary interventions.

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Background: In India, even after spread of literacy, we still have so much of stigma to the mental disorders. So much so that “psychiatric patient” is still used as a derogatory term. The Knowledge, Attitude and Perception to Psychiatry disorders in future doctors reflect the future of mental health in India. Aims: To study Knowledge, Attitude and Perception to Psychiatry disorders in Medical students and compare between those who are exposed to the study of psychiatry and those who are not. Methodology: The current study was undertaken with two groups of students. All students were given a structured pre-designed questionnaire to fill. The data so collected was digitized analysed and a comparison was made between two groups for their Knowledge, Perception & Attitude towards Psychiatry. SPSS software was used to derive simple frequency and percentage of the observations. Results: All the 193 respondents of Final M.B.B.S. responded unanimously, that – 1. In the treatment of psychiatric disorders Psychotherapy is – Essential part of treatment. 2. ECT is one of the effective treatment modality in psychiatry. 37% of first year students felt Psychiatry disorders can be treated by Faith-healers, while only 14% of final year students felt same way, 75% of final year students felt they are treated well by psychiatrists. Conclusions: A Psychiatry posting definitelygives a Better Knowledge, Positive attitude and better perception to PsychiatricDisorders, Psychiatrists and Treatment modalities of mental disorders.

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The objective of this article is to recognize psychological problems and developmental needs of children with the combination of cerebral palsy and intellectual disability. Their families also need to be aware of their individual necessities in order to provide them with psychological help without disturbing them. It addresses all areas of functioning of such adolescents with regard to their teachers and their families, the coping mechanisms and the process of adjustment. It highlights the importance of acceptance and understanding of disability and the diverse consequences that affect every individual adolescent with respect to the self-dependent life, establishing social roles and adaptation to the characteristics of the environment in which affected people are living. It gives an insight on the strategies for handling these adolescents for a positive and smooth psychological growth.

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Leukotriene receptor antagonist (Montelukast) has been used for many years in the treatment of asthma during both acute and chronic stages . It is considered as safe and widely used in pediatric age and adults. However, the use ofMontelukast could also lead to psychiatric disorder.

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