Background: Hypothalamic-pituitary-adrenal (HPA) axis dysfunction in mood disorders is one of the most robust findings in biological psychiatry. However, considerable debate surrounds the nature of the core abnormality, its cause, consequences and treatment implications. Aims: To review the evidence for the role of HPA axis dysfunction in the pathophysiology of mood disorders with particular reference to corticosteroid receptor pathology. Methods: A selective review of the published literature in this field, focusing on human studies. Results: The nature of basal HPA axis dysregulation described in both manic and depressed bipolars appears to be similar to those described in MDD. But studies using the dexamethasone/ corticotropin releasing hormone (dex/CRH) test and dexamethasone suppression test (DST) have shown that HPA axis dysfunction is more prevalent in bipolar than in unipolar disorder. There is robust evidence for corticotropin releasing hormone (CRH) hyperdrive and glucocorticoid receptor (GR) dysfunction in mood disorders, with increasing evidence for disorders within the AVP system. Conclusion: HPA axis dysfunction is prevalent in patients with mood disorder, particularly those with psychotic disorders and bipolar affective disorder. This may be secondary to genetic factors, early life adversities or both. Dysfunction of GR may be the underlying abnormality and preliminary findings suggest that it is a potential target for novel therapies. Declaration of interest: None

Background; Evidence suggests that caudate nucleus abnormalities have a role in schizophrenia. Structural brain imaging studies on caudate size in schizophrenia are inconclusive due to confounding factors. Methods: In this study, caudate volume was measured on coronal Magnetic Resonance Images (I -mm) in consenting 15 never-treated schizophrenia (DSM-IV) patients and 15 age, sex, handedness, education and socioeconomic status matched controls using semi-automated Scion image software. Results: Multivariate analysis revealed significantly smaller caudate volume in patients than controls after controlling for intracranial area (df = 2,27; F = 5.4; p = 0.028). Separate univariate analysis showed that right (df = 2,27; F = 5.4; p = 0.028) and left (df = 2,27; F = 5.2; p = 0.031) caudate were significantly smaller in patients than controls after controlling for intracranial area. Illness duration did not correlate significantly with either right (r = - 0.13; p = 0.65) or left (r = - 0.10; p = 0.7) caudate volume. Discussion: Significantly smaller caudate nucleus in patients with never-treated schizophrenia suggests that some aspect of the disease process of schizophrenia influences the caudate nucleus. In conclusion, smaller caudate volume in never treated schizophrenia with lack of correlation between illness duration and caudate size supports neuro developmental etiopathogenesis in schizophrenia.

The understanding of pathways into care is necessary to plan services and identify health care needs of patients. We set out to study these pathways into care in south Asian and white elderly patients coming into contact with secondary care psychiatric services. All inpatients, day patients and community assessments of patients over 65 being referred for the first time or after a gap of one year were invited to take part in the study over a 6 month period and those willing were interviewed. Pathways to care encounter, GP satisfaction, Past Psychiatric History Schedule and menul illness beliefs were studied. Only the pathways and GP satisfaction are presented here. Of 117 patients, 71 were white and 46 south Asians. South Asians were more likely to ask for help but had longer delays in contacting psychiatric services. They were also more dissatisfied with their GPs. A complex interaction of interpersonal and intrapersonal factors influences pathways into help-seeking.

The higher prevalence of schizophrenia in children of schizophrenics than in the general population has generated an interest in pinpointing those behaviors that may precede the disorder and serve as an index of vulnerability to the disorder. Signs of neurobehavioral dysfunction in areas of neurocognitive functioning and social behavior have been found in school-age children of schizophrenic parents. This study assessed the neurobehavioral functioning, social behavior, cognitive functioning, attention and intelligence in children with a schizophrenic parent and compared the same parameters with children of mentally healthy parents. The children aged 12-15 years, were assessed with a battery of neurobehavioral tests. The children with a schizophrenic parent performed more poorly on the tests as compared to the children of mentally healthy parents. The children with a schizophrenic parent were seen to have more behavioral problems, especially withdrawn behavior and more social problems when compared to the other children in the study. Poor attention, disordered thoughts and lower intelligence were also observed to be more in the children of the schizophrenic parent

One hundred subjects each who reported with a relapse of alcohol and opioid dependence were assessed using Relapse Precipitants Inventory-Hindi (RPI-Hindi), Presumptive Stressful Life Events Scale (PSLES) and Dysfunction Analysis Questionnaire (DAQ). The two groups were similar for substance related clinical profile and RPIHindi score profile. On PSLES, the alcohol group reported higher number of and stress due to desirable (but not undesirable, ambiguous or total) events in lifetime while, the opioid group reported higher number of and stress due to total, desirable and undesirable (but not ambiguous) events in the past one year. On DAQ opioid group reported higher total dysfunction and in social, family and cognitive areas. Regression analysis showed the contribution to relapse to be significant in terms of: the total number of life events in lifetime and in past one year in alcohol group; the number of and stress due to total life events in past one year and social dysfunction in opioid group and; the number of desirable and undesirable events in lifetime and in the past one year and stress due to desirable events in the past one year, when the two groups were combined together. Thus, the results suggest that relapse in alcohol and opioid dependence is associated with similar relapse precipitants but a differential dysfunction and, life events in terms of the number and type of events and associated stress in lifetime and in the past one year.

The aim of the study was to determine the prevalence of psychiatric and personality disorders in survivors following their first suicide attempt. Three hundred and fortyone survivors who received treatment from the various medical wards of a general hospital participated in the study. ICDIO psychiatric disorders were diagnosed in 47.2% of the cases. The most common diagnosis was depressive episode (31 %). Only 7 % qualified for a diagnosis of personality disorder. A significant proportion of patients (52..8%) did not suffer from any identifiable ICD- 10 psychiatric disorder.

Psychopharmacology emerged with the discovery of chlorpromazine in 1952. This led on to the discovery of other antipsychotics, antidepressants, tranquillisers, psychedelics and other drugs. Traditional histories tell of a liberation of the insane from their asylums. This history neglects the rise and fall of antipsychiatry, and the fact that many more people are both employed in and treated by the mental health industry now than ever before. The small companies who manufactured the first drugs have since become the most profitable corporations on the planet, apparently able to mould academic debate at will and to market psychiatric disorders more effectively than they can make new therapeutic agents. In our efforts to govern ourselves through psychopharmacology, we have set up a future of cosmetic psychopharmacology. These developments have been largely unscrutinized.

Thalamic infarcts presenting predominantly with psychiatric manifestations are rather uncommon. They usually have a constellation of neurological and psychiatric symptoms involving altered consciousness, vertical gaze palsy, motor and sensory symptoms with cognitive deficits involving memory. A middle-aged male with Bilateral Thalamic infarct who presented with prominent delusions and cognitive deficits involving memory, orientation and attention despite treatment is here by reported.

Menstrual Psychosis is a unique disorder (Altschule et al, 1963). Over the last 150 years, sporadic case reports of this disorder are found in the literature. As yet, the standard psychiatric diagnostic nomenclature i.e. DSM, ICD-10 does not acknowledge its individuality. We report a 16-year-old female patient who was treated for three episodes of psychosis over a period of 5 months