The information about Urban Mental Health Services has been nearly nonexistent in India, although the developed countries have been focusing on programmes for "Healthy Cities". The initiative taken as part of the WHO-ICMR Pilot Project on Urban Mental Health Services, with a public health perspective is being shared. The objectives of the Health Services Research (HSR) Arm of the project were to study the distribution and the availability of tertiary Mental Health Services, availability of human resources, average service load, mental health service gap, and perceptions of the users and the service providers, regarding the barriers in accessibility of mental health services, unmet service needs and strategies for improvement. The Research Methods involved Mapping Exercises with estimation of Service Loads and Qualitative Research Methods (QRM) like In-Depth Interviews (IDIs), Key Informant Interviews (KIIs), Free Listing and Focused Group Discussions (FGDs). The results indicate uneven availability of mental health services, human resource deficit specially for non-medical mental health professionals and mental health service gap (82% to96%). The average service load in the specialist mental health services is largely carried by the Govt. sector (half to two thirds), followed by the private sector (one third to half), with only a small portion by the NGO sector. The average mental health service load in the primary care general health services is largely carried by the private sector, with significant contribution from the non-formal service providers. The barriers to access, unmet needs and possible strategies as perceived by the community, users and service providers have been identified. The findings are discussed in the context of the mental health programmes and the public policy issues. The implications of the conclusions which suggest that Urban Mental Health Services are far from complete are highlighted.

The sexual dysfunctions are one of the most prevalent conditions. Sexual dysfunctions can have profound effect on the psychological well-being of an individual and the psychosexual relationship of a couple. Management of the sexual dysfunction should be preceded by an accurate diagnosis reached after a complete medical and sexual history and physical examination. Current focus of researchers has been on understanding the pathophysiology of erectile dysfunction, premature ejaculation and other sexual dysfunctions that can help in developing newer pharmacological cures for these conditions. Recently, a number of clinical trials have studied the potential effectiveness of the phosphodiesterase (PDE)-5 inhibitor sildenafil in the treatment of Erectile Dysfunction (ED) and Premature Ejaculation (PME). The introduction of PDE-5 inhibitors like sildenafil, vardenafil and tadalafil has revolutionized the treatment of sexual dysfunctions. This review focuses on the recent pharmacological advances in the treatment of common sexual dysfunctions like ED and PME with special focus on the role of PDE-5 inhibitors. Also discussed is the pharmacological treatment of other less prevalent and recognized disorders like female sexual dysfunction, drug induced sexual dysfunction etc.

Social Anxiety Disorder (SAD) is a chronic, disabling and treatable disorder with common onset in adolescence. Virtually there are no Indian studies on SAD. The study was conducted to find out frequency, demographic and phenomenological characteristics of SAD, family related risk factors, academic impairment and comorbidity of depression among adolescents. 421 adolescents in one high-school were screened for SAD and depression and associated factors with academic impairment. 54 (12.8%) had SAD. The most common manifestation of SAD was avoiding giving speeches. SAD was equally common among both genders, was associated with difficulty in coping with studies, concern about weight, having less friends, lack of intimacy with parents, and being treated differently from siblings. In conclusion, SAD is a common adolescent disorder, with major depression as a comorbidity and associated with impairment in academic functioning. All adolescents especially with depression consulting medical professionals should be interviewed for SAD and treated.

A super-cyclone hit 12 coastal districts of Orissa in October 1999 and caused over 20,000 deaths and a considerable damage to property. The psychiatric sequelae of the super-cyclone was studied using a semi-structured proforma for disaster experience, Self Reporting Questionnaire, Impact of Event Scale, Post Traumatic Symptoms Scale, Hopelessness Scale, Suicidality Screening Questionnaire, Hospital Anxiety and Depression Scale and Presumptive Stressful Life Event Scale. The coping style of the victims was also studied. It was observed that 80.4% of the subjects had probable psychiatric disorder. Posttraumatic stress disorder was found in 44.3%; anxiety disorder in 57.5% and depression in 52.7%. A considerable proportion (63.4%) of cases had comorbidity. Children and adolescents, elderly persons, lower socioeconomic status, lower educational levels, unemployment, physical injury, degree of exposure, need for evacuation, death in the family, fear of imminent death during the event, hopelessness, increased stress before disaster and past psychiatric history were associated with adverse psychological sequelae. Increase in suicidality was observed. Implications of these findings are discussed.

This study aimed to assess and compare the extent and pattern of psychosocial dysfunction and family burden in schizophrenia and obsessive-compulsive disorder, and to identify interrelationships between the two variables in these two disorders. First-degree relatives/spouses of 35 schizophrenic and 30 OCD patients were interviewed using the Dysfunction Analysis Questionnaire (DAQ) and the Family Burden Interview Schedule (FBIS). Global score and scores in vocational, personal, familial and cognitive areas on the DAQ, and global score, subjective score, and scores on items such as financial burden, disruption of family-routine, disruption of family leisure and disruption of family interactions on the FBIS were significantly higher in the schizophrenic group. Dysfunction in social area was comparable in two groups. OCD group showed a significant positive correlation between dysfunction and all areas of family burden except physical and mental health. Schizophrenic group showed a significant positive correlation between dysfunction and disruption of family interaction. The implications of these findings are discussed.

Assessment of needs of patients with schizophrenia permits practitioners to prioritize, formulate and implement rehabilitation goals. Negative symptoms have been shown to present greater obstacles to effective rehabilitation. The study compared the rehabilitation needs of in and out-patients with schizophrenia, and its relationship with negative symptoms. Thirty each of out patients and short term in-patients who fulfilled DSM-IV criteria for schizophrenia were recruited for the study. Patients currently exhibiting severe unmanageable psychoses and depression were excluded. Tools used for the study were DSM-IV-TR, Rehabilitation Needs Assessment Schedule, SANS, HDRS, BPRS, and UKU. Significant difference across the groups were observed as far as needs regarding requirement of help from a voluntary agency, employment, accommodation, leisure activities and help for family was concerned. Moreover, negative symptoms significantly correlated with rehabilitation needs among both groups of patients. The study also elicited family's expectations of their patients regarding their rehabilitation needs. Further, the implications of the association between some negative symptoms and the felt needs of the patients in their rehabilitation were discussed. A full spectrum of functional behaviours needs to be assessed soon after patients recover from their most recent exacerbation and suitable interventions need to be planned.

Prevalence of alcohol and drug abuse is very high. Majority of drug users do not seek treatment which is a major concern for professionals. This study was undertaken to find out the reasons of not seeking treatment for substance use in the community and the factors which motivate drug users to seek treatment from various treatment services. Sample consisted of 2 groups. Group 1 consisted of 100 persons who were dependent on alcohol & drugs and were not receiving any treatment. Group 2 comprised of 48 patients of substance abuse from the same area who were seeking treatment. Both the groups were administered specially designed proforma for assessing reasons of seeking and not seeking treatment. Psychological well being was reported by majority as a reason for not seeking treatment. Other reasons for not seeking treatment were short term useful effects of drugs, lack of awareness about drug related complications, fear of withdrawal symptoms and not being aware of treatment facilities. Wish to improve oneself was the most common reason for seeking treatment. Other reason for treatment seeking were availability and awareness of treatment facility, internal motivation and easy availability and awareness of treatment. Implications of the findings are discussed.

In the remitted phase of bipolar I disorder, sexual dysfunction is commonly due to drugs used in the treatment rather than the disease itself. There are very few studies, especially in the Indian population, addressing the frequency of sexual dysfunction due to antipsychotics in bipolar I disorder. Hence this study was done to determine the sexual dysfunction due to antipsychotics and to compare the same among typical and atypical antipsychotics. A cross sectional study with 108 male patients of remitted bipolar I disorder (DSM-IV), chosen by purposive sampling technique was done. Psychopathology was assessed using the Brief Psychiatric Rating Scale, Structured Interview Guide for the Hamilton Depression Rating Scale and Young Mania Rating Scale. Sexual side effects due to antipsychotics were assessed using the Udvalg for Kliniske ndersogelser (UKU) side effect rating scale. The total sample size was divided into two groups of those on typical antipsychotics (n = 53) and atypical antipsychotics (n = 55). The two groups were compared for sexual dysfunction using Chi-square test. Results showed dysfunction in at least one phase of the sexual response cycle, comprising of desire, arousal and orgasm, was present in 66% of the sample population. Erectile dysfunction was present in 42% of the sample population and it was the most common type of sexual dysfunction reported. It was also significantly different across the two groups (p = 0.025). There was no significant difference in other aspects of sexual dysfunction across the two groups. In conclusion patients of Bipolar I disorder experience sexual side effects of antipsychotics frequently. Erectile dysfunction is the most common sexual dysfunction among men and this is significantly higher with typical than atypical antipsychotics.

A Case of cerebral neurocysticercosis reported with manic episode on first presentation which was confirmed after CT scan of Brain. Psychiatric manifestation showed a gradual decline following treatment with medication. Normal social and occupational functioning was ensured by prolonged treatment with Mood Stabilizer.

A case of Stevens-Johnson syndrome (SJS) following treatment with sodium valproate is presented. A 55-year-old male suffering from manic episode was treated with sodium valproate in addition to haloperidol and trihexiphenidyl. After two weeks he developed cutaneous manifestations of SJS. He was treated with systemic steroids, antihistamines and topical calamine lotion and recovered after a few weeks.

An adult male presented with dyskinetic movements of the face and choreiform movements associated with dysphagia and vocaltics.Obsessive compulsive symptoms and depressive symptoms occurred 3 months after the onset of the illness.Peripheral blood smear revealed an excess of acanthocytes. A diagnosis of neuroacanthocytosis was made and he was started on treatment.

Risperidone has been found to be useful in the treatment of acute bipolar disorders. This is a case report where risperidone mono therapy has been found to be effective in prophylaxis of bipolar affective disorder. The pharmacological and clinical implications of risperidone in the management of BPAD are discussed