Rapid increase in urban population as a proportion of total population is resulting in rapid urbanization of the world. By the end of 2008, a majority of the world's population will be living in the cities. This paradigm shift in the dynamics of human population is attracting attention of demographers, sociologists, scientists, and politicians alike. Urbanization brings with it a unique set of advantages and disadvantages. Though it is driving the economies of most of the nations of the world, a serious concern regarding the impact of urbanization on mental health is warranted. The impact of urbanization on mental health in South-Asian countries needs to be examined. These countries by virtue of their developing economies and a significant proportion of population still living below poverty line are particularly vulnerable and tend to have a higher burden of diseases with an already compromised primary health care delivery system. The range of disorders and deviancies associated with urbanization is enormous and includes psychoses, depression, sociopathy, substance abuse, alcoholism, crime, delinquency, vandalism, family disintegration, and alienation. Thus, it is a heterogenous mix of problems and categorizing them to one particular subtype seems daunting and undesirable. Urbanization is affecting the entire gamut of population especially the vulnerable sections of society - elderly, children and adolescents, and women. Rapid urbanization has also led to creation of "fringe population" mostly living from hand to mouth which further adds to poverty. Poverty and mental health have a complex and multidimensional relationship. Urban population is heavily influenced by changing cultural dynamics leading to particular psychiatric problems like depression, alcoholism, and delinquency. Judicious use of resources, balanced approach to development, and sound government policies are advocated for appropriate growth of advancing economies of South-Asian region.

Background: Schizophrenia is the paradigmatic illness of psychiatry. The involvement of immunological and immunopathological mechanisms in the etiopathogenesis of schizophrenia has been a matter of research, with recently increasing effort. Aims: In this study, we investigated the incidence of human leukocyte antigen (HLA) Class I antigens to understand the role of HLA genes in schizophrenia. Materials and Methods: India born schizophrenic patients in and around Siliguri who attended outpatient department (OPD) of Department of Psychiatry, North Bengal Medical College and Hospital were considered for the present study. After the longitudinal follow up, 50 patients were enrolled for the study. The same number of age, sex and ethnically matched healthy subjects were considered as control. Low resolution polymerase chain reaction-sequence specific primer method was applied for typing the HLA antigens. Statistics: The phenotype frequencies were calculated by direct count. χ² test was done to compare the frequency of each antigen among the patients and control group and it was followed by Fisher's exact test. Relative risk was estimated by using Haldane's method. Results: The result showed that some of the HLA antigens are associated with the schizophrenia and significant increase were observed for HLA A*03 antigen along with the significant decrease for HLA A*25, A*31 and HLA B*51. Conclusions: The study provides the evidence for the possible existence of susceptibility locus for schizophrenia within the HLA region. This preliminary observation may help to understand the etiological basis of this disorder and the study may further strengthen the HLA antigens as the marker for schizophrenia.

Context: Oxidative stress induced lipid peroxidation has been a significant contributing factor for schizophrenia. Older antipsychotics, like haloperidol , were found to increase lipid peroxidation, whereas, the newer atypical antipsychotics, like olanzapine, did not generate free radicals as metabolic end products. Aims: The interrelationship of the antioxidant vitamins and antioxidant enzymes, and their overall effect on regulation of oxidative stress induced by haloperidol as compared to olanzapine were analyzed in present study. Setting and Design: It was an open randomized cross sectional study that consisted of two groups of fifty schizophrenic patients treated by haloperidol and olanzapine, respectively for at least six months. Materials and Methods: Serum thiobarbituric acid reacting substances (TBARS) was selected as marker of lipid peroxidation, whereas, serum tocopherols, plasma ascorbate and plasma superoxide dismutase (SOD) activity, were selected to assess the antioxidant vitamin and antioxidant enzyme status, respectively. All measurements were done by standard photometric methods. Statistical Analysis Used: Statistical analysis was performed to find out the significance for the differences of means between two groups. Bivariate and partial correlation coefficients for assessing the interrelationship between different parameters were done by using statistical package for social sciences (SPSS) software. Results: Results showed significantly higher serum TBARS and lower antioxidant values in the haloperidol treated patients. Significant positive correlations among the individual antioxidant parameters and significant negative correlation between all of the antioxidant parameters and serum TBARS were found only in haloperidol treated patients. Plasma SOD activity correlated to plasma ascorbate in both groups. Partial correlation results revealed that the serum tocopherol decreased linearly with an increase in serum TBARS significantly in olanzapine treated patients when effect of plasma ascorbate was controlled. Conclusions: Haloperidol caused more oxidative stress along with a significant reduction of important antioxidant parameters. Plasma ascorbate was found to be the chief antioxidant on which the activity of both plasma SOD and alpha tocopherol were dependent under oxidative stressful conditions.

Aims: To study the presence of personality disorder in cases of deliberate self harm (DSH) in young (15-24 years) and elderly (45-74 years) and compare. Materials and Methods: Deliberate self harm cases admitted in Medical and surgical departments and cases attending psychiatry department of R.G. Kar Medical College, Kolkata were studied. For diagnosis of personality disorder ICD 10 International Personality Disorder Examination (IPDE) questionnaire was used. Results: Percentage of elderly patients having personality disorder (64%) was higher compared to young DSH patients (58.5%). In young group, most common disorder was emotionally unstable personality disorder (28.6%) and in elderly group most common was anankastic type of personality disorder (36%). Schizoid, dissocial, histrionic, and anxious-avoidant personality disorders were found in small percentages of cases. Conclusion: Among DSH patients, the most common personality disorder found in young age was Emotionally unstable (Impulsive and Borderline) personality disorder, but most common personality disorder found in elderly patients was Anankastic personality disorder.

Aims : The purpose of the present study was to assess quality of life (QOL) in patients with schizophrenia and to determine influence of clinical factors and socio-demographic variables on QOL of schizophrenic patients. Setting and Design : Cross-sectional study carried out on outdoor patients attending Department of Psychiatry, SMS Medical College, Jaipur, India. Materials and Methods : Fifty patients of schizophrenia diagnosed as per ICD - 10 with minimum duration of illness being two years and attending out patient department (OPD) at psychiatric centre or psychiatric clinic at SMS medical college, hospital, Jaipur, India for maintenance treatment fulfilling the criteria given below were registered. They were evaluated using positive and negative syndrome scale (PANSS) and Quality of Life Instrument (WHO QOL - BREF). The data collected on above tools, was analyzed using descriptive and inferential statistics using Pearson correlation coefficient. Results and Conclusions: Patients were having lowest QOL scores in social relationships domain of WHO QOL - BREF scale. Social relationship domain of QOL was significantly negatively correlated with occupation with employed patients reporting better QOL in this domain. There were significant positive correlation of total monthly income with social relationship domain and total QOL. There were no statistically significant correlation between QOL parameters and clinical characteristics in schizophrenics. Scores on positive subscale and total PANSS were significantly negatively correlated with physical, Psychological, social relationship domains and total QOL. Negative subscale had significant negative correlation with physical and psychological domains and total QOL. General psychopathology subscale had significant negative correlation with all subscales of QOL. This study confirms poor QOL in schizophrenia despite significant improvement with pharmacological treatment.

Background: Intentional self-harm is common, through out the world; however, there is scanty data from India. Aims: To study the sociodemographic and clinical profile of subjects with "intentional self-harm" referred to consultation-liaison psychiatric services for evaluation in a tertiary care hospital. Design: Retrospective chart review. Materials and Methods: For this study, the consultation-liaison register of Department of Psychiatry was screened to obtain data of all patients who were referred to psychiatry referral services and were diagnosed as "intentional self-harm" while they were admitted in Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh during the period of 2000-2005. The case notes of these patients were reviewed for obtaining the sociodemographic profile and clinical profile for the current study. Results: Majority of the subjects were married (61%), educated beyond matriculation (75%), were employed or retired (53.6%), belonged to Hindu (87%), nuclear family (64.5%) of middle socioeconomic status (85%) and came from urban background (53%). Most common reasons/precipitating events prior to intentional self-harm were interpersonal problems with family members (39.2%), followed by interpersonal problems with spouse (16.9%). The most common method of intentional self-harm used was consumption of insecticides (44.6%), followed by use of corrosives (17.5%). Half of the sample (48.2%) did not fulfill criteria for any axis-1 or axis-2 psychiatric diagnosis at the time of assessment and most common psychiatric diagnosis was depression (30.7 %). Conclusions: Nearly half of the subjects who present to a tertiary care hospital with intentional self-harm do not have diagnosable psychiatric illness.

Background: Clinical observation and few anecdotal reports suggest that the children with breath holding spells (BHS) have certain temperamental traits, which predispose them to behave in certain way. They seem to have low frustration tolerance, which leads to adamant behavior. Vigorous crying, through various mechanisms, precipitates BHS. Materials and Methods: We assessed the temperamental traits of 30 children with BHS and compared them with 30 normal children after matching for age, sex, and socioeconomic status. Temperament was measured using 'Temperament measurement Schedule'. Results: The data were analyzed using Mann-Whitney U test. The following temperamental traits, threshold of responsiveness ( P <0.001), mood ( P <0.001), activity level ( P <0.001), intensity of emotions ( P <0.001), distractibility ( P <0.001) and rhythmicity ( P <0.05) were found to be significantly different from the control group. Two factors, namely sociability ( P <0.05) and energy level ( P <0.001) were significantly higher in breath holders. Conclusions: Significantly differing temperamental traits in breath holders suggests that these could influence the behavioral pattern exhibited by them. Breath holding spells can act as an easy marker for difficult temperamental traits, which gives an early opportunity to shape their difficult behavior.

This case report deals with 45-year-old male who came for consultation in the psychiatry department for the persisting symptoms, after consulting various departments with no relief. He had episodes of confusion with disorganized behavior, restlessness, and symptoms like talking irrelevantly once a week lasting up to 10-30 min in the preceding six months. Investigations like computerized tomography scan, electroencephalogram were not contributory. While under observation in our ward for evaluation and diagnosis, one such episode with intense sweating and clouding of consciousness was witnessed and helped in clinching the diagnosis of insulinoma. The case is reported for its rarity and as one of the causes of episodic confusional state.

Social anxiety disorder is characterized by overwhelming anxiety in everyday situations which are frequently avoided due to a fear of being watched and scrutinized by others or acting in an embarrassing way. Flashbacks are typical symptoms of post-traumatic stress disorder, and their main features are intrusive and vivid images that occur in a waking state. We present a case study of a man diagnosed with social anxiety disorder who had reexperiencing symptoms similar to flashbacks of what he considered "shameful situations". The differential aspects between flashbacks and obsessional imagery are discussed. Reexperiencing symptoms and imagery of social phobia as well as the sociocultural influence over the symptomatology of psychiatric disorders are then highlighted.

The history of clinical frontal lobe study is long and rich which provides valuable insights into neuropsychologic determinants of functions of prefrontal cortex (PFC). PFC is often classified as multimodal association cortex as extremely processed information from various sensory modalities is integrated here in a precise fashion to form the physiologic constructs of memory, perception, and diverse cognitive processes. Human neuropsychologic studies also support the notion of different functional operations within the PFC. The specification of the component 'executive' processes and their localization to particular regions of PFC have been implicated in a wide variety of psychiatric disorders.

This narrative of some of my professional experiences attempts to present circumstances in which I arrived at certain conclusions like: (a) Subjective personal experiences can be valid contributors to integration of a professional's world-view. (b) Concepts and constructs relating to diagnosis and other systems of understanding and practice are useful only as reference-systems. Rigidity in their use can be counter-productive. (c) Mental health profession is not always indispensable to patient's well being. Professional pride is an obstacle to learning. (d) Psychotherapy is not consciously done, but is a natural consequence of therapist's efforts to understand the patient and his/her predicament. Therapist's qualities play a predominant role. (e) Usefulness of therapeutic methods and techniques is dependent entirely on how the therapist uses them. (f) Absolute therapeutic effectiveness is a myth. (g) Indian mythology can offer a system of "Psycho-pathology," a system of explanation and management, parallel to existing systems.

R. L. Stevenson's novel, The Strange Case of Dr. Jekyll and Mr. Hyde is a prominent example of Victorian fiction. The names Jekyll and Hyde have become synonymous with multiple personality disorder. This article seeks to examine the novel from the view point of dualism as a system of philosophy and as a religious framework and also from the view point of Freud's structural theory of the mind.