Neurocognitive assessments are useful to determine the locus of insult as well as functional capacities of patients on treatment. In psychiatry, neurocognitive assessment is useful in the identification of brain lesions, evaluation of cognitive deterioration over time, and advancement of theories regarding the neuroanatomical localization of symptoms. Neurocognitive models provide a bridging link between brain pathology and phenomenology. They provide a useful framework to understand the pathogenesis of psychiatric disorders, bringing together isolated findings in behavioral, neuroimaging, and other neurobiological studies. This review will discuss neurocognitive model of three disorders - schizophrenia, bipolar disorder, and obsessive compulsive disorder - by incorporating findings from neurocognitive, neuroimaging, and other biological studies.

Background and Objective: Depression among medical students is an area of increasing concern worldwide. This study aimed to assess the prevalence of depression and its associated factors among medical students. Materials and Methods: A stratified random sample of 400 students was assessed using Beck Depression Inventory by investigators. Associations between depression and class of studying, social factors like alcohol use, drug addiction, family problems, family history of depression, and staying away from home were analyzed by univariate analysis. Results: The overall prevalence of depression was found to be 71.25%. Among those with depression, a majority (80%) had mild and moderate degree of depression. The study showed that 46.3% (132) of the depressed were females and 53.7% (153) were males. According to cut-off scores, 115 students (29.8%) scored as normal (0-9), 111 (27.8%) as mild (10-18), 117 (29.3%) as moderate (19-29), 30 (7.5%) as severe (30-40), and 27 (6.7%) as very severe (>40) depression. The prevalence of depression was comparatively less among 1 ^st and 2 ^nd year medical students (57% and 50%, respectively) and the difference between the grade of depression and year of studying was found to be significant (χ² =122, P<0.001). The prevalence was significantly more among those with family problems and family history of depression. Conclusion: Depression is highly prevalent among medical students in this area. Our findings point to the importance of broad screening and psychiatric counseling of this vulnerable population.

Background: Schizophrenia is a highly disabling illness. Previous studies have shown yoga to be a feasible add-on therapy in schizophrenia. Aims: The current study aimed to test the efficacy of yoga as an add-on treatment in outpatients with schizophrenia. Settings and Design: The study done at a tertiary psychiatry center used a single blind randomized controlled design with active control and waitlist groups. Materials and Methods: Consenting patients with schizophrenia were randomized into yoga, exercise, or waitlist group. They continued to receive pharmacological therapy that was unchanged during the study. Patients in the yoga or exercise group were offered supervised daily procedures for one month. All patients were assessed by a blind rater at the start of the intervention and at the end of 4 months. Results: Kendall tau, a nonparametric statistical test, showed that significantly more patients in the yoga group improved in Positive and Negative Syndrome Scale (PANSS) negative and total PANSS scores as well as social functioning scores compared with the exercise and waitlist group. Odds ratio analysis showed that the likelihood of improvement in yoga group in terms of negative symptoms was about five times greater than either the exercise or waitlist groups. Conclusion: In schizophrenia patients with several years of illness and on stabilized pharmacological therapy, one-month training followed by three months of home practices of yoga as an add-on treatment offered significant advantage over exercise or treatment as usual. Yoga holds promise as a complementary intervention in the management of schizophrenia.

Background: Controversy persists with regard to how best we can categorize symptomatic dimension of Schizophrenia. Aim of the study was to compute factorial dimensions in Indian subset of schizophrenic patients and to compare them with five factor pentagonal model extracted in western studies. Materials and Methods: 150 inpatients of Schizophrenia with acute exacerbation were subjected to PANSS rating within one week of admission and statistical calculation done based on exploratory factor analysis. Results: Five factors namely negative, autistic, activation, positive and depression were extracted wherein negative factors showed highest percentage of total variance supporting five factor modal of western literature Conclusion: A consensus is gradually emerging regarding symptomatic dimensions of Schizophrenia.

Background: Caregivers of individuals suffering from psychiatric illness are at risk of being subjected to mental health consequences such as depression, anxiety and burnout. Community-based studies proved that 18-47% of caregivers land in depression. The caregiver burden can be quantified into objective, subjective and demand burdens. There is paucity of data comparing the caregiver burden of psychiatric patients and that of chronic medical illness patients. Aims and Objectives: (1) To compare the caregiver burden in psychiatric illness and chronic medical illness. (2) To study the association of caregiver burden with demographic factors like age, gender, duration of caregiving. Materials and Methods: The study included two groups of caregivers, each of 50 members. Group 1 consisted of caregivers of psychiatric patients and group 2 consisted of caregivers of chronic medical illness patients. The Montgomery Borgatta Caregiver Burden scale was used to assess the burden in terms of objective, subjective and demand burdens. Results and Conclusion: The caregiver burden scores in the caregivers of psychiatric patients were significantly higher than that of chronic medical illness (P<0.0001). The caregiver burden was found to increase with the duration of illness as well as with the age of caregiver. The caregiver burden in the sample population was less as the objective and demand burden did not cross the reference higher value in the given scale, whereas the emotional impact given by the subjective burden was on higher side.

Background: Anxiety and depression form commonest stress-induced psychiatric disorders. To combat the biochemical changes which occur as a result of stress, there is antioxidant defence in the biological system. Secondary defence is by the nonenzymatic antioxidants like vitamins E (alphatocopherol), C (ascorbic acid), and β-carotene. Therefore, the authors interest was aroused to examine the status of these antioxidants in the biological system of patients suffering from stress-induced psychiatric disorders. Aims: This study was carried out to find out whether patients with generalized anxiety disorder (GAD) and depression have any difference in blood serum levels of vitamins A (β-carotene), C, and E in comparison to the normal healthy control group and whether supplementation of adequate doses of vitamins A (β-carotene), C, and E leads to improvement in anxiety and depression and reduction in scores of the patients. Materials and Methods: Eighty subjects in the age group of 20-60 years, who attended a psychiatric clinic of a private hospital and who met inclusion and exclusion criteria of the study and consented for psychological evaluation and blood screening to find out the serum levels of vitamins A, C, and E, were included in the study. Approval was sought from the institutional ethics committee for collecting the blood sample of these subjects before and after vitamins A, C, and E supplements given for a period of 6 weeks. Statistics Analysis: It was observed that patients with GAD and depression had significantly lower levels of vitamins A, C, and E in comparison to healthy controls. After dietary supplementation of these vitamins for a period of 6 weeks, a significant reduction in anxiety and depression scores of patients was observed (P<0.001). A significant increase in the blood levels of antioxidants was observed in patients (P<0.05) except that of vitamin E in the group of depressed patients. Results and Conclusion: The findings suggest that antioxidant supplement therapy as an adjuvant therapy is useful in patients with stress-induced psychiatric disorders and the results have been discussed.

Background: It is not clear if the role of antipsychotics in long-term clinical and functional recovery from schizophrenia is correlated. The pattern of use is a major aspect of pharmacotherapy in long-term follow-ups of schizophrenia. The aim of this study was to examine patterns of antipsychotic usage in patients with longstanding psychosis and their relationship to social outcomes. Materials and Methods: We conducted a cross-sectional study on a cohort from a long-term outcome study. Participants were 116 first episode schizophrenia patients from Mumbai, India, who had more than 80% compliance, as reported by relatives. Patients were assessed on antipsychotic medication use and on clinical and functional parameters. Results: There was a high compliance rate (72%). Most patients (77%) used atypical antipsychotics; only 10 (8.6%) patients were taking typical antipsychotics. There were no among-drug differences in the percentage of patients meeting the recommended dose: Clozapine (200-500 mg), Riseperidone (4.0-6.0 mg), Olanzapine (10-20 mg), Quetiapine (400-800 mg), Aripiprazole (15-30 mg), Ziprasidone (120-160 mg); an equivalent dosage of Chlorpromazine (300-600 mg) did not differ amongst any atypical antipsychotic subgroup. Also, we did not find any significant differences in recovery on Clinical Global Impression Severity scale (CGIS), Quality of Life (QOL), or Global Assessment of Functioning (GAF) between groups of antipsychotic drugs. Conclusion: This study shows that most patients suffering from schizophrenia, in a long-term follow-up, use prescribed atypical antipsychotics within the recommended limits. Also, the chlorpromazine equivalence dosages do not differ across antipsychotic medications. The outcomes on clinical and functional parameters are also similar across all second-generation antipsychotics.

Background: Cardiac autonomic involvement in Alcohol-Dependence Syndrome (ADS) patients has been demonstrated using conventional autonomic tests. Resting heart rate variability (HRV) without normalization has also been reported. Aims: To evaluate cardiac autonomic changes with postural challenge using HRV in ADS and controls while controlling for confounding factors. Settings and Design: Cross-sectional study involving 27 male subjects with ADS and age-matched healthy controls. Materials and Methods: Clinical assessments included Schedules for Clinical Assessment in Neuropsychiatry and Severity of Alcohol Dependence Questionnaire. Spectral measures of HRV while lying and with active standing were assessed. Results: There was an attenuated response in delta high-frequency (P=0.06) and delta low-frequency (P=0.04) power to standing in ADS subjects compared with controls. Conclusion: Patients with ADS appear to have attenuated cardiac vagal and sympathetic responses to standing. HRV with postural challenge may help earlier recognition of autonomic dysfunction in ADS.

Covert medication is the practice of hiding medication in food or beverages so that it goes undetected. Tablets may be crushed or liquid forms of medication may be used for patients who are either not in a position to give consent or refuse consent because of lack of insight. It is commonly practised in two distinct settings. The first is typically in the western world, in old patients, mostly suffering from dementia, admitted in nursing homes. The second is typically in resource strapped developing countries, in patients with psychosis, mostly at home, when patients refuse medication. The latter, from all accounts available, occurs on a large scale, but has not been studied owing to its questionable ethical and legal status and it is not discussed in the open by professionals. This paper examines the pros and cons of covert medication and argues that it should be acknowledged and studied like other therapeutic practices.

Exhorting psychiatrists to use covert medication is not right. Unlike in pediatrics and geriatrics, a small section of schizophrenics and mood disorder patients with full awareness of their legal rights, vehemently refuse medications. In such cases "rules" are required to regulate covert medication, forced medication etc. Only that way both patients' right for autonomy and the professionals duty to administer treatment could be simultaneously taken care of. Section 19 of the Mental Health Act 1987 provides the required legal provision for this. Civil society expects psychiatrists too to function within the boundaries set by a legal framework.

Mental health interventions in low and middle income countries, with limited resources of human and other resources, requires that they be viewed from multiple viewpoints. This applies to the issue of covert medication, which on the face should not be practiced at all, in an ideal care situation. In India, it would be better to consider the use of covert medication, in differing situations and with the varying levels of involvement of patients and their families in a planned manner and with an open approach. Such an approach could meet the care needs of patients as well as protect the rights of the patients.

A response to Kala's article on covert medication. This discusses the issue of covert medication from points of view of autonomy, insight, legality, liability and good practice.

The aim of this communication is to briefly describe the surreptitious practices and management of non-adherence, observed at the services offered by the Schizophrenia Research Foundation. Screening of records at our services for documentations of this practice and the efforts made to deal with non-adherence and concealed treatment was done. Surreptitious practices in SCARF's out-patient services and in community outreach programs have been documented. Efforts to manage non-adherence include educating families on pharmacotherapy and strategies of dealing with non-adherence. At the level the patient, individualised and group strategies deal with the issues addressing lack of insight, acceptance of the disorder, or dealing with perceived side effects are held. Ethical principles of autonomy, justice, beneficence, and respect are adopted in implementing these strategies. There are potential advantages and disadvantages of adopting surreptitious treatment strategies in persons with serious mental illnesses. There is a need to formulate rigorous guidelines for the management of non-adherence.

Using the metaphor of confession in Christianity, this article explores the dilemma of a care giver in handling a non -compliant patient; suggests a solution by legalizing covert medication.

In this article, the author shares his experiences as a user of psychiatric medication administered surreptitiously.

Dysphagia can be due to a variety of causes in a psychotic patient. It could be a side-effect of anti-psychotic medication or the manifestation of a psychotic phenomenon or even due to a co-morbid medical cause. We report a case of dysphagia in a young lady with psychosis who had been recently started on anti-psychotic medication. We would specifically like to highlight the practical challenges regarding its diagnosis and report success with a systematic management approach .

Rumination syndrome is known to exist in infants and mentally retarded adults since long time. In past few years, some reports appeared that showed its existence in adult patients also. It is frequently confused with the intractable vomiting in adults and misdiagnosis leads to delay in appropriate management. We are here describing the case of a female patient with rumination syndrome where specific points in the history delineated the presence of this illness and helped in appropriate management. The patient became symptom free soon after the diagnosis was reached.

Phenytoin is a commonly used antiepileptic medication because of its easy accessibility as well as affordability. However, scientific literature shows various types of side effects of phenytoin. We report a patient who was showing toxicity symptoms in the form of mood, behavior and cognitive symptoms along with scholastic problems and personality change on long term treatment with phenytoin. The patient's serum phenytoin was found to be quite high (>32.8 ng/ml).The symptoms were attributed to phenytoin toxicity which responded within twelve weeks by reducing the dose of phenytoin (with resultant fall in levels of serum phenytoin) and the addition of folic acid. While the mood and behavior symptoms recovered early, the cognitive symptoms responded slowly showing 80% -90 % improvement over a period of fifteen weeks.

Plica neuropathica (Polonica) is a common but rarely reported scalp hair condition. In this condition the hairs of scalp in a localized area is compacted into irregularly twisted, irreversibly entangled plaits. Psychological disturbance is a risk factor for plica formation. We report a case of plica neuropathica in an adult female with schizophrenia.

This poem paints the picture of a gambling addict who narrates his story in the course of a psychiatric consultation.