Since its inception cannabis has been observed to be associated with various psycho-pathology. In this paper, the authors have reviewed the advancement made in this area over the last decade. The association between cannabis and schizophrenia has been researched more intensively. The controversy regarding the reliability, clinical utility, and the existence of a cannabis withdrawal syndrome has also been settled. Recent studies also buttressed the possibility of acute and chronic effect of cannabis on various cognitive functions. There has been a plethora of research regarding the treatment for cannabis use disorders. But the new and most interesting area of research is concentrated on the endocannabinoid system and its contribution in various psychiatric disorders.

Background: Sexuality is an important aspect of the personality of an individual and influences psychological, physical and social well-being of both men and women. It is a paradox, that in the country where 'kamasutra' (by Vatsyayana) took birth, there is a lack of research publications and sexuality related literature; hence the current study was conducted, to estimate the prevalence and association of sexual disorders with various socio-demographic variables, in the selected rural population. Materials and Methods: Subjects who were sexually active and fulfilled the study criteria were administered Arizona Sexual Experience Scale as screening tool for the presence of sexual problems. Those who were found to be having sexual problems were interviewed further using appropriate questionnaires. Results: 21.15% of the male subjects were diagnosed to have one (or more) sexual disorder. Prevalence of erectile dysfunction was found to be 15.77%, male hypoactive sexual desire disorder (HSDD) 2.56%; premature ejaculation was found to be prevalent in 8.76% of the male subjects. Around 14% of the female subjects were diagnosed to have female sexual disorders. Prevalence of female arousal dysfunction was found to be 6.65%, female HSDD 8.87%, female anorgasmia 5.67%, female dyspareunia 2.34% and female sexual aversion disorder was found to be prevalent in 0.37% of the female subjects. Conclusion: This study concluded that one in five males and one in seven females were suffering from one (or more) sexual disorder. Improving the training of undergraduate medical and nursing students in sexuality related issues, increasing trained individuals in sexual medicine by starting new courses, providing sex education to the general population using media and merging sexual health care with primary care, are likely to play a significant role in addressing the increasing sexual health morbidity.

Aim: To investigate the antenatal prevalence of fear of childbirth and its association with depressed mood in low-risk primigravidae in a referral teaching hospital. Settings and Design: The study was conducted in a tertiary referral center catering to three districts in the state of Kerala. This was a cross-sectional study with internal comparison of associated factors. Materials and Methods: Malayalam translation (translation back translation) of Edinburgh Postnatal Depression Scale (EPDS) was self-administered by the participants. It was followed by a structured interview based on the International Classification of Diseases 10 (ICD 10) after which the EPDS scale was scored. Statistical Analysis: Chi-square test was used to compare the presence of fear in women with a EPDS of ≥ 12 and the association of fear and depression. Results: Fear associated with childbirth was expressed by 17.7% women. The prevalence of depressed mood based on the EPDS (score > 12) was 9.8% but based on the ICD 10 criteria, the prevalence of depression was 8.7%. A significant number of women with depressed mood and clinical depression had fear of childbirth of some sort. Conclusions: A significant number of primigravid women with depressed mood and clinical depression had fear of childbirth of some sort.

Context: This article aims at demonstrating the effectiveness of day care centers in Indian setting. This is to provide impetus for an innovative approach in psychiatric practice in India. Aims: The aim was to narrate the experiences of a day care center being practiced in India. Settings and Design: The study provides the experiences gained in a day care center at Lucknow. The center was started in a hired building with a minimum of staff. The cost of the program is around 30,000/months. Subjects and Methods: The day care center has been run for nearly 5 years. During this period, 95 clients visited the center and 69 enrolled in the day care. Nearly 35 continued and 34 dropped out due to various reasons. Statistical Analysis: Descriptive study. Results: There were 49 patients suffering from schizophrenia, 11 from affective disorders, and 9 patients were clubbed in the miscellaneous group. The miscellaneous group consisted of pervasive developmental disorders, slow learners, obsessive compulsive disorders (OCD) and borderline subnormality with psychosis. Most patients had a long duration of illness. The patients of schizophrenia continued in the program more often than other group. Nearly 50% of patients have obtained jobs. The exposure to day care improved the patient's social and occupational behavior. The core symptoms did not change substantially. The families were greatly empowered, and they developed a positive attitude toward illness. Conclusions: Of the 59 patients who joined the day care program 35 could continue regularly. Among these patients, nearly 50% could take up jobs. Social and occupational behaviors improved remarkably. The families were empowered, and they developed a positive attitude toward mental illness. Such programs can be improvised with minimal costs and can be value addition in psychiatric practice. We need to develop indigenous know-how for such programs. This is a preliminary communication.

Background: Research literature has documented the nature of stigma associated with mental illness (MI) and its consequences in all spheres of life of ill persons and their families. It is also suggested that there is a need to develop intervention strategies to reduce stigma. However, very little is reported about these initiatives in the Indian context. Aim: To understand the nature of stigma associated with MI in a rural and semi-urban community in India and to develop an intervention package and study its impact. Materials and Methods: The study adopted a pre- and post-experimental/action research design with a random sample of community members including persons with chronic MI and their caregivers from rural and semi-urban areas. A semi structured interview schedule was used to assess the nature of stigma. An intervention package, developed on the basis of initial findings, was administered, and two post assessments were carried out. Results: Stigmatized attitude related to various aspects of MI were endorsed by the respondents. Caregivers had less stigmatizing attitude than the members of the community. Postintervention assessments (PIAs) revealed significant changes in attitudes towards some aspects of MI and this improved attitude was sustained during the second PIA, that is, after 3 months of intervention. Conclusion: People in the rural and semi-urban community have stigmatizing attitude toward MI. Intervention package focusing on the relevant aspect of MI can be used for reducing stigma of MI.

Background: Globally women confront manifold violations of human rights and women with poverty and mental illness are doubly disadvantaged. Aim: The aim was to examine the influence of poverty in meeting human rights needs among recovered women with mental illness at family and community level. Materials and Methods: This was a descriptive study carried out among randomly selected (n = 100) recovered women with mental illness at a tertiary care center. Data were collected through face-to-face interview using structured needs assessment questionnaire. Results: Our findings revealed that below poverty line (BPL) participants were not satisfied in meeting their physical needs such as "access to safe drinking water" (χ² = 8.994, P < 0.02), "served in the same utensils" (χ² = 13.648, P < 0.00), had adequate food (χ² = 11.025, P < 0.02), and allowed to use toilet facilities (χ² = 13.565, P < 0.00). The human rights needs in emotional dimension, that is, afraid of family members (χ² = 8.233, P < 0.04) and hurt by bad words (χ² = 9.014, P < 0.02) were rated higher in above poverty line (APL) participants. Similarly, 88.9% of women from APL group expressed that they were discriminated and exploited by the community members (χ² = 17.490, P < 0.00). More than three-fourths of BPL participants (76.1%) believed that there were wondering homeless mentally ill in their community (χ² = 11.848, P < 0.01). Conclusion: There is an urgent need to implement social welfare programs to provide employment opportunities, disability allowance, housing and other social security for women with mental illness. Further, mental health professionals play an essential role in educating the family and public regarding human rights of people with mental illness.

Aim: To study the health-care needs of the patients with severe mental disorders as perceived by their family caregivers and the treating psychiatrists. Materials and Methods: Caregivers of patients with severe mental disorders and their treating psychiatrists were assessed using Camberwell Assessment of Need-Research Version (CAN-R) scale and indigenously designed Supplementary Assessment of Needs Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The mean needs as per the CAN-R, perceived by the caregivers were 7.8 and treating psychiatrists were 8.1. About one-third of needs were unmet. On SNAS, both caregivers and treating psychiatrists reported a mean of 7.9 needs, of which more than half were unmet as per the caregivers. As per the treating psychiatrists, 45.5% of the needs as assessed on SNAS were unmet. There was a high level of correlation between needs perceived by the patients, caregivers and the treating psychiatrists. On CAN-R, main domains of needs as reported by the caregivers were those of money, relief of psychological distress, information about the illness and treatment, welfare benefits, transport, company and food. As per the treating psychiatrists, the most common total needs identified were those of relief of psychological distress, welfare benefits, information about the illness and treatment, money, transport, company self-care and physical health. The most common domains of needs as assessed on SNAS as per the caregivers were those of free treatment, medical reimbursement, psychoeducation, financial help, social support, insurance, more time from the clinicians and travel concession. The treating psychiatrists identified dealing with caregiver's stress as the most common need. Conclusions: According to the family caregivers and treating psychiatrists, about one-third of the needs of the patients as assessed using CAN-R and about half of the needs as assessed using SNAS are unmet.

Background: Wide prevalence of mental illness has been documented in South India; however, the magnitude of stigma is unclear. Aims: The aim was to investigate the magnitude of stigma prevalent among medical professionals in Hyderabad, India. Materials and Methods: A prospective survey of seven common psychiatric disorders for eight specified perceptions was conducted. Responses of 226 out of 250 (90%) doctors were analyzed. Results: Significant overall negative perception (P < 0.001), with drug addiction (52.8%) and alcoholism (48.2%) eliciting most negative perceptions (Chi-square: P <0.05) was observed. Significant negative perceptions were also seen among married doctors and those with < 10 years experience. Even though, there was no overall difference based on gender (P = 0.242), more females had significant negative perception toward eating disorders, depression, dementia, alcoholism and schizophrenic patients (P ≤ 0.05). Conclusions: This study revealed negative attitude of doctors toward mentally ill and highlighted the gender difference in perceptions.

Background: P wave dispersion (Pd) is defined as the difference between the maximum and the minimum P wave duration. It has recently been associated with increased anxiety levels, thereby predisposing affected individuals to fatal heart disease. Despite of evidence of this autonomous nervous system (ANS) relationship, there are no electrocardiography (ECG) studies in the patients with obsessive-compulsive disorder (OCD). Thus, in this study, we aimed to evaluate the Pd in OCD patients. Materials and Methods: The study consisted of a total of 25 patients with OCD and same number of physically and mentally healthy age- and gender-matched controls. For psychological testing, Yale-Brown Obsession and Compulsion (Y-BOCS) was administered. Results: Pmax was found to be significantly higher in the patients compared to controls. Pmin did not differ between groups. Left atrium sizes were not different between groups. As for the main parameter investigated in the present study, it was found that Pd was significantly increased in the OCD patients than the controls. Y-BOCS scores for the patient group was positively correlated with Pd (r = 0.73, P < 0.01). Conclusions: In conclusion, our results suggest that Pd may be associated with OCD though our sample is too small to allow us to obtain a clear conclusion. Future studies with larger sample evaluating the effects of treatment are required.

Cushing's syndrome (CS) is the multisystem disorder which is due to cortisol excess. It is very difficult to diagnose in early stages, especially when psychiatric manifestations are the predominant complaints. It could result in significant morbidity and mortality. We report a case of resistant bipolar affective disorder secondary to CS. Early diagnosis and treatment will lead to better functional outcome and prevention of neurocognitive side-effects of excessive cortisol.

A case of Sulphuric acid ingestion with an intention to commit suicide in a patient of Major Depressive Disorder which resulted in death is reported. Aspects of this mode of suicide and legal issues concerning suicide in mentally ill patient have been discussed.

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting.

X-linked adrenoleukodystrophy (X-ALD) is one the leukodystrophies causing a progressive decline in neurological function mainly affecting the children. The most common symptoms are changes in behavior, including social withdrawal or aggression, poor memory or poor scholastic performance. Here, we present a 7-year-old boy who presented with symptoms of inattention and hyperactivity and later turned out to be a case of X-ALD.

Music with its instantaneous pleasing effect can be an answer to misery. It is a form of art that is easily accessible anytime and anywhere. This article gives an overview of music therapy practiced in ancient India, its influence on emotion and mind, and speculates its possible clinical applications in the modern era based on the available scientific literature.

What happens if a King becomes mentally ill? Excerpts from the personal papers of Arthur Henry Cole, Resident to the Kingdom of Mysore in 1809, open up fascinating insights into the madness of rulers, in neighboring Coorg and faraway London, and ways in which different societies responded to this. Musings on legal capacity and restrictions imposed on account of insanity, as well as migration and ennui in imperial colonies inevitably follow.