Consultation–liaison psychiatry (CLP) is a young and upcoming subspecialty of psychiatry. When one looks at the history of CLP in India, the progress in the area of CLP paralleled that seen in various developed countries. However, over the years, compared to developed countries, CLP started lagging behind in India. In India, CLP services are mostly been provided as per the consultation model and true liaison model practice is missing. There has been meager research in the area of CLP in India, and there is marked heterogeneity in training across different centers. There is lack of specialized training programs in this country. Considering the increasing emphasis on providing person-centered care, there is a need to shift the focus of training from identifying and managing only primary psychiatric disorders to interphase of psychiatry and other disciplines.

Context: Severity of alcohol dependence is related to the high-risk behavior of alcohol dependents. Aim: To assess the high-risk behavior in patients with alcohol dependence and study the association between them. Settings and Design: This is a descriptive study of high-risk behavior in patients with alcohol dependence, conducted over a period of 15-month duration that is from January 2011 to April 2012 on 200 alcohol-dependent patients (178 men and 22 women) in the Department of Psychiatry, Mamata Medical College and General Hospital, Khammam (TS), India. Materials and Methods: Patients and their caregivers fulfilling the selection criteria were included in the study, and informed consent was obtained. Interview was carried out after 2 weeks to rule out the possibility of the presence of withdrawal symptoms in alcohol-dependent patients. Tools used for data collection include Sociodemographic and Clinical Profile Schedule, Clinical Institute of Withdrawal Assessment for Alcohol, Mini–Mental Status Examination, Severity of Alcohol Dependence Questionnaire, and High Risk Behavior Questionnaire. Statistical Analysis: Descriptive statistics, Chi-square test, and logistic regression test were used. Results: The occurrence of high-risk behavior was substantial among patients with alcohol dependence syndrome. Event analysis method indicated that road traffic accidents associated with prior heavy drinking was the most frequently observed high-risk behavior. Conclusions: The study reiterates the relationship between alcohol and sexual behavior and also highlights that individuals dependent on alcohol are a specifically vulnerable group.

Background: A substance-dependent person affects almost all aspects of family life, for example, interpersonal and social relationships, leisure time activities, and finances. Substance dependence invariably increases conflicts, negatively affects family members, and burdens the families. Aims and Objectives: To assess family burden perceived by primary caretakers (PCTs) of individuals with substance dependence and relevant clinico-socio-demographic profile of individuals as well as PCTs. Materials and Methods: Individuals and primary caretakers (n = 150) attending psychiatry OPD and emergency were included in the study. Individuals were selected by convenient sampling. The individuals and PCTs were administered psychiatric thesis/interview pro forma and drug abuse schedule. PCTs were administered “family burden interview schedule.” Results: Majority of caretakers had moderate objective burden (65.3%) and severe subjective burden (74%). Objective burden was more in areas of “financial burden” and “disruption of routine activities.” Objective burden had correlation (P < 0.05) with monthly family income, monthly expenses on substance, number and type of substances, treatment history, sex and type of caretaker. Subjective burden was dependent on sex and type of caretaker and treatment history of the patient. Conclusion: Our study concluded that substance dependence is associated with substantial burden for family members, more for subjective and objective burden in families with low income and with patients who are dependent on more number of substances and had taken treatment in the past. Higher proportion of severe burden was reported by female caretakers. These findings suggest directions for future research in this area.

Background: The left dorsolateral prefrontal cortex (DLPFC) seems to exert a bilateral control of chronic pain states such as migraine. Repetitive transcranial magnetic stimulation (rTMS) is known to modulate brain excitability, neurotransmitters, and endogenous opioids involved in pathophysiology of migraine. Aim: This study was designed to assess the efficacy of adjunctive intermittent theta-burst stimulation (iTBS) to the left DLPFC, as a prophylactic treatment in migraine. Materials and Methods: The study was a double-blind, sham-controlled experiment. Patients with migraine were allotted to active (n = 20) or sham (n = 21) rTMS, respectively. Each patient received ten sessions of iTBS over the left DLPFC. Patients were rated at baseline and at 2, 4, 6, and 12 weeks after receiving the treatment. Scores were obtained from the headache diary and by applying the Migraine Disability Assessment Scale (MIDAS). Results: There was a significant decrease in frequency, duration, and severity of migraine in the active group than the sham group over the study period. The effect was more pronounced during the initial 2 weeks. The MIDAS score reduced significantly in the active group than the sham group at 12 weeks. There were no significant adverse effects observed during the entire period of study. Conclusion: Compared to sham stimulation, adjunctive active iTBS over the left DLPFC was safe and effective in reducing the frequency, duration, and severity of migraine headache and in reducing disability associated with the illness.

Background: Congestive cardiac failure (CCF) patients show several neuropsychological impairments and reduced quality of life and impairment of functioning. Objective: The objective of this study was to recognize the deficits in cognition in CCF patients and comparing this cognitive function in the same number of healthy participants. Materials and Methods: A case–control study design was adopted. The study was conducted in the cardiology department of a tertiary care hospital. Convenience sampling was done. Twenty-one participants with CCF (New York Cardiac Association – Class III severity) and 21 healthy participants participated in the study. Each participant in the control group was screened by the General Health Questionnaire-12-item version. We evaluated both groups for the various domains of their cognitive function using a comprehensive battery of neuropsychological tests. Student's t-test was used to analyze the difference between the means for the study variables. Results: We observed that attention, executive function, working memory, psychomotor speed, and visuospatial ability were impaired in the patients with CCF compared to the controls. However, they did not differ significantly in language function. Conclusions: Cognitive functioning is significantly impaired in CCF patients.

Background: Use of coercive measures in mental health care is an important issue for research. There are scarce data available on perception and attitudes toward coercion among Indian psychiatrists. Aims: This study aims to study psychiatrists' attitude and perspectives on the use of coercive measure in clinical practice against the background of family and patients' opinion. Materials and Methods: The study was conducted at the Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India. Psychiatrist in charge of the inpatients was asked about their general opinion on coercion and was administered Staff Attitude to Coercion Scale questionnaire. Findings were compared to previously published studies on patients' opinion and family opinion in the same sample. Data were analyzed using descriptive statistics. Results: Coercion proved to be a common measure applied in nearly 70% of the patients studied. The 189 psychiatrists participating in the study almost all perceived coercion as care, protection and safety, and as protection from dangerous situations. About 66% of psychiatrists perceived physical and chemical restraint (sedation) as necessary and acceptable in acute emergency care. One-third of the psychiatrists felt their patients lost autonomy, dignity, and the possibility of interpersonal contact. The same amount agreed that some patients could have been treated with less restriction and fewer coercive measures. Conclusion: Psychiatrists felt that physical and chemical restraints are necessary and acceptable in acute emergencies. Most psychiatrists considered coercion as a caring protective and safety attitude but also acknowledged its potential negative impact on patient dignity and therapeutic relationships.

Background: Even though particularly bipolar depression and unipolar depression seem to be similar, they show differences in terms of the etiology, phenomenology, course, and treatment process. Bipolar depression is associated with mood lability, motor retardation, and hypersomnia to a larger extent. Early age of onset, a high frequency of depressive episodes, and history of bipolar disease in the family are suggestive of bipolar disorder (BD) rather than major depression. Bipolar and unipolar disorders are also associated with increased impulsivity during illness episodes. However, there is little information about impulsivity during euthymia in these mood disorders. The aim of this study was to illustrate the difference in impulsivity in euthymic bipolar and unipolar patients. Materials and Methods: Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A), in 78 interepisode BD patients, 72 interepisode unipolar disorder patients, and 70 healthy controls. The diagnosis was established by severe combined immunodeficiency. One-way between-groups ANOVA was used to compare the BIS-11A mean scores for all three groups. Results: Impulsivity scores of the bipolar and unipolar disorder patients were significantly higher than controls on total and all subscales measures. There was no difference between the bipolar and unipolar disorder groups on total, attentional, and nonplanning impulsivity measures. However, BD patients scored significantly higher than the unipolar patients on motor impulsivity measures. Conclusions: Both interepisode bipolar and unipolar disorder patients had increased impulsivity compared to healthy individuals. There was no significant difference on attention and nonplanning impulsivity subscales; however, on the motor subscale, bipolar patients were more impulsive than unipolar disorder patients.

Background: The C677T and A1298C mutations of 5,10-methylenetetrahydrofolate reductase (MTHFR) have been linked with conditions such as depression, bipolar disorder, and schizophrenia, but there are not clear the relationship between MTHFR polymorphisms and obsessive-compulsive disorder (OCD). Aim: The current study was planned to investigate the link between the MTHFR polymorphisms and OCD in patients to reveal any potential correlations that may be used as a novel marker in diagnosis of people who are in high-risk group of developing OCD. Materials and Methods: Blood samples from 64 highly characterized symptomatic cases and 64 gender- and age-matched control participants were analyzed for MTHFR C677T and A1298C gene variants. The MTHFR gene polymorphisms were detected through real-time polymerase chain reaction, followed by melting curve analysis. The results were tested with analysis of variance test and the differences with P < 0.05 were reported as statistically significant. Results: A statistically significant difference in age, education level, and marital status was found in the comparison of all groups in sociodemographic findings (P = 0.004, P = 0.001, and P = 0.001, respectively). A statistically significant difference was found in the comparison of the tic story of early- and late-onset OCD patients (P = 0.002). There was no significant difference in the genotype frequencies and allele distributions of MTHFR polymorphisms between the patients and controls (P > 0.05). Conclusion: The results suggest that MTHFR polymorphisms are unlikely to play a major role in the pathogenesis of OCD. Further studies are needed in biochemical data on folate metabolism to clarify the effect of the MTHFR polymorphisms in OCD pathophysiology.

Context: The competence in theory of mind (ToM) abilities occurs in parallel with the development of language. To gain a deeper discernment about its proficiency, tasks tapping on higher-order ToM abilities have been implemented. Aims: This study aims to explore the development of higher-order ToM abilities in bilingual Indian children between 3.0 and 8.11 years of age, to achieve an insight into the influence of language on ToM abilities. Settings and Design: The current study followed a cross-sectional design along with an employment of a random convenient sampling procedure. The study was conducted in regular English medium schools with each participant individually being assessed. Materials and Methods: The study was done on 60 Kannada-English bilingual children, with each participant being assessed using two sets of stories (English and Kannada) that were constructed based on two different central themes which were verbally narrated. The stimulus of each set consisted of questions tapping on three levels (first-second-third orders) of ToM abilities. Statistical Analysis: Descriptive statistics determined the mean and standard deviation of the total ToM scores (in both languages). Wilcoxon Signed-Rank and Mann–Whitney U-tests were done to determine the level of significance across and between the age groups (in both languages), respectively. Results: The results revealed a significant difference across the age groups. In addition, a significant difference between the responses in English and Kannada were obtained. Conclusions: The development of metalinguistic abilities is influenced by socioenvironmental factors as well as the language maturity of the child.

Background: Dissociative disorders are theorized to be caused by extremely stressful situations, including abuse, kidnapping, incest, rape, and other threats of death. Such childhood experiences alter one's cognitive style as well as one's ability to deal with adverse situations. It is important to understand how cognitive style influences the relationship between parental style and resilience to help in the management. We aimed to assess the relationship between perceived parental styles and resilience mediated by cognitive styles in females with dissociative disorder. Materials and Methods: Sample comprised 60 females between 18 and 50 years of age with dissociative disorder (International Classification of Diseases-10 criteria) in a cross-sectional observational study. Perceived parental style of the participant was assessed using s-EMBU, cognitive style using the Cognitive Style Inventory, and resilience using the Conner and Davidson's Resiliency Scale. Data were analyzed using Shapiro–Wilk to assess the normality of the data and Spearman rank correlation for determining the relationship between the variables. Results: The results indicated a significant relationship between emotional warmth and systematic-cognitive style (r_s = 0.398, P = 0.01) and between systematic-cognitive style and high resilience (r_s = 0.256, P = 0.05). A significant regression equation was found (F[1, 58] = 9.146, P < 0.004), with an R² = 0.136 to predict systematic-cognitive style based on emotional warmth as the perceived parental style. To predict resilience based on systematic-cognitive style, a significant regression equation was found (F[1, 58] = 6.006, P < 0.017), with an R² = 0.094. Conclusion: The more emotional warmth was perceived by the participants, the more systematic they were in their perception of the environment, in turn being more resilient. The study findings help in establishing protective psychological factors in dissociative disorder.

Context: Mild cognitive impairment (MCI) is an under-diagnosed health problem in the community. Cognitive screening tools are widely used for MCI detection, but many of them lack sensitivity and specificity in MCI detection. On the basis of literature review, Short test of mental status (STMS) was selected for the present purpose. Aims: The present study purports to standardize STMS for using as a cognitive screening tool in MCI detection in the community-living elderly people in Kolkata. Materials and Methods: Data were collected from 102 community-living elderly people from the city of Kolkata using the purposive method of sampling. MCI was diagnosed using the Peterson's criteria of MCI as the gold standard. A semi-structured demographic proforma, clock-drawing test (CDT), and the Groningen Activity Restriction Scale (GARS) were used for the purpose. Finally, STMS was administered. Statistical Analysis: Statistical computation was done using the SPSS 21. Descriptive statistics, receiver operating curve analysis, and binary logistic regression were used for statistical analysis of the data. Results and Conclusion: STMS emerged as a sensitive and specific cognitive screening tool in the detection of MCI in the current cultural setting. It was also found to be more suited for the purpose than CDT. A score of 34.5 with a sensitivity of 97.5 and a specificity of 90.3% were selected for the optimum cutoff score for the detection of MCI in the present population. With a unit increase in STMS score, the odds of getting diagnosed with MCI were found to be reduced by 48.5%.

Background: The burden of mental disorders has been increasingly recognized and 450 million people globally are suffering from mental illness. Mental–physical comorbidity has adverse effects on the overall outcome. Research is scarce with regard to mental health screening in the context of “preventive health care” in India. Thus, the study aimed to identify the prevalence of mental illness and the effect on quality of life (QOL) among participants attending preventive health-care unit (PHCU). Settings and Design: This was a cross-sectional study conducted in PHCU of a tertiary hospital in Puducherry. Materials and Methods: All consecutive participants (>18 years) attending PHCU were included in the study. The Standard for Clinicians' Interview in Psychiatry (SCIP) screening module, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Level 1 Cross-Cutting Symptom Measure, Mini-Cog, and Quality of Life Enjoyment and Satisfaction Questionnaire were administered. Relevant diagnostic modules of SCIP were applied to participants who screened positive on SCIP. Data analysis was performed using SPSS (version 17.0). Results: The mean age of participants was 43.38 ± 13.99 years. Of 203 participants enrolled, 28.1% screened positive and 26.1% were confirmed to have psychiatric disorder. About 4% screened positive for cognitive impairment. Most commonly diagnosed disorders were alcohol use disorder and major depressive disorder. The prevalence of depressive disorder was higher in patients with physical disorder. Participants with psychiatric disorder alone or with both psychiatric and physical disorders had significantly poorer QOL (F = 27.13; P < 0.001). Conclusion: One-fourth of the participants attending preventive health-care services were found to have psychiatric disorders. The presence of psychiatric disorder was associated with significantly poorer QOL. This highlights the importance of routine mental health screening in this setting.

Aim: This study aims to study the prevalence of psychiatric morbidity among adolescents and compare its distribution in the urban and rural areas. Study Design: This was a cross-sectional study. Materials and Methods: One thousand adolescents aged 11 to 16 years studying in various private and government schools in urban and rural areas in district Patiala, Punjab were studied. Stratified cluster sampling was used considering the type of school as strata and sections of each standard as clusters. The study was conducted in two steps; in the first step, self-designed sociodemographic questionnaire and socioeconomic status scale, Parekh's method of socioeconomic classification for rural area, and Kuppuswamy's revised method of social classification for urban areas. To study the psychiatric morbidity, the strength and difficulties questionnaire (SDQ) self-report version and parent version was used.Students who scored borderline or abnormal on SDQ, were further evaluated in second stage by clinical interview, detailed case history, and mental state examination; psychiatric disorders were diagnosed following International Classification of Diseases-10 (ICD-10) criteria. Statistical Analysis Used: Chi-square, Student's t-test. Results: The prevalence ranges from 17.94 in the private school in the urban area and 20.96% in government schools in the urban area to 20.61% in private schools in the rural area and 22.17 in government school of the rural area. The overall prevalence of psychiatric disorders is higher among adolescents in the rural area (21.38%) as compared to the urban area (19.43%). Rural adolescents had significantly higher rates of somatoform disorders (4.45%), conduct disorder (3.78%), dysthymia (1.11%), and other mood disorders (0.89%) whereas higher rates of depression (3.88%), anxiety (3.67%), and hyperkinetic disorders (3.02%) were found in urban counterparts. Conclusion: An alarming number of adolescents suffer from different emotional and behavioral problems, but there is no excess of formal mental illness reaching the psychiatrist. This should help us formulate a rational basis for deploying our resources for the treatment and prevention of mental illness in tomorrow's adults.

Introduction: The need to integrate psychiatry in primary care is increasingly recognized as the favorable strategy worldwide. The contribution of primary care doctors (PCDs) is extremely important toward it. However, majority PCDs find it difficult to diagnose and treat common psychiatric disorders. Many training programs developed for PCDs, with different methods employed for posttraining evaluation. One of such program is blended psychiatric training program developed at our center. Aim: Case vignette-based outcome evaluation of on-site section of blended psychiatric training of PCDs at the end of 2 weeks. Materials and Methods: Two qualified psychiatrists designed the ten case vignettes after pilot use. Data were collected at baseline and at the end of 2 weeks on-site-training program. Major psychiatric diagnoses and treatments were covered. The responses to each vignette were evaluated with maximum marks 10 (5 each for diagnosis and treatment). Results: The mean age of the 21 participants was 43.1 ± 7.3 years. The posttraining score (83.42 ± 10.38) was significant higher than the baseline score (42.4 ± 23.10). Conclusion: Blended program for training of PCDs in psychiatric disorders significantly improves their diagnostic and treatment capabilities.

The Mental Healthcare Act (MHCA), 2017, is enacted with an aim to promote and protect the rights of and improve the care and treatment for people affected by mental illness in India. The Act purportedly includes substance use disorder (SUD) specifically in the definition of mental illness itself. However, some of the phrases used in the definition such as “abuse” are not clear, as the current classificatory systems of mental illnesses do not have any diagnostic category termed “abuse.” Another important issue is the lack of clarity on which categories of SUD would be covered under MHCA. Simple reading of the text of the Act seems to suggest that SUD is a single entity for the purpose of this law. In such case, many provisions of the act such as supported admission that are meant for the treatment of people with severe mental illnesses with gross impairment may become applicable to all types of SUD. This can create potential problems for addiction treatment providers. On the other hand, certain other provisions of the Act are good news for patients suffering from SUD. The Act lays down various rights that include, among others, protection from cruel, inhuman, or degrading treatment in any mental health establishment. This is very important from the perspective of treatment of SUD in the context of India, where human rights violations in the name of addiction treatment are often reported. The inclusion of SUD in MHCA, 2017, slots SUD as a health issue, rather than a law-and-order issue alone. This displays the intent of policymakers toward SUD, which, in itself, is laudable. There are certain ways in which the potential pitfalls mentioned earlier can be addressed, which is discussed in the article.

Syphilis is a great masquerader of several diseases. About 4%–10% of patients with untreated syphilis may develop neurosyphilis (NS). Psychiatric manifestations may rarely be the presenting feature of NS. We describe herein a case of an elderly man who presented with psychosis and after thorough workup was diagnosed to be a case of a NS. Schizophrenia-like psychosis as the presenting and the only manifested feature of NS in a nonhuman immunodeficiency virus-infected patient was a unusual and noteworthy feature in the present case.