Background: There is a large body of literature and scientific data regarding the efficacy of pharmacological and psychosocial interventions for schizophrenia, however, studies on Yoga therapy is scanty. Yoga is a means of balancing and harmonizing the body, mind and emotion, and for enlightening the mind and upliftment of the total personality. Aims: The present study was conducted to determine the efficacy of Yoga therapy as an adjunctive therapy and to see its effects on psychopathology on the patients suffering from chronic schizophrenia. Settings and Design: Pre- and post-test design with the control group. Materials and Methods: It is a study using purposive sampling technique by which 30 chronic schizophrenic patients were selected and 15 patients were randomly assigned to Yoga therapy along with pharmacotherapy (experimental group), and 15 were assigned pharmacotherapy alone (control group) after the baseline assessment using Positive and Negative Syndrome Scale (PANSS). The Yoga group attended Yoga therapy everyday for about 1½ h including motivational and feedback session. Results: At the end of 1 month postassessment was done, and schizophrenic patients, who received the yogic intervention showed better rating than those in pharmacotherapy alone on PANSS variables. Conclusion: Yoga could be a right choice for improving psychopathology resulting in better quality of life along with other pharmacological management and psychosocial interventions.

Aim: To compare “consultation” and “hybrid” models of consultation-liaison (CL) services provided to patients visiting the medical emergency outpatient services. Materials and Methods: Over the period of 18 months, two different models of consultation psychiatry services (July 2012 to March 2013-consultation model, April 2013 to December 2013 hybrid model) were compared. In the consultation model, the psychiatry resident was available on call to the internists. Whereas, for the hybrid model psychiatry resident was stationed in the medical emergency and was available to assess the patients directly requiring psychiatric evaluation. Results: During the first 9 months, 22,000 patients were evaluated in various emergency medical outpatient services, of which 383 (1.74%) were referred to the on-call psychiatry CL team. However, when the hybrid model was followed, the number of patients evaluated by the psychiatry resident increased to 594 out of 24,737 patients (2.4%) who reported to the emergency during the next 9 months period. There was a substantial increase in the proportion of cases with medical illnesses for which psychiatric consultation was sought, and a change in psychiatric diagnostic profile was observed too. When compared to the consultation model, the hybrid model was associated with greater use of medications, investigations, referrals and psychological measures in the emergency setting itself. Conclusions: Following a hybrid model in the medical emergency leads to an increase in the number of total psychiatric consultations and more extensive management of patients.

Background: Lifetime prevalence of depression and anxiety increases from 1% of the population under age 12 years to ~17%-25% of the population by the end of adolescence. The greatest increase in new cases occurs between 15-18 years.Indian empirical studies have reported a prevalence of psychiatric morbidity in the range between 14.4% and 31.7%; thus, affecting psychosocial functioning. Aims: The objectives of the current study were to (i) examine the psychometric properties of the DASS and SDQ on Indian adolescents, (ii) explore the role of socio- demographic variablesand (iii) examine if there was any difference between school going and school dropouts. Methodology: Data from 1812 students, aged 12-19 years was collected with mean age = 15.67 years (SD =1.41 years). The participants were administered a booklet containing demographic questionnaire and psychometric scales such as DASS-21 (Henry & Crawford, 2005; Lovibond & Lovibond, 1999) and Strengths and Difficulties Questionnaire (Goodman, 1997). Statistical Analysis: Structure validation, correlational analysis and multivariate analysis. Results and Conclusions: The results of validation indicated that English and Hindi version of 3 factor model of DASS and 2 factor model of SDQ was an acceptable model fit. It was noted that early adolescents were high on prosocial behaviour whereas late adolescents were high on difficulties score. Females were higher than males on prosocial behaviour. Adolescents residing in rural areas differed from their urban counterparts on prosocial behaviour and anxiety. Government school going adolescents differed from private school going adolescents on prosocial behaviour, stress and anxiety. Negative perception of relationship with family affected adolescents difficulties score, depression and stress. Similarly, negative perception of self-concept leads to higher difficulties score and lower prosocial behaviour score. The school going adolescents differed from non-school going adolescents on stress, depression and anxiety.

Context: Elder abuse and social neglect are unrecognized problem. Many forms of elder abuse exist including physical, psychological, financial, sexual and social neglect. Social neglect is experienced by elderly through loss of friends and family members. Aim: Comparison of perceived abuse and social neglect among elderly residing in selected rural and urban areas. Settings and Design: Study setting was a rural area Pohir and urban area Jamalpur of district Ludhiana. Subjects and Methods: A sample of 200 subjects (100 subjects each from rural and urban area respectively) of age 60 years and above was drawn by cluster sampling technique and interview method was used to collect data by using Likert scale. Statistical Analysis: Descriptive and inferential statistics were carried out with SPSS package. Results: Results of the present study revealed that perceived physical abuse (25%) was higher among elderly residing in rural and it was found significantly higher among female elderly who were illiterate, widow/widower and partially dependent on caregiver whereas perceived psychological abuse (71%), financial abuse (37%) and social neglect (74%) were higher among elderly residing in urban. A significant association was found between psychological abuse and educational status, which inferred that as the level of education increases perception of psychological abuse also increases. The perceived financial abuse was significantly higher among male elderly who were financially independent. Conclusion: It was concluded that social neglect was most common, followed by psychological abuse and financial abuse among elderly residing in urban whereas physical abuse was more prevalent among elderly residing in rural.

Background: Suicide is one of the leading causes of preventable deaths. Recent data suggest South India as one of the regions with highest suicide rates in the world. In 2013, 134,799 people committed suicide in India according to the statistics released by the National Crime Records Bureau. Suicide note is one of the most important sources to understand suicide, which may be beneficial in suicide prevention. Studies on suicidal notes from this part of the world are sparse. Objective: The aim was to study the themes in suicide notes that might be useful in prevention strategies. Materials and Methods: A descriptive study of all suicide notes of those individuals who committed suicide between 2010 and 2013 available with Police Department, Mysore district was obtained and analyzed. Results: A total of 22 suicide note were available. A majority of suicide note was in age group of 16–40 years (86%) and most were men (59%). All suicide notes were handwritten, the majority (70%) in regional language Kannada. Length of notes varied from just few words to few pages. Contents of suicide notes included apology/shame/guilt (80%), love for those left behind (55%) and instruction regarding practical affairs (23%). Most have blamed none for the act (50%). 23% mentioned that they are committing suicide to prove their innocence. 32% mentioned a last wish. Conclusion: The majority of suicidal note contained “guilt” which is a strong indicator of possible depression in deceased. Creating awareness about suicide among public and ensuring access to professionals trained in suicide prevention is need of the hour in this part of the world.

Background: Usually remembered in the context of Narcolepsy-Cataplexy syndrome, isolated sleep paralysis (SP) and hypnic hallucination are widely prevalent and because of the overlap of symptoms with schizophrenia, their identification is important but unrecognized. Aims: To determine the presence of SP and hypnic hallucinations (HH) in people with schizophrenia and schizoaffective disorder Study Design: Cross-sectional survey. Methods: Participants were patients receiving follow-up care for schizophrenia from Assertive Community Treatment Team. A screening questionnaire was administered during their routine follow-up visits. Results: Of 71 respondents (49 males, 22 females) only 11 (10 males and 1 female), that is, 15% reported SP, and 12 (7 males and 5 females), that is, 16.9% reported HH, a considerably low prevalence. Conclusion: It is difficult to study the presence of SP and HH in patients with active or residual symptoms of schizophrenia, and more refined studies and appropriate questionnaires are required. The possibility of SP and HH confounding or being misdiagnosed as psychotic symptoms needs to be borne in mind.

Background: Sexual dysfunctions have been a major side effect of the second generation anti-psychotic drugs which often affects treatment compliance in patients with schizophrenia. There is no/few systematic review or research addressing sexual dysfunction and their effect on serum prolactin level among different atypical antipsychotics in India. Aims: To determine and compare the frequency of sexual dysfunction associated with olanzapine, risperidone, and clozapine and their effect on serum prolactin level in remitted patients with schizophrenia. Settings and Design: Cross-sectional hospital-based study. Recruitment by purposive sampling. Estimation of serum prolactin was done using enzyme-linked immunosorbent assay technique. Materials and Methods: The total sample size was 103, consisting of 31, 23, and 19 patients in olanzapine, risperidone, and clozapine groups, respectively and 30 controls. A Brief Psychiatric Rating Scale, Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and Sexual Functioning Questionnaire were administered. Analysis of variance was used to compare clinical variables. Chi-square test was used to identify the frequency of sexual dysfunction. Kruskal–Wallis test was used to compare UKU side effect, sexual dysfunction, and blood parameters across the study groups. Results and Conclusion: Eighty-six percentage reported sexual dysfunction in one or more domains of sexual functioning in risperidone group as compared to 48.3% in olanzapine and 31% in clozapine groups, respectively. Prolactin level elevation was statistically significant in risperidone group followed by clozapine and olanzapine groups, respectively.

Background: Several studies have revealed significant differences between bipolar (BP) and unipolar depression (UP). Misdiagnosing BP depression results in suboptimal symptom resolution, induction of manic switch, mixed state, or accelerated cycling. This study compares various psycho-socio-demographic, longitudinal course, and phenomenological factors associated with BP and UP depression. Materials and Methods: We compared 30 UP and 30 BP depression patients using a specially designed intake proforma, International Classification of Diseases-10 diagnostic criteria for research, Hamilton Rating Scale for Depression-21 (HAMD-21), Hypomania Checklist-32 Questionnaire (HCL-32), Brief psychiatric rating scale (BPRS), and Kuppuswami's socioeconomic status scale. Results: BP depression group consisted of mostly males, with earlier age of onset of illness, longer illness duration, frequent episodes, hospitalizations and psychotic symptoms. The total HAM-D score and 4 HAM-D item scores–psychomotor retardation, insight, diurnal variation of symptoms and its severity, and paranoid symptoms were significantly higher in this group. Binary logistic regression identified the age of onset, the total duration of illness, frequency of affective episodes, and presence of delusions as predictors of bipolarity (odds ratio = 1.327; 1.517; 0.062; 0.137). Conclusions: Identification of clinical markers of bipolarity from large scale prospective studies is needed.

Introduction: India accounts for the highest estimated number of suicides in the World. In 2012, more than 258,000 of the 804,000 suicide deaths worldwide occurred in India. Early identification and effective management of suicidal ideation and behavior are paramount to saving lives. However, mental health resources are often scarce and limited. Throughout India, there is a severe shortage in mental health professions trained, which results in a treatment gap of about 90%. A comprehensive needs assessment was undertaken to identify the nature of the deficits in suicide prevention training for physicians in three Indian cities: Mumbai, Ahmedabad, and Mysore. Materials and Methods: The study was carried out in several concurrent phases and used a mixed-method approach of converging quantitative and qualitative methodologies. Data were collected using survey questionnaires, focus groups, consultations, and environmental scans. A total of 46 physicians completed the questionnaire. Focus groups were conducted in Mumbai and Ahmedabad with 40 physicians. Consultations were carried out with psychiatrists and psychiatric residents from hospitals and clinics in Mumbai, Ahmedabad, and Mysore. Results: Training gaps in suicide prevention exist across the health care professions. Existing training lacks in both quality and quantity and result in critical deficits in core competencies needed to detect and treat patients presenting with suicidal ideation and behavior. Only 43% of the surveyed physicians felt they were competent to treat suicidal patients. The majority of surveyed physicians believed they would greatly benefit from additional training to enhance their suicide risk assessment and intervention skills. Conclusions: There is a dire need for medical schools to incorporate suicide prevention training as a core component in their medical curricula and for continuing medical education training programs for physicians to enhance competencies in early detection and management of suicidal behavior.

Context: Treatment nonadherence is one of the major obstacles in recovery even with the availability of a broad range of pharmacological and psychosocial treatments for persons with mental illnesses. Aims: The aim was to evaluate the effectiveness of specific interventions in improvement of treatment adherence of persons with mental illnesses. Settings and Design: A quasi-experimental study was conducted at a tertiary mental health care setting in North-east India. Materials and Methods: Total 30 numbers of patients were selected randomly for the study. Treatment adherence was assessed using the Medication Adherence Rating Scale and a structured Treatment Adherence Checklist. Data were collected before and 1-month after the specific interventions to the patients and their family members. Results: Result showed a significant improvement in the treatment adherence as verbalized by the patient (paired t = 3.973, P = 0.00, df = 29) as well as reported by the family members (paired t = 2.94, P = 0.00, df = 29) following the specific intervention. Conclusion: The study result suggested that specific intervention may be used for a better outcome of treatment for mental illnesses. The findings might be generalized following implementation of the intervention to a larger sample.

Mass media including television, internet, and newspapers influences public views about various issues by means of how it covers an issue. Newspapers have a wider reach and may affect the impact that a news story has on the reader by factors such as placement of the story within the different pages. We did a pilot study to see how two English newspapers from Mumbai, India were covering psychiatry related news stories. The study was done over a period of 3 months. We found a total of 870 psychiatry related news stories in the two newspapers over 3 months with the majority of them being covered in the main body of the newspapers. Sex-related crime stories and/or sexual dysfunction stories received the highest coverage among all the news while treatment and/or recovery related stories received very little coverage. It is crucial that the print media takes more efforts in improving reporting of psychiatry-related stories and help in de-stigmatizing psychiatry as a discipline.

Background: Perinatal depression is a major public health problem, affecting up to a quarter of all pregnant women in rural Asean countries and often leads to psychologic symptoms, lower quality of life, and higher health care costs. The purpose of this study was to assess the impact of supervised physical exercise on depression level of perinatal subjects. Subjects/Intervention: 60 subjects who fulfill the selection criteria were randomly assigned to exercise (Group-1, n=30) and control group (Group-2, n=30). Participants completed general screening form and Physical health questionnaire-9 (PHQ-9) before their intervention and again 4 weeks and 8 weeks later. Group-1 underwent aerobic training with 60-65% maximum heart rate and Group-2 was prescribed with handouts for 4 weeks. Statistics: Repeated-measures analysis of variance (ANOVA) was use to analyze group differences over time while controlling for baseline differences. Results: Demographic and the baseline values show homogenous population (P > 0.05). Patients in both groups experienced significant reduction in depression level. Group A showed reduction of 91.70% (P = 0.00) as compared to Group B 69.01% (P = 0.00). Conclusion: These results suggest that supervised physical exercise provides better improvement in depression status in perinatal subjects than providing handouts alone.

Pulmonary embolism (PE) is a potentially fatal condition. We describe the educative case of a young adult male, with a longstanding history of schizophrenia, who was receiving anticoagulant treatment because of repeated episodes of PE in the past. He presented with severe exacerbation of psychosis and did not respond to oral and parenteral antipsychotic medication during inpatient treatment. He was taken up for electroconvulsive therapy (ECT) and received a single ECT uneventfully. The ECT course had to be interrupted because of the unexpected development of a 4-day febrile illness, after which he experienced sudden onset breathlessness, which was diagnosed as acute-on-chronic PE. After the crisis resolved with 4 days of intensive care, he was managed with clozapine. We discuss concerns associated with the psychiatric management of patients with PE; special issues include the use of restraints, parenteral antipsychotic medications, anticoagulants, and ECT.

Divergent worldviews, incommensurable frameworks, contrasting models, distinct foci, dissimilar logic, different realities, disparate cultures, and complex patient-physician interaction impact the clinical process and problematize decision-making. Attempting to understand the disease-illness divide, engage patient perspectives, go beyond the traditional biomedical understanding of mental illness and negotiate a shared plan for treatment are serious challenges for psychiatry. The challenge for psychiatrists is to appreciate patient reality and negotiate a shared plan of treatment.