The comorbidity of chronic pain and depression has been consistently associated with a poor prognosis and greater disability in patients as compared to those suffering from each illness alone. This further has implications on significant financial costs to the patients and to our society. The biological underpinnings of major depression and chronic pain have considerable overlap in the areas of genetic, structural, functional, neuroendocrine and neurotransmitter functionality. Although the field has evolved in the past decade, more efforts should now focus on understanding the biological underpinnings of this shared comorbidity, while shedding light on treatment implications for these two devastating conditions.

Background: There has been an exponential growth in the number of elderly population in India. This study aims to determine the prevalence of dementia in an urban center of Pune and to evaluate the corresponding socio-demographic correlates along with psychiatric morbidity in the study sample. Materials and Methods : The study population in Pune and Kirkee cantonments was selected based on 2001 census data. The number of people over 65 years numbered 6721 and 2145 of them were randomly selected for a door-to-door survey. They were initially administered household questionnaire and then subjected to a screening tool . Each participant underwent a brief mental state examination and data was collected on the basis of a structured proforma. Patients underwent a detailed cognitive profile using subtests from CSI-D (community screening instrument - dementia), which included a Consortium to Establish a Registry for Alzheimer's Disease (CERAD) word list, word fluency and delayed recall. Information pertaining to socio-demographic factors in participants and caregivers, caregiver-burden and behavioral and psychological symptoms in participants too were collected from the questionnaire. Radio imaging investigation was also carried out to quantify the deficit. Statistical Package for the Social Sciences (SPSS) software was used to compute the results. Results: Findings revealed that prevalence of dementia in the sample population of elderly aged above 65 years was 4.1%. Socio-demographic factors which conferred a statistically higher risk for dementia were identified to be older age, low socio-economic status, low level of education, presence of family history, whereas, marriage was found to be protective. Burden of care was associated with caring for elderly with dementia with increasing severity of dementia. Patients with dementia performed poorly on cognitive test battery. Social network had a protective effect in respect with severity of dementia. On magnetic resonance imaging (MRI) majority of cases of Alzheimer's Dementia (AD) and Vascular Dementia (VaD) were noted to have both gray and white matter involvement. Conclusion: Poor awareness is a key public-health problem. Society plays an important role in the ageing process. The withdrawal of the elderly from the previous societal roles ,reduction in all types of interactions i.e. shift of attention from outer world to the inner world, reduction in the power and prestige of the elderly enhance aging process. Aging in Indian culture though a disability is much stressful today in Indian culture as in others.

Deoxyribonucleic acid (DNA) conformation and stability play an important role in brain function. Earlier studies reported alterations in DNA integrity in the brain regions of neurological disorders like Parkinson's and Alzheimer's diseases. However, there are only limited studies on DNA stability in an aging brain and the factors responsible for genomic instability are still not clear. In this study, we assess the levels of Copper (Cu), Iron (Fe) and Zinc (Zn) in three age groups (Group I: below 40 years), Group II: between 41-60 years) and Group III: above 61 years) in hippocampus and frontal cortex regions of normal brains. The number of samples in each group was eight. Genomic DNA was isolated and DNA integrity was studied by nick translation studies and presented as single and double strand breaks. The number of single strand breaks correspondingly increased with aging compared to double strand breaks. The strand breaks were more in frontal cortex compared to hippocampus. We observed that the levels of Cu and Fe are significantly elevated while Zn is significantly depleted as one progresses from Group I to Group III, indicating changes with aging in frontal cortex and hippocampus. But the elevation of metals was more in frontal cortical region compared to hippocampal region. There was a clear correlation between Cu and Fe levels versus strand breaks in aging brain regions. This indicates that genomic instability is progressive with aging and this will alter the gene expressions. To our knowledge, this is a new comprehensive database to date, looking at the levels of redox metals and corresponding strand breaks in DNA in two brain regions of the aging brain. The biological significance of these findings with relevance to mental health will be discussed.

Context: This study aimed to clarify the difference in the perception of family functioning and social support by the schizophrenic patients and their principal caretakers, and whether the social support is related to healthy family functioning. Setting and Design: The study was set in the psychiatric outpatient department of a tertiary care hospital and data was collected by means of a semi-structured interview. Materials and Methods: Fifty unremitting schizophrenics diagnosed by diagnostic and statistical manual (DSM)-IV criteria and their family members were interviewed. Family functioning was assessed by the family assessment device (FAD) and the social support was assessed by the multidimensional scale of perceived social support (MSPSS). Statistical Analysis: Group differences were analyzed using unpaired 't' test for comparison of FAD and MSPSS means and subscale scores. Pearson's correlation coefficient was used to find the direction and magnitude of association between the various dimensions (subscales) of FAD and the social support from family. Results: Schizophrenic patients had more difficulty on problem solving as compared to their relatives, while no significant differences were noted on the other dimensions of FAD in the two groups. Also, schizophrenics perceived more social support from friends than from their families. All the dimensions of the family functioning correlated to the social support perceived from the family in the schizophrenic patients. Conclusions: Our study highlights the need to study the issues of perception of family functioning and social support so as to improve the prognosis in a disabling disorder like schizophrenia. Providing better social support and understanding the family functioning will result in strengthening the family as a unit, so as to provide better care to the patient.

Background: The point prevalence of depressive disorders in the elderly population in India varies from 13 to 25%. Since the World Health Organization (five) Well-being Index (1998 version) is simple and easy to administer, an attempt is made to evaluate the Indian version of this instrument to identify depression in the elderly Indian community. Objectives: (1) To determine the prevalence of depression among the elderly population of rural areas of Udupi district, Karnataka, India. (2) To determine the validity and reliability of WHO (five) Well-being Index (1998 version) as a screening instrument to identify depressive disorders in elderly population in this Indian setting. Materials and Methods: This cross-sectional study was conducted over a period of eight months (from March 1 to October 31, 2002) in the three taluks of Udupi, Kundapura, and Karkala; belonging to the Udupi district of South India. We selected 627 people in the age group of 60 years and above for the study. Simple random sampling, without replacement method, using the probability proportionate to size (PPS) technique was used. The WHO (five) well-being index (1998 version) was validated against the major International Classification of Diseases and Related Health Problems 10th Revision (ICD-10) depression inventory of mastering depression in primary care version 2.2. Proportions and their 95% confidence intervals were calculated and Kappa statistics was applied to determine the reliability of the screening instrument. P value<0.05 was considered statistically significant. Results: The prevalence of depression in elderly population was determined to be 21.7% (95% CI = 18.4 - 24.9). The Indian version of WHO-five well-being index (1998 version) showed a sensitivity of 97.0%, specificity of 86.4%, positive predictive value of 66.3% and an overall accuracy of 0.89. The Kappa statistics showed significantly high reliability of k = 0.71. Conclusion: The Indian version of "WHO (five) Well-being Index (1998 version)" was found to be an effective instrument for identifying depression in elderly Indian community.

Background: There are 14.9 million refugees and 22 million internally displaced persons in the world. The clinical and research literature shows a significant degree of psychological stress among refugees with relatively high levels of physical and psychological dysfunction in them. Aims: To determine the prevalence of various psychiatric disorders among Kashmiri migrants settled in a migrant camp at Jammu. Materials and Methods: This study was conducted on adults of Kashmiri migrant families residing in Muthi camp at Jammu. Three hundred families (150 each from two camps) were taken up for the study. Psychopathology was measured using Mini International Neuropsychiatry Interview Schedule (MINI). The data was categorized according to age, sex, education. The data was analyzed using Chi-square test with Yate's correction wherever required. P-value less than 0.05 was taken as significant. Results: Psychiatric morbidity was more in migrant population 33.66% (n=208) than in controls 26% (n=52) with major depressive episode being the most common diagnosis Conclusions: Depression, post-traumatic stress disorders (PTSD) and generalized anxiety disorders (GAD) were statistically more prevalent among migrants than in controls.

Background: Cognitive impairment is gaining recognition as sequelae of heart failure and the ICCU environment adds to their worsening symptoms. Objectives: To determine cognitive dysfunctions in patients with heart disease admitted in intensive cardiac care unit (ICCU) and to compare it with patients admitted in general medical wards with heart disease. Materials and Methods: A total of 30 patients admitted to ICCU with heart disease were taken for the study and compared to patients with heart disease admitted in general medicine wards (except ICCU). The tools used were SMMSE (Standardized Mini Mental State Examination) and BCRS (Brief Cognitive Rating Scale). Statistical tests used were Student 't' test and Chi-Square test. Results: This study showed cognitive dysfunctions in the domains of orientation, attention and constructional ability as measured by SMMSE and cognitive dysfunction in the domain of concentration as measured by BCRS. Overall cognitive dysfunctions were present in the total score of both SMMSE and BCRS scale, which was statistically very highly significant. Conclusion: The results showed that the patients in ICCU had cognitive dysfunctions in the domains of orientation, attention, constructional ability and concentration. Overall cognitive dysfunctions were found in the total scores of SMMSE and BCRS, thus signifying a global cognitive deficit.

Duration of untreated psychosis (DUP) has emerged as a reliable predictor of outcome but continues to remain under scientific scrutiny. The present study examines the effect of differential periods of DUP on long-term outcome of first episode schizophrenia at Mumbai, India. This research was a prospective, 10-year follow-up naturalistic study. Hospitalized patients of first episode schizophrenia were selected and followed up. Results showed that the mean DUP was higher for a group which showed clinical recovery on Clinical Global Impression Scale [14.0 months (SD=8.0) in recovered and 10.8 months (SD=5.7) in non-recovered group (P=0.091)]. DUP was not found to be significantly associated with any of the end point parameters of good clinical or social outcome. Thus, this study found that DUP alone does not determine outcome status confirming the role of psychopathological heterogeneity.

Clozapine has been used in the treatment of schizophrenia for about two decades and extensive data have been accumulated with regard to its use in various parts of the world. However, in contrast to Western countries, there are few studies which have evaluated the usefulness of clozapine in Indian patients. This article attempts to review the available data on clozapine originating from India. This review reflects the fact that there are few studies from the Indian subcontinent and most of these are case reports. In view of the same, there is a need for further research to evaluate the effectiveness of clozapine in India.

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.

Background: The Indian Journal of Psychiatry receives many reports which, despite obvious academic worth, are too poorly written to be publishable. Such submissions tax manuscript reviewers and increase the editorial office workload without benefiting the authors with a publication. Methods: We describe an authentic and previously unpublished case of idiopathic leucopenia and psychosis. Leucocyte levels in this patient dropped upon challenge with different atypical antipsychotic drugs. Lithium pretreatment, however, permitted the safe and successful use of trifluperazine. Readers are invited to use a roughly-prepared version of the case report to draft a submission-worthy manuscript. Results: Two versions of the manuscript are presented. The first version is generally satisfactory but will trigger several queries during peer review; these queries are indicated. The second version would be considered acceptable by most reviewers. Conclusions: Readers who work through the exercise provided in this article will better understand how authors should prepare their report and how reviewers may scrutinize their manuscript.