Background: The COVID-19 pandemic has led to a complete shut-down of the entire world and almost all the countries are presently in a “lockdown” mode. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, the impact of the same on mental health is not well known. Aim: This study aimed to evaluate the psychological impact of lockdown due to COVID-19 pandemic on the general public with an objective to assess the prevalence of depression, anxiety, perceived stress, well-being, and other psychological issues. Materials and Methods: It was an online survey conducted under the aegis of the Indian Psychiatry Society. Using the Survey Monkey platform, a survey link was circulated using the Whatsapp. The survey questionnaire included perceived stress scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Warwick-Edinburgh Mental Well-being Scale to assess perceived stress, anxiety, depression, and mental well-being, respectively. The survey link was circulated starting from April 6, 2020 and was closed on April 24, 2020. Results: During the survey, a total of 1871 responses were collected, of which 1685 (90.05%) responses were analyzed. About two-fifth (38.2%) had anxiety and 10.5% of the participants had depression. Overall, 40.5% of the participants had either anxiety or depression. Moderate level of stress was reported by about three-fourth (74.1%) of the participants and 71.7% reported poor well-being. Conclusions: The present survey suggests that more than two-fifths of the people are experiencing common mental disorders, due to lockdown and the prevailing COVID-19 pandemic. This finding suggests that there is a need for expanding mental health services to everyone in the society during this pandemic situation.

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Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.

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Introduction: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted “lockdowns” which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. Materials and Methods: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. Results: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. Conclusions: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

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Menopause is one of the most significant events in a woman's life and brings in a number of physiological changes that affect the life of a woman permanently. There have been a lot of speculations about the symptoms that appear before, during and after the onset of menopause. These symptoms constitute the postmenopausal syndrome; they are impairing to a great extent to the woman and management of these symptoms has become an important field of research lately. This chapter attempts to understand these symptoms, the underlying pathophysiology and the management options available.

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Context: It is estimated that approximately one in four people know someone who has taken their own life and that one suicide death leaves six or more suicide survivors. Aims: The aim of this paper was to review the literature regarding the association between suicide and bereavement, focusing also on the supportive and therapeutic resources available for survivors. Materials and Methods: Careful MedLine and PsycINFO searches for the period 1980-2013. Results: The review of the literature indicates that emotional turmoil in suicide survivors may last a long time and, in some cases, may end with their own suicide. Conclusion: Future research should evaluate the efficacy of professional treatments and of support groups targeting suicide survivors. Practice Implications: It is crucial to understand the bereavement process after the suicide of a significant other in order to provide proper care, reduce stigma, and improve the outcomes of related psychiatric conditions.

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Background: COVID-19, like every other pandemic, has imposed an unprecedented threat to doctors' physical and mental health. Literature in this area is sparse. The present study has been done to explore the knowledge, attitude, and behavior of doctors regarding this pandemic and how it influences their depression, anxiety, and stress level. Materials and Methods: This online survey has been done for 10 days. Data were collected on background characteristics, knowledge, attitude, and behavior of the respondents in a semi-structured pro forma, and psychiatric morbidity was measured by the Depression, Anxiety, and Stress Scale-21. A total of 152 complete responses have been received. The data were assessed using SPSS software. Results: Out of 152 study participants, 34.9% were depressed and 39.5% and 32.9% were having anxiety and stress, respectively. Significant predictors for psychiatric morbidities were experience in health sector, duty hours, use of protective measures, and altruistic coping. Multivariable logistic regression showed most of the factors to be significantly associated with depression, anxiety, and stress level. Discussion: Doctors who were working during COVID pandemic have a high prevalence of psychiatric morbidity. Age and having multiple comorbidities are significant predictive factors. Adequate protective measures should be warranted. Altruistic coping and a sense of greater goal are significant among the doctor community, in this pressing time. The doctors are pushing themselves to the best of their capacity and also protecting their patients' best interest. A large-scale, multicentric study will probably give a larger picture and will guide us for better service planning and delivery.

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Alzheimer's disease (AD) is a devastating neurodegenerative disease, the most common among the dementing illnesses. The neuropathological hallmarks of AD include extracellular β-amyloid (amyloid precursor protein (APP) deposits, intracellular neurofibrillary tangles (NFT)), dystrophic neuritis and amyloid angiopathy. The mismetabolism of APP and the defective clearance of β amyloid generate a cascade of events including hyperphosphorylated tau (τ) mediated breakdown of microtubular assembly and resultant synaptic failure which results in AD. The exact aetiopathogenesis of AD is still obscure. The preeminent hypotheses of AD include amyloid cascade hypothesis and tau hyperphosphorylation. The amyloid hypothesis states that extracellular amyloid plaques formed by aggregates of Aβ peptide generated by the proteolytic cleavages of APP are central to AD pathology. Intracellular assembly states of the oligomeric and protofibrillar species may facilitate tau hyperphosphorylation, disruption of proteasome and mitochondria function, dysregulation of calcium homeostasis, synaptic failure, and cognitive dysfunction. The tau hypothesis states that excessive or abnormal phosphorylation of tau results in the transformation of normal adult tau into PHF-tau (paired helical filament) and NFTs. Vascular hypothesis is also proposed for AD and it concludes that advancing age and the presence of vascular risk factors create a Critically Attained Threshold of Cerebral Hypoperfusion (CATCH) which leads to cellular and subcellular pathology involving protein synthesis, development of plaques, inflammatory response, and synaptic damage leading to the manifestations of AD. Multiple other aetiological and pathogenetic hypotheses have been put forward including genetics, oxidative stress, dysfunctional calcium homeostasis, hormonal, inflammatory-immunologic, and cell cycle dysregulation with the resultant neurotransmitter dysfunctions and cognitive decline. The available therapeutic agents target only the neurotransmitter dysfunction in AD and agents specifically targeting the pathogenetic mechanisms like amyloid deposition and tau hyperphosphorylation might provide a definite therapeutic edge.

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Suicide is the third leading cause of death among young adults worldwide. There is a growing recognition that prevention strategies need to be tailored to the region-specific demographics of a country and to be implemented in a culturally-sensitive manner. This review explores the historical, epidemiological and demographic factors of suicide in India and examines the strategies aimed at the prevention of suicide. There has been an increase in the rates of suicide in India over the years, although trends of both increases and decline in suicide rates have been present. Distinct from global demographic risk factors, In India, marital status is not necessarily protective and the female: male ratio in the rate of suicide is higher. The motives and modes of suicide are also distinct from western countries. Preventive strategies implemented at a community level and identifying vulnerable individuals maybe more effective than global strategies.

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Background: COVID-19 pandemic poses a unique medical challenge to the humanity in recent times. The psychological impact of the pandemic itself and the lockdown in particular is likely to be huge. Aim: To assess the psychological impact of COVID-19 pandemic on general population in West Bengal. Materials and Methods: It was an online survey which was conducted using Google Forms with link sent using WhatsApp. A 38-item self-designed questionnaire was used for the study. The survey questionnaire would take around 5–7 min to complete. Total 507 responses were received by the stipulated time. Results: Near about five-seventh (71.8%) and one-fifth (24.7%) of the respondents felt more worried and depressed, respectively, in the past 2 weeks. Half of the respondents (52.1%) were preoccupied with the idea of contracting COVID-19 and one-fifth (21.1%) of the respondents were repeatedly thinking of getting themselves tested for the presence of COVID-19 despite having no symptoms. Majority (69.6%) of the respondents were worried about the financial loss they were incurring during the period of lockdown. One-fourth (25.6%) and one-third (30.8%) of the respondents found that COVID-19 pandemic had threatened their existence and they found it difficult to adjust to the new routine during 21-day lockdown period, respectively. Conclusion: The index survey suggested that worry and sleep disturbances were common among the respondents in the past 2 weeks. The pandemic threatened the existence of the respondents to a great extent and affected their mental status negatively.

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Suicide is a global public health problem. Asia accounts for 60% of the world's suicides, so at least 60 million people are affected by suicide or attempted suicide in Asia each year. The burden of female suicidal behavior, in terms of total burden of morbidity and mortality combined, is more in women than in men. Women's greater vulnerability to suicidal behavior is likely to be due to gender related vulnerability to psychopathology and to psychosocial stressors. Suicide prevention programmes should incorporate woman specific strategies. More research on suicidal behavior in women particularly in developing countries is needed.

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Background: There has been an explosive growth of internet use not only in India but also worldwide in the last decade. There is a growing concern about whether this is excessive and, if so, whether it amounts to an addiction. Aim: To study the prevalence of internet addiction and associated existing psychopathology in adolescent age group. Materials and Methods: A cross-sectional study sample comprising of 987 students of various faculties across the city of Mumbai was conducted after obtaining Institutional Ethics Committee approval and permission from the concerned colleges. Students were assessed with a specially constructed semi-structured proforma and The Internet Addiction Test (IAT; Young, 1998) which was self-administered by the students after giving them brief instructions. Dukes Health Profile was used to study physical and psychosocial quality of life of students. Subjects were classified into moderate users, possible addicts, and addicts for comparison. Results: Of the 987 adolescents who took part in the study, 681 (68.9%) were female and 306 (31.1%) were males. The mean age of adolescents was 16.82 years. Of the total, about 74.5% were moderate (average) users. Using Young's original criteria, 0.7% were found to be addicts. Those with excessive use internet had high scores on anxiety, depression, and anxiety depression. Conclusions: In the emerging era of internet use, we must learn to differentiate excessive internet use from addiction and be vigilant about psychopathology.

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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.

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Interpersonal violence whether it is sexual or nonsexual, remains a major problem in large parts of the world. Sexual violence against children and women brings with it long-term sequelae, both psychiatrically and socially. Apart from sexual gratification itself, sexual violence against women is often a result of unequal power equations both real and perceived between men and women and is also strongly influenced by cultural factors and values. Within sociocentric and ego-centric cultures, the roles and representations of genders, and attitudes toward sexual violence differ. Cultures which are described as feminist, provide equal power to both men and women. Sexual violence is likely to occur more commonly in cultures that foster beliefs of perceived male superiority and social and cultural inferiority of women. Although culture is an important factor to understand sexual violence in its entirety, we need to look at, as well as beyond cultural structures, their strengths and weaknesses.

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Background: Dementia care in developing countries will continue to be provided by co-resident caregivers at home. Behavioral and Psychological Symptoms of Dementia (BPSD) are difficult to manage at home.Interventions leading to reduction or remission of reduction or remission of BPSD will be of immense help in the management of these patients. Materials and Methods: The nature and prevalence of BPSD in a community sample of patients with dementia was assessed by a clinician .The impact of these symptoms on the caregiver was assessed by measures of burden of care and the psychological well being of the caregiver. Another rater carried out these assessments independently. Results: Prevalence of BPSD was very high and they were more common in patients with Alzheimer's Disease than patients with Vascular Dementia. They were rated as troubling to most caregivers. Caregiver burden was associated with adverse effects on the mental health of the carer. Conclusions: To be effective, dementia care services in developing countries need to focus on management of BPSD at home. Development of a low cost, effective and sustainable dementia care service should be given due importance by the policy makers in the developing world.

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Introduction : Only a limited proportion of patients with psychiatric disorders attend the healthcare facilities, and that too when the condition becomes severe. Treatment from unqualified medical practitioners and faith healers is a common practice, and is attributable to the delay in proper treatment. Materials and Methods: A cross-sectional study was conducted to understand the pathway of care adopted by psychiatric patients and its relationship with the socio-demographic determinants in the study population. The subjects were selected from urban specialty psychiatric hospitals and interviewed using a pre-tested, semi-structured interview schedule. The data was analyzed using SPSS v10.0 software. The Chi square test, T test, and Kruskall Wallis Test were used, as needed. Results: A total of 295 patients (203 males) were included in this study. The majority of the patients (45%) were suffering from Bipolar affective disorders (45%), followed by schizophrenia (36%). The majority, 203 (68%), were from the rural area, with 94 patients being illiterate. The mean distance traveled for treatment was 249 km. The majority of these (69%) had first contacted faith healers and a qualified psychiatrist was the first contacted person for only 9.2% of the patients. Conclusion: A large proportion of psychiatric patients do not attend any health facility due to a lack of awareness about treatment services, the distance, and due to the fear of the stigma associated with treatment. The psychiatric patients first seek the help of various sources prior to attending a psychiatric health facility. The pathway adopted by these patients need to be kept in mind at the time of preparation of the mental health program.

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Depression is conventionally viewed as a state of chemical imbalance, and antidepressants are suggested to act through increasing monoaminergic neurotransmission. These views are currently considered simplistic. This article examines the animal and human literature on the neurohistological mechanisms underlying stress, depression and antidepressant treatment. Pathological stress and depression are associated with changes such as loss of dendritic spines, shrinkage of the dendritic tree and loss of synapses in the hippocampus and prefrontal cortex. There is also a decrease in glia. Apoptosis may occur under extreme circumstances. In contrast, there is increased dendritic arborization and synaptogenesis in the amygdala. Antidepressant treatment protects against and even reverses some but not all of these stress-induced neurohistological changes. Pathological stress results in an aberrant neuroplasticity response characterized by abnormally increased activity in the amygdala and by impaired functioning of the hippocampus, prefrontal cortex and downstream structures. This aberrant neuroplasticity response directly explains most of the clinical symptoms of depression. Antidepressant treatment protects against stress-induced pathoplastic neurohistological and neurocognitive changes. Antidepressant treatment also restores functional neuroplasticity in stressed organisms and, thereby, presumably, facilitates re-adaptation through learning and memory mechanisms. Thus, the stress-depression syndrome and the therapeutic and prophylactic efficacy of antidepressant treatments can be explained through a hardwiring analogy. In this context, glutamate is an important neurotransmitter.

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Cognition denotes a relatively high level of processing of specific information including thinking, memory, perception, motivation, skilled movements and language. Cognitive psychology has become an important discipline in the research of a number of psychiatric disorders, ranging from severe psychotic illness such as schizophrenia to relatively benign, yet significantly disabling, non-psychotic illnesses such as somatoform disorder. Research in the area of neurocognition has started unlocking various secrets of psychiatric disorders, such as revealing the biological underpinnings, explaining the underlying psychopathology and issues related to course, outcome and treatment strategies. Such research has also attempted to uproot a number of previously held concepts, such as Kraepelin's dichotomy. Although the range of cognitive problems can be diverse, there are several cognitive domains, including executive function, attention and information processing, and working memory, which appear more frequently at risk. A broad range of impairment across and within the psychiatric disorders are highlighted in this oration. The oration summarizes the studies investigating cognitive processing in different psychiatric disorders. I will also discuss the findings of my own research on neurocognitive deficits in mood disorders, schizophrenia, obsessive-compulsive disorder, somatoform disorder, including studies on 'high-risk' individuals. Tracing the evaluation of neurocognitive science may provide new insights into the pathophysiology and treatment of psychiatric disorders.

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