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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Aim: Oxidative stress is a state in which there is disequilibrium between pro-oxidant processes and the antioxidant defense system in favor of the former and occurs as a consequence of increased production of free radicals or when the antioxidant defense system is inefficient or a combination of both events. A disturbance in the antioxidant defense system, including antioxidant enzymes superoxide dismutase (SOD) and glutathione peroxidase (GSHPx), due to free radical-induced oxidative injury has also been implicated in various neuropsychiatric disorders. Hence the role of these antioxidant enzymes and the changes in their level in blood and correlation with oxidative stress and the overall mechanism of defense were studied in a common psychiatric illness, schizophrenia. Materials and Methods: Fifty subjects of either sex ranging in age from 18 to 60 years, divided into two age groups (<40 years and >40 years), diagnosed for schizophrenia; and 50 age- and sex-matched normal subjects as controls were included in the study. Blood samples were collected for the determination of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSHPx), and reduced glutathione (GSH). Results: Significantly lower levels of the two antioxidant enzymes were found in schizophrenics compared to normal controls, with an increased oxidative stress as indicated by high blood MDA levels. The condition worsened with advancing age, smoking, among literate masses, and in chronic schizophrenics; whereas gender did not show any effect. Conclusion: It can be concluded that an imbalance in the antioxidant defense system, along with enzymatic antioxidants, occurs in schizophrenia due to the persistent oxidative stress. Modern life style perhaps also contributes to the condition.

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Context: Oxidative stress induced lipid peroxidation has been a significant contributing factor for schizophrenia. Older antipsychotics, like haloperidol , were found to increase lipid peroxidation, whereas, the newer atypical antipsychotics, like olanzapine, did not generate free radicals as metabolic end products. Aims: The interrelationship of the antioxidant vitamins and antioxidant enzymes, and their overall effect on regulation of oxidative stress induced by haloperidol as compared to olanzapine were analyzed in present study. Setting and Design: It was an open randomized cross sectional study that consisted of two groups of fifty schizophrenic patients treated by haloperidol and olanzapine, respectively for at least six months. Materials and Methods: Serum thiobarbituric acid reacting substances (TBARS) was selected as marker of lipid peroxidation, whereas, serum tocopherols, plasma ascorbate and plasma superoxide dismutase (SOD) activity, were selected to assess the antioxidant vitamin and antioxidant enzyme status, respectively. All measurements were done by standard photometric methods. Statistical Analysis Used: Statistical analysis was performed to find out the significance for the differences of means between two groups. Bivariate and partial correlation coefficients for assessing the interrelationship between different parameters were done by using statistical package for social sciences (SPSS) software. Results: Results showed significantly higher serum TBARS and lower antioxidant values in the haloperidol treated patients. Significant positive correlations among the individual antioxidant parameters and significant negative correlation between all of the antioxidant parameters and serum TBARS were found only in haloperidol treated patients. Plasma SOD activity correlated to plasma ascorbate in both groups. Partial correlation results revealed that the serum tocopherol decreased linearly with an increase in serum TBARS significantly in olanzapine treated patients when effect of plasma ascorbate was controlled. Conclusions: Haloperidol caused more oxidative stress along with a significant reduction of important antioxidant parameters. Plasma ascorbate was found to be the chief antioxidant on which the activity of both plasma SOD and alpha tocopherol were dependent under oxidative stressful conditions.

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Background: Studies from Tamil Nadu, South India, have reported the world's highest suicide rates. As per official reports, Kerala, another South Indian state has the highest suicide rate among the major states in India. Objective: The purpose of this analysis is to estimate the rates and age-specific incidence of suicide in a rural community in Kerala, under continuous observation for the last five years. Settings and Design: The study setting comprised of seven contiguous panchayats constituting a development block in Kerala. A prospective cohort study design was used. Materials and Methods: Through regular home visits, every death that occurred in the community was captured by local resident health workers and the cause of death assigned. Statistical Analysis: Suicide rates by age and sex and relative share of suicide deaths to all-cause deaths in men and women were calculated. Results: During the five-year period from 2002 to 2007, 284 cases of suicide were reported. The suicide rates were 44.7/100,000 for males and 26.8/100,000 for females. Male to female suicide ratio was 1.7. Among females aged between 15 and 24, suicides constituted more than 50% of all deaths. Male to female ratio of suicide varied from 0.4 in children aged 14 years or less to 4.5 in the 45-54 year age group. Conclusion: Our analysis shows that the level of under-reporting of suicides in rural Kerala is much less than that reported in Tamil Nadu.

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The prevention and treatment of cognitive impairment in the elderly has assumed increasing importance in an aging population. This article presents a qualitative review of recent research on experimental interventions for the prevention and treatment of mild cognitive impairment and Alzheimer's disease in elderly subjects. Interventions addressed range from lifestyle measures to pharmacological treatments. Epidemiological studies suggest that dietary measures, physical exercise, and mental activity may reduce the risk of cognitive impairment and Alzheimer's disease in elderly subjects. Statins may protect against incident dementia, and lithium may convey similar benefits to bipolar patients. Ginkgo appears ineffective as a primary preventive measure. Donepezil but not Vitamin E may benefit persons with mild cognitive impairment. Experimental treatments potentially useful for Alzheimer's disease include dimebon, PBT2 and etanercept; the safety and efficacy of the Alzheimer's vaccine remains to be proven, and growth hormone secretagogue and tarenflurbil are likely ineffective. Herbal treatments merit study in elderly subjects with cognitive syndromes.

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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.

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Schizophrenia is conceptualized as a disorder of aberrant neurodevelopment, with evident stigmata such as minor physical anomalies (MPA), neurological soft signs (NSS), and abnormalities of brain structure and function, proposed as disease endophenotypes. We have examined the neurobiology of schizophrenia using neurodevelopmental markers, structural MRI (sMRI), EEG spectral power, and coherence as well as neuropsychological testing in neuroleptic-naïve, recent-onset schizophrenia (NRS) subjects. It has been our focus to link the positive and negative symptom dimensions of schizophrenia with their underlying neural correlates specifically reflecting fronto-temporal circuitry dysfunction. We found that MPAs and NSSs constituted independent neurodevelopmental markers of schizophrenia and would afford greater predictive validity when used as a composite endophenotype. In an exploratory factor analytic study of the dimensionality of psychopathology, we noted that the symptoms segregated into three dimensions, viz., positive, negative, and disorganization, even in NRS subjects. Executive function tests as well as EEG spectral power and coherence studies revealed that the symptom dimensions of schizophrenia could be linked to specific neural correlates. In an attempt to study the relationship between the symptom dimensions and brain structure and function using MRI, we have proposed neuroanatomical definitions with cytoarchitectonic meaning for parcellation of the prefrontal sub-divisions. Using sMRI, we have found specific corpus callosal abnormalities that possibly link the temporo-parietal association cortices with the positive symptom dimension. Recently, we also found evidence for neurodevelopmental deviance in schizophrenia possibly involving the frontal pole (FP)-driven cortical network, in a sMRI study linking FP volume and total brain volume with age in NRS subjects and age-, gender- and education-matched healthy subjects. Overall, our findings highlight the potential significance of linking the homogeneous symptom dimensions of schizophrenia with dysfunctional connectivity in the fronto-temporal region.

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Background: Persons with schizophrenia are reported to be more likely to die from cardiovascular illness than those in the general population, and are at a greater risk of developing obesity, diabetes type 2, hypertension and dyslipidemias. Antipsychotic drugs used in the treatment of schizophrenia and other psychotic illnesses can induce weight gain, with some agents having a greater propensity to do so than others. These adverse effects associated with second-generation antipsychotics are also part of the metabolic syndrome. Aims: The aim of this study was to evaluate the emergence of metabolic syndrome due to second-generation antipsychotics as compared with conventional (typical) antipsychotics. Settings and Design: A prospective interventional study was conducted at the Psychiatric Centre, Jaipur. The study included 120 patients, both indoor and outdoor, suffering from schizophrenia diagnosed using the ICD-10 criteria. The patients were grouped into four categories, i.e. control group and three study groups, each group having 30 patients. Materials and Methods: Thirty patients were given conventional antipsychotics and 90 were given second-generation antipsychotics, including risperidone, olanzapine and clozapine. Metabolic parameters were taken before onset of drug treatment therapy and after 4 months. The changes in metabolic parameters were compared using appropriate statistical tools. Statistical Analysis: Chi square chart and Unpaired t-test were used for statistical analysis using a computer. Results: 11.66% of the patients developed metabolic syndrome after 4 months of antipsychotic medication. Conclusions: Second-generation antipsychotics cause significantly more changes in the metabolic parameters, increasing the chances of developing metabolic syndrome and associated disorders like diabetes mellitus type-II and cerebrovascular accidents. Olanzapine is the antipsychotic drug that has the maximum potential to cause metabolic syndrome.

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The etiology of schizophrenia has been the focus of intensive research for a long time. Perspectives have changed drastically with the development of new investigative techniques. Clinical observations made by Kraepelin, Clouston, Bender, and Watt are now being complemented by neuroimaging and genetic studies to prove the neurodevelopmental hypothesis. At the same time, neuropathological and longitudinal studies of schizophrenia often support a neurodegenerative hypothesis. To provide a theoretical basis to the available evidence, another hypothesis called the progressive neurodevelopmental model has also emerged. This review presents some key evidence supporting each of these theories followed by a critical analysis of each.

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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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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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Context: Periodic systematic profiling of suicidal risk factors in developing countries is an established need. Aims: It was intended to study the risk factors associated with suicide attempts in Orissa, one of the most economically compromised states of India. Settings and Design: Cross-sectional study in a general hospital. Materials and Methods: Consecutive 149 suicide attempters were evaluated for psychosocial, situational, and clinical risk factors using the Risk Rescue Rating scale, Suicide Prevention Center scale, Lethality of Suicide Rating scale, and Presumptive Stressful Life Event scale. They were compared with healthy and psychiatric controls who had never attempted suicide. Statistical analysis: Chi-square for comparison of categorical variables, t-tests for comparison of means. Results: The male-to-female ratio was closer to one in adults and around 1:3 in adolescents. Younger age, lower-middle economic group, rural background, unemployed, school educated were more represented in this study. Compared to the controls, significantly more number of attempters had a family history of psychiatric illness and suicide, childhood trauma, medical consultation within one month, had experienced stressful life events and had expressed suicidal ideas. In a considerable proportion of attempts, risk was high and rescuability least; 59.1% had more than 50% chance of death. Suicide potential was high in almost half the cases. More than 80% of all attempters had psychiatric disorder; however, only 31.5% had had treatment. Factors like middle age, family history of psychiatric disorders, past psychiatric history, current psychiatric illness, communication of suicidal ideas, the use of physical methods, and high potential attempts, differentiated repeaters significantly from the first-timers. Major physical illness, family and marital conflicts, financial problems, and failure in examinations were more frequent life events. Childhood trauma, noted in around 40% of the attempters, was considerably associated with adolescent suicide attempts. Conclusions: Modifiable risk factors identified in this study have preventive implications.

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Religious traditions across the world display beliefs in healing through prayer. The healing powers of prayer have been examined in triple-blind, randomized controlled trials. We illustrate randomized controlled trials on prayer and healing, with one study in each of different categories of outcome. We provide a critical analysis of the scientific and philosophical dimensions of such research. Prayer has been reported to improve outcomes in human as well as nonhuman species, to have no effect on outcomes, to worsen outcomes and to have retrospective healing effects. For a multitude of reasons, research on the healing effects of prayer is riddled with assumptions, challenges and contradictions that make the subject a scientific and religious minefield. We believe that the research has led nowhere, and that future research, if any, will forever be constrained by the scientific limitations that we outline.

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Background: Studies on incidence of childhood mental disorders are extremely rare globally and there are none from India. Incidence studies though more difficult and time consuming, provide invaluable information on the pattern and causes of occurrence of mental disorders allowing opportunity for early intervention and primary prevention. Aim: This study aimed at estimating the incidence of psychiatric disorders in school children. Materials and Methods: A representative sample of school children was assessed through a two stage evaluation process involving teacher's rating (N=963) and parent rating (N=873). Children who scored below the cut-off for psychiatric disorder (N=727) on both the screening instruments were re-contacted six years later. 186 children and their families were personally available for reevaluation. All the children and their parents were re-assessed on Parent Interview Schedule; Strengths and Difficulties Questionnaire: and detailed clinical assessment by a psychiatrist. Psychiatric diagnosis was made as per ICD 10 criteria. Data on children who were found to have psychiatric disorder were compared with those who did not have psychiatric disorders. Results: 20 children out of 186 followed up had psychiatric disorder giving the annual incidence rate of 18/1000/yr. Children who had disorder at follow-up did not differ from those who did not on age, gender and psychological (temperament, parental handling, life stress and IQ) parameters at baseline. Discussion: Incidence figures cannot be compared due to lack of any comparable studies. Factors associated with occurrence of new cases of psychiatric disorder and implications for future studies are discussed.

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The suicide rate in India is 10.3. In the last three decades, the suicide rate has increased by 43% but the male female ratio has been stable at 1.4 : 1. Majority (71%) of suicide in India are by persons below the age of 44 years which imposes a huge social, emotional and economic burden. Fifty four articles on suicides have been published in IJP. Several studies reveal that suicidal behaviours are much more prevalent than what is officially reported. Poisoning, hanging and self immolation (particularly women) were the methods to commit suicide. Physical and mental illness, disturbed interpersonal relationships and economic difficulties were the major reasons for suicide. The vulnerable population was found to be women, students, farmers etc. A social and public health response in addition to a mental health response is crucial to prevent suicidal behaviour in India.

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Background: Previous Magnetic Resonance Imaging (MRI) studies using manual techniques reporting significant relationship between psychopathology and gray matter volume in schizophrenia are limited by various confounding factors. None used automated image analysis to examine gray matter volume correlates of psychopathology in antipsychotic-naïve schizophrenia patients. Aim: This study aimed at examining the relationship between psychopathology and gray matter volume abnormalities in antipsychotic-naïve schizophrenia patients. Patients and Methods: MRI of 30 antipsychotic-naïve schizophrenia (DSM-IV) patients and 27 age-, sex- education- and handedness-matched healthy controls were compared for gray matter volume differences using Optimized Voxel-based Morphometry (VBM)-an automated, rapid and unbiased technique. Psychopathology was measured using Positive and Negative Syndrome Scale (PANSS) with good inter-rater reliability. The correlations between PANSS scores and gray matter volume were examined using VBM. Results: Schizophrenia patients had significant gray matter volume deficits in frontal, cingulate, temporal, insula and precuneus cortices; thalamus, caudate and cerebellum. Positive syndrome score had significant negative correlation with left superior temporal gyrus volume. Negative syndrome score had significant inverse correlation with frontal, cingulate and cerebellar gray matter volumes. Conclusions: Cortical and cerebellar gray matter volume deficits and their significant negative correlations with psychopathology scores are supportive of 'Cognitive Dysmetria' in schizophrenia.

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Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues involved in this discussion are the clinical validity of the syndrome, concern about stigma and unnecessary treatment, and need for responding to patients' distress in addition to the ethical dilemma. In this review we examine the issue of inclusion of the risk syndrome as a diagnosis.

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Background: Thalamus, the sensory and motor gateway to the cortex, plays an important role in cognitive and perceptual disturbances in schizophrenia. Studies examining the volume of the thalamus in schizophrenia have reported conflicting findings due to the presence of potential confounding factors such as low-resolution imaging and anti-psychotics. The thalamus volume in anti-psychotic-naοve patients determined using high-resolution 3-Tesla magnetic resonance imaging (MRI) has not yet been examined. Materials and Methods: Using 3-Tesla MRI, this study for the first time examined anti-psychotic-naοve schizophrenia patients (n=18; M:F:11:7) in comparison with healthy controls (n=19;M:F:9:10) group-matched for age, sex, handedness, education, and socioeconomic status. The volume of the thalamus was measured using a three-dimensional, interactive, semi-automated analysis with good inter-rater and intra-rater reliability. Psychopathology was assessed using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS). Results: Right, left, and total thalamus volumes of patients were significantly smaller than those of controls after controlling for the potential confounding effect of intracranial volume. Thalamus volumes had significant positive correlation with positive symptoms score (SAPS) and significant negative correlation with negative symptoms score (SANS). Conclusions: Thalamus volume deficits in anti-psychotic-naοve schizophrenia patients support a neurodevelopmental pathogenesis. The contrasting correlation of thalamus volume deficits with psychopathology scores suggests that contrasting pruning aberrations underlie symptom genesis in schizophrenia.

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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.

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Background: With the advent of newer antipsychotic drugs, side effects such as sexual dysfunction have been a major contributor toward treatment compliance. There are only a few studies that have compared different atypical antipsychotic agents regarding sexual dysfunction. We have not come across any data in this area on Indian population. Aims: To determine and compare the frequency of sexual dysfunction associated with risperidone, olanzapine, and quetiapine, among patients with clinically stable schizophrenia. Settings and Design: It is a cross-sectional hospital-based study. The subjects were recruited for the study by the purposive sampling technique. Materials and Methods: The total sample size was 102, consisting of 25 each in the quetiapine and risperidone groups, 22 in the olanzapine group, and 30 healthy volunteers. A Brief Psychiatric Rating Scale and Sexual Functioning Questionnaire (SFQ) were administered. The Kruskal Wallis test was used to compare the variables in the demographic data and the mean chlorpromazine equivalent doses of the study groups. To analyze the sexual dysfunction, the mean scores on all the domains of sexual functioning in SFQ were compared across the study groups using the Chi square test, for proportions. Results and Conclusion: Twenty-three percent of the healthy volunteers had some impairment in one or more domains of sexual functioning. For the medication groups this was 96, 88, and 90%, respectively for risperidone, quetiapine, and olanzapine. However, there was statistically no significant difference across the study groups although it was relatively less with quetiapine.

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Objective: Schizophrenia is a severe mental disorder for which final outcomes continue to be unfavorable. The main objectives of this research were to examine and determine the baseline predictors of outcome status of first-episode schizophrenia in a long-term follow-up of ten years and of recovery ten years later. Materials and Methods: The study was carried out in a non-governmental, psychiatric hospital and participants consisted of patients available for assessment ten years following their initial diagnosis. Outcome was assessed on clinical and social parameters. Clinical measures of outcome included psychopathology, hospitalization, and suicidality. Social parameters included quality of life functioning, employability, interpersonal functioning, and the ability to live independently. Results: In our sample, mean positive symptoms' score were reduced by more than 65% between baseline and endpoint. The percentage of reduction in scores of negative symptoms is much less than reduction in positive symptoms. It was observed that only 23-25% patients showed social recovery on two or three different parameters. Additionally, fewer negative symptoms, lower depression scores, and low levels of aggression at baseline predicted good outcome. A higher level of positive symptoms at baseline also predicted recovery. The two social variables that predicted later outcomes were initially high levels of work performance and the ability to live independently at baseline. Conclusions: Clinical information is not sufficient to make an accurate prediction of outcome status; rather, outcome depends upon multiple factors (including social parameters). A major implication of this research is the argument for moving toward a comprehensive assessment of outcome and to plan management accordingly. Bringing social outcome measures to the forefront and into the communities will allow for a more patient-centric approach. It also opens newer vistas for addressing the complex interaction of clinical and social parameters.

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Substance use patterns are notorious for their ability to change over time. Both licit and illicit substance use cause serious public health problems and evidence for the same is now available in our country. National level prevalence has been calculated for many substances of abuse, but regional variations are quite evident. Rapid assessment surveys have facilitated the understanding of changing patterns of use. Substance use among women and children are increasing causes of concern. Preliminary neurobiological research has focused on identifying individuals at high risk for alcohol dependence. Clinical research in the area has focused primarily on alcohol and substance related comorbidity. There is disappointingly little research on pharmacological and psychosocial interventions. Course and outcome studies emphasize the need for better follow-up in this group. While lack of a comprehensive policy has been repeatedly highlighted and various suggestions made to address the range of problems caused by substance use, much remains to be done on the ground to prevent and address these problems. It is anticipated that substance related research publications in the Indian Journal of Psychiatry will increase following the journal having acquired an 'indexed' status.

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