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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Insomnia is a general clinical term that refers to a difficulty in initiating or maintaining sleep. Insomnia is widely prevalent in the general population, especially in the elderly and in those with medical and psychiatric disorders. Hypnotic drug treatments of insomnia are effective but are associated with potential disadvantages.This article presents an overview of behavioral interventions for insomnia. Behavioral interventions for insomnia include relaxation training, stimulus control therapy, sleep restriction therapy, sleep hygiene, paradoxical intention therapy, cognitive restructuring, and other approaches. These are briefly explained. Research indicates that behavioral interventions are efficacious, effective, and likely cost-effective treatments for insomnia that yield reliable, robust, and long-term benefits in adults of all ages. Detailed guidance is provided for the practical management of patients with insomnia.

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Aims: To identify the reproductive health issues associated with adolescence and the readiness to avail services like Adolescent Friendly Clinic (AFC) among urban school going children. Materials and Methods: A quantitative survey was carried out using a self-administered structured questionnaire among 1440 (748 girls and 692 boys) students from classes 6 -12 in 7 English medium and 23 Gujarati medium schools. Focus group discussions, 5 each with adolescent boys and girls and teachers were held from Gujarati and English medium schools. Results: A higher proportion of boys and girls could identify visible external changes in the opposite sex as compared to the changes not seen outwardly. The sources of information on human reproduction for most of the boys and girls were schoolbooks, television, teachers, friends and parents in the same order. Over two-thirds of the boys and girls expressed a need for more information on reproduction. Teachers also perceived that adolescents, though curious, lacked opportunities for open discussions to answer their queries related to reproductive health. One-third of the boys and one-fourth of the girls had heard about contraception. Two-thirds of boys and girls had heard of HIV/AIDS, and about half of them correctly knew various modes of transmission of HIV. Majority of the adolescents expressed their readiness to use the services of Adolescent Friendly Centre. Conclusions and Recommendations: Information on the human reproductive system and related issues on reproductive health need special attention. Teachers' sensitization to adolescent health care is required.

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Context: Patient satisfaction with psychiatric services is an important construct, which influences multiple areas including treatment adherance and outcome. There is paucity of studies from India in this area. Aims: To measure satisfaction of psychiatric outpatients of Mental Health Institute, Cuttack, and to assess the relationship between demographic and clinical variables with different domains of patient satisfaction. Settings and Design: In a cross-sectional study, patients of age 18-60 years receiving treatment for at least six months from outpatient department of Mental Health Institute, SCB Medical College, Cuttack, were assessed. Materials and Methods: Participants (n=60) were selected randomly. Satisfaction was assessed by Patient Satisfaction Questionnaire-18 (PSQ-18) and the diagnoses were based on the Diagnostic and Statistical Manual-IV-TR. Severity of psychiatric disorder was measured using Clinical Global Impression-severity scale. The functioning level was assessed by Global Assessment of Functioning. Statistical Analysis: Continuous variables compared using independent t-test or analysis of variance. Results: Diagnostic break-up of the patients included anxiety disorder (36.6%), major depressive disorder (30.0%), bipolar disorder (16.6%), and schizophrenia (16.6%). Greatest level of satisfaction was noted in interpersonal aspects (71.4%) and time spent with doctors (62.4%). General satisfaction level was a little over 50% (57%). Differences between composite scores of PSQ-18 in the diagnostic categories were statistically significant; patients with depression had the highest score followed by those with anxiety disorder, bipolar, and the least was with schizophrenia patients. There was variability among the demographic and clinical groups regarding the various subscale score of PSQ-18. Conclusions: Satisfaction of psychiatric outpatients was observed to be different in various clinical and demographic groups and across many domains of satisfaction.

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Dhat syndrome is a culture-bound syndrome prevalent in the natives of the Indian subcontinent characterized by excessive concern about harmful consequences of loss of semen (ICD-10). Treatment offered to the patients suffering from it continues to be esoteric, unstructured and without standardization. The present study aimed to develop and examine the feasibility of Cognitive - Behavior Therapy module for patients with Dhat syndrome. A draft module was developed based on existing theoretical knowledge and suggestions from five mental health professionals. This module was then applied on five patients with Dhat syndrome to assess and judge the suitability of the module. The pre and post-assessments were carried out using Sexual Knowledge and Attitude Questionnaire - II, Hamilton Depression Rating Scale, The Cognitive-Somatic Anxiety Scale, Screener for Somatoform Disorder, International Index for Erectile Function, Clinical Global Impressions, The World Health Organization Quality of Life Assessment - BREF. Experiences and insights gained from each patient were used to refine the module before applying on the next patient. The final module consisted of the following components was developed: Basic sex education, cognitive restructuring, relaxation training, imaginal desensitization, masturbatory training as homework and Kegel's exercises and 'start-stop technique' and 'squeeze technique' for sexual dysfunctions. Results of the study reveal that it is feasible to carry out the CBT module in clinical settings. Number of sessions ranged from 11 to 16 sessions. The duration of the session was 45 minutes on the average. Findings of the present study revealed improvement in sexual knowledge, anxiety, depressive and somatic symptoms. Implications and limitations of the study are highlighted and suggestions for future research offered.

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Background: Private psychiatric clinics provide help for the bulk of our population, but they have not been evaluated systematically. It is time that we analyze the functioning of these set-ups to improve functioning. This paper is a modest attempt to analyze one such clinic. Aims: To analyze the diagnostic distribution of the clients attending the clinic and to study the pattern of follow-up. Materials and Methods: All records from April 1 ^st 1997 to 31 ^st March 1999 were analyzed. This is a descriptive study. Results and Conclusions: A total of 3077 new patients visited the clinic in this period. The male:female ratio was 54:46. Diagnostic distribution revealed the following: schizophrenia 20%, affective disorders 40%, OCD 8%, dissociative disorders 5.5% and anxiety disorders around 4.5%. The pattern of visits revealed that 50% of the patients dropped out after the first visit. Another 25% did so in next the two visits.

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Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infection (PANDAS) is a group of disorders recently recognized as a clinical entity. A case of PANDAS is described here, which remitted after 1 month of treatment. Recent Group A beta-hemolytic streptococcus infection should be considered in a child who presents with a sudden explosive onset of tics or obsessive compulsive symptoms.

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Background: Beta-thalassemia major is a chronic disorder of blood, having an extensive impact on the affected child. It involves lifelong therapeutic regime, with repeated blood transfusions. With improved life expectancy, due to improved medical management psychosocial aspects of thalassemia are gaining importance. Objective: To assess the behavioral problems in multi-transfused thalassemic children and psychosocial factors affecting them. Setting: The study was conducted in a tertiary care level hospital and research institute catering mainly to a population of low socioeconomic status. Design: The study was a cross-sectional study involving 50 multi-transfused thalassemic children of age 5-10 years. Materials and Methods: Fifty multi-transfused thalassemic children, aged 5-10 years, not suffering from any other major medical illness, were included. Child Behavior Check List (Achenbach) (CBCL) was used to collect data from each parent regarding the child's behavior. Parental Attitude Scale (Rangaswamy 1989) was applied. Descriptive statistical analysis was used with analysis of variance (ANOVA) and Student's t test to find the significance of data. Results: The CBCL total scores were high in 32% patients, indicating the presence of behavioral problems. Higher CBCL scores were found in children of older age group, those with poor school performance, whose mothers' education was more than eighth standard, had history of death of thalassemic relative in family, greater duration of diagnosed illness, poor pre-transfusion hemoglobin level, and who had longer periods of school absenteeism. Conclusions: Behavioral problems are common in multi-transfused thalassemic children. Early diagnosis and intervention of behavioral problems in these children would make them cope with thalassemia better.

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Introduction: Substance abuse may act as precursors and also can form outcomes of sexual behaviors. The confluence of drug use, mental stressors, poverty, sexually transmitted diseases, low self-esteem and high-risk partners forms a fertile ground for psychological morbidity. Aim: To assess the psychological morbidity among female commercial sex workers (CSWs) who use alcohol and other substance abuse. Materials and Methods: One hundred consecutive CSWs with alcohol and drug abuse patients attending the psychiatric OPD at Victoria hospital were assessed clinically. Relevant investigations were also carried out. General health questionnaire and substance use disorder identification tests were administered. Results: A total of 100 cases between 30-40 years of age were taken up for the study. All were abusing alcohol with tobacco chewing or smoking being (64). Eighty-seven were married. Fifty of them being illiterate. Seventy-eight were suffering from physical illness. Two were HIV patient on treatment. Seventy-eight were having psychological morbidity (depression and adjustment disorder). Conclusion: Preventive interventions, targeting substance abuse and stimulating healthier-environments and providing economically independent.

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Background: Alzheimer's disease (AD), a progressive brain disorder, is the most common cause of dementia among the elderly. Donepezil hydrochloride is a potent, reversible, and highly selective inhibitor of acetylcholinesterase (AChE). It is chemically distinct from other cholinesterase (ChE) inhibitors which are effective in the treatment of AD. Objectives: To evaluate the safety and efficacy of donepezil hydrochloride therapy over a 12 weeks period in patients with mild to moderate AD in Indian population. Materials and Methods: In this post-marketing study, patients with mild to moderate AD received oral donepezil hydrochloride 5 mg/day for 4 weeks followed by 10 mg/day for 8 weeks. Patients were assessed 4 times weekly for cognition on 'Mini Mental Status Examination (MMSE) scale', and function on 'Activities of Daily Living (ADL) index'. Clinicians and caregivers assessment of safety and efficacy was assessed on a 5-point rating scale. Results: One hundred and seventy two of one hundred and eighty two patients completed 12 weeks of study period. MMSE score significantly improved (P<0.0001) from 16.72 at baseline to 19.77 after 12 weeks, and there was significant improvement (P<0.05) in ADL index in 13 of 17 domains after 12 weeks. Caregivers and clinicians rated the therapy as very good to good in >80% and >90% patients, respectively. Adverse events were consistent with the known pharmacological and safety profile of donepezil. Conclusions: Donepezil is well tolerated in Indian patients with mild to moderate AD with significant improvement in cognition and function.

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Background: Bipolar affective disorder (BaD) has a great impact on health systems worldwide. Although bibliometric studies have been done on this subject, these studies did not do an analysis of the contents of papers, the cooperation between countries, or of the names currently used to describe the condition. Furthermore, the number of publications since the last bibliometric study has doubled. Aim: This study was to examine the recent developments in the field, explore main topics/subject areas of the top 10 authors in this research field, and to compare diagnosis-defined data between International Classification of Diseases, 10 ^th edition (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Materials and Methods: Using distinct search terms, the Web of Science database developed by the Thompson Reuters Institute of Scientific Information was scanned for relevant items published between 1900 and 2008. Results were analyzed using scientometric methods and density-equalizing calculations. Results: We found an important increase of publications on the subject over the last decade. Most published studies came from North America and Europe, while the countries cooperating with each other were comparable to other areas of medical research. Although there has been an increase in publications on BaD (m=3.3 publications per year in the last decade), the number of works using the term bipolar disorder (BD) was considerably higher (m=141.8 publications per year in the last decade). We found that the subject areas, genetics and pharmacology were focuses of research for the 10 most prolific authors, all of whom where psychiatrists. Conclusion: Research interest in BaD is rising. Reflecting the two main disease classification systems, DSM and ICD, both terms BD and BaD are used in research, with a preponderance of the former. The research of the most prolific authors engages genetic and pharmacological questions.

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Serotonin reuptake inhibitors-induced orgasmic dysfunctions including spontaneous orgasms have been reported in women. Spontaneous orgasm is experiencing orgasm in the absence of sexual sensory stimulation. A woman with sexual abuse in her childhood who later developed distressing spontaneous orgasms is discussed. She stopped experiencing these orgasms with citalopram. However the orgasms soon re-emerged following the abrupt discontinuation of prolonged use of citalopram but disappeared again once the citalopram was re-introduced. To the best of the author's knowledge the therapeutic effect of citalopram to cause cessation of distressing spontaneous orgasms of this kind in a child sexual abuse (CSA) survivor has not been reported. The mechanism of action of SSRIs-induced sexual side effects including orgasmic dysfunctions is complex and poorly understood. It is suggested that the therapeutic cessation of spontaneous orgasms in this case could be due to anorgasmic sexual side effect of Citalopram.

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Background and Aims: Self-harm is a major public health problem in the southern parts of India. This survey was undertaken to assess the nature of psychiatric services available in hospitals attached to medical colleges for those who have attempted suicide. Materials and Methods: After reviewing the relevant literature, a questionnaire was prepared. We sent this questionnaire to 94 medical colleges in South India. Results: The response rate of the survey was 50%. Psychiatric assessment of suicide attempters in the casualty department are done by mental health professionals in 23 (66%) hospitals. Psychotropic medications are prescribed for appropriate patients in 33 (94%) hospitals, while talking therapies are available in 31 (89%) hospitals. Six (17%) centers have training sessions for casualty staff in mental health assessment of patients who have attempted suicide. A majority of hospitals have medical students posted in the psychiatry department. Conclusions: The services available for people who have attempted suicide appear to be patchy in south Indian teaching hospitals. Training of frontline staff in the assessment and management of people who have attempted suicide is extremely important.

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